MRSA- Methicillin-Resistant Staphylococcus Aureus
Infection with MRSA bacteria mainly occurs in people who are already ill in hospital. It can be difficult to treat as MRSA bacteria are resistant to most types of antibiotics.

What is Staphylococcus aureus?
Staphylococcus aureus is a bacterium (germ). It is often just called ‘S.aureus’ or ‘staph’. S. aureus bacteria are often found on the skin and in the nose of healthy people. In fact, about 3 in 10 people have S. aureus bacteria living on (colonizing) their skin. These people are called S. aureus ‘carriers’. In healthy people who are carriers, S. aureus is usually harmless.

However, S. aureus bacteria sometimes invade the skin to cause infection. This is more likely if you have a cut or graze which can allow bacteria to get under the surface of the skin. S. aureus is the cause of skin infections such as boils, pimples, impetigo, skin abscesses, and is a common cause of wound infections.

In some people, S. aureus can sometimes get into the bloodstream and travel to internal parts of the body to cause more serious infections. For example, blood poisoning (septicaemia), lung infection (pneumonia), bone infection (osteomyelitis), heart valve infection (endocarditis), etc. These serious infections are more likely to occur in people who are already unwell or debilitated, or who have a poor immune system. These infections need to be treated with antibiotics.

What is MRSA?
MRSA stands for Methicillin-resistant Staphylococcus aureus. There are various sub-types (strains) of S. aureus and some strains are classed as MRSA. MRSA strains are very similar to any other strain of S.aureus. That is, some healthy people are carriers, and some people develop the types of infections described above.

The difference is that, most S. aureus infections can be treated with commonly used antibiotics. In recent years some strains of S. aureus have become resistant to some antibiotics. ‘Resistance’ means that it is not killed by the antibiotic. MRSA strains are not only resistant to the antibiotic called Methicillin, but also to many other types of antibiotics.

How serious is an MRSA infection?
MRSA strains of bacteria are no more aggressive or infectious than other strains of S. aureus. However, infections are much more difficult to treat because many antibiotics do not work. Therefore, infections tend to become more severe than they may otherwise have been if the cause of the infection is not diagnosed early, and antibiotics that do not work are given at first.

Who gets MRSA?
MRSA occurs most commonly in people who are already in hospital. People who are more prone to it are those who are very ill, or have wounds or open sores such as bed-sores or burns. The wounds or sores may become infected with MRSA and the infection is then difficult to treat. Infections, which start in the skin, may spread to cause more serious infections. Also, urinary catheters and tubes going into veins or parts of the body (‘drips’ etc) are sometimes contaminated by MRSA and can lead to urine or blood infection.

MRSA can also cause infections in people outside hospital, but much less commonly than in hospitalised people.

How is MRSA diagnosed?
If an infection with S. aureus is suspected then, depending on the type of infection, a sample of blood, urine, body fluid, or a swab of a wound can be sent to the ‘lab’ for testing. If S.aureus is detected, further tests are done to see which antibiotics will kill the bacteria. MRSA strains can be identified by seeing which antibiotics kill the bacteria found on testing. Healthy people suspected of being carriers of MRSA can have a swab or the nose or skin taken and tested.

How is S.aureus and MRSA spread?
S.aureus bacteria (including MRSA strains) spread from person to person usually by direct skin-to-skin contact. Spread may also occur by touching sheets, towels, clothes, dressings, etc, which have been used by someone who has MRSA.

However, as mentioned, S. aureus (including MRSA strains) will not normally cause infection if you are well. The bacteria may get onto your skin, but do no harm. So, for example, people who visit patients with MRSA, or doctors and nurses who treat people with MRSA, are not likely to develop an MRSA infection. But, they may become ‘contaminated’ with the bacteria and may pass it on to someone who is ill, or who has a wound, who then may develop infection.

What is the treatment of MRSA infections?
MRSA infections are usually treated with antibiotics. (Boils or abscesses caused by MRSA may only need to be drained and may not need antibiotics.) However, the choice of antibiotic is limited as most antibiotics will not work. Many MRSA infections can only be treated with antibiotics that need to be given directly into a vein. The course of treatment is often for several weeks. Also, the risk of side-effects with the limited choice of antibiotics is higher than the more ‘usual’ antibiotics which are used to treat non-MRSA infections.

People who are carriers of MRSA but who are healthy do not need any treatment. However, in some cases it may be advised to try and clear the bacteria from the skin by washing with antiseptic lotions, and using antiseptic shampoos, and using an antibiotic cream to place in the nose. These measures may reduce the risk of developing an infection, or spreading the bacterium to others (particularly to ill people who may develop an infection).

Can MRSA infections be prevented?
The number of MRSA infections in hospital can be kept down if all hospital staff adhere to good hygiene measures. The most important is to wash hands before and after contact with each patient, and before doing any procedure. This simple measure reduces the chance of passing on bacteria from patient to patient.

Other measures are used in hospitals to reduce the spread of infection. For example, cleaning of bedding, regular cleaning of wards, etc. Patients with an MRSA infection may be kept away from other patients, perhaps in a single bedroom or in an isolation unit until the infection has cleared.

You can find out more by clicking on this link to their website:
http://www.mrsaactionuk.com/

As the government’s market in the supply of healthcare services develops, it is expected the NHS will be the single largest source of funding for hospitals in the independent sector by 2010, the commission says in the final draft of a consultation document – seen by the Financial Times – which it is to issue shortly.

That new approach to acquiring NHS services means that a “level playing field” of inspection and regulation is needed between NHS-run and independent services.

At present, private hospitals and clinics are inspected annually – against, until recently, an inspection once every three or four years for NHS bodies. But against that, different methods of assessment are used that would require independent providers to supply “significantly” more data than they do at present.

The commission’s aim is to produce the same risk-based assessment for independent healthcare providers as it is developing for NHS-run bodies.

That means moving by 2008 to a system where private providers make a self-declaration of the standards of care they provide that will then be checked against information they and others provide.

All establishments will be visited regularly, based on risk assessment. But strong performers will no longer get an annual inspection. As in NHS-run establishments, however, there will still be unannounced spot checks, with the results published, as well as follow-up inspections where concerns are raised.

The government will have to legislate before the changes can be made in full. As a result, all independent sector establishments, which include mental health services, 80 per cent of whose patients are NHS-funded, beauty salons that use lasers, and in time establishments that provide botox and other non-surgical cosmetic procedures will be inspected next year.

New sets of data that the independent sector will have to provide are being developed, but with the aim of lightening the regulatory burden and aligning it with the rest of the NHS.

“In our view, it is inevitable that we will continue to need more detail in our monitoring of the independent sector for the time being,” the consultation document says, “and that we rely less on self-assurance than in the NHS to compensate for the relative scarcity of independent sources of information”.

The commission also plans to hold primary care trusts and other NHS commissioners to account for the services they buy from the independent sector.

http://news.ft.com/cms/s/6636423c-5fb3-11da-a628-0000779e2340.html

The report found that the cataract centre run by South African company Netcare has carried out only 93 of the 572 procedures it has been contracted to perform since April.

The review found the number of patient operations has been ‘disappointing’ and ‘slow’, but despite this the PCTs had been forced to pay £255,000 for a quantity of work that should have cost £40,000.

Lib Deb spokesperson for Wantage councillor Andrew Crawford said the report showed the public had paid ’600 per cent over the odds’ thanks to ‘government bullying’ on choice.

Although the PCTs have used ‘various marketing strategies…to encourage uptake of the service’, not enough patients had been willing to be treated at the Netcare centre.

‘The PCTs are unable to commercially advertise one service over another. The population commonly requiring cataract surgery is elderly, and the Oxford Radcliffe hospitals have a strong reputation and short waiting lists,’ the report found.

Jane Dudley, the PCTs’acting chief executive, told HSJ the contract was ‘an extra burden’ for the trust as it attempted to break even by the end of the financial year.

She said that the PCTs were hoping to use up the spare capacity in the contract by the end of the year and were ‘exploring opportunities’ with other strategic health authorities to use the cataract operations.

According to the review, the SHA is ‘negotiating directly with the Department of Health on Oxfordshire’s behalf to have [the financial risk to the PCTs] underwritten’.

Oxford Radcliffe Hospitals trust ophthalmology unit head of nursing and service development Rebecca Turner said the centre had not had any impact on the trust.

‘The national target is to get the cataract waiting times to three months,’ she said.

‘In Oxford we only have an average wait of five weeks, so we didn’t need the extra capacity. Fundamentally the damn thing was flawed in the first place.’

Netcare was unavailable for comment.

Troubled history of Oxford treatment centre
November 2003 South East and West Oxfordshire PCTs’ board votes against a treatment centre for Oxford but reverse its decision when Thames Valley SHA agrees to take on the risk if capacity is not used.

March 2004 PCTs’ chair Professor Martin Avis and SHA chair Jane Betts both resign over the issue.

June 2004 PCT non-executive director Jane Hanna resigns, claiming the PCTs have been forced to agree a deal with Netcare. NHS chief executive Sir Nigel Crisp terminates a Radio 4 interview after being repeatedly questioned about whether managers were ‘in fear for their jobs’.

September 2004 A report on the deal finds that Oxford already has enough cataract capacity.

December 2004 Then health secretary John Reid tells the Commons health select committee that the government will always ‘reserve a bit of a right [to intervene in a local decision] where self-interest is concerned’.

April 2005 ITC opens.

October 2005 PCTs’review reveals only 93 operations have been carried out.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=3707019

Increases in other sexually transmitted infections, such as chlamydia, which topped 100,000 new cases, and syphilis, were also recorded, the agency said.

Campaigners said there needed to be more focus on prevention and access to halt the rise.

And Dr Barry Evans, an HIV exert at the HPA, added: “There is no part of the UK that remains unaffected by HIV or other sexually transmitted infections.”

But he said rates of infection did differ from area to area.

STI STATISTICS
HIV – 58,300 people now living with infection, up by 5,000 on the previous year, including 7,275 new cases
Chlamydia – New diagnoses up by 8.6% from 95,879 to 104,155
Syphilis – Up by 37% from 1,641 in 2003 to 2,254 a year later
Genital warts Rose by 4.2% from 76,457 to 79,678
Gonorrhoea Fell by 11% from 24,956 to 22,335
Genital herpes – Decrease of 1% in diagnoses from 19,180 to 18,991

And he added people could play their part in preventing STIs by practising safe sex with new and casual partners.

The latest HIV figure included both those who have been diagnosed and also an estimated 19,700, who remain unaware of their infection and therefore undiagnosed – meaning they could unknowingly be helping the spread of the infection.

The report reveals there were 7,275 new infections in 2004 in the UK – up from 7,217 in 2003.

It showed that most of these – 4,287 – were diagnosed in heterosexuals, with 73% most likely to have been acquired in Africa.

Of the 58,300 with HIV in the UK, around 29,700 are thought to be heterosexuals.

The steep rise in the number of syphilis infections from 1,641 to 2,254, has occurred against a backdrop of several localised outbreaks in London and Manchester.

But chlamydia remained the most common STI with new diagnoses rising by 8.6% to 104,155.

While cases of genital warts rose by 4.2% from 76,457 to 79,678.

But diagnoses of gonorrhoea and genital herpes fell by 11% and 1% respectively.

Nick Partridge, chief executive of sexual health charity Terrence Higgins Trust, said: “We’re at a crossroads – if we don’t concentrate on prevention and access to services now, we will continue to have ever-increasing rates of HIV and the worst sexual health in Western Europe.”

And Deborah Jack, chief executive of the National Aids Trust, said: “The continuing high numbers of people newly diagnosed with HIV underlines the need for more effective HIV prevention in this country. In addition, the increased estimate in undiagnosed cases is worrying.”

Shadow Health Secretary Andrew Lansley said there was “now a new generation of younger people oblivious to the dangers posed by STIs”, while Liberal Democrat health spokesman Steve Webb added the findings were “distrubing”.

http://news.bbc.co.uk/1/hi/health/4465884.stm

More private providers of non-emergency care and the shift of more care and diagnosis outside hospital means “the current configuration of acute hospital services is likely to be unsustainable in many parts of the country”, according to a late draft of the report seen by the Financial Times.

The report, being compiled for Sir Nigel Crisp, NHS chief executive, and Patricia Hewitt, the health secretary, in effect heralds the end of the provision of at least one main hospital in every town, offering all but the most specialised services.

Instead, fewer hospitals will have a full accident and emergency service, more care will be delivered by networks of hospitals, and key staff are likely to have to work across institutional boundaries, says the report.

The pressures for change will become “irresistible”. If services do not adapt “they risk becoming unsustainable, unsafe, unstaffable, and unpopular” which in turn will result in “service failure”, the draft adds.

It is being drawn up for the National Leadership Network, an advisory body of top NHS figures set up by Sir Nigel and supported by a Department of Health secretariat. A department official said: “This is a draft report of advice to ministers. It is not departmental policy.”

But senior NHS managers are already acknowledging the scale of the change. Neil Goodwin, chief executive of the Greater Manchester Strategic Health Authority, told a conference this month that what is under way is “the death of the district general hospital as we have come to know and love it”.

That posed a big challenge “to national and local politicians and to NHS management. They will have to explain in a very clear and sophisticated way how hospital services are going to be delivered in future, against a backdrop of dramatic consumer and technologically driven change”, he said.

The report says the local hospital will continue to play a crucial role. But competition between providers is likely to take much routine surgery out of some hospitals, and not all hospitals will be left with the “core” services needed to support trauma and emergency surgery. That is likely to have to be managed across networks in fewer hospitals.

The ambulance service will play an expanded role in providing immediate care and taking key decisions on where people are taken for treatment, and “there will be much greater diversity of service provision between local hospitals than has been allowed for under the old district general hospital model”.

The draft report adds: “A crucial challenge will be to ensure that the future vision for acute hospitals is financially sustainable, especially as the NHS transitions from its current period of expansionary funding to a steady state of lower annual growth.”

The big shift raises important questions about medical and other training and where it will take place, the report says. “Considerable work is still required to improve service integration . . . especially in the area of urgent and emergency care, paediatrics and maternity services.”

Its findings follow warnings earlier this year from Bob Ricketts, head of capacity planning at the health department, that there was “an increasing threat to the viability of the districtgeneral hospital” and the shift of care outside hospital and to private providers could produce the “hollow hospital”.

http://news.ft.com/cms/s/13500c5a-5c8f-11da-af92-0000779e2340.html

After weeks of denying reports in The Times that there would be a shortage, the Department of Health was forced to write to every GP yesterday admitting that 400,000 “contingency” doses of the vaccine were nearly exhausted.

It urged doctors not to overorder any remaining vaccine, to ensure what they have in stock is used for the high-risk groups, and that if they have any spare to let others know, so that it can be shared.

“Vaccine is pretty scarce” David Salisbury, head of immunisation, at the Department of Health said yesterday. Asked if this meant that people in the high-risk categories might go unvaccinated, he said: “I sincerely hope not.”

The letter tells GPs that there is no vaccine left, with the exception of a further contingency of 200,000 doses which will not be delivered until late January.

The unprecedented demand for jabs is blamed on the fears of avian flu developing into a new pandemic that could claim tens of thousands of lives.

Although the vaccine offers no protection against such a pandemic strain, the intensive publicity has driven more people than usual to seek jabs against seasonal flu.

The suspicion is that doctors may have used up the vaccine treating the “worried well” and that as a result the over-65s and other high-risk groups may find that they are denied it.

GPs themselves are responsible for ordering flu vaccine and are only reimbursed by the Government for the actual vaccines given. GPs have to pay for any remaining stock, encouraging them not to overorder. This year, Dr Salisbury said, 14.5 million doses had been ordered, half a million more than last year.

Peter Holden, a GP from Matlock and a senior member of the Derbyshire British Medical Association’s GPs’ committee, said that he was short of 400 vaccines for his patients, who had come to get immunised in unprecedented numbers this year. “At the last count we were 400 short,” he said. “As of Friday night we had no ideas where we are getting vaccines for our clinics from December 3.”

The practice serves 8,500 patients, of whom 2,000 are eligible for flu jabs. But while most years it was hard to get more than 1,200 people interested, this year it had passed 1,500 with ease.

When Patricia Hewitt, the Health Secretary, was pressed in the Commons last month on whether enough supplies of vaccines had been ordered, she said: “I am assured by our experts there are adequate supplies available to ensure anybody at risk can be vaccinated.” She refused to comment yesterday on the new advice to GPs.

The Times was also assured that supplies were ample. A department spokeswoman said: “There are 11 million people who are either over 65 or in the high-risk groups, so there will be enough for them all, even if we got 100 per cent take-up.” But soon after that, on November 3, GPs were sent a letter reminding them to “prioritise” the vaccine for the at-risk groups. This appears tohave been ignored, at least by some. GPs have been ringing the department seeking extra supplies.

The department has no clear idea where the vaccine has gone. Some of it will still be waiting in doctors’ surgeries to be administered, and some has yet to be delivered by the manufacturers. But data on uptake is still scant.

“From the audit that we have undertaken, there is some concern that the vaccine may have been used on the ‘worried well’ rather than the pre-agreed risk groups and that this has contributed to the shortfall,” Dr Salisbury’s letter says.

Laurence Buckman, deputy chairman of the BMA’s GPs Committee, said: “Patients will feel that they have been let down. The flu campaign is designed to protect the old and the sick in advance of the flu season. GPs were told that there would be enough vaccine and now it seems this is not the case. There is no evidence that family doctors have been using the vaccine inappropriately.”

Andrew Lansley, the Shadow Health Secretary, said: “Ministers have unfortunately failed to recognise the risk sufficiently, which has led to the current situation.”

http://www.timesonline.co.uk/article/0,,2-1882775,00.html

Decisions by them to depart would leave the NHS with a huge headache. Although many more people are now going into nursing training, a substantial number decide not to stay. Homegrown nurses, particularly junior staff, may also be tempted to go abroad.

The wage differential is particularly tempting for nurses on the lower grades of the profession. ‘We have Filipino and Indian nurses who may have come to the UK via Saudi Arabia and the Emirates some time ago, who are now looking to move onto other countries,’ said Josie Irwin, head of employment relations at the RCN. ‘They are tempted by offers from America and Australia, who are recruiting staff aggressively.’

An experienced specialist nurse on around £25,000 here would be offered £10,000 more – plus accommodation and opportunities to travel – in the States.

Despite a 23 per cent increase in the nursing workforce in England since 1997, the RCN says the government needs to take urgent action to avoid a return to the chronic shortages of the early 1990s.

The RCN’s annual Labour Market Review highlights an ageing nurse population with an average age of 44. While there are around 20,000 new UK entrants to the nursing register per year, the number of nurses retiring in the near future raises the issue of whether this is enough.

Some 45 per cent of new entrants over the past four years have been from overseas, including more than 12,000 in the past year.

The government claims to have done much to make nursing attractive, with better conditions and fairer pay. But despite increased numbers, pay still lags behind that of other countries.

http://politics.guardian.co.uk/publicservices/story/0,11032,1646871,00.html

Health Direct points out that the NHS already has a huge nursing staff crisis with 50,000 nurses leaving in 2004 alone. See also:
http://www.healthdirect.co.uk/2005/04/50000-nurses-left-nhs-in-2004.html

The medicine can only be obtained from doctors who have a licence for the controlled drug from the Home Office. They will prescribe it on a named patient basis, the system available for the use of unlicensed medicines.

It is expected that people with MS will have to buy Sativex on private prescriptions. It would only be available on the NHS if a trust specifically agreed to its use for an individual patient.

Mike O’Donovan, the chief executive of the Multiple Sclerosis Society said yesterday: “This is a move in the right direction. We believe there is now good evidence that cannabis-derived medicine can relieve distressing symptoms like spasticity and pain in MS.

“Many people do not find available treatments effective and will now have the opportunity to try a new drug which could significantly improve their quality of life. We very much hope it will not be long before it is licensed for NHS prescription.”

A Department of Health spokesman said: “It is vital that we ensure that drugs are safe before they are used in the NHS. It is for this reason that Jane Kennedy, the health minister, has referred Sativex to the Commission on Human Medicines to determine its safety, quality and efficacy.”

http://telegraph.co.uk/news/main.jhtml?xml=/news/2005/11/16/nms16.xml

This is partly fuelled by feedback from the recent public consultation at which the Department of Health found only patchy awareness of the service.

NHS Direct was expected yesterday to outline its vision for a national non-urgent information service, which it wants to run.

Speaking to HSJ before its first major conference this week, the organisation’s medical director, Dr Mike Sadler, said he fully accepted ‘there will be some areas where services will be contestable’ following the white paper.

He added that he believes unscheduled care should be locally commissioned. However, he argued that national contracts should be awarded for the provision of web, phone and digital information services.

The proposed contracts would also cover integrated health and social care advice and interactive forums for patients with long-term conditions.

‘We have said in our consultation response that specific internet and digital television health information provision, which we are already doing in some areas, will only be cost effective if commissioned on a national basis,’ he said.

‘For others to start from scratch what is a difficult and costly service to promote, to divide that market up when we have a service that generates 2 million contacts a month for only £2.40 per head of population, would be unhelpful both for the NHS and the DoH,’ he said.

Former DoH head of unscheduled care Pippa Bagnall told an NHS Confederation conference at the beginning of the month that she believed the government still believed in ‘the model’ of an unscheduled, nurse-led telephone health advice service, but ‘perhaps not the way it is currently delivered’.

Ms Bagnall is currently leading on a regional pilot of an integrated urgent care service for Avon, Gloucestershire and Wiltshirestrategic health authority.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=3650256

A 17-year-old high school student from Gifu jumped in front of a truck in February 2004 shortly after taking the medicine, while a middle school student from Aichi is believed to have fallen from the ninth floor of his apartment building this February, according to Japanese news reports. Neither exhibited psychological problems before taking Tamiflu.

The drug’s Japanese distributor, Chugai Pharmaceutical, issued a report to the health ministry after the first incident saying a link between taking the drug and the odd behaviour that led to the death cannot be ruled out.

The ministry is warning that taking the drug may lead to abnormal behaviour and accidental death, an official said.

The deaths, and their possible link to the drug will cause second thoughts in governments around the world since Tamiflu is now being coveted as an answer to a feared bird flu epidemic. The Japanese government plans to increase its stockpile of Tamiflu to 250 million capsules, from 150 million, over the next five years.

http://news.independent.co.uk/uk/health_medical/article326817.ece

Until now a trust had to earn three- star status in the hospital league tables. This is being reduced to two- star status although the rating system itself is being overhauled.

Patricia Hewitt, the Health Secretary, denied that the standard was falling, saying the base for applications was being broadened as present criteria were too restrictive.

“Performance ratings have only been used to identify which trusts to invite applications from, but they are not part of the formal authorisation criteria for foundation status,” she said.

“So there is no question of lowering the bar and relaxing standards for authorisation as an NHS Foundation Trust.”

Foundation hospitals are allowed to run more or less independently. They are financially managed on strict commercial lines and must be able to balance their books.

Miss Hewitt also announced a new financial “health check” for trusts aimed at improving financial management and making them ready for foundation status. The Government wants all hospitals to be able to apply for foundation status by 2008.

The existing 32 foundation trusts are regulated by the organisation Monitor. William Moyes, its chairman, said: “We will continue to operate our rigorous assessment process which ensures that NHS foundation trusts are financially viable and sustainable and well-managed. We will not lower the bar.”

Sue Slipman, the director of the Foundation Trust Network, said: “Foundation trusts are already using their new freedoms to innovate and improve the services they provide to patients.

“This financial health check is a real step forward in helping more NHS trusts to achieve foundation status so they can realise the same benefits for their local communities.”

Andrew Lansley, the shadow health secretary, said the move would re-open divisions in the Labour Party about private sector involvement in the NHS.

“Labour’s policy towards foundation hospitals is piecemeal and restrictive. Star ratings should not be the basis for foundation status. They neither reflect clinical quality nor the financial status of a hospital.

“Every hospital should be given the opportunity to apply for foundation status.”

http://telegraph.co.uk/health/main.jhtml?xml=/health/2005/11/08/nhosp08.xml&sSheet;=/health/2005/11/09/ixhmain.html

He is planning to issue a “protect and survive” leaflet to every household in England and Wales and has instructed all hospitals, doctors’ practices and National Health Service trusts to inform him of contingency plans for coping with mass casualties. Donaldson fears that the current level of precautions could lead to a lethal strain of flu arriving unnoticed.

“Many doctors think, ‘Flu is flu, we see it every winter’,” Donaldson said. “We have got to get the message through that this is going to be much more serious.

“I can’t give a likelihood of it starting this year, next year or in five years, but it will come. There is a biological inevitability and we’ve got to be prepared for it.”

Donaldson said he was dismayed after hearing that some hospitals were “full of dead parrot jokes and people (don’t) believe this is actually going to happen”. The first victim of bird flu in Britain was a parrot infected with the H5N1 strain that died in quarantine at Heathrow last month.

This strain has devastated poultry flocks in the Far East over the past eight years and killed 62 people, raising fears that the world may be on the brink of a lethal mutation of the virus capable of sparking a human pandemic.

Donaldson, who was appointed to his post in 1998 and knighted in 2002, believes that the predicted emergence of the killer strain will be the biggest test of his career and the worst epidemic to face the NHS.

Responsibility for minimising casualties falls ultimately on him. The disease could strike one in four people and kill more than one in 100.

“The fight will be an extended and protracted one,” he said. “We have to get local tenacity into the planning for this. We can’t be alarmist, but we have to take it seriously and we have to prepare.”

In addition to awarding a contract for 14.5m doses of the anti-viral drug Tamiflu — so far the only one available to combat the disease — Donaldson is supervising the protect and survive leaflets, similar to those produced when the nation believed itself to be under threat of nuclear attack.

The leaflets will put the population on the alert, while seeking to prevent hospitals and surgeries being swamped with anxious patients. They will advise the public on what symptoms to look out for and under what circumstances they should seek medical treatment. They will also give information on the effectiveness of anti-viral drugs and indicate when vaccines will become available.

He said there were no plans at present to impose “stay at home” orders: “On the whole, people are sensible and the majority of people with flu, even pandemic flu, are going to be at home in their own beds taking a whole heap of fluids.”

Donaldson is supervising public information bulletins to be televised in the event of a pandemic. The campaign can be drawn up in detail only in the interval between an outbreak in Asia and its arrival in Britain.

Corbett McDonald, emeritus professor of epidemiology at the Royal Brompton Hospital, London, was among experts invited to Donaldson’s meeting to give accounts of previous crises. McDonald, who helped manage the 1957 Asian flu, described it as “like a bonfire”.

http://www.timesonline.co.uk/article/0,,25149-1869515,00.html

The scheme is central to the government’s plans to give patients wider choice by allowing GPs to book hospital appointments online with consultants throughout the country.

The problems have already caused a year-long delay in the booking system and now threaten to add millions to the cost of the project.

To date the system has made only about 20,000 appointments for patients. It was supposed to have made 250,000 by December 2004.

When it is fully operational the system is meant to be capable of making up to 9.5m first hospital appointments a year.

In the e-mail exchanges in September, Granger blames a senior civil servant in the Department of Health for the fiasco, criticising her repeated last-minute changes and failure to heed his advice.

Granger censures Margaret Edwards, the department’s director for access and patient choice, for adding numerous new specifications to the booking programme, known as Choose and Book. Granger writes: “Choose and Book’s £20m IT build contract is now in grave danger of derailing (not just destabilising) a £6.2 billion programme.” He concludes: “Unfortunately, your consistently late requests will not enable us to rescue the missed opportunities and targets.”

Sir Nigel Crisp, the NHS chief executive, was forced to admit to the Commons health select committee two weeks ago that the booking system was at least a year behind schedule. However, he failed to mention that the delay was having a serious impact on the entire project.

The National Audit Office has identified changes to specifications after the award of IT contracts as a key reason for regular delays and overspends on government projects.

Granger’s comments were triggered by an e-mail on September 9 from Edwards marked “Restricted — Policy” which begins: “We have a problem!” The e-mail reveals that patients and their GPs still cannot book treatment at any of the country’s 32 foundation trust hospitals by computer because they are not on its “choice menu”.

The email from Margaret Edwards was encrypted and cced to a limited distribution list. However Granger’s reply was unencrypted and sent to a wider distribution list.

The 10 private sector treatment centres, set up by the government to reduce waiting lists, are also absent from the official list on the computer.

Edwards warns that the treatment centres and foundation trusts will not be on the “choice menu” until next summer.

http://www.timesonline.co.uk/article/0,,2087-1869851,00.html

In July’s Commissioning A Patient-led NHS policy paper, the Department of Health said it wanted PCTs to divest provision by 2008. Since then, the DoH has urged strategic health authorities not to include decisions on provision in their structure proposals.

And last month, following union and backbench discontent, health secretary Patricia Hewitt told parliament that decisions on whether PCTs should divest services to the private and voluntary sector should be left to individual PCTs.

The survey shows that 36 per cent thought the statement would make no difference, and that stopping provision would still be ‘as good as’ compulsory. A further 51 per cent expected to gain ‘a little more’ flexibility while 13 per cent took Ms Hewitt’s statement at face value.

Although two thirds of chief executives would like to retain more than half of their services if they were given the right to choose, most believe they will not be allowed to.

Ninety-five per cent of those polled said ‘the government badly underestimated how much opposition would be created by the transfer of staff out of the NHS’.

One chief executive said: ‘The Stalinist regime at the DoH increasingly appears to have lost touch with reality. In my 20 years at the top I have never known anything to affect morale to such an extent.’

Another disputed government claims that PCTs could not concentrate on commissioning while continuing to provide services: ‘The problem of ineffective commissioning lies in the imbalance in status and power between commissioners and acute trusts.’

More than 40 per cent of the survey’s 67 respondents believed that, after 2008, less than a tenth of the services they currently provide will still be provided by a larger version of their PCT. Only 27 per cent expect more than half of their services will remain in the hands of PCTs.

Fifty one per cent of chief executives believe it is likely or very likely that services will be handed over to the private sector as soon next year.

They think it is less likely that the voluntary sector or a local foundation trust will have picked up the services.

Patients left out in the cold on local consultations

Fewer than half of patient and public involvement forums have been consulted on proposals to cull primary care trusts, a survey has revealed.

The Commission for Patient and Public Involvement in Health found that only 39 per cent of forums had been consulted and only 22 per cent of these felt it had been meaningful.

CPPIH chair Sharon Grant said the results showed not enough PCTs were consulting on the changes.

Since the survey, the government has said there will be a three-month consultation on the reconfiguration.

But Ms Grant said she had been contacted by angry forum members who felt they were being excluded: ‘It is shocking that so little meaningful consultation appears to be taking place,’ she said.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=3600467

The noise was that of Richard Granger, the head of the NHS’s £6.2bn IT programme, reacting with fury to the disclosure by Sir Nigel Crisp, the NHS chief executive, that the first landmark outcome from this mighty investment – the electronic “choose and book” system for getting hospital appointments – would be a year late.

The result was another set of headlines about failed government IT projects. The truth is a lot more complicated. The software, in fact, works and was delivered on time, despite key changes to its specification.

What has gone wrong is the health department’s spectacular failure to engage the NHS in the programme. There have been more changes to the programme’s clinical and management leadership over two years than it is easy to count. The system will be rolled out late not because it doesn’t work but because hospitals have been slow to put their clinic slots online and because the department has failed to agree payments to family doctors – or even to decide whether it should pay them – for the work involved.

These are management, not IT, failures. They are a repeat of past mistakes. Hence Granger’s anger.

Nothing, however, better illustrates the fact that these huge investments in public service reform are actually about IT enabled change, not IT itself.

Which is why the government’s slim strategy document last week offers grounds for hope. Since the arrival a year ago of Ian Watmore, the government’s chief information officer, the Cabinet Office has ceased to bark (largely unheeded) orders about IT at Whitehall and the wider public sector.

A council of chief information officers from across the public sector has been brought together which appears to be turning into a group of people who can help and learn from each other, and want to do so.

An overview of what the government is doing, and why, is emerging, along with management structures that might, just, deliver it. And the industry itself is being challenged. As more off-the-shelf software is acquired, the big IT consultancies are likely to earn much less from designing bespoke systems which endlessly reinvent the wheel (though they might earn more from helping with the sort of change management that the health department has handled so badly).

This remains a strategy, not yet a set of results. It will require consistent political, as well as managerial leadership to get these projects treated as business change, not IT.

Yet the departure to pensions of John Hutton marks the fifth change in ministerial oversight in a year. His successor needs to grasp what is needed and be around longer. Otherwise more teacups will be broken and more projects will fail.

http://news.ft.com/cms/s/5e7edcd8-4f33-11da-9947-0000779e2340.html

According to the most recent available figures, total research spending by the government and the leading charity in the field comes to £36.8m a year for breast cancer against £9.7m for prostate cancer. In addition, the NHS spends £72m annually on the national breast screening programme but there is no such scheme for prostate cancer.

The government spends £4.2m a year on prostate cancer research. While it does not disclose how much is spent every year on breast cancer, the figure is estimated to be at least £12m.

High levels of funding for breast cancer research over the past decade have led to dramatic rises in survival rates. Some 64% of women diagnosed with the disease today are likely to live for at least 20 years.

Patient groups argue that the imbalance in funding will need to be addressed if men suffering from prostate cancer are to be given the same hope.

The Duchess of York, whose father, Major Ronald Ferguson, died from prostate cancer in 2003 after a seven-year fight, said better funding was “desperately needed”.

She added: “This disease has been ignored for too long. If more people were able to talk about how strongly they feel about this disease, I believe it would encourage more debate, more funding into diagnostic tests and innovative treatments for men with prostate cancer.”

Every year about 34,000 women are diagnosed with breast cancer while 27,000 men are diagnosed with prostate cancer. There are also similar numbers of deaths from the diseases — 13,000 women die from breast cancer while 10,000 men die from prostate cancer.

Breast cancer awareness month is a well established event to raise the disease’s profile — it is currently in progress. Celebrities taking part this year include the chefs Antony Worrall Thompson and Gary Rhodes and the comedians Jack Dee and Graham Norton.

It has proved more difficult to attract well-known figures to raise awareness of prostate cancer, but Ricky Gervais, creator of The Office, is presenting a radio advert on the subject.

The government- funded Medical Research Council (MRC) shows the same bias as direct state spending on research. The latest figures available from the MRC, which are for 2001, show that it spent £4.8m on breast cancer and less than £500,000 on prostate cancer.

The discrimination is just as marked in charity funding. Cancer Research UK spends £20m a year on breast cancer and £5m a year on prostate cancer. Similarly, Macmillan Cancer Relief spends £11.6m on specialist breast cancer nurses and £2.8m on prostate cancer nurses.

The only current test for prostate cancer, the prostate-specific antigen test, is not considered to be accurate enough to use in a national screening programme. However, John Neate, chief executive of the Prostate Cancer Charity, said the government had been “too passive” about the lack of an effective diagnostic test.

“It is not enough for the government to stand back and say they will introduce a screening programme when a reliable test is found. The government needs to fund research into finding that test,” he said.

http://www.timesonline.co.uk/article/0,,2087-1827917,00.html

David Howarth has 11 teeth and they’re all loose — but he can’t find an NHS dentist to give him an examination. Nor can John Kelf, who has resorted to doing his own fillings with a DIY kit from Boots. Which is why they have both been queuing in the rain outside the Langley Dental Practice in Manchester since 5am. The practice advertised that it has a limited number of spaces for new NHS patients, and the queue now stretches over the horizon to Bury.

It hurts Richard Hyland to queue. He is over 80 and has had both knees replaced. It also hurts him because he’s an ex-navy man who believed he fought the second world war for a brighter future. Now here he is with one tooth broken off in his gum and no dentist to examine him.

“I paid my stamps,” he says. “But why? What did I fight for? If I had my time again, I’d have turned round in 1940 and said, ‘I’m not going.’”

The shortage of dentists in the NHS is getting worse. A heavily pregnant woman in Wrexham was unable to find an NHS dentist to deal with her severe toothache. So she rang NHS Direct, which told her the nearest dentist who could register her was 48 miles away. She ended up in A&E; with a tooth infection which, had it been left untreated, could have harmed her and her unborn baby. Those American jokes about the state of Britain’s teeth aren’t so funny any more.

You wouldn’t know it, but the government is in the midst of the most radical reform of dentistry since the NHS was founded. And by April 2006, that reform will be complete.

It will mean a new system of dental charges and a new NHS contract for dentists. It’s designed to remove dentists from what they call the drill-and-fill treadmill by paying them for the overall service they provide to a patient, rather than for each individual treatment they carry out. At least, that’s the idea.

Dentists aren’t convinced. They reckon the charges will mean most patients will end up paying more. And that the new contract will put them on a different sort of treadmill. “It sounds glib,” says Ian Wylie, the chief executive of the British Dental Association ( BDA), “but this could be the last chance to save NHS dentistry. Unless the government restores dentists’ faith in the NHS, you could see a time where they no longer want to work for the health service.”

There is already a shortage of NHS dentists. When a practice opened this year in Ludlow, the local primary care trust (PCT) refused to give out its address or phone number for fear of being inundated with clients. It feared similar queues to the ones in Wooton-under-Edge and Scarborough. When the BDA saw the queues in Carmarthen, after a practice said it was taking on more NHS patients, it said the situation “evoked a Third World country, where you have to queue to access what should be part of NHS care”.

Tony Blair made the mistake of pledging, in 1999, that within two years everyone would have access to an NHS dentist. It didn’t happen. The shortfall of dentists is getting worse. According to the Department of Health, it will more than double in the next five years. In Sweden there is one dentist for every 800 people. In the UK there is one for every 2,300 people and over 40% of dentists are refusing to take on new NHS patients. According to a Which? survey, the worst places to live are Cornwall, Shropshire and the Grampians, where it’s nearer 75%. In parts of Wales your only chance of getting on an NHS dentist’s books is when someone dies.

Most shaming for Labour are the statistics that reveal a widening gap in the levels of decay in children’s teeth between the poorest and richest parts of Britain. In places such as Merthyr in Wales and Argyll and Clyde in Scotland, for instance, tooth decay is getting worse. In Barnsley, decay in five-year-olds is one tooth per child worse than it was seven years ago. Given that 4 out of 10 children aren’t registered with a dentist, that should hardly be a surprise.

At the moment, dentists are allowed to choose how much private work they do. For many, their only commitment to the NHS is to those exempt from dental charges, such as children. The new contract will take away that freedom, and NHS dentists will be obliged to see everyone. The BDA says children are bound to suffer.

Last year the National Audit Office found that spending on the NHS had increased by 75% since 1990-91, but spending on NHS dentistry had risen by 9%. But the government presents a different set of figures. “We’ve invested an extra £368m in improving NHS dentistry,” says the health minister Rosie Winterton. “There are 170 extra places at our dental schools and we’ve recruited the equivalent of 1,000 new dentists.” Although that doesn’t take into account the total number of dentists leaving the NHS.

It’s no wonder people are going abroad for “dental holidays”. Alan Scott-Barrs and his wife, Yasmin, both needed urgent dental work but couldn’t get it done on the NHS. He needed caps and root fillings, but was told — at 75 — he was too old for anything other than a new set of dentures, which he didn’t need. And she faced up to a year’s wait. The private cost of the work in the UK would have been £18,000. On a dental holiday in Poland they paid £4,800.

The government has picked up on the idea and is bringing in dentists from overseas. There are, for instance, 117 Polish dentists in the NHS. “But the level of treatment they offer is limited,” says Ian Mills, who runs a dental practice in Devon. “They’re not general dental practitioners, and are more inclined to hand things on to a specialist. It takes a long time for them to be acclimatised. Then they’re going back home.”

Another short-term solution has been the opening of “phone and go” dental-access centres. These solutions are designed to offer the full range of dental treatments to those who have been unable to register with a dentist. But they are costly to run — on average, £80 per patient, which is more than a normal dental practice charges. They prioritise emergencies, not routine checkups, and offer no continuity of care.

They are not a long-term solution. Which is why the government has started to put more money into dental schools. The number of training places is set centrally, and until 2004 stood around 800 each year. From October this year, the figure will rise to 1,000. Bristol University Dental School, for instance, is admitting 82 students this year rather than 53. But the students won’t be fixing teeth until 2010. Even then, there’s no guarantee they will be fixing them in the UK.

NHS dentists are paid a set fee for each item of work they do. It’s an accounting nightmare. There are 400 separate fees for individual items of work, whether it’s a filling or a crown, but as the fees are not high they end up seeing 40-50 patients a day. That compares with private dentists, who average 10-15 patients a day. NHS dentistry is about keeping the chair busy; it’s all about drill and fill.

So private dentistry is tempting. Especially when, according to the Consumers’ Association, fees are three times higher than in the NHS. But only 1,000 UK dentists are exclusively private. The rest mix private work with the NHS. Some treat children on the NHS, but only if the parents are prepared to go private.

When NHS dentists say they feel unrewarded, it’s all relative. The average dentist earns £60,000 a year, but there is a huge disparity. Some NHS-only dentists earn £30,000, while others, especially in the southeast, earn six-figure salaries. In 2003, for the first time, dentists’ private earnings topped their NHS earnings, with 51% of their overall income coming from charges, according to the analysts Laing & Buisson. Dr Stephen Shimberg sees both sides.

He has his own private practice in Manchester and an NHS practice in Oldham. “Generally, dentists do well — NHS and private,” he says. “Private is more relaxed. The patient comes in, and agrees or disagrees with the treatments and the fees you propose. NHS is different. Fees are small, so you have to work harder to achieve your salary on the treadmill.”

The running cost of a dental surgery averages at £100 per hour. It’s classed as a small business, and attracts business rates. It needs highly specialised equipment — typically worth £40,000 — which is bought and maintained by the dentist. The dentist is solely responsible for the cost of implementing guidelines such as disabled access and cross-infection control procedures, and staffing the surgery with at least one nurse and one receptionist.

To have an NHS crown fitted, for instance, a patient needs to visit the surgery at least twice. The impression is £5 and the laboratory fee £40. If the crown fits the first time, and no more visits are necessary, the dentist’s profit is £15. That is then split with the practice. There is no income if the patient is a bad payer or doesn’t keep their appointment. And that is a crown: one of few dental procedures that makes a clear profit.

“If a new patient comes in for an NHS denture,” says Shimberg, “it would be cheaper to give them a £10 note and tell them to go elsewhere. There used to be compensations. Doing fissure sealants for kids, for instance, was always well paid. Not any more. But dentists have to stay on the right side of the red line. When your bank manager asks about your income, there’s no point saying,”It doesn’t really matter because I’m great with my patients.’”

Like private dentists, NHS dentists run their business for profit, and some have been tempted to “work the system”. It’s one reason why the number of complaints received by the General Dental Council (GDC) has increased steadily since 1995. “Studies show that dentists replace fillings far more than necessary,” says Aubrey Sheiham, professor of dental public health at University College London, “and if they suffer a drop in income, they replace their patients’ fillings more often.

What these studies show is that replacing fillings is not closely related to the need to replace them but to the Ôbusiness’ of the dentist. Because the criteria for replacing fillings are vague, it is not difficult to convince a patient that a filling needs replacing.” In other words, the existing system encourages fraud.

The 2006 contract should get round that. Instead of paying dentists for every item of work they do, it will pay them a salary and — in theory — give them more time to focus on the patient. The new contract is being piloted in 25% of Britain’s dental practices and has been well received. But it’s only a pilot, so nobody knows what to expect when it comes into effect next April.

The government has worried dentists by talking about performance indicators called Units of Dental Activity. Essentially they are targets. “But you can’t really target patient treatments,” says Dr Shimberg. A recent online poll suggested that over 50% of dentists were unhappy with the new contract and would resign from the NHS if it were not redrafted. Another survey indicated that charges under the new scheme would increase for at least 70% of patients.

http://www.timesonline.co.uk/article/0,,2099-1845726,00.html

Jane Kennedy, the junior health minister, appeared almost to invite legal challenges over the provision of costly new cancer drugs when she said patients should appeal against decisions where a primary care trust refuses to fund them and the patient believes that the decision is “inappropriate”.

Ministers announced approval of a system aimed at ending, or at least reducing, “Nice blight” – the situation where hospitals and primary care trusts refuse to fund new treatments until the National Institute for Clinical Excellence has pronounced on them.

Although primary care trusts are told they do not need to wait for Nice guidance when a drug is licensed, and have been specifically told they should not refuse such treatments purely on grounds of cost, Nice acknowledged yesterday that “both patients and primary care trusts tell us PCTs will not pay until they have seen our guidance”.

Under the new system, Nice will cut out some of its consultation processes when conducting appraisals that compare one treatment with another. It will also start its assessment of whether significant new drugs are cost- effective in parallel with the licensing process.

That should cut the typical appraisal time from about 18 months to six, but more importantly, produce a decision on whether the NHS should supply the treatment within about eight weeks of the licence being granted rather than months or years later.

Fourteen cancer drugs, some of which cost between £10,000 and £40,000 for a course of treatment, will be the first to be put through the new routine.

But while Patricia Hewitt, the health secretary, has told NHS trusts that when doctors recommend it on a named patient basis they must fund Herceptin, the new treatment for early breast cancer – even though the drug has yet to be licensed – Ms Kennedy made clear that ruling did not apply to half-a-dozen other cancer drugs that Nice is to consider but which, like Herceptin, have yet to be licensed.

But she said that “if a patient believes the primary care trust has made an inappropriate decision they can appeal that decision”.

The Association of the British Pharmaceutical Industry welcomed the new process, but said it wanted to study the details. “There are sometimes limitations on what evidence is available on clinical and cost-effectiveness at the time of a medicine’s launch,” it said.

It also remained “vital” the guidance was “properly funded and implemented without delay by NHS trusts, Andrew Curl, the association’s deputy director said, particularly given evidence that even when guidance is issued, about half of trusts failed to implement it.

Ms Kennedy said increases in NHS spending gave care trusts the cash for new treatments. But Andrew Lansley, shadow health secretary, said that unless financial problems were resolved, “the benefits will be limited”.

The drugs on the NICE blight bypass list are: Docetaxel (Taxotere) for early breat cancer, Paclitaxel (Taxol) for early breast cancer, Rituximab (Mab Thera) for early stages of non- Hodgkin’s lymphoma, Bortezomib (Velcade) for multiple myeloma and Trastuzimab (Herceptin) for early breast cancer.

http://news.ft.com/cms/s/60f0279a-4cd8-11da-89df-0000779e2340.html

Overall, there remains a clear need to improve evaluation and sharing of lessons and solutions by the large number of organisations with a stake in patient safety. There is also a need for a clear system for monitoring that lessons are learned.

Today’s report by head of the NAO Sir John Bourn on progress made by the NHS in improving the patient safety culture concludes that, at the local level, the vast majority of trusts have developed a predominantly open and fair reporting culture, driven largely by the Department’s clinical governance initiative and more effective risk management systems.

There are, however, trusts where a blame culture still predominates. There is also scope for trusts to improve their strategies for sharing good practice.

The NAO survey found that, in response to the encouragement to report, there have been year on year increases in the number of patient safety incidents and in 2004-05, there were around 980,000 reported incidents and near misses. Patient safety incidents are estimated to cost the NHS some £2 billion a year in extra bed days.

A retrospective study of patient records in two English hospitals found that just over 10 per cent of patients experienced an ‘adverse event’. Around half of these (5.2 per cent) were judged to have been preventable.

Responses to the NAO survey showed that, in 2004-05, trusts recorded some 2,081 deaths as a result of patient safety incidents, but it is widely acknowledged that there is significant under-reporting of deaths and serious incidents. Other estimates of deaths range from 840 to 34,000 but, in reality, the NHS simply does not know.

According to the NAO, trusts are now more likely to be fostering open and questioning communication between staff in teams. Almost all trusts reported that they had made progress in reducing the culture of blame; but surveys of nurses and other non-medical staff highlighted that they perceived that the blame culture continues to exist in the NHS. And there was still more to do to achieve a fully open and fair culture with regard to communicating with patients.

In the NAO survey, 69 per cent of trusts had criteria for staff to follow, but only 24 per cent routinely informed patients when those patients had been involved in a reported incident. And six per cent of trusts did not inform patients at all.

All trusts had established effective reporting systems at the local level – although, despite the general increase in reporting, a substantial number of incidents still go unreported (an estimated 22 per cent, mainly medication errors and incidents leading to serious harm). Reporting of near misses is also low, mainly owing to different perceptions of what constitutes a near miss.

The roll-out of the National Patient Safety Agency’s National Reporting and Learning System has taken two years longer than the December 2002 date originally envisaged. The new target date was for all trusts to report to the system by June 2005, but by August 2005 at least 35 trusts had still not reported any data.

Most trusts pointed to specific improvements derived from lessons learnt from their local incident reporting systems, but these lessons are still not widely promulgated, either within or between trusts. And the National Patient Safety Agency has provided only limited feedback to trusts of evidence-based solutions or actions derived from the national reporting system.

The NAO has made a number of recommendations aimed at enhancing and sustaining the development of an effective safety culture; improving the reliability and completeness of reporting; and encouraging learning and the development of effective solutions. For example: trusts need to evaluate their safety cultures and develop systems in which NHS employees need not fear blame or unequal treatment if they report incidents; and patient safety must become a core part of professional clinical training.

The report also recommends that there should be a clearer definition of ‘near-misses’ and encouragement of staff to report them and that the Department should explore the possibility of a single point to which all staff can report, for example, via the National Programme for Information Technology in the NHS.

Patients also need to be engaged by trusts in identifying important patient safety issues and in helping to design solutions. There should be better dissemination of learning between trusts. And the National Patient Safety Agency needs to expedite its evaluation and feedback programme and focus on developing solutions to nationwide problems with the Healthcare Commission taking responsibility for ensuring that appropriate solutions are implemented across the NHS.
Sir John Bourn said:
“Reducing unintentional harm to patients in NHS hospitals is a central tenet in the management of healthcare quality and risk. Two factors are crucial to this: the establishment of a culture in which incidents can be reported easily, honestly and without fear of blame; and the ability to ensure that lessons learned from these incidents are successfully promulgated to NHS staff both locally and nationally. What today’s report shows is that the Department of Health and the NHS have made some progress in both of these areas – but not enough.

“There needs to be significantly faster progress at the national level in ensuring effective evaluation of numbers, types and causes of incidents. And lessons and solutions must be better evaluated and shared by all organisations with a role in keeping patients safe.”

http://www.nao.org.uk/pn/05-06/0506456.htm

The full integrated airline-style online booking service was due to be fully operational by the end of December for 100 per cent of bookings between GPs and hospitals. Sir Nigel told the PAC the system is “running about 12 months late.”

Quoted in the Financial Times Sir Nigel said that in a few parts of the country half of all outpatient appointments were now being booked using the electronic system. “It is moving fast and we will have a much better position in two to three months time.”

By the end of September only 20,000 appointments in total had been made using the system since it was introduced in 2004, compared to the annual total of 9.9 million first outpatient appointments each year.

Connecting for Health, the Department of Health (DH) agency responsible for delivering the Choose and Book system has previously denied that the target was to deliver full electronic booking across England by December 2005.

A five year contract for Choose and Book, worth £64.5 million, was awarded to SchlumbergerSema (since acquired by Atos Origin) in October 2003. Despite the low take-up of the system Atos Origin is understood to be paid the full monthly contracted fee for providing the system.

The year-plus delay in delivering Choose and Book comes despite the DH offering financial incentives to GPs to use the new system. Some £95 million in incentives were announced in January by the then health secretary John Reid.

On 27 September EHI Primary Care revealed that the DH had admitted that not a single primary care trust in England would meet either the October incentive payment target, or the December Choose and Book target. A leaked email from Margaret Edwards the DH’s director of access confirmed the delays and said PCTs and practices would instead have to rely on more conventional solutions to deliver its flagship policy on choice at referral.

While the national Choose and Book solution, delivered by Atos Origin with software provided by Cerner, is understood to work, there have been significant delays in building and implementing the interfaces to GP and hospital systems.

Technical problems have also been reported with the reliability and robustness of the Choose and Book application when running over the NHS spine, which in the integrated version of the system is used for checking patient demographics, security, user authentication and electronic messaging.

GPs have also been reluctant to use the system, due to concerns about the time it takes to make an appointment during a consultation.

In June Dr Jim Johnson, chairman of the British Medical Association criticised the government’s choice agenda and dubbed Choose and Book a “fiasco” that takes no account of how GPs and hospitals work.

In January of this year an Audit Commission report into patient choice concluded that Choose and Book would at best cover 60-70% of appointments by the end of 2005; a figure that in hindsight now looks over-optimistic. The Audit Commission report highlighted technical problems, delays in delivering upgrades and failure to engage GPs.

Sir Nigel’s statement confirms that another key element of the NHS National Programme for IT is running badly behind schedule. Implementation of the NHS Care Record Service, integrated local clinical solutions and the NHS spine are all running behind the original published timelines.

A DH spokesperson said: “The Department of Health is confident of introducing Choice at the point of referral for patients from January 2006 as we committed to do, with continually increasing numbers of patients booked electronically throughout 2006.

The spokesperson added: “We have introduced a range of support for the NHS, including financial incentives, to speed up progress in choosing and booking appointments electronically, and we are confident that the results of this support will start to show in the coming months.”

“We remain confident that the roll out of Choose and Book will continue to increase and great progress is being made day by day. The number of bookings is also accelerating day by day. It is therefore too soon to speculate on the position around the turn of the year but we will provide updates of progress at regular intervals.”

http://www.e-health-insider.com/news/item.cfm?ID=1514

‘The NHS has got to take the pandemic seriously,’ he said. ‘We regard pandemic flu as public health enemy number one and we are on the march against it. The NHS needs to react as well to this pandemic as it did to the July bombings.’

He added: ‘I hope the urgency of the pandemic will make even the most uninterested managers make the move to develop a plan. With good planning and preparation we can reduce the impact of pandemic flu on the health of our population.’

Primary care trusts are being warned that they should expect to see at least 1,000 new flu patients a week during any pandemic and this figure could rise to over 5,000 at the virus’s peak.

Hospital admissions for acute respiratory and related conditions could increase by at least 50 per cent, with around 20,000 new patients a week at the height of the pandemic.

PCTs have been asked to draw up plans detailing how they would respond to a pandemic, which would be checked by the Department of Health to ensure they were appropriate.

Information packs have been sent out to GPs asking them to be vigilant in recording all cases of flu or flu-like symptoms and to be prepared for mass vaccinations once they become available.

Sir Liam warned that the vaccine might not be available in time for the pandemic reaching the UK, but said the government was stockpiling 15 million anti-viral treatment courses to treat flu victims in the event of an outbreak.

The DoH has invited vaccine manufacturers to tender for ‘sleeping contracts’, which would mean they had to build up capacity to meet demand once the flu strain is identified.

Health Direct questions what extra money is being allocated by the Labour govt to combat the flu epidemic when it does break- is this yet another case of spin before truth?

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=3506985

The figures came in response to parliamentary questions from shadow health secretary Andrew Lansley on how much has been spent implementing cuts to NHS arm’s-length bodies in a process designed to save £500m by 2008-09.

Mr Lansley said the findings showed that ‘the cost of rearranging desks has reached £37m thus far, with no discernable reduction in the level of administration and no discernable improvement in the standard of patient care.’

He said in some cases ‘such as the axing of one of the National Institute for Health and Clinical Execllence’s appraisal committees, the arm’s-length body review has potentially damaged patient care’.

The shadow health secretary said the government would do better to abolish the culture of political targets and bureaucracy to support them.

A DoH spokeswoman said such an ‘ambitious change programme’ had been expected to involve one-off costs, with much of the £32m cost the result of one-off redundancy payments. She said these would be justified by the ongoing savings achieved for redistribution to frontline health and social care.

Since November last year, eight bodies have been wound up: the Family Health Services Appeal Authority, the Health Development Agency, the National Clinical Assessment Authority, the National Radiological Protection Board, the Public Health Laboratory Service, the NHS Information Authority, the Modernisation Agency and the NHSU.

And four bodies have been established: the Health and Social Care Information Centre, the Human Tissue Authority, NHS Connecting for Health and the NHS Institute for Innovation and Improvement.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=3506958