NHS faces uphill task to meet waiting list targets

The pledge that no one will wait more than 18 weeks for hospital treatment by 2008 may not be new. But given where the National Health Service is starting from, it remains ambitious.
The pledge covers the wait from GP to operation - a period the NHS does not currently count. But on the latest quarterly figures about 300,000 people waited that long for a first out-patient appointment in England.
There can then be a gap - for which there are no national statistics - ranging from days to months for diagnostic tests. Once an operation is decided upon and the patient joins a queue, the average wait is another 95 days.
The figures explain the Department of Health's calculation that the service needs to be providing an additional 1m treatments a year by 2008, and that much more investment needs to go into diagnostic tests to cut waiting times.
The pledge came as the monthly waiting list for December was published showing a seasonal blip upwards of 1.7 per cent - 14,100 patients - to 858,000. Some 67,000 patients have been waiting more than six months against 116,000 a year ago, and the total waiting list is 115,000 fewer over the same period.
The department also released figures yesterday showing that, on average, 97 per cent of accident and emergency cases were being dealt with within four hours although the figure varied considerably between hospitals.
Two years ago only 78 per cent of patients were seen within that time.
Andrew Lansley, the Conservative health spokesman, dismissed the promise of a total wait of 18 weeks as "an old pledge we have heard before".

Published: February 12 2005 02:00 | Last updated: February 12 2005 02:00
http://news.ft.com/cms/s/ff4face4-7cd6-11d9-bf35-00000e2511c8.html

MRSA costs the NHS £1bn a year

The UK's MRSA problem may be due to the emergence of highly contagious clones of the superbug, says a scientist.
The emergence of two particularly nasty versions of MRSA coincides with increasing hospital superbug infection rates, says Dr Mark Enright.
The Bath University scientist believes government efforts should focus more on screening for and isolating patients with these strains.
The Department of Health defended its infection control policies.
"We should have clean hospitals but that is a side issue to the MRSA problem" said Dr Enright
Last year it set a target to cut rates of MRSA bloodstream infection by half by March 2008.
To achieve this, strategies to improve hospital cleanliness and infection control are being employed.
There is a big push for better hand hygiene among staff.
Matrons have been given direct responsibility for cleaning staff, and ensuring patients' views are taken on board.
New patient bedside phones are being introduced that include speed dial buttons to alert staff to the need to deal with a hygiene problem.
The government has also been seeking advice from the world's leading infection control experts to discuss how best to tackle the problem.
Last year the number of MRSA infections in the UK jumped by 3.6% to 7,647.
Dr Enright believes the government's measures will not be enough to hit the ambitious target three years from now.
"No one has halved a national MRSA rate ever and we don't know how to do it.
"I'm not very confident this is going to work.
"We should have clean hospitals but that is a side issue to the MRSA problem."
He recommended more extreme measures, such screening and isolating patients with the nastiest strains of MRSA, clones 15 and 16.
He said these two clones account for 96% of MRSA bloodstream infections in the UK and were beginning to spread to other countries.
They were more transmissible than other 15 strains of the bug that have been isolated, allowing them to spread from patient to patient, or via hospital staff or equipment, easily.
"You might only need to isolate one in 10 MRSA cases to stop these outbreaks starting," he said. " One can't say absolutely, but the correlation is very striking"- Dr Alan Johnson
But he acknowledged that this would require "a politically unacceptable level of resource and lengthen hospital waiting lists" in the Society for General Microbiology's publication Microbiology Today.
He also said there had been "an unacceptably low" amount of government spending on research into the causes of the MRSA epidemic started.
The Department of Health said it was working with scientists and researchers to ensure it had the very latest information on the cause, spread and effect of MRSA.
A spokeswoman said: "We have called for proposals on new areas of research, funded as part of the £3million dedicated to developing effective infection control practices in hospitals. We are determined to leave no stone unturned when it comes to the fight against MRSA."
"MRSA infected patients are treated in isolation wherever possible, and this is one of the areas that has been identified for further research."
Health Secretary John Reid told the BBC extra investment in the NHS would enable hospitals to expand their capacity.
This would reduce the need to push patients through the system as quickly as possible in crowded conditions, and thus the potential for spread of MRSA.
Dr Alan Johnson from the Health Protection Agency, said it was the mid-1990s that MRSA started to increase up to the current rates.
"The time scale in which we saw this increase does tie in quite closely with the emergence of the 15 and 16 clones.
"The Health Protection Agency documented the emergence of these strains in the mid-1990s.
"One can't say absolutely, but the correlation is very striking."

http://news.bbc.co.uk/1/hi/health/4249533.stm

Technophobe Tony will be IT disaster

'I'm a technophobe' - Blair's shock confession. The Register's belief that when it comes to UK Government IT, nobody's driving received further support yesterday when Prime Minister Tony Blair happily confessed his technophobia to MPs.
The exposure of Tone the Technoklutz is scarcely news, but for most categories of MPs' questions it is ordinarily good form for the Prime minister to at least feign a knowledgeable and informed stance.
But IT's OK - it's an exception because nobody can programme a video machine anyway, hah hah, right?
Unhappily, IT is of particularly vital importance to the UK Government right now, not just because we are poised to embark on a high tech, all- encompassing and pioneering (so they claim) national identity scheme, but also because Mr Tony and his Blairite modernisers intend to leverage IT to revolutionise Government systems in general, and more prosaically to achieve the efficiency targets and savings called for in the Gershon Review.
So if the new systems don't work, run late, go wildly over budget then the wheels come off Chancellor Gordon Brown's budgeting, which is already generally viewed as being on something of a knife edge.
And it's not as if the first question Blair was lobbed (at yesterday's Liaison Committee session) didn't have a big red flashing *IMPORTANT - DO NOT JOKE* sign attached to it. LibDem Richard Allan enquired: " Prime Minister, do you accept you will not meet your Gershon Review efficiency targets unless Government dramatically improves its ability to purchase the large IT systems it requires?", and the exchange continued as follows:
Mr Blair: The IT systems are a vital part of it, yes.
Mr Allan: Given the performance to date on systems like the Child Support Agency, is this something which is up there on your public services agenda that you receive regular reports on?
Mr Blair: It is. Some of the IT projects do not go well and some of them do go well. Funnily enough, if you look at the comparison between public and private sector on IT projects it is not very much different.
Which of course might be true, depending on what it is you're counting when you list successes and failures, and how you define success and failure. But statistics produced without an examination of the factors that have influenced the outcomes of the projects covered have dubious value. UK Government departmental definitions of 'success', for example, will be influenced by political imperatives ('I want to be able to say it deployed on time'), while an absence of clear project definition and control is a prime characteristic of UK Government IT projects. This boils down to ambitious projects that don't succeed because nobody's driving, but whose failure is camouflaged because admission of another disaster is politically unacceptable. Less ambitious projects with narrower objectives on the other hand will tend to be more successful, pulling up the overall statistics.
But it seems unlikely that Blair will get much beyond the basic stats:
Mr Allan: You have something of a reputation of being a technophobe on a personal level, is that fair?
Mr Blair: I am afraid that is fair actually, yes. [Ingratiating chuckle here? Hansard is silent]
Mr Allan: It is. Have you ever visited the multi-million pound central government website that you have set up to get us all to use these new electronic government facilities?
Mr Blair: I think that is a very unfair question. The answer is no.
Mr Allan: Do you know the address of this multi-million pound project?
Mr Blair: No.
And then the coup de grace:
Mr Allan: Your head of e.government, Ian Watmore, would be able to tell you all about it.
Mr Blair: That is exactly why delegation is such an important part of the job of a prime minister. [Chuckle?]
Mr Allan: Finally, can you tell us when you last met with your head of e.government and how often you do?
Mr Blair: Yes. I cannot remember the exact date but we have regular meetings on this. The use of the new technology is a very, very important thing for Government. Online, for example, people are able to do far more than they ever used to. Some of the self-assessment on tax, there are now lots of people doing that online.
Mr Allan: Not the Prime Minister.
Mr Blair: There is not me doing it online, no, I have to say. I apologise for that, I have a few other things on my plate.

Published by The Register- Wednesday 9th February 2005 12:01 GMT
http://www.theregister.co.uk/2005/02/09/blair_technophobe_confession/

Doctors' support for IT dwindles

Support among doctors for the National Health Service's £6.2bn information technology programme is falling fast, a survey shows.
Only 2 per cent of family doctors rate themselves as "very enthusiastic" about the programme, against 66 per cent of all doctors declaring a year ago that they were fairly or very enthusiastic.
The sharp fall in enthusiasm follows a report last month from the National Audit Office on the electronic booking system, which warned that 60 per cent of GPs were more or less hostile to a system that was meant to be the first big part of the IT programme to be delivered.
The NAO said that while doctors' support was crucial it might now be "hard to secure".
Robin Guenier, chairman of Medix, which has undertaken a regular survey of doctors' views for the past two years, said: "There has been a marked downturn in support and enthusiasm over the past 12 months," with free-standing comments made by doctors to accompany the survey becoming highly critical.
Some believe the flagship IT programme is doomed, raising questions about what can be done to regain support. Many doctors still complain that they know too little about the programme. Dr Paul Cundy, chairman of a joint BMA and Royal College of GPs committee on IT, said the figures were "deeply depressing".

http://news.ft.com/cms/s/24194974-7979-11d9-89c5-00000e2511c8.html

Cancer care is in crisis say Doctors

THE government’s £2 billion scheme to revolutionise the treatment of British cancer sufferers has failed, with much of the money wasted on creating 400 bureaucrats.
A damning report by Britain’s biggest independent group of NHS doctors says many patients are waiting longer for treatment than they were when the programme was launched five years ago.
The proportion facing “appalling” delays for radiotherapy that could cure their cancer has doubled. Many new machines are waiting in boxes because of staff shortages.
The indictment by Doctors for Reform, a group of 900 NHS consultants and GPs, is a big blow for Alan Milburn, Labour’s election supremo, who launched the NHS cancer plan when he was health secretary. At a press conference last week Milburn said delivery of public services was at the heart of the party’s general election strategy.
The report — commissioned by the doctors’ group from three of Britain’s leading cancer experts — pins the blame on the failure to target money on frontline NHS staff. Instead, it says it has been spent on 400 “new, highly paid administrative” staff with no consequent “increase in clinical capacity”.
As a result, the study found:
# More than 70% of cancer patients are having to wait beyond the recommended maximum of four weeks for radiotherapy, compared with 32% five years previously.
# No improvement in waiting times from diagnosis to treatment for all the main cancers throughout 2002 and 2003 — and increased delays for urological and some gynaecological cancers.
# Huge delays in obtaining the scans and pathology tests needed to decide on the best treatment for a cancer victim.
# Patients continue to face a postcode lottery over the prescription of drugs despite an extra £124m to reduce those inequalities. For example, 5% of women with breast cancer in Derbyshire received the new drug Herceptin compared with 90% in Dorset.
# No national cancer information technology system: doctors continue to calculate doses of chemotherapy on paper where they are more likely to make potentially fatal errors than if done by computer. “If such a dangerous system existed for other procedures such as surgery. it would be regarded as completely unacceptable.”
# A projected shortfall of one third — 400 — in the number of key specialists required to analyse tissue to ensure patients get the right treatment.
Dr Maurice Slevin, one of the authors of the report, said: “Cancer care is in crisis but this is a solvable crisis if urgent and fundamental reform is introduced.”
In the past two years the Department of Health has made at least 20 announcements claiming big improvements in cancer care, citing an increase of nearly 1,200 cancer specialists and improvements in cancer survival rates.
However, the latest analysis estimates Britain still has one of the lowest survival rates in western Europe with only 36% of men likely to survive beyond five years compared with 55% in Austria, 50% in Sweden, 45% in France and Germany, and 44% in Spain. Currently more than 1m people are living with cancer in Britain. It has overtaken heart disease as the country’s biggest killer causing about 160,000 deaths a year.
John Reid, the health secretary, often quotes the statistic that more than 99% of patients are now seen by a specialist within two weeks of being referred by their GP but experts say it is the length of time until patients receive treatment that matters.
The report, published today by Reform, an independent think tank that helped set up Doctors for Reform last February, concludes: “The cancer plan is delivering poor value for money. It is simply not delivering as hoped and there are no reasons for expecting any dramatic improvements in the future. In the interests of patients we must look at ways of bringing about a rapid improvement in the situation.”
The study was by Professor Karol Sikora, a former chief of the World Health Organisation’s cancer programme, Nick Bosanquet, professor of health policy at Imperial College London, and Slevin, consultant oncologist at Barts and the London NHS Trust.
Doctors for Reform says progress has been held back by an NHS monopoly and wants 30% of cancer treatment to be handed to private companies over the next two years.
Mike Richards, the cancer czar, said waiting times for radiotherapy had risen as demand had increased sharply but added: “We have installed 40% more linear accelerators in the last five years and doubled the number of therapy radiographers in training.”

Caring costs crisis

We're paying the price of living longer- with 70,000 people a year selling their home to meet care costs.
Anyone with an elderly parent knows that deciding to move him or her into a care home is one of the toughest decisions they will ever make. And financial worries may well add to the stress, for most families in this situation will have to face the question of how their relative's care is to be paid for.
Under current rules, people with capital of more than £20,000 - including the value of their home - must pay the full cost of their own long-term care. This is no easy feat, given that residential or nursing home places currently cost on average around £25,000 a year.
Research from Help the Aged's Care Fees Advice Service shows that 70,000 older people are forced to sell their homes each year to raise the necessary cash. It's the only option left for one in five pensioners who need to go into care, the charity's report says.
Not only that, but the number of elderly homeowners affected will increase over the coming decades, as nursing costs soar and life expectancy rises.
Meanwhile, people who do qualify for financial help are in a dwindling minority. National guidelines on eligibility criteria - typically based on income and benefits - and the range of services funded by the National Health Service have not been updated since 2001.
And interpretation of these guidelines lies in the hands of cash-strapped local health authorities - turning long-term care into a lottery.
Costs will fall into one of two categories: accommodation charges for staying in a residential home, or fees paid for medical care in a nursing home. The latter should be covered at least in part by the NHS, but in reality, the boundaries have become blurred.
In February 2003, the Department of Health ordered a review of the system after the Health Service Ombudsman accused some health authorities of "misinterpreting" the rules and wrongly charging people for nursing care they were entitled to for free on the NHS. Since then, the Ombudsman has received 4,000 complaints from the public on the matter.
Campaigners have long been calling on the Government to implement new, clear-cut national criteria for funding.
"The Ombudsman's figures only begin to reveal how many older people and their families are victims of the shambolic care-funding system," says Gordon Lishman, director general of Age Concern. "Some have received a pittance towards the cost of their care when they should not have paid a penny."
In December last year, the junior health minister, Stephen Ladyman, commissioned a new national framework for the assessment of fully funded NHS continuing care, and announced the publication of an independent report on the matter. No date has yet been set for the framework's introduction
While Help the Aged spokes- man Jonathan Ellis says it will be a "vast improvement" on the existing system, Philip Spiers, director of the Nursing Home Fees Agency (NHFA), is reserving judgement until details are announced. "Funding for long-term care has been a grey area for far too long," he says.
Anyone who believes they are wrongly paying for care should contact their local Primary Care Trust to ask for a review. If they are unhappy with its decision, they can then appeal to the Health Service Ombudsman.
Mr Spiers says the NHFA saw a rise in calls to its helplines last month. Many people complained of inappropriate or delayed assessment of care needs, and information not being provided by social services on time.
"Most of the problems we encounter at this time of year are money-led," he adds.
The good news for those who have to pay for their own care is that there are a number of state-funded benefits and schemes for which they may qualify. For example, if their capital excluding their home is less than £20,000, the local authority must disregard the value of the property and assist with fees for the first 12 weeks of residential care.
After this, the local authority can lend the money to finance care through a "deferred payment agreement", to be recovered when the property is finally sold.
Check, too, for eligibility for what is called attendance allowance. Those who end up funding themselves can qualify for a non-means-tested, non-taxable £39.95 benefit paid weekly for care by day or night - or £58.50 if both are needed.
If one spouse is still living at home, this property should not have to be sold or be included in care-fee calculations. Many elderly people may also be able to claim income support or pension credit, depending on their capital and income.
In any event, professional financial advice will allow you to consider all your options.

Published : 06 February 2005
Independent On Sunday

http://money.independent.co.uk/personal_finance/invest_save/story.jsp?story=608139