Health Direct » 2006 » January

Hewitt calls for hospitals to close- despite record funds

Dr Search- Principal Consultant at the Search Clinic — Tue, 31 Jan 2006 09:10:00 +0000

A swathe of hospital closures and reconfigurations was signalled by Patricia Hewitt as a necessary step to get the National Health Service back into financial balance. The health secretary’s admission that big changes would be needed in the way services were delivered in some parts of the country came as she announced she was sending “turnaround teams” into the 18 NHS organisations facing the greatest financial risks.

But she added that some “very difficult” decisions would be needed in parts of the NHS where “too many services are being delivered from too many different places in a way that is very expensive and very inefficient”.

This would mean “reorganising services, reconfiguring hospitals, doing more treatment and diagnostics in the community, in primary care centres and community hospitals”.

Two separate surveys yesterday showed more than three-quarters of NHS chief executives saying that the areas with the worst financial problems could not solve them without the redesign and closure of services.

The NHS Confederation, which represents health authorities and trusts, said this left the government facing “a stark choice between continuing financial instability and tough political decisions”, even before the implementation of its more radical policies. These in-cluded giving patients a choice of hospitals and “payment by results”, in which hospitals were paid for the number of patients they treated, not through service level contracts.

Ms Hewitt acknowledged that politicians would have to argue the case. Changing medical technology and redesigned services would produce better patient care, and the service could not “do everything, or as much as we are currently doing, in acute hospitals”, she said.

Three-quarters of the NHS is in financial balance. But Ms Hewitt’s admission points to a controversial series of rationalisations, reconfigurations and possibly the closure of some hospitals in Sussex and Surrey, west London, the home counties to the north in Hertfordshire, and in parts of Hampshire, Kent, Lancashire and Yorkshire and possibly in Wiltshire. These are all areas where there are structural underlying deficits as well as current overspends.

Few hospitals are likely to close. But many more could lose accident and emergency departments and the full range of procedures as services are concentrated on fewer sites and in some cases moved out of the hospital entirely. Despite admitting the need for serious structural change in some areas, Ms Hewitt confirmed she was further extending the “payment by results” system, which is currently used for waiting list cases.

This will mean the system is applied to accident and emergency, urgent operations and outpatients. Officials said for a typical district general hospital that would mean about 60 per cent of its income would depend on levels of activity, not on block contracts.

Ms Hewitt insisted that “payment by results” was not causing the NHS’s financial problems, but making them transparent. Some hospitals and areas had failed to redesign activity to get best value and match finances, she said, in effect borrowing from others for years. This practice had to stop.

Dr Gill Morgan, chief executive of the NHS Confederation, said politicians needed the courage to let managers “take difficult decisions that will benefit patients in the long term”. This meant getting away from a fixation with hospital buildings and focusing instead on the services delivered. “Loss of beds does not necessarily equate to a decline in services.”

Dr Morgan called for historic debts to be restructured. However, Department of Health finance officials said debts would have to be cleared, not written off.

http://news.ft.com/cms/s/dc740782-8e10-11da-8fda-0000779e2340.html

Hewitt- Your money not your life- puts money before medicine

Dr Search- Principal Consultant at the Search Clinic — Mon, 30 Jan 2006 08:41:00 +0000

Patricia Hewitt, the health secretary, will call for the end of the “handout culture” in the NHS this week and demand that financial management be put ahead of clinical objectives. Under the new financial regime, health trusts will sink or swim on their ability to attract patients under a system of payment by results that threatens the income of poor performers.

On Thursday, Ms Hewitt will issue the first rulebook for NHS managers in an attempt to eliminate the financial deficits threatening to destabilise reform plans for hospitals and primary care services. She is expected to say that financial management must have a higher priority than clinical objectives during the coming year, a shift expected to enrage medical staff.

Ms Hewitt is determined to eliminate the “handout culture” she thinks may have been responsible for a quarter of trusts veering into the red in 2005/6. Their half-year accounts forecast overspending totalling £948m by the end of March. Many have resorted to emergency measures to cut spending, such as postponing operations until the new financial year, freezing staff vacancies and withholding tax and national insurance payments.

The health secretary will issue the “Business Arrangements” manual explaining how NHS finances should be controlled during 2006/7, when her reforms are due to create unprecedented instability in the service. She will say: “Excellence in financial management is the prerequisite for high quality sustainable services.” Trusts will have to say goodbye to “a culture of balance sheet adjustments and handouts” that allowed hospitals to tolerate inefficiency on the assumption that the NHS would bail them out.

The rulebook will make it clear that strong financial management has moved from the bottom of Ms Hewitt’s list of priorities to the top. Until this year, hospitals could fairly accurately predict the number of patients they would be expected to treat. They agreed contracts with local primary care trusts guaranteeing most of the income they needed to do the work. Patients can now choose, however, from a menu of at least four local NHS trusts where they are entitled to free treatment. Consequently, hospitals can lose income if they do not attract enough patients.

The fee they get for each attendance is also being priced differently. A national tariff was set last April for all non-emergency operations. If a hospital spent more than the norm for a particular procedure, it lost money on every patient treated.

The government had already warned trusts that this system of payment by results would be extended in April. Ms Hewitt will set a national tariff for every hospital activity, except critical care for a tiny minority of the most seriously ill patients.

In a new twist, Ms Hewitt will also create incentives to keep patients out of hospital if they can be cared for better, or more economically, by GPs and healthcare staff in the community. The rulebook will explain how “practice-based commissioning” will give GPs some control over the services available to their patients.

Ms Hewitt disputes reports suggesting that the NHS is in crisis in 2005/6, and the rulebook may explain how trusts can build up small surpluses as a cushion for the years after 2008 when the Treasury intends to reduce the pace of NHS growth.

A survey of trust chief executives by the Health Service Journal found that 63% of acute hospital trusts have been forced to close wards to reduce outgoings, 75% have frozen recruitment and 26% are planning to withhold tax payments until the new financial year. Yet 37% still expect to be in deficit. The Department of Health said the poll was unrepresentative.

http://www.guardian.co.uk/frontpage/story/0,,1692810,00.html

Alzheimer’s drugs to be available to NHS patients

Dr Search- Principal Consultant at the Search Clinic — Fri, 27 Jan 2006 08:58:00 +0000

Key drugs for people with moderate dementia will continue to be available on the NHS under revised plans unveiled by the treatment watchdog. NICE provoked an uproar in March last year when it published draft guidance which stated that drug treatments Donepezil, Rivastigmine and Galantamine for Alzheimer’s were not cost-effective enough to be available on the NHS.

It announced that its Appraisal Committee is now recommending three drugs as “options for people with Alzheimer’s disease of moderate severity only”.

Andrew Dillon, NICE Chief Executive and Executive Lead for the appraisal, said: “People with Alzheimer’s will now get these drugs when they can help them most. Patients and those who care for them will be able to feel more confident about gaining benefit from them.”

Last year’s draft guidance was widely condemned and NICE received an unprecedented response from doctors and campaigners calling for a rethink.

In the draft, NICE accepted that donepezil, rivastigmine, galantamine and memantine – known as cholinesterase inhibitors – could alleviate the symptoms of Alzheimer’s, but said they were not cost-effective for NHS use.

The drugs cost £2.50 a day, and carers say they help them cope with people with Alzheimer’s because they reduce the symptoms which make care more difficult.

The fourth drug, memantine, is not being recommended as an option.

The Alzheimer’s Society estimates some 72,000 people have mild Alzheimer’s in the UK, with around 309,000 in the moderate to severe category.

Neil Hunt, of the Action on Alzheimer’s Drugs alliance, said: “We welcome the fact that Nice has acknowledged the effectiveness of drug treatments”.

However he said the draft placed “severe restrictions” on access to the drugs.

He said sufferers in the later stages “benefit enormously” from Ebixa (memantine), while withholding treatment in the early stages was “unethical”.

The watchdog says the recommendations are subject to consultation, and until then the 2001 guidance is still in force. The original guidance for donepezil, rivastigmine, and galantamine recommends their use for all patients with treatment stopping when they no longer have an effect.

When the guidance is published – it should be in July 2006 – it will apply to newly-diagnosed patients only.

http://news.independent.co.uk/uk/health_medical/article340389.ece

NHS Managers lay the blame at door of Labour govt

Dr Search- Principal Consultant at the Search Clinic — Thu, 26 Jan 2006 09:25:00 +0000

Government targets and badly costed pay schemes are largely to blame for the financial problems in the NHS, chief executives believe. Eighty-four per cent of respondents to HSJ’s survey agreed with the statement that the government was trying to dodge its own culpability for the financial problems by blaming it on a small number of poorly performing trusts.

More than two-thirds of chief executives said the NHS would not be facing such severe financial problems if it were not for ‘inflexible government targets’ such as the four-hour accident and emergency wait.

And 99 per cent agreed that Agenda for Change and the consultant and GP contracts were not costed effectively by the Department of Health, and that this has had a big impact on the financial state of the NHS. Eighty-six per cent agreed strongly with the proposition.

One respondent to our survey of mental health, acute and primary care trust chief executives said: ‘In 30 years I have never experienced such chaos and paralysis and I hold ministers and the DoH absolutely responsible.’

Another said: ‘The DoH is responsible for negotiating Agenda for Change and the consultant and GP contracts so it should be accountable for the financial consequences,’ he added.

Another asked: ‘Who in their right mind would ever give their staff a pay award before agreeing what the productivity improvement will be?’

The ’short-term nature’ of NHS targets was singled out for criticism by one, and another said: ‘The government has put too many changes in place at the same time without considering the impact on the service. Targets are set nationally; locally we try and meet these and then we get the blame when the targets and funding don’t balance.’

NHS Confederation policy director Nigel Edwards agreed that targets were costing trusts more than expected. ‘Some places have discovered that they are experiencing diminishing returns in meeting the targets. One strategic health authority has told me that it cost £15m just going from the 95 per cent to 98 per cent A&E; target, and it cost one trust £1m alone.’

Only 39 per cent of chief executives believed that the calibre of finance directors is a major factor. One senior figure said the government was wrong to blame management failings for the financial crisis: ‘If it is a failure of management, the system put these managers there, they appointed them and are responsible for holding them to account.’

Chief executives also blamed the introduction of the private sector for the problems: 66 per cent said the policy had destabilised parts of the NHS.

SHAs accused of piling debts on ‘bad apples’
Debts are being heaped on trusts by some strategic health authorities so the financial crisis can be put down to a ‘few bad apples’, King’s Fund chief economist John Appleby has claimed.

Questioning the credibility of SHA projections to the Department of Health, Mr Appleby said some authorities ‘centralised’ their deficits because the pressure to present a reasonable picture to the government was ‘immense’.

‘The reality is that most, if not all organisations are suffering to some degree financially. If you have got 10 hospitals in an area and they all have a deficit of £2m that could look worse than if you have two with a £10m deficit each,’ said Mr Appleby.

‘It implies something about who is to blame. If you have just a couple of hospitals with big deficits you can start to say it’s bad management. If every hospital had a deficit it would send out a different message. The finger could start to point upwards in the system.’

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4047199

Sex offenders can still slip through NHS net

Dr Search- Principal Consultant at the Search Clinic — Wed, 25 Jan 2006 12:29:00 +0000

Known sex offenders could be employed in front-line children’s services for up to six months before their records are revealed. Trusts have been using a fast-track system since 2002, which clears recruits against government black lists, but these do not cross-reference with either the sex offenders register or local police information.

The fast-track system was negotiated with the Criminal Records Bureau by the Department of Health in summer 2002 against a backdrop of crippling delays in criminal record check during the CRB’s first year of operation.

Under the system, new employees can be cleared to start work if they do not appear on the Protection of Children Act 1999 (POCA) list of people banned from working with children.

The list – maintained by the Department for Education and Skills on behalf of the DoH – contains names of people deemed unsuitable to work with children on evidence referred to either the health or the education secretaries by employers.

Like ‘list 99′ – the list of teachers with a ban or restrictions on working with children – the POCA list of NHS employees is not cross-referenced with criminal record information. Instead, an enhanced CRB check of individuals is carried out, which would include the sex offender register and local police information checks. But staff applying to work for the NHS can start work before the checks are completed.

Information is not usually sent to trusts until at least one month after the person has started work. And in some areas where local police systems ‘are not adequately resourced’, trusts can wait four to six months for reports, according to NHS Employers senior business manager Gordon Fleck.

Mr Fleck said there was ‘a possibility’ that a known sex offender could fall through gaps in the system. However, he said NHS Employers would like the fast-track system to continue until new legislation introduces a universal barring and vetting scheme for all NHS staff in about a year’s time.

‘In the light of recent events, we will have to look at whether staff should be allowed to start work before full CRB information is available,’ said Mr Fleck. ‘But our response has to be balanced with consideration of whether it’s feasible to expect employers and employees to wait months between appointment and starting work.

‘Look at what happened when the DfES said all staff must be cleared following the Soham inquiry – it led to such a backlog that schools remained closed at the start of term and kids were running around the streets – it was nonsense,’ he said.

The role of list 99 has hit the headlines in recent days after education secretary Ruth Kelly admitted that the DfES had allowed sex offenders whose names were on the list to work in schools.

Asked about checks on potential employees to detect sex offenders, health secretary Patricia Hewitt said the NHS will be ’strengthening them even more’ in line with new legislation set to be discussed in parliament next month.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4047103

NHS chiefs admit patient care is suffering because of cost-cutting

Dr Search- Principal Consultant at the Search Clinic — Tue, 24 Jan 2006 08:00:00 +0000

The financial crisis gripping the NHS is deepening and hitting patient services, with operations cancelled, appointments deferred and wards closed, according to two reports. NHS managers are struggling to reduce ballooning deficits that have swelled to £1.2bn. Managers have been freezing jobs, cancelling training and cutting up to 4,000 posts, the Royal College of Nursing says. A separate survey of NHS chief executives found three-quarters believe patient care is suffering as a result of cuts that are imposed to balance the books.

Almost two-thirds said they had been forced to close wards to bring their finances under control and nearly half said they had postponed building work.

The questionnaire survey by the Health Service Journal was sent to more than 500 chief executives, of whom 117 replied. More than one in three (37 per cent) said they were heading for a deficit by the end of the financial year.

The findings came after ministers announced yesterday that a further 18 hospitals had been approved to apply to become NHS foundation trusts, which enjoy greater financial freedoms.

However, the RCN said the financial crisis in the NHS was deepening and foundation trusts were hardest hit, with more than half overspent.

Government figures published before Christmas showed NHS trusts were heading for an overall deficit of £620m, half the figure calculated by the RCN.

Barbara Tassa, chair of the RCN public policy committee, said: “Patients are suffering and nursing posts are being lost because of the deficits crisis in the NHS and this is unacceptable. “The Government has repeatedly said that action taken by trusts to balance their books would not affect patient services. This is now clearly not the case.

“We are seeing a situation which is deteriorating. We have real concerns about the stability of NHS finances, especially in view of the roll-out of reforms such as patient choice and payment by results.”

NHS chief executives blamed the Government for the high level of debt, saying inflexible targets on cutting waiting times, costly pay awards for consultants and GPs and the growing use of the private sector had put the NHS in jeopardy.

The NHS Confederation, which represents trusts and health authorities, said deficits were falling as measures taken to cut costs, such as shutting wards, began to take effect. Gill Morgan, chief executive, said: “It is worse at the moment because of the Government’s highly ambitious programme [to cut waiting lists and modernise services].

“In many places, the NHS tried to run faster but you can only run faster for so long. There was pressure on pay and higher activity. Now people are taking action to bring the deficits down. What you are seeing in terms of shut wards are the symptoms of efforts to achieve financial balance.

“It will get better financially towards the end of the financial year but it will get worse for patients.”

A health department spokesman said: “We simply don’t recognise the picture being painted. Improving financial management does not mean compromising care. The needs of patients are always paramount. Across the country, patients know their local NHS has new buildings, equipment, more doctors and nurses and faster access to care.”

Andrew Lansley, the shadow Health Secretary, said: “Patricia Hewitt has been in denial over the consequences of NHS financial deficits, any problems she has blamed on local decision-making. It is time for her to take responsibility for the consequence of the Government’s polices.”

http://news.independent.co.uk/uk/health_medical/article339579.ece

Hospitals shut wards as cash crisis bites

Dr Search- Principal Consultant at the Search Clinic — Mon, 23 Jan 2006 10:05:00 +0000

The spiralling cash crisis in the NHS has already forced two thirds of hospitals to close wards and will soon start directly affecting patient care, health chiefs warn. A survey of 117 chief executives of NHS trusts reveals the depth of concern among healthcare professionals about the destabilising impact of wide-ranging govt reforms. Three quarters of them say that growing financial pressures brought on by primary and acute care restructuring will affect patient treatment.

Almost half of hospital trust managers said that building and refurbishment projects were being delayed, while many trusts were also having to make staff redundant and to introduce recruitment freezes.

The Times understands that the Prime Minister is to order a shake-up of ministers and top civil servants, such is the concern in Downing Street about perceived NHS disarray. It follows six years of unprecedented rises in NHS funding.

Mr Blair wants a new junior minister to fend off criticism of the Government’s faltering reform programme and to sell NHS modernisation both to the public and Labour MPs. The health service is braced for even starker financial shortfalls from 2008, when the current round of annual funding increases will stop.

The poll of trust executives, conducted by Health Service Journal, comes as nursing leaders also give a bleak warning of massive NHS deficits. Their research suggests that health service debts in England will hit £1.2 billion this year, putting up to 4,000 jobs at risk.

The new minister, who will be charged with promoting the reform agenda in the media, is expected to be imposed on the Department of Health in a reshuffle due within days. The jobs of Jane Kennedy, the Minister for quality and patient safety, and Rosie Winterton, the Minister for health services, are both at risk. The Times understands that a number of senior bureaucrats will also be moved in an attempt to speed up the pace of delivery.

It is hoped that the MP will be a more effective deputy to Patricia Hewitt, the Health Secretary, who has struggled to explain the benefits of reforms and had to revise plans to reform primary care trusts. The uncertainty surrounding unforeseen knock-on effects of the Government’s reforms emerged when ministers decided to review the £1.2 billion redevelopment of Barts and the Royal London hospitals.

The last-minute decision, taken after more than six years of project planning, prompted 1,000 doctors to write to The Times earlier this week. They gave warning of the serious impact on cancer and cardiac services for London if the project was downscaled.

Evidence of serious financial problems is supported by 75 per cent of hospital chief executives who said that patient care would be affected by cash shortfalls. The warning comes despite assurances from Ms Hewitt that any cuts should only affect administration.

The Royal College of Nursing (RCN), which has been tracking the level of deficits and the impact on staff and services during 2005, confirmed that patient services and treatments were now being disrupted. It found that cost-cutting measures — including freezing job vacancies and use of agency staff — were now having a “direct and detrimental” effect on patients, with operations cancelled, appointments postponed and beds closed.

According to documents obtained under the Freedom of Information Act, a total of 81 NHS trusts in financial difficulties have been investigated by KPMG, the acountant. This is far more than the Department of Health acknowledged when it announced the “turnaround teams” of accountants before Christmas. It said that 50 trusts with financial problems would be visited.

The disclosure, and the full list of trusts visited, was obtained by Accountancy Age. They include 20 out of the total of 28 strategic health authorities, 29 primary care trusts, and 33 hospital trusts.

A Department of Health spokeswoman last night defended the NHS reform programme.

She said that the RCN’s predictions were “back of-an-envelope calculations”, adding that the “turnaround teams” would help to address financial problems centred on a small number of trusts.

http://www.timesonline.co.uk/article/0,,2-1995718,00.html

NHS’s painful struggle for cash is exposed

Dr Search- Principal Consultant at the Search Clinic — Fri, 20 Jan 2006 09:18:00 +0000

A Treasury presentation leaked to the Financial Times reveals vividly how the National Health Service threatens the government’s other competing priorities with its huge demand for cash. The spending review that concludes next year will present Gordon Brown, whether he is prime minister or still chancellor by then, with some hard choices.

If the NHS merely gets the sort of growth in expenditure that the Treasury-commissioned Wanless report in 2002 said was likely to be needed – between 4.4 and 5.6 per cent a year in real terms – health and social care would take between 40 and 80 per cent of all the extra spending available, depending on just how fast total departmental spending grew.

If NHS spending were to carry on growing at the 7 per cent average annual real-terms rate that it has been rising by since 1999, it would take more than 60 per cent of all the available extra cash, even if the government raised overall departmental spending by as much as 3 per cent a year: a significantly faster rate of growth than Gordon Brown is likely to countenance.

If total departmental spending rises by an annual average of 2 per cent in real terms, 7 per cent growth for the NHS would take all the available money, leaving nothing at all for other government departments.

The illustrative figure for annual growth in departmental spending after 2008, used in the pre-Budget report, was 1.9 per cent.

For Patricia Hewitt, the health secretary, that means she faces a fierce battle against her cabinet colleagues to ensure that NHS spending gets somewhere near the 4 per cent-plus growth suggested by the Wanless report. For other ministers, it means they will have to argue hard to prevent health scooping the pot.

One factor that might move in favour of the other departments is that the Treasury is understood to be rerunning the Wanless model, presumably in the hope it can be used to justify somewhat slower growth in NHS spending.

However, one of Sir Derek’s main assumptions was that spending could be lower if the NHS became more efficient. Much of the evidence to date is that its higher levels of spending since 1999 have not been matched by higher productivity.

Part of the NHS’s problem is the steep increase in spending since 1999, amounting to roughly a doubling in real terms by 2008, by when it will account for close to a fifth of all government expenditure. As a result, even relatively moderate rises in spending take a large slice of the total cake.

The biggest problem for the NHS, however, is the government’s string of other priorities and pledges.

Education spending is pledged to be higher as a share of gross domestic product at the end of this parliament than the start.

Labour is committed over time to spending an extra 0.2 per cent of gross domestic product on international aid. It is pledged to halve child poverty by 2010, and the Institute for Fiscal Studies has calculated that requires an additional £1.4bn a year to keep on track.

Government spending will also need to rise faster than currently forecast if it maintains the pension credit’s link with earnings after 2008. That is even before the government addresses the recommendations of the Turner report on pensions, although the increases it recommends start to have a real impact only from 2011, after the next spending round.

John Hawksworth, head of macroeconomics at PwC, the professional services firm, argues that the government is also likely to have to spend more than currently planned to deliver its early years and childcare strategies.

He has warned that if the government sticks to these priorities and pledges, and gives the NHS anything like a 4 per cent increase, “that does imply a big squeeze on spending growth in other departments”.

Nigel Edwards, director of policy for the NHS Confederation, which represents health authorities and trusts, said the presentation clearly showed the Treasury was worried about the NHS’s productivity, given the large amounts of extra spending that have been injected in the past five years.

It also showed that the NHS needed to prepare for growth rates of only 3 to 4 per cent in real terms, and quite possibly slightly less, after 2008.

Mr Edwards said: “Even to get to 3 to 4 per cent the Treasury has to be prepared to give health and social care about 40 per cent of all the extra growth money. That is the most we [in the health service] have ever had since 2000, and it may want to give something less.”

That slowdown from the current 7 per cent growth rate will occur just as the full effects of Agenda for Change – a huge pay and grading deal for all NHS staff other than doctors – is working through in full.

Further cuts in junior doctors’ hours are also taking effect, and the NHS is having to meet the costs of installing the NHS’s £6.2bn information technology programme, which has costs for hospitals and primary care trusts over and above those of the central programme.

“That means it is going to be very tough,” Mr Edwards said.

http://news.ft.com/cms/s/0572120a-86ff-11da-8521-0000779e2340.html

Charities appalled at lack of NHS plans improving sexual health In England

Dr Search- Principal Consultant at the Search Clinic — Thu, 19 Jan 2006 08:47:00 +0000

A report launched by sexual health charities shows an alarming lack of local NHS planning to improve sexual health in England, despite considerable central Government funding being made available to do so. The report, a review of Primary Care Trust (PCT) Local Delivery Plans 2005-2008, finds that despite the introduction of specific targets to tackle poor sexual health in England, up to half of PCTs fail to mention plans to improve key areas such as faster access to sexual health services.

Perhaps more worryingly, there was only limited evidence of plans for service redesign and improvement necessary to achieve improvements in sexual health generally, and only 30% mentioned targeted planned investment in sexual health, despite the Government’s additional £250m local funding for 2006/7 and 2007/8.

The report, published by Brook, fpa, MedFASH, National AIDS Trust and Terrence Higgins Trust found:
– Only 52% mentioned abortion services, and of those that did, it was primarily in the context of improving access for teenagers. Government statistics show that women in their twenties are most likely to seek an abortion.
– More than 50% failed to mention HIV, the fastest growing serious health condition in the UK, and nearly 50% did not mention planned work on reducing gonorrhoea diagnoses – which is another Government health target. Gonorrhoea is the second most common bacterial STI in the UK.
– Over 40% failed to mention tackling sexually transmitted infections (STIs) in general, and the same number made no mention of contraception services. Sexual health in the UK is currently amongst the worst in Western Europe, and we have the highest teenage pregnancy rates.
– One third of PCTs made no mention of plans to achieve the 48 hour access target for GUM services. Yet around one in three people remain sexually active whilst waiting for an appointment, driving up new infection rates.
– Almost a quarter (23%) of PCTs did not mention increasing the uptake of Chlamydia screening among15-24 year olds despite a 223% increase in new diagnoses between 1995 and 2004. One in 10 sexually active young people is now estimated to be infected with Chlamydia.

The charities are urging the Department of Health and the NHS to accord sexual health improvement top tier priority status for PCTs, and to ensure adequate funding to support this. They also want to see a radical shift in thinking about the delivery of sexual health services, and better, more consistent planning.

Said Anne Weyman, Chief Executive of fpa “We are extremely dismayed that despite the public health White Paper, despite the targets, and despite the considerable extra investment that is coming to them in 2006, too few PCTs appear to be planning to take serious advantage of the chance to improve our appalling record on sexual health.

”Sexual health remains too far down the list of local health priorities and is overshadowed by the pressure on PCTs to achieve financial balance.”

During August and September 2005, an audit was undertaken of two PCT LDPs from each of the 28 Strategic Health Authority (SHA) areas, giving a possible sample of 56 LDPs.

79% of PCTs were able to provide LDP data for analysis, either published on their website or provided directly when requested. This gave a final sample of 44 LDPs, which represented PCTs from across England in both urban and rural areas, with varying levels of prevalence of HIV and poor sexual health. The remaining PCTs were unable to provide data on their 2005 – 2008 plans.

National Sexual Health Targets And Investment
In order to address the deterioration in sexual health and the growing pressure on associated services, the Department of Health has committed to a Public Service Agreement (PSA) target in England for 2005 – 2008. PSA targets are agreed with HM Treasury and articulate national ambitions and objectives for public services.

The target refers to the following aspects of sexual health which should be reflected within Local Delivery Plans:
PSA 11a: reduction in the under 18 conception rate by 50% by 2010;
PSA 11b: 100% of patients contacting Genito Urinary Medicine (GUM) clinics to be offered an appointment within 48 hours by 2008;
PSA 11c: Decrease in rates of new diagnoses of gonorrhoea by 2008;
PSA 11d: Increase in the percentage of people aged 15-24 accepting chlamydia screening by 2007.

PCTs are required to submit data related to the target as part of the LDP process.

The charities are recommending the Department of Health and the NHS:
– Establish sexual health improvement as a top tier priority for the NHS for which PCTs should be specifically accountable.
– Support PCTs to make a radical shift in thinking about the delivery of sexual health services and implement significant service redesign. This should include the sharing of best practice where PCTs and other agencies have implemented successful changes.
– Ensure adequate investment within sexual health services to achieve the improvements which are urgently needed.
– Support PCTs to increase capacity and skills in sexual health service commissioning, planning and service delivery.

Oliver Wright
Terrence Higgins Trust
http://www.tht.org.uk

http://www.medicalnewstoday.com/medicalnews.php?newsid=36169

NHS reforms ‘won’t bring more cash’- Lord Winston fertility expert

Dr Search- Principal Consultant at the Search Clinic — Wed, 18 Jan 2006 12:13:00 +0000

Fertility expert Lord Winston expressed doubt that Labour’s NHS reforms would deliver more cash for services and spoke in favour of taking control of healthcare away from politicians. He criticised all political parties for not having been “absolutely candid” about problems facing the NHS and said that it would be difficult to meet spiralling costs from taxation alone.

While he said he believed “passionately” that in vitro fertilisation, his specialism, should be available on the NHS, he was “completely in agreement with the idea that people might pay something towards that”.

The Labour peer and face of TV programmes such as Making Babies was asked for his thoughts on the Government’s controversial plans for the NHS, which focus on the role of primary care trusts.

He told ITN: “I really do not feel that any political party has actually been absolutely candid about the basic problem. Nobody has really costed where we’re going to be politically in ten or 15 or 20 years’ time.

“The escalating and spiralling cost has to be met somewhere. I’m not sure it’s going to be easy to meet it from taxation entirely. I think we need to be looking at different systems for funding as an augmentation.”

Citing problems including the rising cost of drugs, he added: “This Government has done a tremendous job in really trying to increase the budget of the NHS.

“But you can see the effect is, although the NHS has improved, there are still hospital trusts that are in serious deficit and that’s not just bad management. It’s much more than that, it’s a deeper problem.”

Most hospital trusts are struggling “very significantly”, Lord Winston added. And he said that he was “not convinced” that planned market-based reforms to the NHS would deliver the necessary cash to improve the situation.

Lord Winston went on to say that taking control of the NHS away from politicians could have the benefit of bringing stability to health policy.

http://www.thisislondon.co.uk/news/articles/PA_NEWA16965371137314986A0?source=PA%20Feed