In September, Sir Nigel Crisp, the NHS chief executive, told the service it must reduce the overspend to £200m this financial year.

The Department of Health yesterday refused to confirm thefigure, but Chris Ham, professor of health service management at Birmingham University, said the fact that the numbers “are going north rather than heading south so late in the financial year is really bad news”.

The rising deficit is undermining the position of Sir Nigel, who has presided over six years of record rises in NHS spending but during which underlying problems in finances and structure appear not to have been tackled.

Last week he issued a bulletin warning that the financial position was “serious”. Trust and health authority chief executives, many of whom will soon have to reapply for their jobs, were warned he was taking “a direct and personal interest” in their performance.

Organisations projecting a break-even were told they must now make a surplus to offset overspending elsewhere.

Prof Ham, a former head of strategy at the health department, said the warning implied “a sense of desperation at the top of the office”. “There is real pressure to show that things are being done, even though there is very little NHS organisations can do to turn things round with only five weeks of the financial year to go,” he said.

http://news.ft.com/cms/s/5652ff2e-a7ff-11da-85bc-0000779e2340.html

Experts said the increase showed that the public sector pensions bill was growing at an alarming rate.

It came after the Government moved its estimates in line with those used by the private sector and demonstrates the increasing scale of the pensions bill to be borne by taxpayers.

The rise does not, however, mean that more needs to be paid to today’s pensioners.

Experts questioned why the Government’s policy is not to set aside money now, but to pay the bill from future taxes. By failing to make provision now the final bill will spiral.

Government estimates suggest that it could reach £460 billion, but analysts said the new figures supported independent forecasts that public sector pensions could cost up to £800 billion – double the national debt – in the decades ahead.

The increases, published in the Government’s Spring Supplementary Estimates, are the first evidence of the effects of the change in calculations.

They will be embarrassing after last year’s decision to scrap plans to raise the public sector retirement age in the face of strike threats.

The Teachers’ Pension Scheme for England and Wales is £22.2 billion, compared to £6.9 billion, while the Armed Forces scheme is £14.5 billion rather than £3.8 billion.

The Civil Service superannuation scheme, meanwhile, is £16.7 billion, compared to £5.5 billion previously.

The increases were caused by a change in the so-called “discount rate” used to calculate how fast interest rates will erode the pensions bill.

The Government had previously used a generous formula including a discount rate of 3.5 per cent on its liabilities but has reduced that to 2.8 per cent – closer to rates used by the private sector.

This small percentage change has a dramatic impact because pension costs are spread over so many years.

Philip Hammond, the Tory pensions spokesman, said: “If we are going to have a national debate on pensions, then we have to have transparency and we have to cover private and public sectors on an equal basis. The public sector cannot be insulated from the necessary reforms.”

Experts said the increases made estimates of the value of public sector pensions more realistic than in the past.

The “gold-plated” retirement plans enjoyed by public sector employees have come under increased scrutiny in recent years as the pensions crisis surrounding private sector companies intensified.

Almost 90 per cent of public sector pensions are based on final salaries rather than stock market returns, and are inflation-proof.

In contrast, most businesses have closed their final salary schemes after falling investment returns and the fact that people live longer pushed many funds into the red.

The problem was exacerbated by Gordon Brown’s 1997 Budget move to strip pension funds of their tax-free status, which helped push savings ratio to record lows.

Although some require members’ contributions, most public sector schemes are unfunded, meaning they are paid from taxpayers’ money rather than from assets set aside to pay for them.

A Treasury spokesman said: “These figures do not represent the official measure of public sector pensions liabilities. Actual cash payments due each year from Government to pay for liabilities that have been built up over decades and are due to be paid out over decades, are not affected by actuarial and accounting changes to discount rates.

“The annual cash payment from unfunded schemes will rise gradually from about 1.5 per cent of GDP now to 2.1 per cent by the middle of the century, putting the UK in a much better position than many other developed economies to deal with the fiscal challenges of the future.”

“Clearly these figures may go up over time. But we make no apologies for employing tens of thousands more doctors, nurses and teachers.”

http://telegraph.co.uk/news/main.jhtml?xml=/news/2006/02/27/npens27.xml&sSheet;=/portal/2006/02/27/ixportaltop.html

The number of death certificates mentioning Staphylococcus aureus (S.aureus) infection increased each year from 1993 to 2004 in England and Wales. An increase in the number of death certificates specifying MRSA accounted for all of this increase in deaths.

Age-standardised rates for deaths involving S. aureus and MRSA were highest in males. The rates for both males and females increased over the period 1993 to 2004. The age-standardised rate for deaths involving MRSA in males increased from 16.3 per million population in 2003 to 20.2 in 2004. In females the rate for deaths involving MRSA increased from 8.5 to 9.0 per million population over the same period.

Most of the deaths involving S. aureus or MRSA were in the older age groups. Mortality rates in 2004 for deaths involving MRSA – in the 85 and over age group – were 546.3 and 258.0 deaths per million population for males and females respectively. In the under 45 age group there were 0.8 and 0.4 deaths per million population for males and females respectively.

http://www.statistics.gov.uk/cci/nugget.asp?id=1067

Patients Association chairman Michael Summers said: “We are disappointed by these new figures. It is clear that MRSA and hospital infections are winning the war in many of our wards.”
He added simple hygiene measures, such as washing hands, could have a huge impact and should be taken by everyone in hospitals.”

And Tony Field, chairman of MRSA Support patient group, said the problem was that the NHS was focussed on controlling the superbug rather than preventing it.

Shadow Health Secretary Andrew Lansley added: “The government is still failing to tackle the problem, despite pledges to the contrary. Every time a worse statistic is released, patient confidence in the government’s policy is undermined further.”

http://news.bbc.co.uk/1/hi/health/4742770.stm

Sitting somewhere in Health Secretary Patricia Hewitt’s in-tray are documents on the future of England’s oldest hospital. The £1.15bn plan to refurbish St Bartholomew’s Hospital and its near neighbour in east London, the Royal London, was supposed to have been signed off last year.

But the doctors and officials at the hospitals are not the only ones on tender hooks waiting for a decision.

If the health secretary puts the breaks on the PFI scheme, under which private companies build hospitals with NHS trusts repaying them over 25 to 40 years, it would raise serious doubts about the future of the other 47 in the pipeline.

Already a handful of other schemes are reaching critical points and are set to undergo reviews.

Ms Hewitt and her officials are looking at whether the Barts and the London scheme is affordable – an independent review has already established there is a need for the services.

Finances
Officials at the NHS trust believe they may be a victim of the wider problems gripping the NHS – one in four trusts failed to balance the books last year.

A spokeswoman said: “Our scheme has been costed and is affordable. We do not understand why there is a delay.”

However, concerns have been raised that under payment by results – a new system of funding being rolled out whereby hospitals are paid per patient treated rather than given a lump sum based on past activity – NHS trusts may struggle to meet the costs of PFI.

Coupled with that, is the historic shift in care from hospitals to community services, such as super GP surgeries and outreach clinics, set out by a white paper last month, which will mean there is less work for hospitals to do.

Chris Ham, a former Department of Health adviser and professor of health policy at Birmingham University, believes the projects nearing closure may be unsustainable in the current environment.

“Payment by results does not reflect capital outlay and we also have this movement away from hospitals. Things have to change.

“Either we will have less new hospitals, the same number but on a smaller scale or a new system of funding needs to be designed to cover PFI costs but that could be unfair on other hospitals.”

And despite no decision on the Barts and the London scheme, the signs are that some of the predictions are coming true. In December, the Queen Elizabeth Hospital in Woolwich declared itself technically bankrupt, citing PFI.

The Plymouth Hospitals Vanguard PFI Project, a £600m scheme to build a care centre for non-emergency patients and redevelop the Derriford Hospital, has already announced it will review the extension plans for the Derriford.

Infrastructure
And the building of a £500m hospital in Birmingham has stalled as NHS managers await the government go-ahead despite £6m having already being invested in new roads and other infrastructure.

But there are also a host of other schemes waiting to sign deals with private sector partners that are being caught up in the logjam.

Regional health bosses are due to carry out reviews in the coming months into the value for money, affordability and need for about a half a dozen projects.

The Department for Health insists there is no problem, pointing out there was between £7bn and £9bn being invested in forthcoming hospital PFIs.

A spokesman said “The government’s commitment to investment in health has not changed.

“It is extremely important that those schemes that are close to completion are not jeopardised by a panic reaction”, Nigel Edwards, of the NHS Confederation. “Schemes have not been left in limbo, we are currently applying the checks and balances announced in the operating manual to the business cases for projects approaching financial close.”

But the industry remains unconvinced. Jonathan Hills, manager of the PPP Forum, the private sector lobby group, said there seemed to have been a change in tact as the projects in the pipeline amounted to about £12bn – at least £3bn more than the government was now saying. “Something has to give,” he added.

One director of a PFI project, which is at a much earlier stage to the trusts facing reviews, told the BBC that the major problem was the goalposts had changed.

“Many of these scheme were conceived before we had heard of payment by results and the white paper. Whereas we have had to factor these in all along and have had scrutiny of our plans that reflect that, some of the schemes that are further advanced have not. This could cause a problem.”

http://news.bbc.co.uk/1/hi/health/4739734.stm

Walker has claimed that the targets, set in 2001, are meaningless, either because performance can’t be measured or any improvement has nothing to do with executive policy.

Most of the remaining six targets have already been missed, are unambitious, cannot be verified or are unlikely to be achieved, he added.

Walker’s intervention will cause embarrassment to Andy Kerr, the health minister, who was accused last week of short-termism in a report by Audit Scotland which criticised the vast amount of money being spent to cut waiting lists. It said money had gone into short-term bursts of activity to clear the backlog of patients without addressing their underlying health problems.

According to Walker, the money would have been better spent tackling obesity and alcoholism as well as providing nicotine patches and cholesterol-lowering medicines.

In 2001, the executive pledged to cut the proportion of adults exceeding safe weekly drinking limits from 33% to 31% among men and from 13% to 12% among women within four years. Following indications that the target for women wasn’t going to be achieved, the executive dropped it and issued a vague commitment to cut death rates among under-75s by encouraging people to drink and smoke less, improve their diet and take more exercise.

Currently, around 44% of men and 27% of women drink more than the recommended safe level.

“I would call for a specific target to be restored and for it to be an ambitious one,” said Walker, who added that the executive had watered down its commitment because it didn’t want to be seen as a “killjoy”.

Although the target of reducing the proportion of smokers from 35% to 33% between 1995 and 2005 was achieved, Walker said it was “profoundly unambitious”. He believes making nicotine patches and cessation counselling more widely available would have led to a much bigger fall.

While the executive was on course to meet targets to reduce deaths from coronary heart disease, cancer and stroke in the under-75s by 2010, he said the reductions were being achieved by people changing their lifestyles rather than improvements in care.

A target that no patient should wait more than two months for urgent cancer treatment by the end of last year was also missed. More than half of cancer patients requiring an urgent referral are having to wait longer than two months.

“Targets have to be quantifiable and have a time limit. There are too many targets where outcomes cannot be changed by policy or that are so badly worded that progress won’t show up even if the health service is doing a terrific job,” said Walker.

Stewart Maxwell, the SNP shadow deputy health minister, accused the executive of dishonesty. “The executive drops inconvenient targets that they aren’t going to meet — even though most are so utterly simple they could be achieved by any government. The ones they achieve make little or no difference,” he said.

The Scottish executive said the 2001 targets had been “superseded by more recent ones which better reflect the needs of patients and the wider public”.

http://www.timesonline.co.uk/article/0,,2090-2047804,00.html

Swansea-based South West Wales AM Peter Black said the programme had been designed to modernise the pay regime for all non-medical staff in the Welsh NHS.

He said, “Its objective was to produce a more transparent pay structure that better reflected the work and skills of the individuals involved. However the speed of job evaluation and re-grading has been slower than anticipated, certainly in Swansea. As a result staff in Swansea have told me that the trust has only assessed 2,500 staff instead of the planned 8,000. This could mean that many could wait over a year to get any back-pay they are due.

“Staff were told that the relevant job matching would be done by the end of March 2006 but this target has not been met.

“The uncertainty associated with job re-grading is bad enough but to have to wait so long for an outcome is simply unacceptable.

“The Welsh Assembly Government and Swansea NHS Trust appear to have transformed the ‘Agenda for Change’ into a recipe for inaction.

“I understand that there may well be funding issues that are causing these delays but the least that the Trust could do is to explain to the staff why there is a delay. It appears that it is not only the patients that have to wait in the Welsh NHS.”

Swansea NHS Trust said yesterday its performance in achieving back-pay was in line with others across Wales.

A spokeswoman for the trust said, “The trust continues to work in close partnership with the Staff Side in delivering the Assembly Government’s “Agenda for Change”.

“The implementation of the new pay and grading arrangements is a complicated, labour-intensive process. As at February 2006 a total of 87% of the non medical staff have been matched against national job profiles.

“And 33% of staff have been assimilated onto the new pay and grading arrangements.

“The Trust aims to complete the job matching process by the target date of March 2006 and have been commended by the Assembly Government for the quality of its processes and outcomes.

“Swansea NHS Trust’s position overall is comparable with other Trusts in Wales.

“As regards its payment of arrears the Trust is in discussions with the Staff Side to find ways of accelerating this although it is fair to say that other Trusts are having to wrestle with this same issue.

“Our aim is to transfer our staff to the new pay and grading arrangements as quickly as possible and we will continue to do all that we can to achieve this and keep our staff informed of progress.”

http://icwales.icnetwork.co.uk/0100news/0200wales/tm_objectid=16723295&method;=full&siteid;=50082&headline;=annoyed-health-staff-have-joined–a-new-waiting-list-in-wales—this-one-is-expected-to-last-for-over-a-name_page.html

But Mr Justice Bean gave Ms Rogers, from Swindon, permission to appeal and ruled that the health authority should continue to fund the drug, Herceptin, until the end of March. The drug costs £21,800 for a year of treatment.

Ms Rogers had earlier described her “constant fear” of living with the aggressive form of early breast cancer. She described the PCT’s decision “as though I have been given a punishment, like a death sentence”.

The ruling angered cancer charities. Her solicitor, Yogi Amin, from Irwin Mitchell, said: “Ann Marie is devastated, but determined to fight on.

All parties hope that we can have an appeal hearing before the end of March. We believe that it is not for trusts to make decisions based on social factors. In essence, this is about mangers going over the heads of clinicians.”

The case has wide implications for patients, health authorities and NHS funding.

Last summer, research showed that Herceptin could cut by half the chances of breast cancer returning in women whose cancer was described as HER2-positive.

The drug is already licensed for advanced breast cancer, but not for early-stage disease. An application to the licensing authorities will be made in the next few weeks.

After it receives a licence, the National Institute for Health and Clinical Excellence (Nice) will make its decision for NHS patients.

In the meantime, PCTs have set their own rules. Some have agreed to fund the treatment, but others have not. The row has reached the highest levels, with Patricia Hewitt, the Health Secretary, saying that Herceptin should not be denied on grounds of cost alone.

Yesterday, the judge said: “Ms Rogers has not shown that Swindon PCT’s refusal to fund her treatment with Herceptin is contrary to a direction or guidance from the Secretary of State for Health.

“Many primary care trusts have a policy of funding Herceptin treatment for early-stage breast cancer sufferers who are HER2-positive, but Swindon’s is not to provide such funding unless the individual case is exceptional.

“The court’s task is not to say which policy is better, but to decide whether Swindon’s policy is arbitrary or irrational and thus unlawful.”

He added: “Accordingly, despite my sympathy with Ms Rogers’s plight, I must dismiss the claim for judicial review.”

A spokesman for the Department of Health said: “Our position remains unchanged.

“PCTs need to take into consideration a whole range of factors before making a decision whether to fund Herceptin for a woman with early-stage breast cancer.

“Ahead of a decision on licensing, or Nice appraisal, such decisions will continue to be made at a local level on a case-by-case basis.”

Christine Fogg, the chief executive of Breast Cancer Care, said: “This shocking ruling is a huge disappointment and incredibly distressing for Ann Marie Rogers and many other breast-cancer patients. “They were hoping the continuing confusion and fear around access to Herceptin would be resolved by this case.”

Jeremy Hughes, the chief executive of Breakthrough Breast Cancer, said: “We are extremely disappointed. Clarity is now needed over who is entitled to have access to Herceptin, prior to licensing and Nice approval.

“This drug could save the lives of 1,000 women a year and it is unfair and cruel for women like Ann Marie Rogers to know that it is money and their postcode that stands between them and this potentially life-saving treatment.”

http://telegraph.co.uk/news/main.jhtml?xml=/news/2006/02/16/nherc16.xml

Sir Michael stressed his message was not “slow down”. Ministers rightly wanted to see results from reform but he warned that “all these tensions we are looking at have emerged before payment by results, more contestability and more patient choice have taken full effect, and before the full effects of Agenda for Change [a big pay regrading deal that affects most NHS staff].”

“We are demanding some pretty rapid and dramatic changes [of the NHS]. The commission’s view is we need to be careful with this. There is a need to keep an eye on the whole system and watch carefully the pace at which these changes are be-ing assimilated,” he said.

He added, however, that “there are opportunities, as you bring about these changes, to focus on the things that we [the Audit Commission] are most anxious about”.

That included creating a better system to spot and deal with financial and service failure early – “the notion that we are going to have a whole set of hospitals going into financial receivership doesn’t seem to me a very credible model, or one that anyone would want to sign up for,” Sir Michael said. It also meant a change that the department is already seeking to the NHS accounting system.

That, to date, has focused chiefly on a statutory duty to break even on a given day. “To anybody in a local authority or a trading organisation, that would seem a pretty bizarre way to measure your financial performance,” he said. It had led to financial problems being buried and to “fudge and mudge” over the financial standing of individual NHS organisations.

The department is trying to move NHS trusts to the financial regime used for foundation trusts. But that involved “a pretty profound change” that in the short term would be “painful” for the NHS, Sir Michael said.

It raised questions over whether NHS management had “the right financial skills” to cope with the new system, “the right skills on the boards of organisations to ask the right questions” and “whether you have information that you can rely on. On each of these fronts we have reasons for anxiety,” he said.

With primary care trusts being reduced in number, “that is an opportunity to make sure the next generation of PCTs gets these financial skills, which are in short supply”. It was no longer enough to say “the treasurer will sort it” because financial failure would lead to service failure.

http://news.ft.com/cms/s/1f692bfa-9dc8-11da-b1c6-0000779e2340.html

Sexually transmitted diseases have been steadily increasing over the decades, with a current figure of almost 700,000 new diagnoses a year in England alone. There are fears that high levels of sexual activity among young people may be leading to an epidemic.

Syphilis cases have risen by 1,421 per cent in England over the past decade, and diagnoses of chlamydia, the most common sex infection, have risen by 217 per cent since 1995.

With more than 750,000 people contracting STDs last year, the crisis is acute. Sexual health clinics have warned they are overwhelmed and will need to triple their capacity to meet government targets to treat patients within 48 hours.

The numbers of young people affected by sexual disease stabilised or fell during the 1980s and early 1990s but have risen again since Labour came to power. The highest rates of chlamydia are in teenage girls between 16 and 19, and among men and women aged between 20 and 24.

It is the startling rise in chlamydia that has alarmed Labour ministers the most. With few recognisable symptoms, and affecting both men and women, chlamydia can cause infertility and ectopic pregnancy if left untreated. Cases of the disease have risen by over 200 per cent in England over the past decade, with health professionals warning that sexually active young adults are contributing to its spread.

With many men not realising they can contract the infection, they are passing it on to women, some of whom have already been treated with antibiotics.

The Department of Health is so worried by the rapid increase in the number of cases it has launched a national screening programme to try to detect the illness, focusing particularly on men. They plan to send mobile testing units to football clubs, prisons and army barracks to test men for the infection.

And with sexual health clinics warning they cannot accommodate demand among sexually active young people for testing, ministers are turning to new technology and the high street to deliver diagnoses.

A pilot at Boots, which began in November, has allowed 16- to 24-year-olds to take home free chlamydia testing kits. It has proved such a success, with more than 6,000 kits handed out, that ministers want to extend the concept of over-the-counter testing nationwide.

The Department of Health is considering using other outlets, including supermarkets and petrol stations, to encourage the public to test for diseases.

The idea is to make testing for STDs a normal part of personal health checks – as normal as ensuring that you are eating five pieces of fruit a day, according to Caroline Flint, the public health minister.

Ms Flint, who has managed to extract hundreds of millions of pounds from the Treasury to fund the fight against STDs, believes that diagnosis outside clinics will cut queues and allow those who have tested positive to be treated more quickly, and will ultimately save the NHS money.

http://news.independent.co.uk/uk/health_medical/article344955.ece

Anti-smoking campaigners welcomed the measure as the “most important advance in public health for 50 years” since the link between cigarettes and lung cancer was established.

As MPs voted, the Government announced a huge increase to £2,500 in fines for businesses and authorities that fail to stop people smoking in prohibited areas. The original proposal was for a £200 fine.

Spot fines of £200 will be introduced for failing to display no-smoking signs. If the case goes to court, the penalty could rise to £1,000.

The increases follow a consultation which suggested that businesses might be prepared to pay lower fines to keep smokers’ custom after the ban takes effect.

Individual smokers caught lighting up in banned areas will face a fixed penalty notice of £50.

After months of argument in the Cabinet, MPs overturned on a free vote the Government’s original policy to exempt private clubs and those pubs that did not serve food in England. The disarray within the Government was highlighted when Patricia Hewitt, the Health Secretary, performed a bizarre U-turn in less than 12 hours.

On the Radio 4 Today programme in the morning she said there was a strong case for allowing private clubs to choose to allow smoking on the premises because they were like people’s homes.

In the Commons debate on the Health Bill during the afternoon she said the arguments were “finely balanced” on exempting clubs but refused to tell MPs how she intended to vote.

At the end of an impassioned debate she disowned her policy and joined Tony Blair, Gordon Brown, the Chancellor, and 10 other Cabinet ministers in voting for a complete ban. John Reid, the Defence Secretary, and five other Cabinet members voted against a total ban.

Officials said that Miss Hewitt had been “swayed” by the arguments in the debate. MPs cheered when the ban was approved by 384 votes to 184, a majority of 200.

Opening the debate, Miss Hewitt said that an extended ban could help 600,000 people to give up smoking. The Bill also proposed to raise the minimum age for buying cigarettes from 16 to 18.

In Scotland, a complete ban on smoking in enclosed public places comes into force on March 26 and one in Northern Ireland 12 months after that.

The legislation paves the way for the Welsh Assembly to proceed with plans for a similar total ban.

The Labour manifesto promised at the election last year that smoking would be banned in all workplaces, as well as restaurants and pubs serving food. It suggested that non-food pubs and private clubs would be exempted, although smoking would not be permitted in the bar area.

Faced with a back-bench revolt, high-profile ministerial disagreements and the certain prospect of defeat, the Cabinet agreed that MPs should be allowed a free vote, rather than be whipped to support the policy that the party had put to the electorate.

Miss Hewitt said she now believed that it was right to extend the ban to all licensed premises, including bars, discos and nightclubs, even though less than four months ago she introduced the Bill which had proposed only a partial ban for pubs and exemption for private clubs, including
gentlemen’s clubs, working men’s clubs and golf clubs.

She said the Bill would ban smoking in “virtually every enclosed public place and workplace” and would “save thousands of lives every year” as people would no longer be exposed to second-hand smoke.

Miss Hewitt said there were no plans to stop people smoking in their homes, although the ban would give the Government power to require certain vehicles to be smoke-free.

Andrew Lansley, the Conservative health spokesman, who backed the exemption for private clubs but not for non-food pubs, mocked Miss Hewitt for her “handbrake turn”.

He said: “We now have the utter humiliation of the Secretary of State voting against her own legislation. Never before has a Government minister brought forward a measure and voted against it in this way.”

David Cameron, the Tory leader, who is trying to give up cigarettes, missed the vote because of the birth of his son. He had been expected to vote against any form of ban.

http://telegraph.co.uk/news/main.jhtml?xml=/news/2006/02/15/nsmoke15.xml&sSheet;=/portal/2006/02/15/ixportaltop.html

Nick Bosanquet, professor of health policy, and Karol Sikora, professor of cancer medicine, both at Imperial College, London, state in The Economics of Cancer Care that unless the way we fund healthcare is changed, some patients will not be able to buy themselves survival.

Last week Sikora prescribed the cancer drug Tarceva, which is not routinely available on the NHS, privately to a young patient suffering from pancreatic cancer.

The “wonder” drug costs £75 a day and Sikora says the NHS must admit that it cannot afford to buy such expensive medicines for everyone.

Sikora said: “You need to take this drug forever, once a day. Imagine if all cancer patients had that additional cost on top of routine care.”

The survival rate after five years for most cancers, if detected early, is about 90% in western Europe and the USA.

The authors argue that most cancers could be brought under control, if enough money were spent on prevention such as screening programmes to catch the disease at an early stage, followed by swift prescription of the best drugs.

The book states: “We will convert cancer into a chronic, controllable illness similar to diabetes today.”

It adds: “Likely technological advances will bring greater treatment success but in many cases at a price beyond that affordable by state-driven medical services.”

At the moment, access to wonder drugs such as Herceptin and Tarceva is posing financial dilemmas and the government is considering scrapping the national bowel cancer screening programme, which was to be launched this year, because of a cash crisis in the NHS.

The authors say the funding shortfall will intensify: the number of cancer patients in Britain is set to increase by 2.5% every year as more people live with the disease. In the USA, the number of cancer survivors has risen from 3m in 1970 to 10m in 2000.

The cost of looking after these patients has also rocketed. This is not just because more patients are being treated but also because the cost of cancer medicines has increased more than treatments for other illnesses. The cost of cancer drugs in the USA has risen tenfold since 1991 while the cost of drugs for other diseases has risen only threefold.

Statistics from Cancer Research UK show the speed with which survival rates in Britain are improving. In 1986, 42% of men survived prostate cancer. This had increased to 65% by 1999. Survival rates for breast cancer stood at 77% of women in 1999, compared with about 62% in 1986.

http://www.timesonline.co.uk/article/0,,2087-2036557,00.html

The plans include reducing the 12 modern matron posts over the three hospitals. The senior nurses involved will either be found other high-grade jobs in front-line nursing or have to apply for posts that are still senior but do not have the same authority as a matron.

Since modern matrons were introduced about four years ago, 3,000 have been appointed at salaries of up to £35,000. Under new pay scales that can rise to more than £40,000. In most hospitals they are put in charge of groups of wards or specialities, such as medical or surgical wards or care of the elderly.

They were specifically charged with improving hygiene on wards. Modern matrons also act as patients’ advocates, supervise meal times to make sure that patients are encouraged to eat, and oversee discharge arrangements. They are seen as figures to whom patients and relatives can appeal.

The Peterborough and Stamford Hospitals trust has already identified 185 posts that could go and says 100 of these will be clinical posts, mostly nurses. The Royal College of Nursing has already had early discussions with the hospital over nurse and matron job losses.

“Some of the modern matrons will be redeployed at the same level. It is possible that some of them will find themselves applying for posts in a lower pay band,” said Mike Kavanagh, the RCN regional officer for Cambridgeshire.

“We are very concerned by this development. The nurses involved are very unhappy. These are nurses who really love what they do and who do not want to lose the jobs they love or the patients they love to work with.”

Howard Catton, head of policy at the RCN, said it was monitoring nurse redundancies across the country. “We are concerned that trusts are targeting these experienced nurses.

“Modern matrons are very important in keeping experienced nurses in the NHS. These are senior nurses who do not have to move into administrative roles to enhance their careers.”

Chris Wilkinson, director of nursing at the foundation trust, said: “We are consulting on a model that consists of seven matron posts, one part-time. The trust reduced the number of beds by about 100 during the last year, and this has been considered when reviewing the matron roles across the trust.

“Our matrons are pivotal in assisting the trust to maintain focus on quality of care that we provide for our patients.”

A spokesman for the Department of Health said it was a matter for the hospital trust.

http://telegraph.co.uk/news/main.jhtml?xml=/news/2006/02/06/nmatron06.xml

Hundreds of patients have been told by Darent Valley hospital in Dartford, Kent, they will now have to wait longer for their operations. Surgeons performing gynaecological, urological and orthopaedic procedures have been told by local health officials that they have ‘over-performed’.

The three-star hospital – the best trust in the county, according to government criteria – was the first major public finance initiative (PFI) scheme agreed when Labour came to power in 1997.

Its new financial situation is one of the most visible signs of the chaos in the NHS, as primary care trusts (PCTs) that hold the purse strings to hospitals attempt to balance their budgets by the end of the financial year in April.

It is also revealled that more than 900 NHS beds used for maternity, elderly and general hospital care are closed across England due to financial pressures. A further 500, mostly in smaller community hospitals, are planned for closure by primary care trusts over the next year, prompting protests by local campaigners.

In Devon and Cornwall, there is an almost total ban on routine surgery. At the Royal Cornwall hospital in Truro, surgeons have been told to increase their waiting lists. One told The Observer: ‘We can’t see any outpatients until they’ve waited at least 11 weeks, and we can’t operate until they’ve waited an additional 24 weeks. This is ludicrous.’

Mental health services are also under threat, despite receiving the smallest slice of the extra funding for the NHS in the past five years. In Oxfordshire and Cambridgeshire there are plans to close psychiatric beds, putting services under huge pressure.

As the NHS heads for a deficit of more than £1bn, dozens of local groups are protesting against plans to cut the size of community hospitals. The campaign Keep Our NHS Public has documented cases around Britain where cuts are being imposed even though last week the Health Secretary, Patricia Hewitt, said she wanted to move more services out of large hospitals into the community.

Across Suffolk and Lincolnshire, campaigners are trying to save smaller hospitals under the threat of closure. In Cumbria, county councillors are fighting the threat of bed losses at community hospitals serving six towns.

The Tory leader, David Cameron, will highlight the instability in the NHS this week when he visits Charing Cross hospital in west London. The renowned teaching hospital, which The Observer revealed last year was under threat of closure, has had to cut operations because it is facing a £35m deficit. Cameron will stress his commitment to the NHS.

Darent Valley faces a tough future. It will lose money next year under the government’s new payment by results, a system under which hospitals receive no block funding but are paid per patient on a set tariff. It has to start making its savings this year. Three wards are closed and about 200 patients will have their admission or appointment delayed.

Adam Holloway, Tory MP for Gravesham, Kent, said: ‘It’s terrible because this hospital has managed to get its waiting times right down. The doctors and nurses are only allowed to do a little bit of work.’ A hospital spokesman said only non-urgent cases were being delayed, and all would be seen within the government target times of six months for inpatients and 13 weeks for outpatients.

http://politics.guardian.co.uk/publicservices/story/0,,1702780,00.html

Staff, sometimes with a poor grasp of English, are poorly trained and records are badly kept. Private homes for the elderly perform nearly as badly as council ones.

More than 5,000 of 11,500 homes for people over 65 and more than 3,000 of nearly 8,000 homes for people aged 18 to 65 are failing to meet the minimum standards.

About 210,000 people in England live in the nursing and care homes that fail to meet the standards. Some have severe physical or learning disabilities or serious long-term illnesses and the medicine they receive can make a significant difference to their quality of life.

In one fairly typical case, a care home had a “pot pourri” of documents in its procedures file, resulting in “mixed messages” on when and how to administer medicines, the report says. In another “only two staff out of a team of 13 had training in first aid and one of those was off sick”.

A diabetic resident’s records stated that he should start insulin in May 2004 but by September it had still not been administered.

The report covers only England but a commission spokesman said: “I can’t imagine that it is not happening elsewhere.”

Two earlier, equally disturbing studies, suggested that elderly people were being given “a chemical cosh” of anti-psychotic drugs to make life easier for care home staff and that doctors were misdiagnosing elderly people with dementia by confusing the condition with the side-effects of many common medicines. Drugs used to treat allergies, depression, migraine and irritable bowel syndrome can produce dementia-like side-effects.

The report by the commission, an independent body that regulates almost all forms of residential and domiciliary care, is a follow-up to a 2004 report by its predecessor, the National Care Standards Commission. That identified “significant deficiencies” in the way homes managed medicines.

Improvements since 2004 have been “disappointingly slow”, the new report says.

Campaigners for the elderly reacted angrily to the findings, saying that maltreatment of elderly people had gone on too long.

Gary FitzGerald, of the charity Action on Elder Abuse, said that if children were being treated as badly something would have been done by now.

“The last report was bad enough,” he said. “This one is saying that there has been no change of any significance in two years and that is very, very worrying.”

The Government appeared to be trying to pre-empt the commission’s findings by announcing two initiatives to tackle abuse of the elderly.

Liam Byrne, the care services minister, will unveil plans today to register, train and vet 750,000 care workers looking after older people.

He will also announce a £600,000 research project with Comic Relief which will examine the prevalence of abuse of elderly people.

“Our retired citizens are a national asset and after a lifetime’s work deserve the best care,” he will say. “Any abuse of an older person is absolutely unacceptable.”

A Government spokesman said Mr Byrne had decided that those who worked with the elderly “must become more professional to ensure public confidence”.

The report is based on investigations into complaints by the public and spot checks and other inspections by the commission’s inspectorate.

Dame Denise Platt, the commission chairman, said: “It is vital that all care homes treat this issue with the utmost seriousness.”

http://telegraph.co.uk/news/main.jhtml?xml=/news/2006/02/07/ncare07.xml&sSheet;=/portal/2006/02/07/ixportaltop.html

The move follows research carried out by the Roy Castle Lung Cancer Foundation and Macmillan Cancer Relief, showing that more than 38,000 people die from lung cancer each year in the UK.

That amounts to more deaths than from leukaemia, breast and prostate cancer put together. Yet lung cancer receives just 4% of the national cancer research budget.

Cancer charities say the stigma linked to lung cancer as a “smokers’ disease” means patients do not get the best support and information they need.
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But according to figures, one in 10 lung cancer cases are diagnosed in people who have never smoked.

Terry Kavanagh, a recovering lung cancer patient and trustee of The Roy Castle Lung Cancer Foundation, said: “The goal of the Lung Cancer Patients’ Charter is to mobilise Government, policy makers and health professionals to acknowledge the profound impact of lung cancer and ensure the provision of effective resources and support for patients and our families.”

Peter Cardy, chief executive of Macmillan Cancer Relief, added: “Lung cancer has been the poor relation for far too long and it’s time to ensure patients get the care that they deserve.

“We must now focus attention on the UK’s biggest cancer killer and so improve the quality of life for lung cancer patients.”

Anyone wanting to support the Lung Cancer Patients Charter can sign up by visiting
www.roycastle.org.

http://www.sky.com/skynews/article/0,,30100-13503810,00.html?f=rss

Specialist “hit squads” are being sent into 20 trusts facing the biggest challenges in reducing rates of the infection, which is thought to kill thousands of patients each year.

Jane Kennedy, the Health Minister, described the lack of progress as disappointing after the introduction of a series of high-profile government initiatives to address the issue.

The data shows that there were 3,580 cases of MRSA bloodstream infections reported in England from April to September 2005. This was up from 3,525 for the same period the previous year, while the 2004-05 total of 7,269 represents only a slight drop in year-on-year comparisons.

In 2004 John Reid, the Health Secretary, set a target of reducing MRSA bloodstream infections by half — from an annual rate of 7,684 cases to 3,842 by 2008. But the Department of Health said yesterday that although about half of acute trusts were on target to meet this pledge, half were behind target.

Ms Kennedy said the NHS had to do better if it was to halve rates in two years’ time. “I am disappointed that despite many trusts making significant reductions in infections the overall figures do not reflect these improvements,” she said.

She said that the “hit squads” would start work in Sandwell, Northumbria and Aintree NHS trusts before moving on to another 17 organisations facing difficulties with MRSA reduction over 2006.

http://www.timesonline.co.uk/article/0,,2-2028115,00.html

The shocking admission comes as government figures also show English schools are now £120 million in debt.

It means Labour’s experiment to flood public services with taxpayers’ money has not achieved the results they promised.

Mr Bliar says: “While there has been real progress in the NHS, there is one area where improvement has not been fast enough. It is still the case that where you live has a huge impact on your well-being and the care you receive.

“These health inequalities remain much too stark — across social class and income groups, between different parts of the country and within communities.”

In 1999 health spending was £40billion. This year it will be £76bn and it is set to be a whopping £92bn by 2007.

The new education finance figures show that primary schools were £34m in the red last year, while secondary schools were £86m in debt. The worst ten secondaries all had debts in excess of £850,000.

In 1999 education spending was £45bn, but it has risen to £65bn this year.

Last night Shadow education secretary David Willetts said: “People have seen all these billions of their money going in, but they want to know where it has gone.

“In health and education Mr Bliar promised reform and improvements but patients and parents can see that it has not been delivered.”

The PM makes his admission in an introduction to the government’s new health white paper which was launched last week. He wants to stop deprived areas being health black spots.

Mr Bliar said: “The new emphasis on prevention will help close the health gap. So will encouraging GPs and other providers to expand services in the poorer communities.”

Health Secretary Patricia Hewitt is also expected to outline proposals today for a “health MoT” at five key stages in peoples’ lives.

Meanwhile, she has rejected calls to change abortion laws.

A MORI poll yesterday showed 47 per cent of women think the legal limit for abortion should be cut from 24 weeks. But Ms Hewitt said she “did not want to see the legal maximum changed”.

http://www.thesun.co.uk/article/0,,2-2006040741,00.html

And she said that access to GPs at times convenient to patients would also be improved, as well as more support for carers and “Life Checks” to keep an eye on the health of the nation.

But the idea of letting patients register with two GPs – one near home and one near where their work – has been ruled out after being branded “difficult and costly”.

In areas which are under-served by GPs and primary care services, private providers could be brought in to make sure people’s needs are met.

But many questioned how the NHS would be able to financially meet the plans set out in the community services White Paper, especially since the health service already faces mounting deficits running into hundreds of millions of pounds.

The British Medical Association (BMA) said extra resources would be needed to deliver commitments such as longer opening hours for GP surgeries.

The charity Age Concern said it was hard to see how the Government would realise its vision without committing extra money.

Ms Hewitt said the NHS would see substantial funding increases over the next couple of years which would help fund services.

And she denied that moving more treatment out of hospitals and into the community would make their deficit problems worse as money would follow the patient to primary rather than secondary care.

http://icthewharf.icnetwork.co.uk/thisweek/national/tm_objectid=16646163%26method=full%26siteid=50102%26headline=nhs%2dpledge%2d%2dneeds%2dmore%2dmoney%2d-name_page.html

Tony Blair defended the idea of allowing supermarkets to open walk-in clinics. “You can get things like routine checks. There is no reason why couldn’t have a walk-in centre [at a supermarket],” he said on Channel 4′s Richard and Judy Show.

Patricia Hewitt, the Health Secretary, denied that the package of measures aimed at making health care more accessible to patients amounted to a “reform too far”. She said: “The NHS has always used the private sector. The majority of GPs have been private, self-employed people contracting their services to the NHS. I don’t think there is any issue of principle here.”

Ms Hewitt is not expected to face the widespread revolt that Ruth Kelly, the Education Secretary, has encountered with her White Paper on schools. However, some Labour MPs see it as part of Mr Blair’s rush to modernise the public services before he steps down.

John McDonnell, the chairman of the left-wing Campaign Group of Labour MPs, said: “There is deep anxiety about the proposals in the health White Paper. It seems the Government is attempting to set up a shadow NHS in the private sector.”

Mr Dobson, who ran a group dedicated to fighting private sector involvement in NHS care, said: “It’s all very well saying we will get Tescos in but the supermarkets have slaughtered local shops, sometimes to the great inconvenience of the elderly and the disabled. There must be the same danger that supermarket GPs will mean more local surgeries will close in urban areas and in rural areas. When push comes to shove, the first duty of the private sector is to shareholders.”

There are likely to be wider concerns about the ability of the NHS to deliver extra services at a time when many trusts are in deficit and cutting services.

Andrew Lansley, the shadow Health Secretary, accused Ms Hewitt of acting like “Patricia in Wonderland” in which all the patients were happy, “doctors wait in supermarkets for patients to drop by and hospitals are empty of patients”.He said she was taking “an immense gamble”, which could leave hospitals facing more cuts.

http://news.independent.co.uk/uk/politics/article342141.ece

In most cases the cut is likely to be a reduction in the size of projects rather than their abandonment.

That raises question marks over 40 big PFI schemes whose affordability is also being challenged by the introduction of a system where hospitals are paid on a fixed tariff for the number of patients they treat, rather than receive block contracts. The future of the Bart’s element of the Royal London hospital’s £1.1bn redevelopment and a £700m scheme in Leicester are already under review.

A late draft of Monday’s white paper, seen by the Financial Times, says the movement of care out of hospitals means health trusts “will need to review their current plans for PFI-financed hospitals to ensure that any such plans are compatible with a future where resources and activity are moving into primary and community settings”.

A separate document adds that schemes must be “financially robust, affordable and sustainable or not”, and formal approval will be needed in future before preferred bidders are appointed.

It insists that “PFI will remain the major vehicle for delivering capital investment in acute services in the NHS … even after completion of this reappraisal” the programme is likely to be worth “an estimated £7bn-£9bn”.

http://news.ft.com/cms/s/1235967e-8f74-11da-b430-0000779e2340.html