Many trusts are still locked in negotiations with strategic health authorities about whether they can have longer to deal with deficits dating back many years.

Hillingdon primary care trust chief executive Ian Ayres said he had received only the ‘standard Department of Health instruction’ for 2006-07, which is for recurrent balance and to pay back historic debts; the total for his PCT is £58m.

When asked whether a demand to break even would affect patient care, Mr Ayres admitted: ‘Of course it will. I cannot see how we can take a sum like that out without it affecting services. It is about minimising the impact on patient care.

‘Our total budget is around £280m. If you have got to take £58m out of that in one year there isn’t enough slack in the system or that amount of inefficiency. But we would not do it without discussion with our partners, stakeholders and the appropriate consultation.’

Mr Ayres, who took over at Hillingdon two weeks ago, added: ‘Nobody likes working in an organisation with this sort of deficit – this is not what people want to deal with day to day.’

Shrewsbury and Telford Hospital trust chief executive Tom Taylor said the challenges for his organisation were about addressing a whole ‘gamut’ of issues – including workforce and service duplication – to balance a £31m deficit. ‘But there isn’t a quick fix,’ he added.

East Kent Hospitals trust chief executive David Astley urged politicians to back trusts over service reconfiguration. ‘People are up for making difficult decisions. It is an opportunity to deal with issues that have possibly been deferred for some years.’

Another chief executive predicted a turbulent year if trusts were required to settle historic as well as in-year debts, ‘making a very tough situation an impossible one’.

He added that demanding trusts to move so quickly would lead to them losing the ‘good will and understanding’ of staff: ‘It will include significant union disputes, a lack of preparedness to support changes in the way services are delivered, and may involve some national protests.’ He said it could not be done without compromising patient care.

Shadow health secretary Andrew Lansley said patients would ultimately be the victims of a ‘boom and bust’ policy.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4605887

The head of the country’s cancer screening programme, Dr Julietta Patnick, has revealed that the organisation had not yet received any money from the Department of Health for the project.

As it takes months to commission the screening centres and the staff, the programme will now be delayed until at least the autumn and will not now cover many thousands of people who were due to benefit from it this year.

In October 2004 ministers announced in a blaze of publicity that they would fund the programme which would increase patients’ chances of survival. It was then reannounced last August, with another firm commitment that the testing would go ahead in April.

But because of the funding crisis affecting the NHS, which faces a deficit that is already heading past £1bn, its future is now highly uncertain.

Although the Department of Health will this week announce the ‘start of the screening programme’ it will cover only Warwickshire, which has already been performing the tests on a pilot basis. The test kits have not yet been bought and the screening centres have not been given the go -ahead to train the staff.

The cancer check-up involves sending Faecal Occult Blood (FOB) kits to everyone aged between 60 and 69 over a three-year period who could then self-test at home. Early detection would mean that treatment can be given at an early stage, and boost chances of survival by around 15
per cent.

The original promise was that two million people a year would be tested. Twenty-five per cent of the at-risk population was due to be covered by the programme this year, and the rest by the end of 2009.

Screening expert Professor Wendy Atkin, from the Cancer Research UK’s Colorectal Cancer Unit in London, said: ‘It is such an important project.

We have the evidence that it works and that it could cut the mortality rate by 15 per cent – that is an enormous achievement for a disease which is second only to lung cancer in terms of its death rate. If the government has reneged on its promise it is unforgiveable.’

Former health secretary Frank Dobson yesterday accused the government of introducing market reforms which had gobbled up enormous amounts of expenditure in a ‘paperchase’.

http://observer.guardian.co.uk/uk_news/story/0,,1739863,00.html

Called Living well in later life, it assesses progress five years into a 10 year Government plan to improve services for people over the age of 50.

The three inspectorates joined forces to provide a comprehensive assessment of services for older people, the biggest users of health and social care, and services that contribute towards older people’s wellbeing and quality of life.

The report found that services have improved since the March 2001 publication of the Government’s 10 year National Service Framework for Older People. But this progress was not evident consistently across the country and improvement in some areas has been slow.

At this halfway stage, none of the communities inspected had reached all Government-set milestones to enable them to meet the standards in the national service framework.

The report found:
* Improvements in how most public services are addressing age discrimination. All communities inspected had taken steps to ensure that policies and eligibility criteria for access to services did not discriminate against older people.
* More people, who have had a stroke, than ever before have access to good quality hospital care. But more still needs to be done to improve rehabilitation outside hospital and access to specialist units.
* More people are supported to live at home. There is a reduction in the number of older people admitted to care homes, with health and social care services supporting more frail older people to live independently.

Despite this the report found a number of areas of concern:
* Evidence of a lack of priority being given to the needs of older people when planning and commissioning services. For example, local authorities were not considering the needs of older people in planning public transport, when a high proportion of older people do not drive. And podiatry and foot care services were given a very low priority from primary care trusts, resulting in older people losing mobility and becoming socially isolated.
* Evidence of a lack of dignity and respect in the way older people are treated when in hospital. Many older people experienced poorly managed discharge after being rushed through the system, repetitive moving from one ward to another to free up surgical beds, and having meals taken away before they can eat them due to a lack of support at meal times.
* A lack of consultation by service providers with older people to find out exactly what they want. Ninety five per cent of older people surveyed had not been asked their views on NHS or council services in the last year, and 80 per cent did not think that they influenced the planning of services.
* Mental health services for older people were particularly poor. Older people reported a noticeable difference in their experiences of accessing services as they reached and passed 65. Out-of-hours services for psychiatric advice and crisis management are much less developed than for working age adults and older people with dementia experience unacceptably long waits for specialist care.
* Some examples of excellent partnership working were found between different public service providers. However, a lack of shared direction and desired outcomes between partner organisations in most communities have resulted in services that are fragmented and confusing.

Anna Walker, Chief Executive of the Healthcare Commission, said:
“Older people are the biggest users of healthcare, occupying almost two thirds of our hospital beds. Yet they continue to be a low priority in both the planning and development of our health service. The challenge now is to provide much better care for older people closer to home. Health and social care organisations and local authorities need to work better together on behalf of older people.

We will be monitoring the health service’s progress against national targets, and in working with partners as part of our new annual health check, to make sure improvements in the care of older people continue.”

Steve Bundred, Chief Executive of the Audit Commission, said:
“This report provides a snapshot of the national state of services for older people. It confirms that councils and their partners are increasingly aware of their responsibility to support the wellbeing and independence of older people, who now comprise over a quarter of the population. But our findings show that progress has been patchy and services are not as well coordinated as they should be.

Additionally, older people do not feel they are given a voice in shaping the way services are delivered. The Audit Commission will continue to focus and report on this area in our assessment of councils.”

David Behan, Chief Inspector of the Commission for Social Care Inspection, said:
“The best services involve the people they are there to serve. They must be responsive to their needs and assist them to lead independent, fulfilling lives. The evidence from this study is that older people are not involved in the design of services and consequently services are not tailored to their needs and aspirations. It is vital to understand and respond to the specific needs of older people.”

The three inspectorates assessed 10 communities across England. They inspected each local authority and 40 NHS trusts across Brent, Buckinghamshire, Dorset, Greenwich, Leicester, Liverpool, Medway, Portsmouth, Wiltshire, and Redcar and Cleveland.

In order to tackle the issues highlighted in this report, the three commissions have made the following recommendations:
* Managers from all organisations must make sure that older people are treated with dignity and respect and that their basic human rights are upheld at all times;
* NHS trusts and local authorities must take action to ensure that the standards set out in the national service framework for older people are met;
* Partner organisations involved in providing health and local government services need to work together to develop a joint strategy for the promotion of good health and wellbeing for older people; and
* Partner organisations need to work together to ensure that there is a systematic and coordinated approach to engagement that recognises the diversity of the population served.

Unless these overarching issues are tackled as a priority, older people’s experience of public services is unlikely to improve significantly.

The three commissions, as regulatory bodies with responsibilities across healthcare, social care and local government, have committed to take action to ensure that there is continuous improvement of services for older people.

The Audit Commission will monitor progress through the older people’s theme within the corporate assessment, part of the Commission’s Comprehensive Performance Assessment (CPA) of local authorities.

The Commission for Social Care Inspection will monitor organisations’ progress through the annual assessment of councils and inspections of social services for older people.

The Healthcare Commission, as part of the new annual health check, will continue to monitor progress against national targets, including supporting older people to live independently at home and treating patients with dignity and respect.

http://www.audit-commission.gov.uk/reports/PRESS-RELEASE.asp?CategoryID=PRESS-CENTRE&ProdID;=2FEF260C-765A-4D43-BD16-9D2F163E7B3E&page;=index.asp&area;=hped

Doctors are among the 10 occupations most likely to take out personal medical insurance, according to Bupa. More than 90% of the consultants surveyed have posts within the NHS. All of those surveyed also worked in private hospitals.

Dr Sarah Burnett, a consultant radiologist in London who worked in the NHS for 15 years, said she took out private medical insurance while she was employed in the state service because she was unimpressed with the level of care she witnessed first hand.

“NHS treatment is not a pleasant experience in any way — from the standard of the food, to ward cleanliness and the chance of catching MRSA,” she said.

Last year Burnett was diagnosed with breast cancer, detected during a private medical screening. Within two hours of her annual check she underwent an ultrasound examination that showed multiple small tumours. An hour after that Burnett was seen by a surgeon who arranged a skin- sparing mastectomy. A few days later she was recovering from surgery.

“I was lucky enough to have exceptionally prompt treatment because I choose to pay for insurance. Under the NHS I would not have been screened until 50 for breast cancer and would not have been able to catch my cancer at such an early stage,” said Burnett.

“The type of surgery I had is only rarely available on the NHS, depending on the expertise of your local surgeon.”

The British Medical Association (BMA) argues that the consultants’ wish to take out private medical cover does not demonstrate a lack of commitment to the NHS. They want speedy treatment so they can get back to looking after their NHS patients as soon as possible.

Dr Jonathan Fielden, the deputy chairman of the BMA’s consultants’ committee, said: “Consultants may also like the anonymity of private care. One of the problems of being treated in the NHS is that consultants might find they are in a bed next to one of their patients.”

http://www.timesonline.co.uk/article/0,,2087-2104091,00.html

An Independent on Sunday investigation has established that trusts are planning to cut more than £20m from budgets ear-marked for psychiatric care, using the cash to bail out other parts of the NHS instead.

In some parts of the country, primary care trusts have drawn up secret measures to slash spending on mental health care by up to a third.

With new figures today showing that children as young as seven are now being affected in an epidemic that costs Britain £100bn each year, the disclosures were seized on as evidence that mental health services were at breaking point.

Marjorie Wallace, head of the mental health charity Sane, last night described the plight of the estimated 10 million people suffering from mental illness as a “scandal bordering on cruel”. “The real madness is that, while we are bringing in reforms, UK health trusts in debt are turning first to cutting mental health services. It’s cruel and insane.”

Last week, following this newspaper’s four-year campaign, the Government dropped its controversial Mental Health Bill. Ministers announced the abandonment of their draft reforms in response to widespread opposition by psychiatrists, politicians and patients who had labelled them “unworkable and draconian”. These measures included the extension of powers to lock up people suspected of mental illness who had not committed a crime and plans to force those living in the community into taking medication.

A short list of reforms will now be added to existing mental health laws instead, a move which has been cautiously welcomed by campaigners.

But the news that key services are being cut back is expected to push the issue of how Britain cares for the mentally ill back to the top of the political agenda. It comes as a raft of new reports confirm the growing problem of mental illness in the UK, made worse by drug abuse, family break-ups and alcoholism.

Reports by the Mental Health Foundation and the World Health Organisation reveal:
* 1 in 15 children self-harming;
* 19,000 suicide attempts by teenagers every year;
* 20 per cent of people suffering from genuine mental distress such as anxiety or depression and in need of urgent help;
* 25,000 people sectioned every year under the Mental Health Act.

A report to be published tomorrow by Childline will reveal that as many as 1 75,000 children are being deprived of their childhoods because they have been forced into caring for lonely and depressed parents who have been abandoned by services.

Charities say that mental health remains the Cinderella of the NHS and warn of a mental health timebomb if money is wasted on badly thought-out measures. They have reacted with fury to private comments by ministers that the cutbacks are “minor”.

“People are labelled ‘mad’ but what is the real madness?” said Sophie Corlett, policy director at Mind. “Cutting overstrained services struggling desperately to serve some of the most vulnerable people in society?”

http://news.independent.co.uk/uk/health_medical/article353687.ece

The most radical features of the 1946 model were the transfer of funding to general taxation; the freedom from fees or charges to patients; the proposed nationalisation of all hospitals and the proposal to locate all family practitioners and community health services in health centres.

For the next 50 years the citizens of the UK enjoyed entitlements to health care as a right, and the NHS has endured despite the last 30 years of continuous sniping and assaults. It is true that not all that was proposed in the legislation that established it materialised – for example the plans for salaried GPs and for integrating GP and community services were never properly implemented – but the mechanisms for integration and fairness in resource allocation were crucial in protecting the NHS’s founding principles.

But critical weaknesses in the original structure remained – above all lack of capital investment, the retention of private practice, the independent practitioner status of GPs and dentists, the separation of responsibility for health and social care between central and local government, and weak public accountability. In the end these weaknesses would provide fertile soil for market predators, assisted over the last two decades by both Conservative and Labour government policy.

Since 2000, with the launch of the NHS plan and the “concordat” with the private sector, government legislation has been intent upon tearing down the very structures and mechanisms that protected the NHS from market predators and on opening up clinical services to large for-profit corporations.

Following the management reforms and outsourcing of non-clinical services to the private sector by the Thatcher and Major governments, came the “internal market”, breaking up the NHS into hundreds of competing operating companies (culminating in the creation of the almost fully autonomous foundation trusts) and the transfer of political accountability from the secretary of state to a regulator, known0 as Monitor.

The PFI, loading individual NHS hospitals with the costs of private sector borrowing, was followed by the uncoupling of resource allocation from a basis in the needs of local communities and a switch to “payment by results”, involving the costing and payment for every individual patient treatment. The idea was that a market is more efficient and a market in clinical services needs price signals.

Then there began the privatisation of the easy bits of clinical services: elective surgery, diagnostics and pathology, and the giving of new powers to foundation trusts to enter into joint ventures with companies like the US-based UnitedHealth, the Swedish-based Capio, the South African-based Netcare and our own BUPA, for the provision of clinical services.

And so, across the country, the results are unfolding. Moving services out of the NHS into private hospitals and “treatment centres” destabilises the NHS hospitals’ budgets, creating financial difficulties.

Those with PFI schemes are stuck with unaffordable leases that are even more unaffordable now that the revenues they counted on having are being diverted to private providers. Indeed, still more revenue may go elsewhere as a result of “patient choice” – a kind of choice (“any hospital in the country”) that surveys consistently show patients do not really want.

So far from “price signals” becoming a mechanism for allocating resources, central government fiats are channelling funds to what are in effect private semi-monopolies, with ringfenced tax revenues and three to five year guaranteed patient numbers at well above-NHS rates. Many of the contracts are not being fulfilled, leaving the NHS paying twice for care.

Instead of “price signals” we have bureaucratic decisions leading directly to the closure of NHS services, and in many cases to the closure of whole hospitals on which local communities have been able to rely for three generations.

Across the country we are seeing the closure of services for the mentally ill, the chronically sick, those in need of palliative care services and rehabilitation; patients are now going without care and suffering on a scale that has not been seen since before the inception and creation of the NHS in 1948 – all for the sake of the alleged gains to be had from “market efficiency”. Across the country the public is protesting, but the voices go unheard and unanswered in Westminster.

As in 1946, a new white paper would set out the key principles: service on the basis of need and not ability to pay, for everyone wherever they live, that is, a comprehensive and universal service. It would pay close attention to funding and delivery.

As the banker and then adviser to the Treasury, Derek Wanless found, after exhaustive examination – and as other European countries are also finding now – central taxation is the most efficient and cheapest, as well as the fairest, way to pay for health care. The idea of “top-up” fees for “superior” levels of service are transparent attempts to reintroduce unequal health care and should be anathema to us all.

That pregnant women going into labour at the NHS Queen Charlotte’s and Chelsea hospital in London should pay a top-up fee of £4,000 for NHS care to guarantee the presence of a named midwife and a superior birthing package will simply accelerate the cycle of deprivation that babies born to poor mothers will experience.

As for the design of the delivery system, what is critical is the flow of resources through the system to ensure equity. Resource allocation must be on the basis of need and disbursed to geographic planning tiers with budgets for hospitals and community services, which require integrated service planning; the lines that Scotland and Wales are working towards would be good start.

Integrated budgets and service integration are key. Without it, providers can cherry-pick profitable patients, treatments and services, to the neglect of others. Equity also needs good data and monitoring systems, on the basis of geographic populations and integrated service planning.

Finally there needs to be strong public accountability, both at the population level and at the level of the individual patients. Valuable mechanisms that were in place have been eroded or even abolished (for example the community health councils). There is room for important creative action here.

Market mechanisms must be abolished. These include purchaser-provider split, payment by results and practice-based commissioning. US studies show that transaction costs of operating a market in health care provision are in the order of 20-30% of annual income. These costs are the costs of operating a market.

In England, the savings that would accrue would include the appallingly large portion of the NHS budget – estimated at not less than 15%, or some £12bn a year – that is currently spent simply on trying to operate the NHS as a market – on invoicing, accounting for and auditing the accounts of millions of individual patient treatments, on making and monitoring thousands of contracts, on management consultants and financial “rescue” teams from the private sector at £2,000+ per consultant per day, on marketing and advertising and on lawyers and communications, and so on and so on, as hundreds of competing NHS trusts each try to survive in the new marketplace.

If this does not happen, the NHS in England is destined to become no more than a logo attached to a group of corporate chains, while all the old health inequalities and fears return.

http://commentisfree.guardian.co.uk/allyson_pollock/2006/03/regaining_the_values_of_the_nh.html

Many of the trusts forecasting the biggest deficits have not yet announced their plans, but are expected to do so in the next few days. Officials at the Department of Health think local NHS trusts will try to enter redundancy cost estimates on balance sheets before the end of the financial year, so they can make a fresh start in 2006-07.

Andrew Lansley, the shadow health secretary, said the overall job losses could be 15,000 to 25,000. As many as one in three trusts might end this financial year in the red, with the deficit reaching £750m, he said.

He accused the chancellor of deliberately ignoring the troubled NHS in his budget speech on Tuesday. “Gordon Brown promised investment with reform. The NHS has seen the investment but not the reform. Gordon Brown blocked freedom for NHS foundation trusts. He is opposed to patients’ choice. Without patient choice and GP budget holding, the NHS will not respond efficiently.”

Job losses announced over the past two weeks included 1,000 at North Staffordshire, 300 at the Royal Cornwall, 300 at New Cross hospital, Wolverhampton, 300 at Telford and Shrewsbury, 200 in Plymouth, 400 at NHS Direct, 180 at Peterborough. On Wednesday the Royal Free hospital in north-west London said 480 posts would go and St Mary’s hospital, Sidcup, earmarked 190.

Strategic health authorities submitted plans to the Department of Health on Wednesday for eliminating deficits in 2006-07. They are believed to include closing hospitals and shedding more staff.

The Royal College of Nursing said a preliminary analysis suggested nurses on the basic grades are bearing the brunt of cuts, with work transferred to lower-paid healthcare assistants. Trusts were trying to recruit senior nurses to take on some tasks previously performed by doctors.

Frank Dobson, the former Labour health secretary, said: “The so-called NHS reforms are costing a fortune. The government is spending hundreds of millions of pounds on management consultants and franchising operations to the private sector. Money is being squandered on the new payment system. Paperwork used to cost 4% of the NHS budget, but now costs 15-16%.”

Patricia Hewitt, the health secretary, said: “Let’s not forget that most of our hospitals are not only improving patient care and hitting targets, but they’re doing it within their substantially increased budgets. Even where trusts are now making some reductions – starting with agency staff, managers and administrators – patients should be reassured by the determination of clinicians and management to maintain the best care for patients.”

http://society.guardian.co.uk/health/news/0,,1738595,00.html

There were loads of them: education, science, transport, research, poor children, lone parents, overseas aid, security: you name it, he mentioned it.

With one striking exception. The National Health Service – the so-called jewel in Labour’s crown that this year will take almost one-fifth of government expenditure – merited not a single mention in an hour-long speech.

The NHS is clearly in the doghouse with Gordon Brown. He has given the service its longest period of sustained growth in its near 60-year history and it has rewarded him by heading for a record overspend, managing to create a famine of delayed operations and disappearing jobs amid this enormous feast.

It recalls a vignette back in 2000 when the chancellor announced his first big tranche of extra spending for the service. A day later Tony Blair rose to announce Labour would produce its great national plan for the NHS. Beside the prime minister Mr Brown sat glowering. The body language seemed to say: “I’ve given you the money, it’s down to you if you mess it up.”

Well, at least temporarily, the NHS has done just that. Now the suspicion is that the chancellor has reversed the approach to the spending round that many people – certainly health ministers – hoped he would adopt.

Instead of deciding what the NHS needs after 2008 when the record spending increases end, and then adjusting other spending programmes to accommodate it, Mr Brown seems to be working the other way around: establishing his priorities and then leaving the health service to scrap with everyone else over what is left.

It will not be a lot. NHS expenditure is now so large that even if overall government spending rose by 3 per cent after 2008 – 50 per cent more than the purely illustrative figure Mr Brown has pencilled in – the service would need to take 40 per cent of all the available extra money to secure even a 4 per cent increase. That is the absolute minimum Sir Derek Wanless, in his government-commissioned report on future health spending, calculated was needed if the service were to keep up with demand. Were overall spending to rise by 2 per cent, a 4 per cent increase for the NHS would take 60 per cent of all the available extra money.

The NHS’s prospects now look appreciably slimmer than that. Because, as Mr Brown underlined yesterday while sprinkling extra cash on education, training, science and research, these – potentially wealth-creating – categories of public spending appear for now to be his top priorities. In addition, the government is committed by its manifesto to a significant increase in overseas aid: another subject dear to his heart.

The government has missed by a long way its target of reducing child poverty by 1m by 2005. It will have to spend even more if it is to hit the goal of halving child poverty by 2010. And Mr Brown’s belief in that aim was reflected in the more generous child benefits he announced yesterday and in the extra help to get more lone parents back to work. Added to that, he is set to have to find extra cash up to 2010 to keep the pension credit growing in line with earnings, regardless of any more strategic decision on what happens to pensions after 2010.

All of which means that for everyone else – and now, it seems, for the NHS – life will be much tougher after 2008 as Labour’s big spending party ends. That was signalled by the 5 per cent a year real-terms cut each year after 2008 in the budgets for the work and pensions department, revenue and customs, and for the Treasury itself: cuts far larger than those demanded by the Gershon review of Whitehall efficiency.

The Home Office has had to agree to a real-terms freeze. Other departments can expect similar pain, in their administrative budgets if not in their actual spending programmes.

What this implies is a radical reshaping of the way services are delivered, notably in the revenue department and in work and pensions. That will have to go well beyond worthy efforts to share back-office functions. In the case of work and pensions, it probably means heading for a single agency handling all benefits; and perhaps an eventual merging of some of its work with that of the revenue.

The one advantage for those departments is that, following yesterday’s announcement, they now know their budgets for an unprecedented five years – giving them the chance to change how they do business. Public sector employees were already reacting with alarm to that yesterday. For the private sector, however, it probably means only one thing: more outsourcing.

http://news.ft.com/cms/s/20e04174-ba12-11da-9d02-0000779e2340.html

The NHS has been losing dentists to the private sector since 1992 when it introduced changes to their payments. Tony Bliar pledged in 1999 that everybody would be able to see an NHS dentist within two years, but the exodus has continued.

It is expected to accelerate when the new employment contract for dentists takes effect and children will be removed en masse from dentists’ lists for the first time.

The new reforms are forcing dentists to leave the NHS and pushing patients into private practice. There always seems to be a crisis in NHS dentistry, but this time it might be the real thing. On April 1 a new system of health service dental funding will be introduced and, at best, things look chaotic. Many dentists are fuming, predicting a further exodus of dentists from NHS work, an end to preventive work, and higher charges for you and me.

The British Dental Association has called the situation a shambles. With just 14 days to go before the system comes into force, hundreds of NHS dentists who are meant to have signed up to the new agreements with the primary care trusts (PCTs) that will fund them from April 1 have failed to do so. Some have not even received draft contracts from PCTs which are struggling to get to grips with their new responsibilities, even though contracts were meant to be ready by the end of February.

Other dentists have simply decided that they cannot sign up to a system that they believe will give them less money for more work, and encourage patients to be under-treated. In Birmingham, 75 per cent of dentists are reported not to have returned their contracts. In Middleton, Manchester, every dental practice is refusing to sign the contract, and there are similar reports from elsewhere in the country.

Without revealing figures, the Labour Government says that the majority of NHS dentists have signed up. But then there are the dentists, such as John Ginty who have done so reluctantly, knowing that they have virtually no money to provide NHS treatment.

According to the Labour Government, the new arrangements will provide more flexibility in local dentistry, opening up more capacity for people to become registered with an NHS dentist and freeing time for preventive work. That is now seriously contested.

Why the change? The reforms started out with the best of intentions. Funding for NHS treatment is ridiculously complicated, with about 400 different types of treatment with different prices. The current system encourages over-treatment; drilling and filling as much as possible to bring in the money. The more elaborate the procedure, the more money a dentist receives.

About 30 million people in the country do not have an NHS dentist. And about 10,000 dentists are believed to have left the NHS in the past decade, complaining of a lack of government investment in dentistry, and a treadmill of routine drilling and filling with little emphasis on personalised preventive work. So the Labour Government had to do something.

What’s changing? NHS dentists will now be funded directly by their local health authority (primary care trust). The Government believes that this local control will mean that if a dentist opts out of NHS work, PCTs will be able to commission replacement services so capacity will not suffer. Effectively, there will be a local pot of money for NHS dentistry that can be used more flexibly.

Under the new arrangements, there will be a simpler pricing structure for NHS patients: just three bands of payments. This is meant to discourage over-treatment. The first band applies to all check-up and X-ray work; the second applies to simple treatment like extractions and fillings; the third to more complicated work such as crowns and dentures.

Now comes the complicated bit. Each of these treatments is worth a certain number of “units of dental activity”, UDAs, and it’s the number of UDAs a dentist performs in a year that determines how much money he or she gets.

What are UDAs? Dentists get one unit of dental activity for band-one treatments; three UDAs for band 2; and 12 UDAs for band three treatments. From April 1, if they tot up enough UDAs every year, they will be entitled to the same money they received for NHS treatment in the previous year.

http://www.timesonline.co.uk/article/0,,8122-2089458,00.html

Her pledge to press ahead came as it emerged that hundreds of jobs are likely to be cut from NHS Direct, the flagship telephone and web-based helpline as competition from others for services it hoped to provide threaten to plunge it into a deficit later this year.

At the same time, North Staffordshire NHS Trust said it was to cut 1,000 jobs from its 7,000-strong workforce to help balance its books.

Ms Hewitt accepted that “there will be more turbulence, more disquiet and more criticism” as the reform programme, which includes paying hospitals by the number of patients they treat and giving patients more choice, gathers pace.

She argued that staff could be shed without affecting care through the more efficient use of resources and that the government’s reforms “actually give the hospital more incentives to improve patient care and value for money”.

The NHS finances, heading for a £790m overspend on the latest available figures, had to be got right, she said. This will be her first year in full charge of the money “and I know I will be judged on this by the people”.

She pledged that the coming financial year would be the last when underspending organisations had their surpluses taken off them to bail out overspending ones.

She said the current year was “pivotal in the development of the NHS. The year we change it for good, the year we solve some of the long-term problems”.

The lesson of recent history was that “New Labour can never be bold enough when it comes to reform of the public services”. The reforms, she said, “are not the cause of the financial overspends in the NHS. Our reforms are designed firstly to illuminate the problems, hitherto hidden in dark corners and secondly to put the problems right”.

Patient choice was already delivering shorter waits for diagnosis and private sector provision had contributed to waiting times for cataract operations tumbling. “We have a clear choice for the NHS – leave it alone and watch it decay; or hold steady with the reforms and watch it prosper.”

She also disclosed that choose and book, the IT system that helps with choice, has achieved almost 250,000 bookings – the number it should have reached in December 2004 – and will be handling 1m of the 13m first outpatient appointments a year by August.

http://news.ft.com/cms/s/9daac9ea-b5e4-11da-9cbb-0000779e2340.html

“There is a fundamental flaw in terms of the business,” he said. “We are running a business in an increasingly decentralised competitive healthcare market, rather than a centrally managed healthcare market.”

A rigidly standard approach “is not practical in a competitive healthcare market where we may want to look at the business processes within our organisation, be it in accident and emergency or other areas, and to use our IT support systems to help us improve efficiency”.

Michael said the reality of the one-size-fits-all approach is that it doesn’t fit, or if it does, it constrains managers’ ability to run the business flexibly.

“The idea that the requirements for all hospitals are the same is, I think, simplistic. Flexibility is designed out of solutions and out of the implementation process. So standardisation of IT systems effectively dictates the standardisation of the business model,” he said.

Michael’s speech about the NPfIT commanded the rapt attention of his audience not simply because he is running one of the largest NHS trusts in the UK but because it is rare for any senior health service executive, especially one of Michael’s standing, to criticise openly the NPfIT.

After his speech, an IT manager in the audience said that Michael had articulated “what many of us have been thinking for a long time”.

The speech also imposed on Mike Pringle, a professor of general practice at the University of Nottingham and GP lead at Connecting for Health.

Pringle, a strong supporter of the NPfIT, said, “It is very interesting to hear Jonathan’s perspective, a lot of which I have great sympathy with.”

Michael’s speech on 1 March was entitled “Information needs of a large acute provider – can Connecting for Health deliver?” He said of this choice, “I suppose you can see a degree of cynicism in the title I gave this talk as to whether CfH can actually satisfy our needs. CfH was conceived as a fairly centralised approach to IT connectivity across the NHS at a time when the NHS was busy decentralising, so there is a fundamental issue we need to approach.

“The NHS is decentralising, not only across the four countries in the UK but within England. And, of course, foundation trusts are an example of that decentralisation and the change in status within that decentralisation.”

Michael’s criticisms were aimed not at CfH but at the NHS IT programme itself. It is expected to cost £6.2bn, mainly for centrally-signed contracts with a small number of suppliers. But the total sum could be up to £31bn once the costs of implementing national systems locally are taken into account. Yet despite this formidable investment by taxpayers, the programme shaped as it is will not readily suit Guy’s and St Thomas’.

“There are a number of things that we as an organisation are looking for that are not currently available or are not available in a timely fashion within CfH.”

Caring for some cancer patients, for example, requires joint decisions being made increasingly in multi-disciplinary teams. Video conferencing is key to that, said Michael, but the original plans for the NPfIT did not set aside money for video conferencing.

Similarly, treating cancer patients sometimes requires complex calculations of dosages. “Whether it is to do with chemotherapy or radiotherapy, there are real risk management issues if you get that wrong,” said Michael. “You can say exactly the same thing regarding a microdosage for babies. These are the sort of things that are ideally suited to IT support.” However, Michael said the national programme was not due to deliver decision support systems such as these soon.

As a user, Michael also needs flexible communications links between different medical sites. “This comes back to the strategic dilemma about CfH being conceived as a centralised approach, where the focus is on point-to-centre communication rather than point-to-point communication.”

In addition, he wants tailored systems to support patients and clinicians in specialisms such as renal service, but he said, “The original idea of having a standard system that would provide support for all these different sub-specialities has some way to go.”

Michael also regretted that the programme would not now meet the government’s target of treating all patients within 18 weeks of being referred to a consultant. The target for this is December 2008, but Michael said the functionality within CfH was not going to be available until some time after this date, “So it is not going to help us to meet that target.”

Despite its size and complexity, the NPfIT cannot deliver everything that trusts want. Still, Michael’s comments touch on a deep resentment in the medical and NHS IT community that the national programme was set in motion in 2002 without widespread consultation. In a mist of secrecy over the detail, the programme was then, critics argue, presented to the NHS as a fait accompli.

Michael referred to these early days of the national programme when he said that Derek Wanless, in advising the government on the future of NHS IT, had emphasised the importance of having common standards for information and communications technologies. But Wanless’s call for common standards across NHS IT somehow transmogrified into “ruthless standardisation”.

On this, Michael said, “Our view is that wider use of available application software from diverse suppliers would be beneficial and allow us to deal with some of the lack of timeliness in the processes.”

He also alluded to the dual irritation for trust executives of having to countenance delays in the delivery of core systems from local service providers while being restricted from buying IT from suppliers other than those appointed by CfH.

“I see the absolute critical nature of effective IT systems and informatics in its wider sense in allowing us to deliver high-quality, efficient patient care. So the need is as great as ever. Solutions, however, are needed sooner rather than later, preferably today, if not yesterday.

“There are a number of software communications technology solutions already available to meet most of the needs. Our view is that it would be helpful to have a slightly more flexible approach by CfH, utilising these solutions to deliver? more flexible solutions at a faster pace than is currently envisaged.”

A potential sticking point is that if CfH allows trusts to buy what they want – even if to a common standard – this could jeopardise the contracts the health secretary has signed with local and national service providers. These deals commit the NHS to buy a minimum volume of services and systems from the local service providers, though details of the contracts are being kept secret.

Even so, Michael said it was possible for some trusts to buy systems that are not offered by their local service provider. “I believe that some of the providers of CfH are recognising the need for a greater degree of flexibility. Maybe within the contractual framework there exists the opportunity for greater flexibility,” he said.

Picking up on the point, Pringle, CfH’s GP lead, confirmed later at the same event that there was flexibility in the contracts.

“It would have been foolish for CfH to have negotiated without a plan B, and you will know there have been changes in software providers, and that has happened without disaster.”

Another speaker at the symposium, Robin Guenier, former head of the Central Computer and Telecommunications Agency, from which the Office of Government Commerce sprung, suggested that the NPfIT would benefit from appointing one full-time senior responsible owner to take charge of the entire programme.

But Michael said Guenier’s proposal highlighted another fundamental flaw in the NPfIT: it is too big and complex for one person to oversee.

Indeed, Guenier’s proposal gave Michael a chance to identify what, for many, is the reason that numerous GPs and other clinicians are struggling to give their support to the NPfIT is being implemented.

“That [idea of a single senior responsible owner] fundamentally demonstrates a strategic flaw of CfH. The NHS is not a single organisation. No person sat in the centre can dictate what goes on in a whole series of autonomous organisations within a framework of the NHS.”

He added, “What people have been trying to do is to dictate to a whole series of organisations what they should do, when actually it is not what they want to do.”

What is the problem with the National Programme for IT?

In his speech to the City University, Jonathan Michael, chief executive of Guy’s and St Thomas’ NHS Foundation Trust, questioned none of the main objectives of the NHS’s IT plan, which includes establishing an electronic patient record. His criticism was of the way the national programme is being implemented.

He questioned, for example, the wisdom of appointing a small number of suppliers, known as local service providers, to deliver a ruthless standardisation of systems.

Under the national programme for IT, contracts were signed in late 2003 and early 2004 with four local service providers: BT, Accenture, CSC and Fujitsu. The idea was that these suppliers would provide what NHS trusts needed in new technology, including electronic patient records, electronic prescriptions and systems to book hospital appointments, known today as Choose and Book.

But some trusts are discouraged from buying core IT systems from any company other than the local service provider.

Michael said, “From [the trust's] point of view, the constraints of standardisation are that effectively all other IT investments hitherto become legacy needing to be replaced. You end up having to develop software through a small group of providers, even effectively new software, even though there may be off-the-shelf systems available, but available from somebody else, So where the marketplace already has solutions they are not available to us under Connecting for Health.”

About Sir Jonathan Michael

As a user, Jonathan Michael, chief executive of the Guy’s and St Thomas’, speaks with great authority. He was knighted last year for his services to the health service.

Guy’s and St Thomas’ Hospital in London is one of the UK’s largest NHS trusts. It has 1,200 beds, an annual turnover of ?650m and 9,000 staff. The trust provides specialist medical services to south east London as well as nationally and internationally.

Michael was also a consultant in kidney disease at Queen Elizabeth Hospital in Birmingham, where he established the largest kidney unit in the country.

http://www.computerweekly.com/Articles/2006/03/14/214731/NHSplanisevolvingbutone-size-fits-allisafundamentalflaw%2csayshospitalchief.htm

Serious untoward incidents are investigated by the agency when they have, or may have, caused death, serious injury, contributed to a pattern of reduced standard of care, or caused serious disruption to services.

Nuffield papers said the trust had identified “major issues of patient safety” such as patients being “lost in the system”. This could involve patients being “lost” from waiting lists or not being called in for treatment.

The installation of a Care Records Service at Nuffield has also caused what the trust calls “major operational difficulties” including a backlog of appointments and an inability to produce both internal performance reports and those required by Whitehall. These include some details on the size of the waiting lists and cancellations. The trust insisted that patient safety had not been affected.

Hospital executives said they had little choice but to go live with the risky implementation of the system – although there had been inadequate time for testing. The Care Records Service replaces a patient administration system that was built in-house, and was expected to fail completely in February 2006 due primarily to its age and an overload of data.

The trust had been due to replace the old system in 2004 but its procurement was halted by the advent of the NPfIT. Under the national scheme, patient administration systems are bought centrally under contracts with four local service providers.

Further delays occurred when Fujitsu, Nuffield’s local service provider, switched supplier from IDX to Cerner.

Nuffield finally went live on 20 December 2005, after what it said was a “major effort by the trust and Fujitsu”, even though in the week before the switch significant amounts of testing as well as the validation and migration of data were incomplete.

The new system is used in part to call patients into hospital, and track inpatient and outpatient treatment. A report to Nuffield’s board on 6 March 2006 said there was a “significant backlog of outpatient appointments” as a result of data migration and other issues. This backlog and other problems arising from the go-live were described as “critical issues” for the hospital.

In the paper to Nuffield’s board, Jan Fowler, executive director of nursing and operations and the trust’s executive lead for Connecting for Health, the agency which runs the NPfIT, said, “It is likely that it will take the trust some months to address all of the issues which have arisen as a consequence of the Care Records Service system implementation.”

Fujitsu won an £896m contract in January 2004 as part of the £6.2bn worth of deals awarded under the NPfIT. Given the problems at Nuffield, the hospital’s audit committee said it wanted to know who in the NHS was taking redress against Fujitsu.

After the go-live at Nuffield, staff reported that, “Major configuration and software problems led to significant operational disruption, and potential risk to patient safety, business continuity, staff morale, and public and patient confidence.”

The hospital’s audit committee said Nuffield had a duty to inform other trusts about its problems.

Fowler said that two days after going live, the system “went down completely” due to a power outage at the datacentre and the failure of the failover processes. This affected all radiology information systems in the South of England, but at Nuffield resulted in a “full working day without access to the system”.

Since then there have been a “range of significant problems” with the Care Records System and these have “caused major operational difficulties”.

Fowler said the problems were caused by “inadequate configuration of the system for use at Nuffield, and a lack of testing of that configuration, and resilience testing of the system overall, due to the time constraints within the implementation programme”.

Supporters of the NPfIT have long feared that a disruptive implementation at a hospital trust of a core component of the programme could diminish enthusiasm for the programme nationally.

A spokesman for Connecting for Health said, “The Nuffield Orthopaedic Centre (NOC) had an urgent need to replace an obsolete and overloaded IT system. In response to the need, NHS Connecting for Health, working with NOC, installed a new hospital-wide system within some 12 weeks of signing the contract with suppliers. The deployment has led to some issues which, regrettably, caused inconvenience to patients and staff – though there has been no adverse impact on patient safety.

“The trust, NHS Connecting for Health and Fujitsu, the local service provider, are fully engaged in addressing the issues. Intensive work by all parties has already resolved the vast majority of issues raised and we fully expect the remaining small number of concerns to be resolved in the near future.

“At the same time there have been successful deployments at NOC of Picture Archiving and Communications Systems and Radiology Information Systems. In the coming year there will be more than 20 such installations in the NHS Connecting for Health Southern Cluster and we will ensure that lessons are learned from each deployment.

http://www.cw360asp.com/Articles/2006/03/14/214758/NHScarerecordsroll-outraisespatientsafetyfears.htm

This overall “net better” result of -22 is the lowest score that the polling organisation has registered for public perceptions of the NHS since March 2002, when the MORI delivery index was first started.

This result means the public’s view of the NHS’s future performance has plunged dramatically since the last general election, consistently dropping quarter on quarter from a “net better” rating of +9 in May 2005 to its current -22 level.

Growing public disillusion with the NHS – which coincided with last week’s row over the departure of Sir Nigel Crisp, NHS chief executive – is also felt by Labour supporters.

When asked whether they expected the NHS to get better or worse, Labour supporters gave a “net better” score of +2, a figure hugely down from the +53 at the time of the general election.

On the state of the education sector, public perceptions are nowhere near as bad as on the NHS. However, there has been a significant increase in pessimism over the past three months.

Asked whether they thought the education system would get better or worse over the next few years, 30 per cent of respondents said “better” and 28 per cent said “worse” – a net better score of +2. However, this was well down from the net better score of +12 that was registered by Deloitte/MORI in May 2005.

The decline in this score, which comes as Tony Bliar struggles to avoid a big Labour rebellion on his school reforms, means public perceptions are close to being at the lowest level recorded since the MORI survey was first undertaken in March 2002.

On prospects for the economy, there are signs that voters are getting sceptical after a brief post-election honeymoon for Gordon Brown, the chancellor.

Some 38 per cent said they agreed with the statement that, in the long term, the government’s policies would improve the state of the economy, while 48 per cent disagreed. This net better figure of -10 is well down from the comparable figure of +9 at the time of the May 2005 election.

Ipsos/MORI interviewed 977 adults by telephone between March 10 and 12.

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We are seeing every excuse Gordon Brown needs to pull the plug from NHS reform and liberalisation – and be thanked for it. The sheer ineptitude of the Bliar spin machine is sowing the seeds for the destruction of all it has sought to accomplish.

The NHS reform attempted in Britain bears close comparison to Russia’s transition from communism. Blair is seeking to introduce market disciplines to state enterprises without using the work “market”: exactly the agenda Gorbachev started in 1988.

When cost controls are introduced for the first time, the results are always painful. Both NHS and Soviet managers were used to having customers designated by a plan. The notion of choice and consumerisation is alien and a market culture is absent.

And today, the NHS old guard is as disgruntled as a Soviet general in 1990. They had a comfortable life in the old system: it wasn’t very efficient, but there was no talk of losses, profits or markets. There was nothing as crass as competition.

Today, a family doctor, or GP, is paid more than £100,000 (e145,000, $173,000) – higher than any other strata of the British economy save for directors of large corporations who are just higher, at £107,000.

When we hear about extra health “investment”, this is its typical destination. But their old world is being threatened by Blair’s NHS perestroika, which will bring in foreign doctors to run independent clinics which treat NHS patients for less money than the unwieldy NHS charges.

The old guard is in revolt. Trades unions feign concern for the Filipino economy, saying the UK is exploiting the country by granting visas to its nurses. Doctors’ unions seek to smear their new rivals, accusing them of shoddy operations. The Department of Health is too inept to hit back.

This week’s British Medical Journal, for example, carries a report claiming that NHS hospitals have to correct bungled hip and knee operations by independent clinics. It claims, with no evidence, that failure rates are 1% in the NHS and 20% in private clinics.

So anyone who dislikes the new system has an interest in hyping up the health deficits – seizing on it to argue that Blair’s reforms are driving the system to bank-ruptcy. It is an incredibly powerful case for those who want to end liberalisation.

In this information war, one would expect the Secretary of State for Health, Patricia Hewitt, to defend the reform agenda: producing the true data on hip replacements, brutally laying out the inefficiencies and letting no lie go unchallenged. If this means being rude to the old guard, so be it.

John Reid, easily the most eloquent member of the Cabinet outside Bliar, excelled in this task. The rich have choice, he told Labour MPs: why shouldn’t everyone enjoy it? Hewitt, by contrast, is content to let someone else’s head roll.

So why do the deficits exist? The surge in NHS budget started before price controls were running, thus triggering rampant inflation of 4.5%, eating up the lion’s share of new money. Research from Reform, the think tank, shows how.

Of the extra £3.6bn invested in family hospitals in England & Wales in 2005-06, £1.8bn will go straight into pay rises agreed by Whitehall, £400m on new drugs, £320m on PFI deals, £300m on computers, £150m on pensions indexation. The change? Zero.

Health authorities have no fiscal margin for error, which is why two thirds now predict deficits. Their budget has been spent for them by Hewitt’s officials. So, when this is considered, health authorities are bearing up remarkably well.

But instead of explaining the situation, the government – from Downing Street downwards – is sitting back and allowing enemies of health reform to portray it as a financial disaster. The silence is stunning: and ominous.

Under Hewitt, the fight seems to have left the Department of Health – and it seems to be swinging back to its institutional conservatism. It does not defend the health reform agenda too rigorously because so many of its officials don’t really believe in it.

In accepting the premature resignation of Sir Nigel Crisp, chief executive of the NHS, Hewitt accepted the premise that something was going badly wrong. She strikes a pitiful contrast with John Reid, her predecessor, a passionate and forceful advocate of reform.

But ministers and the Whitehall machine expect Brown to either decelerate, redefine or halt the reform agenda when he succeeds Bliar. Whether true or not, this is in itself a huge brake on the process. Why push forward a system that’s about to be dropped?

Brown opposed health reform because he doesn’t trust hospitals to deal with their own finances. The health deficits give him all the ammunition he needs to declare Blair’s NHS perestroika to be a failed experiment, and one which must be drawn to a close.

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The Health Minister Jane Kennedy said she was disappointed at the rate of progress to cut cases of the infection, which is thought to kill thousands of patients each year.

The latest figures showed that in the six month period April to September 2005, there were 3,580 cases of MRSA bloodstream infections reported in England.

This was up from 3,525 for the same period the previous year.

In 2004 former health secretary John Reid set a target of reducing MRSA bloodstream infections by half – from an annual rate of 7,684 cases to 3,842 by 2008.

But today the Department of Health said while around half of acute trusts were on target to meet this pledge, half were behind target.

Ms Kennedy said special teams would be sent into 20 trusts facing the greatest challenges in reducing their rates of MRSA.

The NHS must do better, she said.

“I am disappointed that despite many trusts making significant reductions in infections the overall figures do not reflect these improvements.

“These are early figures from the period at the very start of the comprehensive programme of action we have put in place,” Ms Kennedy said.

“While 7,269 infections is a tiny fraction of the 12 million patients admitted to hospital every year, and more cases are reported now due to better surveillance, any avoidable infection is one too many.”

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Audit Scotland found the new deal was originally expected to add £64m over three years to consultants’ pay. Instead, it added £235m producing a 38 per cent rise. If other costs and inflation are added in, the increase is 44 per cent, making NHS consultants the second highest paid hospital specialists in the world, according to the Treasury’s analysis.

The contract had the potential to improve patient care, but convincing evidence of that had yet to be seen, Audit Scotland said. The National Audit Office is undertaking a similar study for England which, because it will cover a later time period, may produce more evidence of benefit for the extra cash.Nicholas Timmins

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Trafford NHS Trust, in Greater Manchester, said it was closing the two in-patient wards at Altrincham General Hospital because it no longer had enough doctors to provide 24-hour care.

In London, a £1 billion project to rebuild two ageing hospitals was finally given the go-ahead, but three floors will be left empty in a short-term move to save money.

The announcement of closures and job cuts forced Tony Bliar on to the defensive over the finances of the NHS and David Cameron, the Conservative leader, accused ministers of trying to avoid the blame for the cash crisis by “sacking” Sir Nigel Crisp, the NHS chief executive, who quit on Tuesday.

The latest cuts were deeply embarrassing for the Government and highlighted the pressure on hospital managers to balance the books. They will fuel speculation that the deficits are far worse than ministers have admitted – and could reach £800 million in England by the end of the financial year.

In 2002, Labour raised taxes and introduced a one per cent surcharge on National Insurance contributions to allow spending on the NHS to rise from £65 billion to £105 billion by 2008.

Although Mr Blair insisted the deficit was less than one per cent of the annual NHS bill, recent surveys suggest hospitals are experiencing financial difficulties despite the record spending increase.

Operations have been postponed and hospitals are freezing staff vacancies. A survey published by the Royal College of Nursing last week showed that more than two thirds of NHS nurses said their trust was struggling with deficits, which were hitting patient services and leading to the loss of nursing posts.

The RCN fears that up to 3,000 staff, including at least 1,000 nurses, could lose their jobs because of the mounting deficits across the NHS. The losses are expected to be worst in the south east of England, London and East Anglia and could affect all grades.

A British Medical Association spokesman said trusts across the country were forced to make cuts to patient services in order to meet debts.

Karen Jennings, the head of health at the public sector union Unison, said she believed the true level of NHS debt was worse than had so far emerged.

Job cuts, cancelled operations and ward closures were “creating fear and demoralisation among staff and patients” while hospitals would struggle for years to pay off their debts.

The realisation that deficits could reach £800 million resulted in Downing Street insisting on the premature departure of Sir Nigel.

He admitted in his resignation statement that not everything had gone well and the NHS was grappling with financial problems.

Mr Cameron challenged Mr Blair to take responsibility for the financial problems rather than blaming civil servants.

“They’ve poured money into the NHS but there’s an £800 million deficit and the outgoing chief executive said things are getting worse not better,” he said.

Mr Bliar denied that Sir Nigel had said the health service was getting worse and hailed him as “a superb public servant who in the past few years has overseen a transformation of the NHS”.

The NHS, on any basis, was “getting better”. Waiting lists had come down by about 400,000 under Labour, while in 1997 almost 300,000 people were waiting 15 months for an operation. There was now no one waiting more than six months, Mr Blair said.

The Cornwall trust blamed pay rises and drugs budget increases for the need to cut 300 jobs. It was making plans for “a substantial financial recovery programme”.

While it was committed to avoiding compulsory redundancy, the scale of savings needed meant “we will have no option in some areas”.

Trafford trust is closing two in-patient wards to ensure “patient safety” because it does not have enough doctors for 24-hour cover.

A survey of 200 GPs for More4 news found that 73 per cent said they had seen an increase in patients discharged from hospital without proper care, many of whom had to be readmitted.

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Rumours about his future have been circulating for months as NHS debts have grown. Despite the record £74 billion poured into the health service this year, total deficits are predicted to be between £800 million and £1.2 billion. The Department of Health will only confirm the half-year figure of £620 million.

Sir Nigel will be granted a peerage, rarely awarded to a permanent secretary, and Mr Bliar has invited him to take part in consultancy work in Africa.

In his resignation letter, the former production manager for Trebor mints, whose salary was between £200,000 and £210,000, expressed pride at much that had been achieved since he took charge in 2000. But he also admitted that Labour’s much-vaunted reforms had run into serious problems despite record spending. “There have been enormous changes but not everything has gone well,” he said. “I am particularly saddened by the financial problems we’re grappling with.

“As chief executive, I wish to acknowledge accountability for these problems just as I may take some credit for achievements.”

Downing Street insisted that Sir Nigel had been vital to the NHS’s improved overall performance. The Prime Minister was showing how highly he regarded Sir Nigel’s contribution by giving him one of 10 peerages he can award to public servants in the life of a parliament.

The Prime Minister’s official spokesman hinted, however, that Mr Bliar believed it was time for him to go. “Part of being a leader is recognising where there can be improvements as well as where there have been successes.”

Andrew Lansley, the shadow health secretary, said Sir Nigel’s departure was “an admission that the NHS centrally is in crisis”. He added: “Ministers can try to blame Sir Nigel but they are responsible. The NHS is plunging into the red because ministers raised costs and pushed targets without regard to the overall impact on services.”

The deterioration in relations between Sir Nigel and Miss Hewitt dates back to last summer when he published a policy document announcing that primary care trusts could lose their role as “providers” of health services and become, instead, mere commissioners. The plan enraged Labour MPs who said it would mean the “privatisation” of thousands of NHS jobs.

Within a few days of returning to Westminster after the summer recess Miss Hewitt was forced to apologise to MPs. Then, last month, the NHS was forced to admit that there had been a mistake in calculating the “tariff” for 2006-07, the scale of fees charged for all NHS treatments.

Sources said yesterday that Miss Hewitt had become more and more exasperated with Sir Nigel and that Gordon Brown was also worried about NHS debts.

But MPs believe Sir Nigel became the “fall guy” for wider failings of policy. At health questions yesterday, Miss Hewitt paid tribute to Sir Nigel for “extraordinary improvements” in the NHS. But under pressure from the Tories she confirmed that her earlier estimate of total debt this year looked wildly optimistic.

Sir Ian Carruthers, chief executive of Dorset and Somerset strategic health authority, will take over as acting chief executive of the NHS.

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The messages may be modest but the cost runs to hundreds of millions. With a budget just for advertising of £165m in 2004-5, the Central Office of Information (COI) is the third biggest advertiser in the UK. Under Labour, total spending on government marketing, which also includes mailshots, PR and sponsorship, has tripled since 1997 to £334m.

Critics say the “nanny state” campaigns state the obvious. Matthew Elliott, chief executive of the Taxpayers’ Alliance, said: “It has become a massive gravy train. A few decades ago the government restricted its advertising to road safety advice and public notices. Now, as it has expanded this remit to include ‘nanny state’ advertising, the budget has ballooned and taxpayers are worse off.”

Elliott points to a £100,000 campaign by the Department of Health last year warning the public about the dangers of a hot summer. A total of 1.67m leaflets were printed, with tips such as “wear a hat and loose clothes”, “avoid going out during the hottest part of the day” and “take cool showers or baths”.

At Christmas the Food Standards Agency ran an £800,000 advertising campaign to warn families of the dangers of undercooking the turkey. Later this year an anti-chewing-gum campaign is to be launched with posters at bus stops warning people they face £50 fines for dropping litter.

Britain’s most glamorous advertising agencies vie to win a place on the official COI roster, which entitles them to pitch for government business.

Peter Mandelson, the European Union trade commissioner, is a shareholder in Clemmow Hornby Inge, an advertising agency that won a place on the roster shortly after the last general election. It has been asked to pitch for a lucrative account promoting biometric passports.

Johnny Hornby, managing partner of the agency and half-brother of Nick Hornby, the novelist, oversaw Labour’s advertising campaign in the 2001 election. However, he denied the agency enjoyed an unfair advantage. “We have been on the roster for six months now and got nothing,” he said, “so if you’re saying that Peter or my Labour connections are having an influence, it’s clearly not very strong.”

Opposition politicians claim the government is guilty of political advertising by stealth. Oliver Heald, the shadow constitutional affairs secretary, said: “Over the past eight years we have become used to headline-grabbing initiatives and schemes which sadly never seem to achieve what Labour promised they would.”

Both the Conservatives and Liberal Democrats are particularly scathing about the Treasury’s £5m campaign to promote child trust funds. The scheme was launched with a poster of a giant baby crawling across a City trading floor. But despite the campaign, more than 1m families have failed to invest the first tranche of £250 vouchers, handed out to all families with a baby born since September 2002.

Julia Goldsworthy, a Liberal Democrat MP, said: “Some government policies are becoming so complex that they require excessive advertising for the public to understand them.”

A project to offer UK university courses online was backed by a £4.2m marketing campaign. The e-University was scrapped in 2004, having attracted only 900 students at a cost of £50m.

Last year the army fell 1,000 recruits short of its goal of 11,592 new soldiers, despite an £11m marketing campaign.

A spokesman for the COI yesterday insisted that the organisation was both impartial and cost-effective. “Much government advertising aims to alert people to things that can save lives — such as wearing seatbelts, not drinking and driving, quitting smoking, and what to do in an emergency,” he said.

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That appears to have resulted from hospitals putting off treatment until the new financial year, which starts in April, while still keeping to the government’s guarantee of a maximum six-month wait.

At the same time, some primary care trusts are telling hospitals that they must treat no more patients next financial year than this year, and in some cases fewer, to claw back an overspend that has been forecast to hit £790m by the end of this month.

Andrew Lansley, the Conservative health spokesman, said “[some] doctors are being told they cannot treat patients who are waiting in pain and discomfort until they reach the six months deadline. For a government that said it was going to put all this extra capacity into the NHS, and when the capacity becomes available then tells staff they cannot use it, it is the height of absurdity”.

Patricia Hewitt, the health secretary, said that while “a minority of NHS organisations were facing financial challenges” the bigger picture still showed progress. She said the service continued to meet its key target of a maximum six-month wait – the average is eight weeks – and fewer operations were being cancelled.

“NHS reforms are delivering,” she said. “While we continue to see a constant flow of negative speculation and surveys about the state of the NHS, the facts provided to us by the service tell a different story.”

The Department of Health argues that despite the record deficit for the time of year, two-thirds of NHS organisations are in balance or have a financial surplus.

But John Appleby, chief economist at the King’s Fund health think-tank, said the health department’s goal that the service should make a surplus in the coming year to provide a financial buffer now looked unachievable.

http://news.ft.com/cms/s/9fbf975e-ab23-11da-8a68-0000779e2340.html

As 80 eminent doctors have been moved to protest to the Department of Health, the results have been disastrous. Sixty junior doctors recruited in this way have failed to demonstrate a basic level of medical competence, while many others have had to be retrained at huge expense.

Some successful east European recruits turned out not to speak English, while 600 well-qualified British students have been left without jobs at all, leaving them unable to complete their training.

No checks have been made, so it seems, on the information that applicants put on the forms. Moreover, in the absence of an interview, there is no way hospitals can be sure whether the applicant is a genuine, qualified medical student or whether they are an impostor who paid someone to fill in their form for them.

Substitute “pupils” for “junior doctors” and “schools” for “hospitals” and you have another selection system heading for failure: the new “admissions code” that schools will be obliged to follow should the Education Bill get onto the statute book.

Schools, too, will be banned from interviewing their prospective pupils. Not only will they be forbidden from selecting pupils on academic merit; an army of bureaucrats will be employed to check that schools are not inadvertently selecting on ability.

According to the Labour Government, the systems for selecting school pupils and junior doctors have both been devised in the name of fairness. They are both part of a grand scheme of social engineering designed to iron out inequality.

Unless you allocate medical jobs by computer, goes the argument, consultants will inevitably give in to their own prejudices. Likewise, give schools the freedom to select on academic ability, the Government asserts, and the best schools will fill up with middle class children.

The main effect of outlawing grammar schools has been to deny clever children from poor backgrounds the chance to excel at academic work and to go on to take well-paid jobs. A study by the London School of Economics recently showed that Britain has become markedly less socially mobile since the advent of comprehensive education.

It is the absence of academic selection which leads to a class divide: because when schools cease to select their pupils on the grounds of intelligence they end up selecting them on their parents’ intelligence and financial means.

The introduction of a supposedly “fair” recruitment system for NHS hospitals will have a similar effect. The poor will suffer at the hands of incompetent doctors employed because they fulfil the correct gender, racial and socio-economic profile. Well-off patients, by contrast, will simply decamp to private hospitals, which will remain free to hand-pick doctors according to their medical knowledge and ability to do the job.

Because this Labour Government and its bureaucrats only see people as a mass, they fail to recognise the power and potential of the individual. Yet it is the individual – significantly so in education and medicine – who can inspire and transform the lives of those with whom they deal.

Throughout history, when the rights of the individual have been denied for the “good of the masses”, disaster and misery have quickly followed.

http://telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2006/03/05/dl0501.xml&sSheet;=/opinion/2006/03/05/ixopinion.html

Acute and primary care trusts have been left unable to finalise their business plans just a month before the start of the new financial year. Nineteen foundation trust applications will be delayed.

Without next year’s prices, managers have been left in limbo, with PCTs unable to plan how much work to buy from their provider trusts.

Chief executives are railing against the ‘complete and utter cock-up’ which has rendered three weeks of planning on the basis of the tariff published on 31 January ‘totally worthless’.

The DoH would not say where the error lay, or when the new tariff will be issued, although HSJ sources said they were expecting something imminently.

The blunder was revealed on the day that the DoH issued a diktat instructing all NHS organisations to take immediate action to tackle deteriorating finances revealed in January’s financial returns. The timing of the two revelations left many chief executives and finance directors reeling.

The letter, penned by DoH payment by results deputy director of policy and strategy Liz Eccles and sent out last Wednesday, thanks NHS managers for drawing problems with the tariff to the DoH’s attention. It says ‘underlying errors in the calculation’ have been detected and that the tariff will be withdrawn until further notice, following ‘testing’ with NHS colleagues.

NHS Confederation policy director Nigel Edwards said: ‘There’s real anxiety and disbelief about what has happened.’

He said that as well as facing an immediate period of limbo, in which managers will be unable to agree local delivery plans or service-level agreements with partners, they would also need to gear up to cope with the possible implications of an altered tariff.

PCTs had been expecting to submit final planning submissions to the DoH this week, setting out the services they intend to commission next year. Ms Eccles’ memo says this deadline would now be extended, with details provided with the new tariff.

In January 2005 the DoH postponed roll-out of payment by results for emergency services after last-minute calculations highlighted a £1.5bn ‘imbalance’.

NHS Alliance modernisation and commissioning lead Nicola Easey told HSJ that this latest debacle meant that NHS managers were being forced to do their jobs ‘with their hands tied behind their back’.

King’s Fund chief economist Professor John Appleby described the tariff saga as ‘a real mess’.

‘We are a few weeks away from the beginning of the new financial year; it is not just about trusts applying for foundation status having to redo all their forecasts. PCTs and other trusts will be relying on these numbers to get some idea of the levels of predicted income and expenditure. These numbers are really crucial,’ he said.

‘All the planning is worthless’
NHS managers have been unable to contain their rage about the Department of Health blunders that led to the recall of the tariff.

Alerted to the news by HSJ last week, one acute chief executive from the North was stunned: ‘What the hell do they think they are playing at this time?’ he asked.

And a southern counterpart rounded on the government for its ‘complete and utter cock-up of this year’s tariff,’ and demanded that the DoH officials responsible be named and shamed.

Another acute trust chief executive from the South told HSJ: ‘All the planning that has gone on has come to a stop. All of it is worthless. It’s a total cock-up. It’s just mind-blowing.’

A finance director said: ‘My staff have put a lot of time in on the tariff – working weekends and literally until midnight in some cases.’ He said maintaining morale was proving difficult.

In the East, one chief executive said he found it ‘incredible’ that the government ‘could have got the tariff so wrong for the second time in a row’.

Several chief executives said they would expect to be sacked in the event of making a mistake of these proportions, but they had ‘no confidence’ that this would happen at government level.

Delays for 19 foundations
The foundation trust programme faces severe delays following the Department of Health’s decision to withdraw the tariff structure for next year, according to Monitor, the foundation trust regulator.

Last week Monitor chair Bill Moyes sent a letter to foundation trust applicants detailing the set-backs.

In it he confirmed that the six acute trusts hoping for authorisation in April will have to wait until June, and the further 13 aiming to gain foundation status in July would be pushed back to August.

And Mr Moyes warned that even these timings were subject to the DoH reissuing the tariff by mid-March.

In a separate letter to chief executives and finance directors of existing foundation trusts, Mr Moyes expressed concern about the ‘deeply unsatisfactory state of affairs,’ brought about by the withdrawal of the tariff figures. He added that Monitor would be ‘seeking to understand from the DoH exactly how this could have arisen’.

Five mental health trusts due to be authorised in April and July are likely to go ahead, as they are not yet covered by PbR.

The DoH’s suspension of the current tariff has left current and aspirant foundation trusts unable to create credible business plans for the next year.

Foundation Trust Network director Sue Slipman told HSJ that the implementation of the tariff had been ‘far too rushed’, and the situation was ‘completely chaotic’.‘Some foundation trusts will have some major wobbles over this; it will severely affect their business plans’.

Ms Slipman suggested some trusts were considering withdrawing their applications following the withdrawal of the tariff.

One chief executive, whose trust had been expecting authorisation in April, said that if the DoH reduced tariff costs any further he could not guarantee his trust would be able to proceed with its application.

‘If the tariff is further reduced [then] business plans that are just about affordable will become unaffordable – and there will be no time to review them for June. I would not be surprised if there were numerous casualties.’

He said he was ‘amazed that, despite the DoH withdrawing the tariff for emergency services last year, this year’s tariff had not been managed in such a way as to avoid another massive mistake’.

One foundation trust finance director said that he was ‘completely gobsmacked’ that the DoH had taken such a drastic measure: ‘It beggars belief that they would have done this unless there is something fundamentally wrong with the whole tariff structure for this year.’

‘Myself and my staff have been working late into the evening for the past three weeks to get business plans written; this announcement is soul-destroying and hugely frustrating,’ he added.

Another foundation trust chief executive questioned how the DoH had published an incorrect tariff. ‘If it had been a trust chief executive that had engineered such chaos, heads would roll. It’s been cock-up after cock-up – but it’s one rule for the DoH and another rule for us,’ he said.

A year in the life of the troubled tariff

Jan 2005 The Department of Health halts plans for the full roll-out of payment by results, due for April 2005. Emergency and outpatients are excluded from the tariff after the DoH discovers a £1.5bn ‘imbalance’ in the NHS. The sudden change sees trusts and PCTs scrambling to recalculate forecasts for 2005-06.

April 2005 Original full PbR deadline missed.

Dec 2005 DoH misses deadline for publication of 2006-07 national tariff.

26 Jan 2006 DoH publishes NHS operating framework for 2006-07, detailing a 1.5 per cent uplift for inflation.

31 Jan 2006 DoH publishes national tariff for 2006-07.

22 Feb 2006 DoH admits to ‘underlying errors in the calculation of the tariff’.

No date set for publication of revised tariff. DoH only says it will be published ‘as soon as practicable’.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4455211
http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4455126

A year ago Sir Nigel was persuaded to apply for the cabinet secretary’s job to ensure there was competition for Sir Gus O’Donnell, who was eventually appointed.

With the NHS waiting times falling sharply, Sir Nigel’s pitch was that, as an experienced manager, he could deliver the government’s public service reform agenda.

But, according to one senior Whitehall figure, he has gone in the space of 12 months from being “the blue eyed boy of Whitehall to a member of the fingertips club”.

Shortly after that contest, it emerged that the NHS had overspent by £250m last year. That was followed by fury among staff and MPs over a letter at the start of the holiday season telling primary care trusts that they had to divest themselves of services they directly provided. Then in September came the revelation that this year the NHS was heading for a £620m deficit, at the same time as strategic health authorities and PCTs were being pressured into mergers.

Sir Nigel has told the SHA chief executives whom he hand-picked as his top management team in 2002 that barely a handful of them were guaranteed jobs after the mergers. Even among the survivors, that has led to questions over his management judgment.

Evidence of ministers’ loss of confidence was their decision, rather than Sir Nigel’s, to call in McKinsey, the management consultants, to examine the structure inside the health department as the government moves to a supplier market in healthcare. McKinsey’s findings are understood to have been so critical that they have not been committed to paper.

When last month Patricia Hewitt, the health secretary, presented the NHS’s key priorities for next year, she was flanked by the department’s finance chief and an acting policy director, not her chief executive. Ministers have also expressed surprise in private that Sir Nigel chose to go to the Davos economic forum in the run-up to the government’s white paper on healthcare outside hospital.

Asked recently if a new departmental board due to take effect in July was the last word, Ms Hewitt said it would need to evolve further as the NHS did. Asked if Sir Nigel would oversee that, she said: “You will have to ask Nigel that. I think he has made his position clear [that he intends to stay].”

Sir Nigel’s supporters point to a string of improvements in the NHS under his tenure that go well beyond merely eliminating the longest waits for treatment. They add that he has “an almost infinite capacity to absorb punishment” and has dealt with some of Labour’s toughest ministers including Alan Milburn and John Reid.

Whitehall insiders also note that if and when he goes, decisions will be needed on whether once again to split the permanent secretary and chief executive jobs and possibly divide the chief executive position into a commissioning and providing role. These are decisions that ministers do not yet appear ready to take.

David Hunter, professor of health management at Durham University, said yesterday that “most people didn’t expect him to survive last year”. But the scale of NHS deficits built up over the years he has been in charge “are making his position increasingly untenable”.

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 the figure, 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

Karen Dunnell, the national statistician, said no decisions had been taken and she wanted to “stimulate a public discussion”, although Patricia Hewitt, health secretary, assumed big upward revisions were in the bag.

“As the Office for National Statistics estimates, NHS productivity is rising,” she said, adding: “We’re pleased the ONS has, for the first time, included the quality of NHS services into their measure of productivity.”

However, Andrew Lansley, the shadow health secretary, stuck to the existing measure of productivity and insisted the ONS report showed this “had fallen further and faster than was believed to be the case”.

The big issues relate to the inclusion of quality-improvements in NHS output measures and whether any account should be taken of the changing value of the NHS to society.

The Department of Health’s preferred view raises NHS output by 2.68 percentage points a year, while independent research by the National Institute of Economic and Social Research and the University of York recently estimated a more modest uplift to NHS output of 0.17 percentage points. This would not be enough to show rising health productivity.

The most controversial element in the department’s reasoning is an automatic 1.5 percentage point a year uplift in measured NHS output to reflect the increased value of public services as society becomes richer. The principle of such an adjustment was recommended in last year’s review of public sector productivity, led by Sir Tony Atkinson.

Martin Weale, director of NIESR, said this automatic adjustment did not have much theoretical basis. He argued that while the contribution of the NHS to society’s well-being might rise with overall prosperity, the volume of NHS output and productivity did not.

Quality adjustment of NHS output is widely accepted, but there remains little agreement on the best methods.

The Department of Health, for example, finds that increased use of statins, the drugs used to lower cholesterol, extended and improved patients’ lives so much that NHS output growth should be measured as 0.81 percentage points higher than previously.

Mr Weale, however, said that if this assumption was included in NHS output, it should not improve the NHS’s productivity substantially because the gains were largely attributable to pharmaceutical companies.

Another problem was the Department of Health’s assumption that patients’ satisfaction at cleaner hospitals has as much weight in its calculations as the NHS’s ability to save lives. Andrew Street, a senior research fellow at the University of York, said there was no “empirical basis for the weights” the department used.

Mr Street said the estimates in the NIESR/York study were likely to be on the low side, since the data were inadequate for a proper quality assessment.

http://news.ft.com/cms/s/f0663f86-a7ff-11da-85bc-0000779e2340.html

This is the third in a series of reports which examines the effectiveness of the mechanisms to deliver government Public Service Agreement (PSA) targets.

The child obesity PSA target was set in July 2004, but the key ingredients of the delivery plan will not be published until May 2006.

Tackling Childhood Obesity–First Steps warns that a lack of timely guidance has meant that the various organisations that will need to work together to deliver the target have been unclear about their roles. Without greater clarity, those further down the delivery chain may be wasting resources on ineffective or inappropriate interventions that fail to target those children most at risk.

The Labour Government has in place a range of preventative programmes, particularly around school sport and children’s nutrition, through which it aims to address child obesity. The Department of Health recently published guidance on measurement of children and plans further advice for health professionals on weight loss and how obese children may best be helped.

The target ‘to halt the increase in obesity among children under the age of 11 by 2010′ was set in 2004 as a PSA in response to a jump in the growth of childhood obesity. The incidence of childhood obesity grew from 9.6% in 1995 to 13.7% in 2003. The target is jointly owned by the Department of Health, Department for Culture, Media and Sport, and Department for Education and Skills.

Obesity now costs the NHS around £1 billion a year and the UK economy a further £2.3 billion of indirect costs. If this trend continues, the annual cost to the economy could be £3.6 billion a year by 2010.

The childhood obesity target is far-reaching and complex, requiring significant changes in the lifestyles of many children and their families to improve their diet and to exercise more. This target is tougher to deliver because it requires the coordination of many diverse organisations at regional, local and front line level, who all have a key role to play in tackling child obesity.

The report recommends:
* greater clarity and direction from central Government: it is essential that the three Departments work closely together to provide strong leadership;
* better definition of regional roles and responsibilities: Government Offices for the Regions could play a greater role in bringing together the various elements of the delivery chain;
* strengthening local partnerships: local structures and mechanisms, such as local strategic partnerships and children’s trusts, exist to promote joint working and have the potential to reduce the risk of duplication of activities by bringing together funding around agreed priorities;
* more support for front line staff: better information and training on roles and responsibilities and improved dissemination of advice and guidance.

It will be important to build on progress to date and to act quickly on the report’s recommendations to support the target being met and to reduce the risk to children’s health.

Healthcare Commission Chief Executive, Anna Walker, said:
“Childhood obesity is a serious health problem that can follow people much later into life. It is a causal factor in a number of chronic diseases and conditions including high blood pressure, heart disease and type 2 diabetes. If we are serious about tackling childhood obesity then all government agencies and organisations must work together more effectively. Those of us involved in inspection and assessment must ensure that this partnership working really takes place nationally and locally.”

Audit Commission Chief Executive, Steve Bundred, said:
“The Labour Government is facing a significant challenge on a serious social problem, but it is tackling it head on. To succeed, children must be engaged in the home, at school and when being treated by the NHS. It is no surprise that it is very complicated to address because the various government agencies involved are trying to bring about changes to the lifestyles of children and families. The recommendations in this report must be embraced urgently to give the Government the best chance of achieving its target.”

Sir John Bourn, head of the National Audit Office, said:
“Central Government must set a clear direction if we are to tackle obesity in children. Given that the target was established in 2004, the three Government Departments could have been quicker in coordinating their own actions and in making sure that those on the front line were fully informed and supported in their efforts. There is now a need for the three Departments to work closely together to provide the leadership and direction that the whole delivery chain requires.”

http://www.audit-commission.gov.uk/reports/PRESS-RELEASE.asp?CategoryID=PRESS-CENTRE&ProdID;=F4A9AF30-74C2-4803-815A-AC002E652C15&page;=index.asp&area;=hped