Health Direct » 2006 » March

Patient care is suffering in NHS cash cuts

Dr Search- Principal Consultant at the Search Clinic — Fri, 31 Mar 2006 07:39:00 +0000

Forcing trusts to break even too quickly will compromise patient care, chief executives have warned this week. Speaking in parliament in January, health secretary Patricia Hewitt told MPs that actions to deliver organisational turnaround will ‘never compromise patient care’. But chief executives said they could not make the savings demanded of them for 2006-07 without an impact on the quality of care delivered.

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

Bowel cancer screening tests cut in NHS cash crisis

Dr Search- Principal Consultant at the Search Clinic — Thu, 30 Mar 2006 08:21:00 +0000

A national screening programme aimed at saving more than 1,000 lives a year from bowel cancer has been cut because of the funding crisis facing the NHS. The project, which would pick up the disease in patients before they developed any symptoms, was due to be rolled out across the UK in two weeks time. Bowel cancer is a major killer in Britain, and is diagnosed in 34,000 patients a year, claiming 16,000 lives annually.

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

Older people are failed in deep rooted cultural attitudes- joint report

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

Public services often fail to consider the special needs of older people, according to a new report by three independent watchdogs published. It suggests that “deep-rooted cultural attitudes to ageing” in local public services are hampering wider Government plans to improve health, social care and local council services for older people. The report has been produced jointly by the Healthcare Commission, the Audit Commission and the Commission for Social Care Inspection.

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 s
ystematic 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 opt to have private operations out of NHS

Dr Search- Principal Consultant at the Search Clinic — Tue, 28 Mar 2006 09:14:00 +0000

Hospital consultants are spurning the National Health Service by paying for medical insurance so they can be treated privately if they become ill. A survey of 500 consultants, commissioned by Bupa, the health insurer, found that 41% of senior hospital doctors have invested in private health cover.

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

Madness- Britain’s mental health time bomb

Dr Search- Principal Consultant at the Search Clinic — Mon, 27 Mar 2006 08:08:00 +0000

New figures reveal one in five people will need treatment. Which is why experts are calling £20m cuts in services ‘cruel and insane’. Health authorities are secretly cutting millions of pounds in funding for psychiatric services, despite alarming new evidence of a crisis affecting an estimated one in five people in Britain. In a move branded “the real madness” by health experts, debt-ridden NHS trusts are slashing budgets and cutting care for the mentally ill.

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

Would Nye Bevan approve of Labour’s NHS chaos?

Dr Search- Principal Consultant at the Search Clinic — Sat, 25 Mar 2006 08:31:00 +0000

Sixty years after the national health service bill, a new white paper is needed to make good recent damage. March 21 2006 was the 60th anniversary of the postwar Labour government’s white paper, the national health service bill. What would a new white paper for the NHS today look like? We do not need to reinvent the wheel. The weaknesses of the original NHS were serious and they have been skilfully exploited in the drive to privatise it, but the basic design was good; it deserved to be improved, not surrendered to the ideologues of private enterprise.

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

Thousands of jobs go in NHS cash crisis

Dr Search- Principal Consultant at the Search Clinic — Fri, 24 Mar 2006 13:17:00 +0000

NHS hospitals serving Tony Bliar’s Sedgefield constituents announced 700 job losses yesterday, bringing the total cut over the past fortnight to more than 4,000, according to figures compiled by the Guardian. Conservatives accused the government of allowing the health service to sink under financial pressures caused by ministers’ mistakes. They forecast job losses in England might top 15,000 as staff are made to pay for Labour government errors.

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

Brown’s budget- Health service slips down the waiting list

Dr Search- Principal Consultant at the Search Clinic — Thu, 23 Mar 2006 08:51:00 +0000

If the National Health Service was listening to the Budget speech yesterday it should have been quaking in its boots. The chancellor machine-gunned the House of Commons, not just with his usual battery of statistics but with his priorities – ones he clearly sees as shaping his inheritance when, as he hopes, he steps into the prime minister’s shoes.

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

500,000 children set to lose NHS dental treatment in dentistry choas

Dr Search- Principal Consultant at the Search Clinic — Wed, 22 Mar 2006 08:03:00 +0000

Thousands of Dentistry practitioners are likely to reject the contract offered by the government and quit the National Health Service to treat only patients prepared to pay, according to a survey of NHS primary care trusts. The trusts, which provide GP and dental care locally, have admitted that thousands of children will be hit. Some have already written to patients warning them that from April 1 both adults and children will be obliged to find another dentist unless they are prepared to pay for treatment or buy insurance.

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

Hewitt puts job on the line in defence of NHS reforms

Dr Search- Principal Consultant at the Search Clinic — Tue, 21 Mar 2006 08:55:00 +0000

Patricia Hewitt, the health secretary, has put her job on the line over the National Health Service’s finances and pledged to press ahead with market-based reforms. The reforms might seem to be going “too far and too fast”, she said, but were “absolutely necessary” and “the only route to safeguard the NHS”.

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