The climbdown came after the DoH was forced to acknowledge claims by strategic health authorities and primary care trusts that more elective capacity was not needed in their regions.

This week the DoH also announced plans for an independent clinical audit of the first wave of the ITC programme following surgeons’ concerns over the clinical quality of many operations carried out at the sites.

And the news comes as a high-profile independent sector company bidding to provide a practice in the North West pulled out, criticising delays in the process.

In September the DoH sent a ‘pre-qualifying questionnaire’ to prospective private healthcare providers, setting out the 24 elective surgery contracts on offer across the country. HSJ understands that many of the bidders had already been invited to negotiate with the DoH for the work.

However, last week companies bidding for the work received letters from the DoH’s commercial directorate telling them that seven of the contracts had been scrapped.

The letter said: ‘It has become clear for a variety of reasons that the detailed make-up of the schemes needs to be reviewed and that these schemes will not go ahead as part of the phase-two procurement programme. We are currently exploring options to replace the capacity of these schemes.’

HSJ understands that the DoH has told private providers that the monetary value of the schemes – £550m worth of work per year – will still be guaranteed. Meanwhile the other 17 remaining schemes have been delayed for up to a year.

A DoH spokesperson said: ‘We have responded to the changing needs of a small number of health authorities.

‘We continue to work with each of these SHAs to ensure that they have plans in place to deliver better services to patients using the independent sector’.

NHS Confederation policy director Nigel Edwards said: ‘What is becoming increasingly clear is that the level of surgical elective capacity is enough, if not too much. The problem is now one of patient flow rather than capacity, and there has been a growing anxiety that too much capacity had been procured and this has become a big issue.’

He said that the private providers would be ‘pretty disappointed that they have put in so much work’ and suggested that they may want their costs reimbursed. ‘The private sector providers will be pretty aggrieved.’

NHS Alliance chair Dr Michael Dixon welcomed the announcement. ‘The DoH must not straitjacket commissioners into telling them what they have to commission,’ he said. ‘They desperately need the blessing of PCTs and practice-based commissioners. If they are in doubt they should delay in order to get it right for commissioners.’

The second part of the wave two contract known as the ‘extended choice network’, under which the DoH was set to buy elective services on top of the initial national schemes, has also been delayed indefinitely. However, the diagnostic element of the second wave is unaffected.

The SHAs with the cancelled projects
* County Durham and Tees Valley: multi-specialty treatment centre
* Birmingham and the Black Country: Birmingham City treatment centre to be housed on site at Sandwell and West Birmingham Hospitals trust
* South Yorkshire: cardiology treatment centre
* South Yorkshire: general surgery treatment centre
* South West Peninsula: multi-specialty mobile unit
* West Yorkshire: plastic surgery unit
* West Yorkshire: multi-specialty treatment centre

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4703772 ]]> http://www.healthdirect.co.uk/2006/04/treatment-centre-programme-in-disarray-as-contracts-axed.html/feed 0 http://www.healthdirect.co.uk/2006/04/angry-rcn-nurses-drown-out-health-minister.html http://www.healthdirect.co.uk/2006/04/angry-rcn-nurses-drown-out-health-minister.html#comments Thu, 27 Apr 2006 08:01:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=999 Infuriated nurses stopped Patricia Hewitt in her tracks yesterday as they interrupted her speech and demanded their voices be heard. The Health Secretary, who was addressing the Royal College of Nursing conference in Bournemouth, had been met by more than 2,000 stony faces, a sea of white and yellow campaign T-shirts, and a welcome somewhere between cool and frigid.

Nurses run out of patience with Patricia Hewitt yesterday amid a sea of protest posters and T-shirts at the Royal College of Nursing conference

“Put your speech away,” shouted the nurses as Miss Hewitt, almost repeating the address she had made to Unison in Monday, said she would help any nurses made redundant to get new jobs. “Where? Where?” they yelled.

About 15 minutes into her speech, the nurses, who had already interrupted her with derisive laughter, cries of “rubbish”, “resign” and the stamping of hundreds of feet, had finally had enough. There would be more arguments and controversy in the coming year, Miss Hewitt was saying as the shouting spread, the crescendo of stamping grew, and she was finally drowned out.

Dave Nunn, the chairman of the conference, could just be heard telling the Secretary of State that the nurses were indicating that it was time they had their say.

Patricia Hewitt displayed less than her usual composure

Miss Hewitt agreed it was always right to take questions. “Have you finished or do you want to say more?” Mr Nunn asked. “I’ve just said to you that I will,” said Miss Hewitt, displaying less than her usual composure.

Les Miles, from a foundation hospital trust in south Tyneside, wanted to know why was it that, with all this funding going into the NHS, he and one auxillary nurse were left to care alone for a ward for 14 premature babies?

It was clear they were understaffed, said Miss Hewitt, but that really was a matter for the trust. Mr Miles said later that he felt patronised.

Maureen Marshall, a nurse from south London, demanded to know if Agenda for Change, the programme to restructure pay and ways of working, had been fully funded or not. “Yes or no. Yes or no,” thundered the audience, which felt let down by a 2.5 per cent pay rise this year. It had been fully funded said Miss Hewitt, her voice rising. But it looked as if more money would be needed. More scornful laughter.

After three quarters of an hour, Miss Hewitt’s ordeal was nearly over. “I know you are angry with me and I know you disagree with a lot of what I am saying. But I really want to stress that although there may be some areas of disagreement between us, the more we can work together and the more nurses in particular are involved in difficult decisions to be made, the better.”

The conciliation failed. The audience rose and booed. Miss Hewitt quickly left the stage and nurses held aloft the campaign posters they will take to a lobby of Parliament next month.

Dr Beverly Malone, the general secretary of the RCN, said afterwards: “Blame shifting and lame excuses from the minister won’t help a single patient or save a solitary job. What nurses and patients need is long-term planning not short-term cuts.”

Sylvia Denton, the president of the RCN, said she had never seen nurses so angry in the presence of a health secretary. “I’ve been coming to congress for the last 26 years and I don’t think I have ever seen a reception like that but I think this is a symptom of nurses not being listened to.”

Miss Hewitt returned to London to put her message across to the Fabian Society. The NHS was the best medical insurance system in the world, she said.

Under Labour’s reforms, the NHS had improved and would continue to improve, she said. She accused the Conservatives of trying to undermine the service in the hope of persuading voters that state funding was not working.

http://www.telegraph.co.uk/news/main.jhtml;jsessionid=32BYYAXK5X5TLQFIQMFCFFWAVCBQYIV0?xml=/news/2006/04/27/nhew27.xml&sSheet;=/portal/2006/04/27/ixportaltop.html

The angry mood over job losses and privatisation of services was underlined when Patricia Hewitt, the Health Secretary, was given a rough ride by nearly 1,000 delegates at Unison’s health workers’ conference in Gateshead, where delegates sat in silence as she was introduced.

Despite being urged to show respect, some shouted “Rubbish” and booed and hissed as she spoke.

Miss Hewitt refused to apologise for her claim, which attracted widespread ridicule, that the NHS had experienced its “best year ever”, although she amended it to the best year ever “for patients”.

She said: “We have written a very big cheque for the NHS and we are proud of it. But it is not a blank cheque; it never has been and it never will be.”

Overspending hospitals and organisations had to put their houses in order.

The first industrial action could hit trusts that have announced job losses in recent weeks, as well as areas with plans to outsource work.

Nurses at their annual conference in Bournemouth called for an end to bed closures and job losses and spoke of low morale after a “disappointing” pay rise.

Beverly Malone, the general secretary of the Royal College of Nursing, urged the Government to stop treating nurses “like overheads to be cut”. The success of reforms depended on their goodwill.

Mr Blair said at his monthly press conference that Miss Hewitt had his confidence in driving through reforms. He indicated that more jobs could go when he said the NHS faced “a very challenging” year.

Government figures showed yesterday that the number of hospital managers had doubled in 10 years: from 20,842 in 1995 to 39,391 last year.

Overall, the NHS workforce in England has grown by 30 per cent in that time.

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/04/25/nhs25.xml ]]> http://www.healthdirect.co.uk/2006/04/nurses-threaten-to-strike-as-bliar-warns-of-more-job-cuts.html/feed 0 http://www.healthdirect.co.uk/2006/04/rcn-warns-of-13000-nhs-jobs-cuts-in-cash-crisis.html http://www.healthdirect.co.uk/2006/04/rcn-warns-of-13000-nhs-jobs-cuts-in-cash-crisis.html#comments Mon, 24 Apr 2006 09:23:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=1001 Financial instability – the national picture: the NHS audit review shows well over a quarter of NHS organisations in England (including a third of Acute Trusts) have failed to break even at the end of the financial year 04/05. For the financial year 05/06, RCN does not believe that this is improving and estimates 27% of all NHS Trusts (and approximately half of Foundation Trusts) will report an end of year deficit.

Our own review of public reporting of financial deficits by NHS organisations to RCN representatives shows an overall deficit of around £840m in Acute Trusts, £48m in Foundation Trusts and £358m in PCT’s – a total of £1.2bn. Alongside the financial picture, we have received details of a reported loss approaching 4000 WTE posts from the NHS – this figure does not include jobs which may be lost as a result of the changes described in Commissioning a Patient led NHS.

Across the UK, each country has experienced differing levels of growth in funding and expenditure but all have experienced significant increases.

In terms of the experience of financial deficits, this is quite different from country to country as the rules governing expenditure are very different; the structures in which spending occurs are different; and each country will have different priorities in terms of overall allocation and spending plans.

Country 1999/00 2003/4 2005/6 2006/7
England £33.04bn £61.3bn £74.3bn £83.8bn
Northern Ireland £1.8bn £2.9bn £3.3bn £3.75bn
Scotland £5.16bn £7.10bn £8.62bn £9.33bn
Wales £2.98bn £4.1bn £4.87bn £5.14bn

In Wales some Trusts and Local Health Boards are reporting deficits although total spending on health care will increase to £5bn in 2006/07 – this compares with the £2.98bn health budget which the Assembly inherited in 1999.

Several NHS Boards in Scotland are forecasting deficits for the current financial year. Audit Scotland produced a report in December 2005 predicting a cumulative over spend of £91m with funding gaps in excess of £183m anticipated for 2006/7 . Boards are now required to produce savings plans to fill these gaps in funding and reduce expenditure.

In Northern Ireland the levels of deficit remain relatively small in comparison to England and tend to be short-term rather than structural, being managed through the manipulation of year-on-year budgets and through occasional financial assistance from the DHSSPS. There is an increasing shift in emphasis towards value for money in reviewing services which is impacting the distribution and organisation of services.

Whilst there are different experiences in each country, there is an overall trend which can be summarised as follows ;
· There are marked increases in funding allocations to each country from 1999-2006
· The rate of increase will probably level out over 2007/8 – 2008/9 but to different degrees as some countries have historically received insufficient allocations
· Each country health department will increasingly expect evidence of efficiency in spending and evidence of improved outcomes in return for increased investment. This is particularly true for England where a series of reforms have placed increasing emphasis on strict financial management and performance reporting.

Key Facts – sources of financial pressure
The following is a brief summary of some of the issues impacting upon NHS Trusts ability to break even. It is not true to say that the reason most Trusts are in deficit is down to poor management. Similarly, whilst it is true that the NHS has enjoyed record rises in funding, it has not all come directly to Trusts and front line services.

1. Many NHS organisations already have historical deficits to repay on top of those caused ‘in year’. For some, this can amount to millions of pounds. This can arise from previous poor management of resources but can also result, for example, from the changes in the way the PCTs pay money to acute trusts under Payment by Results (see glossary of terms), or the way in which funding formulae have changed over time

2. The current average cost of providing each service is a legacy of past decisions by NHS organisations – hence the term legacy costs (see glossary of terms). The actual costs of some services may be well above or well below the average cost per unit of activity for the NHS as a whole. Unless the services are completely redesigned or stopped altogether, this legacy of high costs will impact for the life of the service. In reality it is very difficult to do this . In England as PbR rolls out, these legacy costs will become more apparent and force Trusts to consider the viability of these higher than average cost services.

3. Across the UK, Health ministers have required substantial increases in activity from the NHS as a whole in order to address waiting lists and A&E; waiting times. The additional activity when coupled with pressures on expenditure from other areas of reform has created cost pressures above and beyond the level of additional funding provided. According to the NHS Confederation, in England only 20% of the new money was spent on providing new services and only part has gone to addressing decades of chronic under funding.

4. In terms of any overspends related to staffing costs, the RCN has found that there is no significant correlation between financial deficits and the implementation of AfC. In fact some of the Trusts with the worst deficits have not even implemented AfC yet so we do not believe AfC is a key cause of deficits. There is evidence to suggest however that the substantially larger sums involved in delivering on Consultant contracts and GP contracts were not properly costed and this has had an impact on financial stability.

5. Alongside increases in activity there have also been net increases in staff numbers in certain areas to meet demand – estimated to have cost around £2bn. There has been an increase of approximately 89,000 more clinical staff employed in the NHS since 1999; 67,880 of which are nurses/midwives/health visitors .

6. Drug costs – these continue to rise and are up 5.6% on last year; by 46% since 2000

7. Total costs for IM&T; have increased to £6.2 billion over 10 years .
Overspends in meeting the technical challenge of linking up thousands of different organisations from SHA’s to Hospitals to GP surgeries are commonly reported. Implementing NPfIT is estimated to eventually run to £15bn.

8. Payment by Results – this averaging out of costs undertaken in drawing up the NHS tariff has left some Trusts with up to 20% less income than they would normally receive for the same or increased levels activity. There are also some Trusts who have benefited from the same process.

9. To date over £19bn has been invested in PFI schemes to provide new buildings in partnership with private companies. However there is ample documented evidence to suggest that on-going capital repayments under PFI are affecting service development and investment.

10. The effects of the global economic slowdown on the UK economy have produced a £20bn gap in public finances. This has forced the UK Treasury to borrow more resulting in criticism from the European Union and the International Monetary Fund (IMF) which has impacted upon Govt spending decisions.

RCN General Policy Position
The actual level of deficit when compared to the total NHS budget appears to be quite small but this is only half the picture. Locally, the impact of even a small percentage change in deficits can be disproportionate, particularly when considered alongside other costs pressures where organisations are already operating on very small margins.

The RCN has been carefully tracking the deficits picture across the UK through reports from activists and Regional staff; reviewing Trust, SHA, and Board governance papers; and monitoring national and local media. We have noticed a general trend in how NHS organisations are progressively responding to financial instability as follows

· In the first instance, many organisations have instigated blanket bans on the usage of temporary staff – this places immense pressure on existing clinical staff to increase activity without a corresponding increase in resources.

· This is often followed by vacancy freezes (with vacancies being eventually removed from establishment to provide financial break even picture). This coupled with freezes on temporary staff usage, and reductions in the funding of professional development and education, can damage staff morale and recruitment and retention.

· Latterly we have seen limitations on service provision (particularly specialist services such as health visiting). For example, changing opening hours and reducing the scope of the service.

· This can be followed by more permanent mergers of departments and directorates coupled with reductions in management and support services. In some cases, NHS organisations have decided to ‘disinvest’ or close a service completely.

· At the start of this year, we have received numerous reports of many NHS organisations are actively considering redundancies in response to their worsening financial situation.

· At the end of this financial year 2005/06, our activists and staff have reported back on a large number of NHS organisations predicted deficits for the end of year 2005/06 based on projected expenditure. Whilst a proportion of the deficit may be recovered, the extent of this recovery will depend on radical recovery plans which we believe will impact upon patient services and our members’ employment.

http://www.rcn.org.uk/news/campaigns/deficits/ ]]> http://www.healthdirect.co.uk/2006/04/rcn-warns-of-13000-nhs-jobs-cuts-in-cash-crisis.html/feed 0 http://www.healthdirect.co.uk/2006/04/chief-execs-should-%e2%80%98take-the-rap%e2%80%99-if-elderly-failed-on-dignity.html http://www.healthdirect.co.uk/2006/04/chief-execs-should-%e2%80%98take-the-rap%e2%80%99-if-elderly-failed-on-dignity.html#comments Fri, 21 Apr 2006 13:09:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=1002 Chief executives could face the sack if their trusts consistently fail to treat their elderly patients with dignity, the national clinical director for older people has said. Professor Ian Philp told HSJ he wanted to see dignity breaches become as ‘totemic’ an issue for senior managers as four-hour accident and emergency waits.

He was speaking ahead of the launch of A New Ambition for Old Age, the follow-up to the 2001 national service framework for older people.

Professor Philp said that while the NSF had helped improve the productivity of older people’s services – such as reducing delayed discharges – it had not done the same for patient experience, hence the new report’s focus on dignity.

‘For many chief executives running acute hospital trusts, the four-hour trolley wait is seen as totemic of the levels of quality at their trust,’ he said.

‘If we regard dignity breaches in the same way, we would see chief executives being treated the same as if they failed on their A&E; targets. So if a trust was consistently failing on dignity breaches we would expect senior management to take the rap for this.’

Care services minister Liam Byrne called on the Healthcare Commission and social care watchdogs to ‘put older people’s dignity at the centre of their investigations’.

The commission said effective arrangements to ensure that patients are treated with dignity and respect were the ‘basic standards of care’ that trusts should meet. The commission’s annual health check includes a core standard – C13 – on treating patients with dignity and respect, which the commission said would now be re-examined.

Head of strategy Jamie Rentoul added: ‘We will seek to focus increasingly on dignity in care for all people as we develop our annual health check and through our other work.’

Professor Philp said inspectorates could measure trusts’ performance on dignity by how far they tried to engage patients on the issue: ‘This is not just about inspectorates coming down hard on trusts, it is about trusts having improvement systems in place.

‘If the inspectorate is satisfied that there is a system to encourage public and patient involvement, they will not have to intervene.’

He said the commission could intervene after receiving complaints about dignity breaches. ‘The system is not intended to be punitive but supportive: the commission could offer trusts help on improving their complaints systems. But, if necessary, it will be punitive,’ he warned.

Professor Philp said work to ensure that future tariffs for payment by results reward outcomes not processes could see organisations punished for breaching patient dignity and rewarded for creating a positive patient experience.

‘It is not impossible to imagine a time when lower levels of dignity breaches or higher positive patient experience responses could be rewarded with a financial incentive,’ he predicted.

Age Concern director general Gordon Lishman welcomed the report.

‘We want its recommendations implemented as soon as possible and a commitment by the government that money to deliver services is available,’ he said.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4677362 ]]> http://www.healthdirect.co.uk/2006/04/chief-execs-should-%e2%80%98take-the-rap%e2%80%99-if-elderly-failed-on-dignity.html/feed 0 http://www.healthdirect.co.uk/2006/04/dental-patients-are-having-to-use-emergency-dental-services-after-their-dentists-left-the-nhs.html http://www.healthdirect.co.uk/2006/04/dental-patients-are-having-to-use-emergency-dental-services-after-their-dentists-left-the-nhs.html#comments Thu, 20 Apr 2006 07:52:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=1003 One in 10 of England’s 21,000 dentists left the NHS at the start of April after rejecting a new contract and local health bosses have struggled to replace them, leaving patients to ring help-lines. Patients are then told of dentists accepting NHS patients – in some areas this is a minority – or diverted to services aimed at out-of-hours care.

It is just not sustainable to keep asking dentists to take on more patients Lester Ellman, of the British Dental Association

But with many dentists unhappy with the deal offered – they thought they would have been given more time to spend on preventative care – PCTs have been unable to open new practices to replace the ones that have gone private.

In Avon, where nearly a third of practices rejected the contract, patients are ringing help-lines and are told of practices that are accepting NHS patients.

But it is estimated four in five are not accepting new patients so instead they are being directed on to dental access centres, which provide emergency out-of-hours care.

John Boyles, consultant in dental public health to the five PCTs in the area, said: “There is a workforce problem. The dentists just are not there, there are plenty in dental school but they take time to train. It could take five years to resolve.”

A similar system is in place in Hampshire and the Isle of Wight, which was the worst affected area in the country by the introduction of the new contract.

In Coventry, more than 8,000 patients were left without a dentist, leaving the local PCT to try to convince dentists that did sign the contract to take on extra patients.

But Lester Ellman, of the British Dental Association, said: “It is just not sustainable to keep asking dentists to take on more patients. They are going to start saying no. This contract has not improved access to services and I can’t see it happening in the future.”

Last week the government insisted PCTs were coping with the walkout – which affected nearly 1m patients – by recruiting graduates and using dentists from abroad.

The reforms were meant to introduce a simpler system of fees and reward dentists for carrying out more preventative work.

It also handed responsibility to PCTs to commission services where there was insufficient provision.

But the NHS Confederation, which represents health service managers, said PCTs had been handed a “tricky challenge”.

Deputy director of policy Jo Webber said: “It is going to take a while to bed in.”

A Department of Health spokeswoman said it was unfair to judge the reform as it was “early days”.

“We are confident that in the future people will have much more access to services.”

http://news.bbc.co.uk/1/hi/health/4908250.stm ]]> http://www.healthdirect.co.uk/2006/04/dental-patients-are-having-to-use-emergency-dental-services-after-their-dentists-left-the-nhs.html/feed 0 http://www.healthdirect.co.uk/2006/04/health-deficits-are-symptoms-of-a-deeper-failure.html http://www.healthdirect.co.uk/2006/04/health-deficits-are-symptoms-of-a-deeper-failure.html#comments Wed, 19 Apr 2006 11:34:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=1004 Tony Bliar once remarked that Labour’s record spending increases and reform were the last chance for the National Health Service. If they did not work, the prime minister warned, waiting in the wings were politicians who would dismantle the NHS. The reality is somewhat different. There is no ideological difference between Labour and Conservative. The real difference, in Rumsfeld- speak, is that Labour ministers know what they don’t know while the Conservatives don’t know what they don’t know.

While the opposition is in the foothills of a policy review, ministers are grappling with the toughest challenge in public sector management: how to transform the NHS from a relatively simple but obsolete supply-constrained model to a patient-driven, demand-led one.

Conceptually their vision is right; but the design capability and implementation plan to realise this vision have been missing. The Department of Health began implementing a partially designed system, leaving the rest to be worked up as it went along.

The results are reminiscent of attempts by Mikhail Gorbachev, the former Soviet leader, to reform the Soviet economy. Financial deficits, overspending and tighter rationing are symptoms of underlying systemic failures.

Midway through the five-year im­plementation of payment by results – under which hospitals and other providers are paid for what they do, rather than simply for being there – the ab­sence of proper commercial costing systems means cost data are unreliable and misleading. If financial management is weak in the acute sector such as hospitals it is worse in primary care.

Pushing economic power closer to doctors and patients with practice-based commissioning is a great idea, but one that will end in chaos if data, management skills and incentives are not properly aligned. NHS managers are drowning in policy documents and guidance notes, each pushing a new initiative. Their impact on each other has not been thought through. As the system is loosened, financial pressures and rationing are likely to intensify.

Can internal markets work? The answer is empirical rather than ideological. It depends on the circumstances and on the quality of system design.

Despite all Labour’s extra money, the Conservatives’ internal market reforms, started in the late 1980s and reversed in Labour’s first term, brought average waiting list times down faster and generated NHS output growth almost double that of Labour’s first six years.

Things started going wrong for Labour’s reforms after the departure of Alan Milburn as health secretary in 2003 and one of the prime minister’s health advisers the following year. The key factors driving change within the health department were at the political level, ministers and their personal advisers, and their vision had not been embraced by senior civil servants.

The department, like others in Whitehall, did not have the policy design capability required for system changes of such magnitude. Neither did it have the implementation skills. Without a guiding mind, there was no one person taking responsibility for implementation. The recent departure of the permanent secretary is recognition of the problem but by itself is not the answer.

As well as fresh leadership, the health department needs to remedy a traditional Whitehall failing and have its own system design and implementation capability. People also need to know where reform is heading, so ministers need to keep articulating their vision for the NHS and the improved outcomes it is meant to deliver.

There needs to be greater radicalism in aligning incentives of clinicians and other staff with improving efficiency. The government’s aim of shifting more care out of hospitals requires rationalisation of capacity. Hospital trusts sit on billions of pounds of property. Giving staff a share in the gains would facilitate capacity changes.

Regimes, it is said, are at their most vulnerable when they start to change. The NHS will not collapse of its own accord because it does not generate its own resources. By 2010, with health spending costing more than 10 per cent of gross domestic product, bailing out the NHS would have greater impact on fiscal policy and the economy than when it was 6 per cent of GDP.

But the prime minister was right in one respect. If Britain ends up with one of the most expensive healthcare systems in Europe still delivering care well below European standards, voters’ demand for an alternative model will become overwhelming.

The writer is author of The Reluctant Managers, a report on reforming Whitehall, published recently by KPMG

http://news.ft.com/cms/s/8b03111e-cf41-11da-925d-0000779e2340.html ]]> http://www.healthdirect.co.uk/2006/04/health-deficits-are-symptoms-of-a-deeper-failure.html/feed 0 http://www.healthdirect.co.uk/2006/04/childrens-hospitals-warn-of-22m-funding-crisis-in-pbr.html http://www.healthdirect.co.uk/2006/04/childrens-hospitals-warn-of-22m-funding-crisis-in-pbr.html#comments Tue, 18 Apr 2006 08:12:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=1005 Four children’s hospitals have warned health ministers they will have to cut specialist services because of miscalculations in the new Payments by Results (PbR) system championed by Tony Bliar as part of his NHS reforms. The shortfall will mean cuts in services with specialist surgical procedures most at risk the trusts claim.

The threat to specialist services for children was revealed by the Liberal Democrats, who released papers showing children’s trusts have told Labour ministers they will have to cut services because they claim they are facing a £22m shortfall in the new financial year.

The letter was sent by the chairs and chief executives of Great Ormond Street, Alder Hey, Birmingham and Sheffield hospitals. Together the four hospitals form the National Children’s Health Alliance, and they claim the proposed funding will damage the provision of cardiac surgery, neurosurgery and spinal surgery.

The news raises the risk of more criticism for Mr Blair’s reforms, already reeling under countrywide job losses and budget deficits approaching £800m.

In the letter to ministers, the trusts say: “We are extremely concerned that vital specialist paediatric capacity, particularly in surgical specialities, will be lost at regional and national level this year, which will lead to public concern.

“The new opportunities presented by choice and through payment-by-results should be benefiting young people and children, but quite the reverse seems to be the case. Our trusts are increasingly the only place of choice for parents whose children need specialist paediatric care.”

The trusts blame an “inaccurate and highly insensitive tariff”, something they claim they have sought to renegotiate with the Department of Health for 18 months without success.

Steve Webb, the Lib Dem health spokesman, claimed the letter showed the government was pushing its reform programme too fast on too many fronts, and the system could not cope.

The letter will add to fears that as many as 20,000 jobs will have to be cut from the NHS to cover the cost of the deficits.

But Mr Bliar argues that the “old monolithic NHS” will be replaced by a one that is “devolved and decentralised with far greater power in the hands of the patient.

The idea was and is to make reform self-sustaining, so that instead of relying on the necessarily crude and blunt instruments of centralised performance management and targets, there is fundamental structural change with incentives for the system and those that work within it, to respond to changing patient demand”.

It is this transition from one phase to the next that has created the “crunch point”. The reform contains four elements: practice-based commissioning, giving GPs an incentive to prevent unnecessary hospital referrals; payment by results for hospitals designed to allow GPs to know what they will be paying for operations and hospitals to know what they will receive; the patient’s right to choose a provider; and new independent providers of treatment and diagnostics within the NHS.

Andrew Lansley, the shadow health spokesman, claimed Mr Blair’s speech, only a week after a summit on trusts’ financial deficits, was another sign of panic in Downing Street. He said the department was responding to deficits by centralising control and reducing choice.

http://politics.guardian.co.uk/publicservices/story/0,,1755844,00.html ]]> http://www.healthdirect.co.uk/2006/04/childrens-hospitals-warn-of-22m-funding-crisis-in-pbr.html/feed 0 http://www.healthdirect.co.uk/2006/04/anatomy-of-a-15bn-gamble-cfhs-nhs-it-busted-flush.html http://www.healthdirect.co.uk/2006/04/anatomy-of-a-15bn-gamble-cfhs-nhs-it-busted-flush.html#comments Mon, 17 Apr 2006 08:43:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=1006 The new NHS computer system could be the biggest IT disaster in history, warn experts. Inside a leading hospital in Oxford, expensive new computers were humming away just before Christmas when disaster struck. The Nuffield Orthopaedic Centre was at the forefront of a multi-billion-pound revolution to modernise the entire computer system of the National Health Service — and the screens had suddenly frozen.

Medical staff looked on in disbelief as they tried to retrieve lost records. “We had only been running the system for a couple of days when it went down,” said one manager. “You would try to get a patient’s records which you knew were there and it just locked you out.”

Although the system was functioning again the next day, some patient files seemed to have disappeared completely. The trust was so alarmed that it sent a report to the National Patient Safety Agency, warning that it had posed a potential risk to patients.

The collapse of the system and further failures led to cancelled operations and a backlog of outpatient appointments. Bob Cullen, 57, a postman who had been referred for treatment by his GP last year, found himself in limbo.

“I was in agony and was on painkillers, as well as taking liquid morphine,” he said. “I was phoning up the Nuffield in so much pain that I hadn’t slept for days and they said ‘We can’t find you on the system’. This was meant to be a hospital with the latest computer systems for patient care and I somehow got lost.”

All new computer systems suffer from “bugs” and the Nuffield’s trust says the problems were merely “glitches”. But to critics of the NHS’s expensive new computer project, Connecting for Health (CfH), the incident was a portent of further trouble.

So concerned are experts that last week 23 senior academics in computer-related science called for a independent review of the project. They fear that the entire scheme is misconceived, overpriced and a waste of billions of pounds.

Last week NHS trusts were facing an estimated deficit of £800m. Staff are being laid off across the country; wards are being closed; patients are being denied potentially life-saving drugs. Yet at the same time the NHS is spending a fortune on a computer system that, critics say, is needlessly expensive.

Even CfH admitted this weekend that the cost of the scheme, now not due to be completed until 2010, could reach £15 billion. Outside experts suggest that £30 billion is more realistic.

It is the largest civilian computer project in the world, designed to transform the NHS into a beacon of electronic wizardry. But could it instead become the mother of all IT disasters while the country’s hospitals remain desperate for cash?

FOR more than 20 years it has been clear that the NHS needed to modernise its information systems to improve patient care and cut delays. The question has always been: how? The initial suggestion under Labour was pragmatic. After a series of reports between 1998 and 2002, advisers recommended an “off-the-shelf” solution which would upgrade and link existing NHS computer systems and buy readily available software.

However, on February 18, 2002 Tony Bliar, a self- confessed computer illiterate, chaired a meeting at Downing Street on the NHS and information technology. Alan Milburn, then health secretary, and his officials outlined a bold new plan to link up GPs, hospitals and patients on a much grander scale.

It envisaged a new NHS computer system designed from the top down to hold the records of 50m patients on one huge database. The prime minister was impressed. One of the main advantages, he was told, was the instant access that the scheme offered to patients’ records. A complete medical history could be pulled up on a screen at the touch of a button — from anywhere in the country.

Patients would be able to book appointments with GPs on their home computer and once in the surgery would choose their preferred hospital for an operation.

Hospital staff would have instant access to electronic records of any accident victim and x-rays would be electronically transferred from one end of the country to the other.

The scheme’s ambition and potential cost were staggering. Yet Bliar gave it the go-ahead without public consultation. The government initially allocated £2.3 billion for the project and boldly proclaimed that electronic records for every patient in the country would be online by the end of last year. The costs and the delays have been mounting ever since.

It is an example, say critics, of how the management consultants contracted to deliver such systems are only too happy to think big since it makes more lucrative work for themselves.

The man tasked with running the CfH project is Richard Granger, a Bristol University graduate and management consultant. A driven, abrasive character, he bought a Porsche as soon as he started earning “serious money”, lives in a large country house in Cumbria and was appointed on a salary of £250,000, making him one of the country’s highest-paid civil servants.

Few dispute the need to make improvements — but critics say that a centralised system will require vast computing power, raises questions of security and will be a nightmare if it goes wrong.

“In the system they are building, errors can get spread and copied across the network and nobody can do anything about it,” said Ross Anderson, professor of security engineering at Cambridge University and one of the 23 academics calling for an independent review of the project. “What they are proposing is a recipe for chaos and disaster.”

Helen Wilkinson-Makey, a 40-year-old manager from High Wycombe, Buckinghamshire, says that her experiences highlight the pitfalls. She discovered that an inputting error had led to her being wrongly logged as having received treatment at an alcohol dependency unit in 1998. The computerised record had been distributed to her strategic health authority, primary care trust and a local “shared care agency”.

http://www.timesonline.co.uk/article/0,,2087-2136718.html
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