The service has awarded national contracts worth £6.2bn over 10 years to create the broadband links and other infrastructure that will allow electronic records largely to replace paper ones. The programme is also steadily allowing digital images to replace old fashioned film for X-rays and scans, outpatient appointments to be booked online, and prescriptions to be transmitted electronically.

But ahead of a report on the national programme due next month from the National Audit Office, Lord Warner said he wanted to clear up “confusion in the public arena” about what the £6.2bn “does and does not cover”.

The national contracts remained on budget, he said. But they essentially covered the infrastructure and applications and not the additional local spending needed to train staff, buy computer screens, assimilate existing systems and convert data and other costs.

This, he said, “has always been the case”. To meet the cost of implementing the programme, hospitals and other parts of the system would have to use their existing spending on IT – around £1.2bn a year and rising. As a result “spending over the next decade is going to be up nearer £20bn,” Lord Warner said. “But that’s not all new money because if we did not have Connecting for Health [the national programme] the NHS would have been spending about £1bn anyway on old systems” that provided nothing like the functionality that the programme will eventually deliver.

In addition, the NHS could take advantage of a whole set of agreements covering software and hardware that allowed it to replace local systems far more cheaply than it had been able to in the past.

The minister’s offer of “clarity” on the full cost of the programme came as he conceded that plans for the national summary electronic record were between two and 2½ years late. The first deployments of the clinical record were originally due last year. But now that would not happen until “late 2007 or early 2008”, Lord Warner said.

The programme was also at a “pivotal point”, he conceded, with the government – three years in – still to get agreement with the medical profession over what would be included in the summary record, and how patients’ data would be added.

Sir John Bourn, head of the National Audit Office, has already indicated that its report will criticise the national programme for failing to engage effectively with staff.

Lord Warner said: “That is probably a fair criticism in part. We possibly could have got into the game earlier, and we could probably have done it better earlier on.”

But a large proportion of the medical profession were “in the understandable mind set – and this is not a criticism of them – of seeing is believing”.

Given the past history of attempts to computerise the NHS, doctors wanted “to see the reality” before they fully engaged, he said. This was now happening and detailed discussions were underway “about how we build up the summary record” and “what goes on to it”.?The argument, he said, “is about how we do it, not should we do it”.

The programme has been working on the assumption that patient data will be uploaded to the summary record on the basis of assumed consent, but with patients retaining the right to opt out.

The British Medical Association’s family doctors committee is now arguing that patients should be consulted individually before any data are uploaded – an approach that would make the adoption of a national clinical record much slower.

Lord Warner said family doctors “need to think about this very, very carefully because of what it means to them in the time that they will have to take with each patient to actually do that”.

He said he was confident “that we will get there”, and “good sense will prevail with the profession” with negotiations still under way on how pilots of the summary record, now planned for early next year, will operate.

Lord Warner conceded that some parts of the programme were running slower than had been hoped, partly because NHS policy had changed since the programme was conceived. However, he said they were now making good progress.

“I don’t feel apologetic about some of the missed targets,” he said. “If you don’t set some ambitious timetables you will not drive a big project of this kind. We owed it to people and the NHS to try to move as quickly as we could.” It was also inevitable “in any complex, contracting process as big as this there are going to be some tiffs with suppliers” – such as those that have delayed the care record and installation of digital imagery in parts of the country. “That’s the real world.”

http://news.ft.com/cms/s/0d6a68c6-ef4c-11da-b435-0000779e2340.html

Even taking the reduced IT cost savings which Lord Warner quotes into account, this leaves a £3.8 billion funding shortfall.

Given that there is still considerable debate about the opt- out approach to data entry further delays will only increase full development costs.

Bear also in mind that many NHS doctors and consultants do not use NHS facilities for personal privacy reasons. So will their reluctance to fully use the system may only increase their scepticism.

As few of the users- the Doctors themselves have been contacted to guage their own requirements, another train crash looks in the offing.

Hospitals and other parts of the NHS would, however, spend billions more on training staff, buying PCs and upgrading and assimilating existing systems over the decade-long programme, Lord Warner said in an interview with the Financial Times.

The extra money did not mean the programme would cost more than expected, he said, but instead reflected the full expense of switching existing IT spending from outdated systems to the new ones.

The delays to the electronic care record, which mean it may not be in place until early 2008, come in part because of delays in providing the software, which is being developed by iSoft and other companies.

But the record’s introduction is also being stalled by a fierce and unresolved dispute within the medical profession over what should be included on the national medical record, and how patients’ data should be added. Some see it as threatening to “derail” the programme.

Lord Warner said some parts of the programme “are going pretty well and pretty much to time”.

But others, he admitted, “are going more slowly than we would otherwise like”. The government has had to “re-group” over the national summary record, meant to make patients’ data available “wherever and whenever” it is needed.

The programme originally proposed that the summary record would include major diagnoses, operations and recent tests, as well as current medications and allergies. It was also proposed that patient data would be added on an “opt out” model, implying that consent to have the basic
data added would be assumed, but with patients retaining the right to opt out.

Ministers recently agreed, however, that the initial upload of data, in pilot schemes to be run next year, would cover only current prescriptions, allergies and contra-indications, and that patients would then be asked if they were happy to have other information added.

But the British Medical Association family doctors’ committee has recently rejected that proposal, saying patients’ consent should be sought even before their medications are added to the summary record.

The programme had reached “a pivotal point”, Lord Warner said, and with many hospital doctors favouring a much richer summary record, “the medical profession have to come together” to agree on what data will be included and how it is added.

http://news.ft.com/cms/s/d8aca40c-ef49-11da-b435-0000779e2340.html

Only 52 per cent of the patients said their ward had been “very clean” last year compared with 56 per cent in 2002.

Less than half – 46 per cent – described lavatories as “very clean” compared with 51 per cent three years before.

Nearly 40 per cent of patients who needed help with eating meals did not get it and nearly one in five said they never received any help.

Only 60 per cent felt there were “always” or “nearly always” enough nurses on duty.

Little progress had been made on hospital food, with 54 per cent saying it was good or very good, a third saying it was fair and 15 per cent saying it was poor. This was similar to responses given previously.

With patients spending less time recovering in hospital after surgery, another area that worried patients was the lack of information they received before they were discharged.

Two fifths received no information about side effects of their drugs, 40 per cent were given no information about “danger signals” after surgery and a quarter were given no contact number in case they were worried on their return home.

In accident and emergency departments a quarter, compared with a third three years before, waited more than four hours before being found a bed.

But most, 92 per cent, rated overall care as “excellent”, “very good” or “good” and 80 per cent said they had been treated with dignity.

Anna Walker, the chief executive of the Labour Government watchdog, the Healthcare Commission, which commissioned the survey, said hospital staff should be heartened by the fact that patients rated their care so highly.

She added: “However, patients are still sending a clear message that there is more work to do. Providing patients with the right information, in the right format and at the right time is crucial to their treatment and recovery, yet so many tell us that they are not receiving this.”

A spokesman for the Patients Association said the findings on cleanliness came as no surprise. “It echoes what we have been hearing from staff, that cleaning services are being cut, cut, cut,” she said. “When trusts face deficits they always cut from the bottom. Porters and cleaners are the first to go.”

On the question of poor information she said: “The NHS has got to learn it can’t fob patients off with petty, handmade leaflets.

“We know patients are spending less and less time in hospital so community services have to be in place when they are discharged. But this does not happen. Patients need to know what to expect. They need to know about the healing process and what to expect in one week, two weeks and in the longer term.”

Dr Gill Morgan, the chief executive of the NHS Confederation which represents more than 90 per cent of NHS organisations, said: “Cleanliness is clearly an issue of concern for many of the patients surveyed.

”This is an area that trusts are very aware of and are therefore working hard to ensure that first rate cleanliness and infection control is achieved.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/05/26/nhs26.xml

The items he requested came to £45,000. But before arriving at his new job, he realised he had forgotten to include a £15 surgical retractor, used to hold wounds open during operations.

Mr Murray decided to save time by bypassing the NHS procurement system and using eBay. But when officials found out, the retractor was confiscated.

Roy Haynes, the director of human resources at the James Paget NHS Trust, said the instrument had been checked and sterilised and posed no threat to public health. It is back in Mr Murray’s hands.

The NHS has repeatedly been urged to speed up its adoption of “eProcurement”, the purchasing of items online.

http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2006/05/22/nebay20.xml&sSheet;=/health/2006/05/23/ixhmain.html

A review of hospital procedures and an investigation into his work was launched last year.

Thousands of cases in which the consultant was involved – at Antrim Area, Belfast City and Altnagelvin hospitals – are being reviewed.

Last week, it emerged that 19 women who were patients at Antrim Area Hospital had breast cancer which went undiagnosed – despite screening.

‘National shortage’
The Northern Health and Social Services Board responded to its breast screening problem by suspending the service completely.

Now some 10,000 women aged between 50 and 64 who live in the board area have not had breast cancer checks that should be routine.

One County Antrim GP, Brian Dunn, said the suspension and inevitable delays meant some women would have undiagnosed breast cancer.

The Northern Board has admitted at least 10,000 women have not yet been invited for mammograms, and the figure is set to rise.

There is presently a national shortage of radiographers and the board was already under pressure when it suspended its service last year.

In a statement, the Northern Board said two new breast radiologists had been appointed and it expected to have three radiologists in place by the end of the summer. It said it hoped to reintroduce the breast screening programme in August.

http://news.bbc.co.uk/1/hi/northern_ireland/5013270.stm

The trust will now revise its plans for the Royal Infirmary and Glenfield sites and explore a ‘radical new approach’ for a planned care and rehabilitation hospital at Leicester General, using existing buildings, backed by modular units, which could be used to meet changing requirements in future.

The decision was announced in the same week that NHS acting chief executive Sir Ian Carruthers outlined the DoH’s approach to reviewing PFI schemes which have been stalled due to national concerns about affordability.

South Devon Healthcare trust capital developments director Richard Glenn has been seconded to the DoH to oversee the review, which should be complete in four to five months.

University Hospitals of Leicester trust chief executive Dr Peter Reading told HSJ that he supported the DoH approach and had held discussions with Mr Glenn about the healthcare model underlying its PFI proposals. But he said the ‘rigid’ application of ‘the Treasury metric’ that repayments on PFI projects should be no more than 15 per cent of a trust’s turnover meant the trust had to reduce the cost of its plans by around £200m.

‘We have always broken even – we had a £6m surplus last year. We are a three-star trust. But we are being treated the same as a trust that is £20m overspent,’ said Dr Reading.

‘The Treasury says we need to reduce the risk trusts are taking on as a 20-30 year commitment, but there is no subtlety to [reflect an individual trust’s] market situation.’

University Hospitals of Leicester trust has been working on PFI plans for five years, and had its proposals approved by the DoH in March 2005.

They were put on hold in January, amid national concern about PFIs.

Dr Reading said it would be ‘hard to be disappointed’ by the latest decision if the trust was now able to make a £600m investment in Leicester’s hospitals.

He said staff felt frustrated, but the trust was determined to use the opportunity to create buildings with ‘greater flexibility’.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4784757

Despite opposition by nurses, who fear that children could be stigmatised, the Government will weigh all those aged four to ten in the next academic year to help to prepare a national obesity map.

Parents of obese children can expect a letter telling them that their child faces long-term health problems unless action is taking to improve diet and lifestyle.

A Department of Health spokesman said that childhood obesity was an issue that had to be taken very seriously.

Caroline Flint, the Public Health Minister, has said that parents were the “first and foremost” influence on children’s health and had a key role to play.

Obesity has doubled in six-year-olds in the past ten years.

http://www.timesonline.co.uk/article/0,,2-2191563,00.html

A classic “New Labour” tactic- Labour’s centralist dictatory arrogance to overule the experts and further extend the nanny state.

Williams Kennedy, the accountancy firm, said it had been appointed as administrators and liquidators to three recruitment groups in recent weeks, including one, Worldwide Recruitment Group, with a £20m turnover. Keith Stevens, a business recovery partner at the firm, said: “This is the first collateral damage from the NHS’s funding crisis.” The service in England was projecting a £790m overspend at the end of January, with Wales clocking up a similar pro-rata deficit.

Late payment left the companies unable to meet their tax and national insurance bills, with action by Revenue and Customs then triggering bankruptcy, Mr Stevens said.

Meanwhile, Doris-Ann Williams, director-general of the British In Vitro Diagnostics Association, said a survey of members who supply pathology equipment and agents showed they were now owed “in excess of £50m” over and above the normal trading terms of 30 days payment.

This compared with a turnover for the sector of about £315m a year, she said. “We haven’t had any companies go under yet. But it is causing plenty of them problems with their cash flow.”

Some NHS trusts were now asking for retrospective discounts on last year’s prices or demanding price cuts for this year’s supplies, Ms Williams added.

“They really are looking for pennies down the back of the sofa, but it all adds up for our members who are their suppliers,” she said.

Trade bodies for companies who supply nurses, IT staff and others to the NHS said they were looking to tighten their credit control procedures with the health service to ensure they were paid more promptly.

Private sector staffing agencies have anyway been put under pressure by the service’s development of NHS Professionals, its own in-house staffing agency.

The Recruitment and Employment Federation has complained to the European Commission that the activities of NHS Professionals have put it in breach of competition law.

A few hospitals and health authorities had to borrow tens of millions of pounds from other parts of the NHS at the end of the last financial year to pay staff and suppliers. Others are having to make significant cuts in staffing to cope with reduced payments for NHS procedures which were aimed at getting the service back on a sound financial footing.

http://news.ft.com/cms/s/a3082afc-e6d3-11da-a36e-0000779e2340.html

In contrast to government announcements proclaiming record investment in primary care premises, the BMA’s GPs Committee (GPC), which commissioned the premises survey, says general practice is being prevented from reaching its potential by the way the – insufficient – funds are channelled.

Dr Hamish Meldrum, chairman of the GPC, comments: “Despite all the fine talk by ministers of money for new buildings, the fact remains that general practice is bursting at the seams. The GPC survey results paint a picture of surgeries where every conceivable space has been converted for clinical use, with consulting rooms in former storage areas and doctors doing their paperwork in the kitchen.”

Just under six in ten of the 251 UK practices who took part in the survey said their premises were not suitable for their present needs. And 182 of them (three quarters) felt their surgeries were not suitable for their expected future needs. Two thirds of the practices said their clinical staff “hot desked”. One GP wrote: “We all hot desk…on Friday we used the staff common room for flu vaccinations.” Another said: ”No clinician has their own room. I have had to move desks up to 5 times in a two-hour period.”

Dr Meldrum commented: “With such a high proportion of GP practices saying their surgeries are not suitable for their future needs there is little hope of implementing the English Department of Health’s plans to move care from hospitals closer to patients’ homes unless a significant amount of resources are set aside for practice premises development.”

If practices could extend or improve their premises, family doctors would like to provide extra patient services as well as taking on additional GPs, nurses and other health professionals to provide more appointments. “Minor surgery, physiotherapy, dermatology, counselling, taking blood for tests, and treating minor injuries were just some of the extra things practices would like to offer their patients if they had the room” said Dr Meldrum.

Evidence that family doctors have been trying to modernise their buildings is shown by the fact that over four in ten practices in the survey had found some funding for improvements in the past five years. The money came from a variety of sources including loans and mortgages, practice savings, private finance initiatives, grants and cost rent schemes that cover the interest on loans.

Many practices in the survey had had planning applications refused or were in listed buildings in a conservation area, making successful planning applications unlikely. “Others had already extended as far as was possible or had no room to expand on their current site”, said Dr Meldrum.

One practice reported: “There are days when there are not enough rooms to allow all the doctors to consult. The extra doctor sits in the kitchen/typing room and works through mail. Another said: “We were hoping to move many years ago and have asked for Primary Care Trust help with funding for the last 8 years at least.”

Lack of space is hampering practices from training the next generation of GPs: Only 46% of practices felt they had enough room to provide training for GP registrars. Worryingly, over a third of the practices responding were unable to make the necessary adjustments to their premises to ensure compliance with the Disability Discrimination Act. A quarter of respondents felt their practice premises posed some risk to the health and safety of their staff and or patients. Cramped conditions also meant that confidentiality was an issue.

Dr Meldrum said: “If the government is serious in its intentions to transfer healthcare out of hospitals and into the community it has to recognise that we need somewhere to treat these patients. General practice premises are very clearly overstretched. The money for premises has been too little, too late, and with too many strings attached. What is needed is a longer-term commitment to regular revenue funding so that GPs can seriously plan for the 21st century.

One-off PFI or capital assistance schemes might provide a short-term political fix but GPs want to plan for the future. That means recognising the need and providing for the cost of being able to give patients the primary health care they need in the environment they deserve.”

http://www.bma.org.uk/pressrel.nsf/wlu/SGOY-6PQHSY?OpenDocument&vw;=wfmms

Medical students and doctors in training say they are often subjected to bullying as part of an “initiation rite” into medicine.

A recent BMA survey of medical students found one in four said they had been bullied by other doctors, while 16% had been bullied by nurses.

Staff grade doctors, associate specialist doctors and staff from overseas were particularly vulnerable to workplace bullying and harassment, the BMA said.

The most common forms of bullying included attempts to belittle and undermine work, withholding necessary information, removing areas of responsibility without consultation and setting impossible deadlines.

It says reports of incidents are increasing, perhaps because people are less prepared to tolerate such pressures than they used to be.

The BMA adds that one on four staff have been bullied or harassed by patients and their relatives.

The BMA is calling for all NHS organisations and medical schools to have policies for dealing with bullying and harassment at work, and support for those affected.

It is also urging people who are aware that others are being bullied or harassed should feel empowered to challenge the situation or report it to a senior colleague.

Dr Sam Everington, Deputy Chairman of the BMA, said: “The cycle of bullying in medicine has to stop. It’s not good enough for a senior doctor to think that he or she had a hard time and was humiliated as medical student so it’s justified for them to dole out the same treatment.

“It’s not just students and juniors who are bullied. Consultants can be bullied by their peers and by managers. The highly pressurised target ethos in the health service only adds to the survival of the fittest culture where bullying is often seen as a way of motivating staff.”

Dr Everington added: “Turning the tide of bullying in the NHS will not only be good for staff but also employers because stressed health professionals end up taking more time of work and will be more likely to leave the health service. It makes economic sense to tackle this problem.”

Alastair Henderson, deputy director of NHS Employers said bullying and harassment was a recognised problem in the NHS but that the situation was improving.

He added: “The BMA is right that bullying has to stop. As the largest employer in the UK, it is vital that the NHS has a culture where any form of bullying and harassment is not tolerated. This is a concern across all staff groups. Tackling this problem is at the top of our agenda.”

http://news.bbc.co.uk/1/hi/health/4992906.stm

The court was ruling in the case of Yvonne Watts, 75, of Bedford, who paid £3,900 for a hip operation in France. But it said in her case UK courts would have to decide if she got a refund.

Mrs Watts said the news was “wonderful” and that if she got the money back she would donate it to a medical charity.

The case, which centres on the definition of “undue delay”, could have a significant impact on the NHS. It will allow any patient facing an unacceptable delay who has the funds to pay for an operation upfront to seek treatment abroad and recoup the costs from the NHS.

The Department of Health said it did not expect the judgment to make a big difference to the numbers travelling abroad to receive hospital treatment. But it has already said it would be issuing new guidance on the issue in June.

Mrs Watts said: “I welcome it for what it means for other NHS patients. That’s why I did it. If other people have to have hips done and have to go abroad, they’ll be encouraged.”

Her solicitor, Richard Stein, said their victory would now act to regulate possible cutbacks in the NHS and increases in waiting times caused by financial constraints. It should also help to make sure that the concept of “undue delay” was based on a medical decision, not just an arbitrary timeframe.

NHS treatment abroad:
The European Court of Justice in Luxembourg was asked to rule on the case after the English Court of Appeal sought its guidance. The ECJ said the UK government wrongly interpreted patients’ rights to access services in other EU countries.

It said just because waiting list targets had been met did not necessarily mean that a patient had not had to wait for an undue length of time for treatment.

Instead primary care trusts must ensure a patient’s waiting time “does not exceed the period which is acceptable in the light of an objective medical assessment” of clinical need.

‘Flexible targets’
The court added the degree of pain the person is in and the nature of his or her disability must be taken into account. Also waiting time targets must be set “flexibly and dynamically” and reassessed if there is a deterioration in condition.

As authorisation for reimbursements of costs was usually sought before treatment was obtained, the primary care trust would be the body to decide on whether the patient was facing an undue delay.

However, the court found that it was for the British courts to decide whether Mrs Watts faced an undue delay and thus whether she should recoup her costs.

http://news.bbc.co.uk/1/hi/health/4985190.stm

In the first study of its kind to calculate the financial burden of cardiovascular disease (CVD), analysts found that the UK is spending more healthcare money on the condition than any other European country. They said that more effort and money should go into preventing CVD through diet and exercise rather than current policies which have focused on improving access to drugs. In Britain, more people die of coronary heart disease and strokes than cancer.

Peter Weissberg, medical director of the British Heart Foundation, said: “This study should stimulate policy-makers to reconsider public health measures to reduce the massive burden of cardiovascular disease in the UK.

“The unfortunate thing is that we know much of this disease burden could be reduced or even abolished with appropriate public health measures such as reducing smoking, increasing opportunities for exercise and improving the nation’s diet.

“Although it might be expensive to provide facilities such as playing fields and gyms, today’s research shows that it is much more expensive not to.”

Britain has one of the world’s highest rates of CVD, which covers a range of illnesses including coronary heart disease, strokes, angina and hypertension. Researchers from the Health Economics Research Centre at Oxford University calculated that the NHS spent £15.7bn on treating CVD in 2004 – 21 per cent of the entire health service budget. Germany spends 15 per cent of its health budget on CVD while France spends just 8 per cent.

Almost 70 million working days were lost due to the diseases and, with other costs to productivity, this added up to £7bn.

When the economic burden of informal care for people with CVD by their relatives was included, along with other factors such as private healthcare bills, the total cost to the UK was £29.11bn a year. The study, published in the medical journal Heart, concluded: “Our study highlights the public health problem CVD poses in the UK in terms of economic burden.”

The Government has pledged to reduce deaths from coronary heart disease by 40 per cent by 2010. Heart deaths fell by 7 per cent in 2004 and experts say progress is being made on treating the diseases but not enough is being done to prevent them.

In an accompanying editorial to the Heart study, Dr Georgias of the Norfolk, Suffolk and Cambridgeshire Strategic Health Authority warned that the costs of CVD were likely to rise, despite the falling death rate.

He said that rising rates of obesity and the associated increase in adult-onset diabetes will both impede the progress being made on heart disease and strokes.

Only a third of men and a quarter of women take the recommended level of exercise and more than half of adults are overweight or obese.

The fall in deaths has been achieved mainly through a massive rise in the prescribing of the cholesterol-lowering drugs, statins. Thirty million prescriptions for the drugs were written in 2004 – double the number in 2001. Medicines for CVD account for £2.77bn of the £15.7bn spent by the NHS and are second only to in-patient hospital stays in terms of healthcare costs.

Statins cuts the risk of a heart attack by up to 30 per cent, but health experts are worried that many people are simply popping pills to manage heart disease rather than changing their unhealthy lifestyles.

Keith Jackson, chairman of the British Cardiac Patients Association, said: “People could do more to manage heart conditions and prevent heart disease through having a better diet and more exercise. Statins are a poor alternative and should not be seen as a fallback. We need a greater emphasis on preventative measures when tackling cardiovascular disease, and need to get the message across that this improves quality of life.”

But Dr Shyam Kolvekar, cardiac surgeon at University College Hospital, London, believes that younger people are more aware of protecting their health.

“People in their twenties and thirties are more image conscious and spend more time exercising, while the people we are treating now are older,” he said. “We are on track to deal with heart disease but the effects of the changing patient population and the use of statins will not be seen for another 10 years.

“We are getting more proactive so all patients who come in for surgery, even if they do not have high levels of cholesterol, will be given statins.

“If a patient with heart disease is treated well, they will be able to play a functioning part in society – they can continue to work and lead a full life.”

A spokeswoman for the Department of Health said that reducing heart disease was a “top priority” for the Government and death rates had fallen by 31 per cent between 1997 and 2004.

http://news.independent.co.uk/uk/health_medical/article484112.ece

She won with 2,176 votes, a majority of 700 over the second placed Liberal Democrats. ‘Health was the major issue in the election in this ward’. ‘The Liberal Democrats even tried to cash in by calling themselves Liberal Democrat Campaign Against Hospital Cuts.’

The Save Chase Farm Hospital Party won two seats on Conservative-controlled Enfield council. It fielded nine candidates who are opposed to proposals to close the hospital’s accident and emergency service as part of a wider reconfiguration. A total of 12,456 people voted for the party whose policy is opposition to the closure of A&E; and to any changes to existing women and children’s services.

In a statement of intent the party’s founder, Scott Wilkinson, said: ‘We’re sad to say that we just don’t feel either major political party has done enough to fight the ludicrous closure proposals.

‘We didn’t want to take this fight into the political arena, but given the lack of real action from most councillors we don’t see any alternative.’

The Independent Kidderminster Hospital and Health Concern Group gained one new seat on Wyre Forest council and is now the second largest party after the Conservatives.

The council is now under no overall control.

Last week senior NHS managers were appointed as chief executives in eightout of 10 strategic health authorities. But two positions, which carry basic salaries of £150,000 to £170,000, are to be readvertised after it was decided that none of the applicants was good enough.

That happened in spite of widespread advertising, which succeeded in attracting some applications from the private sector and from elsewhere outside the NHS.

Exploratory talks have been held with figures in the US whom it is thought would bring some of the commissioning skills that the service needs as it begins to act more as a giant insurance and health purchasing system and less as the direct provider of all services.

An outsider, however, would be taking on a service with an overspend in the past financial year that is expected to reach several hundred million pounds. Ministers acknowledge big restructuring of some hospital services will be needed. But the prospect is that the increases under way in NHS spending will slow markedly after 2008.

The health department said it had not been decided whether to keep the NHS chief executive job separate from that of the department’s permanent secretary, or to remerge the jobs in to the single post that Sir Nigel Crisp held. Lord Warner, the minister for health reform, said in a recent interview that there was a good case for keeping the two separate.

http://news.ft.com/cms/s/408203c4-de2e-11da-af29-0000779e2340.html

The BHF puts this down to breakthroughs in prevention, care and treatment including the development of new drugs called statins, pace-maker technology and clot busting medicines.

The BHF statistics from 2004 reveal huge regional differences in death rates from the disease.

Fewest men die in south-east England at 138 per 100,000 and the fewest women in the South West at 40 per 100,000.

Country by country, Northern Ireland has the second highest rate of deaths from coronary heart disease among men after Scotland, with 194 deaths per 100,000.

Wales has the second highest rate for women at 69 per 100,000.

England has the lowest death rates at 167 per 100,000 for men and 54 per 100,000 for women.

The figures show efforts to tackle the disease over the last 10 years have paid off with steady falls in death rates across the UK.

But these are less steep in Scotland than in England, Wales or Northern Ireland

Heart and circulatory disease continues to be Scotland’s biggest killer, claiming nearly 21,000 lives or a third of all deaths in 2004. More than 11,000 of these were women – 3,000 more than the number who died from cancer.

And while fewer are dying from coronary heart disease in Scotland, more people are living with it.

BHF’s director of prevention and care Dr Mike Knapton pointed out that Scotland had cut premature deaths among women by half between 1994 and 2004.

He said lifestyle measures such as messages on healthy diets, exercise and giving up smoking were getting through but he added: “It must not distract us from the big strides that still need to be made in tackling the root causes of coronary heart disease.”

Scottish Health Minister Andy Kerr said Scotland was well on the way to meeting its targets for reducing deaths from heart disease and stroke.

“However, there is still more to be done, we will continue to target our work towards deprived communities to identify and treat the risk factors surrounding illnesses such as CHD and stroke.

“Stopping smoking is the single biggest step anyone can take to improving their health, the potential benefits to the health of the people of Scotland now the ban is in place are enormous.”

A spokeswoman for the Department of Health, which runs the NHS in England, said it was well on the way to meeting targets to reduce deaths from cardiovascular disease by 40% by 2010. She added that if current trends continue this target may be met as early as 2008.

http://news.bbc.co.uk/1/hi/health/4753547.stm

Last night, the RCM’s general secretary, Dame Karlene Davis, said: “Mothers need to be reassured that they will have the caring support of the midwife they know, and in the situation which best suits their family. This is very important and if the knee-jerk reaction to funding is to freeze recruitment and further reduce the number of midwives, then everyone can see it makes it difficult to achieve.”

They follow revelations in Health Direct that overspending on NHS salaries is £610 million – double the amount previously admitted by ministers – and that chief executives at debt-ridden NHS trusts have received pay rises up to 12 times the rate of inflation.

A quarter of the 92 heads of midwifery at hospitals in England surveyed by the RCM said that staffing numbers had been cut. The study also found that 10 per cent of hospitals have made midwifery staff redundant despite the RCM’s belief that the NHS is already short of 10,000 midwives.

Some of those questioned said that, despite Government guidance that the “gold standard” of care should mean that women in labour get one to one treatment, midwives are now expected to deal with three or four births simultaneously, leading to complaints that mothers are being left to “fend for themselves”.

To make matters worse, more than a quarter of those questioned said that junior midwives were being pushed into senior posts, while midwifery assistants – less qualified than midwives – are carrying out tasks normally given to junior midwives.

The research also reveals that, because of financial or safety concerns due to a lack of staff, seven per cent of trusts are closing a birth centre on either a temporary or permanent basis while eight per cent said that maternity wards had been closed, although in some cases this was part of “planned reconfiguration” of services.

Dame Karlene said: “Funding deficits are definitely making it harder to implement government policies including manifesto commitments around choice for women over where and how they give birth and one-to-one support throughout pregnancy.

“Our members have embraced changes such as shifting services closer to where patients live and providing a more diverse range of services – but funding deficits are making it harder for our members to implement these policies.”

Midwives hope that Miss Hewitt, who escaped Tony Blair’s reshuffle cull, despite being heckled at both the Unison and Royal College of Nursing conferences last month, will listen to their concerns.

An RCM source said: “We are hoping that because she’s had a rocky ride she is going to be less gung-ho with us. Efficiency savings and giving people the care they want don’t go hand in hand, and there has to be a recognition of that.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/05/07/nbaby107.xml

Most GPs opted out of the organisation of the service in 2004, and PCTs took over in 90% of cases. Labour ministers said the new arrangements were already benefiting patients.

It follows a National Audit Office report which found serious shortcomings with the handover arrangements – but said patient safety had not been compromised.

“This new way of providing out-of-hours medical care has so far been a costly mess” said Edward Leigh the Chairman of the public accounts committee.

PCTs had little experience of running such services and were poorly prepared for the transfer between April and December 2004, the NAO said.

Consequently many contracts were signed late or not at all. Where external providers took over the service, contracts were not signed in two thirds of cases by September 2005.

This led to insufficient monitoring of official service standards, the NAO said.

Only a minority (15%) of PCTs could confirm that key targets on responding to emergency calls were being met.

Among other missed targets, the NAO report found only 21% of trusts could show they gave a face-to-face consultation at a patient’s home within one hour for urgent cases.

About a quarter could prove they did so for less urgent cases within six hours.

NAO director of health Chris Shapcott explained that around half simply did not have the information – which made it difficult to be sure that patients’ safety had not been compromised.

“The view of the PCTs and providers that we spoke to was that it was not compromised, there was no evidence of increased complaints, but what there was evidence of was some very long delays.”

Although the NAO said the service was now beginning to reach a satisfactory standard, one in five patients were still not satisfied.

The report also raised concerns about the costs of the new service which rose from the Department of Health estimate of £322m to £392m in the first year.

The financial impact of this increase in cost has been considerable for PCTs, the report said.

Chairman of the public accounts committee Edward Leigh said: “The new way of providing out-of-hours medical care has so far been a costly mess that has left many sick people waiting too long for help.”

Public health minister Lord Warner said officials would work with the NAO to improve the efficiency of evening and weekend cover but stressed the old system was unsustainable.

PCTs would be told to draw up action plans for improvements and offered “master classes” to ensure they grasp the changes needed, he added.

“The NAO report confirms that the NHS is on the right track towards providing quality round-the-clock GP services with high levels of patient satisfaction with the new arrangements.”

Dr Hamish Meldrum of the British Medical Association agreed the old services were unsustainable – but said it was unacceptable for patients to face delays. Better integration of services and planning was needed, he said.

Jo Webber of the NHS Confederation, which represents 90% of health service organisations, said that 80% of patients were satisfied with the service.

She added that PCTs were learning rapidly from experience gained during the first year of commissioning and that the report would help that process.

http://news.bbc.co.uk/1/hi/health/4969462.stm

John Bacon, a Conservative MP and leading member of the Commons public accounts committee, which condemned the gains made at Norfolk and Norwich as “unacceptable”, said: “I am sure we will be taking a closer look at the secondary market and its impact.”

David Metter, the chief executive of Innisfree, which has a 25 per cent stake in the Norfolk and Norwich hospital project, defended the refinancing. It was an early deal, said Mr Metter, struck in 1998 when interest rates were much higher and banks saw the PFI as much riskier than they do now.

That combination of circumstances, he said, had indeed “given rise to some very large refinancing gains of which Norfolk and Norwich was one”.

But those big gains – £95m for the Octagon consortium, which built and runs the hospital, after it had given the hospital a £34m share under the Treasury’s voluntary code of conduct – had to be offset against losses elsewhere, he said.

He noted that John Laing, a member of the Octagon consortium, had lost £80m on the PFI contract for the National Physical Laboratory, a loss that contributed to the destruction of its construction arm.

Most of the other members of the consortium ran for cover in the face of the committee assault. But Mr Metter, who is chairman of the PFI trade body the PPP Forum, said such volatile gains and losses now looked to be a thing of the past as the PFI market had matured and interest rates had fallen.

According to the National Audit Office, up to February this year there have been 47 refinancings, most on the first 500 deals where the public sector gets roughly a 30 per cent share of any gains under a voluntary code. On deals signed since July 2002, the public sector is contractually entitled to a 50 per cent share.

Those 47 refinancings have resulted in internal rates of return for the private investors ranging from a mere 10 per cent to more than 70 per cent on Debden Park school and the Bromley PFI hospital and to returns of 56 and 60 per cent on the Darent Valley and Norfolk and Norwich hospitals respectively.

The NAO has warned that refinancings carry risks for the public sector, often, as in Norfolk and Norwich, in longer contracts and bigger termination costs, plus the theoretical risk that providers will run the contract less well when they have taken big early profits from it.

Mr Metter said refinancings were becoming rarer because market conditions had changed. Furthermore, he said, the “private sector has been frightened away to some extent because of the bad press that has come with Norfolk and Norwich and some of the others. People see that it has not been helpful to get this kind of flak”.

Instead, investors have increasingly been releasing money through the so-called secondary market, selling on their equity shares in projects.

That, he argued, like the refinancings, released cash for investment in future PFI projects, keeping the show on the road.

People investing in secondary funds were also investing for long-term income, he said – 30 or 40 years – and had less interest in taking their gains out early, as has happened in the refinancings.

However, there are signs that the National Audit Office is becoming increasingly concerned about the secondary market. Last week it pointed out that the ownership of 40 per cent of a sample of 102 projects that it had examined had changed hands.

“Profits and losses are not disclosed,” the NAO said, “because the contract is between two private sector parties.” But it still called for greater transparency so that the “full range of costs and benefits which investors experience” from being involved in PFI became clear.

Mr Bacon said any takeover “represents a moment of change for a company and could have a large impact on the operational effectiveness of the services provided. If it happened frequently it could damage operational effectiveness seriously.

“At the very least, there needs to be much greater transparency about what is going on in the secondary market. If there is nothing to hide, why hide it?”

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Norfolk and Norwich is one 47 refinancings of schools, hospitals and other PFI projects up to February this year that in some cases have seen rates of return double, triple, or – in this case – almost quadruple compared with the expected returns just before refinancing.

The five, who make up the Octagon consortium that built and runs the hospital, made gains of £95m but left the hospital with extra potential liabilities of up to £257m should it need to terminate the contract early, according to the Commons Public Accounts Committee.

The gains came from borrowing more at lower rates of interest over a much longer period than the original deal and allowed Octagon to more than triple its original expected internal rate of return from 19 per cent to 60 per cent.

As a consequence, the Norfolk and Norwich NHS Trust is committed to the contract for 39 years rather than 34 even though the committee noted that it was “impossible to predict that far in advance the nature and extent of services that may be needed.” If the contract were terminated early, the hospital might have to pay up to £257m more.

The refinancing produced gains of £129m. The NHS Trust, which had no contractual right to a share, received £34m under a voluntary agreement on refinancings negotiated by the Treasury. However, to receive even that, the trust accepted liability for all the £106m in extra borrowing that the consortium undertook.

“This is taxpayers’ money,” Edward Leigh, the committee chairman said, “and the risk of this large liability was incurred essentially so that investors could have fatter returns”.

The deal is “the unacceptable face of capitalism,” Mr Leigh said. “It is hard to escape the conclusion that the staff managing the project were not up to the rough and tumble of negotiating refinancing proposals with the private sector.”

Such deals, however, are being replaced by sales of the equity in projects through the so-called secondary market.

Last month, however, the National Audit Office called for more figures on gains from such transactions to be published.

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The health service overall is at least £600m in the red with hospitals largely responsible for the overspend.

But the government denied accusations it did not care about mental health, saying it was one of its priorities.

Traditionally, different parts of the NHS have helped out neighbouring trusts which have run up deficits.

But the Tories said it was particularly unfair to take resources from mental health trusts which already ran a “Cinderella service”.

Shadow health minister Tim Loughton said 58% of trusts had had to close wards, while four out of five had introduced recruitment freezes. These cuts are the final straw for mental health services which are already the poor relation of the NHS.”

“Many of these trusts are having to sacrifice parts of their budget when they have already had to shelve plans for further mental health provision in an effort to balance their books in the first place.”

Liberal Democrat health spokesman Steve Webb added it would mean services were “cut to the bone”.

But Louis Appleby, the government’s mental health director, said it would be wrong to say people were being put at risk.

He said 11 out of 84 mental health trusts were being asked to make cuts, but added he was “not happy” with the situation.

Health Minister Rosie Winterton said: “Mental health remains a key priority. There is no evidence to suggest mental health services are being disproportionately affected.”

http://news.bbc.co.uk/1/hi/health/4956158.stm

The full implications for the public purse of that error, reported by The Sunday Telegraph last week, can be revealed today. There are now fears that funding for frontline NHS care may have to be diverted in years to come to cover the cost of the missing pension billions.

The admission on the extent of the crisis was quietly released by the Treasury in a document placed in the House of Commons library. It contains the Government’s latest estimate – £530 billion – of how much it will cost to pay the pensions of all current and former public sector staff until they die.

But the most striking rise is the extra £7 billion on the cost of NHS pensions over the past year – which makes up the bulk of the £10 billion overall increase in public sector pension costs.

The document says: “Of this £10 billion, over £7 billion is attributable to the NHS schemes, mostly as a result of the Agenda for Change programme and the implementation of new GP contracts.”

Agenda for Change is the name for a tranche of pay rises for NHS staff implemented in December 2004.

This contract was overspent by £220 million, while a new work deal for GPs cost an extra £300 million, and consultants a further £90 million. Because of the deals, the NHS’s pensions liability has overtaken that of teachers as the biggest in the public sector and has ballooned from £72.2 billion to £128 billion in five years.

Public sector pension schemes do not own investments, as private and company pensions do. Instead, the liabilities are calculated and paid from tax revenue.

Last night, the Conservative health spokesman, Andrew Lansley, said: “Clearly, this is a consequence they did not calculate and it’s a consequence which, for the generation ahead, will impact on the NHS and hospitals, making it increasingly difficult for the health service to sustain improvements in services.”

NHS liabilities are just one feature of the public sector pension crisis. Those of the Civil Service, Army and teachers’ pension schemes are also climbing alarmingly. Total liabilities of all public sector pensions rocketed to £530 billion by the end of March, a 15 per cent rise on the previous year, according to the Treasury document.

The Government is already facing a huge headache over pensions. Last year, union pressure forced a humiliating climbdown on an attempt to reduce the cost to the taxpayer by requiring teachers and health workers to work until 65, rather than 60, as at present. But even that initiative would have saved only £13 billion over the next 50 years.

Stephen Yeo, a senior partner at the actuaries firm Watson Wyatt, calculates that the new GP contracts and other NHS awards have added as much as £14 billion to the public pension liability.

“These figures are astonishing,” said Mr Yeo. “Just one year of NHS pay rise has cost the taxpayer more money than the Government would have saved if it had raised the public retirement age from 60 to 65.”

A spokesman for the Treasury last night said that the cost of public sector pensions would increase “marginally” over the next 20 years from 1.5 per cent to 2.1 per cent of gross domestic product.

http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2006/05/01/nhs30.xml