Some trusts have imposed recruitment freezes because of mounting deficits.

The Department of Health said jobs existed for newly qualified nurses but they needed to be flexible on location.

The department described the survey as “limited” – and said it ignored the fact that the number of nurses working in the NHS had increased by 85,000 since 1997.

The Council of Deans, which represents health faculties and did the research, said the situation was very serious.

Student debt
It warned of significant consequences for unemployed nurses who have incurred considerable student debt, and fears course applications may be affected by the bleak outlook.

The Royal College of Nursing said the figure was “shocking” and nurses are desperately needed, despite NHS job cuts.

The survey also suggests only a quarter of students who have already graduated from one London university have found work.

And just 5% from a North East Midwifery faculty have secured a post.

The Department of Health said as a consequence of measures taken to reduce vacancy rates, there was now more competition for jobs, it added.

http://news.bbc.co.uk/1/hi/health/5127668.stm

Health Direct noted that in Scandal of the jobless doctors the British Medical Association warned that many junior medics will be left without a job when their contracts expired.

The BMA’s survey of recent graduates – who each received around £250,000-worth of training – found many without work were now considering leaving the country, switching career, or even claiming unemployment.

It is not just Doctors and nurses that will be potentially be left with huge student debts having been given false promises by Bliar.

The decision at the annual representative meeting in Belfast went against the leadership, which had been a fierce critic of elements of the reforms but had worked to maintain a dialogue with ministers.

The 600 doctors at the conference said the BMA now “actively opposes the government’s plans”, stating “there should be no further involvement of the commercial private sector in providing NHS care”.

The government is inviting bids from the private sector to commission healthcare and run family doctor services, establish a new wave of independent treatment centres and commission a new set of diagnostic services. It is also promising the private sector greater involvement in
pathology.

The conference demanded that the association’s council campaign for “an integrated, publicly provided, health service in England”.

Fundamental values “cannot be maintained if the NHS is broken up and tendered to private corporations”, the doctors said, urging their leaders to explore the system in Scotland and Wales, with no split between purchasers and providers.

A rambling and at times contradictory statement was referred to the association’s council for action rather than formal passage – an approach that will leave the council leadership with some room for manoeuvre.

But it means the BMA will go into talks with Patricia Hewitt, health secretary, next week opposing core parts of the policy when ministers hoped the meeting would induce doctors and nurses to make the reforms work. Government policies, the meeting declared, were “incoherent” and damaging patient care.

Andy Burnham, health minister, said the BMA “are entitled to their views” but ministers were determined to continue a “constructive dialogue” with clinicians.

The BMA’s call came as hospitals in Southampton announced more than 500 job losses, taking the total in England in recent months to about 17,000 as NHS organisations seek to balance their books and reshape services.

Most are cuts in posts rather than immediate redundancies. But Mr Miller said about 20 trusts were, or are, seeking to make doctors redundant, with two gastro-intestinal surgeons in Oxford already given notice.

In Bournemouth, the local foundation trust has turned patients away because it says its local primary care trust will not pay for them.

James Johnson, chairman of council, warned earlier in the week that if the BMA simply demanded that the government drop all its policies “the conversation will be a very short one and you won’t be asked back”.

That would leave the BMA with “no influence whatsoever” on policy, he added.

http://www.ft.com/cms/s/4ff6710e-070b-11db-81d7-0000779e2340.html

Health Direct notes that coming on top of the recent mauling given to Labour’s Health Secretary by the normally placid Royal College of Nurses on Thursday, April 27, 2006 Angry RCN nurses drown out health minister the double insult of the BMA members votes against Labour’s reforms means that the Labour govt has an even harder task in implementing their new IT system and the contracting out health services.

While the UK came top for patient information, Health Consumer Powerhouse said weak spots included MRSA infections in hospitals, waiting times for scheduled care, lack of right to a second opinion and high level of breast cancer mortality.

The conclusion was that the United Kingdom is a “Mediocre” overall performer. Good on heart problems. Star performer on healthcare information. The new Freedom of Information Act will hopefully improve score on openness indicators.

Content summary
France emerges as the 2006 winner of the Euro Health Consumer Index (EHCI), with a technically efficient and generously providing healthcare system. France scores 576 out of 750 maximum points. It is sometimes argued that “the French healthcare system has severe budget deficit problems”. The author would like to note that budget deficits in public sector areas, which are not financed for performance and work in a situation of competition, are more or less arbitrary! As long as “France, S.A.” is reasonably solvent, black or red figures in its healthcare system are not very significant.

The scoring has intentionally been done in such a way that the likelihood that two states should end up sharing a position in the ranking is almost zero. It must therefore be noted that France, the Netherlands, Sweden, Switzerland, Germany and Luxembourg are really very difficult to separate, and that very subtle changes in single scores modify the internal order of these six top countries.

One interesting thing about the top six states is that they achieve their top positions in very different ways. Sweden reaches 4th place almost entirely because of a solid victory in the Outcomes quality discipline, and with very poor performance on Accessibility.

(Radically improving Medical Outcomes is a much more laborious and much longer process than reducing waiting times.) This means that if healthcare officials and politicians took to looking across borders, and “steal” good things from their EU neighbours, there is a good chance for a nation to come much closer to the theoretical top score of 750.

In southern Europe, Spain and Italy provide excellent healthcare services. Real excellence in southern European healthcare seems to be a bit too much dependent on the consumers’ ability to afford private healthcare as a supplement to public healthcare for these countries to reach top scores.

A mixed performance is shown by the UK, which wins out on healthcare information. The overall U.K. score is dragged down by waiting lists and uneven quality performance.

The full Euro Health Consumer Index 2006 pdf is available for your delicatation.

One of the surgeons, Simon Cole, is a former president of the Association of Surgeons in Training, while the name of the other has not been disclosed.

Jonathan Fielden, deputy chairman of the British Medical Association’s (BMA) consultants’ committee, said: “This is a deplorable step that shows the state of the financial crisis that many trusts are in. This will have a significant impact on patient care.”

A trust spokeswoman confirmed the trust had to save £33m this year, adding: “A review indicates, among other things, a reduced number of gastrointestinal procedures. We are, therefore, matching our capacity to the reduced use of this service.”

The move comes as Debbie Abrahams, chairwoman of Rochdale NHS Trust, disclosed this weekend that she was resigning her post because of her anger at the use of private health companies in the NHS.

http://www.timesonline.co.uk/article/0,,2087-2242594,00.html

We are due for a lively week as at this week’s BMA annual conference its chairman James Johnson is expected to say the government’s NHS reforms have delivered poor value for money. His research indicates that despite massive funding increases there has not been a dramatic improvement in patient care. “The NHS has got better, but not commensurately better, for the very large amounts of money spent.”

Hospitals in London, the south-east, the Midlands, Hull and the south-west are replacing their medical secretaries with staff employed overseas by private British dictaphone companies who pay 6.5p a line to transcribe doctors’ notes and email them back to hospitals.

Unison accused hospital trusts of putting lives at risk because of typing errors by staff thousands of miles away who are not able to cross-check the information by accessing a patient’s medical history or talking to a consultant.

Dave Prentis, general secretary of Unison, said: “Lives are being put at risk by hospitals desperate to save money. Medical secretaries work to 99.8% accuracy and once phased out their knowledge and expertise will be lost for ever. They have years of experience and are familiar with the consultants and their patients.”

The union says it has evidence of an incorrect incident report which led to a patient being given the wrong treatment, and has examples of other typing errors in the private transcription services which could lead to life and death decisions.

One example shows that hypertension has been confused with hypotension, meaning the wrong treatment can be life threatening. Other examples show known malignant confused with non-malign, the former meaning a cancerous growth, the latter a benign growth; a septic confused with aseptic, the first meaning infected, the second clean; and ectomy with -octomy, the former requiring removal, the latter meaning an incision.

The switch to using private companies – some offering free trials – comes as some hospital trusts face big deficits. The union says the former health secretaryJohn Reid pledged not to introduce such an economy measure.

Patients are also entitled to object and ask that their notes are not transcribed abroad, though a request by one patient in Southampton was ignored.

After protests from Unison, the Cambridge University Hospitals NHS Foundation trust, which includes Addenbrooke’s hospital, has dropped its plan to outsource to the Philippines where overseas staff are being paid 44p an hour.

Hospitals in Hertfordshire have gone ahead with the scheme, threatening one-third of all 160 medical secretaries with the sack. Other big hospitals trialling the service include Hammersmith, Charing Cross, Stoke Mandeville, St Mary’s Paddington, the Whittington, the Norfolk and Norwich and the Royal Cornwall.

Private outsourcing company Uscribe promises to cap and reduce the cost of wages and save a hospital the cost and time of recruiting and training staff and any overtime payments.

http://www.guardian.co.uk/guardianpolitics/story/0,,1803029,00.html

How can anyone have any confidence in the security and functionality of the forthcoming Patient Records IT system when overseas outsourcing appears to be on the rise?

Please also see Saturday, January 14, 2006 Doctors worry about cost and privacy concerns in NHS’s IT plans and Monday, June 05, 2006 £20bn computer left NHS patients waiting longer

‘I want to stimulate a debate about dignity in older people and the disabled. It has to be integral to how we are seen to support people in the modern world.’

He admitted that last month’s reshuffle had caused some destabilisation, but he said the health service and local government now had to move forward rapidly to make a reality of the white paper.

Mr Lewis said that too often primary care trusts and councils ‘go through the motions’ of setting up partnerships as if just ‘sitting round tables and producing strategy documents’ was enough.

He called for more PCT funding on prevention – such as £25 on griprails in people’s homes which would help prevent falls.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=5007746

Classic Labour tactic this. Ivan Lewis’s caring, sharing government announces a laudable new spin policy for caring for the elderly and frail. Brilliant

He then lambasts everybody else for not delivering his policy- when it’s his own fault because the Labour govt has not put a single new penny of money into the pot to pay for the new initiative.

Where is the money to pay for the £25 griprails that you mention- let alone the extra nurses that you want to police your dignity policy, Mr Lewis?

Please also read: Friday, April 21, 2006 Chief execs should ‘take the rap’ if elderly failed on dignity and Wednesday, August 17, 2005 False illusions of haute-couture health care

NHS Alliance chair Dr Michael Dixon said around one in five PCTs were understood to have signed up to PBC, ahead of the government’s end-of-year deadline.

Meanwhile, the restructuring of PCTs and efforts to claw back deficits meant they were unable to ‘commit the necessary resources to the implementation of PBC’. A majority of practices taking part in the workshops said they were still waiting for their indicative budgets.

The workshops revealed that information and data from PCTs on PBC is ‘typically poor, in the wrong format or does not exist’.

Dr Dixon said there was still a ‘hearts and minds issue’ about PBC engagement. He said many clinical staff ‘knew the government wanted them to do it and knew it was about saving money’ but had not been persuaded of the ‘enormous opportunity to make a big difference to services locally’.

Dr Dixon added: ‘GP leaders, PCTs, the Department of Health and government – all of us have failed to fully inspire our frontline GPs in a role that 10 to 15 years ago they were desperately up for.’

Fifteen workshops were conducted by the alliance between March and May, with two-thirds of the delegates from GP practices and the rest from PCTs.

Delegates predicted that PBC would lead to a more a more ‘adversarial’ relationship between commissioners and hospitals, hindering the development of clinical pathways.

GPs often cited ‘fear of competition from the large corporates and multinationals who may come in and provide new services’ as their reason for signing up to PBC.

The report concluded that even though delegates felt ‘frustrated and sceptical’ about PBC at the beginning of each workshop, enthusiasm grew when they realised how information on hospital activity and financial data could stimulate service redesign.

http://www.hsj.co.uk/nav?page=hsj.exclusive.news.story&resource;=4999526

Despite bribing GPs with large pay rises and bonuses for meeting government targets as well as cutting the number of hours worked Labour’s GP commissioning policy bribe will sink before it begins it seems that the usual lack of centralist leadership is not ingratiating themselves with the front line GPs.

To patients, such a move will make no immediate difference. They will still visit their GP and, if need be, move on for treatment, still free at the point of use, to the hospital or community services that are paid for by their primary care trust.

Already these services can be provided by a traditional NHS trust, by the new free-standing Foundation Trusts or by private and not-for-profit providers.

The difference is that it would not be NHS staff, directly employed by a PCT, who would be choosing which services – including GP services – provide the best available choice. That would be undertaken by a privately-owned manager, operating on contract to the PCT’s board and charged with obtaining the best value for money.

The move is part of what the health department calls a “step change” that is shifting the NHS from being “a services provider to a commissioning-led organisation” – one that operates in effect as a giant, tax-funded health insurance scheme with no ideological view remaining about who should provide the service: the publicly- owned NHS, the private sector, or the third sector made up of voluntary organisations and charities.

To opponents, this will be seen as another big step towards “privatising” the NHS even though care will remain, as now, largely free at the point of use.

The move reflects the fact that “ministers do not have huge confidence that the NHS itself can deliver what is required on commissioning”, Chris Ham, professor of health services management at Birmingham University, said yesterday.

“The question,” Prof Ham said, “is how confident you can be that if you bring in external expertise, is it going to do any better?”

Such expertise tends to lie with health insurers. But he said: “UK health insurers have expertise in a fairly narrow range of services, chiefly elective care and diagnostics, that make up a tiny proportion of what the NHS provides.”

“The big US insurers have expertise across the full range of services. But they are not used to operating within the fixed budgets and political constraints on health care in the UK.” German and Dutch sickness funds, which come closer to a direct parallel with NHS commissioning, would also face cultural difficulties.

Commissioning has always been the Achilles heel of the attempts by both Labour and the Conservatives to use market mechanisms to improve NHS care.

Given that the department is advertising only a “framework” agreement, “it remains possible that this will not be implemented”, Prof Ham said.

“Nonetheless, if you are looking for ways to help PCTs improve their performance, this may be a smart way to do it.”

http://www.ft.com/cms/s/19cf82d8-ff30-11da-84f3-0000779e2340.html

Bringing in the insurance companies at the same time as refocusing the NHS purely as a services funder is crossing the final Rubicon.

By admitting to what is in effect the Labour creation of the NHS health insurance company, Tony Bliar is admitting his failure as Tony Bliar admits his NHS failure that the billions of Pounds that he poured into the NHS have not made it the world class service he promised. He reveals that where people live still affects the kind of treatment they get.

The charges against Wakefield, 50, are some of the most extensive seen. Timothy Dutton QC told Mr Justice Silberman that the GMC, the body that regulates doctors, was considering 10 counts of serious professional misconduct.

They include publishing “inadequately founded” research, obtaining funding “improperly” and subjecting children to “unnecessary and invasive investigations” without proper ethical approval.

Early next year these and other charges will be heard by the GMC’s fitness to practise panel. Empowered to strike Wakefield off the medical register, the hearing is expected to last two months and will be one of the most high-profile adjudications seen.

Wakefield was not in court last week. Having been shunned by colleagues in Britain, he runs a business in Austin, Texas, selling surgical tests for autistic children.

Among the cramped pews and gothic ornamentation of court 10, however, his presence hung over the proceedings.

The hearing had been called at the GMC’s request in an effort to obtain the court’s help in gathering documents. Wakefield has said he has lost vital documents and destroyed a key paper.

After more than two years of trying, the GMC’s frustrated lawyers were getting tough.

In February 2004, after a Sunday Times investigation, Wakefield declared that he would welcome an inquiry as an opportunity to clear his name.

“It has been proposed that my role in this matter be investigated by the General Medical Council,” he said in a statement. “I not only welcome this, I insist on it.”

He may have insisted, but he did not cooperate. His lawyers, financed by the Medical Protection Society, have fought trench warfare against the GMC.

The GMC’s work has been made harder by the legislation that governs disciplinary proceedings against doctors.

According to the Medical Act of 1983, the council can demand that any person disclose any document “except the practitioner in respect of whom the information or document is sought”.

In other words, Wakefield cannot be made to hand over his papers.

Field Fisher Waterhouse, the GMC’s lawyers, have been driven close to despair. Unable to secure the facts from Wakefield, they last week took the course of acting against the solicitors who — as The Sunday Times discovered — hired him to make the case against the vaccine before he triggered the MMR scare.

In the event the solicitors agreed to the request after the judge ordered the hearing into secret session. Dates and documents would be handed over within a month, they agreed, bringing the hearing of Wakefield’s case a step closer.

It’s a case in which, Wakefield’s critics say, closure is desperately needed.

“We need to get this over with,” said a close observer last week. “We’ve got to stop the endless re-running of a story that isn’t a story. Every time there is something like the GMC mentioned, journalists keep talking about the link between MMR and autism, and there isn’t one.”

As health chiefs revealed last week, Britain is now in the grip of what has every sign of becoming a measles epidemic. In March the first child in 14 years was killed by the virus. Clusters of infections, such as in Surrey and Yorkshire, have propelled the number of confirmed cases this year to 449, the largest number since the MMR jab was introduced in 1988.

“People think measles is a trivial disease, but it is not,” said a spokesman for the Health Protection Agency. “Our message to parents is to get their children vaccinated to reduce the risk.”

The return of what was once a common disease is almost entirely the result of the MMR scare, say Wakefield’s critics.

As Dutton told the court last week, a paper published by the former gut surgeon in The Lancet medical journal in February 1998 was the trigger for all that followed. In its outward appearance the paper was scientific. It claimed that Wakefield and his team had happened upon a link between the MMR jab — the combined inoculation against measles, mumps and rubella — and the onset of autism in 12 children who had passed through the hospital.

http://www.timesonline.co.uk/article/0,,2087-2230936.html

Like many we at Health Direct have been unsure of the merits of the case for and against the MMR jabs.

The politicians have been extremely quiet on the subject of MMR and measles with the usual lack of leadership from the top.

However, if key research documents have been destroyed by Dr Andrew Wakefield it would appear that not has his own credibility been greatly reduced- but the foundation for the MMR scare would appear to be nullified.

With the immunisation rates falling to around 50 per cent in Westminster and other parts of London Scare over MMR vaccine safety causes cases of Mumps to soar as immunisation postcode lottery grows one would think that the GMC would be moving faster than it is to clear up this sorry mess.

The Programme’s scope, vision and complexity are wider and more extensive than any ongoing or planned healthcare IT programme in the world and it represents the largest single IT investment in the UK to date. It is designed to deliver important financial, patient safety and service benefits.

According to the report by head of the NAO Sir John Bourn, the main implementation phase of the Programme and the realisation of benefits are mainly a matter for the future and it will therefore be some time before it is possible fully to assess the value for money of the Programme, as this will depend on the progress made in developing and using the systems it is intended to provide.

It is therefore important for taxpayers and patients that this investment pays off, and for the Programme to be well managed and open to public scrutiny. Accordingly, the NAO has examined the progress to date in delivering the systems against the original plans and the costs of the Programme; the steps taken by the Department, NHS Connecting for Health and the NHS to deliver the Programme; how the IT systems have been procured; and how the NHS is preparing to use the systems delivered.

The NAO found that the Department and NHS Connecting for Health have made substantial progress with the Programme. Successful implementation of the Programme nevertheless continues to present significant challenges for the Department, NHS Connecting for Health and the NHS, especially in three key areas:

* Ensuring that the IT suppliers continue to deliver systems that meet the needs of the NHS, and to agreed timescales without further slippage.

* Ensuring that NHS organisations can and do fully play their part in implementing the Programme’s systems.

* Winning the support of NHS staff and the public in making the best use of the systems to improve services.

Sir John Bourn said “Substantial progress has been made with the National Programme for IT. The Programme promises to revolutionise the way in which the NHS uses information to improve services and patient care. But significant challenges remain for the Department and NHS Connecting for Health.”

THE NATIONAL PROGRAMME FOR IT IN THE NHS
Achievement of the following milestones has been deferred:
The National Data Spine first went live on time, in June 2004, but achievement of later milestones for building up its functionality has been delayed by up to ten months.

Local Service Providers’ delivery of the first phases of the NHS Care Records Service and the advanced integrated IT systems that are central to the long-term vision for the Programme will now be later than originally planned.

Deployment of the national clinical record is now planned in pilot form from late 2006, compared to the original plan of December 2004, and in its full form from late 2007. In the interim, Local Service Providers have provided Patient Administration Systems; these are linked to the Spine for security, single sign-on, Choose and Book, Personal Demographic Services (PDS), Electronic Prescribing Service and together with other Programme systems, to support NHS organisations in urgent need of new or replacement IT systems. However, the plan remains for the entire implementation to be completed by 2010 in accordance with originally contracted timescales.

While the software for Choose and Book was delivered on time, the take up of the system to support patient choice has been slower than initially planned as a result, amongst other things, of an extension of the scope of the system to support the introduction of patient choice and the time needed by suppliers of existing IT systems to make their systems compliant.

Deployment of the Electronic Prescribing Service and PACS (which was added to the Programme in September 2004) has also started more slowly than initially planned, but NHS Connecting for Health expects Ministerial targets for the later stages of deployment to be achieved.

In May 2005 the Department published the NHS Care Record Guarantee setting out the principles it intends to apply to protect the confidentiality of electronic patient records. Work continues on a number of important practical issues, including sharing information with non-NHS bodies, such as local authority social services, and the working of ‘sealed envelopes’ intended to allow patients to limit the sharing of information about themselves.

The full gross cost of the Programme includes the nationally agreed contracts, including approved additions, other central expenditure and the local implementation costs. Whilst some of this expenditure is directly managed by NHS Connecting for Health, management of local IT expenditure is a matter for the local NHS bodies concerned.

NHS Connecting for Health does not seek to maintain a detailed estimate of overall expenditure on the Programme but makes broad projections of expenditure. Our analysis of these projections indicated that provision had been made for total spending on the Programme (at a gross level, i.e. without deduction for possible savings or benefits) of £12.4 billion (at 2004-5 prices)6 over the ten year life of the main contracts, to 2013-14. This is not a budget but an amalgamation of fixed price contracts, extrapolation of costs beyond the contract periods and provisional forecasts of other costs.

The elements comprising this total are:

£6.2 billion by NHS Connecting for Health on the fixed price contracts let in 2003 and 2004, in line with the announcements made at the time of contract awards. These contracts are being managed within this total.
£382 million contracted expenditure on new projects added to the original scope of the Programme, predominantly PACS, where the cost of providing central data stores is £245 million.

£239 million on additional services to be purchased beyond the scope of the original core contracts (a mixture of contracted expenditure and estimated costs).

http://www.nao.org.uk/pn/05-06/05061173.htm

Health Direct notes that the NAO has three key worries for the future strategy of the NPfIT project:

Ensuring that the IT suppliers continue to deliver systems that meet the needs of the NHS,
Ensuring that NHS organisations can and do fully play their part in implementing the Programme’s systems.
Winning the support of NHS staff and the public in making the best use of the systems to improve services.

Yes the NAO is right on every count. Unfortunately, their report does nothing to address these issues.

On the first point, Health Direct pointed out on Monday, March 20, 2006 that the NPfIT NHS plan is evolving but one-size-fits-all is a fundamental flaw, says hospital chief “When the NHS is fragmenting as Sir Jonathan Michael, a top NHS executive, who spoke at a healthcare symposium at London’s City University pointed out there is a fundamental flaw in the NHS’s IT-driven modernisation. The flaw Michael sees in the National Programme for IT (NPfIT) is its centralised, standardised approach at a time when the health service is decentralising.”

On the second and third points the NHS front line staff are now so over stretched that they cannot afford the extra time that the NpfIT programme needs:on Thursday, June 08, 2006 we warned that Trusts pay to end NPfIT staff supply contracts in red tape chaos “ National Health Service trusts are having to buy themselves out of a commitment to supply staff to companies building the NPfIT electronic patient record system. Trusts in the south are paying Fujitsu £19m after the service found it could not provide 50 NHS employees to help with the programme.”

The MMR vaccine aims to prevent measles, which has a significant complication rate, including pneumonitis and encephalitis, which can kill one in every 1,000 cases. In the case of mumps, more severe in teenagers and adults, a known but relatively rare complication is sterility in males. The major risk of rubella occurs when a pregnant woman is infected, when her baby may suffer significant congenital defects.

Fears about the combined vaccine were triggered in 1998 when Andrew Wakefield published a research paper in The Lancet purporting to show a link between MMR and autism.

The research by a Royal Free Hospital team caused immunisation rates to slump and raised the risk of outbreaks of measles, mumps and rubella, according to the Health Protection Agency.

Immunisation rates fell over the next five years from more than 90 per cent nationally to a low of 78.9 per cent in early 2003. In parts of London rates fell to around 50 per cent.

At the low point of MMR uptake in 2003, a study said measles outbreaks had risen to the point where the disease could re-emerge as endemic in Britain.

Fears of a major epidemic were expressed last night as it emerged that tens of thousands of children are missing out on vaccinations as a result of a postcode lottery created by Labour policies.

New figures have revealed that 60 times more family doctors in the poorest parts of the country have stopped offering vaccinations than those in the leafy suburbs.

The huge difference has been created by new rules introduced by ministers two years ago which allowed GP practices to opt out of providing childhood immunisation services.

The change has led to one in eight practices in the most deprived fifth of the country opting out of vaccinations for children. In contrast, only 0.2 per cent of practices in the most affluent parts have followed suit.

The withdrawal means that parents in many areas can no longer go to their local doctor to get immunisations for diseases such as diphtheria, whooping cough, polio, meningitis C, measles, mumps and rubella.

In 2004 the Government introduced a new contract for family doctors which formally classed childhood immunisation as an “additional service” – a move Mr Webb argued made it easier for surgeries to opt out.

While the Government stresses that around 94 per cent of all GP practices in England and Wales are still offering immunisation services, Ivan Lewis, the health minister, admitted recently: “The practices opting out are disproportionately likely to be in deprived areas.”

The exodus has been driven by Labour’s introduction of bonus payments for doctors who meet immunisation targets.

If a GP manages to increase the proportion of children in their area who receive vaccinations from 70 per cent to 90 per cent, their payment will increase from £995 to £2,865. However, vaccination levels in poorer areas are traditionally low as a result of deprivation, ethnic diversity and high levels of mobility. Many family doctors in these areas appear to have decided to opt out of the system because they have little chance of increasing the numbers and earning the bonus.

In contrast, doctors in the most affluent fifth of the country – where vaccination levels are usually much higher – have a much clearer incentive to carry on offering the service to earn the extra payments.

If a GP stops offering the service, the responsibility for childhood immunisation passes to the local primary care trust.

However, Mr Webb said there were serious doubts whether primary care trusts – many of which are facing serious financial problems – could tackle the issue.

The Department of Health said: “The White Paper, Your Health, Your Care, Your Say reaffirmed our commitment to improve immunisation services for all – set against the trends that relate to deprived and disadvantaged groups – and made clear that inadequate immunisation service provision is unacceptable.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/06/13/nmmr113.xml

Health Direct notes that this is a classic case of Labour Government targets missing the mark and flies in the face of Labour’s pledge to tackle health inequalities. There is now a real postcode lottery in immunisation of our children.

And it’s the children of the country’s poorest families that are disproportionately paying the price with their health and sadly lives for Labour’s health failures.

But the Department of Health disputed the claims, saying it was “absolute rubbish to say there will be thousands of junior doctors without jobs”.

The row, which has been simmering for months, sparked into life yesterday because of concerns about the number of training posts to be offered to junior doctors, part of reforms that the government is introducing from August next year.

The Department of Health said for the first time that the Modernising Medical Careers (MMC) reforms would mean that more than 21,000 aspiring consultants would be competing for 9,500 training posts in England. Last night it said the 9,500 was “an estimate” and a minimum.

But the BMA junior doctors’ committee – which will meet officials to lobby for more posts tomorrow – warned the remaining 11,500 would face options including leaving the NHS and working abroad. “There will be a brain drain,” said Dr Jo Hilborne, chair of the junior doctors’ committee.

“Huge numbers of people will choose to go abroad and significant numbers will choose to leave medicine altogether if they can’t get a job in the UK.” With each doctor costing £237,000 to get through medical school, such an exodus would constitute a huge waste of money for British taxpayers, she said.

“The alternative – pushing doctors into dead-end jobs so they never get essential skills that would benefit their patients – is unacceptable and won’t work. Doctors are simply going to leave the NHS instead,” she added.

The warning came a week after the president of the Royal College of Surgeons, Bernard Ribeiro, told the Guardian there was “a real danger” the medical reforms could lead to a brain drain similar to that in the 1960s, when doctors went to the US.

The shortfall has arisen because the government increased the number of medical students – from just over 4,000 in 2001 to 7,380 last year – while hospital trusts and deaneries failed to match this with an increase in training posts.

Last week Professor Shelley Heard, the MMC’s national clinical adviser, said junior doctors needed to accept that not all would receive training. But critics, including Mr Ribeiro, said doctors who had already committed at least seven years to training were reluctant to settle for jobs which will not lead to consultant status.

A BMA survey shows 61% of doctors would opt to continue their training overseas, and 35% to leave medicine altogether, rather than resign themselves to a career path with no possibility of training. Australian authorities have already visited the UK to recruit doctors.

Dr Hilborne, who will meet MMC officials tomorrow, blamed the government for ignoring doctors’ concerns and forging ahead with MMC. “We asked the government to delay this but it’s part of their wholesale reform of the NHS, which they’re insistent on taking forward” she said. “Meanwhile, these poor guys who by an accident of fate happen to be at this point in their careers are caught in the middle.”

Dr Evan Harris, the Lib Dem MP for Oxford West & Abingdon and a former member of the junior doctors’ committee, said: “This is yet another example of the gross failure of the government … They set numbers for medical students but then allow hospital trusts the freedom to set numbers of consultants. Then they scratch their heads and wonder why there’s this crisis in training posts.”

Andrew Lansley, the shadow health secretary, said: “I have repeatedly questioned the government over their planning failures for the provision of specialist training posts, but they appear to have proceeded without working them out.”

But the health minister Lord Warner accused the BMA of “seeking cheap headlines about unemployed doctors”.

“It’s absolute rubbish to say there will be thousands of junior doctors without jobs – especially as our current estimates show that around three times more training posts will be available next year than under the old system,” he said.

“Some doctors may have to be flexible … but at the end of the day our changes to medical training mean that more doctors will go into specialities where there are shortages.”

http://society.guardian.co.uk/health/story/0,,1797866,00.html

Heath Direct points out that Labour’s contradictory health training policies extend not just to Doctors, but to other medical professions like Physiotherapists as well. As the ward and hospital closures continue there are just not enough qualified working staff left to assist in the practical training that the students rightly need to prove their competence.

This continual cost cutting fixation is yet another example of red tape madness trusts pay to end NPfIT staff supply contracts in red tape chaos and illustrates just how overstretched the NHS frontline staff really are.

However, Monitor chair Bill Moyes says he has ‘every confidence’ that the trusts are being ‘unnecessarily prudent’ in their accounting and will see a ‘significant’ drop in the level of provision by the time full audited accounts are published in July.

‘We do not believe the Department of Health would allow PCTs to fail to honour their debts,’ said Mr Moyes.

He added that he had ‘full confidence’ in the guidance set out in the DoH’s operating framework and code of conduct to ensure that any disagreements were settled and bills paid.

‘I’m genuinely confident that the new strategic health authorities know their job is to make sure PCTs commission effectively and work within government policy,’ said Mr Moyes.

‘I’m also confident that foundation trusts know they have to live within the rules set by the government and Monitor,’ he added.

However Foundation Trust Network director Sue Slipman asked why Mr Moyes was expressing such confidence when ‘some PCTs are not only refusing to pay their bills but won’t take part in dispute procedures as well’.

She said she was happy the right guidance was now in place, but ‘we’ve yet to see how it bites’.

‘We’ve clearly got PCTs that are not yet fit for purpose and do not quite understand their role. It is up to the DoH to demonstrate they will get them there as soon as possible,’ she said.

The preliminary figures show that foundation trusts are set to report a net deficit of £8m – or £24m if asset depreciation is taken into account.

University College London Hospitals foundation trust is heading for a £36m end-of-year deficit.

Mr Moyes said Monitor would not get involved despite having put UCLH on its highest risk rating more than six months ago. ‘Monitor should not intervene if the trust is doing all the right things to address its problems,’ he said.

‘UCLH is strengthening its senior management team, it has appointed KPMG to provide support and it is on course to deliver its recovery plan to drop to a financial risk rating of three by the end of 2007-08,’ he said.

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Health Direct warned last week, when the official NHS deficit figures were finally published for the year 2005/6 NHS needs to take £1bn out of costs after record £536m overspend that there was a significant problem with Trusts under reporting their cashflows.

The £28 million so far reported represents more than 5% of the total NHS overspend.

Senior doctors have signed a statement of protest, and more than 2,000 have written to ministers, including Patricia Hewitt, the health secretary.

DTB is “highly valued and trusted” to give independent and reliable information about drugs, the statement says. Its conclusions “are also widely regarded as a unique counterweight to the influence of the pharmaceutical industry”.

The statement urges the government to continue with its bulk subscription for doctors “in the best interests of patients and the NHS”. It is signed by, among others, Sir Graeme Catto, the president of the General Medical Council, Alan Maynard, professor of health economics at the University of York, and the chief executives of two large patient charities, Asthma UK and Diabetes UK.

Peter Fellowes, the chairman of the British Medical Association’s prescribing forum, says in a letter to the government that the demise of the DTB “will leave GPs more vulnerable to the commercial pressures of the pharmaceutical industry and counter pressures from cash-strapped PCTs [primary care trusts] and that will undoubtedly be to the detriment of our patients”.

The DTB, owned by Which?, sees drug prescribing as a consumer issue and has not always been comfortable reading for the government. The availability of some expensive new medicines, particularly for cancer, has become a hot political issue.

The government set up NICE, the National Institute for Clinical Excellence, to weigh up the evidence and rule on whether drugs work and are value for money in the NHS. Nice has become a battlefield where pharmaceutical companies, patient groups, doctors and scientists fight for their own interests. Some doctors say they find the DTB’s advice more helpful.

It costs £1.4m a year to send DTB to 120,000 doctors and to make it available online to all health professionals. The Labour peer, Lord Toby Harris, says this is a small saving for the Department of Health “whereas the pharmaceutical industry spends £1.65bn on marketing in the UK, including 8,000 reps to see GPs, and we all know about the provision of freebies and hospitality”.

A Department of Health spokeswoman said the cost was not justified, “in the light of other resources”.

Ike Iheanacho, the DTB’s editor, said the department’s reasons for ending the contract were about saving money yet the DTB regularly recommended doctors to use more cost-effective medicines.

http://www.guardian.co.uk/medicine/story/0,,1796246,00.html

The closure of the trusted Drug and Therapeutics Bulletin is another sorry example of the Labour government’s short term NHS cost cuts. In comparison to the annual £1.4 m cost of the DTB, the NHS’s drugs bill is around £11 billion a year.

Even a cursory cost benefit analysis indicates that a 0.1% saving on the drugs bill will pay for the preservation of the DBT eight times over.

But doctors have questioned whether the NHS can afford to fund the drug, without making cutbacks elsewhere.

Campaigners have fought a high profile, and at times emotional battle to make the drug more widely available on the NHS.

‘Historic drug’
Once final guidance is published in July, local health bosses will be given a three-month period of grace to implement it.

They will then face legal proceedings if they fail to offer eligible patients Herceptin.

“It’s essential not to create a climate of false hope for women, where Herceptin is seen as a miracle cure suitable for everyone with breast cancer.” Kate Law, Cancer Research UK

In addition to NICE’s guidance – which applies to England and Wales – the Scottish Medicines Consortium is also putting out its own final guidance recommending Herceptin should be available on the NHS.

Women in Northern Ireland have had access to the drug, where clinically appropriate, since November 2005.

Herceptin has been shown to benefit women with HER2 positive breast cancer – around 20% of all breast cancer cases.

However, up to 10% of that group will not be able to take the drug because of concerns it could exacerbate heart problems.

More than 5,000 women – and possibly hundreds of men – in the UK would be suitable to use Herceptin.

Previous estimates put the cost to the NHS at around £100m a year.

The NHS Confederation warned that with finite resources for the NHS, the ruling could see cutbacks elsewhere.

And Dr Jonathan Fielden, deputy chairman of the BMA¿s Consultants Committee said: “The NHS will now have to find the money to fund this treatment. We have already heard this week how huge amounts are being wasted on management consultants.”

“The government needs to rethink its strategy and spend money that has been earmarked for the NHS on benefits to patients not pie in the sky political ideas.”

However, Professor Mike Richards, the government’s national cancer director, said: “The health service is getting more money each year. This is a major step forward. It’s is good news for women because it may mean more actually get cured of their breast cancer. Because of that it is an absolutely appropriate use of the new funds that are going into the health service.”

A trial of the drug has shown it can increase the chance a woman treated for early stage breast cancer will still be disease-free after three years by 6%.

NICE’s recommendations, produced after a fast-track appraisal, recommend a year’s course of Herceptin. However, it says heart function must be assessed before therapy begins, and Herceptin should not be given to patients at risk of with heart failure.

It should also not be given to patients with certain heart problems including heart failure and severe chest pain, and uncontrolled high blood pressure.

NICE also recommends women who are prescribed Herceptin should have heart checks every three months. It has also called for more research into the drug’s effects, including long-term studies.

Andrew Dillon, chief executive of NICE, said: “These proposals are very good news for women with HER2 positive breast cancer. I hope this means an end to the battle for others who are still fighting their PCTs for the drug.”

“Herceptin, for these women, is clinically and cost effective in the early stage of the disease and we look forward to being able to issue final guidance, subject to any appeal against our recommendations, in a few weeks time.”

“No one should have to suffer like I did and have to fight in the courts for a drug a doctor prescribes you.”

But Kate Law of Cancer Research UK, said: “We must remember that Herceptin is only suitable in about one in five cases of breast cancer.

“So it’s essential not to create a climate of false hope for women, where Herceptin is seen as a miracle cure suitable for everyone with breast cancer.”

Jeremy Hughes, chief executive of Breakthrough Breast Cancer said a year of uncertainty and post-code lottery was “at last coming to an end”.

“But this will only be the case if women are sure they can be tested to see if Herceptin is suitable for them. Nationwide, HER2 testing is being put in place and all women diagnosed with breast cancer need to know this test will be available quickly.”

Doctor Ian Smith, head of the Breast Unit at the Royal Marsden Hospital in London, said the development of the drug heralded similar treatments for other types of cancer.

“It’s the first of a type of targeted therapy, where you pick up a specific molecular abnormality in the cancer cell and you hit it. And there are other drugs already in the pipeline.

“I think Herceptin will be looked back on in breast cancer as a historic drug, the first of a whole new generation.”

http://news.bbc.co.uk/1/hi/health/5058952.stm

Imagine buying a house for a family with four children. Over the next few years you know you will need a lot of space to accommodate noisy teenagers. But in 10 years’ time your needs are not so clear cut: children may leave, elderly relatives may come to stay or you may be on your own. Your income is also uncertain and not under your control: your boss has just refused a pay rise to reflect your high accommodation costs and says you can have the same as everyone else.

Given that, would you take on a 30-year mortgage which could not be transferred to another property and which has severe penalties if you wanted to redeem it early? And, for good measure, it includes all your maintenance, cleaning and catering.

Probably not. But that is effectively what some of the trusts with earlier private finance initiative deals have done. These were often devised when the NHS’s need for extra capacity was acute and hospitals were at the centre of the NHS’s model of care. Early PFI hospital plans were frequently criticised for having too few beds and some were revised upwards.

But in the last few years these assumptions are being challenged. The need for extra capacity post-2008 is now being questioned as up to 10 per cent of NHS patients are likely to be treated in the independent sector. The white paper on care outside hospitals envisages a different role for the acute sector.

But for trusts with PFI payments to make, the immediate problem is payment by results, which does not recognise the higher costs they have to face.

In Woolwich, south London, Queen Elizabeth Hospital trust chief executive John Pelly says: ‘The funding mechanism for hospitals does not reflect the cost of PFI. We are left with a huge extra cost and no chance of recovering it.’

His trust’s PFI scheme adds £8-9m to its costs each year compared with the ‘average’ hospital. This means its reference cost is above the national tariff rate at which it will be paid, even though there is nothing that the trust can do to reduce this additional bill.

The trust was recently the subject of a public interest report from the Audit Commission because of a looming deficit and the likelihood that it would not break even within a set timescale.

PFI expert and Edinburgh University research fellow Mark Hellowell comments: ‘PFI puts a hell of a lot of financial pressure on trusts. PbR will exacerbate that – new market entrants will make demand volatile and it is based on a tariff that does not cover your true costs.

‘We now have a mismatch between the way the NHS is funded and the way PFI is funded.’

The problem is that the national tariff only includes an average payment for capital charges – hospitals which have invested heavily in new buildings either through PFI or other funding will have higher-than-average costs.

However, non-PFI projects are shown as a capital charge of 3.5 per cent of the value of the asset whereas PFI projects typically cost around 15 per cent of a trust’s income (although this may include some services). They are also committed to the payments plus inflation for 25-30 years.

HSJ columnist and independent finance consultant Noel Plumridge says there may be particular issues in south-east London, which has a large number of hospitals with PFI deals, and where choice may bite particularly hard. Many patients will have several hospitals within easy reach, including the central London teaching hospitals. Similar problems may exist in other big cities where there are lot of trusts on the periphery, potentially competing with well-known hospitals in the city centre.

But if the number of trusts in any area looks unsustainable under PbR and choice, the PFI payments may affect reconfiguration. Abandoning a PFI site is likely to incur large penalties – so changes may have to focus on non-PFI hospitals.

For example, Norfolk and Norwich University Hospital trust’s PFI deal could cost up to £257m to terminate early. The Commons public accounts committee recently looked at the refinancing of the project which extended the length of the contract and said ‘there can be no certainty that a hospital will be needed in its current form in over 30 years’ time’. Committee chair Edward Leigh – a Conservative MP – described the refinancing deal as ‘the unacceptable face of capitalism’.

High reference costs
At Bromley Hospitals trust, where the £155m Princess Royal University Hospital (Farnborough) was funded by PFI, managers are reasonably confident they can cope with the challenges of the future. However, estates and facilities director Trevor Willis says that how the trust’s other older hospitals are used may ultimately change.

But the trust’s PFI charges are a major factor in it having high reference costs. ‘We are working to reduce that but that will take a long time,’ he says.

Mr Hellowell says: ‘It would be disproportionately expensive to close down services at PFI trusts. It would not be that surprising to find that it is the non-PFI trusts close to PFI trusts that get services closed down.’

But in the short-term the challenge for some PFI trusts is to break even and this may require radical thinking ‘A hotel may invest a lot in its buildings to improve its attractiveness to guests but recoup this through higher prices. That’s not available in the NHS,’ says Mr Plumridge. ‘I can see some real new thinking about the model of care and how we will change this to get out of deficit.’

Individual trusts will have limited room for manoeuvre because such a large percentage of their costs are fixed. Non-PFI hospitals under pressure may look at reducing non-essential maintenance, or whether savings can be made in soft services such as catering, cleaning and security. Such savings may be ill-advised, but they can help the bottom line in a tough year.

PFI hospitals cannot do this – typically, these services are included in their contract. Inevitably, savings will have to be made elsewhere – and that is likely to focus on staff costs, as these are usually the largest outgoings for a trust.

For trusts with large PFI payments to reduce their costs – to under the national average, for example – they will need to be beacons of efficiency and lean running.

Mr Pelly says: ‘To survive in a world of PbR, irrespective of whether or not the market causes work to move away from us, we need to get ourselves into a position where we are in the upper quartile of all resource usage.

‘On a day-to-day basis in order to achieve break-even it is about driving down all the other costs that we can control.’

Queen Elizabeth Hospital trust is planning to pull £11m out of its costs in 2006-07 – including the abolition of some posts – but is still heading for a £6.5m deficit.

Norfolk and Norwich University Hospital trust has also said its costs are higher – by around £6m a year –because it is an early-stage PFI. The trust is trying to head off a £15m deficit in 2006-07 and is considering cutting jobs. A spokesman said that its £38m yearly payment for the building and facilities was fixed so savings would have to be concentrated elsewhere. ‘You inevitably do start looking at the wage bill,’ a spokesperson said.

In Bromley there is more optimism. Mr Willis believes close working with the PFI partner can help and may even introduce some flexibility around some of the charges, such as those for ‘soft services’. It is not in the interests of the PFI partner for the hospital to be in severe financial trouble, he argues.

In the past, PFI trusts have had some recognition of their high costs through fixed-term payments from government and strategic health authorities, but it is uncertain whether these will survive. Norfolk and Norwich has also been supported by a £3.6m yearly payment from its SHA in recognition of the additional PFI costs. It has already fought off one attempt to reduce this and there is no guarantee the payment will continue.

Many early PFI deals were signed when the expected direction of travel for NHS services involved expansion rather than contraction or a different ‘offering’ of services: they may find downsizing or reshaping their provision more difficult.

The National Audit Office recently looked at the refinancing of the PFI deal for the Darent Valley Hospital in Dartford. It said: ‘It may be less easy for the trust to avoid expenditure on maintaining areas not in use compared with conventional procurement where an NHS trust can make immediate decisions to stop or reduce expenditure on maintaining areas no longer in use.’

Attracting new patients
The plus side for PFI trusts is that they have new hospitals, often with small wards and new equipment, which may prove attractive to patients exercising choice – although this will depend on the local market. Norfolk and Norwich, for example, is 30 miles from other acute hospitals and its patient base may remain relatively stable. In London, choice may be more of a challenge – although Mr Pelly says his hospital has done well in attracting new patients over the last few years.

‘I don’t have a fundamental issue with PFI. Greenwich needed a new hospital. PFI was the only show in town and it enabled it to get its new hospital,’ he says.

‘It’s now been operational for five years. But this was negotiated and put into effect in a world before PbR.’

He would like to see the ‘legacy’ costs of PFI reflected in what individual hospitals are paid. This would involve stripping some building costs out of the tariff and hospitals would then be given an individual payment depending on their circumstances – a little like the market forces factor
adjustment.

The problems with the early PFI model are being recognised by the Treasury. Earlier this year it put out guidance which backed shorter contract periods (but could lead to higher costs per year). Some services such as catering, cleaning and security being less likely to be included in these contracts, and technical changes to the finding of schemes which would allow trusts greater flexibility to get out of schemes earlier.

Mr Hellowell points out that these changes will not affect new schemes for another year or two. He doubts the extent to which flexibility can be built into the system, as the essence of PFI – and what attracts the investors – is that it offers them a more or less guaranteed return for a long period. Flexibility is likely to come at a price for the NHS, he says.

But while new PFI schemes may be better designed financially from an NHS perspective, the costs of such projects have soared in the last few years as construction costs have leapt up.

The Department of Health is examining proposed schemes and has dramatically downsized some of them to make them affordable. In May it ordered University Hospitals of Leicester trust to cut nearly £200m out of its proposed £761m scheme.

Health minister Lord Warner told HSJ that schemes had ‘to conform with the direction of travel set out in the healthcare outside hospitals white paper’.

That is clearly good sense, but it is little consolation with trusts left with earlier schemes to fund for the next 30 years.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4920706

Patricia Hewitt, the health secretary, revealed that the NHS as a whole, including the deficits recorded by foundation trusts, overspent by £536m last year. The figure, at a time of record NHS spending increases, is 2½ times the target Ms Hewitt set in December of limiting it to £200m.

The unaudited figures, which last year deteriorated once audited accounts were in, show that 69 per cent of NHS organisations hit break-even or financial surplus. But 31 per cent failed to, with those that were already in financial trouble getting deeper into it.

This year, the service as a whole will have to repay the £536m overspend and take out the equivalent sum by which it overtraded last year – something over 1 per cent of its budget.

But on top of last year’s overspend, NHS trusts are also carrying an accumulated deficit of £598m, the NAO revealed.

Ten big hospitals, including two of Bristol’s three, the Royal United Hospital, Bath, two in Surrey and Sussex, along with St George’s and the Hammersmith Hospital in London, account for close to £300m of that sum.

For some organisations, the levels of debt are reaching the stage where they may cease to be “viable entities”. “If they are to remain going concerns, something will have to be done to redeem the position,” said Steve Corbishley, the NAO’s director of financial audit for the health service.

For a minority of bodies, “it will not be feasible to recover”, nor would it be possible for them to apply to become foundation trusts, “without some form of financial assistance from the [health] department”.

Ms Hewitt said that while the NHS as a whole would seek financial balance this year, some organisations would be given longer in order to avoid impacts on patient care “that would simply not be acceptable”.

Niall Dickson, chief executive of the King’s Fund think-tank, said the net deficit “masked the true scale of the financial problems in the health service”.

Six months into the financial year, foundation trusts aside, those organisations in deficit were projecting a £948m overspend. Yesterday’s figures showed that sum had increased to £1.27bn, he said, offset by surpluses elsewhere, some of which were achieved by reducing education and training budgets.

Sir Ian Carruthers, acting chief executive of the NHS, argued that the figures needed to be kept in perspective. Two-thirds of the overspend was accounted for by just 10 per cent of organisations, he said, with the health service delivering improved services.

But the tighter, and more transparent, NHS financial regime meant “organisations that get into financial difficulties, and do not address these immediately, find it increasingly difficult to pull back the position as they face income reductions to recover prior-year deficits”.

The picture shows a north-south divide. Many of the worst problems are concentrated in and around London, in east England and parts of the west country. But neither the department nor the NAO had an explanation for that. Serious problems in just a few places “can skew the regional picture”, Mr Corbishley said.

Last year, the service underspent its £3bn capital budget by more than £1.1bn, a measure partly taken to release cash to ensure that staff and suppliers could be paid.

http://news.ft.com/cms/s/d2c2a878-f68a-11da-b09f-0000779e2340.html

And a similar obligation to supply staff in the north-west and West Midlands to CSC, the contractor for the region, has also been “re-moved” after it was found staff could not be spared from their clinical and other commitments.

The payments were disclosed yesterday by Computer Weekly and Richard Bacon, the Conservative MP, who established their scale through a parliamentary question.

Under the deal with CSC, the service agreed to provide 50 staff worth £6.9m a year over the 10-year life of the contract to help reduce costs, with CSC then able to charge the equivalent cost to the NHS if the service could not provide them.

Yesterday CSC said it had been agreed to “remove this obligation”, with staff being provided on a voluntary basis. But the company declined to spell out the financial implications for the service, stating they were “commercial in confidence”.

Mr Bacon, a member of the Commons public ac-counts committee, said: “At a time when hard-pressed NHS trusts are havingto make painful choices in order to reduce deficits,they are being forced to pay money they don’t have and release staff they can’t spare for something they don’t want and doesn’t work.”

Connecting for Health, the NHS programme, said yesterday the secondments were agreed by senior managers when the contracts were originally signed.

“It was always recognised that it would be a challenge to source NHS staff,” said the programme.

Accenture, too, has a deal for NHS staff to be seconded to the programme in the east and north-east but according to ministers no contracted financial obligation went with that.

http://news.ft.com/cms/s/75fd04d2-f4f8-11da-86f6-0000779e2340.html

This just underlines the lunacy that is labour’s NHS strategy. Not only can the NHS trusts not afford to have staff not working for patients, this warns that the new IT system- which is itself under fire for not consulting with potential practitioners is even less likely to succeed. Please see Top UK IT experts call for audit of NHS (NPfIT) programme

It also raises the prospect of the failure of another labour policy of Dignity for the elderly: Chief execs should ‘take the rap’ if elderly failed on dignity when nurses are supposed to promote care of the elderly. But naturally enough Labour haven’t added an extra penny to fund this spin story.

In a report published today by the King’s Fund, ministers are accused of sending mixed signals about their commitment to establishing a market among healthcare suppliers, “one day implying they are in favour, another denying some of the likely consequences”.

The report*, drawn up by a group of senior executives from the NHS, private and voluntary sectors, calls for a clearer split between commissioning and supply, an overhaul of regulation including a new competition body for healthcare, and no arbitrary limit to the role of private or independent providers.

The King’s Fund notes how the government has shifted towards a market system, with payment by results, semi-independent foundation hospitals and a bigger role for the private sector.

But it concludes that without an unequivocal commitment to a market among suppliers, patients will not only fail to win the full benefits of competition and innovation but could lose out if the strengths of services such as emergency care are damaged by half-baked reforms.

The report calls for the government to explain to voters and sceptical MPs that the outcome of its reforms is a clearer split between commissioning healthcare and its supply, with local commissioning bodies or family doctors purchasing care for patients from a variety of suppliers.

Ministers should set the budget and overall policy goals, but step back from day-to-day management. “Without clarity on this, there will be muddle. Muddle will be dangerous for patients,” the report said.

The report also calls for an overhaul of the regulation of healthcare suppliers with a regime to deal with financial or clinical failure, to allow mergers and acquisitions and maintain competition.

The Department of Health should be split, most probably into three separate bodies: a rump department overseeing the NHS budget and general policy; a separate commissioner of services to buy care for patients; and a separate entity overseeing NHS services, whose role would shrink over time as NHS staff transferred to independent employers.

Ministers have set no formal limit to the slice of healthcare that could be provided by theprivate sector but have said itis unlikely to grow beyond 15per cent in the foreseeable future.

*Designing the ‘new’ NHS – ideas to make a supplier market in health care work, published by the King’s Fund

http://news.ft.com/cms/s/e43471fc-f42f-11da-9dab-0000779e2340.html

What we are now seeing in Labour’s brave new world is change for change sake, with no coherent long term answer for funding nor supply.

As the King’s Fund chief executive Niall Dickson said: “The move towards the introduction of a supplier market has been achieved with surprisingly little serious discussion and there is still some uncertainty about where it is all heading. We very much hope this stimulating report will generate debate over what needs to be done to ensure high quality care within a market system.

Doctors and patient groups have accused the NHS of discriminating against men. John Neate, chief executive of the Prostate Cancer Charity, said: “Nobody should have to battle bureaucracy when they need all their energy to come to terms with a diagnosis.”

Brachytherapy has fewer side effects than removing the prostate or giving radiotherapy for five days a week over seven weeks. Only 10%- 15% of men are left impotent after Brachytherapy, compared with about 50% of men who undergo surgery.

The £9,000 treatment takes just one day. The patient has radioactive pellets implanted into the prostate gland. These target and kill the cancer.

Brachytherapy is not suitable for all prostate cancer sufferers but doctors believe that it is the best treatment for patients who have small tumours which have been caught at an early stage.

Stephen Langley, a consultant at the Royal Surrey County hospital in Guildford, one of about 10 in England offering Brachytherapy, said: “A similar number of men die from prostate cancer every year as women who die from breast cancer, but there is a fraction of the money going into prostate cancer.”

The issue will be raised this week at the British Medical Association’s staff and associate specialists conference.

The Department of Health said: “With devolved decision-making, trusts can make different choices. The principle of local autonomy is important.”

http://www.timesonline.co.uk/newspaper/0,,176-2209982,00.html

In December 2005, just 12 people were waiting more than six months for an operation in England. But in the same month the Connecting for Health computer systems were launched at the Nuffield and the number of people waiting longer than six months started to rise.

Within a few weeks more than 100 people in England were waiting longer than six months, most of them at the Nuffield, which insists that the problem is now resolved.

Staff who were instructed to sort out the problem could not even establish from the malfunctioning computers which patients had been waiting the longest and the numbers kept climbing.

Details of the waiting list problems at the Nuffield, released under the Freedom of Information Act, will increase pressure on the government for an independent review of the scheme.

Lord Warner, the health minister, confirmed last week that the system was already delayed and would cost up to £20 billion. The figure originally given by the government for the project was £6.2 billion.

The problems at the Nuffield were so severe that hospital managers could not even compile accurate data for the Department of Health on patients waiting to be treated.

Figures now released by the hospital show that it repeatedly breached the government’s key target of keeping no patient waiting longer than six months for an operation.

On March 31 the number of patients waiting longer than six months for an operation was 123, out of a national total of 199 patients.

This meant that the hospital, in most areas one of the best performers, had temporarily fallen to the bottom of the national league table for patients waiting longer than six months.

Leon Price, 31, who had to wait longer than six months for a back operation, said: “You have to wait long enough to be seen without problems like this. It’s ridiculous that people were waiting even longer because of a faulty computer system.”

The hospital is now confident that it has addressed the problems and that no patients are breaching the government’s key six-month waiting target. Computer experts say the problems at the Nuffield highlight the need for a national review of the programme.

Ross Anderson, a professor in security engineering at the University of Cambridge, warned that the new system was likely to cause “chaos and disaster” in the NHS.

“They’re ripping out the old systems but they’re not replacing them with anything better,” he said.

The Connecting for Health scheme is intended to create centralised medical record systems for 50m patients and link more than 30,000 GPs in England to 300 hospitals by 2012. Many doctors and IT experts are concerned that a centralised system will make the NHS even more vulnerable to damage from computer failures.

Connecting for Health said that the old computer systems at the Nuffield were in a state of near collapse and the new ones would improve patient care, although there had been initial problems.

“It did cause disruptions to some patients, for which we are sorry,” said a spokesman.

http://www.timesonline.co.uk/newspaper/0,,176-2210007,00.html

Health Direct first raised the issue of the first NHS test run of the national programme for IT (NpfIT) on Friday, March 17, 2006 NHS care records IT roll-out raises patient safety fears.

When the Nuffield Orthopaedic Centre had to file a “serious untoward incident” report with the government’s National Patient Safety Agency after the fraught implementation at the hospital of a Care Records Service for sharing electronic records nationwide.

So it’s no surprise that more voices like Ross Anderson, a professor in security engineering at the University of Cambridge, warns that the new system was likely to cause “chaos and disaster” in the NHS. “They’re ripping out the old systems but they’re not replacing them with anything better,” he said.

He told MPs: ‘There have never been systematic arrangements for collecting information on the nationality of mentally disordered offenders.’

Foreign patients had not been assessed for deportation or even referred to the Immigration and Nationality Directorate, he added.

A Home Office spokeswoman told HSJ an investigation had been launched as part of the wider search for foreign ex-convicts but so far no figures had been compiled.

But a spokesperson for Nottinghamshire Healthcare trust, which runs Rampton, said he was not aware of any foreign nationals being released into the community.

A pioneering unit at Rampton Hospital has been closed to admissions after serious disturbances, believed to be assaults on staff. The Peaks Unit treats men with dangerous and severe personality disorder. A spokesperson for Nottinghamshire Healthcare trust said the unit was expected to reopen shortly after an overhaul of operating policies and improvements to staff training.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=4874493

Health Direct warns that the Home Office and Dept of Health’s versions of events just don’t match up. How stringent are any of the checks on all of the released prisoners if the DoH say that they are “not aware of any foreign nationals being released into the community” and the Home Office who can’t find hundreds of missing foreign prisoner patients?

If patients are being released into the community without any knowledge of their basic background- ie can they even understand or speak English, what level of confidence can one have about the rest of the system’s assessment of the likelihood of any of the patients’ reoffending? Not much one would suggest.

Mr Bliar’s promise was made in 2003. He wanted to defuse criticism that the proposal would create a two-tier NHS, of elite foundations and less privileged establishments. The prime minister said all 170 acute hospital trusts would be able to apply for foundation status by 2008 if they wanted the benefits of independence.

But the Monitor board minutes, requested by the Guardian yesterday, show Mr Moyes expects only 75 of the 170 to be able to convince him by April 2008 that they can operate independently.

The minutes describe the delay as “back-end loading of applicants for foundation status up to and beyond 2008″.

Mr Moyes asked Sir Ian Carruthers, the acting NHS chief executive, to back a proposal to help up to 60 trusts a year to prepare themselves to pass the foundation tests, but reportedly did not get a formal reply.

The disclosure came after Monitor awarded foundation status to five more acute hospital trusts – in Salisbury, Reading, Newcastle upon Tyne, Southend and Yeovil. There are now 40 NHS foundation trusts, including three mental health trusts.

A department spokesman said the programme to prepare trusts for foundation status was in its early stages and that it was premature to talk about how many would be ready by 2008.

http://www.guardian.co.uk/uk_news/story/0,,1787037,00.html

As Health Direct pointed out on Saturday, March 04, 2006 in our posting: DoH is a ‘complete and utter cock-up’ over Payment by Results the knock on effect of being unable to decide on the payments system for the NHS only a month before the start of the new financial year would mean that all long term financial planning would be next to impossible.

With the result that the majority of PFI calculations are now being assessed as a higher risk to all parties.