The MPs are highly critical of the Advisory Council on the Misuse of Drugs, the government’s key advisory body on drugs policy, calling its failure to alert the home secretary to the serious flaws in the system “a dereliction of its duty”.

Phil Willis, the committee chairman, said: “The Home Office and ACMD approach to classification seems to have been based on ad hockery and conservatism. It is obvious that there is an urgent need for a root- and-branch review of the classification, as promised by the previous home secretary [Charles Clarke],” Mr Willis said.

“We all know that the current home secretary [John Reid] has other things on his mind but that is not an excuse for trying to kick this issue into the long grass.”

The MPs condemn the government’s “proclivity for using the classification system as a means of ‘sending out signals’ to potential users and society at large – it is at odds with the stated objective of classifying drugs on the basis of harm.” Individual drug classification reviews are “launched as knee-jerk responses to media storms”, they say.

The committee proposes a new scale, decoupled from criminal penalties and based on the best scientific evidence of the harm done by each drug – not just to users but to society as a whole.

It should also give the public a better sense of the relative harm of alcohol and tobacco.

On individual drugs, the report says the government contravened the spirit of the Misuse of Drugs Act when it put “magic mushrooms” into Class A without consulting the ACMD. But the committee undermined its own credibility by not speaking out on the issue.

The MPs express surprise and disappointment that the ACMD has never reviewed the evidence for ecstasy’s Class A status. And they say the committee’s recommendations on the status of methylamphetamine appeared to rely on politics and outside pressure rather than science.

Mr Willis, a Liberal Democrat, said the conclusion was that “it is time to bring in a more systematic and scientific approach to drug classification. How can we get the message across to young people if what we are saying is not based on the evidence?” he asked.

http://www.ft.com/cms/s/825386da-2030-11db-9913-0000779e2340.html

Health Direct highlights the “joined up thinking” or rather the lack of it by the labour government whilst it wanders aimlessly during the bliar/ brown change over and A and E surgeries clog up with drunken patients every night.

The Commons Science and Technology Select Committee are highly critical of the Advisory Council on the Misuse of Drugs, the government’s key advisory body on drugs policy, calling its failure to alert the home secretary to the serious flaws in the system “a dereliction of its duty”.

The credibility of the Advisory Council on the Misuse of Drugs appears to be fatally floored by the MPs verdict that it’s recommendations “rely on politics and outside pressure rather than science.”

The list included John Rowe, executive chairman of Aetna, one of the largest US health insurers; Ken Kizer, former chief executive of the Veterans Administration, the largest tax-funded healthcare provider in the US; and Ian Smith, chief executive of General Healthcare, Britain’s biggest private hospital group.

Mr Nicholson’s appointment comes as doubts remain over the government’s determination to push through what appears to be the prime minister’s long-term goal of turning the NHS largely into a health-purchasing organisation.

Under such an arrangement, provision of services would be increasingly separated out into free-standing businesses, coming either from a much wider variety of foundation trusts; new forms of enterprise in which staff are encouraged to leave the NHS and contract their services back; or from the existing private and voluntary sectors. Some believe that could lead to a formal separation of the NHS from the Department of Health.

Niall Dickson, chief executive of the King’s Fund health think-tank, said: “If they had gone for any of the US or private sector candidates that would have reinforced and made absolutely clear the direction of travel.”

But analysts were divided over whether Mr Nicholson’s appointment suggested any rowing back on the government’s ambition. “It may not,” said one senior figure from the UK private healthcare sector. “But it will give succour to the people who are against all this.”

That comment came as Unison and the British Medical Association, vociferous critics of the government’s involvement of the private sector in healthcare delivery and commissioning, welcomed the internal appointment. The BMA said Mr Nicholson understood the service’s “ethos and values”.

An occasionally slightly dishevelled and, on his own admission, “directly spoken” Yorkshireman, Mr Nicholson, will in September take over a business that by 2008 will have a £90bn turnover.

He has 25 years’ experience in the NHS, helping close long-stay asylums in his early years before turning Doncaster hospital into an NHS Trust during the Conservative internal market reforms of the 1990s. He has since been a regional and strategic health authority chief executive in Trent and Birmingham and the Black Country.

He resisted the imposition of independent treatment centres in Birmingham, arguing the NHS locally had capacity and plans to meet waiting time targets, but he also commissioned work showing patients wanted more choice in the NHS.

He told the Health Service Journal recently he saw his job as “about the management of change, not about keeping the system running”. He added: “I’m on the side of the angels – the patients and taxpayers – not the organisations” and that “we have to change things, not protect the status quo”.

Chris Ham, a former head of strategy at the department and professor of health services management at Birmingham University, said Mr Nicholson would give the top of the NHS a “very strong operational focus”. But he added: “If there is a longer-term plan clearly to separate the commissioning of care from the provider side there is no-one better among NHS managers to oversee that. I don’t think this appointment points to any less radicalism.”

Given the recent rows over the NHS involving the private sector in commissioning care, and ministers’ desire to still charges of “privatisation” ahead of the Labour conference, department insiders said a US appointment would have been “just too provocative”.

Others said Mr Nicholson “sees exactly where it is going” but had the advantage of providing continuity and an understanding that an outsider would struggle to acquire of what needs to be done within the NHS to achieve that.

Andrew Lansley, the Conservative health spokesman, said that he, like others, saw a “strong case” for appointing an outsider.

The appointment comes at the end of a fortnight in which the department has made clear the more market-like approach to buying care will be managed carefully by tight rules that will limit hospitals’ ability to treat many more patients and charge their local primary care trust for the work.

Ministers have decided not to extend to critical care the use of “payment by results” – a payment for each case treated – to let the new system of money following the patient bed down better.

http://www.ft.com/cms/s/070bee7a-1dd5-11db-bf06-0000779e2340.html

At the end of 2002, the Government decided to commission a number of independent sector treatment centres (ISTCs) to treat NHS patients who required relatively straightforward elective or diagnostic procedures. Several objectives were ascribed to the ISTC programme, including:
* Increasing elective capacity available to the NHS in order to reduce waiting lists and times;
* Reducing the spot purchase price in the private sector;
* Increasing patient choice within the NHS;
* Encouraging best practice and innovation;
* Stimulating reform within the NHS through competition.

Many of the ISTCs are stand-alone sites, physically removed from local acute hospitals, and their contracts included a stipulation of ‘additionality’; the independent providers were prohibited from employing anyone who had worked for the NHS in the previous six months. Partly as a result of this, they were overwhelmingly staffed by overseas clinicians.

The contracts also contained financial guarantees, the so-called ‘take or pay’ element, whereby they were assured of a certain level of income, irrespective of how many procedures they performed for the NHS. The Department of Health justified this by arguing that it was necessary to introduce new providers into the health economy.

Our inquiry examined whether the objectives of the programme had been met. We concluded that ISTCs had not made a major direct contribution to increasing capacity. The Department of Health has admitted that the number of procedures performed by ISTCs is a tiny fraction of the NHS’s total capacity. ISTCs have had a significant effect on the spot purchase price and increased patient choice, offering more locations and earlier treatments.

However, without information relating to clinical quality, patients are not offered an informed choice. We found that ISTCs have embodied good practice and introduced innovative techniques, but good practice and innovation can also be found in NHS Treatment Centres and other parts of the NHS. ISTCs are not necessarily more efficient than NHS Treatment Centres. The Department claims that ISTCs drive the adoption of good practice and innovation in the NHS, but we received no convincing evidence which proved that NHS facilities are adopting in any systematic way techniques pioneered in ISTCs.

The threat of competition from the ISTCs may have had a significant effect on the NHS, but the evidence is largely anecdotal. Waiting lists have declined since the introduction of ISTCs, but it is unclear how far this has happened because the NHS has changed in response to the ISTCs or because of additional NHS spending and the intense focus placed on waiting list targets over this period.

We were surprised that the Department made no attempt systematically to assess and quantify the effect of competition from ISTCs on the NHS. Given its importance, the Department should have ensured that this was done from the beginning of the ISTC programme in 2003.

A number of concerns were raised about the ISTC programme by the professional medical bodies and others. There were concerns that ISTCs were poorly integrated into the NHS and that they were not training doctors. These concerns are well-founded. The additionality policy was felt by many to have hindered integration between ISTCs and their local NHS facilities, while the reliance on overseas staff which additionality had necessitated raised concerns about clinical quality and continuity of care.

We concluded that there was no hard, quantifiable evidence to prove that standards in ISTCs differed from those in the NHS; however, there are failings in the quality of data collection by both NHS and IS providers.

We recommend that comparable and standardised data be collected. We welcome the forthcoming inquiry into the quality of care in ISTCs which the Chief Medical Officer, Professor Sir Liam Donaldson, has asked the Healthcare Commission to undertake.

We also received evidence about the effect of ISTCs on the finances of the NHS. The ISTC programme is intended eventually to provide about half a million procedures per year at a cost of over £5 billion in total.

This could clearly affect the viability of many existing NHS providers over the next five years and possibly beyond. Moreover, as the quantity of ISTC activity is not evenly spread across the country, the impact on the budgets of different local health economies is likely to vary. The Phase 1 contracts, including the ‘take or pay’ elements, give ISTCs a significant advantage over NHS Treatment Centres and other NHS facilities. In the longer term, there are good reasons for thinking that ISTCs could have a more significant effect on the finances of NHS hospitals.

We do not know how big that effect might be or how great the dangers might be. The Department of Health has carried out analysis of the possible effects of the ISTC programme on NHS facilities, but it has refused to disclose the analysis to us. Phase 2 ISTCs may lead to unpopular hospital closures under ‘reconfiguration’ schemes.

There was also considerable scepticism about whether the ISTC programme represented value for money. We found it difficult to make an assessment since the Department would not provide us with detailed figures on the grounds of commercial confidentiality.

We have some evidence about the potential benefits. It is hard to see that the decision to commission Phase 1 could have been justified in terms of the need for additional capacity alone. The other major potential benefit, the galvanising effect of competition on the NHS, was not and probably could not be quantified when the decision to go ahead with Phase 1 of the ISTC programme was made.

It is claimed that this decision was a leap in the dark in the hope that the ‘challenge’ of ISTCs would improve efficiency in the NHS. We agree. In view of the high degree of uncertainty about ISTCs’ wider benefits and costs of the ISTC programme, we recommend that the NAO investigate them, in particular the extent to which the challenge of ISTCs has led to higher productivity in the NHS.

In March 2005 the Department announced that it would commission a second wave (“Phase 2″) of ISTCs. Phase 2 is to consist of an elective and a diagnostic element. £2.75 billion is to be spent on the former, £1 billion on the latter. There was a degree of confusion over the scale and nature of Phase 2. 17 elective and 7 diagnostic schemes are likely to go ahead. 7 other schemes are not in the end to go ahead, but the SHAs affected by these cancellations are nonetheless to be obliged to make independent provision available to NHS patients through other means.

The Department acknowledged some of the anxieties which Phase 1 had created and promised to address them in Phase 2: additionality would be restricted to increase the involvement of NHS staff in ISTCs and improve integration; and all ISTCs would be obliged to offer training provision for NHS staff if required by local needs. We support these moves.

In Phase 2, ISTCs are not only to be built where local plans show the capacity is needed but they are also to be used as part of ‘reconfiguration’ plans. This could mean that major hospitals would be closed and the elective services they provide be undertaken by ISTCs. We were told that ISTCs would only go ahead where local health communities considered them appropriate, but there is concern about the pressure put on such communities by the Department.

The second stage of the evaluation of Phase 2 is the Department’s assessment of whether the ISTCs represent value for money. However, we were not given any detailed figures which would enable us to check this assessment. We found it difficult, therefore, to assess the current state of Phase 2 of the ISTC programme, or the rationale behind it.

The Department of Health and the Secretary of State have, over the course of our inquiry, given answers which have shifted in both fact and emphasis as time has gone by, and the statement of the current position by the Secretary of State leaves several important questions unanswered.

The decision to maintain the commitment to spend £550 million per year despite changing circumstances has not been explained, and seems to sit uncomfortably with the Secretary of State’s admission that “in other [areas] it has become clear that the level of capacity required by the local NHS does not justify new ISTC schemes”.

It is not clear whether this represents simply a failure coherently to articulate the situation or a more profound incoherence in terms of policy as opposed to presentation. There are also real concerns that the expansion of the ISTC programme will destabilise local NHS trusts, especially those with financial deficits.

There are major benefits from separating elective and emergency care in treatment centres. Such centres should continue to be built where there is a need and where the decision to build the centre has been agreed with the local health community following Section 11 consultation.

We are not, however, convinced that ISTCs provide better value for money than other options such as more NHS Treatment Centres, greater use of NHS facilities out-of-hours or partnership arrangements such as those at Redwood. All these options would more readily secure integration and may be cheaper.

http://www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/934/93403.htm

The rise may be partly due to increased reporting. But levels of the infection, which mainly affects the hospitalised elderly on antibiotics, are also rising in line with an ageing population.

As levels of C diff escalated, MRSA levels dipped slightly – but not enough to indicate that hospitals will meet the Department of Health’s five-year target. While the number of cases of the superbug decreased by 2% – from 7,233 in 2004/05 to 7,087 in 2005/06 – the government wants levels to be halved by 2008. So far they have only slipped by 11%.

Georgia Duckworth, head of the healthcare associated infection department at the HPA, said: “The fact [MRSA] isn’t still going up is very good news but you might ask: what does this mean in meeting the target?” Yet she added there were “encouraging signs” in curbing the infection. Levels of MRSA – which caused 1,168 deaths in 2004 – have decreased by 350 cases in London hospitals, the worst affected area, and in Yorkshire and the Humber.

C difficile is a hospital-acquired infection which usually causes diarrhoea but can lead to fevers, severe inflammation, and death in around 5% of cases. Older people are particularly at risk, but the figures showed a rise in younger age groups, particularly 45-64. In all, a quarter of all cases of C diff occurred in under-65s.

Treatment is by two antibiotics, vancomycin and metronidazole, but patients are still vulnerable to it recurring. As with MRSA, a blood infection that can cause fever, septicaemia and organ failure, hand washing by doctors and nurses is essential to prevent the spread of infection.

Yesterday’s statistics coincided with the Healthcare Commission report into the fatal outbreaks of C diff at Stoke Mandeville hospital. Professor Peter Boriello, director of the HPA’s centre for infections, said outbreaks of the nature and severity of the Stoke Mandeville case were uncommon, but no one could guarantee it was a one-off.

A DoH spokeswoman said new legal powers would allow ministers to penalise trusts that did nothing to tackle poor infection rates.

http://www.guardian.co.uk/uk_news/story/0,,1828032,00.html

Ms Hewitt visited Cirencester hospital on Tuesday as part of a nationwide tour of health services. She tried to justify the cuts as she has already given her backing to closure of in-patient facilities in Fairford and Tetbury.

The savings are part of moves to reduce an NHS deficit across England, which has reached £512m.

http://news.bbc.co.uk/1/hi/england/gloucestershire/5212320.stm

Dozens of hospitals are facing acute pressure and social care services are being scaled back because of NHS deficits, two separate reports say. A Local Government Association survey of 55 councils in the areas affected by NHS deficits said some services had been withdrawn.

The health service finished last year more than £500m in deficit, with one in three NHS bodies failing to balance their books.

The problems have already led to jobs being cut, operations delayed and wards closed.

They analysed how deficits combined with government reforms introducing more competition in the hospital sector could affect 152 NHS trusts in England in the coming years.

The West Hertfordshire Hospitals NHS Trust, which includes St Albans City, Hemel Hempstead and Watford hospitals, is facing the most problems, the research said. The trust has warned that, if cuts are not made, a £100m deficit could be run up by 2010.

The Local Government Association (LGA) survey, compiled in conjunction with the NHS confederation, also revealed the pressure from NHS deficits was hitting social services. Some 55 of the 78 local authorities in areas with deficits replied to the poll.

Seven in 10 councils said they had suffered because of the financial problems, reporting funding for joint NHS and local government projects had been withdrawn and that there was a “sharp increase” in the referral of patients who would normally have been cared for by the NHS.

The councils reported this had led them to withdraw services from people with low-level care needs and increase waiting times for social care assessments.

Councillor David Rogers, the LGA’s social care spokesman, said: “Health and social care are two sides of the same coin. It is impossible not to cut services on one side without hurting the other.”

Shadow health minister Stephen O’Brien said: “Despite the government’s repeated, barefaced denials of cuts to frontline patient services we see here stealth cuts to social services caused by the NHS deficits.”

Anita Astle is the manager of Wren Hall Nursing Home in Nottingham and the director of the Nottinghamshire Care Home Association. She sent her email to express her own point of view after watching Panorama’s first film on the website.

Out of all the emails we received we chose to feature the people who wrote these messages to Panorama and you can hear them tell their own stories in the film.

Anita’s email “This is appalling. Older people paying for the privilege to be cared for whilst they deteriorate both physically and mentally and subsequently die. Reviewers are more concerned about the cost to the NHS than addressing the health needs of frail older people.”

Lynne Cowley
Lynne Cowley’s mother requires care and Lynne told Panorama that her experiences with her mother have made her question how vulnerable people are treated by the authorities. Her mother, Gladys, died while Panorama investigated her story at Lynne’s request.

“They have tried to bully me, harass me at work for money and the final straw was when I saw the so-called assessment they did on mum. Fortunately I have worked in medical journalism. Even more fortunate I watched your programme.

My mum deserves better than this. She worked and paid in for care, and so did my late dad” who fought a war for this country. Mum has only got me to fight for her and she only has a few months to live. I want her last days to be as good as we can make them. This country owes her.”

Linda Jones was writing a letter to Tony Blair about her uncle’s care when she saw Panorama’s first film.

“Please find attached below a copy of the letter I have sent to Mr Blair. I was in the process of writing this communication and then I saw your programme.

“Dear Mr Blair It is with great sadness that I write to you direct concerning my 79-year-old uncle.

“My uncle served his country during the war and paid all contributions during his working life, worked hard to pay-off his mortgage and to provide for his pension during his retirement. All the things your government encourages a good citizen to do.

“To date we have paid in excess of £45,000 in fees for uncaring services, believing we were doing our best. We have had the door slammed in our faces all the way.

“We have now sold the family home what more do you want us to do? What has happened to the National Insurance Contributions he paid all his life?”

Phil Shakespeare’s mother Pauline requires care and he has started a campaign with details at
fightthebureaucracy.org

“Dear Panorama, I’m tired of having to keep fighting and fighting. The distress this is causing my family far outweighs the illness itself. I don’t know who to trust anymore and it’s getting harder to keep a lid on all this frustration! If mom was eligible then and in 2004 what’s changed, certainly Mom hasn’t improved, her dementia is very advanced, so SOMEONE has moved the goal posts. I have always felt I’m kept in the dark and isolated.”
Read an NHS consultant’s views about the ‘scandalous way’ older people are treated

Panorama received so many emails that unfortunately we could not follow up everyone’s stories and film them.

Three members of the production team who worked on the first film read every single email and letter and chose cases for the follow up which they felt could illustrate some of the main areas of concern raised in the emails.

The distress, frustration and lack of confidence in the system of NHS continuing care is palpable from the following selection of messages.

The vast majority of the emails we received related the sadness and anguish that relatives experience during an already difficult time. The initial distress of moving a loved one into a care home was compounded by the realisation that the family home may have to be sold.

http://news.bbc.co.uk/1/hi/programmes/panorama/5188580.stm

Sir Liam said one factor that could affect the treatment a patient received was their socio-economic status. He pointed to the comparatively high number of poor children who underwent tonsillectomies, suggesting that many unnecessary operations were being carried out.

The professor said if the national rate of tonsillectomies was the same as that in the most affluent children, “around 8,000 operations could be avoided per annum and over £6m saved”.

He also criticised wide regional variations in the number of hysterectomies performed in England.

For women aged between 40 and 59 with excessive bleeding, hysterectomy rates have fallen by as much as 64% in north central London but by as little as 15% in Northumberland and Tyne and Wear.

Sir Liam said: “If the average rate of hysterectomy in England could be reduced to that achieved in the 20% of the country with the lowest current rates, then 5,900 operations, costing £15m could be avoided per annum.”

He also highlighted variations in the treatment of heart attack patients needing revascularisation, a procedure to either open up existing blood vessels or encourages new ones to form to improve blood flow to the heart. In some parts of the country patients were twice as likely to be offered a less-intrusive angioplasty, compared to a coronary artery bypass graft, as in other areas.

Another example of inefficiency highlighted in his report was that there are 574 different hip joints currently in use in the NHS – a reduction in this number could save significant amounts of money.

Sir Liam said the National Institute for Health and Clinical Excellence, which decides what treatments should be provided on the NHS, should issue guidance advising health trusts not to spend money on treatments “that are no longer appropriate or effective or do not provide good value for money”.

There should also be a system sent up to reward effective use of treatments and penalise “useless” or ineffective use of treatments, he added.

The chief medical officer also said the NHS could learn lessons about improving patient safety from the aviation industry. He said it had a “much better record on safety” than the healthcare industry.

“Rather than looking at harm and deaths that occur to patients as one-off events, we should look at connections and similarities, the common causes, and use them as a source for learning and action just as the airline industry has done,” he told the BBC’s Ten O’Clock News last night.

http://www.guardian.co.uk/medicine/story/0,,1826211,00.html

In recent years, hospital patients and their visitors have also had to pay increasing sums for non-clinical services, such as car parking and bedside telecommunications. International research has shown that health charges have a negative effect on health, and that patients with long-term illnesses suffer particularly when charges are in place. There is also some survey-based and anecdotal evidence which suggests that patients are less likely to visit their dentist or have prescriptions dispensed in full because of the costs.

There are exemptions, which aim to mitigate the negative effects of charges on health. Patients are exempt from paying for prescriptions, dental services and sight tests on the basis of age, income and where they are treated.

In addition, patients with specific conditions are exempt from the prescription charge (eg. if they have insulin-controlled diabetes) or sight test fee (eg. if they have glaucoma); pregnant women and those who have recently given birth also receive free dentistry and medicines. Financial assistance towards the cost of charges, and vouchers for spectacles, are available to specified groups.

The system of exemptions is full of anomalies. Age and income exempt some people, but this does not apply across the board. Pensioners are exempt from prescription and sight test charges, regardless of their income, but must pay for dentistry unless they receive help through the NHS Low Income Scheme (LIS). Those in receipt of certain benefits are automatically exempt, others must apply for financial assistance or exemption through the LIS.

The system of medical exemptions to the prescription charge is particularly confusing. People with diabetes who require insulin receive free medicines for all conditions while people with diabetes controlled by diet must pay for all their medication. The list of exemptions was compiled in 1968 and has not changed. Given the vast improvements in medical science since that time, this is unacceptable. People with cystic fibrosis who would have died of their illness during childhood in the 1960s now reach adulthood. Diseases such as HIV/AIDS did not exist in 1968. The original list could not have taken these conditions into account.

The current system of charges must change. However, even after over 50 years of operation, there is a woeful absence of evidence about the effects of charges in this country. It is known that harmful effects occur but they are largely unquantified. The English evidence is limited and one of our key recommendations is that more research on the effects of charges be carried out here.

We need to know the extent to which charges deter patients from seeking medical, dental or ophthalmologic help when they need it and how this affects their health status. Similarly, we do not know what the consequences would be of making large-scale changes to the charging system. It is therefore difficult at this stage to decide what should be done. Accordingly, we recommend that evidence is gathered on:
• public attitudes to health charges;
• the extent to which charges affect the use of health services and, in the long term, health;
• the extent to which charges reduce ‘frivolous’ demand.
There are a number of short-term changes that should be implemented immediately to improve the situation.

Take up of the Prescription Pre-payment Certificate (PPC) is low. We recommend that a monthly PPC be introduced to help those on low incomes who cannot, or prefer not to, buy a yearly PPC. The cost of the yearly PPC should be pegged at 12 times the cost of a single prescription. The cost of a monthly PPC should be pegged at the cost of one prescription. There should also be a reduced price PPC for those receiving help through the Low Income Scheme.

The dental contract, which includes a new, banded system of charges, was introduced in April 2006; it is therefore too early to know how patient care will be affected. Criticisms of the contract include the lack of consideration given to preventative care and the risk that fewer NHS patients will be treated. We therefore recommend a review to report the effects of the new contract on patient access and care, including prevention, and on NHS dentist numbers, recruitment, salaries and workload.

It is unclear whether the sight test fee deters patients from visiting their optician. Sight test numbers, and consequent referrals to hospital for specialist treatment, certainly fell after the free sight test was abolished. However, the Department reported that numbers of over 60s seeking sight tests did not rise significantly after the charge was removed once more for this group. Many opticians practices do not sell spectacles within the value of vouchers provided by the NHS to those eligible for help.

We recommend that all practices carry stock within the value of these vouchers. It is also clear that many of those at risk of eye disease are not being targeted effectively. We recommend that greater efforts be made to improve attendance among these groups, and that sight tests for all children be reintroduced.

The setting of treatments has changed significantly in recent years. Patients who would previously have stayed in hospital now often receive treatment on an outpatient basis. This has led to problems with the cost of attending hospital. While car parking charges must remain a matter for hospital trusts, we recommend that they provide reduced rates for patients and their visitors who attend hospital regularly and free parking for those who must attend on a daily basis.

Those unable to visit friends and family in hospital now usually have the possibility of telephoning loved ones’ bedside telephones. Unfortunately, they have often paid a high price to do so. We recommend that this problem be addressed immediately.

The minor recommendations detailed above will lead to small improvements for patients, but will not address the fundamental problems in the current system of health charges. We heard several other options for major improvements to the system of charges. Inevitably they each have positive and negative consequences and the evidence is not sufficient to reach a conclusion as to which of these options would be best. Little work has been done in this country on the costs or benefits of the different possible systems.

This work needs to be done urgently so that an alternative charging system, with consistent underlying principles, can be developed. The Government should undertake a major review to assess the costs and benefits of the following:
• abolishing all the existing health charges;
• abolishing only the prescription charge;
• abolishing only charges for initial consultation and diagnosis, such as dental check-ups and eye tests;
• establishing a system of reference pricing for medicines;
• completely revising the medical exemptions to the prescription charge;
• introducing a flat-rate prescription charge with no exemptions; and
• basing exemption to charges solely on income so that those who can afford to pay for their prescriptions, dental care and sight tests do so.

The review should also consider a system of charges appropriate for future challenges. In the future, the NHS may not be able to pay for every possible medical treatment in a country with an ageing population, demographic pressures, rising public expectations and increased possibilities of medical treatment and long-term therapies.

Some treatments or procedures may have to be charged for. The Government should consider this possibility sooner rather than later to ensure that a set of consistent criteria apply to those areas for which a fee is charged, to avoid the development of charges in an ad hoc way, as has been the case until now.

With the introduction of such a system, it may be possible to abolish health charges which currently have a negative effect on health outcomes. The key principles that should be considered in this review are:
• services that are clinically necessary should be free;
• fees should not deter patients visiting their doctor or accessing healthcare; and
• any system chosen should be adaptable (to changing medical practice, treatments etc)
and consistent.

The review should include:
• the possibility of establishing a package of core services which would be free (these might include prescriptions and dental care); and
• a set of treatments for which the NHS could charge.

Treatments/interventions that are not cost-effective, such as branded drugs where an effective generic exists, could be subject to a charge. The use of charges to promote more responsible use of services could also be considered, including:
• the introduction of a small charge for non-emergency patients presenting to A&E.;
This would encourage people to register with a GP, and make better use of out-of hours services; and
• a fee for patients who do not attend or fail to cancel GP or hospital appointments.

http://www.publications.parliament.uk/pa/cm/cmhealth.htm

He has questioned plans to close St Michael’s Hospital and cuts at the West Cornwall Hospital given that the county council has not been consulted.

The NHS in Cornwall is facing a potential £31m deficit. The Trust is cutting costs and 300 jobs to try to reduce the projected deficit.

Emergency surgery will not be carried out at the West Cornwall Hospital from the end of August.

All accident and emergency work will be concentrated at the Royal Cornwall Hospital in Truro, although non-urgent booked appointments will continue.

Managers said the emergency surgery issue would be reviewed later in the year.

Plans to shut 70-bed St Michael’s Hospital in Hayle were made public after a memo leaked to the BBC.

Mr McKenna said he had heard about the plans for West Cornwall Hospital via the media.

On legal issues, he said: “A couple of years ago the government introduced a requirement on the NHS to consult with local authorities on major service changes. When I spoke to the county council yesterday, they said they knew nothing about some of the proposals.”

“I would say, and we are investigating the legal position as we speak, that they are not legally empowered to make such cuts until such time as they have consulted on them.”

He asked why services were being slashed before the true extent of the financial situation was known, and has called for an urgent meeting with the trust’s acting chief executive, Paula Friend.

http://news.bbc.co.uk/1/hi/england/cornwall/5196010.stm

Ms Friend has so far been unavailable for comment.

The price of freedom is eternal vigilance – Thomas Jefferson

I must confess I had always taken Jefferson’s aphorism to mean that we must be eternally on our guard against any erosion of our freedom. It now seems I was wrong; or at least, I’m at odds with the Government, which evidently believes that the price of freedom is that we should be under constant surveillance.

Indeed, there are now more than four million surveillance cameras in Britain, one for every 15 citizens. At a ball I attended a few years ago, there was no need for the host to provide souvenir photographs of the guests as they left; there was every chance their arrival had been captured on one of the countless speed cameras (visible and invisible) on the A68.

In the current circumstances, the Government may present the monitoring of our movements as one of the more justifiable restrictions on our freedom; but it is only one of a number of creeping encroachments, some in the name of safety, some in the name of security, some in the name of public order, but all of which, taken together, produce an alarming picture of the society we have allowed ourselves to become.

We are perhaps familiar with the arrest of Oxford student Sam Brown, who suggested to a mounted policeman that his horse was gay and was fined on the spot for making “homophobic remarks likely to cause disorder”. A less trigger-happy (or should that be Trigger-happy?) force might have dismissed his remarks as, well, horseplay. Then there was Walter Wolfgang, detained under the Terrorism Act after heckling Jack Straw’s speech at last year’s Labour Conference. It was an unwarranted attack on a defenceless old man, but Jack Straw should have been able to stand up to it without the intervention of the law.

More sinister is the case of Steve Jago, arrested in Whitehall last month for holding a placard bearing George Orwell’s words: “In a time of universal deceit, telling the truth is a revolutionary act,” and carrying three copies of Henry Porter’s recent Vanity Fair article entitled “Blair’s Big Brother Legacy”. The article is a detailed and robust critique of the cumulative erosion of our rights and freedoms under this Government.

This was cited as “politically motivated material” and Jago was charged under the Serious Organised Crime and Police Act (2005) (Socpa) banning people from demonstrating within one kilometre of Parliament. The same Act was used last year to prosecute Milan Rei and Maya Evans. Their offence was to read out the names of British soldiers and Iraqi civilians killed in Iraq at the Cenotaph.

Brown, Jago, Rei and Evans join a long list of those whose actions put them on the wrong side of the law as defined (or rather redefined) by this Government, using no fewer than 18 pieces of legislation in the last nine years. To that list we can now add Leicestershire trader Tony Wright, recently fined £80 for causing distress by displaying T-shirts with the slogan “Bollocks to Blair”.

The phrase “Bollocks to Blair” isn’t of itself particularly offensive (although, admittedly, the fact that it covers both the Prime Minister and the Commissioner of the Metropolitan Police does give it added value). Certainly it is no more offensive than the ubiquitous French Connection logo “FCUK”. The ad-man who came up with that one, Trevor Beattie, was subsequently re-hired by Labour and produced their flying pig and creepy hypnotist posters for the 2005 campaign. He was lucky not to get an Asbo.

The powers invoked may have varied in each of the cases mentioned, but the effect was the same: to put down criticism and dissent in a manner previously unprecedented in this country. Blair himself is wilfully blind to such concerns in a way that would alarm that other Blair, Eric (otherwise known as George Orwell). Maybe he should wear a “Bollocks to Orwell” T-shirt.

To the powers under the Terrorism Act, the (existing) Criminal Justice Act and Socpa may be added the Protection from Harassment Act (1997). The mere act of emailing or phoning an individual or company twice to complain constitutes “repeated conduct” and can land you with a conviction for harassment.

In 2001, two peace campaigners were prosecuted for causing “alarm, harassment and distress” to American servicemen outside the Menwith Hill base near Harrogate. They were holding up a sign which read “George W Bush? Oh Dear.” The location has an added significance to the debate about the use and abuse of government powers: it is the biggest American phone-tapping and surveillance site outside the US.

Here, a staff of 1,200 from the National Security Agency, together with personnel from British military intelligence and GCHQ, scan telephone, fax and email traffic across Europe while technically beyond US jurisdiction. They can tap into 250,000 UK phone lines simultaneously and receive and analyse information from Echelon, the satellite-based intelligence-gathering network that can intercept all known mobile phone and pager systems. Maybe the demonstrators had a point. At least their protest was worth going to court for. A protester in Hull was arrested under the same Act for “staring at a building”.

American reporters who exposed the NSA for wiretapping without warrants have been threatened with prosecution under the 1917 Espionage Act.

Governments on both sides of the Atlantic claim that the kind of legislation we’re talking about is necessary post 9/11. But none of the British cases I have cited has any effect on the threat from terrorists. As Mary Robinson, a former UN Commissioner for Human Rights, put it, “the extension of security policies in many countries has been used to suppress political dissent and to stifle expression of opinion of many who have no link to terrorism”.

Only last Thursday, the NatWest Three were extradited to the US under a “War on Terror” inspired treaty which requires no legal evidence to be provided before extradition takes place. If these are the standards we apply in this country, you can only imagine what licence it gives to other regimes.

The irony is that in the week Tony Bliar was vowing to use new laws to “harry, hassle and hound criminals… until they leave the country”, it emerged that the Home Office had released 1,023 foreign prisoners without deporting them. It is not new and sweeping laws that are needed, but better policing of existing ones.

That is why it is so important that we are eternally vigilant against a Government which, in using such a crudely-fashioned series of sledgehammers to crack a nut, has succeeded only in undermining the rights of the very citizens it purports to protect, thereby bringing the law – and itself – into disrepute.

The Bliar administration has already banned hunting and smoking (much to the chagrin of beagles everywhere, who now have few pleasures left); it has yet to ban criticism of the Government in areas where food is being served. But let us not be too complacent. Last week saw the UK release of the film Viva Zapatero, the Italian satirist Sabina Guzzanti’s account of her fight against censorship under Berlusconi. I had thought that such censure was inconceivable here. But the David Kelly case, where a Government scientist paid with his life for briefing against the Government, and the prosecutions detailed above, lead me to believe we must renew our vigilance.

And since when did the FBI have the right to reduce a British citizen – Neil Coulbeck, a witness, not even a suspect in the NatWest Three case – to a state where he decided to end his life? To quote the journalist Ed Murrow, recently celebrated in the film Good Night, and Good Luck, you cannot defend freedom abroad by deserting it at home.

http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2006/07/16/do1606.xml

Nearly two thirds (58%) of people with diabetes don’t fully understand the meaning of their diagnosis. Nearly a fifth of people with diabetes don’t understand as much as they would like to about difference between available medicines. Nearly 60% find it difficult to ask questions because there is not enough time during their consultation or their doctor/nurse seems too busy.

The report calls on healthcare professionals to do more to help people with diabetes get appropriate information about their condition.

It will be presented to the Department of Health by Adrian Sanders MP, chair of the All-Party Parliamentary Group on Diabetes. According to the report:
* Half of diabetes patients in the UK have depression
* One in five suffers preventable complications as a result of neglecting to take their medicine
* More than 60% of pregnant women with diabetes do not realise that stillbirth is a possible complication of not managing their condition or that their baby could be born with congenital malformations such as a heart defect or breathing problems
* Almost a third of diabetics (32%) do not realise heart disease is a common complication of diabetes
* More than a third of sufferers in the UK do not realise they will have the condition for life
* Half of patients do not realise that diabetes may reduce life expectancy

Short-term approach
Simon O’Neill, director of care and policy at Diabetes UK, said: “Short-termism is a great enemy of good diabetes care.

“As this research shows, many people struggle to realise the importance of taking their medicines, especially if the consequences are not immediately apparent despite the fact that damage caused by not taking their medicines is irreparable.

“Good diabetes management could be seen to be similar to a pension plan – invest now to gain benefits in the future as in both situations there is no going back.”

Joanne Shaw, chair of Ask About Medicine, said: “It’s vital that people with diabetes are encouraged and empowered to ask questions, as patients who have a good knowledge of their treatment options are better equipped to make informed decisions about medicines and other treatments.”

Richard Tiner, ABPI medical director, said there was no substitute for a good open relationship between diabetes patients and healthcare professionals.

“We hope the report will serve as a call to action to healthcare professionals to experiment with information prescriptions for their patients and encourage them to ask questions about their condition and treatment.”

http://news.bbc.co.uk/1/hi/health/5186560.stm

The figures come from a study of patient “journeys” in eight pilot areas to look at whether a series of government targets is delivering faster treatment times.

The 18-week target from GP to treatment is meant to be met by 2008. But according to the study, some patients face delays of up to six months for diagnostic scans before they can even start to receive treatment.

The Health minister Andy Burnham admitted that one quarter of the 15 most common diagnostic procedures, such as hearing tests and ultrasounds, were taking longer than 13 weeks to conduct.

The Government target is that all diagnostic waits should be no more than13 weeks by March 2007, and six weeks by March 2008.

At the end of April this year, 799,594 patients were waiting for the most common diagnostic procedures, with the average wait being seven weeks.

About 20,000 people were waiting between 13 and 26 weeks, while 30,000 people faced delays of between 26 and 52 weeks. About 40,000 people were waiting more than a year.

Mr Burnham said: “We have put all the pieces out, but there still needs to be some further work to put them all together. This is certainly not an exercise in spin, it is an exercise in honesty. We are saying this is the scale of the challenge.”

The Liberal Democrat health spokesman, Steve Webb, said: “These figures show unacceptably large regional variations. Too many people in too many parts of the country are waiting too long for tests.

“Money for diagnostics is already tight and will be even more at risk by 2008 when extra NHS funding stops, regardless of whether this new target is met.”

Professor Janet Husband, president of the Royal College of Radiologists, said it was “gratifying” to see that progress had been made, but some people were still facing “lengthy waits”. She said efforts would continue to ensure an efficient and effective service.

http://news.independent.co.uk/uk/health_medical/article1174104.ece

Health Direct is pleased at the “honesty” of Health minister Andy Burnham, but he acknowledges that he still hasn’t worked out how he will achieve the 18 week total wait target by 2008.

As Health Direct pointed out on Friday, January 06, 2006 Labour ministers promises on ambitious 18 week maximum wait for surgery the 18 week process involves moving patients through three stages. From the initial visit to the GP, the patient has to go to a first outpatient appointment, then through any diagnostic tests that are needed and finally on to the operation itself once a decision to admit has been taken.

But an analysis of Department of Health data by the Financial Times shows that the government will miss its target without additional capacity and reform of the way the service operates.

Referring to the latest waiting times published in January 2006 “What these figures show,” according to Alan Maynard, professor of health economics at the University of York, “is that of the three elements needed to get to the overall 18-week target, one is falling far too slowly, one is unknown but may well rise before it falls, and the third – the time spent on the waiting list before an operation – is actually going in the wrong direction.

“Unless something changes radically, the government is going to miss its target”.

The Summary of the House of Commons Select Committee on Public Accounts Fifty-Second Report’s follows:

Stroke, the brain equivalent of heart attack, is one of the top three causes of death in England, and the leading cause of adult disability. There are around 110,000 strokes each year in England, a quarter of which occur in people under 65. Some 300,000 people in England are living with moderate to severe disabilities as a result of stroke. However many strokes are preventable; and developments over the last decade have shown that fast and effective acute treatment of stroke, and high quality rehabilitation, can significantly reduce death and disability.

Stroke costs the economy about £7 billion a year. The direct cost to the National Health Service is around £2.8 billion—more than the cost of treating coronary heart disease—yet stroke has not, to date, been given as high a priority by the Department of Health as coronary heart disease and cancer.

We found that the cost of stroke, in both economic and human terms, could be reduced by re-organising services and using existing capacity more wisely to prevent more strokes from occurring, to provide more rapid and responsive acute stroke treatment, and to coordinate post-acute support and rehabilitation services more effectively.

Under the National Health Service’s current approach to stroke care

* Stroke is not treated as a medical emergency in the same way as a suspected heart attack, though the shorter the time between the stroke and the treatment, the greater the chance of reducing damage to brain tissue.
* Brain scans for many stroke patients are being delayed, though a scan is vital for determining appropriate treatment.
* A significant proportion of stroke patients are not being treated on a specialist stroke unit, despite evidence that this is the most clinically effective model for acute care.
* There is considerable variation between hospitals as to what a specialised stroke service entails.
* Public awareness of the symptoms and impact of stroke, and how strokes can be prevented, is very low.
* There are insufficient nursing, therapist and other specialist staff with expertise in stroke care across the primary and secondary healthcare sectors, and there is scope to improve training for the existing stroke workforce in the National Health Service (for example, by training stroke consultants to interpret brain scan results).
* The carers of stroke survivors, and stroke survivors living on their own, are often not accessing the social and care services they need.
* There is low awareness on the part of members of the public and general practitioners about the fact that a transient ischaemic attack (‘mini stroke’) is a strong indication of increased risk of major stroke, and requires immediate investigation and treatment.

The Department of Health has accepted that it needs to do more to raise public and professional awareness of the seriousness of stroke, improve rapid access to brain scanning and appropriate treatment for stroke patients, deliver stroke care through organised stroke units, and provide high quality rehabilitation and coordinated post-acute support for patients and carers, as recommended in the C&AG;’s Report.

It has agreed that implementing these recommendations could save the NHS £20 million a year, and save as many as an extra ten lives each week. It has established a Vascular Programme Board which is now developing a stroke strategy drawing on the approaches it has taken to improve coronary care over the last five years.

http://www.publications.parliament.uk/pa/cm200506/cmselect/cmpubacc/911/91103.htm

On Monday, May 15, 2006 Health Direct examined a pan european health study which found that “Britain- the sick heart of europe“. It noted that “In Britain, more people die of coronary heart disease and strokes than cancer.”

One official warns of a “botched operation” that could put back the introduction of ID cards for a generation. He added: “I conclude that we are setting ourselves up to fail.” Another admits he is planning Home Office strategy around the possibility that the scheme could be “canned completely”.

In one email the prime minister is personally blamed for the fiasco with his proposal for a scaled-down or “early variant” version. “It was a Mr Blair apparently who wanted the ‘early variant’ card. Not my idea,” writes a top Home Office civil servant.

The emails expose another crisis for John Reid, the home secretary, who has already labelled his department as “not fit for purpose” following the recent foreign prisoners scandal.

The correspondence has been leaked by a senior official close to the Treasury. He acknowledges that the documents will infuriate ministers because they contradict the government’s public statements on ID cards.

Bliar has repeatedly trumpeted the scheme as a centrepiece of the government’s efforts to combat terrorism, illegal immigration and crime. Ministers have rounded on critics who say the government has underestimated the cost and complexity of the technology.

Last year ministers rubbished claims by the London School of Economics that the scheme was too unwieldy and would cost as much as £19 billion, compared with the government’s estimate of £6 billion.

The government proposes that all Britain’s 50m adults will eventually carry the cards, which will include biometric data such as digitally encoded fingerprints or iris scans that could be checked against a huge database. The cards are to be introduced voluntarily from 2008 but, if re-elected, Labour proposes to make them compulsory for everyone over 16.

The email correspondence last month was between Peter Smith, acting commercial director at the Identity and Passport Service, the Home Office agency set up to bring in the cards, and David Foord, the ID card project director at the Office of Government Commerce, which is responsible for vetting the project to ensure that the Treasury gets value for taxpayers’ money.

They reveal that the government is “rethinking” the entire scheme with an alternative “face-saving” compromise, which Smith blames on Blair. This “early variant” plan appears to involve collecting and storing biometric data on a temporary ID register but makes no mention of actually using it on cards.

However, officials doubt that this will work. Foord writes: “Just because ministers say do something does not mean we ignore reality — which is what seems to have happened on ID cards until [the contracts were due] to be issued and then reality could not be ignored any longer.”

He adds: “Even if everything went perfectly (which it will not) it is very debatable (given performance of government IT projects) whether whatever [the register] turns out to be (and that is a worry in itself) can be procured, delivered, tested and rolled out in just over two years and whether the resources exist within government and industry to run two overlapping procurements.

“What benchmark in the Home Office do we have that suggests that this is even remotely feasible? I conclude that we are setting ourselves up to fail.”
He reveals that the contracts for the ID card scheme are under threat because of “the amount of rethinking going on about identity management”. He also says they are “[un]affordable”; “lack clear benefits from which to demonstrate a return on investment”; and suffer from a “very serious shortage of appropriately qualified staff”.

Foord says: “I do not have a problem with ministers wanting a face-saving solution but we need to be clear with . . . senior officials, special advisers and ministers just what this implies.” He then warns of a “botched introduction” of the scheme, adding: “If it is subject to a media feeding frenzy, which it might well be close to a general election, [it] could put back the introduction of ID cards for a generation and won’t do much for IPS credibility nor for the government’s election chances.”

Acknowledging these concerns, Smith says his IPS agency is planning around the possibility that the entire protect will fail. In a June 8 e-mail he writes: “We are designing the strategy so that [other contracts such as a contact centre for passport queries] are all sensible and viable contracts in their own right EVEN IF the ID card gets canned completely.”

In public, ministers have so far given no hint of any private fears about the viability of the scheme. But senior officials admit privately that the Home Office has abandoned its timetable for introducing cards.

Foord writes: “This has all the inauspicious signs of a project continuing to be driven by an arbitrary end date rather than reality. The early variant idea introduces huge risk on many levels.”

The problems in designing a workable system have meant a delay until March 2007 in putting out contracts to tender to private companies to build and manage the scheme. They had been due this summer.

Another official involved in the project said: “Nobody expects this programme to work. It is basically on hold while ministers rethink their options. It’s impossible to imagine the full scheme being brought in before 2026.”

The disclosures will be seized on by critics who say it is too expensive, unworkable and a breach of privacy. The Tories plan to scrap the cards and use the money to build prisons.

Simon Davies, a member of the LSE team that said costs could rise to £19 billion, said the rethink was “a vindication of all the concerns we have expressed about the costs and viability” of the scheme.

Last night the Home Office said it remained committed to an ID card scheme but had always maintained its introduction would be an “incremental” process. The cards are expected to cost about £93, which each citizen must pay when getting a new passport from 2010.

http://www.timesonline.co.uk/article/0,,2087-2262437,00.html

Health Direct asks- what do you get when you combine an ambitious IT scheme run by the Labour government and a plan that threatens to ride roughshod over civil liberties? The answer is an unholy mess. As leaked emails reveal, Tony Bliar’s flagship identity card scheme is struggling and could even collapse in an embarrassing shambles. Two years before ID cards are set to be introduced for people renewing their passports, the chances of meeting that timetable look remote. The entire scheme may yet have to be shelved.

In many quarters this will be a cause for celebration. The 9/11 attacks on America produced some overhasty government thinking. They gave us the lopsided extradition laws that permit British bankers to be flown to the United States this week but cannot be used to bring Americans to Britain. They also prompted the ID scheme.

David Blunkett’s relatively modest proposal for an entitlement card for state benefits and National Health Service treatment has been transmuted into a fully-fledged ID card.

In its election manifesto last year Labour sold the policy as strengthening crime and security and protecting Britain’s borders. “Across the world,” it said, “there is a drive to increase the security of identity documents and we cannot be left behind.” Cards would make British citizens safer, protect them from identity fraud and cut the cost of welfare benefits and the NHS. What could be more sensible?

One big hitch was the enormous cost. When the London School of Economics (LSE) published research showing that the cost of ID cards could be as high as £19 billion — more than three times the government’s estimate — and said the cards could be legally unsafe, ministers went into attack mode. Charles Clarke, the former home secretary who now languishes on the back benches, accused the LSE of being “technically incompetent” and said its figures were “simply mad”. But the LSE’s figures were carefully costed and the record of huge cost overruns and delivery failures in government IT projects, admitted in today’s e-mails, always suggested that official estimates should be taken with a pinch of salt.

Mr Clarke was honest enough to admit last year that ID cards would not have stopped the July 7 bombers. Dame Stella Rimington, former head of MI5, said ID cards would not make us safer, even against the threat from foreign terrorists, and she doubted whether anybody in the intelligence services would be pressing for them. As with all official documents, she suspected that determined forgers would find a way of replicating them.

Should the government accept the verdict of its own experts that a politically driven programme with a “lack of clear benefits” might, and perhaps should, be “canned”? It would be another broken promise from Mr Bliar, but he is used to those, as are voters. Why press on with a scheme that will cost billions with very little discernible benefit?

On this, as on many things, Frank Field, the former welfare reform minister, has sound ideas. It was his committee which first identified the scale of National Insurance fraud in Britain, with at least 20m more NI numbers in use than there are people in the country. He believes that the scale of fraud in the NHS is significant.

Rather than scrapping the whole ID scheme, he argues, it should be launched gradually, first to foreigners coming to Britain to stay and then to young people getting their NI numbers for the first time. A programme like this should be within the government’s capabilities and would even allow the prime minister and his colleagues to save face.

If you too want to vent your spleen and protest against Bliar’s costly, incompetent NHS entitlement ID cards, please join the NO 2 ID Cards debaye today.

Health Secretary Patricia Hewitt said she hoped the money could be used to fund new cottage hospitals, mobile scanning units and home cancer therapy.

But campaigners said the drive is being undermined by a spate of community hospital closures.

A white paper, published in January, promised resources would be shifted away from acute hospitals to help provide more care in the community. The £750m is part of this transfer and will be made available for primary care trusts to bid for.

But the cross-party campaign group, Community Hospitals Acting Nationally Together (Chant), said several community hospitals have already closed this year, while another 70 of the 300 in England are under threat because of the financial problems facing the NHS.

Chant chairman Graham Stuart, a Tory MP, said the money may come to late for many services. “We don’t need more warm words, we need action but I am not sure we will get it. Hospitals have continued to close despite the government’s promises earlier this year.”

Dr Gill Morgan, chief executive of the NHS Confederation which represents the majority of NHS organisations, said: “Patients needs are changing and the NHS must adapt to meet those needs – whether this be X-ray and surgical procedures being undertaken locally or chemotherapy and blood testing in people’s homes.

“These new types of services will not necessarily require more hospital beds. We need to move away from a fixation with bricks and mortar and start to think more creatively about how we provide services for large numbers of patients in more convenient community settings.”

Ms Hewitt said she wants to see a new generation of community services built including multi-purpose health centres providing minor injury care, blood testing and ultrasound scanning as well as new and redeveloped community hospitals.

She said smaller-scale projects such as medical teams providing chemotherapy at home and mobile MRI scanners could also be funded.

“With the changes in medical technology and practice, we can now do so much more treatment and care for people much closer to home, sometimes in their own homes.”

She said as well as offering better value for money, community care may enable patients to receive treatment more quickly.

But Shadow Health Secretary Andrew Lansley said: “The government talks about delivering more care in the community but the infrastructure is not in place. This announcement will be too late for the dozens of community hospitals that have already closed across the country.”

Liberal Democrat health spokesman Steve Webb said: “When community hospitals close, the government blames the local health service, but when new hospitals are announced the government is quick to take the credit.”

http://news.bbc.co.uk/1/hi/health/5146388.stm

Coming in the same week that there was a major demonstration against potential NHS cutbacks in Leicester where three hospitals and the county’s primary care trusts are facing millions of pounds-worth of cuts to balance their books Labour’s health policies are like fiddling whilst Rome burns.

As we have seen in Gloucestershire Thursday, May 11 2006 when a Record 6 NHS hospitals closures announced in one day in one county the formation of CHANT is both long overdue and welcome.

The number of cases of whooping cough has fallen substantially over the past 20 years. But Health Protection Agency figures show a rise in the last year in the number of younger children diagnosed with the condition. In 2004, there were 237 cases among children aged four and under, rising to 289 in 2005.

Neither infection nor immunisation with the pertussis jab currently used gives lifelong immunity.

But the researchers say GPs tend to view whooping cough as only affecting very young children who have not been immunised and who have classic features such as whoop.

The researchers found that 64 (37.2%) children had evidence of a recent pertussis infection. Fifty-five (85.9%) of them had been fully immunised.

Children with pertussis were more likely than others to have whooping, vomiting, and sputum production.

They were also more likely to still be coughing two months after the start of their illness, continue to have more than five coughing episodes per day, and cause sleep disturbance for their parents.

Dr Anthony Harnden, an Oxford University lecturer and GP in Oxfordshire, who led the research, said the vaccination policy did work. “The immunisation is very effective – we know that because very few infants die of whooping cough. But what the immunisation does not do is last for a long time.”

He added: “Our main message is that doctors should consider a diagnosis of whooping cough even in a fully immunised child.”

But Dr Hardman said there were still questions. “There’s a debate about whether we should introduce an adolescent booster but that could push it upwards into the parent population, which has its own set of problems. That’s the dilemma.”

A spokesman for the Health Protection Agency said: “We’re fully aware that protection from the vaccine wears off.

“But it’s very good at protecting young babies – and they’re the ones who can die from whooping cough. So we’ve built the whole vaccination programme is built around them.”

And Dr Graham Archard, vice chairman of the Royal College of General Practitioners, said: “It would be unreasonable to suggest that GPs have been performing at a lower standard that patients may expect.

“Making a diagnosis of whooping cough necessitates uncomfortable blood tests which are usually avoided in young children unless there is clear benefit in undertaking the blood test. This new evidence asks many questions of how GPs and other clinicians should be expected to deal with the huge number of children presenting with coughs, of which 40% may have whooping cough.”

A spokeswoman for the Department of Health said it was important that children received all their childhood jabs. “The vaccine is very effective, especially in protecting against severe disease.”

http://news.bbc.co.uk/1/hi/health/5151778.stm

Health Direct noted on Friday, June 16, 2006 Scare over MMR vaccine safety causes cases of Mumps to soar that The scare over the safety of the MMR vaccine is still discouraging parents from immunisation, particularly in London, raising the risk of mumps, measles and rubella.

Cases of mumps soared from 4,204 in 2003 to 16,436 in 2004 and to 56,390 last year. The exodus has been also been driven by Labour’s introduction of bonus payments for doctors who meet immunisation targets leading to even more postcode lotteries.

Nearly 1m lapses in patient safety were recorded in 2004-5. The government said lessons were being learned.

The committee, which based most of its findings on a report by the National Audit Office last year, also attacked the National Patient Safety Agency for failing to provide enough advice on improving safety.

The NHS agency was set up five years ago to develop a national reporting scheme to help the NHS learn lessons from lapses in safety.

One in 10 patients are estimated to be unintentionally harmed under the care of the health service. These can include medication errors, equipment defects and patient accidents, such as falls.

But the committee said the system was too complex and the agency was not offering value for money.

The MPs also said there had been a lack of progress by NHS trusts in the last six years since a report by the chief medical officer attacked the “blame culture” that existed in the NHS for hampering the improvement process.

The study said few NHS trusts “have formally evaluated their safety culture” and “insufficient progress” had been made on achieving targets set out by the Department of Health.

And it added only 24% of trusts routinely inform patients involved in a reported incident and 6% do not involve patients at all.

‘Failures’
Committee chairman Edward Leigh, a Tory MP, said: “What this points to are two related and deep-seated failures. One is the failure of the NHS to secure accurate information on serious incidents and deaths. The other is the failure on a staggering scale to learn from previous experience.”

Peter Walsh, chief executive of the charity Action Against Medical Accidents, said: “We hope the report will give an injection of urgency into work to improve patient safety.”

But Chief Medical Officer Sir Liam Donaldson defended the NHS, saying improvements were being made.

He added: “Over the last five or six years we have put in place a comprehensive patient safety framework in this country which is admired internationally.”

NPSA joint chief executive Susan Williams said: “The NPSA has already acted on a number of issues identified in the report and will work with the Department of Health to consider the report’s recommendations carefully.

“The agency remains committed to helping improve patient safety in the NHS and working with the local NHS to deliver this.”

http://news.bbc.co.uk/1/hi/health/5150994.stm

Health Direct noted on Friday, November 04, 2005 NAO reports that NHS accidents cost £2bn and up to 34,000 lives that according to a report by the National Audit Office, around a half of incidents in which NHS hospital patients are unintentionally harmed could have been avoided, if lessons from previous incidents had been learned.

The NAO noticed that whilst reporting has improved at the local level, at the national level progress on developing a national reporting and learning system has been slower than envisaged in the Department of Health’s 2001 strategy “Building a safer NHS for patients”.

So there seems to have been little change over the past seven months.

Professor Peter Borriello, Director of the Centre for Infections, said “Today’s figures contain mixed news. The number of new cases of gonorrhoea fell by 13%, from 22,350 in 2004 to 19,495 in 2005. This is particularly significant given the previous 10% fall in cases from 2003 to 2004, and with fewer cases reported across all English regions, it appears real progress is being made.

However it is disappointing to see that there was a further rise in new diagnoses of STIs in 2005, and these figures show there is still much to be done to tackle the continuing spread of infection. We have seen increases over the past year in new diagnoses of chlamydia, syphilis, genital warts and genital herpes.”

There was a significant increase in the number of new syphilis diagnoses, which rose by 23% from 2,278 in 2004 to 2,807 in 2005. However this was a smaller increase than in previous years – new cases rose by 39% from 2003 to 2004. New syphilis cases were particularly marked among women, where the increase was almost two and a half times higher than that among men.

The number of new diagnoses for 2005 show:
* An overall rise in the number of all diagnoses made in GUM clinics in the UK of 3% ( from 768,339 cases in 2004 to 790,387 in 2005).
* An increase in the total workload seen in GUM clinics of 9% (from 1,690,597 in 2004 to 1,839,241 in 2005).
* Chlamydia increased by 5% (from 104,840 in 2004 to 109,832 in 2005).
* Syphilis increased by 23% (from 2,278 in 2004 to 2,807 in 2005).
* Genital warts increased by 1% (from 80,082 in 2004 to 81,203 in 2005).
* Genital herpes increased by 4% (from 19,074 in 2004 to 19,771 in 2005).
* Gonorrhoea decreased by 13% (from 22,350 in 2004 to 19,495 in 2005).

http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/060704_sti_figures.htm

As these new Sexually Transmitted Infection rates apply to the year 2005 and since then Health Direct has noted a string of Labour government failures including: Thursday, December 15, 2005 Sex health campaigns face axe in NHS cash crisis and Thursday, January 19, 2006 Charities appalled at lack of NHS plans improving sexual health In England it will be no surprise to any body outside of the government when the 2006 figures are published that they will have gone up again.

The change will apply to nursing posts graded at Agenda for Change bands 5 and 6 where, the DH claims, the overall supply of nurses is now healthy. Removing general nurses from the shortage occupation list means that overseas nurses applying for their first position in the UK, or those changing their employer, must mean that vacancy must be advertised nationally before their applications may be considered.

The RCN believes that overseas nurses are being made scapegoats for the current deficits crisis in the NHS. It is also deeply concerned about the impact on the independent sector which is heavily dependent on recruiting overseas to provide care.

The RCN is lobbying government on this issue which it believes will ultimately compromise patient care and RCN General Secretary , Beverly Malone, has already written to Secretary of State for Health Patricia Hewett.

Dr Beverly Malone, also said “Removing nursing from the list of recognised shortage professions is short-termism in the worst possible sense. We know that the vast majority of international nurses are employed in bands 5 and 6, the very bands which are going to be affected.”

“If this proposal goes ahead I guarantee that the effects will be far-reaching and immediate. Over 150,000 nurses are due to retire in the next five to ten years and we will not replace them all with home grown nurses alone.”

“We also have to remember that this blanket ban on international nurses will also apply to the independent sector who are heavily reliant on international nurses to carry on providing care and are not in the position of financial crisis the NHS finds itself in.”

“If there is solid evidence to show that we no longer need international nurses in the UK’s healthcare system both now and in the future, then we urge the Government to provide it – something they have yet to do. Until that time, the RCN will remain convinced that this is a institutions, trade unions, professional bodies and voluntary organisations.bad decision for patients, for nurses and for the UK healthcare system as a whole.”

http://www.rcn.org.uk/news/display.php?ID=2069

The RCN was responding to the Labour Goverment’s health fall guy Lord Warner who declared yesterday:

“The NHS has seen historical levels of investment and a period of expansion in the nursing workforce since 1997 in order to help reduce waiting times, improve access to services and ensure high quality treatment and care.

“On top of this we have made a huge investment in education and training and in the development of robust recruitment and retention policies. This is now bearing fruit. We now have more than 379,000 qualified nurses working in the NHS, 82,000 more than in 1997 as well as record levels of nurses in training.

“We are now moving away from year-on-year growth in the NHS workforce to more of a steady state where there is a closer match between demand and supply. Large-scale international nurse recruitment across the NHS was only ever intended to be a short-term measure. The aim of the NHS has always been to look towards home-grown staff in the first instance and have a diverse workforce that reflects local communities.

“Therefore to ensure that UK resident and newly trained nurses are given every opportunity to continue their career in the UK and to secure the future workforce of the NHS, we are today taking Agenda for Change band 5 and 6 nurses off the shortage list.”

Health Direct notes that the Department of Health does not publish the breakdown between the number of nurses who work part time or full time, so purely counting numbers is no guide to overall productivity.

But judging by the current bottleneck in training of new health professionals by 2008 there will be another shortage of nurses.

By the end of May 2006, nearly three quarters of patients (74.2 per cent) waited less than 13 weeks for inpatient treatment, with a median waiting time of 7.7 weeks.

Similarly, outpatient waiting times rose between April and May, although the overall trend year on year was downwards.

The number waiting more than 11 weeks rose by 5,100 and the number waiting over eight weeks rose by 18,900 (10 per cent) during May. The percentage of patients waiting under eight weeks increased from 78.2 per cent in May 2005 to 82.2 per cent in May 2006.

Inpatient Waiting times
- The number of patients, for whom English commissioners are responsible, waiting over 26 weeks at the end of May 2006 was 58. Of these 58, 24 were English residents waiting in Welsh hospitals.

- The number of patients, for whom English commissioners are responsible, waiting over 20 weeks at the end of May 2006 was 48,600, down 12,600 from April 2006.

- The number of patients, for whom English commissioners are responsible, waiting over 13 weeks at the end of May 2006 was 198,600, an increase of 600 (0.3%) from April, but a fall of 59,200 (23.0%) from May 2005

- The percentage of patients waiting under 13 weeks was 74.2%, compared to 74.6% in April and 68.3% in May 2005. The median waiting time of those still waiting at the end of May 2006 was 7.7 weeks.

Outpatient Waiting times
- The number of patients, for whom English commissioners are responsible, waiting over 13 weeks for a first outpatient appointment at the end of May 2006 was 199. Of these 199, 115 were English residents waiting in Welsh hospitals.

- The number of patients, for whom English commissioners are responsible, waiting over 11 weeks at the end of May 2006 was 40,500, up 5,100 from April 2006.

- The number of patients, for whom English commissioners are responsible, waiting over 8 weeks at the end of May 2006 was 207,300, an increase of 18,900 (10.0%) from April, but a fall of 90,600 (30.4%) from May 2005.

- The percentage of patients waiting under 8 weeks was 82.2%, compared to 83.6% in April and 78.2% in May 2005. The median waiting time of those still waiting at the end of May 2006 was 3.9 weeks.

https://www.gnn.gov.uk/content/detail.asp?ReleaseID=211289&NewsAreaID;=2&HUserID;=878,793,895,855,782,878,870,845,786,674,677,767

Health Direct noted on Thursday, January 05, 2006 NHS set to miss 18 week waiting times key target that the Labour government’s pledge on it’s proclaimed waiting times target was doomed to failure.

The latest figures for waiting times do nothing to make hitting this target any likelier.

Their comments followed condemnation by Unison, which said it was calling on the Trades Union Congress to organise a campaign of opposition to the move to involve private sector companies in the purchasing of hospital, primary and community care.

Karen Jennings, head of health for Unison, described it as a “contract to privatise the whole of primary care across the UK”. The union’s opposition came on top of comments earlier this week by James Johnson, chairman of the British Medical Association, which said the involvement of the private sector in purchasing NHS care as well as in its provision was a “line in the sand” that the NHS should not cross.

Steve Webb, Liberal Democrat health spokesman, added to the furore, saying that the move involved a “fundamental shift in the NHS”; one that had been taken “without any consultation with parliament, the public or the professions”.

The procurement notice, which was disclosed in the Financial Times and mentioned by Health Direct last week, offered bidders a framework contract that would allow them to undertake anything from the data analysis that underlay commissioning to the actual “purchasing of hospital and community care” on behalf of primary care trusts. These commission care on behalf of their local population.

Companies, from the the UK-based Bupa to the American United Health, could potentially be involved.

Ms Hewitt stressed that primary care trusts would remain the statutory body responsible for commissioning care. “They are can never outsource this responsibility or ask others to make decisions for them,” she said.

But Ms Jennings said that this could still leave private sector commissioners buying services from private sector suppliers. Even if commissioners were prevented from buying directly from themselves “there will be a natural preference for the private sector to look after itself and buy from other private sector providers. There is huge scope for corruption and fraud,” she said.

The row exploded at a meeting between health ministers and the unions on Thursday. The unions denounced the increased involvement of the private sector and accused ministers of reneging on a pledge made last year not to force primary care trusts to divest themselves of the direct provision of services such as district nursing, community hospitals and, in some cases, family doctor care.

Lord Warner accepted that the procurement notice mighty have given a “false impression”. As a result, he said, the advertisement had been withdrawn because of “drafting errors”. However, the department was unable to spell those out yesterday.

He added that the government remained determined to give PCTs access to “expert help” from the private and voluntary sectors with their commissioning role. A revised procurement notice would be issued shortly he said.

The extent to which that will restrict the role the private sector can take in commissioning remains to be seen.

David Hunter, professor of health services management at Durham University, said part of the problem was that ministers appeared to be disingenuous about the direction of policy.

Last year they said there was “no requirement or timetable” for primary care trusts to get out of the direct provision of services.

However, said Professor Hunter, this was the clear thrust of policy, with the department itself being divided into commissioning and providing arms, while also setting up a “social enterprise” unit to encourage staff to leave direct NHS employment and sell their services back.

Equally, although ministers had halted plans last year for the private sector to take over commissioning in Oxfordshire, they were now seeking tenders for it to be able to do precisely that.

Frank Dobson, Labour former health secretary, said: “The government’s approach seems to be to take one step forward, deny it, take one step back and then move forward again.

“But this is the final confirmation that the government wants the private sector involved at every level of the NHS” – an approach he said would lead to fragmentation and mounting administrative costs.

Ms Hewitt insisted there was “no question whatsoever” of privatising the NHS. Care would remain free at the point of use and available to all, regardless of who was providing it.

http://www.ft.com/cms/s/2e66e6de-089d-11db-b9b2-0000779e2340.html

Health Direct first raised on Tuesday, June 20, 2006 in Last brick in the wall for the new look NHS health insurance the new policy initiative to create a new administrative system for funding the UK’s health services.

And warned that a new health insurance tax was not too far behind.

Lord Warner’s “false impression” and “drafting errors”- even though the department was unable to spell those out yesterday, is nothing more than another screeching Labour U Turn.

It is also the first sign that the Unions have woken up to the threat of the final fragmentation of the NHS.

As Frank Dobson, Labour’s former health secretary, said: “The government’s approach seems to be to take one step forward, deny it, take one step back and then move forward again.

“But this is the final confirmation that the government wants the private sector involved at every level of the NHS” – an approach he said would lead to fragmentation and mounting administrative costs. “

The difference that this system would make would be 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.