A further 1,444 are employed by a bewildering array of more than 200 quangos and agencies that are paid for out of the public purse, bringing the total number of press officers to 3,259.

When Labour came to power in 1997, just over 300 fully-fledged press officers were working in Whitehall, although that figure excluded a small number of other public relations staff.

The amount being spent on Government advertising, marketing and public relations has risen three-fold since Mr Bliar entered No 10.

The Central Office of Information’s PR, advertising and marketing budget has soared from £111 million in 1997 to £322 million last year. Much of the money has been spent on advertising flagship policies, including tax credits and extra help for pensioners.

Critics have expressed concern that Government spending on advertisements and public relations tends to peak in election years, prompting suspicions that Labour is using public money to sell its key policies to voters. For instance, the Central Office of Information budget rose from £200 million in 1999-2000 to £295 million in the 12 months before the 2001 election. In 2003-04 a total of £317 million was spent but the figure rose to £343 million in the run-up to last year’s election.

Oliver Heald, the shadow Cabinet Office secretary, said he was astounded that the Ministry of Defence employed 229 press officers and other PR staff. The Home Office has 145 press and information officers, yet it has been unable to avoid a series of PR blunders in recent months over immigration and crime.

Hundreds more are employed by big quangos, including 69 at the Metropolitan Police Service and Authority and 58 at the Health and Safety Executive.

The Tories emphasised that the figures did not include the 77 politically appointed special advisers working for the Prime Minister and his Cabinet colleagues.

Mr Heald said the Government employed 18 press officers in its 24-hour Media Monitoring Unit, which raised further questions about Mr Prescott’s decision to obtain a Commons pass for his son, David, a lobbyist.

Mr Prescott defended the decision at the weekend by saying that his son had been employed over the summer to carry out media monitoring.

Mr Heald said: “Given that the Media Monitoring Unit employs 18 staff, John Prescott’s claims that he gave his lobbyist son a Commons pass for media monitoring appears implausible.”

He added: “Under Labour, taxes have soared, but rather than improving our public services the money has been wasted on wages of spin.

“Tony Blair, Gordon Brown and their army of quangocrats have bankrolled a bloated army of spin doctors, politicising the Civil Service and creating a corrosive culture of spin in Whitehall.”

The Central Office of Information defended the increased spending, saying that Labour was “a radical and reforming Government” and that it had a duty to explain its policies, decisions and actions and to inform members of the public about their rights and liabilities.

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/08/30/nspin30.xml

Coming on top of recent stories about the wasted IT NPfIT project and the 17 million wasted meals a year, it shouldn’t really be a surprise that labour are also wasting our money on their propaganda.

Being overweight can put both the health of the mother and child at risk through problems such as gestational diabetes and high blood pressure. In reality, many primary care trusts do not fund women who are obese. The BFS has published its recommendations in a bid to end the IVF “postcode lottery”. It wants to standardise treatment so that clinics use the same criteria in relation to age and family status as well as weight.

“What we are saying is that they should be less stringent and more consistent with how they apply this. Obese women are less likely to get pregnant and more likely to encounter health problems. It makes sense to address obesity before seeking fertility treatment.”

The BFS, which represents health fertility professionals, also recommended single women and same sex couples be given the same priority as heterosexual couples.

NHS guidelines say women aged 23 to 39 should be entitled to three cycles of IVF, although the government gave the health service a deadline of April last year to provide one cycle with a view to working towards three.

The society made its recommendations after surveying 64 fertility clinics in England and Wales.

It received responses from 37, showing one in 10 was not providing IVF treatment free on the NHS because they were not being given funding by the local PCTs. None of the clinics was providing three cycles, the poll, which will be published in the Human Fertility journal in September, said.

The poll also showed many of the PCTs which did provide IVF treatment were restricting access by taking social factors into account. These included barring people from treatment if one of the partners already had a child from a previous relationship or because the couple had paid for private treatment before going to the NHS.

And it also revealed a quarter of clinics were also restricting treatment according to age, with most only allowing women in their late 30s to have IVF. Dr Gillian Lockwood, who chairs the BFS’s ethics committee, told the BBC that “unfairness” was the aspect of the NHS provision which people objected to most.

But Dr Lockwood said there were clinical factors which affected the success of IVF and, as well as weight concerns being over the age of 40 meant that “even very high-tech treatments like IVF are really very unsuccessful”.

She added: “For £2,500, you have at least a 50% chance of producing a much wanted, beautiful healthy baby – the same cost as stripping varicose veins. I think the fourth richest country on earth should be able to afford effective fertility care for its citizens.”

Clare Brown, chief executive of Infertility Network UK said: “From our own surveys and from the many, many calls we receive from patients, we know only too well that there are still unacceptable inequalities in the funding of treatment around the country and couples face huge difficulties in accessing services.”

But Josephine Quintavalle, of the organisation Comment on Reproductive Ethics, told BBC Five Live limited NHS budgets needed to be focused on treatment for groups which would benefit the most.

“If it’s a proven fact that it’s very difficult to get pregnant when you’re overweight, then the logical cure for that kind of infertility is to encourage the patient to lose weight.”

Jo Webber, deputy director of policy at the NHS Confederation which represents over 90% of NHS organisations, said: “We recognise the distressing circumstances that couples with infertility problems find themselves in. However, primary care trusts receive a fixed allocation of money to deliver all the services for their local community and have to take difficult decisions on competing priorities.”

The Department of Health said that, while it did not support bans being imposed, the current NHS guidelines were broadly in line with the recommendations on obesity.

A spokeswoman added: “Primary responsibility for implementing NICE guidelines, including the rate of implementation, rests with the NHS at local level and we have made it clear that we expect these guidelines to be followed.”

She said the government was working with patient group Infertility Network UK to ensure PCTs listened to the views of patients.

http://news.bbc.co.uk/1/hi/health/5296200.stm

Dr John Reid made his infamous promise about the NHS funding three cycles of IVF a few months before Health Direct Blog got going. However we’ve found a copy of the origional promise on the Guardian’s website. A summary is copied at the bottom of today’s blog.

Health Direct did follow up on the promise a year later and found that: Feb 01, 2005 Labour Government pledge on IVF in tatters as units fail to cope with demand Thousands of couples desperate to become parents will not receive free fertility treatment, despite a government pledge to offer at minimum of one cycle on the National Health Service.

An investigation by revealled that fertility services in England and Wales are in crisis, with some NHS trusts refusing to supply any treatment for certain couples.

Health Direct questions the logic of more social engineering by the BFS when the Labour Government’s delivery of NHS IVF services is of such muppetry proportions anyway.

Reid acts to end IVF postcode lottery- NHS to offer all infertile women under 40 one cycle of treatment Feb 25, 2004

All infertile couples where the woman is under 40 will be offered at least one full cycle of IVF treatment on the NHS from April next year, as the first stage towards making fertility services a more integral part of the state health system.

The health secretary, John Reid, has not, however, put a time scale on full implementation of recommendations from clinical watchdogs for three cycles to be offered.

That would cost an estimated £85m a year in England and Wales and Mr Reid says the transition cannot be made overnight. Priority will be given to couples who have no adopted or foster children.

The guidelines published yesterday by the National Institute for Clinical Excellence (Nice) will, when fully implemented, cause an extra 5,000 babies to be born a year, a huge increase on the 8,000 now conceived through IVF.

Malnourished patients stay in hospital for much longer, are three times as likely to develop complications during surgery, and have a higher mortality rate.

It is a problem which particularly affects the elderly: patients over 80 admitted to hospital have a five times higher prevalence of malnutrition than those under the age of 50.

Guidance
In 2004 the Department of Health issued core standards for the NHS which commit trusts to providing patients with a balanced and nutritional diet.

This was followed earlier this year by guidance from the National Institute for Health and Clinical Excellence designed to help the NHS identify patients who are malnourished or at risk.

However, Age Concern said despite this malnutrition in hospitals continues to be “all too prevalent” – because too often policy is not being put into practice.

The charity is launching a campaign – Hungry to be Heard – to raise awareness of the problem.

Gordon Lishman, Age Concern director-general, said: “Hospitals are in danger of becoming bad for the health of older people. The majority of older patients are being denied some of the basic care they need, leaving hundreds of thousands malnourished. Food, and help with eating it, should be recognised by ward staff as an essential part of care, and they should be given time to perform this task.”

Age Concern is calling for protected mealtimes during which all non-urgent activity is suspended.

It also backs a system where vulnerable people get their food served on a different colour tray to enable staff to easily recognise who needs special help at mealtimes.

Nurse concern
Pauline Ford, Royal College of Nursing advisor for older people, said the survey underlined that, for many nurses, time had become a luxury. She backed the call for protected mealtimes, and a red tray system. And she said nurses who were worried there were not enough staff on wards to help patients eat and drink should notify their manager immediately.

“It is unacceptable if patients are not getting the help they need. Nurses desperately want to be able to give the standards of care they were trained to give, but need the support and resources to do so. Most importantly they need to be given the time to care.”

Public Health Minister Caroline Flint, said improvements were being made – but admitted there were still problems. She said: “Seventy per cent for example of our hospitals do organise preferred meal times. But having said that there are still too many cases where individuals are not being supported and we have to stop that, we can’t tolerate that.”

A Department of Health spokesperson said a summit on how best to improve care of older people was planned for the autumn.

http://news.bbc.co.uk/1/hi/health/5275932.stm

Health Direct questions how the DoH can afford a “summit” in the autumn, when they couldn’t find a single Pound to fund the Dignity spin campaign. Yet the inefficientcy in the NHS system allowed 17 million meals to be wasted last year.

Chief execs should ‘take the rap’ if the elderly are failed on dignity on 21 Apr- Chief executives could face the sack if their trusts consistently fail to treat their elderly patients with dignity, the national clinical director for older people has said. He wanted to see dignity breaches become as ‘totemic’ an issue for senior managers as four-hour accident and emergency waits.

17 million hospital food meals are wasted 13 Oct 05- One in 10 hospital meals is thrown away untouched, according to figures which raise fresh concerns over the hidden scandal of malnutrition among NHS patients. More than 17 million platefuls went into the bin last year, amid complaints from patients’ organisations that elderly and confused patients are not being given the help they need to eat, and that many are missing meals.

At its peak iSoft was worth £1bn but, as the extent of its problems have become clear, shares have slumped. This year they have fallen by 90%. The company is now worth £101m.

The company’s three founders have made £41m, £30m and £10m respectively by selling shares in the software provider between 2001 and 2005. The next generation of the group’s software, which is being developed in India, is earmarked to cover 60% of Britain’s GP practices, hospitals and other NHS trusts. It is to be used by about 600,000 clinicians and managers looking after up to 30 million patients.

The NHS’s computer upgrade programme, one of the world’s biggest IT projects, is already said to be more than two years behind schedule. The collapse of iSoft would paralyse the programme.

This month, an investigation into iSoft’s books found serious accounting irregularities in 2004 and 2005, leading to the suspension of one of the firm’s founders. Other former staff were also said to be involved in irregularities but were not named.

The company was bought by Roger Dickens, Patrick Cryne and Steve Graham from their then employer, KPMG, in 1998. All held executive positions at iSoft. Mr Dickens, who has since died, left the company in late 2003 and Mr Cryne departed late last year. Mr Graham was suspended earlier this month.

The company’s directors were under pressure from investors to show ever-increasing revenues and profits. Their bonuses were directly tied to profits in an effort to motivate them.

A provisional inquiry by accounting firm Deloitte has found that advance payments to iSoft were wrongly included in its accounts. This is not illegal, and can be common practice among many software companies. However, iSoft’s accounting practices were found to have overstepped the mark. When the Guardian approached iSoft with these allegations in 2004 the then chief executive Tim Whiston insisted there was nothing amiss.

“There are no questionable accounting practices. The accounts for the company have never been called into question. Indeed, the level of disclosure and the accounting standards applied have received nothing but positive commendations,” he said.

Until this year, while iSoft’s share price was soaring, the company’s founders were busy selling their stakes in the software business. Mr Cryne, the former chairman, made £41m from selling almost 12m shares on four separate occasions between 2001 and 2005. Mr Dickens made £10m from selling 4.5m shares on two occasions in 2001 and 2003. Mr Graham made £30m from selling 9m shares on four occasions from 2001 to 2005.

The software company has been forced to restate its profits for the financial years 2004 and 2005 because of a radical change in its accounting practices. This has meant that operating profit for 2005 has been reduced from £72m to zero and revenues have been revised from £262m to £190m.

Paul Farrelly, Labour MP for Newcastle-under-Lyme, who has for years been urging the Department of Health to take a closer look at iSoft’s affairs, last night said: “I have been extremely concerned about iSoft’s attempts to deflect legitimate journalistic inquiry and to gag the Guardian. In my experience, when companies try to do this it often shows there is no smoke without fire … This gagging order is now entirely redundant and it is high time it was lifted.” He said he would be joining calls by Conservative MP Richard Bacon, a member of the public accounts committee, for the trade secretary Alistair Darling to appoint inspectors under the Companies Act to examine iSoft’s affairs.

http://business.guardian.co.uk/story/0,,1856154,00.html

Health Direct noted that whilst questions have been asked about iSoft’s accounting practices since 2004, when the NPfIT project was delayed last November in Choose and Book IT fiasco ‘will be a year late’ Thu 3 Nov- The flagship Choose and Book electronic booking application will be at least a year late by the time it is rolled out across England NHS chief executive, Sir Nigel Crisp, said yesterday.”

Thus the matter of exactly when iSoft added the income generated from the NPfIT contract into their accounting sales column became more than of passing interest. And appears to be adding another nail in this white elephant’s coffin.

The judgment could slow the government’s drive to increase the involvement of the private sector in the National Health Service. PCTs, which purchase local healthcare services on behalf of patients, now face having to consult widely with the public before tendering, providing a focal point for campaigners who say the government is bent on privatising the NHS.

The ruling is doubly embarrassing for the government as the chairman of the European arm of UnitedHealth is Simon Stevens, Tony Blair’s former health adviser and a strong advocate of a bigger role for the private sector in healthcare.

The Department of Health insisted the ruling would not affect other contracts with healthcare companies because it hinged on the specific tendering process adopted by one PCT, rather than the principle of private involvement. But campaigners said the ruling could discourage other companies bidding for contracts to run GP services, which could be worth up to £200m.

The government is looking to bring in private providers to deliver services of 800 GPs in 30 areas with a shortage of doctors, mostly in northern England.

Pam Smith, the pensioner who brought the legal challenge, said it was “a real case of David and Goliath”. “I would love to be a fly on [health secretary] Patricia Hewitt’s wall now. She keeps saying patients have a choice; well we’ve made our choice. UnitedHealth would only have taken profits. We will keep our NHS public, not private – that’s what makes Britain unique.”

The court overturned a High Court decision that despite a lack of consultation, UHE would probably have won the contract in any event from among 20 bidders.

http://www.ft.com/cms/s/fababdfc-330c-11db-87ac-0000779e2340.html

Pam Smith’s victory proves what teh public generally think- that choice in the NHS is an illusion: BMA reports that NHS does not provide choice says public More than half the people in a general public survey on patient choice in the health service believe the NHS does not offer choice. The British Medical Association commissioned the survey and is publishing the findings on the eve of its annual meeting.

For background reading- January 02, 2006 Choose and Book- your new right for NHS treatment Most patients in England gain a historic new right this week – to be treated in a private hospital at National Health Service expense. The arrival of “patient choice” – the right to choose, initially from at least four hospitals, and by 2008 from any hospital prepared to meet NHS standards and prices – is a symbolic moment in the Labour government’s endeavour to use market forces to drive up health service performance.

Though quite how this policy will actually work in practise- with the introduction of the
Choose and Book NHS IT disaster- which it is currently hoped that it will be delivered 12 months late in December 2006, is anyone’s guess.

The lack of training for nurses has also emerged as a major concern. 95% of respondents thought nurse training was central to the success of the planned electronic patient health record, but in the last six months 69% had not received any IT training at work. There has been no progress on this front compared with the results of RCN surveys of previous years.

Sharon Levy, informatics advisor at the RCN, said: “This is not just about teaching nurses to press buttons on a computer. Information and its use and management are central to nursing and delivering good patient care. We have got to give nurses the right training and support so that NHS and patients see the benefits that IT could bring to healthcare. If nurses continue to be ignored, a huge amount of money and effort could be wasted in yet another failed public sector IT programme.”

Another feature to emerge is that nurses’ attitudes towards the national NHS IT programmes are becoming more negative. More respondents (43%) said they did not think they were a good use of resources than those who thought they were (40%). In early 2004 there was a big majority (67% against 11%) in support of the programmes.

In addition, only 56% thought that IT developments would improve clinical care, compared with 70% in 2004.

Dr Beverly Malone, RCN general secretary, said: “In the current financial crisis in the NHS it is hardly surprising that nurses are expressing reservations about the large and expensive national NHS IT programmes. Nurses will be by far the largest group of health professionals using NHS IT systems, yet they are hardly being consulted or informed about developments.

“We know from experience that if front-line staff are not involved in change, it fails. This survey is the final wake up call for the government. They need to work much harder and, as a matter of urgency, ensure nurses are involved in the development and evaluation of IT programmes.”

“Nurses are willing to work with the government on this, but we’re not sure the government is willing to work with us.”

In response to the RCN’s statement, Barbara Stuttle, national clinical lead for nurses at NHS Connecting for Health, said: “There is no doubt that nurses are the glue of the NHS and are fundamental to the programme, ensuring IT benefits patients and supports professional practice.

“We are learning from the results of the survey and hope that through our work, not only with the RCN, but other nursing bodies too, we can improve the results for next year by being proactive in working with and engaging in the design and implementation of IT.

“However, we should not forget that the work of NHS Connecting for Health is taking place during a great period of change in the NHS. The IT programme is a 10 year programme, which is evolving the way forward gradually.

“To commence our proactive approach we have a visioning day planned initially with the RCN so we can address issues and concerns improve and strengthen our engagement with nurses in partnership with professional nursing organisations.”

http://www.kablenet.com/kd.nsf/Frontpage/04935A3C57CFD79D802571D10040F2F2?OpenDocument

Health Direct notes that it is not just the nurses who feel that it is important that NHS staff are involved in the IT training process- on Saturday, June 17, 2006 in NAO warns on NHS IT systems two years late and £20bn cost climbs when the National Audit Office reported to Parliament the results of its examination of the National Programme for IT in the NHS. It found key parts of the NPfIT were running at least 2 years late and that the total cost of the project may be as much as £20 billion once all the elements are included.

A key recommendation of the NAO’s report was “Winning the support of NHS staff and the public in making the best use of the systems to improve services.”

What the RCN’s survey highlights is that the NAO’s dreams are just that.

It’s no surprise when NHS front line staff are now so over stretched when 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.”

They say the drugs have been shown to extend life expectancy by four to five months in some patients. A similar decision has already been made in Scotland.

Bowel cancer kills almost 50 people a day in the UK. Each year, there are about 18,700 new cases in men, and nearly 16,200 cases in women. It is easily treatable, but only if caught in its early stages.

Both the new drugs are monoclonal antibodies – the same type of new generation “biological” drug as the breast cancer treatment Herceptin.

Nice considered their use in patients whose cancer had spread, usually to the liver, but sometimes to the lungs. This is known as metastatic cancer.

Avastin, known technically as bevacizumab, works by starving cancerous tumours of blood, thus preventing them from growing in the body. Research has shown it can extend life expectancy by an average of five months.

Lynn Novak, from Crawley, West Sussex, who has advanced bowel cancer, argued that Avastin had reduced the size of her tumours and helped to keep her alive. However, the Nice decision could mean she will have to stop taking the drug, as she cannot afford to continue to fund it herself, having already spent thousands.

Her only hope is to convince her local primary care trust she is an exceptional case. “I’m a different person, a different person. It’s just given me a new life,” she said. I was told I had six months to live in December 2005, but I’m still here, I’m back at work, I’m a productive member of society, and I feel really, really well.”

Erbitux (cetuximab) works by blocking the proliferation of cancer cells, and is usually used after chemotherapy has failed. In tests, it was found to extend life expectancy by at least four months for 50% of patients, and to shrink tumours by 50% in a quarter.

However, both drugs are relatively expensive. Avastin costs on average £16,824 per patient, and Erbitux £11,739.

Andrea Sutcliffe, Nice deputy chief executive, said the institute’s investigations had found that neither drug represented a good use of “scarce NHS resources”.

Andrew Dillon, the chief executive, admitted the drugs were of some benefit – but said there was uncertainly about how good they were compared with current standard treatments.

Decision ‘scandal’
Television presenter Lynn Faulds Wood, who beat the cancer and set up the charity Lynn’s Bowel Cancer Campaign, said the decision was “cruel” to patients.

Hilary Whittaker, chief executive of the charity Beating Bowel Cancer, said the decision was a “scandal” and the value placed on the lives of sufferers seemed to be “minimal”. We are now the only nation in the EU not to offer cetuximab and bevacizumab to bowel cancer patients in the disease’s advanced stages,” she said, urging Nice to review its decision.

“We feel extremely disappointed that bowel cancer – the second biggest cancer killer – is not being given the attention or funding it deserves.”

Ian Beaumont, of the charity Bowel Cancer UK, said: “NICE’s negative decision with regard to the biological agents Avastin and Erbitux is further proof that the NHS is simply not working for bowel cancer patients and is overdue a full and comprehensive review.”

Professor Karol Sikora, a cancer expert at London’s Imperial Colllege, said: “These drugs are expensive but they are effective, trials have shown them to be effective. The difficulty for the NHS is they are costly. The way it is done is simply to calculate the amount of cost for prolonging survival by one year.

“The average NHS limit is around £30,000. That’s what you and I are worth to the NHS for one year’s extension of life.”

Alan Maynard, professor of health economics at the University of York, said the problem was NICE was saying yes too much, adding to the financial pressure in the health service. The Nice decision is now open to consultation before a final ruling is published in the autumn.

http://news.bbc.co.uk/1/hi/health/5262760.stm

All three bowel cancer charities receive financial support from the drugs industry.

The Connecting for Health scheme is intended to create centralised medical record systems for 50m patients. Critics fear it could threaten patient confidentiality and make the NHS more vulnerable to damage from computer failures.

The NAO report on the scheme, published in June, was welcomed by NHS officials for its broad support of the programme. However, a draft of the report, dated January 26, 2006 and obtained by The Sunday Times under the Freedom of Information Act, warned of potential problems. It said:
# The Department of Health had failed to demonstrate “clear and effective leadership” to staff implementing the programme.
# NHS workers were worried “the confidentiality of patient information may be at risk”.
# The NHS lacked sufficient skills to support the delivery of the programme.
# Although there had been “substantial progress”, the programme faced “significant challenges”.

When the report was published six month later, the warning over departmental leadership had been removed; the paragraph highlighting doctors’ worries over confidentiality was also missing and the claim that the NHS did not have the required skills to deliver the programme had been
dropped.

Instead, headings of the report were changed which gave more emphasis to what the project “has achieved”. Even the projected costs of the programme were cut from £13.4 billion in the draft report to £12.4 billion in the final version. The key conclusion on the challenges was unchanged.

One source who has worked closely with the NAO said: “It’s pretty clear the NAO were bullied into changing this report.”

An NAO spokesman said: “Like any report it went through a process to ensure the presentation was fair and the facts were accurate. The overall conclusions are the same in the final report as in the provisional report. The £1 billion fall in cost followed new information.”

The health department said: “We co-operated fully with the NAO to ensure the publication of a balanced and accurate report.”

http://www.timesonline.co.uk/article/0,,2087-2320664,00.html

Health Direct has been warning for a long time that there are fundamental flaws in the NHS’s IT programme: June 17, 2006 NAO warns on NHS IT systems two years late and £20bn cost climbs

The NAO’s final report this summer was very critical of the strategy for developing the NHS’s IT system, now it appears that even this was watered down by the lying, incompetent Labour government.

You can see the draft report “Restricted – Audit & Commercial in Confidence” on the BBC website. The final report can be downloaded from the NAO website Department of Health: National Programme for IT in the NHS.

George Beer, of the British Cardiac Patients Association, who is campaigning against changes to hospital services in Sussex, said: “If services are closed, severely ill patients will have to travel miles for care. It is putting lives at risk.”

Further evidence of the move to centralised services at certain hospitals will emerge on Friday with the unveiling of six new PFI schemes. The projects, worth a combined £1.5bn, include expanding A&E; facilities in hospitals in Salford and Leicester and building a cancer centre in north Staffordshire.

Some of the options being drawn up by those trusts which are looking to cut services involve transferring all acute care – accident and emergency departments, heart care units and critical care beds – to nearby hospitals to create regional “super” centres.

The other hospitals in the area will then be left to carry out more basic care, such as non emergency surgery, diagnostics and rehabilitation care, such as physiotherapy. But in some cases, whole hospital closures are being considered.

Over 30 hospitals could be affected by the reviews – including those losing services and others left to bear the brunt of that work. It is thought about 10 of these could face cuts or closures.

The areas under review are:
* London – Talks under way over Harrow’s Northwick Park and the nearby Central Middlesex hospitals
* Project board set up to review services across the four north central trusts – Barnet and Chase Farm, Royal Free, Whittington and North Middlesex
* Surrey and Sussex – Widespread discussions have been followed by the creation of focus groups to discuss future of the 15 hospitals run by nine NHS trusts. Formal consultation to start in the autumn
* Greater Manchester – Committee set up to decide the future of four hospitals run by the Pennine Acute Hospitals NHS Trust. Decision due end of September
* Lancashire – Changes to the University Hospitals of Morecambe Bay Trust’s three centres – spread across Cumbria and Lancashire, planned, with the Westmorland threatened with losing its acute facilities
* Cornwall – Two proposals have been discussed by Royal Cornwall Hospitals NHS Trust, one of which involves withdrawing services from two of its three hospitals

NHS bosses involved in the reviews have said the measures are part of a push to provide more care in the community, either with hospital doctors setting up local clinics, GPs providing extra specialist services or medics treating patients in their own homes.

However, they also acknowledge deficits and new European working time restrictions are forcing them to reconsider how services are provided.

All the hospitals in Surrey and Sussex, which is overspending by £100m a year, are under review, while talks are in the early stages over five north London trusts and the Royal Cornwall Hospitals Trust.

A consultation has already been launched in Morecambe Bay to decide over the future of three local hospitals – the Westmorland could lose acute services as part of the review.

But a decision is closest on the four hospitals run by the Pennine Acute Hospitals Trust, which is facing a £21m deficit this year, with a committee of local health bosses expected to make an announcement by the end of September.

Three options were consulted on, ranging from keeping three acute hospitals to just one, with the remainder becoming “locality hospitals” providing planned surgery and intermediate care.

There are 175 acute hospital trusts in England -and it is possible that more areas will see hospitals downgraded or closed.

Government ministers are said to be privately bracing themselves for major hospitals to be affected in the coming months as part of the continued pressure on the health service from deficits – the NHS finished last year over £512m in debt.

But, in an official statement, a Department of Health spokesman said it was up to local health bosses to decide on the appropriate level of services.

“In some areas, there are too many hospitals providing the same or similar services which isn’t value for money and means less resources for other forms of health care.”

Nigel Edwards, director of policy at the NHS Confederation, which represents health trusts, said: “One of the reasons trusts are running up deficits is that these decisions were not made earlier. It makes sense to do more care in the community for clinical and financial reasons.”

But he said he was concerned acute care could end up centralised in too few hospitals.

Dr Jonathan Fielden, deputy chairman of the British Medical Association’s consultants committee, added: “In some of these cases we have to ask whether this is being driven by financial reasons. If this is the case, it is likely not to be in the best interests of patients.”

http://news.bbc.co.uk/1/hi/health/5259446.stm

If these anticipated closures are confirmed it will take the total HNS jobs axed well past the 20,000 mark since January.

Researchers believe that in about half of those cases, the adverse event could be prevented.

Robert Wendin, managing director of Marsh’s European healthcare, said studies had shown that giving patients the wrong drugs costs a medium- sized hospital, with about 300 beds, about £677,000 a year.

Other adverse incidents range from patients being infected by diseases latent in the hospital to complications such as babies being delivered with the mothers’ umbilical cords wrapped around their necks, leading to brain damage.

The National Audit Office has calculated that British hospitals spend, on average, £2.5bn a year on litigation and other measures, such as having to keep patients in beds longer as a result of complications suffered in hospital. “There are tried and tested techniques and solutions which would quickly reduce the possibility of adverse events,” Mr Wendin said.

These include introducing a computer system for ordering drugs, rather than the pharmacy department in hospitals having to decipher doctors’ handwriting.

Mr Wendin also pointed to the possibility of plastic bracelets, put on patients when they are admitted, having a bar code so that a full medical history could be accessed quickly.

Another possibility, which the NHS is already trying to implement, is to get employees to wash their hands more frequently in order to combat superbugs.

Mr Wendin said hospitals could also develop more sophisticated strategies when apologising to patients, which could help reduce litigation numbers.

http://www.telegraph.co.uk/money/main.jhtml?xml=/money/2006/08/17/cnhealth17.xml

The maxim of “follow the money” has been a guiding principle of another blog- wise money for several years.

In today’s Health direct blog we ought to listen when a senior money man is telling us in words of one syllable that the NHS needs to literally clean up it’s act, but also how to go about reducing frequent sometimes fatal errors.

Under PFI, companies raise cash to fund public infrastructure projects, with the state signing long-term contracts. When it comes to ‘delivering’ schools and hospitals, Labour claims PFI is ‘the only game in town’. It certainly looks a win-win policy for Gordon Brown. He can claim to be ‘prudent’ – because most PFI borrowing is off the government’s books. And ministers can regularly be seen opening shiny new public buildings.

During a 6-month investigation, Halligan visited some of the UK’s 700 PFI projects. He secured exclusive testimony – with numerous public officials speaking out for the first time – about ‘hidden costs’ and ‘sweated contracts’. And the film revealed Sir John Bourn, the Auditor General’s, concerns about PFI.

The programme Dispatches: Public Service, Private Profit revealed how the ownership of the HQ of a leading government department has been quietly transferred, by one of the UK’s biggest banks, to an overseas tax haven. It reveals how a little-known investment company based in Guernsey is now the biggest owner of UK schools and hospitals after the state – responsible for 100,000 pupils and 13,000 hospital beds.

The film also revealed how PFI locks us into 30-year contracts with companies then charging huge mark-ups for basic maintenance. Changing a light switch in one flagship PFI hospital costs hundreds of pounds. Halligan met an exasperated Head Teacher, constantly battling to get a PFI company to honour its contract. ‘PFI has made students depressed at times – when they’ve seen the lack of interest in the building and poor quality of work. Staff have resigned over it. PFI is threatening this school’.

Dispatches then unveiled a multi-billion pound market in which public sector projects are being traded as commodities in the City of London. This ‘secondary market’ is generating huge profits. Since 1997, Labour has signed PFI deals worth £43 billion – leaving taxpayers with a £150 billion bill over 25 years. And, in his last budget, Brown announced another £26 billion of new PFI projects.

Public Service, Private Profit by Liam Halligan Channel 4 News Economics Correspondent exposes the truth behind PFI.

Back in 2004, I received an invitation to the annual dinner of the Public Private Partnership (PPP) Forum. A glitzy, black-tie evening was promised, amidst the mock-Gothic splendour of London’s Royal Courts of Justice. As a financial journalist, I am asked to numerous swanky, yet frankly humdrum events. But the mighty PPP Forum is different. It comprises many of the UK’s corporate A-list – more than 100 contractors, banks and law firms.

PFI, in turn, is a multi-billion pound industry. New Labour has signed hundreds of long-term contracts with the private sector to construct – and then service and maintain – schools, hospitals and other public buildings. The government pays back investors over 30 years or more, after which the buildings revert to the state.

Even two years ago, it was clear the government had based the biggest public building programme since the war on a gigantic – and controversial – hire-purchase scheme.

Given all that – and noticing the stiff-card dinner invitation implied a cabinet minister would be speaking – I decided to attend. The food wasn’t bad and the atmosphere convivial. But the evening left me disturbed. Whenever I politely asked fellow diners an awkward question, I was – politely, for the most part – fobbed off. Back then, as now, I had reservations about PFI. Amid sumptuous surroundings, I questioned the double- and sometimes triple-digit returns being made from projects driven by public money.

I protested that commercial confidentiality meant the details of long-term agreements between PFI companies and taxpayers often remained under wraps – even to the head teachers and NHS bosses trying to run the schools and hospitals involved. Because the private sector pays more to borrow than the state, I quizzed the logic of today’s politicians building up huge off-balance-sheet liabilities under PFI, to be met by tomorrow’s taxpayers. And, while the government claims to use PFI over conventional procurement only after a rigorous value for money test, I suggested this exercise was a sham.

After all, as early as 1997, then Health Minister Alan Milburn proclaimed, ‘it’s PFI or bust’. In other words, if local health chiefs don’t agree to PFI, the hospital won’t be built. I remember quoting figures to a chap at my table: by the end of 2003, PFI had been used for 90 of the 100 hospitals built or refurbished under Labour.

Similarly – 500 out of 550 new or renovated schools. Surely, the fact that PFI allowed ministers to be regularly photographed opening shiny new buildings – while keeping much of the spending off the government’s books – meant the system was likely to be rigged. Gordon Brown, I argued, would continue using PFI, without question, to bolster his claim to be ‘a prudent chancellor’. My analysis was met with a wry smile.

But what I most vividly recall from that dinner two years ago was a group of cuff-linked PFI professionals noisily toasting Saddam Hussein. ‘The Iraq war has really done us a favour,’ one well-oiled reveller explained, while slapping my back. ‘Since it kicked off, you media types have been so obsessed with foreign policy that PFI has dropped off your radar’. At that point, I resolved to become very interested in PFI. And, over the last six months – with that toast still ringing in my ears – I’ve made an in-depth TV documentary.

So far, much of the analysis into PFI has been party pris. Trade unions, and academics funded by trade unions, have produced a slew of critical studies, which the PPP Forum has rightly dismissed as ‘biased’. After all, much of the public sector is allergic to any form of private involvement in state schools and hospitals. The only other source of detailed ‘research’ has been big City accounting firms, invariably, in favour of PFI. But they’re making a killing from what is now a £4bn-a-year industry so have a vested interest.

I have no ideological aversion to PFI. My only allegiance is to that ultimate vested interest – taxpayers. And, as my documentary – I hope – makes clear, PFI gives very bad taxpayer value. Some of the facts I’ve unearthed – on long-term liabilities, on ramped-up maintenance charges, on broken contracts are shocking.

Labour has signed PFI deals worth £43bn. The long-term taxpayer cost – £150bn. The cost of changing a light switch in a leading PFI hospital? A cool £333 and I’ve got the document which proves it.

Locked into a long-term PFI contract, a local authority is currently shelling out tens of thousands of pounds a month for meals and cleaning services in a school which closed last year. And a head teacher at a school which Tony Blair has singled-out as ‘evidence PFI works’ told me the policy is ‘lunacy’. After years of wrangling with contractors, she said: ‘I was initially very positive about PFI. But I’ve ended up hugely frustrated at the waste of public money’.

In the face of growing discontent, ministers remain petrified of reining-in the all-powerful PFI industry. Without it, public service delivery would grind to a halt. And, having committed themselves – and us – so deeply, the government can’t bear to go back. My invitation to the most recent PPP forum dinner seems to have got lost in the post. The industry will never believe me, but I really wanted PFI to work. The private sector should be heavily involved in delivering our public services. We need to retreat from the dogma of state provision.

But as the PFI stench gets worse, opposition is growing, not only among the usual suspects, but among ranks of non-aligned taxpayers too. And that is the tragedy. PFI is giving the private sector a bad name.

http://www.channel4.com/news/microsites/D/dispatches2006/public_service_private_profit/feature.html

The standard of health care in Britain remains below that of many other countries despite a massive increase in NHS spending under Labour, according to a report.

The study by Civitas, a centre-Right think-tank, says efforts to improve services in many areas have resembled a “country stroll whereas expenditure has increased at a sprint”. It says the lack of progress has been particularly marked in stroke-care and mental health.

Citing data compiled by the Organisation for Economic Co-operation and Development (OECD), Civitas says Britain is the only advanced country to have registered virtually no improvement in mortality as a result of stroke-care between 1999 and 2003.

And while hospitals have met their targets, they have often done so at the expense of the most effective methods of health care.

Total expenditure on the NHS in England increased from £44.9 billion in 2000-2001 to £76.4 billion this year. But the UK now ranks 24th out of 27 countries for the number of doctors per head.

The number of surgical procedures undertaken has fallen since 2000, unlike every in other OECD country except Germany.

The report says: “Improvements in the NHS have in no way increased in proportion to the vast sums of money ploughed into it.”

Dr Jonathan Fielden, of the British Medical Association’s consultants’ committee, said it would be wrong to say that money had been “wasted”.

But he agreed that the extra funding could have been better spent.

“The fundamental incoherence of current government policies have led to lack of engagement, frustration and low morale among doctors,” he said. However, a spokesman for the Department of Health said: “Thanks to record funding and radical reform, NHS patients are receiving better quality care and taxpayers are getting more bang for their buck.

“Our investment has delivered new hospitals, walk-in centres and GP surgeries, more doctors and nurses, and has helped the NHS achieve the [smallest] waiting-lists on record.

“We’re now [implementing] plans to deliver £6.5 billion in efficiency savings within two years.

“Reforms like doing more procedures outside of large hospitals, payment by results and encouraging the NHS to share administrative functions, will ensure every extra penny is wisely spent.”

Today’s update on how Labour is wasting our money is taken from these two links:

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/08/14/ncivitas14.xml

http://www.civitas.org.uk/press/recent.php

Bewley’s research shows that more than 20% of births are now to women over the age of 35 and that the trend is putting a huge strain on National Health Service resources.

Not only do many experience difficulty conceiving and require expensive IVF treatment, but they suffer a much higher rate of miscarriage and complications during pregnancy, putting their own long-term health and the health of their babies at risk.

“Middle-age pregnancy is a public health problem because women en masse are moving out of the optimal age of childbearing and that brings preventable disease and stress with it,” said Bewley last week.

“Middle-age pregnancy has complications in the same way as teenage pregnancy. We have policies to address teenage pregnancy but not middle-age pregnancy.”

Bewley advises women to complete their families between the ages of 20 and 35 to lessen the risk of complications. Not only do the risks of premature births or birth defects increase markedly after 35, but risks to the mother’s health such as high blood pressure and diabetes also jump.

“Doctors and public health authorities have to give clear and consistent messages about the optimal time for reproduction,” says Bewley in a paper to be published later this year in the Fetal and Maternal Medicine Review. “Knowing the constraints, rational women would choose to have completed their families by 35,” she adds.

Bewley’s comparison of older mothers to teenage mums and her call for Labour government intervention is likely to prove highly controversial. While few would object to the risks of late pregnancy being pointed out, most do not see themselves as a public health problem.

Claire Fox, director of the Institute of Ideas, a think tank, said: “Even if there are health risks in older motherhood, and I think they are being overstated, this is not a matter of public policy. It is no business of doctors to tell people when to have their children. This is turning the medical profession into social engineers.”

But Bewley is unapologetic. Her paper looks at the broad costs to society of the trend towards late motherhood. It says: “A rapidly ageing obstetric population inevitably requires more maternity services and resources, and this has not factored prominently in NHS debates about maternity funding.”

http://www.timesonline.co.uk/article/0,,2087-2310533,00.html

Health Direct notes that the comparison with teenage mothers will still sting. The two groups could not be more different. One is made up largely of deprived and feckless girls while the other is dominated by highly educated and successful career women.

The problems caused by single teenage mothers are also very different and largely social in nature. The problems for middle-age women in contrast are mostly — but not entirely — medically related. Bringing up a baby- whatever the age of the parents is still bloody hard work.

In effect, what the social engineers want is to demonise already dissaffected voters by withdrawing funding for maternity services and creating another post code lottery for NHS services.

We are already seeing this happen in Gloucestershire with plans to close all of the county’s maternity wards and moving to one revamped ward in the Labour voting Gloucester constituency.

The NHS’s healthcare commission, which asked for the figures to be compiled for its review of medicines management published today, said more needed to be done to reduce the number of potentially harmful mistakes.

The figures from the NPSA show that about 80% of mistakes (amounting to 32,000 drug errors) caused no harm to the patient, but 15% caused a low degree of harm and 5% (2,000 drug errors) caused moderate or severe harm.

The commission’s review looks at medicine management in all 173 NHS trusts in England, the first of a series of performance reviews that will culminate in an overall rating for each trust in October. Only 18 of the trusts were rated “excellent” in the way they managed medicine; 70 were “good”, 73 were “fair” and 12 were considered “weak”.

Trusts labelled excellent included Airedale NHS trust and Barnsley hospital NHS foundation trust, in Yorkshire, as well as Essex Rivers healthcare trust, and Guy’s and St Thomas’s in London. Those said to be weak included South Warwickshire general hospitals trust, the Royal Cornwall hospitals trust, North Middlesex University hospital trust, and Mid Staffordshire general hospitals trust.

The review looked at 21 aspects of medicine management. Some findings were positive; for instance, 40% of trusts used antibiotics prudently to curb MRSA infections. But the commission said patients should be helped to understand the side-effects and purpose of drugs.

http://society.guardian.co.uk/health/news/0,,1842399,00.html

On Friday, November 04, 2005 Health Direct reported that the NAO had found that NHS accidents cost £2bn and up to 34,000 lives. 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. 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”.

The retrospective study of patient records in two English hospitals found that just over 10 per cent of patients experienced an ‘adverse event’. Around half of these (5.2 per cent) were judged to have been preventable.

Responses to the NAO survey showed that, in 2004-05, trusts recorded some 2,081 deaths as a result of patient safety incidents, but it is widely acknowledged that there is significant under-reporting of deaths and serious incidents. Other estimates of deaths range from 840 to 34,000 but, in reality, the NHS simply does not know.

As evidenced by the NAO survey finding that only 69 per cent of trusts had criteria for staff to follow, with only 24 per cent routinely informing patients when those patients had been involved in a reported incident. And six per cent of trusts did not inform patients at all.

So if the NHS system messes up you and your friends and relatives probably won’t know.

Terminally-ill patients and bereaved relatives will be left without pastoral care if a struggling NHS trust presses ahead with plans to axe most of its chaplaincy service, the union Amicus said yesterday.

Six of seven chaplains are to be laid off under proposals by Worcestershire Acute Hospitals NHS Trust to reduce a projected £30 million deficit. The plans would leave only one chaplain serving three hospitals.

Amicus, which represents the College of Health Care Chaplains, said it was the worst single example of cuts affecting spiritual services in at least seven other trusts across Britain.

Two Anglican chaplains, three Roman Catholics and another from the Free Church would be sacked from the Worcester and Kidderminster hospitals under the plan, leaving one based at Redditch.

The Rev Dr Chris Swift, president of the CHCC, said: “People in really tragic circumstances will find services very patchy or get no response at all.”

The union, which yesterday met hospital officials to protest, said: “The sick and the dying are going to be denied spiritual, religious and pastoral solace. This is a cruel decision by the trust. We believe that such cutbacks are being replicated across the UK. Chaplains are a soft target.”

But NHS managers said variations in spending were not always bad and could reflect the burden of disease.

The research by the health think-tank looked at spending by 303 primary care trusts (PCTs), which are responsible for 80% of the NHS budget and fund hospital, GP and community treatment. It is the first time the information has been presented in this way.

It showed Islington PCT spends £259 per head on mental health each year – four times the £66 spent by Bracknell Forest PCT once deprivation is taken into account.

For cancer there were similar differences. Daventry and South Northamptonshire PCT spent £132 per head on cancer and tumours, while Heart of Birmingham PCT spent about a quarter of that.

Researchers also analysed overall spending on particular disease groups. The greatest proportion – over £7bn – was spent on mental health, with heart disease absorbing nearly £6bn and cancer just over £3.5bn.

The report said there were differences in spending which only appeared to be “partially explained” by need and therefore raised questions over whether spending variations were having “adverse effects on equity and efficiency”.

King’s Fund chief economist Professor John Appleby said: “The new data is very revealing and raises serious questions about the consistency of decisions PCTs make about how much they spend on different diseases.”

Sophie Corlett, policy director at the mental health charity Mind, said: “We know that in many areas primary care mental health services are severely lacking.”

And Cancer Backup chief executive Joanne Rule said: “What people will want to know after seeing this research is, will I receive good cancer care in my area if I need it?”

But Nigel Edwards, director of policy at the NHS Confederation, said: “Variation in the delivery of health services or the ‘postcode lottery’ as it’s often called is frequently seen as a problem by politicians and the public.

“Yet at the same time they say that they want less central control in health and more decisions to be taken locally – there is a direct trade off between them. The healthcare priorities of the people of Brighton will be different to the priorities of those living in Bradford.”

http://news.bbc.co.uk/1/hi/health/5257246.stm

The figures come amid mounting anger from backbench Labour MPs and the trade unions about what they see as the privatisation by stealth of the public services.

Management consultants are set to profit further from a renewed drive for efficiency in the civil service. Gordon Brown has ordered ministries to step up their efforts to cut administrative costs and reorganise their operations.

Mr Craig’s projections are borne out by the latest figures from the Management Consultancies Association, which collects billing information from its members, who account for 70-80 per cent of the UK consulting industry.

The public sector spent £2.2bn on services from MCA members in 2005-06, encompassing advice on improving Whitehall efficiency but not necessarily all the contracted out functions of government, including IT and support administration, much of which is supplied by non-MCA members.

However, total spending on management consultants is hard to calculate precisely. There is no official total for the public sector as a whole or for central government. Individual Whitehall departments present figures in different ways or do not collect them at all.

It is also hard to differentiate between management consultancy, which the MCA defines as advice on business improvement, and other contracted services.

Even the MCA, which has the most complete figures on government spending, finds it hard to provide a clear picture.

“We just find it a nightmare to disaggregate management consultancy from other functions,” said Fiona Czerniawska, who complied the MCA’s figures.

Data issued by Whitehall departments in response to parliamentary questions imply that spending on consultancy is far lower than the £2.2bn figure (see table). This is because, according to the MCA, government de-partments account for only a quarter of consultancy spending.

Public sector bodies, such as the NHS, government agencies, the armed forces and local councils account for the rest, illustrating how widespread the use of external advice has become.

In Whitehall, the biggest departmental spenders on consulting services include the Department for Communities and Local Government, which disbursed £80m in 2004-05.

The Department for Work and Pensions, one of the few ministries that collects figures specifically on management consulting, spent at least £99m in 2004-05, almost £46m of which went to Capgemini. The Department of Health listed its spending as only £12.8m on consultancy services generally in 2004-05, although this figure is outstripped by NHS expenditures, which were not included.

Illustrating the difficulty in differentiating between types of consultancy, the Department for International Development spent £214m in 2003-4, most of which went to companies and non-governmental organisations engaged in delivering overseas aid and helping foreign governments.

http://www.ft.com/cms/s/f4829964-25b0-11db-a12e-0000779e2340.html

Dr John Wynn-Jones, from the Institute of Rural Health, said: “There are some very, very poor communities in rural areas – but they are, in effect, invisible and their health needs are suffering.”

The Government allocates money to health authorities according not only to their population, but also on the basis of poverty and deprivation.

Dr Wynn-Jones said, however: “The Government doesn’t take into account the extra cost of providing health care in rural areas. What we need is a ‘rurality’ index.”

Ministers have sought to blame spiralling NHS debt levels, which last year reached half a billion pounds, on the poor performance of some trusts and health authorities. The researchers say, however, that the debts cannot always be explained away by poor management.

“If this were the case you would not expect to see a clustering of PCTs most in deficit in one type of region as this study shows,” said Dr Padmanabhan Badrinath, who led the research team.

His study, which appears in the journal BMC Health Services Research, suggests that rather than seeking to blame PCTs, the Labour Government should reconsider how it allocates resources. The figures come from 2004-5, the most recent year for which complete data are available.

Michael Dixon, the chairman of the NHS Alliance, which represents PCTs across the country, said the survey confirmed his suspicions of funding bias against rural areas.

The rural Devon GP said: “There has not been a proper allowance for the extra expenses of providing primary care in rural areas. If a GP or nurse has to drive 10 miles to see a patient, that will cost more. Or if the GP has to dispense medicines because there are no other local services, that will cost more, too.”

A Department of Health spokesman said the existing allocation formula was designed to fight health inequalities, but denied that it was stacked against rural communities. “You can always find patterns if you look hard enough,” he said.

One of Dr Badrinath’s fellow researchers, Rosemary Currell, the health intelligence manager at Suffolk West, one of the bottom 29 PCTs, said: “We’re not suggesting money be taken away from deprived inner-city areas, but we are saying that pockets of deprivation in rural areas get overlooked.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/08/06/nhealth106.xml

Health Direct cites the above as another example of Labour’s social engineering by allocating funds to labour voting constituencies.

A survey for the group found that cash set out in the Choosing Health White Paper is reaching frontline services in only 30 of the 191 PCTs questioned. Fifty-one said that they had absorbed their entire allocation into the general budget, and 33 had withheld some or most of the sexual health funding. A further 40 said that funding had not reached contraceptive services.

Baroness Gould of Potternewton, the group’s chairman, said that many trusts were experiencing financial difficulties and that sexual health services were suffering problems such as recruitment freezes and clinics closing.

Nick Partridge, the chief executive of the Terrence Higgins Trust, said: “It would be a great disappointment if sexual health was sacrificed on the altar of financial balance in the NHS.”

The Department of Health said that trusts were responsible for sexual health. “We have provided . . . more sexual health funding than ever before.”

http://www.timesonline.co.uk/article/0,,2-2295495.html

Three PCTs in Lincolnshire have closed all family planning clinics and a network of teenage advice centres to help to tackle a £13.5 million budget deficit. And what cop out was used? Jim Moss, of East Lincolnshire PCT, one of the trusts that is making the cuts, defended the decision. “Family planning services are available at pharmacies and GP surgeries,” he said.

So because Boots down the road can shovel pills, they can now help out with teenage health issues. That’s alright then.

On Tuesday, November 23, 2004 Sexually transmitted disease is reaching “epidemic proportions“, Sexually transmitted disease is reaching “epidemic proportions” amongst young women and requires a government response on the scale of the 1980s’ Aids warnings, says John Reid the Health Secretary.

Since then the number of STD infections has contiued to rise: Wednesday, July 05, 2006
Sexually Transmitted Infections (STI)s increases again for 2005- New figures released today by the Health Protection Agency show that the number of sexually transmitted infections (STIs) and other conditions diagnosed in genitourinary medicine (GUM) clinics in the UK increased by 3% between 2004 and 2005. Chlamydia remains the most commonly diagnosed STI, with 109,832 new cases in 2005, a 5% increase on the previous year. The highest rates of infection and highest increases in diagnoses were seen for both sexes in the 16 to 24 age group.

But that was too fast and too costly for East Suffolk Primary Care Trusts (PCTs), which provide the money for patient care. They had introduced a minimum wait to manage demand, requiring patients to wait at least 122 days before seeing a consultant.

The non-payment of £2.5 million by the PCTs for treatment provided for Suffolk patients was revealed in an independent audit by PriceWaterhouseCoopers, called in by the hospital to review its financial problems.

The report said: “The trust had spare capacity and, to ensure its resources were utilised, treated a number of patients in advance of the 122-day rule.” That cost the hospital £240,000 in 2004-05 and rose ten-fold to £2.4 million in 2005-06.

Hospital staff, pleased with their ability to treat patients quickly, are exasperated. The hospital’s joint unions said: “The PCTs wanted the work done; we did it and now they should pay for it.”

Jan Rowsell, a spokesman for Ipswich Hospital, said that no one needing urgent or emergency treatment had been affected by the rule.

“Anyone deemed to be clinically urgent would be seen earlier. This rule is there for people who are waiting for planned surgery.”

She said the hospital had effectively breached its agreement with the Suffolk East PCTs by treating people more quickly. “Although you can understand the reasons why we did it, the background is that we went against our commissioning agreement.”

Carole Taylor-Brown, the chief executive of Suffolk East PCTs, said they wanted a system that was fair to all patients and that worked within the budget.

“The principle is to make sure that patients are seen in turn as they go through the system and to level out waiting times. It is also about making best use of the money that we have available throughout the year.

“It would be great if we were fully resourced to do everything. But we are given a certain amount for the year and we have to make sure we are using it efficiently.

“This is something that we agreed with the hospital, not just something that was imposed on them, and the most important thing is that we have brought waiting times down.

“Not long ago people had to wait up to 18 months for an operation. Now nobody waits more than six months.”

Miss Taylor-Brown said the 122-day rule had been cut to 98 days in the current year.

Andrew Lansley, the shadow health secretary, said: “It is outrageous that Ipswich Hospital is being penalised for improving on the Government’s target, especially when the trust is crippled by deficit. The Government is more obsessed with meeting its targets than the interests of patients.

“In some cases it may be in the interests of a patient to wait longer than the target time and in some cases for a shorter time. Either way, targets should not override clinical decision making.”

Nigel Edwards, of the NHS Confederation, which represents NHS organisations, said he expected more minimum waiting times to be set as hospitals worked through their waiting list backlogs, allowing them to see new patients more quickly.

The Department of Health said that health authorities were free to manage their finances in the best interests of patients “as long as patients are seen and treated within the six-month [maximum] target”.

http://www.telegraph.co.uk/news/main.jhtml;jsessionid=CVOJ00GQUGWUDQFIQMGSFGGAVCBQWIV0?xml=/news/2006/08/02/nhs02.xml

Health direct cites the above as yet another shining example of the wonders of Labour’s “Payments by Results” NHS health policy.

Phil Willis, who chairs the Commons Science and Technology Select Committee, said the current classifications were “riddled with anomalies” and were “clearly not fit for purpose”.

“This research shows why we need a radical overhaul of the current law and a radical review of the classification system,” he said. “It’s clearly not fit for purpose in the 21st century, neither for informing drug-users nor providing public information.”

1: Heroin (Class A)
ORIGIN: Vast majority comes from poppy fields of Afghanistan
MEDICAL: Sedative made from the opium poppy. Can be smoked or injected to produce a ‘rush’. Users feel lethargic but experience severe cravings for the drug
NO. OF UK USERS: 40,000
NO. OF UK DEATHS IN 2004: 744
STREET VALUE: £30-100 a gram
DANGER RATING: 2.75/3

2: Cocaine (Class A)
ORIGIN: Made from coca shrubs from Colombia and Bolivia
MEDICAL: Stimulant made from leaves of the coca bush. Increases alertness and confidence but raises heart rate and blood pressure and users will crave it
NO. OF UK USERS: 800,000
NO. OF UK DEATHS IN 2004: 147
STREET VALUE: £30-55 a gram
DANGER RATING: 2.25/3

3: Barbiturates (Class B)
ORIGIN: Synthetic lab-made drugs, used to be prominent in clubs
MEDICAL:Powerful sedatives. Widely prescribed as sleeping pills but dangerous in overdose and now superseded by safer drugs
NO. OF UK USERS: Not many
NO. OF UK DEATHS IN 2004: 14
STREET VALUE: £1-2 a tablet
DANGER RATING: 2.10/3

4: Street Methadone (Class A)
ORIGIN: Synthetic drug similar to heroin but less addictive
MEDICAL: Similar to morphine and heroin and used to wean addicts off these drugs because it is less sedating. Street versions may be contaminated
NO. OF UK USERS: 20,000
NO. OF UK DEATHS IN 2004: 200
STREET VALUE: £2 a dose
DANGER RATING: 1.90/3

5: Alcohol (Legal)
ORIGIN: Brewed across the world in many different forms
MEDICAL:Central nervous system depressant used to reduce inhibitions and increase sociability. Increasing doses lead to intoxication, coma and respiratory failure
NO. OF UK USERS: Most adults
NO. OF UK DEATHS IN 2004: 22,000
STREET VALUE: £2.25 pint of lager
DANGER RATING: 1.85/3

6: Ketamine (Class C)
ORIGIN: Anaesthetic drug popular on club and rave scene
MEDICAL:Intravenous anaesthetic used on humans and animals which, when taken in tablet form, creates hallucinatory experiences
NO. OF UK USERS: Unknown
NO. OF UK DEATHS IN 2004: N/A
STREET VALUE: £15-50 a gram
DANGER RATING: 1.80/3

7: Benzodiazopines (Class C)
ORIGIN: Tranquilisers used to beat anxiety and insomnia
MEDICAL:The most common prescription tranquillisers. Effective sedatives which have a calming effect, reducing anxiety, but are addictive
NO. OF UK USERS: 160,000
NO. OF UK DEATHS IN 2004: 206
STREET VALUE: Prescription drug
DANGER RATING: 1.75/3

8: Amphetamines (Class B)
ORIGIN: Synthetic stimulants snorted, mixed in drink or injected
MEDICAL:Man-made drugs that increase heart rate and alertness. Users may feel paranoid. Newer form, methamphetamine, is addictive
NO. OF UK USERS: 650,000
NO. OF UK DEATHS IN 2004: 33
STREET VALUE: £2-10 a gram
DANGER RATING: 1.70/3

9: Tobacco (Legal)
ORIGIN: Most of the leaf comes from the Americas
MEDICAL: Contains nicotine, a fast-acting stimulant which is highly addictive. Tobacco causes lung cancer and increases the risk of heart disease
NO. OF UK USERS: 12.5m
NO. OF UK DEATHS IN 2004: 114,000
STREET VALUE: £4.50 a packet
DANGER RATING: 1.65/3

10: Buprenorphine (Class C)
ORIGIN: Can be made in a laboratory
MEDICAL: More expensive alternative to methadone used to wean addicts off heroin. Preferred by some addicts because it leaves them more ‘clear headed’
NO. OF UK USERS: Unknown
NO. OF UK DEATHS IN 2004: N/A
STREET VALUE: Unknown
DANGER RATING: 1.55/3

11: Cannabis (Class C)
ORIGIN: Plant is easily cultivated in temperate climates
MEDICAL: Leaves of the cannabis sativa plant or resin can be smoked or eaten. It is a relaxant but stronger forms can also cause hallucinations and panic attacks
NO. OF UK USERS: 3m
NO. OF UK DEATHS IN 2004: 16
£40-100 an ounce
DANGER RATING: 1.40/3

12: Solvents (Legal)
ORIGIN: Organic compounds found in glues, paints, lighter fluid
MEDICAL: Includes glue, gas lighters, some aerosols and paint thinners. Produces euphoria and loss of inhibitions but can cause blackouts and death
NO. OF UK USERS: 37,000
NO. OF UK DEATHS IN 2004: 53
STREET VALUE: £9.99 a tin of paint
DANGER RATING: 1.35/3

13: 4-MTA (Class A)
ORIGIN: Amphetamine derivative; similar effects to ecstasy
MEDICAL: Amphetamine derivative, similar to ecstasy, and also known as ‘flatliners’. Popular dance drug, producing feelings of euphoria
NO. OF UK USERS: Unknown
NO. OF UK DEATHS IN 2004: N/A
STREET VALUE: Unknown
DANGER RATING: 1.30/3

14: LSD (Class A)
ORIGIN: Hallucinogenic, synthetic drug more popular in 1960s
MEDICAL: Man-made drug that has a strong effect on perception. Effects include hallucinations and loss of sense of time. A ‘bad trip’ can cause anxiety
NO. OF UK USERS: 70,000
NO. OF UK DEATHS IN 2004: N/A
STREET VALUE: £1-5 a tab
DANGER RATING: 1.25/3

15: Methylphenidate (Class B)
ORIGIN: Medicine, similar to amphetamines
MEDICAL: The chemical name for Ritalin, the stimulant drug used to treat children with attention deficit hyperactive disorder which helps them concentrate
NO. OF UK USERS: Unknown
NO. OF UK DEATHS IN 2004: N/A
STREET VALUE: Unknown
DANGER RATING: 1.20/3

16: Anabolic Steroids (Class C)
ORIGIN: Hormones used by bodybuilders and sportsmen
MEDICAL: Synthetic drugs that have a similar effect to hormones such as testosterone. Used by body builders to increase muscle bulk
NO. OF UK USERS: 38,000
NO. OF UK DEATHS IN 2004: N/A
STREET VALUE: £7.99 a tablet
DANGER RATING: 1.15/3

17: GHB (Class C)
ORIGIN: Synthetic drug, sold as ‘liquid ecstasy’
MEDICAL: The date rape drug, Gammahydroxybutyrate, is a sedative that has a relaxing effect, reducing inhibitions, but can lead to stiff muscles and fits
NO. OF UK USERS: Not many
NO. OF UK DEATHS IN 2004: 3
STREET VALUE: £15 a bottle
DANGER RATING: 1.10/3

18: Ecstasy (Class A)
ORIGIN: Synthetic drug in tablets; popular in dance scene
MEDICAL: MDMA or similar man-made chemicals. Causes adrenaline rushes and feelings of wellbeing but also anxiety and high body temperature
NO. OF UK USERS: 800,000
NO. OF UK DEATHS IN 2004: 33
STREET VALUE: £1-5 a pill
DANGER RATING: 1.05/3

19: Alkyl Nitrites (Legal)
ORIGIN: Liquid, better known as ‘poppers’; inhaled
MEDICAL: Gives a strong, joyous rush and a burst of energy for a few minutes which quickly fades and can leave a powerful headache
NO. OF UK USERS: 550,000
NO. OF UK DEATHS IN 2004: N/A
STREET VALUE: £2-6 for 10ml
DANGER RATING: 0.95/3

20: Khat (Legal)
ORIGIN: Green-leaf shrub grown in region of Southern Africa
MEDICAL: Natural stimulant, its leaves are chewed to produce a feeling of wellbeing and happiness. Popular with the Somali community
NO. OF UK USERS: 40,000
NO. OF UK DEATHS IN 2004: Not many
STREET VALUE: £4 a bunch
DANGER RATING: 0.80/3

http://news.independent.co.uk/uk/health_medical/article1207619.ece

For more information please see the two Health Direct postings below:

Monday, July 31, 2006 MPs demand changes to the classification of illegal drugs The ABC system of classifying illegal drugs should be replaced with a more scientifically based scale of harm. In a scathing report entitled Drug Classification: Making a Hash of It?, the Commons science and technology committee says there is no consistency in the way drugs are classified A, B or C and no evidence to support the official view that the classification has a deterrent effect.

Tuesday, August 01, 2006 Drug classes have little link to the dangers the Home Office has now been warned by its own senior advisers that alcohol and tobacco are more harmful to the nation’s health than the Class A drugs LSD and ecstasy.

Britain’s antiquated drugs laws stand accused of failing millions of people because they bear little or no relationship to the harm caused by everything from a hit of heroin to a seemingly harmless pint of lager.

Research by medical experts, who analysed 20 substances for their addictive qualities, social harm and physical damage, produced strikingly different results from the Government’s drug classification system.

Heroin and cocaine, both Class A drugs, topped the league table of harm, but alcohol was ranked fifth, ahead of prescription tranquillisers and amphetamines.

Tobacco was placed ninth, ahead of cannabis, which has recently been downgraded from a Class B to Class C drug, at 11th.

Alcohol and tobacco, and solvents, which can also be bought legally, were judged more damaging than LSD (14th) and ecstasy (18th).

The warning on alcohol comes amid growing alarm among ministers over a surge of “binge drinking” over the last decade. They fear it is fuelling rising levels of violent crime and creating long-term health problems for the nation.

Methadone, used to wean heroin addicts off the drug, also scored highly, being judged more dangerous other Class A substances.

The research will put more pressure on the Home Office to a rethink the 35-year-old system for classifying illegal drugs as Class A, B or C substances. It reflects the penalties for possessing them or dealing in them, but that means heroin is categorised alongside drugs such as ecstasy.

The analysis was carried out by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council. Copies of the report have been submitted to the Home Office, which has failed to act on the conclusions.

Professor Blakemore told the BBC Radio 4 Today programme: “Alcohol, on our classification, is the fifth most harmful drug – more harmful than LSD and by a long way than ecstasy and cannabis and a whole range of illegal drugs.

“That’s not to say there’s any argument that alcohol should be made illegal, but it does give one a feel for the relative harm potential from any drug.”

Strongly influenced by the research, MPs on the Commons science and technology select committee demanded an overhaul of the system to give the public a “better sense of the relative harms involved”.

They called for a new scale to be introduced, rating substances on the basis of health and social risks and not linked to legality or potential punishments.

They questioned whether ecstasy and magic mushrooms should remain in Class A and called on the Government’s drug adviser, the Advisory Council on the Misuse of Drugs (ACMD), to look at the issue.

Phil Willis, who chairs the committee, said the current classifications were “riddled with anomalies” and were “clearly not fit for purpose”. This research shows why we need a radical overhaul of the current law and a radical review of the classification system,” he said.

“It’s clearly not fit for purpose in the 21st century, neither for informing drug-users or providing public information.”

One committee member, the Liberal Democrat MP Evan Harris, said that putting drugs in the wrong category “undermined the whole system”. “Lots of young people know that there’s a difference between ecstasy and heroin,” he said.

Martin Barnes, chief executive of the drugs charity DrugScope, said: “With ecstasy, although it is a harmful substance and has led to deaths, if you look at its harmfulness with other Class A drugs, it is much less harmful in terms of links to criminality, mortality and poor health.

“But one of the difficulties, if the classification of a drug is changed, is that that then becomes a key issue in terms of politically how it is received.”

Cannabis was reclassified from Class B to Class C in 2004 on the advice of the ACMD. The move prompted fierce criticism in some quarters and was later reassessed in light of new scientific data.

Critics said the change sent out a message that cannabis was not harmful, and downgrading it had caused confusion over whether the drug was still banned.

But in January, the then Home Secretary Charles Clarke announced that after an ACMD review of evidence, the decision to downgrade cannabis would stand. His successor, John Reid, has so far made no pronouncements on drugs policy.

Lord Victor Adebowale, chief executive of the social care organisation Turning Point, said: “Our work across the country with people affected by drugs and alcohol tells us that a classification system should take into account the health, social and economic costs of substance misuse.”

Reforming the laws

More than a third of people claim to have taken illegal drugs during their lifetime, and 10 per cent say they have done so in the last year. Efforts to restrict drug use have failed to curb high rates of consumption in the UK. Though use of heroin and crack cocaine is comparable to other countries, use of recreational drugs is higher.

Britain had a relatively liberal approach to drugs in the 1960s, with heroin prescribed to addicts. The 1971 Misuse of Drugs Act introduced “ABC” classification: Class A drugs such as heroin carry the highest penalties, with lesser penalties for class B and C drugs.

But evidence has shown policies based on enforcement alone have failed. In 2002, the Home Affairs Select Committee, which included the future Tory leader, David Cameron, said this was the “single lesson” that had come from the previous 30 years. It backed a proposal by David Blunkett, former Home Secretary, to downgrade cannabis to class C.

A trial relaxation of the laws on cannabis went ahead in Lambeth, south London, where police guidance was changed from arresting and charging people for possession of small amounts of cannabis, to focusing on dealers. The experiment was extended nationwide with the reclassification of cannabis in 2004. The Government is now considering a proposal for a new lower threshold for a presumption of supply, which sources suggest could be 5g of cannabis and 5 tablets of ecstasy. The proposal has been criticised by the Advisory Council on the Misuse of Drugs as a retrograde step that will lead to more police time being spent on users rather than dealers.

http://news.independent.co.uk/uk/health_medical/article1207620.ece

The list of the top 20 drugs as researched by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council will be carried on tomorrow’s posting.