The annual State of Healthcare report draws on data from surveys, focus groups and inspections.

“It’s frustrating that in 2006 we do not have a clearer idea of how many people die or are harmed when this could have been avoided” Sir Ian Kennedy, of the Healthcare Commission. To illustrate his point, he said the National Audit Office could only estimate the number of deaths as a result of patient safety incidents ranged from 840 to 34,000.

It said attention had to be focussed on four areas: safety; designing services around patients; reducing inequalities in health; and tackling services for people with mental health problems, learning disabilities, older people and children.

Healthcare Commission Chairman Sir Ian Kennedy said: “There are real improvements to applaud and celebrate. These are having a genuine impact on people’s lives with many waiting less time for care and experiencing better treatment.”

The report revealed in the NHS, one in 10 trusts could not confirm that they fully met core standards on safety.

In the independent sector, one in 10 providers were ordered to improve the management of risks last year.

And the Healthcare Commission said 22% of the complaints it handles related to safety. Safety includes areas such as infection control and drug administration.

The report also marks the first publication of an overview of standards in the independent sector in England, which includes both private and voluntary providers.

Some 50% of providers met all 32 minimum standards, but one in 10 failed five or more – broadly in-line with NHS organisations.

Jo Webber, deputy director of policy at the NHS Confederation, said some things were improving with many trusts now actively encouraging their staff to report incidents.

“Communication to staff and patients is key here, but can often be a challenge in large and complex organisations.”

And shadow health secretary Andrew Lansley added: “It is a shame that this willingness to improve patient safety is not shared by the Department of Health.

“In December 2003, the Chief Medical Officer ordered a national audit of deaths caused by hospital-acquired infections. We are still waiting for it to be published.”

More information on this story can be found at: http://news.bbc.co.uk/1/hi/health/6098750.stm

The National Audit Office’s range of patient safety incidents estimates between 840 to 34,000 errs on the side of caution.

Health Direct warned on March 08, 2005 that 25,000 patients die from preventable VTE, when each year over 25,000 people in England die from venous thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than twenty-five times the number who die from MRSA. The figures are alarmingly high.

An aside from the Sir Liam Donaldson’s report last year was that July 20, 2005 Chief Medical Officer’s Annual Report was that the rate of MRSA infection is higher in this country than many other European countries and that Tuberculosis (TB) is another infectious disease that is re-emerging and work is under way to implement an action plan which he published in October 2004.

Ms Eve-Jones said that healthcare resource groups, the standard treatment groupings used as units of currency within the health service, ‘are not designed to support payment systems and we are using them to support PbR’.

She painted a bleak picture of NHS data accuracy, blaming poor training and support for coders, Department of Health tariffs that have ‘no bearing on the real service’, and pressure to ‘upcode’ to generate more cash.

‘Some coders are asked by clinicians “which code will give me a better HRG?”, or you see directors of finance wandering around saying “we need more codes”. I am pleased to say that most coders are immune to this.’

And Ms Eve-Jones concluded that the NHS payments system ‘scares me witless’. ‘It’s like going into Tesco, filling up your basket, and getting charged different prices depending on which checkout you go to.’

Health Direct has long warned that Payment by Results was doomed to be an expensive failure since April 01, 2005 Payment by Results- political pressure is undermining new PbR finance reforms

If you allow a whole load of unbundling – where you pay for little bits of the healthcare resource from up here and there – you destroy the principles, don’t achieve the benefits, and end up with locally based recovery systems, which is back to where we started with this reform.

Earlier this year the HSJ analysed the crazy conflict that Labour has created between PbR and the PFI schemes: June 10, 2006- NHS trusts feel the impact as PFI and Payment by Results collide “Imagine buying a house for a family with four children. Over the next few years you know you will need a lot of space to accommodate noisy teenagers. But in 10 years’ time your needs are not so clear cut: children may leave, elderly relatives may come to stay or you may be on your own.

Your income is also uncertain and not under your control: your boss has just refused a pay rise to reflect your high accommodation costs and says you can have the same as everyone else.”

Sir John warned that “flouting of NHS hygiene was as bad as drink-driving’” and twice as deadly. Doctors and nurses who fail to wash their hands although they know it reduces hospital infections are as bad as drunk drivers, the NHS adviser warned yesterday.

The Health Direct Blog started over three years ago at the beginning of October 2004 when I became worried about the scandalous rise of MRSA in the NHS system. Which is a totally preventable and avoidable infection.

October 07, 2004 Twice as many people die of superbugs in dirty hospitals than die on British roads- The labour government seems to be surprisingly reticent in publicising the fact that twice as many people die in the UK from picking up lethal “superbugs” in dirty hospitals as die on the country’s roads.

Now three years later after the latest outbreak of a “superbug” in three hospitals in Leicester, despite NHS efforts to eradicate them, hospital- acquired infections are not going to go away.

At least 49 – possibly as many as 78 – patients were killed by the bacterium Clostridium difficile (C difficile) in Leicester and it is thought that it killed at least 20 patients at hospitals in Kent earlier this year.

Judy Potter, who chairs the Infection Control Nurses Association (Icna) said “In the last year or so we have seen a more virulent strain of C difficile that seems to cause the more severe symptoms. Antibiotics often cause the balance of friendly bacteria in the bowel to be reduced, predisposing patients to Clostridium difficile infection.”

Until now, MRSA (methicillin resistant Staphylococcus aureus) was considered the biggest superbug danger in hospitals – instances have risen by 600% in the past decade and it was cited on 1,623 death certificates in 2004 as the contributing or underlying cause of death.

However, C difficile is now thought to be a greater danger. In 1999, it was mentioned on 975 death certificates; in 2004, that had risen to 2,247, though not all these infections would have been picked up in hospital.

Experts say that hands should be thoroughly washed with soap and water, surfaces should be washed with bleach and wards steam-cleaned.

Hospitals should also find space to set up isolation wards for those affected. “There are some general measures that are recommended to protect patients against infection generally when coming into hospital,” says Potter. “They are mainly about common sense and good hygiene.”

More information on MRSA and C difficile infections can be found at:
http://www.guardian.co.uk/g2/story/0,,1887742,00.html
http://www.guardian.co.uk/uk_news/story/0,,1931589,00.html

The figure has astonished MPs and consultants who fear NHS funds are being spent on trivial surgery while patients are denied potentially life-saving drugs and staff are laid off.

Even conservative estimates of the cost of removing a small tattoo under anaesthetic on the NHS put the bill for 2004-05 at £37m, but some consultants suggested a figure of £300m.

Steve Webb, the Liberal Democrat health spokesman, said: “In a week when we’ve seen the NHS turning down Velcade (a cancer drug) it seems incredible that so much is being spent on tattoo removal.”

Tattoos were once seen as a rebellious statement and the preserve of criminals, bikers and sailors, but they have become increasingly mainstream adornments. According to research carried out by the Discovery Channel earlier this year, 29% of Britons aged 25-34 have tattoos.

They are popular among celebrities. David Beckham, the former England football captain, has tattoos bearing the names of his three children, while Robbie Williams, the pop singer, has a Maori pattern on his left arm, a Celtic cross on his right hip, a lion on his shoulder and his grandfather’s name on his arm.

Eight years ago there were 300 tattoo parlours in Britain; today there are more than 1,500.

Because tattoos penetrate under the skin, removing them is expensive. The tattooed area must be cut out and skin grafted over the gap. Removing tattoos with skin grafts in the private sector can cost £1,000-£2,500. Laser surgery costs from a minimum £200 to more than £2,500.

While having tattoos removed for “beautification” on the NHS is banned, surgery may be undertaken to “secure mental health wellbeing”. Earlier this year a health trust in Manchester agreed to spend £2,500 removing the tattoos of Tanya Bainbridge, a 57-year-old transsexual. The former merchant seaman, previously called Brian, claimed the large tattoos on her forearms were “not ladylike” and made her depressed.

For more information on expensive tattoos:
http://www.timesonline.co.uk/article/0,,2087-2415981.html

Coming on top of Monday’s Health Direct blog posting: Labour blamed for £2.2 bn wasted by NHS every year when the National Health Service is wasting at least £2 billion a year, more than four times the record deficit reported in 2005-06, it is no wonder that only 14% of voters think the money invested in the NHS since 1997 has been well spent, against 72% who agree that “a lot” has been used badly: Labour support at lowest level since Thatcher’s last election victory in new ICM poll October 25, 2006.

The party’s support has fallen 3 points since last month, despite Labour’s successful annual conference in Manchester and a lack of public conflict over the succession to Tony Blair. The Conservatives have climbed three points, to 39%, with the Liberal Democrats unchanged on 22%.

Support for minor parties, growing in recent months, has dropped back 1 point to 9%. The Green party and the UK Independence party score 2% each.

The poll, carried out last weekend, follows David Cameron’s attack on NHS cuts as well as the publication last week of a party report advocating tax cuts of £21bn.

The results suggest that campaigning on the NHS offers the Tories potential gains, with an overwhelming majority of voters believing that the record sums being spent on health by the government have largely being wasted.

Only 14% of voters think the money invested since 1997 has been well spent, against 72% who agree that “a lot” has been used badly. Even 58% of Labour voters think the extra money has been misspent.

As a result only 25% of voters think that the NHS has improved since Labour came to power in 1997, against 30% who think it has got worse and 39% who think Labour has made little difference.

On the one hand the NHS remains a cherished institution that voters trust to give them the best possible treatment when they fall sick. On the other, voters think that the service has got worse, not better, during Labour’s decade in power and that much of the government’s huge extra investment in healthcare has been wasted.

Labour has more than doubled health spending since 1997 to almost £90bn a year but seems to be gaining little political credit for its efforts.

However, most people remain proud of Britain’s standard of healthcare: 55% still think that the NHS is the envy of the world. People also trust it with their lives, with 60% agreeing that they would get excellent care if they were unwell. Only 30% think they would not.

Trust in the NHS is strong among voters of all parties, and especially among the people most likely to need healthcare, older and poorer voters, with 73% of over-65s confident that they will be well looked after.

True, voters are worried about catching infections such as MRSA in hospital, for instance, with only 35% sure that they will be safe from it if they have to be admitted. Most people, 51%, think they would be at risk.

But the public’s personal experience of using NHS services is none the less overwhelmingly positive: 71% of people say that their family and friends have had a good experience.

But as the government moves ahead with contentious reforms which could see closures of well-loved hospitals, the poll’s findings suggest Labour cannot take the NHS for granted as an electoral asset.

Meanwhile, most people would choose to opt out of the state system if they could afford it: 67%, say they would pay to go private if they had the money, including 61% of Labour voters.

Trust in the private sector is strong, too, when it comes to the NHS itself: 70% of all voters think that private companies should be allowed to care for NHS patients. That suggests there is backing for the government’s reform programme, which has seen private organisations invited to compete for NHS work.

Labour voters are even keener on this than the overall electorate, with 73% agreeing private firms should have a role in the NHS against only 22% who disagree.

The poll comes after other findings suggesting that Mr Cameron’s honeymoon with voters may be over. Data published in the Times on Monday from a small sample of 242 voters, gave Gordon Brown a lead among swing voters.

Even if today’s Guardian/ICM result were repeated at a general election, the Conservatives would only end up as the largest party in a hung parliament, or hold only a narrow majority, since Labour gains most from the distribution of parliamentary seats across the country.

· ICM Research interviewed a random sample of 1,019 adults aged 18+ by telephone on October 20-22. Interviews were conducted around the country and the results have been weighted to the profile of all adults. ICM is a member of the British Polling Council and abides by its rules.

The full ICM research article can be found at:
http://politics.guardian.co.uk/labour/story/0,,1930732,00.html

Health Direct has long warned against Labour’s NHS health spin eg April 11, 2005 Proof Bliar puts targets before patients when an investigation by The Telegraph laid bare how the health of hospital patients up and down the country is put at risk by direct Downing Street interference in the NHS and Labour’s obsession with targets.

Finally, it seems that voters in the real world are seeing through the lies and spin from Labour.

Thirty-four per cent of Tory and 37 per cent of Lib Dem seats in England and Wales have been affected by cuts that have been either announced or proposed. Only 14 per cent of Labour areas are affected. The cuts range from the closure of single wards to the axing of entire hospitals.

The findings follow news that Patricia Hewitt, the Health Secretary, commissioned “heat maps” to show the potential political effects of proposed hospital closures, and figures showing that seven times as many cottage hospitals have closed or are under threat in Opposition-held areas than in Labour ones.

In response, the Government has denied that it is “playing politics” with the health service.

However, the Sunday Telegraph’s findings, calculated by analysing hospital cuts that have been publicly announced or proposed, will re-ignite the debate about the handling of the Labour Government’s much-trumpeted NHS reform plans.

Last night, Andrew Lansley, the shadow health secretary, said: “It’s bad enough that there are nationwide cuts to frontline NHS services, but it adds insult to injury that Labour are manipulating cuts to save their own political skin. Patients and healthcare professionals must come first, but Labour can no longer be trusted to do this.

Steve Webb, the Lib Dems’ health spokesman, said: “The way the dice seem to fall is very suspicious. It would be outrageous if decisions about cuts and closures were manipulated for one party’s political advantage, but this, I believe, is what’s happening.”

Michael Summers, of the Patients’ Association, said: “If political considerations are driving the changes, it is completely unacceptable.”

A spokesman for Ms Hewitt said: “We’re shifting services to areas where the health needs are greatest, which are commonly in urban areas,” he said. “These happen to be mostly Labour seats. Decisions are driven by clinical needs. There is no political meddling.”

The full story including NHS cuts heatmaps can be found at:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/22/nhealth22.xml

Only last week (October 17, 06) Health Direct reported that Scandal of NHS cancelled operations that £150m a year was being wasted as the National Health Service is cancelling more than 620 operations every day because of administrative blunders, it has been claimed. Mistakes, like forgetting to book operating theatres, led to about 162,500 procedures being abandoned in 2005. The numbers also appear to have gone up by a quarter over the past three years, according to newly-released figures.

Prof Sir Liam Donaldson, the chief medical officer, said earlier this year that £21 million could be saved annually by reducing the number of needless tonsil operations and hysterectomies. But today’s figures indicate that the inefficiencies are deeper and much more widespread.

The information will empower primary care trusts, which foot the bill for patients’ care and treatment, to use the figures to try to rein in the money spent by hospital trusts. Trusts in financial trouble finished the end of the last year with gross deficits totalling more than £1 billion.

The Department of Health says that £975 million could be saved by ending the different lengths of time that patients spend in hospital. An acute hospital bed costs around £225 a day.

It says that one reason for the wide variations in the length of time is that too many patients cannot be discharged when they are ready because of lack of care when they get home or absence of “step down” care.

Another £510 million could be saved if patients were not admitted too soon for their operations. This alone would have almost wiped out the £512 million net deficit.

Some trusts admit very few patients, only about 10 per cent, on the day of their operation, carrying the cost of an additional overnight stay while, in others, as many as 60 per cent of patients are admitted on the day of surgery.

The analysis also found that £348 million could be saved if the number of emergency admissions was reduced. Better care by GPs can avoid crises for people with chronic conditions like angina or asthma and some hospital doctors are more inclined to admit patients than others.

Another £278 million would be saved by reducing the cost of referrals to hospital consultants. The figures show that referral rates by GPs can be higher in affluent areas.

The department says that £73 million would be saved by reducing unnecessary surgery for grommet operations for children, tonsillectomies, hysterectomies and dilation and curettage. Some of these conditions can now be treated with drugs and others by wait and see strategies.

Finally, £16 million could be saved if more hospitals provided more day surgery.

A total of 16 “performance indicators” have been sent to all NHS trusts which compare the activities and costs in the top 25 per cent, along with the middle rank and the worst performing trusts.

The idea is to show trusts where they are going wrong and how it is possible to improve.

Andy Burnham, the health minister said the information could “unlock” £2.2 billion for reinvestment in patient care and was not about “penny pinching or cutting corners”. “Productivity is about working smarter not harder, and improved efficiency will deliver both better patient care and better value to the taxpayer,” he added.

Mr Lansley said that Gordon Brown, the Chancellor, had promised investment with reform.
“But there’s been no real reform – only money pumped in,” he added. “These indicators are condemning proof of Labour’s failure. If Labour had maintained the productivity levels they inherited from the Conservatives, they would have cleared 1.4 million patients from waiting lists. “The reality is that since 1997, NHS productivity has fallen by one per cent every year.”

Mr Lansley said the Government had set up primary care trusts four years ago but, according to the Healthcare Commission, 90 per cent were “at best adequate”.

“The average length of hospital stay fell at least twice as fast pre-1997, as after. There are now over 100,000 more administrators in the NHS than in 1997 and nine out of ten PCTs are not using money efficiently.”

Examples of the differences in performance across the country include the Norfolk and Norwich University Hospital NHS Trust which could potentially save £6.1 million if it reduced lengths of stay.

The Hull and East Yorkshire Hospitals NHS Trust could save £11 million by the same method.

Using 100 as the level expected, Newham Primary Care Trust, in east London, had an out-patient appointment rate of 73.9 compared with Richmond and Twickenham, in south-west London, with a rate of 140.61.

In Milton Keynes, Bucks, the out-patient admission rate was 61.13 compared with Windsor, Ascot and Maidenhead, Berks, with a rate of 152.72.

The cost of statins, the drugs given to reduce cholesterol, varies from around £2 a day to £30 a day.

In North East Derbyshire PCT 84.35 per cent of statins prescribed were “low cost” compared with Bradford City Teaching PCT where the proportion of low cost statins prescribed was 36.11 per cent.

More information can be found at:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/23/nhs23.xml

The cuts are being forced by financial deficits and many of the affected hospitals are in Conservative constituencies.

In Surrey, which has to save £100 million across the county, MPs are already concerned over the possible downgrading or amalgamation of large district hospitals and have organised a meeting to consider joint action about the funding of the NHS in the county.

Residents have launched a Surrey-wide petition as well as a separate campaign to “save” the Royal Surrey County Hospital in Guildford, where local people fear services will be downgraded and the accident department may be lost.

Plans are awaited from Surrey Primary Care Trust but a rally is being held in Guildford on Saturday.

Anne Milton, MP for Guildford, said she did not expect to see plans until November or December. “I am appalled at the delays in the process because of the effects on staff. Morale is at rock bottom,” she said.

She said Surrey did not attract extra funding given to deprived areas. But it had a high proportion of elderly residents, who were the highest users of health services.

“There are deficits but I contend that we need to get our fair share in the first place. A significant proportion of tax revenue comes from Surrey. We get a lot of pain for that, it feels like very rough justice,” she said.

In Oxfordshire there is a well established campaign to maintain full children’s and childbirth services and emergency surgery out of hours at the Horton General Hospital in Banbury.

In Ludow, Shropshire, the fight is on to save two wards of the local hospital. Another battle has begun in Skegness, Lincs, to save two wards at a hospital which also deals with the effects of thousands of summer visitors. The campaigners fear that running down services will lead to later closures.

Yesterday Lord Warner, the health minister, launched 30 pilot projects in the drive towards an “NHS closer to home” which would see surgically trained GPs doing operations and out-patient clinics in local centres.

Ministers believe that half of the 45 million out patient appointments could be dealt with locally.

A spokesman for the Department of Health said: “We agree that losing successful community hospitals solely to solve short-term financial problems is not acceptable. Options for changing NHS services must be developed with local people and not for them.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/17/nhospital17.xml

Health Direct is pleased that there is recognition at the Dept of Health of the role that community hospitals can play in improving patients’ service and cutting costs, but since May 11, 06 in A record 6 NHS hospitals closures announced in one day in one county we have been questionning the lack of “joined up thinking” when massive cuts to health services across Gloucestershire saw 500 NHS job losses- many compulsory, community hospitals closed and maternity services moved to help balance a £38 million deficit.

The report concluded that the services were vital for thousands, but councils should rethink them and offer people more choice.

Dame Denise said: “It is critical that those who commission and provide home care services listen to what people say they want and value.

“Failure to listen to what people really need, and respond to this, results in missed opportunities to promote independence and to help people live full and rewarding lives. At worst, it can also result in services that do not respect people’s rights and dignity.”

She said as the numbers of older people grew, councils must reshape services to give people living at home “more personalised care”.

The CSCI also found that councils concentrated services on people with the most severe needs, meaning others who would benefit missed out.

The report said the number of people receiving council-funded home care fell from more than 500,000 homes in 1992 to 354,500 in 2005, despite a rise in the older population.

Inspectors also found the home care services were often beset with serious problems in recruiting, training and retaining quality staff.

Younger people were given little incentive to work in the care industry, with many finding better-paid jobs in their local supermarkets, the report said.

CSCI’s Chief Inspector Paul Snell said since it started regulating the sector three years ago, home care services had improved, but “fundamental change” was still needed.

“What we found in this report is that when we talk to older people about their experiences almost universally they are pleased with the care provided by their direct carer, but that the systems for delivering the care don’t always match up to the quality people want to see.”

He said carers could be rushed and could be numerous, citing one case where a woman had had five different carers in 10 days.

“There are problems of recruiting, retaining and training good quality staff,” he said.

Age Concern’s director general, Gordon Lishman, said care at home was often what older people wanted, but local authorities must “provide the levels of services needed”.

“At a time when the government is emphasising care services that enable older people to stay in their own homes, too many frail and vulnerable older people are being let down by under-pressure staff and over-stretched councils who are not providing the care they need,” he said.

He added that less intensive and preventative services that helped keep older people healthy and independent for longer were being withdrawn.

The full story can be found at:
http://news.bbc.co.uk/1/hi/uk/6061130.stm

Health Direct warned that the lack of real money on Feb 03, 2006 in Labour’s NHS pledge ‘needs more money’ if it will work when health campaigners and doctors insisted more money was needed if the Government was to succeed in meeting its ambitious pledges to improve NHS services in the community.

Health Direct also questioned the seriousness of the Minister wants Dignity debate for caring for the elderly (June 22, 2006) when the new care services minister Ivan Lewis has said he wanted to make dignity of older people one of his top priorities. Speaking at a session on the out of hospitals white paper, he said: ‘I want to make dignity an important theme in my time as a minister. ‘This is not a gimmick; just another initiative. It should be at the heart of what we are doing.

However that heart didn’t include a single new Pound of funding.

Conservative MP Grant Shapps highlighted the figures after using Freedom of Information laws to request data from all NHS trusts in England and Wales.

Estimates for the total number of cancellations were calculated on the basis of the 55 bodies that responded.

Mr Shapps said: “At a fairly conservative guess, this could be costing more than £150m a year.”

Cancellations had also been classed as administrative errors if they were caused by notes being lost or by miscommunication between hospital departments.

Mr Shapps said the problem was that trusts were being sent a “constant stream of diktats” from above, with too many fixed targets. They want to get people out of A&E; in time and things like this slip,” he added.

http://news.sky.com/skynews/article/0,,30000-13547191,00.html

Health Direct notes that it is a change to hear of NHS operations being cancelled through incompetence rather than through funding cutbacks: March 10, 2005 Great Ormond St hospital cancelled operations and wards when Great Ormond Street hospital has revealed they have had to cancel operations, close beds and close wards because of a funding crisis. The famous children’s hospital blamed a systemic financial crisis.

The Times has learnt that seven times as many community hospitals have closed or are under threat in constituencies held by opposition MPs. There are 62 closed or at-risk hospitals in Conservative constituencies and 8 in Liberal Democrats seats, with 11 in Labour areas.

This has prompted opposition MPs to accuse the Government of “playing politics” and undermining the hospital closure programme.

The revelation comes a month after The Times disclosed that ministers and Labour Party officials held meetings to work out ways of closing hospitals without jeopardising key marginal seats. Leaked e-mails showed that Patricia Hewitt, the Health Secretary, called for those at the meeting to be provided with “heat maps”, showing marginal Labour seats where closures or reconfigurations of health services could cost votes.

Health Direct also carried the story Labour targets NHS hospital cuts away from marginal constituencies on 15 Sept 06.

The Department of Health has consistently denied that political considerations reflect policy-making.

But research carried out by the Community Hospitals Association reveals that of the ten community hospitals that have already closed this year five fall in Conservative-held seats while four are in Liberal Democrat areas.

The Department for Health said that it was committed to community hospitals, which are often found in more rural areas. Ms Hewitt recently promised a £750 million cash injection to community health services declaring: “Community hospitals have for too long been viewed as the poor relation of larger hospitals. This stops today.”

However, a spokesman for the department said that some community hospitals could not cope with the challenge of the modern NHS and would close. The spokesman insisted that ministers had no ability to chose directly which hospitals closed and which stayed open.

A statement from the department in February said that “hit squads” of inspectors would be dispatched to meet the heads of strategic health authorities, and reject any plans for community hospital closures from primary care trusts if they could not show that they had considered all other options, including other companies taking over the hospitals.

However, opposition MPs are suspicious of the move. Andrew Lansley, the Conservative health spokesman, said: “Last month we discovered that ministers are more concerned with saving the political skins of Labour MPs than they are with pursuing the long-term interests of the health service.”

Steve Webb, the Liberal Democrat health spokesman, said: “There are too many times for coincidence that the process is favouring Labour seats and Labour MPs. That undermines the whole process. If you go through consultations with a sneaking suspicion that the Labour seat is going to get the hospital anyway, it destroys your faith in these consultations.

“Nobody would argue that a particular set of buildings should be set in stone for ever. Health needs change, population change, so buildings and services should change. The key is that the decision should be clinically based; what delivers the best care.”

The ful story can be found at:
http://www.timesonline.co.uk/article/0,,2-2405932,00.html

Neither project features in the data released yesterday, which include only those that come under the control of the Treasury or one of its agencies.

“With the Treasury, who are allegedly the guardian of government efficiency programmes, finding it so difficult to keep IT projects on schedule, it would be utter madness to go ahead with further large IT projects such as ID cards,” said Vincent Cable, Treasury spokesman for the Lib Dems.

The Conservatives also rounded on the government, arguing that the statistics demonstrated a failure of the efficiency drive heralded by Sir Peter Gershon’s 2004 review of Whitehall.

Theresa Villiers, shadow chief secretary to theTreasury, said: “All that hype about Gershon and efficiency rings hollow when the real facts come out about dismal IT failures like this.”

None of the Treasury schemes are on the scale of the NHS or ID card projects. Four of them are estimated to cost more than£100m, including the setting up of the Child Trust Fund scheme.

Most, however, are much smaller: a drive to comply with a new British information security standard is three years behind schedule but is estimated to cost only £2,000.

For more information, please see:
http://www.ft.com/cms/s/6c10c7be-5a57-11db-8f16-0000779e2340.html

Health Direct has long warned about Labour’s failures in developing IT projects- on March 03, 2005 in Ten government IT projects hit ‘red light’ status we warned that Whitehall has revealed some details of its 10 most ‘at-risk’ IT projects, following a Freedom of Information request. The Office of Government Commerce (OGC) has released details of IT projects found to be most at risk across Whitehall, but is keeping the projects’ identities secret.

Health inspectors demanded urgent action to remedy failings at 50 NHS trusts across England that scored the worst marks in a new tougher system of measuring the quality of patient care. The Healthcare Commission confirmed a report in the Guardian yesterday that it has graded nearly half the country’s hospitals and other healthcare organisations as “weak” in the NHS’s first annual health check published today.

It placed 236 of the 570 trusts in the lowest category, rating some as weak for poor stewardship of resources and others for inadequate control of the quality of patient care. Eight hospitals, four ambulance services, one mental health trust and 11 primary care trusts (PCTs) achieved the unenviable distinction of being weak on both counts.

Anna Walker, the commission’s chief executive, said urgent steps were needed to improve performance in 50 trusts with the lowest quality of patient care. Their defects included failure to ensure proper decontamination of medical equipment, lack of staff training and poor management of patient records.

She said strategic health authorities would ask the trusts to produce action plans within 30 days on how to come up to minimum standards. They would also look into the performance of 290 trusts whose quality was deemed to be no better than “fair”.

Ms Walker said: “Poorer performance is in areas that really matter to patients. A significant number of PCTs are failing to provide out-of-hours crisis care. MRSA [the hospital superbug] targets still need vigorous action. And trusts report not meeting standards on compulsory training and use of medical equipment.”

Sir Ian Kennedy, the commission chairman, said the new system was largely based on trusts owning up to poor performance, although the commission ran checks to ensure honesty. About 43% of trusts should be praised for admitting shortcomings and starting on “a journey of improvement”.

He added: “Patients will want the NHS to raise its game still further. They need a universal guarantee that trusts are meeting general standards … We expect these standards will be met next year.”

The report gave top marks to only two trusts, both foundation hospitals with independence from Whitehall control. Harrogate and the Royal Marsden, a specialist cancer hospital in London, got an “excellent/excellent” rating in recognition of their high performance on finance and quality.

Sue Slipman, director of the foundation trust network, said the results showed its members were “way ahead of the game”, with 87% graded as good or excellent on use of resources. However, Moorfields foundation hospital, the country’s premier ophthalmic centre, was ranked as weak on quality of care.

Among all types of trusts, 36% scored good on quality of services and 4% were excellent. Just 12% were found to be good at managing their finances and 3% were excellent.

Sources at the Department of Health said the commission may have been unduly harsh in its interpretation of financial data provided by the Audit Commission. It was understood that ministers asked the commission to explain why the scores of 50 PCTs were improved a few hours before publication. Without this late adjustment, more than 30 trusts would have got a weak/weak rating.

Andrew Lansley, the Tory health spokesman, said: “It is a pretty sorry state of affairs when nine out of 10 PCTs have been rated only weak or fair. Even with an increase in resources, the government’s policy of using PCTs to manage NHS resources is failing. The healthcheck is at least a dramatic improvement on the discredited star ratings used by ministers over previous years. These results serve to show the weakness of the management by ministers themselves.”

Niall Dickson, chief executive of the King’s Fund health research institute, questioned the reliability of trusts’ self-assessments. “We are concerned that many across the country overestimated their levels and had their standards revised by the commission,” he said.

Gordon Lishman, director general of Age Concern England, said: “The performance assessment ratings largely bypass patients’ views and are the equivalent of asking students to mark their own exam papers.”

The scores for every NHS trust are available on the Healthcare Commission’s website at:
http://annualhealthcheckratings.healthcarecommission.org.uk/annualhealthcheckratings/nationalresults.cfm

For more information please see: http://www.guardian.co.uk/medicine/story/0,,1920170,00.html

The National Institute for Health and Clinical Excellence said donepezil, rivastigmine and galantamine could be used to treat moderate stage disease, but will not be available to early stage sufferers of Alzheimers.Campaigners had argued patients in the early stages of Alzheimer’s should also have access to the £2.50-per-day drugs.

Drug ‘improved our lives’

NICE has also ruled another drug, memantine, should be used only in clinical studies for people with moderately severe to severe Alzheimer’s disease.

Eisai and Pfizer, who produce donepezil, also known as Aricept, said they were considering whether to seek a judicial review of the decision.

Around 750,000 people in the UK are estimated to have dementia, but only 78,000 patients take donepezil, rivastigmine and galantamine, with two thirds of those taking donepezil.

Restrictions

NICE guidance in 2001 recommended the drugs, which can make it easier to carry out everyday tasks, should be used as standard. Galantamine is also known as Reminyl, rivastigmine as Exelon and memantine as Ebixa.

But in July 2005, NICE said access to the drugs should be restricted because they were not good value for money. It has now issued its final guidance, which will apply only to newly diagnosed patients.

Andrew Dillon, chief executive of NICE, said: “Alzheimer’s is a cruel and devastating illness and we realise that today’s announcement will be disappointing to people with Alzheimer’s and those who treat and care for them.”

‘Fundamental flaws’

Action on Alzheimer’s, an alliance of more than 30 professional and patient organisations, reacted angrily to NICE’s ruling. “The decision will force patients to wait until their condition deteriorates into a state of fear and confusion before receiving drugs that work.”

“There is evidence that these drugs work at all stages of the disease, but NICE proposes to restrict their use on grounds of cost.”

Neil Hunt, chief executive of the Alzheimer’s Society, added: “This blatant cost-cutting will rob people of priceless time early in the disease and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke.”

He said there had been “fundamental flaws” in NICE’s appraisal process, and called on the government to step in.

Help the Aged said one in five people over 80 were affected by dementia and the number of people living with the disease was set to double in a decade.

Jonathan Ellis, senior policy manager at the charity, added: “It cannot be right to allow the health of thousands of older people to deteriorate on the altar of cost.

“On the one hand, the government says it is committed to improving care for older people, while on the other NICE is blocking access to treatment which would help them retain their independence and dignity. This is botched policy making at its worst.”

For more on this story please read:
http://news.bbc.co.uk/1/hi/health/6036519.stm

Health Direct have been warning about NICE and it’s profit orientated approach to approving drugs for a long time. Please also read: Nice blight bypass for drugs runs out of money 7 Nov 05- A fast- track scheme to provide drugs on NHS runs into a funding row. Health ministers have approved a fast-track system to decide which new drugs the National Health Service should provide, but have found themselves locked in a row over funding.

Since 1998, 1.2 million people have stopped smoking but Yorkshire and Humber, the North West and the North East regions have higher-than- average death rates from smoking-related diseases.

The Health Profile is aimed at helping areas measure their progress in tackling health inequalities and seek help from those performing better.

It also measures the Labour Government’s progress in tackling health issues since it launched a new campaign in 2004 and set out the “next steps for action”.

The unfortunate label of fat man of Europe is another label that Labour have also achieved to go with The sick heart of europe – when Health Direct reported on May 15, 2006 that Heart disease, the most preventable health threat facing Britain today, is costing the economy £29bn a year. Rising rates of obesity, an ageing population and the soaring prescription bills for heart drugs such as statins mean that the bill is likely to rise in the future.

Further news can be found at:
http://www.channel4.com/news/content/news-storypage.jsp?id=20595265
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/10/uhealth.xml

As more parents have been forced to pay for their children’s treatment, dental practices and health insurers have brought out special children’s policies to cover dental charges.

Derek Watson, chief executive of the Dental Practitioners Association, said: “Primary care trusts will say that, where children have been deregistered, other dentists who want to do more NHS work will be found for these children but, in practice, there are few dentists who want to do more NHS work.”

Thousands of dentists left the NHS at the end of March because they were unhappy with the new pay deal offered by the Department of Health. At that time, thousands of children were dropped by dentists who previously offered NHS care.

Health Direct warned on April 01, 2006 in D Day for Dentists- 1,000 dentists expected to quit NHS in contract row that an exodus of about 1,000 dentists from the NHS in England was predicted by the chief executives of primary care trusts, who take over untried and untested management of the service from today. The NHS Confederation provided the first hard evidence of how patients will be affected by a dentists’ contract that came into effect at midnight.

Last week, a Sunday Times survey found that in Warrington only 31% of children get regular dental treatment, in Luton only 43% of under-18s got regular care.

In the West Berkshire area more than 3,500 children have been dropped from NHS lists, while in Croydon it is more than 2,100, in Bromley 2,000 and in Sheffield 1,500. Across England just 45% of adults and 64% of children get regular treatment.

A recent study found that the proportion of 11-year-olds with tooth decay being treated has fallen by six percentage points in the past four years to only 42%, which researchers call a “disturbingly low” proportion.

Dentists believe access to the NHS will worsen because of government reforms to the way they are paid. A survey of local dental committees, carried out by the British Dental Association, showed 90% predict access to NHS dentistry will worsen.

The new system pays dentists a fixed rate for a series of treatments. Some dentists argue that the fees are too low to pay for high quality care.

NHS dentists who own their own practices earned an average of £105,300 last year, official figures show. But less than half of their gross income came from work carried out on the NHS, with 52% coming from private work.

“Children will be more likely to get good preventative treatment in the private sector such as fluoride treatment and sealing of fissures against decay because the dentists will have more time,” said Watson.

The full article can be found at:
http://www.timesonline.co.uk/article/0,,2087-2393937.html

A study involving 716 people in the New England Journal of Medicine found it slowed vision loss in 90% of patients, and improved vision for about a third. The drug has yet to be granted a European licence.

The Macular Disease Society said it was vital Lucentis was granted a Europe-wide licence and treatment was funded by the NHS as soon as possible. “It is a treatment that is effective within the first few weeks of onset of Wet AMD. If funding by primary care trusts is delayed until Nice complete their review then thousands of people could lose their sight irreversibly.”

Lucentis (ranibizumab), which is used to treat wet age-related macular degeneration (wet AMD), will be appraised by the National Institute for Health and Clinical Excellence (Nice).
However, it has already been approved for use in the US.

The drug, one of a class known as anti-angiogenics, prevents the formation of abnormal, new blood vessels in the eye, and dries up vessels which have already begun to leak.

Eye tests

The 716 patients who took part in the study were given eye chart tests before and after receiving the drug, or a placebo.

Stude Findings

After two years patients taking 0.3mg of Lucentis were able to read on average 5.4 more letters on the sight chart. Patients taking 0.5mg were able to read 6.6 more letters. Patients given a placebo drug were able to read 14.9 fewer letters

Overall, nine out of 10 of those given the drug lost fewer than 15 of the letters on the chart two years after starting treatment. This compared with five out of 10 of the patients given a placebo.

A quarter (26%) of those receiving 0.3mg of the drug and 33% of those receiving 0.5mg also experienced improvements in their sight, compared with 4% on the placebo.

This meant they could read an additional three lines or 15 or more letters on an eye chart after a course of treatments.

Another drug, Macugen, and photodynamic therapy can halt the advance of AMD.

And there is preliminary evidence that Avastin, a drug used to treat cancer, may also potentially restore vision in a way similar to Lucentis, but at a cheaper cost.

Steve Winyard, of the Royal National Institute for the Blind (RNIB), said the results were “very exciting”.

He added: “Thousands of people a year in the UK get wet AMD and it rapidly leads to sight loss. This drug is particularly exciting because it can treat all types of AMD. Although this is not a cure, ranibizumab is great news for individual patients as it offers them the chance of having their vision restored.”

Widespread problem

Wet AMD is the leading cause of blindness in the UK, with thousands of new cases every year.

About 20,000 people in the UK are estimated to suffer from wet AMD, while up to 500,000 suffer from both the wet and dry forms of the condition.

AMD affects the macular – the central part of the retina at the back of the eye that is responsible for the central vision necessary for everyday activities like reading, driving, telling the time or identifying faces.

Winfried Amoaku, a consultant ophthalmologist and member of the Royal College of Ophthalmologists’ scientific committee, said: “This study on Lucentis is the first to show vision improvement in patients with wet AMD.

“Previous studies have demonstrated that other treatments can help maintain vision.”

However, he said there was no data directly comparing Lucentis to other similar treatments.

For more news on AMD and the Macular Disease Society, please see:
http://news.bbc.co.uk/1/hi/health/5405272.stm

http://www.maculardisease.org/show_news.asp?section=00040003&id;=241&date;=2006/10/05

Now building on his lead according to today’s FT David Cameron will next week challenge Gordon Brown to prove his modernising credentials by calling on him to back a Conservative proposal that would finally embed the healthcare market initiated by Tony Blair.

Mr Cameron will seek to turn the spotlight on the chancellor’s commitment to radical reform as parliament returns from the long summer break by urging the government to support Conservative plans for an “independence bill” for the National Health Service.

Under Mr Cameron’s proposal, a statutorily independent board would be responsible for commissioning care for NHS patients. A separate economic regulator would oversee competition between NHS hospitals, foundation trusts and the independent sector. And a third body would undertake resource allocation, ensuring ministers could not manipulate it for political ends.

Mr Cameron will claim the bill represents a coherent way to give the NHS greater independence at a time when the government itself is divided over Mr Brown’s proposal for an NHS board, and when details of the chancellor’s proposals are still skeletal.

The package would cement the separation between commissioning and supply of services, and the greater involvement of the private and voluntary sectors, towards which the NHS is heading.

It would put the seal on Mr Blair’s NHS reform programme, which the Conservatives would offer to support in the teeth of backbench Labour opposition and any reservations the chancellor may have – just as they did with the schools bill earlier this year.

In the longer run, the Conservatives hope it would remove the NHS as an election issue. Mr Cameron has already pledged that under the Conservatives, the NHS would remain tax-funded and free at the point of use, with treatment based on need not ability to pay.

The Tories calculate that if Mr Brown, as Labour’s heir presumptive, backs their “independence bill”, it would be hard for him to accuse them of dismantling the NHS at the election.

If he declines – or supports a version that does not set in place the purchaser/provider divide – it would allow them to portray Mr Brown as “the road block to reform” since government policy is already heading in that direction.

Andrew Lansley, shadow health spokesman, said on BBC radio yesterday the Tories had said repeatedly they wanted “to take the politics and politicians out of day-to-day management of the NHS”. He added: “If Gordon Brown agrees with us, to that extent it is great,” but he doubted the chancellor wanted genuinely to abandon government targets to make the NHS independent.

In the absence of any detail, the chancellor’s proposal for an NHS board has split Labour MPs. Some Blairites believe that implementing such a change now would halt reform as the service would not take the purchaser/provider split to the next stage without ministerial direction. Some Brownites hope that it would indeed slow up, or halt, the marketisation of services.

Mr Brown himself has not made his intention clear.

The full report can be found at:
http://www.ft.com/cms/s/717252ee-540e-11db-8a2a-0000779e2340.html

Mr Cayton, the national director for patients and the public, said of the term frequent flyers: “It implies that somehow these people want regular trips to hospital, that they are collecting points, that they enjoy the health and life-threatening roundabout of continual admission, treatment and discharge.”

Other phrases, such as bed-blockers, shifted the blame from the NHS to the patient, and further examples of labels included referring to those who do not turn up for appointments as “DNAs”. He also attacked the use of words like “dement” to describe somebody with Alzheimer’s disease.

He added: “Labelling people in this way is the most common way in which the NHS dehumanises those it is supposed to care for.”

He said most of the language was used to describe elderly people, possibly reflecting an ageist culture.

“Older people generally use the health service most often but they are also sometimes the least able to speak up for themselves, the most vulnerable.”

Mr Cayton said he understood that health workers needed to create distance due to the stresses of the job, but added they should find other ways of achieving that distance.

The full reviews can be found at:
http://news.bbc.co.uk/1/hi/health/5404248.stm
and
http://www.jrsm.org/cgi/content/full/99/10/484

But there are concerns that the rise in patient numbers has been driven in part by the “safety first” approach of staff at NHS Direct, the telephone advice line, and by the collapse of GP out-of-hours care. Prof Matthew Cooke, an A&E; consultant and former adviser to the DoH, calculated that there had been a 27 per cent increase in A&E; patients at the two Birmingham hospitals where he works and that 51 per cent of patients had conditions that could have been dealt with by a GP.

“One of the biggest increases is in the number of parents bringing in children with respiratory conditions— the most common problem seen by GPs in the out-of-hours period,” he said.

Emergency care specialists say drastic “reconfigurations” of A&E;, requiring people to accept that they cannot expect access to a full service unless they live in a large city or town with a teaching hospital, could prove disastrous and place intolerable pressure on the nurse-led minor injuries units which are left in their place.

Dr Martin Shalley, the president of the British Association of Accident and Emergency Medicine, said: “These figures are extremely high. The main reason is that the GP system has changed considerably. The general public do not see the GP as the place to get emergency care out of hours any more.”

Dr John Heyworth, an emergency care specialist at Southampton General Hospital, said: “Some areas are seeing an increase in demand upwards of 10 per cent per annum, with primary care services collapsing in the community, and the growing needs of an ageing population, which is not matched by an increase in resources.”

In May, a National Audit Office report said that nine out of 10 GPs had taken up the Government’s offer of opting out of out-of-hours care.

Last month, Patricia Hewitt, the Health Secretary, defended plans to “reconfigure” A&E; departments.

“These aren’t cuts,” she insisted. “This is a better service. For all the extra money, NHS productivity has remained almost unmoved. If we are to meet people’s rising expectations, the NHS needs to become not just a bit more efficient, but dramatically more efficient and effective.”

The full report can be found at:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/10/01/nhs101.xml

The story of Good Hope hospital in Birmingham – “No Hope” to its critics – is a chapter in the story of the modern health service.

It’s likely takeover by Heart of England, its city neighbour, dramatises the way the Labour government’s market driven approach is forcing hospital managers to confront issues more associated with the boardroom than with the National Health Service administrator’s office of old. And fragmenting the supposedly “National” Health Service.

Ordinary mergers create a new trust but in this case Good Hope, in Sutton Coldfield, would be formally dissolved.

Good Hope became the first hospital in the country in 2003 to be run by a private company when its star rating dropped from the highest of three stars to no stars.

Heart of England Trust entered into a management contract with the hospital in November 2005 that saw chief executive Mark Goldman running both hospitals. The idea for the merger was put forward by Good Hope’s foundation development board as “the only way” for the hospital to reach foundation status by the government’s deadline of 2008.

The foundation trust currently includes Heartlands Hospital, Birmingham Chest Clinic and Solihull hospital.