On Dec 21, 2006 Health Direct noted that Patients win partial right to block medical records in U turn on CfH IT project when Labour Ministers have bowed to the complete distrust some patients have of the planned National Health Service electronic patient record by agreeing they will be able to place a total block on their records being uploaded to the system – rather than just a bar on them being shared.

Precisely how they will be able to do that, however, has yet to be established ahead of pilot projects planned for the spring.

Health Direct warns- don’t break out the champagne yet. The report was cleverly spun; hidden in an appendix is confirmation that you can opt out of the Summary Care Record, but not from the Detailed Care Record.

Labour ministers say you will only be able to opt out of a detailed care record if you can show “substantial mental distress”. This is a bluff. You can use the letter from the Health Direct this link Save your medical confidentiality- warning over privacy of 50m patient files in NHS IT project to order your GP not to upload your records in the first place.

On Nov 03, 2006 Health Direct origionally Warning over privacy of 50m patient files in NHS IT project when Millions of personal medical records are to be uploaded regardless of patients’ wishes to a central national database from where information can be made available to police and security services, the Guardian has learned.

Details of mental illnesses, abortions, pregnancy, HIV status, drug-taking, or alcoholism may also be included, and there are no laws to prevent DNA profiles being added. The uploading is planned under Whitehall’s bedevilled £12bn scheme to computerise the health service.

About the Big Opt Out Campaign
The NHS Confidentiality campaign was set up to protect patient confidentiality and to provide a focus for patient-led opposition the government’s NHS Care Records System. NHS Care Records are currently being rolled out and will form a huge national database of patient medical records and personal information (sometimes referred to as the NHS ’spine’) with no opt-in or opt-out mechanism for patients at all. It is very much akin to the government’s proposed ID database.

YOUR PRIVACY
Your medical confidentiality is at risk due to this new database, as potentially millions of NHS employees and central government bureaucrats will have access to not only your medical records but also your demographic details—name, address, NHS Number, GP details, phone number (even if it’s ex-directory) and mobile number.

ACT NOW!
Do nothing and you will have only yourself to blame- the ramifications of this medical database make the IC card seem like a cake walk!

Mr Prescott was at home in his Hull East constituency with his wife, Pauline, and other family members when he fell ill. He was taken to Castle Hill Hospital, Hull, where he was treated for a kidney stone. He is now recovering at home. Mr Prescott said: “I’d like to thank the doctors, nurses and staff who looked after me on Christmas Day. They do such a brilliant job, 365 days a year, and it was a real pleasure to have my Christmas dinner among such dedicated people.

The illness is a further tribulation for Mr Prescott, 68, at the end of a challenging year. He announced in September that he would step down as deputy leader next year, apologising to Labour activists for letting them down. His move followed revelations of an affair with Tracey Temple, his secretary, and a Cabinet reshuffle in which he lost many of his responsibilities.

He was also embroiled in controversy over his links to an American billionaire bidding to build a casino in the Millennium Dome, but he rejected calls to resign, claiming that he wanted to attempt to restore his reputation before he left office.

Mr Prescott is diabetic, but his spokeswoman said that she was not aware of any previous problems with kidney stones.

Kidney stones occur in about 12 per cent of men and four per cent of women. They form when minerals or salts usually found in urine form solid crystals in the kidneys.

The condition can cause acute pain, especially when the stones pass from the kidney to the bladder. The pain from kidney stones has been described as second only to child birth.

Partially reproduced from:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/12/27/nburger27.xml

PHG will run all services at the 60-bed hospital, built for £36m under the private finance initiative, including the minor injuries unit, x-ray, urgent care and medical admissions. The company will deliver about 40,000 emergency and non-emergency operations and procedures.

The NHS’s South Central strategic health authority said: “The contract with the independent sector provider will be the first in the country where the provider will manage the services at a whole NHS site. It is also the first contract where the independent sector will be running urgent care services with a state of the art medical admissions unit.”

The authority said the move was aimed at helping to meet the government’s target of treating all NHS patients within 18 weeks of a GP referral by 2008.

Karen Jennings, head of health at the public sector union Unison, said: “Handing over the running of the new hospital in Lymington represents a fundamental, seismic shift towards pushing entire communities out of the NHS and into the private sector. We fear this is just the first wave.”

Mike Parish, chief executive of Care UK, said: “We are particularly pleased that this will be the first independent sector treatment centre to manage the entire range of clinical services at an NHS site.”

The company expects to take over responsibility of the hospital in July.

Yvonne LeBrun, area director of care services for Hampshire primary care trust, said: “Healthcare at the Lymington New Forest Hospital will continue to be funded by the NHS and it will remain an NHS facility. Hospital services will be designed by the NHS to meet the needs of the community and will be funded from the public purse and free of charge to all.”

Reproduced from:
http://www.guardian.co.uk/uk_news/story/0,,1977982,00.html

Health Direct noted on Oct 02, 2006 that the first NHS hospital privatisation was announced and that 60 more may follow when a foundation hospital trust planned to “takeover” a smaller cash strapped NHS hospital in what is thought to be the first privatisation of its kind. The Heart of England NHS Foundation Trust in Birmingham hopes to acquire Good Hope Hospital, which is £15m in debt.

Labour’s policy of outsourcing NHS staff, facilities and responsibilities is an abject admission of it’s inability to manage properly a health service in the UK.

As such it is the end of the National Health Service. From the proud boast of “24 hours to save the NHS” to “10 years to kill the NHS off”.

On Nov 11, 2005 Health Direct warned that Labour’s policy is ‘fatally flawed’ a majority of PCT claim when the Labour government’s policy on primary care provision has become ‘fatally flawed’ because of poor handling, a poll of primary care trust chief executives suggests. More than three quarters of respondents to an HSJ survey agreed with the statement that ‘a badly communicated policy has now become a fatally flawed policy due to government panic’.

Ninety five per cent of those polled said ‘the government badly underestimated how much opposition would be created by the transfer of staff out of the NHS’.

One chief executive said: ‘The Stalinist regime at the DoH increasingly appears to have lost touch with reality. In my 20 years at the top I have never known anything to affect morale to such an extent.’

Details of the outbreak emerged yesterday after the Health Protection Agency put out a warning to the NHS last weekend following the deaths of nurse and a patient from the Panton-Valentine leukocidin (PVL) form of the MRSA bacteria at the University Hospital of North Staffordshire, Stoke-on-Trent, earlier this year. It was the first time the PVL form had been transmitted and caused deaths within a hospital.

Mrs Lynch said she and her daughter, now aged three, made repeated attempts to eradicate the PVL infection without success, after Daisy was born at Derriford Hospital in October 2003. “I was extremely shocked and concerned for my daughter’s health. More should be known about this bug,” she said.

A report into the outbreak produced by the hospital’s microbiology department said there were 10 cases of PVL staphylococcus infection among mothers and babies in the maternity unit in October and November 2003. In seven cases, the infection led to mastitis (inflammation of the breast) and in four, to abscesses requiring surgery.

The report did not confirm that the outbreak was due to MRSA (methicillin resistant staphylococcus aureus) but public health officials said last night that PVL, whether methicillin sensitive (MSSA) or methicillin resistant, were often hard to treat.

“It was horrendous. I had Daisy by Caesarean and was discharged five days later. Then I started getting pains in my breast, and had two courses of two different antibiotics. When they didn’t work I was readmitted and had a scan which revealed the huge abscess on my breast. Within an hour I had emergency surgery.”

In the three years since, Daisy has had 18 boils and abscesses on her body, including one which required surgery under general anaesthetic in August. Mrs Lynch said: “It was on her right buttock and it had to be cut and drained because she wasn’t responding to antibiotics. She has been almost permanently on antibiotics since last June and was pale and off her food. She weighs less than she did when she was two. Now you can see she has more energy and looks better since the surgery.”

According to the report, no trace of the PVL bug was found on equipment in the maternity unit and the most likely source was a member of staff or a visitor.

Mrs Lynch said: “All 10 of us who got infected with the PVL strain were on the same ward and the common factor was we had all had help to breastfeed from the auxiliary nurses … I am convinced that was how the infection was transmitted.”

Sharon Kowalski, the on-call manager at Derriford Hospital, said no one was available to comment last night. A spokesman for the Health Protection Agency in the South-west said PVL-producing strains of staphylococcus aureus posed a particular challenge.

Meanwhile, the mother of Catherine Chadwick, a community midwife who died from PVL in April, spoke of her shock and grief over the loss of her daughter. She died 48 hours after being admitted to hospital in Bradford and had gone to her GP only a day earlier. Vera Ward, 78, said: “Catherine was fit and healthy and at 47 you do not expect to die like that. She has left a hole nothing can fill.”

Origonally published at:
http://news.independent.co.uk/uk/health_medical/article2091880.ece

The preventable scandal that is MRSA in our hospitals was highlighted on Fri 27 Oct 06 when Health Direct noted that MRSA kills twice as many people as drunk drivers in the UK when Sir John Oldham, a GP and head of the Improvement Foundation, which advises primary care trusts, warned that one in five clinical staff failed to wash their hands, despite evidence that doing so cuts the incidence of hospital-acquired infections such as MRSA, which costs the NHS £1bn a year.

Figures for 2004 show MRSA killed 1,623 patients in England and Wales. Some 580 people were killed in drink-driving incidents in Britain.

The Health Direct blog wishes all of our readers a Happy and Healthy Christmas!

The concession came as the health department groped marginally closer to a potentially workable compromise between itself and warring factions of doctors over whether patients should be required to opt in, or should be allowed to opt out, of having their electronic record shared.

But there seems little prospect of a full summary care record being available nationally by 2010.

Pilots of an extremely limited summary – covering present medications, adverse drug reactions and allergies – would go ahead next year, said Lord Warner, the discredited and soon to depart health minister in charge of the programme.

A public information campaign will be run locally, telling patients they have an as yet undefined period of time – perhaps a couple of months – to view their record and correct or amend it. That could be done via the electronic patient portal known as healthspace, or by viewing a printed copy.

They will be able to give explicit consent that their record is shared. However, those who do not reply after a “realistic” period of time will be assumed to have given implied consent – the position the government has held up to now.

Ministers have, however, recognised that “some patients may ask for their summary care record not to be shared or uploaded at all”, and Lord Warner said the government may honour that.

How that will be achieved, both practically and in IT terms, has still to be considered, ahead of the pilots by an advisory group. Whether the new approach will involve writing to every patient to tell them their records are going to be uploaded, rather than relying on public information techniques, is also not clear.

Lord Warner said: “We are now going forward,” but he added “cautiously”. He noted that it took the Veterans Administration in the US 10 years to get to a full summary record with which both patients and clinicians were comfortable.

His statement implies that while the technical infrastructure may be in place by 2010, a full summary record is unlikely to be universally in use by then, given that the limited pilot projects are expected to last into 2008.

Taken from:
http://www.ft.com/cms/s/97f93b44-8f05-11db-a7b2-0000779e2340.html
http://www.guardian.co.uk/comment/story/0,,1976589,00.html

Health Direct warns- don’t break out the champagne yet. The report was cleverly spun; hidden in an appendix is confirmation that you can opt out of the Summary Care Record, but not from the Detailed Care Record.

The first is merely a synopsis for emergency care. It will have your current prescriptions, and will say, for example, whether you are diabetic. But ministers are not offering an easy opt-out from the second – the database replacing your current GP and hospital records. They plan to “upload” your GP data over the next year or two to a regional hosting centre run by a government contractor. The data will initially remain under your GP’s nominal control but, after hospital records have been uploaded too, the chief medical officer will be the custodian of the whole lot.

Your “electronic health record” will be used for many purposes, from cost control through audit to research. So the Home Office plans to use health data to help predict which children are likely to offend (despite a recent report to the information commissioner that collecting large amounts of data on children without their parents’ consent will probably break human rights law).

Yet confidentiality is often vital for care. Victims of child abuse are more likely to contact Childline than the child protection services, as Childline is seen as confidential. So if your GP asks your teenage children whether they indulge in under-age sex, will it be safe to tell?

Ministers say that the rules for police access to data will not change, but this masks a practical shift. At present the law allows the police access to health records that contain evidence of a crime. In practice, they will not ask a judge to order your GP to hand over the record of your 15-year-old daughter’s morning-after pill. The effort is too great and the reward too small.

But once the records of millions of people are on one system, to which a court will give access without GPs’ knowledge, the police will be sorely tempted. They already collect all sorts of operationally useful data: they have had access to opiate prescriptions for years, and there’s been a steady rise in their requests for journey data from London’s Oyster card system.

Undermining medical privacy will harm many vulnerable groups, from children to rape victims. Letting civil servants rather than doctors set the trade-offs between medical privacy and other goals will also be a major change.

Ministers say you will only be able to opt out of a detailed care record if you can show “substantial mental distress”. This is a bluff. You can use the letter from the Health Direct this link Save your medical confidentiality- warning over privacy of 50m patient files in NHS IT project to order your GP not to upload your records in the first place.

The NHS computer project also has grave safety and performance problems. Moving patient records from the hospital or surgery to remote computer centres means that network failures cause havoc. What’s more, the NHS computer system is showing all the classic symptoms of turning into a software project disaster, with changing specifications, slipping deadlines and soaring costs. The NHS must not be dependent on it.

The convoy is heading for the rocks, and perhaps only one man can alter its course. Gordon Brown will have to decide soon whether to scrap the central database and build safe systems that will work. If he calls it wrong then – as with Bliar and Iraq – it may well be the decision for which he is remembered.

The commission measured the hospitals and clinics against 32 standards. They do not measure clinical success rates but standards of cleanliness, decontamination of equipment, catering, hospital infection practices and record keeping.

In the 249 acute private hospitals, 10 per cent failed to meet the standard of properly completed health records and eight per cent did not meet the standards on training and education. Eight per cent also did not meet the standard on controls to prevent cross-infection.

Although the standards are not identical to those set for NHS hospitals, the commission said there are common threads. In the NHS, 20 per cent of trusts could not assure the commission that staff had compulsory training and 13 per cent did not have evidence of systems for decontamination of equipment.

The private hospital information is being made available on the Healthcare Commission website and patients can now look for information on their local hospital.

Anna Walker, chief executive of the commission said: “We want to make sure that patients have access to information about standards of care they can expect, wherever they receive it. It’s important that patients know that health care services meet these standards.”

Bupa, the leading private provider, and the British Pregnancy Advisory Service, the charity which provides abortions, had mixed results.

Both charities said that the results did not reflect on the clinical standards at their hospitals which were not part of the inspections and reviews.

Bupa has four hospitals among the 16 listed as having met all 32 standards but one in the group of nine hospitals which failed to meet the largest number of standards.

BPAS had two hospitals in the category which failed to meet several standards and one in the group that met all the standards.

Bupa said that any standard not met was immediately acted upon. Dr JJ de Gorter, medical director at Bupa, said: “The first thing is that these standards are not a measure of clinical outcome or quality. But if something is wrong we take action straight away.”

Ann Furedi, chief executive of BPAS said: “It’s important for patients to be able to judge in which areas we excel and where we’re working with them to improve our service.

Taken from:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/12/20/nhealth120.xml

On Feb 24, 2005 Health Direct warned that Independent Treatment Centres are not the solution for the NHS, warns BMA leader when speaking at the conference of Honorary Secretaries of BMA Divisions in Edinburgh Dr Sam Everington, Deputy Chairman of the BMA (UK) warned that the Labour Government’s continuing push for private sector involvement in the provision of NHS services could spread.

Commenting on the increasing reliance on Independent Treatment Centres, Dr Everington added: “They are a wonderful idea on paper. Patients get more choice and quicker treatment, NHS capacity is freed and the government meets its targets. Everyone wins. “

“But they are forcing NHS hospitals to compete with the private sector and in a market, as we know, there are winners and losers. NHS trusts will lose money. The natural consequences are for units to close. Some local hospitals will then become increasingly unsustainable.”

The Health Protection Agency said three other nurses in the West Midlands hospital were among eight people who contracted the new, more lethal strain of MRSA, four of whom have infections including boils and abscesses. Two have died.

It is the first time that the toxic strain of the superbug, known as PVL-producing MRSA, has caused infection and deaths in a hospital, the agency said. The outbreak has alarmed public health officials who say it could pose risks for staff as well as patients. The toxic PVL strain has previously been detected only in small outbreaks among healthy children and young people. It attacks the white blood cells, destroys tissue and can cause boils up to 3 inches (10cms) across.

If it became established in hospitals, where people are sicker, have lowered immunity and may have open wounds, it could pose a much more serious threat. Ordinary hospital-associated MRSA preys on older, sicker patients and does not normally affect nurses and other staff.

The Health Protection Agency put out a warning to the NHS at the weekend in its weekly Communicable Disease Report. It said patients with boils and abscesses should be tested for the new strain and the results sent to the Centre for Infections in Colindale, north London.

In a statement, the agency said: “This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales. The HPA is advising the hospital on outbreak control measures and will continue to monitor MRSA infection rates nationally.”

The lethal nature of the new strain of MRSA was demonstrated two years ago when a physically fit young soldier became infected after grazing his leg while out running on Woodbury Common, Devon. Richard Campbell, 18, a Royal Marine recruit, rapidly developed swelling in both legs, became unable to walk and died two days later. A 28-year-old woman also died after picking up the bug in her local gym.

The source of the outbreak is thought to have been a patient who died on the same ward several months earlier. Investigations revealed the nurse had been infected with the PVL strain of MRSA and another nurse on the same ward who had a history of abscesses was also infected. It is likely the nurse who died was carrying the bug on her skin and it became a lethal infection when she had the operation.

The PVL strain of Staphylococcus aureus was identified in the 1930s and accounted for 60 per cent of all staph infections before 1960. It was almost eliminated by antibiotic methicillin in 1961, but has resurged, linked to the growth of MRSA.

Taken from:
http://news.independent.co.uk/uk/health_medical/article2083867.ece

Separately Health Direct has learnt of a new nanny state directive for Doctors, including senior hospital consultants, who have been banned from wearing ties because NHS managers claim they could spread the superbug MRSA.

An NHS trust has told hospital consultants they face disciplinary action if they repeatedly wear a bow tie or neck tie on the wards. Doctors and nurses have even been encouraged to confront colleagues who break the “no-tie” code.

The rules have been introduced by Brighton and Sussex University Hospitals NHS Trust to reduce its rate of MRSA infection, the highest in England.

Managers say neck garments are “superfluous” and that as they are not cleaned as often as other items of clothing could be an infection hazard.

However, doctors say the rules are driven by political correctness rather than scientific evidence. They say their professionalism could be eroded by the dress-down policy and fear patients will have less confidence in open-shirted medics.

One consultant at the trust, who did not want to be named for fear of disciplinary action, said: “If you come to see a consultant in Brighton, you will be greeted by an open neck shirted doctor who will look as if he is the hospital DJ, but will in fact be the consultant.”

Dr Michael Dixon, a bow-tie wearing GP and chair of the NHS Alliance, which represents primary care trusts, said research showed patients had more confidence in smartly-dressed doctors. He said: “I certainly would feel less professional if I was not wearing a tie. It is all right if you are an antipodean doctor but not in this country.

“This is political correctness rather than science. Patients need to be able to respect and trust their doctors and going around without ties might damage that relationship.”

Professor James Drife, a consultant obstetrician in Leeds, said it might even be sexist. Drife, who wears a bow tie, said: “They wouldn’t be allowed to humiliate women by telling them they could not wear a basic item of their clothing.”

Claire Rayner, the agony aunt and president of the Patients Association, agreed. The former nurse and MRSA victim said: “This does seem a very puerile argument to me. If a doctor wears a tie properly, and it does not flop around, then there shouldn’t be any problem. Issuing these little edicts sounds like someone is trying desperately to find something to say and do about hospital infection.

First reported in:
http://www.timesonline.co.uk/article/0,,2087-2508284,00.html

Onlt recently (Fri 27 Oct 06) Health Direct reported that MRSA kills twice as many people as drunk drivers in the UK when Sir John Oldham, a GP and head of the Improvement Foundation, which advises primary care trusts, warned that one in five clinical staff failed to wash their hands, despite evidence that doing so cuts the incidence of hospital-acquired infections such as MRSA, which costs the NHS £1bn a year. Figures for 2004 show MRSA killed 1,623 patients in England and Wales. Some 580 people were killed in drink-driving incidents in Britain.

And what is the great liar doing about MRSA?

On Thu 23 June last year in Bliar’s MRSA “fog of ignorance” Mr Edward Leigh MP, the Chairman of the Committee of Public Accounts in the previous Parliament, said today: “More than four years have passed since our predecessor Committee first highlighted the paucity of information on the extent and cost of hospital acquired infection.

Today we find that little has been done to dispel this fog of ignorance. There is still no mandatory national surveillance and reporting scheme for all hospital acquired infections, the only mandatory reporting scheme for which data has been published is for MRSA bloodstream infections, which account for less than six per cent of all hospital acquired infections.

These data show that the UK’s MRSA infection rate ranks among the worst in Europe.

The committee said historic deficits, long hidden, were revealed when the government changed the rules so trusts could not underspend their capital budget to subsidise current spending.

But it said the government fuelled the problem by agreeing to new pay deals for doctors and nurses using estimates of the cost which were “hopelessly unrealistic”.

In addition, meeting national targets such as the requirement that no patient should wait more than four hours in A&E; had been costly.

Changing targets at short notice also placed unnecessary financial costs on trusts, the report said.

It attacked short-term measures being used by the government to address deficits.

And it said raiding staff training budgets was “unacceptable”, and warned such cuts were affecting staff morale and could damage the quality of the workforce.

MPs also warned other “soft targets” such as mental and public health service budgets should not be raided to ease trusts’ deficits.

And they said the creation of a new contingency fund to help out failing trusts and top-slicing primary care trusts’ (PCTs) budgets should only be temporary measures.

The report said: “The most basic errors have been made; there are too many examples of poor financial information, inadequate monitoring and an absence of financial control.”

It said the NHS may well be in balance as a whole by the end of this financial year, but warned trusts with the highest deficits were unlikely to be in the black within the next five years.

The MPs say the government should change the NHS’s accounting system, which both reduces a trust’s income by the amount of its deficit while also asking it to repay the sum owed. (Please see the Health Direct blog on Thu 14 Dec 06- Labour’s unsustainable NHS resource account and budgeting (RAB) rules to stay for further explanation.)

Kevin Barron, chairman of the committee, said: “I hope the rush for balancing all NHS budgets does not mean further top-slicing next year, particularly in areas of high health inequalities.”

Both the British Medical Association and the Royal College of Nursing condemned the decision to raid training budgets.

And Professor Stephen West, who is on the Council of Deans and Heads of UK Health and Nursing Professions, said: “The universities and statutory bodies were advised that this was a one-year blip where they needed to make some significant reductions.

“Unfortunately it would appear that this was not, and that in order to balance the books there is going to have to be a two or three-year period of reductions in education and training.”

Shadow health secretary Andrew Lansley warned financial problems were leading to cutbacks when reform should have led to service improvements.

Sandra Gidley, Liberal Democrat health spokeswoman, said targeting “soft targets” such as staff training and mental health services was a “false economy”, the effects of which would be felt for years to come.

Taken from:
http://news.bbc.co.uk/1/hi/health/6172423.stm

On Jan 24, 2006 Health Direct warned that even NHS chiefs admit patient care is suffering because of cost-cutting when the financial crisis gripping the NHS is deepening and hitting patient services, with operations cancelled, appointments deferred and wards closed, according to two reports. NHS managers are struggling to reduce ballooning deficits that have swelled to £1.2bn. Managers have been freezing jobs, cancelling training and cutting up to 4,000 posts, the Royal College of Nursing says. A separate survey of NHS chief executives found three-quarters believe patient care is suffering as a result of cuts that are imposed to balance the books.

Almost two-thirds said they had been forced to close wards to bring their finances under control and nearly half said they had postponed building work.

Barbara Tassa, chair of the RCN public policy committee, said: “Patients are suffering and nursing posts are being lost because of the deficits crisis in the NHS and this is unacceptable. “The Government has repeatedly said that action taken by trusts to balance their books would not affect patient services. This is now clearly not the case.

“We are seeing a situation which is deteriorating. We have real concerns about the stability of NHS finances, especially in view of the roll-out of reforms such as patient choice and payment by results.”

NHS chief executives blamed the Government for the high level of debt, saying inflexible targets on cutting waiting times, costly pay awards for consultants and GPs and the growing use of the private sector had put the NHS in jeopardy.

The NHS Confederation, which represents trusts and health authorities, said deficits were falling as measures taken to cut costs, such as shutting wards, began to take effect. Gill Morgan, chief executive, said: “It is worse at the moment because of the Government’s highly ambitious programme [to cut waiting lists and modernise services].

“In many places, the NHS tried to run faster but you can only run faster for so long. There was pressure on pay and higher activity. Now people are taking action to bring the deficits down. What you are seeing in terms of shut wards are the symptoms of efforts to achieve financial balance.

“It will get better financially towards the end of the financial year but it will get worse for patients.”

Andrew Lansley, the shadow Health Secretary, said: “Patricia Hewitt has been in denial over the consequences of NHS financial deficits, any problems she has blamed on local decision-making. It is time for her to take responsibility for the consequence of the Government’s polices.”

The government’s “unprecedented” growth across the public sector on IT, management and other forms of consultancy reflected greater use of the private sector to deliver and support public services – but the labour government was still not securing value for money, the National Audit Office warned yesterday.

The NAO revealed the public sector had spent more than £7bn on consultants in the past three years – even judged against a tight definition of what consultancy involves. Edward Leigh, chairman of the Commons public accounts committee, said: “The external consultancy gravy train continues full steam ahead.”

Central government’s spend dropped marginally, from £2bn to £1.8bn. But big increases in local government and the National Health Service, up £700m over two years to £954m, saw the total across the public sector rise 33 per cent to £2.8bn.

Connecting for Health, the NHS’s £12.4 IT programme, the injection of “turnaround teams” into financially distressed NHS Trusts and local government’s growing use of IT helped explain that rise.

Several measures could generate about £1bn in savings over three years, the NAO said. Consultants should more frequently be required, as part of their contracts, to train public sector workers.

Better use could be made of inhouse staff who could cost around £550 a day rather than the £1,200 typically paid to consultants.

Services could also be bought more cannily. Too many contracts simply paid consultants for time and materials, rather than by results or for passing on their skills, the NAO said.

That helped explain why PA Consulting had racked up £34m in consulting fees on the national identity card scheme even as the project had slipped, with PA at one point earning £2.9m a month from the Home Office.

Departments on the whole did not measure internally how well individual companies, or individual consultants, did. In instances where that happened, the information was not shared across government, the NAO said.

In addition far too little use was made of existing “framework contracts” that could cut the costs of buying in consultancy. Barely a third of contracts were let that way.

The government’s growing reliance on complex, large-scale programmes to provide modern, IT-enabled public services, its lack of in-house skills in project management – many of which were stripped out in the 1990s as government IT was outsourced – and its use of consultants to drive the efficiency programme all helped explain the scale of the spending, the NAO said.

Excess supply in the consulting business had also contributed to the rise as consultancies turned to public sector work when private sector work shrunk.

Taken from:
http://www.ft.com/cms/s/c608165e-8be0-11db-a61f-0000779e2340.html

Health Direct continues to be amazed at the scale of labour’s consultancy bill. On Dec 01, 06 in DoH reveals true extent of NHS management consultant spend Health Direct noted that the imposition of turnaround teams on cash-strapped trusts has cost the NHS more than £22m, new Labour figures reveal. And the report showed that the DoH spent a massive £133m on management consultants last year -more than the £94m projected net deficit for the NHS next year.

The DoH admitted the estimated redundancy costs of the current NHS restructuring of payments to staff who lost their jobs under the reconfiguration of primary care trusts and strategic health authorities has been projected at ‘around £325m’, assuming an average age profile.

And the report showed that the DoH spent a massive £133m on management consultants last year -more than the £94m projected net deficit for the NHS next year.

It confirms that the DoH underestimated the annual cost of the consultant contract by £90m, and the Agenda for Change contract for nurses and managers by £220m, due to mistakes in calculating overtime and the cost of replacing staff working fewer hours under the contract.

The document also shows that in 2005-06 PCTs overspent by £196m on the GP contract, due to better than expected results from the quality and outcomes framework, and extra spend on out-of-hours care.

This was despite a £322m injection from the DoH to help PCTs commission and provide new services after 90 per cent of GPs opted out of the out-of-hours part of their contract.

Richard Douglas, the health department’s finance director, in effect acknowledged that, with the NHS struggling this year to achieve overall financial balance, it cannot at present afford the £600m-plus bill for scrapping the system.

Under resource accounting and budgeting, not only does an overspend have to be paid back but the same amount is knocked off the budget for the succeeding year. As a result a £10m overspend on a £100m budget has to be paid back from a budget that has been reduced to £90m.

That “double whammy” makes it harder to break even and auditors warned last year that it could easily turn a £9m deficit for the Queen Elizabeth Hospital in Woolwich into a £99m one – three quarters of its total budget – within five years.

At least a dozen NHS trusts are faced with a similar spiral of debt whilst others have escaped because, the department admits, the rules have not been applied consistently across the NHS.

The Audit Commission recommended in the summer that the rules should be dropped for individual NHS trusts, although they should still apply to primary care trusts.

However, the health department yesterday said that it needed to find the money to reverse the impact of the system and NHS trusts have first to demonstrate they can cope financially without the discipline that the RAB system brings.

Jonathan Fielden, chairman of the British Medical Association’s consultants committee, said it was “extremely disappointing” to see that the rules had not been scrapped.

They threatened to “imperil” NHS organisations by pushing them yet deeper into debt, while already causing “short term cuts directly impacting on patient care”.

At the same time, NHS trusts are due next year receive interest-bearing loans rather than cash support for any overspends, and loans for capital rather than cash allocations as they are moved towards the financial regime that applies to foundation trusts.

The effect of Labour’s ‘Alice in Wonderland’ rules is staggering as it leave hospitals facing a £1.6bn deficit. At least a dozen NHS hospital trusts are technically bankrupt, with no chance of meeting a legal obligation to balance their books.

Data provided by the Department of Health under the Freedom of Information Act showed 103 hospital trusts across England expect to end the year with accumulated deficits of £1.6bn, caused by overspending since 2001.

Many are taking corrective action, including laying off staff, closing wards and reducing the time patients spend in hospital, but many have passed the point of no return.

The group in greatest difficulty includes Queen Elizabeth hospital in Woolwich, south-east London, which is on course to overspend by £37.1m this year after racking up deficits totalling £28.3m over the previous two years. This would bring its cumulative deficit by the end of March to £65.3m, equivalent to 56.9% of its turnover.

Like every other hospital and mental health trust, the Queen Elizabeth has a legal obligation to balance the books over three years, stretching in exceptional circumstances to five. But to do so it would have to generate surpluses of £65.3m. Its senior executives have convinced the DoH that they have absolutely no chance of doing so.

Other trusts with irrecoverable positions include Surrey and Sussex Healthcare, Hinchingbrooke in Huntingdonshire, Ipswich, North West London and West Hertfordshire. Their financial difficulties became impossible to manage due to a mistake made by the DoH and the Treasury in 2001, when they put NHS trusts under a financial regime known as Resource Accounting and Budgeting (RAB). The Guardian’s analysis used information from thousands of spreadsheets supplied under the Freedom of Information Act.

The new system was designed to regulate spending by Whitehall departments, but had a devastating effect when it was applied to overspending hospital trusts. If a trust spent £105m, but had an income of only £100m, it would end the year with a deficit of £5m. The new rules sliced £5m from its income in the following year and obliged it to make a £5m surplus. That required the trust to cut its spending from £105m to £90m. Trusts faced with this triple whammy could not achieve the target without damaging patient care and so their deficits escalated.

The rules were described last night by one NHS finance director as “a nightmare from Alice in Wonderland”. Ms Hewitt asked the Audit Commission to investigate the problem. It told her in July: “We consider the RAB regime should not be applied to NHS trusts.”

Today’s blog is compiled from:
http://politics.guardian.co.uk/publicservices/story/0,,1969154,00.html
http://www.ft.com/cms/s/7c32ab18-8986-11db-a876-0000779e2340.html
http://politics.guardian.co.uk/publicservices/story/0,,1969173,00.html

The refusal of Hewitt to halt the Resource Account and Budgetting farce nails once and for all the lie that the NHS cutbacks are part of a process by Labour ministers to improve the NHS’s services.

These accounting cutbacks are the purely the result of Brown and Milburn’s incompetent stitch up in 2002 when they tried to agree a new funding process for the NHS.

NHS chief executive David Nicholson also set out new targets for tackling hospital infections and meeting the 18-week waiting time target.

However hospitals and primary care trusts – in charge of community services such as GPs – in particular have already been found to be building up big debts.

But Ms Hewitt told the BBC’s Today programme: “By the end of March next year, we will have the NHS as a whole in financial balance. So in the next financial year, the NHS should expect to make a financial surplus.”

Ms Hewitt said many hospitals could address their deficits by increasing the number of operations they carried out on a day-case basis, saving beds and sometimes requiring fewer staff.

“If every hospital was doing as well as the top 25%, over day case surgery and length of stay, the NHS would realise over £2 billion to invest in other services and new drugs.”

Responding to a report in the Guardian newspaper (and reported by Health Direct) claiming around a dozen trusts are “technically bankrupt” and would be unable to break even, the health secretary accepted there were some trusts where the deficit was so high, they would not be able to balance the books in one year.

But she said they would be asked to balance the books each month and, when the NHS as a whole was back in balance, the government would look at changing the way the accounting system addressed debts built up over previous years.

However, NHS managers said it wanted to see the accounting rules change now as they meant trusts paid a “double deficit” – the amount of the deficit is reclaimed from the following year’s budget but the original deficit is also carried forward.

Jonathan Fielden of the British Medical Association said: “At this current time, the NHS is under intense financial pressure, which is directly impacting on patients.

“There are patients who could be treated quicker being delayed, jobs being frozen, trained doctors and nurses and others not finding jobs to go to while the NHS tries to get its finances sorted.

“While it is good to produce a financial surplus, surely these aspects need to be sorted first?”

Liberal Democrat health spokesman Steve Webb said: “The government has gone into target overdrive. “How can hospitals already at financial breaking point be expected to chase new targets while trying to dig themselves out of the cycle of debt imposed by Labour’s ‘Alice in Wonderland’ accounting rules?”

On Jan 30, 2006 Health Direct in “Your money not your life- Hewitt puts money before medicine Patricia Hewitt, the health secretary, called for the end of the “handout culture” in the NHS and demanded that financial management be put ahead of clinical objectives.

The health secretary issued the “Business Arrangements” manual explaining how NHS finances should be controlled during 2006/7, when her reforms are due to create unprecedented instability in the service. She said: “Excellence in financial management is the prerequisite for high quality sustainable services.”

The rulebook made it clear that strong financial management has moved from the bottom of Ms Hewitt’s list of priorities to the top.

It also makes a mockery of the Government’s much-vaunted “patient choice” policy, they claim.

One hospital consultant, who did not wish to be named, said: “This is totally destabilising the local services.”

In one instance, GPs in Basingstoke, Hampshire, have been told to divert people who need routine hip and knee operations away from North Hampshire Hospital in Basingstoke and to surgical centres run by Capio, a Swedish company.

Waiting times for surgery at the Capio centres in Reading and Salisbury are as short as six weeks and a maximum of 10 weeks. But health bosses are at the same time imposing a “go slow” on orthopædic surgery at North Hampshire Hospital by refusing to fund routine hip and knee surgery if it is carried out before patients have waited 16 weeks.

One GP said: “The business with Capio is a disgrace. We have been told that operations will be done extremely quickly… but there are a whole lot of people waiting longer than that on the local hospital waiting list.

“I don’t understand why they can’t invest this money in the hospital service itself.”

Documents seen by The Sunday Telegraph show a similar “go slow” policy in Coventry and Warwickshire, where primary care trusts (PCT) specified waiting times of 20 weeks for routine surgery by March 2007.

The “commissioning intentions” document states: “Where waiting times are lower than the maximum waiting time trajectory these should be extended to the maximum at a consultant and speciality level. The PCTs will not fund any over-performance generated as a result of enhanced waiting times.”

A spokesman for North Hampshire PCT said that about 120 patients would be operated on under the Capio deal.

Taken from:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/12/10/nhs10.xml

Health Direct notes that Doctors understandably don’t have much faith in Labour’s much vaunted Choose and Book system.

On June 22, 05 Health Direct noted: Doctors reject IT Choose and book- “It’s cobblers, are we doctors or travel agents?” when GPs voted to oppose the new Patients’ IT “choose and book” system, citing numerous objections.

The Doctors had met at the British Medical Association’s Local Medical Committee conference in London June 05 and noted that the IT system supporting patient choice impinges on consultations- without offering patients genuine options.

East Yorkshire GP Dr Andrew Green said: ‘GPs are in favour of choice. Being opposed to choose and book is not the same as being opposed to choice.’

Wirral GP Dr Nev Bradley said the public already had a clear perception of choose and book. ‘It’s cobblers,’ he said. ‘Are we doctors or travel agents?’

Mike Pringle, professor of general practice at Nottingham University and one of the clinical leads for Connecting for Health, the agency running the national IT programme, admitted that choose and book is not currently fit for purpose.

He said: ‘It’s not good enough for the roll-out we need.’ However, Connecting for Health was responding, he said, and a second version will be launched in September.

Doctors rejected a motion that sharing of information would benefit patient care. And they said primary care was failing to maintain and replace GPs’ computer systems.

The changes, which ministers say have “fundamental social, legal and ethical aspects”, are set out in a Department of Health “command paper” seen by The Sunday Telegraph.

Homosexual couples will have the same parental rights as heterosexuals and, for the first time, all parents will be banned from choosing the sex of their baby for non-medical reasons.

However, embryos will be able to be screened for genetic abnormalities “which may lead to serious medical conditions, disabilities or miscarriage”.

Screening will also be expressly permitted to identify a “tissue match for a sibling suffering a life-threatening illness”, but the document rules out “family balancing” and adds that most people surveyed in a consultation exercise believed “this should not be a matter of choice open to parents”.

The creation of combined human-animal embryos under licence will be popular among stem-cell researchers, including a team from the North East England Stem Cell Institute, which has submitted plans to create a human-cow chimera embryo. However, it will be bitterly contested by reproductive ethics campaigners who brand such ideas “abhorrent”.

The aim of the shake-up is to bring the 1990 Human Fertilisation and Embryology Act into line with scientific advances and to make sure the law is “fit for purpose in the early 21st century”. Caroline Flint, the health minister, claims in her foreword: “The over-arching aim is to pursue the common good through a system broadly acceptable to society.”

She proposes doing away with the current regulatory bodies, the Human Fertilisation and Embryology Authority and the Human Tissue Authority, and replacing them with a Regulatory Authority for Tissue and Embryos (Rate). Some medical advances will be outlawed, including the possible creation of a child by combining genetic material of two women, which would render males redundant altogether.

However, the law obliging clinics to consider a child’s “need for a father” is to be scrapped – despite backing from the public for the present system. However, the need to take account of the “welfare of the child” before treatment is given will stay.

Robert Whelan, the deputy director of Civitas, the institute for the study of civil society, criticised the plans to give single mothers the right to fertility treatment.

“It is grossly irresponsible to deliberately bring a child into the world in circumstances which will leave it at a disadvantage,” he said.

“The people who engage in this sort of activity see children as an accessory and something they can have as a right. The fact that the child will suffer is secondary.”

In other changes, private companies which provide sperm to women over the internet will be regulated for the first time and charities and other non-profit-making organisations will be able to advertise surrogacy services.

Another change will affect storage of embryos. This can currently be done for five years as long as neither parent withdraws consent.

The Government proposes extending this period to 10 years and also to introduce a one-year “cooling-off period” where an embryo can still be stored if one parent withdraws consent.

The paper, expected on Friday, will set out the Government’s plans ahead of a draft Bill next year.

Taken from:
http://www.telegraph.co.uk/news/main.jhtml;jsessionid=3F4NWVCKW10VVQFIQMGCFGGAVCBQUIV0?xml=/news/2006/12/10/nivf10.xml

Labour’s IVF policies have been in tatters for years as they unfund, dither and meddle around the edges.

On Feb 01, 05 Health Direct noted that the Labour Government pledge on IVF in tatters as units fail to cope with demand as 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 The Independent on Sunday can reveal that fertility services in England and Wales are in crisis, with some NHS trusts refusing to supply any treatment for certain couples.

In what has been described as a “shambles” by critics of the Labour Government, some cash-strapped trusts will be unable to provide any treatment by the April deadline set a year ago by John Reid, the Secretary of State for Health, while others will be forced to reduce the level of treatment which they already offer.

And again earlier this year: Sept 14, 06- IVF donor sperm crisis revealed as NHS fails couples
when almost 70% of fertility clinics either have no access to donor sperm, or find it extremely difficult to obtain, a BBC survey suggests. Two thirds of IVF clinics have trouble getting the sperm they need. Specialists say infertile patients are becoming desperate and more resources are needed for campaigns aimed at recruiting donors.

Fifty of the clinics surveyed said they either had no sperm or insufficient supplies. Many reported waiting times of at least six months for couples needing donor sperm, and some were having to turn patients away.

The secretary of the British Fertility Society, Dr Allan Pacey, said: “We are certainly in a crisis at the moment – most clinics are finding it difficult to get enough sperm to treat their patients.

The obvious question is why is Labour social engineering when those apparently most appropriate to bring up children are being denied by their costs cuts?

They fear the proposed cuts to A&E; departments and other key hospital services which are being put forward by local health chiefs are being driven by money.

The NHS racked up a deficit of over £500m last year and is predicting another one this year. So the financial advantage in closing A&E;, maternity and trauma departments is obvious.

Karen Jennings, head of health at Unison, said: “The climate of debt in the NHS puts the development of new policy under suspicion. We are extremely concerned that these policies may be being driven by deficits, not what is best for patient care.”

“The key to developing new policy in the NHS must be asking the experts – the staff who work in it – and the announcements have been made without any prior consultation. If we move towards more specialist units we still need to ensure that patients have access to really good local A&E; departments.”

Expertise

“The strength of building specialist units and advancing specialist medical knowledge should be in sharing that expertise and cascading it down. However, in reality, the new markets, commercial confidentiality and competition being fostered by the government in the NHS create obstacles to hospitals working together.”

And Geoff Martin, of the Health Emergency campaign group which has been helping to support local campaigns, believes patients could be put under threat if the proposals being put forward are pushed through.

“Claiming that closing local A&E; departments, trauma units and intensive care facilities will improve services turns all logic on its head. People are fighting these closures in their tens of thousands up and down the country because they know that closing local services and increasing journey times puts lives at risk.”

The government has argued it is all part of the evolution the NHS has been undergoing in recent years with more care being provided in the community.

“Eighteen months ago at the time of the last election I did not hear the government arguing for A&E; and maternity services closing down.” said Andrew Lansley, shadow health secretary.
But Andrew Lansley said if this was the case they should have been making the case months ago.

“Eighteen months ago at the time of the last election I did not hear the government arguing for A&E; and maternity services closing down. This has happened because the government has plunged the health service in deep financial deficit.”

And Professor Peter Weissberg, medical director of the British Heart Foundation, said: “Specialised centres will only benefit the UK¿s heart patients if there are enough of them to support those in need, which will mean significant investment.”

“Until then we need to make sure those people who can¿t access specialised centres aren¿t left at risk, which will only be achieved through investing in emergency care within local communities.”

Critics have also said that if the government was truly motivated by moving care into the community they would wait until the services – such as specialist GP clinics and home chemotherapy were in place.

Ministers have promised £750m over the next five years to fund such projects but the projects are still in their infancy.

Alex Nunns, of the Keep Our NHS Public campaign group, which represents patients and staff, said: “We keep hearing about these projects but on the whole they are not off the ground. yet. Is it surprising people do not believe it is about saving money?”

Taken from:
http://news.bbc.co.uk/1/hi/health/6209908.stm

This news comes only a few weeks since Health Direct warned on Nov 23, 06- NHS Trusts warned not to axe acute beds prematurely that mental health trusts have been warned not to cut acute beds until their community services are fully developed.

In a report about bed over-occupancy, the Mental Health Act Commission found that in the year leading to July 2006 the national average for bed occupancy in acute admission wards visited was 101 per cent. In London it was as high as 112 per cent.

Who’s Been Sleeping in my Bed? The incidence and impact of bed over-occupancy in the mental health acute sector highlights the distress and detrimental effects seen in patients who are asked to take leave or move wards to vacate a bed.

Senior MHAC policy analyst Mat Kinton, author of the report, said: ‘There has been much on the development of community services as an alternative to admitting patients to hospital, but we have found that some community services are very much embryonic.

‘In some areas authorities have cut beds in the hope that the new community outreach projects will take up the slack and that has not universally happened yet. It will eventually, in two or three years- but there is a danger of clipping it too far as it’s easy to make cuts when feeling the financial pinch.’

And the Guardian newspaper reports that ministers have accepted in private that they have failed to sell NHS reform effectively to the public as Health Direct reported in our blog yesterday.

Speaking to an audience of NHS managers and doctors, Mr Bliar said service improvements in NHS hospitals were being implemented to ensure the very sick have speedy access to specialist care but also to treat people more conveniently closer to home.

The Prime Minister said no change was not an option. The key was to shape change to ensure a vibrant future for the NHS. He conceded that there was “in-built resistance” to change, and that managers had a tough job selling it to the public.

But he said: “The best reason for all this change is the best reason there possibly can be: better care for the patient. I genuinely believe the best is yet to come with more lives saved, stopping more pain and distress.”

Dr Jonathan Fielden, chairman of the BMA’s consultants’ committee said decisions on reconfiguration must be based on “good evidence”.

Case against

Professor Christopher Marks, cancer surgeon and chairman of the independent campaign to save the Royal Surrey Hospital in Guildford, said: “What local people want is access to excellent care which they can get to easily.”

He accepted that some complicated cases must go to specialist centres, but warned centralisation of services in Surrey would see a doubling of minimum ambulance times, which could compromise care.

“Thanks to the money that the government has put in, particularly to A&E;, the service has improved marvellously, and it is a pity to throw the baby out with the bath water when you have spent all this money.”

Dr Richard Taylor, the independent MP for Wyre Forest, who campaigned against the closure of his local hospital in Kidderminster, admitted that campaigns to save local facilities were driven in some part by emotion.

But he warned that downgrading A&E; units left them unable to cope.

“There has got to be compromise that keeps adequate facilities at a wider range of acute general hospitals than these super-specialist centres alone.”

Taken from:
http://news.bbc.co.uk/1/hi/health/6207278.stm

Health Direct warns that as long as saving money remains the Hewitt’s number one priority then Bliar will continue to live in his cloud cuckoo land on improvesments to teh NHS:

On Jan 30, 2006 in Hewitt- Your money not your life- puts money before medicine Patricia Hewitt, the health secretary, called for the end of the “handout culture” in the NHS and demanded that financial management be put ahead of clinical objectives. Under the new financial regime, health trusts will sink or swim on their ability to attract patients under a system of payment by results that threatens the income of poor performers.

The health secretary issued the “Business Arrangements” manual explaining how NHS finances should be controlled during 2006/7, when her reforms are due to create unprecedented instability in the service. She said: “Excellence in financial management is the prerequisite for high quality sustainable services.”

Trusts will have to say goodbye to “a culture of balance sheet adjustments and handouts” that allowed hospitals to tolerate inefficiency on the assumption that the NHS would bail them out.

The rulebook made it clear that strong financial management has moved from the bottom of Ms Hewitt’s list of priorities to the top.

One unnamed minister warned Ms Hewitt that financial pressures were mounting too.

This was because “increasing life expectancy and medical advances would lead to new pressures, which would need to be reconciled with the public’s expectations about taxation”.

The minute reveals that Ms Hewitt admitted that the government needed to “be smarter about communications”.

She said the government needed to involve senior NHS staff to help make the case for change. “Where clinicians are prepared to make the arguments for reform, it can have a high impact,” she told the meeting.

She said it was also necessary “to involve the public and patients through patient panels, working with local MPs so they focus on ensuring the best health outcomes for their constituents rather than the number of beds, pursue value for money through shorter hospital stays which the evidence shows can often result in better health outcomes as well as savings”.

The minute also shows that Ms Hewitt told ministers she was determined to press on with the reform, despite the criticisms from colleagues.

The meeting was part of a frank debate being led by Downing Street and the Treasury into the future direction of all government policy. She argued that “it was true there would always be clinicians and frontline workers who did not welcome reforms, but the government has to take on the argument and win over NHS staff and the public”.

The situation has become so acute that Ms Hewitt has staked her ministerial position on returning the NHS in England to financial balance by the end of March. (See The Health Direct blog 21/3/6 below)

The health secretary will adopt a tougher approach when she launches a counter-attack against campaigners across England who are protesting about proposals to close key facilities at NHS hospitals.

She will parade medical experts who are convinced that hundreds of lives could be saved every year if the NHS reorganised to provide specialist care in a small number of regional centres.

Five weeks ago Health Direct and the Guardian identified more than 50 campaigns against proposed or rumoured closures that are building up into the most widespread and prolonged unrest since the poll tax revolt in 1990.

Most of the campaigns present the closures as an economy measure to eliminate NHS overspending. Ms Hewitt will argue that her plans for restructuring the NHS are driven by the need to save lives, not money.

She will also present reports by Sir George Alberti, the government’s emergency care tsar, and Roger Boyle, the heart disease tsar, calling for patients with the most serious conditions to be treated in specialist centres.

Sir George is expected to back proposals from the Royal College of Surgeons and other senior clinicians for “super-regional” A&E; departments serving populations of between 400,000 and 500,000.

These plans imply that 50 or more of the existing A&Es; might be downgraded into urgent care clinics providing a less comprehensive service.

A Department of Health spokeswoman said: “Very few of 18.5 million people who attend A&E; departments have life-threatening conditions. Many are just in pain, while others are just uncertain. For these people it is better to offer more convenient and appropriate care closer to home.”

“But patients in a critical life-threatening emergency needed to be taken to super regional A&E; departments with 24-hour consultant cover and access to state-of-the-art diagnostic equipment.”

Lives could be saved if heart attack patients drove past the local hospital and went straight to a specialist centre for angioplasty, a new keyhole treatment for narrowed and blocked arteries. But not every hospital could justify employing the expert surgical team required to carry out the procedure.

The leaked memo was first published at:
http://society.guardian.co.uk/health/story/0,,1964123,00.html

Health Direct points out that it is frankly absurd for Hewitt to claim that the NHS’s cutbacks and closures are not motivated by cost savings when:

1) On March 21 ,06 Health Direct reported Hewitt puts job on the line in defence of NHS reforms by claimig to balance the NHS budget when Patricia Hewitt, the health secretary, put her job on the line over the National Health Service’s finances and pledged to press ahead with market-based reforms.

The NHS finances, heading for a £790m overspend on the latest available figures, had to be got right, she said. This will be her first year in full charge of the money “and I know I will be judged on this by the people”.

2) On Nov 22, 06- in Hewitt defends more NHS cash for Labour voting areas when Patricia Hewitt sparked new controversy over NHS funding last night after insisting that it was “absolutely right” that spending per head on health care was at least 35 per cent higher in many Labour areas than wealthier Tory ones. The Health Secretary told MPs that people in more prosperous areas had the “good fortune” to be in better health and as a result needed less allocated for their care.

Asked by a Tory member of the health select committee, Mike Penning, if it was fair that people in her Labour constituency of Leicester West received £1,300 per head in NHS spending, compared with £960 in his Hemel Hempstead seat, she replied: “I am satisfied that funding allocations are fair. I believe that reflects the very real differences in health areas, in the prevalence of disease between our two constituencies.”

Almost a third of the killings were committed by people judged by mental health staff not to be a risk to the public in the week before the killing.

One in six deaths were attributed to the failure to ensure that the mentally ill patients continued to take their medication once they had been released into the community.

Professor Louis Appleby, who headed the inquiry, said not enough had been done since the high-profile killing of Jonathan Zito in 1992 by a schizophrenic patient let out into the community.

The government has been promising new legislation for the past seven years but, until the publication last month of a mental health bill, has failed to implement ANY reforms.

Among those killed in that time are Brian Dodd, a retired accountant stabbed to death by a paranoid schizophrenic after care workers failed to check on the patient’s whereabouts every 12 hours, as required, and Detective Constable Michael Swindells, who was killed by another mental patient whose health workers did not check he was taking his drugs.

Last month an inquiry into the murder of Denis Finnegan, a retired investment banker, in Richmond Park, southwest London, found one of the reasons for his death was his killer’s failure to take his medication for paranoid schizophrenia.

Professor Anthony Maden, a psychiatrist at Imperial College London, who works at Broadmoor high-security hospital and advises the Home Office, said: “If you have close involvement with just one of these cases, you never ever want to see it again.”

Ministers will now push ahead with plans to introduce new community treatment orders — so-called mental-health Asbos — to force mental patients to take drugs after being released from hospital. Those refusing to do so risk being sectioned. The system for checking up on patients in the community will also be strengthened in the new year.

The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness found that 5% of all killings were committed by schizophrenics, who make up 1% of the population.

Appleby, who is also the government’s national director for mental health, said: “We have to acknowledge how many [killings] might have been prevented had we acted earlier. Quite a lot of these cases have preventable elements. For example, 25% of patients committing homicide had stopped taking their medication.

“We looked at how many might be prevented by the community treatment orders — how many patients were detained, subsequently stopped their medication and then went out to kill someone. The answer is 16% — one in six of the 52 homicides.”

Appleby said the inquiry had also uncovered a “big issue about risk recognition and management”. “What we have done is look at the timing of the last contact with [mental health] services,” he said. “In 29% of the 52 homicides, the last contact was in the week before the incident. In almost all cases the staff rated the risk as low or absent . . . the risk was underestimated.”

The study said 18 murders were committed by people with a history of violence who were not getting adequate treatment.

Speaking ahead of the report’s publication, Health Minister Rosie Winterton denied that the Government was failing to protect people from the dangerous mentally ill.

Ms Winterton said: “One of the problems at the moment is for the small number of people who are detained in hospital. If they are discharged there are some patients who don’t continue to take medication, who don’t continue to stay in touch with mental health services.”

But Marjorie Wallace, chief executive of the mental health charity Sane, said one in three of these homicides could be prevented.

Today’s blog was compiled from:
http://www.timesonline.co.uk/article/0,,2087-2484061,00.html
http://news.sky.com/skynews/article/0,,30000-13555128,00.html

On 16 Nov 06 Health Direct blogged: Scandal of Labour’s blunders that led to murder by mental patient as the needs of dangerous psychiatric patients are being put before the safety of the general public, according to a report on the murder of a retired banker by a mental health patient. The highly critical report into how a psychiatric patient at a south London hospital escaped and attacked Denis Finnegan as he cycled through Richmond Park will reveal how a catalogue of systemic errors led to his death.

Chaired by Robert Robinson, a mental health lawyer, the report is said to be one of the most damning in the past decade. Over 400 pages it details a catalogue of preventable errors at Springfield Hospital which led to Mr Finnegan’s murder. It concludes that a special medium secure facility in the hospital, the Shaftesbury Unit, must be closed pending an external audit.

London Ambulance Service was at a loss yesterday to explain why the crew had not noticed their journey was taking somewhat longer than expected or how they had managed to miss subtle indicators that it was going awry — such as Birmingham.

Their 400-mile odyssey began in the early hours of Tuesday when they were called to take a patient from King George’s Hospital in Ilford to Mascalls Park Hospital in Brentwood.

According to the AA route planner, that should have taken them 20 minutes.

The ambulance finally arrived at Mascalls Park eight hours later after ploughing up and down the motorway.

A spokesman for the service said the sat-nav device had an incorrect database which placed Mascalls Park in the Manchester area.

He failed to explain why the driver and his colleague had not suspected something might be wrong.

“We believe that the crew, who had not been to this particular hospital before, followed the directions given by the navigation system, without manually confirming their destination,” he said.

“We understand that they reached the outskirts of Manchester before realising they were heading to the wrong destination.”

Easily done.

And the patient? “The patient was comfortable throughout. He slept through the journey and arrived safely in the afternoon.”

The spokesman added: “The problem with the navigation database is now being fixed.”

He did not know whether the crew were to face a reprimand.

Taken from:
http://www.telegraph.co.uk/news/main.jhtml;jsessionid=AWKETPMXQUHCRQFIQMFCFGGAVCBQYIV0?xml=/news/2006/12/02/nsatnav02.xml

Although Health Direct can not condone the waste of resources in the ambulance and it’s crew trundling up the M25, M1 and M6 and back down again, it raises the question in a rather comical fashion of whether skilled NHS staff are now so blinded to using their own common sense having become used to the avalanche of centralist orders and targets from Downing Street.

Three of the trusts with the worst financial problems have each paid out over £1m to finance the management consultants. Surrey and Sussex Healthcare trust came out on top with a £1.5m bill. The Department of Health contributed just £93,000 towards the costs.

The figures were revealed in a 300-page memorandum from the Department of Health to the Commons health select committee’s annual inquiry on public expenditure. The response was one of the answers to over 140 questions posed by MPs contained in the dossier.

In the document, the DoH admitted the accuracy of HSJ’s revelations on the estimated redundancy costs of the current NHS restructuring (news, page 5, 24 November 2005). The evidence said the cost of payments to staff who lost their jobs under the reconfiguration of primary care trusts and strategic health authorities has been projected at ‘around £325m’, assuming an average age profile.

And the report showed that the DoH spent a massive £133m on management consultants last year -more than the £94m projected net deficit for the NHS next year.

It confirms that the DoH underestimated the annual cost of the consultant contract by £90m, and the Agenda for Change contract for nurses and managers by £220m, due to mistakes in calculating overtime and the cost of replacing staff working fewer hours under the contract.

The document also shows that in 2005-06 PCTs overspent by £196m on the GP contract, due to better than expected results from the quality and outcomes framework, and extra spend on out-of-hours care.

This was despite a £322m injection from the DoH to help PCTs commission and provide new services after 90 per cent of GPs opted out of the out-of-hours part of their contract.

The memorandum shows that in 2005-06 total management costs rose on the previous year to £2.6bn; but as a proportion of total NHS spend it fell slightly, to 3.7 per cent. Nevertheless it reveals that the number of managers and senior managers has leapt by more than three-quarters since 1997.

The £21.1m turnaround bill comprises only 97 trusts and PCTs. Since the figures were compiled for MPs in May, the number of turnaround teams has risen to 143.

Turnaround trusts have had to fund their own support; the DoH only contributed £93,000 towards the first three months of the 23 turnaround trusts with the deepest problems.

NHS Confederation chief executive Dr Gill Morgan said: ‘Before we can say whether this has been money well spent, we need to know what has been released in terms of savings. If it has delivered more than £22.1m it will have been money well spent; if it has only delivered £5m it may have been a waste.’

Of the extra £5.5bn invested in the NHS last year, 56 per cent was spent on pay and 33 per cent on drugs and supplies.

The HSJ first published the findings at:
http://www.hsj.co.uk/healthservicejournal/pages/n5/061130

On Sept 12, 2006 Health Direct commented that the NHS external manager bill soars to over £172m this year when the NHS in England is set to spend £172m this year on external management consultants – a rise of 83% in two years – the Conservatives have claimed. The Tories warn spending on managers is detracting from clinical services. Welwyn Hatfield MP Grant Shapps used the Freedom of Information Act to obtain figures from 76% of NHS trusts. The data shows a link between trusts with the biggest debts and most job cuts, the Tories said.

The labour government has also enlisted companies like KPMG and Price Waterhouse Coopers to act as “turnaround teams” for some failing trusts.

In their report, the Tories said trusts’ spending on management consultants was increasing, and that the use of consultants was a “reliable yardstick” for job losses and debts. The report added that a total of £93.8 million was spent in 2004/05 on external consultants, rising to £117.9 million in 2005/06.

The projected spend for was 2006/07 is £171.6 million. However these new figures suggest that even this figure may be an underestimate of how Labour is wasting our money.