While doctors now make less in basic pay – about £55,000 on average – they have been able to top-up their earnings by hitting targets under a performance-related bonus scheme.

Opponents have often criticised the labour government, claiming they mishandled the contract, which is now contributing to NHS deficits.

Earlier this month, Health Secretary Patricia Hewitt admitted she wished the government had capped the profits doctors could take out of the practices because of the soaring sums. Please also see also the abridged Health Direct posting below from last year.

Dr Fradd was part of the negotiating team representing the British Medical Association during the two years of talks between 2001 and 2003, although he is no longer on the BMA’s GP committee.

Interviewed for BBC Radio 4′s The Investigation, which will be aired on 1 February, Dr Fradd said doctors had never believed the government would be willing to allow them to opt out of out-of-hours care.

And when they did, he was surprised the NHS Confederation negotiating team, acting on behalf of the government, was only asking for a 6% cut in pay.

He added: “We got rid of it for effectively 6% of the value of the contract. It was just stunning. Nobody in my position had ever believed we could pull it off but to get it for 6% was a bit of a laugh.”

Since the contract came in, nine out of 10 practices opted out of providing care.

NHS trusts have put alternative arrangements in place, but hospital A&E; departments have reported an increase in patients.

In a separate interview, he told the BBC that he still thought the contract offered good value for money for patients as GPs were still taking up a relatively small part of the NHS budget.

“I think the government underestimated how much out-of-hours care was worth, but there are other parts of the contract, such as performance-related pay, which were harder to sell to doctors.”

Looking back on the new contract, NHS Confederation chief executive Gill Morgan said she felt there were too many sweeteners in the deal offered to GPs. “I think it is always easy to underestimate how strongly GPs respond to an incentive that gives them money.”

Dr Hamish Meldrum, chairman of the British Medical Association and a member of the BMA negotiating team, would not reveal how much the negotiators would have accepted when it came to the opt out although he said it was “not a sticking point”.

“There were areas of the package where big concessions were made. We agreed to other providers in general practice and the other one was performance-related pay.”

The Investigation, BBC Radio 4, 2000 GMT, 1 February, 2007.

From:
http://news.bbc.co.uk/1/hi/health/6314301.stm

On Dec 18, 06 Health Direct wrote that Labour’s mismanagement has led to NHS deficits when mismanagement at all levels of the NHS in England has led to the current multimillion pound deficit, a committee of MPs has found.

The Commons health select committee said existing deficits were made worse by the cost of new staff pay deals and the expense of meeting NHS targets. Last year’s NHS deficit was £547m.

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.

The health department has offered several explanations, including high inflation in the construction industry, the decision to provide more single rooms and expansion in the services planned. But Edward Leigh, the committee’s chairman, said the department “must crack down” where the cost of schemes is forecast to rise.

Mr Leigh was commenting as the committee published a report into the plan to build a £900m PFI hospital in Paddington, London, on which almost £15m was spent before being pulled.

That, Mr Leigh said, was the result of “appalling planning and forecasting” locally, combined with the department failing to challenge the scheme properly.

A review of big PFI hospital projects is under way with the capital programme set to be scaled back from £13bn to about £7bn-£9bn.

Through that, said the department, the closer oversight the committee wants is already being provided. In turn, that should prevent a repeat of the Paddington Campus failure, it said.

The committee said the department’s “hands off” approach meant “there has been too little control of the capital investment programme”. It “remains to be seen” whether the review will be sufficient “to get a grip on a programme which continues to be managed by the NHS locally”.

http://www.ft.com/cms/s/2e0262ba-b007-11db-94ab-0000779e2340.html

Health Direct applauds the Public Accounts Committee’s decision to scrutinise the proposed PFI NHS plans.

Only last week (Jan 22, 07) we reported that PFI firms make £23bn profits from NHS as the private sector will make £53bn in profits and interest over the next 30 years by building NHS hospitals, campaigners have calculated.

Under the private finance initiative, a company builds a hospital and then gets “rent” from the NHS for a set term. A report by the Keep Our NHS Public claims the Labour government is carrying out “patchwork privatisation” of the NHS.

“When the NHS is making cuts and closures across the country, it’s time to ask if this is the best use of public money” said Alex Nunns of Keep Our NHS Public

It says: “Unlike the Thatcher privatisations of the 1980s, the whole NHS is not being put up for auction. Instead, it is being parcelled up into bite-sized pieces and handed over to private control bit by bit. This is happening on such a scale and at such pace as to make it a unique phenomenon.”

Alex Nunns, of Keep Our NHS Public, said: “Unbeknown to the public, the NHS is paying astronomical sums of money to the private sector. When the NHS is making cuts and closures across the country, it’s time to ask if this is the best use of public money.”

The figures, which emerged in a response to a Parliamentary Question tabled by Shadow Health Secretary Andrew Lansley, showed that the NHS would pay a total of £53bn to the private firms involved.

The poll also asked what factors members of the public thought should influence decisions.

Half of the respondents thought the effectiveness of treatment was the most important factor, while 38 per cent said whether the treatment would be used to treat a life threatening condition should be taken into consideration.

Of the 969 polled, just 22 per cent said cost of treatment should be taken into account. Eighteen per cent thought local trusts should consider whether other treatments would have to be withdrawn as a result.

However, the poll did not ask directly whether ministers should be involved, despite the health secretary last year urging primary care trusts not to restrict the cancer drug Herceptin, before it was approved by the National Institute for Health and Clinical Excellence.

From:
http://www.hsj.co.uk/healthservicejournal/pages/n1/p9/070125

The poll of 969 members of the public, conducted by Ipsos MORI, asked which groups should make decisions about which medicines are funded by their local NHS. Respondents were given a list of six groups to choose from.

Only one in 11 (9 per cent) think MPs should be part of the decision making process. Even less people (6 per cent) think local councillors should have a say.

On average respondents opted for a combination of two groups to make decisions about the funding of treatments. Unsurprisingly, most people (70 per cent) think that clinicians should be involved. Patient representatives are the second favourite with 33 per cent of participants thinking they should contribute to the process.

The report from the Public Accounts Committee says obesity costs the nation around £3.5 billion, which will rise to £4.5 billion in three years if the trends continue.

Parents should be told when their children weigh in as overweight or obese, they say, overruling fears that children would be stigmatised.

“If a primary school finds that a child is overweight or obese then the parents must be informed,” Edward Leigh, the chairman of the committee, said. “To do otherwise would be to keep parents in the dark about possible serious health risks to their children.”

The report says obesity among two- to 10-year-olds rose from 9.9 per cent in 1995 to 13.4 per cent in 2004. Mr Leigh said: “Unless we act, the proportion of children who are obese will increase rapidly.”

But changing the behaviour of children and their parents was “tricky territory”, he added. “It is therefore all the more urgent that the departments involved work together to set a clear direction.”

The Public Accounts Committee identified a “complex” chain for tackling childhood obesity which involved 26 different bodies and suffered from “confusion over roles and responsibilities”.

The departments of Health, Education and Culture, Media and Sport set a joint target three years ago to halt the increase in obesity among under-11s by 2011.

Mr Leigh said: “It is lamentable that there is still so much dithering and confusion and still so little co-ordination.”

It was revealed last summer that the Department of Health’s nationwide survey to measure children had failed because less than half of parents gave permission for their children to be weighed.

The report says: “The department of health had initially decided not to tell parents or children the results unless they asked for them, because of concerns raised . . . about potential stigmatisation and bullying in schools.”

The committee had told the department that “failing to tell parents that their child is dangerously overweight could lead to the risk of serious illness or death”.

Tam Fry, for the National Obesity Forum, said: “The Department of Health was totally wrong when it decided to make it difficult for parents to find out about their children’s weight. I am absolutely clear that the parents should get this information. It is essential that they should receive it as of right.”

Some parents, he added, were in denial over their children’s problem or ignorant of it. Mr Fry praised a system in Birmingham primary schools were all children were weighed and measured as part of learning about numbers as part of the curriculum.

“I want to see this idea rolled out across the nation,” he said.

Andrew Lansley, the shadow health secretary, said the Conservatives shared the committee’s alarm at the dramatic increase in childhood obesity and the apparently unco-ordinated way in which the Government was dealing with it.

“We are over two years on from the Labour’s public health White Paper, with no sign of any progress in halting the rise in childhood obesity — let alone reversing it. This report suggests that the Government is thrashing about with a series of loosely connected initiatives in the hope of it amounting to a strategy,” he said.

Norman Lamb, the Liberal Democrat spokesman, said: “Unless action is taken now an entire generation will suffer increased rates of serious disease like Type 2 diabetes and heart disease.”

Caroline Flint, the public health minister, said childhood obesity was a complex issue, as the Public Accounts Committee recognised.

“There are no easy answers or quick-fix solutions. Changing behaviour requires long-term action on a number of fronts and that is what we are putting in place. The Government will consider the report carefully before making a full response,” she said.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/01/25/nfat25.xml

The supreme irony is that as people live longer the value of thier pensions is plummeting as greedy gordon brown’s stealth taxes our pension’s growth and when we do fall ill in our dotage all of the eldery care homes will be full or closed – or darned expensive in what is left of the private sector.

On Dec 20, 05 in Health Service Ombudsman Watchdog targets the scandal of means test injustice, Health Direct then pointed out that many elderly people are still not getting their care costs met, and the Health Service Ombudsman Ann Abraham has had enough. Health authorities’ bungling of means tests for long term care fees prompted the watchdog to act to try to stop the scandal once and for all.

Tens of thousands of family homes are sold each year to pay for the cost of long-term care – but many families that should receive help from the state do not.

Ann Abraham, the health service ombudsman, produced new checklists after becoming increasingly frustrated at the haphazard approach taken by many health authorities. She issued her first damning report into the scandal of misapplied means tests nearly three years ago. Yet despite further criticism since then, she still has cases waiting to be reviewed correctly by health authorities.

Ms Abraham found in February 2003 that many elderly infirm patients have been forced to pay for care that should have been funded by the state. This happened because their health authorities failed to assess their case properly. Ms Abraham ordered a review of all cases back to 1996.

The general rule is that, if the care someone needs is personal, such as help with dressing, they must pay for it themselves. If medical care is needed, the NHS should pay.

The poll underlines the scale of the job facing Gordon Brown if he is to renew support to win a fourth general election. On nine key issues that shape the way people vote, Labour now has a lead in only three. The political map of Britain has been reshaped since 2005, with the Tories now ahead as the party with the best policies in such former Labour stronghold areas as education, tax and public services. Labour leads only on the fight against terrorism, the economy and health.

Labour has a one-point lead as the party with the best policy on the NHS – in contrast to a Guardian/ICM poll in May last year that put the Conservatives narrowly ahead. It can also draw confidence from a narrowing of the gap on some other issues, such as law and order, despite a series of difficulties at the Home Office. But Labour’s lead on the economy is slipping – five points ahead of the Conservatives compared with 20 points at the last general election.

The poll also suggests that the issues on which Labour is most trusted are declining in importance. The economy, the second most important issue in 2005, is now sixth, behind the environment – an issue on which the Conservatives lead.

Meanwhile, the public’s personal backing for Tony Bliar is also falling, suggesting that the worsening situation in Iraq and the impact of the police investigation into the possible sale of honours is having an effect Almost two-thirds of those questioned, 62%, say their opinion of him has become worse over the last year, including 45% of Labour supporters.

Gordon Brown has also suffered, although not to the same extent. More people, 30%, say their view of him has become worse over the past year, compared with 17% who think their view of him has improved. Almost half, 49%, say their opinion of him has not changed – and Mr Brown’s reputation among Labour supporters has grown overall.

By contrast, David Cameron has gone up overall in public estimation, with 25% of those questioned saying their opinion of him has improved in the last year against 14% who say it has gone down.

Sir Menzies Campbell, the Liberal Democrat leader, can draw confidence from the poll, which shows support for his party recovering and finds that the public view of him has remained largely unchanged, despite a difficult first year as leader.

Overall, the Conservative party has a six-point lead among people who say they are likely to vote at the next general election, a slight narrowing of the gap over the last month. The Tories are on 37%, down three points on last month’s Guardian/ICM poll, with Labour on 31%, down one. The Liberal Democrats will be relieved by their rise to 23%, an increase of five points from last month’s unusually low score.

Support for the Liberal Democrats has grown in this month’s poll because the party has picked up the backing of some former Labour voters and because Lib Dem backers are now more likely to say they will turn out to vote.

The poll also shows that there is overwhelming enthusiasm for a general election once a new Labour leader is in place, with 76% of voters saying they would like Mr Brown to call a contest within a year if he enters office this summer, including 76% of Labour supporters. Only 19% think Mr Brown would be right to delay an election, which must take place by 2010.

The reality is that he will only call an early election if he is likely to win it. Asked how they might vote in a contest with Mr Brown as leader, against David Cameron and Sir Menzies, Labour would remain steady on 31% while the Tories would gain two points to 39%, a margin that would put them on the brink of a majority in the Commons.

The reality is that many voters will not make up their minds until Mr Bliar has left office. The fact that the question – unlike the regular survey of party support – names party leaders also makes direct comparison with the regular survey of voting intentions potentially misleading.

But the fact that such questions routinely show that the Conservatives would extend their lead if fighting Mr Brown do suggest that a change of leader will not in itself solve Labour’s problems.

www.icmresearch.co.uk
http://www.guardian.co.uk/frontpage/story/0,,1996532,00.html

The decline in trust in labour’s ability to run the NHS competently has been plummeting for months. On Oct 25, 06 Health Direct noted that Labour’s support at lowest level since Thatcher’s last election victory in 1991: when support for Labour dropped to its lowest level in almost 20 years with the Conservatives opening up a potentially election-winning 10-point lead, according to a Guardian/ICM poll published today. Labour has the backing of only 29% of voters, equal to its lowest-ever level of support in a Guardian/ICM poll – recorded in May 1987, a month before Margaret Thatcher won a third term.

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.

But as yet few doctors have the real budgets that fundholding and some of its more ambitious subsequent developments provided.

Despite the growth in practice-based commissioning, primary care trusts still do most of the contracting with hospitals and otherproviders.

The Conservatives appear keen to focus less on numerical targets and more on measuring whether patients’ health improves. Mr Cameron and Andrew Lansley, the shadow health secretary, acknowledge that they need to discuss with doctors how that might be achieved.

It is a subtler position than the one the party adopted before the last election, when they simply trumpeted their determination to scrap all targets.

The problem they face is that while too many targets, or poorly chosen ones, can distort patient care and lead to “cheating” over figures, targets do deliver results.

That was starkly illustrated a little over a year ago when the NHS in England achieved the aim of no patient waiting more than six months for an operation – although there were still more than 900 patients waiting at English hospitals for treatment because they had been referred from Scotland and Wales. Neither country had such a target and the hospitals thus faced no obligation to treat them within six months.

Mr Lansley said the aim was “to use measures of health outcome which reflect the quality of service provided from start to finish of care”.

The British Medical Association said it would welcome the change if the targets were evidence-based, while the NHS Confederation said it was “an important step in the right direction”. The service needed to measure not just how many things it did but whether patients actually got better as the result of treatment.

From:
http://www.ft.com/cms/s/2929bf84-aa87-11db-83b0-0000779e2340.html

Health Direct has frequently raised the issue of waste that labour’s blizzard of targets has created for the NHS. On Dec 18 06 in Labour’s mismanagement has led to NHS deficits according to Commons Health Select Commitee Mismanagement at all levels of the NHS in England has led to the current multimillion pound deficit, a committee of MPs has found. The Commons health select committee said existing deficits were made worse by the cost of new staff pay deals and the expense of meeting NHS targets. Last year’s NHS deficit was £547m.

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.
http://www.healthdirect.co.uk/2006/12/labours-mismanagement-has-led-to-nhs.html

At the heart of the changes is the creation of a market that welcomes profit-driven international corporations who answer to shareholders, not patients. This market will compel hospitals and health professionals, who have traditionally cooperated to deliver healthcare, to compete with each other and with the private sector. Far from supporting the NHS, the private sector is in competition with it, and is already draining away resources and staff.

If these reforms continue the nature of the health system will change radically:
* Income and profits will increasingly come before patient needs and clinical considerations.
* Greater inequalities in healthcare will appear, as profitable services and patients attract money at the expense of unprofitable ones.
* Forced market competition among NHS hospitals and primary care will break up the NHS as a network of collaborating bodies that share resources and information. Our integrated NHS GP service will be lost. There will be winners and losers, with some units and even entire hospitals having to close. We are already seeing job losses and bed closures in NHS hospitals.
* Even more of the new money allocated to health will be diverted to shareholders and company profits, and wasted on the huge administrative costs associated with establishing and running a market.

There is no evidence that these reforms will improve the health service. And in spite of increased spending on healthcare, and labour government commitment to “patient choice”, the end result of these reforms will undermine the choice that is most important to patients – access to comprehensive, trustworthy, and local health services.

The situation is grave. The value of the NHS is immense and cannot be mirrored by the private sector. It must be kept in public hands, serving the interests of all patients and the broader public, not the private healthcare industry.

We therefore call on organisations, healthcare workers, patients and the public to campaign to protect the NHS from further privatisation and fragmentation, and to keep our NHS public.

The campaigning Keep Our NHS Public website can be found at:
http://www.keepournhspublic.com/launch.php

The report was being launched at a conference for health campaigners in London on Saturday.

“When the NHS is making cuts and closures across the country, it’s time to ask if this is the best use of public money” said Alex Nunns of Keep Our NHS Public

It says: “Unlike the Thatcher privatisations of the 1980s, the whole NHS is not being put up for auction. Instead, it is being parcelled up into bite-sized pieces and handed over to private control bit by bit. This is happening on such a scale and at such pace as to make it a unique phenomenon.”

Alex Nunns, of Keep Our NHS Public, said: “Unbeknown to the public, the NHS is paying astronomical sums of money to the private sector. When the NHS is making cuts and closures across the country, it’s time to ask if this is the best use of public money.”

The sums
As recently as October, the government disclosed some of the figures involved in the NHS’s use of PFI schemes to finance new hospitals.

The figures, which emerged in a response to a Parliamentary Question tabled by Shadow Health Secretary Andrew Lansley, showed that the NHS would pay a total of £53bn to the private firms involved.

That amount was the total cost, as opposed to the numbers in the report by Keep Our NHS Public, which relate to profits.

But the Tories claimed at the time that the new hospitals themselves were only worth £8bn, leaving “completely unjustifiable” extra costs of £45bn.

A spokesman from the Department of Health said in response to the new report that the annual payments made by NHS trusts to private sector partners covered financing charges, repayment of capital, building maintenance and, in most cases, all the non-clinical support services like cleaning and catering.

From:
http://news.bbc.co.uk/1/hi/health/6279889.stm

The fleecing of the NHS by Labour’s extortionate PFI financing has been a founding worry of the Health Direct blog.

On Aug 16 06 in PFI profits exposed by Channel 4 as greater than credit card companies- Public Service, Private Profit, Liam Halligan revealed how the private funding of state schools and hospitals is draining hundreds of millions of pounds from frontline services, while creating a £4 billion-a-year industry and a new elite of publicly-unaccountable PFI professionals.

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

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

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

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

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

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

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

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

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

Chris Grayling, the shadow transport secretary, said the omissions included the fact that 46 per cent of people expected the health service to get worse over the next few years, and the Government’s approval rating on public services had dropped by 46 points in the past five years. The results also showed the public “have pervasive concerns over a political culture of spin and deceit”.

Other embarrassing poll findings not mentioned were that the public was “deeply concerned about crime” and that 74 per cent wanted the Government to build more prisons.

Ministers were condemned by respondents for “lack of consultation on legislation” and for “violating manifesto promises”. The Tories said they had obtained a full copy of the Ipsos MORI research which concluded: “Spin is certainly nothing new. However, the difference is now politicians are seen to be more adept at it and more open about it.

“This openness and awareness has made people more sceptical and more likely to question government information.”

Mr Grayling said last night: “We have been telling ministers for years that the cuts in the NHS are damaging services, that the public have had enough of the culture of spin. But as soon as their own research reveals it, Labour spin doctors try to hide it.”

A spokesman for the Cabinet Office dismissed the claims yesterday, saying their website contained a link to the findings of MORI’s research, which was commissioned by them for discussion by business and public sector representatives.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/01/17/npols17.xml

Health Direct noted on Jan 04, 07 in Public mistrust of labour’s govt statistics remains high that selecting and presenting “good news”, however, is to miss the point. There is an industry doing that. At its centre is the labour government, with a stream of press releases describing how its policies have made our great country greater. The private sector’s PR machine floods us with even more good news.

The problem is that it can be mistaken for spin since it nearly always comes from a source with a vested interest. One Office for National Statistics survey showed that only 17 per cent of us believe official figures are produced without political interference, and only 14 per cent say the labour government uses official figures honestly.

Data showing a decline in hospital waiting lists – ostensibly good news – were among the least trusted. Yet the gaps in the list data and the exposure of practices in some hospitals that made lists appear artificially shorter have further damaged trust.

Labour politicians, it must be said, have “form”. Until recently, a section of the Labour party website showed that each of 30 or so variables quoted for each constituency had improved since it came to power. Labour had carefully selected the start date for the comparison: if the trend had not improved since 1997, it tried 1998. If that did not work, it tried 1999. If the constituency was a basket case, it presented regional figures.

Below is another Mori poll from last year- Nov 28, 2006 when Labour continues to pay the price for NHS cutbacks when the public remained deeply sceptical over the labour government’s ability to improve public services and the economy, according to the latest findings from Ipsos Mori’s public delivery index. A mere 19 per cent of adults believe the National Health Service is getting better, against 46 per cent who believe it is worsening. Just one person in 100 believes the NHS will get better over the next few years, against 13 who believe it will get much worse. (Which proves the adage that you can fool some of the people some of the time- but eventually people will see through the spin and lies.)

She claimed some that patients only saw a nurse when drugs were being handed out, days went by without them seeing consultants and they had to virtually beg for help to move in bed or to go to the lavatory.

Dr Teale said: “It was very upsetting to see relatives develop bed sores, which are painful and distressing and could so easily have been prevented if they had been helped to change position regularly.

“Another relative suffered prolonged nausea, causing weight loss, dehydration and weakness, which could have been prevented with anti-sickness drugs. It really annoyed me because it would have been prevented with the most basic care.”

“I was surprised and annoyed by what I found when I experienced the NHS as a relative rather than a member of staff. I think the trend for shorter hospital stays mean most patients have a pretty good experience but that is not the case for the elderly, who are weaker.

“People will disagree with me but I felt I had to start a debate, because the medical profession needs to acknowledge this. It is madness to spend thousands of pounds on fancy surgery if patients are allowed to develop complications.”

Dr Teale believes it is a systemic problem because there is so much emphasis on getting patients seen as outpatients or day cases.

She says the problem has been sparked by changes in the training and role of junior doctors, who now work fewer hours to meet European law.

Senior nurses are trained to carry out some ward care which used to fall to junior doctors and this, combined with high turnover of patients and occupancy rates, meant that many patients received the majority of their care and contact from untrained auxiliary staff who may not spot
complications.

Recent studies show that three of the four commonest causes of delayed discharge are associated with inadequate care on the ward.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/01/17/nabuse117.xml

The ironically named Hope Hospital hit the headlines earlier this year (Jan 02, 07) in the Labour leader defends hypocritical charges over NHS closures in her constituency when Cabinet minister Hazel Blears defended her decision to take part in a protest over plans to close part of a hospital in her constituency. The proposals for Hope Hospital in Salford, Greater Manchester, are part of the controversial NHS shake up throughout the country.

Ms Blears, Labour chairwoman, said: “My first and foremost job is to represent Salford and the people of the area.” It is very rare for a minister to directly oppose labour government policy.

This view was echoed by Ms Blears’ Conservative counterpart Andrew Lansley, who said she needed to consider whose side she was on.

“It is a labour government policy to say that units must be much larger. So if Hazel Blears doesn’t like what happens as a consequence of government policy in her constituency, then perhaps she should change the government policy – or get out of the labour government.”

One member of staff was jailed for six years last summer after being charged with rape of a woman resident who was considered unable to give consent due to her low mental age. A second staff member had been given a suspended sentence for a sex offence against the same woman a year earlier.

The report by the official healthcare watchdog into conditions at units run by the Sutton and Merton primary care trust also reveals that inspectors found another woman resident “for many years” had her arm tied to a splint for most of the day, apparently to prevent her putting her hand in her mouth and developing sores.

The investigation found people with learning disabilities living at Orchard Hill hospital in Carshalton, south London, and other units run by the trust had been treated in outdated and infantilising ways. Living conditions were impoverished, routines arranged for the convenience of staff and organised activities at the hospital provided for less than five hours a week.

The commission’s findings follow its report last summer on abuse of learning disabled people in services run by the Cornwall Partnership NHS trust.

There, one man who had no speech, sight or hearing was tied to his wheelchair or bed for up to 16 hours a day, ostensibly to stop him harming himself. The commission is launching an audit of learning disability services across England and will inspect 200 of them. Fiona Ritchie, who heads the commission’s work on learning disability, said: “People have lived like this for too long.”

But ministers are poised to step in before the commission uncovers any more scandals, by ordering that the NHS surrender its lead role, and will pass more than £2bn in funding to local councils.

A policy review within the Department of Health is nearing completion after Ivan Lewis, care services minister, told parliament he intended to strengthen local government’s role.

Rob Greig, the government’s co-director or “tsar” for learning disability, told the Guardian: “This is another case where the NHS has been shown to fail in commissioning services for where people live and how they get support. My personal view is that the NHS should be transferring responsibility to local authorities and focusing on commissioning good-quality, mainstream healthcare for people with learning disabilities.”

Sutton and Merton PCT is already preparing to hand over its role, other than in the area of personal health. Caroline Taylor, its chief executive, said: “I don’t think the PCT is the best organisation to be providing learning disability services. Most people who use the services primarily have social needs rather than healthcare needs.”

Councils control more than £3bn of learning disability services, but the NHS in some parts of England has clung to the lead role and not established working partnership arrangements with councils despite the evolution of community care and the closure of long-stay hospitals.

Taken from:
http://society.guardian.co.uk/socialcare/story/0,,1992102,00.html

So die all who try to reform the National Health Service. They have been doing so since a despairing Margaret Thatcher appointed Roy Griffiths, boss of Sainsbury’s, to the task in 1983. The NHS is the North-West Frontier of the public sector. If the health union Tajiks don’t get you, the Pashtun consultants will. You can throw as many men into the Khyber Pass as you like but they never return.

The one laugh in the programme was Robinson’s conclusion that the NHS was “unmanaged”. Yet each frame was crammed with managers falling over each other, with clipboards, pagers, consultancy reports and meeting agendas. There were nursing managers, surgical managers, recovery managers, manager managers, chief executive managers. The one thing they did not do was manage but that, of course, was not their fault.

Through this jungle wandered a charismatic megaspecies, the consultants, whom everyone agreed were “unmanageable”. They were like the weather, an immutable constant. It did not matter what the NHS or its patients wanted, the consultants ruled, which enabled everyone else to be equally obtuse. They seemed to regard their first duty as to the heraldic privileges of their specialist tribe, be it paediatrician, anaesthetist or ophthalmologist.

We watched the consultants, often in league with “health and safety”, blocking rationalisation of a system that had some of them doing three operations a morning and some seven. They demanded their own anaesthetists, who in turn demanded their own schedules. Surgeons wandered in and out of their private practices as waiting lists stretched over the horizon.

NHS productivity would not improve because the fruit machine never yielded oranges in a row. There was always a lemon in the way — unless you were lucky enough to have Robinson and a television camera to move it.

The message of Robinson’s inquiry was devastating and explains the ostensibly terminal chaos enveloping the NHS under Patricia Hewitt. The central arm of government, the Treasury, has clearly given up on NHS reform. No government, Labour or Tory, has the guts to break the consultants’ restrictive practices, the GPs’ “lifestyle” demands or the healthcare unions.

The Treasury itself capitulated to the unions by rubber-stamping the ridiculously expensive 2004 NHS pay deal, depriving Britons for the first time of proper out-of-hours GP cover.

After a quarter century of seeing money piling up in the upper echelons of the NHS, and being wasted on management consultants and useless computers, the paymasters have had enough. While Thatcher hoped for reform by shoving the private sector into the NHS, Gordon Brown is shoving the NHS into the private sector.

If Rotherham hospital can do only half a dozen cataracts a session when it has capacity for 20 or 30, why not give the job to a bunch of South Africans in a caravan in the car park? Outsource routine operations. Switch a few regional general hospitals to accident and acute care and let the public drive to find them. Hence the decision to subcontract 40% of NHS operations to something called a “partners’ network” (Blairism for the private sector). We can hear a muffled cheer rising over the Thatcher home in Chester Square.

Treasury loss of faith in the corporate NHS has all but collapsed public investment in the hospital service, switching some £12 billion of it to private finance. This will be astronomically expensive, consuming reserves that would previously have gone on healthcare. The new Woolwich hospital must find £100m a year from its revenue budget and the Royal London and Barts £120m to service private loans forced on them by the Treasury in the fond belief that private money is more “efficient”.

More alarming is that internal pricing and payment-per-treatment will leave these mastodons financially exposed through loss of business to the private sector. In an attempt to favour this sector, the Treasury and Hewitt are refusing to allow NHS hospitals to cut tariffs to compete. Small wonder James Johnson, the British Medical Association chairman, parodied Blair’s 1997 battle cry, “24 hours to save the NHS” by saying there was now “one year to save the NHS”.

Many hospital trusts are building up large deficits that they cannot possibly cover; 29 are contemplating some 60 “reconfigurations”, code for closures, at a time when Hewitt is also talking of somehow building 50 cottage hospitals. She must also now contend with 11 of her ministerial colleagues declared to be in open opposition.

Meanwhile manpower planning is in disarray, with hiring cuts or freezes almost everywhere and a reported surplus of 3,200 expensively trained NHS consultants by 2010.

How this has been achieved despite five years of 7% annual real rises in health spending is no mystery. A lethal coalition of medical staff and private financiers is walking away with the money. Few demoralised managers will bother to imitate Robinson’s efforts at Rotherham when the lead from Whitehall is to capitulate.

Since many trusts are supposedly free-standing which means bankruptable — it is possible that swathes of the NHS will end the decade in the notional ownership of City banks. Yet even this, for Brown, is preferable to the existing NHS.

The Robinson programme showed what amounted to the collapse of the “public service ethos” in Britain. The government would ideally like to privatise not just the bulk of the NHS but the Post Office, the probation service, the jobcentre network and, it was reported last week, most care of the elderly.

It has clearly lost confidence in the capacity of public officials to administer services (as opposed to regulate and form policy in Whitehall). That this should be the work of a Labour government is ironic since the purpose is to circumvent those classic legacies of socialism: trade unions and the risk aversion of large organisations.

Nothing better illustrates this than the shambles at the Home Office where privatisation is of limited application. Its capacity to administer a service, be it immigration, drug treatment or prisons, has all but failed.

Its boss, John “not fit for purpose” Reid, has rewritten the rulebook of corporate accountability. He will take no collective responsibility for the actions of his forebears as home secretary, though he sat in the same cabinet as them. Nor will he take blame for any decision if he can prove he was “not told about it”. Bang goes the theory of corporate negligence.

The catalogue of Whitehall organisations no longer fit for purpose is lengthening by the week. It embraces the farm payments agency, the child support agency, the immigration service and the criminal assets recovery agency.

In the old days such fiascos would have led to parliamentary uproar and heads rolling. Nowadays they are part of the tragic Whitehall soap opera, cause for rejoicing only among civil servants leaving to join management consultancies and parastatals such as Capita and Serco.

It is hard to imagine what morale must be like among officials in the Home Office or health department. Perhaps the public service ethos is out of date, irretrievably polluted by trade unionism and bureaucratic protectionism. Perhaps it is true that only the hope of personal gain will induce Britons to help their fellow men and women.

I am reluctant to reach that conclusion. The boundary between public and private action must be redefined and the former remoralised. It was a failing of Thatcherism to throw out the baby of social duty with the bathwater of socialism.

Between the charitable sector and the private there has always been a tier of “public servants”, moved in part by philanthropy and in part by patriotism. The title has conferred honour and status but not riches on those who serve their country in peace and war. One day we will miss them.

Taken from:
http://www.timesonline.co.uk/article/0,,2088-2546207.html

In the letter, Mr Lansley said he was concerned that the DoH ‘appears to have lost control of the tools needed to manage workforce numbers’. He quoted the draft document’s warning that ‘with decisions on workforce planning now led by SHAs, the levers available to us to ensure that workforce supply meets demands of the service across the NHS are now limited’, as well as its plea to SHAs to restore recent reductions in nurse training.

He wrote: ‘I was under the impression that the reason for devolving workforce planning to SHAs was to ensure that the supply of staff more adequately matched demand. It seems now that your department has lost confidence in the ability of SHAs to perform this task.’

He asked whether the DoH would take back control of their education and training budgets if SHAs failed to take the ‘clear strategic direction for workforce development’ that the draft strategy called for.

Mr Lansley also asked why the projections revealed last week suggesting an excess of consultants and allied health professionals by 2008-09 were so different from those in a 2004 document which assumed a shortage of 1,040 consultants in the same time.

And he was ‘bemused’ to see that ‘the rationale given for restoring nursing training commissions was a fear that nursing wages would otherwise rise beyond what was affordable as opposed to any genuine desire to improve care for patients.’

NHS Employers deputy director Sian Thomas feared the draft report’s gloomy predictions would deter people from pursuing careers in the health service. She commented: ‘There’s no doubt that the labour market is changing. But it’s important we see staff as a solution to this, not just a problem. We still need many thousands of people to take up careers in the NHS.’

From:
http://www.hsj.co.uk/healthservicejournal/pages/n/070111/workforceplanning

MRSA is cited on the death certificates of more than 1,000 people every year in the UK, with thousands more left severely ill or disabled by the infection.

But lawyers have found it hard to win cases as clinical negligence claims require causation to be established which is next to impossible with MRSA because of a lack of proof over exactly where, when and how the infection was contracted.

Cases that have reached court tend to be about the treatment a patient received once they got MRSA rather than over catching MRSA.

There have only been a handful of settlements – seven involving hospital-acquired infections in England from April 2002 to March 2006 – and no admission of responsibility for causing MRSA has been made.

However, solicitors now believe the tide may be changing after they started adopting a different approach.

Instead of relying solely on the traditional clinical negligence argument, they have started pursuing the NHS by using legislation more common to industrial disputes.

Control of Substances Harmful to Health (COSHH) requires employers to control exposure to hazardous substances to prevent ill health.

Lawyers have argued MRSA comes under such a definition and if it applies to staff it should also apply to patients in hospitals.

The first breakthrough was in July 2005 when Kitty Cope, a pensioner from Bridgend in Wales, won compensation when she got MRSA after having a hip replacement.

What is the nattily titled COSHH?
The 2002 regulations require employers to control exposure to substances which can put people’s health at risk. It defines these substances as those used at work, such as paint, generated at work, such as fumes, and naturally occurring, such as dust. However, most importantly for the MRSA claims, it also involves biological agents such as bacteria and other micro-organisms

The hospital involved settled out of court, but admitted it had not followed its guidelines on infection control.

Since then there are believed to have been several other settlements where COSHH has been used – there are no clear figures as they have all been settled out of court.

Recently, the family of Lincolnshire pensioner Joan Staples won an out of court settlement after she died following a hip replacement operation. COSHH was cited, although the hospital trust involved never admitted it was applicable.

Leading solicitors firms including Irwin Mitchell, Anthony Collins and Hugh James confirmed to the BBC they were now handling dozens of MRSA cases where COSHH was being used in the legal challenge.

Phil Barnes, the solicitor who handled the Cope case, said: “The advantage with COSHH is that it places the burden on the defendant to prove they are meeting the requirements.

“I know solicitors across the county are beginning to look at this as a way of pursuing claims. What we need now is for one to reach court to set a precedent, but at the moment the NHS seems to be picking off the strongest cases to settle them before it gets that far.”

The NHS Litigation Authority, which handles legal challenges for hospitals in England, refused to comment on the issue.

Anne-Louise Ferguson, managing solicitor at Welsh Health Legal Services, which represents Welsh hospitals, said: “It is an interesting proposition whether MRSA, which many people carry with them in the community, can be classed as a hazardous substance.

“But I think from the trusts’ point of view, they are looking at the cases and not wanting to set a precedent.”

Tony Field, chairman of the MRSA Support victims group, said: “I think this has got the NHS really worried. We should see many more successful claims in the future.”

The memo, written by the Department of Health’s director of health protection Liz Woodeson and circulated in October, said: “We have a three-year target to halve the number of MRSA bloodstream infection by April 2008.

“Although the numbers are coming down, we are not on course to hit that target and there is some doubt about whether it is in fact achievable.

“The opinion of DH infection experts is that we will succeed in reducing MRSA bloodstream infections by a third, rather than a half – and even if we had a longer period of time, it may not be possible to get down to a half.”

Much of the document focuses on the “handling” of the target.

The memo said: “Although the MRSA target is regarded as one of our highest priorities by the Prime Minister’s Delivery Unit, it is not a Public Service Agreement target so there is theoretically scope to change it.

“But it has been publicly announced by ministers, including to Parliament, on many occasions so handling would be an issue.”

The document goes on to discuss six options for “handling” the target. Of the six, just one recommends simply trying to meet the current target – the other five discuss ways of changing the target or timescale, or dropping the target altogether.

The memo also warns that another superbug, Clostridium difficile, is now “endemic throughout the health service, with virtually all trusts reporting cases” and shows that 2004 saw twice as many deaths from the bug as were related to MRSA.

And it warns that efforts to combat MRSA, such as alcohol handrubs, have had no impact on C. difficile, which it describes as a “far bigger problem”

Dr Peter Carter, general secretary of the Royal College of Nursing, said: “NHS deficits are forcing Trusts to reduce staff and cut services, so it comes as no surprise that priorities such as MRSA have been allowed to slip.”

And shadow health secretary Andrew Lansley called on the government to “get a grip on these infections”.

He told News 24 the government should follow the example of other European countries, such as Denmark and the Netherlands where employ a “search and destroy” policy is tackling the bug more successfully.

“You have got to have hand hygiene that is really effective,” he said. “Hard-working NHS staff have been set a target which the Department of Health privately admits is unachievable.”

And Liberal Democrat health spokesman Norman Lamb said: “It is time that infection control became a top priority in the NHS rather than just another item on a long shopping list of targets.

“The labour government seems to spend more time worrying about how to bury bad news rather than stopping the rise of deadly infections” claimed Norman Lamb, Lib Dem health spokesman.

But the Department of Health spokesman said: “We deplore this leak. This paper confirms that from the Prime Minister and Health Secretary downwards, the government is determined that the NHS should get on top of the problem of MRSA and other infections.

Reported in
http://news.bbc.co.uk/1/hi/health/6249149.stm

Health Direct is disgusted that the Dept of Health only cares about the bad publicity that it’s incompetence recieves rather than the thousands of preventable deaths that occur every year through it’s penny pinching mismanagement.

This blog was set up partially as we could see that deaths through MRSA and superbugs were a scandal- exceeding the number of people killed on UK roads.

John “Not fit for purpose” Reid knows all about MRSA as on May 10, 05 Health Direct noted that Reid admits MRSA killed his mother when John Reid, the erstwhile health secretary, disclosed that his mother died in a National Health Service ward as a result of a “hospital acquired” infection.

Louise Silverton, the college’s deputy general secretary, said: “This is terrible news for a labour government that in its election manifesto pledged every woman would have a named individual midwife to care for her by 2009. The midwifery shortage is getting worse rather than better at a time when we are experiencing a significant increase in the number of births.”

The survey produced a “depressing picture” of cuts, job freezes, shortages and financial crises.

More than one in five heads of midwifery reported a cut in the number of midwives at their trust. Hospitals were also cutting budgets for the training and development of midwives, in some cases by 75% or even 100%. A few units have become totally dependent on charitable donations to fund midwifery training, the RCM added.

The survey found that midwifery units recruited an average of 6.3 newly qualified midwives last year, compared with 6.8 in 2005. The average unit had 21 maternity support workers last year, compared with 19 in 2005.

Ms Silverton said: “This is irrefutable proof that midwives are under enormous pressure and nothing is being done to alleviate the situation. Unless midwifery services are expanded there is no hope of the labour government’s manifesto commitments being achieved.”

“Heads of midwifery are in charge of making sure that women have a good birthing experience. That is very hard when a third of those who responded to our survey said their maternity services budget had been cut, that a total recruitment freeze was still in place in many units, and that newly-qualified midwives are not getting jobs.”

Reported in:
http://www.guardian.co.uk/medicine/story/0,,1985892,00.html

It was of course the closure of the maternity unit in Salford that led to the charge on Jan 02 07′s Health Direct posting that the Labour leader Blears defends hypocritical charges over NHS closures in her constituency

When Cabinet minister Hazel Blears defended her decision to take part in a protest over plans to close part of a maternity hospital in her constituency. The proposals for Hope Hospital in Salford, Greater Manchester, are part of the controversial NHS shake up throughout the country. Ms Blears, Labour chairwoman, said: “My first and foremost job is to represent Salford and the people of the area.” It is very rare for a minister to directly oppose labour government policy.

Her efforts follow Home Secretary John Reid’s presence at protests against hospital cuts in his Airdrie and Shotts constituency in April.

Health Emergency’s head of campaigns, Geoff Martin, said Cabinet ministers were only supporting local protests “in a bid to save their own political skins. There are 29 hospitals up and down the country facing the immediate threat of cuts and closure to key services in 2007.

“Will Hazel Blears be joining demonstrators on the streets in each of those areas or is this just a classic case of ‘not in my back yard’?

His view was echoed by Ms Blears’ Conservative counterpart Andrew Lansley, who said she needed to consider whose side she was on.

“It is a government policy to say that maternity units must be much larger. So if Hazel Blears doesn’t like what happens as a consequence of government policy in her constituency, then perhaps she should change the government policy – or get out of the labour government.”

Lord Hunt of King’s Heath, currently a minister at the Department for Work and Pensions, takes over from Lord Warner in the Lords and will be responsible, among other issues, for the National Health Service’s troubled IT programme.

But the key role of system reform also held by Lord Warner, one which embraces thorny issues around regulation of the new NHS market as well as the reconfiguration of hospitals, will go to Mr Burnham who is seen as something of a rising star in Labour ministerial ranks.

Lord Hunt brings extensive experience to his role in the Lords. He was the Lords health minister between 1999 and 2003 and began his career as an NHS manager before becoming director of the then National Association of Health Authorities in the 1980s.

He will have responsibility for the health workforce and some of Mr Burnham’s quality issues, while Mr Burnham will be charged with helping get the NHS a decent settlement in the coming spending round, in addition to delivering on the government’s commitment to reduce the total wait for NHS treatment to a maximum of 18 weeks by 2008.

From:
http://www.ft.com/cms/s/8c6458f2-9d2b-11db-8ec6-0000779e2340.html

When the Financial Times announced on Dec 14 06 that the discredited junior health minister Lord Warner had resigned they suggested that “His departure creates a potential headache for the prime minister who will want to install a minister who is equally committed to the reform programme, while finding a replacement health spokesman in the Lords. Ms Hewitt is likely to rejig ministerial portfolios in her department, with Andy Burnham, who took on responsibility for communications earlier in the year, tipped to take on the reform brief.”

Well the FT certainly got this comment right. Though their headline at the time “Blow to Blair’s drive on health reform as minister resigns” was somewhat overstated given the troubled Lord’s checkered past. Please see Health Direct blog posting on Nov 07, 06 Labour’s lying Lord- Baron Warner health minister for some of his rediculous comments.

Health Direct only hopes for the sake of the remains of the NHS that Burnham proves to be a better minister that Warner turned out to be.

In the note on risk and obstacles to the workforce strategy, the workforce directorate said it expected the situation will ‘become clearer’ following a number of hearings on leading cases later this year.

Mike Jackson, Unison’s lead negotiator on AfC, told HSJ that some back-pay claims had arisen because a number of clear cases of gender discrimination had come to light.

Last March, following a landmark case, North Cumbria Acute Hospitals trust agreed to pay 1,500 female staff arrears dating as far back as 1991 as part of an equal value settlement which it costed at £60m, and which predated the introduction of AfC.

‘Under sex discrimination legislation staff can claim six years’ worth of back pay. However, until Agenda for Change was implemented we did not reliably know where the discrimination existed,’ said Mr Jackson.

He confirmed the DoH’s predicted figures although he said that last October (a month after the DoH memo was written), 1,000 new claims had been lodged.

Mr Jackson said that if the claims were successful the government could be forced to pay out millions of pounds to NHS staff.

‘Unison put a claim in to both NHS Employers and the DoH to settle the back-pay claims last year but they weren’t interested in negotiating with us and that is when we started to lodge the claims at employment tribunals,’ he said.

Mr Jackson said that he expected the first case for a back-pay claim under AfC to be heard at a tribunal in Newcastle in February.

NHS Employers head of pay Gill Bellord said the organisation was confident that AfC’s job evaluation system would provide a defence against equal pay claims in the future. But she said the organisation was aware that a large number of retrospective equal pay claims were being lodged against trusts.

She advised: ‘We know that employers have real concerns about the possible impact of equal pay claims and they should register claims with the NHS Litigation Authority in the first instance as a consistent approach to handling claims could help to minimise total costs to the NHS.’

From:
http://www.hsj.co.uk/healthservicejournal/pages/n2/p9/070104

As Labour’s Agenda for Change was the driving force behind the pay rise fiasco when NHS pay rises claim half of extra £5.5bn funding it looks as though this incompetence is going to continue.

On Nov 24, 06 Health Direct noted that almost half of last year’s £5.5bn increase in health spending in England went on higher pay, the latest figures from the Department of Health show. This year, the department expects to incur a redundancy bill of about £400m from shrinking the number of strategic health authorities and primary care trusts.

The redundancy bill, which excludes any redundancies from National Health Service trusts shedding jobs to balance their books, is four times the projected overspend for this year. In addition, the department spent a mighty £133m on external consultants last year.

The figures come from the department’s annual expenditure memorandum to the Commons health committee and show that of the extra spending last year, 56 per cent went on staff.

However, of that 47 per cent – almost £2.6bn – went on higher pay and a mere 9 per cent on extra staff.

And more recently on Dec 18, 06 in Labour’s mismanagement has led to NHS deficits when mismanagement at all levels of the NHS in England has led to the current multimillion pound deficit, a committee of MPs has found. The Commons health select committee said existing deficits were made worse by the cost of new staff pay deals and the expense of meeting NHS targets. Last year’s NHS deficit was £547m.

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.

The document, seen by the Health Service Journal, illustrates the difficulties the NHS faces as it uses cuts in training and staff this year to balance the books – aware that it will need a 7 per cent increase in the workforce in the coming financial year in order to hit the 18-week waiting-time target.

The leaked document is a late draft of the health department’s pay and workforce strategy up to 2011, the end of the next three-year spending period. It suggests radical measures, including regional pay, a three-year pay deal that would start with a below-inflation increase and the creation of a new subconsultant grade of specialist doctor, to contribute to the “substantial efficiency gains” needed as the rate of increase in NHS spending slows next year.

The leak – and the acknowledgement of “a real danger of industrial unrest” if the government gets its way and keeps headline pay increases for the coming year to 2 per cent or less – angered health service unions yesterday.

Dr Jonathan Fielden, chairman of the British Medical Association’s consultants committee, said: “To suggest that there should be fewer consultants, and of a lower grade, will destroy the gold standard of specialist care that patients rightly deserve.”

Unison said a move to regional pay, or, as the document suggests, the use of unemployment to drive down nurses’ pay in the regions, would be “strongly resisted”.

The Royal College of Nursing said the leak “confirms our worst fears” that the government intends to use pay to solve the NHS’s overspend, while suggestions that consultants’ pay should be held back after recent record increases equally angered the BMA.

The health department said the document represented “early stage” thinking. “Some of these ideas will be dropped and some will become policy,” a spokesman said.

As the effects of lower spending growth really begin to bite – a year after the waiting time target has been met – there is set to be a 1.1 per cent fall in the workforce, partly in response to changing needs. The NHS will then have potentially 3,200 more consultants than it can afford to employ by 2010-11, the document says.

Foundation trusts should be encouraged to create lower-grade, and cheaper, posts for consultants, and health staff generally should be offered more fixed-term contracts to smooth out fluctuations in demand.

As reported in:
http://www.ft.com/cms/s/a32edab0-9b98-11db-aa70-0000779e2340.html

It appears that labour have not got a clue what it is doing with the hard pressed NHS labour force.

Nearly two years ago on Feb 15, 2005 Health Direct noted that the NHS was facing serious shortage of 2,760 surgeons. Thousands of extra surgeons are going to be needed over the next few years to meet demand, a report warns. The Royal College of Surgeons (RCS) said there would be a 2,760 shortfall by 2010 because of early retirement and new working practices.

And again on April 25, 2005 when Health Direct reported that 50,000 Nurses left NHS in 2004
Recruits to nursing ‘must double’ according to the Royal College of Nurses. Thousands of UK-trained NHS nurses are quitting every year despite efforts to boost recruitment, the union has warned. Reasons for leaving included violence by patients and rigid working hours, the Royal College of Nursing said. If the trend continues, the number of annual new recruits will need to double to 66,000 by 2014, its report says.

Continuing yesterday’s blog theme about 83% of the populace who don’t believe Labour’s statistics- here’s a story that we found in our archives from exactly two years ago: Labour Govt “exaggerating” the number of NHS staff when the labour government published charts creating a distorted impression of employment in the Department of Health by exaggerating the increase in the number of staff over the past three years.

In last year’s annual publication of the National Health Service workforce figures, reporting 2003 data, about 60,000 health workers were dropped from the previous years’ figures. As a result, the published bar chart appeared to show a steeper rise in employment than had actually occurred, supporting the government’s assertion that the extra resources pouring into the health service were being reflected in higher staffing.

The chart was described by independent statisticians as one of the most blatant misrepresentations of data seen in a government publication.

Hospitals treating patients from north, east and west Hertfordshire have been told not to book them in for non-urgent operations until the start of the new financial year in April. Similar restrictions will apply to new outpatient appointments from the end of January.

Patients in Suffolk are having to wait a minimum of 14 weeks for routine surgery and York NHS Trust has been told by its local primary care trust not to operate on non-urgent cases until they have waited a minimum of 20 weeks – six weeks short of the government’s guarantee that patients will not wait more than six months for an operation.

Kingston primary care trust is operating a standard 10-week wait for outpatient appointments – three weeks short of the13-week maximum wait.

Michael Dixon, chairman of the NHS Alliance, which represents primary care trusts, said: “This is a direct effect of payment by results. In the old days of cost and volume contracts it wasn’t an issue because hospitals didn’t get paid any more if they treated more patients than planned.”

Now that they are paid for each patient they treat, “if a hospital brings its waiting list down rapidly it will do an awful lot of extra work and blow the primary care trusts’ budget”, he said.

A spokesman for the Hertfordshire PCTs said it had only enough funding “to treat patients in line with national targets”. It was, it said, “crucial that referrals are managed to ensure we achieve our financial plan”.

The Tories said patients were having their treatment artificially delayed because trusts were under orders from Patricia Hewitt, the Health Secretary, to ensure that they break even.

The instructions to delay treatment for as long as possible are made in two separate letters sent by health managers in the East of England, which has the worst performance in the NHS.

The first letter was sent by the East of England’s strategic health authority to the chief executives of the region’s primary care trusts, which run GP clinics and pay hospitals if a patient needs treatment.

The letter, written in November by Dr Paul Watson, the strategic health authority’s director of commissioning, underlined the pressing need to get a grip on budgets.

“The current end of year projections for PCTs are simply unacceptable,” he said, before going on to set out his plans to ensure hospital operations were “restricted to the minimum required to meet required access targets.

“PCTs should ensure that elective activity is limited to patients on the 20-week [patient targeting list] and clinically urgent cases only.”

There is a similar message in a separate letter sent to the Queen Elizabeth Hospital in King’s Lynn by Hilary Daniels, the chief executive of the Norfolk primary care trust.

In her letter, she said her PCT was having to impose limits on the number of patients it could pay to be treated at the hospital in the final few months of the financial year.

“We have previously indicated that we expect you not to treat earlier than 17 weeks from 1 December. We expect that by 1 February this wait will have risen to not less than 18 weeks,” she wrote. “Please can you quantify how many cases can be deferred into 2007/08 by not operating on patients where treatments can be deferred into the new financial year without breaching 20 weeks on this basis.”

The delays were condemned last night by Andrew Lansley, the shadow health secretary, who was sent the leaked documents anonymously.

“These patients are being deliberately obstructed in accessing the treatment they need, despite hospitals having paid for the staff who can treat them,” he said.

“There is no point in paying these NHS staff to do nothing in the last quarter of the financial year solely because Patricia Hewitt has put her own job on the line by promising to get the NHS back into the black by April. Even the Department of Health must realise this is false economy.”

No one from the East of England strategic health authority or the Norfolk primary care trust could be contacted for comment yesterday.

Reproduced from:
http://www.ft.com/cms/s/d62fca08-9a05-11db-8b6d-0000779e2340.html
http://www.telegraph.co.uk/news/main.jhtml;jsessionid=VIGNMCTEKE2KPQFIQMFSFFWAVCBQ0IV0?xml=/news/2007/01/02/nhospital02.xml