Only 34 per cent said they would be happy to be treated, five per cent would be “very” happy with the prospect and 33 per cent could not decide.

The survey of 128,000 NHS staff in 326 trusts in England responded to the questionnaire from the Healthcare Commission, seeking information on how working conditions and the NHS could be improved.

Asked if their trusts put patients as the “top priority”, fewer than half agreed and more than a quarter (26 per cent) said patients were not the top priority.

The annual staff survey found the number of staff reporting injury or illness because of work fell from 22 per cent to 17 per cent between 2005 and 2006. Staff reporting mistakes of “near misses” that could affect patients’ safety fell from 49 per cent in 2003 to 38 per cent last year.

NHS employees reporting symptoms of stress caused by work fell from 39 per cent to 33 per cent over the year.

In the fight against hospital super bugs little changed over a year. Nearly a third, 31 per cent, said hot water, soap, hand towels or alcohol rub were not always available, compared with 32 per cent a year before.

Anna Walker, the chief executive of the Healthcare Commission, said: “The NHS is the fourth-largest employer in the world and this is believed to be the largest annual survey of staff in the world. It is vital that we hear loud and clear how staff are coping.

The organisation NHS Employers said staff had a “positive” view of working in the NHS but there were improvements to be made.

“There is clearly work that still needs to be done, particularly on tackling bullying and harassment and on the quality, effectiveness and frequency of appraisals. All staff should expect an annual, well-structured appraisal to help them achieve their full potential and over the coming year we will work with NHS organisations to ensure this happens,” he said.

A total of 59,695 physical assaults on NHS staff in England last year was down by 1,690 from 2004-05.

A spokesman for NHS Security Management Service said: “Although official figures suggest a downward trend in the amount of violence, a lot more work is still needed.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/30/nhs30.xml

Health Direct noted the dissillusionment of NHS staff to be treated in their own hospitals lat year on 28 Mar 06- Doctors opt to have private operations out of NHS

Hospital consultants are spurning the National Health Service by paying for medical insurance so they can be treated privately if they become ill. A survey of 500 consultants, commissioned by Bupa, the health insurer, found that 41% of senior hospital doctors have invested in private health cover.

Dr Sarah Burnett, a consultant radiologist in London who worked in the NHS for 15 years, said she took out private medical insurance while she was employed in the state service because she was unimpressed with the level of care she witnessed first hand.

“NHS treatment is not a pleasant experience in any way — from the standard of the food, to ward cleanliness and the chance of catching MRSA,” she said.

Under resource accounting, a trust that overspends not only has to pay that money back the next year, but has to do so after the same amount is knocked off its budget.

The “double whammy” rule had affected 28 NHS trusts, “making it impossible for them, in some cases, to get out of debt”, Ms Hewitt said.

The accounting rule will still apply to primary care trusts as they are chiefly purchasers, not trading bodies like hospitals.

Some of the 28 trusts will now record a small surplus. Others, however, including Hinchingbrooke, the Queen Elizabeth in Woolwich, Whipps Cross and Mid-Yorkshire, will still be left with deficits not caused by the accounting rule that range from £12m to £21m. These will still have to be paid off over time.

Ms Hewitt told the Financial Times there remained “a small number” of hospitals – thought to be between 15 and 20 – with financial positions so serious that they were unlikely on their own to recover.

With the first takeover of an NHS hospital by a foundation trust expected to be formally approved this week, further foundation trust takeovers “may well be the solution in some cases”, she said, “but it won’t be the solution in every case.”

One surprise is that detailed work has shown the “double whammy” effect on hospitals – which has been inconsistently applied across the NHS – is smaller than original estimates that it would cost £500m to £600m to remove.

Ms Hewitt said the ending of the rule was the final part of a big set of financial reforms that would make the NHS finances “much more transparent” and “much fairer” in future.

They would end a trend that had seen healthier but overspending parts of the country being subsidised by other parts, chiefly in the north and Midlands, that had bigger health problems but which had, nonetheless, tended to break even or make surpluses, she said.

From:
http://www.ft.com/cms/s/26d60290-dcca-11db-a21d-000b5df10621.html

The inequity of Resource Accounting and Budgeting (RAB) was highlighted by Health Direct on Dec 14, 2006 in Unsustainable NHS resource account and budgeting (RAB) rules to stay- Hewitt insists when the health department postponed a decision to scrap a set of accounting rules- that have plunged some NHS trusts into potentially irrecoverable financial deficit.

The NHS Confederation, which represents health authorities and trusts, said yesterday that it was disappointed at the decision which came despite the health department accepting that the application of the rules to individual NHS trusts “will become increasingly unsustainable”.

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.

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.

As the inflated workforce had to be paid, hospitals and trusts plunged into deficit, the Commons Health Select Committee report says. Now posts are being left empty or lost, and a few NHS workers are being made compulsorily redundant. More than half of newly qualified physiotherapists have failed to find work in the NHS.

The MPs are scathing about the failure to maintain a link between staff numbers and the money available to pay them. Instead of raising productivity to meet targets, the NHS “threw new staff into the task rather than consider the most cost-effective way of doing the job”, the report says.

It calls the staff expansion “reckless and uncontrolled” and says that funding increases were often seen as a blank cheque for recruiting new staff.

There is also criticism of generous contracts. “Large pay increases were granted without adequate steps being taken to ensure increases in productivity in return,” it said.

The committee urged the Government to make workforce planning a priority, and for an end to constant health service reorganisation.

Stephen O’Brien, the Shadow Health Minister, said: “Top-down workforce targets imposed by Labour have created confusion amongst NHS staff. Patients are bewildered about where all the money has gone, and hard-working staff are losing confidence by the day in Labour’s stewardship of the NHS.”

The British Medical Association did not entirely endorse the report, however. Sam Everington, its deputy chairman, said: “While agreeing wholeheartedly that integrated workforce planning must be a priority… we do not agree that the expansion of the medical workforce was reckless
and uncontrolled and that pay increases for doctors have not seen a return in productivity.

“The UK is still critically short of doctors and the BMA has always believed that government goals to increase doctor numbers were too low.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article1555642.ece

Labour’s disasterous failure to properly manage NHS staffing levels was commented on 24 Nov 06- in NHS staff pay rises claim half of extra £5.5bn funding when 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 also 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.

Andrew Lansley, the Conservative health spokesman, said the cost of external consultants and the size of the redundancy bill “reflects Labour’s mismanagement of the NHS. It is clear that a lot of the additional growth money this year will be lost”.

NHS antenatal classes have been cut or suspended in at least 10 areas in England and Wales, according to the NCT.

These are Romsey in Hampshire; Worcestershire; Newham in London; Watford; Gwent in south Wales; south-west Kent; Nottinghamshire; Gloucestershire; Hemel Hempstead in Hertfordshire; and Wiltshire.

The NCT said it also understood that postnatal home visits have been stopped or are facing cuts in Wiltshire and in east and north Hertfordshire, which would mean new mothers have to travel to a clinic in order to receive after-birth care.

An NCT spokeswoman said: “These cuts in maternity services may reflect a more widespread pattern. The NCT is concerned that these short-term measures to ease financial deficits are having a negative effect on new parents and parents-to-be, preventing them from getting the information and support they need at this important stage in their lives.”

From:
http://www.guardian.co.uk/uk_news/story/0,,2043159,00.html

Health Direct points out that while the number of births rose from 563,744 in 2001 to 613,029 last year, the number of midwives dropped. In 2005 there were 24,808 midwives, 36 fewer than the previous year.

Midwife cuts
— Trusts are cutting budgets for midwifery training, in some cases by 75 per cent or completely
— Many midwifery units now depend on charitable donations to fund training
— Two thirds of midwifery managers say that their department is understaffed
— Thirty-eight per cent say that they have suffered budget cuts
— Twenty-seven per cent say that their Primary Care Trusts froze recruitment in 2005-06. A fifth say the freeze has not been lifted
— There were 24,808 midwives in NHS England, in 2005
— Since 2001, the annual number of births has risen by 49,285 to 613,029

On Jan 10, 2007 Health Direct posted that Maternity cash is cut amid boom in birthrate, say midwives as the NHS is responding to a boom in the birthrate by cutting spending on maternity services, the Royal College of Midwives said after a survey of more than 100 heads of midwifery in hospital trusts across Britain.

It found that two thirds of maternity units were understaffed and most were trying to save money by employing fewer qualified midwives and taking on maternity support workers instead.

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.

Dr Michael Williams, vice-president of the Royal College of Radiologists and co-author of the report, said that, in addition, some patients were not receiving enough radiotherapy.

Williams said: “One problem is delays in some areas of the country and the other is that, when patients are treated, they receive fewer fractions [doses] of radiation than they would receive elsewhere in Europe and America.”

It is understood that the report, co-authored by Mike Richards, the government’s “cancer czar”, also says that the NHS is administering only about half the amount of radiotherapy needed to treat British patients properly.

Williams has research showing that, in Britain, only 28,000 doses of radiation are given per million people compared with the recommended 54,000.

Williams accepts that the government has invested heavily in radiotherapy since 2000, but he says: “Restricted access to radiotherapy services means that some British cancer patients are dying.”

The government report has been subject to repeated delays. A draft was ready in August and the document has been with health ministers since February. Critics suspect the Department of Health (DoH) will suppress it until it is ready to announce a new plan to improve cancer services in the autumn.

Maidstone and Tunbridge Wells NHS Trust is investigating claims by consultants that three patients have suffered a return of their breast cancer during the long delay between their operation and the radiotherapy.

Peter Jones, a breast surgeon at Maidstone hospital, said: “We have examples of people who have actually developed recurrent cancers in the breast while they have been waiting for their radiotherapy. Over the last three years, we have been aware of this happening in three cases.”

Professor Karol Sikora, medical director of CancerPartners UK, a private company set up to treat NHS patients, added: “In some areas people are getting scarcely any radiotherapy. They are often old, poor, uneducated and forgotten about.”

A DoH spokesman said: “The government has already taken action to improve radiotherapy services. However, we do know there is more to do. The report has only recently been submitted to ministers.”

http://www.timesonline.co.uk/tol/life_and_style/health/article1563920.ece

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

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

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

“Unless something changes radically, the government is going to miss its target”. 6 months on and with 17,000 NHS staff since having their jobs axed- Professor Maynard’s comments are as valid now as they were then.

Now it seems as though cancer patients- who are supposedly a high priority for Labour, are dying because of cash shortages in the key radiotherapy departments there appears to be little chance of achieveing the 18 week target when technological shortages remain the bottleneck.

Scientific evidence shows that heroin and cocaine are correctly ranked as class A drugs as they do cause the most harm. But LSD and ecstasy come close to bottom of the league in terms of harm caused, yet they are also labelled as class A.

Alcohol is legal and widely used but comes fifth in the “harm” table, ahead of amphetamines and cannabis, which are ranked as class B and class C respectively. Tobacco is also ranked as more harmful than cannabis.

The league table of 20 drugs drawn up by drugs specialists is intended to provide a scientifically based model for policy makers of the harm they cause. It shows that the dangers they pose bear little relationship to the official classification, on which the penalties for drug use are based. The eight drugs ranked as most dangerous include two that are unclassified while the eight judged least dangerous include two class A drugs.

The report comes a fortnight after an independent commission called for a radical overhaul of Britain’s drug laws which it said were driven by a “moral panic”. The commission, set up by the Royal Society of Arts, said the aim of public policy should be to reduce the harm drugs cause, not send people to jail. It proposed reclassifying drugs – legal and illegal – according to the harm they do.

Professor David Nutt, who works in addiction psychiatry at the University of Bristol and who led the latest research, said: “The current drug classification system is arbitrary in the way it assesses harms. It is not fit for purpose.

We have tried to come up with a better system by looking at the factors that contribute to drug use and the harms they cause. We should review the penalties for drug use in the light of the harms they cause and have a more proportionate response.”

Professor Colin Blakemore, chief executive of the Medical Research Council and co-author of the study, said: “The object was to bring a dispassionate approach to a very passionate issue. Some conclusions might appear to be liberal in stance, but that was not our starting position. We intended to reach conclusions that were evidence-based.”

“Alcohol and tobacco are way up there in the league table, not far behind heroin and cocaine and street methadone. Society has not only come to terms with alcohol and tobacco but is well aware of the harms associated with them so we felt it was useful to include them as calibration points for other drugs.”

All drugs were marked on the physical harm they caused to the individual user, their tendency to cause dependence and their social harm, including their effect on families, communities and society [such as crime and NHS costs]. Each was given an overall harm score by two separate groups of experts which yielded roughly similar results.

There was little evidence that ecstasy caused extensive harm, despite its widespread use by young people in clubs and pubs at weekends. Cannabis has been cited as a cause of schizophrenia but the authors said a causal relationship had not been established. If it were, evidence showed no more than 7 per cent of cases could be attributed to use of the drug.

Professor Leslie Iversen, of the University of Oxford, said there was a widespread myth that skunk, from the tips of the cannabis plant, was 20 to 30 times more powerful than that available 30 years ago. “It is simply not true,” he said. “The Advisory Council on the Misuse of Drugs looked at this carefully. Cannabis resin [hash] has changed little and is about 5 per cent tetrahydrocannabinol (THC). Skunk has 10-15 per cent THC. That makes it two to three times more powerful, not 20 to 30 times.”

The study, which took five years to complete, is published today in The Lancet. Professor Blakemore said: “We hope that policy makers will take note of the fact that the resulting ranking of drugs differs substantially from their classification in the Misuse of Drugs Act and that alcohol and tobacco are judged more harmful than many illegal substances.”

From:
http://news.independent.co.uk/uk/health_medical/article2383902.ece

Health Direct carried a series of posts last year by the scientific community on the risks of taking drugs compared to the “not fit for purpose” UK drugs laws.

Since then despite a number of high profile crimial offences being reported as being carried out under the influence of drugs and the pressure from the House of Commons Science and Technology committee- what has labour done about this? Absolutely ziltch.

Aug 02, 06. Risks of drugs scientifically compared- “Not fit for purpose” drugs laws criticised-
Risks of taking drugs compared- Scientific review of dangers of drug taking- Drugs, the real deal Health Direct reproduces the first ranking based upon scientific evidence of harm to both individuals and society of taking drugs. It was devised by government advisers- then ignored by Labour ministers because of its controversial findings.

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

Aug 01, 06- Drug classes have little link to the dangers Following on from yesterday’s post MPs demand changes to classification of illegal drugs by the Commons Science and Technology Committee, the Home Office has now been warned by its own senior advisers that alcohol and tobacco are more harmful to the nation’s health than the Class A drugs LSD and ecstasy.

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

On July 31, 06- MPs demand changes to classification of illegal drugs The ABC system of classifying illegal drugs should be replaced with a more scientifically based scale of harm, a committee of MPs will say today.

In a scathing report entitled Drug Classification: Making a Hash of It?, the Commons science and technology committee says there is no consistency in the way drugs are classified A, B or C and no evidence to support the official view that the classification has a deterrent effect.

The deficit was recorded despite a massive rise in NHS spending from £69.7 billion in 2004-5 to £76.4 billion in 2005-6. In this financial year the amount being pumped in will soar again to £92.6 billion.

Edward Leigh, the chairman of the committee, said “weak control of finances” and “lack of interest” by doctors in the sums they were spending were to blame for many of the deficit problems.

In no less than one in three NHS organisations, auditors had raised concerns “about the financial management capabilities of general management”.

In one in four they were worried about the financial performance of non-executive directors.

The committee said that while the Department of Health had no “overall picture” of the effect of deficits on services to patients, it was clear they were adversely affecting the level and quality of care.

“Dealing with financial pressure diverts resources away from normal strategic operational priorities,” the report said.

“If a body’s management are concerned chiefly with recovering a deficit, they may be unable to give sufficient attention to issues such as clinical performance or current NHS restructuring.”

Andrew Lansley, the shadow health secretary, said the report showed ministers had ”no idea about the impact of their mismanagement on local NHS services” and exposed a “worrying lack of financial expertise in Whitehall”.

The committee said “errors” by the Department of Health in estimating the cost of three national pay initiatives for nurses, doctors and consultants were responsible for many of the problems, leaving the NHS having to fund a shortfall of £560 million.

Dr Peter Carter, the general secretary of the Royal College of Nurses, said it was very disturbing that the department had no clue about the effect of deficits on services and jobs. “It’s time for the Government to come clean. Ministers need their advisers to tell them just how damaging the deficits crisis has become and acknowledge the Government’s responsibility to work with front line staff to find a long-term solution.”

The Local Government Association said the deficits in some hospital trusts were having knock on effects on council services.

Sandy Bruce-Lockhart, the chairman of the LGA said: “Health and social care are two sides of the same coin and a financial crisis on one side is having an impact on the other.

“In the next three years alone, there will be over 400,000 more older people, many of whom will require social care. Without additional funding local government may potentially face a situation, by as early as 2009, where it cannot afford to provide support to the 370,000 elderly people with lower levels of need.”

Dr Gill Morgan, the chief executive of the NHS Confederation, said they were working “harder than ever” to achieve financial balance.

“It is important to remember that NHS deficits are concentrated in a relatively small number of organisations with over 50 per cent of the deficit in just six per cent of trusts,” she said.

A recent survey of NHS trust chief executives showed that three out of four trusts are already restricting patients’ access to treatment as they struggle to control deficits. The same survey found that half were delaying operations as they battled to save money.

Meanwhile, figures produced by the independent health think tank, the King’s Fund, showed that less than a third of the extra money spent on the NHS is actually going directly to improve health care and front-line services. Of the £19 billion spent by the Government on hospital and community health since 2003, £6.6 billion had gone on extra pay for clinical staff.

A further £2.2 billion went on the rising cost of drugs; £1.6 billion went on hiring more doctors to meet new EU employment laws on working hours; £1.1 billion went on new buildings and equipment; £1 billion went on equipment and £600 million on negligence law suits.

This left only £5.9 billion to spend on improving performance such as reducing waiting lists, the extension of day surgery and more nurses and consultants.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/20/nhs120.xml

The issue of Labour’s waste on the NHS finances continues to brew ominously for patients.

MPs only recently (30 Jan 07) in MPs want greater scrutiny of PFI hospitals to prevent more waste Health Direct posted that hospitals built under the Private Finance Initiative (PFI) must be subject to much “closer and sustained scrutiny” if millions more pounds are not to be wasted, the Public Accounts Committee said. Estimated capital costs for 17 PFI schemes approved by the end of 2005 have more than doubled – up by some £4bn to £13bn.

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.

And last year (Fri 5 May) Health Direct highlighted the GPs’ out of hours opt out Out of hours GP shake up attacked as “shambolic” as £70 million is overspent when the shake-up of the out of hours health care system in England was “shambolic” and led to longer waits and higher costs, a committee of MPs has said.

New providers are spending 22% more but are not meeting key targets, the public accounts committee claimed. Fewer than 10% of primary care trusts met targets on assessing patients within 20 minutes of an urgent call the National Audit Office found.

His comments came against a backdrop of concern over a growing trend by the Department of Health to stop subsidising publications for prescribers that are designed to provide objective information free from -pharmaceutical companies’ influence.

He was speaking ahead of the launch this week of the latest edition of the twice-yearly British National Formulary, which is produced by the BMJ and which a new survey showed was the preferred medicines reference guide for GPs.

The BNF is distributed free of charge, thanks to government subsidies, to 185,000 prescribers in England alone. However, the DoH threatened at the end of last year to stop subsidising its distribution to medical students in England.

There was a last-minute reprieve after complaints, but Sir George said there had been no assurances that the subsidy to students would not be removed before the next issue of the BNF this autumn.

The threats to the BNF follow a pattern of reductions in government support in England in recent months for other independent assessments of medicines, at a time of growing demand internationally for such information.

The government last year removed the subsidy in England from the Drugs & Therapeutics Bulletin, a source of treatment information for GPs, which has led to subscriptions falling to one-sixth of their previous level.

From the start of this year, it also stopped funding Clinical Evidence, another regular guide produced by BMJ, and Best Treatments, a service that provided information on medicines to patients through the NHS Direct website.

From:
http://www.ft.com/cms/s/0d1c88e0-d5bf-11db-a5c6-000b5df10621.html

On June 13, 2006 Health Direct questioned the action of cutting the dissemination of best drugs practice as a means of costs savings in Doctors fight to save the Drug and Therapeutics Bulletin drug guidance from government axe

A highly respected and influential journal which gives doctors independent advice on the drugs they prescribe is set to close because the government is withdrawing its funding after 40 years.

The Drug and Therapeutics Bulletin is sent to every doctor in the country and offers what many describe as highly readable guidance on the value of sometimes heavily marketed pills. But the Department of Health has refused to renew its contract.

Senior doctors have signed a statement of protest, and more than 2,000 have written to ministers, including Patricia Hewitt, the health secretary.

DTB is “highly valued and trusted” to give independent and reliable information about drugs, the statement says. Its conclusions “are also widely regarded as a unique counterweight to the influence of the pharmaceutical industry”.

Health Direct notes that the closure of the trusted Drug and Therapeutics Bulletin is another sorry example of the Labour government’s short term NHS cost cuts. In comparison to the annual £1.4 m cost of the DTB, the NHS’s drugs bill is around £11 billion a year.

Even a cursory cost benefit analysis indicates that a 0.1% saving on the drugs bill will pay for the preservation of the DBT eight times over.

Southampton University Hospitals NHS Trust took £2,414,672 and Cambridge University Hospitals NHS Foundation Trust took £2,263,297.

Patients and visitors often have no choice but to use hospital parking, which used to be free. Some out-patients are too weak to walk further from their car and many of those who visit in-patients are themselves elderly or infirm.

The charity Macmillan Cancer Support Research raised the parking issue yesterday on behalf of cancer patients who have to make regular hospital visits. It said the £95 million total was shocking.

Judy Beard, Macmillan’s acting chief executive, said: “Cancer patients spend hundreds of pounds each year on hospital parking. Macmillan wants to see all cancer patients travelling regularly for treatment to be able to park free.

“It’s shameful that cancer patients are still paying to park at hospital. The Government should step in and introduce stronger regulations.”

Katherine Murphy, of the Patients’ Association, said: “It is disgraceful that the NHS should exploit the most vulnerable people. It is totally wrong to take money off people who have to attend hospital and those who visit them.

“We would like to know what happens to this money. Is it ploughed back into patient care or is it used to make car parks safer for staff?”

Patient watchdogs and MPs have called hospital parking fees a “tax on sickness”.

The £95 million does not tell the whole story because 74 trusts supplied no figures.

Hospitals have also started to charge for bedside telephones and television sets and many have replaced charity-run cafes with more expensive cafeterias.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/20/nhs20.xml

The issue of ad hoc NHS charges was raised on July 19, 2006 in Health Select Committee finds the system of NHS health charging is a mess as the House of Commons Health Select Committee in it’s report on health charges finds that the system of health charges in England is a mess.

Charges for prescriptions and dentistry have been in place for over 50 years and sight tests for almost 20 years. They have not been introduced following detailed analysis of their likely consequences; rather they have come about piecemeal, often in response to the need to raise money. There are no comprehensible underlying principles. The charges remain largely for ‘historical’ reasons.

In recent years, hospital patients and their visitors have also had to pay increasing sums for non-clinical services, such as car parking and bedside telecommunications. International research has shown that health charges have a negative effect on health, and that patients with long-term illnesses suffer particularly when charges are in place.

There is also some survey-based and anecdotal evidence which suggests that patients are less likely to visit their dentist or have prescriptions dispensed in full because of the costs.

The House of Commons Health Select Committee report also looked at other NHS charges and stated:

The recommendations will not address the fundamental problems in the current system of health charges. Little work has been done in this country on the costs or benefits of the different possible systems.

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

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

The disastrous overhaul of the way in which junior doctors are selected and trained to become consultants is the most serious threat to the patient care and the health service that we have witnessed, and the ramifications are frightening in scope.

Junior medics and surgeons carried banners, chatted and caught up with old friends. Placards were heartfelt: “Our training, your health care, their mistake” and “Don’t dumb down doctors”.

I met people I hadn’t seen since medical school, doctors I had worked with in A&E;, and friends who have been locked away in hospitals all around the country. Everywhere, the stories were the same: no interviews offered, or one perhaps – in Wales.

One friend from university summed up her feelings after being informed, by a computer program, that she had not been successful. “You just think, all those years, all those degrees…”

The mood overall was one of determination: this is a fight that is too important – to us and to our patients – to contemplate losing.

We are protesting against an ill-conceived, centralised attack on the integrity and quality of the medical profession. As a leaked Department of Health memo revealed at the beginning of the year, medical unemployment is seen by the Government as useful to create a downward pressure on wages.

In the context of New Labour’s ideological commitment to introducing market principles and corporate provision into the NHS, this makes sense. In the context of providing safe, high quality health care to Britain’s patients, it does not.

Excellent physicians and surgeons are not readily replaceable. They have to be trained well, for a long time and to exacting requirements. I started at medical school in the year that Tony Bliar took office.

Ten years ago, my colleagues and I were among the brightest and most idealistic school leavers in the country; for the past four, we have worked tirelessly in dreadful conditions. For those of you unfortunate enough to have required our services, we are the doctors who treat you in casualty in the middle of the night, carry the crash bleeps, thrombolyse you when you have a heart attack, resuscitate you, and treat your life-threatening injuries after a car accident.

We routinely work for longer than our contracted hours because medicine is a vocation rather than a job and to leave on time would be dangerous.

This is the situation, with full medical employment.

A deliberate attempt to destabilise the profession, in the hope that it will lessen our power to insist on working to clinical priorities, rather than political and commercial ones, is what the Americans would call a deal-breaker.

As we walked toward Russell Square past the British Medical Association, I was reminded of the London bombs 18 months ago during which my friends and I worked treating the injured. How quickly people forget.

This labour government knows the price of everything and the value of nothing. A downgraded, under-trained, biddable medical workforce might be a cheaper way to meet flashy paper targets, but if we don’t put a stop to this, every one of us will know the true cost.

By Sarah McMahon, a junior doctor, in:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/19/ndocs319.xml

The plight of junior doctors is terrible, as the above shows. Health Direct have been watching this labour created fiasco and have recently posted a couple of posts in:

8 Mar 07- Climb down over junior doctor fiasco MMC MTAS IT system The Labour govt backed down yesterday and agreed to an immediate review of a flawed selection system that has left thousands of able young doctors without the prospect of a job and many threatening to leave the NHS. The independent review will start today and may recommend changes to the system before the current interview round has been completed.

7 Mar 07- Doctors who face the dole as MMC’s application IT system remains as fiasco given all the emphasis on investing in and improving the NHS, the idea of a wave of doctor unemployment seems a nonsense.

Alarmingly, however, it is very much a reality. Last week, the fears of thousands of junior doctors were realised when they failed to secure interviews for trainee consultant posts under a new fast-track system called Modernising Medical Careers. The doctors who missed out are left
wondering whether to try to retrain in another speciality, emigrate, or leave medicine altogether.

James Johnson, head of the British Medical Association said NHS trusts were under pressure to balance their books, leading to posts being cut.

And nurses’ leaders warned workforce cuts would damage patient care.

Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), added: “These alarming figures confirm what the RCN has long been warning – that deficits are leading to serious cuts in the NHS workforce.

“This can only have a damaging impact on patients and services. That’s why we are urging the government to work with us to replace short-term cuts with a long-term recovery plan.”

Mr Johnson added: “This is devastating for the staff who are made redundant and demoralising for those who are left to cover the work.

“Although the majority of job losses are non-medical, they will inevitably have a negative impact on patient care.”

Andrew Lansley, the Shadow Health Secretary, said: “What’s demoralising for NHS staff is that the incompetence and mismanagement of this Labour Government has meant that after additional investment expanded staffing numbers in the NHS, financial deficits now mean hospitals are cutting back on the number of jobs.

“The loss of posts directly contributes to the fact that nurses, physiotherapists and others leaving college cannot find jobs.”

From:
http://news.bbc.co.uk/1/hi/health/6450303.stm

The Office for National Statistics’s analysis that 11,000 NHS job were cut last year proves bliar’s lie that only “a few hundred” NHS staff have lost their jobs due to his under funding.

On 19 Oct 06- Health Direct posted: NHS does not know how many jobs are being axed in recent cutbacks and closures

The newly appointed chief executive of the National Health Service admitted that he did not know how many jobs would be lost this year as a result of budget cuts and reorganisation.

David Nicholson was challenged on the impact on jobs of English NHS trusts plunging £523 million into the red at a press conference called by the Prime Minister to highlight health service reforms. “Out of touch” bliar claimed “only a few hundred” NHS jobs were axed.

Health Direct also reported that the claim by bliar that compulsory redundancies would number only “a few hundred” was described by Dave Prentice the head of the Unison union as showing how out of touch with the real world the prime minister had become.

In comparison to bliar’s discredited spin, Health Direct counted 19,568 NHS staff job cuts that were announced during 2006 as the NHS struggled to balance the books.

“It is clear that when you put those figures together, along with some of the individual issues we have investigated [such as avoidable deaths in maternity units and from hospital-acquired infections], then there is a lot still to be done on safety,” said Anna Walker, chief executive of the Healthcare Commission, which acts as the healthcare inspectorate.

“There is a long way to go to really embed the right kind of attitude, and questioning and learning from events in the healthcare culture.”

Ms Walker stressed the problem was far from unique to the UK. The US had launched a drive to tackle tens of thousands of preventable deaths in its hospitals, with the Institute for Healthcare Improvement estimating that there are 15m incidents of medical harm in US hospitals a year.

“But it is time we had a really sustained drive, through the regulators, on safety issues,” Ms Walker said.

In the coming year, the commission would check more rigorously on the hygiene code aimed at reducing hospital-acquired infections, intervene where data showed high rates of MRSA and C. difficile infections, and look more closely at the use of controlled drugs and of radiation for both diagnosis and treatment.

But it would also be putting pressure on the boards of health organisations, which were responsible for standards, to ensure that they “monitor, analyse, and learn lessons from safety episodes” in their hospitals, “and then act on them”, she said.

From:
http://www.ft.com/cms/s/90f7172e-d03e-11db-94cb-000b5df10621.html

The Healthcare Commission’s renewed interest in the harm that afflicts NHS patients is appluaded by Health Direct.

On 4 Nov 05 Health Direct posted: NAO- NHS accidents cost £2bn and up to 34,000 lives
when according to a report by the National Audit Office, around a half of incidents in which NHS hospital patients are unintentionally harmed could have been avoided, if lessons from previous incidents had been learned.

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

Earlier on 26 July 05 Health Direct posted: NPSA publishes first NHS patient safety data analysis when it found that more than half a million patients every year suffer as a result of medical errors or incidents while in NHS hospitals. The first public analysis of patient safety data in England and Wales is published by the National Patient Safety Agency (NPSA).

From this analysis we estimate that there would be approximately 572,000 incidents and 840 deaths reported to the NRLS each year from acute hospitals.

The Department of Health rejected fears that the pilots would result in NHS medical records and information being made available to law-enforcement officers. A spokesman said “categorically” that the information flow would be one way – the immigration agency providing data to the NHS. “We will not be breaching [medical] confidentiality in any way, or handing over records or identity information to the Border and Immigration Agency.”

“NHS trusts will only be able to approach the Border and Immigration Agency with the patient’s explicit written consent, in order to establish their exact immigration status to help establish a patient’s eligibility for free NHS care.”

If a patient refused, an NHS trust would have to consult the existing 68 pages of guidance on how foreign nationals should be charged, a spokesman said.

The department was unable to say last night whether trusts would be asked to trawl a list of known illegal immigrants against NHS records, a spokesman saying that “the details of the pilots are still being worked on”.

In 2003, John Hutton, then a health minister, promoted the idea of asking patients for utility bills or passports to prove residence, saying the introduction of a national ID card would make checking eligibility “much easier”.

But NHS trusts have been reluctant to take on the bureaucracy of such checks, with the health service having no clear idea of how much “health tourism”, or the supply of NHS care to foreign nationals, costs.

In the past, the British Medical Association has said it would be “totally unjustifiable” to try to charge impecunious failed asylum-seekers who have no money.

The Home Office appears to regard the pilot schemes as a potentially important building block in the development of the government’s ID-card system. But Connecting for Health, the NHS information technology programme, has consistently rejected the idea of using such cards to establish entitlement to treatment.

http://www.ft.com/cms/s/12fe3d10-cd1a-11db-a938-000b5df10621.html

Health Direct warns that the spin of setting up three pilot schemes, is just that. There appears to be no extra money, no new processes and no extra staff to run the checks- either at the NHS’s or Police’s end.

Congratulations John “not fit for purpose” Reid- you did nothing about this when you were the health Secretary, why waste our time now that you are trying to brown nose with the chancellor?

Concerns about the Medical Training Application Service, (MTAS), which was introduced in January, came to a head at the weekend after The Daily Telegraph gave a voice to angry and dismayed junior and senior doctors.

On Monday night Mrs Hewitt met members of the powerful Academy of Medical Royal Colleges. She agreed that the review should take place and that the academy, which represents 14 royal colleges, would lead it.

The decision gives back to the royal colleges powers they lost over regulation of specialist medical training when Modernising Medical Careers, the new training scheme for hospital registrars, was introduced.

Prof Dame Carol Black, the academy president, said: “The academy welcomes the decision to carry out an immediate review of the Medical Training

“Shortcomings in this critical element of the Modernising Medical Careers have caused dismay and much distress. We will work with the department to ensure action is taken to remedy faults and to restore confidence.”

The review will be led by Prof Neil Douglas, the vice-president of the academy and president of the Royal College of Physicians of Edinburgh.

The senior doctors have been given the power to identify what action is needed and when it should be taken – either before the end of the current round or before the start of the next round of job applications at the end of next month.

The British Medical Association said Mrs Hewitt had not gone far enough.

“The Government has finally been forced to address the appalling problems with this system,” said Dr Jo Hilborne, the BMA junior doctors’ committee chairman.

“We have been warning since last summer that these reforms were being rushed through too quickly. From the point of view of the thousands of doctors who’ve been messed around, given incorrect information, or denied job opportunities that they deserved, it’s a shame the Government didn’t listen then.

“Not only is this response too late, it also does not go far enough. While we welcome a review, the only fair solution now is for the interview process to be suspended until it can be clearly shown that no doctor has been disadvantaged as a result of the Government’s mistakes”.

Dr Hilborne said they were disappointed that they had not been invited to take part in the review panel.

Prof Gus McGrouther, professor of plastic and reconstructive surgery at the University of Manchester, has described the new system as the “biggest crises to hit British medicine since the start of the NHS”.

He said the process should be stopped altogether.

“How can we carry on interviewing in a system that they now admit is flawed? It is likely that this first round of interviews will fill most of the jobs up but it may be excluding some doctors who are better. This is unfair,” he said.

On Monday senior surgeons on an interview panel in Birmingham refused to interview 80 candidates because they said the system was not fit for purpose and they could not be confident they would be choosing the right doctors for the jobs.

The Government has promised that there will be enough jobs for British-trained graduates but there were 30,000 applications for 22,000 posts.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/07/ndocs07.xml

Health Direct first warned over a year ago (6 Mar 06) that the MMC’s computerised application was in meltdon in Junior Doctors’ new IT MMC MTAS recruitment system is a disaster.
http://www.healthdirect.co.uk/2006/03/junior-doctors-new-it-mmc-recruitment.html

As it has therefore taken the labour govt a year to wake up to the IT disaster that it created, how can we be confident that it will be sorted quickly?

About as likely as John “not fit for purpose” Reid’s spin yesterday about sending text messages to illegal immigrants asking them to leave. How can anyone have any confidence when the labour govt doesn’t know how many people there are, what their names and addresses are let alone their correct phone numbers. Pathetic.

From:
Sarah Hall is the Guardian’s health correspondent:
http://www.guardian.co.uk/comment/story/0,,2027287,00.html

I know this because it is the conversation that has been going on in my home. My husband, an orthopaedic registrar, is trying to assess whether he has any hope of becoming a fully trained surgeon, or whether, after committing 12 years – five as a student and seven as a doctor – he should leave medicine altogether.

He hasn’t cried – he is too numb for that – but I have never seen him so ashen. A registrar with seven-and-a-half years’ experience, a period of research, a regional prize and a list of academic publications, he had been told by his boss – who shortlists – that his application was sufficiently strong. Sure, the glitch-ridden online application form was repetitive, vague and confusing. True, the whole process seemed geared towards the most junior doctors. But he couldn’t believe that his commitment and skill would not show through.

Now it is clear that it hasn’t – and that this system has scuppered the chances of thousands. No one knows how many of the 30,000 junior doctors are affected – Department of Health officials, who will meet the British Medical Association today, are still collating that information.

But Remedy UK, a grassroots doctors organisation set up two months ago, now has 8,000 members – with 250 applying daily and 3,000 planning to march in protest.

The situation has arisen in part because the government has failed to match the number of training posts – 22,000 – to the 30,000 junior doctors. The most junior, who started on the new system two years ago when they left medical school, have had 5,000 posts ring-fenced for them. But those who began under the old system haven’t received such preferential treatment.

Ministers are right to say no one has the right to a trainee post, but the lack of interviews appears to have been compounded by flaws in the selection process. The online application system felt rushed and botched. Results were due on February 24. On the 28th – the day interviews were meant to start – they had still not been completed.

We are used to problematic government IT systems – and the minister initially in charge, Lord Warner, also oversaw the NHS IT system – but it is hard not to fear careers are being ruined because of such flaws.

At a press conference last year, the same minister dismissed the idea of junior doctors’ unemployment as “absolute rubbish”. Doctors just had to be flexible – change speciality or move. “Instead of working in the south-east,” he explained, “they might have to go to Aberdeen.” Despite having a wife, daughter and mortgage in London, my husband would jump at that option, were it available. Instead, he is asking if he should retrain, move abroad, or try his luck “in the City”, where they apparently value the dedication, coolness and decisiveness of trainee surgeons.

Each option seems bleak. His confidence has been shattered and yet he knows it would be a massive waste, not only of public money – £250,000 just to get him through medical school – but of his talent and experience if he has to hand back his scrubs. “I know what I’m good at,” he says, “and I just want to be able to do it.”

Health Direct warned last year (6 Mar 06) that the MMC’s computerised application was in meltdonw in Junior Doctors’ new IT MMC recruitment system is a disaster

It is an irony that many of the questions junior doctors must answer when they fill in the new form to apply for hospital jobs relate to their leadership skills and ability to work as part of a team. The form is part of a new applications procedure, called Modernising Medical Careers (MMC), which involves no human interaction whatsoever.

Hospitals are banned from holding interviews, having to rely instead upon a computer “dating” system that supposedly matches the applicant to the job.

As 80 eminent doctors have been moved to protest to the Department of Health, the results have been disastrous. Sixty junior doctors recruited in this way have failed to demonstrate a basic level of medical competence, while many others have had to be retrained at huge expense.

Some successful east European recruits turned out not to speak English, while 600 well-qualified British students have been left without jobs at all, leaving them unable to complete their training.

No checks have been made, so it seems, on the information that applicants put on the forms. Moreover, in the absence of an interview, there is no way hospitals can be sure whether the applicant is a genuine, qualified medical student or whether they are an impostor who paid someone to fill in their form for them.

And the consequencies of the Dept of Health’s incompetence? On June 15, 06 Health Direct posted: NHS faces brain drain, BMA doctors warn

Doctors’ leaders said yesterday that the profession faced a potential brain drain because of a shortage of posts being made available under controversial labour government reforms. The British Medical Association said that up to 11,500 doctors could be left disappointed because there were only 9,500 training posts being competed for by more than 21,000 doctors.

But the BMA junior doctors’ committee – which will meet officials to lobby for more posts tomorrow – warned the remaining 11,500 would face options including leaving the NHS and working abroad. “There will be a brain drain,” said Dr Jo Hilborne, chair of the junior doctors’ committee.

“Huge numbers of people will choose to go abroad and significant numbers will choose to leave medicine altogether if they can’t get a job in the UK.” With each doctor costing £237,000 to get through medical school, such an exodus would constitute a huge waste of money for British taxpayers, she said.

“The alternative – pushing doctors into dead-end jobs so they never get essential skills that would benefit their patients – is unacceptable and won’t work. Doctors are simply going to leave the NHS instead,” she added.

The warning came a week after the president of the Royal College of Surgeons, Bernard Ribeiro, told the Guardian there was “a real danger” the medical reforms could lead to a brain drain similar to that in the 1960s, when doctors went to the US.

The shortfall has arisen because the government increased the number of medical students – from just over 4,000 in 2001 to 7,380 last year – while hospital trusts and deaneries failed to match this with an increase in training posts.

Last week Professor Shelley Heard, the MMC’s national clinical adviser, said junior doctors needed to accept that not all would receive training. But critics, including Mr Ribeiro, said doctors who had already committed at least seven years to training were reluctant to settle for jobs which will not lead to consultant status.

A BMA survey shows 61% of doctors would opt to continue their training overseas, and 35% to leave medicine altogether, rather than resign themselves to a career path with no possibility of training. Australian authorities have already visited the UK to recruit doctors.

Dr Hilborne, who will meet MMC officials tomorrow, blamed the government for ignoring doctors’ concerns and forging ahead with MMC. “We asked the government to delay this but it’s part of their wholesale reform of the NHS, which they’re insistent on taking forward” she said. “Meanwhile, these poor guys who by an accident of fate happen to be at this point in their careers are caught in the middle.”

Dr Crippen’s blog also raises the disgraceful fiasco that is the MMC.

Because this Labour Government and its bureaucrats only see people as a mass, they fail to recognise the power and potential of the individual. Yet it is the individual – significantly so in education and medicine – who can inspire and transform the lives of those with whom they deal.

Throughout history, when the rights of the individual have been denied for the “good of the masses”, disaster and misery have quickly followed.

If Labour and the Dept of Health can’t run a small database of doctors what hope is there for their white elephant of a database for 60 million patients?

Under new guidance sent to primary care trusts (PCTs), patients with complex problems who need to see a consultant should be seen within 18 weeks. The other 50% of patients who need a routine hearing aid fitted should be assessed within six weeks, it says.

New guidance advises the NHS to set up one-stop shops to speed up assessment and fitting and to use the private sector to help tackle demand.

Health minister Ivan Lewis admitted waiting times in some parts of the country were “unacceptably long”.

Some reports have suggested some patients are having to wait as long as five years for replacement hearing aids.

The number of referrals to consultants could be cut by a fifth with patients instead being referred directly through audiology services, the guidance advises.

And although there is no target for the length of time between assessment and fitting, the Department for Health said improvements in technology meant that many people did not need separate appointments.

A report from the British Society of Hearing Aid Audiologists (BSHAA) published last year showed that some people were having to wait up to five years to switch their old-fashioned analogue hearing aid to a better digital model.

Government figures from 2006 show that of all patients waiting for an audiology referral, two-thirds had been waiting longer than 13 weeks.

And a recent report by Conservative MP Grant Shapps found that average waiting times were 40 weeks, with reassessments taking over a year.

Mr Lewis said there was no justification for the delays as there was already enough cash in the system.

Mr Shapps, MP for Welwyn Hatfield, in Hertfordshire, said he was disappointed by the report and was sure targets would not be met by next year.

“This report has a lot of noble aims but no practical measures. This is part of a much wider problem about competing pressures within PCTs,” he said.

Shadow health minister Tim Loughton said: “The long waiting lists for digital hearing aids are amongst the biggest scandal in the NHS, particularly for the elderly population.”

Dr John Low, chief executive of the Royal National Institute for the Deaf, welcomed the push to reduce delays but said he would hope waiting lists could be reduced before 2008.

“The commitment to purchase substantial additional capacity from the private sector is particularly welcome since the NHS will not be able to fit hearing aids to 300,000 extra people through productivity gains alone,” he said.

Karen Finch, chairwoman of the BSHAA, said a long-term sustainable solution was needed.

“Engage with High Street hearing aid audiologists,” she said.”There are 1,400 of us and we believe that we have the immediate potential to help the hard-pressed NHS out. We are a skilled resource, trained to dispense hearing aids.”

From:
http://news.bbc.co.uk/1/hi/health/6420205.stm

Thousands of health workers have been holding marches and rallies to protest about cuts to NHS jobs and services, and below-inflation pay increases.

Demonstrations took place in a number of towns and cities, including London, Manchester, Preston, Bristol, Birmingham, Sheffield and Belfast. TUC general secretary Brendan Barber – who spoke in Sheffield – said there was “real concern” about NHS policies. The events were co-ordinated by NHS Together, an alliance of unions and NHS staff organisations.

Random Acts Of Reality, a Blog based in London, England, written by an E.M.T working for the London Ambulance Service. Also, number one search result for “Womble porn”. All names have be changed to protect the guilty. This Blog was previously known as “Why I Hate Humanity” but the antipsychotic medication seems to have kicked in.

Pay ‘Rise’
by Tom Reynolds on Thu 01 Mar 2007 06:19 PM GMT

Expletive Deleted.

Isn’t it nice to be valued by the government? Pay rises below the rate of inflation which are also staggered which effectively means that my standard of living is set to go down.

Crap conditions, increasing demands, moronic running of the NHS and increased expectations with no increase of resources. Lies from the government who took money away from the ambulance service that made it’s (worthless) targets.

A screwing over of our new members of staff giving them barely liveable wages for years. An expectation to work harder, an expectation to increase our scope of practice and all this leading to increased danger to staff.

http://randomreality.blogware.com/blog/_archives/2007/3/1/2773493.html

Dr John Crippen’s diary The trials and tribulations, the pleasures and pitfalls of family medicine in the modern British National Health Service.

Dr Crippen is angry. He has worked for over 20 years in the NHS. He watches and weeps as the Health Service, slowly but inexorably, is destroyed.

He takes a sad, sometimes humorous, sometimes cynical, look at the health care from the inside

http://nhsblogdoc.blogspot.com/

The more I listen to Patricia Hewitt, and her health care “truths”, the more I feel trapped in an Orwellian vision of the future.

A horrifying report from yesterday’s Independent on Sunday.

Record numbers of women are being harmed or dying as a direct result of childbirth in what doctors are labelling as “a crisis” in maternity care.

* 391 women have died in childbirth in the last three years, a 21% increase on the previous comparable period.
* The UK now has one of the highest maternal mortality rates in Europe, with 13 deaths per 100,000.
* 17676 women have suffered physical harm on labour wards in the last three years – harm such as perforated bowels, necessitation temporary colostomies.
* Maternity medical negligence claims are costing the NHS £1 billion a year

It is all due to lack of resources and, as Dr Crippen never tires of saying, dumbing down.
* Midwives are doing work for which they are not trained; work that should be done by doctors.
* Health care assistants are doing work for which they are not trained; work that should be done my midwives.

How is the government dealing with this?

The Independent quotes the Department of Health as saying:

“Giving birth is safer than it has ever been.”

Patricia Hewitt said last year that the NHS had had its “best year ever”. This year, she has promised to “balance the books”; to get the NHS finances out of deficit.

“I’m not planning on failure”

In typical fashion, Ms Hewitt last year declared that she would “take personal responsibility” if she failed to balance the NHS books by this April, the end of the financial year.

Think about that last statement. She says she will “take personal responsibility”. She is the Secretary of State for Health. She is responsible for the NHS.

And precisely how is she going to balance the books?

by closing maternity units
by sacking young hospital doctors who are training in obstetrics
by sacking midwives

How many more deaths do there have to be before Paricia Hewitt is sacked?

Life in the NHS Julie has been a nurse for more than 25 years (yes really), and for the last 5 have managed a training and education department of a Primary Care Trust in the United Kingdom.

Married, have a teenage son and am also studying for a post graduate degree. Not surprisingly I am sometimes unsure of my own sanity!

I was amused to hear that the government is now suggesting round the clock surgery to clear waiting times. The very idea of getting your routine hernia repair, or hip replacement at midnight sounds bizarre beyond belief.

We have PCTs who are bankrupt telling NHS Trusts not to operate on their patients before April and suddenly it is a good idea to operate in the dead of night. How much would it cost your average cash strapped hospital to run services in this way, and how many doctors would be left to cover the day time hours?

Puts a new perspective on ‘day’ cases which would be come ‘night’ ones and if the hospital was in London would save money for all by avoiding congestion charges! Maybe the idea has mileage after-all?
February 19th, 2007
http://lifeinthenhs.wordpress.com/tag/news-and-current-affairs-general/

Nee Naw – Blog by Mark Myers a Dispatcher in the London Ambulance Service’s Control Room

About This Blog
If you were to walk into London Ambulance’s control room and peer down into the call taking area (otherwise known as “the pit”), you might see a young green-clad man ferociously scribbling notes on the back of a rejected annual leave slip between calls.

That man is me, and those notes form the basis of this blog. Since I started work in Central Ambulance Control (or Nee Naw Control, as it shall henceforth be known), I have kept a diary my most memorable calls, from delivering babies in pub toilets to soothing hungover teenagers, via the inevitable embarrassing sexual accident.

I have now decided that the time has come to release that diary on to the Internet for public consumption.

Weeding Out The Snifflers
Posted in Ambulances by Mark Myers on the February 13th, 2007

When it gets busy, the dispatch desks spend a lot of time calling back our lower priority calls “apologising” for delays and hoping that the callers will get the message that they shouldn’t be calling us and should be calling a GP/taxi/etc instead.

We are not allowed to refuse people an ambulance but we are allowed to warn them of long delays and generally coax them into deciding to cancel and deal with the problem more appropriately. We are on rather shaky ground doing this, but since the Telephone Advice people stopped using TAS and started using a new system called PSIAM we have no option.

Gone are the days of the No Send Policy — using PSIAM, Telephone Advice are forced to make us send out ambulances for any person who insists on one. As you can tell, I am not a fan. I fear for us dispatchers, because one day, in an effort to weed out an inappropriate call, we are going end up coaxing someone who is seriously ill but mistriaged as low priority to make their own way to hospital, and the papers will get hold of it, and all hell will break lose.

It shouldn’t fall on us to do this; Telephone Advice should be given their old system back, which worked perfectly well in getting rid of the time wasters and identifying the seriously ill people who had erroneously been triaged as low priority.

Anyway, despite these worries, I felt reasonably confident in calling back a thirty-year old man whose symptoms were given as “runny nose, cough, slight fever, headache, for two days”.

“Hello sir,” I began. “This is the London Ambulance Service here. I’m ringing to apologise for the delay. All our vehicles are busy dealing with other emergencies” (I emphasised the word “emergencies”.) “How are you feeling?”

“I have a cold!” grumbled the man, as if that much had not been obvious.

“I see,” I said. “And has anything changed since you called? Have you done anything for your… cold?”

“No!” said the man. “Nothing has changed, and I have had it for TWO DAYS! I went to the hospital yesterday, and they did NOTHING! They told me to take paracetamol and sent me home. They were not able to cure me!”

“Well, sir,” I said. “That’s the thing about the common cold — there is no cure. If you’re sure that’s what it is, then you just have to wait for it to go away.”

The man tsked and muttered something about the state of the NHS, and then cancelled the ambulance, which was good, because we needed five vehicles for an 80mph RTA on a 30mph road, and wouldn’t have had one for him for hours.

I think a lot of our inappropriate callers share the underlying beliefs of this caller, which is that if you are ill or injured and feeling lousy, you shouldn’t have to put up with it, and that someone from the medical profession will always be able to come along and wave a magic wand, which will make you feel better.

It just doesn’t occur to people to go to bed and take some time out and wait for whatever is wrong with them to go away. Everything has to be fixed instantly, and if it can’t be, it is always someone’s fault.

At the same time, a survey of NHS trust chief executives revealed the impact of the health service’s financial crisis on front-line care.

The survey, published in today’s Health Service Journal, shows that 73 per cent of primary care trusts, which run GP clinics and health centres, are already restricting access to treatments. Half are also delaying operations.

Seven out of 10 chief executives said “patient care will suffer” as a result of short-term financial decisions to cut deficits, while 61 per cent of acute hospital trusts said they were already closing wards.

Almost half of all trusts said that they had made, or intended to make, redundancies this year.

Morale appears to be at rock bottom, with 86 per cent saying that managers were “battered and bruised” by endless reorganisations.

Miss Hewitt published her guide on closures amid growing panic in Whitehall about the looming public backlash as trusts across the country announce plans to cut services over the coming months.

But the opposition immediately accused ministers of “a cynical exercise” in spin as it emerged that the guide includes proposals on “media handling” and urges trusts to use words such as “adapting” or “evolving” services when talking about cuts.

Dozens of accident and emergency units, maternity units and community hospitals are facing the threat of being shut down or downgraded as part of the Government’s plans to “reconfigure” the health service.

Many Labour MPs fear the cutbacks will cost them their seats, prompting four Cabinet ministers to join local protests against planned closures in their own constituencies.

In a covering letter to the guide – which has been sent to all 10 Strategic Health Authorities in England – David Nicholson, the NHS chief executive, said it was vital that managers did not “shy away from major service changes that address financial difficulties”.

Miss Hewitt’s new blueprint on closures, written by Sir Ian Carruthers, the former chief executive of the NHS, stresses that trust managers must do more to sell their closure plans to local people. The report conceded that closures would “lead to a loss of public confidence” and that reconfiguration had “become a euphemism for closures and downgrading of hospitals”.

It argued that NHS managers could limit the damage by developing clear media strategies, using the right language and trying to get some senior doctors to back their plans.

Managers are warned that the media can often run “damaging” stories on closure plans.

“Effective media handling plans, regular engagement of local journalists, care in explaining the case for change and a strong local voice to challenge misleading media stories that worry patients unnecessarily can help mitigate this,” it said.

Language is crucial and managers are urged to use words such as “adapting, developing, evolving and specialising. If a service is changing to improve the health outcomes for patients and save lives, this isn’t a downgrading of the service.”

Managers are also advised to argue that closures will be compensated for by better services in local health centres or GP clinics.

The new spin guide was condemned last night by the Conservatives and Liberal Democrats.

Andrew Lansley, the shadow health secretary, said: “Nothing in this long-winded document will offer any comfort. It is all about advising NHS bureaucracy how it can better sell decisions. It offers no real evidence for how services can and should be improved.

“The Department of Health should be less concerned with spin and more concerned with substance.”

Norman Lamb, the Liberal Democrat health spokesman, said: “This is a cynical exercise and their cover has been blown. It demonstrates that despite claims that decisions are made locally, everything is driven from the centre. Even the spin is sent down from Whitehall.”

Dr Mark Porter, the deputy chairman of the British Medical Association’s consultants’ committee, said changes in services needed to be about improving patient care.

“The BMA is not opposed to reconfiguration if it is done for good, sound clinical reasons. But we have been worried that finances and not patients’ needs have been the driving force behind some plans,” he said.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/01/nhosi01.xml

At the beginning of the new year (3 Jan 07) Health Direct warned that there were signs of NHS hospitals told to delay operations to ease health service’s debt underfunding

The New Year has only just begun but it is clear that the next three months are not a good time to become ill as the NHS can not cope with Labour’s underfunding of the health services as patients in some parts of the National Health Service are for the first time facing minimum waits to be seen and treated as managers attempt to balance their books.

Suffolk, Hertfordshire, North Yorkshire and Kingston are all imposing various forms of minimum wait, with some primary care trust chiefs saying their organisations may follow suit as the NHS battles to recover from last year’s £536m plus overspend.

Only a week later (10 Jan 07) Health Direct posted that Maternity wards are having their cash cut amid boom in birthrate, say midwives

The NHS is responding to a boom in the birthrate by cutting spending on maternity services, the Royal College of Midwives said after a survey of more than 100 heads of midwifery in hospital trusts across Britain.

It found that two thirds of maternity units were understaffed and most were trying to save money by employing fewer qualified midwives and taking on maternity support workers instead.

Then on (1 Feb 07) Health Direct posted that Dental patients hit as dentists funding fails to add up

Dentists are turning away patients because miscalculations by the Department of Health have resulted in local health authorities running out of money in the dental budget. The problem has arisen because dentists have been treating more patients who are exempt from dental charges than had been anticipated under the new dental contract which came into force last April.

Then on Valentine’s Day (14 Feb 07) Health Direct posted that it was the turn of the suppliesr to feel the financial squeeze- NHS paying bills late in struggle to balance books, say suppliers

The National Health Service is delaying paying bills and cutting orders for supplies as it tries to balance its books, according to the trade associations whose members supply the service with everything from scanners to diagnostic tests.

Ray Hodgkinson, director-general of the British Healthcare Trades Association, said that while the picture was highly variable “some of our members are having real trouble getting money out of NHS trusts”.

More recently Labour’s NHS Cash crisis hits sexual health STD clinics, then confirmation that MRSA and Clostridium difficile deaths up by half in year and cancer patients were also cut back in Hospitals told not to operate until cancer patients have waited 20 weeks

Only last week (Feb 22 07) Health direct warned that More trusts expect deficits as NHS spending cuts bite when around a quarter of primary care trusts are setting minimum waiting times for patients or otherwise slowing treatment, at least until the start of the new financial year.

Mr David Nicholson, the NHS chief executive, acknowledged that patients had been affected. But he said the service was still treating more people, and training cuts would be restored next year.

However, Andrew Lansley, the Conservative health spokesman, said “the surplus they have generated is a sham”. More organisations were saddled with worse deficits than last year, he said, adding that “Patricia Hewitt’s skin is being saved only by savage cuts to centrally held budgets”.

The NHS Confederation argued that half the overspend was in just 6 per cent of organisations. It urged the health department to end the “double whammy” caused by a set of accounting rules it said were being applied inappropriately to some hospitals, causing them to enter an inescapable spiral of debt.

David Nunn, a consultant orthopaedic surgeon at Guy’s and St Thomas’ Hospital Trust pointed out that the drive to reduce waiting lists by performing more operations means that hospitals are losing substantial sums for each additional operation carried out.

“This is unsustainable,” wrote Mr Nunn. “Tony Blair knows that his policies will lead to an implosion of the NHS but he will be out of office when it finally occurs.”

What Mr Nunn was referring to is an accounting error built into the NHS, an error which means that, despite the most drastic measures, such as ward closures, staff cuts and withdrawal of certain treatments and services, the books can never be balanced.

The introduction of the NHS tariff in 2002 – a standardised price list for operations and procedures to apply nationally – was intended to reform hospital accounting.

It was also seen as crucial to the war on waiting lists, helping to ensure better use of beds and theatre time by allowing patients to travel around the country for their operations with the procedure being paid for by their own primary care trust (PCT).

Money following the patient in this way was a fine idea in theory, but in practice the tariff has one massive flaw.

Every price for every procedure on the list is a guesstimate. No one in the whole system can say for certain that the price hospitals charge a PCT for work has any relation to the real cost of that procedure. In the majority of cases, it is simply wrong.

When the tariff was first set up, financial directors from hospitals around the country were asked to submit the price they put on a particular procedure.

The figures varied enormously, so the administrators took a mean figure and decided that was close enough.

None of the participating hospitals performed an audit to crosscheck the figures they had submitted.

No one asked the surgeons if they thought these figures were correct. Whitehall signed them off – and the price list was fixed.

Mr Charlie Chan, a surgeon specialising in breast cancer at Cheltenham General Hospital, says no one has any idea how much operations really cost.

Yet, as he points out, pricing them is not a difficult thing to do.

“We know the cost of running a hospital theatre, we know the costs of hip implants, for example. Even though surgeons operate at different speeds and use different quantities of sutures, it is possible to work out a consistent rate, as any ‘sensible’ audit would find.”

Following the introduction of the tariff, hospitals managed to balance their books by juggling operations.

As many as possible of the cheaper, quicker jobs, hernia repairs or bunion removals, for example, were slotted in around major life-saving procedures that cost tens of thousands of pounds. In effect, the simple operations subsidised the complicated ones.

But with the opening of independent sector treatment centres (ISTCs) – privately run clinics endorsed by the Government with the intention of helping to cut NHS waiting lists – there were fewer simple operations for the hospitals to perform.

Bunion sufferers no longer had to wait or go private. They could have their operations performed much more quickly at an ISTC or at special NHS clinics established for the same purpose.

The ISTCs weren’t governed by the troublesome tariff system either. The NHS would pay a fixed lump sum, in separately negotiated business contracts, for the procedures to be carried out there.

Economies of scale meant that a smart, bustling little unit carrying out routine surgery from 9-5, with an hour’s lunch break, using cheaper, sometimes foreign staff, found it much more economical to operate on a bunion than the giant teaching hospital next door, which was paid according to the inaccurate tariff.

Staff at the Royal National Orthopaedic Hospital in Stanmore, Middlesex, must deal with realities of this every day.

Mr Steve Cannon, for example, runs a unit dealing with complicated sarcomas (bone and soft tissue cancers), and correcting complications of knee and hip surgery.

Cannon estimates that inaccurate pricing means he loses about £1,000 a case.

“We used to balance the books by performing arthroscopies [exploratory joint surgery],” he says. “But if you remove these simple procedures, sending them to ISTCs or special NHS clinics, we can’t make any profit. The proposed tariffs for what we have to do are inadequate.”

“For an operation to excise a soft tissue sarcoma, the tariff allows £1,428 per case. Add in a minimum of three days in hospital, perhaps one night in intensive care, and a top-up payment, as it is a specialist area, and the cost we can claim is £5,216 each patient.

“At present, even with all our cost-cutting measures in place, each of these cases actually costs us £8,674. We will be short by £900,000 next year on that group of patients alone.

“Overall, we are looking at a deficit next year of £1,786,000 – all because of the tariffs. We will go on till we are bankrupt and have to close. But then where will the patients go? No one else will want to take on this work as it will cost them too much, nor will you get the same concentration of special skills. It is a horrific situation. People will suffer – this situation has become dire.”

In the longer term, the impact on surgical training is also causing concern. Mr Nunn, who wrote to the Telegraph, says that so much work is being performed in ISTCs by non-NHS doctors that there is no work in hospitals for recent surgical graduates, and no jobs for them to go to.

“Not one of our graduates at Guy’s has a consultant job,” he says.

“We will have a whole generation of junior doctors who won’t be able to do simple operations on their own, let alone complex ones; and in turn they won’t be able to train the next generation. It’s self-perpetuating. This will destroy the health service.”

From:
http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/02/26/hnhs26.xml

The fallability of the finances was raised by Health Direct in 30 Oct 06 when we highlighted that PbR Payment by Results are fundamentally flawed says Clinical Coding chief The current system of Payment by Results (PbR) is ‘fundamentally flawed and unacceptable’ the head of the Professional Association of Clinical Coders warned last week. Managing director Sue Eve-Jones told an HSJ conference last week that the quality of data in the NHS could compromise any chances of ensuring fairness under PbR.

Her presentation was subtitled ‘doing the best we can with a fundamentally flawed and unacceptable system’.

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

Perhaps Tony Blair should look elsewhere for a legacy of his premiership rather than the NHS.