Medical training is, quite rightly, being shortened and modernised. But the new system appears to have been brought in too quickly, leading to fears that there will be several thousand too few training posts come August.

A centralised, online clearing system that has replaced local job applications has gone badly wrong. Junior doctors say the system prevents them listing their full qualifications and experience, while concentrating on questions about empathy and leadership. Highly-qualified doctors have found themselves without even an interview, while less qualified candidates have been called for interview to the wrong jobs.

The system is being patched up for this year, with a second round of recruitment promised for those without jobs after the first round. An independent review has been launched on how it will all work next year.

From:
http://www.ft.com/cms/s/d03967b0-f1ff-11db-b5b6-000b5df10621.html

Junior doctors go overseas after applications disaster

Highly-qualified junior hospital doctors are quitting the National Health Service for jobs in Australia, New Zealand and elsewhere following the fiasco over a new application system for training jobs that has left many without an interview.

The British Medical Association released a survey of 650 doctors yesterday showing that 55 per cent would be likely to seek a training opportunity overseas if their current applications were not successful.

Almost 5 per cent had already had overseas offers. This raised the possibility that many would take four- or five-year training posts that would deprive the NHS of their services for at least that long and perhaps their whole careers, the BMA said.

“The NHS could lose thousands of its best young doctors simply because of poor planning,” said Dr Jo Hilbourne, who chairs the BMA’s juniors’ committee.

The threat is more than theoretical. Kate Bleasdale, chief executive of HCL, an agency that provides locum doctors, said it had already placed about 40 British doctors overseas since late last year, with demand strong from Australia, New Zealand and the United Arab Emirates.

“We currently have about 100 doctors who are looking to move abroad and there is worldwide demand for healthcare staff,” she said.

Dr Richard Thomas, a senior house officer at Whipps Cross Hospital in north-east London, has already received an offer of a four- year post in emergency medicine at a hospital in Sydney, and says that he knows two other juniors who are going there. Aged 29, he qualified in 2003 with an extra year at medical school that gave him an additional research degree.

He has already spent a year in Australia to broaden his experience and has passed all his specialist exams at the first sitting to acquire the higher qualification of membership of the Royal College of Physicians. Speaking after coming off a 13-hour night shift, he said: “I have presented at international meetings in Boston. I have a first-class honours [degree] for my dissertation. I have full membership of the [Royal] College of Physicians. I recognise medicine is very competitive and I could not be more qualified.

“But I got no interviews at all from the medical training application service. The system is telling me I am un-employable in the NHS.”

Dr Thomas said his goal was to work in clinical radiology, and if the latest attempts by Patricia Hewitt, the health secretary, to patch the system up resulted in a job offer, he would stay in the UK. Otherwise “it will have to be plan B” and a job in Sydney that was not his ideal choice.

Andrew Lansley, the Conservative health spokesman, said a strategic solution to the issue was needed, on top of the emergency measures the government was taking on interviews.

http://www.ft.com/cms/s/87189cb2-f200-11db-b5b6-000b5df10621.html

Channel Four News revealled that since at least 9 o’ clock this morning, the details of medical students applying for foundation course posts – the first year to become a junior doctor – were openly available to the public.

This is astonishing. Not only could they see what the doctors wrote in their applications; their addresses; their phone numbers; who their referees are. They could also see if there were white, heterosexual, gay Asian, Christian, Jewish or Hindu, and also if they have got police records and what the crime was.

Channel 4: Once we were informed we checked the site to see if there had been a massive breach of this already controversial system – and there had been.

At 4.35pm we told the Department of Health. The chair of the British Medical Association’s Junior Doctors Committee also called the department – at 5.05 they closed the breach – it took them just half an hour.

They were completely unaware that it had been open – at a minimum since this morning.

“I am absolutely appalled to get in and see this information – I am just flabbergasted.”- Jo Hilborne, BMA junior doctors committee.

What’s more, the doctor who told Channel 4 News that there was this problem did not come to us initially. He went to the Information Commissioners Office – the custodians of data protection. They said there wasn’t much they could do.

Junior doctors have been protesting against MTAS since the outset. Today, their action group Remedy UK, condemned this hole in the security.

“I’m absolutely gob-smacked, I don’t know whether to laugh or cry. I’m not going to be able to laugh because it’s so serious. After I’ve scraped my jaw up off the floor I’ll say that I’m not really surprised – it’s a level of ineptitude that has characterised this whole procecss. It takes the concept of a botched IT job just to a new dimension.” – Matt Jameson-Evans, Remedy UK

No Minister was available for interview tonight. Instead they issued this statement:

“We apologise to any applicants whose details have been improperly accessed. This URL was made available to a strictly limited number of people making checks as part of the employment process. This is a very serious matter and is under investigation. “

When MTAS was launched in January – it kept crashing, listed the wrong jobs, some of the best candidates were excluded from posts and the application period had to be extended.

The Health Secretary last week apologised for the distress it caused junior doctors but yesterday she said this: “It has not been a complete unmitigated disaster…has been working well particularly for GP posts.” – Patricia Hewitt

Experts say the level of data included in the applications makes it a gold mine for identity theft and fraud. It is also likely to be a breach of the data protection act and could lead to criminal charges.

Throughout the junior doctors’ recruitment saga, Channel 4 has been asking the Health Secretary Patricia Hewitt to appear on the programme, but she’s always declined – and tonight was no exception.

Joining us instead was the Shadow Health Secretary Andrew Lansley, who’s at Westminster:

Q – Your reaction?

A – Well I think it’s shocking. I think this is a very serious matter. It’s something which should never have happened. It’s something which clearly is going to further undermine what is already desperately low morale amongst junior doctors, many of whom have indeed as you said suffered considerable disadvantage to the way this system is working.

People we’re trying to give greater confidence to, and the department should have understood that, and I don’t think the department can say this was something they shouldn’t have been aware of. The risks to the security of the site had been highlighted to them before.

I have with me here with me a letter from the British Orthopaedic Trainees Association of the 5th of March to Patricia Hewitt, highlighting risks to security on the site because shortlisters for interview had access not only to the applicants they were shortlisting but to everybody in their region. Now if there were security lapses more than a month ago clearly there ought to have been much heightened security on the site since then.

Q – Looking at it from the perspective of the doctors who have been affected they have really no redress. Their addresses are out there, their details are out there and there is little more sensitive to a doctor than the privacy of where they live. Once a doctor’s place of life is exposed, they are themselves in danger.

A – Well I hope it is the case that this data has not gone in too many directions, but we can’t, I guess you can’t be at all sure about the extent to which this data has become available and to whom it’s become available.

Q – The extraordinary thing is MTAS the people who run this site say it wasn’t open for very long. The truth is you and I both know they don’t know.

A – That’s right and it’s very important therefore that the information commissioner should investigate this and do so urgently. You say the junior doctors have no redress but frankly there should be redress under the data protection acts. There should be redress against anybody who is responsible for such a serious breach of people’s data confidentiality. But frankly, I come back to the point I was making a moment ago. We know that more than a month ago there was a risk to security.

It was a different one but concerned access to data for those who were being interviewed so that everybody doing shortlisting in a region saw everybody’s data not just the people they were responsible for in their particular narrow specialty. That was a serious lapse, this is another and more serious lapse. I’m afraid it’s another, it’s a catalogue of these failures.

Q – One thing we can be sure of is that there will be no political consequence to this.

A – There are a range of serious consequences to this. You have not been able to bring ministers or Patricia Hewitt to your studio to answer questions. Back on March 19 I was able to bring Patricia Hewitt to the House of Commons for the first time to answer questions in person. Yesterday afternoon we brought her to the House of Commons, you showed the debate there. It’s on our time. She didn’t volunteer to come to the House.

Q – Given that there is yet another issue here tonight. Is it a resignation matter?

A – We’ve arrived at the point where there is no confidence in Patricia Hewitt. I know that in a few weeks time the Prime Minister will be leaving. There will be a new Prime Minister.

Q – Does no confidence amount for a call for her to go?

A – She will go. I have no doubt about that. There is no realistic prospect of Patricia Hewitt commanding confidence in the national health service anymore. The junior doctors have completely lost confidence in her and that is true as we saw in the way in which Unison received health ministers, in the way in which the Royal College of Nursing criticised her last week.

From:
http://www.channel4.com/news/articles/society/health/exclusive+junior+doctors+details+exposed+online/469137

Health Direct notes through the Financial Times that despite the truely inept Labour politicans activities Doctors have not lost their sense of humour. In yesterday’ FT Observer Section:

We’ll call you

Junior hospital doctors may be rightly incandescent over the new training and interview system known as Modernising Medical Careers. But at least they have not lost their sense of humour. A motion for their annual conference on Saturday calls on Patricia Hewitt, the health secretary, to resign and reapply for her job using the online application form that has roused their ire.

This would mean, the motion notes, that none of her experience would count, the scoring of her skills would be arbitrary, the website would crash at the crucial moment and she wouldn’t get an interview – all experiences that the juniors say have been their daily lot. They say laughter is the best medicine.

From:
http://www.ft.com/cms/s/fb246a92-f1ff-11db-b5b6-000b5df10621.html

The move is a setback for the Department of Health’s drive to get up to an extra 250,000 patients a year treated in private sector facilities through a second round of independent sector treatment centres (ISTCs).

Profitability has improved since 2005, when the study was last conducted. Eighty-three per cent of contracts are profitable, with a quarter reporting “better than ex-pected” profits. But the survey found almost 20 per cent still did not make money, with almost 40 per cent saying they were making less money than expected.

Some 13 schemes have reached preferred bidder stage but it is now nearly two years since they were first announced, with none having yet reached financial close. Nuffield cited costs and delays in concluding the deal as the reason behind its decision.

A series of factors, including negotiations between the department and the Treasury, have slowed the deals, with some in the private sector uncertain whether Gordon Brown will promote the programme with the same vigour as Tony Blair, assuming the chancellor succeeds him as prime minister.

David Mobbs, Nuffield’s chief executive, said the scheme was originally due to go live this month. But “delays have seen our costs and risks rise” to the point where already slim margins on the contract were being rapidly eroded. With no firm contract in sight, he said, the company had decided to draw a line under the deal.

He insisted that the decision did not imply a loss of interest in doing work for the NHS. “We are still extremely excited about the NHS market and about the increasing right of patients to choose a private hospital [where the hospital agrees to treat patients at NHS prices].”

In addition, primary care trusts in the Midlands were still showing “a high degree of interest” in the project, he said, and Nuffield still hoped to use the mobile theatres for NHS patients under locally agreed arrangements.

The Department of Health now has the choice of dropping the deal or attempting to persuade its reserve bidder, thought to be Netcare, to take it on.

The move comes as most of the companies bidding for the second wave of ISTCs now say privately that they do not believe the programme will reach the government’s original – and repeatedly confirmed – target of spending £550m a year to treat 250,000 patients annually. Most now expect it to add up to only £350m.

But the private sector’s faith in a continuing market for NHS care was demonstrated by the completion yesterday of Care UK’s deal to buy Mercury, which also runs treatment centres and a range of other services for the NHS, from the Tribal Group.

The deal has cost Care UK £77m once debt repayments and debt assumed are included. Mike Parish, Care UK’s chief executive, said: “You don’t get that sort of money back from the residual period of Mercury’s existing contracts. This represents a substantial investment [in our belief] that there will be life [in work for the NHS] after the existing contracts.”

PFI Background

Over 900 PFI projects with a capital value of £40bn have been signed with about 500 of them operational.

The Labour government is committed to just under £170bn in operational payments over the 20-year to 30-year lives of the contracts, although payments in any one year for those already signed peak at only £8.9bn, according to Treasury figures.

From:
http://www.ft.com/cms/s/349865fa-efa6-11db-a64e-000b5df10621.html
and
http://www.ft.com/cms/s/d5af9e3e-f2c8-11db-a454-000b5df10621.html

It found that despite the Government pouring billions of pounds into the NHS, a postcode lottery exists with standards of care varying widely across the country.

While death rates have been falling in hospitals overall, researchers found that the cost of poor performing hospitals in terms of patient lives was staggering.

They looked at 152 NHS trusts in England and estimated that the lives of 7,400 people could have been saved in 2005/6 if all trusts with higher than expected mortality rates had reduced them in line with the expected rate.

Patients at the Royal Free Hospital NHS Trust in north London were identified as the most likely to survive, with a mortality rate 26 per cent below the expected rate.

By contrast, George Eliot Hospital NHS Trust in Nuneaton, Warks, had the highest mortality rate – 43 per cent above the expected rate.

The research did not investigate cause of death at individual hospitals but Dr Foster Research said typical factors would be medical error, infection and failure to deliver “quality of care”.

The findings will raise further fears about the spread of superbugs at a time when cases of Clostridium difficile are soaring, with a 69 per cent increase in deaths between 2004 and 2005. MRSA reduction targets are also unlikely to be met.

Patient groups described the findings as “extremely worrying” and said NHS trusts had to do more to reduce the differences that exist around the country in NHS care.

Dr Foster Research’s mortality rates, the most comprehensive ever compiled, are standardised to take into account a range of risk factors, such as the age of patients, sex, social demographics, the level of deprivation in the area and whether a patient has any other illnesses.

The ratio shows whether the number of patients who died was higher or lower than expected. The expected level is set at 100. A figure of 110 would mean a death rate 10 per cent above expectations.

Of the 152 trusts analysed, 56 were listed as having a high mortality rate, 45 had a low mortality rate and 51 had an average mortality rate. Almost all – 145 – had reduced mortality rates over the past five years.

The seven showing the least improvement included Barts and London NHS Trust, Bedford Hospital NHS Trust, George Eliot Hospital NHS Trust and Lancashire Teaching Hospitals NHS Foundation Trust.

Roger Taylor, the research director at Dr Foster Research, said: “We have seen some fantastic efforts by many hospitals to reduce mortality rates.

“Patients have a right to expect that all hospitals should do the same. Wide variations are worrying and indicate variable standards in the quality of care in hospitals.”

Katherine Murphy, of the Patients’ Association, said: “There should be national standards across the NHS. Patients looking at these figures will be alarmed to learn that they are more likely to die in some hospitals than in others. “It’s essential that poor performing trusts learn from the experiences of better ones. The NHS is very bad at doing that.”

Andrew Lansley, the shadow health spokesman, welcomed the publication of mortality rates, saying they would allow patients to make informed choices. “But NHS trusts need to start working towards publishing mortality rates for each of their departments,” he said. “This would allow patients and GPs to make genuine comparisons across hospitals.”

Andrew Way, the chief executive of the Royal Free Hampstead NHS Trust, said: “We’re very proud to have one of lowest mortality rates. Hospital mortality rates are regarded as a very good indicator of overall clinical performance, so this is a significant achievement.”

Overall, the data indicated that the number of poor performing trusts in England has fallen from 44 in 2001/2 to 36 in 2005/6.

Regional data from Scotland and Wales has only become available recently and is not yet robust enough to draw meaningful comparisons.

Nigel Edwards, the director of policy at the NHS Confederation, said: “This report will help NHS trusts to identify where improvements need to be made.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/04/24/nhs24.xml

Labour’s invention of the NHS postcode lottery started with the creation of NICE. It now extends far and wide. On Aug 09, 06 Health Direct posted Postcode lottery for cancer, hearts and mental health King’s Fund reports

Wide variations in NHS spending may be denying patients fair access to drugs and treatment, a study says. The King’s Fund think tank found that some English trusts spent four times as much on certain diseases than others. The research, compiled from government data from 2003-4 to 2004-5, also showed mental health got the most cash, followed by heart disease and cancer.

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

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

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

Patients are finding sophisticated ways to “top-up” NHS treatment by paying for drugs, devices and investigations privately – sometimes buying them from abroad over the internet – and combining them with NHS treatment, the report says.

In some cases patients opt to pay for all their treatment. In others they get investigations undertaken privately and more quickly, before returning to the NHS for treatment.

The result they say is inequitable. But politicians and others are reluctant to engage with the issue. “By perpetuating the political mirage of a service completely free at the point of delivery, debate is conveniently stifled,” the doctors say. “What is urgently needed is a proper debate on the future of healthcare funding, covering both tax and independent financing”.

Despite the Labour Government pouring billions of pounds into the NHS to improve the quality of care, they claim that top-up payments will increase in major areas of the health service such as cancer care and heart disease.

Hearing aids – audiology services – could be treated the same way as spectacles, they say, with vouchers for the poor and a competitive market for everyone else.

Patient groups said the study highlighted Britain’s “two-tier health system”, where people with money had access to a range of treatments and those without did not.

The report was written by three doctors, including Karol Sikora, a leading professor of cancer medicine at Imperial College School of Medicine.

Published by Doctors for Reform, which represents 1,000 doctors working in the NHS, it accuses the Government of being in denial about the role of the private sector in the NHS.

“It is commonly said that health care in the UK is free at the point of delivery; in fact this mantra is now a political mirage rather than a day-to-day reality,” it says.

“Patients are developing sophisticated approaches to purchasing upgrades to their care [in the areas of] the major killers – cancer and heart disease – [as well as] in areas of medicine benefiting smaller groups of patients such as maternity services.

“It has to be recognised that the use of top-up payments is increasing. We need to face up to this rather than ignore it.”

The doctors published 20 case studies showing how patients used the private sector to upgrade NHS services. They include a 33-year-old secretary who had been trying for four years to become pregnant.

She was eligible for free IVF treatment on the NHS but her primary care trust was in debt and turned her away. She paid £3,500 for treatment at a private London clinic.

Prof Sikora and his co-authors, Paul Charlson, a GP in Yorkshire, and Christoph Lees, a consultant in obstetrics and foetal-maternal medicine, sent the report to Patricia Hewitt, the Health Secretary, the opposition parties and the Royal Colleges.

They called for an open debate about the future of health care funding.

“Patients are already seeking to supplement their NHS care, after a decade of maximum tax-financed spending increases,” they said.

“The Government’s position is that the NHS can provide all of the care that patients need. If this is not the case now, can it be so in the future, given that tax-financed increases are slowing, medical costs are rising and patients are becoming more consumerist in their attitude?”

Norman Lamb, the Liberal Democrat health spokesman, said: “We don’t want to drift into a system where those who don’t have the money to pay for treatments simply go without.”

From:
http://www.ft.com/cms/s/9ab02e22-f136-11db-838b-000b5df10621.html
and
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/04/23/nhs23.xml

The short term incompetence of Labour on the NHS will have long term consequences:

On April 19, 2006 Health Direct posted: Health deficits and waste are symptoms of a deeper failure for NHS funding- Blair warns when Tony Bliar remarked that Labour’s record spending increases and reform were the last chance for the National Health Service. If they did not work, the prime minister warned, waiting in the wings were politicians who would dismantle the NHS.

The reality is somewhat different. There is no ideological difference between Labour and Conservative. The real difference, in Rumsfeld speak, is that Labour ministers know what they don’t know while the Conservatives don’t know what they don’t know.

Pushing economic power closer to doctors and patients with practice based commissioning is a great idea, but one that will end in chaos if data, management skills and incentives are not properly aligned.

NHS managers are drowning in policy documents and guidance notes, each pushing a new initiative. Their impact on each other has not been thought through. As the system is loosened, financial pressures and rationing are likely to intensify.

Despite all Labour’s extra money, the Conservatives’ internal market reforms, started in the late 1980s and reversed in Labour’s first term, brought average waiting list times down faster and generated NHS output growth almost double that of Labour’s first six years.

It also said there was a lack of clarity about where the NHSU fitted into the ‘crowded healthcare education and training sector’.

The report, written by former NHS Appointments Commission chair Sir William Wells, was produced before the announcement, in November 2004, that the NHSU would be scrapped as part of the government’s review of NHS arms-length bodies, but the government did not publish the report.

As Health Direct posted in last week’s HSJ, health informatician Rod Ward lodged a request for the report in January 2005 – the first ever Freedom of Information request to the DoH – but it refused to hand it over until an Information Commissioner ruling last week.

According to the report, the NHSU was flawed from the outset. ‘We have been struck by the absence of simple, clear descriptions of the NHSU’s purpose and the parameters of its role,’ it states. The lack of clear boundaries with other training organisations caused ‘confusion and friction’, it says.

The NHSU’s reputation among stakeholders was poor as it was ‘delivering too little too late to establish credibility in the eyes of the NHS’, Sir William wrote.

Course take-up was well below projected volumes, and efforts by the NHSU to achieve genuine university status were a ‘distraction’. The status was pressed for by ministers but was unlikely to happen.

The report also reveals that NHSU had a budget of £28m in its first year, rising to £44m in its second year, and it was bidding for £73m the following year.

The report was finally given to Mr Ward last week, more than two years after his request. He was told by the DoH that it had not released the report earlier because ‘it would prejudice any future reviews which might be conducted by the department into the economy, efficiency and effectiveness of sponsored bodies’.

Mr Ward said: ‘Hopefully we can learn some lessons from this so we don’t repeat the same mistakes. It is about having clear proposals when you are spending taxpayers’ money and being more open with information that should be freely available.’

All that a Department of Health spokesman could say was: ‘We have learned valuable lessons from NHSU and have implemented the main recommendations in Sir William Wells’ report.’

From:
http://www.hsj.co.uk/healthservicejournal/pages/n1/p7/070419

The sorry issue that was theNHS University was psotes about on Nov 01, 2005 in Red tape costs soar as Labour’s health quangos cost£37m when the closure of eight arm’s length bodies has cost the Department of Health £32m over the past year while the establishment of four new bodies since November 2004 has cost a further £4.7 million.

The figures came in response to parliamentary questions from shadow health secretary Andrew Lansley on how much has been spent implementing cuts to NHS arm’s-length bodies in a process designed to save £500m by 2008-09.

Mr Lansley said the findings showed that ‘the cost of rearranging desks has reached £37m thus far, with no discernable reduction in the level of administration and no discernable improvement in the standard of patient care.’

Another sign of Labour’s double incompetence is that since November 2004, eight bodies have been wound up: the Family Health Services Appeal Authority, the Health Development Agency, the National Clinical Assessment Authority, the National Radiological Protection Board, the Public Health Laboratory Service, the NHS Information Authority, the Modernisation Agency and the NHSU.

And four new bodies have been established: the Health and Social Care Information Centre, the Human Tissue Authority, NHS Connecting for Health and the NHS Institute for Innovation and Improvement.

Over the first three years of the contract, as well as seeing the jump in pay – which does not take into account private earnings – specialist doctors also saw their hours cut.

These changes were expected, as consultants have always argued they were under-paid for the hours they worked.

But at the time the government said it was a “something for something” contract and would lead to increased productivity and better patient care.

The contract – the biggest shake-up in the way consultants worked since the NHS was formed – was designed to free them up to spend more time with patients and provide more flexible services, such as evening clinics.

The National Audit Office (NAO) report said it had failed on both counts.

Since the contract started, consultant numbers have risen by 11% to 31,990, but the number of patients seen has only gone up by 4%. The NAO also said the contract has cost at least £715m.

It added that the Labour government had underestimated the amount of work consultants did, and NHS trust managers had failed to keep within budget.

The watchdog said NHS trusts needed to improve job planning to improve access to service, while consultants should become more engaged with managers.

Karen Taylor, director of health at the NAO, said: “Patients are not seeing consultants work any differently, but if trusts managed job planning better, there is potential for this to change.”

A spokeswoman for the Patients Association said: “The consultants’ contract was a quick fix. Those responsible for the negotiations now have a duty to the public shareholder of the NHS – and patients – the customers to ensure value for money.”

Liberal Democrat health spokesman Norman Lamb said: “This is yet further proof of the Labour government’s incompetent stewardship of the NHS.”

And shadow health secretary Andrew Lansley said there was “no evidence of improved productivity”.

Dr Mark Porter of the British Medical Association’s consultants committee told BBC Radio 4′s Today programme: “The vast majority of consultants are continuing to provide the professional care to their patients that they want as they always have.”

But he said there were tensions about how that was reflected in the number of hours trusts recognised they worked.

From:
http://news.bbc.co.uk/1/hi/health/6568081.stm

The criticism of the consultants’ contract comes after the Labour government was also attacked for the new contract for GPs which, since it started in 2004, has seen GP pay break through the £100,000 a year barrier.

Health Direct posted on 31 Jan 07 Doctors’ delight at Labour’s botched offer: BMA team ‘stunned by GP contract’ as a bit of a laugh as GPs were so stunned by the terms offered to them when negotiating their new contract in 2004 that they thought it was a “bit of a laugh”, a doctor has said.

Dr Simon Fradd, who was one of British Medical Association’s GP negotiators, said they were shocked by the approach taken by the labour government. They could not believe that the labour govt was stupid enough to offer GPs the chance not to do evening and weekend work for only a 6% pay cut, he said.

He added: “We got rid of it (weekend and evening work) 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.”

The dispute was sparked by the contrasting experience of Mark Ziervogel, 70, and his wife Toni, 66, in hospitals in India and Glasgow.

She received specialist treatment in two medical centres in India after suffering a serious head injury when she fell off a bicycle during a cycling holiday in Rajasthan in February.

Her husband, a former consultant radiologist, said the hospital in Ajmer, where she was seen by a neurosurgeon and given CT scans that revealed bruising to the brain, was “superb”.

He praised its cleanliness, the efficiency of the staff and the high standard of equipment available.

After five days in intensive care she was transferred to the Max Super Hospital in Delhi and on March 6 she had recovered enough to be taken home to Scotland.

She was accompanied on the flight by an Indian doctor and nurse, and Mr Ziervogel said he “blushed” with embarrassment when the doctor walked into the “filthy” Western Infirmary in Glasgow.

He added that it was more than four hours before his wife was given a bed on a surgical ward, and staff then told him that the hospital was not able to handle patients with head injuries who required rehabilitation.

She has since been waiting for five weeks for a bed to become available at the physical disability rehabilitation unit in the Southern General Hospital in Glasgow, and fell out of bed and broke her jaw during her stay at the Western.

However, Mr Ziervogel praised the staff at the hospital for their “kindness and patience”, and blamed the problems on bureaucratic “management and systems”.

“Staff have provided Toni with the best care they can given the resources they have,” he added.

Dr Nanette Milne, the Scottish Conservative health spokesman, blamed the conditions experienced by the Ziergovels on Scotland’s Labour/Lib Dem coalition interfering in the day to day running of the NHS.

She added: “The Lib-Lab pact, despite the best efforts of NHS staff, is running our health service down We will take politicians out of the running of the NHS and let the professionals do their job.”

Shona Robison, the Scottish National Party health spokesman, said that after eight years of Labour and Liberal Democrat government, patients and health professionals deserved an NHS “fit for the 21st century”.

She added: “Mr Ziervogel quite rightly praised the professionalism of the staff but raises pertinent questions about the resources the staff have at their disposal.”

The consultant, from East Dunbartonshire outside Glasgow, who formerly ran the X-ray department at Glasgow’s Royal Hospital for Sick Children, also revealed that his wife’s ambulance was kept waiting when it arrived at the Western as another emergency had just come in.

He said standards had declined in the NHS, adding: “It strikes me as strange that an acute receiving hospital with an A&E; can only handle one case at a time.”

“The Indian doctor was appalled. He was also appalled at the filthy and dirty aspect of the Western.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/04/18/nhosp118.xml

Health Direct re examines Tony “Purer than pure” Bliar’s record since he became Prime Minister in May 1997. He has been remarkably consistent in his promises. The reason is… they just haven’t been fulfilled

Then: NHS debt stood at £304 million, and hundreds of hospitals had suffered cuts. 1.1 million people were on hospital waiting lists.

April 1997: “24 hours to save our National Health Service.”

December 1997: “Over time, we can reform and improve the NHS so that, in three or four years, we no longer talk about saving it, but talk about the massive changes and improvements brought about by a Labour Government.”

March 1999: “We believe that the answer to Health Service problems is the £21 billion that we are allocating to the NHS.”

March 2001: “An enormous amount of change and investment is necessary.”

October 2002: “Yes, of course there are still big problems in the Health Service, but massive investment and improvements are also going on.”

November 2004: “We are well on the way to the renewal of the National Health Service.”

March 2005: “Yes, there are problems in our National Health Service — there are in all health-care systems — but any reasonable person looking at our health-care system today would see exactly where the money is going.”

July 2006: Urges British voters to take more responsibility for their own health, to relieve pressures upon the NHS. “What we are part of is a revolution and change in the way people are looking at health care.”

2007: NHS debt has spiralled to a record £1.2 million, hundreds of hospitals face cuts and closures. More than 750,000 people are on hospital waiting lists and more people die of MRSA and superbugs in NHS hospitals that they do on the UK’s roads.

The Department of Health said the Healthcare Commission’s survey suggested that more than 75% of the 8,059 medical staff questioned remain “generally satisfied”. In a statement, it said: “We know that there have been problems with the recruitment process into specialty programmes and apologise for the stress this is causing junior doctors.

When asked as to how NHS reforms had affected their morale, 47% of Doctors said they were unhappy with the government’s reconfiguration of hospital services.

And 63% said changing workloads had damaged morale, while almost half said junior doctors at their NHS trust had “terrible” morale ever since the introduction of changes to specialist training.

Stephen Campion, chief executive of the Hospital Consultants and Specialists Association, said the results of the poll left him “saddened”.

He said: “Traditionally, many doctors have followed in their parents’ footsteps and increasingly we are hearing doctors saying they wished they hadn’t recommended a career in medicine to their children.

“This is indicative of the extreme frustration and low morale hospital doctors are feeling.”

From:
http://news.bbc.co.uk/1/hi/uk/6547379.stm

Health Direct worries for the future of the NHS when Labour’s meddling and underfunding will have a long term detrimental effect on the NHS.

On Feb 19, 07 in Disillusioned doctors say Labour decade of reform has failed NHS Health Direct posted that most doctors believe that Labour has failed to reform the NHS and that funding by taxation alone will not improve the quality of care. An online poll of more than 3,000 doctors carried out for The Times offers the most striking picture yet of the level of disillusionment within the profession. Most say that the billions of pounds injected into the service since 2002 have not been well spent and that services have not improved.

In a surprisingly strong rejection of the Labour Government’s belief that taxation is the only way to pay for the NHS, 79 per cent of respondents doubted that the highest standards expected of the NHS could be sustained through taxation alone after 2008, when the huge annual increases in funding will drop off.

Speaking at the RCN’s annual conference in Harrogate, Lothian nurse Geoff Earl said evidence had shown death rates increased by a third if the number of patients per nurse increased from four to eight.

“The lower the ratio the lower the rates of urinary tract infection and pneumonia,” he said.

“It also improves recruitment and retention, reduces the use of agency staff and leads to less staff sickness. So it also makes financial sense – in the long term.”

David Dawes, part of the RCN’s body for nurses in senior management, said he supported the move as it would make many of the recent cuts – the RCN estimates over 22,000 post have been lost in the last 18 months – illegal.

And Lisa Leicester, a community mental health nurse from Gloucestershire, added: “Lets ensure appropriate staffing levels but also appropriately qualified nurses.”

Nurses voted to pass a motion calling for new legislation to ensure appropriate staffing levels.

Ratios would vary depending the type of care a patient was receiving but could mean in some specialities (did not specify which one) one-to-one care would be guaranteed.

But Howard Catton, head of policy at the RCN, said: “The problem with minimum ratios is that they become maximums and that takes away from professional judgement. And if minimums can’t be met, wards are closed.”

Tough times

The debate came after the RCN’s new leader set out the “tough” times the NHS was facing.

The former NHS trust chief executive, who took up the post in January, said: “Training budgets are being raided and public health programmes are being targeted. We’ve got workloads gong through the roof as jobs are lost and vacancies frozen.”

He said the Labour government deserved credit for increasing funding, which has increased the workforce of nurses and doctors. But he added: “The situation is so serious that the progress we’ve made could soon be reversed or, sadly, lost altogether.”

NHS trusts are making cuts in a bid to balance their books after racking up over £500m of deficits last year.

Alluding to recent press reports, Dr Carter said it had got so bad that nurses were being asked to work for nothing and cutting down on the use of lightbulbs. He also strongly criticised this year’s 2.5% pay rise for nurses, describing the award as “shameful”.

Commenting on the fact the RCN has not invited any politician to congress this year, he said: “It was pointless bringing someone from government in because of how badly they have treated nurses and other health workers.”

From:
http://news.bbc.co.uk/1/hi/health/6559929.stm

The plight of nurses has been long chronicled by Health Direct. Only on March 16, 2007
we posted that the NHS workforce falls by 11,000 as the number of people working in the NHS fell by 11,000 in the last quarter of 2006, official figures reveal. Health unions said the loss across the UK, revealed in Office for National Statistics, would “inevitably have a negative impact on patient care”. Total full and part time NHS staff numbers are estimated by the ONS as being 1,222,000.

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.”

Jonathan Fox of the Association of Professional Ambulance Personnel said: “We have seen patients suffer or even die as a result of not having access to a paramedic.

“It [seems as if it] is almost more acceptable for a person to die when an ambulance gets there within the eight-minute window than for us to get there outside of the eight-minute window and have somebody survive.”

A patient’s chance of being treated by a paramedic depends on where they live. In Wales and the West Midlands, 61% of ambulance staff are paramedics. In Yorkshire 43% of staff are paramedics and the figure drops to 35% in London.

Paramedics can administer more medicines, including clot-busting drugs to heart attack victims and injections of Valium to end epileptic fits. They can also insert tubes into the windpipe to aid breathing.

In a case to be featured on the ITV1 show Tonight With Trevor McDonald tomorrow at 8pm, 15 year-old Kayleigh Macilwraith-Christie, from London, died last July after an epileptic fit of almost 50 minutes.

A technician arrived in a fast-response car within eight minutes of a 999 call, but he could not administer the drugs she needed. An ambulance that arrived 24 minutes later was staffed by another technician and two trainee technicians. They were also unable to administer the drugs. She was taken to hospital in the ambulance but died a few minutes after arrival.

A paramedic at Islington ambulance station in north London, which responded to the 999 call, wrote a letter of complaint to the chief executive of the London Ambulance Service (LAS).

The letter said: “Perversely, this call will be deemed a success for the service as a fast-response unit attended within eight minutes.”

The LAS said there was no way of knowing if the presence of a paramedic would have saved Kayleigh’s life.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article1655010.ece

Health Direct queried the logic of Labour’s ambulance targets on 6 Apr 07 when in Ambulance staff falsified response times figures to meet NHS targets we noted that highly trained staff were questioning the perverse logic of the targets.

Ambulance control room staff changed response time figures, improving the trust’s performance against government targets, an Audit Commission investigation has revealed. Managers and the board at the former Wiltshire Ambulance Service trust, now part of Great Western Ambulance Service trust, put pressure on the control room to meet targets ‘at all costs’ but failed to manage staff effectively or properly follow up concerns about the number of figures being manually altered on the computerised control system, says the report, published last week.

Staff interviewed in the audit could not explain why they had altered data but the report says: ‘Control room staff think there should be a stronger link to patient outcomes. They are frustrated that a category-A incident…met within the eight-minute target is considered a “success” even if the patient dies, while an incident where the ambulance arrives in eight minutes and one second is a “failure”, even if the patient is resuscitated.’

The Tories and Lib Dems questioned the motives behind the spending, but ministers said “patient need, not party politics” was the determining factor.

Of the remaining two, one was in the Respect party’s sole seat of Bethnal Green and Bow, and the final one serves several different constituencies in Avon and Wiltshire.

Overall, the capital value of the projects – almost all undertaken through the public finance initiative whereby a private company builds a hospital and then collects “rent” from the NHS for around 30 years – was around £4.1bn. Of this, nearly £3.5bn was allocated in Labour constituencies.

Labour currently holds 353 of the 646 seats in the Commons, compared to the Tories’ 198 and the Liberal Democrats’ 63.

Shadow Health Secretary Andrew Lansley, who obtained the data by tabling questions in the House of Commons, questioned the motives – especially as ministers were wanting to shift care away from hospitals and into the community.
He said: “Patients in Conservative and Lib Dem areas will be wondering why it is patients in Labour areas [that] benefit from virtually all the spending Labour is committing to building new hospitals which are, apparently, unnecessary.”

And Liberal Democrat health spokesman Norman Lamb said: “The case for new hospitals should be based entirely on medical need and including any political considerations would be quite outrageous. This analysis raises serious questions that the government needs to answer.”

From:
http://news.bbc.co.uk/1/hi/health/6547703.stm

Health Direct is appalled at the biased NHS funding allocations that Labour ministers have been directing to their own constituencies and is one of the greatest scandals of Tony “purer than pure” Blair’s time in office.

On Nov 22, 2006 Health Direct posted: Hewitt defends NHS cash for Labour voting areas when Patricia Hewitt sparked new controversy over NHS funding last night after insisting that it was “absolutely right” that spending per head on health care was at least 35 per cent higher in many Labour areas than wealthier Tory ones.

The Health Secretary told MPs that people in more prosperous areas had the “good fortune” to be in better health and as a result needed less allocated for their care.

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

Mr Penning said Miss Hewitt had given “the most complacent, arrogant and patronising evidence I have ever heard.” He added: “She gets nearly £400 per head more than I do for the NHS because my constituents aren’t as sick. It is the most ridiculous thing I have ever heard.”

Last week, after the health secretary said every mother would have the choice of home, hospital or midwife-led birth by 2009, the Guardian revealed that six out of nine English regions do not employ enough midwives to meet the most basic standards of care. The east Midlands already has the second-worst provision of midwives in the country, according to Guardian figures.

Chesterfield Royal Hospital NHS Trust says each birth at the eight-bed unit costs £3,217 compared with the £1,000 allocated by the government, meaning it loses £312,000 each year. The inefficiency comes because only 120 babies are born at the unit annually compared with 2,700 at the hospital, yet it has to be staffed by two midwives around the clock.

Campaigners dispute the figures and say the trust should promote the unit to make it viable. They argue the closure means women will give birth as they race to hospital. Sam Kay, a member of Moms (Maintain Our Maternity Services), said: “There are going to be babies born in ambulances and in the backs of cars … women already give birth at Darley without planning to because they know they won’t make it to the hospital in time.”

Kate Carlton-Reditt, Moms coordinator and a mother of three, said the reduction in midwives to 33 for the whole of north Derbyshire would rule out home births, which require two midwives, and force women into hospital.

The public consultation, due to end on April 20, has flouted the Cabinet Office code by not involving campaigners before publishing proposals and asking closed questions with no option for the unit to remain open. Challenged on this, the trust’s corporate secretary, Terry Alty, said: “We followed the code. We haven’t specifically complied with it.” The trust faces a judicial review and a freedom of information appeal over the process.

The trust’s head of communications, Sarah Turner-Saint, said the trust needed to save £13.8m over three years. “We’re making a loss on each birth at Darley and we can’t afford to provide this service.”

From:
http://www.guardian.co.uk/uk_news/story/0,,2054159,00.html

Health Direct applauds Sarah Turner-Saint The trust’s head of communications for her candour and honesty. From the horse’s mouth we have proof that patients are being directly effected by labour’s costs cuts- which are nothing to do with increasing patient choice or improving NHS services, just cutting services to satisfy labour’s NHS underfunding.

Labour’s social engineering that is it’s midwifery policy was highlighted on January 10, 2007 in
Maternity 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.

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.

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.”

Last week it was revealed 38 per cent of first hospital referral appointments made by GPs were made through “Choose and Book” – a £64 million online system for which ministers set a target of dealing with 90 per cent of appointments by the end of March.

However, the National Patient Choice survey of 57,000 patients found that only 41 per cent referred to hospitals by GPs could recall being offered a choice. Of those, 28 per cent were offered a copy of Choosing your Hospital, the Government guide giving patients information on how to make their choice. Most – 59 per cent – gave location or transport considerations as the most important factor.

GPs have complained that they do not have enough information about private healthcare providers and hospitals outside their region to be able to help patients make meaningful choices.

A British Medical Association spokesman said: “They are spending an awful lot of money on things like new websites when patients would rather the resources were used to make sure their local hospital was of a good standard, clean and offers the right quality of care.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/04/10/nhosi10.xml

The NHS has missed by a long way a much-revised target to get first out-patient appointments made online through the so-called “choose and book” system.

Originally, all 9m or so first out-patient appointments a year were meant to be made through “choose and book” by December 2005.

That target has been revised repeatedly: at the end of last week it was for 90 per cent of referrals to be made that way. In practice just 38 per cent went through the system in the last week of March, according to Connecting for Health, with referrals running at an annual rate of about 3.3m.

From:
http://www.ft.com/cms/s/4efcea1a-e312-11db-a1c9-000b5df10621.html

On January 02, 2006 Health Direct commented on the latest labour NHS promise that it had broken in Choose and Book- your new right for NHS treatment according to labour’s promises

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

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

A survey of more than 1,000 adults conducted for Nuffield Hospitals shows four out of five do not know that patient choice is arriving next week.

It equally shows that 60 per cent, given the choice, would opt for a private hospital, with only 18 per cent positively choosing an NHS hospital and 22 per cent saying they do not know.

If Florence Nightingale were walking through hospital wards in England today she might well be questioning our understanding of dignity, privacy and choice. In marked contrast with the rest of Western Europe and the US, most patients are still being placed in large wards and many of these are mixed sex. And this practice persists in new hospitals, despite the Labour government’s promises to scrap it.

Labour’s 1997 manifesto included a commitment to “work towards the elimination of mixed-sex wards”, and the 2001 manifesto stated: “Nightingale wards for older people and mixed-sex wards will be abolished.”

But the latest figures from the Healthcare Commission’s 2005 survey of patient experience showed that a fifth of patients (22%) had shared accommodation with the opposite sex at some time during their hospital stay. In London teaching hospitals, one in four patients had been in a mixed ward and in some hospitals, in London and beyond, the proportion was well over half.

A separate Healthcare Commission census of mental health establishments in England and Wales published last month found that 55% of inpatients had to share sleeping accommodation or bathrooms with members of the opposite sex.

A survey of 2,462 patients in 128 hospital trusts, carried out in February and March and published last week by the Commission for Patient and Public Involvement in Health, showed that a quarter of patients had been required to share a bay and toilet with the opposite sex.

Marcia Fry, head of operational development at the Healthcare Commission, told a recent conference that the issue of mixed-sex wards was far from sorted. “In our patient survey a fifth of patients say they have been treated on mixed-sex wards. Yet over 95% of trusts say they are meeting standards on privacy.”

She added that lack of dignity and respect were the subject of 12% of complaints to the commission and many of the issues arose around the time of a patient’s death. She read out a complaint from a family about their mother being placed on a mixed-sex ward where they found her without underwear. The woman’s family, she said, saw “male and female genitalia on display every day”, as patients were not covered properly.

Over lunch at the same conference, a geriatrician lamented that his new hospital built under the private finance initiative (PFI) was organised on mixed-sex lines. This despite the fact that most of those in NHS beds are older people who arrive as emergencies.

“The NHS’s predominant customer is someone who has arrived as an emergency and is likely to be feeling extremely vulnerable,” says Philip Hurst, policy officer at Age Concern. “Two-thirds of those in hospital are over 65 and three-quarters of those come in as an emergency, meaning they have no choice whatsoever about where they go. Imagine what they are going to be feeling after days on a mixed admission ward.”

Joyce Robins, director of the watchdog group Patient Concern, says mixed wards and lack of privacy are a source of continual complaints. But professionals can become oblivious to this. “In hospital, your most private functions are the most public they have ever been,” she told nurses at a recent conference on improving privacy on wards.

She quoted a case of a 70-year-old woman spending weeks on a mixed Nightingale ward where a man with dementia tried to get into her bed. “Nobody came when she pressed the buzzer so she took him back to his bed. And when she told staff in the morning they seemed to think it was a huge laugh. “When it comes to dignity and privacy, it’s perception that counts – and patients don’t see single sex bays as single sex wards,” she said.

Roger Ulrich, professor of architecture at Texas A&M; University, who spent several months in England in 2005 and 2006 advising the Department of Health (DH) on healthcare design, argues that large wards and mixed accommodation make privacy and dignity impossible.

“No other country inflicts this on their patients to the extent that the UK does. There is no privacy in an open bay. A curtain creates no verbal privacy. In the US we have strong regulations to protect verbal comments about patients,” he says. “In a multi-bed room, in order to do their jobs properly, doctors and nurses must inevitably infringe dignity and privacy.”

Ulrich, who has conducted research on the effects of design on patients, regrets that PFI hospitals in the UK consist primarily of shared accommodation. “These hospitals are being put up with 20%, or less, single rooms – and they will be in place for decades. But single rooms reduce infection and provide privacy and dignity”.

This point is endorsed by Bryan Lawson, dean of architecture at Sheffield University, who has advised several health authorities and has produced a buildings assessment tool for DH. He recalls Florence Nightingale’s dictum that hospitals should first do no harm.

“On patient satisfaction, reduced infection and ease of management, single rooms win hands down,” he says. “But, unfortunately, all the emphasis with PFI is on keeping capital costs down rather than operating costs. But the capital cost of any hospital will be exceeded by running costs within two years. Hospitals with single rooms are slightly more expensive to build, but are cheaper to run.

“The evidence on the benefits of single rooms is so overwhelming that we simply must address this,” he urges. “Single rooms achieve privacy and dignity, reduce noise levels and increase comfort. They reduce enforced patient movements to almost zero and massively reduce the risk of hospital acquired infections, and are easier and quicker to disinfect.”

Moving patients is heavily correlated with cross-infection and clinical errors, he adds. Lawson says he knows of no research showing that more nurses are required to look after patients in single rooms, “although it does require different patterns of nursing, with decentralised nursing stations and stores”. Single rooms with en suite bathrooms reduce hospital falls significantly, he adds.

Healthcare design must give much more attention to the patient experience, he says. “For me, the secondary-care environment should look much more like a good quality hotel – somewhere you are happy to spend time rather than feeling like a cog in a machine.” But he admits that the prospect is some way off. “The approach at the last hospital I visited looked like a war zone.”

There are signs of progress. The Scottish executive says it eliminated mixed-sex wards two years ago, following investment of £5m, and the Scotland Patients Association says no complaints have been received in the past two years. A senior hospital manager says it was made clear that failure to address the issue would be a sacking offence for chief executives.

In Northern Ireland, new hospitals are required to provide half their accommodation in single rooms. In 2010, a new 512-bed acute hospital, consisting entirely of single rooms with en suite bathrooms, is due to open in Pembury, Kent. “We took the view that we would put the pound where the patient sees it,” says Bernard Place, director of nursing at Maidstone and Tunbridge Wells NHS trust. The aim is to create a building reflecting modern expectations. “We no longer expect to share a bathroom in a B&B; so why should we in hospital?”

He hopes that the new hospital will point the direction of travel for the NHS, with the emphasis on patient choice. “I think in 20 years we will look back and wonder how we ever expected people to share a loo with 10 others.” Doctors and nurses are behind the development, which is not expected to require extra staff, he adds.

But under current conditions, thousands of NHS patients will spend their time in hospital with only a skimpy curtain between themselves and many strangers, of both sexes. And many will die like that.

The British Geriatrics Society believes this infringes human rights. Submitting evidence to the UK parliament’s joint committee on human rights in February, Peter Crome, president of the society, said: “Meeting targets is used as an excuse to sacrifice older persons’ dignity and human rights. The perception that it is acceptable to use the toilet in a mixed ward next to a person of the opposite sex separated by an insubstantial curtain challenges the human rights of older people.”

Crome, professor of geriatrics at Keele University, regrets that PFI hospitals are being built with a minority of individual rooms, and would wholeheartedly support a move towards single rooms with attached bathrooms in hospital. “But it seems a long way off,” he says. “In my area we have just reopened a ward in a 130-year-old former workhouse.”

From:
http://society.guardian.co.uk/health/story/0,,2049153,00.html

Previously, calls made by NHS patients through Patientline phones cost 10p per minute, but that will now rise to 26p. Patientline, a private company, told the BBC it had invested £160m in the system and needed to recoup its costs and make a profit.

In 2005, the firm was investigated by regulators over its charges, but was cleared of any wrongdoing.

Patientline also provides television screens and radio and internet services at hospital bedsides. The company’s systems are installed at more than 75,000 hospital bedsides.

It says that, while call charges will increase, the cost of the complete bedside “package” will fall from £3.50 a day to £2.90. Calls to patients from outside the hospital cost 39p per minute off-peak and 49p a minute at peak times.

Commercial director Charlotte Brown told BBC News: “Of the people that are in the hospital beds – patients in hospital who spend money with us – 70% of them actually spend that money on watching television.

“What we’ve done in our new pricing structure is, we’ve realigned our prices to bring the price of TV, which the majority of people watch, to a much lower level.”

There would now be reductions in the price of packages for people staying for longer than two or three days who would also be able to get free games and internet services, she added.

Patientline has admitted it is £80m in debt and currently only has enough money left to operate for the next 12 months.

“As a private sector company, we’ve put millions of pounds worth of equipment into these hospitals and that’s a massive investment for us,” Ms Brown said.

“We are trying to recoup that in a way that still provides value for money for the patient in the bed and we feel that we’re doing that.”

BBC Breakfast’s Graham Satchell said the government had always maintained that these services were a luxury and should not come at a cost to the taxpayer or the NHS.

“These people are ill, often recovering from operations, and the hike from 10p to 26p to phone out is really too much.” Michael Summers of the Patients Association

The Patients Association says patients often have no choice but to use Patientline because many hospitals no longer have public pay phones.

Spokesman Michael Summers said the cost of incoming calls was already high, and the latest increase would lead to more complaints.

“These people are ill, often recovering from operations, and the hike from 10p to 26p to phone out is really too much. People are going to be really upset with this.”

Telecoms regulator Ofcom investigated Patientline two years ago after complaints that charges were too high. In the past, many hospitals have operated bans on or restricted the use mobile phones within their buildings, meaning patients often had to use other phone services.

From:
http://news.bbc.co.uk/1/hi/uk/6524545.stm

From 1 April 2005 to 17 July 2006, control room staff manually changed response times or dispatch codes for hundreds of calls, bringing many within the target time of eight minutes for a life-threatening case.

Staff could make changes because automatic recording of data relied on ambulance staff hitting the right button at the right time. In cases where this did not happen the details were recorded manually, allowing staff to enter incorrect data. Some services, such as motorcycle units, were not even on the automatic system.

Staff interviewed in the audit could not explain why they had altered data but the report says: ‘Control room staff think there should be a stronger link to patient outcomes. They are frustrated that a category-A incident…met within the eight-minute target is considered a “success” even if the patient dies, while an incident where the ambulance arrives in eight minutes and one second is a “failure”, even if the patient is resuscitated.’

The performance of individual staff should be reviewed and the new board should decide whether any disciplinary action is needed, recommends the report.

GWAS trust chief executive Tim Lynch commented: ‘Appropriate controls have now been put in place to ensure the accuracy of response-time data, along with additional management support. We can now be confident that they accurately reflect performance.’

GWAS is expecting to miss its year-end target of answering three-quarters of category-A calls in eight minutes, predicting it will answer 73 per cent within the time.

From:
http://www.hsj.co.uk/healthservicejournal/pages/N1/P12/070405

Health Direct warnes that the use of random NHS targets is creating perverse results:
On 3 Aug 2006 in NHS Hospital fined for treating too many patients when an NHS hospital has been penalised for treating its patients too quickly – losing nearly £2.5 million, the cost of the care it provided outside an agreed contract. Ipswich Hospital NHS Trust, which finished the year £16.7 million in the red, had been doing so well with waiting list targets that in one department patients were waiting only a week to see a consultant.

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

Even worse- on 16 Jun 06 Health Direct posted: Scare over MMR vaccine safety causes cases of Mumps to soar as immunisation postcode lottery grows when the scare over the safety of the MMR vaccine is still discouraging parents from immunisation, particularly in London, raising the risk of mumps, measles and rubella. Cases of mumps soared from 4,204 in 2003 to 16,436 in 2004 and to 56,390 last year. The exodus has been also been driven by Labour’s introduction of bonus payments for doctors who meet immunisation targets leading to even more health postcode lotteries.

If a GP manages to increase the proportion of children in their area who receive vaccinations from 70 per cent to 90 per cent, their payment will increase from £995 to £2,865. However, vaccination levels in poorer areas are traditionally low as a result of deprivation, ethnic diversity and high levels of mobility. Many family doctors in these areas appear to have decided to opt out of the system because they have little chance of increasing the numbers and earning the bonus.

Only about two per cent of the 600,000 babies born each year in England are home births but it is estimated that 10 per cent of women could safely have babies at home.

The Royal College of Midwives says only one in five women is currently given the option of a home birth.

Ms Hewitt said it would be up to NHS trusts to decide on staffing levels, although there would be another 1,000 midwives graduating from training by 2009.

She admitted no money was being earmarked for maternity services, which currently receive £1.7 billion a year.

She said the NHS needed to make maternity care more of a priority. While the maternity budget has been rising in recent years, the overall proportion of NHS funds spent on it has fallen.

Ms Hewitt denied that maternity support workers would be used as substitutes for midwives.

Andrew Lansley, the shadow health secretary, said he did not believe that the government would be able to deliver on its promises.

Research by the Tories shows that 43 maternity units are threatened with closure this year. “There is no evidence to support the planned closures and there is no evidence that Patricia Hewitt has substance behind this announcement about home births,” Mr Lansley said.

The RCM said the service, which has the equivalent of 19,000 full-time midwives, would need another 1,000 by 2009 and a further 2,000 by 2012.

Dame Karlene Davis, president of the RCM, told the BBC’s Breakfast programme: “It is an ambitious plan and the RCM supports it wholeheartedly because we believe that the quality of service the Government is aiming for is exactly what the women of England should have.

“We are obviously concerned that there will need to be enough midwives to make it happen.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/04/04/nbirth04.xml

Health Direct is disgusted at the brass neck of Patricia Hewitt’s latest spin/lies. With no new money and labour cutbacks to existing maternity services her latest “promise” is as much welcome as a fart in a space suit.

On March 27, 2007 Health Direct posted in NHS crisis is forcing cuts to maternity care, charity warns when support for pregnant women is being cut because of the NHS’s financial troubles, a healthcare charity has warned.

The National Childbirth Trust (NCT) says it is receiving “increasing reports” that NHS antenatal classes, breastfeeding services and postnatal visits are being cancelled.

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.

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 10 Jan 07 Health Direct posted that Maternity wards are having their cash cut amid boom in birthrate, say midwives when 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.

Speaking on BBC Radio 4′s Today programme, Ms Hewitt said she regretted the failures in implementation of the Modernising Medical Careers (MMC) reforms. “The new system of MMC I think everybody supports but the actual implementation in this first year of transition was nowhere near what it should have been.”

But she still didn’t accept that there were faults with the system. even though she said “The shortlisting process didn’t work. We are in the process of sorting it out and we are now guaranteeing every junior doctor an interview for the speciality of their choice.”

The head of MMC, Professor Alan Crockard, resigned at the weekend over the chaos caused by the introduction of the Medical Training Application Service.

“We really don’t want highly qualified medical staff to be forced to leave the NHS, but if they can’t complete their training in this country, it could be their only option.” Dr Jo Hilborne
BMA Junior Doctors Committee.

It was designed to speed up the process for placing doctors in specialist jobs, but a catalogue of complaints have emerged. Doctors say the forms are badly worded, do not ask pertinent questions, do not allow them to set out relevant qualifications and experience, and have no facility for attaching a CV.

The result, they say, is that the best candidates are not being selected for the right jobs and has left thousands without any interview at all.

Junior doctors abandoned talks with the government’s review group, saying it was “unacceptable” for more than 11,000 doctors who offered two or more interviews to now settle for just one.

Dr Tom Dolphin, deputy chairman of the British Medical Association’s Junior Doctors Committee, said: “It’s long overdue, but at last the government is acknowledging the huge anxiety that this shambles of a system has created.

“However, an apology isn’t enough. We need a way out of this mess for the 32,000 junior doctors who currently don’t know if they have posts to go to in August.”

‘Fewer jobs available’

A BMA analysis has suggested that 18,518 specialist training posts are available under the new system – not 22,000-23,000 indicated by the government.

It is warning that large numbers of doctors will have no training post in August.

Dr Jo Hilborne, chairman of the BMA Junior Doctors Committee, said: “Not only has the government failed to design a fair recruitment process, they’ve also misled everyone on the number of jobs available.

“Even if the application system improves, thousands of doctors are going to find themselves without a training post in August.

“We really don’t want highly qualified medical staff to be forced to leave the NHS, but if they can’t complete their training in this country, it could be their only option.”

From:
http://news.bbc.co.uk/1/hi/health/6521095.stm

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.

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 recent spin about sending text messages to illegal immigrants asking them to kindly leave the country. 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.

The depth of feeling at labour’s incompetence was highlighted by Health Direct on March 19, 2007 in Junior doctors recruitment MMC- this is a fight we cannot afford to lose when some 12,000 people took part in Saturday’s march through central London.

That represents more than one in three junior doctors in Britain. Consider that another one in three or four was working or asleep between nightshifts, and that most doctors have not been on a march before, and you will understand the scale of the anger.

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.

Earlier on March 08, 2007 Health Direct posted : Labour 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.

Patricia Hewitt, the Health Secretary, has come under increasing pressure from within the medical profession to review the new, online system, the selection methods and the questions candidates had to answer. In some hospitals half of junior doctors did not even get interviews for posts at the next level of their training.

The formal takeover – as opposed to a more traditional NHS merger – also marks one more step down the road of the health service operating in a more commercial and market-like environment.

Heart of England, one of the first foundation trusts, which in its first full year of operation recorded a small £5m surplus on its £265m turnover, is taking over the nearby Good Hope Hospital in Birmingham. By last April, Good Hope had an accumulated deficit approaching £20m on a turnover of just over £100m. Its own board judged it “no longer financially viable”.

No other identical takeovers are immediately in the pipeline, according to Monitor, the foundation trust regulator. However, South Staffordshire foundation trust is in the process of taking over mental health services from its local primary care trust.

There are some 15 to 20 NHS trusts which are effectively insolvent, having deficits so large they look to be irrecoverable within 10 years.

Patricia Hewitt, the health secretary, told the Financial Times last week that takeovers of such institutions “won’t be the solution in every case”. But “they may well be the solution in some cases”. She noted in particular that London had set up separate commissioning and provider arrangements which might help drive such acquisitions.

Ms Hewitt is determined not to present the deal as writing off deficits. The new NHS financial framework requires trusts that overspend to take on interest-bearing loans. “We will no longer have a system where hospitals overspent, the deficit got huge, then got written off against a recovery plan, but the overspending just started up all over again,” she said.

But in reality, Good Hope’s deficit has had to be dealt with. Heart of England has received a few millions in one-off payments as a “sweetener” to take Good Hope on. And more than £17m of Good Hope’s historic deficit has been turned into public dividend capital – capital that is in effect underwritten by the Treasury.

Heart of England pays a permanently low interest rate on that, and it is technically repayable. In practice, however, public dividend capital is rarely repaid. The local health authority has in effect accepted that it will never see the money back from Good Hope’s overspending.

The future now depends on the financial disciplines to which Heart of England is subject having the desired effect. In future it will have to generate a surplus, and borrow for its own capital needs, to survive.

It has, however, taken on the liability in spite of the fact that the government still has no regime in place that spells out what happens should a foundation trust fail. None of the current 62, though, is yet close to that.

The Heart of England’s takeover of Good Hope Hospital in Birmingham involved “exactly the same merger and acquisition priniciples . . . and level of detail that you would apply to any FTSE 250 company”, according to Corinne Slingo, a partner at the commercial lawyers Beachcroft, which acted for Heart of England.

The difference, she said, was working out the specific National Health Service risks. These included the impact of payment by results, which increasingly pays hospitals for each individual treatment, and the limited number of buyers of NHS care.

Without the local primary care trusts and health authority on board, indicating that they would commission services at a level to sustain the new trust, “it would be a much riskier exercise”, she said.

From:
http://www.ft.com/cms/s/253bf6d4-e0b6-11db-8b48-000b5df10621.html

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

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

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

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

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

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

Last April the Government introduced a new dental contact intended to improve patient access as well as putting greater emphasis on preventative work. But the predicted benefits have failed to materialise, according to the British Dental Association (BDA).

Its survey found that 85 per cent of dentists believe patient access has not improved as a result of the new contract – under which dentists are paid for carrying out a set number of units of dental activity (UDAs) over a year.

Susie Sanderson, chair of the BDA’s executive board, said: “When the Government is failing to meet even its own success criteria for the new contract, then it’s time for urgent action.

“We now have a reductive, target-driven system that is failing both patients and dentists. The future of NHS dentistry is becoming increasingly fragile and we need action now before it shatters altogether.”

At a BDA conference today Dr Sanderson will call on the Government to scrap the UDA as being the only way of measuring performance.

She will say: “We need a more sophisticated approach which is sensitive to the reality of delivering dental care to patients and which supports preventive care, rather than works against it.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/28/ndentists128.xml

Health Direct only recently (15 Mar 07) noted the chancellor’s distain for UK dentistry when
Hypocrite Brown bitten over his private dental work when the chancellor has been accused of spurning the National Health Service by paying hundreds of pounds for routine dental work to a private dentist known for his celebrity clients.

Gordon “Stalinst” Brown had root canal work done by Mervyn Druian, who runs a surgery in north London. He charges up to £650 for the procedure, compared with a standard NHS cost of £42.

His choice has angered critics who blame Labour for the virtual disappearance of NHS dentistry in large parts of the country, with claims that more than 1m people have lost dental cover in the past year alone.

Labour has come under repeated criticism over NHS dental provision. Reforms 11 months ago were supposed to improve services by giving primary care trusts (PCTs) the power to sign individual contracts with dentists. But most practices now accept only new private patients, with just 29% of dentists prepared to take NHS work.

On Feb 01, 2007 Health Direct posted in Dental health patients hit as dentists funding fails to add up that 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.

Jackie Sowerbutts, dental adviser to Surrey PCT, admitted that the trust had to say no to a number of requests from dentists for money.

“The labour government totally and utterly changed the system. It is not surprising the estimation [of patient charges] is turning out wrong. Many trusts are in this position,” she said.

“Rushed implementation of a system that was not tried and tested has led to the labour Government underestimating the number of exempt patients. The impact will be felt by all patients. It is simply unacceptable that patients seeking NHS dentistry are having to go private.”