They showed NHS trusts responsible for hospitals, mental health, primary care and ambulance services ended the financial year in March with £456.8m in spare cash that could have been used to provide extra healthcare. The total did not include a surplus of £75m that was forecast by NHS foundation trusts.

The underspend angered health union leaders who said it was generated by an unnecessarily harsh squeeze on spending during the winter months when many NHS trusts economised by closing wards, axing jobs and delaying operations until the start of the new financial year in April.

Mr Lamb said patients and staff bore the brunt of economy measures that were designed to save the political career of Patricia Hewitt, the health secretary. She had threatened to resign if the health service made a deficit in 2006/7 after overspending by £547m in 2005/6.

The Liberal Democrat health spokesman said: “Everything was driven by her desire at all costs to avoid another deficit. That distorted everyone’s judgment and as a result they over-compensated.

“I’m writing to the National Audit Office to ask for an investigation of how NHS finances were managed over the last financial year. It should establish whether decisions were rational or distorted by manoeuvring to save Patricia Hewitt’s political skin.”

He added: “It was the soft targets that suffered the most damage. Mental health budgets were cut, voluntary organisations suffered and staff training was axed. This is what happens in a ludicrously over-centralised system. So much is dictated from Whitehall and forced through by strategic health authorities that do the bidding of the health secretary.

Andrew Lansley, the shadow health secretary, said the half billion underspend would, if confirmed by the government, dwarf the previous record surplus of £130m in 1993-04.

“Last year was meant to be a year of growth, but because of the proceeding two years of financial mismanagement the NHS suffered imposed cutbacks – 37,000 jobs losses, 6,000 newly qualified health professionals out of work and 9,000 bed cuts … Most inexcusable are the short-sighted cuts to education and public health budgets, which all now need to be put back in place if intolerable pressures on the NHS are to be avoided in the future.”

He blamed Gordon Brown, the chancellor, for making unnecessary cuts to mask the deficits still arising in many NHS organisations.

The Department of Health would not discuss the underspend before it announces official figures next month. A spokesman said it responded to an “unacceptable” deficit of more than £500m in

The nursing unions said the underspend demonstrated that the NHS could afford a 2.5% pay rise that an independent review body proposed for nurses, midwives and other healthcare staff. The government said it was unaffordable and staged the award, saving about £60m in 2006-07. The Royal College of Nursing and Unison, the public sector union, are preparing to ballot on industrial action.

Hamish Meldrum, the chairman of the British Medical Association’s GPs committee, said in a letter to the Guardian: “The Department of Health and the chief executive of the NHS Confederation may crow about the tremendous efforts involved to achieve the reported £500m surplus in NHS spending for the last financial year. But these “efforts” have been achieved at the cost of multiple ward closures, thousands of job cuts, and a large number of delayed operations and outpatient appointments.”

Mr Brown used to decry the boom/bust management of the economy during the last Conservative administrations as being bad for the country. “Boom and bust are not just bad for the NHS, they’re bad for those who work in it and especially bad for patients who have paid the price for it,” Dr Meldrum said.

The surplus might have, temporarily, saved Ms Hewitt’s job, but it showed the country needed need a change in health secretary and a radical rethink in NHS policy, he added.

From:
http://www.guardian.co.uk/uk_news/story/0,,2090834,00.html

In a desperate attempt to try and balance the NHS’s books Health Direct posted on 9 Feb 07-
Bed closures healthy sign for NHS, says Patricia Hewitt .

Patricia Hewitt, the Health Secretary, was criticised yesterday for claiming bed closures were a sign of “success” as new figures showed NHS trusts will end the year more than £1 billion in the red. The scale of the health service’s financial crisis emerged as Miss Hewitt delivered a presentation to the Cabinet on NHS “reconfiguration”— plans which will lead to the closure of dozens of maternity units, casualty departments and community hospitals.

New research showed that frontline NHS trusts which run hospitals and GP clinics across England are on course to finish the year £1.05 billion in the red — only a fraction below last year’s record deficit.

The figure is drawn from a Conservative analysis of the deficits being forecast by each of England’s 10 strategic health authorities.

While front line trusts are deep in the red, the strategic health authorities themselves are on course to end the year with a huge £920 million surplus — almost twice last year’s figure. This allows ministers to say the overall deficit across the whole NHS is only £132 million.

However, the Tories claimed that health authorities have only been able to produce such a big surplus by slashing the amount they spend on crucial services, including training for doctors and nurses.

The figures were released as Miss Hewitt was accused of living on a “fantasy planet” after defending the proposals to overhaul services across the country.

Andrew Lansley, the shadow health secretary, said Miss Hewitt’s remarks would be greeted with incredulity at a time when many trusts were struggling to cope with huge deficits.

“The Health Secretary is living on a fantasy planet, far removed from the reality of the front line cuts that are having a daily adverse impact on NHS staff and patients,” he said.

“Despite this year’s savage job losses, bed cuts and service closures, the NHS organisations providing front-line care are no less in the red than they were last year.”

The Patients Association said it did not see bed closures as a sign of success. “What we hear about from patients is inappropriate discharges with patients being sent home too soon,” said Katherine Murphy, a spokesman for the association.

“We heard from one patients due to be discharged on a Wednesday who was away from her bed for 50 minutes, the night before to take a bath. When she went back to the ward someone was in her bed. Beds are being closed because of financial deficits. I would not call this a mark of success,” she said.

This view was echoed last month by Health Secretary Patricia Hewitt.

The report, commissioned by the Department of Health, found that the training offered to maternity support staff varied widely across England.

But it found managers were enthusiastic about the contribution of support workers to maternity services, saying they freed up midwives to spend more time with women and babies.

New roles included breastfeeding advice and support, outreach services to women in vulnerable situations, running antenatal and postnatal groups, assisting midwives at home births and in birth centres and working in operating theatres.

However, the report found that some trusts had actually removed midwife posts from wards, replacing them with maternity support staff posts.

Some maternity support staff were carrying out tasks which would normally be left for a fully-trained midwife, such as minor examinations.

Patient safety

Professor Jane Sandall, who led the research, said: “There is a danger that support workers could cease to be ‘another pair of hands’, freeing the midwife and other members of the maternity team from administrative and routine duties in order to look after women.

“Instead they may be called upon to substitute care provided by midwives, without sufficient investment in their training or development. This is a less desirable situation.”

Both the Royal College of Gynaecologists and the Royal College of Midwives have frequently raised concerns over low staffing levels on labour wards.

Professor Shaughn O’Brien, vice president of the Royal College of Obstetricians and Gynaecologists, said: “Midwifery units are currently understaffed and so maternity support workers are a major help in providing essential assistance to midwives.

“Implicit in the establishment of midwifery support workers was that they would not replace midwives but they would be additional. They were not intended to take on duties for which they are not qualified but are employed to enable trained midwives to provide a high standard of skilled one-to-one care. The answer surely must be to provide hospitals with more midwives and consultants to ensure a safe service.”

Susanna Cafferty, a spokesman for the Royal College of Midwives, said: “Our members have told us when support staff are being used inappropriately, and obviously we can’t support that. The Chief Nursing Officer did write to trusts telling them that they didn’t want to see maternity support staff used for putting women onto monitors, for example, and we would agree with this completely.”

The Department of Health said support workers were undertaking inappropriate tasks in only a minority of NHS trusts.

The Chief Nursing Officer Christine Beasley said it was a legal requirement that every baby must be delivered by a registered midwife or a doctor.

“It is completely unacceptable if a hospital is using a maternity support worker as a substitute for a midwife,” she said. “We are very clear about what the role of a maternity support worker is – to support the maternity team in their day to day duties such as clerical work, supporting women with breastfeeding, increasing access for vulnerable women and enhancing the quality of care.”

From:
http://news.bbc.co.uk/1/hi/health/6691787.stm

The plight of expectant mothers and the hard pressed RCM members has been continually highlighted by Health Direct. On Feb 12, 2007 we posted:Mothers are turned away due to midwife shortage

A dire shortage of midwives is forcing maternity units to turn away expectant mothers, a survey has found. Figures show that centres across England closed temporarily for a total of 170 days last year, during which time women would have had to go elsewhere for help.The survey, collated by the controversial research organisation Dr Foster, found that 24 of the 39 maternity units forced to close had to do so for periods of 24 hours or more.

In some regions fewer than two thirds of units were able to offer one-to-one care, in which a woman is looked after by one midwife throughout pregnancy, the report claims.

There are fears that the situation could worsen further still after the labour Government outlined plans for maternity services that could see dozens of units shut down permanently and pregnant women forced to travel further to give birth.

Louise Silverton, the deputy general secretary of the Royal College of Midwives, said: “We have 25,000 midwives in the UK but 55 per cent of them work part time. We estimate that we need 10,000 more.

Former health adviser to Tony Bliar and London School of Economics professor of social policy Julian Le Grand said he thought it was doubtful that another wave of independent sector treatment centres would be commissioned when Mr Brown takes office.

‘I think Mr Brown will still be committed to some degree of contestability, but he is not absolutely sure about market-driven reforms,’ he said.

‘He has sympathy with the US way of doing things, but is aware of the problems involved in introducing markets and quasi-markets into healthcare.’

‘More pragmatic’

And former Department of Health strategy director Professor Chris Ham said: ‘Mr Brown will be a lot more pragmatic about a bigger role for the independent sector.

‘Tony Bliar did it because he thought it was the right thing to do, I think Gordon Brown will see it not so much as an end itself but will be persuaded by a greater role for the independent sector if it can show innovation or deliver shorter waiting times.’

The Institute for Public Policy Research head of health and social care Jessica Allen said: ‘I wouldn’t expect a great expansion in the use of the independent sector. I don’t think there is any sense he will abandon the use of the private sector completely, but we will see it used where there are gaps in services.

‘I think he might have less confidence that the health sector operates in the same way as other sectors, where efficiencies will arise from having a greater market.’

And King’s Fund chief economist Professor John Appleby said the treasury, with Mr Brown at the helm, had expressed ’scepticism in an oblique way’, about how far the use of the independent sector to increase choice could improve quality of services within the NHS.

Independent NHS board

Before Mr Blair announced details of his resignation, Mr Brown was widely believed to be preparing the ground for an announcement to match his decision to free the Bank of England from government control.

He was expected to introduce an independent NHS board in his first few days at Number 10, but Professor Ham said he now seems more cautious about such a move.

‘I would say there is a strong argument for distancing politicians from the NHS and it would perhaps be sensible to start with something modest, like further separating NHS chief executive David Nicholson’s team from the DoH and use that as a staging post for something more radical,’ he said.

Professor Appleby said he was unsure that Mr Brown would announce a fully blown NHS board.

‘Rhetorically it looks appealing for the government to show that they are not interfering, but they have gone a long way down that route already with payment by results and foundation trusts,’ he said.

Launching his campaign to become leader of the Labour Party, Mr Brown stressed how important greater access to health services would be under his leadership.

Professor Ham said he expected the man who commissioned the Wanless report to make public health a major priority.

From:
http://www.hsj.co.uk/healthservicejournal/pages/N1/p5/070524

The eventual arrival of a new prime minister will be eagerly watched by Health Direct. We have become used to news of a pre launching policy as to what might happen for the NHS.

However we also have ten years of experience in what has happened to the purse strings. And so has the Great British public.

On April 03, 2006 Health Direct posted that: Gordon Brown to blame for the crisis in the NHS a new poll finds

Gordon Brown is being blamed for the financial crisis in the National Health Service, which has resulted in hospitals laying off staff and closing wards, according to a YouGov poll for The Daily Telegraph.

His credentials as prime minister-in-waiting are being undermined by a growing impression that he is not spending enough on the health service, and his own personal popularity ratings are falling.

According to the YouGov poll, 64 per cent of those questioned believe that there is a financial crisis throughout the NHS, with hospitals having to cut back on patient care. The NHS in England is expected to be in the red by £1 billion this year.

Voters also think Mr Brown has got his priorities wrong. Asked which should receive any extra money, education or the NHS, a large majority favoured the health service over schools. ]]> http://www.healthdirect.co.uk/2007/05/private-slow-down-expected-as-nhs-prepares-for-stalin-brown.html/feed 0 http://www.healthdirect.co.uk/2007/05/gps-out-of-hours-cover-death-row-shows-systemic-failure.html http://www.healthdirect.co.uk/2007/05/gps-out-of-hours-cover-death-row-shows-systemic-failure.html#comments Fri, 25 May 2007 13:12:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=146 The partner of a woman who died from septicaemia following flaws in out-of-hours GP care has said he is convinced it could happen again. Penny Campbell, 41, from Islington, north London, died in 2005 after consulting eight doctors in four days. A report said a major system failure in the service was a direct factor leading to Miss Campbell’s death.

Her partner Angus MacKinnon has called for doctors found to have provided sub-standard care to be struck off.

Mr MacKinnon, 40, plans to write to the General Medical Council (GMC) about the conduct of four of the doctors. He is also pursuing civil action over the case.

He said he believed the same tragedy could happen again elsewhere in England.

“I’ve had dozens of people contact me, cases where people had really narrow escapes,” he said.

The report identified weaknesses in the arrangements for out-of-hours care nationally.

The report said six GPs provided Miss Campbell with a “reasonable standard” of care but one did not adequately explore her symptoms to see if she had an acute illness.

Mr MacKinnon added: “If Tesco can open till midnight every night, why can’t our GPs open till midnight every night?

“I don’t want to spend the rest of my life feeling bitter about what happened to Penny. I’d like something positive to come out of it.”

Both the Department of Health and Camidoc, the local GP out-of-hours service Miss Campbell contacted, have accepted the finding of the report and said they have accepted, and implemented already, many of the recommendations.

A spokesman for Camidoc said: “The death of Penny Campbell was a terrible tragedy and we at Camidoc continue to extend our sympathies to Miss Campbell’s family and friends.”

Rachel Tyndall, chief executive of Islington PCT, the lead commissioner for Camidoc, said the NHS trust would learn the lessons.

“There were failings in her care and the systems to guarantee quality,” he said.

From:
http://news.bbc.co.uk/1/hi/england/london/6691365.stm

This of course is the same Out of Hours GPs service contract that Labour negotiated only last year which recieved the accolade of: BMA team ’stunned by GP contract’ as a bit of a laugh
in Health Direct’s post on 31 Jan 07.

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. ]]> http://www.healthdirect.co.uk/2007/05/gps-out-of-hours-cover-death-row-shows-systemic-failure.html/feed 0 http://www.healthdirect.co.uk/2007/05/hewitt-battles-for-survival-in-commons-after-day-of-criticism-over-mtas-flawed-dreadful-mess.html http://www.healthdirect.co.uk/2007/05/hewitt-battles-for-survival-in-commons-after-day-of-criticism-over-mtas-flawed-dreadful-mess.html#comments Thu, 24 May 2007 09:33:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=728 The health secretary, Patricia Hewitt, battled for her political reputation, if not her survival, yesterday in a packed Commons debate on a Tory motion of no confidence. It came at the end of a day which featured severe criticism from a high court judge over the junior doctors debacle, and angry scenes at the annual conference of NHS midwives .

Ministers were out in force to support their colleague as she defended her record in the face of taunts from Andrew Lansley, the Conservative health spokesman, who said she had “no credibility left” and had “lost the confidence of the NHS”.

Ms Hewitt said it was “one of the greatest privileges” to be health secretary and insisted she was not taking any lectures from the Tories, who had “starved” the NHS of funds.

Earlier in the day, a high court judge had rejected the junior doctors’ legal challenge to a controversial online job application scheme, but added his voice to the torrent of criticism that has engulfed the government, calling the scheme’s introduction “disastrous” and “a dreadful mess”.

Mr Justice Goldring said many junior doctors had “an entirely justifiable sense of grievance” and raised the spectre of thousands of disappointed young doctors heading for employment tribunals, where some of them may have good grounds to take a future complaint. He said he only reluctantly awarded the health secretary her £45,000 costs.

“The fact that the claimant has failed in what was accepted to be an unprecedented application so far as the law is concerned does not mean that many junior doctors do not have an entirely justifiable sense of grievance,” the judge said, dismissing the case brought by a group of junior doctors called Remedy UK.

“The premature introduction of MTAS has had disastrous consequences. It was a flawed system in the ways I have indicated.”

The failures of the online medical training application scheme first became apparent when thousands of highly qualified applicants for posts leading to consultant jobs failed to get a single interview.

From:
http://politics.guardian.co.uk/homeaffairs/story/0,,2086708,00.html

On April 30, 2007 Health Direct posted: Contender for greatest of all NHS failures- MTAS Junior Doctor application system when the crisis that is leading highly qualified junior doctors to head abroad is the result of one of the National Health Service’s all-time great administrative cock-ups.

It is has left 30,000 junior doctors bitterly disillusioned and angry. But it also has big potential implications for patient care.

Last week (May 16, 2007) started to see the results of this fiasco when Health Direct posted: Doctors MTAS online application system may be ditched in another Hewitt U turn when Channel 4 interviewed the Secretary of State for Health, Patricia Hewitt over the crisis surrounding the appointment of thousands of junior doctors.

The new Medical Training Application Service (MTAS) was heralded by the labour government as an ‘agent of change’, designed to establish a fairer, more transparent system for recruiting the next generation of specialist medics. But for months now it’s been ridiculed within medical circles for effectively deselecting some of the brightest junior doctors.

The new Medical Training Application Service (MTAS) was heralded by thelabour government as an ‘agent of change’, designed to establish a fairer, more transparent system for recruiting the next generation of specialist medics.

But for months now it’s been ridiculed within medical circles for effectively deselecting some of the brightest junior doctors. ]]> http://www.healthdirect.co.uk/2007/05/hewitt-battles-for-survival-in-commons-after-day-of-criticism-over-mtas-flawed-dreadful-mess.html/feed 0 http://www.healthdirect.co.uk/2007/05/thousands-of-nhs-staff-avoid-crime-checks.html http://www.healthdirect.co.uk/2007/05/thousands-of-nhs-staff-avoid-crime-checks.html#comments Wed, 23 May 2007 09:06:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=729 Tens of thousands of people working with children and vulnerable adults in the NHS are still not being put through criminal record checks promised by the government in the wake of the Soham murders, it has emerged. A survey found that 68 per cent of health trusts in the UK are failing to vet staff who began working before the Criminal Records Bureau (CRB) was set up in 2002.

There are an estimated 50,000 NHS staff, including nurses, GPs and healthcare assistants who are not being routinely vetted, the survey, by BBC Radio Five Live found.

After ten-year-old Jessica Chapman and Holly Wells were murdered by their school caretaker Ian Huntley, the government promised to look again at ways to protect children from adults in positions of trust.

A report by Sir Michael Bichard recommended a new vetting and barring system, including compulsory CRB checks for existing school staff. But the tougher procedures, in the form of the Safeguarding Vulnerable Groups Act, will not be brought in until 2008, raising concerns that tens of thousands of NHS staff will remain without criminal record checks in the meantime.

Over 90 per cent of trusts responded to the BBC survey, which was carried out after a child therapist who had worked in the NHS for 16 years queried why she had not been checked.

In England, 64 per cent of trusts who responded said they had failed to routinely run checks. In Scotland the figure was 93 per cent, and in Wales, 91 per cent.

Asked why they did not carry out the checks, many of the health organisations cited financial constraints, adding that there was no guidance from NHS employers to suggest the vetting should take place.

Staff employed before 2002 may have undergone police checks under the old system, but these would only cover any offences committed in the force area in which they live and work.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/22/ncheck122.xml

Labour ministers can’t use the usual excuse of “no one told us” on the subject of dodgy employment recruitment practices. On Jan 25, 2006 Health Direct posted: Sex offenders can still slip through NHS net when known sex offenders could be employed in front-line children’s services for up to six months before their records are revealed.

Trusts have been using a fast-track system since 2002, which clears recruits against labour government black lists, but these do not cross-reference with either the sex offenders register or local police information.

Information is not usually sent to trusts until at least one month after the person has started work. And in some areas where local police systems ‘are not adequately resourced’, trusts can wait four to six months for reports, according to NHS Employers senior business manager Gordon Fleck.

Mr Fleck said there was ‘a possibility’ that a known sex offender could fall through gaps in the system. However, he said NHS Employers would like the fast-track system to continue until new legislation introduces a universal barring and vetting scheme for all NHS staff in about a year’s time.

Asked about checks on potential employees to detect sex offenders, health secretary Patricia Hewitt said then that the NHS will be ’strengthening them even more’ in line with new legislation set to be discussed in parliament next month.

And since then in the last fifteen months what we heard from Patricia Hewitt on the subject of safe recruitment practices? Diddly squat.

While the agency’s decisions are always made public in written form, Mr Rawlins conceded that it was useful to observe the discussion rather than simply reading about it afterwards.

His announcement was made on the first day of an inquiry launched by the House of Commons’ health select committee into the operations of Nice, the second since it was launched in 1999 to advise the government on the efficacy and cost effectiveness of new medicines.

It comes at a time of growing criticism of Nice by pharmaceutical companies and patient organisations after a number of rulings that advised against the NHS paying for drugs for patients. In the case of an Alzheimer’s drug, this will lead to a judicial review next month over the agency’s refusal to release information on how the calculations were made.

The new policy of openness would apply to the deliberations of Nice’s five standing advisory bodies, which study drugs, treatments, surgical procedures and public health.

Andrew Dillon, Nice’s chief executive, told the FT that the decision put it ahead of practices adopted by equivalent agencies in other countries.

But he cautioned that the agency was still considering some of the practical issues involved. These include changes to the five day review period given to interested parties before decisions are made public, and how to release price sensitive information such as approval of a drug developed by a listed company.

Sir Michael cautioned that while Nice could play a role in the Office of Fair Trading’s proposals for a newvalue-based pricing mechanism for drugs in the UK, it would represent “a massive workload” and there were not enough health economists in the country to cope.

Department of Health officials came under criticism from MPs on the committee over the resources made available to local primary care trusts to implement Nice decisions, and the inadequacy of government powers to penalise them if they failed to do so. *GPs could save the NHS more than £200m a year by prescribing lower-cost but perfectly effective drugs, the National Audit Office said yesterday, while patients waste drugs worth at least £100m a year by not taking them.

From:
http://www.ft.com/cms/s/8a923270-04db-11dc-80ed-000b5df10621.html

Health Direct questions Sir Michael Rawlins’s claim that he regrets that its committees had previously met in private when several drug companies are having to take the National Institute for Curbing Expenditure to court in an attempt to find out how it justifies it’s cost beneafit analysis on drug useage.

On Nov 17, 2006 Health Direct posted: Drugs watchdog faces legal review- NICE’s approach is irrational and flawed when a decision by the labour government’s drugs watchdog to restrict the use by the NHS of Alzheimer’s medication is to be challenged in court.

Two drug companies plan to apply for a judicial review of the way the National Institute for Health and Clinical Excellence reached its conclusion. NICE ruled NHS patients with newly diagnosed, mild Alzheimer’s disease should not be prescribed the drugs.

To it’s credit it “only” took that MPs three months to wake up to the increase in legal activities against NICE.

Earlier this year on 7 Feb 07 Health Direct posted :NICE faces inquiry by Commons MPs group when the Commons health committee announced terms of reference for a broad inquiry into the work of NICE, the National Institute for Health and Clinical Excellence.

The committee said it wanted to examine “why Nice’s decisions are increasingly being challenged” after recent controversial recommendations that the NHS should not use certain costly cancer drugs and should restrict the use of drugs to treat Alzheimer’s to those with moderate forms of the disease. ]]> http://www.healthdirect.co.uk/2007/05/move-to-boost-openness-on-nhs-drugs-by-nice.html/feed 0 http://www.healthdirect.co.uk/2007/05/call-for-scrutiny-of-pfi-equity-sales-says-pac.html http://www.healthdirect.co.uk/2007/05/call-for-scrutiny-of-pfi-equity-sales-says-pac.html#comments Mon, 21 May 2007 07:55:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=731 The market for sales of equity in Private Finance Initiative (PFI) deals should be closely watched by the Treasury, parliament’s public spending watchdog said, as it raised fears that they might not be in the public interest.

When privately financed projects such as schools, hospitals and roads are refinanced, the public sector should now receive a share of the gains.

But “there is no requirement for the gains made by investors through selling on their shares in PFI projects to be shared with the government”, Edward Leigh, the chairman of the House of Commons Public Accounts Committee, said.

The precise scale of the equity sale market is not known because the Treasury does not collect figures. But the number of such sales has been rising. All or part of the equity has been sold in 32 of the 80 projects surveyed by the National Audit Office, either to new investors or to one of the initial investors. Carillion, for example, has sold equity investments it acquired for £24m for £46m.

The Treasury takes the view that while debt refinancings affect the public sector’s rights, a change in the equity ownership does not affect the public sector. Profits are taxed through capital gains, and the Treasury believes that, in essence, the transactions are no different to other private- sector deals.

But in the report the committee said the Treasury view “is only credible if there is an efficient equity market” and that the Treasury needed to demonstrate that.

Its report stops short of calling for the public sector to be given a share of the gains, as in debt refinancings. But Mr Leigh said the Treasury “must keep the working of the PFI equity market under close scrutiny to make sure the public interest is not being compromised”.

David Metter, the chief executive of Innisfree and chairman of the PPP Forum, a lobby group for the PFI industry, said it was reasonable for the government to know who owned PFI projects. He said most contracts contained a so-called “Gadaffi clause” aimed at preventing their transfer to undesirable owners.

But the question of profits was “a difficult one” when the price paid would go up and down depending on the market, with people sometimes overpaying and at other times underpaying.

“The government is well placed to stay out of that,” he said, “because if it wants a share of the gains, would it also want a share of the losses?”

The CBI employers’ group said it would be opposed to any “increasing level of Treasury interference”.

The committee also noted that the equity market was beginning to consolidate, so a small number of investors could wind up dominating the market.

Cash shortfall

The public sector has so far received £93m from its agreed share of PFI refinancings – well below an earlier estimate that it might have received £175m to £200m by now.

Parliament’s public spending watchdog suggests the shortfall may arise from investors preferring to sell equity stakes, where the gains do not have to be shared with the public sector.

From:
http://www.ft.com/cms/s/b9e3a108-0283-11dc-ac32-000b5df10621.html

The inefficient financing that Gordon Stalin Brown has created with PFI was highlighted by Health Direct in our post on 16 Aug 06 in PFI profits exposed by Channel 4 as greater than credit card companies when in Public Service, Private Profit, Liam Halligan revealed how the private funding of state schools and hospitals is draining hundreds of millions of pounds from frontline services, while creating a £4 billion-a-year industry and a new elite of publicly- unaccountable PFI professionals.

The programme also highlighted the financial shenanegans that some PFI companies were using- including moving ownership of assets to Guernsey to circumnavigate the new labour PFI taxes. ]]> http://www.healthdirect.co.uk/2007/05/call-for-scrutiny-of-pfi-equity-sales-says-pac.html/feed 0 http://www.healthdirect.co.uk/2007/05/half-of-all-ae-units-marked-for-closure.html http://www.healthdirect.co.uk/2007/05/half-of-all-ae-units-marked-for-closure.html#comments Fri, 18 May 2007 14:03:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=732 Up to half of all hospital accident and emergency (A&E;) departments face cuts or closure under plans to improve patient care, presenting Gordon “Stalin” Brown with a massive dilemma as he takes over as Prime Minister. Ninety-two out of 204 A&E; departments are under threat if guidance attributed to the Department of Health by NHS trusts is followed, the Conservatives claimed.

Some NHS organisations are already using the guidance, which calls for A&E; departments to serve a minimum population of 450,000 patients, to justify closures in smaller catchment areas. The average A&E; unit currently serves just under 250,000 people.

But the plans are proving hugely unpopular, even though they have been promoted as in the interests of patients and NHS staff.

Mr Brown, aware that the closures would come into force around the time of the next election, said last Friday that he would meet front-line NHS staff and patients to discuss health policy.

It was clear last night that the Chancellor will not now face a leadership challenge as he prepares to succeed Tony Blair, having gathered a decisive 308th supporter among Labour’s 353 MPs.

Last Sunday Mr Brown accepted that people were worried about the potential closure of A&E; facilities and maternity services close to their homes, raising speculation that he was pondering a rethink.

If so it is increasingly likely that he will move Patricia Hewitt, the Health Secretary, from her post to pave the way for changes. Which will mean the third Health Secretary since teh Health Direct blog has been running.

The Conservative estimate of 92 nationwide cuts was based on figures in a report circulated to NHS trusts in Surrey.

It states: “Current Department of Health and strategic health authority guidance suggests that, to be viable in terms of patient need, patient safety, staffing numbers and clinical training requirements, a full A&E; department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people.”

A staff briefing by Surrey Primary Care Trust in March repeated the figures, suggesting that such a catchment population was “national guidance”.

Closures could mean seriously ill patients, such as those with heart problems or head injuries, having to travel longer distances to receive care in specialist treatment centres. Patients with minor injuries are expected to be treated in walk-in clinics or smaller A&E; units.

Such a scenario was supported by two reports published by the Government last year. These suggested that specialist high-tech centres could save 500 lives of people suffering heart attacks and result in 1,000 more stroke victims avoiding death and disability each year.

The changes are broadly supported by doctors’ leaders but are fiercely opposed by patients’ groups and MPs. Cuts to local NHS services have also been opposed by several senior Labour politicians in their own constituencies.

The move to close A&Es; comes just as demands on their facilities are rising. The number of attendances at A&E; has risen by more than a million in the past three years and the average number of attendances at each is now 67,000.

A report published last year by the Royal College of Surgeons recommended that the minimum catchment population of a fully resourced A&E; department should be at least 300,000. But there is debate about whether catchment areas alone should be used to allocate NHS services. Local geography, healthcare needs and staffing levels may have to be taken into account.

A Department of Health spokesman said there was no such official guidance from his department. “Any decisions about the shape of A&E; services are taken locally so that services reflect the needs of the local population. Where local health authorities believe that patients can be better served by changing the way services should be delivered, it is right that they make those changes, and they will consult locally on any proposals.”

But he admitted that the recommendations were taken from a report by the Royal College of Surgeons supported by Sir George Alberti, the former director of emergency care. He recently recommended the closure of an A&E; department in North London. The remaining two A&Es; serving the area will be left with catchment populations of 450,000 each.

The Tories claimed that this was evidence of central targets to close units based on the number of patients they served.

Andrew Lansley, the Shadow Health Secretary, said: “Access to accident and emergency services is a vital component of the quality of NHS services. The public know that not every A&E; department can provide every emergency service. But there is no clinical evidence which would justify shutting down A&E; departments simply because they don’t serve a catchment population in excess of 450,000. Yet that is the basis on which the Department of Health is seeking now to justify closures.”

From:
http://www.timesonline.co.uk/tol/news/politics/article1801190.ece

The “idea” of cutting A and E units when demand for them continues to grow is just barking, posts Health Direct.

On Oct 03, 06 Health Direct posted: Record numbers of patients visit A & E as GPs services are cut when the number of people seeking treatment at accident and emergency units is at a record level. Statistics from the Department of Health (DoH) reveal that there were 18,759,104 A&E; visits in 2005-06, up five per cent from 17,837,180 the -previous year.

The rise comes as up to 60 National Health Service trusts face having to downgrade their A&E; units due to Labour’s funding cuts.

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

And whose fault is the growning A and E demand? Step forward Labour’s Dept of Health: On March 15, 07 in GPs’ out-of-hours service ’shambolic’ claim MPs the labour Government’s handling of out-of-hours services for GP patients was condemned as “shambolic” by an all-party committee of MPs.

The best interests of patients had not been served by the new system, the public purse had suffered and Saturday morning surgeries had been abandoned, the MPs said.

The report from the public accounts committee criticised GPs and primary care trusts as well as the Government for the flawed “hand-over” of out-of-hours services.

It says: “We found that preparations for the new service were shambolic, both at the national and local level.”

How had labour’s shambolic service come to this? It’s wonderful new GPs contract: On 31 Jan 07 Health Direct posted BMA team ’stunned by out of hours GP contract’ as a bit of a laugh. 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 Br
itish 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. ]]> http://www.healthdirect.co.uk/2007/05/half-of-all-ae-units-marked-for-closure.html/feed 0 http://www.healthdirect.co.uk/2007/05/nhs-hospital-bought-computer-parts-off-ebay.html http://www.healthdirect.co.uk/2007/05/nhs-hospital-bought-computer-parts-off-ebay.html#comments Thu, 17 May 2007 08:51:00 +0000 Dr Search- Principal Consultant at the Search Clinic http://healthdirect.clickinnovation.co.uk/?p=734 Patients are being put at risk because of delays in implementing the new NHS computer system, according to a study of senior managers. Parts of the £12.4 billion National Programme for IT (NPfIT) are years behind schedule.

Experts writing online in the British Medical Journal say today that senior managers supported the aims of the system but they had concerns.

Many believe patients are being put at risk by delays. Managers are left relying on outdated patient information systems and some trusts have even considered buying interim programmes while they wait for system to get off the ground, the study found.

One manager said: “It’s been urgent that it’s replaced all the time I’ve been here, which is about three and a half years… It is a clinical risk.”

Another described the current system as “not just obsolescent, it’s obsolete” and said the trust had had to buy computer parts off eBay and get them shipped from the US.

Researchers interviewed 25 senior managers and clinicians, including chief executives and directors of IT, in four hospital trusts in England.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/17/nparts17.xml

It’s not the first time that NHS professionals have had to resort to eBay for sourcing their equipment. On May 25, 06 Health Direct posted: Surgeon used eBay to buy equipment- and has it confiscated.

A surgeon has upset hospital bosses by ordering medical equipment through the auction website eBay. Kevin Murray, a newly appointed consultant at the James Paget Hospital in Gorleston, Norfolk, had been asked to provide a list of the equipment he would need for his operating theatre.

Mr Murray decided to save time by bypassing the NHS procurement system and using eBay. But when officials found out, the retractor was confiscated.