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.

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.

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.

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.

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.

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 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.

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.

And for being so transparent that – at one point – it actually left all the personal details of thousands of medics – including their sexual orientation – sitting on a website for all to see.

A gross security breach exposed by this programme – and now – as the Secretary of State revealed today – subject to a possible police investigation.

In a written ministerial statement she said “Action has been taken by the contractor… to address the weaknesses identified. Because the investigation has made it clear that criminal offences may have been committed the… analysis and report have been given to the police.”

Even more embarrassing for the health secretary this morning was the admission that her department’s new £6.3 million medical recruitment system was effectively being shelved.

“Given the continuing concerns of junior doctors about MTAS, the sytem will not be used for matching candidates to training posts, but will continue to be used for national monitoring.

A bit of a coup, you’d think, for the group of junior doctors who mobilised 15 months ago specifically with a remit to discredit MTAS. Not so, they said. the damage has already been done. The new recruitment strategy came in for criticism earlier this year when it emerged that there simply weren’t enough training posts available.

A leaked document from NHS Employers revealed that the charity VSO had been approached by the government – the problem they said was an excess of applicants for training posts over places, by about 10,000. One junior doctor told channel 4 news he was off to Ireland to finish his training.

By March it became clear that very good candidates like Salima Dhalla – an experienced doctor with two degrees – weren’t being short listed for interview.

The BMA declared the system unfair. Thousands protested in London and Glasgow and Patricia Hewitt – who’d already announced a review of MTAS – began saying sorry.

Her final apology followed Channel 4 News’s revelation on 25 April of a major breach of security on the MTAS website.

Intimate confidential details of medical students openly available to the public. The next day Channel 4 news exposed another MTAS security breach.

This time over students able to read each other’s confidential files. The government suspended the website.

The question is why did it take them over 24 hours to do so on a matter of such sensitivity?

In the face of an increasingly indignant junior doctor lobby, Patricia Hewitt announced that thousands more interviews would be made available for those seeking training posts this August.

But in Scotland chaos ensued – as Channel 4 News revealed how employers were desperately emailing candidates to ask them if they were supposed to be being interviewed.

The programme’s revealed how further data problems have stalled a number of candidates applications on the erroneous grounds that they were immigrant workers and last night, on Channel 4 News, consultants finally went public about the pressure this was having on patient care.

Finally, the latest error brought to our attention: An email sent out by Wessex deanery congratulating the candidates on their application. Half an hour later 31 of those contacted were told it had been only a draft email sent in error. They hadn’t in fact got the job.

From:
http://www.channel4.com/news/articles/society/health/doctors+online+system+to+be+ditched/511747

Hewitt’s pathetic record on IT development was highlighted by Health Direct on 30 Apr 07 in our post- Contender for greatest of all Labour’s NHS failures- MTAS Junior Doctor application system- 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.

Highly-qualified junior hospital doctors are now 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.

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.

This disaster waiting to happen recieved a warning form Health Direct over a year ago- 6 Mar 06 in Junior Doctors’ new IT MMC recruitment system is a disaster – It is an irony that many of the questions junior doctors must answer when they fill in the new form to apply for hospital jobs relate to their leadership skills and ability to work as part of a team.

The form is part of a new applications procedure, called Modernising Medical Careers (MMC), which involves no human interaction whatsoever. Hospitals are banned from holding interviews, having to rely instead upon a computer “dating” system that supposedly matches the applicant to the job.

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

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

And what has Patricia Hewitt and her cohort of expensive paper pushers at the Dept of Health done about these warnings for over a year? F All. Talking of Football, DoH and Ostriches- they are all about as impressive as the Football League at ignoring disasters.

It is due to different interpretations of contracts and policies designed to separate private from NHS-funded care. The issue is becoming more critical as the number of new cancer drugs being developed grows.

In all, 180 specialist cancer doctors told the BBC they were worried or very worried about the situation, in response to a questionnaire submitted by the BBC.

Around half the drugs submitted to the English NHS advisory body NICE are for the treatment of cancer. Some, like Herceptin for breast cancer, have won NICE backing as being cost effective for the health service. Others like Tarceva, which can extend the life of lung cancer patients, have been turned down.

Specialists like Nick James, professor of clinical oncology in Birmingham, believe the gap between what the NHS can fund and what is available is going to get bigger.

“The drugs in the pipeline are going to cause even more pressure. I think politicians need to be honest and say this gap is going to be there and we need to look at ways of filling it,” he said.

He believes it is inevitable that patients will make a bigger contribution themselves, but is worried NHS policy stands in the way.

Some patients who offer to pay for a cancer drug recommended by their doctor are told they will have to transfer completely to private care. This can have the effect of doubling bills which already run into many thousands.

In England, the official policy of the Department of Health is that allowing patients to contribute towards NHS care – known as co-payment – is against the principles and values of the NHS. The government says it could lead to a two tier system.

In Scotland a different picture is emerging. Earlier this year Scotland’s Chief Medical Officer issued much more nuanced advice to the health service there.

Two-tier system

He points out that if a patient opts to pay for a particular drug not available from the NHS there is no law which allows health boards to make the patient pay for all aspects of their treatment.

The letter sets out a framework for drawing up ways of allowing “the safe provision of concurrent treatment where appropriate”.

Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation, said she was appalled some people spend the last few months of their life in a desperate fight for NHS funding. The average time from diagnosis to death for lung cancer patients is six months.

“If they’re not going to be allowed to access drugs that improve survival by a few months, or improve their quality of life, we need to have an honest debate about how we’re going to have to fund these things.”

From:
http://news.bbc.co.uk/1/hi/health/6652183.stm

Health Direct on March 14, 2007 highlighted the growing postcode lottery for cancer treatment:
English denied cancer drugs given to Scots by NICE blight and postcode lottery

Lung cancer victims in England and Wales are to be denied a life-saving drug available on the National Health Service in Scotland — at least the eighth such decision in the past two years.

The National Institute for Health and Clinical Excellence (Nice) last week rejected Tarceva, which is used to treat lung cancer, on the grounds it is not an effective use of NHS resources.

A list of “Wonder drugs” available in Scotland but not England and Wales:
- Tarceva, a lung cancer drug. Because it targets only specific cells, it does not have the damaging side effects of other forms off chemotherapy. It is administered by tablet.
- Velcade, a treatment for the aggressive bone marrow cancer multiple myeloma. The drug can extend life for up to seven years. Multiple myeloma kills 3,000 people a year.
- The Alzheimer’s drugs Aricept, Exelon, and Reminyl are available only to patients in England with advanced symptoms, not with the disease at its early stages as in Scotland. Doctors say the drugs significantly improve the quality of life of patients, but England’s drugs regulator argues they are not effective enough. Campaigners are trying to overturn the ruling in the High Court.
- Alimta, used for mesothelioma, which affects the lining of the lungs, and lung cancer, was approved in Scotland in August 2005. It costs about £8,000 to treat a patient. Supporters argue that the side effects of other drugs prolong stays in hospital.
- Gliadel, which extends the lives of patients with brain tumours, is implanted in patients at a cost of £5,000 a time. It was approved in Scotland in December 2005.

The ongoing success of NICE in controlling NHS budgets was posted by Health Direct on April 04, 2006 in Cancer: There are life-saving drugs. So why can’t we have them? when thousands of cancer sufferers are being denied life-saving drugs because of delays and bureaucracy in making them available on the NHS.

The hold-ups are a matter of life and death for desperate people who have been diagnosed with cancer of the breast, colon or lung, or with a brain tumour.

Cancer charities, MPs and leading specialists are warning that this is creating a two-tier system where only those with money, and the well-informed, can afford the drugs, which cost many thousands of pounds.

They also condemn the postcode lottery over prescribing of cancer drugs, which means that some people are turned down for treatment but others are successful in proving that their case is “exceptional”, depending on what part of the country they live in.

She was later invited to Downing Street where he pledged funding to improve registries of bone marrow donors to help save Alice’s life.

Now Mrs Maddocks has described how her father Harry Lister, 74, died an agonising death after contracting MRSA following “awful” care in their local hospital.

“My father was let down by the NHS and we, as a family, are really angry about it. Society now accepts that when we go into hospital we could contract MRSA, but this should not be a risk we run,” she told The Sunday Times.

Mr Lister died of MRSA at Dewsbury and District hospital last June after going in for examination of a bowel problem.

In a statement Julia Squire, the chief executive of The Mid-Yorkshire Hospitals NHS Trust, said: “We are very sorry to hear that Mrs Maddocks is unhappy with the care that her father received. We would be grateful if Mrs Maddocks could get in contact with our complaints department so that we can fully investigate.”

The trust said Mr Lister’s notes were in transit and it would not comment further until it received them.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/14/nmrsa14.xml

Health Direct posts that the scandal of thousands of preventable deaths every year in NHS hospitals through patients contracting MRSA, C Difficile and other superbugs is not going to improve until the labour govt is prepared to finally address the issue.

It means more money to reduce bed occupancy rates, thorough cleaning of the beds between use and constant hygiene on wards including the automatic washing of hands by staff between contact with every patient.

On 15 Feb 07 in Clash of NHS targets- MRSA and cash underfunding or clean hospitals Health Direct posted that the labour government’s NHS waiting targets and wish to tackle the spread of hospital acquired infections like MRSA are in direct conflict, according to a leading expert. Professor Hajo Grundmann, currently based at Groningham University Medical Centre in Holland, maps the incidence of MRSA across the European Union.

And a week later- Feb 23, 2007 in MRSA and Clostridium difficile deaths up by half in year the Health Direct blog we calculated back in 2004 that fewer people being killed on UK roads than by superbugs.

Since then Health Direct calculates that with these new figures for 2005, there were nearly 70% more deaths linked to MRSA and Clostridium difficile than were killed in traffic accidents on all of the UK’s roads.

An inquiry by the Department of Health into the use of mixed-sex wards, to be published tomorrow, has found 31 NHS trusts out of 172 has failed to eliminate them.

Despite government pledges in the 1997 and 2001 Labour manifestos to phase out mixed-sex wards, the finding implies that thousands of male and female patients are still being cared for together, compromising their dignity and adding to the stress of their illness. Tony Blair said in a speech in 1996, as Leader of the Opposition, that it could not be “beyond the wit of government and health administrators” to eliminate mixed-sex wards.

The outcome of the inquiry, launched last December, is an embarrassment to Patricia Hewitt, the Health Secretary, who has defended the NHS’s record after being assured by NHS managers that 99 per cent of hospital trusts had abolished mixed-sex wards.

She ordered the inquiry after being forced on to the defensive last year by The Independent columnist Janet Street Porter whose account of the death of her sister, Patricia Balsom, from cancer provoked a public outcry.

Ms Balsom wrote a diary, published in The Independent last November, explaining in harrowing detail how her final days were blighted by the indignity of being cared for an a mixed-sex ward and Ms Street Porter described how she had been inundated with messages from people appalled that her sister could be treated so shabbily.

Callers besieged radio and television stations and charities including the Patients Association to give distressing accounts of stays in mixed-sex accommodation. One caller to The Independent, Janet Hollis of Stansted, Essex, described visiting her mother, aged 96, who died in Addenbrookes Hospital, Cambridge.

“Having men wandering round in a state of undress is not what you hope to see. When you are in hospital, you are at your lowest ebb. You need privacy to protect your dignity.”

Ms Hewitt ordered the chief executives of the 10 strategic health authorities in England to report back to her after it became plain the experience of patients did not tally with what health managers were telling her.

The report, by the chief nursing officer, Christine Beasley, identifies 31 trusts that need to make improvements to provide single-sex accommodation, which it defines as “separate bays or rooms” and separate lavatory facilities for each sex. It says the NHS “needs to push harder” to eliminate mixed-sex wards for routine patients.

Emergencies are different and some mixing of the sexes is inevitable in accident and emergency departments, medical assessment wards, intensive care and also in day surgery, the report says. These were not included in the assessment of whether trusts were compliant.

The Patients Association said the finding of the inquiry confirmed its worst fears. Vanessa Bourne, chief executive, said: “It is extraordinary because it shows Patricia Hewitt was not being told the truth by the NHS. She should wonder what else she is being hoodwinked over.”

From:
http://news.independent.co.uk/uk/health_medical/article2524441.ece

Only last month (April 10, 2007) Health Direct posted that the mixed sex practise was going to continue for the foreseeable future: Mixed wards- another broken labour promise as new PFI continue the scandal

A spell in a hospital in England is likely to mean being placed on a ward with people of the opposite sex. But in Europe and the US this would be unthinkable.

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.”

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.”

The affected systems are creating up to 400 duplicate patient records a day. Internal documents show that the duplicates have been created on the assumption that a patient does not already have a record – even if they do.

If these duplicates are left in place, it could lead to clinicians seeing patients without access to important medical history.

To stop this happening, the actual patient record must be merged with the duplicates. But if a backlog of unmerged records builds up, hospital record libraries could send clinicians the wrong patient file based on the duplicate record, which could pose a clinical safety risk.

The internal documents warn that merging records is creating significant extra work. And the merged files may later need to be unscrambled to maintain data integrity on patient administration systems.

Problems arose after Maintenance Release 1 of the IPM patient administration system was rolled out by NPfIT local service provider CSC and its subcontractor iSoft.

The upgrade, over the weekend of 21 and 22 April, led to up to 400 duplicated records being created each day for patients who had hospital appointments made using the Choose and Book NPfIT system.

Computer Weekly has received other internal documents which show that the incident in Greater Manchester is not isolated. There have been about 200 “major incidents” at NHS hospitals in the four months to the end of January 2007.

Dozens are in the highest “severity one” classification and some have affected NHS sites across England. Pacs digital systems and radiology information systems are among those to have suffered failures.

The problems undermine the position taken last month by health minister Lord Hunt that a Public Accounts Committee report on the NPfIT was based on information that was out of date. The latest incidents all occurred in the past seven months.

CSC and Connecting for Health, which runs the NPfIT, said of the problems in Manchester, “Although comprehensive testing is undertaken prior to upgrades, it is not unusual for these kinds of upgrades to identify teething problems in the early stages following implementation.”

The Health Committee of the House of Commons began its inquiry into aspects of the NPfIT on 26 April 2007 but its narrow terms of reference exclude looking into the threats to healthcare of troubled NPfIT go-lives.

From:
http://www.computerweekly.com/Articles/2007/05/08/223688/nhs-upgrade-creates-false-patient-records.htm

Labour’s NHS IT record is lamentable. Only last week (30 Apr 07) Health Direct posted: Contender for the greatest of all Labour’s NHS failures- MTAS Junior Doctor application system
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.

Health Direct warned over a year ago that the new Junior Doctors’ IT recruitment system was doomed to failure. Did any politician or civil servant listen?

March 06, 2006 Junior Doctors’ new IT MMC recruitment system is a disaster
It is an irony that many of the questions junior doctors must answer when they fill in the new form to apply for hospital jobs relate to their leadership skills and ability to work as part of a team.

The form is part of a new applications procedure, called Modernising Medical Careers (MMC), which involves no human interaction whatsoever. Hospitals are banned from holding interviews, having to rely instead upon a computer “dating” system that supposedly matches the applicant to the job.

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

Coming back to the £12 billion white elephant that is (NPfIT)- do you want your complete medical details to be available to over a million people?

On 21 Dec 06 Health Direct posted: Patients win partial right to block medical records in U turn on CfH IT project when Labour Ministers have bowed to the complete distrust some patients have of the planned National Health Service electronic patient record Connected for Health IT £20 billion system by appearing to agree that we will be able to place a total block on our records being uploaded to the system- rather than just a bar on them being shared.

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

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

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

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

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

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

Unions and pressure groups have condemned as “scandalous” proposals which would see private sector giants already making billions from PFI schemes receiving further money for plans which fail to get off the drawing board.

A £374 million hospital in Bristol going out to tender this week will be the test case for the scheme which a DoH senior official said would “compensate” private sector consortiums for rising tendering costs following EU laws which came into force at the end of January.

In the case of Bristol, the “runner-up” company could receive around £6 million, while a third firm may also be paid. North Bristol NHS trust is planning the 947-bed hospital, which is due to open in Southmead by 2013.

DoH deputy finance director Peter Coates said shortlisted companies which did not win deals currently pay out the equivalent of 1 per cent of the costs of a scheme while bidding but receive no compensation.

New EU legislation requiring short-listed bidders to work up more detailed proposals, would push up the bid costs by an additional 2 per cent.

Mr Coates said the DoH’s private finance unit was now considering plans under which a “significant proportion” of that extra cost would be paid back by hospitals.

The DoH is understood to be the only Government department drawing up proposals for such payments. Private sector profits from PFI projects, and waste linked to collapsed schemes, have come under increasing attack over the last year.

The Parliamentary public accounts committee criticised a PFI scheme in Norfolk which allowed the private sector to triple its profits, taking out a windfall of £115 million by refinancing the deal, and a scheme in west London axed by the Treasury after £15 million had been spent on lawyers, consultants and architects.

Pressure groups claim the private sector will make at least £23 billion in profits and interest from PFI schemes in the NHS over the next 30 years, a figure denied by the labour Government, although it has yet to produce its own figures.

Under PFI schemes, consortiums of private firms raise the finance to build and maintain sites for around 30 years, during which time the public sector pays back the loan, plus interest. Since Labour came into power, 124 PFI hospital building projects have been approved, 66 of which have been built.

Karen Jennings, Unison head of health, said: “It is incredible that the private sector is able to exert an influence over Government money in such a way as to make money even when they aren’t providing a service.”

Shadow health secretary Andrew Lansley called on Labour to give hospitals the freedom to borrow as they wished, rather than “imposing the straitjacket PFI has become on the NHS”.

Royal College of Nursing general secretary Peter Carter said it was “a bit rich” of the labour Government to be considering compensating failed bids to the tune of millions of pounds, while hanging on to a 0.6 per cent pay increase for nurses which would allow them to receive this year’s pay award in full.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/06/nhs06.xml

The busted flush that is PFI is quickly becoming apparent. And the reason why so many PFI are becoming unprofitable? Labour are making the initial tendering process so complicated and long winded that companies like Nuffield Hospitals- please see below, are saying enough is enough and are walking away.

Health Direct posted on 26 Apr 07- Setback for NHS on treatment centres as one in five PFI projects unprofitable when the Nuffield Hospitals, the not-for-profit private hospital operator, pulled out of negotiations to provide operations for NHS patients using mobile operating theatres in the West Midlands. The news comes at the same time that new research shows that almost one in five private finance initiative projects are still not making their owners money, a survey of almost 100 of them has shown.

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.

The Norfolk PFI deal that the PAC complained about above Health Direct highlighted on May 03, 06 when Watchdog brands 60 per cent profits on PFI scheme as unacceptable

Some of Britain’s biggest investors in the private finance initiative were yesterday condemned as “the unacceptable face of capitalism” by parliament’s public spending watchdog. John Laing, Innisfree, 3i, Barclays Infrastructure and Serco were accused of taking gains “unacceptable even for an early PFI deal” from a refinancing of the £158m Norfolk and Norwich Hospital.

The five, who make up the Octagon consortium that built and runs the hospital, made gains of £95m but left the hospital with extra potential liabilities of up to £257m should it need to terminate the contract early, according to the Commons Public Accounts Committee.

The gains came from borrowing more at lower rates of interest over a much longer period than the original deal and allowed Octagon to more than triple its original expected internal rate of return from 19 per cent to 60 per cent.

As a consequence, the Norfolk and Norwich NHS Trust is committed to the contract for 39 years rather than 34 even though the committee noted that it was “impossible to predict that far in advance the nature and extent of services that may be needed.” If the contract were terminated early, the hospital might have to pay up to £257m more.

James Johnson, the BMA chairman, will warn that patients face a bleak future because they will increasingly be denied treatments. He will urge the NHS to be much more explicit about what it can realistically afford to do and ask political leaders to engage in an open, honest debate about rationing.

The BMA proposes the drawing up of a new patients’ charter specifying those health services to which every citizen across England should be entitled, regardless of the local health authority’s financial situation. They also want to see a second list of all the treatments which the sick will get only if their primary care trust has the money, and if doctors decide they are clinically worthwhile.

Senior BMA sources say their report recognises the reality that despite record investment in the NHS, ‘postcode lotteries’ are rife. Primary care trusts, the local NHS organisations that commission and pay for care from hospitals on behalf of patients, are increasingly rejecting requests to pay for procedures or drugs because they are not perceived to be the best use of funds.

Some PCTs have been bitterly criticised for refusing to pay for expensive new cancer drugs; treatment to prevent older people going blind through age-related eye degeneration and operations to help obese patients lose weight through stomach-stapling.

Each trust already has a committee of medical experts that takes decisions on whether to fund medication for complaints which are not covered in their basic contract with the Department of Health. These include treatments such as growth hormone for adults, neuro-stimulation for migraines, breast reduction and enlargement, treatments for incontinence and even some care for multiple sclerosis.

Johnson will use the launch on Tuesday of a BMA discussion paper on the future of the NHS in England to spell out his belief that Britain’s ageing population will put ever greater pressures on local NHS organisations to decide how best to use their resources, and that the public’s reluctance to put significant extra funding into the NHS means rationing will become increasingly common.

Dr Michael Wilks, one of the BMA’s senior office holders, revealed the organisation’s radical thinking in a recent letter to its 139,000 members updating them on the progress of the BMA working group, headed by Johnson, which has drawn up the document.

He told them the group had concluded that ‘while the service should remain universal, the challenges raise questions about how comprehensive the service can continue to be. This will depend on whether politicians and the taxpayer are prepared to contemplate either increasing expenditure or explicit rationing.

‘Rationing of health care in one form or another has always existed but has not been discussed. While agreeing that an open and honest debate on rationing is needed, the nature of that debate needs to be clarified. It might, for instance, address whether current inequities in care caused by pressures to balance the financial books are preferable to one alternative, which is to set a limit on the availability of some procedures.’

Health Minister Andy Burnham last night welcomed the report as a useful contribution to the debate about the NHS’s future. He defended the NHS as ‘the right model for Britain’s future’.

‘[It is] a system which makes the most modern treatments and medicines available and that is envied by other governments around the world as a fair and cost-effective way of providing high-quality health care to a whole population based on need alone.

From:
http://observer.guardian.co.uk/uk_news/story/0,,2073633,00.html

The common sense of the BMA is congratulated by Health Direct. Nearly three years ago (June 28 05) Health Direct also noted the BMAs sense in Patients want cleanliness not choice BMA poll findsas MRSA grows

Cleaning dirty hospitals should be the top priority for the NHS and is much more important than giving patients a choice of where they are treated, a poll of patients conducted for the doctors’ organisation, the British Medical Association (BMA) found.

James Johnson, chairman of the BMA, said the findings showed what mattered to the public. “Patients are obviously extremely worried about hospital-acquired infections and quite rightly patients want their hospitals to be clean,” he said. “It seems what is not so important to them is the choice of where to have their operation.

“The BMA has been saying for a long time that patients are not so interested in a choice of five hospitals but they want a good service in a clean, local hospital.”

“To have five hospitals to choose from is a good soundbite but it is meaningless outside the metropolitan areas where patients will be lucky to get a choice of two or three. What is important for patients is to have a say in how their illness is managed.”

Harry Keen, president of the NHS Federation, said: “Senior doctors working in frontline services are sending a clear message of their concern. The NHS is at a crossroads. These major changes should await the verdict of wider public debate or the NHS as a collaborative network will be lost, unlikely ever to return.”

Since then has the labour government listened- have they heck.

The labour government robustly defended its management of the NHS with the publication of four Department of Health progress reports on key service areas – emergency care, cancer, coronary heart disease and mental health.

The Conservatives and Liberal Democrats published their own assessments, which called Mr Blair’s legacy ‘incompetent’ and ‘wrong’.

The Conservatives said Labour ‘dismantled’ Tory policies ‘only to re-erect them years later, and administer them incompetently’.

Official government waiting figures showing 100 per cent of people were seen within six months were misleading, the Conservatives argued. According to their report, The NHS under Labour: 10 wasted years, statistics from individual hospitals suggested 90 per cent.

The Liberal Democrats’ report The State They’ve Put Us In: 10 years of Blair and Brown, acknowledged there were ‘more staff, reduced waiting lists, and better care in some areas’. But it criticised Labour’s record on 16 points, including deficits, use of management consultants and threatened closure of community hospitals.

From:
http://www.hsj.co.uk/healthservicejournal/pages/N2/p7/070503

Being fair Health Direct looks at the 4 areas that bliar wants to be remembered for- emergency care, cancer, coronary heart disease and mental health and reposts 4 posts highlighting his abject failure in each category:

Patients die in ambulances with no paramedics on board when NHS Patients are dying directly because low skilled helpers are being sent out to handle life threatening 999 calls, ambulance whistleblowers have warned.

Figures released under the Freedom of Information Act show that in some areas of the country only 35% of ambulance service staff are fully trained paramedics. Ambulance staff say pressure to meet the government’s eight-minute target for responding to life-threatening calls has resulted in “technicians” being sent instead.

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.

Delays in treatments give patients new cancers when Cancer patients who have had tumours removed are dying because they are waiting so long for for follow-up radiotherapy that their tumours return, a government report has found.

After surgery, patients should receive radiotherapy within 28 days, according to the Royal College of Radiologists. However, in some areas, patients are waiting three times as long. In Kent, for example, the waiting time for breast cancer patients who have had tumours removed by surgery is three months.

Britain- the sick heart of europe Heart disease, the most preventable health threat facing Britain today, is costing the economy £29bn a year. Rising rates of obesity, an ageing population and the soaring prescription bills for heart drugs such as statins mean that the bill is likely to rise in the future.

In the first study of its kind to calculate the financial burden of cardiovascular disease (CVD), analysts found that the UK is spending more healthcare money on the condition than any other European country.

They said that more effort and money should go into preventing CVD through diet and exercise rather than current policies which have focused on improving access to drugs. In Britain, more people die of coronary heart disease and strokes than cancer.

Mentally ill murder 400- a rate of 1 every week as more than 400 people have been killed by mentally ill patients released into the community in the past eight years, a government inquiry revealled.

The Department of Health study, concludes that on average 52 people a year — one a week— are killed by mentally ill patients. It will say that a significant proportion of these deaths could have been avoided, had it not been for health service failures or legal loopholes.

As well as the four areas above, Health Direct notes that deaths from superbugs pro rata are the worst in Europe with more people dying after contracting MRSA, MSSA and C Difficile than are killed in road accidents in the UK.

NHS hospitals may never achieve MRSA superbug targets the NHS is not on track to meet its MRSA target and perhaps never will, a leaked government memo says. In November 2004, then health secretary John Reid pledged MRSA rates would be halved by April 2008.

But the memo, sent to ministers by a Department of Health official, said it would only be cut by a third by then. It also reportedly recommended ways to handle the news in the media. Dr Mark Enright, from Imperial College, said the target was “unrealistic”.

National Institute for Curbing Expenditure (NICE) blights Alzheimer sufferers NICE has been renamed by NHS doctors as the National Institute for Curbing Expenditure after it’s latest edict to ban the funding of Alzheimers drugs costing only £2.50 a day- which will effect hundreds of thousands of sufferers.

“This blatant cost-cutting will rob people of priceless time” said Neil Hunt of the Alzheimer’s Society.

Britons are the fattest of Europe a major Government study has shown the continuing North-South divide when it comes to the health of people in England. The report also shows that the UK has the highest obesity rate in Europe and that Boston in Lincolnshire has the highest number of people with obesity in England.

The “Health Profile” says men in northern counties die on average two years earlier than those in the South – partly because of higher obesity levels and smoking-related disease. Life expectancy for women is also a year shorter.

MPs demand changes to “not fit for purpose” classification of illegal drugs The ABC system of classifying illegal drugs should be replaced with a more scientifically based scale of harm, a committee of MPs says.

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

The MPs are highly critical of the Advisory Council on the Misuse of Drugs, the labour government’s key advisory body on drugs policy, calling its failure to alert the home secretary to the serious flaws in the system “a dereliction of its duty”.

Drug specialists say the current system for ranking drugs – class A for the most dangerous to class C for the least dangerous, as set out in the Misuse of Drugs Act – is “not fit for purpose, irrational, arbitrary and lacking in transparency”.

Mixed wards- another broken labour promise as new PFI continue the scandal when a spell in a hospital in England is likely to mean being placed on a ward with people of the opposite sex. But in Europe and the US this would be unthinkable. Health Direct reports on a pledge the labour government has yet to keep.

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.”

NPfIT NHS plan is evolving but one-size-fits-all is a fundamentally flawed, says hospital chief when Sir Jonathan Michael, a top NHS executive, who spoke at a healthcare symposium at London’s City University last week pointed to a fundamental flaw in the NHS’s IT-driven modernisation.

The flaw Michael sees in the National Programme for IT (NPfIT) is its centralised, standardised approach at a time when the health service is decentralising. The chief executive of Guy’s and St Thomas’ NHS Foundation Trust, Michael wants IT support for the specific ways people work in particular parts of his organisation, such as the accident and emergency department.

Health Direct also asks what happened to the billions of our Pounds that labour has put into teh NHS- PFI firms make £23bn profits from NHS

The private sector will make £23bn in profits and interest over the next 30 years by building NHS hospitals, campaigners have calculated. Under the private finance initiative, a company builds a hospital and then gets “rent” from the NHS for a set term. A report by the Keep Our NHS Public claims the Labour government is carrying out “patchwork privatisation” of the NHS.

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

Health Direct also asks what do the hard pressed NHS staff who actually work in the organisations think of bliar’s legacy?

NHS Staff wouldn’t be treated at their own hospital as fewer than half of NHS staff members would be happy to be a patient at their own hospital, according to an official survey by the health service regulator. More than a quarter, 27 per cent, said they disagreed or strongly disagreed with the statement: “I would be happy with the standards of care provided if I was a patient in my trust”.

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

Doctors’ morale hits record low new poll claims as a survey in March of more than 1,400 doctors found that 69% would not recommend a career in medicine. The same number said morale fell in the last year. The study for Hospital Doctor magazine found that many doctors blamed Labour government targets and reforms for their ill-feeling.

Some 54% of those surveyed by Hospital Doctor said morale was “poor” or “terrible” with only 2% of doctors described their level of morale at work as “excellent”.

Disillusioned doctors say Labour decade of reform has failed NHS 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.

“It is tragic that the Labour Government has used so much of the increased expenditure on wasteful initiatives like independent sector treatment centres and PFI. The private sector has certainly done well out of the increased funding.”

A spokesman for Barnet and Chase Farm Hospitals NHS Trust said Panorama did not reflect the dedication and commitment of its midwives. “The programme makes accusations about the care our women receive which are either untrue and or taken completely out of context,” he said.
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“We have conducted a thorough investigation and we have found no evidence of our mothers and babies receiving substandard care or coming to any harm.”

At St Mary’s Hospital for Women and Children in Manchester, a woman in labour had to return to the ward with insufficient pain relief. Prof Dian Donnai, the clinical head, said: “We have a national and international reputation for first-class care of women, babies and families.”

As the beeb’s website don’t currently carry the story this psoting was taken from:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/03/nbirth303.xml

The sorry state of Labour’s NHS labour “service” is disgraceful. on April 05, 2007 Health Direct posted : Hewitt’s home births promise is premature, warn Tories when Labour’s promise that healthy women who choose to can have their babies at home was undermined yesterday by fears of a shortage of midwives and lack of funds.

Patricia Hewitt, the Health Secretary, announced that from 2009 all women would be able to choose where they had their baby – in hospital, in a midwife-led unit or at home. But the Conservatives said there was “no substance” behind the plans and the Royal College of Midwives (RCM) said that the plan would need an extra 3,000 midwives.

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 fox in a chicken coop.

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 HPA said C. difficile rates were “very high” and the Patients Association called for more to be done to protect patients from bugs.

Patients Association spokeswoman Katherine Murphy said: “Too many people are dying from these infections. We must learn from other countries such as Holland which have got infection rates close to zero.

“That is what we should be aiming for. We need to make NHS chief executives more accountable and ring-fence infection control budgets as it is to easy to raid them when there are cuts.”

She also said all patients should be screened – at the moment only those at highest risk are routinely tested as they enter hospital.

In November 2004, then health secretary John Reid pledged MRSA rates would be halved by April 2008.

But government memo, sent to ministers by a Department of Health official last year, predicted it would only be cut by a third by then.

The same memo said C. difficile, a stomach bug which can cause potentially life-threatening bowel inflammation problems, was now “endemic throughout the health service, with virtually all trusts reporting cases”.

Ministers have asked NHS trusts to set their own targets to reduce C. difficile rates. The latest figures confirm the problems – although the rate of increase in C. difficile is slowing.

From 2004 to 2005, there was a 17% rise compared to the 8% being reported last year.

There were 1,542 MRSA bloodstream infections from October to December 2006 – 7% down on the previous quarter.

The HPA does not look at deaths although figures from 2004 show that MRSA was mentioned on over 1,000 death certificates in England and Wales, while C difficile was listed on over 2,000.

Dr Mark Enright, an expert on infections from Imperial College London, said: “C. difficile has hit the NHS out of nowhere and we are still getting our head around dealing with it.”

Shadow Health Secretary Andrew Lansley said: “The government has badly let down NHS staff and the patients they care for.”

And Lib Dem health spokesman Norman Lamb said “tougher action was needed”.

From:
http://news.bbc.co.uk/1/hi/health/6593225.stm

Health Direct is not surprised by teh latest shocking figures on superbugs. On 23 Feb 07-
MRSA and Clostridium difficile deaths up by half in year as the Health Direct blog was partly set up in response to the preventable crisis that is killing thousands of patients in the UK.

We calculated back in 2004 that fewer people being killed on UK roads than by superbugs. Since then Health Direct calculates that in 2005, there were nearly 70 per cent more deaths linked to MRSA and Clostridium difficile than were people killed in traffic accidents on all of the UK’s roads.

In the NHS, the headcount dropped by 17,000, or 1.3 per cent, to 1.34m. The biggest decline – of 16,600, or 6 per cent – was in support staff such as nursing assistants and auxiliaries, according to the NHS information centre.

Lord Hunt, the health minister, said the figures indicated there had actually been a rise in clinical capacity – if an increase in the number of doctors and nurses working full time was considered.

He pointed to a decline in bureaucracy, with the first reduction of NHS managers since 1995, as the number of health authorities and primary care trusts was cut. However the managerial cutbacks are likely to lead to a big redundancy bill.

Andrew Lansley, the Tory health spokesman, said the fall in headcount would have been almost 10,000 higher but for the change in the counting method.

Peter Carter, general secretary of the Royal College of Nursing, said: “When you dig below the surface even further, an estimated 17 per cent of the headline increase in nurse numbers [since 1997] is made up of double-counting existing nurses working extra shifts.

“Meanwhile, internationally recruited nurses, who make up a significant number of the extra nurses, now face the prospect of having to leave at the end of their contracts under new immigration laws.”

Unison, the largest public sector union, said: “These alarming figures appear to confirm our fears that health workers’ jobs are now being lost because welcome extra cash is often being sucked into an endless black hole of ‘strategic’ reforms, which don’t appear to be linked to many meaningful front-line patient care outcomes.”

From:
http://www.ft.com/cms/s/3e7858ea-f45c-11db-88aa-000b5df10621.html

Health Direct kicked off the first week of the New Year with Report on NHS staffing angers unions as it predicts 36,000 NHS jobs lost this year. The National Health Service is set to shed more than 36,000 jobs this year before facing “very volatile” changes in its workforce that could leave it with thousands more hospital consultants than it can afford to employ, according to a leaked document from the Department of Health.

At the same time, however, big cuts in nurse and medical training budgets last year and this year could mean the service will be short of 14,000 nurses, 1,200 family doctors and 1,100 junior hospital staff by 2011.