Gordon Stalin Brown’s immediate priority is to restore stability and financial stability to the National Health Service, which is grappling with Tony Bliar’s market-based reforms. The underlying objective is to restore public trust in the health service and recover Labour’s poll lead over the Conservatives on health.

Patricia Hewitt, the outgoing health secretary, restored financial balance to the NHS as a whole. But there remain big problems in a minority of trusts and Ms Hewitt was criticised in private by colleagues for her poor communication skills and strained relations with the workforce.

Mr Johnson is seen as a conciliator rather than an innovator. His task is to improve relations with NHS staff and project an image of order and stability. If this means slowing reforms, such as extended choice of hospitals and payment by results, Mr Johnson is likely to do it.

The public-sector unions will remember the deal he struck preserving civil servants’ generous final salary schemes and they welcomed his appointment yesterday.

“He is someone we can do business with, and it presents staff, patients and government with a clear opportunity to make a fresh start,” said Dave Prentis, general secretary of Unison.

From:
http://www.ft.com/cms/s/4b662fac-25dd-11dc-b338-000b5df10621.html

After the reigns of John “not fit for purpose” Reid and then Patricia “best year ever” Hewitt the arrival of Alan Johnson the new Heath Secretary looks to be a positive move for the NHA staff.

One of his top priorities will be paying his staff- now that the NHS is in the black Labour can afford to pay the miserly annual pay awards in full and not staged as currently suggested.

Coroner John Pollard urged the NHS to consider the impact of reforms on staff as he recorded a suicide verdict.

He said: “I find it extremely sad that a young woman with such a lot going for her has been reduced to this state of despair. When people introduce these rules and systems, perhaps a bit more thought as to what effect they will have on people would be helpful.”

The inquest heard that Miss Wilson, who lived alone in Sale, Greater Manchester, found her position at work was made increasingly difficult by the Agenda for Change review, which was aimed at making NHS jobs and salaries fairer.

Her own job was reclassified two grades higher. But dieticians at Wythenshawe Hospital did not receive any improvement in their pay scale, although their colleagues at other hospitals in the area were promoted and received higher salaries.

Miss Wilson lobbied hospital chiefs on behalf of her staff but was told there was no money to improve their pay.

She was also upset because a failing student alleged that she had suffered discrimination at the hospital.

Neil Wilson, Morag’s father, visited her in December last year to hear her sing in a hospital choir in Manchester.

He said she felt unable to enjoy a tea break with her staff because they would stop talking as soon as she walked into the room.

Mr Wilson said: “They made her feel as if possibly she was to blame for them not being upgraded, they made her feel so bad she took her tea into her office.”

Mr Wilson, who lives with his wife Betty in Aberdeenshire, described how he found his daughter being sick because she was so worried about a meeting with the failing student and other work issues.

After the meeting she told her father that the student had been aggressive.

Mr Wilson heard his daughter moving about the house at 5am the next morning but went back to sleep.

He was woken again at 5.30am by a phone call but no one replied when he answered. Mr Wilson now believes it was his daughter calling before she committed suicide.

Minutes later, police found Miss Wilson’s car on the hard shoulder on the section of the M60 that crosses the Manchester Ship Canal near the Trafford Centre shopping complex.

Police found her handbag with a kitchen knife inside. Officers arrived at her home just as her father was filing a missing persons report.

Divers found her body in the canal four hours later. After finding stab wounds on her chest, detectives launched an investigation to find out if anyone else was involved in her death.

Two days later a pathologist confirmed that Miss Wilson had died from drowning.

Her family received more than 350 cards and letters after her death, many from her colleagues at the hospital.

It is understood that the complaint by the student has since been resolved.

A spokesman for Wythenshawe Hospital said: “Morag faced the challenges of any head of department, but had not raised any concerns about the demands.

“We cannot speculate on the motivation for Morag’s tragic actions but strongly believe she was appropriately supported by the trust. We would like to reiterate our sincere condolences and sympathy to Morag’s family.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/28/nsuicide128.xml

Health Direct would like to reiterate our sincere condolences and sympathy to Morag’s family, friends and colleagues.

Health Direct would also like to extend our sympathies to the family and friends of Dr David Kelly who also apparently committed suicide after also tangling with labour’s policies.

Against this background of apparent public discontent, doctors will today mount a full-scale attack on NHS reforms, accusing the government of “contemptuous disregard” for the views of the profession and of introducing changes “that are not fit for purpose and are damaging to medicine and healthcare in the UK”.

The Archdeacon of Totnes, John Rawlings, giving the sermon at the BMA’s traditional pre-conference service last night, said the debacle over jobs for junior doctors “has brought heartache of immeasurable proportions”. Earlier Sam Everington, acting chair of the BMA, said he thought the survey of public opinion gave “a very stark message, but I think it is very clear”.

The survey results run counter to most of those commissioned by the government and the official watchdog, the Healthcare Commission, which have traditionally found most patients are happy with their doctors and the treatment they receive on the NHS.

Vivienne Nathanson, head of science and ethics at the BMA, said the survey “reflects a big difference of opinion between the government, patients and doctors”.

The findings of the survey of around 1,000 members of the public in England, questioned on the street, generally reinforced the views of doctors – but there was divergence on the issue of charges in the NHS. The BMA is adamantly opposed to any charges, but 53% of the public thought there was a case for a small charge for some services where resources are limited.

“I wasn’t surprised, but our policy is clearly against it,” said Dr Everington. More work would be needed to find out exactly what sort of charges the public felt would be reasonable, he said.

The BMA has produced its own reform proposals for the NHS, the main one being that the NHS should be run by an independent board of governors. This won 60% support in the survey, but is not expected to find favour with government.

From:
http://politics.guardian.co.uk/publicservices/story/0,,2110593,00.html

The BMA’s critical view of Labour’s NHS policies have been long runing. On June 27 06 Health Direct posted: BMA reports that NHS does not provide choice says public

More than half the people in a general public survey on patient choice in the health service believe the NHS does not offer choice. The British Medical Association commissioned the survey and is publishing the findings on the eve of its annual meeting.

Mr James Johnson, chairman of the BMA, said: “Patient choice is on the lips of every politician and drives the NHS reform agenda. We wanted to find out what it means for ordinary people and how important it is to them. We found some surprising results which don’t seem to match government thinking. Most strikingly, the majority of people (55%) said the NHS did not offer choice”.

In the first ever High Court challenge of its kind, a judge was urged to force the National Institute for Health and Clinical Excellence (aka National Institite for Curbing Expenditure), to reconsider its block on the drugs for those newly diagnosed with the disease.

If successful, the case, brought by the drugs company Eisai and backed by the Alzheimer’s Society, could precipitate a flood of legal actions from patients refused other drugs on the NHS.

Nice decided last year that Aricept, Reminyl and Exelon – three inhibitors – should no longer be made available on the NHS.

At a cost of £2.50 a day, the drugs were too expensive when weighed against the benefits, it said.

But as the case began in London, Alzheimer’s sufferers and their carers protested outside the court, claiming the drugs had given them “a stay of execution”.

Inside the court, Mrs Justice Dobbs heard that Keith Turner, 68, a former chiropodist from Hastings, East Sussex, who was diagnosed in April 2004 and prescribed Aricept, said it had given him back his life.

His wife Lillian said it was “abhorrent and disgusting” that Nice was suggesting that carers such as her would be better off the sooner their sick relatives went into care, she said in a statement. “Even when Keith deteriorates – as we accept he ultimately will – each day we live together at home will be a day we cherish and value,” she said.

Eisai, the Japanese company that makes Aricept; Pfizer, which distributes it in Britain; and the Alzheimer’s Society are accusing Nice of making an “illegal” and “flawed” decision in deciding that those with mild Alzheimer’s be denied the drugs.

There are about 100,000 new cases diagnosed each year. They claim Nice has ignored the proven benefits of the drugs. They want Nice to be forced to reconsider its decision that the drugs be given only to moderate and severe Alzheimer’s sufferers.

David Pannick, QC, for Eisai, said: “One cannot over-emphasise the distress and damage caused to patients and their families by the disease, which progressively destroys the personality.”

Mr Pannick said Eisai and Pfizer recognised that Nice had a difficult job to perform, but it had to adopt a fair procedure, respect rights protected by the law and must not act in an irrational manner.

During the four-day hearing Nice will apparently argue that there was no unfairness.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/26/nelderly226.xml

It has taken 8 months for the legal bods to get to the courts. On 11 Oct 06 Health Direct posted: National Institute for Curbing Expenditure (NICE) blights thousands of 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 hunderds of thousands of sufferers. “This blatant cost-cutting will rob people of priceless time” said Neil Hunt of the Alzheimer’s Society.

Help the Aged said one in five people over 80 were affected by dementia and the number of people living with the disease was set to double in a decade.

Jonathan Ellis, senior policy manager at the charity, added: “It cannot be right to allow the health of thousands of older people to deteriorate on the altar of cost.

“On the one hand, the labour government says it is committed to improving care for older people, while on the other NICE is blocking access to treatment which would help them retain their independence and dignity. This is botched policy making at its worst.”

Patients can rate trusts and comment on their experiences of secondary care, although references to individual clinicians or health professionals will be removed in classic Stalinist style.

They will also be able to compare hospitals on factors such as average length of stay for different treatments, readmission rates, patient survey results and infection levels.

Junior health minister Andy Burnham told HSJ: ‘Health is the second most researched topic on the internet. There’s lots of information out there but what is lacking is lots of validated, authoritative, relevant information. We will see criticism but I also feel people will log on to record thanks and appreciation.’

An electronic health library used by clinicians has been re-written in ‘ordinary language’ so patients can find out more about illnesses and treatments. The website will be able to create tailored individual and family health risk assessments based on age, sex and location.

Hospitals are being encouraged to add to the site by creating their own pages with localised information, governed by the same advertising guidelines used across the NHS. In time, the system is likely to be rolled out to primary care, although unsurprisingly this is still under develpment. Services provided through the independent sector on the NHS can also be rated.

The DoH has spent £3.6m on the website and plans to spend a further £10m a year to keep it going. It is run by Dr Foster Intelligence.

The DoH is also looking at making information available through mobile phones.

The health choices website is at: www.nhschoices.nhs.uk
From:
http://www.hsj.co.uk/healthservicejournal/pages/N1/p9/070621

Health Direct has just conducted a survey of 10 local dentists who are listed on the new nhs choices website. All are listed as
# NOT Currently Accepting New Fee Paying NHS Patients
# NOT Accepting New Charge Exempt Adults for NHS Treatment
# NOT Accepting New Children Aged 0-18 years for NHS Treatment
# DOES NOT Provide Urgent Dental Access Slots

Ergo Health Direct asks the Dept of Health what on earth is the point of your expensive website if patients can’t access the local services that the NHS is supposed to provide?

Voters want health services not yet more expensive spin. So nhschoices.nhs.uk becomes yet another example of labour wasting taxpayers’ money in the name of saving the NHS.

Speaking at the NHS Confederation’s annual conference in London, Mr Cameron promised legislation to outlaw such a policy in the future. He added that the Conservatives’ “first piece of health legislation” would commit the Tories to a comprehensive, universal health service funded out of taxation. But it would go further and “enshrine in law that NHS money should only be spent on NHS patients”, he said, ruling out the “patient passport” proposal.

In future there would be “no opt-outs” and “that’s a guarantee”, Mr Cameron told the conference of NHS managers and board members. “We are not going to use NHS money to help people get out of the NHS into private healthcare. NHS money will be spent on NHS patients and that will be written into the law.”

He underlined that he wanted there to be “no doubt whatsoever” the next Conservative government would uphold the principle of an NHS paid for out of general taxation.

Without naming specific sums, he said the Conservatives would “always support the NHS with the money it needs”.

Andrew Lansley, the party’s health spokesman, said that would mean “additional, growing, real-term resources” – reflecting the fact that as countries grew richer they spent a greater proportion of their total income on healthcare.

Meanwhile, David Nicholson, the NHS chief executive, without directly naming them, launched a strong attack on “the vested interests” of the British Medical Association and the Royal College of Nursing for wild claims that the NHS was “on its knees” or that the service’s financial performance was “a tragedy” or “a farce”.

Such claims “are not just factually incorrect”, said Mr Nicholson. “They are deeply damaging to the public confidence and staff morale”.

From:
http://www.ft.com/cms/s/2477045c-1f93-11dc-ac86-000b5df10621.html

On Jan 24 07 Health Direct posted- Conservative’s David Cameron would hand power back to GPs as many centralist targets for the National Health Service would be scrapped under a Conservative government as more purchasing power was handed to family doctors, David Cameron, the Tory leader said.

The policy would encompass a full-blooded return to GP fundholding – the practice of giving family doctors budgets to buy care on behalf of their patients, which Labour abolished but is now partially reinstating through practice based commissioning.

Health Direct also points out that government actions also loose elections.

Health Direct has frequently raised the issue of waste that labour’s blizzard of targets has created for the NHS. On Dec 18 06 in Labour’s mismanagement has led to NHS deficits according to Commons Health Select Commitee Mismanagement at all levels of the NHS in England has led to the current multimillion pound deficit, a committee of MPs has found.

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

The committee said historic deficits, long hidden, were revealed when the government changed the rules so trusts could not underspend their capital budget to subsidise current spending.

But it said the government fuelled the problem by agreeing to new pay deals for doctors and nurses using estimates of the cost which were “hopelessly unrealistic”.

In addition, meeting national targets such as the requirement that no patient should wait more than four hours in A&E; had been costly.

Central government has made “some progress” in implementing previous recommendations made by the National Audit Office, the report says. These include increased use of framework agreements to cut the costs of buying in consultancy as well as involving qualified procurement staff.

However, the report states that “much more can be done” to improve value for money and identifies several areas where departments across government require “significant improvement”.

These areas include controls on awarding contracts by single tender, planning for and carrying out the transfer of skills from consultants to internal staff and better assessment of whether internal resources could be used instead of consultants.

The PAC praises the Ministry of Defence for using consultants to add “real value” to a government department and helping it make improvements it would not have otherwise achieved.

However, the report notes that departments across Whitehall and the Office of Government Commerce (OGC) do not routinely know how much money is spent on consultants.

The PAC says departments should have comprehensive data to help assess whether benefits obtained are justified by the costs and to judge if the best prices are secured when a consultant has considerable ongoing business.

It also calls for improved sharing across Whitehall and with the OGC on the performance of consultants to minimise the risk of departments being overcharged.

In a veiled challenge to Gordon Brown’s incoming premiership, Edward Leigh, the PAC’s Conservative chairman, said government needed to adopt a “much more intelligent approach” to the use of external consultants and become commercially “much sharper”.

“It is impossible to believe that the public is receiving anything like full value for money from this expenditure. In fact a good proportion of it looks like sheer profligacy,” Mr Leigh said.

Alan Downey, chief operating officer for KPMG Risk Advisory Services, which provides consultancy services to the public and private sector, said that although government expenditure on consultancy had increased over the last three years, more recently it had been declining.

From:
http://www.ft.com/cms/s/f6a2b6e2-1dd6-11dc-89f7-000b5df10621,dwp_uuid=34c8a8a6-2f7b-11da-8b51-00000e2511c8.html

Health Direct has long deplored labour’s waste of voter money- on Sept 12, 06 we posted:
NHS external manager bill soars to over £172m this year.

The NHS in England is set to spend £172m this year on external management consultants – a rise of 83% in two years – the Conservatives have claimed. The Tories warn spending on managers is detracting from clinical services.

Welwyn Hatfield MP Grant Shapps used the Freedom of Information Act to obtain figures from 76% of NHS trusts. The data shows a link between trusts with the biggest debts and most job cuts, the Tories said.

But the Department of Health said the figure should be seen in the context of the annual £70bn NHS budget. NHS trusts are able to employ external consultants for advice on how to run their services and staff.

The government has also enlisted companies like KPMG and Price Waterhouse Coopers to act as “turnaround teams” for some failing trusts.

In their report, the Tories said trusts’ spending on management consultants was increasing, and that the use of consultants was a “reliable yardstick” for job losses and debts. The report added that a total of £93.8 million was spent in 2004/05 on external consultants, rising to £117.9 million in 2005/06.

The projected spend for 2006/07 is £171.6 million.

The figures were calculated using the data returned from trusts, and projections for the remainder.

Mr Shapps said several trusts refused to respond to his request, adding they had an even worse track record than some in the report.

He added: “I think it’s extremely dubious as to how much effect these consultants are having, other than sacking lots of staff. The government needed to look at whether taxpayers were getting value for money when jobs and services were being cut and wards closed.”

The report said 10 of the worst trusts had millions of Pounds of debt, yet had a projected spend each of between £1.9 million and £3.6 million on consultants for 2006/07.

Dr Paul Miller, chairman of the British Medical Association’s (BMA) consultants’ committee, said he would not be surprised if trusts’ total spend was even higher.

He added: “The NHS is wasting hundreds of millions of pounds on management consultants who don’t have the answers. I would like the secretary of state to stop the NHS wasting all this money on management consultants – it takes money away from patient care.”

Dr Miller, who has an MBA, continued: “The NHS needs good management and good managers but that involves people who know the trust, the staff, the locality and the services it provides – not just people parachuted in from outside with no health experience.”

Health Direct agreed with Dr Paul Miller, chairman of the British Medical Association’s (BMA) consultants’ committee, when he said that he would not be surprised if trusts’ total spend was even higher.

On Tue 8 Aug 06 Health Direct noted in Public sector consultants to cost £20bn under Labour’s stewardship that the bill for management consultancy within government is set to top £20bn over the lifetime of three parliaments, according to a former consultant who has carried out an extensive survey of public spending on external advice- David Craig, formerly of Capgemini, the consulting company.

Four years after the original contracts were signed, the £20bn programme, to provide an electronic patient record and much else, is changing – although it is not yet entirely clear how.

Strategic health authorities are being given direct responsibility for improving implementation. A tender is being completed to bring on additional software and service suppliers.

And while key parts of the infrastructure are now in place, big questions remain about when new patient administration systems will go in to hospitals, along with the associated software needed to provide a shared, electronic patient record.

Fears about the future of iSoft, one of the two key software providers for the record, were markedly eased yesterday, as CSC, its parent contractor, took more responsibility for the software itself.

But hospitals are reluctant to take new administration systems until iSoft’s patient record software is available – the earliest installations are not due until next year – and until Cerner, the other record provider, has an accounts package adapted to the NHS.

It looks likely to be 2009 or 2010 before those will be being installed in large numbers nationwide. And some NHS trusts are seeking more variation than is so far theoretically permitted under the fierce standardisation that the programme has sought to date. That would vary existing contracts, as would bringing in more suppliers.

There remains room for fierce debate about where the blame lies for the delays – with the NHS or the suppliers. Mr Granger has paid suppliers only for systems that are working, keeping the programme on budget.

But six months ago, he warned publicly that his departure might lead to claims from key suppliers that their original contracts have been varied and they should be compensated. At the weekend, he described that risk as “significant”. And that appears to be one reason why he and ministers are talking about a “transition” from his full-time role, rather than an immediate departure.

There is also the question of who – given the size of the brickbats that have come to be associated with the job – will want to replace him.

From:
http://www.ft.com/cms/s/5e7e23f8-1e01-11dc-89f7-000b5df10621.html

There is also a question as to why Richard Grainger is leaving his post. Health Direct points out that successful IT projects need a champion to drive the strategic implementation through. With his departure that leadership is now lacking. And patients are having to wait even longer.

On Mon 5 Jun 06 Health Direct posted: £20bn NpfIT computer failures left NHS patients waiting longer as evidence that the Labour government’s troubled £20 billion National Health Service computer system has lengthened waiting times for patients has emerged for the first time.

It was hoped that a pilot scheme for the technology at the Nuffield Orthopaedic Centre NHS Trust in Oxford would show the benefits of the delayed system. Instead, when it went “live”, the computers crashed, data could not be found and some patients found that they were facing among the longest waits for operations in the country.

Staff who were instructed to sort out the problem could not even establish from the malfunctioning computers which patients had been waiting the longest and the numbers kept climbing.

Ross Anderson, a professor in security engineering at the University of Cambridge, warned that the new system was likely to cause “chaos and disaster” in the NHS. “They’re ripping out the old systems but they’re not replacing them with anything better,” he said.

Fewer hospitals and NHS trusts than last year can demonstrate that they are maintaining standards on cleanliness and infection control, despite the introduction of a strict “hygiene code” to eradicate illness caused by MRSA and Clostridium difficile.

Particular problems include failing to decontaminate reusable medical devices, to reduce healthcare-associated infections and to supply the latest recommended treatments for patients. There was also a slight decline in the number of trusts saying they met two standards on treating patients with dignity and respect.

The findings are based on 394 reports by the trusts themselves on their ability to meet the core standards. They show that 40 per cent believe that they met all the requirements in 2006-07, up from 34 per cent in 2005-06.

But 55 trusts (14 per cent) said that they had not met, or lacked evidence to say that they had met, the standard on reducing the risk from infections such as C. difficile, double the 7 per cent from last year.

A similar proportion also said that they had not met, or could not prove that they had met, the standard to disinfect medical equipment properly. In addition, 43 trusts (11 per cent) had failed adequately to keep wards clean and buildings in good order.

Overall, 99 trusts (25 per cent) had failed one or more aspects of a hygiene code, a set of 11 compulsory duties to prevent or cope with hospital superbugsthat was introduced in October 2006.

Inspectors are carrying out unannounced checks on infection control in 120 trusts, and hospitals have been told that they could be served improvement notices if they fail to tackle the bugs.

In April, statistics from the Health Protection Agency (HPA), the public health watchdog, showed that there were 55,681 cases of C. difficile in patients aged 65 and over in England in 2006. That figure was up by 8 per cent on 2005.

MRSA bloodstream infection figures revealed 1,542 cases in England between October and December 2006, down 7 per cent on the previous quarter. Despite this fall, the labour Government is expected to miss its target of halving MRSA rates before next April. Today’s report lists 15 trusts who know that they will get a “weak” rating in this year’s check by the Healthcare Commission. They have already said that they cannot meet 14 or more of the 24 requirements on care.

Four trusts did not meet any of the three standards relating to the hygiene code, the commission said. These were the Royal Cornwall Hospitals NHS Trust, Sheffield Primary Care Trust, Sutton and Merton Primary Care Trust and Wiltshire Primary Care Trust.

The Royal Cornwall was identified this month as being in financial difficulty when the Government published figures on NHS deficits.

A further one in ten trusts could not say that they conformed to guidelines regarding recommended new treatments and medicines.

The commission will now investigate one in five NHS trusts in England before publishing its final report in October.

Anna Walker, the commission’s chief executive, said that there were several possible reasons for the failures on hygiene, but the commission wanted to “applaud trusts that have put their hands up” and declared failures. “The first step to sorting out a problem is recognising you have one,” she said. “That is the action of an honest and responsible board that wants to make improvements and get these standards in place for patients.”

Opposition parties called the findings uanacceptable. Norman Lamb, the Lib Dem health spokesman, said: “There has to be a cultural change within hospitals. Three quarters are successfully implementing effective measures – there is no excuse for others not to follow.

“There has to be a zero-tolerance approach to tackling superbugs. It is shocking that, after countless government initiatives, the number of hospitals failing to protect patients from these infections has doubled.”

A Department of Health spokesman said: “It is encouraging that, for many standards, over 90 per cent of trusts were able to report compliance . . . Where there is evidence of a problem, it is important that individual organisations ensure that they have plans and processes in place to improve.

“The review process will help the trust to develop solutions with their SHA, and this is part of the declaration process.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article1945915.ece

The disgrace that is labour’s policy for the NHS once again shows it is the public that is paying the price for labour’s underfunding – with their lives.

On Fri 23 Feb 07 in MRSA and Clostridium difficile deaths up by half in year 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.

A spokeswoman for the Patients Association said: “Our worry is that these figures will continue to rise as other priorities take precedence “The labour government promised to make infection control one of its top priorities. Yet its own announcement to further reduce waiting times by ’round the clock operations’ will inevitably harm these efforts,” she said.

The paper recommends reducing services at Queen Mary’s Hospital, Sidcup, rather than PFI hospitals in south east London, where a consultation on reconfiguration proposals is expected this autumn.

It adds that decisions should take into account many factors, not just finance. But with significant excess of beds expected and a £65m deficit some cuts seem inevitable. A spokesperson for the project board said hospitals were working to see where care would be best delivered but that all were likely to see significant change.

Reducing work at PFI hospitals at Bromley and Woolwich would achieve few savings as the NHS is committed to annual payments for the buildings, and often additional costs for some elements of facilities. The report says ‘whole hospital PFI sites’ have ‘less flexibility to reduce “hard” facilities managements costs in the event of an unplanned reduction in activity because of constraints in their PFI contracts’.

In contrast, excess land and facilities at non-PFI sites could be sold off to make significant savings.

The paper also warns that a new PFI site at Lewisham Hospital will need to achieve ‘high utilisation rates… if it is to avoid the increased pressures giving rise to a worsening of its income/expenditure and cash flow positions’.

Sharon Massey, cabinet member for health and adult social services at Bexley council, which covers Sidcup, said: ‘We are devastated that Queen Mary’s is coming out as the most vulnerable hospital. There is effectively a mortgage on other hospitals. Queen Mary’s does not have a mortgage so is easy to dispose of.’

The paper focuses on south east London but arguments would apply in other areas with a mix of PFI and non-PFI hospitals.

Imperial College London professor of health policy Nick Bosanquet also sent out a warning. He said: ‘There will be a temptation to say “we are stuck with these contracts, we will close down older hospitals which may in fact be lower cost”.’

From:
http://www.hsj.co.uk/healthservicejournal/pages/N2/p7/070614

On Jan 16, 07 Health Direct warned: Brown can’t cure this paralysed NHS, so he plans to privatise it

The former Granada boss Sir Gerry Robinson recently spent six months trying to reform Rotherham general hospital. The result was shown in three hours of fly on the wall television on BBC2 last week. It was rightly put after the watershed: as politics it was certificate 18. At the end of each day Robinson could be seen slumped in the back of his car, his face buried in his hands. A tycoon sobbing in a limousine is the perfect icon of Labour’s health service.

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

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

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

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

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

Delegates at the British Medical Association’s annual GP conference cheered and applauded enthusiastically when one speaker called on Gordon Brown to sack Patricia Hewitt, the Health Secretary, when he takes over as prime minister on June 27.

Dr Hamish Meldrum, who heads the BMA’s GPs committee, warned the labour Government that it would miss its flagship target of cutting patient waiting times to a maximum of 18 weeks because many of its key reforms were failing.

Doctors at the conference in London voted almost unanimously in favour of a motion stating: “This conference has no confidence in: 1) the UK labour government’s handling of the National Health Service, 2) the Secretary of State for Health in England.”

Proposing the motion, Dr Eric Rose, a GP from Milton Keynes, said: “Ten years ago when Labour came to power, I and others had great hopes. Ten years later the reality is a golden opportunity has been wasted, and the dangers to the fabric of the NHS appear greater than ever.”

“No one is more responsible for this than Secretary of State ‘Call me Patricia’. I don’t want to be on first name terms with someone I can’t trust.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/15/nhs115.xml

The reaction of key workers – who work at the NHS coal face and have been the beneficiary of labour’s largese towards the NHS is illuminating.

On Jan 31, 07 Health Direct posted: BMA team ‘stunned by GP contract’ as a bit of a laugh when 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 it when GPs were given the chance not to do evening and weekend work for only a 6% pay cut, he said.

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

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

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

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

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

The drugs treat wet age-related macular degeneration (AMD), which affects around a quarter of a million people. Wet AMD is the leading cause of sight loss in Britain, with 26,000 new cases each year.

Yesterday Nice issued draft guidance recommending that Macugen should not be used at all on the NHS.

It also only recommends Lucentis for about one in five patients with wet AMD, who have a particular type called predominantly classic subfoveal choroidal neovascularisation (CNV).

Many patients diagnosed with the condition will now be faced with a choice of degenerating eyesight and potential blindness, or finding up to £28,000 to pay for a full course of treatment privately.

The preliminary ruling from Nice is particularly controversial as it comes two days after it was announced that NHS patients in Scotland will get the “gold standard” drug Lucentis for free. Sufferers north of the border have had access to Macugen since last summer, following a decision by the Scottish Medicines Consortium.

Medical trials have shown nine out of 10 patients given Lucentis injections have either improved or stable sight following two years of treatment, compared to half given placebo treatment.

Wet AMD occurs when abnormal new blood vessels grow behind the retina, causing leakage of fluid and blood. This leads to the formation of scar tissue on the macular – the part of the retina responsible for “straight ahead” vision.

Steve Winyard, of the Royal National Institute for the Blind, said: “This preliminary guidance is worse than we ever imagined it could be. It is simply unacceptable that Nice is recommending that only a small minority of patients within England and Wales will benefit from these ground-breaking treatments. Nice must reconsider.”

“The NHS is currently in surplus, yet England and Wales are now two of the only countries in Europe to deny its citizens sight saving treatments.”

Tom Bremridge, the chief executive of the Macular Disease Society, said: “We are appalled by the Nice consultation document. Limiting the treatment options to 20 per cent of patients who would benefit is unjustifiable and allowing one eye to go blind before treating the second eye is cruel and totally unacceptable.”

The Nice recommendation is preliminary and is open to appeals from drug companies and patient groups. A final ruling on the drugs is expected in September.

Andrew Dillon, chief executive of Nice, said: “When treatments are very expensive, we have to use them where they give most benefit to patients.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/14/nblind114.xml

For a spokesman for the Department of Health to try and defend the indefensible by claiming that local primary care trusts should not withhold funding for the drugs in light of the draft guidance is classic stalinism.

Not our fault guv says the labour govt to the PCTs. But as the DoH holds the purse strings what hope is there for the thousands who will be blinded because of labour’s funding shortcomings as they extend the postcode lottery to now include Macugen and Lucentis?

It is also interesting to note Steve Winyard of the Royal National Institute for the Blind’s comment that the NHS is currently in surplus.

It’s the first time that Health Direct has come across this quote and we wonder how many more times we will hear this point in the future.

Since 2001, the number of live births in England has increased by almost 71,000 (12.5%), and is now at a 26-year high. In 2006, 635,679 live births were recorded. However, the increase in the number of midwives has not kept pace, rising by 4.5% over the same period.

The Royal College of Midwives recommends that each midwife should deliver 27.5 babies a year. However, the surge in live births meant that on average each midwife in England delivered 33.7 babies last year.

The Conservatives said government experts had under-estimated the actual number of live births last year by nearly 40,000.

They said the intense pressure being placed on midwives explained why the rate of home births – which are time consuming and labour intensive – is relatively low.

Units under threat

Shadow health secretary Andrew Lansley also argued a shortage of midwives was jeopardising the future of some maternity-led units as midwives were being deployed to larger consultant-led units to ensure safe staffing levels.

We have seen too many service cuts, too many midwives lost, and too many mothers and babies getting a service that should shame the fourth richest country in the world

He said: “Labour’s plans for maternity services are in chaos. Their flagship policy to offer choices to expectant mothers over where and how they give birth is underpinned by assumptions about the number of births which are wide of the mark.”

“Labour are trying to pursue a policy for which they do not have the staff. We are 3,600 midwives short and yet the number of midwives is going down and newly trained midwives can’t find jobs.”

Dame Karlene Davis, general secretary of the Royal College of Midwives, said a survey of heads of midwifery carried out by the college last month showed three quarters had seen an increase in birth rate on their units, and over 80% did not have staffing levels they needed to cope.

She said the problem would be compounded by the fact almost 45% of midwives were set to retire over the next decade.

She said: “We have seen too many service cuts, too many midwives lost, and too many mothers and babies getting a service that should shame the fourth richest country in the world. Action is needed, and needed now, to put the resources and effort needed into maternity services.”

From:
http://news.bbc.co.uk/1/hi/health/6745395.stm

On Feb 12, 2007 Helath Direct posted: Expectant mothers are turned away due to midwife shortage when 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.

There are fears that the situation could worsen further still after the labour Government last week 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.

The minister in charge of maternity care sparked controversy last week when he failed to turn up at the launch of the review of the service. Ivan Lewis, who had already been accused of hypocrisy for campaigning against health cuts in his Bury constituency, said he had to attend another event in his role as minister for older people.

The dire circumstances that faces the midwifery profession was highlighted by Health Direct on
Jan 10, 2007 when the RCM warned that Maternity cash is cut amid boom in the birthrate, say midwives.

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

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

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

A source at a data management service revealed that third quarter data was due in April but had been delayed by ‘various data quality issues’.

Teething problems

It has emerged that some trusts have experienced problems in submitting statistics since the data collection hub – the NHS-wide clearing system – was replaced with the secondary uses service at the end of December.

This appears to have caused delays in the processing of the first statistics extracts because some hospital patient administration systems have been incompatible with new software, meaning some extracts are missing from the latest dataset.

Paul Robinson, external relations manager of independent health service information provider CHKS, said he knew of trusts that had experienced this problem.

Others, he said, had faced delays because they were waiting for new third party software to be accredited. An information manager confirmed this was the case at his Midlands trust and said that the hospital had supplied its episode statistics direct to its PCT, bypassing the secondary uses service, to avoid further delays.

Data duplication

Mr Robinson also said he was aware of some hospitals submitting data under both old and new PCT codes, resulting in duplication of records. ‘Even if the data is published now it is still significantly out of date information to be basing benchmarking on,’ he added.

Dr Paul Aylin, assistant director of the Dr Foster unit at Imperial College London, said: ‘We have certainly heard there are some issues with the third quarter data.

‘If you’re missing records this will impact on benchmarking and payment by results. If you don’t have up-to-date information then the whole issue of charging becomes difficult.’

Information Centre for health and social care operations director Roger Dewhurst admitted: ‘A minority of NHS organisations have had difficulties in submitting the necessary data over the last few months.

‘As a result of the reorganisation of PCTs in October last year, some organisations used incorrect PCT codes to correct previously submitted data. This resulted in a higher number of duplicate patient activity than usual. These have been removed from quarter three statistics and organisations are correcting this through re-submissions.’

Organisations will be able to correct any inaccuracies until mid-June before the final set of annual data is published later this year, Mr Dewhurst added.

From:
http://www.hsj.co.uk/healthservicejournal/pages/N1/p9/070607

The shambles that is Payment by Results was posted by Health Direct on March 01, 2007 in Why the NHS finances will never add up under bliar’s crooked books

A short letter published in the Telegraph this week highlighted the contradiction inherent in the Government’s attempts to improve the cost-effectiveness of the NHS. NHS hospital surgery is paid for on an ill thought out tariff basis that could cripple the health service.

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

The debate on whether labour’s Payments by Results (PbR) ended on 30 Oct 06 when Health Direct highlighted that PbR Payment by Results are fundamentally flawed says Clinical Coding chief

The current system of Payment by Results (PbR) is ‘fundamentally flawed and unacceptable’ the head of the Professional Association of Clinical Coders warned last week. Managing director Sue Eve-Jones told an HSJ conference last week that the quality of data in the NHS could compromise any chances of ensuring fairness under PbR.

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

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

“Lung disease brings untold suffering to millions of children and adults in the UK” says Dame Helena Shovelton the chief executive of British Lung Foundation.

The lung foundation (BLF) has launched “Breathe Easy Week” to highlight the problems faced by people with lung conditions such as lung cancer, chronic obstructive pulmonary disease (COPD), cystic fibrosis and asthma.

It says the UK has one of the worst records on respiratory disease in Europe, with a “postcode lottery” for care and a shortage of specialist lung doctors in some areas.

It is calling for more research into lung disease, alongside with new national standards for COPD, asthma and sleep apnoea care and treatment.

Dame Helena Shovelton, the BLF’s chief executive, welcomed Britain’s ban on smoking, but said other important areas needed to be improved.

“Lung disease brings untold suffering to millions of children and adults in the UK,” she said. “Yet it is the poor relation when it comes to medical research and death rates have seen little improvement over the past 20 years.”

More than half of those who answered the survey said that they lived in fear of an attack of breathlessness, while a third said that they could not play with their children or grandchildren because of the effects of their illness.

“Too often respiratory services are ending up at the bottom of the pile in relation to other health areas” says Professor John McFarlane of the British Thoracic Society

Some said they could not run, dance or even take holidays, while 16% said that their breathlessness stopped them having sex with their partners.

However, 43% of those who responded said there was a postcode lottery of treatment, and wanted it ended, and 35% suggested that a shortfall of specialist respiratory radiologists, nurses and physiotherapists needed to be addressed.

The survey also revealed problems accessing community respiratory services, and pulmonary rehabilitation.

From:
http://news.bbc.co.uk/1/hi/health/6735387.stm

So having gone through the stress of given up smoking with the extension of bliar’s nanny state into just about everywhere new lung patients will be delighted to learn that they are low down on labour’s priority health funding list.

Health Direct on May 15 07- Fears over NHS cancer drug costs blocked by NICE when cancer doctors have told the BBC they fear the NHS will not be able to afford the new generation of cancer drugs.

Specialists are already arguing that patients may have to pay for more drugs themselves, with the issue becoming pressing as new drugs are developed. But some patients offering to pay for a cancer drug are being told they would have to meet all their care costs.

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.

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 results cast doubt on whether the labour government can meet its promise that all patients would be treated within this time by the end of 2008.

Patients in south-east England suffered the longest waits for hospital treatment with only a third seen within the target time.

The east of England and London were ranked second and third worst respectively for delays to hospital treatment. In the former only 41% of patients were treated within 18 weeks, and in the latter only 44%.

Even in the east Midlands – the best-performing region of the country – only 60% of patients were treated within the target time.

The worst performing trust was Swindon primary care trust, where just over a fifth of patients referred for hospital treatment were treated within 18 weeks.

Brighton and Hove city primary care trust was the second worst with only 23% of patients treated within the target period. The third worst was Enfield primary care trust, north London, where only 26% were treated on target. The third worst was Mid Essex primary care trust where only a quarter were treated on target.

Patients referred for trauma and orthopaedic treatments suffered most delays, with only a quarter treated within 18 weeks. Referrals for oral surgery and neurosurgery suffered the next worst delays, with only 37% and 39% of patients treated within the target period.

The study of total waiting times – from GP referral to hospital treatment – covered 208,127 patients in England who started their referral to treatment in March this year.

The Liberal Democrat health spokesman, Norman Lamb, said: “Behind the statistics, thousands of sick people are still waiting more than a year for hospital treatment. Why does the government not publish how long people are waiting over a year? How long do these long waits really last?”

The chairman of the British Medical Association’s consultants’ committee, Dr Jonathan Fielden, said the figures were “encouraging”, but added:

“There is still a long way to go though to ensure that patients are treated as soon as clinically needed and for these improvements to be sustained.”

The NHS Confederation, which represents over 90% of NHS organisations, said the figures provided a clearer and more meaningful picture of actual waiting times for patients.

Its director of policy, Nigel Edwards, said: “There is optimism within the health service that the 18 week target will be met by December 2008. However, we must not forget that this is probably the most challenging target that the health service has been asked to take on.”

But he warned that many trusts’ debts would hinder their ability to meet the target, which is expected to require around a third of the extra NHS funding for the current financial year to achieve.

From:
http://www.guardian.co.uk/uk_news/story/0,,2097562,00.html

Nearly eighteen months ago (Jan 05, 2006) Health Direct warned that the NHS set to miss 18 week waiting times key target

The National Health Service will miss its key target to cut waiting times for treatment to a maximum of 18 weeks by 2008 without additional capacity and more reform, an analysis by the Financial Times shows. Reaching the target will involve either an unprecedented increase in productivity, or more work contracted out to the private sector – or most likely both – according to leading academics.

Waiting times for a first out-patient appointment have been falling – but far too slowly for the government to hit its 18-week target.

In addition, there are fears that increasing diagnostic capacity may prompt more demand, so that waiting times for tests and scans could rise before they fall – something that has happened in other countries when capacity has been expanded.

“What these figures show,” said Alan Maynard, professor of health economics at York University, “is that of the three elements needed to get to an overall 18-week target, one [the outpatient wait] is falling far too slowly, one [the wait for diagnostics] may well rise before it falls, and the third [the time spent on the waiting list before an operation] is going in the wrong direction.

“Unless something changes radically, the government is going to miss its target.”

To offset the deficit and create the surplus, regional health bosses have been building up cash reserves.

They took millions of pounds from primary care trust (PCT) budgets and held back £450 million from training and public health budgets.

The unaudited figures, which exclude NHS foundation trusts, show that PCTs now account for 69% of the gross deficit, compared with 47% in the year before.

A total of 73% of PCTs broke even or achieved a surplus, with debts found mostly in the east of England, the Government report showed.

The net revenue surplus of £510 million is as a result of gross surpluses being created to the tune of £1.42 billion, set off against total gross debts of £911 million.

In 2005/06, the NHS ended the year £547 million in the red.

Mike Jackson, senior national officer for Unison, said: “We welcome the fact that the NHS is in a stronger financial position, but the £510 million underspend shows that staff and patients have been put through an unnecessary year of pain, job losses and cuts.

“The Government’s knee-jerk reaction to the deficits last year has led to 20,000 job losses and damaged morale and patient services.

“Now is the time to give nurses and health staff the full 2.5% pay award recommended by the Pay Review Body.

“It would cost £200 million and would be a small step towards raising staff morale and recognising the enormous efforts that they have made in delivering high quality patient care despite the squeeze on NHS finances.”

Ms Hewitt said nurses would not be getting the 2.5% award in one go.

She said the decision to stage the pay award was based on the whole economy and not on how well the NHS was doing.

Dr Jonathan Fielden, chairman of the British Medical Association’s Consultants’ Committee, said: “While the NHS may be in credit today, the journey to balance the books has wreaked havoc on the NHS and is a return to boom and bust health economics.

“There have been excessive cuts in service and it will take years to rebuild the trust and collaboration that has been destroyed in the past year.

“Consultants are desperate to lead change and introduce new treatments for patients but they are being hampered by cuts, target and micro-management from Whitehall.

“Patients deserve the highest quality service and the labour Government needs to work with us to achieve this goal.”

University bosses – speaking as part of the Universities UK umbrella body of vice chancellors – condemned the cuts to education budgets which were needed to balance the books.

Professor Janet Finch, chair of the Universities UK health and social care policy committee, said: “On the face of it, today’s announcement is good news. But take a closer look at the Strategic Health Authorities’ ‘strategic reserves’ and they seem to consist of funds from the education and training budgets. If things continue in this way, it will be a disaster for patient care and health service morale. “

“Cuts in education commissions now mean fewer qualified staff to care for patients in 2010.

“SHAs are subject to short-term pressures which mean that education and training will always be susceptible to cuts unless the funding is ring- fenced.

“This has been successfully implemented in the case of research and development funding, for instance.”

The Liberal Democrats said the figures hid cuts of almost 1,000 training places for medical professionals.

The party said health authorities cut £135 million from training budgets for doctors, nurses and other health workers in order to balance the books.

Health spokesman Norman Lamb said: “The NHS has clawed its way out of overall debt, but at what cost?

“Tony Blair’s true legacy on the NHS is one of boom and bust – two steps forward, one step back.

“Over the past year, trusts have made harsh cuts to staff and services and raided training and mental health budgets to meet the Government’s political deadline of breaking even this year.

“This problem is far from over. There is still a gross deficit of over £900 million, with a fifth of organisations in the red. The labour Government has also now admitted that 17 trusts are in such heavy debt that they could not afford to repay Government loans.

“With the extra health spending set to end next year, what further cuts will be made? How much more will patients have to suffer?”

From:
http://news.independent.co.uk/health/article2618958.ece

As Health Direct predicted last week- 31 May 07 in National Audit Office asked to investigate record £500m NHS underspend the NHS is supposed to have made a profit past year.

The NAO has been asked to investigate whether a half billion pound underspend by the NHS in England was caused by political chicanery at the Department of Health.

Norman Lamb, the Liberal democrat health spokesman , called in parliament’s spending watchdog yesterday after the record surplus was disclosed in an analysis of strategic health authority board papers.

This political chicanery has been going on for a while. On Feb 09, 2007 Health Direct posted the health secretary’s ridiculous claim that Bed closures are a healthy sign for NHS, says 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.

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.”

Jonathan Fielden, chairman of the British Medical Association’s consultants committee, will tell Mr Brown: “Political meddling has brought the NHS to its knees. Unshackle the profession, give us back the health service, and we will rebuild it. Fail to do so and you will rightly be condemned for destroying the best piece of social capital the country has ever had.”

Dr Fielden made his plea as Patricia Hewitt, the health secretary, announces the NHS’s financial results for the year to March. She is expected to confirm a report in the Guardian and Health Durcet last week that it made a surplus of about £500m.

Dr Fielden will blame the Department of Health for cutting services too aggressively last autumn, when ministers panicked about the possibility of another deficit. “It takes weeks to cut, but years to rebuild trust,” he told the BMA consultants’ conference in London.

“We are angry with the labour government for a woeful dereliction of duty – towards patients, towards the profession and towards the future. We have lost all confidence that the labour government can solve the problems it has created.”

The service suffered from too little strategic direction and too many ministerial policy initiatives. It had become “a distorted skeleton”. The government diverted billions of pounds from improving efficiency to create an internal market in which hospitals competed for patients.

“The excessive use of private firms to provide NHS services has been costly, disruptive and has fragmented care. The independent sector should only be used where the NHS needs it, not thrust into its midst like a carelessly placed hand grenade.”

Mr Brown should work with doctors, patients and other healthcare professionals to stem the loss of trust and collapse in morale. “We will not stand by and see the Trojan horse of the independent sector rolled in to take over the health service from within.”

From:
http://www.guardian.co.uk/uk_news/story/0,,2096405,00.html

Health Direct will watch with interest the reaction to the commonsense that Jonathan Fielden, chairman of the British Medical Association’s consultants committee articulated.

The watchdog has new powers under the Health Act 2006 to order trusts to improve their standards.

It comes as the NHS struggles to meet the government’s target of halving MRSA “superbug rates” between 2004 and 2008.

However Andrew Lansley, shadow health secretary said “It is odd that it has taken 10 years to introduce these unannounced checks, especially as it’s been a period in which the number of deaths from MRSA has quadrupled.”

Cases of MRSA are falling, but Clostridium difficile is becoming more common with 55,681 cases among the over-65s in 2006 – up 8% on the year before.

The watchdog, which will be mainly focusing on hospitals but will also take in some mental health institutions, will examine whether the right management structures and infection control teams are in place.

Inspectors will also be checking that patients with infection are isolated properly and hand-washing is common, as laid out in the government’s hygiene code.

Failure to meet any of the standards will require the trust to produce an action plan to address the problems.

And if this does not resolve the issue, the Healthcare Commission can serve an “improvement notice” which can lead to direct intervention from the health secretary.

‘High-risk trusts’

It is envisaged about two-thirds of hospital trusts will face an inspection with the watchdog using its own data to target the high-risk trusts.

Anna Walker, chief executive of the Healthcare Commission, said: “Although the commission seeks to reduce the overall number of inspections it makes, this is one area where we must be out there actively checking.”

From:
http://news.bbc.co.uk/1/hi/health/6712603.stm

The scandal that are superbug deaths continues. On 23 Feb 07 Health Direct posted:
MRSA and Clostridium difficile deaths up by half in year

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.

The proposal, which is to be put to the department of health, is believed to be the first of its kind and could set a precedent that would help the NHS afford expensive new cancer treatments that can cost between £10,000 and £50,000 a patient. The potential deal has added significance because it was the drug’s manufacturer that proposed the risk-sharing scheme to Nice, rather than the other way round.

Andrew Dillon, Nice chief executive, said: “It is too soon to say whether this could be the start of a trend. But there are certainly signs from our conversations with other companies that they are thinking along the same lines.”

However, the company and Nice are in fierce disagreement over exactly what level of improvement would be needed in patients taking the drug to trigger the moment when the NHS would start to pay.

Velcade is the first new treatment in a decade for the blood cancer multiple myeloma, which affects about 4,000 new patients a year in the UK.

The drug does not cure the disease but, according to its manufacturer, it can prolong some patients’ lives by up to two and a half. A full course of eight 21-day cycles of treatment costs about £25,000.

Nice’s initial assessment was that, given the proportion of patients who respond, the treatment was too expensive to be cost-effective. Janssen-Cilag appealed. In doing so it proposed that the NHS should only pay for patients when a particular serum protein showed a better than25 per cent reduction after four cycles of treatment – a cost of about £12,000.

Nice has backed the principle but has said that, to make the drug cost-effective, the NHS should pay only when the response rate is better than50 per cent. The company said yesterday it was pleased Nice had backed the scheme but was alarmed at the higher threshold for payment that Nice had set.

From:
http://www.ft.com/cms/s/a8288f32-1237-11dc-b963-000b5df10621.html

The proposal to only charge for successful drug usage results strikes Health Direct as being a pretty good idea.

Out in the real world businesses are generally only paid for providing a positive service, so Janssen-Cilag’s suggestion that it will only be paid when patients improve after taking the cancer drug Velcade appears to be progressive business development for the National Health Service.

Speaking at the Guardian Hay festival, Robert Winston also accused the fertility watchdog, the Human Fertilisation and Embryology Authority, of failing to protect women and giving consistently poor information to couples.

“One of the major problems facing us in healthcare is that IVF has become a massive commercial industry,” he said. “It’s very easy to exploit people by the fact that they’re desperate and you’ve got the technology which they want, which may not work.”

Lord Winston, professor of fertility studies at Imperial College London, was particularly critical of doctors in the capital: “Amazing sums of money are being made through IVF. It is really rather depressing to consider that some IVF treatments in London are charged at 10 times the fee that is charged in Melbourne, where there is excellent medicine, where IVF is just as successful, where they have comparable salaries.

“So one has to ask oneself what has happened. What has happened, of course, is that money is corrupting this whole technology.”

There are 85 licensed fertility clinics in the UK, in an industry worth up to £500m a year. According to latest figures from the HFEA, in 2004 more than 30,000 patients underwent more than 40,000 treatment cycles, each costing up to £8,000.

Lord Winston expressed particular concern over some of the tests being offered to infertile couples.

One screening technique which uses fluorescent markers to stain defective parts of an embryo’s chromosomes, and costs several thousands of pounds, is routinely used to weed out unviable embryos. But even the most advanced version of the test can only interrogate a tiny portion of an embryo’s genome. “That’s being sold to patients at £2,000 a time and they’re saying, your chromosomes are fine, that embryo should be transferred, when actually it’s a lie,” Lord Winston said. “There’s no knowledge about the genome from that.”

He added that there was no clinical justification in doing the screening “and yet hundreds of women are being exploited out of their desperation to get pregnant from people who are taking large sums of money from them in private clinics.

“Much of it is in ignorance because most of the people who are doing this work are doing a form of cookery without understanding the science behind it. It’s knowingly done, insofar as the clinicians and scientists doing it don’t actually want to explore the implications, because they’re not engaging with the public, they’re not accountable, they’re being arrogant and making a lot of money.”

Lord Winston also went on to criticise the HFEA for failing to protect women: “The regulatory authority has done a consistently bad job. It’s not prevented the exploitation of women, it’s not put out very good information to couples, it’s not limited the number of unscientific treatments people have access to, it doesn’t prevent sex selection and all sorts of other things people don’t like because there are all sorts of ways around the law.”

A HFEA spokesman said: “No procedure throughout medicine goes into mass use without some sort of leap of faith. Patients just need to be informed that something is on a preliminary stage and if you want to go down that route then do so, but you’re fully informed before you do so.

From:
http://society.guardian.co.uk/health/news/0,,2091791,00.html

The privatisation of the NHS is encapsulated by the expense that that couples are having to pay for IVF. On April 24, 07 Health Direct posted: NHS free at point of use is a political mirage Doctors warn

A National Health Service largely free at the point of use is becoming a mirage, according to Doctors for Reform, a pressure group that would like the NHS to move from a tax-funded model to a system of social insurance with top up payments. The report shatters the NHS’s founding principle that health care should be free for all at the point of delivery.

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

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

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

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

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