Bliar was challenged during a televised debate in the run up to the 2005 election over the system which rewards doctors for seeing patients within 48 hours but means many prevent advance bookings to leave slots open for urgent cases.

He promised to resolve the situation but the survey results unsurprisingly show there has only been limited success.

The survey released by the Department of Health this week showed the vast majority of patients are happy with their family doctors.

In a blow to Stalinist Brown’s call for more GP surgeries to be open on Saturdays and late in the evening, few patients in the survey wanted this. The vast majority, more than eight in ten, said they were happy with their surgery’s opening hours.

Dr Laurence Buckman, chairman of the British Medical Association’s General Practitioners Committee, said: “It seems only four out of every hundred patients want practices to open on a weekday evening, and seven out of every hundred on weekends.

“It comes down to a workforce issue. The danger is that switching normal opening hours away from the daytime to evenings and weekends might please some patients who are out at work all day, but would take appointments away from those who use their local surgery most – patients with long-term conditions and parents with young children.

“All patients are important but we must not penalise the most needy among them.”

The survey findings show the majority of patients say they can apparently get through to their surgery on the phone satisfactorily, can book an appointment quickly and with the doctor they want.

Of those who wanted to book an appointment more than two days in advance, a quarter could not.

Dr Buckman said the findings had confirmed what other studies had shown and questioned whether spending £12m on the survey.

The results also showed that small practices often in rural areas outperformed large urban GP surgeries.

The news will dismay new Health Minister Lord Ara Darzi who advocates super-GP surgeries with up to 20 doctors and serving a population of around 20,000.

Other results showed most patients are being offered a choice of hospital when they are referred to a specialist, in line with labour’s stalinist policy.

The full results of the survey including regional breakdowns can be found at Labours £12 million GP survey

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/24/ngp124.xml

Health Direct pointed out last year that labour was wasting another £12 million Pounds of our tax payers money on this shambolic GPs survey and that the results were hardly likely to be earth shattering. In the intervening period we even managed to receive THREE questionnaires- which further undermines the credibility of this money burning exercise.

On 27 Nov 06 Health Direct posted: £12 million GPs survey to cut doctors funding
when five million patients will next year be asked to fill in a questionnaire which will ask, among other things, whether they have been able to secure an appointment within 48 hours, as the Labour government has promised.

The British Medical Association condemned the poll as unfair and biased, and accused the Department of Health of adding questions that had not been agreed. Most GPs accept that they are unlikely to score 100 per cent and so they will see a reduction in funding.

Britain, and many other countries including Canada, Japan and Australia, use PFI to pay for infrastructure. Instead of paying a contractor to build a school, the government will pay to lease it over 30 years, transferring some management and operating risk to the builder. The question is whether that 30-year lease commitment is a debt, in which case it should be on the balance sheet, or not.

The UK’s answer to this question has been inconsistent, to say the least. Most transport PFIs are on the balance sheet. Many hospital PFIs are not.

The result is a deep-seated public suspicion that disguising debt, and not advantages from transferring risk or better private sector management, is the real reason for for using PFI.

The labour government now has a chance to correct that impression, and allow private finance to show its genuine advantages, when it adopts IFRS in April next year.

IFRS says that most PFI projects should be off-balance sheet for the private sector. The logical consequence is that the public sector should put PFI on the books: the alternative – assets floating in the ether, owned by nobody – is intolerable. The Treasury should embrace, not resist, such an interpretation.

There will be consequences. First, as much as £30bn in off-balance sheet leases may be reclassified as borrowing, causing the government to break a self-imposed rule that limits public sector net debt to no more than 40 per cent of gross domestic product. But that, too, could be an opportunity: to replace increasingly discredited fiscal rules.

Second, in future new schools and hospitals will mean debt on the balance sheet, and there is a risk that the perception of indebtedness may lead to a fall in capital spending. It would be unacceptable – and bear out all the criticism of PFI sceptics – if major infrastructure projects such as London’s Crossrail suddenly became “unaffordable” because of new accounting standards. It will be up to the government to increase capital budgets to compensate for any such nominal changes.

After years of debate it is time for the test: put PFI on the balance sheet, and let it live or die by its merits as a financing technique.

From
http://www.ft.com/cms/s/f0aa9658-3bd9-11dc-8002-0000779fd2ac.html

Health Direct has long noted the tendency of stalinist Brown to flip flop on his financing policies, now we may have some consistency and clarity rather than fudge and obfuscation.

When Sir Liam Donaldson, the chief medical officer, published his annual report last week, he found himself having to justify not resigning over the bungled junior doctors’ appointments system. “The implementation in some respects went wrong,” he conceded. “But the responsibility was very widely distributed.”

His justification, coupled with an apology, followed widespread denunciation of the system by delegates at the British Medical Association’s (BMA) annual conference last month. A motion calling for his resignation was overwhelmingly passed, while the BMA’s then acting chairman, Sam Everington, condemned the “scandal” of thousands of doctors contemplating leaving medicine or going abroad.

The sustained level of anger may surprise those outside the profession who thought the Medical Training Application System MTAS fiasco was resolved in March, when the then health secretary, Patricia Hewitt, announced that it was being abandoned in its current form and promised every junior doctor an interview in their first-choice area.

MTAS had been problematic because the unpiloted computer system, which aimed to appoint junior doctors centrally, was deeply flawed, with problems such as application forms giving too much weight to Labour’s caring sharing touchy feely “creative writing” and too little to academic achievements and clinical experience, and too little consistency to the shortlisting process.

But junior doctors, and their senior colleagues, remain angry and unhappy about the debacle. One in five juniors affected is feeling increasingly suicidal and 94% have felt higher stress levels during the six months covering the application and interview process, according to research published in the British Medical Journal online. Hospitals have been told to be on suicide alert.

Much of this fury is due to the mismatch between training posts and applicants, and the uncertainty this is causing. Department of Health (DH) figures reveal that doctors are chasing 18,391 training posts – with 29,193 applying for 15,600 in England.

A total of 2,320 posts will be on offer in a second round of applications, but at least 12,000 eligible junior doctors will remain without posts and will instead have to seek work abroad, leave medicine, or remain in staff-grade jobs, which will not allow them to become consultants and are often seen as career dead-ends.

The problem is most intense for the more senior doctors in the most competitive areas of surgery: figures released by the DH earlier this month show that 713 orthopaedic surgeons, 885 general surgeons, and 206 plastic surgeons were without training posts at the end of round one. For would-be surgeons, the chances of getting a training post are as slim as one in five for general surgery, or one in six for orthopaedics.

Doctors are also angry that, with most jobs supposed to start on August 1, they face a scramble to apply for the remaining training posts available in round two, or for vacant non-career jobs.

The second round of interviews has been extended to the end of October, and every junior doctor still applying is supposed to be guaranteed employment until that deadline. But there are no promises that this will be in their existing hospital, or even in their existing trust.

Huge uncertainty has surrounded even those who have received jobs, with successful applicants only recently being told in which hospitals they would start. With deaneries such as London covering all of Greater London, Kent, Surrey and Sussex, and the East of England deanery covering Essex, Suffolk, Cambridgeshire and Norfolk, huge logistical problems have been arisen in terms of arranging accommodation and childcare.

Childcare problems

The profession wants to retain women, who now account for 60% of those entering the profession, but they are being forced to abandon their careers to keep their families together or because of childcare problems.

Andrea Siggers, a GP with a one-year-old son, has had to give up her job because her husband was unable to gain a training post in emergency medicine in Wessex, but gained one in the south-west. And Katharine Augustine is having to move to Southampton, with her 19-month-old son, to pursue a training post in radiology, while her husband takes up his cardiology post in Bristol.

With a second baby due in January, she says: “There are no other job options, and I need to be in continuous employment to get maternity pay. This process is forcing apart many families.”

Crucially, the ongoing fiasco will affect not just junior doctors but also patients. Morris Brown, professor of clinical pharmacology at Cambridge University, says it is unlikely hospitals will become “chaotic” at the start of August, but warns that clinics and elective surgery will be cancelled – with an obvious impact on waiting lists.

Brown, a leading critic of MTAS, is more concerned about the long-term impact on the quality of medical care and clinical research. A poll he is conducting suggests that the system, which gives the same weight to a PhD and to a two-day course that can be attended by paramedics, disadvantages the most academically able.

The relative absence of posts for the more senior junior doctors also means the experienced will be shunted into non-career posts, while inexperienced colleagues entering at a lower level will become the consultants of the future. That is compounded by the shortened training offered under modernising medical careers (MMC), the new system to which MTAS relates – and by the European working time directive, which, from 2009, will reduce junior doctors’ hours to 48 a week.

Then there is the long-term impact on the NHS of a demoralised group of doctors, stuck in dead-end jobs, and no longer feeling a strong sense of vocation.

So how did this catastrophe in workforce planning happen? In part, because, with all applications for training under the old system drying up last autumn, an unprecedented number of doctors applied under MTAS. As Donaldson, the original architect of MMC, admits in his report: “The number of doctors … was larger than anticipated.”

The number of junior doctors had burgeoned since the NHS Plan enabled a rapid expansion to allow the NHS to meet new targets. But, with NHS deficits being felt from 2005, hospital trusts then began to cut back jobs and training posts.

Andrew Rowland, of the BMA’s junior doctors committee, says that, when it came to MMC and MTAS, there was a lack of engagement between the bodies involved in workforce planning – individual trusts, deaneries, regions and individual specialities on a national level.

Richard Marks, programme director in anaesthetics for north-central London, says programme directors – the people with experience of the actual numbers needed for each region – were left out of the loop.

“The hierarchy seemed to be that Lord [Norman] Warner [the health minister, who retired in December] wrote to the deaneries for numbers required, the deaneries asked the trusts, and trusts then told the programme directors – without anyone asking the departments what was needed.” Strategists were planning 10 years ahead, but were not sufficiently engaged with the number of doctors currently in the system, he adds.

Meanwhile, it is these doctors, and their future patients, who will suffer.

From:
http://society.guardian.co.uk/health/story/0,,2133622,00.html

On 30 Apr 07- Health Direct wondered whether amongst all of thier fiascos the
Conntender for the greatest of all Labour’s NHS failures- the 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.

Do you feel happy to entrust this shower to keep all of your personal medical information- let alone the ID cards safe?

In a break with Tony Bliar’s drive to expose the health service to the challenge of market forces, Mr Johnson said local NHS commissioners should adopt a more pragmatic approach to treating patients on the waiting list for tests and operations in England.

He will allow them to buy extra capacity from the private sector if they need it to meet targets on waiting times, and can show it provides value for the taxpayer. But he told the Commons health committee: “There will be no need for another national independent-sector procurement … There will not be a third wave.”

The government had been committed to spending about £4bn on the first two waves of treatment centres – fast-track clinics that were to carry out 2m routine medical procedures on NHS patients.

Mr Johnson was presented with plans for a third wave when he became health secretary last month, but he refused to endorse them.

To underline the change, he scrapped contracts with Atos Origin in the north-west and south-east of England, accusing the company of failing to deliver in time. Mr Johnson said: “Where independent sector providers are not offering good value for money or high-quality patient care … we will terminate [their contracts].”

From:
http://society.guardian.co.uk/health/story/0,,2134811,00.html

Health Direct gives a cautious welcome to the Health Secretary’s apparent decision to back the NHS rather than waste money on third party pfi projects.

Some NHS trusts complained that targets – both clinical and financial – were hindering the fight against infection.

In a separate survey carried out by the Healthcare Commission – an NHS watchdog – some 45% of the 155 trusts said time targets for treating patients in A&E; were getting in the way of infection control measures.

These figures represent a very small proportion of the 10 million inpatients that the NHS treats in hospitals every year.

Pressure to move patients to any available bed rather than the most appropriate bed or an isolation ward was one reason cited for the difficulties.

A further 36% of trusts said they were having problems combining investment in cleaning with financial targets, while 88% said their limited IT infrastructure “was restricting their ability to draw important lessons from incidents of infection”.

The survey was carried out in May 2006, and the watchdog noted that a number of practices – particularly regarding individual staff objectives for bringing down infection – had changed.

But Healthcare Commission chief executive Anna Walker added: “We cannot afford to lose momentum. Trusts should be asking themselves what more they can do to protect patients and the public from healthcare associated infection.”

The National Audit Office has estimated that these infections cost the NHS as much as £1bn each year.

Between April 2006 and March 2007, there were 6,378 cases of MRSA infections reported, compared with 7,096 for the previous year, the Health Protection Agency (HPA) said.

Meanwhile, there were 15,592 reported cases of C. difficile in patients aged 65 and over in England in the first quarter of 2007. This represents a 2% rise when compared with the same period last year, but is 22% higher than the previous quarter.

The HPA says this rise can be explained by the fact that higher numbers of vulnerable people are admitted to hospital at this time of year.

Liberal Democrat health spokesman Norman Lamb said the government had “spectacularly failed” to halt C. difficile.

Shadow health secretary Andrew Lansley called the figures “the tip of the iceberg, because they do not include the number of infections in people aged under 65″.

From:
http://news.bbc.co.uk/1/hi/health/6913873.stm

On 2 May 07 Health Direct posted that Deadly NHS superbugs continue rising with C difficile again up when more hospital patients in England are getting the deadly Clostridium difficile bug, figures show.

Health Protection Agency (HPA) data showed 55,681 cases were reported among over 65s in 2006 – up 8% in a year. MRSA cases continued their downward trend, but they are not falling quickly enough to meet Labour’s target next year.

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.

The National Institute for Health and Curbing Expenditure (NICE) will recommend the system of inducements, which could enable clinics to offer televisions and iPods as prizes, to tackle the burgeoning drugs problem.

But patients denied drugs for blindness, Alzheimer’s and lung cancer under Nice rationing are likely to accuse it of wasting public money.

Katherine Murphy, of the Patients Association, said: “Why should these people with self-inflicted problems be given priority over people who have a genuine illness? Some people with genuine disease are being forced to sell their homes for the medicines they need.”

Under the guidelines expected to be published by Nice this week, heroin and cocaine users will be given the financial rewards if they test free of drugs. The scheme is inspired by one already operating successfully in America.

The range of financial incentives is likely to include vouchers, which start at £5 but increase in value each time the addict tests negative. Typically, there would be three tests each week and therefore three chances to gain vouchers of increasing value. Drafts of the guidance suggest giving addicts who test free of drugs tickets for a draw to win prizes worth up to £100.

Research by the University of Connecticut found cocaine and methamphetamine users stayed drug free for longer when they had the chance to win prizes such as telephones, stereos, DVD players and televisions.

Every time addicts gave a negative drugs test they were given tickets for the draw. They “earned” an increasing number of tickets for every week that they remained drug free.

Those who endorse financial rewards for addicts argue that any money will be recouped because those who stay clean will make fewer demands of the NHS.

From;
http://www.timesonline.co.uk/tol/news/uk/health/article2116323.ece

Doctors claim the new multimillion Pound NHS Choices website, developed by Dr Foster Intelligence together with LBi and Sapient, contains incorrect information on GP surgeries including inaccurate opening hours, out-of-date information about partners and errors on practice staff and clinic timings.

At the same time listings of primary care trusts, mental health trusts and strategic health authorities have become much more difficult to find on NHS Choices compared with the old nhs.uk site, according to NHS staff.

The new chairman of the BMA, east Yorkshire GP Dr Hamish Meldrum, this week also criticised the site’s ‘health profile calculator’ which enables individuals to identify the top five conditions they would be most likely to be hospitalised for by putting in their sex, gender and postcode.

He told the BBC such general information would not help people but may cause information overload for patients and create additional anxiety.

He added: “ We all share the desire for patients and the public to be as well informed as possible but this is gimmicky and over simplistic and may cause unnecessary worries.”

Dr Trefor Roscoe, a GP in Sheffield, said the public were in danger of being “grossly misled” by the information on GP surgeries on the NHS Choices website. He told EHI primary Care: “According to the site we still open on Saturday morning which we last did about six years ago.”

A check on the information contained on ten surgeries around the country by EHI Primary Care discovered that at least a third contained errors such as out-of-date opening times or partner listings.

Dr Mary Hawking, a GP in Bedfordshire, said she had complained about inaccurate information on the old nhs.uk site and that although she felt the new NHS Choices site provided some additional information there were errors, including a map of her home town which she claims is at least six years out-of-date.

She added: “The information on GPs is still inaccurate: it doesn’t list clinics, opening hours are inaccurate, most have no facilities or clinics listed, and the list of staff is grossly out of date: in other words I suspect this was taken, unchecked, from NHS England UK.”

From:
http://www.ehiprimarycare.com/news/item.cfm?ID=2838

When the Department of Health launched the NHS Choices website on 25 Jun 07 in NHS Choices labour wastes £14 million on another useless website Health Direct questioned the logic for the site.

Patients are being asked to rate and comment on another NHS services website launched which they launched last week. The Department of Health is ludicrosly comparing the NHS Choices site to tripadvisor.com, which publishes travellers’ holiday reviews.

Heath Direct notes that the Blog Doctors goes further. NHS Choices is described as thus: I have just spent ten minutes looking around NHS Choices and, as you would expect, I hate it. It is utterly dishonest. The last ten years has been about removing patient choice, not increasing it.

The lifestyle advice the site gives is trite and patronising, and at times downright offensive.

http://nhsblogdoc.blogspot.com/2007/06/girls-just-arent-turned-on-by-man-boobs.html

The 50-year-old received a package worth £899,810 including salary and pension arrangements. The reorganisation was supposed to save £250 million a year in administration costs. However, the NHS is thought to have spent at least £320 million on redundancy packages to those who have lost their jobs.

The Royal College of Nursing is concerned that NHS managers are creaming off large sums of money in settlements that should be spent on patient care.

When the North and East Yorkshire and Northern Lincolnshire Strategic Health Authority, where Mr Johnson worked, was abolished the average payment was £24,725 to those who took redundancy and £48,191 for those who took early retirement.

Robert Goodwill, the Tory MP, condemned the settlement awarded to Mr Johnson. He said: “Most people will look at this and say this is a lottery win rather than a payout.”

Mr Goodwill, who represents Scarborough and Whitby, in North Yorks, said he understood Mr Johnson was entitled to the payout under the terms of his contract. But he criticised the contract itself and the multiple reorganisations of the NHS that lead to high-profile job losses.

Mr Goodwill said: “How do I explain these payouts to people who can’t get their Alzheimer’s disease drugs, or they can’t get drugs for conditions causing blindness?”

A spokesman for the Yorkshire and the Humber Strategic Health Authority, created last year in the merger of three regional health authorities, including Mr Johnson’s, said administration staff had lost their jobs in order to save money.

In a statement, he said: “Yorkshire and the Humber SHA were set the target of reducing management costs by £6.8 million by 2007-08.

“A programme was undertaken to reduce workforce numbers, including a recruitment freeze and redeployment of staff within the NHS.

“A number of compulsory redundancies and early retirements formed part of this programme. This incurred one-off costs in line with national terms and conditions for NHS staff. All payments relating to individuals were based on their age, pay scale and length of service.

“By the end of the next financial year the savings to local taxpayers will exceed these one-off costs. These savings will then continue to accrue each year.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/13/npayout113.xml

Given the current climate of tony’s cronies- Health Direct asks if there any relationship between David Johnson the NHS lottery winner and Alan Johnson the NHS boss?

The study analysed data from St Thomas’ hospitalin central London across two months, before and after the licensing act was introduced. St Thomas’ has one of the largest emergency care departments in the UK.

The study showed that in March 2005 there were more than 2,700 overnight visits to emergency care and 3 per cent – 70 of them – were alcohol- related. But in March 2006 this had risen to 3,100 overnight visits of which 8 per cent, or 250, were alcohol-related.

“The increase in alcohol related problems we have recorded is the opposite of the effect the legislation was designed to produce,” said Dr Alastair Newton, consultant at the emergency department of Guy’s and St Thomas’ and one of the authors of the report.

“Our data suggest that the new legislation has also failed to achieve its intended improvement in public safety and reduction in alcohol-related crime and disorder,” he added.

The study showed the number of visits as a result of assault associated with excess drinking doubled and the number of associated hospital admissions almost trebled over the period.

Everyone over the age of 16 who attended the accident and emergency department between 9pm and 9am and who had been drinking was included in the audit.

The overhaul of the drinking laws in England and Wales in 2005 extended the hours pubs were allowed to remain open and enabled some establishments to serve alcohol round the clock.

Critics of the system have voiced concerns that the liberalisation of drinking hours will only fuel the country’s binge drinking and anti-social behaviour problems

The study’s authors called for longer term assessments to help police and health workers deal with the effects of alcohol.

From:
http://www.ft.com/cms/s/26c9f30a-3590-11dc-bb16-0000779fd2ac.html

This stark fact was transmuted by the subsequent press release into “good news”, because 85 per cent of available jobs will be filled by August 1. Even if this obfuscation of jobfill with appointment rates were true – and we believe it is a gross overestimate – it fails to acknowledge that a 15 per cent vacancy rate is ten times that of previous years in most specialties.

Alarmed at so many posts being vacant on August 1, the Department of Health gives trusts two weeks to manage what the hugely expensive national competition failed to achieve in six months.

Before August, trusts are ordered to find somewhere to shuffle 10,000 doctors for three months until the current crisis is past, and these doctors can then be quietly lost from the NHS for ever.

Our poll shows that one third of the 4,000 who have not found jobs as doctors are among our very best graduates, with either a first-class degree or distinction.

This cull of the best happened because the best graduates naturally apply for the most competitive posts and the new system randomly limited half of the applicants to just one interview.

This new career structure is a top-down straitjacket forcing doctors to choose immutably their area of training merely two years after qualification. Hundreds of doctors now face transportation for seven years to posts geographically remote from their families.

Although the professionalism of doctors will save the NHS from chaos in August, the NHS cannot be saved in the long term from the consequences of culling 30 per cent of our best doctors. Some flexibility and free market in posts must be reintroduced into training and appointments.

Those discarded this year should be guaranteed the right to compete again on a level playing field for the next rung up on the career ladder.

MORRIS BROWN, Professor of Clinical Pharmacology, Cambridge
PETER BARNES, FRS, Professor of Respiratory Medicine, Imperial College
NICHOLAS BOON, President Cardiovascular Society
NICHOLAS BROOKS, Past-President Cardiovascular Society
JOHN CAMM, Professor of Clinical Cardiology, St George’s Hospital
MARK CAULFIELD, Professor of Clinical Pharmacology, Queen Mary London
ANGUS DALGLEISH, Professor of Oncology, St George’s Hospital
JON FRIEDLAND, Professor of Infectious Diseases and Immunity, Imperial College
JOHN GIBSON, Professor of Respiratory Medicine, Newcastle
ASHLEY GROSSMAN, Professor of Endocrinology, Queen Mary London
TONY HEAGERTY, Professor of Medicine, Manchester
HUMPHREY HODGSON, Vice-Dean, RFUCMS
JUAN CARLOS KASKI, Professor of Cardiovascular Science, St George’s Hospital
CHRISTOPHER KENNARD, Vice Principal, Charing Cross Hospital
KAY-TEE KHAW, CBE, Professor of Clinical Gerontology, Cambridge
JOHN LAZARUS, Professor of Clinical Endocrinology, Cardiff
STAFFORD LIGHTMAN, Professor of Medicine, Bristol
JIM McKILLOP, Professor of Medicine, Glasgow
PETER McCOLLUM, Professor of Vascular Surgery, University of Hull
JOHN MONSON, Professor of Surgery, Hull
STEPHEN O’RAHILLY FRS, Professor of Medicine and Biochemistry, Cambridge
MARK PEPYS FRS, Professor of Medicine, RFUCMS
RODNEY PHILLIPS, Professor of Clinical Medicine, Oxford
PHILIP POOLE-WILSON, Professor of Cardiology, Imperial College
JON RHODES, Professor of Medicine, Liverpool
JIM RITTER, Professor of Clinical Pharmacology, Kings College London
BRIAN ROWLANDS, President of the Association of Surgeons
NEIL SCOLDING, Professor of Neurology, Bristol
JAMES SCOTT, FRS, Professor of Medicine, Imperial College
RAJ THAKKER, Professor of Academic Endocrinology, Oxford
DOUGLAS TURNBULL, Professor of Neurology, Newcastle
ROBERT WILCOX, Professor of Cardiology, Nottingham
MARK WILES, Professor of Neurology, Cardiff
LORD WINSTON, Emeritus Professor of Fertility Studies, Imperial College London

These eminent medical professional signed their letter at:
http://www.timesonline.co.uk/tol/comment/debate/letters/article2093366.ece

The government has drafted a bill to remove the legal obligation for clinics to take into account a child’s need for a father before deciding whether to grant fertility treatment. This would give far greater access to insemination for healthy single women and lesbians.

Dr Francoise Shenfield, who has run the donor insemination programme at University College London Hospitals NHS Trust for 25 years, believes her hospital should change its policy on insemination as soon as the law allows it to.

She said: “Years ago, we took the decision that we would only treat [heterosexual] couples but society has changed dramatically. Now I think we ought to revise this decision and extend treatment to single women and lesbian couples.

She added: “According to the World Health Organisation (WHO), achieving one’s reproductive wish is a human right.”

Shenfield believes the NHS should treat single women who cannot conceive because they do not have a male partner as well as those who have a medical problem such as blocked fallopian tubes.

She argues that single women should not be offered NHS treatment until their mid30s, however, because, at a younger age, they still have time to find a mate. The rising numbers of childless women have been attributed to a “Bridget Jones” generation of women who have not found a suitable partner even as they approach their 40s.

Sixteen per cent of women born in 1953 were childless by the age of 45 but this is expected to increase to 23% of those born in 1973.

In May, the Department of Health published the draft Human Tissue and Embryos bill which would remove the obligation to consider a child’s need for a father.

The proposal to offer NHS fertility treatment to women who could conceive naturally has been criticised by family campaigners who claim it is an unjustified use of public funds at a time when patients are being denied cancer and blindness drugs.

Ann Widdecombe, the Conservative MP, said: “It does seem to me very odd . . . [the NHS] has got its priorities very badly warped if it allows people to go blind but gives fertility treatment to women who are perfectly capable of conceiving normally.

“On the moral issue, it is wholly wrong that any child should be deliberately conceived without a father. This can happen but we should not inflict this on a child from the very outset.”

Ertan Saridogan, head of UCLH’s reproductive medicine unit, says that, although his clinic would be prepared to offer donor insemination to single women and lesbian couples, primary care trusts, which fund NHS clinics, are, so far, reluctant to pay.

Many primary care trusts state that they will fund treatment only for a medical problem and not for social reasons.

Dr Evan Harris, the Liberal Democrat MP for Oxford West and Abingdon and a member of the Commons science and technology select committee claims that this is unjust because many heterosexual couples are offered treatment when the cause of their infertility is unknown.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article2076122.ece

Mr Johnson has been the least precise. His announcement of a year long review of the NHS talks of it ending with improved “local accountability” and “community responsiveness” – which could mean anything.

Hazel Blears, secretary of state for local government, has gone further, stating that “we need to be thinking about giving local people more control over their NHS” and that she will be discussing with colleagues “how we make that happen”.

But Jack Straw, the cabinet minister in charge of constitutional reform, has gone furthest, saying that too much power has been handed over to “unelected health service quangos”, power that now needs to be “brought back within the elected field”.

This is bizarre. For two decades now both Conservative and Labour ministers have demonstrated that none of them trusts local government an inch. Local authorities have seen their powers in education, planning and much else removed, cribbed or constrained.

They have been inspected, performance managed and capped close to death. And administration after administration has failed to address the issue that really poisons the relationship between central and local government – namely local government finance and its massive over-reliance on central government funding.

Yet ministers who even now believe that local authorities cannot be trusted with big planning decisions somehow seem to believe they could do a good job of commissioning £90bn worth of NHS care.

For the NHS, such proposals ignore the fact that the labour government already has a policy for reform that needs driving through and completing; that the last thing the service needs is another round of structural change; and that there is no evidence that involving local government would make the service more responsive – history suggests the opposite.

The idea would also be unlikely to solve the problem it might be aimed at: “postcode prescribing”, in which variation in local NHS services has proved unpopular. More likely it would – almost by definition – make variation greater.

It also ignores the lessons of history – that representation over how services should be provided, without the ability to raise money to affect that, is a recipe for conflict. Back in the 1970s and 1980s councillors held between a third and a half of the seats on local health authorities.

Without the ability to raise health service money locally – “representation without taxation” – the result was endless wars over whether central government was providing enough money, rather than a concentration on services. In places, service change became paralysed as health authorities refused to balance the books.

That culminated in the government having to send commissioners to the giant health authority that covered the three great teaching hospitals of Guy’s, St Thomas’s and King’s, an experience so bruising, and so damaging for patient care, that no sane person would ever want to see it repeated.

This is not to say that local government and the NHS do not need to work more closely, particularly over social care and public health. But they are already beginning to. Local authority overview and scrutiny committees can already refer big services changes to an independent panel for evaluation.

NHS bodies are about to be required to co-operate in local authority area plans. In some places, the primary care trust chief executive and local social services director has become the same person. In Herefordshire, the council chief executive and primary care trust chief executive will become a joint post.

Such organic initiatives may help make services what they need to be: more nimble and responsive. Imposing some form of elected control – whether via local government or through direct election to primary care trusts, is likely to do the opposite.

Local government has a big enough agenda in local regeneration – and now it appears, once again, in housing – without lumbering it with the health service.

On the health service, the labour government needs to complete its current reforms and see if they work – not divert energy into further changes that would do far more harm than good.

The writer Nicholas Timmins is the FT’s public policy editor

http://www.ft.com/cms/s/cd351e08-3334-11dc-a9e8-0000779fd2ac.html

However, I wish everyone left behind in the NHS all of the very best of luck.

Britain languishes near the bottom of the European league table for the number of victims receiving anti-dementia drugs. Only five countries have a worse record.

The National Audit Office (NAO) report says urgent action is needed to tackle shortcomings in services for a condition which costs the country £14.3 billion a year – more than £25,000 for every man, woman and child – including £1.2 billion spent by the NHS.

In particular, there needs to be more support for the “selfless” army of nearly half a million carers who look after relatives and friends with dementia.

The report’s publication comes as the labour Government’s drugs rationing watchdog NICE is facing a legal challenge over its decision to restrict the availability of drugs that can delay the onset of Alzheimer’s.

The National Institute for Curbing Expenditure ruled that around 100,000 people in the early stages of the disease should not receive the drugs on the NHS. But drugs companies launched a High Court challenge last week to overturn the decision.

While Nice had ruled out drugs for people in the early stages of Alzheimer’s – which accounts for 62 per cent of all dementia cases -this report says there is a consensus that early diagnosis and treatment is vital.

In a highly critical report, the NAO says ministers and the NHS have not given enough priority to a condition which is suffered by around 560,000 people in Britain.

However, that figure is expected to soar by nearly 40 per cent to around 780,000 over the next 15 years as people live longer. By 2051, there will be 1.4 million sufferers.

The report says that dementia is estimated to be a factor in almost 60,000 deaths each year, around 13 per cent of all deaths in Britain. In around 18,000 cases, dementia is the main cause of death, often because victims become so frail they lose the ability to swallow or eat.

Despite its growing prevalence, the report says that only one in three sufferers ever receive a formal diagnosis. It takes twice as long to diagnose patients in Britain than many other European countries.

The report was welcomed last night by campaigners and opposition politicians.

Neil Hunt, the chief executive of the Alzheimer’s Society, said: “The human and economic cost of dementia can’t be ignored – one in three older people will end their lives with a form of dementia.

“It is absolutely crucial that people with dementia get diagnosed as early as possible so that they and their families get the information and support they need.”

• The elderly are finding it increasingly difficult to access crucial care services, a survey reveals today.

Older people are being confronted by a growing “care gap”, with low-level services which allow people to carry on living in their home – such as shopping or cleaning – being squeezed out as authorities focus scarce resources on intensive care for the most vulnerable.

The survey by charity Counsel and Care showed that 70 per cent of local authorities only provide care for those with “critical or substantial needs”.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/04/nhs104.xml

Professional bodies claimed taxpayers’ money is being wasted on training staff who then cannot find work in the NHS, and blamed Government squeezes on funding which lead to local healthcare trusts cutting junior positions.

At least 12,000 nurses qualified in May or September last year. But the Department of Health has admitted that only 69 per cent had found jobs by March this year. Among physiotherapists, only 48 per cent managed to find jobs after finishing their training.

The Royal College of Midwives estimates 3,000 more midwives are needed but about 20 per cent of newly qualified midwives failed to find work last year.

A Royal College of Nursing spokesman said: “It is a big problem. Entry-level jobs, for which newly qualified nurses apply, have been frozen because trusts have been told to reduce their deficits. “We think trusts need to be given more time and flexibility to manage their deficits as otherwise it’s a waste of taxpayers’ money.”

Last year a survey by the RCN found almost three quarters of newly qualified nurses were still searching for a permanent job months after qualifying.

The Department of Health said: “The NHS is balancing its work force after job shortages in the past. We expect people like this would find jobs in the next few months as others leave or retire. It is a more competitive environment now and people have to be a bit more flexible in the jobs they take, especially when they’ve just graduated.”

However, the NHS has been spending £1 billion a year on agency nurses because of poor planning.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/06/nnurses106.xml

At the current rate of progress, the contracts look likely to cover fewer than 300,000 patients a year, even if those still under negotiation are eventually signed.

A review of the private sector’s role is set to be undertaken by Alan Johnson, health secretary, amid speculation he might cancel perhaps the bulk of the second wave of contracts that have yet to be signed for further independent surgical treatment centres (ISTCs).

Some senior NHS figures believe he will press ahead with the right of patients to choose any hospital, public or private, prepared to treat patients at the NHS price. The remaining contracts for diagnostics – scans, X-rays and endoscopies – that are needed for the NHS to hit its target of a maximum 18- week wait for treatment also look set to be confirmed.

These contracts, however, are less contentious than those for the direct treatment of NHS patients. Cancellation of the latter would be a gesture towards the health service unions at a time when some parts of the NHS are arguing that their extra capacity is not needed.

Such a policy, however, would raise questions about whether a long-term role will remain for private hospital operators in treating NHS patients.

Only 170,000 patients a year are being treated under the first wave of independent centres, not the 250,000 originally intended. Talks about a second wave, also intended to treat 250,000 patients, are bogged down.

Six of the original 20-plus schemes have been cancelled and only six contracts have so far been signed. With the deals taking longer to complete than the first wave, two of the remaining 12 had yet even to appoint preferred bidders, said the Department of Health.

Few in the private sector expect the deals to cover more than 130,000 patients – perhaps 300,000 once the first wave is added in. Reaction to the steady shrinkage of the centrally procured treatment centres varies across the private sector.

Richard Jones, commercial director of Bupa Hospitals who chairs the NHS Partners Network, which represents the private providers, said: “It is clear that the second wave of ISTCs is not going to be on the scale of the original procurement.” But that gap, he said, could be filled by the growing right of patients to choose to have their operation in private facilities.

Adrian Bull, managing director of Carillion Health, which saw one of its big schemes cancelled last month, said: “It is very important that the government does not allow serial cancellation of these schemes to undermine the confidence of the private sector in future investment in NHS work.”

David Mobbs, Nuffield’s chief executive, said he remained “excited” about the increasing right of patients to choose.

From:
http://www.ft.com/cms/s/a692477a-29c6-11dc-a530-000b5df10621.html

A second doctor who has also worked in the UK is being questioned by Australian police but has not been arrested.

In the UK’s high state of alert following the failed attacks, police have carried out a series of controlled explosions on a car parked outside a Glasgow mosque.

Police have also carried out a controlled explosion on a suspect package at Hammersmith station in west London, although this is now not thought to be connected to the terror attacks.

In a development that will raise questions over the vetting procedures for medics from abroad, it has emerged that five of the seven suspects held by British police are young Middle Eastern men employed at British hospitals.

One is Mohammed Asha, a “brilliant” neurosurgeon from Jordan. Another being questioned over both the London and Glasgow attacks is Bilal Abdulla, an Iraqi junior doctor who was a passenger in the car that rammed Glasgow airport.

The driver of the Jeep Cherokee -who suffered 90 per cent burns after setting himself on fire in the attack – is said to be a locum doctor working at the hospital where he is now being treated.

Two of his colleagues at the Royal Alexandra Hospital, Paisley, Renfrewshire, were also arrested yesterday and another junior doctor is understood to have been the man police arrested in Liverpool.

Disclosures of the suspected terrorists’ backgrounds – which came as the hunt for any others who may have been connected to the terrorist incidents continued – surprised detectives and the intelligence services.

Five men have been arrested, while a sixth, the Jeep driver, is under police guard in hospital. He was operated on yesterday but doctors said his chances of survival were slim.

He has not been officially arrested because detectives are waiting for him to recover and do not want to trigger the 28-day maximum time limit for detaining him as a terrorism suspect.

The seventh person arrested is Dr Asha’s wife.

The Muslim Council of Great Britain today said is was the “Islamic duty” of Muslims to help the security forces fight terrorism.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/03/nterror103.xml&page;=1

Health Direct considers the new terrorist threat- Doctors

Given that Osama’s number two is a surgeon, maybe we should take more care.

It would appear that all of the men behind the weekend’s bungled terror attacks were doctors of medicine, at least two of whom were working in Scotland. Indeed the car bombs discovered in London’s West End were apparently driven from Scotland down to the capital.

One hopes that they were better doctors than they were terrorists.

Arriving in this country as doctors provided excellent cover stories – ‘deep cover’ in the intelligence jargon. What better way to sneak into the UK?

It’s a clever move by al-Qaeda’s recruiters. Astoundingly, we now discover the checks on doctors from abroad allowed to work in the UK are confined to validating medical qualifications.

Given that Ayman al-Zawahiri, Osama bin Laden’s number two, is a trained surgeon, maybe we need to be a little more inquisitive about doctors who come here from the Middle East.

By day, apparently, these men were assiduous in their professional duties. By night they were scheming Jihadist terrorists waiting for their moment to strike and kill hundreds of innocents, some of whom would have been their patients, as they flew off on their summer holidays from Glasgow airport.

And no one suspected a thing. Or at least that is what we are asked to believe.

It is a huge relief that these terrorists are not British born and bred. We do not have to go through the agonies of confronting ‘the enemy within’ as we did in the summer of 2005.

Although they fit in nicely with a long British tradition of murderous medical men – Drs Crippen and Shipman immediately spring to mind – crucially, these men are foreigners.

Foreigners have to be granted permission to come here and have to pass through our border controls.

Because the July 2005 bombers were British, the debate about our pathetic border regime died down. Expect it to return with a vengeance.

However, Mr Brown avoided equivalent cuts to the Scottish and Welsh NHS budgets even though the funding formula for the UK nations suggests they should have shared the pain. That decision leaves him open to criticism that he favoured patients in his home country.

Those familiar with the situation said the cut to NHS capital spending implied a very tight settlement for the health department for the next three years in October’s Comprehensive Spending Review and indicated a slowdown in hospital building.

The health department’s surrender of £2bn in capital is all the more remarkable because the NHS needs the money and it had not been given greater day-to-day money to spend.

The private finance initiative hospital programme has already been cut from a future programme of £12bn to £8bn, with further reduction likely, amid worries the inflexible payments PFI demands do not fit well with the new system of money following the patients. Big hospital reconfigurations are due in some parts of the country that will inevitably require capital.

The Treasury Friday night confirmed the NHS capital budget had been “adjusted”. But it indicated that, although it was not yet published, it would allocate the missing £2bn to spend to English hospitals over three years from 2008-09.

No published health spending plans exist for these years yet, so hospitals will not be able to verify that the money is additional.

The cut was slipped out in the March Budget, when Mr Brown referred only to spending on day-to-day NHS services when he said “the money available for investment and reform in the NHS in England will be £8bn more than this year, the biggest cash increase ever”.

From:
http://www.ft.com/cms/s/f7a994d0-2677-11dc-8e18-000b5df10621.html

That Stalinist Brown had shifted the goal posts for PFI hospital building is not new- please see below. But his rigging of hospital building funds in England and Scotland shows a new level of contempt for the voters.

On 18 Jun 07 Health Direct posted: NHS service cuts urged at non PFI hospitals when Primary care trusts wanting to reconfigure services were given a stark message in an economic analysis prepared for the NHS in London: financially, it will make sense to cut beds and services at non private finance initiative (PFI) hospitals.

Sharon Massey, cabinet member for health and adult social services at Bexley council, which covers Sidcup- one of the areas covered, 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”.