Experts fear that hundreds of thousands of children returning to school as early as next week may cause the highly infectious disease to spread.

Despite this the labour Government has ordered no extra stocks of the MMR vaccine and doctors may run out if they face a sudden rise in demand, The Times has learnt.

The Health Protection Agency (HPA) said that the number of confirmed cases of measles in children had more than trebled over recent months and was far higher than would normally be expected for this time of year.

By June 10 only 136 cases of measles had been confirmed. But just over 11 weeks later this number has risen to 480, with new cases being detected every day, the HPA said. This compares with 756 cases recorded during the whole of 2006 – the highest year on record.

Measles, which can be life threatening or cause severe disabilities, is most common among children aged 1 to 4 who have not been immunised, but can strike older children and adults, too.

It was difficult to explain the large increase this year, the HPA said, but parents not vaccinating their children and a lower uptake of a second MMR “booster” dose are thought to be key factors.

The triple vaccine has proved highly controversial in recent years over unfounded concerns that it may be linked to autism. The study that first sparked fears about its safety is currently being scrutinised in a hearing by the General Medical Council, the medical watchdog. Andrew Wakefield and two co-authors of his research are currently appearing before the GMC on charges of serious professional misconduct.

MMR coverage began to drop in the late 1990s, though uptake is rising slowly again. The latest figures show that 88 per cent of British children begin school having had one dose of MMR.

The latest data, for January to March 2007, showed particularly high numbers of measles cases in London and southeast England, East Anglia and Yorkshire and Humberside.

Mary Ramsay, a consultant epidemiologist at the HPA, said yesterday: “We’ve been very worried because the cases have stayed up over the summer holidays. This means it is crucial that children are fully immunised with two doses of MMR before they return to school.”

In previous decades, measles could cause an average of 20 deaths a year. Officials are nervous that the numbers could creep up again after gaps in vaccination coverage. “Although the numbers are still small, compared to the history of measles, we’re always worried about measles because very rarely it can kill,” Dr Ramsay added. “We hadn’t had any deaths from measles since the early 1990s, but unfortunately we had one death last year and we don’t want any more.

“Measles is a highly infectious and dangerous illness and, as there is increased close contact in schools, it can spread easily.”

Along with buying school uniforms and other preparations, “parents should think about adding the MMR vaccine to their back to school ‘to do’ list”, she added. “It is never too late to get vaccinated.”

But Laurence Buckman, chairman of the British Medical Association’s GPs’ committee, said that many doctors had not been warned to prepare for a sudden demand and could run out of supplies. “GPs will only have ordered as much vaccine as they would typically use at this time of year, so there may not be enough to satisfy a surge in demand,” he said.

“Doctors and nurses will do their best, but at this short notice, they will not be able to run any extra clinics on the weekend and when they run out of supplies there is not much they can do.”

Doctors’ surgeries at Hackney, East London, are dealing with the effect of reduced levels of vaccination, with more than 120 measles cases in the past three months. Most of those were in children under 5 who had not been immunised.

Michael Fitzpatrick, a GP in the borough, said that he was disappointed but not surprised by the latest figures: “Scepticism about the MMR vaccine results in outbreaks of measles like this,” he said. “This was inevitable and I think the only surprise is this hasn’t happened earlier, and on a bigger scale.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/child_health/article2358240.ece

On June 19, 2006 Health Direct posted: Measles- how a spurious health MMR scare brought an old killer back as health chiefs last week reported the worst outbreaks of measles across Britain in 20 years, slow progress was being made in bringing to justice the doctor who sparked the MMR scare.

At the high court in London, lawyers for the General Medical Council (GMC) gave the first public hearing to disciplinary charges against Andrew Wakefield, whose scientific paper published eight years ago caused millions to shun the vaccination for fear that their children might contract autism.

As health chiefs revealed last week, Britain is now in the grip of what has every sign of becoming a measles epidemic. In March the first child in 14 years was killed by the virus. Clusters of infections, such as in Surrey and Yorkshire, have propelled the number of confirmed cases this year to 449, the largest number since the MMR jab was introduced in 1988.

The current preventable measles crisis is a disaster waiting to happen. On June 16, 2006 Health Direct posted: Scare over MMR vaccine safety causes cases of Mumps to soar

With the immunisation rates falling to around 50 per cent in Westminster and other parts of London Scare over MMR vaccine safety causes cases of Mumps to soar as immunisation postcode lottery grows one would think that the GMC would be moving faster than it is to clear up this sorry mess.

Breastfeeding protects babies from a range of illnesses and saves the NHS millions of pounds a year, says Unicef. Breastfeeding also lowers a mother’s risk of breast cancer, ovarian cancer, hip fractures and low bone density.

Bottle-feeding puts babies at greater risk of gastrointestinal and respiratory infections and other illnesses, yet UK breastfeeding rates are among the lowest in Europe.

NICE recommended that all maternity trusts should adopt the Unicef Baby Friendly programme, which focuses on giving mothers information so they can choose whether or not to breastfeed, and ensuring they have support to do so.

It is intended to be non-judgmental and women who elect to bottle feed will be helped to do it safely and well.

Unicef accredits hospitals that reach an acceptable standard. But some hospitals say budget cuts mean they cannot afford to train staff.

Unicef points out, however, that NICE predicted cost savings for hospitals after three years of the initiative, because of reduced childhood illness.

Some hospitals have seen a transformation in attitudes after adopting the Baby Friendly policies. The Pennines acute trust has seen its breastfeeding rate rise from 29% in 1994 to 65%.

“In 1994 women knew about formula milk but had no knowledge about breastfeeding,” said Val Finigan, infant feeding coordinator for the trust. “We gave them information to enable them to make an informed decision.” The other priority was to train staff at all levels to help women with whichever type of feeding they chose.

Unicef has this week written to all hospital chief executives, reminding them of the Nice guidance.

From:
http://www.guardian.co.uk/medicine/story/0,,2158731,00.html

Health Direct is amazed that with even such a parsimonious organisation as the National Institute for Health and Clinical Excellence (NICE) proclaiming the benefits of breastfeeding that UNICEF’s guidelines are not being followed .

Is this yet another case of the labour govt cow-towing to it’s big business friends?

The findings come amid growing evidence that elder abuse is a widespread problem in families, care homes and hospitals. A study by the National Centre for Social Research and Kings College London suggested that 342,000 older people living in private households are subject to some form of mistreatment every year in the UK.

A report by the parliamentary joint committee on human rights this month highlighted significant levels of abuse and neglect suffered by older people in care homes and hospitals.

Its latest study, based on 848 responses from readers of Nursing Standard and Nursing Older people, found that 58% of nurses would not report abuse of an older person because they fear having got it wrong.

The poll revealed that 68% of nurses felt a lack of training in how to deal with elder abuse was a barrier to them providing decent care.

From:
http://www.guardian.co.uk/uk_news/story/0,,2157864,00.html

On June 22, 2006 Health Direct posted: Minister wants Dignity debate for caring for the elderly
when the new care services minister Ivan Lewis said that he wanted to make dignity of older people one of his top priorities.

Speaking at a session on the out of hospitals white paper, he said: ‘I want to make dignity an important theme in my time as a minister. ‘This is not a gimmick; just another initiative. It
should be at the heart of what we are doing.

As Health Direct also mused: Classic Labour tactic this. Ivan Lewis’s caring, sharing labour government announces a laudable new spin policy for caring for the elderly and frail. Brilliant

He then lambasts everybody else for not delivering his policy- when it’s his own fault because the Labour govt has not put a single new penny of money into the pot to pay for the new initiative.

Where is the money to pay for the extra nurses that you want to police your dignity policy, Mr Lewis?

The result is that they are not monitored closely enough, causing at least 20,000 deaths each year. But consultants say that figure could be halved if high-risk cases were properly identified and transferred to intensive care.

They say the number of critical care beds devoted to post operative patients should be tripled from the 30,000 currently provided, while 50 per cent of patients should receive extra care. Britain has 0.6 critical care beds per 10,000 population compared to 4.4 per 10,000 in the US.

Shadow health secretary Andrew Lansley said: “This is a really critical issue for this country. We have chronically poor levels of intensive care compared with elsewhere.”

In the letter to Mr Johnson, seen by this newspaper, 17 eminent anaesthetists demand an overhaul of NHS surgical practices, warning that four times as many patients die in Britain after surgery as in the United States.

The doctors say the health service has failed to introduce simple tests to identify high-risk patients and challenge the health secretary as to why technology proven to cut deaths is used in a fraction of NHS operations.

One of the co-signatories, David Bennett, Emeritus Professor of Intensive Care Medicine at St George’s Hospital in London, said: “There are at least 20,000 patients dying after surgery across the UK – that is a very conservative estimate.

“We think we could halve the numbers dying, and save at least 10,000 lives a year, if patients were given the right support. This is a political decision. There aren’t many interventions that could have such a dramatic effect.”

Increased use of intensive care, combined with better monitoring, could save money by cutting patients’ time in hospital and preventing emergency re-admissions, he said.

Prof Bennett said that most hospitals had failed to invest in equipment such as fitness bikes, which help to assess the patient’s health prior to surgery, and blood-flow monitors, which maintain fluid levels and cardiac output during an operation.

Despite backing from NHS rationing body the National Institute for Curbing Expenditure (NICE), blood flow monitors are used on less than 10 per cent of patients.

Dr Bruce Taylor, honorary secretary of The Intensive Care Society said more patients should be monitored by intensive care before they became seriously ill. But he said there was “no slack at all in the existing system” to take on more patients without a substantial rise in funds.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/26/nhs126.xml

On March 12, 2007 Health Direct posted: Medical errors- new campaign aims to reduce deaths and costs when a safety drive was launched by the labour government’s health watchdog in the face of “alarming” figures on the harm patients suffer in hospital and elsewhere.

Various studies, some using US data, estimate that there is a one in 300 chance of a hospital patient dying as a result of medical error.

One in 10 is estimated to suffer harm, of whom a third suffer serious harm, while studies suggest that 600 errors are made a day in primary care with more than one in 10 prescriptions containing errors.

And again on 4 Nov 05 Health Direct posted: NHS accidents cost £2bn and up to 34,000 lives finds National Audit Office (NAO) when according to a report by the National Audit Office, around a half of incidents in which NHS hospital patients are unintentionally harmed could have been avoided, if lessons from previous incidents had been learned.

Whilst reporting has improved at the local level, at the national level progress on developing a national reporting and learning system has been slower than envisaged in the Department of Health’s 2001 strategy “Building a safer NHS for patients”.

Hugh Markus, professor of neurology at St George’s university and medical school, said three different studies had put the UK at the bottom among several other western European countries.

The problem appears to lie in the way services are organised, with strokes seen as a “Cinderella” subject that falls between neurology and geriatric medicine, Prof Markus said.

Instead it needs to be treated as “a condition that requires emergency action”.

Clot-busting drugs can now be given to patients whose stroke is due to a blocked blood vessel rather than a broken one.

“It is unlikely that every acute hospital will be able to provide such a service,” Prof Markus said, and alternative strategies that include regional centres and the use of telemedicine are needed, as in Germany and America.

“In many European countries,” Prof Markus added, brain imaging “is performed on admission to the accident and emergency department, while in the UK many units struggle to provide it within 24 hours.”

A National Audit Office report in 2005 calculated that 550 deaths could be avoided a year, and 1,700 patients would recover fully rather than being disabled, if ­services were better organised.

A stroke strategy is apparently due to be published by the health department in the next few months.

The limited data available, Prof Markus said, “show that European countries with better outcomes focus resources more heavily on the acute aspects of care”.

“The vast majority of the cost of in-hospital stroke care in the UK is for nursing and hospital overheads, with the cost of investigations and medical care being very low.”

At present less than 1 per cent of patients eligible for clot-busting drugs get them in the UK, against 20 to 30 per cent in many European countries and North ­America and Australia.

From:
http://www.ft.com/cms/s/0/d7bdb1d6-518f-11dc-8779-0000779fd2ac.html

It is nearly two years since MPs in the National Audit Office pointed out that hundreds of UK citizens are dying needlessly and over a year since Health Direct posted on July 12, 2006- Stroke patients dying needlessly from Labour’s health failures

Since then new Prime minster- same lack of compassion and urgency.

Stroke patients are needlessly dying or suffering more serious disablement because not enough priority is given to stroke services, according to a report by the Commons Public Accounts committee.

The report found that stroke is not treated as a medical emergency, brain scans for patients are often delayed and a significant proportion of stroke patients are not treated on specialist units.

The MPs found:
* Stroke is not treated as a medical emergency in the same way as a suspected heart attack, though the shorter the time between the stroke and the treatment, the greater the chance of reducing damage to brain tissue.
* Brain scans for many stroke patients are being delayed, though a scan is vital for determining appropriate treatment.
* A significant proportion of stroke patients are not being treated on a specialist stroke unit, despite evidence that this is the most clinically effective model for acute care.
* There is considerable variation between hospitals as to what a specialised stroke service entails.
* Public awareness of the symptoms and impact of stroke, and how strokes can be prevented, is very low.
* There are insufficient nursing, therapist and other specialist staff with expertise in stroke care across the primary and secondary healthcare sectors, and there is scope to improve training for the existing stroke workforce in the National Health Service (for example, by training stroke consultants to interpret brain scan results).
* The carers of stroke survivors, and stroke survivors living on their own, are often not accessing the social and care services they need.
* There is low awareness on the part of members of the public and general practitioners about the fact that a transient ischaemic attack (‘mini stroke’) is a strong indication of increased risk of major stroke, and requires immediate investigation and treatment.

“These are the kind of costs that result from endless reorganisations. Not one penny contributes to the health of patients.” claimed Andrew Lansley, shadow health secretary

The BBC obtained the figures from the 10 SHAs using the Freedom of Information Act.

Twenty-eight SHAs were set up in 2002 by the labour govt to supervise local health services in England. Their job was to coordinate care and deliver government policy.

But three years later ministers announced £250m had to be cut from red tape and four years after they were created the regional bodies were merged into 10.

Some 764 people were made redundant or took early retirement at a cost of £82.89m. That included 61 senior managers. Their redundancy packages cost an average of £358,355.

But the Liberal Democrats say the true cost of the changes must include the reorganisation of primary care trusts, which were reduced from over 300 to 152 last year.

They claim that the cost of those mergers could be as high as £60m, making a total bill for the changes of more than £140m.

Liberal Democrat health spokesman Norman Lamb said: “This is the price we’re paying for botched reforms. The government rushed into ill thought out reform…when the system didn’t work they changed it.”

From:
http://news.bbc.co.uk/1/hi/health/6961082.stm

Health Direct posted on 20 Jul 07 NHS manager’s lottery payout is nearly £1m – An NHS manager has been given a redundancy package worth almost £1 million in what was described as “a lottery win rather than a payout”.

David Johnson, the former head of a regional strategic health authority, was one of about 70 staff who left the organisation when it was abolished as part of a restructuring programme.

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?”

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 new NHS boss?

The highest vacancy rate was among consultants, with 1.2 per cent of jobs empty compared with 0.4 in trainee nursing. There are currently 5,000 newly qualified nurses who cannot find a job and half of the 2,413 newly qualified physiotherapists have not found permanent posts.

More than 20,000 jobs have been cut in recent years as managers struggle to bring NHS finances back into balance.

Vacancy rates across the medical professions have dropped, showing the boom and bust nature of current workforce planning in the health service.

Places at medical school and nursing colleges were expanded and the NHS has now almost reached a point where it is self-sufficient in staff.

But experts are predicting shortages again in the medium to long-term because large numbers of nurses, GPs and consultants are nearing retirement age. In the meantime, newly qualified staff are struggling to find work and many are considering retraining or working abroad.

Dr Peter Carter, the general secretary of the Royal College of Nursing, said: “This is not a ‘good news’ story for nurses.

”Vacancy rates appear to have reached their lowest levels for years but we fear that has been achieved only by widespread freezing and deleting of posts by NHS trusts desperate to balance the books.

“Thousands of newly qualified nurses – costing taxpayers millions of pounds to train – cannot find jobs this year yet at the same time the workload on the wards and in the community remains high.

“It’s time for the Government to put in place a long-term workforce strategy that prevents the feast or famine characteristic of the NHS job market in recent years.”

The NHS Vacancy Survey also found that:
- In March 2007 there were 1,695 vacancies for qualified nurses and 391 for trainees.
- There were 364 consultant posts available and 73 jobs for other doctors in non-training posts.
- The vacancy rate for GPs has dropped from 2.4 per cent in March 2005 to 0.8 per cent this year.
- There were just 63 vacancies for physiotherapists in March this year compared with 464 in 2005.
- The highest vacancy rates are in the South East Coast area, followed by the North East, with the lowest in the West Midlands.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/21/nhospital821.xml

Health Direct points out that Labour’s complete and utter incompetence in attempting to “save the NHS” is exposed by these latest figures. It’s a waste of taxpayers money for us to subsidise medical training and then throw the highly skilled new staff out onto the dole queues.

On March 22, 07 Health Direct posted: MPs expose lack of control over NHS billions

A devastating insight into financial mismanagement at all levels of the NHS- from Labour ministers down to hospital bureaucrats- is provided by a committee of MPs. The report by the all party Public Accounts Committee exposes how billions of pounds of taxpayers’ money is being poured into a health system with inadequate financial controls and low levels of accounting expertise.

The MPs conclude that NHS structures are so inadequate that the Department of Health has no idea what the effect of last year’s total deficit of £570 million is having on patient care.

In no less than one in three NHS organisations, auditors had raised concerns “about the financial management capabilities of general management”.

The committee said that while the Department of Health had no “overall picture” of the effect of deficits on services to patients, it was clear they were adversely affecting the level and quality of care.

Dr Peter Carter, the general secretary of the Royal College of Nurses, said it was very disturbing that the department had no clue about the effect of deficits on services and jobs. “It’s time for the Government to come clean.

Ministers need their advisers to tell them just how damaging the deficits crisis has become and acknowledge the Government’s responsibility to work with front line staff to find a long term solution.”

The Eurocare studies of 23 countries looked at the outcome of 2.7m new cases between 1995 and 1999. Government cancer “tsar” Mike Richards said poor results in the UK had been due to delays spotting the disease.

The studies, published in the Lancet Oncology journal, are the largest international projects to compare the survival of patients from 11 different cancers. They reveal wide differences in death rates from both rare and common types of cancer.

“Our concerns illustrate the considerable challenges that now face the UK government if it is to make the NHS work efficiently and effectively” Editorial, Lancet Oncology

The best performers are Nordic countries such as Sweden and Norway and central European countries.

Ranked just beneath them are south European countries, and lower still is the UK, followed by Eastern European countries.

While death rates have fallen in the UK, they have also fallen in the rest of Europe.

Some eastern European countries almost matched the UK’s performance despite spending less than a third of the UK’s health budget per head of population.

Overall, for men Sweden had the best survival rates with 60% of cancer patients alive five years after diagnosis, compared to between 40% and 50% among the UK countries.

For women, Sweden and Iceland were top on 62% with Wales, England and Northern Ireland just below the European average of 56%, while Scotland was among the worse on 48%

Delayed diagnosis

An editorial in the Lancet Oncology questioned whether the NHS Cancer Plan, launched to tackle poor survival rates in the UK, was working.

“Eurocare is an important indicator of oncology provision in Europe, giving insight into healthcare effectiveness and the improvements needed. Our concerns illustrate the considerable challenges that now face the UK government if it is to make the NHS work efficiently and effectively.”

Professor Richards conceded that while some of the data from European countries could be flawed, this was unlikely to account for all of the differences between countries.

“The findings show that many more lives could be saved if the outcomes in all countries were brought up to the standards of the best countries.”

He added: “The poor results from the UK were attributable mainly to patients having more advanced disease at diagnosis than patients in other European countries.”

‘Must ensure access’

The NHS Cancer Plan was launched in 2000, and promised an increase in specialist staff and equipment to tackle the delays in diagnosing and treating cancer.

Strict targets on the waiting times for scans and appointments were set.

Professor Richard Sullivan, Cancer Research UK’s director of clinical programmes, said “Cancer is still not being diagnosed early enough in all cases. And we need to ensure that patients have access to the best surgery, radiotherapy and other treatments. This study shows that cancer is certainly not a ‘ticked box’. We need a sustained effort to beat the disease.”

From:
http://news.bbc.co.uk/1/hi/health/6955545.stm

Health Direct readers will not be surprised by the latest shocking news on cancer survival rates in the UK. On Aug 09, 06 we posted: Postcode lottery for cancer, hearts and mental health King’s Fund reports

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

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

As long as the Labour govt continues to use the National Institute fro Curbing Expenditure to block the use of new cancer drugs like Herceptin then UK patients will contiue to die unnecessarily.

On 4 Apr o6 Health Direct posted: Cancer: There are life-saving drugs. So why can’t we have them?

Thousands of cancer sufferers are being denied life-saving drugs because of delays and bureaucracy in making them available on the NHS. The hold-ups are a matter of life and death for desperate people who have been diagnosed with cancer of the breast, colon or lung, or with a brain tumour.

Doctors are furious that drugs such as Avastin, which is used to treat colon cancer, and Cetuximab, a treatment for head and neck cancers, are being blocked by the National Institute for Curbing Expenditure (NICE), a labour government created quango set up to decide which drugs should be routinely prescribed on the NHS.

But backlogs mean that Nice is taking up to two years to make its decisions. That means drugs such as Avastin, which have been officially licensed and approved for use, are currently denied to NHS patients although well-off people can obtain them privately. In some cases, patients are being told they face a three year wait if they want to obtain these life-saving treatments free.

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

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

A letter sent to local NHS organisations has ordered them to improve surgeries’ responsiveness to the public, along with people’s access to and choice of GP services. This includes the option of seeking alternative providers, including private companies, instead of GPs.

Health Direct and the Times understands that the letter, from Mark Britnell, Director of Commissioning at the Department of Health, was altered before being sent to tone down references to “competitive tendering” – which would include offering GP contracts to private sector companies.

But doctors’ leaders said that the final draft sent to health trusts remained “very aggressively worded” and a clear sign of a labour government mission to bring more private practice into the NHS.

Changes to GPs’ contracts, introduced by the Department of Health in 2004 to relieve some of their work pressures, allowed doctors to opt out of providing night and weekend care. About 90 per cent took up the option, leaving it to Primary Care Trusts to employ private firms, groups of independent doctors and other health staff to provide cover.

Gordon Stalinist Brown promised to address problems with access to GPs on the eve of becoming Prime Minister. His stance was backed by the Confederation of British Industry, which found that 3.5 million working days were lost last year, at a cost of £1 billion by people taking time off to see their GPs.

Leading medical insurance firms have also reported a dramatic rise in the number of complaints against doctors connected to care at evenings and weekends.

The letter, which is seen as a sign of Labour’s willingness for a head-on clash with GPs, threatens to use the GPs’ contract to favour those doctors who provide longer opening hours, and to create new practices using private companies in areas where there are too few GPs.

Mr Britnell’s letter tells PCTs to come up with plans to persuade GPs “to respond to the needs and expectations of their patients, for instance by opening practices for longer periods” and suggesting that PCTs make “full use of existing contractual arrangements and other mechanisms to ensure more locally responsive services”. This replaced the original reference to competitive tendering.

Mr Britnell adds: “We expect PCTs and practices to be able to demonstrate tangible improvements for patients by December 2007”.

The letter has infuriated the British Medical Association, which says that the Government’s own surveys show patients to be content with the services offered by their family doctors.

Dr Laurence Buckman, who chairs the BMA’s GP Committee, said: “It is a very aggressively worded letter which I don’t think can be interpreted in any other way but as giving primary care to the private sector. PCTs are being told that their performance will be judged on how well they do this.

Has anybody asked the public if that is what they want? Has anybody worked out what it will cost?”

Dr Buckman confirmed that an early draft of the letter made clear that trusts would be backed if they sought tenders from the private sector to replace GPs who were failing to provide easier access for patients. This threat was implicit, rather than explicit, in the version finally sent.

The letter followed a Government survey of GPs services, which cost £12 million and found that almost all patients were satisfied with their GPs. The survey found that fewer than one in 10 people want their GP surgery to open on weekday evenings or weekends, and that 84 per cent of people were satisfied with existing hours.

From:
http://www.timesonline.co.uk/tol/news/uk/article2289417.ece

Or is this another example of a Labour health Secretary saying one thing one moment and doing something else?

On July 26 07 Helath Direct posted: Johnson blocks new wave of private health clinics

The health secretary, Alan Johnson, yesterday vetoed plans for a third wave of independent sector treatment centres to compete with NHS hospitals.

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.”

Amid speculation that Gordon Brown is planning an early election, Mr Cameron sought to reassert his centre-ground credentials by claiming that labour Ministers are attempting to close district hospitals.

“The basic point here is we believe the district general hospital is an absolutely key part of the NHS,” the Tory leader said.

“People have put money into the NHS, they’ve paid increased taxes and they want to see their district general hospital improve. People simply do not understand why maternity units and accident and emergency units are being shut down when actually accident and emergency admissions are up and births are up.”

He added: “The labour government’s new health minister, Sir Ara Darzi, has said ’the days of the district general hospital are over’.

“That’s why I say the Government can expect a bare knuckle fight with us over the next few weeks and months about saving district general hospitals as a key part of the local NHS.”

Mr Cameron made his remarks ahead of a trip to Sussex this afternoon where he was due to visit a hospital.

“What people will see in the run-up to the next election is that all the problems the country faces today – whether it’s NHS closures, family and social breakdown, whether it’s a weak pension system, whether it’s the stealth taxes they are having to pay that are making the cost of living so hard to meet – they can trace all of those decisions back to Gordon Brown sitting at a desk in Number 11 Downing Street as Chancellor,” he said.

Speaking later, a Department of Health spokesman said that the Tory leader had quoted Lord Darzi out of context.

From:
http://www.timesonline.co.uk/tol/news/politics/article2294162.ece

The doctor, who is also a representative of the Royal College of Psychiatrists, decided to speak out after a 58 year old female patient was strangled on a mental health ward in Rochdale. A 36 year old male patient has been charged with murder.

The doctor said it was often very difficult to maintain single-sex facilities because of the pressure on beds.

“The wards are packed to the gills with really psychotic patients,” he said. “It is as bad as it ever has been.”

He said most serious incidents on the wards, such as attacks on other patients or staff, absconding and murders, were a direct result of the pressures on beds.

The consultant said: “There are fewer beds, and staff are under immense pressure to get people out because of the number of people coming in.

“The inpatients are really ill, really psychotic and most are detained under the Mental Health Act.

“Most assaults are covered up. Nurses are off sick because they have been beaten up. There will definitely be more tragedies on the wards if the cuts continue,” he said.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/16/npsychic116.xml

On Sept 29, 06 Health Direct posted: Mental health services are ‘failing’ as watchdog finds that the services are abysmal.

People suffering mental health problems are being failed by poor access to key community services, a watchdog says. Most people with mental health problems are treated out of hospitals.

The Healthcare Commission’s review of 174 mental health teams in England found gaps in out-of-hours care, talking therapies and access to information. The watchdog rated only one in 10 as excellent, with nearly half just getting a fair grade.

The scandal of mental health provision- or lack of doesn’t just effect the afflicted. On Nov 16 06 Health Direct posted: Scandal of Labour’s blunders that led to murder by mental patient

The needs of dangerous psychiatric patients are being put before the safety of the general public, according to a report to be published today on the murder of a retired banker by a mental health patient. The highly critical report into how a psychiatric patient at a south London hospital escaped and attacked Denis Finnegan as he cycled through Richmond Park will reveal how a catalogue of systemic errors led to his death.

Chaired by Robert Robinson, a mental health lawyer, the report is said to be one of the most damning in the past decade. Over 400 pages it details a catalogue of preventable errors at Springfield Hospital which led to Mr Finnegan’s murder. It concludes that a special medium secure facility in the hospital, the Shaftesbury Unit, must be closed pending an external audit.

“When people have been negligent it needs to be broadcast far and wide in the NHS. The lack of monitoring of patients like John Barrett is a major issue. I hope that this report will be used nationally to highlight what’s gone wrong and to prevent it from happening again.”

The findings have led to accusations that NHS patients are being ripped off under a system one dentist branded “wicked”.

Dental industry leaders said the disparity between charges had been caused by the new contract the Government had imposed on dentists, which was designed to simplify treatment costs.

Patients pay a flat rate of £43.60 whether they have one filling or six. If they went outside the NHS they would have to pay for only one filling, although many private surgeries do charge much more.

The disclosure comes after an official report revealed that 47,000 fewer patients were being treated since the new NHS contract came into force in April last year and at least 500 dentists have left the health service.

Two million people are trying to register with an NHS dentist but are unable to find one to take them.

Since the untested changes took effect NHS dental treatments have been banded under three costs.

A band one treatment, such as an examination, X-ray or scale and polish, costs £15.90.

Band two treatments, which include anything from one to six fillings or root canal work, cost the patient a fixed flat rate of £43.60.

Band three treatments are crowns, dentures and bridge work and cost the patient £194.

For each treatment carried out dentists earn points, called Units of Dental Activity (UDA), the price of which is set locally and is an average of about £20.

For a band one treatment the dentist earns one UDA, for band two they earn three and for band three they earn 12.

Dentists have been given targets on the number of UDAs they must carry out each year but if they exceed it they are not paid more.

Those who missed their target this year have been asked to pay back thousands of pounds, meaning more dentists are now considering leaving the NHS.

The Daily Telegraph understands that some dentists are playing the system by splitting treatments across several visits so they can collect a new set of payments for each visit.

Ian Mills, who runs a practice in Torrington, Devon, said: “Financially the contract is worse for patients than it is for dentists. If a dentist does complex treatment they are penalised.

“If I have a patient with an abscess I could save that tooth by doing a root filling, which would take two hours, or I could take it out, which would take 20 minutes. Ethically, I should save the tooth but they are the same financial reward so the incentive is to remove the tooth.”

Anthony Halperin, the chairman of the Patients Association and a dentist, said: “I am convinced that this contract is not to patients’ advantage.

They are not being treated as efficiently as they were under the old system and they are paying more for it.

“Dentists are so driven by hitting targets that there is no incentive to carry out complex work that might be best for the patient. I fear more dentists will leave the NHS.”

Peter Ward, the chief executive of the British Dental Association, said: “For a government to be responsible for building a system that drives these potential incentives is wicked. This is the reason dentists are deciding to leave the NHS. We can’t have a situation where delivering the best care for your patients means you lose money.”

The BDA’s records show that 1,600 dentists left the NHS before the new contract was implemented in April 2006.

Mr Ward said he expected more dentists to leave the NHS this year as the inadequacies of the contract were now becoming a reality.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/13/nhs113.xml

The scandal of labour’s dental hypocrisy is boundless. On Oct 09, 06 Health Direct posted: Dentists abandon children on NHS when up to two-thirds of children in some areas of England are failing to get regular dental treatment as thousands of youngsters have been dropped by dentists no longer willing to provide free National Health Service care.

This weekend dentists have warned that children will find it even more difficult to get free dental care in the future as fewer dentists undertake NHS work.

Dentists believe access to the NHS will worsen because of government reforms to the way they are paid. A survey of local dental committees, carried out by the British Dental Association, showed 90% predict access to NHS dentistry will worsen.

On the other hand on March 13, 07 Health Direct posted: Hypocrite Stalinist Brown bitten over private dental work

The chancellor has been accused of spurning the National Health Service by paying hundreds of pounds for routine dental work to a private dentist known for his celebrity clients. Gordon “Stalinist” Brown had root canal work done by Mervyn Druian, who runs a surgery in north London. He charges up to £650 for the procedure, compared with a standard NHS cost of £42.

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

Health unions and opposition politicians blamed the drop on labour government mis­handling of NHS finances, but there was disagreement over the extent of the fall for front-line services.

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

Lord Hunt was pathetically quoted as saying that a small fall in the overall headcount should not distract from the fact that the NHS employed over 279,000 more people than it did in 1997, including 34,338 extra doctors and 79,479 more nurses.

Comparisons with previous years, however, were clouded by the decision to take into account double counting of some jobs in the 2006 figures.

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

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

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

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

From:
http://search.ft.com/ftArticle?queryText=NHS+workers&y;=0&aje=true&x;=0&id;=070426011621

These new NHS staffing levels show that Tony Bliar last year either blatantly lied or was completely incompetent when he claimed last summer that only a “few hundred” NHS staff had been made redundant.

Health Direct last year counted 19,568 NHS redundancies. With more to come.

At the beginning of January 05, 2007 Health Direct posted: Report on NHS staffing angers unions as it predicts 36,000 NHS jobs lost this year

The National Health Service is set to shed more than 36,000 jobs this year before facing “very volatile” changes in its workforce that could leave it with thousands more hospital consultants than it can afford to employ, according to a leaked document from the Department of Health.

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

Official inspection reports reveal that breaches of food hygiene laws include infestations of mice and cockroaches, kitchen staff not washing their hands, food being kept at the wrong temperature and remnants of meals becoming stuck in equipment.

Other hazardous incidents included ice cream and prawns being stored together in fridges and freezers, orange juice kept next to chemicals and patients’ meal trays being used to transport contaminated material from the wards.

The reality of the conditions in which hospital food is prepared is laid bare in a series of official hygiene examinations carried out by environmental health officers, which have been passed to The Observer.

Of 377 National Health Service and private hospitals surveyed in England, 173 – 46 per cent – were found to have poor cleanliness in their kitchens, or canteens or cafes used by staff, patients and visitors. Nine of the 377 were private hospitals, of which six were found to have at least one area of concern.

Eleven of the 173 had experienced a vermin or pest problem, 57 employed catering staff who displayed inadequate personal hygiene and 18 were found to stock out-of-date food. Sixty-eight did not meet the legal minimum standard for food storage and 66 were storing food at the wrong temperature, which can stimulate the growth of bacteria.

‘These findings paint a shocking picture of hospital food hygiene,’ said the Liberal Democrats’ shadow health secretary, Norman Lamb, who used the Freedom of Information Act to obtain from 145 local authorities their most recent food hygiene inspection reports for hospitals they monitor.

‘It is simply unacceptable that such terrible practices are taking place in an environment where hygiene and safety should be paramount. Sick people are already vulnerable to infection. They don’t need the added risk of food-borne bacteria spread by lax standards.’

He suggested the creation of a new system of clear and accessible ratings for hygiene levels in hospital kitchens, with the worst performers being ‘named and shamed’ as a way of driving up standards to benefit patients.

Eight hospitals, including the Royal Hampshire county hospital in Winchester, were judged to have such poor hygiene standards that they were being inspected every six months .

A food handler there was seen to lick his or her fingers, wipe a plate and then eat food from a container while working on the kitchen’s final service line. The inspector’s report said: ‘This practice must cease immediately. The cross-contamination of food in a high-risk business by food handlers’ poor personal hygiene will not be tolerated.

‘If any further breaches are observed, enforcement action will be taken against any individual seen to be breaking statute. In addition, action may be taken against the corporate organisation.’

Six other hospitals were found to have five or more separate areas of concern, such as vermin, poor staff hygiene, inadequate cleanliness and problems with the storage and condition of food.

Inspectors who visited the Mayday University Hospital in Croydon, south London, found pre-cooked chicken being stored next to raw meat in the freezer, used needles and syringes left on meal trays and poor personal hygiene among kitchen workers.

A Mayday spokesman said the hospital had retrained staff and spent tens of thousands of pounds improving 25-year-old kitchens. It recently decided to move to a system under which food will be pre-cooked elsewhere and reheated in ward kitchens.

Neil Fowler, editor of consumer magazine Which?, which investigated hospital kitchen hygiene last year, said: ‘These findings are absolutely shocking.

Hospital kitchens should be the cleanest possible environments because they are catering for people who are trying to recover from serious illness and are at their most vulnerable.’

Andrew Griffiths, policy director of the Chartered Institute of Environmental Health, said the dossier showed poor management at some hospitals had bred inadequate food hygiene standards.

From:
http://observer.guardian.co.uk/uk_news/story/0,,2147195,00.html

And when patients do get their tainted food, a scandalous amount of it is uneaten.

Health Direct posted on Oct 13, 2005 that 17 million hospital food meals are wasted

One in 10 hospital meals is thrown away untouched, according to figures which raise fresh concerns over the hidden scandal of malnutrition among NHS patients. More than 17 million platefuls went into the bin last year, amid complaints from patients’ organisations that elderly and confused patients are not being given the help they need to eat, and that many are missing meals.

A new report from the European Nutrition for Health Alliance warns that one in 10 people entering a nursing home lose five per cent of their body weight within the first month, and more within six months.

Up to 60 per cent of nursing home residents and 40 per cent of those admitted to hospital are malnourished.

The Court upheld NICE’s decision that the drugs are only cost effective in later stage disease. It is the first time a judicial review had been sought on NICE guidance.

Drugs company Eisai brought the case to the High Court with support from fellow drugs firms Pfizer and Shire and the Alzheimer’s Society and are now planning to appeal the decision.

They were successful on one count – that tests to assess Alzheimer’s are discriminatory in people with learning difficulties or those who speak English as a second language.

But claims that NICE did not properly evaluate the impact of the drugs on the quality of life of carers and that the figures on the cost of long term care used in their analysis were too low were not upheld by the court.

The judge dismissed two further claims of irrationality and procedural fairness.

That means patients with early-stage Alzheimer’s will still not be recommended for funding.

NICE guidance in 2001 recommended the drugs – which can make it easier to carry out everyday tasks – should be used as standard.

But guidance published in November 2006, after months of appeals, stated that the drugs should only be prescribed to people with moderate-stage disease.

NICE said the drugs, which cost about £2.50 a day, did not make enough of a difference to recommend them for all patients and were not good value for money.

The Alzheimer’s Society said they had won a very important point that NICE guidance is unlawful because it discriminated against significant groups of people. But called the overall ruling “insulting and devastating news”.

Andrew Dillon, chief executive of NICE said: “Our guidance stands and the drugs continue to be recommended only for people with moderate Alzheimer’s disease, but the court has asked us to clarify our guidance when it is used for certain groups.

Dr Paul Hooper, Managing Director of Eisai UK, said: “The guidance NICE has issued is morally reprehensible. “They are denying patients access to early treatment and that is wrong.”

Harriet Millward, deputy chief executive of the UK’s largest dementia research charity, the Alzheimer’s Research Trust, said: “We are devastated that these drugs will remain unavailable on the NHS to people with early-stage Alzheimer’s when they might benefit from them.

“We urgently need to do more research to find better treatments, but research is currently hugely underfunded – we are scraping for every penny to fund vital work.”

But Mervyn Kohler, Help the Aged special adviser said the ruling represented “some progress”.

“It is important that NICE examines its guidance on these drugs, not just in the light of the ruling today but bearing in mind the public concern which the case has demonstrated.”

Gordon Lishman, director general of Age Concern, said the ruling was disappointing.

“The drugs can cost as little as £2.50 a day per person and could make day-to-day life far more manageable for thousands of people.”

But Professor Richard Gray, director of the University of Birmingham Clinical Trials Unit, said the court made the right decision.

From:
http://news.bbc.co.uk/1/hi/health/6939950.stm

NICE’s Alzheimers drug ban is abhorrent the High Court is told when Health Direct posted on 26 Jun when the health watchdog NICE’s decision to deprive 100,000 mild Alzheimer’s victims of a £2.50 a day drug that can delay the onset of the disease was condemned as “abhorrent and disgusting” in the High Court yesterday.

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.

Patient groups said dentistry needed urgent attention, but the government said it was on a more secure footing.

The new contract was meant to tempt more dentists to work in the NHS by paying them the same money for seeing less patients.

Dentists have long complained that they face a “drill and fill” environment whereby they have to maximise the number of people they treat.

Instead, the new contract was meant to allow them to spend more time with patients to do preventative work, supposedly making NHS work more attractive.

But dentists have been critical of the new arrangements, which also saw a simplified charging system introduced, because of what they say is a lack of money in the system.

The official figures show that there were 21,038 NHS dentists in England at the end of March 2007, down on the 21,111 figure in March 2006.

Although, the contract did end up attracting new dentists into the system because 1,000 dentists left the NHS when the new deal came in to either retire or concentrate solely on private patients.

Difficulties

The government’s report admitted there were “significant challenges ahead” and some areas still had access difficulties.

Liz Phelps, of Citizens Advice, said: “We continue to report huge problems for people trying to find an NHS dentist locally.

“The urgent priority must now be to make the reforms work for patients by funding the new arrangements adequately.”

And Peter Ward, chief executive of the British Dental Association, said: “This is not a picture of success and confidence. The government must start listening to the profession and patients.”

From:
http://news.bbc.co.uk/1/hi/health/6935139.stm

On April Fools day last year Health Direct posted D Day for Dentists- 1,000 dentists expected to quit NHS in new contract row

An exodus of about 1,000 dentists from the NHS in England was predicted last night by the chief executives of primary care trusts, who take over untried and untested management of the service from today.

The NHS Confederation provided the first hard evidence of how patients will be affected by a dentists’ contract that came into effect at midnight.

It said PCT chief executives forecast that 6% of dentists will stop providing free NHS treatment for adults over the next 12 months and 5% will withdraw NHS treatment for children.

Nearly 20,000 dentists were paid for NHS work last year, according to official figures from the Dental Practice Board. But the board’s total included many dentists who also did private work and there was no reliable estimate of the number of patients who could be affected.

Last year Health Direct warned that the labour government may have to review the contract in 2007.

Peter Ward, chief executive of the British Dental Association, said many dentists were signing the new contract while continuing to dispute the terms.

“The profession recognised the need for change from the old system which, in the words of the Audit Commission, put dentists on the treadmill. But the new contract is target-driven and untested, and the fear is that it won’t give time for more preventive care.”

They were informed about the plans on the same day that Health Secretary Alan Johnson told the House of Commons he would limit the role of the private sector in the NHS.
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Mr Johnson, who visited Kingston with Prime Minister Gordon Brown at the end of June, made an announcement on July 25 that he would halt the expansion of the Government’s “stand alone” private surgery centres.

The centres were set up in an attempt to cut NHS waiting lists, but instead attracted criticism over costs and quality of care.

Shadow Health Secretary Andrew Lansley accused him of indulging in a “spin operation” to reassure the concerns of those opposed to the use of the private sector, while actually extending its involvement in the NHS.

But Liberal Democrat health spokesman Norman Lamb warned: “The Government’s fingerprints appear to be all over this.

“It is impossible to imagine the new Prime Minister and Health Secretary would not have known about this, so one must assume it is a pilot to explore new ways of bringing the private sector into the heart of the NHS.”

Staff have been told that the survival of the hospital can only be secured if a private sector company with “significant experience in marketing” is brought in to run services and attract patients from further afield.

Although a new tier of private managers will be enlisted under the contract, the hospital claimed existing NHS managers will not lose their jobs.

Doctors and nurses will remain on NHS contracts, though their “working practices” may change.

Some hospital staff said they were unclear how a private company would turn a profit.

Midwife and Unison branch secretary Nora Pearce said: “We have been told that our terms and conditions will be the same and that the facilities will be the same, so how are they going to make money? These companies aren’t there to be altruistic.”

Geoff Martin, campaigns director at pressure group London Health Emergency, said Kingston was planning “NHS privatisation on a far wider and deeper scale than we have ever seen before”.

He said the Government was guilty of “rank hypocrisy, to suggest it was rowing back on use of the private sector when a major trust is embarking on privatisation on an unprecedented scale.”

The British Medical Association’s consultants committee described the initiative as a “very significant” step.

Deputy chairman Alan Russell said the scheme “crossed a line,” with the private sector replacing NHS services rather than simply helping to bring down waiting lists.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/05/nhs105.xml

Health Direct asks if Alan Johnson is the latest in a long line of labour Health minister who have been caught lying to Parliament?

On 26 July 07 in Alan Johnson blocks new wave of private health clinics it appeared that the health secretary, Alan Johnson, yesterday vetoed plans for a third wave of independent sector treatment centres to compete with NHS hospitals.

However the privatisation of Kingston’s operating theatres seems to contradict the Health Secretary’s promise to the House of Commons.

One of Britain’s leading trauma surgeons has broken cover to expose the scandal of a national shortage of emergency trauma beds which is leading to thousands of serious injury victims suffering in agony.

In an unprecedented intervention by a senior practitioner in the NHS, Martin Bircher, a consultant at St George’s hospital in London, one of Europe’s leading centres in the treatment of major accident victims, has revealed a system paralysed by red tape and disputes over funding, which is putting thousands of patients waiting for treatment in specialist wards at risk.

His revelations have prompted calls for a review of funding for A&E; services and a shake-up in the management of Britain’s leading trauma centres.

Mr Bircher says the problem is worsened by the bureaucracy of the internal market. He has become so frustrated that he has broken free of NHS strictures against speaking to the press and agreed to talk to The Independent on Sunday about the suffering patients are put through.

Every one of Britain’s specialist trauma beds is full, which means some patients can wait up to three weeks after their accident before badly broken bones can be repaired. The delay, says Mr Bircher, can jeopardise recovery.

With nothing but praise for frontline staff, he says patients who have been critically injured in road or other accidents have to wait an average of 12 days – often in agonising pain – before they can receive the vital specialist treatment.

This is because only a limited number of hospitals have the expertise to repair smashed bones, and those hospitals have a shortage of intensive care beds. With the average cost of keeping a trauma patient at around £500 a day and up to £2,000 a day in intensive care, this is also a false economy.

Reacting to the revelations Andrew Lansley, the shadow Health Secretary, said: “It is vital that clinicians are able to prioritise patients according to clinical criteria. It’s only if we dispense with central targets and the bureaucratic burdens of the Department of Health that we can give GPs and local hospitals the opportunity to make services more efficient.”

John Pugh, the Lib Dem health spokesman, added: “This shows how counterproductive the target culture is. Patients are being shunted in and out of A&E; to satisfy the expectations of Whitehall. Medical staff should feel free to act in the best interests of patients.”

Squabbles over funding

Mr Bircher, who risks censure from the NHS for speaking out, said primary care trust and bed managers are involved in making the final decision as to whether a patient can be moved. If they have to move them there is often a conflict or reluctance because the new area does not want an extra cost.

So after initial admission to a general hospital’s emergency wards, where lives are saved, patients can find themselves waiting up to three weeks before their real recovery process can begin.

Mr Bircher, 52, cited one patient who had a motorcycle accident earlier this month and was referred to him to decide if she needed surgery to repair her badly broken pelvis. However, he did not receive the request for a week because an initial referral to another hospital was “intercepted by the primary care trust” and rerouted to a hospital that did not have a surgeon with the expertise to make the decision.

He called for emergency medicine to be funded centrally.

“These are basic core services that have to be provided,” he said. “We shouldn’t be sending each other little bills. Trauma and other emergency services like cardiac and stroke services should be top sliced. The money should come from central government funds.”

Mr Bircher added that doctors and nurses on the frontline in hospitals should not be criticised. He said they do their best but are hampered by layers of managers whose major concern is the budget rather than patient care.

Delays in treatment

He said: “The delays are caused at various levels. If doctors, nurses, physiotherapists, the treating teams, were left to communicate between themselves without bureaucracy, things would happen much more quickly. In the good old days somebody would ring me up about a patient, I’d say send them across, make one call to sister on the ward and it would happen.

“Now I’m loath to accept a patient unless I’m sure their injury requires surgery. If I’m unsure I ask them to send X-rays. Even in this technological age this can take two or three days. It’s not unusual for them to be delayed or get lost.

“It may be decided that the patient needs an operation and we decide to bring them in. There can still be a delay because bed managers are reluctant to accept a patient for three or four days before the operation is due because of the extra costs. So the patients often come in just hours before the operation. It is not unusual for a patient to arrive in the early hours of the morning, a very short time before their surgery.

“You suddenly find the patient may develop a problem and you can’t operate. So you’ve accepted a patient for a slot and then you can’t operate. A much better system would be to have a free flow of patients to the trauma centre where we can get to know them preoperatively. But because trusts all have separate budgets, though we’re all playing for the same team, there seems to be a reluctance to accept patients at an appropriate time before the operation.

“You can argue whether a patient needs a hip replacement at hospital x or y,” he added. “As long as it’s done in a reasonable time by a good team it doesn’t matter. You can’t have these petty squabbles. There just isn’t time with trauma.”

Patients in pain

His argument is illustrated by Lucy Lynn-Evans, a 21-year-old student from London who was severely injured in a road accident last month. She was riding her scooter to Brighton when she was run over by a 10-tonne lorry which came to rest on her hip. She is alive only because a laptop in her backpack took the full force when the lorry ran over her spine.

Her life was saved a second time by the staff at Redhill hospital, where she was initially taken with a smashed pelvis, smashed knee and leg broken in two places. They gave her a blood transfusion – she had lost five pints – and wrapped her hip, described by doctors as a “bag of crisps”, in a sheet which was then pulled tight to keep the fragmented bones together.

This is the correct procedure. But Redhill hospital did not have the expertise to repair Ms Lynn-Evans’s bones. That would require specialist surgeons and equipment that can be found only in certain hospitals around the country. All they could do in Redhill was put her on morphine and wait for a bed – which at one point she was told could take up to three weeks.

Her pain was so intense, however, that the morphine “only took the edge off it”. “I was in a lot of pain, especially when they log-rolled me to change the sheet,” Ms Lynn-Evans said from her hospital bed at St George’s on Thursday. “It took four people to turn me. The nights were horrible. The mornings were really painful. The three weeks of waiting is an extra three weeks of pain. You just feel like you’re going mad. You feel black and despairing. You want with all your heart for someone to make it better. I asked Dad to leave me outside the hospital because then it would be more likely I’d get a bed, rather than waiting by the phone. I felt despair, lying there feeling empty and feeling that I had to tackle this day by day for weeks.”

Lack of beds

Ms Lynn-Evans’s problem was that she was stable and not going to die; when a bed became available it would go to another more pressing case. At one point a bed became available at the John Radcliffe hospital in Oxford, but before she could be moved John Radcliffe’s fund manager had to agree. The fund manager did not arrive at work until 9.30am. By the time Ms Lynn-Evans’s case came to the top of the administrator’s pile and permission was granted, the bed had gone.

Fortunately for Ms Lynn-Evans her mother, Julie, is a psychotherapist who works in child mental health. She is also a broadcaster with a string of top NHS officials in her contacts book. She was able to make a fuss where it counts, and her daughter was moved to St George’s hospital in London after only five days.

“Because of the problems with the beds I didn’t know where to go to after the accident,” Julie Lynn-Evans said. “Lucy was taken to Redhill on the Friday and they saved her life. I cannot thank the doctors enough. But they knew they didn’t have the expertise to fix her so I was told not to go to Redhill because they were going to move her. Then at 4am I was told to go to Redhill after all. I’d spent the whole time living through a mother’s worst nightmare and yet unable to go to my child.

The same night as Lucy, a woman came in from a car crash. She was 63 and had a clot in her lung. Lucy was considered stable, so the woman got her bed. All the time Lucy’s having no treatment. As a mother you’d do anything to help your child when you see them in so much pain. But I know that in securing a bed for Lucy, someone else had to wait longer.”

Fortunately Lucy is going to make a full recovery, which she and her family put down to the excellent care they have received from surgeons, nurses and doctors at both St George’s and Redhill hospitals. The delays, however, caused by bureaucracy and a shortage of beds, could have led to a very different outcome.

“The delays not only cause distress to families and patient, but other serious medical issues – thrombosis, bed sores, chest infections and urine and wound infections,” said Mr Bircher. “The longer the bone fragments are left displaced, the more the clot begins to form new bone, thus the harder it is to replace the fragment to the correct position.

Patients suffer

“The first step to dealing with the problem is an acceptance and realisation that the system isn’t working with trauma and other emergency services in medicine. Sending each other forms and bills is not a good way of doing it. I’m acutely aware that resources are an issue. But basic emergency services should be of the highest quality. If we consider ourselves a leading nation we should have a first-class emergency healthcare system. We do not, and the situation is worsening.

“It’s pot luck where you go. There’s not a defined system. We have to fight every day to get patients in. We have to break through the bureaucracy and develop a new system. There is a lack of intensive care beds in London and around the country which further magnifies the problem.

“Direct funding from the centre, perhaps cutting out the trusts, is perhaps a good idea. One must involve clinicians at the sharp end in the decision-making. Like the Bank of England the politicians should let it go. Doctors, honestly, know best.”

Dermot O’Riordan, a member of the council of the Royal College of Surgeons, agreed that a number of services – not just trauma – needed commissioning at a higher level and in some cases co-ordinating nationally, although not necessarily centrally funding.

Mr O’Riordan, the RCS council member responsible for the Delivery of Surgical Services Committee, said: “Commissioning of very specialist services, whether elective or emergency, needs to be done at a higher level than a primary care trust. Some need to be co-ordinated by the strategic health authority and some even at national level.”

From:
http://news.independent.co.uk/health/article2814751.ece

Other schemes run by PCTs have offered GPs payments if they reduce the number of patients sent to hospital.

Of 750 doctors polled across Britain, 75 per cent said they had referred patients to hospital only to have their decision overruled, with 40 per cent saying that it happened regularly. Dr Laurence Buckman, the chairman of the British Medical Association’s GP committee, himself a London family doctor, said such schemes were a short-sighted attempt to save money by delaying hospital care.

“If I think my patient needs to see an orthopaedic surgeon, the chances are they do,” he said. “These kinds of schemes just set up an extra layer, which delays the patient getting to see the right person.”

Dr Buckman said he believed the schemes were “simply about saving money” by delaying hospital bills. “Most PCTs are on the verge of bankruptcy and if they can find a way to defer payment until the next quarter, or next financial year, they will,” he added.

Norman Lamb, the Liberal Democrat health spokesman, said that GPs in his North Norfolk constituency had complained to him after referrals for teenagers requiring psychiatric help were delayed, while local PCTs had introduced “minimum waits” for surgery in order to push hospital bills into the next financial year.

He warned: “Patients will be confused. They will trust their GP to make the right judgment and when their referral comes back, they can only assume it was for financial reasons.”

Katherine Murphy, from the Patients’ Association, said her group was hearing a growing number of complaints from orthopaedic patients who believed their health had worsened after they were diverted for treatment by a physiotherapist when their GP had intended them to see a surgeon. She described the policy as “a prime example of deficits putting lives at risk”.

Paul Rybinski, a GP in Croydon, Surrey, said doctors were under increasing pressure to reduce hospital referrals to save NHS funds. His own practice has a referral cuts target of 5 per cent.

Dr Rybinksi said he feared “referral centres” would make decisions based on very partial knowledge of the patient. “When I make a referral it is based on a complex decision relating to the individual in front of me. It is very difficult for a panel at a PCT to second-guess what I was thinking, and the factors I was taking into account, based on a reading of a basic referral letter.”

The poll, by Pearl Medical, which provides mobile communications to GPs, also found that doctors strongly opposed Government plans to create networks of “polyclinics”, replacing individual GP surgeries with huge group practices, serving populations of 50,000.

Earlier this month, a blueprint was announced for 150 such clinics across London, in a model expected to become more widespread. Only 12 per cent of GPs polled thought this would improve patient care.

Asked whether the NHS would be better off under Prime Minister Gordon Brown or a government led by David Cameron, the Tory leader nudged ahead among GPs, by 4 per cent. While most family doctors were unconvinced of the merits of either, 23 per cent rated a Cameron government as good for the NHS, compared with 19 per cent who preferred Mr Brown.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/29/nhealth129.xml

It comes after Health Direct and The Daily Telegraph revealed that eight out of 10 hospitals were cancelling operations ahead of the handover and three quarters were postponing outpatients

The online Medical Training Application Service (MTAS) was abandoned in May due to technical faults and a failure to identify the best candidates.

Around 1,000 posts remain unfilled and round two of the process to fill specialist training posts will continue, under the old paper-based CV system, until October 31.

Consultants have reported being unable to plan operating lists, because they have had no idea which junior doctors will be on their team, or what skills they will have. Junior doctors have not been told the hours they will be working or what time to arrive today, or even at which hospital they will be working.

Hospital managers are having to employ expensive locums or risk shortages as doctors leave for their new jobs and some doctors have been employed in roles for which they are overqualified.

Dr Ian Wilson, deputy chairman of the BMA consultants committee, said: “Any forward planning has been impossible. It’s inevitable that more operations and clinics will have to be postponed.”

Officials at the Department of Health have been keen to point out that hospitals are well practised in planning for the August 1 changeover, which happens every year, but have acknowledged that fewer posts have been filled this year than is normal.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/01/ndoctors101.xml

Last week Health Direct posted: MTAS disaster- Labour’s botched NHS plan when the Medical Training Application System (MTAS) junior doctors appointment fiasco still produces fury in the health profession. Why? And how did labour’s defective system get passed in the first place?

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.

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

On 30 Apr 07- Health Direct wondered whether amongst all of their fiascos the
MTAS- Conntender for the greatest of all Labour’s NHS failures- the Junior Doctor application system was the depth.

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?

Agenda for Change, as the deal was known, covered all NHS staff except doctors and some managers, producing a set of pay scales and a training programme that has, to date, helped to head off highly expensive equal pay claims.

It aimed to ensure fair pay and a clear system for career progression, allowing staff to be paid on the basis of the job they do and their skills and knowledge rather than job titles.

But overall “there are few signs as yet that it has delivered increased productivity or transformed practice, and there is evidence that, despite the extra cost, many staff are far from satisfied by the process,” the report says.

“Managers [also] complain that the knowledge and skills framework is too cumbersome and costly to implement.”

“Patients will never feel the intended benefits unless health service leaders secure changes in the working patterns and productivity of more than a million nurses and other staff,” the study warns.

The deal took almost four years to negotiate and more than three years to implement, with some issues, such as an agreement over unsocial hours, still unfinished.

It exceeded cost estimates by hundreds of millions of pounds – by £220m in 2004/05 alone, and possibly by more in later years, the report says.

The latest forecast is that it will have cost £2.2bn to implement. Yet staff recorded lower levels of satisfaction at the end of the exercise than when it started.

The deal has significantly boosted pay, according to findings based on case studies at 10 NHS trusts and interviews with officials, union representatives and managers.

The scales it has introduced will continue to raise pay further even as the growth rate of NHS spending falls, the report says.

Managers at the 10 hospitals said it would take another two to five years to get the long-term benefits for patient care that the deal was meant to bring.

Even then, several cautioned that slower growth and the extra costs of the system meant that “full benefits realisation would be challenging and problematic”.

Without further central government pressure, “opportunities will be lost”, one union official warned.

From:
http://www.ft.com/cms/s/52bc8fa6-3e30-11dc-8f6a-0000779fd2ac.html

The report from the Kings Fund matches Health Direct view of labour’s waste in the NHS.
On March 02, 06 in Why is NHS productivity falling yet Labour claims it could be rising?

The Office for National Statistics started a fierce disagreement over output and productivity in the National Health Service this week as it launched a consultation into the issue. The ONS reported that different techniques could show NHS productivity rose by 1.6 per cent a year between 1999 and 2004 or that it fell by 1.5 per cent a year. Official figures show a decline of close to 1 per cent a year.

A number of labour government assumptions were questioned in the report.

The Department of Health, for example, found that increased use of statins, the drugs used to lower cholesterol, extended and improved patients’ lives so much that NHS output growth should be measured as 0.81 percentage points higher than previously.

If this assumption was included in NHS output, it should not improve the NHS’s productivity substantially because the gains were largely attributable to pharmaceutical companies.

Another problem was the Department of Health’s assumption that patients’ satisfaction at cleaner hospitals has as much weight in its calculations as the NHS’s ability to save lives. Andrew Street, a senior research fellow at the University of York, said there was no “empirical basis for the weights” the department used.

The proposed cuts, phased over the next three years, would hit the “Pooled Treatment Budget” (PTB), the Government’s main funding stream for drug treatment, which for this year is £398 million.

Alison Keating, the acting regional manager for the Government’s National Treatment Agency in the South East, disclosed the scale of the proposed cuts in an email sent to colleagues across the country.

Admitting that there have been “some understandable concerns” about future levels of funding, she adds: “Initial indications have been that there will be a £50 million cut over the three years.”

The period involved is 2008 to 2011, the years covered by the Comprehensive Spending Review of government funding to be announced in the autumn by Alistair Darling, the Chancellor.

The PTB receives its funding from the Home Office and the Department of Health. Any cuts will awaken fears that overall expenditure on health and crime will suffer in what is already expected to be a tough public spending round.

The PTB channels money to locally based Drug Action Teams which make funding decisions partly based on deprivation levels. The teams, of which there are 150 in England, then commission services in their area.

Spending on drug treatment programmes is seen as politically sensitive because of the links between drug-taking and crime. Mr Brown this month signalled a clear about-turn from the Blair era, as well as making a strong appeal to Middle Britain, by announcing a review of the contentious decision taken by David Blunkett, the former home secretary, three years ago to downgrade cannabis from Class B to Class C.

Labour government sources made it clear that Mr Blunkett’s decision was likely to be reversed. The announcement was quickly followed by a string of cabinet ministers including Jacqui Smith, the Home Secretary, admitting that they had tried cannabis in their youth.

Chris Grayling, the shadow work and pensions secretary, said last night: “When he was chancellor, Gordon Brown always used to hide the bad news in the small print. Now he’s Prime Minister, we’re finding the same thing.

“He’s been making high profile announcements, like his war on cannabis, but the reality is very different. This reeks of hypocrisy.”

Martin Barnes, the chief executive of the charity DrugScope, said: “It is extremely concerning that the expectation among officials is of cuts in funding. The Prime Minister has spoken of the need to improve drug treatment, but this is difficult to reconcile with behind-the-scenes discussion of cuts being on the table.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/29/nbrown129.xml

On Aug 02, 06 Heath Direct posted- Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

Health Direct reproduced the first ranking based upon scientific evidence of harm to both individuals and society. It was devised by labour government advisers – then ignored by labour ministers because of its controversial findings.

The analysis was carried out by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council. Copies of the report have been submitted to the Home Office, which has failed to act on the conclusions.

The rankings concluded that Alcohol (Legal) was ranked at number Five, Tobacco (Legal) at number Nine and Cannabis (Class C) at Number 11.