Latest figures show there were 1,072 cases of the superbug in England from July to September last year. This approaches the target of half the 1,925 average quarterly 2003-4 figure, but ignores the seasonal fluctuations.

But the Tories and Lib Dems accused ministers of moving the target back so it takes account of the period directly after the £50m deep clean of hospitals.

The latest quarterly figure represents an 18% fall on the previous quarter and comes after steady falls since September 2006. Decreases have also been seen elsewhere in the UK.

“There are too many people suffering from these infections. It is terribly important that trusts maintain the pressure.” Murray Devine, of the Healthcare Commission

In 2004, the then health secretary John Reid set a target of halving the rates by March 2008. But last year a leaked Department of Health memo suggested the goal was likely to be missed.

But the precise details of the target were never set out at the time and the labour government has now told the BBC News website it will consider it met if there are 963 cases or less in the quarter April to June.

Shadow health secretary Andrew Lansley said: “It appears the government are selectively choosing data to try and fix an outcome. It’s no coincidence that the time frame they selected is after hospitals finish their deep clean programme.”

Lib Dem health spokesman Norman Lamb said: “This is disturbing evidence of the government manipulating figures to hit a target. “By shifting the numbers around in this way, they are far more likely to hit a target which had previously seemed out of reach.”

Labour has denied manipulating the figures – pointing out measuring a period earlier than April to June would give a rate before the target date of the end of March.

The latest hospital infection figures from the Health Protection Agency also showed that Clostridium difficile rates were falling.

There were 10,734 cases of C difficile in patients aged 65 and over in England between July and September 2007.

This was a 21% decrease on the previous quarter, when 13,669 cases were reported, and a 16% drop on the same period in 2006.

Labour has set a target of reducing C difficile by 30% over the next three years.

Murray Devine, head of safety at the Healthcare Commission, which inspects hospitals on infection, prevention and control, said: “MRSA is clearly moving in the right direction and the signs on C difficile are encouraging.

From:
http://news.bbc.co.uk/1/hi/health/7215551.stm

Immigration has raised the birth rate so fast that some units have closed, so that midwives could be moved to areas of urgent need. A unit in Ascot, Berkshire, shut for two months in 2007 because staff had to be transferred to Slough.

The NHS says it is working to “build in” the extra capacity needed.

Maternity units have turned expectant mothers away because they could not cope with unprecedented increases in the local birth rate.

When Labour came to power, the NHS spent around £1bn a year on maternity services, with one baby in eight delivered to a foreign-born mother.

Ten years on, spending has risen to £1.6bn, with almost one baby in four delivered to a mother born overseas.

While the number of babies born to British mothers has fallen by 44,000 a year since the mid-1990s, the figure for babies born to foreign mothers has risen by 64,000 – a 77% increase which has pushed the overall birth-rate to its highest level for 26 years.

In central London, where six out of every 10 babies born has a foreign-born mother, senior consultants and health managers blame the lack of resources to deal with the pressures of migration for unacceptably poor standards.

Professor Philip Steer, editor of the British Journal of Obstetrics and Gynaecology, said: “The Department of Health has been taken by surprise. The demographic change, the sheer numbers, has in some areas increased very substantially without there being any forward planning really to allow for that.”

According to figures from the Office for National Statistics, in 2006 there were 15,000 more Eastern European babies born here than a decade earlier.

The statistics go on to show that 11,000 more babies were born to a mother from the Indian sub-continent, while 8,000 extra babies had mothers born in Africa.

Heatherwood Hospital in Ascot closed its maternity unit for two months in the summer of 2007 because of an “unprecedented increase” in the local birth rate.

Midwives were moved to Wexham Park Hospital, closer to the pressure-point of Slough where in the last year staff have witnessed an extra 150 babies delivered to foreign-born mothers.

The knock-on effect was experienced in nearby Reading where the local maternity unit could not cope with the extra demand.

Tharlie Cooper was supposed to have been born in Reading, but when mother Lavina went into labour two weeks overdue she was told that, despite her being booked in, her local birthing unit was full.

Tharlie’s father Dean was furious. “Basically we got turned away and the reply I got on the phone was wherever you ended up is where you end up”, he said.

He drove his wife to Basingstoke in neighbouring Hampshire where doctors conducted an emergency caesarean.

LIVE BIRTHS BY COUNTRY OF BIRTH OF MOTHER
Births by British-born mothers down 44,000
Births by all foreign-born mothers up 64,000
Births by mothers born in Eastern Europe up 15,000
Births by mothers born in Indian subcontinent up 11,000
Births by mothers born in Africa up 8,000
Source: ONS/BBC

Peterborough has seen a huge increase in births from Eastern Europeans. There were just three such babies in 2000, but almost 200 in 2006.

At the Thistlemoor Medical Centre, births among patients have increased 33% in just two years. GP Nalini Modha fears the authorities have not planned for the new arrivals.

“Hopefully somebody who is in authority is actually looking at the figures to try and work out how they’re going to cope with the influx” she said.

“If you’re going to provide responsible care for all the population – the indigenous as well as the newcomers – then we will have to stop and think about what we can and can’t afford.”

In parts of Greater London, seven out of 10 babies are now delivered to mothers born overseas.

The Strategic Health Authority argues that this partly explains why maternity services in the capital performed so poorly in last week’s Healthcare Commission report.

Births within migrant groups can often be more difficult, more dangerous and more expensive – with much higher rates of type 2 diabetes, tuberculosis and HIV among mothers who often turn up very late in their pregnancy.

London’s chief nurse, Trish Morris-Thompson, admitted that the NHS had not realised how immigration would affect maternity services.

“The timing of the impact is much quicker than we had anticipated”, she said. “We’re working with our commissioners and our maternity providers now to ensure that we’re building in the capacity they need.”

From:
http://news.bbc.co.uk/1/hi/health/7215624.stm

But Lord Darzi said the labour government was committed to single sex accommodation whereby wards are divided into male and female bays by fixed partitions.

Labour promised to end mixed-sex accommodation in England by 2002, but that has still not been met. Campaigners have called for single-sex wards, saying fixed partitions do not give patients enough privacy.

Lord Darzi, a practising surgeon who is currently conducting a review of the NHS in England, told the House of Lords single-sex accommodation should be the “norm”.

“The only way we’re going to have single-sex wards within the NHS is to build the whole of the NHS into single rooms. That is an aspiration that cannot be met.”

But his claim drew an angry response from patient groups.

Katherine Murphy, from the Patients Association, said: “We want to see entirely single sex wards, not accommodation.

“Otherwise patients still have to share bathroom and toilet facilities with members of the opposite sex, and will have members of the opposite sex walking past them on their way to use these facilities.”

Ministers were insisting as recently as November 2006 that 99% of patients were being seen in single-sex accommodation.

But a report by chief nursing officer Christine Beasley last year – commissioned after patient surveys cast doubt on the claims of ministers – showed 15% of hospitals needed more help achieving this.

From:
http://news.bbc.co.uk/1/hi/health/7213836.stm

On Dec 28, 2007 Health Direct posted confirmation of another labour lie in Labour U turn on mixed sex hospital wards. Labour has abandoned its key manifesto pledge to eliminate the controversial practice of mixed sex wards, it has emerged.

The U-turn comes after more than a decade of Government promises, made at the 1997 election and repeated in 2001, to bring an end to male and female patients sharing facilities in NHS hospitals.

Figures reveal that 31 pc of NHS trusts admit to having fully mixed wards – without any form of partition

Patients’ charities have argued for years that mixed-sex wards are undignified, degrading and put women at risk of attack from male patients.

A number of female patients in recent years have been the victims of assault from men in mixed-sex wards.

Figures obtained by the Conservatives under Freedom of Information laws showed that nearly a third of hospitals are still treating men and women in the same wards.

This is almost double the amount stated in a report released in May by the Chief Nursing Officer.

Colette Mills has been told by doctors that in the four months since she asked for the drug the disease has taken such a hold in her body that the cancer will no longer respond to the treatment.

She is the victim of a ruling which states that any patient who wants to pay for additional drugs not prescribed by the NHS should lose their entitlement to their basic NHS cancer care and pay for all their treatment. She was prepared to pay for the drug but not her whole treatment.

Mills, a 58-year-old former nurse, said: “I am just absolutely gutted. I just cannot believe people make these decisions about other people’s lives. It wasn’t going to cost them. I was going to pay for it. How can they say this policy is far more important than somebody’s life?

“The NHS has taken this opportunity away from me and, if they are doing it to me, they are doing it to a lot of other women as well.”

The labour government claims that to allow some patients to pay for additional drugs on top of their NHS treatment creates a two-tier system between those who can and cannot afford them.

Asked about her future prospects, Mills said: “They are not hopeful of halting it. They will give you no promises. I didn’t ask and he [the doctor] didn’t say. It is not something I want to know just yet.”

Mills, a mother of two, launched a legal action to try to force the NHS to allow her to pay for the drug Avastin which she wanted to take alongside another medicine, Taxol, which is prescribed by the health service.

But during her four-month battle with the NHS, the breast cancer has spread to other parts of her body and doctors have told Mills it is too late for her to benefit from the combination of Avastin and Taxol.

An American trial has shown that taking the drugs in combination doubles the chance of preventing the disease from spreading compared to taking Taxol on its own. Taking Avastin in addition to Taxol is also likely to keep the disease under control for almost twice as long. Leading oncologists say Avastin offers a small but significant advantage in treating breast cancer.

Mills will now be prescribed an alternative medicine but does not know how successful this will be in stopping the cancer.

Several other cancer patients are also taking legal action to win the right to pay for medicines that are not available on the NHS. The patients’ lawyer, Melissa Worth, of the law firm Halliwells, said: “Colette has been told by her medical team that she may have missed her chance. “

“If she had been given the opportunity to take the Avastin when she first contacted her medical team about it, then she would have had three months’ treatment by now. Months down the line, the policy will need to change but for those patients currently fighting their NHS trusts, it might be too late.”

Becoming an entirely private patient would have cost Mills, from near Stokesley, North Yorkshire, about £10,000 a month instead of about £4,000 solely to pay for the Avastin and its administration.

Although she could have tried to raise the funds such as finding a loan, she believes it is a fundamental principle that the NHS should continue to fund her basic care for which she has paid through her taxes.

The Department of Health, however, said top-up payments would “undermine” the “fundamental principle of the NHS, now supported by all the main political parties, that treatment should be free at the point of need”.

Mills’s case has provoked a national debate about whether NHS patients should be allowed to pay for top-up treatments.

NHS chief executives, the Patients Association, Doctors for Reform and Saga, the organisation for the over-fifties, have all backed Mills and other patients in her situation since The Sunday Times and Health Direct highlighted their plight last year.

A group of Conservative MPs, including former shadow health minister John Baron, are campaigning for co-payments to be allowed.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3257529.ece

Health Direct finds it scandalous that the labour government is letting voters die just to save the NHS money.

The labour government wants to avoid a two tiered health system, but this is precisely what we have, not least as some have private health insurance and most of us do not. Their argument just does not work.

Health Direct can hardly understand why it is that the government would rather its citizens die in situations where they could receive treatment (albeit at private expense) all to satisfy the ideological goal of avoiding a two-tiered healthcare system.

Since it is clear this already exists with widespread healthcare postcode lotteries which they are creating- how many more people will die at Gordon Brown’s hands?

A similar proportion of hospitals fail to carry out proper ultrasound scans to check for problems affecting developing babies in the womb, the Healthcare Commission said.

Official guidelines recommend that at least 11 checks should take place, including studying the baby’s heart function, length of spine and the development of its face and lips.Yet the report found that only 61 per cent of scans performed by NHS trusts include all such checks recommended by the National Institute for Health and Clinical Excellence (NICE).

In addition, only 11 per cent of trusts were meeting screening standards for Down’s syndrome, which were updated by NICE in April 2007. The remaining women could be receiving insufficient information about the health of their child before birth, the Commission said, potentially putting themselves and their babies at risk.

Critics said that mothers and babies were not getting the high quality care they deserve.

The study found that 63 out of 148 (42 per cent) trusts with full maternity services in England were performing poorly or fairly. Poor performance and regional variations in care are largely linked to staffing shortages, the watchdog suggests.

The commission ranked 21 per cent of trusts as “least well performing”, 22 per cent “fair performing”, 26 per cent “best performing” and 32 per cent “better performing”. A survey of more than 26,000 mothers was included as well as data from NHS trusts. The Commission gave warning that some trusts had been unable to supply full information.

Norman Lamb, the Liberal Democrat health spokesman, said: “It is simply unacceptable that one in five maternity units is putting mothers and babies at risk.”

Dame Karlene Davis, of the Royal College of Midwives (RCM), said that Britain remained among the safest countries in the world in which to give birth.

Findings
48% of the trusts performed poorly or fairly
1 in 3 women did not have a named midwife
10,000 midwives needed to improve quality of care
Source: Healthcare Commission

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3248136.ece

Alan Johnson, the Health Secretary, had been critical of the decision to award Rose Gibb a pay-off of half of her annual salary when she left Maidstone and Tunbridge Wells NHS Trust.

Ms Gibb left the trust by mutual agreement last year after a damning report from the Healthcare Commission revealed appalling hygiene standards, leading to at least 90 deaths.

Today, however, the trust board said it had determined to pay her the minimum to which she is entitled by law – six months’ pay in lieu of notice. Her salary was £145,000 to £150,000 a year, the trust said.

Ms Gibb could contest the payment, claiming unfair dismissal, so the argument may not yet be over. The trust said it had taken legal advice “and, following that advice, she will be paid only her legal entitlement of six months salary.”

The report said “significant failings” at all levels contributed to more than 1,000 patients being infected with the bug across three hospitals run by the trust.

Inadequate staffing levels, dirty wards and too much focus on debts and labour Government targets all contributed to two serious outbreaks of C diff in the autumn of 2005 and early 2006, the study said.

Nurses were found to have told some patients with diarrhoea to “go in their beds”. The affected hospitals were the Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital.

Former Bucks Fizz star Cheryl Baker has previously called for Maidstone Hospital to stop admitting patients who were vulnerable to C diff. Her mother-in-law Doreen Ford, 77, died there from septicaemia while infected with the bug.

The Trust was the subject of an undercover BBC investigation in May 2004 – months before the 2005 and 2006 outbreaks of C diff.

It found evidence of blood stains ingrained on the floor and clinical waste skips containing bags full of old dressings and bodily fluids left open in corridors used by visitors and patients.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3247289.ece

The patients say the NHS will be breaching their human rights if it withdraws the treatment they are receiving.

Two of the patients, Colette Mills, 58, a former nurse from near Stokesley, North Yorkshire, and Debbie Hirst, 56, from St Ives, Cornwall, who both have breast cancer, have been told they will be made to foot the entire £10,000 monthly bill for their care if they attempt to pay privately for an additional drug, Avastin.

Ministers claim that to allow patients to pay for top-up drugs would be unfair to those who cannot afford them and lead to a two-tier NHS. The health department has issued guidance to NHS trusts warning that such co-payments are not allowed.

However, the patients’ solicitor, Melissa Worth of the Manchester law firm Halliwells, said NHS trusts would be breaching several articles of the 1998 Human Rights Act if they withdrew chemotherapy treatment. Worth also argued that in withdrawing treatment NHS trusts would undermine the National Health Service Act of 1977.

She said: “In light of the indisputable obligations of the trusts to provide life-sustaining treatment when there is a known, real and immediate risk to life, there is no legal justification for the trust threatening to withdraw all free treatment should our clients wish to maximise their chances of survival by complementing the treatment they are receiving by receiving Avastin.”

NHS chief executives, the Patients Association, Doctors for Reform and Saga, the organisation for the overfifties, have all backed Mills and Hirst since The Sunday Times highlighted their plight last month.

This weekend they were joined by one of Britain’s leading breast cancer consultants. Professor Ian Smith, head of the breast cancer unit at the Royal Marsden NHS Foundation Trust, said: “I am very sympathetic to the case of these patients. We are looking after patients with life-threaten-ing diseases and it is difficult enough telling them they cannot get the drug on the NHS without needing to then say: ‘Even if you are prepared to pay for it, you still cannot have it.’ This creates a very emotionally fraught situation and seems very harsh.”

Politicians have also pledged to campaign for a change in policy. John Baron, a Conservative MP and former shadow health minister, said: “It is absolutely wrong for the NHS not to allow tax-paying patients to top up their treatment if they so wish. Why shouldn’t patients make that extra payment for a drug that could be life-saving? This is unfair and the government should be ashamed.”

The health department said: “It is a fundamental principle of the NHS, supported by all the main political parties, that treatment should be free at the point of need. Co-payments would undermine this.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3137669.ece

Health Direct asks Why shouldn’t patients pay for any “extra” treatment? If we have money it is because we worked for it and are entitled to spend it as we wish. Why the big brother attitude of fairness?

Why should all suffer for the few as usual who have spent their earning on other things and have ensured that “the state must now keep them”. Isnt that a selfish attitude? Having cancer isnt selfish and I bet the people who created this silly philosophy haven’t got cancer.

If they eventually get it, as statistically twenty five per cent of us will, Health Direct wonders if they will turn to private treatment to help save their lives! Cancer patients should be allowed to spend their OWN money exactly as they choose.

Wage controls under which nurses’ pay is set with relatively little extra for working in London or the south-east mean that hospitals in these high-cost areas struggle to recruit and retain staff, according to Carol Propper and Jan Van Reenen, professors at Bristol University’s Centre for Market and Public Organisation and the London School of Economics’ Centre for Economic Performance.

As a result these hospitals have lower productivity and higher fatality rates among patients admitted with heart attacks.

For each 10 per cent rise in the gap between the wages paid to NHS nurses and those paid to nursing staff in the private sector locally, the death rate from heart attacks rises by 5 per cent, the authors say.

“Common sense would say that hospitals located in places where outside opportunities are better are going to struggle to recruit, retain and motivate staff,” they say. “This is exactly what the study finds.” They add that this leads to “lower-quality service provision and poorer outcomes for patients”.

Hospitals in high-wage areas often try to get around recruitment difficulties by relying more on agency staff, who can sometimes be paid extra. “But they often tend to have less experience and training,” the authors say, with that too feeding into the problems with clinical care.

The study covers data from 1995 to 2002, since when London weighting and other cost of living allowances have improved in the south-east, with NHS foundation trusts no longer bound by national pay rates for NHS staff.

But few foundation trusts have introduced any large variance in nurses’ pay. And it remains the case that nurses working in London and the south-east take a bigger pay cut relative to private sector workers than their colleagues in lower-paid areas, Professors Propper and Van Reenen say.

Prof Propper said they were convinced the finding that death rates from heart attacks are higher and productivity lower, is more than just a chance correlation.

A series of other explanations – from pollution, to higher stress in the workforce in the south-east – have been examined and ruled out, while US studies suggest that deaths from heart attacks are “the canary in the mine” as a measure of the quality of healthcare, she said.

From:
http://www.ft.com/cms/s/0/7abaae9e-c877-11dc-94a6-0000779fd2ac.html

Using data from the World Health Organisation and statistical techniques pioneered in the British Medical Journal, the TaxPayers’ Alliance has produced a major report on NHS performance since the 1980s.

Wasting Lives: A statistical analysis of NHS performance in a European context since 1981, analyses data from the WHO to estimate the number of deaths that could plausibly have been averted by the NHS since the 1980s. The measure used is known as “mortality amenable to healthcare”. The calculations compare the UK performance to that of Germany, France, the Netherlands and Spain.

* If the UK were to achieve the same level of “mortality amenable to healthcare” as the average of the other European countries studied, there would have been 17,157 fewer deaths in 2004, the most recent year for which data is available.
* This is equivalent to over five times the total number of deaths in road accidents and over two and a half times the number of deaths related to alcohol in 2004.
* Steady improvements in mortality rates, relative to European peers, have been made at almost exactly the same rate throughout the Thatcher, Major and Blair governments despite huge increases in spending from 1999 to date. There can no longer be any doubt that the Government’s extra NHS spending has completely failed to deliver results.
* If NHS spending had continued to increase relative to European peers at its pre-1999 rate £34.3 billion – £1,350 per household – less would have been spent between 1999 and 2004. In 2004 alone, £9.8 billion less would have been spent, 9.7 per cent of total spending in that year. This extra money has largely been wasted.

Matthew Sinclair, author of the report and a Policy Analyst at the TaxPayers’ Alliance, said:

“Thousands are dying every year thanks to Britain’s health service not delivering the standards people expect and receive in other European countries. Billions of pounds have been thrown at the NHS but the additional spending has made no discernable difference to the long-term pattern of falling mortality. This is a colossal waste of lives and money. We need to learn lessons from European countries with healthcare systems that don’t suffer from political management, monopolistic provision and centralisation.”

Professor Karol Sikora, Medical Director of CancerPartnersUK, steering group member of Doctors for Reform and author of the foreword to the report, said:

“The NHS should not be a religion, with its structure set in tablets of stone. We face a choice between a modern, consumer driven service for all or a decaying, bureaucratic system which only those with their own resources manage to escape. Politicians need to read this report carefully and determine the optimal strategy they can put to a well informed public. Those that capture the best way forward will carry the British voter with them.”

From:
http://tpa.typepad.com/bettergovernment/2008/01/major-study-on.html

Andrew Lansley told the Financial Times he would write to the Commons public accounts committee and the Department of Health asking them to re-examine the circumstances around the resignation of Professor Denise Lievesley, former chief executive of the Information Centre, the National Health Service’s data factory.

Prof Lievesley, a former Royal Statistical Society president, claimed this week that she was made a “scapegoat” by the Department of Health after repeatedly raising the alarm about the joint venture’s worth and its handling of information. Dr Foster Intelligence, the joint venture, strongly rejects her criticisms.

Mr Lansley said it “might be appropriate” for the public accounts committee to respond to Prof Lievesley’s claims by making new inquiries about the joint venture, whose formation it attacked last year as a “backroom deal” set up at a cost of £12m to the taxpayer.

Mr Lansley said: “It seems to me to be clear that [Prof Lievesley] was, from her own professional point of view, highly sceptical, indeed internally critical, about what was being done. The evidence at the time [of the initial inquiry] doesn’t appear to have included some of the reservations she was expressing internally.”

Prof Lievesley’s claims, which emerged this week at a hearing at Leeds Employment Tribunal, have yet to be tested by cross-examination. Prof Lievesley did not attend the hearing, citing a previous commitment.

Mr Lansley said he also planned to ask the DoH why the Information Centre had agreed a deal under which Prof Lievesley received a pay-off in exchange for her silence about her departure.

Dr Foster Intelligence – which is half-owned by the Information Centre and half by Dr Foster LLP, a private health information company – has defended the quality of the information it provides. It said it and its partners, which include Imperial College, operated to the “highest standards of data quality”.

The Department of Health has declined to comment on Prof Lievesley’s case.

http://www.ft.com/cms/s/0/0ca6578e-c3c0-11dc-b083-0000779fd2ac.html

It questioned people about treatment since April 2006 when a new NHS contract was brought in.

Extrapolating from their poll result, the authors estimate that of the 7.4m who tried and failed to see an NHS dentist, 4.7m eventually opted for private treatment, and 2.7m went without treatment altogether.

Official figures suggest the number of people who have failed to access NHS dentistry is 2m.

Citizens Advice chief executive David Harker said “People on low incomes are particularly affected as private treatment is just not an option.”

The survey showed huge regional variations throughout the country, with the south west and north west of England the worst hit.

Lester Ellman, of the British Dental Association, said: “It is clear dentistry is not getting any better.

“The bottom line is that there are not enough dentists working in the NHS and that is because the government have failed to make it attractive enough.”

He denied it was a matter of money and said instead dentists wanted to spend more time with their patients.

Health minister Ann Keen said: “We are working hard to improve access to NHS dentists and the government remains fully committed to expanding services.

“It is now a national priority for the health service.”

She added the dentistry budget was being increased by 11% from this year to help achieve this.

NHS dentistry has been a long-running problem for the labour government.

A new contract aimed at giving dentists more time with patients to get away from the so-called “drill and fill” culture was introduced as part of a reform of NHS dentistry in 2006.

It was hoped the move would stem the loss of NHS dentists to the private sector.

But despite getting paid the same for seeing less patients, 1,000 of the 21,000 NHS dentists in England refused to sign it, believing it was not as radical as they were led to believe it would be.

New dentists have been gradually recruited to the health service, but figures are no higher than they were before the new contract.

Barry Cockcroft, Chief Dental Officer for Engalnd, said access to NHS dentistry had been a long-standing problem, which could not be ironed out straight away.

He said: “You won’t turn it around absolutely completely in one year – but these reforms are a sound basis.”

The Welsh Assembly Government said the new contract had been successful in developing dental services in Wales, with six new practices in recent months and others expanding the numbers of NHS patients.

From:
http://news.bbc.co.uk/1/hi/health/7189448.stm

Prof Lievesley’s claims are the latest in a series of questions raised about the joint venture, known as Dr Foster Intelligence, which a committee of MPs last year said had been set up in a “backroom deal” at a cost of £12m to the taxpayer.

In an affidavit lodged at Leeds employment tribunal, Prof Lievesley, a former Royal Statistical Society president, claims the health department let her become a scapegoat for the deal.

Stuart Ritchie, for Prof Lievesley, who was not at the hearing, said she had “consistently complained about the joint venture and its operation” throughout her two-year tenure at the Information Centre.

In her affidavit, Professor Lievesley says she felt she had no alternative but to sign off in January 2006 on the creation of Dr Foster Intelligence, as talks on it were far advanced by the time she arrived at the Information Centre in July 2005. She claims she helped the public sector secure better terms for the joint venture, which is 50-50 owned by the Information Centre and Dr Foster LLP, a successful private health data company.

In her affidavit, Prof Lievesley, who was a non executive board member of Dr Foster Intelligence, says some data processed by the joint venture was not, in her view, “fit for purpose”.

She describes an incident last year in which the joint venture included unvalidated official hospital data on a prototype website, creating “grave” potential to mislead the public. She says she high-lighted a “wholly inappropriate” use of statistics in letters to senior officials including David Nicholson, chief executive of the NHS.

Dr Foster hit back at the allegations, saying its data were of a high standard and did not mislead the public. The company said: “We understand [Prof Lievesley] is in dispute with her former employers but do not know the details. We have not seen this affidavit, but we refute the criticisms that appear to have been made.”

The Dr Foster deal first came under fire in a National Audit Office report in February last year, which rebuked the health department for failing to follow a proper tendering process and for paying too much for its half of the joint venture.

In July the Commons public accounts committee unveiled a stinging report on the deal, in which the Information Centre paid £7.6m to Dr Foster LLP and sank another £4.4m into the joint venture company.

Prof Lievesley has gone to the employment tribunal to try to revoke a confidential deal under which she received a pay-off in exchange for her silence about the circumstances surrounding her departure from the Information Centre in July.

She says the agreement was unfair as the health department failed to point out in public that her exit was unconnected with the criticism of the Dr Foster deal made in the Commons public accounts committee report a few weeks later.

Her affidavit says: “It is ironic that my reputation should have been sullied when I was actually trying to promote the principles of proper and ethical access to information.”

The Department of Health said it had sought and followed legal and professional advice during the creation of the venture. It declined to comment on the claim it had made Prof Lievesley a scapegoat, saying it could not speak about an ongoing case.

He said Prof Lievesley had come to the tribunal in part because she was worried about the damage caused to her reputation by events subsequent to her departure.

From:
http://www.ft.com/cms/s/0/ee18797c-c30c-11dc-b617-0000779fd2ac.html

NHS Employers, the agency responsible for staffing the health service, has warned that a Court of Appeal ruling means doctors trained in Britain will need to compete for posts to train as consultants alongside doctors from around the world who want to practise in the UK.

If the juniors do not obtain a training post, they will not be able to become hospital consultants or GPs.

Sian Thomas of NHS Employers said: “There are about 9,000 posts for around 23,000 estimated applicants – that’s what the Department of Health has told us.

“One could argue that the more competition you have, the better quality you will get. It is a good thing for patients that there is competition for jobs – it should mean they get the best doctors wherever they live.”

She admitted, however, that taxpayers’ money would be wasted if junior doctors trained in Britain decide to take consultant posts overseas.

The British Medical Association blames the health department for continuing to recruit medics from overseas at the same time as increasing the number of medical graduates from British universities.

Meanwhile, patients are suffering from a postcode lottery of drug prescription eight years after the labour government set up a body to get rid of the problem, a report by a parliamentary committee will say this week.

The health select committee is expected to say that the National Institute for Health and Clinical Excellence (Nice) has failed to ensure that medicines available in one area are not denied in neighbouring districts.

An inquiry by the committee of MPs is also expected to say that the NHS, which spends about £90 billion a year, should not need to withhold life-saving medicines. It is likely to say that restrictions on drugs to treat cancer or Alzheimer’s could be avoided. The MPs are expected to recommend that Nice gets greater powers to force NHS trusts to make drugs it has approved available to all patients.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3137490.ece

Health Direct continues to wonder whether the labour government realises what devastation is being caused to the lives of our future doctors by this news

These are people with lives and families not just numbers or a resource to be allocated.

Give them a system that considers their needs as well as the needs of the NHS.

In a startlingly forthright submission to a parliamentary committee, Sir Ian Kennedy, chair of the Healthcare Commission, all but called for the merger to be aborted because it would set back the development of a culture of safety.

The labour government has proposed a three-way merger of the Healthcare Commission, the Commission for Social Care Inspection and Mental Health Act Commission to strengthen regulation and save £60m ($118.5m).

However, the wind-up costs have been estimated to be £140m and the reforms have been opposed by all three existing bodies.

Sir Ian, the former chairman of the government inquiry into the scandal of children’s heart surgery at the Bristol Royal Infirmary, said “The reasons for the bill are unclear, the costs are high, the distraction is very considerable and the risk of harm to patients is significant.”

In a stark warning to the labour government, he added: “If one patient dies whose death could have been avoided because of the distraction of the search for the ideal regulatory structure, the public will have been ill served by this proposed legislation.”

Norman Lamb, Liberal Democrat health spokesman, described it as “a devastating condemnation of the proposal”.

“The government would be well advised to take this seriously and think again about whether they can justify this. This sense of perpetual reorganisation drives health professionals and the public crazy.”

In his submission, Sir Ian argued the rationale for the reorganisation was unsound, claimed alternative models for reform had not been explored, and the extra powers for regulators “sounded impressive” but were impractical.

Less than four years after the existing organisations were founded, Sir Ian said we were entering an unnecessary “period of flux”.

“Managers will be organising ‘away days’ and locked in meetings over organisational design … instead of meeting the accelerating demands and expectations of patients.”

http://www.ft.com/cms/s/0/81f90940-be3f-11dc-8bc9-0000779fd2ac,dwp_uuid=f0d249de-e821-11db-b2c3-000b5df10621.html

Instead of pressing NHS hospitals, foundation trusts and the private sector to compete over individual operations, diagnostic procedures and treatments, the service should be building the integrated clinical networks needed to treat the growing number of patients with chronic disease, he said. Once that was done, patients could be given choice over which network they went to.

Prof Ham, professor of health services management at Birmingham university, said the type of competition that the NHS was adopting “risks fragmenting services for patients”. It could be suitable, he said, for relatively young and fit patients needing one procedure.

“But, increasingly, older patients have multiple or complex conditions that require treatment by integrated teams of specialists, not treatment as a series of discrete, fragmented, problems.

“The quality of specialist services like stroke care will require not only closer collaboration between providers, but also clinical integration between family doctor, hospital and out-of-hospital care,” said Prof Ham, who has written a paper on the issue for the Nuffield Trust health think-tank.

“If you look at the evidence from the US, the highest quality care is delivered by integrated organisations that bring together commissioning and provision – for example Kaiser and the Veterans Administration [which provides for US ex-service personnel and their families].

“Integrated organisations may then compete against each other for patients, but once the patient chooses they get integrated, not fragmented, care.” That allowed specialists to lead the drive for service improvement, he said, and the NHS should be commissioning such clinical networks.

“In the longer term, ministers could then explore how patients might choose between integrated systems, rather than just choose isolated elements of their care.” That would retain the benefits of competition, but with patients receiving a much more seamless service.

“If you take diabetes, the challenge for health, social and community services is to enable patients to self-manage their condition. But when things go wrong, patients need the right service, in the right place, at the right time, with the right expertise instantly available. The services need to work together, with patients not having to work out which part of it they need. That requires collaboration not competition,” he added.

Prof Ham said advocates of choice had not properly thought through the implications of the more atomised approach they had advocated. That, he said, had been developed to reduce waiting lists, not to provide the types of service that large numbers of patients actually needed.

From:
http://www.ft.com/cms/s/0/004bf102-bd75-11dc-b7e6-0000779fd2ac,dwp_uuid=f0d249de-e821-11db-b2c3-000b5df10621.html

In a report published on Thursday, the Commons health committee also says the threshold at which the life enhancing impact of expensive drugs is deemed to outweigh their cost must be subject to independent scrutiny.

The report recommends a sharp increase in the workload of the NICE to evaluate medicines as they are launched, and to weed out older treatments that are no longer cost-effective.

The committee calls for a change in the law so that Nice can assess not only medical costs and benefits but also the broader social impact of new medicines. It proposes that an independent body should review the balance of cost versus effectiveness.

Paul Hooper, head of the UK subsidiary of Eisai, the Japanese pharmaceutical company that last year challenged Nice’s rejection of its Alzheimer’s drug, said he “welcomed” the demand that wider social benefits be considered – a reference to the burden imposed on family members and social workers by caring for someone with Alzheimer’s.

However, the Association of the British Pharmaceutical Industry, the main trade body, warned that “patients will see little benefit” from the recommendations, and that assessments at the time of drug launches could further obstruct the use of innovative medicines.

Thursday’s report – the second on Nice by the committee since it was set up in 1999 to advise the government on whether the NHS should pay for new medicines – steers clear of radical calls for reforms to pharmaceutical prices at a time when the government is considering an overhaul of the pricing mechanisms.

“Nice plays a vital role in determining NHS policy and it will become more important and demanding as time goes on, especially with reducing budget increases,” said Kevin Barron, chairman of the committee.

He called for an end to political interference from government ministers in Nice’s work, highlighting the pressure to approve Herceptin for early breast cancer treatment and a decision by the Department of Health to authorise new multiple sclerosis drugs despite opposition from the institute.

The report’s demands could require substantial extra funding for Nice and stretch the ability to recruit specialist health economists to carry out the expanded work. However, Doug Naysmith, a member of the committee, said: “This [advice] should not result in a vast increase of new medicines, and possibly the reverse.”

Prof Sir Michael Rawlins, chairman of Nice, said he broadly supported many of the recommendations in the report, but warned of the risk of “unintended consequences” and cautioned that “the details would have to be looked at very carefully”.

The MPs advised caution in the shift towards “risk-sharing” schemes, including one endorsed by Nice last year by which Janssen-Cilag would rebate the cost to the NHS of its multiple myeloma drug Velcade if patients showed no significant improvement. The committee said such schemes had shown no clear benefits.

http://www.ft.com/cms/s/0/be469c0e-bf08-11dc-8c61-0000779fd2ac.html?nclick_check=1

Health Direct has publicised several recent controversial Nice decisions:

Dec 2007- Nice backs down under heavy public pressure on its previous advice that Lucentis should only be used by the NHS to treat wet age-related macular degeneration, which causes blindness, once it affects a patient’s second eye. It can now be used in the first eye to suffer. Consultation closes next week on its revised guidance that Novartis, the manufacturer, should pay if more than 14 injections are required.

Sept 2007- Nice stands by its ruling that the NHS should not use three drugs for early stage Alzheimer’s disease, after winning most aspects of a judicial review challenging this brought by Eisai, manufacturer of one of the drugs, with support from others – Pfizer and Shire – as well as from the Alzheimer’s Society. Nice supports treatment with the drugs, once moderate Alzheimer’s is diagnosed.

June 2007- Nice recommends approval of Velcade for multiple myeloma – but only on condition that Janssen-Cilag, the manufacturer, agrees to a “risk-sharing agreement” to rebate the cost to the NHS for patients who fail to show a significant improvement.

Professor Sir John Tooke was asked to look at the system after the chaos of last year when 30,000 doctors were competing for 20,000 NHS training jobs.

Thousands of medics protested on the streets, complaining about the system and the application process.

Sir John has called for a new body, NHS Medical Education England to manage postgraduate medical training.

The body should also have responsibility for liaising with the devolved administrations in Scotland, Wales and Northern Ireland to ensure cohesion across the UK.

And it should have its budget ring-fenced – in recent years training funds have been raided to plug deficits.

Sir John’s report also warned measures need to be taken to ensure that junior doctor training did not suffer when the European Working Time Directive – limiting doctors to 48 hours a week – fully comes into force next year.

The inquiry into Modernising Medical Careers (MMC) was set up by then health secretary Patricia Hewitt last May as she faced calls to quit over the new system.

MMC was designed to cut the number of years it takes for junior doctors to reach consultant level from about 14 years to 11.

But medics complained that application forms under the online Medical Training Application Service were badly worded and resulted in many of the best candidates not being granted interviews.

The disparity between the number of training posts and applicants was caused by the streamlining of the system, an increase in graduates from the investment in medical schools since Labour came to power and a large pool of foreign doctors.

Only about 14,000 of the doctors looking for specialist posts were UK trained and the overwhelming majority of these got jobs.

On top of the training posts, there were also thousands of service posts, but these do not count towards a doctor becoming a consultant.

The situation has prompted calls for UK medical graduates to be given a priority.

However, junior doctors have been warned that competition for posts in the coming year could be even more intense.

Sir John said the issue needed to be looked at as it costs the taxpayer £250,000 to put graduates through medical school, but he did not make any direct recommendations.

The final report comes after an interim version published in October found the government’s reform of the system in 2005 was “rushed and poorly communicated”.

“It is a serious blow for the government and essentially a vote of no confidence” said Dr Chris McCullough, of the Remedy pressure group

It also said the present system was unlikely to encourage or reward “striving for excellence” or offer trainees flexibility.

Sir John, who is dean of the Peninsula Medical School in Exeter, said: “Although the original principles of MMC were well conceived, they were lost in translation.

“We have ended up with an inflexible structure that does not encourage excellence.”

This year deaneries are being left to organise their own recruitment at a local level after the government suspended the centrally-run arrangements.

The Department of Health will now spend the next few months assessing the report, before setting out how it will proceed for 2009.

Dr Hamish Meldrum, British Medical Association chairman, said: “This report charts a path that can lead us out of the current mess the government has made of doctors’ training.

“While there are some areas of detail that need further, careful consideration, action on the key recommendations will deliver better education and training for doctors, for the NHS, and for the public.”

Dr Chris McCullough, of the junior doctor pressure group Remedy, said: “We warmly welcome the report. It is a serious blow for the government and essentially a vote of no confidence.”

Professor Dame Carol Black, of the Academy of Royal Colleges added: “The recommendations command the support of the profession and the task that now lies ahead is to ensure they are implemented as a matter of urgency.”

Professor Morris Brown, chair of the Fidelio group set up to campaign against the new arrangements, described the findings as a “truly damning indictment of the evangelical ramblings and chaotic incompetence which caused last year’s disaster.”

http://news.bbc.co.uk/1/hi/health/7176356.stm

Health Direct also notes the stinging rebuke by the BMA at:
http://www.bma.org.uk/pressrel.nsf/wlu/STRE-7ANGP5?OpenDocument

The loss, thought to involve personal information on hundreds of thousands of people, emerged as part of a government-wide review following security breaches in other departments.

The Department of Health said the affected patients had been informed about the loss and there was no evidence the information had fallen into the wrong hands. It added investigations were under way and action would be taken against anyone who had failed to fulfil their responsibilities under data protection laws.

Andrew Lansley, shadow home secretary, said the latest loss underlined the Conservative party’s case against the government developing centralised databases. It also raised questions over how the planned electronic patients database in the NHS would protect sensitive medical records.

“For over two years we have argued for data to be held locally, with networking rather than one central database. The government should accept that this would offer us greater protection,” Mr Lansley said.

The NHS data loss comes after police admitted they had failed to discover the whereabouts of two computer discs lost last month in the post by Revenue & Customs. The discs contained the names, addresses, dates of birth and bank account details of every child benefit claimant, in the biggest recorded loss of data ever in Europe.

While law enforcement and the banking sector have in recent weeks developed a new coordinated system for checking on suspicious transactions, senior investigators say the failure to find the discs containing data on 25m people risks exposing large swathes of the population to possible fraud and identity theft in the future.

The latest loss also follows the more recent revelation, on Monday last week, that details of 3m learner drivers had been lost after being sent to a private contractor in Iowa in the US.

By yesterday afternoon the details of what data had been mislaid by the trusts had not been disclosed by the Department of Health. But according to a report in the Sunday Mirror, one of the breaches was thought to involve the loss of names and addresses of 160,000 children by City and Hackney Primary Care Trust after a disc containing data failed to arrive at a London hospital.

Patient Care, the patient support group, said ministers should not try to gloss over the latest “scandal” affecting the poor handling of data.

Joyce Robins of Patient Care told the BBC: “It’s the tip of the iceberg, actually, because there’s such carelessness within the NHS and it’s always impossible to hold anyone to account and find out who’s actually done anything. It may be only a matter of time before records fall into the wrong hands and we see not only our ex-directory phone numbers posted on the internet but the record of our abortions, HIV and Aids status.”

From:
http://www.ft.com/cms/s/0/1e6bccd8-b1c3-11dc-9777-0000779fd2ac.html

Among 99 primary care trusts, it found 10 were not treating people within a year, with the longest wait of 125 weeks in Kingston-upon-Thames, London.

The average wait for treatment was 22 weeks and the shortest four weeks. The RNID urged the labour government to do more to meet a pledge of 18-week maximum waits.

“An 18 week target is a distant dream for thousands of people waiting over a year for their first hearing aid” Brian Lamb, RNID director of communications

Health Minister Ivan Lewis has pledged that by December 2008 all patients with hearing or balance problems that require care from a hospital consultant will be treated within 18 weeks.

And all other patients with routine hearing loss should be assessed within six weeks.

The RNID wrote to England’s 152 primary care trusts to assess the situation and among the 99 that replied, the average wait for a hearing aid was 22 weeks, affecting 28,384 people.

Sixty-six PCTs said they were providing treatment within 18 weeks.

Patients at the Norfolk and Norwich PCT, Southampton City PCT and Bolton PCT were treated within four weeks.

But there were waits of over one year in nine PCTs other than Kingston-upon-Thames – Suffolk (78 weeks), Gloucestershire (72), Tyne and Wear: Washington Health Centre (68), Ealing (67), Havering (64), Tyne & Wear: Sunderland Royal Hospital (62), Shepway (58), Mid Essex (56) and South Tees (54).

RNID director of communications Brian Lamb said: “Despite government assurances, an 18-week target is a distant dream for thousands of people waiting over a year for their first hearing aid, who are battling isolation and depression because of their hearing loss.

“RNID wants the government to do more to end this scandal, by putting pressure on local health chiefs to take hearing-health seriously and bring down waiting times.”

A Department of Health spokesman said: “We acknowledge that audiology waiting times in parts of the country are too high, and that is why we recently published a national framework which sets out the tools the local NHS needs to transform this service.

From:
http://news.bbc.co.uk/1/hi/health/7162990.stm

The NHS Confederation, which represents hospital chief executives and managers, says denying NHS treatment to patients who pay for top-up drugs is “perverse” and against “common sense”.

The move comes after it emerged that women suffering from breast cancer have been threatened with losing NHS care if they seek to improve their chances by paying privately for an extra drug.

Ministers claim that to allow patients to pay for top-up drugs would be unfair on those who cannot afford them and lead to a two-tier NHS. Their policy was laid down in guidance issued this summer but was criticised last week after The Sunday Times highlighted the case of Colette Mills, 58, from near Stokesley, North Yorkshire.

Mills, a former nurse, has been told that if she pays for the cancer drug Avastin, which the NHS does not fund, she will have to foot the £10,000 total monthly bill for her care.

Another breast cancer patient, Debbie Hirst, 56, from St Ives, Cornwall, has now revealed that she, too, has been told that if she wants to pay for Avastin in addition to her NHS medicines, she will be forced to pay for all her care.

The Royal Cornwall Hospitals NHS Trust issued the threat despite three other patients being allowed to top up their NHS care. The trust says the three had started their private treatment before the guidance was issued.

Hirst, a grandmother, said: “We put our house up for sale in order to pay for this drug. My only option now is to take the treatment they offer on the NHS or go private, which would be totally unaffordable.”

Nigel Edwards, the NHS Confederation’s director of policy, said: “The position appears to run counter to common sense. This should ring alarm bells that something is wrong with the policy.”

Edwards said patients are already regularly combining private and NHS care. For example, thousands mix NHS dental care with treatments available only privately.

Co-payments should be allowed, he said, provided they did not deprive other patients of resources, and those paying for the drugs are well informed of their limitations.

It was also reported that a 62-year-old woman had won a legal battle for the right to be treated with Avastin for bowel cancer. She will pay for the drug while Cumbria Primary Care Trust funds the rest of her care.

Mills and Hirst are to launch a campaign for all patients to have the right to pay for medicines not funded on the NHS. They are backed by the Patients Association, Doctors for Reform and Saga, the organisation for the over-fifties.

Andrew Goodsell, Saga chief executive, said: “People are less concerned about a two-tier health service than whether they have the opportunity to resolve what can be a life or death situation.”

The health department said: “It is a fundamental principle of the NHS, supported by all the main political parties, that treatment should be free at the point of need. Co-payments would undermine this.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3087326.ece

Health Direct asks what a screwed up reality this labour government has foisted upon us. The idea that if one person can’t afford to top-up their treatment to improve their life expectancy, no one should be allowed to do it is crazy.

Is this some kind of perverse communism? No one is allowed to do better than the lowest common denominator?

Nine NHS trusts have admitted losing confidential patients’ information in the aftermath of the HM Revenue and Customs (HMRC) data loss scandal, it emerged.

Hundreds of thousands of people are thought to have been affected by the breaches of strict data protection rules by the health service.

The losses were disclosed as police continued to hunt for two HMRC computer discs containing the details of 25 million child benefit claimants.

Since the tax discs went missing in the post it has also emerged that three million motorists’ details have been lost in Iowa, in the American mid-west.

One of the NHS trusts involved – Maidstone and Tunbridge Wells – has reported two breaches to the Department of Health (DoH), meaning that ten cases have occurred in total.

The DoH said it did not have details of how many patients were affected in each case as the breaches were being dealt with locally.

City and Hackney Primary Care Trust has reportedly lost the details of 160,000 children after a computer disc failed to arrive at its destination at St Leonard’s Hospital, east London.

The other trusts involved are Bolton Royal Hospital, Sutton and Merton PCT, Sefton Merseyside PCT, Mid-Essex Care Trust, East and North Hertfordshire, Norfolk and Norwich and Gloucester Partnership Foundation Trust.

The NHS chief executive, David Nicholson, recently wrote to NHS managers reminding them of their responsibilities with regard to data handling.

A DoH spokesperson said: “Since the recent heightened concern about data protection a small number of trusts have reported breaches of their own security rules. There are strict guidelines and procedures for dealing with such breaches.

From:
http://timesonline.co.uk/tol/news/uk/health/article3089052.ece

Health Direct observes that it may be a New Year, but many of last year’s Labour NHS fiascos continue. Your personal data is at risk.

The Department of Health’s fatuous statement does nothing to grow confidence.