But GPs employed on salaries gained very little, while practice nurses actually saw a real-terms decline in pay. Hoped-for gains in productivity did not occur: productivity fell two years running, by an average of 2.5 per cent a year.

The costs of the contract were partly covered by extra cash from the Department of Health, but the primary care trusts who pay GPs were not fully reimbursed. As a result, they had to find £406 million between 2003-04 and 2005-06 from their own resources, limiting their ability to improve services.

The NAO report does not openly criticise anyone for the outcome, which enriched GP partners at the expense of almost everybody else. But when pressed, Karen Taylor, director of health at the NAO, said: “I think as far as the public and taxpayer is concerned, the benefits they should have been expecting to see have not materialised to the extent they should have done. From their perspective, it’s not a good deal for them.”
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There were some positives, she said. Recruitment and retention of GPs had improved, and the focus that the new contract brought on long-term conditions, such as diabetes, had helped patients. The average general practice appointment was longer — twelve minutes rather then eight — largely because an increasing proportion were being dealt with by nurses.

But NHS managers from top to bottom are found to have failed, by allowing the British Medical Association to negotiate a contract that enriched some of their members, shortened their hours and used up so much cash that reforms to services were stymied.

The report says that in its “business case” to the Treasury justifying the contract, the department had quoted figures that underestimated its actual cost by £1.76 billion over three years.

There were three reasons, Ms Taylor said. The department underestimated how much GPs would earn from the quality and outcomes framework, which rewards them for the number of quality points they earn; it underestimated the cost of switching out of hours responsibilities to primary care trusts; and it underestimated what it would cost PCTs to administer the contract.

GP practices are paid a gross sum, out of which the partners pay the cost of running the surgery, including salaries of nurses and other working doctors. The partners share the profits.

Perhaps the most damaging aspect of the report is the figure showing what partners did with their increased payments. They boosted their own incomes by 58 per cent over the three years, to an average of £113,614 in 2005-06. Salaried GPs whom they employ gained just 3 per cent in the first two years, to £46,905, while the average practice nurse’s income reduced in real terms, the report says.

The NAO concludes that one reason the contract has so far failed in the redesign of services is that the BMA negotiated a minimum practice income guarantee (MPIG), which ensured that no practice would earn less under the new contract than it did under the old. It meant that GPs retained the benefits of the old contract where it suited them, while gaining greatly from the new one. MPIG should be phased out, the report says.

Tim Burr, head of the NAO, said: “There is no doubt that a new contract was needed and there are now 4,000 more GPs than five years ago. But in return for higher pay, we have yet to see real increases in productivity.”

Laurence Buckman, chairman of the BMA’s GP committee, said it was meaningless for the audit office to talk about productivity because the way GPs worked had changed. “Productivity should be measured in improvements in health, not the frequency of consultations. The early evidence is that the contract is leading to improvements in clinical care,” she said.

http://www.timesonline.co.uk/tol/life_and_style/health/article3449057.ece

On February 07, 2008 Health Direct posted:Alan Johnson scraps with GPs over pay and opening hours

The 2004 general practitioner contract which the labour Government is now messily trying to unpick set a new benchmark for ineptitude by the Department of Health, whose weakness in contractual negotiations is legendary.

The agreement gave family doctors lavish salary increases tied to various incentives based on preventative health measures. In its first year it led to an average salary increase of 23 per cent, in the second year 10 per cent – an extra £30,000 a year in total.

Spending on care bought from the private and voluntary sectors and local authorities has been rising by 15 per cent a year on average since 1995. That is faster than the rate of NHS growth as a whole. It reached almost 20 per cent a year between 2002 and 2006.

The proportion of healthcare bought from the private and voluntary sectors and from local authorities has more than doubled since Labour took power in 1997. It has risen from under 3 per cent of all NHS expenditure to just under 7 per cent by 2006. In cash terms, expenditure has risen from £1bn to just under £5bn.

Expenditure figures include: money spent on operations bought from private hospitals and independent treatment centres; spending on acute psychiatry in nursing homes for people with continuing care needs; and spending on community services for older people, those with mental health conditions and people with learning disabilities.

Labour has widened choice over where patients go for non-emergency operations. Also the use of private psychiatric providers (including medium-secure facilities for detained patients) has grown.

The service is now paying for heavily dependent patients who need continuing care. It had tried to shift that cost to the means-tested social care budget.

Where the growth has arisen, the ONS cannot yet say. But primary care trusts’ accounts for 2006-07 suggest that spending in independent sector treatment centres accounted for only 4 to 5 per cent of the growth.

Some 40 per cent of the increase appears to have been spent in private hospitals and psychiatric facilities. Spending on other community services, including the voluntary sector and local authorities, made up most of the rest of the increase.

The other big drivers of increased spending were extra staff, more prescribing by general practitioners, other goods and services, and capital expenditure. Payroll was the biggest destination of spending: the NHS hired nearly 300,000 more staff in the decade to 2006. Purchase of other goods and services was the next highest factor in the increase.

GP prescribing rose steeply as drugs such as statins to prevent heart attacks were prescribed much more widely.

While spending on care outside the NHS was a small proportion of total spending, it was the element that had grown most quickly, the statistics office said.

From:
http://www.ft.com/cms/s/0/3d2bb844-de92-11dc-9de3-0000779fd2ac.html

Allyson Pollock and Sylvia Godden of Edinburgh university’s centre for public health policy said: “There is no good evidence that independent sector treatment centres [ISTCs] have provided additional capacity, value for money or high-quality care,” while they are leading to “fragmentation and financial instability” in the NHS.

Prof Pollock, a critic of private sector involvement in the NHS, said that with the centres running below capacity, and with the Healthcare Commission saying there is inadequate data fully to compare the ISTCs’ performance with the rest of the NHS, “the available evidence suggests that the private sector is profiting at the expense of patients, the public and the NHS”.

Prof Pollock’s criticism in the British Medical Journal comes ahead of a government decision next month on whether to grant seven new contracts to add to the existing 25 centres.

The Department of Health rejected her view saying: “The independent sector has undoubtedly helped improve services for patients, speeding up treatment and reducing waiting times.” The centres had also “galvanised the NHS to raise its game”.

The first centres were set up to treat about 170,000 patients a year, with contracts awarded worth about £1.5bn over five years. The NHS committed itself to pay about 11 per cent on average above the standard NHS price for treatments. As of last September, the centres had an average occupancy of about 84 per cent.

Prof Pollock said the original assurance that the centres would use non-NHS staff had not been honoured, with about a quarter of staff being seconded from the NHS. The centres took work from NHS hospitals and “NHS beds and services are being closed to make way for the for-profit private sector,” she claimed.

The NHS Partners Network, the trade association for the treatment centre providers, said that the claims ignored “incontrovertible evidence” that patients rated the treatment they received from ISTCs very highly, with satisfaction rates of 96 per cent.

“They also miss the fundamental point of this programme, which is to use competition as a mechanism for driving efficiency improvements in the wider NHS, while giving patients some real choice”.

The health department remained “committed to a diversity of providers in healthcare” with more data on quality due to be published.

The remaining schemes would only go ahead where they met local needs, offered value for money and benefited NHS patients, a spokesman said.

From:
http://www.ft.com/cms/s/0/3570ce14-e19e-11dc-a302-0000779fd2ac.html

The actor claimed Labour had pledged to double funding for palliative care in their 2005 manifesto but said the money “hasn’t materialised”.

Grant, whose mother was cared for by Marie Curie cancer nurses during the final stages of pancreatic cancer, told Radio Four’s Today programme: “She was allowed to die peacefully surrounded by her family after receiving the very best attention from those helping us to support her. Everyone should have that choice.”

He is supporting Marie Curie’s latest fundraising drive.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/27/ngrant127.xml

Pulse magazine said 90 per cent of hospital trusts reduced the scope for advanced booking in the past six months to help meet the target of 18 weeks between GP referral and hospital treatment.

The proportion of appointments listed as unavailable on the electronic Choose and Book system – where patients choose where to be treated – rose “sharply”.

Many of the 28 trusts polled in the magazine’s survey said that reducing the number of weeks allowed for advanced booking was “essential” for hitting the target.

Dr Andrew Mimnagh, a GP, said: “Choice is sacrificed to ensure patients are directed to the capacity available – the hospitals people do not choose to go to.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/27/ngrant227.xml

Doctors managed to save Lorraine Maddi’s baby son, who was delivered by caesarean section after she was discovered unconscious in the bath, but the 31-year-old estate agent died eight days later.

Midwives left her unsupervised in the bath despite being told she would sometimes collapse during stressful situations.

Staff at Bassetlaw Hospital in Worksop, Notts, failed to check on her because they all assumed she would not be left alone, the Nottingham inquest heard.

Her husband Phaninder Maddi now intends to take legal action against the hospital authorities.

He was in India when his wife went into labour and was admitted to the hospital on June 1 last year.

A midwife suggested Mrs Maddi took a bath to help with labour pains and family friend Paul Guthrie, who was accompanying her, left the hospital to collect some items.

But before leaving he informed midwives of her condition and told them to keep an eye on her.

When he returned he realised she was still in the bathroom with the door locked.

Midwives knocked, but after she did not respond they opened the door and found her submerged and not breathing.

She was resuscitated and her baby Jaydem survived being born by an emergency caesarean.

But Mrs Maddi, from Worksop, later died.

A number of midwives said it was assumed she would not have been left alone during her bath, but hospital officials admitted there were no official guidelines on whether women should be left on their own.

The inquest was also told a midwife failed to investigate after knocking on the door as Mrs Maddi took her bath and receiving no reply.

Dr Nigel Chapman, the Nottingham coroner, said drowning could not be given as a cause of death because she died eight days later, after her lungs had emptied of water.

He recorded an open verdict.

Mandy Dalton, the hospital’s head of risk and legal services, said the hospital would employ new guidelines about women being left alone in its baths.

Mr Maddi said after the hearing: “ I hope they keep to their word and make the changes.”

He added: “My son will never know his mother. I don’t know what I will say to him when he grows up and starts asking about her. The word observation means to watch but obviously Lorraine wasn’t watched.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/27/npregnant127.xml

At the centre of the row are letters from the health department to all NHS hospitals, including foundation trusts, telling them to appoint extra matrons, undertake an annual deep clean to combat hospital-acquired infections and appoint infection control nurses.

William Moyes, chairman of Monitor, the independent regulator of foundation trusts, has written to NHS chief executive David Nicholson arguing that such instructions amount to line management by the labour government when foundation trusts are meant to be self-governed institutions.

“I do not believe this is consistent with the legislative framework,” Mr Moyes warned the health service’s top boss, because the department’s letter “could only be interpreted as issuing instructions”.

Mr Moyes added it was clear that “there remain different views about who is accountable for the performance of foundation trusts”.

So ministers can no longer set hygiene standards and ensure they are enforced? They can still set standards for hospital cleanliness, which the Healthcare Commission inspects. Monitor requires foundation trusts to meet these and other national standards and targets, such as reducing MRSA infection rates, and can intervene to enforce compliance. But exactly how a foundation trust achieves targets is a matter for them.

But what if there is a known best way of treating patients? Can ministers not make foundation trusts comply?
They can, but not by central direction. National service frameworks, for example, set out approved ways of organising cancer treatment and other services. Primary care trusts are expected to commission care in line with these frameworks. Monitor argues that PCTs should remove services from hospitals that they believe are unsafe or poor quality. PCTs in theory retain the ability to require a deep-clean in a contract.

Like the rest of the NHS, foundation trusts are inspected by the Healthcare Commission. They are answerable to their boards, their governing councils and to Monitor, which authorises them and has the power to direct them and replace their boards.

If problems arose over performance, Mr Moyes warned foundation trust chairmen and chief executives in a separate letter, “it will be no excuse to say you were simply operating within a framework defined by the Department of Health or the strategic health authority”.

The correspondence amounts to a battle for the operational independence of a key part of the government’s reforms, which were meant to end “command and control” from Whitehall and shift responsibility for performance to freer-standing institutions, regulators and the primary care trusts who commission hospital care.

The health department’s letter followed headline-grabbing announcements at Labour’s?party conference by Gordon Brown, prime minister, and Alan Johnson, heath secretary, over hospital deep-cleans and the appointment of 5,000 extra matrons. However, the health department later admitted it no longer had the power to order a foundation trust to appoint matrons.

Mr Moyes said PCTs should not commission care from dirty and unsafe hospitals and should specify their requirements in contracts. If foundation trusts failed to deliver that, then the right approach was for the NHS chief executive to “invite Monitor to act, using its statutory powers”.

On Tuesday, Mr Nicholson tried to defuse the row, declaring: “I fully support the autonomy of NHS foundation trusts and the role of Monitor as their regulator.

“I am also clear that every NHS board has – as part of the NHS family – a very real duty on behalf of their patients to learn lessons” to prevent a repeat of the infection scandal at the Maidstone NHS Trust, where 90 people died from Clostridium difficile.

The Foundation Trust Network, which represents the trusts, said: “It is important that Monitor maintains its status as an independent regulator able to challenge if hard-won freedoms are eroded.”

From:
http://www.ft.com/cms/s/0/9fff97bc-df3f-11dc-91d4-0000779fd2ac.html?nclick_check=1

The practice of “patient stacking” has left some waiting for up to five hours because A&E; units have refused to admit them until they can be treated within the four-hour time limit.

Unison, the public sector union, said the practice poses a danger to other patients because ambulances detained as “waiting rooms” cannot answer new 999 calls.

Mary Maguire, a spokesman for the union, said: “This happens time and time again. It is an appalling waste of resources. We should not use ambulances as waiting rooms.

“A 16-year-old terminally ill cancer patient died after waiting over an hour for an ambulance to transfer him. Three ambulances could have reached him but they were tied up waiting to hand over patients to A&E.;”

Dr Steve Field, the chairman of the Royal College of GPs, called the situation ”entirely inappropriate and unacceptable”.

Evidence of patient stacking is revealed in the official ”turnaround time” data released by seven of England’s 11 regional ambulance services.

The figures show that over the past 15 months at least 44,000 delays were reported by the ambulance services. In some cases the delays were up to five hours.

Norman Lamb, the Liberal Democrats’ health spokesman, said the situation represented ”a scandalous distortion of practice to meet a target that is meant to improve the service”.

Mike Penning, the Tory shadow health minister, said: “Not admitting people to hospital but stacking patients in car parks beggars belief in the 21st century.”

George Alberti, the Department of Health’s national director for emergency access and service design, denied the claim that Government targets are putting pressure on A&E; staff to resort to patient stacking. He said: “The four-hour clock for A&E; waiting starts 15 minutes after the ambulance arrives, regardless of whether the patient has been handed over.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/18/nhealth218.xml

Thousands more are questioning their future in the NHS because of the uncertainty surrounding their earnings, the British Dental Association (BDA) said.

Already the changes have left an estimated one million extra patients without access to a dentist. Almost one in three children do not receive any form of dental care.

The BDA will warn the influential Commons Health Committee that the future of NHS dentistry is “at risk” unless ministers scrap the system.

The new contracts, introduced in April 2006, were designed to provide better access to dentists, and to simplify charges for treatment.

But the BDA said they had driven more than 1,000 dentists – not the official figure of 57 – to concentrate solely on private practice because of the “financial penalties and uncertainty they face”.

Under the new system dentists are forced to pay back money, often thousands of pounds, to their primary care trust if they do not meet a target for the number of NHS treatments provided.

Dentists say the system is patently unfair and does not properly measure the amount of work carried out. For example, they receive the same fee for giving a patient one filling as for giving that patient five fillings.

In addition, the targets are based on the number of patients each dentist saw in 2005, meaning those with expanding or shrinking practices face having to pay back part of their salary.

Dentists also complain that they have less time to advise patients on how to prevent future dental problems because of the “treadmill” conditions they are forced to work under.

The future of NHS dentistry is “at risk”, the BDA says in written evidence to the committee, because “dentists are facing financial penalties derived from untested targets”.

The BDA also accuses the government of “chronically underfunding” dental services. Spending on dentistry in the NHS is now just 2.8 per cent of the overall budget, less than in 2002.

Dr Anthony Halperin, the chairman of the Patients Association and a dentist himself, said: ”Dentists are concerned that they are going to be even more squeezed and have to do more work for less money. Whereas many before saw the NHS as a career they are now beginning to question whether that is really the case.

”Initially their places will be taken by dentists coming in from abroad. But as they become more established those dentists will also begin to look for more salary and move away from the NHS.”

Peter Ward, the chief executive of the British Dental Association, said the new contracts would drive increasing numbers of dentists from the NHS every year.

He added: “This situation is only going to get worse. Dentists who miss their targets by small amounts are not fined if they agree to make up the shortfall the following year. But if dentists are struggling to carry out enough treatments one year it will be harder to hit a higher target the next.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/18/nhealth118.xml

Indeed, when asked about the NHS’s National Programme for IT [NPfIT], ministerial advisers can use Parliamentary replies to make light of the concerns of clinicians and others. And this is what happened when Worthing MP Peter Bottomley put a question about Cerner sites to Ben Bradshaw, who’s the latest in a series of ministers to be put in charge of the NPfIT.

Cerner’s “Millennium” software will be used to help NHS staff administer hospitals and keep records on the care and treatment of patients. It’s due to be installed at hospitals across London and the South of England as part of the NPfIT.

Bottomley asked Bradshaw what representations he’d received from clinicians in hospitals about Cerner Millennium go-lives. Bradshaw’s reply in January 2008 suggested that clinicians are concerned only about things such as the number of keystrokes to carry out certain functions.

Bradshaw said in response to a question from Worthing MP Peter Bottomley:

“While Ministers have not received any direct representations, we are aware that users in the early deployments expressed some concerns about the system’s management and statutory reporting functionality, and some of its usability features, for example the number of key strokes required for certain functions. Action has been taken to address these concerns and to enhance these areas. This is making a positive impact. Many users who have become familiar with Millennium over time have expressed satisfaction with the system.”

There have been some successes with Cerner go-lives. Barnet and Chase Farm Hospitals NHS Trust, for example, now has near a real-time overview of when beds are vacant and where. The reality, also, is that at some hospitals where Millennium has been installed there have been protracted difficulties, not necessarily through any fault of NHS trusts or Cerner, or the local service providers, Fujitsu and BT.

The Audit Commision, in the latest annual audit report on Weston Area Health NHS Trust, referred to the implementation of what it called the Cerner National Care Records System. The Commission said that remedial work continued for months. It said:

“Significant problems with the implementation of the Cerner system have resulted in poor data quality and a lack of robust information…Weston Area Health NHS Trust was included within the first deployment of the Cerner National Care Records Service (NCRS) and implemented the NCRS system in October 2006.

However, it was soon recognised that the system was not providing the services required by the Trust and that significant remedial work would be required.Over the last nine months the Trust has been working with the suppliers and the SHA to resolve these issues…”

Bradshaw’s reply gave no hint that an independent organisation such as the Audit Commission had deemed as “significant” problems arising from a Cerner implementation.

Bradshaw’s answer did include statistics from Cerner sites including Weston. The system at Weston had 1,700 total users, 1,400 at peak times and an average of 450. Queen Mary’s Sidcup NHS Trust had 2,050 total users, 170 at peak time and [only] an average of 50. Buckinghamshire Hospitals NHS Trust had a total of 880 users, 700 at peak time and an average of 450. But do statistics mean anything?

Buckinghamshire Hospitals NHS Trust went live with the Cerner Care Records System on 25 September 2006. More than a year later, in November 2007, the trust’s board was told of some of the day to day difficulties. On the matter of keeping track of patients with MRSA and C Difficile, the Care Records System was “not working consistently” although Fujitsu, the supplier of Cerner’s Millennium system in the South of England, was working on a fix.

The trust board was told:

“CRS – which is not working consistently Fujitsu are working on a fix for this. In the meantime a ‘belt and braces’ approach is being taken by the Infection Control team to ensure patients are not missed. There is currently no functionality in CRS for flagging patients with C. difficile. “

Last month Buckinghamshire Hospitals NHS Trust categorised the risk of the Cerner Care Records Service causing disruption to clinics, targets and workforce as “likely” to materialise, and it categorised the potential severity of the consequences as “major”.

Avon, Somerset and Wiltshire NHS Cancer Services has said that “Current opinion regarding Cerner is that it will not support cancer data collection and reporting requirements for at least 5 years, possibly nearer 10 years.”

And NHS South Central reported in November 2007 that “Deployment problems at those sites that have implemented the [Cerner] system has created concern amongst those organisations in the deployment pipeline. Regular communication is now taking place to rebuild confidence and keep organisations up-to-date with progress on the contract reset.”

Health Direct Comment:

It has been said before but if ministers and officials continue to play down the problems of NPfIT implementations they’ll carry on alienating clinicians and other NHS staff whose support they need to make a success of the programme. Ministers and NHS Connecting for Health, which runs part of the NPfIT, do not need to put the programme in a zoo enclosure marked “Say kind things only – this enclosure is for the worried and nervous”.

This is the question asked by Peter Bottomley MP and Ben Bradshaw’s answer:

Bottomley:

“To ask the Secretary of State for Health which hospital trusts have installed Cerner’s Millennium system; on what date it was installed; which hospital trusts are expected to install the system and when; what the name is of the senior clinician on each hospital IT board; which Minister is responsible for the system roll out; what representations he has received from clinicians in hospitals using the system on their experience of using it; if he will ask a chief medical officer to consult clinicians using the system in (a) Kent, (b) Sussex, (c) Cheshire and (d) Buckinghamshire; and if he will update the figures provided previously in the answer of 23 July 2007.”

Reply by Ben Bradshaw, Minister of State, Department of Health:

“Nine health communities have to date gone live with the Cerner Millennium system provided through the national programme … In addition two London NHS hospital trusts, the Homerton University Hospital NHS Foundation Trust, and Newham University Hospital Trust, had initiated procurements of the Millennium system before the national programme. To date, some 2.7 million patient records have been entered in the systems currently in use.

“Four further trusts are currently expected to go live with the existing release (release 0) of the Millennium system by the early part of 2008. These are Taunton and Somerset NHS Trust in 2007, and the Royal United Hospital Bath NHS Trust, the Royal West Sussex Hospital Trust, and Barts and the London NHS Trust in 2008. Thereafter, release 1 of the system will form the basis for other implementations across both Local Service Provider areas in 2008-09 and beyond…”

“Details of clinical representation on bodies responsible for overseeing local implementation of NPfIT systems are not held centrally.

“While Ministers have not received any direct representations, we are aware that users in the early deployments expressed some concerns about the system’s management and statutory reporting functionality, and some of its usability features, for example the number of key strokes required for certain functions. Action has been taken to address these concerns and to enhance these areas. This is making a positive impact. Many users who have become familiar with Millennium over time have expressed satisfaction with the system.

“From the inception of the IT programme relevant and experienced clinicians have contributed to the effective identification of requirements, design and testing of all systems wherever across the NHS these are being delivered. This continues to be the case. NHS Connecting for Health has appointed a chief clinical officer to lead the clinical engagement and clinical contribution to the programme.”

From:
http://www.computerweekly.com/blogs/tony_collins/2008/02/minister-defensive-over-cerner.html

The survey was carried out by the CV checking company NDF Associates using the Freedom of Information Act.

It found a third of the 40 Trusts polled had had problems with fraudulent applications.

The head of the company Neil Fawcett said some NHS Trusts are failing to do proper checks, leaving the door open to applicants with fake qualifications.

“We all know in this day and age that certificates are easily obtained,” he said.

“You only have to go on the internet to buy them. We would say you should verify those qualifications by going back to the institution that awarded them.

“If the surgeon who was going to operate on me was not qualified I would be very worried.”

Sky News has seen responses to the survey.

Leeds Mental Health NHS Trust said that: “Instances have come to light where members of staff have misled the trust in relation to their criminal record.”

West London Mental Health NHS Trust identified “…one individual, whose true identity came to light through an anonymous tip off.”

And Sheffield Teaching Hospitals NHS Trust admitted “We do not undertake CV and career checks of locums or agency staff…” Wherever possible it relies on agencies to do the checks.

Stephen McKenzie of the NHS Counter Fraud and Security Management Service said he was not surprised by the results.

He said: “The NHS is such a large organisation with 1.3 million employees, plus there are agency staff, dentists and people contracted. So the law of averages says you will get a few people through. We are trying to get NHS employers to check all their staff.”

Sky News tracked down a surgeon who was last week suspended from the medical register for faking records of at least 41 operations.

Dr Polycarp Gana had tried to give the impression that he was more skilled than he really was.

The General Medical Council’s Fitness to Practice Panel told him: “Your statements were intended to give the impression that that you had attained a level of surgical ability, experience and professional judgement that was inaccurate. Had your deception not been exposed patients might have been put at risk.”

Dr Gana refused to comment.

In the last fortnight alone the General Medical Council has begun cases against seven doctors who are charged with misleading their employers.

In a statement the The Department of Health said NHS organisations must check the identities and qualifications of new staff and verify whether they have a criminal record.

It read: “Falsifying a CV is completely unacceptable. It can lead to patient care being compromised.”

http://news.sky.com/skynews/article/0,,91251-1305538,00.html

Public authorities are typically getting “poor value for money” when they ask private sector consortia for additions to ongoing PFI projects, such as building and operating hospitals and schools, an audit office report concluded on Wednesday.

More than £180m ($353m) of taxpayers’ money was spent on changes to many of the 500 PFI deals in 2006. The audit office found that most private sector PFI operators charged “unjustified” extra management fees, often as high as 10 per cent, on top of the charges made by the service providers for requested changes.

Another problem was that public authorities were frequently ill-equipped to manage PFI projects and had little idea how much changes should cost. For example, it found that the cost of adding a single electrical socket varied widely from about £30 to more than £302 in PFI projects, with an average higher than benchmark prices.

James Robertson, chief economist at the NAO, said: “Public authorities are not necessarily sighted on what the typical cost ought to be and that’s a problem.”

Although 82 per cent of changes to PFI projects, which can often run for 25 to 30 years, were small, “these all add up to a sizeable amount of money”.

Changes that cost more than £100,000 accounted for 90 per cent of the spending, yet just 30 per cent of those changes were competitively tendered, with the rest being awarded directly to the existing contractor.

The audit office said about another third of the changes could have gone to tender to drive down costs. For example, it said a £25m new block at HM Prison Altcourse and £22.9m expansion of Hexham General Hospital were among a number of schemes not competitively tendered but which might have been suitable for such treatment.

Edward Leigh, the chairman of the Commons’ public accounts committee, said changes were inevitable but public sector managers should be more “street-wise” when dealing with savvy private sector contractors.

He said: “The public sector has allowed itself to be taken for a ride. It is depressing that, for one in five PFI projects, the public authorities trim the projects at the initial plan stage to save money, only to risk being stung later by the private sector contractors when things are put back into the project.”

Neil Bentley, director of public services at the CBI employers’ body, said: “The report shows PFI deals are flexible and able to respond to public service users’ changing needs. But value for money is paramount and PFI partners need to work together to deliver a good deal for all.”

From:
http://search.ft.com/ftArticle?queryText=PFI+waste&y;=13&aje;=true&x;=19&id;=080117000316&ct;=0

The bill is the latest stage in a decade long saga that began in the mid-1990s when the health service started shifting care for deeply dependent patients whose condition could no longer be improved medically but who required continuing nursing as well as social care.

The patients were moved out of free NHS care and on to the social care budget, where they were means tested for the support they received.

Given the level of care such people needed, families and individuals faced bills that in some cases ran to tens of thousands of pounds.

In 2003 Ann Abraham, the health service ombudsman, said that health authorities had “misinterpreted and misapplied” the difficult rules concerning the boundary between health and social care since 1996. The result, she said, had been both “hardship and injustice”.

The health department agreed to review cases and said yesterday that it had so far examined 12,000.

“In about 2,000 cases it was found that the decision not to award NHS funding had been incorrect,” a departmental spokesman said. “The NHS has paid restitution to the affected individuals or their families, totalling £180m to date,” or about £90,000 on average.

A further 1,300 cases remain under review, with the aim of completing them by the end of March. However, the department said that it was not possible to estimate what the final bill would be.

The department said that the ombudsman’s ruling and the review had led to improved processes within the NHS in deciding who continued to get free treatment.

About 40,000 people get continuing care packages at present.

Mervyn Kohler of Help the Aged, the charity, said that while restitution was welcome, for many the payments came too late. Some people had been forced to sell their homes to pay for care.

The whole system for continuing care remained “a terrible mess”, Mr Kohler said. People were forced to navigate a complex system at a time when they were ill-equipped to do so. Many inconsistencies also remained, he said.

This underlined the need for the government’s promised green paper on social care to lead to a radically new funding system that was “easy to understand, accessible and properly funded”.

The Alzheimer’s Society said that thousands of people with that disease received only means-tested assistance.

From:
http://www.ft.com/cms/s/0/422bbd44-d9d8-11dc-bd4d-0000779fd2ac.html

Several existing and aspiring foundation trusts are keen to extend the percentage of their income gained through private patient work, arguing that the profits can then be ploughed back into the NHS. But figures obtained by HSJ suggest private patient work may not be that profitable, as millions of pounds are either written off as “bad debts” or paid months late.

The figures come as the foundation trust regulator Monitor prepares to consider whether it will continue to allow foundation trusts to make use of a loophole around a statutory cap designed to prevent them increasing their private work.

The loophole has been challenged by the trade union Unison, which has threatened Monitor with a judicial review.

HSJ collated the details of private patient income from four trusts that do a lot of private work. Together this income was reported as £39.3m for 2006-07. But six months after the bills were overdue, 15 per cent of the total was still outstanding. And by the end of the year, the trusts had written off more than £4.8m worth of private bills.

Of these, North Bristol trust had the largest proportion outstanding. As of 31 March 2007, 57 per cent of its total private income of £1.8m was owing and private debt write-offs that year were £855,000 – excluding those made to insurance companies, which were not disclosed to HSJ. But the trust’s business plans show it still wants to use the loophole to expand private IVF services.

Great Ormond Street Hospital for Children trust in London reported its income from private UK and international patients for 2006-07 as £24m, but one third of that was still outstanding a month after the invoices were due and 15 per cent after six months.

At the end of the year just under £3m was written off as “bad debt”.

A spokesman for Great Ormond Street denied that the large levels of bad debt meant the hospital’s private work was unprofitable.

He added: “Historically the issue has been slowness in recovering sums due, rather than failure to pay. Most of this income comes from sovereign governments or large insurers who wish to continue to use us.”

As of June 2007, the biggest single debtor was the Kuwait health office, with outstanding invoices of £2.8m, after £1m of bad debts had been written off.

The largest insurance debt was to the Greek insurer IKA Elefsina, with outstanding debts of £310,600 after £110,000 had been written off. BUPA owed £280,300 after £86,000 was written off.

Great Ormond Street claims its private patient work is exceptional because it is known as a specialist centre internationally.

But figures collected by HSJ show a similar picture at other trusts. These include Chelsea and Westminster Hospital foundation trust, which has said it intends to exploit the loophole to expand its private maternity services.

Last year the trust earned approximately £5.6m from private patients but had to write off the equivalent of 17 per cent of that (£1m) as bad debt. Approximately half of that was debt owed by overseas patients for emergency treatment while the other half was insurance companies.

Chelsea and Westminster director of finance and information Lorraine Bewes said: “We had a big clear-out of debt last year, so quite a lot of the £1m relates to the last few years’ worth of private patient work; it is not just from one year.”

Ms Bewes estimates that if Chelsea and Westminster’s income for private patients was considered over three years, it would be around £18m and that would bring the write-off closer to 6 per cent. But the trust’s breakdown of private debtors shows that £817,000 was outstanding or late in 2006-07 alone. Ms Bewes denied there was any risk that NHS funds subsidised private treatment.

From:
http://www.hsj.co.uk/news/2008/01/private_patient_debts_question_profit_claims.html

The employers’ organisation cast the decision as a “pivotal test” of Gordon Stalinist Brown’s ability to deliver on his promise that National Health Service reform will go “wider and deeper”.

Seven deals remain to be decided out of the original 27 contracts for a second wave of independent surgical treatment centres (ISTCs). Eleven of these have been cancelled, with just nine definitely going ahead. Ministers have promised a decision on the remaining contracts next month.

“Whatever happens is going to send a signal not just about the ISTC programme but about the government’s broader commitment to long-term change in the NHS,” Neil Bentley, the CBI’s director of public services, said.

It will be a signal “not just to the private sector”, which runs the surgical centres and which the government now wants to enter the GP market, “but to the wider NHS about how committed the government is to its reform agenda”, Mr Bentley said.

In his New Year speech on health, the prime minister “mentioned choice 20 times and spoke about NHS reform going wider and deeper. So the decision on these ISTCs is a pivotal test of the government’s ability to deliver on what it says it wants to do,” he said.

The CBI remained “nervous” of whether all seven of the remaining deals would get the go-ahead.

Mr Bentley’s comments were made as the employers’ organisation published a review of the ISTC programme to date. It claims that the first wave of 26 centres and units, now operational, has had a real impact on the performance of the NHS.

Independent assessments from the NHS inspectorate and others show patient satisfaction remains higher in the ISTCs than in the rest of the NHS, with low infection rates, rapid access to services, high standards of cleanliness and, as far as they can be compared, low complication rates, the report says.

However, the NHS information centre said last week that ISTCs were still not reporting all the data required.

The CBI report acknowledges that, on average, only 84 per cent of the procedures contracted for are being taken up. Under the terms agreed for the first wave of treatment centres, the NHS pays for the procedure regardless of whether it is used.

But it blames the poor take-up on “flawed commissioning and procurement and local NHS resistance to ISTCs being introduced”.

Health ministers say that improvements to the performance of the NHS mean the cancelled centres are no longer needed and that change will be driven by the introduction from April of free patient choice of any hospital, whether public or private.

But the Department of Health’s latest figures show that less than half of patients are aware that they have a choice. And while ministers plan a campaign to raise awareness, along with measures to allow hospitals more freedom to advertise, Mr Bentley said “we need to see that in action.

Resistance to reform and the continued protection of traditional NHS provider interests means patient choice remains limited.”

The ISTCs, he claimed, are “an NHS success story” but the £2bn invested in them “is at risk of being wasted if the programme does not achieve sufficient size”.

The challenge ISTCs pose has encouraged NHS hospitals to become more productive and attractive to patients, the CBI argues.

http://www.ft.com/cms/s/0/a5d05aa0-d7f6-11dc-98f7-0000779fd2ac.html

Leeds Employment Tribunal said Denise Lievesley, former head of the Information Centre, the NHS data factory, should honour the deal, which stopped her publicising criticism of a controversial public private health information venture.

The narrow ruling made no comment on the credibility of Professor Lievesley’s written evidence to the tribunal, which claimed she repeatedly raised the alarm with top health officials about the venture’s worth and its handling of data.

The tribunal ruling, which was published last week, said there was no reason Prof Lievesley should be able to renege on a deal she struck with the Information Centre over her July 2007 departure.

Judge Colin Grazin said: “The claimant . . . should not, in my judgment, now be allowed to resile from that clear agreement and to argue that there was a dismissal at all, let alone that there was an unfair dismissal.”

He noted Prof Lievesley made the agreement with the centre in writing after taking competent legal advice. The professor, a former Royal Statistical Society president, received a £65,825 pay-off in lieu of notice.

Judge Grazin said it was clear that Prof Lievesley was worried about whether proper procedures were followed during the creation of the public-private data joint venture, known as Dr Foster Intelligence. In spite of her concerns, she felt she had “no option” but to work with the joint venture and to try to do her best “in difficult circumstances”.

http://www.ft.com/cms/s/0/de3be88e-d5e7-11dc-bbb2-0000779fd2ac.html

The agreement gave family doctors lavish salary increases tied to various incentives based on preventative health measures. In its first year it led to an average salary increase of 23 per cent, in the second year 10 per cent – an extra £30,000 a year in total.

The deal pushed average GP salaries well over the £100,000 mark and some are earning twice that. One senior doctor who took part in the negotiations says the GP side of the table were stunned by the generosity of the DoH’s offer – they thought it a “bit of a laugh”.

The joke was not shared by patients. The deal focused on the producer, not the consumer, interest. Under the new contract most GPs gave up emergency cover – at a “price” of just £6,000 off their newly inflated salaries, who wouldn’t?

Meanwhile, too many surgeries continue to open at hours that suit health practitioners but which are wholly inimical to the requirements of the working population and, to cap it all, in many practices the appointments systems remain hopelessly inflexible.

This triumph was the handiwork of the then Health Secretary Alan Milburn. His successors, Patricia Hewitt and now Alan Johnson, have struggled to amend it in a way that will give patients a more tangible benefit from the outlay of such large amounts of taxpayers’ money.

In the process, there have been hints that GPs are being greedy. In reality, it would have required self-restraint bordering on saintliness for doctors’ negotiators not to have grabbed what the DoH was offering with both hands. And as Dr Michael Ingram points out, conscientious family doctors more than earn their salaries.

The latest Whitehall attempt to amend the deal comes in the form of a letter from Mr Johnson to all GPs urging them to work longer hours. They are squabbling over an hour a week. The British Medical Association has already agreed to an extra two hours a week but the Government wants three. Battle lines are now drawn.

Given that ministers have only themselves to blame for this dispute, it is hard to avoid the suspicion that there is now a rather more sinister agenda being played out here. By appealing directly to GPs, the labour Government seems determined to break the influence of the BMA (just as it is seeking to cow other professional bodies such as the Police Federation) on the basis of divide and rule.

Such tactics are dangerous. While there may be some public disquiet at how well Britain’s 42,000 GPs have done out of this deal, in any dispute between them and the labour Government, the public will instinctively be more sympathetic to their family doctors. Ministers should stop being so belligerent as they struggle to clear up a mess of their own making.

http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/02/05/dl0501.xml

Independent review teams found that plans for a second round of private sector treatment centres worth £550m a year “should be well-matched to the [NHS's] requirement”. The solutions – intended to generate competition to NHS hospitals and provide extra capacity for patients – were “suitably tailored to regional needs”.

Meanwhile, outline contracts to buy £200m a year of extra diagnostics “represent good value for money and are deliverable”, the reviewers concluded in October 2006. Key stakeholders, such as strategic health authorities, told the review that the deals were “appropriate and very welcome”.

Barely a year later, however, Alan Johnson, the health secretary, cancelled the bulk of the contracts, arguing in November that NHS performance had improved so much that they were no longer needed.

Seven contracts remain under review. But the indications are that not all of those will go ahead.

And the health department is currently negotiating over tens of millions of pounds that it will have to pay out in contractors’ bid costs for the cancelled deals.

The independent assessments were undertaken through the so-called “gateway” process, in which outsiders review large government projects at key stages in their development.

Projects’ chances of success are scored according to a “traffic-light system”, rating them as red, amber or green. The two procurements – unusually for a gateway review – scored green in all categories.

The Financial Times used the Freedom of Information Act to ask for the studies, but the health department refused to disclose their conclusions on the grounds that they related to “the formulation of government policy”. The FT, however, has seen the reviews.

They do note challenges still to be overcome, stating that the main risk to the diagnostics contract is the level of commitment to it from primary care trusts and GPs.

But the risk that the treatment centres would be underutilised had “diminished significantly”, the reviews found, and while success depended on third parties, “there are good grounds for having confidence that the delivered solutions will be well-fitted to customer need”.

The reports show that “something must have gone badly wrong when these projects were going so well a year earlier”, said Nick Bosanquet, professor of health policy at Imperial College London. “It does beg the question: what?”

Ken Anderson, the commercial director who was negotiating the projects, left the department for UBS, the investment bank, three months after the reviews reported. Lord Warner, the health minister in charge of pushing them through, also quit shortly thereafter.

Shorn of ministerial drive and Mr Anderson’s commitment, the contracts seem to have drifted for six months before Chan Wheeler, the new commercial director, took the helm in June, just as Gordon Brown became prime minister and Mr Johnson health secretary.

Mr Wheeler concluded that the capacity in some of the schemes had been “severely miscalculated” and recommended cancelling most of them. His review confirmed that “the volume required by the NHS had reduced since the gateway reviews”, a departmental spokesman said yesterday.

Prof Bosanquet said he suspected the health department had refused to disclose the reviews’ conclusions “because they contradict the action that ministers took later. This absolutely confirms the need for an independent competition authority, [to] which the private sector can go to ensure there is a level playing field for NHS business”.

He added: “Ministers claim rising NHS performance makes these schemes unnecessary. But Office for National Statistics figures show that NHS productivity has been falling – however it is measured.”

Opinions vary on cancellations

There is widespread agreement that procuring the independent treatment centres took far too long, with the specifications repeatedly changing.

Beyond that, however, explanations for the retreat vary. The health department says NHS productivity had improved so much that extra capacity was no longer needed. But others believe the argument also changed as key ministers and officials left the department and Gordon Brown replaced Tony Blair.

Part of the justification for extra treatment centres was that they would disrupt the established order, the review acknowledges. Some were “aimed primarily at introducing contestability into the local health economy” to act “as a spur to efficiency improvements among existing NHS providers”.

When new ministers and officials arrived and asked local NHS officials if they wanted the extra centres and the competition, the answer was “no”. Most were then scrapped.

From:
http://www.ft.com/cms/s/0/223e6174-d458-11dc-a8c6-0000779fd2ac.html

The package was yesterday described as “an eye-watering deal” by Stephen O’Brien, Conservative health spokesman, who asked whether it offered value for money for the taxpayer.

Chan Wheeler, the health department’s commercial director, is a former senior executive with UnitedHealth Group who earned an average of almost $1.4m (£700,000) in his last three years as the head of its Uniprise division, according to Securities and Exchange Commission filings.

He also made $8m from the sale of stock options, according to the filings. He has been named in a civil action in the US by public sector unions seeking $5.5m in damages over backdated stock options that he received from UnitedHealth.

His ultimate boss at UnitedHealth, William McGuire, then chairman, recently paid $600m to settle an action by the SEC over backdated options similar to those that, according to court documents, Mr Wheeler received.

Mr Wheeler has said that he has “never been the subject or target of any investigation” by the SEC.

Frank Dobson, the former Labour health secretary, whose parliamentary questions revealed Mr Wheeler’s remuneration, described it as “a bit much when everybody else in the health service is being subjected to pay restraint”.

He hit out at the £8,400-a-month housing allowance – understood to be spent on a three bedroom apartment in Knightsbridge, central London. Many people were finding house prices out of reach, Mr Dobson said, and “we seem to be helping that by making accommodation for the American commercial director of the NHS free.”

The health department declined to justify the deal in detail, but said Mr Wheeler had extensive expertise in commissioning healthcare in the US and had “been doing an excellent job improving healthcare for the people of Britain.

“He has been willing to take tough decisions, including recently paring down the number of independent treatment centres where they didn’t provide the NHS with value for money.”

Mr O’Brien, however, took a different view. He said Mr Wheeler was being paid such sums despite having played a significant part in policy changes that have reduced the amount of care the NHS is to buy from the private sector from an original £6bn-£7bn over five years to £2bn or less – meaning that his empire was shrinking.

Mr Wheeler told the Financial Times recently that his 200-strong staff was likely to be reduced to a core of 50 as primary care trusts took over the responsibility for commissioning private care for NHS patients.

Mr O’Brien said: “He is being paid an ex-pat’s package but getting the advantage of a civil service pension. And the £100,000-a-year in accommodation costs would cover the salaries of four nurses. It looks like the worst of both worlds for the taxpayer.”

From:
http://www.ft.com/cms/s/0/a3f16376-cea2-11dc-877a-000077b07658.html

What is it like to contemplate your own mortality? Colette Mills describes it as like standing on a ladder leading into a deep, dark pit: “Every time something happens you feel yourself slipping down another rung, but it’s dark, you’ve no idea how near you are to the bottom.” What she does know is that it’s a one-way journey. There is no coming back up.

Mills, a former nurse, could never have imagined herself as the standard-bearer in a battle against her former employer, the National Health Service. Yet in the last stages of breast cancer she has been embroiled in a legal action seeking a judge’s ruling on whether, as an NHS patient, she should be allowed to “top up” her basic hospital treatment with a drug that might radically improve her quality of life.

Four months ago, when the cancer had spread to her spine, hips and ribs, Mills, 58, was advised to take a course of Taxol, a form of chemotherapy. She had read about clinical trials showing that Avastin, another drug, appeared to make Taxol twice as effective if used in combination, and asked if she might be prescribed it.

Her consultant agreed that Avastin might be useful, but told her the drug was not available on the NHS as it had not been approved for use by the hospital trust in North Yorkshire. Mills offered to use her savings to pay the £4,000-a-month cost of the drug, plus its administration, herself.

But that, it turned out, was not allowed. She could not pay for some of her treatment without becoming a fully private patient and paying for all of it, pushing the cost up to at least £10,000 a month, far more than she could afford.

“So I was put in an impossible situation,” she says. “Avastin may only increase your lifespan by six weeks or six months but, believe me, when it’s your life, you’re not picky. I could not understand the logic. I’d had a scan privately when there was a two-week wait on the NHS – once I said that I’d pay I was able to have it the next day – and the hospital had no problem with that.

“If I go to the dentist I can mix my NHS and private treatment. No one complained when I topped up my children’s state education with extra maths and English – the school was very happy to take the credit for their good marks! The government says that to allow some people to buy extra drugs would be to undermine the fairness of the NHS. But this is not about fairness, it’s about social control. If one person can’t have something, no one should.”

She has practically lost count of the number of drugs she has taken over the years – the cancer was first diagnosed 26 years ago when her children, Simon and Karen, were four and two. As we talk we can hear Karen in the kitchen. Through an accident of circumstance, Mills tells me, both children are back at the family home looking out over the North Yorkshire moors, but one can’t help feeling that the chicks have flown protectively back to the nest in her hour of need.

Mills first noticed a lump on her breast when breastfeeding, but was told that it was a blocked milk duct and not to worry: “So, like a fool, I didn’t.” Back then she was working nights at Blackburn Royal Infirmary, having come over from Ireland, her birthplace, to train in Liverpool.

She most enjoyed her early years as a nurse in the rough and tumble of A&E;, and is clearly a feisty character. “But I don’t fight everybody for everything,” she laughs. “This is a clear injustice. It’s inhuman.”

In those days there was no question of “co-paying”. The drugs were not very sophisticated and you were grateful for what you got. As she went for her first biopsy, the surgeon told her to “keep an open mind” about what might happen and she woke up to find she’d had a mastectomy. She still winces at the memory of the awful pink prosthesis that was regulation NHS issue and the impossibility of finding nice underwear.

Since then it has been a pitched battle, trying to hold the cancer back as it has inched forward with each scan. Being a nurse, Mills has tried to do everything she can to help herself, using complementary therapies such as reiki healing alongside her conventional treatment and reading her way though medical papers, one of which led her to Avastin and, inadvertently, to becoming a poster girl for other self-helpers who feel cheated by the health service.

As it is now too late to be prescribed the Avastin alongside the Taxol, Mills’s legal action is on hold until a doctor agrees to her trying it with another drug. But her willingness to speak up has encouraged a number of other patients to protest, including Debbie Hirst from Cornwall who is in a similar situation, who put her house on the market to pay for treatment but whose trust has just indicated that it will pay for her to be treated on the NHS as an “exceptional case”.

In Newcastle, Karen Gault, the mother of three-year-old Grace, is paying to be treated privately with Avastin to halt her bowel cancer – thanks to the generosity of friends and colleagues who have raised the money to allow her to do it. She is also appealing against her local hospital’s decision not to treat her on what her husband Paul says is a “slim possibility” that they might be reimbursed.

Mills’s solicitor, Melissa Worth, has had call after call from people caught in the same trap.

There is nothing in the NHS guidelines that specifically rules out co-payment, but the thought of allowing patients to supplement their treatment rouses strong emotions and goes to the heart of what it is reasonable to expect the health service to pay for, given finite resources. Alan Johnson, the health secretary, says that allowing some patients to access treatments that others could not pay for is unthinkable: “That way lies the end of the founding principles of the NHS.”

Professor Karol Sikora, a leading cancer specialist and adviser to the World Health Organisation, says this is ideology gone mad, medical communism. “Nobody pretends this isn’t a difficult issue, but there has to be a solution,” he says.

“Yes, it breaks down the principle of everything on the NHS being free at the point of delivery but one has to live in the real world – these drugs are freely available in Calais. Or patients can order them over the internet.

“We need to put this out in the open and ask some pertinent questions. Because it’s not just about paying for drugs. If the drug causes side effects that result in internal bleeding, or require surgery or intensive care, who pays for that? It would be simple to add on some insurance to the cost to cover such eventualities. But the real problem is that no politician sees it as a vote winner.”

Mills has come in for her fair share of criticism as well as support. Commenting on a story about her in the newspapers, one man said that this was an “end of life issue” and she should “get on with it”.

The whole thinking behind the “one size fits all” approach strikes her as absurd. “Should we all live in council houses even though some of us can afford to buy our own homes?” she asks. “Where does all this stop?”

She has not got long, although who knows with cancer. “At some point I will have to decide whether to carry on with the chemo or just stop it and enjoy whatever time I have left, but I’m not there yet,” she says.

Meantime, she keeps searching for an answer and fighting for her right to try whatever she can to prolong her life.

http://www.timesonline.co.uk/tol/life_and_style/health/article3294447.ece

The fall has occurred even allowing for improvements in the quality of care, the Office for National Statistics says. Without those, the fall would have been faster still, representing a decline of 2.5 per cent a year on average between 2001 and 2005.

From 2005 to 2006, as the immediate effects of big pay rises for doctors began to fall out of the calculations and growth in staff numbers slowed, productivity fell less quickly, by just 0.2 per cent. It is possible that quality adjustment for that year, when the figures are available, will show a small rise in productivity.

Measuring NHS productivity involves “approximations to a complex reality”, the ONS admits. But on the available measures, since 1995, just before Labour took power, and up to 2006, there was a 50 per cent increase in the quantity of care that the NHS provided in terms of operations, GP consultations, prescribing and so on.

Over the same period, however, inputs – chiefly money and staff – rose even faster, up by 67 per cent. Consequently productivity fell by about 10 per cent.

More detailed analysis shows productivity remained broadly stable between 1995 and 2001, but fell by an average of 2.5 per cent a year to 2005, with the decrease slowing sharply in 2006.

However, these figures do not allow for quality improvements, such as whether patients are getting better quicker. The ONS concedes “we may be underestimating quality improvement”, and further work on quality measures is needed.

Alternative assumptions might reduce the estimate of the decline in productivity by up to 0.5 per cent a year, the ONS says. Big falls in death rates from diseases where medical interventions make a difference may suggest bigger quality improvements than so far estimated.

“But none of these uncertainties are sufficiently great to alter the conclusion that productivity has fallen, particularly in the period 2001 to 2005,” the organisation concludes.

David Nicholson, NHS chief executive, has acknowledged that improving productivity in the next few years is crucial as spending growth tightens.

But he said the ONS approach “would count longer appointments with GPs and switching patients from hospital outpatients into more appropriate community settings as a fall in productivity, rather than an improvement in quality”.

http://www.ft.com/cms/s/0/a3644ffe-cec0-11dc-877a-000077b07658.html