Despite the billions Labour has poured into health, the YouGov poll shows that public satisfaction with the NHS is dropping. Barely one in five people believe the Labour party will deliver a better health service over the next ten years, the You Gov poll shows.

It comes on the day Gordon Brown is to publish Lord Darzi’s package of reforms to overhaul the way the NHS is run.

The Prime Minister hopes the comprehensive review will transform Labour’s fortunes and restore the party’s reputation as guardians of the NHS on its 60th anniversary.

The results of the poll show he Tories have a clear lead on health policy with 31 per cent of people saying they would do a better job of running the health service, compared to 23 per cent who think Labour would deliver on the NHS.

The results of the latest poll confirm a shift in the political debate over health care, away from funding and towards improved management and organisation.

After years of above-inflation increases in health spending, most voters now believe the NHS has enough money. But they worry that the service has become bureaucratic and over-burdened with managers.

Sixty-nine per cent of people said reorganising the NHS is more important than spending more on it, up from 38 per cent in 1998. Only 24 per cent now want more spent on health, down from 59 per cent a decade ago.

Seventy-eight per cent of voters believe the NHS has too many managers.

And despite the billions Labour has poured into health, the new poll shows that public satisfaction with the NHS is dropping. In 1998, some 91 per cent of recent patients said they were happy with their treatment. That figure has now fallen to 81 per cent.

Some 44 per cent of people said they think “a great deal” of money is being wasted in the NHS. Another 38 per cent said a “fair amount” is wasted.

“David Cameron’s unambiguous commitment to the National Health Service means a great deal to the public. They know that the NHS needs reform and that Labour have failed them on this crucial issue,” said Andrew Lansley, the shadow health secretary.

“But they also know that Conservative reforms for healthcare will not threaten the security that comes with a health service available to all, based on need. This poll shows that the public, like staff across the NHS, are now willing and ready to trust the Conservatives with the stewardship of the NHS.”

In the foreword to the Darzi report, the Prime Minister hails the document as the blueprint for a “once-in-a-generation” shake-up in the NHS.

The report will usher in the creation of “polyclinics” with several doctors and nurses to replace hundreds of GP surgeries in the biggest cities, despite opposition from patients and the

British Medical Association.

It also says that hospitals should publish death rates for dozens of conditions, allowing patients to make “informed choices” about where to get treatment.

Hospitals should offer more home births for mothers, and old and terminally-ill will get the right to chose to die at home instead of in hospital.

And a new NHS constitution will enshrine rights to confidentiality, control of patient records and a second medical opinion.

Mr Brown writes: “Lord Darzi’s report is a tremendous opportunity to build an NHS which provides truly world-class services for all. It requires government to be serious about reform, committed to trusting front-line staff and ready to invest in new services and new ways of delivering services.”

But Norman Lamb, the Liberal Democrat health spokesman said he feared the Darzi package would be vague and impractical. He said: “What does all this mean? Will patients be able to enforce their rights?”

And despite Mr Brown’s bold claims for the review, there are doubts about whether Lord Darzi has been allowed to go far enough in drawing up his reform plans.

His report is not expect to deal with the controversial issue of “co-payment,” where patients can pay extra to top-up NHS care with private provision. That omission has drawn accusations that the review is too limited to prepare the health service for the demands of the next century.

A separate opinion poll for Reform, a think-tank, has suggested that most doctors believe top-up payments should be introduced to the NHS.

The ComRes poll showed that 79 per cent of GPs believe patients should be able to top-up their NHS care with private treatment.

• YouGov polled 2,163 adults across Great Britain between June 23 and 25.

From:
Labour-no-longer-trusted-on-NHS-reforms.html

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

Three of the cases, involving women suffering from liver and bowel cancer, are expected to prompt a judicial review of the government’s ban on “co-payment”, as the buying of private treatment while under NHS care is called.

Some cancer drugs not yet available on the NHS can markedly increase the chance of survival. But Alan Johnson, the health secretary, claims that co-payment would create a two-tier NHS, with preferential treatment for patients who could afford the extra drugs. Last year he issued guidance to NHS trusts ordering them not to permit patients to pay for additional medicines.

Brian, O’Boyle’s husband, said he was appalled by the way she was treated. He recalled his wife as a woman with an infectious laugh who had given a lifetime of service to the NHS as an assistant occupational therapist. The couple, who had three sons and four grandchildren, lived in Billericay, Essex.

After she developed bowel cancer and began having chemotherapy, doctors told her she should boost her chances of fighting the disease by adding another drug, cetuximab. It is not routinely funded by the NHS.

When she decided to use her savings to pay for it, Southend University Hospital NHS Foundation Trust withdrew her free treatment, including the chemotherapy drug she was receiving.

The trust said yesterday: “A patient can choose whether to continue with the treatment available under the NHS or opt to go privately for a different treatment regime. It is explained to the patient that they can either have their treatment under the NHS or privately, but not both in parallel.”

Brian O’Boyle, 74, who worked as an NHS manager for 30 years running rehabilitation services for the mentally ill, said: “We were happy to pay for this drug, cetuximab, and to give the health service what it cost to buy it and deliver the treatment, but they said they couldn’t do that. That is appalling.”

He added: “When she heard there was something that could extend her life, of course my wife jumped at it. Linda was taking lots of other drugs that she had previously been given on the NHS but \ we had to pay for all of them.

“It was stressful enough for Linda having cancer without her having all this stress on top of it.”

He has the backing of John Baron, the local Conservative MP and a former shadow health minister. “The NHS was very wrong to deny care and treatment to Linda O’Boyle. She has been penalised by an NHS system that is grossly unfair. This is morally wrong,” Baron said.

David Cameron, the Conservative leader, said in a statement that it was “tempting” to allow patients to pay for extra cancer treatments that were not funded by the NHS.

The party has been reluctant to express an opinion on the issue, fearing that it could be portrayed as favouring middle-class patients who can afford to buy themselves extra treatment.

A group of nearly 1,000 NHS doctors, called Doctors for Reform, has raised £35,000 to fund a judicial review of the ban on co-payments.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

The resulting accident is not yet terminal. But it does mean more dire headlines and it is hard to see how the news of Fujitsu’s departure from the Connecting for Health programme will not produce further delays to an electronic record that is already running more than four years late – even if some parts of the exercise, ironically, may speed up.

The bad news that the programme has parted company with another big supplier – Accenture having walked away in 2006 – comes as things were finally looking up. BT appeared to be cracking the installation of the new systems in London, the part of the country for which it holds the local service provider contract.

Preliminary installations that are critical to getting the electronic record to work have gone into most of London’s mental health trusts and two or three big acute hospitals – not without inevitable teething troubles, but without the sort of catastrophic disruption that hospitals in the south have at times seen as Fujitsu tried to do the same.

In the north, iSoft’s long-delayed Lorenzo patient-record software is about to go into three pathfinder trusts this summer. If that had gone well, the programme would have felt itself to be back on track. Now it is plunged into further doubt and condemnation from opposition politicians who were demanding yet again a review.

Fujitsu’s deal always looked questionable. It was the last, and in terms of scope, the biggest of the five regional installation contracts. It covered more than 12m people and 90 hospitals and NHS organisations.

But Fujitsu’s agreed price for it was only £896m, nearly £200m less to cover 25 per cent of the population than Accenture got from the NHS for covering 15 per cent. It looked badly underpriced.

A senior Fujitsu executive predicted that once one or two of the systems were in it would be “like shelling peas”. It proved to be anything but.

Hospital after hospital suffered crashes and troubled installations as what was still an interim system, without the full record, went in. As of March, new systems had gone into just nine out of 41 acute hospitals and they were working so badly that Fujitsu had not been paid for more than half of them, according to the National Audit Office.

Industry sources say both BT and Computer Services Corporation, which now holds the installation contract for almost everything north of London, have been more flexible about giving NHS trusts what they want, instead of insisting they have precisely what was specified in the original contract.

Negotiations with Fujitsu are understood to have broken down not on the price the NHS was prepared to pay for a more flexible deal but on the timing of upfront payments that the company wanted.

The NHS refused to depart from the principle that has kept the programme on budget to date – that it will not pay for services until they are delivered. One senior health department source said: “We have to protect the taxpayer.”

In a letter to NHS trusts, Gordon Hextall, the programme’s chief operating officer, said Fujitsu would support existing live sites and the industry expectation is that they will complete one or two that are about to go live in order to get paid.

Beyond that, rather than a complete takeover of Fujitsu’s contract by one provider, Connecting for Health may use the existing contracts to get both BT and CSC to take over different parts of Fujitsu’s uncompleted work: an approach that could give NHS trusts in the south more choice. Cerner, the key software supplier for the south may take a bigger role.

And Connecting for Health has also just signed a framework contract with a range of other, new, suppliers that could be brought into play.

All that will be the subject of fraught negotiation. For now, the programme feels as if it is on a knife-edge.

From:
http://www.ft.com/cms/s/0/7b9d569e-2db3-11dd-b92a-000077b07658.html

Just months after the Department of Health cut back on a programme of independent sector centres to treat NHS patients at close to NHS prices – claiming that the NHS had sufficient capacity itself – private hospital providers say the service is once again “spot purchasing” significant numbers of operations at the last minute to get waiting times down.

Such last-minute purchases cost appreciably more than the standard NHS price, as the private hospitals are less able to plan and schedule their work.

One senior NHS manager said: “I know of examples where the NHS has recently paid the private sector 140 per cent, and even 160 per cent, of the NHS price to try to hit the waiting time target.”

The practice of spot purchasing had largely disappeared after the first independent treatment centres came in and the NHS introduced more structured contracts with the private sector.

The disclosure of its reemergence came as the DoH claimed to have hit a milestone in its drive to ensure that no one has to wait more than 18 weeks for treatment by the year end.

By the end of March, 85 per cent of patients who require admission were meant to have started treatment within 18 weeks, while 90 per cent of outpatients had started treatment within that period.

The health department said that a “milestone” had been achieved nationally. But closer examination shows that while some hospitals are reaching the 18-week target for almost all patients – pushing the average up – others are still way short of the March measure.

In London, fewer than 70 per cent of orthopaedic and neurology admissions were treated within 18 weeks, for example. In the south-east, fewer than 71 per cent of orthopaedic patients were operated on on time, and only just over 75 per cent in the south-west.

The east Midlands narrowly missed the milestone for cardiothoracic surgery, and the West Midlands missed it for orthopaedics, oral surgery and neurology.

However, David Worskett, director of the NHS Partners Network, which represents private providers, said some of the improvement had been due to a significant rise in spot purchasing in some parts of the country.

“It would have been better to bring more independent sector activity into the system,” he said, “because it is cheaper to have an agreed volume than to go in for last-minute purchases which are inevitably more expensive because the providers cannot plan.”

From:
http://www.ft.com/cms/s/0/27638a84-2daa-11dd-b92a-000077b07658.html

Ten months of renegotiations with Fujitsu, which holds the £896m 10-year contract for installing the record across the whole of the south and west of England, have broken down, according to both the company and the NHS.

The dispute centred on the NHS’s demand for more flexibility in delivery of the services – a request that would cost more. Fujitsu wanted either more money or a return to the original contract specifications.

Connecting for Health, the NHS IT programme, said it is now to issue a termination notice to Fujitsu in a move that could cost the Japanese-owned services company an estimated £300m.

It is the second time the programme has lost one of its big four suppliers after Accenture withdrew in 2006 at a substantial cost to the company.

BT, which runs the programme in London, is the favourite to take over from Fujitsu as Computer Sciences Corporation, which runs the whole of the north and Midlands, uses different software to BT and Fujitsu for the record.

The breakdown is a blow to the programme, although its defenders will argue that the contract structure of having an original four big suppliers is likely to work as BT or CSC is likely to step in.

But the breakdown can only further delay a programme whose core product – the electronic record – is already running more than four years late.

Connecting for Health said: “Regrettably, it has not been possible to reach an agreement on the core Fujitsu contract that is acceptable to all parties. The NHS will therefore end the contract early by issuing a termination notice.”

That is understood to give Fujitsu 20 days to register a counter claim, with the possibility that differences will have to be settled in court.

Connecting for Health said Fujitsu had made a commitment “to providing a smooth transition to new arrangements”, without specifying what those would be.

BT must be the clear favourite to take over if it wants the business.

Given that it uses the same Cerner software that Fujitsu has been installing in the south, BT will be in a strong negotiating position during any takeover talks.

A switch to CSC would be likely to involve a switch to iSoft’s as yet unproved Lorenzo software. BT said Wednesday night it would consider any approach from the NHS to take on the extra work.

Fujitsu confirmed that talks had broken down and the company had wanted to revert to the original contract, which provided less flexibility than the NHS is now seeking. Failure to agree a price for that lay behind the breakdown, a Fujitsu official confirmed.

From:
http://www.ft.com/cms/s/0/41dbc5f0-2cf3-11dd-88c6-000077b07658.html

Cocaine overdose cases quadruple at hospitals

The number of cocaine users being admitted to hospital has quadrupled in eight years, it has emerged as concerns grow that it has become the drug of choice for middle-class men.

An average of more than two people a day are admitted to accident and emergency units for “cocaine-induced health emergencies”, official NHS labour Government data showed.

There were 740 incidents in 2006-07 compared with 161 in 1998-99.

In comparison, heroin overdoses and cannabis poisonings both fell in the same period, according to the figures obtained by Druglink magazine.

The figures for cannabis poisings fell from 171 to 96 and for herion overdoses from 1,962 to 1,530.

The statistics expose the scale and impact of cocaine’s growing popularity and come after a series of high-profile cases involving the drug.

From:
http://www.drugscope.org.uk/

However according to the NHS Information quango -in total 207,800 people were admitted to wards in 2006/7 because of their drinking, either they were drunk, had liver cirrhosis or a secondary disorder such as heart disease brought on by heavy drinking. They may also have been injured or assaulted while drunk.

The data from the NHS Information Centre revealed cases of alcoholic liver disease have trebled in 12 years to reach 43,548 in 2000

Health Direct is not surprised that DrugScope is ‘extremely disappointed’ by the recent labour U Turn to reclassification cannabis. Labour’s decision is not based on science, fact or common sense. Just plain nanny state political stupidity.

Without such action, senior NHS managers say, the declared surplus for the NHS in England in the financial year just ended is likely to have been nearer £3bn.

That money is in addition to the £2bn of cash in the bank, much of it working capital, that foundation trusts are expected to hold as they generate their own surplus of perhaps £500m.

The move appears to have two motives: first to avoid the political embarrassment of the massive swing to a huge surplus of about £3bn just two years after the NHS in England attracted months of dire headlines when it recorded a £571m deficit; and second, to reduce the risk that a cash-strapped Treasury will claw the money back.

Both ministers and David Nicholson, the NHS chief executive, have said the Treasury will allow the service to carry over its forecast surplus. The NHS also aims to carry over a similarly sized sum this financial year.

Last year, however, the Treasury quietly clawed back £2bn of unspent capital from the Department of Health, and there are fears that if the final surplus exceeds the £1.8bn forecast the Treasury – which is under pressure on its borrowing rules, has just had to fund a £2.7bn tax giveaway to tackle the 10p tax band issue and faces spending pressures from other departments, not least defence – will want the money back.

To reduce the risk, managers say NHS hospitals and primary care trusts have been given “control totals”, which stipulate that while they must deliver the surplus they were forecasting, they must also not exceed it.

Some chief executives have been told their personal performance rating would be under threat if they do.

According to people close to the situation, foundation trusts, which as free-standing businesses can keep the cash, were paid £300m-£400m in advance by primary care trusts for services before the end of the last financial year.

Doris-Ann Williams, director general of the British In-Vitro Diagnostics Association, whose members supply equipment to the NHS, said members had received “a flurry of unexpected cash orders for capital equipment purchases as long as they could be invoiced before the end of March [the end of the financial year]”.

The chairman of one London hospital said it had not only been prepaying suppliers but also shifting money to charitable trustees to get it off the books by the end of the financial year. Some primary care trusts are also said to have prepaid local authorities for services.

One senior NHS manager said: “I don’t think anyone knows what the true picture is, but my guess is that without these measures the real surplus is much closer to £3bn.”

From:
http://www.ft.com/cms/s/0/5f05f078-2aa1-11dd-b40b-000077b07658.html?nclick_check=1

As Health Direct posted yesterday- the NHS funding position is down to cost cuts not funding proper health services.

NHS hospitals lose 32,000 beds in a decade

More than 30,000 hospital beds have been lost since Labour came to power, with record cuts in NHS wards last year- which Health Direct chronicled.

The cutbacks mean increasing numbers of hospitals are going on “black alert” – which involves closing their doors to new patients because they are full.

The cutbacks mean increasing numbers of hospitals are going on “black alert” – which involves closing their doors to new patients because they are full.

Patients’ groups described the loss of the beds, at a time when overcrowded wards have seen soaring rates of killer infections, as “a national scandal”.

The reduction contradicts a pledge from Tony Blair at the turn of the century that there would be 7,000 more NHS beds by 2010.

New figures, seen by The Telegraph, show that the number of health service beds fell more than 8,000 last year, as the NHS began a reorganisation process which will mean the closure of dozens of hospitals.

More than 40 per cent of maternity units turned away women in labour last year because they had no room.

Meanwhile, ambulances have been forced to queue outside overstretched hospitals, treating patients in car parks just yards from accident and emergency departments. The new statistics, revealed in response to a parliamentary question by Ed Vaizey, the Conservative MP, show that almost 32,000 NHS hospital beds went between 1997, when Labour took office, and 2007.

More than 8,400 beds were cut in the year ending March 2007, the largest fall in 14 years. One in six beds has been closed over the decade. There are now 167,019 beds in NHS wards, compared with 198,848 in 1997.

The figures emerged as health authorities are drawing up plans which will see the likely closure of dozens of district general hospitals. The East of England health authority has admitted that two accident and emergency departments and a maternity unit could close.

Andrew Lansley, the shadow health secretary, said the labour Government’s financial mismanagement had forced hospitals to make cuts which could risk lives. “These bed cuts were financially driven: the sharp rise in the numbers closed happened at a time when the health service was under desperate pressure to clear a massive deficit.”

Katherine Murphy, from the Patients’ Association, said: “This is a national scandal. More than 30,000 beds have been lost at a time when demand is increasing.”

In the same decade that the beds were cut, death rates from the infections MRSA and Clostridium difficile rose five-fold. Investigations into the biggest C. diff outbreak in Britain, which killed 90 patients at hospitals run by Maidstone and Tunbridge Wells trust in 2005 and 2006, found that overcrowding amid pressure to meet hospital waiting targets was a factor behind the infection’s spread.

More than 2,000 maternity beds have been lost since 1997. Research by the Conservatives found that last year, 42 per cent of maternity units had refused to accept women in labour on at least one occasion.

Sue MacDonald, from the Royal College of Midwives, said: “We feel the cuts have gone too far.”

Norman Lamb, the Liberal Democrat health spokesman, met officials recently after pressures on his local hospital, the Norfolk and Norwich, forced it to declare an emergency “black alert,” closing to new admissions, with 10 ambulances “stacked” outside, treating patients.

From:
NHS-hospitals-lose-32%2C000-beds-in-a-decade.html

Jack Hose, 71, a retired engineer, was receiving a chemotherapy drug called irinotecan on the NHS, but it was failing to halt his bowel cancer.

NHS doctors told Hose, from Bournemouth, that they could do no more for him and that he should go home and make the most of the rest of his life while taking painkillers.

Hose was not prepared to die and sought a second opinion from a private doctor who recommended trying another drug, called cetuximab, in combination with irinotecan.

The mix of drugs appears to have stabilised Hose’s cancer. However, cetuximab is not funded by the NHS.

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, which is treating Hose, has told him that, if he takes the drug, he will need to pay for all his care, including the cost of the medicine he initially received on the NHS.

Hose is the latest victim of the labour government’s policy of denying NHS treatment to patients who pay for an additional private drug.

Alan Johnson, the health secretary, says such an arrangement, known as “co-payments”, would lead to a two-tiered NHS.

“It seems outrageous that, having paid National Insurance contributions for 50 years, they are now asking me to pay for my care,” said Hose.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3999216.ece

The Equality and Human Rights Commission (EHRC), headed by Trevor Phillips, has written to strategic health authorities warning them to ensure that doctors and hospitals in their areas give equal priority to men and women.

The commission has legal powers to issue compliance orders to NHS trusts that persistently fail to provide equal care for men.

While the commission does not cite specific examples of discrimination, it details evidence of poorer male health. Other groups have pointed to male-unfriendly surgery opening hours.

Men are twice as likely as women to die from the 10 most common cancers that affect both sexes and, typically, develop heart disease 10 years earlier than women. Men under the age of 45 visit their GP only half as often as women and are less likely to have dental check-ups.

On average, men die five years younger than women and 16% of men die while still of working age compared with 6% of women. Men are also three times more likely to commit suicide than women.

A new law, the gender equality duty, which came into force in April 2007, obliges all public services to ensure they care for both sexes equally. In March, Phil McCarvill, head of public service duties at the EHRC, sent warning letters to strategic health authorities, the bodies which manage local NHS trusts.

McCarvill said: “We are writing to you specifically regarding the gender equality duty in response to particular concerns raised with us by the Men’s Health Forum and the action we want you to take in response to this. We will view the failure to take any action as a result of this letter as a breach of your legal responsibilities in this area.”

Research carried out by the forum found that men were unhappy with the service provided by their local GP surgeries. The forum points out that since men are twice as likely as women to work full-time and three times as likely to work overtime, it is more difficult for them to see doctors during conventional opening hours.

Other experts have pointed to the fact that, while there is a national screening programme for breast cancer, there is no equivalent yet for men for prostate cancer, although it claims a similar number of lives. Women are also screened for cervical cancer.

Peter Baker, chief executive of the Men’s Health Forum, said: “The GP model doesn’t work particularly well for men, particularly young men aged between 16 and 45 who GPs tend not to see unless there is something very seriously wrong with them. There is discrimination because these services are being underused by the group with the greatest need.”

The forum also suggests trusts offer health checks in venues frequented by men, such as work-places or sports clubs.

The Commons health select committee inquiry into health inequality will next month hear evidence that men are being discriminated against in the NHS.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3999217.ece

Health Direct points out that labour’s centralist politically correct doesn’t just extend to pro women bias. They also channel extra funds into labour voting areas.

On August 07, 2006 Health Direct posted: Rural areas lose out to cities over health spending postcode lottery
Money needed for patients in rural England is being diverted to inner-city areas where it is not even being spent, experts say. Researchers at Cambridge University Medical School say the 29 primary care trusts (PCTs) most in surplus in 2004-5 were virtually all in inner-city areas.

In comparison, the 29 most in-debt PCTs were in rural areas, which received on average £205 less per head of population.

MRSA and Clostridium difficile were linked to more than 8,000 deaths in England and Wales in 2006, up from 5,300 the previous year.

The first ever breakdown of deaths from both infections by location released by the Office for National Statistics shows that the vast majority of patients died from the bugs in hospital.

The deadly infections also killed small numbers of patients in nursing homes and hospices.

In total there were 6,424 deaths from C difficile in all three locations in 2006, almost double the 3,719 deaths caused by the infection in 2005. MRSA was responsible for 1,625 deaths, up from 1,621 the previous year.

The worst hospital for C difficile deaths in England or Wales was the Royal United Hospital in Bath, which had 268 deaths from the infection between 2002 and 2006.

The George Eliot hospital in Nuneaton, Warwickshire, the Walsgrave Hospital in Coventry and the Royal Infirmary in Leicester all had more than 200 deaths caused by the infection over the same period.

Maidstone hospital in Kent, which was part of one of the worst outbreaks of the infection in the country when more than 90 patients died at three hospitals run by Maidstone and Tunbridge Wells NHS Trust died from the bug, had 113 cases over the same period.

With 94 deaths Derriford Hospital in Plymouth had the highest number of deaths from MRSA cases between 2002 and 2006.

Over the same period, The Queen Alexandra Hospital in Portsmouth recorded 81 deaths from MRSA, Maelor Hospital Wrexham 79 deaths and the Musgrove Park Hospital in Taunton, Somerset 77 deaths.

More than 1,100 hospitals, hospices and nursing homes had at least one death from C difficile in the last five years and more than 900 had at least one death from MRSA.

The Office for National Statistics cautioned that many of the hospitals who recorded large numbers of deaths from both infections were also more likely to have high patient numbers generally. The data, collected from death certificates, also shows only where patients died, not where they acquired the infections initially or where they received other treatment before their death.

A spokesman for Help the Aged said he was “concerned” at the wide variation between hospitals.

He added: “We know that older people are at greater risk of hospital acquired infections, so any rise will affect them more heavily.”
Worst ten hospitals for deaths from superbugs

Number of deaths from MRSA 2002 – 2006
Derriford Hospital, Plymouth 94
Queen Alexandra Hospital, Portsmouth 81
Maelor Hospital, Wrexham 79
Musgrove Park Hospital, Taunton 77
Royal Sussex County Hospital, Brighton 75
General Infirmary, Leeds 70
Addenbrookes Hospital, Cambridge 68
Birmingham Heartlands Hospital 67
Norfolk and Norwich University Hospital 65
General Hospital, Southampton 64

Number of deaths from C difficile 2002 – 2006

Royal United Hospital, Bath 268
George Eliot Hospital, Nuneaton 235
Walsgrave Hospital, Coventry 233
Royal Infirmary, Leicester 203
General Hospital, Kettering 200
Birmingham Heartlands Hospital 177
General Hospital, Leicester 169
Frimley Park Hospital 164
Sunderland Royal Hospital 152
General Hospital, Southampton 149

From:
Superbugs-MRSA-and-Clostridium-difficile-killing-record-numbers-of-patients.html

The health department confirmed that Mr Wheeler is to leave in July “for personal, family reasons”.

As commercial director, Mr Wheeler recommended – to the chagrin of the private sector – a marked reduction in the scale of the second wave of independent sector treatment centres set up to treat NHS patients, saying the need for them had been “severely miscalculated”.

He accepted arguments that the NHS itself had sufficient capacity in some areas. He has also overseen the shift from centrally purchased private sector contracts to local purchasing by primary care trusts.

His arrival caused controversy because he had received backdated share options at United Health similar to those that led to William McGuire, its chairman, resigning and reaching a $600m (£300m) settlement with the Securities and Exchange Commission. His UK pay package was attacked by the Tories after it emerged he was receiving £100,000 a year towards his accommodation, on top of a £185,000 salary and pension.

Mr Wheeler said he was sad to be leaving, while David Nicholson, the NHS chief executive, said he had done “a fantastic job”. A departmental spokesman said the balance of Mr Wheeler’s three-year contract would not be paid.

From:
http://www.ft.com/cms/s/0/06a39900-292d-11dd-96ce-000077b07658.html?nclick_check=1

The detail of Chan Wheeler’s renumeration was only revealed this year. February 05, 2008 Health Direct posted: NHS gives American chief ‘eye-watering deal’

The Department of Health is paying more than £100,000 a year towards housing the American who heads its commercial directorate – on top of a salary of at least £185,000, a civil service pension, two business class flights a year to the US, a relocation package of up to £35,000 and eligibility for a bonus.

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.

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

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.”

The broadcaster said he had been forced to complain about the treatment his mother, Freda, received before she died last year aged 95.

But he also admitted fearing the repercussions for her once he made a complaint, saying that he did not want to leave her alone.

Sir Michael was named recently as the labour Government’s new “dignity ambassador” with a mission to raise awareness of the importance of compassion in care services.

He said: “My mother had a wonderful life except for the last five years, and experienced a variety of care. I came across an extraordinary mixture of care – some nurses who were utterly dedicated and wonderful.

“But there were others who treated it as a job and a bit like they were a jailer, treated people in their care as inmates. There were distressing signs of elderly people being left weeping who were still there half an hour later, and that’s obviously not right.”

He said he had complained about his mother’s care once or twice. “When I left the building I did wonder, ‘Who will get the smack for this?’ I used to worry about leaving her on her own.”

Sir Michael, 73, whose chat show ended last year, also said nurses should be paid more. “We take it for granted they’re going to work for less than most people and that’s wrong,” he said at Guy’s and St Thomas’ Hospital in central London.

Over the next six months Ivan Lewis, the Care Services Minister, is to visit every area of England to encourage more people to become “dignity champions”. More than 1,800 people have signed up to promote the respectful and compassionate treatment of elderly people in their areas, but the Government wants twice as many.

Mr Lewis also announced that “discussions” would be opened with councils to make sure that elderly couples were not split up when they need more care.

The Daily Telegraph reported that a married couple who have been together since the Second World War could be separated before their diamond wedding anniversary because their local council would not pay for both to move into a nursing home.

From:
Michael-Parkinson-fights-for-dignity-in-care-homes.html

On June 22, 2006 Health Direct posted: Minister wants Dignity debate for caring for the elderly

New care services minister Ivan Lewis has said he wants to make dignity of older people one of his top priorities. Speaking at a session on the out of hospitals white paper, he said: ‘I want to make dignity an important theme in my time as a minister. ‘This is not a gimmick; just another initiative. It should be at the heart of what we are doing.

Health Direct pointed out that this is a classic Labour tactic. Ivan Lewis’s caring, sharing labour government announces a laudable new spin policy for caring for the elderly and frail. Brilliant

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

Risks associated with alcohol consumption exist on a continuum.

For most people, drinking below a certain so-called “safe” or “minimal risk” level is associated with little harm, but outcomes vary.

* For certain individuals, even low levels of alcohol consumption can be associated with harm (e.g., those with medical conditions, taking medications).
* For others, moderate alcohol consumption is associated with health benefits. For example, a protective effect of moderate alcohol consumption has been demonstrated for cardiovascular disease in middle-aged men and for osteoporosis in elderly women.

Men and women have different sensitivities to the same levels of alcohol consumption, due to differences in physiology. Recommended “safe” or “minimal risk” drinking levels for women are generally lower than for men.

There is inconsistency regarding the official threshold between safe and harmful consumption.

Drinking guidelines exist within broader nutritional or dietary guidelines, as part of a drug strategy, or as stand-alone recommendations about drinking.

Official government guidelines differ with regard to the “safe” or “minimal risk” threshold for alcohol consumption. Recommendations may be presented as daily or weekly limits. For example:

In Portugal the male drinking limit is 42.4 units a week and for women it;s 27.5 unites per week.

Which is 82% more that labour’s nanny state wants us to limit.

DrinkingGuidelines/KeyFactsandIssues/tabid/203/Default.aspx

Health Direct notes that once again labour dithers over another dilemma. One which ignores there own advisers and the science.

On August 02, 2006 Health Direct posted: Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

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

This showed that alcohol was the fifth most risky drug to take.

More than 6,000 people died in 2006 after becoming infected with the gut infection in hospitals across England and Wales – a more than four-fold rise compared with 2001 figures, the Office of National Statistics says.

Meanwhile, the number of deaths linked to MRSA rose by more than one third, with the infection mentioned on almost 1,700 death certificates in 2006.

The figures follow an admission by the Department of Health’s most senior experts in infection control that the main reason for a 50-fold increase in cases of Clostridium difficile in less than two decades is the failure of hospitals to follow hygiene rules drawn up 14 years ago.

Research by the Liberal Democrats found half of hospital trusts still do not put infected patients in their own rooms, while just one in five puts aside dedicated isolation wards in case of an outbreak.

Last year more than 50,000 people in England and Wales were infected with the infection, which is often triggered by a course of antibiotics. Although the elderly are most vulnerable to C. difficile, one in five cases involves those below the age of 65.

Infection experts said the labour Government had prioritised targets and finances at the expense of safety.

Dr Mark Enright, professor of microbiology at London’s Imperial College, said hospitals often suffered the worst outbreaks when managers were afraid to miss targets requiring emergency patients to be admitted within four hours, even if wards were overcrowded or harbouring infection.

The worst-ever outbreak of the disease, at hospitals run by Maidstone and Tunbridge Wells trust, killed 90 people in 2005 and 2006.

An independent investigation said pressure to meet waiting targets was one of the reasons the crisis spiralled out of control.

Prof Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, said patients across Britain had paid a heavy price for the collective failure of hospitals and governments to take infection seriously.

“The failure to invest in proper isolation facilities was wrong; too many people have suffered and perished as a result,” he said.

Health spokesman Norman Lamb said two successive governments had failed to ensure recommendations from their own experts were followed.

He criticised the current labour prime minister for introducing “headline-grabbing gimmicks with little scientific value”, such as the recent “one off” deep-clean of all hospitals, and a new short-sleeves uniform policy, instead of ensuring that hospitals were detecting and isolating infected patients.

From:
Deaths-from-hospital-superbug-Clostridium-Difficile-quadruple

The head of the National Audit Office, Tim Burr, said the challenge was “far greater than envisaged”.

But an NAO report said the project was on budget and that staff thought it would improve patient care.

MP Edward Leigh, who chairs the Commons Public Accounts Committee, said further delays could damage public confidence.

The National Programme for IT in the NHS is one of the most ambitious computer projects ever undertaken – replacing hundreds of different computer systems spread across hospitals and GP practices with new, compatible versions that will allow NHS staff anywhere in England to access a patient’s medical records.

However, the technical challenges involved have led to significant delays and some trusts, desperate to replace ageing systems in order to offer the labour government’s “Choose and Book” service for patients, have been forced to install “interim” systems which will eventually have to be replaced again.

The NAO is responsible for the monitoring of public spending, and its latest report says the benefits are now starting to emerge.

It said that the fixed-price contracts used meant that their costs remained “broadly unchanged”, despite the delays, but that it was likely to be 2014 or 2015 before every NHS trust was running the care records system.

Tim Burr, head of the NAO, said: “The challenge involved in delivering the National Programme for IT has proved to be far greater than envisaged at the start, with serious delays in delivering the new care records systems.

“Progress is being made, however, and financial savings and other benefits are beginning to emerge.”

Doubts

Others are less convinced by these timescales.

Tony Collins, who has investigated the project for the magazine Computer Weekly, said it was possible that some trusts might not want to run the systems offered to them.

“Ministers are discovering that an IT-based scheme conceived at the centre cannot be imposed on a devolved NHS – a lesson that should have been learned from failures in the 1990s.”

Dr Chaand Nagpaul of the British Medical Association, said: “It is clear from this report that the setting of unrealistic deadlines has been very damaging.

“Slipping deadlines for new IT systems and the premature release of systems that are not fit for purpose has been deeply frustrating for NHS staff leaving many doctors thoroughly disillusioned with the programme. “

The report will be considered by the Commons Public Accounts Committee next month.

Mr Leigh said that confidence in the project had been “damaged” by “unrealistic expectations”.

“The current timetables for the care records system to be fully deployed by 2014-15 had better be realistic. The Department of Health cannot afford further knocks to the programme’s reputation or our confidence in it.”

From:
http://news.bbc.co.uk/1/hi/health/7403286.stm

By any measure, the latest big new idea from Gordon Brown, the British prime minister, fails the test: that, after muddling along without one for 60 years, the National Health Service in England (healthcare is now devolved in Scotland and Wales) should have a constitution.

The very origins of the idea betray its weakness. It was initially dreamt up by Andy Burnham, then a junior health minister, as a means of celebrating the NHS’s 60th anniversary this July.

Why not, he mused, lay out the service’s values and ethos, setting out what patients can expect in terms of rights and responsibilities?

The real motivation, however, was far tawdrier.

Labour hoped that something could be written about the service being tax-funded and largely free at the point of use in language that the Conservative opposition would balk at. Labour would then go into the next election arguing that the NHS was not safe in Tory hands.

There was never a chance of that. David Cameron, the Conservative leader, has been at great pains to commit his party to the current model of the NHS, sealing off the subject as an election vulnerability.

But the idea, once born, has refused to die. Even now, weeks before its intended publication, no one in Whitehall seems to have much idea of what might be in it.

The plan may set out some responsibilities (not to abuse the service), some rights to minimum standards of care and possibly some definition of who should do what in the NHS from ministers downwards.

But the odds are it will either be so vacuous as to be meaningless, or that it will open up cans of worms that ministers will wish they had never touched.

If the constitution tries to define entitlements, ministers risk having to decide what should be in (and not in) a “core” NHS. States round the world have tried the idea and found it lacking.

If the new model deals with accountability, it risks freezing what should be flexible: healthcare systems need to be malleable to respond to changing technology, disease and patterns of care. That risk will rise if it is a legal document.

And if it is not put into law it will count for nothing more than the stated principles of the NHS – all of which are contained in countless Department of Health documents, and some of which are already enshrined in law.

This futile exercise will create the illusion of activity while doing nothing to improve patient care. It should be dropped.

Ministers instead should concentrate on their other (and wholly welcome) proposals this week: ensuring that patients have choice and that hospitals have real financial incentives to improve the quality of care.

http://www.ft.com/cms/s/0/0840430e-22ab-11dd-93a9-000077b07658.html?nclick_check=1

To date just 72 acute hospital trusts out of 171 have acquired foundation trust status – becoming free-standing, self-governing organisations responsible for their own success and failure – and the current pipeline of new applicants appears to have slowed to a trickle.

Monitor, the foundation trust regulator and approver, has geared up to handle 80 applications a year.

However, it is unclear that applications will arrive at that rate. If they do, Monitor’s recently published business plan says that half of all acute and mental health trusts should have been approved by April 2009 – assuming that, as now, two out of three survive the assessment process.

Some NHS regions still have remarkably few foundation trusts. The South East and the East Midlands regions have only four each and South Central only five when, compared with other regions, they should have at least double that number, even at the current rate of progress.

In addition to acute trusts, 24 out of the 57 mental health trusts have achieved foundation status.

But even if good applicants arrive as fast as Monitor is geared to cope with them, about 50 trusts could still be directly managed by the NHS, even in 2010.

From:
http://www.ft.com/cms/s/0/2ad94b04-2215-11dd-a50a-000077b07658.html

There are also “striking variations” in performance between hospitals, the survey says, with some “struggling to deliver on some of the basics of hospital care” such as cleanliness and treating patients with dignity.

For the first time the Healthcare Commission has published the data, based on interviews with more than 75,000 patients, together with comparisons going back six years to the first such research in 2002. Since then spending on the NHS in England has risen from £55bn to £87bn in 2007, with staff numbers up by 115,000 over the same period.

In this year’s survey 92 per cent of patients rated their care as “good”, “very good”, or “excellent”, with the percentage rating it as only fair or poor down from 9 per cent in 2002 to 8 per cent in 2007.

But over the six years there has been only a 4 percentage point rise, to 42 per cent, in patients putting their care in the top category of “excellent” – in spite of all the extra spending.

A higher percentage of patients said that they had waited less than four hours in accident and emergency in 2007 than in 2002. However, the increase was only from 67 to 72 per cent. On some of the government’s key targets, performance has been less than impressive.

There has been a 3 percentage-point drop since 2002 to 53 per cent in the proportion describing their ward as “very clean”. But 12 per cent of patients complained that lavatories and bathrooms were dirty, the same figure as six years ago.

Forty six per cent of patients rated hospital food as only fair or poor, with a mere 1 percentage point rise over six years, to 19 per cent, in those saying the food was “very good”. In spite of the government’s emphasis on choice of hospital, precisely the same percentage recall being offered it in 2007 as in 2005 – just 27 per cent.

The survey also reveals dramatic differences in performance between hospitals.

More than 90 per cent of patients in top-performing hospitals, such as the Royal Marsden and Clatterbridge cancer centres, said they were always treated with respect and dignity.

The figure for the worst performers, such as Mayday and Ealing hospitals in London, was 80 per cent. At Ealing, just 58 per cent of patients said their care was very good or excellent, against 90 per cent and more at some specialist hospitals.

Anna Walker, chief executive of the Healthcare Commission, said it was good to see rising percentages of patients saying care was excellent but: “In some hospitals the NHS is struggling to deliver on some of the basics of hospital care.”

The diagnosis
*92 per cent of patients rated their care as ‘good’, ‘very good’, or ‘excellent’ (up from 91 per cent in 2002)
*72 per cent said they waited less than four hours in A&E; (67 per cent)
*46 per cent rated hospital food as only ‘fair’ or ‘poor’ (47 per cent)
*20 per cent did not get enough help eating meals (18 per cent)
*Spending on the NHS in England grew from £55bn in 2002 to £87bn in 2007

From:
http://www.ft.com/cms/s/0/9fa2f8ce-2150-11dd-a0e6-000077b07658.html

Recent Department of Health projections on workforce show there is a need for a focused and planned expansion in consultant numbers to meet the increasing demand for radiological services.

Although government figures on diagnostic waiting times published show improvements in waiting, this level of activity cannot be sustained with the current workforce levels.

The demand for ultrasound, CT and MRI scans is increasing year on year, and with complex imaging now being required around the clock, more consultants are needed to ensure the service can be delivered more quickly and at the highest standard.

The Healthcare Commission’s report on its investigation into maternal deaths at Northwick Park Hospital recognised that there was a shortage of suitably trained interventional radiologists and recommended all obstetric units should have urgent access to this crucial emergency treatment at all times.

The Royal College of Radiologists (RCR) supports the need for consultant expansion. Dr Gill Markham, Vice-President of the RCR and Dean of the Faculty for Clinical Radiology, said: ‘Demand for scans and complex imaging is rising year on year and is set to increase even further in light of recent developments with extra patients being referred from the Government’s planned extension of the Breast programme and Colonic screening programme.

“We need a steady and sustained expansion in consultant numbers if we are to deliver this level of service to patients safely and to the high standards that patients deserve.”

The BMA recently launched a campaign to enhance the quality of care for patients by expanding consultant numbers across many specialities.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee said: “Although waiting times for diagnostics seem to be improving; this progress cannot be sustained unless capacity is expanded to meet future rises in demand.

“Ad-hoc commissioning of poorly integrated private providers is not a long term solution. The NHS needs to build its own sustainable infrastructure to deliver for the longer term benefit of patients.

“Focused expansion of consultant numbers will not only help meet the extra demands on the NHS, but as medical leaders and innovators, this will enhance the development of local services and provision of teaching and research.”

From:
http://www.bma.org.uk/pressrel.nsf/wlu/STRE-7ENBWT?OpenDocument&vw;=wfmms

By the end of March, 85 per cent of patients needing hospital admission should have been treated within 18 weeks of being referred by their family doctors to remain on track to meet the National Health Service’s target that by the end of the year at least 90 per cent of all patients will have been treated within that period.

Latest figures from the department, however, show that at the end of February, with just four weeks to go to that staging post, only 75 per cent of patients had been admitted within 18 weeks.

If the milestone is to be met a 10 percentage points improvement in a month will be required. That suggests the target will be missed, though possibly only narrowly and chiefly in orthopaedics.

For patients whose treatment can be completed without the need for admission, the NHS came closer to meeting its goal. In February, 86 per cent of patients were being treated within 18 weeks against the milestone for the end of March of 90 per cent.

The figures show that a third of patients complete their treatment within six weeks and just more than half within 12 weeks.

However, the scale of the challenge in eliminating the longest waits is shown by the fact that of the 298,762 patients admitted to hospital in February, 3 per cent – almost 9,000 – had been waiting more than a year and 62,000 had been waiting more than 6 months.

In addition, only 60 per cent of patients admitted with orthopaedic problems – one of the biggest specialities – were treated within 18 weeks, suggesting that part of the milestone is almost certain not to be reached.

The department, however, said: “We are expressing cautious optimism that when the March figures are published they will demonstrate achievement of the milestone.”

The department now claims it can report waiting times accurately for 96 per cent of patients – including the wait for an outpatient appointment, any diagnostics needed and then the wait for an operation.

However, some analysts are sceptical about the data as some primary care trusts are reporting “clock stop and start” times for many more patients than they appear to have treated: producing figures for the “completeness” of their data of more than 100 per cent.

“This has to make you very sceptical about the reliability of the data,” said John Appleby, the chief economist at the King’s Fund health think-tank.

The Department of Health said the discrepancy is thought to be due to some primary care trusts counting routine follow-up appointments after treatment as new completed treatments.

From:
http://www.ft.com/cms/s/0/0735cb06-1fad-11dd-9216-000077b07658.html?nclick_check=1