Sir Liam Donaldson, the Government’s chief medical officer, will highlight the cases at the launch of his annual report today when he will announce the establishment of a new clinical board for surgical safety to reduce errors and eliminate “wrong site” mistakes.

About 7.9 million operations are performed in Britain each year, nearly 10 times the number of births, yet surgical safety attracts far less attention than the safety of maternity care.

In 2007 more than one operation a month – 16 in all – was done on the wrong site. Examples include knee replacements on the wrong (healthy) knee, cochlear implants – surgically implanted hearing aids – in the wrong ear, removing bone from the wrong foot and wrong incisions to gain access to organs in the abdomen.

One patient a day was listed for the wrong operation in 2007, and there were 1,136 errors involving operating lists, including mistaken surgery, wrongly identified patients or operations performed in the wrong place.

The 14 brain surgery patients had suffered head injuries causing bleeding in the brain leading to increased pressure in the head. The standard treatment is to drill holes in the skull to release the pressure, but in the 14 cases the “burr-holes”, were drilled on the wrong side. A second set of burr-holes then had to be drilled on the correct side. The 14 cases, all in the UK, were reported to the National Patient Safety Agency over the past three years.

Sir Liam told The Independent: “The procedure of drilling burr-holes can be life-saving and you could say that it is a low number [drilled on the wrong side] in the context of all neurosurgical cases. But many people would be incredulous that it could happen at all, let alone be repeated. It is a challenge to our ability not just to reduce error but to ensure these sorts of error do not happen. They should be ‘never events’.”

In all, almost 130,000 errors involving surgical procedures were reported to the National Patient Safety Agency. In most cases involving operating lists, the error will have been detected before the surgery was done so the true number of errors is likely to be under-reported.

Sir Liam said: “Most surgery is safe but errors do occur. Many are minor but some are serious. Some should be ‘never events’. We really should be able to consign wrong-site surgery to the history books.”

In a second example highlighting a different problem, he will describe 14 deaths and nine serious reactions among patients having hip replacements related to the cement used to fix the artificial joint.

Hip replacements are among the commonest operations in Britain but in rare cases the cement causes globules of fat to be forced out of the bone into the blood, triggering a heart attack. In the UK, half of all hip replacements are performed using cement; in Canada just 3 per cent are. Guidance about the risks of cement had been issued to surgeons in the UK, but practice had not changed as quickly as it had in North America.

Sir Liam said: “No one knows what causes this reaction.”

Two weeks ago, NHS Review by Lord Darzi, the surgeon and Health minister, called for the safety and quality of health care to be placed at the heart of the NHS and said urgent steps should be taken to eliminate “never events”, serious incidents which harm patients and damage public confidence in the service.

The new clinical board will be established by the National Patient Safety Agency and include the Royal Colleges of Surgeons and Anaesthetists and patient organisations. Its first task will be to tackle wrong-site neurosurgery and fatal reactions to cemented hip replacements.

Sir Liam will also call for safety tests based on a checklist to be piloted in all UK hospitals. Surgeons and nurses will run through the checks before each operation in the same way pilots check their aircraft before take-off. The Surgical Safety Checklist was launched by the World Health Organisation last month.

About 20,000 patients die after surgery each year in the UK but it is not known how many were preventable. An estimated 2,000 NHS patients die each year as a result of errors in treatment, and an inquiry by the National Audit Office in 2005 concluded that half of all incidents could have been avoided if staff had learnt the lessons of previous errors.

Although serious errors are rare, a study of 38 surgeons in 14 NHS hospitals in the British Medical Journal in 2006 found “most” had experience of operating on the wrong site.

“We should be able to make major in-roads into reducing surgical errors,” Sir Liam said.

From:
litany-of-surgical-blunders-revealed-866894.html

They warned that not allowing patients to top up their NHS treatment with private medication was a “cruel form of rationing”.

In a close debate, doctors at the British Medical Association conference in Edinburgh voted in favour of a motion saying patients should have the choice to purchase non-health service treatments and medications if they wish and still receive the rest of their treatment free. The motion was passed with 62.8 per cent of the vote in favour.

The debate comes after a woman dying of cancer was denied free NHS treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle, 64, from Billericay, Essex, was receiving chemotherapy on the NHS, but she paid for the drug cetuximab to boost her chances of fighting bowel cancer. She was banned from free NHS care and died in May.

At present, patients who want a drug or treatment that has not been through an appraisal system or has not been licensed can have NHS funding refused by their primary care trust.

If they choose to pay for the treatment they have to have all their care privately. Many trusts are flouting the rules and allowing patients to purchase drugs which are administered within the NHS and continuing with their health service care.

But in a second motion, members of the BMA stopped short of demanding top-ups be introduced now by the narrowest of margins, 154 to 153, and have called for a Royal Commission to look at the issue further. The labour government has already ordered Prof Mike Richards, national director for cancer services to review the position and the report is due in October.

Some labour ministers claim that allowing private top up treatment would bring about the downfall of the NHS by allowing richer patients to pay for improved treatment, while drugs available to poorer patients may be limited.

At the highly charged debate, one doctor, Gordon Matthews, spoke movingly about his own wife with end stage cancer who wants to buy drugs. He argued that it was not ethical to exclude patients from the NHS because they had chosen to pay for drugs when they are ‘clinging to their lives’. Another doctor said the worst moment of his medical career was hearing women screaming while undergoing abortions because they could not afford the anaesthetic.

Proposer of the motion Stephen Austin of the BMA consultants committee said the current rule is “healthcare rationing in its most brutal and cruel form” and that it placed patients in an “impossible” position.

But Dr Jackie Davis of the BMA Council said pharmaceutical companies would put pressure on vulnerable patients and insurance companies would be lining up to offer cover for drugs that the NHS will not pay for. Dr Kevin O’Kane, from the London region, said the motion was ‘poisonous’ and a ‘nail in the NHS coffin’.

He added that the review of the NHS carried out by Lord Darzi meant the appraisal of new drugs by the National Institute for health and Clinical Excellence (Nice) would be speeded up and the postcode lottery in treatment ended, so there was no need for the motion.

Just over 70 per cent voted in favour of a Royal Commission to look into the issue and then supported supplementary motions that co-payments must not be a route to extension of NHS charges.

Commenting after the debate, Dr Hamish Meldrum said: “In principle doctors believe that patients should have the choice to buy additional treatment that is not available on the NHS, without being forced to pay for all their treatment privately.

“However, they stopped short of asking for co-payments to be introduced until there has been a wider debate with the profession and public and the evidence has been collected and examined. Doctors recognised that there were many potential problems with introducing co-payments and suggested a number of safeguards they would wish to see considered were they to be introduced.”

Ian Beaumont, Director of Communications, Bowel Cancer UK said: “We are concerned that while co-payments will enable some patients to receive treatments privately, those who can’t afford to pay will not be able to access them. Co-payments also give the Government, NICE and Primary Care Trusts an excuse to deny patients access to new, effective treatments on the NHS.”

From:
Ban-on-NHS-top-up-is-cruel-rationing%2C-says-BMA.html

Health Direct posts that people who can afford to opt out of the NHS completely and purchase private health care should be able to do so, and they do.

Any one who could afford to top up should be alowed to do so. People who can afford neither will still benefit from free health care from the NHS. Yes this is a multi-tiered health care system , but what is so wrong with that?

The idea that this would spell the end of the NHS is laughable, unless some factions of the BMA are so worried that all their members will do as dentists did and dump NHS practice all togethar.

Pharmaceutical companies cannot pressurise poor people because they are not permitted direct patient advertising as they are in the US. They could pressurise GPs, but you have to hope that the unscrupulous fat cat, pound chasing, sloppy GPs who would in turn pressurise patients are struck off.

Insurance companies will queue up to offer potential NHS blacklisted treatments, but again if someone chooses to invest in their future health provision why shouldn’t they? It is no different than buying critical illness insurance. You buy it or you dont it depends on what value you put on it.

Maybe it is about time that people started to take more responsibility for their own health. The current government think it is a dirty word, but perhaps people should ASPIRE, to be in a better position when benefiting from healthcare; rather than aspiring to own a car they cannot afford or sinking 20 pints and smoking 40 fags that weekend.

It is these people, with skewed notions of aspiration i.e. to appear wealthier and more important that they actually (just like a celebrity) are who will ensure the demise of the NHS, not the ones who have chosen to invest in their health!

Gordon Brown is always battering on about choice, why not put your money where your mouth is then Gordo, give people the choice!

“Technological change is the predominant reason for medical cost increases in the past half-century,” says David Cutler of Harvard University, an expert in the field. “Studies of aggregate medical spending, and of ­particular medical conditions, show that at least half of all cost growth is a result of increased use of tech­nology.”

For Mark Sculpher, professor of health economics at York University, what counts is cost-effectiveness. “It may be appropriate to devote considerable additional resources to new technology if it is good value,” he says.

Joe Hogan, head of GE Healthcare, one of the world’s leading diagnostics and imaging companies, says: “I scratch my head when people say technology adds costs. It’s not the way economics works. In what other industry in the world has it not increased efficacy and efficiency?”

He highlights the surge in the power of diagnostic devices and the extraordinary accompanying drop in costs of scanners in recent years. “There will be an increase in capacity and an unbelievable decrease in costs,” he says.

That view is shared by a group frequently demonised by those who excoriate rising healthcare costs: drug manufacturers. Asked how he responds to fears that the medicines bill will rise too high, Chris Brinsmead, president of the Association of the British Pharmaceutical Industry, the UK trade body, says bluntly: “The evidence points otherwise.”

While the prices of some new drugs – notably for cancer and certain extremely rare diseases – have risen sharply in recent years, he says that the overall proportion of the UK National Health Service budget spent on medicines is not only modest, at less than 10 per cent, but has declined.

That is partly explained by generic competition once patents expire for drugs such as proton pump inhibitors, which have all but eliminated expensive ulcer surgery, and statins, which have helped ease ­cardiovascular problems.

Most academic attempts to measure cost-effectiveness of new technology conclude that it more than pays for its keep. Last year, for instance, Prof Cutler published an extensive study of “revascularisation” (bypass surgery or angioplasty) to restore blood flow after a heart attack. Analysing 17 years of data, he concluded that the procedure was associated with more than a year of extra life expectancy at a cost of about £20,000 – making it “highly cost-effective”.

But it is important to use technology sparingly rather than seeing it as a panacea that can be indiscriminately applied to all patients. The majority of technology is cost-effective and valuable, according to Paul Ginsburg, president of the Centre for Studying Health System Change in Washington. “But the benefits are diminished when the technology is applied beyond those patients most likely to benefit from it,” he says. “We have a tendency to apply new technologies to too many people.”

For example, “arthroscopic”, keyhole operations on the knee were a boon for the original patients, who had a clear-cut requirement for such surgery, but it was extended too far, to people who did not really need it.

In the same way, the painkiller Vioxx undoubtedly benefited many patients with arthritis but Merck withdrew it from the market in 2004 after side-effects emerged when it was used by a far larger number of patients to whom, critics argued, it should never have been marketed.

Booz Allen Hamilton, a consultancy, found “sub­stantial evidence that over­utilisation and misuse of technology is leading to spending that exceeds its value for patients”.

If the technology is available, there is a propensity to use it as extensively as possible. Diagnostic imaging, a £50bn business, is a good example of increases in spending being “driven to a large extent by the growth in the number of machines installed in hospitals, as well as in doctors’ offices and at imaging centres”, the consultants said.

The result, according to Booz Allen, is a strong incentive for doctors to prescribe unnecessary scans that provide little help in getting closer to a diagnosis.

“Healthcare is littered with examples of technologies that have not delivered on their initial promise,” says Prof Sculpher. Even in the more restrained UK environment, there are doubts that imaging technology is being used cost-effectively.

Health systems throughout the world are facing up to the need for better evaluation of the costs and benefits of new technologies before they are introduced on a large scale.

“There is great potential in developing a lot more information about effectiveness,” says Dr Ginsburg.

From:
http://www.ft.com/cms/s/0/9342d5a4-47bb-11dd-93ca-000077b07658.html

“In my experience,” recalls Kenneth Clarke, the highly regarded former health secretary, “at international meetings of health ministers, all they and the other people there ever talk about is how to control costs and they never really seem to find a way to do it.”

All western countries have seen their populations age significantly and the three pressures combined have pushed up costs during the past half century and more.

Nicolaus Henke, head of the London health practice for management consultants McKinsey, flourishes a graph showing that during the past 50 years health spending has outstripped growth in the economy by 2 per cent a year on average in every country in the Organisation for Economic Co-operation and Development.

The trend, he says, is “startling”. Countries occasionally manage to roll back the rate of increase. The US did so briefly in the mid-1990s by putting tighter controls on treatments doctors could use in a drive to raise quality and constrain costs. Other countries have from time to time squeezed budgets or cut them. But the trend always reasserts itself.

If it continues, says Mr Henke, “by 2050 most countries will spend more than 20 per cent of gross domestic product on healthcare. The US will be spending well over 30 per cent”. By 2100, the US health spend would take 97 per cent of national income, the UK’s two-thirds.

“That is difficult to conceive,” says Mr Henke, “but in 1960 most observers would have said that 40 years on it would have been pretty inconceivable that western Europe on average would be spending 9 per cent of GDP on health. But that, of course, has happened.”

The triple pressures prompt apocalyptic predictions. Jonathan Anscombe, head of health of A. T. Kearney’s European health practice, says they create “a perfect storm”, one that will “test the limits of collective funding mechanisms” all around the world.

He predicts that countries will have to restrict tax and social insurance systems to a “core” offering. It will consist chiefly of preventive and primary care services that help restrain costs, along with emergency services and support for the poor, he suggests.

Everything else – most non-emergency care, let alone costly end-of-life cancer drugs – will have to be covered by private individual insurance or by out-of-pocket payments. This, he declares, is “inevitable” and “it is hard to see how this can be achieved without making care more unequal”.

But there is another view. For a start, many of the dire predictions rely on believing that existing trends will simply continue. But that assumption ignores the disruptive effect of the unpredictable, which can lower costs as well as raise them.

Dangerous and costly surgery for gastric ulcers, for example, has disappeared, killed off first by a drug that treated the ulcer then by an antibiotic that cured it.

John Appleby, chief economist at the King’s Fund health think-tank in London, illustrates the dangers of extrapolation with a graph showing that if the steady decline in mortality rates in the UK continues, “by about 2039 the UK will be spending about 10 per cent of GDP on health care and nobody will be dying. Somehow, I don’t think that is going to happen,” he remarks drily.

Many analysts are now much less worried about the impact of ageing than they were. For a start, says Richard Saltman, professor of health policy at the Rollins School of Public Health, as with pensions, “you can fundamentally reduce the costs if people work even one, two or three years longer to pay in rather than take out”.

And there is a growing body of evidence that the older generation, on average, is living longer and healthier, not longer and sicker.

Martin McKee, head of research policy at the European Observatory on Health Systems, says there is good evidence from countries including Canada, Germany and the US Medicare system that the high cost of care for the elderly is chiefly the cost of dying.

“A large part of lifetime expenditure on health care occurs in the last year of life and indeed in the last few weeks before death: and it does so regardless of the age at which you die,” he says.

Added to that is tentative evidence that the costs of dying are lower for those who live longest. “This may be because the old are treated less intensively and so incur fewer costs,” Prof McKee says. That may not be entirely explained by age discrimination.

Raymond Tallis, former professor of geriatric medicine at Manchester University, has argued that even healthy old people’s bodies become frailer. “So it is possible that the stroke or heart attack that you might have survived with a disability at age 70 will kill you at 90.”

Furthermore, any breakthrough in the treatment of dementia – although none is on the near-horizon – could lower long-term care costs

As people live longer, costs will rise, but not necessarily catastrophically. There are, Professor McKee says, “many myths and misunderstandings” about ageing and technology.

But can nations afford the rising bill? Mr Henke of McKinsey has his doubts, although he notes “the most convincing graph in the whole of social science” is the one that shows the richer a country is, the more it spends on health care.

“Healthcare is a wonderful product,” Uwe Reinhardt, professor of political economy at Princeton, says. “So as we get richer we have bought more of it. And if you ask ‘Can we afford the elderly?’ I say – give me a break. Of course we can afford the elderly.”

From:
http://www.ft.com/cms/s/0/85202166-47bb-11dd-93ca-000077b07658.html

In the past decade, the NICE has recommended an overwhelming majority of the 251 drugs it has reviewed. More recently, however, Nice has rejected half a dozen cancer therapies and forced the manufacturers of others to develop more imaginative, and cheaper, alternatives.

Already the agency has encountered difficulty obtaining some of the information it needs to make its assessments. Now, two manufacturers – Roche and Merck Serono – have raised the stakes.

They are explicitly refusing to co-operate with requests for cost-effectiveness data on their medicines Avastin, for lung and breast cancer, and Erbitux, for late-stage colorectal cancer, respectively.

“Roche did not consider it a good use of either public sector or indeed Roche’s own resources to produce a full submission … for a year-long appraisal which would have resulted anyway in negative guidance,” Roche said.

Professor Michael Rawlins, chairman of Nice, has a different explanation: “They’re saying that they felt they could not substantiate the high prices they expected to command in relation to the benefits of the product.”

Nice’s role is to assess both clinical and cost-effectiveness, based on the principle that it is unjust to expect the National Health Service to buy expensive medicines that offer little benefit.

The agency does not scrutinise all medicines, nor does it or the NHS refuse treatments simply because they are expensive – developing effective but costly treatments for rare conditions has fostered an entire sub-sector of companies.

But cancer affects a vast and growing patient pool. While a few new medicines, some linked to diagnostic “markers” such as Herceptin for breast cancer, are providing breakthrough treatments, many others have so far shown far less impressive results, extending life by a few months at best in some patients. Yet prices remain high.

The Association of the British Pharmaceutical Industry, the trade body, stresses the costs of developing cancer medicines and the fact that many fail and never come to market.

The body says medicine prices overall in the UK are below those of a number of other European countries and represent a small and declining proportion of total health spending – below 10 per cent of the NHS budget.

There is debate over the need for Nice both to accelerate its review of new drugs and to review its criteria, as well as for similar levels of scrutiny to apply to other parts of the NHS.

Denise Richard, head of the UK oncology business unit for Merck Serono of Germany, which has failed to win Nice approval for Erbitux for late-stage colo-rectal cancer at £2,700 ($5,330) a month, argues that Nice needs to review its criteria, speed up its reviews and change its procedures.

She says that few cancer specialists are involved in Nice technical reviews because of possible conflicts of interest; that companies cannot update Nice during long appeals, despite fast-changing data on drug efficacy; and that the thresholds for cost-effectiveness should be raised for patients with late-stage cancer, since they rarely lived more than a few extra months.

Pharmaceutical companies are reluctant to cut prices. While the UK represents only 3-4 per cent of the global market for medicines, it punches above its weight, in part because Nice’s assessments are closely followed internationally. Price reductions in the UK would likely trigger copycat actions by purchasers elsewhere and encourage “parallel trade”, by which medicines sold in countries at lower prices are exported by arbitrageurs to higher priced ones.

The result has been a series of hidden discounts, such as on Velcade for multiple myeloma – the nominal list price stays the same, but the company will reimburse the cost to those patients in whom it proves ineffective.

Ultimately, the best hope for better value might be that, as drugs are used for earlier stage treatment in many more patients for a wider range of cancers, falling prices will be compensated by rising volumes. But for now, the industry remains cautious.

From:
http://www.ft.com/cms/s/0/fc9fa62a-42e4-11dd-81d0-0000779fd2ac.html

The Health Protection Agency (HPA) warned that the number of unvaccinated children was now large enough to sustain the “continuous spread” of the potentially lethal virus in the community. It blamed a failure by parents over the past 10 years to give their children the measles, mumps and rubella (MMR) vaccine.

This has resulted in vaccine rates falling below the level necessary to prevent the disease becoming established in the general population.

Figures published show cases of measles in London reached a new peak last month, exceeding last year’s monthly record set in August 2007, and are continuing to rise.

There were 95 cases confirmed in the capital and 35 in the rest of England and Wales bringing the total for the year to 461. A 17-year-old victim from West Yorkshire died from the disease in the first fatality since 2006.

In another case a doctor working in a hospital cancer ward contracted measles prompting the Department of Health to write to all hospitals telling them to ensure that all staff working with vulnerable patients have documented immunity to the disease.

Measles causes fever, and can have serious complications including pneumonia and encephalitis (swelling of the brain). Fifty years ago the illness killed 500 children a year in the UK but vaccination almost eliminated the disease. Last month’s death was only the second in more than a decade.

The HPA, which published the latest figures in its weekly report, said the rise in measles cases in London was linked to an outbreak at a secondary school which had spread to neighbouring schools and nurseries in the capital. It was also the source of clusters in Cornwall and South Yorkshire.

The report said: “Due to almost 10 years of sub-optimal MMR vaccination coverage across the UK, the number of children susceptible to measles is now sufficient to support the continuous spread of measles.

“Health services should exploit all possible opportunities to offer MMR vaccine to children of any age who have not received two doses. Greater awareness of the increasing measles incidence by health professionals and the public is essential to control the spread of infection.”

Elizabeth Miller, head of immunisation at the HPA, said: “In 1994 we interrupted the spread of measles in the UK so that it ceased to be endemic. Since that time the only cases we have had have been as a result of importation and spread from those imported cases. Now we have reached a point where there are a sufficient number of susceptible [unvaccinated] children in the population to sustain spread of the disease. We are concerned there may be a return to pre-1994 levels where there was sustained spread. It is quite disturbing.”

Vaccination rates against MMR vary widely across the country and are especially low in London. In the last quarter of 2007, the rate stood at 71 per cent for children at age two (first dose) and 50 per cent at age five (second dose) compared with the 95 per cent coverage needed to maintain herd immunity and prevent endemic spread.

Nationally, vaccination rates against MMR fell from 92 per cent a decade ago to 79 per cent in 2004, at the height of the scare over the vaccine’s supposed link with autism. They have since recovered to 84 per cent at age two (75 per cent at age five) but are still well below the target level of 95 per cent.

Professor Miller said: “Vaccination rates are on the increase but we have the problem of the legacy of the unvaccinated children over the past six or seven years. People do need to realise that measles is a highly infectious disease and if your child is not vaccinated and exposed to the virus there is a high probability that it will find susceptible children.”

Measles was the single most lethal infectious agent in the world until a vaccine was developed in 1963. In the early 1960s, the disease claimed six million lives yearly in the developing world with about 135 million cases. Today the global death toll has been cut to below 350,000 and the World Health Organisation believes it may be possible to eliminate the disease.

In the UK, cases fluctuated between 160,000 and 800,000 during the 1950s and 1960s, with an epidemic every two years, until the measles vaccine was launched in 1970. In 1987, the year before it was superseded by the triple MMR jab, there were 86,000 cases of measles. Vaccination rates against MMR rose to 92 per cent in the early 1990s and the annual number of measles cases fell. But confidence in the vaccine was dashed by publication of a paper in The Lancet in 1998 by Andrew Wakefield and colleagues from the Royal Free Hospital, linking the jab with autism.

Controversy over the link continued for eight years but is now widely accepted to be without substance. Dr Wakefield and two of his former colleagues have been charged with serious professional misconduct over their research in a case before the General Medical Council which is expected to conclude later this year.

Measles, which is accompanied by a rash, is one of the most infectious diseases known and is spread through direct contact or through droplets in the air when an infected person coughs or sneezes. It is most infectious before the rash appears.

About 90 per cent of people who have not been vaccinated, or have not had measles, catch the disease if they live in the same house as someone with it.

From:
official-warning-measles-endemic-in-britain-851584.html

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves.

One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the labour government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy.

The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care.

Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Recently the Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors.

John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about £2,200 a month compared with about £800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control.

A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan.

Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added.

Erbitux, costing about £3,000 a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.

A former fireman who developed liver cancer after 25 years’ service has been told that if he pays for the only drug that can treat his disease his NHS care will be withdrawn.

Barry Humphrey, 59, from North Walsham, Norfolk, was told by NHS doctors that the drug Nexavar was the only available treatment for his advanced liver cancer.

However, consultants at Addenbrooke’s hospital in Cambridge said the drug was not routinely funded by the NHS and told him that if he paid for it he would be billed for the rest of his NHS care.

Humphrey believes his cancer is linked to his time as a fireman. His cancer was caused by cirrhosis of the liver after he contracted hepatitis C. He believes he caught the virus from a casualty while on duty.

Research presented at the American Society of Clinical Oncology found patients with advanced liver cancer survive for an average of 11 months if they take Nexavar, while those denied the drug live for just eight months.

Humphrey’s wife Hazel, 58, who also worked in the fire service, said: “Doctors said this would ‘not be viable’ because we would be deemed as opting out of the NHS and would need to pay for everything.

“I think it is absolutely disgraceful. When people are terminally ill, they want to spend as much time as they possibly can extending their life expectancy.” She said the couple know the drug will not provide a cure but should have the right to spend their savings to prolong her husband’s life.

They plan to sell a flat that they have been renting out to raise the cash for the drug, which costs about £3,000 a month. Humphrey, who has four children, six grandchildren and helps to care for his elderly mother, said: “I think this is morally wrong and indefensible.”

Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s, said: “We are complying with the national guidance which says we cannot allow co-funding.”

The public’s view

A poll for The Sunday Times shows strong support for allowing co-payment in the National Health Service, with 89% saying that people who buy additional cancer drugs should continue to get free NHS treatment.

Only 5% think allowing co-payment would create a two-tier NHS. Until now this has been the position taken by Alan Johnson, the health secretary.

Ministers had feared that allowing co-payment would upset less well-off patients, but the YouGov poll of nearly 1,800 people shows strong backing across the social spectrum and supporters of all three main parties.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4138237.ece

Labour’s internal NHS targets will be ditched and patients simply told which hospitals get the best results, under the radical Tory plans.

“How long will my dad survive if he gets cancer? What are my chances of a good life if I have a stroke? What are my chances of surviving from heart disease? This is the kind of information people want and need,” Mr Cameron planned to say.

He was also listing a series of goals – reminiscent of New Labour’s 1997 pledge cards – so that voters could hold a Conservative Government to account over its handling of the health service.

These include:

* raising cancer five year survival rates to above the EU average by 2015

* cutting early deaths from stroke and heart disease to below EU averages by 2015

* cutting early deaths from lung disease to below EU averages by 2020

* annual improvements in survival rates and quality of life for patients living with long-term conditions.

The Tories chose the 60th anniversary of the creation of the NHS to unveil their “Green Paper” on health policy, ‘Delivering some of the best health in Europe’, before an audience at the Royal College of Surgeons in London.

Mr Cameron has been eager to stress his commitment to the service, and neutralise Labour claims that a Tory Government would downgrade it.

He argued that Labour has strangled the NHS in red tape, “testing to destruction the idea that the NHS can be improved by more bureaucracy, more central control and more initiatives from the Department of Health”.

According to the Tories, raising NHS standards to the European average would save around 38,000 lives every year, but their “ambition” is to lift performance to match the best systems in the world, which would save at least 100,000.

Mr Cameron insisted that outcomes are the only thing that matters for patients: “What matters is the result itself, not how it is achieved.”

Niall Dickson, chief executive of the King’s Fund, welcomed the plans.

“(The Conservatives) are right that what matters to patients is whether their quality of life has improved following surgery or any other procedure rather than whether top-down targets have been met,” he said.

’But the Conservatives’ plan to abolish central targets needs to be considered carefully. Before we drop central targets altogether, we must be sure that there are appropriate safeguards to ensure standards and aspirations are in place.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4204107.ece

More than 20,000 records were held on computers stolen from a south London hospital. In Wolverhampton, a laptop holding details on around 11,000 patients has been stolen.

The missing data includes names, addresses, NHS numbers and, in the Wolverhampton theft, personal medical histories.

In both cases, sensitive data had been stored on laptops in defiance of rules that are meant to protect such records from theft or loss.

The disclosures follow the revelation earlier this week that Hazel Blears, the communities secretary, had stored confidential labour Government files relating to counter-terrorism on a laptop that has since been stolen from her constituency office.

Of the two NHS thefts, the incident in Wolverhampton appeared to be the more serious, since the computer concerned contained detailed medical records and was not protected by any form of encryption.

The laptop concerned was stolen from the car of an unnamed GP, according to Wolverhampton City Primary Care Trust. Some 11,000 patients have now been sent letters apologizing for the incident.

Jon Crockett, chief executive of the trust, said he was “extremely concerned” about the theft.

He said: “Patients and the public have the right to expect that those dealing with confidential information maintain the highest levels of security and we are carrying out a full and urgent investigation into this incident.”

Department of Health rules say that any confidential information about patients must be stored in a safe and secure environment. Mobile storage devices including laptops must be fully encrypted.

But the Wolverhampton computer had not been encrypted.

In London, thieves stole six laptops from St Georges Hospital in Tooting. Three contained the first and last names, date of birth, postcode and hospital number of around 21,000 patients.

The theft took place between 6 and 9 June, but St George’s Healthcare NHS Trust only recently made the incident public.

In an internal email to its staff, the St Georges trust said he “acknowledges that patient data should not have been stored in laptops.” The laptops had been used as temporary storage, it said.

Hospital managers said the patient data was protected by passwords and held in “hidden” files.

David Astley , the St Georges chief executive, apologised and said: “We owe it to our patients to protect their personal information and we have reminded our staff not to store this kind of data on laptops in the future.”

He said only staff with the correct password could access the data. “Therefore there is only a very small chance that any patient details have been passed on.”

St George’s is in Tooting, one of Labour’s most marginal seats. Mark Clark, the Conservative candidate in Tooting, said the incident would alarm residents.

He said: “Patient confidentiality has been put at risk by this loss and I am concerned that the hospital make preventing more breaches its number one priority.”

From:
NHS-records-lost-as-seven-laptops-stolen.html

Health Direct once again asks whether you are happy trusting the govt to keep all of your medical data secure? Or are you happy to follow the sheep to the slaughterhouse of completely open personal data?

Hundreds of family doctor surgeries across England have been identified by local health Trusts as being in the same catchment area as proposed new polyclinics.

The Conservatives have compiled the list of practices across the country, named in plans for polyclinics drawn up by Primary Care Trusts, which they say could be killed off by the scheme.

They said the list showed practices which could be forced to shut because they would lose patients to the new clinics if they went ahead and warned that the final figure is likely to be much higher as many Trusts are still compiling plans.

Doctors who found their name on the list would now be “even more concerned than they were already” about the possibility of closure, the British Medical Association (BMA) said.

But the labour Government insisted that there was no suggestion in the documents that any of the practices had been earmarked for closure.

Recently, more than 1.2 million patients signed a petition protesting against plans for polyclinics, which was delivered to Gordon Brown.

Doctors’ leaders argue that the new surgeries will destroy the relationship between patients and their GP family doctor and force them to travel much further to see a doctor.

GPs are also worried that polyclinics could “cream off” younger, healthier patients who help to subsidise their practices to treat those with more complex medical problems.

But ministers insist that the clinics, which could house up to 25 GPs as well as extra services such as dentistry and minor surgery and will open during evenings and weekends, will provide a “world class” service.

The Tory research reveals that 608 practices in almost half of all Primary Care Trusts outside London -where ministers insist that the “GP led health centres” will be in addition to existing services – have already been listed as close to proposed new clinics.

If this were replicated across the rest of the country including the capital as many as 1,700 practices could be under threat.

The Tories said the implication was that polyclinics would threaten the viability of the practices listed, even if not all of them would be forced to shut.

Andrew Lansley, the Conservative health spokesman, said: “The Government needs to explain why these GP surgeries are being named if it’s not because polyclinics pose a threat to the local doctor.

“It adds to the huge weight of evidence now building up that polyclinics are not the additional services as Gordon Brown has claimed. Patients and family doctors are right to be worried about losing a valued local service. It’s time Labour faced up to their concerns and called a halt to their unpopular polyclinics scheme.”

A spokesman for the BMA said that the publication of the list would worry GPs already concerned that their practices could shut.

He said: “We have always had concerns about the viability of practices that are close to these polyclinics.

“It is inevitable that they will lose resources because of the new development, even if they are not actually dragged into it.

“Ben Bradshaw [the Health Minister] has said that some patients won’t have to deregister with their GP to use this service, but that is not really the point.

“There is only one pot of money and if it is all going into polyclinics then GP surgeries will have to cut back on services and many could be forced to close.”

He added: “GPs who find themselves on this list will be even more concerned than they were already.”

An official spokesman for Mr Bradshaw said: “There is no suggestion from any of those PCTs that these surgeries are marked for closure.”

Within London, where ministers insist plans for polyclinics differ from the rest of the country, around 100 practices have already been already earmarked for closure, to make way for the new surgeries.

From:
Polyclinics-threaten-600-GP-practices%2C-say-Tories.html

The signatures, collected by the British Medical Association (BMA) in just three weeks as part of its “Support Your Surgery” campaign, was presented to Gordon Brown at Downing Street.

The BMA is concerned that the new clinics will destroy the relationship between patients and their family doctor

The labour government cannot afford to ignore the level of patient concern over polyclinics, which have been dubbed “supersurgeries”, doctors’ leaders will say.

Ministers insist that the centres, designed to house up to 25 GPs under one roof along with other services such as minor surgery, will provide a better service for patients.

But the BMA claims they will destroy the relationship between patients and their family doctor and lead to more private companies running surgeries.

Analysis by the Tories suggests that 1,700 of the 8,700 GP practices in England could have to shut under the plans.

Around 100 GP practices in just eight PCTs in London, the first part of the country to roll out the policy, have already been earmarked for closure to make way for polyclinics.

Doctors will protest against the plans at the BMA’s Local Medical Committees annual conference today, entitled “standing up for General Practice”.

Dr Laurence Buckman, chairman of the BMA’s GPs Committee, will tell GPs at the meeting that the petition “will deliver a stark message to the Prime Minister” about the true level of patient concern.

Dr Buckman will also say: “My message to Gordon Brown is this: Whatever you think of GPs, take note of what your electorate thinks. Work with us to improve the service, not against us, and ignore at your peril the wishes of the most important people in the NHS – the patients.”

He will tell GPs : “If the government won’t listen to you, their doctors, then surely it will listen to the 1.2 million men and women who call for a halt to the plans to promote the use of commercial companies in general practice.

“Voters don’t want funding to move from GP practices to commercial companies who are accountable primarily to shareholders rather than patients. They want to be treated as patients, not customers.”

The petition calls on ministers to “continue to support our existing NHS GP surgeries” and “improve services to patients by further investment in existing GP surgeries”.

But Neil Bentley, from the Confederation of British Industry (CBI), accused doctors’ leaders of “ostrich-like denial” and said that the plans would extend opening hours and increase the range of services offered to patients.

From:
A-million-patients-battle-against-polyclinics.html

Part of the problem is the price of success. The National Institute for Health and Clinical Excellence (Nice) was created in 1999 to advise on which drugs were not just clinically effective but cost-effective as well – in other words, those for which the NHS should pay.

Nice’s standing is such that its judgements are valued and often followed by healthcare providers, public and private, in other countries.

It is right that a health service paid for by taxpayers should spend public money where medical evidence suggests it will do the most good. Its job is not to license treatments where the cost to the NHS is outweighed by the limited prospect of success.

What is wrong is the corollary that the labour government has attached to this: that someone who decides even a small chance of prolonging life is worth a great deal of money becomes an NHS non-person.

The extra costs of paying fully privately for their treatment will not affect the wealthiest, but will hit those financially stretched by paying for the drug alone.

The Department of Health says allowing co-payments would risk creating a two-tier health service. This is simplistic. It also suggests – wrongly – that any sort of personal payment currently precludes all access to state provision.

A pupil whose parent hires a state school teacher to provide some out-of-hours tutoring is not banned from the local comprehensive. A patient who pays privately for physiotherapy is not barred from NHS treatment for back pain.

The “slippery slope” argument about co-payments is not compelling either. This small category of exceptional life-and-death cases is in a different class from decisions whether to allow someone to purchase a far more expensive hip prosthesis that offers only marginal extra benefit.

There is room for serious debate about what role co-payment should play in healthcare.

But those who believe that any form of top-up payment would destroy the principles of the NHS diminish their own case – and the likelihood that anyone will listen to them – if they cannot see the argument for allowing it in these exceptional circumstances.

From:
http://www.ft.com/cms/s/0/d37ced14-338c-11dd-ba8a-0000779fd2ac.html?nclick_check=1

Health Direct notes that the Financial Times now joins the Sunday Times in lambasting labour’s indefensible policy of killing poor cancer patients whilst paying for the removal of tattoos on chavs.

On October 26, 2006 Health Direct posted: NHS blows millions on removing 187,000 tattoos

The National Health Service spent tens of millions of pounds removing nearly 200,000 tattoos in 2006, according to figures released by the Department of Health last week. Rosie Winterton, the health minister, said in a Commons written answer that doctors had carried out the procedure, involving either skin grafts or lasers, on 187,063 tattoos.

The findings highlighted the big differences in how long patients have to wait for non-emergency operations – a practice that has led to complaints that the health service is operating a “post code lottery”.

Smoking among children in 2006, however, was “at its lowest level in over 10 years”, according to the latest health and healthcare figures for England, Scotland, Wales and Northern Ireland published by the Office for National Statistics.

All four countries had reduced waiting times for “common operations”. But these still “varied widely” between the nations, it said.

Some 90 per cent of patients requiring cataract surgery in 2006 were admitted to hospital within 166 days in England. This compared with 172 days in Northern Ireland, 146 days in Scotland and 25 in Wales.

For hip replacements, 90 per cent of patients were admitted within 221 days in Scotland, 223 in England, 337 in Northern Ireland and 367 in Wales.

Deaths from heart disease were highest in Scotland, killing 168 men and 87 women per 100,000 of population compared with 137 and 64 in England.

England may account for 82 per cent of the £119bn UK budget spent on health and social care, but at £1,915 the spend per head of population lagged behind £2,096 per person in Northern Ireland, £2,109 in Wales and £2,313 in Scotland.

Men in England could expect to live an average of 68 years in good health, compared with 66 years in Scotland. English women could expect an average of 71 years in good health compared with 68 in Wales.

Scotland also had the highest death rate related to drug poisoning, with 17 deaths for males and six for females per 100,000 population, while Northern Ireland had the lowest rate for males at six deaths per 100,000 and England the lowest rate for females at three deaths.

The average life expectancy for UK males of 77 years was slightly above the European Union average of 76. Life expectancy for UK females at 81 was slightly below the EU average of 82.

From:
http://www.ft.com/cms/s/0/1eed6a7c-3689-11dd-8bb8-0000779fd2ac.html?nclick_check=1

The charges, paid at hospitals run by the bank’s subsidiary infrastructure company, raise questions about lax controls in Labour’s private finance initiative (PFI), which has been used to build more than 100 hospitals over the past decade.

Richard Bacon, a Conservative MP who sits on the public accounts committee, said: “Anyone who works in the NHS will be dismayed that their managers are paying such rates. More than £200 to install an electric plug is just not on – it’s absolutely absurd, ridiculous.”

Since its launch in March 2006, the HSBC fund has acquired large stakes in 27 PFI projects, including Barnet, Bishop Auckland, Royal Blackburn, Stoke Mandeville, Central Middlesex and West Middlesex University hospitals.

It also manages the central London headquarters of the Home Office as well as schools and police stations. To boost its return to shareholders, the fund is based in Guernsey, the tax haven Channel Island.

Shares in the HSBC Infrastructure Company (HICL) have risen by 25% in the past two years, adding £58.75m to its value on the London stock market. During this period it has also paid more than £30m to investors through dividends.

Under PFI deals, contractors are appointed by project managers such as HICL to maintain the building and provide cleaning, catering and other services. Although they are paid a flat annual fee, they invoice the health trusts for any additional jobs not specified in the contract. In most cases, the hospital is obliged to use its contractor.

According to the National Audit Office, 59% of public sector managers said that contract variations worked out more expensive under PFI. A total of £180m was paid to PFI contractors for such extras in 2006.

Four of the hospitals in HSBC’s fund pay charges at rates far higher than those charged by normal tradesman.

- The Central Middlesex hospital in northwest London said that, on average, its contractor, Ecovert FM, charged £210 to install an electric socket.

- West Middlesex University hospital said it was typically charged £150 by Ecovert FM for the same task. An independent electrician located close to both hospitals in Harrow said a typical charge for replacing a socket was £40. The cost of installing a new one was £80.

- Royal Blackburn hospital said it was charged £198 by its contractor, Consort, to put in a datapoint – needed to plug a computer into an internal network. By contrast, West Middlesex University hospital said it was usually charged about £60 for the same service.

- West Middlesex University and Royal Barnet hospitals said they were normally charged about £100 to install a new lock – a third more expensive than local locksmiths.

A spokesman for the HSBC infrastructure fund said it took “great care in delivering the outsourced services”. Contractors said that each job was different and some seemingly straightforward electrical jobs could involve extensive rewiring.

The contract charges are often higher because PFI hospitals do not have enough handymen to do the job on site and have to call out the contractor’s staff. PFI hospitals typically have a maintenance staff one third smaller than other hospitals.

A spokesman for Ecovert FM said: “The type of wall construction, distance the new socket is from the mains supply, making good and redecoration work can greatly influence the cost of putting in a socket.”

84% of doctors polled by the doctors.net.uk website for The Sunday Times, said PFI had failed to deliver value for money for taxpayers. Only 6% of the 856 doctors polled believed that PFI was delivering at a fair cost.

http://www.timesonline.co.uk/tol/news/uk/health/article4087496.ece

The labour government has deemed that NHS cancer patients cannot pay for an additional anticancer drug without losing their entitlement to state-funded care at that time. It says a patient cannot be a private and an NHS patient in the same “episode of care”.

But we already have a mixed economy in healthcare with private contractors providing NHS-funded care and with those patients who run into problems in the private sector ending up in the NHS at varying stages of their treatment.

The past decade has seen a seismic shift in the NHS, as private contractors provide services, which they do for profit. We use NHS funds to pay agencies for temporary staff, despite the exorbitant cost. Why not allow NHS and personal funding to be integrated if that is what the doctor thinks best for the patient?

The National Institute for Health and Clinical Excellence (Nice) provides important boundaries to what treatment is paid for and what is not by the NHS, but individuals sometimes fall outside the norm. They deserve to be allowed to help fund their care.

When the consultant assesses that a patient is likely to benefit from a drug, yet the drug is not funded by the NHS, what do they do? Do they tell the patient, knowing that the patient has a right to know about their condition and its treatment, or do they keep silent to avoid distress?

Professional codes of conduct demand disclosure. Without that honesty, the patient and their family are left unsupported to surf the net in the vain hope of finding something to help.

The labour government also objects to allowing NHS cancer patients to pay for additional medicines on the grounds that this would create a two-tier NHS with patients on the same ward being administered different drugs based on their ability to pay.

We already have multi-tiered healthcare in this country, however. Those who can afford to pay for their care privately do so.

The labour government is adamant that an “episode of care” is either in the NHS or funded privately by the patient. Yet there is no clear and consistent definition of “an episode of care”.

Is it just the standard course of a drug, including or excluding background investigations and potential but not expected complications? Or is it everything associated with a treatment, even if life-threatening complications occur? We have different definitions of an “episode of care” around the country.

If, for example, a patient has a hernia operation, then suddenly has a massive heart attack immediately after the operation and is shipped into the local NHS coronary care unit, the patient’s dressings relating to the surgery have to be attended to – the NHS does not wash its hands of the patient just because the surgery was done sooner but privately.

When some complication arises following private surgery, many patients land in an accident and emergency department and are treated, not sent away. The episode of care is deemed to be over in the private sector and the patient reverts to the NHS.

There is a provision for the NHS to charge the patients or insurer but this happens rarely, even when the complications arise directly from the privately funded intervention. We have patients in nursing homes paying for their social care, having been means-tested.

This includes care from trained nurses although the rest of their care is rightly provided on the NHS. Yet the boundary between some aspects of health and social care is very blurred.

At present, different NHS trusts take individual decisions in conjunction with their local commissioners over individual high-cost drugs. Often the difficulties arise when high-cost drugs are licensed for one indication but the clinician wants to prescribe it for an individual with another condition.

This can either be because the patient wants to buy the drug but have NHS care, or it may be that the patient wants to top up their care, or wants to self-administer the drug (perhaps purchased via the internet) but remain treated by the NHS. The danger is that if the NHS does not know what the patient is taking, the consultant is unable to advise if the drug is likely to do more harm than good. And the NHS still has to treat the patient when problems arise.

No patient can expect a clinical team to administer a treatment that is unlikely to be of benefit – on balance the benefits must outweigh the risks and burdens.

There will always be patients getting funded drugs but not responding as hoped for. Similarly for unfunded treatments, there will be a small number of patients who might have benefited if they had had the treatment; predicting that can be hard.

But why should we pretend that the lines around NHS episodes of care are clear? They are not. Without clear national definitions of what the NHS does and does not do, can we justify spending billions of pounds on the relief of relatively minor conditions and deny patients with life-threatening disease the support of the NHS when they want to bridge the costs themselves?

Interestingly, the opinion of Nigel Griffin QC is that there is no bar in law, and no reason in principle, for NHS and privately paid-for care to become more integrated so that treatment runs concurrently, providing that nobody else is excluded from treatment in the process.

It cannot be beyond the wit of managers to ensure that those who fund their own treatments integrated with the NHS do so in a way that allows a small fund to be generated to subsidise the odd patient who cannot pay but really would benefit from that rare off-licence treatment.

Surely this would be more equitable than restricting access to potentially life-prolonging treatment to those able to pay for everything included in the “whole episode of care” – whatever that means.

http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article4087623.ece

The outcry from eminent consultants and doctors’ leaders came as news emerged of two more patients whose NHS care was removed while they were dying of cancer.

Alan Johnson, the health secretary, faces opposition from the presidents of the Royal Society of Medicine and the Royal College of Surgeons, as well as British Medical Association consultants.

Baroness Ilora Finlay, president of the Royal Society of Medicine, said the issue went to the heart of the purpose of the health service.

“Can we justify spending billions of pounds on the relief of relatively minor conditions and deny patients with life-threatening disease the support of the NHS when they want to bridge the costs themselves?” she said.

Finlay’s intervention, in an article for The Sunday Times, comes after it emerged that a man dying of kidney cancer had to battle for NHS care because his family followed doctors’ advice to pay privately for a drug.

John Burrell, a retired financial adviser from the Isle of Wight, died last month aged 63. His daughter, Kate Tasquier, said: “The consultant told my dad he would be billed for all of his treatment such as blood tests and scans. My dad was so worried.”

Although she said the NHS eventually compromised on the fees, “he ended up being so scared that he was going to be billed for his care that he was scared to go into hospital and he delayed starting the treatment”.

It also emerged that Sandra Baker, a bowel cancer victim, died last year after being denied NHS treatment in her final months. When she paid £9,500 privately for drugs, she was hit with an extra bill of £16,000 for her treatment.

The Sunday Times revealed the case of Linda O’Boyle who died of cancer aged 64 after being denied NHS treatment because she paid for a drug. Bernard Ribeiro, president of the Royal College of Surgeons, and the annual consultants’ conference of the British Medical Association have also attacked the labour government’s block on NHS patients paying for additional drugs.

While Johnson insists cancer patients should not be allowed to pay for superior drugs because this would create a two-tier NHS, opposition parties have edged closer to supporting co-payments.

Norman Lamb, the Liberal Democrat health spokesman who is developing a new party policy on the issue, said: “When a clinician recommends a proposed treatment as having therapeutic value to the patient, it seems cruel and perverse to withdraw all NHS treatment if the patient follows that advice.”

Ribeiro said: “I would strongly oppose the denial of life-saving operations to patients based on decisions they had made about how they supplement their NHS care.”

Cancer specialists at one of the country’s largest hospitals have found a way around the ban. About 16 oncologists at University Hospital Birmingham NHS Foundation Trust write prescriptions for their patients to receive private cancer drugs at home.

Professor Nick James, one of the doctors, said: “There is no question of us turning away these patients. I believe that to do so is punitive and vindictive. We remain responsible for the NHS care of these patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4087629.ece

Another question for Labour – how come these drugs are free in Scotland and that it’s only Englsih patients who face this dilemma?

The survey, carried out by the British Medical Association, says that over half of respondents say they are prevented from innovating to improve patient care and seven in 10 lack adequate resources to support their work. The policy of patients having a choice over where to have treatment was supported by 69 per cent of respondents.

The BMA Central Consultants and Specialists Committee (CCSC) commissioned this survey on consultant opinion to gather information about consultant members’ views on labour government health policies, how changes are affecting consultants ability to care for their patients and to work to their full potential as trained professionals.

Consultant member views were gathered to ensure that members’ views were represented in future discussions on these issues. and to inform the BMA’s evidence to the review body on doctors’ and dentists’ remuneration (DDRB).

Key findings of the survey
* A total of 1,587 complete responses were received with an overall response rate of 31.7 per cent.

* Only 7 per cent of respondents remain on the pre-2003 contract.

* The average number of PAs included in the job plans of respondents on a full time contract was 11.3. 60 per cent of all respondents stated that the number of PAs accurately reflected the level of direct clinical care undertaken. The average number of SPAs included in the job plans of respondents on a full-time contract was 2.5. 55 per cent of all respondents stated that the number of SPAs did not adequately reflect the work involved.

* The average number of hours worked per week for respondents on a full time contract was 50.73 with almost one in five working more than 55 hours a week.

* There was overwhelming support for further change to the CEA scheme to improve its ability to reward excellence and general support for all awards being made available locally.

* 85 per cent of respondents indicated that there was a process in their Trust for consulting with consultants on contractual and human resource (HR) matters. This was for the most part via the Local Negotiating committee or through the job planning and appraisal process.

* There was overwhelming support for the view that consultants should be leaders and innovators in clinical practice. 52 per cent of respondents believed that consultants were actually prevented from innovation in support of patient care.

* Two thirds (66 per cent) reported that the numbers should be expanded in their departments, 31 per cent reported they should remain the same. 78 per cent of respondents reporting affordability as the reason for their response that consultant numbers should remain the same.

* 70 per cent of respondents reported that they did not have adequate resources to support them in their roles as consultants. Of those respondents who reported they did not have adequate resources 63 per cent of responses from respondents reported lack of secretarial support, 48 per cent reporting a lack of IT and a further 48 per cent a lack of managerial support.

* 60 per cent of respondents disagreed or strongly disagreed that polyclinics would improve the quality of patient care and almost two in five disagreed or strongly disagreed that polyclinics would improve patient access to treatment.

* 73 per cent of respondents reported that the direction of government policy to expand use of the private sector was detrimental to patients and the service as a whole. 83 per cent of respondents reported that privatisation of the NHS would be detrimental to patients and the service as a whole.

From:
http://www.bma.org.uk/ap.nsf/Content/Surveyconsultantopinion08

It is seeking a judicial review of the Department of Health policy that forces patients to pay for all their treatment if they buy any additional medicine.

Many patients would like to buy extra drugs that are not offered as part of their treatment because the National Health Service has ruled that the benefits do not justify the costs.

The labour government fears that if patients make the purchases, called co-payments, it will lead to a “two-tier” NHS.

Doctors for Reform believes patients should be given the freedom to choose. Its intervention follows a campaign by The Sunday Times highlighting the plight of breast cancer sufferers denied the opportunity to improve their chances by paying privately for drugs.

Last December Health Direct reported the case of Colette Mills, a breast cancer sufferer from Stokesley in North Yorkshire, who was told that if she topped up her medication with privately bought drugs she would have to pay for her entire treatment – about £10,000 a month.

The Department of Health has issued guidance to health trusts warning them that co-payments are not allowed. In December Alan Johnson, the health secretary, reiterated the rules.

Doctors for Reform has teamed up with Halliwells, the law firm, to challenge the ruling. Halliwells is offering its services free as the doctors are trying to raise £35,000 in donations towards government legal fees if they lose.

The doctors point out that examples of co-payments already exist in the NHS, for instance in dental care.

Dr Christoph Lees, a steering group member, said: “Doctors are caught in a terrible dilemma: do you tell a patient about a drug that could improve their quality of life, or do you pretend it doesn’t exist?”

Another cancer patient, Debbie Hirst, 56, from St Ives, Cornwall, began legal action against her local NHS trust to win the right to pay for the drug Avastin. Legal judgment was averted when the trust decided to treat Hirst as a special case and paid for the medicine.

For more information, see Doctors for Reform

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3646250.ece

The idea of equal care across all social groups is the ideal. But to achieve this by witholding treatment from the rich rather than improving the care of the poor is typical of this labour government, and leads to only one thing – unnecessary or early death!

Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

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 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

Pfizer of the US, Roche of Switzerland and Merck-Serono of Germany are among the companies which have told the Financial Times they have, or will, reduce the number of British patients enrolled in trials to test experimental medicines for life-threatening diseases such as cancer.

The drug companies are increasingly frustrated by the National Institute for Health and Clinical Excellence, the labour government’s medicines advisory body, which last week handed them fresh setbacks by advising against NHS use of Pfizer’s Avastin and Merck-Serono’s Erbitux.

The result, the companies claim, is that few patients in Britain are receiving “gold standard” treatment so there is too small a group against which to compare their experimental drugs.

Chris Brinsmead, head of the UK arm of AstraZeneca and newly appointed president of the Association of the British Pharmaceutical Industry, the trade body, said a sample of just four companies had revealed that more than 20 trials had failed to get off the ground since the start of last year because they could not recruit patients.

“Two or three years ago, this would have just been hypothetical,” he said, stressing that the UK’s relative share of global clinical trials was already in decline although absolute numbers were stable. “It would be a great shame if the trend continued.”

The warnings are a fresh embarrassment for the labour government, which has stressed its commitment to pharmaceutical research in the UK while imposing a fresh 5 per cost cut after unilaterally scrapping the existing price contract with industry only halfway through its five year term.

Denise Richard, head of the UK oncology business division at Merck-Serono, the German drug company, said a large cancer trial her company had supported three years ago with free medicine and a grant of several million pounds was “the last time we will invest such a massive amount until we see a better return”.

She said that if her company had previously allowed her to include about 20 British centres with cancer patients as part of international clinical trials, it was now willing to permit only four or five “to provide a bit of data from the UK”.

Pfizer has already recently cancelled UK participation in four clinical trials, including one for cancer, because it could not recruit sufficient patients who were taking the existing international “gold standard” approved drugs against which to compare with Avastin, its experimental treatment.

Harpal Kumar, head of Cancer Research UK, said: “In the long-term there is a serious risk that if we get to the point where none of the new drugs are being used in the UK, the trials won’t eb done here.”

From:
http://www.ft.com/cms/s/0/f0e08f2a-42ee-11dd-81d0-0000779fd2ac.html?nclick_check=1

The new contract, introduced in 2006, was intended to simplify charges and make it easier to find an NHS dentist.

But the Commons Health Committee said access remained “patchy” and there had been a sharp fall in the number of complex procedures.

The new contract, under which patients paid fixed charges for particular types of procedure, also gave local primary care trusts the power to commission and pay for dental services.

It has been rolled out to cover Wales, although the report only deals with progress in England.

The number of patients seen fell by 900,000 in the 18 months following the introduction of the new contract in April 2006, the report said.

In the first year of the contract, the number of complex treatments – including bridges and crowns – which involve laboratory work was halved, and the number of root canal treatments fell by 45%. Both of these attract higher fees under the new scheme.

The committee said there were concerns that some patients were not getting the complex treatment they needed.

Conversely, the number of tooth extractions rose.

The committee also heard fears that the changes had not stemmed the exodus of NHS dentists into private-only practices.

Committee chairman Kevin Barron MP said: “It is disappointing that so far the new contract has failed to improve the patient’s experience of dental services.

“While we readily accept that in some areas of the country, provision of NHS dentistry is good, overall provision is patchy.”

He criticised the Department of Health for not piloting the new contract on a smaller scale prior to introduction.

The committee called on the government to improve PCT commissioning and review the “units of activity” system to make sure it rewarded dentists for choosing the most appropriate treatment.

“It highlights the failure of a farcical contract that has alienated the profession and caused uncertainty to patients,” she said. “For the past two years, dentists and patients have told the Department of Health that it got it wrong.”

A Department of Health spokesman said it would “carefully consider” the recommendations but that the benefits of the reforms were already emerging.

From:
http://news.bbc.co.uk/1/hi/health/7483182.stm

In a separate finding, 31% said they would consider avoiding NHS surgery for fear of getting an infection.

Despite the concerns raised by the survey, 82% of respondents said they were proud of the health service, with half claiming it was still the envy of the world.

The most widely-cited concern after infections was the wait people face for treatment.

Despite the NHS in England, Scotland, Wales and Northern Ireland making shorter waits a priority, one in four people still cited this as a concern.

In England, which is the furthest ahead in reducing waits, no-one should be waiting longer than 18 weeks by the end of the year.

One in 10 polled also said that both the lack of staff and mixed-sex accommodation was their biggest concern.

However, it is superbugs which dominate people’s thoughts in the poll carried out by ICM Research for the BBC.

Just 33% of respondents said they were confident that the NHS would protect them from picking up an infection in hospital.

In contrast, 94% were confident that the NHS would provide good care in an emergency such as a car crash, and 86% were confident it would deliver a baby safely.

Ministers have made tackling bugs a priority, launching initiatives such as this year’s £50m deep clean of wards.

Infection rates are even higher in Scotland, while in Wales and Northern Ireland they are slightly lower.

Dr Hamish Meldrum, chairman of the British Medical Association, said the findings on infection were of “huge concern”.

He said: “We understand why people are so concerned about hospital-acquired infections and although infection rates are coming down, no-one can be happy with the levels that still exist.

“We owe it to patients to be able to prove to them that hospitals are a safe place to go to benefit from the help modern medicine can provide.”

Professor John Appleby, chief economist of the independent think thank The King’s Fund, said media coverage had fuelled fears about hospital infections.

A Department of Health spokeswoman said it had “come a long way in tackling infections, but any avoidable infection is one too many”.

“We have introduced a raft of measures that we know will reduce infection and are already having an impact,” she said.

From:
http://news.bbc.co.uk/1/hi/health/7475561.stm