The UK Drugs Policy Commission says classifying illegal drugs on a “danger scale” of classes A, B or C needs to be overhauled because they do not affect drug use.

The news comes ahead of a meeting this Friday when the Home Office’s independent Advisory Council on the Misuse of Drugs will discuss whether to downgrade ecstasy from class A.

Ecstasy remains the third most popular illicit drug in Britain, with five per cent of young adults aged 16 to 24 saying they have used it in the last year.

The council, which is made up of 21 academics and drugs experts, provides advice to Governments on illegal drug use and is expected to recommend downgrading the drug from A to B.

Reports from the Police Foundation in 2000, the Commons Home Affairs Committee in 2002 and the Commons Science and Technology Committee in 2006 have all favoured the move.

However the Commission warned the council in a submission that Home Secretary Jacqui Smith is likely to over-rule any decision to downgrade, in a re-run of the row over cannabis earlier this year.

Then, the council’s recommendation that cannabis should remain a class C drug was ignored by Miss Smith who decided to reclassify the drug on health grounds.

The Commission says: “The UKDPC does not want to second-guess the council’s final conclusions about ecstasy. However were it to recommend a lower classification then it is not unreasonable to anticipate a political response to that with cannabis.”

The Commission was heavily critical of what it describes as the “increased polticisation” of drugs’ classification.

Roger Howard, Chief Executive, UK Drug Policy Commission, told The Daily Telegraph: “The purpose and operation of the drug classification system has become increasingly confused amongst politicians and the public in recent years.

“The time has come for an independent wholesale review of the system to clarify how a scientific rating of drug harms should be used for drug classifications and for wider applications such as setting policing priorities or public health messages.”

Members of the commission include the chairman Dame Ruth Runciman, a former council member who chaired a Police Foundation inquiry which argued for ecstasy to be moved to class B seven years ago, Professor Colin Blakemore, the former chief executive of the Medical Research Council and David Blakey, a former Chief Constable and HM inspector of constabulary.

The council is expected to make its decision on ecstasy next year.

From:
Drugs-classification-should-be-scrapped-experts-say.html

The labour Government is considering giving firms access to a massive computer database which will contain the records of almost every man, woman and child in England.

The information is a goldmine for private companies, who could use it for medical research or for helping them to sell products to the NHS.

But privacy campaigners say they are “horrified” by the proposals which could see patients’ postcodes, medical conditions and treatments – and in some circumstances, their names – passed on to third parties without their consent.

The database, part of a long-delayed scheme to give NHS staff access to computerised medical records, will hold details of almost all visits by patients to hospitals and GPs.

The plans have been dogged by controversy. Last week. ministers gave in to pressure from privacy campaigners and agreed that medics will have to gain the consent of patients before opening their computer records. Yet patients will have almost no control over the same information being passed on to companies and other bodies outside the NHS.

The Department of Health says most records passed onto third parties would be made anonymous, but admits that identifiable data – which could include patient names – could also be handed on if it was deemed to be more useful.

Security experts said the scheme would “hoover up” vast quantities of confidential data which could easily be traced back to individuals, whether or not names and addresses or other personal details were removed.

Ross Anderson, Professor of Security Engineering at Cambridge University, said: “We have had a lot of debate about patients being able to opt out of the national scheme for patient records, but meanwhile the Government have pulled a fast one. There are no limits set on the way this data can be used; this database will hoover up all the personal medical data on every person, and it can be used for whatever the Secretary of State says it can be used for.”

Prof Anderson suggested the creation of one large database would also make it easier for different parts of the state to use confidential health data for other purposes, with social workers, courts and police able to access medical files more easily.

Helen Wilkinson, a former NHS manager who founded The Big Opt-Out, a campaign against the national care records scheme, said she was “horrified” by the latest development and planning a major publicity launch to warn people of the threat it posed to their privacy and security.

She said: “We are talking about a hugely valuable commodity which will be worth a fortune to the pharmaceutical industry, and to all the companies which make their profits from the health service.”

Joyce Robins, from patient pressure group Patient Concern, said patients would be left “entirely at the mercy” of those operating the scheme.

“We have no idea where this information will end up, and we have no control over it. Even when the data is anonymised, it will be easy to trace back to individuals because the nature of medical data is that it reveals a lot about a person. We have seen an endless succession of data losses and breaches, and there is little to reassure anyone that this information would be secure.”

The Government public consultation on secondary uses of NHS data, which began without publicity on Wednesday, has been outsourced to a private company called Tribal, which holds contracts to organise the planning of NHS services.

Its managing director Matthew Swindells was until recently chief information officer of the DoH, and before that adviser to then health secretary Patricia Hewitt.

A spokesman for Connecting for Health, the government agency which oversees the patients records scheme, said that while “in theory” anonymised data could be used to trace an individual, researchers would be more likely to examine records in batches of hundreds of thousands at a time. He described the matter of whether information should stay within the health service, or ever go outside for research – to academic researchers or pharmaceutical companies – as a “valid question” on which the consultation sought public opinion.

The agency’s chief operating officer, Professor Michael Thick, said patients would be able to be removed from the so callled “secondary use” database if they made an application under the Data Protection Act. Under the proposed system, third parties would need to request information from the central database, and fulfil requirements set by data custodians and ethics committees.

From:
Private-companies-could-get-access-to-millions-of-NHS-medical-records.html

Health Direct points out that labour government records have shown themselves to be as watertight as a rusty bucket.

Now labour are openly proposing that your health details will be accessible to many.

Medical records are personal and private to the individuals concerned, having been given in trust to their medical adviser.

The assumption that medical records can be widely disseminated represents a breach of this trust and would be totally unethical.

If you also don’t want your medical details to be widely available, sign up at the Big Opt Out at http://www.nhsconfidentiality.org/
now!

Christine Connolly, previously chief information officer at Cadbury Schweppes and head of IT for a significant part of BT’s business, will become chief information officer for health, with overall responsibility for information strategy across the NHS.

Martin Bellamy, a former KPMG partner who has been chief information officer for the Pensions Service since 2003, will be the scheme’s head of programme and system delivery.

Gordon Hextall, the programme’s chief operating officer, who has been acting as the its head since Mr Granger departed, is expected to stay in post.

The health department said both jobs were advertised and would be paid in the £200,000-a-year range. Mr Granger, when he joined the health department in 2002, was briefly Britain’s highest paid civil servant, on £250,000 a year.

From:
http://www.ft.com/cms/s/0/918e87ec-64e1-11dd-af61-0000779fd18c.html

Health Direct asks why- at a time when NHS penny pinching is condemning thousands to early deaths, does the NHS needs two IT bosses? At a cool £200K each.

The labour Government has pledged 3,400 extra full-time jobs (4,000 including part-time workers), but research for the Darzi review into the NHS shows a shortage of 4,288 midwives.

The shortfall is estimated after comparing it with the NHS “gold standard” for safer childbirth, which demands one midwife per 28 births.

London has the worst shortages with 1,150 more midwives needed to meet a 20 per cent rise in the birthrate.

Louise Silverton, deputy general secretary at the RCM, said: “Women keep hearing about Government policy statements, such as one-to-one care from a midwife, but they are not getting that sort of treatment in many areas.

“Our members are telling us that they are overworked and overstretched and are running between beds dealing with, in some cases, three women at once.”

The RCM added funding for maternity services has been cut by £55 million.

Miss Silverton added: “The maternity services have long been described as a postcode lottery – but our regional NHS responses paint a shocking picture of just how loaded that lottery for maternity care is.”

By next year ministers have promised women will be able to choose whether to have their child in hospital, at home or in a midwife-led birth centre.

The Government has promised £330 million of extra funding for maternity services over three years.

But, according to Miss Silverton, research shows nine out of 10 maternity units do not know where their share of the £330 million had gone, and it could have been diverted into other services.

She said: “It is not enough for the Government to say it has put money into maternity services, but then fail to make sure the money actually goes where it is supposed to.”

From:
Midwives-deal-with-three-births-at-once-says-expert.html

Since the labour government’s teenage pregnancy strategy was introduced in 1999, the number of girls having abortions has soared. You might well be tempted to argue that sex education causes sexual delinquency.

Only two months ago the Health Protection Agency reported that a culture of promiscuity among the young had driven the rate of STDs to a record. Almost 400,000 people – half of them under 25 – were newly diagnosed, 6% more than in 2006.

When something fails, the usual procedure is to drop it and try something else. With sex education, the worse it gets, the more people cry out for more of it and earlier.

Labour ministers are considering whether to make schools offer more sex education, offer it earlier and deny parents the right to withdraw their children from it.

Last week the Family Planning Association – now calling itself the fpa, having joined other charities in a mad rush to reduce themselves to a couple of lower-case letters – published a comic-style sex education booklet for six-year-olds to be marketed in primary schools for use in sex and relationships lessons.

It has printed 50,000 copies of Let’s Grow with Nisha and Joe, and tried it out in more than 50 primary schools; it hopes to encourage schools that have shied away from sex lessons to take them on with Nisha and Joe. Oh dear.

It seems to me highly unrealistic (given that 25% of children leave primary school struggling to read and write) to assume that many six-year-olds could begin to read the labels “testicles” or “vagina”.

And it is infuriating, given that medical-style euphemism has triumphed over plain English, that the authors have chosen one that’s wrong. “Vagina” does not mean the external genital organs, commonly referred to as “front bottom”. It comes from the Latin for sheath or scabbard and means what that suggests. The correct word would be “vulva”, but the ill-educated educationists blithely impose inaccuracy on our tiny children. However, that is not what I most object to.

What I object to about the book is what I object to about sex education as a whole (quite apart from its failures). Sex education – particularly compulsory and standardised sex education – is based on mistaken assumptions.

The first is the pervasive assumption of equality – that is, that all six-year-olds or all 11-year-olds or 15-year-olds can discuss the complexities of sex in the same form in the same way. That’s nonsense. Children vary in intelligence and progress. Some young children can easily decipher words such as “urethra”; others may never be able to read them.

More importantly, children and teenagers mature at different ages and come from different backgrounds with different family expectations. You cannot talk the same way to a shy 13-year-old who hasn’t had her first period to another who is well acquainted with the darker recesses of the school bike shed. Some boys are men at 11 and 12, physically; others are children until much later.

Some children’s parents find it acceptable that their sons and daughters are having sex at 13, while others would be shocked: you cannot talk to all these children together. It would puzzle and offend them and might do them serious damage.

And it undermines the authority of those parents who do not share the values of the teacher, or of the majority of the other pupils. It is wrong to assume that people want equality in such matters. They want differences.

Children and families and moral values are not equal, neither within schools nor outside them. They simply aren’t the same.A sensitive teacher will try to make allowances, but there is a shortage in this country of good and sensitive teachers – hence the crisis in education.

Another mistaken assumption is that sex education ought, necessarily, to be entrusted to teachers, given how wildly they vary in ability and in moral attitudes. The thought that the government is considering making sex and relationship education compulsory in schools is terrifying.

From:

http://www.timesonline.co.uk/tol/comment/columnists/minette_marrin/article4795056.ece

The survey, of more than 800 patients, shows that 82% of NHS patients back the right to pay for top-up medicines.

The survey also found that more than 90% of doctors and nurses favour patients being allowed to pay supplements for proven cancer drugs which are not funded by the NHS.

Archer, chairwoman of Cambridge University Hospitals NHS Foundation Trust, has submitted the results to Mike Richards, the government’s cancer czar, who is conducting an inquiry into the scandal of withdrawing NHS treatment from patients who pay for private medicines.
Private drug helps cancer man left to die

In a letter to Richards, copied to Alan Johnson, the health secretary, Archer described the policy of penalising patients who choose to pay privately for drugs as “illogical and unjust”.

Archer, wife of Jeffrey Archer, the disgraced Tory peer and novelist, also said the co-payments should be allowed, not just for cancer medicines, but for all effective procedures and treatments which are not funded by the NHS.

Christoph Lees, a consultant obstetrician and gynaecologist at the Cambridge NHS Trust, said the labour government should make “sensible provision for patients to exercise what should be their right, rather than penalise them for their choice”.

Meanwhile, nine professors of rheumatology at University College London Hospitals NHS Trust, in central London, and Leeds Teaching Hospitals NHS Trust have claimed British arthritis patients are less likely to get the medicines they need than those in Romania, Hungary and the Czech Republic.

In a letter to The Sunday Times, they accuse the National Institute for Curbing Expenditure (NICE) of making a “senseless decision” by ruling that arthritis sufferers who are not successfully treated by one of a group of medicines known as anti-TNF treatments can’t switch to another type.

From:
http://www.timesonline.co.uk/tol/news/uk/article4794836.ece

Providing a brief, summary electronic patient record has been a key driver for the £12bn ($22bn) NHS IT programme, which will create a detailed, local electronic record as well as the shorter one available nationally, providing doctors with recent medical history, medications and allergies in an emergency or out of hours.

Tony Bliar, then prime minister, declared as long ago as 1997 that the electronic record would mean that “if you live in Birmingham and have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you”.

Development of electronic records, however, has been devilled by a long and bitter dispute, chiefly with general practitioners, over whether patients should explicitly give consent to having such a record – a more complex, lengthy and costly approach – or whether they should be presumed to give consent with the right to opt out – the approach that the IT programme originally backed.

On Thursday, however, Connecting for Health, which delivers computer systems and support to the NHS, announced a change of tack. Patients will now be written to and given the chance to opt out before a summary record is created.

They will in future be asked at each consultation if the clinician can look at their record and will have the right at that point to opt out entirely, to refuse for that episode of care, or to agree to the record being viewed. They will also be able to agree to the record being permanently available to accredited clinicians.

Dr Gillian Braunold, the lead GP for the programme, said the change “gives the patient control to say yes or no and it is much simpler”. The default position will be “Ask me first”, she said. The decision had been reached after consultation with GP leaders, the Information Commissioner and a wide range of others, she added.

The British Medical Association said it welcomed the changes “pending finer details”, believing patients should opt-in rather than opt-out.

The record has been piloted in five parts of the country, with fewer than 1 per cent of 160,000 patients refusing to have a summary record. Connecting for Health said it hoped to roll the record out nationally, starting in 2009 or early 2010. It is likely to take at least 2-3 years to cover the country.

http://www.ft.com/cms/s/0/ff2823e8-85d0-11dd-a1ac-0000779fd18c.html?nclick_check=1

Colin Ross, 55, of Horsham, West Sussex, has multiple myeloma, a cancer of the blood cells, and was not expected to survive to see Christmas unless he was given a drug described as his “last chance”.

The High Court overruled the decision by West Sussex Primary Care Trust that treatment would not be cost-effective, and said that Mr Ross should receive Revlimid as an exceptional case.

Mr Ross had incurable cancer diagnosed in May 2004. In an interview with The Times last month he said that he was “sickened” that he was being denied the £30,000-a-year treatment even though the drug was available to patients living only a few miles away in East Sussex.

But despite the exhortations of doctors treating Mr Ross at the Royal Marsden Hospital, the specialist cancer hospital in London, the trust had, since March, repeatedly refused to fund the drug, raising the issue of a so-called postcode lottery for NHS treatments.

However, Judge Simon Grenfell, sitting in London, condemned the trust’s decision as “one which no reasonable authority could have made on the application before it”.

Revlimid is among the most expensive of new cancer treatments and is readily available to patients across Europe and in the United States and Scotland.

But it has not yet been granted approval by the National Institute for Curbing Expenditure (NICE) and, because of the cost, is likely to be rejected. It is provided by only some trusts in England and then only in exceptional circumstances.

The case is likely to encourage other cancer patients who may have been denied expensive drugs on the NHS, but experts emphasise that the case does not set a legal precedent and that decisions will be taken case by case in other areas.

The judge issued an emergency injunction to enable Mr Ross to begin treatment today, but the ruling was made on an interim basis pending a further appeal and not as the start of permanent treatment.

Mr Ross was too ill to attend court for the ruling but his long-term partner and carer, Wendy Forbes-Newbegin, 52, who has breast cancer, cried after the victory.

She said after the judgment that the family’s treatment by the NHS had been “appalling”.

“The mental anguish that we have been through has at times been unbearable, and wholly unacceptable in this day and age,” she said.

“Colin’s diagnosis and recent prognosis have been so awful in the first place, but to have to endure all the months of waiting for this life-prolonging treatment has been nothing short of shameful in the first degree.”

Mr Ross, who has two children and four grandchildren, told The Times that he feared that delays incurred by his appeals to the trust and ensuing legal action may have reduced the effectiveness of the treatment.

“Depending on what the judges say, I could start treatment with Revlimid, or the doctors will simply refer me to start receiving palliative care,” he said last month. “My bed in the hospice is already booked. I realise the drug is expensive for the NHS, but to think that I could have a few extra months or years to spend with my daughters and watch my grandchildren grow up – I’ve never wanted anything more.”

Before yesterday’s ruling he was taking a cocktail of painkillers and other drugs “just to keep my head above water”, and was advised that Revlimid was now the only option.

In March, Mr Ross’s clinicians asked West Sussex PCT to fund Revlimid for three to four courses at a cost of £5,000 a course and presented evidence to show that it could give Mr Ross up to three more years of life.

He had been unable to purchase the drugs privately, he said. “Even if I could, the law states that I would have to become a private patient and forfeit the rest of my NHS care.”

Richard Clayton, QC, acting for Mr Ross, told the court during a two-day hearing: “This application for this drug is the end of the road for him. Either he gets the drug and is able to have life-prolonging treatment, or he doesn’t and treatment ceases, with inevitable consequences.”

He added: “Were the claimant to live a mile and a half in either direction from where he does, he would have received the drug.”

West Sussex PCT said that it was considering whether to appeal.

From:
http://www.timesonline.co.uk/tol/news/politics/article4727613.ece

Health Direct applauds the judiciary. Having had their power over life and death removed many years ago, it is heartening that they are taking the same power away from labour’s faceless health bureaucrats who are condemning thousands to premature deaths in the name of NHS cash shortages.

There are areas of the NHS where there is inconsistency over patient charging, such as optical care and dental care, and current legislation does not provide clear direction to patients or the NHS about why these top-ups are allowed but others, for example the use of non-NICE approved drugs, are not.

In addition, the basis on which decisions are made locally as to whether drugs are available before they have received NICE approval or if NICE has rejected them, is not always clear.

The rules that do exist are differentially applied and result in significant variations between primary care trusts (PCTs) in the decisions reached – precisely the situation that NICE was established to avoid.

This situation is unlikely to be publicly acceptable and examples of the health service forcing vulnerable patients to lose out on their NHS funded treatment because they wish to pay for a drug themselves risks damaging the reputation of the NHS as a caring and compassionate service.

The difficult decision facing the government is compounded by the lack of available evidence on the numbers of people who could take advantage of any changes in the rules permitting top-ups, which we are assuming are small; the possible costs to the NHS; and the potential opportunity costs of using existing NHS resources in this way.

The absence of such an evidence base makes any recommendation we make more difficult. However, after much consideration of what is undoubtedly a complex issue, The King’s Fund believes that in certain circumstances patients should be permitted to pay privately for drugs that have been rejected on cost-effective grounds and retain their right to access the rest of their treatment on the NHS.

They should also pay for the associated treatment costs over and above the cost of treatment they would have received on the NHS.

The King’s Fund recognises there will be equity concerns raised by this as there will inevitably be some patients who can afford top-ups and some who cannot. This is an inevitable cost of this policy option. Therefore, if the government does take the decision to permit top-ups it should address the following issues and ensure safeguards are in place to minimise the risks of unfairness:

* Identify and specify the circumstances in which top-ups are allowed – the review is focusing on drugs only but there are other procedures and therapies that present similar if less emotive issues.
* Calculate the associated costs, such as the costs of administering a drug. If these costs were met by the NHS, this would mean resources being diverted from other NHS patients to support the delivery of a treatment that may have been judged to be not cost-effective by NICE. We propose that the patient should meet the associated costs over and above the NHS treatment they would already be receiving. These costs would have to be carefully calculated.
* Ensure that individuals understand the financial liabilities they may face if they top-up their care – individuals with a terminal illness may feel they have little to lose by risking their resources on an expensive drug with relatively low efficacy but if the drug proves to extend their life they may find themselves unable to finance payments in the medium or long term.

Finally, The King’s Fund believes the government can use the opportunity created by the top-up debate to improve the way that new medicines – and by extension other forms of treatment – come into use.

The present system is overly dependent on trial data supplied by the pharmaceutical companies that do not necessarily reflect the realities of clinical practice. We need a more systematic and ongoing appraisal of new drugs in both clinical and economic terms.

The pharmaceutical industry has itself recognised that the introduction of new and expensive drugs must be handled in innovative ways. These measures might reduce the number of drugs that are excluded from NHS funding and would reduce the level of variation in the availability of non-NICE appraised drugs and treatments and reduce uncertainty for patients and the public.

From:
http://www.kingsfund.org.uk/media/top_ups_response.html

Last night, patients groups blamed the labour Government for “botching” a contract that allows dentists to make more money from the NHS by carrying out simple work at the expense of complex cases.

Dr Anthony Halperin, a dentist and chairman of the Patients Association, said that he was deeply concerned that treatment was becoming worse under a target-based contract that encouraged dentists to “maximise profits” instead of putting patients first.

“There is evidence that a lot of the most complex work is not being carried out,” he said. “It is easier and more profitable to take out a tooth and replace it with a denture than to carry out complex root canal surgery.

“Dentists are working the system for them, not for the patients.”

Salaries for an average NHS dentist, who spends about 70 per cent of each week doing NHS work, topped six figures in 2006-2007, figures will show.

During the same period, total working hours increased by only half an hour a week, to 37 hours.

Of that, the amount of time devoted to the NHS rose by six minutes a week, to just over 26 hours.

The contract, introduced by labour ministers two years ago, has been attacked by MPs and patient groups as well as some dentists.

Critics say that the “target-based” system has encouraged dentists to concentrate on the work that can be done most quickly and lucratively. The number of people seen by NHS dental practices has dropped by more than a million since the contract was introduced.

Roger Goss, of the pressure group Patient Concern, said: “Dentists are getting more money while patients are getting a worse service.

“This government botched the contract for dentists, in just the same way that they did for GPs and consultants before them.

“All these patients who cannot get their teeth treated on the NHS will find it pretty galling that the average dentist is earning six figures.”

In July, the Commons select committee on health said that the Department of Health had failed in its promise to improve access to dentists.

MPs found evidence that the number of complex treatments such as crowns, bridges and dentures had fallen by 57 per cent since the contract was introduced.

The number of root canal treatments fell by 45 per cent in England and Wales, although it rose in Scotland, where the contract was not brought in.

The committee’s report said that it was “extraordinary” that the department did not test the payment system before introducing it everywhere.

From:
Average-NHS-dentist-earns-six-figure-salary.html

Official figures compiled by the Office for National Statistics show that the amount of treatment the NHS delivers is lagging behind the pace of increase in the service’s budget.

Critics said the statistics showed the NHS had absorbed huge amounts of money with very little to show for it and the Government must reform its management instead of pumping in ever more funding.

NHS productivity fell by 2.0 per cent a year between 2001 and 2005, according to the Centre for the Measurement of Government Activity, the ONS unit that monitors public spending. That was the period of the biggest funding increase in NHS history.

From 1995 to 2006, the NHS annual budget more than doubled from £39 billion to £89.7 billion.

Andrew Lansley, the Conservative shadow health secretary, said the figures proved that Labour’s approach to the NHS had failed.

“Spending more money if it’s not spent well doesn’t necessarily deliver the services you are looking for,” he said, accusing Labour’s use of centralised targets and management of undermining the delivery of healthcare.

As an example, Mr Lansley cited the latest central NHS contract for GPs’ surgeries. A Whitehall audit earlier this year found that the contract had lead to family doctors earning 58 per cent more for doing 5 per cent less work.

The Department of Health said it was more important to focus on improvements in the quality and availability of treatment.

A spokesman said: “Ten years ago people died waiting for operations, today waiting lists are at the lowest ever. The NHS is treating more patients, treating them faster and treating them more safely

“It is also easier to access NHS treatment – through NHS Direct, walk in centres and at A&E; where over 97% of people are now seen within four hours.

And it is easier to see your GP because of extended opening hours in the evening or at weekends

“There are 280,000 more doctors, nurses and other essential staff working for the NHS than in 1997 and all NHS staff have enjoyed well deserved pay rises.

From:
NHS-productivity-falls-as-spending-rises-by-billions-under-Labour.html

Next month, Prof Mike Richards, the Department of Health cancer tsar, will announce results of a labour government review into rules that deny NHS treatment to patients who want to “top up” their care by paying for some of it. The Government had to examine the issue after a public outcry over the death in March of Linda O’Boyle, a grandmother denied free NHS treatment after buying the bowel cancer drug cetuximab, marketed as Erbitux.

Mrs Moss was prescribed Avastin by her consultant at Worcester Royal Hospital, but the primary care trust refused to fund it. Instead, the former schoolteacher and her husband, Mark, a toolmaker, cashed in their pensions, and were given money by Mrs Moss’s 86-year-old mother to pay for the drug.

It shrank a secondary tumour in her liver so successfully that she was able to have it removed. When the cancer returned, she was once again denied Avastin. The couple spent a total of £21,000 on the drug and on the chemotherapy and nursing that Mrs Moss had previously received free of charge.

Latest scans show she is tumour-free. The cancer is likely to return, but already she has survived for 17 months beyond her original prognosis. On holiday in France, Mrs Moss said: “All this extra time has been so precious. I have been able to spend time with my husband and two sons, and it has helped them and me to prepare for my death. Every day now is a bonus, and I am grateful for that. But I am angry that after paying our taxes we had to take on these battles, and I feel really aggrieved for those people who cannot afford these treatments which are available in so many other countries.”

Mrs O’Boyle’s widower, Brian, recently had a private meeting with Prof Richards to discuss the top-up review. Last night Mr O’Boyle told The Sunday Telegraph that he wants the entire system of drug rationing overhauled, so that every patient gets the treatment their consultant prescribes.

The father of three said his wife, who was an NHS occupational therapist, would have been amazed by the impact her death has had. Worcestershire PCT said it had concluded that there was not enough evidence to support the use of Avastin for bowel cancer.

Southend Hospital Foundation trust, which treated Mrs O’Boyle, said the charges for her NHS care followed Government policy, which meant only one organisation could be held accountable for a patient’s care.

The charity Bowel Cancer UK campaigns on behalf of patients seeking both Avastin and Erbitux. The drugs’ use is restricted by the National Institute of health and Clinical Excellence (Nice), the rationing body, on the grounds of cost.

The charity and many bowel cancer doctors are critical of the Nice guidance, but also say PCTs do not have proper policies that should allow some patients to be given the drugs if their cases could be defined as exceptional.

Ian Beaumont, charity’s campaigns director, said: “We think the current system is totally broken. All over Britain we have got patients who are having to battle the NHS system at the same time they are fighting cancer.”

From:
NHSs-refusal-to-fund-cancer-treatment-costs-mother-21000.html

Health Direct thinks that it is quite absurd that a quango like labour’s NICE should have the power of life and death over patients when such powers were abolished years ago for the judiciary.

The problem for the NHS is that labour has blurred the difference between for example top ups for dental treatment and those for life saving cancer drugs- with no idea of the size of potential extra income for the NHS if labour was to see sense and allow extra personal funding.

In Knowsley, Merseyside, healthcare bosses spend £118 per head on cancer treatments, but in Ealing, west London, they spend just £47.

Middlesbrough spends £167 per head on circulatory diseases, including heart disease, compared with £76 by Southwark, central London.

The spending variations were “almost certainly not justified”, warned Nial Dickson, the chief executive of the King’s Fund, the influential health think-tank, which compiled the report.

The wide variations in how much the National Health Service trust spends on these diseases has remained unchanged for three years.

This despite an extra £9billion investment by ministers.

The spending variations were branded “unacceptable” and there were calls on the labour Government to investigate whether they were leading to higher death rates in some areas.

It comes amid increasing concerns over healthcare rationing with several high profile cases where patients have been denied drugs because they were deemed “too expensive” for a particular Primary Care Trust (PCT).

Last week, Colin Ross, a cancer sufferer who has been told he will not survive the autumn unless he receives the cancer drug Revlimid, took his case to the High Court.

Mr Ross, 55, who suffers from multiple myeloma, a cancer of the blood cells, was denied the drug, which costs £4,000 a month, by West Sussex PCT, Despite a leading cancer expert describing him as “eminently suitable” for treatment. It could prolong his life by three years.

If he lived a mile-and-a-half away from his home in Horsham, West Sussex, Mr Ross’s case would come under a different PCT where he would have been more likely to receive the drug.

Jane Tomlinson, the cancer campaigner who died a year ago, was denied a drug that doctors believed could prolong her life although neighbouring PCTs provided it. She eventually received it as part of a clinical trial.

The Government argues that rationing within the NHS is necessary to ensure that resources which could be spent elsewhere are not wasted and that patients receive only treatments which have real clinical benefits.

The new report show that while some PCTs spent more than nine per cent of their budget on cancer care, including drugs, some spent just 3.6 per cent.

The proportions ranged from 5.7 per cent to nearly 11 per cent for circulatory disease.

It also showed discrepancies in treatment for mental health problems. while some trusts spent 8.7 per cent of their budgets on treatments others spent 25 per cent.

Mr Dickson said: “This report raises questions rather providing answers.

“It does not mean that any one PCT’s spending is necessarily wrong but it does suggest that as well as unexplained variations in clinical practice, there are unexplained spending variations – some of these are almost certainly not justified.”

Norman Lamb, the Liberal Democrat health spokesman, said: “This analysis points to an unacceptable postcode lottery of care with Primary Care Trusts totally unaccountable to the communities they serve for these funding decisions.”

He added: “This report begs urgent questions as to what extent these extraordinary variations in spending are affecting patient care and leading to higher death rates. The Government must investigate whether the funding allocations are fair.”

The Tories have called for a system under which ministers would negotiate with drugs companies to bring down the cost of treatments which have proved effective, allowing them to be offered to greater numbers of patients.

David Stout, Director of the PCT Network, which represents most Primary Care Trusts in England, admitted that some of the differences could not be easily explained.

“While this may be due to inconsistencies in the data, it may reveal unacceptable variation in clinical practice or unexplained variation in investment,” he said.

“While this analysis does not in itself provide the answers, it will help local primary care trusts to continue to ask the right questions about how they can best manage their resources.”

Last month cancer charities and patients groups reacted angrily to a decision by the Government’s drugs watchdog, the National Institute for Health and Clinical Excellence (Nice), that four life prolonging kidney cancer medications, costing around £24,000 a year, were not “cost effective” on the NHS.

The organisation has previously faced controversy over its advice that Herceptin, a breast cancer drug, could only be used for advanced cases.

Only after patients groups launched a campaign and legal fight was the drug allowed for early stages of the disease.

Nice has also stoked outrage by refusing to allow an anti-dementia drug, Aricept, which costs around £2.50 a day, in the early stages if Alzheimer’s disease, meaning that thousands of patients have to wait for their condition to worsen before they can receive the drug.

The Government has ordered a review into whether to allow patients to buy their own drugs, under controversial “top ups”, without having to pay for the rest of their NHS care, as the current system demands.

From:
Healthcare-postcode-lottery-means-patients-losing-out-on-cancer-treatments.html

The move to scrap the charges on December 31 this year comes after a review of the car parking policies of NHS boards across Scotland.

A temporary cap of £3 a day on parking charges at hospitals has been in place since January.

The charges will remain at three of Scotland’s biggest hospitals which were built under the Private Finance Initiative (PFI) – Edinburgh Royal Infirmary, Glasgow Royal Infirmary, and Ninewells Hospital in Dundee.

The charges have been particularly unpopular with staff and visitors but some health boards argued that they need to apply them to deter commuters and others not visiting hospitals leaving their cars on site.

By removing the hospital parking charges, the Nationalist government has again demonstrated its populist touch, leaving its opponents with no option but to agree with the move.

However, the decision will irritate patients and staff south of the Border who will ask why English hospitals cannot do the same.

Scrapping the charges will cost Scottish health boards about £5.5million in lost income each year. The boards will get £1.4million from the Scottish government this financial year but will get no more cash. The £1.4million is roughly equivalent to the income lost in the final three months of this financial year once the charges are scrapped.

Nicola Sturgeon, the Scottish Health Secretary, said that it was “simply not fair” to expect patients or visitors to have to pay when they come to hospital. “Put bluntly, a car parking charge is often the last thing people need,” she added.

Ms Sturgeon said she was “determined” that the founding principles of the NHS should remain. “Chief among these is that the NHS should be free at the point of delivery and it is my firm belief that this would apply whether one comes to hospital as a patient, visitor or member of staff,” the health secretary added.

She said that the only exception to the initiative would be car parks in hospitals built through PFI where the cost of early termination would be “prohibitive”, because of the nature of the contracts. However, even in these hospital, she said that boards should work with contractors to limit and reduce charges until the contracts came to an end.

The 14 hospitals where charges will be scrapped are: Aberdeen Royal Infirmary; Dr Gray’s Hospital, Elgin; Gartnavel General Hospital and Gartnavel Royal Hospital; the Southern General Hospital, Stobhill Hospital, Victoria Infirmary, Western Infirmary and Yorkhill Hospital, all in Glasgow; Raigmore Hospital in Inverness; the Lauriston Building, Royal Hospital for Sick Children and the Western General Hospital, all in Edinburgh; St John’s Hospital in West Lothian, and Perth Royal Infirmary.

Before the charges are scrapped the five health boards which apply them will be asked to bring forward plans for meeting increased demand and promoting environmentally-friendly transport.

The move was welcome by the AA motoring organisation, which urged hospitals in England to do the same.

Edmund King, the AA President, said that the scrapping of car park charges at these 14 hospitals was “great news”, particularly for long-term sufferers and their families.

“For cancer sufferers undergoing chemotherapy on a day-patient basis the parking costs soon add up. Also, due to the risk of infection many such sufferers are unable to use public transport,” he added.

Unison, the NHS union, criticised the decision not to scrap charges at PFI hospital car parks. Cathy Miller, the Glasgow and Clyde branch secretary, said that Ms Sturgeon seemed unwilling to be bold enough to remove charges from these sites.

“This decision will create a two-tier system with staff and patients who are unlucky enough to be on a PFI site, such as Glasgow Royal Infirmary, being charged for the pleasure”, she added.

Organisations representing doctors and nurses welcomed the move. Charles Saunders, chairman of the BMA’s Scottish consultants committee, said that charging to park at hospitals was an indirect tax on healthcare.

“The founding principle of the NHS is that healthcare should be free at the point of delivery and we are pleased that the Scottish government has recognised the burden that these charges have put on patients and their relatives when they are at their most vulnerable,” he added.

From:
http://www.timesonline.co.uk/tol/news/uk/scotland/article4663759.ece

Health Direct wonders if Gordon Brown had any sense he would have rather done the same for England.

A majority of people in England would have benefited from this simple measure. Stamp duty holiday for houses under 175000 for a handful of people for a year is neither here nor there.
I wonder who advises him?

WE WISH to support the eminent professors of cancer medicine who have called for a review of the way rationing decisions are made in the NHS (Letters, last week ). The Nice (National Institute for Health and Clinical Excellence) ruling to effectively ban four cancer drugs in England confuses cost-effectiveness with affordability.

These medicines have become the gold standard in the US and are more cost-effective than motorway crash barriers or air bags in our cars. Yet would society deny them?

The NHS has a budget of approximately £100 billion. If Nice applied its criteria to other parts of the health service, it might decide that many of them were not cost-effective. There is much waste in the NHS that should be addressed.

For example, many of the drugs prescribed on the £8 billion primary care drugs bill are not taken by patients. Savings in unnecessary prescribing could free up resources for cancer and other high-cost drugs.

Professor Salman Rawaf Director of Public Health,
Wandsworth Teaching PCT Norman Evans Consultant in Pharmaceutical Public Health

From:
http://www.timesonline.co.uk/tol/comment/letters/article4641096.ece

Subjective evaluation

Andrew Dillon and Sir Michael Rawlings of Nice are being disingenuous when they call for cancer specialists to say which acutely ill patients should be sacrificed to free resources for cancer sufferers. I suffer from breast cancer and I have had a mastectomy.

Like others in my position, I was offered a reconstruction on the NHS (I declined). The immediate and follow-on costs of this procedure can exceed the costs of new cancer drugs. Perhaps Nice could explain the basis of its valuation of one female breast?

Penny Smith Horseheath, Cambridge

Funds wasted

The NHS, as suggested, now spends comparable amounts on healthcare to the UK’s European neighbours, but less than two-thirds of the amount on cancer drugs, so where is the money going?

As a cancer patient I offer one observation on the differences in cancer care in the UK and France, which may indicate just one area where money is wasted. In France there are fewer staff in those meaningless roles so beloved of the NHS; no sign here of nurses employed to bawl out patients’ names over the noise of a television no one wants to watch.

A French oncologist greets patients and escorts them to his consulting room. I also believe wages for medical staff in France, even allowing for a reduced cost of living, are correspondingly lower than in the UK.

Sara Tait Carcassonne, France

Where the money goes

Do other health systems give priority to lives at high risk rather than funding Viagra, fertility treatments and antismoking and antiobesity campaigns led by commercial companies? Are their health management costs lower, in that they don’t fund two Nice bodies, one for Scotland and one for the rest of the UK?

John Allison Maidenhead, Berkshire

Case for co-payments

Surely, the only practical form of rationing that bypasses the Nice committee is for the patient to pay at least a proportion of the drug costs. The precept of “treatment free at the point of delivery” has to be abandoned; then we move into the complicated area of mitigating the costs to those who can’t afford to pay. Is that what the professors want?

Dr Richard Godwin-Austen Southwell, Nottinghamshire

Costly victories

You quote £15m as the cost of an Olympic gold medal, while Nice estimates the cost of anticancer drugs at £30,000 per patient annually? At those rates, one medal equates to 500 years of life.

David Diprose Saundersfoot, Pembrokeshire

Twenty-six professors blame the severe restrictions imposed by the National Institute of Health and Clinical Excellence (Nice) on its failure to “get its sums right”.

Nice refuses, on grounds of cost, to recommend some drugs for patients with advanced kidney cancer. The consultants, who include the directors of oncology at Britain’s two biggest cancer hospitals, the Royal Marsden in London and Christie hospital in Manchester, claim there is enough money in the NHS to pay for the drugs.

Their letter to The Sunday Times states: “We now spend similar amounts to Europe on health generally and cancer care in particular, but less than two thirds of the European average on cancer drugs. It just can’t be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely.” They say: “The time has come for a radical change in how the NHS makes rationing decisions for cancer.”

This weekend Andrew Dillon, the chief executive of Nice, and Sir Michael Rawlins, the chairman, challenged the cancer experts to explain which acutely ill patients should be sacrificed to free resources for cancer sufferers.

They said: “There is a finite pot of money for the NHS, which is determined annually by parliament. If one group of patients is provided with cost-ineffective care, other groups – lacking powerful lobbyists – will be denied cost-effective care for miserable conditions like schizophrenia, Crohn’s disease or cystic fibrosis.”

This week patients from the Kidney Cancer Support Network will demonstrate outside the Nice offices in London against the refusal to fund the kidney cancer drugs Avastin, Sutent, Nexavar and Torisel.

Health Direct asks if National Insurance was brought in so that we could pay for our medicine . was NICE was brought in so there would be some money left in the kitty for “drinks at Christmas “?

The Department of Health said the predicted surplus, based on financial performance for the three months to June, would “stay within the NHS to improve patient care”, adding “this is an excellent start to the year”.

The results mark a significant turnround for the health service in the two years since it recorded a £547m deficit. Only five trusts were in operating deficit for the first quarter of this year, compared with 82 in 2006-07, officials said.

But opposition parties questioned the rationale of the NHS amassing cash at a time when access to drugs and treatments is still being rationed.

“There continue to be hospitals where funds are far from stable,” said Andrew Lansley, the shadow health secretary. “The government should explain why money voted in by parliament for healthcare is not being used to make sure patients get the medical treatments that they need.”

Norman Lamb, the Liberal Democrats’ health spokesman, told the FT that a massive NHS surplus was not “something that should necessarily be celebrated”.

“We seem to have gone from bust to boom,” Mr Lamb said. He warned that payment by results was leading to “distortions in the way NHS funding is being allocated”.

The government and Tories traded blows over how the £90bn-plus annual budget for the NHS should best be spent.

Mr Lansley criticised the decision by the NHS to use measures of deprivation, as well as age, to determine the health needs of different geographic areas. This approach was leading to relatively “greater resources for poorer areas and less for areas that are less deprived and more elderly despite age being a more significant determinant of the relative burden of disease”, Mr Lansley said in a speech to the Reform think-tank.

Labour responded by accusing the Tories of planning to “cut health spending in poorer areas”. The opposition party “would take funding from NHS services that need it most”. said Ann Keen, health minister.

But Mr Lansley hit back, telling the FT: “Public health money should be spent where health outcomes are worst, so that money will go to where the need is greatest. Do Labour really have a problem with that?”

The Lib Dems said a hybrid approach was needed, with public health funding – such as campaigns to tackle obesity and smoking – targeted on the most deprived areas, and funding for combating diseases linked to areas where the demand was highest.

From:
http://www.ft.com/cms/s/0/c3f920f2-747c-11dd-bc91-0000779fd18c.html?nclick_check=1

Bellingham, 60, who became famous for playing the homely matriarch from the Oxo television commercials, said that her mother had dementia for ten years before she died in 2004, but was not given the drugs she needed in time.

She said: “Mum was put on Aricept, one of the new drugs that health chiefs will only fund for some sufferers. It helped a little but for her it came too late.

“I think it’s outrageous that patients are being told they can’t have these drugs.”

Aricept, which improves memory and day to day life for Alzheimer’s suffers, costs about £2.50 a day. The NHS currently only gives it to people with severe forms of the disease, a small proportion of the 700,000 people in Britain with Alzheimer’s.

The Loose Women presenter who is to star in a theatre production of Calendar Girls, said that watching her mother’s mental deterioration was “heart-breaking”.

“Towards the end Mum often didn’t recognise us. Logically you understood but emotionally it was devastating,” she said.

The family even had to make the difficult decision not to tell their mother that her husband had died because they worried she would not remember.

It comes after Carol Thatcher revealed this weekend that Lady Thatcher forgets the death of her husband and has to be reminded.

Terry Pratchett, the author who was diagnosed with early-onset Alzheimer’s last year, has spoken out about the lack of funding the disease attracts and the poor availability of drugs.

He has said that the NHS was not “really set up to deal with” Alzheimer’s sufferers and expressed frustration that funding on research for a cure was three per cent of that for cancer.

Bellingham agreed that the disease attracts less attention than cancer because there “is no physical manifestation”.

She said: “We must act now to provide the care and support dementia patients and their families need.”

From:
Lynda-Bellingham-hits-out-over-Alzheimers-drugs-failure.html

Its role, in essence, is to ration healthcare by assessing the cost effectiveness of new treatments. The startling advances in drugs that can alleviate the symptoms of lethal diseases, particularly cancers, presents it with a particular dilemma, for these new drugs are frequently very expensive.

Nice has to balance the extent to which such drugs may extend a patient’s life, the quality of that life, and the cost of the drug to the National Health Service. This is not an easy or an enviable task.

Most clinicians would argue that such a body is necessary. The NHS has finite resources so rationing is unavoidable. It is also important that there is a uniform approach to treatments across the country – Nice was established in an attempt to end the unfairness of the postcode lottery in health provision.

Yet the institute has attracted criticism for the tardiness of its assessment process and, increasingly, for the quality of its decisions.

For example, its refusal in 2006 to sanction the use of Aricept to delay the onset of Alzheimer’s caused anger, not least because the cost was just £2.50 a day – a tiny price to pay to alleviate the distress of this disease.

More recently, Nice has been condemned for its refusal to authorise the use of four new drugs for kidney cancer which would cost tens of thousands of pounds a year but could prolong a patient’s life, albeit by a matter of months.

Against this background, yesterday’s announcement by Nice, formalising a U-turn on the funding of Lucentis to treat wet age-related macular degeneration, the most common cause of blindness in the elderly, is significant.

The move signals a new pragmatism in the way Nice works. In an agreement with the drugs maker Novartis, the institute has stipulated that the NHS will pay for the first 14 treatments and, if further injections are required, the company will pick up the bill.

Such flexibility is the way forward. In October, a Department of Health review is expected to overturn the spiteful rule that deprives a patient of any NHS care if he pays privately for drugs.

This clears the way to co-payment for drugs and will open the floodgates to a new revenue stream for healthcare.

Insurance companies are waiting to offer low-cost policies to top-up basic NHS care. That will leave Nice facing fewer life-and-death decisions because patients will be able to buy their own life-saving treatments without jeopardy.

It will also give patients greater choice as well as control over their own treatment – and that is long overdue.

From the Telegraph’s Editorial Opinion:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/08/27/dl2701.xml

In a decision that marks a climbdown for the National Institute for health and Clinical Excellence (NICE), the first 14 injections of the sight-saving drug Lucentis will be paid for by the NHS.

If the patient still needs further treatment then Novartis, the manufacturer, will pay for any additional doses.

The ruling overturns previous draft guidance that patients would have to go blind in one eye before receiving treatment with Lucentis, which costs more than £10,000 per eye, on the second.

It also paves the way for other new drugs for which top-up doses may be required to be funded in the same way in future.

Richard Barker, director general of the Association of British Pharmaceutical Industry suggested other medicines the NHS cannot afford to pay for in full could be provided through cost sharing schemes between the NHS and the drugs industry.

A similar approach has been suggested for kidney cancer drug Sutent, which costs £24,000 a year, and three other drugs after Nice issued draft guidance saying that they were not “cost effective” despite extending life by two months.

NICE has been severely criticised in recent months by health campaigners, who have accused them of condemning patients to “an early grave” by denying them the drugs.

It has also been at the centre of a previous controversy over its decision to deny the £2.50-a-day drug Aricept to victims of Alzheimer’s in the early stages of the disease.

Lucentis can stop the deterioration in sight caused by the condition wet age related macular degeneration (AMD), which affects about 250,000 people in the UK including 26,000 new cases each year. It can cause blindness within three months.

Up until now around 40 per cent of primary care trusts have refused to fund the drug while others have approved its use only in ‘exceptional cases’ although the drug was approved in Scotland last year.

Nice has taken over two and a half years to issue its final guidance on the drug in which time many thousands of people have already gone blind as a result of the condition. The drug has no effect on the condition once the patient has gone blind.

Andrew Dillon, NICE Chief Executive, said the decision would be justified by both the improved quality of life for patients and cost savings in the long run.

“Lucentis is an expensive drug, costing more than £10,000 for each eye treated,” he said. “But that cost needs to be balanced against the likely cost savings. AMD results in reduced quality of life and increased risks of illness, particularly in relation to accidents – especially falls – and psychological ill-health.

“Studies have also demonstrated that patients with visual impairment tend to have longer hospitalisations, make greater use of health and community care services and are more likely to be admitted to nursing homes.

From:
Eyesight-of-thousands-to-be-saved-after-Nice-approves-drug.html

Steve Winyard, Head of Campaigns at Royal National Institute for the Blind, said: “We’ve been waiting for this for over two years. It is a victory for thousands, bringing overwhelming relief to desperate people across the country. Finally the torment faced by elderly people forced to either spend their life savings on private treatment or go blind, is over.

“NICE’s guidance will finally bring an end to a cruel postcode lottery.”

Primary care trusts in England and Wales now have three months to fund the treatment for all eligible patients.

Lucentis is being provided through the country’s first dose capping scheme, which sees the NHS funding treatment only up to a given stage, in this case 14 injections.

The decision comes after Health Secretary Alan Johnson ordered an investigation into the policy of denying NHS services to patients in England who top up their care with private treatment.

Currently, anyone who pays for any private care can be barred from receiving the normal package of NHS care but the review will look at whether such co-payments should be allowed in future.

In July, RNIB also backed three pensioners in landmark High Court action against Warwickshire PCT for denying them treatment.

Tom Bremridge, chief executive of The Macular Disease Society said: “Those responsible for NICE should be aware that during the cumbersome two year review process 152 PCTs have individually had the power to decide whether to let patients go blind or to save their sight. The resulting stress and suffering has been cruel and unnecessary.

“Many hundreds of vulnerable patients have been subjected to an appalling emotional rollercoaster ride for the past two years – during which many of them have lost their remaining sight.”

Health direct points out that labour’s NHS cash constraints blocked the use of
over a year ago.

On June 14, 2007 Health Direct posted
Cruel watchdog NICE condems 20,000 to blindness

Twenty thousand people will be condemned to blindness each year following a “cruel” and “appalling” decision by the health watchdog NICE, campaigners said today. The National Institute for Health and Clinical Excellence (aka National Institute for Curbing Expenditure) has come under intense pressure to approve the drugs Lucentis (ranibizumab) and Macugen (pegaptanib) for use on the NHS.

The drugs treat wet age-related macular degeneration (AMD), which affects around a quarter of a million people. Wet AMD is the leading cause of sight loss in Britain, with 26,000 new cases each year.

The advice from the Expert Group on Commissioning NHS Infertility Provision, which was convened by health ministers this year, will put fresh pressure on the 95 per cent of primary care trusts (PCTs) that do not offer the three cycles of IVF recommended by the National Institute for Health and Clinical Excellence (NICE).

The panel proposes infertile couples should be offered wider and more consistent treatment on the NHS.

Its interim report comes as an NHS regional health authority has agreed for the first time to implement the NICE guidelines across all 14 of its trusts.

The decision by NHS East of England means infertile couples in Essex, Suffolk, Norfolk, Cambridgeshire, Hertfordshire and Bedfordshire will be entitled to three cycles of treatment from next April, provided they meet eligibility criteria.

Almost 45,000 cycles of IVF are performed in Britain each year – between one in six and one in seven couples are affected.

But limited NHS provision means the 75 per cent are conducted privately, at an average cost of £2,000 per cycle.

In 2004, NICE recommended PCTs should provide three cycles to women between 23 and 39, but a Department of Health survey in June found only 9 out of 151 PCTs in England met the standard.

The report says: “The provision of infertility treatment has not been seen as a traditional NHS service and, therefore, is often viewed as a relatively low priority compared to more visible conditions whose impact is well established.

“The group’s final report will seek to consider the often unseen consequences of infertility, including the impact on mental health and general wellbeing, which may draw on other NHS services for treatment, as well as the positive benefits of IVF.”

Health Minister Dawn Primarolo will now write to all PCTs to clarify NHS IVF cycles should include the replacement of frozen embryos as well as fresh ones, significantly improving some infertile couples’ chances of having a baby.

The group, made up of five NHS commissioning experts, will also recommend the NHS set a fixed price that PCTs would pay for IVF.

A spokesman for the Department of Health said: “It is appropriate for IVF to be considered carefully for inclusion on the national tariff.”

Mark Hamilton, chair of the British Fertility Society, said: “This is a positive development. Clinicians and practitioners involved in infertility services are all aware that we are not just dealing with physical pathology.

“Infertility is a disease, but it also has fallout beyond that for a significant proportion of couples, causing mental health problems, depression, stress-related illnesses and so on.”

He added of the East of England decision: “It is a tremendous step forward that a region has seen the value of doing this, and I would hope that others will do the same. But there is certainly a view in the sector that central funding would solve an awful lot of problems.”

From:
IVF-for-infertile-couples-should-be-NHS-priority.html

Inspectors will have powers to prosecute dirty hospitals and clinics, and impose sanctions ranging from fixed penalty fines to closure of wards, clinics or services.

The fresh measures are part of the Government’s drive to protect patients against superbugs, including MRSA and Clostridium difficile.

Public anxiety has been increased by incidents such as the 90 deaths attributed to C. difficile at Maidstone and Tunbridge Wells NHS Trust over two and half years. The deaths of a further 255 patients were judged to have been hastened by the bug.

Hospitals that fail to meet minimum hygiene standards will be issued with fixed penalty notices with fines of up to £4,000. Obstructing an inspector or failing to provide documents or information will attract fixed penalty fines of £1,250.

More serious offences, such as failure to act on an improvement notice following an outbreak of infection could lead to prosecution, carrying a maximum £50,000 fine.

The measures are contained in a document released by the Department of Health setting out proposed powers for the Care Quality Commission (CQC), the Government inspectorate that will replace the Healthcare Commission next year.

David Nicholson, chief executive of the NHS, says in a foreword to the document: “Patients keep telling us that contracting a healthcare-associated infection is one of their biggest concerns. It is crucial that we focus on bringing infection rates down even further and protecting patients, staff and visitors from the risk of infection.”

The CQC will have responsibility for overseeing all hospitals in England, both NHS and private, as well as care homes for the elderly, GP surgeries and private clinics. Under regulations to be introduced in April 2009, hospitals and clinics will have to register for an operating licence with the CQC, which will be conditional on meeting minimum standards on hygiene.

A survey published in June showed that one in four NHS trusts in England failed to meet minimum standards on hygiene for the second year running, potentially putting patients at risk.

The Healthcare Commission, which published the survey, said the findings showed that, despite huge political pressure, a minority of trusts had still failed to put the necessary measures in place. Sanctions were an inevitable next step, it said.

Anna Walker, chief executive of the commission, warned in June that NHS trusts had 10 months to get their act together. “This is a wake up call,” she said.

Britain has some of the worst problems with hospital infections in Europe, despite recent falls, and the issue has been at the top of the political agenda for the past three years. Polls show worries about bugs such as MRSA have overtaken concerns about hospital waiting times.

The hygiene code covers infection control, decontamination of equipment and the cleanliness of the hospital environment.

A Department of Health spokeswoman said: “This is a toughening up of the regulations around infection control.”

Jo Webber, of the NHS Confederation, representing NHS trusts, said: “NHS trusts are absolutely clear that they have a responsibility to maintain high standards of hygiene. Where there are problems they would hope that the CQC would work with them to resolve those difficulties. Fines should be a last resort.”

The proposals are out for consultation until October.

From:
nhs-trusts-face-fines-for-poor-hygiene-891487.html

Health Direct is appalled at labour’s complacency. Not only is this an admission that nothing will be done about cleanliness for months, but an obvious remedy is available- prosecute the paperpushers and staff responsible for the poor hygiene. Unfortunately, hundreds of people are going to die prematurely before labour stops it’s pathetic no blame culture.