More than 50,000 addicts on state handouts cite drugs as the reason they cannot work, costing the taxpayer tens of millions of pounds a year.

A study earlier this year estimated the average drug addict costs the country more than £800,000 over the course of their lifetime.

The lBOUR Government has also vowed to get tough on addicts and make them seek treatment if they want to continue receiving handouts.

But the latest figures, slipped out to MPs, show the problem is still growing.

Shadow Home Secretary, Dominic Grieve, said: “This is another example of how Labour has become broken under Britain. Labour are abandoning too many people to a life of misery on drugs.

“Another consequence is extra burden on the benefit bill at a time of economic hardship. We would expand abstinence-based rehabilitation so that we starting ending, not managing, addiction.”

Statistics from the Department for Work and Pensions showed that as of February 51,300 people were on incapacity benefit who had cited drug abuse as the main reason for not being able to work.

It is estimated they cost around £38 million a year but the true cost to the public purse will be much higher.

More than 40,000 of them are in receipt of incapacity benefit credits – where the Government effectively tops up the contribution to national insurance that they would have been paying if working.

The total is up almost 13 per cent on the 45,510 who were on incapacity for similar reasons in 2004 and the numbers have grown steadily each year.

In July, the Government announced plans to make heroin and crack cocaine addicts declare their problem and agree to treatment if they are to continue receiving benefits.

A study by PricewaterhouseCoopers, this year, commissioned by the Ministry of Justice, also estimated a drug addict costs the public £833,000 over their lifetime, including the burden on . health services, the criminal justice system, loss of earnings and productivity and the cost of putting any children into care.

In reply to the written parliamentary answer to the Conservatives, Employment Minister Tony McNulty said: “Drug dependency does not of itself confer entitlement to incapacity benefits.

“The medical assessment of incapacity for work is the Personal Capability Assessment. This assesses the effects of a person’s condition on their ability to carry out a number of everyday activities relevant to work.”

“A majority of people with a recorded diagnosis of drug dependency also have other diagnoses, for example mental illness, which results in their incapacity to work.”

From:
Drug-addicts-on-incapacity-benefit-up-12-per-cent-in-four-years.html

Jonathan Bamford, assistant information commissioner, said too many institutions failed to ensure that they had the electronic tools to limit the confidential details they held and prevent them being copied.

His comments come before the launch by the Information Commissioner’s Office of a report aimed at helping institutions improve public confidence in the ability of the public and private sectors to handle personal data.

Mr Bamford said in an interview that embarrassing data losses by government organisations were part of the price institutions were paying for bolting data security safeguards on as an afterthought rather than designing systems with them in mind.

He said: “It was obviously a bit of an accident waiting to happen. They are all things where people have messed up rather than acted in a malevolent way, which says a lot about what the safeguards were in the technology itself.”

Mr Bamford said organisations should invest more in so-called “privacy enhancing technologies” aimed at minimising the risk of losing sensitive data.

These include stopping information being downloaded on to memory sticks, barring the collection of unnecessary details and giving staff access to data on a need-to-know basis only.

Mr Bamford said: “We have seen the shortfall in the way organisations have approached personal information and have not really valued it.”

Public officials and corporate executives have come under intensifying pressure on data security as the Information Commissioner’s Office and other data watchdogs broadened their assault on bad practices highlighted by Revenue & Customs loss last year of details relating to 25m people.

Companies accounted for 80 of 277 data security breaches reported to the Information Commissioner’s Office during the year to October, ahead of 75 by the National Health Service and other healthcare providers, and 54 by local and central government.

Mr Bamford said private and public organisations should have done better, as data protection law was not “some new-fangled thing” but dated back almost a quarter of a century.

From:
http://www.ft.com/cms/s/0/8cdf8e00-bb47-11dd-bc6c-0000779fd18c.html?nclick_check=1

Unannounced visits to 51 big acute hospitals – around a third of the total in England – found just five following the hygiene code completely. One in five did not comply with all the requirements for safe decontamination of instruments. One in eight had inadequate isolation facilities.

Twenty-seven of the 51 were failing to keep all of their premises clean and well maintained. And in three cases the failings were bad enough for the Healthcare Commission to issue improvement notices with which, it said, the hospitals have complied.

The figures were attacked as shocking by opposition politicians. However, the inspectorate said that 97 per cent of the lapses “did not represent an immediate risk to the safety of patients”.

It added, however, that “almost all acute trusts have more work to do to get systems for infection prevention and control in place”. From April next year, they will have to comply with the code or risk fines, or even removal of their licence to operate.

Anna Walker, chief executive of the Healthcare Commission, said it was clear despite the findings that trusts were making progress on infection control. With three exceptions, the breaches of the code found were not “the most serious kind” although they showed there was still work to do.

From:
http://www.ft.com/cms/s/0/da8cc266-b9c7-11dd-99dc-0000779fd18c.html?nclick_check=1

One PCT has already refunded more than £23,000 to two patients who paid for care that was later deemed to be the responsibility of the NHS.

Another faces a demand for nearly £60,000 from a patient who initially funded his own treatment with Cetuximab before being accepted by the NHS as an exceptional case. The patient’s lawyer told HSJ that if the PCT did not pay up, their fight would go to court, where they hoped to set case law.

PCT network director David Stout warned that in the absence of clear guidance on how to handle retrospective claims, PCTs were likely to come under pressure to follow precedents set by others.

Worcestershire PCT agreed to “compensate” two patients for the cost of NHS care they were forced to pay for while receiving Avastin for bowel cancer. Barbara Moss was awarded £13,658 of her £21,000 treatment bill and Clifford Shore got £10,000 of his £16,000 costs.

A PCT spokeswoman said the PCT had taken legal advice. “We don’t believe this will set a precedent across the country; it will be up to individual PCTs to look at cases individually, as we did,” she said.

Patient Michael Porter is challenging East and North Hertfordshire PCT to refund £55,900 that he used to pay for Cetuximab. His claim rests on the fact he responded well to the drug and was subsequently accepted as an exceptional case by the PCT.

Swaffields Solicitors principal Simon Swaffield, representing Mr Porter, said: “It’s not satisfactory from a health service point of view to just muddle along and if you make enough noise, you might get some money.

“The reality is we’ve taken Michael’s case forward on this footing, very much with a mind to establish liability.”

Mr Stout said PCTs were expected to make judgements on whether to reimburse or not “without any real framework within which to work”.

“If some PCTs start [reimbursing], I’m sure that ratchets up the pressure on other PCTs to do the same,” he said.

He also said that where a patient had secured exceptional case funding on the basis they had proved a drug’s efficacy by self-funding initial courses of treatment, this breached the principles of the Richards review of co-payments because it created inequity.

From:
threat_of_retrospective_topup_pay_outs_looms_for_pcts

NHS Connecting for Health (NHS CFH) is conducting a consultation on the wider use of patient information (see http://tinyurl.com/6l2goc). Details of the consultation are at
http://www.connectingforhealth.nhs.uk/systemsandservices/research/consultation

The consultation relates to the so called “Secondary Uses Service (SUS)” whereby every time you attend a hospital appointment your post code, date of birth, GP details, consultant details, outpatient clinic, inpatient admission, procedure, cost and whether you are to be followed
up is all sent by the hospital to BT.

All these details will be stored at the regional hosting centre and can be accessed by your local Primary Care Trust, Strategic Health Authority and the Department of Health via the SUS database that BT now manage- as well as labour ministers who have given themselves the power to snoop on us. Medical researchers are also allowed access to all this personal and clinical information.

Connecting for Health claims that most data in the SUS will be anonymised but a document obtained from the Department of Health under the Freedom of Information Act by Professor Ross Anderson of Cambridge University shows that they will not be anonymising this medical data. The letter can be downloaded from
http://www.cl.cam.ac.uk/~rja14/Papers/SUS-governance.pdf

The NHS confidentiality group has already produced an opt out letter to allow patients to opt out of the upload of Summary Care Records to the NHS ‘spine’ (the central database that will be used to store electronic patient records) and they are now working on an opt out from the Secondary Uses Service.

The quick and easy to use letter template can be found at: http://www.thebigoptout.com/optoutletter

With the ‘spine’ effectively stalled this is one of the few consultations where sheer volume of negative response may have some effect – so please do help us send a message to the government that our medical records are private and should remain so.

Responses should be sent to Chrissy Brand (FREEPOST RRXB-TTRR-HJGB,
Tribal Consulting, Palatine Road, Manchester, M22 4DB) by 10th December.

The King’s Fund is urging the Department of Health to use the “reinvigoration” of practice based commissioning announced in the next stage review to set out a “clear vision” for the initiative.

Primary care trusts should retain responsibility for strategic commissioning but with clinician involvement. High performing practice based commissioners should be rewarded with increased independence but should not become responsible for the entire healthcare budget.

Individual responsibility

Report author and senior fellow Nick Goodwin said it was essential that the government told people “exactly what the roles and responsibilities of individual parties are”.

The report said even though GPs had received nearly £100m in incentive payments, few were commissioning new services, instead focusing on changing service provision.

From:
practicebased_commissioning_an_expensive_failure_kings_fund.html

The plan is part of a package agreed by the labour government and the pharmaceutical industry yesterday that aims to reward drugs innovation in exchange for cuts in the price the NHS pays for drugs.

The pharmaceutical price regulation scheme will lead to a 5 per cent reduction in the overall medicines bill over the next five years, starting with a 3.9 per cent cut in February.

But the labour government has pledged to sweeten the scheme with measures to link the price of medicines more closely to the value that they provide.

Companies will for the first time be able to raise prices on medicines already launched if clinical data show they provide a greater benefit than originally believed. Any such increases will be exempt from the overall 5 per cent price cut.

Richard Barker, director general of the Association of the British Pharmaceutical Industry, the trade body, said: “This landmark deal marks a turning point for patients, the NHS and the pharmaceutical industry.”

A new process will also be introduced to streamline, accelerate and make systematic the process of renegotiating pricing for medicines initially rejected as not cost effective by the National Institute for Curbing Expenditure (NICE), the medicines advisory body.

This will help the government’s attempts to limit the number of expensive new drugs that patients have to pay for because the NHS refuses to fund them.

The Department of Health, in consultation with Nice, has already approved a handful of such “risk-sharing” schemes, whereby drug companies reduce the NHS bill through discounts, free products or reimbursement for patients for whom the medicines do not work.

Incentive payments to doctors- which already exist to stimulate testing for certain diseases and encourage generic prescriptions – could prove controversial, and may also need to be supplemented by additional funding to primary care trusts.

From:
http://www.ft.com/cms/s/0/d38e92b2-b6a4-11dd-89dd-0000779fd18c.html

A total of £947 million has been spent on compensation relating directly to obstetrics, reflecting the increasing cost of lifetime care for children who have suffered brain damage, cerebral palsy or developmental delay.

The scale of the cost — enough to hire thousands of consultants or midwives — reveals the growing burden of claims on the health service at a time when maternity wards are short-staffed and the birthrate is rising.

Medical colleges say the chances of harm to mother or baby are lower than ever, but they remain concerned that shortages of consultants and midwives leave patients at risk.

Taking into account a backlog of cases from the 1990s, the cost of maternity-related claims has risen from £163million in 2003-04 to £288 million in 2007-08.

The figures, revealed by the NHS Litigation Authority in answers to parliamentary questions by Harry Cohen, the Labour MP for Leyton & Wanstead, reflect the cost of settled claims awarded under the Clinical Negligence Scheme for Trusts.

But this does not include cases that preceded the authority’s creation in 1995, some of which have arisen from health problems diagnosed years after birth.

Medical colleges said that the total bill for litigation put the £330 million pledged by the labour Government to improve maternity services into sharp relief.

As The Times reported in September, trusts have had trouble identifying specific funding promised over three years to help to implement a policy document, Maternity Matters, that promised all women dedicated care from a midwife by the end of next year.

Louise Silverton, the deputy general secretary of the Royal College of Midwives, said that the cost of claims “underlines what a false economy it is to cut back on maternity care”.

“Women keep hearing about these excellent government policy statements such as one-to-one care in labour from a midwife,” she said, “but they are not getting that sort of treatment in many areas such as the East of England, the South West and London.

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.”

Overall NHS spending on maternity in England was cut by £55 million in 2006-07, while the birthrate has risen by 16 per cent — equivalent to 90,000 extra births — since 2001, Ms Silverton added.

Tristian Blomfield, 8, from Watford, Hertfordshire, received a compensation package of just over £8.26 million after suffering permanent brain damage at birth. He has cerebral palsy in all four limbs and requires constant care.

West Hertfordshire Hospitals NHS Trust, which manages Watford General Hospital where Tristian was born, offered his family an unreserved apology and expressed hope that the agreed settlement would provide them with security for the future.

Sabaratnam Arulkumaran, the president of the Royal College of Obstetricians and Gynaecologists, said that only one in every 6,000 births resulted in a litigation claim. But at that rate trusts had to set aside £500 for each birth as a form of insurance, he added.

“In a busy maternity unit of 5,000 births or more, we believe there needs to be 24-hour consultant cover to deal with emergencies and prevent disasters better. Rather than have more negligence cases and pay out on more claims, we should spend on more consultants, better training and reduce the number of cases,” he said.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article5168353.ece

The UK Organ Donation Task Force said that moving to a system where people are presumed to give consent to their organs being used for transplant risked damaging the “vital relationship of trust” between doctors and patients at the end of life.

It admitted that the arguments for and against an “opt-out” system were “finely balanced”.

But it concluded that a “presumed consent” system would be complex and costly and would require a secure IT system – at a time when public trust over the security of labour government held data has diminished.

However, Gordon Brown, the prime minister, said he was “not ruling out a further change in the law”.

From:
http://www.ft.com/cms/s/0/08e63c6a-b512-11dd-b780-0000779fd18c.html

Health Direct’s view of the the UK Organ Donation Task Force’s report is that they are barking.

Commonsence predicts that if over half of the population wants organ donation to be an opt out process then far more organs will become available for transplants in the future when a mandatory transplant system is introduced.

To additionally use the excuse of the £12 billion NPfIT white elephant as an example of data insecurity is a damming indictment of the Department of Health’s incompetence- who fund this quango.

Levels of public trust are much higher for doctors than labour politicians and nhs bureaucrats. Trying to shift the blame onto medical professionals is plainly incredulous.

Even ditherer Brown ought to realise that there are financial savings to had from more transplants in reducing NHS costs and greater economic benefit from sufferers returning to work.

The weakening of sterling against the euro has reduced British drug prices, compared with levels in other countries. That has fuelled a surge in the legal “grey market” practice of exporting drugs from the UK to more expensive medicine markets elsewhere in Europe – so-called parallel trade.

Supplies could tighten further from January 1, when the labour government’s Pharmaceutical Price Regulation Scheme comes into force, imposing a 5 per cent price cut on prescription medicines bought by the National Health Service.

Andrew Hotchkiss, managing director of the UK operations of Eli Lilly, the US-based pharmaceutical company, warned of a “triple whammy” creating supply shortages, with the falling pound, price cuts and both fewer imports and more exports all creating uncertainties that could mean medicines are not available in pharmacies.

“We’re worried about patient access,” he told the Financial Times.

Britain has traditionally been an importer of medicines via parallel trade.

Wholesalers and many individual pharmacies have licences that allow them legitimately to export medicines from the UK to other countries where they fetch higher prices. Concerns are growing that this may increasingly squeeze supplies to British patients.

Martin Sawer, spokesman for the British Association of Pharmaceutical Wholesalers, whose members distribute medicines from drug companies to pharmacies, said he agreed that there were risks of supply shortages, especially since medicine stocks were likely to run low over the Christmas holidays.

The situation risked being worse than at any time in the past because the introduction of computerised stock control meant pharmacies often held smaller volumes of supplies.

Groups of pharmacies may deliberately order more medicine than they require, selling the remainder at a profit – a practice known as skimming. Prices in other northern European countries are about 10 per cent or more higher than in the UK.

Paul Johnson, UK managing director of IMS Health, the data consultancy, agreed that the UK’s share of parallel trade across Europe, traditionally about 30 per cent, had been shrinking since the spring – with faster growth in other higher priced markets. “The UK still has significant parallel imports but they have reduced dramatically in the last few months. And a whole range of products are now being exported. This is a perfect storm.”

He estimated that parallel trade accounted for nearly 10 per cent of Europe’s total prescription medicine sales and involved purchases from low-cost countries led by Greece, Spain and Portugal, with re-sale into the UK, Germany, Benelux and the Nordic region, where parallel imports accounted for nearly €5bn (£4.2bn) a year.

From:
http://www.ft.com/cms/s/0/82357bc2-b511-11dd-b780-0000779fd18c.html?nclick_check=1

The Euro Health Consumer Index 2008 puts the Netherlands in first place, with the UK trailing behind countries including Estonia, France and Germany.

The study looked at areas such as patient rights and information, IT, waiting times, outcomes, the range and reach of services and access to new drugs.

The report’s authors found the UK performed well on patients’ rights and information, but unlike Denmark and the Netherlands there had not been improvement across the board.

Euro Health Consumer Index director Dr Arne Bjornberg said the UK risks “raising expectations that the healthcare system cannot deliver”.

From:
european_healthcare_rankings

The Department of Health feels it needs to be able to call on NHS Direct as an emergency hotline in the event of a terrorist attack or other national incident.

NHS Direct was used as the national hotline for people worried about radiation contamination following the poisoning of former KGB agent Alexander Litvinenko in London in November 2006.

A statement from NHS Direct said: “It has become clear that the organisation’s role, particularly around major incidents, is of strategic national importance. This has led to the Department of Health agreeing with NHS Direct that the traditional model of foundation trust may not be the most appropriate at the moment, given that one of the organisation’s strengths is its national operating model.”

NHS Direct is also seen as a prime contender to run the three digit non emergency phone number recommended by health minister Lord Darzi to direct people to appropriate services.

Around 16,000 people have signed up as “members” of NHS Direct in anticipation of it gaining foundation trust status.

NHS Direct chief executive Matt Tee told HSJ: “I’m slightly disappointed. The Department of Health has said that the arm’s length aspect of foundation status will not work because we are nationally important. We wanted to be a foundation trust as a kind of ‘badge’ that shows that we are a high-performing organisation, but there is the chance that we can get certain freedoms without needing to have foundation status.”

The labour government has previously said that psychiatric hospitals at Rampton, Ashworth and Broadmoor will also not be granted foundation status. Ministers want to hold sway over decisions relating to high-profile criminals.

A DH spokesman said: “NHS Direct, as recognised recently by the Healthcare Commission, provides a popular and important service to patients, undertaking millions of consultations each year. It will have a key part to play in supporting implementation of the next stage review.”

From:
nhs_direct_shelves_foundation_trust_plans

Linda O’Boyle is now dead, but she became the focus of the media campaign that forced the labour Government to change its mind. Her life was prolonged by the use of the anti-cancer drug Cetuximab.

She paid for it because the NHS would not do so. She was denied NHS care as a consequence, and had to pay another £11,000 to private hospitals for chemotherapy and nursing.

Mrs O’Boyle was one of many suffering from terminal illness who have gone through the same ordeal.

Nevertheless, there are plenty of people who continue to insist that, if the NHS cannot afford to pay for a particular drug, it is better that patients who need it die faster without it, and for them to be refused all NHS care should they pay to obtain it for themselves. Why would anyone adopt that cruel and irrational position?

No one is harmed when a patient like Mrs O’Boyle buys a drug which her doctors have recommended but the NHS will not fund. But there is a very obvious benefit to the patient. A policy which generates benefits without causing harm is obviously better than one which just causes harm. The choice between those two is a no-brainer.

Health Direct does not want to accuse those who advocate the policy of denying NHS treatment to patients who buy their drugs of having no brains. It is probably better to call them deluded. The villain is a misunderstanding of the ideal of equality: if everyone cannot have a benefit, it is better that no one should have it.

This implies that there should be no medical care at all if it is impossible to achieve the outcome in which that care is exactly the same for everyone. But that result cannot possibly be achieved, not least because doctors vary in their levels of competence and skill.

Those treated by the better doctors receive a higher standard of medical care than those treated by the less able and experienced. No egalitarian is so deluded as to believe that this means we should dismantle the NHS and make access to any kind of medical care illegal.

But that’s the logical consequence of their doctrine that the most important value is not to provide medical care, but to ensure exact equality of outcomes for everyone.

The “harm” that the egalitarians claim is caused by allowing patients both to purchase drugs and to receive NHS care is, in reality, no harm at all. Someone who does not receive the best care possible from the very best doctors in the world is not harmed by the fact that there are people who do.

Professor Mike Richards, who wrote the report which led to the labour Government changing its policy, ties himself up in knots in an effort to both accept and reject that truth. He ends up recommending a compromise: patients who pay for drugs should not be denied NHS care, but they should not be treated in NHS hospitals. They should pay for any tests, scans and treatments to deal with complications arising from the additional drugs they pay for themselves.

The compromise will soon become untenable: differentiating between the tests and treatments that are made necessary because of the extra drugs, and those that are not, is often impossible. And what will happen if a patient is admitted into intensive care when they are due another dose of the drugs they pay for?

Will those drugs be administered in the NHS ward or not? Assessing such matters on a “case by case basis”, as the Government proposes to do, is a recipe for precisely the outcome the Government says it wishes to avoid: patients being treated in wildly different ways, depending on the whim of the administrator who makes the decision.

The idea that medical care should be distributed according to need, and not on ability to pay for it, has one problem: doctors and nurses do not work for free, and drug companies do not give away drugs for nothing.

In 2003, the Wanless report on the funding of the NHS predicted that total NHS spending would rise from £68 billion to £154 billion in 2022. More recent estimates suggest that spending will increase to £184 billion. Such a huge sum won’t come from general taxation: voters are not willing to pay taxes at the level necessary.

It means that “co-payments” – contributions from individual patients towards the cost of their own care – will inevitably have to increase.

Misguided egalitarians will try to prevent it. But they will only be able to do so by denying people medical care, and by going straight back to the situation in which someone like Linda O’Brien is pushed out of an NHS hospital because she makes a contribution to the cost of the drugs she needs. Is that the outcome they want?

From:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/11/09/do0903.xml

The study of 17,800 men and women with normal cholesterol levels found rosuvastatin cut deaths from heart attacks and strokes.

Currently statins are offered to people with a moderate to high risk of a cardiovascular “event”.

The results are published in the New England Journal of Medicine.

The patients in the trial, funded by AstraZeneca, had cholesterol levels below those usually indicating a need for treatment and had no other signs of heart disease.

But they did have increased levels of a C-reactive protein, which indicates inflammation in the body and is believed to be a marker of future cardiovascular events.

After an average follow-up of two years, 20mg a day of rosuvastatin was found to have cut cholesterol by 50% and C-reactive protein by 37%.

Overall, the chance of a heart attack, stroke, hospital admission for chest pain or death from cardiovascular disease was cut by 44%, researchers said.

A reduction was even seen in those with the lowest chance of a cardiovascular event over the next decade, they said.

Researchers found a higher incidence of physician-reported diabetes in the statin group but could not explain it as blood glucose levels were similar between those taking rosuvastatin and those taking a dummy pill.

Guidelines

Statins are already prescribed to millions of adults in the UK.

The UK’s National Institute of Curbing Expenditure (NICE) recommends doctors carry out a risk calculation based on an individual’s blood pressure, cholesterol, weight and other risk factors, such as whether or not they smoke.

Those with a 20% risk of a heart attack or stroke in the next 10 years should be prescribed a daily dose of simvastatin – the cheapest of the statin class.

Dr Terry McCormack, a GP in Whitby, North Yorkshire, and ex-chairman of the Primary Care Cardiovascular Society, said the results were “astonishing” and much stronger than he would have expected.

He added that NICE should redo their cost-effectiveness calculation on the basis of the latest figures.

“These are people who have an intermediate risk and you wouldn’t normally prescribe statins for them in the UK,” he said.

“It opens up a whole new debate and the trial probably raises more questions than it answers.”

Professor Peter Sever, an expert in clinical pharmacology at Imperial College in London, said the results backed other studies which had shown statins had the same proportional benefit however low an individual’s cholesterol.

But he added: “The thing to remember is that the 20% threshold is arbitrary – it is essentially based on economic issues.

“Most nations have a finite pot and if you’re going to treat everyone with a 10% risk, that’s billions of pounds extra and somewhere along the line someone else is going to miss out.”

Dr Alan McDougall, from AstraZeneca, said there was “no question” the trial would raise some important issues about statin use but that they would recommend doctors still follow existing guidance.

The killer quango NICE is due to consult on plans to review their statin guidance shortly.

From:
http://news.bbc.co.uk/1/hi/health/7715707.stm

On the face of it and from a moral perspective, a decision to allow “top-up” payments for cancer drugs seems the correct course of action to take to curb postcode lotteries for funding cancer drugs. However, this must be seen in the wider context of the future of the NHS and the fundamental principles of “universality” of care.

“Top-up” payments will open the door to the insurance industry and private providers to deliver these treatments. This will become the norm for many new treatments, not only cancer drugs, and will lead to a system of “managed care” much like that in the US where it is the insurers and not doctors who decide who gets treated, where they get treated, how they get treated, who gives the treatment and how much it costs.

The universality of care provided by the NHS has already been eroded (eg, loss of the majority of NHS dentistry and eyecare) and this is the last nail in the coffin. The real tragedy lies in the fact that we should not even be having this debate.

The total NHS drug spend on cancer drugs in England is approximately £1 billlion per year, but, in the British Medical Journal last week, the chief economist of the King’s Fund, Professor John Appleby, stated that the NHS in England is projecting an underspend of £1.7 billion and foundation trusts are reporting cash balances of £2.5 billion.

Furthermore, it is painfully ironic that the huge cost of introducing a market based system to the NHS has actually helped to spark a debate that will lead to further privatisation and fragmentation.

From:
http://www.timesonline.co.uk/tol/comment/letters/article5091892.ece

Health Direct notes that one of the factors behind the current controversy about “top-up” drugs is the absence of any explicit recognition that vital moral issues are involved.

If an old person is trapped under a collapsed building late at night, people do not say: “She has not got long to live anyway, let’s leave it till the morning; it will cost a bomb if we get the cranes and crews out at this time of night.” They are more likely to say: “She is pretty frail; we had better pull out all the stops, and get cracking as soon as possible.”

The weakness of the NICE approach is to assume that life and death decisions about whether the NHS should buy new drugs can be based solely on an economic model. Common humanity comes into it too: even if it may involve paying higher taxes.

This is a crude form of blackmail by the state provider that may have been understandable 60 years ago when the NHS was finding its feet but has no place in a modern healthcare system. It is to the credit of Alan Johnson, the Health Secretary, that he has finally acted to remove this barrier to patient choice.

Allowing a co-payment system to develop in healthcare is, however, more than just a humane decision that will allow seriously ill people to purchase life-saving drugs that may be too expensive for the NHS to prescribe. It is also a fundamental step towards diversifying healthcare in a way that will allow a better-funded and more patient-friendly system.

Health insurance companies will now start marketing policies for top-up payments only, as a supplement – not an alternative – to NHS provision, an attractive option to people who cannot afford full private health insurance.

That will help remove the barrier between state and private provision that has proved so restrictive, while opening up new revenue streams. A hybrid, public/private system could then emerge, without sacrificing the cardinal NHS principle that treatment remains free at the point of delivery to all who need it.

From:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/11/05/dl0502.xml

Health Direct points out that there is now a three tier NHS service. The top level is private health insurance for NHS services. The middle tier is part payment for drugs and services. With the base rate being access for patients only if whitehall edicts allow doctors to prescribe certain life saving drugs.

Top-up insurance is still essentially a means test – and works contrary to the concept of universal access on equal terms to the NHS at all points of contact.

There is no reward here for those who already self-provide, nor any consideration of what those seeking to claim contribute to our taxes, or to the costs of the NHS.

This is a bit like thanking the person, who has decided to refrain from beating you over the head with a baseball bat.

The magic formula, top up insurance- is routine in France. The plan does not call for genius; rather, its absence calls for rebuke.

I have just one question about this, Alan Johnson is claiming credit for changing this particular rule, but which minister was it who allowed the rule to be set in the first place- Health Direct suspects the bean counter Patricia Hewitt?

The NHS in England is currently forecasting it will have a £1.7bn surplus this year and Foundation Trusts, which are not under the direct control of Whitehall, have £2.5bn in the bank.

Prof John Appleby, chief economist at think tank, the King’s Fund, has analysed the effect the financial crisis will have on the health service in the short, medium and long term, in the British Medical Journal.

He warns that the Treasury has a ‘track record’ of clawing back surplus funds from the NHS.

He wrote: “Although the prime minister pledged not to cut spending for health as set out in the 2007 comprehensive spending review, taking back unspent money may not be seen as a cut.”

Prof Appleby said in the short-term the effects on the health service have been minimal, although Virgin Healthcare announced in September that it would not be bidding to run GP-led health centres yet, and several charities and NHS trusts have money on deposit with failed banks in Iceland.

In the medium term, spending on health is supposedly fixed until 2011 so while an outright cut in labour Government funding is unlikely, the NHS budget is being eroded by high inflation.

It is thought that inflation may have peaked but inflation in the NHS runs a little higher than the general economy and every one per cent increase costs the NHS £380m, Prof Appleby wrote.

The real danger for the NHS is in the long term because, with labour Government borrowing rising, and income from taxes likely to fall during a recession, there will be less available to keep up the growth in health funding.

Prof Appleby warned that there may be no real growth in funding until 2014, in contrast to the large real terms increases enjoyed under Labour so far.

The financial situation is also likely to increase demand for health services, so the NHS will be squeezed from both sides, he said.

Prof Appleby wrote: “But not only will there be pressures on NHS funding, the combined effect of the credit crunch and recession on the population’s health and wellbeing will increase ill health and demand on healthcare services.

“The link between deprivation, income, housing, unemployment, and healthcare needs is well documented.”

A Department of Health spokesman said: “While the current financial position is settled for this spending review period, good financial planning means that the NHS needs to plan on a longer-term basis and this means looking to at least a five-year timeframe.

From:
Treasury-could-snatch-3bn-from-NHS-budget-academic-warns.html

The Commons Health Select Committee heard evidence from experts in its first evidence session on its investigation into patient safety.

The NPSA runs a system where all NHS staff can report incidents or near misses so patterns can be spotted and the wider health community warned.

Incidents can include drugs administered in the wrong way or the wrong dose, medicines mixed up, the wrong operation carried out, a patient wrongly identified and broken or malfunctioning equipment.

Howard Stoate, a practising GP and Labour MP for Dartford, said the National Patient Safety Agency’s own estimates suggest there are 72,000 preventable deaths in the NHS each year.

However, the incident recording database had collected just 3,200 reports of patient deaths, in 2007/8. He said: “That is not just under-reporting, that is an extraordinary figure.

“If the public realised that only between five and ten per cent of preventable deaths are being reported they would have something to say about that.

“For example if only ten per cent of airline crashes were reported we’d have some concerns about that.”

NPSA chief executive Martin Fletcher replied that while there were ‘issues’ around under reporting, reporting rates were continually improving.

Sir Bruce Keogh, medical director of the NHS, said no-one was ‘comfortable’ with under reporting but he said people could not be ‘forced’ to report incidents.

He said it was the staff member’s personal, moral and professional duty to report incidents.

In 2004 the NPSA produced a report that said one in ten patients admitted to hospitals will suffer a patient safety incident – almost one million people in 2002/3 – and up to half of these could have been prevented. It added that 72,000 of these incidents may have contributed to the death of the patient.

Dr Richard Taylor, Independent MP for Wyre Forest, said the Committee was ‘absolutely appalled’ that one in ten patients will suffer an incident and said this was the reason they were conducting an investigation. It was ‘utterly unacceptable’, he said, and asked about the financial cost to the NHS of patient safety incidents.

Sir Bruce said that litigation costs were around £600m a year while Christine Beasley, chief nursing officer, said hospital associated infections such as MRSA cost the health service around £1bn a year because of the extra days infected patients have to stay in hospital.

Mr Taylor added that there were 25,000 deaths annually from blood clots after stays in hospital which can be prevented with drugs and this cost the health service around £640m.

He said: “The costs are astronomical and here we are trying to find enough money for Nice (the National Institute for Curbing Expenditure) to afford certain treatments.”

Evidence submitted by the Department of Health to the Committee showed there were 796,106 incidents reported to the NPSA in 2007/8 and the majority resulted in no harm to patients. However there were 48,951 incidents where the patient suffered moderate harm, 7,101 severe harm and 3,282 deaths.

The Government’s chief medical officer Sir Liam Donaldson has called for the NHS to learn from industries such as aviation where safety and reporting incidents or near-misses is embedded in the culture.

A list of ‘never-events’ is being drawn up by experts including operating on the wrong patient, or carrying out the wrong operation, which hospital trusts will not be paid for.

From:
Nine-out-of-ten-preventable-deaths-in-the-NHS-are-not-reported.html

Firm delivery dates for the long delayed first deployments of Lorenzo, the key software for the records, were being promised for the north of England.

BT, which was responsible for London, had successfully installed new systems in a string of mental health and community trusts, and it had a programme for their much more difficult installation in the big hospitals in the capital. While there would be problems ahead, BT said, “we feel we have cracked the nut”.

Fujitsu was still negotiating a “refresh” of its contract, covering the whole of the south of England.

And a few parts of the programme were complete – the installation of digital imaging in place of X-ray film in every hospital in England, for example. Others were making progress.

The National Audit Office reported in May that the £12.7bn project for the full electronic record was running at least four years late. But it remained broadly on budget and, while difficult, still appeared “feasible”, the NAO said.

Since then, however, the project has virtually ground to a halt. There are continuing difficulties with new systems installed in the big hospitals and no deployments planned for the next few months.

Furthermore, while the health department has agreed in principle that NHS hospitals should be given more freedom to customise their systems, there are few details of the extent to which that will be permitted. A new permanent leader for the programme has only just been installed, following the departure of Richard Granger in January.

Matthew Swindells, who until May was the department’s interim chief information officer, says there is “clearly a hiatus”. But it is unclear, he said “whether that is because there is a genuine problem, or because of the shift in leadership means there is nobody pushing it at the moment”.

For long-standing critics of the programme such as Richard Bacon, the South Norfolk MP who has tracked its progress as a member of the Commons Public Accounts Committee, it is clearly now “time to go back to the drawing board”.

The programme’s centralised approach “has been a catastrophe”, he says. But because suppliers are only paid when systems work, “there is still a relatively big pot of money that has not been spent”.

This should be given to local hospitals to enable them to buy the system of their choice, Mr Bacon said. “If there is to be a chance of getting this back on track there has to be 100 per cent local ownership of the programme,” he said.

Jon Hoeksma, editor of E-Health Insider, a website that has tracked the programme from its inception, said: “Something has to give. The programme can’t just keep saying: ‘Give us another three months, give us another three months’.”

http://www.ft.com/cms/s/0/39bb218e-a46e-11dd-8104-000077b07658.html

During this period of labour’s mismanagement of the National Health Service- Health Direct has found billions of taxpayers Pounds wasted, tens of thousands of preventable deaths and thousands of NHS staff sacked because of underfunding.

MRSA and Clostridium difficile superbugs are still killing more people than die from UK road accidents.

PFI and other off balance sheet financing that runs onto billions of Pounds- with restrictive clauses which even prevent local politicians from cutting hospital car parking charges.

The wheels are coming off the world’s most expensive health IT system. Which is so blinkered and rigid that the new polyclinics will not be able to use it- if it ever works properly. Even Google have overtaken the NHS in providing an online health records system- though how secure their system will prove to be is as open to question as labour’s pathetic data privacy track record.

And we have the prospect of nearly another three years of labour’s dithering, stalinist, incompetent direction.