The NHS may not be able to give women a single dedicated midwife during pregnancy and labour, as promised by ministers.

Figures show that 583 midwife posts in NHS hospitals are vacant and 276 maternity support worker jobs are unfilled.

Barking, Havering and Redbridge Hospitals NHS Trust has the higest vacancy rate, 39 per cent. If its 76 full time midwife positions, 29 posts need to be filled.

One in five maternity units (22 per cent) across the country have cut midwife numbers in the past year and some have reported that their maternity unit has been cut in half. Heart of England NHS Foundation Trust has 101 full time midwives last year but this year has 47 which is a 54 per cent drop.

The figures were obtained using the Freedom of Information Act by the Conservatives.

This week, Professor Cathy Warwick, general secretary of the Royal College of Midwives, said tens of millions of pounds that were meant to increase the number of midwives have not been received by hospitals.

“On the very busy labour wards that are struggling to cope with the rising birth rate, midwives are having to look after sometimes two or three women in labour and that’s when the woman ends up being left alone. That’s not only unacceptable, that’s not safe,” she said.

The failure to pass on the money, part of a drive to improve maternity services, means the NHS will not be able to honour promises by ministers to give women a single dedicated midwife during pregnancy and labour.

Alan Johnson, the health secretary, in February pledged £330m of extra funding over the next three years to implement the Maternity Matters strategy whose guarantees include giving women the choice of whether to give birth at home instead of at hospital. He also promised that he would recruit 1,000 more midwives to the NHS by 2009.

Health Minister Ann Keen said: “Claims that midwife numbers are falling are complete and utter nonsense.

“Validated figures from the latest NHS workforce census show the number of midwives has surpassed 25,000 for the first time and we know there is continuing growth towards recruiting an additional 1,000 midwives by September 2009, rising to 4,000 in 2012. There has also been a 25 % increase in the number of students entering midwifery training since 1997.”

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Others risk prosecution and fines because the way they are assessing junior doctors’ compliance with the directive does not match the EU measurement.

Data from 123 trusts shows the proportion of posts compliant with the directive using the EU’s legal definition is up to twice as high as the Department of Health’s figures.

NHS Employers head of programmes David Grantham said: “The situation may be better than people thought. Given the current drive for value for money you’d expect employers to be making every effort to make sure they’re not going beyond what’s necessary.”
“Individual clinicians will be able to bring prosecutions against their employers using the EU law”

The directive, due to affect trainee doctors next August, will cut the maximum working week from 56 hours to 48 hours.

Instead of using the EU measurement, around half of trusts are thought to calculate their compliance with the directive using pay banding data for junior doctors on the new deal contract.

Those on bands 1a, 1b or 1c are deemed to be working within the 48 hours limit, while 2a and 2b posts are assumed to doing more hours than the directive permits. If all NHS bodies in the sample – around half of trusts – moved doctors down a band to ensure compliance under the new deal, they would unnecessarily lose 11,801 service hours.

The study, by doctor management software company Zircadian, said it estimated this meant around 248 more posts would be needed, costing roughly £12.4m.

And up to 26 per cent of band 1 posts are actually non-compliant with the directive, known as regulation four, according to the analysis.

Mr Grantham said the figures chimed with anecdotal evidence that trusts were underestimating how many doctors were compliant.

However, some trusts may be deliberately overcompensating to provide “extra headroom” when the regulation comes into force, he said.

Papworth Hospital foundation trust associate medical director of education and workforce Martin Goddard said squeezing doctors down to band 1 often had no cost benefits and lost them time for training.

Equally worrying was the fear of trusts risking prosecution by unwittingly breaking the law.

He said: “We’ve had no guidance centrally as to which method we should use. It has become a management nightmare.”

The figures undermine statements made by Skills for Health, which is paid by the DH to help health service organisations achieve compliance. Skills for Health states on its website that discrepancies between the new deal and regulation four are “minor”.

Zircadian found that in 54 trusts, compliance was up to twice as high as using the legal definition, 36 trusts showed no difference, and in 33 compliance was up to 40 per cent lower (see graph).

Mr Goddard, who is also a special adviser on the working time directive and new deal for NHS East of England, said he has highlighted the “fundamental differences” between the two calculations to the DH, but it was seen as “too difficult” to change.

The findings, showing around 60 per cent of posts are already meeting the 48 hour limit, also contrast with a Royal College of Surgeons survey last month warning fewer than half of trusts were compliant.

Individual clinicians will be able to bring prosecutions against their employers using the EU law.

Zircadian managing director Henry Carleton warned failure to recognise the difference between the two measures could result in “clinical services and training time being unnecessarily trimmed and large amounts of money being wasted on phantom issues”.

Main differences between new deal and EU measurement of compliance with the working time directive:
* Average working hours under the new deal are normally worked out over an eight week period and take into account “prospective cover” for doctors who work rotas normally carried out by colleagues away on leave.
* The European measurement does not include prospective cover and uses a 26-week reference period for doctors in training.

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The Virgin tycoon, who was recently appointed vice president of the Patients Association, called for all hospital staff to be screened for the superbug MRSA and receive immediate treatment if infected.

He has also said managers at failing NHS trusts should be fired.

Infection rates for MRSA are falling across the UK with the most recent quarterly figures showing a 33 per cent drop year on year, but Sir Richard is calling for far more to be done.

The entrepreneur – whose daughter Holly is a doctor – told the BBC: “There have been some improvements, but the facts speak for themselves – and the facts are still horrific.

“It feels like they have tinkered with the problem rather than really got to the heart of the problem. The hospitals are there to cure people. They are not there to kill people.”

He said the NHS could learn from the airline industry about how to avoid mistakes and improve.

“In the airline industry if we had that kind of track record we would have been grounded years ago,” he said.

“In the airline industry if there is an adverse event that information is sent out to every airline in the world.

“And every airline makes absolutely certain that that adverse event doesn’t happen twice.”

Sir Richard is helping to organise an international conference on infection control and patient safety early next year.

He argued that all hospital staff including doctors, nurses and cleaners should be checked for MRSA and treated if infected – even if that causes disruption to medical services.

He said: “You don’t necessarily have to ask them to leave the hospital while they are being treated.

“They can just not have any contact with patients for those two weeks while their treatment is taking place, and then they can come back and have contact with patients.

“That is far better than having people dying from unnecessary diseases, and all the misery and pain that that causes, and the cost to the NHS which is enormous.”

Official data from the Health Protection Agency (HPA) showed there were 725 MRSA cases in July to September, a 33 per cent drop on the same quarter in the previous year.

The number of C difficile infections in patients aged 65 and over between April and June this year also fell 38 per cent, to 8,683 cases.

Sir Richard, who became the vice-president of the Patients Association in September, called for more patient information about infection rates and a tougher standards for trust bosses.

He said: “The patient should have the right to know the track record not only of the hospitals, but the rate on wards, on departments, on surgeons, on clinicians. That shouldn’t be something which is hidden.”

“And I also think if managers of hospitals are not obeying the rules that have been set by the NHS, those managers should be replaced.”

From:
Sir-Richard-Branson-accuses-politicians-of-failing-over-hospital-superbugs

The number of cases identified by GPs is now also 73 per cent higher than at the same time last year.

The virus is also hitting greater numbers of elderly people, increasing the risk of fatalities, the Royal College of GPs warns.

Experts advised everyone over the age of 65 to ensure that they were vaccinated against the illness.

Around a quarter of elderly people are estimated to be unprotected from the bug, which can cause potentially deadly secondary infections, including pneumonia.

Cases of flu have risen significantly in recent weeks, placing the health service under increasing strain.

The latest figures from surveillance by the RCGP show that there were 69 GP consultations for flu per 100,000 people last week, up from 39.5 per 100,000 on December 14.

Experts have blamed the unseasonably cold start to the winter for encouraging the flu virus to take hold.

Dr Douglas Fleming, director of the RCGP research unit in Birmingham, described the rise in cases as “significant”.

“In the past ten years, the only substantial outbreak was in 1999/2000,” he said. “I think we could be looking at something that approaches that this year.”

Professor David Salisbury, the Government’s director of immunisation, advised anyone eligible for the flu vaccine to ask for it from their doctor.

Professor Steve Field, chairman of the RCGP, said that the increasing instance of the illness among the elderly was “worrying”.

“Older people are more at risk of suffering dangerous complications, including pneumonia and serious chest infections and, of course, we know that influenza can kill the elderly,” he added.

Dr Lorna Layward, from Research into Ageing, the research arm of Help the Aged, said that influenza killed between 3,000 and 4,000 older people every winter but that that figure could reach 30,000 to 40,000 during an epidemic.

A flu outbreak officially becomes an epidemic when there are 200 cases per 100,000 people.

Andrew Lansley, the shadow health secretary, said: “In recent years the Government has rather complacently assumed that winter crises don’t happen anymore, but it has not been since 1999 that we have seen a serious flu outbreak over the winter.

“I know the NHS will respond well, but I continue to regret that ministers have allowed bed numbers to fall sharply and have talked of centralising accident and emergency capacity without paying proper regard to the risks of times of extreme pressure.”

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An upcoming review looking at governance systems and how NHS trust boards respond to information will show that the monitoring of safety issues is often poor.

The early analysis, due to be released in full next year, is contained in the commission’s annual State of Healthcare report.

It says boards vary in their approach to safety, but targets and finances still dominate their priorities. “In many cases, decision-making and acting on safety is devolved to local services or departments.”

Detailed scrutiny of the safety of care often takes place at committee level, “with only key facts and exceptions reported to the board”. While it is good to encourage local solutions to problems, the monitoring and auditing of safety improvements at senior level is “often poor”.
“The NHS has some way to go to ensure it properly learns lessons when things go wrong”

Acute trusts, especially foundation trusts, are best when it comes to acting on incident reports, but primary care trusts are weaker.

The commission found little evidence that PCTs are systematically monitoring the safety of providers.

Failure to report

In addition, the report says many trusts are failing to report serious safety incidents.

Between April and June this year, 7 per cent of acute trusts, 14 per cent of mental health trusts and 13 per cent of PCTs did not report a single incident. In the past two years, there have only been around 600 reports of radiation overdoses – out of about 25 million procedures.

The commission concludes: “The safety of care is improving as its fundamental impact on the quality of services and outcomes for patients is increasingly recognised. But the NHS has some way to go to ensure it properly learns lessons when things go wrong, anticipates and prevents harm where possible and has systems that ensure safe practice is followed every time, for every patient.”

The report also shows health inequalities appear to be narrowing, but progress in reducing the gap has slowed in the past two years.

This is based on a comparison of patients’ blood pressure and cholesterol in GP practices serving the fifth least deprived areas with those in the fifth most deprived areas, using quality and outcomes framework data.

Summarising the report, commission chair Sir Ian Kennedy praised improvements but highlighted the “small number of trusts which are trapped at a level of performance that is unacceptably poor”. The commission has “changed the face of whole areas of care”, such as infection control, over its lifetime, he said.

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They have launched an England wide consultation to ask people whether they want to keep the numbers.

Doctors say the new systems enable them to offer patients a better service.

But campaigners argue using the more expensive numbers is against the founding principles of the NHS, which should be “free at the point of need”.

Increasing numbers of GP surgeries, hospitals and primary care trusts now have 084 numbers for patients’ use, such as when booking appointments.

Any revenue that is raised has to go towards the cost of the phone systems.

However complaints over the use of the numbers – which are usually more expensive than local calls – have led to a government rethink.

In theory the numbers should cost about 5p a minute, but they tend not to be included in calls packages which people often have on their landlines.

For people using a mobile, the additional charge can be as high as 40p per minute.

Over the next three months people in England will be able to give their views on whether the practice should be allowed to continue.

The NEG (Network Group Europe) company, which supplies 084 numbers to the NHS, says 10 million patients across the UK are registered with a doctors’ practice that uses the system.

One such surgery is the Meanwood Practice in Leeds, where Dr Richard Vautrey is based.

Dr Vautrey, deputy chair of the British Medical Association’s GP Committee, said: “Before we put in the system, patients were concerned about the difficulty they had in getting through on the phone.

“Surveys showed it was an area of weakness for us. It’s never going to be perfect but the 084 number has given us a dramatic improvement and certainly made a big difference. “

“Any idea that GPs make money from these numbers is a myth. The cost to our practice has in fact increased since we put in the new system. Before it was £7,000 a year and now it’s £10,000.”

Opposition

But phone campaigner David Hickson said the use of the numbers was “completely unacceptable.”

He said: “The NHS is supposed to be free at the point of need.

“The difference in each call may be only a few pence for some people, but the costs can really mount up for others – especially for people who are using mobiles because they don’t have a landline.

“I find it bizarre that the government is doing a consultation on this now.

“It’s more than three years since the Department of Health banned GPs from using 0870 and other higher cost numbers. 084 numbers should have been stopped then.”

One solution could be to use 03 numbers across the NHS. These offer the extra functions of automated 084 systems, but without patients having to pay extra.

However some GP surgeries are locked into phone contracts lasting as long as seven years.

Health Direct asks if you don’t like being ripped off by the NHS when making a doctor’s appointment, please complete the form at:

http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_091879

The closing date to have your say is 31 March 2009.

CQC chair Baroness Young has revealed that organisations from hospitals to GP surgeries will be expected to prove they are complying with national guidelines on clinical effectiveness as part of the new regulator’s registration process.

Speaking at NICE’s tenth anniversary conference in Manchester last week, Baroness Young said clinical guidance would be “built into” the registration system.

She said: “There’s an opportunity for the registration system and the assessments that follow it to raise the profile of NICE guidance, to highlight [its] importance and to track some of that through the assessment process. The danger here is that we confuse essential entry requirements from providers with gold standards”

The plan is likely to be controversial as clinical guidelines are not currently compulsory and uptake is patchy.

Hardening tone

A CQC spokesman later said providers would be expected to demonstrate compliance with NICE and other national guidance “unless they can show a good reason to vary from them”. He said: “The steps that we can take range from a formal warning notice to prosecution and imposition of restrictions, or even closure of a service.”

The news marks a hardening in tone at the CQC: in August, Baroness Young told HSJ that health service organisations ignoring guidelines faced marked down annual assessment ratings and lower pay.

Foundation trust network director Sue Slipman said: “The danger here is that we confuse essential entry requirements from providers with gold standards.

“Entry level was never meant to be gold standard – that isn’t to say that we don’t want everyone to get there, but that’s a developmental issue.”

Variable quality

And Royal College of GPs chair Steve Field warned that NICE guidelines varied in quality and members had some concerns. He said: “You need to make sure that the guidelines are usable and appropriate.”

NICE itself is gathering data on guidance uptake, but is not able to estimate current compliance levels across the board.

Implementation director Val Moore said uptake often varied within hospital trusts, as well as across PCT areas.

She said NICE had been “knocking around themes” on guidance uptake with the new watchdog but added: “For NICE to work with the regulators but not be a regulator is an important strand.”

From:
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One in ten patients find themselves in mixed sex areas when admitted for planned operations and 29 per cent when admitted as emergency cases. Three in ten patients said they had to use bathrooms or showers that were used by the opposite sex.

Even thought most patients rate their care as good or excellent that is no excuse for the labour Government to ‘rest’ on the issue of treating patients with dignity and respect, Anna Walker chief executive of the Healthcare Commission said.

One in five patients who need help with eating do not get it and complaints from patients include basic care failures such as being left in soiled clothes, exposed in an embarrassing manner and being left in pain.

Services for patients with mental health problems are patchy and a review of care for adults with learning disabilities found ‘institutional abuse’.

Patients also want more involvement in decisions about their care and only a minority of people are being offered a choice of hospital when having a planned operation despite this being a cornerstone labour Government policy.

From:
Too-many-people-still-admitted-to-mixed-sex-sleeping-areas-says-Healthcare-Commission

After holding a consultation on tobacco control, the Department of Health said cigarette displays promote smoking to young people, prompt impulse purchases of cigarettes and undermine efforts to quit.

It said when similar moves had been made in other countries smoking prevalence among young people had fallen by up to 10 per cent.

Age restrictions to vending machines will also be introduced as they are thought to be the primary source of cigarettes for one in five people aged 11-15.

The moves are to be included in primary legislation in the next parliamentary session.

Protecting children

Health secretary Alan Johnson said: “Enticing multi-coloured displays encourage young people to start smoking – we must put a stop to this. Protecting children from smoking is our goal.

“My hope is that shops will use this opportunity to promote healthier goods to their customers.”

From:
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The programme is running at least four years late. New installations in London are on hold, no roll-out of the programme has yet been agreed for the north of England and the Department of Health is still deciding how to replace Fujitsu, the contractor for the south, whom the NHS fired in May.

Mr Nicholson told the Commons health committee he remained “confident” that the NHS would have a workable system by 2015.

But in a first public admission that a rethink might be required, he told MPs: “We do have to think about how we take it forward. We can’t go on and on for this.”

While parts of the programme had gone well, he said, there were “some really difficult issues to tackle” around installation of the clinical record.

The software to be used for the whole of the north, Midlands and east England was finally being tested on a small scale. “Good results are coming out of that”, but “we need to be careful” before rolling it out.

In London, the latest installation at the Royal Free hospital has hit big problems which BT, the installer, and Cerner, the software provider, are working to resolve. “We have said to Cerner and BT that they have to solve that problem at the Royal Free before we will think about rolling it out across the rest of the NHS,” he said.

He hoped that around February there would be a decision about who would take over in the south. The options included BT, which is responsible for the London systems, and CSC, which runs the north; a combination of the two; or bringing in another contractor.

But he conceded: “We really are at quite a pivotal position. If we don’t make progress relatively soon, we are really going to have to think it through again.”

BT said it was “making good progress” at the Royal Free. A health department official said Mr Nicholson’s comments showed the seriousness with which the NHS was taking the successful introduction of the Cerner software system at the Royal Free. “The benefits to patients and clinicians when the system is fully working are clear. We remain confident that the situation at the Royal Free will be resolved and so are not prepared to speculate about possible scenarios if it is not.”

From:
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Ninety-six per cent of men diagnosed in England in 2000 with testicular cancer survived five years, as did 81 per cent of women diagnosed with breast cancer.

Survival rates for those diagnosed in 1999 were also 96 per cent and 81 per cent respectively.

Five-year survival from lung cancer for patients diagnosed in 2000 was 7 per cent for men and 8 per cent for women, also unchanged from 1999.

Cancer Research UK head of policy Catherine Foot said the Department of Health’s NHS cancer plan, published in 2000, had led to “real improvements” in cancer treatment, including reduced waiting times, more specialist surgery and more cancer doctors.

Improving survival

“All these things as well as reductions in smoking rates and better access to new cancer medicines will lead to improvements in cancer survival five years after diagnosis.

“But this takes time to be seen in the statistics,” she said.

“Over the next few years, it is absolutely essential that the NHS focuses on improving the early detection of cancer, as we believe that diagnosing more patients earlier could significantly improve overall cancer survival.”

From:
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His stricture to NHS finance chiefs came as hospitals were told that they will only receive a basic 1.7 per cent increase in the price the NHS pays per treatment next year and no more than 1.2 per cent the year after – in spite of an average 5.5 per cent a year increase in the cash that primary care trusts are to be given to buy the care.

Hospitals and other services covered by the price list will be able to secure an additional 0.5 per cent by hitting quality standards. But the below-inflation increase in the tariff, will put huge pressure on NHS Trusts to improve productivity before much reduced spending growth after 2010.

Failure to do so would put NHS waiting times and other services under pressure.

Alan Johnson, health secretary, indicated on Monday that the NHS hoped to carry over about £1bn ($1.5bn) of its present £2bn surplus into those tough spending years. Just £800m of the existing surplus would be drawn down over the next two years, he told MPs in a statement.

Carrying over £1bn on what will by then be a £110bn budget would help “deal with the days when it rains hard,” Mr Flory said last week, as he declared that the NHS had to “get fit for the tough years” to come.

On the labour government’s published spending plans, most analysts believe the NHS will be lucky to see 1 per cent a year real growth after 2010 – a fraction of the 7 per cent increases of recent years and the 3 per cent current level.

Mr Flory said before then the NHS will have to deliver “a decent part” of the £5bn of extra efficiency savings that the Treasury is seeking from across government in 2010.

The Royal College of Nursing called for all the surplus to be used as it represented money that “could have been spent on frontline care”.

However, Mr Johnson, with an eye on the longer term, described drawing down only £800m of it as “prudent”.

He added that “substantial savings” needed to be made by driving up the quality of care so that errors and waste were reduced.

The warning that a marked increase in productivity was needed came as the health department conceded that while waiting times have been tumbling and activity rising, NHS productivity has still fallen sharply on the most recent figures.

One important reason for that is generous pay deals, which have consumed almost 30 per cent of the increase in resources.

According to the Office for National Statistics, NHS productivity fell 2.5 per cent a year between 2001 and 2005, though the health department argues that the measure does not adequately pick up quality improvements.

A memorandum to the Commons health committee also showed huge capital underspends in recent years, not least on Connecting for Health, the troubled NHS information technology programme.

With suppliers only paid when systems work, the IT programme underspent by £1.2bn between 2005 and 2007.

The NHS underspent by more than £2bn more generally on capital over the same period, with NHS organisations unable to achieve big increases in spending that had been envisaged.

http://www.ft.com/cms/s/0/3da09dd4-c57e-11dd-b516-000077b07658.html

Almost £1.7bn of health and education projects have been postponed in the past two months, despite government efforts to push money through.

The research, by Construction News, suggests the labour government will struggle to spend the £3bn it has brought forward to boost the economy. Dozens of projects have had to be put on hold, including 62 health schemes worth an estimated £1.3bn and 69 education projects worth £400m.

“The government is being held up by the procurement process,” said Allan Wilen, economics director at Glenigan, a construction information service. “There is capacity in the construction sector, but you have to make sure you’re putting up the right school in the right place.”

Instead of increased public sector expenditure offsetting flagging private investment, it appears that cancelled private schemes are holding back health and education projects. “If a planned housing estate is no longer going up, there’s no point in putting up a school either,” Mr Wilen said.

The Department of Health has already cut PFI hospital building from a projected £12bn in 2006 to £7.6bn currently. Some of the remaining schemes have been trimmed and others delayed by redesigns.

Glenigan data show that more than 1,200 building and civil engineering projects have been put on hold since the middle of October, worth an estimated £10.8bn.

http://www.ft.com/cms/s/0/2571a078-c727-11dd-97a5-000077b07658.html

A new report by the think tank says most patients have a mixed experience while they are using services. It says information and evidence is limited and more data is needed to understand the variations.

Seeing the Person in the Patient is based on interviews with staff and patients, as well as a review of surveys and literature.

None of the interviewees’ experiences were “wholly good or wholly bad”, it says.

Unreliable care

“The defining feature of patients’ experience of care in all kinds of settings was that it was unpredictable and unreliable. Almost everything depended on who was on duty, and beyond that, who was in charge: both factors that to the patients seemed unpredictable.”

A large majority of respondents to national patient surveys describe their overall care as good, very good or excellent.

The King’s Fund published the report to launch its Point of Care programme, which calls for increased efforts to study and improve experience. There needs to be a shift in culture at all levels, it says, and staff are urged to “see the person in the patient”.

NHS management factors

The report says several factors in management are important. “The actions and words of senior hospital leaders… have a profound influence on what happens to patients.

“They shape the culture of the hospital: the priorities of managers and staff; how they behave, towards each other and towards patients and families; and how staff feel about the services they provide and the organisation.”

Managers should set direction, create an open and team-working culture, maintain governance and have adequate information at team and specialist level.

Culture change

King’s Fund chief executive Niall Dickson, launching the report, said: “We know good care can aid recovery and that good leadership can create a culture which brings that about.

“Working with patients, their families, staff and the leadership within hospitals we hope that the Point of Care programme will help to transform what it is like to be cared for in hospital.”

Programme director Jocelyn Cornwell, who wrote the report with researcher Joanna Goodrich, said: “Staff come to work intending to provide the quality of care they would want for themselves and their families. But today’s hospitals are vast, time is at a premium and in these busy ‘medical factories’ care of the person can unfortunately get squeezed out.”

From:
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A report for the union by the Office for Public Management is highly critical of aspects of the commissioning process.

The researchers, who interviewed NHS managers, were told by commissioners that they had concerns about “marketisation”, complex tendering processes, and inconsistency across the country.

One said: “[Commissioning decisions up to this point] have just been to do with what are we going to commission our NHS trust to do. We have not been out there stimulating the market or blazing a trail.”

NHS family

Another said: “We are used to just going along to the local trust and talking to them and saying ‘can we just change this a bit?’.

“It is the NHS family. You can’t go along to [a private provider] and say the same – they will say no.”

Providers said they faced difficulty managing to be both flexible and follow the terms of a contract.

Checks and balances

Unison general secretary Dave Prentis said: “It is a slippery slope when health reforms are brought in without the necessary checks and balances of effective scrutiny and accountability.

“At a time when finances are increasingly tight, the NHS cannot afford to be throwing precious money away to the private sector and wasting time and resources on the complexity of the commissioning process.”

From:
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National clinical director for cancer Mike Richards’ review of co-payments allowed patients to pay for drugs that are not funded by the service, as long as private care was given separately from NHS provision.

Charity Age Concern is now calling on the Department of Health to clarify how far its logic may extend to other situations where NHS funds are used to provide care.

Grey areas in current policy include care home residents fearing they will be forced to meet all their bills once they are paid for with continuing care funding. “We can’t see how you can say you can top up all these other things and not top up the care home you wish to go to”.

There are also questions around new policy areas, such as individual budgets for healthcare.

Age Concern care finance policy adviser Pauline Thompson said the charity had heard of cases where elderly care home residents had been afraid to apply for NHS continuing care funding because they feared they would be forced to move to cheaper homes.

She said care home residents should be allowed to top up health service payments, but that their rights to NHS funding must also be spelled out clearly.

“With current support for the idea of being able to top up, we can’t see how you can say you can top up all these other things and not top up the care home you wish to go to.

“But we’d also wish to make absolutely sure that there were some mechanisms in place to ensure that the NHS did pay the going rate.”

Direct payments

King’s Fund senior policy adviser Anna Dixon said whether patients would expect to top up individual health budgets was likely to depend on whether the Department of Health’s pilot scheme allowed for direct payments – as in social care – or was simply a “nominal budget”.

People receiving direct payments under the social care system are currently allowed to top up.

“The suggestion at the moment is that they are not going to go down the route of direct payments, which would suggest that it probably won’t be possible,” she said.

From:
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Research by private dental plan administrator DPAS showed 5 million “units” of dental activity were recorded as undelivered – a 5 per cent increase on the previous year.

Most primary care trusts told the company they were planning to claw back payments where there was more than a 4 per cent shortfall against contract.

DPAS chair Quentin Skinner said the figures showed dentists were doing more work for less money under the general dental services contract introduced in April 2006.

He said: “We could see this coming and, after our research last year on the 2006-07 outcome, I warned that there was a ratcheted treadmill effect built into the new contract.

“Not only would dentists have to work harder in the second year if they were to keep still, but they also had the matter of year one clawback to address – the situation was always likely to compound itself.”

Mr Skinner said dentists who had underperformed would be forced to agree to “a mixture of increased workloads for less money, as their year three revenue is reduced by year two clawback, money already spent on last year’s running costs and drawings”.

From:
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GP referrals made in the quarter ending 30 September have risen by 12.6 per cent, while other referrals have increased by 9.2 per cent.

Inpatients

The figures also show 91 patients for whom English commissioners are responsible waited longer than the 26 weeks standard for inpatient admission at the end of October 2008.

The number waiting more than 13 weeks was 40,800, a drop of 4.8 per cent from September 2008 and 36.4 per cent from last October.

Outpatients

Out of a total of 888,000 patients, 551 waited more than the 13 weeks standard for a first outpatient appointment following GP referral at the end of October.

Of these, 67 were English residents waiting for appointments in Welsh hospitals.

There was an increase of 13.9 per cent in the number of patients waiting longer than eight weeks at the end of October 2008, compared with last October, but the numbers dropped by 14.9 per cent from September this year.

Cancelled operations

During the quarter ending 30 September 2008, 13,100 operations were cancelled at the last minute for non-clinical reasons. In the same period in 2007, 12,500 operations were cancelled.

Of these cancellations, 3.3 per cent of patients were not treated within 28 days, compared with 5 per cent in the same period last year.

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An estimated 77,400 people in the UK are thought to have HIV, up from an estimated 73,000 in 2006.

The agency said there were 7,734 new diagnoses of HIV in 2007 but almost a third of people are being diagnosed late, after the stage at which they should have begun drug therapy for the condition. It said testing needed to be more widely available to reduce transmission rates in the heterosexual and homosexual populations.

“It is very worrying that so many people remain unaware of their HIV status. Wider HIV testing in high prevalence areas of the UK is urgently needed,” said HPA Centre for Infections head of HIV surveillance Valerie Delpech.

Prevalence is greatest in London, parts of the south coast, Manchester and Blackpool.

Of new diagnoses in 2007, 41 per cent were among gay men, the majority of whom had become infected in the UK, and 55 per cent were acquired through heterosexual contact. The majority of the latter were probably acquired abroad.

A total of 180 new infections were acquired through injection drug use and 110 through mother to child transmission.

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The report also says an extra £100m in capital funds will be spent upgrading up to 600 GP practices into “training practices” as part of chancellor Alistair Darling’s £3bn attempt to stimulate the economy by bringing forward planned investment from 2010-11 into the next two years.

That investment will be targeted to practices in under-doctored areas.

Mr Darling’s report outlines a package of measures designed to stimulate the economy through the recession, including £12.5bn of consumer tax cuts and a six-year pause on the government’s investment rules which have dictated that it borrow only to invest.

But tax cuts and a growing budget deficit needed to be paid for over the medium term, Mr Darling said, and his report outlines that part of the payback will come in the form of an increase in the public sector “recoverable savings” target for 2010-11 from £30bn to £35bn.

The report explains that the Treasury believes there is scope for part of that to come from the £70bn NHS commissioning budget.

“As PCTs enhance their commissioning skills over the next years they will develop their strategic and financial plans to ensure they unlock cashable value for money improvements across the £70bn of commissioned health services,” the report says.

The report explains that April’s Budget will set out the “value for money impact” expected from world class commissioning as well as “report on the scope to increase efficiency further in the hospital sector through the tariff prices paid by PCTs and progress on extending pricing to new areas of the health service”.

Mr Darling’s report confirms that the years after 2011-12 will see a sharp drop in public sector spending growth. Last year’s comprehensive spending review pledged to increase public sector spending in real terms by an average of 1.9 per cent a year between 2008-09 and 2010-11.

But this month’s report says that between 2011-12 and 2013-14 spending will grow by just 1.2 per cent in real terms.

From:
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