Death rates at the Essex trust were a third higher than they should have been, said the Care Quality Commission, the health care watchdog.

Among the worst failings were a lack of basic nursing skills, curtains spattered with blood on wards, mould in vital equipment and patients being left in A&E; for up to 10 hours.

Concerns about death rates at the foundation hospital trust were first raised a year ago, but an internal investigation failed to find anything wrong and senior managers dismissed the concerns.

But the new external report found “systematic failings” in the trust’s senior management team, who are still in their jobs. The CQC said its confidence in the management’s ability had been “severely dented”.

The watchdog’s report follows an investigation earlier this year into Mid-Staffordshire NHS Foundation Trust, which found similar problems, with up to 1,200 avoidable deaths.

Ministers assured patients at the time that it was an isolated incident. The failures at Basildon will raise concerns that similar problems are widespread in the NHS.

Among the CQC’s other findings were the avoidable deaths of four patients with learning disabilities; a lack of children’s nurses and doctors in A&E; a failure to feed patients properly or give medication correctly; and a high rate of bedsores among elderly patients. Concerns about standards at Basildon were raised as long ago as 2001, when the Royal College of Nursing described conditions there as “Third World” because of a shortage of beds. Since then the hospital has suffered a series of health scares and accusations of negligence.

The CQC report has been passed on to Monitor, the organisation in charge of foundation hospital trusts.

A statement by Monitor said there had been a “significant breach” by Basildon and a task force of experts would be sent into the trust.

Monitor has the power to replace the trust’s management but it was understood last night that none of the board members had been threatened with dismissal.

Katherine Murphy, the director of the Patients Association said: “Yet again patients are being neglected. Lack of monitoring, lack of help with feeding, lack of dignity, avoidable pressure sores. How many times do the public need to keep hearing about this before the Government is embarrassed enough to do something about it?

“We’re sick and tired of NHS managers and senior staff walking away unscathed when families are left with a life sentence of grief.”

Basildon was one of the country’s first foundation trusts in 2004, meaning it was given more freedom over its spending and did not have to answer to ministers. Mid-Staffordshire was also a foundation trust, raising concerns that the system is failing. It also emerged that Basildon was the first foundation trust to be issued with a warning notice about poor infection control earlier this month over hygiene in its A&E; department and contamination of medical equipment.

The trust, which has a budget of £250 million and more than 700 beds at its main hospital in Basildon, has repeatedly pledged to improve but failed to do so, the CQC said.

Andrew Lansley, the shadow health secretary, said: “I am extremely disturbed by this news and the effect that these shocking conditions may have had on patients. It is unforgivable if any lives have been needlessly lost.

“When the appalling standards of care at Stafford Hospital were revealed, we were assured by Labour ministers that it was ‘an isolated case’ — that sort of complacency is simply not good enough.”

Andy Burnham, the Health Secretary, has proposed a change in the law to allow trusts to be stripped of foundation status if they fail.

The CQC had been aware of problems at Basildon for more than a year and was in contact with managers to correct the situation. Repeat inspections found no improvement. From next April, the CQC can take action, including fines, and, if necessary, closures of departments or the whole hospital. Cynthia Bower, the watchdog’s chief executive, said: “We want to act swiftly at Basildon to nip problems in the bud, working closely with other regulators. The trust has taken our concerns seriously but improvements are simply not happening fast enough.

“Our confidence in the management’s ability to deliver on commitments and to turn the situation around has been severely dented.”

From:
http://www.telegraph.co.uk/Failing-hospital-condemns-hundreds-to-death

The number of confirmed deaths for the week ended November 26 were 21, three higher than the week before and two higher than the previous high a fortnight ago.

However at the same time the overall number of people catching swine flu in England fell to an estimated 46,000 new cases in the last week, 7,000 less than the week before.

There has also been a drop in the number of people in hospital, from 783 to 753.

A total of 154 of those being cared for are in intensive care.

The figures are dropping so low that the government said that it was reviewing its online and telephone flu service with a view to withdrawing it after Christmas.

Sir Liam Donaldson, the chief medical officer for England, said that the number of people who have had swine flu or died means the current pandemic is comparable with a normal winter flu season.

But he said: “If you look at the levels you would say they are comparable with a winter flu outbreak but a winter flu outbreak does not kill young people and does not take under-fives into hospital and intensive care on this scale.”

Meanwhile more than a million people at high risk from swine flu have been vaccinated, according to Government estimates.

About a million people in England and thousands more in Scotland, Wales and Northern Ireland have received their jab in the first month of the programme.

GPs are currently vaccinating people at risk – such as those with asthma, heart disease and diabetes – before moving on to the under-fives.

The number of deaths in England now stands at 163 and the UK total stands at 242, up from 214 last week.

Sir Liam said the one million figure did not include health care workers, who have also been having the vaccine.

One million is about one in 10 of all the people in at-risk groups who are being offered the vaccine.

So far, 10 million doses of the jab have been sent out to GP surgeries, primary care trusts and acute hospitals in England.

A total of 14 million doses of the vaccine Pandemrix have been delivered to the Government, with another 2.3 million doses of Celvapan also delivered.

Earlier, Dr Brenner told MPs on the parliamentary home affairs committee that people working in financial services were more likely to run into problems with powdered cocaine abuse than other elements of society.

“They often have a high-pressure job and will often start using it not so much as a reward system but as a way to keep themselves going,” he said.

Recent Home Office figures show that Britons are the biggest consumers of cocaine in Europe, with 1m people estimated to have taken the drug in the past year. About 12,000 people are being treated for their use of powdered cocaine.

Dr Brenner said the cocaine problem affected all echelons of the financial services industry, “from the chief executive all the way down to the postroom”.

Nick Barton, chief executive of the Action on Addiction charity, which also runs treatment centres for addicts, agreed that he had seen “no kind of decrease” in the number of City cocaine users approaching his organisation for help. “This problem hasn’t disappeared,” he added.

The recent financial crisis might have added to the pressure on bank workers to use narcotics to lift productivity, Mr Barton said. “If people are going to have to work that much harder, cocaine will have its appeal as both an aide and a recreational tool,” he said.

But the medical experts also said alcohol abuse remained a far greater problem among the professions than any other substance.

Couples with relationship problems will be offered free sessions for up to six months, as part of a £270 million programme to increase the provision of “talking therapies” for the public, Andy Burnham, the health secretary, announced.

Doctors and patients’ groups said they were “horrified” by the use of NHS resources for relationship advice when patients with cancer and dementia were being denied treatment they desperately needed.

Currently, most people seeking help from services like Relate pay between £45 and £60 per session, meaning the free counselling packages will be worth around £1,000 per couple.

The NHS is expected to have to pay existing marriage guidance services, and newly-trained counsellors to provide the therapy.

Doctors and patients groups last night attacked the recommendation, contained in guidance by the National Institute for Health and Clinical Excellence (NICE). NICE has repeatedly come under fire for decisions to reject life-extending drugs for cancer and treatment to reduce symptoms of dementia.

On Thursday, NICE was accused by charities of “condemning patients” to an early death by rejecting the use of Nexavar, a drug which can extend the lives of liver cancer, arguing that its £9 million annual cost – £3,000 a month per patient – could not be justified.

Nick James, professor of clinical oncology at the Cancer Research UK Institute for Cancer Studies said: “I am horrified, in particular because of the way these decisions are taken without public debate.

“I think most people would say treatment for those who are sick with cancer should be top of our list, and I would really question whether these kinds of efforts to preserve marriages are a matter for the state.”

NICE has previously restricted the use of drugs to limit the effects of Alzheimer’s, costing £2 a day, while provoking further controversy in May when it ruled in favour of alternative therapies like acupuncture for back pain, despite admitting there was little evidence they worked.

Michael Summers, Vice-President of the Patients Association, urged NICE and the Government to “get their priorities right”. If we had the luxury of untold sums of money, maybe we would think about paying for couples counselling,” he said.

“As things stand, people are still waiting for urgent treatment, being denied drugs for cancer, and dementia, and it seems inappropriate at the very least to start using public money in this way”.

There were an extra 36,700 deaths in England and Wales from December 2008 to March 2009, compared with the average for non-winter periods, figures from the Office for National Statistics (ONS) showed.

This was the highest number since the winter of 1999/2000 and a rise of 49% compared with 2007/08.

Andrew Harrop, head of policy at Age Concern and Help the Aged, said: “It is a national scandal that the UK has more older people dying in winter, compared to the rest of the year, than countries with more severe weather, such as Sweden and Finland.

“Excess winter deaths of older people have remained stubbornly high in recent years, but last winter’s huge spike sounds a deafening wake-up call about the older population’s well-being if we have another cold snap.

“To end this national scandal, the Government must do much more to tackle fuel poverty, which currently affects one in three older households.”

Fuel poverty charity National Energy Action (NEA) warned that a combination of high energy prices, low incomes and poor insulation will continue to pose a serious threat to the health of millions of people, especially pensioners, during the coming months.

Jenny Saunders, NEA chief executive, said: “The Government needs to step up action that will end these shameful statistics and comprehensibly tackle fuel poverty in the UK.”

The winter of 2008/9 had the coldest average winter temperature since 2005/6, one of the factors which affects the number of so-called excess winter deaths, an ONS spokesman said.

He added that the Health Protection Agency (HPA) said influenza activity started early and reached moderate levels during the winter of 2008/9.

Temperature and levels of disease in the population are two of the key factors which contribute to the number of deaths.

The greatest number of excess winter deaths occurred in people aged over 85, the ONS figures showed.

Women accounted for the highest number of excess winter deaths, a fact mostly explained by the higher number of women than men aged over 85, the ONS said.

There were 21,400 excess winter deaths in women and 15,300 in men in the winter of 2008/9, the ONS said.

But the largest increase – 59% – was in men aged 75 to 84, with the overall rate for men 44% higher than the previous year.

Among women, the overall rate increased by 52% compared with 2007/8.

A Department of Health (DH) spokesman said: “The causes of excess winter deaths are very complex. Last year was a colder than average winter, which explains some of the extra deaths seen.

The NEA called for an extension of the winter fuel payments “to include other vulnerable households and not just those who are over 60″.

It also urged the Government to increase the budget for the Warm Front Scheme – which provides a package of insulation and heating improvements up to the value of £3,500 – to £530 million next year.

Ms Saunders said: “As it stands, the budget for 2010 is set to be cut back by around 50% on this year’s budget.

“I urge the Chancellor in his Pre-Budget Report on December 9 to increase support for the life-saving heating and insulation measures available to low income households under this flagship programme.

“People need to be aware of the help that is available to them through the various grants and schemes from DECC, energy companies and our own Warm Zones where we have established these with local authorities.

“Pensioners in particular are often anxious to avoid debt and turn their heating down or even off, often unaware that they are putting their health in danger.”

She said there were more than five million households who cannot afford to heat their homes, putting them at risk of serious health problems like heart disease, strokes, respiratory illnesses – such as asthma and bronchitis – and exacerbating common ailments like colds and flu.

She added that the increase in excess winter deaths was “sadly expected but remains extremely worrying”.

Two of the five have recovered and have been discharged from hospital, one is in critical care and two are being treated on the ward.

The service said the resistant strain does not appear to be more severe than the swine flu virus circulating since the spring.

All patients on the unit have been tested and patients diagnosed with Tamiflu-resistant swine flu have been given other antivirals.

Patients have been isolated or are being cared for in a designated area for influenza cases.

Cardiff and Vale University Health Board has put appropriate infection control measures in place on the unit, the NPHS added.

Staff and patients have been offered swine flu vaccinations, and patients due to come into the unit for treatment are being warned to get the jab from their GP.

Close contacts of the patients are being warned to make sure they are treated quickly if they show any symptoms.

Dr Roland Salmon, director of the NPHS Communicable Disease Surveillance Centre, said: “The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

“In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April. For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness.

“Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.”

It comes after it was announced that more than 3million healthy children under five across the UK are to be offered the swine flu jab.

Parents will be invited by their GPs to bring their children into surgeries, with vaccinations expected to start in December.

Health ministers across the UK agreed children aged six months to five years should be included in the next phase of the vaccination programme after GPs have finished vaccinating at-risk groups, including people aged six months to 65 with conditions like asthma, diabetes and heart disease. Pregnant women and frontline health workers are also currently being given the jab.

Figures released on Thursday showed an estimated 53,000 new cases of swine flu in England in the last week, down from 64,000 in the week before. In Scotland, the figure was 21,200, down from about 21,500 in the previous seven days.

The rate of flu-like illnesses diagnosed by GPs in Wales dropped to 36 cases for every 100,000 people from 65.8 the previous week.

Seven swine flu-related deaths were recorded in Wales in the previous week, taking the total to 21.

Wales’s Chief Medical Officer Dr Tony Jewell said people with suppressed immune systems were designated as a priority group for vaccination because they were known to be more susceptible to the virus.

“We have stringent processes in place for monitoring for antiviral resistance in the UK so that we can spot resistance early and the causes can be investigated and the cases managed,” he said.

“Identifying these cases shows that our systems are working so patients should be reassured.

“Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.

“It’s also important that good hygiene practices are followed to further prevent the spread of the virus.”

Meanwhile, Norwegian health authorities said they had discovered a potentially significant H1N1 mutation that could be responsible for causing the severest symptoms.

The mutated virus was found in the bodies of two people who died of the virus, although medics do not believe it has been transmitted between humans.

The overall number of new cases showed a second successive weekly fall. Health officials estimate there were 55,000 new cases this week in England compared with 64,000 last week. There was a slight drop in Scotland.

The number of people who have died from swine flu in the UK has reached 214. There were 18 deaths in England last week. The figures since the start of the outbreak in May are 142 fatalities in England, 21 in Wales, 38 in Scotland and 13 in Northern Ireland.

The number of people needing hospital care for the virus is 783, down slightly from 785, in the previous week. Of those in hospital, 180 were in intensive care, up from 173 in the previous week.

The Conservative party has been pressing the government to give vaccinations to healthy children because those under the age of 16 are in one of the more vulnerable groups.

Currently people in priority groups – including young children with asthma or diabetes – are being vaccinated.

But the programme will now be rolled out to children with no underlying health issues, aged over six months and under five .

The UK-wide policy was officially confirmed by the Scottish Government today ahead of a similar announcement in England, expected later.

Nicola Sturgeon, the Scottish Health Secretary, said: “I am able to announce today that the next group in the population that will be vaccinated, or offered vaccination, is children aged over six months and under five years.”

The announcement came as it emerged that an 11-year-old girl from Berkshire who had tested positive for the H1N1 virus died on November 11.

NHS figures show that children under 16 are the age group most likely to be admitted to hospital with swine flu, and 21 per cent of deaths in England are among under-14s.

Last week, the death toll in the UK stood at 182, with 124 deaths in England, 33 in Scotland, 11 in Northern Ireland and 14 in Wales.

Currently nine million people in priority groups are being vaccinated against swine flu including those with long-term illnesses and pregnant women. Frontline health and social care workers are also being offered the vaccine.

Britain has ordered enough vaccine for everyone to have two doses, but data from clinical trials has shown that one dose is effective.

Children have been hardest hit by swine flu and are the under fives are the most likely age group to be admitted to hospital with the virus.

Researchers warned that intensive care beds for children could run out in Britain this winter due to swine flu.

All of Britain’s 303 intensive care beds for children could be filled with swine flu patients this winter and this would leave no beds available for children suffering other illness, recovering from surgery or accidents, according to a study conducted by Dr Art Ercole, of Cambridge University and colleagues.

The research was published online ahead of the print edition of the journal Archives of Disease in Childhood.

Dr Ercole said over half of admissions to paediatric intensive care units (PICUS) are unplanned and respiratory illness is the second largest cause of admission, accounting for around one in four cases.

Only around 36,000 of the 180,000 people on the drugs in the UK derive any benefit from them, it said. Overprescribing of the drugs is linked to an extra 1,800 deaths a year among elderly people.

Anti-psychotic medicines are licensed to treat people with schizophrenia and are used off-licence for dementia patients in care homes and hospitals.

In his review, Sube Banerjee, professor of mental health and ageing at the Institute of Psychiatry at King’s College London, said the rate of use of anti-psychotic drugs could be cut to one third of its current level with appropriate action.

Jeremy Wright, chairman of the All Party Parliamentary Group on Dementia, called for more training to be given to care home staff and for greater involvement of the patient’s family and friends over the decision on whether to prescribe.

He told BBC Radio 4′s Today programme: “We need to give people other ways of avoiding the problem and that means making sure staff who work in care homes are properly trained in dementia.

“We need to involve family members and friends and loved ones much more in the decision to prescribe and the decision to keep prescribing these drugs.”

He added: “If we can deal with training, if we can deal with regular reviews and if we can involve family and friends much more often, we will start to reduce the incidence of this very widespread over-prescription.”

Nadra Ahmed, chairman of the National Care Homes Association, said the blame did not lie solely with care homes.

She explained it was GPs who made the decision to prescribe dementia sufferers with anti-psychotic drugs.

She told the programme: “One of the things we need to get absolutely clear here is these drugs are prescribed by general practitioners, they are not prescribed by the care home providers. This is about medical conditions which are obviously reviewed by GPs.

“We have clients who come into our homes, sometimes already on these drugs and actually very good providers do tend to use their initiative and try to manage the conditions and wean people off drugs.

“Very often what happens is that GPs are just not giving us enough time in our services to come and review the medication and people can be on this medication and once they’re on it, people, quite rightly, are reluctant to take them off.”

She also rejected claims that some care home providers sedate dementia sufferers as it makes them easy to manage.

There are around 700,000 people with dementia in the UK. That figure is expected to soar in the coming decades as life expectancy lengthens.

Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said: “It’s critical that the dangers of wrongly-prescribed anti-psychotics are understood and Government action is taken to prevent putting more people at risk.

“Alzheimer’s Research Trust scientists at the Institute of Psychiatry are investigating alternative safer means of reducing agitation among dementia patients.

“We must urgently develop safe and effective treatments for people with dementia.

“Unless researchers develop new treatments, within a generation 1.4 million people will live with dementia in the UK alone.”

Paul Burstow, a Liberal Democrat MP who has led a 10-year campaign highlighting the risks of over and inappropriate prescribing, said: “This review comes much too late for thousands of elderly people whose lives have been cut short by the reckless prescribing of anti-psychotic drugs.

“The evidence that anti-psychotic drugs do more harm than good has been mounting for years. There is next to no benefit for the older person and prolonged prescribing can lead to premature death.

He sacked Professor David Nutt, a renowned neuropharmacologist, as chairman of the government’s Advisory Council on the Misuse of Drugs for insisting publicly that last year’s upgrade of cannabis to a Class B drug was not justified by the evidence. 

http://www.ft.com/cms/s/0/379cbe88-c7e7-11de-8ba8-00144feab49a.html

The National Audit Office said the NHS had duplicated effort and failed to test as many of the under-25 target group in England as it should have.

Last year £17m could have been saved, nearly half the sum spent, if the programme had been better run, it said.

But the government said such an “ambitious” screening programme was always going to take time to perfect.

The programme was set up in response to rising rates of the so-called silent infection – it often shows no symptoms but if left untreated can cause infertility.
  
Edward Leigh, chairman of the House of Common’s Public Accounts Committee, which will now be looking into the issue, added: “This is a classic example of what can go wrong when a national programme is rolled out unthinkingly.”

The screening was initially introduced in several pilot areas in 2003, before being rolled out nationally in 2007. So far £100m has been spent on it.

But the NAO said despite the four-year trial period, the health service failed to learn lessons.

The 152 NHS trusts responsible for delivering the programme should have worked in partnership more, the watchdog said.

Money could have been saved by setting up a more centralised purchasing arrangements, while resources had been wasted on developing different branding and advertising campaigns, it said.

Questions were also raised about how the actual screening was done.

The programme was designed to reach out to people not using sexual health clinics and so health officials went out to places like bars and clubs to encourage young people to come forward.

But the NAO said there was little evidence that this had proved effective.

NHS chiefs also struggled to get GPs fully engaged – they are not paid to do the screening under the terms of their contract although some trusts resorted to paying them extra to get involved.

Failed

The problems meant the programme had failed to reach as many people as it should have – something already well documented.

In the first year of the national programme – 2007/8 – just 5% of the 15 to 24-year-old population was screened, well short of the 15% target.

The following year it was made a priority by the government and screening rose to 16%, although that was still short of the 17% target.

The poor reach of the programme and duplication of resources meant the average cost of each test last year was £56, rather than the £33 experts say it should cost. The highest figure recorded by a trust was £255 per test.

What is more, the NAO noted that it appeared one in 10 of those who tested positive did not receive follow-up treatment, rendering the screening pointless.

However, the watchdog admitted this could just have been because the NHS had not recorded their treatment.
  
Mark Davies, from the NAO, said the piloting of the programme had been a “waste of time” as the problems identified by the watchdog should have been addressed before it was expanded.

From:
http://news.bbc.co.uk/1/hi/health/8354932.stm

The Public Accounts Committee said setting targets in England for the two infections had led to a fall in cases.

But they warned there were signs other bugs, such as E. coli, were becoming more common and they called for better surveillance to curb the problem.

In England, MRSA rates are now a quarter of what they were at their peak in 2004, while C. difficile rates have fallen by nearly a third in the past year, following the introduction of targets.
   
THE OTHER THREATS
E. coli
Pneumonia
Surgical site infections
Urinary tract infections
Gastrointestinal infections
Skin infections

But the MPs said these only accounted for about a fifth of the total number of all infections seen in hospital.

While MRSA is the most high-profile bloodstream infection, E. coli is much more common and has actually increased by a third in the past four years, the report said.

It also highlighted surgical site infections, which were twice as common as bloodstream infections, and respiratory and urinary tract infections, which were three times as common.

MPs warned there was still no robust data on the extent and risks of at least 80% of bugs linked to hospital care.

Committee chairman Edward Leigh said this report was the third time the committee had warned about the threat of other infections, adding it was “disappointing” the issue had yet to be addressed.

“The government has taken its eye off the ball regarding all other healthcare associated infections – which actually constitute most by far of all infections.”

The report suggested hospitals start reporting all types of infection and that they look to curb the use of antibiotics.

Professor Mark Enright, an infections expert at Imperial College London, said: “I can understand why the government focused on the infections it has, but now we are getting to grips with those it is time to look elsewhere.

“There are some strains of infections, such as E. coli, where we are seeing increasing levels of antibiotic resistance and that is concerning.”

Nigel Edwards, of the NHS Confederation, which represents trusts, agreed it was time to review other infections.

But he added: “We would want to know the balance of costs and benefits from additional surveillance.”

Katherine Murphy, director of the Patients Association, said: “This target culture is just like squeezing a balloon – if you squeeze one end it will bulge out at the other.

“But the problem for patients is that the balloon stays the same size. The problem of patient safety will stay the same huge size as long as it is regarded as an optional extra by some.”

From:
http://news.bbc.co.uk/1/hi/health/8351269.stm

All of those affected had been in the hospital’s ward 31, which generally cares for geriatric patients.

Seven of the patients had contracted the more dangerous 027 strain.

NHS Tayside said it carried out regular testing in order to detect C. diff outbreaks early.

Dr Gabby Phillips, lead infection control doctor for Ninewells Hospital, said the ward remained closed to new admissions.

The hospital has been dealing with the outbreak since September, over a 10 week period.

The deaths occurred between 19 October and 6 November.

‘Appropriate measures’

Dr Phillips added: “We have comprehensive infection monitoring procedures throughout our hospitals and these are able to rapidly identify any emerging trends of infection which then trigger a rapid response from our infection control teams.

“These cases of C. diff infection were detected very early which meant we were then able to identify the 027 strain rapidly and reinforce all appropriate infection control measures.

She added that the hospital had sought external advice over its policies and procedures, and had been “reassured that our surveillance systems are robust”.

Unveiling the latest data showing a decline to an estimated 64,000 new infections this week, compared with 84,000 last week, Sir Liam Donaldson said it could be explained by the school holidays.

The reversal caused some surprise, with the trend in recent weeks suggesting the UK was experiencing an escalating “second wave” of the H1N1 virus in the build-up to winter. “We don’t know whether this is the start of a downturn or not,” Sir Liam said.

Officials said the decline could also reflect fewer cases of children reporting to doctors during the holidays even if they did develop symptoms.

The school summer holidays were seen as helping suppress the first pandemic wave, since the virus spreads most easily among children. Since the start of the autumn term there have been 241 school outbreaks recorded, with the highest number of 92 in Yorkshire and Humberside.

There was also a drop over the past week in hospitalisations in England from 848 to 785. An estimated 670,000 people have been infected to date. Vaccination programmes are now under way, with 6.6m doses sent to doctors and 3m new doses arriving each week.

By 2008, however, that figure had fallen to 10.6 per cent, with just over 900,000 patients being treated privately against 7.7m who were funded by the NHS, according to Laing & Buisson in its annual Healthcare Market Review, the bible of the private health industry.

The proportion is likely to have fallen further since then, given a rise in patients choosing NHS-funded care in a private hospital and a steep decline, caused by the recession, in the numbers paying with their own money.

William Laing, chief executive of Laing & Buisson, said: “This remarkable reduction in the privately funded share of elective surgery is not because private healthcare is in decline.”

The numbers choosing to pay for themselves have fallen 20 per cent or more over the past couple of years to just 16 per cent of private hospital income in 2008 against more than 22 per cent a few years earlier.

Until recently, however, the numbers covered by private medical insurance had held up well.

“The main reason for the falling private share is that NHS-funded surgery has been growing so much faster, aided by the massive injection of public spending during the last decade,” Mr Laing said.

The number of cases paid for by the NHS in private hospitals jumped from just above 50,000 in 2007 to 151,000 in 2008. Those numbers are still rising as NHS patients’ rights to choose a private hospital begin to take off. On top of that – and not included in these figures – are approaching 100,000 NHS patients a year being treated in the independent private sector treatment centres that were set up to provide NHS care.

But Mr Laing said the extra business “has been a mixed blessing” for private sector hospitals. NHS work offers a lower profit margin. “If and when” self-pay work revived, many of the private operators would wish to return to their core private market. The big question, he said, was whether any private operators had the appetite to invest in additional, lower cost, facilities aimed at servicing the NHS. 

But the conditions being attached to the seven year franchise to run the 369 bed Hinchingbrooke Hospital in John Major’s former Huntingdon constituency are so stringent that analysts said there was not likely to be much private sector interest.

The offer comes as Andy Burnham, the health secretary, has stressed that while NHS organisations are the labour government’s “preferred provider” of NHS care, services can still be franchised or tendered where they have proved financially unsustainable.

Whoever wins the contract, however, the NHS will continue to own the assets, according to the East of England Strategic Health Authority, which is running the tender. Staff will remain on NHS terms and conditions and will not be transferred to the winning franchisee.

All current services will have to be retained. But the franchisee will have to take full demand and volume risk with no guarantees on future revenue. In addition, on a £92m turnover for the past year, the operator will be expected to help pay back at least some of the £38.9m of debt that the hospital has accumulated over the years and which it owes to the rest of the NHS.

The health authority says there is significant private sector interest in the deal, as well as interest from NHS foundation trusts and other health service organisations.

But the NHS Partners Network, which represents private providers of NHS care, said the offer “appears to lack commercial reality”.

Private providers have been told some of the conditions may be negotiable, said David Worskett, the network’s director. “But it doesn’t seem to give sufficient scope for doing things differently to make it an attractive proposition,” he added.

William Laing, of analysts Laing and Buisson, said the private provider that wins the contract is “being asked to take all of the risk while being denied the tools needed to make any real changes”.

The health authority said it was expected to take 18 months to conclude the deal.
 

The Public Interest Disclosure Act provides protection for people who blow the whistle, providing they have raised concerns with their employer, and it specifically overrides any agreement aimed at preventing proper disclosure.

Furthermore, even before the 1998 act came into force, it was the health department’s policy that confidentiality or gagging clauses should not be used in the NHS, a stance they have since reinforced.

But the case of Peter Bousfield, a consultant who raised fears about patient safety at the Liverpool Women’s NHS Trust, illustrates that such clauses are still in use, the BMJ said. Equally, some consultants who leave their NHS Trust “under a cloud” – because colleagues are worried about their competence – are inserting confidentiality clauses into their departure agreements that prevent the hospital or colleagues disclosing their worries to future employers.

Mr Bousfield, a senior consultant and former medical director, was given early retirement and a pay-off when the hospital rejected his concerns. It inserted a confidentiality clause that prevented him raising concerns with anyone other than the hospital board and the secretary of state for health.

The journal also cites an anonymous case where a consultant reported concerns about a newly appointed colleague’s work, only to find when contacting the doctor’s previous hospital that it had “seemingly been keen to be relieved of the doctor’s services whatever happened in future” but had agreed a gagging clause over the departure so that “nothing could be discussed”.

When the doctor quit his new hospital “another gagging clause” was imposed. The consultant says: “I felt incensed that even when two trusts were aware of repetitive behaviour they did not, or could not, join forces to save a third from employing this person.”

Dr Mark Porter, chairman of the British Medical Association’s consultants committee, said that in a recent survey 15 per cent of doctors who had reported concerns said their employers had indicated that “speaking up could negatively affect their employment”.

Public Concern at Work , the charity that helped engineer the Public Interest Disclosure Act and which runs a whistleblowers’ helpline, said it was aware of other cases in the NHS.

Dr Porter said staff should not be able to take vendettas to the media before employers had had a chance to deal with the concerns. But “to say there are no circumstances in which a concern for patient safety can be raised outside the organisation, or to attempt to enforce silence through a contractual mechanism, is appalling”.

From:

Lord Drayson, the Science and Innovation Minister, wrote to No 10 asking if the Prime Minister could undo the Home Secretary’s decision to dismiss David Nutt.

He said that he had not been consulted by Mr Johnson before Professor Nutt was sacked for having said that alcohol and tobacco were more dangerous than Ecstasy and LSD, and for questioning the decision to downgrade cannabis. 

Almost 100,000 individual patients have now chosen the private sector for diagnostics and waiting list operations, paid for by the NHS, since the option was first offered.

The great bulk have done so during the past year.

The rise in NHS patients has thrown something of a lifeline to private hospitals, which have seen the number of patients willing to pay for treatment out of their own pocket – as opposed to via insurance – fall in the recession. There are also indications that the private health insurance market is stagnant or falling for the same reason.

Since April last year, NHS patients have been able to choose any private hospital willing to take them at NHS prices, and almost all private hospitals are registered to participate in the scheme.

Over 18 months, and after a very slow start, the numbers doing so have quadrupled from 2,100 a month in April 2008 to 8,400 this August. The business is now worth £200m a year to the private sector, and rising, according to Bob Ricketts, director of system management at the Department of Health.

These numbers are on top of NHS patients being treated in independent sector treatment centres, and those treated where primary care trusts or NHS hospitals buy operations from the private sector in order to hit NHS waiting time promises.

All NHS business is now understood to account for more than 20 per cent of the income of some private hospital groups, and more than a third of the income for Ramsay Health Care business, which runs a chain of independent sector treatment centres.

William Laing, chief executive of the analysts Laing and Buisson at whose conference Mr Ricketts disclosed the new figures, said: “This is great news for the private hospital groups because they can turn the tap on and off at will for NHS patients. If and when self-pay revives, they can run down their NHS work.”

Despite the rise in patients choosing the private sector, it still accounts for only a fraction of all NHS waiting list surgery- less than the potential 15 per cent that ministers once indicated was possible. 

The labour Government’s drugs tsar was sacked for stating his view that cannabis, ecstasy and LSD were less harmful than the legal drugs tobacco and alcohol.

The Home Secretary Alan Johnson asked Professor David Nutt to resign as chairman of the Advisory Council on the Misuse of Drugs (ACMD), saying he had “lost confidence” in his ability to give impartial advice.

But Professor Nutt, who is head of psychopharmacology at the University of Bristol, retaliated, accusing the Government of “misleading” the pubic in its messages about drugs and of “Luddite” tendencies.

He was backed by other senior scientists and politicians.

Colin Blakemore, professor of neuroscience at Oxford University and former chief executive of the Medical Research Council, said: “The Government cannot expect the experts who serve on its independent committees not to voice their concern if the advice they give is rejected even before it is published. “I worry that the dismissal of Professor Nutt will discourage academic and clinical experts from offering their knowledge and time to help the Government in the future.”

Richard Garside, director of the Centre for Crime and Justice Studies at King’s College London, where Professor Nutt made his comments, said: “I’m dismayed that the Home Secretary appears to believe that political calculation trumps honest and informed scientific opinion. The message is that, when it comes to the Home Office’s relationship with the research community, honest researchers should be seen but not heard.” He added it was “a bad day for science and for the cause of evidence-informed policy making”.

Professor Nutt had become a thorn in the side of ministers with his criticisms of drugs policy. He clashed with former home secretary Jacqui Smith when he suggested ecstasy, which causes 30 deaths a year, was less dangerous than horse-riding, which causes 100 deaths a year. He also argued that, to prevent one episode of schizophrenia linked to cannabis use, it would be necessary to “stop 5,000 men aged 20 to 25 from ever using” the drug.

Most drugs experts believe his analysis is right. But ministers did not want to hear the truth or at least to be reminded of it repeatedly.