Having launched the Identity and Passport Service last week- which 96% of the population doesn’t want, the labour govt are still going ahead with their health database.

The Department of Health has declared it will push ahead with a mass roll-out of its controversial Summary Care Record (SCR) – uploading parts of your medical record and personal details to a centralised system that is ultimately intended to hold your complete medical history.

So far, only London and the East of England have been mentioned but other regions may be targeted too.

A University College London report found scant evidence for any of the claimed benefits in SCR pilot areas but it appears the Department of Health still wants to ride roughshod over patient consent and medicalconfidentiality.

Having outraged medics and patients with its ‘implied consent’ model – where it is assumed you have consented to having your sensitive information uploaded if you do not respond to a single notification
letter – the Department has adopted a bizarre approach it calls ‘consent to view’.

Under this scheme, you will still only be sent a single letter. If you do not respond, your details will still be uploaded onto the system where they will be accessible to all sorts of non-clinical staff including administrators, bean-counters and bureaucrats, without your knowledge or consent. 

It is clear that ‘consent to view’ will not protect medical confidentiality. And the roll-out may be coming to you, sooner than you think.

Please be on the alert and, if you haven’t done so already, think about opting out now. You can always opt in later, if the government can prove its system works. 

Sufferers living in some parts of the North are far more likely to undergo the major operation, rather than having the “breast conserving” surgery more common elsewhere, according to NHS figures revealing a “postcode lottery” in cancer care.

Statistics showing the ratio of mastectomies to less invasive procedures to treat breast cancer, show that Redcar and Cleveland, in the North East, is the place where patients were most likely to have at least one breast removed.

Those in the London borough of Richmond and Twickenham were the most likely to receive treatment which removed just part of their breast, with radiotherapy used to prevent the spread of tumours.

The statistics show that those living in Wolverhampton, West Midlands, the London borough of Kingston, South Staffordshire and Telford in Shropshire were also more likely to have mastectomies.

Research has found that for many women with breast cancer, either treatment has a similar survival rate, if the tumour is of a size where it can be removed without the whole breast being lost. The chance of drastic surgery was highest in the North. 

Those in Ashton, Leigh and Wigan, in the North West, Middlesbrough, in the North East and Bassetlaw in Nottinghamshire were also most likely to have mastectomies.

The new NHS figures, placed in the House of Commons library, show massive variations in practices across the country. Analysis found no relationship between the patterns and rates of survival in different parts of the country.

Experts said it was impossible to know from the data whether the massive discrepancies reflected the choices made by women from different areas, or pressure put on them by surgeons.

Cancer charities urged surgeons working in the areas most likely to carry out mastectomies, to carry out further investigations.

Women with breast cancer should be offered the option of mastectomy, or less invasive surgery backed by radiotherapy. Research has shown that for most women, the survival chances are similar, although those with larger tumours may have no choice but have the more drastic operation.

Meg McArthur, from Macmillan Cancer Support, said: “These variations are really substantial, and they really do require further investigation. In some cases – such as the way a tumour is positioned, women would have no choice but to have a full mastectomy, but that really wouldn’t explain the scale of the difference shown here.”

She said it was vital that women diagnosed with breast cancer were given full information about the risks and benefits of different treatments.

“I would want all surgeons to look closely at these figures, and for primary care trusts to examine them closely too,” Miss McArthur added.

Dr Jane Maher, chief medical officer for Breakthrough Breast Cancer, said it should not be assumed that women in areas most likely to have mastectomies were necessarily being put under pressure to undergo the procedure. Many women given information about the risks and benefits of both procedures chose the more drastic surgery, because they felt more able to put their fears behind them if they took the most extreme option.

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The so called tariff, or price paid per treatment, which covers about 70 per cent of the income of a typical NHS hospital as well as private ones that take NHS patients, is to be frozen for the next year. It will go up by a “maximum” of zero per cent for the subsequent three years – implying that it could actually be cut.

NHS hospitals will also have to make efficiency savings of 3.5 per cent next year. Where they treat more unplanned admissions than in 2008 they will be paid only 30 per cent of the tariff price – a move aimed at getting them to work with their primary care trusts to prevent unnecessary unplanned admissions.

The moves “will drive all providers to become as efficient as the highest performers”, Andy Burnham, health secretary, said in a document that sets out how he believes the NHS needs to change over the next five years.

Family doctors, who face a pay freeze next year, will also be told they have to hand back at least 1 per cent of their expenditure to primary care trusts in ­cash-releasing efficiency savings.

The strong pressure on prices will either help drive the productivity improvements that the NHS needs to achieve savings of £15bn to £20bn over the next few years, or plunge hospitals that fail to adapt into financial crisis.

Mr Burnham denied that this could mean hospital closures, but said “that hospitals will have to change” with more patients treated in the community.

The best Foundation Trusts were to be allowed to take over community services in an attempt to provide more integrated care, possibly including GP services. And over the next few years up to 10 per cent of the treatment price would depend on surveys of patient satisfaction, the aim being to create “a people-centred service”, Mr Burnham said.

The NHS was to be protected from inflation after 2011, meaning the big spending rises of recent years were being “locked in”, he added.

The Conservatives, however, pointed out that NHS employers would have to pay more than £400m in higher national insurance contributions from that year, creating “a real terms cut” in NHS spending.

Across the country, it will raise more than £9bn, while the Treasury says the inflation protection the NHS is being offered will add about £3.7bn to spending by 2012-13.

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The new scheme will allow patients with rare diseases to receive important new drugs which have not been appraised by the NHS rationing body, NICE (National Institute for Curbing Expenditure).

It will allow the makers to build up sufficient evidence on the benefits of the drugs which will then be used by Nice to decide if the medicine is cost effective enough for the NHS.

Currently, it is very difficult to provide enough evidence of a drug’s benefits if only small numbers of people take it.

A pilot scheme of the so-called Innovation Pass has been launched by ministers.

The Innovation Pass pilot will be funded from a ring-fenced £25m budget in 2010/11.

Health Minister Mike O’Brien said: “I am extremely pleased to launch this consultation that will help patients with the greatest need to benefit from and get access to exciting new innovative drugs.

“The Innovation Pass pilot will help collect the essential data needed to demonstrate that such drugs, which would not otherwise be available to patients, are making a big difference to their lives.”

Andrew Dillon, Chief Executive of Nice, said: “We recognise that for a small number of very promising new treatments, the evidence available may not reveal their full potential benefits for patients.

“Where there is a high risk that a Nice appraisal of a new treatment at the point of its first use in the NHS might underestimate its benefits, providing the opportunity to gather more evidence and making the treatment available before undertaking an appraisal is the right thing to do.

“We’re happy to play our part in making this new arrangement work well, and that it works in the interests of patients and the NHS.”

The Innovation Pass pilot consultation will run for 10 weeks, closing on 8th February 2010. Input and comments are welcome from all groups including stakeholders, industry, the NHS and patient groups.

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GPs are already immunising people with health problems and pregnant women.

But the British Medical Association and labour government have ended talks on children after they failed to agree a deal.

Health visitors and district nurses are now to be asked by local NHS managers to step in – but the programme may will now start in December as planned.

However, the vaccination of the first wave groups, which also include health workers, is continuing as normal as they were covered by a deal that was brokered in early autumn.

It is thought the latest talks broke down over the amount of flexibility the government was willing to give doctors over the rest of their workload.

Negotiators had offered doctors £5.25 per dose – the same as they are getting for the first priority group.

But the BMA had argued doctors should be given leeway over fulfilling their obligations on access to appointments.

Under the terms of their contract, doctors are paid bonuses to give most patients appointments within 48 hours as well as allowing them to book in advance.

Without this, the BMA argued vaccinating 3m children during the busy winter period would leave doctors out of pocket – doctors consider young children to be time-consuming as parents often have to be reassured.

Dr Laurence Buckman, chairman of the BMA’s GPs committee, said: “We sincerely wanted to be able to reach a national agreement. Unfortunately this has not been possible, because the government would not support adequate measures to help free up staff time.”

“At the busiest time of the year for general practice, with surgeries already dealing with the additional work of vaccinating the first wave of at-risk groups, we felt this was vital in order to ensure this next phase could be carried out quickly.”

Health Secretary Andy Burnham said the breakdown of talks was “disappointing”, but he still hoped to get the vaccination of children going by Christmas.

It is still possible that some doctors will agree to vaccinate children if they can reach individual deals with their local health managers.

However, the government has asked health chiefs to focus their attention on other NHS workers.

District nurses routinely carry out vaccinations for housebound patients as part of other immunisation programmes, but it remains to be seen whether they will be able to vaccinate large numbers of children.

Health visitors are also likely to be asked to help, but many of them do not have experience of vaccinating and will need extra training.

The British Medical Association believes it will be “very difficult” to get this all in place this year.

And David Stout, of the Primary Care Trust Network, which represents local health managers, agreed there was still a lot of work to do.

“It is more complicated to get separate agreements in place and will take several weeks. We don’t know who will want to do this so from that point of view it is untested. I can’t see it happening before Christmas.”

The amount spent on employing managers has risen by a quarter, or £78 million, in the past two years, the study shows. NHS Trusts blamed Whitehall targets for the increase.

It comes a day after NICE, the drugs rationing watchdog, refused funding for life prolonging bowel cancer drug Avastin, saying it was not cost effective.

Pulse, a magazine for GPs, found that projected spending on management salaries has increased by 25 per cent between 2007/08 and 2009/10 in primary care trusts, which look after community services. It was up from £312million to £390million.

But the true figure is likely to be far higher, because only a third – 55 – of the 152 trusts responded.

The rise is largely down to trusts taking on more managers, with 15 that provided headcounts saying the number of posts had gone up 14 per cent.

These trusts also reported that the cost per manager had risen by 11 per cent. David Stout, director of the NHS Confederation’s PCT Network, said it was “unrealistic” for such increases to continue.

“A lot of this is spending trusts are carrying out in response to what the Department of Health has asked for,” he told the Daily Mail.

Conservative health spokesman, Mike Penning said: “It is inevitable the rises must be keeping money away from patient care and the front line.

“Labour ministers must explain why so much more is being spent on management after a reorganisationof PCTs that was intended to produce efficiency savings.”

The editor of Pulse, Richard Hoey, added: “What we’re seeing exposed here is the bureaucratic machinery that has been put in place to implement Government policy priorities.

“These are policies which look good on paper, but in practice create whole new chains of managerial command.”

A “Public Sector Rich List”, compiled by the TaxPayers’ Alliance and covering 350 public bodies, shows that 806 executives collected more than £150,000, with eight on packages worth more than £1 million.

The list, which covers Whitehall departments, quangos and nationalised industries, shows that average pay among those identified was £225,000, with 120 chiefs on more than £250,000. More than 250 quango heads were on more than £150,000 in 2008-09. Nearly 80 NHS executives earned more than the Prime Minister.

At a time when all three main parties are proposing a squeeze on public sector pay, salaries at the top have been shooting up, the figures show. While some private companies froze or cut pay, that of the 800 public sector chiefs identified rose by 5.4 per cent, the TaxPayers’ Alliance says.

George Osborne, the Shadow Chancellor, has already pledged to publish the salaries of all public sector staff earning more than £150,000 if the Tories win power. He has also said that anyone earning more than the Prime Minister’s salary of £194,000 would need his approval.

Many of the highest earners in the list include present and former employees of recently nationalised banks. Mark Fisher, former executive director of Royal Bank of Scotland, tops the list with a package of £1.39 million. Sir Fred Goodwin, the bank’s former chief executive, was on £1.3 million.

Vince Cable, the Liberal Democrat Treasury spokesman, said: “With 806 public sector employees taking home more than £180 million a year between them, it is clear that even in these difficult times, profligacy at the top of the public sector lives on.”

The NHS figures show substantial rises for some staff as trusts compete for the best managers. Nearly 60 NHS chiefs earn more than the Prime Minister, with one said to be earning nearly twice as much. A further 290 earn more than £150,000.

Professor Salman Rawaf, who recently retired as director of public health at Wandsworth Primary Care Trust in West London, earned £370,000 last year, comprising a salary of £150,000 and £175,000 of other remuneration.

Sian Thomas, director of NHS Employers, said that many of the individuals’ pay combined salary and clinical excellence awards, all set nationally. “Pay of senior managers in NHS organisations is set by their remuneration committees and boards,” she said. “Therefore these arrangements will vary. Across the public sector the practice of linking remuneration to performance varies.”

Philip Hammond, Shadow Chief Secretary to the Treasury, said: “Nobody objects to paying public sector executives properly if they are delivering excellent results for the taxpayer. But over the last decade, public sector pay has risen while performance has languished. Under a Conservative government, only those who deliver value for the taxpayer can expect high salaries.”

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The chancellor told the BBC’s Andrew Marr Show the £12.7bn NHS IT programme – already running years late – was “something that I think we don’t need to go ahead with just now”.

Treasury officials rushed to explain that the government was looking for “significant savings” of up to perhaps £600m over the medium term by cutting back some features that are less important for patients.

Details of which elements would go were not clear on Sunday night. But the government would face compensation claims of many hundreds of millions of pounds if it cancelled the programme. Fujitsu, an IT provider, is already in mediation with the health department over its £700m compensation claim after it was fired last year.

Ahead of Wednesday’s pre-Budget report, Gordon Brown will on Monday announce that the government has found another £3bn of “efficiency savings” – in practice, many of them cuts – since the Budget.

In a change of rhetoric, Mr Brown is expected to argue these savings are an “element of our efforts to reduce the [£175bn] deficit”, not just a means of protecting frontline services.

Some 123 quangos will go – including the Foreign Office advisory committee on wine purchasing – with the courts inspectorate merged into an existing inspectorate and several health bodies merged with NICE, the National Institute for Curbing Expenditure.

Full details of quango mergers and abolitions will not be spelt out until next year’s Budget, but they are expected to save an estimated £500m.

Central government’s use of consultants will be halved and the marketing budget cut by 25 per cent, saving £650m. Better use of text messaging and online services should save £665m – for example by reducing missed hospital appointments – according to government estimates.

Many of the proposals, which the prime minister will present as “streamlining government”, mirror those from the Tories, who have promised to slash the use of consultants to cut council tax. They also propose reducing by 24,000 the 80,000 civil servants employed in policymaking, inspection and regulation, and grant assessment over the next Parliament.

The FDA, the top civil servants union, condemned the planned cut in civil service numbers as “crude electioneering” and “irresponsible” just months ahead of a general election.

Mr Darling’s apparent scrapping of the NHS electronic record programme excited both the Conservatives and the Liberal Democrats, the latter calling for it to be “abandoned in its entirety” and Andrew Lansley, the Tory health spokesman, describing it as “another government IT procurement disaster”.

Andy Burnham, the Health Secretary, told The Times that millions of pounds would be “reprioritised” from health research and development to pay the costs of the Social Care Bill..

Money will also be diverted from public health campaigns such as those on swine flu, sexually transmitted diseases and obesity.

The Bill, a key plank of Gordon Brown’s pre-election legislative agenda, has been condemned by Labour peers, scientists and health campaigners. It would guarantee free care at home or other support for up to 400,000 elderly and disabled people from next October, at a cost of £670 million a year.

Mr Burnham, disclosing for the first time how he planned to pay for the proposal, said that £60 million would be diverted from the health service’s research and development (R&D;) budget and £50 million from public health promotions.

Scientists warned of the consequences of cutting research budgets, which help to support the clinical trials of new medicines.

Nick Dusic, director of the Campaign for Science and Engineering, said: “This is extremely disturbing as the NHS budget was supposed to be ringfenced to protect long-term investment into the health needs of this country. In any department any raid on the R&D; budget is supposed to be discussed first with the Government’s Chief Scientific Adviser. If they’ve breached this process it’s an extremely worrying development that needs to be looked into.”

Health ministers are expected to be interrogated in detail about which elements of the R&D; budget should be cut to pay for social care as part of a continuing inquiry by the Lords Science and Technology Committee.

Lord Warner of Brockley, the Labour peer and former Health Minister who last week described the social care proposals as “totally misjudged”, said: “I will be looking at the Bill very carefully to see if my worst fears are confirmed and whether the figures really do add up.”

Mr Burnham defended the Bill from claims that it amounted to “an admiral firing an Exocet into his own flagship”.

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http://www.timesonline.co.uk/tol/life_and_style/health/article6930661.ece?token=null&offset;=0&page;=1

The new website www.isdscotland.org/ — unveiled by Malcolm Chisholm, the health minister, was meant to allow patients to choose a clinic with the shortest waiting time but contains information that is up to nine months old.

The leader of Scotland’s GPs condemned the figures as “virtually useless” and patients’ groups described the initiative as “flawed”.

The database should provide the latest waiting times for first outpatient appointments at 3,030 clinics across Scotland. Until now the information had been available only to GPs.

Speaking at the website’s launch, Chisholm said: “This database is good news for patients and will support patient choice.”

However, detailed examination of the information has revealed that waiting times for more than 260 clinics are at least three months out of date.

The figures for outpatient clinics across Fife were last updated at the beginning of July. In Lanarkshire and Glasgow waiting times for more than 100 clinics dated back to February. Two clinics in Lanarkshire even listed waiting times for January. And most hospital waiting times were for early October.

Dr David Love, joint chairman of the British Medical Association’s Scottish GP’s committee, said information dating back several months was “virtually useless”.

He said: “It is a good idea and could be quite useful if patients do their homework before coming to the GP, but the whole thing hinges on the information being accurate. If it is not, it could create more work.”

Margaret Davidson, chief executive of the Scotland Patients’ Association, added: “This website is flawed. The figures have to be up to date for them to be any use.

“Questions also have to be asked as to whether patients will be treated at the hospitals they choose. I don’t think they will.”

Dr Ian Johnston, a member of the local GPs’ committee in East Lothian and a family doctor in Musselburgh, said waiting times should be no more than six weeks old if they were to be of any use. “There is no point in having something on a website that was done in February,” he added.

The launch of the website has been used by opposition politicians to highlight long waiting times of up to 2½ years. According to the target set by the executive, by the end of 2005 nobody should have to wait more than six months for a first outpatient appointment.

A spokeswoman for the executive said the Information and Statistics Division (ISD) of the NHS was responsible for the website. She added that most of the waiting times were up to date.

The ISD admitted that it had decided to launch the website even though some data was many months old. A spokesman said the out-of-date waiting times were the result of old data collection systems which were being modernised.