Patients’ groups described the tactics as an “appalling scam” to enable NHS bosses to claim waiting times are far shorter than they are, simply by denying a place in the queue to many of those referred for surgery.

Under the plans drawn up by NHS bureaucrats in Kent, any smoker referred for “non-urgent” operations – such as hip replacements or cataract surgery – will not be allowed to join the queue until they have either given up smoking, or completed a 12-week course to help them ditch the habit.

Those who are seriously overweight will also be denied a range of operations until they have completed a three month NHS diet programme.

Although every patient has a legal right to be treated in 18 weeks of being referred for treatment by their GP, the protocols agreed mean different rules could be applied for anyone with a body mass index of more than 30, or those who smoke.

Patients groups said delays getting a place on 12-week “smoking cessation” and “weight loss” programmes could leave many patients waiting even longer than 30 weeks implied by proposals drawn up by NHS West Kent Primary Care Trust (PCT).

Katherine Murphy, from the Patients Association, said: “This is an appalling kind of scam – it is a clear device to manipulate the waiting lists simply to cut their deficit. It smacks of desperation, and it is patients who will suffer.”

The plans, seen by The Sunday Telegraph, explicitly say the rules have been introduced to save money by the end of the year.

The document says: “PCTs across the country are making decisions on prioritising treatments in order to match demand to the financial resources available to the economy as a whole and to individual trusts.

“Unfortunately this does not take us far enough: we need to take additional activity to reduce activity in this financial year if we are to be in a position to hand over a balanced budget.”

Under the proposals, smokers already on waiting lists will now be taken off until they have either been on the courses or given up smoking. New referrals will not be allowed on the lists until they have done the same.

All patients with a BMI of 30 or more who are referred for several types of surgery including hip and knee operations will also be cast off the lists until they have been on a three-month diet programme.

Many primary care trusts already try to encourage patients to stop smoking or lose weight before operations, in order to reduce the risks to them.

But patients’ groups said the use of tactics to delay even putting patients on the waiting lists was a far more draconian step.

Mrs Murphy said: “This is a clear way to keep these patients off the lists in order to cut costs, while the PCT can officially claim its waiting times have not lengthened.”

Simon Clark, director of the smokers’ lobby group Forest, accused the PCT of discriminating against smokers and creating a “two-tier” system.

He said: “Of course patients should be told that smoking could have an impact on the success or recovery from an operation, but given that they have paid huge sums in taxation on cigarettes over the years, the question of whether or not they have the surgery should be one for them, not the NHS.”

A letter sent out by the PCT tells local GPs: “There is good evidence that stopping smoking prior to surgery reduces length of stay and infection rates, and improves healing time; it is also a time when people are often highly motivated to give up.”

Kent doctors accused managers of being dishonest about the real reasons why patients were having their treatment delayed.

Dr Stephen Meech, a GP from Maidstone, said: “Patients are going to be told that they cannot have an operation because they smoke or need to lose weight, when that is not actually true – it is because the health authority can’t afford to pay for it.”

Dr John Allingham, a GP from Hawkinge, said: “The plan is extremely contentious and it is a way of extending the waiting times.

“If you’ve got to do a 12-week smoking cessation course before you can have your hernia fixed, or before you’ve even gone on the waiting list to have your hernia fixed, it immediately makes those waiting lists another 12 weeks longer.”

The PCT said it was in talks with local doctors over the proposals. Marion Dinwoodie, its chief executive, said she regretted the need “to take measures in the short term that may have an impact on local people”.

She said no one with a compelling clinical need for treatment this year would miss out.

From: http://www.telegraph.co.uk/Smokers-and-fat-patients-thrown-off-NHS-waiting-lists

This month, Bob Ainsworth, the minister responsible for narcotics policy between 2001 and 2003, called for an end to the “war on drugs”, arguing that addiction is a medical problem and that millions of pounds are being spent without preventing the wide availability of addictive chemicals.

Peter Lilley, the former Conservative cabinet minister, agreed with him. “The current approach to drugs has been an expensive failure,” he said. “For the sake of everyone, and the young in particular, it is time for all politicians to stop using the issue as a political football.”

Do they have a point? After all, the purpose of banning drugs, when prohibition took off in the early 20th century, was to reduce the harm they do.

On that measure, our laws have been a dismal failure. Addiction costs the British economy billions every year, while channelling billions more to criminal networks.

Simply enforcing the law more stringently, as some propose, is not much of an answer, since few people want to see teenagers filling up prisons for possessing small amounts of cannabis. So what would actually happen if the prohibition on the sale of drugs were lifted?

That’s the trouble: no one knows.

The last time all drugs were legally available was the mid-19th century, and that was a more ordered era: then, you could buy laudanum – an alcoholic tincture of opium – for medicinal purposes, in your local corner shop. Some ordinary folk gulped it daily, a bit like Valium 100 years later.

In East Anglia, they grew opium poppies in the fields, and used them to fortify the beer. Even fractious babies were dosed with the stuff, which caused some unfortunate accidents. Cocaine, meanwhile, was a key ingredient in a variety of invigorating tonics.

Despite such widespread availability of narcotics, society didn’t fall apart – but then, the Victorians had social pressures which acted as restraints on behaviour. These days, more people than ever before seem to struggle with their appetites, whether for food, sex, booze or drugs. It’s possible that liberalising the law would lead to a catastrophic increase in the number of addicts.

Mind you, there is one European country where the government has tried a liberal approach: Portugal.

In 2001, the Portuguese enacted a law that decriminalised all drugs. The evidence so far shows no explosion of addiction, nor has Lisbon turned into a cesspit awash with drug traffickers, as some predicted.

“Judged by virtually every available metric,” says Glenn Greenwald of the Cato Institute, a libertarian US think tank, “the Portuguese decriminalisation framework has been a resounding success.” In the first five years of the new policy, illegal drug use among teenagers declined, as did deaths caused by drug use. Portugal now has among the lowest rates of drug use in the EU.

Amid this month’s fuss, we should remember that Bob Ainsworth is an ex-trade union leader from Coventry, not some hippy libertarian proposing hedonism for all. He simply thinks that the current system is causing more harm than good, and we should try something different. He is acknowledging that the debate is changing and that a new approach is needed.

The nature of the problem is changing, too – even the nature of the drugs themselves.

The medicine cabinets of Middle England are increasingly stocked with painkillers – prescribed by doctors – that are every bit as potent as anything than can be bought from a street-corner dealer. These are drugs, too, but they’re perfectly legal ones. So Mr Ainsworth’s remarks are to be welcomed.

At the moment, we live in a strange world in which politicians are frightened to talk about the realities of drugs in the way the rest of us do. It’s about time we allowed them to say what they really think.

From: http://www.telegraph.co.uk/Politicians-should-say-what-they-really-think-about-drugs

A Department of Health spokesman said: ”These figures are in keeping with what we would expect during a winter flu season.

”But everyone can do their bit to help keep well – simple measures like washing your hands help stop flu spreading.

”The Chief Medical Officer has issued clear advice to get the seasonal flu jab if you are in a vulnerable group, particularly pregnant women and people with an underlying health condition, as well as those aged 65 and over.

”We are pleased to hear from RCGP that their estimates show vaccine coverage in over 65s has now caught up with last year and coverage is still going up in under 65s’ in-risk groups.”

The RCGP said that the increase was evident in all age groups except school children.

There has been a substantial increase in age groups 45-64.

The increase still falls short of epidemic levels, which experts define as 200 cases per 100,000.

The figures come after Labour was yesterday accused of dangerous scaremongering over flu jabs for children, as the Government vehemently denied claims it had ignored expert scientific advice over protecting youngsters.

The political row broke out after shadow health secretary John Healey accused ministers of having “cancelled” an immunisation programme for the under-fives.

This provoked a furious response from the coalition, which insisted it was the independent Joint Committee on Vaccination and Immunisation (JCVI) which recommended that no specific programme was required this winter.

Health minister Simon Burns called for an apology and suggested it was Mr Healey who was putting people’s health at risk by creating false fears about the risks.

From: http://www.telegraph.co.uk/Flu-cases-rise-40-per-cent

Senior nurses suggested the helpline was struggling to cope with the overload of calls as figures show the number of people calling the helpline had dramatically increased over the past few days.

An NHS Direct spokeswoman admitted the telephone advice service was “experiencing extremely high demand as a result of the severe weather”. She said the service had received 50 per cent more calls than forecast.

Up to 46,000 people called the service last weekend, the equivalent of almost 960 an hour.

It was also disclosed that there had been 5,700 more calls made to NHS Direct last week compared with the same week last year.

The online “symptom checker” system was used 160,000 times while the colds and flu symptom system was the most used service with almost 59,000 checks.

NHS Direct management apologised to patients who had been forced to wait longer than expected.

It came as doctors were told they could prescribe Tamiflu to otherwise healthy people suffering from flu as the illness prompts a surge in hospital admissions.

The move is an indication of the authorities’ concern about the risks from swine flu, which has become the predominant strain of the virus this winter and is striking younger age groups than usual.

Cases of flu have risen more than six fold in three weeks, the latest figures show.

Normally antiviral drugs, such as Tamiflu and Relenza, are only prescribed to people with flu who have other conditions such as heart disease and severe asthma because of the extra risk that influenza poses to them.

But officials are so concerned at the number of otherwise healthy people who have been admitted to hospital that they are taking special measures to lift these restrictions.

Doctors will be able to use their discretion and prescribe the drugs, which shorten the length of the illness by about one day and reduce spread, to anyone they think will benefit.

The drugs are most effective if taken within 48-hours of symptoms first appearing.

Prof Dame Sally Davies, interim Chief Medical Officer, has written to all GPs with the new instructions as figures were released showing there are more than 300 people in intensive care with flu, higher than during any point in last year’s pandemic. Last week there were 180 people in intensive care.

Nine of the 17 deaths, that have so far been linked to flu this winter, were in otherwise healthy people. None of those victims had been vaccinated with this year’s seasonal flu jab or the pandemic vaccine against just swine flu that was administered last year.

Figures released by the Royal College of GPs disclosed that the number of people going to their GP with flu-like symptoms has more than doubled in a week. There were 87 consultations per 100,000 people in the week up until December 19th compared with 34 the week before.

In the week ending December 5th just 13 consultations per 100,000 people were about fly symptoms. Illness was most common in children aged between five and 14, followed by children under four, and those aged between 15 and 44.

It is not known how many of those people have had swine flu but the H1N1 virus is the most common this winter.

The letter to GPs said: “Antiviral treatments for influenza are currently only available from GPs for NHS patients who are in a designated “at clinical risk” category.

“The most recent surveillance data indicate that higher than normal numbers of patients, who are not in one of the “at clinical risk” groups, are becoming seriously ill with flu – requiring hospitalisation.

“Regulations currently say that prescribers should not order oseltamivir and zanamivir [Tamiflu and Relenza] for patients who are not in the target risk groups.”

It added: “However, the Chief Medical Officer has recommended that the current restrictions should be amended to allow general practitioners (and other prescribers) to exercise their clinical discretion so that any patient who their GP feels is at serious risk of developing complications from influenza may receive these treatments on the NHS.

“This is consistent with guidance from NICE which informs the existing statutory restrictions but which envisages that prescribers may exercise their clinical discretion in individual cases.

“Whilst antiviral manufacturers and wholesalers should have sufficient supply to meet demand, prescribers and pharmacists are asked to consider carefully the need to order sensibly and not to stockpile. Stockpiling and over-ordering could cause shortages.”

It comes as doctors in some parts of the country are preparing to open their surgeries on Christmas Day to deal with large localised outbreaks of flu.

Doctors in Leicester have said the outbreak there is the worst for ten years.

Some GP practices will open on Christmas Day and Boxing Day as well as the Monday and Tuesday bank holidays – although doctors will only see patients registered at the practice.

Ivan Brown, a public health consultant with NHS Leicester City, said: “As things stand at the moment, we are confident we are managing well but we must do anything we can to avoid unnecessary admissions to hospital.

“At the moment, we do have enough hospital beds. There aren’t a huge number to play with but there are enough.

“I understand people are going to have a good deal of anxiety but, for the vast majority of individuals, the raft of winter-related illnesses around are self-limiting and patients will recover.”

Dr Brian Gaffney, NHS Direct’s Medical Director, urged people to use the online system.

“Patients can be assured that they will receive the same quality of advice that they have come to expect from the telephone service when they access our services online,” he said.

Meanwhile sales of over-the-counter medicine have increased dramatically as patients try to keep themselves well at home.

Tesco has reported a surge in demand for cold relieving powders and drinks, cough syrup, lozenges for sore throats and other related pain relievers and is selling around half a million of these products a day.

Tesco pharmacy buyer Joy Wickham said: “As if the Arctic temperatures and horrendous travelling conditions aren’t bad enough the UK is suffering a higher than normal incidence of colds and flu illness.

“We are selling nearly half a million cold and flu remedies plus pain relievers a day while our flu jab service uptake has more than trebled.

“Since the recent heavy snowfall we are also seeing far higher than normal demand in our high street Express stores which suggests that shoppers are finding it easier to buy their essentials in urban areas.”

From: http://www.telegraph.co.uk/NHS-Direct-under-growing-strain-as-doctors-told-to-give-Tamiflu-to-low-risk-patients

Last week, Bob Ainsworth, the minister responsible for narcotics policy between 2001 and 2003, called for an end to the “war on drugs”, arguing that addiction is a medical problem and that millions of pounds are being spent without preventing the wide availability of addictive chemicals.

Peter Lilley, the former Conservative cabinet minister, agreed with him. “The current approach to drugs has been an expensive failure,” he said. “For the sake of everyone, and the young in particular, it is time for all politicians to stop using the issue as a political football.”

Do they have a point? After all, the purpose of banning drugs, when prohibition took off in the early 20th century, was to reduce the harm they do. On that measure, our laws have been a dismal failure. Addiction costs the British economy billions every year, while channelling billions more to criminal networks.

Simply enforcing the law more stringently, as some propose, is not much of an answer, since few people want to see teenagers filling up prisons for possessing small amounts of cannabis. So what would actually happen if the prohibition on the sale of drugs were lifted?

That’s the trouble: no one knows. The last time all drugs were legally available was the mid-19th century, and that was a more ordered era: then, you could buy laudanum – an alcoholic tincture of opium – for medicinal purposes, in your local corner shop. Some ordinary folk gulped it daily, a bit like Valium 100 years later.

In East Anglia, they grew opium poppies in the fields, and used them to fortify the beer. Even fractious babies were dosed with the stuff, which caused some unfortunate accidents. Cocaine, meanwhile, was a key ingredient in a variety of invigorating tonics.

Despite such widespread availability of narcotics, society didn’t fall apart – but then, the Victorians had social pressures which acted as restraints on behaviour. These days, more people than ever before seem to struggle with their appetites, whether for food, sex, booze or drugs. It’s possible that liberalising the law would lead to a catastrophic increase in the number of addicts.

Mind you, there is one European country where the government has tried a liberal approach: Portugal. In 2001, the Portuguese enacted a law that decriminalised all drugs. The evidence so far shows no explosion of addiction, nor has Lisbon turned into a cesspit awash with drug traffickers, as some predicted.

“Judged by virtually every available metric,” says Glenn Greenwald of the Cato Institute, a libertarian US think tank, “the Portuguese decriminalisation framework has been a resounding success.” In the first five years of the new policy, illegal drug use among teenagers declined, as did deaths caused by drug use.

Portugal now has among the lowest rates of drug use in the EU.

Amid the week’s fuss, we should remember that Bob Ainsworth is an ex-trade union leader from Coventry, not some hippy libertarian proposing hedonism for all. He simply thinks that the current system is causing more harm than good, and we should try something different. He is acknowledging that the debate is changing and that a new approach is needed.

The nature of the problem is changing, too – even the nature of the drugs themselves. The medicine cabinets of Middle England are increasingly stocked with painkillers – prescribed by doctors – that are every bit as potent as anything than can be bought from a street-corner dealer.

These are drugs, too, but they’re perfectly legal ones.

So Mr Ainsworth’s remarks are to be welcomed. At the moment, we live in a strange world in which politicians are frightened to talk about the realities of drugs in the way the rest of us do. It’s about time we allowed them to say what they really think.

From: http://www.telegraph.co.uk/Politicians-should-say-what-they-really-think-about-drugs

Health Direct also points out the Professor Nutt- the then head of Labour’s drugs review board, was metaphorically castrated when he menthioned that the legal drug alcohol causes far more harm to society than any other drug.

The rise has been fuelled by growing dissatisfaction over the treatment of the elderly in hospitals, according to The Patients’ Association, which has launched a campign to improve NHS care for older people.

The charity wants matrons appointed within hospitals whose sole role is to look after elderly patients and ensure they are treated with dignity.

It is calling for fundamental change to the complaints system and the creation of an independent complaints body.

At present people must complain to the hospitals they feel have failed them.

The campaign would have met with the approval of their former president Claire Rayner who died in October.

She promised to haunt David Cameron if he failed to improve the NHS.

Her widower Des said: “Let the haunting begin.”

The charity campaign also aims to raise £100,000 to boost its dedicated helpline which helps NHS patients to submit complaints.

According to the NHS Information Centre 101,077 people made written complaints to hospitals compared with 89,139 in 2008/09.

From: http://www.telegraph.co.uk/Complaints-to-NHS-top-100000-for-the-first-time

The Wythenshawe Hospital study was led by Dr Michelle Harvie and examined 100 overweight women from Greater Manchester, with half following a 650-calorie-a-day diet for two days a week, and the rest following a 1,500-calorie-a-day diet for the entire week.

After six months on the diets, the women’s levels of the hormone leptin was down 40 per cent, their insulin levels down 25 per cent and their levels of inflammatory protein down 15 per cent. All three have been linked to breast cancer.

The other women followed a 1,500-calorie-a day Mediterranean diet. They showed similar weight loss and hormone reductions.

Dr Harvie said the new diet could be a life-saver for women who found it difficult to stay on a diet for a week.

Among the women who took part in the trial was research professor Gillian Haddock, who had been in a high-risk group for the disease. She lost a stone in six months on the diet and is now recommending it to her friends.

Pamela Goldberg, chief executive of the Breast Cancer Campaign, said: “There are many breast cancer risk factors that can’t be controlled, such as age, gender and family history – but staying at a healthy weight is one positive step that can be taken.

“This intermittent dieting approach provides an alternative to conventional dieting which could help with weight loss, but also potentially reduce the risk of developing breast cancer.”

Prof Haddock said: “I felt it was a really good study to be part of, and could provide women with some new options to improve their health.

“I had a family history of breast cancer, so I was relatively high risk. I found traditional diets, with calorie counting and preparations difficult to stick to.

“I used to follow the 650-calorie diet on a Monday and Tuesday and it was great because I knew that by Wednesday I would be eating normally.

“It really suited me, I did it on my busiest work days and I would mainly have the milky drinks while I was at work so I didn’t have to worry about shopping or taking in a specially prepared packed lunch.”

Example of 650 calorie day

Breakfast:
Fruit tea and a banana, or mug of milky coffee

Mid-morning:
Can of diet cola, or cup of tea and plum

Lunch:
Carrot and coriander soup and half-pint of milk, or salad, glass of squash and half-pint of milk

Mid-afternoon:
Glass of squash, or glass of sparkling water and satsuma

Dinner:
Soy sauce and ginger stir-fry with two vegetables and glass of water, or vegetable curry with two veg, half-pint of milk and cup of tea

Supper:
Pint of milk, or hot milk with cinnamon and sweeteners.

From: http://www.telegraph.co.uk/Dieting-for-two-days-a-week-can-almost-half-the-risk-of-breast-cancer

The letter says pressures on critical care services are “significantly over and above” those expected at this time of year.

Crucially, the memo, says that while “half of patients requiring respiratory support have had recognised comorbidities [underlying health problems] which increase the risk for severe influenza, half have had no recognised comorbidities.”

A spokesman for the Department of Health (DoH) confirmed that the presence of so many previously healthy people among those worst affected by the virus was “unusual” and said anyone concerned about worsening flu-like symptoms should contact their GP.

While overall flu levels remain normal for this time of year, the rate of flu has more than doubled in just seven days, latest figures show.

The official death toll from flu this winter has now reached 17, including six children. Fourteen of the deaths were linked to swine flu, and none of those who died had been vaccinated against the virus.

In the same letter, the senior doctor says pregnant women, children, young adults, and those who are overweight are among the most severely ill.

Yesterday, Prof Davies criticised the Government’s decision to axe the annual publicity campaign urging people in at risk groups to have the seasonal flu jab, which protects against the main viruses in circulation, including swine flu.

Prof Davies said: “The Government took a decision not to use the marketing campaign this year. I would prefer to have done it because I believe in belt and braces. I am a doctor – I don’t like leaving things to chance.”

For the first time, the winter flu jab is being offered on the NHS to pregnant women, who were disproportionately affected by last year’s swine flu outbreak, as well as to elderly people and those with existing health problems.

Pregnant women are being advised to be immunised, no matter how far into their pregnancy they are, since they are thought to be more than four times more likely than others to develop serious complications if they contract swine flu.

The medical officer said the number of people seeing their GP because of flu was “bang in the range” for the season.

However, the sharp rise in all flu cases in seven days and the number of people below the age of 65 being admitted to hospital were reasons why the Government was examining the patterns carefully, she said.

GPs are worried that elderly people, who suffered less than younger people in last year’s swine flu pandemic, are failing to protect themselves against other strains of flu.

Vaccination rates among the elderly are down two per cent on last year, while among at risk groups, rates are down by 6 per cent.

In some parts of the country, pharmacists and hospitals are complaining of shortages of the drug used to treat the virus. Chemists and hospitals in Yorkshire were unable to track down supplies of Tamiflu, with NHS bosses describing “difficulties with the national supply chain”. The DoH said there was no national shortage of the drugs, and that any local delays “should be short-lived”.

At least four more pregnant women with swine flu in England have undergone intensive care treatment. In Scotland, a woman with swine flu has been placed in a coma after giving birth to a daughter by caesarean section.

A spokesman for the DoH said GPs would be contacting patients in “at risk” groups to invite them to have the vaccination. He said: “It is vital that those at greatest risk are vaccinated as soon as possible.”

Anyone who did not know if they were in such a group should contact their GP, he said.

http://www.telegraph.co.uk/Swine-flu-half-of-worst-afflicted-were-previously-in-good-health

Private hospitals bucked the recession in 2009 – but only by massively expanding the amount of work they carry out for the National Health Service, according to the analysts Laing and Buisson.

However, work for NHS patients, who now have the right to go to any private hospital willing to treat them at the NHS price for waiting-list type treatments, rocketed.

Their numbers almost quadrupled between 2007 and 2009, up from 55,900 to 212,000, so that NHS patients made up almost 22 per cent of private hospital cases, up from 6.3 per cent in 2007.

The result was a rise in independent hospital activity, with about 975,000 patients treated, against 888,000 in 2007.

Some NHS patients are sent by NHS hospitals to keep waiting times down.

But the numbers exercising their right to choose are rising sharply – running at a rate of 200,000 procedures a year in July this year, according to Laing’s Healthcare Market Review, the bible on private sector activity. That is business worth £400m a year.

William Laing of the review said senior health department officials believe patient choice activity in the private sector could triple. His own estimate is that it might ultimately rise five fold to about £2bn a year – although that would still be less than 20 per cent of NHS waiting list activity.

“Expanding the services they provide for the NHS has obvious attractions for independent hospitals because the publicly paid market is massively greater than the traditional private healthcare market.

“But it has great dangers as well, since too much focus on publicly paid patients could compromise their appeal to traditional, privately paying customers. There is a conflict which independent hospital providers have not yet fully resolved.”

If the independent sector seriously wanted to address the potentially huge public market, he said, it would “have to grow a lot more capacity”.

That could come from a mix of the existing players and new hospital providers entering the market with lower cost business models that generate reasonable profits from the prices that the NHS is prepared to pay.

The figures came on the day the Office of Fair Trading launched a wide ranging review into the private healthcare market – among other issues examining the barrier to new entrants joining it.

From: http://www.ft.com/cms/s/0/675afcb4-07b7-11e0-a568-00144feabdc0,s01=1.html#axzz18ALgaS00

It means the scale of the savings required to meet rising demand with a shrinking budget is even greater.

The report quoted NHS chief executive Sir David Nicholson saying: “It is huge. You don’t need me to tell you that it has never been done before in the NHS context and we don’t think, when you look at health systems across the world, that anyone has quite done it on this scale before.”

Sir David predicted last year that the NHS would need to save between £15bn and £20bn over the next four years to keep pace with an ageing population, rising costs and lower funding settlements from government.

The Health Select Committee warned that severe cuts in social care budgets will also hit the NHS as there is a real danger some local authorities will have to reduce the eligibility criteria they use for care services meaning the NHS will have to pick up the pieces.

A large part of the savings is expected to come from paying hospitals less for treatments and operations but the report warned this could result in trusts refusing to provide surgery that they make a loss on.

The Committee was also critical of the government’s reorganisation of the NHS saying that many experts had suggested that it was too complex to try and attempt this at the same time as making such huge savings.

The report said the government must urgently release details of how much they expect the changes, which include abolishing primary care trusts and setting up GP consortia, to cost.

Stephen Dorrell MP, chairman of the committee, said: “The government’s plans for health and social care are based on assumptions which will test these services to the limit.”

Nigel Edwards, NHS Confederation acting chief executive said: “The Committee has hit the nail on the head with the concerns it has highlighted in its report. It has shown a thorough understanding of the fierce pressure that the health and social care sectors are now under.

“All at the same time, NHS trusts are grappling with unprecedented efficiency savings, major management cuts and radical structural reforms. It’s a mixture that is causing real anxiety among NHS leaders.

“We need the government to show that it understands these issues when it announces the next stage of its programme later this week.”

Dr Peter Carter, general secretary of the Royal College of Nursing, said: “This report echoes our fear about the current efficiency challenges facing the NHS. We fully support the Committee’s view that efficiency savings should not be about cuts, but achieving more with the same amount of money.

“Sadly, with 27,000 posts already earmarked for cuts, this message is clearly not reaching NHS Trusts. Some Trusts are already cutting jobs and services at an alarming rate, making short-sighted decisions to plug the gaps in their budgets.”

Dr Hamish Meldrum, chairman of the British Medical Association, said: “Doctors have been working hard to help identify how services can be delivered more efficiently without affecting patient care, and are at the forefront of leading innovation and improving services that will benefit patient and reduce costs. However, doctors are also seeing widespread cuts to staffing and services. There is evidence of posts being frozen and services rationed.

“Despite the Government’s pledge to protect the NHS budget, it would appear that the sums are wrong and there is a now an additional shortfall of over £2 billion. NHS Employers has asked staff to plug this gap by hammering their pay even further.”

John Healey Shadow Health Secretary said: “The last thing the NHS needs is a high-cost, high-risk reorganisation at a time when, in the government’s own words, it is attempting to make ‘unprecedented’ efficiency savings.

“But of equal concern is that the plans follow promises made both before the election and in the Coalition Agreement that there would be no more top down reorganisations in the NHS.

“Promises since broken by a Health Secretary operating in isolation in Whitehall and running a rogue department.”

A Department of Health spokesman said: “The Government is committed to the NHS – to sustain and to improve services in the face of a tough economic climate. But even with this commitment, in order to meet demand and improve the quality of services, the NHS needs to make up to £20 billion of efficiency savings by 2015.

“Reform isn’t an option, it’s a necessity in order to sustain and improve our NHS. We have been clear that the NHS must cut back on bureaucracy, not on frontline care.

“Overall funding will increase by more than 10 per cent in cash terms over the Spending Review period. And the day-to-day funding for the NHS will grow in real terms for the next three years.”

From: http://www.telegraph.co.uk/NHS-will-be-tested-to-limit-by-savings-MPs

The OFT said its preliminary research had raised questions about whether the market was working well for private patients.

It aims to formally launch its investigation in spring next year.

Meantime, it is seeking views on the proposed scope of the study.

The OFT says the private healthcare market is worth £5.5bn and is of growing importance due to an ageing population, improved medical outcomes and higher life expectancy.

It added that it was of growing importance to the NHS because of government initiatives that allow NHS patients to seek treatment from private healthcare providers in certain circumstances.

Sonya Branch, OFT senior director of services and public markets said: “We are keen to focus on whether patients and buyers of private healthcare, including the NHS, are getting the full benefit of choice and competition.”

She added that as the area was a complex one, the OFT would be speaking to providers, patients and government to make sure that it focussed on the correct issues.

For the first time geographical differences have been drawn together into a series of 34 maps that the public can view online to see how well their region is performing.

It shows a 14-fold difference in spend on broken hips between best and worst areas; a four-fold variation in the proportion of stroke patients who spend almost all their hospital time in a dedicated stroke unit; and a 38-fold difference in rates of obesity surgery.

Some health authorities spent more than two-and-a-half times as much on mental health services, while there were similar differences in spend on inpatient cancer care.

Lord Howe, the Health Minister, welcomed publication of the atlas, saying: “In order to improve unwarranted variations in services, it is vital to expose existing flaws in the system.”

Charities said the move demonstrated greater openness but warned the variations showed patients were being let down in many areas.

Prof Chris Ham, chief executive of The King’s Fund, a health think-tank, said the atlas “brings into sharp relief variations in the quality and cost of care across the NHS”.

He said: “With the NHS needing to find £20 billion a year in productivity improvements, reducing unwarranted variation is no longer an option – it is a necessity.”

Many of the maps are standardised to take account of differences in age, sex and prevalence of the condition – some of the major reasons typically cited for variations in care.

The report therefore reveals that practices between NHS trusts vary in ways that cannot always be explained by social or patient factors.

The amount spent on broken hips by primary care trusts (PCTs) ranged from little over £500 per 1,000 people to more than £8,000 – even after differences in local population need were taken into account.

Rates of obesity surgery ranged from just 1.1 operation per 100,000 population to 38.9, with higher rates tending to be in poorer areas.

On cancer, some PCTs spent more than £40,000 per 1,000 population on inpatient care while others spent less than £20,000. Devon, Suffolk and Cambridgeshire were among the higher spenders and parts of London towards the lower end.

However, Mike Hobday of Macmillan Cancer Care said this was one area when higher spend was not necessarily a good thing.

He said: “We think spending less money on inpatient cancer care is better, because that means people are being supported more effectively.”

Shorter hospital stays – and hence lower inpatient costs – indicated better cancer therapies and back-up-treatment were being used, he explained.

Regarding variations as a whole, he added: “What this shows is that the NHS still isn’t very good at sharing good practice from one hospital to another.”

However, he welcomed publication, saying it demonstrated greater “openness”.

The percentage of patients receiving nine key checks on their diabetes control – including for kidney damage, cholesterol and weight – varied from 60 to 70 per cent in Norfolk and parts of Yorkshire to zero to around 40 per cent in places like Cornwall, Lincolnshire and Northamptonshire.

Barbara Young, chief executive of Diabetes UK, said the charity was “seriously concerned”.

“This demonstrates that the NHS is failing to provide universally high quality care across the country and shows that diabetes care is still a postcode lottery,” she said.

The Swine flu H1N1 virus that swept the world last year causing a global health emergency has returned to claim the lives of 10 adults in the UK in the past six weeks.

Seasonal flu normally causes severe illness and death in the elderly. The H1N1 swine flu virus targets pregnant women, younger adults, and those with chronic conditions, making it a cause of particular alarm.

No other similar reports of deaths linked with swine flu have been received from elsewhere in Europe.

Official figures show GP consultations for flu-like illness in England were at 13.3 per 100,000 population last week, well below baseline levels.

Flu experts expressed surprise at the relatively high incidence of deaths and severe illness in the context of the low consultation rates. John Watson, head of respiratory diseases at the Health Protection Agency, said: “We seem to be in the vanguard on this. Other European countries are just beginning to see some H1N1 activity.”

Calls to NHS Direct and other indicators show there is “quite a lot” of H1N1 swine flu about, despite the low GP consultation rate.

Around 30 per cent of those who fell ill, went to their GP and got tested for the virus, were coming up positive for H1N1, which was a high rate. Flu was very difficult to predict, Dr Watson added. “I am a little surprised to see as much activity as we seem to be seeing – both in terms of its spread in the community and its severity. I don’t see it as being extraordinary but it is more than I would have expected.”

All parts of the country are affected with deaths reported from each region, according to the HPA. There were nine flu outbreaks last week, eight in schools and one in an army barracks in Yorkshire.

Pressure has been building on intensive care in recent days with the worst affected patients treated on Extra-Corporeal Membrane Oxygenation (ECMO) machines which bypass the lungs to artificially oxygenate the blood. “A good many intensive care units are seeing severely ill cases including some using ECMO beds,” Dr Watson said.

Swine flu arrived last year from Mexico creating the first flu pandemic for 40 years. In the UK, the first wave of the pandemic struck in the summer – unusually for flu – followed by a second smaller wave before Christmas.

Dr Watson said: “A lot of people were infected through the two waves of the last pandemic. We estimate something like two-thirds of children and a half of adults are likely to have been infected even though they may have had no symptoms.

“We wouldn’t anticipate a big epidemic wave of flu activity due to H1N1 this year. “But there are still a substantial number of people who remain susceptible.”

Many who caught swine flu last year suffered only minor illness but a small number were severely ill. There were 494 deaths in the year to April 2010.

The fear among flu experts is that the virus could mutate to cause more severe illness or target a different section of the population such as the elderly who are more vulnerable.

But laboratory analysis has shown that the circulating strain of the virus is “very much the same” as last year and has not shown “any significant change”, according to the HPA.

Five of the 10 adults who died for whom information was available had not received the flu vaccine, the HPA said. National figures show vaccination rates are lower than in previous years covering 66 per cent of the over-65s and 40 per cent of younger adults at risk (pregnant women and those with chronic diseases such as asthma).

Professor David Salisbury, director of immunisation at the Department of Health said: “These figures demonstrate that the effects of flu are not to be underestimated. It is not the same as getting a cold and can seriously affect your health.

“The seasonal flu jab protects against the dominant strains – this year it protects against three types of flu, including the type known as swine flu. If you are in a risk group, then I would urge you to visit your GP surgery and get the vaccination as soon as possible. It is not too late to get vaccinated for your protection and that of your family.”

In addition to H1N1 swine flu, which has become the dominant Influenza A virus in Britain, about 40 per cent of virus strains isolated this winter are Influenza B, which is most common in children, causes mostly mild illness, and has been responsible for several outbreaks in schools in recent weeks.

The last year in which it caused widespread illness was 2005-6. “There is plenty of B about,” Dr Watson said.

http://www.independent.co.uk/doctors-shocked-by-spread-of-swine-flu-ndash-and-its-severity

It said it had been inundated with similar stories.

The Patients Association acknowledged that most patients do get good treatment, but said some were still being denied the essentials of nursing care, even though it highlighted serious problems last year.

A national survey of hospital experiences in England suggests that nearly half of all patients rate their care as excellent, and just 2% said it was “poor”.

The Patients Association said the 17 cases highlighted wider failings in NHS nursing care.

It is calling for the introduction of independent “patient safeguarding champions” at every hospital to check that nursing standards are maintained. It also wants the NHS complaints process to be overhauled.

“Surely the essentials of nursing care are what every patient deserves and should get?” said Chief Executive, Katherine Murphy.

“It’s a scandal, and it’s outrageous that it has been persisting for years.”

The family of former Patients Association president, Claire Rayner, who died in October, is backing the calls for change.

“If she were here today she would have been hollering from the roof tops about it,” said Claire Rayner’s son Jay.  “Any health system is only as good as its failings, and those detailed in these pages are truly dismal.”

The Royal College of Nursing said there was no excuse for poor care.

General Secretary Peter Carter said: “Neither the RCN nor the overwhelming majority of committed and caring nurses can possibly condone the neglect, rudeness and in some cases outright cruelty outlined in this report.”

However, he said problems often arise when staffing levels are cut.

Care Services Minister, Paul Burstow said the report painted a disturbing picture.

“It is an unacceptable legacy that this government is committed to tackling. The NHS must become much more tuned into patient views and experience.”

He said that was why the government would soon start publishing details about complaints.

From: http://www.bbc.co.uk/news/health-11889342

A service set up to enable millions of patients to email their GPs and access their Summary Care Records online has proved to be unwanted by the vast majority of potential users, according to a major new study.

It was also predicted that patients would access use the HealthSpace service to access their Summary Care Records and notify their GP of errors, thereby driving up data quality in NHS medical records.

In fact, only 2,913 of 2.24 million patients invited to open an advanced HealthSpace account actually did so, and the research team did not find a single person who had accessed their Summary Care Record.

Research into trials of the service, published on BMJ.com, comes as the Government promises an ‘information revolution’ which will offer patients much more control over their records.

Professor Trisha Greenhalgh, from Barts and the London School of Medicine and Dentistry, who led the research covering uptake of HealthSpace from its release in 2007 until mid-2010, concludes in the report: ‘Unless personal electronic health records align closely with people’s attitudes, self-management practices, identified information needs and the wider care package, the risk that they will be abandoned or not adopted at all is substantial.’

She adds: ‘The findings raise questions about how eHealth programmes in England are developed and approved at policy level.’

Problems with HealthSpace uncovered by the researched included a complex registration process, a ‘clunky’ user interface and low levels of knowledge about, or interest in, the product from GPs and other healthcare staff.

HealthSpace’s future is already under review by the Treasury, with the Government increasingly looking for patients’ IT services to be developed by private providers.

Researchers said the recent emergence of rival products from commercial IT giants including Microsoft and Google raised serious questions about the place of a standard-issue personal health organiser from the NHS.

A Department of Health spokesman said: ‘Healthspace gives patients access to their Summary Care Record online and enables secure communication between clinicians and patients.

‘The UCL research has produced a historical snapshot, rather than insight into patients’ needs and expectations. Healthspace continues to be developed in response to those aspirations and the commitment to give patients, as well as clinicians, access to their Summary Care Record.’

From: http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4127785

Legal experts warned the rise could leave GP consortia at risk of being sued by patients when they take over commissioning, since being treated within 18 weeks remains a right under the NHS Constitution.

Department of Health statistics show the proportion of people treated within 18 weeks increased steadily from 2007.

Numbers peaked this July, when 93.3% of admitted and 98.1% of non-admitted patients were treated within target, just after the NHS Operating Framework removed it.

By September, the proportion of admitted patients missing out jumped from 6.7% to 7.5%, and of non-admitted patients from 1.9% to 2.2%.

Overall, 45,000 patients missed out on treatment in 18 weeks during September, up 15% from 39,000 in July. Some 12.6% of patients awaiting orthopaedic or trauma treatment, and 10.6% awaiting oral surgery, waited more than 18 weeks.

Ben Troke, partner in health and social care at Browne Jacobson solicitors, warned: ‘When commissioning passes to GP consortia, it’s hard to see responsibilities [for applying the NHS Constitution] not going with it. There’s a real risk of legal challenge.’

‘Whether a claim would be successful is hard to say, but being dragged through the courts can be damaging even if you win. Courts are starting to rely on the NHS Constitution as a ground for decisions and every consortium can expect to keep their lawyers busy.’

At least one SHA has admitted waiting times are slipping.

NHS South Central said health systems in Oxfordshire, Southampton and south-west Hampshire had been assessed as failing ‘principally due to financial issues and concerns on workforce and 18 weeks’.

Dr Jennifer Dixon, director of the Nuffield Trust, said: ‘Once you scrap hard targets, it’s likely actions to achieve them will wane. I guess that’s what we’re starting to see.’

Dr Chaand Nagpaul, GPC negotiator, said PCTs were already taking advantage of the target’s removal: ‘We’re getting reports of trusts delaying treatment so they can address financial problems. The Government is engaging in double-speak, removing targets on one hand but committing to patients’ rights on the other.’

From: http://www.pulsetoday.co.uk/NHS waiting times increasing after targets scrapped

The government has given up on the need for scientific advice before classifying drugs.

Last week’s police reform and social responsibility bill contains a clause scrapping the requirement for the home secretary to appoint at least six scientists to the Advisory Council on the Misuse of Drugs (ACMD). So that’s that then. They’ve admitted it.

The drugs war has nothing to do with reality. It is now to be based entirely on fairy tales.

The mask has been slipping for a long time. When Jacqui Smith agreed, under Gordon Brown’s orders, to reclassify cannabis as class B, undoing one of the only genuinely liberal acts permitted under the Blair regime, she did so with a ferocious disregard for fact.

Cannabis use was falling and had been since decriminalisation. She did it anyway. For those of us who still value the idea that we might adopt a position on the basis of empirical data, this was practically a self-contained manifesto. It couldn’t have been clearer. Facts were no longer relevant to policy.

But the crux came a little later, when Professor David Nutt was sacked as the chair of the ACMD for suggesting that taking ecstasy was no more dangerous than riding a horse.

This is merely a statistical fact. Nothing more. It is not an offence, or a witticism, or an argument. It is a statistical fact.

It is understood by tens of thousands of young people in the UK every Saturday night, young people who now appreciate the gulf between what the government says about the world and what the world is really like. They might act stupid when they dance, but at least they’re smart enough to realise that the country’s leaders are the ones divorced from reality.

When Alan Johnson sacked Nutt, he was praised across the Commons. “Scientists should be on tap, not on top,” he was told, borrowing an old Churchillian phrase. I like Churchill too, but I’m always rather put off by people who think that quoting the man automatically wins an argument.

MPs have a tendency to get rather hot under the collar with this stuff. They are the elected representatives – they don’t like it when anyone gets superior around them. Their reaction to the ACMD was equivalent to their reaction to the Phil Woolas judgement. On the ACMD they didn’t like a scientist appearing to overrule the home secretary. On the Woolas case, they didn’t like judges appearing to overrule the election of the MP by his constituents.

The only way either one of these arguments holds is if you discount the role of truth in politics. The people of Oldham East and Saddleworth are entitled to accurate information upon which to base their decision at election time. Without it, they cannot make a valid decision.

The home secretary can only make drug policy on the basis of statistical and medical facts. Without it, we’re in the woods without a compass.

Plainly we must be vigilant against any threat to the authority of our elected representatives, such as the presidential administration of Tony Blair and the gradual decline of parliament as a check on the executive.

But without an assurance that our representatives make decisions based on accurate information, their role is without meaning. We might as well blindfold them, spin them round, and get them to pin a policy on the back of a donkey.

The truth is, the ACMD’s scientific requirement is being removed to prolong a drug war which has now been invalidated on every conceivable level – politically, strategically, morally and logically. Drug policy is based on tabloid headlines, not truth – or even a genuine concern for the young people of Britain.

If the Home Office cared at all about young people it probably wouldn’t have reclassified cannabis when its own data showed that decriminalisation had reduced use. If the Home Office cared about young people it would be honest about the relative dangers of drugs such as ecstasy, which tens of thousands take regularly without harm, so that they listen when they receive warnings about genuinely dangerous drugs, like crack cocaine.

A great deal has changed in Westminster over the last few months – but not this. Science is still considered a humiliating distraction by the British government.

Anyone old-fashioned enough to still abide by the ideals of the enlightenment should feel let down – but not surprised.

By Ian Dunt at http://www.politics.co.uk/-the-day-westminster-gave-up-on-science

Health Direct is amazed that this government has abdicated it’s responsibilities on drugs as one of David Cameron’s first speeches as an MP in the House of Commons was to highlight the chronic waste of police time pursuing  illogical and flawed drugs enforcement policies.

Health Direct- top health blog on the Wikio social networking news website.

Please find below the list of the top 30 health websites:

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It is not yet clear whether she contracted the potentially fatal disease there or in Hong Kong.

The territory has raised its alert level to “serious”, meaning there is a risk of contracting the disease.

The last outbreak of the H5N1 bird flu virus in Hong Kong killed six people in 2003.

Health chief York Chow said there was no sign yet that the virus has been spread between humans and that investigations were focusing on poultry as being the source of the infection.

“But we will be concentrating on people who were in contact with her when she showed symptoms and also when she was in Hong Kong,” the AFP news agency quoted him as saying.

“The chances of her catching it is most likely on the mainland, but you cannot rule out Hong Kong,” he said.

The woman is reported to have travelled to the mainland with her husband and daughter, and to have visited Shanghai, Hangzhou and Nanjing.

Mr Chow said officials would meet on Thursday to decide what further precautions are needed.

The first time the virus crossed the species barrier between poultry and humans in 1997, every chicken in Hong Kong was culled.

The World Health Organization says more than 500 cases of bird flu have been diagnosed worldwide since 2003. Of those, 302 cases were fatal.

From: http://www.bbc.co.uk/news/world-asia-pacific-11782582

The science suggests that people should be told that cancer risk is much more related to how much you smoke, eat and drink rather than what you eat.

The review, published in the British Journal of Cancer, looks at a decade of evidence on the links between fruit and vegetables and the development of cancer, but it concludes that the evidence is still not convincing.

The only diet-related factors that definitely affect cancer risk are obesity and alcohol, they discovered.

Tobacco is still the single biggest cause of cancer.

While smoking increases the risk of cancer by as much as 50 fold, even large consumptions of fruit and veg will only reduce the risk by a maximum of 10 per cent.

Professor Tim Key, an epidemiologist from Oxford University, said that while there are undoubted benefits in eating fruit and vegetables there is little hard evidence that they protect against cancer.

But the evidence is indisputable that cancer is strongly linked to being overweight or obese, and drinking more alcohol than the recommended daily limits.

He said: “Fruit and vegetables are an important part of a healthy diet and a good source of nutrients.

“But so far the data does not prove that eating increased amounts of fruit and vegetables offers much protection against cancer.

“But there’s strong scientific evidence to show that, after smoking, being overweight and alcohol are two of the biggest cancer risks.”

Overweight people produce higher levels of certain hormones than people of a healthy weight and this can contribute to an increased risk of breast cancer.

Being overweight can increase your risk of other common cancers like bowel and also hard-to-treat forms of the disease like pancreatic, oesophageal and kidney cancer.

When alcohol is broken down by the body it produces a chemical which can damage cells increasing the risk of mouth, throat, breast, bowel and liver cancers.

In the UK 15,000 cases of cancer are caused by alcohol, it is believed, and 19,000 cases of cancer are caused by being overweight or obese.

Sara Hiom, director of health information at Cancer Research UK, said: “Too few people know about the significant cancer risks associated with obesity and drinking too much alcohol.

“While stopping smoking remains the best way to cut your chances of developing cancer, the importance of keeping a healthy weight and cutting down on alcohol shouldn’t be overlooked.

“Keeping alcohol intake to a maximum of one small drink a day for women and two small drinks per day for men and keeping weight within the healthy limits can have an enormous impact.”

The British research mirrors the findings of an American study published in April.

For every extra two portions consumed the risk of cancer reduced by just three per cent, the research conducted by a team at Mount Sinai School of Medicine, in New York suggested.

From: http://www.telegraph.co.uk/Five-a-day-will-not-stop-cancer

In particular, individuals at higher risk from the country’s two biggest killers would be helped by taking the painkiller as a preventive medicine, they added.

The experts were speaking at the Royal Society of Medicine a month after research from Oxford University published in The Lancet showed that taking 75mg of aspirin daily for five years reduces the risk of getting bowel cancer by a quarter, and deaths from the disease by a third.

A 75mg dose is a quarter of the standard over the counter pill.

Earlier studies had already shown that a low daily dose could reduce the risk of developing heart disease.

Members of the panel said that the recent research was potentially of “enormous importance” to public health.

Bowel, or colorectal, cancer is the third most common form of the disease in Britain, with 39,000 diagnoses annually and 16,000 deaths.

The Lancet study suggests greater aspirin use could potentially save thousands of lives a year in relation to this one cancer alone.

But research is also looking into whether aspirin could have a preventive effect on other types of cancer as well.

Combined, all cancers claim more than 150,000 lives in Britain every year, while cardiovascular disease accounts for some 200,000 deaths.

Prof Peter Rothwell, the Oxford neurologist who led the bowel cancer study and was part of yesterday’s panel, has started taking a daily dose of aspirin himself. He said: “I suspect that in five to 10 years’ time we will be prescribing aspirin to middle-aged people, not only for the known vascular benefits.”

But members of the public might take matters into their own hands before then, he predicted.

“If it becomes clear that there are benefits for other cancers, then the balance of risk and benefit will become so clear that people may take the decision to take it for themselves,” he said. “It seems implausible that this effect on colorectal cancer is going to be a completely isolated phenomenon in relation to other cancers, given that we know that there are similarities between how cancers develop.”

Prof Rothwell said that he thought it would be “sensible” for people to start taking aspirin at about 45, when the chance of developing bowel and other cancers began to rise. “The risk of cancer goes up substantially between the age of 40 and 55,” he said.

As aspirin had a preventive effect, it was advisable to start taking it daily towards the beginning of that period, he explained. However, he said it was ultimately up to individuals to decide whether to take the drug, “rather than us making definitive statements”.

Prof Peter Elwood, of Cardiff University’s School of Medicine, who conducted the first trial into the effect of aspirin on heart disease in the 1970s, said: “I think we are on the brink of another breakthrough of enormous importance to the community in general.”

Prof Gordon McVie, a leading cancer specialist, from the European Institute of Oncology, said the discussion among the experts was whether this was metaphorically a “put-it-in-the-water moment”.

Opinion on the subject varies however. Experts are divided particularly over the question of to whom aspirin should be recommended as a daily preventive medicine.

The drug was formulated as a painkiller more than a century ago but researchers are finding that it can help in diseases ranging from heart disease to dementia.

Advocates believe that its active ingredient is akin to a vitamin that almost everybody should take, as our modern diet does not provide it. Others point out that taking the drug is known to double the incidence of intestinal bleeding, from about one in 1,000 people per year to about two.

The question is how much of the population – in terms of their age and their risk of developing serious diseases – should be recommended to take aspirin on a daily basis.

Prof McVie said: “I think there’s a frankly conservative feeling in this group, that for [colorectal] cancer, it should be targeted for people at higher risk.”

Prof Sir John Burn, a geneticist at Newcastle University, said: “The problem is, if we recommend something to the whole population, then we will see side effects.

“We know aspirin can cause gastrointestinal bleeding. That is to some extent holding back the situation.” Prof Dion Morton, a colorectal surgeon at University Hospital Birmingham, was another of those attending yesterday’s meeting, which was convened by the Aspirin Foundation.

He said that medicine was increasingly using a “stratified approach, where we target the right drugs at the right patients”.

He thought regulatory approval should be sought for doctors to prescribe aspirin as a preventive medicine for those at a higher risk of bowel cancer. “If they have not been told in writing they should be advocating it, they won’t advocate it,” Prof Morton said.

While intestinal bleeding was serious, research suggested that aspirin increased the risk only of less serious cases, said Prof Elwood. He said there was some evidence that the intestines adjusted to aspirin over the long term.

From: http://www.telegraph.co.uk/Daily-aspirin-dose-for-everyone-over-45-to-protect-from-cancer-heart-disease

The disease is one of the most common forms of cancer in men. About 35,000 men are diagnosed with prostate cancer in Britain every year and about 10,000 die from the disease.

Figures show that men diagnosed with the condition in south east Cambridgeshire are almost five times less likely to die from the disease than those in Tottenham, north London.

The statistics, collated by the Prostate Cancer Charter for Action, also show that 96 of England’s 529 parliamentary constituencies have a death rate 25 per cent higher than the England average.

The figures show that in Tottenham, 57 men per 100,000 died from the disease, 131 per cent higher than the national average.

In south east Cambridgeshire the figure was 12 per 100,000.

An earlier report found that areas of the country which had failed to implement NHS guidelines on improving care had a mortality rate 4 per cent higher than those areas were the guidance had been taken up.

Dr Frank Chinegwundoh, a consultant urologist, said: “It is not enough that prostate cancer services are improving as a whole, if patients face such a lottery in the care they receive.”

“We need better services for all patients across the country, not just a lucky few.”

David Smith, of the Prostate Cancer Support Federation, said: “All men with prostate cancer should benefit from better services, yet these figures suggest that the inequalities in prostate cancer are getting worse.

“There can be no excuse for services in some areas of the country to be performing so much worse than in others.

“This situation cannot be allowed to continue.”

Mark Simmonds, the Tory shadow health minister, said: “We have been warning for some time about the inequalities in access to treatment for cancer.

“We want an NHS focused around the needs or patients and the outcomes they want to see.

“And the way funding is allocated to local NHS organisations needs to reflect the burden of disease across the country better.”

Professor Mike Richards, the NHS’s national clinical director for cancer, said: “The Department of Health recognises the importance of implementing the Improving Outcomes Guidance published by NICE and we have asked Strategic Health Authorities to submit action plans to demonstrate how they will implement this.

“Raising the public awareness of prostate cancer is one of the key challenges for the future. We want men to know what their prostate is, what it does, and what can go wrong with it and we are tackling this through the National Awareness and Early Detection Initiative.

“Also for the first time, as a result of the work of the Prostate Cancer Advisory Group, we now have a definitive set of consistent key messages for the general public about the prostate, including prostate cancer. These clear messages provide men and their families with information about the prostate that they need to be aware of and are designed in such a way as not to cause unnecessary anxiety.”

From: http://www.telegraph.co.uk/health/healthnews/5531954/Postcode-lottery-in-protate-cancer-treatment.html

A key driver in this is the provision of meaningful and easily accessible information. An open, transparent NHS is a safer NHS. Dr Foster’s Hospital Guide, published today, is a welcome source of information about standards in healthcare services, which patients and purchasers of healthcare services can use.

In particular, the guide highlights high levels of “adverse medical events”, the widespread under-reporting of incidents and too many hospitals with death rates higher than one would expect.

Safe care saves lives and saves money. Adverse events like high levels of infection, blood clots or falls in hospital, emergency readmissions and pressure sores cost the NHS billions of pounds every year. There is a serious human cost too, with patients ending up injured, or even dead. Most are avoidable with the right care.

So what are we doing about it? For a start, the NHS consists of many highly skilled, dedicated and motivated people. We will free them from central control while holding them to account for the quality of care they deliver. Soon, GPs will be responsible for designing and paying for local health services, working with their colleagues across the NHS to get the best results for their patients.

We will shine a bright light on NHS performance. A new culture of openness and transparency will transform patient care. Everyone – patients, the public and other clinicians – will be able to see just how well a particular organisation, team or even an individual is performing. This will create a huge incentive for ever higher levels of quality and patient safety.

We have already published hospital infection data for MRSA and C-difficile online, updated weekly for all to see. And we are planning to publish regular data on other potentially fatal infections too. We are also changing the way we collect and publish mortality statistics so that they act as an early trigger for unsafe care.

In the coming years, we will add significantly to this, making it much easier for patients and their doctors to choose the best and safest care. Our plan to deliver a payment system linked to the result of treatments will encourage hospitals to improve the quality of care they deliver for patients – like our 30-day readmission tariff – and should help drive up even higher the standards of care in hospitals.

And we will focus on outcomes: reducing avoidable deaths, continually cutting infections, treating patients safely and successfully and then getting them back home. This already happens in heart care where publishing data on outcomes has been critical to taking our results well above those elsewhere in Europe. We want to see this happen across the board.

The NHS deals with nearly a million patients a day. No one can guarantee that nothing will ever go wrong. But we can eliminate the culture of blame and secrecy that can compound the initial mistake and stops lessons being learned.

I never want anyone working in the NHS to be afraid of coming forward when they believe patient safety is compromised. We will strengthen the whistleblowing rights of staff and place a duty on their employer to support and investigate their concerns.

I want the NHS to give all patients care that compares with the very best in the world. To help it achieve this, a new range of quality standards – designed by the professions themselves and monitored by the independent Care Quality Commission – will set out what safe, high-quality care looks like. But the standards will not dictate how this is to be achieved. This government will never undermine the clinical judgment of health professionals.

Where the NHS embraces a culture of transparency, of learning from its mistakes and constantly striving for higher performance, it is a world-beater.

There are real centres of excellence – the challenge now is to achieve that excellence across the whole of the health service.

The interview was carried at: http://www.guardian.co.uk/andrew-lansley-doctor-foster-comment

The authoritative study also identifies four hospital trusts where an unexpectedly high number of patients died after developing complications following routine operations. It names Hull and East Yorkshire Hospitals NHS Trust as the place where patients have the highest risk of dying in these circumstances – 66% above the average.

Last year that equated to 33 deaths more than expected there, although it is not possible to say how many of these deaths could have been prevented. Dr Foster says the mortality rate is too high to occur by chance and is a warning sign of potential issues in the quality of care provided.

The Care Quality Commission – the NHS watchdog for England – will now investigate the trust.

Andrew Lansley, the health secretary, welcomed the report last night and increased the pressure on the NHS to improve patient safety by warning that lax procedures were costing lives.

He wrotes in the Observer: “Safe care saves lives and saves money. Adverse events like high levels of infection, blood clots or falls in hospital, emergency readmissions and pressure sores cost the NHS billions of pounds a year. There is a serious human cost, too, with patients ending up injured, or even killed. Most are avoidable with the right care.”

The minister sets out plans to eliminate what he calls a “culture of blame and secrecy in the NHS that can compound the initial mistake and stop lessons being learned”.

Dr Foster’s report reveals that, despite recent improvements, in 2009-10:
¦ Almost 10,000 patients suffered an accidental puncture or laceration.
¦ More than 2,000 had post-operative intestinal bleeding.
¦ More than 13,000 mothers suffered an obstetric tear while giving birth.
¦ Some 30,500 patients developed a blood clot.
¦ 1,300 patients contracted blood poisoning after surgery.

Naren Patel, who chaired the National Patient Safety Agency (NPSA) until June, said some patients were dying because – as the report confirms – the NHS was still failing to provide high enough quality care in key areas, despite many initiatives from influential bodies.

“It [the report] identifies three or four key areas, such as with strokes, blood clots and prostate care, where there’s evidence that optimum care is still not being delivered,” said Patel. “Therefore some people do die unnecessarily because they haven’t received the best possible care.”

The NHS Confederation, which represents hospitals, conceded more action was needed. “There are still parts of our health system where particular services are having problems, and for the hospitals concerned this report presents an opportunity to learn and improve,” said acting chief executive Nigel Edwards. “There will always be variations in any nationwide system but the golden principle must be that our NHS is safe for the patients who rely on it. This report shows where we can do better.”

Peter Walsh, of patient safety charity Action against Medical Accidents, said: “This report confirms that far too little progress has been made on patient safety. Our system of regulation is failing to deliver consistently good quality care across the country or pick up on unacceptable variations and intervene.”

He also accused ministers of recently backtracking on a pledge to require hospitals to always tell a patient or relatives when a blunder occurs, which could let mistakes be covered up. “Mr Lansley and the coalition government say almost all the right things about patient safety, but now is the time to see them put their money where their mouth is. The worry is that political correctness about not regulating and the financial cutbacks will mean patient safety loses out,” Walsh warned.

John Healey, Labour’s shadow health secretary, welcomed Dr Foster’s disclosure that 30% fewer hospitals than in 2008-09 have unexpectedly high death rates. But he claimed the coalition’s NHS reforms would worsen the problem. “The health secretary should make patient safety and care top of his in-tray, instead of forcing the health service through a £3bn internal reorganisation.

“Andrew Lansley has to drop his hands-off attitude to problems in the NHS and tell people in Hull [and other areas] what he’s going to do to make their hospitals safer and better.”

From: http://www.guardian.co.uk/hospital-death-rates-nhs-dr-foster

This may be due to women recognising that they are pregnant later but also reflects on how well organised services are.

The figures show that almost nine in ten women were seen in the first 12 weeks at the Royal Cornwall Hospitals NHS Trust compared with less than one in ten at Walshall Hospitals NHS Trust in 2009/10.

Similarly more than three in ten women had a caesarean birth at Imperial College Healthcare NHS Trust, in London – twice as many as at Shrewsbury and Telford Hospital NHS Trust in Shropshire.

However the variations cannot be completely explained by deprivation as neighbouring hospitals will had large differences in rates.

At Rotherham NHS Foundation Trust 87.6 per cent were seen in the first 12 weeks, five times higher than in neighbouring Barnsley Hospital NHS Trust where 17.2 per cent were seen.

There were twice as many caesareans at Hereford Hospitals NHS Trust than at nearby Shrewsbury and Telford.

Nationally more women are being seen within the first 12 weeks in 2009/10 compared with the previous year and the caesaearan section rate has remained for the last year at around one in four of all births, the majority of which were conducted as emergencies.

The figures show that the proportion of births delivered by doctors instead of midwives has increased from less than one in four in 1989/90 to almost four in ten in 2009/10, as a result of more caesarean and instrument deliveries due to greater numbers of older and obese mothers giving birth.

Tim Straughan, Chief executive of The NHS Information Centre, said: “The figures show that the experience women have of NHS maternity care varies markedly across the country and even within regions.

“Rates of caesareans and access to antenatal assessment in the first 12 weeks of pregnancy vary according to which hospital they use.

“In some trusts, there may be specific demographic or clinical reasons that explain why they carry out, for example, more caesareans. But others will need to examine closely the full range of reasons why their rate is different from the national average of about one caesarean delivery for every four deliveries.”

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM), said: “These results show that there is a postcode lottery when it comes to maternity services, and this is worrying when those services are part of a ‘national’ health service. Women should expect and receive high quality care wherever they live, not care that is based upon chance and plain old good luck.

“Superficially the huge variations revealed in this report are a concern and further analysis is needed to find out why they are occurring.

“The variation on the first antenatal booking is astonishing and those on caesarean section rates – already widely known – are worrying in their persistence at such a level.

“Midwives are the experts when it comes to normal births and will deliver the vast majority of women having their baby in this way. The fact that midwives’ involvement in birth has decreased will be reflected in the increase in caesarean rates and instrumental deliveries over the years.

“I think some of the large variations could be linked to staffing levels; as we know one-to-one care from a midwife increases the possibility of a normal delivery but I am sure this is not the whole story. It could also be related to how services are organised.

“In the statistics around intervention, maternity units need to be looking at each other’s practice to see where they can learn from each other, and make their services better for women and their babies.”

From: http://www.telegraph.co.uk/Maternity-postcode-lottery-revealed-in-NHS-figures

Macmillan Cancer Support said that showed too many patients were not being cared for properly after being given treatment like chemotherapy and radiotherapy.

According to the NAO’s report, which examines how well the NHS has managed to deliver the last government’s five year Cancer Reform Strategy so far, waiting times have fallen and the number of days cancer patients spend in hospital has dropped.

The strategy, launched in 2007, was meant to make NHS cancer services “among the best in the world” by 2012.

But the NAO report said there was “limited assurance” as to whether the £6.3 billion spent on cancer care annually was money well spent, because such poor information linking spend and outcomes was available.

In particular it illuminated problems caring for cancer outpatients.

Ciaran Devane, chief executive of Macmillan Cancer Support, said: “English cancer services have improved but there is still an incredibly long way to go for the UK to be a world leader.”

She warned: “The NHS won’t be able to support the growing number of cancer patients unless it seriously ups its game.

“The whole NHS needs to realise that cancer is a long term condition for many. If the NHS does not provide appropriate services after patients leave hospital, they can expect to see a massive increase in costs as cancer patients are forced to use emergency services.

“Abandoning cancer patients after treatment is no longer acceptable, nor does it make any financial sense.”

The previous government had pledged to cut the total number of emergency cancer admissions – not just via A&E but also for example by doctors making emergency referrals – but instead the number has been rising steadily.

It has risen from 231,000 in 2000/01 to 300,000 in 2008/09. However, the rate of annual increase has almost halved. Four in five have an existing diagnosis.

Karen Taylor, from the NAO, said there was “poor understanding” of the issue while primary care trusts “don’t appear to be aware of it’s extent”.

Mike Hobday, head of policy at Macmillan, said the reason was clear.

“The traditional NHS approach at the end of cancer treatment has been to say, ‘Go away, you are cured.’ ”

But he explained: “While treatment is in most cases extremely good, people with cancer have ongoing problems. Chemotherapy is toxic – you can’t do it without impacting people’s health.

“Patients aren’t being given the support to manage themselves, so they turn up at A&E.”

A “small investment” in things like better information and dedicated helplines for cancer patients would reap large savings by lowering emergency admissions, he predicted.

With growing numbers of cancer survivors and stretched budgets “the NHS has to do this smarter”, he said.

Dr Jodie Moffatt of Cancer Research UK said the increase could partly be explained by the tripling of cancer patients receiving chemotherapy since 2000. The government was trying to tackle the problem, she argued.

Paul Burstow, the Health Minister responsible for care services, said: “This report is a damning indictment of Labour’s failure to deliver on their promises to improve the quality of cancer care.

“The shocking levels of emergency admissions are the legacy of Labour’s obsession with hitting targets instead of helping patients.

“Under Labour, NHS spending rose to European levels of funding, but they have failed to deliver European levels of quality cancer care. If the NHS was performing at the level of the best in Europe, an extra 10,000 lives could be saved each year.”

Jo Webber, deputy director of policy at the NHS Confederation, which represents health trusts, said: “It is difficult to attribute a rise in emergency re-admissions to any one factor.

“Commissioning appropriate after-care services and providing patients with access to specialist services and home support services all play their part in bringing numbers of re-admissions down.

“Providing patients with access to quality treatment in or close to home, as well as information on local support services, is just as important as the early detection and treatment of the disease when planning an effective cancer strategy.”

From: http://www.telegraph.co.uk/Cancer-patients-abandoned-after-treatment

The plan would involve centralising appointment bookings through a national call centre, clearing surgeries of thousands of staff.

However, doctors and surgery staff say the proposal is “flawed”.

Unison, the public sector trade union, said call centres could not provide the “very personal service” that patients needed.

The report by the NHS Confederation’s Foundation Trust Network looks at ways back office functions could be streamlined.

It says the message to all NHS bodies is that they must “simplify, standardise and share” to save money.

The NHS is “highly fragmented”, with a total of £2.8 billion spent on back office functions.

The trust, headed by Tony Spotswood, chief executive of Royal Bournemouth and Christchurch Hospitals, recommends: “There are substantial efficiency gains to be achieved through transforming GP back office functions, such as the potential to move towards regional and national GP appointment centres.”

A Unison spokesman said surgery staff not only made appointments.

He said: “A call centre cannot begin to do the job these staff do.”

Doctors and their support staff were more forthright.

“Even your average alien would consider this hilarious stupidity,” said Dr David Iles from Southampton.

The Department of Health has distanced itself from the proposal. A spokesman said there were “no plans” for a national call centre.

From: http://www.telegraph.co.uk/Book-time-to-see-GP-via-central-call-centre