IVF blunders by fertility doctors rise for fifth consecutive year

The number of IVF blunders at British clinics is expected to rise when labour Government figures are published.

Official statistics will show around 200 serious mistakes and "near misses" by fertility doctors - the fifth consecutive year the figure has risen.

Experts have warned that the true number of errors is far higher than those reported.

They have also raised concerns about the standards of fertility clinics and the ability of the watchdog - the Human Embryology and Fertilisation Authority - to control the industry.

It follows a series of mistakes by staff at IVF clinics.

It recently emerged that a Cardiff fertility clinic implanted a couple's last usable embryo into the wrong woman.

Last month, a London NHS hospital was forced to destroy three embryos after creating them with the wrong sperm.

In 2003-04 there were 15 mistakes for every 10,000 "cycles" of IVF.

But by 2006-07 there were 40 mistakes for each 10,000 cycles.

According to the HFEA, the rise in reported mistakes is a sign of increased vigilance rather than increased failure.

Josephine Quintavalle, from Comment on Reproductive Ethics, said: "There will be a lot more cases than people realise. You can't rely on the goodness of people to own up to their mistakes.

"It's incomprehensible how these things can happen - even the busiest clinics rarely deal with more than half a dozen patients each day."

From:
Number-of-IVF-blunders-by-fertility-doctors-to-rise-for-fifth-consecutive-year

Warnings ignored over NHS IT system in 2002

Whitehall officials warned repeatedly in private that the NHS information technology programme (NPfIT) would run into serious problems as early as 2002, according to freedom of information requests.

The Office of Government Commerce, a wing of the Treasury, was concerned about the labour government’s ability to take on such an enormous project from the beginning.

Over several years the OGC repeatedly raised issues of unrealistic timetables, unknown procurement risk and an inability to predict costs or value for money.

It questioned whether the labour government had enough qualified staff or an ability to manage large IT programmes. For example, it wrote that there was “no overall concept of affordability or ability to demonstrate value for money”.

The warnings now appear eerily prescient, given that the estimated cost of the project has since ballooned from £5bn to £13bn ($8bn to $21bn). The project is running four years late, prompting the Department of Health to warn that contracts could even be terminated if progress is not made by November.

Companies including CSC, Cerner and BT are involved in the mammoth task of letting half of patients book referral appointments online, setting up broadband connections within the NHS and delivering digital x-ray communication systems.

The OGC’s concerns came to light after the Tories obtained 31 of its reports through an FoI claim.

Nine of the reports gave “red” status to elements of the programme, implying that urgent remedial action was needed for the project to succeed.

“These reviews expose Labour’s incompetence over the NHS IT system,” said Stephen O’Brien, shadow health minister.

“It’s incredible that, right from the beginning, the government should have ignored these repeated warnings about problems.”

The information has only emerged now because the Department of Health previously blocked publication. Six reports, undertaken since 2006 are still being withheld.

From:
http://www.ft.com/cms/s/0/80bcc8c8-604b-11de-a09b-00144feabdc0.html

Quango ties NHS trusts with more red tape

National Health Service trusts could face financial penalties, sacking of executives or even temporary stoppage of some services if they do not meet standards of care to be imposed from April next year.

The stern warning comes from the Care Quality Commission, the main health regulator, less than a year before a system is introduced that will require all the trusts to register with it.

Registration will give the commission more leverage, since it will be able to dictate, for example, that trusts have to improve in specific areas. Cynthia Bower, commission chief executive, said:"We will not hesitate to place conditions upon trusts' registration, as part of our new statutory powers."

A CQC spokeswoman elaborated by saying that if trusts failed to meet the new registration requirements "we could issue an on-the-spot fine, take a trust to court and fine them an even greater amount, look at imposing new management, look at closing particular services. We could say, 'you could no longer carry out heart surgery for this period'".

The commission's warning comes as it publishes a report on whether trusts are meeting existing standards, expected to form the basis of the yet-to-befinalised registration requirements. The study, based on self-reporting, found that in the year to March 2009 about half the 392 trusts were not meeting at least one of the 44 minimum standards it demanded.

The next step is for the commission to test their claims. Last year it dis-agreed with trusts in 28 per cent of cases it inspected, judging that the trusts' own estimates that they were reaching a particular level were over-optimistic.

Fewer trusts than the year before thought they were meeting minimum levels on "learning from safety incidents". More than previously thought they met decontamination standards, although 11 per cent thought they still did not.

The proportion of flagship foundation trusts declaring compliance with all 44 criteria dropped by 6 percentage points to 66 per cent, although it remained much higher than for other trusts.

From:
http://www.ft.com/cms/s/0/50720594-5b9f-11de-be3f-00144feabdc0.html?nclick_check=1

Labour admits it cannot increase NHS funding

Labour has admitted that it cannot commit to increased funding for the National Health Service after 2011, in a move the Tories claim is an embarrassing reversal of their policy.

It comes as ministers also revealed that Labour will have to raise taxes and cut capital spending on major projects if it wins the next election. Capital spending projects will bear the brunt of cuts.

Labour and the Conservatives are locked in a bitter battle over spending plans.

The Tories seized on comments made by Andy Burnham, the new Health Secretary, in which he said Labour would continue to maintain NHS spending in the period after the current Budget period, up to 2011.

At the NHS Confederation annual conference in Liverpool, Mr Burnham admitted: "I can't write the spending review - it would be ridiculous. We have stability for two years but the Prime Minister indicated the NHS will remain the priority for a Labour Government."

The Tories said this contradicted what he had previously said and it should "worry NHS patients and staff."

Labour also had to admit that taxes were likely to increase in try and fend off other cuts.

Liam Byrne, the Chief Secretary to the Treasury, said: "Alistair Darling has been really clear that there are going to be some pretty tough choices to be made. There are going to be conditions of constraint and there are going to be difficult decisions on, for example, tax."

Gordon Brown has been able to appear as if he is maintaining spending on services but cutting public expenditure by looking to savagely cut planned capital projects. That means transport infrastructure, school and hospital building projects, as well as major defence procurement deals.

The Prime Minister has been reluctant to admit that the Government plans to cut capital spending by almost 40 per cent between 2011 and 2014.

Mr Byrne admitted that capital spending would be reduced.

He said: "Once you have built a school you have got a school."

Philip Hammond, the shadow chief secretary, accused My Byrne of being "disingenuous" about public spending. Gordon Brown has, over successive elections, painted the Tories as a party that will cut public services, but David Cameron has made great efforts to blunt that line of attack by promising to match Labour's commitments.

George Osborne, the shadow chancellor, said: "We now see how Labour plans involve spending cuts in a dozen departments next year. But Labour politicians continue to claim that they won't cut spending.

"That's just plain dishonest. Why can't the Prime Minister just be honest with people and admit to the cuts which are in his own Budget?"

From:
http://www.telegraph.co.uk/Labour-admits-it-cannot-increase-NHS-funding.html

NHS waiting times have risen by a third in a month

Waiting times in the NHS have risen by almost a third due to bad weather earlier this year, it has emerged.

Figures show that the number of patients waiting more than eight weeks for an outpatient appointment increased by 31.5 per cent between March and April this year.

There were 43,400 people waiting more than eight weeks for an outpatient appointment in April, 82.7 per cent higher than the previous year, according to Health Service Journal.

Officials said a backlog of appointments has built up after the bad weather in February which saw much of Britain gridlocked under snow.

The NHS suffered an extremely busy winter as the coldest weather for 30 years, coupled with high levels of seasonal flu and norovirus outbreaks.

The Daily Telegraph revealed the extent of the pressure on the ambulance service as national director, Peter Bradley, said the service had seen its busiest ever week in December and others warned staff were 'performing near miracles' to keep the NHS running.

From:
http://www.telegraph.co.uk/health/healthnews/5497044/NHS-waiting-times-have-risen-by-a-third-in-a-month.html

Reverse e-auctions an invitation to cut standards

One company boss who took part in the London Procurement Programme’s reverse e-auctions in May called them depressing.

The chief executive, who wished to remain anonymous, said he thought that the company had completed the procurement process after submitting a 206 point questionnaire, with 9 attachments, followed by a 122 question tendering document with 18 attachments in February.

“We heard nothing for a month, which was odd given the contracts were to start on April 1. Suddenly we were told, ‘Congratulations. You have been selected to take part in a reverse e-auction’.”

On May 19 the chief executive sat down with his finance director, logged into the LPP website and waited for the bidding to start.

The company had submitted tenders to provide palliative care and care for physical frailty and dementia. It had made bids of more than £1,000 a week for places in its homes. To take part in the e-auction it had to drop its price by at least £8 at a time. When bidding began the company was told its price was in the bottom five in the shortlist of 20.

“We wanted to test the system so we gingerly put in a bid of £10 below what we had tendered. Our position didn’t change,” he said.

“After a few more bids our position had not changed at all. By then we had reached the point where we could not cut the price further without undermining the quality of care so we stopped.”

In all, the company took part in three e-auctions. “In the end we really pushed it and cut our price by over £100 really just to see what would happen. I think we moved up a few places to 15th. It was a very depressing experience.

“You are filled with dread about what you are going to have to cut back on to get within the winning price. It is devoid of any human consideration. It’s fine if you are supplying stationery, but we are talking about human beings. This is an open invitation to companies to cut standards.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6401125.ece

Health Direct points out that reverse auctions are the result of the desire to get something for nothing.

They very rarely work as the winning company often has to come back for more money when they find they cannot provide the service to the standard required for the winning bid. It is a fallacy that it saves money!!

IVF baby given to wrong woman was an accident waiting to happen

A solicitor representing an IVF couple whose last embryo was wrongly implanted into another patient has described the clinic mix up as an "accident waiting to happen".

The couple have spoken of how their lives were "shattered" when the University Hospital of Wales' IVF clinic in Cardiff discovered the error.

They were further distressed when they learned the other woman had chosen to have a termination.

The Cardiff and Vale NHS Trust has apologised for the blunder and paid the couple an undisclosed sum in damages.

The woman said: "I will never forget the moment the hospital broke the devastating news to us. I just could not believe what I was hearing. Initially the hospital staff told me there had been an accident in the lab and that the embryo had been damaged, I thought that someone had perhaps dropped the embryo dish.

"I remember thinking, 'That's our last hope gone - we will never have another child.' I left the hospital feeling totally shell-shocked.

"When we went back to the hospital two days later and we were told the truth about my embryo being given to someone else; I was so angry.

"I had been given a handbook before every course of IVF explaining all the elaborate precautions the clinic undertook to ensure this sort of mix-up was impossible - and yet despite everything, it had still happened. "

The couple's solicitor, Guy Forster, from the firm Irwin Mitchell, said there had been two previous "near misses" at the clinic the year before.

The couple were originally referred to IVF Wales after an ectopic pregnancy in 1996 caused damage to the woman's fallopian tubes. The couple began fertility treatment in 2000.

Following the third cycle of treatment, the woman became pregnant and in April 2003 gave birth to a son.

The remaining embryos were frozen and, in line with the clinic's policy, were kept for five years.

In November 2007 the clinic contacted the couple with the news that just one embryo had survived and was in good condition. The woman, who was then 38, and her husband decided to take "this last chance" to add to their family, Mr Forster said.

The couple, named by Mr Forster only as Deborah, a health care assistant, and Paul, a printing firm supervisor, from Bridgend, south Wales, attended the clinic on Dec 5, 2007, for their final embryo to be transplanted.

They were told a trainee embryologist had mixed up their embryo after taking it from the wrong shelf of the incubator.

Mr Forster said that against all guidance, more than one patient's embryos were being temporarily stored in the incubator.

The trainee embryologist failed to carry out 'fail-safe' witnessing procedures to ensure the embryo being taken from the incubator and implanted, belonged to the correct patient, he said.

The mistake was only discovered when another colleague later found that Debroah's embryo was missing from the incubator.

Mr Forster said: "A report by the Human Fertilisation and Embryology Authority showed that the error occurred primarily due to failures by laboratory and theatre staff to carry out basic procedures.

"However, it is clear that there were a number of system failings, in that the clinic had failed to implement the procedures set out in the HFEA's Code of Conduct, workloads were above safe levels and there were staff shortages.

"IVF Wales reported two 'near miss' incidents to the HFEA in 2006 and an HFEA inspection in February 2007 had warned the clinic to tighten its witnessing procedures, yet it would seem nothing was done. This was an accident waiting to happen."

Ian Lane, the health trust's medical director, said: "We apologise unreservedly for this mistake.

From:
http://www.telegraph.co.uk/IVF-baby-given-to-wrong-woman-was-an-accident-waiting-to-happen.html

Patients with suspected cancer forced to wait so NHS targets can be hit

Patients rushed to hospital with suspected cancer are having their treatment delayed so that managers can meet labour Government targets, an NHS investigation has found.

People arriving at Accident and Emergency departments with symptoms which could indicate the aggressive spread of the disease are waiting weeks for diagnosis and treatment while “routine” cases are prioritised.

Hospital managers told researchers that treating desperately sick patients more quickly would “reflect badly” on their performance against Government cancer targets which only cover those referred to specialists by GPs.

Doctors, patients groups and politicians were appalled by what one described as a “breathtaking admission” which confirmed their “very worst fears” about how far the NHS target culture has gone in distorting clinical priorities.

Although most people with suspected cancer are referred to hospitals by their GPs, more than 30,000 people diagnosed with the disease each year are first alerted to tumours by violent symptoms, such as seizures, vomiting and jaundice, which cause such alarm that patients go straight to their local A&E departments.

The report by the NHS Institute for Innovation and Improvement, an official health service agency which issues advice to hospital managers, says that many of these emergency patients waited six weeks or longer for basic tests.

It said they were “often” not given the same priority as patients who had been referred by GPs, who were covered by two targets, ensuring that they see a specialist within two weeks, and start treatment, following diagnostic tests, within two months.

“As a result, they can end up with a very poor experience before finally receiving a diagnosis and the right care,” it warns.

The report, added: “Many trusts recognised the need to get some patients in this group onto the same pathway as people on the cancer two week wait [target] but were concerned this would reflect badly on their cancer figures”.

Some A&E departments failed to recognise the risk of cancer in seriously ill patients. In cases where the disease was suspected, patients were sent home to wait six weeks or longer for diagnostic tests. Others waited weeks on wards before seeing a specialist or having scans, the report, which is endorsed by the Government’s cancer tsar, found.

Nigel Beasley, the NHS Institute’s lead for cancer, and head and neck surgeon from Nottingham University Hospitals said: “Targets are very effective, but they do have side-effects. The risk is that these patients are not being prioritised because of the focus on the two-week target for patients referred by GPs.”

Mr Beasley said: “Patients can be stuck in hospital for a long time, waiting for scans, and other diagnostic tests. Once they are in hospital, they can end up waiting two, three, or even four weeks before there is a diagnosis and any decision to treat.”

The admission about the effect Government targets were having on emergency cancer patients horrified clinicians and patients groups.

Shadow health secretary Andrew Lansley described it as “one of the clearest examples yet of how Labour’s tick-box targets are failing NHS patients”.

He said decisions about which patients should be seen first must be taken by doctors, based on the patient’s clinical needs, not by managers following Government diktats.

Katherine Murphy, from the Patients Association, said the report provided “breathtaking” evidence of a confidence trick being played on the public, repeatedly told that waiting times for patients with suspected cancer are falling, while desperate cases were forced to the back of the queue.

She said: “This confirms our very worst fears, and exposes the scandal of what pernicious targets are doing to patients. We have seen other targets being used in ways that damage patient care, but of everything we have seen, this really is the cruellest of the cruel”.

Leading cancer specialist Prof Karol Sikora said: “I think it is absolutely horrifying that hospital managers are playing around with targets that can delay treatment for people who may well be at an advanced stage of the disease.”

“I know of many cases where people who have been admitted to NHS hospitals as an emergency have languished for weeks before even seeing an oncologist,” added Prof Sikora, Medical Director of independent company CancerPartnersUK.

The British Medical Association said many trusts were bullying doctors into delaying urgent referrals.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee, said: “A number of our members have already expressed fears about the two-week cancer target, because it means all the cases referred by GPs are given the same priority, regardless of whether they are expected to be benign or high risk. When this same target is delaying patients who have been admitted as an emergency that is an even greater cause for concern”.

Several oncologists said they supported two-week waiting time targets for cancer patients referred by GPs, but called for the target to be widened to include all patients.

Ian Beaumont, from charity Bowel Cancer UK said it “beggared belief” that anyone would value statistics over efforts to save lives.

Dr Jane Maher, chief medial officer at Macmillan Cancer Relief described the revelation in the report as worrying, but said the biggest obstacle to getting the right care for patients admitted to hospitals as an emergency was getting the right diagnosis, as cases were often complex, meaning cancer could be mistaken for other conditions.

From:
Patients-with-suspected-cancer-forced-to-wait-so-NHS-targets-can-be-hit.html

Timebomb of Britons unaware they have HIV

Senior doctors accuse the Department of Health of failing to take HIV virus seriously and neglecting to test high risk groups.

More than 20,000 people with HIV are unaware they are carrying the virus and are infecting thousands of others, setting a devastating health “timebomb”, medical experts have warned.

Senior doctors have accused the Department of Health of failing to take the spread of HIV seriously and neglecting to test enough people in high-risk groups, including gay men and heterosexual black Africans.

HIV specialists say they are seeing people in clinics with full-blown Aids who have no idea they have been carrying the virus. They now want all sexually active people to be routinely offered an HIV test.

The Lancet medical journal has published an editorial accusing ministers of an “appalling failure to tackle HIV” and of having “no credible strategy to diagnose and care for those living with, but unaware of, HIV in Britain”.

The Health Protection Agency (HPA), the labour government’s health watchdog, warned that about 77,000 people in the UK have HIV but 21,000 of these do not know they are infected. In 2007, the number of infections through heterosexual contact increased to 960, up from 540 in 2003.

Doctors warn that a third of people with HIV are being diagnosed when their virus is advanced. One London hospital recently treated two teenage sisters, one of whom was pregnant, infected with HIV from the same man. Hospitals are also concerned about men who are diagnosed with HIV but abscond before they can be treated.

They called on the government to take testing more seriously, warning that an A&E target to treat patients within four hours meant people with early symptoms of HIV were not being tested in emergency rooms because of time pressure.

Dr Phillip Hay, reader in HIV medicine at St George’s hospital in Tooting, south London, said testing for the virus should be routine to stop its spread through unprotected sex.

He said: “We have identified some people who have infected multiple individuals”, including couples “where there is a big difference in age between an older adult and a teenager. All men and women accessing medical care should be routinely offered a test”.

The HPA said high-risk groups should be targeted for testing.

“It is a matter of concern that so many individuals in the UK are unaware that they are HIV-infected,” it said.

All the Department of Health could say was that HIV prevention was still a priority.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article6447107.ece

Health Secretary Andy Burnham promises NHS targets massacre

The target culture that has driven NHS reforms over the past dozen years will be dismantled in a “deep clean” that removes alienating bureaucracy, the Health Secretary pronounced.

Giving his first speech since taking office, Andy Burnham said that while the challenges faced by the NHS were substantial, the opportunities to streamline reforms and focus on the prevention of ill health could bring savings.

He added that he would reward the best primary care trusts with even greater control over how they operated, and a “lighter touch performance management”.

Mr Burnham, who was speaking at the NHS Confederation’s annual conference, said he could not make pledges on future spending or budget cuts, but insisted that he would not cut back on agreed funding programmes.

His statement followed revelations in The Times of Government advisers withholding money from a £750 million programme set aside for the building and refurbishment of community hospitals.

A letter sent between health chiefs highlights a Department of Health strategy to divert health authorities away from the programme - which still has £500m to spend - because “the Treasury is unlikely to agree further releases of funding”.

Mr Burnham again sought to allay fears of substantial cuts after a report from the NHS Confederation warned of a multibillion-pound budget shortfall over the next decade. The report, published yesterday, prompted angry exchanges in the Commons as Gordon Brown accused the Tories of planning deep cuts in public services to allow for real-terms increases in health spending.

Mr Burnham refused to say if a Labour Government would allow real-terms growth, saying that he “could not pre-empt Treasury decisions”. But he added that the NHS would improve from stripping away unhelpful targets and concentrating on preventive public health measures.

“I want to deep clean the target regime,” he said.

“Targets have their time and place but where they have served their purpose and they are subsidiary to wider objectives, they should now be removed. And believe me I will do that.”

Mr Burnham said that core targets - such as the 4-hour waiting time target in A&E and the 18-week target from GP referral to treatment - would remain in place as “minimum standards”, but others which had served their purpose and now “alienated people” would be up for review. He said that targets surrounding inpatient waiting times - which include a 13-week target from decision to operate to hospital admission - might be expected to be removed.

“I think there’s scope really now to take away stuff that does not need to be there any more,” he said.

The Health Secretary said that “prevention” needed to be added to the bywords of “quality, innovation and productivity”, adding that smoking, drinking and obesity related admissions to hospital accounted for £10 billion of NHS costs per annum.

“We have, at times, possibly been too timid on public health. Health trusts should not feel they have to wait for permission to invest in prevention. If we believe in investing in people’s health we should go on and do it.

“The Department of Health is in a position of great health,” he added. “There are challenges ahead, as always, but let’s not talk ourselves into a crisis. This is a moment of opportunity not threat.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6479588.ece

Catastrophic shortage of psychiatrists in NHS

There is a "catastrophic" shortage of psychiatrists in the NHS, leading to a reliance on foreign staff who may have difficulties with communication and the UK culture, a senior doctor said.

Prof Robert Howard, dean of the Royal College of Psychiatrists (RCP), said the number of UK doctors was far too few to fill hundreds of training posts.

He pointed to an over reliance on overseas doctors, saying some were brilliant but cultural awareness was an essential part of being a good psychiatrist.

He said: "Catastrophic is the word I would use for the shortage we are now facing. We have always struggled to recruit significant numbers but this year is particularly acute."

"It has got to the point where you can count the number of UK doctors coming into it in tens, when we have hundreds of training posts to fill."

"The doctors who are coming in from overseas to work in the UK: some are brilliant, and our president (Dinesh Bhugra) is a shining example. This is not being racist or unpleasant."

"But many of them have difficulties with communication and the nuances of the UK's culture. And if there is a speciality where it is essential to know the culture, it is psychiatry. There needs to be a balance."

"Overall, because of the lack of competition, we are giving jobs to some people who are 'appointable' but certainly not people who it fills our spirits to have given jobs to."

"The fact that we have to make a decision about the minimum standard cut-off point for potential 'appointability', and that we feel relieved when we find sufficient people who just scrape over this is damning enough."

From:
http://www.telegraph.co.uk/health/healthnews/5445602/Catastrophic-shortage-of-psychiatrists-on-NHS.html

Ditch management consultants from the NHS

Management consultants should be ditched as the NHS is entering a 'dark and dangerous' period, leading doctor warns conference.

Public money must not be diverted away from patient care 'into the pockets of shareholders' at a time when the NHS may see real cuts in budgets, Dr Jonathan Fielden, chairman of the consultants committee of the British Medical Association said in a speech.

He said the £350m reportedly spend on independent management consultants in the NHS in England last year should be spend on patient care instead.
* NHS consultancy bill is £350m
* NHS could have hired 10,000 nurses with money spent on management consultants

This is even more important as in the coming years investment in the NHS is likely to fall, he said.

Dr Fielden said: "For the first time in working memory, we may see real cuts in health spending. This will provoke some stark choices: what is kept, what is cut, what can the NHS afford? Let's ensure that it's doctors making those difficult decisions in partnership with our patients and health care colleagues, not faceless bureaucrats, accountants, and those out to fleece the taxpayer."

He said that an estimated £927m was also spent on contracts with independent sector treatment centres for work that was not carried out as patients shunned the private centres.

This was a 'dangerous waste', Dr Fielden said, and he urged the Treasury not to snatch back the £1.7bn surplus currently in the NHS and for it to be spent on patients instead.

Dr Fielden said overall the NHS has been improving but there have been 'dreadful blots' on the landscape where care has been poor.

He told the BMA's Consultants Conference: "In each of these there is a common theme: targets being put in front of quality, staff not being listened to, aberrant corporate cultures suppressing concerns and disregarding safety. Doctors must challenge this culture of denial and lead a better way forward."

From
http://www.telegraph.co.uk/health/healthnews/5437279/Ditch-management-consultants-from-the-NHS-leading-doctor.html

Elderly suffer after reverse e-auctions for home care

Labour NHS IT reverse auctions reduce dignity and care for elderly

Andrew Wilson, 78, was one of the elderly people who received poor treatment after a reverse e-auction. This was run by South Lanarkshire for the provision of home care.

Domiciliary Care, a big provider in Scotland, won the contract after companies had driven down their prices. It won with a bid to provide care for £9.95 an hour.

Mr Wilson is hard of hearing, blind in one eye and unable to walk more than a few steps. With no close family, he lives alone and depends on carers. He allowed Panorama to fit secret cameras in his home for 19 days.

The cameras showed Mr Wilson being given a bed bath while his carer was constantly on her mobile phone complaining to the office about her workload. The cameras also recorded that, of his four half-hour visits a day, those at lunch and teatime were often curtailed.

His care assessment makes clear that his lunchtime carer should prepare a meal. However, he was routinely fed sandwiches, crisps and toast.

One GP who specialises in old age care said she was shocked by what she saw. “He has been treated with a complete lack of dignity,” she said.

At the time Domiciliary Care denied that Mr Wilson was neglected. It said that carers were under no obligation to go shopping for Mr Wilson but often did so. However, Care Choices Group, which took over the company last September, admitted that an internal inquiry had found that a number of the allegations were correct, and apologised.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6401122.ece

Second UK swine fever death as baby dies after pregnant mum

The partner of the first person in the UK to die of swine flu suffered a second loss last night when his premature son died in hospital.

William McCann said Jack, aged 14 days, died after a “brave fight” at the special-care baby unit at the Royal Alexandra Hospital in Paisley, Renfrewshire.

His partner, Jacqueline Fleming, 38, died at the same hospital on Sunday. Last night Mr McCann said: “Coming so soon after the death of his mum, this is an extremely distressing and difficult time for our family.”

Jack was born 11 weeks early, reportedly weighing just over 3lbs, and suffered complications. He did not have swine flu. His mother, who was being treated in intensive care, was described as having underlying health conditions.

Earlier her relatives said in a statement from the health board: “Our whole family is absolutely devastated and we are doing everything we can to support Jacqueline’s two sons and her partner. Jacqueline had been ill in hospital for a number of weeks but nothing can prepare you for such shattering news.”

Ms Fleming was the first reported swine flu fatality outside the Americas. Details of her other health problems have not been given officially. A neighbour in the Carnwadric area of southwest Glasgow said that she had had strokes or seizures. It was reported she had suffered a stroke two years ago and was admitted to hospital with double pneumonia four weeks ago.

A nurse aged 26 who treated her has also tested positive for swine flu but is said not to be seriously ill. Ms Fleming is understood to have been infected before going to hospital and it is believed that she may have contracted the disease locally.

Nicola Sturgeon, the Scottish Health Secretary, said that in any flu outbreak a small number of victims would develop complications, and some would die. “That said, the vast majority of people will continue to suffer mild symptoms,” she added.

Harry Burns, Scotland’s Chief Medical Officer, said that three distinct clusters of cases had been identified in Scotland — one linked to a Rangers supporters’ bus, one involving contact with people in the West Midlands and the last centred in south Glasgow.

There have been 498 Scottish cases of swine flu. Scotland’s government said yesterday that no more cases had been confirmed by laboratory tests but doctors in Greater Glasgow and Clyde had diagnosed a further 71.

Mr Burns said that the H1N1 strain was unlike common flu in that it appeared to be more prevalent among young people. This could be because those who had lived through a pandemic of Asian flu in 1958-59 had a resistance to it. Those who had survived Hong Kong flu in the Sixties might also have some immunity.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6506806.ece

WHO declares global swine flu pandemic and says virus is 'unstoppable'

The world is officially in the grip of the first global flu pandemic for 40 years.

The World Health Organisation (WHO) has declared that H1N1 swine flu has reached the status after more than 27,000 cases were confirmed across several continents.

The decision to raise its global alert level from five to six — officially signalling a pandemic — came after a day-long emergency meeting of the WHO to discuss the implications of widespread outbreaks of illness in the Americas, Europe and Asia.

A disease is classed as a pandemic when transmission between humans becomes widespread in at least two regions of the world.

The last global flu pandemic came in 1968 over the so-called “Hong Kong” flu, which killed about 1 million people worldwide.

The latest H1N1 viral strain — a combination of previously circulating animal and human strains — emerged in Mexico in April and since then 27,737 cases have been confirmed in 74 countries worldwide since March.

Community spread - in which infections cannot be traced to known cases - has already been confirmed in the North and South America. But WHO officials are reported to have been alarmed by a sudden spike of cases in Australia, and also by rising numbers in Europe.

A total of 25 new cases of the H1N1 virus in England confirmed today by the Health Protection Agency increased the British total to 822. At least 20 schools have been forced to close.

The Department of Health said that the WHO announcement had no immediate implications for the public, but could prompt Governments to take extra prevention measures, such as imposing travel bans and ordering increased vaccine production.

In a statement, the NHS Confederation, which represents health service managers, said: “The confirmation of a level-six global pandemic reinforces the need for the NHS to ensure all the flu plans already in place at local level are as comprehensive as possible and thoroughly tested. We need to avoid complacency in dealing with a virus that is an unknown and seems to be spreading quickly."

The Government’s chief medical officer Sir Liam Donaldson said before the announcement that a WHO pandemic declaration would not significantly change the way the UK was dealing with swine flu.

But he said that the Health Protection Agency was planning to focus the use of anti-viral drugs on close contacts of people carrying the virus, rather than the wider circle of contacts who have been treated so far.

Sir Liam said: “The declaration of a pandemic per se doesn’t make a big difference to the to the way we are handling the outbreaks we have.”

He added: “We are going to continue to investigate every case that occurs and treat their contacts with anti-virals even though they may not be ill.”

Official guidance from the WHO states: “Assessment of the severity of a pandemic is complex. Experience has shown that past influenza pandemics have varied in terms of severity and that the associated health impacts may vary significantly based on a variety of factors.”

From:
http://www.timesonline.co.uk/tol/news/world/article6479389.ece

Many hospital bugs neglected by MRSA targets

The NHS in England is neglecting the threat from many healthcare acquired infections not covered by labour government targets, a watchdog has warned. Efforts to tackle MRSA and Clostridium difficile have been a success, but they account for only about 15% of cases, the National Audit Office said.

Pneumonia and urinary tract infections are among those which deserve more attention, its report said.

The Care Quality Commission said they would "keep up the pressure" on trusts.

Two previous reports from the NAO have played a big role in highlighting the problem of healthcare-associated infections in the NHS.

It led to targets to reduce rates of MRSA and C. difficile - a pressure which has successfully cut those infections.

But they account for only a small proportion of the one in 12 patients admitted to hospital who end up with an infection they did not have before.

Urinary tract infections, largely associated with the use of catheters, are responsible for 20% of these.

Other bloodstream infections with bacteria such as E. coli are also important, the NAO said, and limited data suggests they are on the rise.

Compulsory monitoring of healthcare-associated infections should be widened to cover far more infections and checks should be done to ensure that antibiotics are being used effectively, it concluded.

Karen Taylor, report author, said MRSA and C. difficile rates started to come down only once targets were imposed, although local goals may be more appropriate for other infections.

"It's looking better for MRSA and C. difficile, which have been subject to targets, but the main focus of our report is they only account for about 15% of healthcare associated infections in hospitals and in the rest of the infections there's very poor data.

"Some of the bloodstream infections are just as significant on the impact on the patient."

The report also found that government funding for tackling infections had saved the NHS money overall.

It added that the controversial "deep clean" programme had boosted staff and patient confidence - but it was impossible to measure what effect it had had on the number of infections as other strategies were being implemented at the same time.

HOSPITAL INFECTION BREAKDOWN
Urinary tract infections - 20%
Lower respiratory tract infections - 20%
Gastrointestinal infections - 22%
Surgical site infections - 14%
Bloodstream infections - 7%
Skin and soft tissue infections - 10%

However, even with MRSA and C. difficile there was variation, with 12% of trusts reporting an MRSA infection.

Amyas Morse, head of the NAO, said that in 2004 the problem with MRSA and C. difficile had seemed to be "an intractable problem" and hitting the targets was a "significant achievement".

"Inevitably, with a focused and centrally driven initiative of this kind, the improvements are not uniform across the NHS and we still don't know in any meaningful way what impact there has been on other healthcare-associated infections."

Health minister Ann Keen said: "We remain totally committed to eliminating all preventable healthcare-associated infections.

"As a nurse myself, I am especially pleased to see that the National Audit Office has recognised the contribution that nurses and the reintroduction of matrons onto our wards have had in delivering the reductions in MRSA and C. difficile infections."

From:
http://news.bbc.co.uk/1/hi/health/8095074.stm

Travel, food, chauffeurs - quangos are at it too

Quangocrats are claiming up to £35,000 a year each in expenses for hotels, lavish meals, sat navs and, in one case, £18.50 for dishwasher tablets.

One quango boss made 12 trips abroad during two years in which she claimed £70,000 in expenses. Another claimed nearly £800 for a 42in flatscreen television which he said he would watch only in “times of emergency”. Another spent £16,500 on chauffeur-driven cars.

Details of the claims, released under freedom of information laws, reveal how quangocrats earning six-figure salaries routinely claim tens of thousands of pounds extra in expenses, paid for by taxpayers.

Matthew Elliott, director of the TaxPayers’ Alliance, said: “Quango expenses are potentially even worse than MPs’. Quangocrats are unelected and hidden from public view. They should have all their expenses published on the internet.”

Some of the most controversial claims were made by Paul Evans, former chief executive of the Royal Armouries in Leeds. Evans, who was paid £100,000 a year, claimed nearly £24,000 in 2007-8 including £180 in Farlows, a shooting accessories shop, and £62 in Graingers, a supplier of fishing equipment. He also spent £69 of taxpayers’ money in Davidoff, a London tobacconist renowned for its cigars.

He claimed a further £3,000 on expenses at top bars and restaurants in Leeds and London, £1,170 on an Apple laptop and accessories and £259 on an Apple iPhone.

His claims caught the eye of accountants at the Royal Armouries and he was suspended on full pay in April 2008 over alleged “financial irregularities”. He resigned in September after agreeing to return his computer equipment and to reimburse the Royal Armouries for £289.70 of “personal” expenses claims. An internal investigation later cleared him of any impropriety. Evans last week declined to comment.

Although Evans’s case is unusual, other quango chiefs are making large claims regarded as legitimate.

Dr William Moyes, chief executive of Monitor, a quango that regulates National Health Service trusts, claimed more than £35,000 in expenses in 2007-8 and 2008-9.

His biggest charge was for chauffeur-driven cars, which cost £16,500. Moyes, whose basic salary is £215,000 a year, also spent £7,500 on meals at some of London’s finest restaurants with public servants and consultants.

His favourite venue was the Cinnamon Club, an Indian restaurant in Westminster where he dined on 24 occasions, spending a total of £2,600. A spokeswoman said the meals were important for maintaining relationships with “key stakeholders”.

From:
http://www.timesonline.co.uk/tol/news/politics/article6396004.ece

Elderly left at risk by NHS bidding wars to find cheapest care with reverse auctions

An online auction system developed for councils to buy cheap wheelie bins and stationery is being used to buy end of life and dementia care for vulnerable elderly people.

The NHS in London has held a series of 30 “reverse e-auctions”, where bids are driven down instead of up, for £195 million worth of contracts for palliative and dementia care for patients leaving hospital.

Reverse auctions to buy care for the elderly are relatively new and The Times has found that standards and quality have deteriorated rapidly where they have been used.

In one case a company that won a local authority’s reverse auction in the North East of England was struck off the national register of approved providers weeks later because the palliative care it offered was of such poor quality.

The results of another auction in South Lanarkshire to buy domiciliary care were so disastrous for elderly people that the Scottish Parliament is to hold an inquiry into whether they should be banned.

Companies who took part in the London NHS auction told The Times that they were asked hardly any questions about the quality of palliative or dementia care that they provided, beyond whether they complied with minimum standards.

During the e-auction, companies were invited to reduce their prices for one bed with round-the-clock specialist care for one week by £8 a time.

The NHS and local authorities are under increasing pressure to drive the hardest bargain they can for services, such as care for the elderly, which they buy in from the private sector. Reverse e-auctions, though, were intended to be used to drive down prices for basic goods such as office furniture, IT or stationery, which have limited and exact specifications and where quality is not a serious concern. Critics of care e-auctions say that those who hold them are aware that driving prices down affects the quality of care.

Richard Jones, director of adult social services for Lancashire County Council, said that he would never use an auction to buy care. “If you put your providers into an auction, pushing them to a lower and lower price, somebody is going to lose out, and the losers in this case are vulnerable elderly people and their carers,” he said.

Information given to The Times by the BBC programme Panorama showed that four local authorities — Walsall, Bedfordshire, South Lanarkshire and Edinburgh — had used the system to buy care for elderly people.

In Walsall, the Working Together Specialist Care Agency won a contract to provide palliative care to elderly people in the last few months of their life. Within weeks, the local authority stopped the company taking on any new cases, and then terminated the contract after it emerged that dying people were not receiving the pain relief and help with feeding and washing that they required.

The Care Quality Commission (CQC), the health regulator, confirmed that the agency had been deregistered after an investigation. The agency could not be reached for comment.

Walsall said that price was not the sole consideration in awarding the contract to Working Together. Sue Ryder Care, the specialist charity that held the palliative care contract before the auction, said that it could not even afford to start bidding at the opening price because it was so low.

Domiciliary Care has since been taken over by Choices Care Group, which said that it was appalled by what Panorama found and had apologised for the shortcomings. The Scottish Parliament has started a cross-party investigation into the use of reverse e-actions with a view to having them banned for purchasing care.

In England, the CQC warned NHS purchasers and local authorities that it would examine closely what happened to standards of care in areas where e-auctions were used. “We’ll be keeping a very close eye on standards across the health and adult social care sector. Where we see standards slipping, we won’t hesitate to act,” a spokesman said. Martin Green, chief executive of the English Community Care Association, has written to Alan Johnson, the Health Secretary, to alert him to the practice.

The London Procurement Programme, which ran the NHS reverse e-auction, defended its use of the system. Stuart Saw, chairman of the steering board, said: “We are confident the framework will deliver consistent high-quality standards in nursing home care across the capital. Quality has been embedded throughout the procurement process while making the most of taxpayers’ money.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6401002.ece

Junior doctors asked to lie about working hours to meet red tape targets

Misleading data is being submitted to comply with a directive that restricts junior doctors' hours to 48 a week to meet eu targets.

Junior doctors are being asked to lie about their working hours to meet new European rules, research suggests.

A survey of 31,360 junior doctors who comply with new limits on their working week found that one in 10 had actually worked longer hours, with some asked to submit different data.

Of the 3,938 junior doctors who said in the survey by the Health Service Journal (HSJ) that their hours were not compliant, 17% said they had been asked to submit hours that showed they were in line with the new rules.

The new European Working Time Directive (EWTD), which fully comes into force on 1 August, limits the number of hours that junior doctors can work each week to 48.

Richard Marks, a consultant who is also head of policy at the campaign group Remedy UK, said the findings were interesting and should not be ignored.

But he said his own experience of talking to junior doctors had revealed that many wanted to work more than 48 hours, to ensure good patient care and maximise their training.

He said: "I've been asking lots of trainees about this question. It's true that they are being economical with the truth but it's because they think reduced hours, in line with the EWTD, is bad for patient care and it's also bad for their training.

"They want things to stay as they are – they want good training and exposure."

The Liberal Democrat health spokesman, Norman Lamb, said: "This demonstrates just how ludicrous the imposition of these rules are on the NHS.

"Doctors have been warning for months about the chaos that will happen in the summer when the rules are applied.

"The labour government must take its head out of the sand and recognise the damage that will be done to patient care if it insists on imposing these working hour restrictions. It is vital that we don't see another repeat of the farce that engulfed the recruitment of junior doctors two years ago."

From:
http://www.guardian.co.uk/society/2009/may/28/junior-doctors-working-hours

Andy Burnham is the new health secretary in emergency cabinet reshuffle

Cabinet reshuffle- Andy Burnham moves from best job in the world to the hospital ward

Before the reshuffle Andy Burnham declared a desire to remain in his dream job of Culture, Media and Sport but promotion to the Department of Health proved too tempting.

Alan Johnson has been given the home secretary job in prime minister Gordon Brown’s post regional election cabinet reshuffle.

King’s Fund chief executive Niall Dickson said it was “frustrating” to have a new secretary of state when Alan Johnson had been in post for less than two years. This move has nothing to do with what is best for the health service,” he said.

Ambition has always been at the core of the 39 year old Cabinet minister who grew up in Leigh, the part of Merseyside he has represented since 2001 and who is often spoken of as a future Labour leader.

Initially considered a Blairite, having worked for New Labour stalwarts Tessa Jowell, Chris Smith and Ruth Kelly, his appointment to DCMS on Gordon Brown's arrival at No 10 was considered a conciliatory gesture.

It was a job which suited an Everton fan with a penchant for indie music, and he had been content to remain in post, particularly after his clean cut image was somewhat tarnished by the Daily Telegraph's recent disclosures about his expenses.

In one of the most cringe-worthy revelations about a Cabinet minister, a letter from Mr Burnham to the Commons fees office was made public, in which he begged for a £16,000 decorating bill to be paid, saying: "Otherwise I might be in line for divorce!"

More seriously, he also came to an arrangement whereby a windfall from his landlord was added to his allowances and repaid in expenses, leading to questions over whether he should have paid tax on the transaction.

Mr Burnham's humiliation was complete when it emerged that he had a £19.95 claim for an Ikea bathrobe rejected.

However, Health came as a reward for denouncing the decision of his close friend James Purnell to turn on Mr Brown, and he now commands the largest workforce and one of the biggest budgets of any government department.

Married to Dutch born Marie-France van Heel, a former marketing executive, the couple have three children.

From:
http://www.telegraph.co.uk/news/newstopics/politics/5455058/Cabinet-reshuffle-Andy-Burnham-moves-from-best-job-in-the-world-to-the-hospital-ward.html

Labour fights to keep abortions secret

Data on the number of abortions performed for conditions like club foot and cleft palate must remain secret, labour government officials argue.

An appeal panel will listen to experts who believe the numbers must remain confidential after the Information Commissioner ruled that they must be disclosed.

Such data - involving abortions carried out for reasons like cleft palate, club foot and webbed fingers or toes - was published up until 2002.

But ministers stopped the practice if fewer than 10 cases were involved, saying there was a risk the women or doctors involved could be identified.

The ProLife Alliance challenged this stance in 2005 and requested a release of the figures under the Freedom of Information Act.

The Information Commissioner ordered ministers to publish the data, but the Department of Health refused and appealed against the commissioner's decision.

Ministers originally called for the hearing to be held in private so the data could be discussed.

An agreement has since been reached with the Information Commissioner's Office for only part of the hearing to be heard in private.

Abortions can be carried out up until birth under category E, which relates to disability, as long as two doctors agree the procedure should be performed.

There is no list exempting certain conditions such as cleft palate or club foot.

A spokeswoman for the ProLife Alliance said: "We believe there should be absolute transparency and openness about these statistics. Abortion is not a right; it can be performed if you fulfil certain conditions under law. Otherwise it remains a criminal act. We have been very clear that we have asked for information about all abortions, not just those after 24 weeks. This case is about transparency."

She said it was "nonsense" for the Department of Health to suggest doctors could be at risk of being identified.

People who wished to campaign or pray outside abortion clinics only had to go on the internet to find a clinic rather than looking through Department of Health figures, she said.

She said it was the department's job to adopt a neutral position on the issue rather than "taking sides" in the debate.

A spokesman for the Department of Health said: "Data on abortions is considered highly sensitive personal data.

"The Office for National Statistics guidance does not recommend releasing any data with a count of less than 10. Releasing such data could increase the risk of identifying individuals.

"The guidance provides clear boundaries to make as much information about abortions available as possible, whilst protecting the individuals concerned - both patients and doctors.

"When the ProLife Alliance asked the Department to release the full data in 2005, we withheld it to secure individuals' confidentiality.

"However, following an appeal from the ProLife Alliance, the Information Commissioner ruled that the department should release the full data.

From:
http://www.telegraph.co.uk/health/healthnews/5404825/Government-fights-to-keep-abortions-secret.html

Children's database launched amid leak concerns

A database with details on every child in England has began operating recently, amid criticisms that the labour government cannot be trusted to amass large amounts of information without it falling into the wrong hands.

Nervousness over ContactPoint, which has been delayed twice while ministers met security concerns, has risen following a string of data losses from government departments. These included the 2007 case of two discs containing the child benefit details of 25m people.

Information stored on ContactPoint will be accessible to hundreds of thousands of government and voluntary sector workers, and will span health, education, social work and youth offending.

"We have serious child protection concerns about this database, which will give too many people access to sensitive information about every child in the country," said Isabella Sankey, policy director at Liberty, the civil rights group.

"Kids in most need of urgent attention could be lost like needles in a haystack, while all of this information will be vulnerable to accident and abuse."

David Laws, the Liberal Democrat schools spokesman, said: "The government has shown it can't be trusted with sensitive data. Parents have every right to demand that their children's personal details aren't put at risk."

But Martin Narey, chief executive of Barnardo's, the children's charity, which will share in ContactPoint, said the directory would provide a quick way for professionals to find out who else was working with a child, making it easier to deliver better co-ordinated services.

"ContactPoint has the potential to make the world a safer place for vulnerable children," said Mr Narey.

The database will supply limited information about children, and any "warning flags" - for example, telling users whether social workers have become involved. It began in the north-west yesterday, prior to a planned national roll-out.

It was first proposed after the 2003 Laming report into the death of Victoria Climbié, the eight-year-old girl who died after failures by social services.

The August 2007 death of "Baby Peter" amid further mistakes by welfare services has heightened concerns about how the state can prevent such extreme abuse, although child care experts say it is not clear that ContactPoint would have prevented either death.

Christine Blower, general secretary of the National Union of Teachers, said: "The solutions to preventing future tragedies lie in the provision of proper resources, back-up and training for frontline services such as social work, and in enabling local authorities to construct effective co-ordinated services in the know-ledge that they will face tough action if they fail.

"This database can very easily be viewed as a bureaucratic response to a failure in communications at local level, where face-to-face work plays a crucial role in early intervention."

From:
http://www.ft.com/cms/s/0/dfd694a8-440b-11de-a9be-00144feabdc0.html?nclick_check=1

Health Direct notes that labour has an appalling record of protecting our data. To endanger every single child in the country with this useless database is not only dangerous but a crass waste of tax payers' money.

NHS to give back pain acupuncture after NICE U Turn

Patients with persistent low back pain should be offered acupuncture, massages or exercises on the NHS, says new NICE guidance.

It is the first time that the National Institute for Curbing Expenditure has explicitly backed the use of complementary therapies.

The rationing watchdog said evidence suggests they help and will be cost effective if doctors stop providing less proven back services like x-rays.

The move was welcomed by some charities and experts but criticised by others.

Low back pain is a very common problem affecting one in three adults in the UK each year, with an estimated 2.5 million people seeking help from their GP.

For many people the pain goes away in days or weeks. But for some, the pain can persist for a long time and become debilitating.

NICE says anyone whose pain persists for more than six weeks and up to a year should be given a choice of several treatments, because the evidence about which works best is uncertain.

Complementary therapies

In addition to painkillers and regular advice to stay active and carry on with normal activities as much as possible, patients, together with their doctor, can decide to opt one of three complementary treatments.

This includes up to eight exercise sessions or 10 sessions of acupuncture over 12 weeks, or a course of manual therapy, which includes up to nine sessions of spinal manipulation, mobilisation or massage.

Professor Peter Littlejohns, NICE said NHS providers now had the opportunity to look at the services they provide and decide what changes are needed.

He said: "There is variation in current clinical practice, so this new NICE guideline means that for the first time we now have the means for a consistent national approach to managing low back pain.

"Importantly, patients whose pain is not improving should have access to a choice of different therapies including acupuncture, structured exercise and manual therapy."

Patients who fail to benefit from their first choice may be offered another of these options, he said.

If that doesn't work, they can try an intensive treatment programme combining exercise and psychological therapy.

He said the costs to the NHS would be minimal - in the order of £77,000 - because they are offset by the savings in terms of reducing future disability and healthcare needs and moving away from treatments with little supportive evidence.

The guidelines, which apply to England and Wales, say doctors should no longer offer spinal x-rays or MRI scans or injections of therapeutic substances into the back for non-specific low back pain.

The Chartered Society of Physiotherapy welcomed the guidelines, as did Dr Dries Hettinga of the charity BackCare.

He said: "This offers a real choice for patients. This guideline will help patients understand what treatment and care can help them with their back pain and shows that there can be a positive outlook for treating this condition."

From:
http://news.bbc.co.uk/1/hi/health/8068427.stm

NHS bribes to kick bad habits by nanny state

The NHS is offering iPods, hotel breaks and helicopter trips as incentives to drinkers, smokers and drug users to adopt healthier lifestyles or undergo tests and treatment by the nanny state.

Teenagers who agree to be tested for the sexually transmitted disease chlamydia are being entered in prize draws to win Nintendo Wii games consoles.

Under a pilot scheme run by NHS Fife, smokers who give up cigarettes for three months are entered into a prize draw for a helicopter trip across the River Forth or an overnight stay for two in a luxury hotel. Other gifts on offer include iPods, toiletries and cinema vouchers.

Bexley NHS Care Trust and NHS Lothian have offered smokers who quit cash prizes of up to £500; another authority offers Asda food vouchers worth about £150. In Lanarkshire, recovering alcoholics and drug abusers are offered free passes to leisure centres.

NHS Northamptonshire offers people the chance to win Nintendo Wii games consoles worth about £160 in a monthly prize draw if they agree to be tested for chlamydia. It has also spent about £4,000 on book vouchers for 14 15 year olds who take part in the scheme.

Camden Primary Care Trust in London has spent almost £5,000 on Wiis and iPods for a chlamydia scheme; in Nottinghamshire, participants could win a £1,000 Fujitsu laptop.

The schemes, details of which have been obtained by The Sunday Times under the Freedom of Information Act, have been criticised by politicians and taxpayers’ groups.

They question the efficacy and ethics of using hundreds of thousands of pounds of public money to reward people for giving up vices that they chose to take up in the first place.

“We are extremely sceptical about whether public money should be handed over in this manner,” said Andrew Lansley, shadow health secretary for the Conservatives.

“Incentives should be geared around helping people to live healthier lives, for example by encouraging them to do more exercise, not simply handing over taxpayers’ hard earned money.”

Mark Wallace, campaign director for the TaxPayers’ Alliance, added: “A lot of people would be concerned that this is not what they pay their taxes for. Particularly when a lot of these things people should be doing anyway of their own accord. It’s in people’s own interests to get their health checked out and there are serious questions about the effectiveness of these incentives.”

However, health officials insist that the incentive schemes are cost-effective because they raise awareness and save the NHS money in the long run by preventing disease.

The cost to the NHS of treating smoking related diseases is £3 billion a year. An estimated 1% of women aged 16 to 19 have chlamydia, which can cause infertility. More than 2,000 15-year-olds contracted it in 2008 due to underage, unprotected sex.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article6350486.ece

Health Direct asks when will the insanity stop?

Labour's nanny state rewards those that do wrong then reform. Why don't we try rewarding those that do right in the first place- how about IPods and helicopter trips for kids that are drug free and don't have sexually transmitted diseases?

It's yet another example of how they have created a society that rewards failure.

Public services waste £1.5m on 'non jobs'

Health boards and other quangos have been accused of wasting more than £1m of public money every year on “non jobs”, including a wellbeing unit manager, events planner and buddy project worker.

Despite concern over a shortage of police officers on the beat and frontline medical staff, an investigation by The Sunday Times has revealed that £1.5m a year is being lavished on unnecessary jobs.

The roles, which have little to do with the delivery of core services, include a £40,000 a year wellbeing unit manager and £22,000 a year events planner employed by Lothian and Borders police. The force also pays £17,000 a year for a chauffeur for David Strang, its chief constable.

NHS Fife has a buddy project worker “to support volunteers who help people stop smoking” (between £20,000 and £26,000 a year), a graphic designer (£25,000-£33,000) and a librarian, to help ensure “professional staff keep up to date” (£20,000-£26,000). In the past, the health board has also employed an artist-in-residence.

Most health boards employ chaplains or “spiritual care providers” on salaries of about £30,000 a year. NHS Dumfries and Galloway also has an organist. The National Secular Society has called for an end to NHS funding for chaplains, and says the cost should be borne by churches.

Matthew Elliott, the chief executive of the Taxpayers’ Alliance, said the jobs were evidence of unacceptable public sector profligacy at a time when private firms were shedding jobs or imposing pay cuts.

“We’re in the grip of a recession, and it’s high time those in the public sector started cutting back on these ridiculous non-jobs that would be an extravagance even in good economic times,” he said.

“The public sector must wake up and realise taxpayers want value-for- money, frontline public services, not unnecessary frills that are of no tangible benefit to most ordinary people. Any right-minded person can see this money would be far better spent on more nurses, doctors and bobbies on the beat.”

Margaret Watt of the Scotland Patients Association added: “This is quite obscene when we are short of GPs, consultants, nurses and midwives.

“The health boards seem to have their responsibilities all back to front — these jobs should not be a priority. It is more important that we have the staff to take care of our patients than anything else.

“They should be dealing with the core business at the moment where we have insufficient staff in hospitals across the country.”

NHS Fife said it did not consider any of the jobs “nonessential”.

“The modern NHS requires a range of staff to work together to enable it to develop a service for the 21st century,” said a spokeswoman.

From:
http://www.timesonline.co.uk/tol/news/uk/scotland/article6301788.ece

NHS told to tighten data security by watchdog

The information commissioner has told the NHS to improve its data security, after breaches involving the loss of thousands of personal medical records. The losses were described as a cause of "great concern".

The independent data security watchdog says it has taken action against 14 NHS organisations in the last six months.

Among the data subject to breaches were the medical details of more than 6,000 prisoners and of 700 hospital patients.

A Department of Health spokesman said action would be taken against anyone who breached data protection rules.

'Inexcusable'

Information Commissioner Richard Thomas has written to the Department of Health's top civil servant requesting immediate improvement.

Mick Gorrill, the assistant information commissioner, told the Independent newspaper that the "inexcusable" data losses within the NHS had become a cause of "great concern".

The paper reported that between January and April this year there were 140 reported security breaches within the NHS - more than from central government and local authorities combined.

These included medical details of more than 6,000 prisoners in Preston Prison in Lancashire that were contained on a lost memory stick. The data was encrypted but a note attached to the stick gave the password.

Another memory stick with the details of more than 700 patients at Cambridge University Hospital was left in a vehicle. A car wash attendant was able to access the unencrypted material.

'Secure network'

A Department of Health spokesman said the permanent secretary at the department would be replying "in due course" to Mr Thomas's concerns and that action would be taken "against anyone responsible for breaching our strict data protection rules".

"The chief executive of the NHS wrote to all senior health managers reminding them of their responsibilities," he said.

"The department is also providing, through the National Programme for IT, electronic patient records systems that are protected by the highest levels of access controls and other security measures, a secure NHS network for exchanging information that is centrally monitored and strongly protected and secure NHS e-mail facilities that encrypts all data in its system."

In December 2007, nine NHS trusts in England admitted losing patient records, thought to affect hundreds of thousands of adults and children.

From:
http://news.bbc.co.uk/1/hi/uk/8066609.stm

Swine flu vaccine supplies secured and costed.

Fresh hope of protection against the H1N1 flu outbreak emerged when the labour government said it had signed a £450m agreement to reserve scarce manufacturing capacity for 90m doses of vaccine by the end of the year.

The contract, which individuals close to the talks estimated to be worth about £5 a dose, may spark international concerns as some richer countries negotiate with producers for privileged access to limited supplies of a pandemic vaccine .

The deal comes at a time when worried parents have raised the idea of "swine flu parties" - to expose the family to the virus while it remains relatively mild - and have made efforts to obtain the antiviral flu treatment Tamiflu through private prescriptions and the internet. Officials have advised against both approaches.

No vaccine is currently available to protect against the H1N1 virus first identified in Mexico, and there is considerable doubt that the current seasonal vaccines will provide any help.

With scientists close to preparing a "seed virus" from the current H1N1 strain isolated in Mexico, the UK funding will allow for production of a vaccine over the next few months - in time for a second wave of infection expected during the flu season towards the end of the year.

Alan Johnson, health secretary, said: "These additional arrangements provide the opportunity by December this year to have enough pre-pandemic vaccine to protect at least half of the population from swine flu."

GlaxoSmithKline, which won the contract to supply 60m of the 90m British doses, said it had also sold a further 50m doses to France, 13m to Belgium and 5m to Finland. Baxter, which will supply the UK's remaining 30m doses , said it had not finalised any other H1N1 vaccine contracts.

The UK already agreed two years ago to pay £155m for " advance supply agreements " which reserve manufacturing capacity for production of 132m doses of a future pandemic vaccine sufficient to cover the entire population. If the World Health Organisation raises its assessment of the current H1N1 virus to a full pandemic, this earlier contract will be triggered.

But with total annual seasonal flu production estimated at 400m doses globally, there is unlikely to be sufficient capacity to cover the entire world, even with new approaches and technologies to boost productivity.

From:
http://www.ft.com/cms/s/0/f7a80ecc-41b3-11de-bdb7-00144feabdc0.html?nclick_check=1

What a difference a day and the FT can make.

In the Health Direct blog post yesterday Swine flu: Government signs up for 90 million doses of vaccine Labour Ministers have signed agreements to secure up to 90 million doses of swine flu vaccine.

We asked why the costs of the new order were being kept confidential. Thanks to the Financial Times for uncovering the amount we are paying for the questionable cover.

Swine flu: Government signs up for 90 million doses of vaccine

Labour Ministers have signed agreements to secure up to 90 million doses of swine flu vaccine despite the fact that a pandemic has not yet been declared.

The deals with pharmaceutical companies GlaxoSmithKline (GSK) and Baxter will secure “early supplies” of a vaccine for the newly identified H1N1 strain.

Enough “pre-pandemic” vaccine has been ordered to protect at least half of the population by December, at an estimated cost of £100 million.

This is in addition to the purchase of 500 million doses of anti-viral drugs that have already been stockpiled to help treat illness and deals to procure vaccine in the event of a pandemic.

So far only 184 cases of the newly identified H1N1 strain have been confirmed in Britain, with all those infected showing only minor symptoms.

However, experts predict that swine flu — which is actually a recombination of existing animal and human flu strains — could cause a second wave of more widespread illness in winter.

The Department of Health said that the agreement could provide enough vaccine to protect health workers and the most vulnerable patients before a pandemic arrived, without affecting the normal supply of seasonal flu vaccine.

The jabs could be given as a priority to the elderly, patients with chronic conditions as well as NHS and social care staff.

It may be that the vaccine would be supplied in two or more doses, necessitating the order for more treatment courses than the total population of Britain.

The Government has already signed agreements worth £155 million to supply up to 132 million doses of vaccine to inoculate people in the event of a pandemic.

It has also procured enough anti-viral drugs to cover 80 per cent of the population, at a cost of more than £500 million.

But it refused to disclose the additional cost of the new contracts signed.

The World Health Organisation’s official alert level remains at phase five out of six — one step away from declaring a global pandemic. But France, Belgium and Finland are among other countries that are stockpiling doses of potential vaccine as a precautionary measure for such an event.

The vaccines used before and during a pandemic would almost certainly be the same unless the strain mutates sufficiently to require an entirely new vaccine to be made.

Alan Johnson, the Health Secretary, said: “The localised cases of swine flu found in the UK have so far been mild, and our strategy of containing the spread with anti-virals appears to have been effective in reducing symptoms and preventing further spread of infection.”

But, he added: “Scientists tell us that as yet we don’t know enough about this novel strain, or whether it’s likely to mutate, but that this virus has the potential to become a pandemic and we can’t predict how serious that would be.”

Mr Johnson told the House of Commons that it could take four to six months before a vaccine could be manufactured in the event of a pandemic and more than a year until it would be available in sufficient quantities for the whole population.

“We have an opportunity to secure vaccine in advance of a pandemic wave... These additional arrangements provide the opportunity by December this year to have enough pre-pandemic vaccine to protect at least half of the population from swine flu.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6293951.ece

Health Direct is pleased that Alan Johnson seems to be on the ball with Swine Flu, but why the secrecy over the additional costs?

Surely Alan Johnson- one of the spposedly "saints" over MPs expenses, realises that silence is the devil's friend. These extra costs will eventually be published. And will they met be from the NHS's existing budget or the Treasury's Contingency Fund?

NHS swine flu absence may reach 85%

The NHS may struggle to cope if there is a flu pandemic because of the number of staff who will fail to turn up for work, a report suggests.

Birmingham University researchers quizzed more than 1,000 health workers and found as many as 85% may be absent.

This is more than double the official predictions and the experts believe such a scenario could put too much strain on the health service.

Under contingency plans already drawn up, protocols are in place to allow the NHS to cancel non emergency treatment such as elective operations.

GPs have also been asked to develop networks to allow the sharing of resources to cope with pressures during a pandemic.

But the report, published in the BMC Public Health journal, questioned whether this would be sufficient.

Official estimates suggest the absence rate will be something between 10% to 35%.

But the Birmingham University poll found that in a severe pandemic where many schools were closed and transport disrupted the actual figure could be more than double that.

Researchers asked a range of staff ranging from doctors and nurses to support staff and managers about how they thought they would cope.

High absence rates were predicted for each group, although doctors were among the most likely to turn up.

The most important factor that would lead to an absence was caring responsibilities to children or elderly family members, the report said.

'No easy answers'

Dr Sarah Damery, one of the report authors, said: "It raises questions about the ability of the NHS to cope. The problem is that there are no easy answers.

"Things such as transport and accommodation can be resolved, but the major factor that would influence people staying away is to do with caring responsibilities and these are not that easy to solve."

The findings come as the UK is braced for a pandemic.

The World Health Organization currently rates the swine flu outbreaks at phase five - one level short of a pandemic.

Professor Steve Field, the president of the Royal College of GPs, which has helped draw up the contingency plans, said: "I think the plans in place are excellent and what we have seen so far is that health workers have risen to the challenge.

From:
http://news.bbc.co.uk/1/hi/health/8048554.stm

Private companies increase GP presence

The private sector has established a small but significant bridgehead in general practice in England, but any “corporate takeover” of family doctor surgeries remains a long way off.

Primary care trusts have been commissioning some 260 “GP-led health centres”, or “polyclinics”, open 8am to 8pm, seven days a week – one in each primary care trust and a further 110 or so in areas short of doctors.

With just over 200 of the contracts awarded, 42 per cent have been won by partnerships of GPs, according to health department figures. Private sector companies have won 21 per cent, and consortia – usually a mix of GPs working with independent sector partners – have won 19 per cent.

The remainder have gone chiefly to third sector organisations, including social enterprise, with primary care trusts awarding 6 per cent of contracts to their own provider arms.

When the centres were announced, the British Medical Association ran a “save our surgeries” publicity campaign and petition, saying the labour government was seeking to privatise general practice and that many of the extra surgeries with longer opening hours were unnecessary.

The contract award figures show, however, that GPs locally have bid strongly to run them – even the practice in which Dr Hamish Meldrum, the BMA’s chairman of council is a partner, won one commission.

“How well family doctors and the private sector have done depends somewhat on how you want to look at the figures,” said Helen Parker, co-director of the Health Services Management Centre at Birmingham university.

If GPs working in consortia with independent sector partners are included in the total that are GP-run, family doctors have won 60 per cent of the contracts.

If, however, those consortia that include the independent sector are counted as privately run, private operators have a stake in 40 per cent. But even in this scenario, fewer than 100 of the 8,000 general practices in England will be run by the independent sector.

“This does not yet amount to a corporate takeover of general practice,” Ms Parker said.

Mark Britnell, the health department’s director-general of commissioning, said the outcome “is a good mix, and the fact that GPs have won a significant proportion of the contracts shows that the BMA was wrong to insist that this was bad for GPs”.

Mike Parish, chairman of the NHS Partners Network, which represents private providers, said it was broadly pleased with the outcome.

“It is a fantastic opportunity to build on the new relationships that have been established [with primary care trusts]”, he said. “We see these projects as the beginning rather than the end, or a one-off.”

Some £10bn of efficiency improvements would be needed over the next few years as NHS spending was squeezed, he said. Private sector investment could play a key part in moving services out of hospital to more convenient locations at lower cost.

From:
http://www.ft.com/cms/s/0/75aebad8-3db7-11de-a85e-00144feabdc0.html

MPs criticise NHS in England for forcing patients to spend their last days in uncaring hospital surroundings

Elderly patients in the final stages of terminal illness are being denied the right to die at home due to inadequate NHS and social care, a critical parliamentary report warns.

Newly allocated funds aimed at improving end-of-life care are at risk of being spent on other medical priorities, the Public Accounts Committee (PAC) suggests.

Half a million people die in England every year; almost two-thirds of them are over 75. The vast majority of deaths follow a period of chronic illness such as cancer or heart disease.

About 60% of those deaths occur in an acute hospital despite the fact that "there is no clinical need" for the person to be there, the study says.

"Most people express a preference to die at home [surrounded by friends and family]. People should have the right to die in the place of their choice.

"[Health authorities should increase] the availability of community services, such as 24-hour district nursing, and access to advice and medication out of hours to help reduce the number of unnecessary hospital admissions."

Those who die in hospital are often deprived of effective pain management and not accorded adequate "dignity and respect" in their last days and moments by NHS staff, the report states.

"Because someone is approaching the end of life it should not mean we abandon concern for their quality of life. End of life care should seek to sustain people's quality of life as a priority."

There should be more checks, the paper suggests, to ensure staff receive education and training in end of life care. Specialist palliative care teams should always be deployed to deliver pain relief.

Residential homes, especially those without qualified nursing staff, often feel ill equipped to care for people in the final stages of life and send them to hospital or refuse to take residents back after a hospital admission.

In one local study, the report shows, at least 40% of patients who died in a Sheffield hospital "did not have medical needs which required them to be admitted". Many had been occupying a bed for more a month – suggesting that resources could be freed up and redirected to home care.

The National Audit Office has estimated the cost of caring for cancer patients (who account for 27% of all deaths) in the 12 months before death was £1.8bn. Reducing emergency admissions by 10% and cutting the average length of stay to three days would release £104m for redistribution to other end of life care services.

The Department of Health has allocated £286m over the next two years to improving end-of-life care. But the PAC warns "there is a risk that the additional [sum] will not be used as intended. The department should require primary care trusts to account for how the additional funding is spent."

Co-ordination between health and social care services in this area is "generally poor", the report notes.

"That health and social care providers have traditionally given a low priority to end-of-life care is shown by the lack of training in basic end of life care among front-line staff," the chairman of the PAC, Edward Leigh, said.

The catalogue of problems discovered in hospitals include poor support for basic comfort; lack of privacy for the patient and their family; poor communication by staff; and staff recognising too late that somebody is about to die.

"It is appalling that people dying in hospital are not always being given the end of life care they deserve," Leigh said, "including effective pain management and being treated with dignity and respect."

From:
http://www.guardian.co.uk/society/2009/may/14/end-of-life-care-report-nhs

PFI projects to stay off the books

Many Private Finance Initiative (PFI) projects are to remain, in effect, off the labour government’s balance sheet.

The decision means that hospitals, clinics, schools, waste and local authority projects can continue to be built under PFI without counting against the government’s capital expenditure totals.

With public sector capital spending set to halve in cash terms after 2011, that will come as a considerable relief to public bodies.

They face seeing capital expenditure drop from £44bn ($68bn) this year to a mere £22bn a year in 2013-14, a reduction that would have had an even bigger impact if the billions of pounds of PFIs and PPPs that are in the pipeline had to count within that.

In spite of the widespread expectation that almost all PFI projects would go on the books as the Treasury fulfils a longstanding promise to move the public sector to international financial reporting standards, the Treasury has now issued all but final guidance to Whitehall departments indicating that, while they will count on departmental accounts, a different accounting standard will apply for the Treasury’s budgeting purposes.

That will be based on the European accounting standard that is applied by the Office for National Statistics to the national accounts. It has the effect that many projects will continue to count as off-balance sheet.

”The expected effect is that things will go on much as before,” a leading PFI accounting expert said. “There may be some changes at the margins over which projects count as on the books or off.

“But broadly speaking, where a project would have been off the books up to now, they will remain off the books.”

He added, however, that one effect of the guidance could be that departments would have to produce two sets of accounts, one complying with the IFRS standard and another to meet the European one.

Nick Prior, head of government and infrastructure at the consultants Deloitte, said: “This clarification is extremely welcome for the future of PFI and PPPs. Government departments should now be able to bring forward projects that have been delayed because of uncertainty over budgetary arrangements.”

About 60 per cent by value of PFI projects are currently off balance sheet. Critics, and even some supporters, of PFI have argued that the need to shift risks to the private sector – sometimes artificially – to achieve off-balance sheet treatment has been bad for public procurement.

A study last year by PwC, the professional services firm that advises both the public and private sectors on PPPs, said that if the projects all came back on the books it would ”frankly come as a relief” as some have been “distorted” to get them off balance sheet.

From:
http://www.ft.com/cms/s/0/143664c4-3f4a-11de-ae4f-00144feabdc0.html

NICE guidelines on drugs are unfair MPs decide

The methods used by the labour government's killer quango NICE to decide whether the NHS should pay for expensive drug treatments are wasteful and unfair, according to MPs.

A report from the Commons Health Committee recently attacked the way in which the National Institute for Curbing Expenditure (NICE) assesses costly cancer medicines as "both inequitable and an inefficient use of resources".

The MPs' inquiry was sparked by calls for cancer patients to be able to pay out of their own pockets for medicines that Nice advises the NHS not to use, leading to new guidelines issued late last year by Prof Michael Richards, the government's "cancer tsar".

After a series of decisions by Nice to reject new cancer drugs as insufficiently effective either clinically or on cost, Prof Richards called for the National Health Service to make more expensive drugs available.

However, the select committee argued that Nice had in response adopted a threshold for judging whether to approve "end of life drugs" that was too high, depriving the NHS of resources to spend on more cost effective drugs for other illnesses that had a more significant benefit.

It also criticised Nice for moving too slowly in assessing new drugs, and said the agency's guidelines for selecting the types of costly cancer drugs to be reviewed was "too woolly".

The committee questioned the increased threshold adopted by Nice for approving such drugs above the usual £30,000 per quality adjusted life year (Qaly), the measure it uses to assess the benefit a drug brings to a patient. Nice denied that threshold was as high as £70,000.

Kevin Barron, chairman of the committee, denied that the implication of the report was that Nice should reduce its Qaly threshold, arguing instead that it should make greater efforts to free up resources by finding other ways for the NHS to save money.

His committee said it was "extremely disappointed" little progress had been made by the government in following its previous calls for Nice to "disinvest" in obsolete technologies.

Prof Sir Michael Rawlins, chairman of Nice, said: "There is a balance between egalitarianism and utilitarianism. The select committee has fallen into the latter."

He said Nice was reviewing the Qaly, but it was "the only game in town", and that identifying savings for the NHS from older treatments and techniques was a difficult and "subtle" process.

The health select committee also expressed caution over the growing use of "risk sharing" schemes, whereby the government and pharmaceutical companies agree to reimburse some of the costs of medicines that prove less effective than initially believed.

The debate came as the National Audit Office identified one source of savings, estimating that NHS primary care trusts had saved £394m last year through more consistent use of lower cost, generic medicines for some common conditions such as high blood pressure, high cholesterol and gastric problems.

From:
http://www.ft.com/cms/s/0/3d1bce3a-3f57-11de-ae4f-00144feabdc0.html?nclick_check=1

Health Direct points out that NICE's use of the phrases "difficult" and "subtle process" are similar to that of MPs' expenses. A smokescreen for don't ask me uncomfortable questions.

Until NICE publishes what it's Qaly definition and it's scientific analysis guidelines for evaluating drugs actually are- the killer quango will continue to have the disrespect it deserves.

Health minister to repay £41,000 expenses

Phil Hope, the Labour health minister, has agreed to pay back more than £41,000 he claimed in expenses to refurbish his second home.

The care services minister this morning announced he would write a cheque for £41,709 to cover the cost of the furniture and fittings he claimed for the property – a small two bedroom flat in south London.

The sum being returned by Mr Hope is the largest amount an MP has pledged to refund since the expenses scandal broke, but dozens of other members are expected to follow suit under pressure from their party leaders.

The Corby and East Northants MP said that his announcement was unrelated to fears over his slender 1,517 majority – and said he should be able to find the money "within a week or so".

"It is going to be difficult, it is going to be challenging but this is a personal decision that we [he and his wife Allison] have made together," he told Sky News.

In a statement, Mr Hope insisted his claims were within the rules, but said he wanted to correct the "dreadful perception" and he enriched himself with taxpayers' money.

"The anger of my constituents and the damage done to perceptions of my integrity concerning the money I have received to make my London accommodation habitable has been a massive blow to me that I cannot allow to continue," he said.

Mr Hope is following in the footsteps of Hazel Blears, the communities secretary, and backbench Labour MP Margaret Moran in agreeing to refund questionable payments following a week of disclosures about expense system abuses in The Daily Telegraph.

Miss Blears has agreed to pay back £13,000 in capital gains tax from profits on a house paid for by the taxpayer, while Miss Moran will return the £22,500 she claimed for treating dry rot at a house 100 miles from her constituency.

Alan Duncan, the shadow leader of the Commons, will repay more than £5,000 in gardening costs; Andrew Lansley, the shadow health secretary, will repay £2,600 claimed for home improvements; and Oliver Letwin, the chairman of the Conservatives’ policy team, will refund £2,000 for getting pipes repaired under his tennis court.

Mr Lansley apologised to his South Cambridgeshire constituents for claiming "overgenerous" expenses in a letter to his local paper. "The public has every right to be angry about MPs' allowances. I was part of that system and I'm sorry for my part in it," he wrote.

The announcements come amid a growing acceptance at Westminster that politicians from the three major parties must act decisively to restore public trust in parliamentary democracy or risk a backlash from the electorate in the June 4 European and local council polls.

David Cameron has said that Tory MPs shown to have broken the rules could be sacked, and on Tuesday Gordon Brown has admitted that "extreme" action is needed to restore public trust in politicians.

The Prime Minister said an independent review of every claim made over the past four years would allow MPs to show they are "worthy of public trust".

"I think the issue here with Hazel Blears is about the sale of a house where CGT could or could not have been paid," Mr Brown said. "She has looked at what has happened, I have talked to her, she has repaid the money."

Mr Brown said other ministers who had come in for criticism over their accommodation arrangements, including Chancellor Alistair Darling and Transport Secretary Geoff Hoon, were in a "different position" but could still face disciplinary action if the independent review found there were problems.

Mr Hope, who has also been criticised for employing his son Nick and daughter Anna for parliamentary work, said that he was repaying his expenses because the Telegraph's disclosures had "fundamentally changed the view people have of me and that is something I cannot bear."

The MP billed taxpayers for so much furniture for his second home in Southwark, south London – including a chest of drawers, a mattress, a television, a sofa, an armchair, a washing machine, three chairs, two bookcases, one coffee table, a wardrobe and a dining room table – that questions were raised about how it could have all fitted into the small flat.

His statement read: "I have worked very hard over the last 12 years to represent and fight for my constituents, and their opinion of me as a person matters hugely to both myself and my wife Allison.

"We feel very badly hurt by what has happened and although I kept to the rules laid down by Parliament I cannot allow this dreadful perception about what I claimed in allowances to continue.

"I have decided to try to restore the trust and relationships I have with my constituents. I am returning all of the money that I have claimed for fittings, furniture and household items that I received over a five year period – the sum of £41,709.

"This will be paid to the House authorities as soon as the necessary arrangements can be made."

Speaking to Sky News, he added: "This is not about votes; this is about who I am. This is about me and this is a personal decision I am making.

"Whenever the election comes, whatever goes on there, I just want those people I represent to know, whether they vote for me or not, that I have personal integrity."

From:
http://www.telegraph.co.uk/news/newstopics/mps-expenses/5317104/Phil-Hope-agrees-to-return-41000-as-MPs-retreat-on-expenses-claims.html

Personal Intergrity- Health Direct asks why it took him so long to pay back his fiddled expenses aftre they became public knowledge? And how come he has so much spare cash sloshing around- the equivelent of two thrids of his annual salary- before tax?

Health minister Ben Bradshaw also received attention from The Daily Telegraph, although the paper’s prime interest was in the fact that the second home for which he has claimed around £1,600 a month in mortgage interest payments is jointly owned with his civil partner. His total claims over the four year period were £56,568.

Health secretary Alan Johnson was absent from The Daily Telegraph’s detailed coverage, with no details reported.

Act now to prevent blood clots becoming the next MRSA warns NHS Confederation

NHS trust boards must act to stop deadly blood clots becoming “the next MRSA” in the eyes of patients and the media, the NHS Confederation is warning.

In a report to trusts, the confederation says clinical issues such as healthcare acquired infections have the capacity to cause “enormous damage” to trust reputations.

With public, political and media interest in venous thromboembolism (VTE) increasing, checks for blood clot prevention could become part of future trust assessments, the report says.

The condition causes the deaths of around 40,000 hospital patients each year, as well as increasing treatment costs and hospital stay length.

The cost implications of risk assessing patients are likely to be minor when compared with the costs of treating post-surgical deep vein thrombosis and pulmonary embolism patients, the confederation says.

Policy director Nigel Edwards said: “Managers, clinicians and patients have a real chance to build on the success of reducing infections. If we work together we can save lives and reduce NHS costs by improving the assessment of all patients and using cost effective preventative measures.”

Hospital boards could include venous thromboembolism measurements in trust quality dashboards and appoint clinical champions to promote the issue to colleagues, as well as appointing lead non-executive directors for the condition.

Baseline assessments can be used to establish how trusts are performing on assessing patients and boards can ask whether venous thromboembolism prevention is included in staff training.

Primary care trusts could include risk assessments and prophylaxis targets in contracts with providers.

The report comes as a survey by thrombosis charity Lifeblood reveals the public is largely unaware of the risk of blood clots.

From HSJ:
http://www.hsj.co.uk/5001282.article

Health Direct is amazed that the public is largely unaware of the tens of thousands that deie risk of VTE, because Health Direct certainly is not.

Within only a few months of lauching the Health Direct blog we came across the terrible death toll that VTE causes in the UK.

On March 08, 2005 Health Direct posted- 25,000 die from preventable VTE
Each year over 25,000 people in England die from venous thromboembolism (VTE) contracted in hospital.

This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than twenty five times the number who die from MRSA.

And again, on October 31, 2006 we posted NHS patient safety 'must improve' says Healthcare Commission

More needs to be done to improve standards of safety in the NHS and independent sector, a watchdog says. The Healthcare Commission said that while most patients received safe care, standards were inconsistent in England and Wales.

The watchdog said there was no clear indication on the number of deaths that could be avoided.

Baby Peter died becasue of systemic NHS failings

Health workers missed dozens of opportunities to identify abuse being suffered by Baby Peter before his death because of “systemic failings” in the care given to the child, an official report has found.

The inquiry into NHS failings, conducted by the Care Quality Commission and published today, concludes that doctors and other health professionals had contact with the little boy 35 times but every chance to raise the alarm was missed.

Any one of these professionals could have picked up that he was suffering abuse if they had been “particularly vigilant” and gone “beyond what was required” by the system, the health regulator said.

The commission examined the actions of four NHS trusts in London involved in the care of Baby P, who can now be named as Peter, before his death in August 2007 aged 17 months.

Investigators found a “catalogue of errors”, including chronic staff shortages, inadequate training, long delays in seeing the child and poor communication between health workers, police and social services.

The commission also raised concerns at how the four trusts — North Middlesex University Hospital NHS Trust, Haringey Teaching Primary Care Trust, Great Ormond Street Hospital for Children NHS Trust and Whittington Hospital NHS Trust — rated key services linked to child protection as compliant with core NHS standards.

Three of the four trusts declared themselves compliant in all relevant standards in each of the three annual health checks collated by the Healthcare Commission, the predecessor of the Care Quality Commission, before Peter’s death.

Peter was on the at risk register when he was found dead in his blood-spattered cot in Haringey, North London, on August 3, 2007. He had suffered 50 injuries despite receiving 60 visits from social workers, doctors and police over the final eight months of his life.

Last year his mother, her boyfriend and their lodger were convicted at the Old Bailey of causing or allowing his death. This month the boyfriend was also found guilty of raping a two-year-old girl.

The commission said that its findings had been sent to the trusts in March and action plans had been produced to address care shortfalls that had still not been addressed. Publication of the report was delayed until today to avoid prejudicing the related court case.

The report highlights a series of failings when Sabah al-Zayyat, a consultant paediatrician, saw Peter at St Ann’s Hospital in Tottenham, North London, two days before he died.

Dr al-Zayyat decided that she could not carry out a full check-up because the little boy was “miserable and cranky”, and she did not spot that he had serious injuries, probably including a broken back and fractured ribs.

The doctor had no contact with Baby P’s social worker before or after the appointment and was given no details about the child’s previous hospital admissions, the commission noted in a report.

She was one of only two consultants at the specialist children’s clinic at St Ann’s Hospital, when there should have been four.

On an earlier occasion, in April 2007, Baby P was discharged from North Middlesex University Hospital in Edmonton, North London, without a formal meeting to discuss concerns about possible abuse — contrary to standard procedures.

Sue Eardley, head of children’s strategy and safeguarding at the Care Quality Commission, said that it was a problem of system failures rather than “individual culpability” by the health workers who saw Baby P.

She added: “If somebody had been particularly vigilant and gone beyond their scope, beyond what was required, any one of those could have picked it up.”

Cynthia Bower, the commission’s chief executive, said it was vital that lessons from the case were learnt across the country as well as in North London. She added that stronger legal powers would ensure that, from next year, trusts could be held to account for inaccurate claims of competence.

“There were clear reasons to have concern for this child but the response was simply not fast enough or smart enough.

“The NHS must accept its share of the responsibility. Professionals were not armed with information that might have set alarm bells ringing. Staffing levels were not adequate and the right training was not universally in place. Social care and healthcare were not working together as they should.”

The commission is carrying out a review of all NHS trusts in England to check that they are doing enough to protect vulnerable children. It will be published in July.

The General Medical Council has suspended from practice Dr al-Zayyat and Baby P’s family GP, Jerome Ikwueke, over their involvement in the case.

The NHS trusts criticised in the report apologised for failings in the Baby P case and said that they had taken steps to address them.

Alan Johnson, the Health Secretary, said that the report highlighted “clear failures by local NHS organisations to communicate properly and share information and expertise”.

“These failures are unacceptable. The protection of vulnerable children requires the very highest levels of performance. We must do all we can to learn the lessons of this appalling case.”

Mr Johnson, who ordered the commission’s review in December, pledged that the recommendations would be “rigorously applied” across the health service.

Seen but not spotted

During the period March 1, 2006, to August 3, 2007, a number of health professionals had numerous contacts with Baby P, including:

6 visits by Baby P to an acute hospital (excluding his birth and death). Of these, two were to the North Middlesex University Hospital A&E department, one was to the Whittington Hospital paediatric emergency clinic and three were outpatient appointments (one for paediatric assessment and two for X-rays)

14 visits to the GP practice

1 visit to the specialist child health service, where a consultant paediatrician saw Baby P two days before his death

5 visits by a health visitor in which Baby P was seen at home

6 visits to the child health clinic

2 visits to walk-in centres

1 contact specifically with the midwife

9 attendances by Baby P’s mother at Mellow Parenting sessions, of which five were with Baby P

16 contacts between Baby P’s mother and the primary mental health worker

Source: Care Quality Commission

From:
http://www.timesonline.co.uk/tol/life_and_style/health/child_health/article6276087.ece

Hospital managers worry after Mid Staffs failures

Around half of hospital managers and other staff believe elements of poor standards found at Mid Staffordshire foundation trust exist at their own organisation, a straw poll by HSJ suggests.

Fifty two of 103 respondents - mainly acute managers - said they recognised parts of the poor management and governance highlighted by the Healthcare Commission in March.

Forty two said they recognised elements of the care standards that were criticised.

Examples given included shortage of senior medical staff, lack of protocols, planning and processes, lack of supervision in accident and emergency and junior doctors “used to prop up the service”. One respondent claimed receptionists also assessed patients at their trust.

However, one said: “Sporadic instances of some of these happen at most trusts. Mid Staffordshire seems to have experienced widespread, long term problems.”

Examples of governance problems cited include attention to waiting lists at the expense of care, poor communication, poor board use of benchmarking, lack of board focus on care quality.

The survey results show many trusts have made changes in reponse to the Mid Staffordshire report.

Fifty respondents to the poll said changes were planned or had already been made to information provided to the board following the scandal.

Eighty four respondents said they had read the report but only 60 said their board had already considered the implications. Another 24 planned to. NHS chief executive David Nicholson wrote to trusts telling them to “reflect on this report and the lessons within to ensure these failures cannot be repeated”.

Thirty seven said they planned to or had changed the design of emergency care, for example the use of clinical decision units or emergency care assessment units. Much of the way emergency patients were handled at Mid Staffordshire was criticised.

Nineteen said their trust was planning, or had already, increased numbers of nurses or doctors. Sixty-five said their trusts were now giving more consideration to mortality rates.

In response to government’s new requirement for trusts to publish an annual statement on patient and public involvement, 54 said they did not believe it would help avoid standards becoming so poor elsewhere.

Results are based on an HSJ internet poll completed by 103 respondents.

From:
http://www.hsj.co.uk/5001033.article

NHS governance 'reduced to paper chase' - Audit Commission

Many NHS trust board members cannot be sure whether or not their hospital is operating within the law, the Audit Commission has found.

Formal processes to ensure boards can be certain legal and regulatory standards are met have been reduced to a “paper chase”, risking a repetition of the major failures at Maidstone and Tunbridge Wells and Mid Staffordshire foundation trust, it says.

Audit Commission chief executive Steve Bundred told HSJ the commission’s study, Taking it on Trust, was undertaken in the wake of concerns aired by the foundation trust regulator Monitor about the way boards were working at some applicant trusts, the high profile failures at a handful of NHS hospitals, and discrepancies between what trusts tell regulators about their performance and what inspectors find.

The commission studied governance structures and processes at 15 NHS trusts. It found an abundance of formal controls and processes designed to ensure non-executive board members could hold the trust to account on its performance.

But many of these had been reduced to a “paper chase rather than critical examination,” and had become “disassociated” from the day to day running of the trusts.

“The controls are in place. Everywhere we looked they were there,” Mr Bundred said. “But they are not always being operated as rigorously as they should. If boards don’t get this issue right then patients can be at risk.”

“We are not saying things are going wrong, but that things could be much better,” he added. “Mid Staffordshire and Birmingham [Children’s Hospital foundation trust] are examples where things did go wrong. Because they happened, it’s incumbent on all boards to ensure they are working effectively.”

“In some instances boards might not know where the weaknesses are because the controls they have in place to give them assurance are not working as they should.”

From:
http://www.hsj.co.uk/5000855.article

NHS trust's emergency care 'appalling', say reports

Poorly handled reorganisations, a failure to take patient complaints seriously, a "closed culture" and a "hugely disappointing" failure to blow the whistle lay behind "appalling" standards of emergency care at Mid-Staffordshire NHS Trust, two reports said last week. Health Direct will this week examine the fallout from the preventable deaths.

Even now, problems with staffing and equipment persist at the hospital where the Healthcare Commission said last month that emergency patients died because of chaotic care, the reports said.

The findings came as Alan Johnson, the health secretary, said that primary care trusts will have to publish an annual statement showing how they involve patients in decision making.

Hospitals will have to publish the number of complaints that they receive and how many they successfully resolve.

Health authorities will have to seek explicit assurance from the new NHS regulator, the Care Quality Commission, that the quality of care is acceptable before trusts are put forward to become NHS foundation trusts.

In the case of the Stafford hospital, Monitor, the foundation trust regulator, was unaware of mounting concerns at the Healthcare Commission about the quality of care at the time that it was approved for flagship foundation trust status.

In addition, Mr Johnson announced that a question that has been dropped from the annual staff survey - whether staff are happy with the standard of care their organisation provides - is to be reinstated.

Low scores at Mid-Staffs, where just 27 per cent of staff said they were happy with the care provided, was one factor that alerted the Healthcare Commission to problems there and the decision to drop the question has been fiercely criticised.

Extra nurses were being drafted in to the hospital as Mr Johnson said that while there have been "significant improvements" at Stafford, it was "clear there is more to do".

He also reminded staff that they have a duty to blow the whistle about poor quality care and are protected under the Public Interest Disclosure Act.

Andrew Lansley, the Conservative health spokesman, said the reports by the health department's accident and emergency and primary care tsars "are neither open nor independent enough" and neither, he said, "gets to the heart of why staff did not feel they could speak out".

The Patients Association said it was considering applying for a judicial review of the decision not to hold a formal independent inquiry into what happened at the hospital.

The studies showed that as the local strategic health authority and primary care trust were reorganised in 2006, key information was not transferred and there was "a loss of organisational memory".

http://www.ft.com/cms/s/0/cd056222-35e8-11de-a997-00144feabdc0.html?nclick_check=1

Health Direct is pleased with Alan Johnson's U turn on asking the "difficult questions" about hospital standards.

However, it was only a month ago that his department dropped the common sense requirement:
Labour stops asking the uncomfortable question- is your hospital OK?

Tue, 14 Apr, 2009- National Health Service staff are no longer being asked whether they would be happy to be treated in their own hospitals, because the answers don't match labour's spin.

Pressure mounts on NHS patient e-records NPfIT white elephant scheme

The main suppliers to the stalled £12.7bn National Health Service’s NPfIT programme to ­create an electronic record of patients' records have been given until the end of November to demonstrate real progress in installing the systems in big acute ­hospitals.

If the seven month deadline is not met, “we will look at alternative approaches”, Christine Connelly, the Department of Health’s chief information officer, told the Financial Times.

Asked whether that could involve termination of the billions of pounds’ worth of important contracts held by BT, CSC, Cerner and Isoft, she said: “At this point, we are not ruling anything out.”

She stressed, however, that “it is in all our interests to make the systems and solutions we currently have a success”.

Her comments came as she outlined the latest plan to get back on track the troubled records programme, which is running at least four years late. Under the plan, she said:

• All hospitals will be given greater freedom to configure the system to their local needs.

• A “library” of such adaptations will be built, so trusts can choose which version is closest to their requirements and then, if need be, adapt it further.

• In the south, a nine month competition is to be held to let additional suppliers bid alongside CSC and BT to install and run the record in some 30 trusts where progress was halted after Fujitsu was fired from the programme last May.

• An approach modelled on Apple’s iPhone “apps store” will be allowed, so that any supplier can provide additional functions. That will mean earlier adopters of the BT and CSC systems will be able to exploit what is installed without having to wait “months or years” for the next software release.

Also, specific deadlines have been set to get Isoft’s and CSC’s most advanced system running in a big acute hospital by the end of November and working smoothly across it by next March. At present the clinical part is running in a handful of clinics and wards, without the full integration with a patient administration system that the new deployment will require.

In London, BT will have to install a Cerner system smoothly in a big hospital – probably Kingston – by the end of November. To date, each installation in London and the south has been dogged by problems.

“The key thing we have communicated to our suppliers is significant progress by the end of November,” Ms Connelly said. By then, “if there is a suggestion that everything is just going to slip and slip, that’s the point where we will draw the line” and “start to look at alternative approaches”.

She did not, she said, “want to talk very much” about what that would involve, and added that detailed plans would have to be drawn up. But “at this point we are not ruling anything out”.

In spite of continued slow progress in the north and a fresh competition in the south, the overall revised timetable of having the record in place across England by 2015 held, she said, as did the budget.

http://www.ft.com/cms/s/0/bae2ae52-3358-11de-8f1b-00144feabdc0.html

Health Direct is pleased that Christine Connelly, the Department of Health’s chief information officer is preparing to crack the whip.

Though we have been here many times before: on June 09, 2008- NHS NPfIT will be at least four years late- It will be at least 2014 - four years later than planned - before a single NHS electronic patient records NPfIT system is in place in England, say auditors.

And on October 17, 2007- NHS shakes up £12bn IT programme A big revamp of the National Health Service’s £12bn IT programme is under way that will see NHS trusts given more choice of how systems are installed and which software they get.

So we think that another seven months delay in the scheme of things is neither here nor there and Ms Connelly had to say something to justify her £200,000+ salary.

Though we wonder why it has taken her eight months to state the bleeding obvious.

September 26, 2008 NHS appoints new IT supremos The health department has finally appointed replacements for Richard Granger, the National Health Service's IT supremo, some six months after his departure as head of Connecting for Health, the white elephant health service programme that aims to create an electronic patient record system.

Coroner criticises woeful and unacceptable treatment of Mike Tindall's grandmother

A coroner has criticised a hospital's "woeful and unacceptable" treatment of England rugby player Mike Tindall's grandmother in the hours before she died of a stroke.

Margaret Shepherd died in Leeds General Infirmary, West Yorks, 10 days after she was hit by a car reversing into a parking space.

The 88-year-old relative of Tindall, who is the boyfriend of the Queen's granddaughter Zara Phillips, suffered minor fractures in the incident in Kirkgate, Otley.

However, on the eighth day of her hospital stay in March 2006, she suffered a blood clot in an artery which led to a stroke.

West Yorkshire Coroner David Hinchliff yesterday issued a damning verdict of standards at the hospital after hearing that there was no record of Mrs Shepherd being seen by a doctor in her last 48 hours.

Recording a narrative verdict, Mr Hinchliff said: "Certain aspects of treatment were unacceptable and the notes were woeful.

"In the two days between her cerebral event and collapse Mrs Shepherd was not attended, examined or diagnosed by a doctor. This represents a serious omission by the clinicians."

During the inquest at Leeds Coroner's Court, doctors and consultants who dealt with the case maintained that Mrs Shepherd had been attended to, but that no notes had been made in her file.

Giving evidence, Dr Katrina Topp, a consultant physician on the case, said she had no explanation for the omission on Mrs Shepherd's file on March 9 and 10.

She said: "I think in this individual case there is no entry on the 9th and 10th but I think the entries on the other days show good housekeeping. They are cases of concern as individual incidents.

"I don't have an explanation but I agree it's very poor. Some doctors have done a ward round and not recorded it in their notes, that needs to be addressed."

Mr Hinchliff said: "If it is not in the notes then it hasn't happened, if it is not in the notes there is no way I can speculate. This was a woeful absence, this is extremely unacceptable and the Trust will reap its own problems if this continues to exist."

However. he added that if Mrs Shepherd's condition had been diagnosed and treated, it would not have altered the outcome.

Following the verdict, Mrs Shepherd's daughter, Linda Tindall, said: "It is now clear that reported concerns were not acted upon during these days. I would not wish anyone to be treated as my mother was as a patient on Ward 34 at the LGI. Nor would I wish their family members to suffer the aftermath of such an event."

Leeds Teaching Hospitals NHS Trust issued a statement apologising to Mrs Shepherd's family but denied that the problem was due to a systematic failure.

From:
http://www.telegraph.co.uk/news/uknews/5252761/Coroner-criticises-unacceptable-treatment-of-Mike-Tindalls-grandmother.html

Rose Gibb the MRSA paperpusher judgement ends era of pay-offs

NHS managers could increasingly turn to employment tribunals with the rights and wrongs of their dismissals debated in public after Rose Gibb lost her claim for breach of contract, her union leader has warned.

Ms Gibb left her position as chief executive of Maidstone and Tunbridge Wells trust in October 2007 after agreeing severance terms.

But this week the High Court turned down her bid to enforce this contract, ruling the trust had shown “irrational generosity” in agreeing to pay her £175,000 above the £75,000 she was contractually entitled to in lieu of notice.

Mr Justice Treacy accepted that Ms Gibb had received assurances of the payment’s approval further up the NHS hierarchy. However, even this was not sufficient for her to be awarded any of the outstanding £175,000.

Ms Gibb left the trust days before the Healthcare Commission published a critical report on two C difficile outbreaks which contributed to at least 90 deaths.

Jon Restell, chief executive of Managers in Partnership, Ms Gibb’s union, said the outcome would make it more rigorous in checking compensation agreements were properly authorised.

“If people have been given reassurances this case is a wake-up call to double check,” he said.

He questioned whether it served MiP members’ best interests to enter discussions on severance payments, or whether it would be better to go through a disciplinary process and potentially launch unfair dismissal claims at an employment tribunal.


“Maybe we will see a lot more litigation. That could lead to interesting arguments around whether people are culpable. In the past we would have been sitting down to discuss a compensation agreement. That may not happen in the future.”

Employment tribunals could consider whether a chief executive was responsible for problems, or whether wider, systemic issues such as targets were involved, he said. And he warned that chief executive jobs could look increasingly unattractive.

One foundation trust chief executive in the North of England said the case, combined with the recent turnover of chiefs, added to the unattractiveness of the positions.

“We have got a double whammy,” he said. “There is a great propensity to fire the chief executive and there has been a tightening up on pay-offs.”

County Durham and Darlington foundation trust chief executive Stephen Eames said: “The verdict reinforces the accountability of senior public servants like ourselves.”

The judge awarded costs against Ms Gibb and refused her leave to appeal.

MiP – which gave her legal advice – said options being considered included asking the Court of Appeal directly for permission to appeal and asking an employment tribunal to hear the case, even though it is technically out of time.

In a statement issued by the union, Ms Gibb said: “The evidence showed that senior NHS people made decisions and acted in ways that they themselves agree were both unjust and unfair to me. They said they would not have defended a claim of unfair dismissal. The judge’s ruling has been made over a contentious and complex point of law. This matter has been difficult for all parties and there can be no winners.”

From:
http://www.hsj.co.uk/5000912.article

Health Direct is delighted that Rose Gibb has lost her appeal for more blood money after presiding over the deaths of 90 patients in her dirty hospital.

What were the "NHS hierarchy" thinking of when they tried to pay off Mrs Gibb with another £175,000?

Perhaps they will now be similary generous to the relatives of those who died an early death as a result?

Swine flu- hospitals could turn away critical patients in a pandemic

Hospitals could be "rapidly overwhelmed" and forced to turn away critically ill patients if a flu pandemic reaches Britain, according to the Government's own assessment.

A Department of Health document warns that the health service is already working close to its capacity, leaving little scope to meet the demands of a mass outbreak of swine flu, which could force doctors to turn away patients needing intensive care.

The document, seen by The Daily Telegraph, says cuts in the number of beds since Britain last underwent a pandemic in 1969 – combined with an ageing population and changes in the way patients are treated – mean intensive care units "could be rapidly overwhelmed".

The disclosure of the document last week came as:

Nicola Sturgeon, the Scottish health minister, reported that there has probably been the first British case of swine flu in someone who has not travelled to Mexico, indicating that the virus has begun to pass between people here;

Three new cases were confirmed in Britain;

Countries around the globe continued to report new cases of H1N1, with new confirmed cases in Holland. the Republic of Ireland and Germany.

Authorities in Mexico, the source of the outbreak, asked for a five-day shutdown of non-essential business and travel in an attempt to slow the spread of the disease.

The world is now on the brink of the first flu pandemic in 40 years, with the World Health Organisation's (WHO) alert status at five out of six.

The Department of Health is printing leaflets to put through every door urging people to find "flu friends" who can bring them groceries and supplies if they fall ill.

However, the Department of Health (DoH) document seen by The Daily Telegraph warns that, during the peak of a flu pandemic, complications such as pneumonia could mean there are 10 times as many people requiring ventilators as the NHS can supply.

If demand cannot be met, it recommends doctors deny treatment to the weakest patients so that resources can be shared among the greatest number.

The draft document, which was written in September before the outbreak of swine flu, acknowledges that its recommendations open "controversial ethical issues" and could cause anger and violence from relatives of those refused care.

Doctors taking decisions to deny care are urged to fully document their decisions to protect themselves from litigation, while hospitals are warned that "additional security decisions may be necessary because of the risks of violence directed at staff making triage decisions".

The document, Pandemic Influenza: surge capacity and prioritisation in health services, sets out the criteria which doctors should use to determine which patients receive intensive care.

If there is competition for places in intensive care units, patients suffering from advanced cancer could be refused beds along with pensioners suffering from severe burns, those with multiple organ failure and children suffering from advanced cancer, severe burns or trauma.

If patients competing for life support are likely to have an equal benefit from treatment, decisions should be taken by lottery, the guidance concludes.

The document describes the pressures that the NHS suffered during the last two pandemics, in 1957 and 1969, which caused a total of 3 million deaths worldwide.

It states that the impact of the 1969 outbreak was lessened by a high number of spare hospital beds at the time. The document says cuts to spare bed capacity, so that the health service is now working "at or near capacity", a 31 per cent increase in the number of over-65s, a more complicated out-of-hours system for GPs and more widespread use of critical care would all make it more likely that intensive care units could be "rapidly overwhelmed".

Meanwhile, NHS Direct took a more than 10,000 calls in total on Wednesday and almost 3,000 of them related to swine flu – more than double the calls received on Monday about the virus, reflecting how public concern is growing.

A spokesman for the DoH said: "We have published this draft guidance to help clinicians to work within an ethical framework during a pandemic."

From:
http://www.telegraph.co.uk/health/swine-flu/5254149/Swine-flu-hospitals-could-turn-away-critical-patients-in-a-pandemic.html

Bullying- the corrosive problem the NHS must address

Sir Ian Kennedy’s parting shots and last month’s staff survey both warn of a culture of bullying in the NHS. The HSJ analyses where and why the bullies are found.

Sir Ian Kennedy issued a sombre warning about the “corrosive” impact of bullying among NHS staff last month.

In a farewell interview as he stepped down from his role as Healthcare Commission chair, Sir Ian said bullying worried him “more than anything else” in the NHS and was “permeating the delivery of care”, before calling on managers to stamp it out.

His fears regarding the scale of the problem appear to be well founded if the annual staff survey, published last month, is anything to go by.

Twelve per cent of staff surveyed said they had suffered bullying, harassment or abuse at work by colleagues in the previous year and 8 per cent said this was by managers or team leaders.

At some trusts the problem is more widespread. The highest rates were at St George’s Healthcare trust in London, where 23 per cent of staff said they had been bullied, harassed or abused by their colleagues.

A spokeswoman said the figures were “of great concern” and the trust was looking at how to address the problem. A joint letter from the chief executive and a staff representative will go out with this month’s pay slips stating the trust’s commitment to tackling bullying and encouraging staff to speak out if they experience or witness bullying behaviour.

It is reassuring to see trusts taking action, but why is bullying so widespread in an institution devoted to caring?

Managers in Partnership chief executive Jon Restell says it is embedded in the culture of the NHS. “People tell themselves they do it for patients,” he says. “But to think we have to be brutal [to our colleagues] to be nice to patients - I don’t see how that works.”

To make matters worse, top doctors have had bullying “hardwired” into their training, he says. This is borne out in the 2007 survey of junior doctors by the Postgraduate Medical Education and Training Board, which found half of trainees in non-foundation posts who reported being bullied said it came from consultants.

Department of Health director general of workforce Clare Chapman says undergraduate and postgraduate medical programmes must be adapted to discourage the behaviours that lead to bullying.

However, far from being an isolated issue, many feel the problem is systemic in the medical profession.

Ms Chapman says there is a recognition that action must be taken but “the challenge is that not all trusts are tackling it”.

The Pacesetters programme is working to tackle bullying and discrimination, and the NHS constitution sets out the right to an environment free from harassment, bullying or violence.

Another barometer will be the review of the health and wellbeing of the NHS workforce, which is being led by Dr Steve Boorman and is due to report back by the end of this year.

Given the frequency with which NHS chief executives face sudden departures and complain about harsh performance management, is bullying being driven by the target culture?

There are also questions for regulators: Mr Restell asks whether they perpetuate the problem through their “tough” interactions with organisations.

While bullying occurs at all levels of the health service, close examination of the staff survey reveals stark disparities. For example, 11 per cent of white British staff complained of bullying, harassment or abuse from colleagues in the past year, compared with 19 per cent of Bangladeshi employees.

Bangladeshi staff are followed by Asian/Asian British and Pakistani staff (both 15 per cent), black African, black British, Chinese and Indian staff (14 per cent), and white Irish and black Caribbean staff (13 per cent).

In acute trusts, the proportion of workers saying they were bullied by colleagues was more than a fifth (21 per cent) among staff from white and black African backgrounds as well as employees classing themselves as “other Asian”, meaning they did not define themselves as Pakistani, Bangladeshi, Indian, Chinese or Asian British.

For white British staff the figure was 13 per cent. These statistics will fuel fears that the NHS does not always treat staff from different ethnic groups equally, backing up findings by HSJ and the NHS South East Coast black and minority ethnic network.

Evidence shows the NHS also needs to provide more support to staff with disabilities, who were almost twice as likely to say they had been bullied, harassed or abused by managers (13 per cent) than those who had no disabilities (7 per cent).

In acute trusts, one in five of the 7,486 disabled staff surveyed said they had been bullied by colleagues, compared with 13 per cent of non-disabled workers.

An Equality and Human Rights Commission spokesman said the figures were a “cause for concern”. A report by the commission last year highlighted the “profoundly different” experiences at work of people with long term illnesses or disabilities from their colleagues.

There are also clear distinctions between staff from different professional groups.

Social care managers were the group most likely to say they had suffered bullying, harassment or abuse by their managers in the past 12 months - 16 per cent compared with 4 per cent among arts therapy staff, the group with the lowest figures.

The figure was 13 per cent for midwives, who are also the occupational group most likely to say they have suffered bullying, harassment or abuse from colleagues - 17 per cent, compared with 8 per cent of physiotherapists.
Pressure cooker

Royal College of Midwives director of employment relations Jon Skewes puts this partly down to the “pressure cooker” atmosphere of busy maternity units and acute trusts in general.

However, this is no excuse for bullying, he says. “The midwifery profession has to work towards exemplary behaviour, but it’s also the responsibility of senior managers and boards.”

Investing in organisational development, bringing experts in from outside if necessary, will help tackle bullying, he says. But where will the money come from in a recession?

Mr Skewes says this is a moot point. “Last time the NHS was struggling with deficits there was no money for organisational development and training. That might be a problem again if spending gets cut.”

Before slashing budgets, finance directors may want to read an unpublished report carried out for the DH and released last year under freedom of information legislation.

It calculated that the cost of bullying and harassment to the NHS, taking account of sickness absence, replacement costs, productivity losses, litigation, service delivery, damage to employer brands, and bullying by patients and their families, was an “immense” £325m a year.

From:
http://www.hsj.co.uk/5000577.article

Swine flu- nanny state launches mass advertising campaign as ministers step up fight

Labour ministers will blow more taxpayers' money as a mass advertising campaign will be mounted to try to contain the growing swine flu outbreak in the UK.

Every household in the country will have a leaflet through the door from next Tuesday onwards

As five cases of swine flu were confirmed in the UK – including a 12-year-old girl – and 78 further people are being tested, labour ministers mounted a major offensive to contain the problem.

Adverts will run in newspapers, on radio and on TV from today giving information about swine flu and advising people that basic hygiene measures such as covering your nose and mouth with a tissue and washing your hands are the best ways to protect against the disease.

Every household in the country will have a leaflet through the door from next Tuesday onwards also giving information on the disease and what to do in the event of someone showing symptoms.


Health Secretary Mr Johnson said: "We are following the philosophy to hope for the best but absolutely prepare for the worst. It is inevitable there will be more cases. What is reassuring is that if you take Tamiflu early you make a full recovery. It is just like a dose of flu. It could get much worse but we are prepared."

Sir Liam Donaldson, chief medical officer, said the last bad seasonal flu year was in the winter of 1999/2000 when 22,000 people died – ten times the norm – and he warned that a pandemic could be similar to that situation but 'multiplied several times over'.

Mr Johnson announced a raft of new measures including boosting the stock of antiviral drugs, Tamiflu and Relenza, which reduce symptoms and severity of flu from 33m courses to 50m courses and extra antibiotics are being purchased to treat people who may develop secondary complications such as pneumonia.

Extra face masks with inbuilt filters are being bought for NHS staff and all front line health workers will receive their own course of anti-virals to take if they treat someone found to be infected with swine flu.

Health Protection Agency staff will be at all airports where flights come in from infected areas and all passengers on flights from affected areas to be given a leaflet with advice about seeking medical attention if display symptoms within seven days.

Airlines are being asked to keep passenger manifests for seven days instead of usual 24 hours to aid in contact tracing if necessary.

The public are being advised not to buy face masks as there is no evidence they prevent the spread.

Sir Liam, said: "So far all the cases in the UK have been imported cases from the main affected areas and we have not seen any ongoing transmission."

He said the positive side of this situation is that the virus is so far not spreading easily between people and no onward transmission has been yet seen outside Mexico and the US with the only confirmed cases having caught the disease in Mexico.

He said: "The virus is giving us a bit of time. It may become fast and furious at a later stage."

He warned that in past epidemics and pandemics children have been the 'supercarriers' so the school holidays, going back to school have been key factors in the spread.

This may be why health experts acted quickly to advise that the Paignton Community College be closed for a week after a 12-year-old girl there was confirmed as having contracted swine flu.

Ed Balls, the Schools Secretary egotist said: "We will put the health of children first."

From:
http://www.telegraph.co.uk/health/swine-flu/5244796/Swine-flu-Mass-advertising-campaign-as-ministers-step-up-fight.html

Families call for fresh police investigation into Gosport hospital death ward

Relatives of five patients who died on a hospital's "death ward" have called for a GP to be reinvestigated after an inquest jury decided excessive doses of morphine contributed to their deaths.

Dr Jane Barton, who was the prescribing doctor in each case, was the subject of two lengthy police investigations into a total of 92 deaths which ended with the Crown Prosecution Service deciding there was insufficient evidence to charge her.

But after a 10-year campaign by families of the dead, an inquest in Portsmouth ruled that medication had been a factor in five deaths at the Gosport War Memorial Hospital between 1996 and 1999.

Relatives believed that their loved ones had, in the words of one man, been "intentionally executed" at the hospital's Dryad and Daedalus wards.

The son of one elderly woman who died after being given an increased dose of diamorphine told the inquest that when he asked Dr Barton how long his mother was likely to be in the hospital, she replied: "Do you know your mother has come here to die?"

The inquest jury decided that Robert Wilson, 75, Elsie Devine, 88 and Geoffrey Packman, 67, were given medication which was not appropriate for their condition, and which contributed to their deaths, although it had been given for therapeutic reasons. They also ruled that medication had contributed to the deaths of Elsie Lavender, 83, and Arthur Cunningham, 79, but was appropriate for their condition.

Medication had not been a contributory factor in the deaths of five other patients whose deaths were examined at the inquest.

The inquest jury was not shown a report by Gary Ford, a professor of pharmacology at Newcastle University, who raised concerns that there may have been a "culture of voluntary euthanasia" on the wards.

Nor were they shown a report into allegedly abnormal death rates at the hospital written by Prof Richard Baker, who worked on the Harold Shipman inquiry, and whose findings have never been made public.

Some of the families believe there has been a "cover-up" by the NHS and demanded the CPS look again at the extensive evidence gathered by police.

Iain Wilson, whose father Robert died after telling his family doctors were "killing" him, said: "I feel absolutely ecstatic, and heartbroken at the same time, that my dad died knowing he was being killed. I will carry on now and make sure these people that are responsible for my father's death are brought to justice."

John White, a solicitor for three of the five families, said: "They feel vindicated by the verdicts and they believe the CPS should look again at the evidence. They don't see this as the end of the story."

Dr Barton is currently being investigated by the General Medical Council, which has imposed interim restrictions on her registration, including banning her from prescribing diamorphine.

The wards were nicknamed the "end of the line" locally because of its allegedly high death rates and suspicions of some families that loved ones who seemed to be in no immediate danger deteriorated rapidly after being admitted and often died within days.

Robert Wilson was admitted to Dryad ward in October 1998 after he suffered a broken arm. He also suffered from liver problems because of a long-standing drink problem and the cause of his death was given as heart and liver failure.

Iain Wilson told the inquest his father had made a good recovery at the Queen Alexandra Hospital in Portsmouth from the fall that broke his arm. But when he was transferred to Gosport, his condition deteriorated severely and he died four days later.

Mr Wilson said: "I went to give him a cuddle and he spoke his last words to me: 'Help me son, they are killing me.'

"I said 'No they are not Dad, they are trying to do the best for you' and I left him there. When I went in the following day, he was in a coma."

Prof Baker, of the University of Leicester's department of health and science, told the hearing: "The initiation of the diamorphine was inappropriate and the starting dose too high. Mr Wilson might have left the hospital alive if he had not been started on diamorphine."

Dr Barton, who was the main doctor in charge of the two wards, said that many relatives had "unrealistic expectations" for the health of their loved ones as they arrived at GWMH.

From:
http://www.telegraph.co.uk/health/healthnews/5189604/Families-call-for-fresh-police-investigation-into-Gosport-hospital-death-ward.html

Swine flu confirmed in Britain

Swine flu has reached Britain it was disclosed last night, as officials confirmed that two people were being treated in a hospital isolation unit after contracting the disease on holiday in Mexico.

Cases have also been confirmed in Spain, Canada, and several states in the USA.

They were named in the Scottish press as honeymooners Iain and Dawn Askham, of Polmont, near Falkirk.

The World Health Organisation upgraded its pandemic alert level to 4 - two stages below the most serious threat - while the Foreign Office advised against all but essential travel to Mexico.

"British nationals resident in or visiting Mexico may wish to consider whether they should remain in Mexico at this time," a statement on the Foreign Office website added.

It comes as WHO Assistant Director General Keiji Fukuda said it was "too late" to contain swine flu and countries should now focus on mitigating the effects of the virus.

Describing the significance of the level four threat, Mr Fukuda said: "What this can really be interpreted as is a significant step towards pandemic influenza. But also, it is a phase that says we are not there yet."

It is believed twenty two other people who have been in close contact with the Scottish couple since their return who are receiving anti-viral drugs as a precaution. Seven of them are showing mild symptoms of influenza.

The seven with symptoms have been told to stay at home and will be tested to see if they have swine flu.

Fears were growing that the virus could cause a flu pandemic as a series of countries confirmed cases.

Officials in Mexico – the centre of the outbreak – said there were 1,455 probable cases and 149 confirmed deaths.

Cases have also been confirmed in Spain, Canada, and several states in the USA. More are suspected in New Zealand, Israel and Colombia. Four people in the Irish Republic were being tested for the virus.

The two British patients, from the Falkirk area of Scotland, returned from holiday last Tuesday and on Saturday developed symptoms and contacted doctors.

They are being kept in isolation at a hospital in Airdrie. They are being treated with anti-viral drugs and are said to be ‘‘recovering well’’.

Senior civil servants met in an emergency session in Whitehall to discuss the threat posed by the disease.

Nicola Sturgeon, the Scottish Health Minister, said every precaution was being taken to prevent further spread of the virus.

She said: “The seven displaying, and I stress, very mild symptoms will now be given anti-virals as treatment. The 22 that are not symptomatic will be given very extensive advice about minimising the spread.

“The focus is on the immediate contacts. Effectively, what we are trying to do is put a ring around this. We are trying to contain this as effectively as we can.”

Sir Liam Donaldson, the Government’s Chief Medical Officer, had earlier said that it was “inevitable” that the infection would reach Britain. “Hopefully, if we identify those early and treat people and their contacts, we might be able to reduce the spread,” he said.

Alan Johnson, the Health Secretary, told MPs there had been 25 suspected cases so far in Britain. Eight of them had subsequently tested negative for the disease.

A Canadian woman was taken to hospital in Manchester showing symptoms of flu, but officials said it was highly unlikely she had swine flu.

Mr Johnson added that Britain was – with France – one of the two best-prepared countries in the world to deal with a potential flu pandemic.

The Government had imposed “enhanced” port health checks in an attempt to identify passengers arriving in Britain with symptoms of the illness, he said, and measures were in place to allow the swift nationwide distribution of the drug Tamiflu, which can reduce the severity and length of flu illnesses.

In the Government’s pandemic plan the worst case scenario suggests that if half the population contracted pandemic flu there could be around 709,000 deaths.

Schools, sports events and concerts could be shut down to limit the spread of the illness. Doctors who come into contact with suspected cases should wear face masks, gloves and aprons, under protocols issued by the Health Protection Agency.

The World Health Organisation (WHO) has said the disease has ‘‘pandemic potential’’ and work has already begun on a vaccine against the potentially lethal virus – a variation of H1N1 swine flu – although this is likely to take months before it is ready for use.

Mr Johnson said: “Everywhere outside Mexico the symptoms have been mild and all the victims have made a full recovery.”

People who suspect they may have been infected should stay at home and seek medical advice over the telephone, he added.

The WHO increased the pandemic alert level from level three, where experts have identified little or no human to human transmission to level four indicating that it was spreading much more easily between people across large areas. A pandemic is declared at level six.

Since the alerts were introduced in 2005 it has never been higher than level three.

The Department of Health pandemic plan says that a likely scenario during a pandemic is that businesses should expect repeated waves of one in four employees being off work.

Stephen Alambritis, of the Federation of Small Businesses, said that this could be disastrous during a recession.

From:
http://www.telegraph.co.uk/health/swine-flu/5232846/Swine-flu-confirmed-in-Britain.html

Relatives win 10 year battle to prove NHS culture of euthanasia

Three patients who died at a hospital in Hampshire in the late 1990s were given inappropriate medication, an inquest jury has ruled.

The panel of five women and three men also found that two patients were given the correct medication but in doses which contributed to their deaths.

The patients' families are now calling for a criminal investigation.

Some of the relatives had long believed morphine was being over-prescribed.

Police carried out investigations into 92 patients' treatment at the hospital, but no prosecutions were brought.

The jury at Portsmouth Coroner's Court decided that in the cases of Robert Wilson, 74, Geoffrey Packman, 66, and Elsie Devine, 88, the use of painkillers was inappropriate for their condition.

Arthur Cunningham, 79, and Elsie Lavender, 83, were prescribed medication appropriate for their condition but in doses which contributed to their deaths, jurors found.

In the cases of Leslie Pittock, Helena Service, Ruby Lake, Enid Spurgin and Sheila Gregory, the jury decided that the prescription of painkillers had not contributed to their deaths.

The jury heard evidence from members of the patients' families, medical experts and staff at the hospital, including Dr Jane Barton.

She was investigated by police in connection with deaths at the hospital but she was not charged with any offence.

She said in a statement: "I can say that I have always acted with care, concern and compassion towards my patients.

"I am pleased the jury recognised that in all of these cases, drugs were only given for therapeutic purposes."

In a statement after the verdicts, the families said: "This has been a 10 year emotional journey for the families, not just those families directly involved in the inquest but also the relatives of the 92 victims investigated by the police who are also still waiting for answers.

"We did not expect this inquest to be transparent, honest or fair and our expectations have been met in full."

"Extreme drug overdoses were given without justification or logic that rendered our families comatose in a matter of hours and dead soon after, giving relatives no warning or opportunity to speak with them.

"The families' journeys are not over. Once we have all the evidence as denied by this coroner, we will reflect on the last few weeks and decide our next steps."

The families also said that a fresh criminal investigation by Hampshire police was needed. But in response to their call the force has said it will not reinvestigate any of the deaths.

Meanwhile, the patient safety charity Action against Medical Accidents (AvMA) called for a public inquiry.

AvMA chief executive Peter Walsh said: "It is now quite clear the refusal to hold a public inquiry was wrong.

"There were other deaths at Gosport which should have been looked into as well as the role played by various agencies, which may have prevented the poor practice at Gosport or it being investigated promptly and appropriately."

From:
http://news.bbc.co.uk/1/hi/england/hampshire/8002641.stm

Hospital death rates to be published on NHS Choices website

NHS medical director Sir Bruce Keogh has instructed the website NHS Choices to publish each hospital trust’s overall death rate.

Sir Bruce’s move follows concern that failures at Mid Staffordshire foundation trust may have been spotted sooner had more attention been paid to its hospital standardised mortality ratio (HSMR).

The ratios are one way of measuring whether a hospital’s death rate is within expected limits given the mix of patients it treats. The method is disputed by some academics, including those commissioned by West Midlands Strategic Health Authority, where Mid Staffordshire sits.

Sir Bruce said: “It would be irresponsible of trust boards not to investigate high mortality ratios. The HSMR is one of many measures that will help them do this, but it is not enough on its own. [It is] a rather blunt, but useful, indicator of trouble.”

“Given the controversy around them on both sides of the Atlantic I have instructed NHS Choices to publish HSMRs with reliable information to help the public and boards understand their strengths and weaknesses.”

He said he had also asked NHS Choices to develop plans to publish a set of 250 more sophisticated measures of quality, which have been approved by the new National Quality Board for Health and Social Care.

A spokesman for the Department of Health said there was as yet no time scale for the publication of the HSMRs or 250 additional indicators.

From:
http://www.hsj.co.uk/5000581.article

Health Direct congratulates Sir Bruce Keogh on learning from a dozen years of labour spin- announce a new initiative but don't bother to promise when it might actually be delivered.

If the NHS medical director really wants to know what state hospitals are in- why not do what the real world does and just ask the staff?

Labour stops asking the uncomfortable question- is your hospital OK?
Tue, 14 Apr, 2009- National Health Service staff are no longer being asked whether they would be happy to be treated in their own hospitals, because the answers don't match labour's spin.

NHS and healthcare to bear the brunt of 2009 budget cuts

The NHS and the Department of Health took the biggest hit yesterday as the labour government allocated its £5bn cut in public spending for next year, which it claims will be made up by efficiency savings.

The NHS has to make virtually half the savings - £2.3bn - on top of the 3 per cent a year savings with which it was already charged. Next year's budget has been cut from a planned £104.6bn to £102.3bn, but that will still represent £4bn in growth over this year.

The reduction in health allocations was greeted with equanimity by Alan Johnson, the health secretary, who said the NHS was making the savings "in response to the current economic conditions" and already had plans in hand through shorter length of stay, better commissioning and better procurement.

The already announced allocations to primary care trusts for next year will not be affected, he said, and the department is sufficiently sure of its financial position to have released back to the Treasury an £500m contingency reserve.

The NHS Confederation, which represents health authorities and trusts, said it was "disappointed but not surprised" by a savings target larger than its share of public spending.

"The much bigger issue is the cut in planned public spending growth after next year," Nigel Edwards, the confederation's policy director, said. "Our fear is that 0.7 per cent growth in total spending is not going to translate into anything like 0.7 per cent for the NHS. If we are lucky it might be zero."

The confederation said that would require "difficult decisions about priorities and change" if patient care were not to suffer through budgets being merely "salami sliced".

Other sectors that bear a significant part of the £5bn cut are schools and families, which must find £650m, and work and pensions, which must find £120m even as its budget for the unemployed is boosted by £1.7bn.

Although health takes the biggest cash hit, analysis by the Institute for Fiscal Studies shows transport, the Home Office and environment facing the largest savings requirement as a percentage of budget.

From the Financial Times:
http://www.ft.com/cms/s/0/be915988-2fa0-11de-a8f6-00144feabdc0.html?nclick_check=1

Acute overspending raises questions over PCT plans

Primary care trusts have overspent against acute contracts by hundreds of millions of pounds, raising questions over the success of efforts to deliver care more cheaply in the community.

The average overspend figure for PCTs contacted by HSJ this week was £7.6m, suggesting that nationally the total could be as much as £1.2bn.

HSJ asked a cross-section of 20 PCTs across all strategic health authority areas in England how they had performed against what they had planned in their 2008-09 acute contracts.

Commissioners have been warning of pressure on acute contracts since a spike in referrals by GPs began to drive up hospital activity last year.

PCTs are covering the extra costs using their surpluses or by dipping into next year’s funds.

At the start of March, Warrington PCT predicted in its board papers that its surplus would be half what it had envisaged at the beginning of 2008-09. The acute overspend is listed as a contributing factor.

Some have taken money earmarked in development plans for other areas of care to cover the shortfalls.

PCT leaders attributed the overspend to pressure to achieve the 18-week referral to treatment target, the increase in GP referrals and the bad winter weather increasing hospital activity.

But they also acknowledged that some commissioners had been optimistic when predicting how much money they could save from acute contracts by moving services into community settings.

Shifting treatment out of hospitals in order to provide care more economically was a cornerstone of the 2006 Our Health, Our Care, Our Say white paper.

PCT Network director David Stout said: “Therne has been a history of slightly optimistic demand management assumptions. PCTs need to avoid making optimistic assumptions about demand and capacity, unless they’ve got very worked-through plans about how they are going to [manage demand] that they are confident are deliverable.”

Mr Stout said PCTs needed to understand why the overspend was so high this year, including assessing whether assumptions that demand would go down in certain specialties had been too optimistic.

Birmingham East and North PCT chief operating officer Andrew Donald said shifting more services into primary care would bring returns, but PCTs must monitor activity “forensically” to make sure they were achieving the savings they had planned for.

He said: “You’ve got to have done the detailed business case and understand the consequences in terms of what you’re trying to do in primary care and model cause and effect.

“If it’s not delivering, you’ve got to be brave enough to stop it and say let’s do something else.

“It relies on PCTs measuring outcomes and the impact of what they are doing, which hasn’t been a strong point.”

Mr Donald predicted pressure to stay on top of spending would increase as budgets were squeezed in coming years.

King’s Fund deputy policy director Candace Imison suggested that shorter waiting times could have introduced an element of “supply induced demand”.

The “painfully” slow progress of practice based commissioning was also likely to be a factor in delays in providing more community based services, she said.

PCTs should be more proactive in tracking patients as they moved through the health service and in assessing the effectiveness of treatment.

She urged PCTs to study choose and book data to find out who was using alternative services and what was happening to them afterwards - for instance whether they were ending up in hospital following treatment in the community.

She said: “Maybe they have created services outside of hospital but they haven’t reduced acute activity and have supplemented acute care rather than replacing it.”

From:
http://www.hsj.co.uk/5000506.article

Overworked healthcare professionals blamed for medical errors

Patient safety is being put at risk by overworked medical staff who made 4,000 avoidable errors last year, it has been disclosed.

More than half of the blunders - 2,221 - were considered serious, resulting in deaths, injuries and patients being left in severe pain, according to new figures.

They included surgeons operating on the wrong person or part of the body, doctors making wrong diagnoses and prescribing dangerous doses of medication.

The newspaper submitted Freedom of Information requests to all 172 NHS trusts to obtain details of Serious Untoward Incidents (SUIs).

Of the 97 that responded, most refused to give details and just listed fatal errors as "unexplained deaths", it said.

The Patients' Association described all the mistakes as "avoidable".

In one case in the North West a patient under the care of the Aintree University Hospitals NHS Foundation Trust underwent the wrong urological procedure in May.

In July, a chest drain that had been wrongly inserted punctured a patient's heart and in another case in October a tube was dislodged from the windpipe of a patient who later had a heart attack and died.

In the South East, where a total of 66 SUIs were reported, the wrong unit of blood was administered in January and a mother died of meningitis after giving birth in August.

Katherine Murphy, director of the Patients' Association, told the newspaper: "These are all avoidable accidents. Patient safety must be paramount in every hospital. Saving money must not be put before patients' lives."

Dr Peter Carter, general secretary of the Royal College of Nursing, said staff shortages led to more errors.

"It is always deeply concerning to learn of any mistakes which have endangered the life of a patient," he said. "But the fewer staff there are the more mistakes are made."

According to the newspaper, the NHS paid out £264 million in compensation claims in 2008, plus £134 million costs.

The Department of Health said it was working with regulators to monitor improvements in patient safety.

"Unfortunately, as in any health service, unforeseen incidents occasionally happen.

"The independent National Patient Safety Agency, responsible for monitoring and reporting incidents, and the new independent regulator, the Care Quality Commission, with increased inspection and intervention powers, will help ensure we sustain improvements in safety and quality of care."

The revelations come after the head of the former Healthcare Commission said in December that the NHS was only just out of the "starting blocks" when it came to ensuring patient care was as safe as it could be.

Sir Ian Kennedy said reporting mistakes and learning from them needed to be "internalised in the DNA" of NHS trust boards.

He added that there was a "black hole" in the information available about mistakes made in GP surgeries.

His remarks were made as the commission published a report calling for more coherent systems for reporting mistakes, saying the priority given to safe care varied among NHS trusts.

But the report said estimates suggested that one in 10 patients admitted to hospital would suffer harm as a result of an error.

In primary care, the report referred to a study carried out in 2001 which found that medical errors occur between five and 80 times per 100,000 consultations, "mainly related to the processes involved in diagnosis and treatment".

The Healthcare Commission ceased to exist at the beginning of this month when a new regulator, the Care Quality Commission, took over its role and also adopted the work of the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission.

From:
http://www.telegraph.co.uk/health/healthnews/5147744/Overwork-blamed-for-medical-errors.html

Mid Staffordshire redundancies under scrutiny

Mid Staffordshire hospital trust paid out £1.3m in redundancy payments between 2006 and 2009, figures disclosed under the Freedom of Information Act have revealed.

The request was made by the Liberal Democrats. The party’s health spokesman Norman Lamb said the figures were “absolutely shocking” as the lay offs coincided with at least 400 unnecessary deaths at the trust and levels of care that the Healthcare Commission last month described as “appalling”.

Mr Lamb said the payout figures “demonstrate how much money was being wasted getting rid of staff who were desperately needed, at a time when hundreds of people were dying because of the inadequate care”.

Over the three year period the trust paid out an average of £433,000 a year in redundancy pay offs. Over the same period, payouts across the entire NHS totalled around £438m - so the Mid Staffordshire payouts represented 0.3 per cent of this.

The trust made its biggest payouts in 2007-08 when it spent £878,000 on redundancies, representing 0.5 per cent of the total £183m paid out on the 2,223 NHS redundancies that year.

From:
http://www.hsj.co.uk/5000491.article

Flaws exposed in NHS winter planning

The NHS must improve the way it deals with the increased demand for hospital care in winter months, director general of NHS finance, performance and operations David Flory has said.

Mr Flory said in the quarterly update on performance that he was "disappointed" that the NHS as a whole had missed its target to see 98 per cent of patients in accident and emergency departments within four hours.

He said: "We have had one of the coldest winters for over a decade, placing greater demand on services. Ambulance services experience elevated demand in winter and it is critical that the NHS maintains high levels of service and ensure the timely handover of patient care from ambulance to hospital."

Mr Flory told HSJ that he expected most hospitals to recover their position over the remaining months of the year and so, overall, the NHS would still meet the 98 per cent target for the full year. However, he underlined the importance of better winter planning.

The forecast surplus remains £1.74bn, with only seven organisations forecasting real terms deficits - down from 11 in September.

From:
http://www.hsj.co.uk/news/2009/03/flaws_exposed_in_nhs_winter_planning

Labour's nanny state's health bribes of questionable value

Financial incentives from the taxpayer for people to quit smoking, lose weight or eat better may be an important means of improving the population's health, but more research is required to prove if they are worth the money.

Their verdict comes as advisers to the Department of Health are promoting such schemes and as private health insurers are offering discounts to subscribers who go to the gym, eat more fruit and take other steps towards a healthier lifestyle.

In Dundee, smokers are being offered £12.50 a week by the NHS if carbon monoxide testing shows they have quit. In Essex, pregnant women can claim a £20 food voucher from the NHS after stopping smoking for one week, £40 after four weeks and another £40 at the end of a year if they have still quit.

Brighton offers children £15 for quitting smoking for 28 days, while overweight patients in Kent are also being offered incentives for losing weight. In the US and other countries incentives have been offered for weight loss, complying with diabetes treatment, or regularly testing negative for sexually transmitted diseases.

Such schemes are controversial with the public and professionals, say Theresa Marteau and Richard Ashcroft, professors of health psychology and bioethics at King's College and Queen Mary universities in London.

Writing in the British Medical Journal, they say the programmes are attacked as "a form of bribery" and "rewarding people for unhealthy behaviour", while others believe they undermine the doctor patient relationship and remove patients' autonomy.

But they say evidence is emerging that some programmes may work, although research is needed to establish "the conditions under which change is achieved and sustained, and for whom", and to identify unintended consequences.

"Using payments may be more powerful than providing information, and less restrictive than legislation [which attempts to ban or punish activities]," they say. "Ultimately, if incentives prove to be effective in only a few contexts, they may still offer an important means to improve health."

Julian Le Grand, chairman of Health England, said the difficulty with prevention programmes was that the costs of unhealthy lifestyles could be far off in the future, while the pleasures from them were felt now. Policies were needed that provided some of the benefits of changing lifestyle in the present, he said.

From:
http://www.ft.com/cms/s/0/f29d891e-2630-11de-be57-00144feabdc0.html?nclick_check=1

NHS invites bids for local health services

Foundation trusts are being invited to bid to take over a mental health service in Bedfordshire as part of the National Health Service’s drive to ensure all health services are supplied by freestanding organisations.

The bid could be launched as a joint venture with the private sector and may form the model for other NHS organisations un­able to meet the qualification standards to become freestanding foundation trusts in their own right, said Stephen Dunn, director of strategy for the East of England strategic health authority.

The authority, which is already breaking new ground by seeking Treasury approval for private sector bids to take over and run Hinchingbrooke Hospital in Cambridgeshire, has set a deadline for all its hospitals to apply to become foundation trusts by the end of the year.

However, Mr Dunn said, it had become clear that the Bedfordshire and Luton Mental Health Trust would struggle to do that, so foundation trusts were being asked to bid to take it over. Whether that would involve a payment from them to the SHA, or a subsidy from the authority to the winner, or simply the takeover of the trust’s existing contracts, would depend on the negotiations, he said.

It is understood that the contest is being limited to NHS organisations while the Treasury decides whether to give the go ahead to potential private sector involvement in Hinchingbrooke Hospital.

There has already been one takeover of a mental health service by a foundation trust in Staffordshire, but this is thought to be the first time a health authority has sought to run a competitive process to take over an NHS trust.

From:
http://www.ft.com/cms/s/0/e194c236-23c9-11de-996a-00144feabdc0.html

Labour stops asking the uncomfortable question- is your hospital OK?

National Health Service staff are no longer being asked whether they would be happy to be treated in their own hospitals, because the answers don't match labours' spin.

The question, seen by some as one of the most revealing pointers to underperforming hospitals, has been dropped from an annual official survey.

The Healthcare Commission, which conducts the survey, cited employees’ unhappiness with care standards as one of the concerns at Mid-Staffordshire NHS Trust. A subsequent investigation concluded that hundreds of patients there died as a result of poor quality care.

Only 27 per cent of staff said they would be happy with the standard of care they would receive at the hospital. Almost half disagreed or strongly disagreed with the proposition.

But the question has now been removed from the Department of Health’s survey of 160,000 NHS staff.

Andrew Lansley, the Conservative health spokesman, said a Tory government would restore it. “One of the most telling indicators that things were going badly wrong at Stafford hospital was that too few staff said they’d recommend the hospital to their family or friends,” he said.

Questions in the survey are agreed between the health department and the Healthcare Commission. A spokesman for its successor, the Care Quality Commission, said the original question asked if staff were “happy to be provided care by my own organisation”. It was modified, as some staff answered “no” because they would seek treatment elsewhere on privacy grounds.

The question was then changed to whether staff would be “happy with the standard of care”. But that was dropped after 2006, as staff in mental health and learning disabilities trusts felt uncomfortable answering a question that did not directly apply to their condition, or felt they could not answer, as they felt some parts of a hospital’s service were good and others poor.

John Appleby, chief economist at the King’s Fund health think-tank, said it was a good question to ask. “If there is anybody who knows what the quality of care at their hospital is, it is the people who work there.”

He added: “At Mid-Staffordshire, 47 per cent said they would not be happy with the standard of care, but at some hospitals, fewer than 2 per cent said that. The numbers may require careful interpretation, but that sort of variation must be telling you something.”

From:
http://www.ft.com/cms/s/0/de4ca3b4-23c9-11de-996a-00144feabdc0.html

Health Direct reminds readers that the truth can be painful. If labour can't stand the heat they shouldn't be surprised when patients kick them out in a year's time.

Disabled children wait up to two years for wheelchairs

The NHS was told to stop relying on charities to fill funding gaps after figures revealed many trusts would not pay the full cost of electric wheelchairs for disabled children leaving patients facing a postcode lottery

Freedom of information figures obtained by the Muscular Dystrophy Campaign found children were subject to a postcode lottery in terms of equipment.

Statistics from 54% of NHS trusts in England and Scotland revealed that disabled children in England are forced to wait five months on average for a wheelchair.

The worst performing primary care trust (PCT), East Lancashire, in the north-west of England, had an average wait of two years for an electric wheelchair.

The survey showed 58% of children in England had to wait at least three months for an electric wheelchair and 14% waited more than six months.

In the case of Westminster and Islington PCTs in London, children living just four miles apart could have a difference of 11 months in waiting time.

Overall, 50% of the PCTs that responded said they did not fund the full cost of a powered wheelchair for a disabled child.

Westminster PCT made an average contribution of only £700 towards the cost of a child's powered wheelchair, it said.

Almost all PCTs contacted by the charity said the cost of a wheelchair was around £2,000 but in fact the true cost of a basic electric wheelchair would be around £3,000.

A separate patient survey of 237 children found one in three did not receive any funding at all for their wheelchair.

Philip Butcher, chief executive of the Muscular Dystrophy Campaign, said: "Today's figures are nothing short of a national scandal.

"It is a damning indictment of the NHS that so many families across the UK are forced to rely on charities or be driven into financial hardship just to receive vital, life-improving equipment for their disabled children.

"It's time the NHS stopped relying on charities to fill the gaps left by its inadequate funding."

Two PCTs in the West Midlands – Birmingham East and North, and South Birmingham – have waiting times for a powered wheelchair of 18 months compared to a national average of just under five months, the report said.

From:
http://www.guardian.co.uk/society/2009/mar/04/wheelchair-wait-children

Nanny state fat tests for adults over 40 in new labour Government drive to tackle obesity

Everyone aged between 40 and 74 will be called in to their GP for a fat test and prescribed weight management and exercise if they are found to be overweight, under a new labour Government nanny state drive on obesity.

The NHS Health Checks aim to identify an individual's risk of heart disease, stroke, type 2 diabetes and kidney disease with a personal assessment and tailored advice.

It is the first systematic programme to measure body weight in adults and GPs will be expected to test 2.25m people a year with each person called back on average once every five years for another check.

The Healthy Weight Healthy Lives; one year on report, outlines the labour Government strategy to tackle obesity with the 'ambition' of being the first nation to reverse the rising tide of obesity.

NHS staff will also be targeted as estimates show of the 1.2m people working in the NHS, 300,000 will be obese and a further 400,000 are likely to be overweight.

Personalised support for midwives, health visitors and other NHS staff will 'boost the credibility of the healthy living messages they give to mums to be and families', the report said.

Dawn Primarolo, Public Health Minister, said: "More than 60 per cent of adults in England are overweight or obese, leaving them at increased risk of type 2 diabetes, cancer, heart and liver disease. BMI checks will make sure people know they are overweight and will help to turn their health around

"Early signs show that we may be halting the rise in childhood obesity. But there's still more to do in particular to tackle obesity in adults."

Dr Laurence Buckman, Chairman of the British Medical Association's GPs Committee, said: "Obesity is a serious problem for many people. GPs already advise obese patients about the best ways to lose weight – it's an important issue and has a big impact on a person's overall health and quality of life.

"Extra resources are needed, as well as a public health campaign, much better food education at school and for new parents. We welcome any scheme that might help the NHS to help people tackle the problem of obesity."

The checks will involve taking height and weight measurements and plotting body mass index on a chart with 18.5 to 25 classified as healthy weight, between 25 and 30 as overweight, and over 30 as obese. Other tests such as cholesterol, blood pressure and blood sugar may be taken as well.

However, at the same time a study published in the British Journal of Nutrition said body mass index does not accurately indicate body fat in different ethnic groups.

Dr Molly Bray, Associate Professor of Paediatrics at Texas Children's Hospital, and author of the study said: "This scale was created years ago and is based on Caucasian men and women.

"It doesn't take into account differences in body composition between genders, race/ethnicity groups, and across the lifespan."

The report also outlines a number of initiatives aimed at children with mandatory nutrient content of school meals to be extended from primary schools to secondary schools in September, the publication of a recipe book of 'picnic-style' meals for the school holidays and investment in cycling.

The report said from this month subsidised gym membership for 16 to 22-year-olds will run for 12 months in pilot areas in Newcastle, Bristol, Torbay, Manchester and Bury St Edmonds in order to evaluate the 'feasibility and effectiveness of financial incentive schemes targeted at this age group'.

Sue Davies, chief policy adviser at the consumer group Which?, said: "We know that four in five people want to eat more healthily, but more must be done to make the healthy choice the easy choice.

"We're seeing really positive action in some areas but we can't afford to be complacent; industry and the government are still skirting around contentious issues like promotions to children. Walk around any supermarket and you'll see conflicting labelling schemes, shelves of fatty, sugary and salty foods targeted at kids, and the majority of price promotions are for the less healthy foods.

"To make this work, we need to go much further and faster to break down the barriers to healthy eating."

The report suggests restrictions should be on putting unhealthy food at children's eye height in stores, which was immediately dismissed by food industry representatives.

Andrew Opie, Food Director at the British Retail Consortium said. "Rules about which products should go on which shelves would be seriously misguided. It's very hard to see how this could work in practice. How high is child's eye-line anyway? It's parents who buy children's food. The idea that making particular foods hard to reach would make any difference is ludicrous.

"There are no bad foods only bad diets. This proposal risks demonising foods which can happily be eaten as part of a balanced diet."

Mike Penning, Shadow Health Minister, said the health checks have been announced in different guises several times already.

He said: "Labour continue to be obsessed with chasing headlines rather than putting in place sound policies to improve our NHS.

"Obesity is a really serious issue that deserves a well thought out response. Instead all we get is a long line of re-announcements of tired old ideas from a Labour Government that has run out of steam."

http://www.telegraph.co.uk/health/healthnews/5115679/Fat-tests-for-adults-over-40-in-new-Government-drive-to-tackle-obesity.html

New Care Quality Commission watchdog quango pleads for patience

The new watchdog for health and social care called on politicians to put an end to a decade of regulatory turmoil in hospitals and social work.

The Care Quality Commission, which opened last week, is the third new quality regulator for health, and the fourth for social care, in only nine years.

"To lose one regulator is unfortunate, to lose two is downright careless - and to lose three would be pretty criminal in my view," said Lady Young, its chairman, in an interview with the Financial Times.

The new CQC opens its doors only weeks after Mid-Staffordshire hospital was granted flagship foundation trust status by one regulator, during an inquiry by another that revealed "appalling" standards of emergency care. The Baby P case last year, in which a young London child died after dreadful neglect, raised serious concerns about the regulation of social care.

Lady Young, a former National Health Service manager who came to the CQC from the Environment Agency, which regulates everything from car scrap dealers to nuclear power stations, said the new, combined watchdog needed time to prove itself.

"Good regulators develop a track record," she said. "We need a bit of time, 10 good years at least - preferably longer. Not for me but for the organisation", she said.

"Look at the Audit Commission . . . They have tackled a whole range of new jobs, they have been flexible, they have been adaptive and they have done a good job generally. They know how to do it. They develop a track record."

The new commission will be different, she said, not least because it will embrace both health and social care, along with the supervision of detained mental patients, in one organisation. Given the risks that more members of an ageing population will fall through the cracks between health and social care services, that had to be right, she said.

But, after the regulatory failure at Mid-Staffordshire NHS Foundation Trust, there will be other changes too, she said.

Mid-Staffordshire was granted foundation trust status by one regulator, Monitor, in the middle of the inquiry by another, the Healthcare Commission, one of CQC's predecessors, that found "appalling" standards of emergency care from which, the commission said, patients died.

As well as the two bodies failing to communicate, the hospital's services were rated "fair" - barely adequate but not dangerous - for two years during which, concluded the commission, patients had suffered and died.

A fresh data analysis technique to examine high death rates that will continue to be developed by CQC, eventually picked up the problem.

But as in the case of Baby P, where Ofsted rated Haringey's social services as "good" at the time the child died, "that does raise questions about the balance between clever use of data and inspection," Lady Young said.

"We need to get the balance right between data and inspection - and we will be out there sniffing the breeze, being on the ground and eyeballing staff and patients."

A good regulator is there "to nip problems in the bud," she said. A host of fresh data about the quality of care is on its way, which the commission will share, and which ought to make that easier.

But Lady Young warned against the current trend - "which is: when things go wrong, blame the regulator".

"We do need to highlight where responsibility lies for the provision of quality care," she said. First with doctors, nurses and care workers on the ground. Then with boards of organisations. And then with those who commission care and performance - manage the systems. The commission will provide independent oversight, information that will help address quality, and assurance, she said.

But "it will be a failure of the service if the management [does] not get to quality issues before we do".

From:
http://www.ft.com/cms/s/0/8f51dc0a-1e53-11de-830b-00144feabdc0.html?nclick_check=1

Worst NHS trusts for hygiene threatened with fines and closure by super regulator

The worst NHS organisations for hygiene standards have been named and shamed by a new super regulator and threatened with fines and even closures if they do not improve.

In a first show of strength, the new Care Quality Commission has named 21 organisations which are failing to take sufficient action to prevent superbugs like MRSA and C. difficile.

The list contains eight trusts where there are high infection rates, persistent problems or a potential risk to patients has been identified. They will face further inspections by the regulator.

All the failing trusts have been warned they must improve within set deadlines or face further sanctions including warning notices, fines, and the possibility of wards or units being closed down.

Problems found included inadequate cleaning of ambulances, poor antibiotic prescribing practice, delays in isolating infected patients, lack of supervision of cleaning and infection control staff, dirty surgical equipment, lack of reporting of infection control measures to board level, delays in receiving laboratory test results and poor standards of cleanliness on wards.

All healthcare providers, except GP and dental surgeries, must be registered with the Care Quality Commission by 2010, in what is in effect a 'licence to practice', and the first step has been to register compliance on infection control measures.

All 388 NHS organisations that provide direct care to patients have been registered but the 21 trusts judged to be failing have been given conditional registration.

Barbara Young, chairman of the CQC, said: "Most trusts have stronger systems to protect patients from infection than a few years ago, and trusts' boards are taking the challenges seriously. We commend them for that.

"In 21 trusts we need further assurance that they are meeting the regulations. We have placed rigorous conditions on these trusts' registration and will monitor them closely.

"While infection rates at these trusts are not necessarily higher, they can do more to strengthen their approaches to infection control and help prevent outbreaks. We will monitor their performance throughout the year and will not hesitate to use our enforcement powers to protect patients' safety where needed.

"This is only the beginning of our work with NHS trusts. We aim to ensure they strive for continued improvement and that patients receive the same consistently high service wherever they receive care."

In eight cases, the trust failed to achieve required standards for infection control on repeated occasions and/or had a high infection rate and/or a potential risk to patients' safety was found on inspection.

The eight trusts are: Barnet, Enfield And Haringey Mental Health NHS Trust, Barts And The London NHS Trust, Kettering General Hospital NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, North Bristol NHS Trust, Plymouth Hospitals NHS Trust, South West London And St George's Mental Health NHS Trust, United Lincolnshire Hospitals NHS Trust.

Registration on healthcare associated infection is the first step towards full registration on all basic standards, a regime that will come into force from April 2010.

For the first time the regulator has the power to impose fines of £4,000 on the spot and up to £50,000 through the courts. The Care Quality Commission also has the power to close wards, services or a whole hospital in extreme circumstances.

From:
http://www.telegraph.co.uk/health/healthnews/5095540/Worst-NHS-trusts-for-hygiene-threatened-with-fines-and-closure-by-super-regulator.html

NHS patients must have more input on services

NHS organisations are still not giving patients enough say on health services.

A Healthcare Commission study of more than 130 healthcare organisations and 170 user groups in England found that patients did not feel they had enough input into what services were provided or how they were delivered.

Vulnerable people and those in poorest health often found it most difficult to engage with health services. Many patient groups were not convinced that the health service wanted their views or would act on them.

The report says: "Few trusts could demonstrate that people's views routinely influence their decision making."

This is despite 98 per cent of healthcare organisations telling the commission they sought and took into account patient views in last year's annual health check.

The watchdog said it found "some excellent practice" in primary care trusts, particularly around major reorganisations of services, but also increasingly on service reviews and procurements.

But it said PCTs were making slower progress in driving public influence on GP practices and there were few examples of PCTs writing into contracts that providers must engage with local people.

There were "good examples" of acute and ambulance trusts involving patients in changes to how services are delivered.

And mental health and learning disability trusts in particular demonstrated how users of services could "participate more actively and form partnerships with service providers".

The independent sector was less likely to capture "qualitative" information about patient experience or to share ideas in patient discussion groups.

Local involvement networks (LINks) were seen as an advantage, because they could bring patient and user groups together across local areas and across health and social care.

The commission has called for a national development programme for the NHS and the private sector to support improvements in public engagement. It says staff - including clinicians - must be supported to develop engagement skills. The Department of Health should incorporate patient experience feedback into initiatives such as quality accounts.

NHS organisations should be able to demonstrate a minimum level of performance on patient engagement.

Health minister Ann Keen said: "I welcome the Healthcare Commission's report and will study its findings closely. Many NHS staff already work hand in hand with patients to provide safer, more effective care but we want to make this the norm for all services."

She pointed to the next stage review, the NHS Constitution, and information prescriptions as evidence the department was committed to patient engagement.

From:
http://www.hsj.co.uk/news/2009/03/nhs_must_give_patients_more_input_on_services

Health Direct points our that it was patients' relatives that initially blew the whistle on the Mid Staffs disaster where up to 1,200 people met early deaths.

The Conservatives, the Telegraph, the Patients Association- and now even the Healthcare Commission recognise the importance of listening to patients.

All the labour government can say is that their discredited constitution is concerned.

How many more thousands of people are doing to die early because of labour's incompetence, waste, red tape and discredited targets?

Cure the NHS with far fewer managers- Sir Gerry Robinson

Recent crises in patient care stem from excessive bureaucracy and poor quality leadership, argues Sir Gerry Robinson.

It is almost beyond belief. In just two decades or so, the National Health Service has gone from having virtually no formal management structure, just administrative staff, to this week's announcement that out of a total staff of 1.36 million, 39,900 are managers.

Let me put that in context: there are 5,000 more people now employed to tend to organisation than there are consultants – a mere 34,900 – tending to the sick.

And if that were not enough to savour, new figures from the Incomes Data Services show that chief executives of NHS foundation trusts now earn an average of £158,000. Across the board at executive level within the NHS, salaries rose by 7.6 per cent in foundation trusts, and 5.7 per cent in non-foundation bodies. It is the starkest of all illustrations of just how far the pendulum has swung from medicinal to managerial.

Not that I am against management, nor high salaries – far from it. I am a passionate believer in management. In my career, as a former chairman of Granada, Allied Domecq, and the Arts Council, I spent much time analysing, writing about and teaching management skills. But in the case of the NHS, what we need are far fewer – albeit far better – managers.

I do not base my opinion on the latest statistics, which the labour Government is defending as making a "significant contribution to tackling unemployment" – a rather curious reason for hiring more managers in my view – but on the six months I spent advising Brian James, the chief executive of Rotherham Foundation Trust hospital for a BBC documentary in 2006.

The aim was to see if proven management techniques could overhaul one hospital's waiting lists, where more than 200 patients were waiting longer than the Government's recommended 18 weeks. I wanted to see if we could come up with a template for hospitals all over the country.

The experience was both salutary and shocking; the hospital staff, including management and consultants, was eager to make it a better, more efficient place. There was enormous goodwill and huge pools of talent.

But there was simply no process to pull it all together in a cohesive, sensible way.

When I meet people in the health service now who saw the BBC series, they say the same thing: how typical my experience was of their own hospital – and how the problems I identified persist throughout the NHS today.

I'm afraid this failure of management explains how a hospital such as the Mid-Staffordshire NHS Foundation Trust, which saw 400 needless deaths between 2005 and 2008, continued to function for so long before someone noticed.

It explains why the care of seriously sick children at Birmingham Children's Hospital was so gravely compromised as the Healthcare Commission found earlier this month. It also goes some way to explain the appalling treatment received by four disabled people whose deaths were investigated by Health Service Ombudsman and the Local Government Ombudsman whose report was published this week.

Yes, you will get senior people at any hospital – or in any organisation – who lose the plot, who manage things badly.

But while Health Secretary Alan Johnson is blaming the recent spate of crises on "understaffing and poor management", it is the lack of any normal system of checks and balances on a much wider scale that leads to failings of this magnitude.

In any "normal" organisation, there would be a "normal" management process. The whole would be broken down into constituent parts: one hospital would report to a head of a group of, say, 10 hospitals, who in turn would report to a regional manager, before reporting to national level. Progress would be measured, mistakes noticed and rectified promptly. That's how huge and successful companies such as Tesco manage.

The chain of command is clear so that it is easy to spot when something is going right or wrong – and to implement change when necessary. Follow-up meetings along the chain are so regular that problems get picked up when they are still manageable, and lessons learnt in one part of the group can be applied simply throughout.

In the NHS, staff may spend hours filling in paperwork and ticking boxes to cover their backs. But who is assessing what they do? Who follows it up afterwards? Some Foundation hospitals don't have to report to anyone who will challenge their procedures – as long as they are filing their regular reports. Trusts may appoint chairmen but I discovered they cannot control, and have little influence over, chief executives. No one ever sits down and asks: "How did it go last month?" No wonder it is chaos.

I understand how this culture of multiple managers develops; I think chief executives get to a point where it is easier to manage other managers than it is to deal with medical and nursing staff, especially consultants, who can be resistant to being told what to do by those with no medical background.

Instead, chief executives surround themselves with a safe set of managers who tell them what they want to hear, and perhaps they look to hire more – for business development or finance or new initiatives. Increasingly, the man or woman at the top of the tree is distanced from the reality of leading doctors, nurses and other staff, and delivering care to patients.

In Rotherham, I tried to persuade Brian James to have fewer managers – and I do think he took my suggestions on board. Certainly, recent figures show Rotherham to have among the lowest waiting lists for inpatients in the country.

But that is the exception: the NHS as a whole continues to employ ever greater numbers of managers with no clear evidence that it is being managed better as a result. I want to shake it all up.

We need a system in which regional heads must account for a budget, a cure rate, waiting lists etc – certain defined measures – every month. If they don't succeed or improve over time, they will find themselves replaced.

Health professionals need managing, they need rules, regulations, vetting; they need someone examining how they are handling their waiting lists. They need praising or criticising where necessary; and they need great leadership to help them change. It might take five or six painful years but I don't think it would take much additional money.

It is galling to think that we, the public, are paying for the current highly risky system – in which some hospitals are brilliant and some dire.

With good management, none of them would be dire. That's the truth of it. I'm not a fan of centralisation, but you do need a reporting system that can reveal why hospital A is not a patch on hospital B which is just 15 miles down the road.

The news is not relentlessly grim; the NHS has improved in the past five years – indisputably so. Targets have worked to a degree as they have focused attention on areas that really needed attention. We have also made great advances in the treatment of many diseases, especially cancer.

However, we still rank behind other European nations despite the billions and billions of pounds this labour Government has given to the NHS since 1997. I would argue that poor management is a factor in this. Until we learn to manage the NHS more effectively, we will never have the health service we pay for – and deserve.

From:
http://www.telegraph.co.uk/comment/personal-view/5062266/Cure-the-NHS-with-far-fewer-managers.html

Plans to safeguard NHS patients' lives

Health Direct reproduces the Conservatives and the Telegraph's plans to safeguard patients' lives in the face of labour's NHS targets and red tape.

Andrew Lansley issues five point plan to avoid another Mid Staffs:

Shadow Health Secretary Andrew Lansley has issued a set of five proposals to ensure another healthcare crisis of the kind we saw at the Mid Staffordshire Hospital is avoided in future.

1. Tougher inspection: Additional scrutiny powers for the 'Local Involvement Networks' that represent patients and the local community. 'LINKs' will also be given independence from local authorities so that they cannot be swayed by politics.
2. Empowerment of patients: "Conservatives will establish a strong, independent, national consumer voice for patients: HealthWatch." HealthWatch will help LINKs to hold local hospitals to account and will escalate concerns to national prominence, if necessary.
3. Empowerment of GPs: Rather than Primary Care Trusts holding budgets for buying treatment from local hospitals, the Conservatives would give the power to GPs. GPs, say the Conservatives, are closest to patients and best-placed to keep an eye out for things going wrong.
4. Scrapping targets: Abolition of bureaucratic targets will ensure that "doctors and nurses should never be put in a position where they have to choose between meeting a target and doing what is best for their patients."
5. Greater transparency: The Mid Staffs catastrophe only became apparent after the hospital's mortality rates were published - not something that is routine. A Conservative government will require more information on mortality and survival rates at each NHS trust.

From:
http://conservativehome.blogs.com/torydiary/2009/03/andrew-lansley-issues-five-point-plan-to-avoid-another-mid-staffs.html

The Telegraph suggests:

1 An independent inquiry into the regulation and supervision of NHS hospitals
We, the Patients Association and ‘Cure the NHS’ demand an inquiry, chaired by a judge, into both the failings in Staffordshire and the way hospitals are supervised nationwide.
2A review of hospital targets to ensure they work to improve quality of care
Doctors have warned that the four-hour waiting time target for A&E is attainable only by delaying admissions or forcing some patients through too quickly, to the detriment of their care.
3 Nurses to focus on patient care – not form-filling – as their central duty
Nurses have complained that they are sometimes too busy filling in forms to carry out basic nursing duties that are crucial for the wellbeing of patients.
4 Routine publication of comprehensive death rates for hospitals
Secrecy over mortality rates for particular treatments keeps patients in the dark about failing hospitals.
5 Patients to be given a stronger voice in the running of their hospitals
The local NHS watchdog system has been reformed repeatedly under Labour but there are concerns that the current structures lack the power to hold hospital chiefs to account.
6 Assurance that senior hospital staff will not be rewarded for failure
Martin Yeates, the chief executive of Mid Staffordshire NHS Trust, is now suspended on full pay and could receive a payoff, despite a previous pledge by the Government to clamp down on such payouts.

You can sign up here:
http://www.telegraph.co.uk/telegraph/multimedia/archive/01373/Click_here_to_supp_1373231a.pdf

Poll reveals public distrust of NHS governance

As Health Direct posts that the majority of British voters want an independent inquiry into the supervision of NHS hospitals today- over the rest of the week we will examine the chronic state of paperpushing, targets fixation and waste under labour's maladministration.

An opinion poll by ICM Research found that 78 per cent of the public back our call, in conjunction with the Patients Association, for an independent inquiry into the supervision of NHS hospitals.

It comes as The Sunday Telegraph's Heal Our Hospitals campaign has attracted pledges of support from more than 1,000 readers.

The call has been backed by Dr Phil Hammond, the writer and broadcaster, and by MPs from all three main parties.

Norman Lamb, the Liberal Democrat health spokesman, said "An independent inquiry is needed so that we can learn the lessons from this scandal."

Nine out of 10 people per cent agree that nurses should focus on patient care rather than form filling, while eight out of 10 per cent want a review of hospital targets to ensure they work to improve quality of care.

Stafford's former chief executive Martin Yeates was suspended on full pay following the scandal and could receive a generous pay off.

The poll also found that two-thirds of people want a stronger voice for patients in the running of their hospitals, following claims that local NHS watchdogs lack the power to hold chiefs to account.

Six out of ten per cent back the routine publication of comprehensive mortality rates.

It can also be revealed that Stafford Hospital is unable to give stroke patients and pregnant women vital scans over the week-end because of a shortage of qualified staff.

Patients presenting with a stroke on a Friday evening have had to wait 48 hours for a scan, thereby reducing their chance of a full recovery. Women suspected of suffering from potentially life-threatening ectopic pregnancies face similar delays.

In a blow to Labour the ICM poll found opinion evenly split on which party could be most trusted to run the health service.

The labour Government and the Tories polled 35 per cent each, despite Labour having long been regarded by voters as the party of the NHS.

One NHS campaign group warned that a repetition of the Stafford scandal was "absolutely inevitable".

Geoff Martin, head of campaigns at the Health Emergency pressure group, said: "NHS Trusts are run as managerial fiefdom."

From:
http://www.telegraph.co.uk/health/heal-our-hospitals/Poll-reveals-public-distrust-of-NHS

Ten NHS trusts have worse death rates than shocking Mid Staffordshire

Ten health trusts have worse death rates than the hospital where at least 400 patients died needlessly because of “shocking and appalling” standards of care.

A damning watchdog report detailed a catalogue of failings at Mid Staffordshire NHS Foundation Trust, including dehydrated patients being forced to drink out of flower vases while others were left in soiled linen on filthy wards.

The scandal of poor care at Mid Staffordshire was only uncovered when unusually high death rates at the hospital triggered secret NHS alerts.

The Healthcare Commission has not investigated any of the 10 trusts that currently have worse scores than Mid Staffordshire, and the Care Quality Commission, which takes over from the Commission this week, has no plans to do so either.

Campaign groups and leading experts last night called for the trusts to be investigated. Professor Sir Brian Jarman, a former member of an inquiry into the deaths of heart patients at Bristol Royal Infirmary and an expert on Hospital Standardised Mortality Ratios (HSMRs), said routine investigations of high death rates could "undoubtedly" save thousands of lives every year.

Warning that some trusts were reluctant to admit failures because of a "blame and shame" culture within the NHS, he said: "Of course the regulator should be looking into these trusts, and others with high scores.

"It is important to work with these trusts to identify any possible failures and work towards improvements."

The Sunday Telegraph's Heal Our Hospitals campaign is calling for mortality rates to be published widely and in more detail.

Figures from Dr Foster, the independent health information firm, show that at the height of its problems, in 2007, Mid Staffordshire's hospitals had the fourth highest rate of unexpected deaths in Britain.

The Trust had an HSMR of 127, meaning that 27 per cent more patients died than might be expected.

When the most recent annual figures were compiled last November, Mid Staffordshire's HSMR score had fallen to 116.

By contrast, the worst death rate was at Basildon and Thurrock University Hospitals NHS Foundation Trust, in Essex, with a score of 132.

A spokeswoman for the Basildon trust said it had responded quickly to the finding by employing more doctors and creating a dedicated ward for cancer patients.

The second worst mortality rate, of 126, was at Wrightington, Wigan and Leigh NHS Trust, in north-west England, which has now launched an action plan to tackle the problem, including moves to treat more patients on specialist wards.

Andrew Foster, chief executive of the Wrightington trust, said: "We recognised what the figures were telling us and we are delighted with the progress we have made in reducing our HSMR and to have a sustained improved performance which we intend to continue."

The other eight trusts whose mortality rates are worse than Mid Staffordshire – based on the most recent annual data from Dr Foster – are Blackpool, Fylde and Were Hospitals (123), George Eliot Hospital, Nuneaton (120), Swindon and Marlborough (120), North Middlesex University Hospital (119), Bolton Hospitals (118), Queen Mary’s Sidcup (117), Tameside Hospital (117) and Mid Cheshire Hospitals (117).

Since the data was prepared, Swindon and Marlborough has been renamed Great Western Hospitals NHS Foundation Trust and Bolton Hospital has been renamed Royal Bolton Hospital NHS Foundation Trust.

Health trusts are not obliged to investigate or act on their own HSMR scores, and many choose instead to dismiss high scores as statistical anomalies. All of the trusts contacted by the Sunday Telegraph insisted they had made improvements in the standards of care.

Campaigners warned that the scandal of Mid Staffordshire could be repeated unless high HSMRs were examined as a matter of course.

A spokesman for the Patients Association said: "We are amazed that trusts could have these high mortality rates and yet not automatically face any action. HSMRs are a blunt instrument but even a simple follow-up might uncover wider problems."

Geoff Martin, of the Health Emergency campaign group, said: "There should be an investigation into these trusts and others with high mortality rates and the rates should be a matter of clear public record."

Ben Bridgewater, a leading consultant cardiac surgeon and an expert on mortality rates at the Royal College of Surgeons, said: "You might look at 10 hospitals and find nine of them are actually doing a good job, but you would at least find the one that wasn't, and that is surely the point of regulation.

"It is hardly ever the case that high mortality rates do not indicate hospitals where patient care could be improved. Publication of mortality rates was one of the recommendations of the Professor Ian Kennedy inquiry into death rates at Bristol back in 2001, and it hasn't been achieved for reasons I don't understand. This information is known within the NHS but hard for patients to find."

Cardiac surgeons already have their individual mortality rates published but this is not the case for other treatments.

Ben Bradshaw, the health minister, hinted that the labour Government was reconsidering, saying: "I have asked the medical director to review available measures that can be used by trust boards and to accelerate their publication on NHS Choices."

Professor Sir Bruce Keogh, medical director of the NHS, ruled out investigation of the 10 trusts with high HSMRs but said: "It would be irresponsible of trust boards not to investigate high mortality ratios.

"The HSMR is an aggregate measure of mortality for the organisation and hence a rather blunt, but useful, indicator of trouble."

The Health care Commission launched its investigation into Mid Staffordshire after receiving seven alerts about potentially serious failures of care between July and November 2007.

The alerts, based on mortality for particular conditions such as kidney failure or stroke, are sent to trusts and watchdogs but not made public.

They are compiled by experts at Imperial College, London, led by Professor Jarman, under a system introduced in May 2007.

The investigation found that Mid Staffordshire managers failed to act quickly enough because they were convinced the HSMRs were incorrect.

It called for trusts in future to "conduct objective and robust reviews of mortality rates and individual cases rather than assuming errors in data".

Professor Jarman added: "If HSMRs are acted upon promptly then undoubtedly thousands of deaths could be avoided. We are always open to hearing ways of improving the reliability of the figures, but for now high ratios are a solid indicator that something is going wrong."

Andrew Lansley, the shadow health secretary, said: "The public has a right to know the extent to which patients benefit from treatment in each hospital, patients' views on the standard of care they receive as well as the views of staff about how good a service the hospital provides."

A spokeswoman for the Healthcare Commission said it did not agree that all high HSMR scores should be investigated. She said: "We would expect a trust that had a high HSMR to already have a sense of why that would be.

"It is not a matter of 'forcing' them – good managers generally have a sense of why their death rates are what they are. There are many reasons why a trust's mortality rates may be high – that is why we do not use them in our annual ratings of performance."

From:
http://www.telegraph.co.uk/Ten-NHS-trusts-have-worse-death-rates-than-shocking-Mid-Staffordshire

Lawyers use NHS as £100m cash cow

Lawyers are earning £800 an hour from the National Health Service and taking “indefensible” fees of tens of millions of pounds in legal disputes.

The money is coming from a labour government scheme intended to compensate patients for medical blunders and inadequate care, an investigation has found.

The compensation lawyers are claiming costs and “success fees” worth about £100m a year out of the scheme. In some cases the payouts claimed are 10 times more than the damages won by the patient.

Health professionals warn that it could get much more expensive. There is an estimated backlog of cases against the NHS amounting to £12 billion in claims, of which lawyers could get up to £6 billion.

The NHS Litigation Authority (NHSLA), which operates the compensation scheme, has lambasted the fees in a submission to Lord Justice Jackson, the judge. He is reviewing civil litigation costs.

The document warns that some “no-win, no-fee” lawyers are allowed to charge the NHS compensation scheme £804 an hour to pursue patients’ claims.

It states: “The whole costs structure is indefensibly expensive in relation to the compensation awarded or agreed. It is difficult to believe that it would be sustained were it not for the lack of motivation to change it.”

Mark Simmonds, the shadow health minister, said the huge fees being earned by the lawyers would be better spent on patient care. “It is unacceptable in some cases that the legal fees are many times higher than the awarded damages,” he said.

Bertie Leigh, a lawyer who defends the NHS in litigation cases, said he regards many of the cases he sees as a “buccaneering attack on the funds of the NHS”.

In one case involving Barking, Havering & Redbridge Hospitals NHS Trust, a legal firm claimed nearly £78,000 in costs and fees, having won just £7,000 for a female patient. A Liverpool firm submitted a legal bill for £4.4m for a single case.

The figures for 2007-8 show that more than one in four NHS trusts are paying out more in legal costs than in damages. The clinical negligence scheme paid £264m in compensation in 2007-8 of which £90m was in claimants’ fees.

Compensation lawyers say the success fees help to cover the cost of fighting cases they lose.

From:
http://business.timesonline.co.uk/tol/business/law/article5950503.ece

NICE U turn as kidney cancer patients to get Sutent drug on NHS

Terminal kidney cancer patients will receive an expensive drug on the NHS, following a U turn by the labour Government's drugs rationing body.

The National Institute for Curbing Expenditure (Nice) has approved the use of Sutent, which costs around £27,000 a year, in its final decision yesterday.

But the body will turn down three other kidney cancer drugs insisting that they are not "cost effective" for the health service.

Nice sparked outrage in August last year when it initially turned down Sutent, claiming it was too expensive.

At the time patient groups and cancer charities accused the body of condemning sufferers to an "early death".

The drug, which can prolong life for months, is used in the treatment of patients with terminal kidney cancer.

Since its initial draft guidance on the use of the drug Nice has agreed with the labour Government to look more favourably on drugs which prolong life when it makes it decisions.

This, coupled with an offer from Pfizer, the company which makes Sutent, to cut the price, means that the drug will be approved for use on the NHS.

Under the agreement, Pfizer will pay the £3,139 cost of the first six-week cycle of the drug, with the health service paying the rest of the costs.

Three other kidney cancer drugs, Avastin, Nexavar and Torisel, are expected to be rejected because the body has deemed them too expensive for the benefits they provide.

Around 7,000 people are diagnosed with kidney cancer in Britain every year and an estimated 3,600 could be eligible to receive Sutent.

Earlier this year it was announced that the drug, also called sunitinib, would be given to patients in Wales, paid for by the Welsh Executive, even before the Nice announcement.

Prof Robert Hawkins, Cancer Research UK Professor and Director of Medical Oncology at Christie Hospital Manchester, said: "I am delighted that Sutent will be available.

"It will remove a great deal of anxiety and uncertainty for people diagnosed with renal cancer to know that modern, effective treatment is now available to them."

James Whale, from the James Whale Fund for Kidney Cancer, said: "Finally, we have justice for the kidney cancer community. This positive recommendation from Nice will allow thousands of kidney cancer patients in England and Wales access to this life extending treatment.

"The options previously available to us have been limited and are inadequate for the majority of patients. For some, sunitinib is the only hope."

From:
http://www.telegraph.co.uk/health/healthnews/5044196/Kidney-cancer-patients-to-get-expensive-drug-on-NHS.html

Health Direct asks how many people have been condemned to an early death by labour's killer quango whilst it dragged it's feet over spending NHS money?

NHS is killing patients with learning disabilities, regulators find

The National Health Service is failing people with learning disabilities, according to a report published yesterday on the deaths of six disabled patients.

Regulators blame hospitals and local authorities for “significant and distressing failures” that led to the six patients receiving inadequate care because of their disabilities.

Ann Abraham, the Health Service Ombudsman for England, said the findings suggested that a wider pattern of poor care for people with learning disabilities which was “an indictment of our society”.

Mark Cannon, 30, died after being admitted to hospital with a broken leg. Staff failed to give him any pain relief or to administer the correct medication to control his epilepsy. Renal failure and a severe chest infection were diagnosed only after considerable delays.

Martin Ryan, 43, starved for 26 days following a stroke because a feeding tube was not fitted and he was left too weak to undergo surgery.

Four other cases, all of which ended in the death of the patient, followed a similar pattern, with nurses and doctors accused of complacency or discrimination.

Families of the six put pressure on nurses and doctors to administer proper treatment, but were ignored and dismissed.

When they pursued their complaints formally, they were dealt with inadequately, leaving them “drained and demoralised”, the report says.

The six cases are the subject of a rare joint review by the by the Health Service and Local Authority Ombudsmen entitled Six Lives, which was published yesterday.

It has ordered a total of £120,000 to be paid to compensate the families for the distress caused in the care of their relatives.

Ms Abraham said that serious mistakes were made and ordered the NHS to overhaul its procedures for treating people with learning disabilities.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article5965336.ece

Labour's health databases will break the law

The NHS detailed care record and the secondary uses service are among two public sector databases deemed "almost certainly illegal" in a report by the Joseph Rowntree Reform Trust.

The trust, which funds campaigns to promote civil liberties, warned that a quarter of public sector databases appear to fall foul of human rights or data protection law.

Privacy problems

The report, which assesses 46 databases from different labour government departments, says more than half of public sector databases have "significant problems with privacy or effectiveness and could fall foul of a legal challenge".

The trust found that fewer than 15 per cent of the public databases assessed are effective, proportionate and necessary.

Red ratings

The NHS detailed care record and the secondary uses service are both given a red rating by the trust, signifying they is almost certainly illegal under human rights or data protection law.

The NHS summary care record is given an amber rating, meaning the trust believes it has significant problems and may be unlawful.

The report says databases rated as red should be scrapped or redesigned immediately. Amber databases should be independently reviewed.

The computer registers — including the DNA database, the national identity register, the Contactpoint child protection database and the health service patients’ register – all breach human rights and data protection laws, the Joseph Rowntree Reform Trust reports.

It argues that they should be scrapped or fundamentally redesigned to take privacy objections into account.

The report, whose joint author, an academic expert on privacy at Cambridge University who is one of the most respected in Britain, warns that ministers are planning to spend a further £100 billion on information technology databases over the next five years while only 30% of big information technology projects succeed.

Claims by the labour government that the databases make the provision of public services such as health easier are dismissed as “illusory”.

In fact, the giant repositories of personal data can expose people to greater risk, particularly the most vulnerable, the research says.

More than half the nearly 50 state databases have “significant problems” in protecting privacy, it adds. Only one in seven of the databases assessed by the study was “effective, proportionate or necessary”.

The report is the most comprehensive and damning study of the creeping culture of state surveillance.

It has been overseen by a team including Ross Anderson, professor of security engineering at the University of Cambridge’s computer laboratory.

Campaigners and opposition MPs say the rapid emergence of Britain as a “Big Brother” society is transforming the relationship between the citizen and the state.

One of the planned databases condemned by the report is a Home Office system to store information on every telephone call, e-mail and internet visit made in Britain.

Jacqui Smith, the home secretary, had been planning to announce the database in a bill last October.

She backtracked after officials in her department reportedly expressed concerns about the legality of the plan. Ministers had been planning to release a consultation paper on their plans in January.

This has now been delayed amid speculation at Westminster that Gordon Brown has ordered ministers to ditch all controversial and potentially unpopular legislation in the run-up to the general election, expected in 2010.

The report says Britain is alone among developed countries in the pace at which it is expanding national database systems.

From:
http://www.timesonline.co.uk/tol/news/politics/article5950851.ece

Hospital was upgraded in spite of deaths

A Staffordshire hospital was granted flagship status despite providing such "appalling" emergency care that "there is no doubt that patients will have suffered and some of them will have died", the health service's quality watchdog said last week.

Alan Johnson, the health secretary, apparently failed to pass on patients' concerns at a time when Monitor, the foundation trust regulator, was considering MidStaffordshire NHS Trust's application to become a foundation trust.

The Healthcare Commission presented its findings as a success for its new data mining techniques, after unexplained death rates for emergency care at the hospital triggered concerns in 2007 that led to a formal investigation the following year.

But the case also raises questions about the commission's previous assessment of the hospital, which rated Mid-Staffs' quality of care as "fair" for the two years preceding its foundation trust application, but at a time when the commission now says patients were almost certainly dying as a result of poor care.

Between 2005 and 2008, some 400 more patients died than would have been expected on standardised death rates, although Sir Ian Kennedy, the commission's chairman, stressed that without a detailed examination of all case notes it was impossible to say "how many of those died through bad care".

The commission found untrained receptionists deciding the order in which patients were seen. There were also too few doctors and nurses as the trust cut staffing to create a surplus to boost its foundation trust application, an absence of essential equipment from infusion pumps to defibrillators, and some nurses turned monitors off because they did not know how to use them.

While the Healthcare Commission had growing concerns about Mid-Staffs from the summer of 2007, Anna Walker, its chief executive, said she had "no idea" that Monitor was considering the hospital's application for foundation trust status, which was granted in February 2008. "I discovered by accident after they had taken the decision," she said.

Monitor admitted that it did not speak to the commission during its assessment, instead relying on the commission's published verdict that the quality of care was "fair" and accepting the local NHS view that the elevated death rates were because of "coding errors". William Moyes, Monitor's chairman, said it now actively consulted the commission, nationally and locally, and examined patient complaints when making assessments.

Julie Bailey, whose mother died at Stafford, in December 2007 founded a group to campaign about deaths and poor care at the hospital.

She said she had written to Mr Johnson highlighting patient concerns on January 5 2008, ahead of Monitor's decision. A reply from his office had simply referred her back to the hospital, she said.

From:
http://www.ft.com/cms/s/0/065dd696-135f-11de-a170-0000779fd2ac.html?nclick_check=1

Children's lives put at risk by poor care at specialist hospital

Children's lives were put at risk by the poor standard of care at a specialist hospital, according to the second damning report into health provision to be published this week.

An investigation by the Healthcare Commission found that there was a shortage of beds at Birmingham Children's Hospital NHS Foundation Trust as managers "struggled" to meet rising demand for treatment.

This meant that seriously ill young people were admitted late while others were sent to different hospitals miles away from their families.

Surgeons warned that theatre staff were poorly trained, handed them the wrong instruments and even knocked their hands during critical operations. In addition, managers failed to act when they were warned of the dangers by consultants, the report said.

Paul O’Connor, the hospital's chief executive, resigned two weeks ago.

It comes just days after another report by the watchdog found that as many as 1,200 patients may have died needlessly at Mid-Staffordshire NHS Foundation Trust, as managers put targets and cost cutting ahead of care.

Describing the situation in Birmingham, Anna Walker, the chief executive of the Healthcare Commission, said: "While we have no evidence of serious incidents causing harm to patients, the standard of care has not been as good as it should have been in some cases.

"The response to safety concerns has been slower than ideal. It is deeply concerning that serious issues were raised but not properly or rapidly addressed over several months. While I would not say there were 'third-world' conditions, there were serious potential risks in the way care was provided."

Birmingham Children's Hospital is one of only four specialist hospitals for young people in England, caring for 140,000 patients in 2007-8.

Last year it was rated "excellent" for use of resources by the Healthcare Commission although only "fair" in terms of quality of services.

Senior staff at nearby University Hospital Birmingham NHS Foundation Trust met managers from the children's hospital last June to discuss their concerns about standards of care.

They then wrote a highly critical report that was obtained by a Sunday newspaper under the Freedom of Information Act before it had even been seen by the children's hospital, prompting the Government to order an official investigation in December.

The Healthcare Commission found that because of increasing demand for treatment at the hospital, average bed occupancy was running at more than 98 per cent.

This led to 28 per cent of admissions being cancelled on the day and 70 children a month being sent to other hospitals for treatment because there was no room for them in Birmingham.

The report said this is a "special concern" for patients with liver problems, who need to be seen urgently.

Many members of staff also warned it was "very challenging" to get access to operating theatres for urgent but not life-threatening cases. There are only two days on which neurosurgery sessions take place, meaning that children admitted after Wednesday have to wait until the following Monday for treatment unless they are put on the emergency list.

This situation was said to have led to several "near misses" and was a risk to patients.

The watchdog found that "almost all" consultants were worried that they could not use interventional radiology to diagnose patients because demand was so high.

Surgeons said theatre staff did not always know what instruments were required for operations, and sometimes consultants brought their own equipment because the hospital did not have it.

Leadership of the neurosurgical ward was said to be inadequate, driving nurses to resign.

The watchdog concluded that it was "deeply concerning" that serious concerns had been raised but not dealt with properly, causing "alarm and anxiety" among patients and their families.

It made 12 recommendations about how the children's hospital can improve, including monitoring demand better and working on its relationships with consultants.

From:
http://www.telegraph.co.uk/Childrens-lives-put-at-risk-by-poor-care-at-specialist-hospital.html

Ditherer Brown's PFI U Turn

After a dozen years of wasteful, expensive over spinning and under delivering Stalinist Brown has created a new PFI process.

Seven private sector consortiums are to be given a form of quasi-monopoly on a potential £2bn-£3bn ($3bn-$4bn) market for building health centres, community hospitals and perhaps some local authority facilities.

The Department of Health is expected to announce the winners of the so-called Express Lift (local improvement finance trust) project soon in a move which could in time also open up more of the NHS’s community health services to competition from the private and voluntary sectors.

Under Lift projects, the private sector forms joint companies with primary care trusts – and sometimes local authorities – which finance, build and run GP surgeries and other health facilities. Contracts typically last for 20 years and the public sector owns a 40 per cent equity stake.

Some 47 Liftcos – which use some of the techniques of the private finance initiative – have so far been set up.

More than 220 buildings with a capital value of about £1.5bn are under construction or open, with more to come under the deals already signed.

Half of the country’s 150 primary care trusts, however, still do not have a Lift deal – chiefly those outside the big cities.

Under Express Lift they will be able to choose from the winners of the framework contract without the need for a full EU-style tender. The hope is to cut procurement time from a typical two years to a few months, massively reducing the costs and speeding up the programme.

Sir William Wells, a former regional health authority chairman, is now chairman of Ashley House, whose Odyssey Healthcare is expected to be one of the winners.

“We have been building these great palaces of PFI hospitals like they are going out of fashion, when in fact they are going out of fashion,” he said. “Even cancer care is now moving out of hospital and into people’s homes. This new approach should be far more flexible and – at a time when capital is going to be in very short supply – much more affordable for the NHS than PFI.”

Lift buildings typically cost £3m-£7m, and raising money this way was far easier amid the credit crunch than raising finance for big PFI projects, Sir William said. He added that in time Liftcos could take over a primary care trust’s entire property portfolio.

The National Audit Office has judged the Lift programme to have gone well, although MPs on the Commons public accounts committee have questioned the value for money and the rate of return Liftcos make.

From:
http://www.ft.com/cms/s/0/0e7db1d2-0f5b-11de-ba10-0000779fd2ac.html

Labour's NHS targets may have led to 1,200 deaths in Mid-Staffordshire

NHS managers have been accused of putting targets and cost-cutting ahead of patients as a report found up to 1,200 people may have died needlessly due to "appalling standards of care" at a single hospital.

An astonishing litany of failings at Mid-Staffordshire Hospitals trust was uncovered by the Healthcare Commission in one of the most critical reports of NHS treatment ever published.

Last night there was concern from patient groups that managers who should have spotted the failings at the trust but failed to raise the alarm have now been promoted to key jobs in the NHS and healthcare regulation.

The investigation into care between 2005 and 2008 found overstretched and poorly trained nurses who turned off equipment because they did not know how to work it, newly qualified doctors left to care for patients recovering from surgery at night, patients left for hours in soiled bedclothes, and reception staff expected to judge the seriousness of the condition of patients arriving at A&E.

Doctors were diverted away from seriously ill patients, in order to treat ones with minor problems, to make the trust look better because they were in danger of breaching the Government's four hour waiting time target.

The trust - which was under pressure to save £10m from its annual budget - was more concerned with hitting targets, gaining Foundation Trust status and PR marketing and had "lost sight" of its responsibilities for patient care, the report said.

It is not clear how many patients died as a direct result of the failures but the Commission found that mortality rates in emergency care were between 27 per cent and 45 per cent higher than would be expected, equating to between 400 and 1,200 'excess' deaths.

Sir Bruce Keogh, medical director of the NHS, described the failures as a "gross and terrible breach of trust" of patients.

Health Secretary Alan Johnson offered his apologies to patients and staff who suffered as a result and immediately ordered two more inquiries.

Patients of Mid-Staffordshire NHS Foundation Trust described one ward as a "war zone" and people were often left waiting in A&E for hours covered in their own blood and without pain relief even though they had serious injuries.

Others were left without food or drink, some received the wrong medication - or none at all - and blood and faeces was left on lavatories and floors.

Trust chief executive Martin Yeates and chairman Toni Brisby both stepped down two weeks ago and Mr Yeates, who is paid a salary of £160,000, is suspended on full pay while an independent investigation is carried out.

But patient groups were angered that Cynthia Bower, who was chief executive of the West Midlands Strategic Health Authority - the organisation with responsibility for checking standards at the hospital - from July 2006, is to set to become the new head of the health super-regulator the Care Quality Commission.

Her predecessor David Nicholson at the forerunner of West Midlands Strategic Health Authority - which was Shropshire and South Staffordshire SHA - left in 2006 but is now the head of the NHS, as its chief executive.

Sir Ian Kennedy, chairman of the Healthcare Commission, said the report is a "shocking story" and that there were failures at almost every stage of care of emergency patients.

"There is no doubt that patients will have suffered and some of them will have died as a result," he said. "Trusts must always put the safety of patients first. Targets or an application for foundation trust status do not lessen a board's responsibility to its patients' safety."

The problems first emerged after the hospital was reported in 2007 to have high mortality rates among patients.

But the trust's board of directors "fobbed off" NHS investigators by saying the rates were a result of statistical errors.

Yesterday the Healthcare Commission concluded this was not that case. The report stated that staff members claimed care of patients had become secondary to government-imposed targets.

The report said there was a "reluctance to acknowledge or even consider that the care of patients was poor".

Nurses were threatened with the sack because of the number of breaches of the target to treat A&E patients within four hours and felt they were "in the firing line".

Patients in danger of breaching the target were put in a 'clinical decision unit' which was a "dumping ground" for patients in order to "stop the clock" on the waiting time.

Relatives came forward to report, nurses shouting at patients, staff failed to treat patients with compassion or dignity and respect, lack of help with meals or drinks, and failures to treat bed sores. One comapred the hospital treatment to the "Third World".

A survey found two thirds of doctors would not be happy to have a relative of theirs treated at the hospital.

Director of the Patients Association Katherine Murphy said: "How can any patient have trust in the managers and systems that have allowed this disaster to run and run?

"It is not enough for the Chairman and Chief Executive to take the fall for this.

"Government targets have directly impaired safe clinical practice and money and greed for Foundation Trust benefits has taken priority over patients' lives."

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing (RCN), said: "There is also something very wrong when trusts are achieving foundation status by putting the health of their budgets over the care of their patients as detailed in the accounts of trust board meetings."

Eric Morton, the new chief executive of the Mid-Staffordshire NHS Foundation Trust, said: "We would like to take this opportunity to offer our very sincere apology. We would like to reassure the local community that our focus is, and will remain, on providing high quality, efficient and safe healthcare for the people of Staffordshire. "

Professor Sir George Alberti, national clinical director for urgent and emergency care will now lead an independent review of the trust's current A&E services.

From:
NHS-targets-may-have-led-to-1200-deaths-in-Mid-Staffordshire.html

NHS Choices website spending attacked

Millions of pounds of labour government investment in an NHS Choices website was criticised last week for threatening to stifle independent services that appear to do a better job at less cost.

Patients are to be allowed to post comments about their GP surgeries on the NHS Choices website later this year as the labour government adds online reviews of council and childcare services to the existing ability to review and rate hospitals on NHS Choices.


Gordon ditherer Brown, the prime minister, said the government had “clearly got the balance wrong” when online businesses such as Ebay, Amazon and Tripadviser offered higher transparency through consumer review than did taxpayer funded public services.

However, Colin Talbot, professor of public policy and management at Manchester Business School, said the government appeared “to have got the balance wrong” because it was investing large sums of taxpayers’ money in centralised projects that the independent sector appeared to do at least as well.

Since 2005, for example, patients have been able to comment on hospitals, mental health and primary care trusts, hospices and independent sector hospitals on Patient Opinion (www.patientopinion.org.uk), a social enterprise founded by family doctors.

Feedback can be left on all organisations, but 60 in the NHS subscribe to help fund the not-for-profit group’s £400,000-a-year turnover.

Professor Talbot said that at a time when public spending was under pressure, it seemed wrong to spend taxpayers’ money setting up a new centralised organisation rather than partnering a business that offered independence from the government.

There were other websites that also rated doctors and hospitals.

“Patient Organisation is a not-for-profit social enterprise – something the government says it wants to encourage – and is more likely to be trusted because it is independent of the Department of Health,” he said.

“Organisations that subscribe are far more likely to change what they do because they value the feedback they have decided to pay for, than they are to respond effectively to a bunch of anonymous comments passed on from a Department of Health website.

“It would be perfectly possible, and almost certainly much cheaper, for the government to support an organisation like this, while preserving its independence, rather than risk the elephant of the department sitting on it and squashing it.”

Dr James Munro, research director at Patient Opinion, said it hoped to sign a contract with the Department of Health this year to work with mental health trusts.

“We are hoping to work with NHS Choices more closely,” he said.

From:
http://www.ft.com/cms/NHS Choices

Health Direct points out that the NHS choices was reviewed in our post on August 13, 2007
NHS Choices- massive inaccuracies mar GP patient website

Dr Trefor Roscoe, a GP in Sheffield, said the public were in danger of being “grossly misled” by the information on GP surgeries on the NHS Choices website. “According to the site we still open on Saturday morning which we last did about six years ago.”

He added: “ We all share the desire for patients and the public to be as well informed as possible but this is gimmicky and over simplistic and may cause unnecessary worries.”

Heath Direct notes that the Blog Doctors goes further. NHS Choices is described as thus: I have just spent ten minutes looking around NHS Choices and, as you would expect, I hate it. It is utterly dishonest. The last ten years has been about removing patient choice, not increasing it.

The lifestyle advice the site gives is trite and patronising, and at times downright offensive.

Labour's nanny state wasted health gap money

Labour ministers have wasted tax payers money in their attempts to tackle health inequalities, MPs say.

The House of Commons' Health Committee said the labour government should have been more careful in designing and piloting projects in England.

The MPs highlighted a series of schemes, including Sure Start, which had failed to have much of an impact.

Ministers have pledged to reduce the health inequality gap - measured by infant mortality and life expectancy - by 10% between 1997 and 2010.

But it seems certain they will miss that target as data published last year showed the gap between the richest and poorest has actually widened in the past decade.

The Department of Health has responded by asking World Health Organization expert Sir Michael Marmot to look at developing a new approach to the issue in what was widely interpreted as an admission of failure.

And the report by the cross-party group of MPs has now added to those criticisms.

The MPs said the labour government had often rushed in with insufficient thought and a lack of clear objectives when setting up projects.

They highlighted health action zones, which were regional partnerships set up in the late 1990s between a range of partners from the fields of health, education and employment.

The report said the 26 zones had been created too quickly and been poorly resourced.

It also criticised Sure Start schemes, which were designed to link up services for parents and young children.

The schemes have been predominantly focused on education and welfare and as a result have "yet to demonstrate significant improvements in health".

The MPs also attacked more recent initiatives, including the healthy towns scheme, which they said should have been rigorously evaluated first.

Cycling

Committee chairman Kevin Barron said: "Far more must be done to ensure money injected into implementing these policies is tracked and policy design must be sufficiently improved so that effective and accurate evaluation can take place."

He admitted there were "no easy or quick solutions", but urged the government to focus on improving food labelling, encouraging more cycling and walking and reducing smoking rates.

Professor Danny Dorling, a health inequalities expert at Sheffield University, said: "The problem is that the government has shied away from tackling the wealth gap.

"The countries which have good health all have lower income inequalities, but for some reason the government has been convinced this is not the issue."

From:
http://news.bbc.co.uk/1/hi/health/7942147.stm

Children at risk through lack of training for doctors and nurses, report warns

Children are being put at risk by inexperienced surgeons and a lack of basic child protection training in hospitals, a damning report from the health watchdog has found.

Surgeons and anaesthetists in seven out of ten trusts reviewed by the Healthcare Commission do not have sufficient experience of treating children to maintain the proper level of skill, the report said.

Smaller units offering children's surgery may have to close because the doctors do not operate on child patients often enough, experts said.

It comes after the Royal College of Surgeons warned that waiting times for routine operations will soar as European rules mean junior doctors hours will be cut.

The Healthcare Commission report details failings in child protection training, pain management, and life support two years after first highlighting the problems.

There has been some improvement but many trusts are still failing to train staff to the correct level, the report said.

The Commission carried out a review of 154 hospital trusts where children are treated and checked on progress made since an earlier review in 2005/6.

The key findings were:

– Three in ten trusts 'do not meet basic minimum level of child protection training for key staff', the report said.
– Four in ten trusts did not have the equivalent of one nurse per shift who was trained to assess and treat pain in children.
– Three quarters of trusts did not meet guidelines on life support training and more than one in ten trusts have deteriorated on this score since the first review.
– More than seven out of ten trusts have got worst or been consistently poor at ensuring surgeons and anaesthetists treat enough children to maintain their skills.

Trusts must address these concerns urgently to ensure they are providing care that is safe and effective, the report said.

A spokesman for the Commission said: "The findings do raise questions about the safety and configuration of services that trusts should investigate. However, they do not in themselves provide sufficient information to say whether a particular service is unsafe."

Anna Walker, the Commission's chief executive, said: "We are particularly concerned about training in child protection. It is absolutely vital that NHS staff working with children know how to recognise signs of child abuse and know what to do if they see it.

"Another area of concern is that some surgeons and anaesthetists appear to be performing procedures on children without meeting the recommended levels of work to maintain their skills. There may be good reasons for this, but the figures need exploring in greater depth."

A spokesman for the Royal College of Surgeons said specialist children's surgery should be provided in large regional centres but non-specialist operations can safely be carried out in local hospitals if properly supported.

He added: "One solution would be to maintain simple paediatric surgery in local hospitals by specifically employing surgeons 'with an interest in paediatric surgery' and to fund training for this. If a solution is not found soon then local provision of care may cease in some areas."

Dr Mary McGraw, Vice President for Training and Assessment, at the Royal College of Paediatrics and Child Health, said: "We are very concerned by the findings that although progress has been made in some areas, basic training in child protection, life support and managing pain still do not meet the guidance in a significant proportion of trusts."

Health Minister, Ann Keen said: "We are very disappointed that some hospitals are not reaching the high standards that the Healthcare Commission assessed and expect trusts to take urgent action to ensure that staff and services caring for children are of the highest quality.

From:
Children-at-risk-through-lack-of-training-for-doctors-and-nurses-report-warns

More NHS job cuts on the way

The director general of NHS finance, performance and operations David Flory has warned that health service redundancies are likely to continue at their current rate of around 54 a month.

Compulsory redundancies stemming from the reorganisations of primary care and ambulance trusts and strategic health authorities have now been completed, resulting in a total of 5,318 lay-offs from April 2006 to December 2008, four-fifths of which were non clinical.

But although the numbers being forced to take redundancy are significantly lower than the peak of 256 a month in summer 2007, Mr Flory told HSJ he now expected the figure to stabilise at the current rate of around 54 a month - 72 per cent of which are non clinical.

He said the economic downturn had already caused the Department of Health to make it clear health service organisations would need to make efficiency cuts of more than 3 per cent in 2010-11, much of it through back office rationalisation.

Efficiency

"People are thinking about how to organise themselves to deliver that and are taking early opportunities now to get some of that in the bank," he said. "We are looking for people to take opportunities when they come up, to look rigorously at the way in which they commission and deliver their services, particularly back office and support services - to take every opportunity that they can to improve the efficiency of those."

Many of the redundancies resulting from Commissioning a Patient-led NHS were not made until two years after its 2005 publication, when employment guarantees ran out, with another glut in summer 2008.

In 2007, the Audit Commission found compulsory redundancies were costing an average £82,446. Based on that, the total redundancies to the end of 2008 are likely to have cost the NHS around £438m.

REDUNDANCIES – APRIL 06 TO DECEMBER 08

Period	Compulsory redundancies	Estimated cost (£m)
2006-07 April-Sept	903	74
2006-07 Oct-March	1,426	118
2007-08 April-Sept	1,533	126
2007-08 Oct-March	690	57
2008-09 April-Sept	603	50
2008-09 Oct-Dec	163	13
Total	5,318	438

From:
http://www.hsj.co.uk/news/2009/03/nhs_job_losses_set_to_continue

Department of Health told to improve record management

The Information Commissioner's Office is seeking significant improvements in the way the Department of Health manages and retains its records.

The ICO has issued a formal practice recommendation to the department after an assessment found local managers, given responsibility for record management, had developed inconsistent practices.

The ICO said senior managers must do more to ensure that good behaviours and practices are reinforced, especially where there are organisational changes.

The assessment found that there are good central policies and guidance in place.

Benefit, not burden

Assistant information commissioner Gerrard Tracey said: "Existing guidance states that good records management should be seen as a benefit, not a burden. All organisations, public and private, are advised to have good records management as part of achieving business efficiency, by making sure that information is easily retrieved and properly documented."

This is the second practice recommendation the ICO has issued to the Department of Health for failing to meet its requirements under the Freedom of Information Act. In April 2008, the department was served a practice recommendation in relation to its handling of freedom of information requests.

From:
www.hsj.co.uk/news/2009/03/department_of_health_told_to_improve_record_management

Labour U turn on data sharing your medical records

Labour's Justice secretary Jack Straw has dropped controversial proposals that medical bodies had warned could see patients' confidential medical records being passed to anyone who asks.

It had been feared that the proposals, in clause 152 of the Coroners and Justice Bill, would allow not only the labour government to access medical records but also share them with other any other global organisation.

Concerns

But a Ministry of Justice spokeswoman said following concerns that the clause as defined was very wide and the powers it provided could be misused, Mr Straw had asked cabinet colleagues to withdraw the clause and launch a further consultation.

The U-turn came after eight organisations - the British Medical Association, the Royal College of GPs, the Royal College of Surgeons, the Royal College of Nursing, the Faculty of Public Health, the Academy of Medical Royal Colleges, the Medical Defence Union, and the Medical Protection Society - wrote to Mr Straw protesting about the proposals.

'Disastrous impact'

The organisations had warned that the clause would "undermine the presumption of confidentiality, corrode trust in the doctor-patient relationship and could have a disastrous impact on both the health of individuals and the public".

On Monday, January 26, 2009 Health Direct warned in: Your health records- open to all in new labour data disaster

NO2ID and Health Direct has been warning since 2006/7 about the stated intentions of the labour government "to overcome current barriers to information sharing within the public sector".

This current labour wheeze is only the latest example of the extent to which labour are trying to turn the UK into a big brother stalinist state.

There is absolutely no guarantee that they will not try another scheme in the next thirteen months. If you were stupid enough to allow your medical records to be added to the IT white elephant you are still not safe.

Dept of Health failing to learn from past mistakes

The NHS's IT £12bn programme to create an electronic patient record is a prime example of Whitehall failing to learn from past mistakes, the National Audit Office warns.

So are the computerisation of the Child Support Agency, a grant scheme for farmers, and the cancellation of an asylum centre.

There are plenty of examples of departments learning from mistakes others have made, the NAO said, but Whitehall is still not good enough at learning lessons from previous policy and implementation errors.

The NHS programme spectacularly failed to engage staff. Other programmes were trialled, or implemented at a time when other big changes to the business were under way. Yet all these, and other, mistakes have been made before, the NAO argues in a report on helping labour government to learn.

Examples where lessons have been learnt are the better handling of the foot and mouth outbreak in 2007 compared with 2001; early appreciation by the Treasury that refinancing rules for private finance initiative projects needed to be changed as a result of the financial crisis; and a £2bn programme to roll out Jobcentre Plus came in under budget and on time because officials drew on lessons from big projects that had gone wrong.

"There has been a proliferation of toolkits, guidance and other products to help government learn," the NAO said.

But with a risk of "guidance overload", civil servants need to be given more time to learn what makes projects work and go wrong, and that needs to be built in to day-to-day practice.

Without that, "failures will continue to happen" producing "avoidable waste, inefficient practices and ineffective services".

From:
http://www.ft.com/cms/s/0/d6acb3bc-06cb-11de-ab0f-000077b07658.html?nclick_check=1

NHS chiefs fail to defend Agenda for Change red tape

MPs have attacked health chiefs for failing to ensure Agenda for Change delivered promised gains in staff productivity.

NHS chief executive David Nicholson and Department of Health workforce director Clare Chapman appeared in front of the public accounts committee yesterday afternoon for its inquiry into NHS pay modernisation.

Committee member Richard Bacon, a Conservative MP, said he was "puzzled" as to why the DH did not know whether the pay system, introduced in 2004, had resulted in planned yearly productivity rises of between 1.1 and 1.5 per cent.

He said: "You went to great efforts to set up an all singing, all dancing pay system and yet you can't tell us specifically what it has done."

Turnover and vacancy rates

Mr Nicholson said Agenda for Change was an "enabler" that had led to improvements in turnover and vacancy rates and encouraged trusts to create new roles.

It was difficult to identify how many of the improvements had resulted directly from the simplified pay system and how many were due to other policies such as expanding the workforce, he said.

Accountability

Mr Bacon asked how the DH planned to hold trusts to account for improving staff efficiency.

Mr Nicholson said this was achieved through the tariff, which would probably require 3.5 per cent productivity increases next year.

Knowledge and skills framework

MPs also asked why many trusts were still not adopting the knowledge and skills framework, designed to support NHS employees' career progression.

Mr Nicholson said: "It's proving more difficult than the people who designed it thought. It's generally well regarded by both managers and staff. There are issues about its complexity."

Work was being done to simplify the framework, he said.

The inquiry was set up following the National Audit Office report NHS Pay Modernisation in England: agenda for change, published in January.

http://www.hsj.co.uk/news/2009/03/nhs_chiefs_forced_to_defend_agenda_for_change

HIV and Hepatitis C Blood inquiry condemns commercial priorities which led to thousands of patients being infected

An independent inquiry has condemned the procrastination and penny pinching that led to thousands of patients becoming infected with HIV and Hepatitis C from contaminated blood.

The inquiry, led by Labour Peer Lord Archer of Sandwell, said the infection of so many people was a "horrific human tragedy."

The authors of the report said they were "dismayed" at the time taken by the Government and scientific agencies to respond to the dangers of Hepatitis C and HIV infections.

The report noted there was "lethargic" progress towards national self-sufficiency in blood products in England and Wales, where it took 13 years compared to just five years in Ireland.

As a result the NHS bought blood from US suppliers who used what became known as "skid row" donors, such as prison inmates, who were more likely to have HIV and Hepatitis C.

The report said: "It is difficult to avoid the conclusion that commercial interests took precedence over public health concerns."

It added: "Whether the lack of urgency over much of this period arose from over-hesitant scientific advice or from a sluggish response by Government is now difficult to assess."

Nearly 2,000 haemophiliacs have died as a result of exposure to the contaminated blood in what leading medical expert Lord Winston called "the worst treatment disaster in the history of the NHS".

Some 4,670 patients who received blood transfusions in the 1970s and 1980s were infected with Hepatitis C, of whom 1,243 were also infected with HIV.

Lord Archer's two year privately funded inquiry was set up after decades of campaigning from victims and their families.

The report noted: "The haemophilia community feels that their plight has never been fully acknowledged or addressed."

The authors said a full public inquiry into the scandal should have been held much earlier to address the concerns of haemophiliacs.

In conclusion they said: "Commercial priorities should never again override the interests of public health."

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NHS managers risk court over clinical errors

NHS managers should be legally responsible for some clinical negligence cases, a patient safety expert has argued.

Brian Toft, a professor of patient safety at Coventry University and incident investigator, believes that where healthcare professionals have told managers about a problem with their care environment, the manager should be liable for incidents related to the problem.

He gave the example of clinicians complaining of being overloaded with patients and later making a mistake which harms someone.

Professor Toft, who has advised the World Health Organisation and the National Patient Safety Agency, said having formally told management about an issue could be used as a defence by a professional and as an argument to prosecute a manager.

"When you are under so much pressure you are absolutely going to make mistakes. If the system of work forces people so they can't cope and therefore miss errors it shouldn't be the people who make the error who are held responsible, if they have already told their manager.

"They have to tell them formally in writing. If the manager takes no responsibility then it should be [the manager] that ends up in court."

Unsafe environment

Professor Toft said some investigations of major clinical errors in the past had blamed clinicians where the problem was really the fault of their environment.

But Managers in Partnership chief executive Jon Restell said: "Any employee who raises safety concerns is discharging their responsibility. Managers are already responsible. Professionals still have a responsibility for their actions as well. I don't think managers are under any greater obligation [than before]."

An article by Professor Toft and Cardiff academic Peter Gooderham in the academic journal Quality and Safety in Health Care argues that if a manager ignores a warning from a professional, they are "consciously taking a risk which places the healthcare professional's patients in harm's way".

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http://www.hsj.co.uk/news/2009/02/nhs_managers_risk_court_over_clinical_errors

Health Direct points out that labour has abdicated it's "authority" and accordingly is throttling the NHS with red tape.

On Wed, Feb 18, 2009- we posted: NHS managers voice worries over 'Stalinist' SHA tactics

The zero tolerance culture for failure has made some chief executives fear for their jobs as a "Stalinist" culture is draining the NHS of experienced chief executives and making trusts insular and risk averse, Health Direct has learnt from senior leaders.

If someone asked me for views as to whether they should apply for a chief executive's post, I'd say I wouldn't touch it with a barge pole".

Many also feel the shake-up will discourage people from applying for top jobs at a time when vacant posts often attract just one candidate.

Labour has now created a classic- Not My Fault, Guv environment where no one is in charge. Not the politicians, not the doctors or clinicians and not the paperpushing managers.

Rheumatoid arthritis patients beneift from NICE U turn postcode lottery

Faster treatment has been promised for the 20,000 new sufferers of rheumatoid arthritis every year as part of the first nationwide guidance for treating the incurable condition.

The new advice, to be issued by the National Institute for Health and Clinical Excellence (Nice), follows a damning report that found a postcode lottery with wide variations in the way cases of the painful condition were handled.

It also calls for specialist physiotherapy to improve fitness for the 400,000 existing UK sufferers.

Experts said early treatment was key to reducing the effects of the debilitating auto-immune disease in which a person's joints, particularly hands and feet, are attacked by their body's own defences. It affects relatively young people and cannot be cured.

A report last year by think tank The King's Fund found thousands of sufferers were being let down by "unacceptably wide variations" in care by GPs and hospitals, with some patients waiting years for a diagnosis because of a lack of understanding among GPs.

The guidelines will apply throughout England and Wales.

It calls for anyone with suspected symptoms to be referred to a specialist. The referral should be urgent if the small joints of the hands or feet are affected or it has been three months or longer since the onset of symptoms.

Newly-diagnosed patients, which number some 20,000 a year, should be offered a combination of disease modifying antirheumatic drugs as soon as possible, it says.

The 400,000 existing sufferers should have access to physiotherapy to improve their general fitness and learn exercises for enhancing joint flexibility and muscle strength. The guidance also says they should also have access to assessments of the effects the disease – such as pain, fatigue, and inability to work.

Consultant rheumatologist Dr Chris Deighton, who was clinical adviser to the guideline development group, said: "Early diagnosis and referral to a specialist are key recommendations in this guideline – this will help us catch the disease at earlier stage where it may be possible to reduce future damage to the joints with disease-modifying drugs."

The guidance was welcomed by patients' groups. National Rheumatoid Arthritis Society chief executive Ailsa Bosworth said that, if widely implemented, it would help patients get the care they need.

"This guideline will help patients understand what constitutes best practice in managing RA, and realise that putting up with unbearable pain doesn't have to be an option," she said.

Arthritis Care chief executive Neil Betteridge said that Nice's "whole-person" approach to treatment represented a "giant leap" for sufferers but must now be backed with adequate resources.

"This guideline ticks a lot of boxes and includes much that Arthritis Care has long campaigned for. However, it must be backed up by the range of services needed in GPs' surgeries, hospitals, and the wider community," he said.

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