BMA cost warning on plan to scrap GP boundaries

The British Medical Association has fired a broadside at government plans to give patients a completely free choice of family doctor, warning that the proposals could cost "hundreds of millions of pounds a year".

Laurence Buckman, chairman of the BMA's family doctors committee, said that, at a time when the NHS was about to face the fiercest spending squeeze in its 60-year history, it was not clear that Andy Burnham, health secretary, should be giving the plans priority for extra spending.

Mr Burnham has declared that by September he wants to abolish existing GP practice boundaries , which can leave patients with a limited choice of doctors in fixed catchment areas. The policy would allow commuters to register with a practice near their work, and could drive up standards by increasing local competition between GPs.

However, the BMA has warned that, while the goal is "laudable", it is also expensive .

Both GP and hospital services are funded on the basis of resident populations in such a way that, in broad terms, the young and healthy subsidise the old and sick. If significant numbers registered away from home, the funding of both services would be disrupted. 

And if "dual registration" was allowed with a GP both at work and at home, costs could soar, Dr Buckman warned - even if the second GP was not given full funding.

"You could be talking hundreds of millions of pounds a year," he said, with further complications over home visits, continuity of care, child protection and who was ultimately responsible for a patient's care.

Mr Burnham's proposal was the fourth or fifth attempt to abolish practice boundaries since the mid-1990s, Dr Buckman said.

"When we last looked at this with the Treasury, pointed out the costs, and asked them if they were sure this was a good use of taxpayers' money, their answer was No," he said.

Some of the goals could, however, be achieved at much lower cost. Practice boundaries could be extended in urban areas so that a patient who moved not too far away could keep a GP. Greater use could be made of telephone and webcam consultations, as well as reforming the "temporary resident" arrangements so that a GP who saw a patient near work would be paid a fee.

The cost might then be "tens rather than hundreds of millions", depending on how many patients took advantage of that, Dr Buckman said.

From:

http://www.ft.com/cms/s/0/13ac30f8-0c75-11df-a941-00144feabdc0.html?nclick_check=1

Doctor Daniel Ubani unlawfully killed overdose patient

A coroner has demanded a review of EU agreements over the recognition of doctors when he ruled that the death of a 70-year-old patient who was administered a tenfold overdose by an "incompetent" German GP was unlawful killing.

William Morris called the death of David Gray "gross negligence and manslaughter" and issued 11 recommendations to the Department of Health for the improvement of out-of-hours GP services.

As well as the review of how EU agreements work in the UK, he said the government must issue guidance to all NHS trusts over checking doctors' English, their experience of the NHS and how they had acquired GP status.

Daniel Ubani, a Nigerian-born German citizen, was on his first UK shift as a locum when he killed Gray, whom he injected with 100mg of diamorphine – 10 times the recommended maximum dose.

Gray had been suffering from renal colic when he was treated by Ubani at his home in Manea, Cambridgeshire, on 16 February 2008.

After Gray's death, a national database of all doctors working as out-of-hours GPs will be set up in an attempt to avoid doctors such as Ubani working in Britain.

The database was recommended by Gray's family today, and Mike O'Brien, the health services minister, agreed to implement their suggestion.

He said better sharing of information by primary care trusts (PCTs) would help ensure that only competent and properly-qualified doctors were able to treat patients.

The recommendations are designed to ensure that doctors who have been refused permission to work on call at evenings and weekends in one part of England cannot then start treating patients in another.

They are intended to close the loophole that allowed Ubani to be refused permission to work initially in Leeds but then be approved to supply out-of-hours cover in Cornwall, where entry standards were less stringent, and because of that be employed in Cambridgeshire.

At the end of the inquest into Gray's death, Morris demanded "robust" clinical and management measures, including training and induction for non-UK doctors.

He said only the company actually running an out-of-hours GP service should recruit doctors in future – a blow to private recruitment companies.

Evidence to the inquest, held in Wisbech, Cambridgeshire, suggested Ubani had also inappropriately treated at least two, and possibly three, other patients.

Morris said: "It is clear to me that Dr Ubani, in his dealings with patients that fateful weekend, was incompetent, not of an acceptable standard."

He ruled that 86-year-old Iris Edwards, who also died on Ubani's first shift, had died of natural causes.

Graeme Kelvin, the chairman of Take Care Now (TCN), the private contractor that operated the out-of-hours service that treated Gray, offered his sympathies to the family over the "tragic event".

He said he hoped the recommendations of the coroner would "reduce the chances of a similar event happening anywhere in England".

Paul Zollinger-Read, the chief executive of NHS Cambridgeshire, accepted a systems failure had taken place, and said: "We as an organisation have much to learn from this case."

One of Gray's sons, Stuart, said: "I could not have hoped for anything better [than the verdict]. I hope Andy Burnham, the health secretary, acts on this."

Rory, another of his sons, said: "This vindicates all the hard work we have put in."

Ubani did not want to comment on the verdict, a spokesman at his medical practice in Witten, Germany, said.

During the weekend of Gray's death, Ubani saw 13 patients before being called off his second shift when Gray's death was reported to his managers.

Police and doctors investigating what happened found the 66-year-old had given inappropriate treatment to two other patients, one of whom subsequently died.

Both should have been sent to hospital, but their cases did not form part of a criminal case later built against him.

The case has become a touchstone for public confidence – or otherwise – in out-of-hours GP services, which were revamped more than five years ago.

A new GP contract introduced then shifted responsibility for out-of-hours services from local doctors and put it in the hands of NHS bodies and private firms employing a mix of local GPs, locums from agencies, and sometimes doctors from abroad.

Despite the problems identified in recent months, ministers have insisted services are improving overall.

Ubani was paid £45 an hour for his first work as a locum in the UK, far less than the sums expected by British GPs. He also paid for his own flights, car hire and accommodation.

The story of Gray's death and the subsequent apology from Ubani to his family was first revealed by the Guardian in May.

It quickly raised concerns about EU rules on the registration of doctors from Europe, checks on competence by local primary care trusts, the way in which drug safety warnings are given within the NHS, and how European arrest warrants work.

Police and prosecutors from the UK looking to bring a possible manslaughter charge against Ubani were shocked last April when, by letter, the German authorities convicted Ubani of causing Gray's death by negligence, gave him a nine-month suspended prison sentence and ordered him to pay €5,000 (£4,400)

Ubani, a German national, is suspended from working in Britain but is still allowed to practise in Witten, his home town, where he specialises in cosmetic surgery and anti-ageing medicine.

In August, inquiries by the Guardian prompted the General Medical Council and the Royal College of GPs to demand a rewriting of EU rules that allow doctors from Europe to be registered in the UK without tests on their English or medical competence.

Doctors from the rest of the world already face such checks.

The following month, it emerged that Ubani had failed in his first attempt to work in the UK but was later approved to join a performers' list run by the NHS because a local health trust did not apply such stringent checks as the government demanded.

Soon afterwards, an interim report on the case by the NHS watchdog, the Care Quality Commission (CQC), prompted the Department of Health to order all 152 NHS organisations responsible for running out-of-hours services to do their own safety checks on induction and training of foreign doctors, call handling and prioritising of cases, clinical decisions made by GPs and other staff, and the management of powerful drugs.

In December, the scale of the communications breakdown between police and prosecutors in the UK and Germany over the handling of the criminal case against Ubani was laid bare.

From:
http://www.guardian.co.uk/society/2010/feb/04/doctor-daniel-ubani-unlawfully-killed-patient

Hospitals must cut services to stay afloat, watchdog quango warns

Hospitals will have to reduce services, sell off buildings and move into smaller premises to cope with financial pressures in the next few years, the head of the foundation trusts’ regulatory body has warned.

Accident and emergency departments treating only a few serious cases may be downgraded to minor injury units

William Moyes, who steps down from his role as executive chairman of Monitor after six years told The Times that too many hospitals were not grasping the economic challenges ahead.

While political parties have promised to protect NHS funding and avoid service cuts, Mr Moyes said it was inevitable that some hospitals would have to reduce services and sell off assets to keep afloat.

Any hospital department that was treating too few patients to cover its costs risked compromising the quality of care, he said. Some maternity and paediatric units, which are very costly to run, might be merged or relocated, while A&E departments could be downgraded to minor injury units if they had a small number of serious cases that could be sent elsewhere.

“People need to know where they are making money or losing money. If you find a service where the income can’t cover the cost, you may eventually have to question whether the income is ever going to be sufficient, and whether this is in fact the wrong activity for the hospital.

“In quite a lot of places the number of births is too small to support the cost of giving a high-quality service. You have three choices: increase the flow of patients, move the service elsewhere or stay as you are and risk compromising the care.”

Mr Moyes, who oversees the regulation of finances and governance of England’s 125 flagship foundation trusts, said that as well as focusing on core departments, trusts would need to consider stripping out “uneconomic” facilities such as pathology laboratories and scanning units in some hospitals that were being used for very small numbers of patients.

“There may be surplus assets — buildings, land, equipment, stuff they think they might need in years to come under their development plans — and in some cases working in a much smaller physical space and disposing of all the hospital penumbra that can be brought into the main building.”

Mr Moyes said he had requested that foundation trust chief executives resubmit a “downside assessment” — stripping back their budgets — to get a more realistic grasp of the funding pressures they faced. He said that he was disappointed when, on being asked to revise their financial predictions in September, a number of trusts had resubmitted even more rosetinted forecasts of growth.

“You can’t assume everything will go well and if a problem arises the Department of Health will bail you out,” he said.

His warnings were echoed yesterday by Sir David Nicholson, the chief executive of the NHS, who described the coming years as “extremely challenging”. Giving evidence to the Commons Health Select Committee, Sir David warned of pay cuts and service reorganisation. “It is going to be very tough,” he said, adding that tighter budgets would mean the 1 per cent pay cap demanded by the Treasury would be treated by NHS managers as a maximum rise, not an entitlement. His comments came a day after inflation hit 2.9 per cent when unions are already angry over a pay freeze on council workers.

“There is essentially a trade-off between pay and numbers of jobs,” he told the committee. “In a cash-limited system, that is the big unknown for us. We need to talk through with the trade unions and staff associations about what that trade-off is.”

Sir David has previously warned that the NHS would have to find productivity and efficiency savings of between £15 billion and £20 billion over the three years 2011-12 to 2013-14.

The head of the Audit Commission added to the debate, saying that political pledges to safeguard spending on health and education were “insane”.

Steve Bundred told the Commons public administration committee that billions would have to be saved. “It seems to me absurd to imagine that the only services where no efficiencies can be found are those that have been the most generously funded for ten years,” he said.

Mr Moyes said he thought that an “unintended benefit” of future economic turbulence would be to heighten hospitals’ understanding that they had to operate with a robust business model.

“A lot of hospitals, even the very good ones, are at the stage of learning how to think long-term,” he said. “We are good at strong visions, big pictures, but we need to learn to be very good at pessimism and what will happen if things are not going to turn out well.”

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6997644.ece

Tories to make GPs after hours care a priority

The Conservatives have pledged to make GPs responsible for round-the-clock care after the scandal of foreign locum doctors putting patients’ lives at risk.

Andrew Lansley, the shadow health secretary, says he wants doctors to provide cover at night and weekends, or pay other GPs to provide reliable care. Performance targets which helped to boost the salaries of some GPs to more than £250,000 would also be renegotiated under a Tory government.

Under existing contracts agreed six years ago, GPs can opt out of providing after-hours services, shifting the responsibility to local primary care trusts (PCTs). One in three trusts struggles to find local GPs and flies in foreign doctors who are paid as much as £800 a shift to work unpopular hours.

Lansley confirmed a shake-up of contracts as an inquest last week examined the death of David Gray, a 70-year-old retired engineer from Cambridgeshire. He was killed by a massive overdose of diamorphine in February 2008 administered by Daniel Ubani, a Nigerian-born doctor who had flown in from Germany. Ubani had slept for only three hours before starting his shift.

“When Labour took responsibility for out-of-hours care away from GPs they made a serious error,” said Lansley.

“GPs should be collectively responsible for commissioning out-of-hours services. They are best placed to ensure patients are treated properly and that these awful events are never repeated again.”

Lansley could face a tough battle with GPs. One British Medical Association (BMA) representative said there was “not a cat in hell’s chance” of returning to the old system of the GP being ultimately responsible for out-of-hours care. He warned of mass resignations if contracts are to be torn up in this way.

For many years GPs considered themselves overworked and underpaid compared with hospital doctors. But in 2004 they successfully renegotiated their contracts with the National Health Service.

In what was seen as a coup for the profession, pay packets rose by 30% in the first year of the contracts, with the typical GP earning £106,000. Ministers later admitted they had blundered by seriously underestimating how many GPs would hit the pay-related targets included in the new contracts.

At the same time, GPs could opt out of providing round-the-clock care for patients if they gave up £6,000 a year in their salaries. Nine out of 10 GPs opted out. Out-of-hours cover is now provided by co-operatives run by GPs, private companies and PCTs.

“No one in their right mind would have designed the out-of-hours system in its current form,” said Peter Walsh, chief executive of Action Against Medical Accidents, which has campaigned for reform of the system. “There are a myriad different providers. The most common complaints are failures in making a proper diagnosis.”

Flaws in the system were highlighted by the case of Penny Campbell, 41, a journalist from north London who died in March 2005 despite six telephone calls and two face-to-face meetings with doctors working for an out-of-hours GP service. All failed to diagnose septicaemia.

Shortly before he became prime minister, Gordon Brown pledged to improve out-of-hours services. They started deteriorating in some areas in which trusts turned to foreign locums. One investigation found a third of PCTs were flying in GPs from Poland, Hungary, Italy and Switzerland.

In the early hours of February 16, 2008, Ubani, 66, flew into Britain for a shift starting at 8am with Take Care Now, an out-of-hours service. By his own admission he was exhausted. Gray died after Ubani gave him 10 times the correct dose of a painkiller for kidney stones. Later the same day Ubani failed to send another patient, Iris Edwards, 86, to hospital and she died of a heart attack shortly afterwards.

Take Care Now has promoted itself to health authorities as a cheap out-of-hours service but GPs claims its low prices have come at the expense of quality.

Spot checks by NHS Cambridgeshire, a primary care trust, found “deficiencies” in the cover as recently as last November. The trust subsequently ended its contract with the company.

Gray’s son Stuart, a GP in Kidderminster, Worcestershire, said: “My father was betrayed by the system. All patients are being let down by the NHS because of the lack of vetting procedures and rules in place for EU doctors. It is a national scandal.”

The Tories believe that handing back responsibility for out-of-hours care to GPs will ensure a better service.
 

FAILURES

* April 2004 New contracts introduced for GPs, allowing doctors to drop out-of-hours cover.
* March 2005 Penny Campbell, a 41-year-old mother, dies of blood poisoning after consulting out-of-hours GP service eight times. Official inquiry finds “major system failure”.
* May 2006 National Audit Office finds only one in 10 trusts clinically assesses patient within 20 minutes of phone call.
* February 2008 David Gray, 70, is killed by an overdose accidentally given by Daniel Ubani, a locum out-of-hours doctor who flew in from Germany.
* June 2009 Care Quality Commission report on Gray’s death calls for fresh scrutiny of use of “non-local” doctors and improved training.

From:

http://www.timesonline.co.uk/tol/news/politics/article6991090.ece

Replacement for Professor David Nutt said cannabis should be legalised

A former Oxford academic chosen to replace sacked Professor David Nutt as the head of the government's drugs advisory panel once called for the legalisation of cannabis.

Professor Les Iverson, a retired pharmacologist, has in the past mirrored Professor Nutts comments that cannabis is less harmful than alcohol and tobacco and even called for the drug to be made legal.

He said: "Cannabis should be legalised not just decriminalised because it is comparatively less dangerous than legal drugs alcohol and tobacco."

Professor Iverson played down any potential clashes with Alan Johnson, the Home Secretary, by suggesting the debate had moved on - and that he had changed his mind since his speech at a dinner in 2003 hosted by the Beckley Foundation, a charity in favour of regulating rather than banning drug use.

He said: "I don't remember saying that, it's certainly not my position now. That was a view I had in 2003 and a great deal has happened since then.

"We have now to confront the more potent forms of cannabis. We have the new evidence that arose since 2003 linking cannabis to psychiatric illness.

Prof Iverson, who has sat on the committee for five years, said much more active attention was currently being paid to so-called legal highs such as mephedrone.

"I'm not the drug adviser to the government, I'm a spokesman for a large group of people on the advisory council, only a few of whom are scientists."

In October, Mr Johnson sacked Prof Nutt for "crossing a line" into politics. Prof Nutt, who is setting up a rival think-tank, said he was simply reiterating scientific fact. Five other members on the panel subsequently resigned in protest and have yet to be replaced.

Professor Colin Blakemore, the neuroscientist, said Prof Iverson, a friend and former colleague, was conservative by nature but nevertheless shared the same views as his predecessor.

"I see no reason that Les Iverson's view on ecstasy deviates from the conclusions of the ACMD in that it should be classified as B rather than A.

"Similarly on cannabis that should have remained at C rather than being downgraded."

In the weeks that followed Prof Nutt's sacking, the home secretary tried to smooth over the row by making a number of concessions to his drugs advisers.

Mr Johnson agreed to write to panel members to explain any decisions that went against their advice. He also said he would not prejudge decisions on drug classification ahead of the committee issuing advice.

From:

http://www.telegraph.co.uk/Replacement-for-Professor-David-Nutt-said-cannabis-should-be-legalised.html

How labour government squanders £300 billions with PFI schemes

On the face of it, PFI schemes does not sound like a good deal- decide what you want, find someone to supply it, then sign a contract that binds you into a legal straitjacket for decades, during which you pay them 37 times what the item is worth.

Such a deal makes even less financial sense in a country still struggling to escape the effects of the worst slump since the Great Depression. Yet this is what the labour Government's promotion of private finance initiatives (PFIs) to pay for public services has foisted on the taxpayer.

The taxpayer is, in effect, locked into making enormous annual payments for 667 school, hospital and other public-sector programmes with a capital value, or price, of around £55bn. The good news is that more than £37bn has been paid. 

But the overall bill for the contracts is more than £262bn, and this will not be fully paid off until 2047.

And that is not all. With a fresh catalogue of further projects valued at £11bn – in capital costs alone – currently under negotiation, Britain's liability for PFI projects since 1997 could exceed £300bn.

The PFI – the brainchild of the former Conservative chancellor Norman Lamont – was seized upon by Tony Blair in 1997, when he swept into power with a New Labour government determined to show that it could be the party of business. The Government committed itself to keeping the proportion of public debt to gross national product (GNP) below 40 per cent. Financing investment through PFI – with costs kept off the balance sheet – was seen as a way of achieving this, and led Alan Milburn, then health minister, to declare that PFI was "the only game in town".

PFI works on the principle of private firms building various forms of infrastructure – whether roads or bridges, schools, hospitals or prisons – then charging the public sector for using them over lengthy contracts that can run for more than 30 years.

But it has left a legacy of debt that will last a generation, according to unions who have slammed what they say is a credit-card approach to buying-in essential services. Calling for an end to the use of PFI to pay for public sector projects, Brian Strutton, the GMB's national secretary for public services, said: "PFI is building up a legacy of high-interest debt that will last for decades. The public is paying over the odds on PFI projects, with debt ratios in most areas at over 500 per cent. This is like paying for schools and hospitals by credit card."

Jean Shaoul, professor of public accountability at Manchester Business School, said: "They've mortgaged the future in the most profligate way... we have a government that acts in the interests of a financial oligarchy. Using the private sector as an intermediary to raise finance to build hospitals and to run them is extremely expensive and far more expensive than if the Government were to do it itself."

A case in point is the Norfolk and Norwich University Hospital, where the PFI consortium made tens of millions on a deal described by the Commons' Public Accounts Committee as "the unacceptable face of capitalism".

Firms have also made millions in profit by putting up the money for IT programmes that have become so expensive the Government now frowns on PFI being used to fund them. To take only one case: payments for the Crown Prosecution Service's Compass IT system come to £670m over the 10 years of the contract, 37 times the £18m capital value.

And the nature of PFI deals means that payments still have to be made even if the project is abandoned. Balmoral High School in Belfast closed six years after it was built, when pupil numbers halved. However, the Northern Ireland Department of Education owes the contractor £370,000 a year for the next 18 years.

Making changes to PFI-funded buildings and projects can cause costs to spiral. A 2008 National Audit Office report found that £180m a year is paid out for contractual amendments. And it highlighted extortionate charges for routine maintenance – such as £302 for an electric socket to be fitted, £47 for a key, and almost £500 to fit a lock.

Peter Dixon, chief executive of University College London Hospital – which pays some £43m in PFI charges a year – says that inflation is a real fear. "If we run into a bout of inflation, because all these payments are index-linked, then we are in trouble, all of us."

He described the arrangement as "expensive and inflexible", but added: "For the past 12 years the only way you were going to get a brand new hospital was by the PFI route... people knew they weren't cost effective but it was the only way they could get funding."

But a Treasury spokesman said: "PFI has a good record of delivering to time and budget, and represents good value for money over the whole life costing by telling us what it will cost to build and manage our assets."

Contracting out: Familiar faces with PFI connections

Alan Milburn MP
He famously described PFIs as the "only game in town" during a stint as health minister, and is now a director of Diaverum Healthcare – a company that is contracted to run the kidney dialysis unit at the PFI-funded Burnley General Hospital.

Quentin Davies MP
The Defence minister is a former director (he resigned in 2008) of Vinci UK and Vinci SA – firms involved in PFI projects with a total capital value of £223m which will cost £933m over the terms of their contracts.

John Reid MP
The former home secretary is (since November 2009) a paid consultant to G4S UK and Ireland. G4S is involved in PFIs, mainly in prisons, with a total capital value of £330m; they will end up costing £3.6bn.

Steven Norris
Once Conservative Transport minister under John Major, he is now the chairman of Jarvis, a major PFI player which has a number of contracts, worth £721m, with government. The total capital value of PFI programmes funded by Jarvis comes to £175m.

Adam Ingram MP
A defence minister for six years under Tony Blair, he now gets paid more than £50,000 a year as a consultant to Electronic Data Systems – an MoD contractor responsible for the PFI-funded Tafmis IT system which cost £171m over its 10-year contract.

Patricia Hewitt MP
During her tenure as health secretary, BT won IT contracts from the NHS. The former minister is now a director of BT Group and was paid £59,475 for 140 hours' work over the past six months – a rate of £424 an hour.

PFI initiatives - the Lords' inquiry

The continuing flaws in the PFI option have been exposed in evidence to a House of Lords inquiry into the system.

A consultant, T Martin Blaiklock, said the Government had used the PFI option "like a credit card". He added: "It allows payments, which would normally be due to be paid today, to be paid at some future date. The key is to know when to use it, for what, and for how much."

The British Medical Association said: "PFI appears to be an unnecessarily costly and short-sighted means of building new hospitals."

But the Confederation of British Industry claimed that PFIs had helped to deliver a broad range of modern projects with "high-quality services and maintenance activities".

It added: "Without this long-term investment, the UK would not have the infrastructure required to support our economy, nor the public services that are needed."

The soaring cost to taxpayers

Queen Mary's Hospital, Roehampton Cost £73.5m to build, but will cost taxpayers in excess of £340m by 2034.

John Radcliffe hospital, Oxford Taxpayers will have to pay back £832m for key developments at a hospital which cost £134m to build.

Queen Elizabeth Hospital, Greenwich Trust is locked into a PFI deal costing £9m a year more than if it had borrowed money from the Government. Last year it admitted its PFI contract is "underfunded" by £8m to £10m a year, and it was also carrying debts of £65m.

Norfolk and Norwich University Hospital The 953-bed hospital will cost not £229m, as announced in 1998, but £16bn, including PFI charges, staff and equipment. Rent costs are £800m until the end of the contract in 2037.

Paddington Health Scheme £900m super-hospital abandoned in 2007; costs rose £300m to £894m and finish date slipped to 2013.

Leicester hospitals Pathway Project Costs up from £711m to £921m; scrapped in 2007.

University College London Hospital PFI project, rose from £120m to £430m or so in the three years prior to signing off on the deal.

From:

http://www.independent.co.uk/news/uk/politics/iiosi-special-investigation-how-government-squanders-billions-1877276.html

Obese patients encouraged to put on weight to qualify for surgery

Access to NHS weight loss operations is inconsistent, unethical and a postcode lottery, says Royal College of Surgeons

Obese patients are being "effectively encouraged" to pile on the pounds to qualify for weight-loss operations on the NHS, the Royal College of Surgeons warns.

The college claims lives are being put at risk as some health trusts require patients to reach higher body mass index (BMI) levels than others before they receive surgical treatments.

The postcode lottery means that access to NHS weight-loss surgery is "inconsistent, unethical and completely dependent on geographical location", according to the college.

Last year 4,300 operations to reduce body weight were carried out on the NHS, but as many as 1 million people could meet the National Institute for Curbing Expenditure (Nice) criteria for being classed as having severe obesity.

Bariatric, or weight-loss, surgery is carried out after diets, drugs and lifestyle-altering interventions are seen to have failed. It is not generally recommended for children or young people.

"Constraints on NHS funding mean that in some areas NHS decision-makers are opting to ignore professional guidelines and are denying patients' access to surgery," the college maintains. "In others, patients who already meet the [Nice] criteria are forced to wait until either they become more obese or develop life-threatening illness like diabetes or stroke."

According to the Nice guidelines, bariatric surgery is recommended for adults with a BMI of more than 40, who have other significant diseases (for example, type 2 diabetes) that could be improved if they lost weight, and who have tried but failed to lose weight using non-surgical techniques.

The college, which is holding a conference on the issue today, says hospitals are assessing patients referred from primary care trusts under different eligibility criteria, resulting in some patients with a BMI of 60 or greater being refused surgery while others with a BMI of 40 or less are undergoing operations.

"Nice guidelines are meant to signal the end of postcode lotteries yet local commissioning groups are choosing not to deliver on obesity surgery," said the college's director of education, Prof Mike Larvin. "In many regions the threshold criteria are being raised to save money in the short term, meaning patients are being denied life-saving and cost-effective treatments, and are effectively encouraged to eat more in order to gain a more risky operation further down the line."

One bariatric surgeon, Peter ­Sedman, said: "There is absolutely no doubt that some patients more needy of surgical treatment than others are being denied it. I will treat the patient, my hospital will offer the service, but unless the patient moves house they will not be referred and if they are, the treatment is subsequently blocked."

David Haslam, chair of the National Obesity Forum, said: "Bariatric surgery is amongst the most clinically effective and cost effective specialities in any field of medicine, preventing premature death and transforming lives, whilst saving vast amounts of money for the NHS and the economy.

"Even the most cynical taxpayer should support bariatric surgery, alongside clinicians, in opposing the unethical and immoral barriers to surgery imposed by NHS purse-string holders."

The college is calling on the Department of Health to ensure all patients have equal access to treatment. It estimates that obesity problems cost the NHS £7.2bn a year.

Alberic Fiennes, president-elect of the British Obesity and Metabolic Surgery Society, said: "We recognise the difficulties faced in dealing with a 'new' disease of epidemic proportions, but to limit surgery to the most severely obese is unfair and short-sighted and against basic professional ethics. It is also contrary to strategies that are standard for diseases that overwhelm resources."

From:

http://www.guardian.co.uk/society/2010/jan/21/obesity-weight-loss-surgery

Fear over quality of care if NHS centralises further

There is a real risk that the next government will resort to central control of the NHS, reversing the gains of recent years and damaging patient care, warns the outgoing chairman of Monitor, the independent regulator of the self-governing NHS foundation trusts.

"As public expenditure tightens, the natural response of governments of any colour is to think that central control and central dictation is the only way to keep control of the money," William Moyes, who stands down at the end of the month, told the Financial Times.

The autonomy of foundation trusts, the growing separation of the commissioning of care from its provision, the use of diverse providers, with a degree of competition and choice, might be seen as "just too risky" so "everything becomes pulled into the centre". 

That would be "a huge mistake" when "the only way to run a healthcare system in a developed country in the 21st century" was to have a decentralised approach where "people are not looking up to the secretary of state to see if they have done the right thing, but are actually looking at the patient and asking themselves: 'Is this the right thing for the patient?'"

If clinicians and hospitals were simply reduced to carrying out instructions, "that will not produce good services for patients".

Reflecting on his six years as head of Monitor, Mr Moyes said progress with reform of the health service had moved much too slowly because "at the official level there is still not enthusiasm [for the programme] in the Department of Health.

"I think there are still a lot of people who really would rather go back to the 70s and [a time of] central control."

Given that Tony Blair, former prime minister, had bet his government's majority on forcing through the policy of free-standing foundation trusts, Mr Moyes said: "It never occurred to me it would take so long, and be so hard to persuade the government to implement its own policy, which is what I have spent six years doing with my colleagues."

All hospitals were meant to have had the chance to become foundation trusts by early 2008. But half have still not achieved that.

"Half the hospital system is still not capable of saying it is financially viable and well governed [the requirements to achieve foundation trust status]," Mr Moyes said.

That included big teaching hospitals in Oxford, Nottingham, Leicester, Leeds, St George's in London as well as large institutions in Plymouth, Southampton, Bristol and Liverpool.

If you lived in such a town or city, and the hospital was in effect saying, "'well, actually, we are not really very financially strong and our governance is pretty poor', how would you feel about that?" Mr Moyes said.

The fact that in many parts of the country the NHS remained a mix of foundation trusts and hospitals still answerable to Whitehall and the secretary of state meant that the full benefits of the reform programme were not being felt. Health authorities were continuing to worry about operational problems in hospitals, not about commissioning the best care for patients.

The time had come, he said, for the department to recognise the NHS was not a "a system" of people and buildings the secretary of state had to be involved in managing. Rather, it was a "mutual insurance system" which "defines standards, defines efficiency [and] looks after the interests of patients who pay the cost of the insurance. It challenges inefficiency. It challenges poor quality. It is aggressive and goes for the best. It shapes the whole service".

But the department had never accepted that, and "the culture, and the unsaid assumptions of a lot of people in healthcare is that this is an integrated system that is managed from the top, and therefore they can't see the logic of the reform agenda".

That "underlying culture of corporatism" remained the biggest single obstacle to the decentralised approach that was essential to deliver the best healthcare.

From:

http://www.ft.com/cms/s/0/74d368c8-ff1a-11de-a677-00144feab49a.html?nclick_check=1

Patients in England and Wales denied arthritis drug available in Scotland by NICE

Patients in England and Wales are being denied a powerful new arthritis drug on the NHS despite a decision by Scottish health authorities to provide it to sufferers for free by NICE- the drug rationing quango.

The Government’s drugs rationing body, the National Institute for Curbing Expenditure (Nice), has provisionally said that it does not intend to recommend the use of the drug, called Tocilizumab, or Roactemra.

Nice claims that the £9,000 a year drug, for rheumatoid arthritis, has not proved that it is cost effective.

But patients in Scotland are to receive the treatment after it was recommended by the body which regulates drugs on the Scottish NHS, the Scottish Medicines Consortium (SMC).

The move will reopen accusations of medical ‘apartheid’ within Britain.

It follows an outcry after patients in Scotland were given access to expensive cancer drugs denied on the NHS in England and Wales.

Roactemra has been described as a “life changing” drug because it can be taken after other medications have failed, a common problem in the treatment of rheumatoid arthritis.

Patients groups last night said that denying the medication to tens of thousands of patients with the crippling condition in one part of the country was “cruel”.

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS), said: “I have heard patients stories that would make you weep.

“People are virtually suicidal because they have nowhere else to go and yet they know that there are other drugs out there that they could have access to but cannot because of Nice.”

She added that it was “ludicrous” that the drug would be available in Scotland “and yet two miles on over the border you can’t get it.”

The drug - the first new arthritis treatment for a decade - is already used in most other European countries, including France and Germany.

It offers another option for patients for whom other treatments have failed or no longer work and is used in combination with a standard anti-inflammatory drug, called methotrexate.

Currently many rheumatoid arthritis patients receive methotrexate as a first-line treatment to ease their symptoms.

In later years they are offered another class of drugs, called anti-TNFs, together with methotrexate, but even combined the effects of the drugs can wear off.

In combination Roactemra has been found to improve the rates of remission of the illness sixfold in comparison with just methotrexate alone.

The SMC - set up in the aftermath of devolution to make decisions about drugs north of the border - has agreed that the drug can be used for patients suffering from moderate to severe forms of the disease for whom other medications no longer work.

Prof John Isaacs, from Newcastle University, said: “This is fantastic news for people in Scotland who suffer from this disabling, lifelong disease.

“However, it also highlights the disparities in accessing treatments between Scotland and the rest of the UK.

“Because Roactemra works in a completely different way to the existing drugs it is likely to be effective in some patients where the other drugs don’t work or have stopped working, providing an extremely important option for these individuals.”

Neil Betteridge, chief executive of Arthritis Care and vice president of the European League against Rheumatism (EULAR), said: "There are a number of treatments for RA currently available but they simply don't work for everyone.

"There are people who are most severely affected by this debilitating condition – living in intense pain, unable to work, often struggling even to walk – who have been failed by existing treatments, and it's for them that tocilizumab could provide real hope.”

He called on Nice to follow the lead of the SMC and approve the drug for use in England and Wales.

Up to 37,000 patients across Britain would be eligible for the drug. But local health care trusts do not have to pay for drugs which have not been approved by Nice.

In December Nice took the unusual step of challenging Roche, the drug’s manufacturers, to provide more evidence of that the drug was cost effective.

A final Nice appraisal of the drug is expected later this year.

Around 646,000 people in Britain are though to suffer form rheumatoid arthritis, in which their own immune systems start to attack their joints.

Herceptin, a £21,000-a-year drug for breast cancer, was initially turned down by Nice but available in Scotland, which has its own health budget.

A climb-down, ordered by Patricia Hewitt, the then health secretary, allowed the drug in England and Wales.

Patients in Scotland also had access to Tarceva, a lung cancer treatment, which costs about £1,700 a month, two years before the rest of the country.

Nice also provoked outcry by turning down Lucentis, a £20,000-a-year treatment available in Scotland for wet age-related macular degeneration, one of the most common causes of blindness, although it later also reversed that decision.

From:

http://www.telegraph.co.uk/health/healthnews/7020499/Patients-in-England-and-Wales-denied-arthritis-drug-available-in-Scotland.html

NHS- renowned experts but no world class hospitals

Britain lacks any world- class hospitals because the culture of the National Health Service is still too much one of central direction and control, according to William Moyes.

Having spent six years overseeing the creation and regulation of self-governing NHS foundation trusts - which in theory are Britain's best hospitals - the chairman of Monitor said that, while the UK had at least four or five real world- class universities, "I do not believe we have any world-class hospitals.

"They may have world experts here and there . . . but I just don't believe that any of our best hospitals could genuinely demonstrate that they are world class across the whole range of what they do."

Mr Moyes said he would probably come in for heavy criticism for saying that. But given how much is spent on the NHS "there's something wrong in a framework that doesn't produce that kind of quality".

In the US, he said, the universities of Oxford, Cambridge, the LSE and Imperial "would be recognised as on a par with anything in America". He was speaking on "a hunch and a feel" rather than hard data, but added: "I just don't think you would have that kind of reaction to British hospitals."

It was not money, he said, because hospitals were probably more generously funded than universities in the UK. It was that even self governing foundation trusts spent too much time worrying about what the government was doing and what the secretary of state for health wanted.

Mr Moyes said that when he was on the council of Surrey University, the council "acknowledged the existence of the government" and its policies. "But we felt very much that we were in charge of the university, and as long as we didn't do something manifestly stupid, we would be left to get on with running it. Whereas I don't think anyone in any hospital - foundation trust or not - feels they are that distant [from ministers]. They still feel the heavy hand of the secretary of state is coming in their direction."

That underlined the need to see through a reform of the NHS into a much more decentralised system - one "where you tell the hospitals what you want to buy, and you let them get on with it. Your political ambition is expressed as a commissioning ambition, rather than operational ambition" - the goal being a hospital system "as good as the university system in Britain".

From:

http://www.ft.com/cms/s/0/4a1dd216-ff1b-11de-a677-00144feab49a.html

Labour's computer blunders cost £26bn- and rising

Labour ministers blamed for 'stupendous incompetence' after taxpayers are left with huge bills for bungled IT projects.

A series of botched IT projects has left taxpayers with a bill of more than £26bn for computer systems that have suffered severe delays, run millions of pounds over budget or have been cancelled altogether.

An investigation by The Independent has found that the total cost of Labour's 10 most notorious IT failures is equivalent to more than half of the budget for Britain's schools last year. Parliament's spending watchdog has described the projects as "fundamentally flawed" and blamed ministers for "stupendous incompetence" in managing them.

Further evidence has emerged over the failings of Labour's most costly programme, the mammoth £12.7bn IT scheme to revolutionise the NHS. 

Following Health Direct's post last week- Labours' only success- wasting taxpayers money, the Independent has repeated that just 160 health organisations out of about 9,000 are using electronic patient records delivered under the scheme. 

The vast majority of those were GP practices. New figures have also revealed that millions of pounds have been paid out in legal fees. The taxpayer has footed a £39.2m bill for "legal and commercial support" for the National Programme for IT (NPfIT).

Alan Milburn, the former health secretary, said in 2001 that everyone would have access to their health records online by 2005, but it is understood that the Department for Health is still "years away" from fulfilling the pledge.

Government departments right across Whitehall have been guilty of overseeing embarrassing IT failures. A project that was meant to save the Department for Transport (DfT) about £57m eventually cost £81m, and workers at the Driver and Vehicle Licensing Agency (DVLA) were forced to brush up on their language skills when computer systems gave them messages in German.

Another ill-fated IT scheme, designed to allocate subsidies to farms, cost the Department for Environment, Food and Rural Affairs about £350m and left British farmers more than £1bn out of pocket. Last year the Public Accounts Committee (PAC) warned that the system was already "at risk of becoming obsolete". 

In 2004, the Department for Justice gave the go-ahead for the National Offender Management Information System (C-Nomis) to be rolled out to prisons and the probation service in an attempt to make sharing information about offenders easier. But in 2007, when the estimated cost doubled to more than £600m and senior officials questioned the validity of the project, it was abandoned – after £155m had been wasted.

The MoD's Defence Information Infrastructure project is currently running more than £180m over budget and 18 months late, and is now set to cost £7.1bn. Last year, Edward Leigh, chairman of the PAC, said: "No proper pilot for this highly complex programme was carried out, and entirely inadequate research led to a major miscalculation of the condition of the Department's buildings in which the new system would be installed."

Other botched IT projects include the identity cards scheme; the Libra system for modernising magistrates' courts; an attempt to move the Government's GCHQ computer systems into a new building which ended up costing more than £300m; the Benefit Processing Replacement Programme; and the Foreign and Commonwealth Office's Prism system.

IT experts blamed ministers for being too easily wooed by suppliers. Insiders said a lack of expertise within the Government about the technology industry meant they were willing to believe claims made by major IT firms before contracts were awarded.

Several projects are now under renewed threat of being cut back or abandoned altogether as Alistair Darling, the Chancellor, has targeted them as an area of government spending that can be reined in as he attempts to tackle Britain's record £175bn deficit.

Tony Collins, an expert on the Government's IT failures, said Labour had displayed an "irrational exuberance" for IT projects that has often led them to throw good money after bad at failing schemes. "There are too few people in the hierarchy of Labour who understand IT enough to understand that it is not a talisman – there is nothing magical about it."

David Cameron, the Tory leader, has signalled a move away from big IT projects, suggesting he will use technology to increase the transparency of government. "It is easy to make these noises out of office," said Mr Collins. "Once you've got civil servants giving you a host of reasons why you should not be more open, I fear the Tories will sink into the same depths of secrecy that Labour has found itself in."

Botched projects: The cost of failure
£12.7bn National Programme for IT (NHS)

It was meant to revolutionise the way the health service worked. But far from heralding a new age of efficiency, the National Programme for IT is now widely perceived as the greatest government IT white elephant of history. 

As well as the huge costs involved, suppliers have walked away, projects are running years behind schedule, while medical professionals have complained that they were never consulted on what they wanted the new system to achieve.

£7.1bn Defence Information Infrastructure (DII)
It seemed like a good idea at the time. In 2005, the Ministry of Defence decided to offer a contract to a consortium of suppliers to replace the hundreds of different computer systems being used by the military with a single system that would be used by the army, navy and air force, as well as the MoD itself. It was to be used by 300,000 people across 2,000 sites. 

However, it is running more than £180m over budget and 18 months late. A parliamentary inquiry also warned that forces' reliance on older systems put them at risk of a security breach.

£5bn National Identity Scheme
Originally budgeted at £3bn, the labour Government’s plan for new identity cards, containing biometric data and linked to a central database, soon came under heavy criticism from civil liberty campaigners. As the costs spiralled, so the Home Office began to water down the aims of the scheme to assuage the critics.

In July 2009, Alan Johnson announced that the cards would no longer be compulsory, while moves to force all airport workers to use the cards were also abandoned. However thousands are still being wasted trying to get students to sign up as an alcohol proof card.

£400m Libra system (for magistrates' courts)
An attempt to bring records used by magistrates courts into the digital age backfired when trying to introduce one universal IT system to all courts descended into a costly mess. Fujitsu originally bid £146m to deliver the Libra system in 1998. However, the project proved more complicated than anticipated, and costs have now been put at more than £400m.

£350m Single Payment Scheme system (SPS)
The Single Payment Scheme system was designed in 2003 to be a sophisticated way of giving farmers their subsidies, by mapping their land and working out their level of payment. But failures with the IT systems being used mean that farmers were left short-changed. 

In 2006, around £1.28bn of the £1.5bn subsidies destined for British farmers still had not been given out. 

The Rural Payments Agency overseeing the project was ordered to make 23 major changes to the system. Despite the £350m spent on the technology, the Public Accounts Committee warned last year that it was already “at risk of becoming obsolete”.

£300m GCHQ "box move" of technology
When the Government’s intelligence organisation, GCHQ, decided to move its complex computer systems into a new building in 1997, the projected £41m cost was so small that officials believed it could be absorbed within existing budgets. 

That was until the Curse of the Government IT Project struck. Costs of the so-called “box move” soon began to rise out of control. In 2003, the National Audit Office (NAO) put the costs at more than £300m. Edward Leigh, Tory chairman of the Commons Public Accounts Committee, called the original budget “staggeringly inaccurate”.

Now part of the "old office" housing super computers in Cheltenham has been retained in parallel to the new "doughnut".

£155m National Offender Management Information System (C-Nomis)
In an attempt to make sharing information about offenders easier, the Department for Justice gave the go-ahead for the National Offender Management Information System (C-Nomis) to be rolled out to prisons and the probation service. As the estimated cost doubled to more than £600m and senior officials questioned the whole point of the project, it was abandoned in 2007, with £155m already spent.

£106m Benefit Processing Replacement Programme
In June 2006, the Department for Work and Pensions confidently assured Parliament that new funding for its Benefit Processing Replacement Programme (BPRP) had been approved. So it came as a surprise to many when it emerged just three months later that the project had been quietly scrapped. Little information has emerged on why BPRP was abandoned, but the Government has admitted that £106m had already been spent on it before it pulled the plug.

£88.5m Prism IT project
Undeterred by past failures, the Foreign and Commonwealth Office (FCO) thought it would be a good idea in 2002 to order a new computer system for their 200 offices around the globe. The result was the Prism IT project, seemingly a bargain at just £54m. 

However, delays and costs have risen, while the contractor was even forced to temporarily halt the scheme in 2005 while an investigation took place into its various problems. The system has not proved a hit with staff. 

One wrote in 2004: “In all the FCO’s long history of ineptly implemented IT initiatives, Prism is the most badly designed, ill-considered one of the lot.”

£81m Shared Services Centre
To officials at the Department for Transport, the Shared Services Centre seemed to good to be true: not only would it integrate the human resources and financial services of the department and its various agencies, it would even save the taxpayer £57m. 

Unfortunately, those hopes were dashed as the scheme became another example of an IT project going horribly wrong. Workers at the Driver and Vehicle Licensing Agency (DVLA) were forced to brush up on their language skills as computer systems gave them messages in German. It will now cost £81m, a failure in management that the Public Accounts Committee described as a display of “stupendous incompetence”.

TOTAL: £26.3bn

From:

http://www.independent.co.uk/news/uk/politics/labours-computer-blunders-cost-16326bn-1871967.html

Swine flu- move to recover cost of vaccine

The government is attempting to claw back tens of millions of pounds from flu vaccine manufacturers as it seeks to scale down an immunisation plan to protect the country from a severe pandemic.

Officials have cancelled further orders from Baxter, and are finalising a deal to limit purchases from GlaxoSmithKline, in an effort to recoup part of a £500m deal with the two companies for sufficient vaccine to cover the entire population.

Ministers have decided to abandon the aim of a universal flu vaccination programme, although they are pursuing the drive to vaccinate children under five as well as pregnant women, people with underlying health problems and health and social care workers.

The mild nature of the swine flu virus, the need for only a single rather than a double dose of vaccine and public suspicion and indifference to vaccination have led to lower take-up than anticipated in the UK and other countries.

The government's decision - in the context of severe pressure on public spending - comes at a time of similar moves by other countries including France, Germany, the Netherlands and Spain.

Sir David Salisbury, director of immunisation at the Department of Health, said a break clause had now been activated in the contract agreed with Baxter of the US, while discussions were under way with GSK, from which most of the vaccine had been purchased.

Similar formal break clauses were not included in many countries' contracts with vaccine suppliers, because they were drawn up at a time when governments and manufacturers expected demand would substantially outstrip supply.

However, GSK, like other large suppliers, including Sanofi-Aventis of France, is coming under political pressure to accept a scaling back of previously agreed volumes of orders.

GSK stands to lose tens of millions of pounds alone from the UK renegotiations and smaller amounts from other large purchasers such as France.

The drugmaker had previously estimated total sales of its pandemic flu vaccine across more than 70 countries at £2bn over 2009 and 2010.

It may be able to recover some losses from sales to other countries including in Latin America. Sanofi-Aventis, the world's largest supplier of flu vaccine, stands to lose significant sales, with smaller losses from Novartis, while other suppliers such as Baxter, CSL and MedImmune - part of AstraZeneca - had lower initial sales and much lower exposure.

The UK and other countries are in talks about making donations of surplus vaccine stocks available to poorer countries and selling excess stocks to richer ones - although there are concerns about the issue of liability in such cases.

Sir David said the UK would keep some surplus stocks, both to prepare for any possible third wave of the pandemic and for a future different infection.

The vaccine contains an antigen to protect the body against the current H1N1 virus which would not be useful against future mutations.

But it has an adjuvant stored separately until just before vaccination, which enhances the body's immune response and could be stored over longer periods to help fight a future pandemic.

The latest figures from England show that fewer than 3.8m people have been vaccinated against pandemic flu since last autumn, although 12.5m doses of vaccine have been sent out for health services ready to be used.

From:
http://www.ft.com/cms/s/0/182021e8-fe52-11de-9340-00144feab49a.html?nclick_check=1

Tax inspectors target health professionals such as doctors and dentists

Middle class professionals such as doctors and dentists are facing an unprecedented crackdown on tax evasion.

Previously, the HMRC has focused on people in blue collar jobs, such as publicans and taxi drivers, when fighting tax evasion.

However, it emerged that they are now focusing their attentions on the accounts of white collar professionals earning more than £100,000. Tens of thousands of professionals are set to be targeted.

Experts were surprised at the nature of the middle class clampdown, with the Governments tax inspectors accused of unfairly targeting middle class professionals as “easy pickings”.

They suggested that chasing middle-class professionals for unpaid taxes had been forced on HMRC by the Treasury, which is desperate to raise funds to reduce the national debt.

HMRC said a “significant” minority of medical professionals were engaged in tax evasion.

Examples included not declaring fees for private work done for medical care providers, payments for private consultation work or cash sums for drafting medical reports.

Under a three-month 'amnesty', hospital consultants, GPs and dentists now have until March 31 to make a voluntary disclosure about any income they have not declared to HMRC.

In exchange, they will have to pay the outstanding tax on the undeclared income. They will also face a 'fine' of 10 per cent of the amount they owe - but, as long as they have admitted their undeclared income, the action will stop there.

However, anyone who refuses to reveal their unpaid earnings, and tax and is caught after the deadline has expired, faces criminal prosecution. They could also find themselves 'named and shamed' on HMRC’s website.

In certain circumstances, those found guilty of tax evasion can face a prison sentence of up seven years.

HMRC inspectors can issue formal notices asking people to hand over personal bank statements and business records if they have suspicions about them. They can also legally inspect business premises using their civil powers.

Potential tax evaders could also be tracked down by examining their previous tax returns, which might reveal that their latest tax situation was wrong.

Mike Wells, HMRC’s director of risk and intelligence, said that once the amnesty had expired at the end of March, HMRC would be “using the information at our disposal to investigate medical professionals who have not declared their full income”.

Phil Berwick, director of tax investigations at law firm McGrigors, said tens of thousands of people could be hit across several different professions. Targeting the medical profession alone was “without precedent”, he said.

“You are dealing with people in a position of trust and responsibility who do not want to be named and shamed. It is people who are going to be averse to naming and shaming and probably in a position to make a payment to the revenue," he said.

“Compliance activity is usually costly and time-consuming for HMRC. By offering an amnesty HMRC is hoping to get a significant amount of tax into the Treasury’s coffers very quickly and at a reduced cost to itself.

“The parlous state of the public finances and the pressing need to reduce the deficit has probably forced HMRC’s hand to an extent.”

The middle-class initiative follows a previous HMRC amnesty scheme to allow people with off-shore bank accounts to declare how much tax they owed and pay a small fine. Around 10,000 people made use of the scheme.

Stephen Camm, tax partner at accountancy firm Pricewaterhouse Coopers, said: “In the past they looked at publicans, fish and chip shop owners and tax drivers – typical working class jobs. Now they are looking at professionals. And the middle classes will bear the brunt.”

Richard Limburg, from accountancy firm Vantis Medical Group, added: “It is likely that HMRC sees the medical profession, especially consultants, as easy pickings and this could raise substantial amounts.”

A British Medical Association spokesman said: “The BMA recommends that doctors who may have any concerns consult their financial adviser to ensure their tax affairs are in order.”

A spokesman for the British Dental Association said: “Dental practitioners work in NHS, private and mixed economy settings. Many are therefore used to dealing with their own tax affairs.

From:

http://www.telegraph.co.uk/Middle-class-professionals-such-as-doctors-dentists-lawyers-in-tax-evasion-crackdown

Two catch Legionnaire’s disease at hospital attacked over hygiene

Two patients have contracted Legionnaire’s disease at a hospital recently condemned for poor hygiene, blood splattered equipment and an unusually high death rate among patients.

Both adults were at Basildon University Hospital in Essex when they began to show signs they were affected by the bacteria legionella.

A spokeswoman for the hospital said the patients, who were staying in different parts of the hospital, have responded to antibiotic treatment but one of them is still in a critical condition.

The bacteria is commonly found in sources of water such as rivers and lakes but can sometimes find their way into artificial water supply systems.

Alan Whittle, Chief Executive at the Basildon and Thurrock NHS Foundation Trust, said the hospital was the probable source of the infections, based on tests of water samples. No more suspected cases have been identified.

“Experts agree that the legionella bacteria is a common risk in large buildings with an extensive plumbing system,” Mr Whittle said.

“Based on the results of laboratory tests of water samples, we accept that the hospital is the probable source of the infection, despite our determined efforts to minimise the known risks of legionella.

In November, inspectors from the Care Quality Commission criticised Basildon and Thurrock University Hospitals NHS Foundation Trust after they found blood stains on floors and curtains, blood splattered on trays used to carry equipment and badly soiled mattresses in the A&E department, with stains soaked through.

Andy Burnham, the Health Secretary, told MPs last week that the more work needs to be done to improve standards at the trust.

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6980928.ece

Labour's plans for elderly care put essential services at risk

Frontline services such as social work, meals on wheels and road maintenance may have to be cut to cover the cost of controversial plans for elderly care at home, local authority leaders have warned. 

The £670 million required to provide free care for those most in need in their own homes — a key government policy— will add pressure to councils already trying to find multi million Pound savings.

A rise in council tax of between 1 and 2 per cent will be needed to meet the cost, while cuts in adult and childrens’ social care services are an “unwanted but very real possibility”, council chiefs have told The Times.

The warning came as Andy Burnham, the Health Secretary, was forced to defend his Personal Care at Home Bill in a two hour appearance before the Commons Health Select Committee. He was questioned repeatedly about concerns surrounding the Bill reported by The Times, including its impact on care and clinical research budgets.

Critics believe that the costs calculated by the labour Government are a significant underestimate and care experts have attacked the policy for disrupting elderly care strategies and being little more than an attempt at eye catching electioneering.

The draft Bill, set out in the Queen’s Speech in November, was described by Labour peers as an “exocet” on social-care reform and “a demolition job” on budgets, while MPs and care providers have also criticised it for being ill-conceived and uncosted.

In the latest blow to Mr Burnham’s plans, council chiefs have told The Times that the extra costs will force tax rises and service cuts. 

Backroom staff, from lawyers and human resources workers to environmental planners, would also be at threat, as well as infrastructure programmes such as road maintenance. Plans to introduce or upgrade local amenities such as sports facilities, bus services and meals on wheels would have to be reassessed.

The annual cost of the Bill is put at £670 million, which ministers say will support 400,000 people with the highest needs to stay in their own homes. Of this total, £420 million is to come from existing Department of Health budgets. Local authorities have been told that they must provide the remaining £250 million from efficiency savings. The first year of the scheme, running from October to April 2011, would require £125 million of local authority efficiency savings.

Mr Burnham said that he “fundamentally rejected” the suggestion that the cost calculations were flawed. “The characterisation of an exocet is 100 per cent wrong,” he said.

Pressed on how £60 million of clinical research savings would be made to NHS budgets to help to fund the plans, and which areas would be affected, Mr Burnham said that it had yet to be finally decided, but would not involve frontline services.

Ken Thornber, head of Hampshire County Council and a member of the social care board of the Local Government Association (LGA), said that for councils already making multimillion-pound savings in backroom staff, this could be met only with an increase in council tax.

His council, one of the largest, was already trying to save £15 million a year and a further £15 million in 2011 to absorb inflationary pressures. “As things stand we would have to find between £5 million and £10 million over and above the £30 million which we are presently projected to need to find in 2011-12,” he said.

Mr Thornber added that it could mean up to £20 a year on council tax bills for the 550,000 households in Hampshire.

The funding from the Department of Health would not alleviate pressures on services, he said, because it was covering people who previously would have been cared for by the NHS or in care homes.

Jenny Owen, president of the Association of Directors of Adult Social Services (Adass) and director of adult social care for Essex County Council, said the council estimated that it would need to find £4 million of savings. “If you do not increase council tax by 1 or 2 per cent it will be a reduction in services.”

Andrew Lansley, the Conservative health spokesman, said that the plans were being rushed through for electoral gain. “While in an ideal world we want to give free care to as many elderly people as possible, it is simply not affordable, particularly since we are in the throes of a debt crisis. The reality is that Gordon Brown will only be able to pay for this through cuts to the NHS and higher council taxes.”

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6979815.ece

Labours' only success- wasting taxpayers money

Health Direct is appalled at the expensive IT project that is the NPfIT white elephant- and the money that is being wasted in our names.

On Jan 5th 2010 in the House of Lords Lord Warner (Labour) asked how many (a) acute trusts, (b) mental health trusts, (c) general practitioners, and (d) community services, are using an electronic summary patient record under the NHS National Programme for IT.

Baroness Thornton (Baronesses in Waiting, HM Household; Labour) replied:
As at 16 December 2009, two acute trusts, one mental health trust, 152 general practitioner practices, and additionally three out of hours providers and two walk in centres were using electronic summary care records delivered under the national programme for information technology. No community trusts were doing so.

http://www.publications.parliament.uk/pa/ld200910/ldhansrd/text/100105w0012.htm#10010561002177

What a waste of taxpayers money- a grand total of 160 health organisations were using the £12 billion scheme.

http://www.theyworkforyou.com/wrans/?id=2010-01-05a.64.3&s=speaker%3A12896#g64.4
Hansard source (Citation: HC Deb, 5 January 2010, c64W)

According to Wikipedia, Dorothea Glenys Thornton, Baroness Thornton (born 16 October 1952), known as Glenys Thornton, is a Labour and Co-operative member of the House of Lords.

A graduate of the London School of Economics, Thornton was Political Secretary of the Royal Arsenal Co-operative Society from 1981, joining the public affairs team of the Co-operative Wholesale Society upon their merger in 1985 and working there until 1992. 

She was General Secretary of the Fabian Society from 1993 to 1996. In 1998 she was made a Life peer as Baroness Thornton, of Manningham in the County of West Yorkshire by Tony Bliar. She chaired the Social Enterprise Coalition until January 2008, when she was appointed a junior minister of the House of Lords.

She lives in Belsize Park, London, and is married to internet safety expert John Carr. They have two children, George and Ruby.

Baroness Thornton is no stranger to wasting taxpayers money:
She was reported to be claiming £22,000 a year in expenses by saying that her mother's bungalow in Yorkshire is her main home, amounting to around £130,000 since 2002.
http://en.wikipedia.org/wiki/Baroness_Thornton

Decision on new health regulator quango delayed

Monitor, the foundation trust regulator, is to be left for months without a permanent chairman or chief executive after the Department of Health announced that it was to re-advertise the post of chairman.

William Moyes, the executive chairman, is stepping down in January. Interviews with candidates were completed in mid-October, but Andy Burnham, the health secretary, has only now decided to reject the two candidates approved in the interviewing process.

These are understood to be Chris Mellor, the deputy, who is thought to have withdrawn in frustration at the process, and Keith Pearson, chairman of the East of England strategic health authority. Mr Mellor is to act as interim chairman.

The delay comes when the finances of NHS foundation trusts, which Monitor oversees, are coming under pressure from the squeeze on public spending.

At the same time, David Nicholson, the NHS chief executive, has said he wants to accelerate the much delayed process of converting ordinary NHS hospitals to the free standing businesses that foundation trusts represent.

Finding good candidates to chair Monitor and then appoint a chief executive may prove a challenge in the run up to the general election- not least because the Conservatives, if they win, plan to turn Monitor into a broader economic regulator. 

As a result, candidates will be uncertain about quite what job it is they are applying for.

From:

http://www.ft.com/cms/s/0/a33da618-f02b-11de-833d-00144feab49a.html?nclick_check=1

NHS paid doctor £375 an hour

NHS spending on agency workers has risen sharply in the past financial year in spite of attempts to control such expenditure, according to figures issued by the Conservatives.

Andrew Lansley, shadow health secretary, cited examples of NHS Trusts paying "hugely inflated" salaries to temporary workers for covering shifts.

A nurse in Yeovil was paid £146 an hour, another in Derby £136 an hour, and an IT manager in Whittington received £400 an hour.

The freedom of information disclosures also show that an agency doctor in King's Lynn was paid £375 an hour - equivalent to an annual salary of £660,000. Mr Lansley said that such payments divert funds from the front line and prove that Labour's attempts to control health agency expenditure are failing.

The NHS spent £1.25bn on temps in 2008-09, according to figures provided by the department of health to the Tories. This was a sharp increase on the £831m spent the previous year and the £785m in 2006-07.

But it is below the £1.4bn bill that agencies presented to the NHS in both 2002-03 and 2003-04, when agencies accounted for 5.5 per cent of the payroll.

Patricia Hewitt, former health secretary, described agency pay as "massively expensive" and called for hospitals to use permanent staff instead.

About 130,000 workers in the health service are not permanent staff.

While most trusts did not disclose fees paid to agencies, some of them received as much as 43 per cent of each payment, according to the Tories. The typical agency fee, among the 33 trusts that replied in detail, was 26 per cent.

Trusts and local authorities have been urged to pool resources to improve their purchasing power.

A report last year by Leeds university and the Economic and Social Research Council found that, although fees had dropped in recent years, temps were still generally more expensive than permanent staff.

The presence of temps, while "unavoidable", could also damage the morale of permanent staff because they were often given easier tasks.

But the National Audit Office said last year that agency workers could be used as a way for the NHS to control costs. Temps could be cheaper because they did not receive the same training and perks as permanent staff.

From:

http://www.ft.com/cms/s/0/ed1bd7c2-f4e1-11de-9cba-00144feab49a.html

Fall in clinical trials of drugs through NICE

Investment by drugs companies and access by patients to innovative medicines in the UK are coming under threat, as data show a decline in the number of clinical trials conducted in this country.

Bureaucracy, low recruitment rates and the slow uptake of new drugs are pushing pharmaceutical companies to undertake more research in other countries in Europe and North America, as well as increasingly in low cost developing nations.

In spite of efforts by the labour government to make trials cheaper, faster and easier to conduct, the UK's disproportionately strong historic role in the development of medicines is being undermined. 

Data show a declining role for the UK since the turn of the decade, with its share of global clinical trials falling from 6 per cent in 2002 to only 2 per cent in 2007.

The latest figures from the Department of Health show the number of mid-stage, late-stage and post-approval clinical trials fell from 728 in 2008 to 470 this year, its lowest level in the past decade. Early-stage trials fell to 210, the lowest in five years.

The data were corroborated by figures provided to the Financial Times by Quintiles, one of the world's leading clinical research organisations, which conducts trials for most significant drug companies. These show that the number of patients recruited into mid and late-stage clinical trials in the UK stagnated at 782 last year compared with 749 in 1999. 

By contrast, patient numbers during the same 10-year period almost doubled to 1,283 in France; trebled to 31,617 in the US and to 3,657 in Poland; and quadrupled to 2,117 in the Czech Republic.

Dennis Gillings, chief executive of Quintiles, which has continued to expand early-stage clinical trials in the UK, said: "We would be happy to invest more in the UK, but there's a feeling that the NHS has a negative attitude towards industry and a reluctance to pay for drugs."

The statistics come in spite of rising patient recruitment in some areas, including cancer trials, and a broader range of efforts in conjunction with industry to streamline approvals, reduce costs and encourage National Health Service doctors to participate in research.

The findings come as researchers lead calls for reforms to the EU's clinical trials directive. A consultation on revising the legislation closes in early January. But Kent Woods, head of the Medicines and Healthcare Products Regulatory Agency, the UK body that scrutinises new drugs, said only minor modifications were required to distinguish standards for high-risk and low-risk trials.

From:

http://www.ft.com/cms/s/0/acbd525c-f5ac-11de-90ab-00144feab49a.html?nclick_check=1

GPs to get new IT in drive to prevent 10,000 cancer deaths

GPs are to start predicting whether a patient has the early symptoms of cancer using a computer program that calculates risk, under plans to prevent the 10,000 unnecessary deaths a year caused by late diagnosis.

The new approach by the NHS means that doctors will tell patients their percentage chance of having cancer, based on factors like their age, weight and symptoms such as bleeding or sudden weight loss.

Professor Mike Richards, the government's cancer tsar, who unveiled the move in an interview with the Guardian, said that within five years every GP in England should be using the software as part of a new drive to reduce the huge toll of avoidable cancer deaths.

Computer-assisted cancer risk assessment will help GPs estimate whether a patient's symptoms could indicate the presence of a cancer and decide whether they needed to refer them for urgent tests in hospital, Richards said.

The computer would assess a patient's age, weight and symptoms – such as rectal bleeding and constant fatigue – and if the risk were above a certain level, the person would be referred to hospital for urgent exploratory tests within two weeks.

Cancer is the UK's biggest killer after heart disease and strokes. Every year 293,000 people are diagnosed with cancer, and about 155,000 die of it. GPs are vital because they spot the signs of cancer in 90% of patients, with screening picking up the other 10%. But a typical GP sees only eight or nine cases of cancer a year.

Britain is far worse than many European countries at diagnosing cancer early, when it is more likely to be treatable and the patient has a much better chance of surviving. That is partly because some patients who develop symptoms delay seeking help, but also because GPs sometimes fail to correctly identify signs of cancer.

Support technology is needed because of that poor record, the difficulty of diagnosing cancer and the sheer number of other ailments that GPs have to know about, Richards said.

There are more than 200 forms of cancer, and many of their symptoms are the same as for a range of other, often less serious, conditions. Computers could help doctors get it right more often when deciding whether to investigate a patient further, discharge them or refer them to hospital.

"This is helping GPs because none of us can retain this sort of information [about cancer symptoms] and having to retain it for bowel cancer, lung cancer and ovarian cancer, as well as for heart disease, it would take a remarkable human brain to be able to do that, so why not get computers to support it?" said Richards.

"The benefit of this will be that GPs will know who should be investigated and who shouldn't. It will also help patients to know that whether they are being reassured, or referred, or getting a test, that is the right thing to do."

Richards said the system would mean "better decision-making by GPs, leading also to earlier diagnosis of cancer patients".

Professor Steve Field, chairman of the Royal College of General Practitioners, welcomed the move. "The future of medicine will be that GPs will be using more and more computer-aided diagnostic tools for more and more conditions, and ultimately in years to come genetic information will be part of that," he said.

"GPs will welcome this because it will make their diagnoses quicker and better. Over time this will save lives."

Family doctors rather than computers will continue to make the key judgments, even after software has become routine in surgeries, Richards emphasised.

"The GP will always have the final say. If he wants to refer a patient to hospital, he will always have the right to do so," he said.

England is understood to be the first country in the world to move to introduce such technology, according to the Department of Health. A number of GP practices across the country will take part in a pilot programme to assess the effectiveness of assisted cancer risk assessment, starting in the spring.

GPs have recently begun using similar software to help them assess a patient's risk of developing cardiovascular disease. It analyses blood pressure, family history, cholesterol, smoking history and current symptoms before producing an odds ratio.

The plan to extend the approach to cancer is underpinned by a series of recent DH-funded research studies by Dr Willie Hamilton, an Exeter GP and expert in cancer diagnosis at Bristol University. Richards said the tests had shown, for example, that a man aged over 40 who develops diarrhoea has less than a 1% chance of that indicating bowel cancer, but two visits to the GP with the same symptom produce a 1.5% risk. This rises to 3.4% if there is a combination of diarrhoea and rectal bleeding and 6.8% if he visits his GP twice with rectal bleeding.

Sarah Woolnough, head of policy at Cancer Research UK, said: "We welcome any initiative that encourages the earlier diagnosis of cancer. Late diagnosis is the reason behind thousands of avoidable cancer deaths every year so it has to be a huge priority to make every effort to diagnose cancer earlier. We need to think imaginatively and innovatively about how we encourage earlier diagnosis, so initiatives like this are very promising for the future."

From:
http://www.guardian.co.uk/society/2009/dec/29/cancer-diagnosis-computer-programme

Health Direct questions the sanity of this new spin.

Firstly, labour has an appalling track record on IT projects- the failed NHS records £12 billion NPfIT project is a prime example.

Secondly, this scheme undermines GPs, doctors and health professionals in general. If this new technology really does work- there will be a logic to save money by sacking them all.

Is this yet another example of hope over adversity. Having utterly failed UK patients with some of the worst cancer rates in europe over the past 13 years- is this a dying labour spin clutching at a straw?

Labour delays free hospital car parking again.

Andy Burnham has outlined more proposals to phase out hospital parking charges for in-patients and some out-patients which he says have caused "great resentment".

Mr Burnham origonally announced plans to phase out charges for in patients in September.

The health secretary pledged a "fairer" system for relatives and friends of people admitted to hospital in England.

He is looking at whether to abolish fees for all in-patients' visitors - or just those admitted for a long stay.

For out-patients he will look at free parking, or a cap on charges, for those who need to make regular appointments.

Parking is already free at most hospitals in Scotland and Wales and for certain priority groups of patients in Northern Ireland. Although all PFI hospitals and clinic still charge for car parking.

Mr Burnham announced in September he wanted to phase out over three years charges at hospitals in England for patients who are admitted.

But the eight-week consultation - which runs until 23 February - will also look at charges for out-patients who have to make regular appointments - like cancer patients with regular chemotherapy sessions.

Mr Burnham told the BBC: "I think the time has come for a fairer, more consistent approach to parking across the NHS. Frankly I think it's confusing at present, there are a wide variety of parking schemes."

He added it had "caused great resentment" but the government had to ensure that the costs of running secure car parks were covered.

NHS trusts have argued that some parking charges are necessary to ensure health funds are not diverted towards managing and maintaining car parks.

Mr Burnham said: "We want to have the consultation so we get the balance right, that we don't ask the NHS to do something at a time when there is pressure on its finances that it can't afford. But I believe what we're proposing is affordable."

When Mr Burnham announced plans to phase out charges for in-patients in September, Macmillan Cancer Support raised concerns that it would not apply to people with cancer having treatment as out-patients.

The charity's head of campaigns, Mike Hobday, told the BBC: "MacMillan is really pleased that this consultation could mean free parking for cancer patients who have to go to hospital on average 53 times during the course of their treatment.

"What we need of course is for all political parties to commit to abolishing this unnecessary tax."

http://news.bbc.co.uk/1/hi/uk_politics/8433395.stm

UK health groups look abroad to fight MRSA superbugs

UK companies developing products that fight MRSA hospital superbugs are complaining that there are few opportunities in their domestic markets, and focusing their sales efforts overseas.

In the UK, hospital acquired infections (HAI) such as MRSA and clostridium difficile affect 300,000 patients each year and cause about 5,000 deaths- nearly double the number of people killed in road accidents.

The problem is worse in the US, where HAIs are estimated to be one of the top 10 causes of death, claiming close to 100,000 lives every year.

And the costs are mounting. In the US, government studies estimate that the extra cost of treating a patient with HAI averages almost $9,000 (£5,600).

UK companies are among the leaders in the fight against superbugs but they say that they are encountering problems in getting their products adopted by UK hospitals. They complain that hospital managers lack accountability for deaths relating to HAIs.

In November, a report by the Department of Health criticised the NHS for not achieving “measurable reductions” in HAIs outside of MRSA and C.difficile.

“The heart of the problem is that whatever DoH says or decrees, it doesn’t necessarily impact hospitals,” says Nick Adams, chief executive of Bioquell, the decontamination technology provider. “In the US, a hospital can be sued and that’s a big deal because they’re desperate to keep it out of the press, so they’ll settle. In the UK, hospitals pass the issue very quickly on to the NHS litigation board, so it’s not the hospital’s problem.”

Synergy Health is another company that produces decontamination technology. It has concentrated its sales efforts in Asia and Europe.

One of Synergy’s decontamination products uses a disinfectant technology produced by another company, Byotrol, that has been tested by the NHS in an 11-month study. The Byotrol technology was deployed against a bleach-based product currently used by the NHS.

Despite positive results showing superior effectiveness and lower side effects, the product has not been taken up, even by the Manchester Royal Infirmary where it was tested.

Richard Steeves, Synergy’s chief executive, says that his group is making more sales to countries where hospitals are encouraged to innovate, such as in the Netherlands, where “hospitals are competing for patients”.

Although there is state-funded national insurance for health care in the Netherlands, hospitals compete with each other to provide services for a number of private insurers.

Most UK hospitals are run by the NHS, and Dr Steeves points out that many of the UK’s private hospitals are owned by private equity, and that there is financial pressure to reduce costs.

However, there are those in the sector that say that innovation by UK companies is a direct result of the “laissez faire” environment.

Paul Swinney is chief executive of Tristel, which produces a chlorine dioxide-based disinfectant that treats everything from salads in supermarkets to surgical instruments and surfaces.

Its product is used throughout the UK, which Mr Swinney says is “de facto approval”. Moreover, he says, companies here do not have to pass the expensive regulatory procedure of the US Food and Drugs Administration or the Environmental Protection Agency.

From:
http://www.ft.com/cms/s/0/f989ee86-f405-11de-ac55-00144feab49a.html?nclick_check=1

Labour ministers to take control of hospital charity cash

Hundreds of millions of pounds of charity donations to hospitals are to be “nationalised” under an NHS accounting change, which critics say will make it easier to slash health budgets.

Ministers are imposing new rules on NHS charities requiring all donations — including those to specialist children and cancer units, local fundraising campaigns, teaching hospitals and local community trusts — to be listed on a hospital’s balance sheet.

The Charities Commission says that this is “wholly inappropriate” because combining the trust and charity accounts will jeopardise the charity’s autonomy and discourage donations. 

About £330 million was given to 300 NHS charities in the year to June 2008, and they control an estimated £2 billion of assets. A spokeswoman for the Commission said: “The Charity Commission does not agree with the interpretation of the accounting rules in the Department of Health letter to NHS bodies. We are currently engaging with the Department on this matter.”

Charities also fear that the change, due to come into effect in April, will be used as a smokescreen to hide cuts in health spending, with ministers reducing funds for organisations such as children’s hospitals that have successful charitable arms.

Jenny Willott, a Cabinet Office spokeswoman for the Liberal Democrats, said: “This could lead to hundreds of millions of pounds of charitable donations being effectively nationalised under the NHS.

“The Government has no right to get its hands on any charitable NHS funds. People make donations on the understanding that it is up to charities to decide how to spend it, not ministers.”

A source at a leading hospital said that the rule change appeared entirely unreasonable and risked creating unnecessary budgetary pressures and distorted disparities between hospitals with different levels of fundraising ability.

Ministers were banned from counting charitable donations towards the central NHS budget under the original legislation that created the NHS in 1948.

But this looks set to be reversed after the Treasury agreed to implement International Accounting Standard (IAS) 27. Now all NHS Trusts whose trustees have the “power to control” their charitable arm look likely to be forced to consolidate both sets of accounts in one. Estimates of the number of NHS charities affected vary between 30 and 300 organisations.

From:
http://www.timesonline.co.uk/tol/news/politics/article6969955.ece

Drunk and overdosing homeless people put strain on NHS

One drunk or drug addicted homeless person is admitted to hospital every three hours, putting a severe strain on the National Health Service, new figures show.

The rate of drug and drink related admissions of homeless people has risen by 117 per cent since 2004, with six out of 10 hospital trusts reporting that numbers have gone up in the last five years.

Many of the rough sleepers had overdosed or suffered infections from using dirty needles to inject drugs such as heroin, while others needed their stomachs pumped after drinking too much.

The figures, contained in a series of answers to freedom of information requests put in to 173 hospital trusts, were released by the Conservatives, who issued a report setting out the importance of understanding the health needs of homeless people.

In particular, the party wants the availability of cheap alcohol in supermarkets to be curtailed, and for health boards to work with local homeless charities such as Shelter to consider the best ways to help homeless people in their area.

Grant Shapps, the shadow housing minister, said: "A refusal to confront the extent of the homlessness issue in the United Kingdom leaves our frontline services such as the NHS struggling to cope.

“Our report demonstrates how drugs and alcohol frequently play a major role in perpetuating the chaotic lives lived by many people trapped in homelessness. This is one of the reasons why Conservatives will fix the crazy situation whereby supermarkets are selling high strength larger for less than they charge for a bottle water."

The report shows that nearly 14,000 homeless people were admitted to hospital with drink and drug-related conditions in the last five years, the equivalent of eight a day or one rough sleeper every three hours.

London had the most admissions, followed by Liverpool and Leeds.

More than 10 per cent of rough sleepers who ended up in hospital for alcohol or drugs were under the age of 25, even though young people are estimated to account for between six and seven per cent of the homeless population.

From:

http://www.telegraph.co.uk/Drunk-and-overdosing-homeless-people-put-strain-on-NHS

David Cameron sets out policies to boost NHS

David Cameron has pledged to protect spending on the NHS as he set out twenty policies to boost Britain’s health services if the Conservatives win the forthcoming general election.

Launching the Conservatives’ election campaign, Mr Cameron said that health care was his top priority and that he represented “the party of the NHS”.

The Conservative leader pledged to channel more health spending to poorer areas to tackle the growing gap in life expectancy between the wealthier and less well off.

A new maternity service giving mothers greater choice will also be set up if the Tories are elected.

Mr Cameron published the first chapter of a “draft manifesto” detailing twenty Conservative policies for the NHS.

These included a pledge to end mixed sex hospital wards, a plan to withhold funding from hospitals which infect patients with MRSA, and new proposals to give patients detailed information about the quality of treatment from each doctor, hospital or surgery.

Patients will also be given more opportunity to manage their own care and could receive treatment for minor ailments at their local pharmacist.

In a speech to Conservative activists, Mr Cameron said: “Today, the Conservatives are the party of the NHS. But talk is cheap. You've got to back that with action, and we have.

"We are the only party committed to protecting NHS spending. I'll cut the deficit, not the NHS. And don't for one minute buy the Labour claim that they'll do the same. They won't - and their own figures show they won't.

"Unlike us, they have not committed to protecting areas of the health budget such as public health and capital investment."

Mr Cameron accused Labour of failing to tackle the gap in health between rich and poor, describing it as "one of the most unjust, unfair and frankly shocking things about life in Britain today".

"Health inequalities in 21st century Britain are as wide as they were in Victorian times," he said.

He promised the Tories would introduce a new health premium that would divert cash to the poorest areas and "banish health inequalities to history".

"With our plans, the poorer the area, the worse the health outcomes tend to be, so the more money they can get," he said, adding that local people would decide how it was spent.

From:

http://www.telegraph.co.uk/David-Cameron-sets-out-20-policies-to-boost-NHS

Health Direct NHS preview of 2010

Spending will dominate debates over the NHS and health – especially in an election year and the scale of NHS cuts will become apparent as the year progresses.

Already hospitals have been told that they will receive no increase in the amount of money that they are paid per procedure, essentially a real terms cut in the cash they will receive.

Overall, the health service has also been set a goal to make between £15 million and £20 million of efficiency savings over the next four years.

The fact that McKinsey, the management consultancy firm, estimates that to achieve such that a goal would take making 10 per cent of NHS staff redundant and abandoning procedures such as varicose vein operations suggests the scale of the challenge.

Patients' groups will continue to keep a close eye on the labour government’s drugs rationing body NICE in 2010. Over the last year the National Institute for Curbing Expenditure (NICE) began looking more favourably on drugs which prolong life for terminal patients, as it was instructed to do so by Government.

2009 also saw a number of drug companies come forward with innovative deals that allowed the NHS to pay less for some medicines.

But with expensive drugs for cancer and other illnesses coming through the pharmaceutical pipeline at all times patients will continue to monitor how Nice makes decisions about which drugs it will allow on the NHS.

The Government will scale up its Change4Life campaign, which so far has concentrated on children and families, to focus on adult obesity.

Despite data which suggests that rises in childhood obesity could be levelling off, ministers and health planners are still worried about the strain on the NHS if predictions that half of adults could be heavily overweight by 2050 come true.

2010 should be the defining year for the Swine flu pandemic. Will cases continue to drop or will swine flu return either early in the new year or next winter?

Sir Liam Donaldson, the Chief Medical Officer, warns that we cannot be complacent about the threat that the virus still poses and points to pandemic flus in the 1960s in which death rates were higher in the second winter than the first.

The H1N1 vaccine could be the deciding factor, but to what extent remains to be seen.

Cervical cancer link to early sex as sexually transmitted infection, HPV, causes most cases

Having sex at an early age can double the risk of developing cervical cancer, a study of 20,000 women suggests.

The investigation into why poorer women have a higher risk of the disease found they tended to have sex about four years earlier than more affluent women.

Previously, it had been thought the disparity was the result of low screening uptake in poorer areas.

The International Agency for Research on Cancer findings are published in the British Journal of Cancer.

Although the difference in cervical cancer incidence between rich and poor - across the world - had been noted for many years, it was not clear why this is the case.

Especially as rates of infection with human papillomavirus (HPV) - the sexually transmitted infection linked with the vast majority of cervical cancers - seemed to be similar across all groups.

The study confirmed that the higher rates of cervical cancer were not linked to higher HPV levels.
   
But what it did reveal is that the two fold increased risk was largely explained by women from poorer backgrounds starting to have sex at a younger age.

The age at which a woman had her first baby was also an important factor. Screening was found to have some effect on the level of risk.

But the number of sexual partners a woman has and smoking did not account for any of the difference.

Study leader, Dr Silvia Franceschi, said the findings were not restricted to adolescence and the risk of cervical cancer was also higher in women who had their first sexual intercourse at 20 rather than 25 years.

"In our study, poorer women had become sexually active on average four years earlier. So they may have also been infected with HPV earlier, giving the virus more time to produce the long sequence of events that are needed for cancer development."

Dr Lesley Walker, director of cancer information at Cancer Research UK, said the study raised some interesting questions.

"Although women can be infected by HPV at any age, infections at a very young age may be especially dangerous as they have more time to cause damage that eventually leads to cancer.

"Importantly, the results back up the need for the HPV vaccination to be given in schools at an age before they start having sex, especially among girls in deprived areas."

So after a dozen years of nanny state sex lectures the current crop of school leavers are worse off- as are the UK taxpayers.

From:

http://news.bbc.co.uk/1/hi/health/8420690.stm

Government departments waste £4m on website redesigns

Labour government departments have spent £4 million of public money revamping their existing websites over the past two and a half years.

Much of the money has gone to external consultants and contractors.

In total, £3.96 million has been spent on redesigns and upgrades since June 2007. The figure does not include the estimated £220 million annual cost of running the government sites.

David Davies, Conservative MP for Monmouth who asked for the information in a string of parliamentary questions, said: "Dfid ministers should be giving financial support to the poorest people in the world not the wealthiest web designers.

"The money spent on a web upgrade could have paid the wages of 100 nurses in one of the poorest African nations for a year, but for Labour ministers, internet propaganda is far more important.

The Central Office of Information (COI) is conducting a study, to be published in June, into whether government websites offer value for money. The investigation was prompted by a National Audit Office report that said over one quarter of government organisations did not even know the running cost of their own websites, making it impossible to assess whether they provide value for money.

The NAO also found that one in six government bodies had no data about how their websites were being used.

Matthew Elliot, the campaign director for The TaxPayers' Alliance, said: "This astonishing £4 million figure shows departments must concentrate on content rather than the appearance of government websites. Many of these sites look a lot better than they actually are."

What departments said they spent on redesigns since June 2007:

Department for International Development £970,419
Department for Business, Enterprise and Regulatory Reform £528,912
Department of Health £513,000
Intellectual Property Office £355,000
Electoral Commission £283,744
Department for Environment, Food and Rural Affairs £181,000
Ministry of Defence £150,000
Electoral Commission voter information site £140,600
Serious Fraud Office £113,309
Office of Rail Regulation £107,169
Department for Innovation, Universities and Skills £105,167
British Army £75,000
Crown Prosecution Service £60,085
Attorney General's Office £59,184
Revenue and Customs Prosecution Office £58,741
Office of Government Commerce £54,000
Bona Vacantia £42,598
UKTI Defence and Security Organisation £42,000
National School of Government £27,683
National Measurement Office £20,649
Government Actuary Department £19,461
Scotland Office £12,880
Disposal Services Authority £12,000
Wales Office £10,500
NI Organised Crime Office £6,825
Forensic Science NI £6,187
NI Youth Justice Agency £4,802
Treasury Pre-Budget £4,578
TOTAL £3,965,493

From:

http://www.telegraph.co.uk/Government-departments-spend-4m-on-website-redesigns

NHS faces potentially serious problems from wrong prescriptions on the NHS

Patients face potentially serious problems because of the piecemeal training given to young NHS doctors in giving out prescriptions, claim medicine experts.

Junior doctors on average fill out five or six prescription forms during their whole time in medical school only to have to complete dozens on their first day on the wards.

The inadequate preparation helps contribute to almost one in 10 prescriptions containing errors that could harm patients, it was said.

Now the British Pharmacological Society (BPS) is calling on the doctors to take an exam called the National Prescribing Assessment before being qualified.

They also want a "prescribing simulator" to be introduced to the curriculum so that medics are better prepared when they start in hospitals.

Professor Simon Maxwell, chairman of the BPS, said: "Everybody thinks that the system should and can be overhauled.

"We would not accept this kind of error rate in other industries such as aviation. It is a recipe for problems."

The call for change, outlined in a blueprint by the BPS, comes after the General Medical Council revealed that 10 per cent of all prescriptions issued by doctors contained errors.

The mistakes included omitting drugs, wrong doses, not taking account of a patient's allergies, illegible handwriting or ambiguous orders.

When the hospital doctors were interviewed about their mistakes, some admitted that they used pharmacists or nurses as a "safety net" to correct them afterwards.

The most senior doctors made the fewest mistakes, while doctors in their second year after qualifying made the most, it was found.

In the study, 124,260 prescriptions were checked by pharmacists in 19 hospital trusts in north-west England and 11,077 errors were detected.

While doctors are trained in a "piecemeal way" on symptoms and treatments, they rarely actually fill out a prescription forms before they start work, said the BPS.

A recent survey showed that in training they filled out as little as one a year whereas on the job that jumped to 50 or 60 a day.

That meant that doctors were ill prepared, it concluded.

Prof Maxwell, and his chairman Dr Jeff Aronson, said that it was hoped that the new assessment would be ready for the 2011 intake of medical students.

It was also hoped that an online training programme - including a prescription simulator complete with virtual patients - would be ready by the following year.

Prof Maxwell said: "It doesn't take to much of a wrong dose or too long for the monitoring to be left before there are potentially serious problems. There is a big push now to eliminate this high risk."

From:

http://www.telegraph.co.uk/NHS-faces-potentially-serious-problems-from-wrong-prescriptions-on-the-NHS

Nanny state libel laws gag doctor over drug risks

General Electric, one of the world’s biggest corporations, is using the London libel courts to gag a senior radiologist after he raised the alarm over the potentially fatal risks of one of its drugs.

The multinational is suing Henrik Thomsen, a Danish academic, after he described his experiences of one of the company’s drugs as a medical “nightmare”. He said some kidney patients at his hospital contracted a potentially deadly condition after being administered the drug Omniscan.

GE Healthcare, a British subsidiary of General Electric, has run up more than £380,000 in legal costs pursuing Thomsen.

“I believe the lawsuit is an attempt to silence me,” he said last week. “It’s dangerous for the patient if we can’t frankly exchange views.”

The company admits its product has been linked to serious side effects in some patients, but said Thomsen accused the company of suppressing information in a presentation at a scientific congress in Oxford in October 2007.

A summary of Thomsen’s presentation for the High Court writ, provided by GE Healthcare, appears to show that it was an even-handed account of his clinical experience.

When asked by The Sunday Times to highlight any part of the presentation that explicitly stated wrongdoing by GE Healthcare, a spokeswoman for the company was unable to do so. The writ states that the defamation may have been “by way of innuendo”.

His case will trigger a fresh row over the draconian use of Britain’s libel laws to stifle scientific debate and silence critics. Thomsen now refuses to discuss the possible risks of the drug in any UK public forum.

Evan Harris, a former hospital doctor and the Liberal Democrat science spokesman, who is leading the parliamentary campaign to reform the libel laws, said: “It is hard to conceive a stronger public interest than scientists and clinicians being able to discuss freely their concerns about drugs or devices used on patients. Libel laws should not be used in this way.”

More than 48m doses of Omniscan have been given worldwide and it is safe for the vast majority of people. It is one of a number of “contrast agents” containing the potentially toxic metal gadolinium, which are used to enhance images for magnetic resonance imaging scans.

Omniscan and other products have been linked with a skin condition in kidney patients, known as nephrogenic systemic fibrosis. Sufferers can be confined to a wheelchair and may even die from related causes.

Regulators in Europe and the US are now taking action over the potential risk from Omniscan and two similar products.

Five people in Britain have died from possible side effects after being administered Omniscan, according to the Medicines and Healthcare Products Regulatory Agency.

Patients have launched legal actions in America involving more than 170 deaths where it is claimed Omniscan and similar drugs may have been a factor. Safety problems with the drugs have been highlighted in the US by the independent investigative news organisation ProPublica.

Paul Flynn, the Labour MP, said, “It is a scandal that a company should take action against someone acting in the interests of patients.”

GE Healthcare said it had launched a libel action against Thomsen as a “last resort”. It is also suing Thomsen for an article in a medical magazine published in Brussels, but he said his name had been put on an article that he had not written.

From:
http://business.timesonline.co.uk/tol/business/law/article6962865.ece

Labour doesn't want you to have a High Christmas as more legal drugs are banned

More legal high drugs are banned in UK by the nanny state as several drugs known as "legal highs" has come into force.

The substances, including GBL and BZP, become Class C drugs, with a possible two year jail sentence for possession.

Labour ministers moved to classify them after a recommendation from the Advisory Council on the Misuse of Drugs and fears they are a threat to user health.

GBL was linked to the death of medical student Hester Stewart, 21, in Brighton last April. Her mother, Maryon, campaigned nationally for the ban.

So called legal highs are typically man made chemical substances designed to act like banned drugs.

Scientists, officials and police officers have been concerned for several years that GBL, BZP and other so-called "legal highs" have been sold openly across Britain and on the internet, despite evidence that they can be harmful to health.

GBL, which metabolises in the body into the already banned drug GHB, will become a Class C drug carrying maximum jail terms of two years for possession and 14 years for supply.

Piperazines, of which BZP is the most popular, are also being made Class C drugs.

This group of drugs is popular on the club scene as an alternative to ecstasy and amphetamines.

Synthetic cannabis has also been banned and become a Class B drug. Possession of products such as "spice", a herbal mixture laced with psycho-active chemicals, now carries a maximum five-year jail term.

Fifteen anabolic steroids, associated with drug abuse in sport, have also been classified as Class C.

Police chiefs say their response will be proportionate and focused on dealers.

Home Secretary Alan Johnson said the government was committed to raising awareness of the dangers of psychoactive substances through its Frank campaign, but also wanted to send a clear message to those thinking of using the drugs.

"We are cracking down on so-called 'legal highs' which are an emerging threat, particularly to young people," said Mr Johnson.

"That is why we are making a range of these substances illegal from today with ground- breaking legislation which will also ban their related compounds."

Scientists at the Forensic Science Service laboratories have recently discovered that drug dealers in London have been using one of the newly-banned drugs to manufacture fake "crack cocaine".

Piperazines were first developed as a worming agent and are also used in some manufacturing processes. The FSS says "legal highs" based on the chemical have become more prevalent than ecstasy.

Friday's ban is unlikely to be the last. The Advisory Council on the Misuse of Drugs will next year consider a new wave of so-called "legal highs", which are based on a group of chemicals known as cathinones.

However, the recent controversy over the sacking of the council's chairman, Professor David Nutt, and the subsequent resignation of council members in protest, could mean any final recommendations are delayed.

From:

http://news.bbc.co.uk/1/hi/uk/8427439.stm

Ban on hospital flowers over MRSA fears are wrong

Many hospitals have banned fresh flowers on wards amid concern that they could harbour potentially harmful bacteria or pose a health and safety risk like MRSA and superbugs.

But new research and a survey among staff and patients at the Royal Brompton Hospital and the Chelsea & Westminster Hospital, both in London, found there is little evidence to support some of the concerns around the presence of blooms on wards.

In a study by Giskin Day and Naiome Carter of Imperial College London, and published in bmj.com, it was even claimed flowers could help improve a patient's health and recovery.

One of the reasons given to support the ban was that flower water contained high levels of bacteria, but subsequent research has found no evidence to suggest that it has ever caused a hospital acquired infection.

Southend University Hospital recently imposed a ban on flowers on the grounds that they posed a health and safety risk around high tech medical equipment.

But the report argues that flower vases are no more risky than having crockery containing drinks or food around bedsides.

Interviews with staff in this study however found that nurses were generally more concerned about the practical implications of managing flowers than risks of infection.

Other studies report that flowers have immediate and long term beneficial effects on emotional reactions, mood, social behaviours, and memory for men and women alike.

One trial found that patients in hospital rooms with plants and flowers had reduced systolic blood pressure and heart rate; lower ratings of pain, anxiety, and fatigue; and had more positive feelings.

The authors of the report said given that flowers and herbs have been used as remedies in the earliest hospitals, and as a means of cheering up the hospital environment for at least 200 years, it seems remarkable that flowers still tend to be treated in an ad hoc fashion in hospitals.

Although flowers undoubtedly can be a time consuming nuisance, the giving and receiving of flowers is a culturally important transaction, the report concludes.

In an accompanying editorial, Simon Cohn, a medical anthropologist at Cambridge University argues that flowers have fallen victim to new definitions of care.

Describing the decision to ban flowers, he said: “[The decision] seems to reflect a much broader shift towards a model of care that has little time or place for more messy and nebulous elements.”

Katherine Murphy, director of the Patients Association, said: "Most patients love flowers. The job of nurses is to be the patient's advocate and carer. Surely it is not beyond management capabilities in a trust to ensure that the needs of patients and staff are accommodated.

"If flowers on wards pose such a problem, it's no wonder that critical patient safety issues appear to be insoluble."

Flowers are just one of the items to have fallen foul of strict hospital health and safety regulations.

Mobile phones have long been forbidden on many hospital wards, even though a government report in 2007 said there was no justification for a blanket ban.

Doctors were banned from wearing watches and jewellery last year because of fears that they were an infection hazard.

An NHS Trust in Sheffield also banned nurses from wearing Crocs shoes at work, as the static electricity they generated could disable hospital equipment.

Perhaps the strangest ban, though, was at the Fazakerly Hopsital in Liverpool, where the controversial ITV television programme The Jeremy Kyle Show has been banned after complaints that it was upsetting patients. Well you win some, you lose some.

From:

http://www.telegraph.co.uk/health/healthnews/6824574/Hospital-flowers-not-harmful-report-claims.html

Labour's nanny state failing poor children as child obesity trends show class divide is growing

A widening class gap is likely to be seen in the coming years in childhood obesity, new research suggests.

Previous research has suggested rates in England may be levelling off. But the University College London team found this was happening most in children aged two to 10 from wealthier backgrounds.

Researchers said obesity rates among the lower classes were likely to be significantly higher by 2015 - for girls the levels may even be double.

They analysed data gathered by the government-funded Health Survey for England.

Currently 6.9% of boys and 7.4% of girls are obese - with the difference between the lower and higher classes 0.6% and 1.5% respectively for boys and girls.

But using historical trends, they predicted that by 2015 obesity rates could be above 10% for boys and 8.9% for girls.

Depending on the extent of the "levelling off" reported last month, the overall rates could be even lower.

However, it is the findings for social class that have shed even more light on the obesity problem. The obesity rates for girls are likely to diverge from now on, the team said.

Among those from lower classes it is expected to keep rising to 11.2%, while for those from professional backgrounds it is likely to fall to 5.4%.

Among boys, both groups are likely to see a rise, but it will be faster in the lower class group, meaning 10.7% of this class boys will be obese compared with 7.9% of those from wealthier backgrounds.

Similar trends will also be seen in older aged children, the report in the Journal if Epidemiology and Community Health found.

Lead researcher Dr Emmanuel Stamatakis said: "This highlights the need for public health action to reverse recent trends and narrow social inequalities in health."

"The widening socio-economic gap may be partly due to difficulties to reach and communicate health messages to families from lower socio-economic groups."

Tam Fry, of the National Obesity Forum, agreed awareness was more likely to be greater among wealthier families.

But he added: "It is also often quite expensive and time-consuming to buy healthy food and that puts wealthier parents at an advantage."

He said it was not clear why the differences were so marked in girls, although he said he suspected it was partly to do with the fact that boys tend to be more active generally.

From:
http://news.bbc.co.uk/1/hi/health/8412796.stm

Number of NHS staff at record high

Employment in the National Health Service jumped by another 23,000 jobs to a record high in the third quarter of this year, in spite of the squeeze to come on spending under the next government.

The increase– the seventh successive quarterly rise in NHS employment taking it to above 1.6m people for the first time– took even seasoned observers by surprise following an 18,000 rise in the second quarter.

Most had been predicting at least a levelling off in the workforce despite continued growth in spending, as health authorities and hospitals prepared for the real-terms freeze that is to come.

Nigel Edwards, policy director for the NHS Confederation, said: “We suspect this is the last stage before the tanker slows down and finally turns.”

The confederation runs a website on which most NHS jobs are advertised and the numbers on it at any one time have fallen from 10,000 at the turn of the year to 7,500. “People still do have growth money this year,” he said, “and they are pursuing targets and other government objectives. 

Furthermore, some of this recruitment will have been taking place before people had fully woken up to the scale of the problem to come. We think the decline in the number of jobs advertised, however, is significant.”

The increase, however, leaves the NHS across the UK employing 1,601,000 people, according to the Office for National Statistics: 400,000 more than when Labour took office. The growth follows a study in England by McKinsey, which said the NHS might need to shed 10 per cent of its workforce to keep the books in balance.

The bigger the workforce when the money starts to run out in 2011, the greater the efficiency gains that will be needed if it is not to shrink in the face of a real-terms freeze in spending.

The NHS in England has 5.5 per cent revenue growth for this year and next. However, David Nicholson, NHS chief executive, has ruled that at least 2 per cent of next year’s money must be spent on capital and other projects to transform the way care is delivered in subsequent years.

The rise in staff numbers was the driver for an overall rise of 23,000 in public sector employment in the third quarter of this year to 6.093m. Local government shed 3,000 jobs and public corporations employed 5,000 fewer people.

Civil service employment rose 4,000, driven chiefly by a rise of 7,000 in the numbers employed by Jobcentre Plus to deal with rising unemployment.

From:

http://www.ft.com/cms/s/0/87df4c06-ea9e-11de-a9f5-00144feab49a.html?nclick_check=1

USA is legalising marijuana on the quiet

You know things are shifting in America when Fortune magazine, the bible for business journalism, runs a cover story titled “Is pot already legal?”. 

You also know it when Barack Obama’s Department of Justice publishes a long expected memo signalling that the federal government will no longer raid medical marijuana dispensaries if they are legal under state law. That happened formally last month.

It was not, moreover, a symbolic gesture. Marijuana for medical reasons— to tackle chemotherapy- induced nausea or Aids-related wasting or glaucoma, among other conditions — is now legal in 13 states, including the biggest, California. 

Next year, 13 more states are planning referendums or new laws following suit. Last month a California legislative committee held the first hearings not simply on whether medical marijuana should remain legal, but on whether all marijuana should be decriminalised, full stop. The incentive? The vast amounts of money the bankrupt state could raise by taxing cannabis.

Now look at the polling on the question. In 1970, 84% of Americans supported keeping marijuana illegal. Today, that number has collapsed to 54%. The proportion believing that marijuana should be legal has gone from 18% at the end of the 1960s to 44% today. 

On current trends, a majority of Americans will favour legalisation by the end of Obama’s first term. In the western states, 53% already favour legalising and taxing the stuff. Support for legalisation is strongest among the young — the Obama generation — but has climbed among self-described Republicans as well.

But the reality is already ahead of the polls. Take a trip, so to speak, to Los Angeles today, where one would be forgiven for thinking that marijuana was already legal. There are more than 800 marijuana dispensaries in the city — and an estimated 7,000 in the state of California as a whole (many times more than in Holland).

Getting a doctor’s recommendation for marijuana is easier than getting health insurance — just look at the ads in the papers, where a consultation costs about $200. The dispensaries range from the dime store to elaborate palaces of capitalist taste. Seminars are held for entrepreneurs who want to start a business selling medical cannabis. On display are sophisticated strains that can provide exquisitely tailored effects: some best for countering nausea, some for building appetite, others for going to sleep, others for staying alert or for watching movies or for general relaxation.

The concentration of THC, the active compound, is much higher than in the past. But since no one has ever overdosed on marijuana, it’s difficult to say why that matters. Yes, if someone has a history of mental illness, it’s not that smart to experiment with the cannabinoid receptors in the brain. But it isn’t smart for such people to take any drugs — or too much alcohol — for that matter. For most people, stronger pot merely translates into a need for less of it to get the same effect. 

Too much and you’ll likely nod off — and wake up later with no hangover. If pubs served pot rather than beer, crime rates would plummet.

Americans, for whom the use of marijuana is almost a rite of passage in most colleges, know all this. And at some point they stopped pretending otherwise. The past three presidents smoked marijuana in their earlier days, even if only one has openly written about it. (Obama, when asked the Clinton question — if he had inhaled — responded: “I thought that was the point.”) In an online press conference with his younger supporters, the first question was about whether legalising and taxing pot would be a good thing to help raise revenues. Obama laughed it off. With an annual deficit of more than a trillion dollars, he may not be able to laugh it off much longer.

The key to the shift has been the emphasis on marijuana’s medical properties. Human beings have used marijuana as medicine for millennia. It was once sold in the States by Eli Lilly, the pharmaceutical manufacturer. Allowing this compassionate use for a few soon revealed, accidentally, how harmless it is. It is not chemically addictive, although some mild withdrawal can happen if you are a regular pot-smoker and go cold turkey. 

Its side-effects are minimal compared with those of most authorised drugs for similar conditions. It is far less addictive than tobacco or alcohol. It leads to no measurable degree of antisocial behaviour, as is the case with, say, crystal meth or cocaine or heroin. Many of its users are successful, productive members of society who simply prefer it to alcohol as a relaxant in the evening or as a way to get through cancer treatment.

Denying Aids patients a tool to stay alive tips the balance. I have one friend who would never have been able to tolerate the medications that saved his life without it. That’s pretty persuasive stuff and lots of people have similar first-hand experiences. A gateway drug? Yes, many users of hard drugs smoked pot in the first place. 

But almost all started out with alcohol as well — and that is not illegal.

Of course, nothing is inevitable. The police still police it and hundreds of thousands of Americans — disproportionately black and poor — are in jail for it. Los Angeles’s failure to regulate adequately its hundreds of dispensaries may lead to connections with organised crime that could come back to delegitimise the whole thing.

I give it a couple of years to become a non-issue or to go into reverse. And my bet is that in a decade’s time, the banning of cannabis will seem as strange as the banning of alcohol. In the end, unnecessary prohibition undermines itself. And this time around, there are millions of cancer and HIV patients who are on the side of legalising and some truly desperate branches of government looking to see what they can tax next. In fact, I’ll go further: sooner rather than later, marijuana may be more acceptable than tobacco.

The need for taboos is eternal. But the object of the taboo is always shifting. The age of tobacco may be ending; and the millennium of marijuana may be about to begin.

From:

http://www.timesonline.co.uk/tol/news/world/us_and_americas/article6897958.ece

Santa promotes obesity and drink-driving, claims nanny state health expert

Traditional images of Santa Claus set a bad example and could promote obesity and drink driving, a public health expert has warned.

Dr Nathan Grills said the idea of a fat Father Christmas gorging on brandy and mince pies as he drove his sleigh around the world delivering presents was not the best way to promote a healthy and safe lifestyle among the young.

Writing on bmj.com, Dr Grills said: "Santa only needs to affect health by 0.1 per cent to damage millions of lives."

He said the image of a healthier Santa could be very effective in promoting a positive message about diet and lifestyle to the young.

Dr Grills carried out a review of literature and web based material to assess Santa's potential negative impact on public health.

The investigation revealed very high Santa awareness among children, with children in America stating he was the only fictional character more highly recognised than Ronald McDonald.

Dr Grills also claimed the image of Santa was often used to promote unhealthy products such as soft drinks.

He wrote:"Like Coca-Cola, Santa has become a major export item to the developing world."

While Santa is now banned from smoking, images of him enjoying a pipe or cigar can still be found on Christmas cards.

Father Christmas could also potentially promote drink driving, argued Grills, referring to the tradition of leaving Santa Claus a brandy to wish him well on his travels.

And in a further blow to one of the central symbols of Christmas, Dr Grills claimed Santa also had the potential to spread harmful diseases.

"If Santa sneezes or coughs around 10 times a day, all the children who sit on his lap may end up with swine flu as well as their Christmas present," he said.

From:

http://www.telegraph.co.uk/Santa-promotes-obesity-and-drink-driving-claims-health-expert.html

Your medical confidentiality under threat again

Despite labour's promises to the contrary- their track record on snooping databases is appalling.

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

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

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

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

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

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

Once on the system, you will not be able to have your details taken off - but you will have to give permission for your OWN doctor to view your record!

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

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

Health Direct strongly recommends using the opt-out letter that was developed by with TheBigOptOut at http://www.nhsconfidentiality.org/optoutletter

Breast removal for cancer is postcode lottery, study shows

Women with breast cancer are five times more likely to undergo a mastectomy rather than have less invasive surgery in some parts of the country compared with others, research has shown.

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

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

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

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

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

Women living in Redcar and Cleveland, in the North East, were five times as likely to have their whole breasts removed, rather than part of them, compared with those living in Richmond and Twickenham.

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

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

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

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

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

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

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

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

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

From:

http://www.telegraph.co.uk/Breast-removal-for-cancer-is-postcode-lottery-study-shows.html

NHS hospitals face four year spending squeeze after labour's cuts

NHS hospitals are to face a four year spending squeeze in an attempt to drive up their productivity.

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

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

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

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

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

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

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

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

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

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

From:

http://www.ft.com/cms/s/0/947c7940-e592-11de-81b4-00144feab49a.html

New drugs available on NHS before NICE appraisal

Patients with rare diseases are to get innovative new drugs on the NHS before they have been through NICE under a new pilot scheme.

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

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

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

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

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

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

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

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

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

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

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

From:

http://www.telegraph.co.uk/New-drugs-available-on-NHS-before-Nice-appraisal.html

Swine flu chaos for children over vaccinations

Plans to vaccinate healthy children under the age of five against swine flu are in disarray after doctors refused to sign up to a deal.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

http://news.bbc.co.uk/1/hi/health/8402096.stm

NHS bureaucracy bill soars by £78 million in two years

The number of bureaucrats working for the NHS has soared over the past two years, according to a survey.

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

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

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

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

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

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

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

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

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

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

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

From:

http://www.telegraph.co.uk/NHS-bureaucracy-bill-soars-by-78-million-in-two-years

Rich list reveals 80 NHS chiefs paid more than Gordon Brown

At least 350 NHS executives in hospitals and primary care trusts were paid more than £150,000 last year, according to new research.

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

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

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

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

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

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

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

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

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

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

From:

http://www.timesonline.co.uk/tol/news/uk/article6943540.ece

Turmoil over NHS records scheme as labour cuts NPfIT to save cash

The world’s biggest civilian IT project was thrown into turmoil yesterday after Alistair Darling, the labour chancellor, implied that it was going to be scrapped.

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

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

A senior health department official, meanwhile, said bluntly span that “the chancellor mis-spoke” in saying the project to create an electronic medical record would be scrapped.

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

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

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

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

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

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

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

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

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

From:

http://www.ft.com/cms/s/0/71d29630-e2a5-11de-b028-00144feab49a.html?nclick_check=1

Cancer research at risk in scramble for care funds

Research into cancer and dementia will come under threat from labour government plans to fund social care, experts warned.

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

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

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

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

Further funds will be sought as part of a “major productivity drive”, he said. The NHS is expected to make up to £20 billion in efficiency savings over the next four years. Hospitals could see their income tied to levels of patient satisfaction on matters such as the quality of maternity care.

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

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

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

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

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

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

Website for patient waiting times virtually useless

Patients are being given out of date information by a flagship government scheme designed to reduce waiting times for hospital treatment.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From;

http://www.timesonline.co.uk/tol/news/uk/scotland/article1006886.ece

Dramatic postcode lottery for cancer survival rates shock charities

Department of Health figures have shown a wide variation in cancer survival between different parts of the UK with lung cancer patients in Herefordshire three times more likely to die within a year than those in Kensington and Chelsea.

The country's biggest cancer charity has expressed shock at government figures revealing huge variations in patients' chances of surviving from one area of the UK to another. The biggest survival gap was in lung cancer, where Department of Health figures showed patients in Herefordshire were three times more likely to die within a year of diagnosis than those in Kensington and Chelsea. 

In the London borough, 44% of patients survived the first year after diagnosis, compared with only 15% in Herefordshire.

In bowel cancer there was also a big gap in survival – 80% in Telford and Wrekin after one year, but only 58% in Waltham Forest and Hastings and Rother. The gap was less pronounced in breast cancer, with the best rate in Torbay, where 99% survived for one year, compared with 89% in Tower Hamlets.

"There is no excuse for such a big difference between different areas," said Harpal Kumar, chief executive of Cancer Research UK. "It is appalling that someone with lung cancer in Herefordshire should be three times more likely to die within a year than a patient in Kensington, or that a person diagnosed with bowel cancer in Waltham Forest or Hastings should be 22% more likely to die within a year than a patient in Telford. This is the worst kind of postcode lottery."

Very few primary care trusts (PCTs) had survival rates that were as good as other countries in Europe now or even as good as Europe was achieving 10 years ago, which Kumar called "a disgrace".

"We're pleased that the Department of Health have been bold enough to publish these figures," he said. "The NHS now needs to take them very seriously."

One-year survival figures highlight the issues around delayed diagnosis of cancer. That can be partly the responsibility of the GP, who may not see many cancer cases in a year, but is often to do with the reluctance of the patient to seek medical advice when they suspect a problem.

The figures are contained in the Cancer Reform Strategy second annual report from national cancer director Mike Richards, who points out that cancer deaths continue to fall and that prevention efforts, such as the cervical cancer vaccination programme for schoolgirls and better screening, will further help.

Jeremy Hughes, chief executive of Breakthrough Breast Cancer, said the charity shared the concerns. "Although progress has been made in some parts of the country, in others key Cancer Reform Strategy initiatives are still yet to be implemented," he said. "In particular, urgent action must be taken to ensure that digital mammography is in place by the December 2010 deadline and that, as previously committed by the government, all women with breast problems referred by their GP will see a specialist within two weeks by the end of this year."

Here are the PCTs with the best and worst records for dealing with common types of cancer, in terms of the proportion of patients who are still alive one year after diagnosis:

Breast cancer- Worst
Tower Hamlets (89.3pc)
Hillingdon (89.5)
Barking and Dagenham (90.2)
Hastings and Rother (90.3)
West Hertfordshire (90.6)

Breast cancer- Best
Torbay Care Trust (99.0)
Darlington (97.9)
Stockport (97.6)
Warrington (97.6)
Western Cheshire (97.6)

Colorectal cancer- Worst
Hastings and Rother (57.8)
Waltham Forest (57.9)
Tameside and Glossop (61.5)
Derby City (62.6)
Enfield (62.6)

Colorectal cancer- Best
Telford and Wrekin (80.0)
City and Hackney (77.5)
Shropshire County (77.0)
Peterborough (76.7)
Plymouth Teaching (76.6)

Lung cancer- Worst
Herefordshire (15.4)
Milton Keynes (17.5)
Blackpool (18.3)
East and North Hertfordshire (20.3)
Hartlepool (21.1)

Lung cancer- Best
Kensington and Chelsea (43.7)
Hammersmith and Fulham (35.3)
Richmond and Twickenham (35.2)
Islington (34.8)
South Birmingham (34.6)

Health Direct has compiled this post from:

http://www.guardian.co.uk/society/2009/nov/30/cancer-survival-rates-figures
and
http://www.telegraph.co.uk/health/healthnews/6693438/Cancer-survival-rates-best-and-worst-trusts.html

Hospitals use ploys to beat 4 hour deadline on A&E waiting times targets

More than five per cent of emergency patients are being admitted to wards to help hospitals hit waiting time targets.

Patients are being admitted to hospital to avoid breaching a labour Government target on waiting times, NHS figures suggest.

More than one in twenty patients attending hospital in an emergency are being admitted to wards just minutes before the maximum four hour wait.

Health unions have complained that staff are being “pressured” into manipulating data and admitting patients unnecessarily to meet the target, which aims to treat or discharge all accident and emergency (A&E) patients within four hours.

Figures from the NHS Information Centre show that almost all patients in England are seen within the four hour deadline, but there is a peak in the number of people admitted to a ward with just ten minutes to spare. Two-thirds of those treated as the deadline approaches are admitted to hospital, compared to just over one in five patients coming from A&E overall.

It is the first time such analysis has been done and the statistics are categorised as “experimental”.

The Royal College of Nursing warned that the four hour target meant some nurses were “pushed into practices” that were risky for patients.

It said that there were “negative consequences” for patient care, especially those needing treatment in A&E wards, but not necessarily requiring an overnight stay.

A survey of its members found that nine out of ten accident and emergency nurses claimed they had been unduly pressured to meet the four hour target.

Mark Porter, chairman of the British Medical Association’s consultants’ committee, said that the admission rates were worrying.

“This suggests that when patients have been waiting close to four hours, there is a rush to discharge or admit them so that the hospital meets the four-hour target,” he said.

“Patients must always be treated on the basis of their clinical need, not simply because they have been waiting close to four hours.”

Katherine Murphy, director of the Patients Association, agreed that the right patients are not always made a priority under the target.

“This results in doctors making rushed decisions at three hours and 50 minutes, with patients having to be admitted inappropriately at huge cost to the NHS,” she said. “We have heard instances of ambulance drivers being forced to wait outside A&E with seriously ill patients, until staff have cleared a backlog of people who need to be seen within the four hour target.

“It is unfair to make NHS staff feel like they have to put meeting this target ahead of what’s in the best interests of patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article6921466.ece

12 NHS hospitals at centre of safety scandal

The true scandal of NHS hospitals failing to comply with basic safety standards is revealed. 

Research that ranks every general hospital in England against a range of safety measures has named 12 NHS hospital trusts judged to be "significantly underperforming".

This is despite the fact that last month the Care Quality Commission, the health service regulator, judged overall care at eight of the trusts to be good or excellent. Today's study by Dr Foster, an NHS partner organisation that collates and analyses healthcare data, also highlights 27 trusts with unusually high death rates. Almost 5,000 more patients in their care died in the past year than was expected.

Revelations of such widespread safety failings will send shockwaves through the NHS, already reeling from scandals at two trusts last week. Poor nursing care, filthy wards and hundreds of unnecessary deaths were exposed at Basildon and Thurrock University NHS Hospitals Foundation Trust, and the chair of the NHS trust in Colchester was fired.

Now the new data proves that key safety failings are occurring in 11 more hospital trusts across England. They include Scarborough and North East Yorkshire Healthcare Trust, South London Healthcare Trust, Weston Area Health Trust, Hereford Hospitals Trust, Lewisham Hospital Trust and University Hospitals Coventry and Warwickshire Trust. Eighteen were found to have death rates the same or higher than at Colchester. Ministers want to know why seven in particular have had persistently high death rates over five years.

The Department of Health yesterday ordered the CQC to investigate if any other trusts needed urgent attention. The CQC said it was "monitoring closely a number of other trusts", but had no evidence there was another case in England where it would take action of the kind taken at Basildon.

John Black, president of the Royal College of Surgeons, last night told the Observer that patient safety had been neglected by hospitals too busy meeting NHS-imposed financial targets: "Too many hospitals are too concerned with meeting financial targets at the expense of clinical standards, and we are seeing patients suffering as a consequence."

Today's research exposes systemic failures in large parts of the NHS during the last financial year and finds:
¦ 39% of trusts failing to investigate unexpected deaths or cases of serious harm on their wards.
¦ At least 209 incidents in which "foreign objects", such as swabs and drill-bits, were left inside patients after surgery.
¦ At least 82 cases in which medical staff operated on the wrong part of the patient's body.

It finds that 5,024 people died after being admitted for "low-risk" conditions such as asthma or appendicitis, of whom 848 were under 65. A proportion of those deaths will be linked to safety errors.

The Conservatives reacted by promising a complete overhaul of the regulation system, which rated Basildon "good" only weeks ago. Andrew Lansley, the shadow health secretary, said: "Labour's failed health inspection regime is more interested in targets than patients." 

He also questioned the timing of the Basildon announcement. Officials knew of the hospital's failings weeks ago but decided to publicise them last Thursday, just days before the Dr Foster research was due to be published in the Observer.

The study paints a picture of large variations in the hospital standardised mortality ratio, a measure used by Dr Foster. The measure, which was used last week by Monitor, the regulator for NHS foundation trusts, looks at the likelihood of individual patients dying, given their underlying condition, age and economic background, then compares that to the actual number of deaths.

Cynthia Bower, the CQC's chief executive, said improvements had been made, but added: "The NHS cannot stand still on safety. It must be able to look the public in the eye and say safety is top priority for the leadership of every NHS trust in the country – no ifs and no buts."

Roger Taylor, from Dr Foster, responded: "We have used the most credible available data to assess patient safety. CQC ratings are not designed to just assess patient safety and instead use broader indicators, including measures of effectiveness and patient experience. The hospital guide is focused on patient safety, and mortality ratios are used alongside other indicators."

From:

http://www.guardian.co.uk/society/2009/nov/29/nhs-hospitals-safety-report

Failing hospital condemns hundreds to death

Hundreds of patients died at an NHS hospital after suffering appalling standards of care, a report has found.

Poor nursing, filthy wards and lack of leadership at Basildon and Thurrock University NHS Hospitals Foundation Trust contributed to 400 avoidable deaths in a year.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Swine flu deaths in England reach highest level

Deaths from the swine flu pandemic in England rose to their highest peak yet last week, new figures have shown.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

http://www.telegraph.co.uk/health/swine-flu/Swine-flu-deaths-in-England-reach-highest-level

Drug use in the City still a real problem

The use of alcohol and cocaine remains rife among City workers in spite of rising unemployment and lower wages following the credit crunch, leading physicians involved in the treatment of drug abusing professionals have warned.

Neil Brenner, medical director of Priory psychiatric hospital in north London, told the Financial Times that the number of bankers coming to him for treatment had risen significantly over the past three years, even when taking account of a large dip after the onset of the financial crisis in 2008. "I still think this is a real problem in the City," Dr Brenner said.

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

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

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

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

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

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

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

From:

http://www.ft.com/cms/s/0/cbc7bed0-c361-11de-8eca-00144feab49a.html

Nanny state wants NHS to provide free marriage guidance

Couples are to be offered marriage guidance counselling for free on the NHS, in a move which has drawn strong condemnation from patients and doctors' groups.

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

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

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

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

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

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

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

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

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

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

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

From:

http://www.telegraph.co.uk/health/healthnews/NHS-will-provide-free-marriage-guidance

Winter NHS deaths rise a national scandal

The highest winter NHS deaths figures in almost 10 years should act as a "deafening wake-up call" for the labour Government, charities said today.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

http://www.independent.co.uk/winter-deaths-rise-a-national-scandal

Swine flu- strain resistant to Tamiflu spreads between UK hospital patients

A strain of Tamiflu resistant swine flu has spread between patients in a hospital as five patients on a unit for people with severe underlying health conditions at the University Hospital of Wales, in Cardiff, were diagnosed with swine flu that is resistant to the drug.

Three appear to have acquired the infection in hospital, the National Public Health Service for Wales (NPHS) said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

http://www.telegraph.co.uk/Swine-flu-Strain-resistant-to-Tamiflu-spreads-between-UK-hospital-patients

Sharp rise in England swine flu deaths

The latest weekly bulletin showed a sharp rise in patient deaths and the number of children being admitted to hospital.

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

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

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

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

About 21% of all H1N1 deaths in the UK have been among under 14s.

So far the priority groups have included those with pre-existing medical conditions, their carers and pregnant women. Children with asthma or diabetes are already being vaccinated. Now, children aged six months to five years are to be offered the vaccination from next month.

From:

http://www.guardian.co.uk/world/2009/nov/19/swine-flu-vaccines-healthy-children

Swine flu jab to be given to healthy children under five

Healthy children aged under five are to be given the swine flu jab, the Government has confirmed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From

http://www.telegraph.co.uk/health/swine-flu/6606561/Healthy-children-below-age-of-five-to-get-swine-flu-jab.html

150,000 dementia sufferers being prescribed anti-psychotic drugs unnecessarily

Up to 150,000 people with dementia are being prescribed anti-psychotic drugs unnecessarily, a Government ordered review disclosed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

http://www.telegraph.co.uk/150000-dementia-sufferers-being-prescribed-anti-psychotic-drugs-unnecessarily

The evidence in favour of Prof Nutt- Financial Times Editorial

The UK government published a policy document committing itself to independent scientific advice in all departments, with an introduction by the prime minister proclaiming the “international respect” earned by the UK for “its thorough and professional approach to the use of evidence”. Only two days later Alan Johnson, home secretary, put that respect in jeopardy with an act of political clumsiness.

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

Two members of the council quit immediately in protest, more are threatening to follow – and the great and good of British science have lined up to attack the home secretary.

If Mr Johnson had thought through the consequences of his action, he would surely have consulted Lord Drayson, the science minister, and John Beddington, government chief scientist. They would have warned him of the outcry and dismay that Prof Nutt’s dismissal would cause.

At stake is not just the future of the ACMD, an important body that has helped to formulate drugs policy for more than 30 years, but as many as 80 other scientific councils and committees across government. These advise on everything from food and nutrition to climate change, and they depend on the unpaid part-time service of hundreds of scientists (mainly working in universities because industry researchers are often ignored for having alleged conflicts of interest). 

The volunteers may turn away from the system if they cannot express contrary views in public or if they see advice being rejected without good reason or even courtesy. Across the Atlantic, that sort of treatment gave George W. Bush’s administration a bad reputation with US scientists.

Indeed the row has implications beyond what most people would think of as science. Ultimately it is about the relationship between evidence and policy. 

Democratic governments always say they want to make “evidence-based policy”. The danger is that, when this does not suit them, they search for “policy-based evidence” – in other words picking out what supports their planned course of action and rejecting what does not. Saddam Hussein’s “weapons of mass destruction” are a prime example.

Of course scientific advice is not sacrosanct. Governments have the right to over-ride the evidence for broader policy reasons – but only if they do so openly and without gagging their advisers.

Mr Johnson is unlikely to pay a high political price for the Nutt affair, because the Conservative opposition, to its shame, supports the professor’s sacking. Chris Grayling, shadow home secretary, wants to outdo Mr Johnson in his hard line on illegal drugs, whatever the evidence. Only the Liberal Democrats are prepared to take a broader (and wiser) view of the need to encourage experts to give governments independent advice.

From:

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

Chlamydia sexual health testing wasting money

Millions of Pounds have been squandered on the national chlamydia sexual health screening programme, a watchdog says.

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

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

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

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

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

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

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

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

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

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

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

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

Failed

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

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

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

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

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

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

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

MRSA superbugs not the only threat to NHS warns MPs

The labour government has taken its "eye off the ball" on hospital infections other than MRSA and Clostridium difficile, a cross-party group of MPs says.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Five die in hospital superbug outbreak

An outbreak of the Clostridium difficile (C. diff) superbug has killed two hospital patients and contributed to the deaths of three more.

The patients were among a total of eight elderly people who contracted the infection at Ninewells Hospital in Dundee over an 18 day period.

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

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

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

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

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

The deaths occurred between 19 October and 6 November.

'Appropriate measures'

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

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

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

From:
http://news.bbc.co.uk/1/hi/scotland/tayside_and_central/8352612.stm

Half term helps curb swine flu infections

Half term holidays may have temporarily eased the rise in the number of cases of swine flu, the government's chief medical officer said yesterday.

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

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

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

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

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

From:

http://www.ft.com/cms/s/0/55aecc3a-cff4-11de-a36d-00144feabdc0.html?nclick_check=1

Health department spent £585m on consultants

The Department of Health has spent £585m – the cost of building a district general hospital – on management, legal and financial consultants over the past four years.

The half-a-billion pound bill “is a huge amount of money”, Kevin Barron, chairman of the Commons health select committee, said. The committee has been pressing the department to disclose the sum and Mr Barron said now that it was public “we will be returning to the issue”.

Spending on management consultancy by the NHS itself is not included in the total – an amount that the Management Consultancies Association estimates to have run to about £300m last year, although that figure is likely to include the department’s own spending.

The Conservatives are promising to slash Whitehall’s expenditure on consultants if they win the general election, with the cash earmarked to help introduce a council tax freeze. They are also promising to cut the cost of Whitehall itself by 30 per cent over a Parliament.

However, the level of spending on consultancy services “shows that, at least in part, the department does not have the capacity and staffing to do the work it needs to do,” warned Alan Maynard, professor of health economics at York university, and an adviser to the select committee.

Under pressure from the committee, the department has agreed to start publishing the NHS’s own spending on consultancy, having originally argued that to do so would amount to “micromanaging” the NHS.

The figures for the department’s consultancy expenditure for the past four years show that since 2005/06 it has spent £133m, £205m, £132m and £125m last year – a total of £585m.

A breakdown has been provided for last year only. Then, £93m was spent on general consultancy, about £23m on financial and commercial advice and some £8m on legal consultants. Just over £19m of the total was spent on Connecting for Health, the NHS’s £12bn IT programme.

The spending is spread over more than 120 consultants and advisers. The top three earners were Ernst & Young at £12m, McKinsey at £9m and QI Consulting at £7.1m. The top five, who include PA Consulting and KPMG, accounted for 30 per cent of the total.

Expenditure over the past four years is marginally distorted by the £205m spent in 2006/07 when the department bought in private sector “turnround teams” to sort out the NHS’s then £1bn deficit.

“That was an important thing to do,” Mr Barron said, “and Patricia Hewitt’s determination to sort that out was one of the bravest decisions a secretary of state has taken for a long time”.

But even allowing for that, spending is running at about £130m a year “and we do have real concerns about the ongoing cost of all this,” Mr Barron added.

The MCA argues that its estimate of total spending by the NHS amounts to less than 0.3 per cent of the NHS’s total budget. It is currently agreeing a concordat with the department aimed at ensuring that the NHS gets value for money from consultancy contracts.

From:

http://www.ft.com/cms/s/0/36e48e44-c715-11de-bb6f-00144feab49a.html

Labour's drug policy up in smoke as scientists resign from drugs Council

Five scientists have now resigned from the labour Government's drugs advisory body Advisory Council on the Misuse of Drugs (ACMD) in the wake of the sacking of Professor David Nutt, its chairman.

An ACMD insider said that the three members to quit were Dr Campbell, a former head of worldwide discovery at the drugs company Pfizer and a former President of the Royal Society of Chemistry; Dr Marsden, a research psychologist at the Institute of Psychiatry; and Mr Ragan, a pharmaceutical and biotechnology industry consultant. None of the three was available for comment.

The departures of Dr Campbell and Mr Ragan would be particularly damaging as this would leave the council without representation from the pharmaceutical industry, which is required by law. Professor Walker’s resignation had already left the council without a pharmacist, another required discipline.





The Home Office has confirmed the ACMD, which is down to 25 members, must have at least 20 members to function, and that six key positions must be filled for the advisory group to function.

Professor Nutt said “I’m not surprised. The way I have been treated was reprehensible, and I’m pleased to have the support of these other council members.”

The trio quit the Advisory Council on the Misuse of Drugs following a crunch meeting with Alan Johnson, the Home Secretary, who earlier this month told Prof Nutt to step down after criticising Government policy.

The meeting had been called because members of the advisory body wanted reassurances from the Home Secretary that they could continue in "good conscience" and that their advice would be respected.

The row erupted after Prof Nutt said the dangers of alcohol and tobacco were more serious than those posed by Ecstasy and LSD and criticised the decision to reclassify cannabis as class B, against ACMD advice.

Prior to the news that three more had gone, Mr Johnson said he had told the body that their views will be given "due weight" in future.

He said he stood by the decision to remove his chief drugs adviser but wanted to improve relations but was "very sorry" to lose Marion Walker and Dr Les King, who quit earlier this month.

Mr Johnson said: "I understand why the Advisory Council on the Misuse of Drugs were concerned about this.

"Their major concern – and the reason why two very good people who I'm very sorry to lose – was because they felt Prof Nutt was being dismissed for his views. I reassured them that was not the case."

He added: "There is a duty I think to accept that politicians make the final decision.

Mr Johnson said a joint code between Government and scientists, proposed by the Royal Society, was being considered by Prime Minister Gordon Brown and the Government's chief scientific adviser.

Chris Grayling, the shadow home secretary, said: "Whilst we backed the original decision, by now I would have expected the Home Secretary to be able to sit down with other members of the Council and rebuild confidence and stability in what they are doing. Quite clearly he has failed to do that.”

In a joint statement released by the Home Office, the meeting was described as "very constructive" but made no mention of any impending resignations.

Evan Harris, the Liberal Democrat science spokesman, said: “The latest resignations represent a deepening in the crisis of confidence of scientists in the Government — in particular, in the Home Secretary. That they come after Alan Johnson met the ACMD demonstrates that he just doesn’t get it when it comes to the importance of respecting the academic freedom and integrity of independent, unpaid, science advisers.

Ministers are entitled to their own opinions, but not to their own facts. The cost of the failure of the Home Secretary to understand the lessons of the BSE Inquiry will be poor policy — unless the Prime Minister acts decisively to bring the Home Office and rest of Government into line with established good practice.

“By clumsily and unfairly sacking David Nutt, Alan Johnson has been rewarded with five resignations in protest. That takes a certain kind of ineptitude.”

Health Direct has complied this post from:

http://www.telegraph.co.uk/health/healthnews/6470090/Three-more-drug-advisers-quit-over-David-Nutt-sacking.html

http://www.timesonline.co.uk/tol/news/politics/article6911558.ece

Fall in proportion of patients who pay for private health care

The proportion of patients who pay for their own operations– through private medical insurance or out of their own pocket– has tumbled almost 30 per cent since Labour took power.

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

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

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

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

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

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

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

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

The ISTC programme, where some contracts were cancelled and the fate of those contracts that are coming up for renewal is uncertain, “has dented providers’ confidence in the government’s long-term intentions,” Mr Laing said.

Patients are to be given a legal right to seek treatment at a private hospital if the NHS fails to honour its promise to treat them within 18 weeks, according to government insiders. The measure is expected to be included in the Queen’s Speech this month. The same entitlement is likely to apply to the pledge that patients with suspected cancer must be seen by a specialist within two weeks.

Patients can already choose to receive their NHS funded care for non-urgent procedures at a private hospital – although it is not routinely possible to switch to private care once diagnosis and treatment are under way.

Labour has already said it will turn its 18-week wait target into an “entitlement”. The move to make it a legal right is at least partly political, with Labour ministers planning to challenge the Conservatives over whether they would repeal such a measure.

From:
http://www.ft.com/cms/s/0/b364c9c6-c72d-11de-bb6f-00144feab49a.html?nclick_check=1

Professor Nutt- if we want to reduce deaths, alcohol and heroin are the issues

Having been sacked from the Advisory Council on the Misuse of Drugs (ACMD), Professor David Nutt talks to the Telegraph.

On Saturday evening, two days after he was sacked from his position as drugs tsar for saying that cannabis is less dangerous than alcohol, Professor David Nutt went to a brass band concert in his local church in Keynsham, outside Bristol. "I came in late and sneaked in the back," he says, "but in the interval, the Master of Ceremonies announced I was there. The news was greeted by an amazing round of applause."

So his neighbours are fond of him: no surprise, since this Nutt's tough outer shell seems to hide a friendly father-of-four humanity. But that's missing the point. "The youngest person there was 50. Many were 85." To Nutt, this says it all. Not only is he – as he puts it – "on the side of the angels" in the clash between science and politics, he also believes that he is more in touch than the politicians with even the most conservative of rural electorates.

The past week has not been short of similarly morale-boosting moments. Emails have flooded his in-box – 98 per cent supportive. Ten thousand people have pledged their support on Facebook. Two fellow scientists on the Advisory Council on the Misuse of Drugs (ACMD) have resigned in sympathy. Teenagers, who normally don't even notice what's in the news, are rallying to the cause – to judge from the unusually high level of debate in my own home. My own teenagers, however, abruptly changed their views when they heard some of his suggestions for stopping them wrecking their livers.

Most encouraging of all to him, scientists are leading a march on Downing Street this Sunday, calling on the Government to "back evidence-based drug policy by respecting and upholding the independence of the ACMD" in advance of the Council's meeting next Tuesday. If he had taken a hallucinogen, Nutt couldn't have asked for more.

Far from repenting the remarks that caused Alan Johnson, the Home Secretary, to think Nutt had "crossed the line" between advice and policy – which he surely did – the beaming professor of neuropsychopharmacology is loving every moment of his disgrace. Academics don't usually become folk heroes. Nor do they generally manage to attract more than 30-second news clips. But these days his phone is ringing non-stop with requests for his wisdom from around the globe. "Sorry, it's Radio Bogota,"he says, as his mobile trills yet again.

Nutt enjoys speaking out: earlier this year he pointed out that "Equasy" as he called it – horse riding – was more dangerous than Ecstasy. Having devised a "matrix of harm" – a graph to calculate the damage done by various substances, on the basis of dependence, and physical and social harm – he's delighted to have been handed a platform from which to preach.

The big problem, as he sees it, is that while politicians love to be "tough" on classified drugs, their response to the far greater danger posed by the most dangerous drug of all, alcohol, has been "puny".

"We are not taking the tidal wave of damage seriously enough. If we want to reduce deaths, alcohol and heroin are the issues. I have four children, now aged 18 to 26, and at almost every party they went to in their teenage years, a child was taken to hospital with alcohol poisoning.

"Liver disease will become a worse killer than heart disease within twenty years. Scotland already has the highest proportion of people with sclerosis of the liver in the world. There are hundreds of kids lying in hospital beds waiting for transplants that will never come. But when Sir Liam Donaldson [the Government's chief medical adviser] put forward a radical approach to reduce alcohol consumption by increasing the price, within seconds the government rejected his proposal."

Nutt is not a puritan. He confesses to "liking" alcohol, to having binged occasionally when he was young, and to having tried some drugs as a student – but not cannabis, because he has never smoked. The worst problem with alcohol, he says, is that it is "insidious": people develop a strong head and aren't aware of its toxicity. But the main issue is that moderation doesn't seem to be possible for many people, especially the young.

He has asked his own children why their friends set out to get wasted and break the windows of the Keynsham church. "They say it is the excitement of not knowing what will happen."

His matrix isn't going to stop them experimenting, so what would positive action should politicians take, short of sacking their advisers? "We cannot make alcohol illegal. We need a structural approach. The real price of alcohol has dropped by half since Labour came to power and the use has doubled. To bring consumption down, prices should be doubled, maybe tripled, and the drink-driving limit should be reduced. We could even change the age at which it is legal to start drinking. In the US, since most states switched back from 18 to 21 (in the late 1980s), 170,000 lives have been saved in road traffic accidents. A shifting of the starting age would also reduce the damage to brain and body and the likelihood of young people becoming dependent."

Nutt pauses for effect before offering his most "radical" solution of all: an alternative to alcohol that's safer. Yuck, I don't want to take a soma pill when I get back from work; I want a delicious glass of white wine.

"Aaah, but if we invested some work in it we might find something as delicious. As it stands, though, with the Misuse of Drugs Act, if I came up with it tomorrow, I couldn't sell it. I'd like there to be a prize for inventing a safe alternative, as there was for inventing the chronometer in the 18th century, and the prize would be being allowed to sell it. You could also design an antagonist that would reverse the effects. Science could get there in five to 10 years. Let's move on from 2,000 years of poisoning ourselves."

That's what people thought they had found in cannabis, which makes you light-headed but not likely to get into fights or drive too fast. Forty years on from the Summer of Love, however, everyone knows someone whose brain has turned to mush or, worse, has become psychotic. Yet he opposes plans to reclassify cannabis from B to C, even though "skunk" – one of several cannabis derivatives – is now so much more powerful than standard "weed".

"Stoned people aren't a danger to others," he says. "Classifying it as B will be a disaster, because anyone caught in possession three times can be sent to prison for five years. The prison population will increase, those people will find it hard to get jobs. That way you just add to the underclass and the tax burden."

Sunday's march on Downing Street is emphatically not calling for legalisation. Although legislation might be a logical next step, Nutt is supportive. "It [legislation] would increase use. And I could never countenance the marketing of drugs, as with alcohol and tobacco. But I would like some level of toleration, as in the Netherlands, where cannabis can be smoked in certain cafés and a small amount bought for use off the premises: that has reduced social harm because it makes the drug less appealing. It is no longer a statement of dissent. Many other European countries have moved away from criminalisation for personal possession. In Portugal, people found with cannabis are now sent to social workers; use has gone down."

Nutt cites a MORI poll conducted by the ACMD that suggests most British people don't want stoned youths imprisoned. But, he adds, it's wrong to see him as soft on all drugs because, during his ten years as the Council's chair, he has been the "biggest criminaliser of drugs".

In that time, a host of new ones have been classified, including ketamine and GBL, the party drug that killed medical student Hester Stewart this May. He has also moved Crystal Meth from Class B to Class A, thereby allowing the police to shut down houses where it is produced. Another source of pride is the containment of Aids due to moving heroin addicts onto Methadone.

It all comes back to his matrix of harm. No one much knew of it before; now we do. Outside the ACMD, Nutt may turn out to have more clout than he ever did as an insider. Next Tuesday's meeting may or may result in a mass resignation, but the sacking of Nutt could be a turning point for so-called independent advisory bodies that are allowed to say what they like, providing it fits with Government policy.

Among the many messages of support have been several from people who want scientists to advise on the damage done by the various drugs in circulation, and are willing to fund it.

"I'm hoping," says Nutt, "that we can create a separate, independent scientific body that can take this out of party politics. Then we can monitor drugs and the Government can decide policy." Alan Johnson might agree with him there.

From:

http://www.telegraph.Professor-Nutt-If-we-want-to-reduce-deaths-alcohol-and-heroin-are-the-issues

NHS offers hospital to private bidders

An NHS district general hospital, complete with accident and emergency and maternity services, is being offered up for takeover by the private sector for the first time, alongside bids from other NHS organisations.

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

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

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

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

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

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

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

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

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

From:

http://www.ft.com/cms/s/0/11981a30-c4b7-11de-8d54-00144feab49a.html

Health Direct asks- what is the point? A hospital has over run it's budget with no sign of financial balance in the near future. So some paperpusher in the DoH has come up with the bright idea of external funding. 

Great- except that they don't really want the hassle that will go with the spin. So wait 18 months until a change of govt with new masters. In the meantime, let's waste some poor business sod's time by looking at prospective red tape. 

Ergo 18 months time no new money, same old problem.

NHS accused over illegal gagging of doctors' safety concerns

Outlawed gagging clauses are still being used by the National Health Service to silence concerns about patient safety the British Medical Journal has found.

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

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

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

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

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

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

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

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

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

From:

http://www.ft.com/cms/s/0/37819d76-c362-11de-8eca-00144feab49a.html?nclick_check=1

Science minister calls on Brown to reverse Johnson's big mistake

The labour Government was bitterly divided last night over the sacking of the Home Office’s chief drugs adviser after its Science Minister said that he was appalled by Alan Johnson’s decision.

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

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

In an e-mail to Nick Butler, the Prime Minister’s policy adviser, Lord Drayson wrote: “Alan did this without letting me know and giving me a chance to persuade him. It’s a big mistake. Is Gordon able to get Alan to undo this? As ‘science champion in Government’, I can’t just stand aside on this one.”

According to The Sun, which obtained a series of e-mails written by Lord Drayson, the minister said he was “pretty appalled” at the decision.

Last night Lord Drayson said: “My comments in the e-mail exchange were my immediate reaction to what had happened, without full knowledge of all the facts. I talked to Alan Johnson and he has assured me of the importance he attaches to scientific advice and his respect for scientific advice while being the person who has to make the final difficult decision.”

The resignation of a key member of Britain’s drugs advisory panel after the sacking of Professor Nutt has left ministers powerless to develop or update drugs policy.

The departure of Marion Walker from the Advisory Council on the Misuse of Drugs (ACMD) means that it no longer has a pharmacist representative on the board, contravening its statutory requirements, The Times has learnt.

Mr Johnson is to hold urgent talks with members of the ACMD, who wrote to him yesterday expressing “serious concerns” about the council’s relationship with Government.

It also emerged that the Home Office has started a review of the ACMD to look at whether it is accountable, if it is “discharging its functions” properly and if it continues to represent value for money. The review, which was launched last month and also covers the Animal Procedures Committee, is being conducted by Sir David Omand, a former permanent secretary.

The ACMD is responsible for reviewing all issues of drug misuse and advising Government on abuse, dependency and related social problems.

Under the Misuse of Drugs Act 1971, the Home Secretary is not permitted to amend the classification of any drug, including adding new ones to the list, “except after consultation with or on the recommendation of the advisory council”.

The law requires that six of council members represent particular fields, with Ms Walker the sole pharmacy specialist. Sir Leszek Borysiewicz, chief executive of the Medical Research Council, said that ministers risked losing the confidence of expert advisers across government unless they confirm their independence after the sacking. 

He said that the dismissal of the chief drugs adviser had created an “incredibly regrettable situation that has a potentially negative effect on the relationship between scientists and the Government”.

Sir Leszek, who heads a body that spent £704 million of public money on research in 2008-09, is the highest-ranking scientist on the government payroll to speak out so far over the Nutt affair.

From:

http://www.timesonline.co.uk/tol/news/politics/article6900121.ece

Surge in patients going private on NHS

More patients are choosing private hospitals for their NHS treatment, latest figures from the Department of Health show, as labour's much vaunted "choice" agenda finally takes off.

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

The great bulk have done so during the past year.

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

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

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

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

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

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

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

Asking whether the big squeeze to come on NHS spending is likely to mean fewer opportunities for the private sector or more, Mr Ricketts said: "Probably more".

Dramatic changes in the way care is delivered will be needed to secure efficiencies and quality improvements as the NHS seeks savings of £20bn, he said - and an innovative private sector, prepared to invest, could play a big part. He played down the likely impact of statements from Andy Burnham, the health secretary, that NHS organisations are now the service's "preferred provider".

From:

http://www.ft.com/cms/s/0/4728bd8a-c1ce-11de-b86b-00144feab49a.html?nclick_check=1

Sacked – for telling the truth about drugs

Labour fires top adviser Prof Nutt for challenging its hardline policy on cannabis and ecstasy.

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

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

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

He was backed by other senior scientists and politicians.

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

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

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

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

The Home Secretary asked him to consider his position after a recent lecture in which attacked what he called the "artificial" separation of alcohol and tobacco from other, illegal, drugs. Last night Professor Nutt said he stood by his comments. "My view is policy should be based on evidence. It's a bit odd to make policy that goes in the face of evidence. The danger is they are misleading us. The scientific evidence is there: it's in all the reports we published. Our judgements about the classification of drugs like cannabis and ecstasy have been based on a great deal of very detailed scientific appraisal.

"Gordon Brown makes completely irrational statements about cannabis being 'lethal', which it is not. I'm not prepared to mislead the public about the harmfulness of drugs like cannabis and ecstasy. I think most scientists will see this as an example of the Luddite attitude of governments towards science."

He repeated his view that cannabis was "not that harmful" and that parents should be more worried about alcohol.

"The greatest concern to parents should be that their children do not get completely off their heads with alcohol because it can kill them ... and it leads them to do things which are very dangerous, such as to kill themselves or others in cars, get into fights, get raped, and engage in other activities which they regret subsequently. My view is that, if you want to reduce the harm to society from drugs, alcohol is the drug to target at present."

In a recent broadside, Professor Nutt accused Jacqui Smith, who oversaw the reclassification of cannabis from Class C to Class B, of "distorting and devaluing" scientific research. He said her decision to reclassify cannabis as a "precautionary step" sent mixed messages and undermined public faith in government science.

"I think we have to accept young people like to experiment – with drugs and other potentially harmful activities – and what we should be doing in all of this is to protect them from harm. We therefore have to provide more accurate and credible information. If you think that scaring kids will stop them using, you are probably wrong."

The Home Office said Mr Johnson had written to Professor Nutt expressing "surprise and disappointment" over his remarks. Mr Johnson said in the letter that Professor Nutt had gone beyond providing evidence to "lobbying" for changes to policy. He said: "As Home Secretary it is for me to make decisions, having received advice from the [Council] ... It is important that the Government's messages on drugs are clear and as an adviser you do nothing to undermine the public understanding of them ... I am afraid the manner in which you have acted runs contrary to your responsibilities."

The shadow Home Secretary Chris Grayling said: "This was an inevitable decision after his latest ill-judged contribution to the debate, but it is a sign of lack of focus at the Home Office that it didn't act sooner, given that he has done this before."

But Phil Willis, chairman of the Science and Technology Select Committee, said: "I am writing immediately to the Home Secretary to ask for clarification as to why Sir David Nutt has been relieved of duties as chair of the Advisory Council on Misuse of Drugs at a time when independent scientific advice to Government is essential. It is disturbing if an independent scientist should be removed for reporting sound scientific advice."

Claudia Rubin from Release – a national centre of expertise on drugs and drugs law – said the expert should not have been penalised. "It's a real shame and a real indictment of the Government's refusal to take any proper advice on this subject," she said.

From:

http://www.independent.co.uk/life-style/health-and-families/health-news/sacked-ndash-for-telling-the-truth-about-drugs-1812255.html

Health Direct notes that it is hard not to suspect that Professor Nutt's real crime in the eyes of the labour Government was not his interference in politics but the fact that his words embarrassed ministers.

But why now? Health Direct posted on August 02, 2006 Prof Nutt's orginal research Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

Health Direct reproduces the first ranking based upon scientific evidence of harm to both individuals and society. It was devised by government advisers - then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council. Copies of the report have been submitted to the Home Office, which has failed to act on the conclusions.

Since then Prof Nutt was promoted by labour to be chairman of the govt's Advisory Council for the Misuse of Drugs. So his research and opinions were in the public domain- and presumably approved of when he was promoted. Ergo, why the fuss now? He's not saying anything new. Just common sense.

Postcode lottery for IVF treatment faced by patients

Couples seeking IVF infertility treatment in some parts of Scotland are having to wait up to three years longer than those in other areas, it was revealed.

Labour MSP Jackie Baillie called on the Scottish government to end what she described as a postcode lottery on IVF treatment.

Figures obtained by the MSP under a freedom of information request showed that the longest average waiting times among the 11 boards that responded were in NHS Lothian, where patients wait three years for treatment. Patients in the Borders, referred to the same unit in NHS Lothian, had no waiting time.

In Glasgow the average wait was 22 months, while couples from Lanarkshire were referred to the same hospital, Glasgow Royal Infirmary, within an average of six months.

In Fife the average wait for IVF treatment was two years. In NHS Highland and Tayside it was one year, and in Grampian a maximum of 18 months.

“This shows clearly that it is the board of residence that determines length of wait,” Ms Baillie said. “There is no consistency in the rules. NHS Borders will fund patients for treatment in neighbouring areas if they have shorter waiting lists, but other health boards refuse to consider such a sensible step.”

Although some boards, notably NHS Greater Glasgow and Clyde, did not reveal the number of patients, Ms Baillie’s figures indicate that more than 1,000 couples across Scotland are waiting to see a specialist.

Long waiting times have a particular resonance for inferitlity treatment, as a woman’s age is critical to success rates. One expert describes the age factor as “the most monumental challenge”.

Ms Baillie said national guidelines were needed to ensure that patients were treated fairly and had access to treatment as quickly as possible.

Shona Robison, the Public Health Minister said: “There is huge demand for IVF and we know it can be very upsetting to have to wait for treatment, but we are working to make access as fair as possible.”

Jackie Sansbury, of NHS Lothian, said: “We are investing an additional £180,000 to increase the number of IVF cycles we are able to offer by about 40 per cent during 2009-2010.”

From:

http://www.timesonline.co.uk/tol/news/uk/scotland/article6883053.ece

High society- Britain's drug taking clubbers pt 2

The first wideranging academic study of clubbers’ behaviour in a decade, indicates that thousands of apparently successful, healthy and economically active people in their twenties, thirties and forties choose to be heavy recreational drug users at the weekend.

With permission from club proprietors, Measham and Moore did their fieldwork in Manchester, the epitome of the 24-hour party city. They set up a website to verify their work to clubbers, then interviewed them at the start of the evening before the drugs had made revellers too intoxicated.

One of the fundamental ironies the research uncovered is that because recreational drug users fuel the economy and cause few social problems — violent crime, aggression and antisocial behaviour are much more likely to be alcohol-related and occur outside pubs — they fail to get the support and services they need.

“There is a lack of knowledge about the types of drugs, a lack of accurate, non-judgmental and non-sensationalist information for these users,” says Moore, a lecturer in criminology. “Ketamine, for instance, does not go well with alcohol. Nor does GBL [which coverts to GHB in the body], which is widely used as an industrial cleaner, and is not illegal. I’ve been working with one man who had a serious daily dependency on GBL, but the doctors simply didn’t know what to do with him.”

Here too is highlighted another contradiction: between the growing commercialisation of the night-time economy and the increasing government policy of what Measham calls “the criminalisation of intoxication” without education, advice or treatment services attached. The people who suffer, under the present situation of tacit tolerance of drugs, are the users. “Even if the club owners wanted harmreduction literature in their club, it would acknowledge that there was drug taking on the premises. And they are concerned about being arrested or shut down.”

Last year the owner of the Dance Academy in Plymouth, Manoucehr Bahmanzadeh, and its manager, Tom Costelloe, were found guilty of allowing the venue to be used for the supply of Ecstasy and jailed for nine years and five years respectively. This despite neither man having actually sold drugs on the premises.

What is important, Measham and Moore say, is to draw the distinction between this kind of recreational drug use, and the problem drug use that dominates the political agenda and absorbs its resources. The two groups do not overlap; the dealers are different; and so are the drugs. 

Clubbers almost never take heroin or crack cocaine, the academics’ surveys show, and they remain in society. The UK’s problem drug users, with a daily dependency on such drugs, may be hugely outnumbered by the recreational drug takers — 150,000 as opposed to four million — but they remain the focus of government policy.

To use the phraseology of Russell Newcombe, a drug researcher for Lifeline Manchester, drugs represent “cocktails of celebration” for one group. For the other, they are a “cocktail of oblivion”. And the difference is profound.

Significantly, however, trends are changing. Recent analysis from the NHS’s National Treatment Agency for Substance Misuse shows 22 per cent fewer young adults with a drug problem are using heroin and crack, and the number of under-25s seeking treatment for dependency on cocaine has risen 11 per cent.

To visit a club is to witness striking inconsistencies in the way that society deals with drugs. It is amusing to see a line of people, most of who have taken illegal drugs, queueing politely to get outside to the smoking area to consume a drug that is banned inside.

The lack of focus, criminal and otherwise, on recreational drugs means the risks to clubbers are going largely unassessed. Measham and Moore are concerned about the health impact from the new fashion for mixing drugs. The outcry over the death of Leah Betts appears not to have checked universal acceptance of Ecstasy, although there have been more than 200 Ecstasyrelated deaths in the UK since 1996. Many younger clubbers, the academics discovered, are ignorant of the fact that the increasingly popular MDMA powder is pure Ecstasy; and few are aware that ketamine is dangerous when mixed with alcohol.

“We would like to see a sensible debate about drugs without the shock, horror bit — if only because of the sheer numbers we see involved,” says Measham. “People have a desire to get intoxicated on a Friday night — the American pharmacologist Ronald Siegel once described intoxication as the fourth strongest irrepressable human desire after food, sleep and sex.

“That suggests that blanket prohibition is destined to be a disaster. We need a more sophisticated but also more realistic response. If people have a choice they don’t really want to break the law. That’s where the debate needs to take place.”

98 per cent of club customers had tried an illegal drug at least once
79 per cent had taken an illegal drug within the previous month
Only half as many bar customers (35 per cent) had taken an illegal drug in the previous month
85 per cent of clubbers had tried Ecstasy at least once
83 per cent had tried cocaine at least once
44 per cent had tried ketamine at least once
40 per cent had tried MDMA at least once

From:

http://women.timesonline.co.uk/tol/life_and_style/women/the_way_we_live/article6879862.ece

High society- Britain's drug taking clubbers

Almost all Britain’s thousands of clubbers routinely take drugs, in particular cocaine , cannabis and ecstasy.

The first wideranging academic study of clubbers’ behaviour in a decade, released this month, indicates that thousands of apparently successful, healthy and economically active people in their twenties, thirties and forties choose to be heavy recreational drug users at the weekend.

Not only do the findings suggest almost ubiquitous drug use in and around Britain’s clubs, in particular cannabis, cocaine and Ecstasy, but they point to the emergence of new substances on the pharmaceutical block, such as ketamine and GHB, being used increasingly by clubbers as part of assorted drug “repertoires” at the weekends.

Ketamine, a Class C drug, is an anaesthetic, sometimes used on animals, which causes temporary hallucinations. GHB — gammahydroxybutrate — is also Class C and produces a feeling of euphoria. Both can be dangerous, powerful drugs.

Dr Fiona Measham and Dr Karenza Moore, criminologists from Lancaster University, set out to explore the hidden world of pharmaceutical intoxication in Britain’s bars and night clubs. What they found, in the most thorough examination ever undertaken of drugs across the British night-time economy, was extraordinary.

They discovered evidence that almost all Britain’s thousands of clubbers routinely take drugs, in particular cocaine (tried by 83 per cent of people), cannabis (93 per cent) and ecstasy (85 per cent). Eight in ten had taken a drug within the previous month, and nearly two in three of those questioned had taken, or were going to take, drugs on the night they were surveyed.

These statistics, published in the journal Criminology and Criminal Justice, demonstrate how drug-enduced dancing and socialising has become a significant part of modern culture, albeit taking place “under the radar” with the tacit acceptance of police, politicians and economists.

Indeed, the figures indicate that much of Britain’s burgeoning night time economy, worth as much as £30 billion, and employing about one million people, is inextricably linked to the night long consumption of illegal drugs. 

The trend is such that the main clubbing nights have been moved from Saturdays to Fridays specifically to allow people to recover in time for work or lectures on Monday morning.

The extent and complexity of drug use that the academics uncovered surprised them. “Everyone knows that it goes on,” says Measham, a senior lecturer in criminology, whose 2001 study Dancing on Drugs was until now the seminal study of recreational drug use. “How else would the clubbers stay awake until 5am, when the club closes? But it’s unspoken.

“Drug taking is implicitly facilitated but it’s the individual who takes the risks. And there are risks — the implications of having a criminal record on your career, for one, and the health aspects.

“One of the big surprises was the scale of polydrug use [the taking of several substances]. Fifteen years ago people would take an Ecstasy tablet or two and a wrap of speed; now they are taking a whole range of drugs without knowing what the impact is of these polydrug cocktails. We just don’t know about ketamine and GHB. We’re seeing a lot more use of both drugs. Ketamine has not displaced Ecstasy but it has been added to the repertoire.”

From:
http://women.timesonline.co.uk/tol/life_and_style/women/the_way_we_live/article6879862.ece

Health Direct will be posting the second part of this research tomorrow.

NHS told to brace itself over swine flu epidemic

The NHS has been told to brace itself for action after a steep rise in swine flu infections.

The number of new cases reported in England over the past week has nearly doubled to 53,000. In Scotland, there was a slight rise to 14,650.

It comes as more and more people are being admitted into intensive care and the number of deaths hit 128 in the UK.

Ian Dalton, head of flu planning at the NHS, said if the rises continued critical care would be expanded.

Plans have been drawn up over the last few months to double the number of intensive care beds to over 4,000.

And with the UK well into the second peak, concerns are being raised about the sustained pressure that will be put on the health service.

Mr Dalton said: "If current trends continue we are going to have to surge capacity. My message now is that the NHS must be ready."

In England, there are 99 people in critical care beds - the highest since the pandemic began. But it is the rate of admission to these specialist beds which is causing particular concern.

During the summer, about 1 in 10 patients in hospital with swine flu ended up in critical care, compared with one in five now.