A spate of 13 deaths among heroin users whose drugs were contaminated with anthrax has highlighted how addicts are “demonised” and struggle to get treatment, according to experts.
Since the contaminated batch was first detected in the UK last Christmas, almost 50 addicts have been admitted to hospital, while 13 have died.

Anthrax-related heroin deaths are extremely rare, and in the past were unheard of in the UK. There has been only one known previous outbreak among heroin users, and that took place in Norway in 2000.

The vast majority of the deaths in this new outbreak have occurred in Scotland, predominantly in Glasgow. Several heroin users have also contracted anthrax poisoning in England, and so far one person has died. There has also been one fatality in Germany and nine in Portugal, although the cause of these deaths is disputed.

Drugs counsellors have told the guardian of their frustration that, as the crisis mounted, they were unable to help worried addicts switch to alternative drugs, such as methadone, because of lengthy waiting lists.

“Often, if we have a health scare among drug users, the advice we give is to use drugs in safer ways. For instance with HIV, we encouraged people to use needle exchanges,” said Gareth Balmer, project manager of Addaction Dundee, a support centre. “But this time around, the message we were getting from government was to tell people to stop using heroin, which was as much use as a chocolate teapot.

“If we could have got people access to methadone or Subutex [another heroin substitute] very quickly, it wouldn’t have been a ridiculous message, but we were looking at six-month waiting lists and, in some parts of Scotland, a year.” Balmer said the situation had “brought home how behind we are in helping people access that treatment”.

“Heroin users don’t use heroin for fun; it’s a physical and psychological dependency. We have a constant supply of people who would like to access methadone, but we felt as drug workers it was insulting people to say: ‘There’s possibly anthrax in your heroin; my advice is to stop using.’ I was surprised I didn’t get punched in the face.”

Anthrax infection can be cured if treated early enough. Common signs of infection are redness and swelling around the injection area. The scale of the outbreak is still being assessed, with checks being conducted at the top-secret Porton Down laboratory in Wiltshire, where biological and chemical weapons are tested.

How the anthrax found its way into the heroin is still open to question. Some addicts claimed it was part of a plot by shadowy government agencies to rid the country of drug users. Others speculated that it was the work of the Taliban, who control opium production in Afghanistan, where more than 90% of the UK’s heroin comes from.

However, guidance issued to investigating police officers, states that there are two likely causes: “Heroin could be naturally contaminated after harvesting from contact with soil in an area where an animal had died from anthrax at some point, or by being stored or transported in contact with animal products, especially skins, from an animal that had died from anthrax,” the guidance states.

“The second option is that the heroin was contaminated at some stage during the cutting process… Of feasible agents, animal products are the most likely, and of these, bone meal would be suitable for cutting and has been associated with cases of cutaneous anthrax in people handling it in the past.”

But despite the unprecedented number of deaths, the issue has been largely ignored. “Media indifference on this issue, considering the number of fatalities that have occurred, has been disappointing, but not surprising,” said Martin Barnes, chief executive of DrugScope, an organisation that tracks trends in drug use. “These people are stigmatised and demonised. There is a feeling they are blameworthy and less deserving of public concern and attention.”

The deaths have refocused attention on the 300,000 heroin users in the UK, around 2% of whom will die this year as a result of their drug use. They have drawn comparisons with an earlier health crisis that plagued the addict community when a batch of heroin was infected with botulism.

Experts note that the price of heroin has fallen significantly in the past year, possibly as a result of bumper harvests in Afghanistan. Currently a £10 bag sold on the streets of Glasgow will contain 0.2g of heroin, compared with 0.1g a year ago – although prices have started to rise again as larger quantities of the drug are diverted to China and eastern Europe.

Balmer warned that the crisis could yet reignite. “Our worry is that the infected heroin will be buried somewhere until the heat dies down. It happened with the botulism scare. Somebody could still be holding on to it until we’ve all forgotten about it.”

From: http://www.guardian.co.uk/society/2010/jul/11/anthrax-heroin-deaths

The gap between average life expectancy and that of the poorest in England is widening despite efforts to close it, a National Audit Office report says.
Life expectancy is now 77.9 years for men and 82 years for women but in poor areas it falls to 75.8 and 80.4 years.

The NAO says this means that from 1995-97 to 2006-08 the life expectancy gap grew by 7% for men and 14% for women.

It is calling for more investment to help GPs tackle problems like smoking and poor diet in poor communities.

The NAO says the figures mean a Labour government target to reduce the difference in life expectancy by 10% by 2010 is unlikely to be met.

Its report says it is not possible to show how much money has been spent on tackling health inequalities, as primary care trusts (PCTs) are not allocated specific funding for the task.

But it says that at present the system “does not provide enough of an incentive” to encourage family doctors to focus on the neediest groups in their practices.

The report says it would not cost “a large amount of money” – £24m a year – to take key actions which would improve health in deprived areas.

These include increasing the prescribing of drugs to reduce cholesterol and control blood pressure, and doubling the capacity of services which help people quit smoking.

The report contrasts that amount with the £3.9bn spent by PCTs in the poorest areas on treating circulatory and respiratory illness.

Life expectancy for everyone in England improved under Labour, and now stands at almost 78 years for men and 82 years for women.
MORTALITY RATES FELL SLOWEST IN THE PRIMARY CARE TRUSTS OF:
* Salford
* Bolton
* Middlesbrough
* Blackburn with Darwen
* Hartlepool
* Bradford
* Oldham
* Nottingham City
* Sandwell
* Ashton, Leigh and Wigan
* Leicester City
* Hull
* Blackpool

But the improvement rate has been slower in the most deprived communities, and currently the equivalent figures are 75.8 years for men and 80.4 years for women.

Analysis also showed that success rates in stop-smoking programmes were lower in the poorest communities than in other areas.

A spokesman for the British Medical Association, which has just concluded its annual conference, said: “We are disappointed that today’s report says that the Department of Health will not meet its target to reduce the health inequalities gap.

“At our meeting, the BMA passed a motion calling on the government to increase expenditure on prevention services to reduce health inequalities.

“It is particularly important to do this in early years to give every child the best start in life. We will also lobby for fiscal policies to narrow the income gap between the poorest and the richest in society. Doctors believe it is necessary to take this action to tackle health inequalities.”

From: http://news.bbc.co.uk/1/hi/health/10475835.stm

The Royal College of GPs says thousands of new health visitors whom the government plans to recruit should not solely be placed in children’s centres.
Over 4,000 more health visitors have been promised in England, focused in Sure Start centres.

GPs say there is already a breakdown in communication with health visitors who work in the centres, and placing more there would make it worse.

But children’s charities say parents need a more informal approach.

Health visitors have usually worked out of GPs’ surgeries – but the growth of Sure Start children’s centres has seen more moving to them.

The children’s charity 4children says having health visitors based in these centres means there is less need for mothers to use GPs’ surgeries for non-urgent problems and advice.

The Royal College of GPs says its members are seeing a worrying pattern developing, where vital information is not being passed back to them.

It says GPs need to be more actively involved in the the care of mothers during and after their pregnancy, and health visitors have to link in more with GP practices.

Professor Steve Fields of the Royal College of GPs said: “Mums-to-be are not getting the service they could have had five or 10 years ago.

“It is an unintended consequence of children’s centres being established and health visitors moving out of GPs’ surgeries and GPs not being as actively involved the care of mums-to-be during their pregnancy.

From: http://news.bbc.co.uk/1/hi/uk/10423346.stm

The rise in emergency admissions to hospitals is “overheating” the system in England and is “unsustainable” in the future, a health think tank says.
Analysis by the Nuffield Trust found there were now 4.9 million unplanned admissions a year – a rise of 12% since 2004-05 – costing the NHS £11bn a year.

It said a rise in patients who spent a day or less in hospital suggested many admissions could be avoided. NHS managers agreed action was needed to tackle the problem.

Emergency admissions include patients admitted through A&E units as well as direct into other parts of hospitals.
Ageing population

The think tank, which analysed a range of official NHS data during its research, found emergency admissions now accounted for more than a third of the total.

The rise seen since 2004-05 is costing the NHS an extra £330m a year alone and the think tank said the issue had to be a priority if the NHS was to prosper in the current economic climate.

Researchers found there was a range of factors behind the trend.

They pointed to the ageing population – the elderly were more likely to be admitted as an emergency – as well as financial incentives in the NHS which were motivating hospitals to admit more.

The report also noted there had been a significant jump in patients being admitted for one day or less.

It said this was partly related to advances in medicine which meant patients did not need to spend as long in hospital, but argued many could have been avoided with better community services.

While the report only looked in detail at the situation in England, it also noted rises had been seen elsewhere in the UK.

And it said the recent announcement by ministers that hospitals would be fined for readmissions would only have a limited impact as many of the cases did not fall into that category.

Nuffield Trust director Dr Jennifer Dixon said: “Reversing this unsustainable rise in emergency admissions must be the number one priority for the NHS – any reform to the health service that does not tackle this will fail. Our hospitals are overheating and are treating patients at great cost to the NHS.”

Nigel Edwards, acting chief executive of the NHS Confederation, which represents managers, said: “This report furthers the case for fundamentally reviewing the urgent and emergency care system.

“Hospital is often the right place for sick patients to be but we know that for many there are better, more convenient and more cost-effective alternatives to hospital admission.

Dr John Heyworth, president of the College of Emergency Medicine agreed there were pressures in the system, but questioned some aspects of the research.

“It is fundamentally incorrect to assume that admissions for less than 24 hours are unnecessary or financially inefficient. In fact, the opposite applies.”

From: http://news.bbc.co.uk/1/hi/health/10490508.stm

An NHS worker with an unblemished 27-year career was sacked after she blew the whistle on senior doctors who were moonlighting at a private hospital while being paid to diagnose NHS patients, an employment tribunal has heard.

Sharmila Chowdhury, 51, the radiology service manager at Ealing Hospital NHS Trust, repeatedly warned the hospital’s most senior managers that doctors were dishonestly claiming thousands of pounds every month.

A Watford employment tribunal judge took the unusual step last week of ordering the trust to reinstate Ms Chowdhury’s full salary and said: “I have no hesitation in saying that you are probably going to win.”

The ruling will be a bitter blow for the trust, particularly as despite the seriousness of the allegations, it failed for two years to take any action against Miranda Harvie and Peter Schnatterback, the two doctors accused of fraud at the hearing.

Instead, Ms Chowdhury was suspended after a counter-allegation of fraud made against her by a junior whom she had reported for breaching patient safety. Radiographer Michael McWha made the allegation at the request of Dr Harvie, the tribunal heard. Ms Chowdhury was sacked for gross misconduct in June, eight months after her suspension.

This case is the latest to highlight the inadequate legal protection for whistleblowers who speak out about wrongdoing in the NHS.

It also raises the uncomfortable question about the power yielded in the NHS by senior doctors. The onus is now on the trust to prove at next February’s tribunal that Ms Chowdhury was guilty of fraud and not, as she claims, sacked because she was a whistleblower.

Speaking after the judgment, a tearful Ms Chowdhury expressed her relief after months of financial hardship. A widow with a teenage son, Ms Chowdhury has been forced to move back in with her elderly parents and rely on the goodwill of outraged lawyers.

She told The Independent on Sunday: “I cannot believe what has happened to me. I was horrified and humiliated when escorted out of the building, and for a whole month, I had no idea why I was suspended. I was just doing my job. I thought the trust would want to know consultants were doing private work on NHS time. The public has a right to know what is happening with public money.

“This whole thing has completely changed me. I’m trying to stay positive but I loved my work, my department, and there are not many jobs out there. I hope the trust sees sense and tries to resolve the situation. If it hadn’t been for Julie Morris at Russell Jones and Walker who took on my case for free, I would have lost everything I’d worked for all my life.”

Ms Chowdhury qualified as a radiographer at Hammersmith Hospital in 1983. She worked her way up the management chain before starting as Ealing’s deputy imaging manager in 2003.

The alleged fraud came to her attention after starting as service manager is 2007. It was her job to balance the books, report all staff absences and make sure X-rays, CT and MRI scans were of a high quality.

But in addition, she had a separate informal agreement with the trust to read X-rays, for which she was paid £2 per report. She did this every morning and would then work through lunch to complete her normal duties.

Mr McWha alleged that Ms Chowdhury was carrying out this extra work fraudulently. He did so after Ms Chowdhury launched an investigation upon discovering his failure to upload reports and scans from 100 patients on to the imaging system, which may have caused delays in diagnosing life-threatening conditions.

The trust admitted during the disciplinary hearing that it had failed to find any evidence to support his claim. But Ms Chowdhury was sacked for gross misconduct anyway, in order to placate the consultants who were fed up with Ms Chowdhury’s interference in their business, the tribunal heard.

From July 2007 onwards she had informed managers that Dr Harvie was being paid for 14 half-day sessions a week when she was working only seven. Evidence that Dr Harvie and Dr Schnatterback were working alternate Mondays at the Clementine Churchill Hospital in Harrow, while being paid to be at Ealing, was passed on. Dr Schnatterback also claimed £250 for evening sessions when his private commitments led to an NHS backlog, the tribunal heard. Frustrated by the trust’s apparent refusal to tackle the consultants, Ms Chowdhury wrote to the NHS Counter Fraud service in July 2009. Nothing happened.

Weeks before her suspension, she angered several consultants after reporting them for claiming four hours of overtime when working only three.

Reports of duplicate claims and extra annual leave days were also made. All these protected disclosures were made to the finance director in October 2009, who referred the issue to the trust’s fraud officer. He interviewed Ms Chowdhury in November 2009; days later she was suspended.

Ms Chowdhury’s barristers, Helen Mountfield QC and James Laddie from Matrix Chambers, suggested that the case illustrated the “long-established tradition in the NHS of power being wielded by consultants”.

In defence, Andrew Sharland, said: “This claim that there was some kind of grand conspiracy is unlikely to stand up. Ms Chowdhury is making very serious allegations against senior NHS consultants. This shows an extreme prejudice towards the NHS and towards the senior consultants.”

The trust said it was unable to comment on confidential matters relating to individual employees. Dr Schnatterback told the IoS that his twice-monthly private sessions were always approved by the clinical director and he did more NHS work than he was paid for. Dr Harvie denied the allegations. Mr McWha refused to comment.

Ms Chowdhury’s lawyers told the hearing: “The stated reason for dismissal is scandalous. It does not even survive the briefest scrutiny. This is not a mistake – it is a sham.”

The judge awarded her full pay until the hearing begins in February, including pay for the work which the trust claims was fraudulently completed.

Andrew Lansley, Secretary of State for Health, said last week the Government had plans to give the current legislation “more teeth”. It can’t come soon enough.

From: http://www.independent.co.uk/life-style/health-and-families/health-news/sacked-nhs-whistleblower-vindicated-2023809.html

A policymaker’s dream. A pragmatist’s nightmare. That has to be the verdict on Andrew Lansley’s white paper “Liberating the NHS”, published on Monday.

In one sense it aims to complete the work of the last Conservative government – and much that the Blairites also wanted for the health service. The last Tory government tried to free NHS hospitals from direct management by health authorities.

It aimed to get GPs to buy patient care. And it briefly attempted to absolve ministers from responsibility for the day-to-day management of the NHS by creating a short-lived ministerial supervisory board with an NHS executive beneath it.

But it rapidly got cold feet over the likely impact of the quasi-market it had created, fearing the destruction it would cause would be anything but creative.

Labour, having first ditched much of this, recreated it earlier in the decade in a far more sophisticated form – with independent regulation and inspection and a tariff for NHS care that, in theory at least, encouraged purchasers to put quality above price.

It never quite sorted out who should do the purchasing – primary care trusts or GPs, who have been running a form of practice-based commissioning that, in most places, has been severely constrained.

But had the Blairite plans come to fruition, the purchasing of care would by now have been separated from its provision. All hospitals by 2008 would have been self-governing institutions, positioned part way between the public and private sectors.

Primary care trusts would have been solely commissioners, while their district nursing teams and therapists and community hospitals would now be independently run, either on a foundation trust model, or as social enterprises, or contracted out to the private and voluntary sectors.

There would also have been a more vibrant public/private/voluntary market from which purchasers could buy all sorts of care, with patients being able to choose between them.

What Labour – or more accurately Tony Blair and Alan Milburn, then health secretary – wanted is what Mr Lansley now aspires to create: a self-improving system run as a regulated market of competing providers driven by patient choice and commissioning in a way that no longer needs direct management from politicians and the health department.

From there, the step to an independent commissioning board, with ministers doing little other than continuing to raise the money for the NHS, setting its broad priorities, and then holding the board to account, would have been seen as an interesting evolution, not a revolution.

But the NHS is a long way from that. The Blairite reforms first slowed, then under Gordon Brown, pretty much stalled.

Half of hospitals are still directly managed and a chunk will never pass the financial viability test to become foundation trusts. PCT provider arms have still to be sorted out. Social enterprise in the NHS barely exists. Private suppliers have yet to demonstrate convincingly that they can consistently do things better and more cheaply than the NHS. And the best GP commissioners are still relative beginners.

Yet in a dirigiste decision that smacks more of old Labour central direction than anything else, the Conservative health secretary has decided not to allow GP commissioning to evolve into something demonstrably strong and effective but to require that all GPs – whether willing or not – do the job or acquiesce in their colleagues doing it for them. All in one big bang.

Mr Lansley’s plans amount to an NHS revolution. Virtually no part of the service will be untouched by his announcements on Monday, which aim, in barely three years, not just to complete Labour’s unfinished business but to go much further.

Issues Labour grappled with unsuccessfully, however, remain unanswered.

What, for instance, are the failure regimes for the new arrangements? And thousands of managers whose jobs are to go are expected to retain financial control throughout the upheaval while helping GPs take on their new role. The odds are many will bail out while they have the chance.

As Sir David Nicholson, the NHS chief executive, said on Monday: “The clarity of the vision is all very well. The big issue is how do we manage the transition.” With immense difficulty, is the answer. Mr Lansley, a man with a plan in a hurry, risks losing both financial control and performance.

From: http://www.ft.com/cms/s/0/7f3bc0e4-8def-11df-9153-00144feab49a.html

Self governing NHS hospitals – known as foundation trusts – have had their private income capped to date, but this is to be lifted in the NHS overhaul.
The Foundation Trust Network believes the move will spark a burst of innovation in the sector.  But campaigners said they were worried NHS services would be harmed.

To get foundation trust legislation through parliament in 2003, ministers agreed to a cap on private work to ensure the hospitals remained true to their NHS traditions.

This has stopped some of the leading hospitals in the NHS competing with private firms for patients.

But that will now change under the proposals unveiled in Monday’s white paper. Health Secretary Andrew Lansley said he wanted to create a “vibrant” industry of social enterprises by scrapping the rule and ordering all NHS trusts to become foundation trusts within three years.

Sue Slipman, director of the Foundation Trust Network, said the move would make a big difference.

“It is exciting for foundation trusts. We will have to wait to see what exactly happens, but there are huge opportunities to innovate.”

She said one of the most obvious areas for expansion would be in fertility services where treatment on the NHS is severely restricted.

“In the past these patients have had their NHS cycles and then left for private treatment. That is money that has been lost to the system.”

She also said mental health trusts may be interested in offering talking therapies to businesses for their workforce health schemes.

University College Hospital in London has already gone down this route with a private US health firm which has located a private unit on its site for cancer treatment.

The firm leases the space as well as paying for the NHS services it uses, such as intensive care, radiology and cleaning and catering.

The trust has also established a joint venture with a private firm to provide pathology services.

Sir Robert Naylor, the chief executive of the trust, said: “These initiatives bring in money which can then be reinvested in NHS services.”

Many NHS hospitals also operate their own private wings, although most of these only bring in a small amount of income. The exceptions are specialist centres such as the Royal Marsden cancer hospitals and Moorfield Eye Hospital.

But John Lister, of the union-funded pressure group Health Emergency, said he had concerns.

“Hospitals could overstretch themselves in chasing private patients which in turn takes away from the NHS side of it.  It also creates perverse incentives whereby they stand to make more money by getting patients into their private wings.

“They say money is reinvested in services, but I am not sure this is always the case. Some of these hospitals have huge surpluses, the money is moved around and does not end back where it should. If we get more and more of this, it will be a step towards the privatisation of the health service.”

From: http://www.bbc.co.uk/news/10619463

Having wasted a few reports recently on extending the nanny state by battering voters into not eating fat food the killer quango NICE has now decided to prematurely kill cancer patients.
Kidney cancer patients will not be allowed a new drug that could extend their lives by up to three months because it is too expensive, the NHS drug rationing body has said.

The National Institute for Curbing Expenditure has turned down the drug called everolimus, also known as Afinitor, saying it does not offer enough benefit to patients to justify the cost.

Each pack of the drug costs £2,822 and the manufacturer, Novartis, had offered the first pack free to the NHS and a five per cent discount on following ones.

But even with this, and taking into account new guidance on end of life drugs which allows Nice to approve more expensive drugs that extend life for patients with rare diseases, the treatment was still too expensive, the panel decided.

An estimated eight week cycle of treatment would cost £5,264 per patient.

The cost per quality adjusted life year gained, a complex calculation taking into account improvement in quality of life as well as extra length of life versus the cost of the new drug over and above existing treatments, is almost double what Nice would normally allow.

Around 4,000 people a year in England and Wales are diagnosed with advanced kidney cancer and those who would be eligible for treatment because they had already tried the other drug, called Sutent, and were still fit enough to attempt another drug, would be much fewer, Nice said in a statement.

Patient groups hit out at the draft guidance saying people with rare cancers were being penalised.

Last year patients with advanced kidney cancer campaigned after four drugs including Sutent were turned down. Nice partially reversed the decision and Sutent is now available.

Mike Hobday, Head of Policy at Macmillan Cancer Support, said: “We are disappointed by Nice’s decision not to make everolimus available on the NHS for people living with advanced kidney cancer, who already have limited treatment options following the rejection of three clinically effective drugs last year.”

“It’s unfair that patients suffering from rarer cancers are repeatedly denied treatments that could extend their lives. Drugs like everolimus can dramatically improve people’s quality of life. They can mean the difference between patients being given a few weeks to live and a few months – valuable time that can be spent with family and friends, which means a lot to cancer patients.”

Nick Turkentine, Chief Operating Officer for the James Whale Fund for Kidney Cancer said: “Once again Nice has disappointed the thousands of kidney cancer sufferers in the UK by not approving everolimus, a drug which gives terminal kidney cancer patients and their families some hope.”

From: http://www.telegraph.co.uk/Kidney-cancer-patients-denied-drug-that-can-extend-their-lives

Doctors have found the first clear evidence that overweight women face a heightened risk of miscarriage after undergoing IVF (in vitro fertilisation).
Obese women Women considering IVF should be counselled that being overweight or obese doubles their risk of miscarriage, say fertility experts

Overweight women are more than twice as likely to miscarry an IVF baby compared with those whose weight is healthier, fertility doctors say. The increased risk is so great they believe a warning should be included in counselling for couples before they embark on a course of fertility treatment.

Women who conceive naturally are known to have a greater chance of miscarrying if their body mass index (BMI) is 25 or higher, but the picture has been less clear for women carrying babies produced by in-vitro fertilisation (IVF), or another technique called intra-cytoplasmic sperm injection (ICSI).

“Overweight women wishing to get pregnant by spontaneous conception are already counselled to lose weight before trying for a baby,” said Tarek El-Toukhy, a fertility specialist who led the study at the assisted conception unit of Guy’s and St Thomas’ Hospital in London.

“Our findings have shown clearly that women undertaking ART [assisted reproductive technology] should be strongly encouraged to heed this advice in order that they can have the best possible chance of obtaining and maintaining a pregnancy,” he added.

Overweight mothers have a higher risk of developing other medical conditions that can threaten their pregnancy, including high blood pressure, pre-eclampsia, diabetes, premature delivery and post-partum bleeding.

El-Toukhy’s team examined the medical records of 318 women who each had one embryo implanted during fertility treatment at the clinic between January 2006 and December 2009. The women were divided into two groups: 185 had a healthy BMI between 18.5 and 24.9, while 133 had a BMI of 25 or above. Of the latter group, 19 were obese, defined as having a BMI of 30 or more.

The study, reported today at a meeting of the European Society of Human Reproduction and Embryology in Rome, found a miscarriage rate of 22% among women with a healthy BMI, compared with a 33% miscarriage rate for the overweight women.

After adjusting their data to take account of the women’s age, history of infertility and miscarriage, and lifestyle factors such as smoking, the researchers concluded that being overweight more than doubled the miscarriage rate.

“Although there is evidence that miscarriage rates are higher in overweight women who conceive spontaneously, there were conflicting views about the effect of increased weight on the outcome of pregnancies occurring after IVF and ICSI,” said Vivian Rittenberg, a fertility doctor who took part in the study.

Rittenberg said many studies that have examined the issue in the past have been hard to interpret, not least because doctors looked at miscarriage rates after implanting several embryos at once at different stages of development.

“We transferred only one embryo at a specific stage of development, and were therefore able to provide clear evidence of the deleterious effect of being overweight on the chances of miscarriage,” she said.

From: http://www.guardian.co.uk/science/2010/jun/28/overweight-doubles-risk-miscarriage-ivf

GPs and Doctors are to be given sole responsibility for overseeing front line care to patients under Coalition plans described as the biggest revolution in the NHS since its foundation 60 years ago.
About £80 billion will be distributed to family GPs in a move that will see strategic health authorities and primary care trusts scrapped.

The plan, contained in a white paper to be published this week, is designed to place key decisions about how patients are cared for in the hands of doctors who know them.

Tens of thousands of administrative jobs in the health service will be lost as a result.

At present, funds are given by the Government to primary care trusts, which pay for patients from their area to be treated in hospital.

Under these plans, GPs — who are currently not responsible for paying for hospital referrals — would receive the money instead and pay the hospitals directly.

The Coalition hopes the new system will be less bureaucratic and give doctors and patients more control over treatment.

GPs will also have to organise out-of-hours services, which may see family doctors offering 24-hour care once again.

The decision represents a victory for Andrew Lansley, the Health Secretary. He has been backed by David Cameron in his fight with the Treasury over his decision to give taxpayers’ cash directly to doctors.

George Osborne, the Chancellor, raised serious concerns about putting such a vast sum of money, thought to be between £60 and £80 billion, back in the hands of GPs.

Health spending has been ring-fenced by the Coalition and will not be subject to the severe cuts that will hit other Whitehall departments.

However, it is understood that Mr Osborne has been assured by Mr Lansley that there will be safeguards in place to ensure GPs do not “waste” the money.

The acting chief executive of the NHS Confederation, Nigel Edwards, warned that the changes will be difficult to implement: “In transition to this new system there are some quite significant risks,” he said.

“Obviously it is going to take time to implement this and the PCTs at the moment are the people who keep the lid on the performance and financial management of the system.”

The move to scrap the 150 primary care trusts and strategic health authorities, which cover a range of NHS trusts and supervise local NHS services, will come as a shock to Conservative and Liberal Democrat MPs.

The Coalition agreement explicitly vowed to “stop the top-down reorganisations of the NHS that have got in the way of patient care”.

Rather than talking about scrapping trusts, the document explained the role they would continue to play.

However, Mr Lansley will point to the commitment in the joint Tory-Lib Dem document which states: “We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.”

Commentators are calling the changes “the most revolutionary in the NHS since 1948”. Mr Lansley hopes to have the changes in place by next April, although NHS managers believe that may be over-ambitious. Under the reforms, primary care trusts will not be scrapped immediately, but will be phased out as power is passed to doctors.

A new contract which makes GPs more accountable is likely to be part of the package of measures included in the white paper.

Responsibility will be handed to GPs working in local groups, who will commission services or provide them by working in rotas through co-ops. Mr Lansley believes that if GPs are responsible for their own budgets and have to commission out-of-hours care, most will decide to go back to offering weekend and evening cover themselves or in local groups.

The loss of jobs, which The Daily Telegraph has been told will run into tens of thousands, is also likely to lead to outcry from public sector trade unions. Ministers are already braced for industrial action over plans for severe cuts in the Whitehall workforce.

The fierce dispute over the plans has led to a delay in the publication of the white paper. However, it has been resolved in the past 48 hours.

A source said: “In the end, the Prime Minister clearly said to George Osborne that this was not one he should go to war on.”

Handing over so much power to GPs will revive memories of reforms by the last Conservative government to give control back to the local level through GP fund-holding. Labour, under Tony Blair, attempted a similar plan but fell short.

However, a senior government source told The Daily Telegraph last night that the Coalition’s attempt will succeed because of the political will behind it.

The source said: “GP fund-holding was voluntary. This is going to be compulsory. This is pushing through the whole lot of policy that either Tory or Labour governments have tried in the NHS’s history but have never gone through with properly.”

The reaction of GPs to the changes will be crucial if the Coalition is to avoid confrontation. Ministers will hope that they embrace the opportunity, but some are likely to oppose the moves. Labour failed to drive through public service reforms in the face of opposition from unions and vested interests, as well as opposition from the party’s own MPs.

But Mr Cameron is determined to put his stamp on reform. In a speech to civil servants yesterday, he said his time at No?10 would not be defined solely by cuts and the deficit reduction plan.

From: http://www.telegraph.co.uk/Biggest-revolution-in-the-NHS-for-60-years