Labour U turn on NICE's cancer drugs postcode lottery killing policy

The rule preventing NHS patients from "topping up" their treatment is cruel and vindictive. Under just axed guidelines, anyone paying for drugs with their own money may be deprived of any further free health care.

This is a crude form of blackmail by the state provider that may have been understandable 60 years ago when the NHS was finding its feet but has no place in a modern healthcare system. It is to the credit of Alan Johnson, the Health Secretary, that he has finally acted to remove this barrier to patient choice.

Allowing a co-payment system to develop in healthcare is, however, more than just a humane decision that will allow seriously ill people to purchase life-saving drugs that may be too expensive for the NHS to prescribe. It is also a fundamental step towards diversifying healthcare in a way that will allow a better-funded and more patient-friendly system.

Health insurance companies will now start marketing policies for top-up payments only, as a supplement - not an alternative - to NHS provision, an attractive option to people who cannot afford full private health insurance.

That will help remove the barrier between state and private provision that has proved so restrictive, while opening up new revenue streams. A hybrid, public/private system could then emerge, without sacrificing the cardinal NHS principle that treatment remains free at the point of delivery to all who need it.

From:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/11/05/dl0502.xml

Health Direct points out that there is now a three tier NHS service. The top level is private health insurance for NHS services. The middle tier is part payment for drugs and services. With the base rate being access for patients only if whitehall edicts allow doctors to prescribe certain life saving drugs.

Top-up insurance is still essentially a means test - and works contrary to the concept of universal access on equal terms to the NHS at all points of contact.

There is no reward here for those who already self-provide, nor any consideration of what those seeking to claim contribute to our taxes, or to the costs of the NHS.

This is a bit like thanking the person, who has decided to refrain from beating you over the head with a baseball bat.

The magic formula, top up insurance- is routine in France. The plan does not call for genius; rather, its absence calls for rebuke.

I have just one question about this, Alan Johnson is claiming credit for changing this particular rule, but which minister was it who allowed the rule to be set in the first place- Health Direct suspects the bean counter Patricia Hewitt?

NHS hospitals allowing top up cancer drugs payments

Health Direct has learned that payments to top up NHS care - supposedly banned - are happening at 30 hospitals across the UK.

Professor Mike Richards, the cancer tsar for England, has been holding a review about so called co-payments and will report at the end of this month. The issue is also under review in Wales and Scotland.

But patients are already topping up their NHS care, as hospitals find ways around the current rules.

The current rules say you cannot mix and match between the NHS and private.

You are either all NHS and it is free or you're all private and you pay for everything.

But the details are interesting. The code of practice says a patient cannot be both an NHS patient and private in the same episode of care.

So in Birmingham they have found a way round the ban on top ups.

Separately another consultant at the same hospital writes a private prescription for the drugs that patients wants to keep them alive.

They are supplied at patients' homes by a private company called Healthcare at Home.

They pay the company direct. So the administration of the drugs is viewed as a separate episode of care.

Professor Nick James is the oncologist in Birmingham who designed this model of allowing patients to top up their care.

"Nowhere does it say that an episode of care is from diagnosis to death of your cancer" he said. "So we've just interpreted the rules in a way which is in favour of the patients."

Across the country

What is remarkable is that topping up, something the labour government says is banned, is not just happening in Birmingham.

The company which provides the drugs to Ian says they have contracts with 30 NHS hospitals across the country.

Mike Gordon, chief executive of Healthcare at Home, said: "Top ups are happening today and they'll happen tomorrow. So long as they're done through us not using the auspices of the NHS I see no reason why they shouldn't continue."

A Department of Health spokesperson said: "We know there is variation in how individual Trusts are applying the current guidance, and that is why the Secretary of State asked Professor Mike Richards, National Clinical Director for Cancer, to lead a review into this difficult issue.

"Professor Richards is looking at how a consistent approach across the country might be best achieved."

Shadow Health Secretary Andrew Lansley said: "David Cameron and I have pressed the Health Secretary, Alan Johnson, to enter into a risk sharing scheme for the kidney cancer drug Sutent in order that patients will be able to access this life saving treatment immediately, but nothing has been done."

Norman Lamb, for the Liberal Democrats, said: "We are in an outrageous situation where patients are left in a lottery, dependent on a few hospitals which are bending the rules.

"This case makes the need for reform all the more urgent."

All Ian Jenkins wants is to stay alive as long as possible.

But his story does raise the question, why the need for a high level review of top ups if they are already happening all over the country?

From:
http://news.bbc.co.uk/1/hi/health/7668121.stm

NHS complaints system too bureaucratic for patients, says report

Only a tiny fraction of patients unhappy with the NHS make a formal complaint because of a bureaucratic, confusing system which changes little, according to a new report.

The National Audit Office (NAO) found that while 14 per cent of patients were unhappy with their NHS service, less than one per cent made a formal complaint to their health trust.

There was also little evidence of services improving as a result of complaints made.

It also found that one in five health trusts took too long to respond to patient complaints.

While most met the target of an average of 25 working days to answer complaints, one took 55 days, more than twice as long.

Edward Leigh, Chairman of the Commons Public Accounts Committee, said that the reason so few patients make formal complaints is that they have "no confidence anything will be done as a result".

"Complainants are often confronted with a defensive and unhelpful response when sometimes all that is needed is a simple apology or a promise to improve services.

"There is also little evidence that complaints are leading to better services. This is no way to keep people's faith and trust in health and social care services."

The criticism comes after David Cameron, the Conservative leader, attacked Alan Johnson, the Health Secretary, for an allegedly cold and bureaucratic response to a complaint over the
death one of his constituents, Elizabeth Woods, after she contracted the superbug MRSA.

There were 133,600 official complaints about the NHS last year.

A spokesman for the Department of Health said that ministers agreed that the NHS had to be better at handling complaints and that was why a new, simplified system would be introduced next year.
NHS-complaints-system-too-bureaucratic-for-patients-says-report.html

Lady Archer backs patients in row over top-up drugs

Lady Archer has backed demands for patients to be allowed to pay for additional medicines without losing their NHS care by releasing a survey showing that more than 80% of patients at the trust she chairs back the change.

The survey, of more than 800 patients, shows that 82% of NHS patients back the right to pay for top-up medicines.

The survey also found that more than 90% of doctors and nurses favour patients being allowed to pay supplements for proven cancer drugs which are not funded by the NHS.

Archer, chairwoman of Cambridge University Hospitals NHS Foundation Trust, has submitted the results to Mike Richards, the government’s cancer czar, who is conducting an inquiry into the scandal of withdrawing NHS treatment from patients who pay for private medicines.
Private drug helps cancer man left to die

In a letter to Richards, copied to Alan Johnson, the health secretary, Archer described the policy of penalising patients who choose to pay privately for drugs as “illogical and unjust”.

Archer, wife of Jeffrey Archer, the disgraced Tory peer and novelist, also said the co-payments should be allowed, not just for cancer medicines, but for all effective procedures and treatments which are not funded by the NHS.

Christoph Lees, a consultant obstetrician and gynaecologist at the Cambridge NHS Trust, said the labour government should make “sensible provision for patients to exercise what should be their right, rather than penalise them for their choice”.

Meanwhile, nine professors of rheumatology at University College London Hospitals NHS Trust, in central London, and Leeds Teaching Hospitals NHS Trust have claimed British arthritis patients are less likely to get the medicines they need than those in Romania, Hungary and the Czech Republic.

In a letter to The Sunday Times, they accuse the National Institute for Curbing Expenditure (NICE) of making a “senseless decision” by ruling that arthritis sufferers who are not successfully treated by one of a group of medicines known as anti-TNF treatments can’t switch to another type.

From:
http://www.timesonline.co.uk/tol/news/uk/article4794836.ece

Top-ups for drugs are fair says voters

Patients should be given the chance to pay extra for the best available drugs in addition to their NHS treatment, according to a Sunday Times poll.

Nearly two-thirds of those surveyed said patients should be permitted to top up their treatment. The government is reviewing the issue after a Sunday Times campaign.

According to the latest YouGov poll, 73% believe that if treatments exist they should be available on the NHS. Only 21% think there should be a limit on treatment. Nearly a third said they would be prepared to pay extra taxes so the more expensive treatments could be available on the NHS.

Alan Johnson, the health secretary, has asked Professor Mike Richards, the cancer czar, to consider whether so-called co-payments should be allowed again. The labour government has previously argued such a scheme would create a two-tier service and has warned patients that care may be withdrawn if they pay for drugs privately.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4538256.ece

Health Direct asks why if labour allows the NHS to pay for the removal of 177,00 tattoos why don't they also fund cancer drugs?

Drug companies face fresh action after trial failure

Efforts to punish a group of drug companies allegedly behind one of the biggest price-fixing schemes to hit the public purse are being stepped up after the collapse of their criminal trial.

Frank Field, the former Labour social security minister, wrote to Alan Johnson, the health secretary, yesterday to urge further action against the businesses over a conspiracy that was allegedly taking place while prices of dozens of basic remedies rose as much as 800 per cent.

Mr Field made his intervention as lawyers acting for the National Health Service press for further "substantial recoveries" through a damages action against the companies that has already netted £34m. Many observers say the companies named have never been forced to account fully for their actions, bec-ause of weaknesses in the way Britain deals with financial misconduct.

Mr Field, a former member of the Commons' public accounts committee, said the companies should be "on their knees thanking their lucky stars" at the decision by Mr Justice Pitchford last month to stop their criminal trial on conspiracy to defraud charges.

Peters & Peters, the law firm acting for the NHS, is pressing ahead with a damages action founded on allegations that the companies were involved in a conspiracy to rig the prices of drugs including penicillin and warfarin, a blood thinner.

Jonathan Tickner, a Peters & Peters partner, said: "The obvious success of the civil proceedings . . . speaks for itself and we, on behalf of the Department of Health, fully expect further substantial recoveries to be made."

The main company still in the department's sights is Ashford-based Kent Pharmaceuticals, supplier of many basic antibiotics to NHS hospitals, retail pharmacists and dispensing doctors.

Kent declined to respond to questions on the case. All the other companies that faced criminal charges - Goldshield, Ranbaxy, Generics and Norton Healthcare - declined to comment when asked if they denied colluding with each other, saying they could not speak while the threat of criminal proceedings remained.

Mr Justice Pitchford last month scrapped fraud charges laid by the Serious Fraud Office against the companies after the House of Lords criticised the way the indictment was drafted but left open the possibility it could be amended. The SFO has launched an appeal against the judge's decision, arguing it should be allowed to reformulate the charges.

Since the trial collapsed, some senior executives - notably those at listed Goldshield, which is chaired by Keith Hellawell, the government's former drugs "tsar" - have gone on the offensive and complained £25m of taxpayers' money was wasted in mounting the trial. The companies have always argued that price-fixing was not a crime at the time of their alleged activities.

But lawyers said there seemed to be evidence of subterfuge to justify a prosecution, alleging companies conspired to defraud the government - and hence the taxpayer. Documents seized in the penicillin investigation included a presentation, known as "The Scenario", that contained a bullet-point overview of how to operate a price-fixing cartel.

The case could be picked up by the Office of Fair Trading, which has imposed fines totalling hundreds of millions of pounds over the past year or so on companies involved in cartels in industries such as aviation, supermarkets and tobacco.

Another possibility is that the NHS could launch a private prosecution. It declined to say whether it had plans to do so.

Health checks

2000 SFO starts probe into price-fixing in supply of generic drugs to NHS April 2002 More than 30 premises raided April 2006 Five companies and nine executives charged with conspiracy to defraud January 2008 Lords hear submissions from Goldshield and Ian Norris that price-fixing cannot be prosecuted under the common law offence of conspiracy to defraud March 2008 Lords rule in favour of Mr Norris and Goldshield July 2008 Judge quashes indictment against the five companies and nine executives charged

http://www.ft.com/cms/s/0/32776f1c-6806-11dd-8d3b-0000779fd18c.html

Banned cancer drugs better than NHS ones

Privately bought cancer drugs are proving to be up to five times as effective as NHS treatments, Health Direct reports on the suffering the co-payments ban is inflicting on patients.

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves.

One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the labour government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy.

The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care.

Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Recently the Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors.

John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about £2,200 a month compared with about £800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control.

A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan.

Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added.

Erbitux, costing about £3,000 a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.

A former fireman who developed liver cancer after 25 years’ service has been told that if he pays for the only drug that can treat his disease his NHS care will be withdrawn.

Barry Humphrey, 59, from North Walsham, Norfolk, was told by NHS doctors that the drug Nexavar was the only available treatment for his advanced liver cancer.

However, consultants at Addenbrooke’s hospital in Cambridge said the drug was not routinely funded by the NHS and told him that if he paid for it he would be billed for the rest of his NHS care.

Humphrey believes his cancer is linked to his time as a fireman. His cancer was caused by cirrhosis of the liver after he contracted hepatitis C. He believes he caught the virus from a casualty while on duty.

Research presented at the American Society of Clinical Oncology found patients with advanced liver cancer survive for an average of 11 months if they take Nexavar, while those denied the drug live for just eight months.

Humphrey’s wife Hazel, 58, who also worked in the fire service, said: “Doctors said this would ‘not be viable’ because we would be deemed as opting out of the NHS and would need to pay for everything.

“I think it is absolutely disgraceful. When people are terminally ill, they want to spend as much time as they possibly can extending their life expectancy.” She said the couple know the drug will not provide a cure but should have the right to spend their savings to prolong her husband’s life.

They plan to sell a flat that they have been renting out to raise the cash for the drug, which costs about £3,000 a month. Humphrey, who has four children, six grandchildren and helps to care for his elderly mother, said: “I think this is morally wrong and indefensible.”

Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s, said: “We are complying with the national guidance which says we cannot allow co-funding.”

The public’s view

A poll for The Sunday Times shows strong support for allowing co-payment in the National Health Service, with 89% saying that people who buy additional cancer drugs should continue to get free NHS treatment.

Only 5% think allowing co-payment would create a two-tier NHS. Until now this has been the position taken by Alan Johnson, the health secretary.

Ministers had feared that allowing co-payment would upset less well-off patients, but the YouGov poll of nearly 1,800 people shows strong backing across the social spectrum and supporters of all three main parties.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4138237.ece

Doctors' anger at labour's cruelty to patients

The medical establishment is in revolt against Labour’s policy of denying National Health Service treatment to patients who pay privately for cancer medicines.

The outcry from eminent consultants and doctors’ leaders came as news emerged of two more patients whose NHS care was removed while they were dying of cancer.

Alan Johnson, the health secretary, faces opposition from the presidents of the Royal Society of Medicine and the Royal College of Surgeons, as well as British Medical Association consultants.

Baroness Ilora Finlay, president of the Royal Society of Medicine, said the issue went to the heart of the purpose of the health service.

“Can we justify spending billions of pounds on the relief of relatively minor conditions and deny patients with life-threatening disease the support of the NHS when they want to bridge the costs themselves?” she said.

Finlay’s intervention, in an article for The Sunday Times, comes after it emerged that a man dying of kidney cancer had to battle for NHS care because his family followed doctors’ advice to pay privately for a drug.

John Burrell, a retired financial adviser from the Isle of Wight, died last month aged 63. His daughter, Kate Tasquier, said: “The consultant told my dad he would be billed for all of his treatment such as blood tests and scans. My dad was so worried.”

Although she said the NHS eventually compromised on the fees, “he ended up being so scared that he was going to be billed for his care that he was scared to go into hospital and he delayed starting the treatment”.

It also emerged that Sandra Baker, a bowel cancer victim, died last year after being denied NHS treatment in her final months. When she paid £9,500 privately for drugs, she was hit with an extra bill of £16,000 for her treatment.

The Sunday Times revealed the case of Linda O’Boyle who died of cancer aged 64 after being denied NHS treatment because she paid for a drug. Bernard Ribeiro, president of the Royal College of Surgeons, and the annual consultants’ conference of the British Medical Association have also attacked the labour government’s block on NHS patients paying for additional drugs.

While Johnson insists cancer patients should not be allowed to pay for superior drugs because this would create a two-tier NHS, opposition parties have edged closer to supporting co-payments.

Norman Lamb, the Liberal Democrat health spokesman who is developing a new party policy on the issue, said: “When a clinician recommends a proposed treatment as having therapeutic value to the patient, it seems cruel and perverse to withdraw all NHS treatment if the patient follows that advice.”

Ribeiro said: “I would strongly oppose the denial of life-saving operations to patients based on decisions they had made about how they supplement their NHS care.”

Cancer specialists at one of the country’s largest hospitals have found a way around the ban. About 16 oncologists at University Hospital Birmingham NHS Foundation Trust write prescriptions for their patients to receive private cancer drugs at home.

Professor Nick James, one of the doctors, said: “There is no question of us turning away these patients. I believe that to do so is punitive and vindictive. We remain responsible for the NHS care of these patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4087629.ece

Another question for Labour - how come these drugs are free in Scotland and that it's only Englsih patients who face this dilemma?

Cancer victim told to pay for his own drugs by NHS

A cancer patient who was sent home to die by hospital doctors but then discovered a cocktail of drugs that stabilised his illness has now been told that the NHS will not pay for his medicine.

Jack Hose, 71, a retired engineer, was receiving a chemotherapy drug called irinotecan on the NHS, but it was failing to halt his bowel cancer.

NHS doctors told Hose, from Bournemouth, that they could do no more for him and that he should go home and make the most of the rest of his life while taking painkillers.

Hose was not prepared to die and sought a second opinion from a private doctor who recommended trying another drug, called cetuximab, in combination with irinotecan.

The mix of drugs appears to have stabilised Hose’s cancer. However, cetuximab is not funded by the NHS.

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, which is treating Hose, has told him that, if he takes the drug, he will need to pay for all his care, including the cost of the medicine he initially received on the NHS.

Hose is the latest victim of the labour government’s policy of denying NHS treatment to patients who pay for an additional private drug.

Alan Johnson, the health secretary, says such an arrangement, known as “co-payments”, would lead to a two-tiered NHS.

“It seems outrageous that, having paid National Insurance contributions for 50 years, they are now asking me to pay for my care,” said Hose.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3999216.ece

Polyclinics 'will hit most vulnerable'

Closing GP surgeries to replace them with "polyclinics" will hit the most vulnerable members of society and damage the fabric of local communities, David Cameron said.

The Tory leader warned that Labour's plans for health care could lead to the closure of one in five GP surgeries around the country.

Mr Cameron said local residents should have the final say on whether surgeries should be replaced and urged GPs to fight the changes, signing up to a petition opposing the planned reforms. Polyclinics, conceived by Lord Darzi, a health minister and consultant surgeon, will combine GP services with nursing and social care on one site.

The Government insists they will create more choice for patients and greater access to specialist care.

Opponents fear they will leave some patients with long journeys and destroy the personal relationship between patients and family doctors. In a speech to a health think-tank in London, Mr Cameron said amalgamating as many as 1,700 GP surgeries would damage the fabric of local communities.

He said: "Labour has already tried to bring about the end of the district general hospital. Now they are trying to abolish the family doctor service. Communities which have lost their post office, their local shops, their local police station, are going to lose their doctor."

People including the elderly, those with small children and those with long-term conditions would be worst affected, Mr Cameron said.

"Those are the people least able to get to a polyclinic, and least comfortable in a large impersonal institution. They like to rely on the doctor they know, at the end of their street, often in a building not much bigger than a house," he said. "They have a human relationship with their GP that they simply won't have with a member of staff at a polyclinic."

Instead of "imposing" the clinics on communities, Mr Cameron said ministers should make the changes subject to binding local consultation. He said: "Where they occur, they should occur naturally, as the voluntary combination of free agents, not as the latest structural reorganisation of the NHS.

He also urged GPs to join an independent campaign against the polyclinics plan. The petition, drawn up by the think-tank "2020health" in consultation with the Tories, calls general practice the "foundation of the NHS" and says doctors object to "being forced into polyclinics against our will".

The petition also includes a demand for freedom to determine surgery opening hours.

"We want to work in partnership with GPs, not in conflict with them as this Government is doing," Mr Cameron said. "So I urge GPs to sign up to this petition and ensure that the next Conservative government has the backing of the profession to modernise general practice in a way that works for the staff and patients of the NHS."

Alan Johnson, the Health Secretary, last night accused the Opposition of backing a "free-for-all" that would end a recent agreement for more surgeries to open in the evenings and at weekends.

"This is an astonishing admission by the Conservatives. They are now supporting a free-for-all on opening hours which would see an end to the evening and weekend opening which has just been secured," he said.

"Far from diminishing primary care services we are enhancing them, but it seems that the Tories are more interested in ingratiating themselves with certain elements of the profession than they are in improving access for the public."

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/04/22/nclinics122.xml

Health Direct points out that every new major spin that labour dreams up tend to turn to ashes- just remember tough on crime, tough on the causes of crime.......

NHS pay deal may be cut if offer is rejected

Health workers may have their pay offer cut if they refuse to accept the three year deal which Gordon Brown and labour ministers are offering.

Unions have warned that unrest among nurses and other NHS staff over the settlement could still lead to industrial action.

The proposed increase is worth 8.1 per cent over three years and is part of a new set of public sector pay agreements Gordon Brown hailed as ground breaking and vital to ensure wage stability.

Unison's health officer, Mike Jackson, told a health workers' conference in Manchester that the deal, worth 2.75 per cent this year followed by rises of 2.4 per cent and 2.25 per cent, plus extra for the lowest paid staff, was the best that could be achieved.

But in a stand-off with Alan Johnson, the Health Secretary, his department's officials have written to unions saying the Government reserved the right to stage or even reduce the pay offer if it is not accepted.

Mr Jackson said the only way the deal could now be changed was if "effective" industrial action were taken.

Unison's head of health, Karen Jennings, said there were "huge risks" in accepting a long-term deal but she described the offer as "balanced".

The conference will decide whether to recommend acceptance of the three-year deal to Unison's 500,000 health workers.

Another union, Unite, which represents 12,000 members including health visitors, mental health nurses and some pharmacists, has already recommended that staff reject the deal.

Peter Allenson, a spokesman, said: "This deal is not sufficient for us to be able to recommend acceptance.

"We have reservations that the re-negotiation clause, which should come into effect in situations of rising inflation, is not strong enough and in a climate of economic insecurity, it is not at a level sufficient to meet members' needs."

A Department for Health source said the Government considered the proposal to be "generous".

"We are certain the majority of health staff will be happy with this deal and we hope the unions put it to a full ballot of their membership," he said.

"If that happens, we are confident we will win. If not, we can not guarantee the eventual settlement will be as generous as this offer."

Gordon Brown has repeatedly said he is determined to keep public sector wage rises down to tackle inflation.

Last year, police staged an unprecedented march through Westminster in protest at being awarded a 2.5 per cent increase, below the level recommended by the independent pay review body.

Teachers from the National Union of Teachers have staged a series of strikes over their award, the first industrial action in schools for 21 years.

College lecturers walked out on the same day over their demand that their pay rise by six per cent, to the same level as teachers.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/04/15/nhs115.xml

Health Direct warns that the Labour bullies are up to their old tricks by attempting to blackmail hard working NHS staff to accept the DOH's meagre offer.

Doctors for Reform fight NHS order to halt cancer care

A group representing nearly 1,000 doctors is preparing to mount a legal action against the health service to stop care being withdrawn from patients who want to pay for their own cancer medicines.

It is seeking a judicial review of the Department of Health policy that forces patients to pay for all their treatment if they buy any additional medicine.

Many patients would like to buy extra drugs that are not offered as part of their treatment because the National Health Service has ruled that the benefits do not justify the costs. The labour government fears that if patients make the purchases, called co-payments, it will lead to a “two-tier” NHS.

Doctors for Reform believes patients should be given the freedom to choose. Its intervention follows a campaign by The Sunday Times highlighting the plight of breast cancer sufferers denied the opportunity to improve their chances by paying privately for drugs.

Last December we reported the case of Colette Mills, a breast cancer sufferer from Stokesley in North Yorkshire, who was told that if she topped up her medication with privately bought drugs she would have to pay for her entire treatment – about £10,000 a month.

The Department of Health has issued guidance to health trusts warning them that co-payments are not allowed. In December Alan Johnson, the health secretary, reiterated the rules.

Doctors for Reform has teamed up with Halliwells, the law firm, to challenge the ruling. Halliwells is offering its services free as the doctors are trying to raise £35,000 in donations towards government legal fees if they lose.

The doctors point out that examples of co-payments already exist in the NHS, for instance in dental care.

Dr Christoph Lees, a steering group member, said: “Doctors are caught in a terrible dilemma: do you tell a patient about a drug that could improve their quality of life, or do you pretend it doesn’t exist?”

Another cancer patient, Debbie Hirst, 56, from St Ives, Cornwall, began legal action against her local NHS trust to win the right to pay for the drug Avastin. Legal judgment was averted when the trust decided to treat Hirst as a special case and paid for the medicine.

For more information, see www.doctorsforreform.com

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3646250.ece

Health Direct notes that the argument that allowing patients to buy their own drugs will create a two tier NHS system is specious as is the argument that it will disadvantage those who can't afford to do that.

It may create a 'three-tier' health care system.

With the bottom tier being the health care that the NHS can/is willing to give, the middle tier being those who can afford to pay for drugs not available through the NHS whilst receiving NHS care, and the 'top' tier being those who buy private health care.

Row erupts over NHS health trusts in centralist health dictats

A battle for the soul of NHS reform has broken out after accusations that the labour government has usurped key hospitals’ independence.

At the centre of the row are letters from the health department to all NHS hospitals, including foundation trusts, telling them to appoint extra matrons, undertake an annual deep clean to combat hospital-acquired infections and appoint infection control nurses.

William Moyes, chairman of Monitor, the independent regulator of foundation trusts, has written to NHS chief executive David Nicholson arguing that such instructions amount to line management by the labour government when foundation trusts are meant to be self-governed institutions.

“I do not believe this is consistent with the legislative framework,” Mr Moyes warned the health service’s top boss, because the department’s letter “could only be interpreted as issuing instructions”.

Mr Moyes added it was clear that “there remain different views about who is accountable for the performance of foundation trusts”.

So ministers can no longer set hygiene standards and ensure they are enforced? They can still set standards for hospital cleanliness, which the Healthcare Commission inspects. Monitor requires foundation trusts to meet these and other national standards and targets, such as reducing MRSA infection rates, and can intervene to enforce compliance. But exactly how a foundation trust achieves targets is a matter for them.

But what if there is a known best way of treating patients? Can ministers not make foundation trusts comply?
They can, but not by central direction. National service frameworks, for example, set out approved ways of organising cancer treatment and other services. Primary care trusts are expected to commission care in line with these frameworks. Monitor argues that PCTs should remove services from hospitals that they believe are unsafe or poor quality. PCTs in theory retain the ability to require a deep-clean in a contract.

Like the rest of the NHS, foundation trusts are inspected by the Healthcare Commission. They are answerable to their boards, their governing councils and to Monitor, which authorises them and has the power to direct them and replace their boards.

If problems arose over performance, Mr Moyes warned foundation trust chairmen and chief executives in a separate letter, “it will be no excuse to say you were simply operating within a framework defined by the Department of Health or the strategic health authority”.

The correspondence amounts to a battle for the operational independence of a key part of the government’s reforms, which were meant to end “command and control” from Whitehall and shift responsibility for performance to freer-standing institutions, regulators and the primary care trusts who commission hospital care.

The health department’s letter followed headline-grabbing announcements at Labour’s?party conference by Gordon Brown, prime minister, and Alan Johnson, heath secretary, over hospital deep-cleans and the appointment of 5,000 extra matrons. However, the health department later admitted it no longer had the power to order a foundation trust to appoint matrons.

Mr Moyes said PCTs should not commission care from dirty and unsafe hospitals and should specify their requirements in contracts. If foundation trusts failed to deliver that, then the right approach was for the NHS chief executive to “invite Monitor to act, using its statutory powers”.

On Tuesday, Mr Nicholson tried to defuse the row, declaring: “I fully support the autonomy of NHS foundation trusts and the role of Monitor as their regulator.

“I am also clear that every NHS board has – as part of the NHS family – a very real duty on behalf of their patients to learn lessons” to prevent a repeat of the infection scandal at the Maidstone NHS Trust, where 90 people died from Clostridium difficile.

The Foundation Trust Network, which represents the trusts, said: “It is important that Monitor maintains its status as an independent regulator able to challenge if hard-won freedoms are eroded.”

From:
http://www.ft.com/cms/s/0/9fff97bc-df3f-11dc-91d4-0000779fd2ac.html?nclick_check=1

Alan Johnson scraps with GPs over pay and opening hours

The 2004 general practitioner contract which the labour Government is now messily trying to unpick set a new benchmark for ineptitude by the Department of Health, whose weakness in contractual negotiations is legendary.

The agreement gave family doctors lavish salary increases tied to various incentives based on preventative health measures. In its first year it led to an average salary increase of 23 per cent, in the second year 10 per cent - an extra £30,000 a year in total.

The deal pushed average GP salaries well over the £100,000 mark and some are earning twice that. One senior doctor who took part in the negotiations says the GP side of the table were stunned by the generosity of the DoH's offer - they thought it a "bit of a laugh".

The joke was not shared by patients. The deal focused on the producer, not the consumer, interest. Under the new contract most GPs gave up emergency cover - at a "price" of just £6,000 off their newly inflated salaries, who wouldn't?

Meanwhile, too many surgeries continue to open at hours that suit health practitioners but which are wholly inimical to the requirements of the working population and, to cap it all, in many practices the appointments systems remain hopelessly inflexible.

This triumph was the handiwork of the then Health Secretary Alan Milburn. His successors, Patricia Hewitt and now Alan Johnson, have struggled to amend it in a way that will give patients a more tangible benefit from the outlay of such large amounts of taxpayers' money.

In the process, there have been hints that GPs are being greedy. In reality, it would have required self-restraint bordering on saintliness for doctors' negotiators not to have grabbed what the DoH was offering with both hands. And as Dr Michael Ingram points out, conscientious family doctors more than earn their salaries.

The latest Whitehall attempt to amend the deal comes in the form of a letter from Mr Johnson to all GPs urging them to work longer hours. They are squabbling over an hour a week. The British Medical Association has already agreed to an extra two hours a week but the Government wants three. Battle lines are now drawn.

Given that ministers have only themselves to blame for this dispute, it is hard to avoid the suspicion that there is now a rather more sinister agenda being played out here. By appealing directly to GPs, the labour Government seems determined to break the influence of the BMA (just as it is seeking to cow other professional bodies such as the Police Federation) on the basis of divide and rule.

Such tactics are dangerous. While there may be some public disquiet at how well Britain's 42,000 GPs have done out of this deal, in any dispute between them and the labour Government, the public will instinctively be more sympathetic to their family doctors. Ministers should stop being so belligerent as they struggle to clear up a mess of their own making.

http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/02/05/dl0501.xml

Ward cleaning is reassurance spin admits Johnson

The £50m a year that the labour government is to spend on routinely deep cleaning hospital wards is being spent to reassure the public rather than as a provenly effective way to tackle hospital acquired infections like MRSA admitted Alan Johnson the Health Secretary.

Microbiologists warned on the day that Gordon Brown, the prime minister, announced the "deep clean" policy that such routine annual cleans would be ineffective and the medical journal The Lancet has since said they will not affect the risk of infection.

Challenged by MPs on the Commons' health committee that the policy was really "more a publicity exercise than evidence based", Mr Johnson said that would be "a fair point to make if the only thing we were announcing was deep clean".

From:
http://www.ft.com/cms/s/0/2836088a-9ee7-11dc-b4e4-0000779fd2ac.html

Brown's claim to competence is already finished - kaput. He sold our gold reserves at giveaway prices, vandalised our pension schemes with the sledgehammer of tax, opened the doors to unchecked immigration (ministers have no idea how many foreign workers are here), demanded unconscionable sacrifices from our Armed Forces (for which they pay in blood), and managed the nation's money so ineptly that, despite a long period of economic growth, the United Kingdom is on course this year for a £40 billion shortfall in public finances, £6 billion more than Brown predicted in his last Budget.

On July 24, 2006 Health Direct posted NHS targets blamed as crowded wards increase risk of superbugs when we noted that there is a scientific correlation between high bed occupancy rates with high MRSA superbug ineffections, and deaths.

Government targets to cut NHS hospital waiting times are putting patients at increased risk of infection with the superbug MRSA, an official report has revealed. An internal policy review conducted by the Department of Health, leaked to The Independent, has for the first time shown that there is a direct link between the number of patients in hospital - measured by bed occupancy - and MRSA rates. Ministers have denied there is a link.

The most crowded hospitals, with occupancy rates over 90 per cent, have MRSA rates that are over 42 per cent higher than average, according to the report. Those with occupancy rates above 85 per cent have MRSA rates 16 per cent above average.

The findings of the review are considered so sensitive that two attempts by The Independent to obtain the report under the Freedom of Information Act were rejected. Reducing bed occupancy in all NHS trusts to a maximum of 85 per cent would save 1,000 cases of MRSA a year, it says.

The latest figures for 2004-05 show that 88 NHS trusts in England, one fifth of the total, had occupancy rates over 90 per cent and almost half (45 per cent) had occupancy rates over 85 per cent.

Private sector sees NHS role slashed

Alan Johnson, the health secretary, yesterday slashed a long planned expansion of the private sector’s role in the National Health Service, in effect confirming that contracts originally meant to be worth about £6bn for surgical treatments and diagnostic services are likely to amount to well under half that sum.

The health secretary announced that three small contracts for scans and renal dialysis, worth £40m a year, would go ahead. But six more surgical treatment centre contracts have been scrapped, taking to 15 the total abandoned since the procurement was launched in 2004. Only one out of nine original contracts for diagnostic services now survives.

Procurement will continue on seven more treatment centre deals, most of which have already shrunk considerably in size. But while the intention is to take final decisions by March, a health department spokesman said there was “no guarantee” they would go ahead.

Even if they did, the total value of the contracts looks unlikely to top £2.5bn on industry estimates, against the £6bn that the private sector was originally promised. Without them the total will be nearer £2bn.

Announcing his decisions, Mr Johnson insisted that the reduction in the size of the procurement “does not represent a change in policy”.

But Chris Ham, former head of the strategy unit at the health department, said: “That is not a credible statement. The contribution of the private sector will be much smaller than planned, and the potential for innovation reduced.

This is the strongest signal yet that the prime minister is distancing his government from the policies of his predecessor.”

Mr Johnson insisted the independent sector had “an important and increasing role in the NHS” despite the cutbacks, which included firing Care UK, an independent provider, from an already operational diagnostic contract in the West Midlands on the grounds that only 5 per cent of its capacity was being used.

A “significant increase in productivity” in the local NHS had removed the need for the contract, Mr Johnson said, as he also cited improved NHS performance for the scrapping of six more treatment centre deals.

Mr Johnson said his approach to the independent sector “is pragmatic, not ideological”. Where it offered good value for money “we will bring them in”.

However, both Nuffield and Spire Hospitals, two of the biggest private groups, say the majority of primary care trusts are “hiding” the right to choose by not putting the independent providers on the front screen of the “choose and book” system that family doctors use to help patients decide where to go.

Because the private hospitals are hidden on the back screen, they say, only well-informed patients get through.

That was producing “a postcode lottery” in access to care, said Richard Jones, chairman of the NHS Partners Network, which represents the private providers.

David Mobbs, chief executive of Nuffield Hospitals, said ministers should make clear that such “attempts to thwart choice unfairly and to distort markets will not be tolerated”.

In an attempt to appease the private sector, Mr Johnson promised a campaign to raise the awareness of patients’ right to choose, and a new advisory forum of private providers.

In public, the private operators reacted with restraint at the cutbacks. In private, they were furious.

Neil Bentley, the CBI’s public services director, said the decisions were “a Christmas present for opponents of reform” and that “patients are the losers”.

Karen Jennings, head of health at the trade union Unison, welcomed the government’s “change of emphasis” on private sector involvement, as the Conservatives accused ministers of “incompetence” after spending tens of millions of pounds on the failed bids.

From:
http://www.ft.com/cms/s/0/ca759530-93ab-11dc-acd0-0000779fd2ac.html

The thwarting of private services should come as surprise to readers of Health Direct. On
July 26, 2007 we posted: Alan Johnson blocks new wave of private health clinics when the health secretary, Alan Johnson, yesterday vetoed plans for a third wave of independent sector treatment centres to compete with NHS hospitals.

In a break with Tony Bliar's drive to expose the health service to the challenge of market forces, Mr Johnson said local NHS commissioners should adopt a more pragmatic approach to treating patients on the waiting list for tests and operations in England.

He will allow them to buy extra capacity from the private sector if they need it to meet targets on waiting times, and can show it provides value for the taxpayer. But he told the Commons health committee: "There will be no need for another national independent-sector procurement ... There will not be a third wave."

Mr Johnson was presented with plans for a third wave when he became health secretary last month, but he refused to endorse them.

As for the right to choose on October 31, 2007 Health Direct posted: Only 44pc recall hospital choice watchdog finds

Further evidence that the Labour's "choice" policy is struggling as a means of driving reform in the National Health Service has come from the latest survey of how far it is being offered to patients.

A mere 44 per cent of patients could recall being offered a choice of hospital for their first outpatient appointment in May - down from 48 per cent in March - with provisional results for July showing a further decline to 43 per cent.

Hospitals failing superbug targets as 8.2pc of patients acquire bugs

Hospital superbugs are endemic in Britain's wards and the Government is failing to meet its targets to reduce them, new watchdog figures have disclosed. Cases of Clostridium difficile increased by seven per cent in hospital patients over the age of 65 from 51,829 in 2005 to 55,620 last year – an extra 3,791 cases.

The figures, released yesterday by the Health Protection Agency, cast doubt on whether targets set by the Government to reduce C diff cases by 30 per cent in the next four years can be met.

It comes after at least 90 patients died from C diff at Maidstone and Tunbridge Wells Hospital trust and contributed to the deaths of around 200 others in Britain's worst superbug outbreak.

Alan Johnson, the Health Secretary, said yesterday that the hospital's board may have acted illegally when trying to pay off Rose Gibb, the trust's chief executive, with £250,000 days before a damning report into the outbreak was published.

Signalling a clampdown on the "gravy train" managers who take large payoffs, Mr Johnson blocked the massive severance package.

Managers often receive pension benefits and large lump sums to leave failing trusts, only to re-appear in another hospital within months.

David Nicholson, the NHS chief executive, has today written to all hospital trusts warning them when severance deals are not acceptable.

The Health Protection Agency data showed cases of MRSA fell by 10 per cent last year, with 6,381 reported between April 2006 and March 2007, compared with 7,096 the previous year – but even that is not enough to meet the Government promise to halve the rate by 2008.

In January, a leaked Department of Health memo suggested that the target would never be met and rates of MRSA would only be reduced by a third and not half. Please see the posting by Health Direct below.

Richard James, Professor Of Microbiology at Nottingham University, said: "The target rate for MRSA reduction was over-ambitious and a lot of people suspected it would not be achieved. The Government have given themselves a longer period with C diff, but it remains to be seen if that will be hit."

Mr Johnson insisted he was confident of hitting the target.

"These figures today are very encouraging," he told BBC Radio 4.

Georgia Duckworth, from the HPA Centre For Infections, said the rise in C diff was slowing down and "going into the plateau" as results for April to June 2007 show a 13 per cent drop compared with the same period last year, with 13,660 cases, down from 15,639.

She said the drop in MRSA was impressive and constituted a "major achievement".

However, a spokesman for the Patients Association said the alarming rate of infection in Britain's hospitals — which sees 8.2 per cent of patients pick up a bug each year — was a "disgrace".

Figures for glycopeptide-resistant enterococcal (GRE bacteria), which causes wound infections and blood poisoning, also show an increase in infection rates with 903 cases reported in 2005/06 compared to 758 in the previous year.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/11/02/nhos102.xml

On 11 Jan 07 Health Direct posted NHS hospitals may never achieve MRSA superbug targets

The NHS is not on track to meet its MRSA target and perhaps never will, a leaked government memo says. In November 2004, then health secretary John Reid pledged MRSA rates would be halved by April 2008.

But the memo, sent to ministers by a Department of Health official, said it would only be cut by a third by then. It also reportedly recommended ways to handle the news in the media. Dr Mark Enright, from Imperial College, said the target was "unrealistic".

On the one hand Health Direct is pleased that Alan Johnson is waking up to the disgrace that is thousands of preventable deaths, on the other hand the figures for summer are usually lower than those for winter- so worse may be expected.

MRSA to force ban on doctors' white coats

Doctors will be banned from wearing their traditional white coats as part of a drive to protect patients from contracting MRSA and C Difficle superbugs in hospital, Alan Johnson, the Health Secretary announces.

Staff will also be ordered to ditch their ties, wrist watches and jewellery amid fears that they prevent doctors and nurses from washing their hands properly.

The new "bare below the elbows" dress code, which hospitals in England will have to enforce by next January, will be one of a series of measures announced by Mr Johnson to cut the rate of hospital-acquired infections such as MRSA.

They come only weeks after a report found that British hospitals were among the worst in Europe for superbugs, trailing behind countries including Slovakia, Hungary, Poland and the Czech Republic.

The Health Secretary will also announce that matrons will be given new powers to help the Government to meet the target it set three years ago of cutting MRSA rates by half by next year.

They will report directly to their hospital boards four times a year to ensure that their views are heard by senior management.

The measures follow a warning from doctors last month that the Government would not meet its MRSA target because of poor hospital management practices. Please see also the Health Direct posting below.

An editorial in The Lancet in August blamed hospital managers for failing to train staff in antibacterial prescribing, and providing inadequate hand-washing and isolation facilities.

Patient groups welcomed the initiatives but said they were concerned that they would not improve hygiene conditions in hospitals sufficiently.

"At the moment, about 60 per cent of doctors don't wash their hands between patients," said Derek Butler, the chairman of MRSA Action UK.

"We applaud Mr Johnson for his commitment to cutting infection rates but we think the biggest challenge is getting hospital staff to improve their standards of hygiene. If the Government can't do that, they are going to struggle to cut MRSA rates."

Hospitals will also be issued with new guidance about isolating patients who become infected with C. difficile or MRSA.

This will mean more single rooms being used and more "cohort nursing" - where patients suffering from the same infection are nursed together.

In addition, hospital chief executives will have to report all MRSA and C. difficile infections to the HPA, or face a fine.

Dame Karlene Davis, the general secretary of the Royal College of Midwives, welcomed the Government's commitment to cutting infection rates.

"One of the biggest killers of child-bearing women was puerperal sepsis. This has improved significantly with the recognition of the need for hand hygiene to reduce cross-infection," she said.

"This situation remains as relevant today as it did many decades ago and the RCM wholly supports any measure which seeks to avoid infection."

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/09/17/nhealth117.xml

Health Direct applauds these moves.There has to be a zero tolerance approach to tackling MRSA superbugs. It is shocking that, after countless government initiatives, the number of hospitals failing to protect patients from these infections has quadrupled.

It's a shame though that these measures will not take effect until January next year. Based on current statistics it will mean another 12,000 contracting these killer diseases unnecessarily.

Hospitals losing fight to defeat MRSA, C Difficile superbugs- health watchdog warns was posted by Health Direct on Tue 19 Jun 07- One in four NHS trusts is failing the latest labour government targets on cleanliness and tackling superbug infections.

Figures released by the Healthcare Commission show that six out of ten trusts in England have reported failing one or more of the twenty four “core standards” on all aspects of care, on which they are assessed by the NHS watchdog.

In April, statistics from the Health Protection Agency (HPA), the public health watchdog, showed that there were 55,681 cases of C. difficile in patients aged 65 and over in England in 2006. That figure was up by 8 per cent on 2005.

Labour red tape shake up costs NHS 140 million Pounds

The reorganisation of strategic health authorities (SHAs) in England has seen the NHS pay out more than £80m in redundancy costs, Health Direct and the BBC has learned. More than 700 staff lost their jobs in last year's shake-up, which saw the number of SHAs reduced from 28 to 10. The cost of the average redundancy package for senior managers was more than £350,000.

"These are the kind of costs that result from endless reorganisations. Not one penny contributes to the health of patients." claimed Andrew Lansley, shadow health secretary

The BBC obtained the figures from the 10 SHAs using the Freedom of Information Act.

Twenty-eight SHAs were set up in 2002 by the labour govt to supervise local health services in England. Their job was to coordinate care and deliver government policy.

But three years later ministers announced £250m had to be cut from red tape and four years after they were created the regional bodies were merged into 10.

Some 764 people were made redundant or took early retirement at a cost of £82.89m. That included 61 senior managers. Their redundancy packages cost an average of £358,355.

But the Liberal Democrats say the true cost of the changes must include the reorganisation of primary care trusts, which were reduced from over 300 to 152 last year.

They claim that the cost of those mergers could be as high as £60m, making a total bill for the changes of more than £140m.

Liberal Democrat health spokesman Norman Lamb said: "This is the price we're paying for botched reforms. The government rushed into ill thought out reform...when the system didn't work they changed it."

From:
http://news.bbc.co.uk/1/hi/health/6961082.stm

Health Direct posted on 20 Jul 07 NHS manager's lottery payout is nearly £1m - An NHS manager has been given a redundancy package worth almost £1 million in what was described as "a lottery win rather than a payout".

David Johnson, the former head of a regional strategic health authority, was one of about 70 staff who left the organisation when it was abolished as part of a restructuring programme.

Robert Goodwill, the Tory MP, condemned the settlement awarded to Mr Johnson. He said: "Most people will look at this and say this is a lottery win rather than a payout."

Mr Goodwill, who represents Scarborough and Whitby, in North Yorks, said he understood Mr Johnson was entitled to the payout under the terms of his contract. But he criticised the contract itself and the multiple reorganisations of the NHS that lead to high-profile job losses.

Mr Goodwill said: "How do I explain these payouts to people who can't get their Alzheimer's disease drugs, or they can't get drugs for conditions causing blindness?"

Given the current climate of tony's cronies- Health Direct asks if there any relationship between David Johnson the NHS lottery winner and Alan Johnson the new NHS boss?