NHS managers need disciplinary body, latest inquiry urges

Senior NHS management should be turned into a profession, with an independent body created to discipline managers and board members, the latest inquiry into the Mid Staffordshire NHS Foundation Trust said.

Andy Burnham, the health secretary, who announced a fresh inquiry - the third - into the appalling standards of care at the Staffordshire hospital, said he would consult on the proposal, which was welcomed by the Patients Association.

"We must end the situation where a senior NHS manager who has failed in one job can simply move to another elsewhere," Mr Burnham said.

It was, he said, a "long-standing anomaly" that incompetent doctors and nurses can be disciplined and even struck off, but that there is no equivalent scheme for NHS managers, nor for the non-executive directors who, for salaries of a few thousands pounds a year, help make up the boards of NHS organisations.

The call to give NHS management the status of a new profession came as the inquiry by Robert Francis QC catalogued the most dire standards of care at Stafford hospital, which included needless deaths and staff leaving patients "sobbing and humiliated" while lying in their own faeces. 

The inquiry was highly critical of the Trust's board, which it said took too strategic a view of its function. Most of its members remained "in denial" about the hospital's problems, the inquiry said, even after a damning report from the NHS inspectorate.

The case "highlights the need for a proper system of ensuring the accountability of executive officers and non-executive directors" of NHS organisations, the inquiry said.

The NHS Leadership Council has already been examining the possibility of a regulatory body for NHS managers along the lines of the General Medical Council, which regulates doctors.

Nigel Edwards, head of policy at the NHS Confederation , said there was a good case for accrediting managers - which would establish, among other things, that they had had no major failures in the past - but was much more sceptical about full-blown regulation.

Both he and John Restell, general secretary of Managers in Partnership (MiP), the managers' union, questioned whether clear regulatory standards could be defined for good management as they are for doctors and nurses. Good human resources practice would go a long way to addressing managerial problems, Mr Edwards said.

Mr Restell said: "There is a risk of a big bureaucracy. And there is nothing to suggest that regulation of individuals would have prevented the systemic failures seen at Mid-Staffs and Maidstone and Tunbridge Wells [where patients died from hospital-acquired infections]. We would not want the public to be sold a pup."

There was also the risk that over-regulation of non-executive directors would deter good applicants, he said.

The new inquiry will look into the failure of communication that led Monitor, the trust regulator, to approve the hospital's application to become a foundation trust at the same time as the Healthcare Commission, the quality inspectorate, was becoming seriously concerned about the hospital's quality of care. It will also examine why the local primary care trust, which commissions the hospital's services, appeared unaware of how bad things were.

The department is aiming to produce a standardised measure of hospital death rates after apparently high ones first triggered the inspectors' concerns at Mid-Staffs. Disputes about how they are constructed meant it was "unsafe" to give any range for the excess deaths at the hospital, the inquiry found.

From:

http://www.ft.com/cms/s/0/6f5ee00a-21ae-11df-acf4-00144feab49a.html

Inquiry into NHS preferred provider rule halted

Primary care trusts across the east of England were ordered to suspend procurement for community services yesterday in a move that halted an independent investigation into the legality of Andy Burnham's "preferred provider" policy for the NHS.

The Co-operation and Competition Panel , the health department's advisory body on the application of competition , was left with no case to judge after procurement was halted.

The decision infuriated representatives of voluntary organisations and the private sector, who had brought the complaint.

John Appleby, chief economist at the King's Fund health think-tank, said: "This looks like a piece of naked politics to prevent the panel ruling on [the preferred provider policy]."

Mr Burnham, the health secretary, announced in September that NHS organisations were to be the service's "preferred provider" of care. At the time, under the existing NHS procurement rules designed to encourage competition, Great Yarmouth and Waveney PCT had invited any willing provider to tender to run its community services.

Following Mr Burnham's speech, however, it withdrew the invitation to the private and voluntary sectors, saying it was now "only able to accept bids from NHS organisations".

In December, the NHS Partners Network, which represents private providers, and Acevo, which represents voluntary organisations, complained to the panel that the move breached the NHS's existing procurement rules and almost certainly also breached European Union procurement law.

The panel reached an initial decision in private on Monday to take the case further. It is understood to have decided that there was a strong case for the complainants' view. Before it published, however, it was told by the health department that not just Great Yarmouth but all 14 primary care trusts in the east of England health authority had been told to suspend procurement, leaving no case to consider.

Peter Kyle, deputy chief of the Association of Chief Executives of Voluntary Organisations, said that three months after initial investigation had begun, "the department knew what the panel's verdict was likely to be, so they have pulled the plug on the investigation. It is pretty shaming."

Mike Parish, chair of the NHS Partners Network, said it would still press the case if "preferred provider' leads to other uncontested contracts. These would, the network believes, "run contrary to the principles of procurement law".

From:

http://www.ft.com/cms/s/0/8b719114-272d-11df-b84e-00144feabdc0.html?nclick_check=1

Stafford Hospital patients routinely neglected by cost cutting and targets

NHS Stafford Hospital patients were "routinely neglected" after management became preoccupied with cost-cutting and targets. Appalling standards of care put many patients at risk, and between 400 and 1,200 more people died than would have been expected in a three-year period from 2005 to 2008, the independent commission found.

The Mid Staffordshire NHS Foundation Trust, which runs Stafford Hospital, lost sight of its responsibility to provide safe care, the damning report found.

The probe was launched into events at Stafford Hospital after another report last March from the Healthcare Commission revealed a catalogue of failings at the trust, which also runs Cannock Chase Hospital.

The, inquiry chairman Robert Francis QC made 18 recommendations for both the trust and the government in his final report after hearing evidence from more than 900 patients and families.

But Julie Bailey, who founded the campaign group Cure The NHS after the death of her mother at the hospital, described the report as "absolutely outrageous", adding: "All he's done is recommended another independent inquiry."

Mr Francis, presenting his report at a press conference near Stafford, said: "I heard so many stories of shocking care. These patients were not simply numbers, they were husbands, wives, sons, daughters, fathers, mothers, grandparents.

"They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives."

He said evidence gathered during the inquiry into events at the trust between January 2005 and March 2009 had shown clearly that for many patients the most basic elements of care were neglected.

Patients were left unwashed, at times for up to a month, and food and drinks were left out of reach of patients, the inquiry found.

Mr Francis also identified a chronic shortage of staff, particularly nurses, as being largely responsible for the sub-standard care give to patients.

He also said that while many staff did their best in difficult circumstances, others showed a disturbing lack of compassion to patients.

Mr Francis said: "The evidence gathered by this inquiry means there can no longer be any excuses for denying the scale of failure.

"If anything, it is greater than has been revealed to date. People must always come before numbers. Individual patients and their treatment are what really matters."

Health Secretary Andy Burnham said today: "This was an appalling failure at every level of the hospital to ensure patients received the care and compassion they deserved. There can be no excuses for this.

"I am accepting all of the recommendations in full."

Mr Francis recommended that the Department of Health launches an independent examination of how regulators and bodies such as strategic health authorities monitor hospitals, with the aim of learning lessons about how failing trusts are identified.

Today's report found patients were left in dirty bedding and were caused "considerable suffering, distress and embarrassment".

It said: "Requests for assistance to use a bedpan or to get to and from the toilet were not responded to. Patients were often left on commodes or in the toilet for far too long.

"They were also often left in sheets soiled with urine and faeces for considerable periods of time, which was especially distressing for those whose incontinence was caused by Clostridium difficile.

"Considerable suffering, distress and embarrassment were caused to patients as a result."

The inquiry also found that the attitude of some nurses "left much to be desired".

It added: "Some families felt obliged or were left to take soiled sheets home to wash or to change beds when this should have been undertaken by the hospital and its staff.

"Some staff were dismissive of the needs of patients and their families."

From:

http://www.telegraph.co.uk/Patients-routinely-neglected-at-Stafford-Hospital

Warning over primary care trusts in commissioning health services

Primary care trusts, which commission services for patients from the public, private and voluntary sectors, are at risk of breaching NHS competition rules in a "significant" number of cases. 

The warning comes from the panel set up to advise health ministers on the application of competition in the NHS.

It is the latest twist in a deepening row over whether the government is seeking to squeeze out non-NHS providers - including the not-for-profit sector - in the battle to win contracts for providing publicly-funded healthcare.

In September Andy Burnham, health secretary, appeared to overturn existing policy when he said the NHS should henceforth be regarded as the "preferred provider" of healthcare.

However, almost four months after Mr Burnham pledged the rules governing the bidding process would be rewritten to reflect the new approach, nothing has emerged. 

The Department of Health recently said that they would be published "in the coming weeks" - leading to speculation that they might not emerge before the election, or before the panel issues its initial judgment in March.

That means the panel must make its judgment based on the competition rules currently in force - prompting the warning from Andrew Taylor, the competition panel's chief executive, that PCTs may be making decisions that reflect Mr Burnham's rhetoric but flout current rules.

Mr Taylor said problems it had observed included "excluding potential bidders on grounds unrelated to their ability to deliver the services tendered, and failing to select the bestperforming service provider as the preferred bidder".

However, in a sign of the growing tension between the panel - set up by Alan Johnson, when health secretary - and current health ministers, the health department has publicly rejected that view.

A spokesman said it appeared to be based "on anecdote". The Co-operation and Competition Panel had presented "no evidence" from its casework in a report on its first year's work "to suggest poor procurement practice by commissioners", he said.

The spat comes as the panel is investigating a crucial test case in which Great Yarmouth and Waveney PCT said it could take bids only from NHS organisations to run its provider arm.

From:

http://www.ft.com/cms/s/0/efe144aa-1a99-11df-bef7-00144feab49a.html?nclick_check=1

BMA cost warning on plan to scrap GP boundaries

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

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

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

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

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

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

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

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

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

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

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

From:

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

Doctor Daniel Ubani unlawfully killed overdose patient

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Two catch Legionnaire’s disease at hospital attacked over hygiene

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

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

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

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

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

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

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

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

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

From:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Decision on new health regulator quango delayed

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

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

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

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

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

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

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

From:

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

Labour delays free hospital car parking again.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Swine flu chaos for children over vaccinations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Cancer research at risk in scramble for care funds

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

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

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

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

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

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

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

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

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

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

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

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

Nanny state wants NHS to provide free marriage guidance

Couples are to be offered marriage guidance counselling for free on the NHS, in a move which has drawn strong condemnation from patients and doctors' groups.

Couples with relationship problems will be offered free sessions for up to six months, as part of a £270 million programme to increase the provision of "talking therapies" for the public, Andy Burnham, the health secretary, announced.

Doctors and patients' groups said they were "horrified" by the use of NHS resources for relationship advice when patients with cancer and dementia were being denied treatment they desperately needed.

Currently, most people seeking help from services like Relate pay between £45 and £60 per session, meaning the free counselling packages will be worth around £1,000 per couple.

The NHS is expected to have to pay existing marriage guidance services, and newly-trained counsellors to provide the therapy.

Doctors and patients groups last night attacked the recommendation, contained in guidance by the National Institute for Health and Clinical Excellence (NICE). NICE has repeatedly come under fire for decisions to reject life-extending drugs for cancer and treatment to reduce symptoms of dementia.

On Thursday, NICE was accused by charities of "condemning patients" to an early death by rejecting the use of Nexavar, a drug which can extend the lives of liver cancer, arguing that its £9 million annual cost – £3,000 a month per patient – could not be justified.

Nick James, professor of clinical oncology at the Cancer Research UK Institute for Cancer Studies said: "I am horrified, in particular because of the way these decisions are taken without public debate.

"I think most people would say treatment for those who are sick with cancer should be top of our list, and I would really question whether these kinds of efforts to preserve marriages are a matter for the state."

NICE has previously restricted the use of drugs to limit the effects of Alzheimer's, costing £2 a day, while provoking further controversy in May when it ruled in favour of alternative therapies like acupuncture for back pain, despite admitting there was little evidence they worked.

Michael Summers, Vice-President of the Patients Association, urged NICE and the Government to "get their priorities right". If we had the luxury of untold sums of money, maybe we would think about paying for couples counselling," he said.

"As things stand, people are still waiting for urgent treatment, being denied drugs for cancer, and dementia, and it seems inappropriate at the very least to start using public money in this way".

From:

http://www.telegraph.co.uk/health/healthnews/NHS-will-provide-free-marriage-guidance

NHS offers hospital to private bidders

An NHS district general hospital, complete with accident and emergency and maternity services, is being offered up for takeover by the private sector for the first time, alongside bids from other NHS organisations.

But the conditions being attached to the seven year franchise to run the 369 bed Hinchingbrooke Hospital in John Major’s former Huntingdon constituency are so stringent that analysts said there was not likely to be much private sector interest.

The offer comes as Andy Burnham, the health secretary, has stressed that while NHS organisations are the labour government’s “preferred provider” of NHS care, services can still be franchised or tendered where they have proved financially unsustainable.

Whoever wins the contract, however, the NHS will continue to own the assets, according to the East of England Strategic Health Authority, which is running the tender. Staff will remain on NHS terms and conditions and will not be transferred to the winning franchisee.

All current services will have to be retained. But the franchisee will have to take full demand and volume risk with no guarantees on future revenue. In addition, on a £92m turnover for the past year, the operator will be expected to help pay back at least some of the £38.9m of debt that the hospital has accumulated over the years and which it owes to the rest of the NHS.

The health authority says there is significant private sector interest in the deal, as well as interest from NHS foundation trusts and other health service organisations.

But the NHS Partners Network, which represents private providers of NHS care, said the offer “appears to lack commercial reality”.

Private providers have been told some of the conditions may be negotiable, said David Worskett, the network’s director. “But it doesn’t seem to give sufficient scope for doing things differently to make it an attractive proposition,” he added.

William Laing, of analysts Laing and Buisson, said the private provider that wins the contract is “being asked to take all of the risk while being denied the tools needed to make any real changes”.

The health authority said it was expected to take 18 months to conclude the deal.
 

From:

http://www.ft.com/cms/s/0/11981a30-c4b7-11de-8d54-00144feab49a.html

Health Direct asks- what is the point? A hospital has over run it's budget with no sign of financial balance in the near future. So some paperpusher in the DoH has come up with the bright idea of external funding. 

Great- except that they don't really want the hassle that will go with the spin. So wait 18 months until a change of govt with new masters. In the meantime, let's waste some poor business sod's time by looking at prospective red tape. 

Ergo 18 months time no new money, same old problem.

Surge in patients going private on NHS

More patients are choosing private hospitals for their NHS treatment, latest figures from the Department of Health show, as labour's much vaunted "choice" agenda finally takes off.

Almost 100,000 individual patients have now chosen the private sector for diagnostics and waiting list operations, paid for by the NHS, since the option was first offered.

The great bulk have done so during the past year.

The rise in NHS patients has thrown something of a lifeline to private hospitals, which have seen the number of patients willing to pay for treatment out of their own pocket - as opposed to via insurance - fall in the recession. There are also indications that the private health insurance market is stagnant or falling for the same reason.

Since April last year, NHS patients have been able to choose any private hospital willing to take them at NHS prices, and almost all private hospitals are registered to participate in the scheme.

Over 18 months, and after a very slow start, the numbers doing so have quadrupled from 2,100 a month in April 2008 to 8,400 this August. The business is now worth £200m a year to the private sector, and rising, according to Bob Ricketts, director of system management at the Department of Health.

These numbers are on top of NHS patients being treated in independent sector treatment centres, and those treated where primary care trusts or NHS hospitals buy operations from the private sector in order to hit NHS waiting time promises.

All NHS business is now understood to account for more than 20 per cent of the income of some private hospital groups, and more than a third of the income for Ramsay Health Care business, which runs a chain of independent sector treatment centres.

William Laing, chief executive of the analysts Laing and Buisson at whose conference Mr Ricketts disclosed the new figures, said: "This is great news for the private hospital groups because they can turn the tap on and off at will for NHS patients. If and when self-pay revives, they can run down their NHS work."

Despite the rise in patients choosing the private sector, it still accounts for only a fraction of all NHS waiting list surgery- less than the potential 15 per cent that ministers once indicated was possible. 

Asking whether the big squeeze to come on NHS spending is likely to mean fewer opportunities for the private sector or more, Mr Ricketts said: "Probably more".

Dramatic changes in the way care is delivered will be needed to secure efficiencies and quality improvements as the NHS seeks savings of £20bn, he said - and an innovative private sector, prepared to invest, could play a big part. He played down the likely impact of statements from Andy Burnham, the health secretary, that NHS organisations are now the service's "preferred provider".

From:

http://www.ft.com/cms/s/0/4728bd8a-c1ce-11de-b86b-00144feab49a.html?nclick_check=1

Threat to rural GPs who dispense medicine as fees cut

Rural GP surgeries are under threat as fees paid to them for dispensing medicines are being cut leading to fears some may be forced to cut back services, stop providing drugs or close.

GP practices which dispense medicines are almost entirely in rural areas and 3.5million patients, particularly the elderly, rely on them so they can see their doctor and collect their drugs in one trip.

However, the labour Government is now cutting the fee it pays to the surgery for each medicine it dispenses.

NHS Employers has announced that from October 1st the fee per medicine dispensed will drop from £2.14 to £1.95, leading to a drop in income of around £850 per month for the average dispensing practice.

Dr David Baker, chief executive of the Dispensing Doctors Association, said: "If something does not happen to protect surgeries there is a risk practices will struggle hugely and certainly some will have to cut services. If we cannot cover our costs there is a major problem."

He said surgeries would try to continue dispensing because patients rely so heavily on the service but other things like branch surgeries or nurses would have to be cut.

There are around 1,500 dispensing practices in England and Wales out of around 8,500 in total.

It comes after plans announced by Andy Burnham, Health Secretary, to abolish GP catchment areas so people can visit surgeries near to their work, rather than their homes. There are fears this will lead to them losing their younger healthier patients to surgeries near where they work and leaving the older, sicker patients who are more expensive to care for.

Dr David Bailey, negotiator for the British Medical Association on behalf of dispensing doctors, said there was little choice but to accept the cut in fee and moves to correct the discounting problem will not be solved for some time, meaning dispensing doctors will suffer in the meantime.

He said: "It makes no sense to have a situation where it costs you money to privide a service to the NHS.

"In rural areas the dispensing side of the practice subsidises the GP surgery and if that subsidy is removed there is a diseconomy in running a rural practice. It will threaten small rural practices."

An inquiry is due to be launched next year into the costs of GPs dispensing drugs which may lead to changes and doctors said it was unfortunate that the reduction in fees could not be put off until after that was concluded.

Officials have said the changes in the fee will mean the way funding for dispensing GPs is calculated will be brought into line with non-dispensing GPs.

From:

http://www.telegraph.co.uk/Threat-to-rural-GPs-who-dispense-medicine-as-fees-cut

Patients to be able to choose GP in new labour spin

Patients will be allowed to register with the GP of their choice within the next year, Andy Burnham , the health secretary, announced.

The scrapping of existing GP catchment areas would allow commuters to register with a family doctor near work, or choose another practice locally, outside the catchment area of their primary care trust.

"I want to open up real choice in primary care," Mr Burnham said in a speech to the King's Fund health think-tank. Patients should be able to choose a practice "based on their needs, not by lines on a map" or by postcode.

Wider choice of GP is already Conservative policy and, according to the British Medical Association, this will be the fourth attempt by Labour to widen the choice of a family doctor, with previous efforts foundering over the cost and complexity of what appears a simple change.

Dr Laurence Buckman, chairman of the British Medical Association's GP committee, said: "Most GPs would be comfortable with flexible boundaries."

But "major logistical barriers would need to be overcome for a patient to be able to register with practices a long way from home", he warned.

The issue of home visits would need to be sorted out, Dr Buckman said. But a bigger problem was that patients came with an amount of money attached to them, which funded hospital and community as well as GP services. Without some compensation system, big movements of young, fit patients, whose fees help subsidise sicker and older patients, could hit funding formulas for rural and suburban services.

"Practices in rural and suburban areas could lose significant numbers of young, healthy patients, destabilising their funding and threatening their viability," Dr Buckman said.

"Meanwhile, city centre practices would be inundated with requests for appointments at lunchtimes and evenings, which would effectively limit patient choice." Dr Buckman said the problems "are not insurmountable". But they needed "a lot of careful thought" and could prove costly to solve.

Mr Burnham appears determined to do that. Dual registration - allowing patients to register both with a practice near work and one at home - has been raised in the past, but ruled out because of the cost.

From:

http://www.ft.com/cms/s/0/09770f8e-a3ea-11de-9fed-00144feabdc0.html

Health Direct wonders quite where the funding will come from for the new paperpushers that will be needed to balance the doctors' surgery budgets- as well as transferring patients' data as the much promised NPfIT white elephant is still years away from completion.

Labour to cut £20bn off NHS budget

The National Health Service will have to find savings of £15bn ($24bn) to £20bn, Andy Burnham, the labour health secretary, has acknowledged.

Hospitals are to get their first indication in the autumn of just how far and fast they will have to cut costs to help achieve that. His acknowledgement of  the scale of the challenge comes as Gordon Brown and Alistair Darling, prime minister and chancellor, have begun a series of meetings with cabinet ministers to discuss priorities and potential candidates for cuts in the run-up to the pre-Budget report in the autumn.

Labour Government insiders played down suggestions that the autumn statement would be a mini spending review, setting out departmental spending limits beyond March 2011.

But after the prime minister’s use of the “c” word this week, promising to “cut unnecessary programmes and cut lower priority budgets”, the chancellor is likely to offer some totemic sacrifices in the pre-Budget report, while possibly spelling out areas likely to be protected from the worst of the squeeze.

It is already clear that the capital intensive areas of transport and housing are set to take a hammering given previously announced plans to halve capital spending from this year’s level.

“They will almost certainly be amongst the hardest hit,” said Robert Chote, director of the Institute for Fiscal Studies.

Health is likely to be relatively protected, not least because the Conservatives are promising some real terms growth. That, however, will still leave the NHS having to make massive savings in the face of rising demand from medical advances and an ageing population, which together with pay and price inflation tend to outstrip economic growth.

Mr Burnham indicated this week that he would like to set out an “overall spending settlement” for the NHS in the autumn, while acknowledging that is a matter for the chancellor.

But whether that happens or not, he told the King’s Fund health think-tank, he will take the unprecedented step of spelling out the prices the NHS is likely to pay hospitals for treatment over the next four years.

That “will set out the scale of the efficiency and productivity challenge year on year, building up over time, with the most demanding savings coming later,” he said. In turn, he said, that “will begin the process of showing how we realise [the] challenge of finding £15bn to £20bn of savings” up until 2014.

Nigel Edwards, head of policy for the NHS Confederation, which itself has calculated that the NHS needs to make up to £15bn of savings by 2015, said: “This is the first ministerial acknowledgement that I have seen of the scale of the challenge.

“The good news is that it has been publicly acknowledged, and we welcome that realism. The bad news is that it is at least as bad as we thought”. 

"The price schedule, or tariff, covers about 70 per cent of hospital activity, which itself accounts for only some 40 per cent of the NHS budget. So spelling that out will give an indication but not a firm projection of likely level of NHS spending.

From:

http://www.ft.com/cms/s/0/b56a59c6-a486-11de-92d4-00144feabdc0.html?nclick_check=1

Health secretary attacked over move to call in regulator of NHS trusts

Andy Burnham was yesterday accused of undermining the principle of the government's health service reforms - by the NHS itself.

The health secretary wants powers formally to ask Monitor, which regulates foundation trusts, to intervene when one of the hospitals hits the headlines for the wrong reasons. NHS bodies said that would threaten the regulator's independence.

The move follows the discovery that mistakes in emergency care at Mid-Staffordshire Hospital had caused hundreds of unnecessary deaths.

Mr Burnham is proposing that the health secretary should be able legally to ask the regulator to act where there is "demonstrable poor quality, demonstrable poor governance or a failure of leadership".

But Sue Slipman, director of the Foundation Trust Network, said the issues on which ministers could intervene were far too widely drawn. They threatened an important settlement of the NHS reforms, she said - that foundation trusts would be free-standing organisations, regulated independently, and no longer subject to direction by the secretary of state.

The proposals were "second guessing Monitor", she said, and could mean the health secretary intervening "every time there was a negative story in the newspapers".

Yesterday, the NHS Confederation, which represents all health authorities and trusts, reinforced her argument, saying the proposals were "unnecessary" and threatened a repeat of the 1990s, when similar freedoms given to ordinary NHS trusts were steadily clawed back by the Department of Health.

Nigel Edwards, the confederation's director of policy, said: "It is not clear that this is necessary." If the quality of care were at issue, the new healthcare inspector, the Care Quality Commission, had the power to close services, which would trigger action by Monitor, he said. He also pointed out that Mid-Staffordshire had been dealt with effectively by Monitor, which replaced the trust's leadership.

"This can be seen as a symbolic first step to reclaiming the freedoms and independence that were bestowed on foundation trusts," he said. It was "against the whole spirit of the existing legislation".

The health department insisted the new powers would be used "rarely" and in "exceptional circumstances". But Mr Edwards said having them would put ministers under pressure to act "and the definition of exceptional will become looser and broader".

http://www.ft.com/cms/s/0/dd4d2dac-7d6b-11de-b8ee-00144feabdc0.html?nclick_check=1

Swine flu- labour ministers blamed for chaos

The labour Government will be criticised over its handling of the swine flu crisis by a powerful parliamentary committee this week.

The report will attack the labour Government's failure to keep its promise to set up a flu telephone helpline by April.

Labour Ministers will be held to account for the delay in setting up the national flu helpline and for giving confusing advice to vulnerable groups and NHS staff.

The report will be published as senior doctors hold an urgent meeting with Andy Burnham, the Health Secretary, in a last ditch attempt to persuade him to drop controversial European rules limiting the hours doctors can work, which are due to come into force on Saturday.

One doctor gave warning that the NHS was facing a “triple whammy” as it struggled with swine flu, the introduction of the European Union Working Time Directive and– four days later – the movement of more than 30,000 junior doctors between hospitals as part of the annual rotation of specialities.

Further concerns over Britain’s swine flu response are raised today by a Sunday Telegraph investigation, which has exposed major security lapses in the national flu pandemic service.

The flaws would allow fraudsters to obtain dozens of doses of Tamiflu – the main drug being issued to swine flu victims.

The Sunday Telegraph has also discovered that maternity units are planning to cancel home births and planned caesarean sections if the outbreak turns into a major epidemic.

Andrew Lansley, the shadow health secretary, said government planning failures had created a response to the pandemic that already appeared to be “riddled with problems”. He accused ministers of taking “an ad hoc approach” to a situation which needed careful planning.

This week’s report by the House of Lords science and technology select committee is the first to look into the Government’s preparedness for pandemic flu. It will attack its failure to keep its promise to set up a flu telephone helpline by April when the world was on the brink of a pandemic.

This newspaper disclosed in May that the delay was caused by the Treasury, which took seven months to sign off on the deal.

The hold-up meant the Government had to introduce a stopgap flu phoneline, introduced last week, manned by staff given just one day of training.

In the meantime, NHS Direct, which should have been running the service, has made hundreds of its highly trained staff redundant.

The Lords report will also question the adequacy of advice being issued to the public, in particular that offered to vulnerable groups such as expectant mothers. In evidence sessions, committee members described the lack of public advice for pregnant women as “extraordinary”.

The advice was only publicised last week, leading to further confusion when ministers appeared to distance themselves from recommendations they had previously endorsed.

Last night senior doctors said ministers must take urgent action to avert an impending crisis.

From Saturday, doctors will not be allowed to work more than 48 hours a week, under EU rules. The change has been fiercely resisted by many senior doctors who say it will put lives at risk.

It could mean that the NHS is short of doctors just as pressure on hospitals caused by the swine flu outbreak intensifies.

Britain’s top surgeon has urged ministers to suspend changes to working hours. John Black, the president of the Royal College of Surgeons, accused ministers of “having their heads in the sand”.

He said: “The courageous thing to do would be to step in and suspend the 48-hour limit for the whole of the NHS, once we come under pressure, but that would require political leadership. I don’t expect it to happen.”

Mr Black said despite warnings the Government had made no useful concessions over the rules which he says will put lives at risk, and “devastate” the training of health professionals. He will restate his plea for concessions over doctors’ hours in a meeting with Mr Burnham on Wednesday.

The weekly 48-hour limit for doctors is measured over a sixth-month period, allowing doctors to work extra hours some weeks, if they then cut back on others.

Doctors can opt out of the directive on a voluntary basis, but only individually, throwing rota planning into “chaos”, according to senior doctors. They want whole departments or specialities to be allowed to suspend the rules.

Both Mr Black, and John Heyworth, the president of the College of Emergency Medicine, said they did not expect the introduction of the working directive to have an immediate impact, but they fear it could cause shortages of doctors by September, when flu cases may soar. Mr Heyworth, an A&E consultant at Southhampton General Hospital, said: “There is a triple whammy heading inexorably our way – the directive, doctor rotations, and swine flu, and the impact of all of this happening at once is unknown.”

He said doctors had explained their concerns to ministers about the changes to working hours “at great length”. Last night the Government defended the operation of its Pandemic Flu Service. It said that on the first day of the service, Thursday, it carried out more than 58,000 assessments, and almost 6,000 courses of antiviral drugs were collected in England.

From:
http://www.telegraph.co.uk/health/swine-flu/Swine-flu-ministers-blamed-for-chaos

Swine flu vaccine not ready for months says World Health Organisation

The head of the World Health Organisation, Dr Margaret Chan, has cast doubt on the labour Government's claims that a reliable swine flu vaccine will be available to the public by next month.

Dr Chan said that it would be several months before a safe vaccine was in mass production.

“There’s no vaccine. One should be available soon, in August. But having a vaccine available is not the same as having a vaccine that has been proven safe,” she said in an interview with The Guardian.

Her words appear to undermine assertions made by Andy Burnham, the Health Secretary, that the first vaccines will be ready for use by August, by when it is predicted there could be as many as 100,000 new cases a day in Britain.

Meanwhile, the number of deaths from swine flu in Britain may already be higher than the 16 officially caused by the disease, experts have warned.

Up to one in 200 patients who develop serious swine flu symptoms could die from the disease, they said.

But the official tally of deaths may be an underestimate due to difficulties in assessing causes of death, said the team at Imperial College London.

Prof Azra Ghani said: "For example, we know that flu causes a lot of cases of pneumonia. The cause of death could be recorded just pneumonia and we won't known of it was pneumonia or pneumonia caused by swine flu."

The Daily Telegraph can also disclose that tourists and school parties from abroad are cancelling trips to Britain because of fears that it is a global hot spot for swine flu.

There is concern among tourism chiefs over the potential impact on the economy caused by the virus after the first signs emerged that visitors from Europe and the south east Asia are refusing to travel to the country.

Britain has more confirmed cases of the disease that any other country in Europe and is the fourth worst hit nation in the world.

Two conferences at Cambridge University were recently cancelled because of health concerns and it is understood that a small number of schools in Europe have also pulled out of exchange trips and summer schools.

Nearly 10,000 Britons have been confirmed as suffering from the virus, and 16 deaths are linked to it, including that of six-year-old Chloe Buckley last week.

Visit Britain, the country's marketing agency, said that an official survey was under way to analyse the effect of any potential downturn in the numbers of visitors.

Dr Oliver Pybus, an evolutionary biologist at Oxford University, said that London will already have developed its own mutated strain of swine flu due to the number of infections. (See yesterday's Health Direct post: Swine flu virus has mutated in London, scientists warn 15 Jul 2009- London has already developed its own mutated strain of swine flu, scientists warned.)

Earlier this month Andy Burnham, the Health Secretary, warned that up to 100,000 people a day could become infected with the virus by the end of August, although he has appealed for calm and insisted that most people will develop only mild symptoms.

http://www.telegraph.co.uk/health/swine-flu/5829768/Swine-flu-vaccine-not-ready-for-months-says-World-Health-Organisation.html

NHS dentists to be paid to take on patients

Britain’s much criticised NHS dental services are poised to be overhauled, with dentists being paid more for taking on new patients.

Andy Burnham, health secretary, said he supported “in principle” a plan that would reward dentists for registering new patients.

The author of the report, Professor Jimmy Steele, said dentists would have “a significant chunk” of their annual income – possibly as much as 50 per cent – linked to the number of patients on their books.

“It’s an incentive to take more patients on,” he said. “We are saying there needs to be an incentive to take patients on and it’s also a useful performance measure.”

The Steele report was commissioned by Alan Johnson, the former health secretary, in response to growing public anger about the shortage of NHS dentists in many parts of the country.

Apart from recommending that dentists should earn more for taking on extra NHS patients, the report also proposes remedies for when dental work goes wrong. That could mean dentists being penalised for faulty work and having to carry out repair work at no extra charge to the NHS.

At present dentists can end up being paid twice by the NHS for carrying out faulty work: first for the initial treatment, then for putting right a mistake. “It’s a basic principle of quality and warranty,” said Prof Steele.

Mr Burnham said he wished to challenge the assumption that a previous government attempt to improve dentistry with a new contract in 2006 had “not worked for the public”.

It may not have resulted in the progress the labour Government had hoped for but there had been a “marked increase” in the number of patients getting access to an NHS dentist, he added.

“I recognise this is an area of unfinished business,” he went on. “We need to make sure the NHS is on the right path.”

But he insisted that the measures in the review were “certainly not about ripping up the 2006 reforms”.

According to the review, there has been too much focus since 2006 on paying dentists according to how much work they carry out.

A new way forward was for dentists to be paid according to three elements: registration of patients, quality of work and volume of activity.

Prof Steele also called for a new system of patient charges, replacing the current three band system with one of between five and 12 bands.

This was in response to some patients feeling they were not always getting value for money, he said.

From:
http://www.ft.com/cms/s/0/8f368184-5f77-11de-93d1-00144feabdc0.html

Swine flu cases in Britain could top 100,000 a day

The number of swine flu cases could reach more than 100,000 per day by the end of August, Andy Burnham, the Health Secretary, told the Commons.

The UK has moved past the stage of containing the swine flu outbreak and into the "treatment phase", he said.

"The national focus will be on treating the increasing numbers affected by swine flu. We will move to this treatment phase across the UK with immediate effect."

There are now 7,447 laboratory-confirmed cases in the UK, he said.

London and the West Midlands have already had sufficiently high numbers to move towards a policy of outbreak management, which saw people with swine flu clinically diagnosed rather than being confirmed by laboratory reports.

Mr Burnham said that last week saw a "considerable rise" in swine flu cases.

"There are now on average several hundred new cases every day," he said.

"Our efforts during the containment phase have given us precious time to learn more about the virus. We have always known it would be impossible to contain the virus indefinitely and at some point we would need to move away from containment to treatment."

He added: "We have now signed contracts to secure enough vaccine for the whole population."

The first will become available next month, with 60 million doses available by the end of the year.

From:
http://www.telegraph.co.uk/Swine-flu-cases-in-Britain-could-top-100000-a-day.html

Labour admits it cannot increase NHS funding

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

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

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

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

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

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

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

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

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

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

Mr Byrne admitted that capital spending would be reduced.

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

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

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

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

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

Health Secretary Andy Burnham promises NHS targets massacre

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Andy Burnham is the new health secretary in emergency cabinet reshuffle

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

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

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

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

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

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

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

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

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

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

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

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

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