Treasury could snatch £3bn from NHS budget, academic warns

The Treasury could try to claw back more than £3bn out of the NHS to contribute towards the credit crisis bail-out package, a leading health service academic has warned.

The NHS in England is currently forecasting it will have a £1.7bn surplus this year and Foundation Trusts, which are not under the direct control of Whitehall, have £2.5bn in the bank.

Prof John Appleby, chief economist at think tank, the King's Fund, has analysed the effect the financial crisis will have on the health service in the short, medium and long term, in the British Medical Journal.

He warns that the Treasury has a 'track record' of clawing back surplus funds from the NHS.

He wrote: "Although the prime minister pledged not to cut spending for health as set out in the 2007 comprehensive spending review, taking back unspent money may not be seen as a cut."

Prof Appleby said in the short-term the effects on the health service have been minimal, although Virgin Healthcare announced in September that it would not be bidding to run GP-led health centres yet, and several charities and NHS trusts have money on deposit with failed banks in Iceland.

In the medium term, spending on health is supposedly fixed until 2011 so while an outright cut in labour Government funding is unlikely, the NHS budget is being eroded by high inflation.

It is thought that inflation may have peaked but inflation in the NHS runs a little higher than the general economy and every one per cent increase costs the NHS £380m, Prof Appleby wrote.

The real danger for the NHS is in the long term because, with labour Government borrowing rising, and income from taxes likely to fall during a recession, there will be less available to keep up the growth in health funding.

Prof Appleby warned that there may be no real growth in funding until 2014, in contrast to the large real terms increases enjoyed under Labour so far.

The financial situation is also likely to increase demand for health services, so the NHS will be squeezed from both sides, he said.

Prof Appleby wrote: "But not only will there be pressures on NHS funding, the combined effect of the credit crunch and recession on the population's health and wellbeing will increase ill health and demand on healthcare services.

"The link between deprivation, income, housing, unemployment, and healthcare needs is well documented."

A Department of Health spokesman said: "While the current financial position is settled for this spending review period, good financial planning means that the NHS needs to plan on a longer-term basis and this means looking to at least a five-year timeframe.

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Doctors do not back cervical vaccine choice made by labour ministers

The wrong vaccine against cervical cancer has been chosen by the labour Government and doctors would give their own daughters the alternative jab, a prominent doctor has warned.

GP and broadcaster Dr Phil Hammond, said he and most doctors he has spoken to have opted for Gardasil, rather than Cervarix, for their own children as it also protects against 90 per cent of cases of genital warts as well as cervical cancer.

Writing online in the British Medical Journal, he said the issue has been overlooked because genital warts 'never made it to the front cover' of newspapers, but if it were breast cancer instead there would 'marches on Downing Street' to campaign for the choice of vaccine to be made available on the NHS.

There are two different cervical cancer vaccines on the market, Cervarix and Gardasil, which protect against the human papillomavirus which causes the disease.

The Government has chosen to offer Cervarix as part of a national vaccination programme for all girls aged 11 and 12 with a catch up campaign for older girls.

There are over 100 strains of HPV and Cervarix protects against the two which account for most cases of cancer whereas Gardasil works against an additional two strains so protects against other sexually transmitted conditions as well.

Gardasil remains available but only privately even though most other European countries have chosen it for their own national programmes.

Dr Hammond wrote that with 100,000 new cases of genital warts in England each year and condoms only reducing transmission by up to 50 per cent, the far safer option is to vaccinate with Gardasil.

But, although Gardasil is available privately to parents, at a cost of £350 to £400, most will not be able to afford it, he added.

The vaccine choice could be a false economy because of the estimated cost of treating genital warts is £23m a year and vaccinating with Gardasil would have begun to pay off within three to four years, he said.

According to Hammond, who is a vice-president of the Patients Association, with the current cost of treating genital warts estimated to be £23 million, the government's decision may be a false economy. Within three or four years the use of Gardasil would have begun to have a considerable financial payback.

The NHS offers no information about Gardasil, raising serious questions over patient choice.

The Government's vaccine advisors said that if both vaccines were offered to the NHS at the same price then it would recommend using Gardasil because of the extra protection and because Cervarix, made by Sanofi Pasteur, has been chosen it seems the decision has been made on the basis of cost.

Both vaccines are listed as costing £80.50 in the book of licensed medicines but the details of the discount offered by GlaxoSmithKline to the NHS in order to get the contract, remains 'commerically confidential'.

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UK stroke treatment is worst in Europe

The UK has the worst outcome for strokes in western Europe despite spending the same amount or more on care as other countries, a leading article in the British Medical Journal warned.

Hugh Markus, professor of neurology at St George’s university and medical school, said three different studies had put the UK at the bottom among several other western European countries.

The problem appears to lie in the way services are organised, with strokes seen as a “Cinderella” subject that falls between neurology and geriatric medicine, Prof Markus said.

Instead it needs to be treated as “a condition that requires emergency action”.

Clot-busting drugs can now be given to patients whose stroke is due to a blocked blood vessel rather than a broken one.

To do that, however, rapid 24-hour access to specialised expertise and imaging equipment is needed to determine the type of stroke. The drugs have to be given within three hours to have most effect and can harm a patient whose stroke is due to bleeding.

“It is unlikely that every acute hospital will be able to provide such a service,” Prof Markus said, and alternative strategies that include regional centres and the use of telemedicine are needed, as in Germany and America.

“In many European countries,” Prof Markus added, brain imaging “is performed on admission to the accident and emergency department, while in the UK many units struggle to provide it within 24 hours.”

A National Audit Office report in 2005 calculated that 550 deaths could be avoided a year, and 1,700 patients would recover fully rather than being disabled, if ­services were better organised.

A stroke strategy is apparently due to be published by the health department in the next few months.

The limited data available, Prof Markus said, “show that European countries with better outcomes focus resources more heavily on the acute aspects of care”.

“The vast majority of the cost of in-hospital stroke care in the UK is for nursing and hospital overheads, with the cost of investigations and medical care being very low.”

At present less than 1 per cent of patients eligible for clot-busting drugs get them in the UK, against 20 to 30 per cent in many European countries and North ­America and Australia.

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It is nearly two years since MPs in the National Audit Office pointed out that hundreds of UK citizens are dying needlessly and over a year since Health Direct posted on July 12, 2006- Stroke patients dying needlessly from Labour's health failures

Since then new Prime minster- same lack of compassion and urgency.

Stroke patients are needlessly dying or suffering more serious disablement because not enough priority is given to stroke services, according to a report by the Commons Public Accounts committee.

The report found that stroke is not treated as a medical emergency, brain scans for patients are often delayed and a significant proportion of stroke patients are not treated on specialist units.

The MPs found:
* Stroke is not treated as a medical emergency in the same way as a suspected heart attack, though the shorter the time between the stroke and the treatment, the greater the chance of reducing damage to brain tissue.
* Brain scans for many stroke patients are being delayed, though a scan is vital for determining appropriate treatment.
* A significant proportion of stroke patients are not being treated on a specialist stroke unit, despite evidence that this is the most clinically effective model for acute care.
* There is considerable variation between hospitals as to what a specialised stroke service entails.
* Public awareness of the symptoms and impact of stroke, and how strokes can be prevented, is very low.
* There are insufficient nursing, therapist and other specialist staff with expertise in stroke care across the primary and secondary healthcare sectors, and there is scope to improve training for the existing stroke workforce in the National Health Service (for example, by training stroke consultants to interpret brain scan results).
* The carers of stroke survivors, and stroke survivors living on their own, are often not accessing the social and care services they need.
* There is low awareness on the part of members of the public and general practitioners about the fact that a transient ischaemic attack ('mini stroke') is a strong indication of increased risk of major stroke, and requires immediate investigation and treatment.

Warning over cuts to subsidies on drugs advice

Looming cuts to funding for independent prescription advice for doctors could undermine the best use of medicines in the UK, a senior medical figure warned yesterday. Sir Charles George, director of the British Medical Association's BMJ Group, which publishes a range of guides for doctors, said: "We're worried that a number of sources of information about good prescribing have disappeared."

His comments came against a backdrop of concern over a growing trend by the Department of Health to stop subsidising publications for prescribers that are designed to provide objective information free from -pharmaceutical companies' influence.

He was speaking ahead of the launch this week of the latest edition of the twice-yearly British National Formulary, which is produced by the BMJ and which a new survey showed was the preferred medicines reference guide for GPs.

The BNF is distributed free of charge, thanks to government subsidies, to 185,000 prescribers in England alone. However, the DoH threatened at the end of last year to stop subsidising its distribution to medical students in England.

There was a last-minute reprieve after complaints, but Sir George said there had been no assurances that the subsidy to students would not be removed before the next issue of the BNF this autumn.

The threats to the BNF follow a pattern of reductions in government support in England in recent months for other independent assessments of medicines, at a time of growing demand internationally for such information.

The government last year removed the subsidy in England from the Drugs & Therapeutics Bulletin, a source of treatment information for GPs, which has led to subscriptions falling to one-sixth of their previous level.

From the start of this year, it also stopped funding Clinical Evidence, another regular guide produced by BMJ, and Best Treatments, a service that provided information on medicines to patients through the NHS Direct website.

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On June 13, 2006 Health Direct questioned the action of cutting the dissemination of best drugs practice as a means of costs savings in Doctors fight to save the Drug and Therapeutics Bulletin drug guidance from government axe

A highly respected and influential journal which gives doctors independent advice on the drugs they prescribe is set to close because the government is withdrawing its funding after 40 years.

The Drug and Therapeutics Bulletin is sent to every doctor in the country and offers what many describe as highly readable guidance on the value of sometimes heavily marketed pills. But the Department of Health has refused to renew its contract.

Senior doctors have signed a statement of protest, and more than 2,000 have written to ministers, including Patricia Hewitt, the health secretary.

DTB is "highly valued and trusted" to give independent and reliable information about drugs, the statement says. Its conclusions "are also widely regarded as a unique counterweight to the influence of the pharmaceutical industry".

Health Direct notes that the closure of the trusted Drug and Therapeutics Bulletin is another sorry example of the Labour government's short term NHS cost cuts. In comparison to the annual £1.4 m cost of the DTB, the NHS's drugs bill is around £11 billion a year.

Even a cursory cost benefit analysis indicates that a 0.1% saving on the drugs bill will pay for the preservation of the DBT eight times over.