Hospitals must cut services to stay afloat, watchdog quango warns

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

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

NICE guidelines on drugs are unfair MPs decide

The methods used by the labour government's killer quango NICE to decide whether the NHS should pay for expensive drug treatments are wasteful and unfair, according to MPs.

A report from the Commons Health Committee recently attacked the way in which the National Institute for Curbing Expenditure (NICE) assesses costly cancer medicines as "both inequitable and an inefficient use of resources".

The MPs' inquiry was sparked by calls for cancer patients to be able to pay out of their own pockets for medicines that Nice advises the NHS not to use, leading to new guidelines issued late last year by Prof Michael Richards, the government's "cancer tsar".

After a series of decisions by Nice to reject new cancer drugs as insufficiently effective either clinically or on cost, Prof Richards called for the National Health Service to make more expensive drugs available.

However, the select committee argued that Nice had in response adopted a threshold for judging whether to approve "end of life drugs" that was too high, depriving the NHS of resources to spend on more cost effective drugs for other illnesses that had a more significant benefit.

It also criticised Nice for moving too slowly in assessing new drugs, and said the agency's guidelines for selecting the types of costly cancer drugs to be reviewed was "too woolly".

The committee questioned the increased threshold adopted by Nice for approving such drugs above the usual £30,000 per quality adjusted life year (Qaly), the measure it uses to assess the benefit a drug brings to a patient. Nice denied that threshold was as high as £70,000.

Kevin Barron, chairman of the committee, denied that the implication of the report was that Nice should reduce its Qaly threshold, arguing instead that it should make greater efforts to free up resources by finding other ways for the NHS to save money.

His committee said it was "extremely disappointed" little progress had been made by the government in following its previous calls for Nice to "disinvest" in obsolete technologies.

Prof Sir Michael Rawlins, chairman of Nice, said: "There is a balance between egalitarianism and utilitarianism. The select committee has fallen into the latter."

He said Nice was reviewing the Qaly, but it was "the only game in town", and that identifying savings for the NHS from older treatments and techniques was a difficult and "subtle" process.

The health select committee also expressed caution over the growing use of "risk sharing" schemes, whereby the government and pharmaceutical companies agree to reimburse some of the costs of medicines that prove less effective than initially believed.

The debate came as the National Audit Office identified one source of savings, estimating that NHS primary care trusts had saved £394m last year through more consistent use of lower cost, generic medicines for some common conditions such as high blood pressure, high cholesterol and gastric problems.

From:
http://www.ft.com/cms/s/0/3d1bce3a-3f57-11de-ae4f-00144feabdc0.html?nclick_check=1

Health Direct points out that NICE's use of the phrases "difficult" and "subtle process" are similar to that of MPs' expenses. A smokescreen for don't ask me uncomfortable questions.

Until NICE publishes what it's Qaly definition and it's scientific analysis guidelines for evaluating drugs actually are- the killer quango will continue to have the disrespect it deserves.

Labour's nanny state wasted health gap money

Labour ministers have wasted tax payers money in their attempts to tackle health inequalities, MPs say.

The House of Commons' Health Committee said the labour government should have been more careful in designing and piloting projects in England.

The MPs highlighted a series of schemes, including Sure Start, which had failed to have much of an impact.

Ministers have pledged to reduce the health inequality gap - measured by infant mortality and life expectancy - by 10% between 1997 and 2010.

But it seems certain they will miss that target as data published last year showed the gap between the richest and poorest has actually widened in the past decade.

The Department of Health has responded by asking World Health Organization expert Sir Michael Marmot to look at developing a new approach to the issue in what was widely interpreted as an admission of failure.

And the report by the cross-party group of MPs has now added to those criticisms.

The MPs said the labour government had often rushed in with insufficient thought and a lack of clear objectives when setting up projects.

They highlighted health action zones, which were regional partnerships set up in the late 1990s between a range of partners from the fields of health, education and employment.

The report said the 26 zones had been created too quickly and been poorly resourced.

It also criticised Sure Start schemes, which were designed to link up services for parents and young children.

The schemes have been predominantly focused on education and welfare and as a result have "yet to demonstrate significant improvements in health".

The MPs also attacked more recent initiatives, including the healthy towns scheme, which they said should have been rigorously evaluated first.

Cycling

Committee chairman Kevin Barron said: "Far more must be done to ensure money injected into implementing these policies is tracked and policy design must be sufficiently improved so that effective and accurate evaluation can take place."

He admitted there were "no easy or quick solutions", but urged the government to focus on improving food labelling, encouraging more cycling and walking and reducing smoking rates.

Professor Danny Dorling, a health inequalities expert at Sheffield University, said: "The problem is that the government has shied away from tackling the wealth gap.

"The countries which have good health all have lower income inequalities, but for some reason the government has been convinced this is not the issue."

From:
http://news.bbc.co.uk/1/hi/health/7942147.stm

NHS managers’ skill levels criticised by MPs

The National Health Service lacks the leadership and commissioning skills to implement the labour government’s plans for high quality care in the NHS, a cross party committee of MPs warned.

Despite a programme called “world-class commissioning” aimed at boosting the ability of primary care trusts to buy care for their patients, “there are few signs yet” that wide variations in how well PCTs commission care have been addressed. “We doubt that most are currently capable of doing this task successfully,” the Commons health committee said.

Too many managers lacked the analytic and planning skills needed. And the MPs added that it was “striking and depressing” that commissioning was still not given sufficient status within the service, despite its being nearly 20 years since a ­purchaser/provider split was first introduced.

Furthermore, the link between primary care trusts buying care, and doctors doing the same through practice-based commissioning, “remains opaque”, the committee said, with little progress on the latter.

Part of the drive to im­prove quality involves giving a much higher profile to reporting of the outcomes of the care patients receive. But the committee says there is a lack of information about how extensive the financial incentives associated with that will be, how much it will cost to implement, when it will be fully implemented and whether it will give value for money.

The sceptical assessment of the government’s plans came as a leading academic suggested very few extra new cancer drugs were likely to be approved for use by the NHS, despite a change in policy on “end of life” treatments by Nice, the National Institute for Clinical Excellence.

Nice is to give more weight to such treatments in future assessments, and Professor Michael Rawlins, its chairman, has suggested two to three extra drugs may be approved a year as a result.

However, James Raftery, professor of health technology assessment at Southampton university, says the new arrangements “may do little to improve availability of expensive cancer treatments”.

The price of the 14 cancer drugs Nice has recommended against since 1999, either provisionally or finally, is way above the threshold of £30,000 ($44,325) per quality adjusted life year (Qaly) normally needed to gain Nice approval, Prof Raftery says, writing in the British Medical Journal.

For example, for four kidney cancer drugs that Nice is due to reappraise shortly, the cost per Qaly ranged from £72,000 to £171,000 per Qaly.

Even with a big rise in the threshold, his assessment is that “few of the rejected drugs would qualify under the new criteria”. One or two may, Prof Raftery says, where there is lack of any alternative treatment. But much will depend on how Nice interprets that stipulation.

From:
http://www.ft.com/cms/s/0/998e0454-e100-11dd-b0e8-000077b07658.html?nclick_check=1

Nine out of ten preventable deaths in the NHS are not reported

Of the estimated 72,000 annual deaths in the NHS, just 3,200 are recorded by the National Patient Safety Agency, MPs were told.

The Commons Health Select Committee heard evidence from experts in its first evidence session on its investigation into patient safety.

The NPSA runs a system where all NHS staff can report incidents or near misses so patterns can be spotted and the wider health community warned.

Incidents can include drugs administered in the wrong way or the wrong dose, medicines mixed up, the wrong operation carried out, a patient wrongly identified and broken or malfunctioning equipment.

Howard Stoate, a practising GP and Labour MP for Dartford, said the National Patient Safety Agency's own estimates suggest there are 72,000 preventable deaths in the NHS each year.

However, the incident recording database had collected just 3,200 reports of patient deaths, in 2007/8. He said: "That is not just under-reporting, that is an extraordinary figure.

"If the public realised that only between five and ten per cent of preventable deaths are being reported they would have something to say about that.

"For example if only ten per cent of airline crashes were reported we'd have some concerns about that."

NPSA chief executive Martin Fletcher replied that while there were 'issues' around under reporting, reporting rates were continually improving.

Sir Bruce Keogh, medical director of the NHS, said no-one was 'comfortable' with under reporting but he said people could not be 'forced' to report incidents.

He said it was the staff member's personal, moral and professional duty to report incidents.

In 2004 the NPSA produced a report that said one in ten patients admitted to hospitals will suffer a patient safety incident - almost one million people in 2002/3 - and up to half of these could have been prevented. It added that 72,000 of these incidents may have contributed to the death of the patient.

Dr Richard Taylor, Independent MP for Wyre Forest, said the Committee was 'absolutely appalled' that one in ten patients will suffer an incident and said this was the reason they were conducting an investigation. It was 'utterly unacceptable', he said, and asked about the financial cost to the NHS of patient safety incidents.

Sir Bruce said that litigation costs were around £600m a year while Christine Beasley, chief nursing officer, said hospital associated infections such as MRSA cost the health service around £1bn a year because of the extra days infected patients have to stay in hospital.

Mr Taylor added that there were 25,000 deaths annually from blood clots after stays in hospital which can be prevented with drugs and this cost the health service around £640m.

He said: "The costs are astronomical and here we are trying to find enough money for Nice (the National Institute for Curbing Expenditure) to afford certain treatments."

Evidence submitted by the Department of Health to the Committee showed there were 796,106 incidents reported to the NPSA in 2007/8 and the majority resulted in no harm to patients. However there were 48,951 incidents where the patient suffered moderate harm, 7,101 severe harm and 3,282 deaths.

The Government's chief medical officer Sir Liam Donaldson has called for the NHS to learn from industries such as aviation where safety and reporting incidents or near-misses is embedded in the culture.

A list of 'never-events' is being drawn up by experts including operating on the wrong patient, or carrying out the wrong operation, which hospital trusts will not be paid for.

From:
Nine-out-of-ten-preventable-deaths-in-the-NHS-are-not-reported.html

Drugs classification should be scrapped, experts say

A leading think tank has called for the labour Government’s system of drugs classification to be scrapped.

The UK Drugs Policy Commission says classifying illegal drugs on a “danger scale” of classes A, B or C needs to be overhauled because they do not affect drug use.

The news comes ahead of a meeting this Friday when the Home Office’s independent Advisory Council on the Misuse of Drugs will discuss whether to downgrade ecstasy from class A.

Ecstasy remains the third most popular illicit drug in Britain, with five per cent of young adults aged 16 to 24 saying they have used it in the last year.

The council, which is made up of 21 academics and drugs experts, provides advice to Governments on illegal drug use and is expected to recommend downgrading the drug from A to B.

Reports from the Police Foundation in 2000, the Commons Home Affairs Committee in 2002 and the Commons Science and Technology Committee in 2006 have all favoured the move.

However the Commission warned the council in a submission that Home Secretary Jacqui Smith is likely to over-rule any decision to downgrade, in a re-run of the row over cannabis earlier this year.

Then, the council's recommendation that cannabis should remain a class C drug was ignored by Miss Smith who decided to reclassify the drug on health grounds.

The Commission says: “The UKDPC does not want to second-guess the council’s final conclusions about ecstasy. However were it to recommend a lower classification then it is not unreasonable to anticipate a political response to that with cannabis.”

The Commission was heavily critical of what it describes as the “increased polticisation” of drugs’ classification.

Roger Howard, Chief Executive, UK Drug Policy Commission, told The Daily Telegraph: “The purpose and operation of the drug classification system has become increasingly confused amongst politicians and the public in recent years.

“The time has come for an independent wholesale review of the system to clarify how a scientific rating of drug harms should be used for drug classifications and for wider applications such as setting policing priorities or public health messages.”

Members of the commission include the chairman Dame Ruth Runciman, a former council member who chaired a Police Foundation inquiry which argued for ecstasy to be moved to class B seven years ago, Professor Colin Blakemore, the former chief executive of the Medical Research Council and David Blakey, a former Chief Constable and HM inspector of constabulary.

The council is expected to make its decision on ecstasy next year.

From:
Drugs-classification-should-be-scrapped-experts-say.html

Average NHS dentist earns six-figure salary

The average Health Service dentist received a 13 per cent pay rise last year, official figures shows this week. That means they now earn more than £100,000 on average without any increase in their NHS workload.

Last night, patients groups blamed the labour Government for "botching" a contract that allows dentists to make more money from the NHS by carrying out simple work at the expense of complex cases.

Dr Anthony Halperin, a dentist and chairman of the Patients Association, said that he was deeply concerned that treatment was becoming worse under a target-based contract that encouraged dentists to "maximise profits" instead of putting patients first.

"There is evidence that a lot of the most complex work is not being carried out," he said. "It is easier and more profitable to take out a tooth and replace it with a denture than to carry out complex root canal surgery.

"Dentists are working the system for them, not for the patients."

Salaries for an average NHS dentist, who spends about 70 per cent of each week doing NHS work, topped six figures in 2006-2007, figures will show.

During the same period, total working hours increased by only half an hour a week, to 37 hours.

Of that, the amount of time devoted to the NHS rose by six minutes a week, to just over 26 hours.

The contract, introduced by labour ministers two years ago, has been attacked by MPs and patient groups as well as some dentists.

Critics say that the "target-based" system has encouraged dentists to concentrate on the work that can be done most quickly and lucratively. The number of people seen by NHS dental practices has dropped by more than a million since the contract was introduced.

Roger Goss, of the pressure group Patient Concern, said: "Dentists are getting more money while patients are getting a worse service.

"This government botched the contract for dentists, in just the same way that they did for GPs and consultants before them.

"All these patients who cannot get their teeth treated on the NHS will find it pretty galling that the average dentist is earning six figures."

In July, the Commons select committee on health said that the Department of Health had failed in its promise to improve access to dentists.

MPs found evidence that the number of complex treatments such as crowns, bridges and dentures had fallen by 57 per cent since the contract was introduced.

The number of root canal treatments fell by 45 per cent in England and Wales, although it rose in Scotland, where the contract was not brought in.

The committee's report said that it was "extraordinary" that the department did not test the payment system before introducing it everywhere.

From:
Average-NHS-dentist-earns-six-figure-salary.html

Private hospitals to follow NHS in publishing patient outcomes and death rates

Private hospitals will have to publish an annual "quality" report outlining how their patients have fared, David Nicholson, the National Health Service chief executive, has disclosed.

The move means that for the first time it will be possible to make direct comparisons between the quality of treatment in the two sectors.

Another side-effect should be more information than has previously been available on how many patients the private sector treats.

The requirement for private hospitals, like their NHS counterparts, to publish figures on death rates and other quality measures was revealed by Mr Nicholson to MPs on the Commons health committee. It follows the decision to bring the two halves of the system under the same regulatory umbrella from next year.

David Worskett, director of the NHS Partners Network, which represents private providers of NHS care, welcomed the move. He said yesterday that his members, which include Spire, Care UK, Nuffield Hospitals and General Healthcare, were commissioning "an independent sector-wide approach to collating and presenting patient outcome data".

"Independent sector providers live or die by their quality," he said, "so we have no problem at all with that. There may be some arguments over the technicalities of what is presented in annual quality reports and how. But there will be absolutely no argument about the principle."

In a separate development, Mark Britnell, the health department's director-general of commissioning, has written to the independent sector laying out more than a dozen areas where it can play a role in NHS care. The move is aimed at reassuring the providers that their role in supplying public services - apparently under threat last year - is assured.

He lists policy changes that could lead to business for the private sector, including the patient's right to choose both treatment and providers, providing more information on the quality of care in both the NHS and private sectors, and piloting new integrated care organisations in which the private sector could play a role, along with opportunities to support NHS staff who leave the NHS to sell their services back through social enterprises.

In addition, the jobs of chief executive and chairman of a new competition and co-operation panel have been advertised at what are understood to be attractive salaries. The panel will act as an appeal body for the NHS, private and voluntary sectors if primary care trusts fail fairly to tender new or significantly changed services.

All these and more offer "real potential for private sector involvement", Mr Britnell says in his letter.

Mr Worskett said his members had reservations about one or two of the items. But the private sector's fear last autumn that its potential role in the NHS was shrinking as independent treatment centre contracts were being cancelled had diminished sharply.

"The feeling that it is all going backwards has gone away. A framework [for the independent sector] is now being put in place that looks much more robust for the future. There is still some uncertainty about the best way to achieve change. But there is absolutely no doubt now that the process is continuing and the position has stabilised," he added.

http://www.ft.com/cms/s/0/88ee15b0-5d04-11dd-8d38-000077b07658.html

NHS at 60- Labour's dentistry reforms failing dental patients

NHS at 60- Labour's dentistry changes designed to improve NHS dental services in England have not been successful, a report by MPs says.

The new contract, introduced in 2006, was intended to simplify charges and make it easier to find an NHS dentist.

But the Commons Health Committee said access remained "patchy" and there had been a sharp fall in the number of complex procedures.

The new contract, under which patients paid fixed charges for particular types of procedure, also gave local primary care trusts the power to commission and pay for dental services.

It has been rolled out to cover Wales, although the report only deals with progress in England.

The number of patients seen fell by 900,000 in the 18 months following the introduction of the new contract in April 2006, the report said.

In the first year of the contract, the number of complex treatments - including bridges and crowns - which involve laboratory work was halved, and the number of root canal treatments fell by 45%. Both of these attract higher fees under the new scheme.

The committee said there were concerns that some patients were not getting the complex treatment they needed.

Conversely, the number of tooth extractions rose.

The committee also heard fears that the changes had not stemmed the exodus of NHS dentists into private-only practices.

Committee chairman Kevin Barron MP said: "It is disappointing that so far the new contract has failed to improve the patient's experience of dental services.

"While we readily accept that in some areas of the country, provision of NHS dentistry is good, overall provision is patchy."

He criticised the Department of Health for not piloting the new contract on a smaller scale prior to introduction.

The committee called on the government to improve PCT commissioning and review the "units of activity" system to make sure it rewarded dentists for choosing the most appropriate treatment.

"It highlights the failure of a farcical contract that has alienated the profession and caused uncertainty to patients," she said. "For the past two years, dentists and patients have told the Department of Health that it got it wrong."

A Department of Health spokesman said it would "carefully consider" the recommendations but that the benefits of the reforms were already emerging.

From:
http://news.bbc.co.uk/1/hi/health/7483182.stm

NHS ordered to end care bias against men

The equality watchdog has ordered the National Health Service (NHS) to take urgent action to end it's anti male discrimination in healthcare.

The Equality and Human Rights Commission (EHRC), headed by Trevor Phillips, has written to strategic health authorities warning them to ensure that doctors and hospitals in their areas give equal priority to men and women.

The commission has legal powers to issue compliance orders to NHS trusts that persistently fail to provide equal care for men.

While the commission does not cite specific examples of discrimination, it details evidence of poorer male health. Other groups have pointed to male-unfriendly surgery opening hours.

Men are twice as likely as women to die from the 10 most common cancers that affect both sexes and, typically, develop heart disease 10 years earlier than women. Men under the age of 45 visit their GP only half as often as women and are less likely to have dental check-ups.

On average, men die five years younger than women and 16% of men die while still of working age compared with 6% of women. Men are also three times more likely to commit suicide than women.

A new law, the gender equality duty, which came into force in April 2007, obliges all public services to ensure they care for both sexes equally. In March, Phil McCarvill, head of public service duties at the EHRC, sent warning letters to strategic health authorities, the bodies which manage local NHS trusts.

McCarvill said: “We are writing to you specifically regarding the gender equality duty in response to particular concerns raised with us by the Men’s Health Forum and the action we want you to take in response to this. We will view the failure to take any action as a result of this letter as a breach of your legal responsibilities in this area.”

Research carried out by the forum found that men were unhappy with the service provided by their local GP surgeries. The forum points out that since men are twice as likely as women to work full-time and three times as likely to work overtime, it is more difficult for them to see doctors during conventional opening hours.

Other experts have pointed to the fact that, while there is a national screening programme for breast cancer, there is no equivalent yet for men for prostate cancer, although it claims a similar number of lives. Women are also screened for cervical cancer.

Peter Baker, chief executive of the Men’s Health Forum, said: “The GP model doesn’t work particularly well for men, particularly young men aged between 16 and 45 who GPs tend not to see unless there is something very seriously wrong with them. There is discrimination because these services are being underused by the group with the greatest need.”

The forum also suggests trusts offer health checks in venues frequented by men, such as work-places or sports clubs.

The Commons health select committee inquiry into health inequality will next month hear evidence that men are being discriminated against in the NHS.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3999217.ece

Health Direct points out that labour's centralist politically correct doesn't just extend to pro women bias. They also channel extra funds into labour voting areas.

On August 07, 2006 Health Direct posted: Rural areas lose out to cities over health spending postcode lottery
Money needed for patients in rural England is being diverted to inner-city areas where it is not even being spent, experts say. Researchers at Cambridge University Medical School say the 29 primary care trusts (PCTs) most in surplus in 2004-5 were virtually all in inner-city areas.

In comparison, the 29 most in-debt PCTs were in rural areas, which received on average £205 less per head of population.

Labour ministers ignored junior doctor recruitment warnings

Thousands of junior doctors had their careers thrown into chaos last summer because of "inept" decisions at the highest levels, according to a report by MPs.

Warnings over a new recruitment system and possible job shortages were ignored by the Department of Health, says the Commons health committee.

The labour government's failure to restrict the access of overseas doctors to training posts in Britain was also "inexcusable", it says.

The report also singles out Sir Liam Donaldson, the Chief Medical Officer for England, saying that confidence in his abilities among the medical profession has been "seriously damaged" by the debacle.

Doctors' groups said the report was a "damning indictment" of the Government's failure to listen to warnings from the medical profession.

Thousands of junior doctors found themselves in limbo last year when a combination of factors, including a new computerised recruitment process, left their search for jobs in disarray.

Hundreds marched in protest, which prompted an apology from Patricia Hewitt, the former health secretary.

From:
http://www.telegraph.co.uk/news/1936349/Ministers-%27ignored%27--junior-doctor-warnings.html

Dentists warn of future of NHS services at risk

Contract changes that have seen more than 1,000 dentists leave the health service threaten to bring about the end of NHS dentistry, MPs are warned. The introduction of financial penalties for missing targets has already seen twice as many dentists leave the NHS as the Government estimated.

Thousands more are questioning their future in the NHS because of the uncertainty surrounding their earnings, the British Dental Association (BDA) said.

Already the changes have left an estimated one million extra patients without access to a dentist. Almost one in three children do not receive any form of dental care.

The BDA will warn the influential Commons Health Committee that the future of NHS dentistry is "at risk" unless ministers scrap the system.

The new contracts, introduced in April 2006, were designed to provide better access to dentists, and to simplify charges for treatment.

But the BDA said they had driven more than 1,000 dentists - not the official figure of 57 - to concentrate solely on private practice because of the "financial penalties and uncertainty they face".

Under the new system dentists are forced to pay back money, often thousands of pounds, to their primary care trust if they do not meet a target for the number of NHS treatments provided.

Dentists say the system is patently unfair and does not properly measure the amount of work carried out. For example, they receive the same fee for giving a patient one filling as for giving that patient five fillings.

In addition, the targets are based on the number of patients each dentist saw in 2005, meaning those with expanding or shrinking practices face having to pay back part of their salary.

Dentists also complain that they have less time to advise patients on how to prevent future dental problems because of the "treadmill" conditions they are forced to work under.

The future of NHS dentistry is "at risk", the BDA says in written evidence to the committee, because "dentists are facing financial penalties derived from untested targets".

The BDA also accuses the government of "chronically underfunding" dental services. Spending on dentistry in the NHS is now just 2.8 per cent of the overall budget, less than in 2002.

Dr Anthony Halperin, the chairman of the Patients Association and a dentist himself, said: ''Dentists are concerned that they are going to be even more squeezed and have to do more work for less money. Whereas many before saw the NHS as a career they are now beginning to question whether that is really the case.

''Initially their places will be taken by dentists coming in from abroad. But as they become more established those dentists will also begin to look for more salary and move away from the NHS."

Peter Ward, the chief executive of the British Dental Association, said the new contracts would drive increasing numbers of dentists from the NHS every year.

He added: "This situation is only going to get worse. Dentists who miss their targets by small amounts are not fined if they agree to make up the shortfall the following year. But if dentists are struggling to carry out enough treatments one year it will be harder to hit a higher target the next."

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/18/nhealth118.xml

NHS shakes up £12bn IT programme

A big revamp of the National Health Service’s £12bn IT programme is under way that will see NHS trusts given more choice of how systems are installed and which software they get.

At the same time the De­partment of Health is launching a review of the in­for­mation it collects from the service, aiming to gather less but use what it gets far better.

The department persistently refuses to say that the £12bn programme is formally under review. But senior figures in Connecting for Health were expecting the announcement of a review to go alongside Lord Darzi’s interim report last week on the “next stage” of the NHS.

That appears to have been pulled amid the general election fever for fear it would generate headlines about the government admitting mistakes over the multi-billion-pound 10-year programme.

However, one senior health department official said a study was under way to establish “will this actually work?” The big local service provider contracts held by CSC, BT and Fujitsu are being moved out of Connecting for Health, an arm of the health department, to local level in the NHS, he said.

He added that “a big step change is that we will give people more choice” about what systems are installed in hospitals, to go alongside the wider choice of systems being offered to GPs.

One of the main problems, he said, had been that “we have forced people to take systems that were either worse than those they had already got, or were ones that they didn’t want”.

As a result, installation of new patient administration systems that are needed to underpin the long delayed electronic patient record are themselves also running way behind schedule.

Instead contractors are expected to let hospitals locally choose from “best of breed” applications that suit their local circumstances, while remaining compliant with the communication standards that the national programme has set.

The big contractors are also accepting that they will have to give individual NHS trusts more support to get the systems in.

One effect of the change, according to programme insiders, is likely to be more concentration on getting local systems up and running, and less on the national summary record, which many clinicians see as having little relevance.

The move follows a call from the Commons health select committee last! month for hospitals to be offered a wider choice of systems.

From:
http://www.ft.com/cms/s/0/89fba648-7399-11dc-abf0-0000779fd2ac.html

Yippee Doo. A full eighteen months after Health Direct warned of the impending IT disaster, (April 17, 2006) Health Direct posted Anatomy of a £15bn gamble- CfH's NHS IT busted flush

The new NHS computer system could be the biggest IT disaster in history, warn experts. Inside a leading hospital in Oxford, expensive new computers were humming away just before Christmas when disaster struck.

The Nuffield Orthopaedic Centre was at the forefront of a multi-billion-pound revolution to modernise the entire computer system of the National Health Service — and the screens had suddenly frozen.

Although the system was functioning again the next day, some patient files seemed to have disappeared completely. The trust was so alarmed that it sent a report to the National Patient Safety Agency, warning that it had posed a potential risk to patients.

Even CfH admitted that the cost of the scheme, now not due to be completed until 2010, could reach £15 billion. Outside experts suggest that £30 billion is more realistic.

Move to boost openness on NHS drugs by NICE

The labour government's medicines advisory body will from this autumn open to public scrutiny the work of the committees that decide whether the health service should pay for new drugs. In a ground breaking move to boost transparency, Sir Michael Rawlins, the chairman of the National Institute of Health and Clinical Excellence (Nice), told MPs that the action marked the latest in its efforts to boost transparency and that it had been a matter of "regret" that its committees had previously met in private.

While the agency's decisions are always made public in written form, Mr Rawlins conceded that it was useful to observe the discussion rather than simply reading about it afterwards.

His announcement was made on the first day of an inquiry launched by the House of Commons' health select committee into the operations of Nice, the second since it was launched in 1999 to advise the government on the efficacy and cost effectiveness of new medicines.

It comes at a time of growing criticism of Nice by pharmaceutical companies and patient organisations after a number of rulings that advised against the NHS paying for drugs for patients. In the case of an Alzheimer's drug, this will lead to a judicial review next month over the agency's refusal to release information on how the calculations were made.

The new policy of openness would apply to the deliberations of Nice's five standing advisory bodies, which study drugs, treatments, surgical procedures and public health.

Andrew Dillon, Nice's chief executive, told the FT that the decision put it ahead of practices adopted by equivalent agencies in other countries.

But he cautioned that the agency was still considering some of the practical issues involved. These include changes to the five day review period given to interested parties before decisions are made public, and how to release price sensitive information such as approval of a drug developed by a listed company.

Sir Michael cautioned that while Nice could play a role in the Office of Fair Trading's proposals for a newvalue-based pricing mechanism for drugs in the UK, it would represent "a massive workload" and there were not enough health economists in the country to cope.

Department of Health officials came under criticism from MPs on the committee over the resources made available to local primary care trusts to implement Nice decisions, and the inadequacy of government powers to penalise them if they failed to do so. *GPs could save the NHS more than £200m a year by prescribing lower-cost but perfectly effective drugs, the National Audit Office said yesterday, while patients waste drugs worth at least £100m a year by not taking them.

From:
http://www.ft.com/cms/s/8a923270-04db-11dc-80ed-000b5df10621.html

Health Direct questions Sir Michael Rawlins's claim that he regrets that its committees had previously met in private when several drug companies are having to take the National Institute for Curbing Expenditure to court in an attempt to find out how it justifies it's cost beneafit analysis on drug useage.

On Nov 17, 2006 Health Direct posted: Drugs watchdog faces legal review- NICE's approach is irrational and flawed when a decision by the labour government's drugs watchdog to restrict the use by the NHS of Alzheimer's medication is to be challenged in court.

Two drug companies plan to apply for a judicial review of the way the National Institute for Health and Clinical Excellence reached its conclusion. NICE ruled NHS patients with newly diagnosed, mild Alzheimer's disease should not be prescribed the drugs.

To it's credit it "only" took that MPs three months to wake up to the increase in legal activities against NICE.

Earlier this year on 7 Feb 07 Health Direct posted :NICE faces inquiry by Commons MPs group when the Commons health committee announced terms of reference for a broad inquiry into the work of NICE, the National Institute for Health and Clinical Excellence.

The committee said it wanted to examine "why Nice's decisions are increasingly being challenged" after recent controversial recommendations that the NHS should not use certain costly cancer drugs and should restrict the use of drugs to treat Alzheimer's to those with moderate forms of the disease.