Bliar ally says Tories are best for NHS

One of the architects of Labour’s NHS reforms is to become a key adviser to the Conservatives because the labour Government has “lost the plot” on improving patient care.

Professor David Kerr, a renowned oncologist who led efforts to cut waiting and give hospitals greater independence, said that the Tories now offered the best chance for the NHS, which had been driven into a “whirl of thoughtless tick-box exercises”.

Professor Kerr, a lifelong Labour supporter who campaigned with Tony Blair in the 2001 general election, told The Times that the key principles of giving patients a better choice of health services and a better understanding of how they were performing had been “driven into the sand”.

“To say that we have run out of steam, I would say definitely, definitely yes,” Professor Kerr said. “We have got lost in the blizzard of increasingly irrelevant targets. The position now is disenfranchising, dull and disconnected. That is the clinical reality.”

The doctor, a professor of cancer medicine at the University of Oxford, was a frequent visitor to Downing Street as Labour drew up its reform agenda in Mr Blair’s first and second terms. 

Before 1997 he conducted the first national audit of cancer services — identifying delays that allowed “patients’ cancers go from curable to incurable while they sat and waited”.

Under Labour he worked on ways to improve access as chair of the national Cancer Services Collaborative and became a founding commissioner of the Commission for Health Improvement, the first regulator to assess NHS clinical performance.

He was also one of the main drivers of the foundation trust scheme, offering the best hospitals the chance to become more independent, hold greater responsibility for their budgets and make clinicians more engaged in service improvement. A knife-edge Commons division on foundation status was won by 17 votes after Professor Kerr wrote to all MPs underlining the advantages that it would bring.

In 2005 he was given the task of developing a 20-year plan for the future of the NHS in his native Scotland, known as the Kerr Report.

Professor Kerr said that he felt “for the first time in [his] life” that the Tories offered the health service a better future. He said that the Conservative priority of getting NHS data out to patients in an understandable form, allowing them to choose the highest standard of service best suited to them, was a mission that disappeared with the departure of Mr Blair.

“[The Tories] are more committed to the NHS that we love and understand as free at the point of access and offering universal care. Only that degree of certainty would convince me to go and work for them.”

Professor Kerr would not be drawn on whether he had been a member of the Labour Party, but said that currently he was not a member of any political party.

He said that he hoped to push through the ideas of choice and the empowered patient, encouraging the NHS to make more high-quality information publicly available. “People need to be able to understand how their hospital is improving,” he said.

Another focus will be to allow patients to ask clinicians key questions about care standards without compromising the doctor/patient relationship.

“I firmly believe for the first time in my life that we have a Conservative leadership that is committed to the future of the health service. If I didn’t believe that I wouldn’t be there.”

On informed choice for patients, he said that under the Government “the whole big idea ended up in the foothills of dodgy websites. No one was really engaging with it.”

He identified the loss of momentum “around when the transition happened”, with things “starting to lose the plot” under Patricia Hewitt as Health Secretary, then Alan Johnson, “who is good on many fronts, but was more interested in keeping the NHS out of the headlines”.

Andrew Lansley, the Conservative health spokesman, said of Professor Kerr: “His expertise and knowledge will be crucial in helping us to create a NHS which has patients at its centre. That a key architect of the Blairite health reforms is now working with the Conservatives shows that under David Cameron’s leadership we have truly become the party of the NHS.”

From:

http://www.timesonline.co.uk/tol/news/politics/article7041772.ece

Tories to make GPs after hours care a priority

The Conservatives have pledged to make GPs responsible for round-the-clock care after the scandal of foreign locum doctors putting patients’ lives at risk.

Andrew Lansley, the shadow health secretary, says he wants doctors to provide cover at night and weekends, or pay other GPs to provide reliable care. Performance targets which helped to boost the salaries of some GPs to more than £250,000 would also be renegotiated under a Tory government.

Under existing contracts agreed six years ago, GPs can opt out of providing after-hours services, shifting the responsibility to local primary care trusts (PCTs). One in three trusts struggles to find local GPs and flies in foreign doctors who are paid as much as £800 a shift to work unpopular hours.

Lansley confirmed a shake-up of contracts as an inquest last week examined the death of David Gray, a 70-year-old retired engineer from Cambridgeshire. He was killed by a massive overdose of diamorphine in February 2008 administered by Daniel Ubani, a Nigerian-born doctor who had flown in from Germany. Ubani had slept for only three hours before starting his shift.

“When Labour took responsibility for out-of-hours care away from GPs they made a serious error,” said Lansley.

“GPs should be collectively responsible for commissioning out-of-hours services. They are best placed to ensure patients are treated properly and that these awful events are never repeated again.”

Lansley could face a tough battle with GPs. One British Medical Association (BMA) representative said there was “not a cat in hell’s chance” of returning to the old system of the GP being ultimately responsible for out-of-hours care. He warned of mass resignations if contracts are to be torn up in this way.

For many years GPs considered themselves overworked and underpaid compared with hospital doctors. But in 2004 they successfully renegotiated their contracts with the National Health Service.

In what was seen as a coup for the profession, pay packets rose by 30% in the first year of the contracts, with the typical GP earning £106,000. Ministers later admitted they had blundered by seriously underestimating how many GPs would hit the pay-related targets included in the new contracts.

At the same time, GPs could opt out of providing round-the-clock care for patients if they gave up £6,000 a year in their salaries. Nine out of 10 GPs opted out. Out-of-hours cover is now provided by co-operatives run by GPs, private companies and PCTs.

“No one in their right mind would have designed the out-of-hours system in its current form,” said Peter Walsh, chief executive of Action Against Medical Accidents, which has campaigned for reform of the system. “There are a myriad different providers. The most common complaints are failures in making a proper diagnosis.”

Flaws in the system were highlighted by the case of Penny Campbell, 41, a journalist from north London who died in March 2005 despite six telephone calls and two face-to-face meetings with doctors working for an out-of-hours GP service. All failed to diagnose septicaemia.

Shortly before he became prime minister, Gordon Brown pledged to improve out-of-hours services. They started deteriorating in some areas in which trusts turned to foreign locums. One investigation found a third of PCTs were flying in GPs from Poland, Hungary, Italy and Switzerland.

In the early hours of February 16, 2008, Ubani, 66, flew into Britain for a shift starting at 8am with Take Care Now, an out-of-hours service. By his own admission he was exhausted. Gray died after Ubani gave him 10 times the correct dose of a painkiller for kidney stones. Later the same day Ubani failed to send another patient, Iris Edwards, 86, to hospital and she died of a heart attack shortly afterwards.

Take Care Now has promoted itself to health authorities as a cheap out-of-hours service but GPs claims its low prices have come at the expense of quality.

Spot checks by NHS Cambridgeshire, a primary care trust, found “deficiencies” in the cover as recently as last November. The trust subsequently ended its contract with the company.

Gray’s son Stuart, a GP in Kidderminster, Worcestershire, said: “My father was betrayed by the system. All patients are being let down by the NHS because of the lack of vetting procedures and rules in place for EU doctors. It is a national scandal.”

The Tories believe that handing back responsibility for out-of-hours care to GPs will ensure a better service.
 

FAILURES

* April 2004 New contracts introduced for GPs, allowing doctors to drop out-of-hours cover.
* March 2005 Penny Campbell, a 41-year-old mother, dies of blood poisoning after consulting out-of-hours GP service eight times. Official inquiry finds “major system failure”.
* May 2006 National Audit Office finds only one in 10 trusts clinically assesses patient within 20 minutes of phone call.
* February 2008 David Gray, 70, is killed by an overdose accidentally given by Daniel Ubani, a locum out-of-hours doctor who flew in from Germany.
* June 2009 Care Quality Commission report on Gray’s death calls for fresh scrutiny of use of “non-local” doctors and improved training.

From:

http://www.timesonline.co.uk/tol/news/politics/article6991090.ece

Labour's computer blunders cost £26bn- and rising

Labour ministers blamed for 'stupendous incompetence' after taxpayers are left with huge bills for bungled IT projects.

A series of botched IT projects has left taxpayers with a bill of more than £26bn for computer systems that have suffered severe delays, run millions of pounds over budget or have been cancelled altogether.

An investigation by The Independent has found that the total cost of Labour's 10 most notorious IT failures is equivalent to more than half of the budget for Britain's schools last year. Parliament's spending watchdog has described the projects as "fundamentally flawed" and blamed ministers for "stupendous incompetence" in managing them.

Further evidence has emerged over the failings of Labour's most costly programme, the mammoth £12.7bn IT scheme to revolutionise the NHS. 

Following Health Direct's post last week- Labours' only success- wasting taxpayers money, the Independent has repeated that just 160 health organisations out of about 9,000 are using electronic patient records delivered under the scheme. 

The vast majority of those were GP practices. New figures have also revealed that millions of pounds have been paid out in legal fees. The taxpayer has footed a £39.2m bill for "legal and commercial support" for the National Programme for IT (NPfIT).

Alan Milburn, the former health secretary, said in 2001 that everyone would have access to their health records online by 2005, but it is understood that the Department for Health is still "years away" from fulfilling the pledge.

Government departments right across Whitehall have been guilty of overseeing embarrassing IT failures. A project that was meant to save the Department for Transport (DfT) about £57m eventually cost £81m, and workers at the Driver and Vehicle Licensing Agency (DVLA) were forced to brush up on their language skills when computer systems gave them messages in German.

Another ill-fated IT scheme, designed to allocate subsidies to farms, cost the Department for Environment, Food and Rural Affairs about £350m and left British farmers more than £1bn out of pocket. Last year the Public Accounts Committee (PAC) warned that the system was already "at risk of becoming obsolete". 

In 2004, the Department for Justice gave the go-ahead for the National Offender Management Information System (C-Nomis) to be rolled out to prisons and the probation service in an attempt to make sharing information about offenders easier. But in 2007, when the estimated cost doubled to more than £600m and senior officials questioned the validity of the project, it was abandoned – after £155m had been wasted.

The MoD's Defence Information Infrastructure project is currently running more than £180m over budget and 18 months late, and is now set to cost £7.1bn. Last year, Edward Leigh, chairman of the PAC, said: "No proper pilot for this highly complex programme was carried out, and entirely inadequate research led to a major miscalculation of the condition of the Department's buildings in which the new system would be installed."

Other botched IT projects include the identity cards scheme; the Libra system for modernising magistrates' courts; an attempt to move the Government's GCHQ computer systems into a new building which ended up costing more than £300m; the Benefit Processing Replacement Programme; and the Foreign and Commonwealth Office's Prism system.

IT experts blamed ministers for being too easily wooed by suppliers. Insiders said a lack of expertise within the Government about the technology industry meant they were willing to believe claims made by major IT firms before contracts were awarded.

Several projects are now under renewed threat of being cut back or abandoned altogether as Alistair Darling, the Chancellor, has targeted them as an area of government spending that can be reined in as he attempts to tackle Britain's record £175bn deficit.

Tony Collins, an expert on the Government's IT failures, said Labour had displayed an "irrational exuberance" for IT projects that has often led them to throw good money after bad at failing schemes. "There are too few people in the hierarchy of Labour who understand IT enough to understand that it is not a talisman – there is nothing magical about it."

David Cameron, the Tory leader, has signalled a move away from big IT projects, suggesting he will use technology to increase the transparency of government. "It is easy to make these noises out of office," said Mr Collins. "Once you've got civil servants giving you a host of reasons why you should not be more open, I fear the Tories will sink into the same depths of secrecy that Labour has found itself in."

Botched projects: The cost of failure
£12.7bn National Programme for IT (NHS)

It was meant to revolutionise the way the health service worked. But far from heralding a new age of efficiency, the National Programme for IT is now widely perceived as the greatest government IT white elephant of history. 

As well as the huge costs involved, suppliers have walked away, projects are running years behind schedule, while medical professionals have complained that they were never consulted on what they wanted the new system to achieve.

£7.1bn Defence Information Infrastructure (DII)
It seemed like a good idea at the time. In 2005, the Ministry of Defence decided to offer a contract to a consortium of suppliers to replace the hundreds of different computer systems being used by the military with a single system that would be used by the army, navy and air force, as well as the MoD itself. It was to be used by 300,000 people across 2,000 sites. 

However, it is running more than £180m over budget and 18 months late. A parliamentary inquiry also warned that forces' reliance on older systems put them at risk of a security breach.

£5bn National Identity Scheme
Originally budgeted at £3bn, the labour Government’s plan for new identity cards, containing biometric data and linked to a central database, soon came under heavy criticism from civil liberty campaigners. As the costs spiralled, so the Home Office began to water down the aims of the scheme to assuage the critics.

In July 2009, Alan Johnson announced that the cards would no longer be compulsory, while moves to force all airport workers to use the cards were also abandoned. However thousands are still being wasted trying to get students to sign up as an alcohol proof card.

£400m Libra system (for magistrates' courts)
An attempt to bring records used by magistrates courts into the digital age backfired when trying to introduce one universal IT system to all courts descended into a costly mess. Fujitsu originally bid £146m to deliver the Libra system in 1998. However, the project proved more complicated than anticipated, and costs have now been put at more than £400m.

£350m Single Payment Scheme system (SPS)
The Single Payment Scheme system was designed in 2003 to be a sophisticated way of giving farmers their subsidies, by mapping their land and working out their level of payment. But failures with the IT systems being used mean that farmers were left short-changed. 

In 2006, around £1.28bn of the £1.5bn subsidies destined for British farmers still had not been given out. 

The Rural Payments Agency overseeing the project was ordered to make 23 major changes to the system. Despite the £350m spent on the technology, the Public Accounts Committee warned last year that it was already “at risk of becoming obsolete”.

£300m GCHQ "box move" of technology
When the Government’s intelligence organisation, GCHQ, decided to move its complex computer systems into a new building in 1997, the projected £41m cost was so small that officials believed it could be absorbed within existing budgets. 

That was until the Curse of the Government IT Project struck. Costs of the so-called “box move” soon began to rise out of control. In 2003, the National Audit Office (NAO) put the costs at more than £300m. Edward Leigh, Tory chairman of the Commons Public Accounts Committee, called the original budget “staggeringly inaccurate”.

Now part of the "old office" housing super computers in Cheltenham has been retained in parallel to the new "doughnut".

£155m National Offender Management Information System (C-Nomis)
In an attempt to make sharing information about offenders easier, the Department for Justice gave the go-ahead for the National Offender Management Information System (C-Nomis) to be rolled out to prisons and the probation service. As the estimated cost doubled to more than £600m and senior officials questioned the whole point of the project, it was abandoned in 2007, with £155m already spent.

£106m Benefit Processing Replacement Programme
In June 2006, the Department for Work and Pensions confidently assured Parliament that new funding for its Benefit Processing Replacement Programme (BPRP) had been approved. So it came as a surprise to many when it emerged just three months later that the project had been quietly scrapped. Little information has emerged on why BPRP was abandoned, but the Government has admitted that £106m had already been spent on it before it pulled the plug.

£88.5m Prism IT project
Undeterred by past failures, the Foreign and Commonwealth Office (FCO) thought it would be a good idea in 2002 to order a new computer system for their 200 offices around the globe. The result was the Prism IT project, seemingly a bargain at just £54m. 

However, delays and costs have risen, while the contractor was even forced to temporarily halt the scheme in 2005 while an investigation took place into its various problems. The system has not proved a hit with staff. 

One wrote in 2004: “In all the FCO’s long history of ineptly implemented IT initiatives, Prism is the most badly designed, ill-considered one of the lot.”

£81m Shared Services Centre
To officials at the Department for Transport, the Shared Services Centre seemed to good to be true: not only would it integrate the human resources and financial services of the department and its various agencies, it would even save the taxpayer £57m. 

Unfortunately, those hopes were dashed as the scheme became another example of an IT project going horribly wrong. Workers at the Driver and Vehicle Licensing Agency (DVLA) were forced to brush up on their language skills as computer systems gave them messages in German. It will now cost £81m, a failure in management that the Public Accounts Committee described as a display of “stupendous incompetence”.

TOTAL: £26.3bn

From:

http://www.independent.co.uk/news/uk/politics/labours-computer-blunders-cost-16326bn-1871967.html

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

NHS paid doctor £375 an hour

NHS spending on agency workers has risen sharply in the past financial year in spite of attempts to control such expenditure, according to figures issued by the Conservatives.

Andrew Lansley, shadow health secretary, cited examples of NHS Trusts paying "hugely inflated" salaries to temporary workers for covering shifts.

A nurse in Yeovil was paid £146 an hour, another in Derby £136 an hour, and an IT manager in Whittington received £400 an hour.

The freedom of information disclosures also show that an agency doctor in King's Lynn was paid £375 an hour - equivalent to an annual salary of £660,000. Mr Lansley said that such payments divert funds from the front line and prove that Labour's attempts to control health agency expenditure are failing.

The NHS spent £1.25bn on temps in 2008-09, according to figures provided by the department of health to the Tories. This was a sharp increase on the £831m spent the previous year and the £785m in 2006-07.

But it is below the £1.4bn bill that agencies presented to the NHS in both 2002-03 and 2003-04, when agencies accounted for 5.5 per cent of the payroll.

Patricia Hewitt, former health secretary, described agency pay as "massively expensive" and called for hospitals to use permanent staff instead.

About 130,000 workers in the health service are not permanent staff.

While most trusts did not disclose fees paid to agencies, some of them received as much as 43 per cent of each payment, according to the Tories. The typical agency fee, among the 33 trusts that replied in detail, was 26 per cent.

Trusts and local authorities have been urged to pool resources to improve their purchasing power.

A report last year by Leeds university and the Economic and Social Research Council found that, although fees had dropped in recent years, temps were still generally more expensive than permanent staff.

The presence of temps, while "unavoidable", could also damage the morale of permanent staff because they were often given easier tasks.

But the National Audit Office said last year that agency workers could be used as a way for the NHS to control costs. Temps could be cheaper because they did not receive the same training and perks as permanent staff.

From:

http://www.ft.com/cms/s/0/ed1bd7c2-f4e1-11de-9cba-00144feab49a.html

Drunk and overdosing homeless people put strain on NHS

One drunk or drug addicted homeless person is admitted to hospital every three hours, putting a severe strain on the National Health Service, new figures show.

The rate of drug and drink related admissions of homeless people has risen by 117 per cent since 2004, with six out of 10 hospital trusts reporting that numbers have gone up in the last five years.

Many of the rough sleepers had overdosed or suffered infections from using dirty needles to inject drugs such as heroin, while others needed their stomachs pumped after drinking too much.

The figures, contained in a series of answers to freedom of information requests put in to 173 hospital trusts, were released by the Conservatives, who issued a report setting out the importance of understanding the health needs of homeless people.

In particular, the party wants the availability of cheap alcohol in supermarkets to be curtailed, and for health boards to work with local homeless charities such as Shelter to consider the best ways to help homeless people in their area.

Grant Shapps, the shadow housing minister, said: "A refusal to confront the extent of the homlessness issue in the United Kingdom leaves our frontline services such as the NHS struggling to cope.

“Our report demonstrates how drugs and alcohol frequently play a major role in perpetuating the chaotic lives lived by many people trapped in homelessness. This is one of the reasons why Conservatives will fix the crazy situation whereby supermarkets are selling high strength larger for less than they charge for a bottle water."

The report shows that nearly 14,000 homeless people were admitted to hospital with drink and drug-related conditions in the last five years, the equivalent of eight a day or one rough sleeper every three hours.

London had the most admissions, followed by Liverpool and Leeds.

More than 10 per cent of rough sleepers who ended up in hospital for alcohol or drugs were under the age of 25, even though young people are estimated to account for between six and seven per cent of the homeless population.

From:

http://www.telegraph.co.uk/Drunk-and-overdosing-homeless-people-put-strain-on-NHS

David Cameron sets out policies to boost NHS

David Cameron has pledged to protect spending on the NHS as he set out twenty policies to boost Britain’s health services if the Conservatives win the forthcoming general election.

Launching the Conservatives’ election campaign, Mr Cameron said that health care was his top priority and that he represented “the party of the NHS”.

The Conservative leader pledged to channel more health spending to poorer areas to tackle the growing gap in life expectancy between the wealthier and less well off.

A new maternity service giving mothers greater choice will also be set up if the Tories are elected.

Mr Cameron published the first chapter of a “draft manifesto” detailing twenty Conservative policies for the NHS.

These included a pledge to end mixed sex hospital wards, a plan to withhold funding from hospitals which infect patients with MRSA, and new proposals to give patients detailed information about the quality of treatment from each doctor, hospital or surgery.

Patients will also be given more opportunity to manage their own care and could receive treatment for minor ailments at their local pharmacist.

In a speech to Conservative activists, Mr Cameron said: “Today, the Conservatives are the party of the NHS. But talk is cheap. You've got to back that with action, and we have.

"We are the only party committed to protecting NHS spending. I'll cut the deficit, not the NHS. And don't for one minute buy the Labour claim that they'll do the same. They won't - and their own figures show they won't.

"Unlike us, they have not committed to protecting areas of the health budget such as public health and capital investment."

Mr Cameron accused Labour of failing to tackle the gap in health between rich and poor, describing it as "one of the most unjust, unfair and frankly shocking things about life in Britain today".

"Health inequalities in 21st century Britain are as wide as they were in Victorian times," he said.

He promised the Tories would introduce a new health premium that would divert cash to the poorest areas and "banish health inequalities to history".

"With our plans, the poorer the area, the worse the health outcomes tend to be, so the more money they can get," he said, adding that local people would decide how it was spent.

From:

http://www.telegraph.co.uk/David-Cameron-sets-out-20-policies-to-boost-NHS

Sharp rise in England swine flu deaths

The latest weekly bulletin showed a sharp rise in patient deaths and the number of children being admitted to hospital.

The overall number of new cases showed a second successive weekly fall. Health officials estimate there were 55,000 new cases this week in England compared with 64,000 last week. There was a slight drop in Scotland.

The number of people who have died from swine flu in the UK has reached 214. There were 18 deaths in England last week. The figures since the start of the outbreak in May are 142 fatalities in England, 21 in Wales, 38 in Scotland and 13 in Northern Ireland.

The number of people needing hospital care for the virus is 783, down slightly from 785, in the previous week. Of those in hospital, 180 were in intensive care, up from 173 in the previous week.

The Conservative party has been pressing the government to give vaccinations to healthy children because those under the age of 16 are in one of the more vulnerable groups.

About 21% of all H1N1 deaths in the UK have been among under 14s.

So far the priority groups have included those with pre-existing medical conditions, their carers and pregnant women. Children with asthma or diabetes are already being vaccinated. Now, children aged six months to five years are to be offered the vaccination from next month.

From:

http://www.guardian.co.uk/world/2009/nov/19/swine-flu-vaccines-healthy-children

Conservatives told how to cut NHS red tape to free up £4 billion

Reducing NHS red tape could free up £4 billion over four years to pay for frontline health services, Andrew Lansley has told the Conservative party conference in Manchester.

Health is one of only two budgets the Opposition has guaranteed would be spared the axe if it took power and Mr Lansley, the shadow health secretary, said reducing bureaucracy was the key.

Spiralling running costs of primary care trusts, the £1.94 billion-a-year price tag for health-related quangos and the bills for Whitehall and Strategic Health Authority operations would all face the squeeze.

At least £850 million would be saved by taking PCT and quango budgets back to the level of six years ago - at which point Labour already thought there were potential savings of £750 million according to their own calculations.

The Tories, meeting in Manchester for their annual conference, said those budgets were in direct control by ministers meaning they could give a ''concrete commitment to cut them by a third''.

Mr Lansley said further savings would be found by scrapping some Whitehall imposed targets and returning powers over budgets and out-of-hours care to GPs.

He backed an assessment by NHS chief executive David Nicholson that savings of between £15-20 billion needed to be found between 2011-14 but said the Tories would ''go much further in slashing wasteful bureaucracy in the NHS hierarchy''.

''Labour have made expensive commitments on the NHS with no price tag. In contrast, we are determined to identify how we will save money before we spend it.

''To make the NHS successful we must devolve decision making closer to patients. In doing so we'll save substantial sums of money.

''The NHS must be well managed but that's not expensive bureaucracy, it's about lean and good-quality management.

''Labour has allowed wasteful spending on bureaucracy to spiral. A Conservative government would cut it right back. We are determined to shift NHS funds from the back office to doctors and nurses on the front line.''

From:
http://www.telegraph.co.uk/Conservative-Party-conference-cut-NHS-red-tape-to-free-up-4-billion

NHS IT project still on critical list

“If you live in Birmingham,” declared Tony Bliar when he was UK prime minister, “and you have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you.” Not any more.

Or not, at least, if the Conservatives win the next general election. For the Tories have pledged to scrap the countrywide version of the National Health Service’s electronic patient record.

Back in 2002, the idea of a full patient record, available anywhere in an emergency, was the principal political selling point for what was billed as “the biggest civilian computer project in the world”: the drive to give all 50m or so patients in England (the rest of the UK has its own arrangements) an all-singing, all-dancing electronic record. 

Roll-out was meant to start in 2005 and be completed by 2010.

Under a Conservative government, development of the local record – exchangeable between primary care physicians and their local hospitals – would continue. Nationally, clinicians would still be able to seek access to it when needed from the doctors who would hold it locally. But the idea of a national database of patients’ records, instantly available in an emergency from anywhere in the country, would disappear.

This may or may not matter, depending on your point of view. For many clinicians, the idea of an instantly available national record was always something of a diversion. It is access to a comprehensive record locally that is crucial for day-to-day care.

Nonetheless, the Conservatives’ decision to scrap the central database is a symbolic moment for a £12bn ($20bn, €14bn) programme that has struggled to deliver from day one. 

It is currently running at least four years late – and there looks to be no chance in the foreseeable future of its delivering quite what was promised.

So what went wrong? Too much ambition, too much speed, too much centralisation, too little local ownership and not enough choice have been just some of the problems. 

‘It is more difficult than people think. But I do think that by now, seven years on, we would have been further forward’ Glyn Hayes, former chairman of the British Computer Society’s health section

In hindsight, it is easy to see why the programme was set up the way it was – with big central contracts and a one-size-fits-all central offering. For a start, while there had been some local successes, the health service had also had its share of IT disasters when things were run locally.

“The arguments for centralisation were first that all these systems had to be able to talk to each other,” says someone who was closely involved in the government’s original decision to launch the programme. “Second, there were powerful arguments for economies of scale if the system was bought centrally. And, third, the NHS had a long history at local level of taking ringfenced money, whether for IT or other projects, and finding ways of spending it on something else.

“Looking back, it was the wrong thing to do. It was right to centralise standards for communication and for what should be in the record. It was right to use centralised purchasing power. But the next step, that the whole programme had to be centralised, did not have to flow from that. It proved to be a mistake.”

With a staggeringly ambitious goal to get the first electronic records running just three years down the line – when what was to be in them had yet to be fully defined – Richard Granger, the then director, decided that the fragmented and small providers of IT still in the NHS hospital market did not have the scale or industrial muscle to deliver.

So he brought in some of the big boys of IT – Fujitsu, CSC, BT and Accenture – to install the systems. They, however, were not health IT specialists. And, according to Mr Granger, the two providers of the electronic record software ended up with mirror-image problems.

The US company Cerner had good clinical systems. But software designed for hospital billing systems in the US needed a big rewrite to run all the administration and reporting functions of the NHS. By contrast, iSoft, which at the time was a British company, knew how to run the administrative side of the health service but lacked a clinical record. It has taken years for the often troubled company to come up with one. The first deployments of early versions of it are only just under way.
 

For all the difficulties in getting early versions of an electronic patient record into the NHS, the IT programme has had some success. England is one of the first countries to have fully digital imaging – replacing film X-rays and scans with manipulable digital images that largely put an end to lost films and unnecessary repeat examinations.

In spite of the delays, suppliers insist they will get there in the end. Gary Cohen, CEO of iSoft, one of the record suppliers, says: “It is a bit like swimming the English Channel. If you are 80 per cent of the way there and tired, what you don’t do is say ‘Well, we’ll swim back and start again’.”

On top of that, while there was a £6bn budget for the 10-year central contracts, no money was earmarked for training, in spite of the lesson, from the relatively few successful installations of electronic records in US hospitals, that at least as much has to be spent on changing the way staff work as is spent on the systems themselves.

Furthermore, there was no local ownership of the programme. Local developments of electronic records that were under way were halted. The national programme became something that was delivered from on high to hospitals and clinicians, not something that they chose or voted for. They also had to fund their own training and other costs. On top of that, all the installations of early versions of the software into big hospitals have caused serious disruption.

So where does the programme go now? BT and CSC, the two remaining systems installers, have been given deadlines of November 2009 and March 2010 respectively to achieve a smooth implementation in a big acute hospital. Failing that, the department of health says it will “look at alternative approaches”.

Quite what plan B is, however, remains a mystery. Any decision to cancel the contracts is likely to result in mighty litigation. The for hundreds of millions of pounds set aside to achieve an electronic record could go up in smoke in claim and counter-claim as each side blames the other.

It has been a sorry tale to date- and one that still continues.

From:

http://www.ft.com/cms/s/0/6b74e4c8-8cdd-11de-a540-00144feabdc0.html

Patient records should be given to Microsoft or Google, say Tories

NHS patient records would be outsourced to Microsoft or Google under Tory plans, instead of being held on an expensive, flawed central government database.

The Conservatives, who have close links with Google, argue that developing a database would be unnecessarily expensive, and it would be more beneficial to hold the information on secure systems which already exist, such as Microsoft Healthvault or Google Health.

Patients would be given the choice of storing their records with private companies, although it is not yet clear what would happen to the notes of patients who do not consent.

The Tories estimate that if data were outsourced to sites such as these, the country would save half of the £1.65 billion it spends on IT annually.

Under the plans, which emerged at the weekend, medical staff with appropriate access would log on when necessary, although it does raise issues over security.

David Cameron, leader of the Conservatives, has previously singled out the "Electronic Patient Records system" as an example of the government's wasteful spending.

Winning a contract for medical records would guarantee revenue for Google or Microsoft for years, while it would also help increase the use of their technology in healthcare.

The National Programme for IT, one of the biggest computer contracts in the world, is designed to link more than 30,000 GPs to nearly 300 hospitals.

Parliament's public accounts committee however warned in January that if the scheme was not showing signs of moving forward by July, hospitals should have the option to ditch the plans.

The new system is designed to provide an online booking system, centralised medical records for 50 million patients, e-prescriptions and fast computer links.

But the MPs' report found that progress was "very disappointing" with further delays expected. A revised completion target of 2014/15, already four years behind schedule, was "in doubt", while the report also found the scheme was now costing taxpayers an estimated £12.7 billion.

http://www.telegraph.co.uk/Patient-records-should-be-given-to-Microsoft-or-Google-say-Tories

Health Direct raises one cheer for the proposals. At last- some common sense and recognition that the current project is hopelessly flawed and expensive.

However Microsoft and Google both have bad records for using personal data. The "Opt In" option for patients must be offered and respected.

Plans to safeguard NHS patients' lives

Health Direct reproduces the Conservatives and the Telegraph's plans to safeguard patients' lives in the face of labour's NHS targets and red tape.

Andrew Lansley issues five point plan to avoid another Mid Staffs:

Shadow Health Secretary Andrew Lansley has issued a set of five proposals to ensure another healthcare crisis of the kind we saw at the Mid Staffordshire Hospital is avoided in future.

1. Tougher inspection: Additional scrutiny powers for the 'Local Involvement Networks' that represent patients and the local community. 'LINKs' will also be given independence from local authorities so that they cannot be swayed by politics.
2. Empowerment of patients: "Conservatives will establish a strong, independent, national consumer voice for patients: HealthWatch." HealthWatch will help LINKs to hold local hospitals to account and will escalate concerns to national prominence, if necessary.
3. Empowerment of GPs: Rather than Primary Care Trusts holding budgets for buying treatment from local hospitals, the Conservatives would give the power to GPs. GPs, say the Conservatives, are closest to patients and best-placed to keep an eye out for things going wrong.
4. Scrapping targets: Abolition of bureaucratic targets will ensure that "doctors and nurses should never be put in a position where they have to choose between meeting a target and doing what is best for their patients."
5. Greater transparency: The Mid Staffs catastrophe only became apparent after the hospital's mortality rates were published - not something that is routine. A Conservative government will require more information on mortality and survival rates at each NHS trust.

From:
http://conservativehome.blogs.com/torydiary/2009/03/andrew-lansley-issues-five-point-plan-to-avoid-another-mid-staffs.html

The Telegraph suggests:

1 An independent inquiry into the regulation and supervision of NHS hospitals
We, the Patients Association and ‘Cure the NHS’ demand an inquiry, chaired by a judge, into both the failings in Staffordshire and the way hospitals are supervised nationwide.
2A review of hospital targets to ensure they work to improve quality of care
Doctors have warned that the four-hour waiting time target for A&E is attainable only by delaying admissions or forcing some patients through too quickly, to the detriment of their care.
3 Nurses to focus on patient care – not form-filling – as their central duty
Nurses have complained that they are sometimes too busy filling in forms to carry out basic nursing duties that are crucial for the wellbeing of patients.
4 Routine publication of comprehensive death rates for hospitals
Secrecy over mortality rates for particular treatments keeps patients in the dark about failing hospitals.
5 Patients to be given a stronger voice in the running of their hospitals
The local NHS watchdog system has been reformed repeatedly under Labour but there are concerns that the current structures lack the power to hold hospital chiefs to account.
6 Assurance that senior hospital staff will not be rewarded for failure
Martin Yeates, the chief executive of Mid Staffordshire NHS Trust, is now suspended on full pay and could receive a payoff, despite a previous pledge by the Government to clamp down on such payouts.

You can sign up here:
http://www.telegraph.co.uk/telegraph/multimedia/archive/01373/Click_here_to_supp_1373231a.pdf

NHS patients mixed sex indignity continues on hospital wards

Men and women in hospital are still being treated on mixed-sex wards with little or no segregation, despite government promises to improve privacy for patients, the Conservative Party says.

In April ministers claimed that they were close to abolishing mixed-sex accommodation in the National Health Service. Figures obtained by the Conservatives suggest that 15 per cent of hospitals in England still use mixed, open-plan “Nightingale” wards, while a similar proportion (16 per cent) have wards where patients are segregated only by curtains. The party said that nearly a third of trusts did not have separate bathrooms for men and women.

There were 997 complaints about lack of privacy and dignity in hospital trusts and 135 complaints in mental health trusts in the past year, a poll of 132 acute trusts and 55 mental health trusts showed.

Andrew Lansley, the Shadow Health Secretary, accused the Government of breaking its promises on the issue. “Patients have enough to worry about when they go into hospital without having to suffer the indignity of being placed in accommodation that affords them too little privacy at such a sensitive time,” he said.

Alan Johnson, the Health Secretary, told a nurses’ conference last year that there was a “bit of a political distinction” between the terms mixed-sex accommodation – where men and women are in separate rooms or bays and have their own bathrooms and lavatories – and the larger, mixed sex wards.

The Department of Health responded: “We are reducing mixed-sex accommodation to an absolute minimum and have made significant progress. Some hospitals and local NHS areas still have more to do and they are now required to publish and implement ambitious plans to improve.”

From:
http://www.timesonline.co.uk/tol/news/politics/article5478334.ece

NHS cancels more than 100,000 operations in a year

More than 100,000 operations have been cancelled by the NHS over the past year because of bed shortages, staffing problems and other non-clinical reasons, new figures released reveal.

The Department of Health announced that just over 57,000 operations had been cancelled. However, these figures only cover cancellations made in the 24 hours before an operation.

The number of cancelled operations is almost twice as high as previously admitted by the labour Government with thousands of patients suffering from multiple cancellations.

Ministers have previously said that cancelling operations is "unacceptable" yet have failed to act to prevent hospitals from cancelling procedures, often just hours before surgery is due to take place.

The figures have been obtained by the Conservatives who used Freedom of Information laws to request the data from NHS trusts.

Andrew Lansley, the Shadow Health Secretary, said: "Having an operation cancelled can cause huge distress for patients and their families. It's simply unacceptable that these figures are so high.

"The labour Government are directly to blame for these problems. NHS staff are doing the best they can but how can they plan patients' care properly when they are continually hampered by Labour's top-down targets? Labour's boom and bust approach to the NHS finances has made things even worse, with bed shortages and staffing shortages in far too many trusts."

The Conservatives claim that Kingston Hospital, York Hospitals and Sussex University Hospitals are among the most prolific cancellers of operations. Only one trust, the Clatterbridge Centre for Oncology said it had not cancelled any operations.

In total, more than 7,000 patients had their operation cancelled more than once. A third of trusts cancelled an operation for the same patient at least three times.

The Conservatives' analysis reveals that the most popular reason cited for cancelling an operation was "problems with theatre bookings". Thousands of operations were also cancelled because of bed shortages, administrative problems and staffing shortages.

The figures show that the scale of the problem is far larger than previously disclosed by the Government. Last year, the Department of Health announced that just over 57,000 operations had been cancelled. However, these figures only cover cancellations made in the 24 hours before an operation is due to take place

When hospitals were asked to reveal all cancelled operations, the figures were almost twice as high prompting allegations from the Conservatives that ministers were "spinning the statistics".

131 of the country's 171 NHS trusts responded to the Tories' request for information. The trusts which responded said they had cancelled a total of 77,302 operations which, if extrapolated to include all hospitals, means that about 105,000 operations were cancelled nationally last year.

Shortly before the last election, Tony Blair, the former Prime Minister, said that it was "unacceptable" for operations to be cancelled.

A spokeswoman for the Patients Association said: “Everyone understands that in an emergency, a patient may not have the operation they need because the clinical priorities of another must take priority. The examples in this survey, however, reveal a situation where patients and their families are subject to an increasingly cavalier standard of care in which the NHS is not putting patients first.

“Patients, and taxpayers, expect better management of their NHS than this. The NHS only gets away with it because ultimately its patients cannot go elsewhere. When you know your customer doesn't have a choice, such standards prevail.”

A spokesman for the Department of Health defended the Government and said it only collected figures for late cancellations as these were of most concern to patients.

From:
NHS-cancels-more-than-100000-operations-in-a-year.html

Two in five trusts turn away women in labour

Women in labour were turned away by 42 per cent of trusts last year, figures obtained under the Freedom of Information Act show as labour's maternity promises look stillborn.

The figures, obtained by the Conservatives, show that one in 10 trusts closed their doors to women giving birth more than 10 times in the last year. Larger maternity units were the most likely to close.

Of the trusts that closed, 26 per cent had less than 3,000 births last year, the minimum for an "efficient" service, according to the government.

42% of NHS Trusts providing maternity services had to turn away women in labour last year because they were full.

New statistics reveal that nearly one in ten Trusts had to close more than ten times, with the Scarborough and North East Yorkshire Trust shutting its doors 39 times in 2007 alone.

Andrew Lansley said the figures showed maternity services are already "overstretched", making a mockery of Labour's plans to close maternity units.

The Shadow Health Secretary attacked Labour's plans to cut smaller, local maternity services and concentrate them in big units:

"Women don't want to have to travel miles to give birth. And they certainly don't want to have to travel even further because they're turned away by the hospital of their choice."

http://www.conservatives.com/tile.do?def=news.story.page&obj_id=143112

Tory health bill challenges Labour on improvement plan

The health service would have a clear divide between purchasers and providers with ministers and the Department of Health having much less day to day involvement in its running under a bill published by the Conservatives.

The Tory plans present a political challenge to Gordon Brown's government to spell out how it plans to achieve improvements to the service, commentators say.

Under the Tory proposals a separate NHS board, which would still be subject to ministerial direction, would allocate resources, issue commissioning guidance and performance manage health authorities and primary care trusts, with family doctors being given real budgets to buy NHS care.

Monitor, the foundation trust regulator, would become a full economic regulator for healthcare. It would have a duty to promote competition, set the prices for NHS care and oversee market entry and exit for independent as well as NHS-run providers of care.

Healthwatch, a new patient and public involvement body, would work alongside the existing NHS inspectorate.

Andrew Lansley, the Conservative health spokesman, said the package would "give greater freedom to the NHS" and "get politicians and the Department of Health out of the day to day management of the NHS".

It also allowed for competition and choice to drive improvements, with polls showing that most of the public did "not care who provides the service" as long as it remained free at the point of use and of good quality.

The Conservatives, he said, would use opposition time or a private member's bill to put the proposed legislation before parliament.

He said that last year Mr Brown, when chancellor, appeared to be in favour of a more independent NHS, "but he seems to have reneged on that view".

Chris Ham, the former head of the Department of Health's strategy unit and professor of health service management at Birmingham University, said that while the details differed considerably, the thrust of the Conservatives' bill would have produced similar results as Blairite reforms.

"It begins to establish some clear blue water between Tory and Labour health reforms. It throws down the gauntlet to Gordon Brown and his health ministers to be much clearer about the mechanisms they want to use to drive further improvements in the NHS.

"Are they going to push through Blair's market-based reforms, or are they going to come up with an alternative Brownite version that is different both from where the Blairites were going and where the Tories are?"

Professor Ham said he was sceptical about how far politicians would in practice be willing or able to live with the effects of market-based reform in the NHS.

"But this sounds like a more coherent version of NHS independence combined with market-based reforms than the present government has been able to articulate."

From:
http://www.ft.com/cms/s/0/49ccf188-89b2-11dc-8dff-0000779fd2ac.html

Cameron kills health 'passport' idea

David Cameron has put the final stake in the heart of the Conservatives' proposal at the last election for a "patient passport", which would have allowed patients to use National Health Service funds to contribute towards the cost of private operations.

Speaking at the NHS Confederation's annual conference in London, Mr Cameron promised legislation to outlaw such a policy in the future. He added that the Conservatives' "first piece of health legislation" would commit the Tories to a comprehensive, universal health service funded out of taxation. But it would go further and "enshrine in law that NHS money should only be spent on NHS patients", he said, ruling out the "patient passport" proposal.

In future there would be "no opt-outs" and "that's a guarantee", Mr Cameron told the conference of NHS managers and board members. "We are not going to use NHS money to help people get out of the NHS into private healthcare. NHS money will be spent on NHS patients and that will be written into the law."

He underlined that he wanted there to be "no doubt whatsoever" the next Conservative government would uphold the principle of an NHS paid for out of general taxation.

Without naming specific sums, he said the Conservatives would "always support the NHS with the money it needs".

Andrew Lansley, the party's health spokesman, said that would mean "additional, growing, real-term resources" - reflecting the fact that as countries grew richer they spent a greater proportion of their total income on healthcare.

Meanwhile, David Nicholson, the NHS chief executive, without directly naming them, launched a strong attack on "the vested interests" of the British Medical Association and the Royal College of Nursing for wild claims that the NHS was "on its knees" or that the service's financial performance was "a tragedy" or "a farce".

Such claims "are not just factually incorrect", said Mr Nicholson. "They are deeply damaging to the public confidence and staff morale".

From:
http://www.ft.com/cms/s/2477045c-1f93-11dc-ac86-000b5df10621.html

On Jan 24 07 Health Direct posted- Conservative's David Cameron would hand power back to GPs as many centralist targets for the National Health Service would be scrapped under a Conservative government as more purchasing power was handed to family doctors, David Cameron, the Tory leader said.

The policy would encompass a full-blooded return to GP fundholding - the practice of giving family doctors budgets to buy care on behalf of their patients, which Labour abolished but is now partially reinstating through practice based commissioning.

Health Direct also points out that government actions also loose elections.

Health Direct has frequently raised the issue of waste that labour's blizzard of targets has created for the NHS. On Dec 18 06 in Labour's mismanagement has led to NHS deficits according to Commons Health Select Commitee Mismanagement at all levels of the NHS in England has led to the current multimillion pound deficit, a committee of MPs has found.

The Commons health select committee said existing deficits were made worse by the cost of new staff pay deals and the expense of meeting NHS targets. Last year's NHS deficit was £547m.

The committee said historic deficits, long hidden, were revealed when the government changed the rules so trusts could not underspend their capital budget to subsidise current spending.

But it said the government fuelled the problem by agreeing to new pay deals for doctors and nurses using estimates of the cost which were "hopelessly unrealistic".

In addition, meeting national targets such as the requirement that no patient should wait more than four hours in A&E had been costly.