Row erupts over NHS health trusts in centralist health dictats

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Brown bounce wanes on public services says another poll

Labour's "Brown bounce" in the polls has receded as far as public services are concerned, according to polling by Ipsos Mori.

Ben Page, public affairs managing director, said that the public's expectations about the economy and whether public services would improve had returned to the level they stood at when Tony Blair left office.

The polling company's quarterly "delivery index" has long been used in Downing Street to track the public's views on public service reform.

In May, as Gordon Brown prepared to take over as prime minister, fractionally more of those interviewed believed the government's policy would improve the state of the economy in the long term.

By this month the net score between those who believe things will get better and those who believe they will get worse was minus seven.

On public services generally, those who believe things will get worse outnumber those who believe they will get better by 22 percentage points, against 13 in May.

That is chiefly due to expectations over the future performance of the National Health Service declining from a net score of minus 14 to minus 19.

That is nothing like as bad as in September last year, when the proportion who believed services would get worse outnumbered those who believed they would get better by 32 points.

"The NHS remains a key concern for the government," Ipsos Mori said. But "crime, immigration and pensions are [also] key challenges for the Brown government - most of the public are currently pessimistic about these".

A mere 20 per cent are confident that the government will manage immigration well, 23 per cent that they will do the right thing on pensions and 23 per cent that crime will reduce over the next few years.

From:
http://www.ft.com/cms/s/0/de5492aa-657e-11dc-bf89-0000779fd2ac.html

The dip in Stalinst Brown's fortunes were highlighted in Health Direct's post on 18 Sep 2007-
Labour lead halved as voters feel pinch when Gordon Stalinist Brown’s opinion poll lead has halved in the space of a month, making an early election much less likely, according to the latest Sunday Times-YouGov poll of more than 1,800 people.

Gordon Stalinist Brown's careless health spending will end up wounding the PM

The amount of taxpayers' money spent on the National Health Service has more than doubled in the last five years. The annual cost of our system of universal public healthcare is now approaching £100bn - more than £1,500 a year for every man, woman and child. But is our money being spent wisely?

The UK's ageing population, and the ever-rising cost of new treatments, means NHS spending never actually falls year-on-year - despite politicians endlessly accusing each other of "cuts".

Instead, the NHS spend grows at different rates at different times. And, by this measure, the extent to which New Labour has spent on our health service becomes extremely clear.

Under the Thatcher and Major Tory administrations, real spending - after inflation - grew by between 2 and 4 per cent a year. But Labour's increases cranked up that average to almost 5 per cent after 1997, and more than 7 per cent after 2001.

As Chancellor, Gordon Brown drove through all that new money. Now, as Prime Minister, his chance of winning an election depends in part on the public's perception of how those extra billions have been spent.

It must be galling for Brown, then, that a recent Guardian poll suggested 44 per cent of the public thought the NHS would deteriorate under Labour, but only 35 per cent under the Tories.

Labour is used to "leading" on health. The creation of the NHS after the Second World War is, perhaps, the party's proudest achievement.

More seriously for Brown, NHS resources are set to tighten considerably over the next few years. A new financial settlement, to be announced next month, will reduce spending growth, perhaps by half, but certainly to no more than 5 per cent.

At that point, voters will start asking if Brown's NHS spending splurge has been squandered. The UK now spends around 9 per cent of our national income on health when private care is included - equal to the European average. Yet the NHS lurches from crisis to crisis.

The Labour government's reputation on health took a bad knock after 2005 when big deficits appeared across the service. Earlier this year, almost half of all NHS trusts were in the red - with the total cash shortfall of £1.3bn.

Ministers clamped down, imposed "minimum waiting times" on at least two-fifths of the NHS's acute hospital. The British Medical Association said this was "crazy". Operations and other treatments were being delayed for months, it said, even though staff and equipment were available, "just to make the accountants' numbers add up".

Since then, the NHS has swung back into surplus. But, over the summer, evidence has continued to emerge suggesting "health" may not be the sure-fire electoral asset which Labour has long assumed.

One of Britain's leading trauma surgeons broke cover to expose a national shortage of emergency beds - meaning thousands of serious injury victims are left in agony. And there were more signs that, despite now spending more per head than France and Germany on cancer, our survival rates remain poor.

The NHS continues to lag behind Europe when it comes to diagnostic cancer scans, time to first treatment and access to radiotherapy and cancer drugs.

Then, later in the summer, the head of NHS information technology - the UK's highest paid civil servant - suddenly resigned. While the Government's ambitious plans to harness IT to improve health care are bearing some fruit, parts of the project remain years behind schedule and total costs are heading for £20bn - £7bn over budget.

No one ever said running the NHS is easy. And even number-crunchers like me would be foolish not to recognise the expertise and dedication of countless NHS staff. But, as the political season restarts, and with health set to take centre-stage, it's worth wondering if the tens of billions of pounds we've just thrown at the NHS could have been better spent. I think it could.

By Liam Halligan, Economics Editor, Sunday Telegraph
http://www.telegraph.co.uk/money/main.jhtml?xml=/money/2007/09/09/ccliam109.xml

This voter distrust of labour's NHS funding has been going on for a while. On Tue 28 Nov 06 Health Direct posted: Labour continues to pay the price for it's NHS cutbacks and closures with the voters as the public remains deeply sceptical over the government's ability to improve public services and the economy, according to the latest findings from Ipsos Mori's public delivery index.

A mere 19 per cent of adults believe the National Health Service is getting better, against 46 per cent who believe it is worsening. Just one person in 100 believes the NHS will get better over the next few years, against 13 who believe it will get much worse. (Which proves the adage that you can fool some of the people some of the time- but eventually people will see through the spin and lies.)

"Labour's standing on public services is not quite in free fall," Sir Robert Worcester, founder of MORI said. "But the public is clearly disenchanted with Labour's ability to improve public services after nine years in office. Its figures are down and continuing to fall."

New nurses left jobless by labours NHS budget squeeze

Thousands of newly qualified nurses are facing unemployment because of labour's NHS hospital cutbacks, with vacancies at their lowest for 10 years. New National Health Service figures have revealed how difficult it is for nurses, physiotherapists, scientists and doctors to find jobs.

The highest vacancy rate was among consultants, with 1.2 per cent of jobs empty compared with 0.4 in trainee nursing. There are currently 5,000 newly qualified nurses who cannot find a job and half of the 2,413 newly qualified physiotherapists have not found permanent posts.

More than 20,000 jobs have been cut in recent years as managers struggle to bring NHS finances back into balance.

Vacancy rates across the medical professions have dropped, showing the boom and bust nature of current workforce planning in the health service.

Places at medical school and nursing colleges were expanded and the NHS has now almost reached a point where it is self-sufficient in staff.

But experts are predicting shortages again in the medium to long-term because large numbers of nurses, GPs and consultants are nearing retirement age. In the meantime, newly qualified staff are struggling to find work and many are considering retraining or working abroad.


Dr Peter Carter, the general secretary of the Royal College of Nursing, said: "This is not a 'good news' story for nurses.

''Vacancy rates appear to have reached their lowest levels for years but we fear that has been achieved only by widespread freezing and deleting of posts by NHS trusts desperate to balance the books.

"Thousands of newly qualified nurses - costing taxpayers millions of pounds to train - cannot find jobs this year yet at the same time the workload on the wards and in the community remains high.

"It's time for the Government to put in place a long-term workforce strategy that prevents the feast or famine characteristic of the NHS job market in recent years."

The NHS Vacancy Survey also found that:
- In March 2007 there were 1,695 vacancies for qualified nurses and 391 for trainees.
- There were 364 consultant posts available and 73 jobs for other doctors in non-training posts.
- The vacancy rate for GPs has dropped from 2.4 per cent in March 2005 to 0.8 per cent this year.
- There were just 63 vacancies for physiotherapists in March this year compared with 464 in 2005.
- The highest vacancy rates are in the South East Coast area, followed by the North East, with the lowest in the West Midlands.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/21/nhospital821.xml

Health Direct points out that Labour's complete and utter incompetence in attempting to "save the NHS" is exposed by these latest figures. It's a waste of taxpayers money for us to subsidise medical training and then throw the highly skilled new staff out onto the dole queues.

On March 22, 07 Health Direct posted: MPs expose lack of control over NHS billions

A devastating insight into financial mismanagement at all levels of the NHS- from Labour ministers down to hospital bureaucrats- is provided by a committee of MPs. The report by the all party Public Accounts Committee exposes how billions of pounds of taxpayers' money is being poured into a health system with inadequate financial controls and low levels of accounting expertise.

The MPs conclude that NHS structures are so inadequate that the Department of Health has no idea what the effect of last year's total deficit of £570 million is having on patient care.

In no less than one in three NHS organisations, auditors had raised concerns "about the financial management capabilities of general management".

The committee said that while the Department of Health had no "overall picture" of the effect of deficits on services to patients, it was clear they were adversely affecting the level and quality of care.

Dr Peter Carter, the general secretary of the Royal College of Nurses, said it was very disturbing that the department had no clue about the effect of deficits on services and jobs. "It's time for the Government to come clean.

Ministers need their advisers to tell them just how damaging the deficits crisis has become and acknowledge the Government's responsibility to work with front line staff to find a long term solution."

NHS Dentistry access is not improving

A shake up in NHS dentistry in England has failed to increase access to services, labour government figures show. A Department of Health report showed 28.1m people had been to an NHS dentist in the previous 24 months. This was 50,000 down on the figures on the eve of the changes in April 2006. The number of dentists in the system has also fallen.

Patient groups said dentistry needed urgent attention, but the government said it was on a more secure footing.

The new contract was meant to tempt more dentists to work in the NHS by paying them the same money for seeing less patients.

Dentists have long complained that they face a "drill and fill" environment whereby they have to maximise the number of people they treat.

Instead, the new contract was meant to allow them to spend more time with patients to do preventative work, supposedly making NHS work more attractive.

But dentists have been critical of the new arrangements, which also saw a simplified charging system introduced, because of what they say is a lack of money in the system.

The official figures show that there were 21,038 NHS dentists in England at the end of March 2007, down on the 21,111 figure in March 2006.

Although, the contract did end up attracting new dentists into the system because 1,000 dentists left the NHS when the new deal came in to either retire or concentrate solely on private patients.

Difficulties

The government's report admitted there were "significant challenges ahead" and some areas still had access difficulties.

Liz Phelps, of Citizens Advice, said: "We continue to report huge problems for people trying to find an NHS dentist locally.

"The urgent priority must now be to make the reforms work for patients by funding the new arrangements adequately."

And Peter Ward, chief executive of the British Dental Association, said: "This is not a picture of success and confidence. The government must start listening to the profession and patients."

From:
http://news.bbc.co.uk/1/hi/health/6935139.stm

On April Fools day last year Health Direct posted D Day for Dentists- 1,000 dentists expected to quit NHS in new contract row

An exodus of about 1,000 dentists from the NHS in England was predicted last night by the chief executives of primary care trusts, who take over untried and untested management of the service from today.

The NHS Confederation provided the first hard evidence of how patients will be affected by a dentists' contract that came into effect at midnight.

It said PCT chief executives forecast that 6% of dentists will stop providing free NHS treatment for adults over the next 12 months and 5% will withdraw NHS treatment for children.

Nearly 20,000 dentists were paid for NHS work last year, according to official figures from the Dental Practice Board. But the board's total included many dentists who also did private work and there was no reliable estimate of the number of patients who could be affected.

Last year Health Direct warned that the labour government may have to review the contract in 2007.

Peter Ward, chief executive of the British Dental Association, said many dentists were signing the new contract while continuing to dispute the terms.

"The profession recognised the need for change from the old system which, in the words of the Audit Commission, put dentists on the treadmill. But the new contract is target-driven and untested, and the fear is that it won't give time for more preventive care."

Junior doctors still jobless in MTAS hospitals chaos

Hundreds of operations in hospitals across England will be cancelled in the chaos as 30,000 junior doctors start new jobs this week. The British Medical Association said that because of the scramble to fill posts ahead of Wednesday's deadline after the collapse of the recruitment system, consultants have been left unable to plan theatre time.

It comes after Health Direct and The Daily Telegraph revealed that eight out of 10 hospitals were cancelling operations ahead of the handover and three quarters were postponing outpatients

The online Medical Training Application Service (MTAS) was abandoned in May due to technical faults and a failure to identify the best candidates.

Around 1,000 posts remain unfilled and round two of the process to fill specialist training posts will continue, under the old paper-based CV system, until October 31.

Consultants have reported being unable to plan operating lists, because they have had no idea which junior doctors will be on their team, or what skills they will have. Junior doctors have not been told the hours they will be working or what time to arrive today, or even at which hospital they will be working.

Hospital managers are having to employ expensive locums or risk shortages as doctors leave for their new jobs and some doctors have been employed in roles for which they are overqualified.

Dr Ian Wilson, deputy chairman of the BMA consultants committee, said: "Any forward planning has been impossible. It's inevitable that more operations and clinics will have to be postponed."

Officials at the Department of Health have been keen to point out that hospitals are well practised in planning for the August 1 changeover, which happens every year, but have acknowledged that fewer posts have been filled this year than is normal.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/01/ndoctors101.xml

Last week Health Direct posted: MTAS disaster- Labour's botched NHS plan when the Medical Training Application System (MTAS) junior doctors appointment fiasco still produces fury in the health profession. Why? And how did labour's defective system get passed in the first place?

MTAS had been problematic because the unpiloted computer system, which aimed to appoint junior doctors centrally, was deeply flawed, with problems such as application forms giving too much weight to Labour's caring sharing touchy feely "creative writing" and too little to academic achievements and clinical experience, and too little consistency to the shortlisting process.

But junior doctors, and their senior colleagues, remain angry and unhappy about the debacle. One in five juniors affected is feeling increasingly suicidal and 94% have felt higher stress levels during the six months covering the application and interview process, according to research published in the British Medical Journal online. Hospitals have been told to be on suicide alert.

Much of this fury is due to the mismatch between training posts and applicants, and the uncertainty this is causing. Department of Health (DH) figures reveal that doctors are chasing 18,391 training posts - with 29,193 applying for 15,600 in England.

Meanwhile, it is these doctors, and their future patients, who will suffer.

On 30 Apr 07- Health Direct wondered whether amongst all of their fiascos the
MTAS- Conntender for the greatest of all Labour's NHS failures- the Junior Doctor application system was the depth.

The crisis that is leading highly qualified junior doctors to head abroad is the result of one of the National Health Service's all-time great administrative cock-ups. It is has left 30,000 junior doctors bitterly disillusioned and angry. But it also has big potential implications for patient care.

Do you feel happy to entrust this shower to keep all of your personal medical information- let alone the ID cards safe?

Hospital cases treble since labour's extended drinking pub hours laws

Overnight visits to hospital emergency departments for alcohol related problems have trebled since the introduction of new licensing laws, according to a scientific journal the Emergency Medicine Journal. The EMJ has published research showing that significantly more people have needed hospital treatment for alcohol-related issues since pub hours were extended in November 2005.

The study analysed data from St Thomas' hospitalin central London across two months, before and after the licensing act was introduced. St Thomas' has one of the largest emergency care departments in the UK.

The study showed that in March 2005 there were more than 2,700 overnight visits to emergency care and 3 per cent - 70 of them - were alcohol- related. But in March 2006 this had risen to 3,100 overnight visits of which 8 per cent, or 250, were alcohol-related.

"The increase in alcohol related problems we have recorded is the opposite of the effect the legislation was designed to produce," said Dr Alastair Newton, consultant at the emergency department of Guy's and St Thomas' and one of the authors of the report.

"Our data suggest that the new legislation has also failed to achieve its intended improvement in public safety and reduction in alcohol-related crime and disorder," he added.

The study showed the number of visits as a result of assault associated with excess drinking doubled and the number of associated hospital admissions almost trebled over the period.

Everyone over the age of 16 who attended the accident and emergency department between 9pm and 9am and who had been drinking was included in the audit.

The overhaul of the drinking laws in England and Wales in 2005 extended the hours pubs were allowed to remain open and enabled some establishments to serve alcohol round the clock.

Critics of the system have voiced concerns that the liberalisation of drinking hours will only fuel the country's binge drinking and anti-social behaviour problems

The study's authors called for longer term assessments to help police and health workers deal with the effects of alcohol.

From:
http://www.ft.com/cms/s/26c9f30a-3590-11dc-bb16-0000779fd2ac.html

Junior doctor shambles threatens the NHS- eminent Doctors

Last week a labour ministerial statement confirmed that almost half this year’s applicants under the junior doctors’ career and appointments system have had their careers in UK medicine abruptly cut short.

This stark fact was transmuted by the subsequent press release into “good news”, because 85 per cent of available jobs will be filled by August 1. Even if this obfuscation of jobfill with appointment rates were true – and we believe it is a gross overestimate – it fails to acknowledge that a 15 per cent vacancy rate is ten times that of previous years in most specialties.

Alarmed at so many posts being vacant on August 1, the Department of Health gives trusts two weeks to manage what the hugely expensive national competition failed to achieve in six months.

Before August, trusts are ordered to find somewhere to shuffle 10,000 doctors for three months until the current crisis is past, and these doctors can then be quietly lost from the NHS for ever.

Our poll shows that one third of the 4,000 who have not found jobs as doctors are among our very best graduates, with either a first-class degree or distinction.

This cull of the best happened because the best graduates naturally apply for the most competitive posts and the new system randomly limited half of the applicants to just one interview.

This new career structure is a top-down straitjacket forcing doctors to choose immutably their area of training merely two years after qualification. Hundreds of doctors now face transportation for seven years to posts geographically remote from their families.

Although the professionalism of doctors will save the NHS from chaos in August, the NHS cannot be saved in the long term from the consequences of culling 30 per cent of our best doctors. Some flexibility and free market in posts must be reintroduced into training and appointments.

Those discarded this year should be guaranteed the right to compete again on a level playing field for the next rung up on the career ladder.

MORRIS BROWN, Professor of Clinical Pharmacology, Cambridge
PETER BARNES, FRS, Professor of Respiratory Medicine, Imperial College
NICHOLAS BOON, President Cardiovascular Society
NICHOLAS BROOKS, Past-President Cardiovascular Society
JOHN CAMM, Professor of Clinical Cardiology, St George's Hospital
MARK CAULFIELD, Professor of Clinical Pharmacology, Queen Mary London
ANGUS DALGLEISH, Professor of Oncology, St George’s Hospital
JON FRIEDLAND, Professor of Infectious Diseases and Immunity, Imperial College
JOHN GIBSON, Professor of Respiratory Medicine, Newcastle
ASHLEY GROSSMAN, Professor of Endocrinology, Queen Mary London
TONY HEAGERTY, Professor of Medicine, Manchester
HUMPHREY HODGSON, Vice-Dean, RFUCMS
JUAN CARLOS KASKI, Professor of Cardiovascular Science, St George's Hospital
CHRISTOPHER KENNARD, Vice Principal, Charing Cross Hospital
KAY-TEE KHAW, CBE, Professor of Clinical Gerontology, Cambridge
JOHN LAZARUS, Professor of Clinical Endocrinology, Cardiff
STAFFORD LIGHTMAN, Professor of Medicine, Bristol
JIM McKILLOP, Professor of Medicine, Glasgow
PETER McCOLLUM, Professor of Vascular Surgery, University of Hull
JOHN MONSON, Professor of Surgery, Hull
STEPHEN O'RAHILLY FRS, Professor of Medicine and Biochemistry, Cambridge
MARK PEPYS FRS, Professor of Medicine, RFUCMS
RODNEY PHILLIPS, Professor of Clinical Medicine, Oxford
PHILIP POOLE-WILSON, Professor of Cardiology, Imperial College
JON RHODES, Professor of Medicine, Liverpool
JIM RITTER, Professor of Clinical Pharmacology, Kings College London
BRIAN ROWLANDS, President of the Association of Surgeons
NEIL SCOLDING, Professor of Neurology, Bristol
JAMES SCOTT, FRS, Professor of Medicine, Imperial College
RAJ THAKKER, Professor of Academic Endocrinology, Oxford
DOUGLAS TURNBULL, Professor of Neurology, Newcastle
ROBERT WILCOX, Professor of Cardiology, Nottingham
MARK WILES, Professor of Neurology, Cardiff
LORD WINSTON, Emeritus Professor of Fertility Studies, Imperial College London

These eminent medical professional signed their letter at:
http://www.timesonline.co.uk/tol/comment/debate/letters/article2093366.ece

Do not give local authorities control of healthcare- Financial Times

In the name of devolution or "the new localism", a crime may be about to be committed. Despite promises from Alan Johnson, the new health secretary, of no new structural reform to the National Health Service "for the foreseeable future", labour ministers appear to be considering giving local government a bigger say in, maybe even control over, the NHS.

Mr Johnson has been the least precise. His announcement of a year long review of the NHS talks of it ending with improved "local accountability" and "community responsiveness" - which could mean anything.

Hazel Blears, secretary of state for local government, has gone further, stating that "we need to be thinking about giving local people more control over their NHS" and that she will be discussing with colleagues "how we make that happen".

But Jack Straw, the cabinet minister in charge of constitutional reform, has gone furthest, saying that too much power has been handed over to "unelected health service quangos", power that now needs to be "brought back within the elected field".

This is bizarre. For two decades now both Conservative and Labour ministers have demonstrated that none of them trusts local government an inch. Local authorities have seen their powers in education, planning and much else removed, cribbed or constrained.

They have been inspected, performance managed and capped close to death. And administration after administration has failed to address the issue that really poisons the relationship between central and local government - namely local government finance and its massive over-reliance on central government funding.

Yet ministers who even now believe that local authorities cannot be trusted with big planning decisions somehow seem to believe they could do a good job of commissioning £90bn worth of NHS care.

For the NHS, such proposals ignore the fact that the labour government already has a policy for reform that needs driving through and completing; that the last thing the service needs is another round of structural change; and that there is no evidence that involving local government would make the service more responsive - history suggests the opposite.

The idea would also be unlikely to solve the problem it might be aimed at: "postcode prescribing", in which variation in local NHS services has proved unpopular. More likely it would - almost by definition - make variation greater.

It also ignores the lessons of history - that representation over how services should be provided, without the ability to raise money to affect that, is a recipe for conflict. Back in the 1970s and 1980s councillors held between a third and a half of the seats on local health authorities.

Without the ability to raise health service money locally - "representation without taxation" - the result was endless wars over whether central government was providing enough money, rather than a concentration on services. In places, service change became paralysed as health authorities refused to balance the books.

That culminated in the government having to send commissioners to the giant health authority that covered the three great teaching hospitals of Guy's, St Thomas's and King's, an experience so bruising, and so damaging for patient care, that no sane person would ever want to see it repeated.

This is not to say that local government and the NHS do not need to work more closely, particularly over social care and public health. But they are already beginning to. Local authority overview and scrutiny committees can already refer big services changes to an independent panel for evaluation.

NHS bodies are about to be required to co-operate in local authority area plans. In some places, the primary care trust chief executive and local social services director has become the same person. In Herefordshire, the council chief executive and primary care trust chief executive will become a joint post.

Such organic initiatives may help make services what they need to be: more nimble and responsive. Imposing some form of elected control - whether via local government or through direct election to primary care trusts, is likely to do the opposite.

Local government has a big enough agenda in local regeneration - and now it appears, once again, in housing - without lumbering it with the health service.

On the health service, the labour government needs to complete its current reforms and see if they work - not divert energy into further changes that would do far more harm than good.

The writer Nicholas Timmins is the FT's public policy editor

http://www.ft.com/cms/s/cd351e08-3334-11dc-a9e8-0000779fd2ac.html

Thousands of new nurses still job hunting

Almost a third of nurses - some 4,000 - had not found jobs six months after qualifying last year, according to official statistics. More than half of physiotherapists and one in five midwives were also still unemployed half a year after completing their studies, the Department of Health admits.

Professional bodies claimed taxpayers' money is being wasted on training staff who then cannot find work in the NHS, and blamed Government squeezes on funding which lead to local healthcare trusts cutting junior positions.

At least 12,000 nurses qualified in May or September last year. But the Department of Health has admitted that only 69 per cent had found jobs by March this year. Among physiotherapists, only 48 per cent managed to find jobs after finishing their training.

The Royal College of Midwives estimates 3,000 more midwives are needed but about 20 per cent of newly qualified midwives failed to find work last year.

A Royal College of Nursing spokesman said: "It is a big problem. Entry-level jobs, for which newly qualified nurses apply, have been frozen because trusts have been told to reduce their deficits. "We think trusts need to be given more time and flexibility to manage their deficits as otherwise it's a waste of taxpayers' money."

Last year a survey by the RCN found almost three quarters of newly qualified nurses were still searching for a permanent job months after qualifying.

The Department of Health said: "The NHS is balancing its work force after job shortages in the past. We expect people like this would find jobs in the next few months as others leave or retire. It is a more competitive environment now and people have to be a bit more flexible in the jobs they take, especially when they've just graduated."

However, the NHS has been spending £1 billion a year on agency nurses because of poor planning.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/06/nnurses106.xml

Labour's NHS reforms pushed hospital chief to suicide

A hospital manager jumped 100 feet to her death, driven to suicide by the stress of NHS reforms. Morag Shedden Wilson, 32, stabbed herself with a kitchen knife and then jumped from a motorway bridge on the M60 into the Manchester Ship Canal. An inquest heard that Miss Wilson, who was head of dietetics at Wythenshawe Hospital, was under pressure because of reforms introduced by the Agenda for Change, a labour Government review.

Coroner John Pollard urged the NHS to consider the impact of reforms on staff as he recorded a suicide verdict.

He said: "I find it extremely sad that a young woman with such a lot going for her has been reduced to this state of despair. When people introduce these rules and systems, perhaps a bit more thought as to what effect they will have on people would be helpful."

The inquest heard that Miss Wilson, who lived alone in Sale, Greater Manchester, found her position at work was made increasingly difficult by the Agenda for Change review, which was aimed at making NHS jobs and salaries fairer.

Her own job was reclassified two grades higher. But dieticians at Wythenshawe Hospital did not receive any improvement in their pay scale, although their colleagues at other hospitals in the area were promoted and received higher salaries.

Miss Wilson lobbied hospital chiefs on behalf of her staff but was told there was no money to improve their pay.

She was also upset because a failing student alleged that she had suffered discrimination at the hospital.

Neil Wilson, Morag's father, visited her in December last year to hear her sing in a hospital choir in Manchester.

He said she felt unable to enjoy a tea break with her staff because they would stop talking as soon as she walked into the room.

Mr Wilson said: "They made her feel as if possibly she was to blame for them not being upgraded, they made her feel so bad she took her tea into her office."

Mr Wilson, who lives with his wife Betty in Aberdeenshire, described how he found his daughter being sick because she was so worried about a meeting with the failing student and other work issues.

After the meeting she told her father that the student had been aggressive.

Mr Wilson heard his daughter moving about the house at 5am the next morning but went back to sleep.

He was woken again at 5.30am by a phone call but no one replied when he answered. Mr Wilson now believes it was his daughter calling before she committed suicide.

Minutes later, police found Miss Wilson's car on the hard shoulder on the section of the M60 that crosses the Manchester Ship Canal near the Trafford Centre shopping complex.

Police found her handbag with a kitchen knife inside. Officers arrived at her home just as her father was filing a missing persons report.

Divers found her body in the canal four hours later. After finding stab wounds on her chest, detectives launched an investigation to find out if anyone else was involved in her death.

Two days later a pathologist confirmed that Miss Wilson had died from drowning.

Her family received more than 350 cards and letters after her death, many from her colleagues at the hospital.

It is understood that the complaint by the student has since been resolved.

A spokesman for Wythenshawe Hospital said: "Morag faced the challenges of any head of department, but had not raised any concerns about the demands.

"We cannot speculate on the motivation for Morag's tragic actions but strongly believe she was appropriately supported by the trust. We would like to reiterate our sincere condolences and sympathy to Morag's family."

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/28/nsuicide128.xml

Health Direct would like to reiterate our sincere condolences and sympathy to Morag's family, friends and colleagues.

Health Direct would also like to extend our sympathies to the family and friends of Dr David Kelly who also apparently committed suicide after also tangling with labour's policies.

Software suppliers may seek compensation as IT chief Grainger leaves

The NHS could face pressure from its big three IT suppliers- BT, CSC and Fujitsu- to change the £6bn contracts they have signed, following Richard Granger's departure from the helm of the world's biggest civil IT project.

Four years after the original contracts were signed, the £20bn programme, to provide an electronic patient record and much else, is changing - although it is not yet entirely clear how.

Strategic health authorities are being given direct responsibility for improving implementation. A tender is being completed to bring on additional software and service suppliers.

And while key parts of the infrastructure are now in place, big questions remain about when new patient administration systems will go in to hospitals, along with the associated software needed to provide a shared, electronic patient record.

Fears about the future of iSoft, one of the two key software providers for the record, were markedly eased yesterday, as CSC, its parent contractor, took more responsibility for the software itself.

But hospitals are reluctant to take new administration systems until iSoft's patient record software is available - the earliest installations are not due until next year - and until Cerner, the other record provider, has an accounts package adapted to the NHS.

It looks likely to be 2009 or 2010 before those will be being installed in large numbers nationwide. And some NHS trusts are seeking more variation than is so far theoretically permitted under the fierce standardisation that the programme has sought to date. That would vary existing contracts, as would bringing in more suppliers.

There remains room for fierce debate about where the blame lies for the delays - with the NHS or the suppliers. Mr Granger has paid suppliers only for systems that are working, keeping the programme on budget.

But six months ago, he warned publicly that his departure might lead to claims from key suppliers that their original contracts have been varied and they should be compensated. At the weekend, he described that risk as "significant". And that appears to be one reason why he and ministers are talking about a "transition" from his full-time role, rather than an immediate departure.

There is also the question of who - given the size of the brickbats that have come to be associated with the job - will want to replace him.

From:
http://www.ft.com/cms/s/5e7e23f8-1e01-11dc-89f7-000b5df10621.html

There is also a question as to why Richard Grainger is leaving his post. Health Direct points out that successful IT projects need a champion to drive the strategic implementation through. With his departure that leadership is now lacking. And patients are having to wait even longer.

On Mon 5 Jun 06 Health Direct posted: £20bn NpfIT computer failures left NHS patients waiting longer as evidence that the Labour government’s troubled £20 billion National Health Service computer system has lengthened waiting times for patients has emerged for the first time.

It was hoped that a pilot scheme for the technology at the Nuffield Orthopaedic Centre NHS Trust in Oxford would show the benefits of the delayed system. Instead, when it went “live”, the computers crashed, data could not be found and some patients found that they were facing among the longest waits for operations in the country.

Staff who were instructed to sort out the problem could not even establish from the malfunctioning computers which patients had been waiting the longest and the numbers kept climbing.

Ross Anderson, a professor in security engineering at the University of Cambridge, warned that the new system was likely to cause “chaos and disaster” in the NHS. “They’re ripping out the old systems but they’re not replacing them with anything better,” he said.

GPs have no confidence in Hewitt

Family doctors delivered an overwhelming vote of no confidence in the labour Government's handling of the NHS yesterday. GPs accused ministers of "wasting a golden opportunity" to transform the health service by "squandering millions of pounds of taxpayers' money".

Delegates at the British Medical Association's annual GP conference cheered and applauded enthusiastically when one speaker called on Gordon Brown to sack Patricia Hewitt, the Health Secretary, when he takes over as prime minister on June 27.

Dr Hamish Meldrum, who heads the BMA's GPs committee, warned the labour Government that it would miss its flagship target of cutting patient waiting times to a maximum of 18 weeks because many of its key reforms were failing.

Doctors at the conference in London voted almost unanimously in favour of a motion stating: "This conference has no confidence in: 1) the UK labour government's handling of the National Health Service, 2) the Secretary of State for Health in England."

Proposing the motion, Dr Eric Rose, a GP from Milton Keynes, said: "Ten years ago when Labour came to power, I and others had great hopes. Ten years later the reality is a golden opportunity has been wasted, and the dangers to the fabric of the NHS appear greater than ever."

"No one is more responsible for this than Secretary of State 'Call me Patricia'. I don't want to be on first name terms with someone I can't trust."

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/15/nhs115.xml

The reaction of key workers - who work at the NHS coal face and have been the beneficiary of labour's largese towards the NHS is illuminating.

On Jan 31, 07 Health Direct posted: BMA team 'stunned by GP contract' as a bit of a laugh when GPs were so stunned by the terms offered to them when negotiating their new contract in 2004 that they thought it was a "bit of a laugh", a doctor has said.

Dr Simon Fradd, who was one of British Medical Association's GP negotiators, said they were shocked by the approach taken by the labour government. They could not believe it when GPs were given the chance not to do evening and weekend work for only a 6% pay cut, he said.

Dr Fradd was part of the negotiating team representing the British Medical Association during the two years of talks between 2001 and 2003, although he is no longer on the BMA's GP committee.

Interviewed for BBC Radio 4's The Investigation, which was aired on 1 February, Dr Fradd said doctors had never believed the government would be willing to allow them to opt out of out-of-hours care.

And when they did, he was surprised the NHS Confederation negotiating team, acting on behalf of the government, was only asking for a 6% cut in pay.

He added: "We got rid of it for effectively 6% of the value of the contract. It was just stunning. Nobody in my position had ever believed we could pull it off but to get it for 6% was a bit of a laugh."

Since the contract came in, nine out of 10 practices opted out of providing care.

Concerns raised over accuracy of PCT benchmarking

Doubts have been raised over the accuracy of the latest quarterly hospital episode statistics following reports of problems with data collection. There are concerns that primary care trust benchmarking decisions and information on patient numbers, which informs payment by results, may be out of date as third quarter results (October-December 2006) were not published until mid May.

A source at a data management service revealed that third quarter data was due in April but had been delayed by 'various data quality issues'.

Teething problems

It has emerged that some trusts have experienced problems in submitting statistics since the data collection hub - the NHS-wide clearing system - was replaced with the secondary uses service at the end of December.

This appears to have caused delays in the processing of the first statistics extracts because some hospital patient administration systems have been incompatible with new software, meaning some extracts are missing from the latest dataset.

Paul Robinson, external relations manager of independent health service information provider CHKS, said he knew of trusts that had experienced this problem.

Others, he said, had faced delays because they were waiting for new third party software to be accredited. An information manager confirmed this was the case at his Midlands trust and said that the hospital had supplied its episode statistics direct to its PCT, bypassing the secondary uses service, to avoid further delays.

Data duplication

Mr Robinson also said he was aware of some hospitals submitting data under both old and new PCT codes, resulting in duplication of records. 'Even if the data is published now it is still significantly out of date information to be basing benchmarking on,' he added.

Dr Paul Aylin, assistant director of the Dr Foster unit at Imperial College London, said: 'We have certainly heard there are some issues with the third quarter data.

'If you're missing records this will impact on benchmarking and payment by results. If you don't have up-to-date information then the whole issue of charging becomes difficult.'

Information Centre for health and social care operations director Roger Dewhurst admitted: 'A minority of NHS organisations have had difficulties in submitting the necessary data over the last few months.

'As a result of the reorganisation of PCTs in October last year, some organisations used incorrect PCT codes to correct previously submitted data. This resulted in a higher number of duplicate patient activity than usual. These have been removed from quarter three statistics and organisations are correcting this through re-submissions.'

Organisations will be able to correct any inaccuracies until mid-June before the final set of annual data is published later this year, Mr Dewhurst added.

From:
http://www.hsj.co.uk/healthservicejournal/pages/N1/p9/070607

The shambles that is Payment by Results was posted by Health Direct on March 01, 2007 in Why the NHS finances will never add up under bliar's crooked books

A short letter published in the Telegraph this week highlighted the contradiction inherent in the Government's attempts to improve the cost-effectiveness of the NHS. NHS hospital surgery is paid for on an ill thought out tariff basis that could cripple the health service.

Every price for every procedure on the list is a guesstimate. No one in the whole system can say for certain that the price hospitals charge a PCT for work has any relation to the real cost of that procedure. In the majority of cases, it is simply wrong.

The debate on whether labour's Payments by Results (PbR) ended on 30 Oct 06 when Health Direct highlighted that PbR Payment by Results are fundamentally flawed says Clinical Coding chief

The current system of Payment by Results (PbR) is 'fundamentally flawed and unacceptable' the head of the Professional Association of Clinical Coders warned last week. Managing director Sue Eve-Jones told an HSJ conference last week that the quality of data in the NHS could compromise any chances of ensuring fairness under PbR.

Her presentation was subtitled 'doing the best we can with a fundamentally flawed and unacceptable system'.

And Ms Eve-Jones concluded that the NHS payments system 'scares me witless'. 'It's like going into Tesco, filling up your basket, and getting charged different prices depending on which checkout you go to.'

Half of all A&E units marked for closure

Up to half of all hospital accident and emergency (A&E) departments face cuts or closure under plans to improve patient care, presenting Gordon "Stalin" Brown with a massive dilemma as he takes over as Prime Minister. Ninety-two out of 204 A&E departments are under threat if guidance attributed to the Department of Health by NHS trusts is followed, the Conservatives claimed.

Some NHS organisations are already using the guidance, which calls for A&E departments to serve a minimum population of 450,000 patients, to justify closures in smaller catchment areas. The average A&E unit currently serves just under 250,000 people.

But the plans are proving hugely unpopular, even though they have been promoted as in the interests of patients and NHS staff.

Mr Brown, aware that the closures would come into force around the time of the next election, said last Friday that he would meet front-line NHS staff and patients to discuss health policy.

It was clear last night that the Chancellor will not now face a leadership challenge as he prepares to succeed Tony Blair, having gathered a decisive 308th supporter among Labour’s 353 MPs.

Last Sunday Mr Brown accepted that people were worried about the potential closure of A&E facilities and maternity services close to their homes, raising speculation that he was pondering a rethink.

If so it is increasingly likely that he will move Patricia Hewitt, the Health Secretary, from her post to pave the way for changes. Which will mean the third Health Secretary since teh Health Direct blog has been running.

The Conservative estimate of 92 nationwide cuts was based on figures in a report circulated to NHS trusts in Surrey.

It states: “Current Department of Health and strategic health authority guidance suggests that, to be viable in terms of patient need, patient safety, staffing numbers and clinical training requirements, a full A&E department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people.”

A staff briefing by Surrey Primary Care Trust in March repeated the figures, suggesting that such a catchment population was “national guidance”.

Closures could mean seriously ill patients, such as those with heart problems or head injuries, having to travel longer distances to receive care in specialist treatment centres. Patients with minor injuries are expected to be treated in walk-in clinics or smaller A&E units.

Such a scenario was supported by two reports published by the Government last year. These suggested that specialist high-tech centres could save 500 lives of people suffering heart attacks and result in 1,000 more stroke victims avoiding death and disability each year.

The changes are broadly supported by doctors’ leaders but are fiercely opposed by patients’ groups and MPs. Cuts to local NHS services have also been opposed by several senior Labour politicians in their own constituencies.

The move to close A&Es comes just as demands on their facilities are rising. The number of attendances at A&E has risen by more than a million in the past three years and the average number of attendances at each is now 67,000.

A report published last year by the Royal College of Surgeons recommended that the minimum catchment population of a fully resourced A&E department should be at least 300,000. But there is debate about whether catchment areas alone should be used to allocate NHS services. Local geography, healthcare needs and staffing levels may have to be taken into account.

A Department of Health spokesman said there was no such official guidance from his department. “Any decisions about the shape of A&E services are taken locally so that services reflect the needs of the local population. Where local health authorities believe that patients can be better served by changing the way services should be delivered, it is right that they make those changes, and they will consult locally on any proposals.”

But he admitted that the recommendations were taken from a report by the Royal College of Surgeons supported by Sir George Alberti, the former director of emergency care. He recently recommended the closure of an A&E department in North London. The remaining two A&Es serving the area will be left with catchment populations of 450,000 each.

The Tories claimed that this was evidence of central targets to close units based on the number of patients they served.

Andrew Lansley, the Shadow Health Secretary, said: “Access to accident and emergency services is a vital component of the quality of NHS services. The public know that not every A&E department can provide every emergency service. But there is no clinical evidence which would justify shutting down A&E departments simply because they don’t serve a catchment population in excess of 450,000. Yet that is the basis on which the Department of Health is seeking now to justify closures.”

From:
http://www.timesonline.co.uk/tol/news/politics/article1801190.ece

The "idea" of cutting A and E units when demand for them continues to grow is just barking, posts Health Direct.

On Oct 03, 06 Health Direct posted: Record numbers of patients visit A & E as GPs services are cut when the number of people seeking treatment at accident and emergency units is at a record level. Statistics from the Department of Health (DoH) reveal that there were 18,759,104 A&E visits in 2005-06, up five per cent from 17,837,180 the -previous year.

The rise comes as up to 60 National Health Service trusts face having to downgrade their A&E units due to Labour's funding cuts.

Dr Martin Shalley, the president of the British Association of Accident and Emergency Medicine, said: "These figures are extremely high. The main reason is that the GP system has changed considerably. The general public do not see the GP as the place to get emergency care out of hours any more."

And whose fault is the growning A and E demand? Step forward Labour's Dept of Health: On March 15, 07 in GPs' out-of-hours service 'shambolic' claim MPs the labour Government's handling of out-of-hours services for GP patients was condemned as "shambolic" by an all-party committee of MPs.

The best interests of patients had not been served by the new system, the public purse had suffered and Saturday morning surgeries had been abandoned, the MPs said.

The report from the public accounts committee criticised GPs and primary care trusts as well as the Government for the flawed "hand-over" of out-of-hours services.

It says: "We found that preparations for the new service were shambolic, both at the national and local level."

How had labour's shambolic service come to this? It's wonderful new GPs contract: On 31 Jan 07 Health Direct posted BMA team 'stunned by out of hours GP contract' as a bit of a laugh. GPs were so stunned by the terms offered to them when negotiating their new contract in 2004 that they thought it was a "bit of a laugh", a doctor has said.

Dr Simon Fradd, who was one of British Medical Association's GP negotiators, said they were shocked by the approach taken by the labour government.

They could not believe that the labour govt was stupid enough to offer GPs the chance not to do evening and weekend work for only a 6% pay cut, he said.