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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ailing NHS IT white elephant project takes turn for worse

At the turn of the year, it looked as though the troubled NHS programme to create an electronic patient record might finally be turning a corner.

Firm delivery dates for the long delayed first deployments of Lorenzo, the key software for the records, were being promised for the north of England.

BT, which was responsible for London, had successfully installed new systems in a string of mental health and community trusts, and it had a programme for their much more difficult installation in the big hospitals in the capital. While there would be problems ahead, BT said, “we feel we have cracked the nut”.

Fujitsu was still negotiating a “refresh” of its contract, covering the whole of the south of England.

And a few parts of the programme were complete – the installation of digital imaging in place of X-ray film in every hospital in England, for example. Others were making progress.

The National Audit Office reported in May that the £12.7bn project for the full electronic record was running at least four years late. But it remained broadly on budget and, while difficult, still appeared “feasible”, the NAO said.

Since then, however, the project has virtually ground to a halt. There are continuing difficulties with new systems installed in the big hospitals and no deployments planned for the next few months.

Furthermore, while the health department has agreed in principle that NHS hospitals should be given more freedom to customise their systems, there are few details of the extent to which that will be permitted. A new permanent leader for the programme has only just been installed, following the departure of Richard Granger in January.

Matthew Swindells, who until May was the department’s interim chief information officer, says there is “clearly a hiatus”. But it is unclear, he said “whether that is because there is a genuine problem, or because of the shift in leadership means there is nobody pushing it at the moment”.

For long-standing critics of the programme such as Richard Bacon, the South Norfolk MP who has tracked its progress as a member of the Commons Public Accounts Committee, it is clearly now “time to go back to the drawing board”.

The programme’s centralised approach “has been a catastrophe”, he says. But because suppliers are only paid when systems work, “there is still a relatively big pot of money that has not been spent”.

This should be given to local hospitals to enable them to buy the system of their choice, Mr Bacon said. “If there is to be a chance of getting this back on track there has to be 100 per cent local ownership of the programme,” he said.

Jon Hoeksma, editor of E-Health Insider, a website that has tracked the programme from its inception, said: “Something has to give. The programme can’t just keep saying: ‘Give us another three months, give us another three months’.”

http://www.ft.com/cms/s/0/39bb218e-a46e-11dd-8104-000077b07658.html

NHS complaints system too bureaucratic for patients, says report

Only a tiny fraction of patients unhappy with the NHS make a formal complaint because of a bureaucratic, confusing system which changes little, according to a new report.

The National Audit Office (NAO) found that while 14 per cent of patients were unhappy with their NHS service, less than one per cent made a formal complaint to their health trust.

There was also little evidence of services improving as a result of complaints made.

It also found that one in five health trusts took too long to respond to patient complaints.

While most met the target of an average of 25 working days to answer complaints, one took 55 days, more than twice as long.

Edward Leigh, Chairman of the Commons Public Accounts Committee, said that the reason so few patients make formal complaints is that they have "no confidence anything will be done as a result".

"Complainants are often confronted with a defensive and unhelpful response when sometimes all that is needed is a simple apology or a promise to improve services.

"There is also little evidence that complaints are leading to better services. This is no way to keep people's faith and trust in health and social care services."

The criticism comes after David Cameron, the Conservative leader, attacked Alan Johnson, the Health Secretary, for an allegedly cold and bureaucratic response to a complaint over the
death one of his constituents, Elizabeth Woods, after she contracted the superbug MRSA.

There were 133,600 official complaints about the NHS last year.

A spokesman for the Department of Health said that ministers agreed that the NHS had to be better at handling complaints and that was why a new, simplified system would be introduced next year.
NHS-complaints-system-too-bureaucratic-for-patients-says-report.html

Drug companies face fresh action after trial failure

Efforts to punish a group of drug companies allegedly behind one of the biggest price-fixing schemes to hit the public purse are being stepped up after the collapse of their criminal trial.

Frank Field, the former Labour social security minister, wrote to Alan Johnson, the health secretary, yesterday to urge further action against the businesses over a conspiracy that was allegedly taking place while prices of dozens of basic remedies rose as much as 800 per cent.

Mr Field made his intervention as lawyers acting for the National Health Service press for further "substantial recoveries" through a damages action against the companies that has already netted £34m. Many observers say the companies named have never been forced to account fully for their actions, bec-ause of weaknesses in the way Britain deals with financial misconduct.

Mr Field, a former member of the Commons' public accounts committee, said the companies should be "on their knees thanking their lucky stars" at the decision by Mr Justice Pitchford last month to stop their criminal trial on conspiracy to defraud charges.

Peters & Peters, the law firm acting for the NHS, is pressing ahead with a damages action founded on allegations that the companies were involved in a conspiracy to rig the prices of drugs including penicillin and warfarin, a blood thinner.

Jonathan Tickner, a Peters & Peters partner, said: "The obvious success of the civil proceedings . . . speaks for itself and we, on behalf of the Department of Health, fully expect further substantial recoveries to be made."

The main company still in the department's sights is Ashford-based Kent Pharmaceuticals, supplier of many basic antibiotics to NHS hospitals, retail pharmacists and dispensing doctors.

Kent declined to respond to questions on the case. All the other companies that faced criminal charges - Goldshield, Ranbaxy, Generics and Norton Healthcare - declined to comment when asked if they denied colluding with each other, saying they could not speak while the threat of criminal proceedings remained.

Mr Justice Pitchford last month scrapped fraud charges laid by the Serious Fraud Office against the companies after the House of Lords criticised the way the indictment was drafted but left open the possibility it could be amended. The SFO has launched an appeal against the judge's decision, arguing it should be allowed to reformulate the charges.

Since the trial collapsed, some senior executives - notably those at listed Goldshield, which is chaired by Keith Hellawell, the government's former drugs "tsar" - have gone on the offensive and complained £25m of taxpayers' money was wasted in mounting the trial. The companies have always argued that price-fixing was not a crime at the time of their alleged activities.

But lawyers said there seemed to be evidence of subterfuge to justify a prosecution, alleging companies conspired to defraud the government - and hence the taxpayer. Documents seized in the penicillin investigation included a presentation, known as "The Scenario", that contained a bullet-point overview of how to operate a price-fixing cartel.

The case could be picked up by the Office of Fair Trading, which has imposed fines totalling hundreds of millions of pounds over the past year or so on companies involved in cartels in industries such as aviation, supermarkets and tobacco.

Another possibility is that the NHS could launch a private prosecution. It declined to say whether it had plans to do so.

Health checks

2000 SFO starts probe into price-fixing in supply of generic drugs to NHS April 2002 More than 30 premises raided April 2006 Five companies and nine executives charged with conspiracy to defraud January 2008 Lords hear submissions from Goldshield and Ian Norris that price-fixing cannot be prosecuted under the common law offence of conspiracy to defraud March 2008 Lords rule in favour of Mr Norris and Goldshield July 2008 Judge quashes indictment against the five companies and nine executives charged

http://www.ft.com/cms/s/0/32776f1c-6806-11dd-8d3b-0000779fd18c.html

PFI Hospitals run by HSBC pay £200 to fit wall socket

Britain's biggest bank, HSBC, and its investors have made almost £100m from managing National Health Service hospitals where contractors routinely charge taxpayers inflated bills for simple tasks – such as £210 to fit an electrical socket or £200 to install a computer socket.

The charges, paid at hospitals run by the bank’s subsidiary infrastructure company, raise questions about lax controls in Labour’s private finance initiative (PFI), which has been used to build more than 100 hospitals over the past decade.

Richard Bacon, a Conservative MP who sits on the public accounts committee, said: “Anyone who works in the NHS will be dismayed that their managers are paying such rates. More than £200 to install an electric plug is just not on – it’s absolutely absurd, ridiculous.”

Since its launch in March 2006, the HSBC fund has acquired large stakes in 27 PFI projects, including Barnet, Bishop Auckland, Royal Blackburn, Stoke Mandeville, Central Middlesex and West Middlesex University hospitals.

It also manages the central London headquarters of the Home Office as well as schools and police stations. To boost its return to shareholders, the fund is based in Guernsey, the tax haven Channel Island.

Shares in the HSBC Infrastructure Company (HICL) have risen by 25% in the past two years, adding £58.75m to its value on the London stock market. During this period it has also paid more than £30m to investors through dividends.

Under PFI deals, contractors are appointed by project managers such as HICL to maintain the building and provide cleaning, catering and other services. Although they are paid a flat annual fee, they invoice the health trusts for any additional jobs not specified in the contract. In most cases, the hospital is obliged to use its contractor.

According to the National Audit Office, 59% of public sector managers said that contract variations worked out more expensive under PFI. A total of £180m was paid to PFI contractors for such extras in 2006.

Four of the hospitals in HSBC’s fund pay charges at rates far higher than those charged by normal tradesman.

- The Central Middlesex hospital in northwest London said that, on average, its contractor, Ecovert FM, charged £210 to install an electric socket.

- West Middlesex University hospital said it was typically charged £150 by Ecovert FM for the same task. An independent electrician located close to both hospitals in Harrow said a typical charge for replacing a socket was £40. The cost of installing a new one was £80.

- Royal Blackburn hospital said it was charged £198 by its contractor, Consort, to put in a datapoint – needed to plug a computer into an internal network. By contrast, West Middlesex University hospital said it was usually charged about £60 for the same service.

- West Middlesex University and Royal Barnet hospitals said they were normally charged about £100 to install a new lock – a third more expensive than local locksmiths.

A spokesman for the HSBC infrastructure fund said it took “great care in delivering the outsourced services”. Contractors said that each job was different and some seemingly straightforward electrical jobs could involve extensive rewiring.

The contract charges are often higher because PFI hospitals do not have enough handymen to do the job on site and have to call out the contractor’s staff. PFI hospitals typically have a maintenance staff one third smaller than other hospitals.

A spokesman for Ecovert FM said: “The type of wall construction, distance the new socket is from the mains supply, making good and redecoration work can greatly influence the cost of putting in a socket.”

84% of doctors polled by the doctors.net.uk website for The Sunday Times, said PFI had failed to deliver value for money for taxpayers. Only 6% of the 856 doctors polled believed that PFI was delivering at a fair cost.

http://www.timesonline.co.uk/tol/news/uk/health/article4087496.ece

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

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

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

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

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

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

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

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

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

Conversely, the number of tooth extractions rose.

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

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

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

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

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

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

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

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

Dentists warn of future of NHS services at risk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr Foster health information service- call for new probe

MPs should consider reopening a probe into a contentious public private health data venture Dr Foster in the light of concerns raised by a senior official involved in the deal, the shadow health secretary said.

Andrew Lansley told the Financial Times he would write to the Commons public accounts committee and the Department of Health asking them to re-examine the circumstances around the resignation of Professor Denise Lievesley, former chief executive of the Information Centre, the National Health Service’s data factory.

Prof Lievesley, a former Royal Statistical Society president, claimed this week that she was made a “scapegoat” by the Department of Health after repeatedly raising the alarm about the joint venture’s worth and its handling of information. Dr Foster Intelligence, the joint venture, strongly rejects her criticisms.

Mr Lansley said it “might be appropriate” for the public accounts committee to respond to Prof Lievesley’s claims by making new inquiries about the joint venture, whose formation it attacked last year as a “backroom deal” set up at a cost of £12m to the taxpayer.

Mr Lansley said: “It seems to me to be clear that [Prof Lievesley] was, from her own professional point of view, highly sceptical, indeed internally critical, about what was being done. The evidence at the time [of the initial inquiry] doesn’t appear to have included some of the reservations she was expressing internally.”

Prof Lievesley’s claims, which emerged this week at a hearing at Leeds Employment Tribunal, have yet to be tested by cross-examination. Prof Lievesley did not attend the hearing, citing a previous commitment.

Mr Lansley said he also planned to ask the DoH why the Information Centre had agreed a deal under which Prof Lievesley received a pay-off in exchange for her silence about her departure.

Dr Foster Intelligence – which is half-owned by the Information Centre and half by Dr Foster LLP, a private health information company – has defended the quality of the information it provides. It said it and its partners, which include Imperial College, operated to the “highest standards of data quality”.

The Department of Health has declined to comment on Prof Lievesley’s case.

http://www.ft.com/cms/s/0/0ca6578e-c3c0-11dc-b083-0000779fd2ac.html

Health ministry faces scapegoat claim over Dr Foster

The Department of Health made a "scapegoat" of a top statistician who raised the alarm with senior officials about the contentious public private venture Dr Foster Intelligence joint venture's worth and its handling of information.

Prof Lievesley's claims are the latest in a series of questions raised about the joint venture, known as Dr Foster Intelligence, which a committee of MPs last year said had been set up in a "backroom deal" at a cost of £12m to the taxpayer.

In an affidavit lodged at Leeds employment tribunal, Prof Lievesley, a former Royal Statistical Society president, claims the health department let her become a scapegoat for the deal.

Stuart Ritchie, for Prof Lievesley, who was not at the hearing, said she had "consistently complained about the joint venture and its operation" throughout her two-year tenure at the Information Centre.

In her affidavit, Professor Lievesley says she felt she had no alternative but to sign off in January 2006 on the creation of Dr Foster Intelligence, as talks on it were far advanced by the time she arrived at the Information Centre in July 2005. She claims she helped the public sector secure better terms for the joint venture, which is 50-50 owned by the Information Centre and Dr Foster LLP, a successful private health data company.

In her affidavit, Prof Lievesley, who was a non executive board member of Dr Foster Intelligence, says some data processed by the joint venture was not, in her view, "fit for purpose".

She describes an incident last year in which the joint venture included unvalidated official hospital data on a prototype website, creating "grave" potential to mislead the public. She says she high-lighted a "wholly inappropriate" use of statistics in letters to senior officials including David Nicholson, chief executive of the NHS.

Dr Foster hit back at the allegations, saying its data were of a high standard and did not mislead the public. The company said: "We understand [Prof Lievesley] is in dispute with her former employers but do not know the details. We have not seen this affidavit, but we refute the criticisms that appear to have been made."

The Dr Foster deal first came under fire in a National Audit Office report in February last year, which rebuked the health department for failing to follow a proper tendering process and for paying too much for its half of the joint venture.

In July the Commons public accounts committee unveiled a stinging report on the deal, in which the Information Centre paid £7.6m to Dr Foster LLP and sank another £4.4m into the joint venture company.

Prof Lievesley has gone to the employment tribunal to try to revoke a confidential deal under which she received a pay-off in exchange for her silence about the circumstances surrounding her departure from the Information Centre in July.

She says the agreement was unfair as the health department failed to point out in public that her exit was unconnected with the criticism of the Dr Foster deal made in the Commons public accounts committee report a few weeks later.

Her affidavit says: "It is ironic that my reputation should have been sullied when I was actually trying to promote the principles of proper and ethical access to information."

The Department of Health said it had sought and followed legal and professional advice during the creation of the venture. It declined to comment on the claim it had made Prof Lievesley a scapegoat, saying it could not speak about an ongoing case.

He said Prof Lievesley had come to the tribunal in part because she was worried about the damage caused to her reputation by events subsequent to her departure.

From:
http://www.ft.com/cms/s/0/ee18797c-c30c-11dc-b617-0000779fd2ac.html

NHS database will weaken patient security MPs learn

The man in charge of setting up the NHS medical records database has admitted that "you cannot stop the wicked doing wicked things" with information. Richard Jeavons, director of IT implementation at the Department of Health, said there were instances where staff "abuse their privileges".

These had to be "pursued", he told the Commons home affairs committee. The plan to put 50 million patients' records on the database is part of a £12bn NHS IT overhaul.

The scheme has raised concerns over cost and the security of information.

A poll for the Guardian suggests that 59% of GPs in England are unwilling to upload any record onto the database without the patient's specific consent.

Three quarters of more than 1,000 doctors questioned believed medical details would become less secure when they are put on a database that will eventually be used by the NHS and social services.

'Misuse'

Mr Jeavons, who was appointed in May, said the Department of Health did not itself hold many people's personal records but added that it provided guidance to NHS trusts on how to handle data.

At a committee hearing, Labour MP Margaret Moran said to him: "Even if we get the technology right, the problem is abuse by people or misuse of data. How confident are you that there won't be problems over data and privacy?"

Mr Jeavons replied: "You cannot stop the wicked doing wicked things with information and patient data...

"Of course, we have examples where staff do abuse their privileges and have to be pursued through disciplinary procedures."

He added that the government had to "make sure" that people who abused the system knew they were "going to get caught".

The NHS scheme is intended to "modernise" the service.

By 2014, 30,000 GPs in England are supposed to be linked up to nearly 300 hospitals giving the NHS a "21st century" computer network.

It involves an online booking system, Choose and Book, a centralised medical records system, e-prescriptions and fast computer network links between NHS organisations.

It is said to be the most ambitious computer project in the world and represents the largest single investment in IT in the UK.

'Surveillance'

Opponents say it is too expensive and will compromise the confidentiality of records.

The home affairs committee is looking at whether the UK has become a "surveillance society".

In its hearing, it senior civil servants working in the education, transport and justice fields were also questioned.

The MPs were told different departments could not share information without legal guidelines being followed and rights of access clarified.

Clare Moriarty, constitution director at the Ministry of Justice, said efforts to make data protection as "robust" as possible were essential.

Questioned as to whether information had sometimes gone between departments unofficially, she replied: "I'm not aware of any department sharing data by stealth."

'Foolhardy'

Government chief information officer John Suffolk told the MPs that setting up a nationwide database going across Whitehall departments and other government agencies would create more problems.

He said: "When you work at a national scale, to continue to put more eggs in a single basket is a foolhardy approach."

Mr Suffolk added: "The more and more you put it into a large database, with more and more people having access, it becomes more complex...

"If we can avoid setting up large-scale citizens' databases, that would be a wise thing to do."

The Information commissioner last year warned the UK risked "sleep-walking into a surveillance society".

The committee's inquiry will include the impact of identity cards, the expansion of the DNA database and the rise in the use of CCTV cameras.

From:
http://news.bbc.co.uk/1/hi/uk_politics/7103667.stm

Move to boost openness on NHS drugs by NICE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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