NHS’s major trauma services - not good enough

England has an unacceptably poor service for dealing with major trauma, in spite of 20 years of reports identifying the problem, and a real terms doubling of NHS spending in the past decade, the National Audit Office found.

Some 450 to 600 lives a year could be saved, and much long-term disability prevented, if the NHS had an effective network of centres to deal with multiple injuries from road crashes, burns, blasts, serious falls and major crush injuries, the NAO said.

Death rates from major trauma are 20 per cent higher in the UK than in the US, which has well organised trauma centres, and almost certainly higher than in Germany and some other European countries, according to spending watchdog’s research.

Victims of major trauma need specialist surgical teams that may include orthopaedic, cardiac and neuro-surgeons, but such consultants are not normally on duty at night and weekends when most major trauma occurs. 

Few hospitals have sufficient CT scanning available round the clock to help with diagnosis, and what data there is shows that barely a third of patients who need moving to a more specialist centre in fact get transferred.

Not enough of the patients who need a critical care bed get one, and access to rehabilitation services which can improve quality of life and reduce hospital stays varies widely, the NAO said.

Major trauma services are simply “not good enough”, Amyas Morse, head of the NAO, said. They “have not significantly improved in the last 20 years, despite numerous reports identifying poor practice”.

The result is unnecessary deaths and disability and poor value for money, and while the health department has just appointed a national director for trauma it and the NHS “must get a grip,” Mr Morse said. Co-ordinated trauma networks need developing, with much better information on costs and outcomes. 

The performance of 40 per cent of hospitals cannot even be measured because they do not submit data to the voluntary network which does audit trauma care.

The NAO’s warning came as the department told primary care trusts they must do a better job of monitoring the quality of care delivered by out-of-hours GP services following the death of David Gray, a patient given a fatal overdose by Dr Daniel Ubani, a German flown over as a weekend locum by Take Care Now, Cambridgeshire’s private contractor for out-of-hours care.
 

From:

http://www.ft.com/cms/s/0/581d0e9a-11a4-11df-bceb-00144feab49a.html

Drug use in the City still a real problem

The use of alcohol and cocaine remains rife among City workers in spite of rising unemployment and lower wages following the credit crunch, leading physicians involved in the treatment of drug abusing professionals have warned.

Neil Brenner, medical director of Priory psychiatric hospital in north London, told the Financial Times that the number of bankers coming to him for treatment had risen significantly over the past three years, even when taking account of a large dip after the onset of the financial crisis in 2008. "I still think this is a real problem in the City," Dr Brenner said.

Earlier, Dr Brenner told MPs on the parliamentary home affairs committee that people working in financial services were more likely to run into problems with powdered cocaine abuse than other elements of society.

"They often have a high-pressure job and will often start using it not so much as a reward system but as a way to keep themselves going," he said.

Recent Home Office figures show that Britons are the biggest consumers of cocaine in Europe, with 1m people estimated to have taken the drug in the past year. About 12,000 people are being treated for their use of powdered cocaine.

Dr Brenner said the cocaine problem affected all echelons of the financial services industry, "from the chief executive all the way down to the postroom".

Nick Barton, chief executive of the Action on Addiction charity, which also runs treatment centres for addicts, agreed that he had seen "no kind of decrease" in the number of City cocaine users approaching his organisation for help. "This problem hasn't disappeared," he added.

The recent financial crisis might have added to the pressure on bank workers to use narcotics to lift productivity, Mr Barton said. "If people are going to have to work that much harder, cocaine will have its appeal as both an aide and a recreational tool," he said.

But the medical experts also said alcohol abuse remained a far greater problem among the professions than any other substance.

From:

http://www.ft.com/cms/s/0/cbc7bed0-c361-11de-8eca-00144feab49a.html

Chlamydia sexual health testing wasting money

Millions of Pounds have been squandered on the national chlamydia sexual health screening programme, a watchdog says.

The National Audit Office said the NHS had duplicated effort and failed to test as many of the under-25 target group in England as it should have.

Last year £17m could have been saved, nearly half the sum spent, if the programme had been better run, it said.

But the government said such an "ambitious" screening programme was always going to take time to perfect.

The programme was set up in response to rising rates of the so-called silent infection - it often shows no symptoms but if left untreated can cause infertility.
  
Edward Leigh, chairman of the House of Common's Public Accounts Committee, which will now be looking into the issue, added: "This is a classic example of what can go wrong when a national programme is rolled out unthinkingly."

The screening was initially introduced in several pilot areas in 2003, before being rolled out nationally in 2007. So far £100m has been spent on it.

But the NAO said despite the four-year trial period, the health service failed to learn lessons.

The 152 NHS trusts responsible for delivering the programme should have worked in partnership more, the watchdog said.

Money could have been saved by setting up a more centralised purchasing arrangements, while resources had been wasted on developing different branding and advertising campaigns, it said.

Questions were also raised about how the actual screening was done.

The programme was designed to reach out to people not using sexual health clinics and so health officials went out to places like bars and clubs to encourage young people to come forward.

But the NAO said there was little evidence that this had proved effective.

NHS chiefs also struggled to get GPs fully engaged - they are not paid to do the screening under the terms of their contract although some trusts resorted to paying them extra to get involved.

Failed

The problems meant the programme had failed to reach as many people as it should have - something already well documented.

In the first year of the national programme - 2007/8 - just 5% of the 15 to 24-year-old population was screened, well short of the 15% target.

The following year it was made a priority by the government and screening rose to 16%, although that was still short of the 17% target.

The poor reach of the programme and duplication of resources meant the average cost of each test last year was £56, rather than the £33 experts say it should cost. The highest figure recorded by a trust was £255 per test.

What is more, the NAO noted that it appeared one in 10 of those who tested positive did not receive follow-up treatment, rendering the screening pointless.

However, the watchdog admitted this could just have been because the NHS had not recorded their treatment.
  
Mark Davies, from the NAO, said the piloting of the programme had been a "waste of time" as the problems identified by the watchdog should have been addressed before it was expanded.

From:
http://news.bbc.co.uk/1/hi/health/8354932.stm

MRSA superbugs not the only threat to NHS warns MPs

The labour government has taken its "eye off the ball" on hospital infections other than MRSA and Clostridium difficile, a cross-party group of MPs says.

The Public Accounts Committee said setting targets in England for the two infections had led to a fall in cases.

But they warned there were signs other bugs, such as E. coli, were becoming more common and they called for better surveillance to curb the problem.

In England, MRSA rates are now a quarter of what they were at their peak in 2004, while C. difficile rates have fallen by nearly a third in the past year, following the introduction of targets.
   
THE OTHER THREATS
E. coli
Pneumonia
Surgical site infections
Urinary tract infections
Gastrointestinal infections
Skin infections

But the MPs said these only accounted for about a fifth of the total number of all infections seen in hospital.

While MRSA is the most high-profile bloodstream infection, E. coli is much more common and has actually increased by a third in the past four years, the report said.

It also highlighted surgical site infections, which were twice as common as bloodstream infections, and respiratory and urinary tract infections, which were three times as common.

MPs warned there was still no robust data on the extent and risks of at least 80% of bugs linked to hospital care.

Committee chairman Edward Leigh said this report was the third time the committee had warned about the threat of other infections, adding it was "disappointing" the issue had yet to be addressed.

"The government has taken its eye off the ball regarding all other healthcare associated infections - which actually constitute most by far of all infections."

The report suggested hospitals start reporting all types of infection and that they look to curb the use of antibiotics.

Professor Mark Enright, an infections expert at Imperial College London, said: "I can understand why the government focused on the infections it has, but now we are getting to grips with those it is time to look elsewhere.

"There are some strains of infections, such as E. coli, where we are seeing increasing levels of antibiotic resistance and that is concerning."

Nigel Edwards, of the NHS Confederation, which represents trusts, agreed it was time to review other infections.

But he added: "We would want to know the balance of costs and benefits from additional surveillance."

Katherine Murphy, director of the Patients Association, said: "This target culture is just like squeezing a balloon - if you squeeze one end it will bulge out at the other.

"But the problem for patients is that the balloon stays the same size. The problem of patient safety will stay the same huge size as long as it is regarded as an optional extra by some."

From:
http://news.bbc.co.uk/1/hi/health/8351269.stm

Sacked – for telling the truth about drugs

Labour fires top adviser Prof Nutt for challenging its hardline policy on cannabis and ecstasy.

The labour Government's drugs tsar was sacked for stating his view that cannabis, ecstasy and LSD were less harmful than the legal drugs tobacco and alcohol.

The Home Secretary Alan Johnson asked Professor David Nutt to resign as chairman of the Advisory Council on the Misuse of Drugs (ACMD), saying he had "lost confidence" in his ability to give impartial advice.

But Professor Nutt, who is head of psychopharmacology at the University of Bristol, retaliated, accusing the Government of "misleading" the pubic in its messages about drugs and of "Luddite" tendencies.

He was backed by other senior scientists and politicians.

Colin Blakemore, professor of neuroscience at Oxford University and former chief executive of the Medical Research Council, said: "The Government cannot expect the experts who serve on its independent committees not to voice their concern if the advice they give is rejected even before it is published. "I worry that the dismissal of Professor Nutt will discourage academic and clinical experts from offering their knowledge and time to help the Government in the future."

Richard Garside, director of the Centre for Crime and Justice Studies at King's College London, where Professor Nutt made his comments, said: "I'm dismayed that the Home Secretary appears to believe that political calculation trumps honest and informed scientific opinion. The message is that, when it comes to the Home Office's relationship with the research community, honest researchers should be seen but not heard." He added it was "a bad day for science and for the cause of evidence-informed policy making".

Professor Nutt had become a thorn in the side of ministers with his criticisms of drugs policy. He clashed with former home secretary Jacqui Smith when he suggested ecstasy, which causes 30 deaths a year, was less dangerous than horse-riding, which causes 100 deaths a year. He also argued that, to prevent one episode of schizophrenia linked to cannabis use, it would be necessary to "stop 5,000 men aged 20 to 25 from ever using" the drug.

Most drugs experts believe his analysis is right. But ministers did not want to hear the truth or at least to be reminded of it repeatedly. 

The Home Secretary asked him to consider his position after a recent lecture in which attacked what he called the "artificial" separation of alcohol and tobacco from other, illegal, drugs. Last night Professor Nutt said he stood by his comments. "My view is policy should be based on evidence. It's a bit odd to make policy that goes in the face of evidence. The danger is they are misleading us. The scientific evidence is there: it's in all the reports we published. Our judgements about the classification of drugs like cannabis and ecstasy have been based on a great deal of very detailed scientific appraisal.

"Gordon Brown makes completely irrational statements about cannabis being 'lethal', which it is not. I'm not prepared to mislead the public about the harmfulness of drugs like cannabis and ecstasy. I think most scientists will see this as an example of the Luddite attitude of governments towards science."

He repeated his view that cannabis was "not that harmful" and that parents should be more worried about alcohol.

"The greatest concern to parents should be that their children do not get completely off their heads with alcohol because it can kill them ... and it leads them to do things which are very dangerous, such as to kill themselves or others in cars, get into fights, get raped, and engage in other activities which they regret subsequently. My view is that, if you want to reduce the harm to society from drugs, alcohol is the drug to target at present."

In a recent broadside, Professor Nutt accused Jacqui Smith, who oversaw the reclassification of cannabis from Class C to Class B, of "distorting and devaluing" scientific research. He said her decision to reclassify cannabis as a "precautionary step" sent mixed messages and undermined public faith in government science.

"I think we have to accept young people like to experiment – with drugs and other potentially harmful activities – and what we should be doing in all of this is to protect them from harm. We therefore have to provide more accurate and credible information. If you think that scaring kids will stop them using, you are probably wrong."

The Home Office said Mr Johnson had written to Professor Nutt expressing "surprise and disappointment" over his remarks. Mr Johnson said in the letter that Professor Nutt had gone beyond providing evidence to "lobbying" for changes to policy. He said: "As Home Secretary it is for me to make decisions, having received advice from the [Council] ... It is important that the Government's messages on drugs are clear and as an adviser you do nothing to undermine the public understanding of them ... I am afraid the manner in which you have acted runs contrary to your responsibilities."

The shadow Home Secretary Chris Grayling said: "This was an inevitable decision after his latest ill-judged contribution to the debate, but it is a sign of lack of focus at the Home Office that it didn't act sooner, given that he has done this before."

But Phil Willis, chairman of the Science and Technology Select Committee, said: "I am writing immediately to the Home Secretary to ask for clarification as to why Sir David Nutt has been relieved of duties as chair of the Advisory Council on Misuse of Drugs at a time when independent scientific advice to Government is essential. It is disturbing if an independent scientist should be removed for reporting sound scientific advice."

Claudia Rubin from Release – a national centre of expertise on drugs and drugs law – said the expert should not have been penalised. "It's a real shame and a real indictment of the Government's refusal to take any proper advice on this subject," she said.

From:

http://www.independent.co.uk/life-style/health-and-families/health-news/sacked-ndash-for-telling-the-truth-about-drugs-1812255.html

Health Direct notes that it is hard not to suspect that Professor Nutt's real crime in the eyes of the labour Government was not his interference in politics but the fact that his words embarrassed ministers.

But why now? Health Direct posted on August 02, 2006 Prof Nutt's orginal research Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

Health Direct reproduces the first ranking based upon scientific evidence of harm to both individuals and society. It was devised by government advisers - then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council. Copies of the report have been submitted to the Home Office, which has failed to act on the conclusions.

Since then Prof Nutt was promoted by labour to be chairman of the govt's Advisory Council for the Misuse of Drugs. So his research and opinions were in the public domain- and presumably approved of when he was promoted. Ergo, why the fuss now? He's not saying anything new. Just common sense.

Doctors urge ban on alcohol advertising

Doctors have called for a total ban on alcohol advertising, including happy hours and sponsorship of music and sporting events.

A tough package of measures is needed to "tackle the soaring cost of alcohol related harm" in Britain, said a report from the British Medical Association (BMA).

Young people are particularly affected by such advertising, which encourages them to binge-drink and stock up on cheap alcopops, it said.

The BMA also renewed its calls for a minimum price to be set per unit of alcohol, for alcohol to be taxed at a higher rate than inflation and for a ban on two-for-one offers.

It follows a report last year from the union which said there should be a curb on the sale of cut-price alcohol, such as in supermarkets.

The latest study - Under The Influence - said alcohol consumption in the UK has "increased rapidly" in recent years among all age groups.

It blames advertising and heavy discounting, the availability of cheap alcohol and 24-hour licensing laws.

The report said: "The population is drinking in increasingly harmful ways and the result is a plethora of avoidable medical, psychological and social harm, damaged lives and early deaths.

"As consumption has increased, so the market for alcohol has grown. In 2007, sales (including supermarket, off-licence, restaurant and bar sales) were high enough to put virtually every British adult over Government guideline drinking levels.

"These sales are driven by vast promotional and marketing campaigns that dwarf health promotion efforts: the UK alcohol industry spends approximately £800 million each year encouraging consumption of its wares."

The report said current controls on promoting alcohol are "completely inadequate" because they are based on voluntary agreements with the industry and focus on their content, rather than the amount of alcohol advertising.

"Even in their control of content the rules are weak with, for example, prohibitions on advertising which associates drink with youth culture or sporting success sitting alongside alcohol sponsorship of iconic youth events like music festivals and premiership football."

Dr Vivienne Nathanson, head of science and ethics at the BMA, said the body was not "anti-alcohol" but doctors were right to focus on the health of their patients.

She added: "Over the centuries, alcohol has become established as the country's favourite drug.

"The reality is that young people are drinking more because the whole population is drinking more and our society is awash with pro-alcohol messaging and marketing. In treating this we need to look beyond young people and at society as a whole."

According to the World Health Organisation (WHO), alcohol is the leading risk factor for premature death and disability in developed countries after smoking and high blood pressure.

It is related to more than 60 medical conditions, costs the NHS millions of pounds every year and is linked to crime and domestic abuse, the report said.

Professor Gerard Hastings, who was an author on the study, said: "Given the alcohol industry spends £800 million a year in promoting alcohol in the UK, it is no surprise that we see it everywhere - on TV, in magazines, on billboards, as part of music festival or football sponsorship deals, on internet pop-ups and on social networking sites.

"Given adolescents often dislike the taste of alcohol, new products like alcopops and toffee vodka are developed and promoted as they have greater appeal to young people.

Don Shenker, chief executive of Alcohol Concern, said: "There's no longer any doubt - the heavy marketing and promotion of alcohol, combined with low prices - are encouraging young people to drink at a level our health services are struggling to cope with."

From:

http://www.telegraph.co.uk/Doctors-urge-ban-on-alcohol-advertising

Given that the labour govt actively promotes alcolohol drinking via extended drinking hours and that they ignored scientific advice about the dangers of alchohol Health Direct wonders if MPs will once again ignore qualified practitioners- see yesterday's post and  Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal when Health Direct reproduced the first ranking based upon scientific evidence of harm to both individuals and society. 

It was devised by labour government advisers - then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council. Copies of the report have been submitted to the Home Office, which has failed to act on the conclusions.

Jack Straw wants legal heroin as Health Sec's son is charged for cocaine possession

Jack Straw, the Justice Secretary, has called for the NHS to give out heroin on prescription to addicts where other forms of treatment have failed whilst the former health secretary Patricia Hewitt’s 21-year old son Nicholas has been charged with possessing cocaine.

Justice secretary Jack Straw has called for imaginative solutions to tackling to the problems of drug addiction

He called for “imaginative” solutions to hard-drug abuse and said there could be “huge benefits” to issuing the drug to chronic addicts.

At the moment addicts can be prescribed heroin substitutes designed to wean them off the drug, but the idea of prescribing the drug itself is aimed at keeping long-term addicts away from drug dealers and crime.

“For the most problematic heroin users it may be the best means of reducing the harm they do themselves, and of stamping out the crime and disorder they inflict on the community," said Mr Straw.

The Justice Secretary is the first cabinet minister to get involved in the debate following the results of a pilot scheme involving 127 heroin addicts in three cities, published last week.

The trial, which involved users injecting themselves under medical supervision in London, Brighton and Darlington, showed that crimes committed by addicts who had been prescribed heroin dropped by two thirds after six months.

Mr Straw said prescription heroin was “no magic bullet” but claimed it could reduce the £15 billion a year cost of the abuse of hard drugs.

The trials were set up in 2002 by David Blunkett, the then home secretary, but Mr Straw is the first cabinet minister to endorse prescribing the drug.

Harry Shapiro of Drugscope, which represents 800 drug projects, said: "It's important to do everything possible to discourage Britain's 300,000 problem drug users from injecting their drugs, and we should allow injecting heroin users to be provided with foil as part of a harm-reduction programme."

From:
http://www.telegraph.co.uk/Jack-Straw-calls-for-heroin-on-prescription

Meanwhile, Nicholas Hewitt Birtles, a sales rep, was arrested when police raided a car parked near his home in Camden, north London, on Saturday evening, Scotland Yard said.

Officers observed three men sitting inside the vehicle parked in Camden Square and went to investigate at about 7.45pm.

They searched the car and allegedly recovered a small amount of white powder, arresting two of the occupants while the third was allowed to go.

The pair were taken to a nearby police station for questioning.

Mr Hewitt Birtles, whose father is Judge William Birtles, was later charged with possessing cocaine while the other man, who has not been named, was released on bail while tests are carried out on the powder.

The former Cabinet minister’s son was released on Sunday but ordered to appear in court next week. His friend is to answer police bail next month.

Australian-born Miss Hewitt, who served as Trade and Industry Secretary before moving to the Department of Health, left the Government in 2007 and is stepping down as an MP at the next election.

A Scotland Yard spokesman said: “Nicholas Hewitt Birtles, a sales representative of NW1, is bailed to appear before Highbury Corner Magistrates’ Court on Sept 30 charged with possession of a class A drug, namely cocaine, on Saturday Sept 19 at Camden Square.

From:
http://www.telegraph.co.uk/Patricia-Hewitts-son-Nicholas-charged-with-cocaine-possession

Health Direct has long question the "logic" of labour's drugs policy.

On August 02, 2006 we posted: Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

Health Direct reproduced the first ranking based upon scientific evidence of harm to both individuals and society. It was devised by government advisers - then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council. Copies of the report have been submitted to the Home Office, which has failed to act on the conclusions.

Many hospital bugs neglected by MRSA targets

The NHS in England is neglecting the threat from many healthcare acquired infections not covered by labour government targets, a watchdog has warned. Efforts to tackle MRSA and Clostridium difficile have been a success, but they account for only about 15% of cases, the National Audit Office said.

Pneumonia and urinary tract infections are among those which deserve more attention, its report said.

The Care Quality Commission said they would "keep up the pressure" on trusts.

Two previous reports from the NAO have played a big role in highlighting the problem of healthcare-associated infections in the NHS.

It led to targets to reduce rates of MRSA and C. difficile - a pressure which has successfully cut those infections.

But they account for only a small proportion of the one in 12 patients admitted to hospital who end up with an infection they did not have before.

Urinary tract infections, largely associated with the use of catheters, are responsible for 20% of these.

Other bloodstream infections with bacteria such as E. coli are also important, the NAO said, and limited data suggests they are on the rise.

Compulsory monitoring of healthcare-associated infections should be widened to cover far more infections and checks should be done to ensure that antibiotics are being used effectively, it concluded.

Karen Taylor, report author, said MRSA and C. difficile rates started to come down only once targets were imposed, although local goals may be more appropriate for other infections.

"It's looking better for MRSA and C. difficile, which have been subject to targets, but the main focus of our report is they only account for about 15% of healthcare associated infections in hospitals and in the rest of the infections there's very poor data.

"Some of the bloodstream infections are just as significant on the impact on the patient."

The report also found that government funding for tackling infections had saved the NHS money overall.

It added that the controversial "deep clean" programme had boosted staff and patient confidence - but it was impossible to measure what effect it had had on the number of infections as other strategies were being implemented at the same time.

HOSPITAL INFECTION BREAKDOWN
Urinary tract infections - 20%
Lower respiratory tract infections - 20%
Gastrointestinal infections - 22%
Surgical site infections - 14%
Bloodstream infections - 7%
Skin and soft tissue infections - 10%

However, even with MRSA and C. difficile there was variation, with 12% of trusts reporting an MRSA infection.

Amyas Morse, head of the NAO, said that in 2004 the problem with MRSA and C. difficile had seemed to be "an intractable problem" and hitting the targets was a "significant achievement".

"Inevitably, with a focused and centrally driven initiative of this kind, the improvements are not uniform across the NHS and we still don't know in any meaningful way what impact there has been on other healthcare-associated infections."

Health minister Ann Keen said: "We remain totally committed to eliminating all preventable healthcare-associated infections.

"As a nurse myself, I am especially pleased to see that the National Audit Office has recognised the contribution that nurses and the reintroduction of matrons onto our wards have had in delivering the reductions in MRSA and C. difficile infections."

From:
http://news.bbc.co.uk/1/hi/health/8095074.stm

MPs criticise NHS in England for forcing patients to spend their last days in uncaring hospital surroundings

Elderly patients in the final stages of terminal illness are being denied the right to die at home due to inadequate NHS and social care, a critical parliamentary report warns.

Newly allocated funds aimed at improving end-of-life care are at risk of being spent on other medical priorities, the Public Accounts Committee (PAC) suggests.

Half a million people die in England every year; almost two-thirds of them are over 75. The vast majority of deaths follow a period of chronic illness such as cancer or heart disease.

About 60% of those deaths occur in an acute hospital despite the fact that "there is no clinical need" for the person to be there, the study says.

"Most people express a preference to die at home [surrounded by friends and family]. People should have the right to die in the place of their choice.

"[Health authorities should increase] the availability of community services, such as 24-hour district nursing, and access to advice and medication out of hours to help reduce the number of unnecessary hospital admissions."

Those who die in hospital are often deprived of effective pain management and not accorded adequate "dignity and respect" in their last days and moments by NHS staff, the report states.

"Because someone is approaching the end of life it should not mean we abandon concern for their quality of life. End of life care should seek to sustain people's quality of life as a priority."

There should be more checks, the paper suggests, to ensure staff receive education and training in end of life care. Specialist palliative care teams should always be deployed to deliver pain relief.

Residential homes, especially those without qualified nursing staff, often feel ill equipped to care for people in the final stages of life and send them to hospital or refuse to take residents back after a hospital admission.

In one local study, the report shows, at least 40% of patients who died in a Sheffield hospital "did not have medical needs which required them to be admitted". Many had been occupying a bed for more a month – suggesting that resources could be freed up and redirected to home care.

The National Audit Office has estimated the cost of caring for cancer patients (who account for 27% of all deaths) in the 12 months before death was £1.8bn. Reducing emergency admissions by 10% and cutting the average length of stay to three days would release £104m for redistribution to other end of life care services.

The Department of Health has allocated £286m over the next two years to improving end-of-life care. But the PAC warns "there is a risk that the additional [sum] will not be used as intended. The department should require primary care trusts to account for how the additional funding is spent."

Co-ordination between health and social care services in this area is "generally poor", the report notes.

"That health and social care providers have traditionally given a low priority to end-of-life care is shown by the lack of training in basic end of life care among front-line staff," the chairman of the PAC, Edward Leigh, said.

The catalogue of problems discovered in hospitals include poor support for basic comfort; lack of privacy for the patient and their family; poor communication by staff; and staff recognising too late that somebody is about to die.

"It is appalling that people dying in hospital are not always being given the end of life care they deserve," Leigh said, "including effective pain management and being treated with dignity and respect."

From:
http://www.guardian.co.uk/society/2009/may/14/end-of-life-care-report-nhs

NICE guidelines on drugs are unfair MPs decide

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NHS governance 'reduced to paper chase' - Audit Commission

Many NHS trust board members cannot be sure whether or not their hospital is operating within the law, the Audit Commission has found.

Formal processes to ensure boards can be certain legal and regulatory standards are met have been reduced to a “paper chase”, risking a repetition of the major failures at Maidstone and Tunbridge Wells and Mid Staffordshire foundation trust, it says.

Audit Commission chief executive Steve Bundred told HSJ the commission’s study, Taking it on Trust, was undertaken in the wake of concerns aired by the foundation trust regulator Monitor about the way boards were working at some applicant trusts, the high profile failures at a handful of NHS hospitals, and discrepancies between what trusts tell regulators about their performance and what inspectors find.

The commission studied governance structures and processes at 15 NHS trusts. It found an abundance of formal controls and processes designed to ensure non-executive board members could hold the trust to account on its performance.

But many of these had been reduced to a “paper chase rather than critical examination,” and had become “disassociated” from the day to day running of the trusts.

“The controls are in place. Everywhere we looked they were there,” Mr Bundred said. “But they are not always being operated as rigorously as they should. If boards don’t get this issue right then patients can be at risk.”

“We are not saying things are going wrong, but that things could be much better,” he added. “Mid Staffordshire and Birmingham [Children’s Hospital foundation trust] are examples where things did go wrong. Because they happened, it’s incumbent on all boards to ensure they are working effectively.”

“In some instances boards might not know where the weaknesses are because the controls they have in place to give them assurance are not working as they should.”

From:
http://www.hsj.co.uk/5000855.article

Labour's nanny state wasted health gap money

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

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

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

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

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

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

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

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

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

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

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

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

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

Cycling

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

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

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

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

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

NHS chiefs fail to defend Agenda for Change red tape

MPs have attacked health chiefs for failing to ensure Agenda for Change delivered promised gains in staff productivity.

NHS chief executive David Nicholson and Department of Health workforce director Clare Chapman appeared in front of the public accounts committee yesterday afternoon for its inquiry into NHS pay modernisation.

Committee member Richard Bacon, a Conservative MP, said he was "puzzled" as to why the DH did not know whether the pay system, introduced in 2004, had resulted in planned yearly productivity rises of between 1.1 and 1.5 per cent.

He said: "You went to great efforts to set up an all singing, all dancing pay system and yet you can't tell us specifically what it has done."

Turnover and vacancy rates

Mr Nicholson said Agenda for Change was an "enabler" that had led to improvements in turnover and vacancy rates and encouraged trusts to create new roles.

It was difficult to identify how many of the improvements had resulted directly from the simplified pay system and how many were due to other policies such as expanding the workforce, he said.

Accountability

Mr Bacon asked how the DH planned to hold trusts to account for improving staff efficiency.

Mr Nicholson said this was achieved through the tariff, which would probably require 3.5 per cent productivity increases next year.

Knowledge and skills framework

MPs also asked why many trusts were still not adopting the knowledge and skills framework, designed to support NHS employees' career progression.

Mr Nicholson said: "It's proving more difficult than the people who designed it thought. It's generally well regarded by both managers and staff. There are issues about its complexity."

Work was being done to simplify the framework, he said.

The inquiry was set up following the National Audit Office report NHS Pay Modernisation in England: agenda for change, published in January.

http://www.hsj.co.uk/news/2009/03/nhs_chiefs_forced_to_defend_agenda_for_change

NHS staff face sack if they discuss religion

All National Health Service employees risk losing their job if they discuss their religious beliefs with colleagues or patients, Health Direct has learnt.

Following overwhelming public support for Caroline Petrie, the Christian nurse who was suspended after she offered to pray for an elderly patient, her employers have caved said she could return to her job.

The row over her treatment has reached the House of Commons, with Sir Patrick Cormack, the Tory MP for South Staffordshire, claiming that her case had highlighted the “utter absurdities” of political correctness.

Although Mrs Petrie was relieved her ordeal was over, fears have been raised that new rules could lead to the dismissal of any health care worker who tries to talk about their faith to others.

A little noticed document published by the Department of Health last month gives warning that attempts by doctors or nurses to preach to other staff or patients will be treated as harassment or intimidation under disciplinary procedures.

But it does not make clear the limits of acceptable discussion about religion.

Faith groups said the guidelines were so vague that they could mean action could be taken against anyone who talks about their beliefs to fellow workers or patients.

The document, called Religion or Belief: A Practical Guide for the NHS, states: “Members of some religions... are expected to preach and to try to convert other people. In a workplace environment this can cause many problems, as non-religious people and those from other religions or beliefs could feel harassed and intimidated by this behaviour.

“To avoid misunderstandings and complaints on this issue, it should be made clear to everyone from the first day of training and/or employment, and regularly restated, that such behaviour, notwithstanding religious beliefs, could be construed as harassment under the disciplinary and grievance procedures.”

Dr Peter Saunders, the general secretary of the Christian Medical Fellowship, said: “Much of the ethos of the NHS arose in a Christian environment, and many of the great pioneers in medicine were people who were motivated by a very strong Christian faith. It is quite ironic that people seem to be seeing Christian belief as something unhelpful.

“We live in a post-Christian society and that’s fine as long as we don’t end up with a system where people are actually discriminated against, bullied and not allowed to express their Christian values.

“One of our cherished freedoms is that of freedom of speech, which enables us to have important debates about crucial issues. But we’re seeing a culture of thought police emerging where it seems no longer acceptable to express what are really just orthodox Christian beliefs or the exercise of Christian conscience.”

Neil Addison, a Roman Catholic barrister who specialises in religious discrimination cases, asked: “To what extent do you stop ordinary conversation? What they’re doing is saying you cannot even talk about religion and that means a whole area of human experience is cut off.”

The controversy began in December when Mrs Petrie, a community nurse, visited a patient in Winscombe, Somerset, and asked if she would like her to pray for her. Thewoman said she was “taken aback” by the suggestion and told another nurse about it.

Mrs Petrie, a Baptist from Weston-super-Mare, insists praying is just her way of saying “get well soon”, but she was suspended without pay by North Somerset Primary Care Trust. It said she had breached her professional code by “promoting causes that are not related to health” and by failing to “demonstrate a personal and professional commitment to equality and diversity”.

The trust carried out an internal investigation that could have led to her being sacked, but yesterday it issued a statement which said Mrs Petrie could keep her job.

It said: “It is acceptable to offer spiritual support as part of care when the patient asks for it. But for nurses, whose principal role is giving nursing care, the initiative lies with the patient and not the nurse.”

Last night Mrs Petrie said: “I am not sure what I think about this, I want to know what conditions there are to me coming back to work.”

From:
http://www.telegraph.co.uk/NHS-staff-face-sack-if-they-discuss-religion.html

NHS trust considers abandoning NPfIT electronic records fiasco

An NHS trust is considering ditching its new electronic patient record software in order to revert to its 20 year old system, in a move that underlines the troubles faced by the giant NHS IT project.

Worthing and Southlands Hospitals NHS Trust faced problems with its new system and is planning to abandon it to expedite a merger with a neighbouring trust, according to E-Health Insider, a website that has tracked the programme from its inception.

The news came as the Commons public accounts committee issued a scathing report arguing that the completion - even four years late - of the mighty £12.7bn NHS IT scheme "must now be in doubt".

Edward Leigh, the committee's chairman, said the delivery risks were "as serious as ever" following the termination last May of Fujitsu's contract to install and run the record across the whole of the south of England. Final arrangements for replacing Fujitsu have still not been agreed more than seven months after the company was fired.

"Ministers need to take their heads out of the sand," said Richard Bacon, a committee member. He added the programme was in "deep trouble" and "so far behind schedule that hospitals are walking away".

The first promised deployments of record software in the north of England have still not been completed, the latest deadline of last autumn having again been missed.

In London further deployments at large acute hospitals have been put on hold until serious problems with existing installations have been solved - contributing to a big profits warning last week from BT, the London supplier.

Mr Leigh said the original aim was for the systems to be fully implemented by 2010. "The truth is that, while some are complete or well advanced, the major ones such as the care record systems are way off the pace. Even the revised completion date of 2014-2015 now looks doubtful."

David Nicholson, the NHS chief executive, has conceded that the programme is "at a pivotal point" and cannot "go on and on" in its current state. He told the committee, however, that he remained confident the NHS would have a workable system by 2015.

From:
http://www.ft.com/cms/s/0/ac5b94f4-ec11-11dd-8838-0000779fd2ac.html?nclick_check=1

Health Direct is heartened by the fact that the NHS chief executive claims that the whole IT Connected For Health (NPfIT) system will be working in six years time.

As David Nicholson will be long gone well before then, it will be left to his successors to pick up the tab- and flak for the biggest IT disaster in the world.

NHS managers’ skill levels criticised by MPs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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