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

NHS paid doctor £375 an hour

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Government departments waste £4m on website redesigns

Labour government departments have spent £4 million of public money revamping their existing websites over the past two and a half years.

Much of the money has gone to external consultants and contractors.

In total, £3.96 million has been spent on redesigns and upgrades since June 2007. The figure does not include the estimated £220 million annual cost of running the government sites.

David Davies, Conservative MP for Monmouth who asked for the information in a string of parliamentary questions, said: "Dfid ministers should be giving financial support to the poorest people in the world not the wealthiest web designers.

"The money spent on a web upgrade could have paid the wages of 100 nurses in one of the poorest African nations for a year, but for Labour ministers, internet propaganda is far more important.

The Central Office of Information (COI) is conducting a study, to be published in June, into whether government websites offer value for money. The investigation was prompted by a National Audit Office report that said over one quarter of government organisations did not even know the running cost of their own websites, making it impossible to assess whether they provide value for money.

The NAO also found that one in six government bodies had no data about how their websites were being used.

Matthew Elliot, the campaign director for The TaxPayers' Alliance, said: "This astonishing £4 million figure shows departments must concentrate on content rather than the appearance of government websites. Many of these sites look a lot better than they actually are."

What departments said they spent on redesigns since June 2007:

Department for International Development £970,419
Department for Business, Enterprise and Regulatory Reform £528,912
Department of Health £513,000
Intellectual Property Office £355,000
Electoral Commission £283,744
Department for Environment, Food and Rural Affairs £181,000
Ministry of Defence £150,000
Electoral Commission voter information site £140,600
Serious Fraud Office £113,309
Office of Rail Regulation £107,169
Department for Innovation, Universities and Skills £105,167
British Army £75,000
Crown Prosecution Service £60,085
Attorney General's Office £59,184
Revenue and Customs Prosecution Office £58,741
Office of Government Commerce £54,000
Bona Vacantia £42,598
UKTI Defence and Security Organisation £42,000
National School of Government £27,683
National Measurement Office £20,649
Government Actuary Department £19,461
Scotland Office £12,880
Disposal Services Authority £12,000
Wales Office £10,500
NI Organised Crime Office £6,825
Forensic Science NI £6,187
NI Youth Justice Agency £4,802
Treasury Pre-Budget £4,578
TOTAL £3,965,493

From:

http://www.telegraph.co.uk/Government-departments-spend-4m-on-website-redesigns

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

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

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.

Ditherer Brown's PFI U Turn

After a dozen years of wasteful, expensive over spinning and under delivering Stalinist Brown has created a new PFI process.

Seven private sector consortiums are to be given a form of quasi-monopoly on a potential £2bn-£3bn ($3bn-$4bn) market for building health centres, community hospitals and perhaps some local authority facilities.

The Department of Health is expected to announce the winners of the so-called Express Lift (local improvement finance trust) project soon in a move which could in time also open up more of the NHS’s community health services to competition from the private and voluntary sectors.

Under Lift projects, the private sector forms joint companies with primary care trusts – and sometimes local authorities – which finance, build and run GP surgeries and other health facilities. Contracts typically last for 20 years and the public sector owns a 40 per cent equity stake.

Some 47 Liftcos – which use some of the techniques of the private finance initiative – have so far been set up.

More than 220 buildings with a capital value of about £1.5bn are under construction or open, with more to come under the deals already signed.

Half of the country’s 150 primary care trusts, however, still do not have a Lift deal – chiefly those outside the big cities.

Under Express Lift they will be able to choose from the winners of the framework contract without the need for a full EU-style tender. The hope is to cut procurement time from a typical two years to a few months, massively reducing the costs and speeding up the programme.

Sir William Wells, a former regional health authority chairman, is now chairman of Ashley House, whose Odyssey Healthcare is expected to be one of the winners.

“We have been building these great palaces of PFI hospitals like they are going out of fashion, when in fact they are going out of fashion,” he said. “Even cancer care is now moving out of hospital and into people’s homes. This new approach should be far more flexible and – at a time when capital is going to be in very short supply – much more affordable for the NHS than PFI.”

Lift buildings typically cost £3m-£7m, and raising money this way was far easier amid the credit crunch than raising finance for big PFI projects, Sir William said. He added that in time Liftcos could take over a primary care trust’s entire property portfolio.

The National Audit Office has judged the Lift programme to have gone well, although MPs on the Commons public accounts committee have questioned the value for money and the rate of return Liftcos make.

From:
http://www.ft.com/cms/s/0/0e7db1d2-0f5b-11de-ba10-0000779fd2ac.html

Dept of Health failing to learn from past mistakes

The NHS's IT £12bn programme to create an electronic patient record is a prime example of Whitehall failing to learn from past mistakes, the National Audit Office warns.

So are the computerisation of the Child Support Agency, a grant scheme for farmers, and the cancellation of an asylum centre.

There are plenty of examples of departments learning from mistakes others have made, the NAO said, but Whitehall is still not good enough at learning lessons from previous policy and implementation errors.

The NHS programme spectacularly failed to engage staff. Other programmes were trialled, or implemented at a time when other big changes to the business were under way. Yet all these, and other, mistakes have been made before, the NAO argues in a report on helping labour government to learn.

Examples where lessons have been learnt are the better handling of the foot and mouth outbreak in 2007 compared with 2001; early appreciation by the Treasury that refinancing rules for private finance initiative projects needed to be changed as a result of the financial crisis; and a £2bn programme to roll out Jobcentre Plus came in under budget and on time because officials drew on lessons from big projects that had gone wrong.

"There has been a proliferation of toolkits, guidance and other products to help government learn," the NAO said.

But with a risk of "guidance overload", civil servants need to be given more time to learn what makes projects work and go wrong, and that needs to be built in to day-to-day practice.

Without that, "failures will continue to happen" producing "avoidable waste, inefficient practices and ineffective services".

From:
http://www.ft.com/cms/s/0/d6acb3bc-06cb-11de-ab0f-000077b07658.html?nclick_check=1

Credit crunch slows number of PFI deals

Fewer deals were signed under the private finance initiative (pfi) last year than at any point since the PFI took off a decade ago, according to an authoritative database.

The credit crunch contributed heavily to just 34 PFI deals being signed last year, after at least 60 deals were signed every year over the past decade, according to Public Private Finance magazine. Hospital deals fell to just seven last year, against 20 in 2007, while just three waste management deals were signed.

The economic conditions also mean big deals such as the £4.5bn M25 widening, the M80 in Scotland and Britain’s biggest waste management project in Greater Manchester are still struggling to raise the money needed, with some practitioners arguing that further government guarantees, or public sector funding, will be necessary.

Analysis of last year’s deals comes as the National Audit Office warned that both central and local government faced potentially massive European Union fines for failing to reduce landfill if a string of PFI waste management schemes were not signed soon.

Fines “could run into several hundred millions of pounds”, the NAO said. Projects currently in procurement “face difficulties in obtaining private finance”, it said, adding some schemes will have to be financed more conventionally.

The Greater Manchester Waste Disposal Authority has already had to agree to find an additional £70m from its own borrowing in order to ensure its £600m waste scheme is fully funded. There are concerns that additional public sector cash may also be needed to finalise the M25 deal.

One leading practitioner said that raising private finance remained “a nightmare” with banks still reluctant to lend.

David Metter, chairman of the PPP Forum, the trade body for the industry, said some additional Treasury guarantee might be needed to get funds flowing into infrastructure projects that the government wanted to see built to combat the downturn.

“The risk to the government of doing that would be small,” he said. “In effect, it would be guaranteeing its own payments for the service charges, or unitary payments that it makes on projects.”

The Treasury declined to discuss the idea of further public sector support, arguing it would take time for the measures it had already taken to take effect.

From:
http://www.ft.com/cms/s/0/3d73dfda-e1ab-11dd-afa0-0000779fd2ac.html?nclick_check=1

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 records NPfIT project grinds to halt

Progress on the £12bn computer programme (NPfIT) designed to give doctors instant access to patients’ records across the country has virtually ground to a halt, raising questions about whether the world’s biggest civil information technology project will ever be finished.

Connecting for Health, the ambitious plan to give every patient a comprehensive electronic record, has faced a series of problems over its size and complexity since it was first launched in 2002.

In May this year, the National Audit Office said the project was running at least four years late but still appeared “feasible”.

Since then, however, just one of the scores of acute care hospitals due to install the underlying administration system required in order for the patient record to work has done so. The hospital, Royal Free NHS Trust in London, continues to have difficulties getting it to operate properly.

In addition, the contractor originally hired to build the patient record system for the whole of the south of England, Fujitsu, has been fired. And BT, one of the two key remaining contractors, has been unable to agree a price for taking over the work Fujitsu had begun.

Health ministers originally promised the long-delayed first installation of patient record software in the north of England would finally take place in June at Morecambe Bay on the Lancashire/Cumbria border.

But four months on, the system has still not gone live and neither Morecambe Bay nor Connecting for Health can give a date when it might.

CfH’s most recent published plans for the next three months do not include a single installation of a patient administration system into any acute hospital trust.

And while NHS Trusts in the south – Fujitsu’s former area – are being given a choice of working with BT, the supplier for London, or CSC, the supplier for the north, none has yet signed up with either.

Jon Hoeksma, editor of the e-health insider website which has tracked the CfH programme from its start, said other parts of the £12bn project are continuing to make progress.

“But this key part seems to be simply stuck. It has ground to a halt. And that is not just affecting deployments that should be happening now. It will have a knock-on effect on those that are meant to be going live two or three years down the line.”

Hospital chief executives, he said, did not want to take a new system “until they have seen it put in pretty flawlessly elsewhere”.

Frances Blunden, the IT policy specialist at the NHS Confederation, the body that represents NHS Trusts, said: “It is a little bit too early to pronounce the programme dead.”

She said there were “undeniable” problems, but “to say everyone is walking away from it is a bit premature, probably”.

She said the health department had promised earlier this year to address hospital complaints that the system was too standardised and could not be adjusted to take account of local needs. “But we haven’t seen the implementation document to put flesh on the bones of that.”

A spokesman for Connecting for Health acknowledged that BT, which covers London, was “taking stock” given the difficulties encountered. The spokesman said it was more important to get the quality of installations right rather than promise delivery on a particular date. Talks with suppliers were under way to ensure “a smooth transition” in the south, after Fujitsu’s departure.

From:
http://www.ft.com/cms/s/0/b54a2e1c-a46e-11dd-8104-000077b07658.html?nclick_check=1

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

Litany of surgical blunders revealed

Cases of 14 brain surgery patients who were the victims of catastrophic errors when neurosurgeons operated on the wrong side of the head are to spearhead a government drive to make operations safer.

Sir Liam Donaldson, the Government's chief medical officer, will highlight the cases at the launch of his annual report today when he will announce the establishment of a new clinical board for surgical safety to reduce errors and eliminate "wrong site" mistakes.

About 7.9 million operations are performed in Britain each year, nearly 10 times the number of births, yet surgical safety attracts far less attention than the safety of maternity care.

In 2007 more than one operation a month – 16 in all – was done on the wrong site. Examples include knee replacements on the wrong (healthy) knee, cochlear implants – surgically implanted hearing aids – in the wrong ear, removing bone from the wrong foot and wrong incisions to gain access to organs in the abdomen.

One patient a day was listed for the wrong operation in 2007, and there were 1,136 errors involving operating lists, including mistaken surgery, wrongly identified patients or operations performed in the wrong place.

The 14 brain surgery patients had suffered head injuries causing bleeding in the brain leading to increased pressure in the head. The standard treatment is to drill holes in the skull to release the pressure, but in the 14 cases the "burr-holes", were drilled on the wrong side. A second set of burr-holes then had to be drilled on the correct side. The 14 cases, all in the UK, were reported to the National Patient Safety Agency over the past three years.

Sir Liam told The Independent: "The procedure of drilling burr-holes can be life-saving and you could say that it is a low number [drilled on the wrong side] in the context of all neurosurgical cases. But many people would be incredulous that it could happen at all, let alone be repeated. It is a challenge to our ability not just to reduce error but to ensure these sorts of error do not happen. They should be 'never events'."

In all, almost 130,000 errors involving surgical procedures were reported to the National Patient Safety Agency. In most cases involving operating lists, the error will have been detected before the surgery was done so the true number of errors is likely to be under-reported.

Sir Liam said: "Most surgery is safe but errors do occur. Many are minor but some are serious. Some should be 'never events'. We really should be able to consign wrong-site surgery to the history books."

In a second example highlighting a different problem, he will describe 14 deaths and nine serious reactions among patients having hip replacements related to the cement used to fix the artificial joint.

Hip replacements are among the commonest operations in Britain but in rare cases the cement causes globules of fat to be forced out of the bone into the blood, triggering a heart attack. In the UK, half of all hip replacements are performed using cement; in Canada just 3 per cent are. Guidance about the risks of cement had been issued to surgeons in the UK, but practice had not changed as quickly as it had in North America.

Sir Liam said: "No one knows what causes this reaction."

Two weeks ago, NHS Review by Lord Darzi, the surgeon and Health minister, called for the safety and quality of health care to be placed at the heart of the NHS and said urgent steps should be taken to eliminate "never events", serious incidents which harm patients and damage public confidence in the service.

The new clinical board will be established by the National Patient Safety Agency and include the Royal Colleges of Surgeons and Anaesthetists and patient organisations. Its first task will be to tackle wrong-site neurosurgery and fatal reactions to cemented hip replacements.

Sir Liam will also call for safety tests based on a checklist to be piloted in all UK hospitals. Surgeons and nurses will run through the checks before each operation in the same way pilots check their aircraft before take-off. The Surgical Safety Checklist was launched by the World Health Organisation last month.

About 20,000 patients die after surgery each year in the UK but it is not known how many were preventable. An estimated 2,000 NHS patients die each year as a result of errors in treatment, and an inquiry by the National Audit Office in 2005 concluded that half of all incidents could have been avoided if staff had learnt the lessons of previous errors.

Although serious errors are rare, a study of 38 surgeons in 14 NHS hospitals in the British Medical Journal in 2006 found "most" had experience of operating on the wrong site.

"We should be able to make major in-roads into reducing surgical errors," Sir Liam said.

From:
litany-of-surgical-blunders-revealed-866894.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 scandal of dying cancer victim was forced to pay

A woman who died of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

Three of the cases, involving women suffering from liver and bowel cancer, are expected to prompt a judicial review of the government’s ban on “co-payment”, as the buying of private treatment while under NHS care is called.

Some cancer drugs not yet available on the NHS can markedly increase the chance of survival. But Alan Johnson, the health secretary, claims that co-payment would create a two-tier NHS, with preferential treatment for patients who could afford the extra drugs. Last year he issued guidance to NHS trusts ordering them not to permit patients to pay for additional medicines.

Brian, O’Boyle’s husband, said he was appalled by the way she was treated. He recalled his wife as a woman with an infectious laugh who had given a lifetime of service to the NHS as an assistant occupational therapist. The couple, who had three sons and four grandchildren, lived in Billericay, Essex.

After she developed bowel cancer and began having chemotherapy, doctors told her she should boost her chances of fighting the disease by adding another drug, cetuximab. It is not routinely funded by the NHS.

When she decided to use her savings to pay for it, Southend University Hospital NHS Foundation Trust withdrew her free treatment, including the chemotherapy drug she was receiving.

The trust said yesterday: “A patient can choose whether to continue with the treatment available under the NHS or opt to go privately for a different treatment regime. It is explained to the patient that they can either have their treatment under the NHS or privately, but not both in parallel.”

Brian O’Boyle, 74, who worked as an NHS manager for 30 years running rehabilitation services for the mentally ill, said: “We were happy to pay for this drug, cetuximab, and to give the health service what it cost to buy it and deliver the treatment, but they said they couldn’t do that. That is appalling.”

He added: “When she heard there was something that could extend her life, of course my wife jumped at it. Linda was taking lots of other drugs that she had previously been given on the NHS but \ we had to pay for all of them.

“It was stressful enough for Linda having cancer without her having all this stress on top of it.”

He has the backing of John Baron, the local Conservative MP and a former shadow health minister. “The NHS was very wrong to deny care and treatment to Linda O’Boyle. She has been penalised by an NHS system that is grossly unfair. This is morally wrong,” Baron said.

David Cameron, the Conservative leader, said in a statement that it was “tempting” to allow patients to pay for extra cancer treatments that were not funded by the NHS.

The party has been reluctant to express an opinion on the issue, fearing that it could be portrayed as favouring middle-class patients who can afford to buy themselves extra treatment.

A group of nearly 1,000 NHS doctors, called Doctors for Reform, has raised £35,000 to fund a judicial review of the ban on co-payments.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

Relapse for NPfIT white elephant records system

Just when the National Health Service’s mighty and troubled £12.7bn programme to provide every patient in England with an electronic record looked as though it might be about to turn an important corner, it has skidded off the road again.

The resulting accident is not yet terminal. But it does mean more dire headlines and it is hard to see how the news of Fujitsu’s departure from the Connecting for Health programme will not produce further delays to an electronic record that is already running more than four years late – even if some parts of the exercise, ironically, may speed up.

The bad news that the programme has parted company with another big supplier – Accenture having walked away in 2006 – comes as things were finally looking up. BT appeared to be cracking the installation of the new systems in London, the part of the country for which it holds the local service provider contract.

Preliminary installations that are critical to getting the electronic record to work have gone into most of London’s mental health trusts and two or three big acute hospitals – not without inevitable teething troubles, but without the sort of catastrophic disruption that hospitals in the south have at times seen as Fujitsu tried to do the same.

In the north, iSoft’s long-delayed Lorenzo patient-record software is about to go into three pathfinder trusts this summer. If that had gone well, the programme would have felt itself to be back on track. Now it is plunged into further doubt and condemnation from opposition politicians who were demanding yet again a review.

Fujitsu’s deal always looked questionable. It was the last, and in terms of scope, the biggest of the five regional installation contracts. It covered more than 12m people and 90 hospitals and NHS organisations.

But Fujitsu’s agreed price for it was only £896m, nearly £200m less to cover 25 per cent of the population than Accenture got from the NHS for covering 15 per cent. It looked badly underpriced.

A senior Fujitsu executive predicted that once one or two of the systems were in it would be “like shelling peas”. It proved to be anything but.

Hospital after hospital suffered crashes and troubled installations as what was still an interim system, without the full record, went in. As of March, new systems had gone into just nine out of 41 acute hospitals and they were working so badly that Fujitsu had not been paid for more than half of them, according to the National Audit Office.

Industry sources say both BT and Computer Services Corporation, which now holds the installation contract for almost everything north of London, have been more flexible about giving NHS trusts what they want, instead of insisting they have precisely what was specified in the original contract.

Negotiations with Fujitsu are understood to have broken down not on the price the NHS was prepared to pay for a more flexible deal but on the timing of upfront payments that the company wanted.

The NHS refused to depart from the principle that has kept the programme on budget to date – that it will not pay for services until they are delivered. One senior health department source said: “We have to protect the taxpayer.”

In a letter to NHS trusts, Gordon Hextall, the programme’s chief operating officer, said Fujitsu would support existing live sites and the industry expectation is that they will complete one or two that are about to go live in order to get paid.

Beyond that, rather than a complete takeover of Fujitsu’s contract by one provider, Connecting for Health may use the existing contracts to get both BT and CSC to take over different parts of Fujitsu’s uncompleted work: an approach that could give NHS trusts in the south more choice. Cerner, the key software supplier for the south may take a bigger role.

And Connecting for Health has also just signed a framework contract with a range of other, new, suppliers that could be brought into play.

All that will be the subject of fraught negotiation. For now, the programme feels as if it is on a knife-edge.

From:
http://www.ft.com/cms/s/0/7b9d569e-2db3-11dd-b92a-000077b07658.html

NHS NPfIT will be at least four years late

It will be at least 2014 - four years later than planned - before a single NHS electronic patient records NPfIT system is in place in England, say auditors.

The head of the National Audit Office, Tim Burr, said the challenge was "far greater than envisaged".

But an NAO report said the project was on budget and that staff thought it would improve patient care.

MP Edward Leigh, who chairs the Commons Public Accounts Committee, said further delays could damage public confidence.

The National Programme for IT in the NHS is one of the most ambitious computer projects ever undertaken - replacing hundreds of different computer systems spread across hospitals and GP practices with new, compatible versions that will allow NHS staff anywhere in England to access a patient's medical records.

However, the technical challenges involved have led to significant delays and some trusts, desperate to replace ageing systems in order to offer the labour government's "Choose and Book" service for patients, have been forced to install "interim" systems which will eventually have to be replaced again.

The NAO is responsible for the monitoring of public spending, and its latest report says the benefits are now starting to emerge.

It said that the fixed-price contracts used meant that their costs remained "broadly unchanged", despite the delays, but that it was likely to be 2014 or 2015 before every NHS trust was running the care records system.

Tim Burr, head of the NAO, said: "The challenge involved in delivering the National Programme for IT has proved to be far greater than envisaged at the start, with serious delays in delivering the new care records systems.

"Progress is being made, however, and financial savings and other benefits are beginning to emerge."

Doubts

Others are less convinced by these timescales.

Tony Collins, who has investigated the project for the magazine Computer Weekly, said it was possible that some trusts might not want to run the systems offered to them.

"Ministers are discovering that an IT-based scheme conceived at the centre cannot be imposed on a devolved NHS - a lesson that should have been learned from failures in the 1990s."

Dr Chaand Nagpaul of the British Medical Association, said: "It is clear from this report that the setting of unrealistic deadlines has been very damaging.

"Slipping deadlines for new IT systems and the premature release of systems that are not fit for purpose has been deeply frustrating for NHS staff leaving many doctors thoroughly disillusioned with the programme. "

The report will be considered by the Commons Public Accounts Committee next month.

Mr Leigh said that confidence in the project had been "damaged" by "unrealistic expectations".

"The current timetables for the care records system to be fully deployed by 2014-15 had better be realistic. The Department of Health cannot afford further knocks to the programme's reputation or our confidence in it."

From:
http://news.bbc.co.uk/1/hi/health/7403286.stm

£1.8bn surplus forecast for NHS after cutbacks in patient care

The National Health Service in England is heading for a surplus of £1.8 billion this year, provoking anger among patient bodies over cutbacks to the funding of care.

Details announced by the Department of Health reveal that some health authorities are expected to generate more than £200 million, 25 per cent of their income.

The department played down the £1.8 billion figure last night as a mere 2.3 per cent of turnover, but patient representatives said that it was astonishing that the NHS could be underspending by more than a billion pounds while patients were still being denied vital treatments.

Michael Summers, of the Patients’ Association, said: “When wards are closing and hospitals are cutting back on cleaning and nursing staff up and down the country, it is quite astonishing that they are generating such a huge surplus.”

Last month a former Second World War airman, Jack Tagg, was told by his local primary care trust in Torbay, Devon, that he could not be given drug treatment for age-related macular degeneration because it was too expensive. The trust, which later relented but only on a technicality, is heading for a £7.8 million surplus, 3.5 per cent of turnover, this year.

The figures were released on the same day that the labour Government said that it would not match moves by the Welsh Assembly to abolish parking charges in NHS car parks. Doctors and patients’ groups say that hospital car parking charges are a “tax on the sick” if they are used to subsidise services already funded by the taxpayer. From 2011 patients, staff and visitors will be able to park free at almost every NHS hospital in Wales.

The biggest surpluses have been made by the strategic health authorities: North East SHA, for example, expects to generate a surplus of more than £100 million on a £346 million turnover; North West SHA a £230 million surplus on a turnover of £877 million and Yorkshire and the Humber SHA £267 million on a £784 million turnover. The total surplus is equivalent to almost 1p off income tax.

The Department of Health said that all the surpluses would remain within the NHS. This has been possible since 1999, when Gordon Brown, then Chancellor of the Exchequer, relaxed the rules on carrying forward surpluses from one year to the next.

Last month the National Audit Office gave warning that some departments were losing confidence in the Treasury continuing to allow them to do this as public spending slows. By last April departments were sitting on £10 billion of unspent capital spending and £12 billion in unspent revenue.

The NHS has been told that it is expected to make at least as large a surplus in 2008-09 as it looks like making in 2007-08. Two years ago the NHS returned a deficit of £547 million, which was turned into a £515 million surplus in 2006-07. The steps taken to turn the service round have proved so effective that the surplus has risen to unprecedented levels in 2007-08.

David Nicholson, chief executive of the NHS, said: “Today’s report not only shows that the NHS now has a strong and sustainable financial position, but also, importantly, it shows that we remain on course to deliver against our key pledges.”

Karen Jennings, head of health for Unison, the public service union, said: “The £1.8 billion surplus shows the NHS is now in a much stronger financial position. Patients have the right to expect that this money is spent wisely and ploughed back into patient care.

“It must be remembered that the stronger financial position has been achieved on the backs of NHS staff. They have contributed through greater efficiency but there have also been job losses and below-inflation pay awards. With finance available it is time to give staff a decent pay settlement instead of holding them to a 2 per cent pay limit.”

Stephen O’Brien, the Conservative health spokesman, said: “The Government cannot have it both ways. They are boasting about a £1.8 billion surplus in the NHS but then claim that hospitals cannot improve patient care without revenue from car parking fees. This does not add up.”

From:
http://www.timesonline.co.uk/tol/news/politics/article3479152.ece

Health Direct notes that the management of the NHS is shambolic. At the local trust levels there is a dearth of management with any recognisable qualifications and at national level the whole thing is so big as to be unmanageable.

Meanwhile, website waiting times are up under Labour, patient deaths as a result of infections contracted in hospital are up and the shortage of doctors, nurses and technicians is up.

Contract was a windfall for GPs but ‘not a good deal for patients’

The controversial contract to improve GPs pay and efficiency cost £1.76 billion more than the labour goverment expected and NHS productivity has actually fallen, a damning report by auditors concludes. The findings, by the National Audit Office, show that GPs who run their own practices received huge pay rises while giving up responsibility for the 24-hour care of their patients.

But GPs employed on salaries gained very little, while practice nurses actually saw a real-terms decline in pay. Hoped-for gains in productivity did not occur: productivity fell two years running, by an average of 2.5 per cent a year.

The costs of the contract were partly covered by extra cash from the Department of Health, but the primary care trusts who pay GPs were not fully reimbursed. As a result, they had to find £406 million between 2003-04 and 2005-06 from their own resources, limiting their ability to improve services.

The NAO report does not openly criticise anyone for the outcome, which enriched GP partners at the expense of almost everybody else. But when pressed, Karen Taylor, director of health at the NAO, said: “I think as far as the public and taxpayer is concerned, the benefits they should have been expecting to see have not materialised to the extent they should have done. From their perspective, it’s not a good deal for them.”
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There were some positives, she said. Recruitment and retention of GPs had improved, and the focus that the new contract brought on long-term conditions, such as diabetes, had helped patients. The average general practice appointment was longer — twelve minutes rather then eight — largely because an increasing proportion were being dealt with by nurses.

But NHS managers from top to bottom are found to have failed, by allowing the British Medical Association to negotiate a contract that enriched some of their members, shortened their hours and used up so much cash that reforms to services were stymied.

The report says that in its “business case” to the Treasury justifying the contract, the department had quoted figures that underestimated its actual cost by £1.76 billion over three years.

There were three reasons, Ms Taylor said. The department underestimated how much GPs would earn from the quality and outcomes framework, which rewards them for the number of quality points they earn; it underestimated the cost of switching out of hours responsibilities to primary care trusts; and it underestimated what it would cost PCTs to administer the contract.

GP practices are paid a gross sum, out of which the partners pay the cost of running the surgery, including salaries of nurses and other working doctors. The partners share the profits.

Perhaps the most damaging aspect of the report is the figure showing what partners did with their increased payments. They boosted their own incomes by 58 per cent over the three years, to an average of £113,614 in 2005-06. Salaried GPs whom they employ gained just 3 per cent in the first two years, to £46,905, while the average practice nurse’s income reduced in real terms, the report says.

The NAO concludes that one reason the contract has so far failed in the redesign of services is that the BMA negotiated a minimum practice income guarantee (MPIG), which ensured that no practice would earn less under the new contract than it did under the old. It meant that GPs retained the benefits of the old contract where it suited them, while gaining greatly from the new one. MPIG should be phased out, the report says.

Tim Burr, head of the NAO, said: “There is no doubt that a new contract was needed and there are now 4,000 more GPs than five years ago. But in return for higher pay, we have yet to see real increases in productivity.”

Laurence Buckman, chairman of the BMA’s GP committee, said it was meaningless for the audit office to talk about productivity because the way GPs worked had changed. “Productivity should be measured in improvements in health, not the frequency of consultations. The early evidence is that the contract is leading to improvements in clinical care,” she said.

http://www.timesonline.co.uk/tol/life_and_style/health/article3449057.ece

On February 07, 2008 Health Direct posted:Alan Johnson scraps with GPs over pay and opening hours

The 2004 general practitioner contract which the labour Government is now messily trying to unpick set a new benchmark for ineptitude by the Department of Health, whose weakness in contractual negotiations is legendary.

The agreement gave family doctors lavish salary increases tied to various incentives based on preventative health measures. In its first year it led to an average salary increase of 23 per cent, in the second year 10 per cent - an extra £30,000 a year in total.

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

Strokes- postcode lottery for stroke scans costs lives

Thousands of stroke victims die unnecessarily every year because access to the best care is subject to a "postcode lottery", campaigners have said.

Figures highlighted by the Stroke Association yesterday showed that patients in some parts of England were almost 60 per cent more likely to get a potentially life-saving brain scan diagnosis within 24 hours than those in other regions.

They also revealed that people suffering a stroke in the East Midlands were almost 30 per cent less likely than those in the North East to be treated in a hospital stroke unit with specialist equipment and staff.
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Alan Johnson, the Health Secretary, today set out the Government's new 10-year strategy to accelerate the emergency response to strokes and improve prevention and access to the most effective treatment.

Mr Johnson said that patients suffering a full stroke should have a brain scan in the next available scanning slot during normal working hours, while outside these hours they will receive a scan within 60 minutes before being moved to a stroke unit.

Higher-risk people suffering a minor stroke should have an MRI (magnetic resonance imaging) scan within 24 hours, while patients considered "low-risk" will
have access to a scan within seven days.

Joe Korner, of the Stroke Association, said: "Stroke is the UK's third biggest killer. Despite clear clinical evidence that access to immediate brain scanning and admission directly to a stroke unit saves lives and reduces disability, current access to these life saving facilities is down to luck and postcode."

Strokes are either blood clots or bleeds in the brain, which can leave lasting damage including speech, mobility and sight problems. Approximately a third of the 150,000 people who have a stroke in the UK each year die of it.

A scan is the only way to determine what type of stroke the patient is having and the best way to decide on the most effective form of treatment.

Data collected by the Royal College of Physicians found only 42 per cent of patients in England receive a brain scan to confirm their diagnosis within 24 hours.

New treatments with clot-busting drugs - called thrombolysis - can result in a much better and quicker recovery.

However the drugs must be given shortly after the onset of symptoms to be effective, and can only be used after a brain scan.

An estimated one in 10 stroke patients would benefit from thrombolysis, yet just one in 10,000 receive it.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/12/05/nhs305.xml

On 27 Aug 07 Health Direct posted UK stroke treatment is worst in Europe with hundreds needlessly dying every year- The UK has the worst outcome for strokes in western Europe despite spending the same amount or more on care as other countries, a leading article in the British Medical Journal warned.

And it is nearly two years since MPs in the National Audit Office pointed out that hundreds of UK citizens are dying needlessly and over a year since Health Direct posted on July 12, 2006- Stroke patients dying needlessly from Labour's health failures

Since then new Prime minster- same lack of compassion and urgency.

Stroke patients are needlessly dying or suffering more serious disablement because not enough priority is given to stroke services, according to a report by the Commons Public Accounts committee.

The report found that stroke is not treated as a medical emergency, brain scans for patients are often delayed and a significant proportion of stroke patients are not treated on specialist units.

Private sector role in pioneering healthcare scheme to be slashed

A pioneering £700m a year labour government scheme to buy surgical treatment centres and diagnostic services from the private sector is set to be more than halved by ministers.

The decisio - will not only mark another retreat from the use of the private sector in healthcare but will also see the health department forced to pay out millions of pounds in compensation.

Although Alan Johnson, health secretary, is to announce that a number of contracts will go ahead, including ones for extra imaging and renal services, about six contracts will be canned, on top of a number that were scrapped earlier this year.

The treatment centres that remain in the programme are, in most cases, smaller than the deals originally envisaged.

The move means that the original £700m a year's worth of business will turn out to be worth less than half of that - possibly as little as £200m.

People in the industry say that the late cancellations mean that the government will have to pay out up to £20m in bid costs to contractors, which include Netcare, Clinicenta and Alliance Medical. This is on top of £5m already paid out for scrapped schemes.

Stephen O'Brien, the Conservative health spokesman, said yesterday that he will be asking the National Audit Office to investigate the programme. "The health department has spent a phenomenal amount of money to achieve very little," he said.

Aside from the private sector's costs, the health department had by March this year already spent £72m on the procurement, according to official figures.

The department admitted last month that just eight of the 190 staff in the health department's commercial directorate were civil servants. The remainder were external hirings costing a total of between £88,000 and £120,000 a day - or the equivalent of between £20m and £30m a year.

The dramatic scaling back of the second wave of big central contracts will delight Unison and other opponents of the drive to involve the private sector in the delivery of NHS care.

However, it has left much of the private sector fuming, although ministers will argue that big opportunities remain as the government's focus for the private sector switches from hospital services to primary care and proposed "polyclinics".

But one senior executive said companies were now very wary. "There is a trust issue here," he said. "We have been led up the garden path. We are not sure we want to go up it again".

From:
http://www.ft.com/cms/s/0/1073a3fc-918f-11dc-9590-0000779fd2ac.html

UK stroke treatment is worst in Europe

The UK has the worst outcome for strokes in western Europe despite spending the same amount or more on care as other countries, a leading article in the British Medical Journal warned.

Hugh Markus, professor of neurology at St George’s university and medical school, said three different studies had put the UK at the bottom among several other western European countries.

The problem appears to lie in the way services are organised, with strokes seen as a “Cinderella” subject that falls between neurology and geriatric medicine, Prof Markus said.

Instead it needs to be treated as “a condition that requires emergency action”.

Clot-busting drugs can now be given to patients whose stroke is due to a blocked blood vessel rather than a broken one.

To do that, however, rapid 24-hour access to specialised expertise and imaging equipment is needed to determine the type of stroke. The drugs have to be given within three hours to have most effect and can harm a patient whose stroke is due to bleeding.

“It is unlikely that every acute hospital will be able to provide such a service,” Prof Markus said, and alternative strategies that include regional centres and the use of telemedicine are needed, as in Germany and America.

“In many European countries,” Prof Markus added, brain imaging “is performed on admission to the accident and emergency department, while in the UK many units struggle to provide it within 24 hours.”

A National Audit Office report in 2005 calculated that 550 deaths could be avoided a year, and 1,700 patients would recover fully rather than being disabled, if ­services were better organised.

A stroke strategy is apparently due to be published by the health department in the next few months.

The limited data available, Prof Markus said, “show that European countries with better outcomes focus resources more heavily on the acute aspects of care”.

“The vast majority of the cost of in-hospital stroke care in the UK is for nursing and hospital overheads, with the cost of investigations and medical care being very low.”

At present less than 1 per cent of patients eligible for clot-busting drugs get them in the UK, against 20 to 30 per cent in many European countries and North ­America and Australia.

From:
http://www.ft.com/cms/s/0/d7bdb1d6-518f-11dc-8779-0000779fd2ac.html

It is nearly two years since MPs in the National Audit Office pointed out that hundreds of UK citizens are dying needlessly and over a year since Health Direct posted on July 12, 2006- Stroke patients dying needlessly from Labour's health failures

Since then new Prime minster- same lack of compassion and urgency.

Stroke patients are needlessly dying or suffering more serious disablement because not enough priority is given to stroke services, according to a report by the Commons Public Accounts committee.

The report found that stroke is not treated as a medical emergency, brain scans for patients are often delayed and a significant proportion of stroke patients are not treated on specialist units.

The MPs found:
* Stroke is not treated as a medical emergency in the same way as a suspected heart attack, though the shorter the time between the stroke and the treatment, the greater the chance of reducing damage to brain tissue.
* Brain scans for many stroke patients are being delayed, though a scan is vital for determining appropriate treatment.
* A significant proportion of stroke patients are not being treated on a specialist stroke unit, despite evidence that this is the most clinically effective model for acute care.
* There is considerable variation between hospitals as to what a specialised stroke service entails.
* Public awareness of the symptoms and impact of stroke, and how strokes can be prevented, is very low.
* There are insufficient nursing, therapist and other specialist staff with expertise in stroke care across the primary and secondary healthcare sectors, and there is scope to improve training for the existing stroke workforce in the National Health Service (for example, by training stroke consultants to interpret brain scan results).
* The carers of stroke survivors, and stroke survivors living on their own, are often not accessing the social and care services they need.
* There is low awareness on the part of members of the public and general practitioners about the fact that a transient ischaemic attack ('mini stroke') is a strong indication of increased risk of major stroke, and requires immediate investigation and treatment.

C Difficile and hospital bugs remain a problem

The number of cases of the potentially dangerous Clostridium difficile (C Difficile) is thriving, figures show. A review by the Health Protection Agency showed hospital MRSA cases had fallen by 10% in the first three months of 2007 compared with a year ago. But rates for C. difficile, which mainly strikes the elderly, rose by 22% this quarter.

Some NHS trusts complained that targets - both clinical and financial - were hindering the fight against infection.

In a separate survey carried out by the Healthcare Commission - an NHS watchdog - some 45% of the 155 trusts said time targets for treating patients in A&E were getting in the way of infection control measures.

These figures represent a very small proportion of the 10 million inpatients that the NHS treats in hospitals every year.

Pressure to move patients to any available bed rather than the most appropriate bed or an isolation ward was one reason cited for the difficulties.

A further 36% of trusts said they were having problems combining investment in cleaning with financial targets, while 88% said their limited IT infrastructure "was restricting their ability to draw important lessons from incidents of infection".

The survey was carried out in May 2006, and the watchdog noted that a number of practices - particularly regarding individual staff objectives for bringing down infection - had changed.

But Healthcare Commission chief executive Anna Walker added: "We cannot afford to lose momentum. Trusts should be asking themselves what more they can do to protect patients and the public from healthcare associated infection."

The National Audit Office has estimated that these infections cost the NHS as much as £1bn each year.

Between April 2006 and March 2007, there were 6,378 cases of MRSA infections reported, compared with 7,096 for the previous year, the Health Protection Agency (HPA) said.

Meanwhile, there were 15,592 reported cases of C. difficile in patients aged 65 and over in England in the first quarter of 2007. This represents a 2% rise when compared with the same period last year, but is 22% higher than the previous quarter.

The HPA says this rise can be explained by the fact that higher numbers of vulnerable people are admitted to hospital at this time of year.

Liberal Democrat health spokesman Norman Lamb said the government had "spectacularly failed" to halt C. difficile.

Shadow health secretary Andrew Lansley called the figures "the tip of the iceberg, because they do not include the number of infections in people aged under 65".

From:
http://news.bbc.co.uk/1/hi/health/6913873.stm

On 2 May 07 Health Direct posted that Deadly NHS superbugs continue rising with C difficile again up when more hospital patients in England are getting the deadly Clostridium difficile bug, figures show.

Health Protection Agency (HPA) data showed 55,681 cases were reported among over 65s in 2006 - up 8% in a year. MRSA cases continued their downward trend, but they are not falling quickly enough to meet Labour's target next year.

Patients Association spokeswoman Katherine Murphy said: "Too many people are dying from these infections. We must learn from other countries such as Holland which have got infection rates close to zero.

Dementia victims being failed by NHS- NAO

Hundreds of thousands of elderly people suffering from dementia are being comprehensively failed by the labour government and the health service, Whitehall's spending watchdog warns. Far too few people are being diagnosed as suffering from dementia - or are being diagnosed much too late - and even then drugs and other treatments are not widely available.

Britain languishes near the bottom of the European league table for the number of victims receiving anti-dementia drugs. Only five countries have a worse record.

The National Audit Office (NAO) report says urgent action is needed to tackle shortcomings in services for a condition which costs the country £14.3 billion a year - more than £25,000 for every man, woman and child - including £1.2 billion spent by the NHS.

In particular, there needs to be more support for the "selfless" army of nearly half a million carers who look after relatives and friends with dementia.

The report's publication comes as the labour Government's drugs rationing watchdog NICE is facing a legal challenge over its decision to restrict the availability of drugs that can delay the onset of Alzheimer's.

The National Institute for Curbing Expenditure ruled that around 100,000 people in the early stages of the disease should not receive the drugs on the NHS. But drugs companies launched a High Court challenge last week to overturn the decision.

While Nice had ruled out drugs for people in the early stages of Alzheimer's - which accounts for 62 per cent of all dementia cases -this report says there is a consensus that early diagnosis and treatment is vital.

In a highly critical report, the NAO says ministers and the NHS have not given enough priority to a condition which is suffered by around 560,000 people in Britain.

However, that figure is expected to soar by nearly 40 per cent to around 780,000 over the next 15 years as people live longer. By 2051, there will be 1.4 million sufferers.

The report says that dementia is estimated to be a factor in almost 60,000 deaths each year, around 13 per cent of all deaths in Britain. In around 18,000 cases, dementia is the main cause of death, often because victims become so frail they lose the ability to swallow or eat.

Despite its growing prevalence, the report says that only one in three sufferers ever receive a formal diagnosis. It takes twice as long to diagnose patients in Britain than many other European countries.

The report was welcomed last night by campaigners and opposition politicians.

Neil Hunt, the chief executive of the Alzheimer's Society, said: "The human and economic cost of dementia can't be ignored - one in three older people will end their lives with a form of dementia.

"It is absolutely crucial that people with dementia get diagnosed as early as possible so that they and their families get the information and support they need."

• The elderly are finding it increasingly difficult to access crucial care services, a survey reveals today.

Older people are being confronted by a growing "care gap", with low-level services which allow people to carry on living in their home - such as shopping or cleaning - being squeezed out as authorities focus scarce resources on intensive care for the most vulnerable.

The survey by charity Counsel and Care showed that 70 per cent of local authorities only provide care for those with "critical or substantial needs".

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/04/nhs104.xml