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