Hospital made profit on NHS drugs sold abroad

A Surrey hospital sold millions of pounds worth of NHS medicines abroad during the past year, despite official warnings calling for an end to such arbitrage for fear it could lead to shortages for British patients.

The Royal Surrey County Hospital in Guildford confirmed a report in the Health Service Journal that it had made £300,000 in profit by exporting £4.6m in medicines in the 10 months to January.

The revelations precede a conference convened next month by Mike O'Brien, the health minister, designed to clamp down on such "parallel trade" after pressure by the pharmaceutical industry. They provide a clear example of NHS entities trading for profit, despite a statement by the Department of Health to the Financial Times last week that it was unaware of any particular examples.

The weakness of sterling against the euro has turned the UK into a low priced source of medicines in the past two years, allowing intermediaries to buy them for resale at a higher price elsewhere in Europe, such as Germany.

The UK was formerly a net importer of drugs from lower-priced countries such as Greece, as part of the widespread practice of parallel trade, transferring potential drugs company profits into the hands of intermediary traders.

While individual pharmacies and some drugs wholesalers have long taken part in this cross-border arbitrage, which is legal under European Union law, the government became concerned in recent months at the possible involvement of NHS hospital pharmacies. The chief pharmacist wrote to them last July, calling the practice "irresponsible".

The arbitrage runs the risk of creating medicine shortages in the UK. Officials were particularly concerned because of extra pressure on medical services caused by the flu pandemic. 

Bad weather in recent weeks also caused breaks in the normal drugs supply chain, causing stock shortages that could have threatened patients' lives.

Monitor, the hospital regulator, said it had inspected the Royal Surrey's practices in preparation for its conversion into a foundation trust in December but found no fault with the practice.

"As long as what they are doing is not illegal and doesn't affect their ability to focus on NHS patients, it is not an issue for us," Monitor said. It cited other commercial activities, such as childcare, while saying that car parking had become subject to ministerial  scrutiny.

The hospital said it had discontinued the parallel export of medicines last month in response to negative publicity and when a shift in exchange rates made the practice less lucrative. It said it was satisfied it did not run the risk of forming any medicine shortages for NHS patients.

The Department of Health told the FT last week that it had "received anecdotal evidence of NHS trusts being approached to become involved in such activities but has no concrete evidence that NHS trusts are involved".

The department said that it was "aware of a report that a hospital has considered trading in medicines for short-term financial gain. Such activities are wrong and threaten the medicines supply chain and patient care."

From:

http://www.ft.com/cms/s/0/ecf3b51a-1b62-11df-838f-00144feab49a.html

NHS spending squeeze to hurt PFI hospitals most

NHS hospitals built under the private finance initiative will face a much tougher time making the productivity and efficiency gains that are needed as public spending is squeezed, PFI experts and NHS managers are warning.

Under PFI, hospitals pay a single annual charge, typically for 25 or 30 years. It covers the cost of the capital, maintenance of the building and often other “soft” services such as cleaning, catering and laundry and sometimes equipment replacement.

While the soft service contracts are usually renegotiated every five or seven years, the main payments are fixed at the interest rates prevailing when the deal was done. In the current financial climate there is no possibility of refinancing them to produce lower annual payments, and the cost of buying out the contracts is prohibitive, according to PFI specialists.

Figures published by the Department of Health this week show big variations in the percentage of annual turnover that hospitals pay for their PFI buildings, largely depending on how extensive the rebuild was.

For some it is only 1-3 per cent but for others it is 10-12 per cent. For Walsgrave Hospital in Coventry, Dartford and Gravesham and Queen Elizabeth, Woolwich, it is 16 per cent and more. For Bromley Hospital it is almost 20 per cent of turn­over.

Traditionally, when spending has been tough, NHS hospitals have put back maintenance to retain doctors and nurses and other services.

“If you do that for too long, it is a thoroughly bad thing,” Nigel Edwards, head of policy for the NHS Confederation, said. “But for a year or two it can help you cope.

“But a hospital with a PFI scheme does not have that option. They are contractually bound to keep the maintenance up – and if you are spending 10 or 15 per cent on your buildings it means all the other efficiency and productivity gains you need have to come out of only 85 or 90 per cent of your budget.”

Hospitals without PFIs still paid a capital charge, so the comparison was not quite that bad, Mr Edwards said. “But some of these hospitals with PFIs are going to find it incredibly tough” to make their share of the £15bn-plus savings that the health department says are needed, he said.

Treasury officials privately acknowledge that there is an issue and hope PFI providers will prove flexible as public spending gets tougher. But David Florry, director-general of NHS finance, told MPs that while the level of cleaning of back-office areas, for example, could be reduced at the break points in the soft service contracts, there was no evidence yet that payments had gone down as a result.

William Moyes, chairman of Monitor, the foundation trust regulator, said lack of maintenance in the past had left the NHS estate in an appalling state. “On balance, having to keep up the maintenance is not a bad thing because it means patients will be treated in buildings that have been kept up to scratch.”

From:

http://www.ft.com/cms/s/0/b366ad6a-078b-11df-915f-00144feabdc0.html?nclick_check=1

Call for social care reform as costs escalate

Radical reform of social care is needed both to contain costs and improve the quality of a system that is "fundamentally broken" say leading academics.

Rather than extra spending being seen as "dead money" or a "necessary evil", social care expenditure should be seen as "a form of social and economic investment", according to the study commissioned by Downing Street and the health department.

Effective spending on social care for the frail elderly and for adults with disabilities could generate savings elsewhere in the welfare state, says the report from Birmingham University's Health Services Management Centre and the Institute of Applied Social Sciences. 

It could produce savings in National Health Service expenditure and on social security benefits, while bringing in tax and national insurance income.

Furthermore, "doing nothing to change the way things work is not a viable option", according to Jon Glasby, professor of health and social care at Birmingham University, and the study's lead author.

If the means tested patchwork of poorly co-ordinated services continued unreformed, "costs will double over the next 20 years and that money will be spent on a system that is now widely seen to be delivering poor quality results", he said.

The study argues that better commissioning of social care, more collaboration with the NHS, more support for carers, and greater use of personal budgets, telecare and other forms of IT would cut the rate of growth while producing better quality care.

It makes its case using initiatives from across the country - including the joint management of health and social care in Torbay , Devon; studies that suggest people given personal budgets spend less on social care; and other evidence, and scales up potential savings.

The report is littered with caveats about the certainty with which that can be done and the reliability of some data. But it concludes that undertaken with real vigour, such approaches will improve care and cut the rate at which costs increase - and so should be seen as an investment.

"The savings come primarily from reducing the number of emergency hospital admissions among the frail elderly," said Professor Glasby, "and from supporting a much greater number of adults of working age who have a disability back in to work. There they will earn, pay taxes and claim fewer benefits, while savings also come from supporting informal carers much better, many of whom are struggling to balance work and caring."

From:

http://www.ft.com/cms/s/0/6bd5fd7e-1452-11df-8847-00144feab49a.html

How labour government squanders £300 billions with PFI schemes

On the face of it, PFI schemes does not sound like a good deal- decide what you want, find someone to supply it, then sign a contract that binds you into a legal straitjacket for decades, during which you pay them 37 times what the item is worth.

Such a deal makes even less financial sense in a country still struggling to escape the effects of the worst slump since the Great Depression. Yet this is what the labour Government's promotion of private finance initiatives (PFIs) to pay for public services has foisted on the taxpayer.

The taxpayer is, in effect, locked into making enormous annual payments for 667 school, hospital and other public-sector programmes with a capital value, or price, of around £55bn. The good news is that more than £37bn has been paid. 

But the overall bill for the contracts is more than £262bn, and this will not be fully paid off until 2047.

And that is not all. With a fresh catalogue of further projects valued at £11bn – in capital costs alone – currently under negotiation, Britain's liability for PFI projects since 1997 could exceed £300bn.

The PFI – the brainchild of the former Conservative chancellor Norman Lamont – was seized upon by Tony Blair in 1997, when he swept into power with a New Labour government determined to show that it could be the party of business. The Government committed itself to keeping the proportion of public debt to gross national product (GNP) below 40 per cent. Financing investment through PFI – with costs kept off the balance sheet – was seen as a way of achieving this, and led Alan Milburn, then health minister, to declare that PFI was "the only game in town".

PFI works on the principle of private firms building various forms of infrastructure – whether roads or bridges, schools, hospitals or prisons – then charging the public sector for using them over lengthy contracts that can run for more than 30 years.

But it has left a legacy of debt that will last a generation, according to unions who have slammed what they say is a credit-card approach to buying-in essential services. Calling for an end to the use of PFI to pay for public sector projects, Brian Strutton, the GMB's national secretary for public services, said: "PFI is building up a legacy of high-interest debt that will last for decades. The public is paying over the odds on PFI projects, with debt ratios in most areas at over 500 per cent. This is like paying for schools and hospitals by credit card."

Jean Shaoul, professor of public accountability at Manchester Business School, said: "They've mortgaged the future in the most profligate way... we have a government that acts in the interests of a financial oligarchy. Using the private sector as an intermediary to raise finance to build hospitals and to run them is extremely expensive and far more expensive than if the Government were to do it itself."

A case in point is the Norfolk and Norwich University Hospital, where the PFI consortium made tens of millions on a deal described by the Commons' Public Accounts Committee as "the unacceptable face of capitalism".

Firms have also made millions in profit by putting up the money for IT programmes that have become so expensive the Government now frowns on PFI being used to fund them. To take only one case: payments for the Crown Prosecution Service's Compass IT system come to £670m over the 10 years of the contract, 37 times the £18m capital value.

And the nature of PFI deals means that payments still have to be made even if the project is abandoned. Balmoral High School in Belfast closed six years after it was built, when pupil numbers halved. However, the Northern Ireland Department of Education owes the contractor £370,000 a year for the next 18 years.

Making changes to PFI-funded buildings and projects can cause costs to spiral. A 2008 National Audit Office report found that £180m a year is paid out for contractual amendments. And it highlighted extortionate charges for routine maintenance – such as £302 for an electric socket to be fitted, £47 for a key, and almost £500 to fit a lock.

Peter Dixon, chief executive of University College London Hospital – which pays some £43m in PFI charges a year – says that inflation is a real fear. "If we run into a bout of inflation, because all these payments are index-linked, then we are in trouble, all of us."

He described the arrangement as "expensive and inflexible", but added: "For the past 12 years the only way you were going to get a brand new hospital was by the PFI route... people knew they weren't cost effective but it was the only way they could get funding."

But a Treasury spokesman said: "PFI has a good record of delivering to time and budget, and represents good value for money over the whole life costing by telling us what it will cost to build and manage our assets."

Contracting out: Familiar faces with PFI connections

Alan Milburn MP
He famously described PFIs as the "only game in town" during a stint as health minister, and is now a director of Diaverum Healthcare – a company that is contracted to run the kidney dialysis unit at the PFI-funded Burnley General Hospital.

Quentin Davies MP
The Defence minister is a former director (he resigned in 2008) of Vinci UK and Vinci SA – firms involved in PFI projects with a total capital value of £223m which will cost £933m over the terms of their contracts.

John Reid MP
The former home secretary is (since November 2009) a paid consultant to G4S UK and Ireland. G4S is involved in PFIs, mainly in prisons, with a total capital value of £330m; they will end up costing £3.6bn.

Steven Norris
Once Conservative Transport minister under John Major, he is now the chairman of Jarvis, a major PFI player which has a number of contracts, worth £721m, with government. The total capital value of PFI programmes funded by Jarvis comes to £175m.

Adam Ingram MP
A defence minister for six years under Tony Blair, he now gets paid more than £50,000 a year as a consultant to Electronic Data Systems – an MoD contractor responsible for the PFI-funded Tafmis IT system which cost £171m over its 10-year contract.

Patricia Hewitt MP
During her tenure as health secretary, BT won IT contracts from the NHS. The former minister is now a director of BT Group and was paid £59,475 for 140 hours' work over the past six months – a rate of £424 an hour.

PFI initiatives - the Lords' inquiry

The continuing flaws in the PFI option have been exposed in evidence to a House of Lords inquiry into the system.

A consultant, T Martin Blaiklock, said the Government had used the PFI option "like a credit card". He added: "It allows payments, which would normally be due to be paid today, to be paid at some future date. The key is to know when to use it, for what, and for how much."

The British Medical Association said: "PFI appears to be an unnecessarily costly and short-sighted means of building new hospitals."

But the Confederation of British Industry claimed that PFIs had helped to deliver a broad range of modern projects with "high-quality services and maintenance activities".

It added: "Without this long-term investment, the UK would not have the infrastructure required to support our economy, nor the public services that are needed."

The soaring cost to taxpayers

Queen Mary's Hospital, Roehampton Cost £73.5m to build, but will cost taxpayers in excess of £340m by 2034.

John Radcliffe hospital, Oxford Taxpayers will have to pay back £832m for key developments at a hospital which cost £134m to build.

Queen Elizabeth Hospital, Greenwich Trust is locked into a PFI deal costing £9m a year more than if it had borrowed money from the Government. Last year it admitted its PFI contract is "underfunded" by £8m to £10m a year, and it was also carrying debts of £65m.

Norfolk and Norwich University Hospital The 953-bed hospital will cost not £229m, as announced in 1998, but £16bn, including PFI charges, staff and equipment. Rent costs are £800m until the end of the contract in 2037.

Paddington Health Scheme £900m super-hospital abandoned in 2007; costs rose £300m to £894m and finish date slipped to 2013.

Leicester hospitals Pathway Project Costs up from £711m to £921m; scrapped in 2007.

University College London Hospital PFI project, rose from £120m to £430m or so in the three years prior to signing off on the deal.

From:

http://www.independent.co.uk/news/uk/politics/iiosi-special-investigation-how-government-squanders-billions-1877276.html

Labour's computer blunders cost £26bn- and rising

Labour ministers blamed for 'stupendous incompetence' after taxpayers are left with huge bills for bungled IT projects.

A series of botched IT projects has left taxpayers with a bill of more than £26bn for computer systems that have suffered severe delays, run millions of pounds over budget or have been cancelled altogether.

An investigation by The Independent has found that the total cost of Labour's 10 most notorious IT failures is equivalent to more than half of the budget for Britain's schools last year. Parliament's spending watchdog has described the projects as "fundamentally flawed" and blamed ministers for "stupendous incompetence" in managing them.

Further evidence has emerged over the failings of Labour's most costly programme, the mammoth £12.7bn IT scheme to revolutionise the NHS. 

Following Health Direct's post last week- Labours' only success- wasting taxpayers money, the Independent has repeated that just 160 health organisations out of about 9,000 are using electronic patient records delivered under the scheme. 

The vast majority of those were GP practices. New figures have also revealed that millions of pounds have been paid out in legal fees. The taxpayer has footed a £39.2m bill for "legal and commercial support" for the National Programme for IT (NPfIT).

Alan Milburn, the former health secretary, said in 2001 that everyone would have access to their health records online by 2005, but it is understood that the Department for Health is still "years away" from fulfilling the pledge.

Government departments right across Whitehall have been guilty of overseeing embarrassing IT failures. A project that was meant to save the Department for Transport (DfT) about £57m eventually cost £81m, and workers at the Driver and Vehicle Licensing Agency (DVLA) were forced to brush up on their language skills when computer systems gave them messages in German.

Another ill-fated IT scheme, designed to allocate subsidies to farms, cost the Department for Environment, Food and Rural Affairs about £350m and left British farmers more than £1bn out of pocket. Last year the Public Accounts Committee (PAC) warned that the system was already "at risk of becoming obsolete". 

In 2004, the Department for Justice gave the go-ahead for the National Offender Management Information System (C-Nomis) to be rolled out to prisons and the probation service in an attempt to make sharing information about offenders easier. But in 2007, when the estimated cost doubled to more than £600m and senior officials questioned the validity of the project, it was abandoned – after £155m had been wasted.

The MoD's Defence Information Infrastructure project is currently running more than £180m over budget and 18 months late, and is now set to cost £7.1bn. Last year, Edward Leigh, chairman of the PAC, said: "No proper pilot for this highly complex programme was carried out, and entirely inadequate research led to a major miscalculation of the condition of the Department's buildings in which the new system would be installed."

Other botched IT projects include the identity cards scheme; the Libra system for modernising magistrates' courts; an attempt to move the Government's GCHQ computer systems into a new building which ended up costing more than £300m; the Benefit Processing Replacement Programme; and the Foreign and Commonwealth Office's Prism system.

IT experts blamed ministers for being too easily wooed by suppliers. Insiders said a lack of expertise within the Government about the technology industry meant they were willing to believe claims made by major IT firms before contracts were awarded.

Several projects are now under renewed threat of being cut back or abandoned altogether as Alistair Darling, the Chancellor, has targeted them as an area of government spending that can be reined in as he attempts to tackle Britain's record £175bn deficit.

Tony Collins, an expert on the Government's IT failures, said Labour had displayed an "irrational exuberance" for IT projects that has often led them to throw good money after bad at failing schemes. "There are too few people in the hierarchy of Labour who understand IT enough to understand that it is not a talisman – there is nothing magical about it."

David Cameron, the Tory leader, has signalled a move away from big IT projects, suggesting he will use technology to increase the transparency of government. "It is easy to make these noises out of office," said Mr Collins. "Once you've got civil servants giving you a host of reasons why you should not be more open, I fear the Tories will sink into the same depths of secrecy that Labour has found itself in."

Botched projects: The cost of failure
£12.7bn National Programme for IT (NHS)

It was meant to revolutionise the way the health service worked. But far from heralding a new age of efficiency, the National Programme for IT is now widely perceived as the greatest government IT white elephant of history. 

As well as the huge costs involved, suppliers have walked away, projects are running years behind schedule, while medical professionals have complained that they were never consulted on what they wanted the new system to achieve.

£7.1bn Defence Information Infrastructure (DII)
It seemed like a good idea at the time. In 2005, the Ministry of Defence decided to offer a contract to a consortium of suppliers to replace the hundreds of different computer systems being used by the military with a single system that would be used by the army, navy and air force, as well as the MoD itself. It was to be used by 300,000 people across 2,000 sites. 

However, it is running more than £180m over budget and 18 months late. A parliamentary inquiry also warned that forces' reliance on older systems put them at risk of a security breach.

£5bn National Identity Scheme
Originally budgeted at £3bn, the labour Government’s plan for new identity cards, containing biometric data and linked to a central database, soon came under heavy criticism from civil liberty campaigners. As the costs spiralled, so the Home Office began to water down the aims of the scheme to assuage the critics.

In July 2009, Alan Johnson announced that the cards would no longer be compulsory, while moves to force all airport workers to use the cards were also abandoned. However thousands are still being wasted trying to get students to sign up as an alcohol proof card.

£400m Libra system (for magistrates' courts)
An attempt to bring records used by magistrates courts into the digital age backfired when trying to introduce one universal IT system to all courts descended into a costly mess. Fujitsu originally bid £146m to deliver the Libra system in 1998. However, the project proved more complicated than anticipated, and costs have now been put at more than £400m.

£350m Single Payment Scheme system (SPS)
The Single Payment Scheme system was designed in 2003 to be a sophisticated way of giving farmers their subsidies, by mapping their land and working out their level of payment. But failures with the IT systems being used mean that farmers were left short-changed. 

In 2006, around £1.28bn of the £1.5bn subsidies destined for British farmers still had not been given out. 

The Rural Payments Agency overseeing the project was ordered to make 23 major changes to the system. Despite the £350m spent on the technology, the Public Accounts Committee warned last year that it was already “at risk of becoming obsolete”.

£300m GCHQ "box move" of technology
When the Government’s intelligence organisation, GCHQ, decided to move its complex computer systems into a new building in 1997, the projected £41m cost was so small that officials believed it could be absorbed within existing budgets. 

That was until the Curse of the Government IT Project struck. Costs of the so-called “box move” soon began to rise out of control. In 2003, the National Audit Office (NAO) put the costs at more than £300m. Edward Leigh, Tory chairman of the Commons Public Accounts Committee, called the original budget “staggeringly inaccurate”.

Now part of the "old office" housing super computers in Cheltenham has been retained in parallel to the new "doughnut".

£155m National Offender Management Information System (C-Nomis)
In an attempt to make sharing information about offenders easier, the Department for Justice gave the go-ahead for the National Offender Management Information System (C-Nomis) to be rolled out to prisons and the probation service. As the estimated cost doubled to more than £600m and senior officials questioned the whole point of the project, it was abandoned in 2007, with £155m already spent.

£106m Benefit Processing Replacement Programme
In June 2006, the Department for Work and Pensions confidently assured Parliament that new funding for its Benefit Processing Replacement Programme (BPRP) had been approved. So it came as a surprise to many when it emerged just three months later that the project had been quietly scrapped. Little information has emerged on why BPRP was abandoned, but the Government has admitted that £106m had already been spent on it before it pulled the plug.

£88.5m Prism IT project
Undeterred by past failures, the Foreign and Commonwealth Office (FCO) thought it would be a good idea in 2002 to order a new computer system for their 200 offices around the globe. The result was the Prism IT project, seemingly a bargain at just £54m. 

However, delays and costs have risen, while the contractor was even forced to temporarily halt the scheme in 2005 while an investigation took place into its various problems. The system has not proved a hit with staff. 

One wrote in 2004: “In all the FCO’s long history of ineptly implemented IT initiatives, Prism is the most badly designed, ill-considered one of the lot.”

£81m Shared Services Centre
To officials at the Department for Transport, the Shared Services Centre seemed to good to be true: not only would it integrate the human resources and financial services of the department and its various agencies, it would even save the taxpayer £57m. 

Unfortunately, those hopes were dashed as the scheme became another example of an IT project going horribly wrong. Workers at the Driver and Vehicle Licensing Agency (DVLA) were forced to brush up on their language skills as computer systems gave them messages in German. It will now cost £81m, a failure in management that the Public Accounts Committee described as a display of “stupendous incompetence”.

TOTAL: £26.3bn

From:

http://www.independent.co.uk/news/uk/politics/labours-computer-blunders-cost-16326bn-1871967.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

Labour delays free hospital car parking again.

Andy Burnham has outlined more proposals to phase out hospital parking charges for in-patients and some out-patients which he says have caused "great resentment".

Mr Burnham origonally announced plans to phase out charges for in patients in September.

The health secretary pledged a "fairer" system for relatives and friends of people admitted to hospital in England.

He is looking at whether to abolish fees for all in-patients' visitors - or just those admitted for a long stay.

For out-patients he will look at free parking, or a cap on charges, for those who need to make regular appointments.

Parking is already free at most hospitals in Scotland and Wales and for certain priority groups of patients in Northern Ireland. Although all PFI hospitals and clinic still charge for car parking.

Mr Burnham announced in September he wanted to phase out over three years charges at hospitals in England for patients who are admitted.

But the eight-week consultation - which runs until 23 February - will also look at charges for out-patients who have to make regular appointments - like cancer patients with regular chemotherapy sessions.

Mr Burnham told the BBC: "I think the time has come for a fairer, more consistent approach to parking across the NHS. Frankly I think it's confusing at present, there are a wide variety of parking schemes."

He added it had "caused great resentment" but the government had to ensure that the costs of running secure car parks were covered.

NHS trusts have argued that some parking charges are necessary to ensure health funds are not diverted towards managing and maintaining car parks.

Mr Burnham said: "We want to have the consultation so we get the balance right, that we don't ask the NHS to do something at a time when there is pressure on its finances that it can't afford. But I believe what we're proposing is affordable."

When Mr Burnham announced plans to phase out charges for in-patients in September, Macmillan Cancer Support raised concerns that it would not apply to people with cancer having treatment as out-patients.

The charity's head of campaigns, Mike Hobday, told the BBC: "MacMillan is really pleased that this consultation could mean free parking for cancer patients who have to go to hospital on average 53 times during the course of their treatment.

"What we need of course is for all political parties to commit to abolishing this unnecessary tax."

http://news.bbc.co.uk/1/hi/uk_politics/8433395.stm

Labour ministers to take control of hospital charity cash

Hundreds of millions of pounds of charity donations to hospitals are to be “nationalised” under an NHS accounting change, which critics say will make it easier to slash health budgets.

Ministers are imposing new rules on NHS charities requiring all donations — including those to specialist children and cancer units, local fundraising campaigns, teaching hospitals and local community trusts — to be listed on a hospital’s balance sheet.

The Charities Commission says that this is “wholly inappropriate” because combining the trust and charity accounts will jeopardise the charity’s autonomy and discourage donations. 

About £330 million was given to 300 NHS charities in the year to June 2008, and they control an estimated £2 billion of assets. A spokeswoman for the Commission said: “The Charity Commission does not agree with the interpretation of the accounting rules in the Department of Health letter to NHS bodies. We are currently engaging with the Department on this matter.”

Charities also fear that the change, due to come into effect in April, will be used as a smokescreen to hide cuts in health spending, with ministers reducing funds for organisations such as children’s hospitals that have successful charitable arms.

Jenny Willott, a Cabinet Office spokeswoman for the Liberal Democrats, said: “This could lead to hundreds of millions of pounds of charitable donations being effectively nationalised under the NHS.

“The Government has no right to get its hands on any charitable NHS funds. People make donations on the understanding that it is up to charities to decide how to spend it, not ministers.”

A source at a leading hospital said that the rule change appeared entirely unreasonable and risked creating unnecessary budgetary pressures and distorted disparities between hospitals with different levels of fundraising ability.

Ministers were banned from counting charitable donations towards the central NHS budget under the original legislation that created the NHS in 1948.

But this looks set to be reversed after the Treasury agreed to implement International Accounting Standard (IAS) 27. Now all NHS Trusts whose trustees have the “power to control” their charitable arm look likely to be forced to consolidate both sets of accounts in one. Estimates of the number of NHS charities affected vary between 30 and 300 organisations.

From:
http://www.timesonline.co.uk/tol/news/politics/article6969955.ece

Health department spent £585m on consultants

The Department of Health has spent £585m – the cost of building a district general hospital – on management, legal and financial consultants over the past four years.

The half-a-billion pound bill “is a huge amount of money”, Kevin Barron, chairman of the Commons health select committee, said. The committee has been pressing the department to disclose the sum and Mr Barron said now that it was public “we will be returning to the issue”.

Spending on management consultancy by the NHS itself is not included in the total – an amount that the Management Consultancies Association estimates to have run to about £300m last year, although that figure is likely to include the department’s own spending.

The Conservatives are promising to slash Whitehall’s expenditure on consultants if they win the general election, with the cash earmarked to help introduce a council tax freeze. They are also promising to cut the cost of Whitehall itself by 30 per cent over a Parliament.

However, the level of spending on consultancy services “shows that, at least in part, the department does not have the capacity and staffing to do the work it needs to do,” warned Alan Maynard, professor of health economics at York university, and an adviser to the select committee.

Under pressure from the committee, the department has agreed to start publishing the NHS’s own spending on consultancy, having originally argued that to do so would amount to “micromanaging” the NHS.

The figures for the department’s consultancy expenditure for the past four years show that since 2005/06 it has spent £133m, £205m, £132m and £125m last year – a total of £585m.

A breakdown has been provided for last year only. Then, £93m was spent on general consultancy, about £23m on financial and commercial advice and some £8m on legal consultants. Just over £19m of the total was spent on Connecting for Health, the NHS’s £12bn IT programme.

The spending is spread over more than 120 consultants and advisers. The top three earners were Ernst & Young at £12m, McKinsey at £9m and QI Consulting at £7.1m. The top five, who include PA Consulting and KPMG, accounted for 30 per cent of the total.

Expenditure over the past four years is marginally distorted by the £205m spent in 2006/07 when the department bought in private sector “turnround teams” to sort out the NHS’s then £1bn deficit.

“That was an important thing to do,” Mr Barron said, “and Patricia Hewitt’s determination to sort that out was one of the bravest decisions a secretary of state has taken for a long time”.

But even allowing for that, spending is running at about £130m a year “and we do have real concerns about the ongoing cost of all this,” Mr Barron added.

The MCA argues that its estimate of total spending by the NHS amounts to less than 0.3 per cent of the NHS’s total budget. It is currently agreeing a concordat with the department aimed at ensuring that the NHS gets value for money from consultancy contracts.

From:

http://www.ft.com/cms/s/0/36e48e44-c715-11de-bb6f-00144feab49a.html

Fall in proportion of patients who pay for private health care

The proportion of patients who pay for their own operations– through private medical insurance or out of their own pocket– has tumbled almost 30 per cent since Labour took power.

By 2008, however, that figure had fallen to 10.6 per cent, with just over 900,000 patients being treated privately against 7.7m who were funded by the NHS, according to Laing & Buisson in its annual Healthcare Market Review, the bible of the private health industry.

The proportion is likely to have fallen further since then, given a rise in patients choosing NHS-funded care in a private hospital and a steep decline, caused by the recession, in the numbers paying with their own money.

William Laing, chief executive of Laing & Buisson, said: “This remarkable reduction in the privately funded share of elective surgery is not because private healthcare is in decline.”

The numbers choosing to pay for themselves have fallen 20 per cent or more over the past couple of years to just 16 per cent of private hospital income in 2008 against more than 22 per cent a few years earlier.

Until recently, however, the numbers covered by private medical insurance had held up well.

“The main reason for the falling private share is that NHS-funded surgery has been growing so much faster, aided by the massive injection of public spending during the last decade,” Mr Laing said.

The number of cases paid for by the NHS in private hospitals jumped from just above 50,000 in 2007 to 151,000 in 2008. Those numbers are still rising as NHS patients’ rights to choose a private hospital begin to take off. On top of that – and not included in these figures – are approaching 100,000 NHS patients a year being treated in the independent private sector treatment centres that were set up to provide NHS care.

But Mr Laing said the extra business “has been a mixed blessing” for private sector hospitals. NHS work offers a lower profit margin. “If and when” self-pay work revived, many of the private operators would wish to return to their core private market. The big question, he said, was whether any private operators had the appetite to invest in additional, lower cost, facilities aimed at servicing the NHS. 

The ISTC programme, where some contracts were cancelled and the fate of those contracts that are coming up for renewal is uncertain, “has dented providers’ confidence in the government’s long-term intentions,” Mr Laing said.

Patients are to be given a legal right to seek treatment at a private hospital if the NHS fails to honour its promise to treat them within 18 weeks, according to government insiders. The measure is expected to be included in the Queen’s Speech this month. The same entitlement is likely to apply to the pledge that patients with suspected cancer must be seen by a specialist within two weeks.

Patients can already choose to receive their NHS funded care for non-urgent procedures at a private hospital – although it is not routinely possible to switch to private care once diagnosis and treatment are under way.

Labour has already said it will turn its 18-week wait target into an “entitlement”. The move to make it a legal right is at least partly political, with Labour ministers planning to challenge the Conservatives over whether they would repeal such a measure.

From:
http://www.ft.com/cms/s/0/b364c9c6-c72d-11de-bb6f-00144feab49a.html?nclick_check=1

Labour blows more money on websites as patients urged to rate GPs online

Patients will be able to praise or criticise their doctor on a health website- but the nanny state will not allow us to actually name the person.

Patients are being encouraged to rate their GP surgeries on a new NHS website designed to drive up standards in primary care.

At www.nhs.uk, patients will be able to post comments ranging from how they were treated to whether it was easy to book an appointment.

But mentioning staff by name will not be allowed, say health officials.

The website will compare the 8,269 GP practices in England only.

The health minister Mike O'Brien said the website was part of plans to modernise the health service.

He said: "As we open up real choice in primary care, it is vital we equip patients with enough information to make the right choice for them. This new tool allows every single GP practice in the country to see the patient's view on what they are doing well and what needs to be improved.

"It will help drive up quality across the board, and is another step in ensuring we have a modern NHS which reflects the needs of the patient," he added.

There are 23 million visits to GP practices and related services every month.

In September, ministers announced they wanted to abolish GP boundaries, allowing patients to register with a practice of their choice.

Yet another similar site to compare the performance of hospitals is already up and running.

From:

http://news.bbc.co.uk/1/hi/health/8306041.stm

NHS dental crisis- can the rot be stopped?

New figures reveal over 40 per cent of the population has no NHS dentist. Can a new review finally fix the system once and for all?

Not that long ago we were queuing in the streets for an NHS dentist, with scenes of hundreds of patients camping overnight likened to the January sales. Now, new figures suggest that many of us have given up, and are paying for private treatment or simply going without care if we cannot afford it.

Data from the NHS Information Centre released last month shows that only 58.3 per cent of the population saw an NHS dentist in the two years ending March 2009, with the number of complex treatments, such as root canals and crowns, falling dramatically, by 40 and 50 per cent respectively, since 2004.

Ironically, the parlous state of NHS dentistry seems to have been exacerbated by the very attempt to overhaul it – labour's 2006 dental contract.

The new contract was intended to end the old "drill-and-fill" practice whereby dentists were paid for each treatment they carried out, so the more procedures they undertook the higher their earnings. The idea behind the new contract was to encourage dentists to spend more time on preventative work, teaching patients how to care for their own teeth, thereby reducing future treatment.

Dentists are now paid a fixed contract value for the amount of work they do each year. Work is measured in UDAs (units of dental activity). Dentists now essentially have "UDA targets" to meet each year. Under the new contract, their salaries have not been cut as they had been in the early Nineties, which led to an exodus to the private sector. 

Dentists are free to choose whether to provide NHS or private treatment, or a combination of the two. While many NHS dentists' basic pay is around £90,000 in large practices, but in areas where NHS practitioners are few and far between, they can make a lot more.

Around 400 practices earn up to £300,000 a year, shared among several dentists. Private dentists earn little more – one survey in 2005 by the Health and Social Care Information Centre estimated the gap at no more that £800 a year. Most claimed to have left the NHS due to the pressure of working harder for less money, with less time to spend on each patient.

Local Primary Care Trusts (PCTs) were given responsibility for providing dental care in their areas. It is they who employ dentists, and it means that managers can offer incentives to dentists to work in their area, and thus increase patient access, eradicating once and for all the problem of how to get on an NHS dentist's list.

But, despite these good intentions, the situation appears to have deteriorated further. According to figures from the NHS Information Centre, last year nearly 50 per cent of NHS dentists did not take on any new patients. In addition, 2,000 dentists have left the NHS since 2006. So what has gone so badly wrong?

The flaws are fundamental, says Liberal Democrat health spokesman Norman Lamb. "Many good dentists have become fed up with NHS bureaucracy, voted with their feet, and left the profession. So there is a danger that while not all the NHS dentists left are second rate by any means, we could end up with a two-tier profession."

Lamb believes that the financial disincentive to carry out complex work is so serious it threatens to "de-skill" the profession and that far from encouraging the public to look after their teeth, "there is no incentive for the dentist to do preventative work at all."

The public are not happy, says Dr Anthony Halperin of the Patient's Association."Simple procedures can end up costing the patient more than before, while there is no incentive for dentists to perform complex and time-consuming treatment. Most of all, the overwhelming public complaint is access."

The majority of dentists are unhappy, too. One complained: "If you take on a new patient who has not been to the dentist for a few years, they might need a lot of work, and you are effectively penalised for doing it. Under the new contract, whether a patient needs one filling or 10 fillings, the dentist gets paid the same."

Dr John Milne, chair of the British Dental Association, the professional association and trade union for dentists, adds that many complain that "the target-driven nature of the existing contract has made life difficult". If a PCT has set targets for the number of procedures it expects to be completed, many dentists are left with no time to teach their patients about hygiene.

So what is the answer? Professor Jimmy Steele, Head of the School of Dental Sciences at Newcastle University led the recent independent review of NHS dentistry, which has just published a set of recommendations aimed at redressing the problems of access and receiving appropriate treatment (for patients) and bureaucracy and pay (for dentists). It has been Prof Steele's unenviable task to pick apart the 2006 contract and put it back together, making it work at no extra cost to the taxpayer.

"The 2006 contract was intended to make fundamental changes in thinking. Dentistry had been pretty much unaltered since the birth of the NHS in 1948," he says. "The idea was that the PCT would be able to buy what they wanted on behalf of their patient, making better use of resources. Previously dentists had been able to move around to where they wanted there was no ability to fit services to local needs."

In effect, dentists could set up an NHS practice where they wanted to live, not necessarily where one was needed. "The idea of local commissioning is sensible," he adds. "Access problems should have been addressed in time."

The new contract also aimed to simplify payments. Previously, dentists billed the NHS centrally for any one of 400 different procedures. The more work they did, the more they got paid. "The new system, where contracts are paid on UDAs in three bands is probably too simple," says Prof Steele. "The payment bands are wide and differ depending on where the dentist is located, on their history, sometimes on their negotiating skills."

Dentists earn one UDA (worth between approximately £17 and £40) for a simple procedure such as a check-up, three UDAs (worth about £75 on average) for any number of fillings (in one appointment), or 12 UDAs (worth about £300) for crowns or dentures, in addition to any other treatment.

"The system is open to misuse," says Prof Steele. "It is possible to take one tooth out and make an impression for a denture and then charge 12 UDAs which is clearly not as complex or difficult as root canal work which pays only a quarter of the fee."

Incentives to take on new patients are not having the desired effect. Far from encouraging dentists to see more patients, it has become easier to make a living seeing existing patients more often. One of the biggest problems is taking time to put a mechanism in place for centrally collecting data, so it is difficult to know where and how the system isn't working.

So do we need to start again from scratch? Prof Steele thinks not: "When we carried out the review it became clear that access is improving, but there is a communication problem. The public didn't know how to find an NHS dentist. Meanwhile the PCT claimed that they were running plenty, and that all the public needed to do was ask. The public would then be saying, 'what's a PCT?' Better communication could sort that problem out easily."

Prof Steele is also recommending improvements in payment methods. "We need a blended contract, where a dentist is paid for every person on his list, and also for every treatment he carries out. We don't want people under-treated any more than over-treated. There also needs to be a reward for quality so we need to get data back into the system."

While Prof Steele approves of the scheme of local commissioning, Norman Lamb warns that PCT managers may not be ready. "We need to train them better, a lot of them are far too passive. You do get pockets of excellence but many don't have the skills they need."

Shake-ups, however worthy, cost money, and increased investment is unlikely. Dentistry is threatened by the spectre of financial cuts, as part of cuts in public services, regardless of who wins the next election.

So while the Patients Association has welcomed Prof Steele's review, Dr Halperin, a dental surgeon who does both NHS and private work in central London, says: "We are concerned that because of funding problems, once again there will be no real improvement in the dental contract and subsequently no improvement to the services for our patients."

The biggest challenge says Dr Milne, is to get all political parties to recognise the value of Prof Steele's report. "We need to embrace it; it is our best chance of providing a dental service of which we can all be proud."

Dr Milne is also optimistic: "The number of dentists in training is increasing, but we need to make the NHS an attractive place to work. And dentists who have left will only return if the NHS offers them the chance to treat their patients properly. Some might even be quite excited at the chance."

From:
http://www.telegraph.co.uk/health NHS-dental-crisis-Can-the-rot-be-stopped.html

The new CRB check nanny state paranoia won’t stop another Soham

"I helped to catch Ian Huntley and I know these new stupid rules would not have prevented his crimes." Health Direct reproduces the article below by Chris Stevenson who is a retired detective chief superintendent. 

In 2002 I was a senior detective with Cambridgeshire police. That August two ten year old girls disappeared, and I took over the investigation. Two days later I set up the surveillance operation that led to the arrest of Ian Huntley and Maxine Carr a few hours later.

Huntley has not been a free man since. He was convicted of the murders of Holly Wells and Jessica Chapman in December 2003.

Last weekend my actions came back to haunt me. My wife and I went to Benson, Oxfordshire, to celebrate the birthday of my nine-year-old grandson. We went off to see him play as goalkeeper for his village under-10s football team. Mum and dad, sisters, uncles and both grandparents were there to cheer him on.

One of my hobbies is photography, so I took my camera to take a few “action shots” of my grandson. Ten minutes later I was approached by the manager, who said: “Can I ask you not to take photographs, it’s against the regulations. You have to get permission in writing from every parent of every child.”

I felt humbled. I am now a suspected paedophile — along, I fear, with millions of other parents and grandparents. 

I looked at the pictures I had taken. They were of my grandson making saves as his team came under pressure. I am sure he would have liked to look back on them in the future. Who knows, he may be England’s goalkeeper at a future World Cup, although it’s a remote chance. I deleted the photographs.

The furore that has gripped the nation since the Soham murders has made us all paranoid. Is this in children’s interests? The latest “regulations” will require us to be checked by the Criminal Records Bureau if we give lifts to children going to Scouts or similar activities.

Commentators constantly refer to Huntley and the events in Soham as the reason for this. I am sure Sir Michael Bichard, who chaired the inquiry into the murders, did not intend such a wave of recrimination over one case. Yes, changes were necessary: Huntley lived a charmed life in Humberside, where he was investigated for a number of crimes. He was charged with rape, but after he spent a week in custody the case was dropped for lack of evidence.

As a result of poor intelligence, Huntley was appointed a school caretaker in Soham. Did that give him access to children? Yes, hundreds. Did he abuse them? No. In fact he reported to the headteacher that several teenage girls had made inappropriate comments. 

What Huntley did to Holly and Jessica was as bad as it gets, but did he come into contact with them through being a caretaker? Not exactly — he was caretaker of Soham Village College, a school for the over-11s. The two girls attended St Andrew’s Junior School. Different building, different caretaker. Huntley had contact with them because Carr was employed at St Andrew’s as a classroom assistant. 

She worked in a class with Holly and Jessica, who both liked her. Holly’s mother sent Carr a box of chocolates on the last day of term to say thank you for helping her daughter.

The girls were sorry when Carr was not given a permanent job. This was what led them to Huntley.

Out for a ramble around Soham on the Sunday evening, they stopped outside Huntley and Carr’s house to ask after Carr. Huntley told the media that they were sorry she hadn’t got the job.

Tragically, she was away, visiting her family in Grimsby. It was the first time they had been apart overnight since their relationship started. Huntley was in a bad mood as Carr had told him she was going to her second party in successive nights. He was alone. Somehow he conned the girls into the house and they were never seen alive again.

Did he achieve this because he was a caretaker? He could have been in any occupation, lorry driver, architect, anything, and lived with a woman that the two girls knew and trusted. And were right to, as I am convinced that Carr would never have done anything to hurt them.

How do we prevent such chance encounters happening? We can’t. No amount of legislation, record keeping or checking could prevent this type of crime completely. Thankfully it is extremely rare. Children are far more likely to be killed by a family member or on the roads.

Only recently a young girl was murdered by her mother’s partner. There is a suggestion that she had been sexually abused. He then hanged himself. The girl’s mother described him as loving, caring and the last person she would expect to do anything like that. We await the inquest, when it will be asked if the killings could have been prevented. I doubt that the answer will be yes.

We are subjecting our whole community to paranoia. On Friday a BBC journalist announced on breakfast television that “a million children are being abused”.

Where do these figures come from? How do we know? Are we feeding the paranoia that stops a grandfather taking a picture of his nine-year-old grandson playing football? Surely this cannot continue. Someone needs to put things back on an even keel.

Chris Stevenson is a retired detective chief superintendent

From:
http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article6834362.ece

Child vetting database will cost £200 million and create 1,450 jobs in Labour marginal

The total cost of the child vetting scheme is expected to soar close to £200 million – and will lead to the creation of around 1,450 jobs in a key Labour marginal constituency.

Public bodies such as the NHS and the Prison Service will be forced to spend millions of pounds registering their employees on the scheme at a time when their budgets have already been squeezed.

Almost all of the NHS’s 1.3 million employees will have to join at a cost of around £83m. The Local Government Association has already warned about the increased cost to councils and their staff.

Labour Ministers will have to sanction a huge spending increase as the Criminal Records Bureau employs 582 staff who dealt with 3.9 million cases last year, or 6,700 cases per employee.

By contrast, the Independent Safeguarding Authority (ISA) has 250 staff whose case load will soar to 45,200 cases per employee as they reach the target of monitoring one in four adults. If, as expected, the ISA processed the work at the same rate as the Criminal Records Bureau it will require 1,686 employees, up 1,430. The staff bill will rise to £43 million.

It will provide a timely jobs boost for Darlington, where the ISA is based, which is a key election battle ground. Alan Milburn, the former Labour Cabinet minister and local MP is standing down at the election in a seat which until 1992 was Conservative held.

James Dawkins, Research Associate at the TaxPayers’ Alliance, said: “The Criminal Records Bureau already struggles, at huge cost, to do its job and this task is more complex and larger. While taxpayers and the people forced to undergo the ISA’s checks will lose out, the only people to benefit will be the army of bureaucrats needed to attempt the impossible. The Government have already created far too many quango jobs, and the last thing taxpayers need is yet more officials on the public payroll.”

Tom Brake, the Lib Dem home affairs spokesman, said: “The new database is not only a disproportionate response to the problem it is trying to solve, it is also a very expensive proposal. It is not clear that asking public bodies to pay millions to prove their staff are not sex offenders will significantly enhance the safety of children. Asking people to pay £64 to prove their innocence may put a lot of them off working with children.”

Parents who do not register for driving their children's friends to a sports event or Cub or Scout meeting face fines of up £5,000.

From:
http://www.telegraph.co.uk/Vetting-database-will-cost-200-million-and-create-1450-jobs-in-Labour-marginal

Health Direct applauds labour U Turn as NHS to end premium rate telephone call charges for patients

Health Direct has long campaigned for the end of a stealth tax on booking doctors appointments through the use of premium rate sex charge telephone calls.

Charges under which patients pay more than the cost of a local call from a landline are being scrapped in England after a consultation.

As we reported in 2007, many NHS organisations use numbers starting with an 0844 or 0845 prefix, which can be up to 30p a minute more expensive to call than a standard local number.

Patients will still dial 084 numbers to get through but tariffs will be adjusted to ensure that they pay only for the cost of a local call, ministers said.

Mike O’Brien, the Health Minister, said: “We have been concerned that some people are paying more than the cost of a local-call rate to contact the NHS. For people on low incomes, and for those who need to contact their doctor or hospital regularly, these costs can soon build up.

“We want to reassure the public that when they contact their GP or hospital, the cost of their call will be no more expensive than if they had dialled a normal landline number.”

A letter will be sent to NHS organisations informing them of the changes this week, while amendments will be made to GP contracts over the coming months.

Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, said: “Patients who call their surgery because they’re ill shouldn’t be penalised because they have to call an 084 number, so we’re pleased that the phone companies who supply these lines to practices have agreed to ensure that their tariffs are in line with local charges.

“Combining the benefits of 084 numbers with an assurance that they won’t cost more than a local phone call is the best solution for patients and practices.”

Katherine Murphy, director of the Patients’ Association, said: “It’s great that the Department of Health has listened to patients. Asking them to pay extra costs for phone calls was unreasonable. Patients have had to wait long enough for the ruling-let’s hope the change happens as quickly as possible.”

Whilst the U turn spin is welcome, no definitive date was given for the time by which these stealth tax charges should be abolished.

2 Health Petitions- via the Number 10 website

Two petitions for you kind consideration- the abolition of sex rate charge numbers  to book doctor appointments and to prevent the closure of a thriving hospital:

Local health centres and NHS medical practices should be banned from using 08 numbers or offer a local 01 or 02 number alternative for booking appointments, as health centres make a profit using these numbers. For example, an 0870 number costs 10 pence per minute (whereby 4.5pence per minute goes to the local hospital).

http://petitions.number10.gov.uk/Healthtelephone/

Deadline to sign up by: 28 November 2009 –

Ipswich Hospital needs to be kept as a modern and thriving centre of excellence, the public need Ipswich Hospital to remain available to them and this means providing full services, and giving our consultants the support they need to serve the wider community.

The public in this area of the country are frequently ignored for raising real concerns regarding lack of access to services and our medical teams must be supported and heard. Stop taking vital services away, it is not cost effective and it is downright dangerous!

http://petitions.number10.gov.uk/IpswichHospital

Deadline to sign up by: 21 July 2010

Cancer postcode lottery- London patients get three times more funding than those in Leicester

The full extent of Britain's postcode lottery in cancer care has been laid bare by research showing some health trusts are spending three times as much per patient as others.

Huge variations in funding mean that cancer sufferers' chances of being given life-extending drugs, surgery, and specialist care vary wildly from one part of the country to another.

While the average amount spent on a cancer sufferer in some parts of London is almost £15,000 a year, in Leicestershire it is less than £5,000.

Cancer experts said the research, carried out by The Sunday Telegraph, exposed a "grotesque lottery" in which life-and-death decisions were routinely being made by bureaucrats who were "unelected, unaccountable and unqualified" to make the rulings.

The figures obtained by the paper give the most detailed picture so far of the postcode lottery in cancer care.

Data from 150 Primary Care Trusts for 2007/2008 detailing cancer funding was divided by separate NHS records showing the number of cancer sufferers in each area.

Average spending was highest in Tower Hamlets, in East London, where cancer patients were allotted £14,697 for the year.

Those living in the cities of Birmingham, Leeds and Manchester all received average funding of at least £12,500.

Spending was lowest in Leicestershire and Rutland, with just £4,989 allotted to the average patient; about £500 more was spent in Harrow, North London, Hampshire, Northumberland and North Yorkshire.

Last year a study of patients with advanced cancer showed a tripling in the life-expectancy of those given drugs which many PCTs refuse to pay for.

Research on patients treated by University Hospitals Birmingham Foundation Trust compared the fate of 40 given the drugs Sutent and Nexavar for kidney cancer with 40 whose requests for funding were denied.

Those given the drugs survived 22 months, while those denied them lived just seven months, the study found.

Prof Nick James, director of research and development at University Hospital Birmingham, said: "A lot of PCTs are severely restricting access to drugs which can make a substantial difference to survival".

While PCTs across Birmingham had agreed to fund many drugs for cancer patients living within their borders, those living further afield could only secure the same treatment if they won lengthy battles with bureaucracy, Dr James said.

The oncologist and professor of oncology at the University of Birmingham added: "Clinicians and patients in some areas are forced to battle continuously with bodies which are unelected, unaccountable and unqualified".

He said that patients and doctors wasted "hundreds of hours" drafting appeals, writing to MPs and campaigning in the local media in an attempt to be heard by PCTs who often failed to even reply to correspondence.

The research found that PCTs across the country spent an average of £7,807 on cancer patients per year.

Jonathan Waxman, professor of oncology at Imperial College London, accused the labour Government of devising a "grotesque lottery" of local decision-making by PCTs in order to duck the blame for difficult decisions.

He said: "It is an absolutely absurd system, which is exposed by this excellent investigation. These discrepancies in funding are the reason people die.

"Why should how you are treated depend on where you live, and on decisions made by 150 different organisations who don't have specialist knowledge of the patient?"

The study found the gulf between funding allocated in different parts of the country was growing.

Figures analysing spending per head of population showed the highest spending in Leeds, at £157 per head, compared with just £48 per head in the London boroughs of Camden and Newham.

The gap between the PCTs spending the most and those spending the least per head of population (weighted to take account of the health of the local population) increased from £70 to £109 between 2006/2007 and 2007/2008.

Cancer charities expressed alarm at the extent of the differences revealed by the research.

Sarah Woolnough, head of policy at Cancer Research UK, which raises funds to find treatments for cancer, said: "These huge variations in how much PCTs spend are worrying. We urge the Government to ensure that all PCTs deliver an efficient and high quality service for cancer patients in the face of predicted NHS cutbacks".

Mike Hobday, from Macmillan Cancer Support, said: " We know there are some PCTs which say yes to everything, and others which almost always say no, and that is something that we are concerned about.

"Some variation is to be expected, and in fact is necessary to meet the needs of particular populations, but it is really important that those commissioning services examine these findings closely".

Dr Peter Marks, director of public health at NHS Leicestershire County and Rutland, said its local death rates for cancer were significantly lower than in the rest of England, while survival rates for specific cancers were similar, and in some cases better, to those elsewhere.

Shadow Health Secretary Andrew Lansley described the findings as "extremely concerning".

He said: "Britain languishes near the bottom of the table in Europe when it comes to five year cancer survival rates. It's clear that ministers' promises to improve access to cancer drugs and treatments are ringing hollow for many vulnerable patients."

From:
Cancer-lottery-London-patients-get-three-times-more-funding-than-those-in-Leicester

NHS staffing crisis as one in 20 health professional posts remains unfilled

More than one in 20 posts in the NHS are being left unfilled official figures show as Trusts are forced to spend up to £150,000 to fill each job with agency workers.

The NHS Information Centre found that the number of job vacancies for hospital doctors, dentists, nurses and midwives rose for the first time in five years.

Staff retiring or leaving the sector and the impact of cuts to doctors’ hours are likely to have contributed to shortages across England. London is especially badly hit.

Doctors’ leaders have been heavily critical about the impact of preparing for the European Working Time Directive, which came into force on August 1st.

The directive, which has reduced the maximum working week for junior doctors and other staff by the equivalent of one working day — from 56 hours to 48 — means that a significant number of hospitals are relying on agency staff to plug gaps in their rotas.

As The Times reported last week, the College of Emergency Medicine said that pressure was greatest on “middle-grade” doctors with at least four years training, who would be typically asked to cover shifts in Accident and Emergency (A&E) wards at evenings and weekends.

Trusts are spending tens of thousands of pounds to fill vacant posts with agencies charging between £90 to £95 an hour to provide a middle-grade doctor to staff units when a senior consultant is not present.

The health service spent more than £584 million on employing agency staff in 2007-08, the latest year for which full data is available.

The British Medical Association, the Royal College of Surgeons and the Royal College of Paediatrics and Child Health have been heavily critical of the changes.

Doctors can opt out of the directive on a voluntary basis, but only individually, throwing rota planning into “chaos”, according to senior doctors. They want whole departments or specialities to be allowed to suspend the rules.

John Black, the president of the Royal College of Surgeons, called last week for the 48-hour limit to be postponed or suspended if during the swine flu pandemic, if the NHS has to cope with an expected surge of illness this winter.

The staff vacancy figures, compiled in March, showed that total vacancy rates are also up across most staff groups, rising to 5.2 per cent compared to 3.6 per cent in the same month last year. Three month vacancy rates jumped two thirds from 0.9 per cent to 1.5 per cent.

Of the total number of vacant posts, one in five had been left unfilled for three months or more.

Unions have already warned that a large number of nurses and midwives are due to retire in the next decade and among qualified nursing staff total vacancies rose from 2.5 per cent in 2008 to 3.1 per cent. Long-term vacancies also increased from 0.5 per cent to 0.7 per cent at the end of March.

Among midwives, vacancies increased from 2.1 per cent in 2008 to 3.4 per cent, with long term vacancies accounting for about one in four of all midwife vacancies.

The Royal College of Midwives has called for 5,000 extra staff to be recruited in order to improve care for mothers and babies, but it says the Government has only promised funding for the equivalent of 3,400 posts.

The figures show that London has the highest long-term vacancy rate among qualified nursing staff with the 3 month vacancy rate increasing from 1.2 per cent in 2008 to 1.6 per cent this year.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6741241.ece

Nearly 400 NHS dentists earn more than £300,000

Nearly 400 NHS dentists earned more than £300,000 last year, new figures show, despite millions of patients struggling to access free treatment.

In total almost 1,200, or one in every 20 dentists, earned more than £200,000 between 2007 and 2008, three times as many as the previous year.

The rising number of dentists earning what were described as "staggering" sums was revealed just a day after it was disclosed that some GPs now make up to £380,000 a year.

The payments come despite the fact that 3 million fewer patients are seeing an NHS dentist since a new contract was introduced in 2006.

Official figures show that dentists are carrying out greater numbers of treatments per patient than in the past, as well as more complicated procedures.

Those in the highest earning brackets also put in longer hours, with the majority working more than 45 hours a week, the figures, released by the NHS Information Centre, show.

The income is before tax but after expenses, which typically include the costs of renting surgeries and paying staff, have been taken into account.

The figures, based on dentists' tax returns, include those who work solely for the health service as well as dentists who have a mix of NHS and private work.

They show that 382 of the 20,000 dentists in England and Wales earned more than £300,000 last year, while 1,172 earned more than £200,000. The average income was £89,062.

The new contract was deeply controversial among dentists and around 1,000 left the NHS before it was even implemented.

Problems included quotas to carry out a certain amount of treatments every year.

Dentists who reached their target too soon were effectively asked to work for free, while those who failed to reach the quota faced demands from their local healthcare trust to pay back tens of thousands of pounds of their salary, so-called "clawbacks".

The new contracts also abolished a number of pay bands, meaning dentists now get paid the same to fit a patient with 10 fillings as just one.

The British Dental Association said that the figures reflected the hard work of dentists attempting to make a success of the new contract.

John Milne, Chair of the BDA's General Dental Practice Committee, said: "These statistics reflect the second year of operation of the 2006 dental contract in England and Wales, a time when dentists were working hard to overcome problems with the new arrangements and make them work for their patients.

"Many practitioners were contending with the uncertainty of potential clawback of their contract values," he added.

But Norman Lamb, the Liberal Democrat health spokesman, said that the amounts involved were "staggering".

"These figures will astonish people who are struggling to find an NHS dentist. The amount of money some dentists are earning is staggering. It is vital that the NHS can compete with the private sector to secure the best staff. However, we need to know that we are getting value for money."

Earlier this year ministers announced plans to pilot a change in how dentists are paid, linking part of their income to how many dentists they have on their books, in a bid to improve access.

Earlier this year a survey for Which? magazine suggested that three million people in England had been unable to get an appointment with an NHS dentist in the last two years.

From:
http://www.telegraph.co.uk/Nearly-400-NHS-dentists-earn-more-than-300000

NHS surgery centres in doubt over £400m bill

The future of fast track surgery centres that are run privately was in doubt after it emerged that the NHS faced a £400m bill when their contracts expire during the next two years.

Mike O'Brien, health minister, told the Financial Times it would be up to primary care trusts whether to recommission the treatments they provided.

Independent sector treatment centres (ISTCs) have cut waiting lists and introduced competition since the first ones opened in 2005.

However, Mr O'Brien disclosed that as the contracts expire the NHS is likely to have to pay about £200m for operations that it agreed to buy from them but has not used, and another £200m to buy back premises built by the private sector operators.

In spite of the £400m bill, he insisted that ISTCs had been "value for money", cutting NHS waiting lists and introducing more choice for patients.

So far, they have provided more than 1.7m operations and other procedures, helping cut the maximum NHS wait to 18 weeks while recording very high satisfaction rates in patient surveys.

Leading private sector operators also expressed alarm at the labour government's timetable for re-tendering, which they said in some cases looked likely to lead to contract renewal only after, or just as, they were due to end. With many of the centres staffed from overseas "there is a real risk that staff will leave", one leading private sector operator said, putting services at risk.

To attract operators, the five year deals offered guaranteed volumes of patients, a buy-back clause on the buildings, and prices that, on Department of Health figures, are about 11 per cent above the NHS price.

Although some are now treating more patients than contracted for, on average they have treated only about 85 per cent of the patients they offered to take. As a result, the NHS is likely to have to pay about £200m for operations it has not used, as well as another £200m for the residual value of the ISTC buildings, Mr O'Brien said.

But he insisted that the centrally negotiated deals had cleared more than 40 per cent of a "backlog" of 250,000 NHS patients who had to be treated to get waiting times down.

In future it will be up to primary care trusts whether to recommission services from the ISTC buildings, Mr O'Brien said, and he expected those to be at standard NHS prices with no guarantees of volume - "although PCTs will be free to negotiate otherwise".

Trusts have an incentive to renew the service as otherwise they will be left with an empty surgical centre.

http://www.ft.com/cms/s/0/9621c792-7ca0-11de-a7bf-00144feabdc0.html