Hospitals must cut services to stay afloat, watchdog quango warns

Hospitals will have to reduce services, sell off buildings and move into smaller premises to cope with financial pressures in the next few years, the head of the foundation trusts’ regulatory body has warned.

Accident and emergency departments treating only a few serious cases may be downgraded to minor injury units

William Moyes, who steps down from his role as executive chairman of Monitor after six years told The Times that too many hospitals were not grasping the economic challenges ahead.

While political parties have promised to protect NHS funding and avoid service cuts, Mr Moyes said it was inevitable that some hospitals would have to reduce services and sell off assets to keep afloat.

Any hospital department that was treating too few patients to cover its costs risked compromising the quality of care, he said. Some maternity and paediatric units, which are very costly to run, might be merged or relocated, while A&E departments could be downgraded to minor injury units if they had a small number of serious cases that could be sent elsewhere.

“People need to know where they are making money or losing money. If you find a service where the income can’t cover the cost, you may eventually have to question whether the income is ever going to be sufficient, and whether this is in fact the wrong activity for the hospital.

“In quite a lot of places the number of births is too small to support the cost of giving a high-quality service. You have three choices: increase the flow of patients, move the service elsewhere or stay as you are and risk compromising the care.”

Mr Moyes, who oversees the regulation of finances and governance of England’s 125 flagship foundation trusts, said that as well as focusing on core departments, trusts would need to consider stripping out “uneconomic” facilities such as pathology laboratories and scanning units in some hospitals that were being used for very small numbers of patients.

“There may be surplus assets — buildings, land, equipment, stuff they think they might need in years to come under their development plans — and in some cases working in a much smaller physical space and disposing of all the hospital penumbra that can be brought into the main building.”

Mr Moyes said he had requested that foundation trust chief executives resubmit a “downside assessment” — stripping back their budgets — to get a more realistic grasp of the funding pressures they faced. He said that he was disappointed when, on being asked to revise their financial predictions in September, a number of trusts had resubmitted even more rosetinted forecasts of growth.

“You can’t assume everything will go well and if a problem arises the Department of Health will bail you out,” he said.

His warnings were echoed yesterday by Sir David Nicholson, the chief executive of the NHS, who described the coming years as “extremely challenging”. Giving evidence to the Commons Health Select Committee, Sir David warned of pay cuts and service reorganisation. “It is going to be very tough,” he said, adding that tighter budgets would mean the 1 per cent pay cap demanded by the Treasury would be treated by NHS managers as a maximum rise, not an entitlement. His comments came a day after inflation hit 2.9 per cent when unions are already angry over a pay freeze on council workers.

“There is essentially a trade-off between pay and numbers of jobs,” he told the committee. “In a cash-limited system, that is the big unknown for us. We need to talk through with the trade unions and staff associations about what that trade-off is.”

Sir David has previously warned that the NHS would have to find productivity and efficiency savings of between £15 billion and £20 billion over the three years 2011-12 to 2013-14.

The head of the Audit Commission added to the debate, saying that political pledges to safeguard spending on health and education were “insane”.

Steve Bundred told the Commons public administration committee that billions would have to be saved. “It seems to me absurd to imagine that the only services where no efficiencies can be found are those that have been the most generously funded for ten years,” he said.

Mr Moyes said he thought that an “unintended benefit” of future economic turbulence would be to heighten hospitals’ understanding that they had to operate with a robust business model.

“A lot of hospitals, even the very good ones, are at the stage of learning how to think long-term,” he said. “We are good at strong visions, big pictures, but we need to learn to be very good at pessimism and what will happen if things are not going to turn out well.”

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6997644.ece

Turmoil over NHS records scheme as labour cuts NPfIT to save cash

The world’s biggest civilian IT project was thrown into turmoil yesterday after Alistair Darling, the labour chancellor, implied that it was going to be scrapped.

The chancellor told the BBC’s Andrew Marr Show the £12.7bn NHS IT programme – already running years late – was “something that I think we don’t need to go ahead with just now”.

Treasury officials rushed to explain that the government was looking for “significant savings” of up to perhaps £600m over the medium term by cutting back some features that are less important for patients.

A senior health department official, meanwhile, said bluntly span that “the chancellor mis-spoke” in saying the project to create an electronic medical record would be scrapped.

Details of which elements would go were not clear on Sunday night. But the government would face compensation claims of many hundreds of millions of pounds if it cancelled the programme. Fujitsu, an IT provider, is already in mediation with the health department over its £700m compensation claim after it was fired last year.

Ahead of Wednesday’s pre-Budget report, Gordon Brown will on Monday announce that the government has found another £3bn of “efficiency savings” – in practice, many of them cuts – since the Budget.

In a change of rhetoric, Mr Brown is expected to argue these savings are an “element of our efforts to reduce the [£175bn] deficit”, not just a means of protecting frontline services.

Some 123 quangos will go – including the Foreign Office advisory committee on wine purchasing – with the courts inspectorate merged into an existing inspectorate and several health bodies merged with NICE, the National Institute for Curbing Expenditure.

Full details of quango mergers and abolitions will not be spelt out until next year’s Budget, but they are expected to save an estimated £500m.

Central government’s use of consultants will be halved and the marketing budget cut by 25 per cent, saving £650m. Better use of text messaging and online services should save £665m – for example by reducing missed hospital appointments – according to government estimates.

Many of the proposals, which the prime minister will present as “streamlining government”, mirror those from the Tories, who have promised to slash the use of consultants to cut council tax. They also propose reducing by 24,000 the 80,000 civil servants employed in policymaking, inspection and regulation, and grant assessment over the next Parliament.

The FDA, the top civil servants union, condemned the planned cut in civil service numbers as “crude electioneering” and “irresponsible” just months ahead of a general election.

Mr Darling’s apparent scrapping of the NHS electronic record programme excited both the Conservatives and the Liberal Democrats, the latter calling for it to be “abandoned in its entirety” and Andrew Lansley, the Tory health spokesman, describing it as “another government IT procurement disaster”.

From:

http://www.ft.com/cms/s/0/71d29630-e2a5-11de-b028-00144feab49a.html?nclick_check=1

One in eight NHS trusts could face fines and hospital closures due to substandard services

One in eight local NHS healthcare trusts could face fines and even be forced to close hospitals from next April if they do not improve standards, the new health regulator has warned.

The Care Quality Commission said that “alarm bells” should ring in the boardrooms of 47 of the country’s 392 NHS trusts, which have been persistently rated as either weak or fair.

“They must do better for their patients… It is clear that many have significant work to do and a short time in which to do it,” said Cynthia Bower, the commission’s chief executive.

From next April all NHS organisations must be registered with the CQC in order to treat patients.

Trusts will face tough tests on quality before they will be allowed to register.

From next year the regulator will have powers to demand improvements, to fine and prosecute trusts, suspend services and even close hospitals.

However, Barbara Young, the commission’s chairman, said that they did not want to force hospital closures.

“We don’t want to get to the last one, because quite frankly that raises the major question of when you get to that nuclear option, where do people get services?,” she said.

From:

http://www.telegraph.co.uk/One-in-eight-NHS-trusts-could-face-fines-and-hospital-closures

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

Public want NHS protected from funding cuts

Sacrifice other departments instead of the NHS, say three out of four people in British Medical Association poll.

More than three-quarters of the public – 77% – believe NHS funding should be protected in the face of future spending cuts, an opinion poll has found.

Other departments' budgets should be sacrificed in order to preserve the health service, the British Medical Association survey heard. Four out of 10 people said they would be willing to pay higher taxes to sustain growth in NHS funding.

The poll questioned 1,071 people in five UK cities – London, Edinburgh, Belfast, Manchester and Cardiff – reflects fears that severe cutbacks are looming.

Nine out of 10 people suspect NHS services will be cut as a result of the recession, and almost as many believe waiting times for treatment will rise; 85% anticipate additional charges for NHS treatments.

The level of public support for the NHS at the expense of other departments is likely to be welcomed by the Conservative health spokesman, Andrew Lansley, who last month stirred controversy when he declared that a future Tory administration would protect the health service and target cuts elsewhere.

The poll, released on the eve of the BMA's annual conference in Liverpool, gave conflicting evidence about privatisation. Nearly 60% said the private sector should be more involved in providing NHS services but almost half (47%) said there should be no further contracts for commercial companies.

The BMA chairman, Dr Hamish Meldrum, said: "These results show how anxious the public is about the effects of the recession on the health service, with a significant number saying taxes should increase to protect NHS funding. No one wants to see any cuts in the public sector but our poll reveals just how much society values their health service.

"Fear often goes hand in hand with economic slumps, with people worrying what will happen to them and their families in times of ill health. While we appreciate that the government needs to steer the country through this difficult economic period, we urge it not to do so at the expense of NHS funding."

From:
http://www.guardian.co.uk/society/2009/jun/29/nhs-funding-cuts-survey-bma

Worst NHS trusts for hygiene threatened with fines and closure by super regulator

The worst NHS organisations for hygiene standards have been named and shamed by a new super regulator and threatened with fines and even closures if they do not improve.

In a first show of strength, the new Care Quality Commission has named 21 organisations which are failing to take sufficient action to prevent superbugs like MRSA and C. difficile.

The list contains eight trusts where there are high infection rates, persistent problems or a potential risk to patients has been identified. They will face further inspections by the regulator.

All the failing trusts have been warned they must improve within set deadlines or face further sanctions including warning notices, fines, and the possibility of wards or units being closed down.

Problems found included inadequate cleaning of ambulances, poor antibiotic prescribing practice, delays in isolating infected patients, lack of supervision of cleaning and infection control staff, dirty surgical equipment, lack of reporting of infection control measures to board level, delays in receiving laboratory test results and poor standards of cleanliness on wards.

All healthcare providers, except GP and dental surgeries, must be registered with the Care Quality Commission by 2010, in what is in effect a 'licence to practice', and the first step has been to register compliance on infection control measures.

All 388 NHS organisations that provide direct care to patients have been registered but the 21 trusts judged to be failing have been given conditional registration.

Barbara Young, chairman of the CQC, said: "Most trusts have stronger systems to protect patients from infection than a few years ago, and trusts' boards are taking the challenges seriously. We commend them for that.

"In 21 trusts we need further assurance that they are meeting the regulations. We have placed rigorous conditions on these trusts' registration and will monitor them closely.

"While infection rates at these trusts are not necessarily higher, they can do more to strengthen their approaches to infection control and help prevent outbreaks. We will monitor their performance throughout the year and will not hesitate to use our enforcement powers to protect patients' safety where needed.

"This is only the beginning of our work with NHS trusts. We aim to ensure they strive for continued improvement and that patients receive the same consistently high service wherever they receive care."

In eight cases, the trust failed to achieve required standards for infection control on repeated occasions and/or had a high infection rate and/or a potential risk to patients' safety was found on inspection.

The eight trusts are: Barnet, Enfield And Haringey Mental Health NHS Trust, Barts And The London NHS Trust, Kettering General Hospital NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, North Bristol NHS Trust, Plymouth Hospitals NHS Trust, South West London And St George's Mental Health NHS Trust, United Lincolnshire Hospitals NHS Trust.

Registration on healthcare associated infection is the first step towards full registration on all basic standards, a regime that will come into force from April 2010.

For the first time the regulator has the power to impose fines of £4,000 on the spot and up to £50,000 through the courts. The Care Quality Commission also has the power to close wards, services or a whole hospital in extreme circumstances.

From:
http://www.telegraph.co.uk/health/healthnews/5095540/Worst-NHS-trusts-for-hygiene-threatened-with-fines-and-closure-by-super-regulator.html

Labour closing maternity increasing, say Conservatives

Labour closes maternity services increasing, say Conservatives with nearly 50 per cent of hospital trusts having to close to maternity admissions at least once in 2008.

The Conservatives, who collated the figures from freedom of information requests, said they demonstrated Labour's "terrible record on maternity".

Fifty of 104 trusts that replied to the requests said they had closed to admissions or diverted women elsewhere at least once during the year.

In a similar survey of 83 trusts for 2007, 42 per cent said they had to close at least once.

In total, there were 553 closures in England in 2008, up 38 per cent from 402 in 2007, the Conservatives said.

Labour's record

Shadow health secretary Andrew Lansley said: "These figures are a telling reminder of Labour's terrible record on maternity.

"Every one of these figures tells an awful story of mothers being turned away from hospital at a hugely emotional time - when they are due to give birth. Labour seem to be deliberately running down maternity services in some hospitals as a precursor to shutting down maternity units altogether."

"The labour government must increase midwife numbers as they promised, make sure local maternity units get their fair share of NHS funding, and sort out their disastrous negotiation of EU rules on doctors' working hours."

In 2007, the government committed to improving the safety of maternity services, including by appointing 1,000 midwives by September and "up to 4,000" by 2012. Last January it said an additional £330m funding would go to primary care trusts for maternity over three years.

However, a large proportion of primary care trusts are not earmarking the money for maternity, meaning it may not reach services.

Stretched

Royal College of Midwives director for England Jacque Gerrard said: "Capacity within maternity units is being stretched to the limit and beyond, resulting in closures.

"The Department of Health, however, has set a target to recruit the equivalent of another 3,400 full time midwives by 2012, and it has started to increase the money going into maternity care.

"Some of this money, however, is not finding its way into the hands of the people at the front line to employ more midwives and improve maternity services.

"The Royal College of Midwives is urging people who run health services locally to be more proactive and use money earmarked for maternity services actually for maternity services, so that women are not being left worried and deeply disappointed."

Patient safety

A spokesman for the Department of Health said: "Sometimes units do have to temporarily shut their doors, usually for very short periods of time.

"We appreciate that it is distressing to be told that your care is going to be provided elsewhere but this is always undertaken in the interests of safety for the mother and baby.

From:
http://www.hsj.co.uk/news/2009/02/maternity_closures_increasing_say_conservatives

Health chiefs agree to clear £327m debts

Improvements to London’s health services will be delayed and some hospital services reshaped as the NHS tries to resolve long standing financial problems.

Under a plan agreed by the capital’s 31 primary care trust [PCT] chief executives, though not yet by their boards, about £327m ($481m) of debt would be wiped from 10 of the capital’s 38 acute trusts that are in severe financial trouble.

To get the money, the hospitals, which include four of the six big trusts in the south east of the capital and two in the north east, will have to demonstrate that they can at least break even in future, according to the London strategic health authority.

This is likely to require big changes to services – potentially even the closure of an accident and emergency department.

The decision to clear the deficits will be seen by some as rewarding failure. It also demonstrates the difficulty in allowing big hospitals with accident and emergency services to fail, in spite of the more market like mechanisms that the government is using in the NHS.

A health authority spokesman said because hospitals were paid according to the numbers of patients they took, some had found themselves “locked in a vicious circle”. If they cut back on services to pay off the accumulated deficits, they then lose money as fewer patients come through the door.

Ann Radmore, chief executive of Wandsworth PCT, who is leading the bail-out proposal, said ensuring that all the capital’s hospitals were financially stable and debt-free was “essential” for the capital’s health services.

The health authority conceded that trusts in surplus would have to put off planned improvements to fund the bail-out. But Paul Baumann, finance director for NHS London, said without action, services in London would suffer. Once the whole capital was financially stable, trusts would have greater leverage to demand better performance from their providers, he said.

Without urgent and dramatic action, the accumulated debt held by the troubled hospitals and one primary care trust was poised to rise from £327m to £579m by 2010-11, the health authority said.

To clear the debts, the PCTs have agreed to forgo 1.3 per cent of their planned 5 per cent budget increases over the next two years and a £304m surplus that was earlier taken from their allowances.

John Appleby, chief economist at the King’s Fund health think-tank, said it was vital that the root causes of the financial problems were tackled if this “once-in-a-lifetime opportunity” was to work.

From:
http://www.ft.com/cms/s/0/d7a5906a-c321-11dd-a5ae-000077b07658.html

Polyclinics threaten 600 GP practices, say Tories

More than 600 GP practices are under threat because of labour Government plans for "super surgeries" despite overwhelming public opposition to the proposals, according to the Tories.

Hundreds of family doctor surgeries across England have been identified by local health Trusts as being in the same catchment area as proposed new polyclinics.

The Conservatives have compiled the list of practices across the country, named in plans for polyclinics drawn up by Primary Care Trusts, which they say could be killed off by the scheme.

They said the list showed practices which could be forced to shut because they would lose patients to the new clinics if they went ahead and warned that the final figure is likely to be much higher as many Trusts are still compiling plans.

Doctors who found their name on the list would now be "even more concerned than they were already" about the possibility of closure, the British Medical Association (BMA) said.

But the labour Government insisted that there was no suggestion in the documents that any of the practices had been earmarked for closure.

Recently, more than 1.2 million patients signed a petition protesting against plans for polyclinics, which was delivered to Gordon Brown.

Doctors' leaders argue that the new surgeries will destroy the relationship between patients and their GP family doctor and force them to travel much further to see a doctor.

GPs are also worried that polyclinics could "cream off" younger, healthier patients who help to subsidise their practices to treat those with more complex medical problems.

But ministers insist that the clinics, which could house up to 25 GPs as well as extra services such as dentistry and minor surgery and will open during evenings and weekends, will provide a "world class" service.

The Tory research reveals that 608 practices in almost half of all Primary Care Trusts outside London -where ministers insist that the "GP led health centres" will be in addition to existing services - have already been listed as close to proposed new clinics.

If this were replicated across the rest of the country including the capital as many as 1,700 practices could be under threat.

The Tories said the implication was that polyclinics would threaten the viability of the practices listed, even if not all of them would be forced to shut.

Andrew Lansley, the Conservative health spokesman, said: "The Government needs to explain why these GP surgeries are being named if it's not because polyclinics pose a threat to the local doctor.

"It adds to the huge weight of evidence now building up that polyclinics are not the additional services as Gordon Brown has claimed. Patients and family doctors are right to be worried about losing a valued local service. It's time Labour faced up to their concerns and called a halt to their unpopular polyclinics scheme."

A spokesman for the BMA said that the publication of the list would worry GPs already concerned that their practices could shut.

He said: "We have always had concerns about the viability of practices that are close to these polyclinics.

"It is inevitable that they will lose resources because of the new development, even if they are not actually dragged into it.

"Ben Bradshaw [the Health Minister] has said that some patients won't have to deregister with their GP to use this service, but that is not really the point.

"There is only one pot of money and if it is all going into polyclinics then GP surgeries will have to cut back on services and many could be forced to close."

He added: "GPs who find themselves on this list will be even more concerned than they were already."

An official spokesman for Mr Bradshaw said: "There is no suggestion from any of those PCTs that these surgeries are marked for closure."

Within London, where ministers insist plans for polyclinics differ from the rest of the country, around 100 practices have already been already earmarked for closure, to make way for the new surgeries.

From:
Polyclinics-threaten-600-GP-practices%2C-say-Tories.html

A million patients battle against polyclinics

More than one million patients have signed a petition protesting against plans to close hundreds of GP practices to make way for polyclinics.

The signatures, collected by the British Medical Association (BMA) in just three weeks as part of its "Support Your Surgery" campaign, was presented to Gordon Brown at Downing Street.

The BMA is concerned that the new clinics will destroy the relationship between patients and their family doctor

The labour government cannot afford to ignore the level of patient concern over polyclinics, which have been dubbed "supersurgeries", doctors' leaders will say.

Ministers insist that the centres, designed to house up to 25 GPs under one roof along with other services such as minor surgery, will provide a better service for patients.

But the BMA claims they will destroy the relationship between patients and their family doctor and lead to more private companies running surgeries.

Analysis by the Tories suggests that 1,700 of the 8,700 GP practices in England could have to shut under the plans.

Around 100 GP practices in just eight PCTs in London, the first part of the country to roll out the policy, have already been earmarked for closure to make way for polyclinics.

Doctors will protest against the plans at the BMA's Local Medical Committees annual conference today, entitled "standing up for General Practice".

Dr Laurence Buckman, chairman of the BMA's GPs Committee, will tell GPs at the meeting that the petition "will deliver a stark message to the Prime Minister" about the true level of patient concern.

Dr Buckman will also say: "My message to Gordon Brown is this: Whatever you think of GPs, take note of what your electorate thinks. Work with us to improve the service, not against us, and ignore at your peril the wishes of the most important people in the NHS – the patients."

He will tell GPs : "If the government won't listen to you, their doctors, then surely it will listen to the 1.2 million men and women who call for a halt to the plans to promote the use of commercial companies in general practice.

"Voters don't want funding to move from GP practices to commercial companies who are accountable primarily to shareholders rather than patients. They want to be treated as patients, not customers."

The petition calls on ministers to "continue to support our existing NHS GP surgeries" and "improve services to patients by further investment in existing GP surgeries".

But Neil Bentley, from the Confederation of British Industry (CBI), accused doctors' leaders of "ostrich-like denial" and said that the plans would extend opening hours and increase the range of services offered to patients.

From:
A-million-patients-battle-against-polyclinics.html

NHS at 60- Labour no longer trusted on National Health Service

NHS at 60- On the eve of the NHS's sixtieth aniversary a new poll shows that Labour is no longer the party trusted to bring in the health reforms that are needed to safeguard the NHS for future generations.

Despite the billions Labour has poured into health, the YouGov poll shows that public satisfaction with the NHS is dropping. Barely one in five people believe the Labour party will deliver a better health service over the next ten years, the You Gov poll shows.

It comes on the day Gordon Brown is to publish Lord Darzi's package of reforms to overhaul the way the NHS is run.

The Prime Minister hopes the comprehensive review will transform Labour's fortunes and restore the party's reputation as guardians of the NHS on its 60th anniversary.

The results of the poll show he Tories have a clear lead on health policy with 31 per cent of people saying they would do a better job of running the health service, compared to 23 per cent who think Labour would deliver on the NHS.

The results of the latest poll confirm a shift in the political debate over health care, away from funding and towards improved management and organisation.

After years of above-inflation increases in health spending, most voters now believe the NHS has enough money. But they worry that the service has become bureaucratic and over-burdened with managers.

Sixty-nine per cent of people said reorganising the NHS is more important than spending more on it, up from 38 per cent in 1998. Only 24 per cent now want more spent on health, down from 59 per cent a decade ago.

Seventy-eight per cent of voters believe the NHS has too many managers.

And despite the billions Labour has poured into health, the new poll shows that public satisfaction with the NHS is dropping. In 1998, some 91 per cent of recent patients said they were happy with their treatment. That figure has now fallen to 81 per cent.

Some 44 per cent of people said they think "a great deal" of money is being wasted in the NHS. Another 38 per cent said a "fair amount" is wasted.

"David Cameron's unambiguous commitment to the National Health Service means a great deal to the public. They know that the NHS needs reform and that Labour have failed them on this crucial issue," said Andrew Lansley, the shadow health secretary.

"But they also know that Conservative reforms for healthcare will not threaten the security that comes with a health service available to all, based on need. This poll shows that the public, like staff across the NHS, are now willing and ready to trust the Conservatives with the stewardship of the NHS."

In the foreword to the Darzi report, the Prime Minister hails the document as the blueprint for a "once-in-a-generation" shake-up in the NHS.

The report will usher in the creation of "polyclinics" with several doctors and nurses to replace hundreds of GP surgeries in the biggest cities, despite opposition from patients and the

British Medical Association.

It also says that hospitals should publish death rates for dozens of conditions, allowing patients to make "informed choices" about where to get treatment.

Hospitals should offer more home births for mothers, and old and terminally-ill will get the right to chose to die at home instead of in hospital.

And a new NHS constitution will enshrine rights to confidentiality, control of patient records and a second medical opinion.

Mr Brown writes: "Lord Darzi's report is a tremendous opportunity to build an NHS which provides truly world-class services for all. It requires government to be serious about reform, committed to trusting front-line staff and ready to invest in new services and new ways of delivering services."

But Norman Lamb, the Liberal Democrat health spokesman said he feared the Darzi package would be vague and impractical. He said: "What does all this mean? Will patients be able to enforce their rights?"

And despite Mr Brown's bold claims for the review, there are doubts about whether Lord Darzi has been allowed to go far enough in drawing up his reform plans.

His report is not expect to deal with the controversial issue of "co-payment," where patients can pay extra to top-up NHS care with private provision. That omission has drawn accusations that the review is too limited to prepare the health service for the demands of the next century.

A separate opinion poll for Reform, a think-tank, has suggested that most doctors believe top-up payments should be introduced to the NHS.

The ComRes poll showed that 79 per cent of GPs believe patients should be able to top-up their NHS care with private treatment.

• YouGov polled 2,163 adults across Great Britain between June 23 and 25.

From:
Labour-no-longer-trusted-on-NHS-reforms.html

Hospitals hide funds to rein in NHS surplus

Hospitals and primary care trusts have prepaid suppliers many hundreds of millions of pounds and have hidden money in other ways in order to keep the National Health Service surplus for last year down to the forecast £1.8bn.

Without such action, senior NHS managers say, the declared surplus for the NHS in England in the financial year just ended is likely to have been nearer £3bn.

That money is in addition to the £2bn of cash in the bank, much of it working capital, that foundation trusts are expected to hold as they generate their own surplus of perhaps £500m.

The move appears to have two motives: first to avoid the political embarrassment of the massive swing to a huge surplus of about £3bn just two years after the NHS in England attracted months of dire headlines when it recorded a £571m deficit; and second, to reduce the risk that a cash-strapped Treasury will claw the money back.

Both ministers and David Nicholson, the NHS chief executive, have said the Treasury will allow the service to carry over its forecast surplus. The NHS also aims to carry over a similarly sized sum this financial year.

Last year, however, the Treasury quietly clawed back £2bn of unspent capital from the Department of Health, and there are fears that if the final surplus exceeds the £1.8bn forecast the Treasury – which is under pressure on its borrowing rules, has just had to fund a £2.7bn tax giveaway to tackle the 10p tax band issue and faces spending pressures from other departments, not least defence – will want the money back.

To reduce the risk, managers say NHS hospitals and primary care trusts have been given “control totals”, which stipulate that while they must deliver the surplus they were forecasting, they must also not exceed it.

Some chief executives have been told their personal performance rating would be under threat if they do.

According to people close to the situation, foundation trusts, which as free-standing businesses can keep the cash, were paid £300m-£400m in advance by primary care trusts for services before the end of the last financial year.

Doris-Ann Williams, director general of the British In-Vitro Diagnostics Association, whose members supply equipment to the NHS, said members had received “a flurry of unexpected cash orders for capital equipment purchases as long as they could be invoiced before the end of March [the end of the financial year]”.

The chairman of one London hospital said it had not only been prepaying suppliers but also shifting money to charitable trustees to get it off the books by the end of the financial year. Some primary care trusts are also said to have prepaid local authorities for services.

One senior NHS manager said: “I don’t think anyone knows what the true picture is, but my guess is that without these measures the real surplus is much closer to £3bn.”

From:
http://www.ft.com/cms/s/0/5f05f078-2aa1-11dd-b40b-000077b07658.html?nclick_check=1

As Health Direct posted yesterday- the NHS funding position is down to cost cuts not funding proper health services.

NHS hospitals lose 32,000 beds in a decade

More than 30,000 hospital beds have been lost since Labour came to power, with record cuts in NHS wards last year- which Health Direct chronicled.

The cutbacks mean increasing numbers of hospitals are going on "black alert" – which involves closing their doors to new patients because they are full.

NHS hospitals lose 32,000 beds in a decade

More than 30,000 hospital beds have been lost since Labour came to power, with record cuts in NHS wards last year- which Health Direct chronicled.

The cutbacks mean increasing numbers of hospitals are going on "black alert" – which involves closing their doors to new patients because they are full.

Patients' groups described the loss of the beds, at a time when overcrowded wards have seen soaring rates of killer infections, as "a national scandal".

The reduction contradicts a pledge from Tony Blair at the turn of the century that there would be 7,000 more NHS beds by 2010.

New figures, seen by The Telegraph, show that the number of health service beds fell more than 8,000 last year, as the NHS began a reorganisation process which will mean the closure of dozens of hospitals.

More than 40 per cent of maternity units turned away women in labour last year because they had no room.

Meanwhile, ambulances have been forced to queue outside overstretched hospitals, treating patients in car parks just yards from accident and emergency departments. The new statistics, revealed in response to a parliamentary question by Ed Vaizey, the Conservative MP, show that almost 32,000 NHS hospital beds went between 1997, when Labour took office, and 2007.

More than 8,400 beds were cut in the year ending March 2007, the largest fall in 14 years. One in six beds has been closed over the decade. There are now 167,019 beds in NHS wards, compared with 198,848 in 1997.

The figures emerged as health authorities are drawing up plans which will see the likely closure of dozens of district general hospitals. The East of England health authority has admitted that two accident and emergency departments and a maternity unit could close.

Andrew Lansley, the shadow health secretary, said the labour Government's financial mismanagement had forced hospitals to make cuts which could risk lives. "These bed cuts were financially driven: the sharp rise in the numbers closed happened at a time when the health service was under desperate pressure to clear a massive deficit."

Katherine Murphy, from the Patients' Association, said: "This is a national scandal. More than 30,000 beds have been lost at a time when demand is increasing."

In the same decade that the beds were cut, death rates from the infections MRSA and Clostridium difficile rose five-fold. Investigations into the biggest C. diff outbreak in Britain, which killed 90 patients at hospitals run by Maidstone and Tunbridge Wells trust in 2005 and 2006, found that overcrowding amid pressure to meet hospital waiting targets was a factor behind the infection's spread.

More than 2,000 maternity beds have been lost since 1997. Research by the Conservatives found that last year, 42 per cent of maternity units had refused to accept women in labour on at least one occasion.

Sue MacDonald, from the Royal College of Midwives, said: "We feel the cuts have gone too far."

Norman Lamb, the Liberal Democrat health spokesman, met officials recently after pressures on his local hospital, the Norfolk and Norwich, forced it to declare an emergency "black alert," closing to new admissions, with 10 ambulances "stacked" outside, treating patients.

From:
NHS-hospitals-lose-32%2C000-beds-in-a-decade.html

5,000 cancer beds facing axe in NHS cancer shake-up

The labour government plans to close up to 5,000 beds on cancer wards in a reorganisation of the way patients are treated, according to a report by experts in the disease.

Labour government figures show the National Health Service aims to save up to £500m a year from an “inpatient management programme” that it describes as preventing unnecessary hospital admissions and reducing the length of time patients spend in hospital.

Cancer doctors and health economists say the changes could make better use of money for cancer treatment but accuse the government of hiding the extent of the bed closures from the public.

The report by Nick Bosanquet, professor of health policy at Imperial College School of Medicine, London, and Professor Karol Sikora, medical director of CancerPartnersUK, a private cancer treatment company, comes as a shake-up of NHS hospitals, led by Lord Darzi, the health minister, is expected to include widespread closures of maternity hospitals and accident and emergency units.

Bosanquet and Sikora have analysed figures published by the government as part of its Cancer Reform Strategy in December. They reveal the efficiency savings the NHS will need to make in order to pay for better radiotherapy and screening programmes.

“My worry,” said Sikora, “is that the only way the Cancer Reform Strategy adds up financially is by massive bed closures to produce the funding for the huge deficits in both radiotherapy and cancer drugs.

“Up to 5,000 beds will need to disappear in England to make the spreadsheet balance. How else will the money be saved? Interestingly, the financials are not in the strategy document but hidden in an obscure corner of the Department of Health website.”

The government said cancer services must change so that patients can receive chemotherapy and radiotherapy during day trips to local clinics without going to hospital. It is also centralising specialist cancer care in larger hospitals where there is the expertise to get the best results.

The government has been forced to review NHS cancer treatment after studies showed that, despite spending comparable amounts on the disease as other European countries, Britain still has some of the worst survival rates.

Bosanquet, who was chairman of the Cancer Reform Strategy value for money group, said cutting beds could make better use of NHS funds but added the government should be more open about its plans.

“The Department of Health has put forward aspirations that must inevitably be to lower bed use in cancer services by around 5,000,” he said. “To save £500m, which is urgently needed to build up these community centres, they will need to reduce bed use in cancer services and the best estimate is that it would be by about 5,000 beds. I would urge the Department of Health to be a lot more open about it.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3908507.ece

Health Direct thinks that Professor Sikora is spot on when saying some cancer patients are so sick after chemotherapy and radiotherapy that they need to stay in hospital and also that they just need nursing as opposed to high tech beds in large hospitals.

NHS shake up to axe hospital services

Scores of hospital departments such as maternity units and cancer clinics will be closed or merged across the country under plans for a radical shake-up of the NHS.

Labour ministers are preparing for a summer of protest as residents campaign against proposals that could mean local hospitals losing specialist services to large regional centres.

In an attempt to head off the reaction that could mar the 60th anniversary of the NHS in July, Lord Darzi, the health minister, has pledged that patients would be involved in decisions and hospital units would not close before new ones opened.

Lord Darzi, a surgeon, said specialist services would be moved into larger regional centres only where there was evidence to prove that doing this would provide better care.

But critics argue that this will mean patients having to travel much farther for an operation or an appointment.

The plans, which appear to have been held back until after last week's local elections, will be released over the next four weeks by the nine Strategic Health Authorities in England.

They include setting a local target of reducing the four-hour wait in A&E to two hours, setting up dedicated trauma centres and better co-ordination of out of hours services.

However, in many cases, the changes – which result from Lord Darzi's continuing review of the NHS – will lead to services provided by cottage and district hospitals being moved out of the area.

He acknowledged that the plans would bring protest and said that in the past, officials were poor at communicating the reasons behind such changes.

Lord Darzi said that where care did not need to be provided in hospitals it could be moved into health centres, GP clinics and cottage hospitals closer to patient's homes.

He is convinced that when doctors have led previous changes and explained that they were not being carried out for financial reasons but in the interests of better care, the local community eventually agreed to the plans.

In an interview with The Telegraph, Lord Darzi said the plans were not about closing local hospitals or shutting down good services but were aimed at improving standards of NHS care.

"We need to be much more ambitious," he said. "We spend £110 billion a year on the NHS and we have to challenge ourselves in raising the clinical bar."

He said the challenges of an ageing population and increasing numbers of patients with long-term conditions such as asthma, diabetes and cancer meant changes were needed.

But campaigners and opposition MPs expressed concern. Residents and patients in Ipswich are already furious at proposals to move the head and neck cancer service from the local hospital to Norwich.

"Patients want to be treated in their local hospital safely," Katherine Murphy, of the Patients Association, said.

"To be admitted to a hospital 60 miles away from your home is not convenient. It is all very well having specialist centres around the country but it is not want the public want."

Andrew Lansley, the shadow health secretary, said: "We value our local NHS services and don't want to lose them. Labour seem completely out of touch with that feeling.

"The hints Lord Darzi has given today about his plans for the NHS sound extremely ominous.

"We already know about the huge upheaval and loss of local services there's likely to be in London; now we learn that something similar will happen in every single region.

"Lord Darzi is tripping over himself to say there isn't another big, top-down reorganisation of the NHS coming; unfortunately he has only heightened suspicion that that's exactly what this is."

Councillors will be able to raise objections with Alan Johnson, the Health Secretary. He can ask for an independent panel of experts for advice and where this has happened in the past, the verdict has usually been accepted.

Dr Hamish Meldrum, the chairman of the British Medical Association, said: "These principles are all positive – in fact they're impossible to disagree with. The problem is that the public and health-care staff have yet to see much evidence of them being delivered."

From:
http://www.telegraph.co.uk/news/uknews/1939162/NHS-shake-up-to-axe-hospital-services.html

Health Direct asks what became of joined up thinking and a green focus? By closing local health facilities- patients, relatives and friends will have to fork out more on brown's transport stealth taxes to travel further to visit the victims.

One in five GPs surgeries faces closure in polyclinic plans

One in five GP surgeries in England is set to close, threatening to end the era of a family doctor in every neighbourhood, an analysis of NHS plans reveals.

Labour government proposals to create a new generation of polyclinics will lead to the closure of 1,700 practices, the Tories claimed. In their place will be a series of "super-surgeries" housing up to 25 GPs and offering hospital-style outpatient appointments, minor surgery and pharmacies. While ministers hail this as a vision of 21st-century health care, opponents fear it is the death knell for traditional patient-doctor relationships.

David Cameron claims that the traditional GP surgery is at risk and only the Conservatives will save it.

The Tory leader delivered a speech to the King's Fund, an independent foundation working for improved health, on the future of primary care as the next stage of the party's "NH-Yes" campaign. It aims to reposition the Conservatives in the centre ground and seize the health agenda from Labour.

Health minister Lord Darzi, personally appointed by the Prime Minister to oversee the introduction of polyclinics as part of a major reorganisation of the NHS in England, has said 150 will be needed in London alone.

The Government insists they would create more choice for patients, offering GP, nursing and social care in one place. They would offer extended opening hours, from 8am to 8pm during the week, and weekend appointments.

But critics say those with chronic conditions, who need to visit their GPs more often than the typical patient, want the continuity of seeing the same family doctor.

Having fewer surgeries would also mean elderly patients who rely on public transport would have further to travel to see their GP. In London, patients would have to travel an average of 1.5 miles to reach their nearest polyclinic, according to the Government's own figures.

There are 8,261 GP practices in England, including 1,546 in the capital. Tory research, based on the Department of Health's estimates, shows that 1,701 surgeries in England face closure. Some 1,091 in London may go – nearly three-quarters of the total. In the rest of the country, 609 – almost one in 10 – could close in the next few years.

The research is based on the average number of GPs per practice in each primary care trust, and assumes each polyclinic would be staffed by 25 GPs.

According to a poll in Pulse magazine, eight out of 10 GPs are against the blanket introduction of polyclinics, warning it will dilute the personal relationship between doctor and patient.

The British Medical Association says it risks commercialising primary care as more services are contracted out. Just 8 per cent of GPs believe their local area needs a polyclinic, according to last month's poll. One in three GPs said they would refuse to work in a polyclinic.

Dr Laurence Buckman, chairman of the BMA's GP committee, said the Department of Health had shown little thought on how the local health service would be affected. He added: "Rather than being forced to create polyclinics, PCTs should be encouraged to invest in their local GP practices and support collaboration between practices.

"What works in London is unlikely to suit the needs of a rural community."

Andrew Lansley, the shadow Secretary of State for Health, added: "The Government is pushing ahead with forcing polyclinics in areas where they may not be needed. We are not against the idea in some places, but not at the expense of the local family doctor and patient care. Continuity of care for patients is at risk if their local doctor is closed.

"Patients will have further to travel and will be lucky to see the same doctor twice. The current relationship between GP and patient is one built on respect and trust, for the Government to wilfully destroy that is unforgivable."

Last year Mr Cameron launched a campaign to save the NHS, pledging a "bare-knuckle fight" with the Prime Minister over plans to close maternity and A&E wards in local hospitals. It ran into controversy when some of the 29 district hospitals the Tories said were under threat complained to the party.

But aides say the "NH-Yes" strategy will be centre stage of the next Tory general election campaign. They claim Mr Brown is planning a series of "NHS cuts" – language borrowed from Labour attacks on Conservative management of the service. They warn thousands of nursing jobs, hospital beds and acute wards will go under restructuring plans.

Lord Darzi produced an interim report on the NHS overhaul last November. A full report on the plans is expected in June. According to the minister's vision, patients will be able to see a doctor more quickly, possibly without an appointment, collect their prescriptions, get their eyes tested and see a physiotherapist all in the same building.

Ministers argue that the traditional family doctor of the 1940s, epitomised by the 1960s TV series Dr Finlay's Casebook, does not suit the modern needs of the NHS. Super-surgeries will include services currently only offered in hospitals such as minor surgery, diabetes screening and sexual health clinics, as well as access to traditional GPs and practice nurses.

But critics fear polyclinics will attract large private companies who can outbid local GPs. Union leaders accuse the government of privatisation by stealth and are planning to fight the moves.

GPs fear for their relationship with patients, claiming polyclinics will employ more salaried doctors who are unlikely to stay and work in one place for as long as partners in a local practice, many of whom spend a lifetime attached to one surgery. And while younger, "healthier" people are most concerned about easier access to doctors, patients with long-term conditions such as diabetes, asthma and depression, place greater value on seeing a doctor they know.

Dr Anthony Halperin, chairman of the Patients Association, warned last week: "We are concerned the personal contact with a GP will be lost within a polyclinic because another layer of treatment is being introduced."

Chronically ill patients and the elderly, who are the biggest users of GP services, would prefer to wait a day and see a doctor who knows their history, argue patient groups. And older and disabled people could be unwittingly excluded from the new clinics because they are too far away and difficult to get to.

The British Medical Association has written to Lord Darzi warning against a blanket introduction of polyclinics across the country. But ministers have reportedly told primary care trusts that they have no choice in backing a polyclinic in their area, even if there is already a large health centre nearby.

Another concern is that the £12bn NHS IT system which has already been plagued by delays and technical glitches is not designed to meet the needs of polyclinics.

The NHS Confederation, which represents local health service managers, said in a report published last week that the IT system would make it difficult to share patient information between primary care, social services and the independent sector. Sharing information across a range of departments is essential for polyclinics to work.

However, the NHS Confederation director of policy Nigel Edwards said there had been a "knee-jerk" reaction to the proposals. He said: "While it may sound like the polyclinic system will not resemble the service currently provided by family doctors, in reality it should build on what is best in general practice."

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/struck-off-one-in-five-surgeries-faces-closure-812177.html

Private surgeries hurt NHS, say academics

Two leading academics claimed the government’s fast track private surgery centres for NHS patients would “contribute to NHS deficits, NHS service closure and staff redundancies”.

Allyson Pollock and Sylvia Godden of Edinburgh university’s centre for public health policy said: “There is no good evidence that independent sector treatment centres [ISTCs] have provided additional capacity, value for money or high-quality care,” while they are leading to “fragmentation and financial instability” in the NHS.

Prof Pollock, a critic of private sector involvement in the NHS, said that with the centres running below capacity, and with the Healthcare Commission saying there is inadequate data fully to compare the ISTCs’ performance with the rest of the NHS, “the available evidence suggests that the private sector is profiting at the expense of patients, the public and the NHS”.

Prof Pollock’s criticism in the British Medical Journal comes ahead of a government decision next month on whether to grant seven new contracts to add to the existing 25 centres.

The Department of Health rejected her view saying: “The independent sector has undoubtedly helped improve services for patients, speeding up treatment and reducing waiting times.” The centres had also “galvanised the NHS to raise its game”.

The first centres were set up to treat about 170,000 patients a year, with contracts awarded worth about £1.5bn over five years. The NHS committed itself to pay about 11 per cent on average above the standard NHS price for treatments. As of last September, the centres had an average occupancy of about 84 per cent.

Prof Pollock said the original assurance that the centres would use non-NHS staff had not been honoured, with about a quarter of staff being seconded from the NHS. The centres took work from NHS hospitals and “NHS beds and services are being closed to make way for the for-profit private sector,” she claimed.

The NHS Partners Network, the trade association for the treatment centre providers, said that the claims ignored “incontrovertible evidence” that patients rated the treatment they received from ISTCs very highly, with satisfaction rates of 96 per cent.

“They also miss the fundamental point of this programme, which is to use competition as a mechanism for driving efficiency improvements in the wider NHS, while giving patients some real choice”.

The health department remained “committed to a diversity of providers in healthcare” with more data on quality due to be published.

The remaining schemes would only go ahead where they met local needs, offered value for money and benefited NHS patients, a spokesman said.

From:
http://www.ft.com/cms/s/0/3570ce14-e19e-11dc-a302-0000779fd2ac.html

Cameron promises a bare knuckle fight to save NHS District Hospital services

David Cameron the Conservative leader, attempted to regain the political initiative today by promising a "bare knuckle fight" with the Government to save local NHS hospitals from closure.

Amid speculation that Gordon Brown is planning an early election, Mr Cameron sought to reassert his centre-ground credentials by claiming that labour Ministers are attempting to close district hospitals.

"The basic point here is we believe the district general hospital is an absolutely key part of the NHS," the Tory leader said.

"People have put money into the NHS, they’ve paid increased taxes and they want to see their district general hospital improve. People simply do not understand why maternity units and accident and emergency units are being shut down when actually accident and emergency admissions are up and births are up."

He added: "The labour government’s new health minister, Sir Ara Darzi, has said ’the days of the district general hospital are over’.

"That’s why I say the Government can expect a bare knuckle fight with us over the next few weeks and months about saving district general hospitals as a key part of the local NHS."

Mr Cameron made his remarks ahead of a trip to Sussex this afternoon where he was due to visit a hospital.

"What people will see in the run-up to the next election is that all the problems the country faces today - whether it’s NHS closures, family and social breakdown, whether it’s a weak pension system, whether it’s the stealth taxes they are having to pay that are making the cost of living so hard to meet - they can trace all of those decisions back to Gordon Brown sitting at a desk in Number 11 Downing Street as Chancellor," he said.

Speaking later, a Department of Health spokesman said that the Tory leader had quoted Lord Darzi out of context.

From:
http://www.timesonline.co.uk/tol/news/politics/article2294162.ece

NHS University- an embarrassing failure to deliver value for money says Labour government review

The NHS University (NHSU) the internal training and education body which cost £72m and was scrapped after less than two years, delivered 'too little too late', according to a scathing report that the labour government tried to suppress. A review carried out during the organisation's short existence warns that the Department of Health would suffer 'significant embarrassment' if anyone probed the value for money provided by the NHSU.

It also said there was a lack of clarity about where the NHSU fitted into the 'crowded healthcare education and training sector'.

The report, written by former NHS Appointments Commission chair Sir William Wells, was produced before the announcement, in November 2004, that the NHSU would be scrapped as part of the government's review of NHS arms-length bodies, but the government did not publish the report.

As Health Direct posted in last week's HSJ, health informatician Rod Ward lodged a request for the report in January 2005 - the first ever Freedom of Information request to the DoH - but it refused to hand it over until an Information Commissioner ruling last week.

According to the report, the NHSU was flawed from the outset. 'We have been struck by the absence of simple, clear descriptions of the NHSU's purpose and the parameters of its role,' it states. The lack of clear boundaries with other training organisations caused 'confusion and friction', it says.

The NHSU's reputation among stakeholders was poor as it was 'delivering too little too late to establish credibility in the eyes of the NHS', Sir William wrote.

Course take-up was well below projected volumes, and efforts by the NHSU to achieve genuine university status were a 'distraction'. The status was pressed for by ministers but was unlikely to happen.

The report also reveals that NHSU had a budget of £28m in its first year, rising to £44m in its second year, and it was bidding for £73m the following year.

The report was finally given to Mr Ward last week, more than two years after his request. He was told by the DoH that it had not released the report earlier because 'it would prejudice any future reviews which might be conducted by the department into the economy, efficiency and effectiveness of sponsored bodies'.

Mr Ward said: 'Hopefully we can learn some lessons from this so we don't repeat the same mistakes. It is about having clear proposals when you are spending taxpayers' money and being more open with information that should be freely available.'

All that a Department of Health spokesman could say was: 'We have learned valuable lessons from NHSU and have implemented the main recommendations in Sir William Wells' report.'

From:
http://www.hsj.co.uk/healthservicejournal/pages/n1/p7/070419

The sorry issue that was theNHS University was psotes about on Nov 01, 2005 in Red tape costs soar as Labour's health quangos cost£37m when the closure of eight arm's length bodies has cost the Department of Health £32m over the past year while the establishment of four new bodies since November 2004 has cost a further £4.7 million.

The figures came in response to parliamentary questions from shadow health secretary Andrew Lansley on how much has been spent implementing cuts to NHS arm's-length bodies in a process designed to save £500m by 2008-09.

Mr Lansley said the findings showed that 'the cost of rearranging desks has reached £37m thus far, with no discernable reduction in the level of administration and no discernable improvement in the standard of patient care.'

Another sign of Labour's double incompetence is that since November 2004, eight bodies have been wound up: the Family Health Services Appeal Authority, the Health Development Agency, the National Clinical Assessment Authority, the National Radiological Protection Board, the Public Health Laboratory Service, the NHS Information Authority, the Modernisation Agency and the NHSU.

And four new bodies have been established: the Health and Social Care Information Centre, the Human Tissue Authority, NHS Connecting for Health and the NHS Institute for Innovation and Improvement.

Doctors' morale record low new poll claims

A survey of more than 1,400 doctors found that 69% would not recommend a career in medicine. The same number said morale fell in the last year. The study for Hospital Doctor magazine found that many doctors blamed Labour government targets and reforms for their ill-feeling. Some 54% of those surveyed by Hospital Doctor said morale was "poor" or "terrible" with only 2% of doctors described their level of morale at work as "excellent".

The Department of Health said the Healthcare Commission's survey suggested that more than 75% of the 8,059 medical staff questioned remain "generally satisfied". In a statement, it said: "We know that there have been problems with the recruitment process into specialty programmes and apologise for the stress this is causing junior doctors.

When asked as to how NHS reforms had affected their morale, 47% of Doctors said they were unhappy with the government's reconfiguration of hospital services.

And 63% said changing workloads had damaged morale, while almost half said junior doctors at their NHS trust had "terrible" morale ever since the introduction of changes to specialist training.

Stephen Campion, chief executive of the Hospital Consultants and Specialists Association, said the results of the poll left him "saddened".

He said: "Traditionally, many doctors have followed in their parents' footsteps and increasingly we are hearing doctors saying they wished they hadn't recommended a career in medicine to their children.

"This is indicative of the extreme frustration and low morale hospital doctors are feeling."

From:
http://news.bbc.co.uk/1/hi/uk/6547379.stm

Health Direct worries for the future of the NHS when Labour's meddling and underfunding will have a long term detrimental effect on the NHS.

On Feb 19, 07 in Disillusioned doctors say Labour decade of reform has failed NHS Health Direct posted that most doctors believe that Labour has failed to reform the NHS and that funding by taxation alone will not improve the quality of care. An online poll of more than 3,000 doctors carried out for The Times offers the most striking picture yet of the level of disillusionment within the profession. Most say that the billions of pounds injected into the service since 2002 have not been well spent and that services have not improved.

In a surprisingly strong rejection of the Labour Government’s belief that taxation is the only way to pay for the NHS, 79 per cent of respondents doubted that the highest standards expected of the NHS could be sustained through taxation alone after 2008, when the huge annual increases in funding will drop off.

Labour cuts are squeezing life out of NHS- RCN

The NHS is having the "life squeezed out of it" by cuts imposed because of deficits, says the UK's nurse leader. Dr Peter Carter, general secretary of the Royal College of Nursing, warned the NHS was at risk as wards are closed, jobs lost and services slashed. "The situation is so serious that the progress we've made could soon be reversed or, sadly, lost altogether."

Speaking at the RCN's annual conference in Harrogate, Lothian nurse Geoff Earl said evidence had shown death rates increased by a third if the number of patients per nurse increased from four to eight.

"The lower the ratio the lower the rates of urinary tract infection and pneumonia," he said.

"It also improves recruitment and retention, reduces the use of agency staff and leads to less staff sickness. So it also makes financial sense - in the long term."

David Dawes, part of the RCN's body for nurses in senior management, said he supported the move as it would make many of the recent cuts - the RCN estimates over 22,000 post have been lost in the last 18 months - illegal.

And Lisa Leicester, a community mental health nurse from Gloucestershire, added: "Lets ensure appropriate staffing levels but also appropriately qualified nurses."

Nurses voted to pass a motion calling for new legislation to ensure appropriate staffing levels.

Ratios would vary depending the type of care a patient was receiving but could mean in some specialities (did not specify which one) one-to-one care would be guaranteed.

But Howard Catton, head of policy at the RCN, said: "The problem with minimum ratios is that they become maximums and that takes away from professional judgement. And if minimums can't be met, wards are closed."

Tough times

The debate came after the RCN's new leader set out the "tough" times the NHS was facing.

The former NHS trust chief executive, who took up the post in January, said: "Training budgets are being raided and public health programmes are being targeted. We've got workloads gong through the roof as jobs are lost and vacancies frozen."

He said the Labour government deserved credit for increasing funding, which has increased the workforce of nurses and doctors. But he added: "The situation is so serious that the progress we've made could soon be reversed or, sadly, lost altogether."

NHS trusts are making cuts in a bid to balance their books after racking up over £500m of deficits last year.

Alluding to recent press reports, Dr Carter said it had got so bad that nurses were being asked to work for nothing and cutting down on the use of lightbulbs. He also strongly criticised this year's 2.5% pay rise for nurses, describing the award as "shameful".

Commenting on the fact the RCN has not invited any politician to congress this year, he said: "It was pointless bringing someone from government in because of how badly they have treated nurses and other health workers."

From:
http://news.bbc.co.uk/1/hi/health/6559929.stm

The plight of nurses has been long chronicled by Health Direct. Only on March 16, 2007
we posted that the NHS workforce falls by 11,000 as the number of people working in the NHS fell by 11,000 in the last quarter of 2006, official figures reveal. Health unions said the loss across the UK, revealed in Office for National Statistics, would "inevitably have a negative impact on patient care". Total full and part time NHS staff numbers are estimated by the ONS as being 1,222,000.

Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), added: "These alarming figures confirm what the RCN has long been warning - that deficits are leading to serious cuts in the NHS workforce.

"This can only have a damaging impact on patients and services. That's why we are urging the government to work with us to replace short-term cuts with a long-term recovery plan."

Warning over cuts to subsidies on drugs advice

Looming cuts to funding for independent prescription advice for doctors could undermine the best use of medicines in the UK, a senior medical figure warned yesterday. Sir Charles George, director of the British Medical Association's BMJ Group, which publishes a range of guides for doctors, said: "We're worried that a number of sources of information about good prescribing have disappeared."

His comments came against a backdrop of concern over a growing trend by the Department of Health to stop subsidising publications for prescribers that are designed to provide objective information free from -pharmaceutical companies' influence.

He was speaking ahead of the launch this week of the latest edition of the twice-yearly British National Formulary, which is produced by the BMJ and which a new survey showed was the preferred medicines reference guide for GPs.

The BNF is distributed free of charge, thanks to government subsidies, to 185,000 prescribers in England alone. However, the DoH threatened at the end of last year to stop subsidising its distribution to medical students in England.

There was a last-minute reprieve after complaints, but Sir George said there had been no assurances that the subsidy to students would not be removed before the next issue of the BNF this autumn.

The threats to the BNF follow a pattern of reductions in government support in England in recent months for other independent assessments of medicines, at a time of growing demand internationally for such information.

The government last year removed the subsidy in England from the Drugs & Therapeutics Bulletin, a source of treatment information for GPs, which has led to subscriptions falling to one-sixth of their previous level.

From the start of this year, it also stopped funding Clinical Evidence, another regular guide produced by BMJ, and Best Treatments, a service that provided information on medicines to patients through the NHS Direct website.

From:
http://www.ft.com/cms/s/0d1c88e0-d5bf-11db-a5c6-000b5df10621.html

On June 13, 2006 Health Direct questioned the action of cutting the dissemination of best drugs practice as a means of costs savings in Doctors fight to save the Drug and Therapeutics Bulletin drug guidance from government axe

A highly respected and influential journal which gives doctors independent advice on the drugs they prescribe is set to close because the government is withdrawing its funding after 40 years.

The Drug and Therapeutics Bulletin is sent to every doctor in the country and offers what many describe as highly readable guidance on the value of sometimes heavily marketed pills. But the Department of Health has refused to renew its contract.

Senior doctors have signed a statement of protest, and more than 2,000 have written to ministers, including Patricia Hewitt, the health secretary.

DTB is "highly valued and trusted" to give independent and reliable information about drugs, the statement says. Its conclusions "are also widely regarded as a unique counterweight to the influence of the pharmaceutical industry".

Health Direct notes that the closure of the trusted Drug and Therapeutics Bulletin is another sorry example of the Labour government's short term NHS cost cuts. In comparison to the annual £1.4 m cost of the DTB, the NHS's drugs bill is around £11 billion a year.

Even a cursory cost benefit analysis indicates that a 0.1% saving on the drugs bill will pay for the preservation of the DBT eight times over.

NHS workforce falls by 11,000

The number of people working in the NHS fell by 11,000 in the last quarter of 2006, official figures reveal. Health unions said the loss across the UK, revealed in Office for National Statistics, would "inevitably have a negative impact on patient care". Total full and part time NHS staff numbers are estimated by the ONS as being 1,222,000.

James Johnson, head of the British Medical Association said NHS trusts were under pressure to balance their books, leading to posts being cut.

And nurses' leaders warned workforce cuts would damage patient care.

Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), added: "These alarming figures confirm what the RCN has long been warning - that deficits are leading to serious cuts in the NHS workforce.

"This can only have a damaging impact on patients and services. That's why we are urging the government to work with us to replace short-term cuts with a long-term recovery plan."

Mr Johnson added: "This is devastating for the staff who are made redundant and demoralising for those who are left to cover the work.

"Although the majority of job losses are non-medical, they will inevitably have a negative impact on patient care."

Andrew Lansley, the Shadow Health Secretary, said: "What's demoralising for NHS staff is that the incompetence and mismanagement of this Labour Government has meant that after additional investment expanded staffing numbers in the NHS, financial deficits now mean hospitals are cutting back on the number of jobs.

"The loss of posts directly contributes to the fact that nurses, physiotherapists and others leaving college cannot find jobs."

From:
http://news.bbc.co.uk/1/hi/health/6450303.stm

The Office for National Statistics's analysis that 11,000 NHS job were cut last year proves bliar's lie that only "a few hundred" NHS staff have lost their jobs due to his under funding.

On 19 Oct 06- Health Direct posted: NHS does not know how many jobs are being axed in recent cutbacks and closures

The newly appointed chief executive of the National Health Service admitted that he did not know how many jobs would be lost this year as a result of budget cuts and reorganisation.

David Nicholson was challenged on the impact on jobs of English NHS trusts plunging £523 million into the red at a press conference called by the Prime Minister to highlight health service reforms. "Out of touch" bliar claimed "only a few hundred" NHS jobs were axed.

Health Direct also reported that the claim by bliar that compulsory redundancies would number only "a few hundred" was described by Dave Prentice the head of the Unison union as showing how out of touch with the real world the prime minister had become.

In comparison to bliar's discredited spin, Health Direct counted 19,568 NHS staff job cuts that were announced during 2006 as the NHS struggled to balance the books.

Full scale of Labour's NHS cutbacks revealed

The full scale of impending hospital closures was laid bare last night as it emerged that three out of four trusts are already restricting patients' access to treatment as they battle soaring deficits. Fears about the number of closures intensified as Patricia Hewitt, the Health Secretary, sent NHS managers a guide on how best to handle decisions to shut down hospitals and units - a document that opposition politicians immediately branded a "spin" blueprint.

At the same time, a survey of NHS trust chief executives revealed the impact of the health service's financial crisis on front-line care.

The survey, published in today's Health Service Journal, shows that 73 per cent of primary care trusts, which run GP clinics and health centres, are already restricting access to treatments. Half are also delaying operations.

Seven out of 10 chief executives said "patient care will suffer" as a result of short-term financial decisions to cut deficits, while 61 per cent of acute hospital trusts said they were already closing wards.

Almost half of all trusts said that they had made, or intended to make, redundancies this year.

Morale appears to be at rock bottom, with 86 per cent saying that managers were "battered and bruised" by endless reorganisations.

Miss Hewitt published her guide on closures amid growing panic in Whitehall about the looming public backlash as trusts across the country announce plans to cut services over the coming months.

But the opposition immediately accused ministers of "a cynical exercise" in spin as it emerged that the guide includes proposals on "media handling" and urges trusts to use words such as "adapting" or "evolving" services when talking about cuts.

Dozens of accident and emergency units, maternity units and community hospitals are facing the threat of being shut down or downgraded as part of the Government's plans to "reconfigure" the health service.

Many Labour MPs fear the cutbacks will cost them their seats, prompting four Cabinet ministers to join local protests against planned closures in their own constituencies.

In a covering letter to the guide - which has been sent to all 10 Strategic Health Authorities in England - David Nicholson, the NHS chief executive, said it was vital that managers did not "shy away from major service changes that address financial difficulties".

Miss Hewitt's new blueprint on closures, written by Sir Ian Carruthers, the former chief executive of the NHS, stresses that trust managers must do more to sell their closure plans to local people. The report conceded that closures would "lead to a loss of public confidence" and that reconfiguration had "become a euphemism for closures and downgrading of hospitals".

It argued that NHS managers could limit the damage by developing clear media strategies, using the right language and trying to get some senior doctors to back their plans.

Managers are warned that the media can often run "damaging" stories on closure plans.

"Effective media handling plans, regular engagement of local journalists, care in explaining the case for change and a strong local voice to challenge misleading media stories that worry patients unnecessarily can help mitigate this," it said.

Language is crucial and managers are urged to use words such as "adapting, developing, evolving and specialising. If a service is changing to improve the health outcomes for patients and save lives, this isn't a downgrading of the service."

Managers are also advised to argue that closures will be compensated for by better services in local health centres or GP clinics.

The new spin guide was condemned last night by the Conservatives and Liberal Democrats.

Andrew Lansley, the shadow health secretary, said: "Nothing in this long-winded document will offer any comfort. It is all about advising NHS bureaucracy how it can better sell decisions. It offers no real evidence for how services can and should be improved.

"The Department of Health should be less concerned with spin and more concerned with substance."

Norman Lamb, the Liberal Democrat health spokesman, said: "This is a cynical exercise and their cover has been blown. It demonstrates that despite claims that decisions are made locally, everything is driven from the centre. Even the spin is sent down from Whitehall."

Dr Mark Porter, the deputy chairman of the British Medical Association's consultants' committee, said changes in services needed to be about improving patient care.

"The BMA is not opposed to reconfiguration if it is done for good, sound clinical reasons. But we have been worried that finances and not patients' needs have been the driving force behind some plans," he said.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/01/nhosi01.xml

At the beginning of the new year (3 Jan 07) Health Direct warned that there were signs of NHS hospitals told to delay operations to ease health service's debt underfunding

The New Year has only just begun but it is clear that the next three months are not a good time to become ill as the NHS can not cope with Labour's underfunding of the health services as patients in some parts of the National Health Service are for the first time facing minimum waits to be seen and treated as managers attempt to balance their books.

Suffolk, Hertfordshire, North Yorkshire and Kingston are all imposing various forms of minimum wait, with some primary care trust chiefs saying their organisations may follow suit as the NHS battles to recover from last year's £536m plus overspend.

Only a week later (10 Jan 07) Health Direct posted that Maternity wards are having their cash cut amid boom in birthrate, say midwives

The NHS is responding to a boom in the birthrate by cutting spending on maternity services, the Royal College of Midwives said after a survey of more than 100 heads of midwifery in hospital trusts across Britain.

It found that two thirds of maternity units were understaffed and most were trying to save money by employing fewer qualified midwives and taking on maternity support workers instead.

Then on (1 Feb 07) Health Direct posted that Dental patients hit as dentists funding fails to add up

Dentists are turning away patients because miscalculations by the Department of Health have resulted in local health authorities running out of money in the dental budget. The problem has arisen because dentists have been treating more patients who are exempt from dental charges than had been anticipated under the new dental contract which came into force last April.

Then on Valentine's Day (14 Feb 07) Health Direct posted that it was the turn of the suppliesr to feel the financial squeeze- NHS paying bills late in struggle to balance books, say suppliers

The National Health Service is delaying paying bills and cutting orders for supplies as it tries to balance its books, according to the trade associations whose members supply the service with everything from scanners to diagnostic tests.

Ray Hodgkinson, director-general of the British Healthcare Trades Association, said that while the picture was highly variable "some of our members are having real trouble getting money out of NHS trusts".

More recently Labour's NHS Cash crisis hits sexual health STD clinics, then confirmation that MRSA and Clostridium difficile deaths up by half in year and cancer patients were also cut back in Hospitals told not to operate until cancer patients have waited 20 weeks


Only last week (Feb 22 07) Health direct warned that More trusts expect deficits as NHS spending cuts bite when around a quarter of primary care trusts are setting minimum waiting times for patients or otherwise slowing treatment, at least until the start of the new financial year.

Mr David Nicholson, the NHS chief executive, acknowledged that patients had been affected. But he said the service was still treating more people, and training cuts would be restored next year.

However, Andrew Lansley, the Conservative health spokesman, said "the surplus they have generated is a sham". More organisations were saddled with worse deficits than last year, he said, adding that "Patricia Hewitt's skin is being saved only by savage cuts to centrally held budgets".

The NHS Confederation argued that half the overspend was in just 6 per cent of organisations. It urged the health department to end the "double whammy" caused by a set of accounting rules it said were being applied inappropriately to some hospitals, causing them to enter an inescapable spiral of debt.