European healthcare rankings

New report that ranks the UK 13th for healthcare out of 31 European countries.

The Euro Health Consumer Index 2008 puts the Netherlands in first place, with the UK trailing behind countries including Estonia, France and Germany.

The study looked at areas such as patient rights and information, IT, waiting times, outcomes, the range and reach of services and access to new drugs.

The report's authors found the UK performed well on patients' rights and information, but unlike Denmark and the Netherlands there had not been improvement across the board.

Euro Health Consumer Index director Dr Arne Bjornberg said the UK risks "raising expectations that the healthcare system cannot deliver".

From:
european_healthcare_rankings

Treasury could snatch £3bn from NHS budget, academic warns

The Treasury could try to claw back more than £3bn out of the NHS to contribute towards the credit crisis bail-out package, a leading health service academic has warned.

The NHS in England is currently forecasting it will have a £1.7bn surplus this year and Foundation Trusts, which are not under the direct control of Whitehall, have £2.5bn in the bank.

Prof John Appleby, chief economist at think tank, the King's Fund, has analysed the effect the financial crisis will have on the health service in the short, medium and long term, in the British Medical Journal.

He warns that the Treasury has a 'track record' of clawing back surplus funds from the NHS.

He wrote: "Although the prime minister pledged not to cut spending for health as set out in the 2007 comprehensive spending review, taking back unspent money may not be seen as a cut."

Prof Appleby said in the short-term the effects on the health service have been minimal, although Virgin Healthcare announced in September that it would not be bidding to run GP-led health centres yet, and several charities and NHS trusts have money on deposit with failed banks in Iceland.

In the medium term, spending on health is supposedly fixed until 2011 so while an outright cut in labour Government funding is unlikely, the NHS budget is being eroded by high inflation.

It is thought that inflation may have peaked but inflation in the NHS runs a little higher than the general economy and every one per cent increase costs the NHS £380m, Prof Appleby wrote.

The real danger for the NHS is in the long term because, with labour Government borrowing rising, and income from taxes likely to fall during a recession, there will be less available to keep up the growth in health funding.

Prof Appleby warned that there may be no real growth in funding until 2014, in contrast to the large real terms increases enjoyed under Labour so far.

The financial situation is also likely to increase demand for health services, so the NHS will be squeezed from both sides, he said.

Prof Appleby wrote: "But not only will there be pressures on NHS funding, the combined effect of the credit crunch and recession on the population's health and wellbeing will increase ill health and demand on healthcare services.

"The link between deprivation, income, housing, unemployment, and healthcare needs is well documented."

A Department of Health spokesman said: "While the current financial position is settled for this spending review period, good financial planning means that the NHS needs to plan on a longer-term basis and this means looking to at least a five-year timeframe.

From:
Treasury-could-snatch-3bn-from-NHS-budget-academic-warns.html

NHS data breaches hit 75 in a year

Seventy five breaches of data security rules by the health service have been reported to the information commissioner's office in the past year, new figures reveal.

The NHS and healthcare sector is second only to the whole of the private sector at losing computers, records and data.

The 75 breaches included 27 lost computers and laptops, 14 losses of paper records and 18 of removable media such as memory sticks.

Data was "inappropriately disclosed" on five occasions, there were two postal errors, one email error and one website security breach.

Eighty breaches in the private sector have been reported since November last year, 28 in central government, 26 in local government and 47 in other public sector bodies.

Information Commissioner Richard Thomas said reports had "soared" since the high profile loss of 25m child benefit records in autumn last year.

He said responsibility for data breaches should lay with chief executives, who should ensure appropriate policies and procedures are in place, that privacy is incorporated into their technology and that staff are properly trained.

"It is alarming that despite high profile data losses, the threat of enforcement action, a plethora of reports on data handling and clear ICO guidance, the flow of data breaches and sloppy information handling continues," said Mr Thomas.

From:
http://www.hsj.co.uk/nhs_records_75_data_breaches_in_a_year

Patients at risk from flawed £12bn NPfIT IT system

The NHS computer system (NPfIT) intended to revolutionise patient care has so many software flaws that seriously ill or badly injured patients are at risk of being inaccurately diagnosed, according to an internal health service document.

An assessment of the system at the first hospital to launch it, the Royal Free Hampstead NHS Trust in north London, details a catalogue of software glitches and design faults. It warns that the problems pose a possible “risk to patients by underestimation of clinical condition”.

According to the document, the system, which is being used in the accident and emergency department, is routinely crashing, patient information is intermittently “lost” and some staff are reverting to pen and paper. Extra staff have been drafted in to help cope.

Tony Collins, executive editor of Computer Weekly, said the document, disclosed by an NHS employee, warned that some of the problems could “continue indefinitely”.

He said: “This is the centrepiece of the Connecting for Health programme [the government’s plan to computerise NHS records] and it isn’t working properly.”

Hospital officials said this weekend that continuing problems were being “vigorously” pursued with the contractors while staff were being vigilant to ensure patient safety was not compromised.

The report is the latest setback for the £12 billion Connecting for Health programme, which was meant to provide a single nationwide IT system for the NHS containing records for every patient by 2010.

While some elements of the programme have been introduced ahead of schedule, the patient record system has been beset with delays and software problems.

Last June the Royal Free became the first trust to launch the most advanced version. To protect patient confidentiality, records can be accessed only with a swipe card and a code.

The launch was a key test for Connecting for Health, which has faced questions about the reliability of its systems and whether patient confidentiality could be easily compromised with computerised records. Two months after the launch there were reports of missing data and delays in booking patient appointments.

Now an assessment of the new system at the Royal Free has uncovered a series of problems, which appear to be unlikely to be fixed in the short term.

The Royal Free Hampstead NHS Trust said the implementation of the new system was initially better than expected but there were continuing problems that would “take some time” to rectify.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4882792.ece

Employers face higher bills for health benefits

The cost to UK companies of providing employee healthcare benefits is one of the highest in Europe, according to an independent study published today as worries about the NHS continue.

UK companies on average spend 7 per cent of their total payroll costs on healthcare schemes, compared with 5.3 per cent across Europe.

Only Switzerland (11.3 per cent), Bulgaria (8.8 per cent), Romania (7.5 per cent) and Turkey (7.3 per cent) pay a higher proportion of payroll costs on employee healthcare benefits, according to consultants Mercer, which surveyed almost 800 employers in 24 European countries.

This was still far lower than the US, where employers spend 15.4 per cent of payroll on health benefits.

Employers in European countries, such as the UK, which fund public health through general taxation, spend more on health benefits than countries that operate government-sponsored social insurance schemes, into which citizens pay directly, said Mercer.

It added: "This may reflect a concern that public health systems [funded out of general taxation] do not meet employers' objectives and, hence, there is a greater perceived need to provide supplemental health benefits."

The cost of healthcare schemes to employers has risen sharply in recent years - increasing by 5 per cent per employee last year across Europe as a whole and 5.9 per cent in the UK - as medical costs increased.

The average cost of providing medical cover for employees and dependants has risen by 67 per cent in he UK since 1999, according a separate survey conducted earlier this summer. This has placed an increasing burden on employers. More than half of European employees do not pay towards their employer-provided health benefits, compared with the US, where employees commonly pay around a quarter of the cost.

Despite the rising costs, many companies expected to maintain healthcare schemes in order to retain and attract staff. Some 41 per cent of European employers were unlikely to make any changes at all to their programmes, according to the consultants' latest survey.

Concern over rising costs, however, was reflected in the fact that 38 per cent expected to restrict the scope of coverage, while 34 per cent said they would shift some of the cost to employees. Others were considering offering flexible benefits "to manage costs and better match employee requirements", said Mercer.

Steve Clements, head of Mercer's health and benefits business, said: "Over two- thirds of respondents said they would struggle to retain top-performing employees if they did not offer good health benefits. These programmes are particularly valued as a staff attraction tool by companies in emerging eastern European countries, where migration to western economies has produced a scarcity of talent.

"Health benefits often rank as the most highly valued company benefit in countries where employees perceive national health provision is relatively poor."

From:
http://www.ft.com/cms/s/0/fa1fc904-8f4f-11dd-946c-0000779fd18c.html?nclick_check=1

Drug companies face fresh action after trial failure

Efforts to punish a group of drug companies allegedly behind one of the biggest price-fixing schemes to hit the public purse are being stepped up after the collapse of their criminal trial.

Frank Field, the former Labour social security minister, wrote to Alan Johnson, the health secretary, yesterday to urge further action against the businesses over a conspiracy that was allegedly taking place while prices of dozens of basic remedies rose as much as 800 per cent.

Mr Field made his intervention as lawyers acting for the National Health Service press for further "substantial recoveries" through a damages action against the companies that has already netted £34m. Many observers say the companies named have never been forced to account fully for their actions, bec-ause of weaknesses in the way Britain deals with financial misconduct.

Mr Field, a former member of the Commons' public accounts committee, said the companies should be "on their knees thanking their lucky stars" at the decision by Mr Justice Pitchford last month to stop their criminal trial on conspiracy to defraud charges.

Peters & Peters, the law firm acting for the NHS, is pressing ahead with a damages action founded on allegations that the companies were involved in a conspiracy to rig the prices of drugs including penicillin and warfarin, a blood thinner.

Jonathan Tickner, a Peters & Peters partner, said: "The obvious success of the civil proceedings . . . speaks for itself and we, on behalf of the Department of Health, fully expect further substantial recoveries to be made."

The main company still in the department's sights is Ashford-based Kent Pharmaceuticals, supplier of many basic antibiotics to NHS hospitals, retail pharmacists and dispensing doctors.

Kent declined to respond to questions on the case. All the other companies that faced criminal charges - Goldshield, Ranbaxy, Generics and Norton Healthcare - declined to comment when asked if they denied colluding with each other, saying they could not speak while the threat of criminal proceedings remained.

Mr Justice Pitchford last month scrapped fraud charges laid by the Serious Fraud Office against the companies after the House of Lords criticised the way the indictment was drafted but left open the possibility it could be amended. The SFO has launched an appeal against the judge's decision, arguing it should be allowed to reformulate the charges.

Since the trial collapsed, some senior executives - notably those at listed Goldshield, which is chaired by Keith Hellawell, the government's former drugs "tsar" - have gone on the offensive and complained £25m of taxpayers' money was wasted in mounting the trial. The companies have always argued that price-fixing was not a crime at the time of their alleged activities.

But lawyers said there seemed to be evidence of subterfuge to justify a prosecution, alleging companies conspired to defraud the government - and hence the taxpayer. Documents seized in the penicillin investigation included a presentation, known as "The Scenario", that contained a bullet-point overview of how to operate a price-fixing cartel.

The case could be picked up by the Office of Fair Trading, which has imposed fines totalling hundreds of millions of pounds over the past year or so on companies involved in cartels in industries such as aviation, supermarkets and tobacco.

Another possibility is that the NHS could launch a private prosecution. It declined to say whether it had plans to do so.

Health checks

2000 SFO starts probe into price-fixing in supply of generic drugs to NHS April 2002 More than 30 premises raided April 2006 Five companies and nine executives charged with conspiracy to defraud January 2008 Lords hear submissions from Goldshield and Ian Norris that price-fixing cannot be prosecuted under the common law offence of conspiracy to defraud March 2008 Lords rule in favour of Mr Norris and Goldshield July 2008 Judge quashes indictment against the five companies and nine executives charged

http://www.ft.com/cms/s/0/32776f1c-6806-11dd-8d3b-0000779fd18c.html

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

NHS scandal of dying cancer victim was forced to pay

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chan Wheeler to leave NHS less than one year as commercial director

Chan Wheeler, the health department's controversial US commercial director, whose pay and conditions package was branded "an eye-watering deal" by the Tories, is resigning to return to the US less than one year into his three year contract.

The health department confirmed that Mr Wheeler is to leave in July "for personal, family reasons".


As commercial director, Mr Wheeler recommended - to the chagrin of the private sector - a marked reduction in the scale of the second wave of independent sector treatment centres set up to treat NHS patients, saying the need for them had been "severely miscalculated".

He accepted arguments that the NHS itself had sufficient capacity in some areas. He has also overseen the shift from centrally purchased private sector contracts to local purchasing by primary care trusts.

His arrival caused controversy because he had received backdated share options at United Health similar to those that led to William McGuire, its chairman, resigning and reaching a $600m (£300m) settlement with the Securities and Exchange Commission. His UK pay package was attacked by the Tories after it emerged he was receiving £100,000 a year towards his accommodation, on top of a £185,000 salary and pension.

Mr Wheeler said he was sad to be leaving, while David Nicholson, the NHS chief executive, said he had done "a fantastic job". A departmental spokesman said the balance of Mr Wheeler's three-year contract would not be paid.

From:
http://www.ft.com/cms/s/0/06a39900-292d-11dd-96ce-000077b07658.html?nclick_check=1

The detail of Chan Wheeler's renumeration was only revealed this year. February 05, 2008 Health Direct posted: NHS gives American chief ‘eye-watering deal’

The Department of Health is paying more than £100,000 a year towards housing the American who heads its commercial directorate – on top of a salary of at least £185,000, a civil service pension, two business class flights a year to the US, a relocation package of up to £35,000 and eligibility for a bonus.

He also made $8m from the sale of stock options, according to the filings. He has been named in a civil action in the US by public sector unions seeking $5.5m in damages over backdated stock options that he received from UnitedHealth.

His ultimate boss at UnitedHealth, William McGuire, then chairman, recently paid $600m to settle an action by the SEC over backdated options similar to those that, according to court documents, Mr Wheeler received.

Frank Dobson, the former Labour health secretary, whose parliamentary questions revealed Mr Wheeler’s remuneration, described it as “a bit much when everybody else in the health service is being subjected to pay restraint”.

He hit out at the £8,400-a-month housing allowance – understood to be spent on a three bedroom apartment in Knightsbridge, central London. Many people were finding house prices out of reach, Mr Dobson said, and “we seem to be helping that by making accommodation for the American commercial director of the NHS free.”

The package was described as “an eye-watering deal” by Stephen O’Brien, Conservative health spokesman, who asked whether it offered value for money for the taxpayer.

Mr O’Brien said: “He is being paid an ex-pat’s package but getting the advantage of a civil service pension. And the £100,000-a-year in accommodation costs would cover the salaries of four nurses. It looks like the worst of both worlds for the taxpayer.”

NHS constitution- another bad labour idea- FT Editorial

The key test of any health reform should be whether it will actually improve the quality of care that patients receive.

By any measure, the latest big new idea from Gordon Brown, the British prime minister, fails the test: that, after muddling along without one for 60 years, the National Health Service in England (healthcare is now devolved in Scotland and Wales) should have a constitution.

The very origins of the idea betray its weakness. It was initially dreamt up by Andy Burnham, then a junior health minister, as a means of celebrating the NHS’s 60th anniversary this July.

Why not, he mused, lay out the service’s values and ethos, setting out what patients can expect in terms of rights and responsibilities?

The real motivation, however, was far tawdrier.

Labour hoped that something could be written about the service being tax-funded and largely free at the point of use in language that the Conservative opposition would balk at. Labour would then go into the next election arguing that the NHS was not safe in Tory hands.

There was never a chance of that. David Cameron, the Conservative leader, has been at great pains to commit his party to the current model of the NHS, sealing off the subject as an election vulnerability.

But the idea, once born, has refused to die. Even now, weeks before its intended publication, no one in Whitehall seems to have much idea of what might be in it.

The plan may set out some responsibilities (not to abuse the service), some rights to minimum standards of care and possibly some definition of who should do what in the NHS from ministers downwards.

But the odds are it will either be so vacuous as to be meaningless, or that it will open up cans of worms that ministers will wish they had never touched.

If the constitution tries to define entitlements, ministers risk having to decide what should be in (and not in) a “core” NHS. States round the world have tried the idea and found it lacking.

If the new model deals with accountability, it risks freezing what should be flexible: healthcare systems need to be malleable to respond to changing technology, disease and patterns of care. That risk will rise if it is a legal document.

And if it is not put into law it will count for nothing more than the stated principles of the NHS – all of which are contained in countless Department of Health documents, and some of which are already enshrined in law.

This futile exercise will create the illusion of activity while doing nothing to improve patient care. It should be dropped.

Ministers instead should concentrate on their other (and wholly welcome) proposals this week: ensuring that patients have choice and that hospitals have real financial incentives to improve the quality of care.

http://www.ft.com/cms/s/0/0840430e-22ab-11dd-93a9-000077b07658.html?nclick_check=1

Hospitals are getting better- but only very, very slowly

Patients' experience of National Health Service hospitals is improving, but painfully slowly, according to findings in the annual survey conducted by the health service inspectorate.

There are also "striking variations" in performance between hospitals, the survey says, with some "struggling to deliver on some of the basics of hospital care" such as cleanliness and treating patients with dignity.

For the first time the Healthcare Commission has published the data, based on interviews with more than 75,000 patients, together with comparisons going back six years to the first such research in 2002. Since then spending on the NHS in England has risen from £55bn to £87bn in 2007, with staff numbers up by 115,000 over the same period.

In this year's survey 92 per cent of patients rated their care as "good", "very good", or "excellent", with the percentage rating it as only fair or poor down from 9 per cent in 2002 to 8 per cent in 2007.

But over the six years there has been only a 4 percentage point rise, to 42 per cent, in patients putting their care in the top category of "excellent" - in spite of all the extra spending.

A higher percentage of patients said that they had waited less than four hours in accident and emergency in 2007 than in 2002. However, the increase was only from 67 to 72 per cent. On some of the government's key targets, performance has been less than impressive.

There has been a 3 percentage-point drop since 2002 to 53 per cent in the proportion describing their ward as "very clean". But 12 per cent of patients complained that lavatories and bathrooms were dirty, the same figure as six years ago.

Forty six per cent of patients rated hospital food as only fair or poor, with a mere 1 percentage point rise over six years, to 19 per cent, in those saying the food was "very good". In spite of the government's emphasis on choice of hospital, precisely the same percentage recall being offered it in 2007 as in 2005 - just 27 per cent.

The survey also reveals dramatic differences in performance between hospitals.

More than 90 per cent of patients in top-performing hospitals, such as the Royal Marsden and Clatterbridge cancer centres, said they were always treated with respect and dignity.

The figure for the worst performers, such as Mayday and Ealing hospitals in London, was 80 per cent. At Ealing, just 58 per cent of patients said their care was very good or excellent, against 90 per cent and more at some specialist hospitals.

Anna Walker, chief executive of the Healthcare Commission, said it was good to see rising percentages of patients saying care was excellent but: "In some hospitals the NHS is struggling to deliver on some of the basics of hospital care."

The diagnosis
*92 per cent of patients rated their care as 'good', 'very good', or 'excellent' (up from 91 per cent in 2002)
*72 per cent said they waited less than four hours in A&E (67 per cent)
*46 per cent rated hospital food as only 'fair' or 'poor' (47 per cent)
*20 per cent did not get enough help eating meals (18 per cent)
*Spending on the NHS in England grew from £55bn in 2002 to £87bn in 2007

From:
http://www.ft.com/cms/s/0/9fa2f8ce-2150-11dd-a0e6-000077b07658.html

Who Cares- one family's shocking story of "care" in today's NHS.

Who cares- Paul Steane went into hospital with a minor problem – through repeated neglect in two NHS hospitals he emerged an invalid.

Throughout his time in hospital, his wife Amanda desperately tried to alert nursing staff and hospital authorities to the things that were going wrong with her husband.

Every time she alerted them to a new horror, they would promise that nothing like that would ever happen again – but every time things got worse.

Finally, an invalid deprived of his independence, his legs, his ability to communicate and everything he enjoyed, Paul Steane took his own life.

Inexperienced doctors, overworked nurses, filthy wards, inadequate care - all of these were guilty for Paul Steane’s death.

Hospital management denied all responsibility, claiming key parts of Paul’s medical records had been ‘lost’. But a nurse, outraged at what was happening, sent Amanda copies of the ‘missing’ records and the police began to investigate.

http://www.nhs-whocares.com/who_cares.html

Health Direct finds this a truly moving and horrifying book. It should be compulsory reading for all the hopeless bureaucrats who run our health service and for the labour politicians who ruin it.

Vital year of reform for healthy looking NHS claims nhs spin

The National Health Service faces a critical year that will shape its performance over the next decade, according to David Nicholson, its chief executive.

After some years of financial turmoil, the service is about to record a near £2bn surplus, with NHS foundation trusts - the freestanding, self-governing health service businesses - holding another £1.5bn or so of cash in the bank.

Since April 1, patients have had a choice of any accredited hospital, public or private, for routine treatment. By the end of this year the maximum wait will be 18 weeks, with the average much shorter. And hospital acquired infections - patients' "number one priority" along with hospital cleanliness, according to Mr Nicholson - are finally on their way down.

So in its 60th anniversary year, "on the big safety, money and access issues we will have delivered something quite significant", Mr Nicholson said in an interview with the Financial Times. But while "that is good, it is not good enough", he said as he underlined that the NHS was still in the process of transforming "from one system to another".

That, he stressed, "is not a trivial, piecemeal change. This is a fundamental change in the way health care is delivered".

The NHS had moved from the huge expansion in spending and staff after 2000, to introducing new incentives for commissioning and for choice, and now needed to make services more personalised and responsive to patients.

Key to that would be giving patients far more information, while getting primary care trusts - which purchase care on patients' behalf - "to focus their absolute attention on the benefits to their patients and communities" rather than "always looking after the provider parts of the NHS".

Private sector hospital providers have been expressing disillusionment as the apparent scale of opportunities open to them has shrunk, although Mr Nicholson said private sector interest in providing primary care remained vibrant.

But he added: "I cannot imagine an NHS service in 10 years' time that does not have significantly more private engagement at almost every level - whether it is in the provider arm, or supporting and developing commissioning, or whether it is the direct provision of services. It seems to me that is the nature of the system we are trying to move towards."

The new system has brought tensions. Monitor, the regulator for the foundation trusts, complained recently that the Department of Health still seemed to be trying to subject them to command and control by telling them to appoint extra matrons and to have hospital "deep cleans" to control MRSA infections.

Mr Nicholson acknowledged that in the new system "I haven't got the ability to tell them how to do it. That is absolutely true". But he had every right to tell any NHS provider that they must tackle hospital infections in the wake of the big death toll at the Maidstone NHS Trust.

"I don't want to have a spat with the regulator. I think Monitor is doing a fantastic job." But he added: "It is not public confidence in individual organisations that suffers [in a case such as Maidstone]. It is public confidence in the whole system. I have a responsibility to defend that reputation, and I have a right to express a view."

With the NHS having significant sums of unspent capital, and with the intention being to run the same level of surplus this year to even out expenditure over the three-year spending round, the service was now "in a good place", he said, with ample funds to meet its immediate objectives.

But it had to prove it could complete the reforms and use the money well.

"It is a big test. That is why 2008 is so important. When we look back, whether we have exploited this position well will be the judgment of how successful the NHS is over the next 10 years."

http://www.ft.com/cms/s/0/1661d598-0117-11dd-a0c5-000077b07658.html

Health Direct asks why if the NHS is so financially healthy and can afford cancer drugs aren't doctors being allowed to prescribe them?

Private hospital groups have shown limited enthusiasm for labour's plans to outsource treatments. As one executive put it, their fear is that Whitehall's "push" for private sector provision was "less pronounced than it appeared to be a few years ago".

Private sector providers complain that ministers have a habit of decreeing that the market should be opened - then failing to check their spin has been implemented. Somewhere down the Whitehall chain, companies complain, change is blocked - whether by disapproval of the profit motive, turf wars or an ideology-fuelled conviction that public services should remain in the public domain.

NHS is paying for immigrant baby boom

The NHS is spending £350m a year to provide maternity services for foreign-born mothers, £200m more than a decade ago, the BBC and Health Direct has found.

Immigration has raised the birth rate so fast that some units have closed, so that midwives could be moved to areas of urgent need. A unit in Ascot, Berkshire, shut for two months in 2007 because staff had to be transferred to Slough.

The NHS says it is working to "build in" the extra capacity needed.

Maternity units have turned expectant mothers away because they could not cope with unprecedented increases in the local birth rate.

When Labour came to power, the NHS spent around £1bn a year on maternity services, with one baby in eight delivered to a foreign-born mother.

Ten years on, spending has risen to £1.6bn, with almost one baby in four delivered to a mother born overseas.

While the number of babies born to British mothers has fallen by 44,000 a year since the mid-1990s, the figure for babies born to foreign mothers has risen by 64,000 - a 77% increase which has pushed the overall birth-rate to its highest level for 26 years.

In central London, where six out of every 10 babies born has a foreign-born mother, senior consultants and health managers blame the lack of resources to deal with the pressures of migration for unacceptably poor standards.

Professor Philip Steer, editor of the British Journal of Obstetrics and Gynaecology, said: "The Department of Health has been taken by surprise. The demographic change, the sheer numbers, has in some areas increased very substantially without there being any forward planning really to allow for that."

According to figures from the Office for National Statistics, in 2006 there were 15,000 more Eastern European babies born here than a decade earlier.

The statistics go on to show that 11,000 more babies were born to a mother from the Indian sub-continent, while 8,000 extra babies had mothers born in Africa.

Heatherwood Hospital in Ascot closed its maternity unit for two months in the summer of 2007 because of an "unprecedented increase" in the local birth rate.

Midwives were moved to Wexham Park Hospital, closer to the pressure-point of Slough where in the last year staff have witnessed an extra 150 babies delivered to foreign-born mothers.

The knock-on effect was experienced in nearby Reading where the local maternity unit could not cope with the extra demand.

Tharlie Cooper was supposed to have been born in Reading, but when mother Lavina went into labour two weeks overdue she was told that, despite her being booked in, her local birthing unit was full.

Tharlie's father Dean was furious. "Basically we got turned away and the reply I got on the phone was wherever you ended up is where you end up", he said.

He drove his wife to Basingstoke in neighbouring Hampshire where doctors conducted an emergency caesarean.

LIVE BIRTHS BY COUNTRY OF BIRTH OF MOTHER
Births by British-born mothers down 44,000
Births by all foreign-born mothers up 64,000
Births by mothers born in Eastern Europe up 15,000
Births by mothers born in Indian subcontinent up 11,000
Births by mothers born in Africa up 8,000
Source: ONS/BBC

Peterborough has seen a huge increase in births from Eastern Europeans. There were just three such babies in 2000, but almost 200 in 2006.

At the Thistlemoor Medical Centre, births among patients have increased 33% in just two years. GP Nalini Modha fears the authorities have not planned for the new arrivals.

"Hopefully somebody who is in authority is actually looking at the figures to try and work out how they're going to cope with the influx" she said.

"If you're going to provide responsible care for all the population - the indigenous as well as the newcomers - then we will have to stop and think about what we can and can't afford."

In parts of Greater London, seven out of 10 babies are now delivered to mothers born overseas.

The Strategic Health Authority argues that this partly explains why maternity services in the capital performed so poorly in last week's Healthcare Commission report.

Births within migrant groups can often be more difficult, more dangerous and more expensive - with much higher rates of type 2 diabetes, tuberculosis and HIV among mothers who often turn up very late in their pregnancy.

London's chief nurse, Trish Morris-Thompson, admitted that the NHS had not realised how immigration would affect maternity services.

"The timing of the impact is much quicker than we had anticipated", she said. "We're working with our commissioners and our maternity providers now to ensure that we're building in the capacity they need."

From:
http://news.bbc.co.uk/1/hi/health/7215624.stm

Health Direct wishes all of you a Happy and Healthy New Year

Health Direct wishes all of you a Happy and Healthy New Year.

Doctors quit dirty NHS for India

The influx of thousands of Indian doctors into the National Health Service is going into reverse. Hospitals in India are now said to be cleaner and better equipped than many in Britain and doctors are quitting the NHS to work there instead.

The director of one of India’s biggest private hospital chains said he was receiving five job applications a week from NHS doctors and that half his 3,000 consultants were from Britain.

“There’s a feeling that India’s time has come and there’s a huge need for these people to come back,” Anupam Sibal, director of the Apollo hospital in Delhi, said yesterday.

Doctors say they are moving to India because of its economy, state of the art equipment, higher standards than the NHS and a better quality of life. In particular, they say hospitals in India, which many Britons still imagine to be impoverished and dirty, suffer less from hospital-acquired infections such as MRSA.

India has no equivalent of the NHS but there has been a boom in private hospitals that resemble luxury hotels, with marble foyers and corridors mopped by an army of liveried cleaners.

One of those who has made the transition is Mahesh Kul-karni, an orthopaedic surgeon, who left Bristol Royal Infirmary after 10 years in Britain. He is now a consultant at the Aditya Birla Memorial hospital in Pune.

“The hospitals are better than in Britain,” he said. “This hospital is spotless and clean compared with the old hospitals in the UK, some of which are more than 100 years old. I started in January this year and I have not seen MRSA here yet.

“It’s had a lot of investment, and things I couldn’t do in Britain I can do here. We have ‘clean air’ operating theatres [that remove dust from the air], and our intensive care unit here is fully equipped with special monitoring instruments.

“When I went to England 10 years ago, India was 10 years behind Britain. Now there’s hardly any difference.”

Bristol Royal Infirmary defended its record, saying there had been a 35% increase in spending on new equipment and that its latest inspection had found cleanliness was “acceptable”.

Ameet Kishore had worked as an ear, nose and throat consultant in Glasgow Royal Infirmary for 12 years when he moved to the Apollo hospital in Delhi two years ago. Although reluctant to criticise the NHS, which had taught him so much, he said that the new Indian hospitals were cleaner and better resourced.

He contrasted the number of cochlear implant operations that he could perform: at Crosshouse hospital, Kilmarnock, the main ENT centre for the west of Scotland, he was limited to 40 a year; in Delhi he had done 70 in the past six months.

Other doctors cite new European Union rules for their decision to move. Shailendra Magdum, a specialist registrar in neurosurgery at Radcliffe Infirmary in Oxford until he left for India in August last year, said that rules favouring EU doctors over Indians had played a part.

The EU’s working time directive had also lowered NHS standards, he added, by restricting the amount of time that young doctors could spend on the wards.

“For a neurosurgeon to be good you have to spend a lot of time on the wards, but in Britain the working time directive is running down training,” he said.

Although salaries are usually lower in India, doctors are finding that their standard of living is better. Kishore said he lived in a bigger house with a driver, cleaner, cook, nanny and watchman to look after him, his wife and two young children.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3056942.ece

Health Direct laments the wasted cost of training overseas medical staff- only for the UK to let these talented people slip through our fingers.

Nurses hold silent protest at sacking of colleague for talking to the media

Thousands of health workers from across Britain have held silent protests against the sacking of a Manchester nurse. Members if Unison took to the streets wearing gags a month after psychiatric nurse Karen Reissmann, who criticised NHS cuts, was fired for speaking to the media.

Almost 100 community staff, who care for 1,000 seriously ill patients, have been on strike since November 8 and say they will not return to work until Ms Reissmann is reinstated.

Unison held a solidarity day nationwide under the slogan Silent Nightingales - Don't Silence NHS Staff This Christmas, Reinstate Karen.

Ms Reissmann's appeal started on Monday and is expected to finish today.

Vall Midson, who works with Karen, said: "A lot of staff have thanked us for standing up for the NHS. We had quite a few members of the public bring us sandwiches and flasks of tea to the demos. It is good to know everyone has heard about the strike and why we are doing it."

Unison again backed Ms Reissmann, saying they will defend members' rights to speak out without fear of persecution.

From:
http://www.manchestereveningnews.co.uk/news/s/1027263_nurses_hold_silent_protest

Health Direct wonders if something is seriously amiss in the North West socialist republic. On
June 28, 2007 in Labour's NHS reforms pushed hospital chief to suicide Health Direct posted that a hospital manager jumped 100 feet to her death, driven to suicide by the stress of NHS reforms. Morag Shedden Wilson, 32, stabbed herself with a kitchen knife and then jumped from a motorway bridge on the M60 into the Manchester Ship Canal.

An inquest heard that Miss Wilson, who was head of dietetics at Wythenshawe Hospital, was under pressure because of reforms introduced by the Agenda for Change, a labour Government review.

Coroner John Pollard urged the NHS to consider the impact of reforms on staff as he recorded a suicide verdict.

He said: "I find it extremely sad that a young woman with such a lot going for her has been reduced to this state of despair. When people introduce these rules and systems, perhaps a bit more thought as to what effect they will have on people would be helpful."

Miss Wilson lobbied hospital chiefs on behalf of her staff but was told there was no money to improve their pay.

Tory health bill challenges Labour on improvement plan

The health service would have a clear divide between purchasers and providers with ministers and the Department of Health having much less day to day involvement in its running under a bill published by the Conservatives.

The Tory plans present a political challenge to Gordon Brown's government to spell out how it plans to achieve improvements to the service, commentators say.

Under the Tory proposals a separate NHS board, which would still be subject to ministerial direction, would allocate resources, issue commissioning guidance and performance manage health authorities and primary care trusts, with family doctors being given real budgets to buy NHS care.

Monitor, the foundation trust regulator, would become a full economic regulator for healthcare. It would have a duty to promote competition, set the prices for NHS care and oversee market entry and exit for independent as well as NHS-run providers of care.

Healthwatch, a new patient and public involvement body, would work alongside the existing NHS inspectorate.

Andrew Lansley, the Conservative health spokesman, said the package would "give greater freedom to the NHS" and "get politicians and the Department of Health out of the day to day management of the NHS".

It also allowed for competition and choice to drive improvements, with polls showing that most of the public did "not care who provides the service" as long as it remained free at the point of use and of good quality.

The Conservatives, he said, would use opposition time or a private member's bill to put the proposed legislation before parliament.

He said that last year Mr Brown, when chancellor, appeared to be in favour of a more independent NHS, "but he seems to have reneged on that view".

Chris Ham, the former head of the Department of Health's strategy unit and professor of health service management at Birmingham University, said that while the details differed considerably, the thrust of the Conservatives' bill would have produced similar results as Blairite reforms.

"It begins to establish some clear blue water between Tory and Labour health reforms. It throws down the gauntlet to Gordon Brown and his health ministers to be much clearer about the mechanisms they want to use to drive further improvements in the NHS.

"Are they going to push through Blair's market-based reforms, or are they going to come up with an alternative Brownite version that is different both from where the Blairites were going and where the Tories are?"

Professor Ham said he was sceptical about how far politicians would in practice be willing or able to live with the effects of market-based reform in the NHS.

"But this sounds like a more coherent version of NHS independence combined with market-based reforms than the present government has been able to articulate."

From:
http://www.ft.com/cms/s/0/49ccf188-89b2-11dc-8dff-0000779fd2ac.html

Brown bounce wanes on public services says another poll

Labour's "Brown bounce" in the polls has receded as far as public services are concerned, according to polling by Ipsos Mori.

Ben Page, public affairs managing director, said that the public's expectations about the economy and whether public services would improve had returned to the level they stood at when Tony Blair left office.

The polling company's quarterly "delivery index" has long been used in Downing Street to track the public's views on public service reform.

In May, as Gordon Brown prepared to take over as prime minister, fractionally more of those interviewed believed the government's policy would improve the state of the economy in the long term.

By this month the net score between those who believe things will get better and those who believe they will get worse was minus seven.

On public services generally, those who believe things will get worse outnumber those who believe they will get better by 22 percentage points, against 13 in May.

That is chiefly due to expectations over the future performance of the National Health Service declining from a net score of minus 14 to minus 19.

That is nothing like as bad as in September last year, when the proportion who believed services would get worse outnumbered those who believed they would get better by 32 points.

"The NHS remains a key concern for the government," Ipsos Mori said. But "crime, immigration and pensions are [also] key challenges for the Brown government - most of the public are currently pessimistic about these".

A mere 20 per cent are confident that the government will manage immigration well, 23 per cent that they will do the right thing on pensions and 23 per cent that crime will reduce over the next few years.

From:
http://www.ft.com/cms/s/0/de5492aa-657e-11dc-bf89-0000779fd2ac.html

The dip in Stalinst Brown's fortunes were highlighted in Health Direct's post on 18 Sep 2007-
Labour lead halved as voters feel pinch when Gordon Stalinist Brown’s opinion poll lead has halved in the space of a month, making an early election much less likely, according to the latest Sunday Times-YouGov poll of more than 1,800 people.

The NHS is a service, not a business

From the letters section of the Financial Times: Sir, Margaret McCartney's view would be endorsed by the majority of the medical profession, and shows the hollowness of the labour government's stated policy of a "patient-led NHS".

The Cresswell story shows how far the NHS and Department of Health have blindly followed the prevailing New Labour ideology that the only way to improve public services is by using market mechanisms and introducing competition.

There is no good evidence for this belief, and as David Craig and Richard Brooks show clearly in their recent book Plundering the Public Sector, civil servants have swallowed the advice of expensive management consultants, wasting billions of taxpayers' money and then applying pressure to newly formed, inexperienced primary care trusts to make them toe the party line.

So far, Gordon Brown has not shown any signs of tackling this scandalous situation.

The Liberal Democrat and Green parties have good clear policies, and David Cameron needs to produce a definitive plan to stop this waste of public money.

The NHS is not a business, it is a service, and its staff welcome the extra finance, but not the way in which it is being wasted on setting up a market that is quite inappropriate for healthcare, as the costly and inefficient US system demonstrates clearly.

Wendy Savage,

Chair,
Keep Our NHS Public steering group,
London N1 8HN

From:
http://www.ft.com/cms/s/0/800e7e22-5da4-11dc-8d22-0000779fd2ac.html

NHS IVF clinics to help lesbians get pregnant

An NHS IVF fertility clinic is proposing to treat single women and lesbian couples who have no medical problems. The reproductive medicine unit at University College London Hospitals (UCLH) NHS Trust believes it would be discriminatory to refuse artificial insemination to women who cannot conceive because they do not have a male partner.

The government has drafted a bill to remove the legal obligation for clinics to take into account a child’s need for a father before deciding whether to grant fertility treatment. This would give far greater access to insemination for healthy single women and lesbians.

Dr Francoise Shenfield, who has run the donor insemination programme at University College London Hospitals NHS Trust for 25 years, believes her hospital should change its policy on insemination as soon as the law allows it to.

She said: “Years ago, we took the decision that we would only treat [heterosexual] couples but society has changed dramatically. Now I think we ought to revise this decision and extend treatment to single women and lesbian couples.

She added: “According to the World Health Organisation (WHO), achieving one’s reproductive wish is a human right.”

Shenfield believes the NHS should treat single women who cannot conceive because they do not have a male partner as well as those who have a medical problem such as blocked fallopian tubes.

She argues that single women should not be offered NHS treatment until their mid30s, however, because, at a younger age, they still have time to find a mate. The rising numbers of childless women have been attributed to a “Bridget Jones” generation of women who have not found a suitable partner even as they approach their 40s.

Sixteen per cent of women born in 1953 were childless by the age of 45 but this is expected to increase to 23% of those born in 1973.

In May, the Department of Health published the draft Human Tissue and Embryos bill which would remove the obligation to consider a child’s need for a father.

The proposal to offer NHS fertility treatment to women who could conceive naturally has been criticised by family campaigners who claim it is an unjustified use of public funds at a time when patients are being denied cancer and blindness drugs.

Ann Widdecombe, the Conservative MP, said: “It does seem to me very odd . . . [the NHS] has got its priorities very badly warped if it allows people to go blind but gives fertility treatment to women who are perfectly capable of conceiving normally.

“On the moral issue, it is wholly wrong that any child should be deliberately conceived without a father. This can happen but we should not inflict this on a child from the very outset.”

Ertan Saridogan, head of UCLH’s reproductive medicine unit, says that, although his clinic would be prepared to offer donor insemination to single women and lesbian couples, primary care trusts, which fund NHS clinics, are, so far, reluctant to pay.

Many primary care trusts state that they will fund treatment only for a medical problem and not for social reasons.

Dr Evan Harris, the Liberal Democrat MP for Oxford West and Abingdon and a member of the Commons science and technology select committee claims that this is unjust because many heterosexual couples are offered treatment when the cause of their infertility is unknown.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article2076122.ece

Do not give local authorities control of healthcare- Financial Times

In the name of devolution or "the new localism", a crime may be about to be committed. Despite promises from Alan Johnson, the new health secretary, of no new structural reform to the National Health Service "for the foreseeable future", labour ministers appear to be considering giving local government a bigger say in, maybe even control over, the NHS.

Mr Johnson has been the least precise. His announcement of a year long review of the NHS talks of it ending with improved "local accountability" and "community responsiveness" - which could mean anything.

Hazel Blears, secretary of state for local government, has gone further, stating that "we need to be thinking about giving local people more control over their NHS" and that she will be discussing with colleagues "how we make that happen".

But Jack Straw, the cabinet minister in charge of constitutional reform, has gone furthest, saying that too much power has been handed over to "unelected health service quangos", power that now needs to be "brought back within the elected field".

This is bizarre. For two decades now both Conservative and Labour ministers have demonstrated that none of them trusts local government an inch. Local authorities have seen their powers in education, planning and much else removed, cribbed or constrained.

They have been inspected, performance managed and capped close to death. And administration after administration has failed to address the issue that really poisons the relationship between central and local government - namely local government finance and its massive over-reliance on central government funding.

Yet ministers who even now believe that local authorities cannot be trusted with big planning decisions somehow seem to believe they could do a good job of commissioning £90bn worth of NHS care.

For the NHS, such proposals ignore the fact that the labour government already has a policy for reform that needs driving through and completing; that the last thing the service needs is another round of structural change; and that there is no evidence that involving local government would make the service more responsive - history suggests the opposite.

The idea would also be unlikely to solve the problem it might be aimed at: "postcode prescribing", in which variation in local NHS services has proved unpopular. More likely it would - almost by definition - make variation greater.

It also ignores the lessons of history - that representation over how services should be provided, without the ability to raise money to affect that, is a recipe for conflict. Back in the 1970s and 1980s councillors held between a third and a half of the seats on local health authorities.

Without the ability to raise health service money locally - "representation without taxation" - the result was endless wars over whether central government was providing enough money, rather than a concentration on services. In places, service change became paralysed as health authorities refused to balance the books.

That culminated in the government having to send commissioners to the giant health authority that covered the three great teaching hospitals of Guy's, St Thomas's and King's, an experience so bruising, and so damaging for patient care, that no sane person would ever want to see it repeated.

This is not to say that local government and the NHS do not need to work more closely, particularly over social care and public health. But they are already beginning to. Local authority overview and scrutiny committees can already refer big services changes to an independent panel for evaluation.

NHS bodies are about to be required to co-operate in local authority area plans. In some places, the primary care trust chief executive and local social services director has become the same person. In Herefordshire, the council chief executive and primary care trust chief executive will become a joint post.

Such organic initiatives may help make services what they need to be: more nimble and responsive. Imposing some form of elected control - whether via local government or through direct election to primary care trusts, is likely to do the opposite.

Local government has a big enough agenda in local regeneration - and now it appears, once again, in housing - without lumbering it with the health service.

On the health service, the labour government needs to complete its current reforms and see if they work - not divert energy into further changes that would do far more harm than good.

The writer Nicholas Timmins is the FT's public policy editor

http://www.ft.com/cms/s/cd351e08-3334-11dc-a9e8-0000779fd2ac.html