NHS managers need disciplinary body, latest inquiry urges

Senior NHS management should be turned into a profession, with an independent body created to discipline managers and board members, the latest inquiry into the Mid Staffordshire NHS Foundation Trust said.

Andy Burnham, the health secretary, who announced a fresh inquiry - the third - into the appalling standards of care at the Staffordshire hospital, said he would consult on the proposal, which was welcomed by the Patients Association.

"We must end the situation where a senior NHS manager who has failed in one job can simply move to another elsewhere," Mr Burnham said.

It was, he said, a "long-standing anomaly" that incompetent doctors and nurses can be disciplined and even struck off, but that there is no equivalent scheme for NHS managers, nor for the non-executive directors who, for salaries of a few thousands pounds a year, help make up the boards of NHS organisations.

The call to give NHS management the status of a new profession came as the inquiry by Robert Francis QC catalogued the most dire standards of care at Stafford hospital, which included needless deaths and staff leaving patients "sobbing and humiliated" while lying in their own faeces. 

The inquiry was highly critical of the Trust's board, which it said took too strategic a view of its function. Most of its members remained "in denial" about the hospital's problems, the inquiry said, even after a damning report from the NHS inspectorate.

The case "highlights the need for a proper system of ensuring the accountability of executive officers and non-executive directors" of NHS organisations, the inquiry said.

The NHS Leadership Council has already been examining the possibility of a regulatory body for NHS managers along the lines of the General Medical Council, which regulates doctors.

Nigel Edwards, head of policy at the NHS Confederation , said there was a good case for accrediting managers - which would establish, among other things, that they had had no major failures in the past - but was much more sceptical about full-blown regulation.

Both he and John Restell, general secretary of Managers in Partnership (MiP), the managers' union, questioned whether clear regulatory standards could be defined for good management as they are for doctors and nurses. Good human resources practice would go a long way to addressing managerial problems, Mr Edwards said.

Mr Restell said: "There is a risk of a big bureaucracy. And there is nothing to suggest that regulation of individuals would have prevented the systemic failures seen at Mid-Staffs and Maidstone and Tunbridge Wells [where patients died from hospital-acquired infections]. We would not want the public to be sold a pup."

There was also the risk that over-regulation of non-executive directors would deter good applicants, he said.

The new inquiry will look into the failure of communication that led Monitor, the trust regulator, to approve the hospital's application to become a foundation trust at the same time as the Healthcare Commission, the quality inspectorate, was becoming seriously concerned about the hospital's quality of care. It will also examine why the local primary care trust, which commissions the hospital's services, appeared unaware of how bad things were.

The department is aiming to produce a standardised measure of hospital death rates after apparently high ones first triggered the inspectors' concerns at Mid-Staffs. Disputes about how they are constructed meant it was "unsafe" to give any range for the excess deaths at the hospital, the inquiry found.

From:

http://www.ft.com/cms/s/0/6f5ee00a-21ae-11df-acf4-00144feab49a.html

Patients' medical records go online without consent

Patients’ confidential medical records are being placed on the controversial NHS database (NPfIT) without their knowledge, doctors’ leaders have warned.

At present 1.29 million people have had their details placed on the system. A further 8.9 million records are due to be added by June.

Those who do not wish to have their details on the £11 billion computer system are supposed to be able to opt out by informing health authorities.

But doctors have accused the Government of rushing the project through, meaning that patients have had their details uploaded to the database before they have had a chance to object.

The scheme, one of the largest of its kind in the world, will eventually hold the private records of more than 50 million patients.

But it has been dogged by accusations that the private information held on it will not be safe from hackers.

The British Medical Association claims that records have been placed on the system without patients’ knowledge or consent.

It follows allegations that the Government wanted to complete the project before the Conservatives had a chance to cancel it.

In a letter to ministers published today, the BMA urges the Government to suspend the scheme.

Hamish Meldrum, its chairman, writes: "The breakneck speed with which this programme is being implemented is of huge concern.

"Patients’ right to opt out is crucial, and it is extremely alarming that records are apparently being created without them being aware of it.

"If the process continues to be rushed, not only will the rights of patients be damaged, but the limited confidence of the public and the medical profession

in NHS IT will be further eroded."

At present 1.29 million people have had their details placed on the system. A further 8.9 million records are due to be added by June. By the end of next

year, the NHS hopes to have more than 50 million uploaded.

The "summary" records contain basic medical information including illnesses, vaccination history, and could include medication patients have been given. Ages

and addresses are also included.

Patients are supposed to be notified by letter at least 12 weeks before their details go live on the system and given the chance to opt out.

The BMA says that letters have gone to the wrong addresses and that many patients have been unsure what they mean.

Doctors point out that there has been no national advertising programme to explain the scheme, as has been the case with other government initiatives.

The BMA also criticises the fact that the information packs do not include the form which allows patients to opt out. It can only be obtained via the internet or by calling a helpline.

Katherine Murphy, of the Patients Association, said: "The Health Service should not put in place bureaucratic obstacles to patient choice because they are worried about what patients might choose to do."

Norman Lamb, the Liberal Democrat health spokesman, said: "The Government needs to end its obsession with massive central databases. The NHS IT scheme has been a disastrous waste of money and the national programme should be abandoned."

From:

http://www.telegraph.co.uk/Patients-medical-records-go-online-without-consent

Health Direct was warning of labour's duplicity, for example on Dec 16, 2009's post- Your medical confidentiality under threat again

Despite labour's promises to the contrary- their track record on snooping databases is appalling.

Having launched the Identity and Passport Service last week- which 96% of the population doesn't want, the labour govt are still going ahead with their health database.

Health Direct strongly recommends that you use the opt-out letter which was developed by with TheBigOptOut at http://www.nhsconfidentiality.org/optoutletter

and send it of NOW!

Labour's scramble to launch £11bn IT spending spree

Labour was accused of rushing through huge contracts before the election to safeguard the party's "nanny state pet projects".

The NHS computer scheme has cost £12.7bn; Home Secretary Alan Johnson with the aborted compulsory National ID card; the MOD computer system is £180m over budget.

Labour was accused yesterday of rushing through £11bn of spending before the general election in a "scorched earth" policy to prevent its pet projects being scrapped by an incoming Conservative government.

Despite the looming squeeze on public spending, ministers are trying to push through several massive computer contracts before ballot day, which is widely expected on 6 May. The "break clauses" in some deals may make them very expensive to cancel, locking in the new government.

Tory frontbenchers believe that, if they win power, they would discover "poison pills", making it harder for them to announce the immediate spending cuts they have promised. As well as contracts that are difficult to scrap, the Conservatives fear that Whitehall budgets have been drawn up to protect flagship Labour projects such as housing and children's services, so that any attempt to find small-scale savings would inflict maximum political damage.

Labour insists it has every right to carry on governing and argues that the new information technology (IT) contracts will provide value for money. Cabinet Office rules say that decisions on matters of policy and "other issues such as large and/or contentious procurement contracts, on which a new government might be expected to want the opportunity to take a different view from the present government, should be postponed until after the election, provided that such postponement would not be detrimental to the national interest or wasteful of public money". 

However, the guidelines do not kick in until the election is called – which Gordon Brown is not expected to do for three weeks. Although the Tories would call an immediate halt to all IT contracts if they won power, The Independent understands that last-ditch actions planned by the labour Government this month include:

*approving local supplier contracts for the controversial £12.7bn NHS electronic patient records scheme, the largest computer project in the UK, which the Tories would dismantle;
*signing a £1bn logistics software contract for the Ministry of Defence;
*speeding up a £600m contract to run new personal pension accounts due to start in 2012;
*completing an £800m agreement for communications equipment and services at the Serious Organised Crime Agency;
*starting to print the 30 million forms for the 2011 census, even though the Tories have said they would scale back the £482m project.

Labour denies acting irresponsibly and says an incoming government would be able to cancel the personal pensions contract at a cost of only £25m this autumn. But one minister admitted privately: "We are pushing hard on what we can get through by the end of March and asking civil servants to prioritise that, rather than medium- and long-term projects which could not be completed by the election."

However, some senior civil servants are frustrated that Labour and Tory frontbenchers will engage in frank talks with them about the spending cuts that will inevitably be needed to close this year's £178bn gap in the public finances. They say politicians fear their intentions would leak before the election.

Francis Maude, the shadow Cabinet Office Minister who heads an implementation unit planning the early work of a Tory government, said: "Labour's actions resemble a dying administration making reckless and irresponsible spending commitments to wreck the finances for any incoming government."

He added: "Once again we see Gordon Brown putting the Labour Party ahead of the country. Labour is unable to ditch its obsession with partisan dividing lines. The choice at the election will be clear: a responsible united government under David Cameron or a reckless irresponsible government under Gordon Brown who are only going to make things worse."

About £4bn is believed to have been spent already on the long-delayed NHS scheme for patient records to be available to any GP or hospital in England. The Tories want a local rather than a centralised scheme but fear the contracts would cost billions to unravel.

Labour insists the NHS contracts are being revised to save taxpayers £600m. The Health Minister, Mike O'Brien, said: "What we want to do is make sure we get these savings. I am certainly not going to get into a situation where because we are approaching a general election some day soon, the whole of government stops and we cannot make any contracts with suppliers of key NHS equipment. That would be complete nonsense."

But Stephen O'Brien, the shadow Health Minister, said: "At best it is a last-ditch attempt to tackle a deficit of Labour's own making. At worst it is an underhand effort to tie the hands of the next government."

From:

http://www.independent.co.uk/news/uk/politics/labours-scramble-to-launch-16311bn-spree-1917781.html

Inquiry into NHS preferred provider rule halted

Primary care trusts across the east of England were ordered to suspend procurement for community services yesterday in a move that halted an independent investigation into the legality of Andy Burnham's "preferred provider" policy for the NHS.

The Co-operation and Competition Panel , the health department's advisory body on the application of competition , was left with no case to judge after procurement was halted.

The decision infuriated representatives of voluntary organisations and the private sector, who had brought the complaint.

John Appleby, chief economist at the King's Fund health think-tank, said: "This looks like a piece of naked politics to prevent the panel ruling on [the preferred provider policy]."

Mr Burnham, the health secretary, announced in September that NHS organisations were to be the service's "preferred provider" of care. At the time, under the existing NHS procurement rules designed to encourage competition, Great Yarmouth and Waveney PCT had invited any willing provider to tender to run its community services.

Following Mr Burnham's speech, however, it withdrew the invitation to the private and voluntary sectors, saying it was now "only able to accept bids from NHS organisations".

In December, the NHS Partners Network, which represents private providers, and Acevo, which represents voluntary organisations, complained to the panel that the move breached the NHS's existing procurement rules and almost certainly also breached European Union procurement law.

The panel reached an initial decision in private on Monday to take the case further. It is understood to have decided that there was a strong case for the complainants' view. Before it published, however, it was told by the health department that not just Great Yarmouth but all 14 primary care trusts in the east of England health authority had been told to suspend procurement, leaving no case to consider.

Peter Kyle, deputy chief of the Association of Chief Executives of Voluntary Organisations, said that three months after initial investigation had begun, "the department knew what the panel's verdict was likely to be, so they have pulled the plug on the investigation. It is pretty shaming."

Mike Parish, chair of the NHS Partners Network, said it would still press the case if "preferred provider' leads to other uncontested contracts. These would, the network believes, "run contrary to the principles of procurement law".

From:

http://www.ft.com/cms/s/0/8b719114-272d-11df-b84e-00144feabdc0.html?nclick_check=1

Government to clamp down on health tourists

A new clampdown on health tourism by foreigners who visit Britain for NHS treatment was announced by ministers.

Compulsory health insurance for visitors, refusal of treatment to failed asylum seekers who do not co-operate with the authorities, and a ban on entry for foreigners who have outstanding debts for previous NHS treatment are among measures proposed.

The Department of Health said the measures could save between £6m and £20m over five years. Emergency treatment and treatment for infectious diseases would remain free for all. 

The measures were condemned by human rights organisations but received a qualified welcome from the British Medical Association, which has previously refused to countenance the denial of treatment to patients in need.

A spokesman said: "The BMA appreciates that the NHS does not have infinite resources and that there is a need to restrict services to patients who are eligible to receive them."

"However, we will seek assurances from the Department of Health that, where there is genuine clinical need, doctors will have the discretion to provide treatment, irrespective of an individual's immigration status."

From:

http://www.independent.co.uk/government-to-clamp-down-on-health-tourists

NHS Hospitals to feel the axe as Treasury cuts £11bn

Alistair Darling will reveal details of how he plans to cut £11 billion from Whitehall spending in the pre election Budget.

The £11 billion is the first instalment of drastic cuts intended to slash £82 billion in four years from the record £178 billion deficit. Some hospital buildings face closure as the government seeks to save billions of pounds from more efficient services, Mr Byrne suggested.

Until Mr Byrne’s remarks it had been unclear whether precise cuts would be unveiled next month. The move is a victory for Mr Darling, who has been tussling with Gordon Brown about how far the Budget should detail Labour’s proposed cuts and whether any extra cash should go on spending or savings.

The £11 billion referred to by Mr Byrne was sketched out in the November Pre-Budget Report, but was criticised by some for lacking detail. It is part of the £20 billion savings that will be in place by 2012-13, according to government plans. The rest is made up from freezing public sector pay, curbing public sector pensions and cutting some spending programmes.

Mr Byrne suggested that hospitals will become vulnerable as trusts look to save money and improve efficiency by providing more healthcare in the community. “Some hospitals will have to start doing more of their care in the community rather than in big expensive hospitals,” he said.

Asked if this could mean some hospital buildings closing, he said: “Yes. A lot of hospitals are thinking of moving some of their business out into the community, because it is better care, more convenient, also cheaper. I think it’s possible to improove services, saving money.”

From:

http://www.timesonline.co.uk/tol/news/politics/article7043382.ece

Competition in NHS makes hospitals better, study says

Competition produces better managed hospitals which, in turn, produce better outcomes for patients, according to new research from the Centre for Economic Performance at the London School of Economics.

With the role of choice and competition in the National Health Service still highly controversial - the British Medical Association is currently running a large campaign against the commercialisation of the NHS - the research provides "clear cut evidence that competition between hospitals produces benefits," Carol Propper , one of the study's authors, said.

The study interviewed managers and clinicians at 100 big NHS hospitals, using a mildly adapted version of a standard measure of management performance that is widely used to assess private sector companies.

It compared the quality of management with a small range of clinical outcomes - such as deaths from heart attacks and emergency surgery, or hospital-acquired infections - and the scores given to hospitals for quality of care and financial management by the NHS inspectorate, the Care Quality Commission. It then looked at how many local rivals the hospitals had.

The conclusion, Professor Propper said, is that "better management produces better hospitals and competition between hospitals produces better management".

Hospitals "with higher management scores have better clinical outcomes, shorter waiting times, better financial performance and higher staff satisfaction," the study concludes.

Management was better where senior managers have some clinical training - a finding that reinforces repeated government attempts over recent decades to involve clinicians more in management. But it also concludes that "competition has a large effect in improving managerial quality in hospitals".

How it does so remains open to question, the study says. It may be that the market reforms in the NHS, with money attached to each treatment, mean "hospitals now have an incentive to provide better care to attract patients".

In areas with a relatively large number of competitors, it may be easier to assess performance by comparison with neighbours. Or it may be that a competitive environment provides an attractive market for good managers.

"With more hospitals nearby, it is easier for managers to look out for better employment opportunities."

From:

http://www.ft.com/cms/s/0/3099e87c-1cf6-11df-aef7-00144feab49a.html?nclick_check=1

Warning over primary care trusts in commissioning health services

Primary care trusts, which commission services for patients from the public, private and voluntary sectors, are at risk of breaching NHS competition rules in a "significant" number of cases. 

The warning comes from the panel set up to advise health ministers on the application of competition in the NHS.

It is the latest twist in a deepening row over whether the government is seeking to squeeze out non-NHS providers - including the not-for-profit sector - in the battle to win contracts for providing publicly-funded healthcare.

In September Andy Burnham, health secretary, appeared to overturn existing policy when he said the NHS should henceforth be regarded as the "preferred provider" of healthcare.

However, almost four months after Mr Burnham pledged the rules governing the bidding process would be rewritten to reflect the new approach, nothing has emerged. 

The Department of Health recently said that they would be published "in the coming weeks" - leading to speculation that they might not emerge before the election, or before the panel issues its initial judgment in March.

That means the panel must make its judgment based on the competition rules currently in force - prompting the warning from Andrew Taylor, the competition panel's chief executive, that PCTs may be making decisions that reflect Mr Burnham's rhetoric but flout current rules.

Mr Taylor said problems it had observed included "excluding potential bidders on grounds unrelated to their ability to deliver the services tendered, and failing to select the bestperforming service provider as the preferred bidder".

However, in a sign of the growing tension between the panel - set up by Alan Johnson, when health secretary - and current health ministers, the health department has publicly rejected that view.

A spokesman said it appeared to be based "on anecdote". The Co-operation and Competition Panel had presented "no evidence" from its casework in a report on its first year's work "to suggest poor procurement practice by commissioners", he said.

The spat comes as the panel is investigating a crucial test case in which Great Yarmouth and Waveney PCT said it could take bids only from NHS organisations to run its provider arm.

From:

http://www.ft.com/cms/s/0/efe144aa-1a99-11df-bef7-00144feab49a.html?nclick_check=1

NHS’s major trauma services - not good enough

England has an unacceptably poor service for dealing with major trauma, in spite of 20 years of reports identifying the problem, and a real terms doubling of NHS spending in the past decade, the National Audit Office found.

Some 450 to 600 lives a year could be saved, and much long-term disability prevented, if the NHS had an effective network of centres to deal with multiple injuries from road crashes, burns, blasts, serious falls and major crush injuries, the NAO said.

Death rates from major trauma are 20 per cent higher in the UK than in the US, which has well organised trauma centres, and almost certainly higher than in Germany and some other European countries, according to spending watchdog’s research.

Victims of major trauma need specialist surgical teams that may include orthopaedic, cardiac and neuro-surgeons, but such consultants are not normally on duty at night and weekends when most major trauma occurs. 

Few hospitals have sufficient CT scanning available round the clock to help with diagnosis, and what data there is shows that barely a third of patients who need moving to a more specialist centre in fact get transferred.

Not enough of the patients who need a critical care bed get one, and access to rehabilitation services which can improve quality of life and reduce hospital stays varies widely, the NAO said.

Major trauma services are simply “not good enough”, Amyas Morse, head of the NAO, said. They “have not significantly improved in the last 20 years, despite numerous reports identifying poor practice”.

The result is unnecessary deaths and disability and poor value for money, and while the health department has just appointed a national director for trauma it and the NHS “must get a grip,” Mr Morse said. Co-ordinated trauma networks need developing, with much better information on costs and outcomes. 

The performance of 40 per cent of hospitals cannot even be measured because they do not submit data to the voluntary network which does audit trauma care.

The NAO’s warning came as the department told primary care trusts they must do a better job of monitoring the quality of care delivered by out-of-hours GP services following the death of David Gray, a patient given a fatal overdose by Dr Daniel Ubani, a German flown over as a weekend locum by Take Care Now, Cambridgeshire’s private contractor for out-of-hours care.
 

From:

http://www.ft.com/cms/s/0/581d0e9a-11a4-11df-bceb-00144feab49a.html

NHS spending squeeze to hurt PFI hospitals most

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

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

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

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

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

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

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

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

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

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

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

From:

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

Call for social care reform as costs escalate

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

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

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

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

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

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

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

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

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

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

From:

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

Fear over quality of care if NHS centralises further

There is a real risk that the next government will resort to central control of the NHS, reversing the gains of recent years and damaging patient care, warns the outgoing chairman of Monitor, the independent regulator of the self-governing NHS foundation trusts.

"As public expenditure tightens, the natural response of governments of any colour is to think that central control and central dictation is the only way to keep control of the money," William Moyes, who stands down at the end of the month, told the Financial Times.

The autonomy of foundation trusts, the growing separation of the commissioning of care from its provision, the use of diverse providers, with a degree of competition and choice, might be seen as "just too risky" so "everything becomes pulled into the centre". 

That would be "a huge mistake" when "the only way to run a healthcare system in a developed country in the 21st century" was to have a decentralised approach where "people are not looking up to the secretary of state to see if they have done the right thing, but are actually looking at the patient and asking themselves: 'Is this the right thing for the patient?'"

If clinicians and hospitals were simply reduced to carrying out instructions, "that will not produce good services for patients".

Reflecting on his six years as head of Monitor, Mr Moyes said progress with reform of the health service had moved much too slowly because "at the official level there is still not enthusiasm [for the programme] in the Department of Health.

"I think there are still a lot of people who really would rather go back to the 70s and [a time of] central control."

Given that Tony Blair, former prime minister, had bet his government's majority on forcing through the policy of free-standing foundation trusts, Mr Moyes said: "It never occurred to me it would take so long, and be so hard to persuade the government to implement its own policy, which is what I have spent six years doing with my colleagues."

All hospitals were meant to have had the chance to become foundation trusts by early 2008. But half have still not achieved that.

"Half the hospital system is still not capable of saying it is financially viable and well governed [the requirements to achieve foundation trust status]," Mr Moyes said.

That included big teaching hospitals in Oxford, Nottingham, Leicester, Leeds, St George's in London as well as large institutions in Plymouth, Southampton, Bristol and Liverpool.

If you lived in such a town or city, and the hospital was in effect saying, "'well, actually, we are not really very financially strong and our governance is pretty poor', how would you feel about that?" Mr Moyes said.

The fact that in many parts of the country the NHS remained a mix of foundation trusts and hospitals still answerable to Whitehall and the secretary of state meant that the full benefits of the reform programme were not being felt. Health authorities were continuing to worry about operational problems in hospitals, not about commissioning the best care for patients.

The time had come, he said, for the department to recognise the NHS was not a "a system" of people and buildings the secretary of state had to be involved in managing. Rather, it was a "mutual insurance system" which "defines standards, defines efficiency [and] looks after the interests of patients who pay the cost of the insurance. It challenges inefficiency. It challenges poor quality. It is aggressive and goes for the best. It shapes the whole service".

But the department had never accepted that, and "the culture, and the unsaid assumptions of a lot of people in healthcare is that this is an integrated system that is managed from the top, and therefore they can't see the logic of the reform agenda".

That "underlying culture of corporatism" remained the biggest single obstacle to the decentralised approach that was essential to deliver the best healthcare.

From:

http://www.ft.com/cms/s/0/74d368c8-ff1a-11de-a677-00144feab49a.html?nclick_check=1

NHS- renowned experts but no world class hospitals

Britain lacks any world- class hospitals because the culture of the National Health Service is still too much one of central direction and control, according to William Moyes.

Having spent six years overseeing the creation and regulation of self-governing NHS foundation trusts - which in theory are Britain's best hospitals - the chairman of Monitor said that, while the UK had at least four or five real world- class universities, "I do not believe we have any world-class hospitals.

"They may have world experts here and there . . . but I just don't believe that any of our best hospitals could genuinely demonstrate that they are world class across the whole range of what they do."

Mr Moyes said he would probably come in for heavy criticism for saying that. But given how much is spent on the NHS "there's something wrong in a framework that doesn't produce that kind of quality".

In the US, he said, the universities of Oxford, Cambridge, the LSE and Imperial "would be recognised as on a par with anything in America". He was speaking on "a hunch and a feel" rather than hard data, but added: "I just don't think you would have that kind of reaction to British hospitals."

It was not money, he said, because hospitals were probably more generously funded than universities in the UK. It was that even self governing foundation trusts spent too much time worrying about what the government was doing and what the secretary of state for health wanted.

Mr Moyes said that when he was on the council of Surrey University, the council "acknowledged the existence of the government" and its policies. "But we felt very much that we were in charge of the university, and as long as we didn't do something manifestly stupid, we would be left to get on with running it. Whereas I don't think anyone in any hospital - foundation trust or not - feels they are that distant [from ministers]. They still feel the heavy hand of the secretary of state is coming in their direction."

That underlined the need to see through a reform of the NHS into a much more decentralised system - one "where you tell the hospitals what you want to buy, and you let them get on with it. Your political ambition is expressed as a commissioning ambition, rather than operational ambition" - the goal being a hospital system "as good as the university system in Britain".

From:

http://www.ft.com/cms/s/0/4a1dd216-ff1b-11de-a677-00144feab49a.html

Swine flu- move to recover cost of vaccine

The government is attempting to claw back tens of millions of pounds from flu vaccine manufacturers as it seeks to scale down an immunisation plan to protect the country from a severe pandemic.

Officials have cancelled further orders from Baxter, and are finalising a deal to limit purchases from GlaxoSmithKline, in an effort to recoup part of a £500m deal with the two companies for sufficient vaccine to cover the entire population.

Ministers have decided to abandon the aim of a universal flu vaccination programme, although they are pursuing the drive to vaccinate children under five as well as pregnant women, people with underlying health problems and health and social care workers.

The mild nature of the swine flu virus, the need for only a single rather than a double dose of vaccine and public suspicion and indifference to vaccination have led to lower take-up than anticipated in the UK and other countries.

The government's decision - in the context of severe pressure on public spending - comes at a time of similar moves by other countries including France, Germany, the Netherlands and Spain.

Sir David Salisbury, director of immunisation at the Department of Health, said a break clause had now been activated in the contract agreed with Baxter of the US, while discussions were under way with GSK, from which most of the vaccine had been purchased.

Similar formal break clauses were not included in many countries' contracts with vaccine suppliers, because they were drawn up at a time when governments and manufacturers expected demand would substantially outstrip supply.

However, GSK, like other large suppliers, including Sanofi-Aventis of France, is coming under political pressure to accept a scaling back of previously agreed volumes of orders.

GSK stands to lose tens of millions of pounds alone from the UK renegotiations and smaller amounts from other large purchasers such as France.

The drugmaker had previously estimated total sales of its pandemic flu vaccine across more than 70 countries at £2bn over 2009 and 2010.

It may be able to recover some losses from sales to other countries including in Latin America. Sanofi-Aventis, the world's largest supplier of flu vaccine, stands to lose significant sales, with smaller losses from Novartis, while other suppliers such as Baxter, CSL and MedImmune - part of AstraZeneca - had lower initial sales and much lower exposure.

The UK and other countries are in talks about making donations of surplus vaccine stocks available to poorer countries and selling excess stocks to richer ones - although there are concerns about the issue of liability in such cases.

Sir David said the UK would keep some surplus stocks, both to prepare for any possible third wave of the pandemic and for a future different infection.

The vaccine contains an antigen to protect the body against the current H1N1 virus which would not be useful against future mutations.

But it has an adjuvant stored separately until just before vaccination, which enhances the body's immune response and could be stored over longer periods to help fight a future pandemic.

The latest figures from England show that fewer than 3.8m people have been vaccinated against pandemic flu since last autumn, although 12.5m doses of vaccine have been sent out for health services ready to be used.

From:
http://www.ft.com/cms/s/0/182021e8-fe52-11de-9340-00144feab49a.html?nclick_check=1

Drunk and overdosing homeless people put strain on NHS

One drunk or drug addicted homeless person is admitted to hospital every three hours, putting a severe strain on the National Health Service, new figures show.

The rate of drug and drink related admissions of homeless people has risen by 117 per cent since 2004, with six out of 10 hospital trusts reporting that numbers have gone up in the last five years.

Many of the rough sleepers had overdosed or suffered infections from using dirty needles to inject drugs such as heroin, while others needed their stomachs pumped after drinking too much.

The figures, contained in a series of answers to freedom of information requests put in to 173 hospital trusts, were released by the Conservatives, who issued a report setting out the importance of understanding the health needs of homeless people.

In particular, the party wants the availability of cheap alcohol in supermarkets to be curtailed, and for health boards to work with local homeless charities such as Shelter to consider the best ways to help homeless people in their area.

Grant Shapps, the shadow housing minister, said: "A refusal to confront the extent of the homlessness issue in the United Kingdom leaves our frontline services such as the NHS struggling to cope.

“Our report demonstrates how drugs and alcohol frequently play a major role in perpetuating the chaotic lives lived by many people trapped in homelessness. This is one of the reasons why Conservatives will fix the crazy situation whereby supermarkets are selling high strength larger for less than they charge for a bottle water."

The report shows that nearly 14,000 homeless people were admitted to hospital with drink and drug-related conditions in the last five years, the equivalent of eight a day or one rough sleeper every three hours.

London had the most admissions, followed by Liverpool and Leeds.

More than 10 per cent of rough sleepers who ended up in hospital for alcohol or drugs were under the age of 25, even though young people are estimated to account for between six and seven per cent of the homeless population.

From:

http://www.telegraph.co.uk/Drunk-and-overdosing-homeless-people-put-strain-on-NHS

David Cameron sets out policies to boost NHS

David Cameron has pledged to protect spending on the NHS as he set out twenty policies to boost Britain’s health services if the Conservatives win the forthcoming general election.

Launching the Conservatives’ election campaign, Mr Cameron said that health care was his top priority and that he represented “the party of the NHS”.

The Conservative leader pledged to channel more health spending to poorer areas to tackle the growing gap in life expectancy between the wealthier and less well off.

A new maternity service giving mothers greater choice will also be set up if the Tories are elected.

Mr Cameron published the first chapter of a “draft manifesto” detailing twenty Conservative policies for the NHS.

These included a pledge to end mixed sex hospital wards, a plan to withhold funding from hospitals which infect patients with MRSA, and new proposals to give patients detailed information about the quality of treatment from each doctor, hospital or surgery.

Patients will also be given more opportunity to manage their own care and could receive treatment for minor ailments at their local pharmacist.

In a speech to Conservative activists, Mr Cameron said: “Today, the Conservatives are the party of the NHS. But talk is cheap. You've got to back that with action, and we have.

"We are the only party committed to protecting NHS spending. I'll cut the deficit, not the NHS. And don't for one minute buy the Labour claim that they'll do the same. They won't - and their own figures show they won't.

"Unlike us, they have not committed to protecting areas of the health budget such as public health and capital investment."

Mr Cameron accused Labour of failing to tackle the gap in health between rich and poor, describing it as "one of the most unjust, unfair and frankly shocking things about life in Britain today".

"Health inequalities in 21st century Britain are as wide as they were in Victorian times," he said.

He promised the Tories would introduce a new health premium that would divert cash to the poorest areas and "banish health inequalities to history".

"With our plans, the poorer the area, the worse the health outcomes tend to be, so the more money they can get," he said, adding that local people would decide how it was spent.

From:

http://www.telegraph.co.uk/David-Cameron-sets-out-20-policies-to-boost-NHS

Health Direct NHS preview of 2010

Spending will dominate debates over the NHS and health – especially in an election year and the scale of NHS cuts will become apparent as the year progresses.

Already hospitals have been told that they will receive no increase in the amount of money that they are paid per procedure, essentially a real terms cut in the cash they will receive.

Overall, the health service has also been set a goal to make between £15 million and £20 million of efficiency savings over the next four years.

The fact that McKinsey, the management consultancy firm, estimates that to achieve such that a goal would take making 10 per cent of NHS staff redundant and abandoning procedures such as varicose vein operations suggests the scale of the challenge.

Patients' groups will continue to keep a close eye on the labour government’s drugs rationing body NICE in 2010. Over the last year the National Institute for Curbing Expenditure (NICE) began looking more favourably on drugs which prolong life for terminal patients, as it was instructed to do so by Government.

2009 also saw a number of drug companies come forward with innovative deals that allowed the NHS to pay less for some medicines.

But with expensive drugs for cancer and other illnesses coming through the pharmaceutical pipeline at all times patients will continue to monitor how Nice makes decisions about which drugs it will allow on the NHS.

The Government will scale up its Change4Life campaign, which so far has concentrated on children and families, to focus on adult obesity.

Despite data which suggests that rises in childhood obesity could be levelling off, ministers and health planners are still worried about the strain on the NHS if predictions that half of adults could be heavily overweight by 2050 come true.

2010 should be the defining year for the Swine flu pandemic. Will cases continue to drop or will swine flu return either early in the new year or next winter?

Sir Liam Donaldson, the Chief Medical Officer, warns that we cannot be complacent about the threat that the virus still poses and points to pandemic flus in the 1960s in which death rates were higher in the second winter than the first.

The H1N1 vaccine could be the deciding factor, but to what extent remains to be seen.

Number of NHS staff at record high

Employment in the National Health Service jumped by another 23,000 jobs to a record high in the third quarter of this year, in spite of the squeeze to come on spending under the next government.

The increase– the seventh successive quarterly rise in NHS employment taking it to above 1.6m people for the first time– took even seasoned observers by surprise following an 18,000 rise in the second quarter.

Most had been predicting at least a levelling off in the workforce despite continued growth in spending, as health authorities and hospitals prepared for the real-terms freeze that is to come.

Nigel Edwards, policy director for the NHS Confederation, said: “We suspect this is the last stage before the tanker slows down and finally turns.”

The confederation runs a website on which most NHS jobs are advertised and the numbers on it at any one time have fallen from 10,000 at the turn of the year to 7,500. “People still do have growth money this year,” he said, “and they are pursuing targets and other government objectives. 

Furthermore, some of this recruitment will have been taking place before people had fully woken up to the scale of the problem to come. We think the decline in the number of jobs advertised, however, is significant.”

The increase, however, leaves the NHS across the UK employing 1,601,000 people, according to the Office for National Statistics: 400,000 more than when Labour took office. The growth follows a study in England by McKinsey, which said the NHS might need to shed 10 per cent of its workforce to keep the books in balance.

The bigger the workforce when the money starts to run out in 2011, the greater the efficiency gains that will be needed if it is not to shrink in the face of a real-terms freeze in spending.

The NHS in England has 5.5 per cent revenue growth for this year and next. However, David Nicholson, NHS chief executive, has ruled that at least 2 per cent of next year’s money must be spent on capital and other projects to transform the way care is delivered in subsequent years.

The rise in staff numbers was the driver for an overall rise of 23,000 in public sector employment in the third quarter of this year to 6.093m. Local government shed 3,000 jobs and public corporations employed 5,000 fewer people.

Civil service employment rose 4,000, driven chiefly by a rise of 7,000 in the numbers employed by Jobcentre Plus to deal with rising unemployment.

From:

http://www.ft.com/cms/s/0/87df4c06-ea9e-11de-a9f5-00144feab49a.html?nclick_check=1

Your medical confidentiality under threat again

Despite labour's promises to the contrary- their track record on snooping databases is appalling.

Having launched the Identity and Passport Service last week- which 96% of the population doesn't want, the labour govt are still going ahead with their health database.

The Department of Health has declared it will push ahead with a mass roll-out of its controversial Summary Care Record (SCR) - uploading parts of your medical record and personal details to a centralised system that is ultimately intended to hold your complete medical history.

So far, only London and the East of England have been mentioned but other regions may be targeted too.

A University College London report found scant evidence for any of the claimed benefits in SCR pilot areas but it appears the Department of Health still wants to ride roughshod over patient consent and medicalconfidentiality.

Having outraged medics and patients with its 'implied consent' model - where it is assumed you have consented to having your sensitive information uploaded if you do not respond to a single notification
letter - the Department has adopted a bizarre approach it calls 'consent to view'.

Under this scheme, you will still only be sent a single letter. If you do not respond, your details will still be uploaded onto the system where they will be accessible to all sorts of non-clinical staff including administrators, bean-counters and bureaucrats, without your knowledge or consent. 

Once on the system, you will not be able to have your details taken off - but you will have to give permission for your OWN doctor to view your record!

It is clear that 'consent to view' will not protect medical confidentiality. And the roll-out may be coming to you, sooner than you think.

Please be on the alert and, if you haven't done so already, think about opting out now. You can always opt in later, if the government can prove its system works. 

Health Direct strongly recommends using the opt-out letter that was developed by with TheBigOptOut at http://www.nhsconfidentiality.org/optoutletter

Swine flu- strain resistant to Tamiflu spreads between UK hospital patients

A strain of Tamiflu resistant swine flu has spread between patients in a hospital as five patients on a unit for people with severe underlying health conditions at the University Hospital of Wales, in Cardiff, were diagnosed with swine flu that is resistant to the drug.

Three appear to have acquired the infection in hospital, the National Public Health Service for Wales (NPHS) said.

Two of the five have recovered and have been discharged from hospital, one is in critical care and two are being treated on the ward.

The service said the resistant strain does not appear to be more severe than the swine flu virus circulating since the spring.

All patients on the unit have been tested and patients diagnosed with Tamiflu-resistant swine flu have been given other antivirals.

Patients have been isolated or are being cared for in a designated area for influenza cases.

Cardiff and Vale University Health Board has put appropriate infection control measures in place on the unit, the NPHS added.

Staff and patients have been offered swine flu vaccinations, and patients due to come into the unit for treatment are being warned to get the jab from their GP.

Close contacts of the patients are being warned to make sure they are treated quickly if they show any symptoms.

Dr Roland Salmon, director of the NPHS Communicable Disease Surveillance Centre, said: “The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

“In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April. For the vast majority of people, Tamiflu has proved effective in reducing the severity of illness.

“Vaccination remains the most effective tool we have in preventing swine flu so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery.”

It comes after it was announced that more than 3million healthy children under five across the UK are to be offered the swine flu jab.

Parents will be invited by their GPs to bring their children into surgeries, with vaccinations expected to start in December.

Health ministers across the UK agreed children aged six months to five years should be included in the next phase of the vaccination programme after GPs have finished vaccinating at-risk groups, including people aged six months to 65 with conditions like asthma, diabetes and heart disease. Pregnant women and frontline health workers are also currently being given the jab.

Figures released on Thursday showed an estimated 53,000 new cases of swine flu in England in the last week, down from 64,000 in the week before. In Scotland, the figure was 21,200, down from about 21,500 in the previous seven days.

The rate of flu-like illnesses diagnosed by GPs in Wales dropped to 36 cases for every 100,000 people from 65.8 the previous week.

Seven swine flu-related deaths were recorded in Wales in the previous week, taking the total to 21.

Wales’s Chief Medical Officer Dr Tony Jewell said people with suppressed immune systems were designated as a priority group for vaccination because they were known to be more susceptible to the virus.

“We have stringent processes in place for monitoring for antiviral resistance in the UK so that we can spot resistance early and the causes can be investigated and the cases managed,” he said.

“Identifying these cases shows that our systems are working so patients should be reassured.

“Treatment with Tamiflu is still appropriate for swine flu and people should continue to take Tamiflu when they are prescribed it.

“It’s also important that good hygiene practices are followed to further prevent the spread of the virus.”

Meanwhile, Norwegian health authorities said they had discovered a potentially significant H1N1 mutation that could be responsible for causing the severest symptoms.

The mutated virus was found in the bodies of two people who died of the virus, although medics do not believe it has been transmitted between humans.

From:

http://www.telegraph.co.uk/Swine-flu-Strain-resistant-to-Tamiflu-spreads-between-UK-hospital-patients

Fall in proportion of patients who pay for private health care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conservatives told how to cut NHS red tape to free up £4 billion

Reducing NHS red tape could free up £4 billion over four years to pay for frontline health services, Andrew Lansley has told the Conservative party conference in Manchester.

Health is one of only two budgets the Opposition has guaranteed would be spared the axe if it took power and Mr Lansley, the shadow health secretary, said reducing bureaucracy was the key.

Spiralling running costs of primary care trusts, the £1.94 billion-a-year price tag for health-related quangos and the bills for Whitehall and Strategic Health Authority operations would all face the squeeze.

At least £850 million would be saved by taking PCT and quango budgets back to the level of six years ago - at which point Labour already thought there were potential savings of £750 million according to their own calculations.

The Tories, meeting in Manchester for their annual conference, said those budgets were in direct control by ministers meaning they could give a ''concrete commitment to cut them by a third''.

Mr Lansley said further savings would be found by scrapping some Whitehall imposed targets and returning powers over budgets and out-of-hours care to GPs.

He backed an assessment by NHS chief executive David Nicholson that savings of between £15-20 billion needed to be found between 2011-14 but said the Tories would ''go much further in slashing wasteful bureaucracy in the NHS hierarchy''.

''Labour have made expensive commitments on the NHS with no price tag. In contrast, we are determined to identify how we will save money before we spend it.

''To make the NHS successful we must devolve decision making closer to patients. In doing so we'll save substantial sums of money.

''The NHS must be well managed but that's not expensive bureaucracy, it's about lean and good-quality management.

''Labour has allowed wasteful spending on bureaucracy to spiral. A Conservative government would cut it right back. We are determined to shift NHS funds from the back office to doctors and nurses on the front line.''

From:
http://www.telegraph.co.uk/Conservative-Party-conference-cut-NHS-red-tape-to-free-up-4-billion

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

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

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

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

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

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

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

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

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

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

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

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

Warning- 200,000 NHS nurses are about to walk out the door

The “Sixties Bulge”, as it is known in the NHS, refers not to obesity in those approaching old age but a looming workforce problem that has been visible from some considerable distance.

Mass recruitment schemes in the Sixties were a great success. Nursing numbers rose as social shifts allowed greater numbers of women to take up full-time careers, while doctors’ ranks swelled with immigrants from the Commonwealth.

This workforce bulge can, in part, be identified as a cause of recruitment ripples ever since. Sharp rises in the uptake of staff occurred as the NHS expanded to meet further demand but these have prompted a natural slowdown in recruitment. The key, which the labour Government has yet to grasp properly, is to soften the troughs as effectively as possible.

Take nursing, where the effect of demographics is felt most acutely. In the mid-Nineties health professionals raised concerns about future vacancies. Labour took action when it came to power and hired a total of 80,000 more nurses, many from the Philippines and India. Now the NHS has limits on international recruitment and fewer nursing places in tertiary education.

However, an estimated 200,000 nurses are expected to retire over the next decade, a disproportionate chunk of the workforce and the most valuable in terms of experience. Health professionals argue that governments rarely factor in vital long-term workforce planning because they focus on short-term parliamentary cycles.

For this latest ripple to occur at a time of severe economic stretch is even more concerning. Past worries about retaining sections of the doctors’ workforce have been solved with attractive pay packages.

The likelihood of enough money being found to replace the retiring nurses is slim and will perversely mean the NHS ends up paying more for the quick fix sticking plasters of agency workers who can earn ten times the hourly rate of a middle-ranking staff nurse. 

There will be tight restrictions to come on pay and pensions, encouraging the more experienced to look for work abroad or in the private sector.

Solving the ebb and flow of recruitment should be key to the labour Government’s attempts to improve care and to treat more people outside hospital. These policies need experienced doctors and nurses, and a farsighted approach to recruitment.

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6742118.ece#cid=OTC-RSS&attr=1185799

Couples are still being refused IVF treatment in a postcode lottery

Couples are still facing problems getting IVF treatment on the NHS, with some trusts refusing to fund procedures or comply with guidelines, such as a woman’s age.

Regional disparities mean that the same woman can be too old for treatment in one part of the country and too young in another. Two trusts have provided no IVF treatment in the previous two years.

Research suggests that eight out of ten primary care trusts are still failing to follow government recommendations set out in 2004 by the National Institute for Curbing Expenditure (NICE), allowing women three free cycles of IVF.

Other eligibility criteria, such as whether one of the couple has a child from a previous relationship, smoking habits and weight, also vary widely, the study shows.

The study, by Grant Shapps, the Conservative MP for Welwyn Hatfield, who has campaigned for better access to fertility treatment, was based on an 80 per cent response rate from trusts in England. It found that provision was worse than two years ago.

In the East Midlands, every trust offered one full cycle of treatment but, in the South East, 41 per cent did not offer IVF to women aged 23 to 39, as set out in the NICE guidance. Some trusts, such as North Lincolnshire, offered IVF only to women between 37 and 39, whereas at least four trusts have an upper age limit of 37. One in eight was failing to comply with guidelines on a woman’s age.

In the East Midlands, no trust would offer treatment to couples in which one partner had a child but 70 per cent would in the North East. Overall, 54 per cent of trusts excluded couples from IVF if one partner had a child from a previous relationship.

Almost half of all trusts said that they wanted couples to have been in a relationship for more than three years. Others wanted one or two years while some asked only if the relationship was “stable”. While many trusts refused IVF to couples who smoked, some allowed treatment if the man was the smoker.

The 2004 NICE guidance said that the NHS should fund three cycles of IVF for women under 40. John Reid, then the Health Secretary, said that couples would be offered one free IVF cycle by April 2005, with a view to three cycles being offered in the future.

By 2007 this was still not happening. Dawn Primarolo, the Health Minister, wrote to trusts in that year saying that they should be looking to fund three cycles.

Experts have said that the drive to cut the number of multiple births is also being hampered by the lack of access to free IVF. Couples who have the chance of only one cycle on the NHS might wish to have more than one embryo transferred.

The NICE guidance also said that trusts should allow frozen embryos to be transferred as part of one cycle. But very few offered this.

Mr Shapps said that the study, compiled from freedom of information requests, showed that IVF “remains a postcode lottery in this country”. He added: “Budgets are tight and the NHS must set its priorities, but it is wrong to raise expectations in couples who are desperate to start a family only for them to find out later that they won’t get the real help they expected.”

Clare Lewis-Jones, chief executive of the charity Infertility Network UK, said that although there had been an improvement recently in the provision of treatment by some trusts there remained a totally unjustifiable and unfair variation in the criteria used to determine whether couples could have treatment. “This proves that five years on from the issue of the NICE guideline, patients are still facing a postcode lottery when it comes to accessing NHS fertility treatment.”

She urged trusts to accept recommendations laid down in a document, Standardising Access Criteria to NHS Fertility Treatment, produced by Infertility Network UK and funded by the Department of Health.
 

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6740622.ece

NHS health debate is more heat than light

There are moments when politics and healthcare collide and all that is generated is heat. With absolutely no light.

As opponents turn their fire on to President Obama’s health plan, a gross mischaracterisation of Britain’s tax funded National Health Service has become the weapon of choice to attack it.

In response British politicians from Gordon Brown, the prime minister, downward have resorted to all of the 140 characters available on Twitter to defend it – implying that all is beautiful in the British NHS, and the US system with its 47m uninsured, its monumental costs, and its ability to bankrupt individuals is the approach that is “evil” – to use Sarah Palin’s description of the UK’s NHS.

This is a debate being driven by blind prejudice on both sides. For a start, what Mr Obama is proposing is not a British NHS. There is no proposal that a government backed insurer would run hospitals, as is still largely the case in the UK.

Second, half of the mighty 17 per cent of gross doemstic product that the US spends on health care – roughly double the level in the UK – is already funded by tax dollars through Medicare, Medicaid and the Veterans Health Administration, which incidentally does run medical facilities and provides some of the best health care in the US.

Third some of the charges levelled against the NHS are plumb wrong. That Teddy Kennedy would not get treatment for his brain tumour in the UK. That the NHS indulges in forced euthanasia. That people over the age of 59 do not get coronary artery by-passes.

The fractious British political classes have united in defence of the UK’s healthcare system after it has become a byword for the failings of universal, state-funded provision among the US Republican right.

Gordon Brown, prime minister, and David Cameron, leader of the Conservative opposition party, have both declared their commitment to the National Health Service.

The US right has used the NHS as an example of the potential pitfalls facing President Barack Obama as he tries to push through a healthcare reform bill.

Some Republicans have ridiculed it as a bureaucratic and “Orwellian” system that often denies care to the elderly – with Sarah Palin, the former Republican presidential candidate, decrying it as “evil”.

But in Britain, where since 1948 all citizens have enjoyed free healthcare from birth to death, the attacks are widely seen as wrong and insulting.

Some are true. The UK does have a lower dialysis rate for kidney disease than the US. Some of its cancer survival figures look appreciably worse and quite probably are worse: “probably” for a bunch of reasons, which include comparability of the data and the fact that five-year survival figures are by definition what was happening then, not what is happening now.

The NHS does indeed have waiting lists for non-emergency surgery, although after a doubling in spending in real terms over the past decade they are much shorter than they were. And, in contrast to the impression of “socialised medicine” held by some in the US, people can by-pass those queues by going private.

About 10 per cent of the population has some sort of private insurance, paid for indivdually or by their employers. The proportion has barely shifted over a decade, implying at least some sort of satisfaction among Brits at what they get.

In response to the worst of the UK performance, Brits can also pluck selective statistics from the US showing it has much poorer overall results for diabetes and a bunch of other chronic conditions where Britain’s primary care physicians treat patients well in the community, reducing complications and avoding costly hospital care.

A balanced view of the two systems might go like this. The US has some of the very best medicine in the world, particularly hi-tech medicine, notably in its leading academic health centres, and it has more of it than in the UK.

But study after study shows that overall the highest level of health spending in the world does not deliver anything like the best results.

A recent study, for example, looked at deaths in those aged under 75 that are amenable to treatment – for example, infections, cancers, diabetes, heart and vascular disease.

Overall, the US had the worst record among 19 industrialised countries, and the rate at which those deaths had been declining had slowed over the previous five years against the declines seen in other countries.

The US record was worse than that not just of the UK, but for example Portugal and Ireland. Martin McKee, of the London School of Hygiene and Tropical Medicine, one of the study’s authors, says: “If the US performed as well as the top three countries in the study” – France, Japan and Australia – “there would have been 101,000 fewer deaths per year.” There would also have been tens of thousands fewer in the UK if it had done the same.

Both systems have their strengths and weaknesses. But rather than presenting a caricature of the NHS, US opponents of reform might ask why. The US spends half as much again as almost any other country on healthcare, yet it still gets overall results that are nowhere near the best. One contributory reason, although only one, is the quality of care received by the uninsured. And that should be the real focus of the debate.

From:
http://www.ft.com/cms/s/0/4cecb8e4-88d9-11de-b50f-00144feabdc0.html?nclick_check=1