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!

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

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

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

Labour ministers to take control of hospital charity cash

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

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

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

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

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

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

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

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

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

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

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

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.

Labour's nanny state failing poor children as child obesity trends show class divide is growing

A widening class gap is likely to be seen in the coming years in childhood obesity, new research suggests.

Previous research has suggested rates in England may be levelling off. But the University College London team found this was happening most in children aged two to 10 from wealthier backgrounds.

Researchers said obesity rates among the lower classes were likely to be significantly higher by 2015 - for girls the levels may even be double.

They analysed data gathered by the government-funded Health Survey for England.

Currently 6.9% of boys and 7.4% of girls are obese - with the difference between the lower and higher classes 0.6% and 1.5% respectively for boys and girls.

But using historical trends, they predicted that by 2015 obesity rates could be above 10% for boys and 8.9% for girls.

Depending on the extent of the "levelling off" reported last month, the overall rates could be even lower.

However, it is the findings for social class that have shed even more light on the obesity problem. The obesity rates for girls are likely to diverge from now on, the team said.

Among those from lower classes it is expected to keep rising to 11.2%, while for those from professional backgrounds it is likely to fall to 5.4%.

Among boys, both groups are likely to see a rise, but it will be faster in the lower class group, meaning 10.7% of this class boys will be obese compared with 7.9% of those from wealthier backgrounds.

Similar trends will also be seen in older aged children, the report in the Journal if Epidemiology and Community Health found.

Lead researcher Dr Emmanuel Stamatakis said: "This highlights the need for public health action to reverse recent trends and narrow social inequalities in health."

"The widening socio-economic gap may be partly due to difficulties to reach and communicate health messages to families from lower socio-economic groups."

Tam Fry, of the National Obesity Forum, agreed awareness was more likely to be greater among wealthier families.

But he added: "It is also often quite expensive and time-consuming to buy healthy food and that puts wealthier parents at an advantage."

He said it was not clear why the differences were so marked in girls, although he said he suspected it was partly to do with the fact that boys tend to be more active generally.

From:
http://news.bbc.co.uk/1/hi/health/8412796.stm

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

NHS bureaucracy bill soars by £78 million in two years

The number of bureaucrats working for the NHS has soared over the past two years, according to a survey.

The amount spent on employing managers has risen by a quarter, or £78 million, in the past two years, the study shows. NHS Trusts blamed Whitehall targets for the increase.

It comes a day after NICE, the drugs rationing watchdog, refused funding for life prolonging bowel cancer drug Avastin, saying it was not cost effective.

Pulse, a magazine for GPs, found that projected spending on management salaries has increased by 25 per cent between 2007/08 and 2009/10 in primary care trusts, which look after community services. It was up from £312million to £390million.

But the true figure is likely to be far higher, because only a third - 55 - of the 152 trusts responded.

The rise is largely down to trusts taking on more managers, with 15 that provided headcounts saying the number of posts had gone up 14 per cent.

These trusts also reported that the cost per manager had risen by 11 per cent. David Stout, director of the NHS Confederation's PCT Network, said it was "unrealistic" for such increases to continue.

"A lot of this is spending trusts are carrying out in response to what the Department of Health has asked for," he told the Daily Mail.

Conservative health spokesman, Mike Penning said: "It is inevitable the rises must be keeping money away from patient care and the front line.

"Labour ministers must explain why so much more is being spent on management after a reorganisationof PCTs that was intended to produce efficiency savings."

The editor of Pulse, Richard Hoey, added: "What we're seeing exposed here is the bureaucratic machinery that has been put in place to implement Government policy priorities.

"These are policies which look good on paper, but in practice create whole new chains of managerial command."

From:

http://www.telegraph.co.uk/NHS-bureaucracy-bill-soars-by-78-million-in-two-years

Dramatic postcode lottery for cancer survival rates shock charities

Department of Health figures have shown a wide variation in cancer survival between different parts of the UK with lung cancer patients in Herefordshire three times more likely to die within a year than those in Kensington and Chelsea.

The country's biggest cancer charity has expressed shock at government figures revealing huge variations in patients' chances of surviving from one area of the UK to another. The biggest survival gap was in lung cancer, where Department of Health figures showed patients in Herefordshire were three times more likely to die within a year of diagnosis than those in Kensington and Chelsea. 

In the London borough, 44% of patients survived the first year after diagnosis, compared with only 15% in Herefordshire.

In bowel cancer there was also a big gap in survival – 80% in Telford and Wrekin after one year, but only 58% in Waltham Forest and Hastings and Rother. The gap was less pronounced in breast cancer, with the best rate in Torbay, where 99% survived for one year, compared with 89% in Tower Hamlets.

"There is no excuse for such a big difference between different areas," said Harpal Kumar, chief executive of Cancer Research UK. "It is appalling that someone with lung cancer in Herefordshire should be three times more likely to die within a year than a patient in Kensington, or that a person diagnosed with bowel cancer in Waltham Forest or Hastings should be 22% more likely to die within a year than a patient in Telford. This is the worst kind of postcode lottery."

Very few primary care trusts (PCTs) had survival rates that were as good as other countries in Europe now or even as good as Europe was achieving 10 years ago, which Kumar called "a disgrace".

"We're pleased that the Department of Health have been bold enough to publish these figures," he said. "The NHS now needs to take them very seriously."

One-year survival figures highlight the issues around delayed diagnosis of cancer. That can be partly the responsibility of the GP, who may not see many cancer cases in a year, but is often to do with the reluctance of the patient to seek medical advice when they suspect a problem.

The figures are contained in the Cancer Reform Strategy second annual report from national cancer director Mike Richards, who points out that cancer deaths continue to fall and that prevention efforts, such as the cervical cancer vaccination programme for schoolgirls and better screening, will further help.

Jeremy Hughes, chief executive of Breakthrough Breast Cancer, said the charity shared the concerns. "Although progress has been made in some parts of the country, in others key Cancer Reform Strategy initiatives are still yet to be implemented," he said. "In particular, urgent action must be taken to ensure that digital mammography is in place by the December 2010 deadline and that, as previously committed by the government, all women with breast problems referred by their GP will see a specialist within two weeks by the end of this year."

Here are the PCTs with the best and worst records for dealing with common types of cancer, in terms of the proportion of patients who are still alive one year after diagnosis:

Breast cancer- Worst
Tower Hamlets (89.3pc)
Hillingdon (89.5)
Barking and Dagenham (90.2)
Hastings and Rother (90.3)
West Hertfordshire (90.6)

Breast cancer- Best
Torbay Care Trust (99.0)
Darlington (97.9)
Stockport (97.6)
Warrington (97.6)
Western Cheshire (97.6)

Colorectal cancer- Worst
Hastings and Rother (57.8)
Waltham Forest (57.9)
Tameside and Glossop (61.5)
Derby City (62.6)
Enfield (62.6)

Colorectal cancer- Best
Telford and Wrekin (80.0)
City and Hackney (77.5)
Shropshire County (77.0)
Peterborough (76.7)
Plymouth Teaching (76.6)

Lung cancer- Worst
Herefordshire (15.4)
Milton Keynes (17.5)
Blackpool (18.3)
East and North Hertfordshire (20.3)
Hartlepool (21.1)

Lung cancer- Best
Kensington and Chelsea (43.7)
Hammersmith and Fulham (35.3)
Richmond and Twickenham (35.2)
Islington (34.8)
South Birmingham (34.6)

Health Direct has compiled this post from:

http://www.guardian.co.uk/society/2009/nov/30/cancer-survival-rates-figures
and
http://www.telegraph.co.uk/health/healthnews/6693438/Cancer-survival-rates-best-and-worst-trusts.html

Fall in proportion of patients who pay for private health care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Professor Nutt- if we want to reduce deaths, alcohol and heroin are the issues

Having been sacked from the Advisory Council on the Misuse of Drugs (ACMD), Professor David Nutt talks to the Telegraph.

On Saturday evening, two days after he was sacked from his position as drugs tsar for saying that cannabis is less dangerous than alcohol, Professor David Nutt went to a brass band concert in his local church in Keynsham, outside Bristol. "I came in late and sneaked in the back," he says, "but in the interval, the Master of Ceremonies announced I was there. The news was greeted by an amazing round of applause."

So his neighbours are fond of him: no surprise, since this Nutt's tough outer shell seems to hide a friendly father-of-four humanity. But that's missing the point. "The youngest person there was 50. Many were 85." To Nutt, this says it all. Not only is he – as he puts it – "on the side of the angels" in the clash between science and politics, he also believes that he is more in touch than the politicians with even the most conservative of rural electorates.

The past week has not been short of similarly morale-boosting moments. Emails have flooded his in-box – 98 per cent supportive. Ten thousand people have pledged their support on Facebook. Two fellow scientists on the Advisory Council on the Misuse of Drugs (ACMD) have resigned in sympathy. Teenagers, who normally don't even notice what's in the news, are rallying to the cause – to judge from the unusually high level of debate in my own home. My own teenagers, however, abruptly changed their views when they heard some of his suggestions for stopping them wrecking their livers.

Most encouraging of all to him, scientists are leading a march on Downing Street this Sunday, calling on the Government to "back evidence-based drug policy by respecting and upholding the independence of the ACMD" in advance of the Council's meeting next Tuesday. If he had taken a hallucinogen, Nutt couldn't have asked for more.

Far from repenting the remarks that caused Alan Johnson, the Home Secretary, to think Nutt had "crossed the line" between advice and policy – which he surely did – the beaming professor of neuropsychopharmacology is loving every moment of his disgrace. Academics don't usually become folk heroes. Nor do they generally manage to attract more than 30-second news clips. But these days his phone is ringing non-stop with requests for his wisdom from around the globe. "Sorry, it's Radio Bogota,"he says, as his mobile trills yet again.

Nutt enjoys speaking out: earlier this year he pointed out that "Equasy" as he called it – horse riding – was more dangerous than Ecstasy. Having devised a "matrix of harm" – a graph to calculate the damage done by various substances, on the basis of dependence, and physical and social harm – he's delighted to have been handed a platform from which to preach.

The big problem, as he sees it, is that while politicians love to be "tough" on classified drugs, their response to the far greater danger posed by the most dangerous drug of all, alcohol, has been "puny".

"We are not taking the tidal wave of damage seriously enough. If we want to reduce deaths, alcohol and heroin are the issues. I have four children, now aged 18 to 26, and at almost every party they went to in their teenage years, a child was taken to hospital with alcohol poisoning.

"Liver disease will become a worse killer than heart disease within twenty years. Scotland already has the highest proportion of people with sclerosis of the liver in the world. There are hundreds of kids lying in hospital beds waiting for transplants that will never come. But when Sir Liam Donaldson [the Government's chief medical adviser] put forward a radical approach to reduce alcohol consumption by increasing the price, within seconds the government rejected his proposal."

Nutt is not a puritan. He confesses to "liking" alcohol, to having binged occasionally when he was young, and to having tried some drugs as a student – but not cannabis, because he has never smoked. The worst problem with alcohol, he says, is that it is "insidious": people develop a strong head and aren't aware of its toxicity. But the main issue is that moderation doesn't seem to be possible for many people, especially the young.

He has asked his own children why their friends set out to get wasted and break the windows of the Keynsham church. "They say it is the excitement of not knowing what will happen."

His matrix isn't going to stop them experimenting, so what would positive action should politicians take, short of sacking their advisers? "We cannot make alcohol illegal. We need a structural approach. The real price of alcohol has dropped by half since Labour came to power and the use has doubled. To bring consumption down, prices should be doubled, maybe tripled, and the drink-driving limit should be reduced. We could even change the age at which it is legal to start drinking. In the US, since most states switched back from 18 to 21 (in the late 1980s), 170,000 lives have been saved in road traffic accidents. A shifting of the starting age would also reduce the damage to brain and body and the likelihood of young people becoming dependent."

Nutt pauses for effect before offering his most "radical" solution of all: an alternative to alcohol that's safer. Yuck, I don't want to take a soma pill when I get back from work; I want a delicious glass of white wine.

"Aaah, but if we invested some work in it we might find something as delicious. As it stands, though, with the Misuse of Drugs Act, if I came up with it tomorrow, I couldn't sell it. I'd like there to be a prize for inventing a safe alternative, as there was for inventing the chronometer in the 18th century, and the prize would be being allowed to sell it. You could also design an antagonist that would reverse the effects. Science could get there in five to 10 years. Let's move on from 2,000 years of poisoning ourselves."

That's what people thought they had found in cannabis, which makes you light-headed but not likely to get into fights or drive too fast. Forty years on from the Summer of Love, however, everyone knows someone whose brain has turned to mush or, worse, has become psychotic. Yet he opposes plans to reclassify cannabis from B to C, even though "skunk" – one of several cannabis derivatives – is now so much more powerful than standard "weed".

"Stoned people aren't a danger to others," he says. "Classifying it as B will be a disaster, because anyone caught in possession three times can be sent to prison for five years. The prison population will increase, those people will find it hard to get jobs. That way you just add to the underclass and the tax burden."

Sunday's march on Downing Street is emphatically not calling for legalisation. Although legislation might be a logical next step, Nutt is supportive. "It [legislation] would increase use. And I could never countenance the marketing of drugs, as with alcohol and tobacco. But I would like some level of toleration, as in the Netherlands, where cannabis can be smoked in certain cafés and a small amount bought for use off the premises: that has reduced social harm because it makes the drug less appealing. It is no longer a statement of dissent. Many other European countries have moved away from criminalisation for personal possession. In Portugal, people found with cannabis are now sent to social workers; use has gone down."

Nutt cites a MORI poll conducted by the ACMD that suggests most British people don't want stoned youths imprisoned. But, he adds, it's wrong to see him as soft on all drugs because, during his ten years as the Council's chair, he has been the "biggest criminaliser of drugs".

In that time, a host of new ones have been classified, including ketamine and GBL, the party drug that killed medical student Hester Stewart this May. He has also moved Crystal Meth from Class B to Class A, thereby allowing the police to shut down houses where it is produced. Another source of pride is the containment of Aids due to moving heroin addicts onto Methadone.

It all comes back to his matrix of harm. No one much knew of it before; now we do. Outside the ACMD, Nutt may turn out to have more clout than he ever did as an insider. Next Tuesday's meeting may or may result in a mass resignation, but the sacking of Nutt could be a turning point for so-called independent advisory bodies that are allowed to say what they like, providing it fits with Government policy.

Among the many messages of support have been several from people who want scientists to advise on the damage done by the various drugs in circulation, and are willing to fund it.

"I'm hoping," says Nutt, "that we can create a separate, independent scientific body that can take this out of party politics. Then we can monitor drugs and the Government can decide policy." Alan Johnson might agree with him there.

From:

http://www.telegraph.Professor-Nutt-If-we-want-to-reduce-deaths-alcohol-and-heroin-are-the-issues

NHS accused over illegal gagging of doctors' safety concerns

Outlawed gagging clauses are still being used by the National Health Service to silence concerns about patient safety the British Medical Journal has found.

The Public Interest Disclosure Act provides protection for people who blow the whistle, providing they have raised concerns with their employer, and it specifically overrides any agreement aimed at preventing proper disclosure.

Furthermore, even before the 1998 act came into force, it was the health department's policy that confidentiality or gagging clauses should not be used in the NHS, a stance they have since reinforced.

But the case of Peter Bousfield, a consultant who raised fears about patient safety at the Liverpool Women's NHS Trust, illustrates that such clauses are still in use, the BMJ said. Equally, some consultants who leave their NHS Trust "under a cloud" - because colleagues are worried about their competence - are inserting confidentiality clauses into their departure agreements that prevent the hospital or colleagues disclosing their worries to future employers.

Mr Bousfield, a senior consultant and former medical director, was given early retirement and a pay-off when the hospital rejected his concerns. It inserted a confidentiality clause that prevented him raising concerns with anyone other than the hospital board and the secretary of state for health.

The journal also cites an anonymous case where a consultant reported concerns about a newly appointed colleague's work, only to find when contacting the doctor's previous hospital that it had "seemingly been keen to be relieved of the doctor's services whatever happened in future" but had agreed a gagging clause over the departure so that "nothing could be discussed".

When the doctor quit his new hospital "another gagging clause" was imposed. The consultant says: "I felt incensed that even when two trusts were aware of repetitive behaviour they did not, or could not, join forces to save a third from employing this person."

Dr Mark Porter, chairman of the British Medical Association's consultants committee, said that in a recent survey 15 per cent of doctors who had reported concerns said their employers had indicated that "speaking up could negatively affect their employment".

Public Concern at Work , the charity that helped engineer the Public Interest Disclosure Act and which runs a whistleblowers' helpline, said it was aware of other cases in the NHS.

Dr Porter said staff should not be able to take vendettas to the media before employers had had a chance to deal with the concerns. But "to say there are no circumstances in which a concern for patient safety can be raised outside the organisation, or to attempt to enforce silence through a contractual mechanism, is appalling".

From:

http://www.ft.com/cms/s/0/37819d76-c362-11de-8eca-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

Increasing obesity pushes diabetes drug bill to £600m

The rising problem of obesity has helped to make diabetes treatments the biggest drug bill in primary care, with almost £600 million of medicines prescribed by doctors last year, according to the NHS Information Centre.

Analysts said that young people contracting the condition, which is often associated with obesity, were helping to push up costs as doctors tried to improve their long-term control of the disease and prevent complications.

A total of 32.9 million diabetes drugs, costing £599.3 million, were prescribed in the past financial year. In 2004-05 there were 24.8 million, costing £458 million.

More than 90 per cent of the 2.4 million diabetics in England have type 2 diabetes, with the remainder suffering from type 1, the insulin-dependent form of the disease caused when the body’s immune system destroys insulin-producing cells in the pancreas. There are thought to be 500,000 undiagnosed cases of diabetes.

While rates of type 1 have shown slight increases in recent years, type 2 has risen far more rapidly — a trend linked to the increasing number of people who are overweight or obese. Almost one in four adults in England is obese, with predictions that nine in ten will be overweight or obese by 2050. Obesity costs the NHS £4.2 billion annually. This year the Government started a £375 million campaign aimed at preventing people from becoming overweight by encouraging them to eat better and exercise more.

An NHS Information Centre spokeswoman who worked on the report, which was published yesterday, said that diabetes was dominating the primary care drug bill as better monitoring identified more sufferers and widely used medications such as statins became cheaper. She said that the data suggested a growing use of injectable insulin in type 2 diabetes care, which was helping to push up costs.

Doctors agreed that more expensive long-acting insulin, which can cost about £30 per item, was being used more often, as well as more expensive pills and other agents.

The report, an update of the centre’s June publication Prescribing for Diabetes in England, shows that the number of insulin items prescribed last year rose by 300,000 to 5.5 million, at a total cost of £288.3 million. It marked an 8 per cent rise on the £267 million spent in the previous year. However, while the number of anti-diabetic drugs, which are mostly in tablet form, also rose, the cost dropped slightly to £168.1 million.

“Type 2 is increasing. We are seeing it in younger people, and because it is a progressive disease people are needing an increasing number of interventions as time goes by,” the spokeswoman said, adding that long-acting insulins such as Glargine were now common. “For people who are struggling to control their type 2 diabetes it makes sense, but it is quite a big clinical change from five or ten years ago.”

Other anti-diabetic items, such as use of the subcutaneous injection exenatide, have also increased and cost £14.3 million.

Laurence Buckman, chairman of the British Medical Association’s general practice committee, said that he had observed a trend with drugs such as exenatide, which costs £80 per item. He said that younger patients could start on cheaper tablets such as metformin, which costs £3.70 per box, but were needing increasingly sophisticated treatments to keep their condition in check.

“You are talking about an ever larger number of people getting a large range of drugs to reduce long-term complications. Type 2 is a common chronic illness that is getting commoner. It’s in everyone’s interest to treat people early and with the most effective drugs, and these are the more expensive tablets and long-acting insulins,” he said.

From:

http://www.timesonline.co.uk/tol/news/uk/health/article6836082.ece

Labour to cut £20bn off NHS budget

The National Health Service will have to find savings of £15bn ($24bn) to £20bn, Andy Burnham, the labour health secretary, has acknowledged.

Hospitals are to get their first indication in the autumn of just how far and fast they will have to cut costs to help achieve that. His acknowledgement of  the scale of the challenge comes as Gordon Brown and Alistair Darling, prime minister and chancellor, have begun a series of meetings with cabinet ministers to discuss priorities and potential candidates for cuts in the run-up to the pre-Budget report in the autumn.

Labour Government insiders played down suggestions that the autumn statement would be a mini spending review, setting out departmental spending limits beyond March 2011.

But after the prime minister’s use of the “c” word this week, promising to “cut unnecessary programmes and cut lower priority budgets”, the chancellor is likely to offer some totemic sacrifices in the pre-Budget report, while possibly spelling out areas likely to be protected from the worst of the squeeze.

It is already clear that the capital intensive areas of transport and housing are set to take a hammering given previously announced plans to halve capital spending from this year’s level.

“They will almost certainly be amongst the hardest hit,” said Robert Chote, director of the Institute for Fiscal Studies.

Health is likely to be relatively protected, not least because the Conservatives are promising some real terms growth. That, however, will still leave the NHS having to make massive savings in the face of rising demand from medical advances and an ageing population, which together with pay and price inflation tend to outstrip economic growth.

Mr Burnham indicated this week that he would like to set out an “overall spending settlement” for the NHS in the autumn, while acknowledging that is a matter for the chancellor.

But whether that happens or not, he told the King’s Fund health think-tank, he will take the unprecedented step of spelling out the prices the NHS is likely to pay hospitals for treatment over the next four years.

That “will set out the scale of the efficiency and productivity challenge year on year, building up over time, with the most demanding savings coming later,” he said. In turn, he said, that “will begin the process of showing how we realise [the] challenge of finding £15bn to £20bn of savings” up until 2014.

Nigel Edwards, head of policy for the NHS Confederation, which itself has calculated that the NHS needs to make up to £15bn of savings by 2015, said: “This is the first ministerial acknowledgement that I have seen of the scale of the challenge.

“The good news is that it has been publicly acknowledged, and we welcome that realism. The bad news is that it is at least as bad as we thought”. 

"The price schedule, or tariff, covers about 70 per cent of hospital activity, which itself accounts for only some 40 per cent of the NHS budget. So spelling that out will give an indication but not a firm projection of likely level of NHS spending.

From:

http://www.ft.com/cms/s/0/b56a59c6-a486-11de-92d4-00144feabdc0.html?nclick_check=1

Cancer drugs fail to win NHS funding killer quango NICE

Four drugs for treating various stages of kidney cancer have been turned down for health service funding in England by NICE, in spite of price cuts by the manufacturers.

The decisions by the National Institute for Curbing Expenditure (NICE) underline that new guidance last year for “end of life” treatments will not produce a wave of new approvals for costly drugs that can extend life but where there is not yet evidence of dramatic results.

This year Nice approved Pfizer’s Sutent as a “first line” treatment for kidney cancer. But the institute has now rejected it as a second line treatment – where an initial therapy has failed – and has turned down rival products from Roche, Bayer and Wyeth for first line use.

It has done so in spite of Pfizer, Roche and Bayer agreeing deals with the Department of Health, which effectively cut the price of the drugs to the National Health Service.

The decisions were described as “a bitter blow” by the patients’ charity the Rarer Cancers Forum, which claimed they “went against the spirit” of last year’s amended guidance giving greater weight to end-of-life care.

Roche, whose product Avastin was rejected, was also furious, saying it was “considering all options”, including legal action. It attacked the decision as “illogical” when its product costs broadly the same as Sutent.

Professor Peter Littlejohns, clinical director of Nice, said that in spite of the revised guidance and price cuts “the benefit [from these drugs] was still too small, set against their cost”.

From:
http://www.ft.com/cms/s/0/10069bfc-91bc-11de-879d-00144feabdc0.html?nclick_check=1

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

Health secretary attacked over move to call in regulator of NHS trusts

Andy Burnham was yesterday accused of undermining the principle of the government's health service reforms - by the NHS itself.

The health secretary wants powers formally to ask Monitor, which regulates foundation trusts, to intervene when one of the hospitals hits the headlines for the wrong reasons. NHS bodies said that would threaten the regulator's independence.

The move follows the discovery that mistakes in emergency care at Mid-Staffordshire Hospital had caused hundreds of unnecessary deaths.

Mr Burnham is proposing that the health secretary should be able legally to ask the regulator to act where there is "demonstrable poor quality, demonstrable poor governance or a failure of leadership".

But Sue Slipman, director of the Foundation Trust Network, said the issues on which ministers could intervene were far too widely drawn. They threatened an important settlement of the NHS reforms, she said - that foundation trusts would be free-standing organisations, regulated independently, and no longer subject to direction by the secretary of state.

The proposals were "second guessing Monitor", she said, and could mean the health secretary intervening "every time there was a negative story in the newspapers".

Yesterday, the NHS Confederation, which represents all health authorities and trusts, reinforced her argument, saying the proposals were "unnecessary" and threatened a repeat of the 1990s, when similar freedoms given to ordinary NHS trusts were steadily clawed back by the Department of Health.

Nigel Edwards, the confederation's director of policy, said: "It is not clear that this is necessary." If the quality of care were at issue, the new healthcare inspector, the Care Quality Commission, had the power to close services, which would trigger action by Monitor, he said. He also pointed out that Mid-Staffordshire had been dealt with effectively by Monitor, which replaced the trust's leadership.

"This can be seen as a symbolic first step to reclaiming the freedoms and independence that were bestowed on foundation trusts," he said. It was "against the whole spirit of the existing legislation".

The health department insisted the new powers would be used "rarely" and in "exceptional circumstances". But Mr Edwards said having them would put ministers under pressure to act "and the definition of exceptional will become looser and broader".

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