Health Direct- 4 years and 1000 posts on NHS news, advice and information

Health Direct has now posted over 1,000 news, advice and information stories about the NHS during the past four years.

During this period of labour's mismanagement of the National Health Service- Health Direct has found billions of taxpayers Pounds wasted, tens of thousands of preventable deaths and thousands of NHS staff sacked because of underfunding.

MRSA and Clostridium difficile superbugs are still killing more people than die from UK road accidents.

PFI and other off balance sheet financing that runs onto billions of Pounds- with restrictive clauses which even prevent local politicians from cutting hospital car parking charges.

The wheels are coming off the world's most expensive health IT system. Which is so blinkered and rigid that the new polyclinics will not be able to use it- if it ever works properly. Even Google have overtaken the NHS in providing an online health records system- though how secure their system will prove to be is as open to question as labour's pathetic data privacy track record.

And we have the prospect of nearly another three years of labour's dithering, stalinist, incompetent direction.

Treasury U Turn to ensure taxpayer is no longer the loser in PFI deals

The Treasury ordered public bodies doing private finance initiative (PFI) deals to require a much bigger share of any windfall gains from refinancing them in the future.

PFI deals are still being negotiated - not without difficulty - in spite of the credit crunch as some banks see their government-backed revenues as a haven in the financial turmoil.

However, the credit squeeze has seen funders demanding higher margins on the debt put into them and that has opened up the possibility again of significant refinancing gains if investment and interest rates fall to pre-credit crunch levels.

In a move to avoid the acute embarrassment of the early days of PFI, when investors in projects made millions of pounds from refinancings and it turned out that the taxpayer had no right to any share in the gains, the Treasury has upped the share it is demanding.

Investors in one of the early hospital projects, for example, made a 60% windfall gain and hugely increased rates of return when they used falling interest rates to refinance. As a result, since 2001 contracts have required that any such gains should be split equally between the project's backers and the taxpayer.

That will still apply to the first £1m of any gain. But for new deals the Treasury said yesterday that the next £2m would have to be shared 60/40 in the taxpayers' favour and for anything above that the taxpayer would take 70 per cent.

As an additional protection, new contracts will give the public sector the right to demand a refinancing if it believes that will lead to better terms for the taxpayer, whereas previously only the contractors have been able to initiate such a deal.

In spite of the onset of the credit crunch last year, more than a dozen PFI deals have been signed this year, according to the Treasury, eight or nine of them in the second half of the year, despite the growing problems over bank lending.

Almost £600m of schemes by capital value have been agreed since the middle of the year, though most have been smaller deals in the £20m to £90m range.

Some European banks have withdrawn from the PFI market, and James Stewart, chief executive of PUK, the public-private partnership that advises the public sector on deals, said recently that sponsors had had to go to clubs of several banks to arrange financing - rather than doing a deal with one or two that then sold the debt on.

From:
http://www.ft.com/cms/s/0/ed45ca68-9be2-11dd-ae76-000077b07658.html?nclick_check=1

NHS hospital car parking charges to be abolished

Health chiefs in England were under pressure to scrap hospital car parking charges after a move by the Scottish government to abolish the charges at 14 NHS hospitals.

The move to scrap the charges on December 31 this year comes after a review of the car parking policies of NHS boards across Scotland.

A temporary cap of £3 a day on parking charges at hospitals has been in place since January.

The charges will remain at three of Scotland's biggest hospitals which were built under the Private Finance Initiative (PFI) - Edinburgh Royal Infirmary, Glasgow Royal Infirmary, and Ninewells Hospital in Dundee.

The charges have been particularly unpopular with staff and visitors but some health boards argued that they need to apply them to deter commuters and others not visiting hospitals leaving their cars on site.

By removing the hospital parking charges, the Nationalist government has again demonstrated its populist touch, leaving its opponents with no option but to agree with the move.

However, the decision will irritate patients and staff south of the Border who will ask why English hospitals cannot do the same.

Scrapping the charges will cost Scottish health boards about £5.5million in lost income each year. The boards will get £1.4million from the Scottish government this financial year but will get no more cash. The £1.4million is roughly equivalent to the income lost in the final three months of this financial year once the charges are scrapped.

Nicola Sturgeon, the Scottish Health Secretary, said that it was “simply not fair” to expect patients or visitors to have to pay when they come to hospital. “Put bluntly, a car parking charge is often the last thing people need,” she added.

Ms Sturgeon said she was “determined” that the founding principles of the NHS should remain. “Chief among these is that the NHS should be free at the point of delivery and it is my firm belief that this would apply whether one comes to hospital as a patient, visitor or member of staff,” the health secretary added.

She said that the only exception to the initiative would be car parks in hospitals built through PFI where the cost of early termination would be “prohibitive”, because of the nature of the contracts. However, even in these hospital, she said that boards should work with contractors to limit and reduce charges until the contracts came to an end.

The 14 hospitals where charges will be scrapped are: Aberdeen Royal Infirmary; Dr Gray's Hospital, Elgin; Gartnavel General Hospital and Gartnavel Royal Hospital; the Southern General Hospital, Stobhill Hospital, Victoria Infirmary, Western Infirmary and Yorkhill Hospital, all in Glasgow; Raigmore Hospital in Inverness; the Lauriston Building, Royal Hospital for Sick Children and the Western General Hospital, all in Edinburgh; St John's Hospital in West Lothian, and Perth Royal Infirmary.

Before the charges are scrapped the five health boards which apply them will be asked to bring forward plans for meeting increased demand and promoting environmentally-friendly transport.

The move was welcome by the AA motoring organisation, which urged hospitals in England to do the same.

Edmund King, the AA President, said that the scrapping of car park charges at these 14 hospitals was “great news”, particularly for long-term sufferers and their families.

“For cancer sufferers undergoing chemotherapy on a day-patient basis the parking costs soon add up. Also, due to the risk of infection many such sufferers are unable to use public transport,” he added.

Unison, the NHS union, criticised the decision not to scrap charges at PFI hospital car parks. Cathy Miller, the Glasgow and Clyde branch secretary, said that Ms Sturgeon seemed unwilling to be bold enough to remove charges from these sites.

“This decision will create a two-tier system with staff and patients who are unlucky enough to be on a PFI site, such as Glasgow Royal Infirmary, being charged for the pleasure”, she added.

Organisations representing doctors and nurses welcomed the move. Charles Saunders, chairman of the BMA's Scottish consultants committee, said that charging to park at hospitals was an indirect tax on healthcare.

“The founding principle of the NHS is that healthcare should be free at the point of delivery and we are pleased that the Scottish government has recognised the burden that these charges have put on patients and their relatives when they are at their most vulnerable,” he added.

From:
http://www.timesonline.co.uk/tol/news/uk/scotland/article4663759.ece

Health Direct wonders if Gordon Brown had any sense he would have rather done the same for England.

A majority of people in England would have benefited from this simple measure. Stamp duty holiday for houses under 175000 for a handful of people for a year is neither here nor there.
I wonder who advises him?

PFI Hospitals run by HSBC pay £200 to fit wall socket

Britain's biggest bank, HSBC, and its investors have made almost £100m from managing National Health Service hospitals where contractors routinely charge taxpayers inflated bills for simple tasks – such as £210 to fit an electrical socket or £200 to install a computer socket.

The charges, paid at hospitals run by the bank’s subsidiary infrastructure company, raise questions about lax controls in Labour’s private finance initiative (PFI), which has been used to build more than 100 hospitals over the past decade.

Richard Bacon, a Conservative MP who sits on the public accounts committee, said: “Anyone who works in the NHS will be dismayed that their managers are paying such rates. More than £200 to install an electric plug is just not on – it’s absolutely absurd, ridiculous.”

Since its launch in March 2006, the HSBC fund has acquired large stakes in 27 PFI projects, including Barnet, Bishop Auckland, Royal Blackburn, Stoke Mandeville, Central Middlesex and West Middlesex University hospitals.

It also manages the central London headquarters of the Home Office as well as schools and police stations. To boost its return to shareholders, the fund is based in Guernsey, the tax haven Channel Island.

Shares in the HSBC Infrastructure Company (HICL) have risen by 25% in the past two years, adding £58.75m to its value on the London stock market. During this period it has also paid more than £30m to investors through dividends.

Under PFI deals, contractors are appointed by project managers such as HICL to maintain the building and provide cleaning, catering and other services. Although they are paid a flat annual fee, they invoice the health trusts for any additional jobs not specified in the contract. In most cases, the hospital is obliged to use its contractor.

According to the National Audit Office, 59% of public sector managers said that contract variations worked out more expensive under PFI. A total of £180m was paid to PFI contractors for such extras in 2006.

Four of the hospitals in HSBC’s fund pay charges at rates far higher than those charged by normal tradesman.

- The Central Middlesex hospital in northwest London said that, on average, its contractor, Ecovert FM, charged £210 to install an electric socket.

- West Middlesex University hospital said it was typically charged £150 by Ecovert FM for the same task. An independent electrician located close to both hospitals in Harrow said a typical charge for replacing a socket was £40. The cost of installing a new one was £80.

- Royal Blackburn hospital said it was charged £198 by its contractor, Consort, to put in a datapoint – needed to plug a computer into an internal network. By contrast, West Middlesex University hospital said it was usually charged about £60 for the same service.

- West Middlesex University and Royal Barnet hospitals said they were normally charged about £100 to install a new lock – a third more expensive than local locksmiths.

A spokesman for the HSBC infrastructure fund said it took “great care in delivering the outsourced services”. Contractors said that each job was different and some seemingly straightforward electrical jobs could involve extensive rewiring.

The contract charges are often higher because PFI hospitals do not have enough handymen to do the job on site and have to call out the contractor’s staff. PFI hospitals typically have a maintenance staff one third smaller than other hospitals.

A spokesman for Ecovert FM said: “The type of wall construction, distance the new socket is from the mains supply, making good and redecoration work can greatly influence the cost of putting in a socket.”

84% of doctors polled by the doctors.net.uk website for The Sunday Times, said PFI had failed to deliver value for money for taxpayers. Only 6% of the 856 doctors polled believed that PFI was delivering at a fair cost.

http://www.timesonline.co.uk/tol/news/uk/health/article4087496.ece

Whitehall clash looms over PFI for NHS hospitals

A clash between different accounting standards for private finance initiative projects is threatening to create conflicting incentives within the labour government, with the Treasury continuing to favour PFI while other departments are more circumspect.

Some £30bn of PFI projects, chiefly in health and local government, are off balance sheet and do not count towards the government’s rule that borrowing should not exceed 40 per cent of gross domestic product. Were they to come back on, the sums are large enough to break the rule, potentially altering the government’s assessment of the public finances.

The impending switch to international financial reporting standards from this April is widely expected to have that effect. A meeting of FRAB, the financial reporting board that advises the government, is understood to have backed that shift at a meeting last week.

However, there are signs that the Office for National Statistics, the guardian of the national accounts, will not replicate that change. This would allow the Treasury to continue to ignore a large proportion of PFI debt.

The differing approaches would lead to conflicting incentives. The Treasury would have a strong motive to continue to favour PFI schemes, while departments would no longer care whether a project was privately or publicly financed as both could come on to their books and be subject to government capital charges.

Most Treasury officials originally assumed that new accounting standards would see schemes count as public sector net debt. But the latest ONS view is that this was premature. The ONS is required to follow European accounting methodology which sees many PFI schemes in other European countries sit off the government’s books.

The outcome is likely to be that ONS will have to evaluate every PFI project separately against European national accounts conventions.

http://www.ft.com/cms/s/0/131f686a-e8ac-11dc-913a-0000779fd2ac,dwp_uuid=f0d249de-e821-11db-b2c3-000b5df10621.html

Hospital PFI project hit by US monoline credit crunch

Reverberations from the crisis in US bond insurers were felt this week in an unlikely corner of the financial markets- Tunbridge Wells.

A private finance initiative project to build a new hospital for Maidstone and Tunbridge Wells NHS Trust in Kent has been forced to abandon its plans to issue insured bonds to fund the project, the Financial Times has learnt. It will instead turn to banks to provide the £225m ($446m) needed.

The U-turn is an example of how uncertainty over the future of bond insurers is changing the face of the PFI market, removing the cheapest funding option for big projects and potentially pushing up costs to the tax payer.

In recent years, bond insurers such as Ambac and MBIA have “wrapped” almost all PFI bonds by lending them their top-notch credit ratings, making them safer and so cheaper to issue.

For larger private finance deals of more than £100m, bond insurers undercut traditional competition, offering cheaper funding than bank loans.

An example of the scale of bond insurers’ involvement in PFI projects is Ambac UK, which has insured £5.7bn of PFI deals, including £1.7bn of PFI hospitals. Specific deals include:
£200m Northern batch PFI hospitals project closed last September.
£498mRoyal London and Barts PFI hospitals project – the largest PFI hospital project to date.
£730m Allenby & Connaught PFI military housing project – largest PFI accommodation project.

But as bond insurers, also known as monolines, have run into trouble over their involvement with US subprime debt, the situation has reversed dramatically. Investors’ confidence in “wraps” collapsed as rating agencies downgraded some bond insurers and put others on negative watch.

Tunbridge’s new hospital was to be funded with wrapped bonds, until the bond insurer was downgraded. David Hardy, director of John Laing Investments Limited, which leads the consortium running the project, said this ruled out the bond option.

“As a sponsor you have to ask three questions. First: will they be able to continue supporting the paper with their downgrades? Even if they could, would we be able to get sufficient investors interested in it? And if we could get people interested, at what cost?”

Under pressure to close the deal before delays caused mounting costs, the consortium and the NHS trust decided bank loans would provide the best value for money.

This is a pattern being repeated across the PFI market for big projects. Last month the UK’s largest PFI – to provide the RAF with a fleet of refuelling tankers – also switched from wrapped bonds to bank debt.

The £1bn scheme to provide a military flying training system for the British army may also be facing Tunbridge Wells’ dilemma. The Ministry of Defence said it was still working on a financial arrangement.

Market participants say other projects are going the same way, resulting in potentially higher funding costs for big PFI deals.

This could also be exacerbated by banks’ unwillingness to lend as cheaply as before in a time of tightening credit conditions.

“The bank markets have had a choppy period since the credit crunch, and for the more challenging or bigger deals obviously there’s a pricing consequence,” said Bruce B. White, head of Linklaters’ PFI team, who advises on bringing PFI deals to financial close.

Mike Chappell, who heads Lloyds TSB’s PFI team, said banks’ own exposure to the bond insurers as well as general tough credit conditions were affecting their appetite to buy syndicated debt – small parcels of PFI debt.

This may leave some bigger PFI deals stymied, unable to find sufficiently cheap financing to go ahead.

From:
http://www.ft.com/cms/s/0/15bc5a92-e8ac-11dc-913a-0000779fd2ac.html

PFI wastes £180m finds NAO watchdog

Millions of pounds of public money are being wasted because contractors are charging unjustifiably high fees for making changes to active private finance initiative (PFI) projects, according to the National Audit Office (NAO).

Public authorities are typically getting "poor value for money" when they ask private sector consortia for additions to ongoing PFI projects, such as building and operating hospitals and schools, an audit office report concluded on Wednesday.

More than £180m ($353m) of taxpayers' money was spent on changes to many of the 500 PFI deals in 2006. The audit office found that most private sector PFI operators charged "unjustified" extra management fees, often as high as 10 per cent, on top of the charges made by the service providers for requested changes.

Another problem was that public authorities were frequently ill-equipped to manage PFI projects and had little idea how much changes should cost. For example, it found that the cost of adding a single electrical socket varied widely from about £30 to more than £302 in PFI projects, with an average higher than benchmark prices.

James Robertson, chief economist at the NAO, said: "Public authorities are not necessarily sighted on what the typical cost ought to be and that's a problem."

Although 82 per cent of changes to PFI projects, which can often run for 25 to 30 years, were small, "these all add up to a sizeable amount of money".

Changes that cost more than £100,000 accounted for 90 per cent of the spending, yet just 30 per cent of those changes were competitively tendered, with the rest being awarded directly to the existing contractor.

The audit office said about another third of the changes could have gone to tender to drive down costs. For example, it said a £25m new block at HM Prison Altcourse and £22.9m expansion of Hexham General Hospital were among a number of schemes not competitively tendered but which might have been suitable for such treatment.

Edward Leigh, the chairman of the Commons' public accounts committee, said changes were inevitable but public sector managers should be more "street-wise" when dealing with savvy private sector contractors.

He said: "The public sector has allowed itself to be taken for a ride. It is depressing that, for one in five PFI projects, the public authorities trim the projects at the initial plan stage to save money, only to risk being stung later by the private sector contractors when things are put back into the project."

Neil Bentley, director of public services at the CBI employers' body, said: "The report shows PFI deals are flexible and able to respond to public service users' changing needs. But value for money is paramount and PFI partners need to work together to deliver a good deal for all."

From:
http://search.ft.com/ftArticle?queryText=PFI+waste&y=13&aje=true&x=19&id=080117000316&ct=0

Private sector sees NHS role slashed

Alan Johnson, the health secretary, yesterday slashed a long planned expansion of the private sector’s role in the National Health Service, in effect confirming that contracts originally meant to be worth about £6bn for surgical treatments and diagnostic services are likely to amount to well under half that sum.

The health secretary announced that three small contracts for scans and renal dialysis, worth £40m a year, would go ahead. But six more surgical treatment centre contracts have been scrapped, taking to 15 the total abandoned since the procurement was launched in 2004. Only one out of nine original contracts for diagnostic services now survives.

Procurement will continue on seven more treatment centre deals, most of which have already shrunk considerably in size. But while the intention is to take final decisions by March, a health department spokesman said there was “no guarantee” they would go ahead.

Even if they did, the total value of the contracts looks unlikely to top £2.5bn on industry estimates, against the £6bn that the private sector was originally promised. Without them the total will be nearer £2bn.

Announcing his decisions, Mr Johnson insisted that the reduction in the size of the procurement “does not represent a change in policy”.

But Chris Ham, former head of the strategy unit at the health department, said: “That is not a credible statement. The contribution of the private sector will be much smaller than planned, and the potential for innovation reduced.

This is the strongest signal yet that the prime minister is distancing his government from the policies of his predecessor.”

Mr Johnson insisted the independent sector had “an important and increasing role in the NHS” despite the cutbacks, which included firing Care UK, an independent provider, from an already operational diagnostic contract in the West Midlands on the grounds that only 5 per cent of its capacity was being used.

A “significant increase in productivity” in the local NHS had removed the need for the contract, Mr Johnson said, as he also cited improved NHS performance for the scrapping of six more treatment centre deals.

Mr Johnson said his approach to the independent sector “is pragmatic, not ideological”. Where it offered good value for money “we will bring them in”.

However, both Nuffield and Spire Hospitals, two of the biggest private groups, say the majority of primary care trusts are “hiding” the right to choose by not putting the independent providers on the front screen of the “choose and book” system that family doctors use to help patients decide where to go.

Because the private hospitals are hidden on the back screen, they say, only well-informed patients get through.

That was producing “a postcode lottery” in access to care, said Richard Jones, chairman of the NHS Partners Network, which represents the private providers.

David Mobbs, chief executive of Nuffield Hospitals, said ministers should make clear that such “attempts to thwart choice unfairly and to distort markets will not be tolerated”.

In an attempt to appease the private sector, Mr Johnson promised a campaign to raise the awareness of patients’ right to choose, and a new advisory forum of private providers.

In public, the private operators reacted with restraint at the cutbacks. In private, they were furious.

Neil Bentley, the CBI’s public services director, said the decisions were “a Christmas present for opponents of reform” and that “patients are the losers”.

Karen Jennings, head of health at the trade union Unison, welcomed the government’s “change of emphasis” on private sector involvement, as the Conservatives accused ministers of “incompetence” after spending tens of millions of pounds on the failed bids.

From:
http://www.ft.com/cms/s/0/ca759530-93ab-11dc-acd0-0000779fd2ac.html

The thwarting of private services should come as surprise to readers of Health Direct. On
July 26, 2007 we posted: Alan Johnson blocks new wave of private health clinics when the health secretary, Alan Johnson, yesterday vetoed plans for a third wave of independent sector treatment centres to compete with NHS hospitals.

In a break with Tony Bliar's drive to expose the health service to the challenge of market forces, Mr Johnson said local NHS commissioners should adopt a more pragmatic approach to treating patients on the waiting list for tests and operations in England.

He will allow them to buy extra capacity from the private sector if they need it to meet targets on waiting times, and can show it provides value for the taxpayer. But he told the Commons health committee: "There will be no need for another national independent-sector procurement ... There will not be a third wave."

Mr Johnson was presented with plans for a third wave when he became health secretary last month, but he refused to endorse them.

As for the right to choose on October 31, 2007 Health Direct posted: Only 44pc recall hospital choice watchdog finds

Further evidence that the Labour's "choice" policy is struggling as a means of driving reform in the National Health Service has come from the latest survey of how far it is being offered to patients.

A mere 44 per cent of patients could recall being offered a choice of hospital for their first outpatient appointment in May - down from 48 per cent in March - with provisional results for July showing a further decline to 43 per cent.

Labour govt overpays private groups £222m for NHS treatments

The Labour government is overpaying private hospital operators by more than £200 million to carry out surgery for NHS patients. In an effort to cut waiting lists, labour launched a programme in 2005 to outsource some routine surgery to the private sector.

It says that it is committed to buying £1.4 billion of services from independent surgical treatment centres (ISTC), including hip replacements, cataract surgery and diagnostics, during the initial phase of this programme.

However, according to the Department of Health, the scheme is running at 16 per cent below capacity in value terms, meaning that only £1.18 billion of services are provided by private hospitals for NHS patients.

The remaining £222 million of public money is being paid regardless because most of the hospitals’ operators have negotiated “take or pay” clauses in their contracts with the NHS. It means that they are paid the same sum regardless of whether the NHS sends enough patients.

A spokesman for the Department of Health agreed: “The whole programme utilisation of the wave-one ISTC programme is currently 84 per cent."

The department declined to comment on capacity at individual centres, saying only that “specific details about individual schemes and their contracts are commercially sensitive”.

However, The Times has learnt of several individual ISTCs that have been operating well below capacity.

Mercury Health’s St Mary’s NHS Treatment Centre in Portsmouth is running at just 80 per cent of capacity, according to its owner, Care UK. It was contracted originally to perform 435,000 individual procedures for the NHS over five years. On current trends, it is expected to perform tens of thousands fewer than this.

Another ISTC, Capio Healthcare’s centre in Reading, was also undershooting significantly, although it has increased patient numbers recently and in July was operating at 90 per cent of capacity.

Graham Kendall, spokesman for the NHS Partners Network, the organisation representing independent healthcare providers, said that take-or-pay clauses were common and were crucial at the programme’s outset to justify the initial investment of building and equipping the centres.

Some insiders concede that they have damaged the industry’s reputation and in the new contracts under discussion for the second phase of the programme, due to begin in 2010, the clauses will be dropped, Mr Kendall said.

Privately, independent hospital operators blame poor estimates of numbers of patients when contracts were signed, as well as vested interests in the NHS that have made some trusts reluctant to refer patients to private hospitals. Institutional opposition from unions and other elements within the NHS hierarchy have proved another stumbling block, they say.

From:
http://business.timesonline.co.uk/tol/business/industry_sectors/health/article2485086.ece

Health Direct has witnessed many NHS cockups by the Department of Health, but these no work but pay clauses seem farcical in the extreme.

Labour rewards failure as NHS pays private companies for failed PFI bids On 8 May 07 Health Direct posted: Private companies that fail to win hospital building contracts are set to pocket millions of pounds in "compensation" from the NHS.

Hospitals negotiating private finance initiative (PFI) schemes could be forced to pay almost 2 per cent of the total contract costs to short-listed private companies which fail to secure deals, under proposals being discussed by the Department of Health (DoH).

On Aug 26, 2005 Health Direct also posted: Nearly 70,000 paid for diagnostic scans go unused
as the NHS is failing to use thousands of extra diagnostic scans bought by the Department of Health from the private sector last year.

More than half of the MRI (magnetic resonance imaging) scans - almost 70,000 - that the DoH bought on behalf of the NHS from Alliance Medical last year have yet to be used.

PFI- Time to set the record straight claims FT

Off balance sheet accounting has a long and often dishonourable history. Just think of Enron. The Treasury now has a chance to fix one of the most inconsistent and problematic examples of its use, in the way the private finance initiative is accounted for, by using the introduction of International Financial Reporting Standards as a chance to bring all PFI projects on to the public balance sheet.

Britain, and many other countries including Canada, Japan and Australia, use PFI to pay for infrastructure. Instead of paying a contractor to build a school, the government will pay to lease it over 30 years, transferring some management and operating risk to the builder. The question is whether that 30-year lease commitment is a debt, in which case it should be on the balance sheet, or not.

The UK's answer to this question has been inconsistent, to say the least. Most transport PFIs are on the balance sheet. Many hospital PFIs are not.

The result is a deep-seated public suspicion that disguising debt, and not advantages from transferring risk or better private sector management, is the real reason for for using PFI.

The labour government now has a chance to correct that impression, and allow private finance to show its genuine advantages, when it adopts IFRS in April next year.

IFRS says that most PFI projects should be off-balance sheet for the private sector. The logical consequence is that the public sector should put PFI on the books: the alternative - assets floating in the ether, owned by nobody - is intolerable. The Treasury should embrace, not resist, such an interpretation.

There will be consequences. First, as much as £30bn in off-balance sheet leases may be reclassified as borrowing, causing the government to break a self-imposed rule that limits public sector net debt to no more than 40 per cent of gross domestic product. But that, too, could be an opportunity: to replace increasingly discredited fiscal rules.

Second, in future new schools and hospitals will mean debt on the balance sheet, and there is a risk that the perception of indebtedness may lead to a fall in capital spending. It would be unacceptable - and bear out all the criticism of PFI sceptics - if major infrastructure projects such as London's Crossrail suddenly became "unaffordable" because of new accounting standards. It will be up to the government to increase capital budgets to compensate for any such nominal changes.

After years of debate it is time for the test: put PFI on the balance sheet, and let it live or die by its merits as a financing technique.

From
http://www.ft.com/cms/s/f0aa9658-3bd9-11dc-8002-0000779fd2ac.html

Health Direct has long noted the tendency of stalinist Brown to flip flop on his financing policies, now we may have some consistency and clarity rather than fudge and obfuscation.

Johnson blocks new wave of private health clinics

The health secretary, Alan Johnson, yesterday vetoed plans for a third wave of independent sector treatment centres to compete with NHS hospitals.

In a break with Tony Bliar's drive to expose the health service to the challenge of market forces, Mr Johnson said local NHS commissioners should adopt a more pragmatic approach to treating patients on the waiting list for tests and operations in England.

He will allow them to buy extra capacity from the private sector if they need it to meet targets on waiting times, and can show it provides value for the taxpayer. But he told the Commons health committee: "There will be no need for another national independent-sector procurement ... There will not be a third wave."

The government had been committed to spending about £4bn on the first two waves of treatment centres - fast-track clinics that were to carry out 2m routine medical procedures on NHS patients.

Mr Johnson was presented with plans for a third wave when he became health secretary last month, but he refused to endorse them.

To underline the change, he scrapped contracts with Atos Origin in the north-west and south-east of England, accusing the company of failing to deliver in time. Mr Johnson said: "Where independent sector providers are not offering good value for money or high-quality patient care ... we will terminate [their contracts]."

From:
http://society.guardian.co.uk/health/story/0,,2134811,00.html

Health Direct gives a cautious welcome to the Health Secretary's apparent decision to back the NHS rather than waste money on third party pfi projects.

Hopes fade over private sector role in NHS

Private sector hopes of a sustainable role in delivering National Health Service care are receding, judging by a study commissioned by the NHS commercial directorate. The 2004 study estimated the NHS needed to buy 450,000-500,000 procedures a year if the market that has attracted overseas health groups as well as UK operators such as Bupa and Nuffield was not to "stagnate and ultimately collapse".

At the current rate of progress, the contracts look likely to cover fewer than 300,000 patients a year, even if those still under negotiation are eventually signed.

A review of the private sector's role is set to be undertaken by Alan Johnson, health secretary, amid speculation he might cancel perhaps the bulk of the second wave of contracts that have yet to be signed for further independent surgical treatment centres (ISTCs).

Some senior NHS figures believe he will press ahead with the right of patients to choose any hospital, public or private, prepared to treat patients at the NHS price. The remaining contracts for diagnostics - scans, X-rays and endoscopies - that are needed for the NHS to hit its target of a maximum 18- week wait for treatment also look set to be confirmed.

These contracts, however, are less contentious than those for the direct treatment of NHS patients. Cancellation of the latter would be a gesture towards the health service unions at a time when some parts of the NHS are arguing that their extra capacity is not needed.

Such a policy, however, would raise questions about whether a long-term role will remain for private hospital operators in treating NHS patients.

Only 170,000 patients a year are being treated under the first wave of independent centres, not the 250,000 originally intended. Talks about a second wave, also intended to treat 250,000 patients, are bogged down.

Six of the original 20-plus schemes have been cancelled and only six contracts have so far been signed. With the deals taking longer to complete than the first wave, two of the remaining 12 had yet even to appoint preferred bidders, said the Department of Health.

Few in the private sector expect the deals to cover more than 130,000 patients - perhaps 300,000 once the first wave is added in. Reaction to the steady shrinkage of the centrally procured treatment centres varies across the private sector.

Richard Jones, commercial director of Bupa Hospitals who chairs the NHS Partners Network, which represents the private providers, said: "It is clear that the second wave of ISTCs is not going to be on the scale of the original procurement." But that gap, he said, could be filled by the growing right of patients to choose to have their operation in private facilities.

Adrian Bull, managing director of Carillion Health, which saw one of its big schemes cancelled last month, said: "It is very important that the government does not allow serial cancellation of these schemes to undermine the confidence of the private sector in future investment in NHS work."

David Mobbs, Nuffield's chief executive, said he remained "excited" about the increasing right of patients to choose.

From:
http://www.ft.com/cms/s/a692477a-29c6-11dc-a530-000b5df10621.html

Cynical Stalinist Brown cut budget for English hospitals- but kept Scottish health budgets

Gordon Stalinist Brown quietly slashed by a third this year’s hospital building and equipment budget in one of his last acts as chancellor. Prompted by the tightness of the public finances, the new prime minister, who has placed the NHS as his “immediate priority”, cut the capital budget of the English NHS for 2007-08 from £6.2bn to £4.2bn. The move could delay the labour government’s hospital building and reconfiguration programme in England.

However, Mr Brown avoided equivalent cuts to the Scottish and Welsh NHS budgets even though the funding formula for the UK nations suggests they should have shared the pain. That decision leaves him open to criticism that he favoured patients in his home country.

Those familiar with the situation said the cut to NHS capital spending implied a very tight settlement for the health department for the next three years in October’s Comprehensive Spending Review and indicated a slowdown in hospital building.

The health department’s surrender of £2bn in capital is all the more remarkable because the NHS needs the money and it had not been given greater day-to-day money to spend.

The private finance initiative hospital programme has already been cut from a future programme of £12bn to £8bn, with further reduction likely, amid worries the inflexible payments PFI demands do not fit well with the new system of money following the patients. Big hospital reconfigurations are due in some parts of the country that will inevitably require capital.

The Treasury Friday night confirmed the NHS capital budget had been “adjusted”. But it indicated that, although it was not yet published, it would allocate the missing £2bn to spend to English hospitals over three years from 2008-09.

No published health spending plans exist for these years yet, so hospitals will not be able to verify that the money is additional.

The cut was slipped out in the March Budget, when Mr Brown referred only to spending on day-to-day NHS services when he said “the money available for investment and reform in the NHS in England will be £8bn more than this year, the biggest cash increase ever”.

From:
http://www.ft.com/cms/s/f7a994d0-2677-11dc-8e18-000b5df10621.html

That Stalinist Brown had shifted the goal posts for PFI hospital building is not new- please see below. But his rigging of hospital building funds in England and Scotland shows a new level of contempt for the voters.

On 18 Jun 07 Health Direct posted: NHS service cuts urged at non PFI hospitals when Primary care trusts wanting to reconfigure services were given a stark message in an economic analysis prepared for the NHS in London: financially, it will make sense to cut beds and services at non private finance initiative (PFI) hospitals.

Sharon Massey, cabinet member for health and adult social services at Bexley council, which covers Sidcup- one of the areas covered, said: 'We are devastated that Queen Mary's is coming out as the most vulnerable hospital. There is effectively a mortgage on other hospitals. Queen Mary's does not have a mortgage so is easy to dispose of.'

The paper focuses on south east London but arguments would apply in other areas with a mix of PFI and non-PFI hospitals.

Imperial College London professor of health policy Nick Bosanquet also sent out a warning. He said: 'There will be a temptation to say "we are stuck with these contracts, we will close down older hospitals which may in fact be lower cost".

NHS service cuts urged at non PFI hospitals

Primary care trusts wanting to reconfigure services were given a stark message in an economic analysis prepared for the NHS in London: financially, it will make sense to cut beds and services at non private finance initiative (PFI) hospitals.

The paper recommends reducing services at Queen Mary's Hospital, Sidcup, rather than PFI hospitals in south east London, where a consultation on reconfiguration proposals is expected this autumn.

It adds that decisions should take into account many factors, not just finance. But with significant excess of beds expected and a £65m deficit some cuts seem inevitable. A spokesperson for the project board said hospitals were working to see where care would be best delivered but that all were likely to see significant change.

Reducing work at PFI hospitals at Bromley and Woolwich would achieve few savings as the NHS is committed to annual payments for the buildings, and often additional costs for some elements of facilities. The report says 'whole hospital PFI sites' have 'less flexibility to reduce "hard" facilities managements costs in the event of an unplanned reduction in activity because of constraints in their PFI contracts'.

In contrast, excess land and facilities at non-PFI sites could be sold off to make significant savings.

The paper also warns that a new PFI site at Lewisham Hospital will need to achieve 'high utilisation rates... if it is to avoid the increased pressures giving rise to a worsening of its income/expenditure and cash flow positions'.

Sharon Massey, cabinet member for health and adult social services at Bexley council, which covers Sidcup, said: 'We are devastated that Queen Mary's is coming out as the most vulnerable hospital. There is effectively a mortgage on other hospitals. Queen Mary's does not have a mortgage so is easy to dispose of.'

The paper focuses on south east London but arguments would apply in other areas with a mix of PFI and non-PFI hospitals.

Imperial College London professor of health policy Nick Bosanquet also sent out a warning. He said: 'There will be a temptation to say "we are stuck with these contracts, we will close down older hospitals which may in fact be lower cost".'

From:
http://www.hsj.co.uk/healthservicejournal/pages/N2/p7/070614

On Jan 16, 07 Health Direct warned: Brown can’t cure this paralysed NHS, so he plans to privatise it

The former Granada boss Sir Gerry Robinson recently spent six months trying to reform Rotherham general hospital. The result was shown in three hours of fly on the wall television on BBC2 last week. It was rightly put after the watershed: as politics it was certificate 18. At the end of each day Robinson could be seen slumped in the back of his car, his face buried in his hands. A tycoon sobbing in a limousine is the perfect icon of Labour’s health service.


The message of Robinson’s inquiry was devastating and explains the ostensibly terminal chaos enveloping the NHS under Patricia Hewitt. The central arm of government, the Treasury, has clearly given up on NHS reform. No government, Labour or Tory, has the guts to break the consultants’ restrictive practices, the GPs’ “lifestyle” demands or the healthcare unions.

The Treasury itself capitulated to the unions by rubber-stamping the ridiculously expensive 2004 NHS pay deal, depriving Britons for the first time of proper out-of-hours GP cover.

More alarming is that internal pricing and payment-per-treatment will leave these mastodons financially exposed through loss of business to the private sector. In an attempt to favour this sector, the Treasury and Hewitt are refusing to allow NHS hospitals to cut tariffs to compete. Small wonder James Johnson, the British Medical Association chairman, parodied Blair’s 1997 battle cry, “24 hours to save the NHS” by saying there was now “one year to save the NHS”.

Many hospital trusts are building up large deficits that they cannot possibly cover; 29 are contemplating some 60 “reconfigurations”, code for closures, at a time when Hewitt is also talking of somehow building 50 cottage hospitals. She must also now contend with 11 of her ministerial colleagues declared to be in open opposition.

Meanwhile manpower planning is in disarray, with hiring cuts or freezes almost everywhere and a reported surplus of 3,200 expensively trained NHS consultants by 2010.

Call for scrutiny of PFI equity sales says PAC

The market for sales of equity in Private Finance Initiative (PFI) deals should be closely watched by the Treasury, parliament's public spending watchdog said, as it raised fears that they might not be in the public interest.

When privately financed projects such as schools, hospitals and roads are refinanced, the public sector should now receive a share of the gains.

But "there is no requirement for the gains made by investors through selling on their shares in PFI projects to be shared with the government", Edward Leigh, the chairman of the House of Commons Public Accounts Committee, said.

The precise scale of the equity sale market is not known because the Treasury does not collect figures. But the number of such sales has been rising. All or part of the equity has been sold in 32 of the 80 projects surveyed by the National Audit Office, either to new investors or to one of the initial investors. Carillion, for example, has sold equity investments it acquired for £24m for £46m.

The Treasury takes the view that while debt refinancings affect the public sector's rights, a change in the equity ownership does not affect the public sector. Profits are taxed through capital gains, and the Treasury believes that, in essence, the transactions are no different to other private- sector deals.

But in the report the committee said the Treasury view "is only credible if there is an efficient equity market" and that the Treasury needed to demonstrate that.

Its report stops short of calling for the public sector to be given a share of the gains, as in debt refinancings. But Mr Leigh said the Treasury "must keep the working of the PFI equity market under close scrutiny to make sure the public interest is not being compromised".

David Metter, the chief executive of Innisfree and chairman of the PPP Forum, a lobby group for the PFI industry, said it was reasonable for the government to know who owned PFI projects. He said most contracts contained a so-called "Gadaffi clause" aimed at preventing their transfer to undesirable owners.

But the question of profits was "a difficult one" when the price paid would go up and down depending on the market, with people sometimes overpaying and at other times underpaying.

"The government is well placed to stay out of that," he said, "because if it wants a share of the gains, would it also want a share of the losses?"

The CBI employers' group said it would be opposed to any "increasing level of Treasury interference".

The committee also noted that the equity market was beginning to consolidate, so a small number of investors could wind up dominating the market.

Cash shortfall

The public sector has so far received £93m from its agreed share of PFI refinancings - well below an earlier estimate that it might have received £175m to £200m by now.

Parliament's public spending watchdog suggests the shortfall may arise from investors preferring to sell equity stakes, where the gains do not have to be shared with the public sector.

From:
http://www.ft.com/cms/s/b9e3a108-0283-11dc-ac32-000b5df10621.html

The inefficient financing that Gordon Stalin Brown has created with PFI was highlighted by Health Direct in our post on 16 Aug 06 in PFI profits exposed by Channel 4 as greater than credit card companies when in Public Service, Private Profit, Liam Halligan revealed how the private funding of state schools and hospitals is draining hundreds of millions of pounds from frontline services, while creating a £4 billion-a-year industry and a new elite of publicly- unaccountable PFI professionals.

The programme also highlighted the financial shenanegans that some PFI companies were using- including moving ownership of assets to Guernsey to circumnavigate the new labour PFI taxes.

Thousands of NHS patients still facing ordeal of mixed sex wards

Hospital patients are suffering the indignity and embarrassment of being cared for on mixed-sex wards - a decade after the labour government pledged to abolish the practice. Almost one in five NHS trusts is continuing to treat patients admitted for routine treatment alongside members of the opposite sex in breach of government rules.

An inquiry by the Department of Health into the use of mixed-sex wards, to be published tomorrow, has found 31 NHS trusts out of 172 has failed to eliminate them.

Despite government pledges in the 1997 and 2001 Labour manifestos to phase out mixed-sex wards, the finding implies that thousands of male and female patients are still being cared for together, compromising their dignity and adding to the stress of their illness. Tony Blair said in a speech in 1996, as Leader of the Opposition, that it could not be "beyond the wit of government and health administrators" to eliminate mixed-sex wards.

The outcome of the inquiry, launched last December, is an embarrassment to Patricia Hewitt, the Health Secretary, who has defended the NHS's record after being assured by NHS managers that 99 per cent of hospital trusts had abolished mixed-sex wards.

She ordered the inquiry after being forced on to the defensive last year by The Independent columnist Janet Street Porter whose account of the death of her sister, Patricia Balsom, from cancer provoked a public outcry.

Ms Balsom wrote a diary, published in The Independent last November, explaining in harrowing detail how her final days were blighted by the indignity of being cared for an a mixed-sex ward and Ms Street Porter described how she had been inundated with messages from people appalled that her sister could be treated so shabbily.

Callers besieged radio and television stations and charities including the Patients Association to give distressing accounts of stays in mixed-sex accommodation. One caller to The Independent, Janet Hollis of Stansted, Essex, described visiting her mother, aged 96, who died in Addenbrookes Hospital, Cambridge.

"Having men wandering round in a state of undress is not what you hope to see. When you are in hospital, you are at your lowest ebb. You need privacy to protect your dignity."

Ms Hewitt ordered the chief executives of the 10 strategic health authorities in England to report back to her after it became plain the experience of patients did not tally with what health managers were telling her.

The report, by the chief nursing officer, Christine Beasley, identifies 31 trusts that need to make improvements to provide single-sex accommodation, which it defines as "separate bays or rooms" and separate lavatory facilities for each sex. It says the NHS "needs to push harder" to eliminate mixed-sex wards for routine patients.

Emergencies are different and some mixing of the sexes is inevitable in accident and emergency departments, medical assessment wards, intensive care and also in day surgery, the report says. These were not included in the assessment of whether trusts were compliant.

The Patients Association said the finding of the inquiry confirmed its worst fears. Vanessa Bourne, chief executive, said: "It is extraordinary because it shows Patricia Hewitt was not being told the truth by the NHS. She should wonder what else she is being hoodwinked over."

From:
http://news.independent.co.uk/uk/health_medical/article2524441.ece

Only last month (April 10, 2007) Health Direct posted that the mixed sex practise was going to continue for the foreseeable future: Mixed wards- another broken labour promise as new PFI continue the scandal

A spell in a hospital in England is likely to mean being placed on a ward with people of the opposite sex. But in Europe and the US this would be unthinkable.

Labour's 1997 manifesto included a commitment to "work towards the elimination of mixed-sex wards", and the 2001 manifesto stated: "Nightingale wards for older people and mixed-sex wards will be abolished."

A separate Healthcare Commission census of mental health establishments in England and Wales published last month found that 55% of inpatients had to share sleeping accommodation or bathrooms with members of the opposite sex.

A survey of 2,462 patients in 128 hospital trusts, carried out in February and March and published last week by the Commission for Patient and Public Involvement in Health, showed that a quarter of patients had been required to share a bay and toilet with the opposite sex.

Marcia Fry, head of operational development at the Healthcare Commission, told a recent conference that the issue of mixed-sex wards was far from sorted. "In our patient survey a fifth of patients say they have been treated on mixed-sex wards. Yet over 95% of trusts say they are meeting standards on privacy."

Labour rewards failure as NHS pays private companies for failed PFI bids

Private companies that fail to win hospital building contracts are set to pocket millions of pounds in "compensation" from the NHS. Hospitals negotiating private finance initiative (PFI) schemes could be forced to pay almost 2 per cent of the total contract costs to short-listed private companies which fail to secure deals, under proposals being discussed by the Department of Health (DoH).

Unions and pressure groups have condemned as "scandalous" proposals which would see private sector giants already making billions from PFI schemes receiving further money for plans which fail to get off the drawing board.

A £374 million hospital in Bristol going out to tender this week will be the test case for the scheme which a DoH senior official said would "compensate" private sector consortiums for rising tendering costs following EU laws which came into force at the end of January.

In the case of Bristol, the "runner-up" company could receive around £6 million, while a third firm may also be paid. North Bristol NHS trust is planning the 947-bed hospital, which is due to open in Southmead by 2013.

DoH deputy finance director Peter Coates said shortlisted companies which did not win deals currently pay out the equivalent of 1 per cent of the costs of a scheme while bidding but receive no compensation.

New EU legislation requiring short-listed bidders to work up more detailed proposals, would push up the bid costs by an additional 2 per cent.

Mr Coates said the DoH's private finance unit was now considering plans under which a "significant proportion" of that extra cost would be paid back by hospitals.

The DoH is understood to be the only Government department drawing up proposals for such payments. Private sector profits from PFI projects, and waste linked to collapsed schemes, have come under increasing attack over the last year.

The Parliamentary public accounts committee criticised a PFI scheme in Norfolk which allowed the private sector to triple its profits, taking out a windfall of £115 million by refinancing the deal, and a scheme in west London axed by the Treasury after £15 million had been spent on lawyers, consultants and architects.

Pressure groups claim the private sector will make at least £23 billion in profits and interest from PFI schemes in the NHS over the next 30 years, a figure denied by the labour Government, although it has yet to produce its own figures.

Under PFI schemes, consortiums of private firms raise the finance to build and maintain sites for around 30 years, during which time the public sector pays back the loan, plus interest. Since Labour came into power, 124 PFI hospital building projects have been approved, 66 of which have been built.

Karen Jennings, Unison head of health, said: "It is incredible that the private sector is able to exert an influence over Government money in such a way as to make money even when they aren't providing a service."

Shadow health secretary Andrew Lansley called on Labour to give hospitals the freedom to borrow as they wished, rather than "imposing the straitjacket PFI has become on the NHS".

Royal College of Nursing general secretary Peter Carter said it was "a bit rich" of the labour Government to be considering compensating failed bids to the tune of millions of pounds, while hanging on to a 0.6 per cent pay increase for nurses which would allow them to receive this year's pay award in full.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/06/nhs06.xml

The busted flush that is PFI is quickly becoming apparent. And the reason why so many PFI are becoming unprofitable? Labour are making the initial tendering process so complicated and long winded that companies like Nuffield Hospitals- please see below, are saying enough is enough and are walking away.

Health Direct posted on 26 Apr 07- Setback for NHS on treatment centres as one in five PFI projects unprofitable when the Nuffield Hospitals, the not-for-profit private hospital operator, pulled out of negotiations to provide operations for NHS patients using mobile operating theatres in the West Midlands. The news comes at the same time that new research shows that almost one in five private finance initiative projects are still not making their owners money, a survey of almost 100 of them has shown.

David Mobbs, Nuffield's chief executive, said the scheme was originally due to go live this month. But "delays have seen our costs and risks rise" to the point where already slim margins on the contract were being rapidly eroded. With no firm contract in sight, he said, the company had decided to draw a line under the deal.

The Norfolk PFI deal that the PAC complained about above Health Direct highlighted on May 03, 06 when Watchdog brands 60 per cent profits on PFI scheme as unacceptable

Some of Britain's biggest investors in the private finance initiative were yesterday condemned as "the unacceptable face of capitalism" by parliament's public spending watchdog. John Laing, Innisfree, 3i, Barclays Infrastructure and Serco were accused of taking gains "unacceptable even for an early PFI deal" from a refinancing of the £158m Norfolk and Norwich Hospital.

The five, who make up the Octagon consortium that built and runs the hospital, made gains of £95m but left the hospital with extra potential liabilities of up to £257m should it need to terminate the contract early, according to the Commons Public Accounts Committee.

The gains came from borrowing more at lower rates of interest over a much longer period than the original deal and allowed Octagon to more than triple its original expected internal rate of return from 19 per cent to 60 per cent.

As a consequence, the Norfolk and Norwich NHS Trust is committed to the contract for 39 years rather than 34 even though the committee noted that it was "impossible to predict that far in advance the nature and extent of services that may be needed." If the contract were terminated early, the hospital might have to pay up to £257m more.

Tony Bliar's NHS legacy- Health Direct says 10 years of wasted opportunities

In the week that Tony Bliar celebrates his 10 years in charge of the NHS, Health Direct along with the political parties looks at what damage he has done to our national treasure. The three main political parties have come out fighting over what 10 years under a Labour government has meant for the NHS.

The labour government robustly defended its management of the NHS with the publication of four Department of Health progress reports on key service areas - emergency care, cancer, coronary heart disease and mental health.

The Conservatives and Liberal Democrats published their own assessments, which called Mr Blair's legacy 'incompetent' and 'wrong'.

The Conservatives said Labour 'dismantled' Tory policies 'only to re-erect them years later, and administer them incompetently'.

Official government waiting figures showing 100 per cent of people were seen within six months were misleading, the Conservatives argued. According to their report, The NHS under Labour: 10 wasted years, statistics from individual hospitals suggested 90 per cent.

The Liberal Democrats' report The State They've Put Us In: 10 years of Blair and Brown, acknowledged there were 'more staff, reduced waiting lists, and better care in some areas'. But it criticised Labour's record on 16 points, including deficits, use of management consultants and threatened closure of community hospitals.

From:
http://www.hsj.co.uk/healthservicejournal/pages/N2/p7/070503

Being fair Health Direct looks at the 4 areas that bliar wants to be remembered for- emergency care, cancer, coronary heart disease and mental health and reposts 4 posts highlighting his abject failure in each category:

Patients die in ambulances with no paramedics on board when NHS Patients are dying directly because low skilled helpers are being sent out to handle life threatening 999 calls, ambulance whistleblowers have warned.

Figures released under the Freedom of Information Act show that in some areas of the country only 35% of ambulance service staff are fully trained paramedics. Ambulance staff say pressure to meet the government’s eight-minute target for responding to life-threatening calls has resulted in “technicians” being sent instead.

Jonathan Fox of the Association of Professional Ambulance Personnel said: “We have seen patients suffer or even die as a result of not having access to a paramedic.

Delays in treatments give patients new cancers when Cancer patients who have had tumours removed are dying because they are waiting so long for for follow-up radiotherapy that their tumours return, a government report has found.

After surgery, patients should receive radiotherapy within 28 days, according to the Royal College of Radiologists. However, in some areas, patients are waiting three times as long. In Kent, for example, the waiting time for breast cancer patients who have had tumours removed by surgery is three months.

Britain- the sick heart of europe Heart disease, the most preventable health threat facing Britain today, is costing the economy £29bn a year. Rising rates of obesity, an ageing population and the soaring prescription bills for heart drugs such as statins mean that the bill is likely to rise in the future.

In the first study of its kind to calculate the financial burden of cardiovascular disease (CVD), analysts found that the UK is spending more healthcare money on the condition than any other European country.

They said that more effort and money should go into preventing CVD through diet and exercise rather than current policies which have focused on improving access to drugs. In Britain, more people die of coronary heart disease and strokes than cancer.

Mentally ill murder 400- a rate of 1 every week as more than 400 people have been killed by mentally ill patients released into the community in the past eight years, a government inquiry revealled.

The Department of Health study, concludes that on average 52 people a year — one a week— are killed by mentally ill patients. It will say that a significant proportion of these deaths could have been avoided, had it not been for health service failures or legal loopholes.

As well as the four areas above, Health Direct notes that deaths from superbugs pro rata are the worst in Europe with more people dying after contracting MRSA, MSSA and C Difficile than are killed in road accidents in the UK.

NHS hospitals may never achieve MRSA superbug targets the NHS is not on track to meet its MRSA target and perhaps never will, a leaked government memo says. In November 2004, then health secretary John Reid pledged MRSA rates would be halved by April 2008.

But the memo, sent to ministers by a Department of Health official, said it would only be cut by a third by then. It also reportedly recommended ways to handle the news in the media. Dr Mark Enright, from Imperial College, said the target was "unrealistic".

National Institute for Curbing Expenditure (NICE) blights Alzheimer sufferers NICE has been renamed by NHS doctors as the National Institute for Curbing Expenditure after it's latest edict to ban the funding of Alzheimers drugs costing only £2.50 a day- which will effect hundreds of thousands of sufferers.

"This blatant cost-cutting will rob people of priceless time" said Neil Hunt of the Alzheimer's Society.

Britons are the fattest of Europe a major Government study has shown the continuing North-South divide when it comes to the health of people in England. The report also shows that the UK has the highest obesity rate in Europe and that Boston in Lincolnshire has the highest number of people with obesity in England.

The "Health Profile" says men in northern counties die on average two years earlier than those in the South - partly because of higher obesity levels and smoking-related disease. Life expectancy for women is also a year shorter.

MPs demand changes to "not fit for purpose" classification of illegal drugs The ABC system of classifying illegal drugs should be replaced with a more scientifically based scale of harm, a committee of MPs says.

In a scathing report entitled Drug Classification: Making a Hash of It?, the Commons science and technology committee says there is no consistency in the way drugs are classified A, B or C and no evidence to support the official view that the classification has a deterrent effect.

The MPs are highly critical of the Advisory Council on the Misuse of Drugs, the labour government's key advisory body on drugs policy, calling its failure to alert the home secretary to the serious flaws in the system "a dereliction of its duty".

Drug specialists say the current system for ranking drugs - class A for the most dangerous to class C for the least dangerous, as set out in the Misuse of Drugs Act - is "not fit for purpose, irrational, arbitrary and lacking in transparency".

Mixed wards- another broken labour promise as new PFI continue the scandal when a spell in a hospital in England is likely to mean being placed on a ward with people of the opposite sex. But in Europe and the US this would be unthinkable. Health Direct reports on a pledge the labour government has yet to keep.

If Florence Nightingale were walking through hospital wards in England today she might well be questioning our understanding of dignity, privacy and choice. In marked contrast with the rest of Western Europe and the US, most patients are still being placed in large wards and many of these are mixed sex. And this practice persists in new hospitals, despite the Labour government's promises to scrap it.

Labour's 1997 manifesto included a commitment to "work towards the elimination of mixed-sex wards", and the 2001 manifesto stated: "Nightingale wards for older people and mixed-sex wards will be abolished."

NPfIT NHS plan is evolving but one-size-fits-all is a fundamentally flawed, says hospital chief when Sir Jonathan Michael, a top NHS executive, who spoke at a healthcare symposium at London's City University last week pointed to a fundamental flaw in the NHS's IT-driven modernisation.

The flaw Michael sees in the National Programme for IT (NPfIT) is its centralised, standardised approach at a time when the health service is decentralising. The chief executive of Guy's and St Thomas' NHS Foundation Trust, Michael wants IT support for the specific ways people work in particular parts of his organisation, such as the accident and emergency department.

Health Direct also asks what happened to the billions of our Pounds that labour has put into teh NHS- PFI firms make £23bn profits from NHS

The private sector will make £23bn in profits and interest over the next 30 years by building NHS hospitals, campaigners have calculated. Under the private finance initiative, a company builds a hospital and then gets "rent" from the NHS for a set term. A report by the Keep Our NHS Public claims the Labour government is carrying out "patchwork privatisation" of the NHS.

The figures, which emerged in a response to a Parliamentary Question tabled by Shadow Health Secretary Andrew Lansley, showed that the NHS would pay a total of £53bn to the private firms involved.

Health Direct also asks what do the hard pressed NHS staff who actually work in the organisations think of bliar's legacy?

NHS Staff wouldn't be treated at their own hospital as fewer than half of NHS staff members would be happy to be a patient at their own hospital, according to an official survey by the health service regula