Free elderly care expansion promises spark row over affordability

Plans to expand free home care for the elderly sparked furious exchanges at Prime Minister's questions yesterday as a new report said "radical changes" were needed to maintain the care system in the face of increasing demands.

The Care Quality Commission's (CQC) annual report on health and social care services in England said a predicted 1.7 million more adults will need care by 2030, putting pressure on already stretched public finances.

The Government's Personal Care at Home Bill, which would provide 400,000 vulnerable elderly people with free care in their homes, was criticised by council leaders earlier and Tory leader David Cameron accused Gordon Brown of using it to promote "cheap dividing lines" between the parties ahead of the general election.

Mr Cameron demanded to know where the funding was coming from and insisted the Prime Minister wanted the "benefits" of the policy before the election, leaving the costs to afterwards.

But as Speaker John Bercow struggled to keep the noise down, Mr Brown hit back, attacking the Opposition leader for breaking cross-party "consensus" on the policy.

Mr Cameron asked the Prime Minister if he could rule in or rule out a compulsory levy on the elderly to pay for care, but Mr Brown sidestepped the question and said developing a "full social care system" would take time and needed consensus.

The CQC report, which was published yesterday, said tailoring services to meet people's individual needs would help save money while allowing people to remain independent.

CQC chairwoman Dame Jo Williams said: "We all know that the context is changing. Trends such as increasing demand and rising expectations will be exacerbated by pressure on finances. That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services.

"This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything. A key part of this will involve helping people maintain their independence and health."

The Government has said around £2.7 billion could be saved every year by helping patients avoid making unnecessary hospital visits.

But the CQC said this would require "a fundamental cultural shift" allowing patients to control their own care.

Stephen Burke, chief executive of the charity Counsel And Care, said "an honest and serious" debate was needed about funding.

He said: "Politicians, nationally and locally, owe it to older people, their families and carers to prioritise care reform and funding. As the University of Birmingham has highlighted this week, there are massive economic and social benefits to be gained from a new, properly funded care system.

"Older people and their families want to know what care they will get and how much they will have to pay.

"One way to fund better care would be a care duty on estates but it must be done fairly through a percentage on all estates above a certain value. For example, 2.5% on estates above £25,000 would raise enough to meet the current shortfall in care funding. And it would help older people and their families who currently face losing their home to pay for care."

Director of the Patients Association Katherine Murphy said she welcomed the report's "clear direction" that the NHS and social care services had to start working more closely.

She said: "It is vital this approach becomes widespread if we are to make the most of increasingly restricted budgets and ensure users get a responsive service."

Simon Lawton-Smith, Head of Policy for the Mental Health Foundation, said: "There has been a lot of talk about person-centred services and joined-up health and social care over the last 20 years, so in a way it's disappointing that the CQC still has to make these arguments.

"The hope now is that the likely need to reduce funding might concentrate minds on reform. An often-overlooked benefit of treating people as individuals and focusing on maintaining their independence and health is that it has the potential to save money."

From:

http://www.independent.co.uk/news/uk/politics/free-elderly-care-expansion-plans-spark-row

Hospitals must cut services to stay afloat, watchdog quango warns

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

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

Patients in England and Wales denied arthritis drug available in Scotland by NICE

Patients in England and Wales are being denied a powerful new arthritis drug on the NHS despite a decision by Scottish health authorities to provide it to sufferers for free by NICE- the drug rationing quango.

The Government’s drugs rationing body, the National Institute for Curbing Expenditure (Nice), has provisionally said that it does not intend to recommend the use of the drug, called Tocilizumab, or Roactemra.

Nice claims that the £9,000 a year drug, for rheumatoid arthritis, has not proved that it is cost effective.

But patients in Scotland are to receive the treatment after it was recommended by the body which regulates drugs on the Scottish NHS, the Scottish Medicines Consortium (SMC).

The move will reopen accusations of medical ‘apartheid’ within Britain.

It follows an outcry after patients in Scotland were given access to expensive cancer drugs denied on the NHS in England and Wales.

Roactemra has been described as a “life changing” drug because it can be taken after other medications have failed, a common problem in the treatment of rheumatoid arthritis.

Patients groups last night said that denying the medication to tens of thousands of patients with the crippling condition in one part of the country was “cruel”.

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS), said: “I have heard patients stories that would make you weep.

“People are virtually suicidal because they have nowhere else to go and yet they know that there are other drugs out there that they could have access to but cannot because of Nice.”

She added that it was “ludicrous” that the drug would be available in Scotland “and yet two miles on over the border you can’t get it.”

The drug - the first new arthritis treatment for a decade - is already used in most other European countries, including France and Germany.

It offers another option for patients for whom other treatments have failed or no longer work and is used in combination with a standard anti-inflammatory drug, called methotrexate.

Currently many rheumatoid arthritis patients receive methotrexate as a first-line treatment to ease their symptoms.

In later years they are offered another class of drugs, called anti-TNFs, together with methotrexate, but even combined the effects of the drugs can wear off.

In combination Roactemra has been found to improve the rates of remission of the illness sixfold in comparison with just methotrexate alone.

The SMC - set up in the aftermath of devolution to make decisions about drugs north of the border - has agreed that the drug can be used for patients suffering from moderate to severe forms of the disease for whom other medications no longer work.

Prof John Isaacs, from Newcastle University, said: “This is fantastic news for people in Scotland who suffer from this disabling, lifelong disease.

“However, it also highlights the disparities in accessing treatments between Scotland and the rest of the UK.

“Because Roactemra works in a completely different way to the existing drugs it is likely to be effective in some patients where the other drugs don’t work or have stopped working, providing an extremely important option for these individuals.”

Neil Betteridge, chief executive of Arthritis Care and vice president of the European League against Rheumatism (EULAR), said: "There are a number of treatments for RA currently available but they simply don't work for everyone.

"There are people who are most severely affected by this debilitating condition – living in intense pain, unable to work, often struggling even to walk – who have been failed by existing treatments, and it's for them that tocilizumab could provide real hope.”

He called on Nice to follow the lead of the SMC and approve the drug for use in England and Wales.

Up to 37,000 patients across Britain would be eligible for the drug. But local health care trusts do not have to pay for drugs which have not been approved by Nice.

In December Nice took the unusual step of challenging Roche, the drug’s manufacturers, to provide more evidence of that the drug was cost effective.

A final Nice appraisal of the drug is expected later this year.

Around 646,000 people in Britain are though to suffer form rheumatoid arthritis, in which their own immune systems start to attack their joints.

Herceptin, a £21,000-a-year drug for breast cancer, was initially turned down by Nice but available in Scotland, which has its own health budget.

A climb-down, ordered by Patricia Hewitt, the then health secretary, allowed the drug in England and Wales.

Patients in Scotland also had access to Tarceva, a lung cancer treatment, which costs about £1,700 a month, two years before the rest of the country.

Nice also provoked outcry by turning down Lucentis, a £20,000-a-year treatment available in Scotland for wet age-related macular degeneration, one of the most common causes of blindness, although it later also reversed that decision.

From:

http://www.telegraph.co.uk/health/healthnews/7020499/Patients-in-England-and-Wales-denied-arthritis-drug-available-in-Scotland.html

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

Two catch Legionnaire’s disease at hospital attacked over hygiene

Two patients have contracted Legionnaire’s disease at a hospital recently condemned for poor hygiene, blood splattered equipment and an unusually high death rate among patients.

Both adults were at Basildon University Hospital in Essex when they began to show signs they were affected by the bacteria legionella.

A spokeswoman for the hospital said the patients, who were staying in different parts of the hospital, have responded to antibiotic treatment but one of them is still in a critical condition.

The bacteria is commonly found in sources of water such as rivers and lakes but can sometimes find their way into artificial water supply systems.

Alan Whittle, Chief Executive at the Basildon and Thurrock NHS Foundation Trust, said the hospital was the probable source of the infections, based on tests of water samples. No more suspected cases have been identified.

“Experts agree that the legionella bacteria is a common risk in large buildings with an extensive plumbing system,” Mr Whittle said.

“Based on the results of laboratory tests of water samples, we accept that the hospital is the probable source of the infection, despite our determined efforts to minimise the known risks of legionella.

In November, inspectors from the Care Quality Commission criticised Basildon and Thurrock University Hospitals NHS Foundation Trust after they found blood stains on floors and curtains, blood splattered on trays used to carry equipment and badly soiled mattresses in the A&E department, with stains soaked through.

Andy Burnham, the Health Secretary, told MPs last week that the more work needs to be done to improve standards at the trust.

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6980928.ece

Decision on new health regulator quango delayed

Monitor, the foundation trust regulator, is to be left for months without a permanent chairman or chief executive after the Department of Health announced that it was to re-advertise the post of chairman.

William Moyes, the executive chairman, is stepping down in January. Interviews with candidates were completed in mid-October, but Andy Burnham, the health secretary, has only now decided to reject the two candidates approved in the interviewing process.

These are understood to be Chris Mellor, the deputy, who is thought to have withdrawn in frustration at the process, and Keith Pearson, chairman of the East of England strategic health authority. Mr Mellor is to act as interim chairman.

The delay comes when the finances of NHS foundation trusts, which Monitor oversees, are coming under pressure from the squeeze on public spending.

At the same time, David Nicholson, the NHS chief executive, has said he wants to accelerate the much delayed process of converting ordinary NHS hospitals to the free standing businesses that foundation trusts represent.

Finding good candidates to chair Monitor and then appoint a chief executive may prove a challenge in the run up to the general election- not least because the Conservatives, if they win, plan to turn Monitor into a broader economic regulator. 

As a result, candidates will be uncertain about quite what job it is they are applying for.

From:

http://www.ft.com/cms/s/0/a33da618-f02b-11de-833d-00144feab49a.html?nclick_check=1

Nanny state libel laws gag doctor over drug risks

General Electric, one of the world’s biggest corporations, is using the London libel courts to gag a senior radiologist after he raised the alarm over the potentially fatal risks of one of its drugs.

The multinational is suing Henrik Thomsen, a Danish academic, after he described his experiences of one of the company’s drugs as a medical “nightmare”. He said some kidney patients at his hospital contracted a potentially deadly condition after being administered the drug Omniscan.

GE Healthcare, a British subsidiary of General Electric, has run up more than £380,000 in legal costs pursuing Thomsen.

“I believe the lawsuit is an attempt to silence me,” he said last week. “It’s dangerous for the patient if we can’t frankly exchange views.”

The company admits its product has been linked to serious side effects in some patients, but said Thomsen accused the company of suppressing information in a presentation at a scientific congress in Oxford in October 2007.

A summary of Thomsen’s presentation for the High Court writ, provided by GE Healthcare, appears to show that it was an even-handed account of his clinical experience.

When asked by The Sunday Times to highlight any part of the presentation that explicitly stated wrongdoing by GE Healthcare, a spokeswoman for the company was unable to do so. The writ states that the defamation may have been “by way of innuendo”.

His case will trigger a fresh row over the draconian use of Britain’s libel laws to stifle scientific debate and silence critics. Thomsen now refuses to discuss the possible risks of the drug in any UK public forum.

Evan Harris, a former hospital doctor and the Liberal Democrat science spokesman, who is leading the parliamentary campaign to reform the libel laws, said: “It is hard to conceive a stronger public interest than scientists and clinicians being able to discuss freely their concerns about drugs or devices used on patients. Libel laws should not be used in this way.”

More than 48m doses of Omniscan have been given worldwide and it is safe for the vast majority of people. It is one of a number of “contrast agents” containing the potentially toxic metal gadolinium, which are used to enhance images for magnetic resonance imaging scans.

Omniscan and other products have been linked with a skin condition in kidney patients, known as nephrogenic systemic fibrosis. Sufferers can be confined to a wheelchair and may even die from related causes.

Regulators in Europe and the US are now taking action over the potential risk from Omniscan and two similar products.

Five people in Britain have died from possible side effects after being administered Omniscan, according to the Medicines and Healthcare Products Regulatory Agency.

Patients have launched legal actions in America involving more than 170 deaths where it is claimed Omniscan and similar drugs may have been a factor. Safety problems with the drugs have been highlighted in the US by the independent investigative news organisation ProPublica.

Paul Flynn, the Labour MP, said, “It is a scandal that a company should take action against someone acting in the interests of patients.”

GE Healthcare said it had launched a libel action against Thomsen as a “last resort”. It is also suing Thomsen for an article in a medical magazine published in Brussels, but he said his name had been put on an article that he had not written.

From:
http://business.timesonline.co.uk/tol/business/law/article6962865.ece

New drugs available on NHS before NICE appraisal

Patients with rare diseases are to get innovative new drugs on the NHS before they have been through NICE under a new pilot scheme.

The new scheme will allow patients with rare diseases to receive important new drugs which have not been appraised by the NHS rationing body, NICE (National Institute for Curbing Expenditure).

It will allow the makers to build up sufficient evidence on the benefits of the drugs which will then be used by Nice to decide if the medicine is cost effective enough for the NHS.

Currently, it is very difficult to provide enough evidence of a drug's benefits if only small numbers of people take it.

A pilot scheme of the so-called Innovation Pass has been launched by ministers.

The Innovation Pass pilot will be funded from a ring-fenced £25m budget in 2010/11.

Health Minister Mike O’Brien said: “I am extremely pleased to launch this consultation that will help patients with the greatest need to benefit from and get access to exciting new innovative drugs.

“The Innovation Pass pilot will help collect the essential data needed to demonstrate that such drugs, which would not otherwise be available to patients, are making a big difference to their lives."

Andrew Dillon, Chief Executive of Nice, said: "We recognise that for a small number of very promising new treatments, the evidence available may not reveal their full potential benefits for patients.

"Where there is a high risk that a Nice appraisal of a new treatment at the point of its first use in the NHS might underestimate its benefits, providing the opportunity to gather more evidence and making the treatment available before undertaking an appraisal is the right thing to do.

“We’re happy to play our part in making this new arrangement work well, and that it works in the interests of patients and the NHS.”

The Innovation Pass pilot consultation will run for 10 weeks, closing on 8th February 2010. Input and comments are welcome from all groups including stakeholders, industry, the NHS and patient groups.

From:

http://www.telegraph.co.uk/New-drugs-available-on-NHS-before-Nice-appraisal.html

Rich list reveals 80 NHS chiefs paid more than Gordon Brown

At least 350 NHS executives in hospitals and primary care trusts were paid more than £150,000 last year, according to new research.

A “Public Sector Rich List”, compiled by the TaxPayers’ Alliance and covering 350 public bodies, shows that 806 executives collected more than £150,000, with eight on packages worth more than £1 million.

The list, which covers Whitehall departments, quangos and nationalised industries, shows that average pay among those identified was £225,000, with 120 chiefs on more than £250,000. More than 250 quango heads were on more than £150,000 in 2008-09. Nearly 80 NHS executives earned more than the Prime Minister.

At a time when all three main parties are proposing a squeeze on public sector pay, salaries at the top have been shooting up, the figures show. While some private companies froze or cut pay, that of the 800 public sector chiefs identified rose by 5.4 per cent, the TaxPayers’ Alliance says.

George Osborne, the Shadow Chancellor, has already pledged to publish the salaries of all public sector staff earning more than £150,000 if the Tories win power. He has also said that anyone earning more than the Prime Minister’s salary of £194,000 would need his approval.

Many of the highest earners in the list include present and former employees of recently nationalised banks. Mark Fisher, former executive director of Royal Bank of Scotland, tops the list with a package of £1.39 million. Sir Fred Goodwin, the bank’s former chief executive, was on £1.3 million.

Vince Cable, the Liberal Democrat Treasury spokesman, said: “With 806 public sector employees taking home more than £180 million a year between them, it is clear that even in these difficult times, profligacy at the top of the public sector lives on.”

The NHS figures show substantial rises for some staff as trusts compete for the best managers. Nearly 60 NHS chiefs earn more than the Prime Minister, with one said to be earning nearly twice as much. A further 290 earn more than £150,000.

Professor Salman Rawaf, who recently retired as director of public health at Wandsworth Primary Care Trust in West London, earned £370,000 last year, comprising a salary of £150,000 and £175,000 of other remuneration.

Sian Thomas, director of NHS Employers, said that many of the individuals’ pay combined salary and clinical excellence awards, all set nationally. “Pay of senior managers in NHS organisations is set by their remuneration committees and boards,” she said. “Therefore these arrangements will vary. Across the public sector the practice of linking remuneration to performance varies.”

Philip Hammond, Shadow Chief Secretary to the Treasury, said: “Nobody objects to paying public sector executives properly if they are delivering excellent results for the taxpayer. But over the last decade, public sector pay has risen while performance has languished. Under a Conservative government, only those who deliver value for the taxpayer can expect high salaries.”

From:

http://www.timesonline.co.uk/tol/news/uk/article6943540.ece

Failing hospital condemns hundreds to death

Hundreds of patients died at an NHS hospital after suffering appalling standards of care, a report has found.

Poor nursing, filthy wards and lack of leadership at Basildon and Thurrock University NHS Hospitals Foundation Trust contributed to 400 avoidable deaths in a year.

Death rates at the Essex trust were a third higher than they should have been, said the Care Quality Commission, the health care watchdog.

Among the worst failings were a lack of basic nursing skills, curtains spattered with blood on wards, mould in vital equipment and patients being left in A&E for up to 10 hours.

Concerns about death rates at the foundation hospital trust were first raised a year ago, but an internal investigation failed to find anything wrong and senior managers dismissed the concerns.

But the new external report found “systematic failings” in the trust’s senior management team, who are still in their jobs. The CQC said its confidence in the management’s ability had been “severely dented”.

The watchdog’s report follows an investigation earlier this year into Mid-Staffordshire NHS Foundation Trust, which found similar problems, with up to 1,200 avoidable deaths.

Ministers assured patients at the time that it was an isolated incident. The failures at Basildon will raise concerns that similar problems are widespread in the NHS.

Among the CQC’s other findings were the avoidable deaths of four patients with learning disabilities; a lack of children’s nurses and doctors in A&E; a failure to feed patients properly or give medication correctly; and a high rate of bedsores among elderly patients. Concerns about standards at Basildon were raised as long ago as 2001, when the Royal College of Nursing described conditions there as “Third World” because of a shortage of beds. Since then the hospital has suffered a series of health scares and accusations of negligence.

The CQC report has been passed on to Monitor, the organisation in charge of foundation hospital trusts.

A statement by Monitor said there had been a “significant breach” by Basildon and a task force of experts would be sent into the trust.

Monitor has the power to replace the trust’s management but it was understood last night that none of the board members had been threatened with dismissal.

Katherine Murphy, the director of the Patients Association said: “Yet again patients are being neglected. Lack of monitoring, lack of help with feeding, lack of dignity, avoidable pressure sores. How many times do the public need to keep hearing about this before the Government is embarrassed enough to do something about it?

“We’re sick and tired of NHS managers and senior staff walking away unscathed when families are left with a life sentence of grief.”

Basildon was one of the country’s first foundation trusts in 2004, meaning it was given more freedom over its spending and did not have to answer to ministers. Mid-Staffordshire was also a foundation trust, raising concerns that the system is failing. It also emerged that Basildon was the first foundation trust to be issued with a warning notice about poor infection control earlier this month over hygiene in its A&E department and contamination of medical equipment.

The trust, which has a budget of £250 million and more than 700 beds at its main hospital in Basildon, has repeatedly pledged to improve but failed to do so, the CQC said.

Andrew Lansley, the shadow health secretary, said: “I am extremely disturbed by this news and the effect that these shocking conditions may have had on patients. It is unforgivable if any lives have been needlessly lost.

“When the appalling standards of care at Stafford Hospital were revealed, we were assured by Labour ministers that it was ‘an isolated case’ — that sort of complacency is simply not good enough.”

Andy Burnham, the Health Secretary, has proposed a change in the law to allow trusts to be stripped of foundation status if they fail.

The CQC had been aware of problems at Basildon for more than a year and was in contact with managers to correct the situation. Repeat inspections found no improvement. From next April, the CQC can take action, including fines, and, if necessary, closures of departments or the whole hospital. Cynthia Bower, the watchdog’s chief executive, said: “We want to act swiftly at Basildon to nip problems in the bud, working closely with other regulators. The trust has taken our concerns seriously but improvements are simply not happening fast enough.

“Our confidence in the management’s ability to deliver on commitments and to turn the situation around has been severely dented.”

From:
http://www.telegraph.co.uk/Failing-hospital-condemns-hundreds-to-death

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

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

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

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

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

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

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

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

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

From:

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

Lives put at risk by out of hours GPs, Care Quality Commission reports says

Patients’ lives are being put at risk by  widespread problems in GP out of hours care, claims a report by the Care Quality Commission, the health care quango regulator.

A review into the NHS was ordered after the inquiry suggested that badly trained doctors were being employed to look after patients at nights and weekends.

Foreign doctors hired by care firms may not be able to speak good English and staff may be overworked as adequate checks are not being carried out, the commission’s report suggests.

The review, suggests that the NHS is only “scratching the surface” when looking at the quality of GP services outside normal hours, used by 9 million patients every year.

The inquiry was prompted by the case of David Gray, 70, a retired engineer who died after he was given 10 times the normal dose of diamorphine by a foreign GP employed by Take Care Now.

Mr Gray, of Cambridge, was treated for kidney pains by Dr Daniel Ubani, who had flown in from Germany and who admitted that he was tired when he made the fatal mistake. He has been convicted of causing Mr Gray’s death by negligence.

The commission’s report finds that the five NHS organisations that have used the Take Care Now company have not been monitoring the quality of the out-of-hours care. It says there are indications that it is a “widespread problem”.

The report also says Take Care Now has not been consistently referring patients who have suffered a suspected stroke to 999 services. Delays in treatment can lead to serious disabilities.

Cynthia Bower, the commission’s chief executive, said: “Primary Care Trusts need to reassure local people that they are commissioning good quality out-of-hours services.

"To do this they have to know what those services are doing. Our visits to the five trusts that commission Take Care Now’s services showed they are only scratching the surface in terms of how they are routinely monitoring the quality of out-of-hours services.

“We believe this may point towards a national problem.”

Take Care Now is employed by care trusts, in Worcestershire, Cambridgeshire, Suffolk, Great Yarmouth & Waveney, and South West Essex, covering more than two million people.

A detailed investigation will now examine the arrangements at the care company and a final report is due next year.

Campaigners say lessons have not been learned despite a series of high profile cases. They say out-of-hours care should be removed from private companies and handed back to GPs.

Katherine Murphy, the director of the Patients Association, asked: “Why do NHS managers need to be told that they should ensure out-of-hours care is safe? It is such a vital service, sometimes dealing with very vulnerable patients.

“There have been other cases where patients died when they received poor care from out-of-hours services. Why didn’t NHS managers act then? How many alarm bells need to ring before action is taken?”

Doctors’ out-of-hours services changed in 2004 with the introduction of a contract which offered them the chance to opt out of the service in return for an average drop in income of £6,000. In most cases, the trusts took over the commissioning of the services, employing private companies or co-operatives.

Prof Steve Field, the chairman of the Royal College of General Practitioners, said more family doctors needed to get involved in commissioning out-of-hours services.

“Out-of-hours provision is patchy,” he said. “Some PCTs are not effectively monitoring the performance of some providers.

“Providers need to ensure their doctors are competent to the level of UK trained graduates, have good English skills, are not over-tired after working long shifts and are orientated to the local conditions. What happened in Cambridgeshire was a tragedy and we need to ensure this never happens again.”

Two years ago Gordon Brown said NHS services at weekends needed to improve after the death of the journalist Penny Campbell, 41.

Miss Campbell died from blood poisoning in 2005 after consulting doctors employed by the out-of-hours provider Camidoc eight times over Easter weekend.

A report concluded there had been a “major systems failure”. Crucially, each doctor was not able to see the previous one’s notes. Miss Campbell’s partner Angus MacKinnon, a journalist from London, said yesterday that responsibility for out-of-hours services should be given back to GPs.

Mike O’Brien, the Health Minister, said: “PCTs have a legal responsibility to provide high quality, out-of-hours care and are required to have in place robust performance management arrangements to ensure their out-of-hours services are delivering against contractual requirements.”

From:

http://www.telegraph.co.uk/Lives-put-at-risk-by-out-of-hours-GPs-Care-Quality-Commission-reports-says

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

NHS medication errors double in two years to 860,000 errors

The number of patient safety incidents involving medicines has more than doubled in two years, official figures showed.

A report from the National Patient Safety Agency (NPSA) found a “significant” rise in the number of errors and near misses reported by NHS staff in England and Wales, including cases of avoidable deaths or serious harm.

More than 86,000 such incidents reported in 2007, compared with 64,678 in 2006 and 36,335 in 2005, the agency said.

In 96 per cent of cases, the incidents caused “no or low harm” to NHS patients, but at least 100 were known to have resulted in serious harm or death.

Martin Fletcher, the agency’s chief executive, said the increase in the figures reflected a willingness by NHS staff to report errors and a more open reporting culture.

The figures are still thought to be a vast underestimate of the incidents involving the prescription or administration of medicines.

Professor David Cousins, a senior pharmacist at the NPSA, said it was well known that only about 10 per cent of incidents were reported in most voluntary systems around the world, including Britain.

This suggests there were as many as 860,000 errors or near misses involving medicines across the NHS in 2007.

Most of the errors (82 per cent) were made in the administration or dispensing of the medicines by nurses or pharmacists, rather than in the prescription of drugs by doctors.

The report listed the top five medication errors in the NHS in England and Wales as people being given wrong doses; medicines being missed or delayed; patients being given the wrong drug; the wrong quantity (such as too much chemotherapy), or mismatching, where patient A’s medicine is given to patient B.

Examples include an anticoagulant drug given in error to a patient with a similar name, a strong sedative given to a patient instead of insulin, and heart medicine given instead of an anti-inflammatory. One patient was reported to have received 100mg of morphine instead of 10mg.

The report comes after The Times revealed new guidance from medical regulators to ensure that undergraduate medical students receive more “hands-on” experience of working in hospitals and clinics before they graduate.

The NPSA’s figures are from reports filed by NHS staff in hospital trusts, mental health trusts and in primary care. Nearly three quarters (74 per cent) of the incidents reported in 2007 were in relation to hospital care, but the agency noted that primary care services, such as GPs and community nurses, needed to improve their reporting rates.

The NPSA is in charge of monitoring and helping to reduce patient safety incidents across the NHS. It releases rapid response alerts where particular problems are noted, such as the risk of overdoses with particular medicines.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6820090.ece

Child vetting database will cost £200 million and create 1,450 jobs in Labour marginal

The total cost of the child vetting scheme is expected to soar close to £200 million – and will lead to the creation of around 1,450 jobs in a key Labour marginal constituency.

Public bodies such as the NHS and the Prison Service will be forced to spend millions of pounds registering their employees on the scheme at a time when their budgets have already been squeezed.

Almost all of the NHS’s 1.3 million employees will have to join at a cost of around £83m. The Local Government Association has already warned about the increased cost to councils and their staff.

Labour Ministers will have to sanction a huge spending increase as the Criminal Records Bureau employs 582 staff who dealt with 3.9 million cases last year, or 6,700 cases per employee.

By contrast, the Independent Safeguarding Authority (ISA) has 250 staff whose case load will soar to 45,200 cases per employee as they reach the target of monitoring one in four adults. If, as expected, the ISA processed the work at the same rate as the Criminal Records Bureau it will require 1,686 employees, up 1,430. The staff bill will rise to £43 million.

It will provide a timely jobs boost for Darlington, where the ISA is based, which is a key election battle ground. Alan Milburn, the former Labour Cabinet minister and local MP is standing down at the election in a seat which until 1992 was Conservative held.

James Dawkins, Research Associate at the TaxPayers’ Alliance, said: “The Criminal Records Bureau already struggles, at huge cost, to do its job and this task is more complex and larger. While taxpayers and the people forced to undergo the ISA’s checks will lose out, the only people to benefit will be the army of bureaucrats needed to attempt the impossible. The Government have already created far too many quango jobs, and the last thing taxpayers need is yet more officials on the public payroll.”

Tom Brake, the Lib Dem home affairs spokesman, said: “The new database is not only a disproportionate response to the problem it is trying to solve, it is also a very expensive proposal. It is not clear that asking public bodies to pay millions to prove their staff are not sex offenders will significantly enhance the safety of children. Asking people to pay £64 to prove their innocence may put a lot of them off working with children.”

Parents who do not register for driving their children's friends to a sports event or Cub or Scout meeting face fines of up £5,000.

From:
http://www.telegraph.co.uk/Vetting-database-will-cost-200-million-and-create-1450-jobs-in-Labour-marginal

Quango ties NHS trusts with more red tape

National Health Service trusts could face financial penalties, sacking of executives or even temporary stoppage of some services if they do not meet standards of care to be imposed from April next year.

The stern warning comes from the Care Quality Commission, the main health regulator, less than a year before a system is introduced that will require all the trusts to register with it.

Registration will give the commission more leverage, since it will be able to dictate, for example, that trusts have to improve in specific areas. Cynthia Bower, commission chief executive, said:"We will not hesitate to place conditions upon trusts' registration, as part of our new statutory powers."

A CQC spokeswoman elaborated by saying that if trusts failed to meet the new registration requirements "we could issue an on-the-spot fine, take a trust to court and fine them an even greater amount, look at imposing new management, look at closing particular services. We could say, 'you could no longer carry out heart surgery for this period'".

The commission's warning comes as it publishes a report on whether trusts are meeting existing standards, expected to form the basis of the yet-to-befinalised registration requirements. The study, based on self-reporting, found that in the year to March 2009 about half the 392 trusts were not meeting at least one of the 44 minimum standards it demanded.

The next step is for the commission to test their claims. Last year it dis-agreed with trusts in 28 per cent of cases it inspected, judging that the trusts' own estimates that they were reaching a particular level were over-optimistic.

Fewer trusts than the year before thought they were meeting minimum levels on "learning from safety incidents". More than previously thought they met decontamination standards, although 11 per cent thought they still did not.

The proportion of flagship foundation trusts declaring compliance with all 44 criteria dropped by 6 percentage points to 66 per cent, although it remained much higher than for other trusts.

From:
http://www.ft.com/cms/s/0/50720594-5b9f-11de-be3f-00144feabdc0.html?nclick_check=1

Travel, food, chauffeurs - quangos are at it too

Quangocrats are claiming up to £35,000 a year each in expenses for hotels, lavish meals, sat navs and, in one case, £18.50 for dishwasher tablets.

One quango boss made 12 trips abroad during two years in which she claimed £70,000 in expenses. Another claimed nearly £800 for a 42in flatscreen television which he said he would watch only in “times of emergency”. Another spent £16,500 on chauffeur-driven cars.

Details of the claims, released under freedom of information laws, reveal how quangocrats earning six-figure salaries routinely claim tens of thousands of pounds extra in expenses, paid for by taxpayers.

Matthew Elliott, director of the TaxPayers’ Alliance, said: “Quango expenses are potentially even worse than MPs’. Quangocrats are unelected and hidden from public view. They should have all their expenses published on the internet.”

Some of the most controversial claims were made by Paul Evans, former chief executive of the Royal Armouries in Leeds. Evans, who was paid £100,000 a year, claimed nearly £24,000 in 2007-8 including £180 in Farlows, a shooting accessories shop, and £62 in Graingers, a supplier of fishing equipment. He also spent £69 of taxpayers’ money in Davidoff, a London tobacconist renowned for its cigars.

He claimed a further £3,000 on expenses at top bars and restaurants in Leeds and London, £1,170 on an Apple laptop and accessories and £259 on an Apple iPhone.

His claims caught the eye of accountants at the Royal Armouries and he was suspended on full pay in April 2008 over alleged “financial irregularities”. He resigned in September after agreeing to return his computer equipment and to reimburse the Royal Armouries for £289.70 of “personal” expenses claims. An internal investigation later cleared him of any impropriety. Evans last week declined to comment.

Although Evans’s case is unusual, other quango chiefs are making large claims regarded as legitimate.

Dr William Moyes, chief executive of Monitor, a quango that regulates National Health Service trusts, claimed more than £35,000 in expenses in 2007-8 and 2008-9.

His biggest charge was for chauffeur-driven cars, which cost £16,500. Moyes, whose basic salary is £215,000 a year, also spent £7,500 on meals at some of London’s finest restaurants with public servants and consultants.

His favourite venue was the Cinnamon Club, an Indian restaurant in Westminster where he dined on 24 occasions, spending a total of £2,600. A spokeswoman said the meals were important for maintaining relationships with “key stakeholders”.

From:
http://www.timesonline.co.uk/tol/news/politics/article6396004.ece

Public services waste £1.5m on 'non jobs'

Health boards and other quangos have been accused of wasting more than £1m of public money every year on “non jobs”, including a wellbeing unit manager, events planner and buddy project worker.

Despite concern over a shortage of police officers on the beat and frontline medical staff, an investigation by The Sunday Times has revealed that £1.5m a year is being lavished on unnecessary jobs.

The roles, which have little to do with the delivery of core services, include a £40,000 a year wellbeing unit manager and £22,000 a year events planner employed by Lothian and Borders police. The force also pays £17,000 a year for a chauffeur for David Strang, its chief constable.

NHS Fife has a buddy project worker “to support volunteers who help people stop smoking” (between £20,000 and £26,000 a year), a graphic designer (£25,000-£33,000) and a librarian, to help ensure “professional staff keep up to date” (£20,000-£26,000). In the past, the health board has also employed an artist-in-residence.

Most health boards employ chaplains or “spiritual care providers” on salaries of about £30,000 a year. NHS Dumfries and Galloway also has an organist. The National Secular Society has called for an end to NHS funding for chaplains, and says the cost should be borne by churches.

Matthew Elliott, the chief executive of the Taxpayers’ Alliance, said the jobs were evidence of unacceptable public sector profligacy at a time when private firms were shedding jobs or imposing pay cuts.

“We’re in the grip of a recession, and it’s high time those in the public sector started cutting back on these ridiculous non-jobs that would be an extravagance even in good economic times,” he said.

“The public sector must wake up and realise taxpayers want value-for- money, frontline public services, not unnecessary frills that are of no tangible benefit to most ordinary people. Any right-minded person can see this money would be far better spent on more nurses, doctors and bobbies on the beat.”

Margaret Watt of the Scotland Patients Association added: “This is quite obscene when we are short of GPs, consultants, nurses and midwives.

“The health boards seem to have their responsibilities all back to front — these jobs should not be a priority. It is more important that we have the staff to take care of our patients than anything else.

“They should be dealing with the core business at the moment where we have insufficient staff in hospitals across the country.”

NHS Fife said it did not consider any of the jobs “nonessential”.

“The modern NHS requires a range of staff to work together to enable it to develop a service for the 21st century,” said a spokeswoman.

From:
http://www.timesonline.co.uk/tol/news/uk/scotland/article6301788.ece

Flaws exposed in NHS winter planning

The NHS must improve the way it deals with the increased demand for hospital care in winter months, director general of NHS finance, performance and operations David Flory has said.

Mr Flory said in the quarterly update on performance that he was "disappointed" that the NHS as a whole had missed its target to see 98 per cent of patients in accident and emergency departments within four hours.

He said: "We have had one of the coldest winters for over a decade, placing greater demand on services. Ambulance services experience elevated demand in winter and it is critical that the NHS maintains high levels of service and ensure the timely handover of patient care from ambulance to hospital."

Mr Flory told HSJ that he expected most hospitals to recover their position over the remaining months of the year and so, overall, the NHS would still meet the 98 per cent target for the full year. However, he underlined the importance of better winter planning.

The forecast surplus remains £1.74bn, with only seven organisations forecasting real terms deficits - down from 11 in September.

From:
http://www.hsj.co.uk/news/2009/03/flaws_exposed_in_nhs_winter_planning

New Care Quality Commission watchdog quango pleads for patience

The new watchdog for health and social care called on politicians to put an end to a decade of regulatory turmoil in hospitals and social work.

The Care Quality Commission, which opened last week, is the third new quality regulator for health, and the fourth for social care, in only nine years.

"To lose one regulator is unfortunate, to lose two is downright careless - and to lose three would be pretty criminal in my view," said Lady Young, its chairman, in an interview with the Financial Times.

The new CQC opens its doors only weeks after Mid-Staffordshire hospital was granted flagship foundation trust status by one regulator, during an inquiry by another that revealed "appalling" standards of emergency care. The Baby P case last year, in which a young London child died after dreadful neglect, raised serious concerns about the regulation of social care.

Lady Young, a former National Health Service manager who came to the CQC from the Environment Agency, which regulates everything from car scrap dealers to nuclear power stations, said the new, combined watchdog needed time to prove itself.

"Good regulators develop a track record," she said. "We need a bit of time, 10 good years at least - preferably longer. Not for me but for the organisation", she said.

"Look at the Audit Commission . . . They have tackled a whole range of new jobs, they have been flexible, they have been adaptive and they have done a good job generally. They know how to do it. They develop a track record."

The new commission will be different, she said, not least because it will embrace both health and social care, along with the supervision of detained mental patients, in one organisation. Given the risks that more members of an ageing population will fall through the cracks between health and social care services, that had to be right, she said.

But, after the regulatory failure at Mid-Staffordshire NHS Foundation Trust, there will be other changes too, she said.

Mid-Staffordshire was granted foundation trust status by one regulator, Monitor, in the middle of the inquiry by another, the Healthcare Commission, one of CQC's predecessors, that found "appalling" standards of emergency care from which, the commission said, patients died.

As well as the two bodies failing to communicate, the hospital's services were rated "fair" - barely adequate but not dangerous - for two years during which, concluded the commission, patients had suffered and died.

A fresh data analysis technique to examine high death rates that will continue to be developed by CQC, eventually picked up the problem.

But as in the case of Baby P, where Ofsted rated Haringey's social services as "good" at the time the child died, "that does raise questions about the balance between clever use of data and inspection," Lady Young said.

"We need to get the balance right between data and inspection - and we will be out there sniffing the breeze, being on the ground and eyeballing staff and patients."

A good regulator is there "to nip problems in the bud," she said. A host of fresh data about the quality of care is on its way, which the commission will share, and which ought to make that easier.

But Lady Young warned against the current trend - "which is: when things go wrong, blame the regulator".

"We do need to highlight where responsibility lies for the provision of quality care," she said. First with doctors, nurses and care workers on the ground. Then with boards of organisations. And then with those who commission care and performance - manage the systems. The commission will provide independent oversight, information that will help address quality, and assurance, she said.

But "it will be a failure of the service if the management [does] not get to quality issues before we do".

From:
http://www.ft.com/cms/s/0/8f51dc0a-1e53-11de-830b-00144feabdc0.html?nclick_check=1

NHS managers’ skill levels criticised by MPs

The National Health Service lacks the leadership and commissioning skills to implement the labour government’s plans for high quality care in the NHS, a cross party committee of MPs warned.

Despite a programme called “world-class commissioning” aimed at boosting the ability of primary care trusts to buy care for their patients, “there are few signs yet” that wide variations in how well PCTs commission care have been addressed. “We doubt that most are currently capable of doing this task successfully,” the Commons health committee said.

Too many managers lacked the analytic and planning skills needed. And the MPs added that it was “striking and depressing” that commissioning was still not given sufficient status within the service, despite its being nearly 20 years since a ­purchaser/provider split was first introduced.

Furthermore, the link between primary care trusts buying care, and doctors doing the same through practice-based commissioning, “remains opaque”, the committee said, with little progress on the latter.

Part of the drive to im­prove quality involves giving a much higher profile to reporting of the outcomes of the care patients receive. But the committee says there is a lack of information about how extensive the financial incentives associated with that will be, how much it will cost to implement, when it will be fully implemented and whether it will give value for money.

The sceptical assessment of the government’s plans came as a leading academic suggested very few extra new cancer drugs were likely to be approved for use by the NHS, despite a change in policy on “end of life” treatments by Nice, the National Institute for Clinical Excellence.

Nice is to give more weight to such treatments in future assessments, and Professor Michael Rawlins, its chairman, has suggested two to three extra drugs may be approved a year as a result.

However, James Raftery, professor of health technology assessment at Southampton university, says the new arrangements “may do little to improve availability of expensive cancer treatments”.

The price of the 14 cancer drugs Nice has recommended against since 1999, either provisionally or finally, is way above the threshold of £30,000 ($44,325) per quality adjusted life year (Qaly) normally needed to gain Nice approval, Prof Raftery says, writing in the British Medical Journal.

For example, for four kidney cancer drugs that Nice is due to reappraise shortly, the cost per Qaly ranged from £72,000 to £171,000 per Qaly.

Even with a big rise in the threshold, his assessment is that “few of the rejected drugs would qualify under the new criteria”. One or two may, Prof Raftery says, where there is lack of any alternative treatment. But much will depend on how Nice interprets that stipulation.

From:
http://www.ft.com/cms/s/0/998e0454-e100-11dd-b0e8-000077b07658.html?nclick_check=1

More Department of Health paperpushers earning top salaries

The number of Department of Health staff earning more than £100,000 a year has risen from eight to 50 since 1997.

Annual figures show the number earning more than £100,000 peaked in 2005 at 71. During 2007 and 2008 the figure was 50.

The information was released in response to a parliamentary question from Liberal Democrat health spokesman Norman Lamb.

Mr Lamb said: "For too long the labour government's priority has been increasing the amount of bureaucracy in the NHS.

"The explosion in the number of managers, not just in the Department of Health but across the NHS in general, is crazy when frontline services are under huge pressure.

"People will be shocked that so many civil servants are earning over £100,000 when nurses are struggling to make ends meet, especially after what looks like turning into a real terms pay cut."

Strategic

A DH spokesman said: "Overall staff numbers in the Department of Health have reduced greatly over the last few years and because we're now more strategic we've a higher proportion of senior posts.

From:
hsj.co.uk/news/2009/01/more_department_of_health_staff_earning_top_salaries.html

Labour government spending on quangos soars

Labour ministers have authorised a huge increase in spending on quangos despite having promised to reduce their cost.

New figures released by the Cabinet Office show that the overall cost of the so-called “arm’s length bodies” fell only because of the transferring of one of the biggest ones into a Whitehall department.

The winding down of the Strategic Rail Authority, whose work is now carried out by the Department for Transport, resulted in a saving of £2.5 billion. Spending on the remaining quangos rose by £1.7 billion, leaving a net saving of £830m.

Gordon Brown promised a “bonfire of the quangos” before Labour came to power, claiming that they were “often government in secret, free from full public scrutiny”. But 13 out of 16 Whitehall departments failed to reduce their spending on quangos and seven departments created new ones, with more in the pipeline this year.

Francis Maude, shadow minister for the Cabinet Office, said: “People are crying out for more accountability and transparency in government. These figures confirm that Labour’s unelected, unaccountable quango state is not only alive and well but increasing at an alarming rate.

“Cutting quangos is yet another of Gordon Brown’s broken promises.”

Quango chairmen and consultants, many closely connected to Labour, often earn huge sums for part-time roles.

The biggest rise in staff was in quangos linked to the Home Office, which expanded by 1,671 employees last year, followed by Department of Health quangos, which added almost 600 workers.

From:
http://www.timesonline.co.uk/tol/news/politics/article3690961.ece

Health Direct asks how many former Ministers, MP's, former MP's and people with links to Labour work in these quangos? No wonder people are sick and tired of unelected people who mismanage a portfolio waste tax payers money and are not accountable.

This is just another of Labours "third way" policies that is a sham.

Dr Gerard Bulger has a really comprehensive list of health quangos at:
http://www.careprovider.com/nhsorgs.htm

It is shocking in it's size and cost. It lists the organisations, ALBs, Quangos, directly sponsored organisations and free floating departmental organisations that now dominate the NHS.

They come and go and morph. The NHS Modernisation Agency was so 2004; it died having spawned other organisations. We now have NHS Improvement Agency.

An investigative team, such as Insight should look at the cost, who knows who, and their associations with consultancy companies.

All these organisations set about producing acres on management speak verbiage to such little effect. When it is obvious they are achieving nothing everyone moves onto the next political fad organisation.