Hospitals use ploys to beat 4 hour deadline on A&E waiting times targets

More than five per cent of emergency patients are being admitted to wards to help hospitals hit waiting time targets.

Patients are being admitted to hospital to avoid breaching a labour Government target on waiting times, NHS figures suggest.

More than one in twenty patients attending hospital in an emergency are being admitted to wards just minutes before the maximum four hour wait.

Health unions have complained that staff are being “pressured” into manipulating data and admitting patients unnecessarily to meet the target, which aims to treat or discharge all accident and emergency (A&E) patients within four hours.

Figures from the NHS Information Centre show that almost all patients in England are seen within the four hour deadline, but there is a peak in the number of people admitted to a ward with just ten minutes to spare. Two-thirds of those treated as the deadline approaches are admitted to hospital, compared to just over one in five patients coming from A&E overall.

It is the first time such analysis has been done and the statistics are categorised as “experimental”.

The Royal College of Nursing warned that the four hour target meant some nurses were “pushed into practices” that were risky for patients.

It said that there were “negative consequences” for patient care, especially those needing treatment in A&E wards, but not necessarily requiring an overnight stay.

A survey of its members found that nine out of ten accident and emergency nurses claimed they had been unduly pressured to meet the four hour target.

Mark Porter, chairman of the British Medical Association’s consultants’ committee, said that the admission rates were worrying.

“This suggests that when patients have been waiting close to four hours, there is a rush to discharge or admit them so that the hospital meets the four-hour target,” he said.

“Patients must always be treated on the basis of their clinical need, not simply because they have been waiting close to four hours.”

Katherine Murphy, director of the Patients Association, agreed that the right patients are not always made a priority under the target.

“This results in doctors making rushed decisions at three hours and 50 minutes, with patients having to be admitted inappropriately at huge cost to the NHS,” she said. “We have heard instances of ambulance drivers being forced to wait outside A&E with seriously ill patients, until staff have cleared a backlog of people who need to be seen within the four hour target.

“It is unfair to make NHS staff feel like they have to put meeting this target ahead of what’s in the best interests of patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article6921466.ece

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

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

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

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

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

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

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

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

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

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

From:

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

Cruel and neglectful care of one million NHS patients exposed

One million NHS patients have been the victims of appalling care in hospitals across Britain, according to a major report released last week.

In the last six years, the Patients Association claims hundreds of thousands have suffered from poor standards of nursing, often with 'neglectful, demeaning, painful and sometimes downright cruel' treatment.

The charity has disclosed a horrifying catalogue of elderly people left in pain, in soiled bed clothes, denied adequate food and drink, and suffering from repeatedly cancelled operations, missed diagnoses and dismissive staff.

The Patients Association said the dossier proves that while the scale of the scandal at Mid-Staffordshire NHS Foundation Trust - where up to 1,200 people died through failings in urgent care - was a one off, there are repeated examples they have uncovered of the same appalling standards throughout the NHS.

While the criticisms cover all aspects of hospital care, the treatment and attitude of nurses stands out as a repeated theme across almost all of the cases.

They have called on Government and the Care Quality Commission to conduct an urgent review of standards of basic hospital care and to enforce stricter supervision and regulation.

Claire Rayner, President of the Patients Association and a former nurse, said:“For far too long now, the Patients Association has been receiving calls on our helpline from people wanting to talk about the dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses.

“I am sickened by what has happened to some part of my profession of which I was so proud. These bad, cruel nurses may be - probably are - a tiny proportion of the nursing work force, but even if they are only one or two percent of the whole they should be identified and struck off the Register.”

The charity has published a selection of personal accounts from hundreds of relatives of patients, most of whom died, following their care in NHS hospitals.

They cite patient surveys which show the vast majority of patients highly rate their NHS care - but, with some ten million treated a year, even a small percentage means hundreds of thousands have suffered.

Ms Rayner said it was by "sad coincidence" that she trained as a nurse with one of the patients who had "suffered so much".

She went on: "I know that she, like me, was horrified by the appalling care she had before she died. We both came from a generation of nurses who were trained at the bedside and in whom the core values of nursing were deeply inculcated."

Katherine Murphy, Director of the Patients Association, said “Whilst Mid Staffordshire may have been an anomaly in terms of scale the PA knew the kinds of appalling treatment given there could be found across the NHS. This report removes any doubt and makes this clear to all. Two of the accounts come from Stafford, and they sadly fail to stand out from the others.

“These accounts tell the story of the two percent of patients that consistently rate their care as poor (in NHS patient surveys). If this was extrapolated to the whole of the NHS from 2002 to 2008 it would equate to over one million patients. Very often these are the most vulnerable elderly and terminally ill patients. It’s a sad indictment of the care they receive.”

The Patients Association said one hospital had threatened it with legal action if it chose to publish the material.

Pamela Goddard, a piano teacher from Bletchingley, in Surrey, was 82 and suffering with cancer but was left in her own excrement and her condition deteriorated due to her bed sores.

Florence Weston, from Sedgley in the West Midlands, died aged 85 and had to remain without food or water for several days as her hip operation was repeated cancelled.

The charity released the dossier to highlight the poor care which a minority of patients in the NHS are subjected to.

Ms Murphy said the numbers rating care as poor came despite investment in the NHS doubling and the number of frontline nurses increasing by more than a quarter since 1996.

The personal stories were revealed to prevent their cases being ignored as only representing a small portion of patients.

The report said: "These are patients, not numbers. These are people, not statistics."

Dr Peter Carter, Chief Executive of the Royal College of Nursing, said he was concerned that public confidence in the NHS could be undermined by the examples cited and it would affect morale in hardworking staff.

He said: “The level of care described by these families is completely unacceptable, and we will not condone nurses who behave in ways that are contrary to the principles and ethics of the profession.

"However we believe that the vast majority of nurses are decent, highly skilled individuals. This report is based on the two per cent of patients who feel that their care was unacceptable. Two per cent is too many but we are concerned that this might undermine the public’s confidence in the world-class care they can expect to receive from the NHS."

Barbara Young, Chairman of the Care Quality Commission, the super-regulator, said: “It is absolutely right to highlight that standards of hospital care can vary from very good to poor.

“Many people are happy with the care they receive, but we also know that there are problems. I am in no doubt that many hospitals need to raise their game in this area.

“Where NHS trusts fail to meet the mark, we have tough new enforcement powers, ranging from warnings and fines to closure in extreme cases. We will not hesitate to use these powers when necessary to bring improvement.

"We will be asking NHS trusts and primary care trusts how they are ensuring that the needs of patients and their safety and dignity are kept at the heart of care.”

From:
http://www.telegraph.co.uk/Cruel-and-neglectful-care-of-one-million-NHS-patients-exposed

Overworked healthcare professionals blamed for medical errors

Patient safety is being put at risk by overworked medical staff who made 4,000 avoidable errors last year, it has been disclosed.

More than half of the blunders - 2,221 - were considered serious, resulting in deaths, injuries and patients being left in severe pain, according to new figures.

They included surgeons operating on the wrong person or part of the body, doctors making wrong diagnoses and prescribing dangerous doses of medication.

The newspaper submitted Freedom of Information requests to all 172 NHS trusts to obtain details of Serious Untoward Incidents (SUIs).

Of the 97 that responded, most refused to give details and just listed fatal errors as "unexplained deaths", it said.

The Patients' Association described all the mistakes as "avoidable".

In one case in the North West a patient under the care of the Aintree University Hospitals NHS Foundation Trust underwent the wrong urological procedure in May.

In July, a chest drain that had been wrongly inserted punctured a patient's heart and in another case in October a tube was dislodged from the windpipe of a patient who later had a heart attack and died.

In the South East, where a total of 66 SUIs were reported, the wrong unit of blood was administered in January and a mother died of meningitis after giving birth in August.

Katherine Murphy, director of the Patients' Association, told the newspaper: "These are all avoidable accidents. Patient safety must be paramount in every hospital. Saving money must not be put before patients' lives."

Dr Peter Carter, general secretary of the Royal College of Nursing, said staff shortages led to more errors.

"It is always deeply concerning to learn of any mistakes which have endangered the life of a patient," he said. "But the fewer staff there are the more mistakes are made."

According to the newspaper, the NHS paid out £264 million in compensation claims in 2008, plus £134 million costs.

The Department of Health said it was working with regulators to monitor improvements in patient safety.

"Unfortunately, as in any health service, unforeseen incidents occasionally happen.

"The independent National Patient Safety Agency, responsible for monitoring and reporting incidents, and the new independent regulator, the Care Quality Commission, with increased inspection and intervention powers, will help ensure we sustain improvements in safety and quality of care."

The revelations come after the head of the former Healthcare Commission said in December that the NHS was only just out of the "starting blocks" when it came to ensuring patient care was as safe as it could be.

Sir Ian Kennedy said reporting mistakes and learning from them needed to be "internalised in the DNA" of NHS trust boards.

He added that there was a "black hole" in the information available about mistakes made in GP surgeries.

His remarks were made as the commission published a report calling for more coherent systems for reporting mistakes, saying the priority given to safe care varied among NHS trusts.

But the report said estimates suggested that one in 10 patients admitted to hospital would suffer harm as a result of an error.

In primary care, the report referred to a study carried out in 2001 which found that medical errors occur between five and 80 times per 100,000 consultations, "mainly related to the processes involved in diagnosis and treatment".

The Healthcare Commission ceased to exist at the beginning of this month when a new regulator, the Care Quality Commission, took over its role and also adopted the work of the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission.

From:
http://www.telegraph.co.uk/health/healthnews/5147744/Overwork-blamed-for-medical-errors.html

Labour U turn on data sharing your medical records

Labour's Justice secretary Jack Straw has dropped controversial proposals that medical bodies had warned could see patients' confidential medical records being passed to anyone who asks.

It had been feared that the proposals, in clause 152 of the Coroners and Justice Bill, would allow not only the labour government to access medical records but also share them with other any other global organisation.

Concerns

But a Ministry of Justice spokeswoman said following concerns that the clause as defined was very wide and the powers it provided could be misused, Mr Straw had asked cabinet colleagues to withdraw the clause and launch a further consultation.

The U-turn came after eight organisations - the British Medical Association, the Royal College of GPs, the Royal College of Surgeons, the Royal College of Nursing, the Faculty of Public Health, the Academy of Medical Royal Colleges, the Medical Defence Union, and the Medical Protection Society - wrote to Mr Straw protesting about the proposals.

'Disastrous impact'

The organisations had warned that the clause would "undermine the presumption of confidentiality, corrode trust in the doctor-patient relationship and could have a disastrous impact on both the health of individuals and the public".

On Monday, January 26, 2009 Health Direct warned in: Your health records- open to all in new labour data disaster

NO2ID and Health Direct has been warning since 2006/7 about the stated intentions of the labour government "to overcome current barriers to information sharing within the public sector".

This current labour wheeze is only the latest example of the extent to which labour are trying to turn the UK into a big brother stalinist state.

There is absolutely no guarantee that they will not try another scheme in the next thirteen months. If you were stupid enough to allow your medical records to be added to the IT white elephant you are still not safe.

Unemployment will put pressure on health services, RCN warns

The Royal College of Nursing has called on the labour government to work to prevent health services being "swamped" because of rising unemployment.

Chief executive and general secretary Peter Carter said: "We know that periods of economic downturn often feature rises in health problems, particularly among those affected by long term unemployment.

"In many cases losing your job can be the tipping point which leads to isolation, family breakdown and mental health problems, and things can get much worse when people are out of work for more than six months.

"This, combined with the impact on general health from hardship and the struggle to make ends meet, can combine to put real pressure on the NHS."

Employment support

The college's call comes as prime minister Gordon ditherer Brown meets business leaders and trade unions to discuss measures to support employment.

Mr Carter said: "We would now urge the government to make sure that these measures can make an impact quickly, so that health services are not stretched further by the avoidable effects of unemployment on individuals and families.

"This is particularly important in areas which are already blighted by health inequalities, where any further job losses would be most keenly felt."

From:
unemployment_will_put_pressure_on_health_services_rcn_warns

NHS chief warns on productivity

The National Health Service will have “to deliver efficiencies and productivity like we have never done before,” David Flory, the health department’s director-general of finance and performance, has warned.

His stricture to NHS finance chiefs came as hospitals were told that they will only receive a basic 1.7 per cent increase in the price the NHS pays per treatment next year and no more than 1.2 per cent the year after – in spite of an average 5.5 per cent a year increase in the cash that primary care trusts are to be given to buy the care.

Hospitals and other services covered by the price list will be able to secure an additional 0.5 per cent by hitting quality standards. But the below-inflation increase in the tariff, will put huge pressure on NHS Trusts to improve productivity before much reduced spending growth after 2010.

Failure to do so would put NHS waiting times and other services under pressure.

Alan Johnson, health secretary, indicated on Monday that the NHS hoped to carry over about £1bn ($1.5bn) of its present £2bn surplus into those tough spending years. Just £800m of the existing surplus would be drawn down over the next two years, he told MPs in a statement.

Carrying over £1bn on what will by then be a £110bn budget would help “deal with the days when it rains hard,” Mr Flory said last week, as he declared that the NHS had to “get fit for the tough years” to come.

On the labour government’s published spending plans, most analysts believe the NHS will be lucky to see 1 per cent a year real growth after 2010 – a fraction of the 7 per cent increases of recent years and the 3 per cent current level.

Mr Flory said before then the NHS will have to deliver “a decent part” of the £5bn of extra efficiency savings that the Treasury is seeking from across government in 2010.

The Royal College of Nursing called for all the surplus to be used as it represented money that “could have been spent on frontline care”.

However, Mr Johnson, with an eye on the longer term, described drawing down only £800m of it as “prudent”.

He added that “substantial savings” needed to be made by driving up the quality of care so that errors and waste were reduced.

The warning that a marked increase in productivity was needed came as the health department conceded that while waiting times have been tumbling and activity rising, NHS productivity has still fallen sharply on the most recent figures.

One important reason for that is generous pay deals, which have consumed almost 30 per cent of the increase in resources.

According to the Office for National Statistics, NHS productivity fell 2.5 per cent a year between 2001 and 2005, though the health department argues that the measure does not adequately pick up quality improvements.

A memorandum to the Commons health committee also showed huge capital underspends in recent years, not least on Connecting for Health, the troubled NHS information technology programme.

With suppliers only paid when systems work, the IT programme underspent by £1.2bn between 2005 and 2007.

The NHS underspent by more than £2bn more generally on capital over the same period, with NHS organisations unable to achieve big increases in spending that had been envisaged.

http://www.ft.com/cms/s/0/3da09dd4-c57e-11dd-b516-000077b07658.html

New nurses left jobless by labours NHS budget squeeze

Thousands of newly qualified nurses are facing unemployment because of labour's NHS hospital cutbacks, with vacancies at their lowest for 10 years. New National Health Service figures have revealed how difficult it is for nurses, physiotherapists, scientists and doctors to find jobs.

The highest vacancy rate was among consultants, with 1.2 per cent of jobs empty compared with 0.4 in trainee nursing. There are currently 5,000 newly qualified nurses who cannot find a job and half of the 2,413 newly qualified physiotherapists have not found permanent posts.

More than 20,000 jobs have been cut in recent years as managers struggle to bring NHS finances back into balance.

Vacancy rates across the medical professions have dropped, showing the boom and bust nature of current workforce planning in the health service.

Places at medical school and nursing colleges were expanded and the NHS has now almost reached a point where it is self-sufficient in staff.

But experts are predicting shortages again in the medium to long-term because large numbers of nurses, GPs and consultants are nearing retirement age. In the meantime, newly qualified staff are struggling to find work and many are considering retraining or working abroad.


Dr Peter Carter, the general secretary of the Royal College of Nursing, said: "This is not a 'good news' story for nurses.

''Vacancy rates appear to have reached their lowest levels for years but we fear that has been achieved only by widespread freezing and deleting of posts by NHS trusts desperate to balance the books.

"Thousands of newly qualified nurses - costing taxpayers millions of pounds to train - cannot find jobs this year yet at the same time the workload on the wards and in the community remains high.

"It's time for the Government to put in place a long-term workforce strategy that prevents the feast or famine characteristic of the NHS job market in recent years."

The NHS Vacancy Survey also found that:
- In March 2007 there were 1,695 vacancies for qualified nurses and 391 for trainees.
- There were 364 consultant posts available and 73 jobs for other doctors in non-training posts.
- The vacancy rate for GPs has dropped from 2.4 per cent in March 2005 to 0.8 per cent this year.
- There were just 63 vacancies for physiotherapists in March this year compared with 464 in 2005.
- The highest vacancy rates are in the South East Coast area, followed by the North East, with the lowest in the West Midlands.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/21/nhospital821.xml

Health Direct points out that Labour's complete and utter incompetence in attempting to "save the NHS" is exposed by these latest figures. It's a waste of taxpayers money for us to subsidise medical training and then throw the highly skilled new staff out onto the dole queues.

On March 22, 07 Health Direct posted: MPs expose lack of control over NHS billions

A devastating insight into financial mismanagement at all levels of the NHS- from Labour ministers down to hospital bureaucrats- is provided by a committee of MPs. The report by the all party Public Accounts Committee exposes how billions of pounds of taxpayers' money is being poured into a health system with inadequate financial controls and low levels of accounting expertise.

The MPs conclude that NHS structures are so inadequate that the Department of Health has no idea what the effect of last year's total deficit of £570 million is having on patient care.

In no less than one in three NHS organisations, auditors had raised concerns "about the financial management capabilities of general management".

The committee said that while the Department of Health had no "overall picture" of the effect of deficits on services to patients, it was clear they were adversely affecting the level and quality of care.

Dr Peter Carter, the general secretary of the Royal College of Nurses, said it was very disturbing that the department had no clue about the effect of deficits on services and jobs. "It's time for the Government to come clean.

Ministers need their advisers to tell them just how damaging the deficits crisis has become and acknowledge the Government's responsibility to work with front line staff to find a long term solution."

Thousands of new nurses still job hunting

Almost a third of nurses - some 4,000 - had not found jobs six months after qualifying last year, according to official statistics. More than half of physiotherapists and one in five midwives were also still unemployed half a year after completing their studies, the Department of Health admits.

Professional bodies claimed taxpayers' money is being wasted on training staff who then cannot find work in the NHS, and blamed Government squeezes on funding which lead to local healthcare trusts cutting junior positions.

At least 12,000 nurses qualified in May or September last year. But the Department of Health has admitted that only 69 per cent had found jobs by March this year. Among physiotherapists, only 48 per cent managed to find jobs after finishing their training.

The Royal College of Midwives estimates 3,000 more midwives are needed but about 20 per cent of newly qualified midwives failed to find work last year.

A Royal College of Nursing spokesman said: "It is a big problem. Entry-level jobs, for which newly qualified nurses apply, have been frozen because trusts have been told to reduce their deficits. "We think trusts need to be given more time and flexibility to manage their deficits as otherwise it's a waste of taxpayers' money."

Last year a survey by the RCN found almost three quarters of newly qualified nurses were still searching for a permanent job months after qualifying.

The Department of Health said: "The NHS is balancing its work force after job shortages in the past. We expect people like this would find jobs in the next few months as others leave or retire. It is a more competitive environment now and people have to be a bit more flexible in the jobs they take, especially when they've just graduated."

However, the NHS has been spending £1 billion a year on agency nurses because of poor planning.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/06/nnurses106.xml

Cameron kills health 'passport' idea

David Cameron has put the final stake in the heart of the Conservatives' proposal at the last election for a "patient passport", which would have allowed patients to use National Health Service funds to contribute towards the cost of private operations.

Speaking at the NHS Confederation's annual conference in London, Mr Cameron promised legislation to outlaw such a policy in the future. He added that the Conservatives' "first piece of health legislation" would commit the Tories to a comprehensive, universal health service funded out of taxation. But it would go further and "enshrine in law that NHS money should only be spent on NHS patients", he said, ruling out the "patient passport" proposal.

In future there would be "no opt-outs" and "that's a guarantee", Mr Cameron told the conference of NHS managers and board members. "We are not going to use NHS money to help people get out of the NHS into private healthcare. NHS money will be spent on NHS patients and that will be written into the law."

He underlined that he wanted there to be "no doubt whatsoever" the next Conservative government would uphold the principle of an NHS paid for out of general taxation.

Without naming specific sums, he said the Conservatives would "always support the NHS with the money it needs".

Andrew Lansley, the party's health spokesman, said that would mean "additional, growing, real-term resources" - reflecting the fact that as countries grew richer they spent a greater proportion of their total income on healthcare.

Meanwhile, David Nicholson, the NHS chief executive, without directly naming them, launched a strong attack on "the vested interests" of the British Medical Association and the Royal College of Nursing for wild claims that the NHS was "on its knees" or that the service's financial performance was "a tragedy" or "a farce".

Such claims "are not just factually incorrect", said Mr Nicholson. "They are deeply damaging to the public confidence and staff morale".

From:
http://www.ft.com/cms/s/2477045c-1f93-11dc-ac86-000b5df10621.html

On Jan 24 07 Health Direct posted- Conservative's David Cameron would hand power back to GPs as many centralist targets for the National Health Service would be scrapped under a Conservative government as more purchasing power was handed to family doctors, David Cameron, the Tory leader said.

The policy would encompass a full-blooded return to GP fundholding - the practice of giving family doctors budgets to buy care on behalf of their patients, which Labour abolished but is now partially reinstating through practice based commissioning.

Health Direct also points out that government actions also loose elections.

Health Direct has frequently raised the issue of waste that labour's blizzard of targets has created for the NHS. On Dec 18 06 in Labour's mismanagement has led to NHS deficits according to Commons Health Select Commitee Mismanagement at all levels of the NHS in England has led to the current multimillion pound deficit, a committee of MPs has found.

The Commons health select committee said existing deficits were made worse by the cost of new staff pay deals and the expense of meeting NHS targets. Last year's NHS deficit was £547m.

The committee said historic deficits, long hidden, were revealed when the government changed the rules so trusts could not underspend their capital budget to subsidise current spending.

But it said the government fuelled the problem by agreeing to new pay deals for doctors and nurses using estimates of the cost which were "hopelessly unrealistic".

In addition, meeting national targets such as the requirement that no patient should wait more than four hours in A&E had been costly.

NHS hit by first staffing fall in decade

The number of National Health Service workers fell last year for the first time since comparable records began in 1996 - a year before Labour came to power. Health unions and opposition politicians blamed the drop on government mishandling of NHS finances, but there was disagreement over the extent of the fall for front line services as labour's dodgy accounting was again called into question.

In the NHS, the headcount dropped by 17,000, or 1.3 per cent, to 1.34m. The biggest decline - of 16,600, or 6 per cent - was in support staff such as nursing assistants and auxiliaries, according to the NHS information centre.

Lord Hunt, the health minister, said the figures indicated there had actually been a rise in clinical capacity - if an increase in the number of doctors and nurses working full time was considered.

He pointed to a decline in bureaucracy, with the first reduction of NHS managers since 1995, as the number of health authorities and primary care trusts was cut. However the managerial cutbacks are likely to lead to a big redundancy bill.

Andrew Lansley, the Tory health spokesman, said the fall in headcount would have been almost 10,000 higher but for the change in the counting method.

Peter Carter, general secretary of the Royal College of Nursing, said: "When you dig below the surface even further, an estimated 17 per cent of the headline increase in nurse numbers [since 1997] is made up of double-counting existing nurses working extra shifts.

"Meanwhile, internationally recruited nurses, who make up a significant number of the extra nurses, now face the prospect of having to leave at the end of their contracts under new immigration laws."

Unison, the largest public sector union, said: "These alarming figures appear to confirm our fears that health workers' jobs are now being lost because welcome extra cash is often being sucked into an endless black hole of 'strategic' reforms, which don't appear to be linked to many meaningful front-line patient care outcomes."

From:
http://www.ft.com/cms/s/3e7858ea-f45c-11db-88aa-000b5df10621.html

Health Direct kicked off the first week of the New Year with Report on NHS staffing angers unions as it predicts 36,000 NHS jobs lost this year. The National Health Service is set to shed more than 36,000 jobs this year before facing "very volatile" changes in its workforce that could leave it with thousands more hospital consultants than it can afford to employ, according to a leaked document from the Department of Health.

At the same time, however, big cuts in nurse and medical training budgets last year and this year could mean the service will be short of 14,000 nurses, 1,200 family doctors and 1,100 junior hospital staff by 2011.

Labour cuts are squeezing life out of NHS- RCN

The NHS is having the "life squeezed out of it" by cuts imposed because of deficits, says the UK's nurse leader. Dr Peter Carter, general secretary of the Royal College of Nursing, warned the NHS was at risk as wards are closed, jobs lost and services slashed. "The situation is so serious that the progress we've made could soon be reversed or, sadly, lost altogether."

Speaking at the RCN's annual conference in Harrogate, Lothian nurse Geoff Earl said evidence had shown death rates increased by a third if the number of patients per nurse increased from four to eight.

"The lower the ratio the lower the rates of urinary tract infection and pneumonia," he said.

"It also improves recruitment and retention, reduces the use of agency staff and leads to less staff sickness. So it also makes financial sense - in the long term."

David Dawes, part of the RCN's body for nurses in senior management, said he supported the move as it would make many of the recent cuts - the RCN estimates over 22,000 post have been lost in the last 18 months - illegal.

And Lisa Leicester, a community mental health nurse from Gloucestershire, added: "Lets ensure appropriate staffing levels but also appropriately qualified nurses."

Nurses voted to pass a motion calling for new legislation to ensure appropriate staffing levels.

Ratios would vary depending the type of care a patient was receiving but could mean in some specialities (did not specify which one) one-to-one care would be guaranteed.

But Howard Catton, head of policy at the RCN, said: "The problem with minimum ratios is that they become maximums and that takes away from professional judgement. And if minimums can't be met, wards are closed."

Tough times

The debate came after the RCN's new leader set out the "tough" times the NHS was facing.

The former NHS trust chief executive, who took up the post in January, said: "Training budgets are being raided and public health programmes are being targeted. We've got workloads gong through the roof as jobs are lost and vacancies frozen."

He said the Labour government deserved credit for increasing funding, which has increased the workforce of nurses and doctors. But he added: "The situation is so serious that the progress we've made could soon be reversed or, sadly, lost altogether."

NHS trusts are making cuts in a bid to balance their books after racking up over £500m of deficits last year.

Alluding to recent press reports, Dr Carter said it had got so bad that nurses were being asked to work for nothing and cutting down on the use of lightbulbs. He also strongly criticised this year's 2.5% pay rise for nurses, describing the award as "shameful".

Commenting on the fact the RCN has not invited any politician to congress this year, he said: "It was pointless bringing someone from government in because of how badly they have treated nurses and other health workers."

From:
http://news.bbc.co.uk/1/hi/health/6559929.stm

The plight of nurses has been long chronicled by Health Direct. Only on March 16, 2007
we posted that the NHS workforce falls by 11,000 as the number of people working in the NHS fell by 11,000 in the last quarter of 2006, official figures reveal. Health unions said the loss across the UK, revealed in Office for National Statistics, would "inevitably have a negative impact on patient care". Total full and part time NHS staff numbers are estimated by the ONS as being 1,222,000.

Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), added: "These alarming figures confirm what the RCN has long been warning - that deficits are leading to serious cuts in the NHS workforce.

"This can only have a damaging impact on patients and services. That's why we are urging the government to work with us to replace short-term cuts with a long-term recovery plan."

MPs expose lack of control over NHS billions

A devastating insight into financial mismanagement at all levels of the NHS- from Labour ministers down to hospital bureaucrats- is provided by a committee of MPs. The report by the all party Public Accounts Committee exposes how billions of pounds of taxpayers' money is being poured into a health system with inadequate financial controls and low levels of accounting expertise. The MPs conclude that NHS structures are so inadequate that the Department of Health has no idea what the effect of last year's total deficit of £570 million is having on patient care.

The deficit was recorded despite a massive rise in NHS spending from £69.7 billion in 2004-5 to £76.4 billion in 2005-6. In this financial year the amount being pumped in will soar again to £92.6 billion.

Edward Leigh, the chairman of the committee, said "weak control of finances" and "lack of interest" by doctors in the sums they were spending were to blame for many of the deficit problems.

In no less than one in three NHS organisations, auditors had raised concerns "about the financial management capabilities of general management".

In one in four they were worried about the financial performance of non-executive directors.

The committee said that while the Department of Health had no "overall picture" of the effect of deficits on services to patients, it was clear they were adversely affecting the level and quality of care.

"Dealing with financial pressure diverts resources away from normal strategic operational priorities," the report said.

"If a body's management are concerned chiefly with recovering a deficit, they may be unable to give sufficient attention to issues such as clinical performance or current NHS restructuring."

Andrew Lansley, the shadow health secretary, said the report showed ministers had ''no idea about the impact of their mismanagement on local NHS services" and exposed a "worrying lack of financial expertise in Whitehall".

The committee said "errors" by the Department of Health in estimating the cost of three national pay initiatives for nurses, doctors and consultants were responsible for many of the problems, leaving the NHS having to fund a shortfall of £560 million.

Dr Peter Carter, the general secretary of the Royal College of Nurses, said it was very disturbing that the department had no clue about the effect of deficits on services and jobs. "It's time for the Government to come clean. Ministers need their advisers to tell them just how damaging the deficits crisis has become and acknowledge the Government's responsibility to work with front line staff to find a long-term solution."

The Local Government Association said the deficits in some hospital trusts were having knock on effects on council services.

Sandy Bruce-Lockhart, the chairman of the LGA said: "Health and social care are two sides of the same coin and a financial crisis on one side is having an impact on the other.

"In the next three years alone, there will be over 400,000 more older people, many of whom will require social care. Without additional funding local government may potentially face a situation, by as early as 2009, where it cannot afford to provide support to the 370,000 elderly people with lower levels of need."

Dr Gill Morgan, the chief executive of the NHS Confederation, said they were working "harder than ever" to achieve financial balance.

"It is important to remember that NHS deficits are concentrated in a relatively small number of organisations with over 50 per cent of the deficit in just six per cent of trusts," she said.

A recent survey of NHS trust chief executives showed that three out of four trusts are already restricting patients' access to treatment as they struggle to control deficits. The same survey found that half were delaying operations as they battled to save money.

Meanwhile, figures produced by the independent health think tank, the King's Fund, showed that less than a third of the extra money spent on the NHS is actually going directly to improve health care and front-line services. Of the £19 billion spent by the Government on hospital and community health since 2003, £6.6 billion had gone on extra pay for clinical staff.

A further £2.2 billion went on the rising cost of drugs; £1.6 billion went on hiring more doctors to meet new EU employment laws on working hours; £1.1 billion went on new buildings and equipment; £1 billion went on equipment and £600 million on negligence law suits.

This left only £5.9 billion to spend on improving performance such as reducing waiting lists, the extension of day surgery and more nurses and consultants.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/20/nhs120.xml

The issue of Labour's waste on the NHS finances continues to brew ominously for patients.

MPs only recently (30 Jan 07) in MPs want greater scrutiny of PFI hospitals to prevent more waste Health Direct posted that hospitals built under the Private Finance Initiative (PFI) must be subject to much "closer and sustained scrutiny" if millions more pounds are not to be wasted, the Public Accounts Committee said. Estimated capital costs for 17 PFI schemes approved by the end of 2005 have more than doubled - up by some £4bn to £13bn.

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.

And last year (Fri 5 May) Health Direct highlighted the GPs' out of hours opt out Out of hours GP shake up attacked as "shambolic" as £70 million is overspent when the shake-up of the out of hours health care system in England was "shambolic" and led to longer waits and higher costs, a committee of MPs has said.

New providers are spending 22% more but are not meeting key targets, the public accounts committee claimed. Fewer than 10% of primary care trusts met targets on assessing patients within 20 minutes of an urgent call the National Audit Office found.