NHS health debate is more heat than light

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Health minister to repay £41,000 expenses

Phil Hope, the Labour health minister, has agreed to pay back more than £41,000 he claimed in expenses to refurbish his second home.

The care services minister this morning announced he would write a cheque for £41,709 to cover the cost of the furniture and fittings he claimed for the property – a small two bedroom flat in south London.

The sum being returned by Mr Hope is the largest amount an MP has pledged to refund since the expenses scandal broke, but dozens of other members are expected to follow suit under pressure from their party leaders.

The Corby and East Northants MP said that his announcement was unrelated to fears over his slender 1,517 majority – and said he should be able to find the money "within a week or so".

"It is going to be difficult, it is going to be challenging but this is a personal decision that we [he and his wife Allison] have made together," he told Sky News.

In a statement, Mr Hope insisted his claims were within the rules, but said he wanted to correct the "dreadful perception" and he enriched himself with taxpayers' money.

"The anger of my constituents and the damage done to perceptions of my integrity concerning the money I have received to make my London accommodation habitable has been a massive blow to me that I cannot allow to continue," he said.

Mr Hope is following in the footsteps of Hazel Blears, the communities secretary, and backbench Labour MP Margaret Moran in agreeing to refund questionable payments following a week of disclosures about expense system abuses in The Daily Telegraph.

Miss Blears has agreed to pay back £13,000 in capital gains tax from profits on a house paid for by the taxpayer, while Miss Moran will return the £22,500 she claimed for treating dry rot at a house 100 miles from her constituency.

Alan Duncan, the shadow leader of the Commons, will repay more than £5,000 in gardening costs; Andrew Lansley, the shadow health secretary, will repay £2,600 claimed for home improvements; and Oliver Letwin, the chairman of the Conservatives’ policy team, will refund £2,000 for getting pipes repaired under his tennis court.

Mr Lansley apologised to his South Cambridgeshire constituents for claiming "overgenerous" expenses in a letter to his local paper. "The public has every right to be angry about MPs' allowances. I was part of that system and I'm sorry for my part in it," he wrote.

The announcements come amid a growing acceptance at Westminster that politicians from the three major parties must act decisively to restore public trust in parliamentary democracy or risk a backlash from the electorate in the June 4 European and local council polls.

David Cameron has said that Tory MPs shown to have broken the rules could be sacked, and on Tuesday Gordon Brown has admitted that "extreme" action is needed to restore public trust in politicians.

The Prime Minister said an independent review of every claim made over the past four years would allow MPs to show they are "worthy of public trust".

"I think the issue here with Hazel Blears is about the sale of a house where CGT could or could not have been paid," Mr Brown said. "She has looked at what has happened, I have talked to her, she has repaid the money."

Mr Brown said other ministers who had come in for criticism over their accommodation arrangements, including Chancellor Alistair Darling and Transport Secretary Geoff Hoon, were in a "different position" but could still face disciplinary action if the independent review found there were problems.

Mr Hope, who has also been criticised for employing his son Nick and daughter Anna for parliamentary work, said that he was repaying his expenses because the Telegraph's disclosures had "fundamentally changed the view people have of me and that is something I cannot bear."

The MP billed taxpayers for so much furniture for his second home in Southwark, south London – including a chest of drawers, a mattress, a television, a sofa, an armchair, a washing machine, three chairs, two bookcases, one coffee table, a wardrobe and a dining room table – that questions were raised about how it could have all fitted into the small flat.

His statement read: "I have worked very hard over the last 12 years to represent and fight for my constituents, and their opinion of me as a person matters hugely to both myself and my wife Allison.

"We feel very badly hurt by what has happened and although I kept to the rules laid down by Parliament I cannot allow this dreadful perception about what I claimed in allowances to continue.

"I have decided to try to restore the trust and relationships I have with my constituents. I am returning all of the money that I have claimed for fittings, furniture and household items that I received over a five year period – the sum of £41,709.

"This will be paid to the House authorities as soon as the necessary arrangements can be made."

Speaking to Sky News, he added: "This is not about votes; this is about who I am. This is about me and this is a personal decision I am making.

"Whenever the election comes, whatever goes on there, I just want those people I represent to know, whether they vote for me or not, that I have personal integrity."

From:
http://www.telegraph.co.uk/news/newstopics/mps-expenses/5317104/Phil-Hope-agrees-to-return-41000-as-MPs-retreat-on-expenses-claims.html

Personal Intergrity- Health Direct asks why it took him so long to pay back his fiddled expenses aftre they became public knowledge? And how come he has so much spare cash sloshing around- the equivelent of two thrids of his annual salary- before tax?

Health minister Ben Bradshaw also received attention from The Daily Telegraph, although the paper’s prime interest was in the fact that the second home for which he has claimed around £1,600 a month in mortgage interest payments is jointly owned with his civil partner. His total claims over the four year period were £56,568.

Health secretary Alan Johnson was absent from The Daily Telegraph’s detailed coverage, with no details reported.

Ditherer Brown's PFI U Turn

After a dozen years of wasteful, expensive over spinning and under delivering Stalinist Brown has created a new PFI process.

Seven private sector consortiums are to be given a form of quasi-monopoly on a potential £2bn-£3bn ($3bn-$4bn) market for building health centres, community hospitals and perhaps some local authority facilities.

The Department of Health is expected to announce the winners of the so-called Express Lift (local improvement finance trust) project soon in a move which could in time also open up more of the NHS’s community health services to competition from the private and voluntary sectors.

Under Lift projects, the private sector forms joint companies with primary care trusts – and sometimes local authorities – which finance, build and run GP surgeries and other health facilities. Contracts typically last for 20 years and the public sector owns a 40 per cent equity stake.

Some 47 Liftcos – which use some of the techniques of the private finance initiative – have so far been set up.

More than 220 buildings with a capital value of about £1.5bn are under construction or open, with more to come under the deals already signed.

Half of the country’s 150 primary care trusts, however, still do not have a Lift deal – chiefly those outside the big cities.

Under Express Lift they will be able to choose from the winners of the framework contract without the need for a full EU-style tender. The hope is to cut procurement time from a typical two years to a few months, massively reducing the costs and speeding up the programme.

Sir William Wells, a former regional health authority chairman, is now chairman of Ashley House, whose Odyssey Healthcare is expected to be one of the winners.

“We have been building these great palaces of PFI hospitals like they are going out of fashion, when in fact they are going out of fashion,” he said. “Even cancer care is now moving out of hospital and into people’s homes. This new approach should be far more flexible and – at a time when capital is going to be in very short supply – much more affordable for the NHS than PFI.”

Lift buildings typically cost £3m-£7m, and raising money this way was far easier amid the credit crunch than raising finance for big PFI projects, Sir William said. He added that in time Liftcos could take over a primary care trust’s entire property portfolio.

The National Audit Office has judged the Lift programme to have gone well, although MPs on the Commons public accounts committee have questioned the value for money and the rate of return Liftcos make.

From:
http://www.ft.com/cms/s/0/0e7db1d2-0f5b-11de-ba10-0000779fd2ac.html

NHS managers voice worries over 'Stalinist' SHA tactics

The zero tolerance culture for failure has made some chief executives fear for their jobs as a "Stalinist" culture is draining the NHS of experienced chief executives and making trusts insular and risk averse, senior leaders have told the Health Service Journal.

The concerns were prompted by the departure of two London hospital chief executives from trusts facing serious performance challenges. The sudden resignations of Tara Donnelly, from West Middlesex University Hospital trust, and Julian Nettel, from Barts and the London trust, have left managers across the capital fearing for their jobs.

"If someone asked me for views as to whether they should apply for a chief executive's post, I'd say I wouldn't touch it with a barge pole".

Many also feel the shake-up will discourage people from applying for top jobs at a time when vacant posts often attract just one candidate.

Making mistakes

University College London Hospitals foundation trust chair Sir Peter Dixon told HSJ: "It raises all sorts of questions about the way we treat our senior managers. I think there's a Stalinist culture among SHAs that isn't helpful. You need to be able to make a mistake."

He added: "There's not a mass of people waiting on the sidelines who want to take these jobs on."

Barts and West Middlesex face deep rooted problems and have been named as trusts that will fail to secure foundation status.

But many trusts in London are performing badly against targets - and the region has the highest number of trusts that will fail to become foundation trusts. Managers fear NHS London is looking for scalps in response to Department of Health pressure.

Performance anxiety

A London acute trust chief executive said: "It feels as though there's a new intolerance in London and that some excellent, talented leaders are being forced out or put under so much pressure they leave.

"A lot of chief execs are thinking 'there but for the grace of God'."

A London insider said: "If someone asked me for views as to whether they should apply for a chief executive's post, I'd say I wouldn't touch it with a barge pole."

The insider added: "These are difficult jobs and this makes people adopt risk averse behaviours."

Ms Donnelly stood down after her trust failed to alert NHS London that eight patients had waited more than 12 hours in accident and emergency. The SHA said this meant nearby trusts were unable to help.

But a chief executive at a neighbouring hospital said: "We wouldn't have been in a position to help out, however much we'd have wanted to.

"I think [the resignation] is very hard on a first offence and whether that's really in the best interests of the organisation is very debatable."

Official protocol

HSJ understands West Middlesex had established informally that other hospitals were unable to help but did not follow official protocol.

NHS London has taken a hard line on trusts it feels should be able to deliver on key targets. HSJ understands this was not the first time there had been a difference of opinion between the trust and the SHA.

One London hospital chief executive said the departure of Malcolm Stamp, NHS London's provider agency chief executive, last December had deprived leaders of someone at the SHA with whom to have informal discussions.

The "high level of anxiety" resulting from recent resignations made trusts potentially reluctant to help other organisations if it meant they would miss targets, the chief said.

Performance management

Managers in Partnership has seen an increase in casework involving senior managers in London in recent months, mainly disciplinaries, grievances and capability procedures related to performance management. Chief executive Jon Restell said it was understandable that SHAs wanted to hold top managers accountable but said putting people under "unreasonable amounts of pressure" would not help.

However, King's College Hospital foundation trust chief executive Tim Smart was unsympathetic. He said: "Personally I don't subscribe to the view that there is a climate of fear. I think targets are targets and you have to deal with them."

The SHA denies any suggestion that it bullies managers. Deputy chief executive Anne Rainsberry said the SHA simply wanted to improve performance and there would always be a turnover of chief executives.

From:
hsj.co.uk/news/2009/02/anxiety_on_the_up_as_managers_react_to_stalinist_sha_tactics

Health Direct has seen this increasing trend in intolerant centralist health bosses for a while.

On Wed, Feb 11, 2009 we posted London acute trusts face shake up as bosses resign
London's hospital trusts face a massive management shake up after the resignations of five chief executives over failures in their trusts.

NHS boss angry at transplant organs for foreigners

A leading National Health Service hospital has come under attack from the government’s transplant authority for giving livers from dead Britons to overseas European Union patients in private operations.

More than 40 procedures using organs from British donors have been carried out on foreigners at King’s College hospital, London, over two years.

According to NHS Blood and Transplant (NHSBT), the trade undermines Gordon Brown’s £4.5m attempt to increase organ donations and creates an “obvious potential conflict of interest”. It accused King’s of “a persistent lack of clarity” over the trade.

The criticisms appear in correspondence released to The Sunday Times under the Freedom of Information Act.

Lynda Hamlyn, chief executive of NHSBT, wrote in one letter to the hospital: “This is the third specific issue of concern raised by UK Transplant [part of NHSBT] over the past four years about the transplantation of livers from deceased UK donors into nonUK residents undertaken on a private basis at King’s.

“People joining the organ donor register and families giving consent for organ donation need to be completely confident that UK residents . . . are treated fairly.”

In one week following publication in The Sunday Times last month of figures on private transplants given to foreigners at King’s, 22 people withdrew their names from the organ donor register in protest.

Tim Smart, chief executive, denied King’s College Hospital NHS Foundation Trust had failed to give clarity. He said EU patients had the same legal entitlement as British patients to receive donated organs.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article5683680.ece

Last month Health Direct posted Outrage over NHS organ donations sold to foreigners
when the organs of 50 British National Health Service donors have been given to foreign patients who have paid about £75,000 each for private transplant operations in the past two years, freedom of information documents show.

NHS Direct shelves foundation trust plans

NHS Direct has put its plans to become a foundation trust on ice. The decision follows government reluctance to free the national service from central control.

The Department of Health feels it needs to be able to call on NHS Direct as an emergency hotline in the event of a terrorist attack or other national incident.

NHS Direct was used as the national hotline for people worried about radiation contamination following the poisoning of former KGB agent Alexander Litvinenko in London in November 2006.

A statement from NHS Direct said: "It has become clear that the organisation's role, particularly around major incidents, is of strategic national importance. This has led to the Department of Health agreeing with NHS Direct that the traditional model of foundation trust may not be the most appropriate at the moment, given that one of the organisation's strengths is its national operating model."

NHS Direct is also seen as a prime contender to run the three digit non emergency phone number recommended by health minister Lord Darzi to direct people to appropriate services.

Around 16,000 people have signed up as "members" of NHS Direct in anticipation of it gaining foundation trust status.

NHS Direct chief executive Matt Tee told HSJ: "I'm slightly disappointed. The Department of Health has said that the arm's length aspect of foundation status will not work because we are nationally important. We wanted to be a foundation trust as a kind of 'badge' that shows that we are a high-performing organisation, but there is the chance that we can get certain freedoms without needing to have foundation status."

The labour government has previously said that psychiatric hospitals at Rampton, Ashworth and Broadmoor will also not be granted foundation status. Ministers want to hold sway over decisions relating to high-profile criminals.

A DH spokesman said: "NHS Direct, as recognised recently by the Healthcare Commission, provides a popular and important service to patients, undertaking millions of consultations each year. It will have a key part to play in supporting implementation of the next stage review."

From:
nhs_direct_shelves_foundation_trust_plans

Cancer drugs prescription charge move ‘bizarre’

Health economists and opposition politicians have expressed bemusement at Gordon Brown’s decision to exempt cancer sufferers from prescription charges when patients are having to pay thousands of pounds for cancer drugs that the NHS will not fund.

“This seems a rather bizarre decision and a low priority when there are much more serious issues facing the NHS over cancer treatment,” said Adrian Towse, director of the Office of Health Economics, which is financed by the pharmaceutical industry.

It became clear on Wednesday that the prime minister’s announcement had not been fully costed. The final bill would depend on which other long-term conditions were eventually included in the scheme, said the Department of Health, adding that it still expected to raise £150m-£200m a year out of the £400m in revenue that prescription charges currently generated in England.

Almost 90 per cent of prescriptions are dispensed free of charge. Those who pay but need drugs regularly can buy a pre-payment certificate, or “season ticket”, that covers all their drugs for £27.85 for three months – the cost of four prescriptions.

Andrew Lansley, the Conservative health spokesman, said it was “absurd” that the government was exempting cancer suffers from a maximum £100 a year bill for their medicines “while patients who could benefit from clinically effective cancer drugs that may extend their lives are being expected to pay out tens of thousands of pounds for their treatment”.

Mike Richards, the cancer czar, is compiling data and reviewing the policy on such “top-ups” to NHS treatment. But initial health department estimates are understood to indicate that it would cost the NHS between £100m and £300m a year to cover the cancer drugs that it currently refuses to fund.

That is a similar sum to the amount the government now plans to spend extending the exemption to prescription charges.

“It does seem rather odd to focus on the prescription charge rather than the much more serious issue of whether patients will get access to expensive drugs or will have to pay for them themselves,” Mr Towse said.

Alan Maynard, professor of health economics at York University, said given the problems that the government faced with the public finances, “this seems a very strange set of priorities”.

From:
http://www.ft.com/cms/s/0/c7c59448-8a7c-11dd-a76a-0000779fd18c.html?nclick_check=1

Nanny state bans children with no MMR vaccinations

Labour's latest nanny state wheeze to cover up their MMR vaccinations fiasco is to ban children from starting school until they receive the MMR jab.

Parents will have to provide proof their offspring have had a full range of vaccinations when they put in applications for primary schools.

The plan, designed to increase the take-up of the measles, mumps and rubella triple jab, has been drawn up by Mary Creagh, the Labour MP in charge of the party’s health manifesto for the next general election.

“Parents need to protect their children and science gives them a way to do that,” said Creagh. “We need to get that message across.”

However, doctors’ leaders warned that the idea was “morally dubious”.

Dr Hamish Meldrum, chairman of the British Medical Association, said: “A Stalinist approach like this would be likely to backfire.”

Andrew Lansley, the shadow health secretary, accused Labour of “playing politics” with children’s lives.

Take-up of the MMR jab fell dramatically after research – now discredited – appeared to show a link between the triple vaccination and autism.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3909515.ece

Health Direct finds the latest labour "thinking" plain incredible. The highest proportion of children who do not have the vaccine live in inner London, so labour's plans will compound the disadvantage that these children will endure.

Statistically speaking, 100% of us are fed up with dodgy data

The majority of 25 to 34-year-olds have sex three to four times a week,” Health Direct reads. There I am, minding my own business on the train and a statistic attacks. Four times a week?

I do some quick desperate calculations in my head. That can’t be right, can it? “For 35 to 44-year-olds, it’s more likely to be twice a week,” the article continues. Well, I’m 33. Which is nearly 35. But still . . . twice a week? Don’t any of these people have kids? Or jobs?

At work I search for a more encouraging statistic. The Durex website comes to the rescue. We, the British, have sex 55 times a year, it says. Even a GCSE mathematician will tell you that’s a snip over once a week.

This must mean that if the 25-44 age group are averaging thrice-weekly how’s-your-father, everyone else must be almost hanky-panky free. But wasn’t there a report out recently that said the over 55s were at it like rabbits? Someone, I conclude, must be lying – and my money’s on the 25 to 34-year-olds.

As of April Fool’s Day, all labour government statistics require a kitemark to show they’ve been approved by the new UK Statistics Authority.

Anything that stops politicians making things up is a good thing, but it still won’t rid society of all the non governmental statistics that hang around making all our lives a misery.

It’s not just sex. Men who eat four meals a day are half as likely to be obese as men who eat three meals a day (Men’s Health); women who give birth in their forties are four times more likely to live to 100 (Grazia); eating sausages daily increases your risk of cancer by 20% (Daily Alarmist, sorry Mail); and my own favourite, women spend as much on make-up as they do on household cleaning products. Honestly, ladies.

At lunch, apropos of nothing, a female colleague storms over and says she was right: she is a better driver than me. “What’s your evidence?” I demand huffily. She tells me about a new survey which shows that men are three times more likely to be convicted of a driving offence than women. “Big wow,” I reply, “but statistically speaking I have hit 100% fewer lampposts than you. Which means I am 100% better.” You see how we need all our statistics kite-marked?

Sex is off which is bad, given the statistics. My mood thickens further when I remember that only one in nine readers gets to the end of the average article. This is below average so what’s the point in finding child-abduction panic button installed at the end of every street so we’re all just that bit more paranoid and overprotective of our kids.

From:
http://www.timesonline.co.uk/tol/incomingFeeds/article3735971.ece

Health Direct reveals a small flaw in labour's plans to restore trust in labour's use of statistics. The new statistics website's name- www.statistics.gov.uk

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.

Row erupts over NHS health trusts in centralist health dictats

A battle for the soul of NHS reform has broken out after accusations that the labour government has usurped key hospitals’ independence.

At the centre of the row are letters from the health department to all NHS hospitals, including foundation trusts, telling them to appoint extra matrons, undertake an annual deep clean to combat hospital-acquired infections and appoint infection control nurses.

William Moyes, chairman of Monitor, the independent regulator of foundation trusts, has written to NHS chief executive David Nicholson arguing that such instructions amount to line management by the labour government when foundation trusts are meant to be self-governed institutions.

“I do not believe this is consistent with the legislative framework,” Mr Moyes warned the health service’s top boss, because the department’s letter “could only be interpreted as issuing instructions”.

Mr Moyes added it was clear that “there remain different views about who is accountable for the performance of foundation trusts”.

So ministers can no longer set hygiene standards and ensure they are enforced? They can still set standards for hospital cleanliness, which the Healthcare Commission inspects. Monitor requires foundation trusts to meet these and other national standards and targets, such as reducing MRSA infection rates, and can intervene to enforce compliance. But exactly how a foundation trust achieves targets is a matter for them.

But what if there is a known best way of treating patients? Can ministers not make foundation trusts comply?
They can, but not by central direction. National service frameworks, for example, set out approved ways of organising cancer treatment and other services. Primary care trusts are expected to commission care in line with these frameworks. Monitor argues that PCTs should remove services from hospitals that they believe are unsafe or poor quality. PCTs in theory retain the ability to require a deep-clean in a contract.

Like the rest of the NHS, foundation trusts are inspected by the Healthcare Commission. They are answerable to their boards, their governing councils and to Monitor, which authorises them and has the power to direct them and replace their boards.

If problems arose over performance, Mr Moyes warned foundation trust chairmen and chief executives in a separate letter, “it will be no excuse to say you were simply operating within a framework defined by the Department of Health or the strategic health authority”.

The correspondence amounts to a battle for the operational independence of a key part of the government’s reforms, which were meant to end “command and control” from Whitehall and shift responsibility for performance to freer-standing institutions, regulators and the primary care trusts who commission hospital care.

The health department’s letter followed headline-grabbing announcements at Labour’s?party conference by Gordon Brown, prime minister, and Alan Johnson, heath secretary, over hospital deep-cleans and the appointment of 5,000 extra matrons. However, the health department later admitted it no longer had the power to order a foundation trust to appoint matrons.

Mr Moyes said PCTs should not commission care from dirty and unsafe hospitals and should specify their requirements in contracts. If foundation trusts failed to deliver that, then the right approach was for the NHS chief executive to “invite Monitor to act, using its statutory powers”.

On Tuesday, Mr Nicholson tried to defuse the row, declaring: “I fully support the autonomy of NHS foundation trusts and the role of Monitor as their regulator.

“I am also clear that every NHS board has – as part of the NHS family – a very real duty on behalf of their patients to learn lessons” to prevent a repeat of the infection scandal at the Maidstone NHS Trust, where 90 people died from Clostridium difficile.

The Foundation Trust Network, which represents the trusts, said: “It is important that Monitor maintains its status as an independent regulator able to challenge if hard-won freedoms are eroded.”

From:
http://www.ft.com/cms/s/0/9fff97bc-df3f-11dc-91d4-0000779fd2ac.html?nclick_check=1

CBI seeks go ahead on ISTC extra health centres

The Confederation of British Industry (CBI) raises the stakes on Monday over the role of the private sector in public service provision as it challenges the labour government to stop dithering and give the green light to another wave of health treatment centres.

The employers’ organisation cast the decision as a “pivotal test” of Gordon Stalinist Brown’s ability to deliver on his promise that National Health Service reform will go “wider and deeper”.

Seven deals remain to be decided out of the original 27 contracts for a second wave of independent surgical treatment centres (ISTCs). Eleven of these have been cancelled, with just nine definitely going ahead. Ministers have promised a decision on the remaining contracts next month.

“Whatever happens is going to send a signal not just about the ISTC programme but about the government’s broader commitment to long-term change in the NHS,” Neil Bentley, the CBI’s director of public services, said.

It will be a signal “not just to the private sector”, which runs the surgical centres and which the government now wants to enter the GP market, “but to the wider NHS about how committed the government is to its reform agenda”, Mr Bentley said.

In his New Year speech on health, the prime minister “mentioned choice 20 times and spoke about NHS reform going wider and deeper. So the decision on these ISTCs is a pivotal test of the government’s ability to deliver on what it says it wants to do,” he said.

The CBI remained “nervous” of whether all seven of the remaining deals would get the go-ahead.

Mr Bentley’s comments were made as the employers’ organisation published a review of the ISTC programme to date. It claims that the first wave of 26 centres and units, now operational, has had a real impact on the performance of the NHS.

Independent assessments from the NHS inspectorate and others show patient satisfaction remains higher in the ISTCs than in the rest of the NHS, with low infection rates, rapid access to services, high standards of cleanliness and, as far as they can be compared, low complication rates, the report says.

However, the NHS information centre said last week that ISTCs were still not reporting all the data required.

The CBI report acknowledges that, on average, only 84 per cent of the procedures contracted for are being taken up. Under the terms agreed for the first wave of treatment centres, the NHS pays for the procedure regardless of whether it is used.

But it blames the poor take-up on “flawed commissioning and procurement and local NHS resistance to ISTCs being introduced”.

Health ministers say that improvements to the performance of the NHS mean the cancelled centres are no longer needed and that change will be driven by the introduction from April of free patient choice of any hospital, whether public or private.

But the Department of Health’s latest figures show that less than half of patients are aware that they have a choice. And while ministers plan a campaign to raise awareness, along with measures to allow hospitals more freedom to advertise, Mr Bentley said “we need to see that in action.

Resistance to reform and the continued protection of traditional NHS provider interests means patient choice remains limited.”

The ISTCs, he claimed, are “an NHS success story” but the £2bn invested in them “is at risk of being wasted if the programme does not achieve sufficient size”.

The challenge ISTCs pose has encouraged NHS hospitals to become more productive and attractive to patients, the CBI argues.

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Major study on the NHS reveals over 17,000 unnecessary deaths a year

A statistical analysis of World Health Organisation data reveals that the poor performance of the NHS is causing 17,157 deaths per year and £34 billion of extra spending under Brown has made no difference to UK mortality.

Using data from the World Health Organisation and statistical techniques pioneered in the British Medical Journal, the TaxPayers’ Alliance has produced a major report on NHS performance since the 1980s.

Wasting Lives: A statistical analysis of NHS performance in a European context since 1981, analyses data from the WHO to estimate the number of deaths that could plausibly have been averted by the NHS since the 1980s. The measure used is known as “mortality amenable to healthcare”. The calculations compare the UK performance to that of Germany, France, the Netherlands and Spain.

* If the UK were to achieve the same level of “mortality amenable to healthcare” as the average of the other European countries studied, there would have been 17,157 fewer deaths in 2004, the most recent year for which data is available.
* This is equivalent to over five times the total number of deaths in road accidents and over two and a half times the number of deaths related to alcohol in 2004.
* Steady improvements in mortality rates, relative to European peers, have been made at almost exactly the same rate throughout the Thatcher, Major and Blair governments despite huge increases in spending from 1999 to date. There can no longer be any doubt that the Government’s extra NHS spending has completely failed to deliver results.
* If NHS spending had continued to increase relative to European peers at its pre-1999 rate £34.3 billion – £1,350 per household – less would have been spent between 1999 and 2004. In 2004 alone, £9.8 billion less would have been spent, 9.7 per cent of total spending in that year. This extra money has largely been wasted.

Matthew Sinclair, author of the report and a Policy Analyst at the TaxPayers’ Alliance, said:

“Thousands are dying every year thanks to Britain’s health service not delivering the standards people expect and receive in other European countries. Billions of pounds have been thrown at the NHS but the additional spending has made no discernable difference to the long-term pattern of falling mortality. This is a colossal waste of lives and money. We need to learn lessons from European countries with healthcare systems that don’t suffer from political management, monopolistic provision and centralisation.”

Professor Karol Sikora, Medical Director of CancerPartnersUK, steering group member of Doctors for Reform and author of the foreword to the report, said:

“The NHS should not be a religion, with its structure set in tablets of stone. We face a choice between a modern, consumer driven service for all or a decaying, bureaucratic system which only those with their own resources manage to escape. Politicians need to read this report carefully and determine the optimal strategy they can put to a well informed public. Those that capture the best way forward will carry the British voter with them.”

From:
http://tpa.typepad.com/bettergovernment/2008/01/major-study-on.html

Social care watchdogs merger will risk lives claims Healthcare Commission

Gordon Stalinist Brown’s plan to merge three health and social care regulators was dealt a blow after the chairman of the healthcare inspectorate described the reorganisation as a costly distraction that will put lives at risk.

In a startlingly forthright submission to a parliamentary committee, Sir Ian Kennedy, chair of the Healthcare Commission, all but called for the merger to be aborted because it would set back the development of a culture of safety.

The labour government has proposed a three-way merger of the Healthcare Commission, the Commission for Social Care Inspection and Mental Health Act Commission to strengthen regulation and save £60m ($118.5m).

However, the wind-up costs have been estimated to be £140m and the reforms have been opposed by all three existing bodies.

Sir Ian, the former chairman of the government inquiry into the scandal of children’s heart surgery at the Bristol Royal Infirmary, said “The reasons for the bill are unclear, the costs are high, the distraction is very considerable and the risk of harm to patients is significant.”

In a stark warning to the labour government, he added: “If one patient dies whose death could have been avoided because of the distraction of the search for the ideal regulatory structure, the public will have been ill served by this proposed legislation.”

Norman Lamb, Liberal Democrat health spokesman, described it as “a devastating condemnation of the proposal”.

“The government would be well advised to take this seriously and think again about whether they can justify this. This sense of perpetual reorganisation drives health professionals and the public crazy.”

In his submission, Sir Ian argued the rationale for the reorganisation was unsound, claimed alternative models for reform had not been explored, and the extra powers for regulators “sounded impressive” but were impractical.

Less than four years after the existing organisations were founded, Sir Ian said we were entering an unnecessary “period of flux”.

“Managers will be organising ‘away days’ and locked in meetings over organisational design ... instead of meeting the accelerating demands and expectations of patients.”

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Ministers back GP plan that sidesteps contracts

Family doctors face working unorthodox hours in so called super surgeries under a radical pilot scheme that could turn into a nationwide blueprint for medical care.

Ministers have given their backing to an initiative in Birmingham that is seeking to sidestep the controversial GP contract by encouraging doctors effectively to reapply for their jobs.

The project has angered the British Medical Association for seeking to corral GPs working alone into multi-doctor health centre "franchises" that would have set standards, longer opening hours and offer services ranging from x-rays to mental health advice.

"The idea that you can franchise health care and put health service workers in a uniform franchise like McDonald's sounds so ridiculous I cannot believe anyone would consider doing this," said Laurence Buckman, chairman of the BMA's GPs committee. "Working evenings and weekends . . . is the only thing that matters to Gordon Brown."

The Heart of Birmingham Teaching Primary Care Trust's corporate franchise strategy suggests the model could eventually allow private providers, such as "Virgin, Tesco or Asda", to quote the document, enter the market for GP services.

Managers are unable to force GPs to give up their single-practice surgeries. But they believe making doctors sign up to franchise agreements - overlaid on their existing contracts - will make them extend opening hours and offer more services, which would be easier to achieve in a bigger surgery. Doctors who opt out would face intense competitive pressure from other surgeries, managers believe.

The initiative may give the labour government a way to meet its pledge to increase out-of-hours care without having fully to renegotiate controversial GP contracts that gave family doctors a sharp pay rise through incentives that tended to shorten opening hours.

Health officials are closely monitoring the Birmingham scheme to see whether it can be used as a nationwide model. Ben Bradshaw, health minister, said: "Improving the quality and flexibility of GP services is a priority for the public. I applaud initiatives such as Birmingham's to respond to the views and needs of the local community."

From:
http://www.ft.com/cms/s/0/13fa0aac-ac42-11dc-82f0-0000779fd2ac.html

Health Direct notes that this is the same Brown Mr Bean that negotiated away the need for doctors to work weekends in the first place.

On January 31, 2007 Health Direct posted BMA team 'stunned by GP contract' as a bit of a laugh

GPs were so stunned by the terms offered to them when negotiating their new contract in 2004 that they thought it was a "bit of a laugh", a doctor has said.

Dr Simon Fradd, who was one of British Medical Association's GP negotiators, said they were shocked by the approach taken by the labour government. They could not believe it when GPs were given the chance not to do evening and weekend work for only a 6% pay cut, he said.

Targeted cleaning is key to MRSAsuperbugs

Targeted cleaning to tackle MRSA hotspots is the key to reducing hospital infections, an expert says. Microbiologist Dr Stephanie Dancer said cleaning should focus on objects which people frequently touch rather than on "catch-all blitzes".

She found bed linen, gowns and tables were a more common source of the superbug than floors, the Lancet Infectious Diseases study said.

The most common MRSA superbugs sites are:
Bed linen - 41% of sites contaminated
Patient gown - 40.5%
Overbed table - 40%
Floor - 34.5%
Furniture, bed-rails, side-rails - 27%

Dr Dancer, from Glasgow's South General Hospital, said the problem was that hospital cleaning tended to concentrate on areas of visible dirt such as floors.

But she said they would be much more effective if they targeted hotspots that hands came into contact with regularly.

She added that without such strategies, campaigns to get people to wash their hands were not effective.

Bed linen, patient gowns and overbed tables were the most common sources with over 40% of these sites contaminated. Door handles, bed-rails, furniture and taps were also common sources, she said.

Dr Dancer also claimed that the cleaning did not even need to be done with state-of-the-art cleaning agents.

"Hot soapy water is enough," she said.

"Governments across the UK need to reconsider their approaches. We are just trying to remove visible dirt from areas such as floors when this is not the best approach," she added.

She also criticised the Department of Health in England for the plans for a deep clean of hospitals. "It is like using a sledgehammer to crack a nut. And anyway it will only have an impact in the first week and then hospitals will be dirty again."

Chief Nursing Officer Christine Beasley said the government was using a range of measures, including enforcing hygiene rules with the threat of fines.

But she defend deep cleaning as an "important tool".

She added: "Infection control is a complex problem that needs a range of solutions and the fact is there is no single remedy."

From:
http://news.bbc.co.uk/1/hi/health/7069897.stm

Health Direct notes that most of the experts' suggestions for solving the MRSA superbugs crisis are sadly lacking from Stalinist Brown's centralist dictat:

On Sept 26, 2007 Health Direct posted: Gordon Stalinist Brown pledge on NHS funding and MRSA

Hospitals are to use new deep clean techniques in which wards are stripped and subjected to steam cleaning and high strength disinfectant in an attempt to reduce outbreaks of MRSA and C difficle superbugs.

Labour rewards drug addicts as only 6pc of users are free of drugs each year.

Heroin and cocaine addicts on the labour government's treatment programme are being given drugs as a reward for clean urine samples, Health Direct has learned.

The National Treatment Agency (NTA), which runs the £500m-a-year scheme, admits the practice is "unethical".

Its own survey of almost 200 clinics in England found users were being offered extra methadone, a heroin substitute, or anti-depressants for good behavior.

A third of clinics in the survey said users who produced a drug-free urine sample may be offered increased doses of heroin substitute as a reward - known as "contingency management".

A quarter admit that clients can choose the type of substitute drugs they want.

The survey also found clinicians offering anti-depressants, cash vouchers or access to detox as a reward.

The NTA said offering drugs for anything other than clinical need was wrong and it wanted certain practices "squeezed out of the system".

The agency's chief executive Paul Hayes told the BBC: "One of the things that's important before we start rewarding people through things like contingency management is to make sure that we're doing it according to the best principles for drug treatment.

He said the NTA was set up to not only expand the provision of drug treatment, but also to improve its quality.

He added: "It is entirely appropriate to prescribe other drugs alongside prescription drugs that are to deal with withdrawal. Not as a reward, which is why we wouldn't advocate it.

"What we would say is the dose people get ought to be determined by the individual's needs, not by whether or not they're co-operating with the regime.

"That's why the contingency management programme that we're thinking of introducing, based on American research, is going to be very different to the ad hoc rewards that operate in not very well managed services in this country at the moment."

Martin Barnes, chief executive of drug information charity DrugScope, said it was "appalling" to offer drugs as a reward.

"The idea of bribing the patient to achieve a result which wasn't actually something they felt important is quite abhorrent" said Dr Michael Ross who was a drug service clinical director in Bradford

"It is a complete distortion of the principles of 'contingency management'," he said. "The practice is unethical, contrary to official guidance and creates potentially serious risks for the drug user."

Matthew Taylor, of the Royal Society of Arts, a think tank looking at how best to get addicts off drugs, said an overhaul of current policies was needed.

"I think the reality is that our drug strategy just isn't working," he told BBC One's Breakfast.

"Only a very small proportion of those people who are put through drug detoxification successfully complete the programme, and even when people do successfully complete the programme they revert to drug use very quickly.

"So we need a different approach, and the fact that some people feel that they need to incentivise drug users with other drugs in order to keep them off illegal drugs is, I think, part of that general problem."

The drugs treatment project is the centrepiece of labour government strategy. Only about 6% of users on the programme leave free of drugs each year.

However, there is evidence that giving addicts access to services can reduce crime and improve health even if they continue to take drugs.

From:
http://news.bbc.co.uk/1/hi/uk/7049934.stm

Drug addicts problmes are compounded by labour's failed financial fudges. On August 01, 2007
Health Direct posted: Hypocrite Stalinist Brown cuts £50m from drugs rehab budget

The flagship labour government scheme for treating drug addicts faces swingeing budget cuts of £50 million.

Plans to slash total funding by more than 12 per cent, outlined in an email leaked to The Sunday Telegraph Health Direct has learnt , come less than a fortnight after Stalinist Brown tried to show off his anti-drug credentials by signalling his desire to reclassify Cannabis from Class C to the more serious Class B. The Conservatives accused the Prime Minister of hypocrisy.

Health efficiency gains data uncertain

Up to three quarters of the £13.3bn efficiency gains the labour government claims to have made may be based on unreliable and inaccurate estimates, a committee of MPs has found.

In a scathing report into the Gershon efficiency drive, the Public Accounts Committee (PAC) argues that just £3.5bn of the gains “represent efficiencies”. The remainder of the savings are “uncertain” because departmental calculations are often inconsistent, unsustainable, unsound and incomplete.

Service quality may have deteriorated instead of improved in some instances, the report claimed. Patients spending less time in hospital were classified as an efficiency saving, for example, in spite of a rise in re-admission rates.

The committee’s conclusions echo the findings of an investigation by the National Audit Office this year. Edward Leigh, PAC chairman, said the Treasury claim “does not stand up to close scrutiny”. “Too much of the data on which claims of efficiency gains are founded is simply unreliable.”

As he underlined in Tuesday’s pre-Budget report, Alistair Darling, the chancellor, aims to make £30bn of savings by 2010 with departments making 3 per cent efficiency savings every year.

Many projects included one-off savings rather than long-term improvements, excluded ongoing costs to maximise the apparent gains and misrepresented staffing figures to show headcount reductions.

A £300m saving by the Department of Work and Pensions from paying benefits electronically, for example, failed to take account of the £164m cost of the Post Office card account, through which some of those payments are made.

The committee concluded that the Office of Government Commerce, which verifies efficiency claims, left many calculations “insufficiently challenged”.

From:
http://www.ft.com/cms/s/0/4558bfc0-7787-11dc-9de8-0000779fd2ac.html?nclick_check=1

On March 02, 2006 Health Direct posted Why is NHS productivity falling- yet Labour claims it could be rising? when the Office for National Statistics started a fierce disagreement over output and productivity in the National Health Service this week as it launched a consultation into the issue.

The ONS reported that different techniques could show NHS productivity rose by 1.6 per cent a year between 1999 and 2004 or that it fell by 1.5 per cent a year. Official figures show a decline of close to 1 per cent a year.

The Department of Health's preferred view raises NHS output by 2.68 percentage points a year, while independent research by the National Institute of Economic and Social Research and the University of York recently estimated a more modest uplift to NHS output of 0.17 percentage points. This would not be enough to show rising health productivity.

The most controversial element in the department's reasoning is an automatic 1.5 percentage point a year uplift in measured NHS output to reflect the increased value of public services as society becomes richer.

Another problem was the Department of Health's assumption that patients' satisfaction at cleaner hospitals has as much weight in its calculations as the NHS's ability to save lives. Andrew Street, a senior research fellow at the University of York, said there was no "empirical basis for the weights" the department used.

Tony crony Lord Darzi's health review targets GPs and MRSA superbugs

Lord Ara Darzi, Health Minister and author of the interim report on the NHS says that every patient who stays in hospital will be screened for the superbug infection MRSA and at least half of GP practices will open on Saturday mornings or one or more evenings per week.

Tackling infections which can be acquired both in an outside of hospital, is a key theme of Sir Ara Darzi’s interim review of the NHS in England.

Nurses will be required to swab all patients admitted for planned and emergency procedures, to test for life-threatening infections which could put other patients at risk. Those with positive results will be placed in isolation and given creams and body washes to clear the bugs.

Lord Darzi, a Health Minister and part-time surgeon, is conducting a review of services across England and Wales and also aims to improve patients’ access to their local GPs. Gordon Brown and Alan Johnson, the Health Secretary, attended the launch of an interim report on his review in London.

The report was published amid claims by campaigners and opposition MPs that it had been brought forward for publicity purposes amid mounting speculation of a snap election. Doctors and Opposition parties accused the Government of using the NHS as a “political football”.

Lord Darzi's study sets out how local Primary Care Trusts could work with new and existing GP practices to ensure greater flexibility on opening hours.

Family doctors have come under fire in recent months after nine out of ten decided to “opt out” of providing care on evenings and weekends.

Lord Darzi announced today that the Government’s aim was that at least half of all GP practices would open on Saturday mornings or one or more evenings per week.

A total of 150 GP-run health centres that open seven days a week, 8am to 8pm, will also be established in prominent locations around the country.

In addition, more than 100 new GP practices with up to 900 GPs, nurses, and health care assistants will open in the quarter of primary care trusts with the poorest provision, he said. The aim is to improve the health of people living in deprived areas.

Under measures aimed at tackling hospital bugs, all patients entering hospital for planned and emergency procedures will be screened for MRSA.

The Government’s aim is to screen all elected admissions for MRSA next year, rising to include all emergency admissions over the next three years.

The Lancet, a leading medical journal, said the only way to beat infection was through hand-washing.

Lord Darzi said: “Cleanliness is not just about wards being clean. It’s about preventing the spread of infection. I wash my hands for at least five minutes before I carry out an operation. I tell patients not to let anyone touch them unless they have washed their hands.”

The Darzi review was announced in the summer with the final report expected next year in time for the 60th anniversary of the NHS. But doctors and political parties are sceptical about the Government’s motives, as the interim report was not expected for another week.

Jonathan Fielden, of the British Medical Association, said: “We hope it will set out a clear vision for the NHS and be about engaging with clinicians. But my concern is that it will be about getting good news about before an election.”

Shadow Health Secretary Andrew Lansley said: “Bringing forward Darzi’s findings so soon is yet another example of this labour government using our NHS as a political football.

“How can NHS professionals feel confident and how can patients feel safe when they know that this report must have been cobbled together without consideration for clinical evidence.”

Norman Lamb, Liberal Democrats’ health spokesman, said it had only been three months since Gordon Brown launched the review.

“How much can he have listened while engineering all the talk about elections? The key to providing better services to patients is making the NHS more responsive to local communities, not a plan imposed on the whole country by ministers sitting in Whitehall.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article2588491.ece

Stalinist Brown's MRSA superbug plans ignore scientific evidence claims Lancet On 28 Sep 2007 Health Direct posted that the Labour government plans for tackling superbugs, such as MRSA, have been condemned by a leading medical journal for not being based on scientific fact.

The Lancet said there was little evidence to support hospital "deep cleans" or short sleeves for medical staff as also recently mentioned by Health Direct.

Brown's superbug plans ignore evidence claims Lancet

Labour government plans for tackling superbugs, such as MRSA, have been condemned by a leading medical journal for not being based on scientific fact. The Lancet said there was little evidence to support hospital "deep cleans" or short sleeves for medical staff as recently proposed.

Instead of "pandering to populism" politicians should listen to the evidence, the editorial said.

The government said the plans were part of a wide range of preventive measures.

Prime Minister Gordon Stalinist Brown announced plans to "deep clean" hospitals ward by ward over the next year to return hospitals to the state they were in when they were built.

His comments followed proposals from Health Secretary Alan Johnson for a new dress code for NHS staff which would advise against long-sleeved coats and ties for doctors as they can become contaminated.

But The Lancet said a government working group had found no conclusive evidence that uniforms or other work clothes posed a significant hazard in terms of spreading infection.

Instead the focus should be on disinfection of high touch surfaces rather than deep-cleaning wards to get rid of visible dirt, the journal said.

The editorial said: "Brown also plans to double the number of hospital matrons, to check on ward cleaning, and accost doctors wearing long sleeves.

"They would be better employed making sure doctors, nurses and visitors wash their hands properly, the proven way to stop hospital acquired infections," the editorial stated.

Professor Richard James, director of the Centre for Healthcare Associated Infections at the University of Nottingham agreed the evidence on transmission of infection from clothing such as long sleeves was not clear but short sleeves may encourage staff to wash their hands properly.

He added: "The main route of transmission of MRSA is person-to-person contact and this will be affected little by deep cleaning.

"In contrast, Clostridium difficile is transmitted by contact with faecal contamination so it may be more effective here."

He said in addition to hand washing, other useful strategies would be screening patients for MRSA on admission, regular use of hydrogen peroxide vapour generators to kill bugs in the hospital environment and educating patients and visitors on ways they can reduce risk.

Chief Nursing Officer, Professor Christine Beasley said there was no single solution and the new proposals were part of a wider set of measures to reduce hospital-acquired infections.

She agreed that there was no evidence that uniforms themselves pose a significant risk of transmitting infections but said long sleeves and watches "get in the way of washing and decontaminating the hands, wrists and forearms".

"Clean and tidy hospitals and staff are very important to patients," she said. "We make no apology for asking hospitals to take every reasonable measure to reduce infection and increase patient confidence that this is an issue the NHS is taking seriously."

Dr Mark Enright, an expert in molecular epidemiology at Imperial College, London said deep cleaning would be a waste of resources and an inconvenience to patients and staff.

"MRSA is a major problem in the UK because it is present, mostly unknowingly, in patients and staff.

"Interrupting the chain of transmission from these people to new hosts should be the main focus of infection control, not attempts at the sterilisation of floors and windows."

From:
http://news.bbc.co.uk/1/hi/health/7016425.stm

On Sept 26, 2007 Health Direct posted: Gordon Stalinist Brown pledge on NHS funding and MRSA as hospitals are to use new deep clean techniques in which wards are stripped and subjected to steam cleaning and high strength disinfectant in an attempt to reduce outbreaks of MRSA and C difficle superbugs.

Earlier this year (11 Jan 07) Health Direct also posted that NHS hospitals may never achieve MRSA superbug targets when the NHS was not on track to meet its MRSA target and perhaps never will, a leaked labour government memo said.

Gordon Stalinist Brown pledge on NHS funding and MRSA

Hospitals are to use new deep clean techniques in which wards are stripped and subjected to steam cleaning and high strength disinfectant in an attempt to reduce outbreaks of MRSA and C difficle superbugs.

The move comes as Gordon Brown seeks to make the state of the National Health Service a top priority and will be funded with £50 million from strategic health authority budgets.

Deep cleaning will be used to target the superbug Clostridium difficile, which has proved more difficult to reduce than MRSA.

Hospitals are expected to begin the programme from December, although health professionals said that basic hygiene, such as handwashing and other cleanliness, was the key to eradicating hospital-acquired infections.

Mr Brown announced the move in a column in a Sunday newspaper, writing: “A ward at a time, walls, ceilings, fittings and ventilation shafts will be disinfected and scrubbed clean.”

Mike Penning, a Conservative health spokesman, said: “Thousands of relatives who have lost loved ones to hospital diseases each year will be asking, ‘What has Gordon Brown been doing for the past ten years?’”

From:
http://www.timesonline.co.uk/tol/news/politics/article2518134.ece

As for the prospective of an imminent general election- don't hold you breath as Brown like any bully is running scared. He hasn't got the funds nor the candidates in place

Sir Bob Worcester, of Mori, is unconvinced. “The polls are being so misread that I almost weep reading some of this nonsense,” he said. “There is absolutely no way this guy is going to call an election.”

Health Direct notes that the Stalinist's trite idea of deep cleaning hospitals over Christmas is as fatuous as John Not Fit For Purpose Reid's broken promise of halving the number of MRSA cases. The government hasn't a clue how many people have MRSA now- up until last month they only counted cases in the over 65 year olds.

Also Brown cynically doesn't promise clean wards. All he mentions is cleaner hospitals. Until he develops a zero tolerance towards dirty hospitals we are all going to suffer.

Earlier this year (11 Jan 07) Health Direct also posted that NHS hospitals may never achieve MRSA superbug targets when the NHS was not on track to meet its MRSA target and perhaps never will, a leaked labour government memo says.

On 2 May 07 Health Direct posted that Deadly NHS superbugs continue rising with C difficile again up when more hospital patients in England are getting the deadly Clostridium difficile bug, figures show.

Health Protection Agency (HPA) data showed 55,681 cases were reported among over 65s in 2006 - up 8% in a year. MRSA cases continued their downward trend, but they are not falling quickly enough to meet Labour's target next year.

A terrible way to treat our doctors- Financial Times Comment

Modernising Medical Careers (MMC) is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service. The phrase is a perfect example of newspeak. To oppose a "modern" system is to be a conservative, if not a reactionary.

Yet, like all systems of centralised planning, this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever-growing capture of hitherto autonomous professions and institutions by the state.

Like most outsiders (and many insiders), I find it impossible to understand precisely what has happened, but having a daughter-in-law at the sharp end has helped. The outlines at least are clear. They also offer a classic example of how a government-run monopoly behaves.

What, then, lay behind the fiasco that Modernising Medical Careers has become? There appear to be three causes.

First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.

Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.

Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.

As always, reasons existed for the shift to central planning: critics complained that the traditional apprentice system was riddled with favouritism; and the European Union's working time directive sharply cut hours for junior doctors, which not only necessitated a greater number of them, but also reduced the experience each would gain from a given period of training.

Some reform was presumably necessary. But this one is an object lesson in what happens when the government introduces a "big bang" shift to a centralised, computer-driven system. A bureaucratic monster replaced what had been a moderately flexible, albeit imperfect, system.

In the old system hospitals hired senior house officers; now they are sent them like a parcel of slaves. In the old system, if doctors did not get a job first time they could keep on applying; in the new system, they were to be given just one chance a year.

In the old system, if they made a wrong choice it was relatively easy to change; in the new system, doctors must decide early and are then stuck with the consequences. In the old system, hospitals could change the mix of junior doctors relatively easily; in the new system, nobody knows what flexibility will exist.

Allocations to training posts are within huge geographical areas. But doctors are dispatched, like so much meat, to one hospital. Do they live hours away? That is tough luck. Do they have a partner, or even children? That is just tougher luck. Do they wish to switch hospital or sub-speciality? They must be joking. Do they wish to know the terms and conditions of their employment before arriving? They must reallybe joking.

To put the point bluntly, these highly trained professionals, on whom you may depend for your lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone so treated?

To make the computerisation manageable, the doctors were allowed only very limited choices - far too few to eliminate random factors. As the chaos mounted, people were offered just one interview each.

The result was that those most likely to fail to get a job were the best, because they made the most desirable options their first choice. To make the computerised system "fair", much of the detail of people's careers and the detailed knowledge of those they worked for were also eliminated.

Centrally planned systems always eliminate latent knowledge, ignore human motivation and destroy flexibility. It was predictable that this Gosplan for the training of doctors would end up just as it has. It could not do anything else. This is a superb example of how the combination of centralisation of power with a belief in rationalistic planning works in the real world.

No less predictable is the fact that those who made these blunders are still in place. One might have expected resignations, starting with Sir Liam Donaldson, chief medical officer.

But bureaucrats are far too grand to be held accountable. It is doctors whose lives are disposable. Who cares that they have devoted up to a decade to the acquisition of knowledge and experience? Who cares that patients will be worse served? What matters is that the Department of Health is firmly in charge.

So is the NHS suffering from an excess of free market zeal, as many on the left believe? Hardly. Where it matters, the planners are in charge. As always, they are making a big mess and, as almost always, they look likely to get away with it unscathed.

By Martin Wolf
http://www.ft.com/cms/s/0/bb574538-5cda-11dc-9cc9-0000779fd2ac.html

Health Direct notes that the Financial Times then printed a torrent of letters in response to this considered review. Two are included below:

Bureaucratic machine that cares little for best medical practice

From Dr Angus McNair.

Sir, I would like to congratulate Martin Wolf for such an accurate summary of the feelings of junior doctors at the present (“A terrible way to treat our doctors”, September 7, 2007). I have been struggling to explain to people outside the profession exactly how bad this process has been and he has described it very eloquently.

Like the majority of doctors, I entered this profession with the main aim of looking after patients. I realised that this would involve sacrifices to many aspects of my life, but I accepted these sacrifices with this aim in mind.

When a patient you are responsible for is sick you need to be with them and have the knowledge and skills required to treat them. This is what motivates doctors to work as hard as they do, not the financial reward or apparent “social status”, but the knowledge that you make a difference when it counts.

Therefore it seems farcical that our employers would do anything but create a supportive and flexible environment for us to practise.

This process has only succeeded in making us feel undervalued and is demotivating the whole workforce.

It becomes very difficult to make these great personal sacrifices when they are in the name not of patient care but of a bureaucratic machine that seems to care little for your welfare or best medical practice.

Angus McNair,
Bristol BS8 4BG

http://www.ft.com/cms/s/0/b4b6eed2-6008-11dc-b0fe-0000779fd2ac.html

Ministers were warned but insisted on the ‘big bang’ approach to change

From Dr Andrew Rowland.

Sir, Martin Wolf is absolutely right that the implementation of the Modernising Medical Careers applications process has left us with an inflexible system that threatens professional standards in the NHS.

Thousands of junior doctors are now in posts for which they are massively overqualified, in areas where they do not want to be or specialities they would not have not chosen. Many are being underpaid by their new employers, who claim that they have had insufficient time to identify the hours their new trainees are working.

But, as Mr Wolf quite rightly points out, ultimate responsibility for this whole mess lies not with NHS trusts but with the ministers and civil servants who insisted on a "big bang" approach to change.

There was little engagement with the medical profession, which repeatedly warned that disaster was looming. Even when 10,000 doctors took part in a public protest calling for the plans to be delayed, the government ploughed ahead.

Doctors are understandably concerned that their professionalism is being undermined and that standards of care could be eroded. A recent survey of British Medical Association members showed that nine in 10 believe MMC, in combination with working time reductions, represents a threat to the "gold standard" of consultant training for which the NHS used to be famous.

Those who call for trainee doctors to show more flexibility should be aware that they are at the mercy of a monopoly employer, and that within such a rigid appointments system it is verging on the impossible to change posts. Insofar as it is possible for the government to address the bitterness of junior doctors, a relaxation of the rules on job transfers would be a step in the right direction.

Andrew Rowland,

Vice-Chairman,
Junior Doctors Committee,
British Medical Association

http://www.ft.com/cms/s/0/7a2aee9a-6007-11dc-b0fe-0000779fd2ac.html

NHS dentists can cost more than private

Patients are paying less for some private dental treatment than they do on the NHS because of controversial untested changes introduced by the labour Government last year. The price for a filling on the NHS is now £43.60 but some private surgeries charge just £35, Health Direct and the Daily Telegraph can reveal.

The findings have led to accusations that NHS patients are being ripped off under a system one dentist branded "wicked".

Dental industry leaders said the disparity between charges had been caused by the new contract the Government had imposed on dentists, which was designed to simplify treatment costs.

Patients pay a flat rate of £43.60 whether they have one filling or six. If they went outside the NHS they would have to pay for only one filling, although many private surgeries do charge much more.

The disclosure comes after an official report revealed that 47,000 fewer patients were being treated since the new NHS contract came into force in April last year and at least 500 dentists have left the health service.

Two million people are trying to register with an NHS dentist but are unable to find one to take them.

Since the untested changes took effect NHS dental treatments have been banded under three costs.

A band one treatment, such as an examination, X-ray or scale and polish, costs £15.90.

Band two treatments, which include anything from one to six fillings or root canal work, cost the patient a fixed flat rate of £43.60.

Band three treatments are crowns, dentures and bridge work and cost the patient £194.

For each treatment carried out dentists earn points, called Units of Dental Activity (UDA), the price of which is set locally and is an average of about £20.

For a band one treatment the dentist earns one UDA, for band two they earn three and for band three they earn 12.

Dentists have been given targets on the number of UDAs they must carry out each year but if they exceed it they are not paid more.

Those who missed their target this year have been asked to pay back thousands of pounds, meaning more dentists are now considering leaving the NHS.

The Daily Telegraph understands that some dentists are playing the system by splitting treatments across several visits so they can collect a new set of payments for each visit.

Ian Mills, who runs a practice in Torrington, Devon, said: "Financially the contract is worse for patients than it is for dentists. If a dentist does complex treatment they are penalised.

"If I have a patient with an abscess I could save that tooth by doing a root filling, which would take two hours, or I could take it out, which would take 20 minutes. Ethically, I should save the tooth but they are the same financial reward so the incentive is to remove the tooth."

Anthony Halperin, the chairman of the Patients Association and a dentist, said: "I am convinced that this contract is not to patients' advantage.

They are not being treated as efficiently as they were under the old system and they are paying more for it.

"Dentists are so driven by hitting targets that there is no incentive to carry out complex work that might be best for the patient. I fear more dentists will leave the NHS."

Peter Ward, the chief executive of the British Dental Association, said: "For a government to be responsible for building a system that drives these potential incentives is wicked. This is the reason dentists are deciding to leave the NHS. We can't have a situation where delivering the best care for your patients means you lose money."

The BDA's records show that 1,600 dentists left the NHS before the new contract was implemented in April 2006.

Mr Ward said he expected more dentists to leave the NHS this year as the inadequacies of the contract were now becoming a reality.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/13/nhs113.xml

The scandal of labour's dental hypocrisy is boundless. On Oct 09, 06 Health Direct posted: Dentists abandon children on NHS when up to two-thirds of children in some areas of England are failing to get regular dental treatment as thousands of youngsters have been dropped by dentists no longer willing to provide free National Health Service care.

This weekend dentists have warned that children will find it even more difficult to get free dental care in the future as fewer dentists undertake NHS work.

Dentists believe access to the NHS will worsen because of government reforms to the way they are paid. A survey of local dental committees, carried out by the British Dental Association, showed 90% predict access to NHS dentistry will worsen.

On the other hand on March 13, 07 Health Direct posted: Hypocrite Stalinist Brown bitten over private dental work

The chancellor has been accused of spurning the National Health Service by paying hundreds of pounds for routine dental work to a private dentist known for his celebrity clients. Gordon "Stalinist" Brown had root canal work done by Mervyn Druian, who runs a surgery in north London. He charges up to £650 for the procedure, compared with a standard NHS cost of £42.

His choice has angered critics who blame Labour for the virtual disappearance of NHS dentistry in large parts of the country, with claims that more than 1m people have lost dental cover in the past year alone.