Labour hid ugly truth about National Health Service (NHS) neglect

Damning reports on the state of the National Health Service, suppressed by the labour government, reveal how patients’ needs have been neglected.

They diagnose a blind pursuit of political and managerial targets as the root cause of a string of hospital scandals that have cost thousands of lives.

The harsh verdict on the state of the NHS, after a spending splurge under Labour between 2000 and 2008, raises worrying questions about the future quality of the health service as budgets are squeezed.

One report, based on the advice of almost 200 top managers and doctors, says hospitals ignored basic hygiene to cram in patients to meet waiting time targets.

It says “several interviewees” cited the Maidstone and Tunbridge Wells [NHS Trust in Kent where 269 deaths during 2005-6 were caused by infection with Clostridium difficile bacteria].

“Managers crowded in patients in order to meet waiting-time targets and, in the process, lost sight of the fundamental hygiene requirements for infection prevention,” the report stated.

There were subsequent failings at health trusts in Basildon in Essex, and Mid Staffordshire. Filthy wards and nurse shortages led to up to 1,200 deaths at Stafford hospital.

Lord Darzi, the former health minister, commissioned the three reports from international consultancies to assess the progress of the NHS as it approached its 60th anniversary in 2008. They have come to light after a freedom of information request.

The first report, by the Massachusetts-based Institute for Healthcare Improvements (IHI), identified the neglect of patients as a serious obstacle to improving the NHS. “The lack of a prominent focus on patients’ interests and needs ... represents a significant barrier to shifting the trajectory of quality improvement in the NHS.”

One heading in the report says: “The patient doesn’t seem to be in the picture.” It adds: “We were struck by the virtual absence of mention of patients and families ... whether we were discussing aims and ambition for improvement, measurement of progress or any other topic relevant to quality.

“Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experience of care.”

This weekend it emerged the recommendations of the reports, intended to help the NHS improve, have not even been circulated.

The stark assessments, collected from leading NHS clinicians and managers, include:

A damaging rift between doctors and managers: “The GP and consultant contracts are de-professionalising, and have had the peculiar effect of simultaneously demoralising and enriching doctors. We’ve lost the volitional work of the doctors and far too many of us are now just working to rule.”

Pointless new structures. “Stop the restructurings. The only thing they generate is redundancy payments.” One body responsible for improving standards reported to five different ministers and had three different names in the space of 30 months.

A culture of fear and slavish compliance. “The risk of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.”

The IHI report, whose interviewees included Lord Crisp, chief executive of the NHS between 2000 and 2006, also described a system of self-assessment where only 4% of trusts are externally inspected.

A similar picture emerges in the second report, by the US-based Joint Commission International. It says the “quality and integrity of [NHS]performance data is suspect”.

Dennis O’Leary, its lead author and an international expert on patient safety and improvement, said it was not intended as an exposé but as a series of useful suggestions for change.

“Our instructions were to pull no punches and tell it like it was, but the report wasn’t overstated,” he said. “It was how we saw things based on interviews with more than 50 people.”

The third report, by the US-based Rand Corporation, expresses surprise at the lack of a requirement to identify the specific drug involved when patient accidents are reported.

In 2008 Darzi issued his own blueprint for the future of the NHS, High Quality Care for All, but resigned from the government last July to return to his surgical commitments.

Last week he said: “The NHS is continuing a journey of improvements, moving from a service that has rightly focused on increasing the quantity of care to one that focuses on improving the quality of care.

However, Brian Jarman, emeritus professor at Imperial College London and an expert in hospital standards, said the findings should have been made available to Robert Francis QC, who led the inquiry into the Mid Staffordshire NHS Foundation Trust.

He said: “These reports have never seen the light of day. We desperately need a better monitoring system for the NHS which actually works.”

From:

http://www.timesonline.co.uk/tol/news/uk/health/article7052606.ece

Government to clamp down on health tourists

A new clampdown on health tourism by foreigners who visit Britain for NHS treatment was announced by ministers.

Compulsory health insurance for visitors, refusal of treatment to failed asylum seekers who do not co-operate with the authorities, and a ban on entry for foreigners who have outstanding debts for previous NHS treatment are among measures proposed.

The Department of Health said the measures could save between £6m and £20m over five years. Emergency treatment and treatment for infectious diseases would remain free for all. 

The measures were condemned by human rights organisations but received a qualified welcome from the British Medical Association, which has previously refused to countenance the denial of treatment to patients in need.

A spokesman said: "The BMA appreciates that the NHS does not have infinite resources and that there is a need to restrict services to patients who are eligible to receive them."

"However, we will seek assurances from the Department of Health that, where there is genuine clinical need, doctors will have the discretion to provide treatment, irrespective of an individual's immigration status."

From:

http://www.independent.co.uk/government-to-clamp-down-on-health-tourists

NHS Hospitals to feel the axe as Treasury cuts £11bn

Alistair Darling will reveal details of how he plans to cut £11 billion from Whitehall spending in the pre election Budget.

The £11 billion is the first instalment of drastic cuts intended to slash £82 billion in four years from the record £178 billion deficit. Some hospital buildings face closure as the government seeks to save billions of pounds from more efficient services, Mr Byrne suggested.

Until Mr Byrne’s remarks it had been unclear whether precise cuts would be unveiled next month. The move is a victory for Mr Darling, who has been tussling with Gordon Brown about how far the Budget should detail Labour’s proposed cuts and whether any extra cash should go on spending or savings.

The £11 billion referred to by Mr Byrne was sketched out in the November Pre-Budget Report, but was criticised by some for lacking detail. It is part of the £20 billion savings that will be in place by 2012-13, according to government plans. The rest is made up from freezing public sector pay, curbing public sector pensions and cutting some spending programmes.

Mr Byrne suggested that hospitals will become vulnerable as trusts look to save money and improve efficiency by providing more healthcare in the community. “Some hospitals will have to start doing more of their care in the community rather than in big expensive hospitals,” he said.

Asked if this could mean some hospital buildings closing, he said: “Yes. A lot of hospitals are thinking of moving some of their business out into the community, because it is better care, more convenient, also cheaper. I think it’s possible to improove services, saving money.”

From:

http://www.timesonline.co.uk/tol/news/politics/article7043382.ece

NHS spending squeeze to hurt PFI hospitals most

NHS hospitals built under the private finance initiative will face a much tougher time making the productivity and efficiency gains that are needed as public spending is squeezed, PFI experts and NHS managers are warning.

Under PFI, hospitals pay a single annual charge, typically for 25 or 30 years. It covers the cost of the capital, maintenance of the building and often other “soft” services such as cleaning, catering and laundry and sometimes equipment replacement.

While the soft service contracts are usually renegotiated every five or seven years, the main payments are fixed at the interest rates prevailing when the deal was done. In the current financial climate there is no possibility of refinancing them to produce lower annual payments, and the cost of buying out the contracts is prohibitive, according to PFI specialists.

Figures published by the Department of Health this week show big variations in the percentage of annual turnover that hospitals pay for their PFI buildings, largely depending on how extensive the rebuild was.

For some it is only 1-3 per cent but for others it is 10-12 per cent. For Walsgrave Hospital in Coventry, Dartford and Gravesham and Queen Elizabeth, Woolwich, it is 16 per cent and more. For Bromley Hospital it is almost 20 per cent of turn­over.

Traditionally, when spending has been tough, NHS hospitals have put back maintenance to retain doctors and nurses and other services.

“If you do that for too long, it is a thoroughly bad thing,” Nigel Edwards, head of policy for the NHS Confederation, said. “But for a year or two it can help you cope.

“But a hospital with a PFI scheme does not have that option. They are contractually bound to keep the maintenance up – and if you are spending 10 or 15 per cent on your buildings it means all the other efficiency and productivity gains you need have to come out of only 85 or 90 per cent of your budget.”

Hospitals without PFIs still paid a capital charge, so the comparison was not quite that bad, Mr Edwards said. “But some of these hospitals with PFIs are going to find it incredibly tough” to make their share of the £15bn-plus savings that the health department says are needed, he said.

Treasury officials privately acknowledge that there is an issue and hope PFI providers will prove flexible as public spending gets tougher. But David Florry, director-general of NHS finance, told MPs that while the level of cleaning of back-office areas, for example, could be reduced at the break points in the soft service contracts, there was no evidence yet that payments had gone down as a result.

William Moyes, chairman of Monitor, the foundation trust regulator, said lack of maintenance in the past had left the NHS estate in an appalling state. “On balance, having to keep up the maintenance is not a bad thing because it means patients will be treated in buildings that have been kept up to scratch.”

From:

http://www.ft.com/cms/s/0/b366ad6a-078b-11df-915f-00144feabdc0.html?nclick_check=1

More patients die as lone GPs cover thousands in opt out services

Some parts of Britain are relying on just one out-of-hours GP at night to serve more than 240,000 residents.

An investigation by The Sunday Times into the inadequacy of round-the-clock cover has established two further deaths, including that of a three-year-old boy, after failures in the system.

Brighton, Bolton and Wigan are among the areas where a lone doctor is responsible for dealing with late-night emergencies. The news follows revelations last weekend that just two GPs provide cover for Suffolk and its 600,000-strong population on some nights.

Mark Simmonds, the Tory health spokesman, said repeated warnings about out-of-hours cover had gone unheeded by ministers: “It’s disgraceful that the government hasn’t taken action over this before.”

Brighton and Hove primary care trust (PCT) has one GP to cover an area with 248,000 residents on most nights. It claimed the doctor can receive as few as 10 calls each evening. However, in one case involving the trust, a three-year-old boy from Hove died from blood poisoning after the failure of the out-of-hours service.

The frantic parents of Joseph Seevaraj phoned the duty doctor at 11pm on a Sunday and asked whether they should take their son to hospital because he was vomiting and suffering from diarrhoea.

Joseph was already taking antibiotics for tonsillitis and the doctor advised his parents, Jean and Nicola, to wait for those to take effect. They watched over the toddler closely, but he died a few hours later.

A consultant in paediatric intensive care later said she believed the child would have survived if his parents had received proper advice from the out-of-hours service.

“He needed basic medical attention,” said Veronica Hamilton-Deeley, the coroner, at the inquest. “The failure to provide it was gross failure.”

South East Health, which provides round-the-clock services for Brighton and Hove PCT, said it had learnt from the incident in January 2008.

This weekend it emerged that only one GP serves 310,000 residents in the Wigan area on most nights, while 270,000 residents in the Bolton area also have to routinely rely on a single out-of-hours doctor.

In North Somerset there is just one GP for 200,000 residents on a week night. Cambridgeshire has three GPs at night, Norfolk has four and Cumbria has six.

Such skeleton cover was introduced when labour negotiated new contracts with GPs in 2004, boosting their average salary to more than £100,000 and allowing them to opt out of providing round-the-clock care.

While some PCTs say that just one or two GPs can adequately cover a population of more than 250,000, others have more doctors available for home visits.

Under South Birmingham PCT there are 11 doctors on overnight duty, each covering an average population of about 35,000.

Hampshire has 13 GPs on duty at night and Devon has eight, working at medical centres across the county.

Patients are often unaware if their local service is in crisis because most trusts do not publish performance reports. NHS Bristol said last week that a report on the quality of its out-of-hours GPs’ service was “confidential” and “commercially sensitive”.

Most round-the-clock services struggle to fill shifts with local GPs. Instead they use doctors from other parts of the country or foreign GPs who fly in for their shifts. A parliamentary debate was told last week of a case in Cornwall in which a patient had been confronted with a foreign doctor who used “an electronic word converter” to communicate. Other patients have complained of waiting eight hours for a doctor to arrive.

There have also been complaints that out-of-hours GPs do not have access to patient notes and sometimes fail to diagnose serious conditions. In one case, a doctor working as a duty GP in West Yorkshire was suspended from the General Medical Council register after he failed to examine an elderly patient properly. She died the next day.

Dr Krzysztof Robak, 62, commuted more than 175 miles from Surrey, where he worked for a diet clinic, to his Yorkshire employer, Local Care Direct. When he visited the 86-year-old patient, he failed to check her blood pressure or take her temperature and did not consider her seriously ill.

Local Care Direct, a non profit organisation which provides out-of-hours care services for 2.5m people in Yorkshire, said it had vetted Robak rigorously before employing him.

It said it did not consider that he had contributed to the patient’s death in July 2007, but it had raised concerns about his conduct.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article7009692.ece

Whistleblower who criticised NHS cost cutting wins damages

A consultant urologist who was suspended after speaking out against cost cutting at an NHS hospital has won damages at an employment tribunal in a landmark case.

Ramon Niekrash, 50, was removed from duty at the hospital and called a "troublemaker" after he questioned the effects of cost-cutting on patients at the Queen Elizabeth Hospital in Woolwich, South London.

A tribunal ruled that he was entitled to damages because he has been acting as a whistle-blower in the public interest when he wrote letters to hospital management raising his concerns about the health of patients.

The verdict also placed blame on government targets for raising tensions between management and clinical staff at the NHS hospital.

Mr Niekrash claimed he was the victim of bullying and harassment after he criticised cutbacks at the hospital, which he said included a shortage of senior medical staff and the closure of the specialist urology ward.

At one point a senior doctor at the hospital allegedly said she wished that Mr Niekrash, who was trained in Australia, was "in chains on a plane in Heathrow back to Australia."

Mr Niekrash's lawyers said the case revealed the way in which senior NHS whistleblowers are punished for speaking out.

One case he raised was of a prostate cancer patient who was allegedly not told that he had the disease, nor given treatment for six months after he was diagnosed.

In a letter, he also accused hospital management of behaving like a "plantation owner" towards doctors, The Independent reported.

A 50-page ruling from the tribunal found that Mr Niekrash's suspension from the hospital breached laws put in place to protect whistle-blowers.

Judge Burton, sitting at the tribunal, said: "We have no doubt that the exclusion of a consultant, being a rare occurrence, must have an adverse impact on the claimant's reputation," adding that Mr Niekrash had been "hurt" and that his health had suffered.

The judge said tensions had arisen between the claimant's desire to provide health care and "the requirement of management to reduce or limit costs and also comply with varying targets laid down by the Department of Health from time to time."

A hospital spokesman said: "We are considering this judgment very carefully ... There are nearly always lessons to be learned from cases like this, and as soon as we have carefully considered the judgment, we will respond in full."

From:

http://www.telegraph.co.uk/Whistleblower-who-criticised-NHS-cost-cutting-wins-damages

Hospitals must cut services to stay afloat, watchdog quango warns

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Obese patients encouraged to put on weight to qualify for surgery

Access to NHS weight loss operations is inconsistent, unethical and a postcode lottery, says Royal College of Surgeons

Obese patients are being "effectively encouraged" to pile on the pounds to qualify for weight-loss operations on the NHS, the Royal College of Surgeons warns.

The college claims lives are being put at risk as some health trusts require patients to reach higher body mass index (BMI) levels than others before they receive surgical treatments.

The postcode lottery means that access to NHS weight-loss surgery is "inconsistent, unethical and completely dependent on geographical location", according to the college.

Last year 4,300 operations to reduce body weight were carried out on the NHS, but as many as 1 million people could meet the National Institute for Curbing Expenditure (Nice) criteria for being classed as having severe obesity.

Bariatric, or weight-loss, surgery is carried out after diets, drugs and lifestyle-altering interventions are seen to have failed. It is not generally recommended for children or young people.

"Constraints on NHS funding mean that in some areas NHS decision-makers are opting to ignore professional guidelines and are denying patients' access to surgery," the college maintains. "In others, patients who already meet the [Nice] criteria are forced to wait until either they become more obese or develop life-threatening illness like diabetes or stroke."

According to the Nice guidelines, bariatric surgery is recommended for adults with a BMI of more than 40, who have other significant diseases (for example, type 2 diabetes) that could be improved if they lost weight, and who have tried but failed to lose weight using non-surgical techniques.

The college, which is holding a conference on the issue today, says hospitals are assessing patients referred from primary care trusts under different eligibility criteria, resulting in some patients with a BMI of 60 or greater being refused surgery while others with a BMI of 40 or less are undergoing operations.

"Nice guidelines are meant to signal the end of postcode lotteries yet local commissioning groups are choosing not to deliver on obesity surgery," said the college's director of education, Prof Mike Larvin. "In many regions the threshold criteria are being raised to save money in the short term, meaning patients are being denied life-saving and cost-effective treatments, and are effectively encouraged to eat more in order to gain a more risky operation further down the line."

One bariatric surgeon, Peter ­Sedman, said: "There is absolutely no doubt that some patients more needy of surgical treatment than others are being denied it. I will treat the patient, my hospital will offer the service, but unless the patient moves house they will not be referred and if they are, the treatment is subsequently blocked."

David Haslam, chair of the National Obesity Forum, said: "Bariatric surgery is amongst the most clinically effective and cost effective specialities in any field of medicine, preventing premature death and transforming lives, whilst saving vast amounts of money for the NHS and the economy.

"Even the most cynical taxpayer should support bariatric surgery, alongside clinicians, in opposing the unethical and immoral barriers to surgery imposed by NHS purse-string holders."

The college is calling on the Department of Health to ensure all patients have equal access to treatment. It estimates that obesity problems cost the NHS £7.2bn a year.

Alberic Fiennes, president-elect of the British Obesity and Metabolic Surgery Society, said: "We recognise the difficulties faced in dealing with a 'new' disease of epidemic proportions, but to limit surgery to the most severely obese is unfair and short-sighted and against basic professional ethics. It is also contrary to strategies that are standard for diseases that overwhelm resources."

From:

http://www.guardian.co.uk/society/2010/jan/21/obesity-weight-loss-surgery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Labour's plans for elderly care put essential services at risk

Frontline services such as social work, meals on wheels and road maintenance may have to be cut to cover the cost of controversial plans for elderly care at home, local authority leaders have warned. 

The £670 million required to provide free care for those most in need in their own homes — a key government policy— will add pressure to councils already trying to find multi million Pound savings.

A rise in council tax of between 1 and 2 per cent will be needed to meet the cost, while cuts in adult and childrens’ social care services are an “unwanted but very real possibility”, council chiefs have told The Times.

The warning came as Andy Burnham, the Health Secretary, was forced to defend his Personal Care at Home Bill in a two hour appearance before the Commons Health Select Committee. He was questioned repeatedly about concerns surrounding the Bill reported by The Times, including its impact on care and clinical research budgets.

Critics believe that the costs calculated by the labour Government are a significant underestimate and care experts have attacked the policy for disrupting elderly care strategies and being little more than an attempt at eye catching electioneering.

The draft Bill, set out in the Queen’s Speech in November, was described by Labour peers as an “exocet” on social-care reform and “a demolition job” on budgets, while MPs and care providers have also criticised it for being ill-conceived and uncosted.

In the latest blow to Mr Burnham’s plans, council chiefs have told The Times that the extra costs will force tax rises and service cuts. 

Backroom staff, from lawyers and human resources workers to environmental planners, would also be at threat, as well as infrastructure programmes such as road maintenance. Plans to introduce or upgrade local amenities such as sports facilities, bus services and meals on wheels would have to be reassessed.

The annual cost of the Bill is put at £670 million, which ministers say will support 400,000 people with the highest needs to stay in their own homes. Of this total, £420 million is to come from existing Department of Health budgets. Local authorities have been told that they must provide the remaining £250 million from efficiency savings. The first year of the scheme, running from October to April 2011, would require £125 million of local authority efficiency savings.

Mr Burnham said that he “fundamentally rejected” the suggestion that the cost calculations were flawed. “The characterisation of an exocet is 100 per cent wrong,” he said.

Pressed on how £60 million of clinical research savings would be made to NHS budgets to help to fund the plans, and which areas would be affected, Mr Burnham said that it had yet to be finally decided, but would not involve frontline services.

Ken Thornber, head of Hampshire County Council and a member of the social care board of the Local Government Association (LGA), said that for councils already making multimillion-pound savings in backroom staff, this could be met only with an increase in council tax.

His council, one of the largest, was already trying to save £15 million a year and a further £15 million in 2011 to absorb inflationary pressures. “As things stand we would have to find between £5 million and £10 million over and above the £30 million which we are presently projected to need to find in 2011-12,” he said.

Mr Thornber added that it could mean up to £20 a year on council tax bills for the 550,000 households in Hampshire.

The funding from the Department of Health would not alleviate pressures on services, he said, because it was covering people who previously would have been cared for by the NHS or in care homes.

Jenny Owen, president of the Association of Directors of Adult Social Services (Adass) and director of adult social care for Essex County Council, said the council estimated that it would need to find £4 million of savings. “If you do not increase council tax by 1 or 2 per cent it will be a reduction in services.”

Andrew Lansley, the Conservative health spokesman, said that the plans were being rushed through for electoral gain. “While in an ideal world we want to give free care to as many elderly people as possible, it is simply not affordable, particularly since we are in the throes of a debt crisis. The reality is that Gordon Brown will only be able to pay for this through cuts to the NHS and higher council taxes.”

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6979815.ece

UK health groups look abroad to fight MRSA superbugs

UK companies developing products that fight MRSA hospital superbugs are complaining that there are few opportunities in their domestic markets, and focusing their sales efforts overseas.

In the UK, hospital acquired infections (HAI) such as MRSA and clostridium difficile affect 300,000 patients each year and cause about 5,000 deaths- nearly double the number of people killed in road accidents.

The problem is worse in the US, where HAIs are estimated to be one of the top 10 causes of death, claiming close to 100,000 lives every year.

And the costs are mounting. In the US, government studies estimate that the extra cost of treating a patient with HAI averages almost $9,000 (£5,600).

UK companies are among the leaders in the fight against superbugs but they say that they are encountering problems in getting their products adopted by UK hospitals. They complain that hospital managers lack accountability for deaths relating to HAIs.

In November, a report by the Department of Health criticised the NHS for not achieving “measurable reductions” in HAIs outside of MRSA and C.difficile.

“The heart of the problem is that whatever DoH says or decrees, it doesn’t necessarily impact hospitals,” says Nick Adams, chief executive of Bioquell, the decontamination technology provider. “In the US, a hospital can be sued and that’s a big deal because they’re desperate to keep it out of the press, so they’ll settle. In the UK, hospitals pass the issue very quickly on to the NHS litigation board, so it’s not the hospital’s problem.”

Synergy Health is another company that produces decontamination technology. It has concentrated its sales efforts in Asia and Europe.

One of Synergy’s decontamination products uses a disinfectant technology produced by another company, Byotrol, that has been tested by the NHS in an 11-month study. The Byotrol technology was deployed against a bleach-based product currently used by the NHS.

Despite positive results showing superior effectiveness and lower side effects, the product has not been taken up, even by the Manchester Royal Infirmary where it was tested.

Richard Steeves, Synergy’s chief executive, says that his group is making more sales to countries where hospitals are encouraged to innovate, such as in the Netherlands, where “hospitals are competing for patients”.

Although there is state-funded national insurance for health care in the Netherlands, hospitals compete with each other to provide services for a number of private insurers.

Most UK hospitals are run by the NHS, and Dr Steeves points out that many of the UK’s private hospitals are owned by private equity, and that there is financial pressure to reduce costs.

However, there are those in the sector that say that innovation by UK companies is a direct result of the “laissez faire” environment.

Paul Swinney is chief executive of Tristel, which produces a chlorine dioxide-based disinfectant that treats everything from salads in supermarkets to surgical instruments and surfaces.

Its product is used throughout the UK, which Mr Swinney says is “de facto approval”. Moreover, he says, companies here do not have to pass the expensive regulatory procedure of the US Food and Drugs Administration or the Environmental Protection Agency.

From:
http://www.ft.com/cms/s/0/f989ee86-f405-11de-ac55-00144feab49a.html?nclick_check=1

Health Direct NHS preview of 2010

Spending will dominate debates over the NHS and health – especially in an election year and the scale of NHS cuts will become apparent as the year progresses.

Already hospitals have been told that they will receive no increase in the amount of money that they are paid per procedure, essentially a real terms cut in the cash they will receive.

Overall, the health service has also been set a goal to make between £15 million and £20 million of efficiency savings over the next four years.

The fact that McKinsey, the management consultancy firm, estimates that to achieve such that a goal would take making 10 per cent of NHS staff redundant and abandoning procedures such as varicose vein operations suggests the scale of the challenge.

Patients' groups will continue to keep a close eye on the labour government’s drugs rationing body NICE in 2010. Over the last year the National Institute for Curbing Expenditure (NICE) began looking more favourably on drugs which prolong life for terminal patients, as it was instructed to do so by Government.

2009 also saw a number of drug companies come forward with innovative deals that allowed the NHS to pay less for some medicines.

But with expensive drugs for cancer and other illnesses coming through the pharmaceutical pipeline at all times patients will continue to monitor how Nice makes decisions about which drugs it will allow on the NHS.

The Government will scale up its Change4Life campaign, which so far has concentrated on children and families, to focus on adult obesity.

Despite data which suggests that rises in childhood obesity could be levelling off, ministers and health planners are still worried about the strain on the NHS if predictions that half of adults could be heavily overweight by 2050 come true.

2010 should be the defining year for the Swine flu pandemic. Will cases continue to drop or will swine flu return either early in the new year or next winter?

Sir Liam Donaldson, the Chief Medical Officer, warns that we cannot be complacent about the threat that the virus still poses and points to pandemic flus in the 1960s in which death rates were higher in the second winter than the first.

The H1N1 vaccine could be the deciding factor, but to what extent remains to be seen.

NHS hospitals face four year spending squeeze after labour's cuts

NHS hospitals are to face a four year spending squeeze in an attempt to drive up their productivity.

The so called tariff, or price paid per treatment, which covers about 70 per cent of the income of a typical NHS hospital as well as private ones that take NHS patients, is to be frozen for the next year. It will go up by a “maximum” of zero per cent for the subsequent three years – implying that it could actually be cut.

NHS hospitals will also have to make efficiency savings of 3.5 per cent next year. Where they treat more unplanned admissions than in 2008 they will be paid only 30 per cent of the tariff price – a move aimed at getting them to work with their primary care trusts to prevent unnecessary unplanned admissions.

The moves “will drive all providers to become as efficient as the highest performers”, Andy Burnham, health secretary, said in a document that sets out how he believes the NHS needs to change over the next five years.

Family doctors, who face a pay freeze next year, will also be told they have to hand back at least 1 per cent of their expenditure to primary care trusts in ­cash-releasing efficiency savings.

The strong pressure on prices will either help drive the productivity improvements that the NHS needs to achieve savings of £15bn to £20bn over the next few years, or plunge hospitals that fail to adapt into financial crisis.

Mr Burnham denied that this could mean hospital closures, but said “that hospitals will have to change” with more patients treated in the community.

The best Foundation Trusts were to be allowed to take over community services in an attempt to provide more integrated care, possibly including GP services. And over the next few years up to 10 per cent of the treatment price would depend on surveys of patient satisfaction, the aim being to create “a people-centred service”, Mr Burnham said.

The NHS was to be protected from inflation after 2011, meaning the big spending rises of recent years were being “locked in”, he added.

The Conservatives, however, pointed out that NHS employers would have to pay more than £400m in higher national insurance contributions from that year, creating “a real terms cut” in NHS spending.

Across the country, it will raise more than £9bn, while the Treasury says the inflation protection the NHS is being offered will add about £3.7bn to spending by 2012-13.

From:

http://www.ft.com/cms/s/0/947c7940-e592-11de-81b4-00144feab49a.html

New drugs available on NHS before NICE appraisal

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

MRSA superbugs not the only threat to NHS warns MPs

The labour government has taken its "eye off the ball" on hospital infections other than MRSA and Clostridium difficile, a cross-party group of MPs says.

The Public Accounts Committee said setting targets in England for the two infections had led to a fall in cases.

But they warned there were signs other bugs, such as E. coli, were becoming more common and they called for better surveillance to curb the problem.

In England, MRSA rates are now a quarter of what they were at their peak in 2004, while C. difficile rates have fallen by nearly a third in the past year, following the introduction of targets.
   
THE OTHER THREATS
E. coli
Pneumonia
Surgical site infections
Urinary tract infections
Gastrointestinal infections
Skin infections

But the MPs said these only accounted for about a fifth of the total number of all infections seen in hospital.

While MRSA is the most high-profile bloodstream infection, E. coli is much more common and has actually increased by a third in the past four years, the report said.

It also highlighted surgical site infections, which were twice as common as bloodstream infections, and respiratory and urinary tract infections, which were three times as common.

MPs warned there was still no robust data on the extent and risks of at least 80% of bugs linked to hospital care.

Committee chairman Edward Leigh said this report was the third time the committee had warned about the threat of other infections, adding it was "disappointing" the issue had yet to be addressed.

"The government has taken its eye off the ball regarding all other healthcare associated infections - which actually constitute most by far of all infections."

The report suggested hospitals start reporting all types of infection and that they look to curb the use of antibiotics.

Professor Mark Enright, an infections expert at Imperial College London, said: "I can understand why the government focused on the infections it has, but now we are getting to grips with those it is time to look elsewhere.

"There are some strains of infections, such as E. coli, where we are seeing increasing levels of antibiotic resistance and that is concerning."

Nigel Edwards, of the NHS Confederation, which represents trusts, agreed it was time to review other infections.

But he added: "We would want to know the balance of costs and benefits from additional surveillance."

Katherine Murphy, director of the Patients Association, said: "This target culture is just like squeezing a balloon - if you squeeze one end it will bulge out at the other.

"But the problem for patients is that the balloon stays the same size. The problem of patient safety will stay the same huge size as long as it is regarded as an optional extra by some."

From:
http://news.bbc.co.uk/1/hi/health/8351269.stm

Unoffical NHS euthenasia as daughter saves mother, 80, left by doctors to starve

An 80 year old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened.

Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients.

Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed.

“It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered. 

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6869646.ece

Nanny state bribes may be more efective than diets

Paying people to lose weight works better than diet plans, research suggests. 

A scheme being trialled by the NHS that rewards slimmers with cash or shopping vouchers could be more than twice as effective, it is claimed.

Those who sign up to the programme, from a company known as Weight Wins, are paid if they lose a certain amount of weight and then keep it off for a period of three months or more, with payments increasing the more weight someone can shed.

Slimmers on a 13 month “Pounds for Pounds” plan can be paid up to £425 for losing 50lb (23kg), while a six month reduction of 30lb would accrue £160.

Weight Wins, the company running the scheme, is extending it to offer a maximum of £1,000 for a loss of 150lb, to be achieved and maintained over two years. Preliminary results for 600 obese people found they lost an average of 14.4lb in six months. One in four of those who were still attending regular weigh-ins to get paid after 12 months lost an average of 29lb, equivalent to a 13 per cent reduction. The typical diet programme leads to a loss of only around 5 per cent, the company’s founders say.

But the results are not from a controlled trial, and the scheme is not without its critics, including the Conservative MP Ann Widdecombe. 

Ms Widdecombe, who lost 35lb on ITV’s Celebrity Fit Club show in 2002, said: “If the NHS had money to spare it would be okay, but the fact is the NHS is short of money. There are plenty of people who cannot get funding to pay for treatment for illnesses,” she said. “We can all control our own weight. If the NHS has to prioritise, then this should be at the end of its priorities.”

Winton Rossiter, managing director of Weight Wins, said that offering money as an incentive could be cost-effective for the NHS, which spends more than £4 billion annually on treating obesity and related illnesses. The findings, verified by the University of Hertfordshire, were presented this week at the National Obesity Forum, a charity set up by medical practitioners.

The Weight Wins programme is being tested by the NHS in Eastern and Coastal Kent, as part of a national trial. The full results are expected early next year. There are already similar pay-to-quit schemes to encourage people to stop smoking, while GPs can already refer seriously overweight people to dieticians or exercise classes that are subsidised by the NHS.

Weight Wins says that its cash rewards programme could save the NHS £1.7 billion in lifetime medical expenses for every million people taking part. A total of 31 million adults in Britain are now thought to be overweight or obese.

People can pay upwards of £45 to enrol in the scheme privately, with the chance of more than doubling their money, Mr Rossiter said. “We believe we could have a breakthrough solution to resolving the obesity epidemic. Most people know how to lose weight, through controlled dieting and exercise, but they fail to maintain their plans because of a lack of motivation. Financial incentives work because they reward you for losing weight steadily and safely month by month, and then you have a bonus for keeping it off.”

The National Obesity Forum said: “We would only support this if there was a proper randomised controlled trial that proved that weight was being kept off.”

From:

http://www.timesonline.co.uk/tol/life_and_style/health/article6861154.ece

Threat to rural GPs who dispense medicine as fees cut

Rural GP surgeries are under threat as fees paid to them for dispensing medicines are being cut leading to fears some may be forced to cut back services, stop providing drugs or close.

GP practices which dispense medicines are almost entirely in rural areas and 3.5million patients, particularly the elderly, rely on them so they can see their doctor and collect their drugs in one trip.

However, the labour Government is now cutting the fee it pays to the surgery for each medicine it dispenses.

NHS Employers has announced that from October 1st the fee per medicine dispensed will drop from £2.14 to £1.95, leading to a drop in income of around £850 per month for the average dispensing practice.

Dr David Baker, chief executive of the Dispensing Doctors Association, said: "If something does not happen to protect surgeries there is a risk practices will struggle hugely and certainly some will have to cut services. If we cannot cover our costs there is a major problem."

He said surgeries would try to continue dispensing because patients rely so heavily on the service but other things like branch surgeries or nurses would have to be cut.

There are around 1,500 dispensing practices in England and Wales out of around 8,500 in total.

It comes after plans announced by Andy Burnham, Health Secretary, to abolish GP catchment areas so people can visit surgeries near to their work, rather than their homes. There are fears this will lead to them losing their younger healthier patients to surgeries near where they work and leaving the older, sicker patients who are more expensive to care for.

Dr David Bailey, negotiator for the British Medical Association on behalf of dispensing doctors, said there was little choice but to accept the cut in fee and moves to correct the discounting problem will not be solved for some time, meaning dispensing doctors will suffer in the meantime.

He said: "It makes no sense to have a situation where it costs you money to privide a service to the NHS.

"In rural areas the dispensing side of the practice subsidises the GP surgery and if that subsidy is removed there is a diseconomy in running a rural practice. It will threaten small rural practices."

An inquiry is due to be launched next year into the costs of GPs dispensing drugs which may lead to changes and doctors said it was unfortunate that the reduction in fees could not be put off until after that was concluded.

Officials have said the changes in the fee will mean the way funding for dispensing GPs is calculated will be brought into line with non-dispensing GPs.

From:

http://www.telegraph.co.uk/Threat-to-rural-GPs-who-dispense-medicine-as-fees-cut

Labour to cut £20bn off NHS budget

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

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

2 Health Petitions- via the Number 10 website

Two petitions for you kind consideration- the abolition of sex rate charge numbers  to book doctor appointments and to prevent the closure of a thriving hospital:

Local health centres and NHS medical practices should be banned from using 08 numbers or offer a local 01 or 02 number alternative for booking appointments, as health centres make a profit using these numbers. For example, an 0870 number costs 10 pence per minute (whereby 4.5pence per minute goes to the local hospital).

http://petitions.number10.gov.uk/Healthtelephone/

Deadline to sign up by: 28 November 2009 –

Ipswich Hospital needs to be kept as a modern and thriving centre of excellence, the public need Ipswich Hospital to remain available to them and this means providing full services, and giving our consultants the support they need to serve the wider community.

The public in this area of the country are frequently ignored for raising real concerns regarding lack of access to services and our medical teams must be supported and heard. Stop taking vital services away, it is not cost effective and it is downright dangerous!

http://petitions.number10.gov.uk/IpswichHospital

Deadline to sign up by: 21 July 2010

NHS staffing crisis as one in 20 health professional posts remains unfilled

More than one in 20 posts in the NHS are being left unfilled official figures show as Trusts are forced to spend up to £150,000 to fill each job with agency workers.

The NHS Information Centre found that the number of job vacancies for hospital doctors, dentists, nurses and midwives rose for the first time in five years.

Staff retiring or leaving the sector and the impact of cuts to doctors’ hours are likely to have contributed to shortages across England. London is especially badly hit.

Doctors’ leaders have been heavily critical about the impact of preparing for the European Working Time Directive, which came into force on August 1st.

The directive, which has reduced the maximum working week for junior doctors and other staff by the equivalent of one working day — from 56 hours to 48 — means that a significant number of hospitals are relying on agency staff to plug gaps in their rotas.

As The Times reported last week, the College of Emergency Medicine said that pressure was greatest on “middle-grade” doctors with at least four years training, who would be typically asked to cover shifts in Accident and Emergency (A&E) wards at evenings and weekends.

Trusts are spending tens of thousands of pounds to fill vacant posts with agencies charging between £90 to £95 an hour to provide a middle-grade doctor to staff units when a senior consultant is not present.

The health service spent more than £584 million on employing agency staff in 2007-08, the latest year for which full data is available.

The British Medical Association, the Royal College of Surgeons and the Royal College of Paediatrics and Child Health have been heavily critical of the changes.

Doctors can opt out of the directive on a voluntary basis, but only individually, throwing rota planning into “chaos”, according to senior doctors. They want whole departments or specialities to be allowed to suspend the rules.

John Black, the president of the Royal College of Surgeons, called last week for the 48-hour limit to be postponed or suspended if during the swine flu pandemic, if the NHS has to cope with an expected surge of illness this winter.

The staff vacancy figures, compiled in March, showed that total vacancy rates are also up across most staff groups, rising to 5.2 per cent compared to 3.6 per cent in the same month last year. Three month vacancy rates jumped two thirds from 0.9 per cent to 1.5 per cent.

Of the total number of vacant posts, one in five had been left unfilled for three months or more.

Unions have already warned that a large number of nurses and midwives are due to retire in the next decade and among qualified nursing staff total vacancies rose from 2.5 per cent in 2008 to 3.1 per cent. Long-term vacancies also increased from 0.5 per cent to 0.7 per cent at the end of March.

Among midwives, vacancies increased from 2.1 per cent in 2008 to 3.4 per cent, with long term vacancies accounting for about one in four of all midwife vacancies.

The Royal College of Midwives has called for 5,000 extra staff to be recruited in order to improve care for mothers and babies, but it says the Government has only promised funding for the equivalent of 3,400 posts.

The figures show that London has the highest long-term vacancy rate among qualified nursing staff with the 3 month vacancy rate increasing from 1.2 per cent in 2008 to 1.6 per cent this year.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6741241.ece

Patients forced to live in agony after NICE refuses to pay for painkilling injections

Tens of thousands with chronic back pain will be forced to live in agony after a decision to slash the number of painkilling injections issued on the NHS by the killer quango, doctors have warned.

The labour Government's drug rationing watchdog says "therapeutic" injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known.

Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy.

Specialists fear tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain or pay as much as £500 each for private treatment.

The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.

But the British Pain Society, which represents specialists in the field, has written to NICE calling for the guidelines to be withdrawn after its members warned that they would lead to many patients having to undergo unnecessary and high-risk spinal surgery.

Dr Christopher Wells, a leading specialist in pain relief medicine and the founder of the NHS' first specialist pain clinic, said it was "entirely unacceptable" that conventional treatments used by thousands of patients would be stopped.

"I don't mind whether some people want to try acupuncture, or osteopathy. What concerns me is that to pay for these treatments, specialist clinics which offer vital services are going to be forced to close, leaving patients in significant pain, with nowhere to go,"

The NICE guidelines admit that evidence was limited for many back pain treatments, including those it recommended. Where scientific proof was lacking, advice was instead taken from its expert group. But specialists are furious that while the group included practitioners of alternative therapies, there was no one with expertise in conventional pain relief medicine to argue against a decision to significantly restrict its use.

Dr Jonathan Richardson, a consultant pain specialist from Bradford Hospitals Trust, is among more than 50 medics who have written to NICE urging the body to reconsider its decision, which was taken in May.

He said: "The consequences of the NICE decision will be devastating for thousands of patients. It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate."

One in three people are estimated to suffer from lower back pain every year, while one in 15 consult their GP about it. Specialists say therapeutic injections using steroids to reduce inflammation and other injections which can deaden nerve endings, can provide months or even years of respite from pain.

Experts said that if funding was stopped for the injections, many clinics would also struggle to offer other vital services, such as pain management programmes and psychotherapy which is used to manage chronic pain.

Anger among medics has reached such levels that Dr Paul Watson, a physiotherapist who helped draft the guidelines, was last week forced to resign as President of the British Pain Society.

Doctors said he had failed to represent their views when the guidelines were drawn up and refused to support the letter by more than 50 of the group's members which called for the guidelines to be withdrawn.

In response, NICE chairman Professor Sir Michael Rawlins expressed outrage over the vote that forced Dr Watson from his position, describing the actions of the society as "shameful". He accused pain specialists of refusing to accept that there was insufficient scientific evidence to support their practices.

A spokesman for NICE said its guidance did not recommend that injections were stopped for all patients, but only for those who had been in pain for less than a year, where the cause was not known.

Iris Watkins, 80 from Appleton, in Cheshire said her life had been "transformed" by the use of therapeutic injections every two years. The pensioner began to suffer back pain in her 70s. Four years ago, despite physiotherapy treatment and the use of medication, she had reached a stage where she could barely walk.

"It was horrendous, I was spending hours lying on the sofa, or in bed, I couldn't spend a whole evening out. I was referred to a specialist, who decided to give me a set of injections. The difference was tremendous",

Within days, she was able to return to her old life, gardening, caring for her husband Herbert, and enjoying social occasions.

"I just felt fabulous – almost immediately, there was not a twinge. I only had an injection every two years, but it really has transformed my life; if I couldn't have them I would be in despair".

http://www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html

Public want NHS protected from funding cuts

Sacrifice other departments instead of the NHS, say three out of four people in British Medical Association poll.

More than three-quarters of the public – 77% – believe NHS funding should be protected in the face of future spending cuts, an opinion poll has found.

Other departments' budgets should be sacrificed in order to preserve the health service, the British Medical Association survey heard. Four out of 10 people said they would be willing to pay higher taxes to sustain growth in NHS funding.

The poll questioned 1,071 people in five UK cities – London, Edinburgh, Belfast, Manchester and Cardiff – reflects fears that severe cutbacks are looming.

Nine out of 10 people suspect NHS services will be cut as a result of the recession, and almost as many believe waiting times for treatment will rise; 85% anticipate additional charges for NHS treatments.

The level of public support for the NHS at the expense of other departments is likely to be welcomed by the Conservative health spokesman, Andrew Lansley, who last month stirred controversy when he declared that a future Tory administration would protect the health service and target cuts elsewhere.

The poll, released on the eve of the BMA's annual conference in Liverpool, gave conflicting evidence about privatisation. Nearly 60% said the private sector should be more involved in providing NHS services but almost half (47%) said there should be no further contracts for commercial companies.

The BMA chairman, Dr Hamish Meldrum, said: "These results show how anxious the public is about the effects of the recession on the health service, with a significant number saying taxes should increase to protect NHS funding. No one wants to see any cuts in the public sector but our poll reveals just how much society values their health service.

"Fear often goes hand in hand with economic slumps, with people worrying what will happen to them and their families in times of ill health. While we appreciate that the government needs to steer the country through this difficult economic period, we urge it not to do so at the expense of NHS funding."

From:
http://www.guardian.co.uk/society/2009/jun/29/nhs-funding-cuts-survey-bma

Labour admits it cannot increase NHS funding

Labour has admitted that it cannot commit to increased funding for the National Health Service after 2011, in a move the Tories claim is an embarrassing reversal of their policy.

It comes as ministers also revealed that Labour will have to raise taxes and cut capital spending on major projects if it wins the next election. Capital spending projects will bear the brunt of cuts.

Labour and the Conservatives are locked in a bitter battle over spending plans.

The Tories seized on comments made by Andy Burnham, the new Health Secretary, in which he said Labour would continue to maintain NHS spending in the period after the current Budget period, up to 2011.

At the NHS Confederation annual conference in Liverpool, Mr Burnham admitted: "I can't write the spending review - it would be ridiculous. We have stability for two years but the Prime Minister indicated the NHS will remain the priority for a Labour Government."

The Tories said this contradicted what he had previously said and it should "worry NHS patients and staff."

Labour also had to admit that taxes were likely to increase in try and fend off other cuts.

Liam Byrne, the Chief Secretary to the Treasury, said: "Alistair Darling has been really clear that there are going to be some pretty tough choices to be made. There are going to be conditions of constraint and there are going to be difficult decisions on, for example, tax."

Gordon Brown has been able to appear as if he is maintaining spending on services but cutting public expenditure by looking to savagely cut planned capital projects. That means transport infrastructure, school and hospital building projects, as well as major defence procurement deals.

The Prime Minister has been reluctant to admit that the Government plans to cut capital spending by almost 40 per cent between 2011 and 2014.

Mr Byrne admitted that capital spending would be reduced.

He said: "Once you have built a school you have got a school."

Philip Hammond, the shadow chief secretary, accused My Byrne of being "disingenuous" about public spending. Gordon Brown has, over successive elections, painted the Tories as a party that will cut public services, but David Cameron has made great efforts to blunt that line of attack by promising to match Labour's commitments.

George Osborne, the shadow chancellor, said: "We now see how Labour plans involve spending cuts in a dozen departments next year. But Labour politicians continue to claim that they won't cut spending.

"That's just plain dishonest. Why can't the Prime Minister just be honest with people and admit to the cuts which are in his own Budget?"

From:
http://www.telegraph.co.uk/Labour-admits-it-cannot-increase-NHS-funding.html

Catastrophic shortage of psychiatrists in NHS

There is a "catastrophic" shortage of psychiatrists in the NHS, leading to a reliance on foreign staff who may have difficulties with communication and the UK culture, a senior doctor said.

Prof Robert Howard, dean of the Royal College of Psychiatrists (RCP), said the number of UK doctors was far too few to fill hundreds of training posts.

He pointed to an over reliance on overseas doctors, saying some were brilliant but cultural awareness was an essential part of being a good psychiatrist.

He said: "Catastrophic is the word I would use for the shortage we are now facing. We have always struggled to recruit significant numbers but this year is particularly acute."

"It has got to the point where you can count the number of UK doctors coming into it in tens, when we have hundreds of training posts to fill."

"The doctors who are coming in from overseas to work in the UK: some are brilliant, and our president (Dinesh Bhugra) is a shining example. This is not being racist or unpleasant."

"But many of them have difficulties with communication and the nuances of the UK's culture. And if there is a speciality where it is essential to know the culture, it is psychiatry. There needs to be a balance."

"Overall, because of the lack of competition, we are giving jobs to some people who are 'appointable' but certainly not people who it fills our spirits to have given jobs to."

"The fact that we have to make a decision about the minimum standard cut-off point for potential 'appointability', and that we feel relieved when we find sufficient people who just scrape over this is damning enough."

From:
http://www.telegraph.co.uk/health/healthnews/5445602/Catastrophic-shortage-of-psychiatrists-on-NHS.html

Elderly suffer after reverse e-auctions for home care

Labour NHS IT reverse auctions reduce dignity and care for elderly

Andrew Wilson, 78, was one of the elderly people who received poor treatment after a reverse e-auction. This was run by South Lanarkshire for the provision of home care.

Domiciliary Care, a big provider in Scotland, won the contract after companies had driven down their prices. It won with a bid to provide care for £9.95 an hour.

Mr Wilson is hard of hearing, blind in one eye and unable to walk more than a few steps. With no close family, he lives alone and depends on carers. He allowed Panorama to fit secret cameras in his home for 19 days.

The cameras showed Mr Wilson being given a bed bath while his carer was constantly on her mobile phone complaining to the office about her workload. The cameras also recorded that, of his four half-hour visits a day, those at lunch and teatime were often curtailed.

His care assessment makes clear that his lunchtime carer should prepare a meal. However, he was routinely fed sandwiches, crisps and toast.

One GP who specialises in old age care said she was shocked by what she saw. “He has been treated with a complete lack of dignity,” she said.

At the time Domiciliary Care denied that Mr Wilson was neglected. It said that carers were under no obligation to go shopping for Mr Wilson but often did so. However, Care Choices Group, which took over the company last September, admitted that an internal inquiry had found that a number of the allegations were correct, and apologised.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article6401122.ece