NHS managers need disciplinary body, latest inquiry urges

Senior NHS management should be turned into a profession, with an independent body created to discipline managers and board members, the latest inquiry into the Mid Staffordshire NHS Foundation Trust said.

Andy Burnham, the health secretary, who announced a fresh inquiry - the third - into the appalling standards of care at the Staffordshire hospital, said he would consult on the proposal, which was welcomed by the Patients Association.

"We must end the situation where a senior NHS manager who has failed in one job can simply move to another elsewhere," Mr Burnham said.

It was, he said, a "long-standing anomaly" that incompetent doctors and nurses can be disciplined and even struck off, but that there is no equivalent scheme for NHS managers, nor for the non-executive directors who, for salaries of a few thousands pounds a year, help make up the boards of NHS organisations.

The call to give NHS management the status of a new profession came as the inquiry by Robert Francis QC catalogued the most dire standards of care at Stafford hospital, which included needless deaths and staff leaving patients "sobbing and humiliated" while lying in their own faeces. 

The inquiry was highly critical of the Trust's board, which it said took too strategic a view of its function. Most of its members remained "in denial" about the hospital's problems, the inquiry said, even after a damning report from the NHS inspectorate.

The case "highlights the need for a proper system of ensuring the accountability of executive officers and non-executive directors" of NHS organisations, the inquiry said.

The NHS Leadership Council has already been examining the possibility of a regulatory body for NHS managers along the lines of the General Medical Council, which regulates doctors.

Nigel Edwards, head of policy at the NHS Confederation , said there was a good case for accrediting managers - which would establish, among other things, that they had had no major failures in the past - but was much more sceptical about full-blown regulation.

Both he and John Restell, general secretary of Managers in Partnership (MiP), the managers' union, questioned whether clear regulatory standards could be defined for good management as they are for doctors and nurses. Good human resources practice would go a long way to addressing managerial problems, Mr Edwards said.

Mr Restell said: "There is a risk of a big bureaucracy. And there is nothing to suggest that regulation of individuals would have prevented the systemic failures seen at Mid-Staffs and Maidstone and Tunbridge Wells [where patients died from hospital-acquired infections]. We would not want the public to be sold a pup."

There was also the risk that over-regulation of non-executive directors would deter good applicants, he said.

The new inquiry will look into the failure of communication that led Monitor, the trust regulator, to approve the hospital's application to become a foundation trust at the same time as the Healthcare Commission, the quality inspectorate, was becoming seriously concerned about the hospital's quality of care. It will also examine why the local primary care trust, which commissions the hospital's services, appeared unaware of how bad things were.

The department is aiming to produce a standardised measure of hospital death rates after apparently high ones first triggered the inspectors' concerns at Mid-Staffs. Disputes about how they are constructed meant it was "unsafe" to give any range for the excess deaths at the hospital, the inquiry found.

From:

http://www.ft.com/cms/s/0/6f5ee00a-21ae-11df-acf4-00144feab49a.html

Patients' medical records go online without consent

Patients’ confidential medical records are being placed on the controversial NHS database (NPfIT) without their knowledge, doctors’ leaders have warned.

At present 1.29 million people have had their details placed on the system. A further 8.9 million records are due to be added by June.

Those who do not wish to have their details on the £11 billion computer system are supposed to be able to opt out by informing health authorities.

But doctors have accused the Government of rushing the project through, meaning that patients have had their details uploaded to the database before they have had a chance to object.

The scheme, one of the largest of its kind in the world, will eventually hold the private records of more than 50 million patients.

But it has been dogged by accusations that the private information held on it will not be safe from hackers.

The British Medical Association claims that records have been placed on the system without patients’ knowledge or consent.

It follows allegations that the Government wanted to complete the project before the Conservatives had a chance to cancel it.

In a letter to ministers published today, the BMA urges the Government to suspend the scheme.

Hamish Meldrum, its chairman, writes: "The breakneck speed with which this programme is being implemented is of huge concern.

"Patients’ right to opt out is crucial, and it is extremely alarming that records are apparently being created without them being aware of it.

"If the process continues to be rushed, not only will the rights of patients be damaged, but the limited confidence of the public and the medical profession

in NHS IT will be further eroded."

At present 1.29 million people have had their details placed on the system. A further 8.9 million records are due to be added by June. By the end of next

year, the NHS hopes to have more than 50 million uploaded.

The "summary" records contain basic medical information including illnesses, vaccination history, and could include medication patients have been given. Ages

and addresses are also included.

Patients are supposed to be notified by letter at least 12 weeks before their details go live on the system and given the chance to opt out.

The BMA says that letters have gone to the wrong addresses and that many patients have been unsure what they mean.

Doctors point out that there has been no national advertising programme to explain the scheme, as has been the case with other government initiatives.

The BMA also criticises the fact that the information packs do not include the form which allows patients to opt out. It can only be obtained via the internet or by calling a helpline.

Katherine Murphy, of the Patients Association, said: "The Health Service should not put in place bureaucratic obstacles to patient choice because they are worried about what patients might choose to do."

Norman Lamb, the Liberal Democrat health spokesman, said: "The Government needs to end its obsession with massive central databases. The NHS IT scheme has been a disastrous waste of money and the national programme should be abandoned."

From:

http://www.telegraph.co.uk/Patients-medical-records-go-online-without-consent

Health Direct was warning of labour's duplicity, for example on Dec 16, 2009's post- Your medical confidentiality under threat again

Despite labour's promises to the contrary- their track record on snooping databases is appalling.

Having launched the Identity and Passport Service last week- which 96% of the population doesn't want, the labour govt are still going ahead with their health database.

Health Direct strongly recommends that you use the opt-out letter which was developed by with TheBigOptOut at http://www.nhsconfidentiality.org/optoutletter

and send it of NOW!

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

Bliar ally says Tories are best for NHS

One of the architects of Labour’s NHS reforms is to become a key adviser to the Conservatives because the labour Government has “lost the plot” on improving patient care.

Professor David Kerr, a renowned oncologist who led efforts to cut waiting and give hospitals greater independence, said that the Tories now offered the best chance for the NHS, which had been driven into a “whirl of thoughtless tick-box exercises”.

Professor Kerr, a lifelong Labour supporter who campaigned with Tony Blair in the 2001 general election, told The Times that the key principles of giving patients a better choice of health services and a better understanding of how they were performing had been “driven into the sand”.

“To say that we have run out of steam, I would say definitely, definitely yes,” Professor Kerr said. “We have got lost in the blizzard of increasingly irrelevant targets. The position now is disenfranchising, dull and disconnected. That is the clinical reality.”

The doctor, a professor of cancer medicine at the University of Oxford, was a frequent visitor to Downing Street as Labour drew up its reform agenda in Mr Blair’s first and second terms. 

Before 1997 he conducted the first national audit of cancer services — identifying delays that allowed “patients’ cancers go from curable to incurable while they sat and waited”.

Under Labour he worked on ways to improve access as chair of the national Cancer Services Collaborative and became a founding commissioner of the Commission for Health Improvement, the first regulator to assess NHS clinical performance.

He was also one of the main drivers of the foundation trust scheme, offering the best hospitals the chance to become more independent, hold greater responsibility for their budgets and make clinicians more engaged in service improvement. A knife-edge Commons division on foundation status was won by 17 votes after Professor Kerr wrote to all MPs underlining the advantages that it would bring.

In 2005 he was given the task of developing a 20-year plan for the future of the NHS in his native Scotland, known as the Kerr Report.

Professor Kerr said that he felt “for the first time in [his] life” that the Tories offered the health service a better future. He said that the Conservative priority of getting NHS data out to patients in an understandable form, allowing them to choose the highest standard of service best suited to them, was a mission that disappeared with the departure of Mr Blair.

“[The Tories] are more committed to the NHS that we love and understand as free at the point of access and offering universal care. Only that degree of certainty would convince me to go and work for them.”

Professor Kerr would not be drawn on whether he had been a member of the Labour Party, but said that currently he was not a member of any political party.

He said that he hoped to push through the ideas of choice and the empowered patient, encouraging the NHS to make more high-quality information publicly available. “People need to be able to understand how their hospital is improving,” he said.

Another focus will be to allow patients to ask clinicians key questions about care standards without compromising the doctor/patient relationship.

“I firmly believe for the first time in my life that we have a Conservative leadership that is committed to the future of the health service. If I didn’t believe that I wouldn’t be there.”

On informed choice for patients, he said that under the Government “the whole big idea ended up in the foothills of dodgy websites. No one was really engaging with it.”

He identified the loss of momentum “around when the transition happened”, with things “starting to lose the plot” under Patricia Hewitt as Health Secretary, then Alan Johnson, “who is good on many fronts, but was more interested in keeping the NHS out of the headlines”.

Andrew Lansley, the Conservative health spokesman, said of Professor Kerr: “His expertise and knowledge will be crucial in helping us to create a NHS which has patients at its centre. That a key architect of the Blairite health reforms is now working with the Conservatives shows that under David Cameron’s leadership we have truly become the party of the NHS.”

From:

http://www.timesonline.co.uk/tol/news/politics/article7041772.ece

Call for social care reform as costs escalate

Radical reform of social care is needed both to contain costs and improve the quality of a system that is "fundamentally broken" say leading academics.

Rather than extra spending being seen as "dead money" or a "necessary evil", social care expenditure should be seen as "a form of social and economic investment", according to the study commissioned by Downing Street and the health department.

Effective spending on social care for the frail elderly and for adults with disabilities could generate savings elsewhere in the welfare state, says the report from Birmingham University's Health Services Management Centre and the Institute of Applied Social Sciences. 

It could produce savings in National Health Service expenditure and on social security benefits, while bringing in tax and national insurance income.

Furthermore, "doing nothing to change the way things work is not a viable option", according to Jon Glasby, professor of health and social care at Birmingham University, and the study's lead author.

If the means tested patchwork of poorly co-ordinated services continued unreformed, "costs will double over the next 20 years and that money will be spent on a system that is now widely seen to be delivering poor quality results", he said.

The study argues that better commissioning of social care, more collaboration with the NHS, more support for carers, and greater use of personal budgets, telecare and other forms of IT would cut the rate of growth while producing better quality care.

It makes its case using initiatives from across the country - including the joint management of health and social care in Torbay , Devon; studies that suggest people given personal budgets spend less on social care; and other evidence, and scales up potential savings.

The report is littered with caveats about the certainty with which that can be done and the reliability of some data. But it concludes that undertaken with real vigour, such approaches will improve care and cut the rate at which costs increase - and so should be seen as an investment.

"The savings come primarily from reducing the number of emergency hospital admissions among the frail elderly," said Professor Glasby, "and from supporting a much greater number of adults of working age who have a disability back in to work. There they will earn, pay taxes and claim fewer benefits, while savings also come from supporting informal carers much better, many of whom are struggling to balance work and caring."

From:

http://www.ft.com/cms/s/0/6bd5fd7e-1452-11df-8847-00144feab49a.html

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

Swine flu- move to recover cost of vaccine

The government is attempting to claw back tens of millions of pounds from flu vaccine manufacturers as it seeks to scale down an immunisation plan to protect the country from a severe pandemic.

Officials have cancelled further orders from Baxter, and are finalising a deal to limit purchases from GlaxoSmithKline, in an effort to recoup part of a £500m deal with the two companies for sufficient vaccine to cover the entire population.

Ministers have decided to abandon the aim of a universal flu vaccination programme, although they are pursuing the drive to vaccinate children under five as well as pregnant women, people with underlying health problems and health and social care workers.

The mild nature of the swine flu virus, the need for only a single rather than a double dose of vaccine and public suspicion and indifference to vaccination have led to lower take-up than anticipated in the UK and other countries.

The government's decision - in the context of severe pressure on public spending - comes at a time of similar moves by other countries including France, Germany, the Netherlands and Spain.

Sir David Salisbury, director of immunisation at the Department of Health, said a break clause had now been activated in the contract agreed with Baxter of the US, while discussions were under way with GSK, from which most of the vaccine had been purchased.

Similar formal break clauses were not included in many countries' contracts with vaccine suppliers, because they were drawn up at a time when governments and manufacturers expected demand would substantially outstrip supply.

However, GSK, like other large suppliers, including Sanofi-Aventis of France, is coming under political pressure to accept a scaling back of previously agreed volumes of orders.

GSK stands to lose tens of millions of pounds alone from the UK renegotiations and smaller amounts from other large purchasers such as France.

The drugmaker had previously estimated total sales of its pandemic flu vaccine across more than 70 countries at £2bn over 2009 and 2010.

It may be able to recover some losses from sales to other countries including in Latin America. Sanofi-Aventis, the world's largest supplier of flu vaccine, stands to lose significant sales, with smaller losses from Novartis, while other suppliers such as Baxter, CSL and MedImmune - part of AstraZeneca - had lower initial sales and much lower exposure.

The UK and other countries are in talks about making donations of surplus vaccine stocks available to poorer countries and selling excess stocks to richer ones - although there are concerns about the issue of liability in such cases.

Sir David said the UK would keep some surplus stocks, both to prepare for any possible third wave of the pandemic and for a future different infection.

The vaccine contains an antigen to protect the body against the current H1N1 virus which would not be useful against future mutations.

But it has an adjuvant stored separately until just before vaccination, which enhances the body's immune response and could be stored over longer periods to help fight a future pandemic.

The latest figures from England show that fewer than 3.8m people have been vaccinated against pandemic flu since last autumn, although 12.5m doses of vaccine have been sent out for health services ready to be used.

From:
http://www.ft.com/cms/s/0/182021e8-fe52-11de-9340-00144feab49a.html?nclick_check=1

Labours' only success- wasting taxpayers money

Health Direct is appalled at the expensive IT project that is the NPfIT white elephant- and the money that is being wasted in our names.

On Jan 5th 2010 in the House of Lords Lord Warner (Labour) asked how many (a) acute trusts, (b) mental health trusts, (c) general practitioners, and (d) community services, are using an electronic summary patient record under the NHS National Programme for IT.

Baroness Thornton (Baronesses in Waiting, HM Household; Labour) replied:
As at 16 December 2009, two acute trusts, one mental health trust, 152 general practitioner practices, and additionally three out of hours providers and two walk in centres were using electronic summary care records delivered under the national programme for information technology. No community trusts were doing so.

http://www.publications.parliament.uk/pa/ld200910/ldhansrd/text/100105w0012.htm#10010561002177

What a waste of taxpayers money- a grand total of 160 health organisations were using the £12 billion scheme.

http://www.theyworkforyou.com/wrans/?id=2010-01-05a.64.3&s=speaker%3A12896#g64.4
Hansard source (Citation: HC Deb, 5 January 2010, c64W)

According to Wikipedia, Dorothea Glenys Thornton, Baroness Thornton (born 16 October 1952), known as Glenys Thornton, is a Labour and Co-operative member of the House of Lords.

A graduate of the London School of Economics, Thornton was Political Secretary of the Royal Arsenal Co-operative Society from 1981, joining the public affairs team of the Co-operative Wholesale Society upon their merger in 1985 and working there until 1992. 

She was General Secretary of the Fabian Society from 1993 to 1996. In 1998 she was made a Life peer as Baroness Thornton, of Manningham in the County of West Yorkshire by Tony Bliar. She chaired the Social Enterprise Coalition until January 2008, when she was appointed a junior minister of the House of Lords.

She lives in Belsize Park, London, and is married to internet safety expert John Carr. They have two children, George and Ruby.

Baroness Thornton is no stranger to wasting taxpayers money:
She was reported to be claiming £22,000 a year in expenses by saying that her mother's bungalow in Yorkshire is her main home, amounting to around £130,000 since 2002.
http://en.wikipedia.org/wiki/Baroness_Thornton

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

Labour ministers to take control of hospital charity cash

Hundreds of millions of pounds of charity donations to hospitals are to be “nationalised” under an NHS accounting change, which critics say will make it easier to slash health budgets.

Ministers are imposing new rules on NHS charities requiring all donations — including those to specialist children and cancer units, local fundraising campaigns, teaching hospitals and local community trusts — to be listed on a hospital’s balance sheet.

The Charities Commission says that this is “wholly inappropriate” because combining the trust and charity accounts will jeopardise the charity’s autonomy and discourage donations. 

About £330 million was given to 300 NHS charities in the year to June 2008, and they control an estimated £2 billion of assets. A spokeswoman for the Commission said: “The Charity Commission does not agree with the interpretation of the accounting rules in the Department of Health letter to NHS bodies. We are currently engaging with the Department on this matter.”

Charities also fear that the change, due to come into effect in April, will be used as a smokescreen to hide cuts in health spending, with ministers reducing funds for organisations such as children’s hospitals that have successful charitable arms.

Jenny Willott, a Cabinet Office spokeswoman for the Liberal Democrats, said: “This could lead to hundreds of millions of pounds of charitable donations being effectively nationalised under the NHS.

“The Government has no right to get its hands on any charitable NHS funds. People make donations on the understanding that it is up to charities to decide how to spend it, not ministers.”

A source at a leading hospital said that the rule change appeared entirely unreasonable and risked creating unnecessary budgetary pressures and distorted disparities between hospitals with different levels of fundraising ability.

Ministers were banned from counting charitable donations towards the central NHS budget under the original legislation that created the NHS in 1948.

But this looks set to be reversed after the Treasury agreed to implement International Accounting Standard (IAS) 27. Now all NHS Trusts whose trustees have the “power to control” their charitable arm look likely to be forced to consolidate both sets of accounts in one. Estimates of the number of NHS charities affected vary between 30 and 300 organisations.

From:
http://www.timesonline.co.uk/tol/news/politics/article6969955.ece

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

Winter NHS deaths rise a national scandal

The highest winter NHS deaths figures in almost 10 years should act as a "deafening wake-up call" for the labour Government, charities said today.

There were an extra 36,700 deaths in England and Wales from December 2008 to March 2009, compared with the average for non-winter periods, figures from the Office for National Statistics (ONS) showed.

This was the highest number since the winter of 1999/2000 and a rise of 49% compared with 2007/08.

Andrew Harrop, head of policy at Age Concern and Help the Aged, said: "It is a national scandal that the UK has more older people dying in winter, compared to the rest of the year, than countries with more severe weather, such as Sweden and Finland.

"Excess winter deaths of older people have remained stubbornly high in recent years, but last winter's huge spike sounds a deafening wake-up call about the older population's well-being if we have another cold snap.

"To end this national scandal, the Government must do much more to tackle fuel poverty, which currently affects one in three older households."

Fuel poverty charity National Energy Action (NEA) warned that a combination of high energy prices, low incomes and poor insulation will continue to pose a serious threat to the health of millions of people, especially pensioners, during the coming months.

Jenny Saunders, NEA chief executive, said: "The Government needs to step up action that will end these shameful statistics and comprehensibly tackle fuel poverty in the UK."

The winter of 2008/9 had the coldest average winter temperature since 2005/6, one of the factors which affects the number of so-called excess winter deaths, an ONS spokesman said.

He added that the Health Protection Agency (HPA) said influenza activity started early and reached moderate levels during the winter of 2008/9.

Temperature and levels of disease in the population are two of the key factors which contribute to the number of deaths.

The greatest number of excess winter deaths occurred in people aged over 85, the ONS figures showed.

Women accounted for the highest number of excess winter deaths, a fact mostly explained by the higher number of women than men aged over 85, the ONS said.

There were 21,400 excess winter deaths in women and 15,300 in men in the winter of 2008/9, the ONS said.

But the largest increase - 59% - was in men aged 75 to 84, with the overall rate for men 44% higher than the previous year.

Among women, the overall rate increased by 52% compared with 2007/8.

A Department of Health (DH) spokesman said: "The causes of excess winter deaths are very complex. Last year was a colder than average winter, which explains some of the extra deaths seen.

The NEA called for an extension of the winter fuel payments "to include other vulnerable households and not just those who are over 60".

It also urged the Government to increase the budget for the Warm Front Scheme - which provides a package of insulation and heating improvements up to the value of £3,500 - to £530 million next year.

Ms Saunders said: "As it stands, the budget for 2010 is set to be cut back by around 50% on this year's budget.

"I urge the Chancellor in his Pre-Budget Report on December 9 to increase support for the life-saving heating and insulation measures available to low income households under this flagship programme.

"People need to be aware of the help that is available to them through the various grants and schemes from DECC, energy companies and our own Warm Zones where we have established these with local authorities.

"Pensioners in particular are often anxious to avoid debt and turn their heating down or even off, often unaware that they are putting their health in danger."

She said there were more than five million households who cannot afford to heat their homes, putting them at risk of serious health problems like heart disease, strokes, respiratory illnesses - such as asthma and bronchitis - and exacerbating common ailments like colds and flu.

She added that the increase in excess winter deaths was "sadly expected but remains extremely worrying".

From:

http://www.independent.co.uk/winter-deaths-rise-a-national-scandal

Sharp rise in England swine flu deaths

The latest weekly bulletin showed a sharp rise in patient deaths and the number of children being admitted to hospital.

The overall number of new cases showed a second successive weekly fall. Health officials estimate there were 55,000 new cases this week in England compared with 64,000 last week. There was a slight drop in Scotland.

The number of people who have died from swine flu in the UK has reached 214. There were 18 deaths in England last week. The figures since the start of the outbreak in May are 142 fatalities in England, 21 in Wales, 38 in Scotland and 13 in Northern Ireland.

The number of people needing hospital care for the virus is 783, down slightly from 785, in the previous week. Of those in hospital, 180 were in intensive care, up from 173 in the previous week.

The Conservative party has been pressing the government to give vaccinations to healthy children because those under the age of 16 are in one of the more vulnerable groups.

About 21% of all H1N1 deaths in the UK have been among under 14s.

So far the priority groups have included those with pre-existing medical conditions, their carers and pregnant women. Children with asthma or diabetes are already being vaccinated. Now, children aged six months to five years are to be offered the vaccination from next month.

From:

http://www.guardian.co.uk/world/2009/nov/19/swine-flu-vaccines-healthy-children

Swine flu jab to be given to healthy children under five

Healthy children aged under five are to be given the swine flu jab, the Government has confirmed.

Currently people in priority groups - including young children with asthma or diabetes - are being vaccinated.

But the programme will now be rolled out to children with no underlying health issues, aged over six months and under five .

The UK-wide policy was officially confirmed by the Scottish Government today ahead of a similar announcement in England, expected later.

Nicola Sturgeon, the Scottish Health Secretary, said: "I am able to announce today that the next group in the population that will be vaccinated, or offered vaccination, is children aged over six months and under five years."

The announcement came as it emerged that an 11-year-old girl from Berkshire who had tested positive for the H1N1 virus died on November 11.

NHS figures show that children under 16 are the age group most likely to be admitted to hospital with swine flu, and 21 per cent of deaths in England are among under-14s.

Last week, the death toll in the UK stood at 182, with 124 deaths in England, 33 in Scotland, 11 in Northern Ireland and 14 in Wales.

Currently nine million people in priority groups are being vaccinated against swine flu including those with long-term illnesses and pregnant women. Frontline health and social care workers are also being offered the vaccine.

Britain has ordered enough vaccine for everyone to have two doses, but data from clinical trials has shown that one dose is effective.

Children have been hardest hit by swine flu and are the under fives are the most likely age group to be admitted to hospital with the virus.

Researchers warned that intensive care beds for children could run out in Britain this winter due to swine flu.

All of Britain's 303 intensive care beds for children could be filled with swine flu patients this winter and this would leave no beds available for children suffering other illness, recovering from surgery or accidents, according to a study conducted by Dr Art Ercole, of Cambridge University and colleagues.

The research was published online ahead of the print edition of the journal Archives of Disease in Childhood.

Dr Ercole said over half of admissions to paediatric intensive care units (PICUS) are unplanned and respiratory illness is the second largest cause of admission, accounting for around one in four cases.

From

http://www.telegraph.co.uk/health/swine-flu/6606561/Healthy-children-below-age-of-five-to-get-swine-flu-jab.html

150,000 dementia sufferers being prescribed anti-psychotic drugs unnecessarily

Up to 150,000 people with dementia are being prescribed anti-psychotic drugs unnecessarily, a Government ordered review disclosed.

Only around 36,000 of the 180,000 people on the drugs in the UK derive any benefit from them, it said. Overprescribing of the drugs is linked to an extra 1,800 deaths a year among elderly people.

Anti-psychotic medicines are licensed to treat people with schizophrenia and are used off-licence for dementia patients in care homes and hospitals.

In his review, Sube Banerjee, professor of mental health and ageing at the Institute of Psychiatry at King's College London, said the rate of use of anti-psychotic drugs could be cut to one third of its current level with appropriate action.

Jeremy Wright, chairman of the All Party Parliamentary Group on Dementia, called for more training to be given to care home staff and for greater involvement of the patient's family and friends over the decision on whether to prescribe.

He told BBC Radio 4's Today programme: "We need to give people other ways of avoiding the problem and that means making sure staff who work in care homes are properly trained in dementia.

"We need to involve family members and friends and loved ones much more in the decision to prescribe and the decision to keep prescribing these drugs."

He added: "If we can deal with training, if we can deal with regular reviews and if we can involve family and friends much more often, we will start to reduce the incidence of this very widespread over-prescription."

Nadra Ahmed, chairman of the National Care Homes Association, said the blame did not lie solely with care homes.

She explained it was GPs who made the decision to prescribe dementia sufferers with anti-psychotic drugs.

She told the programme: "One of the things we need to get absolutely clear here is these drugs are prescribed by general practitioners, they are not prescribed by the care home providers. This is about medical conditions which are obviously reviewed by GPs.

"We have clients who come into our homes, sometimes already on these drugs and actually very good providers do tend to use their initiative and try to manage the conditions and wean people off drugs.

"Very often what happens is that GPs are just not giving us enough time in our services to come and review the medication and people can be on this medication and once they're on it, people, quite rightly, are reluctant to take them off."

She also rejected claims that some care home providers sedate dementia sufferers as it makes them easy to manage.

There are around 700,000 people with dementia in the UK. That figure is expected to soar in the coming decades as life expectancy lengthens.

Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "It's critical that the dangers of wrongly-prescribed anti-psychotics are understood and Government action is taken to prevent putting more people at risk.

"Alzheimer's Research Trust scientists at the Institute of Psychiatry are investigating alternative safer means of reducing agitation among dementia patients.

"We must urgently develop safe and effective treatments for people with dementia.

"Unless researchers develop new treatments, within a generation 1.4 million people will live with dementia in the UK alone."

Paul Burstow, a Liberal Democrat MP who has led a 10-year campaign highlighting the risks of over and inappropriate prescribing, said: "This review comes much too late for thousands of elderly people whose lives have been cut short by the reckless prescribing of anti-psychotic drugs.

"The evidence that anti-psychotic drugs do more harm than good has been mounting for years. There is next to no benefit for the older person and prolonged prescribing can lead to premature death.

From:

http://www.telegraph.co.uk/150000-dementia-sufferers-being-prescribed-anti-psychotic-drugs-unnecessarily

The evidence in favour of Prof Nutt- Financial Times Editorial

The UK government published a policy document committing itself to independent scientific advice in all departments, with an introduction by the prime minister proclaiming the “international respect” earned by the UK for “its thorough and professional approach to the use of evidence”. Only two days later Alan Johnson, home secretary, put that respect in jeopardy with an act of political clumsiness.

He sacked Professor David Nutt, a renowned neuropharmacologist, as chairman of the government’s Advisory Council on the Misuse of Drugs for insisting publicly that last year’s upgrade of cannabis to a Class B drug was not justified by the evidence. 

Two members of the council quit immediately in protest, more are threatening to follow – and the great and good of British science have lined up to attack the home secretary.

If Mr Johnson had thought through the consequences of his action, he would surely have consulted Lord Drayson, the science minister, and John Beddington, government chief scientist. They would have warned him of the outcry and dismay that Prof Nutt’s dismissal would cause.

At stake is not just the future of the ACMD, an important body that has helped to formulate drugs policy for more than 30 years, but as many as 80 other scientific councils and committees across government. These advise on everything from food and nutrition to climate change, and they depend on the unpaid part-time service of hundreds of scientists (mainly working in universities because industry researchers are often ignored for having alleged conflicts of interest). 

The volunteers may turn away from the system if they cannot express contrary views in public or if they see advice being rejected without good reason or even courtesy. Across the Atlantic, that sort of treatment gave George W. Bush’s administration a bad reputation with US scientists.

Indeed the row has implications beyond what most people would think of as science. Ultimately it is about the relationship between evidence and policy. 

Democratic governments always say they want to make “evidence-based policy”. The danger is that, when this does not suit them, they search for “policy-based evidence” – in other words picking out what supports their planned course of action and rejecting what does not. Saddam Hussein’s “weapons of mass destruction” are a prime example.

Of course scientific advice is not sacrosanct. Governments have the right to over-ride the evidence for broader policy reasons – but only if they do so openly and without gagging their advisers.

Mr Johnson is unlikely to pay a high political price for the Nutt affair, because the Conservative opposition, to its shame, supports the professor’s sacking. Chris Grayling, shadow home secretary, wants to outdo Mr Johnson in his hard line on illegal drugs, whatever the evidence. Only the Liberal Democrats are prepared to take a broader (and wiser) view of the need to encourage experts to give governments independent advice.

From:

http://www.ft.com/cms/s/0/379cbe88-c7e7-11de-8ba8-00144feab49a.html

Labour's drug policy up in smoke as scientists resign from drugs Council

Five scientists have now resigned from the labour Government's drugs advisory body Advisory Council on the Misuse of Drugs (ACMD) in the wake of the sacking of Professor David Nutt, its chairman.

An ACMD insider said that the three members to quit were Dr Campbell, a former head of worldwide discovery at the drugs company Pfizer and a former President of the Royal Society of Chemistry; Dr Marsden, a research psychologist at the Institute of Psychiatry; and Mr Ragan, a pharmaceutical and biotechnology industry consultant. None of the three was available for comment.

The departures of Dr Campbell and Mr Ragan would be particularly damaging as this would leave the council without representation from the pharmaceutical industry, which is required by law. Professor Walker’s resignation had already left the council without a pharmacist, another required discipline.





The Home Office has confirmed the ACMD, which is down to 25 members, must have at least 20 members to function, and that six key positions must be filled for the advisory group to function.

Professor Nutt said “I’m not surprised. The way I have been treated was reprehensible, and I’m pleased to have the support of these other council members.”

The trio quit the Advisory Council on the Misuse of Drugs following a crunch meeting with Alan Johnson, the Home Secretary, who earlier this month told Prof Nutt to step down after criticising Government policy.

The meeting had been called because members of the advisory body wanted reassurances from the Home Secretary that they could continue in "good conscience" and that their advice would be respected.

The row erupted after Prof Nutt said the dangers of alcohol and tobacco were more serious than those posed by Ecstasy and LSD and criticised the decision to reclassify cannabis as class B, against ACMD advice.

Prior to the news that three more had gone, Mr Johnson said he had told the body that their views will be given "due weight" in future.

He said he stood by the decision to remove his chief drugs adviser but wanted to improve relations but was "very sorry" to lose Marion Walker and Dr Les King, who quit earlier this month.

Mr Johnson said: "I understand why the Advisory Council on the Misuse of Drugs were concerned about this.

"Their major concern – and the reason why two very good people who I'm very sorry to lose – was because they felt Prof Nutt was being dismissed for his views. I reassured them that was not the case."

He added: "There is a duty I think to accept that politicians make the final decision.

Mr Johnson said a joint code between Government and scientists, proposed by the Royal Society, was being considered by Prime Minister Gordon Brown and the Government's chief scientific adviser.

Chris Grayling, the shadow home secretary, said: "Whilst we backed the original decision, by now I would have expected the Home Secretary to be able to sit down with other members of the Council and rebuild confidence and stability in what they are doing. Quite clearly he has failed to do that.”

In a joint statement released by the Home Office, the meeting was described as "very constructive" but made no mention of any impending resignations.

Evan Harris, the Liberal Democrat science spokesman, said: “The latest resignations represent a deepening in the crisis of confidence of scientists in the Government — in particular, in the Home Secretary. That they come after Alan Johnson met the ACMD demonstrates that he just doesn’t get it when it comes to the importance of respecting the academic freedom and integrity of independent, unpaid, science advisers.

Ministers are entitled to their own opinions, but not to their own facts. The cost of the failure of the Home Secretary to understand the lessons of the BSE Inquiry will be poor policy — unless the Prime Minister acts decisively to bring the Home Office and rest of Government into line with established good practice.

“By clumsily and unfairly sacking David Nutt, Alan Johnson has been rewarded with five resignations in protest. That takes a certain kind of ineptitude.”

Health Direct has complied this post from:

http://www.telegraph.co.uk/health/healthnews/6470090/Three-more-drug-advisers-quit-over-David-Nutt-sacking.html

http://www.timesonline.co.uk/tol/news/politics/article6911558.ece

Fall in proportion of patients who pay for private health care

The proportion of patients who pay for their own operations– through private medical insurance or out of their own pocket– has tumbled almost 30 per cent since Labour took power.

By 2008, however, that figure had fallen to 10.6 per cent, with just over 900,000 patients being treated privately against 7.7m who were funded by the NHS, according to Laing & Buisson in its annual Healthcare Market Review, the bible of the private health industry.

The proportion is likely to have fallen further since then, given a rise in patients choosing NHS-funded care in a private hospital and a steep decline, caused by the recession, in the numbers paying with their own money.

William Laing, chief executive of Laing & Buisson, said: “This remarkable reduction in the privately funded share of elective surgery is not because private healthcare is in decline.”

The numbers choosing to pay for themselves have fallen 20 per cent or more over the past couple of years to just 16 per cent of private hospital income in 2008 against more than 22 per cent a few years earlier.

Until recently, however, the numbers covered by private medical insurance had held up well.

“The main reason for the falling private share is that NHS-funded surgery has been growing so much faster, aided by the massive injection of public spending during the last decade,” Mr Laing said.

The number of cases paid for by the NHS in private hospitals jumped from just above 50,000 in 2007 to 151,000 in 2008. Those numbers are still rising as NHS patients’ rights to choose a private hospital begin to take off. On top of that – and not included in these figures – are approaching 100,000 NHS patients a year being treated in the independent private sector treatment centres that were set up to provide NHS care.

But Mr Laing said the extra business “has been a mixed blessing” for private sector hospitals. NHS work offers a lower profit margin. “If and when” self-pay work revived, many of the private operators would wish to return to their core private market. The big question, he said, was whether any private operators had the appetite to invest in additional, lower cost, facilities aimed at servicing the NHS. 

The ISTC programme, where some contracts were cancelled and the fate of those contracts that are coming up for renewal is uncertain, “has dented providers’ confidence in the government’s long-term intentions,” Mr Laing said.

Patients are to be given a legal right to seek treatment at a private hospital if the NHS fails to honour its promise to treat them within 18 weeks, according to government insiders. The measure is expected to be included in the Queen’s Speech this month. The same entitlement is likely to apply to the pledge that patients with suspected cancer must be seen by a specialist within two weeks.

Patients can already choose to receive their NHS funded care for non-urgent procedures at a private hospital – although it is not routinely possible to switch to private care once diagnosis and treatment are under way.

Labour has already said it will turn its 18-week wait target into an “entitlement”. The move to make it a legal right is at least partly political, with Labour ministers planning to challenge the Conservatives over whether they would repeal such a measure.

From:
http://www.ft.com/cms/s/0/b364c9c6-c72d-11de-bb6f-00144feab49a.html?nclick_check=1

Professor Nutt- if we want to reduce deaths, alcohol and heroin are the issues

Having been sacked from the Advisory Council on the Misuse of Drugs (ACMD), Professor David Nutt talks to the Telegraph.

On Saturday evening, two days after he was sacked from his position as drugs tsar for saying that cannabis is less dangerous than alcohol, Professor David Nutt went to a brass band concert in his local church in Keynsham, outside Bristol. "I came in late and sneaked in the back," he says, "but in the interval, the Master of Ceremonies announced I was there. The news was greeted by an amazing round of applause."

So his neighbours are fond of him: no surprise, since this Nutt's tough outer shell seems to hide a friendly father-of-four humanity. But that's missing the point. "The youngest person there was 50. Many were 85." To Nutt, this says it all. Not only is he – as he puts it – "on the side of the angels" in the clash between science and politics, he also believes that he is more in touch than the politicians with even the most conservative of rural electorates.

The past week has not been short of similarly morale-boosting moments. Emails have flooded his in-box – 98 per cent supportive. Ten thousand people have pledged their support on Facebook. Two fellow scientists on the Advisory Council on the Misuse of Drugs (ACMD) have resigned in sympathy. Teenagers, who normally don't even notice what's in the news, are rallying to the cause – to judge from the unusually high level of debate in my own home. My own teenagers, however, abruptly changed their views when they heard some of his suggestions for stopping them wrecking their livers.

Most encouraging of all to him, scientists are leading a march on Downing Street this Sunday, calling on the Government to "back evidence-based drug policy by respecting and upholding the independence of the ACMD" in advance of the Council's meeting next Tuesday. If he had taken a hallucinogen, Nutt couldn't have asked for more.

Far from repenting the remarks that caused Alan Johnson, the Home Secretary, to think Nutt had "crossed the line" between advice and policy – which he surely did – the beaming professor of neuropsychopharmacology is loving every moment of his disgrace. Academics don't usually become folk heroes. Nor do they generally manage to attract more than 30-second news clips. But these days his phone is ringing non-stop with requests for his wisdom from around the globe. "Sorry, it's Radio Bogota,"he says, as his mobile trills yet again.

Nutt enjoys speaking out: earlier this year he pointed out that "Equasy" as he called it – horse riding – was more dangerous than Ecstasy. Having devised a "matrix of harm" – a graph to calculate the damage done by various substances, on the basis of dependence, and physical and social harm – he's delighted to have been handed a platform from which to preach.

The big problem, as he sees it, is that while politicians love to be "tough" on classified drugs, their response to the far greater danger posed by the most dangerous drug of all, alcohol, has been "puny".

"We are not taking the tidal wave of damage seriously enough. If we want to reduce deaths, alcohol and heroin are the issues. I have four children, now aged 18 to 26, and at almost every party they went to in their teenage years, a child was taken to hospital with alcohol poisoning.

"Liver disease will become a worse killer than heart disease within twenty years. Scotland already has the highest proportion of people with sclerosis of the liver in the world. There are hundreds of kids lying in hospital beds waiting for transplants that will never come. But when Sir Liam Donaldson [the Government's chief medical adviser] put forward a radical approach to reduce alcohol consumption by increasing the price, within seconds the government rejected his proposal."

Nutt is not a puritan. He confesses to "liking" alcohol, to having binged occasionally when he was young, and to having tried some drugs as a student – but not cannabis, because he has never smoked. The worst problem with alcohol, he says, is that it is "insidious": people develop a strong head and aren't aware of its toxicity. But the main issue is that moderation doesn't seem to be possible for many people, especially the young.

He has asked his own children why their friends set out to get wasted and break the windows of the Keynsham church. "They say it is the excitement of not knowing what will happen."

His matrix isn't going to stop them experimenting, so what would positive action should politicians take, short of sacking their advisers? "We cannot make alcohol illegal. We need a structural approach. The real price of alcohol has dropped by half since Labour came to power and the use has doubled. To bring consumption down, prices should be doubled, maybe tripled, and the drink-driving limit should be reduced. We could even change the age at which it is legal to start drinking. In the US, since most states switched back from 18 to 21 (in the late 1980s), 170,000 lives have been saved in road traffic accidents. A shifting of the starting age would also reduce the damage to brain and body and the likelihood of young people becoming dependent."

Nutt pauses for effect before offering his most "radical" solution of all: an alternative to alcohol that's safer. Yuck, I don't want to take a soma pill when I get back from work; I want a delicious glass of white wine.

"Aaah, but if we invested some work in it we might find something as delicious. As it stands, though, with the Misuse of Drugs Act, if I came up with it tomorrow, I couldn't sell it. I'd like there to be a prize for inventing a safe alternative, as there was for inventing the chronometer in the 18th century, and the prize would be being allowed to sell it. You could also design an antagonist that would reverse the effects. Science could get there in five to 10 years. Let's move on from 2,000 years of poisoning ourselves."

That's what people thought they had found in cannabis, which makes you light-headed but not likely to get into fights or drive too fast. Forty years on from the Summer of Love, however, everyone knows someone whose brain has turned to mush or, worse, has become psychotic. Yet he opposes plans to reclassify cannabis from B to C, even though "skunk" – one of several cannabis derivatives – is now so much more powerful than standard "weed".

"Stoned people aren't a danger to others," he says. "Classifying it as B will be a disaster, because anyone caught in possession three times can be sent to prison for five years. The prison population will increase, those people will find it hard to get jobs. That way you just add to the underclass and the tax burden."

Sunday's march on Downing Street is emphatically not calling for legalisation. Although legislation might be a logical next step, Nutt is supportive. "It [legislation] would increase use. And I could never countenance the marketing of drugs, as with alcohol and tobacco. But I would like some level of toleration, as in the Netherlands, where cannabis can be smoked in certain cafés and a small amount bought for use off the premises: that has reduced social harm because it makes the drug less appealing. It is no longer a statement of dissent. Many other European countries have moved away from criminalisation for personal possession. In Portugal, people found with cannabis are now sent to social workers; use has gone down."

Nutt cites a MORI poll conducted by the ACMD that suggests most British people don't want stoned youths imprisoned. But, he adds, it's wrong to see him as soft on all drugs because, during his ten years as the Council's chair, he has been the "biggest criminaliser of drugs".

In that time, a host of new ones have been classified, including ketamine and GBL, the party drug that killed medical student Hester Stewart this May. He has also moved Crystal Meth from Class B to Class A, thereby allowing the police to shut down houses where it is produced. Another source of pride is the containment of Aids due to moving heroin addicts onto Methadone.

It all comes back to his matrix of harm. No one much knew of it before; now we do. Outside the ACMD, Nutt may turn out to have more clout than he ever did as an insider. Next Tuesday's meeting may or may result in a mass resignation, but the sacking of Nutt could be a turning point for so-called independent advisory bodies that are allowed to say what they like, providing it fits with Government policy.

Among the many messages of support have been several from people who want scientists to advise on the damage done by the various drugs in circulation, and are willing to fund it.

"I'm hoping," says Nutt, "that we can create a separate, independent scientific body that can take this out of party politics. Then we can monitor drugs and the Government can decide policy." Alan Johnson might agree with him there.

From:

http://www.telegraph.Professor-Nutt-If-we-want-to-reduce-deaths-alcohol-and-heroin-are-the-issues