Labour plans to cuts hundreds of NHS hospital wards

Plans that could lead to the closure of hundreds of hospital wards are being drawn up but will not be made public until after the general election, opposition parties have said.

Last year, the Government asked NHS authorities to come up with proposals to reorganise the service to save money as a result of the recession. Details have started to emerge of what is likely to be a rolling programme of cuts that contrasts sharply with assurances from Labour and the Tories that the NHS was “safe”.

So far, only the plans for London have come to light. Campaigners claimed the proposals threatened services such as casualty and maternity units at 13 out of 36 hospitals in the capital.

The failure of health authorities in other areas to disclose their response has prompted allegations that proposed closures, which could be politically damaging to the Government, will not be published until after polling day.

The scale of the cuts has caused a rebellion among Labour ministers who have openly defied the Government by publicly protesting at closures at their local hospitals.

Next week, health ministers will come under pressure from the Conservatives and Liberal Democrats to disclose the scale of the plans, with the Tories calling an emergency debate on the issue.

Norman Lamb, the Liberal Democrats’ shadow health spokesman, said the scale of the cuts to hospitals was likely to be “vast”, with potentially “hundreds” of wards closing.

He said: “The Government will be desperate to avoid these cuts ahead of an election. We could end up with the threat of cuts to services being a key issue in the election campaign. The electorate will feel conned if they come out after the campaign.

“It is hard to judge the scale of this but it could be vast. It could be hundreds [of wards]. The savings they have to achieve are enormous. What has emerged in London could be the tip of the iceberg and the public is unaware of the scale of potential cuts.”

Mike Penning, the Tory shadow minister for health in London, said: “I see no reason why these reports cannot be published before the election. Labour must be straight with people about the cuts that they are planning to make to their local NHS.”

The cutbacks are partly as a result of Lord Darzi’s 2008 review of the NHS, which recommended more community based treatment in large GP centres and bigger, specialist treatment centres in hospitals.

Authorities were asked by the Department of Health to draw up plans to implement Lord Darzi’s review. But last year, they were told to reconsider their proposals after the recession.

Opposition parties have claimed that health authorities were considering closing or merging key hospital departments, many of which have received millions of pounds in investment in recent years.

The NHS is coming under pressure to find other savings despite government claims that the health service would be protected from widespread public spending cuts.

In this month’s budget, Alistair Darling, the Chancellor, is expected to announce that the NHS will have to find savings of up to £10 billion a year. Liam Byrne, a Treasury minister, said last month that hospital buildings were likely to be mothballed as services were moved to community based health centres.

Dr John Lister, the author of the British Medical Association’s recent report on the plans, described the scale of the cuts being proposed as “a disaster”. Threatened hospital closures are likely to become one of the key election issues.

Labour ministers and MPs faced claims of hypocrisy after starting pre-election campaigns to block closures at their local hospitals. Ministers were pictured protesting against closures and writing to residents setting out their opposition. Many fear they will lose their seats if they are seen to back government policy.

Last weekend, David Lammy, the Higher Education minister, was joined by other local Labour MPs when he led a march to “save” the Whittington Hospital casualty department in north London.

The Whittington also faces cuts to maternity services, although £600,000 of public money was recently spent on its new birth centre. Other high-profile Labour MPs campaigning to protect hospitals in their constituencies include Margaret Hodge, the Culture and Tourism Minister who represents the marginal seat of Barking. She has led a campaign to save the Accident and Emergency unit at King George Hospital in Ilford.

Mike Gapes, the Labour MP for Ilford South, also backs the campaign. “I will fight a Labour government, a Conservative government or a Martian government to keep a hospital in my constituency,” he said yesterday.

Last night, Andrew Lansley, the shadow health secretary, said: “Labour MPs are campaigning on a general election manifesto which would lead to the first cuts to the NHS budget for years, but yet they still try to portray themselves as local champions by protesting against cuts in their own backyards.”

From:
http://www.telegraph.co.uk/Hundreds-of-NHS-wards-to-be-shut-in-secret-plans

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

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

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

Drunk and overdosing homeless people put strain on NHS

One drunk or drug addicted homeless person is admitted to hospital every three hours, putting a severe strain on the National Health Service, new figures show.

The rate of drug and drink related admissions of homeless people has risen by 117 per cent since 2004, with six out of 10 hospital trusts reporting that numbers have gone up in the last five years.

Many of the rough sleepers had overdosed or suffered infections from using dirty needles to inject drugs such as heroin, while others needed their stomachs pumped after drinking too much.

The figures, contained in a series of answers to freedom of information requests put in to 173 hospital trusts, were released by the Conservatives, who issued a report setting out the importance of understanding the health needs of homeless people.

In particular, the party wants the availability of cheap alcohol in supermarkets to be curtailed, and for health boards to work with local homeless charities such as Shelter to consider the best ways to help homeless people in their area.

Grant Shapps, the shadow housing minister, said: "A refusal to confront the extent of the homlessness issue in the United Kingdom leaves our frontline services such as the NHS struggling to cope.

“Our report demonstrates how drugs and alcohol frequently play a major role in perpetuating the chaotic lives lived by many people trapped in homelessness. This is one of the reasons why Conservatives will fix the crazy situation whereby supermarkets are selling high strength larger for less than they charge for a bottle water."

The report shows that nearly 14,000 homeless people were admitted to hospital with drink and drug-related conditions in the last five years, the equivalent of eight a day or one rough sleeper every three hours.

London had the most admissions, followed by Liverpool and Leeds.

More than 10 per cent of rough sleepers who ended up in hospital for alcohol or drugs were under the age of 25, even though young people are estimated to account for between six and seven per cent of the homeless population.

From:

http://www.telegraph.co.uk/Drunk-and-overdosing-homeless-people-put-strain-on-NHS

Breast removal for cancer is postcode lottery, study shows

Women with breast cancer are five times more likely to undergo a mastectomy rather than have less invasive surgery in some parts of the country compared with others, research has shown.

Sufferers living in some parts of the North are far more likely to undergo the major operation, rather than having the "breast conserving" surgery more common elsewhere, according to NHS figures revealing a "postcode lottery" in cancer care.

Statistics showing the ratio of mastectomies to less invasive procedures to treat breast cancer, show that Redcar and Cleveland, in the North East, is the place where patients were most likely to have at least one breast removed.

Those in the London borough of Richmond and Twickenham were the most likely to receive treatment which removed just part of their breast, with radiotherapy used to prevent the spread of tumours.

The statistics show that those living in Wolverhampton, West Midlands, the London borough of Kingston, South Staffordshire and Telford in Shropshire were also more likely to have mastectomies.

Research has found that for many women with breast cancer, either treatment has a similar survival rate, if the tumour is of a size where it can be removed without the whole breast being lost. The chance of drastic surgery was highest in the North. 

Women living in Redcar and Cleveland, in the North East, were five times as likely to have their whole breasts removed, rather than part of them, compared with those living in Richmond and Twickenham.

Those in Ashton, Leigh and Wigan, in the North West, Middlesbrough, in the North East and Bassetlaw in Nottinghamshire were also most likely to have mastectomies.

The new NHS figures, placed in the House of Commons library, show massive variations in practices across the country. Analysis found no relationship between the patterns and rates of survival in different parts of the country.

Experts said it was impossible to know from the data whether the massive discrepancies reflected the choices made by women from different areas, or pressure put on them by surgeons.

Cancer charities urged surgeons working in the areas most likely to carry out mastectomies, to carry out further investigations.

Women with breast cancer should be offered the option of mastectomy, or less invasive surgery backed by radiotherapy. Research has shown that for most women, the survival chances are similar, although those with larger tumours may have no choice but have the more drastic operation.

Meg McArthur, from Macmillan Cancer Support, said: "These variations are really substantial, and they really do require further investigation. In some cases – such as the way a tumour is positioned, women would have no choice but to have a full mastectomy, but that really wouldn't explain the scale of the difference shown here."

She said it was vital that women diagnosed with breast cancer were given full information about the risks and benefits of different treatments.

"I would want all surgeons to look closely at these figures, and for primary care trusts to examine them closely too," Miss McArthur added.

Dr Jane Maher, chief medical officer for Breakthrough Breast Cancer, said it should not be assumed that women in areas most likely to have mastectomies were necessarily being put under pressure to undergo the procedure. Many women given information about the risks and benefits of both procedures chose the more drastic surgery, because they felt more able to put their fears behind them if they took the most extreme option.

From:

http://www.telegraph.co.uk/Breast-removal-for-cancer-is-postcode-lottery-study-shows.html

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

Turmoil over NHS records scheme as labour cuts NPfIT to save cash

The world’s biggest civilian IT project was thrown into turmoil yesterday after Alistair Darling, the labour chancellor, implied that it was going to be scrapped.

The chancellor told the BBC’s Andrew Marr Show the £12.7bn NHS IT programme – already running years late – was “something that I think we don’t need to go ahead with just now”.

Treasury officials rushed to explain that the government was looking for “significant savings” of up to perhaps £600m over the medium term by cutting back some features that are less important for patients.

A senior health department official, meanwhile, said bluntly span that “the chancellor mis-spoke” in saying the project to create an electronic medical record would be scrapped.

Details of which elements would go were not clear on Sunday night. But the government would face compensation claims of many hundreds of millions of pounds if it cancelled the programme. Fujitsu, an IT provider, is already in mediation with the health department over its £700m compensation claim after it was fired last year.

Ahead of Wednesday’s pre-Budget report, Gordon Brown will on Monday announce that the government has found another £3bn of “efficiency savings” – in practice, many of them cuts – since the Budget.

In a change of rhetoric, Mr Brown is expected to argue these savings are an “element of our efforts to reduce the [£175bn] deficit”, not just a means of protecting frontline services.

Some 123 quangos will go – including the Foreign Office advisory committee on wine purchasing – with the courts inspectorate merged into an existing inspectorate and several health bodies merged with NICE, the National Institute for Curbing Expenditure.

Full details of quango mergers and abolitions will not be spelt out until next year’s Budget, but they are expected to save an estimated £500m.

Central government’s use of consultants will be halved and the marketing budget cut by 25 per cent, saving £650m. Better use of text messaging and online services should save £665m – for example by reducing missed hospital appointments – according to government estimates.

Many of the proposals, which the prime minister will present as “streamlining government”, mirror those from the Tories, who have promised to slash the use of consultants to cut council tax. They also propose reducing by 24,000 the 80,000 civil servants employed in policymaking, inspection and regulation, and grant assessment over the next Parliament.

The FDA, the top civil servants union, condemned the planned cut in civil service numbers as “crude electioneering” and “irresponsible” just months ahead of a general election.

Mr Darling’s apparent scrapping of the NHS electronic record programme excited both the Conservatives and the Liberal Democrats, the latter calling for it to be “abandoned in its entirety” and Andrew Lansley, the Tory health spokesman, describing it as “another government IT procurement disaster”.

From:

http://www.ft.com/cms/s/0/71d29630-e2a5-11de-b028-00144feab49a.html?nclick_check=1

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

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

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

NHS waiting times have risen by a third in a month

Waiting times in the NHS have risen by almost a third due to bad weather earlier this year, it has emerged.

Figures show that the number of patients waiting more than eight weeks for an outpatient appointment increased by 31.5 per cent between March and April this year.

There were 43,400 people waiting more than eight weeks for an outpatient appointment in April, 82.7 per cent higher than the previous year, according to Health Service Journal.

Officials said a backlog of appointments has built up after the bad weather in February which saw much of Britain gridlocked under snow.

The NHS suffered an extremely busy winter as the coldest weather for 30 years, coupled with high levels of seasonal flu and norovirus outbreaks.

The Daily Telegraph revealed the extent of the pressure on the ambulance service as national director, Peter Bradley, said the service had seen its busiest ever week in December and others warned staff were 'performing near miracles' to keep the NHS running.

From:
http://www.telegraph.co.uk/health/healthnews/5497044/NHS-waiting-times-have-risen-by-a-third-in-a-month.html

NHS swine flu absence may reach 85%

The NHS may struggle to cope if there is a flu pandemic because of the number of staff who will fail to turn up for work, a report suggests.

Birmingham University researchers quizzed more than 1,000 health workers and found as many as 85% may be absent.

This is more than double the official predictions and the experts believe such a scenario could put too much strain on the health service.

Under contingency plans already drawn up, protocols are in place to allow the NHS to cancel non emergency treatment such as elective operations.

GPs have also been asked to develop networks to allow the sharing of resources to cope with pressures during a pandemic.

But the report, published in the BMC Public Health journal, questioned whether this would be sufficient.

Official estimates suggest the absence rate will be something between 10% to 35%.

But the Birmingham University poll found that in a severe pandemic where many schools were closed and transport disrupted the actual figure could be more than double that.

Researchers asked a range of staff ranging from doctors and nurses to support staff and managers about how they thought they would cope.

High absence rates were predicted for each group, although doctors were among the most likely to turn up.

The most important factor that would lead to an absence was caring responsibilities to children or elderly family members, the report said.

'No easy answers'

Dr Sarah Damery, one of the report authors, said: "It raises questions about the ability of the NHS to cope. The problem is that there are no easy answers.

"Things such as transport and accommodation can be resolved, but the major factor that would influence people staying away is to do with caring responsibilities and these are not that easy to solve."

The findings come as the UK is braced for a pandemic.

The World Health Organization currently rates the swine flu outbreaks at phase five - one level short of a pandemic.

Professor Steve Field, the president of the Royal College of GPs, which has helped draw up the contingency plans, said: "I think the plans in place are excellent and what we have seen so far is that health workers have risen to the challenge.

From:
http://news.bbc.co.uk/1/hi/health/8048554.stm

Swine flu- hospitals could turn away critical patients in a pandemic

Hospitals could be "rapidly overwhelmed" and forced to turn away critically ill patients if a flu pandemic reaches Britain, according to the Government's own assessment.

A Department of Health document warns that the health service is already working close to its capacity, leaving little scope to meet the demands of a mass outbreak of swine flu, which could force doctors to turn away patients needing intensive care.

The document, seen by The Daily Telegraph, says cuts in the number of beds since Britain last underwent a pandemic in 1969 – combined with an ageing population and changes in the way patients are treated – mean intensive care units "could be rapidly overwhelmed".

The disclosure of the document last week came as:

Nicola Sturgeon, the Scottish health minister, reported that there has probably been the first British case of swine flu in someone who has not travelled to Mexico, indicating that the virus has begun to pass between people here;

Three new cases were confirmed in Britain;

Countries around the globe continued to report new cases of H1N1, with new confirmed cases in Holland. the Republic of Ireland and Germany.

Authorities in Mexico, the source of the outbreak, asked for a five-day shutdown of non-essential business and travel in an attempt to slow the spread of the disease.

The world is now on the brink of the first flu pandemic in 40 years, with the World Health Organisation's (WHO) alert status at five out of six.

The Department of Health is printing leaflets to put through every door urging people to find "flu friends" who can bring them groceries and supplies if they fall ill.

However, the Department of Health (DoH) document seen by The Daily Telegraph warns that, during the peak of a flu pandemic, complications such as pneumonia could mean there are 10 times as many people requiring ventilators as the NHS can supply.

If demand cannot be met, it recommends doctors deny treatment to the weakest patients so that resources can be shared among the greatest number.

The draft document, which was written in September before the outbreak of swine flu, acknowledges that its recommendations open "controversial ethical issues" and could cause anger and violence from relatives of those refused care.

Doctors taking decisions to deny care are urged to fully document their decisions to protect themselves from litigation, while hospitals are warned that "additional security decisions may be necessary because of the risks of violence directed at staff making triage decisions".

The document, Pandemic Influenza: surge capacity and prioritisation in health services, sets out the criteria which doctors should use to determine which patients receive intensive care.

If there is competition for places in intensive care units, patients suffering from advanced cancer could be refused beds along with pensioners suffering from severe burns, those with multiple organ failure and children suffering from advanced cancer, severe burns or trauma.

If patients competing for life support are likely to have an equal benefit from treatment, decisions should be taken by lottery, the guidance concludes.

The document describes the pressures that the NHS suffered during the last two pandemics, in 1957 and 1969, which caused a total of 3 million deaths worldwide.

It states that the impact of the 1969 outbreak was lessened by a high number of spare hospital beds at the time. The document says cuts to spare bed capacity, so that the health service is now working "at or near capacity", a 31 per cent increase in the number of over-65s, a more complicated out-of-hours system for GPs and more widespread use of critical care would all make it more likely that intensive care units could be "rapidly overwhelmed".

Meanwhile, NHS Direct took a more than 10,000 calls in total on Wednesday and almost 3,000 of them related to swine flu – more than double the calls received on Monday about the virus, reflecting how public concern is growing.

A spokesman for the DoH said: "We have published this draft guidance to help clinicians to work within an ethical framework during a pandemic."

From:
http://www.telegraph.co.uk/health/swine-flu/5254149/Swine-flu-hospitals-could-turn-away-critical-patients-in-a-pandemic.html

NICE U turn as kidney cancer patients to get Sutent drug on NHS

Terminal kidney cancer patients will receive an expensive drug on the NHS, following a U turn by the labour Government's drugs rationing body.

The National Institute for Curbing Expenditure (Nice) has approved the use of Sutent, which costs around £27,000 a year, in its final decision yesterday.

But the body will turn down three other kidney cancer drugs insisting that they are not "cost effective" for the health service.

Nice sparked outrage in August last year when it initially turned down Sutent, claiming it was too expensive.

At the time patient groups and cancer charities accused the body of condemning sufferers to an "early death".

The drug, which can prolong life for months, is used in the treatment of patients with terminal kidney cancer.

Since its initial draft guidance on the use of the drug Nice has agreed with the labour Government to look more favourably on drugs which prolong life when it makes it decisions.

This, coupled with an offer from Pfizer, the company which makes Sutent, to cut the price, means that the drug will be approved for use on the NHS.

Under the agreement, Pfizer will pay the £3,139 cost of the first six-week cycle of the drug, with the health service paying the rest of the costs.

Three other kidney cancer drugs, Avastin, Nexavar and Torisel, are expected to be rejected because the body has deemed them too expensive for the benefits they provide.

Around 7,000 people are diagnosed with kidney cancer in Britain every year and an estimated 3,600 could be eligible to receive Sutent.

Earlier this year it was announced that the drug, also called sunitinib, would be given to patients in Wales, paid for by the Welsh Executive, even before the Nice announcement.

Prof Robert Hawkins, Cancer Research UK Professor and Director of Medical Oncology at Christie Hospital Manchester, said: "I am delighted that Sutent will be available.

"It will remove a great deal of anxiety and uncertainty for people diagnosed with renal cancer to know that modern, effective treatment is now available to them."

James Whale, from the James Whale Fund for Kidney Cancer, said: "Finally, we have justice for the kidney cancer community. This positive recommendation from Nice will allow thousands of kidney cancer patients in England and Wales access to this life extending treatment.

"The options previously available to us have been limited and are inadequate for the majority of patients. For some, sunitinib is the only hope."

From:
http://www.telegraph.co.uk/health/healthnews/5044196/Kidney-cancer-patients-to-get-expensive-drug-on-NHS.html

Health Direct asks how many people have been condemned to an early death by labour's killer quango whilst it dragged it's feet over spending NHS money?

More NHS job cuts on the way

The director general of NHS finance, performance and operations David Flory has warned that health service redundancies are likely to continue at their current rate of around 54 a month.

Compulsory redundancies stemming from the reorganisations of primary care and ambulance trusts and strategic health authorities have now been completed, resulting in a total of 5,318 lay-offs from April 2006 to December 2008, four-fifths of which were non clinical.

But although the numbers being forced to take redundancy are significantly lower than the peak of 256 a month in summer 2007, Mr Flory told HSJ he now expected the figure to stabilise at the current rate of around 54 a month - 72 per cent of which are non clinical.

He said the economic downturn had already caused the Department of Health to make it clear health service organisations would need to make efficiency cuts of more than 3 per cent in 2010-11, much of it through back office rationalisation.

Efficiency

"People are thinking about how to organise themselves to deliver that and are taking early opportunities now to get some of that in the bank," he said. "We are looking for people to take opportunities when they come up, to look rigorously at the way in which they commission and deliver their services, particularly back office and support services - to take every opportunity that they can to improve the efficiency of those."

Many of the redundancies resulting from Commissioning a Patient-led NHS were not made until two years after its 2005 publication, when employment guarantees ran out, with another glut in summer 2008.

In 2007, the Audit Commission found compulsory redundancies were costing an average £82,446. Based on that, the total redundancies to the end of 2008 are likely to have cost the NHS around £438m.

REDUNDANCIES – APRIL 06 TO DECEMBER 08

Period	Compulsory redundancies	Estimated cost (£m)
2006-07 April-Sept	903	74
2006-07 Oct-March	1,426	118
2007-08 April-Sept	1,533	126
2007-08 Oct-March	690	57
2008-09 April-Sept	603	50
2008-09 Oct-Dec	163	13
Total	5,318	438

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

20 trusts set to miss foundation trust deadline

More than 20 hospital and mental health trusts have been warned they are entering an "end game" because they will not be ready to become foundation trusts before December 2010.

Those unable to meet the labour government's deadline face either radical restructuring or becoming part of a "shopping list" for existing foundation trusts looking for takeover opportunities.

The list of trusts has been compiled by HSJ after NHS chief executive David Nicholson ordered strategic health authorities to estimate the date they expected each of the outstanding 111 non-foundations to apply to the regulator Monitor for authorisation.

"I'm sure there will be takers for these organisations. You focus on becoming a foundation or someone else will do it for you"

Even with two years of restructuring and investment to go, SHAs anticipate 20 trusts will not be ready by the deadline. An additional six have been scheduled for December 2010, leaving no room for delay.

Capital problems

The list includes some trusts with long standing problems, such as Royal Cornwall Hospitals, and others that are more surprising, such as Great Ormond Street Hospital and University Hospitals of Leicester. Of the 20 with no date at all, 12 are in London - a further indication of the scale of the capital's problems.

Foundation Trust Network director Sue Slipman told HSJ: "This will concentrate minds. I'm sure there will be some takers for some of these organisations. Either you focus on becoming a foundation trust or someone else will do it for you. The Department of Health is saying this is the end game and we need to get things moving now."

HSJ understands that Mr Nicholson's instruction to SHAs to draw up "foundation trajectories" followed behind-the-scenes pressure from foundation trusts. They wanted the DH to be explicit about trusts in trouble so they could start negotiating takeovers and, where appropriate, government subsidies for this.

Recently, chief executives at two of the 20 - Barts and the London and West Middlesex University Hospital - resigned amid performance problems. This has sparked concerns that SHAs could try to clear out chief executives to make way for takeovers or enforced mergers.

Outright failure

Foundation trust leaders contend that being on the list is tantamount to outright failure. There are three times more on the list than the six trusts deemed "financially challenged" by the DH.

North Bristol trust chief executive Sonia Mills said her trust had no anticipated application date as it had reached an "impasse" over its historical deficit. It will not clear it until 2012 and is in the middle of difficult planning for a large private finance initiative hospital, she said.

Monitor rules out applications from trusts with deficits.

"The clash of rules is out of our hands," Ms Mills said. "At the moment we are not discussing it with the board because we want to get our private finance initiative through first."

The trust is not exploring any merger or takeover options.

A spokesperson for Great Ormond Street Hospital for Children trust said its main sticking point was the pending legal challenge to the private patient income cap, which could see its private income radically curtailed.

The list includes district general hospitals seen as too small to survive the migration of patients to either community or specialist tertiary services. NHS North West director of healthcare systems Alison Tonge said Trafford Healthcare trust fell into that camp.

She said the SHA was exploring whether it could be merged with its primary care trust provider arm to form an organisation focused on community services.

Only one SHA - NHS North East - expects all its trusts to be ready before the deadline.

A DH spokesperson said: "SHAs are continuing to work with trusts to achieve foundation trust status and are identifying those who need more support."

From:
www.hsj.co.uk/news/2009/02/more_than_20_trusts_are_set_to_miss_application_deadline

Health Direct is not surprised by the impending failure of labour's NHS red tape.
On NHS managers voice worries over 'Stalinist' SHA tactics we posted:

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

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

NHS Project delays hold back stimulus plans

Plans to stimulate the flagging economy by bringing forward capital spending on public works are being undermined because existing projects are running into difficulties, research suggests.

Almost £1.7bn of health and education projects have been postponed in the past two months, despite government efforts to push money through.

The research, by Construction News, suggests the labour government will struggle to spend the £3bn it has brought forward to boost the economy. Dozens of projects have had to be put on hold, including 62 health schemes worth an estimated £1.3bn and 69 education projects worth £400m.

"The government is being held up by the procurement process," said Allan Wilen, economics director at Glenigan, a construction information service. "There is capacity in the construction sector, but you have to make sure you're putting up the right school in the right place."

Instead of increased public sector expenditure offsetting flagging private investment, it appears that cancelled private schemes are holding back health and education projects. "If a planned housing estate is no longer going up, there's no point in putting up a school either," Mr Wilen said.

The Department of Health has already cut PFI hospital building from a projected £12bn in 2006 to £7.6bn currently. Some of the remaining schemes have been trimmed and others delayed by redesigns.

Glenigan data show that more than 1,200 building and civil engineering projects have been put on hold since the middle of October, worth an estimated £10.8bn.

http://www.ft.com/cms/s/0/2571a078-c727-11dd-97a5-000077b07658.html

Midwives deal with three births at once, says expert

Midwives are "overworked and overstretched", sometimes caring for three women in labour at the same time, according an expert.

Since 2001 there has been a 16 per cent rise in birthrates yet there are vacancies for midwives in every part of the country, according to the Royal College of Midwives.

The labour Government has pledged 3,400 extra full-time jobs (4,000 including part-time workers), but research for the Darzi review into the NHS shows a shortage of 4,288 midwives.

The shortfall is estimated after comparing it with the NHS "gold standard" for safer childbirth, which demands one midwife per 28 births.

London has the worst shortages with 1,150 more midwives needed to meet a 20 per cent rise in the birthrate.

Louise Silverton, deputy general secretary at the RCM, said: "Women keep hearing about Government policy statements, such as one-to-one care from a midwife, but they are not getting that sort of treatment in many areas.

"Our members are telling us that they are overworked and overstretched and are running between beds dealing with, in some cases, three women at once."

The RCM added funding for maternity services has been cut by £55 million.

Miss Silverton added: "The maternity services have long been described as a postcode lottery - but our regional NHS responses paint a shocking picture of just how loaded that lottery for maternity care is."

By next year ministers have promised women will be able to choose whether to have their child in hospital, at home or in a midwife-led birth centre.

The Government has promised £330 million of extra funding for maternity services over three years.

But, according to Miss Silverton, research shows nine out of 10 maternity units do not know where their share of the £330 million had gone, and it could have been diverted into other services.

She said: "It is not enough for the Government to say it has put money into maternity services, but then fail to make sure the money actually goes where it is supposed to."

From:
Midwives-deal-with-three-births-at-once-says-expert.html

Polyclinics threaten 600 GP practices, say Tories

More than 600 GP practices are under threat because of labour Government plans for "super surgeries" despite overwhelming public opposition to the proposals, according to the Tories.

Hundreds of family doctor surgeries across England have been identified by local health Trusts as being in the same catchment area as proposed new polyclinics.

The Conservatives have compiled the list of practices across the country, named in plans for polyclinics drawn up by Primary Care Trusts, which they say could be killed off by the scheme.

They said the list showed practices which could be forced to shut because they would lose patients to the new clinics if they went ahead and warned that the final figure is likely to be much higher as many Trusts are still compiling plans.

Doctors who found their name on the list would now be "even more concerned than they were already" about the possibility of closure, the British Medical Association (BMA) said.

But the labour Government insisted that there was no suggestion in the documents that any of the practices had been earmarked for closure.

Recently, more than 1.2 million patients signed a petition protesting against plans for polyclinics, which was delivered to Gordon Brown.

Doctors' leaders argue that the new surgeries will destroy the relationship between patients and their GP family doctor and force them to travel much further to see a doctor.

GPs are also worried that polyclinics could "cream off" younger, healthier patients who help to subsidise their practices to treat those with more complex medical problems.

But ministers insist that the clinics, which could house up to 25 GPs as well as extra services such as dentistry and minor surgery and will open during evenings and weekends, will provide a "world class" service.

The Tory research reveals that 608 practices in almost half of all Primary Care Trusts outside London -where ministers insist that the "GP led health centres" will be in addition to existing services - have already been listed as close to proposed new clinics.

If this were replicated across the rest of the country including the capital as many as 1,700 practices could be under threat.

The Tories said the implication was that polyclinics would threaten the viability of the practices listed, even if not all of them would be forced to shut.

Andrew Lansley, the Conservative health spokesman, said: "The Government needs to explain why these GP surgeries are being named if it's not because polyclinics pose a threat to the local doctor.

"It adds to the huge weight of evidence now building up that polyclinics are not the additional services as Gordon Brown has claimed. Patients and family doctors are right to be worried about losing a valued local service. It's time Labour faced up to their concerns and called a halt to their unpopular polyclinics scheme."

A spokesman for the BMA said that the publication of the list would worry GPs already concerned that their practices could shut.

He said: "We have always had concerns about the viability of practices that are close to these polyclinics.

"It is inevitable that they will lose resources because of the new development, even if they are not actually dragged into it.

"Ben Bradshaw [the Health Minister] has said that some patients won't have to deregister with their GP to use this service, but that is not really the point.

"There is only one pot of money and if it is all going into polyclinics then GP surgeries will have to cut back on services and many could be forced to close."

He added: "GPs who find themselves on this list will be even more concerned than they were already."

An official spokesman for Mr Bradshaw said: "There is no suggestion from any of those PCTs that these surgeries are marked for closure."

Within London, where ministers insist plans for polyclinics differ from the rest of the country, around 100 practices have already been already earmarked for closure, to make way for the new surgeries.

From:
Polyclinics-threaten-600-GP-practices%2C-say-Tories.html

A million patients battle against polyclinics

More than one million patients have signed a petition protesting against plans to close hundreds of GP practices to make way for polyclinics.

The signatures, collected by the British Medical Association (BMA) in just three weeks as part of its "Support Your Surgery" campaign, was presented to Gordon Brown at Downing Street.

The BMA is concerned that the new clinics will destroy the relationship between patients and their family doctor

The labour government cannot afford to ignore the level of patient concern over polyclinics, which have been dubbed "supersurgeries", doctors' leaders will say.

Ministers insist that the centres, designed to house up to 25 GPs under one roof along with other services such as minor surgery, will provide a better service for patients.

But the BMA claims they will destroy the relationship between patients and their family doctor and lead to more private companies running surgeries.

Analysis by the Tories suggests that 1,700 of the 8,700 GP practices in England could have to shut under the plans.

Around 100 GP practices in just eight PCTs in London, the first part of the country to roll out the policy, have already been earmarked for closure to make way for polyclinics.

Doctors will protest against the plans at the BMA's Local Medical Committees annual conference today, entitled "standing up for General Practice".

Dr Laurence Buckman, chairman of the BMA's GPs Committee, will tell GPs at the meeting that the petition "will deliver a stark message to the Prime Minister" about the true level of patient concern.

Dr Buckman will also say: "My message to Gordon Brown is this: Whatever you think of GPs, take note of what your electorate thinks. Work with us to improve the service, not against us, and ignore at your peril the wishes of the most important people in the NHS – the patients."

He will tell GPs : "If the government won't listen to you, their doctors, then surely it will listen to the 1.2 million men and women who call for a halt to the plans to promote the use of commercial companies in general practice.

"Voters don't want funding to move from GP practices to commercial companies who are accountable primarily to shareholders rather than patients. They want to be treated as patients, not customers."

The petition calls on ministers to "continue to support our existing NHS GP surgeries" and "improve services to patients by further investment in existing GP surgeries".

But Neil Bentley, from the Confederation of British Industry (CBI), accused doctors' leaders of "ostrich-like denial" and said that the plans would extend opening hours and increase the range of services offered to patients.

From:
A-million-patients-battle-against-polyclinics.html

NHS hospitals lose 32,000 beds in a decade

More than 30,000 hospital beds have been lost since Labour came to power, with record cuts in NHS wards last year- which Health Direct chronicled.

The cutbacks mean increasing numbers of hospitals are going on "black alert" – which involves closing their doors to new patients because they are full.

Patients' groups described the loss of the beds, at a time when overcrowded wards have seen soaring rates of killer infections, as "a national scandal".

The reduction contradicts a pledge from Tony Blair at the turn of the century that there would be 7,000 more NHS beds by 2010.

New figures, seen by The Telegraph, show that the number of health service beds fell more than 8,000 last year, as the NHS began a reorganisation process which will mean the closure of dozens of hospitals.

More than 40 per cent of maternity units turned away women in labour last year because they had no room.

Meanwhile, ambulances have been forced to queue outside overstretched hospitals, treating patients in car parks just yards from accident and emergency departments. The new statistics, revealed in response to a parliamentary question by Ed Vaizey, the Conservative MP, show that almost 32,000 NHS hospital beds went between 1997, when Labour took office, and 2007.

More than 8,400 beds were cut in the year ending March 2007, the largest fall in 14 years. One in six beds has been closed over the decade. There are now 167,019 beds in NHS wards, compared with 198,848 in 1997.

The figures emerged as health authorities are drawing up plans which will see the likely closure of dozens of district general hospitals. The East of England health authority has admitted that two accident and emergency departments and a maternity unit could close.

Andrew Lansley, the shadow health secretary, said the labour Government's financial mismanagement had forced hospitals to make cuts which could risk lives. "These bed cuts were financially driven: the sharp rise in the numbers closed happened at a time when the health service was under desperate pressure to clear a massive deficit."

Katherine Murphy, from the Patients' Association, said: "This is a national scandal. More than 30,000 beds have been lost at a time when demand is increasing."

In the same decade that the beds were cut, death rates from the infections MRSA and Clostridium difficile rose five-fold. Investigations into the biggest C. diff outbreak in Britain, which killed 90 patients at hospitals run by Maidstone and Tunbridge Wells trust in 2005 and 2006, found that overcrowding amid pressure to meet hospital waiting targets was a factor behind the infection's spread.

More than 2,000 maternity beds have been lost since 1997. Research by the Conservatives found that last year, 42 per cent of maternity units had refused to accept women in labour on at least one occasion.

Sue MacDonald, from the Royal College of Midwives, said: "We feel the cuts have gone too far."

Norman Lamb, the Liberal Democrat health spokesman, met officials recently after pressures on his local hospital, the Norfolk and Norwich, forced it to declare an emergency "black alert," closing to new admissions, with 10 ambulances "stacked" outside, treating patients.

From:
NHS-hospitals-lose-32%2C000-beds-in-a-decade.html

5,000 cancer beds facing axe in NHS cancer shake-up

The labour government plans to close up to 5,000 beds on cancer wards in a reorganisation of the way patients are treated, according to a report by experts in the disease.

Labour government figures show the National Health Service aims to save up to £500m a year from an “inpatient management programme” that it describes as preventing unnecessary hospital admissions and reducing the length of time patients spend in hospital.

Cancer doctors and health economists say the changes could make better use of money for cancer treatment but accuse the government of hiding the extent of the bed closures from the public.

The report by Nick Bosanquet, professor of health policy at Imperial College School of Medicine, London, and Professor Karol Sikora, medical director of CancerPartnersUK, a private cancer treatment company, comes as a shake-up of NHS hospitals, led by Lord Darzi, the health minister, is expected to include widespread closures of maternity hospitals and accident and emergency units.

Bosanquet and Sikora have analysed figures published by the government as part of its Cancer Reform Strategy in December. They reveal the efficiency savings the NHS will need to make in order to pay for better radiotherapy and screening programmes.

“My worry,” said Sikora, “is that the only way the Cancer Reform Strategy adds up financially is by massive bed closures to produce the funding for the huge deficits in both radiotherapy and cancer drugs.

“Up to 5,000 beds will need to disappear in England to make the spreadsheet balance. How else will the money be saved? Interestingly, the financials are not in the strategy document but hidden in an obscure corner of the Department of Health website.”

The government said cancer services must change so that patients can receive chemotherapy and radiotherapy during day trips to local clinics without going to hospital. It is also centralising specialist cancer care in larger hospitals where there is the expertise to get the best results.

The government has been forced to review NHS cancer treatment after studies showed that, despite spending comparable amounts on the disease as other European countries, Britain still has some of the worst survival rates.

Bosanquet, who was chairman of the Cancer Reform Strategy value for money group, said cutting beds could make better use of NHS funds but added the government should be more open about its plans.

“The Department of Health has put forward aspirations that must inevitably be to lower bed use in cancer services by around 5,000,” he said. “To save £500m, which is urgently needed to build up these community centres, they will need to reduce bed use in cancer services and the best estimate is that it would be by about 5,000 beds. I would urge the Department of Health to be a lot more open about it.”

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3908507.ece

Health Direct thinks that Professor Sikora is spot on when saying some cancer patients are so sick after chemotherapy and radiotherapy that they need to stay in hospital and also that they just need nursing as opposed to high tech beds in large hospitals.

23m have not seen a dentist for two years

Almost half of Britons have not seen an NHS dentist in the past two years, it has been claimed.

More than 23.1 million people received no dental care on the NHS in the two years to last September, according to statistics obtained by the Tories.

This represents an increase of 4 per cent, or 840,342 people, since the labour Government introduced the controversial contract for dentists in 2006.

The figures also showed that as the number of people routinely seeing a dentist has decreased, the number of hospital admissions for dental treatment has risen.

Last year almost 240,000 were admitted to wards, an increase of six per cent, figures released by the NHS Information Centre showed.

The labour Government hoped the new contracts would give more patients the chance to register with an NHS dentist and encourage preventive care.

Instead of being paid per treatment, dentists were given a flat annual salary and were encouraged to undertake more preventive treatment.

But there is growing concern that the reforms have led to a worse service as many dentists have since rejected NHS patients and are providing less complex treatment amid fears that their income will be affected.

Some specialists have left the NHS to go private because they are not paid well enough for the amount of work done.

Andrew Lansley, the shadow health secretary, said: "We know that there are people out there who are pulling out their own teeth because they can't find an NHS dentist.

"These shocking figure are proof that Labour can't negotiate a contract with NHS professionals. Some patients have no option but to take their problems to hospital A&E, a service which is already under great pressure."

Michael Summers of the Patients Association said: "This really is a scandal. People tell us it is almost impossible to find an NHS dentist in many parts of the country.

"They either have to pay for private treatment or go without check-ups and treatment for years on end. There are real dangers in that, because one of the objects of regular check-ups is to identify infections or signs of oral cancers."

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/04/17/ndentist117.xml

£1.8bn surplus forecast for NHS after cutbacks in patient care

The National Health Service in England is heading for a surplus of £1.8 billion this year, provoking anger among patient bodies over cutbacks to the funding of care.

Details announced by the Department of Health reveal that some health authorities are expected to generate more than £200 million, 25 per cent of their income.

The department played down the £1.8 billion figure last night as a mere 2.3 per cent of turnover, but patient representatives said that it was astonishing that the NHS could be underspending by more than a billion pounds while patients were still being denied vital treatments.

Michael Summers, of the Patients’ Association, said: “When wards are closing and hospitals are cutting back on cleaning and nursing staff up and down the country, it is quite astonishing that they are generating such a huge surplus.”

Last month a former Second World War airman, Jack Tagg, was told by his local primary care trust in Torbay, Devon, that he could not be given drug treatment for age-related macular degeneration because it was too expensive. The trust, which later relented but only on a technicality, is heading for a £7.8 million surplus, 3.5 per cent of turnover, this year.

The figures were released on the same day that the labour Government said that it would not match moves by the Welsh Assembly to abolish parking charges in NHS car parks. Doctors and patients’ groups say that hospital car parking charges are a “tax on the sick” if they are used to subsidise services already funded by the taxpayer. From 2011 patients, staff and visitors will be able to park free at almost every NHS hospital in Wales.

The biggest surpluses have been made by the strategic health authorities: North East SHA, for example, expects to generate a surplus of more than £100 million on a £346 million turnover; North West SHA a £230 million surplus on a turnover of £877 million and Yorkshire and the Humber SHA £267 million on a £784 million turnover. The total surplus is equivalent to almost 1p off income tax.

The Department of Health said that all the surpluses would remain within the NHS. This has been possible since 1999, when Gordon Brown, then Chancellor of the Exchequer, relaxed the rules on carrying forward surpluses from one year to the next.

Last month the National Audit Office gave warning that some departments were losing confidence in the Treasury continuing to allow them to do this as public spending slows. By last April departments were sitting on £10 billion of unspent capital spending and £12 billion in unspent revenue.

The NHS has been told that it is expected to make at least as large a surplus in 2008-09 as it looks like making in 2007-08. Two years ago the NHS returned a deficit of £547 million, which was turned into a £515 million surplus in 2006-07. The steps taken to turn the service round have proved so effective that the surplus has risen to unprecedented levels in 2007-08.

David Nicholson, chief executive of the NHS, said: “Today’s report not only shows that the NHS now has a strong and sustainable financial position, but also, importantly, it shows that we remain on course to deliver against our key pledges.”

Karen Jennings, head of health for Unison, the public service union, said: “The £1.8 billion surplus shows the NHS is now in a much stronger financial position. Patients have the right to expect that this money is spent wisely and ploughed back into patient care.

“It must be remembered that the stronger financial position has been achieved on the backs of NHS staff. They have contributed through greater efficiency but there have also been job losses and below-inflation pay awards. With finance available it is time to give staff a decent pay settlement instead of holding them to a 2 per cent pay limit.”

Stephen O’Brien, the Conservative health spokesman, said: “The Government cannot have it both ways. They are boasting about a £1.8 billion surplus in the NHS but then claim that hospitals cannot improve patient care without revenue from car parking fees. This does not add up.”

From:
http://www.timesonline.co.uk/tol/news/politics/article3479152.ece

Health Direct notes that the management of the NHS is shambolic. At the local trust levels there is a dearth of management with any recognisable qualifications and at national level the whole thing is so big as to be unmanageable.

Meanwhile, website waiting times are up under Labour, patient deaths as a result of infections contracted in hospital are up and the shortage of doctors, nurses and technicians is up.

NHS is paying for immigrant baby boom

The NHS is spending £350m a year to provide maternity services for foreign-born mothers, £200m more than a decade ago, the BBC and Health Direct has found.

Immigration has raised the birth rate so fast that some units have closed, so that midwives could be moved to areas of urgent need. A unit in Ascot, Berkshire, shut for two months in 2007 because staff had to be transferred to Slough.

The NHS says it is working to "build in" the extra capacity needed.

Maternity units have turned expectant mothers away because they could not cope with unprecedented increases in the local birth rate.

When Labour came to power, the NHS spent around £1bn a year on maternity services, with one baby in eight delivered to a foreign-born mother.

Ten years on, spending has risen to £1.6bn, with almost one baby in four delivered to a mother born overseas.

While the number of babies born to British mothers has fallen by 44,000 a year since the mid-1990s, the figure for babies born to foreign mothers has risen by 64,000 - a 77% increase which has pushed the overall birth-rate to its highest level for 26 years.

In central London, where six out of every 10 babies born has a foreign-born mother, senior consultants and health managers blame the lack of resources to deal with the pressures of migration for unacceptably poor standards.

Professor Philip Steer, editor of the British Journal of Obstetrics and Gynaecology, said: "The Department of Health has been taken by surprise. The demographic change, the sheer numbers, has in some areas increased very substantially without there being any forward planning really to allow for that."

According to figures from the Office for National Statistics, in 2006 there were 15,000 more Eastern European babies born here than a decade earlier.

The statistics go on to show that 11,000 more babies were born to a mother from the Indian sub-continent, while 8,000 extra babies had mothers born in Africa.

Heatherwood Hospital in Ascot closed its maternity unit for two months in the summer of 2007 because of an "unprecedented increase" in the local birth rate.

Midwives were moved to Wexham Park Hospital, closer to the pressure-point of Slough where in the last year staff have witnessed an extra 150 babies delivered to foreign-born mothers.

The knock-on effect was experienced in nearby Reading where the local maternity unit could not cope with the extra demand.

Tharlie Cooper was supposed to have been born in Reading, but when mother Lavina went into labour two weeks overdue she was told that, despite her being booked in, her local birthing unit was full.

Tharlie's father Dean was furious. "Basically we got turned away and the reply I got on the phone was wherever you ended up is where you end up", he said.

He drove his wife to Basingstoke in neighbouring Hampshire where doctors conducted an emergency caesarean.

LIVE BIRTHS BY COUNTRY OF BIRTH OF MOTHER
Births by British-born mothers down 44,000
Births by all foreign-born mothers up 64,000
Births by mothers born in Eastern Europe up 15,000
Births by mothers born in Indian subcontinent up 11,000
Births by mothers born in Africa up 8,000
Source: ONS/BBC

Peterborough has seen a huge increase in births from Eastern Europeans. There were just three such babies in 2000, but almost 200 in 2006.

At the Thistlemoor Medical Centre, births among patients have increased 33% in just two years. GP Nalini Modha fears the authorities have not planned for the new arrivals.

"Hopefully somebody who is in authority is actually looking at the figures to try and work out how they're going to cope with the influx" she said.

"If you're going to provide responsible care for all the population - the indigenous as well as the newcomers - then we will have to stop and think about what we can and can't afford."

In parts of Greater London, seven out of 10 babies are now delivered to mothers born overseas.

The Strategic Health Authority argues that this partly explains why maternity services in the capital performed so poorly in last week's Healthcare Commission report.

Births within migrant groups can often be more difficult, more dangerous and more expensive - with much higher rates of type 2 diabetes, tuberculosis and HIV among mothers who often turn up very late in their pregnancy.

London's chief nurse, Trish Morris-Thompson, admitted that the NHS had not realised how immigration would affect maternity services.

"The timing of the impact is much quicker than we had anticipated", she said. "We're working with our commissioners and our maternity providers now to ensure that we're building in the capacity they need."

From:
http://news.bbc.co.uk/1/hi/health/7215624.stm

Private sector role in pioneering healthcare scheme to be slashed

A pioneering £700m a year labour government scheme to buy surgical treatment centres and diagnostic services from the private sector is set to be more than halved by ministers.

The decisio - will not only mark another retreat from the use of the private sector in healthcare but will also see the health department forced to pay out millions of pounds in compensation.

Although Alan Johnson, health secretary, is to announce that a number of contracts will go ahead, including ones for extra imaging and renal services, about six contracts will be canned, on top of a number that were scrapped earlier this year.

The treatment centres that remain in the programme are, in most cases, smaller than the deals originally envisaged.

The move means that the original £700m a year's worth of business will turn out to be worth less than half of that - possibly as little as £200m.

People in the industry say that the late cancellations mean that the government will have to pay out up to £20m in bid costs to contractors, which include Netcare, Clinicenta and Alliance Medical. This is on top of £5m already paid out for scrapped schemes.

Stephen O'Brien, the Conservative health spokesman, said yesterday that he will be asking the National Audit Office to investigate the programme. "The health department has spent a phenomenal amount of money to achieve very little," he said.

Aside from the private sector's costs, the health department had by March this year already spent £72m on the procurement, according to official figures.

The department admitted last month that just eight of the 190 staff in the health department's commercial directorate were civil servants. The remainder were external hirings costing a total of between £88,000 and £120,000 a day - or the equivalent of between £20m and £30m a year.

The dramatic scaling back of the second wave of big central contracts will delight Unison and other opponents of the drive to involve the private sector in the delivery of NHS care.

However, it has left much of the private sector fuming, although ministers will argue that big opportunities remain as the government's focus for the private sector switches from hospital services to primary care and proposed "polyclinics".

But one senior executive said companies were now very wary. "There is a trust issue here," he said. "We have been led up the garden path. We are not sure we want to go up it again".

From:
http://www.ft.com/cms/s/0/1073a3fc-918f-11dc-9590-0000779fd2ac.html