GPs- Quarter of patients can't book in advance 12 million Pound survey finds

A quarter of patients still cannot book advance appointments with their GP - more than two years after Tony Bliar promised to solve the problem. The results from an "unfair and biased" £12m survey of more than two million people about services at their GP surgery found doctors are still manipulating their appointments system to hit targets.

Bliar was challenged during a televised debate in the run up to the 2005 election over the system which rewards doctors for seeing patients within 48 hours but means many prevent advance bookings to leave slots open for urgent cases.

He promised to resolve the situation but the survey results unsurprisingly show there has only been limited success.

The survey released by the Department of Health this week showed the vast majority of patients are happy with their family doctors.

In a blow to Stalinist Brown’s call for more GP surgeries to be open on Saturdays and late in the evening, few patients in the survey wanted this. The vast majority, more than eight in ten, said they were happy with their surgery’s opening hours.

Dr Laurence Buckman, chairman of the British Medical Association’s General Practitioners Committee, said: “It seems only four out of every hundred patients want practices to open on a weekday evening, and seven out of every hundred on weekends.

“It comes down to a workforce issue. The danger is that switching normal opening hours away from the daytime to evenings and weekends might please some patients who are out at work all day, but would take appointments away from those who use their local surgery most – patients with long-term conditions and parents with young children.

“All patients are important but we must not penalise the most needy among them.”

The survey findings show the majority of patients say they can apparently get through to their surgery on the phone satisfactorily, can book an appointment quickly and with the doctor they want.

Of those who wanted to book an appointment more than two days in advance, a quarter could not.

Dr Buckman said the findings had confirmed what other studies had shown and questioned whether spending £12m on the survey.

The results also showed that small practices often in rural areas outperformed large urban GP surgeries.

The news will dismay new Health Minister Lord Ara Darzi who advocates super-GP surgeries with up to 20 doctors and serving a population of around 20,000.

Other results showed most patients are being offered a choice of hospital when they are referred to a specialist, in line with labour's stalinist policy.

The full results of the survey including regional breakdowns can be found at Labours £12 million GP survey

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/24/ngp124.xml

Health Direct pointed out last year that labour was wasting another £12 million Pounds of our tax payers money on this shambolic GPs survey and that the results were hardly likely to be earth shattering. In the intervening period we even managed to receive THREE questionnaires- which further undermines the credibility of this money burning exercise.

On 27 Nov 06 Health Direct posted: £12 million GPs survey to cut doctors funding
when five million patients will next year be asked to fill in a questionnaire which will ask, among other things, whether they have been able to secure an appointment within 48 hours, as the Labour government has promised.

The British Medical Association condemned the poll as unfair and biased, and accused the Department of Health of adding questions that had not been agreed. Most GPs accept that they are unlikely to score 100 per cent and so they will see a reduction in funding.

NHS service cuts urged at non PFI hospitals

Primary care trusts wanting to reconfigure services were given a stark message in an economic analysis prepared for the NHS in London: financially, it will make sense to cut beds and services at non private finance initiative (PFI) hospitals.

The paper recommends reducing services at Queen Mary's Hospital, Sidcup, rather than PFI hospitals in south east London, where a consultation on reconfiguration proposals is expected this autumn.

It adds that decisions should take into account many factors, not just finance. But with significant excess of beds expected and a £65m deficit some cuts seem inevitable. A spokesperson for the project board said hospitals were working to see where care would be best delivered but that all were likely to see significant change.

Reducing work at PFI hospitals at Bromley and Woolwich would achieve few savings as the NHS is committed to annual payments for the buildings, and often additional costs for some elements of facilities. The report says 'whole hospital PFI sites' have 'less flexibility to reduce "hard" facilities managements costs in the event of an unplanned reduction in activity because of constraints in their PFI contracts'.

In contrast, excess land and facilities at non-PFI sites could be sold off to make significant savings.

The paper also warns that a new PFI site at Lewisham Hospital will need to achieve 'high utilisation rates... if it is to avoid the increased pressures giving rise to a worsening of its income/expenditure and cash flow positions'.

Sharon Massey, cabinet member for health and adult social services at Bexley council, which covers Sidcup, said: 'We are devastated that Queen Mary's is coming out as the most vulnerable hospital. There is effectively a mortgage on other hospitals. Queen Mary's does not have a mortgage so is easy to dispose of.'

The paper focuses on south east London but arguments would apply in other areas with a mix of PFI and non-PFI hospitals.

Imperial College London professor of health policy Nick Bosanquet also sent out a warning. He said: 'There will be a temptation to say "we are stuck with these contracts, we will close down older hospitals which may in fact be lower cost".'

From:
http://www.hsj.co.uk/healthservicejournal/pages/N2/p7/070614

On Jan 16, 07 Health Direct warned: Brown can’t cure this paralysed NHS, so he plans to privatise it

The former Granada boss Sir Gerry Robinson recently spent six months trying to reform Rotherham general hospital. The result was shown in three hours of fly on the wall television on BBC2 last week. It was rightly put after the watershed: as politics it was certificate 18. At the end of each day Robinson could be seen slumped in the back of his car, his face buried in his hands. A tycoon sobbing in a limousine is the perfect icon of Labour’s health service.


The message of Robinson’s inquiry was devastating and explains the ostensibly terminal chaos enveloping the NHS under Patricia Hewitt. The central arm of government, the Treasury, has clearly given up on NHS reform. No government, Labour or Tory, has the guts to break the consultants’ restrictive practices, the GPs’ “lifestyle” demands or the healthcare unions.

The Treasury itself capitulated to the unions by rubber-stamping the ridiculously expensive 2004 NHS pay deal, depriving Britons for the first time of proper out-of-hours GP cover.

More alarming is that internal pricing and payment-per-treatment will leave these mastodons financially exposed through loss of business to the private sector. In an attempt to favour this sector, the Treasury and Hewitt are refusing to allow NHS hospitals to cut tariffs to compete. Small wonder James Johnson, the British Medical Association chairman, parodied Blair’s 1997 battle cry, “24 hours to save the NHS” by saying there was now “one year to save the NHS”.

Many hospital trusts are building up large deficits that they cannot possibly cover; 29 are contemplating some 60 “reconfigurations”, code for closures, at a time when Hewitt is also talking of somehow building 50 cottage hospitals. She must also now contend with 11 of her ministerial colleagues declared to be in open opposition.

Meanwhile manpower planning is in disarray, with hiring cuts or freezes almost everywhere and a reported surplus of 3,200 expensively trained NHS consultants by 2010.

Cruel watchdog NICE condems 20,000 to blindness

Twenty thousand people will be condemned to blindness each year following a "cruel" and "appalling" decision by the health watchdog NICE, campaigners said today. The National Institute for Health and Clinical Excellence (aka National Institute for Curbing Expenditure) has come under intense pressure to approve the drugs Lucentis (ranibizumab) and Macugen (pegaptanib) for use on the NHS.

The drugs treat wet age-related macular degeneration (AMD), which affects around a quarter of a million people. Wet AMD is the leading cause of sight loss in Britain, with 26,000 new cases each year.

Yesterday Nice issued draft guidance recommending that Macugen should not be used at all on the NHS.

It also only recommends Lucentis for about one in five patients with wet AMD, who have a particular type called predominantly classic subfoveal choroidal neovascularisation (CNV).

Many patients diagnosed with the condition will now be faced with a choice of degenerating eyesight and potential blindness, or finding up to £28,000 to pay for a full course of treatment privately.

The preliminary ruling from Nice is particularly controversial as it comes two days after it was announced that NHS patients in Scotland will get the "gold standard" drug Lucentis for free. Sufferers north of the border have had access to Macugen since last summer, following a decision by the Scottish Medicines Consortium.

Medical trials have shown nine out of 10 patients given Lucentis injections have either improved or stable sight following two years of treatment, compared to half given placebo treatment.

Wet AMD occurs when abnormal new blood vessels grow behind the retina, causing leakage of fluid and blood. This leads to the formation of scar tissue on the macular - the part of the retina responsible for "straight ahead" vision.

Steve Winyard, of the Royal National Institute for the Blind, said: "This preliminary guidance is worse than we ever imagined it could be. It is simply unacceptable that Nice is recommending that only a small minority of patients within England and Wales will benefit from these ground-breaking treatments. Nice must reconsider."

"The NHS is currently in surplus, yet England and Wales are now two of the only countries in Europe to deny its citizens sight saving treatments."

Tom Bremridge, the chief executive of the Macular Disease Society, said: "We are appalled by the Nice consultation document. Limiting the treatment options to 20 per cent of patients who would benefit is unjustifiable and allowing one eye to go blind before treating the second eye is cruel and totally unacceptable."

The Nice recommendation is preliminary and is open to appeals from drug companies and patient groups. A final ruling on the drugs is expected in September.

Andrew Dillon, chief executive of Nice, said: "When treatments are very expensive, we have to use them where they give most benefit to patients."

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/06/14/nblind114.xml

For a spokesman for the Department of Health to try and defend the indefensible by claiming that local primary care trusts should not withhold funding for the drugs in light of the draft guidance is classic stalinism.

Not our fault guv says the labour govt to the PCTs. But as the DoH holds the purse strings what hope is there for the thousands who will be blinded because of labour's funding shortcomings as they extend the postcode lottery to now include Macugen and Lucentis?

It is also interesting to note Steve Winyard of the Royal National Institute for the Blind's comment that the NHS is currently in surplus.

It's the first time that Health Direct has come across this quote and we wonder how many more times we will hear this point in the future.

IVF clinics corrupt and greedy Winston claims

Britain's leading fertility expert condemned the IVF industry yesterday, saying that it had been corrupted by money and that doctors were exploiting women who were desperate to get pregnant who were failed by the NHS.

Speaking at the Guardian Hay festival, Robert Winston also accused the fertility watchdog, the Human Fertilisation and Embryology Authority, of failing to protect women and giving consistently poor information to couples.

"One of the major problems facing us in healthcare is that IVF has become a massive commercial industry," he said. "It's very easy to exploit people by the fact that they're desperate and you've got the technology which they want, which may not work."

Lord Winston, professor of fertility studies at Imperial College London, was particularly critical of doctors in the capital: "Amazing sums of money are being made through IVF. It is really rather depressing to consider that some IVF treatments in London are charged at 10 times the fee that is charged in Melbourne, where there is excellent medicine, where IVF is just as successful, where they have comparable salaries.

"So one has to ask oneself what has happened. What has happened, of course, is that money is corrupting this whole technology."

There are 85 licensed fertility clinics in the UK, in an industry worth up to £500m a year. According to latest figures from the HFEA, in 2004 more than 30,000 patients underwent more than 40,000 treatment cycles, each costing up to £8,000.

Lord Winston expressed particular concern over some of the tests being offered to infertile couples.

One screening technique which uses fluorescent markers to stain defective parts of an embryo's chromosomes, and costs several thousands of pounds, is routinely used to weed out unviable embryos. But even the most advanced version of the test can only interrogate a tiny portion of an embryo's genome. "That's being sold to patients at £2,000 a time and they're saying, your chromosomes are fine, that embryo should be transferred, when actually it's a lie," Lord Winston said. "There's no knowledge about the genome from that."

He added that there was no clinical justification in doing the screening "and yet hundreds of women are being exploited out of their desperation to get pregnant from people who are taking large sums of money from them in private clinics.

"Much of it is in ignorance because most of the people who are doing this work are doing a form of cookery without understanding the science behind it. It's knowingly done, insofar as the clinicians and scientists doing it don't actually want to explore the implications, because they're not engaging with the public, they're not accountable, they're being arrogant and making a lot of money."

Lord Winston also went on to criticise the HFEA for failing to protect women: "The regulatory authority has done a consistently bad job. It's not prevented the exploitation of women, it's not put out very good information to couples, it's not limited the number of unscientific treatments people have access to, it doesn't prevent sex selection and all sorts of other things people don't like because there are all sorts of ways around the law."

A HFEA spokesman said: "No procedure throughout medicine goes into mass use without some sort of leap of faith. Patients just need to be informed that something is on a preliminary stage and if you want to go down that route then do so, but you're fully informed before you do so.

From:
http://society.guardian.co.uk/health/news/0,,2091791,00.html

The privatisation of the NHS is encapsulated by the expense that that couples are having to pay for IVF. On April 24, 07 Health Direct posted: NHS free at point of use is a political mirage Doctors warn

A National Health Service largely free at the point of use is becoming a mirage, according to Doctors for Reform, a pressure group that would like the NHS to move from a tax-funded model to a system of social insurance with top up payments. The report shatters the NHS's founding principle that health care should be free for all at the point of delivery.

In some cases patients opt to pay for all their treatment. In others they get investigations undertaken privately and more quickly, before returning to the NHS for treatment.

The result they say is inequitable. But politicians and others are reluctant to engage with the issue. "By perpetuating the political mirage of a service completely free at the point of delivery, debate is conveniently stifled," the doctors say. "What is urgently needed is a proper debate on the future of healthcare funding, covering both tax and independent financing".

"It has to be recognised that the use of top-up payments is increasing. We need to face up to this rather than ignore it."

The doctors published 20 case studies showing how patients used the private sector to upgrade NHS services. They include a 33-year-old secretary who had been trying for four years to become pregnant.

She was eligible for free IVF treatment on the NHS but her primary care trust was in debt and turned her away. She paid £3,500 for treatment at a private London clinic.

Audit Office asked to investigate record £500m NHS underspend

The National Audit Office has been asked to investigate whether a half billion pound underspend by the NHS in England was caused by political chicanery at the Department of Health. Norman Lamb, the Liberal democrat health spokesman , called in parliament's spending watchdog yesterday after the record surplus was disclosed by the Guardian in an analysis of strategic health authority board papers.

They showed NHS trusts responsible for hospitals, mental health, primary care and ambulance services ended the financial year in March with £456.8m in spare cash that could have been used to provide extra healthcare. The total did not include a surplus of £75m that was forecast by NHS foundation trusts.

The underspend angered health union leaders who said it was generated by an unnecessarily harsh squeeze on spending during the winter months when many NHS trusts economised by closing wards, axing jobs and delaying operations until the start of the new financial year in April.

Mr Lamb said patients and staff bore the brunt of economy measures that were designed to save the political career of Patricia Hewitt, the health secretary. She had threatened to resign if the health service made a deficit in 2006/7 after overspending by £547m in 2005/6.

The Liberal Democrat health spokesman said: "Everything was driven by her desire at all costs to avoid another deficit. That distorted everyone's judgment and as a result they over-compensated.

"I'm writing to the National Audit Office to ask for an investigation of how NHS finances were managed over the last financial year. It should establish whether decisions were rational or distorted by manoeuvring to save Patricia Hewitt's political skin."

He added: "It was the soft targets that suffered the most damage. Mental health budgets were cut, voluntary organisations suffered and staff training was axed. This is what happens in a ludicrously over-centralised system. So much is dictated from Whitehall and forced through by strategic health authorities that do the bidding of the health secretary.

Andrew Lansley, the shadow health secretary, said the half billion underspend would, if confirmed by the government, dwarf the previous record surplus of £130m in 1993-04.

"Last year was meant to be a year of growth, but because of the proceeding two years of financial mismanagement the NHS suffered imposed cutbacks - 37,000 jobs losses, 6,000 newly qualified health professionals out of work and 9,000 bed cuts ... Most inexcusable are the short-sighted cuts to education and public health budgets, which all now need to be put back in place if intolerable pressures on the NHS are to be avoided in the future."

He blamed Gordon Brown, the chancellor, for making unnecessary cuts to mask the deficits still arising in many NHS organisations.

The Department of Health would not discuss the underspend before it announces official figures next month. A spokesman said it responded to an "unacceptable" deficit of more than £500m in

The nursing unions said the underspend demonstrated that the NHS could afford a 2.5% pay rise that an independent review body proposed for nurses, midwives and other healthcare staff. The government said it was unaffordable and staged the award, saving about £60m in 2006-07. The Royal College of Nursing and Unison, the public sector union, are preparing to ballot on industrial action.

Hamish Meldrum, the chairman of the British Medical Association's GPs committee, said in a letter to the Guardian: "The Department of Health and the chief executive of the NHS Confederation may crow about the tremendous efforts involved to achieve the reported £500m surplus in NHS spending for the last financial year. But these "efforts" have been achieved at the cost of multiple ward closures, thousands of job cuts, and a large number of delayed operations and outpatient appointments."

Mr Brown used to decry the boom/bust management of the economy during the last Conservative administrations as being bad for the country. "Boom and bust are not just bad for the NHS, they're bad for those who work in it and especially bad for patients who have paid the price for it," Dr Meldrum said.

The surplus might have, temporarily, saved Ms Hewitt's job, but it showed the country needed need a change in health secretary and a radical rethink in NHS policy, he added.

From:
http://www.guardian.co.uk/uk_news/story/0,,2090834,00.html

In a desperate attempt to try and balance the NHS's books Health Direct posted on 9 Feb 07-
Bed closures healthy sign for NHS, says Patricia Hewitt .

Patricia Hewitt, the Health Secretary, was criticised yesterday for claiming bed closures were a sign of "success" as new figures showed NHS trusts will end the year more than £1 billion in the red. The scale of the health service's financial crisis emerged as Miss Hewitt delivered a presentation to the Cabinet on NHS "reconfiguration"— plans which will lead to the closure of dozens of maternity units, casualty departments and community hospitals.

New research showed that frontline NHS trusts which run hospitals and GP clinics across England are on course to finish the year £1.05 billion in the red — only a fraction below last year's record deficit.

The figure is drawn from a Conservative analysis of the deficits being forecast by each of England's 10 strategic health authorities.

While front line trusts are deep in the red, the strategic health authorities themselves are on course to end the year with a huge £920 million surplus — almost twice last year's figure. This allows ministers to say the overall deficit across the whole NHS is only £132 million.

However, the Tories claimed that health authorities have only been able to produce such a big surplus by slashing the amount they spend on crucial services, including training for doctors and nurses.

The figures were released as Miss Hewitt was accused of living on a "fantasy planet" after defending the proposals to overhaul services across the country.

Andrew Lansley, the shadow health secretary, said Miss Hewitt's remarks would be greeted with incredulity at a time when many trusts were struggling to cope with huge deficits.

"The Health Secretary is living on a fantasy planet, far removed from the reality of the front line cuts that are having a daily adverse impact on NHS staff and patients," he said.

"Despite this year's savage job losses, bed cuts and service closures, the NHS organisations providing front-line care are no less in the red than they were last year."

The Patients Association said it did not see bed closures as a sign of success. "What we hear about from patients is inappropriate discharges with patients being sent home too soon," said Katherine Murphy, a spokesman for the association.

"We heard from one patients due to be discharged on a Wednesday who was away from her bed for 50 minutes, the night before to take a bath. When she went back to the ward someone was in her bed. Beds are being closed because of financial deficits. I would not call this a mark of success," she said.

Private slow down expected as NHS prepares for Stalin Brown

Less emphasis on the use of the private sector and a slow down in market based reforms could be the hallmark of Gordon "Stalin" Brown's premiership for the NHS, according to a review of health experts by Health Direct.

Leading health service academics and commentators have told HSJ that Mr Brown is expected to soft-pedal on use of the independent sector in the health service when he becomes prime minister next month.

Former health adviser to Tony Bliar and London School of Economics professor of social policy Julian Le Grand said he thought it was doubtful that another wave of independent sector treatment centres would be commissioned when Mr Brown takes office.

'I think Mr Brown will still be committed to some degree of contestability, but he is not absolutely sure about market-driven reforms,' he said.

'He has sympathy with the US way of doing things, but is aware of the problems involved in introducing markets and quasi-markets into healthcare.'

'More pragmatic'

And former Department of Health strategy director Professor Chris Ham said: 'Mr Brown will be a lot more pragmatic about a bigger role for the independent sector.

'Tony Bliar did it because he thought it was the right thing to do, I think Gordon Brown will see it not so much as an end itself but will be persuaded by a greater role for the independent sector if it can show innovation or deliver shorter waiting times.'

The Institute for Public Policy Research head of health and social care Jessica Allen said: 'I wouldn't expect a great expansion in the use of the independent sector. I don't think there is any sense he will abandon the use of the private sector completely, but we will see it used where there are gaps in services.

'I think he might have less confidence that the health sector operates in the same way as other sectors, where efficiencies will arise from having a greater market.'

And King's Fund chief economist Professor John Appleby said the treasury, with Mr Brown at the helm, had expressed 'scepticism in an oblique way', about how far the use of the independent sector to increase choice could improve quality of services within the NHS.

Independent NHS board

Before Mr Blair announced details of his resignation, Mr Brown was widely believed to be preparing the ground for an announcement to match his decision to free the Bank of England from government control.

He was expected to introduce an independent NHS board in his first few days at Number 10, but Professor Ham said he now seems more cautious about such a move.

'I would say there is a strong argument for distancing politicians from the NHS and it would perhaps be sensible to start with something modest, like further separating NHS chief executive David Nicholson's team from the DoH and use that as a staging post for something more radical,' he said.

Professor Appleby said he was unsure that Mr Brown would announce a fully blown NHS board.

'Rhetorically it looks appealing for the government to show that they are not interfering, but they have gone a long way down that route already with payment by results and foundation trusts,' he said.

Launching his campaign to become leader of the Labour Party, Mr Brown stressed how important greater access to health services would be under his leadership.

Professor Ham said he expected the man who commissioned the Wanless report to make public health a major priority.

From:
http://www.hsj.co.uk/healthservicejournal/pages/N1/p5/070524

The eventual arrival of a new prime minister will be eagerly watched by Health Direct. We have become used to news of a pre launching policy as to what might happen for the NHS.

However we also have ten years of experience in what has happened to the purse strings. And so has the Great British public.

On April 03, 2006 Health Direct posted that: Gordon Brown to blame for the crisis in the NHS a new poll finds

Gordon Brown is being blamed for the financial crisis in the National Health Service, which has resulted in hospitals laying off staff and closing wards, according to a YouGov poll for The Daily Telegraph.

His credentials as prime minister-in-waiting are being undermined by a growing impression that he is not spending enough on the health service, and his own personal popularity ratings are falling.

According to the YouGov poll, 64 per cent of those questioned believe that there is a financial crisis throughout the NHS, with hospitals having to cut back on patient care. The NHS in England is expected to be in the red by £1 billion this year.

Voters also think Mr Brown has got his priorities wrong. Asked which should receive any extra money, education or the NHS, a large majority favoured the health service over schools.

Doctors admit NHS treatments must be rationed- BMA

British doctors will take the historic step of admitting for the first time that many health treatments will be rationed in the future because the NHS cannot cope with spiralling demand from patients. In a major report that will embarrass the government, the British Medical Association (MBA) will say fertility treatment, plastic surgery and operations for varicose veins and minor childhood ailments, such as glue ear, are among a long list of procedures in jeopardy.

James Johnson, the BMA chairman, will warn that patients face a bleak future because they will increasingly be denied treatments. He will urge the NHS to be much more explicit about what it can realistically afford to do and ask political leaders to engage in an open, honest debate about rationing.

The BMA proposes the drawing up of a new patients' charter specifying those health services to which every citizen across England should be entitled, regardless of the local health authority's financial situation. They also want to see a second list of all the treatments which the sick will get only if their primary care trust has the money, and if doctors decide they are clinically worthwhile.

Senior BMA sources say their report recognises the reality that despite record investment in the NHS, 'postcode lotteries' are rife. Primary care trusts, the local NHS organisations that commission and pay for care from hospitals on behalf of patients, are increasingly rejecting requests to pay for procedures or drugs because they are not perceived to be the best use of funds.

Some PCTs have been bitterly criticised for refusing to pay for expensive new cancer drugs; treatment to prevent older people going blind through age-related eye degeneration and operations to help obese patients lose weight through stomach-stapling.

Each trust already has a committee of medical experts that takes decisions on whether to fund medication for complaints which are not covered in their basic contract with the Department of Health. These include treatments such as growth hormone for adults, neuro-stimulation for migraines, breast reduction and enlargement, treatments for incontinence and even some care for multiple sclerosis.

Johnson will use the launch on Tuesday of a BMA discussion paper on the future of the NHS in England to spell out his belief that Britain's ageing population will put ever greater pressures on local NHS organisations to decide how best to use their resources, and that the public's reluctance to put significant extra funding into the NHS means rationing will become increasingly common.

Dr Michael Wilks, one of the BMA's senior office holders, revealed the organisation's radical thinking in a recent letter to its 139,000 members updating them on the progress of the BMA working group, headed by Johnson, which has drawn up the document.

He told them the group had concluded that 'while the service should remain universal, the challenges raise questions about how comprehensive the service can continue to be. This will depend on whether politicians and the taxpayer are prepared to contemplate either increasing expenditure or explicit rationing.

'Rationing of health care in one form or another has always existed but has not been discussed. While agreeing that an open and honest debate on rationing is needed, the nature of that debate needs to be clarified. It might, for instance, address whether current inequities in care caused by pressures to balance the financial books are preferable to one alternative, which is to set a limit on the availability of some procedures.'

Health Minister Andy Burnham last night welcomed the report as a useful contribution to the debate about the NHS's future. He defended the NHS as 'the right model for Britain's future'.

'[It is] a system which makes the most modern treatments and medicines available and that is envied by other governments around the world as a fair and cost-effective way of providing high-quality health care to a whole population based on need alone.

From:
http://observer.guardian.co.uk/uk_news/story/0,,2073633,00.html

The common sense of the BMA is congratulated by Health Direct. Nearly three years ago (June 28 05) Health Direct also noted the BMAs sense in Patients want cleanliness not choice BMA poll findsas MRSA grows

Cleaning dirty hospitals should be the top priority for the NHS and is much more important than giving patients a choice of where they are treated, a poll of patients conducted for the doctors' organisation, the British Medical Association (BMA) found.

James Johnson, chairman of the BMA, said the findings showed what mattered to the public. "Patients are obviously extremely worried about hospital-acquired infections and quite rightly patients want their hospitals to be clean," he said. "It seems what is not so important to them is the choice of where to have their operation.

"The BMA has been saying for a long time that patients are not so interested in a choice of five hospitals but they want a good service in a clean, local hospital."

"To have five hospitals to choose from is a good soundbite but it is meaningless outside the metropolitan areas where patients will be lucky to get a choice of two or three. What is important for patients is to have a say in how their illness is managed."

Harry Keen, president of the NHS Federation, said: "Senior doctors working in frontline services are sending a clear message of their concern. The NHS is at a crossroads. These major changes should await the verdict of wider public debate or the NHS as a collaborative network will be lost, unlikely ever to return."

Since then has the labour government listened- have they heck.