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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Bliar ally says Tories are best for NHS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From:

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

Website for patient waiting times virtually useless

Patients are being given out of date information by a flagship government scheme designed to reduce waiting times for hospital treatment.

The new website www.isdscotland.org/ — unveiled by Malcolm Chisholm, the health minister, was meant to allow patients to choose a clinic with the shortest waiting time but contains information that is up to nine months old.

The leader of Scotland’s GPs condemned the figures as “virtually useless” and patients’ groups described the initiative as “flawed”.

The database should provide the latest waiting times for first outpatient appointments at 3,030 clinics across Scotland. Until now the information had been available only to GPs.

Speaking at the website’s launch, Chisholm said: “This database is good news for patients and will support patient choice.”

However, detailed examination of the information has revealed that waiting times for more than 260 clinics are at least three months out of date.

The figures for outpatient clinics across Fife were last updated at the beginning of July. In Lanarkshire and Glasgow waiting times for more than 100 clinics dated back to February. Two clinics in Lanarkshire even listed waiting times for January. And most hospital waiting times were for early October.

Dr David Love, joint chairman of the British Medical Association’s Scottish GP’s committee, said information dating back several months was “virtually useless”.

He said: “It is a good idea and could be quite useful if patients do their homework before coming to the GP, but the whole thing hinges on the information being accurate. If it is not, it could create more work.”

Margaret Davidson, chief executive of the Scotland Patients’ Association, added: “This website is flawed. The figures have to be up to date for them to be any use.

“Questions also have to be asked as to whether patients will be treated at the hospitals they choose. I don’t think they will.”

Dr Ian Johnston, a member of the local GPs’ committee in East Lothian and a family doctor in Musselburgh, said waiting times should be no more than six weeks old if they were to be of any use. “There is no point in having something on a website that was done in February,” he added.

The launch of the website has been used by opposition politicians to highlight long waiting times of up to 2½ years. According to the target set by the executive, by the end of 2005 nobody should have to wait more than six months for a first outpatient appointment.

A spokeswoman for the executive said the Information and Statistics Division (ISD) of the NHS was responsible for the website. She added that most of the waiting times were up to date.

The ISD admitted that it had decided to launch the website even though some data was many months old. A spokesman said the out-of-date waiting times were the result of old data collection systems which were being modernised.

From;

http://www.timesonline.co.uk/tol/news/uk/scotland/article1006886.ece

Hospitals use ploys to beat 4 hour deadline on A&E waiting times targets

More than five per cent of emergency patients are being admitted to wards to help hospitals hit waiting time targets.

Patients are being admitted to hospital to avoid breaching a labour Government target on waiting times, NHS figures suggest.

More than one in twenty patients attending hospital in an emergency are being admitted to wards just minutes before the maximum four hour wait.

Health unions have complained that staff are being “pressured” into manipulating data and admitting patients unnecessarily to meet the target, which aims to treat or discharge all accident and emergency (A&E) patients within four hours.

Figures from the NHS Information Centre show that almost all patients in England are seen within the four hour deadline, but there is a peak in the number of people admitted to a ward with just ten minutes to spare. Two-thirds of those treated as the deadline approaches are admitted to hospital, compared to just over one in five patients coming from A&E overall.

It is the first time such analysis has been done and the statistics are categorised as “experimental”.

The Royal College of Nursing warned that the four hour target meant some nurses were “pushed into practices” that were risky for patients.

It said that there were “negative consequences” for patient care, especially those needing treatment in A&E wards, but not necessarily requiring an overnight stay.

A survey of its members found that nine out of ten accident and emergency nurses claimed they had been unduly pressured to meet the four hour target.

Mark Porter, chairman of the British Medical Association’s consultants’ committee, said that the admission rates were worrying.

“This suggests that when patients have been waiting close to four hours, there is a rush to discharge or admit them so that the hospital meets the four-hour target,” he said.

“Patients must always be treated on the basis of their clinical need, not simply because they have been waiting close to four hours.”

Katherine Murphy, director of the Patients Association, agreed that the right patients are not always made a priority under the target.

“This results in doctors making rushed decisions at three hours and 50 minutes, with patients having to be admitted inappropriately at huge cost to the NHS,” she said. “We have heard instances of ambulance drivers being forced to wait outside A&E with seriously ill patients, until staff have cleared a backlog of people who need to be seen within the four hour target.

“It is unfair to make NHS staff feel like they have to put meeting this target ahead of what’s in the best interests of patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article6921466.ece

3,000 NHS staff get private health care

The National Health Service has spent £1.5m paying for hundreds of its staff to have private health treatment so they can leapfrog their own waiting lists.

More than 3,000 staff, including doctors and nurses, have gone private at the taxpayers’ expense in the past three years because the queues at the clinics and hospitals where they work are too long.

Figures released under the Freedom of Information act show that NHS administrative staff, paramedics and ambulance drivers have also been given free private healthcare. This has covered physiotherapy, osteopathy, psychiatric care and counselling — all widely available on the NHS.

“It simply isn’t fair to have one service for staff and another for everyone else,” said Norman Lamb, the Liberal Democrat health spokesman, who obtained the figures.

“If the NHS has to circumvent their own waiting lists the system isn’t working well enough. It’s an admission by the NHS that their own system isn’t able to respond to the mass of people desperate to get back to work.”

The number of health service employees sent to private healthcare facilities has more than doubled in the past three years.

In 2006-7, 708 staff working for NHS trusts received private treatment at a cost of £279,000. Last year it increased to 1,641 at a cost of £828,413.

The health department defended the practice and said sending doctors, nurses and other key staff for private treatment helped to get them back to work.

“If trusts want to get their staff back to work more quickly they can’t jump NHS waiting lists, so going private is an option,” said the spokesman.

“There is evidence that early intervention in tackling sickness absence enables staff to return to work more quickly. Other benefits include: reducing the risk of chronic illness that could result in ill health retirement, cost-saving on temporary staff and having a positive impact on staff health and wellbeing and, in turn, patient satisfaction.”

The East Midlands ambulance service recently set up a contract with a private occupational healthcare specialist worth £300,000 a year. It has sent its staff to the specialist for vaccines, health screening and to deal with needle injuries and blood tests.

Other big spenders include the south east coast ambulance service, which has sent more than 800 staff for physiotherapy, osteopathy and counselling at a cost of more than £279,000 over three years.

Humber mental health trust has spent more than £47,000 on private counselling, even though it specialises in offering this service along with psychiatric help. A spokeswoman said staff would feel awkward being counselled by NHS colleagues.

“An appropriate and professional counselling and therapeutic service has to be free from any other existing pressures in respect of relationships and therefore cannot always be provided by an organisation,” she said.

“Staff may also be referred externally due to peak of demand to meet the need in a timely manner.”

West Suffolk hospital has spent £56,000 over the past three years on private treatment for staff but said it would no longer do so.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article6879553.ece

False waiting time figures probed

A hospital has apologised and launched an inquiry after hundreds of patients' records were altered to suggest NHS waiting time targets were met.

Records were changed to claim patients were treated within four hours at the Queen's Medical Centre, Nottingham.

A review found 765 records were amended between March and September.

The hospital previously said it met government targets of treating 98% of patients within four hours, but the review shows in reality it did not.

The actual figure is 97.4% rather than the published figure of 98.3%, which was based on the altered records.

'Small number'

Officials are now looking back even further to see whether records from other periods were altered.

Dr Peter Homa, chief executive of Nottingham University Hospitals NHS Trust, said: "The scale of the problem relating to the inaccurate reporting of breach numbers remains unclear at this stage.

"However our initial review, which was initiated on Friday when this first came to our notice, indicates this involves a small number of patients.

"We would like to reassure our patients and the public that this has not in any way affected the standard of care our patients have received at our hospital.

From:

http://news.bbc.co.uk/1/hi/england/nottinghamshire/8307100.stm

NHS surgery centres in doubt over £400m bill

The future of fast track surgery centres that are run privately was in doubt after it emerged that the NHS faced a £400m bill when their contracts expire during the next two years.

Mike O'Brien, health minister, told the Financial Times it would be up to primary care trusts whether to recommission the treatments they provided.

Independent sector treatment centres (ISTCs) have cut waiting lists and introduced competition since the first ones opened in 2005.

However, Mr O'Brien disclosed that as the contracts expire the NHS is likely to have to pay about £200m for operations that it agreed to buy from them but has not used, and another £200m to buy back premises built by the private sector operators.

In spite of the £400m bill, he insisted that ISTCs had been "value for money", cutting NHS waiting lists and introducing more choice for patients.

So far, they have provided more than 1.7m operations and other procedures, helping cut the maximum NHS wait to 18 weeks while recording very high satisfaction rates in patient surveys.

Leading private sector operators also expressed alarm at the labour government's timetable for re-tendering, which they said in some cases looked likely to lead to contract renewal only after, or just as, they were due to end. With many of the centres staffed from overseas "there is a real risk that staff will leave", one leading private sector operator said, putting services at risk.

To attract operators, the five year deals offered guaranteed volumes of patients, a buy-back clause on the buildings, and prices that, on Department of Health figures, are about 11 per cent above the NHS price.

Although some are now treating more patients than contracted for, on average they have treated only about 85 per cent of the patients they offered to take. As a result, the NHS is likely to have to pay about £200m for operations it has not used, as well as another £200m for the residual value of the ISTC buildings, Mr O'Brien said.

But he insisted that the centrally negotiated deals had cleared more than 40 per cent of a "backlog" of 250,000 NHS patients who had to be treated to get waiting times down.

In future it will be up to primary care trusts whether to recommission services from the ISTC buildings, Mr O'Brien said, and he expected those to be at standard NHS prices with no guarantees of volume - "although PCTs will be free to negotiate otherwise".

Trusts have an incentive to renew the service as otherwise they will be left with an empty surgical centre.

http://www.ft.com/cms/s/0/9621c792-7ca0-11de-a7bf-00144feabdc0.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

Disabled children wait up to two years for wheelchairs

The NHS was told to stop relying on charities to fill funding gaps after figures revealed many trusts would not pay the full cost of electric wheelchairs for disabled children leaving patients facing a postcode lottery

Freedom of information figures obtained by the Muscular Dystrophy Campaign found children were subject to a postcode lottery in terms of equipment.

Statistics from 54% of NHS trusts in England and Scotland revealed that disabled children in England are forced to wait five months on average for a wheelchair.

The worst performing primary care trust (PCT), East Lancashire, in the north-west of England, had an average wait of two years for an electric wheelchair.

The survey showed 58% of children in England had to wait at least three months for an electric wheelchair and 14% waited more than six months.

In the case of Westminster and Islington PCTs in London, children living just four miles apart could have a difference of 11 months in waiting time.

Overall, 50% of the PCTs that responded said they did not fund the full cost of a powered wheelchair for a disabled child.

Westminster PCT made an average contribution of only £700 towards the cost of a child's powered wheelchair, it said.

Almost all PCTs contacted by the charity said the cost of a wheelchair was around £2,000 but in fact the true cost of a basic electric wheelchair would be around £3,000.

A separate patient survey of 237 children found one in three did not receive any funding at all for their wheelchair.

Philip Butcher, chief executive of the Muscular Dystrophy Campaign, said: "Today's figures are nothing short of a national scandal.

"It is a damning indictment of the NHS that so many families across the UK are forced to rely on charities or be driven into financial hardship just to receive vital, life-improving equipment for their disabled children.

"It's time the NHS stopped relying on charities to fill the gaps left by its inadequate funding."

Two PCTs in the West Midlands – Birmingham East and North, and South Birmingham – have waiting times for a powered wheelchair of 18 months compared to a national average of just under five months, the report said.

From:
http://www.guardian.co.uk/society/2009/mar/04/wheelchair-wait-children

Labour's NHS targets may have led to 1,200 deaths in Mid-Staffordshire

NHS managers have been accused of putting targets and cost-cutting ahead of patients as a report found up to 1,200 people may have died needlessly due to "appalling standards of care" at a single hospital.

An astonishing litany of failings at Mid-Staffordshire Hospitals trust was uncovered by the Healthcare Commission in one of the most critical reports of NHS treatment ever published.

Last night there was concern from patient groups that managers who should have spotted the failings at the trust but failed to raise the alarm have now been promoted to key jobs in the NHS and healthcare regulation.

The investigation into care between 2005 and 2008 found overstretched and poorly trained nurses who turned off equipment because they did not know how to work it, newly qualified doctors left to care for patients recovering from surgery at night, patients left for hours in soiled bedclothes, and reception staff expected to judge the seriousness of the condition of patients arriving at A&E.

Doctors were diverted away from seriously ill patients, in order to treat ones with minor problems, to make the trust look better because they were in danger of breaching the Government's four hour waiting time target.

The trust - which was under pressure to save £10m from its annual budget - was more concerned with hitting targets, gaining Foundation Trust status and PR marketing and had "lost sight" of its responsibilities for patient care, the report said.

It is not clear how many patients died as a direct result of the failures but the Commission found that mortality rates in emergency care were between 27 per cent and 45 per cent higher than would be expected, equating to between 400 and 1,200 'excess' deaths.

Sir Bruce Keogh, medical director of the NHS, described the failures as a "gross and terrible breach of trust" of patients.

Health Secretary Alan Johnson offered his apologies to patients and staff who suffered as a result and immediately ordered two more inquiries.

Patients of Mid-Staffordshire NHS Foundation Trust described one ward as a "war zone" and people were often left waiting in A&E for hours covered in their own blood and without pain relief even though they had serious injuries.

Others were left without food or drink, some received the wrong medication - or none at all - and blood and faeces was left on lavatories and floors.

Trust chief executive Martin Yeates and chairman Toni Brisby both stepped down two weeks ago and Mr Yeates, who is paid a salary of £160,000, is suspended on full pay while an independent investigation is carried out.

But patient groups were angered that Cynthia Bower, who was chief executive of the West Midlands Strategic Health Authority - the organisation with responsibility for checking standards at the hospital - from July 2006, is to set to become the new head of the health super-regulator the Care Quality Commission.

Her predecessor David Nicholson at the forerunner of West Midlands Strategic Health Authority - which was Shropshire and South Staffordshire SHA - left in 2006 but is now the head of the NHS, as its chief executive.

Sir Ian Kennedy, chairman of the Healthcare Commission, said the report is a "shocking story" and that there were failures at almost every stage of care of emergency patients.

"There is no doubt that patients will have suffered and some of them will have died as a result," he said. "Trusts must always put the safety of patients first. Targets or an application for foundation trust status do not lessen a board's responsibility to its patients' safety."

The problems first emerged after the hospital was reported in 2007 to have high mortality rates among patients.

But the trust's board of directors "fobbed off" NHS investigators by saying the rates were a result of statistical errors.

Yesterday the Healthcare Commission concluded this was not that case. The report stated that staff members claimed care of patients had become secondary to government-imposed targets.

The report said there was a "reluctance to acknowledge or even consider that the care of patients was poor".

Nurses were threatened with the sack because of the number of breaches of the target to treat A&E patients within four hours and felt they were "in the firing line".

Patients in danger of breaching the target were put in a 'clinical decision unit' which was a "dumping ground" for patients in order to "stop the clock" on the waiting time.

Relatives came forward to report, nurses shouting at patients, staff failed to treat patients with compassion or dignity and respect, lack of help with meals or drinks, and failures to treat bed sores. One comapred the hospital treatment to the "Third World".

A survey found two thirds of doctors would not be happy to have a relative of theirs treated at the hospital.

Director of the Patients Association Katherine Murphy said: "How can any patient have trust in the managers and systems that have allowed this disaster to run and run?

"It is not enough for the Chairman and Chief Executive to take the fall for this.

"Government targets have directly impaired safe clinical practice and money and greed for Foundation Trust benefits has taken priority over patients' lives."

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing (RCN), said: "There is also something very wrong when trusts are achieving foundation status by putting the health of their budgets over the care of their patients as detailed in the accounts of trust board meetings."

Eric Morton, the new chief executive of the Mid-Staffordshire NHS Foundation Trust, said: "We would like to take this opportunity to offer our very sincere apology. We would like to reassure the local community that our focus is, and will remain, on providing high quality, efficient and safe healthcare for the people of Staffordshire. "

Professor Sir George Alberti, national clinical director for urgent and emergency care will now lead an independent review of the trust's current A&E services.

From:
NHS-targets-may-have-led-to-1200-deaths-in-Mid-Staffordshire.html

GP referrals up by 300,000, statistics show

The number of GP referrals has shot up by nearly 300,000 compared with the same period last year, official statistics released reveal.

GP referrals made in the quarter ending 30 September have risen by 12.6 per cent, while other referrals have increased by 9.2 per cent.

Inpatients

The figures also show 91 patients for whom English commissioners are responsible waited longer than the 26 weeks standard for inpatient admission at the end of October 2008.

The number waiting more than 13 weeks was 40,800, a drop of 4.8 per cent from September 2008 and 36.4 per cent from last October.

Outpatients

Out of a total of 888,000 patients, 551 waited more than the 13 weeks standard for a first outpatient appointment following GP referral at the end of October.

Of these, 67 were English residents waiting for appointments in Welsh hospitals.

There was an increase of 13.9 per cent in the number of patients waiting longer than eight weeks at the end of October 2008, compared with last October, but the numbers dropped by 14.9 per cent from September this year.

Cancelled operations

During the quarter ending 30 September 2008, 13,100 operations were cancelled at the last minute for non-clinical reasons. In the same period in 2007, 12,500 operations were cancelled.

Of these cancellations, 3.3 per cent of patients were not treated within 28 days, compared with 5 per cent in the same period last year.

From:
gp_referrals_up_by_300000_statistics_show.html

Two thirds of patients fail to get GP's appointment within 48 hours

Two thirds of NHS patients cannot get an appointment with their GP within 48 hours, a wide ranging report by the healthcare watchdog has found- and the situation is getting worse as last year 80 per cent of patients could see their GPs within 48 hours.

The most comprehensive study of its kind has shown that millions of people are being failed by their local surgeries.

Under key NHS targets, patients should be able to see their family doctor within two working days. However, the report said that just one third of people were able to see their GP within this time.

The findings come at a time when the relationship between patients and their doctors is already under strain.

There has been widespread anger over the large pay rises enjoyed by GPs under the new contract.

And ministers and GPs have been locked in bitter negotiations about forcing surgeries to open for extended hours, offering appointments into the evening, early in the morning and on Saturdays.

Gary Needle, at the Healthcare Commission, said: "Patients are not getting sufficient access to their GPs is the message from this measure."

Andrew Lansley, Shadow Health Secretary said: "Despite all their talk, Labour are still failing patients when it comes to choice and access to a GP.

"It's appalling that in seven out of ten areas, people aren't able to see their doctor within 48 hours when they wish. It shows the utter failure of Labour's top-down targets to bring about the best results for patients."

Liberal Democrat health spokesman Norman Lamb said: "For years people have known that ministers' complacent assurances about how easy it was to see a GP were wrong.

"At last a proper assessment has taken place so we can see the reality of the situation. This scandalous finding must force the Government to act now."

Last year the report found that 80 per cent of patients were able to see their GPs within 48 hours.

However, the data was gathered by using 'mystery patients' to carry out spot checks to see if they could get an appointment rather than asking patients.

This year, for the first time, the commission included information from a patient survey. The report has sparked a row with doctors who have said the figures are misleading.

Dr Hamish Meldrum, chairman of the British Medical Association said: "The report's conclusion that there has been a dramatic decline in primary care trusts meeting the GP 48-hour access target is misleading.

"There has been such significant change in the way the research has been compiled compared to last year that it is impossible to compare the data for the two years in question. The access figures are even more confusing when you consider that a recent survey showed almost 9 out of 10 patients were satisfied that they were able to get an appointment within 48 hours.

"GPs are working hard to offer as much flexibility as they can to patients, as well as providing speedy access, and delivering an expanding range of services to patients."

The latest figures show the average annual earnings of GPs, who are paid to hit the targets on appointments, are £103,530 - a drop of 2.6 per cent on last year after years of rising pay. They also showed 258 doctors earned more than £250,000 before tax last year.

The commission's healthcheck is an in-depth investigation into the NHS with each hospital trust, primary care trust, mental health trust and ambulance trust measured on waiting times, hygiene, confidentiality, management of records, reducing deaths from cancer and heart disease, cutting superbug rates and treating patients with dignity and respect.

While the report found there had been improvements in many areas, it found that infection control was a serious problem with 'lapses at almost every trust visited' and six out of ten trusts failing on at least one measure.

The Commission warned that other infections such as norovirus - the winter vomiting bug that reached record levels last winter - should be included in the measures in the future alongside Clostridium difficile and MRSA.

Of the 114 trusts that failed on at least one infection control measure, 11 said they were compliant only for this to be overturned by inspectors.

There is concern about infection control in community hospitals, district nursing, ambulances and midwifery and these areas will have extra focus in the next inspections.

From:
Two-thirds-of-patients-fail-to-get-GPs-appointment-within-48-hours.html

NHS trust spends £12,000 treating staff privately

An NHS trust has spent more than £12,000 on private treatment for hospital staff because its own waiting times are too long.

The money was used to bring in physiotherapists to help workers recover from muscular skeletal injuries at West Suffolk Hospital in Bury St Edmunds.

Bosses said it prevented them from leapfrogging NHS patients and enabled them to return to work more quickly.

However, the private treatment, which amounted to £12,116 for 271 appointments over the past year, was described by critics as "shocking".

Mark Wallace of the TaxPayers' Alliance said: "Their staff should have to wait like everybody else. "Perhaps if they experienced it as their customers - that is the taxpayer - experienced it, they might be a little keener to improve their waiting times."

Frances Jackson, a patient who receives physiotherapy treatment from the hospital, said: "It's great that staff are being catered for because there is a need for it - they do get work-related injuries which can lead to osteoarthritis.

"But what about everybody else? There's an amazing amount of people who can't afford private physiotherapy. They need to appoint more physiotherapists and bring the waiting lists down."

Jan Bloomfield, executive director of workforce and communications at the hospital, said: "In line with national best practice, and with policies adopted by other major employers, we offer a physiotherapy service to help staff with specific work-related problems.

"Staff must meet very precise criteria to receive the service, which offers good value for money as it helps them get back to work quickly so they can continue to provide high quality care to our patients, avoiding the need to draft in expensive locum care."

She added: "Funding for the service is generated by our occupational health team, who go into businesses to advise on health and safety, and is not taken from budgets set aside for patient care.

"We are currently looking at whether it would be cost-effective to extend the service to offer different types of rehabilitation to staff."

From:
NHS-trust-spends-12000-treating-staff-privately.html

NHS pays up to 60pc higher prices to cut waiting lists

Private hospitals are once again being paid well above the standard National Health Service price in a drive to get waiting times down that has proved only partially successful.

Just months after the Department of Health cut back on a programme of independent sector centres to treat NHS patients at close to NHS prices – claiming that the NHS had sufficient capacity itself – private hospital providers say the service is once again “spot purchasing” significant numbers of operations at the last minute to get waiting times down.

Such last-minute purchases cost appreciably more than the standard NHS price, as the private hospitals are less able to plan and schedule their work.

One senior NHS manager said: “I know of examples where the NHS has recently paid the private sector 140 per cent, and even 160 per cent, of the NHS price to try to hit the waiting time target.”

The practice of spot purchasing had largely disappeared after the first independent treatment centres came in and the NHS introduced more structured contracts with the private sector.

The disclosure of its reemergence came as the DoH claimed to have hit a milestone in its drive to ensure that no one has to wait more than 18 weeks for treatment by the year end.

By the end of March, 85 per cent of patients who require admission were meant to have started treatment within 18 weeks, while 90 per cent of outpatients had started treatment within that period.

The health department said that a “milestone” had been achieved nationally. But closer examination shows that while some hospitals are reaching the 18-week target for almost all patients – pushing the average up – others are still way short of the March measure.

In London, fewer than 70 per cent of orthopaedic and neurology admissions were treated within 18 weeks, for example. In the south-east, fewer than 71 per cent of orthopaedic patients were operated on on time, and only just over 75 per cent in the south-west.

The east Midlands narrowly missed the milestone for cardiothoracic surgery, and the West Midlands missed it for orthopaedics, oral surgery and neurology.

However, David Worskett, director of the NHS Partners Network, which represents private providers, said some of the improvement had been due to a significant rise in spot purchasing in some parts of the country.

“It would have been better to bring more independent sector activity into the system,” he said, “because it is cheaper to have an agreed volume than to go in for last-minute purchases which are inevitably more expensive because the providers cannot plan.”

From:
http://www.ft.com/cms/s/0/27638a84-2daa-11dd-b92a-000077b07658.html

NHS waiting list promise likely to be broken

A milestone in the labour government’s drive to ensure that no one waits more than 18 weeks for hospital treatment looks set to be missed, suggest latest figures from the Department of Health.

By the end of March, 85 per cent of patients needing hospital admission should have been treated within 18 weeks of being referred by their family doctors to remain on track to meet the National Health Service’s target that by the end of the year at least 90 per cent of all patients will have been treated within that period.

Latest figures from the department, however, show that at the end of February, with just four weeks to go to that staging post, only 75 per cent of patients had been admitted within 18 weeks.

If the milestone is to be met a 10 percentage points improvement in a month will be required. That suggests the target will be missed, though possibly only narrowly and chiefly in orthopaedics.

For patients whose treatment can be completed without the need for admission, the NHS came closer to meeting its goal. In February, 86 per cent of patients were being treated within 18 weeks against the milestone for the end of March of 90 per cent.

The figures show that a third of patients complete their treatment within six weeks and just more than half within 12 weeks.

However, the scale of the challenge in eliminating the longest waits is shown by the fact that of the 298,762 patients admitted to hospital in February, 3 per cent – almost 9,000 – had been waiting more than a year and 62,000 had been waiting more than 6 months.

In addition, only 60 per cent of patients admitted with orthopaedic problems – one of the biggest specialities – were treated within 18 weeks, suggesting that part of the milestone is almost certain not to be reached.

The department, however, said: “We are expressing cautious optimism that when the March figures are published they will demonstrate achievement of the milestone.”

The department now claims it can report waiting times accurately for 96 per cent of patients – including the wait for an outpatient appointment, any diagnostics needed and then the wait for an operation.

However, some analysts are sceptical about the data as some primary care trusts are reporting “clock stop and start” times for many more patients than they appear to have treated: producing figures for the “completeness” of their data of more than 100 per cent.

“This has to make you very sceptical about the reliability of the data,” said John Appleby, the chief economist at the King’s Fund health think-tank.

The Department of Health said the discrepancy is thought to be due to some primary care trusts counting routine follow-up appointments after treatment as new completed treatments.

From:
http://www.ft.com/cms/s/0/0735cb06-1fad-11dd-9216-000077b07658.html?nclick_check=1

Average NHS waiting times up under Labour

Average hospital waiting times have risen under Labour, figures show. Before Labour came to power in 1997 waits of more than 18 months were not uncommon, but now few people waits longer than six months in England.

However, NHS data reveals in 1997-98 median average waits stood at 41 days, but by last year had risen to 49 days.

The labour government said it was the price paid for the end of really long waits, but doctors said longer waits included some patients with serious conditions.

Jonathan Fielden, chairman of the British Medical Association's consultants committee, said: "All that has happened is that the government has put an end to the really long waits and the really short waits.

"Doctors have been stopped from using their clinical judgement and pushing people through the system when they need to be.

"Of course, it is good that the really long waits have gone, but it is wrong to say that all patient care has improved because of shorter waits."

Labour has concentrated on reducing waiting times by introducing a succession of targets.

When the party came to power in 1997 waits of over 18 months were not uncommon.

Even by 2000, when the 10-year NHS Plan was published, there were still 125,000 people waiting over nine months.

However, the push has had the opposite - albeit fairly small - impact on average waiting.

The figures obtained by the BBC News website, from the NHS Information Centre, show that for some cancers average waiting has increased slightly, while big falls have been seen in more minor conditions such as cataract operations and treatment for dermatitis and eczema.

Katherine Murphy, of the Patients Association, said: "These figures make us really question whether patients are getting a better deal.

"What concerns me is that patients with serious conditions may be waiting longer than they used to be. That is wrong."

Shadow health secretary Andrew Lansley said: "This shows how the bigger picture gets neglected in order to meet the government's top-down targets.

"In meeting one target, another patient misses out. It is simply unfair."

And Lib Dem health spokesman Norman Lamb added: "These figures massively undermine Labour's claims to have made a substantial difference to NHS waiting times."

http://news.bbc.co.uk/1/hi/health/7271772.stm

Health Direct warns that hard of hearing and dental patients still wait years for treatments, so there is stil considerable work to done to meet yet another labour promise.

Deaf aids postcode lottery scandal exceeds 18 week promise

Some people in England are facing waits of nearly two and a half years for an NHS hearing aid, the RNID charity says.

Among 99 primary care trusts, it found 10 were not treating people within a year, with the longest wait of 125 weeks in Kingston-upon-Thames, London.

The average wait for treatment was 22 weeks and the shortest four weeks. The RNID urged the labour government to do more to meet a pledge of 18-week maximum waits.

"An 18 week target is a distant dream for thousands of people waiting over a year for their first hearing aid" Brian Lamb, RNID director of communications

Health Minister Ivan Lewis has pledged that by December 2008 all patients with hearing or balance problems that require care from a hospital consultant will be treated within 18 weeks.

And all other patients with routine hearing loss should be assessed within six weeks.

The RNID wrote to England's 152 primary care trusts to assess the situation and among the 99 that replied, the average wait for a hearing aid was 22 weeks, affecting 28,384 people.

Sixty-six PCTs said they were providing treatment within 18 weeks.

Patients at the Norfolk and Norwich PCT, Southampton City PCT and Bolton PCT were treated within four weeks.

But there were waits of over one year in nine PCTs other than Kingston-upon-Thames - Suffolk (78 weeks), Gloucestershire (72), Tyne and Wear: Washington Health Centre (68), Ealing (67), Havering (64), Tyne & Wear: Sunderland Royal Hospital (62), Shepway (58), Mid Essex (56) and South Tees (54).

RNID director of communications Brian Lamb said: "Despite government assurances, an 18-week target is a distant dream for thousands of people waiting over a year for their first hearing aid, who are battling isolation and depression because of their hearing loss.

"RNID wants the government to do more to end this scandal, by putting pressure on local health chiefs to take hearing-health seriously and bring down waiting times."

A Department of Health spokesman said: "We acknowledge that audiology waiting times in parts of the country are too high, and that is why we recently published a national framework which sets out the tools the local NHS needs to transform this service.

From:
http://news.bbc.co.uk/1/hi/health/7162990.stm

NHS trusts fail on waiting times as more than half wait over 18 weeks

Less than half of NHS patients are receiving hospital treatment within the government's flagship waiting time target of 18 weeks, new figures revealed. Only 48% of patients in England are treated within 18 weeks and 12.4% have to wait more than a year for treatment, according to figures published by the Department of Health.

The results cast doubt on whether the labour government can meet its promise that all patients would be treated within this time by the end of 2008.

Patients in south-east England suffered the longest waits for hospital treatment with only a third seen within the target time.

The east of England and London were ranked second and third worst respectively for delays to hospital treatment. In the former only 41% of patients were treated within 18 weeks, and in the latter only 44%.

Even in the east Midlands - the best-performing region of the country - only 60% of patients were treated within the target time.

The worst performing trust was Swindon primary care trust, where just over a fifth of patients referred for hospital treatment were treated within 18 weeks.

Brighton and Hove city primary care trust was the second worst with only 23% of patients treated within the target period. The third worst was Enfield primary care trust, north London, where only 26% were treated on target. The third worst was Mid Essex primary care trust where only a quarter were treated on target.

Patients referred for trauma and orthopaedic treatments suffered most delays, with only a quarter treated within 18 weeks. Referrals for oral surgery and neurosurgery suffered the next worst delays, with only 37% and 39% of patients treated within the target period.

The study of total waiting times - from GP referral to hospital treatment - covered 208,127 patients in England who started their referral to treatment in March this year.

The Liberal Democrat health spokesman, Norman Lamb, said: "Behind the statistics, thousands of sick people are still waiting more than a year for hospital treatment. Why does the government not publish how long people are waiting over a year? How long do these long waits really last?"

The chairman of the British Medical Association's consultants' committee, Dr Jonathan Fielden, said the figures were "encouraging", but added:

"There is still a long way to go though to ensure that patients are treated as soon as clinically needed and for these improvements to be sustained."

The NHS Confederation, which represents over 90% of NHS organisations, said the figures provided a clearer and more meaningful picture of actual waiting times for patients.

Its director of policy, Nigel Edwards, said: "There is optimism within the health service that the 18 week target will be met by December 2008. However, we must not forget that this is probably the most challenging target that the health service has been asked to take on."

But he warned that many trusts' debts would hinder their ability to meet the target, which is expected to require around a third of the extra NHS funding for the current financial year to achieve.

From:
http://www.guardian.co.uk/uk_news/story/0,,2097562,00.html

Nearly eighteen months ago (Jan 05, 2006) Health Direct warned that the NHS set to miss 18 week waiting times key target

The National Health Service will miss its key target to cut waiting times for treatment to a maximum of 18 weeks by 2008 without additional capacity and more reform, an analysis by the Financial Times shows. Reaching the target will involve either an unprecedented increase in productivity, or more work contracted out to the private sector – or most likely both – according to leading academics.

Waiting times for a first out-patient appointment have been falling – but far too slowly for the government to hit its 18-week target.

In addition, there are fears that increasing diagnostic capacity may prompt more demand, so that waiting times for tests and scans could rise before they fall – something that has happened in other countries when capacity has been expanded.

“What these figures show,” said Alan Maynard, professor of health economics at York University, “is that of the three elements needed to get to an overall 18-week target, one [the outpatient wait] is falling far too slowly, one [the wait for diagnostics] may well rise before it falls, and the third [the time spent on the waiting list before an operation] is going in the wrong direction.

“Unless something changes radically, the government is going to miss its target.”

New hearing aid target set as patients wait up to 70 weeks.

Health trusts are being told by the government to make sure people with routine hearing problems are assessed for a hearing aid within six weeks. Thousands of people in the North West of England are being forced to wait up to 70 weeks for tests to see if they need a hearing aid. Stockport has been found to be the worst area for waiting times.

Under new guidance sent to primary care trusts (PCTs), patients with complex problems who need to see a consultant should be seen within 18 weeks. The other 50% of patients who need a routine hearing aid fitted should be assessed within six weeks, it says.

New guidance advises the NHS to set up one-stop shops to speed up assessment and fitting and to use the private sector to help tackle demand.

Health minister Ivan Lewis admitted waiting times in some parts of the country were "unacceptably long".

Some reports have suggested some patients are having to wait as long as five years for replacement hearing aids.

The number of referrals to consultants could be cut by a fifth with patients instead being referred directly through audiology services, the guidance advises.

And although there is no target for the length of time between assessment and fitting, the Department for Health said improvements in technology meant that many people did not need separate appointments.

A report from the British Society of Hearing Aid Audiologists (BSHAA) published last year showed that some people were having to wait up to five years to switch their old-fashioned analogue hearing aid to a better digital model.

Government figures from 2006 show that of all patients waiting for an audiology referral, two-thirds had been waiting longer than 13 weeks.

And a recent report by Conservative MP Grant Shapps found that average waiting times were 40 weeks, with reassessments taking over a year.

Mr Lewis said there was no justification for the delays as there was already enough cash in the system.

Mr Shapps, MP for Welwyn Hatfield, in Hertfordshire, said he was disappointed by the report and was sure targets would not be met by next year.

"This report has a lot of noble aims but no practical measures. This is part of a much wider problem about competing pressures within PCTs," he said.

Shadow health minister Tim Loughton said: "The long waiting lists for digital hearing aids are amongst the biggest scandal in the NHS, particularly for the elderly population."

Dr John Low, chief executive of the Royal National Institute for the Deaf, welcomed the push to reduce delays but said he would hope waiting lists could be reduced before 2008.

"The commitment to purchase substantial additional capacity from the private sector is particularly welcome since the NHS will not be able to fit hearing aids to 300,000 extra people through productivity gains alone," he said.

Karen Finch, chairwoman of the BSHAA, said a long-term sustainable solution was needed.

"Engage with High Street hearing aid audiologists," she said."There are 1,400 of us and we believe that we have the immediate potential to help the hard-pressed NHS out. We are a skilled resource, trained to dispense hearing aids."

From:
http://news.bbc.co.uk/1/hi/health/6420205.stm

Hospitals told not to operate until cancer patients have waited 20 weeks

A NHS surgeon today exposed how cash-strapped hospitals were being barred from operating on cancer patients who had not waited long enough. Wayne Jaffe laid the blame for the appalling state of affairs at the feet of Tony Bliar, with his vision of reduced waiting times and 24-hour surgery. In a withering assessment of the financial management of the health service, Mr Jaffe said that doctors were being restricted in getting waiting lists down by financial limitations and ever-changing targets.

The consultant plastic and reconstructive surgeon, who specialises in skin cancer and breast reconstruction, said he and his colleagues are being prohibited from operating in non-urgent cases unless the patient has been waiting for a minimum of 20 weeks.

This is because the hospital would not get paid – even if the patient and staff were ready for the operation.

Mr Jaffe said the Prime Minister's pledge to have patients waiting no longer than 18 weeks between referral and treatment would be "impossible" unless more money was made available to primary care trusts.

He rubbished the Government's vision of 24-hour surgery, saying that after normal working hours only a skeleton staff was available.

"We are trying to do what the Prime Minister wants us to do but we cannot do it properly because there is no money," he said.

"Waiting lists will only go up if, as is the case, doctors cannot perform operations unless the patient has been waiting for more than 20 weeks. It's absurd."

Mr Jaffe, who works at the University Hospital of North Staffordshire NHS Trust, said the 20-week ruling was a "global issue" within the NHS and not just a problem at UHNS. He claimed that he was unable to fill his evening lists because of the 20-week constraint, and that patients were having to wait longer to be seen than necessary.

He said: "Doctors across the country are talking about the same thing and it's happening everywhere.

"It's not the hospitals – these rules are being put in place by the PCTs to take them over the April 1 threshold, when the new financial year begins and they get their money from the Labour Government.

At the moment they have no money so cannot pay the hospitals. How that tallies with getting maximum waiting times down to seven weeks, which is another target, I do not know.

"The way things stand, waiting lists will grow, not shorten, if operations have to be put back because of a lack of money. It's clearly a ridiculous way of doing business."

His candid remarks come on the same day that radiotherapists reveal how other cancer patients are having to wait months beyond their recommended dates for treatment that can prevent the disease returning.

Channel 4's Dispatches programme, to be shown tonight, found that the waiting gap between operations to remove cancerous growths and radiotherapy treatment is at least three months in Kent, breaching the Royal College of Radiologists' guidelines.

Three patients have seen the disease return during the long gap between their operation and radiotherapy.

The programme found that five UK radiotherapy units have an average wait of 28 days, which means that many patients are waiting longer. In two centres, more than three-quarters of patients were not treated within 28 days.

Mr Jaffe said Government proposals to increase operating hours into the night were "laudable". But he added: "We would need more doctors, more nurses, more staff. More, in fact, of all the people they keep making redundant.

They are getting rid of people yet trying to impose regulations on us that mean we need more people. Nurses are qualifying yet no trusts are employing them because they have no money."

A spokesman for the UHNS trust said that waiting times at the hospital had dropped from 26 weeks to 20 weeks in the last year, and he added that Mr Jaffe's comments only covered routine surgery, not emergency surgery.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/02/26/nops26.xml

Health Direct questioned last week (Feb 20) how Bliar intends to achieve his latest spin NHS target without providing any more money.

Health Direct posted : Barking Bliar's latest drive to cut waiting times for NHS operations
when Tony Bliar stepped up the drive to define his legacy by declaring that he wanted to see "the framework" in place to ensure that by the end of 2008 no one waits more than 18 weeks for an operation after seeing the GP.

The target- originally announced two and a half years ago implies an average wait of eight to nine weeks. How he intends to achieve this breakthrough without providing any extra money was not explained.

James Johnson, chairman of council of the British Medical Association, said there were two "stumbling blocks" to using operating theatres more intensively. One was how to staff them.

But the other was that "many parts of the NHS are broke. If primary care trusts have run out of money, they clearly cannot buy a lot more operations. This and the lack of staff have already prevented extended working from happening in many parts of the NHS."

Barking Bliar's latest drive to cut waiting times for NHS operations

Tony Bliar yesterday stepped up the drive to define his legacy by declaring that he wanted to see "the framework" in place to ensure that by the end of 2008 no one waits more than 18 weeks for an operation after seeing the GP. The target- originally announced two and a half years ago implies an average wait of eight to nine weeks. How he intends to achieve this breakthrough without providing any extra money was not explained.

It would mean that over the course of a decade "what was the biggest problem in the National Health Service - that people had to wait months and months, often in pain and sometimes even dying for want of their operations" would have been "transformed", the prime minister said.

Some hospitals are considering keeping operating theatres open in the evenings and at weekends. But the NHS Confederation, which represents health authorities and trusts, said many hospitals would have "to completely redesign how patients flow through the system" to achieve the goal.

Nigel Edwards, the confederation's director of policy, also warned of the challenge that lay ahead as the increase in NHS spending slowed: to create the facilities to deal with the current backlog of cases without then leaving the NHS with higher costs or excess capacity once that had been done.

James Johnson, chairman of council of the British Medical Association, said there were two "stumbling blocks" to using operating theatres more intensively. One was how to staff them.

But the other was that "many parts of the NHS are broke. If primary care trusts have run out of money, they clearly cannot buy a lot more operations. This and the lack of staff have already prevented extended working from happening in many parts of the NHS."

Bliar's latest spin comes as news that some primary care trusts are delaying operations into the next financial year, or putting a minimum wait on treatment, while, according to suppliers, some parts of the NHS are paying bills late or cutting orders for supplies until the financial year ends in March.

While the NHS overall may achieve financial balance, a large number of hospitals and primary care trusts will be saddled both with overspends this year and years of accumulated debt.

The figures emerged as a doctors.net poll of more than 3,000 doctors for The Times showed that almost three-quarters believe that the extra money for the NHS has not been spent well. Some 28 per cent believe David Cameron would protect the NHS more effectively than would Gordon Brown, who is favoured by just 15 per cent. (Please see yesterday's Health Direct posting- Disillusioned doctors say Labour decade of reform has failed the NHS)

From:
http://www.ft.com/cms/s/19ec376e-c089-11db-995a-000b5df10621.html

How Bliar intends to achieve his latest spin NHS target without providing any more money has not been explained.

Especially from an organisation that is desperately indulging in every trick in the financial book
to massage the cash flow figures.

On 14 Feb 07 in NHS paying bills late in struggle to balance books, say suppliers, Health Direct posted: The National Health Service is delaying paying bills and cutting orders for supplies as it tries to balance its books, according to the trade associations whose members supply the service with everything from scanners to diagnostic tests.

Ray Hodgkinson, director-general of the British Healthcare Trades Association, said that while the picture was highly variable "some of our members are having real trouble getting money out of NHS trusts".

NHS paying bills late in struggle to balance books, say suppliers

The National Health Service is delaying paying bills and cutting orders for supplies as it tries to balance its books, according to the trade associations whose members supply the service with everything from scanners to diagnostic tests. Ray Hodgkinson, director-general of the British Healthcare Trades Association, said that while the picture was highly variable "some of our members are having real trouble getting money out of NHS trusts".

Most had standing orders that said bills should be paid within 30 days, Mr Hodgkinson said. "But some are not paying for 60 or 90 days and even longer. They are in breach of their standing orders and for a lot of our members who are small businesses this is creating problems with cash flow. There is no doubt there is slow payment on a significant scale."

With Patricia Hewitt, the health secretary, having said she would take "personal responsibility" for restoring the NHS to financial balance this year, Mr Hodgkinson said: "NHS chief executives are telling us that they must balance their books at all costs."

Doris-Ann Williams, director-general of the British In-Vitro Diagnostics Association, whose members provide diagnostics supplies and tests, said: "We are starting to see invoices not being paid and orders not being closed until the start of the new financial year [in April].

"All sorts of measures are being taken to try not to spend money in this financial year."

Having seen orders dry up and bills not paid this time last year as the NHS headed for a £500m-plus financial deficit, she added that this was "starting to seem like an annual event".

She said: "We did a survey of our members in September and things had got much better than at this time last year. But the reports we are getting now is that the problem is recurring."

John Wilkinson, director-general of the Association of British Healthcare Industries, whose members supply everything from latex gloves to high-technology life support machines, said they had seen the impact most in bigger items of capital spending.

"We traditionally get late payment around this time of year and we have had some reports of that recently but not an overwhelming crescendo. But capital spending on equipment seems to have dropped quite dramatically - it is really quite badly down."

That was worrying when the NHS had a target to reduce the maximum wait from GP to surgery to 18 weeks and that goal would not be achieved by simply doing more faster but by reshaping the way services were delivered, Mr Wilkinson said. "Quite a lot of those changes will involve capital spending on equipment."

One supplier who declined to be named said: "The instructions seem to be 'spend absolutely nothing' and we in common with our competitors have seen a marked drop in order levels. We're expecting a flood of orders next month since payment will then fall in the next financial year."

From:
http://www.ft.com/cms/s/e30c4d3c-bb07-11db-bbf3-0000779e2340.html

The cash crunch is also having a direct effect on patients. On March 07, 2006 Health Direct posted: NHS overspending increases waiting times for patients when early signs that a big overspend in the National Health Service in England is starting to affect patient care came with the waiting list figures for January. Although the total list rose by only 7,600 in the month, up 1 per cent, the number of patients waiting between three and five months for treatment has jumped by 36,600 - 25 per cent. In other words, while the number of patients waiting has only risen slightly, the wait has increased.

That appears to have resulted from hospitals putting off treatment until the new financial year, which starts in April, while still keeping to the government's guarantee of a maximum six-month wait.

At the same time, some primary care trusts are telling hospitals that they must treat no more patients next financial year than this year, and in some cases fewer, to claw back an overspend that has been forecast to hit £790m by the end of this month.

Andrew Lansley, the Conservative health spokesman, said "[some] doctors are being told they cannot treat patients who are waiting in pain and discomfort until they reach the six months deadline. For a government that said it was going to put all this extra capacity into the NHS, and when the capacity becomes available then tells staff they cannot use it, it is the height of absurdity".

Last year, on January 23, 2006 the same thing happened when NHS Hospitals shut wards as cash crisis bites. The spiralling cash crisis in the NHS has already forced two thirds of hospitals to close wards and will soon start directly affecting patient care, health chiefs warn. A survey of 117 chief executives of NHS trusts reveals the depth of concern among healthcare professionals about the destabilising impact of wide-ranging govt reforms.

Three quarters of them say that growing financial pressures brought on by primary and acute care restructuring will affect patient treatment.