Health Direct official NHS Blog- advice, news, information

GP commissioning costs lots and delivers little

noreply@blogger.com (Drs Search) — Fri, 21 Nov 2008 09:13:00 +0000

A major study into practice based commissioning has found it to be an "expensive investment" that has delivered little in terms of better services for patients or financial savings.

The King's Fund is urging the Department of Health to use the "reinvigoration" of practice based commissioning announced in the next stage review to set out a "clear vision" for the initiative.

Primary care trusts should retain responsibility for strategic commissioning but with clinician involvement. High performing practice based commissioners should be rewarded with increased independence but should not become responsible for the entire healthcare budget.

Individual responsibility

Report author and senior fellow Nick Goodwin said it was essential that the government told people "exactly what the roles and responsibilities of individual parties are".

The report said even though GPs had received nearly £100m in incentive payments, few were commissioning new services, instead focusing on changing service provision.

From:
practicebased_commissioning_an_expensive_failure_kings_fund.html

Doctors will be offered cash incentives to prescribe new medicines

noreply@blogger.com (Drs Search) — Thu, 20 Nov 2008 09:35:00 +0000

Doctors will be given extra cash when they prescribe newer, more expensive medicines under a pilot scheme aimed at accelerating the UK's slow uptake of new medicines compared with other European countries.

The plan is part of a package agreed by the labour government and the pharmaceutical industry yesterday that aims to reward drugs innovation in exchange for cuts in the price the NHS pays for drugs.

The pharmaceutical price regulation scheme will lead to a 5 per cent reduction in the overall medicines bill over the next five years, starting with a 3.9 per cent cut in February.

But the labour government has pledged to sweeten the scheme with measures to link the price of medicines more closely to the value that they provide.

Companies will for the first time be able to raise prices on medicines already launched if clinical data show they provide a greater benefit than originally believed. Any such increases will be exempt from the overall 5 per cent price cut.

Richard Barker, director general of the Association of the British Pharmaceutical Industry, the trade body, said: "This landmark deal marks a turning point for patients, the NHS and the pharmaceutical industry."

A new process will also be introduced to streamline, accelerate and make systematic the process of renegotiating pricing for medicines initially rejected as not cost effective by the National Institute for Curbing Expenditure (NICE), the medicines advisory body.

This will help the government's attempts to limit the number of expensive new drugs that patients have to pay for because the NHS refuses to fund them.

The Department of Health, in consultation with Nice, has already approved a handful of such "risk-sharing" schemes, whereby drug companies reduce the NHS bill through discounts, free products or reimbursement for patients for whom the medicines do not work.

Incentive payments to doctors- which already exist to stimulate testing for certain diseases and encourage generic prescriptions - could prove controversial, and may also need to be supplemented by additional funding to primary care trusts.

From:
http://www.ft.com/cms/s/0/d38e92b2-b6a4-11dd-89dd-0000779fd18c.html

Doubts about safety of NHS maternity care as negligence payouts reach £1 billion

noreply@blogger.com (Drs Search) — Wed, 19 Nov 2008 14:25:00 +0000

Errors that caused serious harm to mothers and babies have accounted for nearly half of the £2.1 billion paid out as a result of medical negligence since 1995, Health Direct has learnt.

A total of £947 million has been spent on compensation relating directly to obstetrics, reflecting the increasing cost of lifetime care for children who have suffered brain damage, cerebral palsy or developmental delay.

The scale of the cost — enough to hire thousands of consultants or midwives — reveals the growing burden of claims on the health service at a time when maternity wards are short-staffed and the birthrate is rising.

Medical colleges say the chances of harm to mother or baby are lower than ever, but they remain concerned that shortages of consultants and midwives leave patients at risk.

Taking into account a backlog of cases from the 1990s, the cost of maternity-related claims has risen from £163million in 2003-04 to £288 million in 2007-08.

The figures, revealed by the NHS Litigation Authority in answers to parliamentary questions by Harry Cohen, the Labour MP for Leyton & Wanstead, reflect the cost of settled claims awarded under the Clinical Negligence Scheme for Trusts.

But this does not include cases that preceded the authority's creation in 1995, some of which have arisen from health problems diagnosed years after birth.

Medical colleges said that the total bill for litigation put the £330 million pledged by the labour Government to improve maternity services into sharp relief.

As The Times reported in September, trusts have had trouble identifying specific funding promised over three years to help to implement a policy document, Maternity Matters, that promised all women dedicated care from a midwife by the end of next year.

Louise Silverton, the deputy general secretary of the Royal College of Midwives, said that the cost of claims “underlines what a false economy it is to cut back on maternity care”.

“Women keep hearing about these excellent government policy statements such as one-to-one care in labour from a midwife,” she said, “but they are not getting that sort of treatment in many areas such as the East of England, the South West and London.

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

Overall NHS spending on maternity in England was cut by £55 million in 2006-07, while the birthrate has risen by 16 per cent — equivalent to 90,000 extra births — since 2001, Ms Silverton added.

Tristian Blomfield, 8, from Watford, Hertfordshire, received a compensation package of just over £8.26 million after suffering permanent brain damage at birth. He has cerebral palsy in all four limbs and requires constant care.

West Hertfordshire Hospitals NHS Trust, which manages Watford General Hospital where Tristian was born, offered his family an unreserved apology and expressed hope that the agreed settlement would provide them with security for the future.

Sabaratnam Arulkumaran, the president of the Royal College of Obstetricians and Gynaecologists, said that only one in every 6,000 births resulted in a litigation claim. But at that rate trusts had to set aside £500 for each birth as a form of insurance, he added.

“In a busy maternity unit of 5,000 births or more, we believe there needs to be 24-hour consultant cover to deal with emergencies and prevent disasters better. Rather than have more negligence cases and pay out on more claims, we should spend on more consultants, better training and reduce the number of cases,” he said.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article5168353.ece

Labour's organ donor fiasco grows

noreply@blogger.com (Drs Search) — Tue, 18 Nov 2008 09:42:00 +0000

A change in the law on organ donation may yet occur, in spite of an expert advisory body rejecting the idea.

The UK Organ Donation Task Force said that moving to a system where people are presumed to give consent to their organs being used for transplant risked damaging the "vital relationship of trust" between doctors and patients at the end of life.

It admitted that the arguments for and against an "opt-out" system were "finely balanced".

But it concluded that a "presumed consent" system would be complex and costly and would require a secure IT system - at a time when public trust over the security of labour government held data has diminished.

However, Gordon Brown, the prime minister, said he was "not ruling out a further change in the law".

From:
http://www.ft.com/cms/s/0/08e63c6a-b512-11dd-b780-0000779fd18c.html

Health Direct’s view of the the UK Organ Donation Task Force’s report is that they are barking.

Commonsence predicts that if over half of the population wants organ donation to be an opt out process then far more organs will become available for transplants in the future when a mandatory transplant system is introduced.

To additionally use the excuse of the £12 billion NPfIT white elephant as an example of data insecurity is a damming indictment of the Department of Health’s incompetence- who fund this quango.

Levels of public trust are much higher for doctors than labour politicians and nhs bureaucrats. Trying to shift the blame onto medical professionals is plainly incredulous.

Even ditherer Brown ought to realise that there are financial savings to had from more transplants in reducing NHS costs and greater economic benefit from sufferers returning to work.

Medicines shortage fears grow

noreply@blogger.com (Drs Search) — Mon, 17 Nov 2008 09:19:00 +0000

British patients face the prospect of drug shortages as the falling price of medicines makes it more profitable for pharmacists and wholesalers to sell them abroad.

The weakening of sterling against the euro has reduced British drug prices, compared with levels in other countries. That has fuelled a surge in the legal "grey market" practice of exporting drugs from the UK to more expensive medicine markets elsewhere in Europe - so-called parallel trade.

Supplies could tighten further from January 1, when the labour government's Pharmaceutical Price Regulation Scheme comes into force, imposing a 5 per cent price cut on prescription medicines bought by the National Health Service.

Andrew Hotchkiss, managing director of the UK operations of Eli Lilly, the US-based pharmaceutical company, warned of a "triple whammy" creating supply shortages, with the falling pound, price cuts and both fewer imports and more exports all creating uncertainties that could mean medicines are not available in pharmacies.

"We're worried about patient access," he told the Financial Times.

Britain has traditionally been an importer of medicines via parallel trade.

Wholesalers and many individual pharmacies have licences that allow them legitimately to export medicines from the UK to other countries where they fetch higher prices. Concerns are growing that this may increasingly squeeze supplies to British patients.

Martin Sawer, spokesman for the British Association of Pharmaceutical Wholesalers, whose members distribute medicines from drug companies to pharmacies, said he agreed that there were risks of supply shortages, especially since medicine stocks were likely to run low over the Christmas holidays.

The situation risked being worse than at any time in the past because the introduction of computerised stock control meant pharmacies often held smaller volumes of supplies.

Groups of pharmacies may deliberately order more medicine than they require, selling the remainder at a profit - a practice known as skimming. Prices in other northern European countries are about 10 per cent or more higher than in the UK.

Paul Johnson, UK managing director of IMS Health, the data consultancy, agreed that the UK's share of parallel trade across Europe, traditionally about 30 per cent, had been shrinking since the spring - with faster growth in other higher priced markets. "The UK still has significant parallel imports but they have reduced dramatically in the last few months. And a whole range of products are now being exported. This is a perfect storm."

He estimated that parallel trade accounted for nearly 10 per cent of Europe's total prescription medicine sales and involved purchases from low-cost countries led by Greece, Spain and Portugal, with re-sale into the UK, Germany, Benelux and the Nordic region, where parallel imports accounted for nearly €5bn (£4.2bn) a year.

From:
http://www.ft.com/cms/s/0/82357bc2-b511-11dd-b780-0000779fd18c.html?nclick_check=1

European healthcare rankings

noreply@blogger.com (Drs Search) — Fri, 14 Nov 2008 14:40:00 +0000

New report that ranks the UK 13th for healthcare out of 31 European countries.

The Euro Health Consumer Index 2008 puts the Netherlands in first place, with the UK trailing behind countries including Estonia, France and Germany.

The study looked at areas such as patient rights and information, IT, waiting times, outcomes, the range and reach of services and access to new drugs.

The report's authors found the UK performed well on patients' rights and information, but unlike Denmark and the Netherlands there had not been improvement across the board.

Euro Health Consumer Index director Dr Arne Bjornberg said the UK risks "raising expectations that the healthcare system cannot deliver".

From:
european_healthcare_rankings

NHS Direct shelves foundation trust plans

noreply@blogger.com (Drs Search) — Thu, 13 Nov 2008 09:18:00 +0000

NHS Direct has put its plans to become a foundation trust on ice. The decision follows government reluctance to free the national service from central control.

The Department of Health feels it needs to be able to call on NHS Direct as an emergency hotline in the event of a terrorist attack or other national incident.

NHS Direct was used as the national hotline for people worried about radiation contamination following the poisoning of former KGB agent Alexander Litvinenko in London in November 2006.

A statement from NHS Direct said: "It has become clear that the organisation's role, particularly around major incidents, is of strategic national importance. This has led to the Department of Health agreeing with NHS Direct that the traditional model of foundation trust may not be the most appropriate at the moment, given that one of the organisation's strengths is its national operating model."

NHS Direct is also seen as a prime contender to run the three digit non emergency phone number recommended by health minister Lord Darzi to direct people to appropriate services.

Around 16,000 people have signed up as "members" of NHS Direct in anticipation of it gaining foundation trust status.

NHS Direct chief executive Matt Tee told HSJ: "I'm slightly disappointed. The Department of Health has said that the arm's length aspect of foundation status will not work because we are nationally important. We wanted to be a foundation trust as a kind of 'badge' that shows that we are a high-performing organisation, but there is the chance that we can get certain freedoms without needing to have foundation status."

The labour government has previously said that psychiatric hospitals at Rampton, Ashworth and Broadmoor will also not be granted foundation status. Ministers want to hold sway over decisions relating to high-profile criminals.

A DH spokesman said: "NHS Direct, as recognised recently by the Healthcare Commission, provides a popular and important service to patients, undertaking millions of consultations each year. It will have a key part to play in supporting implementation of the next stage review."

From:
nhs_direct_shelves_foundation_trust_plans

Top up fees- why equality is a cruel doctrine in the NHS

noreply@blogger.com (Drs Search) — Wed, 12 Nov 2008 09:16:00 +0000

It has taken an inexcusably long time, but last week, the labour Government finally recognised that it was both cruel and unfair to deny NHS patients who decided to buy themselves drugs that the NHS would not purchase for them.

Linda O'Boyle is now dead, but she became the focus of the media campaign that forced the labour Government to change its mind. Her life was prolonged by the use of the anti-cancer drug Cetuximab.

She paid for it because the NHS would not do so. She was denied NHS care as a consequence, and had to pay another £11,000 to private hospitals for chemotherapy and nursing.

Mrs O'Boyle was one of many suffering from terminal illness who have gone through the same ordeal.

Nevertheless, there are plenty of people who continue to insist that, if the NHS cannot afford to pay for a particular drug, it is better that patients who need it die faster without it, and for them to be refused all NHS care should they pay to obtain it for themselves. Why would anyone adopt that cruel and irrational position?

No one is harmed when a patient like Mrs O'Boyle buys a drug which her doctors have recommended but the NHS will not fund. But there is a very obvious benefit to the patient. A policy which generates benefits without causing harm is obviously better than one which just causes harm. The choice between those two is a no-brainer.

Health Direct does not want to accuse those who advocate the policy of denying NHS treatment to patients who buy their drugs of having no brains. It is probably better to call them deluded. The villain is a misunderstanding of the ideal of equality: if everyone cannot have a benefit, it is better that no one should have it.

This implies that there should be no medical care at all if it is impossible to achieve the outcome in which that care is exactly the same for everyone. But that result cannot possibly be achieved, not least because doctors vary in their levels of competence and skill.

Those treated by the better doctors receive a higher standard of medical care than those treated by the less able and experienced. No egalitarian is so deluded as to believe that this means we should dismantle the NHS and make access to any kind of medical care illegal.

But that's the logical consequence of their doctrine that the most important value is not to provide medical care, but to ensure exact equality of outcomes for everyone.

The "harm" that the egalitarians claim is caused by allowing patients both to purchase drugs and to receive NHS care is, in reality, no harm at all. Someone who does not receive the best care possible from the very best doctors in the world is not harmed by the fact that there are people who do.

Professor Mike Richards, who wrote the report which led to the labour Government changing its policy, ties himself up in knots in an effort to both accept and reject that truth. He ends up recommending a compromise: patients who pay for drugs should not be denied NHS care, but they should not be treated in NHS hospitals. They should pay for any tests, scans and treatments to deal with complications arising from the additional drugs they pay for themselves.

The compromise will soon become untenable: differentiating between the tests and treatments that are made necessary because of the extra drugs, and those that are not, is often impossible. And what will happen if a patient is admitted into intensive care when they are due another dose of the drugs they pay for?

Will those drugs be administered in the NHS ward or not? Assessing such matters on a "case by case basis", as the Government proposes to do, is a recipe for precisely the outcome the Government says it wishes to avoid: patients being treated in wildly different ways, depending on the whim of the administrator who makes the decision.

The idea that medical care should be distributed according to need, and not on ability to pay for it, has one problem: doctors and nurses do not work for free, and drug companies do not give away drugs for nothing.

In 2003, the Wanless report on the funding of the NHS predicted that total NHS spending would rise from £68 billion to £154 billion in 2022. More recent estimates suggest that spending will increase to £184 billion. Such a huge sum won't come from general taxation: voters are not willing to pay taxes at the level necessary.

It means that "co-payments" - contributions from individual patients towards the cost of their own care - will inevitably have to increase.

Misguided egalitarians will try to prevent it. But they will only be able to do so by denying people medical care, and by going straight back to the situation in which someone like Linda O'Brien is pushed out of an NHS hospital because she makes a contribution to the cost of the drugs she needs. Is that the outcome they want?

From:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/11/09/do0903.xml

Statin use may benefit healthy in new NICE postcode lottery

noreply@blogger.com (Drs Search) — Tue, 11 Nov 2008 08:49:00 +0000

Guidelines on who is eligible for statins may need to be rewritten after an international trial found benefits in "healthy" adults, experts say- leading to a new postcode lottery for labour's killer quango NICE.

The study of 17,800 men and women with normal cholesterol levels found rosuvastatin cut deaths from heart attacks and strokes.

Currently statins are offered to people with a moderate to high risk of a cardiovascular "event".

The results are published in the New England Journal of Medicine.

The patients in the trial, funded by AstraZeneca, had cholesterol levels below those usually indicating a need for treatment and had no other signs of heart disease.

But they did have increased levels of a C-reactive protein, which indicates inflammation in the body and is believed to be a marker of future cardiovascular events.

After an average follow-up of two years, 20mg a day of rosuvastatin was found to have cut cholesterol by 50% and C-reactive protein by 37%.

Overall, the chance of a heart attack, stroke, hospital admission for chest pain or death from cardiovascular disease was cut by 44%, researchers said.

A reduction was even seen in those with the lowest chance of a cardiovascular event over the next decade, they said.

Researchers found a higher incidence of physician-reported diabetes in the statin group but could not explain it as blood glucose levels were similar between those taking rosuvastatin and those taking a dummy pill.

Guidelines

Statins are already prescribed to millions of adults in the UK.

The UK's National Institute of Curbing Expenditure (NICE) recommends doctors carry out a risk calculation based on an individual's blood pressure, cholesterol, weight and other risk factors, such as whether or not they smoke.

Those with a 20% risk of a heart attack or stroke in the next 10 years should be prescribed a daily dose of simvastatin - the cheapest of the statin class.

Dr Terry McCormack, a GP in Whitby, North Yorkshire, and ex-chairman of the Primary Care Cardiovascular Society, said the results were "astonishing" and much stronger than he would have expected.

He added that NICE should redo their cost-effectiveness calculation on the basis of the latest figures.

"These are people who have an intermediate risk and you wouldn't normally prescribe statins for them in the UK," he said.

"It opens up a whole new debate and the trial probably raises more questions than it answers."

Professor Peter Sever, an expert in clinical pharmacology at Imperial College in London, said the results backed other studies which had shown statins had the same proportional benefit however low an individual's cholesterol.

But he added: "The thing to remember is that the 20% threshold is arbitrary - it is essentially based on economic issues.

"Most nations have a finite pot and if you're going to treat everyone with a 10% risk, that's billions of pounds extra and somewhere along the line someone else is going to miss out."

Dr Alan McDougall, from AstraZeneca, said there was "no question" the trial would raise some important issues about statin use but that they would recommend doctors still follow existing guidance.

The killer quango NICE is due to consult on plans to review their statin guidance shortly.

From:
http://news.bbc.co.uk/1/hi/health/7715707.stm

The last nail in the NHS coffin

noreply@blogger.com (Drs Search) — Mon, 10 Nov 2008 08:53:00 +0000

Top up co-payments are the last nail in the coffin for the NHS as it opens the door to private providers.

On the face of it and from a moral perspective, a decision to allow “top-up” payments for cancer drugs seems the correct course of action to take to curb postcode lotteries for funding cancer drugs. However, this must be seen in the wider context of the future of the NHS and the fundamental principles of “universality” of care.

“Top-up” payments will open the door to the insurance industry and private providers to deliver these treatments. This will become the norm for many new treatments, not only cancer drugs, and will lead to a system of “managed care” much like that in the US where it is the insurers and not doctors who decide who gets treated, where they get treated, how they get treated, who gives the treatment and how much it costs.

The universality of care provided by the NHS has already been eroded (eg, loss of the majority of NHS dentistry and eyecare) and this is the last nail in the coffin. The real tragedy lies in the fact that we should not even be having this debate.

The total NHS drug spend on cancer drugs in England is approximately £1 billlion per year, but, in the British Medical Journal last week, the chief economist of the King’s Fund, Professor John Appleby, stated that the NHS in England is projecting an underspend of £1.7 billion and foundation trusts are reporting cash balances of £2.5 billion.

Furthermore, it is painfully ironic that the huge cost of introducing a market based system to the NHS has actually helped to spark a debate that will lead to further privatisation and fragmentation.

From:
http://www.timesonline.co.uk/tol/comment/letters/article5091892.ece

Health Direct notes that one of the factors behind the current controversy about “top-up” drugs is the absence of any explicit recognition that vital moral issues are involved.

If an old person is trapped under a collapsed building late at night, people do not say: “She has not got long to live anyway, let’s leave it till the morning; it will cost a bomb if we get the cranes and crews out at this time of night.” They are more likely to say: “She is pretty frail; we had better pull out all the stops, and get cracking as soon as possible.”

The weakness of the NICE approach is to assume that life and death decisions about whether the NHS should buy new drugs can be based solely on an economic model. Common humanity comes into it too: even if it may involve paying higher taxes.

Labour U turn on NICE's cancer drugs postcode lottery killing policy

noreply@blogger.com (Drs Search) — Fri, 07 Nov 2008 09:07:00 +0000

The rule preventing NHS patients from "topping up" their treatment is cruel and vindictive. Under just axed guidelines, anyone paying for drugs with their own money may be deprived of any further free health care.

This is a crude form of blackmail by the state provider that may have been understandable 60 years ago when the NHS was finding its feet but has no place in a modern healthcare system. It is to the credit of Alan Johnson, the Health Secretary, that he has finally acted to remove this barrier to patient choice.

Allowing a co-payment system to develop in healthcare is, however, more than just a humane decision that will allow seriously ill people to purchase life-saving drugs that may be too expensive for the NHS to prescribe. It is also a fundamental step towards diversifying healthcare in a way that will allow a better-funded and more patient-friendly system.

Health insurance companies will now start marketing policies for top-up payments only, as a supplement - not an alternative - to NHS provision, an attractive option to people who cannot afford full private health insurance.

That will help remove the barrier between state and private provision that has proved so restrictive, while opening up new revenue streams. A hybrid, public/private system could then emerge, without sacrificing the cardinal NHS principle that treatment remains free at the point of delivery to all who need it.

From:
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/11/05/dl0502.xml

Health Direct points out that there is now a three tier NHS service. The top level is private health insurance for NHS services. The middle tier is part payment for drugs and services. With the base rate being access for patients only if whitehall edicts allow doctors to prescribe certain life saving drugs.

Top-up insurance is still essentially a means test - and works contrary to the concept of universal access on equal terms to the NHS at all points of contact.

There is no reward here for those who already self-provide, nor any consideration of what those seeking to claim contribute to our taxes, or to the costs of the NHS.

This is a bit like thanking the person, who has decided to refrain from beating you over the head with a baseball bat.

The magic formula, top up insurance- is routine in France. The plan does not call for genius; rather, its absence calls for rebuke.

I have just one question about this, Alan Johnson is claiming credit for changing this particular rule, but which minister was it who allowed the rule to be set in the first place- Health Direct suspects the bean counter Patricia Hewitt?

Treasury could snatch £3bn from NHS budget, academic warns

noreply@blogger.com (Drs Search) — Thu, 06 Nov 2008 08:58:00 +0000

The Treasury could try to claw back more than £3bn out of the NHS to contribute towards the credit crisis bail-out package, a leading health service academic has warned.

The NHS in England is currently forecasting it will have a £1.7bn surplus this year and Foundation Trusts, which are not under the direct control of Whitehall, have £2.5bn in the bank.

Prof John Appleby, chief economist at think tank, the King's Fund, has analysed the effect the financial crisis will have on the health service in the short, medium and long term, in the British Medical Journal.

He warns that the Treasury has a 'track record' of clawing back surplus funds from the NHS.

He wrote: "Although the prime minister pledged not to cut spending for health as set out in the 2007 comprehensive spending review, taking back unspent money may not be seen as a cut."

Prof Appleby said in the short-term the effects on the health service have been minimal, although Virgin Healthcare announced in September that it would not be bidding to run GP-led health centres yet, and several charities and NHS trusts have money on deposit with failed banks in Iceland.

In the medium term, spending on health is supposedly fixed until 2011 so while an outright cut in labour Government funding is unlikely, the NHS budget is being eroded by high inflation.

It is thought that inflation may have peaked but inflation in the NHS runs a little higher than the general economy and every one per cent increase costs the NHS £380m, Prof Appleby wrote.

The real danger for the NHS is in the long term because, with labour Government borrowing rising, and income from taxes likely to fall during a recession, there will be less available to keep up the growth in health funding.

Prof Appleby warned that there may be no real growth in funding until 2014, in contrast to the large real terms increases enjoyed under Labour so far.

The financial situation is also likely to increase demand for health services, so the NHS will be squeezed from both sides, he said.

Prof Appleby wrote: "But not only will there be pressures on NHS funding, the combined effect of the credit crunch and recession on the population's health and wellbeing will increase ill health and demand on healthcare services.

"The link between deprivation, income, housing, unemployment, and healthcare needs is well documented."

A Department of Health spokesman said: "While the current financial position is settled for this spending review period, good financial planning means that the NHS needs to plan on a longer-term basis and this means looking to at least a five-year timeframe.

From:
Treasury-could-snatch-3bn-from-NHS-budget-academic-warns.html

Nine out of ten preventable deaths in the NHS are not reported

noreply@blogger.com (Drs Search) — Wed, 05 Nov 2008 09:04:00 +0000

Of the estimated 72,000 annual deaths in the NHS, just 3,200 are recorded by the National Patient Safety Agency, MPs were told.

The Commons Health Select Committee heard evidence from experts in its first evidence session on its investigation into patient safety.

The NPSA runs a system where all NHS staff can report incidents or near misses so patterns can be spotted and the wider health community warned.

Incidents can include drugs administered in the wrong way or the wrong dose, medicines mixed up, the wrong operation carried out, a patient wrongly identified and broken or malfunctioning equipment.

Howard Stoate, a practising GP and Labour MP for Dartford, said the National Patient Safety Agency's own estimates suggest there are 72,000 preventable deaths in the NHS each year.

However, the incident recording database had collected just 3,200 reports of patient deaths, in 2007/8. He said: "That is not just under-reporting, that is an extraordinary figure.

"If the public realised that only between five and ten per cent of preventable deaths are being reported they would have something to say about that.

"For example if only ten per cent of airline crashes were reported we'd have some concerns about that."

NPSA chief executive Martin Fletcher replied that while there were 'issues' around under reporting, reporting rates were continually improving.

Sir Bruce Keogh, medical director of the NHS, said no-one was 'comfortable' with under reporting but he said people could not be 'forced' to report incidents.

He said it was the staff member's personal, moral and professional duty to report incidents.

In 2004 the NPSA produced a report that said one in ten patients admitted to hospitals will suffer a patient safety incident - almost one million people in 2002/3 - and up to half of these could have been prevented. It added that 72,000 of these incidents may have contributed to the death of the patient.

Dr Richard Taylor, Independent MP for Wyre Forest, said the Committee was 'absolutely appalled' that one in ten patients will suffer an incident and said this was the reason they were conducting an investigation. It was 'utterly unacceptable', he said, and asked about the financial cost to the NHS of patient safety incidents.

Sir Bruce said that litigation costs were around £600m a year while Christine Beasley, chief nursing officer, said hospital associated infections such as MRSA cost the health service around £1bn a year because of the extra days infected patients have to stay in hospital.

Mr Taylor added that there were 25,000 deaths annually from blood clots after stays in hospital which can be prevented with drugs and this cost the health service around £640m.

He said: "The costs are astronomical and here we are trying to find enough money for Nice (the National Institute for Curbing Expenditure) to afford certain treatments."

Evidence submitted by the Department of Health to the Committee showed there were 796,106 incidents reported to the NPSA in 2007/8 and the majority resulted in no harm to patients. However there were 48,951 incidents where the patient suffered moderate harm, 7,101 severe harm and 3,282 deaths.

The Government's chief medical officer Sir Liam Donaldson has called for the NHS to learn from industries such as aviation where safety and reporting incidents or near-misses is embedded in the culture.

A list of 'never-events' is being drawn up by experts including operating on the wrong patient, or carrying out the wrong operation, which hospital trusts will not be paid for.

From:
Nine-out-of-ten-preventable-deaths-in-the-NHS-are-not-reported.html

Ailing NHS IT white elephant project takes turn for worse

noreply@blogger.com (Drs Search) — Tue, 04 Nov 2008 09:32:00 +0000

At the turn of the year, it looked as though the troubled NHS programme to create an electronic patient record might finally be turning a corner.

Firm delivery dates for the long delayed first deployments of Lorenzo, the key software for the records, were being promised for the north of England.

BT, which was responsible for London, had successfully installed new systems in a string of mental health and community trusts, and it had a programme for their much more difficult installation in the big hospitals in the capital. While there would be problems ahead, BT said, “we feel we have cracked the nut”.

Fujitsu was still negotiating a “refresh” of its contract, covering the whole of the south of England.

And a few parts of the programme were complete – the installation of digital imaging in place of X-ray film in every hospital in England, for example. Others were making progress.

The National Audit Office reported in May that the £12.7bn project for the full electronic record was running at least four years late. But it remained broadly on budget and, while difficult, still appeared “feasible”, the NAO said.

Since then, however, the project has virtually ground to a halt. There are continuing difficulties with new systems installed in the big hospitals and no deployments planned for the next few months.

Furthermore, while the health department has agreed in principle that NHS hospitals should be given more freedom to customise their systems, there are few details of the extent to which that will be permitted. A new permanent leader for the programme has only just been installed, following the departure of Richard Granger in January.

Matthew Swindells, who until May was the department’s interim chief information officer, says there is “clearly a hiatus”. But it is unclear, he said “whether that is because there is a genuine problem, or because of the shift in leadership means there is nobody pushing it at the moment”.

For long-standing critics of the programme such as Richard Bacon, the South Norfolk MP who has tracked its progress as a member of the Commons Public Accounts Committee, it is clearly now “time to go back to the drawing board”.

The programme’s centralised approach “has been a catastrophe”, he says. But because suppliers are only paid when systems work, “there is still a relatively big pot of money that has not been spent”.

This should be given to local hospitals to enable them to buy the system of their choice, Mr Bacon said. “If there is to be a chance of getting this back on track there has to be 100 per cent local ownership of the programme,” he said.

Jon Hoeksma, editor of E-Health Insider, a website that has tracked the programme from its inception, said: “Something has to give. The programme can’t just keep saying: ‘Give us another three months, give us another three months’.”

http://www.ft.com/cms/s/0/39bb218e-a46e-11dd-8104-000077b07658.html

Health Direct- 4 years and 1000 posts on NHS news, advice and information

noreply@blogger.com (Drs Search) — Mon, 03 Nov 2008 09:24:00 +0000

Health Direct has now posted over 1,000 news, advice and information stories about the NHS during the past four years.

During this period of labour's mismanagement of the National Health Service- Health Direct has found billions of taxpayers Pounds wasted, tens of thousands of preventable deaths and thousands of NHS staff sacked because of underfunding.

MRSA and Clostridium difficile superbugs are still killing more people than die from UK road accidents.

PFI and other off balance sheet financing that runs onto billions of Pounds- with restrictive clauses which even prevent local politicians from cutting hospital car parking charges.

The wheels are coming off the world's most expensive health IT system. Which is so blinkered and rigid that the new polyclinics will not be able to use it- if it ever works properly. Even Google have overtaken the NHS in providing an online health records system- though how secure their system will prove to be is as open to question as labour's pathetic data privacy track record.

And we have the prospect of nearly another three years of labour's dithering, stalinist, incompetent direction.

NHS data breaches hit 75 in a year

noreply@blogger.com (Drs Search) — Fri, 31 Oct 2008 09:15:00 +0000

Seventy five breaches of data security rules by the health service have been reported to the information commissioner's office in the past year, new figures reveal.

The NHS and healthcare sector is second only to the whole of the private sector at losing computers, records and data.

The 75 breaches included 27 lost computers and laptops, 14 losses of paper records and 18 of removable media such as memory sticks.

Data was "inappropriately disclosed" on five occasions, there were two postal errors, one email error and one website security breach.

Eighty breaches in the private sector have been reported since November last year, 28 in central government, 26 in local government and 47 in other public sector bodies.

Information Commissioner Richard Thomas said reports had "soared" since the high profile loss of 25m child benefit records in autumn last year.

He said responsibility for data breaches should lay with chief executives, who should ensure appropriate policies and procedures are in place, that privacy is incorporated into their technology and that staff are properly trained.

"It is alarming that despite high profile data losses, the threat of enforcement action, a plethora of reports on data handling and clear ICO guidance, the flow of data breaches and sloppy information handling continues," said Mr Thomas.

From:
http://www.hsj.co.uk/nhs_records_75_data_breaches_in_a_year

NHS records NPfIT project grinds to halt

noreply@blogger.com (Drs Search) — Thu, 30 Oct 2008 08:35:00 +0000

Progress on the £12bn computer programme (NPfIT) designed to give doctors instant access to patients’ records across the country has virtually ground to a halt, raising questions about whether the world’s biggest civil information technology project will ever be finished.

Connecting for Health, the ambitious plan to give every patient a comprehensive electronic record, has faced a series of problems over its size and complexity since it was first launched in 2002.

In May this year, the National Audit Office said the project was running at least four years late but still appeared “feasible”.

Since then, however, just one of the scores of acute care hospitals due to install the underlying administration system required in order for the patient record to work has done so. The hospital, Royal Free NHS Trust in London, continues to have difficulties getting it to operate properly.

In addition, the contractor originally hired to build the patient record system for the whole of the south of England, Fujitsu, has been fired. And BT, one of the two key remaining contractors, has been unable to agree a price for taking over the work Fujitsu had begun.

Health ministers originally promised the long-delayed first installation of patient record software in the north of England would finally take place in June at Morecambe Bay on the Lancashire/Cumbria border.

But four months on, the system has still not gone live and neither Morecambe Bay nor Connecting for Health can give a date when it might.

CfH’s most recent published plans for the next three months do not include a single installation of a patient administration system into any acute hospital trust.

And while NHS Trusts in the south – Fujitsu’s former area – are being given a choice of working with BT, the supplier for London, or CSC, the supplier for the north, none has yet signed up with either.

Jon Hoeksma, editor of the e-health insider website which has tracked the CfH programme from its start, said other parts of the £12bn project are continuing to make progress.

“But this key part seems to be simply stuck. It has ground to a halt. And that is not just affecting deployments that should be happening now. It will have a knock-on effect on those that are meant to be going live two or three years down the line.”

Hospital chief executives, he said, did not want to take a new system “until they have seen it put in pretty flawlessly elsewhere”.

Frances Blunden, the IT policy specialist at the NHS Confederation, the body that represents NHS Trusts, said: “It is a little bit too early to pronounce the programme dead.”

She said there were “undeniable” problems, but “to say everyone is walking away from it is a bit premature, probably”.

She said the health department had promised earlier this year to address hospital complaints that the system was too standardised and could not be adjusted to take account of local needs. “But we haven’t seen the implementation document to put flesh on the bones of that.”

A spokesman for Connecting for Health acknowledged that BT, which covers London, was “taking stock” given the difficulties encountered. The spokesman said it was more important to get the quality of installations right rather than promise delivery on a particular date. Talks with suppliers were under way to ensure “a smooth transition” in the south, after Fujitsu’s departure.

From:
http://www.ft.com/cms/s/0/b54a2e1c-a46e-11dd-8104-000077b07658.html?nclick_check=1

Doctors do not back cervical vaccine choice made by labour ministers

noreply@blogger.com (Drs Search) — Wed, 29 Oct 2008 09:59:00 +0000

The wrong vaccine against cervical cancer has been chosen by the labour Government and doctors would give their own daughters the alternative jab, a prominent doctor has warned.

GP and broadcaster Dr Phil Hammond, said he and most doctors he has spoken to have opted for Gardasil, rather than Cervarix, for their own children as it also protects against 90 per cent of cases of genital warts as well as cervical cancer.

Writing online in the British Medical Journal, he said the issue has been overlooked because genital warts 'never made it to the front cover' of newspapers, but if it were breast cancer instead there would 'marches on Downing Street' to campaign for the choice of vaccine to be made available on the NHS.

There are two different cervical cancer vaccines on the market, Cervarix and Gardasil, which protect against the human papillomavirus which causes the disease.

The Government has chosen to offer Cervarix as part of a national vaccination programme for all girls aged 11 and 12 with a catch up campaign for older girls.

There are over 100 strains of HPV and Cervarix protects against the two which account for most cases of cancer whereas Gardasil works against an additional two strains so protects against other sexually transmitted conditions as well.

Gardasil remains available but only privately even though most other European countries have chosen it for their own national programmes.

Dr Hammond wrote that with 100,000 new cases of genital warts in England each year and condoms only reducing transmission by up to 50 per cent, the far safer option is to vaccinate with Gardasil.

But, although Gardasil is available privately to parents, at a cost of £350 to £400, most will not be able to afford it, he added.

The vaccine choice could be a false economy because of the estimated cost of treating genital warts is £23m a year and vaccinating with Gardasil would have begun to pay off within three to four years, he said.

According to Hammond, who is a vice-president of the Patients Association, with the current cost of treating genital warts estimated to be £23 million, the government's decision may be a false economy. Within three or four years the use of Gardasil would have begun to have a considerable financial payback.

The NHS offers no information about Gardasil, raising serious questions over patient choice.

The Government's vaccine advisors said that if both vaccines were offered to the NHS at the same price then it would recommend using Gardasil because of the extra protection and because Cervarix, made by Sanofi Pasteur, has been chosen it seems the decision has been made on the basis of cost.

Both vaccines are listed as costing £80.50 in the book of licensed medicines but the details of the discount offered by GlaxoSmithKline to the NHS in order to get the contract, remains 'commerically confidential'.

From:
Doctors-do-not-back-cervical-vaccine-choice-made-by-ministers.html

Nanny state children aged five to get sex education

noreply@blogger.com (Drs Search) — Wed, 29 Oct 2008 09:11:00 +0000

Children as young as five will be given sex education under labour's nanny state plans to cut teenage pregnancy and sexually transmitted diseases.

Pupils will get basic classes in identifying body parts in the first few years of primary school.

In later years, they will be required to have more structured lessons about reproduction and relationships, a major review will recommend.

At secondary level, schools should improve the way issues such as civil partnerships and the importance of marriage are covered.

Teachers will also be given training in delivering lessons amid fears too many are embarrassed to discuss sex in the classroom.

The labour Government has already admitted that sex and relationship education across England is too "patchy".

However, the move will be opposed by family campaigners who accuse ministers of subjecting pupils to controversial issues before they are ready.

To allay concerns, ministers are expected to announce a consultation ahead of the implementation of the lessons on whether or not to give parents an opportunity to withdraw their children.

In a further move, ministers will also announce a radical shake-up of the way children are taught about the dangers of drugs and alcohol.

Jim Knight, the Schools Minister, who has led the review, insisted exposure to sex education before puberty reduced teenage pregnancy rates.

"It is important that we as a society allow better sex and relationship education in both primary and secondary schools without sexualising young people too early," he said. "It is right to share the responsibility between home and school."

At present, all primary and secondary pupils have to learn about the biology of reproduction in science.

In primary schools, pupils should learn about how animals and humans reproduce, but can limit lessons to the biology curriculum.

Schools can also cover the subject in personal, social and health education, although it is not a compulsory part of the National Curriculum.

In secondary schools, teachers must go further, covering issues such as relationships and sexually transmitted diseases. Lessons on civil partnerships and marriage are also offered at secondary level as part of PSHE but they are non-statutory.

Mr Knight said he had received "many strong representations" for making PSHE statutory at all ages to address the problem of poor lessons.

Speaking in the Commons, he said: "The international evidence suggests that teaching aspects of sex and relationship education before puberty has a positive effect on such things as teenage pregnancy rates. Clearly, that has to be done with a high degree of sensitivity and... the involvement of parents, with children reaching puberty at different ages. We must ensure not only that, as a society, we are comfortable with the level of detail and of education that people receive during sex education, but that we are strong on relationship education."

Leading charities including the Sex Education Forum and Brook, the sexual health advice service, which have taken part in the Government review, have already called for lessons to be compulsory in all schools.

It follows the publication of labour Government figures earlier this year showing that the number of abortions in girls under 16 last year rose 10 per cent to 4,376.

Norman Wells, director of the Family Education Trust, said making sex education mandatory would "seriously undermine parents".

New-style lessons on drugs and alcohol lessons will also be overhauled.

Primary school pupils will be given warnings on avoiding medicines and prescription drugs left in the home - as well recognising the difference between soft drinks and alcohol.

Stephen Burgess, national director of Life Education Centres, the health charity, said: "If we want to make a real and lasting difference to teenage drug and alcohol misuse, we must reach them early – at primary school. Then, as they reach adolescence and are most at risk from peer influence, they can make informed decisions based on fact rather than hearsay."

*Health officials were forced to apologise after sending letters to children as young as nine, demanding they are tested for sexually transmitted diseases.

Primary school children were also offered the chance to win an iPod if they attended a clinic for testing. A primary care trust in Harrow blamed an administrative error.

Geraldine Smith, the Labour MP for Morecambe and Lunesdale, told the Telegraph: "To start sex education at primary school is to rob young children of their innocence. I know children seem to grow up faster these days but to start formally teaching them about sex education would be quite wrong and would encourage under-age sex. Being exposed to this sort of thing at such an age would put an awful lot of pressure on very young children."

From:
Children-aged-five-to-get-sex-education.html

Health Dept prescription medicines pricing shake up descends into chaos

noreply@blogger.com (Drs Search) — Mon, 27 Oct 2008 08:44:00 +0000

Plans to introduce a new system for setting the price of prescription medicines have been thrown into chaos by the Department of Health, potentially costing the health service tens of millions of Pounds.

A joint memo circulated this week by the department and the Association of the British Pharmaceutical Industry, the trade body, warns that there will now be a delay of at least three months in implementing one part of the arrangement negotiated with industry over the summer.

In spite of having had months to prepare for the new arrangement, which had been due to come into force by the start of next year, the Department of Health has also failed to develop a system to monitor drug prices systematically, which is essential for implementing another part of the new deal.

The moves are fresh blows to relations between the pharmaceutical sector and the government, which sparked industry ire last year when it unilaterally decided to scrap the present Pharmaceutical Pricing Regulation Scheme, which determines how drug prices are set.

One pharmaceutical industry official said the issue was causing a "furore" in the sector and said it would take at least several weeks to clarify the full implications and how to respond.

The memo circulated last week says that industry will not now be expected to cut the price of off-patent branded medicines from January 1, as had been previously agreed, since the department decided it needed to hold a public consultation on the issue.

In the short term, the uncertainty means that the NHS will be sacrificing an estimated £80m in annual savings from price cuts in these so-called branded generics or "loss of exclusivity" medicines.

But the delay also creates uncertainty over how to implement the entire PPRS deal, which gives companies flexibility over how much they charge the NHS for individual medicines, provided there is an overall price cut of 5 per cent in the £8bn annual total.

Under the agreement reached with the pharmaceutical industry this summer, 3.9 per cent of the annual savings were des-igned to come from price reductions on patented medicines, and a further 1.1 per cent from the off-patent brands.

The new deal was supposed to reduce the price of branded generic drugs to 1.5 times the government's reimbursement level set for generic medicines. Generic drug manufacturers fear they may lose out if this ratio is modified as a result of the latest department consultations.

A second aspect of the PPRS raises the possibility of fresh price cuts, on top of the 5 per cent scheduled for the start of this year, if drug prices rise too fast.

From:
http://www.ft.com/cms/s/0/de162cfc-a099-11dd-80a0-000077b07658.html?nclick_check=1

Treasury U Turn to ensure taxpayer is no longer the loser in PFI deals

noreply@blogger.com (Drs Search) — Fri, 24 Oct 2008 07:47:00 +0000

The Treasury ordered public bodies doing private finance initiative (PFI) deals to require a much bigger share of any windfall gains from refinancing them in the future.

PFI deals are still being negotiated - not without difficulty - in spite of the credit crunch as some banks see their government-backed revenues as a haven in the financial turmoil.

However, the credit squeeze has seen funders demanding higher margins on the debt put into them and that has opened up the possibility again of significant refinancing gains if investment and interest rates fall to pre-credit crunch levels.

In a move to avoid the acute embarrassment of the early days of PFI, when investors in projects made millions of pounds from refinancings and it turned out that the taxpayer had no right to any share in the gains, the Treasury has upped the share it is demanding.

Investors in one of the early hospital projects, for example, made a 60% windfall gain and hugely increased rates of return when they used falling interest rates to refinance. As a result, since 2001 contracts have required that any such gains should be split equally between the project's backers and the taxpayer.

That will still apply to the first £1m of any gain. But for new deals the Treasury said yesterday that the next £2m would have to be shared 60/40 in the taxpayers' favour and for anything above that the taxpayer would take 70 per cent.

As an additional protection, new contracts will give the public sector the right to demand a refinancing if it believes that will lead to better terms for the taxpayer, whereas previously only the contractors have been able to initiate such a deal.

In spite of the onset of the credit crunch last year, more than a dozen PFI deals have been signed this year, according to the Treasury, eight or nine of them in the second half of the year, despite the growing problems over bank lending.

Almost £600m of schemes by capital value have been agreed since the middle of the year, though most have been smaller deals in the £20m to £90m range.

Some European banks have withdrawn from the PFI market, and James Stewart, chief executive of PUK, the public-private partnership that advises the public sector on deals, said recently that sponsors had had to go to clubs of several banks to arrange financing - rather than doing a deal with one or two that then sold the debt on.

From:
http://www.ft.com/cms/s/0/ed45ca68-9be2-11dd-ae76-000077b07658.html?nclick_check=1

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

noreply@blogger.com (Drs Search) — Thu, 23 Oct 2008 07:51:00 +0000

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

Specialist maternity baby care overstretched

noreply@blogger.com (Drs Search) — Wed, 22 Oct 2008 07:42:00 +0000

Staffing shortages are stretching specialist baby care units to the limit, campaigners say.

Premature baby charity Bliss found just 20% of UK hospitals had enough staff to meet recommended care guidelines.

The study of 194 neonatal units showed that more than 50% had been forced to close to new admissions during a five-month period because of shortages.

The charity said it was shocking that such problems were persisting.

Each year, more than 80,000 babies - 10% of the total born - need specialist care in a neonatal unit - usually because they are underweight or premature.

Bliss surveyed all 213 British hospitals with neonatal units about care, from April to September 2007, and 91% of those asked responded.

They found that only 21% of the hospitals which responded had enough staffing to provide the recommended nurse to baby ratios.

These vary between one-on-care in intensive care wards to one nurse to every four babies on the least-intensive special care baby units.

To meet the recommended guidelines the charity said it believed an extra 1,700 neonatal nurses were needed in addition to the 6,500 already employed.

More doctors were also needed, it added. But it warned there had been a lack of progress made in neonatal care over the years.

This is the fourth report the charity has produced highlighting the issue. Over the last year fewer than 200 extra nurses have been recruited.

The charity also polled more than 300 parents who complained of being transferred between hospitals - sometimes over long distances - because of staffing shortages.

Bliss chief executive Andy Cole said: "Professionals are increasingly being stretched to the limit.

"Staffing shortages are all too apparent on units and the care of our most vulnerable babies is being compromised.

"No other critical care service would permit the capacity and staffing levels seen on special care baby units."

David Field, president of the British Association of Perinatal Medicine, agreed the staff shortages were worrying.

He added: "We would like neonatal care to be given the same kind of priority that other specialist services such as cancer care or A&E have received."

But a Department of Health spokesman said there was no evidence that services were "unsafe".

"We are committed to providing mothers and babies with safe, high quality neonatal services and have made neonatal services a top priority for the NHS.

"However, we recognise there is still more to do."

Meanwhile, a spokeswoman for the Scottish government said that a review of neonatal care was currently taking place.

She added: "The Scottish government is committed to providing the best possible care for premature babies."

From:
http://news.bbc.co.uk/1/hi/health/7669634.stm

NHS hospitals are warned on core standards

noreply@blogger.com (Drs Search) — Tue, 21 Oct 2008 07:44:00 +0000

Almost a third of National Health Service hospitals risk being refused a licence to operate because they are still not meeting core standards of safety, effectiveness cleanliness and record keeping, the Healthcare Commission, the NHS inspectorate warned.

The failure fully to cover the basics comes despite a big improvement in the health service's performance over the past three years, the commission said in its annual "state of the nation" report on the NHS.

From April 2010, NHS hospitals and organisations will go through a registration system that will issue them with a licence to operate.

But while two-thirds of NHS organisations and 70 per cent of acute hospitals meet all the core standards laid down by the Department of Health, and a further 25 per cent are judged to be almost there and therefore likely to meet the standard for registration, about 10 per cent of NHS organisations and hospitals are still some way from the target.

"If they don't meet these core standards," said Sir Ian Kennedy, chairman of the Healthcare Commission, "then the Care Quality Commission could withdraw registration or impose tough penalties such as fines or operating conditions.

"I would urge trusts to get their act together with all appropriate urgency."

Baroness Young, chairman of the Care Quality Commission, which next April replaces the Healthcare Commission as the inspectorate, has said she thinks it "very unlikely" that an entire NHS hospital will be refused a licence to operate.

"I doubt there will be many to whom we say: up with this we cannot put; we will not register you," she has said.

But hospital departments and services could find themselves operating under strict conditions and improvement plans, with the inspectorate holding tougher enforcement powers than the existing one. The warning that a small minority of NHS organisations have a long way to go to hit standards came as the inspectorate's annual check showed significant overall improvements in performance.

From:
http://www.ft.com/cms/s/0/b495c044-9b18-11dd-a653-000077b07658.html?nclick_check=1

NHS hospitals allowing top up cancer drugs payments

noreply@blogger.com (Drs Search) — Mon, 20 Oct 2008 08:23:00 +0000

Health Direct has learned that payments to top up NHS care - supposedly banned - are happening at 30 hospitals across the UK.

Professor Mike Richards, the cancer tsar for England, has been holding a review about so called co-payments and will report at the end of this month. The issue is also under review in Wales and Scotland.

But patients are already topping up their NHS care, as hospitals find ways around the current rules.

The current rules say you cannot mix and match between the NHS and private.

You are either all NHS and it is free or you're all private and you pay for everything.

But the details are interesting. The code of practice says a patient cannot be both an NHS patient and private in the same episode of care.

So in Birmingham they have found a way round the ban on top ups.

Separately another consultant at the same hospital writes a private prescription for the drugs that patients wants to keep them alive.

They are supplied at patients' homes by a private company called Healthcare at Home.

They pay the company direct. So the administration of the drugs is viewed as a separate episode of care.

Professor Nick James is the oncologist in Birmingham who designed this model of allowing patients to top up their care.

"Nowhere does it say that an episode of care is from diagnosis to death of your cancer" he said. "So we've just interpreted the rules in a way which is in favour of the patients."

Across the country

What is remarkable is that topping up, something the labour government says is banned, is not just happening in Birmingham.

The company which provides the drugs to Ian says they have contracts with 30 NHS hospitals across the country.

Mike Gordon, chief executive of Healthcare at Home, said: "Top ups are happening today and they'll happen tomorrow. So long as they're done through us not using the auspices of the NHS I see no reason why they shouldn't continue."

A Department of Health spokesperson said: "We know there is variation in how individual Trusts are applying the current guidance, and that is why the Secretary of State asked Professor Mike Richards, National Clinical Director for Cancer, to lead a review into this difficult issue.

"Professor Richards is looking at how a consistent approach across the country might be best achieved."

Shadow Health Secretary Andrew Lansley said: "David Cameron and I have pressed the Health Secretary, Alan Johnson, to enter into a risk sharing scheme for the kidney cancer drug Sutent in order that patients will be able to access this life saving treatment immediately, but nothing has been done."

Norman Lamb, for the Liberal Democrats, said: "We are in an outrageous situation where patients are left in a lottery, dependent on a few hospitals which are bending the rules.

"This case makes the need for reform all the more urgent."

All Ian Jenkins wants is to stay alive as long as possible.

But his story does raise the question, why the need for a high level review of top ups if they are already happening all over the country?

From:
http://news.bbc.co.uk/1/hi/health/7668121.stm