The Government is trying to reassure women fitted with PIP implants to prevent a rush for NHS surgery to remove faulty breast implants.

Almost £135,000 is being spent by the Department of Health on the campaign, which will also run in social media sites. Posters will appear in GPs’ surgeries and hospitals as well.

The advert reads: “The latest advice from the NHS and plastic surgery experts is that women with PiP breast implants do not need to have them removed unless they have symptoms such as pain and tenderness.

“There is no link to cancer and there is no clear evidence of an increased risk of harm compared to other brands of breast implants.”

However, it also states, in large-type at the top of the advert: “The NHS will support women with PiP breast implants.”

Clarifying the situation for those who received implants as part of private breast enlargement operations, it states: “”The NHS will remove your implants if your doctor agrees, but the NHS will not replace implants unless it is clinically necessary.”

It advises those worried about whether they have implants made by Poly Implant Prothese (PIP), which contain industrial-grade silicone, to find out if they have them, to speak to their specialist or GP, and “agree what’s best for you”.

Despite the campaign, Fazel Fatah, president of the British Association of Aesthetic Plastic Surgeons (BAAPS), said the organisation’s stance remained that all 40,000 women fitted with them in Britain should have them removed.

He said: “We remain steadfast in our recommendation to the public of precautionary removal of these defective devices. Although there is no immediate health risk, the gel within these implants is simply not meant to be inside the human body.”

A survey of its 230 members found 95 per cent agreed that “it should be the clinics and hospitals that should pay for the replacement surgery, rather than burden the taxpayer with these costs”.

Women given the PIP implants are due to protest in London on Saturday at the reluctance of private firms like Harley Medical Group, The Hospital Group and Transform Cosmetic Surgery to fund removal and replacement surgery.

Explaining the rationale for the campaign, Andrew Lansley, the Health Secretary, said: “The refusal of some clinics to help their patients has left some of those women worried and confused.

“That’s why we are running this ad campaign, to give women clear, definitive advice about what course of action they should take. I hope it helps women decide what is best for them. We have made it very clear to private companies what we expect of them – to provide their patients with the aftercare that they need and deserve.”

“I do not think it is fair to the taxpayer or other NHS patients for the NHS to foot the bill.  We will pursue private clinics with all means at our disposal to avoid this.”

Professor Sir Bruce Keogh, NHS medical director and leader of an expert group on PIP implants convened by Mr Lansley, said: “At present there is insufficient evidence to recommend routine removal of these implants.

“But I know women will be worried. That’s why the expert group supports the NHS offer and believes the private industry should do the same.”

From: http://www.telegraph.co.uk/Breast-implant-scandal-Government-campaign-to-reassure-women

The figures for last year represent an 11 per cent increase on the previous 12 months, when alcohol-related admissions stood at 1,056,962.

Separate information published by Anne Milton, the public health minister, showed that since January an estimated 7,074 under-18s have been admitted to hospital due to alcohol abuse.

A recent report predicted that binge drinking will cost the NHS £3.8 billion by 2015, with 1.5 million A&E admissions a year.

Andrew Lansley, the Health Secretary, blamed Labour’s 24-hour drinking policy and accused the last government of “taking their eye of the ball” on the issue of binge drinking.

He said: “These figures are disturbing evidence that, despite total consumption of alcohol not increasing recently, we have serious problems with both binge-drinking and long-term excessive alcohol abuse in a minority of people.

“Our alcohol strategy, which we will set out in the new year, will outline what further steps we are taking to tackle this growing problem.”

Recent Local Alcohol Profiles for England figures also show that the number of hospital admissions for conditions attributable to alcohol are rising at a similar rate.

The number of admissions has more than doubled since 2002/03 and increased by nine per cent last year.

In 2002/03 there were 926 admissions per 100,000 people for conditions caused by alcohol, rising to 1,743 per 100,000 in 2009/10 and 1,898 last year.

The biggest increase over the past 12 months was in London, with a jump in admissions of 14 per cent, followed by the East of England with 10 per cent.

More than 660,000 people were brought back to hospital last year within 28 days of leaving, statistics show, sparking allegations that patients are being “hurried through the system” so the NHS can meet waiting-list targets.

The official figures show that some NHS trusts have seen their emergency readmission rate rise more than threefold over the past decade – while some hospitals have seen only a modest increase.

Last night, Andrew Lansley, the Health Secretary, said that the “hugely distressing” trend must stop.

“Patients have a right to expect that when they go in for treatment that they are looked after properly and that the treatment they are given helps them to recover,” he said.

“Having to be readmitted and treated all over again is hugely distressing. These figures show how Labour’s obsession with waiting time targets meant that patients were treated like parts on a production line to be hurried through the system rather than like people who need to be properly cared for.”

The Department of Health has released detailed information on the number of emergency readmissions in every area across Britain.

The figures show that 620,054 patients had to be readmitted in 2009-10 – compared to just 348,996 a decade before, a 78 per cent increase. Over the past five years, there has been a 31 per cent rise and a five per cent increase on the previous 12 months.

The data also highlights the widespread regional variations. The rate of readmission in the Kensington & Chelsea PCT area has risen by 287 per cent over the past decade to 1,582 people.

However, North Lincolnshire PCT has only experienced a 3.37 per cent rise over the same period.

Hospitals within the Hampshire PCT area readmitted 13,239 people last year. The nearby area covered by the Isle of Wight PCT only had to readmit 1,098 people.

The figures, do not include patients suffering from cancer or mental health problems or maternity patients.

Most of the areas with the highest increases in readmission numbers are in London and the south east, where pressure is greatest on the NHS. The Department of Health has analysed the social make-up of each area and concludes that the so-called “thriving London periphery” – the relatively wealthy commuter hinterland around the capital has suffered the biggest recent deterioration.

About 10 million people are admitted to hospital wards each year. Critics claim that government targets, such as the demand that patients be admitted to hospital for treatment within 18 weeks of seeing their GP, mean hospital managers are pressured into releasing patients early to make beds available.

Earlier this month, The Daily Telegraph disclosed that the Government is moving from a system of targets for hospitals based on waiting and treatment times – to a system of so-called “outcomes” which measures the success of treatment.

In a criticism of previous targets which he blames for the increase in emergency readmissions, Mr Lansley said: “Instead of focusing on the results which actually matter for patients, they focused on narrow processes to the detriment of patient care. That is why we have taken action to address these increases in emergency readmissions.

“One of the new goals we are setting the NHS is reducing emergency readmissions. In order to help achieve this we have created a re-ablement fund of £300 million and we have taken action to stop hospitals being paid when they readmit a patient after discharging them too early. These steps will turn Labour’s poor performance around.”

Under the Government scheme, hospitals will effectively be responsible for people’s care in the weeks after they return home and will be financially penalised for discharging patients too soon.

From:  http://www.telegraph.co.uk/Scandal-of-NHS-production-line-as-readmissions-soar

Comprehensive data on hospital death rates, the individual performance of GPs and surgeons and patients’ experiences under their care are to be published in an attempt to improve standards.

Mr Lansley has set out 60 benchmarks that will replace Labour’s system of targets and will be used to define success in the NHS.

These include a commitment to preventing unnecessary early deaths, a pledge to enhance the quality of life for people with long-term conditions and a drive to ensure that people have a positive experience when using the health service.

If the new standards are achieved, 24,000 early deaths a year could be prevented from cancer and other long-term conditions, Mr Lansley believes.

In addition, fewer people with long-term conditions including asthma and diabetes will be treated in hospitals, he will claim, while patients undergoing routine hip and knee operations will no longer be left in pain or unable to walk.

Access to NHS dentists will also be improved, he will say.

The Cabinet minister said the record on unnecessary early deaths varied across specialties as he urged the health service to focus on “what really matters” – the results achieved for patients and their experiences while being treated.

“If you look at the question of how many patients in this country die who could live if they got the best health care, it is literally over 10,000 patients a year if we were simply to get to a place which is better than the average across the OECD (Organisation for Economic Co-operation and Development) countries.”

In an interview with The Daily Telegraph, Mr Lansley says his tenure as Health Secretary will have been a “failure” if the 60 new “outcome” targets do not improve by the next election. He pledges that the benchmarks will now “define what the NHS is setting out to achieve”.

“We have to clear the decks and be clear this is what we are focusing on,” he says. “People say in three and a half years’ time, in 2015, at the next election, how will we know whether you’ve succeeded or not? The answer is ‘have the outcomes improved?’

“It will be my failure if we haven’t improved them and the NHS should feel that it has not succeeded, that is what we are setting out to do.”

Next week, the Government will set out current performance for each of the 60 indicators. It will then set out national targets for improvement “by the time of the next election and beyond”.

The new NHS Commissioning Board and the Care Quality Commission will also intervene directly to address problems that are highlighted by the data.

In today’s interview, Mr Lansley says that the long-running row over NHS reform must end and the health service must concentrate on improving patient care.

“We’ve really got to get into the big picture, which is delivering improvements in the results we achieve for patients right across the board,” he said. “We know that we can do it.”

The benchmarks will be monitored partly through studying clinical data – for example, to ascertain whether mortality rates for cancer, liver and heart disease are improving — and partly through surveying patients to gauge whether they were satisfied by the standard of care they received and the speed of their recovery.

The Health Secretary says: “This is literally saying to patients ‘if you were in hospital, if you were being looked after by your general practitioner was the service and experience you had good or not?’ It’s not like some other kinds of medical model where you kind of treat people and they get better. This is different.

“This is really where you begin to kind of focus on the experience of care.”

For the first time, the views of bereaved relations and even children will be surveyed so that the quality of NHS care from early years until death can be assessed.

“We’ll be undertaking a consistent national survey of the bereaved relatives of people who received end of life care,” Mr Lansley said. “Asking them, after a suitable passage of time, what was their loved one’s experience of care and how well were they looked after towards the end of life.”

From: http://www.telegraph.co.uk/Andrew-Lansley-sixty-step-plan-to-help-NHS-focus-on-what-matters

Diagnostic tests and outpatient appointments will also be delayed, but hospitals insist emergency and critical care will not be affected.

Managers say they are preparing as they would for Christmas or bank holidays.

An estimated 400,000 nurses and healthcare assistants, as well as paramedics, physiotherapists, and support staff like cleaners and administrators have said they will join the action on 30 November over changes to public sector pensions.

However, the main medical unions – the Royal College of Nursing, the Royal College of Midwives and the British Medical Association are not taking part.

The Department of Health in England said it was expecting at least 5,500 non-emergency procedures like hip and knee operations to be rearranged.

More than 12,000 patients are likely to have diagnostic tests postponed, and 40,000 outpatient appointments are expected to be rescheduled.

On an average day, 28,000 patients have planned treatments or operations in England and there are 60,000 diagnostic tests.

However, managers say they are putting plans in place to make sure people can still get emergency or urgent care, in the way they do on bank holidays or at Christmas.
999 calls

Patients needing urgent treatment like chemotherapy and kidney dialysis will still be able to get it, and maternity units will remain open.

Calls to 999 will still be answered, but patients are being urged to think hard and only call if it is a genuine emergency.

The Health Secretary, Andrew Lansley, said health service workers should not take action that harms the interests of patients.

“I would ask staff to consider carefully whether going on strike is the right thing to do,” he said.

Survival rates for breast cancer, prostate cancer and cervical cancer were below the average for the 34 developed countries in the study.

Mr Lansley lays the blame for the poor performance on the previous government’s failure to make sure that extra investment in the NHS reached the front line. He claims patient care was ignored in favour of increased salaries and botched computer systems.

Writing in The Daily Telegraph, Mr Lansley says: “Unfortunately this report shows how much work there is to do to deal with Labour’s legacy of neglect and mismanagement of our NHS.

“They hugely increased spending on the Health Service, but wasted much of it on managers, failed IT projects and unsustainable PFI projects.

“They failed to focus on what really matters – patients – which is why we still have some of the worst cancer outcomes amongst comparable countries.”

Under Labour, spending on the NHS trebled, reaching almost £100 billion in 2009, but money for treating cancer still lags behind much of the rest of the world.

A report by the Policy Exchange think tank last year found that England spent around 5.6 per cent of its health care budget on cancer care, compared with 7.7 per cent in France, 9.6 per cent in Germany and 9.2 per cent in America.

In September it emerged that private finance initiatives, introduced by Labour to fund capital projects, have left 60 NHS hospitals on the “brink of financial collapse”. Meanwhile, the pay of NHS chief executives has risen, with typical earnings now more than £150,000.

The OECD figures reveal that the best breast cancer survival rates were in the US, where 89.3 per cent of women were alive five years after being diagnosed. The average across all OECD countries was 83.5 per cent, while in the UK it was 81.3 per cent.

Survival rates for cervical cancer were worse. Norway topped the table with 78.2 per cent still alive after five years, compared with 58 per cent of women in the UK. There were also more hospital admissions for asthma and other lung conditions than the average and infant mortality was higher.

The report also showed that consultations by doctors have fallen, and were below he OECD average in 2009.

Katherine Murphy, the chief executive of the Patients Association, said: “The NHS provides some excellent care but it does fall down on many counts. We know from patients phoning our helpline that the quality of care that they have experienced can be very poor and sometimes it is downright neglectful.

“Rather than trying to tackle the issue of poor care, the Department of Health is demanding that the NHS makes £20 billion of efficiency savings while spending a million pounds a day on a reform plan that doctors, nurses, patients and NHS managers all say risks irrevocably damaging the NHS.”

From:  http://www.telegraph.co.uk/Cancer-cash-wasted-on-NHS-salaries

But a pilot in four areas – Luton, County Durham and Darlington, Lincolnshire, and Nottingham – is highlighting worrying problems.

Official statistics show that in September, 12 per cent of calls went unanswered.

Across the four areas there were 33,707 calls to the service.

The Department of Health expects 12 million calls a year to the free 111 number in England, based on scaling up that figure.

Writing on the NHS’s own web page about the 111 number, one caller expressed frustration at being unable to get through despite waiting 35 minutes.

“All I wanted was a bit of advice. I now need to go to work and have had no help from anyone,” the caller wrote. “I had the sense to take pain killers myself, hope this new service gets better.”

A month ago Andrew Lansley, the Health Secretary, announced that 111 would be rolled out nationwide by April 2013, abolishing the concept of “out-of-hours” care. It is also meant to encompass NHS Direct.

The Department of Health claimed the September statistics showed an “encouraging picture”.

A spokesman said: “Lessons learned from the pilots will ensure that when the service is rolled out nationally it will provide people with a first class service.”

He added: “We know that unanswered calls are usually callers who get through to the NHS 111 message and hang up. This could be because they wanted to speak to their GP practice, but it was still in the ‘out of hours’ period and they were therefore transferred to NHS 111.

“This figure does not mean patients are receiving a poor service.”

A spokesman for NHS Direct echoed this, saying the vast majority of the 12 per cent of unanswered calls were of people who chose to hang up, after learning they were being put through to the 111 service when they wanted to speak directly to their GP.

From:  http://www.telegraph.co.uk/NHS-111-number-1-in-8-calls-unanswered

Scientists relish this fact. However, for those on the outside, this can be bewildering. We are told one thing one minute, only for it to be ridiculed the next. With its definitions and protocols, medicine serves to give the illusion of stability when, in truth, doctors are all too often unsure.

The furore around breast screening perfectly illustrates this. It began when the Government’s cancer “tsar”, Prof Sir Mike Richards, announced that he is setting up an independent review of the NHS programme.

He has also ordered that patient leaflets, which explain the screening programme, be rewritten to take into account claims by some experts that the benefits have been exaggerated.

Understandably, this has prompted widespread confusion. The issue of breast cancer is always emotive. When I worked in breast surgery, I saw first hand the horrors of this disease on sufferers and their families, and it is vital that we do everything we can to treat and prevent it. But the debate over screening has been raging for some time within the medical community. I remember attending a lecture on this issue when I was at medical school more than 10 years ago.

The NHS screening programme was introduced by the Thatcher government following the 1987 Forrest Report, which recommended a national screening programme for breast cancer for women aged between 50 and 74. The report was based on the most up-to-date research.

But, since then, by comparing countries that have a screening programme with those that don’t, evidence has emerged suggesting that the steady fall in mortality in Western countries is not due to the screening programme, but to improved treatment and service provision.

If this is shown to be true – and it’s still a big if – then this would mean we are needlessly screening thousands of women. And there is an argument that many of the tumours detected by screening would not actually have developed into a life-threatening cancer.

For every screening test, whatever the disease, there is a margin of error. How good a test is can boil down to two things. The first is sensitivity, which measures how good the test is at giving a positive result in those who have the disease. The second is specificity, which refers to how many of those tested are disease-free and test negative.

Now, if you act on the results every time a test records a positive – in the case of breast cancer by doing invasive surgery or giving radiotherapy or chemotherapy – the sensitivity and specificity has to be very high (as near to 100 per cent as possible) to warrant a national screening programme. If it’s not sensitive enough, you’ll be giving women false reassurance when, in fact, tumours are being missed. Similarly, if it’s not specific enough, you’ll be needlessly treating people, with all the associated risks that treatment brings. It is this that is concerning some experts.

They argue that women are being over-diagnosed and over-treated because screening is not specific enough. It can pick up breast abnormalities that may look worrying when biopsied but are actually harmless. It’s a balancing act between saving lives and not causing harm by needless treatment. While doctors are used to adapting to changes in evidence, this is little consolation to women who worry about the disease.

It is perfectly sensible to have an independent review of the research, but I can’t help but think of the women who have had treatment,or are facing treatment, or those who are deciding if they should go for screening. The fact that the current debate waging in the medical establishment is part of the reflexive process that underpins science is of little comfort to them.

Let’s deal firmly with those who fail in patient care

Health Secretary Andrew Lansley should be congratulated – and it’s not often I say that – for his announcement last week that widespread spot checks on hospitals and care homes will be introduced in a drive to improve standards.

The checks will be undertaken by the Care Quality Commission (CQC). It comes after the Government reviewed the findings of the first wave of unannounced visits to care of the elderly wards in the summer. Over half the hospitals inspected had problems, particularly in relation to issues around patient dignity.

Spot checks are the way to tackle this and weed out bad practice and serious failings. But, they will only have any meaning if the CQC – often felt by those campaigning for improved standards as toothless – act on what they find. We don’t need endless reports and bureaucratic stalling. If it will work, the CQC will have to use its muscle. Those in charge of wards and hospitals found to be failing must be held accountable and dealt with firmly.

From: http://www.telegraph.co.uk/the-ifs-and-buts-of-breast-screening

Meanwhile in other parts of the country married couples are being denied help in starting a family, forcing them to spend thousands of pounds on private treatment.

It comes after a Labour nanny state law removed the requirement for fertility doctors to consider a child’s need to have a male role model before going ahead with IVF.

Critics say the Government, which David Cameron promised would be “the most family friendly we’ve ever had in this country”, should tackle the postcode lottery of IVF provision and ensure that the needs of children are put first.

Frank Field, the Labour MP who carried out a high-profile review into poverty and life chances last year, said: “It’s clearly wrong that while couples in stable relationships can’t get IVF and in other areas, single women can.

“It’s really important that Government ministers speak up for children who are the ones left out of this. It needs someone in a position of authority to reflect what most taxpayers think.”

The Rt Rev Michael Nazir-Ali, the former Bishop of Rochester who once chaired the ethics committee of Britain’s fertility watchdog, said: “The irony is that at the very time research is showing the need for both parents, we are writing fathers out of the legislation.

“It’s one thing for a mother to find herself a single parent because of tragic circumstances. It’s quite another to plan for a situation where the child comes into the world without having a father or any possibility of having a father.”

Most local health authorities stipulate that couples must have been in a relationship for two or three years to qualify for IVF treatment.

That requirement is based on guidance issued in 2004 by the National Institute for Curbing Expenditure (Nice), the NHS rationing body,.

It states: “Couples in which the woman is aged 23–39 years at the time of treatment and who have an identified cause for their fertility problems … or who have infertility of at least three years’ duration, should be offered up to three stimulated cycles of in vitro fertilisation treatment.”

The document does note that the guidelines do not address social criteria “for example, whether it is single women or same-sex couples who are seeking treatment”.

However the Human Fertilisation and Embryology Act 2008 removed the reference to “the need for a father” when considering the welfare of the child when considering fertility treatment, replacing it with “the need for supportive parenting”.

Gareth Johnson MP, who chairs the All Party Parliamentary Group on Infertility, said that trusts offering the service to single women were going against one of the guiding principles of IVF, “that you are treating an infertile couple, not an infertile individual”.

Mr Johnson, the Conservative MP for Dartford, said: “Speaking in a personal capacity, if you are going for IVF, you are trying to create a baby, so there should be some evidence of a stable background, which you would expect to be a couple.”

Earlier this year he led an APPG report that found startling differences between what health authorities offered in terms of IVF.

It found three-quarters of Primary Care Trusts were failing to offer three cycles of IVF, as stipulated by Nice. Each cycle comprises a woman’s ovaries being stimulated to produce eggs, which are then fertilised in vitro and implanted in the womb. Spare eggs should be frozen for use if the first attempt fails.

The report found five trusts offered no IVF at all – Warrington, West Sussex, Stockport, North Staffordshire and North Yorkshire and York. Since then, NHS West Sussex has decided to start funding IVF again.

Many trusts have also started putting in place further barriers to IVF funding – for example demanding obese women lose weight – in part to limit demand as health budgets tighten.

Against a background of increasingly scarce provision, as the NHS tries to save £20billion by 2015, Mr Johnson said the decision to offer IVF to single women was misplaced.

From: http://www.telegraph.co.uk/Single-women-being-offered-IVF-on-the-NHS

Consequently some luxury manufacturers have begun road testing the next generation of larger sized vehicles.

In plans dubbed “plump my ride” – in a play of words from the television show Pimp My Ride – BMW has recruited 800 volunteers, ranging from the slim to the obese, for a study to gauge how obesity affects mobility while driving.

The unnamed volunteers were put through a series of tests designed in part to examine factors such as getting in and out of cars or looking over their shoulder while reversing.

“People are getting more obese and we want to find out how that limits their range of motion and how our vehicles can adapt to the changing needs of our customers,” Ralf Kaiser, a member of BMW’s ergonomics team, told the Sunday Times.

“We know that a lot of overweight and obese people have problems in daily life, and in the car this starts with getting in and getting out.  In general, these aren’t sporty people. We already have things like the parking distance control, which shows obstacles on a screen when you are reversing.”

He added: “For someone who can find it difficult to turn 140 degrees to look behind them, they can now just look at the screen.  The study will mean we can look at things more scientifically and build a car that at least 95 per cent of people can use.”

Mercedes has unveiled plans to strengthen grab handles above its doors, in part to help heavier passengers support themselves.

Porsche, meanwhile, is installing “electrically-powered steering columns” on top-of-the-range models that rise when the engine is switched off.

Over the past decade, Honda has widened its seats by up to 2 inches to accommodate larger bottoms while its new range of vehicles will also have buttons that will allow for so called “sausage fingers”.

Other manufacturers are installing reversing aids and blind spot detectors as standard.

According to the latest figures a Ford Prefect was 4ft 9in wide with an 18 inch long seat cushion in 1953. This compared to a 2011 Ford Focus that was 6ft 1in wide with a 23 inch long seat cushion.

Government statistics show that more than 60 per cent of adults in England and a third of 10 and 11-year-olds are obese.

In August The Lancet medical journal said that by 2030 more than 11m would classed as obese, with a body mass index (BMI) above 30, compared with a healthy BMI score of between 18.5 and 25.

Obesity and chronic health conditions such as high blood pressure and diabetes cost Britain £20 billion a year in terms of lost productivity, it was claimed last month.

It was recently disclosed that over the past five years Yorkshire Ambulance Service spent nearly £10 million on specialist vehicles to transport obese patients.

Speaking earlier this month at a launch that unveiled plans to cut obesity levels by 2020, Andrew Lansley, the Health Secretary, said Britain had to become a nation of calorie counters to counter the obesity crisis.

After lengthy consultation, those have now been raised slightly – by a frugal 55 calories for men, but a comparatively generous 139 calories for women.

Which means 2,605 calories a day for men and 2,079 calories a day for women.

Prof Alan Jackman, chair of the Scientific Advisory Committee on Nutrition (SACN), explained that the old figures were based on “limited available evidence”.

They have been updated to take into account advances in science and better understanding of the physical activity people took.

Sadly, that is where the good news ends.

Speaking at a briefing to launch the Government’s new “ambition” to see obesity levels falling by 2020, Prof Jackman; Andrew Lansley, the Health Secretary; and Prof Dame Sally Davies, the Chief Medical Officer for England, emphasised that this was “not a licence to eat more”.

Prof Jackman said “the majority of adults” already ate much more than the new guideline amounts.

“We estimate that on average the population is eating 10 per cent more than they require,” he said.

Thus, as little over a third of the adult population is now not overweight or obese, only that minority is really entitled to an extra guilt-free indulgence.

Mr Lansley decided to unveil the Government’s new anti-obesity ambition the same day, leading to accusations of mixed messages.

The Health Secretary said Britain had to become a nation of calorie counters.

“People should have a pretty good sense of how many calories they are consuming,” he said.

Department of Health policy officers have calculated that England needs to consume five billion fewer calories daily, to ensure average weights fall to healthy levels.

That equates to enough cheeseburgers to cover 20 football pitches, or enough cafe lattes to fill four Olympic swimming pools, said a spokesman.

But Prof Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said it amounted to “peanuts”.

He added: “Sixteen dry roasted peanuts per person, per day to be precise.”

Like others, he attacked the Health Secretary’s reluctance to use stronger measures to tackle obesity, which already costs the NHS one pound in every 20 it spends.

The Prime Minister last week said a ‘fat tax’ on some foods was “something we should look at”, but yesterday Mr Lansley would only say that while taxes might have “a part to play”, they were not a “first resort”.

But Jamie Oliver, the chef and healthy eatign campaigner, dismissed the whole strategy as a “farce” and a “cop-out”, saying it was “worthless, regurgitated, patronising rubbish”.

He said: “Simply telling people what they already know – that they need to eat less and move more – is a complete cop out.  The country’s bill of health is shocking, and it’s not going to get any better over the next 30 years if a clearly defined plan isn’t put into place soon.”

“We simply can’t afford the financial or health costs of doing nothing. This Government might be able to navigate us slowly out of a recession, but it has no clue about how to make sustainable change in the short or long term, or how to inspire, enforce or empower public health.”

Dr David Haslam, a GP and chair of the National Obesity Forum, said issuing the new calorie guidelines alongside the updated anti-obesity drive was “really unhelpful”.

“It gives out entirely the wrong message,” he said. “People are going to think that they can eat that little bit more. If anything, that will add to the obesity problem.”

http://www.telegraph.co.uk/health/healthnews/8825271/Green-light-to-eat-a-little-more-if-you-are-thin.html

Patients should, however, be given an opportunity for a second opinion wherever possible.

While the General Medical Council (GMC), the doctor’s watchdog, said last year there was no absolute obligation to prolong life, the medical profession does have a final say about whether resuscitation is in the patient’s best interest.

This has led to accusations from some critics who believe doctors are “playing God” and ignoring vulnerable patients’ right to life.

It has also prompted fears that as hospitals face deeper budget cuts, not resuscitating patients will become a cost-cutting option. It is thought that four in five people who die in hospital are the subject of “do not resuscitate”(DNR) orders.

Cardiopulmonary resuscitation (CPR) attempts to restore breathing or blood flow to those whose heart has stopped beating or who have stopped breathing.

It can include using electric shocks to try to correct the rhythm of the heart, repeatedly pushing down firmly on the patient’s chest and inflating the lungs with a mask or tube inserted into the windpipe.

While television medical dramas suggest it is often successful less than a fifth of those who have had such treatment actually go home, according to the British Medical Association (BMA). Inevitably, the young and fit are more likely to survive than the frail and elderly.

In 2007 the BMA, together with the Resuscitation Council (UK) and the Royal College of Nursing, issued joint guidelines on the issue in a 25 page document titled “decision relating to cardiopulmonary resuscitation”.

Legal experts say the “do not resuscitate” advice is essential where a “patient or their family disagree with doctors about whether a particular treatment is futile, a burden rather than a benefit, or inappropriate”.

Roger Goss, the co-director of Patient Concern, has raised concerns previously that “do not attempt resuscitation” orders are being misused.

“We are concerned that patients are having “do not resuscitate” written on their notes without they or their relatives knowing,’ he said earlier this month.

‘Bearing in mind NHS budget cuts over the next few years, it is not far-fetched to foresee that “do not resuscitate” orders will proliferate to the point where everyone over a certain age — perhaps 65 or 70 — gets one stuck on them.”

In England, Andrew Lansley, the Health Secretary, has stopped short of a national policy.

From: http://www.telegraph.co.uk/Paramedic-patients-resuscitation-advice-focus-on-current-rules

It is feared by opponents that the wording of the legislation will remove the Secretary of State’s duty to provide healthcare for all, while plans to widen competition will see the back-door privatisation of the NHS.

But following two days of debate by 100 members of the upper house, and pressure applied by ministers and whips to Tories and Lib Dems, attempts to delay or thrown out the Bill were defeated comfortably in the biggest turnouts seen in the Lords for more than a decade.

A motion by Lord Owen, a former health minister and SDP leader, to let a special committee spend until Christmas studying the constitutional impact of the reforms was rejected by a margin of 330 to 262.

Labour’s Lord Rea had wanted the second reading to be refused altogether but this proposal was lost by 354 votes to 220.

Baroness Williams of Crosby, the Lib Dem grandee who had been among the first to raise fears over the Bill, abstained on the critical Lord Owen vote and went with the Government on the Lord Rea motion.

The results means the Bill, which seeks to remove two tiers of NHS management and give more power to GPs and patients, will now be considered line-by-line in committee stage in the Lords and remains on track to receive Royal Assent by next summer.

It has already survived a rebellion by Lib Dem activists in the spring and an unprecedented “pause” in the parliamentary proceedings for doctors’ concerns to be heard, which led to competition plans being watered down.

But even the Government accepts that more changes will be made to contentious areas.

A Department of Health spokesman said: “The vote today moves us one step closer to delivering a world-class health service that puts patients at its heart and hands more power to health professionals. We now look forward to working with the Lords to scrutinise the Bill during Committee Stage to improve our plans further.”

Labour said it would continue to call for “drastic changes”.

The plans had been criticised in the debate by well-known figures including Lord Winston, the fertility pioneer, who described the Bill as “unnecessary and, I’m afraid to say, irresponsible”.

After the vote Dr Hamish Meldrum, Chairman of BMA Council, said: “It remains the BMA position that the Health and Social Care Bill should be withdrawn, or if not that it should be substantially amended, and we will continue to raise our concerns at every available opportunity as the Bill progresses through the House of Lords.

“The BMA continues to have many areas of concern, including the need for assurance that increasing patients’ choice of provider for specific elements of their care won’t be given priority over the development of integrated services and fair access.

“We also need to see an explicit provision that the Secretary of State will retain ultimate responsibility for the provision of comprehensive health services.”

From: http://www.telegraph.co.uk/NHS-reform-Bill-survives-fatal-Lords-vote

The tax is expected to raise about £140 million, and cut consumption of saturated fat by close to 10pc, and butter consumption by 15pc.

“It’s the first ever fat-tax,” said Mike Rayner, Director of Oxford University’s Health Promotion Research Group, who has long campaigned for taxes on unhealthy foods.

“It’s very interesting. We haven’t had any practical examples before. Now we will be able to see the effects for real.” The tax will be levied at 2.5 per Kg of saturated fat and will be levied at the point of sale from wholesalers to retailers.

Less than 10pc of Danes are clinically obese, putting them slightly below the European average.

But researchers at Denmark’s Institute for Food and Economic estimate that close to 4pc of the country’s premature deaths are a result of excess consumption of saturated fats.

For Britain, where more than 20pc of the population is obese, the number will be considerably higher.

A 2007 study by Mr Rayner’s group concluded that a combination of taxes on healthy foods and tax breaks on fruit and vegetables could save 3,200 lives a year in the UK.

Health Minister Andrew Lansley has up until now resisted calls for taxes on unhealthy foods, but Mr Rayner said they were the only credible way to combat Britain’s obesity problem.

“I think we’re going to have them in Britain whether Mr Lansley wants them or not, because the obesity crisis in the UK is such that we need to take more action.

From: http://www.telegraph.co.uk/Denmark-taxes-fatty-products

The decision follows a series of cases in which patients have died or suffered poor care as a result of doctors speaking sub-standard English.

The issue was brought to national attention three years ago when Dr Daniel Ubani, a German-trained GP on his first out-of-hours shift in Britain, killed David Gray, 70, by giving him 10 times the normal dose of diamorphine.

In his speech to the Conservative Party conference today, Andrew Lansley will say that the Medical Act will be amended so that doctors must speak good English to practise in Britain.

“I am determined that doctors who come from overseas to work here in our NHS must not only have the right qualifications, but also the language skills to practise here,” the Health Secretary is expected to say. “We will amend the Medical Act to ensure that any doctor from overseas who can’t use a decent level of English is not able to treat NHS patients. This is not about discriminating; we’ve always appreciated how much overseas doctors and nurses give to our NHS. It is simply about our absolute commitment to put patients’ safety first.”

There are more than 88,000 foreign-trained doctors registered to work in Britain, including 22,758 from Europe. They account for almost a third of the total.

Under the proposals, local NHS trusts would have a duty to check the language skills of foreign-trained doctors before they can be employed. In addition, the General Medical Council would be given powers to take action against doctors when there were concerns about their ability to speak English. At present, only doctors from outside the European Economic Area are routinely scrutinised for their language skills before being registered by the GMC.

This means that doctors from Canada or Australia are routinely tested for their language skills while those from countries such as Poland and France are not.

It had previously been thought that European Union laws ensuring the freedom of movement of labour prevented language testing. However, the European Commission has recently stated that the language tests would be legal.

Dr Ubani, who admitted he had never heard of the drug he gave to Mr Gray, was struck off by the GMC in June last year but still practises in Germany. His poor English meant he was refused work by the NHS in West Yorkshire but was accepted in Cornwall and Camb-ridgeshire, where he saw Mr Gray.

Since the case, the GMC and other NHS leaders have repeatedly warned that some foreign doctors’ language skills are so poor that patients are being put at risk.

Compulsory language tests for foreign doctors will raise concerns that the NHS could be left short-staffed, such is its reliance on overseas medics. Ministers believe that the majority will reach the necessary standard of English.

Mr Lansley will today deliver a robust defence of the Government’s health policy, saying that money is being diverted from cutting bureaucracy to front-line services.

“Unlike Labour, we will make sure that every penny of our investment goes right to the patients who matter, not the huge Labour bureaucracy which we inherited,” he will say. “And all that is why, since the election, we now have 1,500 more doctors and 5,000 fewer managers in the NHS.”

He will also claim that hospital infection rates have fallen and the number of people being treated in mixed-sex wards has fallen by more than 90 per cent over the past eight months.

From: http://www.telegraph.co.uk/Conservative-Party-Conference-2011-doctors-from-overseas-must-speak-English-or-be-banned

The rest of the UK is expected to implement a similar ban next year.

Some pub landlords say it is a further threat to a livelihood that has already been damaged by the smoking ban.

But Cancer Research and the British Heart Foundation have welcomed the move.

According to the Department of Health, nearly all adult smokers started smoking before they turned 18.  Of the children who regularly smoke, 11% buy their cigarettes from vending machines.

It is also estimated that 35 million cigarettes are sold illegally through vending machines to children every year.

Under the new rules, pub landlords will still be able to sell cigarettes from behind the bar but they must ensure all tobacco advertising on vending machines is removed. Any person found guilty of displaying cigarette adverts on a vending machine could face imprisonment for up to six months, a fine of £5,000, or both.

Health Secretary Andrew Lansley said smoking was “one of the biggest and most stubborn challenges in public health”, with more than eight million people in England still smoking, causing more than 80,000 deaths each year.

He said: “Cigarette vending machines are often unsupervised, making it easy for children to purchase cigarettes from them.

“The ban on cigarette sales from vending machines will protect children by making cigarettes less accessible to them – we want to do everything we can to encourage young people not to start smoking in the first place.”

Jo Butcher, the National Children’s Bureau’s programme director of health and wellbeing, welcomed the ban and said a person’s lifetime smoking or non-smoking behaviour was “heavily influenced” by decisions in their adolescence.

“Children and young people tell us that external influences make it even more difficult for them to choose healthier lifestyles.

“It’s essential that we create environments that improve health and tobacco legislation is an important part of public health protection and promotion,” she said.
Protection

Charities have also welcomed the ban.

Betty McBride, director of policy and communications at the British Heart Foundation, said thousands of children at risk of this “deadly addiction” regularly got tobacco from vending machines, “which conveniently don’t ask them to prove their age”.

“These children are often blissfully unaware of the damage smoking does to their health and, by the time they realise, they’re hooked.

“Scrapping these machines cuts off an easy source of tobacco for existing young smokers and makes it harder for a new generation to start.

“We’re encouraging landlords to remove machines completely now so they – and any left-over branding – don’t act as dusty old adverts for tobacco,” she said.

Eileen Streets, director of tobacco control at the Roy Castle Lung Cancer Foundation, said she hoped the ban would play a “significant part in stopping many children becoming the next generation of lung cancer victims”.

Jean King, of Cancer Research UK, added: “Tobacco kills half of all long-term users and is responsible for one in four cancer deaths.

“Cancer Research UK is determined to protect children from tobacco marketing and through our Out of Sight Out of Mind campaign we are continuing to work for legislation to introduce plain packaging for cigarettes.”

But the British Beer and Pub Association described the ban as “an unnecessary measure”.

A spokesman said the machines were there for the convenience of adult customers, and that the association did not believe they played a role in childhood smoking.

Although cigarettes can be sold by bar staff, the spokesman said many pubs would not opt to introduce that, as it raised issues about having a “high-value” item behind the bar and interfered with serving drinks.

Other measures to protect young people from the dangers of smoking are also on the way.

In April 2012, large retailers in England and Scotland will have to get rid of all tobacco displays. Small shops will be expected to comply from April 2015.

Wales and Northern Ireland plan to implement similar regulations.

The government is also due to begin a public consultation before the end of the year on whether to introduce plain packaging for cigarettes in order to lessen their marketing appeal to young people, help make health warnings more effective and help reduce the number of smokers.

From: http://www.bbc.co.uk/news/uk-15132529

The governance board of the programme will now be scrapped, and local trusts will be given the freedom to develop their own versions of the electronic care record rather than having the rules dictated by Whitehall. A new Cabinet Office oversight committee will monitor future IT investment to ensure money is not wasted.

But many trusts across England have large contracts with private suppliers to supply their care record systems, and their cancellation could leave taxpayers even more out of pocket.

The Department of Health’s own chief information officer, Christine Connelly, told MPs on the Public Accounts Committee in May that a £3bn deal with CSC to deliver systems in the north, midlands and east of England would cost more to get out of than to keep going.

She said: “Potentially, if you ask me about the absolute maximum, we could be exposed to a higher cost than the cost to complete the contract as it stands today.”

A decision will be made on the future of the contract later in the autumn.

However the Cabinet Office’s Major Projects Authority said that some parts of the £12.7bn programme had worked and would be retained, including the NHSmail email system and the Choose and Book process of arranging hospital referrals.

Andrew Lansley, the Health Secretary, said: “Labour’s NHS IT Programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs.

“We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernised NHS.”

Roger Goss, co-director of the pressure group Patient Concern said: “Thank goodness politicians have decided to stop money being poured into a huge bottomless pit. Now we must pray that they don’t sanction pouring it into endless incompatible regional pits.”

From: http://www.telegraph.co.uk/Dismantling-NHS-computer-scheme-could-cost-more-money

The trusts in jeopardy include Barts and the London, Oxford Radcliffe, North Bristol, St Helens and Knowsley, and Portsmouth.

Between them the trusts run more than 60 hospitals which care for 12 million patients.

There is already evidence that waiting lists for non–urgent operations have begun to rise as hospitals delay treatment to save money. Adding to this are growing fears over the impact of the financial crisis on care this winter.

Under the PFI deals, a private contractor builds a hospital or school. It owns the building for up to 35 years, and during this period the public sector must pay interest and repay the cost of construction, as well as paying the contractor to maintain the building.

However, the total cost of the deals is often far more than the value of the assets. As a result, Mr Lansley says, the 22 trusts “cannot afford” to pay for their schemes, which in total are worth more than £5.4billion, because the required payments have risen sharply in the wake of the recession.

Mr Lansley said: “Over the last year, we’ve been working to expose the mess Labour left us with, and the truth is that some hospitals have been landed with PFI deals they simply cannot afford.

“Like the economy, Labour has brought some parts of the NHS to the brink of financial collapse. Tough solutions may be needed for these problems, but we’ll help the NHS overcome them. We will not make the sick pay for Labour’s debt crisis.”

He said hospitals would not be allowed to collapse financially.

“There are many hospitals that are well run, do not have a legacy of debt and do have projects which are perfectly sustainable. My point is that we have looked since the election and are working together with individual trusts to arrive at a place where they are financially, and in terms of the quality of their services, sustainable for the future. We can only do that if we work closely with them,” he said.

“This is about making very clear that we are not only working on unsustainable PFIs, but also working with legacy debt that the NHS has been left with, working on the IT programmes which were on an unsustainable scale of contractual commitments that didn’t meet the need of the NHS’s customers.

“Across the board, we have to tackle Labour’s legacy of poor value formoney and debt.”

Over the next few weeks, Department of Health officials and executives at the 22 trusts will develop detailed plans for dealing with the crisis. Their proposals are expected to include significant cost–cutting and the renegotiation of PFI contracts.

Money will also be moved from NHS trusts that are in better financial shape to cover the debt costs at those that are struggling. However, officials are braced for the need to use Whitehall funds to bail out some hospitals.

Among the trusts which have contacted Mr Lansley to inform him of their severe financial problems are several London institutions, including South London Healthcare, Barking, Havering and Redbridge, and North Middlesex.

Outside the capital, other trusts to have approached the health department include Wye Valley, Worcester Acute Hospitals, Mid Yorkshire, and Walsall.

After the general election last year, Mr Lansley ordered officials to establish why some NHS hospitals were under–performing. The health department is assessing the financial position of every hospital. It is understood that the PFI costs have emerged as a leading factor in poor patient care in some areas.

The Health Secretary decided to disclose the list of hospitals in difficulty and is expected to announce the rescue plans for each trust next month.

Taxpayers are having to pay more than £200 billion for schools, hospitals and other projects whose capital value is little more than £50 billion.

In one example, a hospital in Bromley, south east London, will ultimately cost the NHS £1.2 billion, more than 10 times what it is worth. Another hospital was charged £52,000 for maintenance that cost £750. The annual cost of the schemes is almost £400 for each household.

The public payments for PFI deals are typically linked to inflation and therefore the cost to taxpayers has increased by up to a third since the beginning of the credit crisis, according to the National Audit Office. Last month, MPs on the Treasury select committee effectively called for a moratorium on new PFI projects, which it said were “like a drug” as the costs were not apparent at the outset.

George Osborne, the Chancellor, has tightened the rules on the deals.

Earlier this year, John Healey, the shadow health secretary, admitted in an interview that Labour ministers had failed when negotiating the multi–million pound schemes for hospitals.

“There is definitely a case for saying we were poor at PFI, poor at negotiating PFI contracts at the outset,” he said.

Companies who run PFI schemes boast profit margins of up to 71 per cent on the projects, but have come under growing pressure from MPs and ministers to return some of their “windfall profits”.

From: http://www.telegraph.co.uk/NHS-hospitals-crippled-by-PFI-scheme

The health secretary pushed ahead with HealthWatch, the new body to champion patients’ views, despite ministers being forced to apologise and withdraw a consultation on the new watchdog. Ministers had conceded that their original plans had been conceived in haste and without proper consultation.

But Lansley announced that 75 local HealthWatch groups were in place. HealthWatch is supposed to replace local patient involvement networks, known as LINks, in 2012 – bringing “real local democratic accountability and legitimacy” to the NHS “for the first time in 40 years”.

Malcolm Alexander, chair of the National Association of Local Involvement Networks Members, said that, instead of increasing budgets to fund the new bodies, cash was being cut even though the government was asking local groups to take on a range of new responsibilities, such as promoting the integration of care and health services and improving choice for patients, without extra money.

Alexander said: “It’s pathetic. The consultation had a figure of £20,000, which was confusing and looked like a cut. Then that was withdrawn. Our figures show that networks are having their budgets cut this year by 24% on average.”

He said there was no start-up funding for local HealthWatch “pathfinder” groups and no ringfenced money in local authority budgets to run the new bodies.

The money for HealthWatch comes out of local council budgets, which are being cut by 30% over the next four years. “Our own research asked whether these new policies were evolution or abolition. It looks like abolition to us,” he said.

Sally Brearley, senior research fellow in patient and public involvement at King’s College London, who sat on the prime minister’s Future Forum which re-examined the health reforms, said she “shared the concerns”.

“There’s a lot of extra work to develop these new HealthWatch bodies and they are supposed to be monitoring the NHS as services are being cut and finances are under strain. It’s a real issue.”

A Department of Health spokesperson said the criticism was misleading.

“The government has not cut funding, and has no plans to do so – in fact, we retained the current level of funding at £27m, rising in line with inflation, for the spending review period.”

From: http://www.guardian.co.uk/andrew-lansley-condemned-healthwatch

The Public Accounts Committee says that although £2.7bn of taxpayers’ money has already gone on the scheme, it is unclear what the benefits have been and so ministers should think about whether the rest of the cash could be better spent elsewhere.

Although the intention was to create a single network that would allow NHS staff across England to access any patients’ details, the report says this will not happen now and the country has been left with a “patchwork” of costly and fragmented IT systems whose future is uncertain because of reforms to the health service.

The chief executive of the NHS, Sir David Nicholson, also comes in for criticism for failing to oversee the project properly while civil servants provided “late, inconsistent and contradictory” information to the MPs’ inquiry.

Margaret Hodge, the committee’s chairman, said: “The Department of Health is not going to achieve its original aim of a fully integrated care records system across the NHS. Trying to create a one-size-fits-all system in the NHS was a massive risk and has proven to be unworkable.

“The Department has been unable to demonstrate what benefits have been delivered from the £2.7 billion spent on the project so far.

“It should now urgently review whether it is worth continuing with the remaining elements of the care records system. The £4.3 billion which the Department expects to spend might be better used to buy systems that are proven to work, that are good value for money and which deliver demonstrable benefits to the NHS.”

The integrated electronic care records system was a central part of Labour’s £11bn National Programme for IT in the NHS, which was set up in 2002 and faced repeated criticism since then over its cost and technical problems, most recently from the National Audit Office.

In the report the MPs say the intention to allow rapid sharing of patients’ records was “worthwhile” but the Department of Health has been unable to make it work.

They claim that creating a single system was always a “massive risk” especially as clinicians were not asked for suggestions on its operation.

In the north, midlands and east of England just 10 of 166 trusts have received only a basic system, while no mental health body has received one. Dozens of different interim and local schemes have been devised, at greater cost.

Whitehall officials are said to lack “basic management information” on the number of systems built and their cost, even though there is a body overseeing the whole project with 1,300 staff that has spent £820million.

Sir David Nicholson was accused by the committee of having “lacked the capacity to meet his responsibilities fully” as Senior Responsible Owner for the scheme, leading to “increasing costs and delays”.

The Department of Health is now trying to renegotiate some contracts and is working on a slimmed-down “menu of modules” that hospitals can choose for their patient records systems, but there is no guarantee the systems will work with each other.

In addition, the Strategic Health Authorities responsible for delivery of the programme are being scrapped and there is “considerable uncertainty” over how the new NHS bodies will adopt the IT systems and how much it will cost them.

Andrew Lansley, the Health Secretary, said: “This is yet more evidence that Labour’s botched approach to IT in the NHS failed taxpayers and failed patients. Their one-size-fits-all IT programme has once again been found unworkable.

“This Government is taking action where Labour failed. Already, we have reduced expenditure on Labour’s costly IT schemes by £1.3 billion. We are making sure that systems are not imposed on the NHS from the centre which organisations do not want. And we will shortly announce our plans for even stronger action to deliver value for money for taxpayers and the NHS.”

From: http://www.telegraph.co.uk/NHS-should-consider-abandoning-7bn-IT-project.html

Critics believe it is evidence that the Coalition is pandering to the interests of the drinks industry, potentially at the expense of the nation’s health.

Some nine million people in Britain suffer from the harms of alcohol in some, either directly or indirectly, while the cost to the NHS stands at £2.7 billion a year.

Don Shenker, chief executive of the charity Alcohol Concern, believed companies were being allowed a bigger say in “setting the agenda” under the Coalition.

Speaking of the changes to the working group “I can only imagine it’s because this government believes that the drinks industry has a big role to play in shaping policy, in setting the agenda.

“And so they have extended the invitations to a larger set of people from the drinks industry.”

However, Anne Milton, the Public Health Minister, claimed ignorance of the body.

She said: “I think we have a communications problem in Whitehall because you know something that I have never heard of before.”

In opposition David Cameron talked tough on alcohol abuse, and the Conservatives’ manifesto said the party would ban off-licences and supermarkets from selling alcohol below cost price.

In January the Coalition announced that retailers would be banned from selling drinks for less than the value of duty and VAT.

But they will not have to take into account the cost of producing the drinks, meaning they will still be able to sell drinks at a net loss.

The Coalition has pursued an approach of working with industry, arguing it will be more effective than legislation.

However, in March eight organisations pulled out of the Coalition’s Public Health Responsibility Deal – including Alcohol Concern, the Institute of Alcohol Studies and the British Liver Trust.

They wrote to Andrew Lansley, the Health Secretary, saying the deal on alcohol – which includes voluntary agreements with industry – would not help reduce illness or deaths.

At the time Mr Lansley said imposing laws was often “costly” and they could “take years” to implement.

A spokesman for the Department of Health yesterday re-iterated that argument.

She did not deny that changes to the working group had been made.

The spokesman said: “We are committed to challenging the assumption that the only way to change people’s behaviour is through adding to rules and regulations.

From: http://www.telegraph.co.uk/Alcohol-advisory-body-stacked-with-drinks-industry-lobbyists

Ministers have said they will consider the proposals, but the Treasury is known to have reservations.

However, both the Dilnot Commission and campaigners are preparing to keep the pressure on in the coming months.

Commission chairman Andrew Dilnot is urging ministers to act quickly and consider ways extra funds could be found.

After launching his report on Monday, he said he wanted to see the government come forward with a white paper by Easter, paving the way for the introduction of the new system by the end of this parliament.
‘Build momentum’

Meetings are now being planned with officials about how his proposals would work in practice.

He is said to be confident that he will be able to win the argument and wants to use the next few months to “build momentum” around his plans.

The Dilnot Commission’s proposals would require an extra £1.7bn a year – a figure which would rise along with the ageing population.

This could be found by making cuts elsewhere. The NHS has already been pinpointed as it has a budget of over £100bn and many of its services overlap with social care.

Alternatively, £3bn a year could be raised through getting those who work past the normal retirement age to pay national insurance contributions or through an across the board rise of 0.25% in contributions

Increasing the basic rate of income tax by 0.25%, VAT by 0.5% or reducing pension tax relief would bring in £2bn a year.

In a warning to ministers, he said if they did not act before Easter the commission’s feelings would move “quickly to disappointment”.

His case is being strengthened by having widespread support from charities – some of whom are involved in delivering social care services.

More than 20 charities, including Carers UK and Mencap, immediately put their names to a joint statement calling for action.

It said: “It is now vital that government sets out a clear timetable for change and does so quickly.”

Many of them will also be seeking talks with government in the coming months. A number of options are being put forward for finding the money.

These include taking money from other departments as the £1.7bn represents just 0.25% of total government spending.

It will also be argued that improving social care will help save the NHS money as fewer people will need expensive hospital treatment if they get better access to social care.

However, raising more through taxes or the benefits system will also be put forward.

An analysis from Age UK setting out how this could be done has already been handed over to the Treasury.

It includes suggestions such as making those working past the normal retirement age pay national insurance contributions. This would raise £3bn a year.

Alternatively a 0.25% rise in contributions across the board would make a similar amount.

Meanwhile, £2bn could be found by either increasing the basic rate of income tax by 0.25%, VAT by 0.5% or reducing pension tax relief.

For any of these to happen, cross-party support would almost certainly be needed.

The Labour party has already indicated it would be willing to enter talks. But doubts still remain about the appetite for change.

In his official response to the Dilnot Commission, Health Secretary Andrew Lansley said the proposals would be “carefully considered”.

But he acknowledged they would involve “significant cost” and need to be balanced against other funding priorities.

A spokeswoman for the Treasury refused to be drawn on any of the suggestions.

But she said officials would welcome “constructive engagement from all stakeholders”.

Michelle Mitchell, of Age UK, said: “The government now needs to act on Andrew Dilnot’s proposals. Delay would be indefensible.”

And Richard Humphries, of the King’s Fund health think-tank, added: “A solution must be found.

“What we are talking about is a relatively small proportion of government spending.”

From: http://www.bbc.co.uk/news/health-14017252

Doctors’ groups have broadly welcomed the revisions.

The NHS bill will now go back to the committee stage in the House of Commons to be scrutinised again by MPs before going through its House of Lords stages.

The prime minister’s official spokesman said he expected that to happen before the summer recess begins in July, and the bill to be on the statute book by the end of the current Parliamentary session.

That gives ministers until May 2012 to make it law.

On Monday – following a 10-week “listening exercise” – a panel of experts called the NHS Future Forum gave its recommendations on the changes needed to the bill.

They include:

• Reinstating the legal responsibility of the health secretary for the overall performance of the NHS
• Scrapping the primary role of the regulator, Monitor, to promote competition – and focusing on improving patient choice instead
• Relaxing the 2013 deadline for new GP commissioning arrangements to be introduced – a National Commissioning Board, based in Leeds, will control budgets until GP groups are “able and willing” to take over
• Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them
• Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them

After criticism from medics and complaints from rebellious MPs, the Coalition will be hoping the dust will now settle over its NHS reforms.

If politics is the art of persuasion, then the test for Messrs Cameron, Clegg and Lansley is whether or not they have convinced people that the listening process has been, as the prime minister claimed, a sign of strength.

The government and many health professionals believe changes to the NHS are necessary to deal with the demands of the ageing population, cost of new drugs and lifestyle changes such as obesity.

Mr Cameron said those who described the reworking of the plans as “a humiliating U-turn”, or the listening exercise as “a big PR stunt”, were both wrong.

“The fundamentals of our plans – more control to patients, more power to doctors and nurses, less bureaucracy in the NHS – they are as strong today as they’ve ever been,” the PM said.

The health secretary has faced personal criticism for his inability to garner widespread support for the original bill, but the prime minister said he accepted full responsibility for what had happened.

“I am every bit as responsible as Andrew Lansley for the fact that we actually decided we could improve on what we already put forward,” Mr Cameron said.

The British Medical Association said it was pleased the government had accepted the Future Forum’s recommendations and addressed many of doctors’ concerns.

But it said more detail was needed on how commissioning of care would work in future and there must be “robust safeguards” to prevent competition of any kind destabilising the health service.

From: http://www.bbc.co.uk/news/uk-politics-13757380

Dr Michael Dixon, chairman of the NHS Alliance, defended the changes by saying that neither medics nor the public wanted to be “pawns in the system” any more.

But he was warned that the power GPs appear to have been given to buy treatment is just an “illusion” and that they will end up merely rationing care in order to save money.

It comes after the Health Secretary, Mr Lansley, wrote in The Daily Telegraph that the NHS faces a £20 billion a year funding black hole unless it undergoes major surgery.

His Health and Social Care Bill proposes abolishing two tiers of management and allowing new GP-led bodies, called commissioning consortia, to buy £60billion a year of treatment from either state-run hospitals or private providers.

It has been bitterly opposed by much of the medical establishment on the grounds it may fragment services and lead to backdoor privatisation, and the legislation was put on “pause” by David Cameron after Liberal Democrats and peers threatened a rebellion.

But BBC Radio 4’s Today programme heard on Thursday that many of the changes are already happening on the ground, as clusters of GPs form consortia to take over from Primary Care Trusts.

Dr Dixon of the NHS Alliance said: “The evidence is in our report, showing over 20 commissioning groups already delivering better services for their patients and also delivering them more cost effectively.

“For instance, in this country the use of hospitals is disproportionately more than anywhere else in the world and those commissioning groups are showing how they can look after patients better in the community.

“If the commissioner is king, they can get the right balance of private and public and the right balance of competition and collaboration.”

Asked why more GPs were not in favour of the new regime, he replied: “To look after our whole patient population is quite an added responsibility and I think some people find that quite daunting.”

But he went on: “Many of us in this commissioning movement are fed up with being pawns in the system and fed up with our patients being pawns in the system.

“We feel that if we can make sure the NHS is delivering change and improvement from the bottom up instead of having to listen to targets coming down from Whitehall, that often don’t mean much to us, we can actually make a difference.”

From: http://www.telegraph.co.uk/GP-group-says-Andrew-Lansleys-NHS-reforms-are-already-working

The CQC, which carried out unannounced inspections, also raised concerns about three other NHS hospitals.

The commission has published the first 12 results of 100 such inspections, called for by the health secretary Andrew Lansley after a long campaign by the Patients Association, which highlighted poor care for the elderly.

While its inspectors said there had been many examples of people being treated with respect and given excellent care, in other cases people had not been helped to eat and drink, “with their care needs not assessed and their dignity not respected”.

All six hospitals about which concerns were raised must now say how and when they will improve. The worst three offenders will have to improve or face action from the regulator.

The inspections looked at nutrition and found cases of patients not being helped to eat, poor monitoring of patients’ weight and people not being given enough to drink, with water being out of reach for long periods of time.

In one case, a member of staff at Worcestershire Acute Hospitals NHS Trust said they had to prescribe water on medical charts to ensure patients got enough to drink.

Inspectors also looked at dignity and respect, noting that elderly patients were sometimes not involved in their own care and were given no explanation of the treatment they were to receive or asked for consent.

Staff also treated people in a disrespectful way, spooning food into their mouths without engaging them.

The reports acknowledge examples of excellent care where treatment was explained in a way patients could understand and they were treated with respect and dignity.

Jo Williams, chair of the CQC, said the inspections had built a detailed picture of the care being received by elderly patients in NHS hospitals in England.

“Many of these reports describe people being ‘cared for’ in the truest sense. Sadly, however, some detail omissions which add up to a failure to meet basic needs – people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink.

“These are not difficult things to get right – and the fact that staff are still failing to do so is a real concern. These are the basics that help ensure every patient is treated like an individual – not a nuisance to be ignored or a task that must be completed.

“This is what we expect for ourselves and for our own families, and what every patient should expect from the people who care for them.”
Enforcement powers

Health Secretary Andrew Lansley said that everyone admitted to hospital deserved to be treated as an individual, with compassion and dignity.

More CQC reports will be published over the summer with the findings of the programme of inspections released in the autumn.

From: http://www.bbc.co.uk/news/health-13545780

Such is the concern in Downing Street at the damage the issue of NHS reform is causing the Government, that Mr Cameron will put his reputation on the line with a personal pledge to protect its core values. It represents his boldest attempt yet to assuage criticism from his Liberal Democrat Coalition partners and from many health professionals over the impact of the reforms.

In his speech, the Prime Minister will admit that he is willing to act on their concerns after listening to the “profession and patients” during a two-month exercise which was held after Mr Cameron called for a “pause” in the Health Bill’s passage.

His “five guarantees” are designed to show the Prime Minister is committed to the NHS, and “he is hearing what is being said”, according to one source. Mr Cameron’s promise on integrated care is designed to ensure patients receive continuity of treatment, without having to explain their condition from scratch each time to different doctors.

It also means that nurses and hospital professionals will retain a role in commissioning services, and that not everything is transferred to GPs.

His commitment to the “national” part of the NHS represents a pledge to keep it as a universal service, free at the point of use. But Mr Cameron will also say that “no change” is not an option.

He will echo the words of Andrew Lansley, the Health Secretary, who wrote in last week’s Daily Telegraph about the threat to the NHS if it does not reform. He warned of a £20 billion a year funding black hole without reform.

Despite ring fencing health spending, Mr Cameron is expected to make clear that NHS services will be threatened unless there is reform because of the rising costs of drugs and an increasing elderly population.

Mr Cameron is likely to say that the Coalition’s reforms will see the NHS working better. He will point out that in Europe there are health systems which work more effectively.

The speech comes as ministers prepare to rewrite much of the Health Bill. At present the plans involve abolishing two tiers of NHS management and handing control of a £60 billion-a-year budget to groups led by GPs, who can choose to buy treatment for patients from local state-run hospitals or private providers.

This week, the Royal College of Nursing is expected to renew its call for nurses to have a key role on the GP commissioning boards. Mr Lansley will not commit to such a plan until he has heard from the Future Forum, which is reporting back on possible changes to the Bill.

Tomorrow, Mr Lansley, who has been subject to rumours that he is about to resign or be sacked over the issue, faces MPs in the Commons. He will defend the reforms, although he is prepared to see them substantially watered down. However, Labour will seize on stories circulating that Cabinet colleagues had suggested he would not last the year in his post.

Downing Street polling has painted a stark picture of the problems Mr Cameron faces over the NHS and Mr Lansley’s presentation of the plans over the past 12 months is being blamed.

Last week Stephen Dorrell, who was health secretary in John Major’s government, added to speculation that he will replace Mr Lansley. Asked on BBC’s Question Time about whether he would do a better job, he said: “I am going to plead the Fifth Amendment.”

From:
http://www.telegraph.co.uk/David-Cameron-puts-reputation-on-the-line-with-five-pledges-on-the-future-of-the-NHS

They argue: “The reforms have received a very bad press lately but much of the criticism has been noticeably misinformed.”

The doctors are all heads of recently-formed GPs’ consortia – groups of practices that have joined together to take over responsibility for almost four-fifths of the NHS’s £100 billion budget from 2013.

They write that they “wholeheartedly support” moves to scrap primary care trusts and strategic health authorities, which currently decide how that money is spent.

“The reforms are not revolutionary but an evolution,” they say.

Putting GPs in charge will make the health service more effective and accountable at a time of “considerable financial constraints”, they add.

The letter is a welcome boost for Mr Lansley after Nick Clegg, the Deputy Prime Minister, described the reforms as a “disruptive revolution”.

It also marks the first time that a significant group of doctors has pledged such apparently unequivocal support for the Bill, which has attracted fierce criticism from health professionals over several months.

The attacks led Mr Lansley to tell MPs last month that there would be a “pause” in the Bill to listen to critics and, if necessary, make changes.

Some Liberal Democrats want the Bill killed, fearing that moves to make it easier for private companies to become NHS suppliers amount to privatisation by the back door.

Earlier this week, the Royal College of General Practitioners wrote to the Prime Minister warning that the bill could damage the NHS irreparably.

In today’s letter, GPs say that ditching the reforms would be a mistake.

The signatories, led by Dr Jonathan Munday, chairman of the Victoria Commissioning Consortium in London, write: “Our patients should feel comfortable that decisions about the local provision of health care are to be taken in future by their family doctors, many of whom they know personally. We caution the Coalition of the danger of confusing and diluting the responsibility for effecting change in any amendments to the current proposals.”

They add: “Now that there are considerable financial constraints nationally, difficult decisions will have to be made on the provision of care. Surely it is better that these decisions are taken locally by professionals in daily contact with the patients who will be affected by them, rather than by remote administrators.

“On average, our patients see their GP four times a year, and if they are dissatisfied with the services … will have no difficulty in saying so. When was the last time any patient managed an audience with a PCT chairman?”

They also claim that the advantages of plans to coordinate health and social care into “a seamless whole” have been overlooked.

“If successful, there will be enormous benefits to the most elderly, infirm and vulnerable people in our community, whose care is often currently too fragmented,” they say.

The letter neglects to mention concerns about privatisation, however.

Responding to the letter last night, Mr Lansley said: “I welcome the appetite shown by doctors to lead improvements in the NHS and deliver benefits for patients.”

Stephen Dorrell, the Tory chairman of the Commons health select committee, added: “The reforms are an evolution of the policies pursued by both Labour and Conservative governments since 1990.

“No change is not an option. We need to move on to discuss this process of change to ensure that the health service continues to meet the needs of patients in the years ahead.”

From: http://www.telegraph.co.uk/Health-reforms-will-benefit-most-vulnerable-in-society

He insisted the Health and Social Care Bill would not allow private companies to ”cherry-pick” the NHS’s most profitable services.

He told MPs that while the Government had an electoral mandate for its reforms, the Bill would only implement changes which were best for patients.

And he claimed Labour wou