More than 3 million doctors have downloaded a 59p application – invented by Prof Peter Bentley, a researcher from University College London – which turns an Apple iPhone into a stethoscope.Last week, Bentley introduced a free version of the app, which is being downloaded by more than 500 users a day. Experts say the software, a major advance in medical technology, has saved lives and enabled doctors in remote areas to access specialist expertise.

“Everybody is very excited about the potential of the adoption of mobile phone technology into the medical workplace, and rightly so,” said Bentley, who initially developed the app “as a fun toy”.

“Smartphones are incredibly powerful devices packed full of sensors, cameras, high-quality microphones with amazing displays,” he said. “They are capable of saving lives, saving money and improving healthcare in a dramatic fashion – and we carry these massively powerful computers in our pockets.”

Bentley’s iStethoscope Pro application is not the only mobile phone programme lightening doctors’ bags and transforming their practices: there are nearly 6,000 applications related to health in the Apple App Store. The uptake has been rapid. In late 2009, two-thirds of doctors and 42% of the public were using smartphones – in effect inexpensive handheld computers – for personal and professional reasons. More than 80% of doctors said they expected to own a smartphone by 2012.

The trend looks likely to gain pace as younger doctors enter the workplace. Some medical schools issue students with smartphones. In America, Georgetown University, the University of Louisville and Ohio State University are among those requiring undergraduates to use one.

However, experts say they are being prevented from exploiting the technology’s opportunities. Bentley says that he is unable to launch a new range of applications because of out-of-date regulations.

“It’s much easier to develop technology than it is to get permission to use it,” he said. “I could create a mobile ultrasound scanner and an application to measure the oxygen content in blood, but the regulations stop me. We’re not allowed to turn the phone itself into a medical device, and what that precisely means is currently a grey area in terms of regulation. That’s the only reason we’re not seeing a flood of these devices yet.”

Professor Ian Wells, head of the scientific computing section in the department of medical physics at the Royal Surrey County hospital in Guildford, agrees that innovation is being hindered by regulations that are “still in their infancy”.

He said: “The approach of the regulators is not well worked out yet. There’s a wonderful new world out there but we need to find a way for regulators to protect patients and doctors, while not impeding innovation, research and development.”

The Medicines and Healthcare products Regulatory Agency (MHRA) – the government body with responsibility for standards of safety, quality and performance in healthcare – recently set up the Medical Device Technology Forum, a group of industry representatives, regulators, users and scientists, to help establish how to regulate novel technologies.

“This is such a complex area that we are currently looking at every application on a case-by-case basis,” said an MHRA spokesman. “We want to ensure that these new technologies are effectively regulated – thereby protecting health and avoiding unnecessary deterrents – while at the same time removing any unnecessary obstacles to manufacturers who wish to exploit new technologies for the benefit of patients.”

European regulators are also striving to bring their guidelines up to date. A group of regulators from Austria, Belgium, Denmark, France, Ireland, Sweden and the UK was set up last December to develop guidance for software under the European Medical Device Regulations. They are expected to report at the end of the year.

• Star Analytical Services has developed an app that allows patients to cough into their phone, and tells them whether they have a cold, flu, pneumonia or other respiratory diseases.

• OsiriX lets doctors look at x-rays, ultrasounds, CT and MRI images on handheld devices or mobile phones with special software, enabling radiologists, for example, to diagnose acute appendicitis from remote locations.

• ERoentgen Radiology Dx helps radiologists identify the most appropriate radiology exam for a patient by searching a large database of signs, symptoms and diagnoses to help them make quick assessments.

• Instant ECG is just one app that analyses the most common ECG results. It distinguishes the difference in various myocardial ischemia or injury patterns. Using the iPhone’s interactive touch screen, the app offers “real-time” films to make rhythm analysis similar to the clinical setting.

• AirStrip OB, an iPhone app, gives obstetricians real-time remote access to foetal heart tracings, contraction patterns, nursing notes, and vital signs. Obstetricians can monitor different stages of labour even when they are not by a patient’s side.

From: http://www.guardian.co.uk/technology/2010/aug/30/iphone-replace-stethoscope

The declining role of GPs in maternity care is leading to some pregnant women feeling “abandoned” by the system, a leading think-tank has claimed.
Often expectant mothers do not know who to turn to if they suffer health problems during pregnancy, according to The King’s Fund.

Although family doctors frequently know a woman’s medical history best, their role in pregnancy care has become sidelined in recent decades, found the authors of the report, The role of GPs in maternity care – what does the future hold?

The King’s Fund concluded that GPs’ role in maternity care had “all but disappeared over the past 30 years, with recent policy and guidance omitting any reference to their role in caring for pregnant women”.

“Under the terms of the new GP contract introduced in 2004, GPs are no longer paid for each pregnant woman they look after,” it noted.

“In addition, many GPs have opted out of providing out-of-hours care, resulting in sick pregnant women going to A&E with pregnancy-related problems – or simply not knowing what to do if they are ill.”

Nick Goodwin, director of the Fund’s GP Inquiry, said such care was increasingly dealt with by specialists, which had led to a less connected service for pregnant women.

He said: “As a result of that you get reports that some mothers feel a bit abandoned at the beginning of their pregnancy. Who is looking after them?”

Sometimes pregnant women’s other health needs – like mental health issues and obesity – were not being dealt with, he said.

“More needs to be done to make sure that the whole person is treated.”

The report proposed that GPs should now take “a more active role”.

Anna Dixon, lead author of the report and director of policy at The King’s Fund, said: “It is right that those with specialist skills, such as midwives and obstetricians, take the lead role in caring for pregnant women but GPs have a vital role to play in pre-conception and shared ante-natal and post-natal care.”

The report has been widely welcomed by GPs’ groups.

Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said: “GPs want to be more involved in maternity care because they see it as an important part of their job.”

Prof Steve Field, chairman of the Royal College of General Practitioners, welcomed the “timely” report, saying it made “a very compelling case for GPs to play a more central role”.

However, Belinda Phipps chairman of the National Childbirth Trust, which campaigns for less medical intervention during pregnancy and birth, said it would be better to “actively promote midwife-led care to women”.

From http://www.telegraph.co.uk/Pregnant-women-feel-abandoned-by-NHS

McDonald’s, Burger King and other fast food outlets should offer diners free drugs to compensate for the risk of heart disease, cardiologists have proposed.
If burger joints offered cholesterol-lowering statins, customers would offset the unhealthy effects of a cheeseburger and milkshake, according to researchers at Imperial College London.

The pills could be placed beside the salt, pepper and tomato ketchup to encourage people to pop one after their meal.

The suggestion is made in a paper by Dr Darrel Francis, a cardiologist at Imperial’s National Heart and Lung Institute, and colleagues published in the American Journal of Cardiology.

The idea was criticised by leading doctors, who said the study could encourage ill-health by prompting even greater consumption of junk food and increasing the belief in “a pill for every ill”.

Francis said: “Statins do not cut out all of the unhealthy effects of burgers and fries. It’s better to avoid fatty food altogether. But in terms of your likelihood of having a heart attack, taking a statin can reduce your risk to more or less the same degree as a fast food meal increases it.”

People eat fast food despite knowing that it is bad for them. Given that, said Francis: “It makes sense to make risk-reducing supplements available just as easily as the unhealthy condiments that are provided free of charge. It would cost less then 5p per customer – not much different to a sachet of ketchup.”

The proposal was in line with other established risk-reducing measures such as wearing a seatbelt or buying filtered cigarettes, Francis argued.

Professor Steve Field, chairman of the Royal College of General Practitioners, denounced the proposal. “This paper just amazes me,” he said. “Let’s get real; we should be encouraging healthy lifestyles, not pill popping. This is an unwelcome addition to the ‘pill for every ill’ attitude that’s already much too common. The danger of this research is that some people will become even more complacent about eating fatty food and high calorie food, and might even increase their intake of them.”

While statins were generally safe they could increase the risk of muscle weakness and, in rare cases, of kidney failure, cataracts and liver problems, Field added.

Millions of Britons who have dangerously high cholesterol levels, and those with existing heart problems, take statins regularly to reduce the risk of a heart attack or stroke.

Professor Peter Weissberg, medical director of the British Heart Foundation, said: “The suggestion that the harmful effects of a junk food meal might be erased by taking a cholesterol-lowering statin tablet should not be taken literally. Statins are a vital medicine for people with, or at high risk of developing, heart disease. They are not a magic bullet.”

From: http://www.guardian.co.uk/fast-food-free-drugs-heart-disease

The official cause of Dr David Kelly’s death is extremely unlikely say a group of medical experts.
The inquest into the death of David Kelly was suspended before the Hutton inquiry and not resumed afterwards in one of bliar’s many spin events.

A group of prominent legal and medical experts have called for a full inquest into the death of the government scientist David Kelly in 2003.

An inquest was suspended by Lord Falconer, then lord chancellor, before the Hutton inquiry into the circumstances of the scientist’s death. It was not resumed after Hutton’s report in 2004 concluded that Kelly killed himself by cutting an artery in his wrist.

Nine experts including Michael Powers, a QC and former coroner, and Julian Blon, a professor of intensive care medicine, said in a letter to the Times that the official cause of death – haemorrhage from the severed artery – was “extremely unlikely”.

“Insufficient blood would have been lost to threaten life,” they said. “Absent a quantitative assessment of the blood lost and of the blood remaining in the great vessels, the conclusion that death occurred as a consequence of haemorrhage is unsafe.”

Kelly’s body was found in woods close to his Oxfordshire home in 2003, shortly after it was revealed that he was the source of a BBC report casting doubt on the government’s claim that Iraq had weapons of mass destruction which could be fired within 45 minutes.

Lord Hutton concluded that “the principal cause of death was bleeding from incised wounds to his left wrist which Dr Kelly had inflicted on himself with the knife found beside his body”.

In January, five doctors who made an application to the Oxford coroner to have the inquest reopened, were told that Hutton made a ruling in 2003 to keep medical reports and photographs closed for 70 years. Hutton responded by saying the documents could be revealed to doctors and that he had made the gagging order to spare Kelly’s family “unnecessary distress”.

Hopes for a new inquest have been raised by the change in government. Dominic Grieve, the attorney general, said in April, when he was shadow justice secretary, that the Tories would consider a new inquest into Kelly’s death. He also called for a review of the government’s decision not to release related medical records and postmortem documents.

Grieve is looking at the matter with the justice secretary, Kenneth Clarke. Norman Baker, the Liberal Democrat MP and a junior minister in the coalition government, supports resumption of the inquest. He resigned from the front bench while in opposition to write a book, The Strange Death of David Kelly, which argued that the scientist’s life had been “deliberately taken by others”.

The Hutton inquiry applied a less stringent test than would have been used in an inquest, where a coroner has to be sure “beyond reasonable doubt” that a person intended to kill themselves.

From: http://www.guardian.co.uk/politics/2010/aug/13/experts-call-david-kelly-inquest

The coalition Government ignored scientific advice on the questionable value of homeopathy by continuing to allow the NHS to fund homeopathic treatment despite there being next to no evidence that it works.
Last week, health ministers refused calls from the House of Commons science and technology committee to stop the NHS funding homeopathic treatment on the grounds that such a ban would limit patient choice and contradict the Government’s stated aim of devolving more power to the Primary Care Trusts (PCTs) of the NHS.

However, the Government’s own chief scientific adviser, Sir John Beddington, said that he had spoken informally to coalition ministers about his grave concerns about homeopathy and the Department of Health’s policy of allowing it to be prescribed under the NHS.

“I remain of the view that the evidence of efficacy and the scientific evidence base of homeopathy is highly questionable. It is vitally important that the public can make informed choices on their use of homeopathy, so the evidence base must be freely available in an easily-accessible format,” Sir John said.

The Government does not know how many PCTs prescribe homeopathic treatment or how much it costs but the total annual funding is believed to run into millions of pounds.

Earlier this year, the Commons’ science committee recommended that the NHS should stop funding homeopathy on the grounds that it is a waste of money and it gives patients the false impression that such treatment works.

“When the NHS funds homeopathy, it endorses it. Since the NHS Constitution explicitly gives people the right to expect that decision on the funding of drugs and treatments are made ‘following proper consideration of the evidence’, patients may reasonably form the view that homeopathy is an evidence-based treatment,” the select committee’s report said.

In its response to the report, the Government said that it will keep the position on NHS funding under review. “However, we believe that providing appropriate information for patients should ensure that they form their own views regarding homeopathy as an evidence-based treatment,” it said.

Scientists point out, however, that if patients are told clearly that there is no credible evidence to support homeopathic treatments, this may undermine the only benefit that homeopathy is likely to provide, namely the well-established “placebo effect” where someone feels and gets better because they believe a treatment is working.

“Doctors are not allowed to prescribe an honest placebo, even if they think that is the best they can do for the patient. But they are allowed to prescribe a dishonest placebo by referring the patient to a homeopath,” said Professor David Colquhoun, a pharmacologist at University College London.

“Certainly you may feel better after the pill, because you were getting better anyway, or because of the placebo effect. That can’t justify your doctor giving a pill that contains nothing whatsoever,” Professor Colquhoun said.

“If there is no evidence that homeopathy works beyond the placebo effect, why does the Government pay for it? The answer given to that is ‘patient choice’. I dare say the patient would cheer up if the NHS paid for a bottle of Chanel No 5,” he said.

Professor Edzard Ernst, a specialist in complementary medicine at the Peninsula Medical School in Exeter, said: “If the Government is serious about putting patient choice over evidence, it not only displays a profound misunderstanding of both these issues but should then also give cream cakes to diabetics and cigarettes to someone with a lung disease.”

Evan Harris, a former Liberal Democrat MP who sat on the science select committee when it carried out its inquiry, said that the decision to continue NHS funding homeopathy by the Government is not a good start for the health secretary Andrew Lansley.

“How does the Government justify allowing treatments that do not work to be provided by the NHS in the name of choice, when it allows medicines which do work to be banned from NHS use?” Dr Harris said.

From:  http://www.independent.co.uk/government-ignored-our-advice-on-homeopathic-remedies-say-experts

Hospital waiting times have begun to rise again after years of decline following the introduction of European rules on junior doctors’ working hours.Waiting times in the NHS had been dropping since the 1990s but the rules limiting junior doctors to a 48-hour week, which were implemented last August, had reversed the trend.

Thousands more patients were now waiting longer than 18 weeks for surgery because of eu red tape.

Ministers were seeking to renegotiate Britain’s position on the European Working Time Directive, including a possible opt-out for NHS staff. The Royal College of Surgeons carried out the first comprehensive analysis of how the directive had affected waiting times.

According to the research, the proportion of NHS patients having to wait longer than the 18-week target for non-emergency surgery such as hip replacements had almost doubled from 1.5 per cent 18 months ago to nearly three per cent in March this year.

Waiting times reached an all-time low at the end of 2008, with patients waiting just a few weeks for surgery on average.

However, since the EU directive cut junior doctors’ hours from 56 to 48 per week, these gains had been wiped out, the Royal College said.

According to data from the Department of Health, the number of patients waiting longer than 18 weeks — from GP referral to being treated as an inpatient — fell steadily from April 2007, when almost 34,000 people were waiting, to 8,674 in December 2008.

The figure remained stable at about 10,000 until June 2009, just before the new rules came in, when the rise began.

In March this year, it had risen to 17,515, a level last seen in September 2007.

John Black, the president of the Royal College of Surgeons, said the increase was predictable.

“If you have the same number of patients, no more doctors and ask them to work less then it is inevitable that the time available for elective procedures will reduce and waiting lists grow,” he said.

Almost two thirds of consultants now frequently operated without assistants because departments were so stretched.

Mr Black said most European countries had bypassed the legislation by either not monitoring compliance or, as in Germany and Holland, finding ways around the directive.

“We look forward to this happening in the UK,” he said.

Sir Richard Thompson, the new president of the Royal College of Physicians, said the directive had been a “complete disaster” for both patient care and the quality of training for doctors.

“We are not providing the service or the training that we require,” he said. “I cannot overemphasise the damage to service provision and to training.”

According to the survey, 80 per cent of consultant surgeons and two thirds of surgical trainees said patient care had deteriorated since the directive was implemented.

Dr Matt Jameson-Evans, a spokesman for Remedy UK, a junior doctors campaign group, said the impact of the directive on services was inevitable.

“Patients are simply not being treated by as many doctors as before,” he said. “A second consequence of this and equally important is that doctors are not receiving as much training as they were and this has serious implications for the future quality of care.”

The Royal College of Surgeons has argued for an opt-out to allow trainees to work up to 65 hours per week because they were not getting enough practical experience on a 48-hour week.

The Coalition has abolished the 18-week target, saying it was not backed by evidence that it benefited patients.

Dr Mark Porter, the chairman of the British Medical Association’s consultants committee, said the drive for cuts within the NHS was also a factor in the rise in waiting times.

From: http://www.telegraph.co.uk/NHS-waiting-lists-rise-after-doctors-hours-cut

European rules are creating a generation of “lazy, clock-watching” junior surgeons who lack the skills to operate safely, their bosses have warned.
A year after the EU directive limiting workers to a 48-hour week was brought in for the NHS, 80 per cent of consultants polled by the Royal College of Surgeons said quality of care had already been damaged by the changes, with risks to patients who are repeatedly “handed” from one shift to the next.

The survey also found that two thirds of junior surgeons said their hours in training had been cut.

Children at risk through lack of training for doctors and nurses, report warns

Consultants who took part in the study were most damning about the impact of the changes on their trainees.

Among responses from more than 500 senior surgeons taking part were repeated warnings that the rules were creating a generation of “clock-watchers” with a “lazy work ethic” who no longer felt personal responsibility for their patients.

Trainees were now spending so little time in operating theatres that they would lack the “cutting skills” required to perform safely when they became consultants, many warned.

College president John Black urged the Government to take urgent action to address the concerns, having pledged in its Coalition agreement that it would work to limit the application of the EU rules in the UK.

He described the situation facing the NHS as “acutely urgent”.

Mr Black said: “Without action we are going to see a generation of specialists with less experience than any that have gone before.”

Many consultants responding to the survey said the changes – which began in 2007 when a 56 hour maximum working week was introduced, following EU legislation – were already changing the attitude of young doctors, who were becoming too detached from the patients in their care.

Marjan Jahangiri, Professor of Cardiac Surgery at St George’s Hospital in London said: “We have created a generation of surgeons who lack technical skills and operate within a “clocking off” culture where they do not feel personal responsibility for their patient.”

The surgeon said the change in attitude was “as fundamental and dangerous” as the lack of expertise among junior doctors, who now received far less training than their predecessors.

She said: “We have now got a system where trainees begin keen and motivated, become restless from a lack of training opportunities, and they will end up lazy and unskilled”.

The heart surgeon, 48, said that by the time she became a consultant, nine years ago, she had undertaken 900 cardiac operations. The current generation were likely to become senior doctors after performing less than 300, she said.

Consultants who used to do most of their surgery assisted by trainees said they were now often forced to operate alone.

While some juniors ignored the rules and came in on their days off, most had far less time in the operating theatre because of strictures limiting them to a maximum of 48 hours, including all time on call, as well as their night shifts, and time on wards and in Accident and Emergency departments.

One respondent to the survey described the directive as the “single most damaging factor affecting training and continuity of care”.

The surgeon added: “The most insidious problem is that it fosters the concept that you are responsible for a patient only for a shift.

“A consultant surgeon has a particular and continuing responsibility – we are training clock watchers whose work life balance is more important than anything else.”

More than half of the 982 consultants and trainees polled said they were not truly complying with the rules, with many saying they lied about the true hours they worked because of pressure from NHS managers.

Among consultants who did comply with the 48 hour limit, 56 per cent said they had only done so at the expense of patient safety.

Many of the risks came from the increased numbers of “handovers” from one shift to another, and the use of inexperienced locums to cover gaps in rotas.

While some respondents in the anonymous survey said only luck had avoided serious incidents, others described specific errors which they attributed to the new system – such as the removal of an eight year old’s ovary, instead of her appendix, by an inexperienced doctor.

Mr Black said the NHS was “skating on very thin ice” under the current system, given that most doctors said they were still working longer than the 48 hours,

Doctors described handover procedures between teams which were unsafe, inadequate and in some cases, non-existent.

Trainees also described despair about the system, with many saying their training had suffered, and others saying they were only managing to improve their skills by lying about their hours and working on their days off.

Estimates suggest the current generation of trainees will have spent about half as much time in training or on call as those who became consultants before the EU rules were introduced.

A consultant summed up the training problems as a “complete disaster”, adding: “I just hope my colleagues can look after me when I get old. The only problem is they are going to be getting old too.”

From: http://www.telegraph.co.uk/EU-rules-are-making-our-doctors-lazy-clock-watchers

The Royal College of GPs says thousands of new health visitors whom the government plans to recruit should not solely be placed in children’s centres.
Over 4,000 more health visitors have been promised in England, focused in Sure Start centres.

GPs say there is already a breakdown in communication with health visitors who work in the centres, and placing more there would make it worse.

But children’s charities say parents need a more informal approach.

Health visitors have usually worked out of GPs’ surgeries – but the growth of Sure Start children’s centres has seen more moving to them.

The children’s charity 4children says having health visitors based in these centres means there is less need for mothers to use GPs’ surgeries for non-urgent problems and advice.

The Royal College of GPs says its members are seeing a worrying pattern developing, where vital information is not being passed back to them.

It says GPs need to be more actively involved in the the care of mothers during and after their pregnancy, and health visitors have to link in more with GP practices.

Professor Steve Fields of the Royal College of GPs said: “Mums-to-be are not getting the service they could have had five or 10 years ago.

“It is an unintended consequence of children’s centres being established and health visitors moving out of GPs’ surgeries and GPs not being as actively involved the care of mums-to-be during their pregnancy.

From: http://news.bbc.co.uk/1/hi/uk/10423346.stm

An NHS worker with an unblemished 27-year career was sacked after she blew the whistle on senior doctors who were moonlighting at a private hospital while being paid to diagnose NHS patients, an employment tribunal has heard.

Sharmila Chowdhury, 51, the radiology service manager at Ealing Hospital NHS Trust, repeatedly warned the hospital’s most senior managers that doctors were dishonestly claiming thousands of pounds every month.

A Watford employment tribunal judge took the unusual step last week of ordering the trust to reinstate Ms Chowdhury’s full salary and said: “I have no hesitation in saying that you are probably going to win.”

The ruling will be a bitter blow for the trust, particularly as despite the seriousness of the allegations, it failed for two years to take any action against Miranda Harvie and Peter Schnatterback, the two doctors accused of fraud at the hearing.

Instead, Ms Chowdhury was suspended after a counter-allegation of fraud made against her by a junior whom she had reported for breaching patient safety. Radiographer Michael McWha made the allegation at the request of Dr Harvie, the tribunal heard. Ms Chowdhury was sacked for gross misconduct in June, eight months after her suspension.

This case is the latest to highlight the inadequate legal protection for whistleblowers who speak out about wrongdoing in the NHS.

It also raises the uncomfortable question about the power yielded in the NHS by senior doctors. The onus is now on the trust to prove at next February’s tribunal that Ms Chowdhury was guilty of fraud and not, as she claims, sacked because she was a whistleblower.

Speaking after the judgment, a tearful Ms Chowdhury expressed her relief after months of financial hardship. A widow with a teenage son, Ms Chowdhury has been forced to move back in with her elderly parents and rely on the goodwill of outraged lawyers.

She told The Independent on Sunday: “I cannot believe what has happened to me. I was horrified and humiliated when escorted out of the building, and for a whole month, I had no idea why I was suspended. I was just doing my job. I thought the trust would want to know consultants were doing private work on NHS time. The public has a right to know what is happening with public money.

“This whole thing has completely changed me. I’m trying to stay positive but I loved my work, my department, and there are not many jobs out there. I hope the trust sees sense and tries to resolve the situation. If it hadn’t been for Julie Morris at Russell Jones and Walker who took on my case for free, I would have lost everything I’d worked for all my life.”

Ms Chowdhury qualified as a radiographer at Hammersmith Hospital in 1983. She worked her way up the management chain before starting as Ealing’s deputy imaging manager in 2003.

The alleged fraud came to her attention after starting as service manager is 2007. It was her job to balance the books, report all staff absences and make sure X-rays, CT and MRI scans were of a high quality.

But in addition, she had a separate informal agreement with the trust to read X-rays, for which she was paid £2 per report. She did this every morning and would then work through lunch to complete her normal duties.

Mr McWha alleged that Ms Chowdhury was carrying out this extra work fraudulently. He did so after Ms Chowdhury launched an investigation upon discovering his failure to upload reports and scans from 100 patients on to the imaging system, which may have caused delays in diagnosing life-threatening conditions.

The trust admitted during the disciplinary hearing that it had failed to find any evidence to support his claim. But Ms Chowdhury was sacked for gross misconduct anyway, in order to placate the consultants who were fed up with Ms Chowdhury’s interference in their business, the tribunal heard.

From July 2007 onwards she had informed managers that Dr Harvie was being paid for 14 half-day sessions a week when she was working only seven. Evidence that Dr Harvie and Dr Schnatterback were working alternate Mondays at the Clementine Churchill Hospital in Harrow, while being paid to be at Ealing, was passed on. Dr Schnatterback also claimed £250 for evening sessions when his private commitments led to an NHS backlog, the tribunal heard. Frustrated by the trust’s apparent refusal to tackle the consultants, Ms Chowdhury wrote to the NHS Counter Fraud service in July 2009. Nothing happened.

Weeks before her suspension, she angered several consultants after reporting them for claiming four hours of overtime when working only three.

Reports of duplicate claims and extra annual leave days were also made. All these protected disclosures were made to the finance director in October 2009, who referred the issue to the trust’s fraud officer. He interviewed Ms Chowdhury in November 2009; days later she was suspended.

Ms Chowdhury’s barristers, Helen Mountfield QC and James Laddie from Matrix Chambers, suggested that the case illustrated the “long-established tradition in the NHS of power being wielded by consultants”.

In defence, Andrew Sharland, said: “This claim that there was some kind of grand conspiracy is unlikely to stand up. Ms Chowdhury is making very serious allegations against senior NHS consultants. This shows an extreme prejudice towards the NHS and towards the senior consultants.”

The trust said it was unable to comment on confidential matters relating to individual employees. Dr Schnatterback told the IoS that his twice-monthly private sessions were always approved by the clinical director and he did more NHS work than he was paid for. Dr Harvie denied the allegations. Mr McWha refused to comment.

Ms Chowdhury’s lawyers told the hearing: “The stated reason for dismissal is scandalous. It does not even survive the briefest scrutiny. This is not a mistake – it is a sham.”

The judge awarded her full pay until the hearing begins in February, including pay for the work which the trust claims was fraudulently completed.

Andrew Lansley, Secretary of State for Health, said last week the Government had plans to give the current legislation “more teeth”. It can’t come soon enough.

From: http://www.independent.co.uk/life-style/health-and-families/health-news/sacked-nhs-whistleblower-vindicated-2023809.html

A policymaker’s dream. A pragmatist’s nightmare. That has to be the verdict on Andrew Lansley’s white paper “Liberating the NHS”, published on Monday.

In one sense it aims to complete the work of the last Conservative government – and much that the Blairites also wanted for the health service. The last Tory government tried to free NHS hospitals from direct management by health authorities.

It aimed to get GPs to buy patient care. And it briefly attempted to absolve ministers from responsibility for the day-to-day management of the NHS by creating a short-lived ministerial supervisory board with an NHS executive beneath it.

But it rapidly got cold feet over the likely impact of the quasi-market it had created, fearing the destruction it would cause would be anything but creative.

Labour, having first ditched much of this, recreated it earlier in the decade in a far more sophisticated form – with independent regulation and inspection and a tariff for NHS care that, in theory at least, encouraged purchasers to put quality above price.

It never quite sorted out who should do the purchasing – primary care trusts or GPs, who have been running a form of practice-based commissioning that, in most places, has been severely constrained.

But had the Blairite plans come to fruition, the purchasing of care would by now have been separated from its provision. All hospitals by 2008 would have been self-governing institutions, positioned part way between the public and private sectors.

Primary care trusts would have been solely commissioners, while their district nursing teams and therapists and community hospitals would now be independently run, either on a foundation trust model, or as social enterprises, or contracted out to the private and voluntary sectors.

There would also have been a more vibrant public/private/voluntary market from which purchasers could buy all sorts of care, with patients being able to choose between them.

What Labour – or more accurately Tony Blair and Alan Milburn, then health secretary – wanted is what Mr Lansley now aspires to create: a self-improving system run as a regulated market of competing providers driven by patient choice and commissioning in a way that no longer needs direct management from politicians and the health department.

From there, the step to an independent commissioning board, with ministers doing little other than continuing to raise the money for the NHS, setting its broad priorities, and then holding the board to account, would have been seen as an interesting evolution, not a revolution.

But the NHS is a long way from that. The Blairite reforms first slowed, then under Gordon Brown, pretty much stalled.

Half of hospitals are still directly managed and a chunk will never pass the financial viability test to become foundation trusts. PCT provider arms have still to be sorted out. Social enterprise in the NHS barely exists. Private suppliers have yet to demonstrate convincingly that they can consistently do things better and more cheaply than the NHS. And the best GP commissioners are still relative beginners.

Yet in a dirigiste decision that smacks more of old Labour central direction than anything else, the Conservative health secretary has decided not to allow GP commissioning to evolve into something demonstrably strong and effective but to require that all GPs – whether willing or not – do the job or acquiesce in their colleagues doing it for them. All in one big bang.

Mr Lansley’s plans amount to an NHS revolution. Virtually no part of the service will be untouched by his announcements on Monday, which aim, in barely three years, not just to complete Labour’s unfinished business but to go much further.

Issues Labour grappled with unsuccessfully, however, remain unanswered.

What, for instance, are the failure regimes for the new arrangements? And thousands of managers whose jobs are to go are expected to retain financial control throughout the upheaval while helping GPs take on their new role. The odds are many will bail out while they have the chance.

As Sir David Nicholson, the NHS chief executive, said on Monday: “The clarity of the vision is all very well. The big issue is how do we manage the transition.” With immense difficulty, is the answer. Mr Lansley, a man with a plan in a hurry, risks losing both financial control and performance.

From: http://www.ft.com/cms/s/0/7f3bc0e4-8def-11df-9153-00144feab49a.html