A British man has been sentenced to eight years in prison for his role in what law enforcers describe as the “most serious known breach” of the regulated UK medicines supply chain.
Following a four month trial in Croydon Crown Court, 64-year old Peter Gillespie was found guilty for working with an international network of criminals to introduce fake drugs into the UK’s legitimate supply chain during a five month period in 2007.

The case, known as Operation Singapore, centred on the importation of more than two million doses of counterfeit life saving medicines into the country.

More than half of these were captured by the Medicines and Healthcare products Regulatory Agency, but a huge amount – almost 900,000 doses – initially reached pharmacies and patients.

Despite an immediate recall of Eli Lilly’s antipsychotic Zyprexa (olanzapine), Bristol-Myers Squibb’s bloodthinner Plavix (clopidogrel) and AstraZeneca’s prostate cancer drug Casodex (bicalutamide), 700,000 doses were left unaccounted for, putting the health of many Britons in jeopardy.

Mick Deats, the MHRA’s head of enforcement, also revealed that plans to bring in three other counterfeit drugs – Pfizer/Eisai’s Alzheimer’s drug Aricept (donepezil), UCB’s antiepileptic Keppra (levetiracetam) and Johnson & Johnson’s antipsychotic Risperdal (risperidone) – had been foiled.

“They didn’t get to bring them in but they were definitely well on the way to being prepared to receive them,” he told the media, according to Reuters.

“This is serious criminal activity and puts people’s lives at risk,” Deats said, and stressed that the Agency would not hesitate “to take all appropriate action to eliminate the risks posed by counterfeit medicines and take action against those engaged in their supply”.

However, he also noted current evidence suggests that medicines supplied through the UK legitimate supply chain are genuine and safe to take.

Since 2004 there have been just 15 known instances of counterfeit medicines in the UK regulated supply chain, and given that 850 million prescriptions are dispensed every year in the UK, the likelihood of receiving a counterfeit medicine remains extremely rare, the MHRA said.

From: http://www.pharmatimes.com/Man_jailed_for_worst_ever_breach_of_medicines_supply_chain

Public satisfaction with the NHS has reached record levels, according to a leading health economist.
Writing on the BMJ website, Professor John Appleby said 64% of people were either very or quite satisfied with the NHS.

Critics have questioned why the government is reorganising the NHS when the public is happy with it.

The Department of Health said reform was necessary to sustain the future of the NHS.

Professor John Appleby was quoting data from the latest annual British Social Attitudes Survey.

It shows satisfaction is at the highest level since the survey began in 1983 and much higher than their levels of 39% in 2001.

Professor Appleby, of the King’s Fund think tank, said: “The NHS must have been doing something right to earn this extra satisfaction, something even Conservative supporters have noticed, and something probably not unadjacent to the large rise in funding since 2000.”
Reform

Much of the NHS budget is to be handed to GPs as part of healthcare reforms in England.

In the survey, satisfaction with GPs was at 80%, just short of its peak in the 1990s.

A Department of Health spokesperson said: “We welcome the findings which show public satisfaction levels are good, particularly with GPs. Our reforms will empower GPs, not bureaucrats, to commission services.

“If we want to sustain the NHS in the future, we need to modernise it now.”

Last week the British Medical Association called on the government to halt to its overhaul of the NHS.

“With survey results like this you have to question why the government feels it is necessary to embark on such a radical and costly re-organisation of the NHS right now, particularly when you take into account the financial pressure the service is already under”, a spokesperson said.

Professor Appleby concluded: “Future British Social Attitudes surveys will reveal how satisfied the public remain as funding for the NHS is squeezed and the government’s proposed reforms take shape on the ground.”

Leading health organisations have slammed the Government’s “responsibility deal” on alcohol and refused to sign up as partners.
The six organisations, including Alcohol Concern, the British Medical Association and the Royal College of Physicians, accused the Department of Health of allowing the drinks industry to dictate health policy.

Under the deal, the drinks industry would be asked to sign up to a number of alcohol pledges.

These reportedly include ensuring 80% of products on the shelf are labelled for unit content, raising awareness of the unit content of drinks in pubs and clubs and taking action to reduce under-age drinking.

There would also be a pledge to commit to action on advertising and marketing by promoting responsible drinking and keeping alcohol adverts away from schools.

But the six organisations which had been involved in the Government’s Responsibility Deal Alcohol Network (RDAN), which also include the British Association for the Study of the Liver, the British Liver Trust, and the Institute of Alcohol Studies, refused to support the deal.

They said the pledges were neither specific nor measurable, that they lacked scope and that there was no evidence such voluntary interventions would be effective.

The statement read: “We have not yet seen evidence that Government is working towards a comprehensive, cross-departmental strategy to reduce alcohol harm, based on evidence of what works, with rigorous evaluation metrics.”

The organisations called on the Government to provide:

• A clear and firm commitment on how it intends – via evidence based policy – to tackle affordability, availability and promotion of alcohol as part of a cross-government strategy;

• A clear presentation of the steps that will be taken if the current RDA objectives are not met in 12 months’ time;

• A firm commitment to consider change – including through regulation – if voluntary commitments from business are not met after an agreed time period.

Don Shenker, chief executive of Alcohol Concern, said: “This is the worst possible deal for everyone who wants to see alcohol harm reduced.

“There are no firm targets or any sanctions if the drinks industry fails to fulfil its pledges.  It’s all carrot and no stick for the drinks industry and supermarkets.”

“By allowing the drinks industry to propose such half-hearted pledges on alcohol with no teeth, this Government has clearly shown that when it comes to public health its first priority is to side with big business and protect private profit.”

Dr Vivienne Nathanson, director of professional activities at the BMA, said: “The Government has talked the talk in respect of wanting to tackle alcohol misuse but when it comes to taking tough action that will achieve results, it falls short.

“Instead it has chosen to rely on the alcohol industry to develop policies – given the inherent conflict of interest these will do nothing to reduce the harm caused by alcohol misuse.”

Katherine Brown, Head of Research and Communications at the Institute of Alcohol Studies, said: “The most effective means of reducing alcohol-related harm is through adjustments in affordability, availability and promotion.

“These policies are supported by a broad evidence base and have been recommended to Government by a recent cross party House of Commons Health Committee report.

“The Responsibility Deal fails to address any of these policy areas and we are yet to see any real proof that Government is looking into developing a cross-departmental comprehensive alcohol strategy, based on evidence of what works.”

Alison Rogers, chief executive of the British Liver Trust, said: “For more than 10 years we have been persuaded to play the long game, sitting and watching the alcohol industry cultivate their relationship with the Government.

“Now it must stop for the sake of the 100 families losing loved ones each week from alcohol-related liver disease.”

And Sir Ian Gilmore, the Royal College of Physicians’ special adviser on alcohol, said: “The industry pledges published in various newspapers do not give practising doctors, who see the rising tide of health harm from drink in their daily practice, any confidence that they will get to the core of how we reverse this entirely preventable cause of illness and death.”

Sir Ian was among a trio of experts who recently warned the Government that up to 250,000 extra lives could be lost in the next 20 years in England and Wales unless tough restrictions on alcohol are introduced.

The liver death rate in the UK is 11.4 per 100,000 people, more than double that of other countries with similar drinking cultures, including Australia and Holland.

Health Secretary Andrew Lansley said: “We have made clear from the start that the responsibility deal is just one strand of the Government’s wide public health policy. It explicitly excludes cost and price competition to avoid conflicts of interest.

“The Treasury have already announced an introduction of a new tax on super-strength beers; the Home Office have made their announcement on a ban in sales of alcohol below cost and plans to tighten licensing laws; and, our public health strategy sets out how local areas will be given a ring-fenced public health budget to ensure alcohol misuse gets the priority it deserves.

“In tandem to this action, the responsibility deal is working with the industry on voluntary agreements to get speedier results. For example, to improve unit labelling. The Responsibility Deal has achieved more in the last six months than the previous Government’s Coalition for Better Health did in a year and a half. What is more, this is only the first step.”

From: http://www.independent.co.uk/health-bodies-attack-government-alcohol-plans

The NHS will be ‘tested to the limit’ as unprecedented savings ordered by ministers take effect on the front line, a powerful group of MPs have warned.
The Coalition pledge to increase spending on health in real terms will not be met, the Commons Health Select Committee has warned.

It means the scale of the savings required to meet rising demand with a shrinking budget is even greater.

The report quoted NHS chief executive Sir David Nicholson saying: “It is huge. You don’t need me to tell you that it has never been done before in the NHS context and we don’t think, when you look at health systems across the world, that anyone has quite done it on this scale before.”

Sir David predicted last year that the NHS would need to save between £15bn and £20bn over the next four years to keep pace with an ageing population, rising costs and lower funding settlements from government.

The Health Select Committee warned that severe cuts in social care budgets will also hit the NHS as there is a real danger some local authorities will have to reduce the eligibility criteria they use for care services meaning the NHS will have to pick up the pieces.

A large part of the savings is expected to come from paying hospitals less for treatments and operations but the report warned this could result in trusts refusing to provide surgery that they make a loss on.

The Committee was also critical of the government’s reorganisation of the NHS saying that many experts had suggested that it was too complex to try and attempt this at the same time as making such huge savings.

The report said the government must urgently release details of how much they expect the changes, which include abolishing primary care trusts and setting up GP consortia, to cost.

Stephen Dorrell MP, chairman of the committee, said: “The government’s plans for health and social care are based on assumptions which will test these services to the limit.”

Nigel Edwards, NHS Confederation acting chief executive said: “The Committee has hit the nail on the head with the concerns it has highlighted in its report. It has shown a thorough understanding of the fierce pressure that the health and social care sectors are now under.

“All at the same time, NHS trusts are grappling with unprecedented efficiency savings, major management cuts and radical structural reforms. It’s a mixture that is causing real anxiety among NHS leaders.

“We need the government to show that it understands these issues when it announces the next stage of its programme later this week.”

Dr Peter Carter, general secretary of the Royal College of Nursing, said: “This report echoes our fear about the current efficiency challenges facing the NHS. We fully support the Committee’s view that efficiency savings should not be about cuts, but achieving more with the same amount of money.

“Sadly, with 27,000 posts already earmarked for cuts, this message is clearly not reaching NHS Trusts. Some Trusts are already cutting jobs and services at an alarming rate, making short-sighted decisions to plug the gaps in their budgets.”

Dr Hamish Meldrum, chairman of the British Medical Association, said: “Doctors have been working hard to help identify how services can be delivered more efficiently without affecting patient care, and are at the forefront of leading innovation and improving services that will benefit patient and reduce costs. However, doctors are also seeing widespread cuts to staffing and services. There is evidence of posts being frozen and services rationed.

“Despite the Government’s pledge to protect the NHS budget, it would appear that the sums are wrong and there is a now an additional shortfall of over £2 billion. NHS Employers has asked staff to plug this gap by hammering their pay even further.”

John Healey Shadow Health Secretary said: “The last thing the NHS needs is a high-cost, high-risk reorganisation at a time when, in the government’s own words, it is attempting to make ‘unprecedented’ efficiency savings.

“But of equal concern is that the plans follow promises made both before the election and in the Coalition Agreement that there would be no more top down reorganisations in the NHS.

“Promises since broken by a Health Secretary operating in isolation in Whitehall and running a rogue department.”

A Department of Health spokesman said: “The Government is committed to the NHS – to sustain and to improve services in the face of a tough economic climate. But even with this commitment, in order to meet demand and improve the quality of services, the NHS needs to make up to £20 billion of efficiency savings by 2015.

“Reform isn’t an option, it’s a necessity in order to sustain and improve our NHS. We have been clear that the NHS must cut back on bureaucracy, not on frontline care.

“Overall funding will increase by more than 10 per cent in cash terms over the Spending Review period. And the day-to-day funding for the NHS will grow in real terms for the next three years.”

From: http://www.telegraph.co.uk/NHS-will-be-tested-to-limit-by-savings-MPs

Tens of thousands of GPs’ patients are now waiting more than 18 weeks from referral to treatment following the Government’s decision to scrap performance management of the flagship target.
The number of patients missing out on treatment within 18 weeks of referral jumped by 15% between July and September this year, after PCTs were released from their strict obligation to meet the target in June.

Legal experts warned the rise could leave GP consortia at risk of being sued by patients when they take over commissioning, since being treated within 18 weeks remains a right under the NHS Constitution.

Department of Health statistics show the proportion of people treated within 18 weeks increased steadily from 2007.

Numbers peaked this July, when 93.3% of admitted and 98.1% of non-admitted patients were treated within target, just after the NHS Operating Framework removed it.

By September, the proportion of admitted patients missing out jumped from 6.7% to 7.5%, and of non-admitted patients from 1.9% to 2.2%.

Overall, 45,000 patients missed out on treatment in 18 weeks during September, up 15% from 39,000 in July. Some 12.6% of patients awaiting orthopaedic or trauma treatment, and 10.6% awaiting oral surgery, waited more than 18 weeks.

Ben Troke, partner in health and social care at Browne Jacobson solicitors, warned: ‘When commissioning passes to GP consortia, it’s hard to see responsibilities [for applying the NHS Constitution] not going with it. There’s a real risk of legal challenge.’

‘Whether a claim would be successful is hard to say, but being dragged through the courts can be damaging even if you win. Courts are starting to rely on the NHS Constitution as a ground for decisions and every consortium can expect to keep their lawyers busy.’

At least one SHA has admitted waiting times are slipping.

NHS South Central said health systems in Oxfordshire, Southampton and south-west Hampshire had been assessed as failing ‘principally due to financial issues and concerns on workforce and 18 weeks’.

Dr Jennifer Dixon, director of the Nuffield Trust, said: ‘Once you scrap hard targets, it’s likely actions to achieve them will wane. I guess that’s what we’re starting to see.’

Dr Chaand Nagpaul, GPC negotiator, said PCTs were already taking advantage of the target’s removal: ‘We’re getting reports of trusts delaying treatment so they can address financial problems. The Government is engaging in double-speak, removing targets on one hand but committing to patients’ rights on the other.’

From: http://www.pulsetoday.co.uk/NHS waiting times increasing after targets scrapped

Patients could be forced to make doctors’ appointments through remote call centres under an efficiency drive to save the NHS £600 million.
A report commissioned by the Department of Health says GPs’ administrative support teams should be radically altered to cut costs.

The plan would involve centralising appointment bookings through a national call centre, clearing surgeries of thousands of staff.

However, doctors and surgery staff say the proposal is “flawed”.

Unison, the public sector trade union, said call centres could not provide the “very personal service” that patients needed.

The report by the NHS Confederation’s Foundation Trust Network looks at ways back office functions could be streamlined.

It says the message to all NHS bodies is that they must “simplify, standardise and share” to save money.

The NHS is “highly fragmented”, with a total of £2.8 billion spent on back office functions.

The trust, headed by Tony Spotswood, chief executive of Royal Bournemouth and Christchurch Hospitals, recommends: “There are substantial efficiency gains to be achieved through transforming GP back office functions, such as the potential to move towards regional and national GP appointment centres.”

A Unison spokesman said surgery staff not only made appointments.

He said: “A call centre cannot begin to do the job these staff do.”

Doctors and their support staff were more forthright.

“Even your average alien would consider this hilarious stupidity,” said Dr David Iles from Southampton.

The Department of Health has distanced itself from the proposal. A spokesman said there were “no plans” for a national call centre.

From: http://www.telegraph.co.uk/Book-time-to-see-GP-via-central-call-centre

Labour chair of public accounts committee laments ‘bad story of missed opportunities’ in tackling health inequality.
Labour’s stewardship of the NHS produced an alarming health gap that saw people living in the poorest neighbourhoods in England die almost two years before those in the rest of the country, in what the head of the public accounts committee today calls a “bad story of missed opportunities”.

Margaret Hodge, the Labour chair of the committee, said that despite the doubling of the NHS budget and rising prosperity levels there had been “lots of reports and inaction about health inequality”.

“New Labour came in in 1997 and announced it would put reducing health inequalities at the heart of tackling the root causes of ill-health. But it was unacceptable that health inequalities only became a NHS priority in 2006, and primary care trusts not required to report on it until 2007. It was too late.”

The committee’s report found that, as a result, the gap in life expectancy between the poorest areas and the national average grew by 7% for men and 14% for women, and Labour missed its own targets on public health. It says that the Department of Health did not have enough resources and lacked leadership and a “clear focus on health inequalities”.

“This was a bad story … of missed opportunities,” said Hodge, who said the premature mortality amounted to 3,335 excess deaths across the country. There were not enough family doctors in poor areas and no ideas to prevent public health problems rather than reacting to crises in, for example, obesity.

The report says two-thirds of the poorest places in the country still had “lower levels of GP coverage than the national average of 60 GPs per 100,000 population”. In the north-east, the report said, this dropped as low at 25 per 100,000.

Hodge, a minister in the last government, said Labour should have forced GPs in “single-handed practices” to band together in bigger practices in poorer areas, and paid new doctors more money to work in difficult areas. Single-handed practices make up 22% of all GP surgeries in poor areas.

“We should have drawn up new contracts, closed down single-GP practices and basically told them who to hire and how much to pay them,” she said, pointing out 10 of the 146 measures outlined in a doctor’s contract rewarded physicians for focusing on the neediest groups.

The committee’s response comes as the health secretary, Andrew Lansley, is preparing a white paper on public health to be published this month. The report says that at present around 4% of the NHS budget is spent on public health, although actual spending is not easy to identify. It calls on the government to develop “transparency and accountability for this [money]“.

Hodge said the committee had identified three public health prevention strategies – stopping smoking, high blood pressure and lowering cholesterol – which cost £24m out of a total budget of £3.9bn. “But it was not spent. We are too reluctant to spend on prevention in this country and end up spending billions on treatments.”

The government welcomed the report, saying it was committed to renegotiating doctors’ contracts so that disadvantaged areas could deal with their population’s health needs. “We’ve already set out proposals for how areas with the poorest health will be given money to help them be healthy, and public health budgets will be ringfenced,” said Anne Milton, the public health minister. “We need a new approach to improve the health of the poorest, fastest.”

From: http://www.guardian.co.uk/health-inequality-labour-margaret-hodge

NHS patients will be denied hospital beds because they will be bed blocked by the elderly and vulnerable who are unable to get council care after government cuts, a health service chief has warned.The Coalition has promised to increase the NHS budget over the next four years, even as it cuts more than £40 billion from other public services.

Patients will be left untreated as the NHS struggles to mop up the consequences of severe cuts in local authority funding, said Nigel Edwards, the head of the NHS Confederation.

The Coalition has promised to increase the NHS budget over the next four years, even as it cuts more than £40 billion from other public services. Local councils will bear some of the heaviest cuts.

In a letter to The Daily Telegraph, Mr Edwards — whose organisation represents NHS trusts running hospitals and ambulance services — says the cuts in local authority budgets will force them to reduce care services for the elderly and vulnerable.

“Less support from council services will quickly lead to increased pressure on emergency services and hospitals,” he writes. “Hospital beds will be blocked for those who badly need care because the support services the elderly require after discharge will not be available.”

Calling for a greater co-ordination of council care services and NHS facilities, he says: “When it comes to the care of the most vulnerable in our society, it really is essential that the NHS and local authorities are in it together.”

His warning coincides with the most explicit admission yet from a Cabinet minister that the Coalition’s cuts in public spending will cause genuine distress.

Danny Alexander, the Chief Secretary to the Treasury, says in an interview with The Daily Telegraph that the cuts will mean real hardship for many. “For a lot of people it’s going to be very difficult indeed,” he says.

Mr Edwards’s warning comes in response to this week’s spending review, which set out Coalition plans to address the deficit in public finances. Central government support for councils in England will be reduced by 27 per cent over the next four years, leaving them seeking deep cuts in the services they offer.

Councils last year spent £14 billion on adult social care services. Care funding is the largest part of council budgets not legally ring-fenced, leaving it vulnerable to cuts.

To reduce the scale of any cuts in care, the Treasury this week earmarked £2 billion over the next four years for councils to spend on adult care services. However, local government leaders and charities said it was not enough to compensate for larger cuts in council budgets.

The Local Government Association, which represents councils in England and Wales, said even with the extra cash councils would still face a £4 billion shortfall in budgets for adult social care by 2014. A spokesman for the LGA said the spending review would have a significant impact on care services.

Some councils have already begun raising the entry criteria for care to those judged to be in the most severe need.

Government sources said ministers were aware of the likely pressure on the health service and had set aside funds in the NHS budget for care services.

A spokesman for the Department of Health said it was understood that social care could have an impact on NHS demands and that is why they were strengthening programmes that would integrate hospital care with care in the community, as well as providing the extra funding.

He added that “we expect local health and social care professionals will work together” to “improve outcomes for everyone”.

Kieran Mullan, from the Patients Association, said: “Social care and the NHS do not exist in silos. One impacts directly on the other. Poor services in the community lead to admissions to hospital and lack of services prevent discharge when it might be best for the patient.”

From: http://www.telegraph.co.uk/Spending-Review-2010-NHS-faces-bed-blocking-crisis

The number of under-18s admitted to hospital because of drinking has increased by a third, according to a new report.The figure went up by 32 per cent between 2002 and 2007, with 36 children a day being admitted for alcohol related conditions, the study by the charity Alcohol Concern found.

Over the last five years, London Ambulance Service responded to 11,780 alcohol-related call-outs involving under-18s at a cost of more than £2.5m, the research showed.

In 2009/10, West Midlands Ambulance Service responded to 1,296 alcohol-related call-outs involving under-18s at a cost of almost £250,000, while the North East Ambulance Trust responded to just under 1,000 at a cost of £175,000.

In all cases, more young girls were seen by ambulance crews than young boys, the charity said.

Alcohol Concern also found that between 2004 and 2009 28% more girls were admitted to hospital via accident and emergency departments for alcohol than boys – 23,347 girls compared to 18,159 boys.

The report ‘Right time, right place: Alcohol-harm reduction strategies with children and young people’ calls for earlier identification of young people engaged in ‘risky’ drinking such as young people attending A&E or getting into trouble with the police for alcohol, so they can access information, advice and support.

The charity’s chief executive, Don Shenker, said: “As long as alcohol remains as heavily promoted as it currently is, young drinkers will continue to consume far more than they might otherwise, leading to inevitable health harms, wasting ambulance and police time.

“As well as tackling the ludicrously cheap price of alcohol in some settings, we want all under-18-year-olds who turn up at A&E to be advised and supported to address their drinking.”

A spokesman for the Department of Health said: “This report shows the devastating impact that alcohol has on the lives of young people who drink too much. We must educate them so they understand how bad it is for their health now and in the long term. And we must do more to stop shops selling alcohol to under 18s.

“Everyone has a part to play in this. Parents, police, education and social services need to work together. The new Public Health Service will give communities the power and budget to tackle alcohol problems in their areas.”

From: http://www.independent.co.uk/figures-show-rise-in-drinkrelated-hospital-admissions-for-children

Patients will be able to view their medical records online, email their GP and compare doctors across Britain under plans for an “information revolution” in the NHS to be led by Martha Lane Fox, the internet entrepreneur.
Martha Lane Fox says that the most useful online services for consumers should be made available to NHS patients over the next few years.

Those requiring treatment for cancer will be able to study survival rates – and waiting times – for different medical teams and then opt to have treatment where they wish, under the plans to be announced today. Proposals are being drawn up to give patients online access to their medical records.

Miss Lane Fox says that the most useful online services for consumers should be made available to NHS patients over the next few years.

It is hoped this will help drive up hospital standards as patients choose not to use the services of poor doctors, who will then lose funding. Patients will also be asked to rate the service and treatment they receive from different hospitals and medics.

They will be able to choose which GP they register with and whether to be treated at an NHS hospital or private or charity-run institution, within certain cost limits.

Miss Lane Fox, the founder of Lastminute.com, says the data could prove invaluable.

The Department of Health is the only major Whitehall department which will not see its spending cut this week. However, Andrew Lansley, the Health Secretary, still has to push ahead with major reforms as the ageing population is causing a sharp rise in health-care costs.

Miss Lane Fox, the Government’s digital champion said: “A recent YouGov poll found that 40 per cent of people believe the NHS can learn from the service offered by supermarkets, banks and utility companies. I’ve always believed in the power of information and technology as an incredibly useful tool.

“There’s clearly an appetite for a new approach. The Department of Health is launching a consultation this week into how information and technology can help people take more control of their health and make the best choices for themselves and their families.”

The consultation will study how internal data could be offered to websites like TripAdvisor or Mumsnet, which could “empower patients and families”.

Mr Lansley said: “The first principle of the White Paper is that the NHS should ensure that for patients, ‘no decision about me, without me’ is the invariable practice. To realise this means patients must have more say and more choice.”

From: http://www.telegraph.co.uk/NHS-patients-to-see-medical-records-online