The NHS spends up to £86m a year on thousands of websites that are difficult to find, confusing for patients and which do not meet their needs, according to research commissioned for a Department of Health report.
Research for the NHS Digital Communications Review, conducted by communications agency Precedent and leaked to the Health Service Journal, found 2,873 nhs.uk websites that were in use and more than 1,000 other nhs.uk sites that were no longer active. A total of 287,300 web pages were accessible and Google listed 56 million pages within the nhs.uk domain.

The researchers concluded that the public would appreciate fewer contact points online but the digital communications review said there was not sufficiently strong evidence that there were too many NHS domains.

Instead the review said there was a need for a digital brand strategy with standards for all NHS sites. It said a central information role was “sound in principle but its adoption requires a general acceptance that it is the role of the centre to perform this organising function.”

EHI understands that the researchers suggested that the NHS may be spending too little on too many websites rather than too much.

The Precedent researchers said that two of most recognised health service websites, NHS Choices and NHS Direct, were often competing for attention and although NHS Choices focuses on health information and local service data and NHS Direct offers online diagnostic tools the differences in content between the two was not clear to patients.

They added: “NHS Choices and NHS Direct are both established as national sites with similarities of positioning, brand and audience. This confuses users about the ‘definitive’ access point for NHS information and the roles of each site.”

Research for the review also concluded that GP practices websites were also the weakest of the health service’s online offerings.

It added: “GP surgeries have by far and away the poorest sites, in that they have the largest percentage of problems identified. GP sites failed to provide the means to allow interaction with users.”

The researchers found that overall the NHS was failing to meet patients’ needs for online functionality such as online appointment booking, repeat prescription requesting, test result reporting and contact via email. Only 50.3% of sites included email addresses. “The NHS is not making itself easy to do business with,” the report said.

The research is also critical of the accessibility of websites and said that vulnerable members of the public were not been catered for with 30% of sites exhibiting at least one “notable deficit in standards” which might cover poor quality content, lack of NHS branding, poor navigation or out of date content.

The researchers said it was very difficult to estimate the cost to the NHS of the websites with responses to information on usage and cost received from only 188 out of 4,121 sites. However it estimated that the cost of running the sites “could be as high as £86m per year” and said costs could be higher as those figures did not include set up costs.

The digital review, however, said no broad conclusions could be drawn about value for money “given the relatively low cost of establishing and operating small, focused websites.”

The researchers claimed the public “struggled to locate the NHS online with a Google search” when searching on health-related terms and said the scale and depth of information on offer was daunting to many. It said patients also often ended up going to information offered by Wikipaedia, the charity sector and websites such as NetDoctor and PatientUK rather than the NHS.

The researchers said interviews with users revealed that the public wanted to see “one NHS” online which would tally with their perception that they were receiving care from “one NHS”.

The Department of Health said the white paper had outlined the government’s plan to being about an NHS information revolution to give people access to comprehensive, trustworthy and easy to understand information. Information on how this will be achieved is to be set out in the DH’s information strategy, due to be published in the autumn.

From: http://www.e-health-insider.com/nhs_%C3%82%C2%A386m_website_spend_confusing

Ministers are considering ‘privatising’ an NHS agency that provides 50,000 nurses and other workers to the health service.
An advert has been placed for private sector investment in NHS Professionals, a company owned by the Department of Health, which provides bank staff to fill shifts in the health service.

Unions criticised the plan saying it was privatisation and that NHS Professionals was set up to stop the NHS being ripped off by private agencies charging large sums for staff to work unfilled shifts.

NHS Professionals has 50,000 staff on its books who cover around two million shifts in 77 organisations around England.

Karen Jennings, head of health at Unison, said: “The whole reason that NHS Professionals was set up, was because private agencies were ripping off hospitals by charging them outrageous fees for recruiting or finding staff for shifts. It makes no sense at all to bring back private companies who will want their slice of the action in return.

“This proposal is purely about Tory plans to promote privatisation and hive off parts of the NHS to private companies, regardless of the consequences on patient care.”

A Department of Health spokesman said: “This is about exploring ways that the commercial skills of the independent sector can make NHS Professionals Ltd a more efficient business and save the NHS money.

“NHS Professionals Ltd is a business, not a public service, and like any business it must ensure its services are as efficient and effective as possible. We want to discuss options with potential independent sector investors that could help to achieve this, and ultimately improve services outcomes for patients.”

It comes as the Royal Berkshire Hospital Trust announced up to 600 jobs will be cut to make £60 million worth of savings in the next few years, pledging that frontline staff would not be affected.

The Royal College of Nursing said last month that thousands of NHS jobs were being cut despite Government promises to protect frontline services.

The nurses’ group said it was aware of almost 10,000 posts lost through recruitment freezes, redundancies and people not replaced when they retired, or which face cuts in the future.

From http://www.telegraph.co.uk/Ministers-accused-of-privatising-NHS-nursing-agency

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

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

Self governing NHS hospitals – known as foundation trusts – have had their private income capped to date, but this is to be lifted in the NHS overhaul.
The Foundation Trust Network believes the move will spark a burst of innovation in the sector.  But campaigners said they were worried NHS services would be harmed.

To get foundation trust legislation through parliament in 2003, ministers agreed to a cap on private work to ensure the hospitals remained true to their NHS traditions.

This has stopped some of the leading hospitals in the NHS competing with private firms for patients.

But that will now change under the proposals unveiled in Monday’s white paper. Health Secretary Andrew Lansley said he wanted to create a “vibrant” industry of social enterprises by scrapping the rule and ordering all NHS trusts to become foundation trusts within three years.

Sue Slipman, director of the Foundation Trust Network, said the move would make a big difference.

“It is exciting for foundation trusts. We will have to wait to see what exactly happens, but there are huge opportunities to innovate.”

She said one of the most obvious areas for expansion would be in fertility services where treatment on the NHS is severely restricted.

“In the past these patients have had their NHS cycles and then left for private treatment. That is money that has been lost to the system.”

She also said mental health trusts may be interested in offering talking therapies to businesses for their workforce health schemes.

University College Hospital in London has already gone down this route with a private US health firm which has located a private unit on its site for cancer treatment.

The firm leases the space as well as paying for the NHS services it uses, such as intensive care, radiology and cleaning and catering.

The trust has also established a joint venture with a private firm to provide pathology services.

Sir Robert Naylor, the chief executive of the trust, said: “These initiatives bring in money which can then be reinvested in NHS services.”

Many NHS hospitals also operate their own private wings, although most of these only bring in a small amount of income. The exceptions are specialist centres such as the Royal Marsden cancer hospitals and Moorfield Eye Hospital.

But John Lister, of the union-funded pressure group Health Emergency, said he had concerns.

“Hospitals could overstretch themselves in chasing private patients which in turn takes away from the NHS side of it.  It also creates perverse incentives whereby they stand to make more money by getting patients into their private wings.

“They say money is reinvested in services, but I am not sure this is always the case. Some of these hospitals have huge surpluses, the money is moved around and does not end back where it should. If we get more and more of this, it will be a step towards the privatisation of the health service.”

From: http://www.bbc.co.uk/news/10619463

Health Direct wonders if you had a good weekend- as nearly a quarter of the UK popultaion is overweight and the number of alcohol related deaths has more than doubled since the early nineties according to the Office for National Statistics.
The latest edition of the Social Trends report also reveals that one-in-five men and one-in-seven women over 16 drink more than double the recommended daily allowance of alcohol once a week.

The ONS has been capturing statistical data since the 1970’s on the way that we live.

During that time, life expectancy has increased by almost 10 years for men, who on average live until they are 77.8 years old, and seven years for women, who lived on average until they are 82.

The number of heavy smokers has fallen from 26 per cent of men and 13 per cent of women to seven and five per cent respectively.

Mr Hughes said: “Health is undoubtedly an important indicator and life expectancy is a good indicator of the national health.”

Mr Hughes said: “The statistics highlight some of the main social changes over the last four decades. We are now living longer, less of us get married, and household sizes are smaller.”

“More of us have cars, women are having babies later in life, and more of our household spending goes on housing, water and fuel.”

Mr Hughes said: “It is interesting that more than two thirds of people aged 18 and over in Great Britain believe that they do not need a partner to be happy and fulfilled in life.”

The latest analysis of the way we live also shows that UK residents are taking nearly 40 million more foreign holidays than in the 1970s, with Spain remaining the most popular destination.

This year’s edition of Social Trends will be the last available in paper form, showing how even our statistical analysis is moving with the times, Mr Hughes said.

From: http://www.telegraph.co.uk/Britons-are-drinking-more-getting-fatter-but-living-longer-official-figures-show

Health Direct warns that with the weekend coming up, patients are much more likely to die if they are rushed to hospital at weekends than during the week, because too few senior staff are working.
Higher deaths rates at weekends mean thousands of patients every year are dying unnecessarily, according to the findings.

Patients were seven per cent more likely to die if they were admitted as an emergency case on a Saturday or Sunday, the largest study of its kind shows.

The higher rates were equivalent to 3,369 extra deaths a year, more than the total number who die every year on Britain’s roads.

Conditions including heart attacks, heart failure, stroke and some cancers all had higher deaths rates at weekends than Monday to Friday.

The team behind the findings warned that a lack of senior staff, such as consultants, working weekends and reduced access to specialist services could be behind the higher death rates.

Hospitals should look closely at weekend staffing rotas and other potential problem areas, according to researchers.

Dr Paul Aylin, from Imperial College London, who led the study, said: “We estimate that there were over 3,000 more deaths than expected at weekends in 2005/06 compared to weekdays – more than the number of people dying in road accidents in 2006.

“Clearly this is a significant number of people and we need to get to the bottom of what this means. Staffing levels are often lower at weekends, with fewer senior medical staff around, and some specialist services are less available.

“We believe this may be contributing to the increase in mortality rates on Saturdays and Sundays but we would like to see more research.”

The study looked at all emergency patients admitted to 163 hospital trusts across England between 2005 and 2006.

The findings are published in the journal Quality & Safety in Health Care.

The study, supported by Dr Foster Intelligence, the independent research company, reviewed more than four million admissions and 215,000 deaths.

From: http://www.telegraph.co.uk/Thousands-of-hospital-patients-dying-because-too-few-senior-staff-work-weekends

Millions of British women have potentially dangerous diets ranging from teenage girls missing out on healthy food to pensioners not getting their vitamins it is claimed.
Health experts pulled together the results of 110 separate scientific and medical research studies to paint a worrying picture of what the UK’s female population eats.

Not only are women in the prime of their lives not getting the right amount of nutrition, which in turn can affect the weight of newborn babies too, but the poor diet extends across all age groups.

The review, commissioned by the independent body Health Supplements Information Service (HSIS) discovered a lack of balanced meals in a nation hooked on junk food or obsessed with eating fads. Dietitian Dr Carrie Ruxton and researcher Dr Emma Derbyshire of Manchester Metropolitan University reviewed 110 published papers covering women’s health for the journal Nutritian Bulletin.

They discovered that even at school age, more than half of girls aged 11-18 to not get the recommended intake of such minerals as magnesium, found in fruit and veg to increase energy.

One in four were not getting enough zinc, 30 per cent were lacking potassium, 16 per cent were deficient in iodine and almost half failed to reach recommended levels of iron in their diet.

Between the ages of 19 to 50, 20 per cent of women were still not getting enough iron, vital for the production of healthy red blood cells, and 11 per cent had a deficiency in the vitamin B2.

In particular there was a worrying lack of vitamin D among this child-bearing age group as this is the vitamin pregnant women need to strengthen a baby’s bones and reduce the risk of an underweight birth.

Up to 80 per cent of adult women get less than the amount recommended by EU health organisatons.

Even as they get older and are not constrained by the time pressures of work or bringing up children the diets of women do not become much better.

People aged over 65 need more vitamin D in their diet to prevent brittle bones but only a third of women in this age group meet their recommended daily levels, said the HSIS collective research.

Women need to make better dietary choices to ensure that they consume enough vitamins and minerals and, thus, safeguard their health. As a result, those women missing out on vital daily vitamins and minerals, should supplement their diet with a daily multivitamin. In addition, those not consuming 2 portions of fish a week, one of which should be an oily fish, should take a fish oil and Omega 3 supplement. ”

The report blamed a variety of factors from busy lives to a lack of cooking skills for the lack of key ingredients in a daily diet and called for more awareness of fortified foods and vitamin and mineral supplements to make up for this loss.

From: http://www.telegraph.co.uk/health/Millions-of-British-women-on-danger-diets

A shortage of junior doctors to start work in hospitals this August is forcing the NHS to try to recruit from India.Tighter immigration rules introduced in recent years meant many overseas medics left Britain and returned home.

But the exodus, added to new European regulations limiting the hours of doctors, caused unfilled vacancies.

Attempts to recruit scores of Indian doctors foundered on a disagreement between government departments.

“We pulled the plug on overseas recruitment far too quickly,” said Professor Derek Gallen, who is postgraduate dean of medical training for Wales.

“We didn’t realise what the implications of that action would be two, three or four years down the line,” he added.

The Welsh Deanery is one of four medical training schools across the UK which has been recruiting in India over this year.

The other deaneries involved cover the Severn area, the West Midlands and Northern Ireland. In total, they plan to take more than 100 junior doctors over to the NHS.

The deaneries are looking to recruit in areas such as paediatrics, obstetrics, gynaecology, anaesthesia, as well as accident and emergency.

The need for junior doctors is most acute outside the big metropolitan areas.

The European Working Time Directive, which was fully introduced into the NHS last August, limits doctors to working no more than 48 hours per week and has left gaps on rotas.

Some district general hospitals have had trouble attracting enough staff to cope with the changes leading, in some cases, to services being cut.

In May, the Victoria Hospital in Kirkcaldy had to close its accident and emergency department overnight for a week due to a shortage of junior doctors.

At Erne hospital in Enniskillen, its obstetric and gynecology service had to be suspended for several weeks for the same reason.

The shortage of junior doctors means hospitals are struggling to fill vacancies, and having to devise their own initiatives to recruit doctors wherever they can find them.

From: http://news.bbc.co.uk/1/hi/health/10202803.stm