The NHS in England faces a total bill of £65bn for new hospitals built under the private finance initiative (PFI)- six times more than the buildings cost.
Figures obtained by the BBC show that some NHS trusts are spending more than 10 percent of their turnover on the annual ”mortgage” repayments.

Under PFI, private companies win contracts to build and maintain new hospitals and mental health units and the NHS pays off the ”mortgage” over around 30 years.

The 103 schemes were valued at a total of £11.3bn when they were built.

But when rising fees and additional costs such as maintenance, cleaning and catering are taken into account, the NHS will have to pay back £65.1bn over the lifetime of the schemes. Some contracts are reportedly so restrictive that trusts are forced to pay hundreds of pounds just to get half a dozen pictures put up.

According to the data, the NHS currently pays back a total of £1.25bn each year but this figure is expected to increase until 2030 when it will hit £2.3bn, the BBC reported.

The final payment will not be made until 2048.

Professor John Appleby, chief economist at the King’s Fund health think-tank, said: ”It is a bit like taking out a pretty big mortgage in the expectation your income is going to rise, but the NHS is facing a period where that is not going to happen.”

Dr Mark Porter, of the British Medical Association, added: ”Locking the NHS into long-term contracts with the private sector has made entire local health economies more vulnerable to changing conditions.

”Now the financial crisis has changed conditions beyond recognition, so trusts tied into PFI deals have even less freedom to make business decisions that protect services, making cuts and closures more likely.”

Nigel Edwards, director of policy at the NHS Confederation, which represents trusts, told the BBC: ”They were planned for a different world. I’m sure that in some cases people feel their hands are tied.”

From: http://www.telegraph.co.uk/NHS-facing-65bn-mortgage-bill-for-PFI

The Department of Health has spent almost £500 million on management consultants, including deals with firms which have hired senior Labour figures and high ranking civil servants.The disclosure of more than 100 contracts worth a total of £470 million last night engulfed the labour Government in accusations of “cronyism”.

Among those recruited by the favoured firms are a former health minister, an ex-adviser to the health secretary and a senior Whitehall official responsible for encouraging private sector involvement in the NHS.

Doctors’ and nurses’ leaders expressed concern over the use of resources which could have paid for more than 60,000 hip operations, or the annual salary of 22,000 nurses.

Critics also said the revelations indicated that the “revolving door” between the labour Government and its favourite consultant firms was spinning ever more quickly, with former senior politicians, officials and advisers linked to companies profiting directly from the policies they had introduced.

Lord Warner, a Labour peer, who was a health minister until December 2006, now acts as an adviser to PA Consulting group, which received £4.9 million from the Department of Health (DoH) in 2007/8.

Until last December he also advised Deloitte, which received almost £3 million in the same year.

Since resigning as a minister in 2006, the peer has also registered interests working for six other health care, technology and IT firms.

Matthew Swindells, policy adviser to then health secretary Patricia Hewitt between 2005 and 2007, who was earning £195,000 at the DoH, is now group managing director for health at Tribal, which earned more than £2 million from the department in 2007/8.

KPMG, the finance firm, secured £4.9 million in the same year. Last month the firm announced the appointment of Mark Britnell, currently on gardening leave from his £235,000 role as DoH director general for commissioning.

The civil servant was responsible for a policy to encourage more private sector involvement in the health service. He drew up plans which allowed a shortlist of firms – including KMPG – preferential access to lucrative NHS contracts.

Under rules intended to reduce conflicts of interests, Mr Britnell has been told that he cannot lobby the Government for his first nine months in his new job.

Other figures to have crossed from Government to private sector firms which won the management consultancy contracts include Sir Michael Barber, who was Tony Blair’s chief adviser on delivery – focusing on education and health – from 2001 to 2005.

Since September 2005 Sir Michael has been a partner at McKinsey, which was paid £9 million for management consultancy services to the DoH in 2007/8.

Lord Birt, the former BBC director general, was Tony Blair’s strategy adviser from 2000 to 2005. In 2006 he was appointed as an adviser to Capgemini UK, the British arm of the global outsourcing giant.

The DoH figures show that Capgemini UK was paid £3.2 million in 2007/8 for management consultancy to the DoH and the agency running the NHS IT programme.

Information released under the Freedom of Information Act discloses for the first time the details of 111 management consultancy contracts held by the DoH and two of its central agencies.

In total, the DoH, its IT programme Connecting for Health and the NHS Purchasing and Supplies Agency spent £470 million on management consultants in the three years from 2005/6 to 2007/8.

It came after the department had made hundreds of its own staff redundant via an “efficiency programme” intended to save money.

The spending came in addition to an estimated £350 million spent annually on consultants by 150 primary care trusts. Research has shown consultants in the NHS earning up to £2,000 a day for project work.

Matthew Sinclair, from the TaxPayers’ Alliance, said: “It is particularly alarming that many of these management consultants are political cronies or have only recently finished working for the Department of Health.”

Dr Mark Porter, deputy chairman of the BMA’s consultants committee, said: “These consultants aren’t just taking money from the front line, they are often drawing up policies which in themselves damage patient care.”

Dr Peter Carter, general secretary of the Royal College of Nursing, said: “We are unable to find any evidence about whether this represents good value.”

Andrew Lansley, the health secretary, said: “This lays bare the hypocrisy of Labour’s claims to have cut back on Government administration costs.”

PA Consulting group said Lord Warner’s advisory work for them did not relate to any contracts held with the DoH. Deloitte said the peer’s role as a strategic adviser ran from March to December last year.

Lord Warner said he only began advising PA Consulting in Autumn 2008, and was no longer advising four of the eight companies he has worked for since stepping down as a minister.

He added: “Provided people leave a decent period after they are in office before they take up such posts – which I did – provided they clear it with the Advisory Committee on Business Appointments, which I did, and provided they register the interest in a public document – which again I did, I don’t think it is right to stop people who were involved in Government forever from working elsewhere. I would defend to the death the right to have a free flow of labour.”

From: http://www.telegraph.co.uk/Millions-spent-on-NHS-management-consultants-with-Labour-links

The number of 11 and 12-year-old girls prescribed the pill by a family doctor has soared five fold in the past decade, according to new figures.
More than 1,000 girls in the first year of secondary school have been given prescriptions for the pill, according to figures from GPs, while a further 200 have long-term injectable or implanted contraceptive devices.

The disclosure prompted warnings that Britain was “facilitating the sexualisation of young people at an every younger age”.

It follows the publication of guidance by the nanny state’s National Institute for Curbing Expenditue (NICE)  that sex education should be introduced from the age of five.

Trevor Stammers, chairman of the Christian Medical Fellowship and a GP in south London, told The Sunday Times: “If sex education is introduced in primary schools in the way being proposed, we will see many more 11-year-old girls seeking contraception without pointing out the risks…. We are going to make matters worse.”

He added: “These figures illustrate the fact that the UK is facilitating the sexualisation of young people at an ever younger age.”

The latest figures came from the General Practice Research Database, which collects information on medical records from 500 GP practices.

The data also shows that at least 58,000 15-year-olds were on the pill last year – more than double the number in 1999.

By law, doctors are bound by a duty of confidentiality towards children – even if they are under the legal age of consent – unless they suspect abuse.

From: http://www.telegraph.co.uk/Huge-rise-in-11-year-olds-on-the-pill

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

Whistleblowing doctors are being gagged as NHS managers attempt to divert attention away from complaints – as the Patients Association said that the scale of the problem is “deeply worrying”.
Whether it is a complaint about a fellow surgeon botching operations or over a manager distorting waiting times, NHS whistleblowers are meant to be protected by law. They are not allowed to be gagged.

But last night in a joint investigation with the Bureau of Investigative Journalism, Channel 4 News revealled that doctors are being gagged after they have blown the whistle.

And in a number of cases their reputations are shredded as NHS managers apparently attempt to divert attention from the problem raised in the first place.

In a number of requests made under the Freedom of Information Act we discovered that over the past decade 170 doctors signed a settlement, or compromise, agreement with their trust. We were given 64 heavily redacted contracts to review.

Of those 55 – that is nearly 90 per cent – contained gagging clauses.

The trusts did not tell us if these all involved whistleblowers. But from discussions with doctors and medical law experts, we know that staff who blow the whistle are often asked to sign these confidentiality contracts.

There is a Public Interest Disclosure Act (PIDA) that is meant to be the government’s guarantee to the whistleblower that he or she will not be sacked. An FOI of 400 trusts in England asked how many staff had blown the whistle and gone to an employment tribunal, using PIDA, over the past decade. We were told of 19 members of staff who settled before their cases could be heard.

Again we were told that it is standard practice to include a gagging clause in a settlement agreement. Yet these were, by the very nature of the act they were using to take action against their employers, whistleblowers.

“Gagging clauses have absolutely no place in the NHS when it comes to concerns about patient safety”, a Patients Association spokesman told Channel 4 News.

“No Trusts should be offering them and no healthcare professional should be accepting them if it keeps problems about care kept under wraps. Doctors have a professional duty to raise concerns about patient safety.

“The scale of the problem unearthed by this investigation is deeply worrying. There should be strict rules about the circumstances in which gagging clauses can be used and all of them should be scrutinused by an external independent body with a remit to protect patient safety. The Care Quality Commission could perform such a role.”

“All the protection and legal safeguards in the world won’t reassure staff if they know for the rest of their careers their CV will always be at the bottom of the pile when applying for another job if they speak out.

“Proving that is happening to whistleblowers is next to impossible, so little can be done to protect them from this unofficial victimisation.  Addressing that will take more than just a change in the law or a new set of guidance from the Health Secretary.”

In the Baby P case, a locum at St Ann’s Hospital in north London failed to spot injuries that led to his death. Yet a paediatrician there, Dr Kim Holt, with three colleagues, had earlier raised concerns about the hospital. She was reportedly later offered £120,000 to leave and stay silent, which she refused. The hospital denies that the payoff was an attempt to gag her.

In Wales, Dr Lucy Dawson, was an accident and emergency doctor at Nevill Hall Hospital in Abergavenny for 17 years. Under the trust’s whistleblowing policy, she raised concerns in 2006 about a clinical incident which she believes could have resulted in the loss of a young man’s life.

She brought two sets of proceedings before the employment tribunal, one of which involved her whistleblowing claim and how it was dealt with.

Before either case could be heard, Dr Dawson was offered a payoff but only if she signed an agreement with a gagging clause. She refused.

Dr Dawson’s case is complex, involving a number of issues and allegations on both sides.  But she says this is not just about her.

“I cannot see a reason why, in a public organisation which is funded by taxpayers’ money, why there is not absolute transparency. I cannot think of a single reason why anybody should be paid to keep their mouth shut in the NHS,” she said.

Under another FOI we asked all 225 hospital trusts in England how much they had spent on settlement agreements over the past decade. Of those who responded, only 71 trusts admitted to entering into these agreements, 40 revealed they had spent a total of £3m. In one case, a doctor was paid a quarter of a million pounds. However, a further 31 trusts simply refused to tell us how much they had paid out.

Health Secretary Andrew Lansley has acknowledged that the scandal of Mid Staffs hospital was allowed to continue because whistleblowers were ignored. One of them was even suspended. The official inquiry report said another whistleblower was given inadequate protection and there was a culture of fear.

Our request for an interview was refused but a Department of Health statement said: “The health secretary has made it clear that patient safety should be at the heart of the NHS and that the improvement of whistleblowing policies is a key part of this.

“He has, therefore, taken action to give teeth to the protection available under the Public Interest Disclosure Act and will reinforce the NHS constitution to make clear rights and responsibilities in respect of whistleblowing.”

But Mr Lansley has also made it clear that he will not be changing the law. Yet all the evidence we have seen is that trusts have been simply ignoring the rules – devastating the careers of doctors, costing the NHS millions. And putting unknown numbers of patients lives at risk.

From:http://www.channel4.com/news/articles/uk/nhs+whistleblowers+apospaid+to+keep+mouth+shut

Almost one in five girls say they have been pregnant at least once by the age of 18, according to a Government survey.
Just under half (46 per cent) decided to keep their baby, while more than a third (36 per cent), had an abortion, the figures show.

The statistics are part of wider research on the experiences of 18-year-olds in England, published by the Department for Education.

The responses of thousands of 18-year-olds questioned for the Youth Cohort Study and the Longitudinal Study of Young People in England were analysed.

The findings show that of the 18-year-old girls questioned about pregnancy, 18 per cent had been pregnant at least once.

Of these, almost eight in 10 (79 per cent) had been expecting a baby on just one occasion, nearly one in five (18 per cent) had been pregnant twice, and 3 per cent had been pregnant at least three times.

The survey concluded there was a “noticeable trend” between the young women who fell pregnant by 18, and their GCSE results.

A third (33 per cent) of those who gained between one and four GCSEs at grades D-G had been pregnant at least once by the time they were 18, compared to just 6 per cent of those who scored eight or more GCSEs at Grades A*-C.

Teenage girls who were eligible for Free School Meals – a measure of poverty – at age 16, or who had parents who left school at 16, were also more likely to get pregnant by the age of 18, the figures showed.

According to figures published by the Office for National Statistics, there were 25.3 births for every 1,000 women under 20, in 2009.

Girls aged 15 to 19 accounted for 39,020 abortions carried out in England and Wales in 2009.

The figures show that 18 per cent of girls who said they were sexually active had been pregnant by the age of 18.

More than eight in ten (83 per cent) of the boys and girls questioned said they were sexually active by the time they turned 18.

From: http://www.independent.co.uk/a-fifth-of-girls-pregnant-by-18-survey-reveals-2032952

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

Finger on the Pulse- pointless and costly bureaucracy and ludicrous management salaries have no place in this era of austerity.
Several years ago, a friend worked as a temp in the NHS. She was the secretary to a group of middle management in a primary care trust (PCT) and spent the summer holiday before going to law school running their office. Within a few weeks, she quit. Not because she couldn’t do the job, but because she was disgusted with the waste she witnessed.

She was told not to work too hard. She would sit in meetings where the same things were discussed repeatedly without any decision being made. She was taken aside by a colleague when she attempted to improve efficiency and asked if she wanted to make everyone unemployed. It was shortly after this incident that she walked out.

All this was particularly galling to me at the time. I was working on a ward for elderly patients with dementia, and the ward didn’t even have its own resuscitation equipment. Instead, the clinical staff had to beg, borrow or steal from other wards. The amount of fruit that patients were given at lunchtime was cut.

I would sit in outpatient clinics and have to tell the families of people with Alzheimer’s that I wasn’t allowed to prescribe the anti-dementia drugs for their loved ones because the government had decreed that at £2.50 a day, they were too costly.

Frontline NHS staff look at the legions of paper-pushers in their offices and wring their hands in despair. Something needs to be done to prune this stratum in the health service, and last week there were the first signs that this might happen.

The Coalition government’s recent plans to improve the NHS will see PCTs and strategic health authorities scrapped. This is a bold move. In recent years, these organisations have morphed into unwieldy bodies that do little more than provide jobs for people who have no hard clinical skills, but who couldn’t quite hack it in the corporate sector.

While these organisations have responsibility for patient care, they are distant and detached, and it is difficult to see how they contribute in any meaningful way to the day-to-day care of patients. Yet, they cost millions to maintain. A report published last week found that more than 300 NHS executives have salaries larger than the Prime Minister.

Ian Miller, for example, worked as the interim director of finance and investment for South East Coast Strategic Health Authority and earned £310,000 for nine months’ work from April 2009 to January 2010. This equates to £400,000 a year, which would pay for 14 nurses. Financial experts have described these salaries as “unsustainable”.

The plans are not without potential pitfalls: will GPs, for example, be able to manage such large budgets effectively? But I wholeheartedly support the essence of these proposals, which is that pointless and costly bureaucracy and ludicrous management salaries have no place in this era of austerity.

I also believe that giving power to clinicians will benefit patients. It’s doctors and nurses who have a far greater understanding of what is needed and where resources should be directed than a person with an MBA sitting in an office well away from the action.

My friend, who is now a successful corporate lawyer, says that if the NHS wants to operate along corporate lines, it needs to heed corporate principles: no business would employ so many people who don’t do what the business is set up to do – namely to treat patients.

I hope the Government’s proposals address this once and for all, and that patients and those who care for them are put back at the centre of the NHS.

From: http://www.telegraph.co.uk/health/7895365/Banishing-the-NHS-paper-pushers.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

Patients less likely to die in some hospitals finds Guardian investigation which suggests that vascular surgery patients are less likely to die in bigger, busier hospital units. Doctors in the NHS do not know how well they are performing and whether they are more likely than their colleagues to kill or cure their patients, because of a widespread failure to collect the information, a Guardian investigation reveals.

The results of a major exercise looking at one particular procedure – vascular surgery – show a massive variation in death rates among patients admitted for planned operations and reveal that some hospitals have unacceptably high mortality.

The investigation reveals the hollowness of patient choice, which the coalition, like Labour before it, has made the centrepiece of NHS policy. The data amassed by the Guardian from surgeons at 116 hospital trusts after an extensive freedom of information trawl is not publicly available – and is at odds with what appears on the NHS Choices website, set up to help patients choose where to be treated.

The Guardian investigation focused on vascular surgery, where there is a significant risk of dying in planned operations, but the conclusions apply to every other branch of medicine – with the exception of heart surgery, where doctors collect and publish their individual results.

They embraced transparency following the Bristol babies scandal in the late 1990s, when doctors were struck off the medical register over the deaths of babies who underwent operations for heart defects that they might have survived at other hospitals.

The investigation reveals that:

• More than a decade on from Bristol, doctors are failing to collect and publish data that would tell them and their patients how well or badly they are doing and allow patients to chose a hospital where their risks are lowest.

• Death rates in planned vascular surgery for abdominal aortic aneurysm (AAA – to prevent a burst artery) vary from under 2% in some hospitals to at least 10% in 10 of them. More than 5,000 of the operations are carried out each year – most of them planned admissions in which the patient decides where to go for surgery.

• Patients are less likely to die in the bigger, busier hospital units where surgical teams are more skilled because they do more of the operations. The results strongly suggest that smaller units should close. This presents a major challenge to the health secretary, Andrew Lansley, who has stopped all hospital reorganisation.

The most worrying death rates were at Scarborough hospital in Yorkshire, where 29% of patients scheduled in advance for AAA surgery died in the three-year period from 2006 to 2008. The national average was just over 4%. Scarborough says it has now stopped offering the operation.

Results for planned surgery at several other hospitals also gave cause for concern, including Gateshead on 12.9%, Hull on 9%, Pennine Acute Trust on 8.4% and Leeds on 7.1%. Gateshead and Hull blamed a high number of difficult cases, Pennine argued there had been an issue around the way transferred cases were recorded, which is now resolved. Leeds pointed out that it takes difficult cases and has brought its death rates steadily down.

The data also shows the UK lagging in Europe. The second Vascunet report, on vascular surgery across 10 European countries in 2008, found the average death rate was just 2.8%.

Professor Sir Bruce Keogh, medical director of the NHS and a former heart surgeon, who was involved in successful efforts to publish mortality data in cardiac surgery said: “Surgeons have a moral and professional duty to know what they are doing, how well they are doing it and to use that information to help them improve – otherwise they have no right to be doing it at all.” He intends to take steps to ensure that senior doctors personally take responsibility for the accuracy of data relating to their specialist area that is published by their trust – whether in surgery, cancer care, diabetes or arthritis.

David Mitchell of the Vascular Society, which has been collecting mortality data on a voluntary basis from surgeons for several years but does not publish it, said they had embarked on a quality improvement programme, aimed at bringing the average death rate down to 3.5%.

From: http://www.guardian.co.uk/society/2010/jun/13/nhs-death-rates-huge-disparity