The NHS has wasted more than £11m using ambulances as “waiting rooms” to get around Labour’s target that patients should be treated within four hours of entering casualty.

New figures reveal the time spent by crews waiting outside hospitals for their patients to be admitted last year was the equivalent to funding 31 fully staffed ambulances to do nothing for 24 hours a day.

The statistics released by NHS ambulance trusts show the amount of time ambulances are forced to remain idle is increasing each year. In the first nine months of 2009 the total so-called “dead time” in England reached 284,000 hours — more than the whole of 2007.

The four hour target was introduced in 2004 in an effort to end the scandal of patients left on trolleys overnight waiting to be seen by doctors.

However, it has led to hard-pressed casualty departments refusing to admit patients until they can be sure they can be seen within the four hour limit. Waits of more than two hours occur in hundreds of cases each year.

Mike Penning, a shadow health minister, said: “It is a scandal that desperately needed frontline paramedics are trapped at hospitals around the country because of Labour’s fixation with the target culture.

“It can’t be right that bureaucracy has taken over from clinicians being able to put patients first, rather than watching the clock. Millions of pounds are being wasted and patients are suffering.”

The Conservatives have promised to slash the number of NHS targets and hand more power to doctors.

From: http://www.timesonline.co.uk/tol/news/politics/article7078867.ece

The National Health Service’s £12.7bn scheme to create an electronic patient record will “no longer provide the comprehensive solution” originally promised, says a top NHS executive.

Until now, health ministers and officials have acknowledged that the world’s biggest civilian information technology project is running four to five years late, and have said they want to make £600m savings on the £4bn-plus worth of contracts held by CSC and BT to deliver it.

Up to now, however, no one has conceded that the programme will fail to deliver everything that was promised back in 2003 when the contracts were signed.

Following a revamped deal with BT – the London supplier, which has cut £112m or about 12 per cent off its contract – Ruth Carnall, the chief executive of the London strategic health authority, has said the spending reduction means “it will no longer be possible to provide the comprehensive solution that was anticipated in 2003″.

Not all NHS organisations in London will now receive the software needed to deliver the records, Ms Carnall makes clear in a letter to London chief executives.

Meanwhile, Christine Connelly, the health department’s chief information officer, has said that only about half of London’s 32 big acute trusts will now get the full solution. Others will be able to add clinical systems to existing patient administration systems.

In place of a dedicated means of sharing records across hospitals, and between hospitals and primary care – a key goal of the programme – London will have to rely on the national summary care record, Ms Carnall says. However, this contains little other than allergies and current medication, and does not yet carry referral or discharge information.

On top of this, the Tories have said they will scrap the national record if they win the election.

BT will no longer have to deliver new systems to London’s ambulance service or GP practices. And London can afford to pay for Map of Medicine, a decision support tool for treating patients, for only one more year, says Ms Carnall.

In much of the country, installations in acute hospitals are stalled after CSC missed a deadline to get its solution running at Morecambe Bay NHS Trust. The supplier risks being fired, but is likely to sign a similar, more restricted, deal if it does hit a new deadline for a successful installation.

Glyn Hayes, president of the UK Council for Health Informatics Professions, said it had been clear for some time that the programme was to be reduced. “But this is the first official admission that there are things it will not do that it was intended to do.”

It was unclear, he said, whether the Conservatives would in fact scrap the national record if they won. “But if they do, it knocks a hole in London’s plans,” because without it the capital had no easy means of transferring patient information between settings.

From: http://www.ft.com/cms/s/0/fba8e660-436d-11df-833f-00144feab49a.html

The biggest single supplier to the £12bn NHS NPfIT white elephant programme is on the brink of being fired from a key part of its contract after failing to meet a deadline to install systems at hospitals in the north west.

CSC, which holds the contract for two-thirds of England, missed the deadline to get the Lorenzo electronic medical record product up and running at the Morecambe Bay NHS Trust’s hospitals.

CSC originally said the system would go live almost two years ago, in June 2008.

The failure is the latest crisis for the much-troubled programme which is running at least four or five years late.

CSC and BT, which covers London, had each been given a deadline to get new systems running smoothly in a big, acute, hospital, with the Department of Health warning last year that it would “look at alternative approaches” if that failed to happen.

BT has since installed a system at Kingston Hospital to the health department’s satisfaction. Christine Connelly, the department’s chief information officer, said it now needs to go through a due process under its contract with CSC which could yet see a new deadline set and met.

But if progress is not made, she told the Financial Times, the department has the option of cancelling CSC’s contract to install the systems in acute hospitals and letting hospitals choose from other suppliers.

Morecambe Bay, she said, remained keen to continue and under the contract CSC has to be given time to propose a fresh deadline for deployment, with the programme then assessing the credibility of that and whether to agree it.

“We have to walk through this step by step,” Ms Connelly said. “In a contract as large and complex as this we cannot just set a deadline and say that’s it. We have to act responsibly and not expose the department and the taxpayer to risk.”

But, she warned bluntly, “we cannot wait for ever”.

CSC has contracts worth about £3.3bn to install hospital, community, mental health and GP systems, with the latter elements progressing much better.

But Ms Connelly said if CSC’s plan was not credible the NHS had the option of cancelling the acute hospital part of the deal, thought to be worth around £1bn. CSC did not respond to attempts to contact it last night.

BT, having hit its deadline, has agreed a contract variation, signed yesterday, which the department said would save the NHS £112m, or about 12 per cent of the contract value, as part of the £600m savings the health service is seeking on the programme as a whole.

As part of the deal, BT is now signed up to install much fewer full systems in London, with about half the hospitals likely to add clinical systems to their existing IT arrangements, rather than replacing everything, Ms Connelly said.

Allowing hospitals to choose other suppliers is already starting to happen in the south of England, although the first contracts for that have yet to be signed. That should start to take place from May this year, she said.

From: http://www.ft.com/cms/s/0/6a9f7ee2-3d26-11df-b81b-00144feabdc0.html

Go to the doctor for a sick note today and you may find yourself issued instead with a “fit note”.

For the first time in almost 90 years doctors will no longer simply certify whether a patient is fit for work or not, but will have a form allowing them to state whether the patient “may be fit for work” if certain conditions were met.

These include an employer offering a phased return to work, altered hours, changed duties or adaptations to the workplace.

There is considerable scepticism about the initiative as the employer does not have to take any notice of the “fit note”. But Dame Carol Black, the labour government’s health and work tsar whose 2008 recommendation led to the change, says she hopes the scheme will be the start “of a quiet revolution”.

The government, she notes, has spent billions of pounds on welfare-to-work programmes to get people off incapacity benefits and back to work. “But until now it has done almost nothing at the very start of the process that can lead people to dependence on long-term sickness benefits in the first place. The logical thing is to staunch the flow.”

Many people with back pain, neck pain, anxiety and stress are able to work with only limited adaptations needed from their employer, she argues.

Recent research by the insurer Aviva, however, shows two-thirds of employers have little or no knowledge of the change and how it will work for them. Just 5 per cent thought it would reduce absence rates that are estimated to cost the UK more than £100bn a year. The research also shows 57 per cent of employees do not believe their doctor is qualified to judge them fit for work.

The British Medical Association has supported the change in principle, but some GPs fear it could change their relationship with patients, turning them from patient advocates into judges of someone’s ability to work.

Dame Carol says she does not consider it “good advocacy” just to give people repeated sick notes when it is established that the longer people are off sick the less likely they are to return to work.

“What this is really about is a change of culture, and the way people think about work and what they can do,” she says. “It will be a slow revolution. I don’t expect rapid change. But it is the start of better early intervention.”

From: http://www.ft.com/cms/s/0/5e715882-3a94-11df-b6d5-00144feabdc0.html

The taxpayer’s commitment to pay for hospitals, schools, roads and other projects built under the private finance initiative has topped £200bn, documents published in the Budget showed – a total that would pay to run the National Health Service for two years.

The cash will be paid out over the next 25 years to cover the capital cost and services of the projects, with annual payments set to peak at just over £10bn a year in 2017.

The commitments, totalling £210bn, come as concerns are mounting that public services with big PFI projects may be at a disadvantage as the government seeks efficiency savings to help reduce the deficit.

PFI contracts usually include maintenance requirements that cannot be abandoned and must be paid for.

Although dangerous in the long term, the public sector tends to put off maintenance when expenditure is squeezed.

Treasury officials acknowledge that talks with PFI providers may be required to persuade them to offer more flexibility than the contracts stipulate.

The Budget report on UK infrastructure assumes the PFI will continue to provide finance for schools, hospitals and housing.

However, it warns that the massive demand for private capital to build energy, transport, waste and water projects – at £40bn to £50bn a year for the foreseeable future – means these “may compete for the same sources” of finance, at a time when the government plans to halve its own capital spending.

From: http://www.ft.com/cms/s/0/84618b94-383b-11df-8420-00144feabdc0.html

National Health Service productivity has fallen by 3 per cent, or 0.4 per cent a year on average, since 2001, latest official figures show. The biggest annual fall, 0.7 per cent, occurred in 2008, the most recent year for which the Office for National Statistics has figures.

The continued decline in productivity will be an embarrassment for health ministers, since it shows that the huge increase in the numbers of patients treated as NHS spending has doubled in real terms has been outpaced by the growth in the service’s workforce and the volume of goods and services bought by the NHS.

The ONS has adjusted its measurements of quality, putting a value on any increase in short-term survival rates, health gains following treatment, shorter waiting times and some measures of the performance of primary care – for example, improvements in blood pressure or cholesterol levels.

Without that adjustment, the productivity fall would have been even steeper – 7.8 per cent since 2001.

The figures make grim reading for the NHS. Health ministers concede the service, which faces a real-terms freeze in funding, will need to make efficiency savings and productivity gains worth between £15bn and £20bn over the next few years.

Mike O’Brien, the health minister, said Labour had inherited a severely under-staffed and underfunded NHS, and addressing that had affected productivity.

He said: “Most economists, and HM Treasury, accept it is difficult to grow capacity and productivity at the same time, yet the NHS maintained virtually flat productivity [a 0.3 per cent a year decline] over the longest period of sustained growth in its history.”

The figures come, however, with some qualifications. The ONS has improved its measures of quality over the years but there are still significant aspects of quality that the data fail to capture.

For example, longer consultations with a family doctor would show up as a productivity fall, even if they left patients more satisfied and produced better long-term clinical outcomes. The NHS has also hired more specialist cancer nurses, who have improved the quality of care but not extended life expectancy, producing a productivity drop.

The ONS said yesterday that the quality measures were “the best we have at the moment but measuring quality [in the NHS] is very difficult”. Furthermore, while the figures are for the UK, no data are available for the productivity of care in Scotland.

From: http://www.ft.com/cms/s/0/67f8afe0-37b0-11df-88c6-00144feabdc0.html