The last Labour government left taxpayers with a £60 billion PFI bill for the scores of new hospitals it built during its 13 years in power, new figures reveal.
They shine a fresh light on the profligacy of the party’s use of Private Finance Initiative (PFI) schemes.

Labour ministers only paid £5 billion of the £65 billion “spent” on building more than 100 hospitals between 1997 and 2010.

The rest of the money, some £60 billion, must still be repaid by the taxpayer – with some of the gigantic debt lasting for more than 30 years.

The highest profile case concerns Barts and the London NHS Trust project, signed by ministers 2006, which provided two new hospitals in the capital.

By the time the coalition took office four years later nothing at all had been repaid – leaving an outstanding bill of £5.3 billion.

Jesse Norman, the Conservative MP, accused Labour of “extraordinary hypocrisy”. Their PFI bill for hospitals will cost every working family in Britain £3,600, according to Mr Norman’s figures.

PFI schemes were started by the last Conservative government under John Major in the early 1990s. However, they mushroomed under Labour with Gordon Brown, as Chancellor, using them as a way of meeting his own public borrowing rules.

Under the schemes, instead of the government raising money upfront, a private company is given a lengthy contract to build a school or hospital and then provides related ‘services’ to the public sector.

The Government leases the building for the length of the contract before it goes back into public ownership.

Any change, however small, to the building or service provided can be charged at sky high rates, allowing the company to make a huge profit.

New analysis of official figures shows that Labour initiated PFI contracts to build 103 new hospitals between 1997 and 2010. The party proclaimed at the time of the last election it has been responsible for a “new generation” of hospitals in Britain.

The total “unitary charge” payments for these hospitals was £5.1 billion. However, many projects will not be fully paid off for more than two decades – with the last one not “completing” until 2048.

The total accumulated “unitary charge” payments for the hospitals will be £65.1 billion – meaning that only 7.8 of the total was actually paid for before Labour left office.

Costs have escalated because of rising fees and additional charges for maintenance, cleaning and catering.

According to official figures, the NHS currently pays back £1.25 billion each year – but this figure will increase until 2030 when it is expected to hit £2.3 billion.

The Barts and the London NHS Trust project, to develop Barts into a “centre of excellence” for cancer and cardiac treatment and to build a new hospital at The Royal London , was started in 2006 – but payments will not even commence until 2013-14 and will not be finished until 2048.

By that time, it will have cost £5.3 billion despite only having a “capital value” of £1 billion, according to the Treasury.

Poorly negotiated PFI contracts have already led to examples of waste including Queen Elizabeth Hospital in Woolwich having to have 64 visits a year from pest controllers even if there are no pests to control. When there are pests, the trust must pay for further visits.

In another example, officials at the Central Middlesex Hospital in north west London said that, on average, contractors charged it £210 to install an electric socket.

Senior Labour figures including Gordon Brown strongly defended using PFI schemes while in power but, more recently, leading shadow ministers have admitted errors.

John Healey, the shadow health secretary, said earlier this month: “There is definitely a case for saying we were poor at PFI, poor at negotiating PFI contracts from the outset.”

Andy Burnham, a former health secretary who is now shadow education secretary, said last year: “We made mistakes. I’m not defending every pen stroke of the PFI contracts we signed.”

Mr Norman, a member of the Treasury select committee, said: “This shows extraordinary hypocrisy. The last Government claimed to be investing in public services.”

“In fact their true investment was less than less than one tenth of what they claimed. Labour didn’t manage to pay for even one new PFI hospital on their watch.”

“Labour maxed out the nation’s credit card with a £60 billion bill for new hospitals, loading future generations with staggering debt repayments.”

“After bringing the country to the brink of bankruptcy, they now have no credible plan to clear up the mess they left us with.”

“Their approach – to spend less without making any reforms at all – would leave the NHS in crisis.”

From: http://www.telegraph.co.uk/Labour-left-taxpayer-60billion-bill-for-new-hospitals

Parents should not dose up children who have a simple fever on regular spoonfuls of paracetamol and ibuprofen, according to doctors who say that doing so could put them at risk.
The advice comes after a study indicated that children given paracetemol before 15 months were more than twice as likely to develop asthma by the age of six as those not given it

A misplaced “fever phobia” in society means parents too frequently use both medicines to bring down even quite slight temperatures, say the paediatricians, who warn that children often receive accidental overdoses as a result.

A high temperature is usually the body’s way of fighting an infection, according to advice issued today by the American Academy of Pediatrics, so to bring it down could actually lengthen the time a child suffers.

Doctors too readily advise parents to give the medicines, known collectively as “antipyretics”, according to the Academy.

The advice comes after a study indicated that children given paracetemol before 15 months were more than twice as likely to develop asthma by the age of six as those not given it.

Writing in a clinical report on fever and the use of paracetamol and ibuprofen in children, the authors warn: “Combination therapy with acetaminophen [paracetamol] and ibuprofen may place infants and children at increased risk because of dosing errors and adverse outcomes, and these potential risks must be carefully considered.”

Doctors, they write, should begin “by helping parents understand that fever, in and of itself, is not known to endanger a generally healthy child”.

They explain: “It should be emphasized that fever is not an illness but is, in fact, a physiologic mechanism that has beneficial effects in fighting infection.”

It slows the spread of bacteria and viruses, enhances white blood cell production, and “actually helps the body recover more quickly from viral infections”.

Despite this, they say: “Many parents administer antipyretics even though there is either minimal or no fever.”

Half consider it to be a fever even if their child’s temperature is not higher than 38C (101.4F), they report.

Many doctors are happy to advise parents to give paracetamol and ibuprofen alternately – known as combination therapy – believing side effects are very rare and minimal.

But the Academy warns: “Unfortunately as many as one half of parents administer incorrect doses.”

A frequent error is giving children adult-sized doses, while children who are small for their age can also receive doses that are too high even if their parents follow box instructions based on age alone.

In Britain, the National Institute for Health and Clinical Excellence (Nice) advises that the use of anti-pyretics “should be considered in children with fever who appear distressed or unwell”.

However, they “should not routinely to used with the sole aim of reducing body temperature in children with fever who are otherwise well”.

Similarly, “paracetamol and ibuprofen should not routinely be given alternately to children with a fever”, although it states this approach “may be considered if the child does not repsond to the first agent.”

The guidance also states: “The views and wishes of parents and carers should be taken into consideration.”.

Children’s paracetamol solutions like Calpol and ibuprofen solutions like Nurofen for Chilren are sold over the counter in chemists. Recommended dosage quantities vary by age.

There are different strength solutions for different ages, meaning it is possible for parents with different aged children to mix up which they are giving.

Rather than focusing on temperature alone, doctors should advise parents to look out for signs of serious illness, make sure their child is drinking enough, and “advocate a limited number” of doses of medication.

Dr Clare Gerada, chairman of the Royal College of GPs, said the two medications should be used “only to help a child be comfortable, and not to chase down a temperature.”

However, she said: “I don’t think we over-prescribe anti-pyretics and I don’t think parents give them too readily.”

She added: “I think they have their place. The younger the child the more cautious you have to be.”

She did not think that giving ibuprofen and paracetamol together was more likely to lead to increased dosing errors, saying: “In my experience of 20 years as a GP, parents are usually pretty careful.”

“I think the most important thing to be worried about is keeping medicines out of the reach of children, because some of them taste quite nice.”

They could also give “a false sense of security” in depressing a high temperature with a more serious underlying cause than a mild infection, she said.

From: http://www.telegraph.co.uk/Fever-medicines-given-to-children-too-readily

Overweight pregnant women are more likely to be overdue and have more complicated births, a study has found.
Women who were overweight or obese before they conceived were more likely to have a longer pregnancy, need to have labour induced artificially and to go on to require caesarean section births.

The research was conducted by a team at Liverpool University who examined the records of almost 30,000 women who gave birth over four years.

Three in ten obese women were overdue, defined as still pregnant ten days after their due date, compared with around two in ten of healthy weight women.

More than a third of obese women had their labour induced, compared with just over a quarter of normal weight women, the study published in the British Journal of Obstetrics and Gynaecology found.

In addition almost three in ten obese women had an induction of labour which later resulted in a caesarean delivery compared to less than two in ten normal weight women.

However, more than seven in ten obese women still gave birth naturally and the rates of complications in labour and for the baby were the same as in normal weight women.

Other studies have found that maternal obesity is now one of the biggest risks in childbirth. In 2007 it was found that half of all women who died during pregnancy or soon after giving birth were overweight.

Maternity units have had to order special operating tables, wheelchairs and other equipment to deal with the increasing number of obese mothers and doors have had to be widened to accommodate them.

Management of obese prolonged pregnancies is often difficult as induction of labour is associated with a high risk of caesarean section and the possible complications that follow including infection, bleeding and clots.

Dr Sarah Arrowsmith, from the University of Liverpool’s Institute of Translational Medicine, and lead author on the paper said: “Maternal obesity has become one of the most commonly occurring risk factors in obstetric practice including greater risk of prolonged pregnancy.

“The importance of this research is that it investigates delivery outcomes for women who are obese with prolonged gestation and receiving labour induction. The fact that the majority of obese women did have a vaginal delivery, with labour complications being largely comparable to normal weight women, suggests that induction of labour in obese women with prolonged pregnancy is a safe method for managing these difficult pregnancies.

“Our findings were somewhat unexpected, given the well-reported complications surrounding obesity in pregnancy, but were clinically reassuring.

“Our current research is focused towards underlying causes of prolonged pregnancy, which can affect up to ten per cent of women, as currently we know little about it.”

Professor Philip Steer, BJOG editor-in-chief said: “Maternal obesity is on the rise and is associated with pregnancy complications. The risk of caesarean section is heightened when the woman is induced, however, it is promising to see that a large number of obese pregnant women delivered vaginally.”

From: http://www.telegraph.co.uk/Obese-pregnant-women-have-more-complicated-births-research

Pregnant women were denied the seasonal flu jab in some parts of the UK, before swine flu began claiming more lives, because not all GPs were aware that mothers-to-be had been made a priority group to receive the jab this winter.
Louise Silverton, deputy general secretary of the Royal College of Midwives, told the Guardian that a number of pregnant women had been refused the vaccine by family doctors in autumn.

“In October, when GPs started telling patients to come for immunisation, some pregnant women got it and some didn’t. GPs sent some of them away because they thought they didn’t need it, because no one had told them that pregnant women had been added to the list of groups of people considered ‘at risk’,” she said.

Research shows pregnant women are four times more likely to develop serious complications if they catch H1N1 swine flu, which is the main strain of seasonal flu circulating this winter. There has been concern that takeup of the jab protecting against all three strains of flu has been low among pregnant women.

Silverton also criticised the decision by the health secretary, Andrew Lansley, to cancel the usual advertising campaign intended to prompt the 16 million Britons classed as vulnerable to have the jab.

“It was short-sighted of the Department of Health not to have the usual campaign, she said. “It was done to save money. I agree with the government’s overall aim of reducing government advertising, but they should have been more selective and kept the campaign for all at-risk groups.

“Usually there are posters on buses and all sorts, but this year there was nothing. It was a wasted opportunity not to have the awareness campaign stressing the importance of people in at-risk groups being vaccinated.”

A majority of the 50 people to die from flu so far this winter had not had the three-in-one jab at least two weeks before falling ill, the Health Protection Agency said.

The outbreak has so far claimed 50 lives and left 783 people in intensive care, amid vaccine shortages and low takeup rates of the seasonal flu jab.

From:  http://www.guardian.co.uk/pregnant-women-flu-jabs-midwives

Nearly £200,000 in compensation has been paid to women who have become pregnant or been hurt after they were fitted with a popular contraceptive implant.

The NHS has received more than 1,000 complaints about Implanon, a device that had been hailed as the future of family planning.

The procedure involves injecting a plastic implant under a woman’s skin, which releases the “pill” hormone progesterone, guarding against pregnancy for up to three years.

The procedure is regularly given to under-16s who are not deemed responsible enough to remember to take oral contraceptives on a daily basis.

Figures obtained by Channel 4 News show that 584 women who had the hormone-filled tube inserted into their arms have reported unwanted pregnancies to the Medicines and Healthcare Regulatory Agency.

There have been a total of 1,607 complaints about scarring and other problems associated with the device, the majority made by doctors and nurses who claimed it was difficult to insert properly and could not be checked afterwards. In the most serious cases, NHS Trusts have offered settlements to seven women totalling nearly £200,000.

Some women who took Implanon terminated pregnancies and suffered the breakdown of relationships.

One woman, named as Lara, said her marriage collapsed due to the stress. “I don’t want kids at this time. It really disturbed me,” she said.

MSD, which manufactured the implant, said it was replacing Implanon with a new contractive implant named Nexplanon.

In a statement, it added that the active ingredient would remain the same but, unlike Implanon, the new implant would show up on X-rays and CAT scans. The applicator has been modified, the company said.

It added that a training programme was available for health professionals involved in fitting the devices.

Family planning clinics in England have reported rapidly increased use of contraceptive implants, from 16,000 women in 2005 to nearly 82,000 in 2010. Implanon, which cost £90 per treatment, was more than 99 per cent effective.

A spokesman for the MHRA said: “The reports we received from health care professionals and consumers played a strong role in the update of the device.”

From: http://www.telegraph.co.uk/Women-win-200000-payout-over-pill-implant-pregnancies

Midwives have criticised the postcode lottery in maternity care after official NHS figures revealed caesarean rates are twice as high in some hospitals as others.
In some cases even neighbouring hospitals have widely varying rates of caesarean section, revealing that it is not necessarily down to the characteristics of the local population.

The proportion of women having their first antenatal appointment within the first 12 weeks of pregnancy varies 11-fold, according to the data published by the NHS Information Centre.

This may be due to women recognising that they are pregnant later but also reflects on how well organised services are.

The figures show that almost nine in ten women were seen in the first 12 weeks at the Royal Cornwall Hospitals NHS Trust compared with less than one in ten at Walshall Hospitals NHS Trust in 2009/10.

Similarly more than three in ten women had a caesarean birth at Imperial College Healthcare NHS Trust, in London – twice as many as at Shrewsbury and Telford Hospital NHS Trust in Shropshire.

However the variations cannot be completely explained by deprivation as neighbouring hospitals will had large differences in rates.

At Rotherham NHS Foundation Trust 87.6 per cent were seen in the first 12 weeks, five times higher than in neighbouring Barnsley Hospital NHS Trust where 17.2 per cent were seen.

There were twice as many caesareans at Hereford Hospitals NHS Trust than at nearby Shrewsbury and Telford.

Nationally more women are being seen within the first 12 weeks in 2009/10 compared with the previous year and the caesaearan section rate has remained for the last year at around one in four of all births, the majority of which were conducted as emergencies.

The figures show that the proportion of births delivered by doctors instead of midwives has increased from less than one in four in 1989/90 to almost four in ten in 2009/10, as a result of more caesarean and instrument deliveries due to greater numbers of older and obese mothers giving birth.

Tim Straughan, Chief executive of The NHS Information Centre, said: “The figures show that the experience women have of NHS maternity care varies markedly across the country and even within regions.

“Rates of caesareans and access to antenatal assessment in the first 12 weeks of pregnancy vary according to which hospital they use.

“In some trusts, there may be specific demographic or clinical reasons that explain why they carry out, for example, more caesareans. But others will need to examine closely the full range of reasons why their rate is different from the national average of about one caesarean delivery for every four deliveries.”

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM), said: “These results show that there is a postcode lottery when it comes to maternity services, and this is worrying when those services are part of a ‘national’ health service. Women should expect and receive high quality care wherever they live, not care that is based upon chance and plain old good luck.

“Superficially the huge variations revealed in this report are a concern and further analysis is needed to find out why they are occurring.

“The variation on the first antenatal booking is astonishing and those on caesarean section rates – already widely known – are worrying in their persistence at such a level.

“Midwives are the experts when it comes to normal births and will deliver the vast majority of women having their baby in this way. The fact that midwives’ involvement in birth has decreased will be reflected in the increase in caesarean rates and instrumental deliveries over the years.

“I think some of the large variations could be linked to staffing levels; as we know one-to-one care from a midwife increases the possibility of a normal delivery but I am sure this is not the whole story. It could also be related to how services are organised.

“In the statistics around intervention, maternity units need to be looking at each other’s practice to see where they can learn from each other, and make their services better for women and their babies.”

From: http://www.telegraph.co.uk/Maternity-postcode-lottery-revealed-in-NHS-figures

The Royal College of Midwives (RCM) has accused the government of backing down on a pre-election pledge to increase midwife numbers in England.

It says mothers and babies will suffer unless the 3,000 extra midwives it says were promised are delivered by 2014.

RCM general secretary Cathy Warwick told its annual conference there are too few to cope with a rising birth rate and increasingly complex births.

The Tories said the rise was now not needed as the birth rate was stable.

She said: “Just before the election, both the prime minister and the deputy prime minister told us that they would commit to continuing the previous government’s promise to give us more midwives.

“We’ve just done a survey of all the heads of midwifery and they’ve got vacant posts but they’re having difficulty filling them.”

The RCM survey of 83 out of 194 heads of midwifery suggested maternity units were already seeing budget and staffing cuts.

Some 30% said their budgets had fallen over the past year, while a third had been asked to reduce staff.

And two-thirds surveyed said they did not have enough midwives to cope with demand.

Meanwhile, the number of live births in England has risen by 19% between 2001 and 2009, to 670,000 a year.

The RCM said births over the same period had become more complex, with obese pregnant women and older or teenage women needing extra support.

The Royal College of Obstetricians and Gynaecologists (RCOG) said maternity services were facing many challenges.

President, Dr Tony Falconer, said: “As well as need for more midwives, there is a need for more consultants to deal with the increase in the number of high-risk pregnancies.”

A Conservative Party spokesman said: “The commitment to 3,000 midwives made in opposition was dependent on the birthrate increasing as it has done in the recent past. It was not in the coalition agreement because predictions now suggest the birthrate will be stable over the next few years.

“People can be absolutely clear that our commitment to meet the needs of expectant mothers remains, and we will continue to train new midwives to meet the demands arising from the births.”

From: http://www.bbc.co.uk/news/health-11772485

Emergency patients are being let down by the health service because managers are more concerned with meeting targets by treating those with appointments, the heads of Royal Colleges warn.

In a letter to The Daily Telegraph, some of the country’s most senior doctors say they are “deeply frustrated” at the low priority given to Accident and Emergency.

Targets concerning waiting times and cancelled operations, introduced under Labour, result in managers pushing doctors to operate on patients whose care has been pre-planned, in order to avoid financial penalties. But they can also mean that those who come in as emergency cases are stabilised and admitted but then left to wait for surgery.

Studies have shown that elderly people with fractured hips who do not undergo surgery within 48 hours are less likely to regain full mobility. Younger patients with shattered pelvises, from motorcycle or horse-riding accidents, are less likely to walk again if their operations are delayed.

A report published on Thursday criticised care for the elderly, finding that two thirds of those who died within a month of surgery had not received proper care and that they had often been left in pain.

Most of those patients were being treated for bowel conditions or broken hips, which are usually admitted as emergency cases.

John Black, president of the Royal College of Surgeons, said the report echoed concerns that surgeons had been raising for some time.

In the letter, Mr Black said: “It is a source of deep frustration to our members that hospitals have become organised to deal quickly with elective operations at the cost of properly managing emergency care.”

The Coalition’s reforms of the NHS could help by making hospitals more accountable to GPs for the care they provide, he said.

The letter was signed by Peter Nightingale, president of the Royal College of Anaesthetists; Peter Kay, president of the British Orthopaedic Association; Finbarr Martin, president of the British Geriatric Society; Mike Horrocks, president of the Association of Surgeons; and Clare Marx, the Royal College of Surgeons’ lead representative in matters of patient safety.

Mr Horrocks said: “In recent years, the NHS has been set targets for elective operations to bring down waiting lists.

“This has been fantastic for patients with non-emergency conditions, but came at the detriment of those who require urgent treatment as hospitals focused on hitting those targets.

“The new government has committed to moving away from targets and towards measuring and rewarding hospitals who deliver good outcomes and this report should provide further evidence that this approach is correct.”

Under Labour, patients had to be treated within 18 weeks of a referral by their family doctor.

Surgeons have told the Telegraph that this resulted in extreme pressure to operate on any patients in danger of failing to meet that target, ahead of cases that came in as emergencies.

Any pre-planned operation that was cancelled was recorded and the data published. The patient then had to be rescheduled within 28 days, adding to the pressure to give elective operations priority, doctors have said.

Mr Black added: “Surgeons have been saying for some time that emergency surgery is a Cinderella service in the modern NHS.

“We will only solve these problems if focusing on emergency care becomes a priority in the boardroom as well as the ward.”

Katherine Murphy, director of the Patients Association, said: “It can be so debilitating for someone who has a fracture to be left for a couple of days or longer, waiting for an operation when the trust is focused yet again on meeting these pernicious targets. It is an appalling way to determine who gets care. An emergency should be an emergency.

“The financial rewards for elective surgery are more lucrative for the trust than for emergencies and that is why trusts continue to focus on elective treatment. We cannot make savings by putting patients through unnecessary pain and suffering.”

From: http://www.telegraph.co.uk/Emergency-patients-let-down-by-targets-say-surgeons

New mothers are left frightened and alone after childbirth, because midwives do not have time to care for them, a major study has warned.
The report by the National Childbirth Trust (NCT) says staff shortages have left increasing numbers of mothers feeling isolated at a time when they are desperate for reassurance.

The charity’s poll of more than 1,200 first time mothers found 59 per cent did not get the “emotional support” they felt they needed after giving birth – compared with 51 per cent in a similar survey a decade ago.

Women who had undergone a caesarean section were the least happy about their experience.

Asked about the 24 hours following birth, 66 per cent said they had not received enough support, compared to 57 per cent of those who had a natural labour in hospital, and 24 per cent of those who gave birth at home.

Mothers who had gone through traumatic labours said they had been left to cry themselves to sleep, while others said overstretched midwives had no time to offer a kind word of reassurance.

In total, 42 per cent said there were not enough midwives to care for them, compared with 33 per cent, when the question was posed in 2000.

Those who gave birth at home, or in a midwife-led birth centre, were less likely to describe shortages of midwives.

The NCT findings show that despite a large investment in maternity services, and pledges from the last Government to make care “woman-centred” with a choice of where to give birth, many women are being denied even basic care.

Among the poll of 1260 first time mothers, 44 per cent said they did not even get the physical help they needed, while 55 per cent said they did not get enough information or advice in the weeks after having their first child.

Anne Fox, the head of campaigns and public policy for the NCT, said; “It’s clear postnatal care urgently needs improvement – our report paints a dreadful, shocking picture of care in the UK – we’re letting women and their babies down.

“Many of the problems these women highlight seem to be due to staff shortages or lack of visits once they had left hospital – and this issue needs to be addressed if the quality of postnatal care is to be improved, particularly for vulnerable women.

In the report, new mothers describe being “absolutely terrified” and alone during their first night in hospital, frightened to ask for help from staff who responded to them rudely.

One mother said: “As soon as the baby was born, I felt I was on my own. I spent the first night after the birth of my son in floods of tears and unable to sleep as every time I closed my eyes the nightmare of my birth experience came flooding back.

“Nobody came to check on me to see if I was OK, even though I know I was sobbing loudly and uncontrollably.”

Louise Silverton, Deputy General Secretary of the Royal College of Midwives, described the report’s findings as “disappointing,” but said the study sent a compelling message to those in charge of NHS budgets, about the need to keep investing in maternity services.

From: http://www.telegraph.co.uk/Midwives-have-no-time-to-care-for-new-mums-report-warns

Employers will not be able to ask people who apply for a job about their health under new equality laws that came into force on Friday.
The Hattie Harperson cartoon is from: http://sgspolitics.blogspot.com/2007_11_01_archive.html

Staff who are dyslexic, have taken a large number of sick days or who look after disabled and elderly relatives will also find it easier to win unfair dismissal cases under the new law.

Other provisions will allow bankers to compare salaries, and guarantee mothers the right to breastfeed their babies in public.

Experts fear the significant strengthening of anti-discrimination law will lead to a surge in employment tribunal claims as well as increasing the burden of red tape on businesses when they are struggling to recover from the recession.

However some of the most controversial elements of the single Equality Act – driven through by Hattie Harperson just weeks before the general election – have not yet been implemented by the Coalition. These include the requirement for large organisations to publish the gap in pay between male and female employees, and the right of employers to use “positive action” to recruit more female or ethnic minority staff.

The Act aims to make rights simpler by bringing together nine pieces of legislation, and creating a list of “protected characteristics” on which it is unlawful to discriminate: age, disability, gender, gender reassignment, race, religion, sexual orientation, marriage and maternity.

Business leaders, lawyers and personnel experts agreed that the most significant change is the new ban on questions about a prospective employee’s health at first interview.

Until now, employers have routinely asked about the medical background of job applicants but under the Equality Act they will be breaking the law unless they can prove their questions were designed to monitor diversity, or check whether the interviewee can carry out an essential task.

It will be illegal to ask how much time off work a prospective employee has taken, while one HR expert claimed managers will not even be allowed to ask: “How are you this morning?”

However bosses will be able to screen by health after making an offer or drawing up a short-list.

The British Chambers of Commerce estimates it will cost £189million for business to implement the Equality Act. David Frost, its director-general, said: “At a time when the Government is trying to create as many jobs as possible in the private sector this legislation will put people off for fear of getting it wrong. The Equality Act is a very complex bit of employment legislation. If small businesses get this wrong they end up in an employment tribunal.”

A spokesman for the Institute of Directors said: “The health provision is undoubtedly an extra burden on businesses. All business will need to be very clued up on the ramifications of what the new regulations are – if you have a whole HR team that’s fine, but a lot of our members are small businesses and they don’t have that.”

Deborah Casale at Gannons Solicitors said: “This will no doubt become a grey area in the law and may open the door to more disability discrimination claims.”

However supporters of the law believe it could help injured veterans who are seeking work after leaving the Armed Forces, as well as people who have a history of mental illness.

The Equality Act will make it easier for staff to claim they were discriminated against because of a disability. This is because they no longer have to prove they were treated less favourably than non-disabled colleagues.

It is expected to lead to discrimination claims from dyslexic workers who have been barred from carrying out certain tasks because of their tendency to make spelling mistakes.

An employee who had been disciplined for taking a lot of sickness leave could also claim they had been treated unfairly.

The law also introduces the category of “discrimination by association”, which allows carers of disabled children or elderly parents to claim they suffered in the office as a result of their responsibilities at home.

Edward Wanambwa, employment and discrimination specialist at Russell Cooke Solicitors, said: “The Equality Act 2010 is the most ambitious and overarching piece of discrimination legislation for decades. Its purpose is to harmonise and clarify existing law; the impact of which will perhaps most significantly be felt by the 6million carers across the UK who now have an unambiguous right to sue for discriminatory conduct experienced as a result of an association with a disabled person.”

Another category, combined discrimination, could see staff claim they were treated badly because of a combination of their age and their gender – where an allegation under a single area would have failed.

It also becomes illegal to discriminate against someone for the “perception” that they are homosexual, for instance, even if they are not. Transsexuals are protected from discrimination even if they are not undergoing “gender reassignment” treatment.

Employment tribunal judges will be able to recommend changes to the practices of a business rather than just concentrating on the experience of the individual who brings a claim.

Elsewhere, the Act specifically allows nursing mothers to breastfeed their baby in public places. Managers in shops or cafes will not be allowed to ask a mother to stop breastfeeding, move to somewhere more private or leave because they are breastfeeding.

The new law also stops colleges from preventing teenage girls at school who are pregnant or who have had a baby from taking their A-levels.

The legislation does not cover breast feeding at work, however a mother who is discriminated against for feeding would likely have a case for sex discrimination because of existing laws, experts say.

Under the new legislation, staff particularly in the financial sector will be free to discuss their pay, and can claim victimisation if they are disciplined for sharing information about wages or bonuses.

Rachel Dineley, employment partner at law firm Beachcroft, warned that small firms were likely to be caught out, and forecast a rise in cases brought in front of tribunals.

DLA Piper, the law firm that employs Nick Clegg’s wife, said detailed guidance on the new law had only been published in the past month.

Sandra Wallace, the firm’s head of equality and diversity, said: “Unfortunately, by issuing the implementing legislation so late in the day, and not incorporating all elements of the Act, businesses have been left with a halfway house that will potentially confuse them even more than they already were, and risk protracted legal wrangles in employment tribunals that are already overstretched with a general increase in claims.”

Some groups said the Government should have gone further and implemented all of the parts of the Act drawn up by Labour. It is estimated that 90 per cent of the law comes into force today.

Ceri Goddard, chief executive of the Fawcett Society, said: “Rowing back on the requirement for big business to publish and take action on any differences in pay between men and women employees – so to conduct gender pay audits – is tantamount to endorsing the shocking gender pay gap.”

The Government likened the advance in employment rights guaranteed under the Equality Act to an equal pay campaign launched by female factory workers in 1968, commemorated in a film that opens in cinemas today.

Theresa May, the Equality Minister, said: “Thanks to pioneers like the women who feature in Made in Dagenham, the workplace is much fairer than it was in 1968, but there is still plenty of room for improvement.

“In these challenging economic times it’s more important than ever for employers to make the most of all the talent available. When a company reflects the society it serves, it’s better for the employer, the employees and the customers, so being a woman should never be a barrier to being treated fairly at work.

“From today the gagging clauses that stop people discussing their pay with their colleagues will be unenforceable, allowing women and men to find out if they’re being paid unfairly.

“This move towards transparency is just one part of the Equality Act, which also makes it easier for businesses to comply with discrimination law by streamlining the equality laws, and provides more protection to disabled people.”

From: http://www.telegraph.co.uk/Equality-Act-firms-must-not-ask-job-applicants-about-health