Controversial reforms to the NHS have avoided a potentially “fatal” delay in the House of Lords, to the relief of ministers.Amid deep concern in the medical profession and among many members of the public, some peers had tried to have the Health and Social Care Bill thrown out or subjected to detailed scrutiny that would have ruined the Government’s timetable.

It is feared by opponents that the wording of the legislation will remove the Secretary of State’s duty to provide healthcare for all, while plans to widen competition will see the back-door privatisation of the NHS.

But following two days of debate by 100 members of the upper house, and pressure applied by ministers and whips to Tories and Lib Dems, attempts to delay or thrown out the Bill were defeated comfortably in the biggest turnouts seen in the Lords for more than a decade.

A motion by Lord Owen, a former health minister and SDP leader, to let a special committee spend until Christmas studying the constitutional impact of the reforms was rejected by a margin of 330 to 262.

Labour’s Lord Rea had wanted the second reading to be refused altogether but this proposal was lost by 354 votes to 220.

Baroness Williams of Crosby, the Lib Dem grandee who had been among the first to raise fears over the Bill, abstained on the critical Lord Owen vote and went with the Government on the Lord Rea motion.

The results means the Bill, which seeks to remove two tiers of NHS management and give more power to GPs and patients, will now be considered line-by-line in committee stage in the Lords and remains on track to receive Royal Assent by next summer.

It has already survived a rebellion by Lib Dem activists in the spring and an unprecedented “pause” in the parliamentary proceedings for doctors’ concerns to be heard, which led to competition plans being watered down.

But even the Government accepts that more changes will be made to contentious areas.

A Department of Health spokesman said: “The vote today moves us one step closer to delivering a world-class health service that puts patients at its heart and hands more power to health professionals. We now look forward to working with the Lords to scrutinise the Bill during Committee Stage to improve our plans further.”

Labour said it would continue to call for “drastic changes”.

The plans had been criticised in the debate by well-known figures including Lord Winston, the fertility pioneer, who described the Bill as “unnecessary and, I’m afraid to say, irresponsible”.

After the vote Dr Hamish Meldrum, Chairman of BMA Council, said: “It remains the BMA position that the Health and Social Care Bill should be withdrawn, or if not that it should be substantially amended, and we will continue to raise our concerns at every available opportunity as the Bill progresses through the House of Lords.

“The BMA continues to have many areas of concern, including the need for assurance that increasing patients’ choice of provider for specific elements of their care won’t be given priority over the development of integrated services and fair access.

“We also need to see an explicit provision that the Secretary of State will retain ultimate responsibility for the provision of comprehensive health services.”

From: http://www.telegraph.co.uk/NHS-reform-Bill-survives-fatal-Lords-vote

Overseas patients owe the NHS almost £60 million in unpaid medical bills, with foreign governments among those with the biggest debts.The figures, which cover the past six years, show an increase in the number of visitors leaving the country without paying for treatment.

Embassies and foreign governments have run up debts of nearly £6 million at two London hospitals after failing to pay for non-emergency treatment, according to figures released under the Freedom of Information Act.

More than £4 million is owed to Great Ormond Street children’s hospital by Middle Eastern governments that arrange for children to have treatments not available in their own countries.

While much of the debt is still being chased, more than half has been abandoned or written off.

Free NHS hospital treatment is available to British residents. Overseas patients are charged for the full cost of any treatment they receive unless a specific exemption applies.

Urgent treatment is always available to overseas visitors, regardless of their residence status or ability to pay, but non-urgent treatment should not go ahead without the NHS first receiving payment.

In 2009, West Middlesex University Hospital, in west London, became the first to tell foreign patients they must pay in advance.

The figures reveal that hospitals threatened with closures over mounting debts have written off some of the highest amounts. Imperial College trust, which is £100 million in debt and in the process of making major cuts, is owed £2.5 million and has written off a further £2 million.

The trust for Chase Farm hospital, in north London, which received a bail-out from the Challenged Trust Board and is being forced to close its A&E department, has a foreign debt of £2.5 million.

The Government recently introduced a policy to deny new visas to tourists with outstanding NHS payments.

The burden on the taxpayer is expected to increase next year with one million extra visitors and foreign dignitaries attending the Olympics in London.

Separate figures show that European governments owe £38.5 million to Britain under the system that allows visitors free emergency treatment on the NHS.

Statistics released in a Parliamentary written question show that almost half of the total owed in the European Health Insurance Card scheme, £17.2 million, is due from Ireland.

Katherine Murphy, chief executive of the Patients Association, said: “At a time when the NHS needs to make £20 billion of savings by 2014, why are managers at hospitals not desperately chasing these unpaid bills? Why are we writing off this money and throwing it down the drain when it could be used to fund front line services and help patients?”

Simon Burns, a health minister, said: “Hospitals must take every reasonable measure to recover any debts from overseas patients. The NHS has a duty to anyone whose life or long-term health is at immediate risk, but we cannot afford to become an international health service, providing free treatment for all.”

From: http://www.telegraph.co.uk/Overseas-patients-owe-health-service-60m

Dismantling Labour’s disastrous £12 billion NHS IT programme may cost taxpayers more than keeping it going.Ministers announced on Thursday that they will speed up the scrapping of the National Programme for IT (NPfIT)  after a review concluded “there can be no confidence that the programme has delivered or can be delivered as originally conceived”.

It confirmed earlier reports that the central part of the scheme, allowing NHS staff across England to access any patient’s details, was unworkable while costs had increases and deadlines were missed.

The governance board of the programme will now be scrapped, and local trusts will be given the freedom to develop their own versions of the electronic care record rather than having the rules dictated by Whitehall. A new Cabinet Office oversight committee will monitor future IT investment to ensure money is not wasted.

But many trusts across England have large contracts with private suppliers to supply their care record systems, and their cancellation could leave taxpayers even more out of pocket.

The Department of Health’s own chief information officer, Christine Connelly, told MPs on the Public Accounts Committee in May that a £3bn deal with CSC to deliver systems in the north, midlands and east of England would cost more to get out of than to keep going.

She said: “Potentially, if you ask me about the absolute maximum, we could be exposed to a higher cost than the cost to complete the contract as it stands today.”

A decision will be made on the future of the contract later in the autumn.

However the Cabinet Office’s Major Projects Authority said that some parts of the £12.7bn programme had worked and would be retained, including the NHSmail email system and the Choose and Book process of arranging hospital referrals.

Andrew Lansley, the Health Secretary, said: “Labour’s NHS IT Programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs.

“We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernised NHS.”

Roger Goss, co-director of the pressure group Patient Concern said: “Thank goodness politicians have decided to stop money being poured into a huge bottomless pit. Now we must pray that they don’t sanction pouring it into endless incompatible regional pits.”

From: http://www.telegraph.co.uk/Dismantling-NHS-computer-scheme-could-cost-more-money

The General Medical Council (GMC) says some overseas doctors come to the NHS with ‘little or no preparation’ for working in the UK.Along with the Nursing and Midwifery Council, it wants the right to test the English language skills of applicants from within the EU in the same way they test applicants from outside of Europe.

But an EU red tape Directive prevents any systematic testing of language skills of doctors from the European Economic Area (EEA).

The GMC says UK legislation – the Medical Act 1983 – ‘gold plates’ the directive and prevents the GMC from doing any language-testing of doctors from the EEA at all.

Employers are allowed to assess the language skills of applicants from the EEA, but it is thought many do not.

A spokesperson from the GMC said: “Doctors who come to work in the UK make a vital contribution to our healthcare system, but we must make sure they receive the support they need to practise safely and to conform to UK standards.”

“It is unacceptable that the current system enables doctors to practise in the UK without a sufficient grasp of English.”

The GMC says some overseas doctors come to the NHS with “little or no preparation” for working in the UK and those trained under different cultural and professional standards need more support.

The GMC is planning a basic induction programme for all doctors – including those who qualify in the UK – to help understand how healthcare is practised in the UK.

A spokesperson from the Department of Health said: “This government is determined to make sure that foreign healthcare professionals are not allowed to work in the NHS unless they have proven their competence and language skills.”

“We do think the Directive needs updating and we are in the process of responding to the EU proposals, but we can’t pre-empt that response.

“We have already taken steps to strengthen the current system by introducing a duty for responsible officers to check the qualifications, experience and references of all doctors, including foreign doctors.”

But poor English language standards are not just an issue among some European NHS staff, for whom English is not their first language.

Asian nurses said they found it difficult to understand European colleagues – particularly those from Eastern Europe.

But when one was asked what a patient meant if they said they wanted to ‘spend a penny’ – slang for go to the lavatory – she replied “they want to spend money”.

A spokesperson from Imperial College Healthcare NHS Trust, said: “We take patient experience and patient complaints very seriously.”

“We care for a diverse patient population and employ a diverse workforce, and understand the importance of staff being able to talk to patients and their families in an appropriate way.”

From: http://www.bbc.co.uk/news/health-14921565

England’s NHS hospitals needed at least £200 million in bailouts and loans as they struggled to balance their books while also meeting tough savings targets, according to a spending watchdog.The Audit Commission said nine NHS trusts “failed to achieve financial balance” and many more applied for extra funding from managers and the Government, although overall performance “continues to be good”.

Health bodies spent £289m on redundancy payments but the number of staff employed in hospitals actually rose by almost 8,000.

Dozens were found at fault with the “value for money” they offer and a fifth of all NHS bodies failed to meet their savings targets despite cutting back on staff and the number of patients they treat.

The Audit Commission, the public spending watchdog that is being scrapped, warned that health service providers face even tougher times ahead as savings become harder to find and Government spending increases dry up.

Andy McKeon, managing director for health at the Audit Commission, said: “It is impressive that the NHS overall performed so well financially last year, even if some organisations struggled.

“But there is no room for complacency. Tighter funding, and the need to continue to improve services and implement reforms, will make the next three years much tougher.  NHS organisations will need to make a determined effort to find further recurrent savings while continuing to deliver high quality services.”

The watchdog looked at the 2010-11 accounts for Primary Care Trusts, which pay for treatment; hospitals not including the semi-independent Foundation Trusts; and the regional Strategic Health Authorities.

It found that they were running a £1.5 billion surplus and had actually underspent by £272 millon on the £2.95 billion in capital expenditure they were given by the Department of Health, twice as much as recorded the previous year.

But seven hospitals and two PCTs failed to break even, one fewer than in 2009-10, with the biggest deficit of £41m recorded by South London Healthcare NHS Trust.

At least 16 NHS organisations needed additional financial support from PCTs which is never paid back “thereby obscuring their real financial health”.

Managers gave out £90 million to hospitals, while the Department of Health issued loans totalling £34 million to four hospitals and also gave £76 million to two trusts which did not even have enough money to pay back loans.

Ministers want to cut management costs by 45 per cent at SHAs and PCTs, which are being restructured, and they did let 5,713 people go with average pay-offs of £40,000 each.

But the headcount at hospitals actually rose by 7,616 and only fell by 27 in the 10 SHAs.

The Audit Commission did not find any NHS body’s accounts were not “true and fair”, but it did issue “qualified Value For Money conclusions” for 27 hospitals and 18 PCTs, suggesting they had problems with “financial resilience” or “economy, efficiency and effectiveness”.

The Audit Commission warns next year will be “a more financially challenging year” as there will be no “significant real-terms increase” in the central budget, so trusts will require “determined effort and strong leadership”.

From:  http://www.telegraph.co.uk/NHS-hospitals-needed-200m-in-bailouts-and-loans

The head of a scandal hit NHS hospital has claimed there is something “fundamentally wrong” with nurses and the nursing profession.Sir Stephen Moss, chairman of Stafford Hospital and himself a nurse for 40 years, said that “too many patients and families” are being let down but that staff shortages are not to blame.

He suggested the problems lie in the training nurses receive as well as the way they work on hospital wards, and plans to lead a new campaign to improve standards.

His comments come in the wake of a series of scandals at NHS hospitals in which vulnerable patients have been neglected with sometimes fatal consequences.

At Stafford Hospital, which Sir Stephen arrived at in 2009 to help turn around its fortunes, as many as 1,200 patients are feared to have died unnecessarily over three years as managers became preoccupied with cost-cutting.

A recent report by the Health Service Ombudsman condemned the NHS for failing to meet “even the most basic standards of care” for pensioners, while spot inspections by the Care Quality Commission have uncovered geriatric wards where doctors are prescribing water to elderly patients to stop them becoming dehydrated.

Unions and professional bodies have suggested that the problems are down to staff being over-worked or forced to focus on Government targets rather than providing personal care.

But other commentators have claimed that too much care is now provided by cheap healthcare assistants, who do not need to meet national training standards and who are not regulated by a professional body; or that nurses think they are “above” feeding and cleaning patients now that they have to be university-educated.

In an interview with a local newspaper, Sir Stephen said: “Not everything in nursing is bad, but after the events at Stafford Hospital, the recent concerns at New Cross Hospital [in Wolverhampton, where high death rates are being investigated] and others around the country you can’t tell me there isn’t an issue here that needs addressing and we have to do something about it.

“There is something fundamentally wrong with the nursing profession and the way it is focused at the moment.  We are getting a lot right but we are also letting down too many patients and families. We can’t just stand by and not do something.”

Sir Stephen is drawing together a group of seven “big hitters” in the health service to suggest ways that hospital care can be improved.

Their plans, to be disclosed in September, will focus on how nurses can be trained for “the real world of the NHS rather than the classroom”.

From: http://www.telegraph.co.uk/NHS-boss-something-fundamentally-wrong-with-nursing

Health secretary Andrew Lansley’s decision to launch groups designed to champion views of patients leads to complaints.
Andrew Lansley’s plans to put the patient at the heart of the NHS have been labelled as “confusing, vague and insulting”.

The health secretary pushed ahead with HealthWatch, the new body to champion patients’ views, despite ministers being forced to apologise and withdraw a consultation on the new watchdog. Ministers had conceded that their original plans had been conceived in haste and without proper consultation.

But Lansley announced that 75 local HealthWatch groups were in place. HealthWatch is supposed to replace local patient involvement networks, known as LINks, in 2012 – bringing “real local democratic accountability and legitimacy” to the NHS “for the first time in 40 years”.

Malcolm Alexander, chair of the National Association of Local Involvement Networks Members, said that, instead of increasing budgets to fund the new bodies, cash was being cut even though the government was asking local groups to take on a range of new responsibilities, such as promoting the integration of care and health services and improving choice for patients, without extra money.

Alexander said: “It’s pathetic. The consultation had a figure of £20,000, which was confusing and looked like a cut. Then that was withdrawn. Our figures show that networks are having their budgets cut this year by 24% on average.”

He said there was no start-up funding for local HealthWatch “pathfinder” groups and no ringfenced money in local authority budgets to run the new bodies.

The money for HealthWatch comes out of local council budgets, which are being cut by 30% over the next four years. “Our own research asked whether these new policies were evolution or abolition. It looks like abolition to us,” he said.

Sally Brearley, senior research fellow in patient and public involvement at King’s College London, who sat on the prime minister’s Future Forum which re-examined the health reforms, said she “shared the concerns”.

“There’s a lot of extra work to develop these new HealthWatch bodies and they are supposed to be monitoring the NHS as services are being cut and finances are under strain. It’s a real issue.”

A Department of Health spokesperson said the criticism was misleading.

“The government has not cut funding, and has no plans to do so – in fact, we retained the current level of funding at £27m, rising in line with inflation, for the spending review period.”

From: http://www.guardian.co.uk/andrew-lansley-condemned-healthwatch

Patients will routinely be able to consult with doctors over the internet from their own homes within “a year rather than a decade”, the medical director of the NHS has said.
Sir Bruce Keogh said that using emerging video internet technology he could envisage an NHS that was “available 24-7″.

High-speed broadband – essential to internet video calling – could allow people to consult international experts or to take advantage of out-of-hours care provided by overseas doctors in another time zone, he said.

Such technology would lessen the need for a “geographical connection” between GPs and their patients, while it would also enable doctors to conduct what he called “virtual ward rounds”.

Sir Bruce, who as a cardiac surgeon persuaded his colleagues to make their success rates public, was speaking at the Government’s launch of its plans to make all state data available online.

He said the NHS had to adapt because “young people won’t put up with having to travel to a doctor and wait 20 minutes when they can just use the web to talk directly to a doctor”.

Patients for whom such “telehealth” services might be useful included those who needed to see a specialist about a chronic condition such as diabetes, or those with visible conditions like skin complaints.

Some doctors are already trialling services online, but in rural areaswhere the benefits would be most apparent, poor broadband infrastructure is holding back progress.

Sir Bruce acknowledged that the NHS had yet to lay out a “national vision” for digital access, but he said that it would happen in the future.

As well as being better for patients, he argued that in the long term it would be cheaper and more efficient for the NHS.

In Northern Ireland, he said, a group of neurologists had found using new technology was “cheaper and the patients like it more”.

However, he also acknowledged that his plans would “open up a whole heap of financial issues”.

High-speed broadband connections are already being used to monitor older people who are able to stay in their own homes with remote supervision.

The new telehealth technologies are one reason why the Government has allocated £530 million to spend on improving broadband in the UK by 2015.

Frances Maude, Cabinet Office Minister, said that plans to release data about all NHS performance, including GPs as well as surgery, would allow patients to be more selective about their treatment.

The British Medical Association is leading a project to present data on GP performance.

The Government is set to announce how superfast broadband networks, essential for high-quality video consultations, will be funded next week. Each county is set to be allocated an amount of money based on the geographical challenges it faces.

http://www.telegraph.co.uk/Doctors-to-see-patients-by-video-link.html

Government policies for treating drug addicts in England are flawed and “doomed to failure”, a think tank says.
The Centre for Policy Studies says rehabilitation is a better use of the £3.6bn now spent on treating users with drug substitutes like methadone and keeping them on benefits each year.

But it says plans to reward groups which treat addicts so they can return to work are open to manipulation.

The Department of Health said it aimed to get users “off drugs for good”.

The coalition government wants to change the way drug addiction is tackled, with more people with problems diverted away from prison and into treatment as part of what it calls a “rehabilitation revolution”.

Part of this involves rewarding treatment providers who show addicts have improved their health and employment prospects.

A report from the right-of-centre think tank, which has links to the Conservative Party, says these payment by results schemes were being run by the very organisations “responsible for the current failure of policy”.

It says the current annual cost of maintaining treatment for 320,000 problem drug users is made up of £1.7bn in benefits, £1.2bn for looking after their children and £730m for prescribing the heroin substitute methadone.

Kathy Gyngell, Centre of Policy Studies: “The Department of Health has been paying 153,000 people to be on methadone”

The think tank calls for “a real transfer of power from large distant organisations to small innovative providers” for rehabilitation.

It says such units have a better chance of getting addicts off drugs completely, adding: “There is one simple measure of success: That of six months abstinence from drugs.”

According to the report’s author Kathy Gyngell, chairwoman of the prisons and addictions policy forum at the CPS, prescribing methadone to addicts delays their recovery.

She told the BBC: “The state is subsidising people to be any number of years on methadone, which has turned out not to be a cheap option and will only subsidise the tiniest proportion – 2% – to go into a rehabilitation unit that would actually free them from dependency and allow them to live their life.”

A Department of Health spokesman said: “The 2010 Drug Strategy is fundamentally different from those that have gone before.

“Instead of focusing primarily on reducing the harms caused by drug misuse, our approach will be to go much further and offer every support for people to choose recovery as an achievable way out of dependence.”

He added: “Work is under way to support local recovery systems tailored to the needs of communities, many of which are already showing positive results.”

From: http://www.bbc.co.uk/news/uk-13826759

Health Direct has for a long time noted the costly failure that is the current policy on drugs. On August 02, 2006 in Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

we reproduced the first ranking based upon scientific evidence of harm to both individuals and society.

It was devised by government advisers – then ignored by ministers because of its controversial findings.

The analysis was carried out by David Nutt, the then senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council.
http://www.healthdirect.co.uk/2006/08/risks-of-taking-drugs-compared.html

David Cameron has agreed to make changes to the plans for the NHS in England and insisted the government had not made “a humiliating U-turn”.
Ministers have accepted all the recommendations suggested by a panel of experts, including more controls on competition and a slower pace of change.

Doctors’ groups have broadly welcomed the revisions.

The NHS bill will now go back to the committee stage in the House of Commons to be scrutinised again by MPs before going through its House of Lords stages.

The prime minister’s official spokesman said he expected that to happen before the summer recess begins in July, and the bill to be on the statute book by the end of the current Parliamentary session.

That gives ministers until May 2012 to make it law.

On Monday – following a 10-week “listening exercise” – a panel of experts called the NHS Future Forum gave its recommendations on the changes needed to the bill.

They include:

• Reinstating the legal responsibility of the health secretary for the overall performance of the NHS
• Scrapping the primary role of the regulator, Monitor, to promote competition – and focusing on improving patient choice instead
• Relaxing the 2013 deadline for new GP commissioning arrangements to be introduced – a National Commissioning Board, based in Leeds, will control budgets until GP groups are “able and willing” to take over
• Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them
• Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them

After criticism from medics and complaints from rebellious MPs, the Coalition will be hoping the dust will now settle over its NHS reforms.

If politics is the art of persuasion, then the test for Messrs Cameron, Clegg and Lansley is whether or not they have convinced people that the listening process has been, as the prime minister claimed, a sign of strength.

The government and many health professionals believe changes to the NHS are necessary to deal with the demands of the ageing population, cost of new drugs and lifestyle changes such as obesity.

Mr Cameron said those who described the reworking of the plans as “a humiliating U-turn”, or the listening exercise as “a big PR stunt”, were both wrong.

“The fundamentals of our plans – more control to patients, more power to doctors and nurses, less bureaucracy in the NHS – they are as strong today as they’ve ever been,” the PM said.

The health secretary has faced personal criticism for his inability to garner widespread support for the original bill, but the prime minister said he accepted full responsibility for what had happened.

“I am every bit as responsible as Andrew Lansley for the fact that we actually decided we could improve on what we already put forward,” Mr Cameron said.

The British Medical Association said it was pleased the government had accepted the Future Forum’s recommendations and addressed many of doctors’ concerns.

But it said more detail was needed on how commissioning of care would work in future and there must be “robust safeguards” to prevent competition of any kind destabilising the health service.

From: http://www.bbc.co.uk/news/uk-politics-13757380