The government has confirmed it is planning to scrap the NHS Direct telephone service in England and replace it with an alternative service.
Nick Chapman, chief executive of NHS Direct: “The new helpline will be better and more cost effective than NHS Direct” A new 1-1-1 helpline is already being piloted in north-east England.

It was previously reported that the new service may replace NHS Direct, but now the Department of Health has confirmed it will definitely do so.

The move comes as the government curtails public spending, even though it has promised to protect the NHS.

The change will not affect existing NHS helpline services in Scotland and Wales.

Health Secretary Andrew Lansley announced the plan to scrap NHS Direct in England during a hospital visit.

NHS Direct currently employs more than 3,000 staff, 40% of whom are trained nurses. It is understood the ratio on the 1-1-1 helpline is “slightly less” in the pilot, but no figures are yet available for what will happen when the scheme is rolled out nationally.

Critics claim the change would undermine the quality of the service by reducing the number of qualified nurses answering calls, but chief executive of NHS Direct Nick Chapman told the BBC the new helpline would be better and more cost effective than NHS Direct.

In June GPs urged the government to get rid of NHS Direct, claiming it was not cost effective.

Roughly 14,000 people a day call NHS Direct for medical advice, with the service costing £123m a year to run.

Dr Peter Carter, chief executive and general secretary of The Royal College of Nursing , said reducing the number of specialist nurses who worked on the new helpline was “short-sighted.”

He said: “We urge the government to consult fully and look at all the evidence before enacting changes which could leave people without expert advice from trained nurses.”

From: http://www.bbc.co.uk/nhs-direct-to-be-scrapped

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Health Service Journal, found 2,873 nhs.uk websites that were in use and more than 1,000 other nhs.uk sites that were no longer active.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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

An investigation found that 320 hospital, ambulance and health authority chiefs are paid more than David Cameron’s annual salary of £142,500.
The report comes as the health service faces cuts to frontline services to reduce the deficit. Of those 58 are paid more than £200,000 a year. Financial experts described the salaries as “unsustainable”.

The number of high-earners has increased 50-fold since Labour came to power in 1997. Prior to that only six NHS officials were paid more than John Major, who then earned a salary of £101,557.

The highest paid was Ian Miller, Interim Director of Finance and Investment for South East Coast Strategic Health Authority, who earned £310,000 for nine months work from April 2009 to January 2010.

His salary – which would be £400,000 per year – would pay for up to 14 nurses.

Meanwhile Ron Kerr, Chief Executive of Guys and St Thomas’ NHS Foundation Trust, earns the second-highest amount with £270,000.

Some health executives also receive additional bonuses such as leased luxury cars that cost more than a nurses salary of £20,000 a year.

The survey looked at 172 acute hospital trusts, 11 ambulance trusts and the ten regional strategic health authorities.

In total 734 staff earned more than £100,000 per year according to available records.

Matthew Elliott, chief executive of the TaxPayers Alliance, said: “It’s shocking that pay in some parts of the NHS has now reached these stratospheric new heights. It simply isn’t sustainable.”

Anthony Marsh, chief executive of West Midlands Ambulance Service NHS Trust, earns £232,000 – more than 14 times the salary of some ambulance drivers.

Pay does not appear to be linked to performance. Martin Yeates, former chief of Mid Staffordshire NHS Trusts, which runs Stafford hospital where 400 died due to inadequate care, earned up to £160,000 a year before he left.

Meanwhile the Department of Health said it was “committed to cutting NHS management costs” and planned to reduce them by 46 per cent in the next three to four years.

From: http://www.telegraph.co.uk/More-than-300-NHS-executives-have-a-larger-salary-than-the-prime-minister

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 coalition Government ignored scientific advice on the questionable value of homeopathy by continuing to allow the NHS to fund homeopathic treatment despite there being next to no evidence that it works.
Last week, health ministers refused calls from the House of Commons science and technology committee to stop the NHS funding homeopathic treatment on the grounds that such a ban would limit patient choice and contradict the Government’s stated aim of devolving more power to the Primary Care Trusts (PCTs) of the NHS.

However, the Government’s own chief scientific adviser, Sir John Beddington, said that he had spoken informally to coalition ministers about his grave concerns about homeopathy and the Department of Health’s policy of allowing it to be prescribed under the NHS.

“I remain of the view that the evidence of efficacy and the scientific evidence base of homeopathy is highly questionable. It is vitally important that the public can make informed choices on their use of homeopathy, so the evidence base must be freely available in an easily-accessible format,” Sir John said.

The Government does not know how many PCTs prescribe homeopathic treatment or how much it costs but the total annual funding is believed to run into millions of pounds.

Earlier this year, the Commons’ science committee recommended that the NHS should stop funding homeopathy on the grounds that it is a waste of money and it gives patients the false impression that such treatment works.

“When the NHS funds homeopathy, it endorses it. Since the NHS Constitution explicitly gives people the right to expect that decision on the funding of drugs and treatments are made ‘following proper consideration of the evidence’, patients may reasonably form the view that homeopathy is an evidence-based treatment,” the select committee’s report said.

In its response to the report, the Government said that it will keep the position on NHS funding under review. “However, we believe that providing appropriate information for patients should ensure that they form their own views regarding homeopathy as an evidence-based treatment,” it said.

Scientists point out, however, that if patients are told clearly that there is no credible evidence to support homeopathic treatments, this may undermine the only benefit that homeopathy is likely to provide, namely the well-established “placebo effect” where someone feels and gets better because they believe a treatment is working.

“Doctors are not allowed to prescribe an honest placebo, even if they think that is the best they can do for the patient. But they are allowed to prescribe a dishonest placebo by referring the patient to a homeopath,” said Professor David Colquhoun, a pharmacologist at University College London.

“Certainly you may feel better after the pill, because you were getting better anyway, or because of the placebo effect. That can’t justify your doctor giving a pill that contains nothing whatsoever,” Professor Colquhoun said.

“If there is no evidence that homeopathy works beyond the placebo effect, why does the Government pay for it? The answer given to that is ‘patient choice’. I dare say the patient would cheer up if the NHS paid for a bottle of Chanel No 5,” he said.

Professor Edzard Ernst, a specialist in complementary medicine at the Peninsula Medical School in Exeter, said: “If the Government is serious about putting patient choice over evidence, it not only displays a profound misunderstanding of both these issues but should then also give cream cakes to diabetics and cigarettes to someone with a lung disease.”

Evan Harris, a former Liberal Democrat MP who sat on the science select committee when it carried out its inquiry, said that the decision to continue NHS funding homeopathy by the Government is not a good start for the health secretary Andrew Lansley.

“How does the Government justify allowing treatments that do not work to be provided by the NHS in the name of choice, when it allows medicines which do work to be banned from NHS use?” Dr Harris said.

From:  http://www.independent.co.uk/government-ignored-our-advice-on-homeopathic-remedies-say-experts

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

Controversial US group UnitedHealth, which runs GPs’ practices and advises PCTs in UK reported a 30% leap in profits to $1.1bn.The company recently had to repay $350m to settle a US case in which it was accused of artificially depressing insurance repayments to customers.

A US health insurance company that recently won a multimillion-pound contract to advise primary care trusts (PCTs), has reported a surge in profits over the last three months.

UnitedHealth Group, which also operates five GP practices in Derbyshire and London, reported second-quarter profits climbed 30% on the same quarter a year ago to $1.1bn (£720m) on turnover of $23bn.

The stock market-listed firm said the bulk of its growth came in the United States after it signed up more members for the government-backed Medicare and Medicaid policies.

The company signed a contract with the Department of Health last month to advise PCTs on commissioning ahead of reforms that will give GPs the lion’s share of the NHS budget.

PCTs directly run GP practices and offer contracts to self-employed GP doctors and private firms to operate independent practices. GPs will be in charge of £90bn of the health budget under plans put forward by the health secretary, Andrew Lansley.

UnitedHealth will use its experience of private healthcare to bring efficiencies to the bidding processes.

US unions have complained about the company, which has come under fire for malpractice. In 2008, its former boss William McGuire was banned as a director and forced to repay $468m following a scandal related to backdated stock options.

In January the company agreed to pay $350m to settle a case brought by the New York attorney general, Andrew Cuomo, who accused the firm of boosting profits by artificially depressing insurance repayments to customers.

The company based repayments on “independent” assessments by a company called Ingenix, which was a subsidiary of UnitedHealth.

The company is based in Minnesota, from where it has grown to be the largest health insurer by sales in the US. The company, which has more than 50,000 staff and 60 million health plan customers, is expected to have annual revenues in excess of $80bn this year.

From: http://www.guardian.co.uk/business/2010/jul/20/nhs-health-firm-profits-surge

The NHS is suffering potentially devastating cuts to jobs and patient services as the Government’s austerity drive hits the health service, doctors’ leaders have warned.Thousands of doctors and nurses face being made redundant or not replaced if they leave, while many hospitals have cut treatments, the British Medical Association has found.

Despite ministers’ assurances that the health service would not face the same cuts as other departments, many hospitals are feeling the strain, according to the BMA.

Andrew Lansley, the Health Secretary, has boasted that frontline services would be protected. But it emerged yesterday that in his Cambridge constituency, Addenbrooke’s Hospital is planning to sack 170 nurses and up to 500 staff in total over the next year.

A survey for the BMA asked 361 doctors, who between them represent committees at all of Britain’s hospital trusts and some larger primary care trusts, how the NHS was being affected by the demand to make £20billion of cuts.

It comes as the Coalition faces political pressure to reverse its pledge to ring-fence health spending.

The BMA found that 43 per cent of those who responded said there was a freeze on recruiting doctors and nurses at their trust. Almost as many, 40 per cent, said that patient treatments, including varicose vein operations and blood tests, were being rationed.

GPs in Bedfordshire said they had been told not to refer patients with certain conditions, such as skin lesions and cysts, to hospitals except in exceptional circumstances.

Nearly a quarter of those who responded said that their trust was planning to make workers redundant. Although the majority of these would not affect frontline staff, the union warned that cuts to administrative workers could force doctors and nurses to spend more time on these duties and less time with patients.

The poll – to which 92 doctors responded – represents the first real evidence of how the NHS has been hit by the cuts. It found trusts were trying to make annual savings of six per cent on average. The Government has promised to guarantee NHS spending growth in real terms but the BMA says this will be “minimal”. The association called the cuts potentially “devastating”.

Dr Hamish Meldrum, the chairman of the BMA, said: “Whilst we accept that difficult decisions need to be taken in this tight financial climate, there is a real danger that cutting back on health now will have a long-lasting impact on our ability to maintain high-quality, comprehensive and universal care in the future.”

The warning came as senior Tories broke ranks to object to plans to protect health service funding.

Lord Lawson, the former Chancellor, and Nadine Dorries, a Tory member of the Commons health select committee, said that health funding should not be ring-fenced.

Ms Dorries told the BBC’s Politics Show: “I think we need to find the political courage to accept that there is excessive waste in the NHS and that it’s unfair to expect other departments to take all the hits.”

The Royal College of Nursing said earlier this year that about 5,600 jobs were under threat across 26 hospital trusts. In a “worst case scenario”, the true figure could be as high as 30,000, it said.

A spokesman for the Department of Health said: “Alongside all the public services, the NHS will need to deliver significant savings over the coming years.

“The department is very clear that savings should be implemented in a way that does not affect the quality of services and the Secretary of State has been very clear that every penny saved will be reinvested back into patient care.”

From: http://www.telegraph.co.uk/NHS-suffering-devastating-cuts-to-jobs-and-services-warns-BMA

The rise in emergency admissions to hospitals is “overheating” the system in England and is “unsustainable” in the future, a health think tank says.
Analysis by the Nuffield Trust found there were now 4.9 million unplanned admissions a year – a rise of 12% since 2004-05 – costing the NHS £11bn a year.

It said a rise in patients who spent a day or less in hospital suggested many admissions could be avoided. NHS managers agreed action was needed to tackle the problem.

Emergency admissions include patients admitted through A&E units as well as direct into other parts of hospitals.
Ageing population

The think tank, which analysed a range of official NHS data during its research, found emergency admissions now accounted for more than a third of the total.

The rise seen since 2004-05 is costing the NHS an extra £330m a year alone and the think tank said the issue had to be a priority if the NHS was to prosper in the current economic climate.

Researchers found there was a range of factors behind the trend.

They pointed to the ageing population – the elderly were more likely to be admitted as an emergency – as well as financial incentives in the NHS which were motivating hospitals to admit more.

The report also noted there had been a significant jump in patients being admitted for one day or less.

It said this was partly related to advances in medicine which meant patients did not need to spend as long in hospital, but argued many could have been avoided with better community services.

While the report only looked in detail at the situation in England, it also noted rises had been seen elsewhere in the UK.

And it said the recent announcement by ministers that hospitals would be fined for readmissions would only have a limited impact as many of the cases did not fall into that category.

Nuffield Trust director Dr Jennifer Dixon said: “Reversing this unsustainable rise in emergency admissions must be the number one priority for the NHS – any reform to the health service that does not tackle this will fail. Our hospitals are overheating and are treating patients at great cost to the NHS.”

Nigel Edwards, acting chief executive of the NHS Confederation, which represents managers, said: “This report furthers the case for fundamentally reviewing the urgent and emergency care system.

“Hospital is often the right place for sick patients to be but we know that for many there are better, more convenient and more cost-effective alternatives to hospital admission.

Dr John Heyworth, president of the College of Emergency Medicine agreed there were pressures in the system, but questioned some aspects of the research.

“It is fundamentally incorrect to assume that admissions for less than 24 hours are unnecessary or financially inefficient. In fact, the opposite applies.”

From: http://news.bbc.co.uk/1/hi/health/10490508.stm