Professor Rawlins, the chairman of NICE said the economic pressure on trusts meant that “completely illegal” decisions were being made to limit the use of expensive drugs.

He told the Financial Times: “I just wish a patient organisation would take a Trust to court for failing to comply.”

Nice has been criticised for ruling against the prescription of expensive new drugs on the grounds that they are not cost-effective.

But Sir Michael told the paper that most of Nice’s recommendations were in favour of prescription and that it was other bodies that blocked the drugs’ use.

Sir Michael criticised the local lists of approved medicines drawn up across the NHS which “second-guess” and sometimes ignore Nice recommendations.

While patient groups for particular diseases – often helped by pharmaceutical companies – have attacked Nice for advising against the use of some expensive new medicines, Sir Michael said they should be directing more criticism instead to the drug companies for charging high prices.

The government’s own innovation review recognised the problem by pledging a Nice “compliance regime” to reduce regional variation – the so-called “postcode lottery” – and to improve adherence to the agency’s guidelines.

It cautioned that local decisions should not act as a barrier to the medicines that Nice had approved.

Taxpayers are now facing an estimated £2 billion bill, despite the company already failing to deliver a fully functional version of its software, The Times reported.

The £11.4 billion National Programme for IT, set up in 2002 by bliar, was at the time spun as the world’s biggest civilian computerisation project.

It aimed to give doctors instant access to patient records wherever they were being treated and CSC had signed a deal to computerise records in most of England.

Digitising the medical records of the country’s 62 million people was the core objective of the National Programme for IT in the NHS, accounting for £7 billion of the total estimated cost.

Andrew Lansley, the Health Secretary, announced in September that he was abandoning the scheme to create a national patient database because it had “let down” the health service.

He made the decision to “urgently dismantle” the failed project after criticism it was not value for taxpayers’ money.

Yet the company stated in official US papers that it was in talks with the British Government for its contract to be extended until 2017, at a cost of up to £2 billion.

Computer applications installed as part of the scheme have also failed or been scrapped.

However, £250,000 in bonuses has been paid by the DoH to 80 people involved in the scheme as a reward for “an exceptional contribution to delivery”.

CSC, one of the world’s biggest IT providers, had been contracted to provide patient record software, known as the Lorenzo system, to 166 NHS hospitals. But it has delivered on 10 projects. None of those systems is fully functional.

CSC has signed deals worth hundreds of millions of pounds with Royal Mail, Identity and Passport Service and UK Atomic Energy Authority.

The Coalition’s Major Projects Authority, established to review Labour’s financial commitments, found the scheme was not fit to provide services to the NHS.

A cross-party committee of MPs concluded the programme had proved “beyond the capacity of the DoH to deliver”.

Katherine Murphy, of the Patients Association, said it was “shameful” to pour more money into a failed initiative.

Although the policy was described as a “recommendation” by NHS authorities, local medical committees told the GPs’ magazine Pulse in GPs slam secrecy over evidence for Viagra rationing restrictions it was being handed down to family doctors as an “edict”.

Erectile dysfunction medication is already stringently limited on the NHS and can only be prescribed to patients with certain conditions such as diabetes, multiple sclerosis and prostate cancer.

According to the NHS some 2.2 million prescriptions for erectile dysfunction drugs were issued last year, with 14.5 million tablets issued at a cost of about £78 million.

NHS guidance acknowledges that there “appears to be no clinical reason to restrict the number of tablets” but it adds that, according to research, the average person has sex four times a month.  The average frequency of sexual intercourse in the 40 to 60 age range is once a week.”

The new policy is aimed at economising on non-essential treatments, recommending that the minimum effective dose be prescribed “two times per month using the drug with the lowest acquisition cost.”

The guidance applies to sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis).

Richard Hoey, editor of Pulse, said: “Ask most doctors and they will say that being able to live a satisfactory sex life is a key part of health and wellbeing, but the NHS has never recognised that in its policy on treatment for erectile dysfunction.

“Limiting patients to drugs like Viagra just twice a month is to treat sex like an unnecessary luxury, and completely fails to recognise the degree of anguish it can cause some men with erectile dysfunction.”

Erectile dysfunction is very common in middle aged and older men, with an estimated 50 per cent of those between 40 and 70 experiencing the condition to some degree.

Viagra and other medications can be bought privately, but the cost of about £40 for eight pills can be prohibitive, and patients must also pay for a private prescription.

The new prescription guidelines were drawn up by South Central Priorities Committees, which covers primary care trusts (PCTs) in Milton Keynes, Oxfordshire, Berkshire East, Berkshire West and Buckinghamshire.

The Government is trying to reassure women fitted with PIP implants to prevent a rush for NHS surgery to remove faulty breast implants.

Almost £135,000 is being spent by the Department of Health on the campaign, which will also run in social media sites. Posters will appear in GPs’ surgeries and hospitals as well.

The advert reads: “The latest advice from the NHS and plastic surgery experts is that women with PiP breast implants do not need to have them removed unless they have symptoms such as pain and tenderness.

“There is no link to cancer and there is no clear evidence of an increased risk of harm compared to other brands of breast implants.”

However, it also states, in large-type at the top of the advert: “The NHS will support women with PiP breast implants.”

Clarifying the situation for those who received implants as part of private breast enlargement operations, it states: “”The NHS will remove your implants if your doctor agrees, but the NHS will not replace implants unless it is clinically necessary.”

It advises those worried about whether they have implants made by Poly Implant Prothese (PIP), which contain industrial-grade silicone, to find out if they have them, to speak to their specialist or GP, and “agree what’s best for you”.

Despite the campaign, Fazel Fatah, president of the British Association of Aesthetic Plastic Surgeons (BAAPS), said the organisation’s stance remained that all 40,000 women fitted with them in Britain should have them removed.

He said: “We remain steadfast in our recommendation to the public of precautionary removal of these defective devices. Although there is no immediate health risk, the gel within these implants is simply not meant to be inside the human body.”

A survey of its 230 members found 95 per cent agreed that “it should be the clinics and hospitals that should pay for the replacement surgery, rather than burden the taxpayer with these costs”.

Women given the PIP implants are due to protest in London on Saturday at the reluctance of private firms like Harley Medical Group, The Hospital Group and Transform Cosmetic Surgery to fund removal and replacement surgery.

Explaining the rationale for the campaign, Andrew Lansley, the Health Secretary, said: “The refusal of some clinics to help their patients has left some of those women worried and confused.

“That’s why we are running this ad campaign, to give women clear, definitive advice about what course of action they should take. I hope it helps women decide what is best for them. We have made it very clear to private companies what we expect of them – to provide their patients with the aftercare that they need and deserve.”

“I do not think it is fair to the taxpayer or other NHS patients for the NHS to foot the bill.  We will pursue private clinics with all means at our disposal to avoid this.”

Professor Sir Bruce Keogh, NHS medical director and leader of an expert group on PIP implants convened by Mr Lansley, said: “At present there is insufficient evidence to recommend routine removal of these implants.

“But I know women will be worried. That’s why the expert group supports the NHS offer and believes the private industry should do the same.”

From: http://www.telegraph.co.uk/Breast-implant-scandal-Government-campaign-to-reassure-women

There are a host of challenges looming for the NHS in the next 12 months.

The inquiry has been looking at what happened at Stafford Hospital from 2005 to 2008 during which hundreds of patients died needlessly and why it went undetected for so long. In particular, the findings promise to have major implications for regulation of the health service.

In recent months, the Care Quality Commission, which now regulates quality in the NHS after taking on responsibility for it from the Healthcare Commission in 2009, has come under criticism from the House of Commons health committee for losing sight of what it should be doing. Ominously for the quango, the prime minister was quick to give his backing to the findings.

What is more, during the inquiry the culture and vision of the regulator came under attack from its own officials, prompting the health secretary to order an investigation himself. It seems unlikely that the CQC will survive unchanged.

Politically, the government’s reform of the NHS in England may be over the worst hurdles, but that does not mean it will be an easy ride from now until the big bang in 2013 when GPs finally get control over the purse strings.

There is growing frustration among doctors who are getting involved in the new clinical commission groups. In many ways, they should be the greatest advocates of the plans as they are supposed to be getting more power than ever before.

But the Clinical Commissioning Coalition, which represents the GPs who are piloting the new arrangements, has started reporting that they are being bullied by senior managers in the health service. They say they are interfering with their structures and decision-making process – and this in turn is threatening the whole project. Expect another 12 months of arguments and controversy.

Although it is not part of the NHS, the social care system is closely linked to the fortunes of the health service. Whether it is arranging discharge from hospital or preventing falls in the home, when social services are not working as they should, the effect is felt in the NHS.

When Tony Blair came to power in 1997 he talked about improving social care. But at the end of Labour’s 13 years in power, ministers were still arguing about the best way forward.

After 13 years of labour’s dithering the system is suffering from chronic under funding.

While the NHS enjoys a budget in excess of £100 billion, adult social care has to get by on about £14 billion.

This is topped up by individual contributions – the system is means-tested – but nonetheless councils across the country are cutting back on what they can offer. And so reform will require extra money – something which is of course in short supply at the moment.

It is also likely to require cross-party consensus, but there is still some bad blood between the health secretary and his Labour opponent Andy Burnham over the death tax row which effectively scuppered the shadow health secretary’s plans to reform social care when he was in power.

The budget is increasing by an average of 0.1%, but as inflation in the health service is rising at a much quicker rate to cover costs associated with the ageing population and rising levels of obesity, savings are having to be made.

The NHS has a target of £20 billion by 2015, the equivalent of about 4% a year. That means there is pressure on jobs – unions say tens of thousands are being lost – and front-line services.

In particular, hospitals are coming under pressure. Advances in medicine and the nature of illnesses in the 21st century – many more people are suffering from chronic conditions like diabetes – means more and more can be done in the community.

It has meant an increasing number of hospitals are piling up debts because they are not getting enough patients through the door.

This in turn means managers and ministers are having to make difficult decisions about closing departments and even whole centres. The process will continue in 2012, particularly in and around London which was recently described as being in a “shocking” state by a committee of MPs.

Under Labour, an 18-week waiting time target was set for non-emergency hospital treatment, such as knee and hip operations. Within months of the coalition being formed, ministers said it was being relaxed to move away from the tick-box culture that they say had developed.

But when the government was knee-deep in criticism over its reforms the prime minister made the specific pledge that waiting times would not be allowed to slip. This has resulted in more attention than ever being given to waiting times.

And signs are emerging that hospitals are beginning to struggle to keep up with the 18-week goal. Overall, the NHS is still meeting the target – they only have to achieve it for 90% of patients to reflect the fact there are valid reasons why some wait longer.

But that masks the fact that there is a rising number of places where it is being breached, leaving the best-performers to bring the national figure up.

It means there could be growing dissatisfaction with the waits patients are facing, although it must be remembered a return to the 1990s when waits of six months and even a year were the norm for many patients is still a long, long way off.

Two thirds of parents who have children fighting cancer are being forced into debt due to the costs of caring for them, according to research.

Many such parents also take extensive unpaid leave, so the families have to get by on reduced incomes.

The survey of 245 parents found 66 per cent were having to borrow money to make ends meet, while 76 per cent said extra costs were having a major impact on family finances.

More than two in five (42 per cent) were borrowing on a credit card, while 20 per cent had taken out a loan.

More than one in 20 (6 per cent) had turned to high interest, short-term loans to cope with additional costs.

Of those in debt, 41 per cent had been forced to borrow more than £1,000 to fund extra costs while 27 per cent borrowed more than £2,000.

More than half (55 per cent) had taken unpaid leave – many more than three months – while 13 per cent said they felt they had been demoted as a result.

Cancer-related expenses every month amounted to more than £360 on average.

Lorraine Clifton, chief executive of CLIC Sargent, said: “Everyone is suffering in this economic climate but parents of children with cancer are amongst the hardest hit. The extra costs can be significant.

“It’s shocking to hear that some families felt driven to debt in order to get through financially. Unpaid leave from work, travel costs and care for siblings are some of the additional costs that families face once cancer treatment begins.

“CLIC Sargent is concerned that Government reforms will restrict families’ options to financial support through the benefits system.

“Which is why we want to work with the Government and other organisations to ensure young people and children with cancer, and their families, have the financial support they need.”

It has accused the Care Quality Commission for failing to follow up a whistle blower’s warnings of alleged abuse of patients at the Winterbourne View care home near Bristol, of failing to “provide value for money”.

The CQC was established by Labour and cam into being in April 2009, bringing together three predecessor organisations – the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.

But the NAO report said work on inspecting health and social care organisations “fell significantly” after April 2009, “due to the Commission’s decision to prioritise registration over compliance”.

Besides checking institutions, the CQC also has responsibility for registering them.

The report found the CQC “diverted resources in a bid to meet the statutory timetable for registration”.

As a result, it completed just 47 per cent of its target number of compliance reviews of standards of care between October 2010 and April 2011.

Government recruitment restrictions meant 14 per cent of staff positions were vacant last September, with serious shortages of registration assessors and compliance inspectors.

The CQC was established with a budget six per cent lower than the money given to the organisations it replaced, the NAO noted.

Amyas Morse, the Auditor General, said the CQC has had “an uphill struggle to carry out its work effectively and has experienced serious difficulties”.

Margaret Hodge, chairman of the House of Commons’ Public Accounts Committee, said of the CQC: “This report raises serious concerns about whether it is up to scratch.”

Cynthia Bower, the CQC’s chief executive, said it was now “firmly on the right track”.

From: http://www.telegraph.co.uk/Care-home-checks-fell-significantly-under-CQC-warns-NAO

When a BBC Panorama programme contacted 85 hospital trusts with PFI deals, it found 80 of them said they were having to make increased payments due to inflation.

When most of the deals were set up, inflation was low and the outlook was for that to continue well into the future.

Most trusts decided not to protect their debts from rising inflation, against the advice of the Treasury.

By contrast, the companies building the hospitals insured themselves against losses due to inflation.

The PFI deals, under which companies build hospitals to be leased back by the NHS, typically run for 30 years.

Margaret Hodge, the Labour MP who now chairs the Public Accounts Committee, admitted to the programme: “We should have been much more transparent about the costs. I think we got the balance wrong.”

Richard Bacon, a Conservative member of the committee, said he thought taxpayers were being “ripped off”.

A spokesman for the Treasury said that protecting PFI debts against inflation was “not mandatory … because it is subject to individual authorities undertaking their own project assessments”.

He added said: “The Government has consistently expressed concerns about the misuse and costliness of PFI. That is why, less than two weeks ago, the Government launched a fundamental review of the PFI model, which will see the end of PFI as we know it.”

The Prime Minister will say that the controversial industry has the potential to be a powerhouse of Britain’s 21st century economy, but that it is stifled by excessive regulation at present.

Speaking to Sky News, Mr Burnham said that while he did not object in principle to close ties between the NHS and private sector life science companies, he was concerned that “one of the patients’ groups that was on the working group looking at this issue has walked away”.

“That gives real cause for concern and rings alarm bells” he said. “The Government simply can’t say: ‘This is all red tape and it all must be brushed away’”.

“Proper regulation, essential safeguards need to be in place when it comes to the use of patient data.”

The move, which will give life science companies more freedom to run clinical trials inside hospitals, is likely to face a backlash from privacy campaigners who have consistently opposed private companies being given access to medical records.

There will be particular opposition from animal rights activists who object vehemently, and sometimes violently, to vivisection, while religious groups, particularly the Roman Catholic Church, could object to firms that use stem cells harvested from embryos being allowed access to NHS data.

One senior executive at a leading drugs company well-known for using animal testing said: “You can look at the NHS as one massive database with 60 million people in it.”

The Prime Minister will stress that greater integration between private companies and the NHS could advance medical science, give patients greater access to cutting-edge treatments and save money, while boosting economic growth.

With Britain teetering on the brink of a double-dip recession, ministers are keen to show that they have a positive vision of the future.

“Britain has the potential to become a powerhouse in the world’s life sciences industry,” said a Downing Street source this weekend.

“We want to see much closer collaboration between the NHS and life science companies — not just greater data-sharing, but more clinical trials in hospitals.

“These changes will not only boost the industry, but also potentially give the NHS early access to new, innovative drugs treatments.”

Welcoming the move, Andrew Witty, the chief executive of GlaxoSmithKline, one of the world’s largest pharmaceutical companies, said: “Any action the Government takes to improve the environment in this country for life science across these activities is welcome.”

Britain is considered uniquely placed to become a world leader in life sciences because of the strength of scientific research at its top universities and the amount of data and expertise amassed by the NHS since its creation in 1948.

The industry already employs about 160,000 people in 4,500 companies, ranging from large multinationals to small businesses.

These firms employ highly skilled researchers with PhDs down to lower-skilled workers in drugs manufacturing plants.

Whether such companies would be charged for access to NHS records was not clear.

Although personal information should be anonymised, the public sector has an appauling history of handling the personal details of citizens.

Numerous health trusts have been criticised for losing patient records in recent years and HM Revenue & Customs has previously lost the financial records of millions of taxpayers.

Privacy campaigners led a vigorous campaign against the previous Labour government’s plans to place every medical record on a central electronic database.

It is understood that the Medicines and Healthcare Products Regulatory Agency would oversee the sharing of NHS data with businesses.

Joyce Robins, from Patient Concern, said many people would be “deeply disturbed” by the notion that their private medical records could be handed to firms seeking new markets.

“Even when they say records will be anonymised, the amount of detail contained in medical records means that companies may be able to find ways to target people with particular conditions,” she said.

“This data is absolutely private; it is not the Government’s to give.”

Health Direct has long warned that patients’ personal data security.

If the Government is genuine in their desire to speed up drug development- they ought to cut red tape.

10 years ago 10% of all new drugs developed in the world were tested in the UK. Since labour created the killer quango National Institute for Curbing Expenditure (NICE) this figure that fallen to only 3%.

Studies show that up to 10 per cent of women in Britain suffer from a serious fear of natural childbirth, called tokophobia.

Now the National Institute for Curbing Expenditure (NICE) is recommending that women should always have the right to a caesarean, even if they have no physical or mental health need.

The guidelines, state: “For women requesting a CS [caesarean section], if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.”

Malcolm Griffiths, a consultant obstetrician and gynaecologist at Luton and Dunstable Hospital, who chaired the guidelines development group, said most women were not interested in having a caesarean.

“It is a major operation, about as major as a hysterectomy,” he said.

Nonetheless, 25 per cent of births in Britain are now by caesarean. Between a third and a half of them are pre-planned.

Figures show that rates in Nordic countries are much lower, at about 15 per cent.

Many obstetricians want the UK rate to come down, but believe that is impossible without better midwifery services.

Mr Griffiths said: “I think probably key to the difference is support during labour, with one-to-one midwifery care and support in Nordic countries.”

Better midwifery care was “key to reducing the caesarean rate”, he added.

Nina Khazaezadeh, a consultant midwife at St Thomas’ Hospital in London and a member of the guidelines panel, said some women opted for caesareans because they feared childbirth after a “traumatic” first experience in an understaffed ward – a condition known as “secondary tokophobia”.

She said: “We might see a rise in secondary tokophobia where women have already had a birth that they have found very traumatic, and the perceived lack of support will have had an impact on their decisions for the next pregnancy.”

Cathy Warwick, chief executive of the Royal College of Midwives, said: “There is very clear evidence that one-to-one support in labour reduces caesarean rates”.

However, she welcomed the new Nice guidelines, saying it was “absolutely acceptable” that a woman who feared childbirth should be offered a caesarean.

Coincidentally, the RCM publishes a new report today claiming that England faces “massive midwife shortages” and needs another 5,000 of them.

Even though numbers have increased since 2001, they have “failed to keep pace with the rocketing number and increasing complexity of births”, it warns.

The number of births has risen by 22 per cent in a decade, with midwives having to deal with 120,000 more in 2010 than in 2001.

Mothers also tend to be older and heavier than in the past, which both raise the chance of complications.

Belinda Phipps, chief executive of NCT, said: “Most women want a straightforward birth, some need a caesarean. When women are treated with respect, and are offered support and information tailored to their concerns, very few of them will choose a caesarean birth unless there are clear health reasons.

“However, our services fail women badly at the moment, with midwifery numbers well below the level required to guarantee safe and satisfying care.”

She went on: “If caesarean rates go up following the change to the guidelines, it will be evidence that women are not getting the quality of midwifery support they need.”

The guidelines do recommend that a woman requesting a caesarean should be made to talk about her fear of childbirth before an operation is granted.

From: http://www.telegraph.co.uk/Caesareans-to-be-offered-to-all-amid-fears-over-midwife-shortages

Survival rates for breast cancer, prostate cancer and cervical cancer were below the average for the 34 developed countries in the study.

Mr Lansley lays the blame for the poor performance on the previous government’s failure to make sure that extra investment in the NHS reached the front line. He claims patient care was ignored in favour of increased salaries and botched computer systems.

Writing in The Daily Telegraph, Mr Lansley says: “Unfortunately this report shows how much work there is to do to deal with Labour’s legacy of neglect and mismanagement of our NHS.

“They hugely increased spending on the Health Service, but wasted much of it on managers, failed IT projects and unsustainable PFI projects.

“They failed to focus on what really matters – patients – which is why we still have some of the worst cancer outcomes amongst comparable countries.”

Under Labour, spending on the NHS trebled, reaching almost £100 billion in 2009, but money for treating cancer still lags behind much of the rest of the world.

A report by the Policy Exchange think tank last year found that England spent around 5.6 per cent of its health care budget on cancer care, compared with 7.7 per cent in France, 9.6 per cent in Germany and 9.2 per cent in America.

In September it emerged that private finance initiatives, introduced by Labour to fund capital projects, have left 60 NHS hospitals on the “brink of financial collapse”. Meanwhile, the pay of NHS chief executives has risen, with typical earnings now more than £150,000.

The OECD figures reveal that the best breast cancer survival rates were in the US, where 89.3 per cent of women were alive five years after being diagnosed. The average across all OECD countries was 83.5 per cent, while in the UK it was 81.3 per cent.

Survival rates for cervical cancer were worse. Norway topped the table with 78.2 per cent still alive after five years, compared with 58 per cent of women in the UK. There were also more hospital admissions for asthma and other lung conditions than the average and infant mortality was higher.

The report also showed that consultations by doctors have fallen, and were below he OECD average in 2009.

Katherine Murphy, the chief executive of the Patients Association, said: “The NHS provides some excellent care but it does fall down on many counts. We know from patients phoning our helpline that the quality of care that they have experienced can be very poor and sometimes it is downright neglectful.

“Rather than trying to tackle the issue of poor care, the Department of Health is demanding that the NHS makes £20 billion of efficiency savings while spending a million pounds a day on a reform plan that doctors, nurses, patients and NHS managers all say risks irrevocably damaging the NHS.”

From:  http://www.telegraph.co.uk/Cancer-cash-wasted-on-NHS-salaries

The threats are part of the Revenue’s efforts to recover unpaid tax owed by various professions and trades.

People selling on internet marketplaces, and electricians, will be targeted early next year.

As well as doctors and dentists, HMRC has already been paying special attention to the tax affairs of restaurant owners and their staff, plumbers, private tutors and scrap metal dealers, as well as people with money hidden in offshore bank accounts.

Last month, the Revenue added to its list of potential miscreants, announcing it would also be focusing on wealthy people who own homes abroad, as well as commodity traders.

Gary Ashford of the Chartered Institute of Taxation (CIOT) said doctors and dentists should not ignore the Revenue’s latest letters.

“HMRC will either ‘make a determination’, which would result in the taxpayer incurring significant additional charges, or refer the case to their criminal investigations department with a view to prosecution,” he said.

“They have offered the carrot of a relatively low penalty rate for doctors to get their affairs in order and 1,500 health professionals took it up, bringing in £10m for the Exchequer.

“Now they are wielding the stick at those who have not come forward,” he said.

Mr Ashford pointed out that the Revenue had been gleaning information from employers of doctors and dentists, such as locum agencies, drug companies and medical insurance firms.

“What we are now seeing is HMRC starting to use that information, to identify who has not notified HMRC of all their tax liabilities,” Mr Ashford pointed out.

The rise comes after years of success in tackling the problem, and illustrates growing pressures on the NHS and social services.

According to Department of Health statistics, the number of hospital bed days lost to bed blockers rose from 115,648 during September and October 2010, to 128,517 in the same two month period this year.

That comes after a sustained period of falls between 2003 and 2009, as a result of concerted ministerial action to tackle the problem.

With the average cost of providing a hospital bed for a day estimated at £255, that means the daily NHS bill for bed blockers has risen from £483,000 to £537,000.

Aside from this economic cost, it also means hospitals cannot admit new patients as quickly, which can delay waiting times for pre-planned operations.

The statistics confirm what many have been fearing for months: that reductions in local authority social care budgets would quickly lead to clogged up hospital wards.

In February Bupa warned that “chronic under-funding” of care home places would lead to an “intolerable” bed-blocking crisis in the long term, costing the NHS millions of pounds a day.

Oliver Thomas, director of UK care homes for Bupa, said last night: “If you slow down the number of people placed in residential care, because you are trying to manage your budgets better, then inevitably people will stay longer in the acute sector.”

Others described the latest figures as a “warning” of worse to come and a “pinch point”.

Jo Webber, of the NHS Confederation, which represents health service authorities, said: “This is a worrying sign of the pressure which is building in the system. Like waiting times, it is a pinch point.”

Last month The Daily Telegraph reported that government funding for nursing homes and home help for pensioners had been cut by almost a fifth, with some councils cutting spending by up to 30 per cent.

At the same time many hospitals are cutting hospital bed numbers, by up to 10 per cent, in part to meet tough efficiency saving targets.

Dr Ian Donald, of the British Geriatrics Society, said: “The trouble is hospitals operate on such tight margins. Even small delays can cause problems.”

The term ‘bed blocker’ tends to imply the patient is the cause of the problem, but Dr Donald emphasised that was not the case.

“Delayed discharges are not just statistics, but individual patients who are frail and vulnerable. “To them and their families it can feel like they are stuck and lost in the system,” he said.

The new figures follow the introduction in August 2010 of a new monthly reporting system for counting ‘delayed discharges’ – incidents when an otherwise healthy patient is kept in due to lack of community care facilities – brought in due to concerns over quality of data.

From: http://www.telegraph.co.uk/Bed-blocking-rise-of-11pc-in-last-year

Dieters lost more weight and kept it off for longer by joining a slimming club than after having counselling from specially trained staff in GP surgeries or pharmacies, it was found.

Experts said money would be better spent on encouraging people to attend classes run by commercial companies.

The study, Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity is published online in the British Medical Journal (BMJ), involved 740 obese or overweight men and women recruited from one NHS trust in Birmingham.

They were divided into six groups and attended either Weight Watchers, Slimming World, Rosemary Conley, a group-based NHS programme run by advisers and dieticians called Size Down, one-to-one counselling sessions in GP surgeries, or one-to-one counselling in pharmacies.

Another group was provided with 12 vouchers for free entrance to a local fitness centre.

At 12 weeks, data was available for 658 of the participants and 522 after one year.

All programmes achieved weight loss at 12 weeks – from an average of 1.37kg in the GP group to 4.43kg in the Weight Watchers group.

But the NHS programmes were found to be no better than the people exercising at a local fitness centre at this point.

At the one year mark, all the programmes except the GP and pharmacy groups had resulted in “significant weight loss”.

However, Weight Watchers was the only programme to achieve significantly greater weight loss than the control group – and was the best attended group.

Compared to the NHS programmes, commercially-run ones meant people typically lost an extra 2.3kg.

The authors, from the University of Birmingham, the Nursing and Midwifery Council and NHS South Birmingham concluded: “Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective.”

A spokesman for the Department of Health said: “Weight management programmes can be very cost-effective and make losing weight easier for some people, but the best way to lose weight will be different for everyone.

“The local NHS must think about which weight management service will work best based on an individual patient’s needs.”

In September, another study conducted in the UK, Germany and Australia showed that a year-long Weight Watchers programme was far more beneficial than helpful doctor’s advice.

That study was published in The Lancet medical journal.

Parking fees at most Scottish hospitals were abolished in 2009 but remained at three sites where car parks were built under Labour’s Private Finance Initiative (PFI) .

NHS Greater Glasgow and Clyde said a limited number of £25 permits were available for staff who needed cars.

The multi-storey car park, which opened in 2005, is owned by Impreglio Car Parking and managed by Apcoa under contract to the health board.

Approximately 940 subsidised permits are issued with priority given to staff such as consultants who need to travel between different sites.

Other staff can apply for these permits, but demand outstrips availability and not all applicants are successful.

At the time, Scottish Health Secretary Nicola Sturgeon urged health boards to limit and reduce the charges until the contracts came to an end.

In September, the issue was raised in the Scottish parliament by Glasgow Kelvin MSP Sandra White.

She was told that the first minister sympathised with the staff, but the Scottish Government was bound by the terms of the PFI agreement signed by the previous Labour administration.

A spokeswoman for NHS Greater Glasgow and Clyde said: “Unfortunately, as the car park is privately-owned, we do not have any control over any tariff increases that Impreglio choose to make.”

The protest was due to take place at the hospital car park from 13:00.

From: http://www.bbc.co.uk/news/uk-scotland-glasgow-west-15622723

Meanwhile in other parts of the country married couples are being denied help in starting a family, forcing them to spend thousands of pounds on private treatment.

It comes after a Labour nanny state law removed the requirement for fertility doctors to consider a child’s need to have a male role model before going ahead with IVF.

Critics say the Government, which David Cameron promised would be “the most family friendly we’ve ever had in this country”, should tackle the postcode lottery of IVF provision and ensure that the needs of children are put first.

Frank Field, the Labour MP who carried out a high-profile review into poverty and life chances last year, said: “It’s clearly wrong that while couples in stable relationships can’t get IVF and in other areas, single women can.

“It’s really important that Government ministers speak up for children who are the ones left out of this. It needs someone in a position of authority to reflect what most taxpayers think.”

The Rt Rev Michael Nazir-Ali, the former Bishop of Rochester who once chaired the ethics committee of Britain’s fertility watchdog, said: “The irony is that at the very time research is showing the need for both parents, we are writing fathers out of the legislation.

“It’s one thing for a mother to find herself a single parent because of tragic circumstances. It’s quite another to plan for a situation where the child comes into the world without having a father or any possibility of having a father.”

Most local health authorities stipulate that couples must have been in a relationship for two or three years to qualify for IVF treatment.

That requirement is based on guidance issued in 2004 by the National Institute for Curbing Expenditure (Nice), the NHS rationing body,.

It states: “Couples in which the woman is aged 23–39 years at the time of treatment and who have an identified cause for their fertility problems … or who have infertility of at least three years’ duration, should be offered up to three stimulated cycles of in vitro fertilisation treatment.”

The document does note that the guidelines do not address social criteria “for example, whether it is single women or same-sex couples who are seeking treatment”.

However the Human Fertilisation and Embryology Act 2008 removed the reference to “the need for a father” when considering the welfare of the child when considering fertility treatment, replacing it with “the need for supportive parenting”.

Gareth Johnson MP, who chairs the All Party Parliamentary Group on Infertility, said that trusts offering the service to single women were going against one of the guiding principles of IVF, “that you are treating an infertile couple, not an infertile individual”.

Mr Johnson, the Conservative MP for Dartford, said: “Speaking in a personal capacity, if you are going for IVF, you are trying to create a baby, so there should be some evidence of a stable background, which you would expect to be a couple.”

Earlier this year he led an APPG report that found startling differences between what health authorities offered in terms of IVF.

It found three-quarters of Primary Care Trusts were failing to offer three cycles of IVF, as stipulated by Nice. Each cycle comprises a woman’s ovaries being stimulated to produce eggs, which are then fertilised in vitro and implanted in the womb. Spare eggs should be frozen for use if the first attempt fails.

The report found five trusts offered no IVF at all – Warrington, West Sussex, Stockport, North Staffordshire and North Yorkshire and York. Since then, NHS West Sussex has decided to start funding IVF again.

Many trusts have also started putting in place further barriers to IVF funding – for example demanding obese women lose weight – in part to limit demand as health budgets tighten.

Against a background of increasingly scarce provision, as the NHS tries to save £20billion by 2015, Mr Johnson said the decision to offer IVF to single women was misplaced.

From: http://www.telegraph.co.uk/Single-women-being-offered-IVF-on-the-NHS

The drug, called ipilimumab, works by teaching the immune system how to tackle melanomas and was widely seen as an important advance on “old-fashioned” chemotherapy.

But in draft guidance NICE- the National Institute for Curbing Expenditure has recommended that NHS trusts do not prescribe the treatment, because it costs about £80,000 per patient and because it had doubts over the research data.

It means that unless the manufacturer cuts the price, the only way that the growing number of advanced melanoma sufferers can access the drug is by applying to the Government’s Cancer Drugs Fund.

The decision comes after a provocative academic report claimed that some expensive cancer drugs are “futile” as they cost a lot and cause toxic side-effects yet only give dying patients a few more weeks to live.

In a joint statement, the support group Factor 50 and charity SKCIN said: “The breakthrough that patients and clinicians throughout the UK have been waiting for has arrived in the form of this drug.”

“Standard treatments that have been available since the 1970s are ineffective and to deny this drug to patients, many of whom are young and with very young families, has undoubtedly handed them down a death sentence.”

“To have come so close to a breakthrough and to be told no at this stage is truly devastating.”

Dr Pippa Corrie, Consultant Medical Oncologist at Cambridge University Hospitals NHS Foundation Trust, added: “Licensing of this drug for use in the UK marked a step change in melanoma patient care, and whilst the Nice decision is predictable, it is disappointing.

“It is essential that we all work to avoid any negative impact on facilitating patient access to this drug. Our patients have waited too long already.”

Rates of skin cancer are rising faster than any other type of the disease in Britain and it affects teenagers and young adults more than any other group.

Almost 12,000 people now develop the most serious kind, malignant melanoma, every year and about 2,000 will die after it spreads across the body.

For the past 30 years the only treatment has been a type of chemotherapy called dacarbazine which is not seen as particularly effective and leaves patients tired and at greater risk of infection.

The new treatment, marketed by Bristol-Myers Squibb as Yervoy, is taken in just four injections, one every three weeks and is said to have fewer side-effects.

In a trial on patients who had undergone prior therapy for skin cancer, 46 per cent who took the new drug were still alive after a year compared with 25 per cent who had not taken it.

In addition, 24 per cent were still alive at two years compared with 14 per cent of those who did not take the drug, and the median survival was 10.1 months compared with 6.4 months among those who did not take it.

But Nice, which assesses whether or not new treatments should be widely available on the NHS in England and Wales, has recommended against its use.

Sir Andrew Dillon, its chief executive, said: “We need to be sure that new treatments provide sufficient benefits to patients to justify the significant cost the NHS is being asked to pay.”

He said the evidence showed that ipilimumab was only effective for a “small percentage” of patients, it was not clear how long its effects last, and that it was linked to “a number of adverse reactions”.

“The Committee considered all these factors and concluded that, on the basis of the evidence provided so far, ipilimumab could not be considered a cost-effective use of NHS resources.”

But he added that the decision is open to public consultation while the manufacturer can offer to cut the cost.

Amadou Diarra, European Vice President and General Manager at Bristol-Myers Squibb UK, said: “We are fully committed to demonstrating that Yervoy represents real value for money to the NHS, and we will be submitting further evidence the hope that Nice will reconsider this decision so that all patients with metastatic melanoma can access this potentially life-extending treatment.”

From: http://www.telegraph.co.uk/Death-sentence-as-NHS-watchdog-rejects-skin-cancer-drug

A drug that can give advanced prostate cancer sufferers an extra two months to live has been rejected by the NHS’s rationing body.

It said that although the drug did extend survival for patients with advanced prostate cancer, it was “concerned” about the side-effects experienced in clinical trials and that at an average cost of £22,000 per patient it was too expensive.

The move comes after an important study commissioned by The Lancet Oncology warned that the cost of cancer care is becoming unsustainable in developed countries, and that it makes no sense to keep giving “toxic” and costly drugs to patients with just a few weeks to live.

Sir Andrew Dillon, the chief executive of Nice, said: “The committee concluded that cabazitaxel would not be a cost effective use of limited NHS resources.”

But Owen Sharp, chief executive of the Prostate Cancer Charity, said: “Cabazitaxel is an important treatment, only recently licensed for use here in the UK, which can help to extend the lives of men in the final stages of prostate cancer for whom existing treatments have stopped working.

“These men currently have very few treatment options open to them when their cancer reaches this advanced stage. Increasing the number of treatments that may extend the lives of these men and allow them to spend precious time with their families is essential.”

Prostate cancer is the most common form of the disease among British men, with 37,000 cases diagnosed every year.

Some men live for years with slow-growing tumours, but in other cases it develops aggressively and kills after spreading to other organs.

Treatments often attempt to reduce the production of testosterone, a hormone that fuels the growth of the tumours, but patients can develop resistance to this type of therapy.

In clinical trials, men with advanced prostate cancer who were given cabazitaxel in combination with prednisone, a drug that suppresses the immune system, lived for an extra 10 weeks.

But Nice said there was “uncertainty” about the new drug’s effect on patients’ hearts and livers, and it did not meet its criteria for being considered as an end-of-life drug worthy of additional funding.

It means that anyone who hopes to obtain the new type of chemotherapy on the NHS must make an individual application through the Cancer Drugs Fund.

Nice is still assessing the value of a daily pill that can treat advanced prostate cancer, called abiraterone acetate, which is believed to have kept the Lockerbie bomber alive longer than expected.

From: http://www.telegraph.co.uk/NHS-rationing-body-rejects-prostate-cancer-drug

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

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 launch was hosted by television presenter Eamonn Holmes, who will also front the live draw to be shown on ITV1 and Channel 5 each Saturday from October 8.

He said: “It’s such a great idea, I am really excited about being part of something that not only makes people smile every week, but also has the ability to change lives in the longer term.

“In these difficult economic times, the Health Lottery will inject a sizeable amount of new money into that local network, and the projects that are supported will help people live longer, healthier lives.”

Twenty pence from tickets, which cost £1, will go towards health-related good causes.

Matching three numbers wins £50 and four numbers £500.

No matter how many people win, everyone will get the advertised prize, the Health Lottery said.

John Hume, chief executive of the People’s Health Trust, said: “We will be working directly with communities to identify practical and sustainable ways in which funding from the Health Lottery can have real impacts on health and well-being in communities experiencing significant disadvantages.”

Martin Hall, chief executive of the Health Lottery said: “The Health Lottery game is a fresh new alternative which has one single good cause at its heart – health.

“We will be offering people the opportunity to win a life-changing amount of money while at the same time contributing to tackling real health issues in their own communities.

“It is an exciting new launch which will benefit every community in Great Britain.”

But the launch attracted criticism from Sir Stephen Bubb, of the Association of Chief Executives of Voluntary Organisations, who dubbed it a “disgraceful new development”.

He wrote on his blog: “He (Northern & Shell owner Richard Desmond) intends to only give 20p in the pound to health, whereas the National Lottery is giving 28p to good causes.

“So if people switch to Desmond from the National Lottery charities will lose out.”

Health Direct also notes that the marketing and admin charges are higher for the new lottery than the national Camelot lottery.

The trusts in jeopardy include Barts and the London, Oxford Radcliffe, North Bristol, St Helens and Knowsley, and Portsmouth.

Between them the trusts run more than 60 hospitals which care for 12 million patients.

There is already evidence that waiting lists for non–urgent operations have begun to rise as hospitals delay treatment to save money. Adding to this are growing fears over the impact of the financial crisis on care this winter.

Under the PFI deals, a private contractor builds a hospital or school. It owns the building for up to 35 years, and during this period the public sector must pay interest and repay the cost of construction, as well as paying the contractor to maintain the building.

However, the total cost of the deals is often far more than the value of the assets. As a result, Mr Lansley says, the 22 trusts “cannot afford” to pay for their schemes, which in total are worth more than £5.4billion, because the required payments have risen sharply in the wake of the recession.

Mr Lansley said: “Over the last year, we’ve been working to expose the mess Labour left us with, and the truth is that some hospitals have been landed with PFI deals they simply cannot afford.

“Like the economy, Labour has brought some parts of the NHS to the brink of financial collapse. Tough solutions may be needed for these problems, but we’ll help the NHS overcome them. We will not make the sick pay for Labour’s debt crisis.”

He said hospitals would not be allowed to collapse financially.

“There are many hospitals that are well run, do not have a legacy of debt and do have projects which are perfectly sustainable. My point is that we have looked since the election and are working together with individual trusts to arrive at a place where they are financially, and in terms of the quality of their services, sustainable for the future. We can only do that if we work closely with them,” he said.

“This is about making very clear that we are not only working on unsustainable PFIs, but also working with legacy debt that the NHS has been left with, working on the IT programmes which were on an unsustainable scale of contractual commitments that didn’t meet the need of the NHS’s customers.

“Across the board, we have to tackle Labour’s legacy of poor value formoney and debt.”

Over the next few weeks, Department of Health officials and executives at the 22 trusts will develop detailed plans for dealing with the crisis. Their proposals are expected to include significant cost–cutting and the renegotiation of PFI contracts.

Money will also be moved from NHS trusts that are in better financial shape to cover the debt costs at those that are struggling. However, officials are braced for the need to use Whitehall funds to bail out some hospitals.

Among the trusts which have contacted Mr Lansley to inform him of their severe financial problems are several London institutions, including South London Healthcare, Barking, Havering and Redbridge, and North Middlesex.

Outside the capital, other trusts to have approached the health department include Wye Valley, Worcester Acute Hospitals, Mid Yorkshire, and Walsall.

After the general election last year, Mr Lansley ordered officials to establish why some NHS hospitals were under–performing. The health department is assessing the financial position of every hospital. It is understood that the PFI costs have emerged as a leading factor in poor patient care in some areas.

The Health Secretary decided to disclose the list of hospitals in difficulty and is expected to announce the rescue plans for each trust next month.

Taxpayers are having to pay more than £200 billion for schools, hospitals and other projects whose capital value is little more than £50 billion.

In one example, a hospital in Bromley, south east London, will ultimately cost the NHS £1.2 billion, more than 10 times what it is worth. Another hospital was charged £52,000 for maintenance that cost £750. The annual cost of the schemes is almost £400 for each household.

The public payments for PFI deals are typically linked to inflation and therefore the cost to taxpayers has increased by up to a third since the beginning of the credit crisis, according to the National Audit Office. Last month, MPs on the Treasury select committee effectively called for a moratorium on new PFI projects, which it said were “like a drug” as the costs were not apparent at the outset.

George Osborne, the Chancellor, has tightened the rules on the deals.

Earlier this year, John Healey, the shadow health secretary, admitted in an interview that Labour ministers had failed when negotiating the multi–million pound schemes for hospitals.

“There is definitely a case for saying we were poor at PFI, poor at negotiating PFI contracts at the outset,” he said.

Companies who run PFI schemes boast profit margins of up to 71 per cent on the projects, but have come under growing pressure from MPs and ministers to return some of their “windfall profits”.

From: http://www.telegraph.co.uk/NHS-hospitals-crippled-by-PFI-scheme

NHS managers are trying to restrict access to crucial tests and scans in a move that could mean diseases being diagnosed later. 

An investigation has found that a quarter of Primary Care Trusts are either investigating how many patients individual GP practices send for examinations or looking for ways to reduce the numbers.

In addition, a handful are identifying “excessive” use of the tests or setting upper targets while others have completely stopped letting doctors have direct access to the scans.

Experts said the tactics could lead to patients being diagnosed later with diseases such as cancer, which research shows lowers survival chances.

Dr Clare Gerada, head of the Royal College of GPs, said: “This is about money and finances driving behaviour by the PCT – not about putting patients first.”

Cancer Research UK’s director of policy, Sarah Woolnough, added: “It is very worrying to hear of PCTs setting referral targets and decommissioning direct access to tests that could speed up a cancer diagnosis.”

Meanwhile, official figures show that even patients who are being referred to hospitals for tests are being forced to wait longer than a year ago.

Department of Health statistics show that 10,700 patients were waiting more than six weeks for any one of 15 key diagnostic tests at the end of July, a rise of 7,000 on the figure for the previous year.

The Government has told health service managers to improve direct access to diagnostic scans such as MRI, CT and ultrasound in order to improve early diagnosis of cancer and heart disease.

But an investigation by GP magazine suggests that many trusts want to reduce the number of patients sent directly to tests at specialist centres in order to save money.

Of the 116 Primary Care Trusts contacted, 28 per cent said they had either started looking into how many referrals GPs carried out across their area, or were planning to do so. A quarter are helping practices reduce inappropriate access.

Nine trusts said they had found surgeries that either sent too many or too few patients for tests while two are considering introducing upper and lower targets.

Five PCTs have scrapped direct access altogether to at least one type of test.

Dr Chaand Nagpaul, a leading member of the British Medical Association, said restricting access to scans risks “turning back the clock” on plans to diagnose disease early.

“An intelligent approach would be to have guidelines for appropriate use of diagnostics and incorporate them into the pathway.”

The moves are the latest example of how managers are rationing patient care in an attempt to make unprecedented efficiency savings totalling £20billion across the NHS by 2015.

From: http://www.telegraph.co.uk/NHS-managers-restricting-access-to-crucial-scans-and-tests

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

It is set to embark on a major restructuring exercise to rebalance its books, which includes setting up eight regional boards and merging offices in 41 regions.

But the charity, which has recorded operating losses seven years in a row, is accused of “kicking volunteers in the teeth” by those who regularly help out.

They claim that disillusioned volunteers will no longer want to raise money if the cash goes in a central pot rather than helping local projects.

“All counties work in their own particular way according to their local people and in a way that can only be done by them,” one senior volunteer said.

“If the structure is changed … what incentive is there for local people to volunteer and raise money?”

A former chairman of a county division claimed the changes would lead to “financial ruin”.

“We are absolutely horrified because we feel that this restructure is doing away with the strong volunteer ethos of St John’s. It’s like kicking volunteers in the teeth” she said.

Under the plans eight regional directors will be created on salaries of £80,000 a year plus benefits to represent London, the south east, south west, East Midlands, West Midlands, East of England, North-West and North East.

Officials admitted that “financial” pressures were partly behind the new structure as well as “increasing regulation”. It denied it was in “imminent financial crisis”.

While the service claimed there would be no redundancies the charity admitted “some roles have been placed at risk and are therefore undergoing consultation”. It would not provide further details.

The charity, founded in 1877, currently employs about 1600 staff across the country and has more than 40,000 volunteers on its books.

It trains more than half a million people a year and has more than 1000 ambulances that provide support to NHS trusts. The Duke of Gloucester is the service’s Grand Prior of the Order.

In a letter sent to volunteers around the country, Rodney Green, the charity’s Prior and chairman of board of trustees, admitted the organisation faced a “number of difficult challenges in the years ahead”.

A briefing note sent to volunteers explaining the changes, said the organisation needed to increase its “charitable and community impact”.

“We need a greater consistency in our quality – so that we can meet more stringent regulatory requirements and also better support the front line,” stated the document, titled “Becoming ‘The Difference’: transforming St John Ambulance”.

“More urgently, we need to balance the books and achieve secure finances.  For seven years running, we have spent more than we earned and are set to make further losses this year. The charity cannot sustain this.”

Mr Green insisted the changes, signed off by the trustees last month following “rigorous analysis of the current structure”, would transform the organisation “so that we can save yet more lives”.

From: http://www.telegraph.co.uk/St-John-Ambulance-abandoning-volunteers-over-restructure-project

Mr King said the number of care home places in the UK will fall unless operators get “fairer fees”.

His comments came as he unveiled a sharp rise in Bupa’s overall global profits, but a fall in the UK division.

About 70% of Bupa’s 18,000 care residents, in its more than 300 homes, are paid for by local authorities- and local authorities pay for well over half of England’s 390,000 care home residents.

But Mr King said operators are seeing a real terms fall in fees as authorities’ budgets come under pressure.

Bupa believes there could be a 100,000 care home bed shortfall within 10 years, if investment in the sector is not increased and current funds are not ring fenced.

This could put pressure on the NHS to take in people who would normally go into care homes.

Bupa, which is a provident company with no shareholders, said its global care services division lifted revenues by 1% to £589 million and profits by 2% to £67.7 million in the half year to June.

But the UK care arm saw a “marginal” fall in profits and occupancy, a situation that could worsen.

Mr King said: “We are calling for the chronic underfunding of the social care system to be urgently addressed. At the absolute minimum, there must be a real terms increase in funding for local authority purchased care home places over 2012-15.”

Clinical negligence claims against the National Health Service have increased by almost a third over the past year, with an extra £100 million paid out to victims of medical blunders.

It paid out £863m to victims of accidents in hospitals and clinics, up from £787m the year before, after settling 5,398 cases.

But a quarter of this was spent on legal costs, with £200m going to claimants’ lawyers under the system whereby so-called “ambulance chasers” can charge up to £900 an hour to pursue claims.

The litigation authority’s annual report is scathing about the current regime, which it claims is driving the “rapid growth in claims numbers” rather than any increase in mistakes by NHS staff.

Under the “no-win, no-fee” system set up by Labour so poorer people could have access to justice, known as Conditional Fee Arrangements, claimants do not have to pay for lawyers upfront. But if they win cases, the lawyers can claim big “success fees” from the defendant.

Steve Walker, chief executive of the NHS Litigation Authority , said: “We believe very strongly that a regime which allows success fees and the recoverability of After the Event (ATE) insurance premiums makes litigation so profitable that solicitors and so-called ‘claims farmers’ are drawn into the market thereby fuelling the rise in claims volumes we have experienced.”

However he added that the body is “delighted” that the Ministry of Justice is acting on the Jackson review of civil litigation costs, which recommended that success fees and ATE premiums should not be recoverable in no-win, no-fee cases.

At the same time the Government hopes to save millions every year by scrapping Legal Aid in cases of alleged malpractice.

The litigation authority’s report shows that in total it recorded 12,142 claims against NHS trusts in 2010-11 but expects only 4 per cent to go to court, as most will either be settled beforehand or dropped.

Of these, 8,655 were clinical claims, up from 6,652 the previous year, and 4,346 were non-clinical, up from 4,074.A further 22,364 claims were still open at the end of the financial year.

The authority – funded partly by trusts and partly by the Department of Health directly – paid out £729m under its main clinical scheme and a further £134m under claims relating to incidents that took place before 1995.

This was an increase on £651m under the current scheme and £136m under the old schemes recorded in 2009-10.

A further £47.9m was paid out in non-clinical cases.

However these figures do not only include compensation paid to patients, staff and members of the public but legal costs as well.

The costs claimed by claimant lawyers continue to be significantly higher than those incurred on our behalf by our panel defence solicitors. This continues to be a major concern.

“The availability of Conditional Fee Agreements (CFAs) and the continued increase in their use by claimants in clinical negligence claims has also meant that claimants’ costs are almost invariably disproportionate, often significantly, to the amount of damages paid, particularly in low-value claims.

“In the 5,398 clinical negligence claims closed by us with a damages payment in 2010/11, we paid over £257m in total legal costs, of which almost £200m (76 per cent of the total costs expenditure) was paid to claimant lawyers.”

From: http://www.telegraph.co.uk/30-rise-in-negligence-claims-against-NHS

There was enormous excitement among Britain’s 100,000 MS sufferers in January when EU drugs regulators gave fingolimod preliminary marketing approval.

Novartis, which markets fingolimod under the brand name Gilenya, subsequently applied for it to be prescribed on the NHS in situations where existing drugs do not work.

To receive these drugs, called interferon therapy, patients either have to self-inject every few days or go to hospital for supervised infusions.

A trial, published last year in the New England Journal of Medicine, showed that fingolimod halved the number of disabling relapses compared with interferon beta.

However, the National Institute of Curbing Expenditure (Nice) has decided that – at £20,000 a year – fingolimod “would not be a cost effective use of NHS resources”.

Prof Carole Longson from Nice said: “Unfortunately our independent committee wasn’t given sufficient evidence to show that fingolimod could reduce relapses considerably better than the other treatments currently being used.”

MS charities last night said the decision was “disappointing”.

Simon Gillespie, chief executive of the MS Society, warned: “It will leave some people with no effective treatment option.”

He added: “Access to MS treatments in the UK is very poor – in fact people with MS would be better off living almost anywhere else in Europe, and this decision will only deepen that inequality.”

The German health service is already paying for 2,000 people to receive fingolimod for highly active relapsing-remitting MS (RRMS).

Fingolimod is an immumosuppressant and, while it is well tolerated by most patients, it does have side effects in some.

From: http://www.telegraph.co.uk/MS-pill-rejected-as-too-costly-by-Nice.html