Comprehensive data on hospital death rates, the individual performance of GPs and surgeons and patients’ experiences under their care are to be published in an attempt to improve standards.

Mr Lansley has set out 60 benchmarks that will replace Labour’s system of targets and will be used to define success in the NHS.

These include a commitment to preventing unnecessary early deaths, a pledge to enhance the quality of life for people with long-term conditions and a drive to ensure that people have a positive experience when using the health service.

If the new standards are achieved, 24,000 early deaths a year could be prevented from cancer and other long-term conditions, Mr Lansley believes.

In addition, fewer people with long-term conditions including asthma and diabetes will be treated in hospitals, he will claim, while patients undergoing routine hip and knee operations will no longer be left in pain or unable to walk.

Access to NHS dentists will also be improved, he will say.

The Cabinet minister said the record on unnecessary early deaths varied across specialties as he urged the health service to focus on “what really matters” – the results achieved for patients and their experiences while being treated.

“If you look at the question of how many patients in this country die who could live if they got the best health care, it is literally over 10,000 patients a year if we were simply to get to a place which is better than the average across the OECD (Organisation for Economic Co-operation and Development) countries.”

In an interview with The Daily Telegraph, Mr Lansley says his tenure as Health Secretary will have been a “failure” if the 60 new “outcome” targets do not improve by the next election. He pledges that the benchmarks will now “define what the NHS is setting out to achieve”.

“We have to clear the decks and be clear this is what we are focusing on,” he says. “People say in three and a half years’ time, in 2015, at the next election, how will we know whether you’ve succeeded or not? The answer is ‘have the outcomes improved?’

“It will be my failure if we haven’t improved them and the NHS should feel that it has not succeeded, that is what we are setting out to do.”

Next week, the Government will set out current performance for each of the 60 indicators. It will then set out national targets for improvement “by the time of the next election and beyond”.

The new NHS Commissioning Board and the Care Quality Commission will also intervene directly to address problems that are highlighted by the data.

In today’s interview, Mr Lansley says that the long-running row over NHS reform must end and the health service must concentrate on improving patient care.

“We’ve really got to get into the big picture, which is delivering improvements in the results we achieve for patients right across the board,” he said. “We know that we can do it.”

The benchmarks will be monitored partly through studying clinical data – for example, to ascertain whether mortality rates for cancer, liver and heart disease are improving — and partly through surveying patients to gauge whether they were satisfied by the standard of care they received and the speed of their recovery.

The Health Secretary says: “This is literally saying to patients ‘if you were in hospital, if you were being looked after by your general practitioner was the service and experience you had good or not?’ It’s not like some other kinds of medical model where you kind of treat people and they get better. This is different.

“This is really where you begin to kind of focus on the experience of care.”

For the first time, the views of bereaved relations and even children will be surveyed so that the quality of NHS care from early years until death can be assessed.

“We’ll be undertaking a consistent national survey of the bereaved relatives of people who received end of life care,” Mr Lansley said. “Asking them, after a suitable passage of time, what was their loved one’s experience of care and how well were they looked after towards the end of life.”

From: http://www.telegraph.co.uk/Andrew-Lansley-sixty-step-plan-to-help-NHS-focus-on-what-matters

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.”

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 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

But a pilot in four areas – Luton, County Durham and Darlington, Lincolnshire, and Nottingham – is highlighting worrying problems.

Official statistics show that in September, 12 per cent of calls went unanswered.

Across the four areas there were 33,707 calls to the service.

The Department of Health expects 12 million calls a year to the free 111 number in England, based on scaling up that figure.

Writing on the NHS’s own web page about the 111 number, one caller expressed frustration at being unable to get through despite waiting 35 minutes.

“All I wanted was a bit of advice. I now need to go to work and have had no help from anyone,” the caller wrote. “I had the sense to take pain killers myself, hope this new service gets better.”

A month ago Andrew Lansley, the Health Secretary, announced that 111 would be rolled out nationwide by April 2013, abolishing the concept of “out-of-hours” care. It is also meant to encompass NHS Direct.

The Department of Health claimed the September statistics showed an “encouraging picture”.

A spokesman said: “Lessons learned from the pilots will ensure that when the service is rolled out nationally it will provide people with a first class service.”

He added: “We know that unanswered calls are usually callers who get through to the NHS 111 message and hang up. This could be because they wanted to speak to their GP practice, but it was still in the ‘out of hours’ period and they were therefore transferred to NHS 111.

“This figure does not mean patients are receiving a poor service.”

A spokesman for NHS Direct echoed this, saying the vast majority of the 12 per cent of unanswered calls were of people who chose to hang up, after learning they were being put through to the 111 service when they wanted to speak directly to their GP.

From:  http://www.telegraph.co.uk/NHS-111-number-1-in-8-calls-unanswered

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.

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

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

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

It suggested areas like Manchester and the London borough of Tower Hamlets would lose out to parts of the wealthy south east, such as Surrey and Hampshire.

Labour based the claims on an assessment of funding reforms by public health bodies in Manchester.

But the government has disputed the allegations and claimed Labour’s figures were misleading.

Department of Health officials said primary care budgets in Surrey and Tower Hamlets would go up by a similar amount this year.

The Conservatives claimed every area would have suffered health funding cuts under Labour.

A Conservative party spokesman said: “This is yet another own goal from Labour. If they had won the last election, the NHS would now be being cut by £28 billion across the country. Every area would have seen spending on the NHS cut – as it is in Labour-run Wales.

“This Government is increasing spending on the NHS in real terms over this parliament, and every region of the country will receive more money as a result of this investment.”

Health Direct has repeatedly tracked Labour’s proud boast when it was in power of creating postcode lotteries based on it’s voting constituencies:

Friday, April 13, 2007 Labour voting areas get most PFI NHS cash
http://www.healthdirect.co.uk/2007/04/labour-voting-areas-get-most-pfi-nhs.html

Wednesday, November 22, 2006 Hewitt defends NHS cash for Labour voting areas
http://www.healthdirect.co.uk/2006/11/hewitt-defends-nhs-cash-for-labour.html

Tuesday, October 24, 2006 NHS cuts twice as likely in Tory and Lib Dem areas
http://www.healthdirect.co.uk/2006/10/nhs-cuts-twice-as-likely-in-tory-and.html

Monday, September 25, 2006 NHS closures rigged in Labour voting constituencies
http://www.healthdirect.co.uk/2006/09/nhs-closures-rigged-in-labour-voting.html

Friday, September 15, 2006 Labour accused over hospital cuts in marginal constituencies
http://www.healthdirect.co.uk/2006/09/labour-accused-over-hospital-cuts-in.html

Examples of the rationing now being used include:

• Hip and knee replacements only being allowed where patients are in severe pain. Overweight patients will be made to lose weight before being considered for an operation.
• Cataract operations being withheld from patients until their sight problems “substantially” affect their ability to work.
• Patients with varicose veins only being operated on if they are suffering “chronic continuous pain”, ulceration or bleeding.
• Tonsillectomy (removing tonsils) only to be carried out in children if they have had seven bouts of tonsillitis in the previous year.
• Grommets to improve hearing in children only being inserted in “exceptional circumstances” and after monitoring for six months.
• Funding has also been cut in some areas for IVF treatment on the NHS.

The alarming figures emerged from a survey of 111 PCTs by the health-service magazine GP, using the Freedom of Information Act.

Doctors are known to be concerned about how the new rationing is working – and how it will affect their relationships with patients.

Birmingham is looking at reducing operations in gastroenterology, gynaecology, dermatology and orthopaedics. Parts of east London were among the first to introduce rationing, where some patients are being referred for homeopathic treatments instead of conventional treatment.

Medway had deferred treatment for non-urgent procedures this year while Dorset is “looking at reducing the levels of limited effectiveness procedures”.

Chris Naylor, a senior researcher at the health think tank the King’s Fund, said the rationing decisions being made by PCTs were a consequence of the savings the NHS was being asked to find.

“Blunt approaches like seeking an overall reduction in local referral rates may backfire, by reducing necessary referrals – which is not good for patients and may fail to save money in the long run,” he said. “There are always rationing decisions that have to go on in any health service. But at the moment healthcare organisations are under more pressure than they have been for a long time and this is a sign of what is happening across many areas of the NHS.”

According to responses from the 111 trusts to freedom-of-information requests, 64 per cent of them have now introduced rationing policies for non-urgent treatments and those of limited clinical value. Of those PCTs that have not introduced restrictions, a third are working with GPs to reduce referrals or have put in place peer-review systems to assess referrals.

In the last year, 35 per cent of PCTs have added procedures to lists of treatments they no longer fund because they deem them to be non-urgent or of limited clinical value.

Some trusts expect to save over £1m by restricting referrals from GPs.

Chaand Nagpaul, a member of the British Medical Association’s GPs committee, said he was concerned about PCTs applying different low-priority thresholds and rationing access to treatments on the basis of local policies.

He said the Government needed to decide on a consistent set of national standards of “low priority” treatments to help remove post-code lotteries in provision. “Patients and the public recognise that with limited resources we need to make the maximum health gains and so there needs to be prioritisation. What is inequitable is that different PCTs are applying different thresholds and criteria,” he said.

A Department of Health spokesman said: “Decisions on the appropriate treatments should be made by clinicians in the local NHS in line with the best available clinical evidence and Nice [National Institute for Health and Clinical Excellence] guidance. There should be no blanket bans because what is suitable for one patient may not be suitable for another.”

From: http://www.independent.co.uk/cataracts-hips-knees-and-tonsils-nhs-begins-rationing-operations

The programme has been described as not being “value for money” in a report from public spending watchdog the National Audit Office (NAO) and critics have called for the project to be abandoned.

But yesterday, Department of Health (DoH) CIO Christine Connelly told the parliamentary public accounts committee that cancelling the contract with supplier CSC could potentially leave the DoH “exposed to a higher cost than the cost to complete the contract as it stands today”.

She said if the contract were terminated, the resulting contractual costs could run up to “several hundred million pounds”, with the possibility that the supplier could seek damages.

Still further costs could be incurred during the process of moving health trusts over to new care records systems, she said.

But Connelly went on to say that the DoH is still considering all options for the contract with CSC, which the DoH has previously stated includes termination.

Sir David Nicholson, chief executive of the NHS, told the committee that the DoH is not currently minded to cancel its contract with CSC: “That’s not what we’re planning to do at the moment.”

Bizarrely he said the DoH could still get something “really good” out of its contract with CSC.

Care records systems are being installed across the whole of England, although progress has been slowest in the north, east and Midlands, the NAO report found.

CSC has repeatedly missed it’s required targets- known as milestones, for the rollout of the care records systems.

By March this year, CSC had missed 67 milestones set under its Local Service Provider (LSP) contract, and recently suffered a further setback when one of four trusts chosen to be early adopters of the care records system pulled out of the project.

The NAO report found that £2.7bn has been spent installing care records systems across the whole of England, and that there is a further £4.3bn still to be spent.

The care records system is being installed in the north, east and Midlands by CSC under the terms of its LSP contract, which is worth just over £3bn, but the DoH has said it expects negotiations will reduce the contract’s value by about £500m.

From: http://www.silicon.com/doh-cio-warns-on-cost-of-scrapping-e-records-project

The National Audit Office also said some patients would not even get one as large chunks of the NHS had pulled out.

In conclusion, the NAO said the system was not providing value for money – something the government rejected.

The Electronic care records are the key part of the overall £12.4bn NHS IT project.

The scheme was launched in 2002 by Tony Bliar with the aim of revolutionising the way the health service uses technology and also includes developments such as digital x-rays and fast internet connections.

It is the third time the NAO has looked at electronic records – and each time the findings have been more damning.

The report from the NAO presents a depressing account of delays, contractual wrangling and technical glitches.

The original vision for the scheme was compelling – a national network connecting hospitals, GP practices, ambulance services and mental health trusts, and an end to the tortuous paper trails that have caused frustration and misery for doctors and patients alike.

But the complexity and cost of the scheme meant it was always seen by many as a high risk strategy. And when it ran into trouble the plans were scaled back, and the original vision set aside.

Many GPs and hospitals are now working with different systems, prompting the NAO to question whether further investment in the national programme would be pouring good money after bad.

The latest report details a range of problems that the programme is struggling with.

In London, all GP practices and more than half of hospital trusts have pulled out, while in the south three-quarters have. However, this has not been accompanied by a proportionate drop in cost.

Meanwhile, the contract covering the rest of country is currently being renegotiated. Even after such a scaling back, roll out in places that remain part of the system is still proving difficult.

The NAO said it doubted the final deadline of 2016 – which is already six years later than originally envisaged – would be met.

And even in those trusts that have electronic records, there are problems. For example, some hospitals have struggled to introduce electronic prescriptions.

The NAO said the difficulties were caused by a range of factors, including the government being too ambitious, difficulties with technology and the complexity of the NHS.

The problems have prompted some critics to call for the entire scheme to be scrapped – although this is something the NAO stopped short of suggesting.

The government has already announced there will be a review of the project. This is due to start next week.

Tory MP Richard Bacon, a member of the House of Commons’ Public Accounts Committee and long-standing critic of the plans, said: “It is perfectly clear that throwing more money at the problem will not work.

“This turkey will never fly and it is time the Department of Health faced reality and channelled the remaining funds into something useful that will actually benefit patients. The largest civilian IT project in the world has failed.”

But the Department of Health said while the original vision “was flawed”, the project still had the potential to deliver value for money.

Dr Chaand Nagpaul, of the British Medical Association, said: “We cannot turn the clock back, but this report provides useful lessons on how best to use resources in the future.”

From: http://www.bbc.co.uk/news/health-13430375

The closure of the site, which discovered some of Pfizer’s most high-profile medicines, including Viagra, brings to an end the company’s 57-year history in the town.

Like other major drug companies facing patent expiries on top-selling medicines, Pfizer is taking steps to streamline its research and development (R&D) activities.

Tuesday’s announcement marked an acceleration of that strategy as Pfizer revealed plans to reduce the number of disease areas it focuses on and cut its R&D budget by up to £1.2 billion each year, to around £4 billion to £4.4 billion.

A Pfizer spokesman said the company was concentrating its efforts on “where we can deliver the greatest medical and commercial impact”.

Dr Ruth McKernan, head of the Sandwich site, said the plant had a “rich history in science research”. “It is hoped that we can retain this proud R&D heritage through strategic partnerships in the future,” she added.

Vince Cable, Secretary of State for Business, Innovation and Skils, described the decision as “extremely disappointing”.

“The company has been clear that this decision was part of its global programme of change and not based on a judgement of the UK as a location for pharmaceutical research,” he added.

“This country is an attractive location for the life sciences industry and with R&D tax credits and our plans to introduce a Patent Box, the Government is committed to ensuring the UK is the destination of choice for investment, research and growth.”

But Colin Blakemore, professor of neuroscience at the University of Oxford, said the move was “a shocking wake-up call”. “We must respond to this signal that one of our most important industries no longer has confidence in the future of British science,” he said.

The news came as Pfizer reported a 4pc rise in full-year net income to £5.2 billion, on sales 36pc higher at £42.4 billion.

From: http://www.telegraph.co.uk/Pfizer-to-close-Viagra-research-site-putting-2400-UK-jobs-at-risk

The Pfizer closures comes only a few days after Health Direct posted that NHS red tape harming patients and medical research at http://www.healthdirect.co.uk/2011/02/nhs-red-tape-harming-patients-and-medical-research.html when we said that urgent changes are required to the regulation and governance of health research in the UK because unnecessary delays, bureaucracy and complexity are stifling medical advances, without additional benefits to patient safety.

Fewer than a quarter of England’s 168 NHS hospital trusts have significant PFI hospitals in operation. But these trusts account for almost two-thirds of A&E closures or proposed closures.

Health campaigners said there was a “clear connection” between the “inflated” costs of the PFI and the cuts in A&E.

Most trusts insisted there was no connection — not all A&E closures are necessarily done on financial grounds and some are supported by local clinicians.

In recent days, The Daily Telegraph has disclosed how some PFI hospitals – built and operated by the private sector, and effectively rented back to the taxpayer – will end up costing the public purse more than 10 times their capital value.

The new Princess Royal University Hospital in Bromley, south London, cost £118million to build. It will end up costing taxpayers £1.2billion, including facilities management. South London Healthcare, the NHS trust responsible for the Princess Royal, has a second PFI hospital, the Queen Elizabeth in Woolwich.

The trust’s annual deficit was raised to £100million by the two deals. It has closed the A&E unit at one of its non-PFI hospitals, Queen Mary’s in Sidcup.

In internal documents seen by The Daily Telegraph, the trust stated that the “occupation costs” of the PFI hospitals were roughly double those of its non-PFI hospital.

A spokesman admitted that its PFI contracts placed “some undeniable restrictions on our flexibility”. But she insisted that the decision to close A&E at Sidcup was “entirely unrelated” to PFI.

Other trusts closing A&E units include Coventry and Warwickshire NHS Trust, which recently opened a new PFI hospital and plans to shut the full A&E unit at its non-PFI hospital in Rugby.

Barking, Havering and Redbridge Trust, which opened a new PFI hospital in Romford, wants to close the A&E unit King George’s Hospital in Ilford.

East Lancashire Trust has closed A&E at its Burnley hospital to help pay for a new PFI hospital at Blackburn. In Nottinghamshire, Sherwood Forest NHS Trust has downgraded A&E services at Newark after opening a new PFI hospital in Mansfield. At least four other trusts with PFI hospitals have similar plans.

Under its PFI contract, Queen Elizabeth Hospital, Woolwich, must have 64 visits a year from pest controllers, even when there are no pests to control. When there are pests, the hospital must pay for further visits, which it did 10 times last year.

Food served at the Queen Alexandra PFI hospital in Portsmouth is cooked in south Wales, then driven 100 miles to Hampshire.

Early PFI hospitals had on average 20 per cent fewer beds than the hospitals they replaced, according to research. Because of high service charges, several PFI hospitals cannot afford to keep even these reduced numbers of beds fully open.

In an effort to disguise their private ownership, a number of PFI hospitals have changed their names to include a royal connection. Greenwich District Hospital became Queen Elizabeth Hospital. Salford Hope Hospital is now Salford Royal. Oldchurch Hospital, Romford, became Queen’s Hospital. Farnborough Hospital, in Bromley, was renamed after Princess Anne.

From: http://www.telegraph.co.uk/Casualty-units-shut-to-pay-for-private-finance-hospital-contracts

The HFEA was one of 192 quangos listed for abolition in October as one of the coalition’s flagship money saving initiatives.

Its office does not have the aura of a body that has been freshly culled. Staff are preparing for a general meeting in Cardiff, where the 2011-12 business plan will be agreed. Inspectors are reviewing recent inspections of IVF clinics. Employees are still pinning crayoned pictures by their children above their workstations and watering the plants.

A parliamentary committee’s withering conclusion last week that the government “botched” its mission to “reduce the number and cost of quangos” is met with no surprise by staff here, who remain bemused by the decision to close down their organisation.

News of the HFEA’s planned closure, and distribution of its functions to other organisations, has been greeted with dismay by doctors and research scientists, who warn that it threatens the government’s ability to make sound decisions about crucial ethical issues.

Of all the dull-sounding, bureaucratic bodies crossed out in a pen stroke last October, the HFEA has the least arcane function. Responsible for inspecting and regulating IVF clinics, it also deliberates on the ethical boundaries of creating life and using embryos for research, a sector that is developing with rapacious speed.

Anyone planning to undergo fertility treatment in the UK depends on the HFEA to ensure that clinics are safe. Children who have been born as a result of donated sperm or eggs may want to turn to the organisation to discover information about the donor.

Practitioners rely on the body to help set out moral guidelines: is it ethical (to give one example under consideration at the moment) to allow a woman to use frozen embryos left to her by her grandmother, which would result in her giving birth to her own aunt or uncle?

The HFEA’s chair, Professor Lisa Jardine, the high-profile and outspoken academic, has reined in any personal impulse towards protest or defiance, and is mounting a delicate campaign to ensure that the organisation can be preserved.

She insists that her job is to comply with what the government has ruled, but makes it clear that she will be working to promote an alternative, which would see the HFEA continue broadly unchanged, swept into the folds of another government-run organisation.

“It’s the most controversial area of medicine, apart from assisted dying. It’s the most morally difficult area, it’s the most carefully legislated-for area, and the most tightly regulated area. I’m totally committed to doing this job of regulating assisted reproduction, above all IVF and research on embryonic tissue,” she says. “My only aim is to keep doing that until someone else can do it properly.”

She believes the HFEA was included on the list of quangos to be abolished by accident. “I feel very passionately that this is a mistake,” she says, stressing that no steps have been made towards closure. “We’re nowhere near. We haven’t even started.”

Provisional Department of Health plans indicate that the HFEA’s functions are to be transferred and split between other DH bodies. None of the 79 staff members know whether they will keep their job when the quango is wound down, nor when that might happen. Employees, from computer technicians to policy experts, seem united in their loyalty to the organisation, and voice anxiety not only for their own job security, but for the ability of a restructured HFEA to perform the range of services it was created to provide. The staff are civil servants, not inclined towards intemperate expressions of outrage. Instead, their laments cautiously warn that the proposed course of action may prove to have been ill-advised.

In a side room in the quiet central London office, Peter Thompson, the HFEA’s director of strategy, says staff had not expected the body to be scrapped, because as recently as 2008 parliament had debated its role and there had been “almost no voices at all saying this organisation ought to be abolished”.

He says: “Having had that endorsement in 2008, from all sides of parliament, to have this decision only two years later did come as a bit of a shock”

At the last authority meeting the governing body agreed it was a “very difficult” process for staff and “asked that efforts were made to minimise their stress”. Someone has cut a slit out of an empty cardboard box, and stuck a label on it marked “Worry Box”, inviting colleagues to post their concerns.

“My job as one of the senior people here is to lead and manage people through that uncertainty. Keeping our focus on doing the job well, maintaining morale, keeping people’s spirits up,” Thompson says.

The bonfire of the quangos appeared to herald a straightforward, hard-nosed money-saving exercise. The reality is much messier. Only a few bodies are to be closed outright. The others will have their functions transferred to new bodies, at some uncertain point in the future.

Cabinet Office minister Francis Maude insisted last week that the axing would save “significantly more” than £1bn. However, the public administration select committee warns that the “current approach is not going to make significant cost savings or result in greater accountability”.

Ian Magee, a senior fellow at the Institute for Government (IFG), and co-author of Read Before Burning, a report into the closure of the quangos published last year, says that unless the functions performed by the organisations are also abolished, very little money will be saved.

“It’s not going to contribute much to the budget deficit reduction,” he says. Closing down quangos is a complex process, he adds. “You can’t just turn the tap straight off.”

Maude is confident that the correct decisions have been made. “We think the process has gone pretty well. All three parties fought the election with a commitment to reducing significantly the number of quangos. There is a uniform view across the political spectrum of the desirability of doing so,” he says.

On the decision to wind down the HFEA, he adds: “You have a very complicated landscape of health regulatory bodies. The view taken by the health minister was that there is scope for simplifying that operation and making it a much more efficient and streamlined operation.”

The government has said that the HFEA will continue working “for the time being”, but that its functions will be transferred by the end of the current parliament. Government officials are examining the “practicalities (and legal implications) of how to divide the HFEA’s functions between a new research regulator, the Care Quality Commission and the Health and Social Care Information Centre”.

But the announcement was so confused when it was made that many people – staff included – thought the closure would be immediate. On the HFEA’s website a notice states prominently: “You may have seen reports in the press that the HFEA ‘has been abolished’. This is not so.”

The notice points out that the government cannot scrap the HFEA without first introducing new legislation.

“At the moment, we have no – literally zero – idea of what the Department of Health plan is,” Jardine says.

With such a delayed death knell, staff were uncertain whether to be devastated or sanguine at the news. Paula Robinson, head of business planning, says: “The time frame was so long, I can’t say it really rocked my world. It’s not brilliant to hear that an organisation is going to be abolished, but if you hear that it is going to be a matter of years, it eases the pain. I am not sitting here wringing my hands. I am a change-friendly person.”

But one of the inspectors, who carries out regulatory checks on IVF clinics, was aghast. “I felt very worried. I have just bought my first house. My husband works for the NHS. Two jobs that are very uncertain,” she says.

In a proposal aimed at streamlining the bodies regulating medical research, the Academy of Medical Sciences today suggests that the HFEA’s research and ethical functions should be transferred to a new Health Research Agency. But any move towards splitting up its responsibilities is not welcomed by employees.

“I think that the decision ignored the fact that because all our functions are together in one body, that enables us to be a more intelligent, more efficient regulator,” Thompson says. “This body has dedicated people who know what they are doing. These are people who care about the sector they regulate and the patients. I think by having all of those functions in one place, we do a more efficient and intelligent job than by scattering those functions to other places.”

Policy manager Helen Richens leads a campaign to reduce the number of multiple births from IVF clinics. Historically, she says, doctors would transfer multiple embryos, but the health risks to the mother and the embryos were very high. Now, if the woman is under 40, doctors can transfer no more than two embryos; over 40, no more than three. The HFEA has imposed a 20% maximum multiple births target on each of the country’s 138 clinics, enforced with the threat of losing a licence.

“One of the reasons we are good at this is that we have the policy staff and inspectors, who are going and seeing what is happening; we hold all the data on all the fertility treatment in the UK, we can analyse it and monitor it, so when we make policy it is proper, evidence-based policy,” she says. “We will be moving from a world-leading model to something that is a less than gold-standard regulatory model.”

She adds: “I think I feel maybe a bit unappreciated. You do your job well, other countries look towards us … there is a collective feeling, what is the point of moving us on, breaking us up? It is not going to save money. If there isn’t a measurable benefit, what is the point of getting rid of this quango?”

The HFEA has an annual budget of £7m, only £2m of which is provided by the government; the remaining £5m is funded by the clinics, which pay to be regulated. The body charges clinics, both private and NHS, £104 for an IVF cycle and £52 for donor insemination.

Jardine, who has just been reappointed for a three-year term, hopes to be able to trim the amount needed from the government to around £1m. “There will be additional expenditure. There will certainly be no saving,” she says of the planned abolition. “We are incredibly cheap.”

Collectively, the senior management have taken a clear decision not to campaign noisily against closure. They point to the unsuccessful campaign mounted to save the UK Film Council, whose demise was announced at the same time. Despite the appointment of a PR adviser and the involvement of director Steven Spielberg, the abolition went ahead.

Instead, they set out the value of their work.

“Any couple can walk into any clinic in the British Isles and know that their IVF or other reproductive treatment has been fiercely vetted and that they will come to no harm. No person walking into a plastic surgery clinic has that assurance,” Jardine says.

Supporters of the decision argue that as IVF has become much more common in the 20 years since the HFEA has been operating, there is less need to regulate it so closely. Jardine disagrees.

“IVF is not routine. There are people out there who still think that we shouldn’t be doing any of what we are doing. Some of them have seats in the House of Lords.”

The issues are too ethically and politically explosive to be dealt with by politicians, she argues. “There are too many pressures on parliament, and civil servants are not trained to deal with those kinds of issues. I believe that these morally fraught issues must be held at arm’s length from government.”

http://www.guardian.co.uk/politics/2011/jan/10/battle-life-ivf-regulator-hfea

“I have not announced plans to scrap NHS Direct. I have announced plans to phase out the NHS Direct number,” the health secretary said in a letter.

This appears to contradict statements from the Department of Health last month, including to the BBC, that said the service would be scrapped. The new 111 helpline is already being piloted in the north-east of England.

However, there are concerns that fewer medical staff will be employed by the new service. NHS Direct employs 3,400 people, 40% of whom are trained nurses. It was reported that the ratio for the new helpline would be lower.

The threat to the telephone service, which costs £123m a year to run, provoked an immediate backlash. In the fortnight since the story broke, more than 16,000 people have signed a petition to save NHS Direct, which provides general health advice and information about out-of-hours GPs, walk-in centres, emergency dentists and 24-hour chemists.

Lord Prescott, the former deputy prime minister, played an active role in the campaign – including changing his Twitter picture to a “Save NHS Direct” badge.

Significantly, the Royal College of Nursing said it would be “shortsighted” of ministers to axe a service that had saved the NHS more than £200 million by dispensing advice over the phone.

Labour attacked Lansley for a “significant U-turn” that had seen the health secretary “rowing back” from previous statements. “It’s an incredible victory for the campaign to save NHS Direct,” said Andy Burnham, Labour’s leadership contender and spokesman for health.

A series of letters between Lansley and Burnham, the previous health secretary, reveals a combative exchange. Burnham accused his Tory counterpart of “misrepresenting his position” as Lansley claimed that the 111 number was Labour’s idea and he was “getting on with what you failed to do”.

In a statement the health secretary said: “This is the latest political stunt from [Burnham]. He seems more concerned with trying to boost his leadership campaign than discussing our policies accurately.”

Unions warned that the future of medical staffing levels in the new service would remain an issue. Dave Prentis, general secretary of Unison, said: “Staff will still be confused and worried the government may have another change of heart. I would like a guarantee from the health minister that the 1,300 nurses working for NHS Direct will still have a job there this time next year.”

Despite its popularity, the medical establishment has been divided over the benefits of phone line. Earlier this summer British Medical Association chairman Dr Laurence Buckman said that getting rid of NHS Direct could be one way of cutting back on spending — adding that the “expensive” phoneline delayed healthcare reaching patients.

From: http://www.guardian.co.uk/nhs-direct-closure-Andrew Lansley backtracks

Unions criticised the plan saying it was privatisation and that NHS Professionals was set up to stop the NHS being ripped off by private agencies charging large sums for staff to work unfilled shifts.

NHS Professionals has 50,000 staff on its books who cover around two million shifts in 77 organisations around England.

Karen Jennings, head of health at Unison, said: “The whole reason that NHS Professionals was set up, was because private agencies were ripping off hospitals by charging them outrageous fees for recruiting or finding staff for shifts. It makes no sense at all to bring back private companies who will want their slice of the action in return.

“This proposal is purely about Tory plans to promote privatisation and hive off parts of the NHS to private companies, regardless of the consequences on patient care.”

A Department of Health spokesman said: “This is about exploring ways that the commercial skills of the independent sector can make NHS Professionals Ltd a more efficient business and save the NHS money.

“NHS Professionals Ltd is a business, not a public service, and like any business it must ensure its services are as efficient and effective as possible. We want to discuss options with potential independent sector investors that could help to achieve this, and ultimately improve services outcomes for patients.”

It comes as the Royal Berkshire Hospital Trust announced up to 600 jobs will be cut to make £60 million worth of savings in the next few years, pledging that frontline staff would not be affected.

The Royal College of Nursing said last month that thousands of NHS jobs were being cut despite Government promises to protect frontline services.

The nurses’ group said it was aware of almost 10,000 posts lost through recruitment freezes, redundancies and people not replaced when they retired, or which face cuts in the future.

From http://www.telegraph.co.uk/Ministers-accused-of-privatising-NHS-nursing-agency

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 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.

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

Despite pledges from Labour and the Conservatives to protect front line services, there is evidence that their promises may have come too late.

A list of cuts has already been identified – including job losses, banning certain operations, closing casualty departments, downgrading maternity services and reducing the number of junior doctors. But these have been mostly quietly ignored by the three main parties.

The Conservatives pledged to stop all closures until they could be reviewed but, with billions of pounds of savings needed to cope with growing demand, cuts and closures are almost inevitable.

David Cameron emphasised that he was personally in favour of the NHS, after his experiences with his disabled son Ivan, who died last year, to combat arguments that the health service was not safe in Tory hands. The party manifesto contained promises about dentistry and round-the-clock GP services which appear too expensive in the current climate.

Both the major parties were accused of chasing the “fear of cancer” vote. The Tories said they would fund cancer drugs turned down by Nice, the health rationing watchdog, but did not mention drugs for other illnesses such as arthritis or dementia.

Labour said cancer patients would see a specialist and have test results back within a week. The party was criticised for unveiling its manifesto at a new hospital in Birmingham. It is against the rules to use NHS premises for election events.

But Labour pointed out that the hospital was still in the hands of the private finance initiative organisation – a policy which means the NHS will be repaying billions of pounds for new hospitals for decades.

Nick Clegg refused to ring-fence NHS spending given the size of the national debt.

The Liberal Democrat campaign focused on cutting waste on managers, scrapping regional strategic health authorities and pledging more power to communities to direct the health service locally.

From: http://www.telegraph.co.uk/General-Election-2010-cuts-inevitable-as-NHS-must-make-savings

Politicians clamour to praise its world-class status and laud the dedication of nurses and the skill of its doctors. And all parties are united in the view that, despite the need for austerity measures, frontline staff and services will not be cut. So where are the savings planned? Watch the hand and not the mouth.

When I started in medicine, the hospital was run by about three people. Things were so much more simple when doctors and nurses treated patients, doing their best without the guidance of guidelines and targets, doing their best … yes … to make the patients better.

How did we manage without forms to fill and waiting times compliance? Quite well actually. The medical director ran the medical side of things while matron and the accountant handled the rest. It wasn’t much of a business then: it didn’t have to be, because there was no internal market to manage.

The internal market — Mrs Thatcher’s plan to introduce efficiency by having hospital compete against hospital to provide patient treatment — has wreaked havoc. It has spawned a nation of administrators, here today and gone to another post tomorrow — while doing nothing to bring costs under control.

The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford, when it is not Oldham or Oxford that pays the bill — there is only one person that picks up the tab: the taxpayer, you and me.

And there are big problems with the billing process. For example, if a patient is seen in an outpatient clinic then there is a charge made by the hospital for his or her first attendance — but follow-up appointments are not charged. And if many treatments are given in a hospital to a patient, only the most expensive of the treatment episodes is charged.

There are savings to be made. It is alleged that there are just 75,000 administrators at work in the NHS but this figure is laughably mythological. Doctors and nurses know that there are many more than this. They look around and see the numbers increasing.

One report by the Centre for Policy Studies published in 2003 indicated that there were 250,000 administrative staff employed in the NHS: at least one administrator for every nurse. In recent times the rate of increase of admin staff within the NHS has exceeded that of nursing staff.

There is a general feeling in the NHS of disempowerment of the professionals. People can’t face up to the incredible struggle, the disapproval that faces any of them if they have the temerity to suggest that things should be run differently.

The principle of care for all from cradle to grave is worthy and wonderful. But the current reality is a cradle rocked by accountants who are incapable of even counting the number of times that they have rocked it. The reality is gravediggers working with a cost improvement shovel made of rust.

Over the years politicians have made dramatic changes to the way that the NHS has been run. Recent changes have caused fragmentation and not led to any cost saving. Moving patients from one place to another does not save the nation’s money, though it might save a local hospital some dosh. So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice.

So what should we do? Let us go back to the old discipline of the NHS. Let the professionals manage medicine, empower the professionals, the doctors and nurses and shove the internal market in the bin and screw down the lid.

At this election time please let us hear from all political parties that they will ditch this absurd love-affair with the internal market. Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition.

Professor Jonathan Waxman is a consultant oncologist

http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article7112167.ece

Hundreds of chief executives, departmental directors and board members of hospitals and other NHS organisations have received extra payments of as much as £32,000 – the largest single year’s bonus unearthed by freedom of information requests submitted by the Liberal Democrats.

The £32,000 bonus went in 2008-09 to Beccy Fenton, deputy chief executive of the Heart of England hospital trust, who already earns £170,000 a year. She received it after generating almost £1m of consultancy work for her employers, including private sector contracts. The trust stressed last night that the £32,000 was a one-off sum for consultancy work.

Anna Walker, who was chief executive of the Healthcare Commission until it was disbanded last year, earned the largest combined amount in the past three years – £68,150 on top of her six-figure salary. She received £22,375 in 2006-07, £23,000 in 2007-08 and £22,775 in 2008-09 for running the then NHS watchdog in England.

Norman Lamb, the Lib Dems’ health spokesman, condemned the payments as shocking. “These bonuses are utterly scandalous. People will be disgusted by the extent to which fat cats in the public sector have been enriched at a time when the NHS has denied people drugs that they need and access to treatments such as in mental health,” he said. “We thought it was just in banking, but the unacceptable bonus culture appears to be alive and kicking in the upper echelons of the NHS.”

This is the first time both the number of bonuses and their size has been disclosed. The Lib Dems sought information from every hospital trust, primary care trust (PCT), mental health trust and ambulance service in England, as well as other NHS bodies such as strategic health authorities.

While some pay no bonuses, many do. However, the figures do not reveal the full picture because some refused to disclose theirs and a few simply gave their chief executive’s salary band.

The £32,000 one-off bonus and the £68,150 over three years are large but not atypical.

Laura Roberts, chief executive of the Manchester PCT, received £25,732 extra in 2008-09, while Dr Patrick Geoghegan, her counterpart at South Essex Partnership mental health trust – who earns £170,000-180,000 – received £20,573 in the same year for helping it do well against NHS targets.

South Essex trust spokeswoman Maxine Forrest, said: “In 2008-09, to recognise the trust’s exceptional performance in national ratings, a one-off bonus was paid. Dr Patrick Geoghegan is chief executive of one of the most successful and highest-performing NHS organisations in the country.”

Paul O’Connor, a former chief executive of Birmingham Children’s Hospital, received a one-off £15,000 bonus in 2007 for helping it to achieve semi-independent foundation trust status within the NHS. He resigned late in 2008 after the Observer revealed doctors’ concerns that some care was sub-standard.

The chief executive of the Royal Berkshire hospital trust received £54,611 in bonuses over three years in 2007-09, while the chief executive of the Human Tissue Authority was given £37,895 in 2006-09.

Many chairmen, divisional directors and both executive and non-executive directors of NHS bodies also receive bonuses. The Royal Berkshire hospital trust spent £240,728 on bonuses in 2007-09, more than any other NHS body that provided figures. Eight executive directors shared another £186,117, as well as the £54,611 payment to the chief executive.

Large payments to senior figures in those three years were also made by the Healthcare Commission (£215,550), the London Ambulance Service (£130,646), the Hertfordshire Partnership mental health trust (£122,465) and Portsmouth Hospitals (£105,000).

All three main parties have pledged to slash NHS management and bureaucracy. “This is the first real analysis of the bonus culture at the top of the NHS, and it’s shocking,” said Lamb. “Bonuses of £20,000 or more are more than many NHS staff receive as their full year’s salary.”

From: http://www.guardian.co.uk/society/2010/apr/25/nhs-bonus-liberal-democrats

Health trusts are planning to cut thousands of staff “by stealth” to deliver £20bn of “NHS efficiencies”, according to a survey by the Royal College of Nursing. Labour reacted by promising that there would be more jobs in the health service at the end of the next Brown administration if it wins the election.

The move comes as Gordon Brown addresses the RCN’s four-day annual conference today. More than 4,000 nurses have gathered in Bournemouth for the event, which is expected to be dominated by NHS finances.

The nurses’ union has been riled by a warning from Sir David Nicholson, the chief executive of the health service, that up to £20bn of savings will have to be found by 2014.

A survey by the RCN of 26 of the 168 English health trusts revealed that 5,600 jobs were already earmarked for cuts in an attempt to slash costs. That figure could rise to more than 36,000 in a “worst-case scenario” if the trend was replicated across all hospital trusts, said Howard Catton, head of policy at the Royal College of Nursing. The loss of posts – including redundancies and staff not being replaced if they leave or retire – could happen over the next three years, he added.

In an online survey of 287 nurses earlier this month, the RCN said hospital wards were already operating with an average of 13% fewer staff than officially needed. Nine out 10 nurses said that patient care was being compromised by short staffing.

There is little doubt that the nurses’ union, which has 400,000 members, has political clout. Last year Brown became the first prime minister to speak at the conference in its 93-year history – to a warm reception by delegates.

Although health has not been a major focus of this election campaign, the issue of NHS job cuts is an explosive one for Labour. In 2006 the then health secretary Patricia Hewitt was jeered and slow-hand-clapped by nurses as she tried to address their fears about NHS deficits.

Andrew Burnham, the health secretary, told the Guardian that savings would come from wage restraint, cutting management costs by a third, and asking “some nurses and doctors to take on different roles in different locations outside of hospitals”.

“It is unlikely that we would need fewer people in five years in the health service. Labour will ensure sufficient funding to frontline NHS services so that they do not need to make any compulsory clinical redundancies and we will ask the NHS to co-operate across organisational boundaries and work towards ensuring this basic guarantee,” he went on. “Cutting doctors, nurses and frontline staff would be costly, counterproductive and would risk a return to the kind of NHS we saw under the Tories.”

The problem for Labour is that decisions on savings are being made at a local level. The RCN points out that managers at some trusts are already openly equating efficiency savings with job cuts.

In an open letter to staff, the chief executive at Salford Royal, a foundation hospital, said: “We are about to enter a financial crisis that could ruin all that we have achieved … this means reducing costs by about £16m a year [and] providing safe standards of serv