The HFEA was one of 192 quangos listed for abolition in October as one of the coalition’s flagship money saving initiatives. Three months after the formal announcement of its abolition, the authority is continuing its work and gently fighting a low-key, behind-the-scenes battle for survival.

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

A political row has erupted after Andrew Lansley the health secretary was accused of making “a significant U-turn” over plans to scrap NHS Direct, in the face of widespread public anger.
Andrew Lansley said that NHS Direct would remain but that its telephone number would be replaced so that from 2013 people could call 111 for non-emergencies and 999 for emergencies.

“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

Ministers are considering ‘privatising’ an NHS agency that provides 50,000 nurses and other workers to the health service.
An advert has been placed for private sector investment in NHS Professionals, a company owned by the Department of Health, which provides bank staff to fill shifts in the health service.

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

The NHS in England faces a total bill of £65bn for new hospitals built under the private finance initiative (PFI)- six times more than the buildings cost.
Figures obtained by the BBC show that some NHS trusts are spending more than 10 percent of their turnover on the annual ”mortgage” repayments.

Under PFI, private companies win contracts to build and maintain new hospitals and mental health units and the NHS pays off the ”mortgage” over around 30 years.

The 103 schemes were valued at a total of £11.3bn when they were built.

But when rising fees and additional costs such as maintenance, cleaning and catering are taken into account, the NHS will have to pay back £65.1bn over the lifetime of the schemes. Some contracts are reportedly so restrictive that trusts are forced to pay hundreds of pounds just to get half a dozen pictures put up.

According to the data, the NHS currently pays back a total of £1.25bn each year but this figure is expected to increase until 2030 when it will hit £2.3bn, the BBC reported.

The final payment will not be made until 2048.

Professor John Appleby, chief economist at the King’s Fund health think-tank, said: ”It is a bit like taking out a pretty big mortgage in the expectation your income is going to rise, but the NHS is facing a period where that is not going to happen.”

Dr Mark Porter, of the British Medical Association, added: ”Locking the NHS into long-term contracts with the private sector has made entire local health economies more vulnerable to changing conditions.

”Now the financial crisis has changed conditions beyond recognition, so trusts tied into PFI deals have even less freedom to make business decisions that protect services, making cuts and closures more likely.”

Nigel Edwards, director of policy at the NHS Confederation, which represents trusts, told the BBC: ”They were planned for a different world. I’m sure that in some cases people feel their hands are tied.”

From: http://www.telegraph.co.uk/NHS-facing-65bn-mortgage-bill-for-PFI

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The NHS is facing upheaval and cutbacks as a decade of budget increases comes to an end and £20 billion of savings must be found over the next five years.

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

On election day Health Direct quotes this cancer specialist- The internal market has been a costly disaster. Let the professionals manage medicine.

It’s election time, and our glorious political classes are marching forward on the massed ranks of the electorate with banners that claim that their party, only their party, will save the NHS.

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

NHS bosses are earning annual bonuses of tens of thousands of pounds on top of their six figure salaries as Anna Walker, chief executive of the Healthcare Commission, got £68,000 in bonuses.

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

A survey by the RCN found thousands of jobs were already earmarked for cuts in an attempt to slash costs.

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 service with about 250 fewer people for each of the next three years.”

The market reforms that Labour implemented have made it possible for hospitals to identify savings easily. Dorset county hospital, which made 28 posts redundant in March, admitted that its strategy to “attract more patients” with 300 new staff had failed, leaving a putative black hole of £11m in next year’s budget. The hospital issued a blunt press release: “These extra patients never came and so we are left with rising costs but without the income to cover them.” .

The Conservatives say that their promise to outspend Labour on the NHS insulates them against the charge that the health service is not “safe in their hands”. They say that thousands of NHS medics will lose their jobs over the next five years under Labour’s “secret” cost-cutting plans, which would see 651 fewer doctors and 2,050 fewer nurses across England.

Disclosures made under the Freedom of Information Act at the request of the Tories show half of NHS trusts that responded were planning reductions in the numbers of full-time equivalent doctors and nurses.

The shadow health secretary, Andrew Lansley, said: “We will back the NHS. Conservatives will increase funding for the NHS each year in real terms. So instead of Labour’s cuts to doctors and nurses, we will support the recruitment of staff we need, like specialist nurses, midwives and health visitors.”

From: http://www.guardian.co.uk/politics/2010/apr/26/health-trusts-planning-job-cuts

The National Health Service’s £12.7bn scheme to create an electronic patient record will “no longer provide the comprehensive solution” originally promised, says a top NHS executive.

Until now, health ministers and officials have acknowledged that the world’s biggest civilian information technology project is running four to five years late, and have said they want to make £600m savings on the £4bn-plus worth of contracts held by CSC and BT to deliver it.

Up to now, however, no one has conceded that the programme will fail to deliver everything that was promised back in 2003 when the contracts were signed.

Following a revamped deal with BT – the London supplier, which has cut £112m or about 12 per cent off its contract – Ruth Carnall, the chief executive of the London strategic health authority, has said the spending reduction means “it will no longer be possible to provide the comprehensive solution that was anticipated in 2003″.

Not all NHS organisations in London will now receive the software needed to deliver the records, Ms Carnall makes clear in a letter to London chief executives.

Meanwhile, Christine Connelly, the health department’s chief information officer, has said that only about half of London’s 32 big acute trusts will now get the full solution. Others will be able to add clinical systems to existing patient administration systems.

In place of a dedicated means of sharing records across hospitals, and between hospitals and primary care – a key goal of the programme – London will have to rely on the national summary care record, Ms Carnall says. However, this contains little other than allergies and current medication, and does not yet carry referral or discharge information.

On top of this, the Tories have said they will scrap the national record if they win the election.

BT will no longer have to deliver new systems to London’s ambulance service or GP practices. And London can afford to pay for Map of Medicine, a decision support tool for treating patients, for only one more year, says Ms Carnall.

In much of the country, installations in acute hospitals are stalled after CSC missed a deadline to get its solution running at Morecambe Bay NHS Trust. The supplier risks being fired, but is likely to sign a similar, more restricted, deal if it does hit a new deadline for a successful installation.

Glyn Hayes, president of the UK Council for Health Informatics Professions, said it had been clear for some time that the programme was to be reduced. “But this is the first official admission that there are things it will not do that it was intended to do.”

It was unclear, he said, whether the Conservatives would in fact scrap the national record if they won. “But if they do, it knocks a hole in London’s plans,” because without it the capital had no easy means of transferring patient information between settings.

From: http://www.ft.com/cms/s/0/fba8e660-436d-11df-833f-00144feab49a.html