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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 the organisation said even more people needed to register.

Although nearly 30% of the UK population have registered their willingness to help others live in the event of their death, Black and Asian people had to wait three times longer for a transplant, because of a shortage of donors in those communities.

Sally Johnson, director of organ donation and transplantation, said the number of people on the register represented “a fantastic achievement”.

But she added: “Getting people to sign up to the register is only half the battle.

“In order to see that their wishes are carried out in the event of their deaths, it is essential that those who want to become donors discuss donation with family and friends.”

People in Scotland are the most likely to donate, 37% are on the register. The South West of England isn’t far behind with 35% of people signing up.

In 2010, more than 1,000 people donated their organs, and 2,700 organs were transplanted, across the UK.

However, 10,000 people are still on a waiting list for transplants.

To add your name to the NHS Organ Donor Register, please ring 0300 123 23 23 or visit www.organdonation.nhs.uk.

Such is the concern in Downing Street at the damage the issue of NHS reform is causing the Government, that Mr Cameron will put his reputation on the line with a personal pledge to protect its core values. It represents his boldest attempt yet to assuage criticism from his Liberal Democrat Coalition partners and from many health professionals over the impact of the reforms.

In his speech, the Prime Minister will admit that he is willing to act on their concerns after listening to the “profession and patients” during a two-month exercise which was held after Mr Cameron called for a “pause” in the Health Bill’s passage.

His “five guarantees” are designed to show the Prime Minister is committed to the NHS, and “he is hearing what is being said”, according to one source. Mr Cameron’s promise on integrated care is designed to ensure patients receive continuity of treatment, without having to explain their condition from scratch each time to different doctors.

It also means that nurses and hospital professionals will retain a role in commissioning services, and that not everything is transferred to GPs.

His commitment to the “national” part of the NHS represents a pledge to keep it as a universal service, free at the point of use. But Mr Cameron will also say that “no change” is not an option.

He will echo the words of Andrew Lansley, the Health Secretary, who wrote in last week’s Daily Telegraph about the threat to the NHS if it does not reform. He warned of a £20 billion a year funding black hole without reform.

Despite ring fencing health spending, Mr Cameron is expected to make clear that NHS services will be threatened unless there is reform because of the rising costs of drugs and an increasing elderly population.

Mr Cameron is likely to say that the Coalition’s reforms will see the NHS working better. He will point out that in Europe there are health systems which work more effectively.

The speech comes as ministers prepare to rewrite much of the Health Bill. At present the plans involve abolishing two tiers of NHS management and handing control of a £60 billion-a-year budget to groups led by GPs, who can choose to buy treatment for patients from local state-run hospitals or private providers.

This week, the Royal College of Nursing is expected to renew its call for nurses to have a key role on the GP commissioning boards. Mr Lansley will not commit to such a plan until he has heard from the Future Forum, which is reporting back on possible changes to the Bill.

Tomorrow, Mr Lansley, who has been subject to rumours that he is about to resign or be sacked over the issue, faces MPs in the Commons. He will defend the reforms, although he is prepared to see them substantially watered down. However, Labour will seize on stories circulating that Cabinet colleagues had suggested he would not last the year in his post.

Downing Street polling has painted a stark picture of the problems Mr Cameron faces over the NHS and Mr Lansley’s presentation of the plans over the past 12 months is being blamed.

Last week Stephen Dorrell, who was health secretary in John Major’s government, added to speculation that he will replace Mr Lansley. Asked on BBC’s Question Time about whether he would do a better job, he said: “I am going to plead the Fifth Amendment.”

From:
http://www.telegraph.co.uk/David-Cameron-puts-reputation-on-the-line-with-five-pledges-on-the-future-of-the-NHS

Teather, who spent most of her own secondary school days in a wheelchair after suffering from a viral infection, said the health service “has not always been good at doing its fair share for children in this position”. Families were often left as the “piggy in the middle”, she said in an interview with the Guardian.

Health workers often agreed with parents that a child needed a wheelchair, incontinence pads or a form of therapy, but “nobody pays for it” and it fails to arrive, she said. This could severely impair a child’s chances in the future, she warned: “A six-month wait for speech and language therapy can be critical; an 18-month wait can be really critical.”

In some cases, by the time a wheelchair arrives, a child has grown too big for it, she said, adding that it was a “postcode lottery” to get basic equipment.

Government proposals, published in a green paper in March, would improve life for children with special needs and disabilities and their families, she said.

At the moment, children with severe or multiple health and learning disabilities receive a statement from their local authority. This covers only the services that schools are expected to give children, rather than those they need from the health service or social services.

The green paper proposes to replace the existing statement of special educational needs with a single care plan covering schooling, health and social services from birth to the age of 25. This would mean a child’s educational, social and health needs would be dealt with together. The plan would reflect a family’s needs and ambitions for the child’s future and would be continually reviewed.

The green paper also set out plans to give parents a personal budget to spend on services such as one-to-one tuition, laptops and wheelchairs.

“Rather than a family having to go to the council trying to bang down their door to get something, [the council] are coming to you saying, this is what we normally provide. The family then has a conversation about whether it is appropriate,” Teather said.

The government also plans to introduce into all schools a programme to help children with special needs improve at a faster rate.

Researchers found the Achievement for All programme helped nine- and 10-year-olds with special needs to learn reading, writing and maths three times faster than they were expected to under the national curriculum. Under the same programme, 14- and 15-year-olds with special needs made progress in maths and English that was equivalent to having an extra term of lessons in a year.

The programme, which has been piloted in 454 schools in 10 local authorities since 2009, works by setting pupils regular targets. Teachers and parents discuss progress three times a year for a minimum of 45 minutes. Children with special needs and disabilities are strongly encouraged to join school clubs and activities outside lessons.

Sonia Blandford, director of the programme, said it could reduce by 10% the proportion of children registered as having special needs.

From: http://www.guardian.co.uk/nhs-failing-vulnerable-young-people

Nearly 15% of hospital inpatients waited over the 18-week period the Labour government had made its target for treatment in February 2011 – the highest level for nearly three years.

Patients waiting over four hours in accident and emergency was up to its highest level since 2004/05, but the proportion of patients waiting more than six weeks for diagnostic services fell back in February.

“This report will provide a regular health check on the state of the NHS as it comes to terms with the new financial climate and implements the government’s reforms,” King’s Fund chief economist John Appleby said.

“It highlights significant concern among NHS finance directors – who are well placed to report on the stresses in the system – about the prospects for the year ahead.

“With hospital waiting times rising, the NHS faces a considerable challenge in maintaining performance as the financial squeeze begins to bite.”

The first instalment of the report found that nearly half of its panel identified ward closures and cuts in services as among the main ways of meeting productivity targets in their area.

David Flory, deputy chief executive of the NHS, said the health service had had a good year in spite of last year’s “exceptionally cold winter”.

He pointed out that average waiting times remained low and broadly stable and that the NHS had a healthy financial surplus “in line with its plans”.

Mr Flory added: “Despite continued good performance, the NHS is still facing pressure from growing demand and will do so for many years to come.

“This particular snapshot shows that the NHS must maintain its focus on waiting times and improving patient outcomes, while dealing with the extra demands on the service.

“Under the government’s modernisation plans, patient choice and transparent information will increasingly drive improved performance in the NHS.”

Health secretary Andrew Lansley’s proposed reforms of the NHS, which would create a market dynamic based on GP consortia being handed the bulk of commissioning powers, remain deeply uncertain, however.

Massive opposition from NHS workers, culminating in a no-confidence vote in Mr Lansley from the Royal College of Nursing earlier this month, has forced ministers to pause the health and social care bill’s progress through the Commons as the government embarks on a ‘listening exercise’.

From: http://www.politics.co.uk/health/hospital-waiting-times-highest-in-three-years

The moves are part of the NHS drive to find £20bn efficiency savings by 2015.

The government said performance should be measured by outcomes not numbers.

Surgeons have described the delays faced by patients as “devastating and cruel”. Peter Kay, the president of the British Orthopaedic Association (BOA), says they’ve become increasingly frustrated that hip and knee replacements are being targeted as a way of finding savings.

“GPs were told not so send as many patients to hospital, maybe to delay referrals until the end of the financial year while perhaps introducing thresholds for surgery.”

He says that simply delaying surgery by one means or another does not improve the outcome for patients as their condition can deteriorate.

“The double jeopardy is that patients wait longer in pain, and when they have the operation, the result might not have been as good as it otherwise would have been had they had it early. ”

The BBC asked orthopaedic surgeons through the BOA if they had seen delays to these operations as a result of measures introduced during the last financial year.

Overall, 692 surgeons in England sent the BBC information about the policy on hip and knee replacement of their local Primary Care Trust (PCT).

Between them they covered the majority of PCTs in England. In some areas no restrictions were being imposed, but in others the specialists reported delays or new thresholds for surgery.

106 surgeons told the BBC routine operations had been put on hold in their area. Others described new limits on when patients qualify for hip or knee replacements.

152 specialists said patients now have to be more disabled or in greater pain, and 118 told us hip and knee surgery had been regarded as a procedure of low priority.

The data reveals a picture of overlapping restrictions, with some surgeons reporting more than one new policy had been introduced in the same area.

A number of PCTs have been explicit about their decisions to put all routine operations on hold for several months up to April to help balance their budgets by the end of the financial year. They include Warrington, Sheffield, Eastern and Coastal Kent, Bury and Warwickshire.

Putting routine operations on hold means that GPs simply stop referring their patients for surgery. So although a patient might be waiting longer, this isn’t recorded in the official waiting statistics.

Another way of adding invisible waiting time into the system is to implement stricter new criteria which have the effect of delaying the point when a patient can be referred for treatment. An investigation by the BBC also found evidence in many PCT board papers of new thresholds being added for hip and knee replacements.

They include introducing scoring systems for patients for pain or disability, or not allowing some obese patients to be referred for surgery until they have been on a weight loss programme.

Professor John Appleby, chief economist at the Kings Fund, says it is a mystery why these operations are being targeted for savings. “I find it difficult to understand. Hip operations are quite expensive, but patients get a lot of benefit for that money. This is actually very good value for money indeed.”

These delays and restrictions are a response to the financial challenge facing the NHS in England. The scale of it was set out under the last Labour government, but the decisions on how to find those savings are being made now.

The coalition government has stopped performance managing the 18 week waiting time, although it remains a legal right under the NHS constitution.

From: http://www.bbc.co.uk/news/health-12964360

The trusts that replied carried out 1,227 fewer knee replacements, a drop of six per cent, and 531 fewer hip replacements.

And they carried out 2,041 fewer hernia operations, down 7.25 per cent, and 1,770 fewer tonsillectomies, a drop of 11 per cent.

The figures are from Freedom of Information requests to England’s 170 NHS hospital trusts, made by the Patients Association, of which 62 responded.

The pressure group described the figures as “a disgrace” while doctors labelled them “worrying”.

The Patients Association also found that, on average, waiting times for hip replacements rose from 80 to 88 days and for knee replacements from 82 to 90 days.

The organisation undertook the research after receiving triple the number of calls in 2010 from patients saying they were having problems getting the surgery they needed, compared to 2009.

In December The Daily Telegraph reported how some trusts were postponing lower-priority procedures to save money.

Although the NHS is receiving a 0.5 per cent above inflation increase each year between now and 2014, critics say a commitment to make internal savings of up to £20 billion by then means front-line services are being affected.

Katherine Murphy, chief executive of the Patients Association, said: “It is a disgrace that patients are being denied access to surgical procedures that they would have had if they had needed them a year ago.”

She added: “With the NHS needing to make £20 billion of savings by 2014, we are worried that this situation is only going to get worse – how many more thousands of patients are going to be denied operations this time next year?

“This research backs up what patients are telling us every day on our helpline, less operations are being carried out, and those fortunate enough to get an operation are having to wait longer for it to take place.”

John Black, president of the Royal College of Surgeons, described the figures as “worrying”.

He said: “Patients must be seen on a clinical need, rather than a financial basis. Any cost savings this may bring in the short term will be negated as these patients present with more serious conditions further down the line.”

However, the Department of Health said official hospital statistics for all trusts in England indicated that NHS activity went up in 2010, not down.

For example, from April to October 2010 there were 41,863 hip operations, compared to 39,114 for the corresponding six months in 2009; while the figures for knee operations were 45,463 and 43,454 respectively.

A spokesman said: “There is no justification for asserting that quality of care is slipping. Official figures show that the NHS is delivering more for patients and that waiting times are stable.”

From: http://www.telegraph.co.uk/Hospitals-cutting-operations-while-waiting-times-rise

Consultants have been accused of playing the system, but doctors said poor planning by managers was to blame.

Overtime rates vary, but are often about £600 for four hours – treble what senior medics get for contracted work.

Basic pay for consultants stands at just under £90,000 a year on average. For full-time consultants, this pays for 10 separate four-hour blocks a week.

Consultants who do private work are also obliged to do an extra four hour session paid at their basic rate if their NHS trust needs them.

Any extra work beyond that is then done at a higher rate under a system known as waiting list initiative payments (WLIs).

These are negotiated individually by each trust so there are no figures for how much is spent nationally.

The Department of Health stressed the need for the efficient use of money in the current climate.

Depending on what speciality they are in, consultants can earn tens of thousands of pounds on top of their basic pay.

Consultants involved in common forms of surgery, such as ear, nose and throat and hip and knees, tend to do the most overtime alongside anaesthetists. Others, working in areas such as geriatrics, are likely to get very little.

At Coventry and Warwickshire NHS Trust, one ear, nose and throat specialist made more than £105,000 in 2009-2010 in overtime. Another three consultants from other areas made in excess of £80,000.

Similar figures were also seen in the previous years.

Ed Burns, from Newton Europe, a consultancy which has carried out work for NHS trusts to improve productivity, said figures in excess of £60,000, including those above £100,000, would not be seen in every trust but were “not unusual” either.

He said poor job planning was the most common cause of high overtime payments, but added sometimes consultants fought against giving them up by employing tactics such as under-booking theatre sessions to make sure there was a need for overtime.

The total bill for the waiting list initiative payments has nearly doubled in two years to £2.35m in 2009-10 for the trust, which runs two major hospitals for a population of over 1m in the West Midlands.

And despite attempts to curb the amount being spent this year, latest figures suggest it will rise again.

Like many NHS trusts, consultants are offered up to £600 for a four-hour session. Some are only too happy to accept.

One ear, nose and throat consultant made more than £105,000 in overtime payments last year. Another three from other specialities got in excess of £80,000.

Not everyone gets the extra work. In total, 123 consultants out of a total of 350 did overtime.

A spokeswoman for the trust said such payments were unavoidable to ensure patients received “timely” care. She added the trust always sought to use resources “as responsibly as possible”.

“Consultants work hard to provide the best possible patient care, and by volunteering for WLIs they help keep waiting times down. However, for a few, WLI payments can serve as a disincentive to working more efficiently because they face a loss of earnings.”

His claims are supported by the experience of some NHS trusts.

Managers at Mid Staffordshire NHS Trust tried to reduce the rate for overtime for orthopaedic surgeons from £1,000 to £500 for a four-hour session. But minutes from official meetings showed consultants would be “downing tools” if they did so. In the end, managers had to compromise on a fee of £750.

Paul Flynn, from the British Medical Association, admitted some of the higher sums “sounded unhealthy”, but pointed out research by the union also suggested consultants were doing six hours a week extra for free.

He also rejected suggestions that consultants were blocking moves to make hospitals more productive.

“WLI is a quick fix and consultants certainly would not want to come to rely on the payments as they are unpredictable.”

He said hospitals could reduce the reliance on overtime by easing the load on consultants by recruiting extra staff or giving admin tasks and duties such as routine follow-ups to other staff.
‘Publish data’

News of the overtime payments comes after the BBC reported at the end of last year that doctors were getting bonuses of up to £75,000 a year.

It means overall pay, once basic salary, bonus and overtime are totted up, can be well in excess of £200,000 a year.

From: http://www.bbc.co.uk/news/health-12115669

He said desperately sick people had been left for hours waiting on trolleys, with even those requiring intensive care enduring long delays.

Dozens of NHS units have cancelled surgery and clinics for outpatients.

At least 10 major centres issued “black alerts” — the highest emergency warning — meaning they were at breaking point, forcing patients to be sent elsewhere.

Scores of hospital wards closed due to norovirus, the winter vomiting bug, which put more than 1,200 beds out of use in one week as nurses attempted to isolate the disease.

Hospitals in Cambridge and Norfolk were on “black alert” for more than two weeks. In the past 10 days, major hospitals in London, Liverpool, Surrey, Southampton, Peterborough, Derby, King’s Lynn and Great Yarmouth issued the same warning.

While many hospitals did not schedule non-emergency surgery during the Christmas and New Year period, in the past week dozens cancelled thousands of planned operations.

Routine surgery was stopped at hospitals in Leicester, Sheffield, Macclesfield, Middlesbrough, Northallerton, Durham, Darlington, Bassetlaw, Belfast, Portsmouth, south Wales and many parts of London.

Last night it was disclosed that two boys, aged two and 10 months, had died from swine flu in Northern Ireland.

John Heyworth, the president of the College of Emergency Medicine, said: “We have seen A&Es absolutely overwhelmed, with people queuing on trolleys and long delays even for those being admitted to intensive care. The hospitals are gridlocked.”

He expressed anger about the failure of Government and the NHS to develop sufficient contingency plans, given that a flu outbreak was widely anticipated following the swine flu pandemic in 2009. “My frustration is that so much of this is predictable. This did not come out of the blue and yet the planning is inadequate — as though there is a sense of denial about it. The planning this winter has been far less effective than last year.”

Mr Heyworth claimed that casualty units had been hit by a “dramatic surge” in demand not just because of an increase in the number of very sick patients suffering flu complications, but also because less serious cases went to A&E because they could not see a GP at evenings or weekends.

“In many parts of the country out-of-hours services are absolutely inadequate, so what we get is people turning up at A&E simply because they do not know where else to go, or else they delay and only seek help when their condition is serious,” said Mr Heyworth. It is not good enough. We are failing the public.”

Across the country, hospitals were struggling to cope. Southampton General Hospital spent more than three weeks on “black alert”, closing 10 wards as norovirus swept through the centre. It was forced to stop all non-emergency surgery and cancel most appointments for outpatients during the period. The crisis warning was finally lifted on Thursday.

Because of the same bug, four wards were closed at Royal Cornwall Hospital last week and cancer and surgery wards in Poole, Dorset, were closed to new admissions. Three wards were closed at West Suffolk hospital.

On Thursday, it was disclosed that the number of deaths from flu had almost doubled, with 110 deaths this winter.

Hospitals were already struggling to cope with an increased number of elderly patients needing surgery following falls during the big freeze when they were hit by rising influenza admissions and cases of norovirus.

The latest figures for England showed that in the week ending last Sunday, 23 casualty units were filled to capacity, forcing ambulances carrying emergency patients to take desperately sick people miles further for treatment.

The Government was criticised by influenza experts for failing to introduce a national public advertising campaign about the perils of swine flu until Jan 1, by which time the outbreak was on course to hit epidemic levels.

Katherine Murphy, of the Patients Association, said: “It is really worrying that the NHS is not prepared to deal with these sorts of pressures. The system is on a knife-edge, and it does not have enough slack in it to cope once we have an outbreak of flu and cases of norovirus.”

She said the charity was “inundated” with calls from elderly people who had their operations cancelled and had not been given a date for the surgery to go ahead.

“What concerns me even more is that this is happening at a time when the health service is gearing up to make major savings, and massive reforms,” said Ms Murphy.

A spokesman for the Department of Health said there was always more pressure on the NHS at this time of year and insisted that the service had been prepared and was coping well.

“This year’s flu has resulted in greater than usual numbers of patients requiring critical care,” he said.

“Where necessary, local NHS organisations have increased their critical care capacity, in part by delaying routine operations requiring critical care back-up. This is a normal operational process which is initiated by NHS organisations at the local level.”

From: http://www.telegraph.co.uk/Swine-flu-hospitals-gridlocked

Patients’ groups described the tactics as an “appalling scam” to enable NHS bosses to claim waiting times are far shorter than they are, simply by denying a place in the queue to many of those referred for surgery.

Under the plans drawn up by NHS bureaucrats in Kent, any smoker referred for “non-urgent” operations – such as hip replacements or cataract surgery – will not be allowed to join the queue until they have either given up smoking, or completed a 12-week course to help them ditch the habit.

Those who are seriously overweight will also be denied a range of operations until they have completed a three month NHS diet programme.

Although every patient has a legal right to be treated in 18 weeks of being referred for treatment by their GP, the protocols agreed mean different rules could be applied for anyone with a body mass index of more than 30, or those who smoke.

Patients groups said delays getting a place on 12-week “smoking cessation” and “weight loss” programmes could leave many patients waiting even longer than 30 weeks implied by proposals drawn up by NHS West Kent Primary Care Trust (PCT).

Katherine Murphy, from the Patients Association, said: “This is an appalling kind of scam – it is a clear device to manipulate the waiting lists simply to cut their deficit. It smacks of desperation, and it is patients who will suffer.”

The plans, seen by The Sunday Telegraph, explicitly say the rules have been introduced to save money by the end of the year.

The document says: “PCTs across the country are making decisions on prioritising treatments in order to match demand to the financial resources available to the economy as a whole and to individual trusts.

“Unfortunately this does not take us far enough: we need to take additional activity to reduce activity in this financial year if we are to be in a position to hand over a balanced budget.”

Under the proposals, smokers already on waiting lists will now be taken off until they have either been on the courses or given up smoking. New referrals will not be allowed on the lists until they have done the same.

All patients with a BMI of 30 or more who are referred for several types of surgery including hip and knee operations will also be cast off the lists until they have been on a three-month diet programme.

Many primary care trusts already try to encourage patients to stop smoking or lose weight before operations, in order to reduce the risks to them.

But patients’ groups said the use of tactics to delay even putting patients on the waiting lists was a far more draconian step.

Mrs Murphy said: “This is a clear way to keep these patients off the lists in order to cut costs, while the PCT can officially claim its waiting times have not lengthened.”

Simon Clark, director of the smokers’ lobby group Forest, accused the PCT of discriminating against smokers and creating a “two-tier” system.

He said: “Of course patients should be told that smoking could have an impact on the success or recovery from an operation, but given that they have paid huge sums in taxation on cigarettes over the years, the question of whether or not they have the surgery should be one for them, not the NHS.”

A letter sent out by the PCT tells local GPs: “There is good evidence that stopping smoking prior to surgery reduces length of stay and infection rates, and improves healing time; it is also a time when people are often highly motivated to give up.”

Kent doctors accused managers of being dishonest about the real reasons why patients were having their treatment delayed.

Dr Stephen Meech, a GP from Maidstone, said: “Patients are going to be told that they cannot have an operation because they smoke or need to lose weight, when that is not actually true – it is because the health authority can’t afford to pay for it.”

Dr John Allingham, a GP from Hawkinge, said: “The plan is extremely contentious and it is a way of extending the waiting times.

“If you’ve got to do a 12-week smoking cessation course before you can have your hernia fixed, or before you’ve even gone on the waiting list to have your hernia fixed, it immediately makes those waiting lists another 12 weeks longer.”

The PCT said it was in talks with local doctors over the proposals. Marion Dinwoodie, its chief executive, said she regretted the need “to take measures in the short term that may have an impact on local people”.

She said no one with a compelling clinical need for treatment this year would miss out.

From: http://www.telegraph.co.uk/Smokers-and-fat-patients-thrown-off-NHS-waiting-lists

Private hospitals bucked the recession in 2009 – but only by massively expanding the amount of work they carry out for the National Health Service, according to the analysts Laing and Buisson.

However, work for NHS patients, who now have the right to go to any private hospital willing to treat them at the NHS price for waiting-list type treatments, rocketed.

Their numbers almost quadrupled between 2007 and 2009, up from 55,900 to 212,000, so that NHS patients made up almost 22 per cent of private hospital cases, up from 6.3 per cent in 2007.

The result was a rise in independent hospital activity, with about 975,000 patients treated, against 888,000 in 2007.

Some NHS patients are sent by NHS hospitals to keep waiting times down.

But the numbers exercising their right to choose are rising sharply – running at a rate of 200,000 procedures a year in July this year, according to Laing’s Healthcare Market Review, the bible on private sector activity. That is business worth £400m a year.

William Laing of the review said senior health department officials believe patient choice activity in the private sector could triple. His own estimate is that it might ultimately rise five fold to about £2bn a year – although that would still be less than 20 per cent of NHS waiting list activity.

“Expanding the services they provide for the NHS has obvious attractions for independent hospitals because the publicly paid market is massively greater than the traditional private healthcare market.

“But it has great dangers as well, since too much focus on publicly paid patients could compromise their appeal to traditional, privately paying customers. There is a conflict which independent hospital providers have not yet fully resolved.”

If the independent sector seriously wanted to address the potentially huge public market, he said, it would “have to grow a lot more capacity”.

That could come from a mix of the existing players and new hospital providers entering the market with lower cost business models that generate reasonable profits from the prices that the NHS is prepared to pay.

The figures came on the day the Office of Fair Trading launched a wide ranging review into the private healthcare market – among other issues examining the barrier to new entrants joining it.

From: http://www.ft.com/cms/s/0/675afcb4-07b7-11e0-a568-00144feabdc0,s01=1.html#axzz18ALgaS00

Legal experts warned the rise could leave GP consortia at risk of being sued by patients when they take over commissioning, since being treated within 18 weeks remains a right under the NHS Constitution.

Department of Health statistics show the proportion of people treated within 18 weeks increased steadily from 2007.

Numbers peaked this July, when 93.3% of admitted and 98.1% of non-admitted patients were treated within target, just after the NHS Operating Framework removed it.

By September, the proportion of admitted patients missing out jumped from 6.7% to 7.5%, and of non-admitted patients from 1.9% to 2.2%.

Overall, 45,000 patients missed out on treatment in 18 weeks during September, up 15% from 39,000 in July. Some 12.6% of patients awaiting orthopaedic or trauma treatment, and 10.6% awaiting oral surgery, waited more than 18 weeks.

Ben Troke, partner in health and social care at Browne Jacobson solicitors, warned: ‘When commissioning passes to GP consortia, it’s hard to see responsibilities [for applying the NHS Constitution] not going with it. There’s a real risk of legal challenge.’

‘Whether a claim would be successful is hard to say, but being dragged through the courts can be damaging even if you win. Courts are starting to rely on the NHS Constitution as a ground for decisions and every consortium can expect to keep their lawyers busy.’

At least one SHA has admitted waiting times are slipping.

NHS South Central said health systems in Oxfordshire, Southampton and south-west Hampshire had been assessed as failing ‘principally due to financial issues and concerns on workforce and 18 weeks’.

Dr Jennifer Dixon, director of the Nuffield Trust, said: ‘Once you scrap hard targets, it’s likely actions to achieve them will wane. I guess that’s what we’re starting to see.’

Dr Chaand Nagpaul, GPC negotiator, said PCTs were already taking advantage of the target’s removal: ‘We’re getting reports of trusts delaying treatment so they can address financial problems. The Government is engaging in double-speak, removing targets on one hand but committing to patients’ rights on the other.’

From: http://www.pulsetoday.co.uk/NHS waiting times increasing after targets scrapped

Macmillan Cancer Support said that showed too many patients were not being cared for properly after being given treatment like chemotherapy and radiotherapy.

According to the NAO’s report, which examines how well the NHS has managed to deliver the last government’s five year Cancer Reform Strategy so far, waiting times have fallen and the number of days cancer patients spend in hospital has dropped.

The strategy, launched in 2007, was meant to make NHS cancer services “among the best in the world” by 2012.

But the NAO report said there was “limited assurance” as to whether the £6.3 billion spent on cancer care annually was money well spent, because such poor information linking spend and outcomes was available.

In particular it illuminated problems caring for cancer outpatients.

Ciaran Devane, chief executive of Macmillan Cancer Support, said: “English cancer services have improved but there is still an incredibly long way to go for the UK to be a world leader.”

She warned: “The NHS won’t be able to support the growing number of cancer patients unless it seriously ups its game.

“The whole NHS needs to realise that cancer is a long term condition for many. If the NHS does not provide appropriate services after patients leave hospital, they can expect to see a massive increase in costs as cancer patients are forced to use emergency services.

“Abandoning cancer patients after treatment is no longer acceptable, nor does it make any financial sense.”

The previous government had pledged to cut the total number of emergency cancer admissions – not just via A&E but also for example by doctors making emergency referrals – but instead the number has been rising steadily.

It has risen from 231,000 in 2000/01 to 300,000 in 2008/09. However, the rate of annual increase has almost halved. Four in five have an existing diagnosis.

Karen Taylor, from the NAO, said there was “poor understanding” of the issue while primary care trusts “don’t appear to be aware of it’s extent”.

Mike Hobday, head of policy at Macmillan, said the reason was clear.

“The traditional NHS approach at the end of cancer treatment has been to say, ‘Go away, you are cured.’ ”

But he explained: “While treatment is in most cases extremely good, people with cancer have ongoing problems. Chemotherapy is toxic – you can’t do it without impacting people’s health.

“Patients aren’t being given the support to manage themselves, so they turn up at A&E.”

A “small investment” in things like better information and dedicated helplines for cancer patients would reap large savings by lowering emergency admissions, he predicted.

With growing numbers of cancer survivors and stretched budgets “the NHS has to do this smarter”, he said.

Dr Jodie Moffatt of Cancer Research UK said the increase could partly be explained by the tripling of cancer patients receiving chemotherapy since 2000. The government was trying to tackle the problem, she argued.

Paul Burstow, the Health Minister responsible for care services, said: “This report is a damning indictment of Labour’s failure to deliver on their promises to improve the quality of cancer care.

“The shocking levels of emergency admissions are the legacy of Labour’s obsession with hitting targets instead of helping patients.

“Under Labour, NHS spending rose to European levels of funding, but they have failed to deliver European levels of quality cancer care. If the NHS was performing at the level of the best in Europe, an extra 10,000 lives could be saved each year.”

Jo Webber, deputy director of policy at the NHS Confederation, which represents health trusts, said: “It is difficult to attribute a rise in emergency re-admissions to any one factor.

“Commissioning appropriate after-care services and providing patients with access to specialist services and home support services all play their part in bringing numbers of re-admissions down.

“Providing patients with access to quality treatment in or close to home, as well as information on local support services, is just as important as the early detection and treatment of the disease when planning an effective cancer strategy.”

From: http://www.telegraph.co.uk/Cancer-patients-abandoned-after-treatment

Emergency patients are being let down by the health service because managers are more concerned with meeting targets by treating those with appointments, the heads of Royal Colleges warn.

In a letter to The Daily Telegraph, some of the country’s most senior doctors say they are “deeply frustrated” at the low priority given to Accident and Emergency.

Targets concerning waiting times and cancelled operations, introduced under Labour, result in managers pushing doctors to operate on patients whose care has been pre-planned, in order to avoid financial penalties. But they can also mean that those who come in as emergency cases are stabilised and admitted but then left to wait for surgery.

Studies have shown that elderly people with fractured hips who do not undergo surgery within 48 hours are less likely to regain full mobility. Younger patients with shattered pelvises, from motorcycle or horse-riding accidents, are less likely to walk again if their operations are delayed.

A report published on Thursday criticised care for the elderly, finding that two thirds of those who died within a month of surgery had not received proper care and that they had often been left in pain.

Most of those patients were being treated for bowel conditions or broken hips, which are usually admitted as emergency cases.

John Black, president of the Royal College of Surgeons, said the report echoed concerns that surgeons had been raising for some time.

In the letter, Mr Black said: “It is a source of deep frustration to our members that hospitals have become organised to deal quickly with elective operations at the cost of properly managing emergency care.”

The Coalition’s reforms of the NHS could help by making hospitals more accountable to GPs for the care they provide, he said.

The letter was signed by Peter Nightingale, president of the Royal College of Anaesthetists; Peter Kay, president of the British Orthopaedic Association; Finbarr Martin, president of the British Geriatric Society; Mike Horrocks, president of the Association of Surgeons; and Clare Marx, the Royal College of Surgeons’ lead representative in matters of patient safety.

Mr Horrocks said: “In recent years, the NHS has been set targets for elective operations to bring down waiting lists.

“This has been fantastic for patients with non-emergency conditions, but came at the detriment of those who require urgent treatment as hospitals focused on hitting those targets.

“The new government has committed to moving away from targets and towards measuring and rewarding hospitals who deliver good outcomes and this report should provide further evidence that this approach is correct.”

Under Labour, patients had to be treated within 18 weeks of a referral by their family doctor.

Surgeons have told the Telegraph that this resulted in extreme pressure to operate on any patients in danger of failing to meet that target, ahead of cases that came in as emergencies.

Any pre-planned operation that was cancelled was recorded and the data published. The patient then had to be rescheduled within 28 days, adding to the pressure to give elective operations priority, doctors have said.

Mr Black added: “Surgeons have been saying for some time that emergency surgery is a Cinderella service in the modern NHS.

“We will only solve these problems if focusing on emergency care becomes a priority in the boardroom as well as the ward.”

Katherine Murphy, director of the Patients Association, said: “It can be so debilitating for someone who has a fracture to be left for a couple of days or longer, waiting for an operation when the trust is focused yet again on meeting these pernicious targets. It is an appalling way to determine who gets care. An emergency should be an emergency.

“The financial rewards for elective surgery are more lucrative for the trust than for emergencies and that is why trusts continue to focus on elective treatment. We cannot make savings by putting patients through unnecessary pain and suffering.”

From: http://www.telegraph.co.uk/Emergency-patients-let-down-by-targets-say-surgeons

Those requiring treatment for cancer will be able to study survival rates – and waiting times – for different medical teams and then opt to have treatment where they wish, under the plans to be announced today. Proposals are being drawn up to give patients online access to their medical records.

Miss Lane Fox says that the most useful online services for consumers should be made available to NHS patients over the next few years.

It is hoped this will help drive up hospital standards as patients choose not to use the services of poor doctors, who will then lose funding. Patients will also be asked to rate the service and treatment they receive from different hospitals and medics.

They will be able to choose which GP they register with and whether to be treated at an NHS hospital or private or charity-run institution, within certain cost limits.

Miss Lane Fox, the founder of Lastminute.com, says the data could prove invaluable.

The Department of Health is the only major Whitehall department which will not see its spending cut this week. However, Andrew Lansley, the Health Secretary, still has to push ahead with major reforms as the ageing population is causing a sharp rise in health-care costs.

Miss Lane Fox, the Government’s digital champion said: “A recent YouGov poll found that 40 per cent of people believe the NHS can learn from the service offered by supermarkets, banks and utility companies. I’ve always believed in the power of information and technology as an incredibly useful tool.

“There’s clearly an appetite for a new approach. The Department of Health is launching a consultation this week into how information and technology can help people take more control of their health and make the best choices for themselves and their families.”

The consultation will study how internal data could be offered to websites like TripAdvisor or Mumsnet, which could “empower patients and families”.

Mr Lansley said: “The first principle of the White Paper is that the NHS should ensure that for patients, ‘no decision about me, without me’ is the invariable practice. To realise this means patients must have more say and more choice.”

From: http://www.telegraph.co.uk/NHS-patients-to-see-medical-records-online

The cuts:
Technically the NHS has been given an increase in funding but this is less than half a per cent over four years.

£1bn will be diverted from the NHS to social care to help cut emergency readmissions to hospitals.

Psychological therapies will be boosted for those with mental health problems.

A new cancer drug fund for medicines that have been turned down by Nice worth up to £200m a year.

Three new hospitals were given the go ahead including Epsom and St Helier, West Cumberland and the Royal Oldham.

However the extension of free prescriptions to people with long-term conditions will be stalled.

One to one nursing care for cancer patients and a pledge under the previous government to have cancer tests conducted within one week will also be postponed.

The number of quangos will be cut from 18 to 10 by 2014 and the administration costs will be reduced by a third.

Radiographers will examine some x-rays as well as take them in order to save £7.9m of consultant radiologists’ time.

What it means:

Although an increase in funding sounds generous compared to the other departments it is nowhere near enough to keep pace with inflation in the NHS or the increase in demand for healthcare as the population ages and new treatments are developed.

The NHS has already been planning to make £20bn worth of savings over the next four years and it is not yet clear if this will have to be increased in light of the CSR settlement.

The Chancellor said the NHS spent £102bn this year but this is £5bn lower than what was planned for in the 2007 spending round, raising the question of where that money has gone.

Thousands of jobs in the NHS are already earmarked for cuts as primary care trusts and strategic health authorities are to be abolished as part of the coalition’s reforms and it is feared that some hospitals may seek to cut frontline jobs as well.

Experts have warned that plans to give GPs greater control over the NHS budget and the reorganisation this will take will cost between £2bn and £3bn.

What is the department’s budget?

£109.4bn

How well does the department perform?

Waiting times for patients needing treatment in hospital reduced dramatically under Labour, following the introduction of many targets. But with them came an expanding bureaucracy. The number of managers rose by 84 per cent in a decade, while nurse numbers grew by just 24 per cent.

Recent scandals such as that at Stafford Hospital, where patients suffered appalling and basic failings, illustrated the dangers of prioritising finances and targets over care.

Britain’s record in funding drugs for many serious diseases – especially cancer – compares poorly with the rest of Europe, and survival rates are worse than in other countries.

While growth in spending on the NHS in the past decade was at a record level, most of the money went on pay. GP pay rose by nearly 50 per cent in a decade, to an average of £106,000.

Had any savings already been identified?

The Government says more than £1 billion will be saved by halving the size of NHS bureaucracy in four years. 150 primary care trusts and 10 health authorities will be scrapped. However, redundancy payouts to get rid of so many managers will be expensive. Quangos such as the Health Protection Agency will be culled. Funding for a £75 million public campaign against obesity and drinking is to be stopped, with food and drinks companies asked to foot the bill.

From: http://www.telegraph.co.uk/Spending-Review-What-it-means-for-the-National-Health-Service-NHS-Department-of-Health

Hospital waiting times have begun to rise again after years of decline following the introduction of European rules on junior doctors’ working hours.

Thousands more patients were now waiting longer than 18 weeks for surgery because of eu red tape.

Ministers were seeking to renegotiate Britain’s position on the European Working Time Directive, including a possible opt-out for NHS staff. The Royal College of Surgeons carried out the first comprehensive analysis of how the directive had affected waiting times.

According to the research, the proportion of NHS patients having to wait longer than the 18-week target for non-emergency surgery such as hip replacements had almost doubled from 1.5 per cent 18 months ago to nearly three per cent in March this year.

Waiting times reached an all-time low at the end of 2008, with patients waiting just a few weeks for surgery on average.

However, since the EU directive cut junior doctors’ hours from 56 to 48 per week, these gains had been wiped out, the Royal College said.

According to data from the Department of Health, the number of patients waiting longer than 18 weeks — from GP referral to being treated as an inpatient — fell steadily from April 2007, when almost 34,000 people were waiting, to 8,674 in December 2008.

The figure remained stable at about 10,000 until June 2009, just before the new rules came in, when the rise began.

In March this year, it had risen to 17,515, a level last seen in September 2007.

John Black, the president of the Royal College of Surgeons, said the increase was predictable.

“If you have the same number of patients, no more doctors and ask them to work less then it is inevitable that the time available for elective procedures will reduce and waiting lists grow,” he said.

Almost two thirds of consultants now frequently operated without assistants because departments were so stretched.

Mr Black said most European countries had bypassed the legislation by either not monitoring compliance or, as in Germany and Holland, finding ways around the directive.

“We look forward to this happening in the UK,” he said.

Sir Richard Thompson, the new president of the Royal College of Physicians, said the directive had been a “complete disaster” for both patient care and the quality of training for doctors.

“We are not providing the service or the training that we require,” he said. “I cannot overemphasise the damage to service provision and to training.”

According to the survey, 80 per cent of consultant surgeons and two thirds of surgical trainees said patient care had deteriorated since the directive was implemented.

Dr Matt Jameson-Evans, a spokesman for Remedy UK, a junior doctors campaign group, said the impact of the directive on services was inevitable.

“Patients are simply not being treated by as many doctors as before,” he said. “A second consequence of this and equally important is that doctors are not receiving as much training as they were and this has serious implications for the future quality of care.”

The Royal College of Surgeons has argued for an opt-out to allow trainees to work up to 65 hours per week because they were not getting enough practical experience on a 48-hour week.

The Coalition has abolished the 18-week target, saying it was not backed by evidence that it benefited patients.

Dr Mark Porter, the chairman of the British Medical Association’s consultants committee, said the drive for cuts within the NHS was also a factor in the rise in waiting times.

From: http://www.telegraph.co.uk/NHS-waiting-lists-rise-after-doctors-hours-cut

Nursing and doctors’ leaders welcomed the greater flexibility they have been given to treat patients according to clinical need rather than being forced to stick to strict central guidelines.

But patients’ groups expressed concern that the reforms could result in a “free-for-all,” and that without targets long waiting times could return to the NHS.

GPs will no longer be forced to see patients within 48 hours of them seeking an appointment.

The requirement for 98 per cent of patients attending Accident and Emergency wards to be seen within four hours has been relaxed to 95 per cent.

And the target for patients to be given a hospital appointment within 18 weeks of being referred by their GP has been abandoned altogether.

Andrew Lansley, the Health Secretary, insisted that people would still have the right to demand high levels of service from the NHS, but that this would be done locally rather than dictated from the centre.

“I want to free the NHS from bureaucracy and targets that have no clinical justification and move to an NHS which measures its performance on patient outcomes,” he added.

“Doctors will be free to focus on the outcomes that matter – providing quality patient care.”

Katherine Murphy, director of the Patients Association, said: “The targets focused minds in the NHS, made people start realising services had to get better.”

But Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, welcomed the relaxation in targets.

He said: “Patients should have good access to GPs. However, while this target may have been intended to improve access it has in fact had adverse consequences.

“At the moment practices need to have enough appointments available on the day or the following day to meet the target, so those who want to book in advance find there are fewer appointments available.”

Under the changes to the NHS Operating Framework, Mr Lansley has also ordered health bodies to reduce management costs from £1.85 billion to £1 billion by 2013.

While spending on the health service will continue at current levels, he said it was crucial to make “immediate” savings which could be reinvested in patient care.

From: http://www.telegraph.co.uk/NHS-waiting-times-are-relaxed-and-abandoned

Hospitals in England will be paid for initial treatment but not paid again if a patient is brought back in with a related problem, he said.

It has been argued that patients are being discharged early to free up beds.

The Conservatives have said cuts to the number of hospital beds under Labour put pressure on NHS staff to discharge people without support.

Between 1998-99 and 2007-08, the number of emergency readmissions in England rose from 359,719 to 546,354. But there was also a significant rise in the number of procedures performed over the same time period.

Readmissions as a percentage of all patient discharges went up marginally, from 8% in 1998-99 to 10.5% in 2007-08.

Speaking about his vision for the NHS, Mr Lansley called for patients to be given more control over their healthcare.

And he said hospitals would have the responsibility of looking after patients’ health and well-being for up to a month after they are discharged.

Currently primary care trusts and GPs look after patients once they are discharged from hospital.

Under the new plans hospitals would receive funding for the first hospital stay plus treatment for the patient’s first 30 days after discharge.

Mr Lansley promised to “empower patients as well as health professionals” and “disempower the hierarchy and the bureaucracy”.

He said: “We need a cultural shift in the NHS. From a culture responsive mainly to orders from the top-down, to one responsive to patients, in which patient safety is put first.

This change of direction will send a ripple through hospital managers with some enterprising chief executives will see it as a chance for hospitals to extend their services into the community.

If they are to provide extra follow up care, and bear the cost of unavoidable complications, hospitals will be hoping to see that reflected in the price they are paid for each operation.

England is unique in the UK in paying its hospitals for each treatment they carry out, a system called payment by results.

This will be the main lever which the Health Secretary can use to change the incentives in the system.

He said that targets focused on processes, data returns and more Department of Health circulars would not achieve these aims.

“Over the last ten years emergency readmissions have increased by 50 percent. Not, it seems, primarily because patients were more frail, but because hospitals have been incentivised to cut lengths of stay and send patients home sooner – process targets creating risks for patients.

“So in addition to getting rid of these targets – we’re going to ensure that hospitals are responsible for patients not just during their treatment but also for the 30 days after they’ve been discharged. It will be in the interests of the hospital for patients to be discharged only when they are ready and safe.”

And if a patient is readmitted within that time the hospital will not receive any additional payment for the additional treatment – they will be focused on successful initial treatment, he said.

Nigel Edwards, policy director of the NHS Confederation, which represents most NHS trusts, said the proposal to withhold money for readmissions was a good idea.

“The principle of offering this, as long as we don’t have hospitals getting in the way of GP care, is a perfectly sensible one and certainly one we see in other countries.”

Dr Anna Dixon of the King’s Fund said readmissions can occur because of a lack of proper care provision in the community. And she warned that abolishing targets might lead to a rise in hospital waiting times.

The British Medical Association’s Dr Hamish Meldrum agreed saying: “This could result in patients being kept in hospital longer than necessary, when it might be better for them to be at home.

“We should remember that there can be a range of reasons that a patient is readmitted, many of them beyond the control of the hospital.”

Katherine Murphy, director of the Patients Association, said: “We have always campaigned for patient safety to be at the forefront of services and withholding payment to fix poor outcomes and giving patients more information to help them make informed decisions about their care are significant steps towards this.

“We welcome a much greater emphasis on the patient experience and a focus on patient needs and helping patients play a bigger role in shaping their health service.”

From : http://news.bbc.co.uk/1/hi/health/10262344.stm

New figures reveal the time spent by crews waiting outside hospitals for their patients to be admitted last year was the equivalent to funding 31 fully staffed ambulances to do nothing for 24 hours a day.

The statistics released by NHS ambulance trusts show the amount of time ambulances are forced to remain idle is increasing each year. In the first nine months of 2009 the total so-called “dead time” in England reached 284,000 hours — more than the whole of 2007.

The four hour target was introduced in 2004 in an effort to end the scandal of patients left on trolleys overnight waiting to be seen by doctors.

However, it has led to hard-pressed casualty departments refusing to admit patients until they can be sure they can be seen within the four hour limit. Waits of more than two hours occur in hundreds of cases each year.

Mike Penning, a shadow health minister, said: “It is a scandal that desperately needed frontline paramedics are trapped at hospitals around the country because of Labour’s fixation with the target culture.

“It can’t be right that bureaucracy has taken over from clinicians being able to put patients first, rather than watching the clock. Millions of pounds are being wasted and patients are suffering.”

The Conservatives have promised to slash the number of NHS targets and hand more power to doctors.

From: http://www.timesonline.co.uk/tol/news/politics/article7078867.ece

Jenny Whitehead, a breast cancer survivor, paid £250 for an appointment with the orthopaedic surgeon after being told she would have to wait five months to see him on the NHS. He told her he would add her to his NHS waiting list for surgery.

She was barred from the list, however, and sent back to her GP. She must now find at least £10,000 for private surgery, or wait until the autumn for the NHS operation to remove a cyst on her spine.

“When I paid £250 to see the specialist privately I had no idea I would be sacrificing my right to surgery on the NHS. I feel victimised,” she said.

The case will reopen the debate over NHS policy towards patients who pay for some of their care privately. Following a Sunday Times campaign in 2008, the government ordered the NHS to stop withdrawing care from patients who received additional private treatment or drugs.

Cancer sufferers were being barred from further NHS treatment after buying potentially life saving medicines not offered by the health service.

Whitehead’s case, which has shocked her local Labour MP, reveals that patients who go private in despair at long waiting lists still risk jeopardising their NHS treatment. Department of Health officials admit it remains official policy.

Whitehead, 64, a former museum assistant from Yorkshire who works as a volunteer at a hospice, went to her GP in December for back pain. Because of her breast cancer history, she was immediately offered an MRI scan to check the disease had not returned. It revealed a cyst on her spine, pressing against her sciatic nerve. Her GP referred her to a consultant at Airedale NHS hospital.

She was told the next available NHS appointment was in May, so she accepted the offer of a private slot to see him the following week.

“My husband and I are retired and don’t have a lot of money, but I am in intense pain and couldn’t face the thought of waiting months just for an initial consultation,” she said.

The specialist promised to add her to his NHS waiting list for surgery. After two months, however, hospital managers told her she had been barred from the waiting list because she had seen the surgeon privately.

Now her only alternative to paying £10,000 privately is to go back to her GP, seek another referral to the same specialist, this time on the NHS, and face another 18-week wait.

“We will scratch together the money if we absolutely have to, but I feel it’s incredibly unfair,” said Whitehead. “I’ve paid full National Insurance contributions all my working life and feel I should get this operation on the NHS.”

Ann Cryer, who is standing down as Labour MP for Keighley, has written to the hospital urging it to reconsider. She told Whitehead that she had been “badly let down and ill advised”.

Bradford and Airedale NHS trust said it was looking into the case “as a matter of urgency” but added: “Anyone who chooses to pay for a private outpatient consultation cannot receive NHS treatment unless they are then referred on to an NHS pathway by their consultant.”

From:http://www.timesonline.co.uk/tol/life_and_style/health/article7100968.ece

The College of Emergency Medicine says the target, at English hospitals, puts staff under “incredible pressure”.

It says it supports having a target in principle, but that doctors sometimes need time to make the right decision.

The government says safety and good quality care should always take priority over targets.

The NHS target in England to deal with patients in A&E within four hours has been highly controversial. Critics say it forces clinical staff to put deadlines before quality of care.

The chairman of the College of Emergency Medicine, Dr John Heyworth, says the target has helped to make emergency care a priority for the NHS. But he says staff are being forced to meet it at almost any cost.

“We’ve had nurses reduced to tears. We’ve had very senior consultants in emergency medicine threatened with a disciplinary process.
 
Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary
Department of Health spokeswoman

“This is an outrageous misuse of the standard.

“It’s not what the clinicians are in the emergency departments for. But it’s representative of the immense pressure being put on chief executives and all managers downwards from there to comply with the target.”

The four-hour target is just one of a range of centrally imposed standards, most of them designed to speed up treatment.

They have been used in other parts of the UK but have been much more heavily enforced in England.

Politicians now dislike the language of centrally-imposed targets in the NHS.

The Conservatives and Liberal Democrats say they will scrap them. Labour now prefers to talk about “standards”, “entitlements” and “guarantees”. The issue promises to be an important dividing line in the general election.

Professor Julian Le Grand, who was senior policy adviser to Tony Blair between 2003 and 2005, says many patients did benefit from targets – but he recalls that the then-PM was troubled by complaints from doctors about the targets regime.
 
“I remember sitting in a meeting once where the prime minister said ‘do we have to just keep beating up on the consultants – in A&E for instance – endlessly to achieve this? Or is there some way we can think of building in incentives within the system so that we’ll get these quality improvements on their own, without always having to crack the whip?’”

That led to a shift towards encouraging more patient choice and competition between hospitals, rather than relying on targets to improve standards.

The trust’s director, Dr Jennifer Dixon, says they are a potent way of achieving quick results.

“I think there’s widespread consensus that targets have resulted in immediate benefits, for example in reduction in waiting times.

“It’s highly unlikely that those other reforms could have had that impact so quickly and so precisely on the waiting times. So it’s really ministerial “diktat” almost that’s produced the goods.”

The Department of Health said that, in England at the beginning of 2003, almost a quarter of patients spent more than four hours in Accident and Emergency. It argued that since then there has been a “revolution in patient care”, reducing that figure to less than 2%.

A spokeswoman said: “The funding for hospitals has risen dramatically and targets are minimum standards which taxpayers have a right to expect from NHS hospitals.

“Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary.

“Despite his concerns over the four-hour standard, Dr John Heyworth from the College of Emergency Medicine said he had nothing against targets in principle. But he said he wanted a more sophisticated measure that accounts for quality of care, as well as speed.

From: http://news.bbc.co.uk/1/hi/health/8580761.stm