Their discovery that oxyntomodulin reduces appetite offers a potential new treatment for obesity.

Prof Bloom said he was delighted by his knighthood.

“This is a testament to the efforts of a great many colleagues with whom I have worked over the years. This is a unique period in the history of scientific research when we are at last able to work out the details of how the body functions and therefore contribute to the prevention of disease. I am proud that the units are helping patients. I get letters from them all the time.”

Professor Sir Keith O’Nions, rector of Imperial College London, said Prof Bloom’s research was “pioneering” and had changed the approach to treating obesity, for the benefit of everyone in society.

A large variety of vocations are also honoured in health and medicine.

They include MBEs for six GPs, five nurses, a physiotherapist, two pharmacists, a dentist and a volunteer ambulance driver.

John Wallwork, professor of cardiothoracic surgery and director of transplantation at Papworth Hospital in Cambridge, is the recipient of a CBE.

Julie Moore, chief executive of University Hospital Birmingham NHS Foundation Trust becomes a Dame. Her personal involvement in the development and staffing of the military managed ward concept at Selly Oak Hospital has been recognised.

Christine Mills, founder of Hope for Tomorrow charity, receives an MBE for launching the first UK mobile chemotherapy unit.

She founded the charity after her husband died from cancer of the spine and wanted to alleviate the suffering of people travelling long distances to and from hospital to receive chemotherapy treatment.

She raised enough money to build the world’s first mobile chemotherapy unit, which can treat 12 to 20 cancer patients a day on the road, complete with two dedicated nurses.

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 annual study carried out across England is a detailed survey of the “postcode lottery” in NHS treatment.

Ministers say the results will help identify “unjustified” disparities and drive up standards resulting in “consistently high quality care”.

The report shows a stark contrast in the rate of prescribing anti-dementia drugs.

Patients in north Lancashire are being described 25 times as many treatments and tablets to help “temporarily improve or stabilise symptoms” than in Kent.

The report suggests that one possible reason is the lack of awareness some GPs have about how to spot early symptoms of Alzheimer’s disease – a concern shared by campaigners for those living with the illness.

It also highlights worries that some breast cancer patients are staying in hospital too long in some parts of the country as compared with others.

The survey notes that most patients undergoing breast cancer surgery can be “safely managed as day cases or with a single overnight stay” but that currently more than 20 primary care trusts have average lengths of stay “in excess of three days”.

For example, the same surgery carried out in parts of south Wales resulted in patients staying in hospital for a few days where in Hertfordshire they stayed only one night.

Access to care homes – paid for by the NHS for those receiving end-of-life care or round-the-clock intensive care – also varied considerably.

In Devon and Cornwall, with its high elderly population, the admission rate for those aged over 74 to care homes funded by the NHS was just under three per 100,000 of the population. The figure in Northumberland was 190.

Meanwhile the rate of angioplasty operations – which tackle blocked and narrowed arteries – was three times higher in Peterborough than County Durham.

The report measures 71 key indicators, including hospital admission rates, what treatments health trusts choose to fund, and how children are managed in the NHS.

It attempts to map the “utilisation of healthcare services that cannot be explained by variation in patient illness or patient preferences”.

Health minister Lord Howe said: “The Atlas of Variation lets us look at how the local NHS is meeting the clinical needs of their local population.

“This will help commissioners to identify unjustified variations and drive up standards so patients are receiving consistently high quality care throughout the NHS.

“We are committed to improving results for patients and our new NHS Outcomes Framework will hold the NHS to account for this. Commissioners will be able to apply contractual penalties if any organisation is failing to deliver improvements for patients.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It finds people in Britain have among the fastest access to GPs, the best co-ordinated care, and suffer from the among the fewest medical errors, of 11 high income countries surveyed.

The countries examined were: the UK, France, Germany, Switzerland, Sweden, Norway, the Netherlands, the US, Canada, Australia and New Zealand.

Britain and Switzerland were consistently among the best performers, found the analysis of answers from over 18,000 adults with chronic and serious illness.

For example, the Washington DC based organisation reported: “UK and Swiss patients reported more positive health care experiences than sicker adults in the other countries: they were more likely to be able to get a same- or next-day appointment when sick and to have easy access to after-hours care, and they were less likely to experience poorly coordinated care.”

The success of the NHS stands out despite the fact that per capita health spending in the UK is the third lowest of the 11, at £2,170 per head, compared with £3,200 in Switzerland and £4,950 in the US.

The Commonwealth Fund is a private foundation which claims to support “independent research on health policy reform”.

However, it is widely seen in the US as being strongly in favour of President Obama’s health reforms.

Today’s report is highly critical of current US healthcare. Karen Davis, its president, says the country “practically stands alone when it comes to people with illness or chronic conditions having difficulty affording health care and paying medical bills”.

A spokesman for the Royal College of General Practitioners said the survey “shows yet again that the excellent work carried out by GPs in the UK is recognised worldwide, leading the field in ease of access, coordinated care and good patient doctor relationships”.

He added: “If the current reform of the NHS is to achieve anything, it must preserve and build on the strengths of general practice by producing more GPs, who are trained for longer so that they can do even more to improve the health of their patients.

“The NHS stands out internationally as an example of excellence, and general practice is what makes the NHS safe, fair and value for money.”

It is feared by opponents that the wording of the legislation will remove the Secretary of State’s duty to provide healthcare for all, while plans to widen competition will see the back-door privatisation of the NHS.

But following two days of debate by 100 members of the upper house, and pressure applied by ministers and whips to Tories and Lib Dems, attempts to delay or thrown out the Bill were defeated comfortably in the biggest turnouts seen in the Lords for more than a decade.

A motion by Lord Owen, a former health minister and SDP leader, to let a special committee spend until Christmas studying the constitutional impact of the reforms was rejected by a margin of 330 to 262.

Labour’s Lord Rea had wanted the second reading to be refused altogether but this proposal was lost by 354 votes to 220.

Baroness Williams of Crosby, the Lib Dem grandee who had been among the first to raise fears over the Bill, abstained on the critical Lord Owen vote and went with the Government on the Lord Rea motion.

The results means the Bill, which seeks to remove two tiers of NHS management and give more power to GPs and patients, will now be considered line-by-line in committee stage in the Lords and remains on track to receive Royal Assent by next summer.

It has already survived a rebellion by Lib Dem activists in the spring and an unprecedented “pause” in the parliamentary proceedings for doctors’ concerns to be heard, which led to competition plans being watered down.

But even the Government accepts that more changes will be made to contentious areas.

A Department of Health spokesman said: “The vote today moves us one step closer to delivering a world-class health service that puts patients at its heart and hands more power to health professionals. We now look forward to working with the Lords to scrutinise the Bill during Committee Stage to improve our plans further.”

Labour said it would continue to call for “drastic changes”.

The plans had been criticised in the debate by well-known figures including Lord Winston, the fertility pioneer, who described the Bill as “unnecessary and, I’m afraid to say, irresponsible”.

After the vote Dr Hamish Meldrum, Chairman of BMA Council, said: “It remains the BMA position that the Health and Social Care Bill should be withdrawn, or if not that it should be substantially amended, and we will continue to raise our concerns at every available opportunity as the Bill progresses through the House of Lords.

“The BMA continues to have many areas of concern, including the need for assurance that increasing patients’ choice of provider for specific elements of their care won’t be given priority over the development of integrated services and fair access.

“We also need to see an explicit provision that the Secretary of State will retain ultimate responsibility for the provision of comprehensive health services.”

From: http://www.telegraph.co.uk/NHS-reform-Bill-survives-fatal-Lords-vote

Embassies and foreign governments have run up debts of nearly £6 million at two London hospitals after failing to pay for non-emergency treatment, according to figures released under the Freedom of Information Act.

More than £4 million is owed to Great Ormond Street children’s hospital by Middle Eastern governments that arrange for children to have treatments not available in their own countries.

While much of the debt is still being chased, more than half has been abandoned or written off.

Free NHS hospital treatment is available to British residents. Overseas patients are charged for the full cost of any treatment they receive unless a specific exemption applies.

Urgent treatment is always available to overseas visitors, regardless of their residence status or ability to pay, but non-urgent treatment should not go ahead without the NHS first receiving payment.

In 2009, West Middlesex University Hospital, in west London, became the first to tell foreign patients they must pay in advance.

The figures reveal that hospitals threatened with closures over mounting debts have written off some of the highest amounts. Imperial College trust, which is £100 million in debt and in the process of making major cuts, is owed £2.5 million and has written off a further £2 million.

The trust for Chase Farm hospital, in north London, which received a bail-out from the Challenged Trust Board and is being forced to close its A&E department, has a foreign debt of £2.5 million.

The Government recently introduced a policy to deny new visas to tourists with outstanding NHS payments.

The burden on the taxpayer is expected to increase next year with one million extra visitors and foreign dignitaries attending the Olympics in London.

Separate figures show that European governments owe £38.5 million to Britain under the system that allows visitors free emergency treatment on the NHS.

Statistics released in a Parliamentary written question show that almost half of the total owed in the European Health Insurance Card scheme, £17.2 million, is due from Ireland.

Katherine Murphy, chief executive of the Patients Association, said: “At a time when the NHS needs to make £20 billion of savings by 2014, why are managers at hospitals not desperately chasing these unpaid bills? Why are we writing off this money and throwing it down the drain when it could be used to fund front line services and help patients?”

Simon Burns, a health minister, said: “Hospitals must take every reasonable measure to recover any debts from overseas patients. The NHS has a duty to anyone whose life or long-term health is at immediate risk, but we cannot afford to become an international health service, providing free treatment for all.”

From: http://www.telegraph.co.uk/Overseas-patients-owe-health-service-60m

But an EU red tape Directive prevents any systematic testing of language skills of doctors from the European Economic Area (EEA).

The GMC says UK legislation – the Medical Act 1983 – ‘gold plates’ the directive and prevents the GMC from doing any language-testing of doctors from the EEA at all.

Employers are allowed to assess the language skills of applicants from the EEA, but it is thought many do not.

A spokesperson from the GMC said: “Doctors who come to work in the UK make a vital contribution to our healthcare system, but we must make sure they receive the support they need to practise safely and to conform to UK standards.”

“It is unacceptable that the current system enables doctors to practise in the UK without a sufficient grasp of English.”

The GMC says some overseas doctors come to the NHS with “little or no preparation” for working in the UK and those trained under different cultural and professional standards need more support.

The GMC is planning a basic induction programme for all doctors – including those who qualify in the UK – to help understand how healthcare is practised in the UK.

A spokesperson from the Department of Health said: “This government is determined to make sure that foreign healthcare professionals are not allowed to work in the NHS unless they have proven their competence and language skills.”

“We do think the Directive needs updating and we are in the process of responding to the EU proposals, but we can’t pre-empt that response.

“We have already taken steps to strengthen the current system by introducing a duty for responsible officers to check the qualifications, experience and references of all doctors, including foreign doctors.”

But poor English language standards are not just an issue among some European NHS staff, for whom English is not their first language.

Asian nurses said they found it difficult to understand European colleagues – particularly those from Eastern Europe.

But when one was asked what a patient meant if they said they wanted to ‘spend a penny’ – slang for go to the lavatory – she replied “they want to spend money”.

A spokesperson from Imperial College Healthcare NHS Trust, said: “We take patient experience and patient complaints very seriously.”

“We care for a diverse patient population and employ a diverse workforce, and understand the importance of staff being able to talk to patients and their families in an appropriate way.”

From: http://www.bbc.co.uk/news/health-14921565

Health bodies spent £289m on redundancy payments but the number of staff employed in hospitals actually rose by almost 8,000.

Dozens were found at fault with the “value for money” they offer and a fifth of all NHS bodies failed to meet their savings targets despite cutting back on staff and the number of patients they treat.

The Audit Commission, the public spending watchdog that is being scrapped, warned that health service providers face even tougher times ahead as savings become harder to find and Government spending increases dry up.

Andy McKeon, managing director for health at the Audit Commission, said: “It is impressive that the NHS overall performed so well financially last year, even if some organisations struggled.

“But there is no room for complacency. Tighter funding, and the need to continue to improve services and implement reforms, will make the next three years much tougher.  NHS organisations will need to make a determined effort to find further recurrent savings while continuing to deliver high quality services.”

The watchdog looked at the 2010-11 accounts for Primary Care Trusts, which pay for treatment; hospitals not including the semi-independent Foundation Trusts; and the regional Strategic Health Authorities.

It found that they were running a £1.5 billion surplus and had actually underspent by £272 millon on the £2.95 billion in capital expenditure they were given by the Department of Health, twice as much as recorded the previous year.

But seven hospitals and two PCTs failed to break even, one fewer than in 2009-10, with the biggest deficit of £41m recorded by South London Healthcare NHS Trust.

At least 16 NHS organisations needed additional financial support from PCTs which is never paid back “thereby obscuring their real financial health”.

Managers gave out £90 million to hospitals, while the Department of Health issued loans totalling £34 million to four hospitals and also gave £76 million to two trusts which did not even have enough money to pay back loans.

Ministers want to cut management costs by 45 per cent at SHAs and PCTs, which are being restructured, and they did let 5,713 people go with average pay-offs of £40,000 each.

But the headcount at hospitals actually rose by 7,616 and only fell by 27 in the 10 SHAs.

The Audit Commission did not find any NHS body’s accounts were not “true and fair”, but it did issue “qualified Value For Money conclusions” for 27 hospitals and 18 PCTs, suggesting they had problems with “financial resilience” or “economy, efficiency and effectiveness”.

The Audit Commission warns next year will be “a more financially challenging year” as there will be no “significant real-terms increase” in the central budget, so trusts will require “determined effort and strong leadership”.

From:  http://www.telegraph.co.uk/NHS-hospitals-needed-200m-in-bailouts-and-loans

He suggested the problems lie in the training nurses receive as well as the way they work on hospital wards, and plans to lead a new campaign to improve standards.

His comments come in the wake of a series of scandals at NHS hospitals in which vulnerable patients have been neglected with sometimes fatal consequences.

At Stafford Hospital, which Sir Stephen arrived at in 2009 to help turn around its fortunes, as many as 1,200 patients are feared to have died unnecessarily over three years as managers became preoccupied with cost-cutting.

A recent report by the Health Service Ombudsman condemned the NHS for failing to meet “even the most basic standards of care” for pensioners, while spot inspections by the Care Quality Commission have uncovered geriatric wards where doctors are prescribing water to elderly patients to stop them becoming dehydrated.

Unions and professional bodies have suggested that the problems are down to staff being over-worked or forced to focus on Government targets rather than providing personal care.

But other commentators have claimed that too much care is now provided by cheap healthcare assistants, who do not need to meet national training standards and who are not regulated by a professional body; or that nurses think they are “above” feeding and cleaning patients now that they have to be university-educated.

In an interview with a local newspaper, Sir Stephen said: “Not everything in nursing is bad, but after the events at Stafford Hospital, the recent concerns at New Cross Hospital [in Wolverhampton, where high death rates are being investigated] and others around the country you can’t tell me there isn’t an issue here that needs addressing and we have to do something about it.

“There is something fundamentally wrong with the nursing profession and the way it is focused at the moment.  We are getting a lot right but we are also letting down too many patients and families. We can’t just stand by and not do something.”

Sir Stephen is drawing together a group of seven “big hitters” in the health service to suggest ways that hospital care can be improved.

Their plans, to be disclosed in September, will focus on how nurses can be trained for “the real world of the NHS rather than the classroom”.

From: http://www.telegraph.co.uk/NHS-boss-something-fundamentally-wrong-with-nursing

The health secretary pushed ahead with HealthWatch, the new body to champion patients’ views, despite ministers being forced to apologise and withdraw a consultation on the new watchdog. Ministers had conceded that their original plans had been conceived in haste and without proper consultation.

But Lansley announced that 75 local HealthWatch groups were in place. HealthWatch is supposed to replace local patient involvement networks, known as LINks, in 2012 – bringing “real local democratic accountability and legitimacy” to the NHS “for the first time in 40 years”.

Malcolm Alexander, chair of the National Association of Local Involvement Networks Members, said that, instead of increasing budgets to fund the new bodies, cash was being cut even though the government was asking local groups to take on a range of new responsibilities, such as promoting the integration of care and health services and improving choice for patients, without extra money.

Alexander said: “It’s pathetic. The consultation had a figure of £20,000, which was confusing and looked like a cut. Then that was withdrawn. Our figures show that networks are having their budgets cut this year by 24% on average.”

He said there was no start-up funding for local HealthWatch “pathfinder” groups and no ringfenced money in local authority budgets to run the new bodies.

The money for HealthWatch comes out of local council budgets, which are being cut by 30% over the next four years. “Our own research asked whether these new policies were evolution or abolition. It looks like abolition to us,” he said.

Sally Brearley, senior research fellow in patient and public involvement at King’s College London, who sat on the prime minister’s Future Forum which re-examined the health reforms, said she “shared the concerns”.

“There’s a lot of extra work to develop these new HealthWatch bodies and they are supposed to be monitoring the NHS as services are being cut and finances are under strain. It’s a real issue.”

A Department of Health spokesperson said the criticism was misleading.

“The government has not cut funding, and has no plans to do so – in fact, we retained the current level of funding at £27m, rising in line with inflation, for the spending review period.”

From: http://www.guardian.co.uk/andrew-lansley-condemned-healthwatch

Examples of the rationing now being used include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

High-speed broadband – essential to internet video calling – could allow people to consult international experts or to take advantage of out-of-hours care provided by overseas doctors in another time zone, he said.

Such technology would lessen the need for a “geographical connection” between GPs and their patients, while it would also enable doctors to conduct what he called “virtual ward rounds”.

Sir Bruce, who as a cardiac surgeon persuaded his colleagues to make their success rates public, was speaking at the Government’s launch of its plans to make all state data available online.

He said the NHS had to adapt because “young people won’t put up with having to travel to a doctor and wait 20 minutes when they can just use the web to talk directly to a doctor”.

Patients for whom such “telehealth” services might be useful included those who needed to see a specialist about a chronic condition such as diabetes, or those with visible conditions like skin complaints.

Some doctors are already trialling services online, but in rural areaswhere the benefits would be most apparent, poor broadband infrastructure is holding back progress.

Sir Bruce acknowledged that the NHS had yet to lay out a “national vision” for digital access, but he said that it would happen in the future.

As well as being better for patients, he argued that in the long term it would be cheaper and more efficient for the NHS.

In Northern Ireland, he said, a group of neurologists had found using new technology was “cheaper and the patients like it more”.

However, he also acknowledged that his plans would “open up a whole heap of financial issues”.

High-speed broadband connections are already being used to monitor older people who are able to stay in their own homes with remote supervision.

The new telehealth technologies are one reason why the Government has allocated £530 million to spend on improving broadband in the UK by 2015.

Frances Maude, Cabinet Office Minister, said that plans to release data about all NHS performance, including GPs as well as surgery, would allow patients to be more selective about their treatment.

The British Medical Association is leading a project to present data on GP performance.

The Government is set to announce how superfast broadband networks, essential for high-quality video consultations, will be funded next week. Each county is set to be allocated an amount of money based on the geographical challenges it faces.

http://www.telegraph.co.uk/Doctors-to-see-patients-by-video-link.html

But it says plans to reward groups which treat addicts so they can return to work are open to manipulation.

The Department of Health said it aimed to get users “off drugs for good”.

The coalition government wants to change the way drug addiction is tackled, with more people with problems diverted away from prison and into treatment as part of what it calls a “rehabilitation revolution”.

Part of this involves rewarding treatment providers who show addicts have improved their health and employment prospects.

A report from the right-of-centre think tank, which has links to the Conservative Party, says these payment by results schemes were being run by the very organisations “responsible for the current failure of policy”.

It says the current annual cost of maintaining treatment for 320,000 problem drug users is made up of £1.7bn in benefits, £1.2bn for looking after their children and £730m for prescribing the heroin substitute methadone.

Kathy Gyngell, Centre of Policy Studies: “The Department of Health has been paying 153,000 people to be on methadone”

The think tank calls for “a real transfer of power from large distant organisations to small innovative providers” for rehabilitation.

It says such units have a better chance of getting addicts off drugs completely, adding: “There is one simple measure of success: That of six months abstinence from drugs.”

According to the report’s author Kathy Gyngell, chairwoman of the prisons and addictions policy forum at the CPS, prescribing methadone to addicts delays their recovery.

She told the BBC: “The state is subsidising people to be any number of years on methadone, which has turned out not to be a cheap option and will only subsidise the tiniest proportion – 2% – to go into a rehabilitation unit that would actually free them from dependency and allow them to live their life.”

A Department of Health spokesman said: “The 2010 Drug Strategy is fundamentally different from those that have gone before.

“Instead of focusing primarily on reducing the harms caused by drug misuse, our approach will be to go much further and offer every support for people to choose recovery as an achievable way out of dependence.”

He added: “Work is under way to support local recovery systems tailored to the needs of communities, many of which are already showing positive results.”

From: http://www.bbc.co.uk/news/uk-13826759

Health Direct has for a long time noted the costly failure that is the current policy on drugs. On August 02, 2006 in Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

we reproduced the first ranking based upon scientific evidence of harm to both individuals and society.

It was devised by government advisers – then ignored by ministers because of its controversial findings.

The analysis was carried out by David Nutt, the then senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council.
http://www.healthdirect.co.uk/2006/08/risks-of-taking-drugs-compared.html

Doctors’ groups have broadly welcomed the revisions.

The NHS bill will now go back to the committee stage in the House of Commons to be scrutinised again by MPs before going through its House of Lords stages.

The prime minister’s official spokesman said he expected that to happen before the summer recess begins in July, and the bill to be on the statute book by the end of the current Parliamentary session.

That gives ministers until May 2012 to make it law.

On Monday – following a 10-week “listening exercise” – a panel of experts called the NHS Future Forum gave its recommendations on the changes needed to the bill.

They include:

• Reinstating the legal responsibility of the health secretary for the overall performance of the NHS
• Scrapping the primary role of the regulator, Monitor, to promote competition – and focusing on improving patient choice instead
• Relaxing the 2013 deadline for new GP commissioning arrangements to be introduced – a National Commissioning Board, based in Leeds, will control budgets until GP groups are “able and willing” to take over
• Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them
• Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them

After criticism from medics and complaints from rebellious MPs, the Coalition will be hoping the dust will now settle over its NHS reforms.

If politics is the art of persuasion, then the test for Messrs Cameron, Clegg and Lansley is whether or not they have convinced people that the listening process has been, as the prime minister claimed, a sign of strength.

The government and many health professionals believe changes to the NHS are necessary to deal with the demands of the ageing population, cost of new drugs and lifestyle changes such as obesity.

Mr Cameron said those who described the reworking of the plans as “a humiliating U-turn”, or the listening exercise as “a big PR stunt”, were both wrong.

“The fundamentals of our plans – more control to patients, more power to doctors and nurses, less bureaucracy in the NHS – they are as strong today as they’ve ever been,” the PM said.

The health secretary has faced personal criticism for his inability to garner widespread support for the original bill, but the prime minister said he accepted full responsibility for what had happened.

“I am every bit as responsible as Andrew Lansley for the fact that we actually decided we could improve on what we already put forward,” Mr Cameron said.

The British Medical Association said it was pleased the government had accepted the Future Forum’s recommendations and addressed many of doctors’ concerns.

But it said more detail was needed on how commissioning of care would work in future and there must be “robust safeguards” to prevent competition of any kind destabilising the health service.

From: http://www.bbc.co.uk/news/uk-politics-13757380

Dr Michael Dixon, chairman of the NHS Alliance, defended the changes by saying that neither medics nor the public wanted to be “pawns in the system” any more.

But he was warned that the power GPs appear to have been given to buy treatment is just an “illusion” and that they will end up merely rationing care in order to save money.

It comes after the Health Secretary, Mr Lansley, wrote in The Daily Telegraph that the NHS faces a £20 billion a year funding black hole unless it undergoes major surgery.

His Health and Social Care Bill proposes abolishing two tiers of management and allowing new GP-led bodies, called commissioning consortia, to buy £60billion a year of treatment from either state-run hospitals or private providers.

It has been bitterly opposed by much of the medical establishment on the grounds it may fragment services and lead to backdoor privatisation, and the legislation was put on “pause” by David Cameron after Liberal Democrats and peers threatened a rebellion.

But BBC Radio 4’s Today programme heard on Thursday that many of the changes are already happening on the ground, as clusters of GPs form consortia to take over from Primary Care Trusts.

Dr Dixon of the NHS Alliance said: “The evidence is in our report, showing over 20 commissioning groups already delivering better services for their patients and also delivering them more cost effectively.

“For instance, in this country the use of hospitals is disproportionately more than anywhere else in the world and those commissioning groups are showing how they can look after patients better in the community.

“If the commissioner is king, they can get the right balance of private and public and the right balance of competition and collaboration.”

Asked why more GPs were not in favour of the new regime, he replied: “To look after our whole patient population is quite an added responsibility and I think some people find that quite daunting.”

But he went on: “Many of us in this commissioning movement are fed up with being pawns in the system and fed up with our patients being pawns in the system.

“We feel that if we can make sure the NHS is delivering change and improvement from the bottom up instead of having to listen to targets coming down from Whitehall, that often don’t mean much to us, we can actually make a difference.”

From: http://www.telegraph.co.uk/GP-group-says-Andrew-Lansleys-NHS-reforms-are-already-working

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

That includes liver disease and mental disorders due to alcohol abuse as well as some cancers, accidents and injuries.

The Department of Health will publish a new alcohol strategy later this year.

The number of admissions reached 1,057,000 in 2009-10 compared with 945,500 in 2008-09 and 510,800 in 2002-03.

Earlier this year the charity Alcohol Concern predicted the number of admissions would reach 1.5m a year by 2015. It estimated that would cost the NHS £3.7bn a year.

Tim Straughan, chief executive of the NHS Information Centre, said: “Today’s report shows the number of people admitted to hospital each year for alcohol related problems has topped 1m for the first time.

“The report also highlights the increasing cost of alcohol dependency to the NHS as the number of prescription items dispensed continues to rise.

“This report provides health professionals and policy makers with a useful picture of the health issues relating to alcohol use and misuse. It also highlights the importance of policy makers and health professionals in recognising and tackling alcohol misuse which in turn could lead to savings for the NHS.”

Professor Sir Ian Gilmore, the chair of the UK Alcohol Health Alliance, said: “This confirms doctors’ impressions that the health harm from alcohol continues to rise.”

“While total alcohol consumption has fallen in recent years it is likely that the number of abstainers in England is increasing, but those who do drink continue to do so in a harmful and destructive way.”

The body which represents drinks manufacturers in the UK, the Portman Group, expressed surprise that admissions had increased at the same time as alcohol consumption had decreased.

David Poley, chief executive of the Portman Group, said: “If the hospital admissions data are robust, they clearly put paid to the argument that measures to reduce overall alcohol consumption are effective in reducing harm.

“The report shows that the proportion of people misusing alcohol is falling. We just need to find a way of persuading and educating this hard core of misusers who account for these admissions to drink responsibly.”

Alcohol Concern said the latest set of figures were alarming but that early detection of alcoholism contributed to the increase.

Its director of policy and communications, Nicolay Sorensen, said: “More people than ever before are drinking in a way that is harming their health and it’s a serious public health problem. It’s one of the biggest public health problems facing the country.

“In addition, the NHS has been doing some great work to identify people that have alcohol problems and so some of the increase is due to better identification and better referral.”

Public Health Minister Anne Milton said: “These statistics show that the old ways of tackling public health problems have not always yielded the necessary improvements.

“We are already taking action to tackle problem drinking, including plans to stop supermarkets selling below cost alcohol and working to introduce a tougher licensing regime.

“We will also be publishing a new alcohol strategy later this year.”

Rates of alcohol-related hospital admissions came down in the past two years in Scotland, after increasing for a decade. In Wales, figures for up to 2006 showed increasing admission rates and in Northern Ireland the total number of admissions increased year on year since 2006/07.

From: http://www.bbc.co.uk/news/health-13559455

The mounting costs will leave working adults facing a triple blow of higher taxes, longer working lives and less inherited wealth as their parents are forced to sell property to pay for care, the study said.

The Organisation for Economic Cooperation and Development (OECD), which conducted the research, warned that workers may be unable or unwilling to take time off to look after elderly relatives or pay more tax to support rising numbers of older people in future.

In order to preserve goodwill, the elderly will have to stay in work for longer and save more towards their own private pensions so that they are seen to be fending for themselves, the study said.

In an interview with The Daily Telegraph, the OECD’s leading pensions analyst warned that Britain’s ageing population, combined with already high rates of family breakdown, meant relations between the old and the young are under threat.

Edward Whitehouse, the organisation’s head of pensions policy analysis, said the UK was projected to have “among the highest long-term care expenditures by 2050” of any of the 28 countries examined.

“I don’t think that future governments will be able to afford that, which brings us on to how we are going to pay for that system,” he said. “The money has got to be found from somewhere. It is going to have to be higher taxes or cuts in public spending on other programmes.”

The research suggested that by 2050, the UK will be forced to spend 21.6% of GDP on long-term care, pensions and health services to cope with the rise in elderly people requiring state assistance.

This is an increase from 16.5% of GDP spent in 2010, and equates to a rise of about £80 billion in today’s terms.

According to government projections, 11 million Britons will live to the age of 100. Economists have estimated that the international cost of ageing populations will be 10 times that resulting from the financial crisis.

Last week, the pensions minister, Steve Webb, warned that the UK must radically re-think the idea of retirement as life expectancy continues to lengthen.

Plans are in place to raise the state pension age to 66 and the default retirement age of 65 has already been abolished.

Last night, David Willetts, the universities minister, backed the OECD for setting out the “inevitable” burden Britain faces “as the baby boomers age”.

The OECD analysis, which will be presented in Paris this week, suggested that to pay for the care and pensions that an ageing population will need, adults will be forced to spend much longer working and taxes may have to rise.

According to the OECD’s figures, Britain’s projected bill for long-term care and support services – such as home help, adaptations to property, and residential accommodation – will almost double from 2.2% of GDP to 4.3% by 2050.

Of the 28 OECD countries included in the research, only Malta and Spain will be spending a higher proportion of national income on long-term care.

But the research on “intergenerational solidarity” warned that the rising bill for elderly care could “undermine the nexus of family relations between generations”.

The OECD report said: “Future generations may be less willing and able to pay continually rising taxes to support a growing share of economically inactive people.”

Countries where large numbers of older people rely on state pensions and care are more likely to regard the elderly as “a burden” on society, the research suggested.

In addition, the UK is particularly at risk as a result of high rates of family breakdown, with more than 12% of British children living in step families, compared with an OECD average of 8%, and more single parents.

Mr Whitehouse said smaller and more complex families meant there would be fewer people to provide “informal care” to frail relatives in future.

One key solution would be for older people to remain in work for longer and build up their own private pensions, he said.

“When people see that older people are doing things to help themselves they have a more positive attitude towards them than in countries where they are very reliant on the state and where people are retiring early,” he said.

The research also suggested, however, that many older people provide childcare for their grandchildren and give more of their time and money to younger people than they receive directly in return.

Those most likely to regard older people as “a burden” were the elderly themselves.

Mr Willetts, whose has written a book on the subject, The Pinch, will detail the government’s plans to ensure fairness between generations in a speech at the Social Market Foundation think tank.

He told The Telegraph that the OECD had set out some of the increased burdens are “inevitable” as the post-war “baby boom” generation ages.

“Any healthy society has an obligation to its older members as well as its younger members but we have got to be more flexible,” he said. “That’s why we are moving to raise the pension age.

“The contract between generations is in everyone’s interest. We have got an obligation to our kids to give them a good education and help them get a start on the housing ladder and build up pension savings. That increases the chance that they will then sustain us when baby boomers need domiciliary care and nursing care.

“There is an American bumper sticker which says, ‘Be nice to your kids, they choose your nursing home.’”

Stephen Burke, director of United for All Ages, a social enterprise working with councils and charities, said the growing bill for elderly care was “already causing tensions between generations”.

“The cuts in public spending are pitting the needs of older and disabled people against children, young people and families,” he said. “Using older people’s wealth, for example through a care duty on estates, would be a fairer way of paying for better care for our ageing population.”

From: http://www.telegraph.co.uk/OECD-huge-elderly-care-bill-threatens-family-ties

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This was because the formation of Health and Wellbeing Boards on local councils would “coordinate all aspects of care … into a coherent and seamless whole”.

For decades elderly people had been shunted into hospital when they did not really need to be there because growing demand for social care, such as home care assistants, had been neglected.

She thought the Bill offered a vital opportunity to change the situation.

“We will have to address this and integrate, so let’s get on with it,” she said. “None of this is going to be easy, but so far we have not had any serious attempts to solve it. After pensions, it’s the next crisis coming down the tracks.”

“I’m hoping that this Government is really serious about getting it right, rather than doing the spin. I’m reasonably optimistic.”

She hoped reforms would lead to GPs being able to prescribe “domiciliary care” for elderly people while they could not cope at home, for example after a minor fall, “just as they prescribe drugs now”.

Such a move would stop large numbers being admitted to hospital and becoming “bed blockers”.

Ms Mitchell said: “At the moment, silo thinking means that health and social needs are not considered as a whole and there is little or no joint planning between the respective services.

“If the Government is concerned about how best to meet the needs of older people with complex needs, joining up services is a must.”

Ruth Isden, the charity’s public services programmes manager, said improving “poor coordination” could deliver “huge benefits” for patients and large efficiency savings.

But she warned that the Health and Wellbeing Boards, as currently envisaged, “do not have a strong enough role”.

Local public health and social care directors will sit on them with GPs to formulate strategy. She said the boards needed to be given “teeth” to ensure the GP consortia followed through.

Meanwhile, Ed Miliband, the Labour leader, admitted that sticking with the status quo on the NHS was not an option.

From: http://www.telegraph.co.uk/NHS-will-collapse-without-reform-warns-Saga

The Department of Health has told NHS trusts that executive salaries should rise by no more than 1.5 per cent a year, but IDS estimated that average executive pay rose by 4.5 per cent in 2009-10.

Based on salaries disclosed in annual reports, the median salary of an NHS trust chief executive in England was £158,800 last year.

Steve Tatton, of IDS, said: “With salary rises running at these levels, such restraint so far does not seem to have been a feature of boardroom pay deliberations.”

The research also found that NHS trusts that were free of central control tended to pay their bosses more. The median earnings of chief executives in foundation trusts was £164,500, compared with £152,500 for non-foundation trusts.

Mr Tatton said those findings posed a dilemma for ministers. “The Government wants to bear down on senior executive pay in the public sector, yet it also wants to see decisions made locally without interference from central authorities.

“The issue for NHS organisations is will they be free to pay their senior executives what they decide is necessary or will they have to follow externally imposed pay restraints?,” he added.

Some health executives are paid much more than the median, with at least 46 receiving pay and benefits packages worth more than £200,000. The best-paid executive identified was Ron Kerr, the head of Guys and St Thomas’ foundation trust in London, who had a total remuneration package worth £274,000.

Several of the best paid executives lead trusts that have announced job losses.

University College London trust, whose chief executive Sir Robert Naylor was paid £262,500, is cutting more than 300 posts, and Barts and London, where Peter Morris received £262,000, is cutting 635.

IDS also found increasing “instability” on NHS trusts’ management boards, with almost a quarter of senior jobs changing hands every year.

Boardroom turnover for non-foundation NHS trusts was 24 per cent in the year to March, up from 17 per cent the previous year. In foundation trusts, it rose from 14 per cent to 21 per cent.

From: http://www.telegraph.co.uk/NHS-pay-bosses-ignore-calls-to-curb-pay-rises

They argue: “The reforms have received a very bad press lately but much of the criticism has been noticeably misinformed.”

The doctors are all heads of recently-formed GPs’ consortia – groups of practices that have joined together to take over responsibility for almost four-fifths of the NHS’s £100 billion budget from 2013.

They write that they “wholeheartedly support” moves to scrap primary care trusts and strategic health authorities, which currently decide how that money is spent.

“The reforms are not revolutionary but an evolution,” they say.

Putting GPs in charge will make the health service more effective and accountable at a time of “considerable financial constraints”, they add.

The letter is a welcome boost for Mr Lansley after Nick Clegg, the Deputy Prime Minister, described the reforms as a “disruptive revolution”.

It also marks the first time that a significant group of doctors has pledged such apparently unequivocal support for the Bill, which has attracted fierce criticism from health professionals over several months.

The attacks led Mr Lansley to tell MPs last month that there would be a “pause” in the Bill to listen to critics and, if necessary, make changes.

Some Liberal Democrats want the Bill killed, fearing that moves to make it easier for private companies to become NHS suppliers amount to privatisation by the back door.

Earlier this week, the Royal College of General Practitioners wrote to the Prime Minister warning that the bill could damage the NHS irreparably.

In today’s letter, GPs say that ditching the reforms would be a mistake.

The signatories, led by Dr Jonathan Munday, chairman of the Victoria Commissioning Consortium in London, write: “Our patients should feel comfortable that decisions about the local provision of health care are to be taken in future by their family doctors, many of whom they know personally. We caution the Coalition of the danger of confusing and diluting the responsibility for effecting change in any amendments to the current proposals.”

They add: “Now that there are considerable financial constraints nationally, difficult decisions will have to be made on the provision of care. Surely it is better that these decisions are taken locally by professionals in daily contact with the patients who will be affected by them, rather than by remote administrators.

“On average, our patients see their GP four times a year, and if they are dissatisfied with the services … will have no difficulty in saying so. When was the last time any patient managed an audience with a PCT chairman?”

They also claim that the advantages of plans to coordinate health and social care into “a seamless whole” have been overlooked.

“If successful, there will be enormous benefits to the most elderly, infirm and vulnerable people in our community, whose care is often currently too fragmented,” they say.

The letter neglects to mention concerns about privatisation, however.

Responding to the letter last night, Mr Lansley said: “I welcome the appetite shown by doctors to lead improvements in the NHS and deliver benefits for patients.”

Stephen Dorrell, the Tory chairman of the Commons health select committee, added: “The reforms are an evolution of the policies pursued by both Labour and Conservative governments since 1990.

“No change is not an option. We need to move on to discuss this process of change to ensure that the health service continues to meet the needs of patients in the years ahead.”

From: http://www.telegraph.co.uk/Health-reforms-will-benefit-most-vulnerable-in-society

The findings in Heart journal come from a study of over 800 patients in Spain.

Experts say the body’s natural sleep-awake cycle could explain the differences seen, but advise more research to confirm the findings.

It is well established that a person’s 24-hour body clock can influence heart attack risk.

For example, doctors know that people are more likely to have a heart attack around the time when they are waking up from sleep than at other times, but what is less known is the extent of damage that this leads to.

To investigate, Dr Borja Ibanez and colleagues analysed data on 811 patients at their hospital who had suffered a type of heart attack known as an ST elevation myocardial infarction, which occurs when there is a prolonged period of blocked blood supply to the heart muscle.

The researchers split the patients into four groups based on what time segment of the 24-hour clock the heart attack occurred.

They found that one group in particular – the 0600 to midday or “morning” heart attack group – had the most severe heart attacks.

This morning group had much higher levels of an enzyme in their blood that is a marker of dying heart tissue than patients whose heart attack had occurred in the evening (between 6pm and midnight).

Judging by the blood enzyme levels, the researchers estimate that the area of the heart damaged in the morning group was, on average, a fifth larger in comparison.

Judy O’Sullivan, senior cardiac nurse at the British Heart Foundation, said: “This study provides some interesting observations on the association between the time of day a heart attack occurs and the degree of subsequent damage to the heart muscle.

“However further research is needed before we can draw firm conclusions.

“Regardless of the time of day, the quicker someone having a heart attack is treated, the less the damage they will have, which is why it is essential that anyone who experiences heart attack symptoms should call 999 immediately.”

From: http://www.bbc.co.uk/news/health-13195209

Other councils are planning to shut centres altogether or dramatically tighten up the eligibility for places over coming years.

The disclosure will fuel warnings over a crisis in care for the elderly.

It follows warnings last year that growing numbers of pensioners are being forced to sell their homes to cover expensive care home fees amid spiralling costs.

Emily Thornberry, the shadow care services minister, who obtained the latest figures, said the Government was failing to protect social care. Miss Thornberry’s office surveyed 50 councils providing care services.

Almost all said they were being forced to make sweeping changes to residential accommodation because of a combination of cuts and increasing pressure on services.

Some 88 per cent confirmed plans to increase care charges. A quarter of these were pegging increases to inflation, but others were introducing new and additional charges, raising or abolishing the maximum contribution from users or making other increases.

Almost two-thirds of councils said they were being forced to close care homes or day centres to save money.

Many confirmed plans to close homes in the next two years, while others said money was being saved by putting more emphasis on providing services in residents’ own homes.

A previous survey carried out by the Care and Support Alliance, whose members including more than 40 leading charities, has found that 23 per cent of disabled and older people have already seen their services cut.

Many said they can no longer afford essentials such as food and heating as a result of having to pay for care, while more than half said their health had suffered after support was reduced.

Paul Burstow, Minister of State for Care Services, said: “Under Labour social care was always the poor relation. Under the Coalition social care is receiving a £2bn spending boost including an unprecedented transfer of funds from the NHS to support integration.

“In 13 years Labour failed to reform the way we fund social care. Labour’s survey results are the product of that failure. Without the Coalition’s decision to priorities social care Labour’s legacy of underfunding would have been even greater.

“We are determined to put in place a lasting and fair settlement to the funding question. This Government has acted quickly to set up the Dilnot Commission on funding.”

From: http://www.telegraph.co.uk/health/Councils-planning-sharp-rise-in-care-home-fees

Its briefing, Reducing expenditure on low clinical value treatments, found that a clearer approach among primary care trusts (PCTs) to what it called “ineffective or inefficient treatments” would ensure more consistency across the country.

It came as another report, by the health think-tank The King’s Fund, criticised “persistent and widespread variations across England in patients’ chances of undergoing surgery for common medical problems”.

Both reports, by coincidence issued on the same day, agreed that some patients were undergoing operations “that do not benefit them”, in the words of The King’s Fund.

However, while the Audit Commission report focused on the potential cost savings of reducing operations, The King’s Fund called for an end to the “unfair” and “inefficient” variations in accessing worthwhile surgery.

The former identified tonsil removals as “relatively ineffective” and hysterectomies in cases of heavy menstrual bleeding as less cost-effective than alternatives.

Wisdom teeth extraction was often not worthwhile, because of a “close benefit and risk balance”, while some procedures, such as orthodontics, were nothing more than “potentially cosmetic”.

Some PCTs, of which there are about 150 in England, could save more than £12 million a year by reducing such operations, the soon-to-be-abolished spending watchdog calculated.

Andy McKeon, its managing director of health, said: “PCTs across the country are currently paying for treatments that cost the taxpayer money, and according to clinical experts have little or no real value to patients. This needs to change.”

The King’s Fund report – Variations in Health Care: the good, the bad and the inexplicable – found that tonsil removal operations in children were 10 times more common in Coventry than in Kingston, even though the procedure “has been queried since the 1930s”.

But it concentrated on lack of access to operations that did work.

For example, it found that rates of admission for hip and knee replacement varied by up to 400 per cent, with people in poorer areas much less likely to receive one.

Rates of coronary artery bypass grafts varied from 34 per 100,000 in Westminster to 197 per 100,000 in Berkshire.

John Appleby, chief economist at The King’s Fund, said: “This report confirms research over decades, both in the UK and internationally, which has shown persistent and unwarranted variations in use of and access to even the most common surgical procedures. This is unfair to patients and inefficient for the NHS.

“Remedying this is urgent given the need to improve quality of care while the NHS grapples with the biggest financial challenge in its history.”

From: http://www.telegraph.co.uk/Tonsil-removals-and-other-ineffective-operations-cost-NHS-500m-a-year

The decision to choose a private firm with a limited record in providing healthcare in the face of rival bids from two well-regarded local NHS GP practices sparked controversy. Local doctors passed a motion of no confidence in Tower Hamlets PCT.

Angry medics and patients, fearful of the potential impact of the privatisation of this part of the NHS, staged a protest march, and wrote to MPs and the PCT to complain about the decision.

Alwen Williams, chief executive of the embattled PCT, assured patients that Atos’s stewardship of the St Paul’s Way medical centre in Bow would mean much-needed “major new service improvements”.

Although Atos ran an NHS walk-in centre in nearby Canary Wharf, it was better known for its expertise in healthcare technology rather than primary healthcare. And Tower Hamlets faces some difficult challenges. It has the third highest level of multiple deprivation in England, significant numbers of children living in families that depend on benefits, the highest rate of overcrowding in London and a 49% non-white population.

“As a multi-ethnic community, we have a disease spectrum that’s a lot wider than many areas,” says Abdur Rahim, a GP at Chrisp Street health centre in Tower Hamlets, which was part of one of the losing bids. “This is a very challenging area.”

Now, barely three years on, Atos has just walked away from its deal, having failed to revive St Paul’s Way’s fortunes. The PCT says that in November, it and the firm “mutually agreed to terminate the contract with an exit date of 31 March 2011 in order to allow for safe transfer of patient care and for effective plans for staff to be made.”

Local GPs, whose expertise was overlooked in 2007, have been put in temporary charge of the centre while the PCT decides its next step.

“Atos never had any experience of running GP surgeries. They didn’t know Tower Hamlets or the health needs here. They put their bid in with the lowest cost, but that isn’t the same as showing they could best meet the local people’s needs,” says Rahim.

Now doctors are warning that the company’s failure is a foretaste of what lies in store if health secretary Andrew Lansley’s attempt to impose a competition-driven model of healthcare on to the NHS in England becomes reality.

“St Paul’s Way is a very cautionary tale. There’s an unavoidable contradiction between running something to maximise profit as opposed to running a service designed to meet the needs of patients,” says Anna Livingstone, a GP who opposed Atos’s takeover. She feels that the case offers a telling example of the pitfalls of competitive commissioning and questions the ethics of a system where big companies can walk away from contracts after outbidding smaller providers.

“There really was a huge amount of anger. Patients and ourselves were angry not only about privatisation but privatisation with a company that we had never worked with before and that had no track record in general practice,” she says. “Still, we thought this might be a testing ground for Atos, that they would work hard to provide a good practice. They had good doctors there. But we were naive. The low-cost contract they had won was impossible to deliver on.”

Data from Ipsos Mori’s GP Patient Survey shows Atos failed to lift St Paul’s Way from the bottom of Tower Hamlets’ patient satisfaction league table.

In 2009-10, only 41% of St Paul’s Way patients said they could access a doctor’s appointment within 48 hours, compared with the Tower Hamlets average of 72%. Just over a quarter said they were able to see their preferred doctor most of the time, less than half of the borough average and way below the national average in England.

Doctors working at St Paul’s Way concede that patients have been unhappy with appointment arrangements for some time. Fahim Chowdhury, clinical lead at the surgery, insists that the practice could get patients seen within 48 hours, but says that it often struggled to arrange appointments for patients with specific doctors. He says impr