An investigation into how well the private healthcare market is working is being planned by the Office of Fair Trading (OFT).
It will examine the nature of competition in the market, as well as whether it is fully competitive.

The OFT said its preliminary research had raised questions about whether the market was working well for private patients.

It aims to formally launch its investigation in spring next year.

Meantime, it is seeking views on the proposed scope of the study.

The OFT says the private healthcare market is worth £5.5bn and is of growing importance due to an ageing population, improved medical outcomes and higher life expectancy.

It added that it was of growing importance to the NHS because of government initiatives that allow NHS patients to seek treatment from private healthcare providers in certain circumstances.

Sonya Branch, OFT senior director of services and public markets said: “We are keen to focus on whether patients and buyers of private healthcare, including the NHS, are getting the full benefit of choice and competition.”

She added that as the area was a complex one, the OFT would be speaking to providers, patients and government to make sure that it focussed on the correct issues.

Bringing more competition to the NHS under White Paper reforms would be “potentially damaging” the British Medical Association (BMA) argues.A market-led approach “creates waste, bureaucracy and inefficiency”, Dr Hamish Meldrum, chairman of council at the BMA, said.

Under proposals put forward in July by Andrew Lansley, the Health Secretary, GPs are to be given the power to manage £80 billion of the NHS budget to buy care from hospitals and other doctors, while tiers of management are to be axed.

The BMA said today- Friday, that while it was “interested” in these proposals, the greater efficiencies they could bring might be undermined by more private sector involvement.

Dr Meldrum said: “There are proposals in the White Paper that doctors can support and want to work with. But there is also much that would be potentially damaging.

“The BMA has consistently argued that clinicians should have more autonomy to shape services for patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency.”

Dr Meldrum said that while he was “not ideologically against markets” he did not believe the evidence showed they had worked in the NHS so far.

Private finance initiatives and privately-run treatment centres, which sold their services to the NHS, resulted in taxpayers’ money leaving the service, he said.

“The private sector is not doing this out of some great social generosity, they want to make a profit,” he argued.

He was talking as the BMA submitted its response to the White Paper: Equity and Excellence: Liberating the NHS.

From: http://www.telegraph.co.uk/BMA-says-White-Paper-reforms-potentially-damaging

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

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

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

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

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

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

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

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

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

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

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

International travel and medical tourism helped the spread of drug resistant bacteria that could lead to the end of antibiotics, scientists have warned.
A new gene, NDM-1 (New Delhi metallo—lactamase), emerged which allows bacteria to be highly resistant to almost all antibiotics, the scientists said.

NDM-1 spread in India, Pakistan, and Bangladesh.  But it was also found in 37 patients from the UK, who travelled to India or Pakistan for medical procedures including cosmetic surgery, according to an article published in The Lancet.

“The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed,” Timothy Walsh of Cardiff University and his international colleagues wrote.

The gene was mostly found in E Coli, a common cause of urinary tract infections and pneumonia, which is highly resistant to antibiotics.

The authors said it could be easily copied and transferred between different bacteria, suggesting “an alarming potential to spread and diversify among bacterial populations”.

The paper said several of the UK patients had travelled to India or Pakistan for surgical procedures within the past year.

They wrote: “India also provides cosmetic surgery for other Europeans and Americans, and it is likely NDM-1 will spread worldwide.”

Study co-author Dr David Livermore, director of antibiotic resistance monitoring at the Health Protection Agency, said: “The findings of this paper show that resistance to one of the major groups of antibiotics, the carbapenems, is widespread in India.

“This is important because carbapenems were often the last ‘good’ antibiotics active against bacteria that already were resistant to more standard drugs.

“We have now also identified bacteria with this type of resistance – NDM – in around 50 patients in the UK.  Most, not all, had previously travelled to the Indian subcontinent, and many had received hospital treatment there.”

“International travel gives a great potential for spread of resistant bacteria between countries.  Few antibiotics remain active against these bacteria. Their spread underscores the need for good infection control in hospitals both in the UK And overseas, and the need for new antibiotic development.”

A Department of Health spokesman said: “We are working with the Health Protection Agency on this issue. The HPA alerted the NHS in January and July last year to be vigilant about these bacteria and take appropriate action where necessary.

“Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to HPA for testing.

“So far there has only been a small number of cases in UK hospital patients. The HPA is continuing to monitor the situation and we are investigating ways of encouraging the development of new antibiotics with our European colleagues.”

From: http://www.independent.co.uk/new-superbug-spreads-to-uk-hospitals

Controversial US group UnitedHealth, which runs GPs’ practices and advises PCTs in UK reported a 30% leap in profits to $1.1bn.The company recently had to repay $350m to settle a US case in which it was accused of artificially depressing insurance repayments to customers.

A US health insurance company that recently won a multimillion-pound contract to advise primary care trusts (PCTs), has reported a surge in profits over the last three months.

UnitedHealth Group, which also operates five GP practices in Derbyshire and London, reported second-quarter profits climbed 30% on the same quarter a year ago to $1.1bn (£720m) on turnover of $23bn.

The stock market-listed firm said the bulk of its growth came in the United States after it signed up more members for the government-backed Medicare and Medicaid policies.

The company signed a contract with the Department of Health last month to advise PCTs on commissioning ahead of reforms that will give GPs the lion’s share of the NHS budget.

PCTs directly run GP practices and offer contracts to self-employed GP doctors and private firms to operate independent practices. GPs will be in charge of £90bn of the health budget under plans put forward by the health secretary, Andrew Lansley.

UnitedHealth will use its experience of private healthcare to bring efficiencies to the bidding processes.

US unions have complained about the company, which has come under fire for malpractice. In 2008, its former boss William McGuire was banned as a director and forced to repay $468m following a scandal related to backdated stock options.

In January the company agreed to pay $350m to settle a case brought by the New York attorney general, Andrew Cuomo, who accused the firm of boosting profits by artificially depressing insurance repayments to customers.

The company based repayments on “independent” assessments by a company called Ingenix, which was a subsidiary of UnitedHealth.

The company is based in Minnesota, from where it has grown to be the largest health insurer by sales in the US. The company, which has more than 50,000 staff and 60 million health plan customers, is expected to have annual revenues in excess of $80bn this year.

From: http://www.guardian.co.uk/business/2010/jul/20/nhs-health-firm-profits-surge

Self governing NHS hospitals – known as foundation trusts – have had their private income capped to date, but this is to be lifted in the NHS overhaul.
The Foundation Trust Network believes the move will spark a burst of innovation in the sector.  But campaigners said they were worried NHS services would be harmed.

To get foundation trust legislation through parliament in 2003, ministers agreed to a cap on private work to ensure the hospitals remained true to their NHS traditions.

This has stopped some of the leading hospitals in the NHS competing with private firms for patients.

But that will now change under the proposals unveiled in Monday’s white paper. Health Secretary Andrew Lansley said he wanted to create a “vibrant” industry of social enterprises by scrapping the rule and ordering all NHS trusts to become foundation trusts within three years.

Sue Slipman, director of the Foundation Trust Network, said the move would make a big difference.

“It is exciting for foundation trusts. We will have to wait to see what exactly happens, but there are huge opportunities to innovate.”

She said one of the most obvious areas for expansion would be in fertility services where treatment on the NHS is severely restricted.

“In the past these patients have had their NHS cycles and then left for private treatment. That is money that has been lost to the system.”

She also said mental health trusts may be interested in offering talking therapies to businesses for their workforce health schemes.

University College Hospital in London has already gone down this route with a private US health firm which has located a private unit on its site for cancer treatment.

The firm leases the space as well as paying for the NHS services it uses, such as intensive care, radiology and cleaning and catering.

The trust has also established a joint venture with a private firm to provide pathology services.

Sir Robert Naylor, the chief executive of the trust, said: “These initiatives bring in money which can then be reinvested in NHS services.”

Many NHS hospitals also operate their own private wings, although most of these only bring in a small amount of income. The exceptions are specialist centres such as the Royal Marsden cancer hospitals and Moorfield Eye Hospital.

But John Lister, of the union-funded pressure group Health Emergency, said he had concerns.

“Hospitals could overstretch themselves in chasing private patients which in turn takes away from the NHS side of it.  It also creates perverse incentives whereby they stand to make more money by getting patients into their private wings.

“They say money is reinvested in services, but I am not sure this is always the case. Some of these hospitals have huge surpluses, the money is moved around and does not end back where it should. If we get more and more of this, it will be a step towards the privatisation of the health service.”

From: http://www.bbc.co.uk/news/10619463

Doctors’ leaders are demanding curbs on the boom in private screening clinics offering services ranging from simple blood pressure checks to full body scans costing more than £1,000.
Patients are being exploited by “irresponsible” marketing of private health screening tests, the British Medical Association and the Academy of Royal Medical Colleges say in a letter to health secretary Andrew Lansely.

Screening tests can harm in two ways. First, there’s the positive result that triggers further investigation and treatment but which turns out to be a false alarm, thus subjecting the individual to unnecessary anxiety and pain. And second, there’s the negative result that lulls the individual into a false sense of security – until the disease that has been lurking undetected strikes.

In a joint statement, Hamish Meldrum, chairman of the BMA and Professor Sir Neil Douglas, chairman of the Academy, warn that there are “significant risks” with direct-to-consumer tests. They say private companies are highlighting the benefits of screening while ignoring or playing down the risks.

“Many are unreliable and inaccurate. Patients may be falsely reassured, or undergo unnecessary and sometimes invasive follow-up tests and treatments. Unnecessary procedures may have long-term or permanent complications. These problems often create unnecessary burdens for mainstream NHS services.”

The statement does not mention specific tests but one that is widely promoted is a blood test for prostate cancer which measures the level of prostate specific antigen (PSA).

Research shows that seven in 10 men with a high reading will not have cancer. Worse, two in 100 with a low reading will have significant cancer. So a lot of men will get treatment they don’t need, and some will not get treatment they do.

For those with a high reading, the next stage is a biopsy. This is a painful procedure in which a hollow needle is inserted into the gland close to the rectum and a sample of tissue removed to be examined for the presence of malignant cells.

As the PSA level is a poor predictor of prostate cancer, there is no NHS screening programme. Men are advised to be tested only if they have symptoms, such as difficulty urinating, or a family history of the cancer.

If cancer is found, it may lead to surgery – with its risks – followed by radiotherapy and chemotherapy, which have side effects. But the cancer may not need treating. Prostate cancer is often slow-growing, and many men die with it rather than from it. For them, screening and treating the cancer brings pain and anxiety – and no health benefit.

In the case of whole body scans, sometimes marketed as the “ultimate health check” or “health MOT” for a milestone birthday at 40, 50 or 60, the promise is that it can offer more accurate checks than are usually carried out by old-fashioned family doctors.

The problem is that most scans throw up abnormalities – and if the patient is paying £1,000-plus they are unlikely to feel satisfied with a report that says simple “all’s well”. The clinic may feel under pressure to highlight any abnormalities.

But distinguishing those that are benign from those that indicate serious disease is often difficult. The risk is instead of bringing extra years of life the scans will bring years of anxiety.

In their letter Dr Meldrum and Professor Douglas call on the government to introduce tougher regulations on the marketing of private screening tests to ensure it is factual and balanced. They say clinics must include information on the risks and limitations of the tests, the implications of the results, the procedures not included in the price and the evidence of health benefit.

Dr Meldrum said: “Some private companies are taking advantage of vulnerable people by claiming the health screening they offer will detect diseases early or reduce an individual’s risk of developing specific illnesses.

“However, the NHS has safeguards in place to ensure the public can be confident the tests are supported by sound research evidence. This ensures that anyone having a test is aware of the benefits, risks and limitations involved.

“Such safeguards often do not exist in the private sector which makes it impossible for people to distinguish between private testing services that may do some good, and those that are of no value or potentially harmful.”

Professor Douglas said: “There are significant risks with direct-to-consumer tests. Many are unreliable and inaccurate. Patients may be falsely reassured, or undergo avoidable and invasive follow-up tests and treatments.

“Unnecessary procedures may have long-term or permanent complications which can place a burden on the NHS.”

From: http://www.independent.co.uk/the-1631000-body-scans-that-ought-to-come-with-a-health-warning

A new working weekday- so a topical posting. Are you one of the more than 520,000 people a day who arrive for work suffering from hangovers after drinking too much last night?However, almost 90 per cent of people accepted having a hangover at work is “unacceptable”

Almost one in ten people in Britain says they go to work with a hangover at least twice a week, and one in five of those admits it has an adverse effect on their work, according to the research.

Seventeen per cent of those who conceded to working with a hangover said it caused them to make mistakes and fall behind with their work, while seven per cent said they had to go home early because they felt too unwell.

The survey of more than 1,000 adults also raised fears that bosses are not doing enough to curb excessive weekday drinking by their employees, despite its negative impact on productivity.

Almost 90 per cent of people accepted having a hangover at work is “unacceptable”, but three out of five respondents admitted having joked with a boss or colleague about suffering the morning after the night before.

Dr Katrina Herren, Medical Director, Bupa Health and Wellbeing, said: “As an employer, it is important not to ignore the effects of alcohol on employees or the adverse effects it can have on the workplace environment.”

According to Drinkaware, the alcohol charity that commissioned the survey, workforce productivity is set to plummet even further during the World Cup as drinking increases.

Chris Sorek, CEO of Drinkaware, said: “An international sporting event like the World Cup will inevitably capture the attention of the nation and is a great time for people to come together, but hangovers at work are likely to increase.”

An estimated 1.2 million pints of lager were drunk by 70,000 England fans at the 2006 World Cup, according to German officials – an average of 17 pints each.

http://www.telegraph.co.uk/Half-a-million-work-with-hangovers-every-day

Dentists are still encouraging patients to return for excessive appointments and follow-ups, putting income ahead of care, research suggests.Data gathered by the Conservatives shows dentists to be “gaming the system”.

The Tory analysis, based on figures for 2008-09, suggests that 6.8 million slots could have been made available to those without access to an NHS dentist had they not been used for excessive appointment-setting or needless splitting of courses of treatment into separate sessions.

The Tories calculate the cost to NHS patients of “unnecessary charges” at £117 million, up from £109 million the year before. The burden represents a fifth of the £572 million charged each year for treating NHS patients.

Andy Burnham, the outging Health Secretary, acknowledged last year that dentisty remained “unfinished business” after the failure of a new dentists’ contract to address problems with a so-called drill and fill culture.

An independent review ordered by the labour Government, led by Jimmy Steele, of Newcastle University, found that dentistry was too preoccupied with treatment rather than prevention, and that dentists should be paid according to the number of patients on their list and penalised for poor work that leads to repeated visits.

Professor Steele’s proposals, which were accepted by the Government and put into pilot schemes, include rewarding dentists for registering new patients and building relationships with existing ones. Income is determined by the size of the patient-list, quality of care and the number of courses of treatment.

Andrew Lansley, the Tory health spokesman, who acquired the figures from parliamentary questions in February, said that the lack of political drive to rectify problems with dentistry was shown by its absence from the manifestos of Labour and the Lib Dems.

From: http://www.timesonline.co.uk/tol/life_and_style/health/article7115298.ece

The rising rate of blunders in IVF treatment ‘may be systemic’, says leading patient safety expert

The number of reported mistakes a t the 138 fertility clinics in England and Wales nearly doubled in the year to April 2009, rising to 334 from 182 the previous year. One leading patient safety expert has now warned that blunders which have occurred as record numbers of women seek treatment, may be “systemic”.

The increase comes as one clinic, IVF Wales, is at the centre of a fresh scandal after losing the last two remaining embryos it had frozen for one of its patients. It is the second time in less than 12 months that a mix up at the centre, based at University Hospital of Wales in Cardiff, has left patients devastated.

The Cardiff-based couple has had their eight-year quest to have a baby put on hold as a result of the blunder, which followed an initial, unsuccessful course of IVF. The pair, identified only as Clare and Gareth, are suing Cardiff and Vale University Health Board, which last year paid out a five-figure sum in compensation for negligence after another mix up.

Guy Forster, a solicitor at the law firm Irwin Mitchell who is representing the couple, said the incident raised questions about the Government’s IVF watchdog, the Human Fertilisation and Embryology Authority.

“This raises concerns about the HFEA’s ability to regulate the IVF industry properly. I think it should be doing a lot more to follow up when an incident occurs, especially at a clinic with a poor track record,” he said, adding: “These problems appear to be on the rise.”

An official review last year found that the HFEA was failing to punish badly run fertility clinics by not using the “full range of sanctions” at its disposal. Professor Brian Toft, a patient safety expert at Coventry University, said: “If the HFEA fails to clamp down when something has gone wrong then things will continue to go wrong.”

He said the rise in reported incidents, uncovered by BBC Radio 5 Live, implied clinics were not learning from their mistakes, adding: “I have been told there are not enough qualified staff doing the work. HFEA do not make any recommendations for staffing levels per number of patients. If you have a lot of patients and not enough staff, this could account for an increase in errors. This problem may well be systemic.”

Professor Sammy Lee, an IVF expert, said the watchdog must ensure clinics comply with regulations. “They need to obtain staff that have experience of enforcement and are able to make sure that regulations are put into place,” he said.

An HFEA spokesman played down the increase in blunders, which he said was partly due to new rules requiring clinics to include incidents when patients suffered from ovarian hyperstimulation syndrome (OHSS). “The number of reported incidents has increased as the sector has responded positively to the opportunity to share lessons learned from incidents which have been reviewed and investigated,” the HFEA added in a statement.

From: http://www.independent.co.uk/errors-at-ivf-fertility-clinics-double-in-just-one-year