The number of NHS patients who have to undergo emergency readmission to hospital within a month of being discharged has increased by more than three quarters over the last decade, the Daily Telegraph has disclosed.Hospitals have been accused by ministers of treating patients “like parts on a production line” after official figures suggested that hundreds of thousands of people every year are being sent home before they are well enough.

More than 660,000 people were brought back to hospital last year within 28 days of leaving, statistics show, sparking allegations that patients are being “hurried through the system” so the NHS can meet waiting-list targets.

The official figures show that some NHS trusts have seen their emergency readmission rate rise more than threefold over the past decade – while some hospitals have seen only a modest increase.

Last night, Andrew Lansley, the Health Secretary, said that the “hugely distressing” trend must stop.

“Patients have a right to expect that when they go in for treatment that they are looked after properly and that the treatment they are given helps them to recover,” he said.

“Having to be readmitted and treated all over again is hugely distressing. These figures show how Labour’s obsession with waiting time targets meant that patients were treated like parts on a production line to be hurried through the system rather than like people who need to be properly cared for.”

The Department of Health has released detailed information on the number of emergency readmissions in every area across Britain.

The figures show that 620,054 patients had to be readmitted in 2009-10 – compared to just 348,996 a decade before, a 78 per cent increase. Over the past five years, there has been a 31 per cent rise and a five per cent increase on the previous 12 months.

The data also highlights the widespread regional variations. The rate of readmission in the Kensington & Chelsea PCT area has risen by 287 per cent over the past decade to 1,582 people.

However, North Lincolnshire PCT has only experienced a 3.37 per cent rise over the same period.

Hospitals within the Hampshire PCT area readmitted 13,239 people last year. The nearby area covered by the Isle of Wight PCT only had to readmit 1,098 people.

The figures, do not include patients suffering from cancer or mental health problems or maternity patients.

Most of the areas with the highest increases in readmission numbers are in London and the south east, where pressure is greatest on the NHS. The Department of Health has analysed the social make-up of each area and concludes that the so-called “thriving London periphery” – the relatively wealthy commuter hinterland around the capital has suffered the biggest recent deterioration.

About 10 million people are admitted to hospital wards each year. Critics claim that government targets, such as the demand that patients be admitted to hospital for treatment within 18 weeks of seeing their GP, mean hospital managers are pressured into releasing patients early to make beds available.

Earlier this month, The Daily Telegraph disclosed that the Government is moving from a system of targets for hospitals based on waiting and treatment times – to a system of so-called “outcomes” which measures the success of treatment.

In a criticism of previous targets which he blames for the increase in emergency readmissions, Mr Lansley said: “Instead of focusing on the results which actually matter for patients, they focused on narrow processes to the detriment of patient care. That is why we have taken action to address these increases in emergency readmissions.

“One of the new goals we are setting the NHS is reducing emergency readmissions. In order to help achieve this we have created a re-ablement fund of £300 million and we have taken action to stop hospitals being paid when they readmit a patient after discharging them too early. These steps will turn Labour’s poor performance around.”

Under the Government scheme, hospitals will effectively be responsible for people’s care in the weeks after they return home and will be financially penalised for discharging patients too soon.

From:  http://www.telegraph.co.uk/Scandal-of-NHS-production-line-as-readmissions-soar

Andrew Lansley has called on the NHS to focus on “what really matters” as he prepares to announce plans to judge hospitals and doctors against 60 new goals that are designed to save more than 20,000 lives a year.The Health Secretary has unveiled a new system to assess success in the health service based on the quality of care patients receive – not merely the speed at which they are treated.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Critics warn that parts of the Government’s plan to share patient records with private companies give real concern over personal data privacy issues.Mr Burnham said it is “absolutely essential” that patient data is safeguarded, after The Sunday Telegraph revealed David Cameron will use a keynote speech to outline far closer “collaboration” between the health service and life science companies.

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%.

Controversial reforms to the NHS have avoided a potentially “fatal” delay in the House of Lords, to the relief of ministers.Amid deep concern in the medical profession and among many members of the public, some peers had tried to have the Health and Social Care Bill thrown out or subjected to detailed scrutiny that would have ruined the Government’s timetable.

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

Patient care is under threat at more than 60 NHS hospitals which are “on the brink of financial collapse” because of costly private finance initiative schemes the Health Secretary warns.Andrew Lansley says he has been contacted by 22 health service trusts which claim their “clinical and financial stability” is being undermined by the costs of the contracts, which the Labour government used extensively to fund public sector projects.

The trusts in jeopardy include Barts and the London, Oxford Radcliffe, North Bristol, St Helens and Knowsley, and Portsmouth.

Between them the trusts run more than 60 hospitals which care for 12 million patients.

There is already evidence that waiting lists for non–urgent operations have begun to rise as hospitals delay treatment to save money. Adding to this are growing fears over the impact of the financial crisis on care this winter.

Under the PFI deals, a private contractor builds a hospital or school. It owns the building for up to 35 years, and during this period the public sector must pay interest and repay the cost of construction, as well as paying the contractor to maintain the building.

However, the total cost of the deals is often far more than the value of the assets. As a result, Mr Lansley says, the 22 trusts “cannot afford” to pay for their schemes, which in total are worth more than £5.4billion, because the required payments have risen sharply in the wake of the recession.

Mr Lansley said: “Over the last year, we’ve been working to expose the mess Labour left us with, and the truth is that some hospitals have been landed with PFI deals they simply cannot afford.

“Like the economy, Labour has brought some parts of the NHS to the brink of financial collapse. Tough solutions may be needed for these problems, but we’ll help the NHS overcome them. We will not make the sick pay for Labour’s debt crisis.”

He said hospitals would not be allowed to collapse financially.

“There are many hospitals that are well run, do not have a legacy of debt and do have projects which are perfectly sustainable. My point is that we have looked since the election and are working together with individual trusts to arrive at a place where they are financially, and in terms of the quality of their services, sustainable for the future. We can only do that if we work closely with them,” he said.

“This is about making very clear that we are not only working on unsustainable PFIs, but also working with legacy debt that the NHS has been left with, working on the IT programmes which were on an unsustainable scale of contractual commitments that didn’t meet the need of the NHS’s customers.

“Across the board, we have to tackle Labour’s legacy of poor value formoney and debt.”

Over the next few weeks, Department of Health officials and executives at the 22 trusts will develop detailed plans for dealing with the crisis. Their proposals are expected to include significant cost–cutting and the renegotiation of PFI contracts.

Money will also be moved from NHS trusts that are in better financial shape to cover the debt costs at those that are struggling. However, officials are braced for the need to use Whitehall funds to bail out some hospitals.

Among the trusts which have contacted Mr Lansley to inform him of their severe financial problems are several London institutions, including South London Healthcare, Barking, Havering and Redbridge, and North Middlesex.

Outside the capital, other trusts to have approached the health department include Wye Valley, Worcester Acute Hospitals, Mid Yorkshire, and Walsall.

After the general election last year, Mr Lansley ordered officials to establish why some NHS hospitals were under–performing. The health department is assessing the financial position of every hospital. It is understood that the PFI costs have emerged as a leading factor in poor patient care in some areas.

The Health Secretary decided to disclose the list of hospitals in difficulty and is expected to announce the rescue plans for each trust next month.

Taxpayers are having to pay more than £200 billion for schools, hospitals and other projects whose capital value is little more than £50 billion.

In one example, a hospital in Bromley, south east London, will ultimately cost the NHS £1.2 billion, more than 10 times what it is worth. Another hospital was charged £52,000 for maintenance that cost £750. The annual cost of the schemes is almost £400 for each household.

The public payments for PFI deals are typically linked to inflation and therefore the cost to taxpayers has increased by up to a third since the beginning of the credit crisis, according to the National Audit Office. Last month, MPs on the Treasury select committee effectively called for a moratorium on new PFI projects, which it said were “like a drug” as the costs were not apparent at the outset.

George Osborne, the Chancellor, has tightened the rules on the deals.

Earlier this year, John Healey, the shadow health secretary, admitted in an interview that Labour ministers had failed when negotiating the multi–million pound schemes for hospitals.

“There is definitely a case for saying we were poor at PFI, poor at negotiating PFI contracts at the outset,” he said.

Companies who run PFI schemes boast profit margins of up to 71 per cent on the projects, but have come under growing pressure from MPs and ministers to return some of their “windfall profits”.

From: http://www.telegraph.co.uk/NHS-hospitals-crippled-by-PFI-scheme

The General Medical Council (GMC) says some overseas doctors come to the NHS with ‘little or no preparation’ for working in the UK.Along with the Nursing and Midwifery Council, it wants the right to test the English language skills of applicants from within the EU in the same way they test applicants from outside of Europe.

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

Patients have been left at risk as the country’s main health watchdog quango carried out 70 per cent fewer inspections in order to focus on bureaucracy MPs find.The Care Quality Commission was guilty of a “significant distortion” in its priorities as it concentrated on red tape rather than checking that hospitals and care homes were safe, according to the Health Select Committee.

The situation was made worse by the fact that almost 300 posts were unfilled at the regulator and it failed to make Government understand the difficulties it was facing in adding dentists to the professions it monitors.

A damning report accuses the CQC of responding “woefully” to a whistleblower who uncovered abuse of people with learning disabilities at a private hospital, and of only offering “out of date and unhelpful” information to the public.

The MPs also call on the watchdog to focus on the broader culture at hospitals and care homes, rather than individual failings in treatment, to make sure that complaints are not being suppressed.

Stephen Dorrell, the Health Secretary under John Major who now chairs the select committee, said: “In its review of the CQC, the Committee concluded that the organisation’s priorities became distorted by a statutory deadline for the registration of dentists and that this distortion led directly to a drop of 70 per cent in inspection activity during the second half of 2010-11 compared with the same period in the previous year.

“The primary causes of this distortion, which resulted in increased risk to patients, were the unrealistic statutory obligations imposed on the CQC.”

Rosie Cooper, a Labour member of the committee, said: “I was really disappointed that the CQC allowed itself to get trapped in the regulatory profess and that restricted its ability to carry out inspections, which left vulnerable people at risk.”

The CQC, which has a budget of more than £160 million, was formed in 2009 in a merger of three separate watchdogs for healthcare, mental health and social care, and set about registering thousands of NHS hospitals and care homes.

But it missed its target of registering 8,000 dentists by April because of its complex process and the deadline for putting GP practices on its books has been postponed for a year so it can catch up.

As a result of this focus on administration, the select committee says that CQC inspections to see if patients are being looked after safely fell by 70 per cent, from 6,840 between October 2009 and March 2010 to 2,008 in the following six months.

Meanwhile its number of job vacancies rose from 148 in June 2010 to 297 a year later, “a further cause for concern”, almost half of whom were the inspectors and registration assessors it needed the most.

The MPs said the watchdog should have argued its case to Government more persuasively and far sooner.

Caseloads for the CQC’s inspectors have risen from 50 to 62 organisations over the past year, and so many assessments are mere “box-ticking” exercises carried out from its offices.

After a nurse contacted the CQC to complain about abuse at Winterbourne View, its response was “woefully inadequate”. Calls from whistleblowers elsewhere increased after the scandal was exposed by Panorama but this could be “only the tip of the iceberg”.

The CQC has a website where patients and relatives can read reports on hospitals and care homes but in many cases they are “several years old” and contain “limited” information.

The MPs say that inspectors should visit hospitals and nursing homes every year and speak to staff, patients and visitors to get a true picture of the quality of care being provided, rather than just relying on easily met targets.

From: http://www.telegraph.co.uk/Patients-left-at-risk-by-watchdogs-focus-on-red-tape

St John Ambulance, the charity, has been accused of abandoning its volunteers as it attempts a widespread restructuring project.The first aid organisation has announced plans to streamline its management amid financial woes.

It is set to embark on a major restructuring exercise to rebalance its books, which includes setting up eight regional boards and merging offices in 41 regions.

But the charity, which has recorded operating losses seven years in a row, is accused of “kicking volunteers in the teeth” by those who regularly help out.

They claim that disillusioned volunteers will no longer want to raise money if the cash goes in a central pot rather than helping local projects.

“All counties work in their own particular way according to their local people and in a way that can only be done by them,” one senior volunteer said.

“If the structure is changed … what incentive is there for local people to volunteer and raise money?”

A former chairman of a county division claimed the changes would lead to “financial ruin”.

“We are absolutely horrified because we feel that this restructure is doing away with the strong volunteer ethos of St John’s. It’s like kicking volunteers in the teeth” she said.

Under the plans eight regional directors will be created on salaries of £80,000 a year plus benefits to represent London, the south east, south west, East Midlands, West Midlands, East of England, North-West and North East.

Officials admitted that “financial” pressures were partly behind the new structure as well as “increasing regulation”. It denied it was in “imminent financial crisis”.

While the service claimed there would be no redundancies the charity admitted “some roles have been placed at risk and are therefore undergoing consultation”. It would not provide further details.

The charity, founded in 1877, currently employs about 1600 staff across the country and has more than 40,000 volunteers on its books.

It trains more than half a million people a year and has more than 1000 ambulances that provide support to NHS trusts. The Duke of Gloucester is the service’s Grand Prior of the Order.

In a letter sent to volunteers around the country, Rodney Green, the charity’s Prior and chairman of board of trustees, admitted the organisation faced a “number of difficult challenges in the years ahead”.

A briefing note sent to volunteers explaining the changes, said the organisation needed to increase its “charitable and community impact”.

“We need a greater consistency in our quality – so that we can meet more stringent regulatory requirements and also better support the front line,” stated the document, titled “Becoming ‘The Difference’: transforming St John Ambulance”.

“More urgently, we need to balance the books and achieve secure finances.  For seven years running, we have spent more than we earned and are set to make further losses this year. The charity cannot sustain this.”

Mr Green insisted the changes, signed off by the trustees last month following “rigorous analysis of the current structure”, would transform the organisation “so that we can save yet more lives”.

From: http://www.telegraph.co.uk/St-John-Ambulance-abandoning-volunteers-over-restructure-project

Clinical negligence claims against the National Health Service have increased by almost a third over the past year, with an extra £100 million paid out to victims of medical blunders.Nearly 9,000 patients claimed for damages after allegedly suffering at the hands of doctors or nurses, figures from the NHS Litigation Authority show.

It paid out £863m to victims of accidents in hospitals and clinics, up from £787m the year before, after settling 5,398 cases.

But a quarter of this was spent on legal costs, with £200m going to claimants’ lawyers under the system whereby so-called “ambulance chasers” can charge up to £900 an hour to pursue claims.

The litigation authority’s annual report is scathing about the current regime, which it claims is driving the “rapid growth in claims numbers” rather than any increase in mistakes by NHS staff.

Under the “no-win, no-fee” system set up by Labour so poorer people could have access to justice, known as Conditional Fee Arrangements, claimants do not have to pay for lawyers upfront. But if they win cases, the lawyers can claim big “success fees” from the defendant.

Steve Walker, chief executive of the NHS Litigation Authority , said: “We believe very strongly that a regime which allows success fees and the recoverability of After the Event (ATE) insurance premiums makes litigation so profitable that solicitors and so-called ‘claims farmers’ are drawn into the market thereby fuelling the rise in claims volumes we have experienced.”

However he added that the body is “delighted” that the Ministry of Justice is acting on the Jackson review of civil litigation costs, which recommended that success fees and ATE premiums should not be recoverable in no-win, no-fee cases.

At the same time the Government hopes to save millions every year by scrapping Legal Aid in cases of alleged malpractice.

The litigation authority’s report shows that in total it recorded 12,142 claims against NHS trusts in 2010-11 but expects only 4 per cent to go to court, as most will either be settled beforehand or dropped.

Of these, 8,655 were clinical claims, up from 6,652 the previous year, and 4,346 were non-clinical, up from 4,074.A further 22,364 claims were still open at the end of the financial year.

The authority – funded partly by trusts and partly by the Department of Health directly – paid out £729m under its main clinical scheme and a further £134m under claims relating to incidents that took place before 1995.

This was an increase on £651m under the current scheme and £136m under the old schemes recorded in 2009-10.

A further £47.9m was paid out in non-clinical cases.

However these figures do not only include compensation paid to patients, staff and members of the public but legal costs as well.

The costs claimed by claimant lawyers continue to be significantly higher than those incurred on our behalf by our panel defence solicitors. This continues to be a major concern.

“The availability of Conditional Fee Agreements (CFAs) and the continued increase in their use by claimants in clinical negligence claims has also meant that claimants’ costs are almost invariably disproportionate, often significantly, to the amount of damages paid, particularly in low-value claims.

“In the 5,398 clinical negligence claims closed by us with a damages payment in 2010/11, we paid over £257m in total legal costs, of which almost £200m (76 per cent of the total costs expenditure) was paid to claimant lawyers.”

From: http://www.telegraph.co.uk/30-rise-in-negligence-claims-against-NHS

Hip replacements, cataract surgery and tonsil removal are among operations now being rationed in a bid to save the NHS money.
Two thirds of health trusts in England are rationing treatments for “non-urgent” conditions as part of the drive to reduce costs in the NHS by £20bn over the next four years. One in three primary-care trusts (PCTs) has expanded the list of procedures it will restrict funding to in the past 12 months.

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