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

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

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 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

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

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 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

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.

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

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

In the past, gluten-free products were difficult and costly to get hold of, and many people obtained them via prescription. They are now commonly found on supermarket shelves and their cost has come down.

While they cost more than standard versions, typically up to twice as much, the NHS appears to be paying well over the odds.

Darren Millar, the Conservative shadow minister for health in the Welsh Assembly, found out that the NHS in Wales paid £984,185 for 47,684 gluten-free loaves last year — or £20.64 a loaf. In an answer to a question he put to the assembly, he was also told that packets of gluten-free pasta were costing the NHS £11.54 per bag. Similar packs cost £2 in supermarkets.

Ginger snap biscuits cost £10.07, compared with £2.35 in the shops, and wheat-free gravy mix £15.21, rather than £2.59.

Mr Millar said: “It’s currently costing the NHS 10 times more for this bread than the price in a supermarket.

“Many taxpayers will question why they are also footing the bill for hundreds of thousands of pounds worth of snacks such as biscuits and cakes.”

“Foods of this type have become much more widely available and yet the number of prescriptions has risen.”

A spokesman for the TaxPayers’ Alliance said: “It smacks of incompetence that the Welsh NHS is paying so much more than they are available for in the shops.

“This doesn’t look like taxpayers are getting value for money.”

Dr David Bailey, chairman of the British Medical Association’s GP committee in Wales, added: “It makes little sense for gluten-free foods to be prescribed.”

In 2010, the NHS in Wales, which serves a population of three million, spent just over £2 million on gluten-free products.

Given that the population of Britain is some 20 times that, it is likely that the overall NHS bill stands at £40 million, although in England some patients pay prescription charges.

Mr Millar commented: “That’s a heck of a sum of money. When cash is short, should we really be spending public money on such things? I think not.”

Sarah Sleet, chief executive of the charity Coeliac UK, said the high costs resulted from bureaucratic supply chains in the NHS.

She called for greater efficiency but said such items should still be available on prescription for sufferers.

“It’s in the interest of the NHS to keep people with coeliac healthy, and prescriptions play an important role in this,” she said.

A spokesman for Lesley Griffiths, the Welsh health minister, said: “Work is now under way to identify savings that can be made in reducing the number of gluten-free products prescribed by the NHS.”

From:
http://www.telegraph.co.uk/NHS-pays-20-for-a-loaf-that-costs-2-in-a-supermarket

Ministers have said they will consider the proposals, but the Treasury is known to have reservations.

However, both the Dilnot Commission and campaigners are preparing to keep the pressure on in the coming months.

Commission chairman Andrew Dilnot is urging ministers to act quickly and consider ways extra funds could be found.

After launching his report on Monday, he said he wanted to see the government come forward with a white paper by Easter, paving the way for the introduction of the new system by the end of this parliament.
‘Build momentum’

Meetings are now being planned with officials about how his proposals would work in practice.

He is said to be confident that he will be able to win the argument and wants to use the next few months to “build momentum” around his plans.

The Dilnot Commission’s proposals would require an extra £1.7bn a year – a figure which would rise along with the ageing population.

This could be found by making cuts elsewhere. The NHS has already been pinpointed as it has a budget of over £100bn and many of its services overlap with social care.

Alternatively, £3bn a year could be raised through getting those who work past the normal retirement age to pay national insurance contributions or through an across the board rise of 0.25% in contributions

Increasing the basic rate of income tax by 0.25%, VAT by 0.5% or reducing pension tax relief would bring in £2bn a year.

In a warning to ministers, he said if they did not act before Easter the commission’s feelings would move “quickly to disappointment”.

His case is being strengthened by having widespread support from charities – some of whom are involved in delivering social care services.

More than 20 charities, including Carers UK and Mencap, immediately put their names to a joint statement calling for action.

It said: “It is now vital that government sets out a clear timetable for change and does so quickly.”

Many of them will also be seeking talks with government in the coming months. A number of options are being put forward for finding the money.

These include taking money from other departments as the £1.7bn represents just 0.25% of total government spending.

It will also be argued that improving social care will help save the NHS money as fewer people will need expensive hospital treatment if they get better access to social care.

However, raising more through taxes or the benefits system will also be put forward.

An analysis from Age UK setting out how this could be done has already been handed over to the Treasury.

It includes suggestions such as making those working past the normal retirement age pay national insurance contributions. This would raise £3bn a year.

Alternatively a 0.25% rise in contributions across the board would make a similar amount.

Meanwhile, £2bn could be found by either increasing the basic rate of income tax by 0.25%, VAT by 0.5% or reducing pension tax relief.

For any of these to happen, cross-party support would almost certainly be needed.

The Labour party has already indicated it would be willing to enter talks. But doubts still remain about the appetite for change.

In his official response to the Dilnot Commission, Health Secretary Andrew Lansley said the proposals would be “carefully considered”.

But he acknowledged they would involve “significant cost” and need to be balanced against other funding priorities.

A spokeswoman for the Treasury refused to be drawn on any of the suggestions.

But she said officials would welcome “constructive engagement from all stakeholders”.

Michelle Mitchell, of Age UK, said: “The government now needs to act on Andrew Dilnot’s proposals. Delay would be indefensible.”

And Richard Humphries, of the King’s Fund health think-tank, added: “A solution must be found.

“What we are talking about is a relatively small proportion of government spending.”

From: http://www.bbc.co.uk/news/health-14017252

The study shows that 2,880 applications were made to the interim Cancer Drugs Fund during October 2010-March 31, 2011 (773 applications in March alone) and that, overall, 2,506 cancer patients gained access to treatment as a result of the Fund, although applications for 187 patients were denied.

It also reveals a dramatic postcode lottery with a northsouth divide in approvals, as SHAs in the south of England approved a lower number of applications than those in the north.

For example, NHS South Central approved around 75% of applications during the period whereas NHS North East approved every application it received, and while NHS South West used less than a quarter of its allocated funds, NHS Yorkshire and the Humber spent slightly more than its allocated budget.

Most SHAs have taken steps to expedite the application process for the Fund, with one – NHS East of England – removing the requirement for clinicians to submit exceptional-case applications before they can access the Fund.

Also, six out of 10 SHA operate lists of drugs which will be routinely reimbursed through the Fund. “This approach reduces bureaucracy, enables rapid decision-making and provides greater certainty to clinicians and patients,” says the RCF.

However, NHS North West’s operation of a negative list of drugs which will only be funded in exceptional circumstances breaches the spirit of the Cancer Drugs Fund policy, says the RCF, adding that, despite guidance instructing SHAs to cease using negative lists, NHS North West’s list was still operational on June 3, 2011.

The Fund could potentially benefit more than 30,000 patients, enabling them to access 34 treatments which would not have been routinely available on the NHS, and patients with bowel, kidney and blood cancers have been among the greatest beneficiaries, the report finds.

The most-requested drug – by far – has been Roche’s Avastin (bevacizumab), followed by Merck & Co’s Erbitux (cetuximab), Novartis’ Afinitor (everolimus), GlaxoSmithKline’s Tyverb (lapatinib) and Roche’s MabThera (rituximab).

Commenting on these findings, RCF chief executive Andrew Wilson said that while it was “great news” that thousands of patients have benefited from the Fund, it was concerning that 187 patients had been denied life-extending treatment “despite money going unspent and the emergence of significant regional variations in approval rates.”

The report also looks at progress with Primary Care Trust (PCT) exceptional-case processes. It estimates that 7,743 applications were submitted between April 2007 and December 2010, and suggests that the substantial increase in application rates during October-December last year reflects the fact that many SHAs required clinicians to submit exceptional-case applications to PCTs before a treatment could be considered for reimbursement from the Cancer Drugs Fund.

October-December 2010 (the period in which the interim Fund was introduced) also saw a dramatic drop in the exceptional-case approval rate.

This is likely due to more clinicians being encouraged to apply for treatments which would have stood little chance of being approved before the Fund was introduced, the Foundation suggests, although it adds that this requires further investigation.

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

Hospitals in England have been fined for keeping patients in mixed sex accommodation under a new push to eradicate the problem.

Hospitals are fined £250 for each day a patient is kept in mixed sex wards.

It means at least £665,000 of fines have been levied, although the sum could be higher as the data does not detail how long a breach has been for.

The Coalition government’s drive on mixed sex accommodation follows failed attempts by the Labour administration to tackle the issue.

Labour ministers struggled, partly because large chunks of the NHS estate date back decades and proved hard to convert.

Extra money has now been ploughed in to the system to help build more single rooms to rectify this.

April marked the first month the new fining system was applied. Previously, the levels of fines varied considerably depending on the treatment and were inconsistently levied.

Over the past few months, the government has been publishing breach figures ahead of the start of the new fining system. These show the problem has been improving.

In December there were more than 11,000 breaches. By March that had fallen to under 5,500. However that has to be seen in the context of the one million plus patients seen each month.

Single sex accommodation means patients sharing sleeping, bathroom and toilet facilities only with people of the same sex.

The rules do allow wards to be segregated into distinct bays as long as they have separate facilities.

They apply to all trusts from acute hospitals to mental health units. Only intensive care and A&E are excused.

Health Secretary Andrew Lansley said the downward trend was pleasing, but there were “still too many breaches”.

He added all the fines would be reinvested back into patient care.

From: http://www.bbc.co.uk/mixed sex wards lead to hospital fines

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

For the first time, new regulations will allow only long-established and quality-controlled medicines to be sold.

But both herbal remedy practitioners and manufacturers fear they could be forced out of business.

To date, the industry has been covered by the 1968 Medicines Act, drawn up when only a handful of herbal remedies were available and the number of herbal practitioners was very small.

But surveys show that about a quarter of all adults in the UK have used a herbal medicine in the past two years, mostly bought over the counter in health food shops and pharmacies.

The regulations will cover widely used products such as echinacea, St John’s Wort and valerian, as well as traditional Chinese and Indian medicines.

But safety concerns have focused on the powerful effects of some herbal remedies, as well as the way they interact with conventional drugs.

For example, St John’s Wort can interfere with the contraceptive pill, while ginkgo and ginseng are known to have a similar effect to the blood-thinning drug warfarin.

From now on only products that have been assessed by the Medicine and Healthcare products Regulatory Agency (MHRA) will be allowed to go on sale.

Manufacturers will have to prove that their products have been made to strict standards and contain a consistent and clearly marked dose.

And to count as a traditional medicine, products must have been in use for the past 30 years, including 15 years within the EU.

They will also only be approved for minor ailments like coughs and colds, muscular aches and pains, or sleep problems.

The manufacturers of herbal remedies have had seven years to prepare for the new rules after the European Directive on Traditional Herbal Medicinal Products was introduced in 2004.

These regulations apply to over-the-counter sales, which form the bulk of herbal remedies sold in the UK.

But some manufacturers and herbal practitioners have expressed concern, arguing the new rules are too onerous for many small producers.

Michael McIntyre, chairman of the European Herbal and Traditional Medicines Practitioners Association, says there will be a significant impact on herbal medicine practitioners and their suppliers, but admits the rules do need bringing up to date.

“Products that go on the market now will definitely do what it says on the bottle, while we didn’t know how good they were in the past.

“But registration is expensive so perhaps there may be fewer products on the market and a smaller range.

“It’s difficult to argue that the market should stay as it is, without any regulation, but how many businesses will pack up and walk away? I can’t say.”

A Department of Health spokesperson said: “We have swiftly introduced a system to register herbal practitioners using unlicensed herbal medicines, so consumers will be able to continue to use unlicensed herbal medicines if they wish.”

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 improvements were made to the continuity of care, thanks to Atos replacing locum GPs with a stable staff of five doctors, all of who still work at St Paul’s Way.

Chowdhury says lessons can be learned from Atos’s experience. He was impressed by the company’s employee relations, the stability it brought to a practice that had undergone turbulent times, the administrative and managerial support, and its readiness to leave clinical matters in the doctors’ hands. Yet it highlights the difficulties facing private providers looking to get involved in frontline healthcare provision, which the coalition’s “any willing provider” vision of the NHS will encourage.

“The NHS can learn from the efficiency of private business. In this day and age GP practices can’t ignore things like budgets,” Chowdhury says. “If a private company is going to make money in this area, it will be one that is well established in providing primary care. Atos didn’t have that. It came to St Paul’s Way at a tough time. There was a financial crisis and it was taking over a practice that is incredibly demanding.”

Clare Gerada, chair of the Royal College of GPs, says the saga raises troubling questions about how healthcare in the new era will operate. “What will the failure regime be for private providers? What will happen if such providers go bankrupt and can’t deliver services they promised?” she asks.

“The risk is that patients could be left in the lurch, and without access to the appointments or operations they were expecting. St Paul’s Way shows that some people may not be able to sustain a service at the price they’ve taken it on at and that the promised quality of patient care may not be delivered. Competition should always be on quality rather than price.”

From: http://www.guardian.co.uk/nhs-privatisation-future-policy

In the UK alone there are more than 500,000 people who suffer from epilepsy.

Dr Ben Whalley, who is leading the research at the department of pharmacy at the University of Reading, said tests in animals had shown the compounds effective at preventing seizures and convulsions while also having less side effects than existing epilepsy drugs.

He said: “There was a stigma associated with cannabis that came out from the 60s and 70s associated with recreational use, so people have tended not to look at it medicinally as a result.”

“Cannabis is thought of being a treasure trove of compounds that could be used for pharmacological development. We have a list of around a dozen potential candidates for epilepsy and have tested three that show promise.”

“These compounds are very well tolerated and you are not seeing the same kind of side effects that you get with the existing treatments.”

Epilepsy is caused by sudden bursts of electrical activity in the brain that disrupt the normal way in which messages are transmitted. This can cause debilitating seizures and fits that can lead to sufferers injuring themselves.

Dr Whalley, together with his colleagues Dr Claire Williams and Dr Gary Stephens have been working with drug company GW Pharmaceuticals to develop and test new treatments for the disease from cannabis.

Two of the compounds they have identified, one called cannabidiol and the other called GWP42006, have been highly effective at controlling seizures in animals and the researchers now hope to begin clinical trials in humans within the next three years.

Neither of the compounds produce the characteristic “high” associated with cannabis use.

The scientists, whose latest findings on the compounds are published in the scientific journal Seizure, believe they work by interfering with the signals that cause the brain to become hyper-excitable, which leads to epileptic seizures.

Until now the main medicinal use that has been explored for cannabis has been in treating Multiple Sclerosis and for pain relief in cancer patients.

GW Pharmaceuticals has been given a license to grows around 20 tonnes of cannabis a year at its facilities in a rural part of southern England for medicinal research. In each glasshouse the temperature is carefully maintained at 77 degrees F while the crops are protected by electric fences and 24 hour security.

Mark Rogerson, from GW Pharmaceuticals, said: “Medicinal cannabinoids can treat a wide range of diseases like MS and pain.

“The work by Dr Whalley and his team is taking us into a whole new area where there is a real unmet need. The stigma is counterbalanced by the fact that it is a serious medicine for a serious condition.”

A spokesman for Epilepsy Action said: “Epilepsy is a condition that can be very difficult to treat.

“We are aware of some people with epilepsy who have used cannabis for medicinal purposes. However, it should be noted that although taking cannabis may reduce seizures in some people, it could actually increase seizures in others.

“We therefore welcome research into this treatment area. It could help our understanding of alternative therapies and may prove useful in the long-term for people whose epilepsy does not respond to more traditional methods.”

From: http://www.telegraph.co.uk/Cannabis-could-be-used-to-treat-epilepsy

The extensive review also other widespread variations in the quality of care and performance throughout primary care.

For example, one-third of patients with stomach or oesophageal cancer who needed an urgent referral to hospital were actually given a non-urgent referral by GPs.

In fact, overall, an eight-fold variation at which practices urgently refer patients with suspected symptoms of cancer on to specialists in secondary care was found.

Continuity of care continues to be an issue, as only just over a quarter of patients are able to see the doctor of their choice in the lowest performing practices.

Crucially, there were also wide variations in admission rates for patients that could actually be treated outside hospital, which is particularly important as the effective management of patients within the community could also save the NHS hundreds of millions of pounds a year, The King’s Fund said.

On a more general note, the inquiry’s report strongly backs the position of GPs as generalists rather than specialists, but also notes that the profession must embrace the radical changes laid out in the government’s reform of the health system – particularly new commissioning powers -  in order to “maintain its international reputation for excellence”.

In addition, in order to help meet the growing challenges in healthcare, such as the ageing population and increasing demand on service, by building on the changes already taking place within the system.

It calls on GPs to accelerate the trend for multi-professional teams that work closely alongside specialists outside the practice, move away from being ‘gatekeepers’ to ‘navigators’ who essentially co-ordinate care for people with complex needs, and place a greater emphasis on prevention of ill health.

There must also be a much stronger focus on improving the quality of care, the report notes, and also calls on GPs to take responsibility for driving forward progress through a stronger commitment to transparency, particularly on performance data, peer review and benchmarking, and better data capture and use of information.

“Although general practice in this country remains the envy of the world, there is no room for complacency,” warned The King’s Fund’s chief executive Chris Ham.

“While many practices have been at the vanguard of innovation and quality improvement, too many GPs remain unaware of significant variations in performance and do not give priority to improving quality,” he noted.

NHS Confederation acting chief executive Nigel Edwards said improving primary care and GP services is one of the biggest challenges facing the NHS, and that the report “highlights the need to address the major variations in the standards of care patients are receiving”.

He calls for the introduction of a national process to compare general practice standards which, he claims, would not only empower patients to compare the standard of care, but would also help “drive down variation in diagnosis, referrals and prescriptions, all of which are central to saving lives”.

According to the British Medical Association a “culture of self-scrutiny has existed for many years but now more than ever, given the increased intensity and complexity of general practice work nowadays, GPs need time off the treadmill so they can look critically at what they do and make improvements”.

“A reduction in bureaucracy would help them to do this, as would stopping the constant reorganisations within the NHS”, it stressed.

From: http://www.pharmatimes.com/NHS_could_save_millions_of_pounds_with_better_prescribing

An 18-page document from the Department for Business, Innovation and Skills (BIS) sent to the European commission this month on all professional qualifications covered by an 2005 EU directive did not specifically mention medical training. It did, however, raise concerns the present rules do not allow systematic language testing of EU doctors when they apply to join the UK medical register.

The issue of doctors’ training and their understanding of the differing health systems within the EU has come to the fore following the scandal over Daniel Ubani, a German doctor on his first UK shift as an out-of-hours GP, who accidentally killed a patient in 2008.

Labour’s shadow public health minister, Dianne Abbott, said: “David Cameron and Andrew Lansley are putting patient safety and standards of care at risk. The official government response on professional qualification does not include a single line about medical training, which is a travesty.

“To suggest that workers can operate in our healthcare system without proper training, assessments or being able to communicate with patients seems to me to be absurd.

“Whilst patient groups, professional bodies and health experts are all uniting in opposition to the NHS reorganisation, the Tory-led government has already abandoned any substantive commitment to minimum standards for doctors.”

A statement from BIS defended the department’s stance. “The European commission are chairing working groups of experts in medical education across the EU to look at the current minimum training standards for the main health professions, as part of the broader review of the mutual recognition of professional qualifications directive,” it said.

“They will look at each of the five health professions for which minimum standards are laid out in the directive, with a view to updating the training requirements and ensuring transparency. We are awaiting the outcome of these groups in April and May before considering this matter further.”

From: http://www.guardian.co.uk/nhs-patient-care-risk-eu-training-standards

There will be a three month pause in the legislative process which allows Liberal Democrat opponents of the plans time to weaken them. The proposals will pass to the Lords in June, giving the Coalition time for further changes.

Mr Cameron, Nick Clegg, his Lib Dem deputy, and Andrew Lansley, the Health Secretary, will explain the plans to give power to GP–led bodies and let private companies treat more NHS patients at a series of meetings.

They have been forced into the move after criticism from health experts and politicians.

Stephen Dorrell, the former Tory health minister, said that the Government had lost control of the changes. The electorate had the impression the reforms were an abrupt departure from those followed by health secretaries over the past two decades, he said.

“There’s a danger that the politics is seriously getting in the way of the policy,” he said. “The Government needs to rebuild political support.”

Officials have signalled that the Government is prepared to make some changes to the legislation to appease the Liberal Democrats.

These include the dropping of a requirement to force GPs to take control of health budgets even if they do not want to. There will also be new protections so that private firms cannot “cherry pick” the most lucrative work. Any changes are expected to be made during the Bill’s passage through the Lords in June.

Lib Dem backbenchers will meet on Monday evening to discuss what Mr Clegg should ask for in his negotiations.

Today MPs on the Health Select Committee will issue a report likely to be critical of the contentious issue of GPs commissioning care.

From: http://www.telegraph.co.uk/David-Cameron-to-take-charge-of-under-fire-NHS-reforms

Labour ministers only paid £5 billion of the £65 billion “spent” on building more than 100 hospitals between 1997 and 2010.

The rest of the money, some £60 billion, must still be repaid by the taxpayer – with some of the gigantic debt lasting for more than 30 years.

The highest profile case concerns Barts and the London NHS Trust project, signed by ministers 2006, which provided two new hospitals in the capital.

By the time the coalition took office four years later nothing at all had been repaid – leaving an outstanding bill of £5.3 billion.

Jesse Norman, the Conservative MP, accused Labour of “extraordinary hypocrisy”. Their PFI bill for hospitals will cost every working family in Britain £3,600, according to Mr Norman’s figures.

PFI schemes were started by the last Conservative government under John Major in the early 1990s. However, they mushroomed under Labour with Gordon Brown, as Chancellor, using them as a way of meeting his own public borrowing rules.

Under the schemes, instead of the government raising money upfront, a private company is given a lengthy contract to build a school or hospital and then provides related ‘services’ to the public sector.

The Government leases the building for the length of the contract before it goes back into public ownership.

Any change, however small, to the building or service provided can be charged at sky high rates, allowing the company to make a huge profit.

New analysis of official figures shows that Labour initiated PFI contracts to build 103 new hospitals between 1997 and 2010. The party proclaimed at the time of the last election it has been responsible for a “new generation” of hospitals in Britain.

The total “unitary charge” payments for these hospitals was £5.1 billion. However, many projects will not be fully paid off for more than two decades – with the last one not “completing” until 2048.

The total accumulated “unitary charge” payments for the hospitals will be £65.1 billion – meaning that only 7.8 of the total was actually paid for before Labour left office.

Costs have escalated because of rising fees and additional charges for maintenance, cleaning and catering.

According to official figures, the NHS currently pays back £1.25 billion each year – but this figure will increase until 2030 when it is expected to hit £2.3 billion.

The Barts and the London NHS Trust project, to develop Barts into a “centre of excellence” for cancer and cardiac treatment and to build a new hospital at The Royal London , was started in 2006 – but payments will not even commence until 2013-14 and will not be finished until 2048.

By that time, it will have cost £5.3 billion despite only having a “capital value” of £1 billion, according to the Treasury.

Poorly negotiated PFI contracts have already led to examples of waste including Queen Elizabeth Hospital in Woolwich having to have 64 visits a year from pest controllers even if there are no pests to control. When there are pests, the trust must pay for further visits.

In another example, officials at the Central Middlesex Hospital in north west London said that, on average, contractors charged it £210 to install an electric socket.

Senior Labour figures including Gordon Brown strongly defended using PFI schemes while in power but, more recently, leading shadow ministers have admitted errors.

John Healey, the shadow health secretary, said earlier this month: “There is definitely a case for saying we were poor at PFI, poor at negotiating PFI contracts from the outset.”

Andy Burnham, a former health secretary who is now shadow education secretary, said last year: “We made mistakes. I’m not defending every pen stroke of the PFI contracts we signed.”

Mr Norman, a member of the Treasury select committee, said: “This shows extraordinary hypocrisy. The last Government claimed to be investing in public services.”

“In fact their true investment was less than less than one tenth of what they claimed. Labour didn’t manage to pay for even one new PFI hospital on their watch.”

“Labour maxed out the nation’s credit card with a £60 billion bill for new hospitals, loading future generations with staggering debt repayments.”

“After bringing the country to the brink of bankruptcy, they now have no credible plan to clear up the mess they left us with.”

“Their approach – to spend less without making any reforms at all – would leave the NHS in crisis.”

From: http://www.telegraph.co.uk/Labour-left-taxpayer-60billion-bill-for-new-hospitals

The current system is “a chaotic and unfair mess – patients in England have to pay, while those in Wales and Northern Ireland do not,” and from April 1 Scotland will completely scrap its charges, “a move that further exaggerates the absurd postcode lottery that exists in the UK,” said Dr Meldrum.

“The bureaucracy needed to administer prescription charges is cumbersome, many of the exemptions are confusing and unfair. Patients with disabling long term conditions still have to pay them, despite a recent report recommending they be phased out,” he added.

The BMA accepts that these are financially difficult times, said Dr Meldrum but, he added: “this is a tax on the sick that contributes only a modest amount to the NHS budget and does not offset the unfair disadvantage of asking the ill to pay for their medicine.”

Responding to the BMA’s charges, a Department of Health official claimed that around 90% of prescription items in England are already dispensed free of charge, and that the price of the 12-month prescription pre-payment certificate is to be frozen for the second year running, allowing patients to get all the prescriptions they need for an average of £2 a week.

Moreover, abolishing prescription charges in England would lead to a shortfall for the NHS of more than £450 million a year, equivalent to the salary costs of nearly 18,000 nurses, or 15,000 midwives or more than 3,500 consultants, the official added.

The Scottish National Party (SNP) pledged to scrap prescription charges during its election campaign in 2007, and since then the price has dropped each year. Last week, the Scottish Parliament’s health committee voted to finally remove the charge, which now stands at £3, defeating a last-minute attempt by Scottish Conservative Member of Parliament (MSP) Mary Scanlon, -  with the sole support of Liberal Democrat MSP Ross Finnie – to retain it.

Scottish Public Health Minister Shona Robison described free prescriptions as “a long-term investment in improving health” and dismissed allegations that the measure “will only help those people who are described as rich.”

“If people are put off seeking appropriate care for financial reasons their health will not improve, but if patients can get the treatment they need it will not only help their health but ultimately help to reduce the longer-term costs to the health service as well,” said Ms Robison. “Importantly, abolition will help all those people who have long-term health conditions which don’t currently entitle them to exemptions,” she added.

From: http://www.pharmatimes.com/Doctors_slam_UK_prescription_charge_lottery

The cuts in after-hours budgets led to warnings of a repeat of the case of Daniel Ubani, the incompetent German locum who killed a Cambridgeshire man with a morphine overdose in 2008.

About 78 of England’s 152 primary care trusts released information on their out-of-hours spending after Freedom of Information Act requests by the magazine GP. Twenty said they had cut their budgets.

The cuts, made in the trusts’ 2010-11 budgets, come before the start of the next four-year spending round, which will require the NHS to find efficiency savings worth £20 billion.

Across the remaining trusts that released information, total spending on out of hours care rose by only £3.6 million.

Health experts said some trusts might have been able to make savings without affecting services, by renegotiating inflated contracts.

However, doctors and patients’ groups said that in many cases lower spending would add to concern about the quality of care.

A study commissioned by the Department of Health last year found wide variations in the quality of care provided by out-of-hours contractors, including GP groups and private health care firms.

Katherine Murphy, the chief executive of the Patients’ Association, said the latest cuts would reduce the quality of care, risking “a repeat of the case of Dr Ubani”.

She said: “By pressuring providers to look for ever cheaper options, the Government is forcing them to enter a race to the bottom.

“Out-of-hours services need to be staffed by doctors who are as trained and experienced as their colleagues who work during the day. Cutting funds to pay for them will mean fewer and possibly less able doctors.”

Dr Fay Wilson, who chairs an out-of-hours group in Birmingham, said cutting out-of-hours care was a “false economy” for trusts because more patients would be forced to seek care from accident and emergency wards.

“If you are going to reduce the cost, then you will be reducing the number of clinicians you have on,” she said. “That leaves gaps. You also don’t get the same level of supervision and support.”

Richard Vautrey, of the British Medical Association, said cutting costs could harm services.

“There is a concern that you can pare a service down to such a level and reduce funding to such a level that you put patient safety issues at a higher risk,” he said.

The Department of Health said the Coalition was improving out-of-hours care. A spokesman said: “This is not about cutting costs – we are investing an extra £10.7 billion in the NHS – it’s about ensuring GPs, not bureaucrats, are responsible for securing safe and appropriate out-of-hours care.”

The BMA also published a poll which it said showed that most GPs opposed government plans to give them control over £80 billion of NHS budgets.

About 65 per cent of family doctors believe competition between providers, including NHS and private companies, will reduce the quality of patient care, while 61 per cent said the Government’s reforms mean they will spend less time with patients.

The Department of Health said the survey showed some doctors had “misconceptions” of the planned reforms. Andrew Lansley, the Health Secretary, said there was no alternative to his reforms to make the health service more efficient.

“Unless we modernise, every year the relative costs of running the NHS will go up,” he said. “Demand will grow, the bureaucracy will expand and inefficiencies will become entrenched.

“There is no easy option. Sticking with the status quo and hoping that a bit more money will be enough to meet the challenges ahead is a complete fiction.”

From: http://www.telegraph.co.uk/Patients-at-risk-as-health-trusts-trim-out-of-hours-care

Only those which professionally register all their staff are expected to be allowed to take part and the results of the tests will be published to give families information on what they can expect from individual homes.

Ministers have warned that only those institutions which meet the new standards are likely to be funded in future by local councils.

But critics of the plan said small independent care homes might not be able to afford the cost of registering for the new scheme and could go bankrupt, forcing residents to move even if the home was offering outstanding care.

The Independent has been highlighting the neglect of elderly residents in some homes, which campaigners say will get worse as public-sector cuts start to bite. More than half a million elderly people are in nursing homes and the number is expected to rise to 1.3 million by 2050.

Local councils spend around 50 per cent of their budgets on social care, the bulk of which is for the elderly. As a result of the public-sector funding cuts highlighting the neglect of elderly residents in some homes, which campaigners say will get worse as public-sector cuts start to bite.

More than half a million elderly people are in nursing homes and the number is expected to rise to 1.3 million by 2050.

Local councils spend around 50 per cent of their budgets on social care, the bulk of it on the elderly. As a result of the public-sector funding cuts announced in October’s comprehensive spending review, the same councils will have their budgets cut by up to 9 per cent a year for the next four years.

At Christmas, the Care Quality Commission (CQC) carried out spot inspections of 234 health and social-care institutions, including nursing homes, which revealed significant lapses in standards in more than a third of cases. Ten reviews resulted in the highest form of censure, which could to lead to the commission withdrawing licences to operate.

After one review, a nursing home in Luton – run by Southern Cross, Britain’s largest care-home provider – was closed immediately because conditions were so bad. The commission found that 26 other institutions were not meeting required standards in all areas and ordered improvements.

Later in the year, the Government will unveil its long-term plans for reforming the care sector. These are likely to include the introduction of a new “insurance model” to pay for care in later life. People without insurance forfeit their assets when they die to pay for care they have received.

Speaking before a consultation to decide how the excellence rating will be assessed, Paul Burstow, the Care Services minister, said good-quality care was not always about money. “Compassion, common sense, treating people with dignity and respect are not simply about spending more. They are about the way you do things. We want to look at what’s being done [in nursing homes] to add life to the years you’re having rather than just adding years to the life you’re leading.

“The new ratings will provide further pressure within the sector to improve. So it creates another lever for the commissioner to pull, to say we are only going to place people with you if you are excellent.”

The scheme will start out as optional and the cost of the inspections will be borne by the care homes. The commission’s chief executive, Cynthia Bower, said: “CQC’s role is to identify and react to signs that people may be at risk of receiving poor care. But this is not the same as saying other provider are offering ‘excellent’ care.

“An excellence award can recognise best practice, be a spur to improvement for providers who already meet CQC’s essential standards, and can help people who need longer-term care to make choices.”

Under the plans, all staff working for “excellent” nursing homes will likely have to be registered with a new Health and Care Workers Professions Council. This means care workers could be “stuck off” for poor practice and eventually the body could require minimum qualifications for registration.

“We want to see if we can work it on a voluntary basis but you probably won’t be able to have an excellence rating unless you employ people who are registered,” said Mr Burstow.

His long-term intention was to make the care system much more transparent and clear for both residents and their families,” he said.

From:  http://www.independent.co.uk/excellence-ratings-for-care-homes