Only 44pc recall hospital choice watchdog finds

Further evidence that the Labour’s “choice” policy is struggling as a means of driving reform in the National Health Service has come from the latest survey of how far it is being offered to patients.

A mere 44 per cent of patients could recall being offered a choice of hospital for their first outpatient appointment in May – down from 48 per cent in March – with provisional results for July showing a further decline to 43 per cent.

An even smaller proportion of patients were aware before visiting their GP that they had the right to be offered a choice of at least four hospitals. Just 38 per cent were aware of this right, although that figure for May is one percentage point up on March.

However, of those who were aware of their right to choose, only 63 per cent remember being offered a choice, a drop from 63 per cent on the March figure.

The Healthcare Commission, the NHS inspectorate, said this week that choice was the national NHS target that was being missed the most, with 2 per cent of primary care trusts in March achieving the indicators on which the effectiveness of patient choice is measured.


Nearly two years ago Health Direct posted, January 02, 2006 Choose and Book- your new right for NHS treatment

Most patients in England gain a historic new right this week – to be treated in a private hospital at National Health Service expense. The arrival of “patient choice” – the right to choose, initially from at least four hospitals, and by 2008 from any hospital prepared to meet NHS standards and prices – is a symbolic moment in the Labour government’s endeavour to use market forces to drive up health service performance.

Though quite how this policy will actually work in practise- with the introduction of the Choose and Book IT disaster– which it is currently hoped that it will be delivered 12 months late in December 2006, is anyone’s guess.

Experts criticise NICE drugs advisory body

Labour’s drugs advisory body NICE is issuing poor quality guidance because it excludes experts from the drafting process, doctors told MPs on Friday.

Experts on aspects of thrombosis attacked guidelines issued by the National Institute for Clinical Excellence (Nice) for lack of consultation and inappropriate use of evidence.

Dr Beverley Hunt, medical director of Lifeblood, the thrombosis charity, told the Commons health committee: “The Nice process doesn’t use experts well.”

She said specialists in the field were often excluded for fear of conflicts of interest, but those drafting drugs guidance lacked understanding of the scientific data they were reviewing.

Dr Hunt argued that suitably qualified experts should be more closely involved, and that conflicts of interest could be tackled through disclosure and excluding only those who derived more than 10 per cent of their salary from products linked to their advice.

Conflicts could be further minimised by allowing experts to act as advisers rather than formally being among the drafters of guidance, she said.

Dr Hunt’s criticisms were shared by Prof Roger Atkins from the British Orthopaedic Association, who expressed frustration that his colleagues “who have dedicated 20 to 30 years of their lives [to the subject] were simply not involved” in drafting relevant guidance.

Prof Atkins said some guidance issued last year had “very significant flaws”, and it had proved difficult to discuss and propose amendments with the Nice committee concerned.

Richard Barker, director-general of the Association of the British Pharmaceutical Industry, the trade body, endorsed the calls, but stressed that drug companies were keen to consult leading specialists when designing clinical trials.

Nancy Devlin and John Appleby from the King’s Fund, the health think-tank, called for the creation of an independent review mechanism separate from Nice to assess its cost-effectiveness threshold – similar to the Bank of England’s monetary policy committee.

Drugs watchdog faces legal review- NICE’s approach is irrational and flawed

Health Direct notes that even the experts are questioning the deliberations of the National Institute for Curbing Expenditure.

On Fri 17 Nov 06 Health Direct posted- Drugs watchdog faces legal review- NICE’s approach is irrational and flawed

A decision by the Labour government’s drugs watchdog to restrict the use by the NHS of Alzheimer’s medication is to be challenged in court.

Two drug companies plan to apply for a judicial review of the way the National Institute for Health and Clinical Excellence reached its conclusion. NICE ruled NHS patients with newly diagnosed, mild Alzheimer’s disease should not be prescribed the drugs.

Neil Hunt, chief executive of the Alzheimer’s Society, said: “It’s great news that NICE will be challenged in court. NICE holds the fate of thousands of people’s lives in its hands and it is only right that it is brought to account.”

Record numbers go abroad for health treatments

Record numbers of Britons are flying abroad for medical treatment to escape NHS waiting lists and the rising threat of hospital superbugs. More than 70,000 Britons will have treatment abroad this year, a figure that is forecast to rise.

Thousands of “health tourists” are going as far as India, Malaysia and South Africa for major operations – such is their despair over the quality of health services.

The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration with NHS waiting lists are fuelling the increasing trend.

More than 70,000 Britons will have treatment abroad this year – a figure that is forecast to rise to almost 200,000 by the end of the decade.

Patients needing major heart surgery, hip operations and cataracts are using the internet to book operations to be carried out thousands of miles away.

India is the most popular destination for surgery, followed by Hungary, Turkey, Germany, Malaysia, Poland and Spain. But dozens more countries are attracting custom.

Research by the Treatment Abroad website shows that Britons have travelled to 112 foreign hospitals, based in 48 countries, to find safe, affordable treatment.

Almost all of those who had received treatment abroad said they would do the same again, with patients pointing out that some hospitals in India had screening policies for the superbug MRSA that have yet to be introduced in this country.

Andrew Lansley, the shadow health secretary, said the figures were a “terrible indictment” of labour government policies that were undermining the efforts of NHS staff to provide quality services.

The findings come amid further revelations about the Government’s mishandling of NHS policies, and ahead of official statistics that will embarrass ministers:

• On Wednesday, figures are expected to show rising numbers of hospital infections. Cases of the superbug Clostridium difficile, which have risen five-fold in the past decade, are expected to increase beyond the 55,000 cases reported last year.

• On the same day, statistics will show that vast sums have been spent on pay, with GPs’ earnings rising by more than 50 per cent in three years to an average of more than £110,000.

• New research shows that growing NHS bureaucracy has left nurses with little time to see patients – most spending long periods dealing with paperwork.

Katherine Murphy, of the Patients’ Association, said the health tourism figures reflected shrinking public faith in the Government’s handling of the NHS.

“The confidence that the public has in NHS hospitals has been shattered by the growth of hospital infections and this Government’s failure to make a real commitment to tackling it,” she said.

“People are simply frightened of going to NHS hospitals, so I am not surprised the numbers going abroad are increasing so rapidly. My fear is that most people can’t afford to have private treatment – whether in this country or abroad.”

Some foreign hospitals touting for business on the internet offer consultations in hotels in Britain. But other patients are happy to rely on email to discuss their treatment with doctors thousands of miles away.

Low prices in India, where flights, hotels and a heart bypass cost less than half the price charged by British private hospitals, explain its top ranking in the survey by Treatment Abroad, a British website providing information on hospitals overseas.

Hungary’s popularity rests on a boom in dentistry, thanks to a shortage of NHS dentists in Britain.

Mr Lansley said: “Healthcare is an area where Britain could be a world beater because we have some of the best research and best clinicians. If people don’t trust the health service, then that is a terrible indictment of this Government, which has turned the NHS into a nationalised bureaucracy, instead of something able to focus on what patients want.”

The British Medical Association advised people to be careful when considering treatment abroad, highlighting the dangers of flying soon after surgery, which can cause complications.

A spokesman said: “Travelling can place a great deal of stress on the body. Patients travelling abroad for surgery should consider their fitness to fly and get an understanding of an appropriate convalescence period before attempting to return home.”

A Department of Health official said the number of patients seeking treatment abroad was a tiny fraction of the 13 million treated on the NHS each year.

Waiting times had fallen. Almost half of patients were treated within 18 weeks of seeing a GP. Most people who had hospital care did not contract infections.


Health Direct is incredulous. The complacency of Department of Health officials and ministers is breathtaking. For someone to say “most people who had hospital care did not contract infections” is disgraceful. Why should ANYONE be treated in dirty hospitals?!

Tories on attack over MRSA, C Diff hospital superbugs

Labour ministers knew about the findings of a report into 90 patient deaths from Clostridium difficile at Kent hospitals months ago, the Conservative party claimed this week.

Andrew Lansley, opposition health spokesman, accused the government of taking too long to address the problem and said something had “gone wrong” within the Department of Health.

In a report published earlier this month, the Healthcare Commission, the National Health Service inspectorate, found that a “litany” of errors led to at least 1,170 patients being infected in outbreaks of C. difficile at the Maidstone and Tunbridge Wells NHS Trust over two years.

Alan Johnson, health secretary, told parliament he had received the report on October 9. But the Conservatives alleged that the health department had received an initial draft report on May 3 and a further draft on September 12.

Mr Lansley said: “As health secretary, Alan Johnson has the power to suspend NHS board members, so why wasn’t this exercised until after patients and the media learnt the contents of the report?”

The DoH said: “The report received on May 3 was an early outline of the final report, and did not contain either recommendations or conclusions for ministers.”


Coming only days after Health Direct learnt that labour’s own MRSA report was buried as it carried bad news, this new report compounds the culpability of labour health ministers.

As 40 to 50 people every week die from MRSA, Clostridium Difficile and other superbugs in UK hospitals, it’s the equivalent of a plane crash every month.

Every week that labour ministers and health officials bury their heads in the sand and ignore warnings there will be a growing and huge outcry when the general public wake up to their negligence.

Labour rewards drug addicts as only 6pc of users are free of drugs each year.

Heroin and cocaine addicts on the labour government’s treatment programme are being given drugs as a reward for clean urine samples, Health Direct has learned.

The National Treatment Agency (NTA), which runs the £500m-a-year scheme, admits the practice is “unethical”.

Its own survey of almost 200 clinics in England found users were being offered extra methadone, a heroin substitute, or anti-depressants for good behavior.

A third of clinics in the survey said users who produced a drug-free urine sample may be offered increased doses of heroin substitute as a reward – known as “contingency management”.

A quarter admit that clients can choose the type of substitute drugs they want.

The survey also found clinicians offering anti-depressants, cash vouchers or access to detox as a reward.

The NTA said offering drugs for anything other than clinical need was wrong and it wanted certain practices “squeezed out of the system”.

The agency’s chief executive Paul Hayes told the BBC: “One of the things that’s important before we start rewarding people through things like contingency management is to make sure that we’re doing it according to the best principles for drug treatment.

He said the NTA was set up to not only expand the provision of drug treatment, but also to improve its quality.

He added: “It is entirely appropriate to prescribe other drugs alongside prescription drugs that are to deal with withdrawal. Not as a reward, which is why we wouldn’t advocate it.

“What we would say is the dose people get ought to be determined by the individual’s needs, not by whether or not they’re co-operating with the regime.

“That’s why the contingency management programme that we’re thinking of introducing, based on American research, is going to be very different to the ad hoc rewards that operate in not very well managed services in this country at the moment.”

Martin Barnes, chief executive of drug information charity DrugScope, said it was “appalling” to offer drugs as a reward.

“The idea of bribing the patient to achieve a result which wasn’t actually something they felt important is quite abhorrent” said Dr Michael Ross who was a drug service clinical director in Bradford

“It is a complete distortion of the principles of ‘contingency management’,” he said. “The practice is unethical, contrary to official guidance and creates potentially serious risks for the drug user.”

Matthew Taylor, of the Royal Society of Arts, a think tank looking at how best to get addicts off drugs, said an overhaul of current policies was needed.

“I think the reality is that our drug strategy just isn’t working,” he told BBC One’s Breakfast.

“Only a very small proportion of those people who are put through drug detoxification successfully complete the programme, and even when people do successfully complete the programme they revert to drug use very quickly.

“So we need a different approach, and the fact that some people feel that they need to incentivise drug users with other drugs in order to keep them off illegal drugs is, I think, part of that general problem.”

The drugs treatment project is the centrepiece of labour government strategy. Only about 6% of users on the programme leave free of drugs each year.

However, there is evidence that giving addicts access to services can reduce crime and improve health even if they continue to take drugs.


Drug addicts problmes are compounded by labour’s failed financial fudges. On August 01, 2007
Health Direct posted: Hypocrite Stalinist Brown cuts £50m from drugs rehab budget

The flagship labour government scheme for treating drug addicts faces swingeing budget cuts of £50 million.

Plans to slash total funding by more than 12 per cent, outlined in an email leaked to The Sunday Telegraph Health Direct has learnt , come less than a fortnight after Stalinist Brown tried to show off his anti-drug credentials by signalling his desire to reclassify Cannabis from Class C to the more serious Class B. The Conservatives accused the Prime Minister of hypocrisy.

Ministers bury report on MRSA, C Difficile superbugs

Once again Health Direct learns that labour’s ridiculous health targets are resulting in many NHS patients having an early death and or unnecessarily pain. The Financial Times discovered that there is a direct correlation between be occupancy rates and incidents of patients contracting MRSA, C Difficile and other superbugs.

Why have ministers been sitting on a report that shows a dramatic link between outbreaks of hospital superbugs and high levels of bed occupancy?

The Financial Times understands that a report, commissioned by the Department of Health and based on research covering every hospital in England, reveals that MRSA rates are a staggering 42 per cent higher in hospitals with bed occupancy rates of 90 per cent or more than in those with occupancy rates below 85 per cent.

In hospitals where bed occupancy rates are 85-90 per cent, infection rates are 16 per cent higher. In spite of rising public anxiety about hospital infections, I am told that this research, which covered 2001-02 to 2002-03, has been gathering dust for more than two years.

Had ministers acted on the research instead of suppressing it, lives might have been saved – not least in hospitals run by the Maidstone and Tunbridge Wells Trust, where superbugs killed at least 90 patients. In a damning report on the Maidstone tragedy last week, the Healthcare Commission blamed “pressure on beds” and the trust’s desire to meet government targets.

Why is high bed occupancy directly linked to infection rates? Because it means that often there is not enough time to clean beds properly – sometimes the sheets are not even changed.

At Maidstone, nurses told patients with diarrhoea to “go in the bed” and then left some for hours in soiled sheets. If beds were cleaned superficially afterwards, it is little wonder so many died.

Crucially, the report indicates that there is no link between infection rates and bed occupancy provided the levels are below 85 per cent.

The pity is that in the past five years, with the labour government using targets to press hospitals into cutting waiting times and improving financial performance, the proportion of hospitals with more than 90 per cent bed occupancy has risen from 13 per cent to 20 per cent.

Had ministers not suppressed this report, might not some National Health Service trusts have thought twice about increasing patient throughput?

There are all the hallmarks here of labour ministers trying to cover up inconvenient truths.

Public discussion of the report might have forced them to take a more flexible approach to NHS targets. There is talk of bringing criminal charges against the Maidstone NHS Trust.

Perhaps the police should widen their inquiries to find out what ministers knew about superbugs and whether they gave adequate support and information to health workers on the ground.


Health Direct continues the Police investigation point. In Superbug hospital may face criminal charges over 331 C difficle deaths on Fri 12 Oct 2007 we noted that hospital managers could face criminal prosecution for the worst ever recorded outbreaks of the superbug Clostridium difficile which killed at least 90 patients.

Inadequate staffing levels, dirty wards and too much focus on cost-cutting and government targets contributed to two serious outbreaks of C difficile in as many years at Maidstone and Tunbridge Wells NHS Trust, an investigation by the Healthcare Commission found.

DIY dentistry- lack of access to NHS Dentists leaves people having to pull their own teeth

Problems with getting an NHS dentist are leading some people to pull their own teeth out. If that’s not enough to make you wince, then the potential pitfalls will be. There are people out there pulling their own teeth out with pliers.

It’s the most gruesome image accompanying the allegations that there’s a crisis in dentistry provision in the UK.

Mark Cowley is a furniture restorer from Wisbech in Cambridgeshire. After travelling long distances to get temporary procedures done, and having suffered the cracking of his tooth, he decided to take matters into his own hands.

He picked up a pair of mole grips, plier-like tools, and pulled the offending tooth out. “I just got a bit desperate and this tooth was waggling. There’s no pain in it now.”

His friends and family do “get a bit squeamish” when they hear about his DIY dentistry. But what do the experts advise about tackling your own gnashers?

Professor Liz Kay, dean of the Peninsula Dental School in Plymouth, stresses that anybody who is able to pull out their own teeth probably has extremely advanced periodontitis, a collection of diseases that cause the loss of the bone supporting the teeth.

Robert Jagger, senior lecturer in restorative dentistry at Bristol Dental School, says cases of people with periodontitis removing their own teeth are not unusual.

“It can sound absolutely horrendous, but in the case of periodontitis, one of the things is that they become very, very loose. It has been reported very frequently over the years. You could get some pain but I don’t know if there’s a greater risk of infection [than in a dentist’s surgery].”

Of course, if you mess it up, leave a fragment of a broken tooth remaining, and you risk abscess and infection. And, as Prof Kay, points out, the complex anatomy of the head means one doesn’t want to be messing around in there for fear of doing something exceedingly bad.

However, while pulling out a waggly tooth is one thing, the reports of people who have used powerful household glue to put a crown back in place are not good.

“It is a very foolish thing to do,” Prof Kay suggests. “If you superglue it and there’s any problem you are going to lose the tooth.”

And if you’ve done a procedure in a permanent fashion and put your crown or filling in the wrong place, you are not likely to notice until it’s too late to get help.

“There are more insidious dangers. Things may appear to be OK but the filling is still leaking,” Mr Jagger adds.

At the other end of the DIY spectrum are the dental first aid kits, provided mainly for tourists and recognised as an option for emergencies by dentists, which contain the tools to deal with a dislodged filling or crown until you get back to civilisation.

A kit might contain zinc oxide powder and eugenol, effectively clove oil. Mix it together and you can improvise glue for a crown, or a filling. It can hold for a few days at least with the dentist removing the material and doing a proper job.

As a “very, very temporary measure” such kits are “useful” for people on holiday, says Prof Liz Kay.

Jenny Lees, managing director of Dentanurse, says her firm has doubled the sale of kits over the last five years, and suggests they are being used domestically as people cope with long waits for NHS dentists.

Sticking a crown back in place is safe and simple as long as people read the instructions. But they should do it themselves.

“Legally you shouldn’t get someone else to do it. If someone else does it for you they are breaking the law by practising dentistry.”

“It’s like making custard, as long as you read the instructions you are fine,” she says.

Rose Matthews, 24, found herself left in the lurch and needing the kits when her dentist stopped a procedure midway and told her it could not be completed on the NHS. Being unable to afford the fee, she endured an 18-month wait for NHS treatment. The hole in her drilled-out tooth was tackled using a kit once a month.

“It was quite difficult and quite painful and because I couldn’t do it properly the walls of the tooth were starting to break away.”

But despite the less than ideal solution, it was a lot better than plan A.


Health Direct feels that the plight of people needing urgent dentistry is both distressing and unnecessary.

On April 02, 2007 Health Direct posted: Labour’s dentistry health reforms ‘have failed’

Radical Labour Government reforms to improve patient access to NHS dentists have failed, it was claimed today. The charity Citizens Advice said there is “huge inequality” in access to dentists in England and Wales, and urged action to deal with “dentistry deserts” in many areas including some parts of Hampshire and Lancashire.

It claimed two million people are forced to put off treatment or go private because they can’t find an NHS dentist.

Susie Sanderson, chair of the BDA’s executive board, said: “When the Government is failing to meet even its own success criteria for the new contract, then it’s time for urgent action.

“We now have a reductive, target-driven system that is failing both patients and dentists. The future of NHS dentistry is becoming increasingly fragile and we need action now before it shatters altogether.”

On April Fools Day in 2006 Health Direct warned- The saddest April Fool joke of all- D Day for Dentists- 1,000 dentists expected to quit NHS in contract row.

Unfortunately, not an April Fool joke but an exodus of about 1,000 dentists from the NHS in England was predicted last night by the chief executives of primary care trusts, who take over untried and untested management of the service from today.

The NHS Confederation provided the first hard evidence of how patients will be affected by a dentists’ contract that came into effect at midnight.

Nanny state burns £500m on failed anti smoking campaigns

The National Health Service has spent almost £500m on services to stop people smoking but with no discernible impact on either the proportion of the adult population that smokes or the numbers smoking.

Since the NHS rolled out its smoking cessation programme in 2001, it claims that almost 1.4m people have given up smoking as a result of the £470m it has spent on stop-smoking clinics, nicotine replacement therapies and the anti-depressant Zyban, which reduces the craving for cigarettes.

But the proportion of the adult population that smokes in England has remained constant at 24 per cent, according to official figures. The actual number who smoke has, if anything, grown.

According to the Office for National Statistics, the number of adult smokers is up from about 9.5m in 2001 to nearer 9.9m in 2006, although that increase in part reflects a growth in the adult population. It may also reflect high rates of smoking among migrants from eastern Europe, according to the anti-smoking charity Action on Smoking and Health.

The sharp discrepancy between the numbers smoking and the NHS’s claim that 1.4m have quit comes because the Department of Health measures “quitters” as those who have stopped smoking for just four weeks – although its own research shows that 90 per cent of those who stop end up starting again within two years.

Colin Talbot, professor of public policy at Manchester Business School, said: “These figures suggest that not only has the government’s campaign not actually reduced smoking at all, but at the same time they were spending £500m the proportion smoking actually flat-lined when it had – up until then – been falling.

“Common sense alone ought to have told health department officials that a four-week cessation was likely to be highly misleading. The department clearly needs to review both the anti-smoking campaign and how it measures its effectiveness.”

The programme was defended, however, by Robert West, director of tobacco studies at Cancer Research UK’s health behaviour unit at University College London.

He estimates that only 20 per cent of the 1.4m are likely to have given up smoking successfully in the long term, and two-thirds of those might well have given up anyway. But even if the programme had stopped only 100,000 people smoking it remained “a very cheap way of saving lives – much, much cheaper than heart operations and tablets to control blood pressure”, Professor West said.

The Department of Health rejected the idea that the programme had been ineffective. It said independent academic research in the journal Addiction had judged it to be “extremely cost effective” and indeed “the most cost-effective of any intervention” provided by the NHS.

However, Alan Maynard, professor of health economics at the University of York, said it was “very sad that the NHS has spent so much money on this to so little effect”. Scottish evidence suggested the ban on smoking in public places recently introduced in England might have a far bigger health impact, he said.

The NHS is spending about £100m a year on the stop-smoking programme at a time when the growth rate of NHS spending is set to slow.


Whilst Health Direct acknowledges the importance of reducing smoking, why doesn’t labour target the more serious damage that drinking alcohol causes both to it’s imbibers and the NHS in treating the more resultant harm?

On Aug 02, 06 Heath Direct posted- Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal

Health Direct reproduced the first ranking based upon scientific evidence of harm to both individuals and society. It was devised by labour government advisers – then ignored by labour ministers because of its controversial findings.

The analysis was carried out by David Nutt, a senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council. Copies of the report have been submitted to the Home Office, which has failed to act on the conclusions.

The rankings concluded that Alcohol (Legal) was ranked at number Five, Tobacco (Legal) at number Nine and Cannabis (Class C) at Number 11.

Quarter of NHS trusts are failing on C Difficile, MRSA superbug infections

A quarter of hospital trusts in England are failing to meet new standards on infection control, a survey by the Healthcare Commission has found. Forty four trusts were not complying with one or all aspects of the hygiene code, standards seen as key after the recent deaths from hospital infections.

The general picture in the watchdog’s annual health check of England’s trusts was, however, one of improvement. But regional divides persist, with the north performing better than the south.

Trusts were rated on two principle categories: quality of services and how they had managed their finances.

Nineteen trusts scored “excellent” on both parts of the rating, up from two last year.

But 20 were deemed “weak” – the lowest scoring – on both counts, four of these for two years in a row.

Health Secretary Alan Johnson said he had asked the commission to re-inspect the 44 trusts failing on infection.

He also said that if the chief executive of the NHS was unable to resolve the situation through talks with the boards at the four weakest hospitals, one option would be a takeover by a well performing trust.

The four comprise West Hertfordshire Hospitals NHS Trust, Surrey and Sussex Healthcare Trust, Northern Devon Healthcare Trust and Royal Cornwall Hospitals NHS Trust.

Meanwhile, the proportion of operations which were cancelled fell for the third year in a row.

But there were targets not being met: some 70% were failing on “convenience and choice”, which says patients should be able to choose from four different NHS providers.

This, the commission said, was primarily because GPs were not contractually obliged to offer the choice, and technical problems with the computer booking system were not uncommon.

The disappointing findings on infection control were partially mitigated by the fact that new and more rigorous standards were introduced in October 2006, the commission said.

“The bar was raised dramatically on infection control and that explains why trusts seem to be performing worse than in the past,” said chief executive Anna Walker.

But the findings on the failure of some trusts to ensure hygiene standards – including cleaning hands and instruments – comes just a week after serious such shortcomings at the Maidstone and Tunbridge Wells NHS Trust were blamed for the deaths of up to 90 patients from C. difficile.

Overall, the South West strategic health authority (SHA), one of the 10 covering the country, had the highest proportion of weak trusts. The South East Coast SHA had the lowest proportion of “excellent” trusts and the highest combination of “weak” and “fair”.

Health Direct also shows the good NHS news. The following were rated as excellent trusts
Basingstoke and North Hampshire
Birmingham Children’s Hospital
Calderdale and Huddersfield
Cambridge University Hospitals
Chelsea and Westminster Hospital
Chesterfield Royal Hospital
Frimley Park Hospital
Guy’s and St Thomas’, London
Heart of England
Liverpool Women’s Hospital
Papworth Hospital
Queen Victoria Hospital
Salford Royal
Sheffield Children’s
Sheffield Teaching Hospitals
Royal Marsden
Yeovil District Hospital
South Essex Partnership
South Staffordshire Healthcare
Trusts rated excellent in both principle categories

The East Midlands SHA had the highest proportion of “excellent” trusts and the North East SHA had the highest combination of “excellent” and “good” trusts.


Health Direct has long been warning about the disaster that is MRSA, Clostridium difficle and superbugs in general. What we want is CLEAN hospitals not clean ER hospitals. Until politicians develop a zero tolerance towards poor hygiene more people will continue to die unnecessarily.

On Thu 11 Jan 07 Health Direct posted NHS hospitals may never achieve MRSA superbug targets as the NHS is not on track to meet its MRSA target and perhaps never will, a leaked government memo says.

In November 2004, then health secretary John Reid pledged MRSA rates would be halved by April 2008. But the memo, sent to ministers by a Department of Health official, said it would only be cut by a third by then. It also reportedly recommended ways to handle the news in the media. Dr Mark Enright, from Imperial College, said the target was “unrealistic”.

The document went on to discuss six options for “handling” the target. Of the six, just one recommends simply trying to meet the current target – the other five discuss ways of changing the target or timescale, or dropping the target altogether.

The memo also warns that another superbug, Clostridium difficile, is now “endemic throughout the health service, with virtually all trusts reporting cases” and shows that 2004 saw twice as many deaths from the bug as were related to MRSA.

And it warns that efforts to combat MRSA, such as alcohol handrubs, have had no impact on C. difficile, which it describes as a “far bigger problem”.

Health efficiency gains data uncertain

Up to three quarters of the £13.3bn efficiency gains the labour government claims to have made may be based on unreliable and inaccurate estimates, a committee of MPs has found.

In a scathing report into the Gershon efficiency drive, the Public Accounts Committee (PAC) argues that just £3.5bn of the gains “represent efficiencies”. The remainder of the savings are “uncertain” because departmental calculations are often inconsistent, unsustainable, unsound and incomplete.

Service quality may have deteriorated instead of improved in some instances, the report claimed. Patients spending less time in hospital were classified as an efficiency saving, for example, in spite of a rise in re-admission rates.

The committee’s conclusions echo the findings of an investigation by the National Audit Office this year. Edward Leigh, PAC chairman, said the Treasury claim “does not stand up to close scrutiny”. “Too much of the data on which claims of efficiency gains are founded is simply unreliable.”

As he underlined in Tuesday’s pre-Budget report, Alistair Darling, the chancellor, aims to make £30bn of savings by 2010 with departments making 3 per cent efficiency savings every year.

Many projects included one-off savings rather than long-term improvements, excluded ongoing costs to maximise the apparent gains and misrepresented staffing figures to show headcount reductions.

A £300m saving by the Department of Work and Pensions from paying benefits electronically, for example, failed to take account of the £164m cost of the Post Office card account, through which some of those payments are made.

The committee concluded that the Office of Government Commerce, which verifies efficiency claims, left many calculations “insufficiently challenged”.


On March 02, 2006 Health Direct posted Why is NHS productivity falling- yet Labour claims it could be rising? when the Office for National Statistics started a fierce disagreement over output and productivity in the National Health Service this week as it launched a consultation into the issue.

The ONS reported that different techniques could show NHS productivity rose by 1.6 per cent a year between 1999 and 2004 or that it fell by 1.5 per cent a year. Official figures show a decline of close to 1 per cent a year.

The Department of Health’s preferred view raises NHS output by 2.68 percentage points a year, while independent research by the National Institute of Economic and Social Research and the University of York recently estimated a more modest uplift to NHS output of 0.17 percentage points. This would not be enough to show rising health productivity.

The most controversial element in the department’s reasoning is an automatic 1.5 percentage point a year uplift in measured NHS output to reflect the increased value of public services as society becomes richer.

Another problem was the Department of Health’s assumption that patients’ satisfaction at cleaner hospitals has as much weight in its calculations as the NHS’s ability to save lives. Andrew Street, a senior research fellow at the University of York, said there was no “empirical basis for the weights” the department used.