Ward cleaning is reassurance spin admits Johnson

The £50m a year that the labour government is to spend on routinely deep cleaning hospital wards is being spent to reassure the public rather than as a provenly effective way to tackle hospital acquired infections like MRSA admitted Alan Johnson the Health Secretary.

Microbiologists warned on the day that Gordon Brown, the prime minister, announced the “deep clean” policy that such routine annual cleans would be ineffective and the medical journal The Lancet has since said they will not affect the risk of infection.

Challenged by MPs on the Commons’ health committee that the policy was really “more a publicity exercise than evidence based”, Mr Johnson said that would be “a fair point to make if the only thing we were announcing was deep clean”.

From:
http://www.ft.com/cms/s/0/2836088a-9ee7-11dc-b4e4-0000779fd2ac.html

Brown’s claim to competence is already finished – kaput. He sold our gold reserves at giveaway prices, vandalised our pension schemes with the sledgehammer of tax, opened the doors to unchecked immigration (ministers have no idea how many foreign workers are here), demanded unconscionable sacrifices from our Armed Forces (for which they pay in blood), and managed the nation’s money so ineptly that, despite a long period of economic growth, the United Kingdom is on course this year for a £40 billion shortfall in public finances, £6 billion more than Brown predicted in his last Budget.

On July 24, 2006 Health Direct posted NHS targets blamed as crowded wards increase risk of superbugs when we noted that there is a scientific correlation between high bed occupancy rates with high MRSA superbug ineffections, and deaths.

Government targets to cut NHS hospital waiting times are putting patients at increased risk of infection with the superbug MRSA, an official report has revealed. An internal policy review conducted by the Department of Health, leaked to The Independent, has for the first time shown that there is a direct link between the number of patients in hospital – measured by bed occupancy – and MRSA rates. Ministers have denied there is a link.

The most crowded hospitals, with occupancy rates over 90 per cent, have MRSA rates that are over 42 per cent higher than average, according to the report. Those with occupancy rates above 85 per cent have MRSA rates 16 per cent above average.

The findings of the review are considered so sensitive that two attempts by The Independent to obtain the report under the Freedom of Information Act were rejected. Reducing bed occupancy in all NHS trusts to a maximum of 85 per cent would save 1,000 cases of MRSA a year, it says.

The latest figures for 2004-05 show that 88 NHS trusts in England, one fifth of the total, had occupancy rates over 90 per cent and almost half (45 per cent) had occupancy rates over 85 per cent.

One in 10 suffers hospital harm as blunders kill 90,000 patients

Accidents, errors and mishaps in hospital affect as many as one in 10 in-patients, claim researchers. The report in the journal Quality and Safety in Health Care said up to half of these were preventable. Checks on 1,000 cases in just one hospital found examples of fatal surgical errors, infections and drug complications.

Researchers from the University of York experts say more should be spent on monitoring “adverse incidents”.

The labour government has encouraged trusts in recent years to spend more effort looking at complications and mistakes involving their patients.

Managers are supposed to report even “near misses” in which patients suffered no harm, so that lessons can be learned.

However, other studies have suggested that the reporting rate is poor. The University of York study focused on a single major acute hospital in England, and pored over the notes of 1,006 people admitted into it.

Possible under-estimate

While 87 people had definitely suffered at least one “adverse event”, the researchers said it was likely that even more had suffered harm.

Alongside more than 40 infections, there were 27 complications during or following operations, 19 drug complications, and 12 cases of bedsores. Between 30% and 55% of these could have been prevented by clinical staff or managers.

Examples of preventable incidents included a mistake in an operation which led to the death of the patient, another which caused lifelong damage, and a case in which a patient became addicted to opioid drugs after being given a high dose during and after a hospital stay.

Professor Trevor Sheldon, who led the research, said that “finger-pointing” was not the answer – although the scale of the problem meant that more resources should be spent tackling it.

“The rates we found do not show that the NHS is faring worse – this is an international issue, and other countries have similar or worse rates.

“The question we have to ask is whether the NHS is currently doing enough to help people find the time to reflect on these cases and learn lessons from them.

“Our research does confirm though that hospitals are not completely safe places, and that people should try to steer clear of them unless absolutely necessary.”

A spokesman for the NPSA welcomed the study, and said it was working with the NHS to improve safety.

“Around 13 million people are admitted to acute hospitals each year in England and Wales. Most people are cared for safely, however regrettably sometimes things can and do go wrong.”

From:
http://news.bbc.co.uk/1/hi/health/7116711.stm

On March 08, 2005 Health Direct posted: 25,000 die from preventable VTE
as each year over 25,000 people in England die from venous thromboembolism (VTE) contracted in hospital.

This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than twenty five times the number who die from MRSA. The figures are alarmingly high.

“It’s frustrating that in 2006 we do not have a clearer idea of how many people die or are harmed when this could have been avoided” Sir Ian Kennedy, of the Healthcare Commission. To illustrate his point, he said the National Audit Office could only estimate the number of deaths as a result of patient safety incidents ranged from 840 to 34,000.

Health Direct suggests that being treated in a UK hospital is now three times as dangerous as it was only three years ago.

Dirty ambulances spread MRSA superbugs infection

Ambulances may be spreading infections because they are not being cleaned properly, union leaders warn. An investigation by Unison found large variations in cleaning practices at ambulance trusts in the UK.

Some areas do not have dedicated cleaning staff and ambulance crews are left to give the vehicles a “quick mop out”, the health union said.

The government said it expected trusts to follow national guidance on ambulance cleaning.

Unison called for cleanliness standards to be properly applied and monitored across trusts to improve standards.

Ambulance crews questioned by the union said targets, time and money were all to blame for different cleaning practices between trusts. In the worst example, ambulance crews in the North West have no dedicated cleaning staff or cleaning time.

Paramedics report that they do not get time to even check the vehicles, which are never deep cleaned.

The only precaution is that if staff know a patient is infected, for example with Clostridium difficile, the ambulance will be mopped out.

At the other end of the scale London Ambulance Service has introduced on-site cleaners who work throughout the night to routinely deep clean the fleet.

They also restock ambulances with fresh kit, freeing up paramedics for seeing patients. Effectively, crews bring in a dirty vehicle and leave with a cleaned one, Unison said.

In the South West, funding problems are causing delays to plans to employ staff to carry out deep cleaning, staff said.

And paramedics in Wales agreed not enough was being done although the service is looking at a similar deep clean system to that used in London. Sam Oestreicher, Unison national officer for ambulance staff said: “The government recently announced extra money for deep cleaning hospitals, but ambulances seem to have been forgotten.

“They are part of the patient care package and no one should have to travel or work in a dirty ambulance.

He added: “In many trusts, ambulance crews are responsible for cleaning their own vehicles and this is a waste of their time and training.

“They should be out there saving lives not mopping out the back of a dirty ambulance.”

He said existing voluntary guidelines should become mandatory standards. But stressed that extra funding would be needed if or resources would be cut elsewhere.

“The Ambulance Service Association has issued guidance and we expect trusts to follow this. “Trusts should also take cleaning time into account when managing their supply of ambulances to attend emergency calls.”

From:
http://news.bbc.co.uk/1/hi/health/7109769.stm

Last minute private operations cost NHS more when broken targets loom

NHS hospitals and primary care trusts are paying private hospitals excessive prices because they treat patients at the last minute, the industry says. This is despite the availability of more than 120 independent hospitals and surgical centres that will treat patients at NHS prices or just above.

Before the arrival of the first treatment centres, private hospitals frequently charged 30 to 50 per cent above the NHS price.

The treatment centres helped to drive that cost down and the growing number of private hospitals on the so-called “extended choice network” treat patients at the NHS price, so long as they can control the workflow.

However, hospitals and primary care trusts in which patients are in danger of breaching waiting-time targets have reverted to “spot purchasing” – buying operations at the last minute, say Richard Jones, commercial director of Spire Healthcare (formerly Bupa Hospitals), and David Mobbs, chief executive of Nuffield Hospitals.

“We are not bound by the tariff [the NHS price] when we are called in as a distress purchase caused by the need to treat patients urgently so that they do not breach waiting times,” Mr Jones said.

“It costs us more because we cannot plan our spare capacity in the way we can when patients choose to use us, or the primary care trust has a longer-standing contract.

“It would be better value for money for the NHS if we were able to treat patients in a planned way or through patients choosing to come to us, as they are entitled to.”

Neil Bentley, director of public services with the CBI employers’ group, said the re-emergence of spot purchasing “shows why it does not make sense to cut back on the second wave of independent treatment centres”, as ministers are expected to do this week.

“Does the government really want to go back to a regime where it will cost the NHS more to get patients treated?”

From:
http://www.ft.com/cms/s/0/bddd10a8-9308-11dc-ad39-0000779fd2ac.html

NHS underspends by £1.8bn

The NHS is heading for a record £1.8bn underspend this financial year, Health Direct can reveal.

The total surplus will be almost 2 per cent of the NHS budget. It is understood to be causing embarrassment at the Department of Health amid concerns that it will be accused of presiding over a ‘bust and boom’ health economy, coming just two years after the NHS was more than £500m in the red.

Part of the massive surplus is made up of £729m ‘topsliced’ from primary care trust allocations by strategic health authorities, according to figures placed in the House of Commons library.
“A £1.8bn projected underspend for this financial year would be more than three times the £510m underspend for 2006-07”

An inspection of board documents shows that, by September this year, the SHAs were forecasting an annual underspend of £1.5bn in total.

But since then SHAs are thought to have identified a further £300m in surpluses.

An underspend of this size at this time is particularly difficult for the DoH as it recently told the NHS pay review body that staff should get pay rises next year of no more than 2 per cent.

A senior source close to the DoH said ‘It doesn’t look good. The £1.8bn net surplus is a conservative estimate. There will be a lot of pressure on SHAs over the next few weeks to manage the situation closely and to bring the underspend down.’

NHS Confederation policy director Nigel Edwards said: ‘There’s a lot of anxiety that these overspends will now be clawed back. In some cases PCTs have run up surpluses to fulfil strategic plans but there are now a number of rumours that the Treasury will claw these back.’

A £1.8bn projected underspend for this financial year would be more than three times the £510m underspend for 2006-07. That followed a £547m overspend in 2005-06. King’s Fund chief economist John Appleby said: ‘An underspend by that amount will be seen as just as bad as an overspend.

Parliament does not approve of large NHS underspends as it commits those resources for health spending, not to just sit there.’

Speaking at the King’s Fund last week – before the size of the underspend was revealed – NHS chief executive David Nicholson said it was important that NHS organisations made a surplus in order to support financial planning and service development.

However, he added: ‘We don’t want to go from bust to boom or for people to use the surplus to avoid making difficult decisions.’

A senior source at one SHA told HSJ it had experienced problems persuading PCTs to spend more money. ‘PCTs have been in turnaround mode for two years. We keep telling them there must be more things they can spend their money on but they are being too careful.’

He said it was particularly frustrating as PCTs had more work to do to reach the 18-week target, yet were hesitant to commit more funds to achieve it.

http://www.hsj.co.uk/news/nhs_underspends_by_18bn.html;jsessionid=B8A4866B8FD4B1
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LsisaNXWUsjCN5y1kupJw-tDw7kXdRuUDHrfbhT$

Health Direct thinks that it is an absolute disgrace that we have had trusts making large numbers of staff and nurses redundant to achieve financial targets, whilst we witness obscene amounts of public monies paid out in redundancy payoffs!

The new Strategic HA’s are growing at a rapid rate (and cost) and will soon be a mirror image of what they replaced – yet they still remain in denial over the real NHS funding issues. Cautious PCT’s are not the underlying reason for the surplus – it is the freeze on recruitment.

The latter contributing to over-stressed and over worked staff – and subsequently a demoralised NHS workforce.

Ambulances queue at full hospital at Norfolk and Norwich University Hospital

Paramedics are treating patients in ambulances outside the Norfolk and Norwich University Hospital and ambulances are queuing outside the hospital because of a major alert which has left it with no beds available to new admissions.

The Norfolk and Norwich University Hospital is on “black alert” and has declared a major incident in order to discharge non-urgent patients.

In a statement, the hospital said 10 ambulances were waiting to admit patients with paramedics treating them.

It said all other general hospitals in the east were on the same alert level.

The statement added: “All the hospitals in the region are currently on black alert and the Norfolk and Norwich University Hospital is also experiencing very high emergency demand. The hospital is currently full and our emergency areas are at full capacity.”

‘Extreme pressure’

The hospital said it was working with social services and other organisations to help move patients with less-severe medical conditions.

“As a result of the extreme pressure we are under, we have declared a major incident in order that all the agencies can take appropriate action to discharge patients and free-up beds,” the statement added.

“We currently have 10 ambulances waiting to admit patients and ambulance crews are looking after those patients.”

The Norfolk and Norwich University Hospital NHS Trust said while it was under extreme pressure, the hospital was not turning patients away.

The statement continued: “The hospital is not closed, but we would also urge members of the public who have minor health problems not to attend A&E; as staff are being kept extremely busy dealing with 999 patients with more serious health problems.”

From:
http://news.bbc.co.uk/1/hi/england/norfolk/7106402.stm

NHS database will weaken patient security MPs learn

The man in charge of setting up the NHS medical records database has admitted that “you cannot stop the wicked doing wicked things” with information. Richard Jeavons, director of IT implementation at the Department of Health, said there were instances where staff “abuse their privileges”.

These had to be “pursued”, he told the Commons home affairs committee. The plan to put 50 million patients’ records on the database is part of a £12bn NHS IT overhaul.

The scheme has raised concerns over cost and the security of information.

A poll for the Guardian suggests that 59% of GPs in England are unwilling to upload any record onto the database without the patient’s specific consent.

Three quarters of more than 1,000 doctors questioned believed medical details would become less secure when they are put on a database that will eventually be used by the NHS and social services.

‘Misuse’

Mr Jeavons, who was appointed in May, said the Department of Health did not itself hold many people’s personal records but added that it provided guidance to NHS trusts on how to handle data.

At a committee hearing, Labour MP Margaret Moran said to him: “Even if we get the technology right, the problem is abuse by people or misuse of data. How confident are you that there won’t be problems over data and privacy?”

Mr Jeavons replied: “You cannot stop the wicked doing wicked things with information and patient data…

“Of course, we have examples where staff do abuse their privileges and have to be pursued through disciplinary procedures.”

He added that the government had to “make sure” that people who abused the system knew they were “going to get caught”.

The NHS scheme is intended to “modernise” the service.

By 2014, 30,000 GPs in England are supposed to be linked up to nearly 300 hospitals giving the NHS a “21st century” computer network.

It involves an online booking system, Choose and Book, a centralised medical records system, e-prescriptions and fast computer network links between NHS organisations.

It is said to be the most ambitious computer project in the world and represents the largest single investment in IT in the UK.

‘Surveillance’

Opponents say it is too expensive and will compromise the confidentiality of records.

The home affairs committee is looking at whether the UK has become a “surveillance society”.

In its hearing, it senior civil servants working in the education, transport and justice fields were also questioned.

The MPs were told different departments could not share information without legal guidelines being followed and rights of access clarified.

Clare Moriarty, constitution director at the Ministry of Justice, said efforts to make data protection as “robust” as possible were essential.

Questioned as to whether information had sometimes gone between departments unofficially, she replied: “I’m not aware of any department sharing data by stealth.”

‘Foolhardy’

Government chief information officer John Suffolk told the MPs that setting up a nationwide database going across Whitehall departments and other government agencies would create more problems.

He said: “When you work at a national scale, to continue to put more eggs in a single basket is a foolhardy approach.”

Mr Suffolk added: “The more and more you put it into a large database, with more and more people having access, it becomes more complex…

“If we can avoid setting up large-scale citizens’ databases, that would be a wise thing to do.”

The Information commissioner last year warned the UK risked “sleep-walking into a surveillance society”.

The committee’s inquiry will include the impact of identity cards, the expansion of the DNA database and the rise in the use of CCTV cameras.

From:
http://news.bbc.co.uk/1/hi/uk_politics/7103667.stm

Shocking labour incompetent data misuse as 25 million parents exposed to risk of ID fraud

Health Direct asks if you remember all those labour MPs who supported the national ID card scheme, the DNA database and the NHS IT system? They said we had nothing to fear…..labour said that your data will be safe with them.

The sensitive personal details of 25 million Britons could have fallen into the hands of identity fraudsters after a government agency lost the entire child benefit database in the post.

A major police investigation is being conducted after Alistair Darling, the Chancellor, admitted yesterday that names, addresses, birth dates, national insurance numbers and bank account details of every child benefit claimant in the country had gone missing.

The confidential material is on two CDs that were placed in the post by a junior employee at the HM Revenue & Customs office in Tyne & Wear more than a month ago and have not been seen since.

The Chancellor and the Prime Minister have known about the loss since November 10 but there were concerns last night that the police were not told for a further five days and the banking industry was not alerted until last Friday.

The catastrophic breach of personal security led to the resignation of Paul Gray, the chairman of HMRC, and called into question the Government’s competence, especially its ability to manage an ID card system in the future.

No evidence of criminal activity has been detected but Scotland Yard has appointed an expert in organised crime to head the investigation. Acting Assistant Commissioner Janet Williams is heading a team of 12 officers who are combing Government offices for the lost data.

The Serious Organised Crime Agency is also advising on the potential criminal abuses of information about the identities and finances of 7.25 million British households.

Equipped with such detail, identity thieves could plunder bank accounts, obtain credit cards and take out fraudulent loans.

The banking industry has upgraded its fraud detection systems to keep a constant watch on all accounts into which child benefit is paid.

Bankers reacted angrily to a suggestion by Mr Darling that he had delayed his announcement because the financial sector was “adamant” it needed time to prepare.

A senior City source said: “By 9.30 on Monday we were ready to run. It is hard to fathom why any suggestion was made that any delay was down to us.”

Mr Darling told the Commons that the information should never have left the HMRC offices and its transfer in unregistered mail was against all procedures.He said the missing data was not enough in itelf for someone to access an account for fraudulent purposes because passwords and pin numbers were required.

But he apologised to the country for what he described as an “extremely serious failure on the part of HMRC to protect sensitive personal data entrusted to it.”

Richard Thomas, the Information Commissioner, said: “This is an extremely serious security breach.”

Health Direct points out that it’s clear breach of the Data Protection Act by the HM Revenue & Customs (Principle 7 – keeping subject data safe). The Revenue have acted illegally.

Opposition MPs should press for a full enquiry by the Information Commissioner’s Office.

From:
http://timesonline.co.uk/tol/news/uk/article2910705.ece

Doctors revolt at anti white bias political correctness of labour’s nanny state

One of Britain’s most eminent consultants has claimed white male doctors are being denied bonuses because of politically correct “reverse discrimination” by the National Health Service.

David Rosin, a former vice-president of the Royal College of Surgeons, says female and ethnic minority consultants are being given preferential treatment to meet artificial quotas.

Rosin, also a former president of the Association for Cancer Surgery, failed to get the top “platinum award” award 10 years in a row despite being backed in his application by the royal college and his NHS trust.

He said: “When I asked a previous president [of the Royal College of Surgeons] why I had been unsuccessful, the answer came back immediately: ‘What do you expect? You are not black, you are not female and you have all four limbs.’ ”

Rosin’s comments are likely to provoke a row about whether policies to promote equal opportunities in the NHS have led to positive discrimination.

Figures show a dramatic increase in the number of women and ethnic minorities winning merit awards over the past five years. They can add up to £73,000 to a consultant’s annual salary of about £112,000.

Ministers and NHS chiefs have been encouraging more women and ethnic minorities to apply. Supporters say that in the past the vast majority of the extra payments went to an “old boys’ network” of sometimes “mediocre” white male consultants.

However, Rosin, who retired from his NHS post as a senior consultant surgeon at St Mary’s NHS Trust hospital, London, in June, believes it has now tipped into positive discrimination.

“It is time that someone spoke up concerning the reverse discrimination with respect to merit awards,” he wrote in a letter to the magazine Hospital Doctor. “In the politically correct environment in which we live, there is now definitely reverse discrimination.”

He was incredulous at his failure to get a platinum award, despite being editor of an international medical journal, editing 16 textbooks and publishing more than 100 peer-reviewed medical papers.

He said he was also on call for the NHS every second night for his first 14 years as a consultant and helped to introduce a new form of cancer surgery clinic and many new minimal access surgical techniques.

Rosin was supported by a council member of one of the royal medical colleges, who, asking to remain anonymous, said: “As in any situation where people are trying to correct what is perceived as a wrong in the past, an element of bias will be introduced.

The feedback one hears from these committees is that, where there is a fine balance between two candidates, then there will be a willingness to recognise the merits of someone who has been previously disadvantaged.”

About half of Britain’s 33,000 consultants receive an award at some level, ranging from £2,850 to £73,158. The scheme costs the NHS at least £250m a year.

Aneez Esmail, professor of general practice at Manchester University, whose research in 1998 showed how few women and ethnic minority consultants got the awards, denied that standards had been compromised.

“More women and ethnic minorities are successful but the actual standards are not compromised,” he said. “Previously, mediocre white candidates were getting awards and you really had to be quite exceptional as a woman or ethnic minority to get an award. With more transparency and clear criteria there is greater competition and more women and ethnic minorities are successful. People like Mr Rosin may lose out.”

His 1998 research, published in the British Medical Journal, showed that white consultants were given 95% of bonuses despite making up just 74% of the eligible consultant workforce. Nonwhite consultants earned just 5% of bonuses despite making up 14% of the eligible consultant workforce.

A follow-up paper in 2000-2001 found that white consultants received 37% more bonuses than nonwhite consultants and men gained 25% more bonuses than women. However, this year’s data, released by the health department, show that the percentage of women applicants succeeding in getting bronze awards, worth about £34,000 on top of their annual salary, is now equal to that of men.

Doctors would not be expected to apply for the four top awards until they had been consultants for a decade. Women taking breaks to have children have therefore been less likely to apply.

As many British Indian consultants as white British consultants are also now being awarded the first level of bonus, worth £2,850.

Professor Hamid Ghodse, medical director of the committee which decides on who gets awards, acknowledged that it had actively been trying to get more women and ethnic minority consultants to apply for bonuses – and would continue to do so.

Health Direct reproduces some more posted comments:

Why call it reverse discrimination? It is racial and gender discrimination, plain and simple, and there is a law against it but our political elite think they are above the law.

R Mason, London, UK

This is not about money but a perception of an unfairness which is currently rife in our society as well as the natural desire of any hard working , exceptionally productive professional to receive an acknowledgement from his peers of his achievemnets and worth.

C J Hathaway, Billericay, UK

The system of merit awards for consultants should be scrapped. It is unfair, unjust and, as all consultants that I know will agee, misused. Like the jealousy generated by private practice it is a force for distrust and anger which divides the consultant body. and this can only be bad for the profession and patients alike.

Dr. Patrick J. Salt, Walsall, West Midlands

From:
http://timesonline.co.uk/tol/news/uk/health/article2890947.ece

NHS must keep taking the tablets- Financial Times Editorial

The Financial Times last week criticised labour’s health services incompetent U Turn. Health Direct reproduces the Editorial below.

A patient who is feeling better can readily – and wrongly – believe it is not worth finishing the course of medicine, especially if it tastes nasty.

In the same way, it is a mistake to think that the role of the private sector in improving the National Health Service can be cut back now that some benefits are already evident. Yet Alan Johnson, health secretary, is on the brink of slashing plans to extend private sector involvement in treatment centres and diagnostic services. This would be an unwelcome retreat.

Private sector companies had been expecting the award of business worth £700m a year from this second wave of big central contracts. Instead, it looks as though the schemes going ahead will be worth less than half that, and may total as little as £200m.

The adverse effects of this reduction go well beyond the compensation that the government will have to pay for cancelling so late.

The argument is not really about the details of each contract up for decision. It is about the broader impact on public healthcare of such a significant scaling back of private sector work.

In the years when Tony Blair was pursuing market-like reforms for the health service, he had a dual purpose in involving the private sector. He wanted to increase capacity and also to challenge NHS hospitals so they would perform more strongly.

This meant the drive to include the private sector had to come from Whitehall and was often resented at local level because it caused disruption.

The success to date in both aims should not disguise the animosity that has accompanied it. As a result, if ministers do not push the role of the private sector in the NHS, there is little chance that anyone will call on private companies.

This matters, because it is too soon to be sure that public sector healthcare will hold on to the benefits already gained if competition from the private sector fades away.

Shrinking the scale of private sector NHS contracts also makes businesses warier about engaging in this activity. The first wave of contracts was also smaller than initially expected. So private sector contractors are surely pricing into their bids the prospect that the health service will be an unreliable customer.

Even more worrying for the government, they may decide that their time and money is better spent elsewhere entirely. This would mean that there was not a flourishing private sector to act as a force for change at primary care level. For a lasting benefit to the NHS, the dose of competition needs to be stepped up, not scaled down.

From:
http://www.ft.com/cms/s/0/729db8cc-9236-11dc-8981-0000779fd2ac.html