Litany of surgical blunders revealed

Cases of 14 brain surgery patients who were the victims of catastrophic errors when neurosurgeons operated on the wrong side of the head are to spearhead a government drive to make operations safer.

Sir Liam Donaldson, the Government’s chief medical officer, will highlight the cases at the launch of his annual report today when he will announce the establishment of a new clinical board for surgical safety to reduce errors and eliminate “wrong site” mistakes.

About 7.9 million operations are performed in Britain each year, nearly 10 times the number of births, yet surgical safety attracts far less attention than the safety of maternity care.

In 2007 more than one operation a month – 16 in all – was done on the wrong site. Examples include knee replacements on the wrong (healthy) knee, cochlear implants – surgically implanted hearing aids – in the wrong ear, removing bone from the wrong foot and wrong incisions to gain access to organs in the abdomen.

One patient a day was listed for the wrong operation in 2007, and there were 1,136 errors involving operating lists, including mistaken surgery, wrongly identified patients or operations performed in the wrong place.

The 14 brain surgery patients had suffered head injuries causing bleeding in the brain leading to increased pressure in the head. The standard treatment is to drill holes in the skull to release the pressure, but in the 14 cases the “burr-holes”, were drilled on the wrong side. A second set of burr-holes then had to be drilled on the correct side. The 14 cases, all in the UK, were reported to the National Patient Safety Agency over the past three years.

Sir Liam told The Independent: “The procedure of drilling burr-holes can be life-saving and you could say that it is a low number [drilled on the wrong side] in the context of all neurosurgical cases. But many people would be incredulous that it could happen at all, let alone be repeated. It is a challenge to our ability not just to reduce error but to ensure these sorts of error do not happen. They should be ‘never events’.”

In all, almost 130,000 errors involving surgical procedures were reported to the National Patient Safety Agency. In most cases involving operating lists, the error will have been detected before the surgery was done so the true number of errors is likely to be under-reported.

Sir Liam said: “Most surgery is safe but errors do occur. Many are minor but some are serious. Some should be ‘never events’. We really should be able to consign wrong-site surgery to the history books.”

In a second example highlighting a different problem, he will describe 14 deaths and nine serious reactions among patients having hip replacements related to the cement used to fix the artificial joint.

Hip replacements are among the commonest operations in Britain but in rare cases the cement causes globules of fat to be forced out of the bone into the blood, triggering a heart attack. In the UK, half of all hip replacements are performed using cement; in Canada just 3 per cent are. Guidance about the risks of cement had been issued to surgeons in the UK, but practice had not changed as quickly as it had in North America.

Sir Liam said: “No one knows what causes this reaction.”

Two weeks ago, NHS Review by Lord Darzi, the surgeon and Health minister, called for the safety and quality of health care to be placed at the heart of the NHS and said urgent steps should be taken to eliminate “never events”, serious incidents which harm patients and damage public confidence in the service.

The new clinical board will be established by the National Patient Safety Agency and include the Royal Colleges of Surgeons and Anaesthetists and patient organisations. Its first task will be to tackle wrong-site neurosurgery and fatal reactions to cemented hip replacements.

Sir Liam will also call for safety tests based on a checklist to be piloted in all UK hospitals. Surgeons and nurses will run through the checks before each operation in the same way pilots check their aircraft before take-off. The Surgical Safety Checklist was launched by the World Health Organisation last month.

About 20,000 patients die after surgery each year in the UK but it is not known how many were preventable. An estimated 2,000 NHS patients die each year as a result of errors in treatment, and an inquiry by the National Audit Office in 2005 concluded that half of all incidents could have been avoided if staff had learnt the lessons of previous errors.

Although serious errors are rare, a study of 38 surgeons in 14 NHS hospitals in the British Medical Journal in 2006 found “most” had experience of operating on the wrong site.

“We should be able to make major in-roads into reducing surgical errors,” Sir Liam said.


Ban on NHS top up is cruel rationing, says BMA

Doctors believe patients should be allowed to pay for drugs that are not available on the NHS as they called for an independent inquiry into the controversial problem.

They warned that not allowing patients to top up their NHS treatment with private medication was a “cruel form of rationing”.

In a close debate, doctors at the British Medical Association conference in Edinburgh voted in favour of a motion saying patients should have the choice to purchase non-health service treatments and medications if they wish and still receive the rest of their treatment free. The motion was passed with 62.8 per cent of the vote in favour.

The debate comes after a woman dying of cancer was denied free NHS treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle, 64, from Billericay, Essex, was receiving chemotherapy on the NHS, but she paid for the drug cetuximab to boost her chances of fighting bowel cancer. She was banned from free NHS care and died in May.

At present, patients who want a drug or treatment that has not been through an appraisal system or has not been licensed can have NHS funding refused by their primary care trust.

If they choose to pay for the treatment they have to have all their care privately. Many trusts are flouting the rules and allowing patients to purchase drugs which are administered within the NHS and continuing with their health service care.

But in a second motion, members of the BMA stopped short of demanding top-ups be introduced now by the narrowest of margins, 154 to 153, and have called for a Royal Commission to look at the issue further. The labour government has already ordered Prof Mike Richards, national director for cancer services to review the position and the report is due in October.

Some labour ministers claim that allowing private top up treatment would bring about the downfall of the NHS by allowing richer patients to pay for improved treatment, while drugs available to poorer patients may be limited.

At the highly charged debate, one doctor, Gordon Matthews, spoke movingly about his own wife with end stage cancer who wants to buy drugs. He argued that it was not ethical to exclude patients from the NHS because they had chosen to pay for drugs when they are ‘clinging to their lives’. Another doctor said the worst moment of his medical career was hearing women screaming while undergoing abortions because they could not afford the anaesthetic.

Proposer of the motion Stephen Austin of the BMA consultants committee said the current rule is “healthcare rationing in its most brutal and cruel form” and that it placed patients in an “impossible” position.

But Dr Jackie Davis of the BMA Council said pharmaceutical companies would put pressure on vulnerable patients and insurance companies would be lining up to offer cover for drugs that the NHS will not pay for. Dr Kevin O’Kane, from the London region, said the motion was ‘poisonous’ and a ‘nail in the NHS coffin’.

He added that the review of the NHS carried out by Lord Darzi meant the appraisal of new drugs by the National Institute for health and Clinical Excellence (Nice) would be speeded up and the postcode lottery in treatment ended, so there was no need for the motion.

Just over 70 per cent voted in favour of a Royal Commission to look into the issue and then supported supplementary motions that co-payments must not be a route to extension of NHS charges.

Commenting after the debate, Dr Hamish Meldrum said: “In principle doctors believe that patients should have the choice to buy additional treatment that is not available on the NHS, without being forced to pay for all their treatment privately.

“However, they stopped short of asking for co-payments to be introduced until there has been a wider debate with the profession and public and the evidence has been collected and examined. Doctors recognised that there were many potential problems with introducing co-payments and suggested a number of safeguards they would wish to see considered were they to be introduced.”

Ian Beaumont, Director of Communications, Bowel Cancer UK said: “We are concerned that while co-payments will enable some patients to receive treatments privately, those who can’t afford to pay will not be able to access them. Co-payments also give the Government, NICE and Primary Care Trusts an excuse to deny patients access to new, effective treatments on the NHS.”


Health Direct posts that people who can afford to opt out of the NHS completely and purchase private health care should be able to do so, and they do.

Any one who could afford to top up should be alowed to do so. People who can afford neither will still benefit from free health care from the NHS. Yes this is a multi-tiered health care system , but what is so wrong with that?

The idea that this would spell the end of the NHS is laughable, unless some factions of the BMA are so worried that all their members will do as dentists did and dump NHS practice all togethar.

Pharmaceutical companies cannot pressurise poor people because they are not permitted direct patient advertising as they are in the US. They could pressurise GPs, but you have to hope that the unscrupulous fat cat, pound chasing, sloppy GPs who would in turn pressurise patients are struck off.

Insurance companies will queue up to offer potential NHS blacklisted treatments, but again if someone chooses to invest in their future health provision why shouldn’t they? It is no different than buying critical illness insurance. You buy it or you dont it depends on what value you put on it.

Maybe it is about time that people started to take more responsibility for their own health. The current government think it is a dirty word, but perhaps people should ASPIRE, to be in a better position when benefiting from healthcare; rather than aspiring to own a car they cannot afford or sinking 20 pints and smoking 40 fags that weekend.

It is these people, with skewed notions of aspiration i.e. to appear wealthier and more important that they actually (just like a celebrity) are who will ensure the demise of the NHS, not the ones who have chosen to invest in their health!

Gordon Brown is always battering on about choice, why not put your money where your mouth is then Gordo, give people the choice!

Innovation needs cost benefit treatment

Will technology break the NHS bank? The question preoccupies health experts across the developed world, who have universally identified medical innovation as one of the main forces propelling costs upwards.

“Technological change is the predominant reason for medical cost increases in the past half-century,” says David Cutler of Harvard University, an expert in the field. “Studies of aggregate medical spending, and of ­particular medical conditions, show that at least half of all cost growth is a result of increased use of tech­nology.”

For Mark Sculpher, professor of health economics at York University, what counts is cost-effectiveness. “It may be appropriate to devote considerable additional resources to new technology if it is good value,” he says.

Joe Hogan, head of GE Healthcare, one of the world’s leading diagnostics and imaging companies, says: “I scratch my head when people say technology adds costs. It’s not the way economics works. In what other industry in the world has it not increased efficacy and efficiency?”

He highlights the surge in the power of diagnostic devices and the extraordinary accompanying drop in costs of scanners in recent years. “There will be an increase in capacity and an unbelievable decrease in costs,” he says.

That view is shared by a group frequently demonised by those who excoriate rising healthcare costs: drug manufacturers. Asked how he responds to fears that the medicines bill will rise too high, Chris Brinsmead, president of the Association of the British Pharmaceutical Industry, the UK trade body, says bluntly: “The evidence points otherwise.”

While the prices of some new drugs – notably for cancer and certain extremely rare diseases – have risen sharply in recent years, he says that the overall proportion of the UK National Health Service budget spent on medicines is not only modest, at less than 10 per cent, but has declined.

That is partly explained by generic competition once patents expire for drugs such as proton pump inhibitors, which have all but eliminated expensive ulcer surgery, and statins, which have helped ease ­cardiovascular problems.

Most academic attempts to measure cost-effectiveness of new technology conclude that it more than pays for its keep. Last year, for instance, Prof Cutler published an extensive study of “revascularisation” (bypass surgery or angioplasty) to restore blood flow after a heart attack. Analysing 17 years of data, he concluded that the procedure was associated with more than a year of extra life expectancy at a cost of about £20,000 – making it “highly cost-effective”.

But it is important to use technology sparingly rather than seeing it as a panacea that can be indiscriminately applied to all patients. The majority of technology is cost-effective and valuable, according to Paul Ginsburg, president of the Centre for Studying Health System Change in Washington. “But the benefits are diminished when the technology is applied beyond those patients most likely to benefit from it,” he says. “We have a tendency to apply new technologies to too many people.”

For example, “arthroscopic”, keyhole operations on the knee were a boon for the original patients, who had a clear-cut requirement for such surgery, but it was extended too far, to people who did not really need it.

In the same way, the painkiller Vioxx undoubtedly benefited many patients with arthritis but Merck withdrew it from the market in 2004 after side-effects emerged when it was used by a far larger number of patients to whom, critics argued, it should never have been marketed.

Booz Allen Hamilton, a consultancy, found “sub­stantial evidence that over­utilisation and misuse of technology is leading to spending that exceeds its value for patients”.

If the technology is available, there is a propensity to use it as extensively as possible. Diagnostic imaging, a £50bn business, is a good example of increases in spending being “driven to a large extent by the growth in the number of machines installed in hospitals, as well as in doctors’ offices and at imaging centres”, the consultants said.

The result, according to Booz Allen, is a strong incentive for doctors to prescribe unnecessary scans that provide little help in getting closer to a diagnosis.

“Healthcare is littered with examples of technologies that have not delivered on their initial promise,” says Prof Sculpher. Even in the more restrained UK environment, there are doubts that imaging technology is being used cost-effectively.

Health systems throughout the world are facing up to the need for better evaluation of the costs and benefits of new technologies before they are introduced on a large scale.

“There is great potential in developing a lot more information about effectiveness,” says Dr Ginsburg.


NHS at 60- Growing ranks of elderly add to costs dilemma

NHS at 60- Technological change, ageing populations and rising expectations: for health ministers and executives worldwide they are the three furies that bedevil attempts to contain the spiralling cost of care.

“In my experience,” recalls Kenneth Clarke, the highly regarded former health secretary, “at international meetings of health ministers, all they and the other people there ever talk about is how to control costs and they never really seem to find a way to do it.”

All western countries have seen their populations age significantly and the three pressures combined have pushed up costs during the past half century and more.

Nicolaus Henke, head of the London health practice for management consultants McKinsey, flourishes a graph showing that during the past 50 years health spending has outstripped growth in the economy by 2 per cent a year on average in every country in the Organisation for Economic Co-operation and Development.

The trend, he says, is “startling”. Countries occasionally manage to roll back the rate of increase. The US did so briefly in the mid-1990s by putting tighter controls on treatments doctors could use in a drive to raise quality and constrain costs. Other countries have from time to time squeezed budgets or cut them. But the trend always reasserts itself.

If it continues, says Mr Henke, “by 2050 most countries will spend more than 20 per cent of gross domestic product on healthcare. The US will be spending well over 30 per cent”. By 2100, the US health spend would take 97 per cent of national income, the UK’s two-thirds.

“That is difficult to conceive,” says Mr Henke, “but in 1960 most observers would have said that 40 years on it would have been pretty inconceivable that western Europe on average would be spending 9 per cent of GDP on health. But that, of course, has happened.”

The triple pressures prompt apocalyptic predictions. Jonathan Anscombe, head of health of A. T. Kearney’s European health practice, says they create “a perfect storm”, one that will “test the limits of collective funding mechanisms” all around the world.

He predicts that countries will have to restrict tax and social insurance systems to a “core” offering. It will consist chiefly of preventive and primary care services that help restrain costs, along with emergency services and support for the poor, he suggests.

Everything else – most non-emergency care, let alone costly end-of-life cancer drugs – will have to be covered by private individual insurance or by out-of-pocket payments. This, he declares, is “inevitable” and “it is hard to see how this can be achieved without making care more unequal”.

But there is another view. For a start, many of the dire predictions rely on believing that existing trends will simply continue. But that assumption ignores the disruptive effect of the unpredictable, which can lower costs as well as raise them.

Dangerous and costly surgery for gastric ulcers, for example, has disappeared, killed off first by a drug that treated the ulcer then by an antibiotic that cured it.

John Appleby, chief economist at the King’s Fund health think-tank in London, illustrates the dangers of extrapolation with a graph showing that if the steady decline in mortality rates in the UK continues, “by about 2039 the UK will be spending about 10 per cent of GDP on health care and nobody will be dying. Somehow, I don’t think that is going to happen,” he remarks drily.

Many analysts are now much less worried about the impact of ageing than they were. For a start, says Richard Saltman, professor of health policy at the Rollins School of Public Health, as with pensions, “you can fundamentally reduce the costs if people work even one, two or three years longer to pay in rather than take out”.

And there is a growing body of evidence that the older generation, on average, is living longer and healthier, not longer and sicker.

Martin McKee, head of research policy at the European Observatory on Health Systems, says there is good evidence from countries including Canada, Germany and the US Medicare system that the high cost of care for the elderly is chiefly the cost of dying.

“A large part of lifetime expenditure on health care occurs in the last year of life and indeed in the last few weeks before death: and it does so regardless of the age at which you die,” he says.

Added to that is tentative evidence that the costs of dying are lower for those who live longest. “This may be because the old are treated less intensively and so incur fewer costs,” Prof McKee says. That may not be entirely explained by age discrimination.

Raymond Tallis, former professor of geriatric medicine at Manchester University, has argued that even healthy old people’s bodies become frailer. “So it is possible that the stroke or heart attack that you might have survived with a disability at age 70 will kill you at 90.”

Furthermore, any breakthrough in the treatment of dementia – although none is on the near-horizon – could lower long-term care costs

As people live longer, costs will rise, but not necessarily catastrophically. There are, Professor McKee says, “many myths and misunderstandings” about ageing and technology.

But can nations afford the rising bill? Mr Henke of McKinsey has his doubts, although he notes “the most convincing graph in the whole of social science” is the one that shows the richer a country is, the more it spends on health care.

“Healthcare is a wonderful product,” Uwe Reinhardt, professor of political economy at Princeton, says. “So as we get richer we have bought more of it. And if you ask ‘Can we afford the elderly?’ I say – give me a break. Of course we can afford the elderly.”


Tensions grow over cancer treatments as NICE blocks drugs

The new generation of cancer medicines raises delicate and potentially explosive issues for the labour government’s medicines advisory body National Institute for Curbing Expenditure (NICE).

In the past decade, the NICE has recommended an overwhelming majority of the 251 drugs it has reviewed. More recently, however, Nice has rejected half a dozen cancer therapies and forced the manufacturers of others to develop more imaginative, and cheaper, alternatives.

Already the agency has encountered difficulty obtaining some of the information it needs to make its assessments. Now, two manufacturers – Roche and Merck Serono – have raised the stakes.

They are explicitly refusing to co-operate with requests for cost-effectiveness data on their medicines Avastin, for lung and breast cancer, and Erbitux, for late-stage colorectal cancer, respectively.

“Roche did not consider it a good use of either public sector or indeed Roche’s own resources to produce a full submission … for a year-long appraisal which would have resulted anyway in negative guidance,” Roche said.

Professor Michael Rawlins, chairman of Nice, has a different explanation: “They’re saying that they felt they could not substantiate the high prices they expected to command in relation to the benefits of the product.”

Nice’s role is to assess both clinical and cost-effectiveness, based on the principle that it is unjust to expect the National Health Service to buy expensive medicines that offer little benefit.

The agency does not scrutinise all medicines, nor does it or the NHS refuse treatments simply because they are expensive – developing effective but costly treatments for rare conditions has fostered an entire sub-sector of companies.

But cancer affects a vast and growing patient pool. While a few new medicines, some linked to diagnostic “markers” such as Herceptin for breast cancer, are providing breakthrough treatments, many others have so far shown far less impressive results, extending life by a few months at best in some patients. Yet prices remain high.

The Association of the British Pharmaceutical Industry, the trade body, stresses the costs of developing cancer medicines and the fact that many fail and never come to market.

The body says medicine prices overall in the UK are below those of a number of other European countries and represent a small and declining proportion of total health spending – below 10 per cent of the NHS budget.

There is debate over the need for Nice both to accelerate its review of new drugs and to review its criteria, as well as for similar levels of scrutiny to apply to other parts of the NHS.

Denise Richard, head of the UK oncology business unit for Merck Serono of Germany, which has failed to win Nice approval for Erbitux for late-stage colo-rectal cancer at £2,700 ($5,330) a month, argues that Nice needs to review its criteria, speed up its reviews and change its procedures.

She says that few cancer specialists are involved in Nice technical reviews because of possible conflicts of interest; that companies cannot update Nice during long appeals, despite fast-changing data on drug efficacy; and that the thresholds for cost-effectiveness should be raised for patients with late-stage cancer, since they rarely lived more than a few extra months.

Pharmaceutical companies are reluctant to cut prices. While the UK represents only 3-4 per cent of the global market for medicines, it punches above its weight, in part because Nice’s assessments are closely followed internationally. Price reductions in the UK would likely trigger copycat actions by purchasers elsewhere and encourage “parallel trade”, by which medicines sold in countries at lower prices are exported by arbitrageurs to higher priced ones.

The result has been a series of hidden discounts, such as on Velcade for multiple myeloma – the nominal list price stays the same, but the company will reimburse the cost to those patients in whom it proves ineffective.

Ultimately, the best hope for better value might be that, as drugs are used for earlier stage treatment in many more patients for a wider range of cancers, falling prices will be compensated by rising volumes. But for now, the industry remains cautious.


Measles endemic in Britain official warning

Measles has become endemic in Britain, 14 years after its spread was halted in the resident population, the country’s public health watchdog says.

The Health Protection Agency (HPA) warned that the number of unvaccinated children was now large enough to sustain the “continuous spread” of the potentially lethal virus in the community. It blamed a failure by parents over the past 10 years to give their children the measles, mumps and rubella (MMR) vaccine.

This has resulted in vaccine rates falling below the level necessary to prevent the disease becoming established in the general population.

Figures published show cases of measles in London reached a new peak last month, exceeding last year’s monthly record set in August 2007, and are continuing to rise.

There were 95 cases confirmed in the capital and 35 in the rest of England and Wales bringing the total for the year to 461. A 17-year-old victim from West Yorkshire died from the disease in the first fatality since 2006.

In another case a doctor working in a hospital cancer ward contracted measles prompting the Department of Health to write to all hospitals telling them to ensure that all staff working with vulnerable patients have documented immunity to the disease.

Measles causes fever, and can have serious complications including pneumonia and encephalitis (swelling of the brain). Fifty years ago the illness killed 500 children a year in the UK but vaccination almost eliminated the disease. Last month’s death was only the second in more than a decade.

The HPA, which published the latest figures in its weekly report, said the rise in measles cases in London was linked to an outbreak at a secondary school which had spread to neighbouring schools and nurseries in the capital. It was also the source of clusters in Cornwall and South Yorkshire.

The report said: “Due to almost 10 years of sub-optimal MMR vaccination coverage across the UK, the number of children susceptible to measles is now sufficient to support the continuous spread of measles.

“Health services should exploit all possible opportunities to offer MMR vaccine to children of any age who have not received two doses. Greater awareness of the increasing measles incidence by health professionals and the public is essential to control the spread of infection.”

Elizabeth Miller, head of immunisation at the HPA, said: “In 1994 we interrupted the spread of measles in the UK so that it ceased to be endemic. Since that time the only cases we have had have been as a result of importation and spread from those imported cases. Now we have reached a point where there are a sufficient number of susceptible [unvaccinated] children in the population to sustain spread of the disease. We are concerned there may be a return to pre-1994 levels where there was sustained spread. It is quite disturbing.”

Vaccination rates against MMR vary widely across the country and are especially low in London. In the last quarter of 2007, the rate stood at 71 per cent for children at age two (first dose) and 50 per cent at age five (second dose) compared with the 95 per cent coverage needed to maintain herd immunity and prevent endemic spread.

Nationally, vaccination rates against MMR fell from 92 per cent a decade ago to 79 per cent in 2004, at the height of the scare over the vaccine’s supposed link with autism. They have since recovered to 84 per cent at age two (75 per cent at age five) but are still well below the target level of 95 per cent.

Professor Miller said: “Vaccination rates are on the increase but we have the problem of the legacy of the unvaccinated children over the past six or seven years. People do need to realise that measles is a highly infectious disease and if your child is not vaccinated and exposed to the virus there is a high probability that it will find susceptible children.”

Measles was the single most lethal infectious agent in the world until a vaccine was developed in 1963. In the early 1960s, the disease claimed six million lives yearly in the developing world with about 135 million cases. Today the global death toll has been cut to below 350,000 and the World Health Organisation believes it may be possible to eliminate the disease.

In the UK, cases fluctuated between 160,000 and 800,000 during the 1950s and 1960s, with an epidemic every two years, until the measles vaccine was launched in 1970. In 1987, the year before it was superseded by the triple MMR jab, there were 86,000 cases of measles. Vaccination rates against MMR rose to 92 per cent in the early 1990s and the annual number of measles cases fell. But confidence in the vaccine was dashed by publication of a paper in The Lancet in 1998 by Andrew Wakefield and colleagues from the Royal Free Hospital, linking the jab with autism.

Controversy over the link continued for eight years but is now widely accepted to be without substance. Dr Wakefield and two of his former colleagues have been charged with serious professional misconduct over their research in a case before the General Medical Council which is expected to conclude later this year.

Measles, which is accompanied by a rash, is one of the most infectious diseases known and is spread through direct contact or through droplets in the air when an infected person coughs or sneezes. It is most infectious before the rash appears.

About 90 per cent of people who have not been vaccinated, or have not had measles, catch the disease if they live in the same house as someone with it.


Banned cancer drugs better than NHS ones

Privately bought cancer drugs are proving to be up to five times as effective as NHS treatments, Health Direct reports on the suffering the co-payments ban is inflicting on patients.

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves.

One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the labour government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy.

The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care.

Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Recently the Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors.

John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about £2,200 a month compared with about £800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control.

A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan.

Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added.

Erbitux, costing about £3,000 a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.

A former fireman who developed liver cancer after 25 years’ service has been told that if he pays for the only drug that can treat his disease his NHS care will be withdrawn.

Barry Humphrey, 59, from North Walsham, Norfolk, was told by NHS doctors that the drug Nexavar was the only available treatment for his advanced liver cancer.

However, consultants at Addenbrooke’s hospital in Cambridge said the drug was not routinely funded by the NHS and told him that if he paid for it he would be billed for the rest of his NHS care.

Humphrey believes his cancer is linked to his time as a fireman. His cancer was caused by cirrhosis of the liver after he contracted hepatitis C. He believes he caught the virus from a casualty while on duty.

Research presented at the American Society of Clinical Oncology found patients with advanced liver cancer survive for an average of 11 months if they take Nexavar, while those denied the drug live for just eight months.

Humphrey’s wife Hazel, 58, who also worked in the fire service, said: “Doctors said this would ‘not be viable’ because we would be deemed as opting out of the NHS and would need to pay for everything.

“I think it is absolutely disgraceful. When people are terminally ill, they want to spend as much time as they possibly can extending their life expectancy.” She said the couple know the drug will not provide a cure but should have the right to spend their savings to prolong her husband’s life.

They plan to sell a flat that they have been renting out to raise the cash for the drug, which costs about £3,000 a month. Humphrey, who has four children, six grandchildren and helps to care for his elderly mother, said: “I think this is morally wrong and indefensible.”

Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s, said: “We are complying with the national guidance which says we cannot allow co-funding.”

The public’s view

A poll for The Sunday Times shows strong support for allowing co-payment in the National Health Service, with 89% saying that people who buy additional cancer drugs should continue to get free NHS treatment.

Only 5% think allowing co-payment would create a two-tier NHS. Until now this has been the position taken by Alan Johnson, the health secretary.

Ministers had feared that allowing co-payment would upset less well-off patients, but the YouGov poll of nearly 1,800 people shows strong backing across the social spectrum and supporters of all three main parties.


Tories plan a bonfire of the NHS targets in bid to save 100,000 lives

David Cameron has set out his vision for the health service, with a promise to save 100,000 lives a year by giving patients more information and more power over their own care.

Labour’s internal NHS targets will be ditched and patients simply told which hospitals get the best results, under the radical Tory plans.

“How long will my dad survive if he gets cancer? What are my chances of a good life if I have a stroke? What are my chances of surviving from heart disease? This is the kind of information people want and need,” Mr Cameron planned to say.

He was also listing a series of goals – reminiscent of New Labour’s 1997 pledge cards – so that voters could hold a Conservative Government to account over its handling of the health service.

These include:

* raising cancer five year survival rates to above the EU average by 2015

* cutting early deaths from stroke and heart disease to below EU averages by 2015

* cutting early deaths from lung disease to below EU averages by 2020

* annual improvements in survival rates and quality of life for patients living with long-term conditions.

The Tories chose the 60th anniversary of the creation of the NHS to unveil their “Green Paper” on health policy, ‘Delivering some of the best health in Europe’, before an audience at the Royal College of Surgeons in London.

Mr Cameron has been eager to stress his commitment to the service, and neutralise Labour claims that a Tory Government would downgrade it.

He argued that Labour has strangled the NHS in red tape, “testing to destruction the idea that the NHS can be improved by more bureaucracy, more central control and more initiatives from the Department of Health”.

According to the Tories, raising NHS standards to the European average would save around 38,000 lives every year, but their “ambition” is to lift performance to match the best systems in the world, which would save at least 100,000.

Mr Cameron insisted that outcomes are the only thing that matters for patients: “What matters is the result itself, not how it is achieved.”

Niall Dickson, chief executive of the King’s Fund, welcomed the plans.

“(The Conservatives) are right that what matters to patients is whether their quality of life has improved following surgery or any other procedure rather than whether top-down targets have been met,” he said.

’But the Conservatives’ plan to abolish central targets needs to be considered carefully. Before we drop central targets altogether, we must be sure that there are appropriate safeguards to ensure standards and aspirations are in place.”


30,000 NHS records lost as seven laptops stolen

Laptops containing the personal details of more than 30,000 NHS patients have been stolen in two separate thefts- one of which was not encrypted.

More than 20,000 records were held on computers stolen from a south London hospital. In Wolverhampton, a laptop holding details on around 11,000 patients has been stolen.

The missing data includes names, addresses, NHS numbers and, in the Wolverhampton theft, personal medical histories.

In both cases, sensitive data had been stored on laptops in defiance of rules that are meant to protect such records from theft or loss.

The disclosures follow the revelation earlier this week that Hazel Blears, the communities secretary, had stored confidential labour Government files relating to counter-terrorism on a laptop that has since been stolen from her constituency office.

Of the two NHS thefts, the incident in Wolverhampton appeared to be the more serious, since the computer concerned contained detailed medical records and was not protected by any form of encryption.

The laptop concerned was stolen from the car of an unnamed GP, according to Wolverhampton City Primary Care Trust. Some 11,000 patients have now been sent letters apologizing for the incident.

Jon Crockett, chief executive of the trust, said he was “extremely concerned” about the theft.

He said: “Patients and the public have the right to expect that those dealing with confidential information maintain the highest levels of security and we are carrying out a full and urgent investigation into this incident.”

Department of Health rules say that any confidential information about patients must be stored in a safe and secure environment. Mobile storage devices including laptops must be fully encrypted.

But the Wolverhampton computer had not been encrypted.

In London, thieves stole six laptops from St Georges Hospital in Tooting. Three contained the first and last names, date of birth, postcode and hospital number of around 21,000 patients.

The theft took place between 6 and 9 June, but St George’s Healthcare NHS Trust only recently made the incident public.

In an internal email to its staff, the St Georges trust said he “acknowledges that patient data should not have been stored in laptops.” The laptops had been used as temporary storage, it said.

Hospital managers said the patient data was protected by passwords and held in “hidden” files.

David Astley , the St Georges chief executive, apologised and said: “We owe it to our patients to protect their personal information and we have reminded our staff not to store this kind of data on laptops in the future.”

He said only staff with the correct password could access the data. “Therefore there is only a very small chance that any patient details have been passed on.”

St George’s is in Tooting, one of Labour’s most marginal seats. Mark Clark, the Conservative candidate in Tooting, said the incident would alarm residents.

He said: “Patient confidentiality has been put at risk by this loss and I am concerned that the hospital make preventing more breaches its number one priority.”


Health Direct once again asks whether you are happy trusting the govt to keep all of your medical data secure? Or are you happy to follow the sheep to the slaughterhouse of completely open personal data?

Polyclinics threaten 600 GP practices, say Tories

More than 600 GP practices are under threat because of labour Government plans for “super surgeries” despite overwhelming public opposition to the proposals, according to the Tories.

Hundreds of family doctor surgeries across England have been identified by local health Trusts as being in the same catchment area as proposed new polyclinics.

The Conservatives have compiled the list of practices across the country, named in plans for polyclinics drawn up by Primary Care Trusts, which they say could be killed off by the scheme.

They said the list showed practices which could be forced to shut because they would lose patients to the new clinics if they went ahead and warned that the final figure is likely to be much higher as many Trusts are still compiling plans.

Doctors who found their name on the list would now be “even more concerned than they were already” about the possibility of closure, the British Medical Association (BMA) said.

But the labour Government insisted that there was no suggestion in the documents that any of the practices had been earmarked for closure.

Recently, more than 1.2 million patients signed a petition protesting against plans for polyclinics, which was delivered to Gordon Brown.

Doctors’ leaders argue that the new surgeries will destroy the relationship between patients and their GP family doctor and force them to travel much further to see a doctor.

GPs are also worried that polyclinics could “cream off” younger, healthier patients who help to subsidise their practices to treat those with more complex medical problems.

But ministers insist that the clinics, which could house up to 25 GPs as well as extra services such as dentistry and minor surgery and will open during evenings and weekends, will provide a “world class” service.

The Tory research reveals that 608 practices in almost half of all Primary Care Trusts outside London -where ministers insist that the “GP led health centres” will be in addition to existing services – have already been listed as close to proposed new clinics.

If this were replicated across the rest of the country including the capital as many as 1,700 practices could be under threat.

The Tories said the implication was that polyclinics would threaten the viability of the practices listed, even if not all of them would be forced to shut.

Andrew Lansley, the Conservative health spokesman, said: “The Government needs to explain why these GP surgeries are being named if it’s not because polyclinics pose a threat to the local doctor.

“It adds to the huge weight of evidence now building up that polyclinics are not the additional services as Gordon Brown has claimed. Patients and family doctors are right to be worried about losing a valued local service. It’s time Labour faced up to their concerns and called a halt to their unpopular polyclinics scheme.”

A spokesman for the BMA said that the publication of the list would worry GPs already concerned that their practices could shut.

He said: “We have always had concerns about the viability of practices that are close to these polyclinics.

“It is inevitable that they will lose resources because of the new development, even if they are not actually dragged into it.

“Ben Bradshaw [the Health Minister] has said that some patients won’t have to deregister with their GP to use this service, but that is not really the point.

“There is only one pot of money and if it is all going into polyclinics then GP surgeries will have to cut back on services and many could be forced to close.”

He added: “GPs who find themselves on this list will be even more concerned than they were already.”

An official spokesman for Mr Bradshaw said: “There is no suggestion from any of those PCTs that these surgeries are marked for closure.”

Within London, where ministers insist plans for polyclinics differ from the rest of the country, around 100 practices have already been already earmarked for closure, to make way for the new surgeries.