Dentists pulling out more teeth instead of fixing them

Dentists are increasingly pulling patients’ teeth out because they lose money if they carry out more complex operations to fix them, official figures show.

In the two years since dentists were given a new contract, 1.1m fewer people were treated on the health service than in the two previous years. Those patients were more likely to have a tooth removed and a denture fitted than under the old contract as dentists opt for easier treatments to help cover costs.

The contract has been heavily criticised for failing to deliver promised improvements in dental care.

In 1999 Tony Blair pledged that everyone would have access to NHS dentistry within two years.

Figures out show that around half of the people in England saw an NHS dentist in the last two years. It means there has been a 3.9 per cent drop in the number of people treated in the first two years of the new system compared to the last two years of the old contract.

The data from the NHS Information Centre shows a rise in the number of treatments involving tooth extractions and dentures and a fall in the more complex crowns and fillings.

Dentists have consistently warned that the payment methods did not cover the costs of carrying out complex treatments and it would mean the incentive would be to pull the tooth out rather than attempt to fix it.

An analysis revealed that in England the proportion of treatments involving dentures increased from 38 per cent to 48 per cent and tooth extractions increased from seven per cent to eight per cent of treatments carried out in 2007/8.

In Wales the proportion of treatments where a tooth was pulled out increased from almost eight per cent to over nine per cent although there was no significant change in dentures.

Meanwhile treatments including crowns dropped from 48 per cent to 35 per cent in England and in Wales dropped from 44 per cent to 35 per cent.

Fillings also reduced from 28 per cent of treatments to 26 per cent.

Other findings show the number of dentists carrying out NHS work has increased by 3.2 per cent , an extra 655 dentists, compared to 2006/7.

Patients also paid more towards their NHS treatment with an increase of £56m or almost 12 per cent in revenue from patient charges.


Health Direct asks what is the difference between being made to pay for NHS dentistry services and being made to pay for cancer drugs?

Labour targets created £90,000 NHS smoking fraud

A man defrauded nearly £90,000 from the NHS by working as a stop smoking adviser and signing up non smoking strangers to exaggerate his success rates and income.

Harry Singer, 54, took advantage of the labour Government’s smoking cessation programme which pays doctors, pharmacists and community groups £45 for every patient they convince to give up for four weeks.

Stop Smoking Counsellor Singer received £89,505 from the NHS for signing people up to programmes to kick the habit. But many of the ‘registrants’ details were taken from other surveys or were friends who either did not smoke at all or had no intention of giving up.

Jailing Singer for 18-months, judge John Hillen said the antismoking scheme was “amateurish” and “cavalier” and blamed the labour Government’s target-driven culture.

“To pay lay people, albeit briefly trained, as stop smoking counsellors for recruiting and spending a few sessions with smokers is an astonishing way to spend public money,” said the judge.

He criticised Kensington and Chelsea Primary Care Trust for operating the scheme without checks which he said was an “extraordinary derogation of responsibility.”

“This was all driven by the need to meet targets and it is a feature of the target-driven culture of the governments of this country that it can lead to the opportunity for fraud,” the judge added.

“Anyone else listening to this case would have been appalled at the cavalier way in which the taxpayers’ money was dealt with by the Kensington and Chelsea Primary Care Trust and the positively amateurish way in which the finance department failed to have any sufficient checks on the money it was paying out on the no smoking service.”

The Primary Care Trust did not suspect the fraud even though Singer was 27 times better than the next best adviser. In just six months he claimed to have convinced 2,017 people to stop smoking, shattering the local target and winning a 2006 nomination for the Stop Smoking Supporter Award.

He received payments in respect of 1,989 people.

But he was eventually caught out when NHS bosses contacted his clients to find out the secret of his success and realised most of the people had never heard of him.

Police described Singer as a “Water Mitty” figure who had recognised the lax regime as an opportunity to print money.

Judge Hillen added: “This was not a sophisticated fraud. I am not going to name names but the public will be very surprised if there have not been resignations over this matter.”

Singer was convicted of 18 specimen false accounting charges between March and October 2006, and one count of concealing criminal property.

Diana Middleditch, Chief Executive of Kensington and Chelsea PCT, said: “The actions of one individual should not detract from the excellent work of the majority of our community advisers, who have a genuine interest in working alongside the local NHS to improve the health of our communities.”

A Department of Health spokesman added: “This year £56m was allocated to the NHS for smoking cessation services. We know that NHS stop smoking services have been hugely effective in helping people quit.”


Health Direct laments the yet again waste of tax payers’ money to hit labour’s NHS targets. This case further undermines any statistics that labour spout for the “success” of this costly project.

NHS diabetes care ‘still has mountain to climb’, experts warn

The NHS still ‘has a mountain to climb’ in the treatment and prevention of diabetes despite labour Government boasts of good progress, experts have said.

A report from the Department of Health said diabetes care is improving rapidly thanks to new guidelines developed five years ago.

More people are being diagnosed and are receiving treatment, the report said.

But critics said there are still 100 amputations a week due to diabetes complications and one in 10 adult deaths can be attributed to the condition and more children are being attending A&E; due to complications, showing that the Department of Health report ‘paints too rosy a picture’.

Diabetes UK chief executive Douglas Smallwood, said: “In view of such outcomes and the fact that the number of people with diabetes is set to double to four million by 2020, this report paints too rosy a picture of the current standard of diabetes care.

“We have a huge mountain to climb to ensure that all people with, and those at risk of, diabetes have access to the information, education, support and high-quality care to enable them to manage their condition on a day-to-day basis, with the help of specialist diabetes teams.

“The rate of progress in diabetes care needs to be much greater in the next five years than we’ve achieved in the previous five years.”

Five years after the Diabetes National Service Framework was published, around 600,000 people have been diagnosed with the condition, the report said.

And vascular checks announced in April, but yet to begin, are expected to prevent around 4,000 people from developing diabetes each year, it said.

Liberal Democrat health spokesman Norman Lamb said: “This report shows the NHS has taken a step in the right direction, but there is still a long way to go before people with diabetes are getting the help they need to manage their condition.

“But what is most striking about the report is what it doesn’t say. Almost no mention is made of the big risk that, unless we effectively tackle obesity, the number of people suffering with diabetes will almost certainly increase.

“A diabetes strategy will not be worth the paper it’s written on if a greater focus is not put on obesity.”

Health Minister, Ann Keen, said: “Today’s report shows that the NHS is getting better and better at identifying people with diabetes and at supporting them to manage their condition.”


NHS cancels more than 100,000 operations in a year

More than 100,000 operations have been cancelled by the NHS over the past year because of bed shortages, staffing problems and other non-clinical reasons, new figures released reveal.

The Department of Health announced that just over 57,000 operations had been cancelled. However, these figures only cover cancellations made in the 24 hours before an operation.

The number of cancelled operations is almost twice as high as previously admitted by the labour Government with thousands of patients suffering from multiple cancellations.

Ministers have previously said that cancelling operations is “unacceptable” yet have failed to act to prevent hospitals from cancelling procedures, often just hours before surgery is due to take place.

The figures have been obtained by the Conservatives who used Freedom of Information laws to request the data from NHS trusts.

Andrew Lansley, the Shadow Health Secretary, said: “Having an operation cancelled can cause huge distress for patients and their families. It’s simply unacceptable that these figures are so high.

“The labour Government are directly to blame for these problems. NHS staff are doing the best they can but how can they plan patients’ care properly when they are continually hampered by Labour’s top-down targets? Labour’s boom and bust approach to the NHS finances has made things even worse, with bed shortages and staffing shortages in far too many trusts.”

The Conservatives claim that Kingston Hospital, York Hospitals and Sussex University Hospitals are among the most prolific cancellers of operations. Only one trust, the Clatterbridge Centre for Oncology said it had not cancelled any operations.

In total, more than 7,000 patients had their operation cancelled more than once. A third of trusts cancelled an operation for the same patient at least three times.

The Conservatives’ analysis reveals that the most popular reason cited for cancelling an operation was “problems with theatre bookings”. Thousands of operations were also cancelled because of bed shortages, administrative problems and staffing shortages.

The figures show that the scale of the problem is far larger than previously disclosed by the Government. Last year, the Department of Health announced that just over 57,000 operations had been cancelled. However, these figures only cover cancellations made in the 24 hours before an operation is due to take place

When hospitals were asked to reveal all cancelled operations, the figures were almost twice as high prompting allegations from the Conservatives that ministers were “spinning the statistics”.

131 of the country’s 171 NHS trusts responded to the Tories’ request for information. The trusts which responded said they had cancelled a total of 77,302 operations which, if extrapolated to include all hospitals, means that about 105,000 operations were cancelled nationally last year.

Shortly before the last election, Tony Blair, the former Prime Minister, said that it was “unacceptable” for operations to be cancelled.

A spokeswoman for the Patients Association said: “Everyone understands that in an emergency, a patient may not have the operation they need because the clinical priorities of another must take priority. The examples in this survey, however, reveal a situation where patients and their families are subject to an increasingly cavalier standard of care in which the NHS is not putting patients first.

“Patients, and taxpayers, expect better management of their NHS than this. The NHS only gets away with it because ultimately its patients cannot go elsewhere. When you know your customer doesn’t have a choice, such standards prevail.”

A spokesman for the Department of Health defended the Government and said it only collected figures for late cancellations as these were of most concern to patients.


NHS risks losing cancer drugs after NICE blights patients

One of the world’s leading drug companies is threatening to withdraw some of its new cancer treatments from the process by which they are approved for use in the National Health Service.

Cancer patients in Britain will consequently be denied more effective drugs that are available to sufferers in other countries.

Roche, the Swiss pharmaceutical giant, has already refused to supply economic data on its drug Avastin for treatment of lung and breast cancer to the National Institute for Health and Clinical Excellence (Nice), the authority that evaluates the cost-effectiveness of medicines for the NHS. This means Avastin will not be available on the NHS for those diseases.

Avastin is said to double the time a breast cancer patient’s condition remains stable when compared with existing treatments. Studies have also shown improved survival rates for lung cancer victims.

Roche said last week it will consider withdrawing from other evaluations rather than submit products only for them to be rejected by Nice as too expensive.

The statement is the latest twist in the growing row over decisions by Nice. Earlier this month Nice caused an outcry in a preliminary decision when it rejected the use of Avastin (also known as bevacizumab), Sutent (sunitinib), Nexavar (sorafenib) and Torisel (temsirolimus) as too expensive to treat kidney cancer.

“The alternative to these drugs for many patients is death,” said Jonathan Waxman, professor of oncology at Imperial College, London. “Nice is making terrible mistakes.”

The survival rates for cancer in Britain are already among the lowest in Europe — on a par with Poland, Slovenia and the Czech Republic, according to data published last year.

However, cancer charities acknowledge there has been significant improvement in rates since the government made the issue a priority with its NHS Cancer Plan, first launched in 2000.

Some consultants argue, however, that Britain already spends less on cancer drugs than many other European countries and that it is “crazy” to reject drugs proven to prolong life.

Richard Barker, director- general of the Association of the British Pharmaceutical Industry, which represents the drug companies, said: “Nice does a tough and necessary job, but is making errors because of a very mechanistic approach.

It relies too much on arithmetic and not enough on clinical judgment.”

Nice was created in 1999 with the aim of ensuring that decisions on the best and most cost-effective drugs for the NHS were made at a national level, were transparent and could be challenged.

When the drug companies scrutinised the economic modelling used by Nice, they realised that the estimated costs of their drugs and effectiveness could vary widely.

Even more seriously, some of the calculations were wrong. There was an outcry in the medical community in February 2006 when Nice stated that Temodal (temozolomide) — declared as the biggest breakthrough in treating brain tumours for decades — did not offer value for money.

Temodal had won approval from the European regulator in 2004, but many British patients were denied treatment as Nice wrangled over costs.

Peter Davison, 48, a manager for Cambridge University Press, was among the few British patients who received the drug — because he was diagnosed with a brain tumour while working in Singapore.

“I was lucky to be abroad,” said Davison, who is now in remission. “Four months after I had the operation to remove the tumour, I was running and climbing mountains.”

When Schering-Plough — the pharmaceutical company which markets Temodal — prepared its appeal against the Nice decision, it identified an error in the modelling. Once corrected, the model showed the drug was cost-effective — and as a result it was ultimately approved for NHS use.

Not surprisingly, the drugs companies now want full access to the economic models, with the chance to check the accuracy of the calculations. In May, the High Court ruled that Pfizer and Esai, the companies which market the Alzheimer drug Aricept, should be given full access to these models.

“We believe this modelling might not be fit for purpose and we want to check it,” said a Pfizer spokesman last week. Nice said it was seeking leave to appeal to the House of Lords after the High Court decision.

Even where the models are correct, consultants and patients’ groups say Nice fails to give proper weight to the evidence from clinicians and patients’ groups.

The Sunday Times has highlighted the fact that NHS patients do not even have the option of paying for the drugs privately because of government ban on “co-payments”. The labour government has said it will review the issue.

Professor Sir Michael Rawlins, chairman of Nice, said the evaluation process was recognised internationally and Nice had been commended by the World Health Organisation for the quality of its work. He said: “We have a finite amount of money to spend on healthcare and we have to divide it up in as fair and as equitable a way as we can. We can’t say to yes to everything. It’s awkward, it’s difficult, it’s unpleasant.”


Top-ups for drugs are fair says voters

Patients should be given the chance to pay extra for the best available drugs in addition to their NHS treatment, according to a Sunday Times poll.

Nearly two-thirds of those surveyed said patients should be permitted to top up their treatment. The government is reviewing the issue after a Sunday Times campaign.

According to the latest YouGov poll, 73% believe that if treatments exist they should be available on the NHS. Only 21% think there should be a limit on treatment. Nearly a third said they would be prepared to pay extra taxes so the more expensive treatments could be available on the NHS.

Alan Johnson, the health secretary, has asked Professor Mike Richards, the cancer czar, to consider whether so-called co-payments should be allowed again. The labour government has previously argued such a scheme would create a two-tier service and has warned patients that care may be withdrawn if they pay for drugs privately.


Health Direct asks why if labour allows the NHS to pay for the removal of 177,00 tattoos why don’t they also fund cancer drugs?

Dental NHS copayments total £4.5bn since 1997

NHS dental patients have paid £4.5bn in charges since 1997, while 2 million people have “lost” their dentist, the Conservatives have claimed.The total paid in charges per year increased 22 per cent between 1997 and 2007, according to figures released to shadow health secretary Andrew Lansley.

New analysis by the Conservatives reveals that:

NHS dental patients have paid £4.5 billion in charges under Labour since 1997, despite 2 million people losing their NHS dentist.

Although spread between fewer patients, the annual amount paid in dental charges has soared by 22 per cent since 1997. Patients are now on average paying 35 per cent more for NHS dental treatment than they were in 1997.

Shadow Health Minister Mike Penning said: “Labour’s dental legacy is one of shameful failure.

“Not only are people now paying 35 per cent more when they see their NHS dentist, but Labour’s botched policies mean that millions of hard-working families have completely lost access to affordable dental care.

“Labour ministers need to own up to their mistakes, stop dithering and take action now to rectify the mess they’ve got the country into.”


Drug companies face fresh action after trial failure

Efforts to punish a group of drug companies allegedly behind one of the biggest price-fixing schemes to hit the public purse are being stepped up after the collapse of their criminal trial.

Frank Field, the former Labour social security minister, wrote to Alan Johnson, the health secretary, yesterday to urge further action against the businesses over a conspiracy that was allegedly taking place while prices of dozens of basic remedies rose as much as 800 per cent.

Mr Field made his intervention as lawyers acting for the National Health Service press for further “substantial recoveries” through a damages action against the companies that has already netted £34m. Many observers say the companies named have never been forced to account fully for their actions, bec-ause of weaknesses in the way Britain deals with financial misconduct.

Mr Field, a former member of the Commons’ public accounts committee, said the companies should be “on their knees thanking their lucky stars” at the decision by Mr Justice Pitchford last month to stop their criminal trial on conspiracy to defraud charges.

Peters & Peters, the law firm acting for the NHS, is pressing ahead with a damages action founded on allegations that the companies were involved in a conspiracy to rig the prices of drugs including penicillin and warfarin, a blood thinner.

Jonathan Tickner, a Peters & Peters partner, said: “The obvious success of the civil proceedings . . . speaks for itself and we, on behalf of the Department of Health, fully expect further substantial recoveries to be made.”

The main company still in the department’s sights is Ashford-based Kent Pharmaceuticals, supplier of many basic antibiotics to NHS hospitals, retail pharmacists and dispensing doctors.

Kent declined to respond to questions on the case. All the other companies that faced criminal charges – Goldshield, Ranbaxy, Generics and Norton Healthcare – declined to comment when asked if they denied colluding with each other, saying they could not speak while the threat of criminal proceedings remained.

Mr Justice Pitchford last month scrapped fraud charges laid by the Serious Fraud Office against the companies after the House of Lords criticised the way the indictment was drafted but left open the possibility it could be amended. The SFO has launched an appeal against the judge’s decision, arguing it should be allowed to reformulate the charges.

Since the trial collapsed, some senior executives – notably those at listed Goldshield, which is chaired by Keith Hellawell, the government’s former drugs “tsar” – have gone on the offensive and complained £25m of taxpayers’ money was wasted in mounting the trial. The companies have always argued that price-fixing was not a crime at the time of their alleged activities.

But lawyers said there seemed to be evidence of subterfuge to justify a prosecution, alleging companies conspired to defraud the government – and hence the taxpayer. Documents seized in the penicillin investigation included a presentation, known as “The Scenario”, that contained a bullet-point overview of how to operate a price-fixing cartel.

The case could be picked up by the Office of Fair Trading, which has imposed fines totalling hundreds of millions of pounds over the past year or so on companies involved in cartels in industries such as aviation, supermarkets and tobacco.

Another possibility is that the NHS could launch a private prosecution. It declined to say whether it had plans to do so.

Health checks

2000 SFO starts probe into price-fixing in supply of generic drugs to NHS April 2002 More than 30 premises raided April 2006 Five companies and nine executives charged with conspiracy to defraud January 2008 Lords hear submissions from Goldshield and Ian Norris that price-fixing cannot be prosecuted under the common law offence of conspiracy to defraud March 2008 Lords rule in favour of Mr Norris and Goldshield July 2008 Judge quashes indictment against the five companies and nine executives charged

New prostate cancer drug hailed by experts

A powerful new drug could transform the treatment of men with aggressive prostate cancer, according to London’s Institute of Cancer Research whose scientists developed it.

The drug – abiraterone – received an enthusiastic endorsement from the institute, Europe’s largest cancer research laboratory, and its associated Royal Marsden hospital, as the first clinical trial results were published online by the Journal of Clinical Oncology.

Ten thousand British men a year, diagnosed with the most aggressive (and normally fatal) form of prostate cancer, could benefit, says the ICR.

Johann de Bono, head of the abiraterone clinical programme, said: “This is the biggest step forward in prostate cancer treatment since the 1940s.”

The ICR and Royal Marsden are usually too cautious to enthuse about a new treatment, for fear of raising excessive expectations among desperate patients. But Dr de Bono said their confidence was based on a substantial amount of unpublished data, as well as the formal analysis in the Journal of Clinical Oncology of the Phase 1 trial with 21 men.

“The Royal Marsden patients have very aggressive prostate cancer which is exceptionally difficult to treat and almost always proves to be fatal,” he said. “They have been monitored for up to two-and-a-half years and with continued use of abiraterone they were able to control their disease with few side-effects.”

Patients showed big falls in levels of prostate specific antigen or PSA, the blood protein associated with prostate cancer activity. “A number of patients were able to stop taking morphine for the relief of bone pain,” Dr de Bono added.

Abiraterone works by blocking the generation of male hormones that drive growth of prostate cancers.

Cougar Biotechnology, a Los Angeles company, is funding extensive further trials, including an international study with 1,200 patients under Dr de Bono’s supervision. He hopes abiraterone will be available for general use from 2011.


Health Direct ask s if this new treatment Abiraterone will be approved by the female biased NICE at the same speed with which they approved Herceptin?

Drug appeal procedures chaotic

The pleas of cancer sufferers in England for drugs other than those usually funded by the NHS are not dealt with fairly, a patient group claims.

The Rarer Cancers Forum said the appeal system was chaotic and the result often depended on where the patient lived.

One in four appeals made in a 20-month period was rejected. But one primary care trust had no successful appeals, compared to 96% in a nearby trust.

“In the last 20 months, 5,000 cancer patients have been forced to plead for their lives. There has to be a better way.” Penny Wilson-Webb of Rarer Cancers Forum

The recent decision by the National Institute for Health and Clinical Excellence (NICE) advising against the use of four drugs for advanced kidney cancer in England and Wales has thrown the spotlight on the patients fighting to receive them.

One of the routes a patient can take if the drug they believe they need is not funded by their local NHS is to lodge an “exceptional request” directly to the primary care trust, and put forward their particular medical or personal circumstances which they say means it should be funded for them.

The latest report, compiled using information obtained under the Freedom of Information Act, reveals that approximately a quarter of appeals are rejected. In total, 5,000 appeals were made, mostly by patients with advanced cancer, over a 20-month period.

There is no national guidance on how appeals should be run by individual primary care trusts, with some choosing to appoint committees including experts, while others do not.

The forum said there was not even a definition of what constituted an “exceptional case”.

It is calling for the appeals to be handled on a regional, or even national level, rather than left in the hands of local NHS managers.

Its chief executive Penny Wilson-Webb said: “This audit shows that the exceptional cases process is in chaos and patients are suffering.

Expert criticism

Dr Steve Schey, a consultant haematologist at King’s College Hospital in London, who has appeared before appeal committees, said that the process seemed to be a “lottery”.

“We urgently need some standardisation and transparency in the decision-making process.”

NICE guidelines cover England and Wales, where similar appeals process is in force.

Scotland and Northern Ireland have their own guideline bodies, and systems for patients to challenge decisions not to fund drugs.

A spokesman for the Department of Health said: “We have heard from patients that one of their major concerns is the perceived ‘postcode lottery’ in access to drugs – that there are too many variations around who gets access to prescribed drugs and that these variations are a lottery depending on where you live.