Drugs classification should be scrapped, experts say

A leading think tank has called for the labour Government’s system of drugs classification to be scrapped.

The UK Drugs Policy Commission says classifying illegal drugs on a “danger scale” of classes A, B or C needs to be overhauled because they do not affect drug use.

The news comes ahead of a meeting this Friday when the Home Office’s independent Advisory Council on the Misuse of Drugs will discuss whether to downgrade ecstasy from class A.

Ecstasy remains the third most popular illicit drug in Britain, with five per cent of young adults aged 16 to 24 saying they have used it in the last year.

The council, which is made up of 21 academics and drugs experts, provides advice to Governments on illegal drug use and is expected to recommend downgrading the drug from A to B.

Reports from the Police Foundation in 2000, the Commons Home Affairs Committee in 2002 and the Commons Science and Technology Committee in 2006 have all favoured the move.

However the Commission warned the council in a submission that Home Secretary Jacqui Smith is likely to over-rule any decision to downgrade, in a re-run of the row over cannabis earlier this year.

Then, the council’s recommendation that cannabis should remain a class C drug was ignored by Miss Smith who decided to reclassify the drug on health grounds.

The Commission says: “The UKDPC does not want to second-guess the council’s final conclusions about ecstasy. However were it to recommend a lower classification then it is not unreasonable to anticipate a political response to that with cannabis.”

The Commission was heavily critical of what it describes as the “increased polticisation” of drugs’ classification.

Roger Howard, Chief Executive, UK Drug Policy Commission, told The Daily Telegraph: “The purpose and operation of the drug classification system has become increasingly confused amongst politicians and the public in recent years.

“The time has come for an independent wholesale review of the system to clarify how a scientific rating of drug harms should be used for drug classifications and for wider applications such as setting policing priorities or public health messages.”

Members of the commission include the chairman Dame Ruth Runciman, a former council member who chaired a Police Foundation inquiry which argued for ecstasy to be moved to class B seven years ago, Professor Colin Blakemore, the former chief executive of the Medical Research Council and David Blakey, a former Chief Constable and HM inspector of constabulary.

The council is expected to make its decision on ecstasy next year.


Private companies get access to millions of NHS medical records

The confidential medical records of millions of NHS patients could be handed over to private companies under controversial plans being drawn up by labour ministers.

Patients’ postcodes, medical conditions and treatments – and in some circumstances, their names – could be passed on to third parties without their consent.

The labour Government is considering giving firms access to a massive computer database which will contain the records of almost every man, woman and child in England.

The information is a goldmine for private companies, who could use it for medical research or for helping them to sell products to the NHS.

But privacy campaigners say they are “horrified” by the proposals which could see patients’ postcodes, medical conditions and treatments – and in some circumstances, their names – passed on to third parties without their consent.

The database, part of a long-delayed scheme to give NHS staff access to computerised medical records, will hold details of almost all visits by patients to hospitals and GPs.

The plans have been dogged by controversy. Last week. ministers gave in to pressure from privacy campaigners and agreed that medics will have to gain the consent of patients before opening their computer records. Yet patients will have almost no control over the same information being passed on to companies and other bodies outside the NHS.

The Department of Health says most records passed onto third parties would be made anonymous, but admits that identifiable data – which could include patient names – could also be handed on if it was deemed to be more useful.

Security experts said the scheme would “hoover up” vast quantities of confidential data which could easily be traced back to individuals, whether or not names and addresses or other personal details were removed.

Ross Anderson, Professor of Security Engineering at Cambridge University, said: “We have had a lot of debate about patients being able to opt out of the national scheme for patient records, but meanwhile the Government have pulled a fast one. There are no limits set on the way this data can be used; this database will hoover up all the personal medical data on every person, and it can be used for whatever the Secretary of State says it can be used for.”

Prof Anderson suggested the creation of one large database would also make it easier for different parts of the state to use confidential health data for other purposes, with social workers, courts and police able to access medical files more easily.

Helen Wilkinson, a former NHS manager who founded The Big Opt-Out, a campaign against the national care records scheme, said she was “horrified” by the latest development and planning a major publicity launch to warn people of the threat it posed to their privacy and security.

She said: “We are talking about a hugely valuable commodity which will be worth a fortune to the pharmaceutical industry, and to all the companies which make their profits from the health service.”

Joyce Robins, from patient pressure group Patient Concern, said patients would be left “entirely at the mercy” of those operating the scheme.

“We have no idea where this information will end up, and we have no control over it. Even when the data is anonymised, it will be easy to trace back to individuals because the nature of medical data is that it reveals a lot about a person. We have seen an endless succession of data losses and breaches, and there is little to reassure anyone that this information would be secure.”

The Government public consultation on secondary uses of NHS data, which began without publicity on Wednesday, has been outsourced to a private company called Tribal, which holds contracts to organise the planning of NHS services.

Its managing director Matthew Swindells was until recently chief information officer of the DoH, and before that adviser to then health secretary Patricia Hewitt.

A spokesman for Connecting for Health, the government agency which oversees the patients records scheme, said that while “in theory” anonymised data could be used to trace an individual, researchers would be more likely to examine records in batches of hundreds of thousands at a time. He described the matter of whether information should stay within the health service, or ever go outside for research – to academic researchers or pharmaceutical companies – as a “valid question” on which the consultation sought public opinion.

The agency’s chief operating officer, Professor Michael Thick, said patients would be able to be removed from the so callled “secondary use” database if they made an application under the Data Protection Act. Under the proposed system, third parties would need to request information from the central database, and fulfil requirements set by data custodians and ethics committees.


Health Direct points out that labour government records have shown themselves to be as watertight as a rusty bucket.

Now labour are openly proposing that your health details will be accessible to many.

Medical records are personal and private to the individuals concerned, having been given in trust to their medical adviser.

The assumption that medical records can be widely disseminated represents a breach of this trust and would be totally unethical.

If you also don’t want your medical details to be widely available, sign up at the Big Opt Out at http://www.nhsconfidentiality.org/

NHS appoints new IT supremos

The health department has finally appointed replacements for Richard Granger, the National Health Service’s IT supremo, some six months after his departure as head of Connecting for Health, the white elephant health service programme that aims to create an electronic patient record system.

Christine Connolly, previously chief information officer at Cadbury Schweppes and head of IT for a significant part of BT’s business, will become chief information officer for health, with overall responsibility for information strategy across the NHS.

Martin Bellamy, a former KPMG partner who has been chief information officer for the Pensions Service since 2003, will be the scheme’s head of programme and system delivery.

Gordon Hextall, the programme’s chief operating officer, who has been acting as the its head since Mr Granger departed, is expected to stay in post.

The health department said both jobs were advertised and would be paid in the £200,000-a-year range. Mr Granger, when he joined the health department in 2002, was briefly Britain’s highest paid civil servant, on £250,000 a year.


Health Direct asks why- at a time when NHS penny pinching is condemning thousands to early deaths, does the NHS needs two IT bosses? At a cool £200K each.

Midwives deal with three births at once, says expert

Midwives are “overworked and overstretched”, sometimes caring for three women in labour at the same time, according an expert.

Since 2001 there has been a 16 per cent rise in birthrates yet there are vacancies for midwives in every part of the country, according to the Royal College of Midwives.

The labour Government has pledged 3,400 extra full-time jobs (4,000 including part-time workers), but research for the Darzi review into the NHS shows a shortage of 4,288 midwives.

The shortfall is estimated after comparing it with the NHS “gold standard” for safer childbirth, which demands one midwife per 28 births.

London has the worst shortages with 1,150 more midwives needed to meet a 20 per cent rise in the birthrate.

Louise Silverton, deputy general secretary at the RCM, said: “Women keep hearing about Government policy statements, such as one-to-one care from a midwife, but they are not getting that sort of treatment in many areas.

“Our members are telling us that they are overworked and overstretched and are running between beds dealing with, in some cases, three women at once.”

The RCM added funding for maternity services has been cut by £55 million.

Miss Silverton added: “The maternity services have long been described as a postcode lottery – but our regional NHS responses paint a shocking picture of just how loaded that lottery for maternity care is.”

By next year ministers have promised women will be able to choose whether to have their child in hospital, at home or in a midwife-led birth centre.

The Government has promised £330 million of extra funding for maternity services over three years.

But, according to Miss Silverton, research shows nine out of 10 maternity units do not know where their share of the £330 million had gone, and it could have been diverted into other services.

She said: “It is not enough for the Government to say it has put money into maternity services, but then fail to make sure the money actually goes where it is supposed to.”


Harmful mistakes of sex education in school

Judged by its results – sex education has been an utter failure. The increase in sex education here in recent years has coincided with an explosion of unwanted pregnancies and sexually transmitted disease (STD) far worse than anywhere else in Europe.

Since the labour government’s teenage pregnancy strategy was introduced in 1999, the number of girls having abortions has soared. You might well be tempted to argue that sex education causes sexual delinquency.

Only two months ago the Health Protection Agency reported that a culture of promiscuity among the young had driven the rate of STDs to a record. Almost 400,000 people – half of them under 25 – were newly diagnosed, 6% more than in 2006.

When something fails, the usual procedure is to drop it and try something else. With sex education, the worse it gets, the more people cry out for more of it and earlier.

Labour ministers are considering whether to make schools offer more sex education, offer it earlier and deny parents the right to withdraw their children from it.

Last week the Family Planning Association – now calling itself the fpa, having joined other charities in a mad rush to reduce themselves to a couple of lower-case letters – published a comic-style sex education booklet for six-year-olds to be marketed in primary schools for use in sex and relationships lessons.

It has printed 50,000 copies of Let’s Grow with Nisha and Joe, and tried it out in more than 50 primary schools; it hopes to encourage schools that have shied away from sex lessons to take them on with Nisha and Joe. Oh dear.

It seems to me highly unrealistic (given that 25% of children leave primary school struggling to read and write) to assume that many six-year-olds could begin to read the labels “testicles” or “vagina”.

And it is infuriating, given that medical-style euphemism has triumphed over plain English, that the authors have chosen one that’s wrong. “Vagina” does not mean the external genital organs, commonly referred to as “front bottom”. It comes from the Latin for sheath or scabbard and means what that suggests. The correct word would be “vulva”, but the ill-educated educationists blithely impose inaccuracy on our tiny children. However, that is not what I most object to.

What I object to about the book is what I object to about sex education as a whole (quite apart from its failures). Sex education – particularly compulsory and standardised sex education – is based on mistaken assumptions.

The first is the pervasive assumption of equality – that is, that all six-year-olds or all 11-year-olds or 15-year-olds can discuss the complexities of sex in the same form in the same way. That’s nonsense. Children vary in intelligence and progress. Some young children can easily decipher words such as “urethra”; others may never be able to read them.

More importantly, children and teenagers mature at different ages and come from different backgrounds with different family expectations. You cannot talk the same way to a shy 13-year-old who hasn’t had her first period to another who is well acquainted with the darker recesses of the school bike shed. Some boys are men at 11 and 12, physically; others are children until much later.

Some children’s parents find it acceptable that their sons and daughters are having sex at 13, while others would be shocked: you cannot talk to all these children together. It would puzzle and offend them and might do them serious damage.

And it undermines the authority of those parents who do not share the values of the teacher, or of the majority of the other pupils. It is wrong to assume that people want equality in such matters. They want differences.

Children and families and moral values are not equal, neither within schools nor outside them. They simply aren’t the same.A sensitive teacher will try to make allowances, but there is a shortage in this country of good and sensitive teachers – hence the crisis in education.

Another mistaken assumption is that sex education ought, necessarily, to be entrusted to teachers, given how wildly they vary in ability and in moral attitudes. The thought that the government is considering making sex and relationship education compulsory in schools is terrifying.



Lady Archer backs patients in row over top-up drugs

Lady Archer has backed demands for patients to be allowed to pay for additional medicines without losing their NHS care by releasing a survey showing that more than 80% of patients at the trust she chairs back the change.

The survey, of more than 800 patients, shows that 82% of NHS patients back the right to pay for top-up medicines.

The survey also found that more than 90% of doctors and nurses favour patients being allowed to pay supplements for proven cancer drugs which are not funded by the NHS.

Archer, chairwoman of Cambridge University Hospitals NHS Foundation Trust, has submitted the results to Mike Richards, the government’s cancer czar, who is conducting an inquiry into the scandal of withdrawing NHS treatment from patients who pay for private medicines.
Private drug helps cancer man left to die

In a letter to Richards, copied to Alan Johnson, the health secretary, Archer described the policy of penalising patients who choose to pay privately for drugs as “illogical and unjust”.

Archer, wife of Jeffrey Archer, the disgraced Tory peer and novelist, also said the co-payments should be allowed, not just for cancer medicines, but for all effective procedures and treatments which are not funded by the NHS.

Christoph Lees, a consultant obstetrician and gynaecologist at the Cambridge NHS Trust, said the labour government should make “sensible provision for patients to exercise what should be their right, rather than penalise them for their choice”.

Meanwhile, nine professors of rheumatology at University College London Hospitals NHS Trust, in central London, and Leeds Teaching Hospitals NHS Trust have claimed British arthritis patients are less likely to get the medicines they need than those in Romania, Hungary and the Czech Republic.

In a letter to The Sunday Times, they accuse the National Institute for Curbing Expenditure (NICE) of making a “senseless decision” by ruling that arthritis sufferers who are not successfully treated by one of a group of medicines known as anti-TNF treatments can’t switch to another type.


Labour U Turn on medical data- NPfIT medical records a step closer

After another labour U turn the national electronic record of patients’ health (NPfIT) looks finally on the cards – five years late – after the NHS IT programme on Thursday changed the way patients will give their consent to the system.

Providing a brief, summary electronic patient record has been a key driver for the £12bn ($22bn) NHS IT programme, which will create a detailed, local electronic record as well as the shorter one available nationally, providing doctors with recent medical history, medications and allergies in an emergency or out of hours.

Tony Bliar, then prime minister, declared as long ago as 1997 that the electronic record would mean that “if you live in Birmingham and have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you”.

Development of electronic records, however, has been devilled by a long and bitter dispute, chiefly with general practitioners, over whether patients should explicitly give consent to having such a record – a more complex, lengthy and costly approach – or whether they should be presumed to give consent with the right to opt out – the approach that the IT programme originally backed.

On Thursday, however, Connecting for Health, which delivers computer systems and support to the NHS, announced a change of tack. Patients will now be written to and given the chance to opt out before a summary record is created.

They will in future be asked at each consultation if the clinician can look at their record and will have the right at that point to opt out entirely, to refuse for that episode of care, or to agree to the record being viewed. They will also be able to agree to the record being permanently available to accredited clinicians.

Dr Gillian Braunold, the lead GP for the programme, said the change “gives the patient control to say yes or no and it is much simpler”. The default position will be “Ask me first”, she said. The decision had been reached after consultation with GP leaders, the Information Commissioner and a wide range of others, she added.

The British Medical Association said it welcomed the changes “pending finer details”, believing patients should opt-in rather than opt-out.

The record has been piloted in five parts of the country, with fewer than 1 per cent of 160,000 patients refusing to have a summary record. Connecting for Health said it hoped to roll the record out nationally, starting in 2009 or early 2010. It is likely to take at least 2-3 years to cover the country.


Cancer patient with months to live wins court order for last-chance drug on NHS

A cancer patient has won a legal battle against the NHS to be given a drug that doctors say could prolong his life by up to three years.

Colin Ross, 55, of Horsham, West Sussex, has multiple myeloma, a cancer of the blood cells, and was not expected to survive to see Christmas unless he was given a drug described as his “last chance”.

The High Court overruled the decision by West Sussex Primary Care Trust that treatment would not be cost-effective, and said that Mr Ross should receive Revlimid as an exceptional case.

Mr Ross had incurable cancer diagnosed in May 2004. In an interview with The Times last month he said that he was “sickened” that he was being denied the £30,000-a-year treatment even though the drug was available to patients living only a few miles away in East Sussex.

But despite the exhortations of doctors treating Mr Ross at the Royal Marsden Hospital, the specialist cancer hospital in London, the trust had, since March, repeatedly refused to fund the drug, raising the issue of a so-called postcode lottery for NHS treatments.

However, Judge Simon Grenfell, sitting in London, condemned the trust’s decision as “one which no reasonable authority could have made on the application before it”.

Revlimid is among the most expensive of new cancer treatments and is readily available to patients across Europe and in the United States and Scotland.

But it has not yet been granted approval by the National Institute for Curbing Expenditure (NICE) and, because of the cost, is likely to be rejected. It is provided by only some trusts in England and then only in exceptional circumstances.

The case is likely to encourage other cancer patients who may have been denied expensive drugs on the NHS, but experts emphasise that the case does not set a legal precedent and that decisions will be taken case by case in other areas.

The judge issued an emergency injunction to enable Mr Ross to begin treatment today, but the ruling was made on an interim basis pending a further appeal and not as the start of permanent treatment.

Mr Ross was too ill to attend court for the ruling but his long-term partner and carer, Wendy Forbes-Newbegin, 52, who has breast cancer, cried after the victory.

She said after the judgment that the family’s treatment by the NHS had been “appalling”.

“The mental anguish that we have been through has at times been unbearable, and wholly unacceptable in this day and age,” she said.

“Colin’s diagnosis and recent prognosis have been so awful in the first place, but to have to endure all the months of waiting for this life-prolonging treatment has been nothing short of shameful in the first degree.”

Mr Ross, who has two children and four grandchildren, told The Times that he feared that delays incurred by his appeals to the trust and ensuing legal action may have reduced the effectiveness of the treatment.

“Depending on what the judges say, I could start treatment with Revlimid, or the doctors will simply refer me to start receiving palliative care,” he said last month. “My bed in the hospice is already booked. I realise the drug is expensive for the NHS, but to think that I could have a few extra months or years to spend with my daughters and watch my grandchildren grow up – I’ve never wanted anything more.”

Before yesterday’s ruling he was taking a cocktail of painkillers and other drugs “just to keep my head above water”, and was advised that Revlimid was now the only option.

In March, Mr Ross’s clinicians asked West Sussex PCT to fund Revlimid for three to four courses at a cost of £5,000 a course and presented evidence to show that it could give Mr Ross up to three more years of life.

He had been unable to purchase the drugs privately, he said. “Even if I could, the law states that I would have to become a private patient and forfeit the rest of my NHS care.”

Richard Clayton, QC, acting for Mr Ross, told the court during a two-day hearing: “This application for this drug is the end of the road for him. Either he gets the drug and is able to have life-prolonging treatment, or he doesn’t and treatment ceases, with inevitable consequences.”

He added: “Were the claimant to live a mile and a half in either direction from where he does, he would have received the drug.”

West Sussex PCT said that it was considering whether to appeal.


Health Direct applauds the judiciary. Having had their power over life and death removed many years ago, it is heartening that they are taking the same power away from labour’s faceless health bureaucrats who are condemning thousands to premature deaths in the name of NHS cash shortages.

The King’s Fund- labour’s NHS top up payments strategy is untenable

The King’s Fund believes the current policy and practice on top-ups, which prohibits people from privately purchasing drugs not available on the health service while continuing a course of NHS care, is untenable.

There are areas of the NHS where there is inconsistency over patient charging, such as optical care and dental care, and current legislation does not provide clear direction to patients or the NHS about why these top-ups are allowed but others, for example the use of non-NICE approved drugs, are not.

In addition, the basis on which decisions are made locally as to whether drugs are available before they have received NICE approval or if NICE has rejected them, is not always clear.

The rules that do exist are differentially applied and result in significant variations between primary care trusts (PCTs) in the decisions reached – precisely the situation that NICE was established to avoid.

This situation is unlikely to be publicly acceptable and examples of the health service forcing vulnerable patients to lose out on their NHS funded treatment because they wish to pay for a drug themselves risks damaging the reputation of the NHS as a caring and compassionate service.

The difficult decision facing the government is compounded by the lack of available evidence on the numbers of people who could take advantage of any changes in the rules permitting top-ups, which we are assuming are small; the possible costs to the NHS; and the potential opportunity costs of using existing NHS resources in this way.

The absence of such an evidence base makes any recommendation we make more difficult. However, after much consideration of what is undoubtedly a complex issue, The King’s Fund believes that in certain circumstances patients should be permitted to pay privately for drugs that have been rejected on cost-effective grounds and retain their right to access the rest of their treatment on the NHS.

They should also pay for the associated treatment costs over and above the cost of treatment they would have received on the NHS.

The King’s Fund recognises there will be equity concerns raised by this as there will inevitably be some patients who can afford top-ups and some who cannot. This is an inevitable cost of this policy option. Therefore, if the government does take the decision to permit top-ups it should address the following issues and ensure safeguards are in place to minimise the risks of unfairness:

* Identify and specify the circumstances in which top-ups are allowed – the review is focusing on drugs only but there are other procedures and therapies that present similar if less emotive issues.
* Calculate the associated costs, such as the costs of administering a drug. If these costs were met by the NHS, this would mean resources being diverted from other NHS patients to support the delivery of a treatment that may have been judged to be not cost-effective by NICE. We propose that the patient should meet the associated costs over and above the NHS treatment they would already be receiving. These costs would have to be carefully calculated.
* Ensure that individuals understand the financial liabilities they may face if they top-up their care – individuals with a terminal illness may feel they have little to lose by risking their resources on an expensive drug with relatively low efficacy but if the drug proves to extend their life they may find themselves unable to finance payments in the medium or long term.

Finally, The King’s Fund believes the government can use the opportunity created by the top-up debate to improve the way that new medicines – and by extension other forms of treatment – come into use.

The present system is overly dependent on trial data supplied by the pharmaceutical companies that do not necessarily reflect the realities of clinical practice. We need a more systematic and ongoing appraisal of new drugs in both clinical and economic terms.

The pharmaceutical industry has itself recognised that the introduction of new and expensive drugs must be handled in innovative ways. These measures might reduce the number of drugs that are excluded from NHS funding and would reduce the level of variation in the availability of non-NICE appraised drugs and treatments and reduce uncertainty for patients and the public.


Average NHS dentist earns six-figure salary

The average Health Service dentist received a 13 per cent pay rise last year, official figures shows this week. That means they now earn more than £100,000 on average without any increase in their NHS workload.

Last night, patients groups blamed the labour Government for “botching” a contract that allows dentists to make more money from the NHS by carrying out simple work at the expense of complex cases.

Dr Anthony Halperin, a dentist and chairman of the Patients Association, said that he was deeply concerned that treatment was becoming worse under a target-based contract that encouraged dentists to “maximise profits” instead of putting patients first.

“There is evidence that a lot of the most complex work is not being carried out,” he said. “It is easier and more profitable to take out a tooth and replace it with a denture than to carry out complex root canal surgery.

“Dentists are working the system for them, not for the patients.”

Salaries for an average NHS dentist, who spends about 70 per cent of each week doing NHS work, topped six figures in 2006-2007, figures will show.

During the same period, total working hours increased by only half an hour a week, to 37 hours.

Of that, the amount of time devoted to the NHS rose by six minutes a week, to just over 26 hours.

The contract, introduced by labour ministers two years ago, has been attacked by MPs and patient groups as well as some dentists.

Critics say that the “target-based” system has encouraged dentists to concentrate on the work that can be done most quickly and lucratively. The number of people seen by NHS dental practices has dropped by more than a million since the contract was introduced.

Roger Goss, of the pressure group Patient Concern, said: “Dentists are getting more money while patients are getting a worse service.

“This government botched the contract for dentists, in just the same way that they did for GPs and consultants before them.

“All these patients who cannot get their teeth treated on the NHS will find it pretty galling that the average dentist is earning six figures.”

In July, the Commons select committee on health said that the Department of Health had failed in its promise to improve access to dentists.

MPs found evidence that the number of complex treatments such as crowns, bridges and dentures had fallen by 57 per cent since the contract was introduced.

The number of root canal treatments fell by 45 per cent in England and Wales, although it rose in Scotland, where the contract was not brought in.

The committee’s report said that it was “extraordinary” that the department did not test the payment system before introducing it everywhere.