NHS data breaches hit 75 in a year

Seventy five breaches of data security rules by the health service have been reported to the information commissioner’s office in the past year, new figures reveal.

The NHS and healthcare sector is second only to the whole of the private sector at losing computers, records and data.

The 75 breaches included 27 lost computers and laptops, 14 losses of paper records and 18 of removable media such as memory sticks.

Data was “inappropriately disclosed” on five occasions, there were two postal errors, one email error and one website security breach.

Eighty breaches in the private sector have been reported since November last year, 28 in central government, 26 in local government and 47 in other public sector bodies.

Information Commissioner Richard Thomas said reports had “soared” since the high profile loss of 25m child benefit records in autumn last year.

He said responsibility for data breaches should lay with chief executives, who should ensure appropriate policies and procedures are in place, that privacy is incorporated into their technology and that staff are properly trained.

“It is alarming that despite high profile data losses, the threat of enforcement action, a plethora of reports on data handling and clear ICO guidance, the flow of data breaches and sloppy information handling continues,” said Mr Thomas.


NHS records NPfIT project grinds to halt

Progress on the £12bn computer programme (NPfIT) designed to give doctors instant access to patients’ records across the country has virtually ground to a halt, raising questions about whether the world’s biggest civil information technology project will ever be finished.

Connecting for Health, the ambitious plan to give every patient a comprehensive electronic record, has faced a series of problems over its size and complexity since it was first launched in 2002.

In May this year, the National Audit Office said the project was running at least four years late but still appeared “feasible”.

Since then, however, just one of the scores of acute care hospitals due to install the underlying administration system required in order for the patient record to work has done so. The hospital, Royal Free NHS Trust in London, continues to have difficulties getting it to operate properly.

In addition, the contractor originally hired to build the patient record system for the whole of the south of England, Fujitsu, has been fired. And BT, one of the two key remaining contractors, has been unable to agree a price for taking over the work Fujitsu had begun.

Health ministers originally promised the long-delayed first installation of patient record software in the north of England would finally take place in June at Morecambe Bay on the Lancashire/Cumbria border.

But four months on, the system has still not gone live and neither Morecambe Bay nor Connecting for Health can give a date when it might.

CfH’s most recent published plans for the next three months do not include a single installation of a patient administration system into any acute hospital trust.

And while NHS Trusts in the south – Fujitsu’s former area – are being given a choice of working with BT, the supplier for London, or CSC, the supplier for the north, none has yet signed up with either.

Jon Hoeksma, editor of the e-health insider website which has tracked the CfH programme from its start, said other parts of the £12bn project are continuing to make progress.

“But this key part seems to be simply stuck. It has ground to a halt. And that is not just affecting deployments that should be happening now. It will have a knock-on effect on those that are meant to be going live two or three years down the line.”

Hospital chief executives, he said, did not want to take a new system “until they have seen it put in pretty flawlessly elsewhere”.

Frances Blunden, the IT policy specialist at the NHS Confederation, the body that represents NHS Trusts, said: “It is a little bit too early to pronounce the programme dead.”

She said there were “undeniable” problems, but “to say everyone is walking away from it is a bit premature, probably”.

She said the health department had promised earlier this year to address hospital complaints that the system was too standardised and could not be adjusted to take account of local needs. “But we haven’t seen the implementation document to put flesh on the bones of that.”

A spokesman for Connecting for Health acknowledged that BT, which covers London, was “taking stock” given the difficulties encountered. The spokesman said it was more important to get the quality of installations right rather than promise delivery on a particular date. Talks with suppliers were under way to ensure “a smooth transition” in the south, after Fujitsu’s departure.


Doctors do not back cervical vaccine choice made by labour ministers

The wrong vaccine against cervical cancer has been chosen by the labour Government and doctors would give their own daughters the alternative jab, a prominent doctor has warned.

GP and broadcaster Dr Phil Hammond, said he and most doctors he has spoken to have opted for Gardasil, rather than Cervarix, for their own children as it also protects against 90 per cent of cases of genital warts as well as cervical cancer.

Writing online in the British Medical Journal, he said the issue has been overlooked because genital warts ‘never made it to the front cover’ of newspapers, but if it were breast cancer instead there would ‘marches on Downing Street’ to campaign for the choice of vaccine to be made available on the NHS.

There are two different cervical cancer vaccines on the market, Cervarix and Gardasil, which protect against the human papillomavirus which causes the disease.

The Government has chosen to offer Cervarix as part of a national vaccination programme for all girls aged 11 and 12 with a catch up campaign for older girls.

There are over 100 strains of HPV and Cervarix protects against the two which account for most cases of cancer whereas Gardasil works against an additional two strains so protects against other sexually transmitted conditions as well.

Gardasil remains available but only privately even though most other European countries have chosen it for their own national programmes.

Dr Hammond wrote that with 100,000 new cases of genital warts in England each year and condoms only reducing transmission by up to 50 per cent, the far safer option is to vaccinate with Gardasil.

But, although Gardasil is available privately to parents, at a cost of £350 to £400, most will not be able to afford it, he added.

The vaccine choice could be a false economy because of the estimated cost of treating genital warts is £23m a year and vaccinating with Gardasil would have begun to pay off within three to four years, he said.

According to Hammond, who is a vice-president of the Patients Association, with the current cost of treating genital warts estimated to be £23 million, the government’s decision may be a false economy. Within three or four years the use of Gardasil would have begun to have a considerable financial payback.

The NHS offers no information about Gardasil, raising serious questions over patient choice.

The Government’s vaccine advisors said that if both vaccines were offered to the NHS at the same price then it would recommend using Gardasil because of the extra protection and because Cervarix, made by Sanofi Pasteur, has been chosen it seems the decision has been made on the basis of cost.

Both vaccines are listed as costing £80.50 in the book of licensed medicines but the details of the discount offered by GlaxoSmithKline to the NHS in order to get the contract, remains ‘commerically confidential’.


Nanny state children aged five to get sex education

Children as young as five will be given sex education under labour’s nanny state plans to cut teenage pregnancy and sexually transmitted diseases.

Pupils will get basic classes in identifying body parts in the first few years of primary school.

In later years, they will be required to have more structured lessons about reproduction and relationships, a major review will recommend.

At secondary level, schools should improve the way issues such as civil partnerships and the importance of marriage are covered.

Teachers will also be given training in delivering lessons amid fears too many are embarrassed to discuss sex in the classroom.

The labour Government has already admitted that sex and relationship education across England is too “patchy”.

However, the move will be opposed by family campaigners who accuse ministers of subjecting pupils to controversial issues before they are ready.

To allay concerns, ministers are expected to announce a consultation ahead of the implementation of the lessons on whether or not to give parents an opportunity to withdraw their children.

In a further move, ministers will also announce a radical shake-up of the way children are taught about the dangers of drugs and alcohol.

Jim Knight, the Schools Minister, who has led the review, insisted exposure to sex education before puberty reduced teenage pregnancy rates.

“It is important that we as a society allow better sex and relationship education in both primary and secondary schools without sexualising young people too early,” he said. “It is right to share the responsibility between home and school.”

At present, all primary and secondary pupils have to learn about the biology of reproduction in science.

In primary schools, pupils should learn about how animals and humans reproduce, but can limit lessons to the biology curriculum.

Schools can also cover the subject in personal, social and health education, although it is not a compulsory part of the National Curriculum.

In secondary schools, teachers must go further, covering issues such as relationships and sexually transmitted diseases. Lessons on civil partnerships and marriage are also offered at secondary level as part of PSHE but they are non-statutory.

Mr Knight said he had received “many strong representations” for making PSHE statutory at all ages to address the problem of poor lessons.

Speaking in the Commons, he said: “The international evidence suggests that teaching aspects of sex and relationship education before puberty has a positive effect on such things as teenage pregnancy rates. Clearly, that has to be done with a high degree of sensitivity and… the involvement of parents, with children reaching puberty at different ages. We must ensure not only that, as a society, we are comfortable with the level of detail and of education that people receive during sex education, but that we are strong on relationship education.”

Leading charities including the Sex Education Forum and Brook, the sexual health advice service, which have taken part in the Government review, have already called for lessons to be compulsory in all schools.

It follows the publication of labour Government figures earlier this year showing that the number of abortions in girls under 16 last year rose 10 per cent to 4,376.

Norman Wells, director of the Family Education Trust, said making sex education mandatory would “seriously undermine parents”.

New-style lessons on drugs and alcohol lessons will also be overhauled.

Primary school pupils will be given warnings on avoiding medicines and prescription drugs left in the home – as well recognising the difference between soft drinks and alcohol.

Stephen Burgess, national director of Life Education Centres, the health charity, said: “If we want to make a real and lasting difference to teenage drug and alcohol misuse, we must reach them early – at primary school. Then, as they reach adolescence and are most at risk from peer influence, they can make informed decisions based on fact rather than hearsay.”

*Health officials were forced to apologise after sending letters to children as young as nine, demanding they are tested for sexually transmitted diseases.

Primary school children were also offered the chance to win an iPod if they attended a clinic for testing. A primary care trust in Harrow blamed an administrative error.

Geraldine Smith, the Labour MP for Morecambe and Lunesdale, told the Telegraph: “To start sex education at primary school is to rob young children of their innocence. I know children seem to grow up faster these days but to start formally teaching them about sex education would be quite wrong and would encourage under-age sex. Being exposed to this sort of thing at such an age would put an awful lot of pressure on very young children.”


Health Dept prescription medicines pricing shake up descends into chaos

Plans to introduce a new system for setting the price of prescription medicines have been thrown into chaos by the Department of Health, potentially costing the health service tens of millions of Pounds.

A joint memo circulated this week by the department and the Association of the British Pharmaceutical Industry, the trade body, warns that there will now be a delay of at least three months in implementing one part of the arrangement negotiated with industry over the summer.

In spite of having had months to prepare for the new arrangement, which had been due to come into force by the start of next year, the Department of Health has also failed to develop a system to monitor drug prices systematically, which is essential for implementing another part of the new deal.

The moves are fresh blows to relations between the pharmaceutical sector and the government, which sparked industry ire last year when it unilaterally decided to scrap the present Pharmaceutical Pricing Regulation Scheme, which determines how drug prices are set.

One pharmaceutical industry official said the issue was causing a “furore” in the sector and said it would take at least several weeks to clarify the full implications and how to respond.

The memo circulated last week says that industry will not now be expected to cut the price of off-patent branded medicines from January 1, as had been previously agreed, since the department decided it needed to hold a public consultation on the issue.

In the short term, the uncertainty means that the NHS will be sacrificing an estimated £80m in annual savings from price cuts in these so-called branded generics or “loss of exclusivity” medicines.

But the delay also creates uncertainty over how to implement the entire PPRS deal, which gives companies flexibility over how much they charge the NHS for individual medicines, provided there is an overall price cut of 5 per cent in the £8bn annual total.

Under the agreement reached with the pharmaceutical industry this summer, 3.9 per cent of the annual savings were des-igned to come from price reductions on patented medicines, and a further 1.1 per cent from the off-patent brands.

The new deal was supposed to reduce the price of branded generic drugs to 1.5 times the government’s reimbursement level set for generic medicines. Generic drug manufacturers fear they may lose out if this ratio is modified as a result of the latest department consultations.

A second aspect of the PPRS raises the possibility of fresh price cuts, on top of the 5 per cent scheduled for the start of this year, if drug prices rise too fast.


Treasury U Turn to ensure taxpayer is no longer the loser in PFI deals

The Treasury ordered public bodies doing private finance initiative (PFI) deals to require a much bigger share of any windfall gains from refinancing them in the future.

PFI deals are still being negotiated – not without difficulty – in spite of the credit crunch as some banks see their government-backed revenues as a haven in the financial turmoil.

However, the credit squeeze has seen funders demanding higher margins on the debt put into them and that has opened up the possibility again of significant refinancing gains if investment and interest rates fall to pre-credit crunch levels.

In a move to avoid the acute embarrassment of the early days of PFI, when investors in projects made millions of pounds from refinancings and it turned out that the taxpayer had no right to any share in the gains, the Treasury has upped the share it is demanding.

Investors in one of the early hospital projects, for example, made a 60% windfall gain and hugely increased rates of return when they used falling interest rates to refinance. As a result, since 2001 contracts have required that any such gains should be split equally between the project’s backers and the taxpayer.

That will still apply to the first £1m of any gain. But for new deals the Treasury said yesterday that the next £2m would have to be shared 60/40 in the taxpayers’ favour and for anything above that the taxpayer would take 70 per cent.

As an additional protection, new contracts will give the public sector the right to demand a refinancing if it believes that will lead to better terms for the taxpayer, whereas previously only the contractors have been able to initiate such a deal.

In spite of the onset of the credit crunch last year, more than a dozen PFI deals have been signed this year, according to the Treasury, eight or nine of them in the second half of the year, despite the growing problems over bank lending.

Almost £600m of schemes by capital value have been agreed since the middle of the year, though most have been smaller deals in the £20m to £90m range.

Some European banks have withdrawn from the PFI market, and James Stewart, chief executive of PUK, the public-private partnership that advises the public sector on deals, said recently that sponsors had had to go to clubs of several banks to arrange financing – rather than doing a deal with one or two that then sold the debt on.


Two thirds of patients fail to get GP’s appointment within 48 hours

Two thirds of NHS patients cannot get an appointment with their GP within 48 hours, a wide ranging report by the healthcare watchdog has found- and the situation is getting worse as last year 80 per cent of patients could see their GPs within 48 hours.

The most comprehensive study of its kind has shown that millions of people are being failed by their local surgeries.

Under key NHS targets, patients should be able to see their family doctor within two working days. However, the report said that just one third of people were able to see their GP within this time.

The findings come at a time when the relationship between patients and their doctors is already under strain.

There has been widespread anger over the large pay rises enjoyed by GPs under the new contract.

And ministers and GPs have been locked in bitter negotiations about forcing surgeries to open for extended hours, offering appointments into the evening, early in the morning and on Saturdays.

Gary Needle, at the Healthcare Commission, said: “Patients are not getting sufficient access to their GPs is the message from this measure.”

Andrew Lansley, Shadow Health Secretary said: “Despite all their talk, Labour are still failing patients when it comes to choice and access to a GP.

“It’s appalling that in seven out of ten areas, people aren’t able to see their doctor within 48 hours when they wish. It shows the utter failure of Labour’s top-down targets to bring about the best results for patients.”

Liberal Democrat health spokesman Norman Lamb said: “For years people have known that ministers’ complacent assurances about how easy it was to see a GP were wrong.

“At last a proper assessment has taken place so we can see the reality of the situation. This scandalous finding must force the Government to act now.”

Last year the report found that 80 per cent of patients were able to see their GPs within 48 hours.

However, the data was gathered by using ‘mystery patients’ to carry out spot checks to see if they could get an appointment rather than asking patients.

This year, for the first time, the commission included information from a patient survey. The report has sparked a row with doctors who have said the figures are misleading.

Dr Hamish Meldrum, chairman of the British Medical Association said: “The report’s conclusion that there has been a dramatic decline in primary care trusts meeting the GP 48-hour access target is misleading.

“There has been such significant change in the way the research has been compiled compared to last year that it is impossible to compare the data for the two years in question. The access figures are even more confusing when you consider that a recent survey showed almost 9 out of 10 patients were satisfied that they were able to get an appointment within 48 hours.

“GPs are working hard to offer as much flexibility as they can to patients, as well as providing speedy access, and delivering an expanding range of services to patients.”

The latest figures show the average annual earnings of GPs, who are paid to hit the targets on appointments, are £103,530 – a drop of 2.6 per cent on last year after years of rising pay. They also showed 258 doctors earned more than £250,000 before tax last year.

The commission’s healthcheck is an in-depth investigation into the NHS with each hospital trust, primary care trust, mental health trust and ambulance trust measured on waiting times, hygiene, confidentiality, management of records, reducing deaths from cancer and heart disease, cutting superbug rates and treating patients with dignity and respect.

While the report found there had been improvements in many areas, it found that infection control was a serious problem with ‘lapses at almost every trust visited’ and six out of ten trusts failing on at least one measure.

The Commission warned that other infections such as norovirus – the winter vomiting bug that reached record levels last winter – should be included in the measures in the future alongside Clostridium difficile and MRSA.

Of the 114 trusts that failed on at least one infection control measure, 11 said they were compliant only for this to be overturned by inspectors.

There is concern about infection control in community hospitals, district nursing, ambulances and midwifery and these areas will have extra focus in the next inspections.


Specialist maternity baby care overstretched

Staffing shortages are stretching specialist baby care units to the limit, campaigners say.

Premature baby charity Bliss found just 20% of UK hospitals had enough staff to meet recommended care guidelines.

The study of 194 neonatal units showed that more than 50% had been forced to close to new admissions during a five-month period because of shortages.

The charity said it was shocking that such problems were persisting.

Each year, more than 80,000 babies – 10% of the total born – need specialist care in a neonatal unit – usually because they are underweight or premature.

Bliss surveyed all 213 British hospitals with neonatal units about care, from April to September 2007, and 91% of those asked responded.

They found that only 21% of the hospitals which responded had enough staffing to provide the recommended nurse to baby ratios.

These vary between one-on-care in intensive care wards to one nurse to every four babies on the least-intensive special care baby units.

To meet the recommended guidelines the charity said it believed an extra 1,700 neonatal nurses were needed in addition to the 6,500 already employed.

More doctors were also needed, it added. But it warned there had been a lack of progress made in neonatal care over the years.

This is the fourth report the charity has produced highlighting the issue. Over the last year fewer than 200 extra nurses have been recruited.

The charity also polled more than 300 parents who complained of being transferred between hospitals – sometimes over long distances – because of staffing shortages.

Bliss chief executive Andy Cole said: “Professionals are increasingly being stretched to the limit.

“Staffing shortages are all too apparent on units and the care of our most vulnerable babies is being compromised.

“No other critical care service would permit the capacity and staffing levels seen on special care baby units.”

David Field, president of the British Association of Perinatal Medicine, agreed the staff shortages were worrying.

He added: “We would like neonatal care to be given the same kind of priority that other specialist services such as cancer care or A&E; have received.”

But a Department of Health spokesman said there was no evidence that services were “unsafe”.

“We are committed to providing mothers and babies with safe, high quality neonatal services and have made neonatal services a top priority for the NHS.

“However, we recognise there is still more to do.”

Meanwhile, a spokeswoman for the Scottish government said that a review of neonatal care was currently taking place.

She added: “The Scottish government is committed to providing the best possible care for premature babies.”


NHS hospitals are warned on core standards

Almost a third of National Health Service hospitals risk being refused a licence to operate because they are still not meeting core standards of safety, effectiveness cleanliness and record keeping, the Healthcare Commission, the NHS inspectorate warned.

The failure fully to cover the basics comes despite a big improvement in the health service’s performance over the past three years, the commission said in its annual “state of the nation” report on the NHS.

From April 2010, NHS hospitals and organisations will go through a registration system that will issue them with a licence to operate.

But while two-thirds of NHS organisations and 70 per cent of acute hospitals meet all the core standards laid down by the Department of Health, and a further 25 per cent are judged to be almost there and therefore likely to meet the standard for registration, about 10 per cent of NHS organisations and hospitals are still some way from the target.

“If they don’t meet these core standards,” said Sir Ian Kennedy, chairman of the Healthcare Commission, “then the Care Quality Commission could withdraw registration or impose tough penalties such as fines or operating conditions.

“I would urge trusts to get their act together with all appropriate urgency.”

Baroness Young, chairman of the Care Quality Commission, which next April replaces the Healthcare Commission as the inspectorate, has said she thinks it “very unlikely” that an entire NHS hospital will be refused a licence to operate.

“I doubt there will be many to whom we say: up with this we cannot put; we will not register you,” she has said.

But hospital departments and services could find themselves operating under strict conditions and improvement plans, with the inspectorate holding tougher enforcement powers than the existing one. The warning that a small minority of NHS organisations have a long way to go to hit standards came as the inspectorate’s annual check showed significant overall improvements in performance.


NHS hospitals allowing top up cancer drugs payments

Health Direct has learned that payments to top up NHS care – supposedly banned – are happening at 30 hospitals across the UK.

Professor Mike Richards, the cancer tsar for England, has been holding a review about so called co-payments and will report at the end of this month. The issue is also under review in Wales and Scotland.

But patients are already topping up their NHS care, as hospitals find ways around the current rules.

The current rules say you cannot mix and match between the NHS and private.

You are either all NHS and it is free or you’re all private and you pay for everything.

But the details are interesting. The code of practice says a patient cannot be both an NHS patient and private in the same episode of care.

So in Birmingham they have found a way round the ban on top ups.

Separately another consultant at the same hospital writes a private prescription for the drugs that patients wants to keep them alive.

They are supplied at patients’ homes by a private company called Healthcare at Home.

They pay the company direct. So the administration of the drugs is viewed as a separate episode of care.

Professor Nick James is the oncologist in Birmingham who designed this model of allowing patients to top up their care.

“Nowhere does it say that an episode of care is from diagnosis to death of your cancer” he said. “So we’ve just interpreted the rules in a way which is in favour of the patients.”

Across the country

What is remarkable is that topping up, something the labour government says is banned, is not just happening in Birmingham.

The company which provides the drugs to Ian says they have contracts with 30 NHS hospitals across the country.

Mike Gordon, chief executive of Healthcare at Home, said: “Top ups are happening today and they’ll happen tomorrow. So long as they’re done through us not using the auspices of the NHS I see no reason why they shouldn’t continue.”

A Department of Health spokesperson said: “We know there is variation in how individual Trusts are applying the current guidance, and that is why the Secretary of State asked Professor Mike Richards, National Clinical Director for Cancer, to lead a review into this difficult issue.

“Professor Richards is looking at how a consistent approach across the country might be best achieved.”

Shadow Health Secretary Andrew Lansley said: “David Cameron and I have pressed the Health Secretary, Alan Johnson, to enter into a risk sharing scheme for the kidney cancer drug Sutent in order that patients will be able to access this life saving treatment immediately, but nothing has been done.”

Norman Lamb, for the Liberal Democrats, said: “We are in an outrageous situation where patients are left in a lottery, dependent on a few hospitals which are bending the rules.

“This case makes the need for reform all the more urgent.”

All Ian Jenkins wants is to stay alive as long as possible.

But his story does raise the question, why the need for a high level review of top ups if they are already happening all over the country?