NHS told to tighten data security by watchdog

The information commissioner has told the NHS to improve its data security, after breaches involving the loss of thousands of personal medical records. The losses were described as a cause of “great concern”.

The independent data security watchdog says it has taken action against 14 NHS organisations in the last six months.

Among the data subject to breaches were the medical details of more than 6,000 prisoners and of 700 hospital patients.

A Department of Health spokesman said action would be taken against anyone who breached data protection rules.


Information Commissioner Richard Thomas has written to the Department of Health’s top civil servant requesting immediate improvement.

Mick Gorrill, the assistant information commissioner, told the Independent newspaper that the “inexcusable” data losses within the NHS had become a cause of “great concern”.

The paper reported that between January and April this year there were 140 reported security breaches within the NHS – more than from central government and local authorities combined.

These included medical details of more than 6,000 prisoners in Preston Prison in Lancashire that were contained on a lost memory stick. The data was encrypted but a note attached to the stick gave the password.

Another memory stick with the details of more than 700 patients at Cambridge University Hospital was left in a vehicle. A car wash attendant was able to access the unencrypted material.

‘Secure network’

A Department of Health spokesman said the permanent secretary at the department would be replying “in due course” to Mr Thomas’s concerns and that action would be taken “against anyone responsible for breaching our strict data protection rules”.

“The chief executive of the NHS wrote to all senior health managers reminding them of their responsibilities,” he said.

“The department is also providing, through the National Programme for IT, electronic patient records systems that are protected by the highest levels of access controls and other security measures, a secure NHS network for exchanging information that is centrally monitored and strongly protected and secure NHS e-mail facilities that encrypts all data in its system.”

In December 2007, nine NHS trusts in England admitted losing patient records, thought to affect hundreds of thousands of adults and children.


Swine flu vaccine supplies secured and costed.

Fresh hope of protection against the H1N1 flu outbreak emerged when the labour government said it had signed a £450m agreement to reserve scarce manufacturing capacity for 90m doses of vaccine by the end of the year.

The contract, which individuals close to the talks estimated to be worth about £5 a dose, may spark international concerns as some richer countries negotiate with producers for privileged access to limited supplies of a pandemic vaccine .

The deal comes at a time when worried parents have raised the idea of “swine flu parties” – to expose the family to the virus while it remains relatively mild – and have made efforts to obtain the antiviral flu treatment Tamiflu through private prescriptions and the internet. Officials have advised against both approaches.

No vaccine is currently available to protect against the H1N1 virus first identified in Mexico, and there is considerable doubt that the current seasonal vaccines will provide any help.

With scientists close to preparing a “seed virus” from the current H1N1 strain isolated in Mexico, the UK funding will allow for production of a vaccine over the next few months – in time for a second wave of infection expected during the flu season towards the end of the year.

Alan Johnson, health secretary, said: “These additional arrangements provide the opportunity by December this year to have enough pre-pandemic vaccine to protect at least half of the population from swine flu.”

GlaxoSmithKline, which won the contract to supply 60m of the 90m British doses, said it had also sold a further 50m doses to France, 13m to Belgium and 5m to Finland. Baxter, which will supply the UK’s remaining 30m doses , said it had not finalised any other H1N1 vaccine contracts.

The UK already agreed two years ago to pay £155m for ” advance supply agreements ” which reserve manufacturing capacity for production of 132m doses of a future pandemic vaccine sufficient to cover the entire population. If the World Health Organisation raises its assessment of the current H1N1 virus to a full pandemic, this earlier contract will be triggered.

But with total annual seasonal flu production estimated at 400m doses globally, there is unlikely to be sufficient capacity to cover the entire world, even with new approaches and technologies to boost productivity.


What a difference a day and the FT can make.

In the Health Direct blog post yesterday Swine flu: Government signs up for 90 million doses of vaccine Labour Ministers have signed agreements to secure up to 90 million doses of swine flu vaccine.

We asked why the costs of the new order were being kept confidential. Thanks to the Financial Times for uncovering the amount we are paying for the questionable cover.

Swine flu: Government signs up for 90 million doses of vaccine

Labour Ministers have signed agreements to secure up to 90 million doses of swine flu vaccine despite the fact that a pandemic has not yet been declared.

The deals with pharmaceutical companies GlaxoSmithKline (GSK) and Baxter will secure “early supplies” of a vaccine for the newly identified H1N1 strain.

Enough “pre-pandemic” vaccine has been ordered to protect at least half of the population by December, at an estimated cost of £100 million.

This is in addition to the purchase of 500 million doses of anti-viral drugs that have already been stockpiled to help treat illness and deals to procure vaccine in the event of a pandemic.

So far only 184 cases of the newly identified H1N1 strain have been confirmed in Britain, with all those infected showing only minor symptoms.

However, experts predict that swine flu — which is actually a recombination of existing animal and human flu strains — could cause a second wave of more widespread illness in winter.

The Department of Health said that the agreement could provide enough vaccine to protect health workers and the most vulnerable patients before a pandemic arrived, without affecting the normal supply of seasonal flu vaccine.

The jabs could be given as a priority to the elderly, patients with chronic conditions as well as NHS and social care staff.

It may be that the vaccine would be supplied in two or more doses, necessitating the order for more treatment courses than the total population of Britain.

The Government has already signed agreements worth £155 million to supply up to 132 million doses of vaccine to inoculate people in the event of a pandemic.

It has also procured enough anti-viral drugs to cover 80 per cent of the population, at a cost of more than £500 million.

But it refused to disclose the additional cost of the new contracts signed.

The World Health Organisation’s official alert level remains at phase five out of six — one step away from declaring a global pandemic. But France, Belgium and Finland are among other countries that are stockpiling doses of potential vaccine as a precautionary measure for such an event.

The vaccines used before and during a pandemic would almost certainly be the same unless the strain mutates sufficiently to require an entirely new vaccine to be made.

Alan Johnson, the Health Secretary, said: “The localised cases of swine flu found in the UK have so far been mild, and our strategy of containing the spread with anti-virals appears to have been effective in reducing symptoms and preventing further spread of infection.”

But, he added: “Scientists tell us that as yet we don’t know enough about this novel strain, or whether it’s likely to mutate, but that this virus has the potential to become a pandemic and we can’t predict how serious that would be.”

Mr Johnson told the House of Commons that it could take four to six months before a vaccine could be manufactured in the event of a pandemic and more than a year until it would be available in sufficient quantities for the whole population.

“We have an opportunity to secure vaccine in advance of a pandemic wave… These additional arrangements provide the opportunity by December this year to have enough pre-pandemic vaccine to protect at least half of the population from swine flu.”


Health Direct is pleased that Alan Johnson seems to be on the ball with Swine Flu, but why the secrecy over the additional costs?

Surely Alan Johnson- one of the spposedly “saints” over MPs expenses, realises that silence is the devil’s friend. These extra costs will eventually be published. And will they met be from the NHS’s existing budget or the Treasury’s Contingency Fund?

NHS swine flu absence may reach 85%

The NHS may struggle to cope if there is a flu pandemic because of the number of staff who will fail to turn up for work, a report suggests.

Birmingham University researchers quizzed more than 1,000 health workers and found as many as 85% may be absent.

This is more than double the official predictions and the experts believe such a scenario could put too much strain on the health service.

Under contingency plans already drawn up, protocols are in place to allow the NHS to cancel non emergency treatment such as elective operations.

GPs have also been asked to develop networks to allow the sharing of resources to cope with pressures during a pandemic.

But the report, published in the BMC Public Health journal, questioned whether this would be sufficient.

Official estimates suggest the absence rate will be something between 10% to 35%.

But the Birmingham University poll found that in a severe pandemic where many schools were closed and transport disrupted the actual figure could be more than double that.

Researchers asked a range of staff ranging from doctors and nurses to support staff and managers about how they thought they would cope.

High absence rates were predicted for each group, although doctors were among the most likely to turn up.

The most important factor that would lead to an absence was caring responsibilities to children or elderly family members, the report said.

‘No easy answers’

Dr Sarah Damery, one of the report authors, said: “It raises questions about the ability of the NHS to cope. The problem is that there are no easy answers.

“Things such as transport and accommodation can be resolved, but the major factor that would influence people staying away is to do with caring responsibilities and these are not that easy to solve.”

The findings come as the UK is braced for a pandemic.

The World Health Organization currently rates the swine flu outbreaks at phase five – one level short of a pandemic.

Professor Steve Field, the president of the Royal College of GPs, which has helped draw up the contingency plans, said: “I think the plans in place are excellent and what we have seen so far is that health workers have risen to the challenge.


Private companies increase GP presence

The private sector has established a small but significant bridgehead in general practice in England, but any “corporate takeover” of family doctor surgeries remains a long way off.

Primary care trusts have been commissioning some 260 “GP-led health centres”, or “polyclinics”, open 8am to 8pm, seven days a week – one in each primary care trust and a further 110 or so in areas short of doctors.

With just over 200 of the contracts awarded, 42 per cent have been won by partnerships of GPs, according to health department figures. Private sector companies have won 21 per cent, and consortia – usually a mix of GPs working with independent sector partners – have won 19 per cent.

The remainder have gone chiefly to third sector organisations, including social enterprise, with primary care trusts awarding 6 per cent of contracts to their own provider arms.

When the centres were announced, the British Medical Association ran a “save our surgeries” publicity campaign and petition, saying the labour government was seeking to privatise general practice and that many of the extra surgeries with longer opening hours were unnecessary.

The contract award figures show, however, that GPs locally have bid strongly to run them – even the practice in which Dr Hamish Meldrum, the BMA’s chairman of council is a partner, won one commission.

“How well family doctors and the private sector have done depends somewhat on how you want to look at the figures,” said Helen Parker, co-director of the Health Services Management Centre at Birmingham university.

If GPs working in consortia with independent sector partners are included in the total that are GP-run, family doctors have won 60 per cent of the contracts.

If, however, those consortia that include the independent sector are counted as privately run, private operators have a stake in 40 per cent. But even in this scenario, fewer than 100 of the 8,000 general practices in England will be run by the independent sector.

“This does not yet amount to a corporate takeover of general practice,” Ms Parker said.

Mark Britnell, the health department’s director-general of commissioning, said the outcome “is a good mix, and the fact that GPs have won a significant proportion of the contracts shows that the BMA was wrong to insist that this was bad for GPs”.

Mike Parish, chairman of the NHS Partners Network, which represents private providers, said it was broadly pleased with the outcome.

“It is a fantastic opportunity to build on the new relationships that have been established [with primary care trusts]”, he said. “We see these projects as the beginning rather than the end, or a one-off.”

Some £10bn of efficiency improvements would be needed over the next few years as NHS spending was squeezed, he said. Private sector investment could play a key part in moving services out of hospital to more convenient locations at lower cost.


MPs criticise NHS in England for forcing patients to spend their last days in uncaring hospital surroundings

Elderly patients in the final stages of terminal illness are being denied the right to die at home due to inadequate NHS and social care, a critical parliamentary report warns.

Newly allocated funds aimed at improving end-of-life care are at risk of being spent on other medical priorities, the Public Accounts Committee (PAC) suggests.

Half a million people die in England every year; almost two-thirds of them are over 75. The vast majority of deaths follow a period of chronic illness such as cancer or heart disease.

About 60% of those deaths occur in an acute hospital despite the fact that “there is no clinical need” for the person to be there, the study says.

“Most people express a preference to die at home [surrounded by friends and family]. People should have the right to die in the place of their choice.

“[Health authorities should increase] the availability of community services, such as 24-hour district nursing, and access to advice and medication out of hours to help reduce the number of unnecessary hospital admissions.”

Those who die in hospital are often deprived of effective pain management and not accorded adequate “dignity and respect” in their last days and moments by NHS staff, the report states.

“Because someone is approaching the end of life it should not mean we abandon concern for their quality of life. End of life care should seek to sustain people’s quality of life as a priority.”

There should be more checks, the paper suggests, to ensure staff receive education and training in end of life care. Specialist palliative care teams should always be deployed to deliver pain relief.

Residential homes, especially those without qualified nursing staff, often feel ill equipped to care for people in the final stages of life and send them to hospital or refuse to take residents back after a hospital admission.

In one local study, the report shows, at least 40% of patients who died in a Sheffield hospital “did not have medical needs which required them to be admitted”. Many had been occupying a bed for more a month – suggesting that resources could be freed up and redirected to home care.

The National Audit Office has estimated the cost of caring for cancer patients (who account for 27% of all deaths) in the 12 months before death was £1.8bn. Reducing emergency admissions by 10% and cutting the average length of stay to three days would release £104m for redistribution to other end of life care services.

The Department of Health has allocated £286m over the next two years to improving end-of-life care. But the PAC warns “there is a risk that the additional [sum] will not be used as intended. The department should require primary care trusts to account for how the additional funding is spent.”

Co-ordination between health and social care services in this area is “generally poor”, the report notes.

“That health and social care providers have traditionally given a low priority to end-of-life care is shown by the lack of training in basic end of life care among front-line staff,” the chairman of the PAC, Edward Leigh, said.

The catalogue of problems discovered in hospitals include poor support for basic comfort; lack of privacy for the patient and their family; poor communication by staff; and staff recognising too late that somebody is about to die.

“It is appalling that people dying in hospital are not always being given the end of life care they deserve,” Leigh said, “including effective pain management and being treated with dignity and respect.”


PFI projects to stay off the books

Many Private Finance Initiative (PFI) projects are to remain, in effect, off the labour government’s balance sheet.

The decision means that hospitals, clinics, schools, waste and local authority projects can continue to be built under PFI without counting against the government’s capital expenditure totals.

With public sector capital spending set to halve in cash terms after 2011, that will come as a considerable relief to public bodies.

They face seeing capital expenditure drop from £44bn ($68bn) this year to a mere £22bn a year in 2013-14, a reduction that would have had an even bigger impact if the billions of pounds of PFIs and PPPs that are in the pipeline had to count within that.

In spite of the widespread expectation that almost all PFI projects would go on the books as the Treasury fulfils a longstanding promise to move the public sector to international financial reporting standards, the Treasury has now issued all but final guidance to Whitehall departments indicating that, while they will count on departmental accounts, a different accounting standard will apply for the Treasury’s budgeting purposes.

That will be based on the European accounting standard that is applied by the Office for National Statistics to the national accounts. It has the effect that many projects will continue to count as off-balance sheet.

”The expected effect is that things will go on much as before,” a leading PFI accounting expert said. “There may be some changes at the margins over which projects count as on the books or off.

“But broadly speaking, where a project would have been off the books up to now, they will remain off the books.”

He added, however, that one effect of the guidance could be that departments would have to produce two sets of accounts, one complying with the IFRS standard and another to meet the European one.

Nick Prior, head of government and infrastructure at the consultants Deloitte, said: “This clarification is extremely welcome for the future of PFI and PPPs. Government departments should now be able to bring forward projects that have been delayed because of uncertainty over budgetary arrangements.”

About 60 per cent by value of PFI projects are currently off balance sheet. Critics, and even some supporters, of PFI have argued that the need to shift risks to the private sector – sometimes artificially – to achieve off-balance sheet treatment has been bad for public procurement.

A study last year by PwC, the professional services firm that advises both the public and private sectors on PPPs, said that if the projects all came back on the books it would ”frankly come as a relief” as some have been “distorted” to get them off balance sheet.


NICE guidelines on drugs are unfair MPs decide

The methods used by the labour government’s killer quango NICE to decide whether the NHS should pay for expensive drug treatments are wasteful and unfair, according to MPs.

A report from the Commons Health Committee recently attacked the way in which the National Institute for Curbing Expenditure (NICE) assesses costly cancer medicines as “both inequitable and an inefficient use of resources”.

The MPs’ inquiry was sparked by calls for cancer patients to be able to pay out of their own pockets for medicines that Nice advises the NHS not to use, leading to new guidelines issued late last year by Prof Michael Richards, the government’s “cancer tsar”.

After a series of decisions by Nice to reject new cancer drugs as insufficiently effective either clinically or on cost, Prof Richards called for the National Health Service to make more expensive drugs available.

However, the select committee argued that Nice had in response adopted a threshold for judging whether to approve “end of life drugs” that was too high, depriving the NHS of resources to spend on more cost effective drugs for other illnesses that had a more significant benefit.

It also criticised Nice for moving too slowly in assessing new drugs, and said the agency’s guidelines for selecting the types of costly cancer drugs to be reviewed was “too woolly”.

The committee questioned the increased threshold adopted by Nice for approving such drugs above the usual £30,000 per quality adjusted life year (Qaly), the measure it uses to assess the benefit a drug brings to a patient. Nice denied that threshold was as high as £70,000.

Kevin Barron, chairman of the committee, denied that the implication of the report was that Nice should reduce its Qaly threshold, arguing instead that it should make greater efforts to free up resources by finding other ways for the NHS to save money.

His committee said it was “extremely disappointed” little progress had been made by the government in following its previous calls for Nice to “disinvest” in obsolete technologies.

Prof Sir Michael Rawlins, chairman of Nice, said: “There is a balance between egalitarianism and utilitarianism. The select committee has fallen into the latter.”

He said Nice was reviewing the Qaly, but it was “the only game in town”, and that identifying savings for the NHS from older treatments and techniques was a difficult and “subtle” process.

The health select committee also expressed caution over the growing use of “risk sharing” schemes, whereby the government and pharmaceutical companies agree to reimburse some of the costs of medicines that prove less effective than initially believed.

The debate came as the National Audit Office identified one source of savings, estimating that NHS primary care trusts had saved £394m last year through more consistent use of lower cost, generic medicines for some common conditions such as high blood pressure, high cholesterol and gastric problems.


Health Direct points out that NICE’s use of the phrases “difficult” and “subtle process” are similar to that of MPs’ expenses. A smokescreen for don’t ask me uncomfortable questions.

Until NICE publishes what it’s Qaly definition and it’s scientific analysis guidelines for evaluating drugs actually are- the killer quango will continue to have the disrespect it deserves.

Health minister to repay £41,000 expenses

Phil Hope, the Labour health minister, has agreed to pay back more than £41,000 he claimed in expenses to refurbish his second home.

The care services minister this morning announced he would write a cheque for £41,709 to cover the cost of the furniture and fittings he claimed for the property – a small two bedroom flat in south London.

The sum being returned by Mr Hope is the largest amount an MP has pledged to refund since the expenses scandal broke, but dozens of other members are expected to follow suit under pressure from their party leaders.

The Corby and East Northants MP said that his announcement was unrelated to fears over his slender 1,517 majority – and said he should be able to find the money “within a week or so”.

“It is going to be difficult, it is going to be challenging but this is a personal decision that we [he and his wife Allison] have made together,” he told Sky News.

In a statement, Mr Hope insisted his claims were within the rules, but said he wanted to correct the “dreadful perception” and he enriched himself with taxpayers’ money.

“The anger of my constituents and the damage done to perceptions of my integrity concerning the money I have received to make my London accommodation habitable has been a massive blow to me that I cannot allow to continue,” he said.

Mr Hope is following in the footsteps of Hazel Blears, the communities secretary, and backbench Labour MP Margaret Moran in agreeing to refund questionable payments following a week of disclosures about expense system abuses in The Daily Telegraph.

Miss Blears has agreed to pay back £13,000 in capital gains tax from profits on a house paid for by the taxpayer, while Miss Moran will return the £22,500 she claimed for treating dry rot at a house 100 miles from her constituency.

Alan Duncan, the shadow leader of the Commons, will repay more than £5,000 in gardening costs; Andrew Lansley, the shadow health secretary, will repay £2,600 claimed for home improvements; and Oliver Letwin, the chairman of the Conservatives’ policy team, will refund £2,000 for getting pipes repaired under his tennis court.

Mr Lansley apologised to his South Cambridgeshire constituents for claiming “overgenerous” expenses in a letter to his local paper. “The public has every right to be angry about MPs’ allowances. I was part of that system and I’m sorry for my part in it,” he wrote.

The announcements come amid a growing acceptance at Westminster that politicians from the three major parties must act decisively to restore public trust in parliamentary democracy or risk a backlash from the electorate in the June 4 European and local council polls.

David Cameron has said that Tory MPs shown to have broken the rules could be sacked, and on Tuesday Gordon Brown has admitted that “extreme” action is needed to restore public trust in politicians.

The Prime Minister said an independent review of every claim made over the past four years would allow MPs to show they are “worthy of public trust”.

“I think the issue here with Hazel Blears is about the sale of a house where CGT could or could not have been paid,” Mr Brown said. “She has looked at what has happened, I have talked to her, she has repaid the money.”

Mr Brown said other ministers who had come in for criticism over their accommodation arrangements, including Chancellor Alistair Darling and Transport Secretary Geoff Hoon, were in a “different position” but could still face disciplinary action if the independent review found there were problems.

Mr Hope, who has also been criticised for employing his son Nick and daughter Anna for parliamentary work, said that he was repaying his expenses because the Telegraph’s disclosures had “fundamentally changed the view people have of me and that is something I cannot bear.”

The MP billed taxpayers for so much furniture for his second home in Southwark, south London – including a chest of drawers, a mattress, a television, a sofa, an armchair, a washing machine, three chairs, two bookcases, one coffee table, a wardrobe and a dining room table – that questions were raised about how it could have all fitted into the small flat.

His statement read: “I have worked very hard over the last 12 years to represent and fight for my constituents, and their opinion of me as a person matters hugely to both myself and my wife Allison.

“We feel very badly hurt by what has happened and although I kept to the rules laid down by Parliament I cannot allow this dreadful perception about what I claimed in allowances to continue.

“I have decided to try to restore the trust and relationships I have with my constituents. I am returning all of the money that I have claimed for fittings, furniture and household items that I received over a five year period – the sum of £41,709.

“This will be paid to the House authorities as soon as the necessary arrangements can be made.”

Speaking to Sky News, he added: “This is not about votes; this is about who I am. This is about me and this is a personal decision I am making.

“Whenever the election comes, whatever goes on there, I just want those people I represent to know, whether they vote for me or not, that I have personal integrity.”


Personal Intergrity- Health Direct asks why it took him so long to pay back his fiddled expenses aftre they became public knowledge? And how come he has so much spare cash sloshing around- the equivelent of two thrids of his annual salary- before tax?

Health minister Ben Bradshaw also received attention from The Daily Telegraph, although the paper’s prime interest was in the fact that the second home for which he has claimed around £1,600 a month in mortgage interest payments is jointly owned with his civil partner. His total claims over the four year period were £56,568.

Health secretary Alan Johnson was absent from The Daily Telegraph’s detailed coverage, with no details reported.

Act now to prevent blood clots becoming the next MRSA warns NHS Confederation

NHS trust boards must act to stop deadly blood clots becoming “the next MRSA” in the eyes of patients and the media, the NHS Confederation is warning.

In a report to trusts, the confederation says clinical issues such as healthcare acquired infections have the capacity to cause “enormous damage” to trust reputations.

With public, political and media interest in venous thromboembolism (VTE) increasing, checks for blood clot prevention could become part of future trust assessments, the report says.

The condition causes the deaths of around 40,000 hospital patients each year, as well as increasing treatment costs and hospital stay length.

The cost implications of risk assessing patients are likely to be minor when compared with the costs of treating post-surgical deep vein thrombosis and pulmonary embolism patients, the confederation says.

Policy director Nigel Edwards said: “Managers, clinicians and patients have a real chance to build on the success of reducing infections. If we work together we can save lives and reduce NHS costs by improving the assessment of all patients and using cost effective preventative measures.”

Hospital boards could include venous thromboembolism measurements in trust quality dashboards and appoint clinical champions to promote the issue to colleagues, as well as appointing lead non-executive directors for the condition.

Baseline assessments can be used to establish how trusts are performing on assessing patients and boards can ask whether venous thromboembolism prevention is included in staff training.

Primary care trusts could include risk assessments and prophylaxis targets in contracts with providers.

The report comes as a survey by thrombosis charity Lifeblood reveals the public is largely unaware of the risk of blood clots.

From HSJ:

Health Direct is amazed that the public is largely unaware of the tens of thousands that deie risk of VTE, because Health Direct certainly is not.

Within only a few months of lauching the Health Direct blog we came across the terrible death toll that VTE causes in the UK.

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

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

And again, on October 31, 2006 we posted NHS patient safety ‘must improve’ says Healthcare Commission

More needs to be done to improve standards of safety in the NHS and independent sector, a watchdog says. The Healthcare Commission said that while most patients received safe care, standards were inconsistent in England and Wales.

The watchdog said there was no clear indication on the number of deaths that could be avoided.