Labour admits it cannot increase NHS funding

Labour has admitted that it cannot commit to increased funding for the National Health Service after 2011, in a move the Tories claim is an embarrassing reversal of their policy.

It comes as ministers also revealed that Labour will have to raise taxes and cut capital spending on major projects if it wins the next election. Capital spending projects will bear the brunt of cuts.

Labour and the Conservatives are locked in a bitter battle over spending plans.

The Tories seized on comments made by Andy Burnham, the new Health Secretary, in which he said Labour would continue to maintain NHS spending in the period after the current Budget period, up to 2011.

At the NHS Confederation annual conference in Liverpool, Mr Burnham admitted: “I can’t write the spending review – it would be ridiculous. We have stability for two years but the Prime Minister indicated the NHS will remain the priority for a Labour Government.”

The Tories said this contradicted what he had previously said and it should “worry NHS patients and staff.”

Labour also had to admit that taxes were likely to increase in try and fend off other cuts.

Liam Byrne, the Chief Secretary to the Treasury, said: “Alistair Darling has been really clear that there are going to be some pretty tough choices to be made. There are going to be conditions of constraint and there are going to be difficult decisions on, for example, tax.”

Gordon Brown has been able to appear as if he is maintaining spending on services but cutting public expenditure by looking to savagely cut planned capital projects. That means transport infrastructure, school and hospital building projects, as well as major defence procurement deals.

The Prime Minister has been reluctant to admit that the Government plans to cut capital spending by almost 40 per cent between 2011 and 2014.

Mr Byrne admitted that capital spending would be reduced.

He said: “Once you have built a school you have got a school.”

Philip Hammond, the shadow chief secretary, accused My Byrne of being “disingenuous” about public spending. Gordon Brown has, over successive elections, painted the Tories as a party that will cut public services, but David Cameron has made great efforts to blunt that line of attack by promising to match Labour’s commitments.

George Osborne, the shadow chancellor, said: “We now see how Labour plans involve spending cuts in a dozen departments next year. But Labour politicians continue to claim that they won’t cut spending.

“That’s just plain dishonest. Why can’t the Prime Minister just be honest with people and admit to the cuts which are in his own Budget?”


NHS waiting times have risen by a third in a month

Waiting times in the NHS have risen by almost a third due to bad weather earlier this year, it has emerged.

Figures show that the number of patients waiting more than eight weeks for an outpatient appointment increased by 31.5 per cent between March and April this year.

There were 43,400 people waiting more than eight weeks for an outpatient appointment in April, 82.7 per cent higher than the previous year, according to Health Service Journal.

Officials said a backlog of appointments has built up after the bad weather in February which saw much of Britain gridlocked under snow.

The NHS suffered an extremely busy winter as the coldest weather for 30 years, coupled with high levels of seasonal flu and norovirus outbreaks.

The Daily Telegraph revealed the extent of the pressure on the ambulance service as national director, Peter Bradley, said the service had seen its busiest ever week in December and others warned staff were ‘performing near miracles’ to keep the NHS running.


Reverse e-auctions an invitation to cut standards

One company boss who took part in the London Procurement Programme’s reverse e-auctions in May called them depressing.

The chief executive, who wished to remain anonymous, said he thought that the company had completed the procurement process after submitting a 206 point questionnaire, with 9 attachments, followed by a 122 question tendering document with 18 attachments in February.

“We heard nothing for a month, which was odd given the contracts were to start on April 1. Suddenly we were told, ‘Congratulations. You have been selected to take part in a reverse e-auction’.”

On May 19 the chief executive sat down with his finance director, logged into the LPP website and waited for the bidding to start.

The company had submitted tenders to provide palliative care and care for physical frailty and dementia. It had made bids of more than £1,000 a week for places in its homes. To take part in the e-auction it had to drop its price by at least £8 at a time. When bidding began the company was told its price was in the bottom five in the shortlist of 20.

“We wanted to test the system so we gingerly put in a bid of £10 below what we had tendered. Our position didn’t change,” he said.

“After a few more bids our position had not changed at all. By then we had reached the point where we could not cut the price further without undermining the quality of care so we stopped.”

In all, the company took part in three e-auctions. “In the end we really pushed it and cut our price by over £100 really just to see what would happen. I think we moved up a few places to 15th. It was a very depressing experience.

“You are filled with dread about what you are going to have to cut back on to get within the winning price. It is devoid of any human consideration. It’s fine if you are supplying stationery, but we are talking about human beings. This is an open invitation to companies to cut standards.”


Health Direct points out that reverse auctions are the result of the desire to get something for nothing.

They very rarely work as the winning company often has to come back for more money when they find they cannot provide the service to the standard required for the winning bid. It is a fallacy that it saves money!!

IVF baby given to wrong woman was an accident waiting to happen

A solicitor representing an IVF couple whose last embryo was wrongly implanted into another patient has described the clinic mix up as an “accident waiting to happen”.

The couple have spoken of how their lives were “shattered” when the University Hospital of Wales’ IVF clinic in Cardiff discovered the error.

They were further distressed when they learned the other woman had chosen to have a termination.

The Cardiff and Vale NHS Trust has apologised for the blunder and paid the couple an undisclosed sum in damages.

The woman said: “I will never forget the moment the hospital broke the devastating news to us. I just could not believe what I was hearing. Initially the hospital staff told me there had been an accident in the lab and that the embryo had been damaged, I thought that someone had perhaps dropped the embryo dish.

“I remember thinking, ‘That’s our last hope gone – we will never have another child.’ I left the hospital feeling totally shell-shocked.

“When we went back to the hospital two days later and we were told the truth about my embryo being given to someone else; I was so angry.

“I had been given a handbook before every course of IVF explaining all the elaborate precautions the clinic undertook to ensure this sort of mix-up was impossible – and yet despite everything, it had still happened. “

The couple’s solicitor, Guy Forster, from the firm Irwin Mitchell, said there had been two previous “near misses” at the clinic the year before.

The couple were originally referred to IVF Wales after an ectopic pregnancy in 1996 caused damage to the woman’s fallopian tubes. The couple began fertility treatment in 2000.

Following the third cycle of treatment, the woman became pregnant and in April 2003 gave birth to a son.

The remaining embryos were frozen and, in line with the clinic’s policy, were kept for five years.

In November 2007 the clinic contacted the couple with the news that just one embryo had survived and was in good condition. The woman, who was then 38, and her husband decided to take “this last chance” to add to their family, Mr Forster said.

The couple, named by Mr Forster only as Deborah, a health care assistant, and Paul, a printing firm supervisor, from Bridgend, south Wales, attended the clinic on Dec 5, 2007, for their final embryo to be transplanted.

They were told a trainee embryologist had mixed up their embryo after taking it from the wrong shelf of the incubator.

Mr Forster said that against all guidance, more than one patient’s embryos were being temporarily stored in the incubator.

The trainee embryologist failed to carry out ‘fail-safe’ witnessing procedures to ensure the embryo being taken from the incubator and implanted, belonged to the correct patient, he said.

The mistake was only discovered when another colleague later found that Debroah’s embryo was missing from the incubator.

Mr Forster said: “A report by the Human Fertilisation and Embryology Authority showed that the error occurred primarily due to failures by laboratory and theatre staff to carry out basic procedures.

“However, it is clear that there were a number of system failings, in that the clinic had failed to implement the procedures set out in the HFEA’s Code of Conduct, workloads were above safe levels and there were staff shortages.

“IVF Wales reported two ‘near miss’ incidents to the HFEA in 2006 and an HFEA inspection in February 2007 had warned the clinic to tighten its witnessing procedures, yet it would seem nothing was done. This was an accident waiting to happen.”

Ian Lane, the health trust’s medical director, said: “We apologise unreservedly for this mistake.


Patients with suspected cancer forced to wait so NHS targets can be hit

Patients rushed to hospital with suspected cancer are having their treatment delayed so that managers can meet labour Government targets, an NHS investigation has found.

People arriving at Accident and Emergency departments with symptoms which could indicate the aggressive spread of the disease are waiting weeks for diagnosis and treatment while “routine” cases are prioritised.

Hospital managers told researchers that treating desperately sick patients more quickly would “reflect badly” on their performance against Government cancer targets which only cover those referred to specialists by GPs.

Doctors, patients groups and politicians were appalled by what one described as a “breathtaking admission” which confirmed their “very worst fears” about how far the NHS target culture has gone in distorting clinical priorities.

Although most people with suspected cancer are referred to hospitals by their GPs, more than 30,000 people diagnosed with the disease each year are first alerted to tumours by violent symptoms, such as seizures, vomiting and jaundice, which cause such alarm that patients go straight to their local A&E; departments.

The report by the NHS Institute for Innovation and Improvement, an official health service agency which issues advice to hospital managers, says that many of these emergency patients waited six weeks or longer for basic tests.

It said they were “often” not given the same priority as patients who had been referred by GPs, who were covered by two targets, ensuring that they see a specialist within two weeks, and start treatment, following diagnostic tests, within two months.

“As a result, they can end up with a very poor experience before finally receiving a diagnosis and the right care,” it warns.

The report, added: “Many trusts recognised the need to get some patients in this group onto the same pathway as people on the cancer two week wait [target] but were concerned this would reflect badly on their cancer figures”.

Some A&E; departments failed to recognise the risk of cancer in seriously ill patients. In cases where the disease was suspected, patients were sent home to wait six weeks or longer for diagnostic tests. Others waited weeks on wards before seeing a specialist or having scans, the report, which is endorsed by the Government’s cancer tsar, found.

Nigel Beasley, the NHS Institute’s lead for cancer, and head and neck surgeon from Nottingham University Hospitals said: “Targets are very effective, but they do have side-effects. The risk is that these patients are not being prioritised because of the focus on the two-week target for patients referred by GPs.”

Mr Beasley said: “Patients can be stuck in hospital for a long time, waiting for scans, and other diagnostic tests. Once they are in hospital, they can end up waiting two, three, or even four weeks before there is a diagnosis and any decision to treat.”

The admission about the effect Government targets were having on emergency cancer patients horrified clinicians and patients groups.

Shadow health secretary Andrew Lansley described it as “one of the clearest examples yet of how Labour’s tick-box targets are failing NHS patients”.

He said decisions about which patients should be seen first must be taken by doctors, based on the patient’s clinical needs, not by managers following Government diktats.

Katherine Murphy, from the Patients Association, said the report provided “breathtaking” evidence of a confidence trick being played on the public, repeatedly told that waiting times for patients with suspected cancer are falling, while desperate cases were forced to the back of the queue.

She said: “This confirms our very worst fears, and exposes the scandal of what pernicious targets are doing to patients. We have seen other targets being used in ways that damage patient care, but of everything we have seen, this really is the cruellest of the cruel”.

Leading cancer specialist Prof Karol Sikora said: “I think it is absolutely horrifying that hospital managers are playing around with targets that can delay treatment for people who may well be at an advanced stage of the disease.”

“I know of many cases where people who have been admitted to NHS hospitals as an emergency have languished for weeks before even seeing an oncologist,” added Prof Sikora, Medical Director of independent company CancerPartnersUK.

The British Medical Association said many trusts were bullying doctors into delaying urgent referrals.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee, said: “A number of our members have already expressed fears about the two-week cancer target, because it means all the cases referred by GPs are given the same priority, regardless of whether they are expected to be benign or high risk. When this same target is delaying patients who have been admitted as an emergency that is an even greater cause for concern”.

Several oncologists said they supported two-week waiting time targets for cancer patients referred by GPs, but called for the target to be widened to include all patients.

Ian Beaumont, from charity Bowel Cancer UK said it “beggared belief” that anyone would value statistics over efforts to save lives.

Dr Jane Maher, chief medial officer at Macmillan Cancer Relief described the revelation in the report as worrying, but said the biggest obstacle to getting the right care for patients admitted to hospitals as an emergency was getting the right diagnosis, as cases were often complex, meaning cancer could be mistaken for other conditions.


Timebomb of Britons unaware they have HIV

Senior doctors accuse the Department of Health of failing to take HIV virus seriously and neglecting to test high risk groups.

More than 20,000 people with HIV are unaware they are carrying the virus and are infecting thousands of others, setting a devastating health “timebomb”, medical experts have warned.

Senior doctors have accused the Department of Health of failing to take the spread of HIV seriously and neglecting to test enough people in high-risk groups, including gay men and heterosexual black Africans.

HIV specialists say they are seeing people in clinics with full-blown Aids who have no idea they have been carrying the virus. They now want all sexually active people to be routinely offered an HIV test.

The Lancet medical journal has published an editorial accusing ministers of an “appalling failure to tackle HIV” and of having “no credible strategy to diagnose and care for those living with, but unaware of, HIV in Britain”.

The Health Protection Agency (HPA), the labour government’s health watchdog, warned that about 77,000 people in the UK have HIV but 21,000 of these do not know they are infected. In 2007, the number of infections through heterosexual contact increased to 960, up from 540 in 2003.

Doctors warn that a third of people with HIV are being diagnosed when their virus is advanced. One London hospital recently treated two teenage sisters, one of whom was pregnant, infected with HIV from the same man. Hospitals are also concerned about men who are diagnosed with HIV but abscond before they can be treated.

They called on the government to take testing more seriously, warning that an A&E; target to treat patients within four hours meant people with early symptoms of HIV were not being tested in emergency rooms because of time pressure.

Dr Phillip Hay, reader in HIV medicine at St George’s hospital in Tooting, south London, said testing for the virus should be routine to stop its spread through unprotected sex.

He said: “We have identified some people who have infected multiple individuals”, including couples “where there is a big difference in age between an older adult and a teenager. All men and women accessing medical care should be routinely offered a test”.

The HPA said high-risk groups should be targeted for testing.

“It is a matter of concern that so many individuals in the UK are unaware that they are HIV-infected,” it said.

All the Department of Health could say was that HIV prevention was still a priority.


Health Secretary Andy Burnham promises NHS targets massacre

The target culture that has driven NHS reforms over the past dozen years will be dismantled in a “deep clean” that removes alienating bureaucracy, the Health Secretary pronounced.

Giving his first speech since taking office, Andy Burnham said that while the challenges faced by the NHS were substantial, the opportunities to streamline reforms and focus on the prevention of ill health could bring savings.

He added that he would reward the best primary care trusts with even greater control over how they operated, and a “lighter touch performance management”.

Mr Burnham, who was speaking at the NHS Confederation’s annual conference, said he could not make pledges on future spending or budget cuts, but insisted that he would not cut back on agreed funding programmes.

His statement followed revelations in The Times of Government advisers withholding money from a £750 million programme set aside for the building and refurbishment of community hospitals.

A letter sent between health chiefs highlights a Department of Health strategy to divert health authorities away from the programme – which still has £500m to spend – because “the Treasury is unlikely to agree further releases of funding”.

Mr Burnham again sought to allay fears of substantial cuts after a report from the NHS Confederation warned of a multibillion-pound budget shortfall over the next decade. The report, published yesterday, prompted angry exchanges in the Commons as Gordon Brown accused the Tories of planning deep cuts in public services to allow for real-terms increases in health spending.

Mr Burnham refused to say if a Labour Government would allow real-terms growth, saying that he “could not pre-empt Treasury decisions”. But he added that the NHS would improve from stripping away unhelpful targets and concentrating on preventive public health measures.

“I want to deep clean the target regime,” he said.

“Targets have their time and place but where they have served their purpose and they are subsidiary to wider objectives, they should now be removed. And believe me I will do that.”

Mr Burnham said that core targets – such as the 4-hour waiting time target in A&E; and the 18-week target from GP referral to treatment – would remain in place as “minimum standards”, but others which had served their purpose and now “alienated people” would be up for review. He said that targets surrounding inpatient waiting times – which include a 13-week target from decision to operate to hospital admission – might be expected to be removed.

“I think there’s scope really now to take away stuff that does not need to be there any more,” he said.

The Health Secretary said that “prevention” needed to be added to the bywords of “quality, innovation and productivity”, adding that smoking, drinking and obesity related admissions to hospital accounted for £10 billion of NHS costs per annum.

“We have, at times, possibly been too timid on public health. Health trusts should not feel they have to wait for permission to invest in prevention. If we believe in investing in people’s health we should go on and do it.

“The Department of Health is in a position of great health,” he added. “There are challenges ahead, as always, but let’s not talk ourselves into a crisis. This is a moment of opportunity not threat.”


Catastrophic shortage of psychiatrists in NHS

There is a “catastrophic” shortage of psychiatrists in the NHS, leading to a reliance on foreign staff who may have difficulties with communication and the UK culture, a senior doctor said.

Prof Robert Howard, dean of the Royal College of Psychiatrists (RCP), said the number of UK doctors was far too few to fill hundreds of training posts.

He pointed to an over reliance on overseas doctors, saying some were brilliant but cultural awareness was an essential part of being a good psychiatrist.

He said: “Catastrophic is the word I would use for the shortage we are now facing. We have always struggled to recruit significant numbers but this year is particularly acute.”

“It has got to the point where you can count the number of UK doctors coming into it in tens, when we have hundreds of training posts to fill.”

“The doctors who are coming in from overseas to work in the UK: some are brilliant, and our president (Dinesh Bhugra) is a shining example. This is not being racist or unpleasant.”

“But many of them have difficulties with communication and the nuances of the UK’s culture. And if there is a speciality where it is essential to know the culture, it is psychiatry. There needs to be a balance.”

“Overall, because of the lack of competition, we are giving jobs to some people who are ‘appointable’ but certainly not people who it fills our spirits to have given jobs to.”

“The fact that we have to make a decision about the minimum standard cut-off point for potential ‘appointability’, and that we feel relieved when we find sufficient people who just scrape over this is damning enough.”


Ditch management consultants from the NHS

Management consultants should be ditched as the NHS is entering a ‘dark and dangerous’ period, leading doctor warns conference.

Public money must not be diverted away from patient care ‘into the pockets of shareholders’ at a time when the NHS may see real cuts in budgets, Dr Jonathan Fielden, chairman of the consultants committee of the British Medical Association said in a speech.

He said the £350m reportedly spend on independent management consultants in the NHS in England last year should be spend on patient care instead.
* NHS consultancy bill is £350m
* NHS could have hired 10,000 nurses with money spent on management consultants

This is even more important as in the coming years investment in the NHS is likely to fall, he said.

Dr Fielden said: “For the first time in working memory, we may see real cuts in health spending. This will provoke some stark choices: what is kept, what is cut, what can the NHS afford? Let’s ensure that it’s doctors making those difficult decisions in partnership with our patients and health care colleagues, not faceless bureaucrats, accountants, and those out to fleece the taxpayer.”

He said that an estimated £927m was also spent on contracts with independent sector treatment centres for work that was not carried out as patients shunned the private centres.

This was a ‘dangerous waste’, Dr Fielden said, and he urged the Treasury not to snatch back the £1.7bn surplus currently in the NHS and for it to be spent on patients instead.

Dr Fielden said overall the NHS has been improving but there have been ‘dreadful blots’ on the landscape where care has been poor.

He told the BMA’s Consultants Conference: “In each of these there is a common theme: targets being put in front of quality, staff not being listened to, aberrant corporate cultures suppressing concerns and disregarding safety. Doctors must challenge this culture of denial and lead a better way forward.”


Elderly suffer after reverse e-auctions for home care

Labour NHS IT reverse auctions reduce dignity and care for elderly

Andrew Wilson, 78, was one of the elderly people who received poor treatment after a reverse e-auction. This was run by South Lanarkshire for the provision of home care.

Domiciliary Care, a big provider in Scotland, won the contract after companies had driven down their prices. It won with a bid to provide care for £9.95 an hour.

Mr Wilson is hard of hearing, blind in one eye and unable to walk more than a few steps. With no close family, he lives alone and depends on carers. He allowed Panorama to fit secret cameras in his home for 19 days.

The cameras showed Mr Wilson being given a bed bath while his carer was constantly on her mobile phone complaining to the office about her workload. The cameras also recorded that, of his four half-hour visits a day, those at lunch and teatime were often curtailed.

His care assessment makes clear that his lunchtime carer should prepare a meal. However, he was routinely fed sandwiches, crisps and toast.

One GP who specialises in old age care said she was shocked by what she saw. “He has been treated with a complete lack of dignity,” she said.

At the time Domiciliary Care denied that Mr Wilson was neglected. It said that carers were under no obligation to go shopping for Mr Wilson but often did so. However, Care Choices Group, which took over the company last September, admitted that an internal inquiry had found that a number of the allegations were correct, and apologised.