Couples are still being refused IVF treatment in a postcode lottery

Couples are still facing problems getting IVF treatment on the NHS, with some trusts refusing to fund procedures or comply with guidelines, such as a woman’s age.

Regional disparities mean that the same woman can be too old for treatment in one part of the country and too young in another. Two trusts have provided no IVF treatment in the previous two years.

Research suggests that eight out of ten primary care trusts are still failing to follow government recommendations set out in 2004 by the National Institute for Curbing Expenditure (NICE), allowing women three free cycles of IVF.

Other eligibility criteria, such as whether one of the couple has a child from a previous relationship, smoking habits and weight, also vary widely, the study shows.

The study, by Grant Shapps, the Conservative MP for Welwyn Hatfield, who has campaigned for better access to fertility treatment, was based on an 80 per cent response rate from trusts in England. It found that provision was worse than two years ago.

In the East Midlands, every trust offered one full cycle of treatment but, in the South East, 41 per cent did not offer IVF to women aged 23 to 39, as set out in the NICE guidance. Some trusts, such as North Lincolnshire, offered IVF only to women between 37 and 39, whereas at least four trusts have an upper age limit of 37. One in eight was failing to comply with guidelines on a woman’s age.

In the East Midlands, no trust would offer treatment to couples in which one partner had a child but 70 per cent would in the North East. Overall, 54 per cent of trusts excluded couples from IVF if one partner had a child from a previous relationship.

Almost half of all trusts said that they wanted couples to have been in a relationship for more than three years. Others wanted one or two years while some asked only if the relationship was “stable”. While many trusts refused IVF to couples who smoked, some allowed treatment if the man was the smoker.

The 2004 NICE guidance said that the NHS should fund three cycles of IVF for women under 40. John Reid, then the Health Secretary, said that couples would be offered one free IVF cycle by April 2005, with a view to three cycles being offered in the future.

By 2007 this was still not happening. Dawn Primarolo, the Health Minister, wrote to trusts in that year saying that they should be looking to fund three cycles.

Experts have said that the drive to cut the number of multiple births is also being hampered by the lack of access to free IVF. Couples who have the chance of only one cycle on the NHS might wish to have more than one embryo transferred.

The NICE guidance also said that trusts should allow frozen embryos to be transferred as part of one cycle. But very few offered this.

Mr Shapps said that the study, compiled from freedom of information requests, showed that IVF “remains a postcode lottery in this country”. He added: “Budgets are tight and the NHS must set its priorities, but it is wrong to raise expectations in couples who are desperate to start a family only for them to find out later that they won’t get the real help they expected.”

Clare Lewis-Jones, chief executive of the charity Infertility Network UK, said that although there had been an improvement recently in the provision of treatment by some trusts there remained a totally unjustifiable and unfair variation in the criteria used to determine whether couples could have treatment. “This proves that five years on from the issue of the NICE guideline, patients are still facing a postcode lottery when it comes to accessing NHS fertility treatment.”

She urged trusts to accept recommendations laid down in a document, Standardising Access Criteria to NHS Fertility Treatment, produced by Infertility Network UK and funded by the Department of Health.


Want your NHS records to stay private? Good luck

If you don’t want your health records stored online, you may have some trouble finding the ‘opt out’ option.

If you are registered with a GP in any of six primary care trusts — Bolton, Bradford and Airedale, Bury, Dorset, South Birmingham and South West Essex — you will last week, have received a leaflet about new “summary care records”. 
It comes with a letter explaining what’s in the leaflet, and a form to order another leaflet in one of 12 formats, from the sensible (Braille) via the surprising (Farsi) to the faintly depressing nanny state (easy-read picture version).

If, like most people, you develop an eye spasm when privacy issues arise, you might want to opt out of having your health records stored online.

If you have no continuing medical conditions (besides the eye tic) and are capable of speaking and listening to doctors, you might think you don’t need your records to be computerised. And opting out means that when the laptop of private information is inevitably left in a pub somewhere in Berkshire, you won’t have to grind your teeth in impotent rage.

The leaflet explains that if you want to opt out, you can do so at — but go to that site, and you will search in vain for any mention of opting out. And when I say search in vain, I mean by clicking on each available link, not using a search box.

There is no search box. Once you’ve clicked on all the links, you will be no wiser. Many of the links have sub-links, which you are welcome to try. They also yield nothing, other than the occasional derisive hoot when they are called “HealthSpace Troubleshooting”.

You will have need to refer to your glossy leaflet, ignore it and try the covering letter again. Eventually you will discover that you must type to gain access to the list of “early adopter PCTs”. 

Click on your area. Only then can you download the opt-out form. There is no link to a “patients” or “info” page on the site you first went to. The patient page is the internet equivalent of being behind the fake door covered in books that leads to the secret room.

This, you will recall, is exactly why you are incensed about privacy. Because when they tell you that they value your privacy, what they are actually telling you is that they will take advantage of people being too busy to track things down or too polite to bother their GP’s practice manager during a pandemic.

Douglas Adams’s Arthur Dent once sighed that plans to demolish his home were “on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard’”. 

Do not fear the leopard. The form can be accessed from here: with the actual pdf form which you will have to print off at:
from: with additional research by Health Direct

One in three nurses say they will not be immunised against swine flu, despite being offered the vaccine as a priority to protect patients.

Concerns about the swine flu vaccine’s safety and a perception that the infection is mild are among reasons that NHS staff gave for refusing to have the jab, a survey of nearly 1,500 staff found.

Frontline health and social care workers will be offered the jab from October, along with patients in at-risk groups — such as those with diabetes, asthma or pregnant women.

In the online survey for Nursing Times magazine, 30 per cent of nurses said that they would not get immunised when the vaccine for H1N1 became available; 37 per cent said they would. Thirty-three per cent were undecided.

Of those who said that they would not be vaccinated, 60 per cent cited concern about the safety of the vaccine as the main reason.

Thirty-one per cent said they did not consider the risks to their health from swine flu to be great enough, and 9 per cent did not think they would be able to take time out of work to visit their GP to be immunised.

Two possible vaccines are being tested in trials run by the University of Leicester and the Health Protection Agency to assess immunity levels and identify side-effects.

A decision on licensing is expected at the end of September, with nearly 55 million doses expected to be delivered to Britain by the end of the year.

David Salisbury, the Department of Health’s director of immunisation, said it was unfortunate that nurses could “knowingly leave themselves at risk” of contracting the illness.

“They have a duty to themselves, they are at risk. They have a duty to their patients not to infect their patients and they have a duty to their families. I think you solve those responsibilities by being vaccinated,” he said.

He added: “The evidence that we’ve had is sufficient to persuade the regulators that these are vaccines that will be licensed.”

Professor Salisbury’s comments follow a warning from Sir Liam Donaldson, the Chief Medical Officer for England, that swine flu could leave up to 12 per cent of the NHS workforce on sick leave at any one time.

Low vaccination rates among NHS staff have previously been blamed for causing disruption to services and illness among patients during typical winter flu seasons.

Transmission by staff of contagious viruses was blamed for some hospital outbreaks of flu last winter, when fewer than one in seven NHS staff received the annual flu vaccine, while shortages of workers also put pressure on accident and emergency departments.

Reported cases of swine flu this summer have already surpassed the levels typically seen during a winter flu season, and the figures are expected to surge in the coming months.

George Kassianos, the immunisation spokesman for the Royal College of GPs, said: “More than any other year, this year it is extremely improtant that people get vaccinated against flu. It is very important that nurses, doctors and healthcare workers do not get influenza themselves and have to go off sick, and also that we do not give it to our patients.

“We are lucky that we will have enough doses of this vaccine in Britain, and we as health professionals need to put it in our own arms first to better protect our patients.”

Dr Kassianos added that it was understandable that people were unsure about having a new vaccine, “but its ingredients and the way it’s being manufactured are almost exactly the same as the annual flu vaccine. I see no reason why this vaccine should be any different to the flu vaccines of the past. People’s confidence should rise as the programme gets under way.”


Why it’s time to end the war on drugs

The director of public health for Cumbria, Professor John Ashton, startled a room full of local delegates at a conference entitled “Tackling Drugs, Changing Lives” by calling for total legalisation. “The war on drugs has failed,” he said. “We need to think differently.” He said that heroin, and everything else now banned, should be available over the counter in chemists’ shops.

At any rate, he certainly startled the reporter from the Carlisle News & Star who made a splendid splash with the story, giving just a paragraph to the counter-argument from Detective Superintendent Paul Carter of Cumbria Police. “Class A drugs destroy the fabric of people’s lives,” he responded.

“We have to do everything we can to get people away from drugs like heroin and cocaine.” Well, “Cop Backs Drug Laws” hardly sounds like news, does it? But actually it is Carter who seems increasingly out of step.

For decades many academics and professionals have regarded the current blanket prohibition on recreational drugs (though not alcohol or tobacco) as absurd, counter-productive and destructive. But there has never been any political imperative for change, and a thousand reasons to do nothing.

For nearly 40 years, since the habits established in the 1960s took root in society, there has been a stand-off. Across the free world, and most of the unfree, anyone ­seriously interested in smoking, snorting, swallowing or injecting illegal substances can acquire the wherewithal with a little effort, and proceed without much fear of retribution, particularly if they are wealthy enough.

Police and politicians say they are ­interested in punishing the suppliers and not the users. This is an intellectual nonsense, but it has suited everyone who matters. The drug users don’t care; governments have felt no ­pressure to attempt a politically dangerous reform; and above all it suits the international gangsters who control the drug business, which offers massive rewards and – for them – minimal risks.

But 2009 has seen a change: among the academics and professionals who study this issue, from Carlisle Racecourse to the think-tanks of ­Washington, there is growing sense that reform is possible and increasingly urgent.

The argument is not that drug use is A Good Thing. It is that the collateral damage caused by the so-called war on drugs has now reached catastrophic proportions. And even some politicians have started to think this might be worth discussing.

The biggest single reason (as with so much else this year) is the Obama Effect. In one way, this may be short-lived since the president’s reputation will eventually be tarnished by ­reality. But the chief barrier to reform has been that the international agreements barring the drugs trade have been enforced primarily by threats of retaliation from the White House.

Obama is the third successive president believed to have used illegal drugs: Bill Clinton famously did not inhale; in a conversation that was secretly taped when he was governor of Texas, George W. Bush didn’t deny that he had smoked marijuana or used cocaine; Obama has admitted using both dope and “a little blow”.

Unlike the other two, he is also on record as favouring decriminalisation of cannabis and more generally addressing the problem. The president having other preoccupations, there is no sign of him proposing the Do What The Hell You Like Bill to Congress any time soon. There is every sign that the blanket ban on other people’s initiatives has been partially lifted.

Obama has also come to power amid a growing sense of alarm about the US prison population. Nearly four million Americans are either physically in jail (including almost 5 per cent of all black males) or under some form of state or federal jurisdiction. About 20 per cent of these are listed as having committed drug offences.

But this must be a gross underestimate of reality. I recently asked a British judge what percentage of the defendants in his court were there for drugs-related crimes: not just direct breaches of the drug laws, but also crimes committed by those whose behaviour was affected by drug use or who were trying to obtain money to buy them.

He thought for a moment then said: “Sixty per cent. And most of the rest involve alcohol.” We may assume that, in the more drug-pervasive ­American culture, the figure would be higher than this.

At the same time, Americans have seen on the nightly news the brutal wars between ­Mexican drug gangs reach their border. And afterwards they have watched The Wire, which has given them a serious dose of daily inner city reality. Some observers see the collective shrug that greeted the admission of dope-smoking by the ­Olympic swimming hero Michael Phelps as a sign that ­attitudes are changing in middle America.

What would be less clear to TV watchers is the extent to which, under harsh and prescriptive sentencing guidelines, the wrong criminals are locked up. According to Sanho Tree of the Institute for Policy Studies in Washington: “There have been judges who’ve been literally in tears because they have been forced to sentence girlfriends of low-level dealers to 20 years. Perhaps they fielded a call for their boyfriends. And then the kingpin walks out in six months depending on how much ­information they’ve given.”

Attitudes are certainly changing elsewhere. Several countries, especially in South America, are starting to flirt with liberalisation – Portugal decriminalised all drug use in 2001 and the policy is said to have widespread acceptance. Now the former president of Brazil, Fernando Henrique Cardoso, has called for the decriminalisation of cocaine and says that many serving politicians quietly agree with him.

The South American shift ties in with a growing belief that the US-backed policy of coca eradication has been useless – if the crop disappears from one remote valley, it pops up in another. Meanwhile, the once trumpeted poppy-eradication mission in Afghanistan is increasingly perceived as a strategy that could strengthen the Taliban by curbing overproduction.

“We’re fighting over minimally processed agricultural commodities,” says Tree. “Heroin, cocaine and marijuana are incredibly cheap to produce. There is an inexhaustible resource of poor farmers to grow these crops and an undiminished supply of consumers. The more we increase law enforcement the greater the risk-reward for the traffickers. It’s an exercise in futility.”

Tree is by no means a lone voice in the Washington policy nexus. Jim Webb, ­the Democratic senator for Virginia, said in April that the issue of marijuana legalisation should be “on the table”. There is interest too from rightwing libertarians such as the Texas congressman and sometime presidential candidate Ron Paul. Indeed a leading pro-reform voice in Washington is the Cato Institute, usually associated with the Republicans. And the campaign is backed by well-organised pressure groups.

It is hard to find coherent advocates on the other side of the argument. On the web, I came across Drug Watch International, based in Omaha, promising “current information … to counter drug ­advocacy propaganda”.

The lead item on its site dates from 2002. I did track down its president, Dr John Coleman, formerly an undercover agent at what is now the Drug Enforcement Administration. He proved an ­amiable interviewee who offered me an intriguingly contrarian defence of the American alcohol prohibition years: unpopular though the law was, ­­­drink-related diseases fell. The drug prohibition, he felt, also worked.

“In the US, the levels of drug use in most categories are lower than in the 1960s, ’70s and ’80s. There’s a lot of social change, a lot of ageing out,” he said. “We have a more intelligent law enforcement system. The confiscation laws are very effective. I don’t think we should be surprised if public policies work. We do have drug problems, I’m not minimising them. But if we ignore the progress we’ve made, we’re short-changing ourselves.”

It is the practical men who seem most disposed to support the status quo. The most eloquent I discovered was back in Carlisle – Paul Carter, the cop at the racecourse conference. “I joined the police 28 years ago and I went to the deaths of many young people who had overdosed on heroin, particularly, and each one is an utter tragedy. I think there are fewer now and that we are beginning to make a difference.

“There’s a cycle of life when you’re on heroin when you’re either asleep or not aware of what’s going on around you. If society sanctioned that effect on another generation, what does that say about us all?”

The policy wonks arguing for change have not, as a rule, attended a dead body in a dingy flat, but the macro-argument tends to lead in another direction even among senior police officers like Norm Stamper, the former police chief of Seattle, who told The New York Times: “We’ve spent a ­trillion dollars prosecuting the war on drugs. What do we have to show for it? Drugs are more readily available, at lower prices and higher levels of potency. It’s a dismal failure.”

The drug laws were dingy from the start: Congress made marijuana illegal in 1937 after a farcical debate, due to pressure from ­western farmers who wanted their Mexican labourers to work harder. The user community keeps discovering “legal highs”, governments promptly ban them whereupon their popularity increases.

In Britain, there is something close to despair among academics about the political process. Drugs are classified A, B and C, allegedly according to the degree of harm. But the theory ignores the immutable constitutional provision that laws are subject to the approval of the editor of the Daily Mail. Cannabis was downgraded from B to C and then back again, to meet the government’s political needs; this had no effect on either ­suppliers or users.

Ecstasy (which alarms the Mail) is deemed a class A drug, the most dangerous rating, although – according to a major study published by The Lancet in 2007 – it ranks 18th in degree of harm among 20 well-known substances, ahead only of poppers and khat (both legal) and well behind alcohol and tobacco (ditto).

“We’re supposed to have evidence-led policy formulation,” says Mike Levi, professor of criminology at Cardiff University, “but it often doesn’t happen in the drugs area.”

At the conferences Levi attends, the argument has shifted. “The question of a more rational drug policy is certainly being debated. There aren’t many old-fashioned zealots for the old methods of drug control even in the police, who are more open to change than recent home secretaries. But however good an idea it might be in the abstract it would take a more mature political and media conversation about it before it is likely to ­happen. Always keep ahold of nurse, for fear of finding something worse, that’s where we are now.”

In Britain, with its top-down system of government, a notionally left-of-centre but illiberal administration and a hysterical press, reform is improbable, although Gordon Brown recently had a brief meeting with Danny Kushlick, from the pro-legalisation group Transform. But there is a new atmosphere in the US, where the change in emphasis in ­Washington is enough to allow initiatives to come from below.

Already, dope-­smoking is de facto legal in California thanks to the lifting of the ban on medical marijuana. Purchase requires a prescription – but anyone who wants a joint but can’t find a Californian medic who thinks it will help backache just isn’t trying. This system may well spread.

Strangely, all this is happening just as Holland, the country that has been out on a limb for years with its coffee-shop culture, is beginning to row backwards. Once again, though, it may well be an anomaly. The Dutch are starting to tire of their exceptionalism and the drugs tourism that has resulted, just as they have tired of their liberal immigration policies. And the coffee shops have fallen foul of the indoor-smoking taboo.

Drug use generally in Holland seems to be low. But then you can prove almost anything with selective use of drug statistics: it is also low in ­Sweden, which is surprisingly stern. The main source for these stats is the UN Office on Drugs and Crime, which maintains a huge bureaucracy to fight the drug problem, or at least to collect astonishingly detailed statistics: 3.8 per cent of Scots aged 15-64 use cocaine every year; 21.5 per cent of the same cohort of Ghanaians use cannabis; opium prices in the ­Phongsaly and Huaphanh provinces of Laos range between $556 and $744 per kilo … You might think that, knowing all this, they might be able to do something.

The UNODC’s executive director, Antonio Maria Costa, has been the chief proponent of continued prohibitionism. But, even as he introduced his 2009 report which, as ever, trumpeted evidence of success, he seemed a little rattled, repeating the new White House line about treatment rather than enforcement while warning that legalisation would be “a historic ­mistake”. He went on: “Proponents of legalisation can’t have it both ways. A free market for drugs would unleash a drug epidemic, while a regulated one would create a parallel criminal market. Illicit drugs pose a danger to health. That’s why drugs are, and must remain, controlled.”

Of course drugs need to be controlled, just as alcohol, tobacco, firearms, prescription drugs, food additives and indeed UN bureaucrats with massive budgets need to be controlled. But the whole point is that illicit drugs are not controlled.

The international ­pretence of ­prohibition sees to that. One of the major arguments advanced for continuing the ban on ­cannabis is that the currently available strains of the drug do not offer the gentle highs of the hippie years but are ­intensively cultivated and far more potent, with potentially serious ­psychological effects. The analysis is correct, according to my stoner friends. But the logic is 180 degrees wrong. Imagine a total ban on tobacco, which is no longer so unthinkable.

Among the consequences would be an immediate return to the unfiltered full-strength gaspers of the 1950s, just as American alcohol prohibition produced moonshine. One benign ­consequence of drug legalisation would be that users would have a ­guarantee of quality and strength/mildness: an end to heroin flavoured with brick dust (many believe adulteration is the real killer), and the type of ­marijuana they actually want.

But the case for legalisation is not about allowing baby-boom couples to enjoy a joint after a dinner party without drawing the curtains or being obliged to visit a dodgy bloke called Dave. Decriminalisation or even legalising cannabis on its own would achieve little. Something more radical is required.

The crucial issue concerns the supply chain: the way prohibition has enriched and empowered gangsters, corrupt officials and indeed wholly corrupt narco-states across the planet. It was a point made ­eloquently by the Russian economist Lev Timofeev, when interviewed by Misha Glenny for his book about global organised crime, McMafia. ­

“Prohibiting a market does not mean destroying it,” ­Timofeev said. What it means is placing a “dynamically developing market under the total control of criminal corporations”. He called the present situation a threat to world civilisation, which international public opinion had failed to grasp.

Proper reform means legitimising production and supply, precisely so it can be controlled. Would it unleash a drug epidemic worse than the one we now have? Well, it would be an unusual child of the 1960s who did not mark the moment with a celebratory joint. But the novelty would soon wear off. And from then on, the places where it is easiest to obtain drugs would no longer be the inside of jails and inner-city school playgrounds.

Imagine a situation – as John Ashton started to do at Carlisle ­Racecourse – where all drugs were sold in pharmacies licensed for the purpose. ­Taxation could be set at a level that brought in revenue but still made ­illegal dealing uncompetitive. For the more dangerous and addictive drugs there would be compulsory medical supervision. Identity checks and strict record-keeping would be required. There would be laws (which could ­actually be enforced) against advertising, adulteration, use in public, ­driving under the influence and supply to minors.

In what way would that be worse than the present situation?

Matthew Engel is a regular contributor to FT Weekend Magazine

We should abandon the fantasy of a drug free world and start taking responsibility for regulation. If you really want to control who grows coca, who produces cocaine, who sells it and for how much, who can take it, and how much they pay for it, create a framework that is logical, accountable and adjustable.

Still not convinced? Consider the declining popularity of tobacco smoking. High taxation, credible education programmes and effective treatment programmes work – a legal ban on smoking would not. Why should cocaine be treated any differently?


Since Health Direct posted on Feb 24, 2009 High Stakes- Spice legal highs from the lab
we have consistently recieved high levels of readership.

Indeed Labour’s incompetent hypocracy has been frequently highlighted by Health Direct.

On Aug 02, 2006 we posted: Risks of taking drugs compared- Scientific review of dangers of drugtaking– we reproduced the first ranking based upon scientific evidence of harm to both individuals and society. It was devised by government advisers – then ignored by labour ministers because of its controversial findings.

NHS health debate is more heat than light

There are moments when politics and healthcare collide and all that is generated is heat. With absolutely no light.

As opponents turn their fire on to President Obama’s health plan, a gross mischaracterisation of Britain’s tax funded National Health Service has become the weapon of choice to attack it.

In response British politicians from Gordon Brown, the prime minister, downward have resorted to all of the 140 characters available on Twitter to defend it – implying that all is beautiful in the British NHS, and the US system with its 47m uninsured, its monumental costs, and its ability to bankrupt individuals is the approach that is “evil” – to use Sarah Palin’s description of the UK’s NHS.

This is a debate being driven by blind prejudice on both sides. For a start, what Mr Obama is proposing is not a British NHS. There is no proposal that a government backed insurer would run hospitals, as is still largely the case in the UK.

Second, half of the mighty 17 per cent of gross doemstic product that the US spends on health care – roughly double the level in the UK – is already funded by tax dollars through Medicare, Medicaid and the Veterans Health Administration, which incidentally does run medical facilities and provides some of the best health care in the US.

Third some of the charges levelled against the NHS are plumb wrong. That Teddy Kennedy would not get treatment for his brain tumour in the UK. That the NHS indulges in forced euthanasia. That people over the age of 59 do not get coronary artery by-passes.

The fractious British political classes have united in defence of the UK’s healthcare system after it has become a byword for the failings of universal, state-funded provision among the US Republican right.

Gordon Brown, prime minister, and David Cameron, leader of the Conservative opposition party, have both declared their commitment to the National Health Service.

The US right has used the NHS as an example of the potential pitfalls facing President Barack Obama as he tries to push through a healthcare reform bill.

Some Republicans have ridiculed it as a bureaucratic and “Orwellian” system that often denies care to the elderly – with Sarah Palin, the former Republican presidential candidate, decrying it as “evil”.

But in Britain, where since 1948 all citizens have enjoyed free healthcare from birth to death, the attacks are widely seen as wrong and insulting.

Some are true. The UK does have a lower dialysis rate for kidney disease than the US. Some of its cancer survival figures look appreciably worse and quite probably are worse: “probably” for a bunch of reasons, which include comparability of the data and the fact that five-year survival figures are by definition what was happening then, not what is happening now.

The NHS does indeed have waiting lists for non-emergency surgery, although after a doubling in spending in real terms over the past decade they are much shorter than they were. And, in contrast to the impression of “socialised medicine” held by some in the US, people can by-pass those queues by going private.

About 10 per cent of the population has some sort of private insurance, paid for indivdually or by their employers. The proportion has barely shifted over a decade, implying at least some sort of satisfaction among Brits at what they get.

In response to the worst of the UK performance, Brits can also pluck selective statistics from the US showing it has much poorer overall results for diabetes and a bunch of other chronic conditions where Britain’s primary care physicians treat patients well in the community, reducing complications and avoding costly hospital care.

A balanced view of the two systems might go like this. The US has some of the very best medicine in the world, particularly hi-tech medicine, notably in its leading academic health centres, and it has more of it than in the UK.

But study after study shows that overall the highest level of health spending in the world does not deliver anything like the best results.

A recent study, for example, looked at deaths in those aged under 75 that are amenable to treatment – for example, infections, cancers, diabetes, heart and vascular disease.

Overall, the US had the worst record among 19 industrialised countries, and the rate at which those deaths had been declining had slowed over the previous five years against the declines seen in other countries.

The US record was worse than that not just of the UK, but for example Portugal and Ireland. Martin McKee, of the London School of Hygiene and Tropical Medicine, one of the study’s authors, says: “If the US performed as well as the top three countries in the study” – France, Japan and Australia – “there would have been 101,000 fewer deaths per year.” There would also have been tens of thousands fewer in the UK if it had done the same.

Both systems have their strengths and weaknesses. But rather than presenting a caricature of the NHS, US opponents of reform might ask why. The US spends half as much again as almost any other country on healthcare, yet it still gets overall results that are nowhere near the best. One contributory reason, although only one, is the quality of care received by the uninsured. And that should be the real focus of the debate.


Cancer postcode lottery- London patients get three times more funding than those in Leicester

The full extent of Britain’s postcode lottery in cancer care has been laid bare by research showing some health trusts are spending three times as much per patient as others.

Huge variations in funding mean that cancer sufferers’ chances of being given life-extending drugs, surgery, and specialist care vary wildly from one part of the country to another.

While the average amount spent on a cancer sufferer in some parts of London is almost £15,000 a year, in Leicestershire it is less than £5,000.

Cancer experts said the research, carried out by The Sunday Telegraph, exposed a “grotesque lottery” in which life-and-death decisions were routinely being made by bureaucrats who were “unelected, unaccountable and unqualified” to make the rulings.

The figures obtained by the paper give the most detailed picture so far of the postcode lottery in cancer care.

Data from 150 Primary Care Trusts for 2007/2008 detailing cancer funding was divided by separate NHS records showing the number of cancer sufferers in each area.

Average spending was highest in Tower Hamlets, in East London, where cancer patients were allotted £14,697 for the year.

Those living in the cities of Birmingham, Leeds and Manchester all received average funding of at least £12,500.

Spending was lowest in Leicestershire and Rutland, with just £4,989 allotted to the average patient; about £500 more was spent in Harrow, North London, Hampshire, Northumberland and North Yorkshire.

Last year a study of patients with advanced cancer showed a tripling in the life-expectancy of those given drugs which many PCTs refuse to pay for.

Research on patients treated by University Hospitals Birmingham Foundation Trust compared the fate of 40 given the drugs Sutent and Nexavar for kidney cancer with 40 whose requests for funding were denied.

Those given the drugs survived 22 months, while those denied them lived just seven months, the study found.

Prof Nick James, director of research and development at University Hospital Birmingham, said: “A lot of PCTs are severely restricting access to drugs which can make a substantial difference to survival”.

While PCTs across Birmingham had agreed to fund many drugs for cancer patients living within their borders, those living further afield could only secure the same treatment if they won lengthy battles with bureaucracy, Dr James said.

The oncologist and professor of oncology at the University of Birmingham added: “Clinicians and patients in some areas are forced to battle continuously with bodies which are unelected, unaccountable and unqualified”.

He said that patients and doctors wasted “hundreds of hours” drafting appeals, writing to MPs and campaigning in the local media in an attempt to be heard by PCTs who often failed to even reply to correspondence.

The research found that PCTs across the country spent an average of £7,807 on cancer patients per year.

Jonathan Waxman, professor of oncology at Imperial College London, accused the labour Government of devising a “grotesque lottery” of local decision-making by PCTs in order to duck the blame for difficult decisions.

He said: “It is an absolutely absurd system, which is exposed by this excellent investigation. These discrepancies in funding are the reason people die.

“Why should how you are treated depend on where you live, and on decisions made by 150 different organisations who don’t have specialist knowledge of the patient?”

The study found the gulf between funding allocated in different parts of the country was growing.

Figures analysing spending per head of population showed the highest spending in Leeds, at £157 per head, compared with just £48 per head in the London boroughs of Camden and Newham.

The gap between the PCTs spending the most and those spending the least per head of population (weighted to take account of the health of the local population) increased from £70 to £109 between 2006/2007 and 2007/2008.

Cancer charities expressed alarm at the extent of the differences revealed by the research.

Sarah Woolnough, head of policy at Cancer Research UK, which raises funds to find treatments for cancer, said: “These huge variations in how much PCTs spend are worrying. We urge the Government to ensure that all PCTs deliver an efficient and high quality service for cancer patients in the face of predicted NHS cutbacks”.

Mike Hobday, from Macmillan Cancer Support, said: ” We know there are some PCTs which say yes to everything, and others which almost always say no, and that is something that we are concerned about.

“Some variation is to be expected, and in fact is necessary to meet the needs of particular populations, but it is really important that those commissioning services examine these findings closely”.

Dr Peter Marks, director of public health at NHS Leicestershire County and Rutland, said its local death rates for cancer were significantly lower than in the rest of England, while survival rates for specific cancers were similar, and in some cases better, to those elsewhere.

Shadow Health Secretary Andrew Lansley described the findings as “extremely concerning”.

He said: “Britain languishes near the bottom of the table in Europe when it comes to five year cancer survival rates. It’s clear that ministers’ promises to improve access to cancer drugs and treatments are ringing hollow for many vulnerable patients.”


NHS staffing crisis as one in 20 health professional posts remains unfilled

More than one in 20 posts in the NHS are being left unfilled official figures show as Trusts are forced to spend up to £150,000 to fill each job with agency workers.

The NHS Information Centre found that the number of job vacancies for hospital doctors, dentists, nurses and midwives rose for the first time in five years.

Staff retiring or leaving the sector and the impact of cuts to doctors’ hours are likely to have contributed to shortages across England. London is especially badly hit.

Doctors’ leaders have been heavily critical about the impact of preparing for the European Working Time Directive, which came into force on August 1st.

The directive, which has reduced the maximum working week for junior doctors and other staff by the equivalent of one working day — from 56 hours to 48 — means that a significant number of hospitals are relying on agency staff to plug gaps in their rotas.

As The Times reported last week, the College of Emergency Medicine said that pressure was greatest on “middle-grade” doctors with at least four years training, who would be typically asked to cover shifts in Accident and Emergency (A&E;) wards at evenings and weekends.

Trusts are spending tens of thousands of pounds to fill vacant posts with agencies charging between £90 to £95 an hour to provide a middle-grade doctor to staff units when a senior consultant is not present.

The health service spent more than £584 million on employing agency staff in 2007-08, the latest year for which full data is available.

The British Medical Association, the Royal College of Surgeons and the Royal College of Paediatrics and Child Health have been heavily critical of the changes.

Doctors can opt out of the directive on a voluntary basis, but only individually, throwing rota planning into “chaos”, according to senior doctors. They want whole departments or specialities to be allowed to suspend the rules.

John Black, the president of the Royal College of Surgeons, called last week for the 48-hour limit to be postponed or suspended if during the swine flu pandemic, if the NHS has to cope with an expected surge of illness this winter.

The staff vacancy figures, compiled in March, showed that total vacancy rates are also up across most staff groups, rising to 5.2 per cent compared to 3.6 per cent in the same month last year. Three month vacancy rates jumped two thirds from 0.9 per cent to 1.5 per cent.

Of the total number of vacant posts, one in five had been left unfilled for three months or more.

Unions have already warned that a large number of nurses and midwives are due to retire in the next decade and among qualified nursing staff total vacancies rose from 2.5 per cent in 2008 to 3.1 per cent. Long-term vacancies also increased from 0.5 per cent to 0.7 per cent at the end of March.

Among midwives, vacancies increased from 2.1 per cent in 2008 to 3.4 per cent, with long term vacancies accounting for about one in four of all midwife vacancies.

The Royal College of Midwives has called for 5,000 extra staff to be recruited in order to improve care for mothers and babies, but it says the Government has only promised funding for the equivalent of 3,400 posts.

The figures show that London has the highest long-term vacancy rate among qualified nursing staff with the 3 month vacancy rate increasing from 1.2 per cent in 2008 to 1.6 per cent this year.


Death toll from MRSA hospital bugs hits new high

More than 30,000 people have died after contracting the hospital infections MRSA and Clostridium difficile in just five years, official figures show.

Between 2004 and 2007 there were more than 20,000 deaths linked to C. diff and more than 6,000 associated with MRSA.

Data from the Office for National Statistics covering 2004 to 2008 shows record numbers of deaths linked to the superbugs in England and Wales.

Opposition politicians said the labour Government had allowed “a horrifying death toll” because of its “slow and sloppy” response to spiralling levels of infection in NHS hospitals.

Official data shows a doubling in the death toll linked to MRSA during the period 2004 to 2007, compared with the previous four years, and a quadrupling in deaths linked to C. diff, when two sets of three-year figures are compared.

Norman Lamb, the Liberal Democrat health spokesman, said: “These figures describe an absolutely horrifying death toll, and many of these people have lost their lives because of infections which could have been avoided if firm action on infection had been taken a long time ago”.

Annual deaths linked to MRSA quadrupled between 1997 and 2007, while those associated with C. diff quadrupled between 2004 and 2007, figures show.

Katherine Murphy, from the Patients Association, said the statistics showed the gulf between “flowery” Government rhetoric about a war on infection, and poor hygiene which had been allowed to continue unchecked.

“The NHS has been told to put other targets ahead of safety, and this is the inevitable outcome,” she added.

Infection experts have repeatedly warned that assessments based on the number of death certificates which record the presence of MRSA and C. diff are likely to underestimate the scale of the problem, because doctors are reluctant to admit that basic infections have caused fatalities.

Earlier figures published by the ONS have shown that the worst hospital for C. diff deaths in England or Wales was the Royal United Hospital in Bath, which had 268 deaths from the infection between 2002 and 2006.

The George Eliot hospital in Nuneaton, Warwickshire, the Walsgrave Hospital in Coventry and the Royal Infirmary in Leicester all had more than 200 deaths caused by the infection over the same period.

The worst-ever outbreak of C. diff in this country occurred between 2004 and 2006 at Maidstone and Tunbridge Wells NHS Trust, where the bug was linked to the deaths of 331 patients.

More than 5,000 people have backed The Sunday Telegraph’s Heal Our Hospitals campaign, which is calling for a review of hospital targets to make sure they work to improve quality of care.


Nearly 400 NHS dentists earn more than £300,000

Nearly 400 NHS dentists earned more than £300,000 last year, new figures show, despite millions of patients struggling to access free treatment.

In total almost 1,200, or one in every 20 dentists, earned more than £200,000 between 2007 and 2008, three times as many as the previous year.

The rising number of dentists earning what were described as “staggering” sums was revealed just a day after it was disclosed that some GPs now make up to £380,000 a year.

The payments come despite the fact that 3 million fewer patients are seeing an NHS dentist since a new contract was introduced in 2006.

Official figures show that dentists are carrying out greater numbers of treatments per patient than in the past, as well as more complicated procedures.

Those in the highest earning brackets also put in longer hours, with the majority working more than 45 hours a week, the figures, released by the NHS Information Centre, show.

The income is before tax but after expenses, which typically include the costs of renting surgeries and paying staff, have been taken into account.

The figures, based on dentists’ tax returns, include those who work solely for the health service as well as dentists who have a mix of NHS and private work.

They show that 382 of the 20,000 dentists in England and Wales earned more than £300,000 last year, while 1,172 earned more than £200,000. The average income was £89,062.

The new contract was deeply controversial among dentists and around 1,000 left the NHS before it was even implemented.

Problems included quotas to carry out a certain amount of treatments every year.

Dentists who reached their target too soon were effectively asked to work for free, while those who failed to reach the quota faced demands from their local healthcare trust to pay back tens of thousands of pounds of their salary, so-called “clawbacks”.

The new contracts also abolished a number of pay bands, meaning dentists now get paid the same to fit a patient with 10 fillings as just one.

The British Dental Association said that the figures reflected the hard work of dentists attempting to make a success of the new contract.

John Milne, Chair of the BDA’s General Dental Practice Committee, said: “These statistics reflect the second year of operation of the 2006 dental contract in England and Wales, a time when dentists were working hard to overcome problems with the new arrangements and make them work for their patients.

“Many practitioners were contending with the uncertainty of potential clawback of their contract values,” he added.

But Norman Lamb, the Liberal Democrat health spokesman, said that the amounts involved were “staggering”.

“These figures will astonish people who are struggling to find an NHS dentist. The amount of money some dentists are earning is staggering. It is vital that the NHS can compete with the private sector to secure the best staff. However, we need to know that we are getting value for money.”

Earlier this year ministers announced plans to pilot a change in how dentists are paid, linking part of their income to how many dentists they have on their books, in a bid to improve access.

Earlier this year a survey for Which? magazine suggested that three million people in England had been unable to get an appointment with an NHS dentist in the last two years.


Swine flu shirkers cost firms more than virus, say employers

Staff using the swine flu pandemic as an excuse to take time off work are causing more disruption to businesses than the virus itself, according to employers.

Thousands of healthy workers are thought to have taken advantage of official guidelines on the pandemic to extend their summer holidays.

By simply phoning the NHS swine flu hot line or visiting its website, unscrupulous workers can get themselves a course of antiviral medicine and do not need a sick note from their GP for the first seven days’ absence.

The labour Government is considering doubling this period to a fortnight, which companies fear could make the situation worse and cost them millions of pounds in lost productivity at a time when they are struggling with the effects of the recession.

There are predictions that more healthy workers will be tempted to call in sick as the weather improves over the next week, after the wettest July on record.

The Employment Law Advisory Service, which provides legal advice to companies on personnel problems, disclosed yesterday that it had begun receiving calls from concerned managers as soon as the self-diagnosis website was set up last month.

It has since heard from more than 1,000 companies that believe staff have exploited concern about the spread of the H1N1 virus to take an extra week off. It believes that the Department of Health’s guidance risks creating a “skiver’s charter”.

Peter Mooney, the service’s head of consultancy, said: “Managers feel that some staff are simply taking advantage of concerns about the transmission of swine flu to take an extra few days off work. Because the emphasis has been on not going to your local GP but using websites to assess the infection and the risk to others, those who stay at home are not going to need a doctor’s note or have too many people calling on them to see how they feel.

“Based on the volume, and the nature, of calls we have been taking, the number of deliberate false cases of the condition is having a significant impact on workplaces across the country — something bosses are keen to tackle.”

The Department of Health’s own planning assumptions state that nine per cent of the workforce could be absent at any one time during August, rising to 12 per cent in the winter. Ministers set up emergency measures to reduce the pressure on the NHS and slow the transmission of the virus amid predictions of a worst-case scenario in which one in three of the population falls ill and 65,000 people die.

Those who believe they have symptoms are advised to contact the National Pandemic Flu Service over the phone or online, rather than visit a family doctor.

If they are diagnosed with swine flu, they are given a number to allow them to collect a course of antiviral drugs and told to stay at home for a minimum of seven days in order to prevent further spread of the virus.

The flu service website and phone line handed out over 150,000 doses of Tamiflu in its first week. However, there is evidence that only about one in four recipients actually has the H1N1 virus.

GPs have said that they are being inundated with calls from patients claiming to have swine flu and requesting a note to sign them off work for longer than a week. Many are concerned that they are being asked to certify that people are ill without having seen them, meaning shirkers could take advantage.

Recent figures suggest the average worker takes 7.4 days off sick a year at a total cost of £17.3?billion to the economy, so the impact of staff taking another fortnight off for self-diagnosed swine flu could cripple some small businesses.

Ben Willmott, a senior public policy adviser at the Chartered Institute of Personnel and Development, said: “Obviously some employers are concerned that employees could take advantage of that.”

He urged managers to make sure they have contingency plans in place so they can cope if staff are genuinely ill with swine flu, and also to ensure that workers know that absence levels are monitored in order to catch those “swinging the lead”.

Meanwhile, GPs have been warned that a Tamiflu solution designed for babies will run out if it continues to be given to people who do not like to swallow capsules.

The Royal College of General Practitioners has told doctors not to prescribe the antiviral liquid to older children or adults. In a bulletin to members, the college said this was happening “across the country” and was “causing an unprecedented demand for the solution”.

Those who cannot swallow capsules should instead open the capsule and dissolve the powder in a sweet drink, it recommended.