HIV infection rate in over 50s doubles

HIV infections among the over 50s have more than doubled in seven years.
HIV infection rate in over 50s doublesThe number of new cases per year recorded in England, Wales and Northern Ireland rose from 299 to 710 between 2000 and 2007, research has shown.

Half were diagnosed late, increasing the risk of an early death from Aids.

Among younger age groups, a third have the HIV infection identified at a similar level of progression.

During the study period, three quarters of deaths among HIV-infected people aged 50 and over occurred within a year of diagnosis.

Compared with younger adults carrying the virus, older people were significantly more likely to have been infected through sex with men.

Older “straight” adults were more likely to acquire the virus in the UK, but there was evidence of white heterosexual men picking up the infection abroad.

Ruth Smith, a senior HIV scientist at the Health Protection Agency’s Centre for Infections, said: “We estimate that nearly half of older adults diagnosed between 2000 and 2007 were infected at age 50 or over and this highlights the importance of HIV testing – whatever your age.

“We must continually reinforce the safe sex message – using a condom with all new or casual partners is the surest way to ensure people do not become infected with a serious sexually transmitted infection such as HIV.”

The findings are published online in the journal AIDS and were presented today at the International Aids Conference in Vienna.

HPA data shows there are more than 83,000 people in the UK living with HIV, a quarter of whom do not know they are infected.

In 2008 there were 7,382 new HIV diagnoses in the UK with an estimated 32% over the age of 15 being diagnosed late.

A late diagnosis of HIV infection is defined as having a CD4 white blood cell count of less than 200 cells per cubic millimetre of blood. Healthy individuals have CD4 counts of 500 and above.

CD4 cells are a key part of the immune system. When their numbers fall too low, a person becomes vulnerable to infection.

Study co-author Valerie Delpech, head of HIV surveillance at the HPA, said: “Although adults aged 50 and over account for just 8% of all new HIV diagnoses, the fact that cases have more than doubled in recent years serves as a timely reminder that anybody is at risk of HIV infection if they do not use protection and practise safe sex.

“HIV remains a serious infection particularly when diagnosed late. The fact that we’ve seen an increase in the number of older adults getting diagnosed, and in particular getting diagnosed late, highlights the need for raised awareness in that age group.”

“Medical guidelines issued in 2008 encouraged widespread testing in areas where there is a high prevalence of HIV and the HPA fully supports any NHS or charity organisation initiative which will encourage increased testing and increased offering of testing across the UK.”


Private US firm advising NHS sees profits surge

Controversial US group UnitedHealth, which runs GPs’ practices and advises PCTs in UK reported a 30% leap in profits to $1.1bn.Private US firm advising NHS sees profits surgeThe company recently had to repay $350m to settle a US case in which it was accused of artificially depressing insurance repayments to customers.

A US health insurance company that recently won a multimillion-pound contract to advise primary care trusts (PCTs), has reported a surge in profits over the last three months.

UnitedHealth Group, which also operates five GP practices in Derbyshire and London, reported second-quarter profits climbed 30% on the same quarter a year ago to $1.1bn (£720m) on turnover of $23bn.

The stock market-listed firm said the bulk of its growth came in the United States after it signed up more members for the government-backed Medicare and Medicaid policies.

The company signed a contract with the Department of Health last month to advise PCTs on commissioning ahead of reforms that will give GPs the lion’s share of the NHS budget.

PCTs directly run GP practices and offer contracts to self-employed GP doctors and private firms to operate independent practices. GPs will be in charge of £90bn of the health budget under plans put forward by the health secretary, Andrew Lansley.

UnitedHealth will use its experience of private healthcare to bring efficiencies to the bidding processes.

US unions have complained about the company, which has come under fire for malpractice. In 2008, its former boss William McGuire was banned as a director and forced to repay $468m following a scandal related to backdated stock options.

In January the company agreed to pay $350m to settle a case brought by the New York attorney general, Andrew Cuomo, who accused the firm of boosting profits by artificially depressing insurance repayments to customers.

The company based repayments on “independent” assessments by a company called Ingenix, which was a subsidiary of UnitedHealth.

The company is based in Minnesota, from where it has grown to be the largest health insurer by sales in the US. The company, which has more than 50,000 staff and 60 million health plan customers, is expected to have annual revenues in excess of $80bn this year.


Banishing the NHS paper pushers to cut waste and red tape

Finger on the Pulse- pointless and costly bureaucracy and ludicrous management salaries have no place in this era of austerity.
Banishing the NHS paper pushers to cut waste and red tapeSeveral years ago, a friend worked as a temp in the NHS. She was the secretary to a group of middle management in a primary care trust (PCT) and spent the summer holiday before going to law school running their office. Within a few weeks, she quit. Not because she couldn’t do the job, but because she was disgusted with the waste she witnessed.

She was told not to work too hard. She would sit in meetings where the same things were discussed repeatedly without any decision being made. She was taken aside by a colleague when she attempted to improve efficiency and asked if she wanted to make everyone unemployed. It was shortly after this incident that she walked out.

All this was particularly galling to me at the time. I was working on a ward for elderly patients with dementia, and the ward didn’t even have its own resuscitation equipment. Instead, the clinical staff had to beg, borrow or steal from other wards. The amount of fruit that patients were given at lunchtime was cut.

I would sit in outpatient clinics and have to tell the families of people with Alzheimer’s that I wasn’t allowed to prescribe the anti-dementia drugs for their loved ones because the government had decreed that at £2.50 a day, they were too costly.

Frontline NHS staff look at the legions of paper-pushers in their offices and wring their hands in despair. Something needs to be done to prune this stratum in the health service, and last week there were the first signs that this might happen.

The Coalition government’s recent plans to improve the NHS will see PCTs and strategic health authorities scrapped. This is a bold move. In recent years, these organisations have morphed into unwieldy bodies that do little more than provide jobs for people who have no hard clinical skills, but who couldn’t quite hack it in the corporate sector.

While these organisations have responsibility for patient care, they are distant and detached, and it is difficult to see how they contribute in any meaningful way to the day-to-day care of patients. Yet, they cost millions to maintain. A report published last week found that more than 300 NHS executives have salaries larger than the Prime Minister.

Ian Miller, for example, worked as the interim director of finance and investment for South East Coast Strategic Health Authority and earned £310,000 for nine months’ work from April 2009 to January 2010. This equates to £400,000 a year, which would pay for 14 nurses. Financial experts have described these salaries as “unsustainable”.

The plans are not without potential pitfalls: will GPs, for example, be able to manage such large budgets effectively? But I wholeheartedly support the essence of these proposals, which is that pointless and costly bureaucracy and ludicrous management salaries have no place in this era of austerity.

I also believe that giving power to clinicians will benefit patients. It’s doctors and nurses who have a far greater understanding of what is needed and where resources should be directed than a person with an MBA sitting in an office well away from the action.

My friend, who is now a successful corporate lawyer, says that if the NHS wants to operate along corporate lines, it needs to heed corporate principles: no business would employ so many people who don’t do what the business is set up to do – namely to treat patients.

I hope the Government’s proposals address this once and for all, and that patients and those who care for them are put back at the centre of the NHS.


Coroner condemns maternity unit after death of third baby

A coroner yesterday condemned a “scandalous” hospital maternity unit over the death of a third baby in its care.

Milton Keynes General Hospital has been heavily criticised over shortages of beds and midwives following the deaths of baby girls Romy Feast and Ebony McCall.

Yesterday, its maternity unit faced fresh scrutiny after an inquest found Alex Broughton died within a day of being born after staff failed to recognise a problem with his heart.

Thomas Osborne, deputy coroner for Milton Keynes, said by failing to recognise the baby’s deteriorating heart condition during birth, staff “lost an opportunity” to speed up delivery and treat him.

The child suffered severe brain damage during birth and died on December 3 last year after being moved to a specialist unit at the John Radcliffe Hospital in Oxford.

Mr Osborne said the way Alex’s heart was monitored was a “major area of concern”.

He said: “The monitoring of his fetal heart rate during delivery failed to recognise his deteriorating condition prior to his birth and thus failed to trigger any concern for his well being that resulted in a lost opportunity to expedite his delivery and render further medical treatment.”

The coroner added that there had been conflicting evidence about how a midwife had monitored Alex’s heart rate.

He said an Oxford medical student observing the birth had given “surprising and unhelpful” evidence by saying that he could not recall what monitoring method had been used.

The inquest also heard that Alex’s parents, Lorna Howell and Matthew Broughton, received a hospital “birth congratulations” letter on the day Alex died.

Speaking after the hearing, Alex’s grandfather, Alan Broughton, branded the treatment as “a disgrace”. He added: “It would seem that serious problems continue to exist in the maternity unit.”

The criticisms are the latest in a string of scandals to hit the Buckinghamshire maternity unit in recent years.

Last year, Mr Osborne complained that midwife shortages were “nothing short of scandalous” after the death of Ebony McCall on an overstretched maternity ward.

An inquest heard that Ebony would probably have survived, had her mother, Amanda, been given a caesarean section when she asked for one. But staff were too busy and told her they would only carry out the procedure in an emergency, the inquest heard.

The scandal came despite having already been investigated over the death of Romy Feast in the same unit in 2007, who died after her heart condition was misinterpreted. Following the inquest into Romy’s death, Mr Osborne reported the hospital to the Department of Health, which prompted an investigation by the Healthcare Commission.

Earlier this year, the Care Quality Commission, the health watchdog, issued a damning report saying its maternity unit still had too few midwives and beds.

In March, Monitor, the independent regulator of NHS foundation trusts, intervened by sending in a team of clinical advisers to ensure that services are improved.

The hospital yesterday said the circumstances surrounding deaths of the two girls and Alex had been different and added that there was “nothing to suggest that any aspect of treatment or management (of Alex) … was in any material sense deficient”.

A spokeswoman for Milton Keynes NHS Foundation Trust said: “After the death of Ebony McCall and Romy Feast, we accepted mistakes had been made and we have been making significant improvements to our maternity services over the last year.

“While equally tragic, the circumstances around the death of Alexander Broughton were very different. His mother was given one-to-one care by a qualified midwife and appropriate procedures were followed.”


NHS suffering devastating cuts to jobs and services warns BMA

The NHS is suffering potentially devastating cuts to jobs and patient services as the Government’s austerity drive hits the health service, doctors’ leaders have warned.NHS suffering devastating cuts to jobs and services warns BMAThousands of doctors and nurses face being made redundant or not replaced if they leave, while many hospitals have cut treatments, the British Medical Association has found.

Despite ministers’ assurances that the health service would not face the same cuts as other departments, many hospitals are feeling the strain, according to the BMA.

Andrew Lansley, the Health Secretary, has boasted that frontline services would be protected. But it emerged yesterday that in his Cambridge constituency, Addenbrooke’s Hospital is planning to sack 170 nurses and up to 500 staff in total over the next year.

A survey for the BMA asked 361 doctors, who between them represent committees at all of Britain’s hospital trusts and some larger primary care trusts, how the NHS was being affected by the demand to make £20billion of cuts.

It comes as the Coalition faces political pressure to reverse its pledge to ring-fence health spending.

The BMA found that 43 per cent of those who responded said there was a freeze on recruiting doctors and nurses at their trust. Almost as many, 40 per cent, said that patient treatments, including varicose vein operations and blood tests, were being rationed.

GPs in Bedfordshire said they had been told not to refer patients with certain conditions, such as skin lesions and cysts, to hospitals except in exceptional circumstances.

Nearly a quarter of those who responded said that their trust was planning to make workers redundant. Although the majority of these would not affect frontline staff, the union warned that cuts to administrative workers could force doctors and nurses to spend more time on these duties and less time with patients.

The poll – to which 92 doctors responded – represents the first real evidence of how the NHS has been hit by the cuts. It found trusts were trying to make annual savings of six per cent on average. The Government has promised to guarantee NHS spending growth in real terms but the BMA says this will be “minimal”. The association called the cuts potentially “devastating”.

Dr Hamish Meldrum, the chairman of the BMA, said: “Whilst we accept that difficult decisions need to be taken in this tight financial climate, there is a real danger that cutting back on health now will have a long-lasting impact on our ability to maintain high-quality, comprehensive and universal care in the future.”

The warning came as senior Tories broke ranks to object to plans to protect health service funding.

Lord Lawson, the former Chancellor, and Nadine Dorries, a Tory member of the Commons health select committee, said that health funding should not be ring-fenced.

Ms Dorries told the BBC’s Politics Show: “I think we need to find the political courage to accept that there is excessive waste in the NHS and that it’s unfair to expect other departments to take all the hits.”

The Royal College of Nursing said earlier this year that about 5,600 jobs were under threat across 26 hospital trusts. In a “worst case scenario”, the true figure could be as high as 30,000, it said.

A spokesman for the Department of Health said: “Alongside all the public services, the NHS will need to deliver significant savings over the coming years.

“The department is very clear that savings should be implemented in a way that does not affect the quality of services and the Secretary of State has been very clear that every penny saved will be reinvested back into patient care.”


Anthrax deaths expose drug addicts’ plight

A spate of 13 deaths among heroin users whose drugs were contaminated with anthrax has highlighted how addicts are “demonised” and struggle to get treatment, according to experts.
Anthrax deaths expose drug addicts' plightSince the contaminated batch was first detected in the UK last Christmas, almost 50 addicts have been admitted to hospital, while 13 have died.

Anthrax-related heroin deaths are extremely rare, and in the past were unheard of in the UK. There has been only one known previous outbreak among heroin users, and that took place in Norway in 2000.

The vast majority of the deaths in this new outbreak have occurred in Scotland, predominantly in Glasgow. Several heroin users have also contracted anthrax poisoning in England, and so far one person has died. There has also been one fatality in Germany and nine in Portugal, although the cause of these deaths is disputed.

Drugs counsellors have told the guardian of their frustration that, as the crisis mounted, they were unable to help worried addicts switch to alternative drugs, such as methadone, because of lengthy waiting lists.

“Often, if we have a health scare among drug users, the advice we give is to use drugs in safer ways. For instance with HIV, we encouraged people to use needle exchanges,” said Gareth Balmer, project manager of Addaction Dundee, a support centre. “But this time around, the message we were getting from government was to tell people to stop using heroin, which was as much use as a chocolate teapot.

“If we could have got people access to methadone or Subutex [another heroin substitute] very quickly, it wouldn’t have been a ridiculous message, but we were looking at six-month waiting lists and, in some parts of Scotland, a year.” Balmer said the situation had “brought home how behind we are in helping people access that treatment”.

“Heroin users don’t use heroin for fun; it’s a physical and psychological dependency. We have a constant supply of people who would like to access methadone, but we felt as drug workers it was insulting people to say: ‘There’s possibly anthrax in your heroin; my advice is to stop using.’ I was surprised I didn’t get punched in the face.”

Anthrax infection can be cured if treated early enough. Common signs of infection are redness and swelling around the injection area. The scale of the outbreak is still being assessed, with checks being conducted at the top-secret Porton Down laboratory in Wiltshire, where biological and chemical weapons are tested.

How the anthrax found its way into the heroin is still open to question. Some addicts claimed it was part of a plot by shadowy government agencies to rid the country of drug users. Others speculated that it was the work of the Taliban, who control opium production in Afghanistan, where more than 90% of the UK’s heroin comes from.

However, guidance issued to investigating police officers, states that there are two likely causes: “Heroin could be naturally contaminated after harvesting from contact with soil in an area where an animal had died from anthrax at some point, or by being stored or transported in contact with animal products, especially skins, from an animal that had died from anthrax,” the guidance states.

“The second option is that the heroin was contaminated at some stage during the cutting process… Of feasible agents, animal products are the most likely, and of these, bone meal would be suitable for cutting and has been associated with cases of cutaneous anthrax in people handling it in the past.”

But despite the unprecedented number of deaths, the issue has been largely ignored. “Media indifference on this issue, considering the number of fatalities that have occurred, has been disappointing, but not surprising,” said Martin Barnes, chief executive of DrugScope, an organisation that tracks trends in drug use. “These people are stigmatised and demonised. There is a feeling they are blameworthy and less deserving of public concern and attention.”

The deaths have refocused attention on the 300,000 heroin users in the UK, around 2% of whom will die this year as a result of their drug use. They have drawn comparisons with an earlier health crisis that plagued the addict community when a batch of heroin was infected with botulism.

Experts note that the price of heroin has fallen significantly in the past year, possibly as a result of bumper harvests in Afghanistan. Currently a £10 bag sold on the streets of Glasgow will contain 0.2g of heroin, compared with 0.1g a year ago – although prices have started to rise again as larger quantities of the drug are diverted to China and eastern Europe.

Balmer warned that the crisis could yet reignite. “Our worry is that the infected heroin will be buried somewhere until the heat dies down. It happened with the botulism scare. Somebody could still be holding on to it until we’ve all forgotten about it.”


UK life expectancy gap is widening- despite labours promises

The gap between average life expectancy and that of the poorest in England is widening despite efforts to close it, a National Audit Office report says.
UK life expectancy gap is widening- despite labours promisesLife expectancy is now 77.9 years for men and 82 years for women but in poor areas it falls to 75.8 and 80.4 years.

The NAO says this means that from 1995-97 to 2006-08 the life expectancy gap grew by 7% for men and 14% for women.

It is calling for more investment to help GPs tackle problems like smoking and poor diet in poor communities.

The NAO says the figures mean a Labour government target to reduce the difference in life expectancy by 10% by 2010 is unlikely to be met.

Its report says it is not possible to show how much money has been spent on tackling health inequalities, as primary care trusts (PCTs) are not allocated specific funding for the task.

But it says that at present the system “does not provide enough of an incentive” to encourage family doctors to focus on the neediest groups in their practices.

The report says it would not cost “a large amount of money” – £24m a year – to take key actions which would improve health in deprived areas.

These include increasing the prescribing of drugs to reduce cholesterol and control blood pressure, and doubling the capacity of services which help people quit smoking.

The report contrasts that amount with the £3.9bn spent by PCTs in the poorest areas on treating circulatory and respiratory illness.

Life expectancy for everyone in England improved under Labour, and now stands at almost 78 years for men and 82 years for women.
* Salford
* Bolton
* Middlesbrough
* Blackburn with Darwen
* Hartlepool
* Bradford
* Oldham
* Nottingham City
* Sandwell
* Ashton, Leigh and Wigan
* Leicester City
* Hull
* Blackpool

But the improvement rate has been slower in the most deprived communities, and currently the equivalent figures are 75.8 years for men and 80.4 years for women.

Analysis also showed that success rates in stop-smoking programmes were lower in the poorest communities than in other areas.

A spokesman for the British Medical Association, which has just concluded its annual conference, said: “We are disappointed that today’s report says that the Department of Health will not meet its target to reduce the health inequalities gap.

“At our meeting, the BMA passed a motion calling on the government to increase expenditure on prevention services to reduce health inequalities.

“It is particularly important to do this in early years to give every child the best start in life. We will also lobby for fiscal policies to narrow the income gap between the poorest and the richest in society. Doctors believe it is necessary to take this action to tackle health inequalities.”


Royal College of GPs warns over NHS health visitors

The Royal College of GPs says thousands of new health visitors whom the government plans to recruit should not solely be placed in children’s centres.
Royal College of GPs warns over NHS health visitorsOver 4,000 more health visitors have been promised in England, focused in Sure Start centres.

GPs say there is already a breakdown in communication with health visitors who work in the centres, and placing more there would make it worse.

But children’s charities say parents need a more informal approach.

Health visitors have usually worked out of GPs’ surgeries – but the growth of Sure Start children’s centres has seen more moving to them.

The children’s charity 4children says having health visitors based in these centres means there is less need for mothers to use GPs’ surgeries for non-urgent problems and advice.

The Royal College of GPs says its members are seeing a worrying pattern developing, where vital information is not being passed back to them.

It says GPs need to be more actively involved in the the care of mothers during and after their pregnancy, and health visitors have to link in more with GP practices.

Professor Steve Fields of the Royal College of GPs said: “Mums-to-be are not getting the service they could have had five or 10 years ago.

“It is an unintended consequence of children’s centres being established and health visitors moving out of GPs’ surgeries and GPs not being as actively involved the care of mums-to-be during their pregnancy.


Emergency hospital admissions rises are unsustainable for NHS

The rise in emergency admissions to hospitals is “overheating” the system in England and is “unsustainable” in the future, a health think tank says.
Emergency hospital admissions rises are unsustainable for NHSAnalysis by the Nuffield Trust found there were now 4.9 million unplanned admissions a year – a rise of 12% since 2004-05 – costing the NHS £11bn a year.

It said a rise in patients who spent a day or less in hospital suggested many admissions could be avoided. NHS managers agreed action was needed to tackle the problem.

Emergency admissions include patients admitted through A&E units as well as direct into other parts of hospitals.
Ageing population

The think tank, which analysed a range of official NHS data during its research, found emergency admissions now accounted for more than a third of the total.

The rise seen since 2004-05 is costing the NHS an extra £330m a year alone and the think tank said the issue had to be a priority if the NHS was to prosper in the current economic climate.

Researchers found there was a range of factors behind the trend.

They pointed to the ageing population – the elderly were more likely to be admitted as an emergency – as well as financial incentives in the NHS which were motivating hospitals to admit more.

The report also noted there had been a significant jump in patients being admitted for one day or less.

It said this was partly related to advances in medicine which meant patients did not need to spend as long in hospital, but argued many could have been avoided with better community services.

While the report only looked in detail at the situation in England, it also noted rises had been seen elsewhere in the UK.

And it said the recent announcement by ministers that hospitals would be fined for readmissions would only have a limited impact as many of the cases did not fall into that category.

Nuffield Trust director Dr Jennifer Dixon said: “Reversing this unsustainable rise in emergency admissions must be the number one priority for the NHS – any reform to the health service that does not tackle this will fail. Our hospitals are overheating and are treating patients at great cost to the NHS.”

Nigel Edwards, acting chief executive of the NHS Confederation, which represents managers, said: “This report furthers the case for fundamentally reviewing the urgent and emergency care system.

“Hospital is often the right place for sick patients to be but we know that for many there are better, more convenient and more cost-effective alternatives to hospital admission.

Dr John Heyworth, president of the College of Emergency Medicine agreed there were pressures in the system, but questioned some aspects of the research.

“It is fundamentally incorrect to assume that admissions for less than 24 hours are unnecessary or financially inefficient. In fact, the opposite applies.”


Sacked NHS whistleblower vindicated and should be reinstated

An NHS worker with an unblemished 27-year career was sacked after she blew the whistle on senior doctors who were moonlighting at a private hospital while being paid to diagnose NHS patients, an employment tribunal has heard.

Sharmila Chowdhury, 51, the radiology service manager at Ealing Hospital NHS Trust, repeatedly warned the hospital’s most senior managers that doctors were dishonestly claiming thousands of pounds every month.

A Watford employment tribunal judge took the unusual step last week of ordering the trust to reinstate Ms Chowdhury’s full salary and said: “I have no hesitation in saying that you are probably going to win.”

The ruling will be a bitter blow for the trust, particularly as despite the seriousness of the allegations, it failed for two years to take any action against Miranda Harvie and Peter Schnatterback, the two doctors accused of fraud at the hearing.

Instead, Ms Chowdhury was suspended after a counter-allegation of fraud made against her by a junior whom she had reported for breaching patient safety. Radiographer Michael McWha made the allegation at the request of Dr Harvie, the tribunal heard. Ms Chowdhury was sacked for gross misconduct in June, eight months after her suspension.

This case is the latest to highlight the inadequate legal protection for whistleblowers who speak out about wrongdoing in the NHS.

It also raises the uncomfortable question about the power yielded in the NHS by senior doctors. The onus is now on the trust to prove at next February’s tribunal that Ms Chowdhury was guilty of fraud and not, as she claims, sacked because she was a whistleblower.

Speaking after the judgment, a tearful Ms Chowdhury expressed her relief after months of financial hardship. A widow with a teenage son, Ms Chowdhury has been forced to move back in with her elderly parents and rely on the goodwill of outraged lawyers.

She told The Independent on Sunday: “I cannot believe what has happened to me. I was horrified and humiliated when escorted out of the building, and for a whole month, I had no idea why I was suspended. I was just doing my job. I thought the trust would want to know consultants were doing private work on NHS time. The public has a right to know what is happening with public money.

“This whole thing has completely changed me. I’m trying to stay positive but I loved my work, my department, and there are not many jobs out there. I hope the trust sees sense and tries to resolve the situation. If it hadn’t been for Julie Morris at Russell Jones and Walker who took on my case for free, I would have lost everything I’d worked for all my life.”

Ms Chowdhury qualified as a radiographer at Hammersmith Hospital in 1983. She worked her way up the management chain before starting as Ealing’s deputy imaging manager in 2003.

The alleged fraud came to her attention after starting as service manager is 2007. It was her job to balance the books, report all staff absences and make sure X-rays, CT and MRI scans were of a high quality.

But in addition, she had a separate informal agreement with the trust to read X-rays, for which she was paid £2 per report. She did this every morning and would then work through lunch to complete her normal duties.

Mr McWha alleged that Ms Chowdhury was carrying out this extra work fraudulently. He did so after Ms Chowdhury launched an investigation upon discovering his failure to upload reports and scans from 100 patients on to the imaging system, which may have caused delays in diagnosing life-threatening conditions.

The trust admitted during the disciplinary hearing that it had failed to find any evidence to support his claim. But Ms Chowdhury was sacked for gross misconduct anyway, in order to placate the consultants who were fed up with Ms Chowdhury’s interference in their business, the tribunal heard.

From July 2007 onwards she had informed managers that Dr Harvie was being paid for 14 half-day sessions a week when she was working only seven. Evidence that Dr Harvie and Dr Schnatterback were working alternate Mondays at the Clementine Churchill Hospital in Harrow, while being paid to be at Ealing, was passed on. Dr Schnatterback also claimed £250 for evening sessions when his private commitments led to an NHS backlog, the tribunal heard. Frustrated by the trust’s apparent refusal to tackle the consultants, Ms Chowdhury wrote to the NHS Counter Fraud service in July 2009. Nothing happened.

Weeks before her suspension, she angered several consultants after reporting them for claiming four hours of overtime when working only three.

Reports of duplicate claims and extra annual leave days were also made. All these protected disclosures were made to the finance director in October 2009, who referred the issue to the trust’s fraud officer. He interviewed Ms Chowdhury in November 2009; days later she was suspended.

Ms Chowdhury’s barristers, Helen Mountfield QC and James Laddie from Matrix Chambers, suggested that the case illustrated the “long-established tradition in the NHS of power being wielded by consultants”.

In defence, Andrew Sharland, said: “This claim that there was some kind of grand conspiracy is unlikely to stand up. Ms Chowdhury is making very serious allegations against senior NHS consultants. This shows an extreme prejudice towards the NHS and towards the senior consultants.”

The trust said it was unable to comment on confidential matters relating to individual employees. Dr Schnatterback told the IoS that his twice-monthly private sessions were always approved by the clinical director and he did more NHS work than he was paid for. Dr Harvie denied the allegations. Mr McWha refused to comment.

Ms Chowdhury’s lawyers told the hearing: “The stated reason for dismissal is scandalous. It does not even survive the briefest scrutiny. This is not a mistake – it is a sham.”

The judge awarded her full pay until the hearing begins in February, including pay for the work which the trust claims was fraudulently completed.

Andrew Lansley, Secretary of State for Health, said last week the Government had plans to give the current legislation “more teeth”. It can’t come soon enough.