North Devon Gazette

• Greens Condemn 'creeping NHS privatisation'. The South West Green Party has called for the drive for private profit to be kicked out of the health service. The Green Party maintains that the NHS is being systematically dismantled and sold off to large healthcare providers to run on a profit-making business model. Dr Richard Lawson, a GP and a SW Green Party list candidate for the Euro Elections in 2009, said: "I was informed many years ago by a top BMA representative that the underlying agenda of the NHS, under both Tories and Labour, was to refashion the service into the American model, with private Health Maintenance Organisations (for that read Primary Care Trusts) providing medical services only for people who have medical insurance. Uninsured people will have to take their chance in American style 'Emergency Rooms'." Dr Lawson added: "One of my older patients met Nye Bevan and heard him say that if we abuse the NHS, we will lose it. The NHS has been abused by politicians, who first failed to educate patients in the proper use of the service, and now by Labour and Tory politicians who want to privatise it by stealth". North Devon's Ricky Knight, lead Euro candidate for the SW Green Party, stated: "Sixty years ago, Bevan strived to bring different health service providers into a nationalised health service. Sixty years on, Labour are working hard to hand the NHS to private health care providers, paid for by the tax-payer. Time and time again, private companies have been shown to have cost taxpayers more to provide equivalent healthcare services than the NHS, with no benefits in quality. Why then do Labour insist on continuing with this destructive and misguided policy ? The answer is that New Labour politicians have bought in to the free market economic model lock stock and barrel. Their refusal to re-integrate hospital cleaning services into the NHS is a symptom of their new ideology. Integrated cleaning services, with fully trained and well-motivated cleaners, are the best weapon that there is against hospital acquired infections such as MRSA and Clostridium Difficile. The Green Party is the only major party saying no to the prioritising of private profit from a service that should be run for the good of the patients and not the shareholders. It is time to say no to Labour's privatisation agenda and return to efficient and effective state run services that benefit local people."
  
  http:/ / www.devon24.co.uk/ northdevongazette/ news/ story.aspx ?brand=NDGOnline& category=news& tBrand=devon24& tCategory=newsndga& itemid=DEED04% 20Jul% 202008% 2007% 3A24% 3A51% 3A380

Public Finance

• GP contract raised costs by £160m. The 2004 General Medical Services contract has resulted in general medical services in Scotland costing £160m more than they should, according to a report by Audit Scotland. The report concluded that the contract should have been better planned and will take time to improve patient care. The survey found that the cost of implementing the contract in Scotland was underestimated. In the first three years it was £160.4m more than the amount allocated to NHS boards to pay for GMS. Most of the extra expenditure was due to the higher than expected costs of introducing an incentive payment system to ensure quality of care and that no practice was financially disadvantaged by the contract. The report highlighted a lack of management information about general practice in Scotland. It said the NHS did not know how many GPs worked full- or part-time. There was also a lack of comprehensive data on staff numbers, workload and activity in practices. Auditor general Bob Black said the contract had appeared to address GP concerns about pay and work-life balance and had improved some services. But he added: "There was insufficient planning for implementing this contract, partly due to a lack of available data on primary care and an underestimation of the costs of the contract. The challenge for the Scottish government, the NHS and GPs is to build on the early signs of improvement and to deliver better outcomes for patients."
  
  http:/ / www.publicfinance.co.uk/ news_ details.cfm ?News_ id=58480

Management in Practice

• Committee sounds warning over general practice funding. A BMA committee has welcomed a review of the new contract for GP practices in Scotland, but warned that the "boom and bust" approach to funding is a mistake. The review found that the contract has produced some improvements in areas such as monitoring and flexibility, but would take time to provide benefits to patient care. Dr Dean Marshall, chairman of the BMA's Scottish GPs Committee, said the report was a "timely reminder" that a new contract was needed. "GPs were struggling to manage an ever-growing workload, morale was at an all time low and recruitment and retention was becoming a significant problem," he said. "The new contract sought to resolve these issues which helped to make general practice an attractive career option once again." He said that he was glad to see the commitment of GPs recognised in the report but without better cooperation between government and GPs, the benefits might be short-lived. "Just as we are beginning to see the beneficial effects on patients' lives, cuts in funding could mean that those improvements are less likely to continue," he added.
  
  http:/ / www.managementinpractice.com/ default.asp ?title=Committeesoundswarningovergeneralpracticefunding& page=article.display& article.id=12149

Hartlepool Mail

• Hospital campaigners reject plans. Hospital campaigners have refused to endorse the Labour Group's plans for Hartlepool's University Hospital. Keith Fisher, chairman of the Save our Hospital campaign, has been calling for the hospital to remain where it is on Holdforth Road and has refused to enter debate about a new site because he believes it could be preserved at its current location if the Labour party had the will to do so. Mr Fisher said: "I would never engage into a discussion about my preferred choice for the new hospital site because that cuts across our basic principle. All of what the Labour Group is saying about free parking and good access fades into insignificance because it should be helping us to save the hospital in the first place. It is the 60th birthday of the NHS this week and this is no time to be going backwards. Building a new hospital doesn't mean it will be better." Carole Langrick, deputy chief executive for North Tees and Hartlepool NHS Foundation Trust, said: "We are committed to gaining public funding for the new hospital because we think this is the most affordable route for building what will be a world class facility. We know people want to stay healthy and when they are ill they want services close to or in their own homes, designed around them and their needs, not the needs of the health service. The NHS has continued to flourish based on the same abiding principles on which it was originally set up. As custodians of this service we are totally committed to retaining those principles and as custodians, it is also our duty to plan and to ensure that health services are meeting the needs of local people, both now and in the future. "
  
  http:/ / www.hartlepoolmail.co.uk/ news/ Hospital- campaigners- reject- plans.4255721.jp

The Financial Times

• GPs angry at cartel accusation. A fresh drive to increase patient choice has been launched by the government, triggering a clash with the BMA. Ben Bradshaw, the health minister, accused some GPs of operating "gentlemen's agreements" not to poach each other's patients, effectively eliminating patients' ability to choose GPs. Bradshaw made the accusation as he launched a raft of measures designed to promote patient choice and increase completion between GPs. They include ending an income guarantee for practices, which can discourage them from taking on new patients; rewarding practices that expand; giving patients more information about the quality of local general practice; and removing a practice's right to operate if it handles complaints badly. Mr Bradshaw's charge that some GPs effectively operate a cartel brought an angry reaction from Dr Laurence Buckman, chairman of the BMA's general practice committee. "It is absolute nonsense to suggest that there are gentleman's agreements - it just doesn't happen," he said. But he warned "nor are we going to compete for patients, that is not the way general practice works". The government measures, however, are aimed at producing exactly that, while also making is easier for PCTs to bring in alternative providers. The BMA has indicated willingness to discuss phasing out the income guarantee, and accepts that GP's pay should better reflect their workload. The annual patient satisfaction survey will be broadened to cover how user-friendly GP practices are with the results published, and pay potentially related to the findings. Niall Dickson, chief executive of the King's Fund health think-tank, said patients would not move when services were good and "the vast majority of excellent GPs" would welcome the moves.
  
  http:/ / www.ft.com/ cms/ s/ 0/ 2a9df2de- 4961- 11dd- 9a5f- 000077b07658.html

Thursday 3rd July 2008

Guardian

• Small IT is beautiful. The Medical Training Application Service (MTAS) debacle cost the Department of Health £6m. It is also emerging as a key exhibit in the campaign to change a distinctive feature of the way the government buys IT - its preference for large suppliers. IT industry veteran Nic Birtles blames the fiasco on the way the government's own rules prevented the Department of Health from hiring a specialist business (of which he is chairman) which was already supplying a similar working system, in favour of a generalist IT systems integration company. He says these same rules are paving the way for more disasters - and also damaging the national economy. The government's fondness for large IT suppliers is well documented. A study published in 2006 found the UK to be unusually dependent on a few large IT companies. The study concluded that the relationship was "dangerously imbalanced" and that there was a direct correlation with disasters. At least one large government programme - the £12bn NHS National Programme for IT - had an explicit aim to lure multinationals in to the market. MTAS was not part of the national programme, but Birtles says it was a victim of the same mentality. He claims that his company, Konetic, had developed a working system for handling GP recruitment which went live in 2005. However, when the Department of Health went out to tender for a replacement system covering all medical specialities, Konetic was not allowed to bid for the work as it was not listed in S-CAT, a catalogue of approved suppliers. In the event, the contract went to Methods Consulting, which describes itself as a UK top 20 Business and IS consultancy with an annual turnover in excess of £50m. Its clients include the Department of Work and Pensions, HM Revenue and Customs and the Ministry of Defence. Birtles claims Methods Consulting had "no previous experience of implementing such large and complex recruitment system". "The big question this asks is: why does government procurement policy go against giving business to smaller specialist companies in favour of big generalist companies that often don't really understand the problems involved ?" he says. The inquiry comes a little late. The 2002 spending review injected £6bn into government IT. The contracts funded by that wave of investment - overwhelmingly with large companies - are now in place. It will be many years before the government goes computer shopping on that scale again.
  
  http:/ / www.guardian.co.uk/ technology/ 2008/ jul/ 03/ information.security

Financial Times

• Health tourism prescription for galloping costs. Strengthened rights for patients to seek treatment in other countries were put forward by the European Commission to the dismay of the UK. The draft directive would allow patients to travel to other EU countries for routine treatment without prior approval from doctors. Their health authorities or insurers would then have to meet the bill, up to the cost that would have been incurred at home. Britain, however, insists it will retain the power to decide which treatments it will reimburse, putting Alan Johnson, health secretary, on a collision course with Brussels. The Commission argues that landmark court cases have shown that a failure to gain prior approval for treatment abroad is not a legal basis for nations refusing to reimburse patients for the cost. But, in a concession to London, the directive includes an "emergency brake" giving nations the power to restrict the rights of patients if they can show they cannot afford to fund the procedures. The burden of proof, however, is shifted firmly from the patient to the healthcare provider, meaning the NHS would have to show clear evidence that a limitation on treatment overseas was justified. That qualification left the UK declaring bluntly that "health tourism will not be funded" by the NHS. Androulla Vassiliou, the EU's senior health official, presented the move as a way of controlling spiralling healthcare costs. Mrs Vassiliou said nations would "realise they cannot have everything". "It is better to specialise in certain things and rely on your neighbour for something else and vice versa. There will be this pooling together of expertise and knowledge." It would require countries to be more open about costs as governments bill each other for treating patients.
  
  http:/ / www.ft.com/ cms/ s/ 0/ c055530a- 4897- 11dd- a851- 000077b07658.html

Daily Telegraph

• GPs' 'gentlemen's agreements' undermine patient choice, claims Ben Bradshaw. The Government has launched a new assault on GPs by claiming some surgeries are operating "gentlemen's agreements" not to poach each other's patients. The agreements undermine patients' choice by making it more difficult for patients to switch doctors and allow GPs to close their lists to new patients, according to Ben Bradshaw, the Health Minister. The British Medical Association immediately dismissed the accusations as "nonsense". Mr Bradshaw's comments will do nothing to ease doctors' concerns that the Department of Health is conducting a co-ordinated campaign against them in order to force through reforms.
  
  http:/ / www.telegraph.co.uk/ news/ 2239544/ GPs- % 27gentlemen% 27s- agreements% 27- undermine- patient- choice% 2C- claims- Ben- Bradshaw.html

Wednesday 2nd July 2008

Guardian

• Patients and dentists let down by NHS reforms, say MPs. The government's "unpopular and untested" reform of NHS dentistry in England has failed patients and the profession, MPs on the Commons health select committee said. An investigation of changes made two years ago showed fewer NHS dentists were providing less treatment for 900,000 fewer patients. The working conditions of dentists had deteriorated and there was a danger of a mass exodus into private practice in 2009, when those working for the NHS lose the right to a guaranteed minimum income, the MPs said. The dental reforms, introduced in April 2006, were supposed to encourage dentists to spend more time on teaching patients how to look after their teeth and less time on "drill and fill". But the committee, on which Labour MPs have a majority, said the outcome had been higher charges for patients needing a single filling. "We heard concerns that some low-income patients store up dental problems and delay visiting their dentist, at some cost to their long-term dental health," the report said. The number of complex treatments, such as the fitting of crowns, bridges and dentures, fell by 50% over the first year of the contract. Dentists were now less likely to carry out root canal treatment and more likely to extract teeth. The Department of Health could not explain why. The report said it was "extraordinary" that the department did not test the payment system before introducing it everywhere. The committee recommended financial rewards for dentists who provide a high-quality service, a scheme similar to the GP bonus system. The government should reinstate a procedure that allowed patients to register with an NHS dentist to secure continuity of care, and the dental budget should be distributed according to each area's need, and not the historical accident of how many NHS dentists it used to have, the MPs said.
  
  http:/ / www.guardian.co.uk/ politics/ 2008/ jul/ 02/ health.health

Tuesday 1st July 2008

Times

• The NHS: world class care costs. Gordon Brown made a brave attempt to explain government policy on healthcare reform. So far, Labour has concentrated on "capacity", he said in a forward to Lord Darzi of Denham's 60th anniversary review of the NHS. From now on the focus will be quality. Nurses will be rated according to their attitude and performance. Hospitals will be ranked by objective data, including death rates from specific illnesses, and by asking patients how they feel they have been treated. Extra money will flow to the best performers. The Prime Minister spoke of ten years of NHS investment that has indeed boosted capacity - at a cost now of about £100bn a year - but has also wasted tens of billions on ill-judged pay settlements and failed to boost outcomes for patients with severe and chronic illness into the top tier where British healthcare should belong. Lord Darzi's emphasis on quality is depressing for its tacit acknowledgement that quality of care could have been neglected in a field where it should be non-negotiable. His report says that patients will benefit if the private sector has more freedom to bid for primary care contracts. But it demands substantially improved care across the board, without giving any indication how this might be funded. The context is important: after five years of substantial real-terms increases, NHS budgets have been effectively frozen until 2011. Baby-boomers outnumber under-16s in the UK and are now entering old age, when their demand for life-extending but increasingly expensive drugs will peek. The NHS stepped on to this inflationary train by guaranteeing patients access to all approved drugs "where the clinician recommends them". The "constitution" attached to the Darzi report that sets out this new entitlement fails conspicuously to acknowledge that its cost could quickly spiral out of control. The only cost-control tool to feature in the report is an end to GPs' minimum income guarantee - and it will not be enough.
  
  http:/ / www.timesonline.co.uk/ tol/ comment/ leading_ article/ article4244725.ece

Mirror

• Thief gets NHS files on laptop. A laptop computer holding details of 21,000 NHS patients was stolen from a manager's car. The blunder is the latest in a string of embarrassing thefts of NHS computers containing patient records. The laptop listed the names, contact details, birth dates, postcodes and hospital numbers of patients at Colchester University Hospital, Essex. It also held details of their medical treatment. The hospital trust has written an apology to all patients affected and the senior manager has been suspended from duty.
  
  http:/ / www.mirror.co.uk/ news/ topstories/ 2008/ 07/ 01/ thief- gets- nhs- files- on- laptop- 89520- 20627546/

Worcester News

• Mental health unit facing axe threat. Health chiefs will meet in a fortnight to decide the fate of a mental health unit which faces the axe. The decision on whether to close Sheffield House in Malvern will be taken by Worcestershire Mental Health NHS Partnership Trust board. The 8-bed unit in Court Road provides 24-hour care for patients who are mentally unwell but are not ill enough to be treated in a psychiatric ward such as the one at Newtown Hospital, Worcester. Trust chiefs want to close the unit because they say only 40% of the beds are filled. But former patients say it was a lifeline to them in times of need and should be kept open. The trust will take into account a consultation conducted by Worcestershire County Council's health overview and scrutiny committee. Staff, patients, councillors and MPs were consulted about the changes, which will save the trust £350,000 and help plug a £2.4m black hole in its finances. Harriett Baldwin, Conservative parliamentary candidate for West Worcestershire, said the trust's negotiating and consultative committee rubber-stamped the closure last week and that the health overview and scrutiny committee will write to the trust to say its concerns about the closure have now been addressed. Neither the trust or Worcestershire County Council were able to confirm this.
  
  http:/ / www.worcesternews.co.uk/ news/ 3187175.Mental_ health_ unit_ _ facing_ axe_ threat_ /

Nottingham Evening Post

• Delay-hit NHS centre to open its doors. Patients can soon use a new treatment centre that has been dogged by delays. The privately-run building for NHS patients is seven months over deadline. The Nottingham NHS Treatment Centre at the Queen's Medical Centre will open its doors on July 28. Run by Nations Healthcare on behalf of the NHS, it was due to open in December, but its owners said more work was needed to make sure the centre was fit for patients' needs. Day case surgery and outpatient clinics will be offered at the centre. It houses five operating theatres and diagnostic testing facilities including MRI and CT scanning.
  
  http:/ / www.thisisnottingham.co.uk

Monday 30th June 2008

Pulse

• Private polyclinic firm sets out plans for 68 health centres. A private firm bidding for the new polyclinics has set out plans for 68 health centres across 30 PCTs. Assura, one of the first companies to be revealed to be queuing up to be at the forefront of the polyclinic drive, revealed that it was already running 15 primary care services via GP partnerships and was planning a total of 68. The firm, whose model is based on forming joint ventures with GPs, revealed it was targeting relationships with "in excess of 30 PCTs by 2013". It said it had already formed 15 GPCos covering a population of 1.8m, and said it could potentially serve 3.5 million patients. The figures are published in the company's operational report for the 15 month period leading up to 31 March 2008. GPs wishing to partner the firm can sign up to Limited Liability partnerships, with shares on any profits split 50/ 50. A report summary said the group had made "Significant progress during the last 15 months in the transformation of the Group from a medical property investor and developer to a property-backed operator of pharmacy and medical services". Richard Burrell, chief executive officer of Assura, said: "The NHS is committed to improving choice and providing better medical services to patients and it is clear that open competition and a free market around the provision of health care services will have a vital role to play, irrespective of which political party is in power. Assura's integrated business model, working with GPs to provide local, high quality, out-patient, diagnostic and pharmacy services, is ideally positioned for this very significant opportunity. We look forward with optimism to the continuing roll-out of our services in the UK health care market."
  
  http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4119844& c=2

Exeter Express and Echo

• Patients demand rules changes over Bandages. Patients who have struggled to pay for specialist bandages after surgery are calling for changes to prescription rules. The problem first came to light after Stephen Morrison was asked to pay £7.10 for specialized dressings after surgery for pilonidal sinus, and ingrowing hair that turns into an abscess. The labourer had to take time off work and those on sick pay are not exempt from charges. After telling his GP surgery he was unable to afford the prescription he was told to put it on a credit card. Now other patients have come forward to reveal their problems in affording prescriptions while on sick pay. Martin Milton, 40, had six operations and was off work for 20 weeks when he suffered from pilonidal sinus. He was forced to pay for the weekly prescriptions for specialised dressings that needed to be changed every day. "The surgeon said I would only be off work for a couple of weeks and 20 weeks later I eventually got back to work," the 40-year-old from Exwick said. You go in for an operation expecting to be looked after and treated afterwards. It's not your fault your body has reacted to a certain problem and it's wrong to get lumbered with a massive bill when you have surgery to cure it. If you're paying your National Insurance, why should you have to get these things on prescription ?" Mr Milton, a bus driver for Stagecoach, had his surgery two years ago and said he paid around £120 in prescription charges. It was only towards the end of his care that he was informed about the prescription repayment certificate, which is cheaper for those taking out more than four prescriptions a month for six-months. Stephanie Patrick, 20, from St Leonard's, had the same complaint in September and, after surgery, had to go to the NHS walk-in centre in Sidwell Street every day to have her dressings changed. She said: "I went through it thinking it was the norm but I had to get to Sidwell Street every day and moving was agonising. Then I found a friend who said he had the same problem and had a district nurse visiting him and bringing the dressings with her. I think we should all get the same treatment." A spokesperson for Devon Primary Care Trust said: "Once a patient has had an operation and moved from a secondary care provider (hospital) into a primary care provider (GP surgery), all medication and dressings they require are available on prescription only. This is in line with national NHS guidelines, which state that all prescriptions have to be paid for by the patient unless they are exempt from prescription charges." A spokeswoman from the Department of Health said: "The extensive exemption arrangements we have in place mean that, in England, 88 per cent of prescription items are dispensed free of charge. Anyone may obtain all the prescriptions they need if they buy a prescription prepayment certificate, which works out at less than £2 per week." A BMA spokesman said: "The BMA is concerned that the current system for prescription charges is inequitable. We now have a situation where patients in some of the devolved nations will get their medicines free while others will not. Doctors fear that the ever rising prescription charges are resulting in some patients not taking the drugs they need and the BMA wants the Government to review the prescription charges system to remove inequalities."
  
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Southern Daily Echo

• City hospital on 'red alert' most of the year. Southampton General Hospital has been on "red alert" most of this year because of lack of beds and staff. New figures show that in the early months of 2008 additional beds had to be opened to cope with patient demand on 72 out of 121 days. On five of these days the hospital was put on black alert meaning that even the additional beds were full and in some cases patients could not be transferred from the emergency ward. Bosses say the situation is not unusual for hospitals of the General's size. Liberal Democrat public health spokeswoman and Romsey MP Sandra Gidley, who obtained the figures, said: "These figures show how ill-equipped Southampton would be to cope with a major incident or an outbreak of flu. This is an appalling state of affairs which must end. The people of Southampton deserve a good quality of healthcare that they can rely upon, not a health service living on the edge. Local NHS staff must be concerned that, rather than being the exception, a red alert is fast becoming the norm." Trust medical director William Roche said: "It is not unusual for a large emergency centre like ours to be on red alert because the flow of patients is unpredictable. Being on red alert simply means we closely monitor our bed situation to make sure all patients who need to be admitted can be. Occasionally, the number of patients arriving causes us to trigger a black alert and in that case we take a series of steps to reduce demand in collaboration with other health organisations."
  
  http:/ / www.dailyecho.co.uk/ display.var.2370064.0.city_ hospital_ on_ red_ alert_ most_ of_ the_ year.php

The Daily Telegraph

• Darzi review - Key points. Some of the major proposals likely to be included in Lord Darzi's report: " Polyclinics open from 8am-8pm with several doctors and nurses will replace GP surgeries
  " Hospitals should publish death rates for dozens of conditions.
  " Hospitals to offer more home births for mothers.
  " Old and terminally-ill to get the right to chose to die at home instead of in hospital.
  " Primary care trusts to prescribe drugs not yet been approved by the National Institute for Clinical Excellence.
  " Nurses will be set free to set up not-for-profit companies that supply NHS trusts with specialist services.
  " Greater scope for private health care firms to supply primary care services.
  " New NHS constitution will enshrine rights to confidentiality, control of patient records and a second opinion.
  " Patients with life-long conditions such as diabetes to control their own treatment budgets
  
  http:/ / www.telegraph.co.uk/ news/ newstopics/ politics/ health/ 2218294/ Darzi- review- - - Key- points.html

THe Guardian

• NHS is being seriously wounded by privatization. Dr Lailash Chand writes in the Guardian:
  
  The National Health Service is about to celebrate its 60th birthday and remains Britain's most cherished public service and one of the fairest systems of healthcare in the world. It started with the opening of the Park Hospital in Manchester on July 5 1948 under the principle that treatment should be "free for all at the point of delivery". It has been described as one of the greatest social achievements of the 20th century with its promise to care for the British people from cradle to grave. Why then is our efficient, effective and hugely beneficial NHS being dismantled and privatised ? And by a political party that once denounced the private finance initiative (PFI) as "creeping privatisation" and the internal market as a cancer eating away at the NHS. Alan Milburn, when he was health secretary in 1999, marked the start of the transition from the public sector to the private sector under the disguise of choice and competition. By 2004, the private sector had metastasised to virtually every organ of the NHS. The agenda of privatisation continues unabated with Lord Ara Darzi's polyclinic plans. There are success stories, not least the way NHS staff have worked hard to bring waiting lists down to the lowest level on record. The maximum wait on the in-patient list is down from 18 months to six months. By the end of 2008, ministers have promised every patient will be treated within 18 weeks of the GP referral. Yet the very fabric, ethos and future of the NHS are in jeopardy from relentless political assault. The government is implementing plans the Conservatives would scarcely have dared to suggest. The professionalism of doctors is undermined by ideological reforms, built on commercialism, competition, patronage and fear for survival, compounded by orchestrated adverse media publicity. And the huge increase in NHS spending has largely missed its intended target - the health of the nation - because of malignant control freakery over clinically irrelevant targets, grotesque waste on an unstoppable proliferating quangocracy, a manic dependence on organisational restructuring as a surrogate for clear thinking on public health priorities, a wide-eyed obsession with IT and management consultants, profligate waste on a "choice" agenda that few patients want or need, and a pathological dread of trusting clinicians. Can it survive as it is ? To many people, it is clear that the NHS is being taken over by big business and private healthcare teams, so money that could go towards clinical care is diverted to corporations and their shareholders. As Allyson Pollock has pointed out in her book, NHS plc, huge amounts are paid to large private firms for advice about PFI and independent sector treatment centres (ISTCs). Profits made by consortia involved in PFI are swollen by the scandalous practice of refinancing buildings, while cash-strapped hospitals must pay the mortgage for 30 years. The NHS's founding principles and values have stood the test of time. We must continue to fight for those ideals - for comprehensiveness, universality, access based on need not on ability to pay, for a service that is free at the point of use, for mutuality in which the public accepts that priority should be given to those in most need. What is required, even at this late stage, is to abolish the purchase-provider split and reintegrate health services. This will save on transaction costs, marketing, billing and invoicing but it will also ensure patients are not treated as commodities, forced to shop around for care. A GP friend who makes time to visit the spouses and families of deceased patients because of the risk of suicide in the first six months does not see these visits awarded Quality and Outcomes Framework points nor are they given bonus payments. But they are part and parcel of what good GP care was: holistic, family based and continuous. We should get rid of foundation trust status and the independent monitor. This will allow reintegration of the health service and bring it back into direct parliamentary accountability and stop the culture of secrecy, corporatism, bullying and commercial confidentiality that surrounds every transaction. There is a need to end the "money follows patients" system of resourcing and bring back needs-based planning for geographic populations. The NHS should terminate commercial contracting for NHS services and abandon proposals to offer GP services to commercial companies. We must analyse the weaknesses of the NHS and work for improvements such as the benefits of NHS-salaried GP services in health centres. We should restore long-term care and mental health services to the NHS and bring for-profit care homes under NHS control. We should end means testing and cost shunting of services, while public accountability must be strengthened and renewed. We should restore the principle of fairness through national terms and conditions of service for doctors and all NHS staff. Above all, we must allow professional standards to thrive since these are the basis of public and patient trust. Doctors in the UK, unlike the US, are highly trusted because there are no commercial conflicts - doctors do not find operations for patients that are not needed or deny care because the financial risks are too great. In its 60th anniversary year, what the NHS needs is reintegration not fragmentation Providers of NHS services must be public, not for-profit, bodies and the same applies to training. As Allyson said: "What is required now is not reform but revolution - a quiet, collective and reflective revolution of the sort that brought the NHS into being in the first place."
  
  http:/ / www.guardian.co.uk/ society/ 2008/ jun/ 30/ nhs60.nhs

The Guardian

• New NHS plan to emphasise quality of care. The income of hospitals and GPs will depend on how much they improve their patients' health, under the 10-year plan for the NHS in England to be unveiled by Lord Darzi. NHS trusts will be paid according to the outcome of treatment, using a new set of indicators ranging from surgeons' death rates to surveys of how well patients feel after treatment. Patient's views on quality and compassion shown will be considered as important as medical outcomes. Darzi intends to make teams of doctors and GPs compete with rivals in other NHS establishments. To establish a more thrusting marketplace, he wants patients to be given enough information to be able to choose the nearest hospital demonstrating superior medical results. In a foreword to the review, Gordon Brown will say: "If the challenge 10 years ago was capacity, the challenge today is to drive improvements in the quality of care. We need a more personalised NHS, responsive to each of us as individuals." Patient choice will be enshrined in an NHS constitution to be announced by Brown and Alan Johnson, the health secretary. The constitution is expected to assert patients' rights to dignity, privacy, confidentiality and the opportunity to get a second opinion from another doctor. In an interview, Johnson said it would also enshrine a right to approved treatments if clinically appropriate for individual patients. He said the government intended to end the so-called "postcode lottery", which has allowed NHS commissioners in some areas to refuse to fund drugs that are freely prescribed elsewhere. He also promised to speed up decisions by NICE on whether drugs are cost-effective and the body will no longer wait until a drug has been licensed as safe before starting its assessments. Johnson said: "What we have heard from patients is that one of their major concerns is the perceived 'postcode lottery' in access to drugs - that there are too many variations around who gets access to prescribed drugs and that these variations are a lottery depending on where you live. The draft constitution will address this by making it explicit that patients have the right to Nice-approved drugs if clinically appropriate." The Department of Health said the constitution would be the first of its kind in the world and would state "what patients, public and staff are entitled to expect from the NHS and what they can do if their needs are not met". The report will also support health authorities that want to move services out of hospital into polyclinics or super-surgeries, but it will not require this. Johnson said that polyclinics were being introduced in London because of special conditions. He said that 54% of GP surgeries in the Capital were "single-handed or double handed", compared to 40% in the rest of the country. Johnson said the government was also providing, in every part of the country, GP-led health centres open 8am to 8pm for 365 days a year. He said he wanted to correct three misconceptions about these health centres. They would each have about 5 GPs in them, not 25, as some people have claimed; patients would not have to register - they would just be able to "drop in"; and most of them would probably be run by GP consortiums, not private health care providers. Shadow health secretary Andrew Lansley said the plans to end the postcode lottery would not end the NHS's "scandalously" slow uptake of new drugs. Liberal Democrat health spokesman Norma Lamb said the plan to speed up Nice decisions "looks like another Labour placebo for the NHS ... There are many drugs which have never been approved by Nice. It appears that for these drugs the postcode lottery will remain."
  
  http:/ / www.guardian.co.uk/ politics/ 2008/ jun/ 30/ health.alanjohnson ?gusrc=rss& feed=networkfront

Sunday 29th June 2008

The Mail on Sunday

• NHS locum firm 'fixed charges 15% higher than rivals'. The government is investigating allegations that recruitment companies colluded to charge the NHS 15 per cent above market rate for temporary medical staff. Three leading agencies are being probed by the Purchasing and Aupply Agency (PASA), the NHS body which oversees private contracts. The inquiry will examine whether there is any substance to claims made in an anonymous letter that the companies formed a cartel to charge hospitals more than their competitors. The letter suggests that one agency alone would have been unable to raise its rates so significantly. The letter alleges that the firms decided to fix the rates for specialist anaesthetists, paediatricians and psychiatrists, forcing hospitals to pay more for their services. The agencies have vigorously denied the allegations. The letter was sent to all 55 medical recruitment companies on an approved Government supplier list known as the 2008-2011 National Framework Agreement. It says: "It is abundantly clear that the companies would not risk submitting these rates in isolation as NHS Trusts would not use them. Every previous Agreement has shown that these three suppliers have erred on the side of caution, aware that it would be impossible to submit significantly higher rates. But with an agreement between all three suppliers, the door has been opened for them to control the medical locum market at extraordinary margins. More worrying is that the taxpayer will lose out on over £100,000,000 for every year of the Agreement due to this artificial increase." Inclusion in the agreement is lucrative because it is the first place managers look for staff. The new Agreement, which lasts until 2011, comes into force on Tuesday and all agencies have had their bids and charges approved by PASA. Most have stayed within the NHS target rates to ensure they appear on the list. However confidential documents show the three companies under investigation are charging rates significantly higher than the PASA targets. While many rival agencies are charging an average of £70 an hour for specialists - the basic PASA target - the three companies involved in the probe have prices set around the £85 an hour. PASA said it is taking the investigation and the allegations "very, very seriously" and that "if any substance to the allegations is found we will pursue this with all our power, including engaging the Serious Fraud Office or the police." Representatives for the companies said: "Following an investigation into the matter, we are of the view that there is no basis for the allegations made in the letter, which we note is anonymous and advances no evidence to support its unfounded allegations."
  
  http:/ / www.dailymail.co.uk/ news/ article- 1030200/ NHS- locum- firms- fixed- charges- 15- higher- rivals.html

Friday 27th June 2008

Wimbledon Guardian

• Health report recommends demolition for Bolingbroke. Wandsworth's Primary Care Trust has recommended that Bolingbroke Hospital be demolished as part of its presentation to the health board on its preferred option for the future of healthcare in North Wandsworth. The presentation followed a consultation in which 80% of respondents said the Bolingbroke should be refurbished and used for future treatment. In a draft report making the case for the closure, the PCT said it would build a new centre in Grant Road, next to Clapham Junction. The report said: "It should be noted that the development is likely to lead to the demolition of the Bolingbroke Hospital, which will resurrect strong feelings amongst the Bolingbroke supporters and some local residents." As well as refurbishing the Bridge Lane Health Centre, the report suggests not redeveloping the Bolingbroke site, which is owned by St George's Hospital Trust, until at least 2015. Peter Dawson, Northcote Ward councillor, said: "I am very disappointed the PCT's proposals fail to deliver on the need for two primary care facilities, one at the Bolingbroke and one in north Battersea. The PCT board report seems to confirm the ongoing determination of local health trusts to transfer permanently all services from the Bolingbroke, demolish the building and sell the site to developers. This flies in the face of the wishes of local people. Almost 80 per cent in the PCT's own consultation backed the Bolingbroke as their preferred location for a new primary care centre."
  
  http:/ / www.wimbledonguardian.co.uk/ news/ wandsworthnews/ display.var.2367672.0.health_ report_ recommends_ demolition_ for_ bolingbroke.php

Basingstoke Gazette

• MP hits out over plans for super-surgery. MP Maria Miller has hit out in Parliament over plans for a "polyclinic" in Basingstoke, saying it will be developed at the expense of local surgeries. In a House of Commons debate, she told health secretary Alan Johnson: "The proposal put forward by the Hampshire PCT to locate a polyclinic - or whatever he wants to call it - in my constituency talks about building "capacity to absorb a growing population. That sounds to me as if the polyclinic is replacing the need to build new surgeries as new houses are built." Mr Johnson replied: "It sounds to me that building capacity to absorb a growing population is absolutely right because this new service will deal with greater capacity - so well done Hampshire." But speaking afterwards, Mrs Miller said: "The priority in Basingstoke should be to make sure the doctors' surgeries are serving families and the elderly to the highest level." A group of local doctors have produced their own bid to run the surgery under the name North Hampshire Alliance as they feel they can run the clinic better than a private provider.
  
  http:/ / www.basingstokegazette.co.uk/ news/ newsheadlines/ display.var.2365938.0.mp_ hits_ out_ over_ plans_ for_ a_ supersurgery.php

The Evening Standard

• The Evening Standard Ruth Carnall, head of NHS London, has declared war on single-handed GP practices, saying there was no future for doctors who run crappy end-of-terrace" practices. In an interview with the Evening Standard, Ms Carnall said: "We're not forcing GPs to leave. But can singlehanded practice provide the range of modern primary care and other services ? The answer is 'No.' What isn't possible is the single-handed GP operating out of his front room with a family friend or wife doing reception and no visible practice nurse. The ones which are going to close are the ones in crappy end-of-terrace houses where you can't park, get up the stairs or get a pram through the front door. Many premises are wholly indequate. Why would we want to invest in those ?" Her remarks have provoked outrage from the British Medical Association. Laurence Buckman, chairman of the BMA's GP committee, said: "As London's health chief you have to be careful if you use words like 'crappy'. These practices are popular with all races and religions because they provide continuity which larger practices don't. But London PCTs have starved them of funds. You don't judge a practice by the its building but by patient satisfaction." The BMA is opposing the Darzi proposals on super-surgeries. However it has been revealed that the first plans for such surgeries in London have been given the go ahead in Redbridge and at University College Hospital. Ms Carnall said: "The plans are not perfect and there are controversial aspects. But polyclinics were developed in London for London by people in London."
  
  http:/ / www.thisislondon.co.uk/ standard/ article- 23501399- details/ NHS+boss+signals+death+of+'crappy'+GP+practices/ article.do

The Independent

• Nurses clinics to compete with GPs' surgeries. Nurses are to run their own "companies" within the NHS to compete with traditional surgeries and provide more services. Lord Darzi's report on Monday will propose that nurses create new organisations offering physiotherapy, health checks and immunisation programmes. They will be encouraged to be more entrepreneurial, to run their own social enterprises for the NHS and they could even employ doctors. Ministers believe that the competition will shake up family doctors who have become set in their ways. Lord Darzi will announce that the nurses who leave local primary care trusts to run such social enterprises will be able to keep their NHS pensions, an issue which had previously been a sticking point. Staff will be given a "right to request" that a nurse-led organisation be created and primary care trusts which run local health services will be forced to consider the requests. If the PCT agrees it would improve care, a new independent NHS organisation would be established to provide services to patients, under contract to the PCT, using NHS resources.
  
  http:/ / www.independent.co.uk/ life- style/ health- and- wellbeing/ health- news/ nurses- clinics- to- compete- with- gps- surgeries- 855420.html

The Daily Telegraph

• NHS hospital death rates to be published under Lord Darzi plans. Hospitals will have to publish death rates for 50 different conditions under plans to be unveiled by Lord Darzi. This summer, data on survival rates for hip and knee replacements and surgery on the throat and blood vessels in the abdomen will be added to the information already available on heart bypass surgery and the survival rates of specific surgeons. Sir Bruce Keogh, medical director at the Department of Health was instrumental in the first figures going on line and has been co-ordinating plans to extend the scheme. After initial fears that the move would lead surgeons to shun difficult operations, the figures have been adjusted to show the number who would be expected to survive compared to those who did. The plans will be included in the Lord Darzi Next Stage Review of the NHS, to be published on Monday, and has been a massive year-long project by the junior health minister and surgeon.
  
  http:/ / www.telegraph.co.uk/ news/ newstopics/ politics/ health/ 2205371/ NHS- hospital- death- rates- to- be- published- under- Lord- Darzi- plans.html

Thursday 26th June 2008

Scotsman

• Further £2.65m to extend GP surgery hours. Family doctors have been handed an extra £2.65m in the Scottish Government's latest efforts to encourage more to open their surgeries in the evenings and at weekends. GPs have been reluctant to extend hours, with many prepared to lose money rather than provide the extra appointments. Shona Robison, the public health minister, announced that £2.65m would be made available to GP practices to fund nursing cover during the extended hours' period. But doctors' leaders said the move would simply further fuel GPs' anger, with the belief that the extra funding for extended hours was not a good use of scarce resources.
  
  http:/ / news.scotsman.com/ health/ Further- - - 265m- to.4223856.jp

Derbyshire Evening Telegraph

• Nurses' strike is called off. A bitter dispute which saw Derby nurses threaten strike action in a row over their pay has been resolved. Health union Unison has reached an agreement with hospital bosses to end the five-month stand-off. But the financial constraints that caused the wage row still dog Derby Hospitals NHS Trust. The Government asked the trust to make budget savings of 3% - which equated to £55m over three years. In one bid to cut costs, the trust wanted to regrade some surgical nurses, meaning their pay would fall. Unison said yesterday that the trust initially tried to introduce the pay cut plans "like a bull at a gate". Negotiations and threats of strike action from nurses led to the trust agreeing not to reduce wages for up to three years and Unison members have now voted to accept the changes, bringing an official end to the dispute. But finance director Lee Outhwaite says the trust still needs to find £11m of savings and has called for patients and staff to come up with ideas.
  
  http:/ / www.thisisderbyshire.co.uk/ news/ NURSES- STRIKE- CALLED/ article- 198130- detail/ article.html

Yorkshire Post

• Anger as top executives at cash-strapped hospital given pay rises of up to 22%. Bosses running a Yorkshire hospital were awarded pay rises of up to 22% as other staff were hit with below-inflation increases. Unions last night angrily criticised the huge rises handed to executive board members at York Hospitals NHS Foundation Trust. Newly-published figures show former chief executive Jim Easton saw his annual salary rise by 22% to £139,000 in 2007-8. All but one of his board colleagues won increases of 12 or 17%. Hospital chiefs claim the increases were vital to prevent top executives being headhunted amid concerns their pay had fallen significantly behind other organisations. The awards were made last year when the trust was forced to axe nearly 100 beds and shed 200 posts as NHS services in North Yorkshire plunged into financial crisis. They compare with increases of about 1.3% for other NHS managers.
  
  http:/ / www.yorkshirepost.co.uk/ news/ Anger- as- top- executives- at.4224643.jp

Wednesday 25th June 2008

Financial Times

• Private groups to get bigger role in primary healthcare. The private and voluntary sectors will play a bigger role in the provision of community services and primary care, David Nicholson, the National Health Service chief executive, has insisted. The Department of Health has advertised for a chairman and a chief executive for the "co-operation and competition" panel that is to be set up in the autumn. This is the body to which disgruntled providers - whether the independent sector, foundation trusts or GPs - can appeal if they believe a primary care trust has not put new or changed services out to tender fairly. Primary care trusts still run many community and some primary care services themselves. Mr Nicholson said the current policy - that it was up to primary care trusts themselves whether they continued to do so - remained. There were now new providers, he said, both in the independent sector and the private sector, that were interested in supplying community and primary care services. And moves were under way to turn community services into free-standing foundation trusts, and to encourage staff to set up a social enterprises and sell their services back to the NHS. It is widely expected that Lord Darzi's "next stage" review of the NHS will make it easier for staff to leave the service and sell their services back, but remain part of the NHS pension scheme: a key part of remuneration that has proved a barrier to social enterprises getting off the ground. Mr Nicholson had no doubt as time went on that "we will see more services provided by the independent sector as part of this, where they can provide value for money and can do it better. But it is a matter for individual primary care trusts to work it through". With Chan Wheeler, the department's commercial director returning to the US, Peter Coates, the department's private finance initiative specialist, is taking over in an interim role. The commercial directorate, however, will come under the wing of Mark Britnell, the director-general of commissioning, who, Mr Nicholson said, "has really good relationships with the private sector".
  
  http:/ / www.ft.com/ cms/ s/ 0/ e86bad24- 424f- 11dd- a5e8- 0000779fd2ac.html ?nclick_ check=1

Tuesday 24th June 2008

Plymouth Herald

• 'We don't need city polyclinic'. Plans to open a new 'polyclinic' in Plymouth next year have been attacked by a top GP and city councillors. The facility would provide healthcare and social services on one site, seven-days-a-week - but GP Dr Preston de Mendonca accused the Government of privatising the NHS by the back door. City councillors have also voiced their anger at being kept in the dark after Plymouth's Primary Care Trust (PCT) revealed that its plans were already well advanced. Dr de Mendonca, chairman of the Local Medical Committee, said a polyclinic was a waste of public money and would force small GP surgeries to close. He said: "This isn't just privatisation of the health service by the back door; it's saying 'Welcome in, guys, and help yourselves'," he said. Tenders will be invited from the private sector this summer and contracts will be signed in December. The clinic is scheduled to open next year. Dr de Mendonca said. "If you take away the 'Martini' patients - the 'Anytime, any place, anywhere' ones who don't care which doctor they're seen by - you'll destabilise GP practices. We could end up like the post offices. The Government creamed off the easy, high-volume, high- profit parts of the post office business, and post offices found themselves closing."
  
  http:/ / www.thisisplymouth.co.uk/ news/ don- t- need- city- polyclinic/ article- 195977- detail/ article.html

Press Association

• Cameron vows to ditch NHS targets. Labour's internal NHS targets will be ditched and patients simply told which hospitals get the best results, under radical Tory plans. Conservative leader David Cameron is to promise patients information on performance and power over their own care in a bid to save 100,000 lives a year. He will also set out a series of goals so voters could hold a Conservative Government to account over its handling of the health service. The foray on to a decisive political battleground comes on the 60th anniversary of the creation of the NHS. Mr Cameron has been eager to stress his commitment to the service, and neutralise Labour claims that a Tory Government would downgrade it. However, ministers are certain to say the proposals risk undermining the progress they have made in cutting waiting times.
  
  http:/ / ukpress.google.com/ article/ ALeqM5jx- x7vryBR_ tNZAd3MxQq7z3x0EQ

Monday 23rd June 2008

The Daily Telegraph

• Lord Darzi says doctors will not innovate. Lord Darzi, who's far reaching review will be published in a month, has claimed that some doctors are blocking new treatments because they are resistant to innovation. He said that there were "some laggards" in the system who "needed to catch up". He said patients needed to be treated more like customers and should be able to rate their treatment as they would a meal. However, he was quickly rebuked by medical professionals, who suggested that "meddling politicians" and "pointless targets" which had actually stifled innovation. Lord Darzi, who continues to work as a surgeon, said: "In all areas of healthcare you have innovators, people who really want to change things for the better, and you also have, in other areas of the healthcare system, people who are lagging behind and need to catch up. They will eventually catch up once they know that, if you start thinking about what really matters to patients, how you can improve the care you provide, you get over all these different obstacles." He added: "Have patients been treated as customers ? When you go to a restaurant you look at a website and find out exactly what people said about that restaurant. In future, I want to show which hospitals, doctors and nurses are actually bringing innovation into their healthcare." Lord Darzi has recently attracted criticism for his support of "super surgeries". However his comments were backed by Sir Liam Donaldson, the chief medical officer, who claimed surgeons had resisted changes which would make operations safer. He said: "I think it is a new idea for some traditional people holding traditional attitudes in medicine and I think we need to break those down and get people thinking and learning from other industries."Dr Jonathan Fielden, chairman of the consultants' committee for the British Medical Association, countered the claims. He said: "There's been far too much structural change and meddling by politicians looking for a soundbite to allow innovation to develop. If doctors were allowed to let their best practice flourish, rather than being left to struggle to meet pointless targets, better ways of doing things would evolve." He said it was "rubbish" that doctors and nurses were not able to learn from other industries, citing Great Ormand Streets success in learning from Formula 1 to improve relative positions of staff during surgery. A spokeswoman for the Patients' Association said: "If doctors are resistant to change, we would be concerned because they might be putting patients' lives at risk."
  
  http:/ / www.telegraph.co.uk/ news/ newstopics/ politics/ health/ 2176055/ NHS- Lord- Darzai- says- doctors- will- not- innovate.html

The Financial Times

• Study sees greater role for private providers. All developed countries will be forced to define core health services and allow some treatments to be paid for by patients or private health insurance, according to a study by consultants AT Kearney. The study comes after Alan Johnson announced a review of whether patients should be able to make "top-up" payments for cancer drugs. The stresses of technology, ageing populations and rising expectations will hit all countries, however their healthcare system is organised or funded, according to Jonathan Anscombe, AT Kearney's head of health practice. These pressures will create "a perfect storm" that will test the limits of collective funding mechanisms, he added. Mr Anscombe also said that pharmaceutical companies' focus on "end of life" cancer treatments would also be threatened as governments become increasingly reluctant to fund them even when they are effective. Tax and social insurance funding will have to concentrate on "core" services and those in charge of funding will increasingly have to define how care will be provided. And "a plethora of private, insurance-based services will focus on faster access and expensive, marginally cost-effective, and lifestyle therapies". Countries may not want this change, Mr Anscombe argued, but it is inevitable. "It is hard to see how this can be achieved without making care more unequal," he said. He also predicted that pharmaceutical and technology companies will face stricter evaluations of their products.
  
  http:/ / www.ft.com/ cms/ s/ 0/ 92b2957e- 40a0- 11dd- bd48- 0000779fd2ac.html

The Guardian

• The NHS has stayed true to the principles of 1948. An opinion piece by Ian Gilmore, President of the Royal College of Physicians, reads:
  
  The NHS is in our blood. Even those rich enough to have shunned the NHS in preference for private treatment will have accessed free care when they have needed help most - in an emergency. This is when comfort-wrapped private care is paradoxically least available. The NHS is certainly in my blood, having lived through each of its 60 years and worked in it for 37, and I feel privileged to have been part of the most coveted example of socialised healthcare. But is the NHS the same as in 1948 ? The answer is no - it has got a lot better. While there has been some nibbling erosion of free healthcare, for example dentistry, both the manner and range of delivery have been transformed. As those who remember pre-war days dwindle, treatment is no longer seen as charity but as a right earned through citizenship and taxation, and this has quite appropriately fuelled expectations of better access and shorter waits. However, the core values in the doctor-patient consultation, unsullied by a financial transaction and based on clinical need, remain. Indeed perhaps the most surprising feature of the NHS is how little these values have changed in spite of continuous reorganisations and perturbations. Administrative tiers come and go, political parties change, yet the care on the wards and in the clinics seems little affected. This has been undoubtedly a frustration for health ministers as the monolithic NHS has seemed unresponsive to the latest initiative. But most new treatments have been adopted, most new drugs utilised, even if a little behind neighbouring countries, and the doctors, nurses and managers have continued to do their best for mainly satisfied patients. There are still some arrogant doctors, occasionally brusque nurses, sometimes dirty floors and inefficiencies in the system. But the results would have been a lot worse without a degree of inertia in the face of political short-termism. I am not arguing for complacency. Indeed medical royal colleges such as my own are at the forefront in developing medical professionalism and leadership. Increasing funding leading to a fall in waiting times, modern buildings and more clinical staff have been appreciated. But now we need to focus on quality not numbers, outcomes not processes, the patient experience and not staff convenience. We need to make sure that the drive for competition through private providers of care and the use of private funding to build new hospitals does not mortgage the future and erode those founding principles of 1948.
  
  http:/ / www.guardian.co.uk/ commentisfree/ 2008/ jun/ 23/ nhs.welfare

Friday 20th June 2008

Hexham Courant

• New threat to GP surgeries. Doctor's surgeries in Tynedale are under threat from the Pharmacy White Paper just months after swinging cuts were proposed in negotiations with Northumberland Care Trust. The paper, currently out to consultation, proposes that all doctor's dispensaries within one mile of a pharmacy should be deemed unnecessary and closed. But the NHS income these dispensaries draw in is vital to surgeries, doctors have warned. "Dispensaries contribute between 10 and 20 per cent to a practice's income - and more in the most rural areas," said Corbridge GP Roger Dykins. "If all the dispensaries across Northumberland affected by these changes closed it would take between £1.2 million and £1.5 million out of the primary care system."The dispensary at Corbridge pays for one full-time and one part-time doctor. Haydon Bridge's dispensary pays the wages of one doctor, said GP Steven Ford. "This will be disastrous if it goes through - many rural practices are only really kept going by their dispensaries," he said. "We could soon be looking at villages with a pharmacy, but no doctors. We are being squeezed with the PMS contracts and with the dispensaries - basically, small practices will eventually close." A spokesperson for the Department of Health said it had to be recognised that primary care extended further than the family doctor. "There is an important role to play for community nurses and health visitors, for mental health teams, for pharmacies - and for voluntary organisations," she said."The Pharmacy White Paper sets out measures to enhance the role of pharmacy in providing a wide range of local health services." Health minister Ben Bradshaw said: "These proposals are not about pharmacists taking over the work of GPs - it's about complementing them, taking pressure off GPs and enabling them to spend more time with those patients who really need it."
  
  http:/ / www.hexham- courant.co.uk/ news/ news_ at_ a_ glance/ 1.126705

BBC Online

• Charity props up NHS cancer care. The NHS is heavily reliant on charitable donations to fund treatment and support for children and teenagers with cancer, according to research by a team of health economists. Up to half the funding for specialist cancer services in England and Wales comes from charities. Study author, Dr Dyfrig Hughes, said the charity figures could be an underestimate, as they did not include the many hospital and local charities which also provide funding. "The take-home message is that it is a significant contribution towards work which arguably should be paid for by the NHS. "People tend to give money to things which play on the heart strings and cancer is an area which attracts a huge amount of charity but there are other diseases that do not get the same donations." He said the reliance on charitable funding may skew NHS priorities and means services are available in some areas but not others. "For things which might be labelled as luxury that's fine, but essential things should come from central resources to ensure equal access." Dr James Nicholson, consultant paediatric oncologist at Addenbrookes Hospital in Cambridge, said he was not surprised by the figures as some consultant and many hospital and nurse positions around the country were charity posts. He said: "The absolute basic care around the country probably doesn't vary but the experience for the child and their family varies widely and I worry about how long it will be before that encroaches on treatment of children."
  
  http:/ / news.bbc.co.uk/ 1/ hi/ health/ 7424169.stm

The Guardian

• The problem with payments. An editorial leader in the Guardian reads:
  
  The proper emotional response to tales about cancer is sympathy, pure and simple. A growing band of commentators has coalesced on the view that the proper policy response to ultra-expensive treatments is equally straightforward: namely scrapping the rule under which patients can have NHS treatments withdrawn if they pay privately for extra medicines the service refuses to fund. The rule has been dubbed a Maoist affront to common sense, a utopian dogma that would rather see patients dead than give them treatment that not everyone can have. On Tuesday ministers bowed to the pressure and signalled a review. The reality, however, is that there is nothing straightforward about allocating life-extending drugs: the ethical complexities are great. It is indeed profoundly cruel when - as in half a dozen well-publicised cases - patients spend their savings in a desperate bid to buy a little more life, only to find that the NHS starts billing them for their original treatments. But there would be cruelty too if the rules were changed so NHS doctors had to give different treatments to two patients - in neighbouring beds, with identical prognoses - depending on which each could afford. One set of horror stories about treatment being denied would soon be replaced by another. Proponents of change insist it would add to, not substitute for, NHS spending. But the option of free basic treatment with paid-for top-ups would lure into the health service some who now go fully private. With a fixed budget covering more of those prepared to pay, there would be less left over for those who simply cannot. There are practical considerations too, such as the dilution of the NHS's considerable power as a near-monopoly buyer of drugs. The current arrangements have terrible flaws, but reform risks equally serious problems. Still, there is a powerful case for re-examining rules set in 1986. Since then the internet has made it possible for patients to buy drugs without the involvement of their doctor. The list of drugs rejected by the rationing body, the National Institute for Health and Clinical Excellence, on cost grounds is short but growing. As it grows, so will pressure to allow top-up purchases. Most decisively, the regulations are applied inconsistently. It is better for ministers to clarify these than allow judges to force their hand. Whatever the outcome, the government must continually work to push the boundaries of what can be publicly provided, by raising spending and containing costs. The core purpose of the health service is providing universal insurance against catastrophic medical risk. Charging patients for life-prolonging treatments will never fit comfortably with that.
  
  http:/ / www.guardian.co.uk/ commentisfree/ 2008/ jun/ 20/ nhs.health1

Essex Echo

• Private firm will run uni's GP clinic. The new GP surgery at the University of Essex's Southend site will be run by private firm ChilversMcCrea Health-care after it offered longer opening hours than its competitors. Primary care trust spokesman Paul Ilett said that both the new surgery and one already run by the company offered flexible opening hours. He added: "Chilvers-McCrea Healthcare will also run the new campus surgery. Patients registered with the practice will be able to use either site. The campus surgery will also be used as a training site for GPs, hopefully attracting new doctors to the area. We are still working to agree the lease for the campus site, but hope to conclude negotiations shortly." The company took over management of its first NHS GP practice, in Harlow, in 2002 and by October 2007, was running more than 30 such practices. It currently employs about 300 people.
  
  http:/ / www.echo- news.co.uk/ news/ southendnews/ display.var.2353072.0.private_ firm_ will_ run_ unis_ gp_ clinic.php

Thursday 19th June 2008

Wharfdale and Airdale Observer

• MP calls for inquiry into Wharfdale Hospital Privatisation plans. An inquiry into the proposed privatisation of part of Wharfedale Hospital has been demanded by Otley's MP. A leaked staff briefing note recently revealed plans for the running of the minor injuries to be transferred from Leeds Teaching Hospitals NHS Trust (LTHT) to a private firm. Leeds North West MP Greg Mulholland, who passed on the document, has now written to Leeds PCT expressing his "deep concerns" and asked Leeds City Council's health scrutiny board to examine the proposal. Mr Mulholland's letter to the PCT says: "I was very surprised to hear about these plans and I am very concerned about the impact this could have on services at Wharfedale Hospital, and also what this means in terms of the future of the hospital as a core NHS facility. The minor injuries service is important and well run, and is one which is one of the few services at the hospital local people are all aware they can access. The service works very well, with excellent staff, and patients are satisfied. In which case, the first question is why on earth propose major changes to a service that is working very well ? I am also very concerned that in reality this represents a significant downgrading of the minor injuries unit. All three companies who are interested in bidding for the unit tender have very minimal Accident and Emergency provision in the service they provide, which will surely diminish services available at the Wharfedale. Finally, if any patient has to start from scratch' when they are referred to an A and E, surely that will mean that if they have any doubt at all about the severity of their injury they would bypass the Wharfedale entirely ? In other words, people will simply lose faith in the unit and will go to Harrogate or Leeds A & E instead, and the so-called minor injuries unit will then be dealing with matters that are clearly just out of hours GP matters. I also must ask you to explain how this can fit into your commitment to Wharfedale Hospital as an important and valued part of the hospital provision in Leeds. Privatising an important, well used and well understood service flies in the face of claims you want more core NHS services delivered from Wharfedale. Leeds NHS Primary Care Trust Chief Executive Christine Outram, in a letter to the press, said: "I would like to reassure people that Leeds Primary Care Trust (PCT) has no intention of downgrading the minor injuries unit at Wharfedale Hospital. Indeed it is quite the reverse, as we are planning to make significant improvements for people who need healthcare urgently by extending the range of services, increasing the opening hours and extending the current GP out of hours services based at the unit. As a result of what people told us, we want to improve the care provided to patients by bringing all urgent care services together, provided by one organisation and with one central phone number for patients to ring. The service will work with Leeds Teaching Hospital Trust (LTHT) to ensure that the minor injuries unit continues to be based there and that there is a permanent base for a GP out-of-hours service. Local NHS organisations, GPs, GP consortia, social enterprises and independent sector organisations are all able to bid to deliver NHS funded services for local people. We are currently in discussion with three independent sector organisations about taking our proposals forward and plan to make a final decision about who will be awarded the contract later this year. The NHS has always funded services provided by independent contractors, such as GPs, and will continue to do so."
  
  http:/ / www.wharfedaleobserver.co.uk/ news/ newsroundup/ display.var.2351733.0.mp_ calls_ for_ inquiry_ into_ wharfedale_ hospital_ privatisation_ plans.php

St Albans and Harpenden Review

• GP surgeries at risk. Eight GP surgeries in Welwyn Hatfield are facing the threat of closure, according to the Conservatives. The Tories have released a list of surgeries endangered by the plans to build "super-surgeries". Hertfordshire Primary Care Trust says no GP surgeries are at risk. But the Tories have named eight practices in Welwyn Hatfield that it says are. None have been identified in the St Albans district. Practices named in Hatfield are: Wrafton House, Lister House Surgery, Burvill House and Potterells Medical Centre. Doctor surgeries facing the chop in Welwyn Garden City are: Peartree Surgery, Garden City Practice and Hall Grove Surgery. Bridge Cottage Surgery in Welwyn has also been named. The total number of patients registered at these surgeries is 108,378. Welwyn Hatfield MP Grant Shapps, who has previously lobbied against polyclinics', said: "This is outrageous. The Government was not concerned about closing down the emergency services at the QEII and now it is planning on closing our GP surgeries and our Post Offices." However Hertfordshire Primary Care Trusts spokeswoman Rose Child says the opening of a super surgery will not lead to closures elsewhere. "The new GP led health centre in Welwyn Garden City will not lead to the closure of any GP surgeries," she said. "The family doctor is at the core of delivering quality health care for Hertfordshire - our vision for the future of the NHS in Hertfordshire. Making it easier for more people to access these services and moving care away from hospitals to an NHS that delivers services people want and need as close to home as possible. GP led health centres will not lead to reduced funding to our current GPs, we will not corral GPs into new centres, and if GPs are providing the services and access their patients want there is absolutely no reason why patients should choose to move their registration. We do not apologise for increasing funding for primary care and making access to that primary care for all a priority in our vision."
  
  http:/ / www.stalbansobserver.co.uk/ news/ localnews/ display.var.2350158.0.gp_ surgeries_ at_ risk.php

The Evening Times

• Union: nurse shortage putting "lives at risk". Unison has warned that patients and workers at Glasgow hospitals are being put in danger as nurses and midwives struggle with a shortage of 500 workers. Matt McLaughlin, the union's regional organiser, said: "Staff should not be put under this kind of stress as they work to provide care. It is clear we do not have enough nurses and midwives on the wards. We need 500 more staff to provide the level of care people are entitled to." Staff at Princess Royal Maternity Hospital say babies are routinely being looked after by staff trained to work with adults. There are also fears that nurses caring for elderly patients lack the manpower to handle those with complex problems and a pioneering coronary heart unit in Stobhill is so short-staffed that nurses have been told they cannot have a summer holiday. Yet union representatives believe the health board's acute division, which runs hospitals, is sitting on an unspent £3.5million that could fund extra staff. Nurse Cathy Miller, who leads the union's Glasgow health branch, raised the issue in a letter to Tom Divers, chief executive of NHS Greater Glasgow and Clyde. She said she feared the board was failing in its duty of care to patients and staff by refusing to recruit sufficient staff. Mr McLaughlin said all 7000 members working with the health board were now being asked to complete a survey giving details of problems across the city as well as in Paisley, Inverclyde and West Dunbartonshire. He said: "We have anecdotal evidence of severe problems at a number of locations and are asking staff to tell us about conditions. We need to know if this is a general trend because the signs are there are similar problems across the board. We need safe staffing levels in all our hospitals." A health board spokeswoman said: "A letter from a senior Unison steward has been received. We are disappointed we have not been allowed to respond to this in accordance with our normal partnership working arrangements. However, the financial information in the letter is broadly correct. The allegations on staffing levels affecting patient care are being looked at and we will respond to the letter as soon possible."
  
  http:/ / www.eveningtimes.co.uk/ news/ display.var.2351156.0.union_ nurse_ shortage_ putting_ lives_ at_ risk.php

Wednesday 18th June 2008

Politics.co.uk

• NHS Direct joins forces with Pfizer Health Solutions and Humana Europe. A Press Release from NHS Direct reads:
  
  NHS Direct has joined forces with Pfizer Health Solutions and Humana Europe in a bid to strengthen its position as a provider of telephone-based care management. Ronnette Lucraft, Commercial Director, said: "Pfizer Health Solutions and Humana have complementary and world class skills which will enable us to forge a powerful partnership. This will allow us to reach out into the community, helping and encouraging people to follow personalised health plans, learn how to manage their own condition and ultimately enjoy a better, healthier, quality of life. Moving care closer to home and encouraging self care are absolutely central imperatives for the 21st century NHS."
  NHS Direct and Pfizer Health Solutions - together with Birmingham East and North Primary Care Trust- have been working in partnership since 2006 delivering Birmingham OwnHealth - the UK's first large-scale telephone-based care management programme. John Procter, Head of Pfizer Health Solutions in the UK, said: "Today's announcement takes the NHS Direct and Pfizer Health Solutions partnership to a whole new level. Working together, we can build upon our joint expertise in successfully delivering Birmingham OwnHealth, to benefit many more people with long term conditions, as well as the wider NHS. The complementary skills and experience of all three organisations create a partnership ready to deliver leading-edge NHS services and care." Welcoming the partnership, Humana Chief Executive Dr Jonathan Lord said: "This is a unique opportunity to bring together the different expertise we have as organisations to configure a service that can meet the different needs of patients across the NHS in a personalised way and can help them achieve happier, longer and healthier lives."
  
  http:/ / www.politics.co.uk/ opinion- formers/ press- releases/ opinion- former- index/ business- and- industry/ nhs- direct- joins- forces- with- pfizer- health- solutions- and- humana- europe- $1227918$366373.htm

• Polyclinics threat to surgeries: Much will depend on how changes are handled. An opinion piece by Niall Dickinson, chief executive of the Kings' Fund reads:
  
  Our model of health care has changed little since the NHS began 60 years ago - advances in medical technology, changes in public expectations and in the ways staff work all signal the need to review how and where care is delivered. In many cases, no change is not an option. The latest review of the NHS, led by Lord Darzi, will set out a vision of how health services could be reorganised to improve the quality of care. The most controversial aspect of the review - and the issue that has seen the Government at loggerheads with the medical profession - are plans for super-surgeries, or polyclinics. The term has been used to describe a variety of different approaches from very large surgeries, which involve closing current GP practices and moving services into the new centre, to the hub-and-spoke model where most existing practices continue but share access to a set of new diagnostic and other services in one facility. In London, plans for polyclinics are proceeding. Outside the capital the Government says it wants to introduce 150 GP-led health centres, which it insists are not polyclinics in the sense that they will be additional to existing practices. Confused ? It probably does not help that all this is being conducted in the political arena. Scaling up some aspects of general practice may not be a bad thing and some aspects of the polyclinic model are worth considering. For example, bringing together family doctors and specialist consultants alongside other services, such as diagnostic testing, minor surgery, blood tests and X-rays could, if organised well, improve the quality of care. Although patients are sceptical about downgrading hospital services in favour of providing them in the community, there is a strong case for providing more support in the community to prevent avoidable hospital admissions. Some patients will find it much easier to access services usually delivered in hospitals that are further from their homes. This has to be a good thing. Of course, there are some genuine concerns about polyclinics, particularly in terms of access to GP services for older people if it does result in closures of smaller practices. That is why much will depend on how these changes are handled. Polyclinics may be the right answer in some areas, they will not be right for others. In most cases local health organisations should consider models which do not require mass centralisation of family doctor services. Above all, this should be decided locally using the best clinical evidence available with a full assessment of the costs and the impact on patient access.
  
  http:/ / www.telegraph.co.uk/ news/ newstopics/ politics/ health/ 2147691/ Polyclinics- threat- to- surgeries- Much- will- depend- on- how- changes- are- handled.html

The Telegraph

• Alan Johnson wants NHS nurses judged on how smiley they are. Health Secretary Alan Johnson wants nurses to be judged on how caring, compassionate and cheerful they are as part of new quality measurements. Treating patients with compassion, reducing the number of falls on wards and good hand-washing are some of the ways the quality of nursing care will be measured, Mr Johnson told the NHS Confederation in Manchester. Nursing teams on ever ward are to be scored, based on patient surveys, infection rates, hand-washing and the number of falls and then published on a website. Individuals will not be scored but Mr Johnson hoped a "friendly rivalry" would develop between teams. The new measures will be included in the Workforce Strategy section of Health Minister Lord Darzi's review of the NHS to be released next month. Mr Johnson said: "Our nurses do a brilliant job, often delivering very intimate care. They know instinctively that a patient's understanding of quality in the NHS is about much more than excellent clinical care. The personal touch is so important too. Patients want to be kept well-informed by staff and treated with compassion and sensitivity." Dr Peter Carter, Chief Executive and General Secretary of the Royal College of Nursing, said they are delighted with the plans. He added: "These new standards are groundbreaking in that they will directly recognise nurses for the kind of care that patients really value. Nurses across the UK work tirelessly to ensure that patients are treated with dignity, compassion and sensitivity, aspects of care which are so important but rarely measured." Steve Barnett, acting chief executive of the NHS Confederation which represents over 95 per cent of NHS organisations said: "There is no quick fix for compassion. Addressing the problem of compassion in the NHS is a wide cultural, leadership and management issue. It is also an issue for every professional.It will be very difficult to measure and benchmark compassion - particularly at the level of the ward. We do need to improve the measures we use to assess the quality of nursing but the element of compassion is not easily quantified. It is much more straightforward to measure clinical outcomes and it is invaluable to get feedback from patients. We need to start by using and refining existing measures before we consider new ones."
  
  http:/ / www.telegraph.co.uk/ news/ 2150655/ Alan- Johnson- wants- NHS- nurses- judged- on- how- smiley- they- are..html

The Times

• Health divide: inequalities start in the womb. An opinion piece by Nigel Hawkes reads:
  
  Sixty years in hot pursuit of equity have left Britain a country as divided as ever between healthy haves and unhealthy have-nots. Endless intellectual effort has been put into devising a formula that will allocate NHS resources in such a way as to eliminate such differences. They have failed. Since 1997, inequalities of health have in some respects widened. Targets have been missed. Alan Johnson's response is to throw another £34million at the problem, and shift the deadline from 2008 to 2010. Ministers' latest wheeze is to inject more money to provide extra GP surgeries in areas that have fewer doctors. Let us pass over the fact that these areas are already well-funded under the allocation formula, so should not need any more. Of course it is right that everybody should have equal access to a GP, so far as human ingenuity can provide it, but by the time most patients reach the GP's surgery the damage is done. Health inequalities begin in the womb, are nurtured by poor diet and bad parenting, and multiplied by habits such as smoking. Once, high cancer rates in the North would have been explained by occupational exposure in the workplace but that is no longer plausible. Smoking, and increasingly obesity, are the greatest risk factors. There is a near-doubling of lung cancer incidence in men between Surrey, West Sussex and Hampshire (the lowest) and Merseyside and Cheshire (the highest). In women the gap between highest and lowest is wider still. Breast cancer is much more egalitarian, with only small variations. There are bigger variations in prostate cancer incidence, but this largely reflects local enthusiasm for screening: the differences in death rates are smaller. The literature of health inequalities generally concludes that they follow disparities of wealth: the wider the wealth gap, the wider the health gap. If this is so, then Labour has been caught in a trap of its own making. Gordon Brown was happy to "eliminate poverty" with handouts, but not by squeezing the rich until the pips squeaked, as Denis Healey once promised. And American evidence suggests that there is no threshold above which the wealth-health link diminishes in force. In a world of haves, have-nots, and have-yachts, it is the yacht-owners who do best of all. So you can have a go-getting economy where entrepreneurs flourish and hedge-fund billionaires proliferate, or you can have Scandinavian-style leveling down and more equal health outcomes. What nobody has yet devised is a way of combining the two.
  
  http:/ / www.timesonline.co.uk/ tol/ life_ and_ style/ health/ article4160421.ece

The Guardian

• Dementia burden could bring down the NHS, experts warn. Dementia experts have written to Health Secretary Alan Johnson to warn that the disease could make the NHS financially unsustainable. They said more funding was needed for research into the disease to devise better treatments and reduce care costs, which currently costs the UK economy more than £17bn. The figure is expected to double within 20 years. The letter, signed by Professor Simon Lovestone, of the Institute of Psychiatry at King's College, London, and 10 other dementia experts, said: "As the NHS turns 60, the question isn't whether it will last a further 60 years, but if it can survive the next 20. Funding for dementia research is pitifully low, while care costs are at an all-time high. With the prevalence of dementia expected to double within a generation, the health service as we know it may well be unsustainable." The letter went on: "A quarter of the Department of Health's research budget is spent on cancer research, compared with just 3% invested in finding new ways of preventing or treating dementia. We urgently need to encourage national dementia research strategies to resolve this. The government must greatly increase dementia research funding now, or the NHS won't survive the next 20 years." Rebecca Wood, the chief executive of the Alzheimer's Research Trust, said: "If under-investment persists, the economic consequences arising from dementia care costs will be catastrophic. The government must reassert its commitment to social justice and financial prudence by proportionately funding dementia research." The government is set to launch a consultation on a dementia care strategy tomorrow. A Department of Health spokeswoman said the strategy was focused on "improving awareness, early diagnosis and intervention and improving the quality of care for people with dementia".
  
  http:/ / www.guardian.co.uk/ society/ 2008/ jun/ 18/ nhs.longtermcare

• Rethink over NHS ban on buying drugs. The health secretary, Alan Johnson, has announced a review of the 20-year-old rule banning patients from "topping up" NHS treatment by buying expensive drugs. The move follows a furore and threats of court action over instances of patients who wanted to pay for cancer drugs not authorised by the National Institute for Clinical Excellence. Ministers, however, have been concerned that allowing patients to buy extra drugs if they could afford it would result in a two-tier health service and damage the principles behind an NHS free at the point of access. But Johnson told the Commons that he had asked Prof Mike Richards, the national clinical director for cancer, "to review policy relating to patients who choose to pay privately for drugs not funded on the NHS". Niall Dickson, chief executive of the King's Fund, said it was an issue that would not go away. "In the face of rising demand and finite budgets it is something politicians and indeed the rest of society must address," he said. The review would need to protect the integrity of the NHS while finding whether there was a way to allow "a small number of patients in extreme cases to top-up their care ... This has obvious implications for an NHS based on need not ability to pay, but it does seem as if there will increasingly be cases where it is hard to justify withdrawing NHS treatment just because someone wants access to a particular drug or procedure." The review would have to look at the implications for those unable to pay. Ciaran Devane, chief executive at Macmillan Cancer Support, said it was an important issue for patients and was also "a complex issue for the NHS because many patients cannot afford to pay for drugs privately".
  
  http:/ / www.guardian.co.uk/ society/ 2008/ jun/ 18/ nhs.health

• Guardian's Future of the NHS special: 'A core service with core standards'. Home-based care, local practices, business parks of health services ... what do the experts want the future NHS to look like ?
  
  For the text of this segment of the Guardian's special report on the future of the NHS see:
  
  http:/ / society.guardian.co.uk/ futureofthenhs/ story/ 0,,2286033,00.html

• Guardian's Future of the NHS special:: Less waiting, more decision-making. Patients want more say in, and greater control over, their treatment. The question is: how much power will the professionals hand over ?
  
  For the text of this segment of the Guardian's special report on the future of the NHS see:
  
  http:/ / society.guardian.co.uk/ futureofthenhs/ story/ 0,,2286043,00.html

• Guardian's Future of the NHS special: Private matters. Richard Branson's Virgin Group wants to run polyclinics, and ministers believe private providers could turn around failing NHS trusts. But others are not so sure.
  
  For the text of this segment of the Guardian's special report on the future of the NHS see:
  
  http:/ / society.guardian.co.uk/ futureofthenhs/ story/ 0,,2286035,00.html

Tuesday 17th June 2008

Guardian

• Staff shortages put premature babies at risk, warn MPs. Premature babies are being put at unnecessary risk of infection and death in understaffed neonatal units across England, MPs have said. The Commons public accounts committee found that about 60,000 babies a year are born prematurely, about 10% of all births. Five years ago the Department of Health ordered a reorganisation of 180 neonatal units into 23 regional networks, to provide a complete range of services in each area, with rapid emergency transport facilities to ensure that each baby receives the appropriate intensity of care. But the cross-party committee found that about half the networks do not have access to a 24-hour specialist transport service, seven days a week. Only 24% have enough qualified staff to achieve the one-to-one nurse-to-baby ratio recommended by the British Association of Perinatal Medicine. The MPs said the service across England would need 2,285 extra nurses to come up to the association's standard. In 2006-07, one-third of neonatal units operated above the recommended cot occupancy rate of 70%, and three units operated above 100%. The average unit had to close its doors to new admissions at least once a week due to lack of cots, the MPs said. In the south Midlands there were 4.8 neonatal deaths per 1,000 live births in 2005, compared with 1.8 deaths in Surrey and Sussex. The Department of Health could not explain whether the difference was caused by social and economic characteristics of the population or the quality of the neonatal service.
  
  http:/ / www.guardian.co.uk/ society/ 2008/ jun/ 17/ nhs.health

Times

• Hospitals with poor hygiene 'could be closed'. More than 40 hospitals risk failing a new registration test unless they improve hygiene standards in the next 10 months. When the new Care Quality Commission comes into operation in April 2009, it will impose minimum standards that all hospitals must achieve in order to be allowed to treat patients. Figures published by the Healthcare Commission show that more than 100 NHS trusts - including 41 hospitals - admit failing to meet at least one of these hygiene standards in the year up to March 31. Until now, this has been a black mark and has affected their position in the commission's annual ratings. But, after next April, it could in principle prevent a hospital operating at all. Anna Walker, chief executive of the commission said, "In practice, it's unlikely to mean they won't be allowed to operate. It is possible for them to be registered with conditions. But these conditions will be made public." The figures, which are the trusts' own self-assessments of whether they met the standards, show a small improvement on most measures when compared to last year's, but many admit they did not meet them all. 26% declared non-compliance with one or more aspects of the hygiene code, compared to 25% in 2006-07. In part, said Ms Walker, this was because in some respects the standards had been clarified and toughened, so that trusts realised they were not meeting them, and admitted so. Thirty-five trusts could not say they complied with standards on infection control, 70 could not meet requirements on decontaminating equipment and 21 could not hit targets on hygiene control and the upkeep of buildings. Overall, just 39.4% of trusts (154 out of 391) could say they met 100% of the Government's requirements for the NHS, down slightly on the 40.1% figure for the year before. The commission will audit them by inspecting% of trusts - 12.5% where its own information and data suggests that particular trusts may be exaggerating, and another 7.5% chosen at random just to keep the NHS on its toes. Last year these inspections did lead to downgrading of nine hospital trusts and four primary care trusts who were found not to have met standards they claimed to have met.
  
  http:/ / www.timesonline.co.uk/ tol/ news/ uk/ health/ article4146771.ece

Financial Times

• U-turn likely for patients who 'top-up' drugs. The government is poised to rewrite rules that force patients to go entirely private if they want to buy cancer and other drugs that the NHS does not provide. A big rewrite of the rules on NHS "top-ups" is on the way, and the issue will be at least partially addressed by Lord Darzi in his "next stage" health service review in the next few weeks. Downing Street denied reports that Gordon Brown, prime minister, would make an announcement on the issue this week. No firm decisions have been taken. However, patients are likely to be allowed to keep the rest of their NHS care, but purchase drugs that the National Institute of Clinical Excellence (Nice), has not approved, provided they pay not just for the drugs, but also for the associated costs of administering them when this adds to the cost of their existing NHS treatment. Patients who choose to top up their care in this way, however, will not have to pay the full cost of all their NHS cancer care, as some primary care trusts and hospitals have been insisting. Until now, Number 10 and the Department of Health have said that any move to allow top-ups would create "a two-tier" health service. They now appear to accept that this line cannot be maintained. Ministers are determined to protect the NHS principle that health service money will not be used to subsidise private treatment - so the full cost of the additional treatment, not just the cost of the drug itself, will have to be met. But one official said: "We do want to make it easier for private care to sit alongside NHS care."
  
  http:/ / www.ft.com/ cms/ s/ 0/ 0a70a302- 3afd- 11dd- b1a1- 0000779fd2ac.html

Monday 16th June 2008

Midhurst and Petworth Observer

• West Sussex County Council bid to take over PCT. West Sussex County Council has decided to bid to take over the functions of the area's PCT. The move comes just a week after it was announced by West Sussex PCT that Worthing would be the county's major hospital and St Richard's in Chichester would be downgraded. Council leader Henry Smith said the takeover bid was not in direct response to the PCT's controversial Fit for the Future consultation which will see Worthing become the county's major hospital and St Richard's in Chichester downgraded. He said: "It wasn't the biggest matter but exemplifies why we think there should be greater democracy." He said the consultation would have been a "more robust" process had it been "subject to democratic control". Liberal Democrat county councillor Derek Deedman made the proposal to bring the functions of the PCT under democratic control. He said: "Direct county council responsibility for local health services would enable the democratic deficit to be addressed, and would lead to improved working between health and social care. If it had already been in place, this would have enabled the appalling original Fit for the Future proposal to be avoided." Campaigners for Worthing Hospital have welcomed the outcome of the review. However those supporting St Richards have vowed to initiate judicial review proceedings.
  
  http:/ / www.midhurstandpetworth.co.uk/ worthing- news/ West- Sussex- County- Council- bid.4187836.jp

The Times

• Hospitals with poor hygiene 'could be closed'. More than 40 hospitals risk failing a new registration test unless they improve hygiene standards in the next ten months. When the new Care Quality Commission comes into operation in April 2009, it will impose minimum standards that all hospitals must achieve in order to be allowed to treat patients. Figures published today by the Healthcare Commission show that more than 100 NHS trusts - including 41 hospitals - admit failing to meet at least one of these hygiene standards in the year up to March 31. This has until now affected a hospitals annual ratings. But, after next April, it could in principle prevent a hospital from operating. "These trusts risk not being registered in April 2009," said Anna Walker, chief executive of the commission. "They need to improve to meet the hygiene code as it moves to becoming a requirement. In practice, it's unlikely to mean they won't be allowed to operate. It is possible for them to be registered with conditions. But these conditions will be made public." The figures, based on trusts' self assessment, show a small improvement on last year, but many trusts admitted they did not meet all standards. Overall, just 39.4 per cent of trusts (154 out of 391) could say they met 100 per cent of the Government's requirements for the NHS, down slightly on the 40.1 per cent figure for the year before. Primary Care Trusts, which run community hospitals and provide nurses and health visitors, did especially poorly, with 37 per cent failing to meet compliance with one or more aspects of the hygiene code. The data released today is the trusts' own assessment of how well they have done. The commission will audit them by inspecting 20 per cent of trusts - 12.5 per cent where its own information and data suggests that particular trusts may be exaggerating, and another 7.5 per cent chosen at random just to keep the NHS on its toes. Ben Bradshaw, the Health Minister, said: "We welcome this year's findings, which show a dramatic fall in the number of trusts that are reporting serious non-compliance from 15 to four. This improvement is a great tribute to the hard work of NHS staff. We are also pleased that infection control is showing significant improvement - reflecting the importance both the Government and public place on this."
  
  http:/ / www.timesonline.co.uk/ tol/ news/ uk/ health/ article4146771.ece

The Financial Times

• U-turn likely on rules for patients who 'top-up' drugs. The government is poised to change rules forcing patients to pay for the entirety of their treatment if they opt to purchase drugs unavailable on the NHS. A rewrite of the rules is expected and the issue will be at least partially addressed by Lord Darzi in his "next stage" health service review. No firm decision has been taken and Downing Street has denied reports that Gordon Brown would make an announcement this week. However, patients are likely to be allowed to keep the rest of their NHS care if they purchase drugs not approved by the National Institute for Clinical Excellence, as long as they also pay for any additional costs incurred from the administration of the drug. The U-turn was signalled by Downing Street as the NHS itself declared the policy to be "unsustainable". Nigel Edwards, policy director for the NHS Confederation, said: "Excluding patients from the NHS system because they have chosen to top up their treatment with privately funded drugs seriously threatens to undermine public credibility in the NHS. The current situation is unsustainable. We are pleased the government is going to review this issue". In a paper published at the weekend on how the rules might change, Mr Edwards expressed concern shared by ministers that some form of "consumer protection" will be needed to prevent people from being pushed into buying drugs that may extend life only for a short time in a minority of patients. Mr Edwards said. "We cannot allow people in such vulnerable positions to have false hope." Ministers are determined to protect the NHS principle that health service money will not be used to subsidise private treatment - so the full cost of the additional treatment, not just the cost of the drug itself, will have to be met. But one official said: "We do want to make it easier for private care to sit alongside NHS care."
  
  http:/ / www.ft.com/ cms/ s/ 0/ caeac00a- 3b3d- 11dd- b1a1- 0000779fd2ac.html ?nclick_ check=1

Sunday 15th June 2008

The Independent on Sunday

• NHS neglects refugee doctors, says BMA. Hundreds of refugee doctors are being denied jobs in the NHS due to red tape and the unreasonable expense of registration. While nearly 1,200 refugee and asylum-seeking doctors are registered with the British Medical Association, the actual numbers now in the UK are thought to be closer to 2,000. Of these, only one in seven are currently working in the NHS. A further 25% are "job ready" but not working, having passed the necessary language and professional exams but held back by the slow and expensive process involved in practicing in the UK. Cash-strapped hospitals are increasingly charging for the necessary unsalaried work experience and advice on navigating the system is becoming rarer. Furthermore, NHS loans to help pay for expensive exams are scarce, leading to further delays and increasing reliance on charities. As a result, says the BMA, motivated doctors are prevented from making a valuable contribution to the NHS. Dr Edwin Borman, chairman of the BMA refugee doctor liaison group, said: "Dealing with this better would be a win-win situation: for the refugees, who desperately want to re-establish their medical careers and build a new life after horrific trauma, and for the NHS, which would get doctors in areas that are difficult to fill."
  
  http:/ / www.independent.co.uk/ life- style/ health- and- wellbeing/ health- news/ nhs- neglects- refugee- doctors- says- bma- 847472.html

Friday 13th June 2008

Guardian

• GPs condemn Johnson over polyclinics plan. GPs gave overwhelming backing to a motion of no confidence in Alan Johnson, the health secretary, as a row over the government's plans to shake up the family doctor service in England turned increasingly bitter. Dr Laurence Buckman, leader of the GP section of the British Medical Association, won a standing ovation at its annual conference in London when he promised "a never-ending fight" against proposals to build a network of polyclinics.
  Ministers have ordered the construction of 150 health centres across England, offering a wide range of medical services for 12 hours a day, seven days a week. Some may be run by the private sector. Buckman said this was the first stage of a scheme that could destroy the traditional family doctor service. Private healthcare corporations would tempt patients by offering easy access to care, but patients would lose a valuable relationship with a trusted professional. Later he delivered a petition to Downing Street, signed by more than 1.2 million patients, protesting about a perceived threat to local surgeries. Ministers were furious about what they regard as a mischievous campaign by the BMA to whip up public anxiety about commercialisation of the NHS.
  
  http:/ / www.guardian.co.uk/ society/ 2008/ jun/ 13/ nhs.health

Thursday 12th June 2008

Guardian

• Patients 'no better off' in competitive NHS. Patients have not yet reaped any significant benefit from the government's attempts to turn the NHS into a competitive market, two official health watchdogs said in a report. After a joint investigation, the Healthcare Commission and Audit Commission found the NHS spent about £1bn over the past five years on schemes to make NHS trusts in England compete for patients. They said the reforms may work eventually, delivering extra value for taxpayers' money. But progress is much slower than ministers hoped when they launched with a fanfare the flagship policies of patient choice and payment by results. The commissions said: GPs are being paid handsome bonuses for helping people choose between hospitals, but most patients cannot recall being offered any choice; Foundation hospitals are not using freedom from Whitehall control to innovate and are hoarding financial surpluses; New contracts for doctors and nurses were a "missed opportunity", raising costs without a proportionate increase in productivity; Areas served by independent sector treatment centres do not have shorter waiting times; Plans to move care out of hospitals into community clinics and surgeries have made little progress. The inquiry found the parts of the NHS that adopted "market-style" reforms most keenly did not perform significantly better than those slower to change. The NHS improved thanks to record growth in spending, backed by targets to reduce waiting times. These were "substantially delivered without using the system reforms".
  
  http:/ / www.guardian.co.uk/ society/ 2008/ jun/ 12/ nhs.health

Daily Telegraph

• A million patients battle against polyclinics. More than one million patients have signed a petition protesting against plans to close hundreds of GP practices to make way for polyclinics. The signatures, collected by the British Medical Association (BMA) in just three weeks as part of its "Support Your Surgery" campaign, will be presented to Gordon Brown at Downing Street. The government cannot afford to ignore the level of patient concern over polyclinics, which have been dubbed "supersurgeries", doctors' leaders will say.
  
  http:/ / www.telegraph.co.uk/ news/ newstopics/ politics/ 2111187/ A- million- patients- battle- against- polyclinics.html

BBC Online