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Friday 3rd July 2009

Pulse

  • Darzi centre funding dwarfs GMS cash. The GP-led health centre jointly run by BMA chair Dr Hamish Meldrum is one of many receiving vastly higher levels of funding than traditional practices. Our investigation shows funding per patient at GP-led health centres is almost three times as high on average, and in some cases as much as seven times as high, as at GMS practices. Some 25 PCTs released details of contracts under the Freedom of Information Act, although many more refused, claiming the release of figures would prejudice future tendering processes. Trusts are paying an average of £180.92 per registered patient to GP-led health centres in their first year, far outstripping estimated average funding of £63.24 per patient for GMS and £78.63 for PMS contracts. But those figures mask huge variation. NHS Halton and St Helens is providing the highest funding - £560 per patient in the first year - and two further trusts are paying more than £400 per patient, whereas one centre in the South-East is getting just £63.21 per patient. A few trusts revealed providers would be paid progressively less over the five-year period of contracts, based on an assumption of increased list sizes. Dr Meldrum, who first attracted criticism back in January following his practice's successful bid to run the centre, added: 'I would have much preferred the new money had gone to existing practices. It was only when it became absolutely clear this not an option that local practices decided the least worst option was to try to exert some control over the centre.'Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, Middlesex, urged the Government to learn the lessons from independent sector treatment centres, which were often paid large sums regardless of how many patients were seen.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4123157& c=2

Mirror

Birmingham Mail

  • Petition strengthens challenge to cuts in maternity service at Solihull Hospital. A campaign to stop maternity services being downgraded in Solihull is gathering momentum with a petition gaining thousands of signatures in just four hours. Local campaigners Maggie Throup and Jim Ryan are leading a battle to stop Heart of England Foundation Trust moving ahead with plans to no longer carry out complicated births at Solihull Hospital. They have even set up a "Save Solihull's Maternity Services" website to attract even more support for their campaign online. Pregnant women who risk having premature babies or more complicated births would have to travel to Heartlands Hospital, in Bordesley Green, or Good Hope Hospital, in Sutton Coldfield, to give birth under the plans. Trust bosses say the move is due to new, tighter regulations on safety on maternity wards.

    http:/ / www.birminghammail.net/ news/ solihull- news/ 2009/ 07/ 03/ petition- strengthens- challenge- to- cuts- in- maternity- service- at- solihull- hospital- 97319- 24061371/

Thursday 2nd July 2009

HSJ

  • Practice based Commissioning relationships finally paying off. Primary care trusts’ efforts to formalise practice based commissioning relationships are finally paying off. A survey of GPs and practice managers by the King’s Fund and the NHS Alliance published this week found 60 per cent had an agreed governance framework with their PCT, while 40 per cent had an agreement in place to manage conflicts of interest. Earlier this year, PCTs were told that if they did not make progress with practice based commissioning they would be held back at level one in the world class commissioning competency on clinical engagement. But more than half of survey respondents (52 per cent) said they did not feel very or at all engaged by their PCT. Less than half said they were receiving the support from their PCT to which they were entitled.

    http:/ / www.hsj.co.uk/ news/ primary- care/ practice- based- commissioning- relationships- finally- paying- off/ 5003379.article

  • NHS hospital ward shut due to poor cleanliness. Poor standards of cleanliness have led inspectors to order the closure of a neurosurgery ward in a Northern Ireland hospital, it has been revealed. An unannounced inspection was conducted at Belfast`s Royal Victoria Hospital last month while refurbishment work was under way. The body responsible for keeping the Northern Ireland government informed about the overall state and provision of health services - the Regulation and Quality Improvement Agency - said the ward “fell short of the required standard of cleanliness”.

    http:/ / www.hsj.co.uk/ news/ acute- care/ nhs- hospital- ward- shut- due- to- poor- cleanliness/ 5003284.article

  • NHS Competition panel allows Foundation Trust to take over community service. The co-operation and competition panel has recommended that the transfer of a primary care trust’s community services arm to a foundation trust be allowed. The panel has concluded that the proposal to move across Barking and Dagenham primary care trust’s provider arm to North East London foundation trust would not significantly reduce the scope for patient choice or competition. Panel director Andrew Taylor said the panel had identified a “substantial number” of possible providers of community services in the area. “As a result, the loss of North East London foundation trust as a potential provider of these services in competition with Barking and Dagenham community services is not significant,” he said. The panel concluded it would benefit patients and taxpayers by allowing the PCT to focus on its commissioning responsibility and that the foundation trust would be likely to bring “stronger governance arrangements and financial controls” to the services. However, its report warned that there was a risk that the merger “will delay the introduction of any patient choice and competition in community services that is appropriate beyond what would have otherwise occurred”. It said this risk would be minimised if the PCT met NHS London’s deadline to complete its community services commissioning strategy by autumn 2010.

    http:/ / www.hsj.co.uk/ news/ primary- care/ nhs- competition- panel- allows- foundation- trust- to- take- over- community- services/ 5003426.article

  • Monitor insists new rule has not “cancelled” PFI. The foundation trust regulator Monitor has hit back at claims it has “effectively cancelled” the remaining NHS private finance initiative contracts. In its prudential borrowing code, published in April, Monitor introduced a new rule saying trusts must be able to show annual debt payments are less than 10 per cent of revenue. HSJ has been told this “effectively cancelled” the remaining private initiative schemes. But in a statement issued in response to that claim, a spokeswoman for Monitor said the regulator’s approach to the schemes had “not changed”. “The question Monitor has always asked of applicants and of foundation trusts is: ‘Is this affordable’ ? A crucial part of our role is to ensure foundations remain financially viable organisations capable of providing high quality care to patients,” she said. She said Monitor’s 10 per cent test should not be confused with the Department of Health’s 12.5 per cent test, which referred to the maximum size of the total private finance initiative annual payment in relation to a trust’s income, not just the size of debt repayments. But she added that boards of applicant trusts would only pass the assessment process if they could show their forward business plans were “affordable based on reasonable assumptions around commissioning intentions and realistic in their approach”. The new code applies only to private finance schemes that have not been signed off. Existing schemes will be allowed to exist outside the rules.

    http:/ / www.hsj.co.uk/ news/ finance/ monitor- insists- new- rule- has- not- cancelled- pfi/ 5003330.article

Wednesday 1st July 2009

The Guardian

  • Hospital Doctors to get more control over budgets. Hospital doctors and nurses should be given greater control of their budgets, the health minister, Lord Darzi, urged as he backed away from proposals for closing district general hospitals. Launching a progress report on his plans to restructure the health service, the minister promised to scrap more performance targets and improve the "wellbeing" of NHS staff. The transfer of budgetary powers to clinicians has been widely welcomed as a means of handing power over to frontline medical staff. For Darzi, the surgeon turned politician, it is key to delivering quality patient care and "innovation" in the way the health service is delivered. In an interview with the Guardian, the minister said: "We are making the case that clinicians should start running their own budgets. We want more of them to do it in the acute [hospital] sector. "We are talking about what brings clinicians to work, about quality of care. It's going to make a difference." The move to devolve budgetary control to doctors and nurses in hospitals is aimed at improving efficiency within the NHS. It is already happening in some local trusts.

    http:/ / www.guardian.co.uk/ society/ 2009/ jul/ 01/ doctors- control- budgets

Tuesday 30th June 2009

BBC Online

  • There is a 'revolving door of patients'. The buzz word in the NHS at the moment is efficiency. But according to doctors in Shropshire it has gone too far. "I have heard of one hospital bed being used by four different patients in the space of 24 hours," said Shrewsbury GP Dr Mary McCarthy. Dr McCarthy believes it has got so bad that there are other hospitals which are at risk becoming "another Stafford". Dr McCarthy, as chairman of the local GPs committee, is meeting with managers this week to discuss her concerns. She said because of the closure of community hospitals Shropshire has lost 300 hospital beds over the past 10 or 15 years. "There is a pressure on GPs not to admit because there are not enough beds. Patients are also discharged too quickly and have to be readmitted. That is bad for the patient, but is also a waste of resources for the NHS. My concern is that the emphasis on cutting bed numbers - per head of population the UK has much fewer beds as places such as France and Germany - and saving money means there are other hospitals out there which are on the verge of the same situation." It is a view shared by the British Medical Association as a whole. The union's annual meeting in Liverpool voted in favour of a motion warning that the problems highlighted in the case of the Stafford Hospital were at risk of happening elsewhere. Dr George Rae, a GP from the north east who put forward the motion, said the whole health system is geared up to making finances a priority because of the emphasis placed on gaining foundation trust status.

    http:/ / news.bbc.co.uk/ 1/ hi/ health/ 8124830.stm

  • NHS finances 'must not be raided'. The NHS must not be raided to bail out the mess created by bankers and politicians, the leader of the UK's medical workforce says. British Medical Association chairman Dr Hamish Meldrum said with a £100bn budget the NHS could face cuts to plug the gaps in the nation's finances. He said the answer was not to cut back on traditional NHS services but to end the involvement of the private sector. The government said the NHS was still a priority for funding but argued that doctors were wrong to call for an end to private sector involvement. Dr Meldrum said moves to create polyclinics and PFI schemes, which use private money to build hospitals, were draining the health service in England of resources and fragmenting care. While other parts of the UK have experimented with getting the private sector involved in the NHS, it has not be done on the scale that it has in England. The NHS has its funding guaranteed until 2011, but many experts predict it will face a freeze or even fall in budget after that. Mr Meldrum spoke out after a BMA poll of 1,000 people showed nine in 10 were worried that services were going to be cut because of the recession. A Department of Health spokeswoman said the use of the private sector was aimed at improving services. "Where independent sector providers offer high quality patient care, innovation, good value for money and meet local needs, we will continue to bring them in to work as part of the family of NHS providers."

    http:/ / news.bbc.co.uk/ 1/ hi/ health/ 8123338.stm

  • Court bid to save hospital unit. Campaigners are taking a primary care trust to the High Court over its decision to close the minor injuries unit at a Wiltshire hospital. NHS Wiltshire said half the patients using the facility only needed to see their GP. The judicial review of the trust's decision is due to end on Friday. NHS Wiltshire said it would be defending its decision vigorously.

    http:/ / news.bbc.co.uk/ 1/ hi/ england/ wiltshire/ 8125756.stm

Healthcare Republic

  • Targets to blame for NHS scandals, say doctors. Blame for scandals such as the Mid Staffordshire hospital one lies with the government rather than medical staff, GPs have said. Dr Chaand Nagpaul told the BMA's annual representative meeting that the four-hour A& E target had led eight out of 10 A& E wards to discharge patients too soon. And the infectious diarrheoa outbreak in Stoke Mandeville, which killed 33, was 'partly a result of patients being hastily transferred from A& E cubicles to open wards'.Meanwhile, the 18-week target has resulted in patients inappropriately being removed from waiting lists and then re-referred, he said. 'There's nothing wrong with wanting to shorten NHS waits,' he said. 'What's wrong is the government's rigidity in implementing targets. When things go wrong as a result, is it fair that government can distance itself as having no part to play, while local healthcare staff face disciplinary action ?' The motion was carried.

    http:/ / www.healthcarerepublic.com/ news/ GP/ 916562/ Targets- blame- NHS- scandals- say- doctors/

Comnputer Weekly

  • Tories would scrap £8bn of IT projects. The Conservative Party would cut or kill new and proposed IT projects worth at least £8bn, with the national identity card and the Interception Modernisation Programme (IMP) top of the list. In a paper on the effective use of IT in government for the Centre for Policy Studies, Liam Maxwell, said the government spent £16.5bn a year - about 1.4% of GDP - on IT, but only 30% of projects succeeded. He said the way forward was to scrap government's penchant for large, centralised databases and to "yield control of personal data to individual citizens". Maxwell said the National Programme for IT, the NHS's troubled new £12bn IT project, could have been given to the private sector.

    http:/ / www.computerweekly.com/ Articles/ 2009/ 06/ 29/ 236686/ tories- would- scrap- 8bn- of- it- projects.htm

Monday 29th June 2009

The Guardian

  • Gordon Brown to unveil series of new policies. Gordon Brown will today attempt to revive his political fortunes with a radical new agenda for government. The Building Britain's Future document being unveiled by the prime minister is expected to contain a series of policy shifts designed to give people more power over public services. It is likely to form the basis for Labour's policy platform going into the next general election and is expected to contain proposals for:

    • A major expansion of private sector involvement in health provision

    • The scrapping of "top-down" targets across services

    • Making the current 18-week NHS waiting list target an obligation

    • Free health test for anybody between the age of 40 and 74

    • Cancer patients to be given the right to private healthcare if NHS hospitals can not see them within two weeks

    • New rights to one-on-one tuition will be extended into early secondary education

    • Allowing local authorities to give housing priority to people with ties to the community

    • A "significant" expansion of funding for social housing

    http:/ / www.guardian.co.uk/ politics/ 2009/ jun/ 29/ building- britains- future- gordon- brown

  • Public want NHS protected from funding cuts. More than three-quarters of the public – 77% – believe NHS funding should be protected in the face of future spending cuts, an opinion poll has found. Other departments' budgets should be sacrificed in order to preserve the health service, the British Medical Association survey heard. Four out of 10 people said they would be willing to pay higher taxes to sustain growth in NHS funding. The poll questioned 1,071 people in five UK cities – London, Edinburgh, Belfast, Manchester and Cardiff – a week ago, and reflects fears that severe cutbacks are looming. Nine out of 10 people suspect NHS services will be cut as a result of the recession, and almost as many believe waiting times for treatment will rise; 85% anticipate additional charges for NHS treatments. The level of public support for the NHS at the expense of other departments is likely to be welcomed by the Conservative health spokesman, Andrew Lansley, who last month stirred controversy when he declared that a future Tory administration would protect the health service and target cuts elsewhere. The poll, released on the eve of the BMA's annual conference in Liverpool, gave conflicting evidence about privatisation. Nearly 60% said the private sector should be more involved in providing NHS services but almost half (47%) said there should be no further contracts for commercial companies.

    http:/ / www.guardian.co.uk/ society/ 2009/ jun/ 29/ nhs- funding- cuts- survey- bma

Sunday 28th June 2009

Norfolk Eastern Daily Press

  • Taxpayers foot bill for private Hospital beds. Private hospital beds paid for by the NHS have cost the taxpayer £300,000, even though some were left empty, the EDP can reveal. The bill for the beds at the Spire hospital, the former BUPA hospital on the edge of Norwich, is considerably higher than they would have cost within the NHS. In April, the EDP revealed some of the beds, bought to relieve pressure on the Norfolk and Norwich University Hospital, were not being used. But bosses at NHS Norfolk, which paid for the beds, refused to say how much they had cost. Now, after a Freedom of Information Act request by the EDP, NHS Norfolk has revealed that the cost of the beds is £300,000. This covers 10 beds from mid-March this year, when the contract started, to mid-April and five beds from mid-April to July 19 when the contract ends. The cost per bed per day is about £392 - far higher than the cost in an NHS hospital of £180 to £270 per day.

    http:/ / www.edp24.co.uk/ content/ edp24/ news/ story.aspx ?brand=EDPOnline& category=News& tBrand=EDPOnline& tCategory=xDefault& itemid=NOED28% 20Jun% 202009% 2021% 3A00% 3A19% 3A020

Saturday 27th June 2009

The Times

  • Whistleblower helpline for doctors as concerns for patient safety grow. Hospital doctors wanting to raise fears about patient safety are to be given an anonymous “whistleblower” helpline because of growing evidence of staff reluctance to speak out for fear of recriminations. The dedicated phone line has been set up as part of new guidelines issued by the British Medical Association, and seen by The Times, designed to help to formalise the process of “whistleblowing” in the NHS. Doctors will be presented with two motions at the BMA annual conference next week calling for action to address staff concerns about reporting malpractice. One motion, proposed by the BMA’s agenda committee, warns that the NHS risks another patient safety scandal like that of Mid-Staffordshire where 400 deaths were linked to poor care; such is the scale of the problem. It calls for trusts and regulators to pool all complaints from clinicians to identify worrying trends. A second motion, proposed by junior doctors, calls on the General Medical Council to recognise formally that the harassment of whistleblowers is a serious breach of medical regulations. It also requests guidance on whistle-blowing.

    http:/ / www.timesonline.co.uk/ tol/ news/ uk/ health/ article6586423.ece

Friday 26th June 2009

Pulse

  • Screening committee aims to curb rise in private tests. The UK National Screening Committee is to produce guidance for GPs on which private health tests are safe to recommend to patients, in response to growing concerns over the pressure screening companies are placing on the NHS. Pulse learned of the move as part of a major investigation into the health screening industry, which found four in five GPs had seen patients at their surgery about suspected problems uncovered by private tests and scans. Just over a third of GPs said they did not believe the NHS should be liable for the care of suspected problems uncovered by private screening, while another 19% were not sure who should be liable. Fewer than half said the NHS should be responsible. The new guidance, currently being drawn up and to be issued to GPs and the public in the summer, will clarify which of the myriad of health tests and scans available in the private sector are backed by evidence, and which are not.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4123043& c=2

  • NHS to block GP referrals for surgery to save cash. NHS leaders plan to cut millions from the budgets of primary care organisations by blocking GPs from referring patients for a series of common surgical procedures. The NHS confederation has told PCOs to urgently look at 'raising treatment thresholds' for cataract, hernia and varicose vein surgery, warning vast sums are being wasted on operations that are not needed. GPs warned rationing operations purely on the basis of short-term assessments of effectiveness was unreliable and could inappropriately deny patients treatment. The NHS Confederation's report, Commissioning in a Cold Climate refers to controversial results from the Department of Health's pilots into patient-reported outcome measures, or PROMs, finding patients were often referred for operations even though their quality of life was not significantly impaired. But GPs warned of the dangers of relying too heavily on PROMs, which were designed as comparative tools to help patients choose between hospitals.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4123048& c=2

Healthcare Republic

  • DoH 'considers dropping private finance initiative for NHS buildings'. The government is considering ditching private finance initiative (PFI) as its main way of funding new health buildings, Lord Darzi has hinted. The DoH has used the PFI to build dozens of new hospitals over the last 10 years. But the model has remained controversial, with many observers convinced it delivers worse value than public money and has been favoured purely to disguise costs. Now Lord Darzi has hinted that the government is reconsidering its position. 'That model of funding may have been the right model,' he told the BMA. 'But I have no doubt that the Department [of Health] will be appraising whether that it is still the model for the future or whether there are other, better models.'

    http:/ / www.healthcarerepublic.com/ / news/ index.cfm ?fuseaction=HCR.News.PRACTICESTAFF.Article& nNewsID=916062& sHashCode=#AddComment

Nursing Times

  • Union welcomes PFI rethink. The union Unite has welcomed a possible rethink into Private Finance Initiative (PFI) schemes proposed following Lord Darzi's Next Stage Review of the NHS. The surgeon and health minister said the PFI funding system for hospitals 'needs to be looked at' in an interview. Unite National Officer for Health, Karen Reay said: 'At long last, the government is beginning to realise that PFI is a flawed and expensive exercise that continues to consume billions of pounds in costly contracts for the enormous profit of private companies. This is money that could be better spent on frontline services for patients and clients. Lord Darzi comments are to be welcomed, however, when he talks about 'better models for the future', we hope he means that the PFI experiment is abandoned, and not that the whole sorry process should be accelerated. We shall be seeking clarification from government on this point.'

    http:/ / www.nursingtimes.net/ nursing- practice- clinical- research/ acute- care/ union- welcomes- pfi- rethink/ 5003246.article

Thursday 25th June 2009

Health Service Journal

  • Foundation trust compliance with core standards tails off. The proportion of foundation trusts admitting that they are failing on core standards has risen year on year for the first time. Nearly a third said they failed to comply with all the core standards during 2008-09 in annual health check self declarations submitted to the Care Quality Commission. Foundation trust leaders are denying that the figures have been skewed by lower standards among the newer foundation trusts or that the regulator Monitor has "lowered the bar" for gaining foundation status.

    http:/ / www.hsj.co.uk/ acute- care/ news/ foundation- trust- compliance- with- core- standards- tails- off/ 5003117.article

  • Monitor has 'effectively cancelled' PFI contracts. Monitor has been accused of "effectively cancelling" the remaining NHS private finance initiative schemes. Managers have said the tight limits the foundation trust regulator sets on the amount of debt a foundation trust can carry mean they cannot take forward plans. The limits are set out in Monitor's prudential borrowing code, which was updated in April. Under the new code, trusts planning a PFI scheme and wanting to be granted foundation status must be able to show their annual debt payments are less than 10% of their revenue. The 10% figure replaces the 12.5% test set by Richard Glenn's 2007 review of the affordability of NHS PFI schemes for the Treasury. That figure related to the maximum size total PFI payments should be in relation to a trust's turnover to obtain Treasury approval. Total PFI payments include facilities management costs as well as debt servicing and so the two figures are not directly comparable. However a number of trusts already have total payments in excess of 15% of their turnover. The chief executive of one NHS trust with a large PFI scheme said there was "absolutely no way" the trust could take forward its plans for a new hospital and still achieve foundation status. Trusts that are already foundations or that already have PFI schemes under way will permitted to exist outside the rules.

    http:/ / www.hsj.co.uk/ news/ finance/ monitor- has- effectively- cancelled- pfi- contracts/ 5003163.article

Healthcare Republic

  • GP warning on threat from private providers. GPs have called for a cap on private providers in the NHS, warning that expansionist GP-led companies are as big a threat to general practice as other private firms. Nearly 60% of those who replied to a GP newspaper survey agreed that such consortia - sometimes partnerships with private firms - are just as much of a threat to traditional general practice as commercial providers. One GP said GP-led private firms 'appear to have an inordinate amount of clout for their relatively small proportion of involvement in the sector'. Most GPs were concerned that private providers were 'cherry picking' easy, profitable services, leaving the hard work to the NHS (78%). And a majority (64%) backed a 'cap' on private provision. The survey also found that the profession is broadly supportive of the BMA's anti-commercialisation campaign, with 73% backing it.

    http:/ / www.healthcarerepublic.com/ news/ GP/ LatestNews/ 915015/ GP- warning- threat- private- providers/

Wednesday 24th June 2009

Daily Mail

  • NHS may slash services due to swine flu cost after Treasury say they've no spare cash. NHS hospitals could be forced to slash services because the Treasury is refusing to fund the costs of the swine flu pandemic, officials warned. The Department of Health has spent at least £2bn on preparations for a mass swine flu outbreak on British soil. Officials were counting on the Treasury to pay for these emergency costs out of a crisis budget. But, with public services squeezed as a result of the recession Alistair Darling's department has told health secretary Andy Burnham that there is no spare cash. They say the £2bn will have to be found from existing health budgets.

    http:/ / www.dailymail.co.uk/ health/ article- 1195283/ NHS- axe- services- swine- flu- cost- Treasury- say- theyve- spare- cash.html

Solihull News

  • Maternity services set to be slashed at Solihull Hospital. Controversial plans to slash maternity services at Solihull Hospital will see a majority of borough mums to be sent to Heartlands or Good Hope Hospitals to give birth. Expectant mothers with potentially high risk births will no longer be treated at Solihull Hospital under new plans for a scaled down midwife-led service unveiled by Heart of England NHS Foundation Trust. The proposals would see women with conditions such as high blood pressure or who need a caesarian have to travel out of the borough from next April. A spokeswoman for Heart of England NHS Foundation Trust, said there were no plans to close the maternity unit at Solihull Hospital and added the trust was just changing the service to a midwifery led one and the plans were not part of a cost-cutting exercise.

    http:/ / www.solihullnews.net/ news/ solihull- news/ 2009/ 06/ 24/ maternity- services- set- to- be- slashed- at- solihull- hospital- 105074- 23964774/

Tuesday 23rd June 2009

This is Scunthorpe

  • Hospital needs to save £60m. Scunthorpe General Hospital bosses fear savings of up to £60m may have to be made by 2013. The Northern Lincolnshire and Goole NHS Foundation Trust, which runs the hospital, could have to make the efficiency savings following projected figures from the Department of Health. A definitive target for savings has not yet been set and is unlikely to be known until after the next general election.

    http:/ / news.google.co.uk/ news ?pz=1& ned=uk& hl=en& q=nhs& cf=all& scoring=n& start=10

Holdthefrontpage.co.uk

  • Echo fights to save hospital burns units. The NHS is planning to base a so-called 'supra centre' for treatment of severe burns injuries, either in Wakefield or Wythenshawe, Greater Manchester, and a third children's hospital also in Manchester. But the Liverpool Echo fears this would mean the loss of its current "world class" services at the city's Alder Hey and Whiston hospitals. The paper fears the most serious burns victims would have to travel to the new centre for treatment, with Wakefield around 70 miles away from Liverpool. It is now running a petition to gather support both in print and online on the Downing Street website. The paper also fears that resources and funding will be focused at the new supra-centre.

    http:/ / www.holdthefrontpage.co.uk/ campaigns/ 090623burns.shtml

Norwich Evening News

  • New GP-led centre open in 4 weeks. Thousands of patients are being promised a wide range of additional, easy to access health services as the opening date for the £2m GP-led health centre is announced. Timber Hill Health Centre will offer GP registered services 365 days a year alongside a number of enhanced health services. The centre will be run by Norwich Practices Ltd (NPL). NPL incorporates 15 existing NHS GP practices based around Norwich and was awarded the tender to run the centre in December.

    http:/ / www.eveningnews24.co.uk

Press Association

  • Call to reverse health cutbacks. A delegation of politicians is to visit Our Lady's Children's Hospital in Crumlin ahead of a Dail motion calling on the Government to reverse swingeing health cutbacks. The cross-party group will meet the board of management to see first-hand the impact of ward closures and reductions at the site. The Dail's committee on health and children has also invited Health Service Executive chief executive Professor Brendan Drumm to discuss the situation in the coming weeks. Hospital management have revealed they have been forced to close wards, reduce outpatient appointments and shut theatres in the upcoming months in a bid to meet budget cuts.

    http:/ / www.google.com/ hostednews/ ukpress/ article/ ALeqM5iJqEkvKp772vdZuDB60Nt9gMb2ng

Monday 22nd June 2009

BBC Online

  • NHS dentistry 'facing overhaul'. Ministers have agreed to an overhaul of NHS dentistry - just three years after the last shake-up of the system. They have acted after heavy criticism of the 2006 dental contract, which has led to fewer patients accessing care. The government said it would accept "in principle" the recommendations of an independent review of NHS care. Unions welcomed the move which will see income determined by three factors - patient list size, quality of care and the number of courses of treatment. It represents a return to patient registration which was scrapped under the 2006 changes. Over the last three years dentists have been working in a system where they were given a set number of courses of NHS treatment to provide to any patient that asked for care. It was structured so that they were effectively paid the same amount of money to see slightly fewer patients. The deal was introduced in a bid to end the so-called "drill and fill" culture. It was hoped that the changes would make NHS work more attractive to the profession - dentists also carry out a significant amount of private practice. But instead of improving access, official statistics show that more than 1m fewer patients have been treated in the two years since it was introduced than the two years before. One of the key problems was that some dentists had used up all their allocation of courses before the end of the year, meaning they had to turn away patients. The proposals put forward by the review, which was led by Newcastle University expert Professor Jimmy Steele, will now be piloted in the autumn. As well as the changes to the contractual arrangements, the report said patients needed to be provided with better information. It also suggested the three bands of patient fees - NHS patients contribute towards the cost of their care - should be widened to up to 10 bands as the current arrangements were overly simplistic.

    http:/ / news.bbc.co.uk/ 1/ hi/ health/ 8109679.stm

Scotsman

  • Rationing and charges would destroy NHS principles. Professor Allyson Pollock, head of the Centre for International Public Health Policy at Edinburgh University, writes: Careless talk costs lives and it may cost us our NHS. We are told an ageing population and rising patient expectations are placing inexorable demands on the NHS, but these claims have been contradicted by parliamentary enquiries. To date, there has been too little scrutiny of where the cost pressures are coming from and how money is spent. The real inflationary pressures are the rising cost of pharmaceuticals, technologies and the exorbitant cost of new hospitals and GP surgeries financed using private finance and equity. In the UK, 12-14% of all health service expenditure is on pharmaceuticals, but there has been too little public examination of why the prices charged for drugs and new technologies are so high. Cost pressures also manifest themselves through the new charges for private finance. The taxpayer, having bailed out the banks to the tune of hundreds of billions of pounds, is now being charged excessive amounts for hospital building so that the banks can rebuild their balance sheets. Patient charges would not promote efficiency or fairness in the NHS. Charges would create a two-tiered system based on a patient's ability to pay. The principle of the NHS is that all effective treatments should be available free at the point of delivery. This principle should be inviolate. Rationing will destroy it. Advocating changes to funding and a reduction in services is a bridge too far. The solution is not to blur the principles and goals of the NHS by allowing the introduction of private funding and private health care.

    http:/ / news.scotsman.com/ health/ Rationing- and- charges- would- destroy.5387033.jp

Herald

  • Doctors want future of the NHS debated as costs soar. Doctors have called for an "informed discussion" about the future funding of the NHS. Members of the Royal College of Physicians of Edinburgh (RCPE) said a debate was needed about how long the country could afford to pay for free healthcare for all. Members of the RCPE said that during the last year the NHS has found itself under increasing financial pressure. The RCPE call came after the Scottish Government announced record funding for the NHS in February. More than £8.64bn was given to the country's 14 regional health authorities for the next financial year, mostly for day-to-day running costs. However, it was the lowest rise for 10 years. Health Secretary Nicola Sturgeon said: "This record funding for NHS boards across Scotland underlines this government's unshakeable commitment to our publicly-owned health service."

    http:/ / www.theherald.co.uk/ news/ health/ display.var.2515630.0.Doctors_ want_ future_ of_ the_ NHS_ debated_ as_ costs_ soar.php

Healthcare Republic

  • Unite launches drive against privatization. Health union Unite has launched a campaign calling for the end of the privatisation of the NHS. The campaign, Health B4 Profit, appears to chime with the BMA's anti-marketisation drive launched earlier this month. The union published a report entitled The Patchwork Privatisation of Our Health Service which highlights how private companies, are taking over swathes of the health service with adverse knock-on effects for patients and staff. Karen Reay, Unite's national officer for health, said: 'Reading this document should make anyone concerned about the future of the NHS very angry indeed. The myth that private companies can provide better services than the NHS is a giant experiment based on a flawed ideology.'

    http:/ / www.healthcarerepublic.com/ / news/ index.cfm ?fuseaction=HCR.News.GP.LatestNews.Article& nNewsID=914597& sHashCode=#AddComment

  • Darzi centre pay for nurses 'worse than Agenda for Change'. GP-led healthcare centres are offering nurses pay and conditions that are worse than Agenda for Change (AfC), nursing leaders have warned. Some observers argued that the resulting demand for nurses would bring better terms and conditions for staff. But, in the event, none of the new centres is led by its nursing team, and RCN primary care adviser Lynn Young said nurses have reported employment terms 'less than AfC'. Unite nursing lead Barrie Brown said the centres seemed to be offering similar terms to existing GP practices, most of which pay less than AfC rates. He said it was too early to say whether the new centres were allowing nurses to expand their roles. Even if they were, he added: 'We're not over optimistic that it'll be reflected in pay.' One northern RCN representative said that he struggled to think of any new centres that were offering AfC terms. He said that the generosity of the AfC terms - and particularly of NHS pensions - made it hard for providers from outside the health service to compete.

    http:/ / www.healthcarerepublic.com/ news/ PRACTICESTAFF/ 914705/ Darzi- centre- pay- nurses- worse- Agenda- Change/

ZDNet UK

  • Early warning failed to put NHS IT back on track. The government was warned back in 2004 that immediate action was needed to fix problems in the £12.7bn programme to revamp NHS IT, official reports have revealed. Fast forward to 2009, and the National Programme for IT (NPfIT) is facing a number of difficulties: key projects to digitise patient records are running four years late, two major suppliers have walked away from the NPfIT, and the Department of Health CIO has given suppliers six months to speed up delivery of IT systems or risk seeing the NPfIT replaced. The root of the difficulties now facing the NPfIT were laid bare in 31 Office of Government Commerce (OGC) gateway reviews published between 2002 and 2007 and released to the public for the first time on 18 June. According to a 2004 strategic assessment, one of the major challenges facing the NPfIT was the NHS's decision to roll out systems without satisfactorily engaging with staff. "A conscious decision was... taken that, counter to the generally accepted wisdom, the approach for the National Programme would be to procure and deliver the new IT infrastructure and only seek to engage the users who would need to be involved in its implementation when there was something specific to present them with and when delivery dates were firm," the assessement stated. "The vast majority of the user community have yet to be properly engaged. There is therefore a massive challenge in engaging with this large and diverse community such that they are sufficiently prepared to implement the new services when they receive their systems," it continued. Later OGC reviews of the rollout of the Care Records Service (CRS) found bad feeling towards the electronic medical records project among clinicians had been compounded by technical difficulties. These included suppliers missing deadlines for rollouts of patient administration systems (PAS) and delays in the deployment of the Spine central database, which limited the tasks the PAS could be used for. Commenting on the reviews, Dr Grant Ingrams, chairman of the British Medical Association's joint GP IT Committee, said, "It was obvious to us that it was wrong back in 2001 and we had tried to tell the Department of Health but nobody was listening," he said. Of the 31 reviews published, nine were given a red status, indicating immediate action should be taken. Earlier this year, the parliamentary spending watchdog, the Public Accounts Committee, described the Department of Health's progress on CRS as "very disappointing" and said if the deployment of the scheme did not improve, the department should consider abandoning the planned national implementation of it.

    http:/ / news.zdnet.co.uk/ itmanagement/ 0,1000000308,39666196,00.htm

North Wales News

  • North Wales NHS patients offered private ops to hit targets. Up to 1,500 patients in North Wales are being offered operations at private hospitals in a bid to meet shorter waiting times targets in the NHS. Most of the patients waiting for orthopaedic surgery at Wrexham Maelor hospital could be switched to the town's private Spire hospital, and receive treatment from the same consultants employed by the NHS. Others are being offered surgery at Spire Hospitals in a 60 miles radius in Cheshire, Merseyside or Manchester. Doctors leaders fear the practice is pumping money into the private sector, treating patients as units of production, rather than investing in the NHS. NHS bosses were set a deadline of December to meet the latest Assembly Government target that no-one should wait longer than 26 weeks from a GP's referral to the start of hospital treatment. The North Wales NHS Trust admits it has a backlog of procedures, forcing it to seek extra capacity in the private health sector and effectively privatise the work. The cost of the treatment is more expensive but managers defending the bill say once the backlog is cleared, future treatment will be carried out within existing capacity.

    http:/ / www.dailypost.co.uk/ news/ north- wales- news/ 2009/ 06/ 22/ north- wales- nhs- patients- offered- private- ops- to- hit- targets- 55578- 23942164/

Sunday 21st June 2009

Surrey Comet

  • Kingston GPs given permission to buy Hook health centre. A pair of Hook GP practices have been given permission to buy their "leaky" and "cramped" surgery and spill over into the clinic next door. But a plan to start a new "super surgery" walk-in centre nearby which patients fear could damage the livelihood of Orchard Practice is still going ahead. Kingston NHS Primary Care Trust chief executive David Smith confirmed that he was willing to sell the Orchard Practice. The next door Gosbury Hill health centre will also be sold, allowing Drs Bala and Siva Balasingam and Dr John Gray to expand. Meanwhile a mystery application has been put in to change the Old Coach House in Chessington from offices to a doctor's surgery. The application is on behalf of the Drake Pension Trust, a business not registered with Companies House, but residents believe it is being earmarked for use by the winner of the contract to run the GP walk-in centre. Kingston PCT is currently deciding who will win the bid to run the new GP walk-in centre. The announcement of the contract was supposed to be made in April. The final bids were all handed in at the end of January.

    http:/ / www.surreycomet.co.uk/ news/ 4448315.GPs_ given_ permission_ to_ buy_ Hook_ health_ centre/

Saturday 20th June 2009

Stourbridge News

Friday 19th June 2009

Pulse

  • GPs line up to appeal patient survey results. Up to two-thirds of GP practices may appeal their results from this year's patient survey, early figures from Scotland suggest. Some 35 out of 59 practices in Ayrshire and Arran and 43 out of 57 practices in Fife have decided to appeal, joining 170 out of 270 practices in Glasgow. It comes after the Department of Health issued fresh guidance opening the door for GPs to appeal against their results. Although the guidance makes it clear that no national agreement has been reached, it reminds PCOs that they are able to make discretionary payments to practices, if they can prove that survey results were 'unduly skewed' from limited response rates. Practices across the UK have been hit by this year's new QOF thresholds and the change in survey methodology, with early survey results suggesting typical shortfalls of up to £9,000 each. Speaking at the LMCs conference, GPC chair Dr Laurence Buckman called for the survey to be scrapped. 'This survey is rubbish. It is a waste of money,' he told delegates.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4123010& c=2

  • Patient choice 'risks the founding principles of the NHS'. Government initiatives to move towards a US-style model of patient choice is likely to widen health inequalities and undermine the founding principles of the NHS, a top expert has said. Writing in the British Medical Journal, Dr Adam Ali, Frank Knox fellow at Harvard University, USA, said there was a 'fundamental difference in mentality' between US and UK approaches to healthcare that the British Government was at risk of forgetting in the pursuit of scoring political points. He said promoting choice in the NHS would undermine the 'noble ideal' of ensuring equality in access to care in the NHS and would inevitably result in some patients getting a sub-standard service. 'If choice is possible then, by definition, differences exist in the quality of care being provided in the NHS and some are receiving a substandard service that an informed patient would not choose. Allowing patient choice by publicly reporting outcomes is likely to exacerbate inequality as some are better positioned to exercise choice - most likely rich and well educated people,' he said.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4122999& c=2

  • GPs warn over use of 'traffic light' ratings to shut practices. Attempts to use traffic light ratings to create unfair league tables and close down practices must be strongly opposed by the GPC, GPs at the LMCs conference agreed. LMC leaders passed a motion claiming that the use of balanced scorecards often misrepresented the performance of practices. It also deplored the use of balanced scorecards to threaten closure or amalgamation of practices and called on the GPC to take a tougher line in negotiations. PCT managers have already begun moves to terminate the practice contracts of GPs failing to meet stringent access targets under the Government's national series of contractual reviews. Under the measures, practices judged as the worst performers face losing their contracts, with others expected to work under special measures or handed stringent improvement targets.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4122991& c=2

  • GPs prepare to take back OOH under Tories. GPC leaders have begun planning how a new GP-led model for out-of-hours services would work under the Conservatives, as they prepare for a major shake up of the sector as one of the first health priorities of a David Cameron Government. Delegates at the LMCs conference in London heard the committee was already drawing up details on proposed safeguards, to make sure GP practices were not swamped with extra work if they were handed responsibility for commissioning services. The move represents a significant shift from the GP leadership and came as for the second year in a row the conference passed a motion calling on the GPC to pave the way for GPs to take back responsibility for out-of-hours cover.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4122990& c=2

Islington Tribune

  • 'Consult us' say health campaigners. Campaigners fighting to save Finsbury Health Centre are meeting with council chiefs tonight seeking confirmation that they will be included in a new round of talks over the future of the Grade I-listed building by celebrated architect Berthold Lubetkin. Islington Primary Care Trust, now NHS Islington, decided to abandon the centre and sell the building to a private developer - but councillors intervened and referred the decision to the Department of Health. Health minister Alan Johnson, who has since been promoted in Gordon Brown's cabinet reshuffle, has advised NHS Islington to investigate alternatives to selling-up - but campaigners fear they will be left out of the loop.

    http:/ / www.thecnj.co.uk/ islington/ 2009/ 061209/ inews061209_ 15.html

Healthcare Republic

  • Private firms to issue patient advice with an NHS kitemark. The DoH has announced plans to accredit private companies as 'trustworthy' providers of information on healthcare. The government thinks that patients require more information about medicine and health services to be able to make informed choices. But it is concerned that they may feel overwhelmed by the quantity of material available, and uncertain as to what they can trust. The Information Standard scheme - itself run by private firm Capita - will certify organisations that produce health and social care information, such as websites, leaflets and brochures. The DoH said it expects that all NHS organisations will join the scheme. But it will also include private health organisations such as Bupa, as well as complementary medicine providers. GPC chairman Dr Laurence Buckman said that the scheme was 'only of use as a way of giving money to the private sector'. He compared the scheme to the £350m the NHS spent on management consultants last year. The Information Standard scheme is currently being tested with 39 selected providers. It is expected to launch nationwide this summer.

    http:/ / www.healthcarerepublic.com/ news/ PracticeStaff/ LatestNews/ 912959/ Private- firms- issue- patient- advice- NHS- kitemark/

  • PCTs must offer multi-practice contracts. PCTs must offer larger contracts involving groups of practices to attract private sector providers, according to the chairman of London PCTs' commercial board. Sarah Crowther, also chief executive of Harrow PCT in north London, said contracts involving many practices and associated services would be less risky for potential providers. Discussing the use of private providers at the NHS Confederation conference, Ms Crowther encouraged PCT chief executives to have 'informal chats' with private firms about contracts before tender. 'We don't think enough in the NHS about the size of the deal we need to be putting out to make it more commercially attractive to the independent sector,' she said. 'From the discussion I have had with the private sector it would like fewer procurements because they are long, protracted things that take a lot of effort.' Ms Crowther said contracts for any similar health centres should be bundled together in groups. 'If we don't make contracts bigger we will not be able to benefit from all the players in the market.' Dr Mark Hunt, managing director of Care UK, which has secured at least 13 contracts for GP-led health centres, echoed the call to NHS managers.

    http:/ / www.healthcarerepublic.com/ news/ GP/ LatestNews/ 913458/ PCTs- offer- multi- practice- contracts/

Thursday 18th June 2009

The Guardian

  • New NHS pay system has not delivered promised savings, say MPs. A revolutionary pay system introduced to save the NHS £1.3bn has not produced any evidence of lower costs, a report by MPs says today. The Agenda for Change pay modernisation programme was supposed to improve efficiency and encourage new ways of working. Three years after its arrival, however, the cost of employing the 1.1 million NHS staff employed through the system has risen by 5.2%, the Commons public accounts committee study concludes. The pay system covers all staff except doctors, dentists and senior managers. The report states: "No reliable figure is available for the extent to which the £1.3bn net savings promised by Agenda for Change have been achieved. A similar report by the National Audit Office in January found no evidence of better working or increased productivity. Overall productivity within the NHS fell markedly in the early part of the decade, the committee notes, by on average 2.5% a year between 2001 and 2005. The Department of Health had estimated cumulative savings from Agenda for Change of between £1.1bn and £2.2bn after citing a figure of £1.3bn in its business case to the Treasury. Peter Carter, general secretary of the Royal College of Nursing, defended the new system. "Transferring over a million staff to a new pay system in such a short time is no mean feat," he said. "NHS staff and employers have worked closely together to achieve this.”

    http:/ / www.guardian.co.uk/ society/ 2009/ jun/ 18/ nhs- pay

Health Service Journal

  • Two health boards to pilot direct elections. Members of the public will be directly elected to the boards of NHS Fife and NHS Dumfries and Galloway from next year, Scottish health secretary Nicola Sturgeon has announced. Elections will be held for the first time in the spring. The system, using postal ballots, will run for at least two years before an evaluation. Ms Sturgeon said: “This is designed to ensure that the views of local people about the NHS services they pay for can no longer be ignored. “This approach reflects the ideals laid out in the publication ‘Better Health, Better Care’ for a mutual NHS. “I am confident the people of Fife and Dumfries and Galloway will welcome this chance to be at the heart of healthcare decisions and their examples could set the pattern for the whole of Scotland.” As well as the election pilots, NHS Lothian and NHS Grampian are to trial other improvements to boards’ existing engagement and involvement systems. The Scottish government will meet the cost of the elections - estimated to be just under £3m. Unions have said the elections will bring about a necessary change of culture on health boards, but doctors’ groups have criticised the extra cost.

    http:/ / www.hsj.co.uk/ news/ policy/ two- health- boards- to- pilot- direct- elections/ 5002866.article

  • Wales’s public NHS board to meet for first time. The Welsh health service’s national advisory board will hold its first meeting later this month - with the public allowed to attend. Health minister Edwina Hart’s board will meet on 29 June with an agenda and board papers published in advance. The creation of the board is one of several significant reforms to the country’s health service announced during the past year. It will “provide independent advice to the health minister to help inform her decisions on setting priorities for the NHS”, according to a statement. Ms Hart said: “By holding the national advisory board meetings in public, wherever possible, and publishing papers and decisions, people will have a greater understanding for the decision making process, which I believe will give them more confidence in the NHS. The creation of the board was criticised by Welsh Conservatives and Liberal Democrats for politicising NHS management, but Ms Hart said it was right for politicians to take responsibility for decisions.

    http:/ / www.hsj.co.uk/ news/ policy/ wales- public- nhs- board- to- meet- for- first- time/ 5002905.article

  • Home care to ease hospital bed demands. A Number 10 document setting out the government’s plans for the next 12 months will promise more care for people in their own homes. Next week Downing Street is expected to publish Building Britain’s Future, which will list the government’s forthcoming strategies and white papers. It is understood that following a disastrous showing in the local elections and the installation of a new cabinet, the government feels it must set out its priorities more clearly. The intention to offer people more healthcare in their own homes fits with the emphasis from the Department of Health and the NHS on the need to reduce the use of hospital beds - even more pressing given the impending spending cuts. HSJ understands this will include palliative care, cancer and children’s services. The document is also expected to signal the government’s intention to set out new proposals on maternity later this year, likely to seek to extend birthing units, improve post-natal care and give parents, particularly fathers, a bigger role in the birth of their children. Individual budgets are understood to be under consideration.

    http:/ / www.hsj.co.uk/ news/ policy/ home- care- to- ease- hospital- bed- demands/ 5002907.article

  • Foundations defend private board meetings. Foundation trust directors have defended their decisions to meet in private, despite growing pressure on them to be more open. Following the Mid Staffordshire foundation trust scandal, the government has said all boards should meet publicly. Care Quality Commission chief executive Cynthia Bower appeared to support that view at the NHS Confederation conference last week. However, several foundation trust directors and the Foundation Trust Network insisted their governance system allowed them to be more open than other trusts, for example by giving additional information and access to governors. Those with open meetings could avoid scrutiny by discussing sensitive topics in private sessions. Chesterfield Royal Hospital foundation trust chair Richard Gregory, also chair of Yorkshire Bank and former managing director of Yorkshire Television, told a conference seminar that public meetings made it difficult to “discuss issues constructively”. They would also discourage private sector directors from joining foundations, he said.

    http:/ / www.hsj.co.uk/ news/ policy/ foundations- defend- private- board- meetings/ 5002811.article

Friday 12th June 2009

Public Finance

  • NHS systems ‘not fit’ for economic climate. The NHS’s payments and incentive systems are ‘not fit for purpose’ as it faces cuts of £15bn to £20bn over the five years from 2011, the NHS Confederation has claimed. The warning followed publication of a report at the confederation’s annual conference on June 10, outlining the grim financial climate facing the health service following the public spending squeeze signalled in the Budget. It said the NHS would need to plan for funding to fall by between 2.5% and 3% a year from 2011/ 12 – equivalent to £8bn to £10bn over the next Comprehensive Spending Review and up to £15bn over five years. The report, dealing with the downturn, also cited NHS chief executive David Nicholson’s warning that the health service might be required to save up to £20bn over the CSR period. But report author and confederation policy director Nigel Edwards told Public Finance that the NHS would ‘need to redesign some of the payment systems and incentives systems’ to deal with the new situation. The systems had been introduced during the years of growth in NHS funding and were ‘often designed to incentivise additional activity’, Edwards said. As the NHS heads into years of funding cuts, these systems were ‘not fit for purpose’. Edwards also told PF that it was time to consider restraints on decisions made by the National Institute for Health and Clinical Excellence – the government agency that assesses the clinical- and cost-effectiveness of new treatments. Nice ‘ought to think about a total budget for pharmaceutical innovation and maybe look at what the cost-effectiveness threshold is’, he said. Edwards also said that NHS managers might have to adapt to cuts as early as next year.

    http:/ / www.publicfinance.co.uk/ news_ details.cfm ?News_ id=60514

BMJ

  • Patients and staff not fully engaged with commissioning. Neither patients nor frontline staff, such as GPs and primary care nurses, have had a strong influence on most patient and public engagement strategies, a survey has found. The Picker Institute, a research charity that promotes patient centred health care, which carried out the survey, says that its findings amount to the beginnings of a cultural change. It warns, however, that the change has so far penetrated only trusts’ own management. More than eight in 10 primary care trusts say that they have made considerable changes in the past two years in the way that they organise patient and public engagement in commissioning. The English government launched its vision for "world class commissioning" in December 2007.

    http:/ / www.bmj.com/ cgi/ content/ extract/ 338/ jun10_ 1/ b2388

Pulse

  • Managers move to axe low-scoring practices under new ratings system. NHS managers have begun moves to terminate the practice contracts of GPs failing to meet stringent access targets, under the Government’s national programme of contractual reviews. PCT lawyers are already working on removing practices judged as the worst performers on traffic-light ratings, with many more expected to work under school-style special measures or handed stringent improvement programmes. At least five PCTs have now published balanced scorecard results on their websites under the Government’s World Class Commissioning initiative, with several more already initiating disciplinary action against some practices. NHS Barking and Dagenham has become the first to take legal moves against those it has judged not up to standard. It has spent £650,000 using private firm McKinsey to investigate access at 21 of its practices – out of a total of 43 – most of which had been identified as substandard through patient survey results. All these were rated on a balanced scorecard by McKinsey – which has also been commissioned by the Government to develop a national rating system. GPs were scored red, amber or green against indicators including number of GP appointments, response times during opening hours and number of manned phone lines per 2,500 patients during peak hours. Ten practices received an overall red rating, with five only switched to amber after agreeing to a series of measures including increases in total appointments of 50% or more. The trust has now instructed a legal team to begin taking sanctions against GPs, with two practices facing loss of their contracts.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4122954& c=2

  • King's fund inquiry 'a weapon to bash GPs with'. The King’s Fund’s wide-ranging inquiry into quality in general practice will be used as a ‘weapon to bash GPs with’, GPC chair Dr Laurence Buckman has warned. In an interview with Pulse on the eve of the LMCs conference, Dr Buckman revealed that the BMA had not been invited to serve on the expert panel overseeing the inquiry, which includes RCGP chair Professor Steve Field and NHS Alliance chair Dr Michael Dixon. The 18-month inquiry, launched in April, had already come under fire from BMA Council member Dr Kailash Chand, who accused it of being run by ‘a bunch of academics looking for errors and poor performance yet.’ But Dr Buckman’s comments are the first indication of wider unease among the BMA leadership at an inquiry which will draw up a series of quality indicators for use by managers, commissioners and regulators. Dr Buckman said: ‘The fact that the BMA are excluded from that inquiry, other than as just another stakeholder, I think that’s unfortunate.’ ‘You would have thought that the only GP representative organisation might actually be invited to represent GPs.’ He added: ‘The word inquiry is an unfortunate word, because inquiry is very close to the word inquisition, which is never a term of endearment.’ ‘I think [the inquiry] will be used by those who like to do such things as another weapon to bash GPs with.’

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4122957& c=2

  • Deprived area GPs lose battle for funding formula change. A controversial motion calling for the practice allocation formula to be revised to benefit GPs in deprived areas has been voted down by the LMC's conference. In what would have been a major change to the Carr-Hill formula, the proposers of the motion said practices with large numbers of patients from ethnic minorities or in disadvantaged areas should be rewarded for their extra workload. The conference voted against the whole motion, except for one section that called for practice funding to be increased 'realistically and quickly' to reflect sudden increases in population. Proposing the motion, Dr Cornelia McCarthy, a member of Greenwich LMC and a GP in Blackheath, London, said the allocation formula 'gravely disadvantaged' GPs in London and other areas, such as Kent, which has seen a rapid influx of immigrant patients. GPC negotiator Dr Chaand Nagpaul spoke against the motion, saying there was no evidence that large numbers of patients from ethnic minorities resulted in extra work and that the right way to fund the particular problems in London was for PCTs to offer enhanced services.

    http:/ / www.pulsetoday.co.uk/ story.asp ?sectioncode=23& storycode=4122969& c=2

Press Association

Herald

  • Billions locked in PFI will cost public dear, claims union. Billions of pounds of public money has become "locked" into paying for expensive, privately financed school and hospital projects, landing taxpayers with huge bills for years to come, the public-sector union Unison warned. The union said a new analysis of the private finance initiative (PFI) had forecast that projects across the UK currently valued at £64bn would actually result in a bill of more than £217bn in repayments by 2033/ 4. It called for an end to the "bottomless pit" and argued that new PFI schemes should be replaced with publicly funded design-and-build plans. Unison General Secretary Dave Prentis called on the UK government to bring existing PFI contracts back into public ownership, and criticised a special unit being set up to administer £2bn in funds to help bring stalled PFI deals to a financial close. Unison's report claims that PFI consortiums continue to make huge profits at the expense of the taxpayer, on contracts that are inflexible, complex and often lead to poor design. PFI projects are also hugely complex and slow, and tie managers running hospitals and schools into inflexible 30-year contracts, it says. It highlights the irony of PFI schemes that are supposed to be privately funded but, because of the collapse in banks and lending, have had to turn to the government for support. At the same time, the government has been forced into taking a stake in the same banks whose lending policies have caused the crisis and who in turn have been big lenders to PFI. Unison in Scotland has highlighted concerns over a number of PFI schemes, including car-parking contractors in Edinburgh whom it says wanted to charge the NHS £70,000 for recalibrating meters at Edinburgh Royal Infirmary when the VAT rate was cut. The Scottish Government has opposed the use of PFI, but its own solution, the Scottish Futures Trust (SFT), has been heavily criticised. Last year Unison condemned it as "PFI-lite" and warned it would retain higher borrowing costs and excessive risk-transfer costs. Instead, Unison set out a five-point plan calling for a review of existing contracts; a freeze on the awarding of new contracts; the awarding of government capital grants equally to projects; the introduction of "prudential" borrowing for health boards; and better protocols to protect staff in any transfers. Councils have increasingly become restive about the SFT, which has yet to deliver any major infrastructure investment, despite two years of planning. A recent leaked report from the Convention of Scottish Local Authorities (Cosla) condemned the PFI alternative as "unfocused", "disappointing" and "not in any position to fund infrastructure investment". Many councils are now looking at ways of bypassing the SFT and devising "workable" ways of funding new schools.

    http:/ / www.theherald.co.uk/ features/ otherfeatures/ display.var.2514495.0.Billions_ locked_ in_ PFI_ will_ cost_ public_ dear_ claims_ union.php

Staffordshire Sentinel

  • Fears for future of hospital. The future of Congleton War Memorial Hospital will be discussed at a public meeting amid fears it will be demolished. Hundreds of people are expected to attend The Central and Eastern Cheshire Primary Care Trust gathering. They will debate the future of the 90-year-old hospital as part of the PCT's revamp of community healthcare. Campaigner Michael Knowles said the health body's commitment to retaining 46 care beds on the site did not rule out knocking down the building and starting afresh. "I accept the building needs work, but I object to the idea of a developer taking over the site, demolishing the building and constructing a new hospital. Then under PFI terms they could rent it back to the NHS." The meeting is being held after protests at the PCT's plan, called the Congleton Community Healthcare Project. It proposed transferring services from the hospital to a purpose-built centre which would also oversee outpatient clinics and diagnostic services such as blood tests and scans. As a result, the hospital would close along with three GP centres.

    http:/ / www.thisisstaffordshire.co.uk/ news/ FEARS- FUTURE- HOSPITAL/ article- 1075552- detail/ article.html

Thursday 11th June 2009

Health Service Journal

  • Concerns NHS could be challenged under EU competition law. NHS contracts with private providers could fall foul of EU competition rules if they allow excessive profits, a briefing paper from the NHS Confederation warns. The NHS pension scheme and the minimum income guarantee paid to GP practices could also be subject to legal challenge if viewed as state aid in the form of preferential rates or subsidies to private companies. EU competition law does not apply to non-profit public bodies but the confederation warns growing private sector involvement in the NHS could open up areas where the law may apply. There are concerns trusts such as the Royal Marsden foundation and Great Ormond Street Hospital for Children, with substantial income from private patients, might not be exempt. HSJ has reported that up to 30% of patients treated privately in NHS hospitals were charged less than the hospital's actual costs, raising concerns the patients were being subsidised.

    http:/ / www.hsj.co.uk/ news/ legal/ concerns- nhs- could- be- challenged- under- eu- competition- law/ 5002554.article

  • Management consultant costs to be laid bare. The daily rates of a management consultants employed by NHS organisations could soon be published. The health select committee called for the step in a one-off report. MPs said they felt moved to issue the report after the 2007-08 NHS accounts revealed that primary care trusts, acute trusts and strategic health authorities were spending in the region of £300m a year. That sum excluded spending by foundation trusts. Giving evidence on NHS spending late last year Department of Health officials told the committee the day rate for senior consultants was "usually in excess of £1,000" and for junior consultants around £400-£500. But when MPs asked NHS chief executive David Nicholson if he would collect a fuller breakdown of spending he implied it would be complicated as "external consultancy" could mean anything from a very small spend to a major programme. The MPs disagreed, saying in their report: "The information must be collected locally and it would be a simple matter to bring this together centrally. We do not accept Mr Nicholson's argument [this] would inevitably lead to more micromanaging." The MPs have formally recommended the DH collects a list of all management consultants used by the DH, SHAs, PCTs and trusts, detailing the work, its duration, cost and purpose. The committee warns it will ask the DH for the information each year and publish it, with the top 10 daily rates paid to consultants by each organisation type. The MPs have asked the foundation trust regulator Monitor to provide similar information.

    http:/ / www.hsj.co.uk/ news/ finance/ management- consultant- costs- to- be- laid- bare/ 5002437.article

  • Southampton City PCT attempts to mitigate £3.6m losses. Southampton City primary care trust is renegotiating arrangements with its local Care UK treatment centre contract in a bid to stop the PCT losing up to £3.6m a year. The treatment centre opened in October 2008 but its activity is at only 75% of the value the PCT is contractually obliged to pay. PCT chief executive Bob Deans said the shortfall between the number of patients treated and the guaranteed payments was around £3.6m a year. The PCT is negotiating with Care UK and Southampton University Hospitals trust to "reduce the risk to the PCT". Under the proposed changes, the hospital trust will transfer £3.6m of elective and day case patients to the treatment centre for 2009-10. The trust would then use the spare capacity this would provide to increase its specialist services. Although the PCT will still be liable to make the minimum payments if the hospital fails to transfer enough patients to the treatment centre, Mr Deans said the plan offered the best chance to reduce the risk of paying even when no patients were treated. The Southampton treatment centre is part of the much-reduced phase two of the controversial independent sector treatment centre programme. There had been concerns about the area's ability to provide enough patients for the scheme led to it being scaled down, only to be scaled up again after a reduced scheme was deemed to fall outside Treasury value for money rules on achieving economies of scale. Under the original arrangement, the hospital trust agreed to transfer 7,500 patients to the centre a year. At the time, a senior source in the region warned there was "no evidence" of demand for the extra capacity that would be made available if the centre scaled up to 14,900 operations a year.

    http:/ / www.hsj.co.uk/ news/ finance/ southampton- city- pct- attempts- to- mitigate- 36m- losses/ 5002568.article

  • Trusts in the dark over cost of private patients. Private patients are getting hundreds of thousands of pounds of treatment subsidised by the NHS. The most concerning revelation was not that some 30% of patients were charged less than cost, but that almost half of trusts were unable to share even a rudimentary understanding of their spending on private patients. When HSJ asked acute trusts to show their private patient income, expenditure and profit and match procedures and care to the codes used to categorise NHS patient costs, only 13 trusts were willing and able to do so. HSJ's findings contradict the received thinking that private patients make profits which are ploughed back into NHS services. This is frequently used to argue that the cap on the income foundation trusts can earn from private patients should be lifted. 48% of acute trusts said they could not measure their spending on private patients, or determine a rate of return, or match patients to cost codes. The 13 trusts that met the request provided details of 4,142 private patients treated in 2007-08. The total profit margin on those patients appeared to be 35%. NHS finance directors say this figure should be inflated by around 15% because the costing data relates to the trust's average cost for treating a patient with that specific condition in the NHS. These NHS costs include the salaries of consultants and anaesthetists, who are billed separately for private patients via a direct contract between the clinician and the patient. In practice many NHS trusts use this point as a rule of thumb to calculate that as long as they charge the going NHS tariff rate to a private patient, they will automatically make a margin of around 15%. But 11 out of the 13 of the trusts revealed they were making a loss on some of those patients - even after the 15% margin related to consultants' pay was taken into account. The 1,238 patients being charged less than the hospitals' apparent costs made up almost a third of all the patients covered by the information released. On average, the discount was 23%, after adjustment for consultant costs. Primary Care Trust Network director David Stout says undercharging is potentially problematic as it could mean the NHS is "in effect, subsidising private healthcare". Rather than a ploy to sell loss-leaders into the private healthcare market, he suspects a lack of understanding of costs - "quite bizarre" when there are plans to expand private patient work.

    http:/ / www.hsj.co.uk/ news/ finance/ trusts- in- the- dark- over- cost- of- private- patients/ 5001878.article

Times

  • Spending cuts start to bite as hospitals lose £500 million. Funding of £500m for hospital building and refurbishment is being withheld by the Government in the first sign of the severe cuts likely to be forced on the NHS in the recession. A letter between health chiefs suggests that "the Treasury is unlikely to agree further releases of funding" for the building of a new generation of community hospitals, announced to much fanfare three years ago.

    http:/ / www.timesonline.co.uk/ tol/ life_ and_ style/ health/ article6474925.ece

East Anglia Daily Times

  • Inquiry into out-of-hours medical care. A formal investigation is being carried out into out- of-hours medical care in Suffolk following concerns about patient safety. Ipswich-based private healthcare company Take Care Now (TCN) is under the spotlight over a series of failings in patient care - including two cases of patients being given too much of potentially fatal drug diamorphine in Suffolk, and another which left a Cambridgeshire man dead. National watchdog, the Care Quality Commission (CQC), has pledged to thoroughly investigate all concerns about the company, which also runs out of hours dentistry, minor injuries units, and - controversially - sexual health services, in Suffolk. It will also examine if commissioner NHS Suffolk was stringent enough in checking patient safety standards. The company, which does not hold public board meetings, was plunged into the spotlight following the death of David Gray, a Cambridgeshire patient who was treated by a locum doctor from Germany and given a lethal dose of diamorphine.

    http:/ / www.eadt.co.uk

Wednesday 10th June 2009

Guardian

  • Jobs at risk as NHS faces cuts to meet £15bn shortfall. The health service faces an "unprecedented" £15bn shortfall which is likely to trigger job losses and service reorganisation as it is forced to get to grips with the "most severe contraction in finances it is ever likely to face", NHS leaders warn. The NHS Confederation calls for "hard decisions" if the NHS is to remain true to its founding principles and provide care free at the point of need over the next few years. The NHS Confederation's chief executive, Steve Barnett, will tomorrow challenge the NHS to "prepare itself for real-terms reductions". Despite running a surplus of around £1.35bn this financial year, NHS finances are likely to deteriorate dramatically after the current spending review in 2011, a study by the confederation warns. The report, Dealing with the Downturn, says, "It is unavoidable that this will also translate into fewer staff." Proposals for charges for visits to GPs or accident and emergency treatment are likely to emerge, says the report, but the NHS Confederation does not support them. Restricting pay rises could be another option.

    http:/ / www.guardian.co.uk/ society/ 2009/ jun/ 10/ nhs- jobs- at- risk

Tuesday 9th June 2009

Kent Online

Healthcare Republic

  • Unite campaigns for end of privatisation of the NHS. Unite/ CPHVA has launched a campaign calling for the end of the privatisation of the NHS. Health B4 Profit appears to chime with the BMA's anti-marketisation drive launched earlier this month. Unite has published a report titled 'The Patchwork Privatisation of Our Health Service' which highlights how private companies with government encouragement are taking over swathes of the health service with adverse knock-on effects for patients and staff employment conditions.

    http:/ / www.healthcarerepublic.com/ / news/ index.cfm ?fuseaction=HCR.News.NURSE.Article& nNewsID=911745& sHashCode=#AddComment

Thursday 4th June 2009

Health Service Journal

  • Czars to focus on cost cutting as well as quality. Reducing costs is becoming an integral part of the role of the Department of Health's czars. NHS chief executive David Nicholson said national clinical directors, appointed to plan and deliver service improvements, would help engage staff in efficiency and productivity. Referring to the example of cancer czar Mike Richards, Mr Nicholson said, "Now the challenge is how do we improve quality of cancer services and reduce costs at the same time." Professor Richards said the NHS medical board of national directors and strategic health authority medical directors, chaired by medical director Sir Bruce Keogh, was looking at how to help cut costs. Professor Richards is looking at how to improve productivity by, for example, reducing inpatient bed days in cancer care. Sir George Alberti, who was national clinical director for emergency access for more than six years until April, was cautious about the approach. He said: "Obviously finances matter, but equally clinical directors will lose value if their starting point is not quality and safety from a clinical standpoint. You then have to be realistic about what is affordable and how quickly you can get there."

    http:/ / www.hsj.co.uk/ news/ acute- care/ czars- to- focus- on- cost- cutting- as- well- as- quality/ 5002296.article

  • Treasury U-turn on PFI reprieves DH capital budget. A Treasury U-turn over accounting rules for hospitals built under the private finance initiative has given the Department of Health's capital budget a reprieve. Treasury guidance due to be published next week is expected to say that government departments will be exempt from changes to accounting rules for PFI which took effect in April. Since April, NHS organisations have had to report their PFI and local improvement finance trust assets on their balance sheets, in line with international reporting rules. Approximately £16bn of assets and their associated debts are expected to come on to the NHS's books over the next few years. The change will mean some trusts will need to substantially increase their capital charge and depreciation payments, forcing them into a technical deficit. Spending on assets previously accounted for as revenue will need to be reclassified as capital. Experts had warned that the amount of NHS assets due to come on to balance sheets would bring the DH dangerously close to breaching the Treasury's strict limits on departmental annual capital spending, resulting in a squeeze on the NHS capital pot. The move was expected to mean that up to £30bn of PFI debts would be included in the UK's public sector net debt figures - a measure used by the government to indicate the stability and credit-worthiness of the public finances. The Treasury is expected to claim the U-turn is needed so that national accounts align with EU standards. But sources close to the Treasury said the real reason was the need to improve the appearance of the national accounts, which had worsened in the economic downturn. NHS organisations are likely to be asked to provide the DH with two balance sheet statements for their PFI deals, which will mean there will be a mismatch between their own accounts and those of the DH. Last year HSJ reported that NHS organisations were considering handing their PFI assets over to specially created charities to get around the accountancy rule change.

    http:/ / www.hsj.co.uk/ news/ finance/ treasury- u- turn- on- pfi- reprieves- dh- capital- budget/ 5002285.article

  • PCTs fail to engage public in public engagement. Primary care trusts are failing to put patients and the public at the centre of the very strategies designed to engage them. Only 38% of PCTs responding to a Picker Institute survey said patient forums and local involvement networks had been "highly influential" in developing their patient and public engagement strategies. Even fewer said the wider general public (10%) or clinicians (8%) had been highly influential in plans. By contrast, over 40% said managers and board members had been highly influential.

    http:/ / www.hsj.co.uk/ news/ primary- care/ pcts- fail- to- engage- public- in- public- engagement/ 5002146.article

  • David Nicholson warns NHS: 'all bets are off'. David Nicholson has said, "All bets are off. We need to move away from the NHS being built for growth to being able to sustain itself in a prolonged limitation on resources," he said. The scale of the challenge is unprecedented, he said. In his annual report last week, Mr Nicholson said the NHS would have to make efficiency savings of £15bn-£20bn from 2011-14. He said the Department of Health would "really squeeze" the NHS as soon as 2010-11, expecting it to sustain a surplus of £1bn and to increase the proportion of non-recurring expenditure from 0.6 to 1%. There will be full details in the next operating framework. The DH will lead changes that "we can only do at the centre", he said, such as improving value for money in procurement or changing policy. The recession will bite earlier in some regions than others and new approaches to commissioning will be "prototyped" in those areas, he said. Mr Nicholson's comments came as shadow health secretary Andrew Lansley said he could not guarantee a Conservative government would stick to the NHS allocations for 2010-11, when the Tories could well be in power. Trade unions have said privately that they have not yet developed a strategy for negotiating public sector pay with the Conservatives, but they acknowledge something radical may need to be done if headcount reductions are to be kept to a minimum. A senior figure at one union said that hospital or ward level performance related pay may be an option.

    http:/ / www.hsj.co.uk/ news/ finance/ david- nicholson- warns- nhs- all- bets- are- off/ 5002342.article

  • Unite campaigns against community service reforms. Trade union Unite has launched a campaign against Department of Health plans to separate primary care trust provider arms from commissioning PCTs. Unite said the transforming community services programme amounted to "the latest patchwork privatisation of the NHS" and "promotes the myth that any provider will be better than a PCT provider". PCT provider arms will be able to turn themselves into social enterprises or community foundation trusts under the scheme, which is likely to result in increased competition in the community services sector. The news came as the British Medical Association stepped up activity to publicise its concerns about the creation of a market in healthcare with its own new campaign, Look after our NHS. It is looking for examples of where public money has been "wasted" as a result of market-driven reforms.

    http:/ / www.hsj.co.uk/ news/ primary- care/ unite- campaigns- against- community- service- reforms/ 5002289.article

Daily Telegraph

  • Ditch management consultants from the NHS: leading doctor. Public money must not be diverted away from patient care 'into the pockets of shareholders' at a time when the NHS may see real cuts in budgets, Dr Jonathan Fielden, chairman of the consultants committee of the British Medical Association said in a speech. He said the £350m reportedly spend on independent management consultants in the NHS in England last year should be spend on patient care instead. He said that an estimated £927m was also spent on contracts with independent sector treatment centres for work that was not carried out as patients shunned the private centres. This was a 'dangerous waste', Dr Fielden said, and he urged the Treasury not to snatch back the £1.7bn surplus currently in the NHS and for it to be spent on patients instead.

    http:/ / www.telegraph.co.uk/ health/ healthnews/ 5437279/ Ditch- management- consultants- from- the- NHS- leading- doctor.html

Computer Weekly

  • BT gets extra £815m from NPfIT. BT is to be paid £815m more than it had first expected from its contracts under the National Programme for IT. The minister Ben Bradshaw said on 1 June 2009 that BT is to receive £1.567m under a local service provider contract to provide systems, including the Cerner Millennium software, to hospitals in London. This is £546m more than the £1.021m LSP deal agreed in 2003.
    Bradshaw also said that BT will receive £889m for the NPfIT data "spine", which is £269m more than the £620m which was agreed in 2003. With all the extras, I calculate that the NPfIT contracts - which were originally announced as costing £6.2bn - have risen by more than £1bn to about £7.3bn.

    http:/ / www.computerweekly.com/ blogs/ tony_ collins/ 2009/ 06/ post- 11.html

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