Category: Government
Doctors told to put financial considerations ahead of clinical need
19th October 2008
The NHS is paying family doctors a bonus if they cut the number of patients that they refer to hospital for specialist treatment. NHS managers say referral rates, which rose 16 per cent nationwide during the first quarter of this year, have to be cut to save money. They claim many patients can receive equally good care from community NHS staff, such as physiotherapists and nurses.
In a variety of schemes, which differ from region to region, GPs are being offered cash incentives for deciding not to refer a patient for specialist treatment. Surgeries are given a target of how many patients they should refer to hospital each year and will receive a windfall payment if they meet the quota.
Surgeons are already reporting cases that show that cancer patients had not been referred straight away because of this scheme and the outcomes because of the delays had been “terrible”.
Shadow Health Secretary Andrew Lansley added: “It is inefficient and unethical to pay GPs to refer fewer patients to hospital. “If patients find out that their local health bureaucracy is paying their doctor not to refer them to hospital they will be rightly outraged.”
Such schemes mean that decisions by family doctors could be based on financial considerations rather than clinical need. Government health ministers, usually keen to have their opinions in print, have been strangely (guiltily?) silent on this issue. We need a clear unambiguous statement from the Health Secretary that he will not countenance such practices and that PCTs that have introduced them will be forced to abandon them immediately.
GPs productivity is down in spite of 58% pay rise
9th October 2008
A new report out today by the Commons Public Accounts Committee shows that family doctors are putting in fewer hours since they received their 58% pay rise in 2004.
It also claims that the Department of Health's failed to properly estimate how much the deal would cost which has led to an overspend of £1.8 billion to fund family doctors opt out of responsibility for their patients in the evenings and weekends.
The report is also criticises the failure of the contracts to significantly improve access to GP services or increase the number of family doctors in deprived areas.
Edward Leigh, the committee's chairman, said that the new deal "has so far failed to live up to expectations. "Partners in GP practices are now putting in less time and their productivity has decreased. Only their pay is burgeoning, having increased on average by an eye-watering 58 per cent since 2003. " The new pay system has made it too easy for GP practices to achieve high scores, resulting in their earning higher than expected levels of payments."
Doctors are working 44 hours a week, seven fewer than before the introduction of the contracts in 2004 and are pushing their practices' increased workload on to nurses and trainee doctors, whose pay has increased far less sharply.
Health minister Ben Bradshaw said moves had already started to improve services, citing the longer opening hours. Norman Lamb, the Liberal Democrat Shadow Health Secretary, described the contract as "staggeringly incompetent". Andrew Lansley, the shadow health secretary, said that the Government had "botched" the handling of the contract.
No heads have rolled and none are planned!
The Prime Minister's speech - playing politics with the sick
24th September 2008
Gordon Brown’s speech to the labour conference yesterday contained some promises in healthcare.
He announced that prescription charges for cancer patients in England will be scrapped from next year with other chronic conditions to follow afterwards. In Wales all prescription charges have already been scrapped and they are in the process of being phased out in Scotland, so this announcement is little more that the Prime Minister playing tail end Charlie. Patients in Wales and Scotland will still be treated significantly better. Brown claims that his proposal will be funded through savings in bulk buying of drugs in the NHS.
He failed to deal with the controversy over the post code lottery in availability of some cancer drugs. A recent study has found that some drugs that have not yet been assessed by the National Institute for Health and Clinical Excellence (NICE) such as Avastin, Nexavar and Tarceva are made available routinely by some authorities and not by others.
He also failed to deal with the issue of cancer patients paying privately for drugs the health service will not fund. Again there are differing approaches depending where the patient lives. The government has said that it is reviewing the situation. Yesterday’s speech would have been an excellent opportunity to announce what is to be done.
Once again the Prime Minister seeks to improve his standing in the labour party by making gestures, this time to cancer patients, but fails to deal with the issues that cancer patients are most concerned about… it is shameful that our leaders play politics with the sick.
Government targets delaying surgery on road traffic victims
18th September 2008
The findings from a study carried out by the the Royal College of Surgeons and British Orthopaedic Association are particularly disturbing. They claim that road traffic victims who have multiple injuries and fractures are not being transferred to specialist units for surgery fast enough because beds are full of routine cases. Since these routine cases such as hip and knee replacements have to be carried out within Government waiting time targets it means that the urgent trauma cases are delayed.
Prompt surgery for complex injuries, such as pelvic and hip socket fractures which are common in road accidents, is essential. Treatment, which includes the initial stabilising of the fracture followed by the final fixing and setting a few days later, means that 80% of patients can recover with excellent results, avoiding disability. But after 10 days that figure drops to 50% and by three weeks to almost zero. Research shows that NHS hospitals waiting time is running at between 10 and 20 days. The resulting more complex surgery and longer rehabilitation is costing the NHS more money than if these trauma patients were operated on quickly.
The British Orthopaedic Association and The Royal College of Surgeons have repeatedly called for the creation of a regional trauma network, where patients with complex, multiple injuries can be treated quickly.
The government admitted failings, but said reform was in place with the appointment of a 'trauma tsar' to lead nationally on trauma policy.
Such unintended consequences of the plethora of government top-down targets need to be addressed properly. Appointing a ‘tsar’ is little more than spin. With a Health Secretary probably focusing on the problems of the Labour party rather than trying to put right the mistakes of his predecessors sadly there is little hope for meaningful change.
NHS productivity has deteriorated
12th September 2008
Figures compiled by the Office for National Statistics (ONC) show that the amount of treatment the NHS delivers is lagging behind the pace of increase in the service's budget. This is consistent with the recent King’s Fund report on NHS funding and performance, which presented evidence of rising unit costs
According to Centre for the Measurement of Government Activity (part of ONC) NHS productivity fell by 2.0% a year between 2001 and 2005. This was the period of the biggest funding increase in NHS history. From 2005 to 2006, productivity fell less quickly, by 0.2%. From 1995 to 2006, the NHS annual budget more than doubled from £39 billion to £89.7 billion.
Most healthcare experts warned the government in 2001 that to massively increase spending before first dealing with the well known bureaucratic, union and efficiency issues within the NHS was wrong and would lead to large amounts of taxpayers money being wasted. To counter this a report was commissioned by Gordon Brown from a retired banker to show that it was safe to put the money in first and sort out the problems later. Anxious to demonstrate progress on their various promises to improve the NHS after doing nothing for their first four years in office, Blair and Brown immediately seized on the report's conclusion and started to pour huge amounts of money into the service. Sadly the obvious absurdity of this strategy has now come home to roost.
Public misled over level of cancelled operations
21st August 2008
Information released under the Freedom of Information Act calls into question government figures on the number of cancelled operations. The true level is twice that reported by the government! The figures show that more than 100,000 operations have been cancelled by the NHS over the past year because of bed shortages, staffing problems and other non-clinical reasons. More than seven thousand patients suffered multiple cancelations. One patient had an operation cancelled by Plymouth Hospitals nine times. A patient at Kingston was let down eight times and one at York had surgery postponed six times.
The most common reported reason for cancellation was problems with theatre bookings, responsible for 16,617 cases. Other causes included 400 operations cancelled because the patient's notes had been lost, more than 10,000 cancelled because of bed shortages, nearly 4,000 because of equipment failure and more than 11,000 because of staffing shortages.
Last year, the Department of Health announced that just over 57,000 operations had been cancelled. However, these figures only cover cancellations made in the 24 hours before an operation is due to take place. When hospitals were asked to reveal all cancelled operations, the figures were almost twice as high prompting allegations from the Conservatives that ministers were "spinning the statistics". Shortly before the last election, Tony Blair, the former Prime Minister, said that it was "unacceptable" for operations to be cancelled.
The trusts with the highest reported cases of cancelled surgery apologised yesterday for providing inaccurate data.
A spokesman for the Department of Health defended the Government saying that patients were more concerned with those cancelled within 24 hours before an operation and so it was reasonable not to report cancelations before that.
This excuse is frankly a disgrace. The government have been caught out “spinning” the statistics. This attempt to mislead the public is shameful and we would expect the Health Secretary to apologise and promise to review the basis of all statistics supplied by his service.
Scrapping NHS targets will save lives
24th June 2008
In a speech today to the Royal College of Surgeons David Cameron announced that the next conservative government will ditch Labour's internal NHS targets and patients will instead be simply told which hospitals get the best results. He believed that by giving patients information on performance and power over their own care it could save 100,000 lives a year.
He declared that Labour has "tested to destruction the idea that the NHS can be improved by more bureaucracy, more central control and more initiatives from the Department of Health. "Despite all the extra money, all the extra spending, we still have some of the worst health outcomes in the whole of Europe. Right now, England is near the bottom of the table when it comes to five-year cancer survival rates, far below countries like Sweden and Germany, and on a par with Slovenia and Poland.
"We have one of the worst records of diabetic control, especially among children. And it's awful that you're more likely to die from a stroke in England than you are in any other country in Western Europe. So we've got a situation where we pump the same money into our health system as other countries, but on the thing that actually matters, a patient's health and the results of their actual treatment, we're doing worse."
A Green Paper on NHS reform will be issued very soon that will include the pledge to increase British cancer survival rates above the European average by 2015 if elected while reducing premature deaths compared to other countries.
Under the Conservative proposals, all central targets would be scrapped and the Government would instead publish information on "healthcare outcomes", such as how long the average patient survives after contracting cancer; how many people live active lives while suffering from lung disease; and the chances of recovering from a stroke.
The scrapping of targets, now running at about a hundred, is supported by most health professionals since they result in perverse incentives. Cameron’s choice of attacking bureaucracy within the NHS and publishing outcomes rather than trying to micro manage through targets is encouraging.
NHS top-up care ban is unsustainable
18th June 2008
Alan Johnson, the Health Secretary, said yesterday that there would now be a review of the rule that patients who want to pay privately for drugs are not allowed to have them administered as part of an NHS course of treatment. Professor Mike Richards, the national director for cancer, has been asked to examine the issue and report back in October.
Recent cases where dying patients have found themselves banned from free NHS care after opting to pay for cancer drugs not available on the Health Service have horrified both doctors and the public. The policy undermined public confidence in the NHS and Nigel Edwards, the NHS Confederation director of Policy called the Government's position unsustainable.
This marks a welcome U-turn from the health secretary, who said previously that allowing top-ups “would sound the death knell for a founding principle of the NHS and lead to a two-tier health service”. It is understood that this change may have been brought about by expert legal opinion that the present policy would be torn apart if it was challenged in the courts.
Perhaps another question that now needs to be highlighted is why these eleven cancer drugs are routinely made available in other western countries for cancer patients yet they are not available on the NHS here. Alan Johnson says that this is a matter for NICE and not him. We would beg to differ. It is time that he exercised some authority!
The problems in the NHS pile up for the government
9th June 2008
These are not happy times for the government as past decisions are coming home to roost.
The clampdown on spending forced on the NHS by ministers has produced a surplus of £1.7 billion but this has led to criticism that the service is being starved of cash. (The true surplus is nearer £3 billion - see our report of the 27th May, 2008 - “Hospitals and Primary Care Trusts hiding their surpluses”).
New figures from the Office for National Statistics (ONS), show the gap between spending on patients in Scotland and England widening by 12% in just two years. The NHS and social services is spending £2,313 per head in Scotland compared to just £1,915 in England (2006/07). The figure in Wales was £2,109. Yet the government refuses to look at the Barnet formula for fear that it will cost them votes in Scotland.
Meanwhile doctors will vote next week on a resolution that they should resign from the NHS in protest at the government's plans for so-called "super surgeries". These plans would shut hundreds of successful practices to make way for polyclinics, designed to house up to 25 GPs as well as specialist services such as minor surgery and X-rays. It is estimated that 1,700 of England's 8,700 GP practices could be forced to shut under the plans. Ministers are insisting that the one size fits all policy is forced through in spite of objections from patient groups, doctors and charities for the elderly.
Local Government Associations are reporting that care for the elderly and disabled is "coming apart at the seams" with a study showing that three out of four councils have cut free home support services in order to save money. Only councils in Scotland are provided with enough money from the government to treat these groups properly.
Also in the last week further revelations about cancer patients being told that they will have to pay the NHS for their treatment because they followed their own doctors advice and bought cancer drugs not available to NHS patients to prolong their lives. The obscenity of such decisions which NHS managers insist result from directives by government ministers brings into stark relief the appalling way that this government puts doctrine before people.
Hospitals cancel more operations for non medical reasons
31st May 2008
16,800 operations were cancelled in England during the first three months of this year for non-medical reasons, an increase of 15% year on year. Norman Lamb, the Liberal Democrat health spokesman, claimed that the rise suggests that this is the latest casualty of the Government’s obsession with targets. "By rushing the treatment of certain patients to meet their 18 week target, other patients will have fallen by the wayside and seen their operations cancelled.”
Whilst many of the patients had their operations re-scheduled within 28 days, 1,025 had to wait longer. This represented an increase year on year of 20%.
A Department of Health spokesman denied that the cancellations were linked to the 18-week target, blaming instead a statistical blip. He repeated the mantra that the NHS was "firmly on track" to treat all patients within the time limit by the end of the year. He failed to apologise to patients hit by this statistical blip, who have suffered enormous distress waiting for vital treatments.
Is it now time for government health ministers to reflect on the benefits of piling pressure onto hospital trusts to meet targets at the expense of clinical priorities. Forcing hospitals to shuffle operations to bring forward simpler procedures to meet their targets is quite simply wrong.
Mixed-sex wards - Government problems with the truth
20th May 2008
Late last year the Health Secretary, Alan Johnson, said that the NHS was now within touching distance of eliminating mixed sex wards and that they would finally be abolished this year.
Sadly this turns out to be just more New Labour spin. Data provided under the Freedom of Information Act shows that two thirds of hospital trusts are still failing to provide single-sex accommodation which, according to the Government's own guidance, is single-sex bays with three solid walls where patients do not have to walk past opposite sex bays to get to the toilet or washroom.
Can we believe anything that government ministers tell us? The distortion of facts to fit the story has been legitimised by New Labour as necessary spin. They had pledged to end mixed-sex accommodation by 2002 and their spin to hide the truth since then has been shameful. In 2006 ministers were claiming it had been achieved in 99% of cases!
As we have said many times before, spin (aka lying) may sadly be regarded as an acceptable tactic of government in many ministries BUT it is shameful when used by the Ministry of Health. Lying to sick people is despicable and shame on politicians that resort to it.
Gordon Brown dithers over social care for the elderly
12th May 2008
Gordon Brown has called for a six months period of consultation on the future of social care for the elderly in England. He says that he believes that the system should be made better, fairer and affordable. He accepts that the present means-tested system can seem unfair.
The present system whereby those that have assets such as their home, which they had hoped would be passed on to their children, are forced to use these to fund their care needs whilst those that have no savings find that social services are having to severely ration what care they can fund.
Whilst the present system is bad it is forecast to get much much worse because of the aging population. Forecasters say that in the next two decades a quarter of the UK's adult population will be over 65 and the number of people over 85 will have doubled. Without radical reform the care system in England faces a £6bn shortfall within 20 years.
The Prime Minister has said that finding a solution is extremely difficult, indeed his health minister has said today that he has no idea what the solution could be, but, he and his health minister could look north of the border, where the devolved government have built a model that has abolished means tested social care. Pensioners in England will wonder why the Prime Minister is willing to provide the funding for his fellow countrymen there but is not willing to do the same for the English
The government appointed a Royal Commission into this matter in 1999, it produced a Green paper 3 years ago, and now Gordon Brown has launched a public consultation which means at least another year of talking rather than some action. This points to a government that is bereft of ideas and solutions and is just treading water hoping something will magically come along, or, trying to give the appearance of action whilst in reality kicking the matter into the long grass
Polyclinics threaten local GP surgeries
21st April 2008
David Cameron has launched a campaign to save the family doctor warning that one in five GP surgeries in England is threatened by government proposals. He said that the Government's intention to create a new generation of "polyclinics" will lead to the closure of about 1,700 family doctor surgeries and is “another example of the Government’s mistaken, top-down reform to the NHS”.
Polyclinics will combine GP, nursing and social care services in one place, and the Government insists that they will create more choice for patients. However, critics fear some patients will be left with long journeys to get medical care and argue that the relationship between patient and family doctor will be lost.
David Cameron said "What I object to is the Government's policy of imposing polyclinics on local communities without public support and in the face of opposition from doctors. “The NHS has suffered hugely from fads driven from Whitehall. And my worry, and why we’re launching this campaign, is that this is the latest fad. The Government has already tried to bring about the end of the district general hospital. Now ministers are trying to abolish the family doctor service. “Communities which have lost their Post Office, their local shops and their local police station, are now going to lose their doctor.”
Heath Secretary Alan Johnson has said Mr Cameron is "misleading the public"; he insists GP services will not be cut.
The British Medical Association has also criticised the Government’s “headlong rush” to replace GPs’ surgeries with polyclinics, which they fear will result in the “commercialisation of patient care” as private firms bid to run such centres.
The Conservatives are right to bring this issue to the fore. This government has too often run with the latest “ideas” without sufficient consideration. Such a radical change should not precede proper debate.
Patients are not the top priority of the NHS according to its staff
9th April 2008
Most staff in the NHS do not believe that patient care is their top priority according to a poll conducted by the Healthcare Commission, and, only 46% believed that their trust made care its top priority.
The poll contained a number of other startling results. Three quarters of staff believe that they are not valued by their managers, just over a fifth thought that there was adequate communication between them and their managers. Only 61% said that facilities to wash hands was available, this in spite of the drive in recent years to tackle Clostridium difficile and MRSA. Surprisingly then four out of five staff said their trust was doing enough to tackle these superbugs
There has been no reduction in the numbers of staff suffering physical abuse by patients and their relatives in the last year. One in four said they had been harassed, bullied or abused by patients or their relatives.
Half of those working in ambulances thought the vehicles were in a poor state of repair while 42% thought they did not offer a safe working environment.
Health minister Ann Keen responded to the findings saying the NHS was improving in many areas.
The findings of this survey are worrying. That healthcare workers do not believe that patients are their first priority, and even that their employers do not regard them as the top priority demonstrates clearly the fundamental problem of the NHS. It is a pity that the government missed the opportunity to restructure and refocus the NHS before it poured billions of new money into it. Sooner or later politicians will have to grasp this issue but until they do patients needs will run a poor second in the view of its staff.
Prescription charges rise, but only for the English
2nd April 2008
The prescription charge gap between Scotland and England widened yesterday to £2.10. In Scotland charges were reduced by 25% to £5.00 whilst in England they went up by 25p to £7.10. For patients with chronic conditions or cancer the reduction in Scotland is 50%.
Scottish patients already have free eye care and dental check ups, free personal care for the elderly, extra central heating grants and a number of drugs that are too expensive for the National Health Service in England and Wales. Scottish health ministers have also announced that they will eventually follow Wales by making prescriptions free.
Nicola Sturgeon, the Scottish Health Minister, said yesterday "The National Health Service is based on the principle that health services should be free at the point of use, no matter what the patient's income is. "We believe that prescription charges are a tax on ill health and a barrier to good health for too many people. "The reduced charges will mean that everyone who pays for prescriptions will pay less from today, making a significant difference to literally hundreds of thousands of Scots. "We want to support people living longer and healthier lives; and we intend to ensure that people have timely access to the health and social care services that they need. "We plan to reduce charges again next year and in 2010, before abolishing them altogether in April 2011."
Currently the NHS “earns” £500M from prescription charges, with most of this cost now falling upon English patients. It is reasonable to ask how in a NATIONAL Health Service costs can be subsidised in some parts of the country and not in others. As we have reported prescription charges are only one area of the NHS where patients in England are discriminated against, and surely it must now be time for the government to step in and sort this out. At the moment it seems that a succession of Scottish prime ministers and chancellors of the exchequer prefer to condone this unfair treatment rather than risk the wrath of Scottish labour voters.
Health voucher scheme announced by the Health Secretary
30th March 2008
The Health Secretary, Alan Johnson, has announced that he is bringing forward plans to give some patients with chronic conditions vouchers that will enable them to decide how and where their care should be provided.
Patients with acute conditions, such as multiple sclerosis and motor neurone disease and the most severe cases of other conditions, including asthma and diabetes will receive the vouchers that will allow them to shop around for care, arrange visits when they want, swap one type of treatment for another or buy their services from the voluntary and private sectors.
The Department of Health say that the vouchers cannot be converted into cash and so no money will leave the NHS as a result.
This scheme follows on from announcements that will allow elderly and disabled people to control the way care budgets are spent.
Mr Johnson said yesterday "Choice is a means to an end, the end being better quality and more personalisation of healthcare. "Choice, combined with payment by results, is an important driver of quality."
These schemes can only work however if there is real choice that can be exercised by the patient. For example it will require the NHS to bring together all of the league tables and reports produced onto their website so that members of the public can have a basis for making their choice of hospital or treatment in both the NHS and private sectors. Currently the NHS website fails to address this.
Extra Care housing initiative announced
3rd March 2008
The Health Secretary, Alan Johnson, used his speech at the Labour Party Spring Conference to reprise his speech to the main party conference last September (see our report “Another party conference but the same set of promises - 26th September, 2007). He told us again about his vision for a more user friendly NHS. He also urged GPS to agree to his proposals for longer opening of surgeries (up to an extra 3 hours a week).
His only “new” initiative appears to be to allow elderly couples to stay together when they go into residential care. He will unveil plans costing £40m to build more "extra care" housing, a form of very sheltered accommodation with care on hand, for frail couples to live in. This is aimed at those older people who would traditionally have been accommodated in sheltered housing, residential care or nursing homes, and can include very high level nursing care needs, including palliative care for the terminally ill.
On the face of it this is a good proposal but we look forward to seeing the details when they are published. We are anxious to ensure that this is more than just a cost saving proposal.
NHS dentists treat half a million less patients
29th February 2008
New data published by the NHS Information Centre shows that half a million less patients were seen by NHS dentists in the two years after the new dentist contract was introduced compared to the two years prior. Figures also show a drop in the amount of complex work being carried out. These patients have been forced to either pay for expensive private care or go without treatment.
The deal was designed to allow dentists to spend more time with NHS patients in a bid to make the profession more attractive. But last month, a British Dental Association survey revealed that more than 1,000 dentists had stopped providing state-funded care since the introduction of the new contract.
Susie Sanderson, of the British Dental Association, said: "Today's statistics offer fresh evidence that the government's reforms to NHS dentistry have failed to achieve the stated aim of improving access to care for patients. "The reforms have also failed to allow dentists to deliver the kind of modern, preventive care they believe their patients deserve."
A government spokesman said it was confident access would improve in time.
Our report on 16th January, 2008 (More that seven million patients can’t find an NHS dentist) provides further background to this.
It is clear that NHS dentistry is in crisis. The new contract has failed in its purpose of providing easy access to an NHS dentist. Is the Prime Minister brave enough to admit it and look to find a proper solution?
Its official - The GP contract was a bad deal for patients and the taxpayer!
28th February 2008
The National Audit Office (NAO) has today reported on the GP contract introduced in 2004. Its damning report shows that practice partners now work seven less hours a week on average, but earn 58% more. Also the overall cost of the contract is £1.76 billion over budget but this was not properly funded by the government, leaving primary care trusts to pick up half of the overrun from other budgets.
When the contract was announced ministers said that it provided incentives for GP practices to improve quality of care but these hoped-for gains in productivity did not occur with productivity falling in the two years by an average of 2.5 per cent a year. Controversially it also provided for GPs to be able to opt out of delivering out of hours care.
The report also highlights a disparity between practice partners who boosted their own income by 58% yet paid salaried GPs only an extra 3% in the two years examined.
Karen Taylor, the director of health at the NAO said that the contract was a “bad deal” for patients and taxpayers. The shadow health secretary Andrew Lansley commented "The government's negotiation of the GP contract was incompetent and hopeless." Ben Bradshaw, the health minister, in a pathetic attempt to spin the conclusions of the report said that the new GP contracts had improved the quality of care for the public.
Department of Health - "Delusional"
25th February, 2008
Computer Weekly has published papers obtained under the Freedom of Information Act that show the Department of Health (DOH) drastically underestimated the time it would take to make electronic patient records available online. This followed pressure from Tony Blair to shorten the timetable for the NHS IT programme to ensure demonstrable results for patients in time for a general election in 2005.
The DOH promised systems would provide "seamless" care across the NHS by 2004/05 This has proved hopelessly optimistic. Access by patients and doctors to national summary care records are even now only at a trial stage. And contracts for the delivery and implementation of new national systems run until 2013 - eight years later than the timetable then issued by the DOH.
These papers raise real questions about whether the timetable was geared towards a general election, rather than the practicalities and complexities of the scheme, and whether the DOH put politics before realities in promising the programme in less than three years.
Paul Cundy, GP IT spokesman for the British Medical Association, said it appeared that the DOH had been "wildly, even delusionally, optimistic about the timetable for the NPfIT in order to secure funding".
So it appears that political pressure from Tony Blair in a 45 minute meeting in February 2002 may have resulted in a £12 Billion IT commitment that has so far spectacularly failed to achieve its objectives. It is disgraceful, but after 11 years of New-Labour spin are we really surprised?
NHS reform: national mantra, not local reality
11th February 2008
An influential think tank claims that reform of the National Health Service is stalling as Britain continues to fall behind comparable countries in Europe. The study, by the Reform think tank, says ministers and the Department of Health, are "in denial" over what is going on in the health service.
The NHS cannot cope with a combination of an ageing population, economic pressures, expensive new technologies and a population with constantly rising expectations, according to the report.
Claims by the government that its change agenda, which brings more patient choice and expansion of the private sector’s involvement in providing NHS care is profoundly misleading. "Each of the reform programmes is either far behind schedule or in actual retreat," according to the report. Without a meaningful reform the NHS will decline, providing substandard quality and access.
The Report highlights the need for a drastic change of approach to achieve more value out of the vast amount of money going into the NHS. It states that central policy is not the answer to the problems, instead an end to the inefficiencies of a huge bureaucratic system is needed. "The NHS needs an economic constitution which gives every level of the service the duty to achieve value for money.”
The report, NHS reform: National Mantra, Not Local Reality, highlights seven international studies last year that showed Britain was falling behind on a number of key measures. Britain's infant death rate is the 4th worst among 25 countries. Maternity services are causing "grave concerns". Child wellbeing is lower than in any of 21 other industrialised countries. Death rates for stroke victims are the 3rd highest among 11 countries. Diagnosis of dementia takes longer than anywhere else. Waiting times for surgery are longer than in most European nations. Mental health patients wait up to two years for psychological therapies.
Nick Bosanquet, professor of health policy at Imperial College London and a consultant director of Reform, said: "The NHS does not need a 'charter' which amounts to a statement of good intentions. "It needs an economic constitution which gives every level of the service the duty to achieve value for money."
More squabbling over GP surgery opening hours
4th February 2008
The government is taking the British Medical Association (BMA) head on today over surgery opening times. It is writing to every GP to ask them to extend evening and weekend opening.
Alan Johnson, the Health Secretary, has thrown down the gauntlet saying that it will impose a settlement if agreement cannot be reached with the BMA. One of his minister’s, Ben Bradshaw, has claimed that the BMA has misrepresented the government’s negotiations with them to the GPs.
The BMA’s refusal is because it claims that the government’s real agenda is to privatise services and undermine traditional general practice. It also insists that any agreement for longer opening hours must be paid for by the Department of Health. The average size surgery would be expected to open for an extra three hours a week.
The chairman of the BMA's GPs committee, Laurence Buckman, believes that this is a case of softening up GPs "Patients are being prepared to view their GP as not very good and not very willing and not very flexible, and as a result to look kindly on the government's currently favoured model which is that patients should receive general practice from polyclinics." He believes that this could herald the demise of traditional general practice with its focus on continuity and quality of care.
In October Ben Bradshaw said, in dismissing a Royal College of Physicians (RCP) recommendation for better out of hours care provision, "We are already making sure that people have access to care around the clock”. It makes this u-turn all the more surprising then!
In spite of its vacillating minister the government is desperately trying to paper over the hole left by its failure to negotiate an acceptable contract with GPs in 2004. As a result GPs are earning more money for less work. It is long overdue time for action instead of this squabbling!
Mixed sex wards to stay in spite of this government's previous promises
29th January 2008
Yesterday the health minister Lord Darzi said “We'll never achieve single-sex wards. “ It is an aspiration that cannot be met.” So ends Labour’s commitments made in 1997 and 2001. Of course the government’s spin machine is now trying to repair the damage by suggesting that their commitment can be met by having a curtain drawn between men and women patients. This was certainly not what was envisaged as recently as last May when the then health secretary said that more must be done to meet their commitment to eliminate mixed-sex wards and that partitioned bays were "not good enough".
Tony Blair famously asked in 1997 if it was beyond the collective wit of government to deal with this issue. Well apparently it was beyond his and Brown's!
Darzi’s admission follows on from a department of health (DOH) official’s low key announcement made over the Christmas period that single sex wards were no longer an aim.
One could say that this is simply coming to terms with the reality since eighty percent of patients are not properly segregated today, after 10 years of this administration. In spite of the fine words of the prime minister, manifestos and speeches by health secretaries it has simply never been made a priority...the words had achieved all that was ever intended. As we have said before, spin may be a necessary evil in many departments of state however in the health department it is shameful.
Gordon Brown announces health screening plans
7th January 2008
In an attempt to improve his public image Gordon Brown has pushed his health ministers aside to announce himself BUPA style health screening inside the NHS.
The Prime Minister’s headline grabbing statement is that every adult will be given a “health MOT”. It will target groups such as middle aged men at risk from heart disease, stroke, kidney disease and diabetes. The screening will be carried out by GPs or private contractors. Eligibility however will be based on postcode studies pinpointing the parts of the country where high rates occur. The PM wants to “turn the NHS into a preventative health service in its 60th anniversary year”. A health MoT would check patients' blood pressure, cholesterol levels and BMI - and would test their urine for signs of diabetes. The first test offered will be an ultrasound check on men 65+ to detect signs of abdominal aneurysm , a weakening of the artery from the heart to the abdomen which kills 3,000 men a year.
We must remember that this is simply an announcement about an announcement that may be made some time later in the year. We will have to wait for the detail now to see if the hype matches the reality. New Labour’s track record on this is not encouraging!
Mixed-sex wards to stay in government u-turn
22nd December 2007
This government has kept up its tradition of trying to bury bad news whilst parliament isn’t sitting and while most of the country is preparing for Christmas. This year it is mixed sex wards in our hospitals. Bringing an end to such wards was a key manifesto commitment in both 1997 and 2001 but the Department of Health have quietly announced that this is no longer an aim. Since 1997 there have been a number of deadlines - all missed! And, all attempts to spin their way out of the issue were shown to be little more than apparently deliberately misleading statistics.
These Nightingale wards are undignified, degrading and put women at risk of attack from male patients. In spite of £120m being allocated in 2001 to solve this problem, ongoing financial problems in hospitals have meant that a third of our hospitals are still treating men and women in mixed sex wards.
Tony Blair famously asked in 1997 if it was beyond the collective wit of government to deal with this issue. Well apparently it was beyond his and Brown's!
New cancer plan announced
4th December 2007
Seven years on from the announcement of New Labour’s “Cancer Plan” survival rates in the UK are still below the European average with patients denied access to the latest generation drugs that are freely available in other countries including Scotland. Current forecasts are that by 2020 we will have 299,000 cases of cancer each year compared to 224,000 today.
Yesterday the Government announced a new plan designed to deflect the criticism that in spite of the money spent since 2001 the cancer strategy has been a failure. The focus of the new plan is to get across the message that over half of all cancers could be prevented if people adopted healthy lifestyles such as stopping smoking, avoiding obesity, eating a healthy diet, undertaking a moderate level of physical activity, avoiding an excessive alcohol intake and avoiding excessive exposure to the sun. It will speed up approval of new drugs and expand radiotherapy, and, it will encourage people who fear that they may have cancer to see their GP immediately and GPs to refer patients to consultants faster. Alan Johnson, the Health Secretary, announced that the plan would cost £370 million by 2010
The announcement is welcome but spending on the disease will still be below the levels in for example France, Germany and the US and so is unlikely to bring survival rates up to their levels. Also it does not address the “postcode” lottery whereby new drugs are made available in Scotland but not in England.
The Prescription Gap Widens
13th November, 2007
In a new ruling the National Institute for Health and Clinical Excellence (NICE) have decided to deny 200,000 arthritis sufferers a drug that is already available in Scotland.
People suffering with ankylosing spondylitis, a form of spinal arthritis, have been told that NICE will not approve the drug infliximab, which costs £15,000 a year. There are currently two drugs licensed for treating this form of arthritis costing £5,000 less. But bizarrely if patients fail to respond to one they are not allowed to try the other. Trials of infliximab are claimed by patients to have transformed their quality of life.
In Scotland there is a different method of evaluating the cost effectiveness of drugs and this has resulted in a significant number of the new wonder drugs being made available by the NHS in Scotland compared to the rest of the country. We reported before on NICE’s decision to reject the drug Macugen for the treatment of age-related macular degeneration, the most common cause of blindness in the elderly, and to restrict another drug, Lucentis, to patients who had already gone blind in one eye and who were considered to be at great risk of losing sight in the other eye. In Scotland both drugs are approved.
The list of drugs available in Scotland but not in the rest of the country also include Alimta and Tarceva - lung cancer drugs, Bonviva and Fosavance – osteoporosis treatments, Erbitux - a head and neck cancer drug, Aricept, Exelon and Reminyl - alzheimer’s drugs, Gliadel – an implant used in the treatment of brain tumours, and Velcade – used in the treatment of bone and marrow cancers.
We have commented before on this iniquitous post-code lottery. Is it not time that the prime minister stepped in and made the same drugs available to patients in the rest of the country that are available to his own constituents?
The Queen's Speech lacks measures to improve healthcare
7th November 2007
The Queen’s speech yesterday contained few measures to support the Prime Minister’s promise one hundred days ago that he had listened to the voice of the people and had decided to make health his key priority.
We are promised the long overdue appointment of a regulator, the Care Quality Commission, to oversee health and social care in England by bringing the functions of the existing Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission together.
This is of course a welcome move in the right direction but does little to deal with the inherent problems of our healthcare system. It does not deal with the postcode lottery that exists today (including the growing disparity in healthcare provision between Scotland and the rest of the country), nor the failure to provide the elderly with quality healthcare, nor the lack of any productivity improvements in the NHS, nor the crisis of out of hours GP cover... we could go on!
Tories plan independent NHS
4th November 2007
The Tories have unveiled their latest plans for the NHS in England. Andrew Lansley, the shadow health secretary, announced an NHS (Autonomy and Accountability) Bill that would be introduced as one of the first acts of a Conservative government.
The main changes proposed include:
The allocation of the £90 billion a year NHS budget switching from the Department of Health to a new, independent NHS board. There has been much criticism of the practice of the government in diverting funds for political expediency to areas that are not in most need.
Responsibility for determining national standards of care and determining the treatment to which patients will be entitled for all different conditions. The Conservatives want patients to be able to see for themselves the treatment to which they are entitled.
Set a framework for reducing bureaucracy in the NHS in order to free doctors and nurses to concentrate more on the delivery of care and away from "political tinkering".
Making the National Institute for Health and Clinical Excellence independent, and giving patients a "stronger voice" through a new body - Healthwatch.
An NHS constitution which would enshrine the principles of the health service.
The government have predictably poured scorn on the proposals saying that there must be direct political accountability over the £90 billion spent on the NHS.
We think that the Tories should be applauded for generating a debate on how the service should be run. There is much to commend in their plans and some which will require improvement but compared to the government’s head in the sand approach it is welcome initiative.
70,000 Britons go abroad this year for medical treatment rather than risk using the NHS
28th October 2007
Ten years ago New Labour told us that voting for them was the only way to save the NHS. The over forty billion pounds that has been spent since then to improve the service should by now have delivered a world class service. That it has not is an indictment of Blair and Brown’s stewardship.
We have seen record numbers of Britons going abroad for their medical treatment or signing up to private health care schemes. It is estimated that 70,000 will go abroad this year to receive treatment. Fear of hospital acquired infections and waiting lists are cited as the major reasons. India, Germany, Spain, France and Turkey are amongst the main destinations where patients can get for example major heart surgery, hip operations and cataracts at affordable prices and without the delays experienced here.
The state of NHS dentistry is no better with 20,000 seeking treatment abroad last year, many of them going to Hungary. This has been fuelled by the changes to NHS dental contracts which have resulted in patients struggling to find a dentist.
The government are in a state of denial. When critics complain about the NHS Gordon Brown and his ministers trot out statistics spun to persuade the public that all is well. But until they address the underlying causes of the problems nothing will change and more Britons will conclude that the NHS can increasingly only provide a third world health service. Profligate spending is not a solution. Sooner or later we will have to tackle the bureaucratic problems that beset it as well as putting the patients needs in front of those of the organisation. The longer this is delayed the harder it becomes whilst at the same time bringing closer the debate on healthcare in Britain without an NHS.
Department of Health knew all about the Kent superbug report months ago
22nd October 2007
Shadow health minister Andrew Lansley has claimed that the Department of Health knew of a damning report into an outbreak of Clostridium difficile at a hospital trust in Kent more than five months ago and failed to act. (see “Report catalogues hospitals catastrophic failures in tackling C difficile” on 11th October, 2007 and a follow up article on the 15th “The Health Secretary tries spin to deflect blame”).
It appears that the department received the initial draft report by the Healthcare Commission on May 3 and a further draft on September 12. Andrew Lansley is accusing ministers of not taking action until there was a public outcry about the scale of the outbreak. The chief executive of the Kent trust resigned shortly before the final version of the report was published but it was after this that the health secretary, Alan Johnson, decided to try to hold a severance package, thought to worth £250,000. He had the power to suspend this and other officials before the severance package was agreed.
Given the seriousness of the findings in the report and the number of deaths that resulted from the catastrophic failures to tackle hygiene at the trust’s hospitals Alan Johnson must now answer the questions that the shadow health minister has posed…
“When did you or (your) ministers see the draft report?”
“If you saw it, what action did you take?”
“If you didn’t see it, why not?”
Andrew Lansley concludes that “something has clearly gone wrong within the Department of Health and I think for the good of the NHS we must know what that is as soon as possible.” We agree!
Now the Scots get free prescriptions
22nd October 2007
We have reported many times on the inequality of healthcare between the populations of Scotland and England. The Scots funded by the Barnet formula which gives each Scot an extra £1,500 each (20% more) compared to residents of England and Wales, get significantly more health care. This includes free personal care in nursing homes, free eye tests and dental check-ups for the elderly, no means testing for pensioners heating costs, and access to the latest drugs which are considered too costly south of the border.
Now the Scottish Health Minister, Nicola Sturgeon, has announced that from 2011 all Scots will not have to pay prescription charges. The cost of this will be £70 million a year (£50 million in lost revenue and a further £20 million in increased costs as patients seek prescriptions when previously they simply bought the item over the counter). Currently patients in both Scotland, Northern Ireland and England pay £6.85 for each prescription which generates £500 million a year. The Welsh assembly abolished prescription charges earlier this year.
How much longer will taxpayers in England be expected to put up with this iniquitous post code lottery? The government has consistently refused to re-open the Barney formula when patently it is no longer meaningful. Even Lord Barnet, who introduced the formula in the 1970’s when he was the Financial Secretary, believes that it should be overhauled – see our report – “The growing disparity in healthcare provision between Scotland and the rest of the country” on 13th July 2007.
It is common sense that the formula should be based on real need in the country as a whole and not political expediency. This government, through its failure to act, is demonstrating that it cares more about Scottish votes than the healthcare needs of the rest of the population.
New report catalogues ongoing failure to achieve hygiene standards in hospital wards
18th October 2007
The Healthcare Commission have carried out a new review of hygiene standards in the NHS. The findings show that a quarter of trusts are failing to meet acceptable standards. The Commission looked at 394 NHS organizations and found 111 trusts where patients were not adequately protected from infections such as MRSA and Clostridium difficile. The worst performing trusts were:
Northern Devon Healthcare
Royal Cornwall Hospitals
Surrey and Sussex Healthcare
West Hertfordshire Hospitals
They found that in 12 trusts senior managers had signed declarations stating that they were complying with the standards but when audited were found to be in breach of them. Grounds for their dismissal?
The report can be accessed at:
http://www.healthcarecommission.org.uk/
This comes on top of the revelations last week about the Maidstone and Tunbridge Wells Trust (see our reports of 11th and 15th October 2007) where hundreds of patients had died from C difficile as a result of appalling standards of hygiene.
The Health Minister, Ben Bradshaw, said today that progress is being made and that … just because these trusts do not meet one of these codes does not mean that their treatment or the hospitals are unsafe, or that patients need to worry about them." Until Bradshaw and his boss Alan Johnson stop spinning and take real action too many patients will continue to die from superbugs in our hospitals. Britain has the worst record on hospital acquired infections in Europe. If they don’t know what to do perhaps if they visited their opposite numbers across the Channel they would learn how to bring down the levels of infections.
E-Petition... Not to deny people in the early and late stages of Alzheimer’s Disease access to drug treatments
17th October 2007
We reported on 11th August 2007 (NICE win court case to deny drug to patients with early stage Alzheimer's) that campaigners had lost their bid to have the courts force the NHS to fund a drug for people with early stage Alzheimer’s. There is now an E-Petition on the 10 Downing Street website 'Not to deny people in the early and late stages of Alzheimer’s Disease access to drug treatments'. The E-Petition link is:
http://petitions.pm.gov.uk/alzheimerdrugs
The deadline is 10th January 2008. We urge you to sign it.
The Health Secretary tries spin to deflect blame
15th October 2007
As a post script to the Maidstone and Tunbridge Wells debacle, see our article “Report catalogues hospitals catastrophic failures in tackling C difficile” on 11th October 2007, the government are desperate to have us believe that this case is the exception and not the rule. Firstly the Health Secretary, Alan Johnson, stepped in to block the payment to Miss Gibb, who left her post as head of Maidstone and Tunbridge Wells NHS Trust by "mutual agreement" at the end of last week, even though he probably does not have the authority to do so. But it gave him some positive headlines when they were as rare as hens teeth for New Labour in the last week.
Encouraged by this he told parliament today that he hoped MPs would recognise that "the awful failures" were entirely unrepresentative of the standards of care expected and delivered in hospitals across the country. This is a clear attempt to whitewash the government’s lack-lustre performance on dealing with superbugs in our hospitals. In fact there were 20 hospitals with a worse level of C difficile in 2006. The worst, Kettering, has a rate of infection 84% worse than Maidstone and Tunbridge Wells. If Mr Johnson is to have any credibility he needs to recognise that spin may be acceptable in some ministries but in health it costs lives!
Means testing of care under review
10th October 2007
According to Niall Dickson of the King's Fund the government may be about to scrap means-testing for long term care of elderly and disabled people in England. He points to comments made in the Comprehensive Spending Review yesterday by Alistair Darling that a green paper is planned to look at the issue.
This morning the Chancellor appeared reluctant to be drawn on the detail however he did say that he would like to move to a system coupling universal entitlement with a top-up co-payment. But, this clearly would not remove the means testing which forces people to sell their homes to pay for the care that they need.
In 1999 the previous Chancellor ignored the recommendations of the Royal Commission on Long-Term Care, which called for all personal social care to be made free to the patient. The move was taken up in Scotland (where Alistair Darling has his parliamentary seat) which benefits from significant extra funding from the Treasury than authorities in England and Wales receive.
We have previously reported (19th September 2007) on the low levels of funding provided to local councils outside of Scotland for social care and how these were now forcing social services to turn people away that are in desperate need of support and care. We reported then that already two thirds of councils have stopped funding the bottom two levels of care and with an extra 400,000 people now entering the age bracket that will need social services care provision the service is approaching crisis. It is to be hoped that the Chancellor is not simply grabbing headlines and that he intends to tackle this issue.
Lord Darzi's review of the NHS - a missed opportunity
5th October 2007
Lord Darzi stands accused of being a pawn in that dirty game of politics. Persuaded to carry out a detailed review of the health service and then to bring forward his conclusions to fit with Gordon Brown’s election plans. After just twelve weeks he appeared in front of the media this week to announce his conclusions.
What has he come up with? Simply more central control of the NHS. Of course there are some sensible points contained in his report – the need to sort out the damage caused by this government’s disastrous 2004 agreement with GPs and improve access to doctors surgeries. More must be done to combat MRSA, and that the NHS must do better on outcomes for stroke patients. Does any of this represent a truly fundamental review of our health service? No, it contains some quick fixes for issues that embarrass this government, some London centric solutions, and kicking into the long grass of next May the detail of what cuts in local services are a consequence of Lord Darzi’s report.
The prospects of an election will produce a rash of “fixes” by the political parties and we can hope that the promises made will be of some benefit to the NHS. Sadly this report by Lord Darzi will go down as an opportunity missed.
The elderly suffer inhumane and degrading treatment in the NHS
27th September 2007
Tony Blair said in 1996 that it could not be "beyond the wit of government and health administrators" to eliminate mixed-sex wards. In New Labour’s 1997 and 2001 manifestos the party committed itself to abolishing them. So perhaps it should come as a surprise that today almost one in four elderly patients are still forced to suffer the indignity of being treated on mixed-sex wards.
The Healthcare Commission have issued a report cataloging a series of failings showing that elderly patients are subjected to abuse and violence, as well as neglect. As well as mixed-sex wards the report highlights elderly patients left in soiled clothes or forced to use lavatories or bedpans in front of other people, even given food they are allergic to or can choke on.
Eighteen of the 23 hospital trusts studied by the health services watchdog were found to be failing to care properly for the elderly. Eight Trusts were formally warned for failing to meet core standards. These were: Barts and the London NHS trust, Hull and East Yorkshire Hospitals NHS trust, Luton and Dunstable Hospital NHS Foundation trust, Oxford Radcliffe Hospitals NHS trust, Princess Alexandra Hospital NHS trust, Harlow, Essex, Queen Elizabeth Hospital NHS trust, Greenwich, south-east London, West Dorset General Hospitals NHS trust, West Hertfordshire Hospitals NHS trust.
The Commission calls the treatment "inhumane and degrading".
Ivan Lewis, the minister for social care, said that the report concerned him and he is announcing new action plans, but we should not forget that the government has tripled investment in the NHS.
So the virtual NHS is still alive and well under Brown’s leadership! The promise by the Health Secretary this week to make the NHS more “personal” is shown up as just a cynical attempt to grab some headlines. In the Real NHS patients are still being treated in an inhumane and degrading manner, and that Mr Johnson IS personal to each and every one of them!
You can read the report here:
http://www.healthcarecommission.org.uk/homepage.cfm
Another party conference but the same set of promises
26th September 2007
Alan Johnson, the Health Secretary, has used his speech at the Labour conference to give some detail on how he and Gordon Brown will make meaningful changes to the NHS.
In between trumpeting his party’s “proud record” of increasing funding to the health service he talked about making the NHS more user-friendly and improving standards.
Like his predecessors he again promised personal safety alarms for frontline staff most at risk of assault by the public and also pledged tougher powers for inspectors to shut infected wards that could endanger patients' lives. Again this is a pledge that has been made a few times over the last ten years.
He also said that the government would reshape the NHS to become "clinically led and locally driven" by trying to treat patients closer to home where possible. "GP surgeries should be open at times and in locations that suit the patient, not the practice."Pharmacies, sports centres and high street walk-in centres can do much more to provide primary care effectively and conveniently."
We will watch with interest to see if the promises of this health secretary are any more likely than his predecessors to be translated into action.
Brown says he is committed to improving the NHS...again
24th September 2007
The Prime Minister said this weekend that he has listened to the voice of the people (how?) and has decided to make health his key priority. This seems to be little more than a re-statement of what he said when he became Prime Minister. Over the weekend we have witnessed a plethora of “promises” from him… from a blitz on superbugs in our hospitals to tougher targets on cancer treatment.
This is of course welcome if it brings any better attention to the sorry state of healthcare in this country. Gordon Brown was the architect of the massive increase in NHS funding which was injected before sorting out the inherent problems of the service in the foolish belief that simply pouring money in would act as a catalyst for the changes that everyone knew were needed.
This weekend The Observer published the results of an investigation that it had carried out. This showed that the NHS is facing £4.5bn in compensation claims over alleged blunders by midwives and doctors that have left babies suffering severe brain damage. Other papers detail other blunders from malfunctioning equipment causing for example brain damage to surgeons drilling holes to the wrong side of a patient’s head.
The Department of Health have responded to all of this by saying that only a small number of errors will have serious consequences.
Whether or not the Prime Minister’s re-statement of his commitment to improving the NHS is a result of election fever, lets hope that the consequence is meaningful action rather than more of the Blair strategy of simply grabbing headlines.
Councils failing to provide social service care because of lack of proper funding
19th September 2007
Councils across the country are failing to provide social service care. Since 1997 they have received increases in their budget from central government of 14%, which compares to a 90% increase for the NHS. Over this time they have been told by ministers to provide significantly more care in the community and even penalising them if they fail to remove elderly bed-blockers from hospitals.
Sir Simon Milton, the Local Government Association Chairman, said yesterday that rationing of social care would get worse if councils did not get adequate funds in the next government spending settlement. Ministers have already warned councils to expect a tight settlement over the next three years in the forthcoming comprehensive spending review. Councils believe that they need an annual increase above inflation of 2% if they are to stand any chance of meeting their obligations.
Already two thirds of councils have stopped funding the bottom two levels of care and with an extra 400,000 people now entering the age bracket that will need social services care provision the service is approaching crisis. Sir Simon is arguing that if necessary councils should be able to use some NHS funds since he argues that social services are more efficient at spending monies, and, using these funds for preventative measures would reduce the numbers having to spend time in hospitals.
We have reported (see 3rd September 2007 article – the appalling state of financial management in our health service) that a financial crunch is going to hit the NHS as managers find that the amount of new money is significantly reduced in the next spending settlement and so hiving off some of their budget to pay for social services is probably not a meaningful option. Government ministers have been piling additional work onto social services for many years without the funding needed to implement them. It is time for a mature and adult debate!
The NHS plan has failed to deliver
11th September 2007
Sir Derek Wanless, who was the man appointed by Gordon Brown in 2002 to rubber stamp the NHS plan, has now said that the £43 billion that has been spent in the last five years on the NHS has failed to deliver a first-class healthcare system.
In a report for the King’s Fund he states that the benefits of the extra spend were eroded by poor productivity, the huge pay rises given to GPs and consultants, IT delays and a worsening in the British lifestyle that is fuelling an obesity crisis.
Wanlass now believes that the NHS has failed to deliver even the modest productivity improvements anticipated in the 2002 plan. Costs have risen alarmingly and there is no evidence that the NHS improved productivity by raising the quality of its service. Whilst more people have been treated this occurred mainly where patients were admitted as emergencies.
The report predicts that if funding for growth is cut back, as is widely predicted (see our 3rd September, 2007 report “The appalling state of financial management in our health service”) then the NHS will slip back to the bottom of the European health league table.
His conclusion that we are not on course to deliver the sustainable and world-class health care system, and ultimately healthier nation, that we all desire is a damning comment on this government’s stewardship of our healthcare.
NHS reforms have failed patients
9th September 2007
Harry Cayton, the man who until a month ago was the NHS patient tsar, says in a valedictory speech that patients' needs have been ignored under Labour's reform of the NHS.
He highlights the endless rounds of re-organisations with in the health service and the GP contracts introduced in 2004. He complains that his job was hindered by a plethora of policy changes introduced by government health ministers, some that he considered were not driven by the needs of the public.
He reserved some of his criticism for the British Medical Council (BMA) which he calls the most conservative union he had ever come across, which recoiled in horror at any sign of progress. He said that it opposed choice for patients, the new IT system, and resisted attempts to get doctors to provide copies of their letters to patients.
This is a damning report on New Labour’s 10 years of managing our health service. None of it will be news to those involved in the sector, either as patients or workers. Given the huge amounts poured into the NHS it is a public disgrace. No one comes out of this favourably, including the conservative party, who as the main opposition party has failed to hold this government to account. But it is New Labour’s ministers that must take the brunt of the blame, their failure to grasp the opportunity to introduce meaningful change to the NHS has consigned patients to another decade of unsatisfactory treatment, leaving us looking enviously across the Channel where good health care is routinely delivered.
DOH procrastinate whilst out of hours services complaints soar
9th August 2007
New figures show that complaints over doctors out of hours services have soared since the changes to GPs contracts. Figures published by the two leading doctors insurance companies, covering the vast majority of all GPs show that the number of cases that they are dealing with have tripled when compared to 2003 before the new contracts came into effect.
Ninety percent of GPs have taken up the option to opt out of providing night and weekend cover leaving local PCTs to cobble together some level of out of hours care. The Department of Health have responded by delivered their usual mantra that out of hours service is subject to national standards and that this is being monitored. This of course does not mean that they really believe that an acceptable service is being delivered consistently across the country. Tellingly they say that they don’t centrally record complaints against GPs out of hours services… why not??? They then state that in their view the patient experience is positive… how do they know when they fail to collect proper statistics?
We have been reporting for some time the problems that patients are experiencing with the out of hours service. Gordon Brown has said before becoming prime minister that he would address this issue. Gordon we are still waiting!
The growing disparity in healthcare provision between Scotland and the rest of the country
13th July 2007
At Prime Minister’s Question Time this week Gordon Brown was taunted over the decision to delay the implementation of the nurses pay increase in England until November, when in Scotland it is being paid now. Of course he failed to properly answer the question.
The problem is not limited just to nurses pay. There is also for example extra care home funding for the elderly in Scotland, with free personal care being provided for all. And, the problem extends beyond healthcare with Scottish university students not having to pay the tuition fees that English ones do.
Gordon Brown responded that from November nurses in England would receive the same pay, so where was the problem. When pressed further he simply stated that the House had voted to allow the Scots devolution and it would now be wrong to question this.
The real cause of these disparities is the Barnett funding formula whereby Scots received nearly £1,500 more per head in public spending than the English. This formula was created in the 1970’s by Labour’s Lord Barnet when he was Financial Secretary to the Treasury. In the House of Lords last month he said "the Treasury's latest figures on public expenditure per head of population show that in England it is £6,949, but in Scotland £8,414. "Those figures are clearly in need of a change. "Surely, the least that you can agree is that there should be a review of the current formula, to see that we have one based on genuine need."
The government minister, Lord Davies, refused saying "We have no plans to change the formula at this stage.”
Surely it is iniquitous that such a formula should in effect go on in perpetuity instead of being reviewed, as its originator has repeatedly requested, based on genuine need. Scotland, with its bloated public sector, is being subsidised by English taxpayers creating a two tier health service to the detriment of those resident in England.
This is not somewhere that the new Prime Minister wishes to be cornered, ever fearful of the West Lothian question whereby the Scots are significantly over represented compared to English and Welsh voters in the Commons, and the thorny question of Scots MPs voting on matters concerning England when English MPs have no say on the same matters in Scotland.
We feel that it is time that the growing disparity in healthcare provision between Scotland and England should be addressed.
Gordon Brown cuts hospital budgets
30th June 2007
One of Gordon Brown’s last acts as chancellor was to cut the hospital building and equipment budget for this year. This after his promise that the NHS was his “immediate priority”. In the March budget Brown said “the money available for investment and reform in the NHS in England will be £8bn more than this year, the biggest cash increase ever”. But it appears now that this only referred to spending on day-to-day NHS services. Once again we find that when Gordon Brown speaks we must look for the detail. He is as accomplished at the dark arts of spin as Blair.
He has cut the capital budget of the English NHS for 2007-08 from £6.2bn to £4.2bn. No additional money has been found for the day-to-day needs of the NHS in spite of its well publicised cash troubles.
The implication behind the cuts is that there will now be a very tight settlement for the health department for the next three years when the next Comprehensive Spending Review is published in October and indicates that a slowdown is planned in hospital building. The PFI hospital programme had already been cut from £12bn to £8bn, with more reductions predicted.
Last night the Treasury confirmed that there had been an “adjustment” to the capital budget but hinted that it would allocate the missing £2bn to spend over the three years from 2008-09. But, since there are no published health spending plans it wont be possible to verify this.
It is worth pointing out that he did not make the equivalent cuts to the Scottish and Welsh NHS budgets. We will be returning to this issue later!
The NHS under Brown - a fresh start?
28th June 2007
All change at the Department of Health! Patricia Hewitt is out as the health secretary and Alan Johnson is in. On the face of it this is most welcome news. We have been critical of Hewitt’s performance in promoting the concept of a virtual NHS, ignoring the inconvenient truth that the NHS is a long way from delivering a world class service.
However briefings given over the last 24 hours to the scribblers appear to have a consistent theme, that Johnson has been given the job to improve the presentation of the NHS, and not to start a root and branch review.
If this is true then the new Prime Minister’s promise that one of his priorities is “change in our NHS” means only how it is spun! We at Careworld would be very disappointed if this were indeed the case.
Of course we recognise the difficulty for someone so intimately involved in the decisions taken on the NHS over the last 10 years to now ask for fundamental changes, but we are at an important crossroad for the service and failure to deal with the issues now will condemn the NHS to a future as a red giant… unsustainable expansion eventually leading to collapse and explosion.
There is a real opportunity now to remove party politics from the NHS. The appointment of an independent board to run it (as proposed by the conservatives, and in the past favoured by the new Prime Minister) would allow an experienced executive to perform the radical overhaul of the service that is long overdue, cutting bureaucracy, moving control of budgets to the front line etc, and to apply its policies consistently.
For the first time in a generation there is the possibility of cross party agreement on the proper level of state funding for the service. But there are some tricky problems that need to be tackled now and not ignored… for example:
(i) The post code lottery of treatment. This includes the disparity in health care between Scotland, England and Wales where there are now significant differences
(ii) The growing costs of health treatments and expectations. For example should patients make some payment for extra services
And let us not forget the importance of regaining the confidence of the people working in the NHS. Perhaps in this at least Alan Johnson is an inspired choice.
Tony Blair has failed the NHS - new Poll
26th June 2007
Tony Blair’s frantic search for a favourable legacy as his period of office runs out this week has failed to find much and a poll carried out this month into public attitudes to the NHS wont provide any help for him.
The poll, commissioned by the BMA, shows that 40% of people in England do not think that the NHS has improved under his stewardship with only one in three believing that there have been any improvements at all.
Naturally government surveys disagree with this one. They traditionally find that patients are happy with the treatment they receive on the NHS. But therein lies another problem for Blair’s legacy. We don’t believe government spin anymore either!
The survey had some other interesting “nuggets”. It seems we support the idea of an independent board to run the NHS, a Conservative policy announced this month, which is opposed by Patricia Hewitt, the health secretary. And, we support the idea of charges for some services. The survey did not explore what size of charges and what for.
The Blair government has spent enormous amounts of our money on the NHS. But much of this money has been wasted on increased bureaucracy, inflation busting contracts and profligate spending in inessential areas. If only the NHS’s well known organisational issues had been tackled before opening the sluice gates and pouring in the money how different Blair’s legacy could have been! A missed opportunity that has cost all of us dear in extra taxation and lives. Sadly Tony Blair has not been good for the NHS!
The lives lost because out of hours care is not fit for purpose
12th June 2007
A report from the Medical Defence Union identifies thirty five patients that died last year because of failures in GP out-of-hours care. It also highlights the increasing number of complaints over the service – up 17.5% year on year. The most common complaints were about failure to diagnose an illness correctly and delays in visiting the patient. But other complaints included lack of access to patient records, difficulties in arranging follow-up care and the absence of any established relationship with the patient.
We reported on 26th May about the case of Miss Campbell, who died from septicaemia because eight doctors working for an out of hours provider failed to recognise her condition.
Gordon Brown promised quick action to improve out of hours care. Since then silence from him whilst he postures around the world, silence from the prime minister, who is spending his time looking for his “legacy”, and silence from the health secretary, who is just keeping her head down in the faint hope that she wont be sacked at the end of the month. In a couple more weeks Gordon Brown will have no excuses and we will expect swift action on the NHS
Nurses... the crisis grows
19th May 2007
Patricia Hewitt, the Health Secretary, is trying to save her skin following last week’s humiliating climb down over the junior doctor MTAS debacle. Although news today that she may have misled parliament in her statement on Wednesday may ensure another nail biting week for her. But whilst she is worrying about her own job she is ignoring the plight of another group within the NHS – the nurses
There are now over 1,000 nurses claiming unemployment benefit and job seeker allowance in the UK according to the latest government figures, almost double the level of twelve months ago. The average cost of training a student nurse was £40,225 in 2005-06. So using this figure it means that the cost to the taxpayer of the wasted nurses can therefore be estimated over £40 million.
In addition to this there are many more nurses unable to find full-time posts, who are carrying out temporary or bank work and so are not eligible for jobseeker’s allowance. And, added to the nurses unemployment there are another 2,000 healthcare workers also claiming the benefit. These include therapists and pharmaceutical dispensers.
RCN head of employment relations Josie Irwin said the figures proved deficits are having an impact on nurse jobs. ‘This is evidence that what we know anecdotally is actually happening,’ she said.
The Health Secretary told us that no trained staff would lose their jobs as a result of the deficits in the Trusts. We wonder then how she can explain why the numbers out of work have doubled in the last year. Add to this the drop out rate from disillusioned student nurses which is still running at record levels (50% in some areas) and it would not be too unkind to suggest that the minister is not paying enough attention and that we will soon find ourselves with a shortage of nurses!
She has more immediate problems with the nurses however. RCN and Unison leaders are holding a ‘council of war’ this week to discuss their strategies for industrial action over the government’s bid to stage the nurses’ pay award.
The dispute arises from the decision to ignore recommendations from the nurses’ pay review body to give nurses and other NHS staff a 2.5 per cent pay rise. Nurses are bitter and angry that the government decided instead to give staff a 1.5 per cent rise from April 1 and a further 1 per cent in November. (Staff in Scotland though have been told they will be given the full 2.5 per cent, backdated to April 1)
Latest research by independent pay experts Incomes Data Services suggests that average pay settlements in the UK remain steady at 3.5 per cent. But more than a third of deals are of 4 per cent or more, up from a quarter in the previous three- month period.
If Ms Hewitt has time from trying to save her own skin we would like to know what she is doing to avert a crisis with our nurses…
Will the closure of half of our A&E departments help to make our health service the envy of the world?
17th May 2007
It would appear that almost half of the accident and emergency units in England are threatened with closure. The Government wants larger, more specialised A&E departments to be created so that whilst patients may have to travel further to reach them, they would receive better care once they got there.
In December the Prime Minister and Sir George Alberti, the Health Department's national director for emergency access, said that fewer A&E departments would save lives. Sir George said: "We have to tell the public that some of the A&E departments they cherish are not able to provide specialist care and cannot and will not be able to provide the degree of specialisiation and specialist cover that modern medicine dictates the public deserves."
Campaigners said lives would be put at risk if the plans go ahead and that local geography, healthcare needs and staffing levels should be taken into account.
The shadow health secretary, Mr Lansley said: "There is no clinical evidence which would justify shutting down A&E departments simply because they don't serve a catchment population in excess of 450,000. Yet this is the basis on which the Department of Health is seeking to justify closures.”
The average A&E unit currently serves just under 250,000 people
Perversely the move to close A&E departments comes as the demands made on them is rising. The number of attendances has risen by more than a million in the past three years.
This sits awkwardly against Gordon Brown’s claim that New Labour is making a health service that will be the envy of the world doesn’t it?
Surely the final act of this Health Secretary...
16th May 2007
Patricia Hewitt is a humiliated health secretary this morning. It is now almost inconceivable that she can survive the cabinet reshuffle that will take place when Gordon Brown takes over as PM. She tried slipping out the news that she was abandoning the online job application system for junior doctors in a written ministerial statement rather than coming to the House of Commons where she could have been properly cross-examined by MPs.
The statement said "Given the continuing concerns of junior doctors about MTAS, the system will not be used for matching candidates to training posts, but will continue to be used for national monitoring."
It went on to say that intensive security checks had been made of the website and the MTAS computer system, allowing it to reopen partially. A report was being sent to the police and Hewitt later admitted that criminal offences may have been committed.
The Medical Training Application Service has plunged the whole process for recruiting junior doctors into chaos. Hundreds of highly qualified doctors were not even offered interviews when they applied. The website was finally closed down after a series of serious security breaches which allowed people to access confidential details about applicants.
The statement has been made now in an apparent attempt to outflank a legal action by junior doctors due to be heard in court today. But the campaign group of doctors, Remedy UK, that launched the legal challenge are proceeding with it. They argue that the whole process, including the first round of recruitment, was unlawful, and should be scrapped.
The Health Minister must take full responsibility for her failure to act decisively when serious problems surfaced last year. Criticisms that academic qualifications were being sidelined and that poor candidates were being appointed by this system were ignored. She has spent much of this year simply trying to defend the indefensible in spite of the chorus of complaint by the medical profession about the chaos it was causing. Such arrogance and stupidity should not go unpunished!
"A Health Service that is the envy of the world"... where to start?
13th May 2007
It is not so surprising that Gordon Brown wants to be all things to all people just now. So his announcement that education and healthcare are his top domestic priorities is about par for the course.
The chancellor said he wanted "fairness and opportunity for all" in the UK, and for the health service to become "the envy of the world". "I am going to be going round the country in the next few weeks and months listening to what the patients tell me, listening to what the staff tell me, listening to what people say about the future of the healthcare system and what they want as patients and they want as staff."
He needs to start with an understanding of what is wrong with the service now and so, just in case he doesn’t get to the Careworld offices we’ll tell him here what we think!
Since 2000, NHS funding in England has grown by about 7% per annum in real terms and is now running 40% higher yet this money has not resulted in meaningful sustainable improvement. Why? High cost inflation – over 50% of the extra funding was absorbed by higher pay costs – eg - GP contracts up by 25% over 2 years - Agenda for Change for non clinical staff in the NHS resulted in substantial increases in average pay but required no change in working practices or increased flexibility – the extra costs of this alone amounted to £4 billion per annum (a feature common to all these pay deals was that they were negotiated centrally and PCTs and providers had no option but to adopt them!)
The Kings Fund said that there are no mechanisms to direct the extra money to where it would do most good. The policy levers put in place to manage demand and encourage NHS providers to improve productivity were too week. The centrally negotiated pay deals have not delivered any higher productivity.
Understandable then why Blair concentrated his rhetoric on inputs and not enough on outputs!
According to the Office of National Statistics during the last 10 years there has been a steady decline in the productivity of NHS hospital providers. This is a disgrace given the huge amounts of money that have been spent. So Gordon, if you are serious about delivering a heath service that will be the envy of the world the place to start is not by making promises about wonderful new additions to it, but instead putting right the fundamentals – value for money and productivity - We will watch your progress with interest.
The clash between the virtual NHS and the real one
10th May, 2007
Two reports out today highlight the points made in our article below on the Blair legacy. The clash between his “virtual" NHS and the real one is brought into stark reality…
Blair’s claims that he has transformed cancer treatment in the NHS is reeled out every week at Prime Minister's Questions. Yet a report out today demonstrates that because of poor access to the latest drugs British cancer patients are substantially more likely to die of the disease than those in other western European countries. Whilst France has the best survival rates at 71% we are languishing down at 43%. This puts us in the company of Poland and the Czech Republic.
The other report examines the claim that only 1% of patients are now being cared for in mixed wards (this was a claim made last year by Patricia Hewitt). In the “real” NHS one in six hospitals are still treating patients alongside members of the opposite sex. In 1996 Tony Blair said that it could not be "beyond the wit of government and health administrators" to eliminate mixed-sex wards. He put the commitment to eliminate them into both his 1997 and 2001 manifestos. Patricia Hewitt’s response yesterday to being caught out by the lie… "The NHS overall has an excellent record of treating people with dignity and respect.”
Oh well Tony, it WAS beyond the wit of your government then
Blair's virtual NHS...his legacy?
9th May 2007
Now that we are in the final days of Blair’s administration it is appropriate for us to ask what his achievements in the healthcare of the nation have been. Firstly it is fair to say that he was always well intentioned. But as we know all too well the road to Hell is paved with them!
His first big mistake was the decision to stick with the spending plans that he inherited in 1997 from the outgoing Major government. As a result no new money was available to kick start the much needed overhaul of the NHS. It wasn’t until his second term that he allocated any new money, but by now he was desperate to demonstrate progress to the electorate. However instead of heeding the advice of every expert not to pour money into the service until the bureaucratic and union problems had been sorted, a report was commissioned from a retired banker friend to show that it was safe to put the money in first and sort out the problems later. Armed with this endorsement he went ahead. Sadly the result was the one that the "real" experts predicted.
His second mistake was the curse of all socialist administrations… the need for central control. The result was a plethora of targets that meant that the service was pushed into manipulating statistics to please its political bosses rather than serving its patients.
As the results of these mistakes have come home to roost we now have a service that is still inferior to our neighbours, many of the trusts all but bankrupt and desperate to cut costs by reducing doctors and nurse numbers and the public has grown weary of the constant recital of the Blair mantra about the improved outcomes in his virtual NHS. The real NHS is one of post code lottery, treatment determined by the need to demonstrate positive statistics rather than clinical priority, a bloated structure that swallows up the money that should be improving the service, and, in spite of Blair's claims to the contrary, long waiting lists
So Prime Minister don’t look to the "real" NHS for your legacy!
Ex government minister claims NHS staff are luddites
24th April 2007
Lord Warner, the government health minister responsible for health service reform in the NHS who retired in December has claimed that the major reason why hoped for improvements in our health service had not been made was the refusal of staff to accept the need for change.
In particular he claims that NHS staff groups refused to embrace the £12 billion IT upgrade. According to him staff groups took a luddite approach insisting that everything was alright as it was and they didn’t need computerisation... paper is best!
Well well, chickens coming home to roost! I remember Gordon Brown being warned that he should not pour billions into the NHS until the bureaucratic problems had been tackled. Not to be thwarted from being seen to tackle the NHS (nothing had been done in the first Blair/Brown term) he had Derek Wanlass carry out a ten minute enquiry that surprise surprise found that it was not necessary to wait and sort the fundamental problems of the NHS before shovelling billions into it.
The result is that we are now spending similar amounts of money on our healthcare as our continental neighbours but have a much worse service. And this man is about to become our prime minister… Oh dear! Oh dear!
Is a free NHS just a political mirage?
23rd April 2007
A report this weekend by Doctors for Reform, which represents 1,000 doctors working in the NHS, accuses the Government of being in denial about the role of the private sector in the NHS.
"It is commonly said that health care in the UK is free at the point of delivery; in fact this mantra is now a political mirage rather than a day-to-day reality," it says. "Patients are developing sophisticated approaches to purchasing upgrades to their care in the areas of the major killers - cancer and heart disease - as well as in areas of medicine benefiting smaller groups of patients such as maternity services. "It has to be recognised that the use of top-up payments is increasing. We need to face up to this rather than ignore it."
The doctors are calling for an open debate about the future of health care funding. "Patients are already seeking to supplement their NHS care, after a decade of maximum tax-financed spending increases."The Government's position is that the NHS can provide all of the care that patients need. If this is not the case now, can it be so in the future, given that tax-financed increases are slowing, medical costs are rising and patients are becoming more consumerist in their attitude?"
In a letter to Patricia Hewitt, Shadow health secretary Andrew Lansley and the Liberal Democrat's health spokesman Norman Lamb, Doctors for Reform set out three key questions...
"Can the NHS guarantee a universal service in future, given that it does not today?
"Should doctors inform patients of 'top-up' options as part of their general duty of care?
"How can access to healthcare be made equitable, given that neither NHS care nor the current 'top-up' payments meet that criterion"
A Department of Health spokesman responded by simply repeating the mantra that the NHS remains tax funded and free at the point of use.
It was also announced that an insurance company will this week launch a policy that gives access to the most modern and expensive cancer drugs for less than £100 a year. Patients covered by a WPA policy would be treated on the NHS, but the cost of the drugs prescribed would be underwritten.
The truth is that in spite of record levels of spending on the NHS we still have a service that does not bear comparison with our continental neighbours. So an open honest debate is surely the way forward. Of course we are unlikely to find it sponsored by this government, but it would be disappointing if the opposition parties let the chance go by
Is Patricia Hewitt the worst Health Secretary in living memory?
21st April 07
The press is full of leaks this morning about Patricia Hewitt's master plan to deal with the appalling mess her department has created through the botched introduction of an online appointments system, which could leave thousands of junior doctors without training places this summer, and, it is to offer them voluntary work overseas!
I suppose this is to be expected from Patricia Hewitt. How would she know anything about the financial hardship that these young doctors have experienced to get through their years of study? Unlike her they probably didn’t have an Australian millionaire daddy to fund their tuition fees and living costs
It is a disgrace – both to these young doctors and to we the taxpayers that they are being thrown onto the scrapheap.
She doesn’t need to dream up fancy schemes to hide the problem of what do with them… they could help to bring down waiting times in the real world of hospitals and general practice rather than the virtual world of phoney statistics that Hewitt inhabits
Of course some young doctors will want to go overseas and help organisations like VSO to do good in the most deprived parts of the world. But this should not be forced on them!
Her department continues to stumble from crisis to crisis and from blunder to yet more blunder... is Patricia Hewitt the worst Health Secretary in living memory?
Who knows best?
21st April 07
Care homes for the elderly across the country have been reporting a reduction in demand from social services for some time. No surprise really. If you read the CSCI reports on council performance they reward those that are cutting back on placements in care homes to keep the elderly in their own homes
Experts tell us that care in the community is much to be preferred and anyone that challenges this is awarded pariah status. Of course for many elderly people it is clearly a good idea - good mobility, friendly supportive community, caring family and carers on tap – but I wonder how accurately this represents the reality rather than a rosy idyll?
Living alone, poor mobility, no entertainment, no one to help you eat and take your medicines, not enough money, fear of burglary or assault, and no friendly faces to greet you in the morning. How many people are closer to this picture? Councils tell us that they fund carers to visit them daily but in reality this is often little more than half an hour a day and sometimes no one at all arrives.
Care homes tell us that delayed entry to their homes reduces remaining life expectancy and produce figures comparing average life expectancy of their residents now compared to say ten years ago. We have not been able to find any independent study on this – a useful research project perhaps?
Looking at the macro level the government is struggling with a shortage of housing with the undesirable effects of soaring prices and new build eating into the green belt. At the same time they are encouraging old and frail people living on their own to stay in their sometimes large family houses. Is this joined up thinking?
The real point is that elderly people that need or want to move to a care home are finding it harder to get social service funding. They speak of long delays. The only way to cut the delay is to somehow pay themselves or hope that their children will. Or, is that the real macro point – the government are saving a load of money this way?
NHS consultants contract - 27% pay increase for less work!
19th April 07
The National Audit Office (NAO) have said that the pay of hospital consultants have risen by 27% in the last three years whilst their workload has fallen. They say that poor financial management at the Department of Health is the cause. The new contract was put in place by John Reid in 2003 after much of the work had been done by Alan Milburn, his predecessor - it seems that John Reid's contribution was just to offer yet more money. In the NAO report they say that "This is one more example of weak financial management ... it drove through the new pay deal with scant regard for proper evidence and solid financial forecasting"
The contract - the biggest shake-up in the way consultants worked since the NHS was formed - was designed to free them up to spend more time with patients and provide more flexible services, such as evening clinics. The National Audit Office (NAO) report said it had failed on both counts. Patients have not seen any improvement in the care they get as a result of the new consultant contract
The report is the latest in a series that have been critical of health ministers for increasing budgets without securing proportionate increases in productivity. Last month the Commons health select committee accused the department of a disastrous failure over its reckless and uncontrolled recruitment of doctors and nurses.
Should we conclude that the Department of Health is not "fit for purpose" either?
Contaminated blood supplies
18th April 07
A report by the BBC’s Newsnight team suggests that successive governments were well aware in the 1970’s and 80’s that haemophilia patients were being given contaminated blood in NHS hospitals. It is alleged that the authorities chose to ignore warnings about the blood supplies sourced from the US where people are paid for donations. Experts warned the government that blood from this source was contaminated with HIV and hepatitis C.
As a result nearly 1,800 people have died and 5,000 more are terminally ill. Not surprisingly the documents have had to be forced out using the Freedom of Information Act. But as you would expect there is to be a public enquiry into this led by Lord Archer of Sandwell, a former solicitor general. Though you might be surprised to find that this has to be independently funded. Yet another case where ministers and civil servants know best and don’t want us to be told the truth
Drug abuse - more obfuscation?
18th April 07
The Home Office are boasting about the success of their strategy on drug abuse. They say that there has been a 16% decline in drug use since 1998… so that’s alright then? Well not really. Had they told us that we have the highest level of drug use in Europe, or, that we have the second highest number of drug deaths, that might have painted a less rosy picture.
Why do government ministers believe that it is their right to fool all of the people all of the time? Whilst it may be true that more users are going onto education schemes there is no evidence that it is having a positive impact. Drug prices on the street are falling and new dealers are appearing faster than the courts can lock them up.
The UK Drug Policy Commission has been set up to analyse drug policy. Lets hope they wont be pulling their punches – we will be watching with interest
Another sleight of hand...
3rd April 07
The Home Office has quietly cut its funding for drug education and prevention services for children.
When they announced the local grant allocations in February they hid away this cut. A cut of £6.6 Million! And in good New Labour tradition they are now trying to spin statistics to support it. They say that drug misuse in children has fallen by a fifth in the last 5 years, but, they fail to mention that those taking serious drugs have not reduced at all! Faced with this they then said that money could be taken from funds for adult drug treatment, but this ignores that cuts have been made there too!
Recent studies show that nearly 30% of kids have tried drugs and almost 5% have taken hard drugs (Class A).
So at two levels this is a worrying decision… does it make any sense to pull back on the fight to combat drug taking in the young? And, here we have yet another example of government duplicity. Don’t they get it? Spinning is distorting the truth and demonstrates an ongoing contempt for the electorate
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