NHS Support Federation - News archive April

Choice for patients can worsen quality of care
A survey originally published on the Department of Health website showed that there is no evidence that patient choice improves the quality of care. Choose and Book was seen as limiting patient choice and sometimes being driven by inappropriate referrals. The survey was removed from the website within a few weeks of being posted.

Full article:
There is no evidence that giving patients the ability to choose where they are treated improves the quality of care, a survey on the Department of Health's own website showed. An emphasis on choice could also increase inequality by favouring the more affluent and more articulate patients, BMA representatives heard. Terry John, from Waltham Forest, told the audience that the survey appeared on the website late last year but was removed just a few weeks later because, it was said, the views were not those of the department and the NHS logo had been used without permission. Representatives agreed in a motion that the idea of patient choice does not offer real choices and insisted that the Department of Health work with the BMA and patients' organisations to identify patients' real needs. Representatives also agreed overwhelmingly that Choose and Book, the electronic referral system by which patients can choose the date, location, and time of hospital appointments, was currently unfit for purpose, actually limited patients' choice, and should be suspended until "such time as the system is efficient and effective." Consultant gynaecologist Alan Russell said that his private practice had been booming recently because so many patients who wanted to see him on the NHS were unable to do so through Choose and Book. Mr Russell said that he had to reject about half of the patients referred to him through the Choose and Book system because they were referred to him inappropriately.
http://www.bmj.com/cgi/content/full/334/7608/1343-b

Health Service Journal (28 June 2007)

£35m ISTC deal scrapped
In a move predicted to be the first step in the cancellation of a large part of wave two of the independent sector treatment centre programme, the Department of Health has terminated the south London ISTC scheme procurement process. Independent bidders are said to be less attracted to wave two procurement because, unlike the first wave, payment is not guaranteed irrespective of the number of procedures carried out.

Full article:
The Department of Health has pulled the plug on one of the biggest wave-two independent sector treatment centre schemes. And there are rumours that more cancellations are on the way, with the entire surgical component at risk. The DoH confirmed it had terminated the south London ISTC scheme procurement process, which had reached preferred bidder stage with Clinicenta, earlier this month. Under new EU procurement rules, the DoH is likely to have to pay the company millions of pounds in compensation. The £35m contract would have provided a new surgical centre at Queen Mary's Hospital in Sidcup, with existing facilities receiving varying degrees of refurbishment. Clinicenta would have provided clinical services. The cancellation marks another contraction of the wave-two procurement, which has been running since March 2005. It was originally expected to deliver 250,000 procedures a year and create an extended choice network that would deliver an additional 150,000 procedures and cost £3bn over five years. The wave-two procurement has been less attractive to independent bidders because, unlike the first wave, it does not guarantee payment irrespective of the number of procedures carried out. Only two contracts have been signed, both with BUPA, and volumes are down to 130,000 procedures a year. Of the 24 contracts initially up for grabs, a combination of DoH cancellation and providers walking away leaves just 13. This is expected to fall further.
http://www.hsj.co.uk/healthservicejournal/pages/N1/p6/070628

Guardian (28 June 2007)

Hewitt leads exit of women from Brown cabinet
Bequeathing a possible nurses' strike as her legacy after two years as health secretary, Patricia Hewitt is replaced by Alan Johnson.

See full article at:
http://www.guardian.co.uk/guardianpolitics/story/0,,2113350,00.html

Financial Times (26 June 2007)

Advice on dementia drug was flawed
NICE, the National Institute for Clinical Excellence, is being challenged in the High Court by drug companies over its ruling that particular drugs should not be available to patients with mild Alzheimer's, and that the drugs should be reserved for those at the "moderate" stage of the disease.

See full article at:
http://www.ft.com/cms/s/21a0e28a-233e-11dc-9e7e-000b5df10621.html

Guardian (25 June 2007)

Victory over care ‘lottery’ for the elderly
The government is to reveal guidelines defining what conditions entitle the seriously ill to free care. However, only nursing or medical care will be covered, not social care. The Local Government Association has demanded extra funding to meet the rising costs of social care.

See full article at:
http://www.guardian.co.uk/medicine/story/0,,2110264,00.html

BBC Online (22 June 2007)

Plans to end private cash for the NHS
Citing polls which reflect the public's concern over “creeping privatisation of schools and hospitals” the Scottish Health Secretary Nicola Sturgeon has announced the end to partnerships between the NHS and the private sector in Scotland. Rather than markets being a way of improving the NHS, this would best be achieved by cooperation between staff, patients and communities.

See full article at:
http://news.bbc.co.uk/1/hi/scotland/6225328.stm

Guardian (22 June 2007)

NHS head hits back over union leaders claims
David Nicholson, NHS chief executive, has claimed that doctors' and nurses' leaders are putting vested interests ahead of patients and the wider interests of the NHS. His attack follows Jonathan Fielden of the BMA describing how "political meddling has brought the NHS to its knees" and Peter Carter of the RCN referring to "the tragedy and farce of NHS finances".

See full article at:
http://www.guardian.co.uk/uk_news/story/0,,2108840,00.html

Health Service Journal (21 June 2007)

PCTs ignoring orders on patient group involvement
A Picker Institute survey has found that only 20% of PCTs expect patient groups to have an effect on decision making despite the government's professed requirement that PCTs are judged on how well patient groups are involved in service delivery.

Full article:
Primary Care Trusts do not expect patient groups to influence commissioning as required by the Department of Health, a survey has revealed. Only 20% of 52 PCTs questioned by a Picker Institute survey expected such groups to have an impact on decision making, despite the 2006 white paper Our Health, Our Care, Our Say, which said that PCT’s performance rating would be assessed on how well local groups play a part in the delivery of services. In the last year, fewer than half the respondents had engaged the public in deciding priorities for commissioning in what the institute described as “major gap between current practice and government expectations”. The survey also found that only a small number of PCTs were prepared for key aspects of the paper concerning public involvement such as managing public petitions and the change over from public and patient involvement forums to local involvement networks. This was despite most trusts saying they understood their responsibilities regarding consultation. Common reasons for failure included difficulty reaching “seldom heard” groups, a lack of public understanding of commissioning and a lack of reliable data on patient experiences. To make progress, most respondents called for training, better data and opportunities to share best practice. However around three quarters said they expected patients to be more involved over the next twelve months. Institute policy head Don Redding said: “The results show the gap between what the government would like to expect and claim and what is actually happening. Part of the reason for this could be that the drivers are too weak and the incentives to do good patient and public involvement are not strong enough. Although there is some best practice, there is a big danger of some trusts just resting with existing procedures, finding innovation too difficult and that help is not at hand.”
http://www.hsj.co.uk/healthservicejournal/pages/N1/p12/070621

Michelmores (19 June 2007)

Michelmores concerned by further delays in publication of Healthcare Commission report into ISTC quality of care issues
The long awaited report by the Healthcare Commission into care provided by independent sector treatment centres has again been delayed, allegedly due to problems with the NHS IT system. A leaked draft of the interim findings was said to show that some ISTCs were compromising patient care.

See full article at:
http://medneg.michelmores.com/news/default.asp?Display=246

Guardian (19 June 2007)

MPs criticise £2bn cost of consultants
The Commons public accounts committee has found that government departments often hire consultants before evaluating whether in-house staff could be used. Taxpayers could be saved at least £500m a year, the committee says.

See full article at:
http://www.guardian.co.uk/uk_news/story/0,,2106077,00.html

Times (19 June 2007)

Private equity faces healthcare check
Following the sale of 26 Bupa hospitals to a private equity firm, the Healthcare Commission regulator is to examine the increasing role of such companies in Britain's healthcare. Of the top seven private hospital groups, just two are not controlled by private equity. The financial stability of such hospitals could be implicated, the regulator's head of independent healthcare has said.

See full article at:
http://business.timesonline.co.uk/tol/business/industry_sectors/health/article1951256.ece

Independent on Sunday (17 June 2007)

Babies ‘will be put at risk’ as experienced doctors are replaced by trainees
A senior London doctor has said the government's Modernising Medical Careers (MMC) programme "is a bad idea and against the principles of good patient care" which could result in patient deaths. MMC plans to replace some senior staff in paediatric wards with trainee doctors.

See full article at:
http://news.independent.co.uk/health/article2666400.ece

Pulse (15 June 2007)

GPs face cuts despite underspend
Hard on the heels of the reported transformation of a £500+ NHS deficit into a £500+ surplus, PCTs are trying to make further cuts, with primary care contributing a greater share of the deficits than in the past.

Full article:
GPs are facing major cutbacks in prescribing budgets and enhanced services payments, despite a £500m NHS underspend. In its financial report for the final quarter of last year, the Department of Health confirmed the NHS had turned around a deficit of £547m into a net surplus of £510m. But primary care trusts are now contributing a bigger share of the deficits, the report states. It identifies more than £700m that could be further squeezed from PCTs in 'productivity' savings, on top of the £650m made from savings to the GP contract. GPC chair, Dr Hamish Meldrum, said: 'I'm highly critical of the methods the Government used to achieve this so-called surplus. These have affected patient care with delayed referrals, longer waits for outpatient appointments, ward closures and job losses. There has been a lack of openness about the impact on patient care.' Dr Meldrum also emphasised that a quarter of trusts were still in deficit. The report identifies that PCTs are now responsible for 69% of the gross NHS deficit, up from 47% last year. The combined deficit of £326m in 2005/6 has been transformed into a surplus of £348m this year. In 49 out of 55 overspending trusts the situation has improved, but six have deteriorated. In Cambridgeshire, GPs are threatening to pull out of practice-based commissioning after the PCT proposed severe cuts to enhanced services payments and is refusing to negotiate on future PMS contracts. This is after more than £3.5m was cut from prescribing in the last year with similar savings forecast for the coming year. But the PCT's turnaround report says £900,000 worth of savings still have to be found. Kensington and Chelsea PCT was identified by the Department of Health as a model of good practice for making £10m savings and turning a debt of £21.7m into a surplus of almost £5m. But a local GP and former PCT insider said this had been achieved by 'selling off the family silver', with assets sold and services such as nursing cut and maintained at 'a level I would not want to see continue'.
http://www.pulse-i.co.uk/articles/

Yorkshire Post (15 June 2007)

Health staff protest over job cuts at blood centres
The planned closure of blood centres in Yorkshire, two of the seven to be closed around the country in the next four years, will be demonstrated against by staff in Leeds and Sheffield. Unions have attacked the closure plans as putting patients' lives at risk.

See full article at:
http://www.yorkshirepost.co.uk/news?articleid=2957277

Health Service Journal (14 June 2007)

LINKs scrutiny system to bar patient networks from access to key services
Local involvement networks, the replacement for public and patient involvement forums, will have fewer powers to monitor public services, which will therefore be less subject to public accountability.

Full article:
The replacement for public and patient involvement forums, local involvement networks, will be denied access to mental health facilities, children’s care homes and non-communal areas of residential homes. An internal Department of Health draft policy document includes a table of where LINKs members will not be allowed to visit. The Department of Health confirmed it was planning limitations, a position backed up by its response to the health select committee’s report on patient and public involvement, which stated: “A change in the mechanisms for patient and public involvement has been made necessary by significant changes in the health and social care system. It is no longer appropriate to have a system based around scrutiny of individual institutions. We want this new system to consider both health and social care.” Malcolm Alexander, chair of the newly elected National Association of Patients' Forums Steering Group, said he was not surprised at the restrictions: “The way LINks are being set up is absurd. There is no intention to appoint members, which means they will be very weak compared to what [PPI forums] do now - it's another example of DoH chaos.” He added: “The whole system is designed to result in less scrutiny. There is currently a duty for members to monitor and influence standards. The new system will keep public and patients at arm's length. The DoH is trying to design a system which excludes the public from proper monitoring and prevents them having some input.” Steering group vice-chair Ruth Marsden said: “These new powers are regressive. That forums have less accountability to the public is dangerously ill-advised.” Currently, patient and public involvement forums exist for each individual primary care, acute and mental health trust. Although they cannot review social services, they can go into the private sector if it is treating NHS patients. They are also able to conduct spot checks, however LINKs will have to apply for permission to the Healthcare Commission or its successor, Ofcare. Commission for Patient and Public Involvement in Health chair Sharon Grant, whose organisation is set to be disbanded next April, said: “We were shocked when we first heard the proposals. If they are agreed, not only will LINks have fewer powers than patient forums but they will let down the patients that most need a voice. The DoH is seeking to impose limits such as having to seek permission for a visit or excluding particular groups. This would remove important elements of independence and the current rights and responsibilities to monitor and inspect that existing patient forums have used to great effect. By excluding vulnerable groups from inspections, the DoH is denying them a right to be heard and designing a wholly inadequate system.” London Network of Mental Health Patient and Public Involvement Forums chair Mike Loosley said: “This latest proposal from the government only shows that they pretend to be in favour of public and patient involvement but are really undermining the principle.” He added “Inspections are not undertaken frivolously. Approval by the Healthcare Commission will inevitably lead to delay and in a minority of cases it is important to carry out an inspection quickly.” A spokesman for the Commission for Social Care Inspection said it had concerns about giving LINks right of entry to premises. He said: “We felt that this proposal did not take account of the difference between a health setting and a social care setting. Care homes are just that homes for people who live in them. It is important that people in care homes have as much say as possible about who comes into their home.”
http://www.hsj.co.uk/healthservicejournal/pages/N1/p5/070614

Guardian (13 June 2007)

Fund ‘opens door’ for US partner
Humana, the huge US health insurer, has signed a partnership deal with the Kings Fund health think tank. The American company is interested in playing a role in NHS commissioning.

See full article at:
http://society.guardian.co.uk/health/story/0,,2101029,00.html

BBC Online (12 June 2007)

Sturgeon confirms NHS pay deal
Scottish Executive Health Secretary Nicola Sturgeon has confirmed a 2.5% NHS pay award backdated to April. While unions have welcomed the deal as better than the staged increase recommended by Gordon Brown, Glyn Hawker of Unison described the rise as a “low level” award.

See full article at:
http://news.bbc.co.uk/1/hi/scotland/6743211.stm

Telegraph (12 June 2007)

Alliance Boots to put GPs in stores
The high street store group is planning an aggressive expansion of its healthcare marketing, with GP surgeries in 150 stores and a doubling of its late night pharmacies.

See full article at:
http://www.telegraph.co.uk/money/main.jhtml?xml=/money/2007/06/10/cnboots110.xml

Guardian (7 June 2007)

Foundation hospitals have £1bn reserve, says regulator.
The sale of assets, as well as profits raised from the treatment of patients, has led to unspent reserves of £995m accrued by foundation hospitals in England. Critics have said that cuts in the NHS have been used to achieve the surplus.

See full article at:
http://www.guardian.co.uk/uk_news/story/0,,2097069,00.html

Health Service Journal (7 June 2007)

Confederation opens door to private sector
The private healthcare providers who make up the NHS Partners Network are to be allowed to join the NHS Confederation as a member network rather than just affiliate members, as at present.

Full article:
Private healthcare providers are to be allowed full membership of the NHS Confederation as the NHS Partners Network joins the organisation. The network has nine members and was set up to represent private sector healthcare providers. Members of the confederation will vote to allow the NHS Partners Network to join as a member network on the 20^th June. Currently, private sector providers may only join as affiliate members. NHS Partners Network chair Richard Jones said: “Joining the confederation not only marks a coming of age for the independent sector, but an important transition for the NHS itself as it embraces the benefits for patients arising from a plurality of providers. We are proud of our partnership with the NHS. We are determined to see that partnership strengthen and succeed in the interests of NHS patients. By becoming part of the NHS Confederation, the NHS Partners Network will work closely with commissioners and providers across the service to achieve these aims.”

NHS Partners Network members include:

Alliance Medical
Amicus Healthcare (part of General Healthcare Group)
Bupa Hospitals
Capio Healthcare UK
Clinicenta
Mercury Health
Nations Healthcare
Netcare UK
Nuffield Hospitals
Partnership Health Group
UK Specialist Hospitals.

http://www.hsj.co.uk/healthservicejournal/pages/N2/p9/070607

Guardian (6 June 2007)

NHS is on the brink of collapse, say consultants
The chairman of the BMA's consultants' committee will tell Gordon Brown that the NHS can only be saved from imminent collapse by giving doctors the power to rebuild the health service, and by providing strategic direction from Government rather than political meddling in the guise of policy initiatives. Jonathan Fielden also likens the use of the private sector in the NHS to a "carelessly placed hand grenade" thrust into its midst.

See full article at:
http://www.guardian.co.uk/uk_news/story/0,,2096405,00.html

Nottingham Evening Post (4 June 2007)

Op tragedy: family call for new laws
The death of a patient at a private hospital has led the bereaved family to call for changes to the law to make aftercare following surgery a legal requirement.

See full article

Times (5 June 2007)

Incidents going unreported
Foundation trusts are opting out of the reporting of clinical incidents, as is permitted by their independent status.

See full article at: http://www.timesonline.co.uk/tol/life_and_style/career_and_jobs/public_sector/article1881283.ece

Financial Times (2 June 2007)

US health companies may win the chance to buy NHS care
Two big US companies, in addition to Bupa, have won a contract to buy healthcare on behalf of the NHS. Giving private companies a role in the commissioning process is seen as a major step in the Blairite NHS reforms.

See full article at:

http://www.ft.com/cms/s/a9b911f2-10a5-11dc-96d3-000b5df10621.html

Public Finance (1 June 2007)

Cash strapped NHS manages to underspend £500m
One result of the much publicised NHS deficits is a reported "underspend" of £500m. Furious health professionals have said that patients and staff have suffered as a consequence, with a 22% increase in hospital readmissions within a month of discharge. Health minister Andy Burnham admitted that the readmission figures were "worrying".

See full article at: http://www.cipfa.org.uk/publicfinance/news_details.cfm?news_id=30673

Health Service Journal (31 May 2007)

SHAs' £117m training raid attacked
Strategic health authorities are diverting funds from training budgets to their reserves. The move is described as "short sighted" the NHS Confederation and the British Medical Association.

Full article:
Strategic health authorities are raiding over £117m from this year's training budgets. In a move condemned by NHS Employers and the British Medical Association as 'short-sighted', five SHAs have indicated they will divert up to 11.8% of the money allocated to them for training into their strategic reserves. This contradicts undertakings given by the Department of Health to the Commons health select committee during its 2006 inquiry into NHS workforce planning, and undermines a service-level agreement between SHAs and higher education institutes announced by health minister Lord Hunt.
http://www.hsj.co.uk/healthservicejournal/pages/N1/p7/070531

BBC Online (30 May 2007)

Tories ‘to carry on Blair reform’
While George Osborne, shadow chancellor, has claimed that Gordon Brown has "abandoned the centre ground of public service reform to the Conservative Party", the prime minister in waiting has signalled "no retreat" from the centre ground. Hazel Blears meanwhile "completely and utterly rejected" that Labour was "lurching to the left".

See full article at:
http://news.bbc.co.uk/1/hi/uk_politics/6702295.stm

Guardian (28 May 2007)

Brown urged to improve relations with NHS staff

In her quest for the deputy leadership of the Labour party, party chair Hazel Blears has said that Gordon Brown should seek a better dialogue with NHS staff both nationally and locally. She also defended the continued use of the private sector in the NHS.

See full article at:
http://www.guardian.co.uk/guardianpolitics/story/0,,2089407,00.html

Telegraph (31 May 2007)

Babies 'at risk from use of stand-in midwives'

An independent study paid for by the Department of Health says that unqualified "maternity support workers" are doing the work of trained midwives and putting the lives of mothers and babies at risk. The criticism comes after Patricia Hewitt asserted last month that maternity support workers were "not a substitute for midwives".

See full article at:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/05/29/nbabies29.xml

Sunday Times (27 May 2007)

Dentists refuse to treat bad teeth

Dentists treating patients on the NHS are rejecting people with bad teeth in favour of those who have been dropped by an NHS practice which has gone private, because those patients are likely to need less work. Under the terms of the most recent contract, dentists are paid per patient rather than per procedure, so the dentist earns the same for giving a single patient one filling or many.

See full article at:
http://www.timesonline.co.uk/tol/life_and_style/health/article1845202.ece

BBC Online (25 May 2007)

Brown calls for better GP cover

Following a report into the death of a woman who died after contacting eight doctors working for Camidoc, the GP out-of hours service, Gordon Brown has admitted that improvements are needed to night and weekend GP cover. The doctors all failed to identify septicaemia, and the lack of diagnosis contributed to the death. Confusion over the system was blamed, with each consultation being treated as an isolated case.

See full article at:
http://news.bbc.co.uk/1/hi/health/6689483.stm

Guardian (24 May 2007)

Hewitt battles for survival in Commons after day of criticism

A Tory motion of no confidence in the Commons, severe criticism from a high court judge about the junior doctors' training fiasco, and an angry reception from the Royal College of Midwives conference all added up to a trying day in the political life of the secretary of state for health.

See full article at:
http://www.guardian.co.uk/guardianpolitics/story/0,,2086667,00.html

Financial Times (21 May 2007)

NHS tops health system survey

According to a study by a New York based health foundation, the UK has the best health system among large English speaking countries and Germany. With the best coordinated care, resulting from the GP system, and at a fraction of the cost of US healthcare, the existing model of the NHS (i.e. without the pro-market trappings beloved of New Labour). The move up the league table from third to first place may be a reflection of the great recent increases in health spending.

See full article at:
http://www.ft.com/cms/s/5df42990-0737-11dc-93e1-000b5df10621.html

Yorkshire Post (21 May 2007)

Nurses strike over cost-cutting plans

A dispute over demotions and staff cuts at a foundation trust has led to strike action by theatre nurses at Barsley Hospital. GMB union has been in talks with bosses for 10 months, but with a £1.5m saving required on the payroll bill, the specialist nurses are seen as too expensive.

See full article at:
http://www.yorkshireposttoday.co.uk/news?articleid=2892112

Guardian (18 May 2007)

A&E patient “forced to sleep in car park”. A woman with severe arthritis and osteoporosis was forced to sleep on a bench in a hospital car park after staff told her there were not enough beds in the A&E unit she had been taken to and she would have to leave. Evelyn Beale, 61, from Lydney, Gloucestershire, was taken to the accident and emergency ward at Gloucestershire Royal hospital by ambulance on April 28 after a fall. Given painkillers for the agonising pain in her back and neck, she was told there was nothing that could be done as the pain was the result of existing conditions. “He said there were no beds available anyway so he discharged me and told me I could go home,” Miss Beale said. “I said I couldn't because I had no money with me and I was only wearing a pair of half-length trousers, a thin top and a very thin coat. I had nothing on my feet.” Despite asking to wait until someone could come and get her as she couldn’t afford the £40 taxi fare home, she was discharged at 2:30am. Miss Beale then spent six hours on a bench before walking into town in her hospital slippers. “I was frozen and terrified every time someone went by,” she said. “They just wanted to get rid of me. It was the one place you would think they would look after you if you were sick, but they couldn't care less ... I couldn't walk properly, I was in so much pain. I was stumbling around. People thought I was drunk. I came across a bench and felt quite poorly. I thought ‘I'm going to have to lie down’. It was so cold.” Ms Beale, who is dependent on her sheltered housing warden for assistance with meals and housework, rang a friend from the waiting room at 9am after sleeping on the bench. On receiving no reply, she began walking back into town. Police later found her a mile from the city with bleeding feet and took her home. A spokeswoman for the Gloucestershire Hospitals NHS Foundation Trust said: “We're sorry that Miss Beale is unhappy with her experience. She has made a formal complaint and we're investigating the issues she has raised.” Mark Harper, the local MP, said the hospital needed to review late night transport services for vulnerable patients. “Regardless of hospital policy, I'd have thought a little humanity and common sense wouldn't have seen her treated in this way,” he said. “This case highlights a concern where patients taken to A&E who are not admitted are expected to find their own way home. The hospital trust must come up with a better solution” Go to article

Guardian (17 May 2007)

A&E closure guidance denied. The Conservatives have released NHS guidance which suggests the government may be planning to close nearly half the A&E departments in English hospitals. The Tories say that the guidelines suggest that A&E units should serve a minimum population of 450,000, 200,000 more than the current average unit. Extrapolating the figures, the Conservatives said that if the guidance were followed, 92 of 204 casualty units would close. Andrew Lansley, the shadow health secretary, said that the guidelines were already being used to justify closures in the South-East, pointing to the recent recommendation from the government’s emergency care tsar for the reorganisation of north London casualty units into two departments serving 450,000 each. But a Department of Health spokeswoman denied issuing the guidelines. “There is no such guidance from us. It is absolutely rubbish to suggest we are demanding closure of A&E departments,” she said. Dermot O'Riordan, of the Royal College of Surgeons, said: “Very major trauma cases with multiple injuries like road traffic accidents are more likely to survive at specialist centres, but local emergency departments should stay open to focus on what they do well.” Go to article

Guardian (17 May 2007)

Public sector union warns Brown over summer of discontent. Mark Serwotka, general secretary of the 300,000 member Public and Commercial Services Union (PCSU), has warned Gordon Brown that he could face a “summer of discontent” from over 1 million public sector workers as they take strike action over pay, privatisation and job cuts. Mr Serwotka told the union’s annual conference in Brighton that it should be to the government’s “eternal shame that a Labour government elected in 1997 telling us that things can only get better have presided over coordinated and simultaneous attacks on their own workforce that would have made Mrs Thatcher blush ... They have undertaken more privatisation of civil service work than the governments of Margaret Thatcher and John Major combined. They are now seeking to impose cuts on the living standards of some of the lowest paid civil servants in the UK.” The news comes as the Royal College of Nursing has decided to ballot members over national strike action for the first time since it’s inception in 1916. However the first move to organise strike action came yesterday as Dave Prentis, general secretary of Unison, released a letter saying that it and the PCSU should co-ordinate industrial action across the public sector. Mr Prentis said privatisation and the Treasury's 2% pay norm were the two issues which had to be challenged by both unions. He said: “Unions cannot fight these battles alone and the PCS and Unison should be working together to maximise our impact in responding to the attacks on us.” The PCSU’s conference voted unanimously to escalate strike and industrial action in Whitehall, which has already resulted in two one-day strikes which the Cabinet Office acknowledged as involving 119,000 people on May 1st, disrupting jobcentres, tax offices, driving tests, courts and museums and art galleries. Go to article

Burton Mail (16 May 2007)

Private treatment centre "fails conclusively". The Midlands Treatment Centre at Burton’s Queen’s Hospital, is costing PCTs millions each year whether or not patients are treated there, according to Labour MP Charlotte Atkins. Ms Atkins told a parliamentary debate that she was personally worried about how the centre is run. The centre, which opened in July last year, is run by private US firm Nations Healthcare, whose lease does not run out till 2011. Ms Atkins said that, despite its short period of operation, no NHS facility would be allowed to “fail as conclusively as that treatment centre”. Ms Atkins said that a number of senior staff had been fired due to the failings which include: failure to meet targets (despite being below capacity), a cost of £2m a year to Stoke-on-Trent PCT over six months for treating just 59 patients, failing to contact patients waiting to transfer from other waiting lists to the centre, and the centre not being available for referral under choose and book. Health Minister Andy Burnham said: “In situations where an ISTC might be under-utilised, I intend to work closely with the local health economy[sic] to ensure that measures are put in place to build utilisation rates so that the full value of a contract can be realised over its lifetime, even though take-up may be slow at the beginning.” After appeals and a submission to the Government’s information officer, the Burton Mail was eventually allowed to view documentation of the potential risks of the centre, though with key portions blacked out. A South Staffordshire PCT spokesman said: “For patients in South Staffordshire, the Midlands Treatment Centre has made progress in terms of the numbers of patients treated at the facility and their health outcomes. The contract for the centre was agreed between a number of PCTs a few years ago. Since then NHS organisations have made major progress and brought down waiting times.” Go to article

Financial Times (15 May 2007)

Hewitt denies retreat on health reforms. A structural shake-up at the Department of Health should not be seen as a sign that the government is rowing back on its reforms, Patricia Hewitt, the health secretary, said. David Nicholson, the National Health Service chief executive, has announced a new "leadership team" that had a single post of "director-general for commissioning and system management" in place of separate roles that reflected the "purchaser/provider" divide in the NHS. With some in the private sector worried that Gordon Brown's accession to the premiership might lead to a dilution of, or even a halt to, the government's market-based reforms, Ms Hewitt said the decision to end the distinction between the two roles should not be seen that way. The responsibility for ensuring that more hospitals became foundation trusts, and that more staff moved out of the NHS to create not-for-profit "social enterprises", was being devolved to the 10 strategic health authorities, she said. The move towards making NHS providers more independent needed to be pursued "primarily at the regional level". London had led the way by creating its own separate purchaser and provider organisations, she said. The new leadership team would not have a formal annual agreement with ministers over what the NHS should deliver. Meanwhile 180 cancer specialists told the BBC in a survey that they were worried or very worried about the NHS's ability to afford the cost of a series of new cancer drugs that are coming on stream. Go to article

Independent (15 May 2007)

City runs rings round taxpayers in PFI refinancings. Civil servants face being "outwitted by their commercially-sophisticated private sector counterparts" when private finance initiative deals are renegotiated, a report by the influential Commons Public Accounts Committee (PAC) will warn. The report finds that a voluntary code to allow public bodies to share the proceeds of lucrative Private Finance Initiative refinancing deals has fallen "well short of expectations", yielding just £93m by the end of last year, far lower than the £175-£200m that had been predicted in 2002. The MPs on the PAC are demanding extra training for public sector staff, noting that most of the negotiation of refinancing deals happens at a local level where staff are often "painfully lacking in commercial experience". In some cases this has produced very high returns for the investors and increased risks for the public sector on renegotiated deals. They also want the Treasury to approve the final terms of any refinancing arrangement that give substantial gains to investors. The committee also expressed concern at the way the Government misses out on gains made by PFI investors selling their equity interests on to third parties. It warned that consolidation among PFI investors could see a small number of investors dominate the market. The voluntary code for sharing gains on refinancing was agreed with contractors after anger over huge profits companies made on refinancing early PFI projects once they were up and running. These often took advantage of the cheaper finance available once the higher-risk construction phase has been completed. Ministers faced outrage in 2003 when investors in the Norfolk and Norwich Hospital PFI scheme secured an £80m windfall by renegotiating their borrowing. MPs accused the consortium involved of "lining investors' pockets". Under the code, companies originally agreed to share 30% of refinancing gains on early PFI projects with the public sector. More recent projects stipulate that half of any refinancing gains should be paid to public sector clients. Treasury officials blamed the shortfall on the decline in firms attempting to renegotiate the finance for PFI projects. But MPs warned that the code might discourage contractors to make savings by renegotiating their debts. Officials insist that refinancing PFI projects can cut the cost to the taxpayer. They insist that NHS trusts and local authorities have built up a pool of expertise in negotiating PFI deals and point to the work of the Government-backed consultancy Partnerships UK in advising on PFI contracts. Go to article

Stoke Sentinel (15 May 2007)

NHS scandal as £2.5m goes down the pan. An estimated £2.5m of NHS cash has been wasted in North Staffordshire because hundreds of patients are refusing to be treated at a private hospital 30 miles away. The area's two PCTs have signed a five-year deal with a centre in Burton to pay for medical procedures. These include operations such as such as joint replacements and cataract removal. But patients won't travel to the hospital. Despite a request under the Freedom of Information Act, Stoke-on-Trent Primary Care Trust (PCT) has refused to disclose the lost sums involved. It argues that the figures are too commercially sensitive. And the Trust ruled it would be "misleading" to say how many patients declined to travel to Burton for operations the PCT has paid for. But it has emerged in its first six months, just 59 city patients agreed to be treated at the centre out of nearly 1,000 offered appointments there. The rest insisted on going instead to the University Hospital of North Staffordshire, forcing the PCT to pay for their care a second time. MPs have learned the problem is costing £2m a year for the city PCT which is already £2.8m in debt - leaving the trust paying a staggering £16,000 per case. And the area's other PCT - North Staffordshire - is losing at least £500,000 annually on the Burton contract. The unit is run by U.S. company Nations Healthcare and is one of a network of so-called independent treatment centres in the UK which the Government has forced PCTs to buy services from in order to increase total treatment capacity. But the waste has emerged because trusts have signed a five-year contract to pay them the same sum every month no matter how few patients they treat. Go to article

Guardian (14 May 2007)

Hospital choice irrelevant, say patients. Labour's health policy giving people the right to choose between NHS hospitals in England is regarded by most patients as irrelevant, the government's health watchdog will disclose. The Healthcare Commission found the issues people regard as most important are whether they have confidence in a hospital's doctors and nurses, whether staff answer questions clearly and whether they wash their hands after contact with a patient before they touch another. The issues they regarded as least important included whether they have a choice of admission dates, choice of hospital and enough information about different hospitals to make an informed decision where to be treated. The commission asked the Picker Institute research organisation to investigate recent inpatients' views about 82 aspects of their hospital experience. The aim was to discover what patients care about most so that the commission could ask the most relevant questions in future surveys of hospitals' performance. The three questions about choice were deemed by patients to be among the 10 least important aspects of a hospital's service out of the 82. The results are likely to be a disappointment to Patricia Hewitt, the health secretary, who has made patient choice a cornerstone of NHS reform. The Picker institute told the commission that patients had so little interest in choice that there would be no point in asking more questions about it in the 2007 survey of patient opinion. Results from the 2006 survey are due to be published, providing information to grade the performance of 167 acute hospitals. Go to article

Daily Telegraph (14 May 2007)

Cutbacks ‘rationing services for elderly’. Hundreds of thousands of elderly people have had their "social care" cut in the past decade. Seven in 10 councils in England have been forced to "ration" services since Labour came to power, according to the Local Government Association. Most town halls now provide services only to pensioners with "substantial" or "critical" needs. A submission to the Treasury titled "Without A Care?" by the LGA - which represents 1.2m elderly people - says government funding has failed to keep pace with the demands of an ageing population and a shift in healthcare provision away from hospitals towards the home. Eric Pickles, the shadow local government minister, said: "Funding for care for the elderly is one of the biggest problems facing local government. Thanks to the financial crisis in the NHS, councils and NHS trusts are now playing pass the parcel to see who picks up the tab." Go to article

Public Finance (11 May 2007)

Cut spending and put more services out to market, CBI tells chancellor. Public spending should be curtailed and more services opened up to private competition if the UK is to meet the challenges of the new century, according to business leaders offering their advice to the chancellor. The CBI’s submission to the Comprehensive spending review said spending growth should be limited to 1.6% in real terms. This is less than current government plans and would require a cut of £8bn. The CBI wants this money to be used to provide a tax cut for business to help maintain economic competitiveness. The CBI submission included a five-point plan for reform of public services to tackle globalisation and the emergence of China and India as economic superpowers. John Cridland, CBI deputy director general, said: “A strategic co-ordinated approach to policy will be needed with a radical rethink of the priorities and objectives required. The Comprehensive Spending Review should be a blueprint for policy strategy not only for the next three years, but for the next 25.” The CBI plan is built around changing the role of the state from provider to commissioner and thus calls for more markets within provision of services, as well as finding economy savings through greater use of shared services. There was scepticism from trade union leaders who criticised the plans as backward looking. TUC general secretary Brendan Barber said: “The CBI’s call for a smaller public sector will inevitably lead to poorer public services, with any savings coming from fewer jobs, worse conditions and lower pay.” Go to article

Telegraph (10 May 2007)

Brown’s first task is to curb NHS ‘privatisation’. Gordon Brown is expected to halt the private sector’s rapid expansion in Britain’s health service. Allies of the chancellor say he is concerned by the way in which Labour has stopped being the champion of the NHS and is seen as masterminding the creeping “privatisation” of the service by many of its supporters. Mr Brown is also though to have concerns that some contracts for the private sector to provide simple operations are not providing good value for money. Labour sources and the health unions think Brown is ready to break with Blairite reforms and commit to limiting the role of the private sector. “He sees the sense of this both politically for Labour and for the NHS,” said one official. Brown will counter accusations of being reactionary by setting out his own ambitious reforms which will place more emphasis on NHS rather than private sector staff. The British Medical Association recently released a report on the future of the NHS which called for private involvement to be “conditional on meeting a need which has been identified by the NHS, that it cannot itself meet”. Go to article

Financial Times (9 May 2007)

Take politics out of day-to-day NHS management, urge doctors. The British Medical Association has called for independent management of the NHS and a more explicit means of rationing care. The proposals, contained in what the BMA described as a “green” paper for debate, challenge both Labour and Conservative policy for the NHS and the BMA has said it wants to move away from the “purchaser/provider” division that is a central part of both parties’ policies. Private provision should only be used where there was no NHS capacity in order to support rather than supplant the service and there should be “no further central procurement of private sector provision,” said the association. The BMA wants an independent board of governors to run the NHS and an executive board to handle day-to-day demands. James Johnson, the BMA's chairman of council, said: “We need a public debate to decide a process to define a list of core NHS services - it will be a very substantial core - that will be available nationally,” with the NHS able to top that up locally where money was available. He added that rationing already occurred within the NHS but it needed a “clear and transparent approach” rather than the “piecemeal fashion” it was currently implemented in. The BMA declined to define what these services would be. It recently emerged that the Department of Health was examining drawing up a list of “a package of services that all users are entitled to”, however Andy Burnham, the health minister, said yesterday that it would resist any attempt to slim down the NHS. Andrew Lansley, the Conservative health spokesperson, said the BMA were taking a “pessimistic rather than optimistic” attitude to the future of the NHS. Go to article

Telegraph (8 May 2007)

Hospitals suffer in computer fiasco. Hospitals have been hit by 200 "major incidents" in four months because of breakdowns in the NHS's £12bn computer system, a report claims. The problems, affecting dozens of hospitals between last October and January, led to doctors being unable to call up X-rays on computer screens in wards and operating theatres, creating delays in treatment. Some hospitals also lost access to records on appointments and planned treatments. The report in Computer Weekly magazine is another blow to the Government's scheme to centralise the records of 50m patients and link 30,000 GPs to 300 hospitals by 2012. MPs have warned that it is turning into the "biggest disaster" in the world. Another glitch, in Manchester, led to hundreds of inaccurate patient records being created every day last month after a software upgrade. Go to article

Portsmouth News (8 May 2007)

MP quizzes secretary over NHS web breach. Portsmouth's Labour MP has challenged the health minister over 'dreadful' security lapses on an NHS website. Sarah McCarthy-Fry went head-to-head with Patricia Hewitt over breaches in the on-line job application website for junior doctors. The Medical Training Application Service has been suspended after personal details of junior doctors accidentally became accessible to the public. Ms Hewitt – who has faced calls to resign over ‘shambolic’ medical training reform – was forced to explain in the House of Commons what precautions she had ordered. Ms McCarthy-Fry, MP for Portsmouth North, said: ‘The website has been closed while investigations into this dreadful security breach take place, quite rightly, but has not yet re-opened. I was concerned that this delay could jeopardise junior doctors’ training. I asked the Health Secretary if she could give any clearer indication of when the website would re-open.’ The health minister assured MPs that it would take a while to fix and she had brought in technical experts to help restore confidence in the system. Go to article

Financial Times (7 May 2007)

Private GP surgery opens in Manchester city centre. A health entrepreneur has opened a privately run general practice in Manchester in a sign of the mounting difficulties that patients have getting to a National Health Service family doctor in city centres. The opening of the facility by Octopus Health is a response to the demand for access to a GP from busy city centre workers and a growing resident population, said John Spencer, the man behind the business. The Octopus model does not intend that patients will have an exclusive relationship with the private GP, who will charge £55 for a 15-minute appointment. Patients are encouraged to maintain a relationship with an NHS GP for chronic or long-term conditions. This partly reflects the fact that private GPs cannot prescribe drugs on the NHS and some medicines cost vastly more than the prescription charge if privately prescribed. Nor do medical insurance schemes usually cover a visit to a private GP. However, Octopus says 80% of the most commonly prescribed medications will cost no more to provide privately than via an NHS doctor. Mr Spencer says the venture offers "joined-up" care in which patients can be referred to about 40 other private health providers on the same premises. Michael Goldsmith, who pioneered a one-stop private medical service with GPs in the 1980s, said: "These sorts of thing are not going to supplant the NHS. They are only going to thrive where there is a reasonably well-to-do population." Go to article

Telegraph (7 May 2007)

NHS pay private companies for failed PFI bids. Private companies that fail to win hospital building contracts are set to pocket millions of pounds in "compensation" from the NHS. Hospitals negotiating private finance initiative (PFI) schemes could be forced to pay almost 2% of the total contract costs to short-listed private companies which fail to secure deals, under proposals being discussed by the Department of Health (DoH). Unions and pressure groups have condemned as "scandalous" proposals which would see private sector giants already making billions from PFI schemes receiving further money for plans which fail to get off the drawing board. A £374m hospital in Bristol going out to tender this week will be the test case for the scheme which a DoH senior official said would "compensate" private sector consortiums for rising tendering costs following EU laws which came into force at the end of January. In the case of Bristol, the "runner-up" company could receive around £6m, while a third firm may also be paid. The DoH is understood to be the only Government department drawing up proposals for such payments. Private sector profits from PFI projects, and alleged waste linked to collapsed schemes, have come under increasing attack over the last year. The Parliamentary public accounts committee criticised a PFI scheme in Norfolk which allowed the private sector to triple its profits, taking out a windfall of £115m by refinancing the deal, and a scheme in west London axed by the Treasury after £15m had been spent on lawyers, consultants and architects. Pressure groups claim the private sector will make at least £23bn in profits and interest from PFI schemes in the NHS over the next 30 years, a figure denied by the Government, although it has yet to produce its own figures. Since Labour came into power, 124 PFI hospital building projects have been approved, 66 of which have been built. Karen Jennings, Unison head of health, said: "It is incredible that the private sector is able to exert an influence over Government money in such a way as to make money even when they aren't providing a service." Royal College of Nursing general secretary Peter Carter said it was "a bit rich" of the Government to be considering compensating failed bids to the tune of millions of pounds, while hanging on to a 0.6% pay increase for nurses which would allow them to receive this year's pay award in full. Go to article

Health Service Journal (3 May 2007)

Community foundations set for pilots, but names under wraps. The Department of Health is considering piloting community foundation trusts with the first to go live by the end of 2008. Foundation trust regulator Monitor began working on plans in 2006 and its minutes for March 28^th state: “The Department of Health had selected seven pilots to further develop the CFT model”. HSJ understands the CFT pilots are being developed in Middlesbrough, Cambridgeshire, Southampton City, South Birmingham, Liverpool, Newcastle, and Ashton, Leigh and Wigan PCT areas. However the Department of health will not confirm the sites and has asked all PCTs to not discuss the issue ahead of a national announcement this summer. A spokesman for the DoH said: “We didn't want PCTs leaking information about CFTs when the final list has not been agreed. What we weren't happy with is PCTs which have actively gone out and publicised it. We will make an announcement of all the PCTs taking part in the CFT pilots in the summer when the full list is finalised so it's not scuppered by little bits of information when we have not finalised anything.” Department of Health policy adviser John Pope said: “CFTs are a tried and tested governance model; there would be a trust secretary to look at issues around strategy and planning. They would have mutual principles as they would be owned by the community, allowed the freedom to innovate and improve the service, provide a way to reconfigure acute trusts and shift care closer to home.” The trusts would also remain part of the NHS, thus safeguarding pensions. He said risks included a possible reduction in competition, potentially high costs in some areas and a return to community trusts, which were considered monopoly providers. Mr Pope said: “At the back end of 2007 people will be fit and ready for the challenge. We are on a journey, an extremely challenging one, but look at what we did with acute trusts. However CFTs are not the only show in town; form should follow function and one model is not good for all situations.” He added that CFTs have support from trade unions. Go to article

Observer (6 May 2007)

Brown rules out independence for the NHS. Gordon Brown has abandoned the idea of creating an independently run NHS, amid growing concerns that it would make pushing through key reforms or controlling the £92bn budget impossible. The reversal comes eight months after the proposal was mooted by the Chancellor's supporters. They said that freeing the NHS from political control would create a fairer system, where healthcare decisions could be taken without political fall-out. Ministers would be kept at arm's length, and their job would be limited to setting the annual budget and strategic objectives. Brown has ruled out creating a body because of the continuing concerns about financial competence in the NHS. A source said: 'We've always supported the idea of giving local trusts greater autonomy, and we're still keen to move things in that direction. But the problem of handing over total financial control is what you do if it goes very badly wrong. If Great Ormond Street goes bankrupt, for example, who's going to pick up the pieces?' Health Minister Andy Burnham last night explicitly rejected any chance of Labour creating an independent service. He said: 'The era of the top-down, centrally driven target is coming to an end. An independent, central board running the NHS would replicate the same top-down approach but with less accountable people running the NHS.' Abandonment of the idea creates one of the clearest policy divides between Labour and the Tories. David Cameron decided more than a year ago that the Conservatives would free the health service from political control. He has since promised an NHS independence bill during a first term of Tory government, arguing that more power should be put in the hands of doctors and healthcare staff. As Mr Brown prepares to take over at No 10, he is looking at how decision-making could be devolved to a local level, based on patient choice but with overall financial control in Whitehall. Despite having spent much of his time at the Treasury setting targets for hospitals on waiting times and performance, he is said to be keen to allow hospital leaders to focus over the coming year on consolidation. Go to article

Financial Times (30 April 2007)

Private sector squeezes workforce. What has been the impact of the private sector on the National Health Service? In terms of the number of patients treated, tiny. In terms of managers' capacity to squeeze more out of their workforce, substantial. About 200,000 NHS patients a year are now receiving operations in private facilities, a drop in the ocean amid the 6m-plus planned procedures that the health service performs annually in England. Chris Ham, a former head of the strategy unit at the health department, says: "The volumes are almost insignificant in relation to what the NHS itself does." But he adds: "The impact on behaviour has been larger." Prof Ham goes on: "It has enabled hospital chief executives to negotiate with their staff, particularly their doctors, to achieve higher levels of performance. They are able to say 'if we don't change the way we do things we will lose patients and income to those people down the road'. It has given managers a pretty powerful lever to change medical practices in ways that might not have been so achievable with-out the private sector's involvement." But a question remains over whether the private sector will be able and willing to meet NHS prices. For the first round of surgical centres, private operators were guaranteed patients and paid about 15% above the NHS average price, or "tariff", to compensate for start-up costs. For the second wave, fewer patients will be guaranteed and it is not yet known if the prices will be "below tariff", as they should be, given that the centres tend to take the less complex, less costly cases. Go to article

Guardian (30 April 2007)

Labour’s Scottish health policy may provide UK blueprint. A blueprint for a shake-up of the NHS in England when Tony Blair's successor takes over as prime minister in the summer has been provided by Labour in its campaign for this week's elections. They are strikingly different from policies being pursued in England by Patricia Hewitt, who is not expected to remain as health secretary if Gordon Brown becomes prime minister. The policies include reform of prescription charges and hospital car parking tariffs, salaries for student nurses and speedy access for all patients needing chiropody, physiotherapy or clinical psychology. The chancellor has not allowed his friends and advisers to speak about the health policy changes he might make. He is thought to be considering a proposal to give the NHS independence from political control. The manifesto for Scotland would provide a blueprint for a quick makeover of health policies. The manifesto said a Labour administration in Scotland would run a pilot scheme for the direct election of a majority of members on health boards. And it gave a commitment to a reform of prescription charges, including a lower annual fee for patients who depend on repeat prescriptions. In hospitals there would be "a presumption that in-house cleaning services are the norm". Nigel Edwards, policy director of the NHS Confederation, said the initiatives "address the niggles about the NHS that people are voicing, such as the anomalies in prescription charges and fears about reconfiguration of services".

http://www.guardian.co.uk/guardianpolitics/story/0,,2068492,00.html

Health Service Journal (26 April 2007)

DoH to get the measure of PCTs working with private sector. The Department of Health will measure strategic health authorities on the percentage of primary care trusts in their region that use the private sector to help them commission. In a March draft of the DoH's NHS performance metrics for 2007-08, the DoH detailed plans to measure SHAs on the percentage of PCTs that are working with the private sector under the government's national Framework for Procuring External Support for Commissioners (FESC). Under the heading 'Health Reform Deployment Report Indicators', the document states that the DoH will require SHAs to assess the
'percentage of PCTs using the option of FESC for specific commissioning functions'. However, the early draft does not indicate an acceptable percentage range of PCT take-up of FESC, or whether SHAs will be penalised if not enough PCTs use the private sector for commissioning services. The document, which sets out a range of
performance metrics on which the NHS will be measured this year, is currently being circulated at DoH and SHA level and is expected to be published next month. Last week companies bidding to win a place on the FESC list lodged their final bids with the DoH and must now wait until 21 May to learn if they have been successful. A DoH spokesman confirmed that the bidding process is expected to be completed by the end of May. The DoH intends to publish a full list of FESC suppliers on 1 June after a 10-day period in which those companies that have lost out under the tendering exercise can lodge an appeal. Last June, the DoH published its controversial
contract notice in the Official Journal of the European Union, inviting companies to join a list of eligible providers to offer PCTs commissioning and managerial services from 2007. Companies which hope to be added to the framework include Bupa, UnitedHealth, Tribal Group, Dr Foster, Health Dialog UK, management consultants McKinsey, US healthcare insurance company Humana, and South African healthcare insurer Discovery. In all there are thought to be more than 100 companies bidding to be added to the framework. The FESC will comprise three lists detailing companies that can provide support to PCTs under the headings 'micro', 'macro' and 'end-to-end', split into four areas. The DoH's proposed areas are assessment and planning; contracting and procurement; performance management, settlement and review; and patient and public engagement. Companies that are on the 'end-to-end' list would be allowed to run the entire commissioning function on behalf of a PCT. However, in February the DoH published a policy statement which introduced stringent conditions under which PCTs could fully outsource commissioning support. The statement warned that PCTs will only be able to outsource all their commissioning expertise in 'exceptional circumstances'. Go to article

Health Service Journal (26 April 2007)

£1m company to tackle inequalities in North West. A company established to deliver better public health for people across the North West is set to launch in the next few months. NHS North West is planning to pump £1m into a community interest company in an attempt to improve the health of its population and stem the tide of rising health inequalities. The strategic health authority hopes the company, under its 'living better, living longer, caring more' campaign, will develop a region-wide health programme supported by a social marketing campaign. NHS North West is currently recruiting a programme director to run the company and will bring together stakeholders from public sector organisations across the region to form a board. In a briefing paper to the SHA board, director of public health Dr Ruth Hussey said 'leadership and direction on health messages would be best accepted from an independent organisation', as public confidence in what are seen as government messages is low. The company will run the public health programme over four years, focusing on obesity in its first year. According to the briefing paper the programme also aims to: transform public sector approaches to communication with the public about health; build capability for improved communication with the public and private sectors; engage the public and private sectors in understanding the health impact of key policies and strategies in order to facilitate policy change; measure and disseminate the impact of the programme through research and evaluation. Go to article

Pulse (27 April 2007)

Patient diagnoses delayed as trusts stall on referrals. Patient referrals are being delayed and mismanaged as primary care organisations struggle to cope with the effect of NHS deficits. A Pulse investigation reveals intense frustration among GPs and consultants at long delays to referrals – in some cases by as much as 16 weeks. The investigation uncovered a catalogue of problems – including administrative hold-ups, bouncebacks and failures by specialist teams to flag up patients. In one case a PCT was refusing to allow patients to be referred to save cash. It follows a Pulse survey earlier in the month finding two-thirds of GPs were seeing their referrals inappropriately diverted by managers. GPs' concerns were echoed by those working in secondary care. A consultant diabetologist said anonymously that referrals were being delayed by up to 16 weeks: 'Gatekeepers in general practice and PCTs are responsible. The PCT is preventing referrals being made to save money.' Go to article

Health Service Journal (26 April 2007)

Open or shut case as service shake-ups hinge on SNP result. The bruising process of NHS reconfiguration in Scotland could be repeated as NHS reforms are reversed if the SNP comes to power in the Scottish Parliament elections on May 3^rd. The SNP, which is ahead in the polls, has promised to reverse the decision to close two accident emergency wards and adopt a “presumption against” further centralisation of services. Although there is little space between the SNP and Labour on the health service – both propose different methods to achieve shorter waiting times – the centralisation issue is what separates them. During the last parliament, all parties in Scotland signed up, in principle, to the National Framework for Service Change, better known as the Kerr Report. There was also support for the Scottish Executive's response, Delivering for Health. However the SNP has broken from this path. “The SNP has taken a populist line on saving accident and emergency departments,” says Institute for Public Policy Research senior research fellow Joe Farrington-Douglas. “But whether they will be able to end reconfiguration, taking into account clinical and financial drivers, remains to be seen, especially if there's less money about.” Although independence may be a way off, even if the SNP take control, government’s from the different parties are likely to clash as the nationalists fight their corner in negotiations with the Treasury and the Department of Work and Pensions. Mr Farrington-Douglas believes there are challenges ahead for the Scottish NHS, whoever wins the election. “I think we could see a new debate on funding. The comprehensive spending review will be decided in London by Gordon Brown or whoever is chancellor. Nobody seems to doubt it will be a tight settlement that will have an impact on the Scottish NHS. Until now the Scottish Executive hasn't been complaining that they've not been given enough money, but if there is lower spending as a result of the spending review then the SNP, if they win in May, could complain that the NHS in Scotland is underfunded because of decisions taken by the chancellor in London.” Both parliaments could indulge in the blame game. “And it could work the other way as well,” says Mr Farrington-Douglas. “Health spending is historically higher per capita in Scotland but if people in England see that Scotland isn't having reconfiguration, while England is, there might be a feeling that the money should be cut.” The SNP also hold an anti-PFI stance, though it is not yet clear how this will apply in practise. Although the party has been vocal on the issue, its manifesto is more much cautious. Professor Allyson Pollock, head of Edinburgh University's centre for international public health policy and a leading critic of PFI, hopes the election will provide an opportunity re-evaluate the situation. “Servicing PFI debt is already having a financial impact in Lanarkshire and Lothian and there are big plans for PFI projects elsewhere in Scotland.” Workforce issues may also show up differences, the Scottish Executive has already broken with Westminster in awarding the full pay increase to healthcare workers and providing a more generous resolution to the furore over applications for specialist training. But BMA Scotland chair Dr Peter Terry calls this “small-scale stuff”. “The big differences are that the NHS in England is performance managed, usually through financial systems, while the health service in Scotland is run much more on partnership. I'd hope that consensus building would continue whoever is in power.” Whatever happens in the future, Dr Terry is optimistic. “Clearly if there are different parties in power north and south of the border England could make things difficult for Scotland, but I see opportunities. If at a strategic level they are mired in constitutional matters then maybe we on the ground can just get on with running the NHS.”
If Labour wins in Wales next week then there is likely to be increased scrutiny and a “get tough” approach to costs. The party’s manifesto promises independent analysis of managerial capacity and administrative costs to underpin a drive to move as much money as possible into frontline services. Last week research from BBC Wales was forecasting a £33m NHS overspend for the last 12 months, added to historical debts of £84m. However the most likely outcome is coalition government, the shape of which no one is certain of. If so, any policy will be the result of negotiation over manifesto pledges between the partners. This will have an impact on policy with parties clinging to key proposals. The Conservatives are likely to hold on to their policy of replacing 22 existing health boards with one all-Wales commissioning body. The Lib Dems want to introduce “health hubs” bring services together and introduce nurse-led walk-in centres. Plaid wants to halt proposed closures and require health boards and local authorities to share budgets to ease bed blocking. Labour’s proposal, which wants services to be based on co-operation, not competition, should probably be remembered by all who make up any coalition. Go to article

Guardian (26 April 2007)

Junior doctors’ personnel details made public in website blunder. The Department of Health has apologised for a security lapse on the junior doctors’ recruitments website which let the public access confidential information on thousands of applicants, including sexual orientation and previous convictions. The security breach is another blow to the controversial scheme. From 9am yesterday a range of personnel information on applicants was available on the NHS medical training website. The breach was initially revealed by Channel 4 news. The department said the problem was fixed immediately. “We apologise to any applicants whose details have been improperly accessed. This is a very serious matter and is under investigation,” it said. “This URL [website address] was made available to a strictly limited number of people making checks as part of the employment process. This information was never publicly available through the website and was only accessible for only a short period of time after details of the URL were leaked.” Earlier this year the website crashed under the weight of large numbers of doctors trying to apply simultaneously. Jo Hilborne, of the BMA's junior doctor committee, said there should be an enquiry into how the mistake occurred, particularly as the scheme was already under scrutiny. “It hasn't been a secret that juniors' faith in this whole system has been very, very badly damaged and this isn't going to help at all.” Andrew Lansley, the shadow health secretary, last night called for an urgent investigation by the information commissioner into the confidentiality breach. “There should be redress against anybody who is responsible for such a serious breach of people's data confidentiality,” he said. “It's something which clearly is going to further undermine what is already desperately low morale amongst junior doctors, many of whom have suffered considerable disadvantage to the way this system is working.” Go to article

Health Service Journal (26 April 2007)

S11 changes weaken consultation, says Commons health select committee. The commons health select committee has warned that plans in the Local Government and Health Involvement Bill to change section 11 consultation rules would further weaken public and patient involvement which is already a “sham” in places. The change would mean consultation would only have to take place on “significant” decisions, not all, with significant being defined as having substantial impact on the manner in which services are delivered to a wide range of users, or the range of services available. The report states that at present the theoretically excellent system suffers because “people feel they are consulted after decisions have been made”. “There has also been criticism of NHS organisations' refusal to consult about major changes and of the Department of Health's vigorous support of these decisions,” the report says. “We fear the bill will weaken section 11. The change of definition it proposes may lead to confusion and could lead to more court cases when the act is tested.” NHS Confederation policy manager Maria Nyberg said the committee's conclusions on the bill were worrying. “We do not believe that the legislation will weaken consultation. Rather, we need to be clear about the difference between ongoing patient and public involvement in decision-making, and formal consultations on significant service redesign. Ongoing involvement and engagement with patients and the public about health is of course essential if healthcare is truly going to be patient focused. Engaging with the local population must be properly embedded within NHS organisations. However, involvement is very different from formal public consultation, which is not required unless significant changes are being made to service quality, quantity or access.” She added: “Healthcare providers and commissioners need to be able to make clinical and managerial decisions quickly and remain agile in a competitive market.” Go to article

Guardian (25 April 2007)

Confusing ‘information jungle’ fails long term sick. Research from the Department of Health has acknowledged that millions of patients with long-term conditions find it virtually impossible to discover where to get essential services due to NHS failings. The researchers sent a team of “mystery shoppers” to investigate services. They found themselves referred from one organisation to another, with no one taking personnel responsibility for matching the services to the condition. The Picker Institute, an independent charity commissioned by the department to run the survey, said the NHS and social services were to blame for “an information jungle” that vulnerable people could not penetrate. Angela Coulter, the institute's chief executive, said: “The potential service users were frequently pushed from person to person, or from organisation to organisation. They were often left dangling by calls that went unanswered. They encountered sheer brick walls. Too often the services supposed to help people in real need throw them back on their own resources. Patients, service users and carers are left standing at a crossroads in their lives with no signposts to information about the kinds of support they say are vital.” The institute said those attempting to locate services were experienced information searchers who knew about the services they were pursuing. They were assigned to telephone providers in other areas saying they were about to move and needed information on the care available. The institute said that GPs were generalists who are often unable to advise on specialist services and that “a single contact point in each local area, with trained staff to help people navigate the information jungle” was needed. Rosie Winterton, the health minister, said: “Dispensing good, clear information is as important as prescribing pills or performing operations. We absolutely agree that information should be proactively given to people who use the NHS. To do this better we are piloting information prescriptions, which will give people a tailor-made 'prescription' of reliable sources of information about their condition.” Go to article

Guardian (25 April 2007)

Doctors and unions in dual NHS protest. The government faced protest from both junior doctors and unions over its NHS reforms yesterday. Doctor’s pressure group Remedy UK held a rally at Westminster in support of an opposition debate over the new computerised recruitment system for specialist training. The shadow health secretary, Andrew Lansley, and the Liberal Democrat health spokesman, Norman Lamb, were joined by Labour MP Ian Gibson as they addressed the protest. Meanwhile, health minister Andy Burnham faced half an hour of heckling at Unison’s annual conference in Brighton as delegates showed their displeasure at the decision to withhold this year’s pay increase. Nurses, paramedics and healthcare auxiliaries, who are preparing to ballot for a strike, waved handwritten posters telling him: “Low pay. No way. NHS here to stay.” Mr Burnahm finished his speech after a plea for restraint from the conference chairman. Although he gave no ground on pay, he promised to abandon plans to privatise and the Prescription Pricing Department and move the work offshore. “While we have further work to get better value for money, there will not be any outsourcing or offshoring,” he said. He went on to promise a reduction in centrally-set targets and major reorganisation in the short to mid-term but attracted heckles when he said he was “defending to the hilt the fundamental principles of the NHS”. Karen Jennings, Unison's head of health, said: “The conference conducted itself well, given the strength of feeling.” Go to article

Financial Times (24 April 2007)

Junior doctors go overseas after applications disaster. The fiasco over the application system for junior doctor’s training is making highly qualified junior doctors seek positions overseas in such countries as Australia and New Zealand. The British Medical Association released a survey yesterday of 650 doctors showing that over half would be likely to seek opportunities elsewhere if their applications are not successful. Almost five per cent had already received offers from other countries. “The NHS could lose thousands of its best young doctors simply because of poor planning,” said Dr Jo Hilbourne, who chairs the BMA's juniors' committee. HCL, an agency that provides locum doctors, said it had already placed 40 doctors overseas. “We currently have about 100 doctors who are looking to move abroad and there is worldwide demand for healthcare staff,” said Kate Bleasdale, chief executive of HCL. Andrew Lansley, shadow health secretary, said a strategic solution was needed. The Department of Health said it was not unusual for doctors to work abroad, adding that the interviews being conducted were “only training posts, and there are still jobs in the NHS for junior doctors who do not get a training place”. Go to article

Guardian (24 April 2007)

Unions threaten NHS strike over below-inflation pay increase. Representatives of public service union Unison voted overwhelmingly yesterday for a ballot on industrial action across the NHS in protest at a below-inflation pay increase. The representatives decided to offer Gordon Brown the chance to reverse his decision to withhold part of the recommended 2.5% pay increase, otherwise they will proceed with the ballot. Health workers in Scotland were awarded the full 2.5% this month. Both the Royal College of Nursing and the Society of Radiographers are considering strike action. Karen Jennings, Unison's head of health, said: “We have over 450,000 members in the NHS and the government ignores this growing wave of anger at their peril. We are not prepared to accept a pay cut and we are not alone in rejecting this paltry pay offer. We will unite with other health unions who have rejected the offer and with public sector unions fighting for a fairer pay deal ... it's time for the government to stop trying to defend the indefensible and to start listening to the largest workforce in Europe - the NHS.” Mike Jackson, the national officer, said: “We have a system of pay determination that we expect to be honoured. We don't expect the government to rip up the arrangements.” Janet Maiden, a nurse from University College Hospital in London, said: “There are over one million health workers and we could all take action together and show Tony Blair's replacement that we will not tolerate putting up with this any longer. Let us give this government a summer of discontent.” A Department of Health spokesman said: “The award represents a sensible increase.” Andy Burnham, the health minister, is due to address the Unison conference today. Go to article

Guardian (23 April 2007)

Brown set to face NHS strike. Gordon Brown faces the biggest NHS strike in more than two decades just weeks after he is expected to take over as prime minister, as Unison is set to become the second healthcare union to back industrial action over pay. The Labour-affiliated union will attempt to exert maximum pressure on the expected new Labour leader following a motion tipped to receive overwhelming support at Unison's annual health conference. Nurses, occupational therapists, administrative workers and auxiliary staff are furious over the government's move to stage their 2.5% pay award over six months, which the union says reduces the value of the overall increase to just 1.9%. It follows the decision by the Royal College of Nursing, whose members last week overwhelmingly backed industrial action over the decision. The backlash from one of the government's most loyal union allies could take place within weeks of Tony Blair's departure, leaving Mr Brown as the expected future leader to face massive industrial rest early in his tenure. Unison has also scheduled a national demonstration against further privatisation and marketisation in the NHS on October 13. Karen Jennings, Unison's national secretary for health, said healthcare unions would orchestrate their ballots, to ensure maximum impact. They are likely to coincide with the Labour leadership and deputy leadership election. Hilary Benn, the international development secretary and a deputy Labour leadership contender, was forced onto the back foot by delegates who accused the government of running a campaign to privatise the health service. The hostile reception is a foretaste of the rough ride health minister Andy Burnham is expected to receive over pay and healthcare reforms when he makes his address to the Unison conference. Platform speakers pointed to a series of reports which found that privatisation - such as independent treatment centres - were inefficient and wasteful. Delegate Martin Booth told the conference: "Whatever Mr Benn or any other government minister says, there are whole areas of the NHS in serious crisis because of this government's determination to privatise and marketise the NHS." Go to article

East Anglian Daily Times (23 April 2007)

Health campaigners launch new legal bid. Health bosses are gearing up a fresh legal fight after High Court judges agreed to look at controversial plans to axe beds at a threatened community hospital. Determined campaigners hailed the decision in the latest twist to save health services in the Sudbury area - claiming that any bed closures would lead to the eventual demise of the town's Walnuttree Hospital. Officials at Suffolk Primary Care Trust said the decision to axe three beds was taken due to health and safety reasons and that it planned to reopen the beds as soon as possible. But leading campaigner Frances Jackson, a member of the Walnuttree Hospital Action Committee, claimed the plans were part of a “closure by stealth”. She said: “I know it is only a few beds but I think most people think it would be the beginning of a gradual filtering out of all beds in Sudbury. It is so important we retain these beds - otherwise patients and their families might have to travel to Newmarket or Bury St Edmunds to hospital.” London solicitors Leigh Day & Co had filed for a judicial review, claiming the cutbacks were unlawful as the decision was taken without public consultation. But John Such, chief operating officer for Suffolk Primary Care Trust, last night said the decision was taken on the advice of clinicians to have the “right number of professional staff” to ensure patient care. Suffolk PCT had announced plans for a new healthcare hub in Sudbury centring around a number of outpatient facilities and a few inpatient beds in a community facility. But the new proposals have been sent to Health Secretary Patricia Hewitt after members of the Suffolk Health Scrutiny Committee said they were too vague. Go to article

Observer (22 April 2007)

NHS row over cheap insurance for cancer drugs. An insurance company will 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. In recent years a number of new cancer drugs have come on the market which offer patients a better chance of survival or a longer period before they relapse and the disease returns. However, the drugs can cost £20,000 a year per patient, and the NHS has struggled to fund the demand. The initiative comes as a group of senior doctors will argue that the NHS must also address the issue of co-payment - where a patient is seen for free, but can 'top up' the treatment by paying for extra therapies not available on the health service. The group, Doctors for Reform, will argue that the NHS should accept that it cannot meet all the costs of newer treatments, and that a co-payment system would be fairer and ultimately cheaper. Patients would not be forced to opt out of the health service if they want the most expensive therapies. But the move will be fiercely resisted by Health Secretary Patricia Hewitt, who has argued that the level of spending on the health service has been unprecedented and that the newer treatments are affordable and should be given by doctors if there is a clinical indication, regardless of whether or not they are approved by the National Institute for Health and Clinical Excellence (Nice). She intervened last year to fast-track the breast cancer drug Herceptin, after outcries over rationing. Joanne Rule, head of Cancerbackup, said: 'The policy will pay for drugs that are unavailable on the NHS, which highlights a gap in the current provision of cancer drugs within the NHS, but this must not set the long-term future for cancer care.' Karol Sikora, a senior cancer specialist who supports Doctors for Reform, has argued in the past that new methods of paying for therapies must be found. Go to article

Financial Times (21 April 2007)

Setback for NHS on treatment centres. Nuffield Hospitals, the not-for-profit private hospital operator, has pulled out of negotiations to provide operations for NHS patients using mobile operating theatres in the West Midlands. The move is a setback for the Department of Health's drive to get up to an extra 250,000 patients a year treated in private sector facilities through a second round of independent sector treatment centres (ISTCs). Some 13 schemes have reached preferred bidder stage but it is now nearly two years since they were first announced, with none having yet reached financial close. Nuffield cited costs and delays in concluding the deal as the reason behind its decision. A series of factors, including negotiations between the department and the Treasury, have slowed the deals, with some in the private sector uncertain whether Gordon Brown will promote the programme with the same vigour as Tony Blair, assuming the chancellor succeeds him as prime minister. David Mobbs, Nuffield's chief executive, said the scheme was originally due to go live this month. But "delays have seen our costs and risks rise" to the point where already slim margins on the contract were being rapidly eroded. With no firm contract in sight, he said, the company had decided to draw a line under the deal. He insisted that the decision did not imply a loss of interest in doing work for the NHS. "We are still extremely excited about the NHS market and about the increasing right of patients to choose a private hospital [where the hospital agrees to treat patients at NHS prices]." In addition, primary care trusts in the Midlands were still showing "a high degree of interest" in the project, he said, and Nuffield still hoped to use the mobile theatres for NHS patients under locally agreed arrangements. The Department of Health now has the choice of dropping the deal or attempting to persuade its reserve bidder, thought to be Netcare, to take it on. The move comes as most of the companies bidding for the second wave of ISTCs now say privately that they do not believe the programme will reach the government's original - and repeatedly confirmed - target of spending £550m a year to treat 250,000 patients annually. Most now expect it to add up to only £350m. But the private sector's faith in a continuing market for NHS care was demonstrated by the completion yesterday of Care UK's deal to buy Mercury, which also runs treatment centres and a range of other services for the NHS, from the Tribal Group. The deal has cost Care UK £77m once debt repayments and debt assumed are included. Mike Parish, Care UK's chief executive, said: "You don't get that sort of money back from the residual period of Mercury's existing contracts. This represents a substantial investment [in our belief] that there will be life [in work for the NHS] after the existing contracts." Go to article

PFI.net (21 April 2007)

SNP outline alternative plans to PFI. SNP Deputy Leader, Nicola Sturgeon, has met Unions to outline its party’s plans for an alternative to PFI. Ms Sturgeon attended the STUC Conference in Glasgow to set out the SNP's plans in government to develop high class public services within the public sector. Speaking from the STUC Conference, Ms Sturgeon said: "It's time for a better value alternative to the costly PFI/PPP. In communities across Scotland we see the real cost of Labour's privatisation agenda, with the loss of vital local health services the unacceptable price Scots are being asked to pay. Our new approach will put people before profiteering and communities before centralisation. PFI/PPP means credit card levels of annual interest repayment. I have no doubt we can do better with public assets delivered through a not-for-profit trust. That's why we will bring forward plans for a Scottish Futures Trust. This will offer better value finance through bond issue and, I believe, over time crowd out the costly PFI/PPP. There is no doubt the public are paying a hefty price for Labour's PFI/PPP. It's time for fresh thinking so we can deliver the better value and fully public services communities across Scotland expect and deserve." Go to article

Guardian (13 April 2007)

Concern over junior doctors’ shift pattern. A report in the