NHS Support Federation - News archive March 07

End fertility treatment on the NHS, say doctors. A survey of more than 1,000 GPs and hospital doctors showed that 70% said that the NHS should not pay for every type of operation but there was no consensus on what the NHS should fund. When asked if patients should pay for treating accidents or illnesses caused by lifestyle choice, 38% were unsure, 33% said the NHS should pay and 28% said patients should pay. The online survey by Doctors.net.uk, shows that doctors continue to support the health service, but are increasingly concerned about how it can be afforded. There was support for asking patients to pay for all or part of their treatment as a means of deterring time-wasters, with 70% agreeing this would be an effective measure. But when the doctors were asked if they thought paying for treatment would reduce the number of diseases or accidents caused by drinking, 42% thought that it would while, 45% thought that it would not. Eighty per cent did not believe that the NHS should pay for vasectomy reversal and 84% said the NHS should not pay for gender reassignment surgery. About a third thought that the NHS should not pay for elective caesarean operations. But other operations which some doctors argue should not be done on the NHS or have unproven merit - varicose veins, grommet insertion, hernia repair and tonsil and adenoid removal met with more approval. Between 70 and 80% thought these operations should be free. Dr Jonathan Fielden, the chairman of the NHS consultants' committee, said the time was right for a debate on how the health service should be funded. "There would probably be agreement on providing core services and agreement on not providing services such as cosmetic surgery or fertility treatment, but there would be grey areas. I believe these would need to be decided democratically at a local level, but this would have the effect of increasing the post code lottery," he said. Dr Tim Ringrose, the director of professional relations at Doctors.net.uk, said the large number of respondents "illustrated that the profession has widely differing opinions about how far the NHS can go to provide "cradle to the grave" care. "The vast majority of doctors still believe that the NHS should fund the majority of care for surgical procedures, but only a minority think that fertility treatment, gender reassignment and illnesses related to lifestyle should be fully funded by the public purse." Go to article

Independent (30 March 2007)

Cancer specialist: ‘Let NHS patients pay for their treatment’. A cancer specialist has said that NHS patients risk losing out on an imminent revolution in cancer treatment unless they are made to pay towards the cost of their care. Professor Karol Sikora said at least six powerful cancer drugs would become available over the next year, costing at least £60,000 a year per patient. The "designer" cancer drugs, similar to Herceptin, are among the first to offer targeted therapy for cancers of the breast, lung, kidney and bowel. But it is unlikely the NHS will be able to afford any of them and the backlog of drugs awaiting approval by the National Institute for Clinical Excellence (Nice) will delay their assessment for at least a year, he said. Writing in the Journal of the Royal Society of Medicine, Professor Sikora said the dilemma this posed for the NHS could not be ducked any longer. If it declined to pay for the drugs, patients would be forced to go without. The only alternative was to allow patients to top up their NHS care by paying privately for the drugs. "There is now evidence of a growing use of co-payments to break through the access barriers in the NHS," he wrote. "Cancer patients are beginning to develop sophisticated approaches to buying extra clinical services either from the NHS directly or through the selective use of the private sector to purchase upgrades to their basic NHS care." NHS patients are officially forbidden from buying their drugs privately as this would mix NHS and private care. The Department of Health says patients must choose whether to be treated on the NHS, and accept what the NHS offers, or to go private in which case all of their care, not just the drugs, must be paid for. A Department of Health spokesman said: "You cannot be both a NHS patient and a private patient at the same time. Co-payments would risk creating a two- tier health service and be in direct contravention with the principles and values of the NHS." Go to article

BMJ (30 March 2007)

Minister backs social enterprise model in healthcare market. Social enterprises—businesses for which the bulk of profits are reinvested in the community—will be one of the keys to transforming health and social care in the next decade, claims the health secretary, Patricia Hewitt. Ms Hewitt was speaking at the launch of Healthy Business, a publication from the Social Enterprise Coalition, which describes nine social enterprises already operating successfully in health care. They include an out of hours GP service, a nurse run general practice, and a community led primary care centre. The government has put increasing weight behind encouraging new providers into the health market. Last year's Our Health, Our Care, Our Say white paper on primary care identified social enterprises as an important means of raising quality and stimulating innovation. Go to article

Pulse (29 March 2007)

Prime Minister's adviser calls for charges to visit GP. Patients should be charged to see GPs in order to limit the 'frivolous' use of services, a leading Blairite has said. Professor Anthony Giddens, who wrote New Labour bible The Third Way, believes the concept of an NHS 'free at the point of use' should be consigned to the past. Instead patients should be charged 'modest fees' to access GP services, Dr Giddens writes in his new book Over to you Mr Brown, published this week. In exchange, patient choice should be expanded to make it much easier to switch practices 'at short notice'. The former London School of Economics director believes 'modest' fees, such as in Sweden, contribute a little over 1 per cent of total funding. He argues: 'The principle that the NHS should be free at the point of use is based on the notion that even a small fee would deter some people from visiting the doctor when they need to, especially poorer people. 'But the whole point of introducing fees would be to deter people from seeing the doctor – those who come for minor or non-existent ailments. In a society where there is no grinding poverty, it is hard to see that a small charge would deter those who really might need treatment.' Go to article

Health Service Journal (29 March 2007)

Demise of 'double deficit' prompts refunds to budgets as loans system is introduced. The Department of Health is to scrap the 'double deficit' accounting system for acute trusts and pay back deductions taken from them during 2006-07. The move will see the Treasury's resource accounting and budgeting system abolished from 1 April, as well as several trusts receiving rebates that significantly reduce their end-of-year deficits. Under the RAB system, introduced in 2001, trusts that run up an in-year deficit are penalised by the same amount the following year. Dismantling the system means that acute trusts that have been paying deductions this year for overspends in 2005-06 will get the money back; however, the DoH will not refund RAB deductions for previous years. A DoH spokeswoman told HSJ that, where RAB cash had been deducted before 2006-07, NHS trusts would have to 'agree with their auditors a "disregard" of RAB deductions for the purpose of meeting the statutory break-even duty'. A total of 28 acute trusts will benefit from the RAB rebate. The DoH has given back £178m to the trusts to be distributed by strategic health authorities. North West London Hospitals trust stands to gain the single biggest refund, getting around £24m and reducing its current deficit from £25.6m to just over £1.5m. London's Queen Elizabeth Hospital trust gets a refund of just over £23m, cutting its debt from £36m to £12.6m. Last July, the Audit Commission recommended trusts be reimbursed for RAB deductions from 2001 and called for the system to be scrapped. Its report, commissioned by health secretary Patricia Hewitt, said that RAB was incompatible with the NHS financial regime. However, the DoH delayed the decision to scrap it until it was confident that the NHS would balance its books this year. Go to article

Doctor (27 March 2007)

Private push begins. The government has signalled its determination to increase the role of the private sector in running primary care services with the announcement that it will invite retailers to open GP surgeries in underdoctored areas. The move, unveiled by Health Secretary Patricia Hewitt, will see adverts placed in the national and local press this month calling for 'experienced healthcare providers' to apply for four contracts initially worth £30m over five years. The Government envisages major retailers or groups of entrepreneurial GPs setting up new practices, walk-in-centres and minor injuries units, potentially based in supermarkets or high-street stores, by the end of the year. The programme is to be piloted in PCT areas covering Hartlepool, Durham, Ashfield and Great Yarmouth, but a further 26 are thought to be in the pipeline. The announcement has led to fresh concerns that new privately-run services will have a competitive advantage over existing GPs. GPC member Dr Fay Wilson said GPs would struggle to compete against the private sector when tendering for services because of a lack of resources and skills in putting bids together. 'The department said this is a level playing field, but just because Accrington Stanley and Chelsea play on a level playing field does not make it fair,' she added. In Ashfield, one of the pilot areas where a new primary care centre and intermediate care service are proposed, the PCT is already in the process of consulting on setting up an alternative provider medical services practice to tackle the GP shortage. Chris Locke, chief executive of Nottinghamshire LMC, said the PCT may now have to invite tenders to set up a new practice in the light of the announcement. 'It would have to start from scratch in recruiting patients, leaving local practices feeling threatened. That's how they would bring in competition.' The new services planned include: Hartlepool - two GP practices and urgent care service; County Durham - one new GP practice; Ashfield - new primary care centre and intermediate care service; Great Yarmouth - one new GP practice. There are a total of 30 projects in the pipeline. Go to article

Daily Mail (26 March 2007)

Care for new mothers being cut ‘to save money’. Valuable support for pregnant women is being cut because of the NHS's financial troubles, a healthcare charity has warned. The National Childbirth Trust (NCT) says it is receiving "increasing reports" that NHS antenatal classes, breast-feeding services and post-natal visits are being cancelled. NHS antenatal classes have been cut or "temporarily suspended" in at least 10 areas in England and Wales, according to the NCT. The NCT said it also understood that postnatal home visits have been stopped or are facing cuts in Wiltshire and in east and north Hertfordshire. This would mean new mothers having to travel to a clinic in order to receive after-birth care. An NCT spokeswoman said: "These cuts in maternity services may reflect a more widespread pattern. The NCT is concerned that these short-term measures to ease financial deficits are having a negative effect on new parents and parents-to-be, preventing them from getting the information and support they need at this important stage in their lives."
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Sunday Telegraph (25 March 2007)

A&E reform could put lives at greater risk. Patients' lives will be put at risk by a major shake-up of accident and emergency departments, a secret report by senior doctors has warned. The new system - which could see casualty departments operating without back-up services such as intensive care, paediatrics and surgery - is too dangerous according to a joint paper by the British Association of Emergency Medicine (BAEM) and the College of Emergency Medicine. The confidential report follows controversial plans for a system of acute hospital care, drawn up at the request of the Department of Health, which wants to see a reorganisation of hospital services across England agreed within months. Under the draft proposals, patients in need of urgent care would go to one of five types of centre, depending on how seriously ill they were. The most contentious aspect is that district general hospitals could be downgraded to become emergency hospitals offering A&E services, but without the back-up of intensive care, surgery or paediatric care. The response from the emergency doctors paints a bleak picture. "Increasingly, doctors will be faced with an extremely ill or injured patient and have a stark choice of letting the patient deteriorate and die, or performing a procedure that is not part of their everyday practice," it warns. The two bodies call for support for doctors who get out of their depth, given "an increasing trend for minute examination of critical decisions, especially in an unexpected death", with the possibility of complaints, inquests, investigations by disciplinary bodies and criminal investigation. The Royal College of Paediatrics and Child Health and the Royal College of Surgeons have raised similar concerns, warning that hospitals with an A&E but no surgery could struggle to keep enough intensive care staff on their books to support patients who suddenly fall critically ill. Martin Shalley, the BAEM president and an A&E consultant in Heartlands Hospital, Birmingham, said his greatest fear was for parents who drove sick children to their local A&E department - only to find that it lacked the equipment and expertise they needed. The plans to downgrade district general hospitals were drawn up by the Royal Academy of Medical Royal Colleges, an umbrella body representing a number of doctors' specialities. Even it admits there are problems to overcome if its proposals are to work. It cites a lack of evidence showing what the outcomes are for patients who travel longer distances, but insists "big is not necessarily better" when it comes to hospitals. Shadow health secretary Andrew Lansley attacked the Government for pushing changes which were driven "not by clinical reasons, but by finance and the need to shut things down". Go to article

Newcastle Journal (26 March 2007)

Hospital campaign expects a victory. Campaigners who fought controversial plans to close a hospital day surgery expect to learn that they have been successful. Consultancy firm Tribal began examining the work of a Day Surgery Unit at Shotley Bridge, County Durham, four months ago to see whether it could be cost-effective. County Durham and Darlington Acute Hospitals NHS Trust had proposed to close it last August, before the publication of a government White Paper advocated making more use of community hospitals. The board agreed to defer a six month temporary closure so that Tribal's evaluation could be carried out. The results are expected to be known this week. The council says closure would break a pledge made in 1999 by the former County Durham Health Authority to maintain a full range of community hospital services at Shotley Bridge. Go to article

Public Finance (23 March 2007)

PFI hospitals ‘costing NHS extra £480m a year’. The Private Finance Initiative could be costing the NHS an extra £480m a year as private equity providers enjoy a 58% return on their investment, according to research from Manchester Business School. An MBS report, The cost of using private finance to build, finance and operate the first 12 NHS hospitals in England, examines the first PFI hospitals, which became operational in 2000/01. By studying the charges paid by the hospital trusts and the accounts of the PFI special purpose vehicles, the authors found that the average cost of capital for SPVs was 8% – or £123m a year: almost twice as high as the cost of public sector borrowing. ‘This means that by 2005, the additional cost of private finance was about £60m a year on 12 capital projects worth £1.2bn,’ the researchers – Jean Shaoul, Anne Stafford and Pam Stapleton – state. ‘If this experience is generalised across the entire PFI programme… then the extra cost of private finance for the signed PFI capital programme in hospitals… is about £480m every year.’ The higher cost of capital for the SPVs was accounted for largely through the higher interest rate private borrowers are subject to (around 7%–8% in the cases examined), but also by the rates of return paid to private equity investors. After five years with no return on their investment (while the hospitals were still being built), equity providers claimed a 58% post-tax return in 2005; a rate that Shaoul said was ‘set to continue for the remainder of the 30-year contracts’. That return is four times higher than the ceiling 14%–15% rate of return seen in other PFI deals, which the Treasury described as ‘too high’ in 2005. The report also raises concerns about the on-going affordability of PFI schemes as hospital trusts move to a less stable funding regime. Between 2000 and 2005, the annual charges paid by hospital trusts to PFI SPVs increased by an average 20% above the anticipated charges detailed in the full business case. This meant that despite large increases in NHS funding over the same period, PFI charges remained fixed at around 12% of a trust’s income. The research has been peer-reviewed for academic publication later this year. The Department of Health rejected the figures. ‘We would dispute the researchers’ conclusions,’ a DoH spokesman said. ‘The use of 7%–8% as the private sector rate of debt is wrong as this is project finance and the rate depends on the project and the clients.’ The researchers say their figure is an arithmetic average based on actual figures. The DoH also disputed the 58% figure for the return on private equity. ‘The equity returns of NHS PFI schemes are in the region of 12%–14%,’ the spokesman said. He added: ‘The PFI payment may take up 12% of a trust’s income, but this will be no more than would be paid if the new non-clinical services and estate had been paid for under the conventional route.’ Go to article

E-Health Insider (22 March 2007)

BMA sits on critical Choose and Book survey results. The British Medical Association has decided not to publish its own survey of Choose and Book which is highly critical of the e-booking system. A copy of the survey has, however, been obtained by EHI Primary Care. At the beginning of February BMA chairman Mr James Johnson promised the survey would be published “shortly” but EHI Primary Care has now learnt that the association has changed its mind. A spokesperson told EHI Primary Care: “We are not publishing the survey as we feel it does not move things on any further. We will, however, continue to monitor how members feel about Choose and Book.” The decision not to publish the survey is in contrast to earlier highly public criticism of the e-booking system from within the association. GP representatives at last year’s annual local medical committees conference passed a motion describing Choose and Book as “deeply flawed and not fit for purpose” and a year earlier Mr Johnson himself told the BMA’s annual conference that Choose and Book was a “fiasco”. The unpublished survey of 279 GPs and 128 consultants carried out between 30 November 2006 and 10 January this year shows that members’ views have changed little since then. A total of 57 % of GPs and 81% of consultants described their experience of Choose and Book over the previous month as negative or very negative and 87% of consultants and 71% of GPs said they would not recommend Choose and Book to a colleague. Asked about whether patient choice had improved with Choose and Book the majority of GPs (68%) reported that in their view it had not as did 56% of consultants with a further 30% of consultants saying that they did not know. Consultants appear to be even unhappier with the e-booking system’s impact on patients than GPs with almost 92% of consultants disagreeing or strongly disagreeing with the statement that patient feedback had been generally positive compared to 64% of GPs. A total of 65% of GPs in the survey did not think the system was user friendly and 69% did not think it was reliable either. On a slightly more positive note 87% of GPs reported that patients generally get the choice they want but 84% disagreed or strongly with the statement that Choose and Book gave them more control over the referral process. Just over 1% of consultants felt that the management of referrals had improved. Two thirds of GPs and consultants reported that they strongly disagreed or disagreed with the statement that Choose and Book provides improved patient safety as referrals did not get lost or that Choose and Book provides improved patient safety as they are less likely to not attend. Go to article

Guardian (21 March 2007)

Hospital parking 'a stealth tax on illness'. The NHS may be free at the point of delivery, but patients and their families paid hospital parking charges in England totalling £95m in 2005/06. The figures, released under the Freedom of Information Act, show that 12 hospital trusts each raised more than £1m in charges. Government guidelines on car parking charges in December "strongly recommended" that NHS bodies introduce some kind of "season ticket" arrangement, allowing free or reduced-price parking for patients with a long-term illness or those with serious conditions who require daily or regular treatment, and their prime visitors. It also suggested a weekly cap on parking charges. Macmillan Cancer Support, which is campaigning for all cancer patients to get free hospital parking and help with travel charges, says the figures are shocking. Research by the charity last year found a postcode lottery of hospital car parking costs, with patients in Scotland spending an average of £636 on travel and parking throughout their cancer treatment compared with patients in Wales who spent £318. In south-west England, the average bill was £477, in the south-east, £424, and those in the north paid £371. Some patients were found to have spent more than £1,000. The charity called the charges "a stealth tax on illness". Go to article

Doctor (21 March 2007)

GPs refuse to be OOH scapegoat. Doctors' leaders and grass-roots GPs have warned that any attempts by ministers to extend GPs' working hours will fail if not properly funded. Struggling GP out-of-hours (OOH) services and overstretched hospital A&E departments could lead to pressure on GPs to open later in the evenings and on Saturday mornings. The warning follows the publication last week of a report by the Commons Public Accounts Committee that severely criticises the running of OOH services since PCOs took over responsibility for them in 2004. It says they are not serving patients well, with access to advice and treatment 'often extremely difficult and slow'. The report also describes the DoH's preparations for the introduction of the PCO-run services as 'shambolic' and 'thoroughly mishandled'. It is costing £70m more a year to run OOH services than expected. But GPC negotiator Dr Peter Holden said any back-door attempt by the Government to extend GPs' involvement in OOH would only be acceptable if it was properly funded. Go to article

Financial Times (20 March 2007)

NHS may be restricted to core services. The prospect that the NHS might provide only core services, with additional treatment paid for directly or through private insurance by patients, has been raised by the government. The small print of the public services policy review, launched by Tony Blair and Gordon Brown, says the government should “look at the possibility of drawing up a package of services that all users are entitled to”. The Department of Health confirmed that it was examining the possibility as part of normal process and that deciding what people were entitled to would also involve deciding “what they are not entitled to.” Academics however warned that defining such a “basic basket” would be fraught by technical and political difficulties. Anna Dixon, deputy director of policy at the King's Fund think-tank, and a specialist on international health systems, said: “It sounds like establishing a core package of benefits that the NHS will fund - and that is something that has long been debated in academic circles. But politicians . . . have always shied away from being more explicit about entitlements.” Social insurance systems tended to be much more explicit about what they covered, with private insurance markets developing to cover excluded treatments, she said. But she warned that when lists of exclusions were drawn up, “they often do not feel right to the public”. She added that such a difficult exercise “is going to be very controversial”. David Hunter, professor of health policy at Durham University, said: “It is very difficult to define what is in the basket, so either it doesn't get done or very little gets left out. You don't save much, and you are still left with the issues of how to ration care and assess quality and cost effectiveness” - something Nice was already doing but “in a rather less prescriptive way”. The Health Secretary, Patricia Hewitt, was involved in producing a pharmaceutical industry-financed report study that in 1995 said that there should be restrictions on free services. But she disowned the report on becoming health secretary, saying the government's big increase in NHS spending removed the need for such measures. Go to article

PFI.net (20 March 2007)

Assembly minister claims PFI wasting millions. A Welsh Assembly member has claimed that PFI deals are wasting millions of pounds. Owen John Thomas, Assembly Member for South Wales Central, has claimed that PFI deals were a ‘scandalous’ waste of money when patients are having to take out loans to pay for treatment privately. The members comments came after it was revealed that a former soldier had taken out a loan to pay for treatment for prostate cancer because the NHS refused to fund it. Finance Minister Sue Essex yesterday suggested the Assembly Government was flexible on the role of private finance initiatives as she faced questions in the chamber about why there had been fewer PFI projects in Wales than in England under Labour. Ms Essex said PFI had been used to build roads, schools and hospitals, but she was happy to look at 'other mechanisms rather than PFI if it doesn't fit the proposal”. Plaid Cymru Assembly Memeber Alun Ffred Jones asked, “What advantage is there in borrowing money in the private sector at higher interest rates than the public sector can borrow the funding, and therefore increase the payment?” Go to article

Pulse (16 March 2007)

Care closer to home 'costly and unsafe'. The Government's flagship policy to shift care en masse from hospitals to primary care will in many cases lower quality and increase costs, a damning NHS report concludes. Its findings shatter the assumption that care 'closer to home' will necessarily be safe, cheaper than hospital care or popular with patients. There will only be concrete benefits for rural areas and in a small subset of initiatives, warns the wide-ranging analysis commissioned by the Department of Health. The report comes as consultant leaders claim as few as a third of GPSIs may be competent to take on work from specialists. It finds a few policies – including telemedicine and direct GP access to diagnostic tests – can reduce demand on hospitals and maintain quality. But in many other areas, including minor surgery, specialist clinics in the community and GPSI clinics, services are likely to be more expensive and potentially less safe than hospital care. In Our Health, our care, our say, the department insisted some primary care procedures cost only a third of those in hospitals, with potential to 'considerably' reduce demand for specialists. But the report, a comprehensive review of evidence for transferring care to the community, casts a long shadow over those claims. 'The paucity of high-quality research for any one intervention was striking,' it says. It is 'often not the case' that care in the community is cheaper than hospital care and 'not true' services like minor surgery can safely be transferred to GPs, it warns. It also concludes there is 'a serious risk that increasing provision may increase demand'. Report author Professor Martin Roland, director of the National Primary Care Research and Development Centre, said shifting work might only be beneficial where access to hospital was difficult – such as in rural areas. 'It should be applied selectively where patients will benefit.' Go to article

Financial Times (15 March 2007)

Calls for clarity on NHS market strategy. The two big regulators of NHS and private care have warned that Ministers must be clearer about how far they want to use competition within the NHS. The extent to which market forces are to be applied to the NHS will be critical for what role the new regulator intended to cover the emerging market in the NHS will take. The outcome is also likely to be a strong indicator of how far Gordon Brown wants competition and the private sector to be involved in the NHS if he becomes prime minister. “It is clear that the new regulator will have a competition function,” said Anna Walker, the Healthcare Commission's chief executive. “But it is not clear from the department's document whether the function will be to police anti-competitive behaviour, or to promote competition. These two roles are very different.” The foundation trust regulator, Monitor, echoed her comments in its response to the healthcare regulation review saying: “Our view is that greater clarity is needed and that you need to decide on the policy before you can decide how to regulate it.” Go to article

Guardian (15 March 2007)

First test launched of controversial ‘spine’ database. The first trials of the government’s plans to put the medical records of all NHS patients in England onto a central electronic database will begin at two Bolton GP practises. Around 14,500 patients will have their records uploaded to the database known as the Spine, unless they object. Whether they accept the government’s argument that the database can save lives, or side with campaigners who see it as a move towards a Big Brother state, Bolton will provide the first test of public opinion. Although the government has conceded that people should be able to refuse having their information uploaded onto the spine, they have postponed explaining how this will happen until the first trial. Patients at the two practises will receive a letter from their GPs saying they have eight weeks in which they may decide to opt out by writing to their GP or lodging their objection on a helpline or through NHS direct. Connecting for Health, the NHS IT agency, will tell 50 million patients about a procedure to inform their GP that they do not want their information uploaded at the same time. There will be three options given to the Bolton patients who want to opt out. Having none of their information uploaded, allowing uploading but restricting who can access the information to a few NHS staff, or requiring that specific details on their records are left out. After eight weeks, all those who have not opted out will be assumed to have consented and uploading will begin after a further eight weeks. However an agency spokeswoman said that unless over 60% consented, at least implicitly, then the scheme would not go ahead. If all goes well after more trials around the country, summary records of NHS patients will be uploaded in spring next year. Go to article

Guardian (13 March 2007)

Hewitt hands over NHS decision. Health Secretary Patricia Hewitt has set up an independent inquiry into plans to axe maternity units in north-west England. The plans provoked a revolt among the Labour party, including cabinet minister, labour party chair and deputy leader candidate, Hazel Blears. Ms Blears has been campaigning against plans to close a maternity unit in her Salford constituency. At least 13 members of the government who support the principle of reorganising NHS services oppose loss of facilities in their own back yards. If Ms Hewitt had reprieved maternity units in Salford and Bury, the closure of which health minister Ivan Lewis has been campaigning against, she would have faced outrage from managers. She equally could not rubber-stamp the decisions as this would have caused dismay among many Labour MPs. Ms Hewitt resolved the issue by referring changes to the Independent Reconfiguration Panel which was set up in 2003 to advise on the most controversial changes. Go to article

Guardian (13 March 2007)

Divisive choice. Choose and Book, the IT programme that allows doctors to book hospital appointments electronically, is to miss a key target. The government wanted 90% of referrals to go through this system by March but the figure is well below that and a picture has emerged of varying enthusiasm for the programme. “Clearly, the target isn't going to be met everywhere,” says Dr Mark Davies, medical director for Choose & Book at Connecting for Health (CfH) - the government agency responsible for the NHS IT programme - which runs the service. Usage is currently at 37% and he now expects the 90% target to be met nationally later this year. Dr Davies went on to say that some doctors “are not particularly bought into” patient choice, and this is reflected in their attitude to the system that enables it. A poll by medical pollsters Medix in November found that half of GPs use the system for more than 40% of referrals. But among these regular users, 90% say it increases the time taken to refer a patient to hospital and 70% think it is detrimental to patient care or makes no difference. Go to article

Daily Telegraph (13 March 2007)

Angry doctors to march over selection system. Thousands of doctors are expected to march in London and Glasgow this Saturday over the NHS selection system. Calls are continuing for the new online applications and interview system to be suspended despite conciliatory noises from Lord Hunt, the health minister. Figures suggest that there have been 33,000 applications for 18,500 training posts. Go to article

Financial Times (12 March 2007)

Hospitals told to focus on profit centres. Hospitals are being told to identify the services and treatments on which they turn a profit. In the last resort, that could lead to some ceasing to provide services that do not make money. The move marks a further injection of market disciplines into the National Health Service and is being promoted by Monitor, which regulates quasi-independent foundation trust hospitals. By the end of next year it will expect all NHS hospitals applying for foundation trust status to scrutinise their balance sheets in this way. Basing decisions on the profitability of individual treatments will be seen by some as cutting across the culture of the NHS. But William Moyes, Monitor's chairman, said the approach was a logical outcome of the decision to pay hospitals a set price for most of the treatment they provide. The aim, he said, was to ensure that inefficiency "does not threaten the quality of care, or the hospital's financial viability", he said. Monitor was providing tools to help foundation trusts work out which "service lines" they made money from under the NHS price list or tariff. Where they were making money, they could consider expanding the work to boost surpluses that could be reinvested in services, Mr Moyes said. "Where they have unprofitable lines, they can see whether that is due to staffing levels, or inefficient use of theatres, or other issues they can tackle. If they are being efficient and it is still unprofitable, that may suggest that the tariff [the price the NHS pays] is wrong. "Where that is not the case, they could have a discussion with their primary care trust [which buys the treatments] about whether doing higher volumes - more cases - would make it profitable, or whether they should exit the service and let someone else do it." At present, primary care trusts could require a foundation trust to provide anything that it designated as a core service. "But the time may come when foundation trusts may be able to walk away from a service, provided we are confident that the primary care trust has alternative suppliers." The aim was to "understand profitability, efficiency and quality - and to strike the right balance between the three", he said, with hospitals merely "behaving like any other business" and understanding their profit and loss centres. The approach could also help the NHS to set the right tariff by demonstrating - as was almost certainly the case with specialist orthopaedics - that the price needed adjustment, he said. The NHS inspectorate, the Healthcare Commission, is taking steps to measure the quality of care by the same "service line" approach. Three trusts - Chelsea and Westminster in London, Frimley Park in Surrey, and University College London Hospitals - have piloted the scheme, with others to follow. All foundation trust applicants would be expected in time to have such data – and "once they have the information, they would be pretty stupid not to use it", Mr Moyes added.