RxPG News : NHS

Systematic bias in the assessment of UK doctors

Fri, 28 Oct 2011 20:00:00 PST

( from http://www.rxpgnews.com ) Official assessments of a doctor's professionalism should be considered carefully before being accepted due to the tendency for some doctors to receive lower scores than others, and the tendency of some groups of patient or colleague assessors to provide lower scores, claims new research published on bmj.com today.

Researchers from the Peninsula College of Medicine and Dentistry in Exeter investigated whether there were any potential patient, colleague and doctor-related sources of bias evident in the assessment of doctors' professionalism.

Doctors' regulator the General Medical Council (GMC) is working on a new system of revalidation for all UK doctors that could be introduced next year as a way of ensuring doctors are fit to continue to practise. This is likely to involve the use of multi-source feedback from patients, peers and supervisors as part of the evidence used to judge a clinician's performance.

The researchers used data from two questionnaires completed by patients and colleagues. A group of 1,065 doctors from 11 different settings, including mostly NHS sites and one independent sector organisation, took part in the study.

They were asked to nominate up to 20 medical and non-medically trained colleagues to take part in an online secure survey about their professionalism, as well as passing on a post-consultation questionnaire to 45 patients each. Collectively, the doctors returned completed questionnaires from 17,031 colleagues and 30,333 patients.

Analysis of the results that allowed for characteristics of the doctor and the patient to be taken into account, showed that doctors were less likely to receive favourable patient feedback if their primary medical degree was from any non-European country.

Several other factors also tended to mean doctors got less positive feedback from patients, such as that they practised as a psychiatrist, the responding patient was not white, and the responding patient reported that they were not seeing their usual doctor.

From colleagues, there was likely to be less positive feedback if the doctor in question had received their degree from any country other than the UK or South Asia. Other factors that predicted a less favourable review from colleagues included that the doctor was working in a locum capacity, the doctor was working as a GP or psychiatrist, or the colleague did not have daily or weekly professional contact with the doctor.

The researchers say they have identified possible systematic bias in the assessment of doctors' professionalism.

They conclude: Systematic bias may exist in the assessment of doctors' professionalism arising from the characteristics of the assessors giving feedback, and from the personal characteristics of the doctor being assessed. In the absence of a standardised measure of professionalism, doctor's assessment scores from multisource feedback should be interpreted carefully, and, at least initially, be used primarily to help inform doctor's professional development.

Depression is wrongly seen as natural part of getting older

Tue, 12 Aug 2008 10:02:41 PST

( from http://www.rxpgnews.com )

Photo by paveitapics

The vast majority of older people over the age of 65 in England have symptoms of depression are denied any help, according to a new report published today by Age Concern.

The charity found that shocking ageist attitudes held by many people, including GPs, and ageist rules in the NHS mean that an astounding eight out of ten older people with clinical depression don’t get any treatment. Most mental health services for depression exclude people aged 65 and older, despite the risk of depression increasing with age in later life.

Age Concern’s new campaign, ‘Down, but not out’, aims to improve the quality of life for older people with depression. Depression is the most common mental health problem in later life, affecting one in four older people yet it is often ignored. If depression is not identified and treated, it can lead to a life of misery. It can also cause other illnesses and, in extreme cases, can lead to suicide.

The charity will be helping older people to recognise the symptoms of depression and encouraging them to seek help. It will also be working with GPs to improve the diagnosis of older people with depression and ensure that effective treatments are available to all, regardless of age.

Poor health and problems, such as money worries, losing a loved one and stressful events like moving into a care home can trigger depression. Recently bereaved older people are three times more likely than married older people to show signs of depression.

Gordon Lishman, Director General of Age Concern, said:
“Negative attitudes about mental health problems make it very difficult for older people to talk about their feelings or to ask for help. It is scandalous that hundreds of thousands of older people may be denied treatment because depression is wrongly seen as a natural part of getting older.

“Older people deserve better treatment - there should be no excuse for inaction. Without a major change in policy and practice, there will be 3.5 million older people in UK with symptoms of depression by 2021.

“The Government and the NHS need to take action to stamp out ageist attitudes and practice, once and for all. The neglect of older people’s mental health ruins lives and must no longer be ignored.”

Awareness of depression is low among older people themselves and their relatives and is worse in some communities because of negative cultural perceptions of mental health problems. Beliefs about the origin of the illness and the high value placed on family reputation results in many black and minority ethnic (BME) elders, and their families, keeping the depression a secret.

NRI doctor guilty of unethical tests on British patients

Sat, 29 Mar 2008 18:04:41 PST

( from http://www.rxpgnews.com ) London, March 29 - An NRI psychiatrist from Assam faces the sack after being found guilty of conducting unethical drug tests on mentally ill patients, according to reports Saturday.

The General Medical Council has found Tonmoy Sharma, a former lecturer at the prestigious Institute of Psychiatry in London, guilty of recruiting patients suffering from schizophrenia and Alzheimer's in unsolicited telephone calls, conducting unauthorised tests and misleading drug companies about his methods, a newspaper reported.

The verdict could not be independently verified but a spokeswoman for the GMC, a regulatory body, told IANS Saturday that newspaper reporting on the case has been 'accurate'.

A GMC panel on 'Fitness to Practice' has been hearing Sharma's case this week, she confirmed.

The Times said the GMC, which examined Sharma's research over 10 years, could force the pharmaceutical industry to re-examine the way in which research on psychiatric drugs is commissioned and conducted.

It quoted the GMC panel as concluding: 'The findings of the panel indicate serious failings of personal integrity and honesty, of good clinical research practice, as regards to potential welfare of patients and participants in ethical research ... which risks bringing the reputation of the medical profession into disrepute.

'The panel has found that the facts proved against you would not be insufficient to support a finding of serious professional misconduct.'

According to the GMC website, Sharma gained his MBBS from Dibrugarh University, Assam, in June 1987 and has been on Britain's register of general psychiatry since May 1996.

Sharma is a Clinical Lecturer at the Institute of Psychiatry, Kings College, University of London, and a Principal Investigator undertaking research studies, the GMC said.

'The panel is satisfied that in acting the way you did, your intention was to conceal from each sponsor the fact that you were using the identical group of patients for their studies,' the panel report says.

'As a consequence, the patients were subjected to tests beyond those approved... The panel is satisfied that your conduct towards them - was dishonest. It was also unprofessional and not in the best interests of the patients.'

New steps to curb overseas doctors in Britain

Tue, 09 Oct 2007 15:46:42 PST

( from http://www.rxpgnews.com ) London, Oct 9 - Indian doctors should think several times before coming to Britain for jobs - the employment situation has been difficult for non-European Union doctors, and new proposals have been drawn to guarantee jobs to doctors trained in Britain.

An increase in fresh graduates turned out by British medical schools and the availability of a large number of doctors from an expanded European Union have made it difficult for non-EU doctors to gain employment in the National Health Service -.

The health minister, Ben Bradshaw, has drawn up proposals to slash the number of junior doctors from overseas coming to Britain to train. The idea behind the proposals is to preserve jobs for the rising number of British medical graduates.

During the recent round of recruitment in the Medical Training Application Service -, non-EU doctors could not be excluded from consideration under court orders. During the MTAS rounds earlier this year, several hundred Indian doctors gained employment in the NHS.

However, the situation is likely to change if the new proposals are implemented. A court hearing is due later this month on the case brought by the British Association of Physicians of Indian origin -, which challenged changes to immigration rules for non-EU doctors who had entered Britain under the highly skilled migrants permit.

Putting forth his new proposals, Bradshaw said that if overseas applicants were preventing those educated here from getting specialist training places, 'then it is only right that we should consider what needs to be done'.

The government is proposing that doctors from countries outside the EU should not be considered for a job unless there are no qualified applicants from Britain or from elsewhere in Europe. This is an unlikely scenario given the popularity of medical training in Britain and the EU.

According to Bradshaw, Britain now has 6,451 medical school places, compared with 3,749 in 1997, and each student can cost up to 250,000 pounds to train. During the MTAS rounds, several British doctors who could not find employment left the country as the issue snowballed into a major public controversy through demonstrations and petitions.

There is also a proposal that fresh British medical graduates would automatically get a first-year hospital training place on graduation, which would give them a head start over even other European candidates.

Meanwhile, representatives of BAPIO met officials of the Conference of Postgraduate Medical Deans - after a BAPIO study raised concerns that non-white British graduates as well as those who had received their primary qualification overseas were more likely - to be found to be not making adequate progress with their training and referred for remedial training.

BAPIO sources told IANS that during the meeting, both groups affirmed their strong commitment to equality of opportunity within medical education. The discussions included plans to monitor educational outcomes and address areas of concern where these were identified.

Ramesh Mehta, president of BAPIO, said: 'We are pleased to note that COPMeD chairman Elisabeth Paice was very receptive of our concerns. We look forward to the approval of the draft plan by the CoPMeD.'

Elizabeth Paice said: 'It was very useful to exchange viewpoints with Mehta, and to discuss how we could move from concern and evidence to appropriate action.'

Should EU patient information laws be relaxed?

Fri, 30 Mar 2007 02:07:46 PST

( from http://www.rxpgnews.com ) In 2002 the European parliament voted resoundingly against allowing drug companies to provide information about their products directly to patients. However, five years on, this decision is set to be challenged again.

A special report in this weekâs BMJ looks at the arguments.

Hard lobbying by the drug industry has convinced EU health commissioners that increasing the extent to which drug companies can provide information to patients is essential to stop Europeâs drug industry falling further behind those of the United States and Japan. Drug companies also assert that this change would benefit patients.

But health campaign groups insist that drug companies cannot provide the independent information consumers need.

The commission will set out its final position next month, but speculation is already rife that it is likely to suggest changes to legislation that would jeopardise the current ban on direct to consumer advertising for prescription drugs.

Campaigners are particularly concerned that if the commission decides it needs to relax the laws then direct to consumer advertising would be introduced almost as a side effect.

Despite assurances that blatant advertising is not the intention, Barbara Mintzes of the University of British Columbia disagrees, saying that any change in the law to allow industry to provide information could produce undesirable effects â even if the advertising ban remains in place.

Rita Kessler of the campaign group AIM agrees. She believes that the current proposals would result in poor quality information and questions the need for more health information. She suggests that the commission should instead endorse an EU logo mark that would be awarded to high quality information sources and act as a quality stamp to help patients identify reliable, evidence based advice.

In anticipation of the commissionâs final report in April, five international health associations have joined forces to step up their opposition campaign. They assert that ârelevant, comparative and appropriate information on health issues cannot be provided by drug companies,â because in a competitive marketplace, dug companies must present their own products in a more favourable light than other preventive or therapeutic options.

However, the quick turnaround of MEPs means that few of the original objectors from 2002 remain in office â and that could mean a completely different outcome when patient information laws are debated again.

Institutional discrimination by NHS causing unnecessary deaths of people with a learning disability

Fri, 23 Mar 2007 02:49:32 PST

( from http://www.rxpgnews.com ) Leading learning disability charity, Mencap, is calling for an independent inquiry into six deaths. The charity believes people with a learning disability have died unnecessarily due to institutional discrimination within NHS care. The cases are set out in Death by indifference, published by Mencap today (12 March 2007). Mencap says the deaths are a result of widespread ignorance and indifference within the NHS.

â¢Martin, aged 43, went without food for 26 days whilst he was in hospital following a stroke. This left him too weak to undergo surgery. Martin died on 21 December 2005.

â¢Doctors told Emma, aged 26, that she had a 50:50 chance of survival, but decided not to treat her as they believed she would not cooperate with treatment.

Emma died of cancer on 25 July 2004.

â¢Mark, aged 30, died eight and a half weeks after being admitted to hospital with a broken leg (femur). He was clearly distressed and in pain, but he had to wait three days to see the pain team.

Mark died on 29 August 2003.

Dame Jo Williams, Mencapâs chief executive, said: âWe are deeply disturbed that three years on from Mencapâs Treat me right! report which exposed inequalities within the NHS, people with a learning disability continue to receive worse healthcare than those without a disability. Despite government recognition of the inequalities experienced by people with a learning disability within NHS care , there has been no commitment to tackle them. It is an outrage that the solutions to this problem have long been recognised, and yet action has not been taken.

âMencap is calling for an urgent independent inquiry into the six deaths outlined in Death by indifference. We want the underlying bad practice, which we believe is a result of poorly designed systems, policies and procedures within the NHS, to be identified and acted upon. If action is not taken to eliminate institutional discrimination from our health services, people with a learning disability will continue to die unnecessarily.â

Mencap is calling for an independent inquiry into the six deaths in the report - An independent inquiry, which investigates all six deaths together rather than individually, will uncover underlying poor practice behind the deaths. This will show what lessons can be learnt to stop such tragedies happening again. It is also asking for a confirmation that the long promised confidential inquiry into premature deaths of people with a learning disability will be carried out - Only the confidential inquiry will reveal the number of people with a learning disability dying unnecessarily, and the scale of the problem the NHS must address. It has called for major improvements to the investigation of complaints against the health service - The current complaints system is lengthy and complex. Families want to find out how their loved one died, and whether that death was avoidable.

Allan, father of Mark, who died in August 2003, said: âMark was the centre of our lives and gave us such joy. I believe that if my son had not had a learning disability, he would still be with us today. The discrimination and indifference my family faced was shocking. The medical staff had such poor understanding of Markâs needs. Our family will never recover from having him ripped from us so suddenly. Lessons must be learnt from my sonâs death, so that nobody has to go through the torture of losing a loved one as a result of discrimination.â

The new report follows Mencapâs 2004 Treat me right! report which exposed the unequal healthcare that people with a learning disability often receive from healthcare professionals.

In 2001 Valuing People acknowledged that âhealth outcomes for people with learning disabilities fall short when compared with outcomes for the non-disabled populationâ, and identified solutions â including the need for a confidential inquiry in to premature deaths, annual health checks and staff training. The White Paper âOur health, Our care, Our sayâ admitted that people with learning disabilities face inequalities and that âthe NHS has historically not served such people wellâ. However, nearly six years after the introduction of Valuing People (2001), Mencap says no action has been taken.

Recent cases of âinstitutional abuseâ found at NHS primary care trusts in Cornwall and Sutton and Merton , which included physical and sexual abuse, serve as further evidence that discriminatory practices still exist within the NHS. In September 2006 the Disability Rights Commission (DRC) conducted a formal investigation into physical health inequalities experienced by people with learning disabilities . The investigation showed that people with a learning disability are less likely to receive the healthcare they need.

The Royal College of Psychiatrists strongly supports the recommendations of MENCAPâs report, Death By Indifference, which raises questions about the standards of care from professionals in the National Health Service.

âThe tragic stories in this report about neglect of people with learning disabilities who were physically ill is of deep concern to the College,â said Dr. Roger Banks, Vice-President.

âWe are in total support of the recommendations on the need to educate health professionals, and to listen carefully to the views of families and carers.

âThe College is very aware, through its members working in this area and through research, of the health needs of people with learning disabilities, the higher rates of morbidity and mortality in this population, and the difficulties often experienced in gaining access to appropriate assessment and treatment.

Should the NHS curb spending on translation services?

Fri, 23 Feb 2007 12:59:55 PST

( from http://www.rxpgnews.com ) In December it was reported that the NHS was spending £55 million (82m; $107m) each year on translation services. In this weeks BMJ, two doctors practising in inner London go head to head over whether language services in the NHS should be curbed.

Kate Adams, a general practitioner in Hackney, believes that doctors should encourage patients to learn English to avoid future public health problems.

Many people who have lived in the UK for more than 20 years speak little English, she writes. These patients are vulnerable to depression and related psychological responses to alienation. Can we really say that this is in either their interests or the interests of the wider community?

In the UK, the legal right to translation services is unclear. Citizenship must balance rights against duties, and may include a right to a reasonable standard of health care that will, in certain circumstances, entail the use of a translator. But should there not also be a corresponding duty to learn the language of the adopted community which has granted the rights, she asks?

However we decide to respond to this, health professionals need to encourage their patients to learn English, thereby helping them in the process of integration, otherwise we will be storing up public health problems for the future, she warns.

Translation services will always need to be available for elderly people whose English is poor, and for new arrivals, but at a time when the NHS is facing a huge financial crisis, is it in anyones interests to see the costs of translation services increasing?

She believes that high profile campaigns are needed to encourage people to learn English. If doctors can prescribe gym classes for depression, is it really so far fetched to suggest that we should also be prescribing English classes?

But David Jones, a general practitioner in Tottenham, argues that more, not less, spending is needed on language services.

It is clearly a disadvantage not to speak the majority language of the country in which you live. But he believes it is inappropriate for doctors to encourage patients to acquire English language skills.

The GMCs 2006 publication, Good Medical Practice, clearly states: To communicate effectively you must: make sure, wherever practical, that arrangements are made to meet patients language and communication needs. But all too often no such arrangements are in place.

This is not because such arrangements are impractical but because provision for translation and interpreting in the NHS is patchy and often not adequate or not used, he writes.

Current NHS interpreting services may also have negative health and social care consequences because they are so poor, he adds. For example, a new study from the United States has shown that adverse clinical events are more likely to result in physical harm in patients with limited English proficiency.

All doctors working in the NHS, certainly in the inner cities, understand quite clearly that care for non-English speakers regularly falls short of the GMCs expectation of good communication with patients. We must not let the politicians persuade us that it is the patients fault, he says.

The NHS Redress Act may lead to more complaints

Fri, 23 Feb 2007 12:48:38 PST

( from http://www.rxpgnews.com ) The NHS Redress Act should make clinical negligence cases simpler and less costly, but it may create more, not fewer, complaints warn experts in this weeks BMJ.

The current system for patients to obtain compensation after medical error has been much criticised by the government, writes barristers Richard Furniss and Sarah Ormond-Walshe. It is seen as complex, slow, and costly, both in terms of legal fees and staff time. Patients are said to be dissatisfied with the lack of explanation and apologies, and the system is believed to encourage defensiveness and secrecy in the health service.

The new NHS redress scheme aims to improve on the present system.

The scheme will apply to hospital care in England and Wales and will allow negligence claims to be made without court involvement. Redress may include an apology, explanation, or compensation up to £20,000. The scheme is therefore likely to be more useful to, and used by, those who have no grounds for monetary compensation because they have suffered no financial loss.

The scheme will fill a gap in the current system, but there are some concerns, say the authors.

For example, it may be seen as less impartial because NHS trusts will carry out the investigations. It may also create more cases because claims for small amounts of compensation or an apology are not currently included in the present system.

As a result, overall costs could rise because more clinicians will be diverted from their duty as part of the investigations, argue the authors.

Currently the scheme seems likely to give rise to more complaints and the way in which it deals with them may be less satisfactory than at present, they conclude.

Patients should cc the benefits of doctors' letters

Mon, 12 Feb 2007 06:37:19 PST

( from http://www.rxpgnews.com ) Patients should be kept informed of their condition and care said health minister Rosie Winterton today, as she called on healthcare professionals to make more effort to routinely copy letters to their patients.

Ms Winterton will be writing to healthcare professional bodies like the RCN, BMA, and General Practitioners Committee, urging them to encourage their members to copy patients into correspondence between clinicians so that patients are more informed about their condition and can make better decisions about their own healthcare. They will also be invited to take part in a round table discussion to agree a consensus on how to push this important issue forward.

In a recent Department of Health survey, nearly 7 out of 10 patients referred to a specialist in the last year said they had not received any copies of correspondence, with only a quarter saying that they had received copies of all letters.

Rosie Winterton says:

"Copying letters to patients is at the heart of creating a partnership between patients and their clinicians - it helps patients share in the decision making process about their care and make informed choices. One of the issues that patients frequently raise with me is that this is not happening nearly enough. Too few patients are routinely copied into their clinicians' letters and so are kept out of the loop on their care. The knock-on effect of this is that patients cannot participate fully in decisions about their care."

Joanne Rule, Chief Executive of Cancerbackup, says:

"Most patients want to see what is written about their condition and treatment - it's hopelessly old-fashioned to be excluded like this. Cancer patients say that access to letters helps them to share information about their treatment history and also to ask further questions. Access to letters would improve communication because no one should read news they haven't already been told and more attention would be paid to clear, jargon-free writing styles. I wholeheartedly support this Ministerial initiative."

The Minister of State for Health Services is writing to the Royal College of Nursing, Allied Health Professionals, BMA, General Practitioners Committee, NHS Confederation, as well as voluntary organisations, like Cancerbackup and the Long Term Medical Conditions Alliance, to draw their attention to the patient benefits of seeing letters written about them, and inviting them to meet to discuss ways of promoting and implementing the policy.

The NHS Plan (2000) established the right for patients to see correspondence relating to their care: "Letters between clinicians about individual patient's care will be copied to the patient as of right." DH issued guidance on copying letters to patients in 2003, with an expected implementation date of April 2004.

The PCT Patient Survey of 2005/06 (published January 2007) revealed that 68% of patients (who had been referred from their GP to a specialist in the previous 12 months) received no copies of correspondence between their GP and hospital. 7% received some letters, and 25% received them all.

Copying letters to patients helps:

- Establish more trust between patients and healthcare professionals
- Ensure patients are better informed so better able to make informed decisions about treatment options and to support self care and management
- Give patients written confirmation of what was said at consultations and what action is being taken, and
- Promote better compliance, as patients who understand their treatment are more likely to follow medical advice.

Is doctors' pay responsible for the financial crisis in the NHS ?

Mon, 05 Feb 2007 12:54:37 PST

( from http://www.rxpgnews.com ) Recent newspaper headlines have suggested that doctors' pay is responsible for the financial crisis in the NHS. In this week's BMJ, two experts go head to head over whether the remuneration is justified.

Alan Maynard, Professor of Health Economics at York University argues that doctors' self interest manifests itself in two ways: enhancing personal income and protecting clinical autonomy fiercely - the right to do what they think is best for their patients.

He maintains that the first type of self interest has enhanced average UK earnings to over £100,000 for both general practitioners and consultants, with little observable improved activity or patient outcomes.

The general practice quality and outcomes framework raised earnings, but, he argues, with a limited evidence base and little baseline data its benefits are uncertain. The consultant contract and the cost of replacing out-of-hours cover with other providers have also increased expenditure.

Professor Maynard writes that this pay increase has inflated NHS expenditure with all too little benefit to patients or taxpayers, while giving more general practitioners incentives to deliver what good practitioners were already providing.

The second area of doctors' self interest is the understandable desire to do the best for their patients. But he believes that this can lead to inefficient practice that ignores the opportunity costs of decision making. For example, a decision to give Jones a marginally cost effective treatment deprives Smith of cost effective care. Such inefficiency in the use of society's scarce resources is surely unethical, he asks?

These pay increases, together with workforce management which has led to unaffordable employment increases, are creating deficits and undermining patient care and the financial performance of the NHS, he argues. Instead of talking simply about money, we need to determine whether its use benefits patients or is merely a form of social security for providers.

But Laurence Buckman, a GP in London believes that demanding and receiving proper pay and conditions is everyone's right, even in the public sector. This is not self interest. Self interested doctors would go and work elsewhere, he writes.

Until 2003, general practitioners were working long hours, including nights and weekends, and out of hours pay was low. The new contract was an attempt to correct that by placing contracts with practices rather than general practitioners, setting limits to what a practice could be asked to do, and creating a total budget for staff and expenses. General practitioners' pay became the profit that was left after expenses.

The main source of extra income into practices from the new contract is the quality and outcomes framework, which accounts for 40% of practice income. The government claims that general practitioners' pay has risen unexpectedly, but this is not so. The BMA predicted the rise quite accurately, he says.

Total pay has been deliberately misquoted by adding the employers' pension contribution that general practitioners have to pay for themselves which makes pay seem 14% higher than it is.

Government figures show a shortage of general practitioners. If self interest had been pandered to there would be a glut of doctors. That there isn't is because of the dreadful way that the NHS is managed by a government bereft of ideas and the honesty and wit to tackle the problems that deter young people from joining us, he argues.

Doctors are fed up with being told that the small percentage of the NHS that they cost is the reason why the NHS is in financial trouble. Most patients see us as part of the solution and are willing to pay.

Obese patients in Britain to dance

Mon, 04 Dec 2006 19:29:36 PST

( from http://www.rxpgnews.com ) London, Dec 4 - Obese patients in Britain may have to dance to improve their fitness level as a part of upcoming national campaigns to get people to take more exercise.

The department of health is going to introduce dance classes such as street-dancing and tango classes to counter declining fitness levels and prevent a national obesity crisis, according to the online edition of Daily Mail.

Ministers are preparing to roll out a campaign to get people to take more exercise across England and Wales.

A spokesperson for the department of health said a series of pilot projects around the country had demonstrated that 'physical activity interventions were cost effective and saved the National Health Service money in the long run'.

More than 14 million people in Britain will be dangerously overweight by 2010, the website said.

The cost could be upwards of $15.8 billion a year, including medical bills for diabetes, heart disease, depression and lost work.

The British government has recommended that children participate in at least an hour of moderate activity a day while adults should lightly exercise for 30 minutes five days a week, it said.

Mental health units should not be exempt from smoking ban

Fri, 25 Aug 2006 19:43:00 PST

( from http://www.rxpgnews.com ) Exempting mental health units from the ban on smoking in public places would worsen health inequalities for people with mental health problems, warn doctors in this week's BMJ.

Smoking is the largest single cause of preventable illness and premature death in the United Kingdom, with 106,000 people dying of smoking related diseases in 2002, and more than 10,000 dying each year as a result of passive smoking.

The Health Act 2006 will make all enclosed public and work places in England and Wales smoke-free environments, but may exclude some mental health settings.

This would be a mistake, argue Jonathan Campion and colleagues, as the prevalence of smoking is high among people with mental health problems.

Nearly three quarters of people with schizophrenia, affective psychosis, and other mental health disorders who live in mental health settings are smokers, and they are more likely to be heavier and more dependent smokers than the general population, they write.

As a result, people with mental health problems are at a substantially greater risk of premature death from smoking related diseases than is seen in the general population. This is particularly important given that those with mental illness already experience high levels of social exclusion and health inequality, which are exacerbated by smoking.

Arguments for excluding mental health settings from the new smoke-free legislation are that they are places of residence and that some patients are detained under the Mental Health Act. However, health and safety legislation places a duty on NHS employers to protect staff and patients from exposure to environmental tobacco smoke.

Another argument is that preventing people smoking is an infringement of human rights, particularly for detained patients. But the Human Rights Act 1998 allows an individual choice only if that does not endanger others. Furthermore, this argument is not applied to other forms of drug misuse, and people are not allowed to drink alcohol or use illegal drugs in mental health units.

Research also shows that smoke-free policies have succeeded in mental health settings. Such bans have caused fewer problems than anticipated, and policies applied in a consistent way to all patients were more effective than selective bans.

The health select committee has proposed that psychiatric institutions in England and Wales should not be exempt from the Health Act 2006, say the authors. "We strongly endorse this proposal and suggest that all mental health settings should introduce complete smoke-free policies. These policies should be introduced in a flexible and pragmatic way, with support and treatment available for patients to stop smoking and manage withdrawal."

"Exemption from the Health Act will exclude mental health patients from mainstream health improvement strategies and exacerbate the inequality they already experience," they conclude.

NHS may be buying surgical equipment unethically

Sun, 30 Jul 2006 02:56:00 PST

( from http://www.rxpgnews.com ) The NHS may be buying medical equipment unethically and exploiting developing countries, it has been claimed in an article published on bmj.com today.

Unlike the campaigns for fair trade of goods like bananas and coffee, there have been no such campaigns for medical commodities, says Dr Mahmood Bhutta, a specialist registrar in otolaryngology (head and neck surgery) at Guys and St Thomas Hospital in London.

Dr Bhutta says that while NHS suppliers are encouraged to act in an ethical business manner, they do not and there are currently no checks or assessments made into the origins of surgical instruments used by the NHS.

The trade in surgical instruments is open to unethical sourcing because many such instruments are manufactured in the developing world, writes Dr Bhutta.

The global trade in hand held stainless steel surgical instruments is worth around £352million ($650m, 507m) a year and many of these instruments are made by firms in towns in Europe and Asia. The two largest producers are Tuttlingen in Germany and Sialkot in Pakistan.

Companies in Sialkot use more traditional production methods with most instruments manufactured and finished by hand, so production is more labour intensive, employing 50,000 people (7,700 of whom are children aged from 7 and older) to supply a fifth of the worlds surgical instruments.

Many firms in Sialkot sub-contact the initial production of these instruments to workers in small workshops or their own homes in an attempt to reduce overheads and minimise costs. These workers earn around £1 a day ($2, 1.50).

The firms sell to suppliers and retailers in the developed world who then sell on to companies in Germany which sell to the NHS and elsewhere in the world at a marked up price, says Dr Bhutta.

The solution lies in purchasers insisting on fair and ethical trade when sourcing instruments, he adds.

Is it time to give NHS more independence?

Sun, 30 Jul 2006 02:49:00 PST

( from http://www.rxpgnews.com ) In April this year, BMJ Editor Fiona Godlee called for an independent NHS run by a board of governors responsible for managing health care within a set budget and a broad political framework.

In this weeks BMJ, four opinion leaders give their views on whether it is time to give the NHS greater independence from government.

Democratic control is essential, argues Stephen Thornton, Chief Executive of The Health Foundation. Democratic checks and balances are the best way to ensure we continue to move the NHS in the right direction, not the creation of a barely accountable technocracy that would place all power in the hands of professionals and bureaucrats."

The key issue is how to do this more effectively than at present. He believes the trick is to deal with the democratic deficit in policy making and commissioning while giving much more operational freedom to healthcare providers.

A second article, by Gwyn Bevan, Professor of Management Science at the London School of Economics, argues that the destabilisation of the NHS in England through successive reorganisations has meant that the only options for governance have been either a competitive provider market or a regime of targets.

Each has serious limitations, he says, and the movement from one to the other has contributed to the squandering of unprecedented increases in NHS funding. His call for 'independence' for the NHS is to design systems of local accountability that would offer an effective alternative to provider competition or a centrally-driven regime of targets.

General gractitioner Stephen Gillam warns that "an independent NHS will become a glorified commissioning agency as what used to be a national health service becomes an amalgam of free floating foundation hospitals, NHS trusts, private companies, and traditional primary care providers."

We may now, indeed be ruled by fundamentalists whose faith in markets, competition, and the profit motive as the sole path to effective public service is unshakeable, he writes. Paradoxically, an NHS agency could spearhead the crusade.

In the final article, two US health experts believe that the NHS has the inherent capability to become the greatest healthcare system of any nation.

They applaud Labours original plan for modernisation and advise not to remove NHS leadership too far from government power. But they wonder whether something big should change to steady the NHS on its worthy, inspiring journey.

The NHS is not just a national treasure; it is a global treasure, they write. As unabashed fans, we urge a dialogue on possible forms of stabilisation to better provide the NHS with the time, space, and constancy of purpose to realise its enormous promise.

Experts Comment on New Blood Pressure Guidelines

Thu, 29 Jun 2006 01:52:00 PST

( from http://www.rxpgnews.com ) Professor Peter Littlejohns, Clinical and Public Health Director at NICE and Executive Lead for the guideline, said: It is unusual for NICE to consider reviewing its guidance ahead of its planned review date. In this case however, because significant new data became available, we took the decision to consider that data as part of a limited review of the existing NICE guideline. It is important to emphasise that the review was limited to the pharmacological aspects of managing hypertension. The original guideline also covered other aspects of managing the condition, such as lifestyle interventions, and these remain crucial to a proper holistic approach to controlling blood pressure.

Professor Bryan Williams, Member of the Guideline Development Group and Professor of Medicine, University Hospitals NHS Trust, Leicester, said: This is a hugely important step for people with hypertension and the healthcare professionals who treat them. This new guidance has benefited from a rigorous evaluation of the evidence and has resulted in a simple, pragmatic and practical approach to treating blood pressure, one of the most important causes of premature death in the UK. In addition, the recommendations have undergone a cost-effectiveness analysis which has reinforced the guidance. It is no longer a case of can we afford to do it? but more, can we afford not to do it! The decision to recommend that beta-blockers should no longer be used as a routine initial treatment for high blood pressure is a bold decision and the correct decision.

Professor Morris Brown, President of the BHS and member of the guideline development group, said: "The British Hypertension Society is pleased to be a partner in the first joint guideline between NICE and a specialist society. The application of the full rigour of the NICE process to the newer data on drug treatments has resulted in recommendations which, although not dissimilar to those at which the BHS arrived two years ago, has permitted some preferences to be expressed between drugs of the AB and CD pairs used in the treatment of hypertension. I hope that the new guideline will both stimulate and enable doctors to review treatment of all their patients with hypertension, and achieve the internationally accepted target blood pressure of 140 in the majority of patients.

Dr Mark Davis, GP, of the Primary Care Cardiovascular Society and member of the Guideline Development Group, commented: Primary care will welcome this unified guidance from two authoritative and respected organisations. The management of hypertension forms a major part of our workload and we can incorporate this update into our practice protocols. This will help us to further improve our success in managing this important cardiovascular risk factor to the benefit of our practice population. "

Courtesy: Blood Pressure Association (BPA)

Jan Procter- King, Nurse Practitioner and member of the Primary Care Cardiovascular Society and Guideline Development Group, said: These guidelines will be very welcome to all primary care nurses. Since the introduction of the Quality Outcome Framework for general practice, hypertension has been a fundamental focus of the primary care nurse. These pragmatic evidence based guidelines, presented in this clear manner, will I am certain, support the delivery of evidence based hypertension management.

Jean Thurston, patient and carer representative on the guideline development group, said: It is reassuring for patients to know that the treatment changes recommended in this guideline are based on the very latest evidence available and use a consistent approach. The accompanying Information for Patients literature is informative and should be easily understood by everyone.

Professor Graham MacGregor, Chairman of the Blood Pressure Association, said: High blood pressure is by far the biggest preventable cause of death and disability in the UK through the strokes, heart attacks and heart failure that it causes. This new agreed treatment regimen is tremendous news for people affected by raised blood pressure as the combination of drugs suggested are more effective and have less side effects. This will result in much better control of blood pressure and therefore large reductions in stroke, heart attack and heart failure.

Sarah Ransome, BPA Head of Information and Support, said: "Living with high blood pressure can be very difficult. We know from our own research that beta-blockers commonly cause side effects, including tiredness, lethargy, impotence and mood swings, and can enormously impact on that individual and their family's quality of life.

"The Hypertension Guideline update is good news for doctors treating hypertension and more importantly for people with high blood pressure. We now have clear, unified, evidence-based advice on the optimal drugs for younger and older individuals, and how to use these drugs to achieve the recommended targets." Professor Gordon McInnes, Vice-President, British Hypertension Society

New Guideance will Result in Better Control of Hypertension - BPA

Thu, 29 Jun 2006 01:45:00 PST

( from http://www.rxpgnews.com ) The UK's blood pressure charity, the Blood Pressure Association (BPA), heralded 28 June, 2006 launch of the updated NICE guideline on the clinical management of hypertension as a major advance in the treatment of the condition. For the first time, NICE and the British Hypertension Society have reached a clear consensus on the best way of treating raised blood pressure, and the BPA strongly endorses this new guideline.

Professor Graham MacGregor, Chairman of the Blood Pressure Association, said: "This is a major step forward in the treatment of high blood pressure and tremendous news for the millions of people in this country with the condition.

"The new guideline can easily be followed by health professionals and people with high blood pressure. The net result will be much better control of blood pressure with far fewer strokes, heart attacks and heart failure. This is particularly so because the treatment combinations suggested are more effective and have less side effects."

A major change is that beta-blockers, which have been shown to be less effective in reducing strokes and more likely to cause diabetes2, are no longer recommended for the routine treatment of the majority of people with high blood pressure.

"Access to more effective drugs will be really welcomed by patients and will have implications, not only for the newly diagnosed, but for the many millions of people already on beta-blockers," said Professor MacGregor.

High blood pressure is the biggest preventable cause of death and disability in the UK through the strokes, heart attacks and heart failure that it causes. Poor blood pressure control results in approximately 125,000 unnecessary stroke and heart attack events every year, about half of which are fatal3.

Sarah Ransome, BPA Head of Information and Support, said: "Living with high blood pressure can be very difficult. We know from our own research that beta-blockers commonly cause side effects, including tiredness, lethargy, impotence and mood swings, and can enormously impact on that individual and their family's quality of life.

"The new guideline will result in better control of blood pressure by giving patients access to the best available treatments and encouraging dialogue between patients and their health professionals so that they can make informed decisions about their care."

Professor MacGregor added: "We would encourage those people currently taking beta-blockers to talk to their GP or health professional on their next visit to discuss whether changing the medication in the fullness of time to newer medicines would be appropriate for them. People should not stop taking beta-blockers on their own as this will do far more harm than good. Furthermore, beta-blockers will continue to have an important role in the treatment of angina, heart failure and following a heart attack, or in women of child-bearing age with high blood pressure."

NHS care for older people is still patchy

Fri, 19 May 2006 20:02:00 PST

( from http://www.rxpgnews.com ) Good, respectful NHS care for older people is still too patchy, argue senior members of the British Geriatrics Society in this week's BMJ.

Last month's government report A New Ambition for Old Age examined how the national service framework (NSF) for older people is being implemented and announced new aims and targets under three themes: dignity in care, joined up care, and healthy ageing.

So what has improved since the framework was launched five years ago, ask the authors?

A third of older people needing intensive daily help in England now receive this in their own homes rather than in residential care; delayed discharge from acute hospitals has been reduced by more than two thirds; and specialist services for people with stroke and for those prone to falls continue to improve.

But such health gains now need to be built on, say the authors. Despite older people being the prime users of health care and social services, investments have not been made in more specific services, such as general hospital care for older people.

Care for older people is still not sufficiently integrated, they add. The increasing emphasis in the NHS on moving patients rapidly through the emergency system towards discharge may benefit younger people at the expense of effective planning and specialist assessment of the frail and old.

The separation in the NHS of medical specialties from psychiatry is also hampering the provision of effective, humane, and responsive services for older people with mental health problems, such as dementia and depression.

They suggest that better coordination of care for people with complex needs will be achieved by strengthening commissioning arrangements between the NHS and local authorities, to ensure that social care is not provided without medical problems being treated.

The dignity of older frail patients is also infringed every day in many different ways, they warn. The establishment of a seven point plan to improve dignity in care is to be welcomed.

"This report contains much that is praiseworthy," they conclude. "We hope that the levers set out in this report really convince providers of health and social care to reorganise their priorities."

NHS could save £78m by improving staff productivity

Sun, 30 Apr 2006 23:40:00 PST

( from http://www.rxpgnews.com ) Health Secretary, Patricia Hewitt, highlighted recommendations from an NHS Institute for Innovation and Improvements report, showing that £78m could be saved by the NHS by driving down agency spend and improving staff productivity.

Patricia Hewitt said Most NHS resources are invested in staff so using staff as effectively as possible is crucial for patient care, staff satisfaction and financial efficiency. The HR function has delivered some major achievements in recent years and I congratulate you on them. Now we have a real opportunity to drive forward the productivity agenda.

Effective management of temporary staffing costs is one of the highest impact HR changes. Nursing has made the greatest reduction in agency costs out of all staff categories as the overall agency spend is continuing to decline, down from £1.4bn in 03/04 (5.1% of pay bill), to £1.3bn in 04/05 (4.2% of pay bill).

And whilst these reductions are significant, further action is needed. Based on 2004/05 figures, if all NHS Trusts reduced their agency spend to the national average, that would release around £78m for other improvements in the NHS."

The Institute will shortly be publishing a document "Delivering Quality and Value Focus on Productivity and Improvement." This document will identify where to focus activity for the greatest potential productivity and efficiency gains.

The creation of an in-house bank of staff at North Bristol NHS Trust in 2004 has achieved a reduction from an average 5,300 agency shifts per month in 2003 to under 500 by the end of 2005.

In addition Bank staff provide better continuity of care which in turn contributes to better patient satisfaction. NHS Trusts are encouraged to use the NHSs own bank staffing organisation, NHS Professionals, or ensure their high standards of NHS employment practice are rigorously adhered to for in-house bank staff recruitment.

On top of this, the Trust saved at least £100 per shift that was covered by its bank staff rather than an expensive external agency which resulted in a £6 million save in spending on temporary staff in 2004/05 compared to 2003/03.

The Health Secretary also encouraged NHS Trusts to reduce their sickness and absence levels in order to curb agency staffing spend.

The sickness absence rate for acute trusts varies from under three percent to over six per cent across the country. Reducing sickness rates to even average levels would create savings for each trust with a higher than average rate.

Have targets improved performance in the English NHS?

Fri, 17 Feb 2006 19:05:00 PST

( from http://www.rxpgnews.com ) The star rating system for English NHS trusts seems to have improved performance, but systems need to be put in place to minimise gaming and ensure targets are not causing problems elsewhere, warn researchers in this weeks BMJ.

Annual performance ratings have been published for NHS trusts in England since 2001. This process of naming and shaming gave each trust a rating from zero to three stars. Although the government has now abandoned star ratings, targets are likely to remain.

But have targets improved performance and what ought to happen in the future, ask professors Gwyn Bevan and Christopher Hood?

The key target for accident and emergency departments was the percentage of patients to be seen within four hours. In 2002, before any target was set, 23% of patients spent over four hours in accident and emergency, but by 2004 only 5.3% stayed that long.

Similarly, reported performance improved greatly after ambulance trusts were star rated on their response times, and hospitals were rated on the number of patients waiting for elective surgery.

Interestingly, after 2003, reported performance improved in other UK countries, dramatically in Wales and Northern Ireland. This suggests that the naming and shaming policy in England put pressure on the NHS in the other countries, say the authors.

But the use of targets results in gaming, they add. For example, extra staff being drafted into accident and emergency departments, operations being cancelled, and patients having to wait in ambulances until staff were confident of meeting the target.

This means that when reported performance meets the targets, nobody knows how genuine the improvements are.

Nobody would want to return to the NHS performance before the introduction of targets, so how can we maximise the social benefits and minimise the costs of a regime of targets with sanctions?

They suggest introducing more uncertainty in the way that performance is assessed and better auditing of performance data. They also call for an independent body to investigate the genuineness of reported improvements and the costs to other services.

Although these changes would not wholly eliminate the gaming problems associated with any regime of targets and terror, they could reduce them, they say. The current combination of performance measures that are highly predictable to managers and an audit system that is poorly equipped to detect gaming, risks losing credibility, they conclude.

Denying Joint Replacements Based On Prejudice

Mon, 19 Dec 2005 15:48:00 PST

( from http://www.rxpgnews.com ) A decision by NHS trusts in Suffolk to deny replacement joints to obese patients seems to be based on prejudice or attribution of blame, argues a senior doctor in a letter to this week's BMJ.

In fact, no evidence supports withholding joint replacement from obese people, even on utilitarian grounds, says Nicholas Finer, a consultant in obesity medicine at Addenbrookes Hospital, Cambridge.

For knee replacement, there is no evidence that age, gender, or obesity is a strong predictor of functional outcomes, while a UK health technology assessment of hip replacement concluded that obese patients could benefit from surgery and are not noticeably at increased operative risk.

Another study concluded that relative body weight alone does not influence the benefit derived from hip replacement surgery, he writes.

Since obesity does not increase the risks or diminish the benefits of joint replacement, the trusts decision to deny such treatment seems to be based on prejudice or attribution of fault, or both, he says. Logically extended, such a policy would deny treatment to, among others, smokers, most patients with HIV infection, and those who sustain sports injury.

Rationing joint replacements is also false economy and potentially damaging, writes retired doctor, Martin McNicol in another letter.

Delaying operations on punitive grounds may increase long term costs. Personal experience shows that delaying joint replacement surgery causes deterioration of functional capacity, which is difficult or impossible to reverse after later operation. This is rationing by any other name, he says.

NHS needs to do more to provide need based health care

Mon, 19 Dec 2005 15:44:00 PST

( from http://www.rxpgnews.com ) The NHS needs to do more to provide health care according to need, argue researchers in this weeks BMJ.

They analysed the availability of primary care according to deprivation and health need in Scotland. Their study was based on a sample population of 5.35 million people served by 1,050 general practices and divided into ten groups of equal size according to deprivation.

They show that ill health is two and a half times greater in the most deprived group compared to the most affluent, but the number of whole time equivalent GP principals is distributed evenly across the population.

However, including non-principals and doctors in training, there are 11% more GPs in the more affluent compared with the more deprived half of the population.

Although they found larger numbers of practices in the most rural and deprived areas, this reflects the higher proportion of single handed and small practices in such areas, say the authors.

In fact, they show that practices in deprived areas tend to have younger doctors, fewer female doctors, and less involvement in voluntary activities such as quality schemes, health service initiatives, and training than practices serving more affluent areas.

Practices serving the most deprived areas are less likely to volunteer because they are so consumed by dealing with increased levels of morbidity, without increased levels of medical manpower, that they are unable or unwilling to take on additional activities, they write.

Professor Graham Watt, from the Department of General Practice at Glasgow University commented: Our paper helps to explain the persistence of health inequalities in the UK, and the under-achievement of the NHS in narrowing these inequalities.

The strict rationing of medical manpower, irrespective of need, places a major constraint on what the NHS can deliver in deprived areas. It follows that general practitioners in such areas have to ration what they do for patients in the time available.

Too many NHS agencies have policies and initiatives which fizzle out in the most deprived third of the population. There is an urgent need for NHS initiatives and support systems which reach the parts that current approaches fail to reach, he concludes.

UK's Ageing Population Will Impose Huge Healthcare Burden

Mon, 12 Dec 2005 16:05:00 PST

( from http://www.rxpgnews.com ) New figures published by Dr Foster in this weeks BMJ predict that the UKs ageing population will impose considerable workload and financial pressures on the NHS.

The number of people aged 65 and over is predicted to increase by about 53% between 2001 and 2031. This is likely to lead to an increase in the number of people who have chronic diseases, including cardiovascular diseases.

Researchers examined the possible impact of the ageing population on the expected number of people with three cardiovascular disorders: coronary heart disease, heart failure, and atrial fibrillation (irregular heart rhythm).

By 2031, they predict that the number of cases of coronary heart disease will increase by 44%, the number of cases of heart failure will increase by 54%, and the number of cases of atrial fibrillation will increase by 46%.

If realised, these increases will have important implications for the NHS, say the authors.

For example, statins have become the single biggest component of the NHS prescribing budget, and their cost to the NHS is likely to increase further. So too will the costs of other drugs, as well as the costs of diagnostic tests, surgical procedures, and regular monitoring of patients. New medical technologies may also have a considerable impact on future caseloads.

Obesity, diabetes, and high blood pressure all increase the risk of developing heart disease, they write. A key aim of government policy should therefore be to encourage people to remain active, engage in regular physical exercise, and refrain from behaviours that could have a detrimental effect on their health, such as smoking and overeating.

Nurses key to restore public confidence in UK hospital care

Mon, 12 Dec 2005 16:00:00 PST

( from http://www.rxpgnews.com ) Nurses are the key to restoring public confidence in UK hospital care, argues an expert in this weeks BMJ.

Nurses led the transformation of hospitals in the 19th century. So, why after a century of outstanding success, is the future of the large general hospital in question? asks Professor Nick Black of the London School of Hygiene and Tropical Medicine.

Hospitals are partly a victim of their success, he says. Developments in pharmaceuticals, information and communication technology now offer alternative ways of delivering care. And when patients do need to attend hospital, they are less likely to stay overnight.

These changes are generally welcomed by the public, healthcare professionals, managers, and politicians. But negative reasons also threaten the future of large hospitals, arising from changes over the past 20 years in management, nursing, and building strategy.

So, what can save the hospitals? If public confidence is to be maintained, nurses must have a central role. Indeed, nurses rather than doctors have always really run the hospitals at the clinical level with doctors providing specialist help, writes the author.

Nursing also has the potential to moderate the publics need for hospital care through innovations such as nurse led telephone help lines and delivering more care in the community.

In many ways, nursing is the key profession and doctors, managers and politicians must recognise and respect the contribution nurses can and must make, he argues. The response to the current crisis posed by MRSA suggests that this may be happening.

The 19th century teaches us that nurses must be central to the running of all aspects of hospitals, not just those areas deemed appropriate by the medical profession.

This will require improved leadership and enhanced opportunities for nurses. In this way everyone can benefit: hospitals will remain viable, doctors will be able to pursue the activities in which they excel, and the publics concerns will be allayed, he concludes.

NHS waiting list falls below 800,000 for the first time

Sun, 04 Dec 2005 10:03:00 PST

( from http://www.rxpgnews.com ) The number of people on NHS waiting lists in England has fallen below 800,000 for the first time, new figures released today by the Department of Health have shown.

The figures show that in October the waiting list stood at 792,000 a fall of 366,000 since March 1997. This is the lowest figure recorded since waiting list data was first collected in this way in September 1988.

Health Secretary Patricia Hewitt welcomed the further progress in improving access to NHS treatment.

She said:

Investment and reform are working. The waiting list is at a record low and patients are experiencing the fastest ever access to NHS treatment.

The service is on target to achieve a maximum wait of six months for an operation by the end of this year and we know that most patients are already being treated much quicker, with an average wait of around eight weeks.

But there is still more to do. In October I set out further details of how, by 2008, no one will wait longer than 18 weeks from GP to hospital treatment.

We are on track to abolish waits in the NHS.

Reforms are threatening the future of district general hospitals

Fri, 02 Dec 2005 19:24:00 PST

( from http://www.rxpgnews.com ) Government reforms are threatening the future of district general hospitals, says an expert in this weeks BMJ. Given the iconic status of hospitals in the eyes of the public, government risks huge unpopularity in dealing with the consequences.

District general hospitals have formed the backbone of NHS hospital care since the 1960s, but government reforms to increase patient choice will see these hospitals competing with other NHS hospitals, NHS treatment centres, and independent sector providers, writes Professor Chris Ham.

District general hospitals may also find themselves under pressure from the devolution of budgets to general practices and payment by results.

Taken together, these policies mean that many district general hospitals may find it difficult to sustain a full range of services and could be left providing expensive complex care.

In these circumstances, one strategy is for hospitals to compete aggressively to maintain, and if possible, increase market share. An alternative and more plausible strategy is for hospitals to reduce or cease some activities and to focus on improving productivity in areas where they have competitive advantage.

A third strategy is for hospitals to diversify into other services - for example, sub-acute and primary care.

In the NHS of the future, it is possible to envisage enhanced primary care facilities and independent sector providers acting as a one stop shop for most forms of care apart from hospital inpatient services, says the author. On a more pessimistic note, the changes could result in reduced access to services and ultimately hospital closures.

However, one thing is certain. Managing the effects of choice and competition represents a huge political challenge, he concludes.

New NHS patient choice policies take no account of limited resources

Fri, 02 Dec 2005 19:22:00 PST

( from http://www.rxpgnews.com ) The Governments current NHS reform programme could lead to patients being charged for access to healthcare, argues a paper in this weeks BMJ.

New patient choice policies take no account of limited resources and funding, say the authors. Patients - consumers in the new NHS - bear no financial responsibility for the choices they make. Primary Care Trusts (PCTs), who pay for local health services in each area, are simply picking up the bill with no control on spending.

The Governments proposals for expanding market forces in the NHS will also be inefficient, say the authors. The aim is to drive costs down and improve quality through competition - external companies vying for NHS contracts. But prices have been fixed in advance, neutralizing the benefits of market forces.

In addition, more resources are going into the black hole of the hospital sector, and the way Foundation Trusts are funded heavily distorts the market.

Such a system will not be sustainable, say the authors: We face the prospect of an NHS led totally by patients, with supply responding purely to consumer demand without any recognised cap on expenditure. If the Government does not change tack, this can only lead to user charges, they warn.

Current UK policy seems based on US systems, say the authors. But these may not be transferable, particularly since organisations in the US deemed as successful models to follow, such as Kaiser Permanente, do not have to look after the range of health needs of a whole community, as the NHS does.

Instead the UK should introduce specifically-designed superpractices, family doctor surgeries expanded to include some hospital and social care services, all working together. Superpractices, servicing communities of 25-30,000 people and based on the old 'fundholding' model, would work best for controlling costs without compromising patient care, conclude the authors.

Examining NHS reforms: Health care in the market place

Sat, 12 Nov 2005 20:08:00 PST

( from http://www.rxpgnews.com ) The Government's use of private health care in the NHS is a much more open and aggressive version of the "internal market" tried by the Conservatives in the 1990s, says an article in this week's BMJ - the first of a series examining NHS reforms.

Initiatives like 'payment by results', foundation hospitals, and the "deliberate injection" of independent sector treatment centres (ISTCs) and other private sector services all create a sophisticated "supplier market" in UK health care, says the author.

The escalating use of the private sector stems from the NHS Plan in 2000, when the Government pledged to reduce waiting times, but realised that the NHS was too short of doctors and facilities.

The NHS already paid for extra capacity from private healthcare on an ad hoc basis, usually to meet year-end targets. But at prices sometimes 40% higher than the average NHS cost for each operation, Health Secretary Alan Milburn was keen to find a more cost-effective system, says the author.

Independent sector treatment centres, derived from fast-track surgery units in the US and staffed from overseas to avoid draining the NHS, were his answer.

The reforms have proved unpopular with the wider Labour party, but successive health ministers have pursued the policies, says the author. Within a few years, for instance, ISTCs will perform 500,000 operations - providing the private sector with more than £1bn worth of business annually.

The most important of the reforms is 'payment by results', says the author, which underpins all others since it fixes a rate for treatment based on average NHS costs. Critics say that ISTCs are not good value for money, as they are paid at the national tariff per case but mainly perform simpler - and below average cost - procedures. The NHS is left with more difficult and costly cases, but only paid the average rate.

Private sector providers have to date also been given guaranteed volumes of patients from NHS managers, while NHS treatment centres are not allowed to 'compete' for patients. One result is that NHS units have been running half empty say critics - and thus losing money, adds the author.

Current reforms in the NHS represent nothing short of "the biggest revolutionsince its foundation in 1948," says the author. Many fear they will result in the destabilising, and eventual closure of hospitals, he concludes.

Nurse and pharmacist prescribing powers extended

Fri, 11 Nov 2005 00:52:00 PST

( from http://www.rxpgnews.com ) Patients will be able to get quicker and more efficient access to medicines thanks to extensions to nurse and pharmacist prescribing announced today by Health Secretary Patricia Hewitt at the Chief Nursing Officers conference in London.

From spring 2006, qualified Extended Formulary nurse prescribers and pharmacist independent prescribers will be able to prescribe any licensed medicine for any medical condition with the exception of controlled drugs.

The extension means that specialist nurses running diabetes and coronary heart disease clinics will be able to prescribe independently for their patients. Pharmacists will be able to prescribe independently for the local community; for example, controlling high blood pressure, smoking cessation, diabetes, etc. This will take pressure off GPs, allowing them to focus on more complex cases and improving the availability of care for patients.

Patricia Hewitt said:

"Extending prescribing responsibilities is an important part of our commitment to modernise the NHS. By expanding traditional prescribing roles, patients can more easily access the medicines they need from an increased number of highly trained health professionals.

Todays announcement means that the young person wanting to control their asthma or the terminally ill patient being cared for at home by a multi-disciplinary healthcare team will soon find it easier and more convenient to get the medicines they need. This is another step towards a truly patient-led NHS, giving patients the power to choose where and by whom they are treated.

Chief Nursing Officer Christine Beasley said:

Nurses are the biggest single staff group in the NHS and they have already demonstrated that they are safe, careful and professional prescribers. Pharmacists have wide knowledge of medicines and the effects they have on people. This knowledge is invaluable to their colleagues and to patients. Todays announcement demonstrates our confidence in nurses and pharmacists and our wish to use their skills and professionalism to the full.

With these extended prescribing powers, nurses and pharmacists will be able to improve choice for patients and enable more flexible team working within the NHS.

And, as nurses and pharmacists undergo rigorous training before being able to prescribe, patients can be confident that they are receiving the safest, best possible care.

Head of Pharmacy Jeannette Howe, said:

"This is a major step forward in providing care that is more responsive to the needs of patients and the public. It is ground-breaking for the pharmacy profession. As independent prescribers, pharmacists will fully use their expertise in medicines, in partnership with patients and other members of the health care team."

Nurses and pharmacists will be able to undertake these roles once they have successfully completed the relevant training courses accredited by their respective regulatory bodies and had these qualifications noted on the professional register. Once trained, they will be required to keep their skills up to date. Employers will allow nurses and pharmacists to prescribe once they are satisfied that they have appropriate registration and have all the skills and competencies relevant to the clinical area in which they will be prescribing.

Nurse and pharmacist prescribers will have to work within their employers clinical governance frameworks and they will be accountable to both their employers and their regulatory bodies for their actions.

Orphan drugs and the NHS: should we value rarity?

Sat, 29 Oct 2005 15:04:00 PST

( from http://www.rxpgnews.com ) The growing number and costs of drugs for rare diseases (orphan drugs) are straining healthcare budgets. Should the NHS continue to pay for them and how will this affect other health services, ask two articles in this weeks BMJ. Orphan drugs are often expensive to produce and benefit only small numbers of patients. Historically, the NHS has paid for them because treatments for these diseases were so rare that the effect on health services was negligible.

But, as more and more orphan drugs come on to the market, the impact on other health services is becoming substantial.

In the first article, experts argue that the cost effectiveness of orphan drugs should be treated in the same way as for other healthcare technologies.

They believe that the costs of production and the value of innovation cannot justify special treatment, and that arguments about the measurement and valuation of health outcomes apply equally to orphan drugs and drugs for more common conditions. Why should a persons health be valued less simply because the condition is not rare?

Special status for orphan drugs in resource allocation will avoid difficult and unpopular decisions, but it may impose substantial and increasing costs on the healthcare system, they write.. The costs will be borne by other patients with more common diseases who will be unable to access effective and cost effective treatment as a result.

The second article describes how a national decision to provide therapies for a group of rare disorders prevented local funding for other equally vital services in the West Midlands.

The new commissioning arrangement came with no extra funding. The cost to primary care trusts doubled from £3.2m to £6.7m, limiting budgets available to commission and develop other services.

It is time to educate ourselves, policy makers, and the public, say the authors. We need to learn how to make trade-offs between equity and efficiency that are explicit, principled, and generalisable and how to admit openly when there are treatments and services that are not being funded.

Meeting MRSA Targets Largely Down To Chance, Says Expert

Sat, 29 Oct 2005 14:53:00 PST

( from http://www.rxpgnews.com ) Chance makes it impossible to assess reliably whether hospitals are meeting government targets to reduce MRSA infections, argues a statistics expert in this weeks BMJ. The UK government has set a national target for reducing the rate of MRSA infection by 50% by 2008, but David Spiegelhalter, a senior scientist at the MRC Biostatistics Unit Cambridge, warns that setting these targets for individual hospitals is fraught with difficulties.

The basic problem, he says, is that it is unclear whether the targets refer to an observed rate reduction or a true reduction in underlying risk: this ambiguity is unimportant at the national level but, for individual hospitals, chance variation can make the observed rates extremely volatile and make simplistic notions of hitting targets unreliable.

MRSA is an infectious disease and so tends to occur in clusters, making the volatility even worse.

Using data for financial years 2001-4, he found far more variability in the figures than would be expected by simple chance alone. For example, Aintree Hospitals NHS Trust had 34 cases in 2001-2, rising to 66 cases in 2002-3, and falling to 48 in 2003-4.

He therefore suggests that any attempt at ranking trusts into a detailed league table of change would be entirely spurious.

He also shows that, since high or low rates are largely due to chance events that are unlikely to be repeated, rates in the subsequent year will tend to be closer to the overall average rate (a phenomenon known as regression to the mean). This immediately explains reports of hospitals slipping significantly down the league table from one year to the next.

He believes that, if MRSA rates are to be used to assess performance, further changes are needed.

Finally, the government needs to be more precise about what it means by the term target, he adds. When it comes to assessing whether a target has been met, it is vital to distinguish between observed reduction in numbers of cases and reduction in true underlying risk.

Even if the average trust is truly reducing the underlying risk at the government target of 20% per year, there is still only a 50:50 chance that the observed rate will drop by more than 20%. Underlying risk, though it cannot be precisely measured, is the appropriate interpretation when setting local targets, he concludes.

But an accompanying editorial says that, despite these limitations, mandatory surveillance of MRSA infection rates has raised the profile of infection control .

Call for an independent regulator for NHS

Fri, 21 Oct 2005 15:51:00 PST

( from http://www.rxpgnews.com ) The NHS should have an independent regulator like other public utilities in the UK, argues a senior doctor in this weeks BMJ. Many public utilities have independent regulators to see that commercial interests and unfair pricing do not disadvantage the public.

At present the UK does not have an independent regulator of healthcare reform, yet the consequences of ill judged reform of the NHS may inflict long term damage to the delivery of health care to its citizens, says Ian Kunkler, a consultant at the Western General Hospital in Edinburgh.

He believes that the shortcomings of the private finance initiative are persuasive arguments for an independent regulator, and suggests that key tests might include equity of access to care; collaboration between healthcare professionals, managers, and patients, and financial prudency and transparency.

If these golden rules were met, the UK government would be more likely to carry the support of the public and NHS professionals to meet the healthcare challenges of the 21st century, he concludes.

Cost effectiveness of complementary treatments in the United Kingdom

Fri, 14 Oct 2005 21:43:00 PST

( from http://www.rxpgnews.com ) The cost-effectiveness of using complementary treatments in the United Kingdom has been the subject of much speculation and controversy.

For instance, a report commissioned by the Prince of Wales last week said that complementary therapies should be given a greater role in the NHS, while others believe that more studies are needed before they are made widely available.

As an example of how poor the evidence is, researchers carried out a systematic review of cost effectiveness analyses of complementary treatments. They found only five studies done in the UK before April 2005, one of acupuncture for headache and four of spinal manipulation for back pain.

They conclude that these treatments represent an additional cost to usual care with questionable clinical benefit.

In an accompanying editorial, two senior doctors and general practice researchers suggest that complementary medicine should be considered for inclusion in national clinical guidelines despite limited evidence of cost effectiveness.

They believe that the integration into the NHS of specific complementary therapies for chronic conditions would be beneficial to patients, but that each therapy needs to be considered on its merits, including cost-effectiveness.

Services for liver disease in the United Kingdom need immediate improvement

Fri, 14 Oct 2005 21:43:00 PST

( from http://www.rxpgnews.com ) Mortality from liver disease is increasing in the UK. In 2000 liver disease killed more men than Parkinsons disease and more women than cancer of the cervix. Deaths from alcoholic liver disease has doubled in the past 10 years, while liver disease arising from hepatitis C infection is expected to treble by 2020.

Evidence also suggests that the standard of care may vary widely from place to place.

But are there enough specialist staff and facilities in the UK to manage these projected increases in liver disease, or even the current workload, asks the author?

He conducted a survey on the staffing and facilities of liver centres at 28 English hospitals. Relatively few were able to provide a full range of liver services and there were serious shortages of staff at all levels.

Lack of dedicated beds was one of the most common problems, while waiting times for outpatient appointments were often unacceptable, with only seven hospitals able to offer an urgent appointment within two weeks. An earlier survey also showed the need for a substantial increase in consultant liver specialists (hepatologists).

Recent initiatives to improve teaching and specialist training are a step forward, says the author, but liver services need better funding as well as better staffing.

Increasing the number of transplant centres would be one way to provide liver services more widely in the United Kingdom, he suggests. At present, large areas of the country currently lack a transplant centre, and it was once estimated that a patient living in Cornwall was four times less likely to be referred for a liver transplant than someone in Leeds.

Clearly, specialised services for liver disease and transplantation will have to improve substantially to meet the considerably increased burden of liver disease that is predicted for the next 20 years, he concludes.

Hewitt fulfils commitment to NHS workers

Sat, 08 Oct 2005 05:52:00 PST

( from http://www.rxpgnews.com ) Thousands of staff working in the NHS are set to benefit from a new agreement that will bring cleaning, portering, catering and other similar soft facilities management services provided by contractors into line with the NHS Agenda for Change pay deal, Health Secretary Patricia Hewitt announced today.

The joint statement agreed in partnership between the Department of Health, relevant NHS Unions, the CBI and BSA and the new NHS Employers organisation is part of the NHS Agenda for Change programme (covering 1.2 million NHS employees) to create a modern flexible workforce that delivers better health outcomes.

From October next year, the new deal will give cleaners, porters and other soft facilities management staff working for contractors, pay and conditions no less favourable overall than the Agenda for Change pay deal, and provide for better development and training and closer involvement in NHS workforce reforms.

Interim measures have also been agreed.

* From 1 October 2005 staff covered by the agreement will receive a minimum of £5.65 an hour basic pay
* From 1 April 2006, the minimum hourly rate of basic pay will rise to £5.88 (matching the current minimum under Agenda for Change)

Health Secretary Patricia Hewitt said:

Cleaners, porters, and catering assistants are all part of the team that delivers care to patients in every hospital, whether employed directly or through a contractor. They are key to delivering cleaner hospitals, reducing MRSA, helping patients access services and ensuring patients have nutritious meals.

Government, unions, and private sector employers recognise that hospitals function better when there is good team working between clinical and support staff, and fair rewards irrespective of how they are employed. This deal will help ensure better services for patients in our hospitals.

The NHS is a unique institution and this agreement demonstrates that all parties central to its success - the public sector, unions and the private sector - can work together effectively to achieve the reform of the NHS to create a modern health service.

Dave Prentis, General Secretary of UNISON, the UK's largest union said:

"This is a great step forward towards ending the two-tier workforce in the NHS. The proposals will also avert the threat of widespread industrial action by contracted out staff across the country.

"The new £5.88 minimum wage will drive up standards and help tackle the recruitment and retention problems experienced by many hospitals. It will also give a welcome boost to staff who, as a result, will feel more valued and respected as an integral part of the NHS team. The agreement will also provide staff with better training opportunities which is very welcome."

Steve Barnett, Director of NHS Employers said:

This is an important agreement which will make a big difference to the lives of thousands of staff who are part of the wider NHS team . They provide a crucial service and are integral to positive patient experiences.

Norman Rose, BSA Director-General said: "Under the proposed deal announced today, private sector employers will be given the opportunity to demonstrate their ability to deliver high-quality services to the NHS through flexibility and innovation and not through cutting costs. We welcome this deal as setting the foundations for a new way forward in which we and the public sector unions can work together with NHS Trusts in the interests both of our employees and the patients whom we serve."

John Tizard, Director of Public Services at the CBI said: We welcome this agreement and the commitment to continued reform it embodies. This agreement recognises that there are a wide range of private and voluntary providers involved in delivering health services and their staff have an important part to play in NHS reform

Day surgery rates continue to rise in UK

Fri, 07 Oct 2005 21:16:00 PST

( from http://www.rxpgnews.com ) New figures published by Dr Foster in this weekâs BMJ show that day surgery rates continue to rise, yet there is still considerable scope for improvement. These findings support a recent Healthcare Commission report showing that day surgery units are not being used to their maximum capacity.

The NHS Plan predicts that 75% of all elective operations will be carried out as day cases. According to the British Association of Day Surgery, patients prefer day surgery as it provides timely treatment with less risk of cancellation, lower incidence of hospital acquired infections, and an earlier return to normal activities.

Researchers looked at day surgery rates by using hospital episode statistics between 1996-7 and 2003-4, and comparing them against the 25 operations identified by the Audit Commission as day cases.

Overall, the proportion of procedures carried out as day surgery rose from 55.7% in 1996 to 67.2% in 2003. Cataract operations showed the greatest increase in total admissions (including day cases), rising 94.8% over the study period.

Day surgery rates varied considerably between NHS trusts ranging from 40.2% to 82.7%, with only 12% of trusts carrying out 75% or more of the 25 operations identified by the Audit Commission as day cases. The authors suggest this variation might be explained by inconsistent coding or differences in case mix between hospitals.

The conclusions are much the same as those of the Healthcare Commission: day surgery rates are continuing to improve, yet the range of performance between NHS trusts remains wide leaving considerable scope for the poorer performers to improve.

Reforming the NHS in England - Views

Fri, 07 Oct 2005 21:16:00 PST

( from http://www.rxpgnews.com ) The NHS is being taken over by big business so that money that could go towards clinical care is diverted to corporations and their shareholders, warn two senior doctors in this weekâs BMJ.

Robert Lane and Alex Paton argue that huge amounts are paid to large private firms for advice about the Private Finance Initiative (PFI) and independent sector treatment centres (ISTCs). Profits are then swollen by the scandalous practice of refinancing buildings, while cash-strapped hospitals must pay the mortgage for 30 years.

But problems go deeper than money, they say. While clinicians are expected to provide evidence to support the actions they take, ideas generated by government advisers are often applied without consultation.

âThe result is a stream of untried schemes, based on ideology rather than evidence, that often have unforeseen consequences on different parts of the NHS.â

But for those in favour of reform, the problem is not that we have gone too far but that we have not yet gone far enough. In a second article, Jennifer Dixon calls for full implementation of the reforms already designed (payment by results, patient choice, and provision of care by non-NHS providers).

âThe supply of private providers must continue to grow,â she says.

But she also wants more. Key elements, such as stronger financial incentives, boosted commissioning, and effective economic regulation, are urgently needed. The government must also provide more evidence that the risks of reform on this scale can be managed effectively, she concludes.

Is the private finance initiative dead in NHS?

Fri, 07 Oct 2005 21:16:00 PST

( from http://www.rxpgnews.com ) Government enthusiasm for the Private Finance Initiative (PFI) in the health service - private sector investment in hospital building projects - may be dropping because of its high cost, says an editorial in this weekâs BMJ.

Hospital trust boards initially welcomed the financing system, which they were told was the major way they could fund new facilities, paying investors back in annual instalments.

But concerns were soon raised that new PFI funded projects were providing less patient capacity than those they were designed to replace. PFI contracts also seemed very expensive, though details on costs were âshrouded in commercial secrecyâ, says the author.

The House of Commons Public Accounts Committee recently questioned the âlarge profits made by the private contractor which built the Norfolk and Norwich hospitalâ, says the author. And the recent shelving of a flagship PFI venture in West London may herald the end for the PFI healthcare experiment in the UK, he suggests.

The fundamental problem is that PFI does not suit the rapidly changing climate of delivering healthcare in the UK, says the author, as private investors need long-term commitment from hospital managers â commitments increasingly unwise for trust boards to make.

The final blow could be the Governmentâs own economic operating constraint that debt should not exceed 40% of gross domestic product. Hospital repayments to PFI investors have always been treated as âoff balance sheetâ finance - not registered in public accounts. But this may soon change if the Governmentâs Office for National Statistics reclassifies PFI investment, since much of it may be categorized as debt â and at levels possibly breaching the Governmentâs own economic condition, says the author.

This would remove a key justification for PFI in healthcare, since a financing system which incurred heavy debts on the Government balance sheet overturns the argument for having PFI in the NHS at all, he concludes.

National consultation on NHS-funded infertility treatment

Sat, 10 Sep 2005 23:11:00 PST

( from http://www.rxpgnews.com ) A national consultation on NHS-funded infertility treatment aimed at improving equality of access across Scotland was launched today.

The consultation, which runs until December 8, will examine:

* Clinical criteria - e.g should the (38 year-old) age limit for women to receive infertility treatment be increased?
* Social criteria - e.g should priority for treatment be given to couples who have no other children living in the home?
* Other issues - e.g what impact would widening the access criteria have to NHS waiting times for treatment?

Deputy Health Minister Lewis Macdonald said:

"Infertility affects roughly 75,000 couples in Scotland. Demand for NHS-funded assisted conception has increased and we need to ensure there is equal access for all regardless of where people live in Scotland.

"We have national criteria for accessing infertility treatment provided by the NHS, and Boards are expected to follow this guidance. However I am aware there is still some variation among Boards regarding the provision of infertility treatment, and that not all Boards are following this guidance as they should.

"I also know there are differences in criteria and waiting times for the most specialist treatments within the four specialist centres in Scotland. This is why we are launching a national consultation today, with the aim of securing equity of access to high quality infertility services across Scotland.

"We want to seek views on what changes are necessary to improve access to assisted conception treatment. This consultation is mainly aimed at NHS Boards and service providers so we can examine the issues that are preventing the implementation of consistent access criteria. We also hope to find out why there are discrepancies in waiting times across different areas in Scotland.

"I am also keen to hear from people who use infertility services and other interested groups. We are asking questions to gauge people's views on issues that may affect access to infertility treatment for women in Scotland like age or whether their partner has a child who lives in their home.

"We are consulting widely in the hope that we can secure an equal service for all in Scotland."

Infertility is defined as a 'failure to conceive after regular unprotected intercourse for one or two years".

There has been no real increase in prevalence of infertility, but evidence shows that more couples are seeking fertility assistance.

The Expert Group on Infertility Services in Scotland (EAGISS) set out recommendations for national criteria for NHS-funded infertility treatment in 1999. It was hoped the publication of the report would provide equity of access to service and treatment. In 2000, the Chief Medical Officer asked Boards to adopt this framework.

EAGISS criteria states a woman should be less than 38 at the time of treatment. It also states that eligible women should be entitled to a maximum of three assisted conception cycles.

Following one cycle of treatment, a couple should be able to undergo successive cycles within a timeframe of their own choosing.

However more recently, guidelines produced by NICE in 2004 state the age limit for women to receive infertility treatment should be 40 and that cycles of treatment should be increased to five. Clinicians, NHS Boards and service users will be consulted to find out what criteria should apply in Scotland.

Access to infertility treatment is not currently covered by the waiting times guarantee as it is measured separately from national waiting times standards. Following this consultation on access criteria for NHS-funded infertility services, the need to apply a target waiting time for tertiary infertility treatment will be considered.

A woman's age is the single most important variable that affects the success of conception. Women aged 35 to 39 have a 50percent less chance of conceiving spontaneously than women aged 19 to 26 years. Approximately 30 per cent of infertility is unexplained and the rest can be contributed to ovulatory failures, low sperm count or quality, tubal damage or conditions such as endometriosis. Lifestyle factors such as diet, smoking and substance misuse also influence a couple's chance of successful conception.

PCT patient survey is proof of high standards in primary care services

Fri, 09 Sep 2005 15:51:00 PST

( from http://www.rxpgnews.com ) The NHS Confederation, which represents 93 per cent of primary care trusts (PCTs), says that the key findings of the Healthcare Commissions PCT patient survey are good news for NHS patients.

Patients overall impressions of their experiences of primary care services are broadly positive and PCTs have made clear improvements in meeting the Governments waiting times targets.

The Healthcare Commissions survey highlights that 74 per cent of patients are seen within the Governments waiting time target of 48 hours for a GP appointment - an increase from 65 per cent in 2003.

Dr Gill Morgan, Chief Executive of the NHS Confederation, said: the Healthcare Commissions PCT patient survey shows that standards continue to improve in primary care services and patient satisfaction is improving.

Most patients accessing primary care services are happy with the care that they receive, for example 92 per cent said that they were always treated with dignity and respect by their GP.

Although largely positive, the survey highlights room for improvement, especially with regards to GP access and registering with an NHS dentist.

Dr Gill Morgan said: of course it is not right that 12 per cent of patients surveyed could not get a GP appointment within 48 hours but the flipside of the coin is that 88 per cent are able to see their GP within two days when they really need to.

It is clear that the 48-hour target is still having unintended consequences in a minority of areas but many PCTs and GP practices have found ways to deal with this and now is the time for this learning to be shared.

We welcome todays announcement by the Department of Health that NHS patients and staff will be asked for their views on advance booking of GP appointments as part of the White Paper public consultation and our members will be feeding their experiences of what works into the consultation.

And PCTs will clearly have a key role to play in the tighter checks on the 48-hour target which have also been announced by the Department of Health today.

The PCT patient survey identified that 69 per cent of patients who were not registered with an NHS dentist would like to be while 75 per cent of those treated by an NHS dentist said they definitely had confidence in their dentist.

Dr Gill Morgan said: Access to NHS dentistry is clearly an issue for patients and we hope that the increased funding being devoted to training more dentists will ensure that access to NHS dentistry improves over time.

However, it is positive that 75 per cent of patients who saw an NHS dentist were happy with the care that they received.

NHS Confederation calls for debate on NHS drug costs

Fri, 09 Sep 2005 15:49:00 PST

( from http://www.rxpgnews.com ) The NHS Confederation is calling for an urgent debate on rapidly increasing NHS drug costs following todays Audit Commission report about the financial implications of implementing NICE guidance on new medication and surgical procedures.

Dr Gill Morgan, Chief Executive of the Confederation which represents more than 90% of NHS organisations, says: The annual cost to the NHS of complying with NICE guidance on new drugs and procedures is £800 million, but thats just 10% of the total NHS drugs bill.

Prescribing drugs cost the NHS £8 billion last year, an increase of 46% since 2000, and this rapid rise in the medication bill is a major cause of the financial pressures currently facing NHS organisations.

Extra investment in the NHS is growing by an average of 7.4% a year in real terms but drug costs are rising even faster.

That is why 85% of the NHS organisations who were questioned by the Audit Commission for its report said there wasnt enough funding available for them to fully implement NICEs guidance on new drugs and procedures.

The Audit Commission acknowledges that the NHS is not given specific funding to implement NICE guidance and that comprehensive implementation of all guidance across the NHS may not be possible as there may be competing priorities for funding locally.

Dr Gill Morgan says: Scientific advances mean that new and often expensive drugs are recommended for NHS use, which is clearly good news for patients and clinicians, but we urgently need a proper debate about how these drugs can be funded.

Weaknesses in NHS financial management, rather than cost, are identified by the Audit Commission as the major barrier to implementation of NICE guidance.

Dr Gill Morgan says: Financial planning and management can always be improved and we welcome NICEs proposals to help NHS organisations.

NICE guidance is published throughout the financial year and so PCTs are in the difficult position of trying to second guess NICEs likely decisions when they are planning their annual budgets and set aside money they anticipate will be sufficient to implement their guidance.

If the cost of implementation is greater than anticipated or if NICE issues unexpected guidance, thats when PCTs face financial issues.

'Guaranteed' appointments with your GP

Thu, 08 Sep 2005 01:31:00 PST

( from http://www.rxpgnews.com ) Patients will be guaranteed the choice of being able to book an advance appointment with a GP under measures to improve access to family doctor services announced today by Health Minister Lord Warner.

The move to guarantee advance booking should allow patients to be able to fit in seeing a GP around their daily lives and remove the frustration of having to call their practice back on the day they require an appointment.

Checks will also be tightened to ensure that achievement of the 24/48 hour access target, which allows patients to book a GP appointment within two days, is a true reflection of patient experiences.

The strengthened checks will include tighter monitoring by Primary Care Trusts (PCTs) by varying monthly survey dates, a sample check of PCT data and introducing more patient surveys to ensure that existing tests reflect patients experiences.

Lord Warner said:

The Healthcare Commission survey confirms that NHS care outside of hospitals is improving. It shows improvements in GP access when necessary compared with 2004 and very high levels of satisfaction with the visit to the GP. However, the commissions survey also brings to light areas where further improvement is needed.

It is unacceptable that some practices are still not allowing patients to book an advance appointment with a GP. Patients rightly expect to see a GP at a convenient time more than two days in advance.

They should not face the frustration of having to call their practice back on the day they want an appointment. Practices must already offer quick access to a GP, but we will move to guarantee patients more flexible access if they want to book ahead.

The 24/48 hour access target is a key priority and has by any measure led to patients being able to see a GP more quickly. There is absolutely no justification for this target being used as an excuse for an inflexible appointments system. We recognise patient surveys show a gap between patient experience and the departments data. Our aim now is to make improved access more real for everybody.

We will make our system of checks more robust to ensure achievement of the target truly reflects the experience of patients across the country.

Whilst official figures show a steady reduction in the percentage of patients who are being denied the choice of booking ahead, some GP practices are still operating restrictive booking systems preventing patients from booking an appointment with a GP more than two days ahead. Instead, patients are often required to contact their practice nearer the time.

The department will now ask patients and NHS staff what timescale they want to see in terms of a national guaranteed advance booking period as part of the Your Health, Your Care, Your Say White Paper public consultation process. This will enable contract improvements to be agreed.

Virtually all patients can see a GP within 2 working days or a primary care professional under current measures of achievement against the 24/48 hour target.

Sprayed cultured skin cells in burns treatment - Study

Tue, 06 Sep 2005 19:51:00 PST

( from http://www.rxpgnews.com ) The first controlled clinical study to examine the effectiveness of sprayed cultured skin cells to close the wounds of burns victims is being undertaken at the Queen Victoria Hospital NHS Foundation Trust (QVH), East Grinstead.

Mr Phil Gilbert, Consultant Plastic Surgeon who specialises in burns said: In pilot studies we get the impression that wounds heal noticeably quicker with less scarring using this spray on method with skin cells. We now need to quantify how good it is at saving lives, repairing wounds and reducing the cost of caring for burns victims to the NHS.

Skin cells have been grown in the laboratory since the mid 1970s, but until now there has not been a significant scientifically controlled study. Dr Liz James, a cell culture scientist and Head of Research at the Blond McIndoe Centre for medical research, based at the Queen Victoria Hospital, East Grinstead, said: We will be conducting the multi-centre study on two groups of patients; 24 adults with severe burns and 50 children aged between 12 and 36 months with scalds. We have seen what I can only describe as miraculous results using spray on skin with patients surviving 90% burns who otherwise had very little chance of survival.

Scalding is one of the most common reasons for children to be seen in hospital. Amanda Wood, head of the paediatric burns unit at the Queen Victoria Hospital said: We admit 300 paediatric cases a year, of these 200 are as a result of scalding. Until now, children with scalds have been at a high risk of developing scars. We hope that this study will show that they need not be left with a lifetimes reminder of a childhood accident.

New NHS campaign raises awareness of invisible killer

Mon, 05 Sep 2005 23:23:00 PST

( from http://www.rxpgnews.com ) Sixty per cent of smokers go ahead and smoke without asking for permission, despite the fact that most non-smokers mind if other people are smoking nearby, according to new research(1) launched today by the NHS 'Don't Give Up Giving Up campaign'.

The survey marks the launch of new NHS ads raising awareness of the health risks of secondhand smoke to adults. The poll shows that 21 per cent of non-smokers still don't feel comfortable asking somebody not to smoke near them or in their own home. This is despite the fact that continued exposure to secondhand smoke puts non-smokers at a 24 per cent increased risk of lung cancer and a 25 per cent increased risk of heart disease(2).

The adverts, which highlight the fact that 'Secondhand smoke is a killer' also demonstrate that exposure to secondhand smoke makes breathing problems worse for asthma sufferers.

This is the first time the campaign has addressed the issue of secondhand smoke in relation to adults, and within a home environment. According to a recent report(3), 95 per cent of estimated deaths from secondhand smoke are due to exposure in the home. Previous NHS campaigns have addressed the issue of smoking around children and helped to raise awareness of the fact that it can be harmful for children to be in a room where somebody has recently smoked even if the room appears not to be smoky, as 85 per cent of smoke is invisible and odourless.

Caroline Flint, Public Health Minister said:

"It is clear that both smokers and non-smokers don't appreciate the full dangers of secondhand smoke. Tobacco smoke contains around 4,000 different chemicals, including more than 50 known cancer-causing substances, such as arsenic, formaldehyde and ammonia(4). By ignoring these facts and smoking around others they are putting them at serious risk of increased disease. This campaign is designed to show that it's often the places we feel safest that put us at the greatest risk, such as relaxing at home in front of the television.

"We are hoping that this campaign will give smokers an excellent reason to quit smoking - to protect their families, friends and colleagues. By arming everyone with the facts about the very real dangers of secondhand smoke we are providing people another motivation to give up for good."

The television advert will show a group of family and friends relaxing at home watching TV, where one person is smoking. As the advert progresses, the smoke moves around the group, snaking round necks, revealing the long term damage it can cause and then forming a menacing, evil face that looms above the assembled group. It carries the messages that 'Secondhand smoke can restrict the oxygen around your heart, causing it to fail' and 'It increases your family's chance of getting heart disease by 25 per cent'. New print and radio advertising will also be launched.

Christine Owens, Head of Tobacco Control, The Roy Castle Lung Cancer Foundation said:

"The message of these ads couldn't be clearer - secondhand smoke is a killer. Each year in the UK, secondhand smoke in the home is estimated to account for thousands of deaths(3). Like smoking, secondhand smoke is a proven cause of both lung cancer and heart disease. It is estimated that more than 2000 lung cancer deaths can be attributed to exposure to secondhand smoke. This campaign is a major step towards increasing public awareness of these dangers."

New guide published to promote equality and diversity in the NHS

Sat, 23 Jul 2005 01:30:00 PST

( from http://www.rxpgnews.com ) The Department of Health, the NHS Appointments Commission and the NHS Confederation today published a new Guide to help promote equality and human rights in the NHS.

The Guide targeted at NHS Boards, and Non-Executive Directors in particular, contains details of current and imminent legislation, vital statistical information on communities, patients and the workforce, and a set of 15 prompts to enable Boards to embed good equality and human rights practices into their decision-making and the performance of their organisations. As a result, the NHS will be able to maintain its commitment to providing fairer, faster and personalised services to communities and patients, and recruit, develop and retain the best talent in its workforce.

The NHS currently employs over 14% of its workforce from black and minority ethnic backgrounds and almost 75% are women, and is at the forefront of promoting equality and human rights within both national and local economies.

Health Minister, Rosie Winterton said:

"I am proud to announce the publication of the Equality and Human Rights Guide today. If the NHS is to maintain and develop its position as a world-class service, it must be a service that treats its patients and staff with fairness, dignity and respect. This means respecting people's age, disability, sexual orientation, gender, race and faith. Discrimination on these grounds, which leads to people being treated unfairly, is unacceptable in the culture and practice of the Department of Health, NHS and social services. The Guide will help NHS Boards to deliver appropriate, personalised services to the diverse communities they serve and to be employers of choice that recruit, develop and retain the best talent from all communities."

Surinder Sharma (Equality and Human Rights Group, Department of Health) said:

"The Equality and Human Rights Guide will make a real difference. It reminds the NHS of its legal responsibilities for equality and human rights. The Guide provides the NHS with a series of prompts to help NHS Boards review their policies and practices towards equality and human rights. The Guide also includes a comprehensive set of Vital Information that the NHS can use and adapt to generate their own local data on health inequalities and workforce issues. This local information can then be used to build up a powerful and robust business case for equality and human rights, which in turn can inform local NHS policy making. I expect NHS Boards to work with me in making sustained improvements to services and workforce practices for all communities based on use of the Guide."

NHS Appointments Commission chief executive Roger Moore said:

"This guide makes a new and substantial contribution to information on equality matters that will enable non-executive members of NHS Boards to provide an even better service within health. It contains background to legislation and important health data that will promote greater understanding and awareness among Board members of these vital issues. We will be ensuring that Board members receive the guide and will be using it extensively in NHS Appointments Commission training and induction programmes."

Dr Gill Morgan, Chief Executive of the NHS Confederation whose members include more than 90% of NHS organisations throughout the UK, said:

"Equity of access to treatment for all patients is a founding principle of the NHS and so we wholeheartedly support the publication of this new guide for non-executive directors.

"We also agree that NHS organisations need to demonstrate they are employers of choice and NHS Employers, part of the NHS Confederation, is now responsible for the majority of health service workforce issues including equality and diversity.

"We help NHS employers and professional bodies to ensure that equality and diversity is at the heart of everything they do by taking a strategic approach and by sharing examples of good practice.

"NHS Employers looks forward to working with the Department of Health in driving forward this work programme."

Patricia Hewitt calls for improved family health services

Fri, 20 May 2005 23:26:00 PST

( from http://www.rxpgnews.com ) Health Secretary Patricia Hewitt called on NHS leaders to kick start a big programme of public engagement in order to shape the future of NHS family health services.

Speaking to the National Leadership Network, Patricia Hewitt said:

"I said when I was appointed ten days ago that I wanted to spend the next few months listening and learning. I want to hear the views of people working in the NHS and Social Care. And I want to hear from the patients and users of its services about their experiences.

"My predecessors, Alan Milburn and John Reid, put in place a series of major structural reforms that were largely focussed on hospital services. Over the next few years we need to implement these changes, giving patients far more choice and control over their treatment, improving quality and safety, and delivering on our promise of a maximum 18 weeks between GP referral and treatment.

"I have already made clear there will be no back-tracking on the direction or pace of reform, and that under this government, healthcare will remain available to all according to clinical need and free at the point of use.

"However, the point of contact for most people with the NHS and Social Care system is their GP or other non-hospital services.

"Half-way through our ten-year programme of investment and reform, it is now time to focus more closely on the family health services provided by GPs, dentists, nurses, pharmacists, paramedics and others in primary and non-scheduled care. Most people value greatly the continuity of care provided by their GP service. But we are also seeing many new ways of getting health care NHS Direct, walk-in and minor injuries centres, treatment provided by paramedics from the ambulance service and so on.

"In the forthcoming White Paper promised by the Prime Minister, we will set out a vision for family health services fit for the 21st century. Everyone will have their views to contribute. Because we want the White Paper to be firmly based on the experience and expectations of patients as well as practitioners, I will be initiating a programme of public engagement in which we will invite people to help design the twenty-first century health service outside hospitals.

"I want the National Leadership Network to play a central role in this important task. Over the next few months as I go round visiting the front-line for myself, listening and learning, I want you - leaders from all parts of the NHS and Social Care - to consult staff in your organisations and users in your areas about what sort of family health services they want to see.

"It is vital that any future changes should come from the bottom up and not be imposed from the top down. The aspirations and expectations of patients and the public about their family health services should be the starting point for the next stage of reform. I invite you to join me in this exciting challenge."

Heart patients getting faster treatment in UK

Fri, 13 May 2005 19:53:00 PST

( from http://www.rxpgnews.com ) Tens of thousands of patients needing heart surgery are getting treatment quicker than ever before thanks to the NHS meeting targets ahead of schedule, new Health Secretary Patricia Hewitt announced today.

Patients requiring heart bypasses or angioplasties - a procedure to unblock arteries - are having their operations within three months, she said.

Publishing the latest report from NHS Chief Executive Nigel Crisp, she said the progress made in tackling heart disease typified the huge improvements being experienced across the service.

Sir Nigel's report shows that:

* more than 99 per cent of people with suspected cancer are seen by a specialist within two weeks of referral, and over 97 per cent of women with breast cancer receive treatment within one month of diagnosis;
* British men have had the world's sharpest fall in deaths from lung cancer, and in the past decade British women have had the world's biggest decrease in deaths from breast cancer; and
* by the end of January 2005, no-one was waiting more than three months for their first cataract operation, one of the most common types of operation, a target met four years ahead of schedule.

New figures published today show the target to treat heart patients within three months was met in March 2005 - three years ahead of schedule - compared to waits of over 18 months in 2000 and up to two years in 1997.

Heart bypasses and angioplasty are the most common types of heart operations, totalling 69,000 last year. This includes around 47,000 angioplasties and 22,000 heart bypasses. Heart bypass surgery accounts for 70 per cent of the total cardiac surgery activity for last year.

Sir Nigel's report confirms that patients are continuing to experience faster access to services across the board and that the NHS is providing improved quality of care. Sir Nigel says the progress marks the halfway point in delivering the NHS Plan.

Other highlights of the report include:

* faster treatment is also shown by the reduction of 491,000 people waiting for surgery - a record low of 822,000 in March 2005 compared to 1,313,000 in April 1998, a reduction of 37 per cent.
* quality of care is improving across the service - from GPs being rewarded for the standard of their care, to patients being placed at the heart of services;
* the NHS is becoming a world-leader for emergency care, with over 98 per cent of patients seen and treated in A&E within 4 hours;
* unnecessary waiting for discharge from hospital after treatment is continuing to reduce - levels of delayed discharges have fallen considerably from 2,841 in March 2004 to 2,359 in March 2005.

Health Secretary Patricia Hewitt said:

"This report should give patients, staff and taxpayers great encouragement.

"These are significant achievements for the NHS. They are a result of the extra investment we've been putting into the system, our programme of reform, and the dedication and hard work of NHS staff

"My appointment falls at almost precisely the half way mark in the 10-year programme that the Prime Minister and Alan Milburn set out in the NHS Plan in 2000.

"That was an ambitious programme of investment and reform which required the commitment of staff. It set a direction of modernisation that is putting patients - not the providers - at the centre of everything the NHS does.

"I intend to continue to modernise and reform the way services are provided to patients and there are a number of important challenges ahead. We need to focus on achieving our pledge to reduce the maximum waiting time to 18 weeks, we need to transform the system to give patients more choice and more control over their treatment, and we need to press on with tackling MRSA."

Sir Nigel Crisp said:

"In my previous two reports, I said that efforts over the last few years have concentrated on expanding, and speeding up access, to NHS services.

"My latest report confirms that this is continuing, but also that the quality of care is increasing too.

"We're at the halfway point in the NHS Plan. Since the Plan was published in 2000, the main focus has been on increasing capacity.

"We are now able to concentrate on making sure that the services we deliver are of a high level of quality and ensuring that we constantly strive to improve them, ensuring that patients throughout the NHS receive the same high level of care.

"For example, GPs are now being rewarded for the quality of their work, not just the size of their patient list. Practices are being rewarded for delivering high-quality care and prevention of the big killers such as cancer and heart disease, and also diabetes, stroke, lung disease, asthma and mental illness.

"More procedures are also being undertaken in primary care settings, bringing services closer to the patient.

"By placing patients at the heart of services, offering greater choice, encouraging patients to take a stake in their own care and through the local NHS understanding patients' needs better, I'm confident this commitment to quality will be experienced across the whole NHS.

"We are now at the halfway mark of the NHS Plan and progress has been very good. We know there is more to do but these achievements give me confidence that we can improve services even further."

Patients Concerned at Hidden Waiting Lists

Wed, 20 Apr 2005 19:37:00 PST

( from http://www.rxpgnews.com ) The Chairman of the Royal College of General Practitioners (RCGP), Dr Mayur Lakhani, spoke today of the bottleneck experienced by many patients during their care within the National Health Service (NHS).

Speaking at the launch of the RCGPs General Election Manifesto, Dr Lakhani said: Patients do experience a bottleneck in their care where GPs are not able to order a scan for a patient but have instead to refer a patient to a consultant first. Patients can have to wait a number of weeks or months for this appointment and then again once the scan has been ordered. It is like a hidden waiting list and is of great concern to patients who want to have investigations and get the results from those investigations.

Launching its ten key areas for action, the RCGP is calling for provision of better and faster access to diagnostic tests and other support to enable GPs to deliver high quality and safer care in order to help eliminate such bottlenecks.

Other key areas outlined in the Manifesto include a call for longer GP consultation times and tackling fragmentation of the primary health care service.

Dr Lakhani said: Every minute makes a difference in a general practice consultation. We need more flexibility in the system as time with patients is a valuable commodity. It builds trust and we need to invest in it. Ten minutes is increasingly not enough and we would like to work towards 15 minute consultations for those that need it.
It is good that patients have a choice of services but this is tending to fragment care. Patients are not sure who to turn to and we dont want the health service to become so fragmented that services become complex and confused. An important function of general practice is that GPs co-ordinate care.

One area of significant concern is out-of-hours care and the Manifesto calls for improvement in the quality of out-of-hours care by enforcing standards and investing further in GP involvement. Outside of normal surgery hours is a time when patients feel very vulnerable said Dr Maureen Baker, Honorary Secretary of the RCGP, at todays press conference. People are concerned when they fall ill out-of-hours and currently there can be a delay in getting a response. GPs did vote in their new contract not to have 24 hour responsibility for their patients but that doesnt mean they dont want to be involved in the out-of-hours service. It seems some Primary Care Trusts have set up new services that havent sufficiently drawn on the experience of GPs. We are concerned that this is not good for patients.

Tackling health inequalities in both inner city and rural areas is a vital area for all the political parties to acknowledge says the Manifesto. It is now quite clear that the areas that have the greatest need also have the least number of GPs explained Dr Baker. We need better mechanisms to ensure a fairer distribution of GPs.

Charing Cross Hospital Closure Rumours Untrue

Fri, 15 Apr 2005 16:12:00 PST

( from http://www.rxpgnews.com ) The Hammersmith Hospitals NHS Trust has been looking at the long term capital investment programme required. The trust expects to have to spend up to £400 million on renewing its buildings during the next ten years. With that level of investment the trust has to look at all the options available to demonstrate that what is being planned is the best way of spending public funds. But the trust has no proposals that would involve ceasing to provide hospital services at Charing Cross hospital site. In the long term the hospital will either have to be extensively refurbished or rebuilt.

Decisions will be driven by the strategic requirements of health care in west London, not a short term need to make savings, says chief executive Derek Smith. We are looking at options at the moment, but as yet have no plans, and are unlikely to have for some time yet. Any changes would first be tested through full-scale staff and public consultation.

While we will need to institute a savings programme for 2005/2006, there is no plan to close services provided by the largest hospital in west London, including essential cancer, neurosciences and vascular services, the world class Kennedy Institute of Rheumatology, undergraduate training and essential local services for people in Hammersmith and Fulham.

In recent years the trust has invested more than £14 million improving ITU, HDU, and MRI services at Charing Cross. It has introduced a picture archiving and communication system (PACS), and just last week formally opened a one-stop urology service. It is continuing to invest in day and stay facilities, a programmed investigation unit and day beds for imaging. The trust has also been supported by North West London Strategic Health Authority in funding £5 million capital to make improvements to fire precautions at Charing Cross to meet regulatory requirements.

Orthopaedic patients get faster treatment

Wed, 06 Apr 2005 18:26:00 PST

( from http://www.rxpgnews.com ) The number of patients waiting over six months for orthopaedic surgery has fallen by more than 50 per cent in just over a year, Health Minister John Hutton announced today.

Orthopaedics - common surgery like hip and knee operations - is considered the biggest challenge to delivering the December 2005 target that no-one will wait more than six months for an operation.

Demand for orthopaedic treatment has grown over the last 20 years, both in terms of numbers of patients seen per year and the number of treatments. In March 1998 the number of patients waiting longer than six months for orthopaedic surgery stood at 95,000.

Mr Hutton today published a progress report about the work of the National Orthopaedic Project (NOP) - a programme set up in January 2004 to help speed up access to surgery.

The report shows that:

* the number of patients waiting longer than six months for orthopaedic surgery has fallen by 55 per cent from 57,000 in January 2004 to 25,700 in February 2005;
* average waiting time for orthopaedic patients has also fallen - from over 19 weeks in 1998 to the current average of just over 12 weeks, a reduction of over 40 per cent; and
* a troubleshooting team working with the 40 most challenged health economies helped to implement especially fast progress - the improvement rate of these sites is 15 per cent quicker than in all other sites.

Mr Hutton said that early indications of NHS performance data for March 2005 made him confident that the NHS would meet the December 2005 target. He said that the progress of the NOP represented an important step towards the 18 week referral-to-treatment target.

John Hutton said:

"The Government has made faster access to treatment a key priority.

"Patients can now expect faster treatment than ever before. Those on the waiting list have fallen by almost 300,000 from more than a million in March 1997.

"The National Orthopaedic Project was set up to reduce long waits in a challenging area. It has delivered real benefits with the number of people waiting over six months for surgery dramatically reduced.

"In 1998, 95,000 patients were waiting six months and over for surgery. Latest data shows the number stands at 25,694 - a reduction of 73 per cent. Within the last year, progress has been especially fast with a 55 per cent reduction in those waiting from 57,128 to 25,694.

"That's unprecedented progress but I know we need to build on this achievement so that no-one is waiting longer than six months by the end of the year. I'm confident we can meet the target.

"This project is a real example of increased investment and NHS reform delivering benefits for the patients. By working in new ways the NHS is providing patients with faster access than ever before.

"The project will also help drive progress towards the 18 week referral-to-treatment target. The NOP will work with other teams to speed up access, such as cancer treatment."

The NOP strategy contained four workstreams:

* increasing the focus on orthopaedics - to ensure awareness and ownership by all those involved in delivering orthopaedic care;
* maximising the benefit of existing initiatives on orthopaedics - co-ordinating programmes across the Department to maximise impact, such as driving choice at six months and using treatment centres;
* risk-based performance management - two-way performance management such as providing action plans for at risk SHAs; and
* the tailored support programme - a support team, comprising a chief executive, orthopaedic surgeon, project managers and analysts - identified challenges and assisted progress in 40 local health economies. Using the average number of patients waiting for 6 months per Trust as a measure, the improvement rate of these sites is 15% quicker than all other sites.

The success of this project is in no small part due to a collaborative working approach between the NHS, the NOP team and key stakeholders.

Michael Benson, President of the British Orthopaedic Association (BOA) said:

"The British Orthopaedic Association believes patients who need orthopaedic or trauma care should be seen quickly, evaluated promptly and treated expeditiously. The National Orthopaedic Project has recognised there has been an imbalance between supply and demand which the Association has highlighted over many years.

"There are other issues of how services are organised and run that also needed to be addressed. A series of initiatives has been undertaken to accelerate treatment. The Tailored Support Programme has proved very helpful in supporting those health economies with major challenges and intrinsic working difficulties.

"Recognition that team working and efficiency are key elements is laudable. It is good to know the Department of Health can work with specialist associations to improve access and it is hoped that continued collaboration will ensure that the quality agenda is also delivered."

£20m investment in osteoporosis services

Wed, 06 Apr 2005 18:26:00 PST

( from http://www.rxpgnews.com ) People with suspected osteoporosis will be diagnosed more rapidly and treated more quickly thanks to a £20m investment in scanning equipment and service improvements announced by Health Minister Stephen Ladyman.

One in three women over 50 suffer from osteoporosis, which can lead to fractures and disability. DXA scanners measure bone density and are used to diagnose osteoporosis. A cash injection of £3m this year will quickly increase the NHS's capacity to provide this key diagnostic service. And a further £17m will be made available over three years to build NHS capacity to improve access and reduce waiting times.

Health Minister Stephen Ladyman said:

"Each year 14,000 people die in the UK as a result of an osteoporotic hip fracture. Osteoporosis is a devastating, debilitating condition which increases the risk of fracture when an older person falls.

"Improving access to scanning for those attending falls services is part of our pledge to have an integrated falls service in place by April 2005, which the NHS is on target to meet. We spend £1.7bn a year treating fractures caused by falling these integrated services reduce the risk of falls by half.

"We know that 400,000 older people attend A & E as a result of a fall every year. They can suffer serious injury and also lose their confidence and mobility. We are determined that older people stay active, healthy and retain their independence through exercise."

Professor Ian Philp, the National Clinical Director for Older People said:

"We are on course for delivering integrated falls services to help reduce the risk of future falls and fractures amongst the many people who present to health services with a serious fall. This additional investment will increase the capacity and responsiveness in scanning for osteoporosis amongst fallers and reduce their risk of subsequent fractures."

Terry Eccles, Chief Executive of the National Osteoporosis Society, said:

"This is excellent news because the NOS has long campaigned about the patchy access to DXA scanners in the UK. This money will ensure that areas that still need to purchase DXA scanners will now be able to do so. The challenge now for the NHS is to recruit and train staff to ensure these scanners are used full time."

The Department of Health has been working in partnership with the National Osteoporosis Society to identify areas where scanners are needed to increase diagnostic capacity.

The risk of osteoporosis can be reduced by adequate nutrition especially with calcium and vitamin D, regular weight bearing exercise, stopping smoking and avoiding alcohol.

NHS Staff congratulated for providing better A&E services

Thu, 31 Mar 2005 21:58:00 PST

( from http://www.rxpgnews.com ) Patients had better quality health services over the winter months, according to Emergency Care and Primary Care Tsars Sir George Alberti and Dr David Colin-Thome.

In a winter-months performance report presented to Health Secretary John Reid today, the Tsars found that, despite pressures, winter was 'handled smoothly as part of the NHSs everyday business'. Against a backdrop of increased demand for services in many localities the NHS delivered sustained improvements in key areas such as A&E and primary care.

For instance:

99 percent of patients were offered an appointment to see a primary care professional within 24 hours or a GP within 48 hours;

Despite a five percent increase in attendances at A&E between October-December 2004 compared to the same period in 2003, almost 97 percent of patients were seen in under 4 hours, compared to 90 percent for the equivalent period in 2003;

uptake of the flu vaccine among over 65 year-olds was over 70 percent and the highest ever;

the number of critical care beds again increased, from 3,143 in January 2004 to 3,213 in January 2005;

Provisional management data indicate that more patients received an emergency response within 8 minutes for immediately life-threatening 999 calls

Fewer patients operations being postponed at the last minute; and

Critical care services again performed well as, between October 2004 and January 2005, there were eight per cent fewer non-clinical transfers of critically ill patients than during the corresponding period in 2003-04.

Health Secretary John Reid said:

"This years winter report is evidence of unprecedented improvements in the NHS for patients. This is not a fluke. The NHS is achieving sustained and improved A&E and primary care performance over the winter months thanks to the hard work and professionalism of thousands of front-line NHS staff. Patients can expect the same better quality and faster access to NHS services during winter, as any other time of year.

"Years ago the vast majority of our A&E departments looked terrible, people waited for days to see a GP, waited days to be treated in A&E - sometimes on trolleys - and patients couldn't leave hospital when they were ready because social services had not assessed their needs. This is now the exception not the norm.

"Last winter we saw considerable improvements. For the first time in years we were able to announce that the NHS took winter in its stride. Emergency Care Tsar, Sir George Alberti, confidently diagnosed that patients could expect to receive the same high standards of services in January as they would expect in June. This year's winter report, and others from the NAO, Healthcare Commission and the Public Accounts Committee confirms that people are experiencing better NHS care.

"We are proud of the steps we have taken to improve A&E services for patients by setting a four hour target. NHS patients tell us that A&E is better than ever. The first validated data on sustained A&E performance between January and March 2005 will be published in May 2005. Provisional management information shows that the NHS is performing strongly so far.

"Investment and reform is working. Our drive to eliminate long waits in A&E has made the whole health and social care system work together in new and better ways resulting in faster access to treatment for patients. Going forward the NHS and its partners will be looking to continue to improve services for patients for next winter and beyond.

"I am delighted to see that despite manufacturing problems at the Chiron plant last year, that our flu-jab campaign has again been successful. More than 70 per cent of pensioners had a free jab this year. We also made special efforts to target patients under 65 living with chronic conditions. We estimate that 1.2 million of these patients received the jab."

Emergency Care Tsar Sir George Alberti said:

"Demand for healthcare services over winter 2004-05 was higher than before. Quarterly data shows that A&E performance has been transformed over the last three years. In December 2002, 78 percent of A&E patients were discharged or admitted within four hours. By December 2004, despite rising demand, this had reached 96.8 percent.

"A requirement for 98 percent of patients to be seen and treated within four hours became a live operational standard from this January. Nationally 19 out of 20 patients are already seen, diagnosed, treated and admitted or discharged within four hours of arrival and the majority of Trusts are well on the road to embedding 98 percent or above as their operating norm.

"Winter 2004-05 showed how far the NHS has come in improving emergency care. It is a tribute to the hard work of staff that A&E performance, already at unprecedented levels, continued to improve through the traditionally tough winter period.

"However, there is no room for complacency and the lessons of 2004-05 were that we can do more to improve the way demand is managed and to embed further the core changes in the way emergency care and, more widely, overall patient flow are managed."

Primary Care Tsar Dr David Colin Thome said:

"We were able to offer even more support to PCTs developing out-of-hours services thanks to, last year, an extra £316 million in funding being provided. So, for example, the extended opening hours of Walk-in-Centres means people who find it difficult to access primary care during working hours, at weekends and over bank holidays can still have first rate health care.

"This is not to say that challenges do not remain. Not all local health communities are yet delivering consistently high standards for all. Work remains to bring the experience of all patients up to that of the majority."

Winter always has the potential to impact upon health and social care services because of increases in the number of people suffering from flu, respiratory ailments and accidents due to bad weather. The NHS experienced very busy periods this winter due to unusually long Christmas and New Year bank holidays and a cold spell from mid-February to March cold which particularly affected the north, north-east and south-east.

New action begins to tackle racism in Mental Health Services

Thu, 31 Mar 2005 21:58:00 PST

( from http://www.rxpgnews.com ) Seventeen sites across the country will pioneer best practice in eliminating discrimination in mental health care, Health Minister Rosie Winterton announced today.

The sites will support the implementation of Delivering Race Equality in Mental Health Care, an action plan for reform both inside and outside NHS mental health services over the next five years, published in January this year. Implementation of the plan should have begun everywhere, but these sites will act as "hothouses of reform", identifying best practice and spreading what they learn across the whole country.

Rosie Winterton said:

"These sites show that we are serious about following through the commitments we made in Delivering Race Equality.

"For too long there have been significant and unacceptable inequalities in the access to mental health services that black and minority ethnic patients have, both in their experience of those services and in the outcomes.

"Delivering Race Equality is a clear and comprehensive action plan for making sure that progress continues and accelerates. These sites are the next steps towards making it happen on the ground, and I hope that they will be a valuable source of best practice and support for the rest of the NHS."

Each site will be different, depending on local needs. Main elements of the DRE action plan include:

* PCTs providing more responsive services based on the needs of the local population, helped by local demographic data;
* NHS trusts being assessed by the Healthcare Commission on their performance in challenging discrimination and providing equality of access;
* a new commitment to reduce the disproportionate rates of compulsory detention of black and ethnic minority mental health patients and preventing deaths in mental health services following physical intervention;
* new focused implementation sites where SHAs and organisations will work together, on a local level, to drive change in mental health services for black and ethnic minority people and develop best practice;
* creating a workforce that has the knowledge and skills to deliver equitable care to black and minority ethnic populations with support from the Royal College of Psychiatrists and better race equality training;
* an important role for the independent sector, supported by a £2 million national community engagement scheme to help PCTs identify black and minority ethnic voluntary and community organisations that can advise them, and, in some cases act as partners in delivering services. PCTs will be supported by 500 new community development workers;
* NHS Direct providing a national interpretation and translation service and PCTs providing directories of NHS and social services targeted at BME people; and
* working with the Home Office and police to improve local liaison and the National Patient Safety Agency (NPSA) to reform the process of independent inquiries and issue guidance on creating safer environments on acute psychiatric wards.

The successful SHAs are:

Northumberland, Tyne & Wear;
West Yorkshire;
County Durham & Tees Valley;
South Yorkshire;
Leicestershire, Northamptonshire & Rutland;
Trent;
Bedfordshire & Hertfordshire;
South East London;
North East London;
North Central London;
North West London;
Hampshire & Isle of Wight;
Surrey & Sussex;
South West Peninsula;
Dorset & Somerset;
Birmingham & the Black Country;
Greater Manchester.

They will now be asked to develop project plans by the end of May.