'Shameful' NHS chief is 'absolutely determined' to stay despite admitting he had 'no idea' of death rate scandal at Stafford Hospital... and he STILL has the PM's support
- Sir David Nicholson grilled by MPs over his role in Mid Staffordshire scandal
- 'I am absolutely the right person to take the NHS forward', he said
- Admits he had 'no idea' what was going on at the hospital where 1,200 died
- PM continues to give Sir David his backing as MPs demand he quits
- 'The health system had failed'
- The health service 'lost its focus' and patients were not at 'the centre of the system'
Head of the NHS Sir David Nicholson has again refused to resign despite admitting personal failings while helping to run Stafford Hospital and having 'no idea' about rocketing death rates there. He told MPs today the health service 'lost its focus' and patients were not at 'the centre of the system' when 1,200 people died in Mid-Staffordshire between 2005 and 2009.
Sir David also admitted the NHS was neither 'equipped or capable' of finding out how the biggest scandal in NHS history had happened, and expressed his 'regret' that he had refused to meet the families of the dead when the scandal 'blew-up'.
But despite spelling out where 'the health system had failed', he said he would not quit his £200,000-a-year job and told the Commons Health Select Committee he is 'absolutely the right person to take the NHS forward'.
Soon after his two-hour grilling ended the Prime Minister's spokesman said that Mr Cameron thinks he 'does a very good job' and had 'properly apologised' for the Mid-Staffordshire scandal.
Responding to David Cameron's backing, Tory health committee member Dr Sarah Wollaston said: 'He (Sir David) has a lot of powerful friends watching his back, that's very clear'. Campaigners have called for Sir David's resignation following the publication of the Francis Report into serious failings at Mid Staffordshire NHS Foundation Trust.
The health boss was in charge of the regional health authority for part of the time that patients were being mistreated at Stafford Hospital where hundreds of patients may have died needlessly after they were 'routinely neglected'.
But today he said he saw himself having several more years in the job. 'At the moment the NHS is facing its greatest challenge,' Sir David told the Commons Health Select Committee this morning.
'In the next few days we will abolish over 160 organisations and we will set up another 211 local organisations and a whole myriad of national ones. We'll completely change the way in which we allocate resources and incentivise the NHS.
'At the same time, we have already lost 13,500 administrative and management staff that have all that corporate memory in them'. 'So it is at maximum risk over the next few days.
'I said two years ago that I would take the responsibility of leading the NHS through this enormously complex set of changes. 'I promised both the Government and the NHS that I would see that through and I am absolutely determined to do that over the next period. 'I am absolutely the right person to take the NHS forward'.
Sir David said that the regional health authority had 'no idea' what was going on at Stafford Hospital.
Robert Francis QC's damning 1,782 page report published last month shocked Britain after it found ‘failures at every level' which led to the scandal, while not a single nurse or doctor has been disciplined or struck-off.
Patients at Stafford Hospital were left lying in their own urine and excrement for days, forced to drink water from vases, given the wrong medication or sent home with life-threatening conditions.
'The information was not brought to the strategic health authority, we did not see any of the information which would lead you to believe that there was all of this going on in Mid Staffordshire,' he said. He told the Committee that he did not receive any information about high mortality rates at the trust while in the regional role.
'I had not come across hospital standardised mortality rates during my period at Shropshire and Staffordshire nor before that,' he said, adding: 'I did not have access to that information. 'At that moment in time, surprising as it may seem in retrospect, it was not part of the regular way in which NHS organisations were monitored in the NHS.'
Sir David said that he did visit the hospital during the time when problems were emerging but was not alerted to the problems of neglect and poor care.
Committee member Dr Sarah Wollaston asked: 'How far do you take personal responsibility for an organisation that has been shown to minimise patient complaints, to gag whistleblowers, to massage mortality data, and bury bad news and frankly to lose sight of the patient in the bed?'
Sir David replied: 'First of all I don't accept the way that you have described the NHS, it's a much more balanced picture than you have described but secondly, I have spent 35 years being a chief executive in the NHS and I am completely dedicated to improving services for patients.
'Of course when I hear bad stories about the NHS, of course I feel responsible.'
Sir David said gagging clauses to stop clinical staff blowing the whistle over patient safety issues were 'unacceptable' and issued a plea to NHS employees who were worried about their institutions to 'speak out'.
In a message to whistle-blowing staff, he said: 'If they want my permission to speak out in public - speak out. Because we will protect them in whatever way we need to do.'
Asked about the £500,000 deal reached by United Lincolnshire Hospitals Trust with former chief executive Gary Walker, which required him to keep quiet about his concerns about the trust, Sir David said: 'It is completely and utterly unacceptable. I would never sanction anything of that sort.'
Sir David stressed that Mr Walker's account of events was 'bitterly contested' by the trust. But he added: 'I have made it absolutely clear that it is unacceptable and also illegal for organisations to gag people for issues around patient safety and improving services to patients.'
Sir David said Mr Walker's pay-off had been undertaken through a process of judicial mediation, which he had never witnessed before and which meant it did not have to be signed off by the SHA, the Department of Health or the Treasury. 'If it's a loophole to get round the department, then it needs to be closed,' he said.
It came as he was ordered to explain why hospitals have been allowed to ‘cook their books' on death rates. Sir David Nicholson was accused of letting managers routinely fiddle the figures to mask the numbers of patients dying needlessly.
Last week a whistleblower claimed she was hired by the Royal Wolverhampton hospital trust to ‘fix' its shockingly high death rates. And the chief executive of another trust, Bolton University, has stepped aside over a possible cover-up.
A number of trusts have been accused of deploying similar tactics – including Medway in Kent, George Eliot in Warwickshire and Walsall in the West Midlands.
Sir David will this morning come under further pressure when he is grilled over his role in the Mid Staffordshire hospital scandal by MPs from the health select committee.
He was in charge of the regional health body supervising the trust, and later head of the Department of Health, over the four-year period in which up to 1,200 are feared to have died needlessly. But while relatives of victims called for his head, Sir David insisted he was ‘not ashamed' of his tenure.
His £211,000-a-year position has been in question since last month when a report implicated him in the horrific neglect at Mid Staffs between 2005 and 2009.
Although the Prime Minister has repeatedly given Sir David his full backing – and did so again today – MPs have demanded he quits. Twenty signed an early day motion, proposed by Charlotte Leslie, member for Bristol North West, and at least ten more have backed it. Many NHS managers, doctors, patient groups and relatives believe that unless Sir David leaves, the culture of secrecy within the Health Service will remain unchecked.
In a speech to the Commons last night, Steve Barclay said it was highly unlikely Sir David would not have known of an unusually high number of complaints and abnormally elevated death rates at some trusts.
‘He presided over a system in which officials were effectively cooking the books,' said the MP for North East Cambridgeshire. ‘By fixing the codes that registered deaths, the true causes of mortality were disguised and death rates were sent plummeting.
‘He shrugged off complaints from staff and patients as simply lobbying while appointing people to whitewash what was actually going on in NHS hospitals.'
Sir David is expected to face tough questioning on why he did not react sooner to claims of poor care at Stafford. He says he became aware of problems in February 2009 – but experts said they warned him months before. Nigel Ellis, former head of investigations at the Healthcare Commission, said he made Sir David aware of an ‘overwhelming response' from local people about poor care in Mid Staffordshire.
Mr Ellis said in an email to the public inquiry into the scandal: ‘David said that there had been a local campaign group in existence against Mid Staffordshire for some time. ‘Clearly patients needed to express their views but he hoped the Healthcare Commission would remain alive to something which was simply lobbying.'
Miss Leslie has accused the Department of Health of a cover-up for claiming in internal memos, seen by the Mail, that officials were alerted to high death rates only from 2007. Miss Leslie said Sir David and the Department of Health had questions to answer: ‘It's becoming clearer and clearer there was a culture of hiding the truth at all costs.
‘Ministers and officials knew vital data on death rates existed for as far back as 2001, yet the line to take was to deny all knowledge and keep pumping out their version of reality while patients died. ‘It's absolutely vital the committee get to the bottom of this.' 5.3.13
30,000 die every year 'because of failings in the NHS' Health Secretary admits as experts warn Britain lags behind other countries in cutting premature deaths
- Jeremy Hunt will tell Parliament thousands of patients die too early
- Health Secretary will say Britain is 'lagging behind' other countries
- Soaring use of drink and drugs means many 20-54 year-olds will die early
- Smoking is top reason for early death, followed by high blood pressue
Thousands of patients die unnecessarily every year because of failings in the health system, Jeremy Hunt will admit today The Health Secretary is expected to tell Parliament that 30,000 people a year in England die too early.
His comments come as experts warn Britain has a poorer record of premature death from many diseases than a host of other comparable countries, and the gap is widening.
Mr Hunt will call for regular health checks for everyone from middle age to cut deaths from cancer, heart disease, strokes, respiratory and liver disease. He will say: ‘Despite real progress in cutting deaths we remain a poor relative to our global cousins on many measures of health, something I want to change.'
‘For too long we have been lagging behind and I want the reformed health system to take up this challenge and turn this shocking under-performance around.' Between 1990 and 2010 life expectancy in the UK increased by an average of 4.2 years to 79.9 years.
But the trend masks worrying declines when matched against other nations with similar levels of health care, it is claimed. In 1990 the UK ranked tenth in a league table of 19 countries showing years of life lost per 100,000 members of the population – a standard method of measuring levels of premature death. Twenty years later Britain had slipped to 14th.
In terms of death rate – numbers of deaths per 100,000 – the UK fell from 12th in 1990 to 14th in 2010. Despite this, based on 2011 prices, NHS spending has risen from £45billion in 1990 to £121billion in 2011, according to figures from the House of Commons library.
Some specific causes of death had a significantly increased impact over the two decades, including Alzheimer's disease, cirrhosis of the liver and drug use disorders.
But Britain saw the largest fall in death rates from heart disease of any of the 19 countries.
Scientists compared the UK's record for a range of important health indicators with that of 14 other EU countries, plus Australia, Canada, Norway and the US.
Data was drawn from the Global Burden of Disease Study, published in 2010. The results covered 259 diseases and injuries, and 67 risk factors or risk factor clusters.
Outlining their findings in The Lancet medical journal, the international authors pointed to the biggest individual risk factors for illness and disease in the UK. Heading the list was tobacco, accounting for 12 per cent of the disease burden, followed by high blood pressure, high body-mass, physical inactivity, alcohol and poor diet.
Levels of disability at specific ages had not improved in the UK over the 20-year period, the study found. This was a problem shared to a greater or lesser degree by all the countries.
Major causes of disability varied by age but included mental and behavioural disorders such as depression, anxiety and psychosis,
Across all ages, the top eight diseases or causes responsible for the most years of life lost in the UK remained largely the same in 2010 as 20 years earlier.
In order, these were heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, lower respiratory infections, bowel cancer, breast cancer and self harm. Ninth in 2010 was cirrhosis and Alzheimer's disease was tenth. Years of life lost from drugs increased nearly six-fold over the period. 5.3.13
The frightening truth: NHS managers are incentivised to ignore problems
The culture of the NHS, and the incentives that make staff act against their better judgement, need to change if there is to be no repeat of the Mid Staffs scandal, argues Roger Taylor.
A dog shelter in New Zealand recently made headlines by training some of its dogs to drive cars prompting delighted applause from YouTube viewers worldwide. Psychologists pointed out that the praise ought to go the trainers, not the dogs. It was, they said, nothing more than an example of “operant conditioning” - the phrase psychologists use to describe the way in which animals can be made to do things utterly contrary to their nature by rewarding certain behaviours and punishing others.
It is important to bear this in mind in trying to understand what happened in Mid Staffordshire NHS Foundation Trust during the middle years of the last decade when standards of care fell so low that the treatment meted out to some patients was at times cruel.
A lot of people have asked, ‘How could people employed to care for the sick have behaved as they did?” In the case of some, that is the right question.
But for most, the question is rather different: for most the question is: ‘How did we create a health service that could induce decent people to do things so thoroughly against their better nature?”
Reading the stories about the infamous Wards 10 and 11 it is clear that unconscionable behaviour had somehow become routine. Patients were humiliated, mistreated and in some cases lost their lives unnecessarily. Doctors, nurses and NHS managers have all accepted that the service provided was unacceptable, yet somehow no-one was able to stop it.
The Francis Inquiry which is due to report on Wednesday will talk about the culture of the NHS and how it needs to change. But in what way does the culture of the NHS allow this to happen? To answer that we need to understand the incentives – the rewards and the punishments - that shape the behaviour of NHS organisations.
What happens when a hospital like Mid-Staffordshire finds it is struggling to deliver a high quality service with the resources available? As an NHS chief executive in that situation, you could simply overspend and breach your targets – and quite likely lose your job. You could try to argue to re-organise services but you are likely to face considerable opposition from both clinicians and the public. Or you can just cut costs, cross your fingers and and hope that no-one notices if the standards of care deteriorate.
The frightening truth about the NHS is that the third of those options is the one that every incentive in the system is pushing you towards. Because the risks that a poor quality service will get identified quickly and the risks of that having consequences for your career remain troublingly remote.
Dr Foster has been publishing data on mortality for all hospital in England since 2001. From the start Mid-Staffordshire had higher than expected mortality rates. In 2007, the data showed the trust had amongst the highest rates in the country. It was mortality analyses from Dr Foster that first triggered the Healthcare Commission, the regulator at the time, to start investigating the hospital. So why did they not prompt a similar reaction from the hospital board or the local NHS?
I was asked to testify to the Mid-Staffordshire inquiry to try to explain this mystery.
It was not that these organisations failed to take any action. They commissioned studies into statistical methodology. They conducted investigations into data quality. They changed the records to make the figures look better. They took plenty of action. The only thing they did not do was uncover the problems with the care being given to patients.
After the problems at Mid Staffordshire first came to light, the Department of Health set up a group of experts to try to fix the problem. The question we were asked was: what is the right way to interpret and respond to mortality figures? After much debate, we concluded that mortality data should act as a prompt to ask further questions.
What? Is that it? But wasn't that exactly what the problem was in the first place? That instead of acting on the data the hospital simply asked more and more questions.
Actually, this is the right answer. Complex data such as outcome measures require careful interpretation. They should act as spur to ask more questions. But this will only work if the people asking them are competent to judge when they are getting the right answers and have a desire to know the truth. .
In December the Dr Foster Hospital Guide named 12 NHS trusts with worryingly high mortality and just last week the NHS named five trusts - many of them the same a- as having consistently high death dates. The response from many commentators was, as always, that care needs to be taken in interpreting the figures. That is true. But who is actually doing that? Who is carefully interpreting the figures and coming to a reliable assessment of quality.
We have regulators, commissioners, health authorities, oversight committees and a host of other interested parties. But if you ask where in this panoply is there someone who can reliable recognise quality and its opposite, or where, in all the myriad information published about NHS services, there is anyone making a credible assessment about whether a service is superb, just about up to scratch, or simply no good; the answer is nowhere.
This is a vacuum that needs to be filled as a result of this inquiry.The NHS needs to move away from its blame culture in which performance is assessed on the basis of report cards and targets. It needs to develop a culture in which quality is assessed with skill and judgment.
Much of the response to Mid-Staffordshire has focused on improving the available data about standards. This is entirely welcome. The NHS Commissioning Board is now starting to replace the old targets with measures of the outcomes of care and the experience of patients. But these changes on their own are not enough. These new data are complex and require interpretation.
The NHS is getting better a producing information about quality. But its ability to interpret it lags far behind. For too much of the time, work by NHS organisations to understand the quality of services is too much like a dog driving a car. It looks impressive but we all know, in truth, it is not the real thing.
If the NHS is to prevent another Mid-Staffs, front line staff must work in organisation that can recognise and reward quality care. The managers and boards of these organisations must, in turn, be held to account by commissioners and regulators who have the skills to spot failing services and acknowledge those that excel.
Doctors, nurses and NHS managers come into their professions wanting to ensure that patients are treated and looked after as well as they can be. Where they fail it is all too often they have been incentivised to act against their better instincts and been managed by organisations that are blind to the differences that matter. 4.3.13
Mid Staffs shows everything that's rotten in the house of NHS management
NHS management failures stem from the same flawed system that gave us Enron and Lehman Bros in the private sector.
The Mid Staffs NHS scandal will not go away. The collapse of the hospital trust into administration and the subsequent resignation of two board members ensures that the wound will continue to bleed, ratcheting up the pressure on the embattled NHS chief executive Sir David Nicholson.
Investigation of suspicious death rates at a number of other hospitals just increases the sense of foreboding. One reason that scandals like these both run on and recur is that we persist in thinking of them as exceptional; one-offs caused by a few incompetents or rotten apples in an otherwise wholesome barrel.
But they're not. The terrible outcomes at Mid Staffs were the logical consequence of a disastrously flawed management system that systematically forces people to face in the wrong direction, counts the wrong things, and focuses management attention on the wrong part of the job.
This is "deliverology", as unappealing in practice as in print, otherwise "targets and terror" – the direct public-sector counterpart of the ideologically-driven, shareholder-first management model that in the private sector gave us Enron, then sub-prime, Lehman Bros, and seemingly innumerable banking scandals in their wake.
Unconsciously emphasising how closely the two are related, David Cameron's big idea for preventing more Mid Staffs was performance-related pay for clinical staff – the very thing that in the financial sector brought the global banking system to the brink of collapse.
Just like these private-sector exemplars, Mid Staffs demonstrates everything that's rotten in the house of management, from bottom to top. At individual level, targets cause people to face managers and regulators rather than patients; and the tighter the performance management, the more essential elements not subject to targets, such as care and compassion, are squeezed out. Hence the grotesque absurdity of targets for compassion in hospitals or making lessons engaging in schools.
Targets always result in gaming. When it does, the knee-jerk reaction on the part of everyone from politicians to top managers is to tighten supervision to identify and root out offenders. Unfortunately, performance management has a poor record – partly because in overall performance individuals are far less important than the system in which they operate; but also because it is self-defeating, driving a vicious circle in which tight supervision and monitoring lead to demoralisation, disengagement and worse performance, apparently justifying a further turn of the supervisory screw.
The process is graphically described in a recent research report for the Scottish TUC, with the self-explanatory title of Performance Management and the New Workplace Tyranny.
Originally presented as an enlightened expression of shared interest, like many other things in management (lean working, human resource management), performance management has morphed into its dark opposite, synonymous "not with developmental HRM and agreed objectives but with a claustrophobically monitored experience of top-down target driven work".
Applied to individuals such tactics lead directly to Mid Staffs, a system which reshaped people into target-chasers who couldn't afford to care. At the level of the supply chain the same kind of fierce control gives us a different form of butchery. Scaling up the performance-management tyranny, the big supermarket chains treat meat suppliers as adversaries, writing short-term term contracts, playing one off against the other and driving prices way below the point where something had to give.
The immediate result was horseburgers. But behind the scenes is a much bigger, very British tragedy: a meat industry that is in long-term crisis and decline, wholly unable to defend itself against less cannibalistic European counterparts.
Few these days would want to be treated with the mixture of superstition, ideological prejudice and pseudo-science that constituted medical knowledge in the Middle Ages. But that's hardly an exaggeration of the state of management today. It is management not medicine that has put our institutions in intensive care, and until we decide to do it better unfortunately that's where they will remain. 2.3.13
Hospital hired me to fiddle death figures: Expert claims NHS ordered cover-up
- Sandra Haynes Kirkbright hired due to concerns over high number of deaths
- The Trust was scoring one of the highest mortality rates in the country
- She claims patient care was as bad as at scandal-hit Stafford Hospital
- Bosses offered to double her salary to £54,000 a year to distort death rates
- She refused but said others were breaking 'every rule in the book'
- Allegations have been denied by the Royal Wolverhampton Hospital
A whistleblower claimed last night that she was hired by an NHS hospital to fiddle its shocking death rates. As hundreds of patients died needlessly, Sandra Haynes Kirkbright says she was headhunted by hospital bosses and asked to 'fix' the figures. She claims 'every rule in the book' was broken to try to improve mortality rates – without saving lives.
The data recorder says she was suspended after refusing to take part in a cover-up, and even claims she was ordered not to put her concerns in writing in case they reached the Press.
The astonishing allegations – which are denied by the hospital – have emerged days after the chief executive of another NHS Trust, in Bolton, was forced aside over a possible cover-up of high death rates. Experts have warned similar incidents could be happening in hospitals across the country.
The fresh allegations are yet another blow for NHS chief executive Sir David Nicholson, who refuses to resign despite widespread condemnation from MPs, doctors and patients since last month’s damning Mid Staffordshire report.
Mrs Haynes Kirkbright was hired by the Royal Wolverhampton Hospitals NHS Trust as a ‘health coder’, an administrative role which involves recording data detailing patients’ care in hospitals. Coders do not need medical qualifications, leading critics to argue that they have disproportionate power to affect how hospitals are seen to be performing.
Mrs Haynes Kirkbright, from Texas, said she was approached following concerns over the shocking number of weekend deaths, which had contributed to the Trust scoring one of the highest mortality rates in the country. She said she ‘wouldn’t even send a dog’ to Royal Wolverhampton Hospital and claims patient care was as bad or worse as at scandal-hit Stafford Hospital, where as many as 1,200 patients died needlessly.
But instead of making efforts to improve care, bosses at the Trust were convinced that the high death rate could be ‘fixed’ by fiddling statistics, she said. She claimed they offered to almost double her salary to £54,000 a year to distort mortality figures, mistakenly believing she had been doing the same at her former employer, Stafford.
‘They wanted me to fix it. But they didn’t want me to fix it properly,’ she said. She took the job in October 2011 – but said that when she realised what hospital bosses wanted her to do, she refused. However, she claimed others at the Trust were ‘breaking every rule in the book’.
For example, recording that a patient was being treated by the palliative care team means their death, effectively, does not alter the mortality rate, because it is classed as unavoidable. She claims the Trust used any excuse to code patients’ deaths as unavoidable, even if they were never seen by palliative care doctors.
The Trust angrily denies this claim – yet between 2009 and 2011, Wolverhampton’s death rate dropped by 13 per cent, from very worrying levels to the national average. This coincided with the number of deaths recorded as ‘palliative care’ soaring from 2.19 per cent to 20.3 per cent, about double the national average.
The whistleblower said the Trust also hired an independent company in 2011 to advise coders on how to make deaths count for less on the mortality score – yet said she made sure this was not acted on. And she also claims she accused bosses of fraud as the Trust was making money by charging the local Primary Care Trust for expensive procedures they had not done.
In response, she says a senior figure warned her not to put allegations in writing because ‘the Press can get hold of it through Freedom of Information’.
After four months at the Trust, Mrs Haynes Kirkbright was suspended for alleged bullying and harassment – which she denies. She says the real reason she was suspended was to silence her. She is still suspended pending a disciplinary hearing, but decided to speak out despite fearing the repercussions.
The Royal Wolverhampton NHS Trust strenuously denied Mrs Haynes Kirkbright’s allegations. Chief executive David Loughton said ‘every Trust in the country looked to Mid Staffs’ at the time to learn how to reduce death rates – but denied hiring Mrs Haynes Kirkbright to ‘fiddle’ death rates.
‘We categorically deny the allegations,’ he said. ‘The suggestion of any wrongdoing is simply not true. Improvements in the hospital’s mortality rates have been audited and independently verified.’
The Trust admitted, however, they had been coding against national guidelines, but said they corrected this as soon as they became aware of the mistake.The Trust added that it was ‘categorically false’ to suggest palliative care patients had been coded incorrectly to alter overall death rates. They explained the fall by saying 200 fewer patients had died. 2.3.13
Now even doctors don't trust their own hospitals: Study finds one third of health service workers would not recommend own workplace to friends or family
- Department of Health surveyed 101,000 doctors, nurses and paramedics
- One quarter said they had been harassed or bullied in the past 12 months
- 38 per cent suffered work-related stress and 15 per cent bullied by patients
A third of health service workers would not recommend their own hospital to friends or family, a poll has found. A further one in three do not believe NHS managers act on the concerns of patients. The Department of Health’s own survey also found that a third of NHS staff had witnessed medical blunders or near misses at least once in the last month.
It also revealed that nearly a quarter of workers had been harassed or bullied by other colleagues over the past 12 months.
Just over 101,000 doctors, nurses, paramedics, and administrative staff took part in the annual survey. Ministers said the overall findings were broadly similar to this time last year although insisted there were some improvements. They also revealed that 17 per cent of staff did not think patient care was their manager’s top priority.
A total of 38 per cent said they had suffered work-relayed stress in the last 12 months while 15 per cent had been bullied by patients or the relatives of patients.
Health Minister Dr Dan Poulter said: ‘NHS staff have some of the hardest and most respected jobs in our country. It is good to see that staff motivation, job satisfaction and engagement are all up on 2011, demonstrating the commitment of NHS staff to providing the best possible care for patients.’
Staff at North Cumbria University Hospitals and United Lincolnshire Hospitals are the least likely to recommend their own hospitals to friends of family, according to the figures.
Less than 40 per cent of those who work at the two trusts, both of which have relatively high death rates, would recommend the treatment available, compared with more than 90 per cent of staff at the top-rated hospitals.
Grieving families walk out in fury as the man with no shame snubs them: NHS chief is backed by the only people who can sack him
In the survey, 203,000 NHS staff were asked to respond to the statement: ‘If a friend or relative needed treatment, I would be happy with the standard of care provided by this organisation.’ They had to say whether they strongly agreed, strongly disagreed, agreed, disagreed or had no view. More than 101,000 staff responded. Nationally, 63 per cent said they strongly agreed or agreed with the statement, 12 per cent said they disagreed or disagreed strongly, 25 per cent did not ‘express a preference’.
That left 37 per cent of staff who did not recommend treatment. At 17 health service trusts, fewer than half of staff would recommend treatment to friends and families.
In January David Cameron announced that from next month every hospital and doctors’ surgery in England will face a ‘friends and family test’ to see if patients would recommend them to loved ones.
The Prime Minister said the surveys would act as an early warning ‘flashing light’ to highlight where parts of the NHS are failing.
The North Cumbria University Hospitals Trust, which runs Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven, was the worst ranked of all the trusts surveyed. Just 35 per cent of staff would recommend treatment to their friends of family. The trust is among several being investigated for high death rates by Sir Bruce Keogh, the medical director of the NHS.
Croydon Health Services, Mid Yorkshire Hospitals and Weston Area Health were also among the poor performers. And Mid Staffordshire NHS trust, which was yesterday facing administration by regulators, also continues to perform poorly, according to the survey. Only 59 per cent of staff said they would recommend treatment to family and friends.1.3.13
Hinchingbrooke Hospital: private firm 'transforms' failing NHS trust
The first NHS trust to be operated entirely by a private company has recorded one of the highest levels of patient satisfaction in the country, it emerged last night.
Circle Holdings became the only private company running an NHS hospital last year when it began a 10 year contract to run Hinchingbrooke Hospital, Cambridgeshire.
But new NHS figures show it is now ranked as one of the highest for patient happiness and has also recorded shorter waiting times.
Circle Holdings, whose operating subsidiary is 49.9pc owned by a staff partnership, has also dramatically cut losses at the hospital by 60 per cent and will soon begin to pay off burgeoning debts racked up from years of mismanagement.
While early signs are encouraging regional NHS officials emphasised that improvements had to be sustained, according to the Daily Mail.
The takeover deal, which saved the hospital from closing down, is seen as a blueprint for the future of many NHS trusts. Experts said the Hinchingbrooke's system, which empowers doctors and nurses, could be used in dozens of other struggling NHS trusts.
According to new figures, patient satisfaction has risen to 85 per cent, placing Hinchingbrooke in the top six of the East of England's 46 hospitals. It was previously recorded one of the lowest rankings.
When Circle started managing the hospital, it also consistently ranked near the bottom of the 46 trusts for waiting times, with many patients forced to endure more than four hours in A&E.
It now tops the list for short waiting times, seeing 98.2 per cent of patients within the required window, according to the newspaper.
Cancer testing has also increased while millions of pounds has been saved from cutting paperwork. “We put more of the decision-making in the hands of the doctors and nurses,” Jim O'Connell, chief executive of the hospital, told the newspaper. “There are still a lot of inefficiencies in the NHS because it is the bureaucracy that has built up over all these years, and we have to change that. “Any changes that we make have to be good for patients and good for efficiency as well.”
The group, which operates independent hospitals in Reading and Bath, inherited debts of £39 million with the project. The hospital had been expected to lose £10 million last year, but this has been reduced to £3.7 million. 23.2.13
NHS spent £15m gaging whistleblowers
Pressure has increased on Sir David Nicholson to resign after it emerged £15m has been spent on gagging hundreds of whistleblowers. The public money spent on stopping NHS staff from speaking out is almost equivalent to the salaries of around 750 nurses.
The figures were revealed after a two year battle by Conservative MP Steve Barclay, who eventually obtained them after tabling a number of Parliamentary Questions.
The figures show a total of £14.7m of taxpayers' money was spent on almost 600 compromise agreements, most of which included gagging clauses to silence whistleblowers.
Mr Barclay, a member of the Public Accounts Committee, told the Daily Mail: "These gagging clauses are having a chilling effect on whistleblowers." Mr Barclay said the figures show that over three years around 90 per cent of the 598 NHS compromise agreements included the silencing clauses.
The MP for North East Cambridgeshire has requested Sir David be recalled to give evidence to the Commons public accounts committee to discuss the use of gagging clauses in the health service. He added: "It means that hundreds of potential whistleblowers may have been prevented from speaking out for fear of legal action, at a total cost to the taxpayer of almost £15million.
"It is now clear that a whistleblower who has reported concerns internally, but has not seen improvements take place, is induced, with taxpayers' money, to agree to sign away their rights to not take them any further. It begs the question: Were NHS officials genuinely in the dark about the use of gagging clauses – in which case why were executives like Sir David Nicholson not aware it was going on? – or were they actually the ones turning off the lights when the gag went on?
"It is glaringly obvious that many NHS employees feel they are being silenced by non-disclosure clauses in their contracts."
The Department of Health and the Treasury have previously refused to publish the costs.
Mr Barclay said he raised concerns with Sir David three times asking why whistleblowers were not being excluded from confidentiality clauses, and each time was told action had been taken.
The figures, which cover three years up to 2011, have been revealed after Health Secretary Jeremy Hunt last week warned against silencing dissent from within the NHS.
The figures have also dealt a further crippling blow to Sir David in light of the Mid Staffordshire scandal, where 1,200 patients died. South Staffordshire and Shrosphire Health Care, which borders Mid Staffordshire, made some of the highest severance payments. Central Manchester University Hospitals NHS Foundation Trust, was also on this list of the highest payers, after paying out £224,000 in 2011.
A Department of Health spokesman told the Daily Mail that the number of confidentiality clause payouts was falling sharply and that in 2011/12, there were just 20 cases in NHS Trusts at a cost of just over £500,000. However, this figure did not include costs for the 105 Foundation Trusts which in 2010/11 spent a total £2.5million on gagging clauses. 22.2.13
90% of NHS staff say sack the man with no shame (but Cameron insists health service chief David Nicholson is doing a good job)
- Nine out of ten NHS employees want health chief Sir David to resign
- David Nicholson was chief executive during the Stafford Hospital scandal
- Prime Minister David Cameron defends Sir David saying he was 'impressed'
- Polls say 92 per cent of health workers and 89 per cent of GPs want him out
Nine in ten NHS staff say Sir David Nicholson should resign for presiding over one of our worst-ever hospital scandals. But as the NHS chief executive lost the confidence of doctors, nurses and other senior managers, the Prime Minister came to his defence in an extraordinary show of support.
Mr Cameron insisted Sir David was doing a ‘very good job' and should not be made a ‘scapegoat' after a report this month implicated him in the Mid Staffordshire disaster, in which 1,200 patients died needlessly.
Sir David, who has faced widespread calls to resign, insists he is ‘not ashamed' to still be in his job and has blamed the failings on the ‘whole system'. But the findings from two online polls – which together received 2,000 responses – show he has lost the trust of health service professionals.
When asked whether it was time for him to step down, 91 per cent voted yes.
Speaking to reporters during his trip to India, the Prime Minister leapt to Sir David's defence, saying: ‘I've been impressed with the grip and grasp he has over the NHS and his knowledge and understanding and love for it and what he helps to deliver in terms of results. ‘I obviously read that report very carefully. I looked at what people were responsible for.
‘It seemed to me that he had properly apologised and acknowledged the mistakes that the regional health authority had made when he ran it for that short period of time as these events unfolded.
‘We should not be seeking scapegoats and I think to highlight David Nicholson in that way would be seeking a scapegoat.'
A poll of 1,723 doctors, nurses, managers and other senior staff by NHSmanagers.net, a website for health workers, found 92 per cent wanted him to resign. A similar survey of 255 family doctors by GP magazine found 89 per cent wanted him out.
Roy Lilley, a respected health policy analyst who runs NHS managers.net said: ‘This is a huge blow for Sir David. ‘It is clear he no longer enjoys the support of front-line staff.
‘As stories of quality horrors, bullying and service dislocation emerge, it would seem time to recognise Sir David's huge contribution to the NHS in the past but make it clear he is not the man to take the NHS into the future. Politicians insist on the NHS being run in a business-like way.
He continued: ‘If this were a business I think the shareholders would be calling for a new boss and a clean sweep of the board. ‘I don't see why taxpayers should expect anything less.'
Sir David's position has come under increasing pressure over the last fortnight following a damning report into the Mid Staffordshire disaster. Up to 1,200 patients are feared to have died at the trust unnecessarily between 2005 and 2009 while countless others suffered horrific neglect.
Sir David has been accused of ignoring the warning signs and failing to intervene while head of the regional health board and later, the Department of Health. Although he has apologised to bereaved families, he has refused to quit his £211,000-a-year post.
Last week he was implicated in another scandal when it emerged he had ignored warnings about a hospital trust now at the centre of a probe into high death rates.
Gary Walker and David Bowles, two senior managers at United Lincolnshire hospitals, said they raised concerns three years ago but were hounded from their jobs.
As many as 670 patients are now thought to have died unnecessarily at the trust and it faces an investigation over poor care.
Sir David appears to be losing political support and at least two Tory MPs from the health select committee, Chris Skidmore and Dr Sarah Wollaston, believe he should go. On Tuesday, health minister Dr Daniel Poulter also appeared to invite him to ‘consider' his position.
When questioned on BBC's Newsnight, Dr Poulter said: ‘David Nicholson can obviously consider his own position. ‘But at the moment we are accepting the fact that he, like many people, has made an apology for what he has done and we need now to move on and make sure that we never let another Mid Staffs happen again.'
Aside from his role in the scandal, many health professionals privately believe that unless Sir David leaves, the culture of secrecy within the NHS will not change. A spokesman for Sir David declined to comment on the results of the polls. 21.2.13
Crisis No2 for the man with no shame: NHS chief and the whistleblower reveals he was paid £500,000 to keep quiet over second hospital
- Gary Walker was Chief Executive of the United Lincolnshire Hospital Trust
- He says he was fired after warning about a dangerous NHS 'target culture'
- His comments raise more questions about NHS Chief Sir David Nicholson
- Sir David is already under fire after the Mid Staffordshire NHS Trust scandal
- United Lincolnshire Hospital Trust is now being investigated over poor care
- Walker 'threatened with legal action because of BBC R4 interview he gave'
- Former health sec. Stephen Dorrell slams 'corrupt' culture of NHS gagging
Damning new questions have been raised about the most powerful man in the NHS - by a whistleblower paid £500,000 to stay quiet over the state of his hospital. Former hospital chief executive Gary Walker sensationally broke his silence to reveal he was driven from his job after warning NHS boss Sir David Nicholson that patients were in danger as long as four years ago.
He received the hush money to prevent him going public with his fears that the ‘target culture’ at the United Lincolnshire Hospitals trust could cost lives - and was reportedly threatened with legal action because of an interview he gave to BBC Radio 4 this morning.
The trust is now being investigated over fears that as many as 500 patients may have died needlessly because of poor care. Sir David, who presided over the Mid Staffordshire scandal, said last week he was ‘not ashamed’ to remain in his job despite calls to quit from relatives of those who died because of his failure to take action during his time as a regional watchdog seven years ago.
Now Mr Walker has broken rank to say that he warned Sir David about the state of care at the United Lincolnshire Hospitals trust four years ago – but was ‘thrown to the wolves’ for speaking out.
Today the trust is at the centre of a major investigation over its alarmingly high death rates. It risks becoming another Mid Staffordshire, where up to 1,200 patients died at Stafford Hospital because of appalling failures in care.
Last night Mr Walker said Sir David ignored him when he raised his concerns in 2009. He was forced out of his job the following year. He claimed the NHS chief was ‘not interested in patient safety’ and called on him to resign to end the ‘culture of fear’ he had created in the NHS.
Mr Walker has been emboldened by last week’s demand from Robert Francis, QC, who led the Stafford inquiry, that NHS whistleblowers should be protected.
Last night he said: ‘I want David Nicholson to be held to account. I warned him that this was going to happen. 'I warned him that Lincolnshire was going to become the next Mid Staffordshire. He didn’t investigate those concerns, and now look what’s happened.’ Mr Walker also told BBC Radio 4's Today this morning: ‘It's a simple decision: you have emergency care or you have care that could wait.
‘It's not nice to wait but it could wait and therefore we chose as a board - it was not just me - that... emergency care should take priority.’
He said he was ordered by the East Midlands Strategic Health Authority to meet the 18-week non-emergency target ‘whatever the demand’ and was told to resign when he would not do so.
Mr Walker told the programme he accepted a so-called ‘supergag’ as part of a settlement package of an unfair dismissal claim - reported to be at least £500,000 - to protect his family. He told the programme: ‘This is a culture of fear, a culture of oppression - of information that's either going to embarrass a civil servant or embarrass a minister. These are big problems. ‘And if you consider that the people that have been running the NHS have created that culture of fear, they need either to be held to account or new people need to be brought in to change that culture.’
‘I was in danger of losing my house - I have children to support,’ he went on. ‘And one thing you must remember, that if you're attacking the very top of the NHS the sanctions are pretty dramatic. ‘So I spent 20 years in the health service and I'm blacklisted from it. I can't work in the health service again.’
He added: ‘You have to remember that if you work in the NHS and you cross the people in power there will be consequences for you and people are appointed to do specific jobs of getting rid of people. ‘I think if you consider that had they got a case against me that was reasonable and it was gross misconduct, then why would they spend so much time, effort and money to silence me?’
Sir David is already under pressure to leave his £270,000-a-year post over his links to the Mid Staffordshire scandal. He was in charge of the regional health board that had overall responsibility for the trust between 2005 and 2006. Sir David also appointed the trust’s chief executive Martin Yeates – even though he had no managerial training – who later sacked dozens of nurses.
Then in 2008, as chief executive of the NHS, he is said to have dismissed concerns of relatives who died at the trust as ‘simply lobbying.’ A petition urging him to resign has so far received 1,800 signatures, and the testimony of Mr Walker will pile further pressure on him to give up his lucrative post.
Mr Walker says he warned Sir David in 2009 that things were going badly wrong at his hospital trust, where hundreds of patients are now suspected to have died needlessly over the past two years. Managers in the trust had been told their ‘careers rested on delivering the targets’ and so were neglecting patient care, Mr Walker said.
He wrote a three-page letter to Sir David setting out what he thought was wrong and telling him he needed to intervene. But he says Sir David ignored his concerns. Mr Walker was fired in 2010, apparently for swearing in meetings – but he and his supporters say he was forced out because of his whistleblowing.
After he was dismissed, Mr Walker, whose formerly unblemished career in the NHS spanned 21 years, was forced to sign a £500,000 ‘supergag’ order preventing him from speaking out about his concerns.
A Department of Health spokesman said: 'It is absolutely critical that all staff working within the NHS feel able to speak up and raise concerns and that every NHS organisation takes concerns seriously and acts on them.
'The Government has taken a series of steps to encourage an open dialogue, including changing the NHS Constitution to enshrine the fact that NHS organisations should support staff who raise concerns, ensure those concerns are fully investigated and ensure that there is someone independent, outside of their team, to speak to.
'That change also set out a legal right for staff to raise concerns about safety, malpractice or other wrongdoing without suffering any detriment.
We have consistently made clear to the NHS that local policies should prohibit the inclusion of confidentiality "gagging" clauses in contracts of employment and compromise agreements which seek to prevent the disclosure of information which is in the public interest.
'Sir David Nicholson has also written to NHS organisations reminding them of their responsibilities in relation to compromise agreements. 'As we made clear in our initial response to the Francis Inquiry last week, the culture in the NHS needs to change and high quality patient care must be paramount.'
An NHS Commissioning Board spokesman added: 'In relation to Mr Walker’s specific comments, we know that he is unhappy about his personal case.
'Allegations made by Mr Walker regarding behaviour at the SHA have been independently investigated and found to be without merit. 'It is important to stress that allegations of this nature are taken extremely seriously.
'Following Mr Walker’s initial concerns raised in 2009 Sir David commissioned a rigorous independent review, following which it was concluded that no evidence whatsoever was found of bullying and harassment by the Trust or SHA.' 14.2.13
Flu jabs are a 'waste of taxpayer's money', claim scientists who say the benefits have been over-hyped
- University of Minnesota report says benefits - especially for older people - have been over-promoted
- New vaccine pipeline hindered as a result
- But experts still recommend current vaccination 'as it's the best we have'
The benefits of the annual flu jab have been ‘over-hyped', scientists claim. They say the vaccine is far less effective than is widely believed, with some studies showing it protects less than two-thirds of the population.
The US researchers say ministers in Britain as well as America are ‘wasting taxpayers' money' on the jab. And they claim that because the benefits have been so ‘over-promoted', scientists have been deterred from inventing vaccines that would be far more effective.
But the Department of Health has insisted the flu jabs ‘save lives' and urged the elderly and patients with long-term conditions to come forward for their vaccinations. Researchers from the University of Minnesota looked at 12,000 studies on the effectiveness and safety of the flu jab, going back to the 1930s.
They say that although Government officials claim it protects between 70 and 90 per cent of the population, this is actually not the case. In fact, they say, it protects just 59 per cent of adults aged 18 to 65, but is far less effective in the elderly.
Professor Michael Osterholm, who was involved in the study, said: ‘I have been a strong proponent of vaccination in general, and flu vaccine in particular, for many years. I still recommend its use as the best we have. ‘But we have over-promoted this vaccine. For certain age groups in some years its effectiveness has been severely limited relative to what has been previously reported.
‘That has had a very dampening effect on the development of new vaccines.' And Douglas Fleming, of the Royal College of General Practitioners' Influenza Monitoring Unit in Birmingham, said: ‘No vaccines are perfect. Last year's flu vaccine was a bad match with the circulating strains. Its effectiveness varies from year to year and with different age groups.
‘Among the elderly it is widely recognised that its effectiveness decreases. Better vaccines are needed for this reason particularly. It has been over-hyped by many people.'
At present the flu jab is offered free to the over-65s, pregnant women and anyone with an underlying health condition such as asthma, diabetes or epilepsy. The immunisation programme is estimated to cost the taxpayer £115million a year.
The latest figures from the Health Protection Agency show that 61 per cent of the over-65s have been vaccinated this year, as well as 30 per cent of pregnant women and 37.5 per cent of those with long-term conditions.
A Department of Health spokesman said: ‘There is no doubt that the flu programme saves lives. ‘Evidence on the effectiveness of the vaccine is reviewed by the Joint Committee of Vaccination and Immunisation and this year the committee undertook a detailed review of the flu vaccine programme.
‘We strongly encourage scientists and the vaccine industry in their efforts to develop new and more effective flu vaccine and do not agree that these efforts are being discouraged.
‘Each year thousands of people die after catching flu and we urge everyone that is in an at-risk group to get the vaccine.' Professor Osterholm added: ‘We support using flu vaccine in all age groups. Even among the over-65s, although it is of limited benefit, it is still a benefit.' 21.11.12
'Essential medicine' Tamiflu accused of being useless in fighting flu as experts call for legal action against manufacturers
A leading British medical journal is asking the drug maker Roche to release all its data on Tamiflu, claiming there is no evidence the drug can actually stop the influenza virus.
The drug has been stockpiled by dozens of governments worldwide in case of a global flu outbreak and was widely used during the 2009 swine flu pandemic. On Monday, one of the researchers linked to the BMJ journal called for European governments to sue Roche.
'I suggest we boycott Roche's products until they publish missing Tamiflu data,' wrote Peter Gotzsche, leader of the Nordic Cochrane Centre in Copenhagen. He said governments should take legal action against Roche to get the money back that was 'needlessly' spent on stockpiling Tamiflu.
Last year, Tamiflu was included in a list of 'essential medicines' by the World Health Organization, a list that often prompts governments or donor agencies to buy the drug. Tamiflu is used to treat both seasonal flu and new flu viruses like bird flu or swine flu.
WHO spokesman Gregory Hartl said the agency had enough proof to warrant its use for unusual influenza viruses, like bird flu. 'We do have substantive evidence it can stop or hinder progression to severe disease like pneumonia,' he said.
In the U.S., the Centers for Disease Control and Prevention recommends Tamiflu as one of two medications for treating regular flu. The other is GlaxoSmithKline's Relenza.
The CDC says such antivirals can shorten the duration of symptoms and reduce the risk of complications and hospitalization. In 2009, the BMJ and researchers at the Nordic Cochrane Centre asked Roche to make all its Tamiflu data available.
At the time, Cochrane Centre scientists were commissioned by Britain to evaluate flu drugs. They found no proof that Tamiflu reduced the number of complications in people with influenza. 'Despite a public promise to release (internal company reports) for each (Tamiflu) trial...Roche has stonewalled,' BMJ editor Fiona Godlee wrote in an editorial last month.
In a statement, Roche said it had complied with all legal requirements on publishing data and provided Gotzsche and his colleagues with 3,200 pages of information to answer their questions. 'Roche has made full clinical study data ... available to national health authorities according to their various requirements, so they can conduct their own analyses,' the company said.
Roche says it doesn't usually release patient-level data available due to legal or confidentiality constraints. It said it did not provide the requested data to the scientists because they refused to sign a confidentiality agreement.
Roche is also being investigated by the European Medicines Agency for not properly reporting side effects, including possible deaths, for 19 drugs including Tamiflu that were used in about 80,000 patients in the U.S. 13.11.12
Complaints about the NHS rise by 8% in a year
- Health Service Ombudsman received 150,859 complaints between 2011 and 2012
- Included not acknowledging mistakes in care and inadequate apologies being offered
- GPs also under fire for striking off patients
The number of complaints made to the Health Service Ombudsman increased by 8 per cent in a year, figures show. Between 2011 and 2012, 150,859 complaints were received.
Of those, 16,337 patients or family members were dissatisfied with the way the NHS tried to resolve their concerns and referred the complaint on to the Health Service Ombudsman.
GPs fared particularly badly. The ombudsman said that despite issuing a warning about GPs unfairly or hastily striking off patients from their practice lists, the number of such cases has risen by 16 per cent since last year. Almost 100 people said they had been unfairly removed from GP practice lists after a dispute or disagreement.
Health Service Ombudsman Dame Julie Mellor said: 'Our casework tells us there needs to be a clear shift in the attitude and practice of some GPs towards complaints. 'Our concerns about how GPs are handling complaints about their practices need to be addressed as a priority.
'As the new NHS begins to take shape, GPs and other providers, GP-led Clinical Commissioning Groups and the NHS Commissioning Board will need to work to embed good complaint handling across the NHS.'
Elsewhere, there were 1,523 complaints about the NHS not acknowledging mistakes in care, according to a report by the ombudsman. And more than 1,600 people complained about inadequate remedies being offered, including inadequate apologies.
Dame Julie is also calling on the NHS to improve the way it deals with complaints on the ground.
‘All too often the people who come to us for help are unhappy because of the careless communication, insincere apologies and unclear explanations they've received from the NHS,' she said.
'A poor response to a complaint can add to the problems of someone who is unwell, struggling to take care of others or grieving. The NHS needs to get better at listening to patients and their families and responding to their concerns.'
In one of the cases highlighted in the ombudsman's report, a bereaved daughter was told 'death is rarely an ideal situation for anyone' and that 'truth be told your mother probably said her goodbyes long before the final moments'.
Another case details how a surgeon called a male patient a ‘baby' when he expressed his anxiety about having a general anaesthetic.
Health Minister Dr Dan Poulter said: 'The vast majority of NHS patients are happy with the care they receive, but if things go wrong, some NHS organisations respond to complaints better than others. This is something that the NHS must improve.
'That is why, under the NHS constitution, we have proposed introducing a new right for complaints to be acknowledged within three days and stronger rights to make sure complaints are handled openly. 'We want to see a patient-centred NHS where patients have a stronger voice. This means making the NHS more accountable for the quality of care it provides for patients.
'The Government has set up the new patient champion HealthWatch, which will argue on behalf of patients and help drive improvements in the quality of health and social care services.' 9.11.12
24,000 deaths: The cost of poor diabetes treatment
Twenty-four- thousand people die prematurely each year because their diabetes has not been managed properly according to an influential committee of MPs.
Many others also suffer from other complications such as blindness and kidney disease – complications which could easily be avoided.
"The NHS spends at least £3.9 billion a year on diabetes services and around 80% of that goes on treating avoidable complications," chairman of the public accounts committee Margaret Hodge said.
"The number of people with diabetes is set to rise from 3.1 million to 3.8 million between now and 2020 and unless care improves significantly the NHS will face ever-increasing costs." Hodge was speaking as the committee published its report into NHS treatment of diabetes patients in the UK.
The report was highly critical of the NHS's handling of diabetes sufferers, saying the organisation had "failed to hold commissioners of diabetes services to account for poor performance," and that the performance of eleven primary care trusts had gotten worse between 2006-2010.
"Fewer than one in five people with diabetes have the recommended levels of blood glucose, blood pressure and cholesterol, leaving an unacceptably high number at risk of developing complications, being admitted to hospital and costing the NHS more money," she added.
There are nearly two and a half million diabetes sufferers in the UK, but it is believed that there are as many as 800,000 with the condition who have not been diagnosed – a figure which is expected to rise significantly in the years ahead. 6.11.12
The everyday medicines that make women ill because they have only been tested on MEN
For two years, Janice Price, 37, has struggled with a dilemma. She wants to start a family with her husband, Paul, but charity worker Janice has suffered from depression for a decade and is worried about evidence linking the side-effects of depression drugs with harm to mother and baby.
Recent studies of mothers taking anti-depressants indicate they may have a significantly higher risk of the potentially lethal blood-pressure condition, pre-eclampsia, and of going into premature labour. Their babies may suffer problems with their IQ and growth, other reports suggest.
And Harvard researchers recently linked the drugs to a much greater risk of miscarriage and autism, too.
Janice*, who lives in Brighton, West Sussex, says she dare not stop taking anti-depressants, because when she has tried in the past she has plummeted into the depths of psychiatric illness. ‘Trying to get pregnant while on these drugs, with all the reported risks, just seems too frightening,' she says. ‘I'd like some reassurance.'
No one can tell Janice the real risks, because the drugs were not tested for safety on pregnant women before being approved for use.
Fears over the safety of antidepressants for pregnant women have been raised only after the drugs were approved for use — and only when researchers around the world noticed abnormal patterns of illness among mothers and babies, and then found unusually high proportions of the women had taken anti-depressants while pregnant.
Retrospective research can raise questions about a drug's safety, but it does not provide the same level of sound scientific proof as clinical trials of a drug before it is approved.
In properly controlled clinical trials, scientists can account for variables — such as women's weight, diet, lifestyle, pre-existing health and any other drugs they take — so they can pin harmful side-effects on to the treatment.
But many pills most commonly used daily by women — such as painkillers and heart drugs — were never tested on females, pregnant or otherwise, before being put on the market. Instead, they were tested for safety on men — because males don't have fluctuating monthly hormonal cycles that may alter the drug's actions, making them simpler test subjects.
It avoids complicating trial results, which could affect getting that drug onto the market quickly.
Mounting evidence shows women's bodies can react far differently than men's to the same widely prescribed drugs. At least one million people a year in Britain are admitted to hospital for treatment after severe adverse reactions to prescription medicines.
Most recently a Dutch study found that women were four times more likely than men to suffer side effects to diuretics — commonly prescribed blood pressure pills. These range from nausea and confusion to coma and even death, but this study is the first to suggest women face a much greater danger.
Researchers at Erasmus Medical Centre in Rotterdam analysed 7,000 patients admitted to hospital after reacting to their medicines.
They studied the types of drugs involved and the ratio between the sexes. The biggest difference was in commonly used cardiovascular drugs, which accounted for one in three admissions. Researchers found that with one of these drugs — diuretics — women are four times more likely to experience side-effects.
The most common reaction was a sharp drop in sodium levels, caused when too much gets flushed out in water through the kidneys.
The Dutch study supports earlier research. In 2001, New Zealand scientists found women were 70 per cent more likely to suffer reactions to drugs for skin conditions.
With the commonly used blood-thinning drug, warfarin, the problems with excess bleeding are significantly more common in women, while anti-histamines for allergies are another case in point, says Dr Peter Dewland, an independent pharmaceutical consultant.
‘Antihistamines, particularly the older types, are processed much more slowly in women, so tend to make women feel more sleepy than men.
‘Also, the newer classes of antipsychotic drugs — used for mental problems such as schizophrenia, bipolar disorder, severe anxiety and depression — have a significantly increased chance of side-effects in women. 'They are known to cause metabolic syndrome (increased body weight and diabetic problems), and dangerous heartbeat irregularities.'
‘Women are about twice as likely to suffer side-effects from prescribed drugs as men,' says Dr Anita Holdcroft, a consultant anaesthetist at Imperial College London. This may be because the drugs are not tested on women or because of different female biology: lack of research means we can't be sure.
Dr Holdcroft arrived at his figure by studying the latest official figures on reported side-effects, released earlier this year by the official drugs watchdog, the Medicines and Healthcare Products Regulatory Agency (MHRA).
Harmful side-effects are reported to the agency by doctors and patients.
Of course, men also react badly to drugs. But the fact that they report only half as many bad side-effects indicates women's problems differ widely in their scale and nature. It may also be that women perceive side-effects differently than men — they may be more alert to their bodies' responses — but again, this has not been investigated properly.
Even with the most common drugs, such as non-steroidal anti-inflammatory painkillers, ‘we do not know how they affect women differently, even though these drugs are potentially dangerous,' says Dr Holdcroft, who is a member of the Medical Women's Foundation, the largest organisation of women doctors in the UK.
‘For example, we know from studies that the effects can be intensified by the use of contraceptive pills.' But often the reasons remain unknown.
‘The basic science of pain research has involved only 8 per cent females. 'In tests of anti-inflammatory drugs, 90 per cent have no data about sex differences,' says Dr Holdcroft.
There are no legal barriers to women participating in clinical trials, but practices in the pharmaceutical industry means they are often excluded.
This is particularly true when drugs are safety-tested in humans for the first time, with dosages gradually increased. ‘Women are more variable as research subjects. They have hormonal cycles and child-bearing, and their responses to drugs may change again after the menopause,' says Dr Holdcroft.
Drug researchers often avoid testing such variations because they complicate results — which is not what drug companies want. As the first stage of clinical trials are aimed mainly at persuading regulators that a medicine is safe and effective enough to be licensed for profitable commercial use, drug company researchers focus on the more physically stable male sex.
A spokesman for the drug-makers' representative organisation, the Association of the British Pharmaceutical Industry, says women are not excluded from clinical trials ‘unless it would be unethical to include them, as in the case of a male-specific disease such as prostate cancer,' he says.
‘Careful consideration is given to whether a woman is of child-bearing potential or menopausal, as these would be specified in the inclusion and exclusion criteria for a trial. 'To restrict recruitment into clinical trials for a gender reason, without rationale, does not happen.'
However, independent pharmaceutical consultant Dr Dewland, who has been involved in running more than 100 human drug trials, says nearly all these studies have been on men — at the drug companies' request. ‘Because the effect on fertility on drug trial results has not been adequately studied, we tend to use males.
'Even if we find a drug affects male and female animals differently in lab tests, we may not look hard for those problems when we test the drug on humans,' he says. ‘I was even asked to use men in a safety trial for a drug for helping women in labour.
'The pharmaceutical-industry client took some persuading to use women.'
But proper trials of all drugs should involve women, says Dr Dewland — women are generally smaller and weigh less than men, so may require different dosages or smaller pills. And women's bodies can absorb drugs differently and react to them in different ways.
‘Often, drugs may bind differently to chemical receptors in women's bodies,' he says. Chemical receptors are the points in the body that react with the drug and absorb it. ‘Women also tend to have a higher proportion of body fat than men — and many drugs bond to fat molecules.'
This means that a woman's body may absorb a higher amount of a drug than a man, even when given the same dose. They are likely to store more lipophilic medications, which dissolve better in fat than water, before releasing them into the bloodstream.
Even if they take the same dose of a lipophilic medicine as a man, women's blood levels may be much higher, potentially raising side effect risks.
Women's kidneys work more slowly than men's, so chemicals stay in their systems longer. This may lead to excessive drug levels and increased risk of reactions. Women's stomachs are also less acidic than men's, which may change the nature of drug reactions.
Serious ethical dilemmas must be tackled if women — particularly in pregnancy — are to be represented in drug trials.
Virginia Watson, president of the National Association of Women Pharmacists, says: ‘Women take medicine while pregnant, so the drugs are being used in an unauthorised way, because their effects haven't been clinically tested.'
It would mean intentionally exposing mothers and babies to a new, possibly dangerous drug in a controlled trial with medical monitoring and support. How many pregnant women would go on a drug trial? The alternative is to give the drug to millions of pregnant women, then try to monitor what happens.
The meeting of the Royal Pharmaceutical Society last year agreed to press the MHRA to ensure women are represented in all drug trials, and that information on differences in women's and men's reactions to drugs are studied and published.
In the meantime, women such as Janice Price will be worried. ‘I'd love to try for a baby, but I can't stop my antidepressants,' she says. ‘Without information about the side-effects, I'm stuck.' 6.11.12
Millions of patients are hooked on tranquillisers with some using pills for 20 years
Psychiatrists say some patients are begging for repeat prescriptions
Pills increase the risk of dementia by 50%, according to BMJ study
More than a million patients are taking potentially harmful tranquillisers, with some hooked for more than 20 years, experts have warned. Although guidelines state benzodiazepines should only be used for a maximum of a month, many users are becoming dependent.
Psychiatrists say that some patients are begging for repeat prescriptions while others are buying them illegally from foreign websites. It is estimated 1.5million Britons are currently taking a form of benzodiazepines, which include temazepam and diazepam.
A study published in the British Medical Journal found the pills increased the risk of dementia by 50 per cent, even if only taken for short periods. Other research has linked them to premature death. Dr Owen Bowden-Jones, of the Royal College of Psychiatry, said: ‘There's no doubt that benzodiazepines can form a dependence, can be addictive for people.
‘But on the other hand if used properly, they are a short-term treatment for anxiety. ‘I can certainly imagine how the doctor feels they are doing some good and unfortunately that's not always the case. I've seen patients on benzodiazepines for 20 years.'
Dementia risk from sleeping tablets: Pensioners on pills taken by 1.5m are 50% more likely to be hit, warns Harvard study
Researchers estimate that as many as 8 per cent of the over-65s are taking them at any one time. However in the past two decades the number of prescriptions have fallen by 40 per cent, largely because GPs are far stricter in handing them out.
There were nearly 10,600 prescriptions written out last year, down from 16,400 in 1991. Some patients who were addicted say their drugs made their lives a ‘complete blur' and caused memory lapses and extreme tiredness.
But when they tried to come off the pills they suffered withdrawal symptoms including severe abdominal pain, sickness and loss of appetite.
Dr Peter Carter, general secretary of the Royal College of Nursing, said: ‘The NHS should accept it has a part to play in treating the side-effects of a drug which was originally prescribed with the best of intentions.' 2.10.12
Quackwatch: Give statins to all over-50s: Even the healthy should take heart drug, says British expert
- Currently statins only given to around eight million high-risk patients
- But Professor Sir Rory Collins says healthy people can also benefit
- He said evidence from 130,000 patients taking statins shows they're safe
Statins should be given to all over-50s, regardless of their health history, because they dramatically cut the risk of heart attacks and strokes in later life, one of the UK's leading experts has said.
Currently statins are given only to high-risk patients, around eight million people, who have high cholesterol or have a risk of heart disease. But there is 'clear evidence' that healthy people can also benefit based on their age alone, says Professor Sir Rory Collins, who has links with the pharmaceutical industry.
Critics said 'the first principle of medical treatment is to establish a diagnosis before administering drug therapy. Prof. Collins is suggesting treating everyone as the statistically average patient, great if you happen to fit the bill, not so great if you don't'.
He led the world's largest study to investigate statins in the prevention of cardiovascular disease which proved that cutting levels of 'bad' LDL cholesterol in the blood saved lives. The risk of having a major vascular event such as a heart attack is cut by one-fifth for each 1.0mmol/L (millimoles per litre) fall in LDL, whether in high or low risk patients.
But current guidelines on their use - and misguided safety fears about muscle pain and memory loss - are restricting the range of people who can take them, he said. 'At 50 you should be considering it and whether you should be taking them at an earlier age is an open question' he said.
'If you start treatment earlier and continue for longer the benefits will be much greater, you're not trying to unfur the arteries, you're preventing them from furring in the first place' he said. Prof Collins, who was giving a keynote lecture at the European Cardiology Congress in Munich, said evidence from 130,000 patients taking statins in trials show they are safe.
Yet drug safety watchdogs here and in the US have insisted on flagging up relatively minor side effects which are putting patients off the drugs, he said. These include memory loss, depression, sexual difficulties and depression, while recent research suggests cataracts and diabetes may be more common in patients taking statins.
Trial data shows only one significant side effect, myopathy or muscle pain, which affects one in 10,000 patients, said Prof Collins. He said: 'We need to look properly at the safety of statins. The reality is that these drugs are remarkably safe, but the problem is that high risk patients are getting the message that these drugs have side effects.'
Prof Collins, 57, went to his GP a fortnight ago to ask about taking statins despite a relatively low cholesterol level, and was dismayed to learn she could not get high risk patients to take them because of fears about side effects. Research earlier this year co-ordinated by the Clinical Trial Service Unit Oxford University, where Prof Collins is co-director, reviewed findings from 27 statin trials involving 175,000 people, some of whom were at low risk of heart problems.
The drugs cut the risk of heart attacks, strokes and operations to unblock arteries by one third or more.
The benefits were gained no matter what level of cholesterol patients started out with. Healthier people who were given statins also had lower overall death rates than those who were given a placebo. It concluded the positives greatly exceeded any side-effects from taking the drugs.
More than eight million adults are already taking statins, but it is estimated that routine use by the over 50s would lead to 10,000 fewer heart attacks and strokes a year, including 2,000 fewer deaths in the UK.
The small cost of the drugs - as low as £16 a year - would be outweighed by NHS savings due to the reduced number of heart attacks and strokes. At present, statins are restricted to those with at least a 20 per cent risk of having a heart attack or stroke over the next five years.
But, said Prof Collins, trial data shows very low risk groups can benefit where individuals have just a five to 10 per cent chance of heart disease, and even lower. He said there did not appear to be a threshold at which the drugs didn't work and the longer they were taken, the greater the benefit. 'We need to review the guidelines and the current thresholds should go,' said Prof Collins, who claimed medical tests such as liver function were also unnecessary.
Professor Peter Weissberg, medical director of the British Heart Foundation, said: 'The issue is where do you set the threshold between low, normal and high risk. 'The current arbitrary threshold was decided by cost but now statins are off patent (and much cheaper) it may be appropriate to see if there are benefits for more people - the threshold is a bit too high,' he added. 29.8.12
Boss of first privately run NHS hospital says its model is key for best patient care
The company that runs Hinchingbrooke Hospital is 'co-owned' by its workers and clinicians
The first NHS hospital to be run entirely by a private firm has slashed waiting times and drastically improved patient care.
Hinchingbrooke, a struggling trust in Cambridgeshire, was taken over in February. But NHS figures show that since the company, Circle, stepped in to save the debt-ridden hospital from closure, it has gone from being among the worst-performing trusts in the region to one of the best.
Its accident and emergency unit is currently ranked first out of 46 NHS trusts in the Midlands and East Anglia region in terms of waiting times. Before the takeover it was consistently near the bottom and many patients were forced to wait longer than four hours.
It now also ranks fifth in terms of the proportion of patients with suspected cancer having tests within two weeks. Previously it was one of the area's worst performers and had missed its target every month since June 2010.
The hospital also claims to have reduced paperwork so nurses spend more time with patients – 62 per cent of their working day, up from 50 per cent – and has even hired a Michelin-starred chef to improve hospital food.
However, Circle's chief executive Ali Parsa admitted the hospital may not meet its savings target for this year.Under the arrangement, which was overseen by the Government, Circle must ensure Hinchingbrooke saves £10million by next March, and £230million over the next ten years.
Mr Parsa said although it was ‘broadly' on course to meet these targets, the immediate priority was improving patient care.
He said he had changed the hospital's management style, explaining: ‘You let the doctors and nurses and the healthcare professionals – who know the patient best and who know their services best – take charge.'
The hospital – which serves 160,000 patients near Huntingdon – is being closely monitored by the Government. If deemed a success, other failing NHS trusts may follow suit.
But unions say that it is early days – and warn that the only way the hospital can save the vast sums of money required is by laying off staff.
Karen Jennings, assistant general secretary at Unison, said: ‘The staff at Hinchingbrooke Hospital have worked enormously hard to turn around what not too long ago was a failing hospital, and for this they should be rightly congratulated. However, these early clinical successes should not be used by Circle to whitewash persisting financial problems.'
Before the takeover, the hospital had amassed debts of nearly £40million brought about by decades of poor management, failed private finance schemes and lack of funding from the NHS. 2.8.12
Bankruptcy and criminal record may be no bar to top NHS roles
Fit and proper persons test may be waived under proposals put forward by the government's NHS regulator
Private health companies, charities and hospital trusts will be able to appoint directors and governors with criminal convictions, director disqualifications and a history of bankruptcy to run NHS funded services, under proposals put forward by the government's NHS regulator.
At present NHS foundation trusts can only appoint to their boards those who pass a "fit and proper persons test" – a requirement enshrined in law. But in a consultation paper Monitor, which will oversee all providers of NHS-funded services in England, says it is considering "waiving the requirements of... the test" for other providers after lobbying by "stakeholders".
Officials said that while the requirement could not be "relaxed" for foundation trusts without primary legislation Monitor believes that other healthcare providers – such as mental health trusts or private companies – should not have to meet the same criteria.
The regulator will have a "light touch" and has retreated from plans that could have seen shareholders of private companies delivering healthcare subjected to a fit and proper test. "We do not want a hugely bureaucratic exercise. We will be satisfied with self-certification".
However critics say there will not be a "level playing field" in the NHS, where providers will compete for patients from 2014. A Labour spokesman said: "It's ludicrous for the government's regulator to think about scrapping its strict checks on the people running our NHS – at the same time as the government wants to put unqualified teachers in our schools. Patients are being repeatedly let down by this government's mismanagement of the NHS."
Experts questioned the regulator's strategy. "This is not a sensible idea," said Roy Lilley, a respected NHS commentator who has called for a "fit and proper" test across the NHS. Lilley said that it was legitimate to ask whether Richard Branson should be able to run NHS services – Virgin Care won large NHS contracts this year in Surrey and Devon. "I am sure he's an excellent businessman but he's also run Virgin Cola and Virgin Brides."
The consultation paper also reveals that the regulator has backed away from other more radical proposals. Earlier this year Monitor had proposed that credit rating agencies such as Standard & Poor's and Moody's could be asked to assess whether hospitals are financially robust enough to treat patients. However the regulator has said it will not now implement such a scheme.
After an industry backlash Monitor has also dropped proposed rules that would have imposed strict financial conditions on health service providers. After the Southern Cross care home debacle threatened to leave 31,000 residents homeless when the company collapsed last year, the regulator planned to impose borrowing limits on providers and restrict the selling and mortgaging of their own assets.
The new proposals reveal a more pro-market vision of NHS reform, with the emphasis on patient choice and competition between providers. David Bennett, chair of Monitor said, "Today we have launched an important consultation explaining our proposals for how NHS providers will be regulated and services protected for patients in the future." 31.7.12
NHS workers took 15 days off sick last year... compared with just SIX in the private sector
Average private sector worker took 6.2 days off sick
More than 42,000 NHS workers are calling in sick every day, figures reveal. Some 15million days are being lost to illness each year and absence rates are twice as high as in the private sector. Nurses and paramedics are far more likely to be off than doctors and high-paid managers and chief executives.
On any given day 14,000 nursing staff and 11,000 ambulance workers are off ill, according to the NHS Information Centre figures.
Overall, just over 4 per cent of all NHS employees are absent at any one time but in some trusts it is nearly 7 per cent. This compares with 1.6 per cent for private sector workers and 2.6 per cent for those employed elsewhere in the public sector.
One reason NHS staff may be more inclined to take time off is that their sickness benefit scheme is so generous. Employees who are absent for long periods will still be paid any bonuses and overtime they are likely to have received over that time – on top of their normal wage.
And they can even go on holiday while they are supposedly off sick if they can prove it is for ‘recuperation' purposes. Stress is one of the main reasons staff take time off as well as back problems, arthritis and other long-term aches and pains.
The Department of Health has previously calculated the NHS could save £555million a year if staff sickness rates were reduced by a third.
A spokesman pointed out that levels had fallen compared with last year – albeit by only 0.04 per cent. The spokesman added: ‘Overall, NHS sickness absence has fallen in 2011/12 compared to the previous year. ‘We remain committed to work with NHS employers, trade unions and staff to promote healthy workplaces and reduce the number of sick days by one third by the end of March 2013.'
In the past few years NHS trusts have been trying to encourage their staff to be healthier by setting up fitness classes and stop-smoking sessions. And a number of hospitals have gone further by bringing in policies that allow NHS employees to get hospital appointments ahead of ordinary patients, in the hope that they will return to work sooner.
The measures were prompted by a major report in 2009 – the Boorman Review – which warned that high rates of absence were affecting patient care. The sickness figures come as a study suggests three-quarters of nurses do not think there are enough staff to get the job done.
Two-fifths are dissatisfied with their job, with 44 per cent saying they would leave if they could. The study, conducted by the National Nursing Research Unit, involved almost 3,000 nurses in general medical and surgical wards across England. 25.7.12
NHS doctors are turning a blind eye to poor practice to protect their own jobs
Mid Staffs medical director criticises doctors' 'self-preservation' as doctors are turning a blind eye to poor practice to protect their own jobs, according to Mid Staffordshire Foundation Trust's medical director.
Manjit Obhrai, who is leaving his post next month after more than three years at the scandal hit trust, said processes for tackling underperforming doctors needed to be overhauled.
In an exclusive interview with HSJ, Mr Obhrai, a consultant obstetrician, urged NHS medical directors to be “brave” and take action over poor performance to protect patients. He said: “The current national process for managing poorly performing doctors is too cumbersome and weighted towards the individual and not the trust.”
He cited as an example the fact NHS trusts were unable to present their case for referring a doctor to a fitness-to-practise panel. Mr Obhrai said revalidation could be one answer, adding: “Most doctors in the NHS are aware of poor practice but they often turn a blind eye to it. I think they do that for their own self-preservation.”
He said a duty to speak out should be made an explicit contractual obligation for all NHS staff.
In 2009 Mr Obhrai instigated an internal review of surgery services at Mid Staffordshire, undertaken by the Royal College of Surgeons, following concerns over patient deaths. The review found the department was “inadequate, unsafe and at times frankly dangerous”.
Mr Obhrai said medical directors must take similar action if they suspected patients were at risk: “Medical directors should listen to low-level noise in their organisations and there comes a time when this low-level noise becomes audible.
“You then have to be brave enough to look at a department or a member of staff and do the right things for patients irrespective of the risk to yourself.
“Anyone who thinks Mid Staffs is unique or a one-off couldn't be further from the truth.”
Critics said ' Whenever there is any attempt to change anything that might improve the service to patients doctors start to worry about the effect on the change on their unit or practice. So much of the noise from doctors regarding any change has more to do with protecting their unit's budget or their income. Where are the ethics & morals in that? 20.7.12
NHS patients to get ‘right to ask’ for personal health budget
Patients will have a ‘right to ask' for a personal health budget under plans to extend choice and control for patients revealed in the Government's draft mandate for the NHS.
The plans will see a massive extension to the scheme – currently still being piloted – with patients given a cash budget by the NHS to spend on whatever they choose.
But GP commissioners raised concerns that adoption of personal health budgets was being set in stone before the evidence on their effectiveness was available.
The plans were revealed in the first annual mandate given to the NHS Commissioning Board from health secretary Andrew Lansley for 2013.
The mandate also revealed the quality premium for GP practices would be funded from NHS administration costs and tied the board to various targets, such as treating patients within 18 weeks, improving dementia care and increasing the number of health visitors.
One of the 22 objectives the board must deliver between April 2013 and March 2015 included extending choice and control for patients.
This includes giving patients receiving NHS Continuing Healthcare and parents of children with special educational needs or disabilities the right to a personal budget spanning health, social care and education from April 2014.
The document says: ‘The Government's aim is to create a right to ask for a personal health budget for all those who would benefit from one.'
Pulse reported last month that the budgets had been used to buy diverse items such as theatre tickets, frozen meals and complementary therapies in the pilots.
Health secretary Andrew Lansley said: ‘The launch of these care objectives underlines my ambition to improve outcomes for patients and place patients right at the heart of everything the NHS does.'
A spokesperson for the Department of Health said an evaluation of the pilots due in the Autumn would feed into the final version of the NHS mandate providing more details on how personal health budgets would work.
But Dr David Jenner, a GP in Cullompton, Devon, and GMS/PMS contract lead for the NHS Alliance, said the jury was still out on whether personal health budgets were of benefit to patients.
He said: ‘The pilots are yet to report so as a commissioner I would be waiting to see the results because I believe in evidence-based policy not policy-based evidence.'
Dr Johnny Marshall, a GP in Wendover, Bucks, and interim project manager of NHS Clinical Commissioners, said: ‘How will the effectiveness of personal health budgets be assessed, who decides who would benefit and also what exactly do we mean by personal health budgets? This doesn't answer any of those questions.'
What the mandate says
Personal health budgets extend choice and can empower people to have even more control over their NHS-funded care.
Subject to the results of the current pilot programme, the Government wants commissioners across the country to offer personal health budgets wherever appropriate, including the option of direct payments, and joint budgets across health, social care and other services. The Government's aim is to create a right to ask for a personal health budget for all those who would benefit from one. 12.7.12
Now GPs should ask how far you walk, not what you weigh as it is more important to your health, say experts
GPs should ask all patients how far they walk because it is more important to their health than either weight or blood pressure, say experts.
They warn that a lack of activity causes far more deaths than smoking, obesity or diabetes and urge family doctors to question patients on their exercise habits – particularly walking – and keep a record of them.
If patients admit to walking for fewer than 30 minutes a day they must be urged to do more.
The group of scientists from Canada, America and Australia believe that a lack of exercise leads to many cases of fatal cancers and heart disease. However, activity can prevent hip fractures and there is evidence it may ward off dementia.
Professor Karim Khan, from the University of British Columbia said: 'Activity levels are the most important factor influencing our health. 'They are much more important than our blood pressure or how many times we breathe a minute. 'In the US more people die as a result of physical activity than smoking, obesity or diabetes. It's fitness not fatness.'
Professor Khan, whose study is published in the Lancet, said: 'Physical activity affects every system. Not getting enough can lead to a range of illnesses including cancers and diabetes. 'You don't have to be an Olympian. If people take more than 150 minutes exercise a week, including walking, they probably don't need to worry about it.
'If they take less their doctor needs to be encouraging them to take more.'
Professor Khan said patients could fill in forms about their exercise levels in the waiting room to save GPs time during the appointment. 'Low fitness is a better predictor of mortality than obesity or hypertension, which are health risk factors afforded far greater emphasis than fitness by the media and most health professionals,' he added.
The researchers are recommending that doctors should record exercise along with patients' temperature, blood pressure, pulse, and breathing.
At present the Department of Health recommends that everyone takes at least two and a half hours exercise a week - or 30 minutes spanned over five days. Exercise is known to prevent certain cancers including breast and bowel. It also helps strengthen the bones, helping to prevent hip fractures, which often eventually lead to death.
Doctors say patients with a growing waistline have a better chance of surviving heart failure than their thinner counterparts. This could be because fatter patients had more reserves to fight disease. Another explanation might be that obese patients seek medical advice earlier because they are suffering other symptoms.
The US study of 3,000 patients showed that thinner individuals of both sexes were more than twice as likely to have died or needed surgery to shore up their failing heart after two years, says the American Journal of Cardiology.
However, doctors point out that acquiring the extra weight round our middles leaves us more likely to develop heart problems in the first place. Heart failure occurs when a heart, weakened by disease or an attack, struggles to pump blood round the body. 6.7.12
GPs to quiz NHS patients over alcohol intake as watchdog pleads for minimum pricing
GPs 'should offer climate change advice to patients'
Thirty NHS trusts rack up a £300m debt mountain as number being bailed out by taxpayer trebles in just one year
- Taxpayers' money spent on bailing out hospitals has trebled
- South London trust on the verge of going bust
- Government blames Labour PFI deals
- Margaret Hodge MP describes figures as 'shocking'
More than 30 hospital trusts have amassed debts totalling £300million, it has emerged. The amount of taxpayers' money being used to bail out stricken hospitals has trebled in the past year. Only last week it was announced South London Healthcare was being put into special measures as it is on the brink of going bust.
Today a report by the National Audit Office warns it and another 30 trusts are in the red, with total debts of £307million. The Government blames much of the debt on controversial private finance initiative deals, which were expanded under Labour.
The NAO warned that the Government cannot afford to carry on bailing out the trusts. There are also concerns that the hospitals' dire financial situation will lead to worsening patient care.
Last year £253million of public money was given to failing hospitals to help them cover everyday running costs – more than treble the £76million spent the previous year. Next year the bailout bill is likely to rise to £300million.
Margaret Hodge MP, chairman of the Public Accounts Committee said: ‘It is shocking that over the past year alone the amount the Department for Health has had to spend on bailing out trusts in financial difficulty rose by 333 per cent.
‘Trusts in particular received significant support; South London Healthcare NHS Trust and Barking and Havering and Redbridge University Hospitals NHS Trust.' The Government blames much of the debt on botched PFI deals which were encouraged by the Labour government.
These enabled private firms to pay up front for a new cancer ward or maternity department, for example, and the trust would then pay them back in yearly instalments. But this amount goes up with interest every year and trusts also have to spend large amounts of money maintaining the buildings so they are ‘new'.
As such, many have been unable to make these repayments. The NAO warns that in future, the NHS will not be able to afford to continue bailing these trusts out.
It points out that there is unlikely to be any increase in Government spending on the NHS - once inflation is taken into account - for at least the next three years. The future of South London Healthcare trust is uncertain but health secretary Andrew Lansley is likely to make a decision later this year.
It covers three hospitals - Princess Royal University Hospital in Orpington and Queen Mary's Hospital in Sidcup in Kent and the Queen Elizabeth Hospital in Woolwich, South London - and any may be closed-down. 5.7.12
NHS will need extra £20bn a year by 2020, says think-tank
Ministers should contemplate charging for the NHS to meet patient demand, claims Institute of Fiscal Studies.
The health service will need an extra £20bn a year by the end of the decade to meet patient demand and implement the Dilnot report into social care without cutting other essential services - a level of funding that means ministers should contemplate charging for the NHS and tax rises, a leading think-tank will say on Wednesday.
The Institute for Fiscal Studies (IFS) says in a report that England's NHS budget squeeze - with savings of £20bn up to 2015 - is already the "tightest four-year period for the last 50 years". NHS spending will be essentially flat in real terms - at about £110bn a year - until 2015.
However, with the NHS accounting for 23% of government spending, plus an ageing population, rising patient expectations and expensive new drugs on the horizon, the think-tank warns that in the last half of the decade a mixture of charging, tax rises and perhaps even greater borrowing will be needed.
The IFS considers a range of scenarios from the beginning of the next parliament in 2015 until 2022 - and calculates the tax gap between spending and receipts if public spending were to rise. The analysis factors in the £10bn of welfare cuts called for in the March budget.
The authors also consider the Dilnot recommendations for the elderly, which argue that lifetime costs for social care needed to be capped at £35,000 - and that council-funded home help and care home places for the elderly and adults with disabilities should be offered to everyone with less than £100,000 of assets, up from the current limit of £23,250.
There are growing concerns within the Treasury about the cost of the changes while meeting the political charge that this would be a sop to wealthy baby boomers. However, the IFS says if the NHS were to cope with the rising cost of an elderly population, Dilnot's proposals were implemented and other government spending kept growing to 1% a year, the extra cost every year would be £19.5bn.
Even if the elderly are discounted from the calculations the cost runs into billions of pounds. The IFS suggests that after 2015, even if NHS spending were just to keep pace with projected economic growth - at 2.4% - and letting other public spending to rise at 1% a year, there would be a need for an "increase in taxation, borrowing or further welfare cuts of roughly £9bn". This it says is equivalent to increasing VAT by 2% from its current level of 20%.
Carl Emmerson of the IFS said "serious consideration should be given to the options for the NHS, which include reviewing the range of services available free at the point of use and reconsidering the level of taxation needed to finance them."
The study reveals the cost of "tax and spend" politics. To keep the share of public spending as a percentage of GDP constant after 2015 the IFS calculates it would need an additional £44bn of "tax increases or extra borrowing" - the equivalent tax burden of £1,400 for every family in the UK. 4.7.12
Drugs companies 'are putting profits ahead of medical discoveries', claims hard-hitting report
For every £1 spent on basic research a whopping £19 is spent on marketing, claim experts
Current reward system discourages innovation, they add
The pharmaceutical industry is in crisis because companies are rewarded for developing new drugs that have few clinical advantages over existing ones, experts say. Writing in the British Medical Journal, Professor Donald Light from the University of Medicine and Dentistry of New Jersey and Joel Lexchin from York University in Toronto, say this has discouraged innovation for the past five decades.
They pointed to independent reviews that found between 85 and 90 per cent of all new drugs developed over the past 50 years have provided few benefits and considerable harms.
They said most research funds don't go towards finding breakthrough drugs but towards developing scores of minor variations that produce a steady stream of profits. Heavy promotion of these drugs can account for up to 80% of a nation's drug spending, they add.
The duo warn that companies exaggerate research and development costs to lobby for more protection from free market competition. Yet, according to an independent analysis, the 1.3 per cent of revenues devoted to discovering new molecules compares with an estimated 25 per cent spent on promotion.
This means for every £1 spent on basic research a whopping £19 is spent on marketing.
Professor Light and Mr Lexchin said urgent changes needed to be made to make the industry focus on more cost effective and safer medicines. They said the first step should be to stop approving so many new drugs of little therapeutic value.
'EU countries are paying billions more than necessary for drugs that provide little health gain because prices are not being set to reward new drugs in proportion to their clinical value,' they say. They also believe that regulators should be publicly funded and that new ways of rewarding innovation should be considered.
'This approach would save countries billions in healthcare costs and produce real gains for people's health', they conclude.
In a second paper, researchers from the London School of Economics said drug manufacturers should be made to demonstrate that their products are superior to existing treatments.
However, Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, said: 'We strongly disagree with the claims made in these papers. 'Medical research has always rested on iterative and gradual innovation rather than breakthrough advances which are very rare. If it were not for the incremental improvements made in the treatment of HIV, the disease would still be terminal rather than a manageable long term condition.
'The pharmaceutical industry's medicines pipeline is promising with many new treatments in development. But the discovery of medicines is an increasingly difficult process as the cost of research and development continues to rise and regulation becomes more onerous. In 2012, it costs on average over £1 billion to develop a new medicine and takes between 12 and 15 years to develop.' 13.8.12
GlaxoSmithKline to pay $3bn in US drug fraud scandal
GlaxoSmithKline (GSK) is to pay $3bn (£1.9bn) in the largest healthcare fraud settlement in US history. The drug giant is to plead guilty to promoting two drugs for unapproved uses and failing to report safety data about a diabetes drug to the Food and Drug Administration (FDA).
GSK targeted the antidepressant Paxil to patients under age 18 when it was approved for adults only, and it pushed the drug Wellbutrin for uses it was not approved for, including weight loss and treatment of sexual dysfunction, according to an investigation led by the U.S. Justice Department.
The company went to extreme lengths to promote the drugs, such as distributing a misleading medical journal article and providing doctors with meals and holidays, spa treatments and various gifts that amounted to illegal kickbacks, prosecutors said.
Doctors were persuaded to prescribe drugs later linked to suicide in children.
The company pleaded guilty to criminal charges related to the marketing of Paxil for use by children between 1999 and 2003, when it:
* failed to reveal the existence of two scientific studies that showed the drug was ineffective in treating childhood depression;
* cut out important caveats to the conclusion of a third study which suggested it may improve a small number of symptoms in children;
* over-hyped the conclusions of that study, after it was published, in marketing materials at conferences and distributed to doctors.
The settlement will cover criminal fines as well as civil settlements with the federal and state governments. The case concerns the drugs Paxil, Wellbutrin and Avandia. Deputy US Attorney General James Cole told a news conference in Washington DC that the settlement was "unprecedented in both size and scope".
GSK, one of the world's largest healthcare and pharmaceuticals companies, admitted to promoting antidepressants Paxil and Wellbutrin for unapproved uses, including treatment of children and adolescents. The illegal practice is known as off-label marketing.
The company also conceded charges that it held back data and made unsupported safety claims over its diabetes drug Avandia.
In addition, GSK has been found guilty of paying kickbacks to doctors. "The sales force bribed physicians to prescribe GSK products using every imaginable form of high-priced entertainment, from Hawaiian vacations [and] paying doctors millions of dollars to go on speaking tours, to tickets to Madonna concerts," said US attorney Carmin Ortiz.
As part of the settlement, GSK agreed to be monitored by government officials for five years.
GSK said in a statement it would pay the fines through existing cash resources. Andrew Witty, the firm's chief executive, said procedures for compliance, marketing and selling had been changed at GSK's US unit.
"We have learnt from the mistakes that were made," Mr Witty said. "When necessary, we have removed employees who have engaged in misconduct." 3.7.12
Break NHS state monopoly over mental health counselling, urges major new report
The NHS is failing to offer the mentally ill a full choice of psychological counselling and therapies, according to a major new report published by the Centre for Social Justice.
The report, ‘Commissioning Effective Talking Therapies,' is highly critical of the NHS's talking & other therapy services, and urges the NHS to slash its red tape and use therapists from the private and voluntary sector to allow people more choice, improved services and equal access.
At present, many therapies offered by specialists in the private and voluntary sector are not yet recommended by the National Institute for Health and Clinical Excellence (NICE), as it requires the same level of supporting evidence as treatments for chemotherapy or open heart surgery.
The report finds that the existing monoculture approach which favours the disproportionate use of cognitive behavioural therapy (CBT) is failing 84 - 87% of patients, while invalidating the broad range of other successful therapies available, and wasting millions of taxpayer's money in the process.
The scale of mental illness is startling, with one in four adults experiencing mental illness at some point during their lifetime, and one in six experiencing symptoms at any one time – making mental illness the largest single cause of disability in our society.
The cost to the economy is estimated at £105 billion annually, with a loss of around £13 billion in earnings sustained by people of working age.
Yet the report finds that the NHS continues to choke the recovery of its patients by sticking to the stringent guidance and limited number of NICE approved therapies, which specify very narrow activities, rather than rewarding successful outcomes.
Currently 15% of NHS expenditure is spent on treatment for mental illness, but the report highlights how only a narrow range of therapies are made available by its main psychological therapy service IAPT (Improving Access to Psychological Therapies).
The Government has committed to spend a further £400 million over four years to 2014/15 on counselling but this is focused predominantly on CBT, and the seven other therapies approved by NICE guidelines, leaving no additional funds to spend on additional therapies so that they can undergo the research tests necessary to secure approval.
The success rate for current therapies is just 13-16% of all clients referred to IAPT, at a time when there are at least 45 other types of therapy delivered by smaller NHS units, all of which are readily available on a national scale in the private sector.
As a result many people are denied a wider range of effective therapies through the NHS's main delivery channel IAPT. If they request an alternative therapy, they usually have no other option than to try what is on offer. When this fails, there is no second option on the NHS.
Psychotherapists and counsellors who do not practice CBT, or the other therapies approved for delivery in rarer circumstances, are simply unable to treat patients who could benefit from an alternative approach.
At the same time, IAPT is spending around £10 million per year training up a parallel workforce within the state system specialising in CBT to meet its service goals, and continues to increase its training targets.
These practioners are usually trained for just one year, when there are 17,000 professionally qualified private sector therapists accredited at the highest level by registration bodies, which requires 4 years of training and supervision.
Many also have a decade or more of practical experience.
Despite claims by the Department of Health that it listens to the needs of the patients, the report finds that little has been done to break down the crippling bureaucracy and one-size-fit-all approach favoured by NICE. In the Department for Health's report ‘Liberating the NHS: greater choice and control,' the majority of people said more choice was paramount to NHS reform, especially mental health services.
Yet only this month, the first service specification inviting public tender for any qualified provider (AQP) offered no development in providing additional therapies.
Published on 19 March 2012 by Dorset PCT, it specified its intention to ‘build firmly on the Improving Access to Psychological Therapies (IAPT) programme...[using] NICE approved/recommended psychological therapies in line with relevant clinical guidance.'
In reality, what began with a consultation with the public about additional choice, finished with a tender to the market that will deliver no additional choice in terms of available treatment.
This is despite patients and doctors wanting a choice of treatments, not simply a choice of providers of the same treatment.
Speaking at the launch of the CSJ report, Benjamin Fry, the co-author of the report and psychotherapist with his own private practice, said:
“The Department of Health's own figures show that IAPT, doesn't reach what the NHS defines as recovery for nearly 90% of the people referred to it, and costs the State about 50% more per recovery than voluntary sector services.
“The recent Dorset Primary Care Trust tender document highlights how out of touch the NHS is when it comes to psychological therapies and delivering what the patients need.
“Here was an opportunity to listen to the public and to allow a greater number of qualified providers to provide patients with real choice but nothing has changed. The number of therapies that have the potential to change people's lives for the better are being squeezed out and only available to those who can afford them.”
“The needs of those who cannot afford to pay for treatment, but whose recovery will not be achieved through the limited range of therapies IAPT offers, are going unmet; some of them will die. It is a complete disgrace.
“Tight specifications and narrow guidelines have squeezed out countless other forms of therapies which have been proven to work and are what the patients ask for.
“The much smaller non-IAPT services in the NHS employ a far wider range of therapies than IAPT and still adhere to the patient safety aspects of NICE guidelines very strictly and successfully. There is no reason why the voluntary and private sectors cannot follow this lead.”
The report cites the Department of Work and Pensions as an example of how the NHS could adopt a payment by results commissioning approach whereby voluntary and private sector providers of talking therapy are commissioned by the NHS to work at their own financial risk until they have reached a proven effective outcome with each client.
The report calls on the Department of Health to adopt the approach of the Work Programme which rewards outcome in the opposite way to NICE guidelines which specify activities, regardless of outcomes.
Minimum safety standards would be essential but this approach would obviate the need for the higher barrier of NICE guidelines and result in an integrated system.
At present, if an individual on the Work Programme needs counselling, they can be sent to a therapist who is not following NICE guidelines, and receive a full range of therapies, but at the same time, a GP cannot send his employed neighbour with the same problem for identical treatment.
The report highlights how this results in a perverse inequality of access whereby someone who is out of work and on benefits is able to take advantage of a far greater choice of therapies to get well through the Work Programme than someone who remains at work.
Dr Samantha Callan, chairman-in-residence at the CSJ, who co-authored the report, advised the NHS to pull together more effectively with the aims of the Work Programme. She said: “If therapists are paid on a consistent basis, budgets for therapy could be pooled for far greater effect.”
Dr Callan continued: “If the Department for Health used a similar approach to the DWP, they would create a range of safe, new choices without having to invest in a new workforce, and without wasting public money on unsuccessful treatments.”
“The current system has limited the number of experienced therapists available to supply the NHS at a time when the need for their effective contribution has never been more urgent.
“The patients have spoken and demand more choice. If the NHS genuinely allowed any qualified provider to provide therapy rather than the small number whose work is approved by National Institute for Health and Clinical Excellence (NICE) guidelines then patients would have greater choice and greater chance of recovery.” 25.5.12
Doctors and dentists investigated by HMRC
New evidence has suggested that more than 1,000 doctors and dentists are under investigation for tax evasion.
Her Majesty's Revenue & Customs (HMRC) has launched “civil investigations” against medical professionals after intelligence indicated widespread abuse and in some cases it is reported to be considering separate criminal investigations against doctors and dentists.
The investigation is said to have uncovered a series of complex schemes used by medical professional including use of off-shore accounts and payments made by insurance companies. 22.6.12
Monitor probes barriers to NHS competition
Health sector regulator Monitor has launched a review of possible barriers to "a fair playing field" among current and potential NHS providers.
The regulator says the move is "an independent review of matters that may be affecting the ability of current and future providers of NHS serves to participate fully in improving patient care." The aim is “to identify barriers to a fair playing field, and possible solutions which would protect and promote the interests of patients," it adds.
Matters that have already been raised as areas which might prevent some providers from operating on an equal footing with others include: - corporation and value-added tax (VAT); - NHS staff contracts and pensions; - payment systems; - barriers to exit; - teaching and training for clinical staff; - incumbency advantages; - costs of capital; - access to capital; - information and IT; - insurance; and - tendering and commissioning behaviours.
This list has been drawn up from the Department of Health's previous work on the fair playing field issue and from academic sources, but the review will start with a very broad scope, Monitor's chairman and interim chief executive, David Bennett, has told Health Secretary Andrew Lansley, who requested the review.
It "will be open to looking at any problem raised and cover all types and different sizes of providers, including NHS trusts, foundation trusts, social enterprises, voluntary and community sector providers and for-profit providers," Mr Bennett adds.
He also agrees with Mr Lansley on the need to proceed speedily with the review, given the requirement for the Health Secretary to lay a report before Parliament by March 27, 2013, as required under the Health and Social Care Act. "This requirement reflects the House of Lords' agreement to proposals from Lord Patel of Bradford regarding the urgent need for such a review," Mr Lansley notes, in his original request to Monitor to undertake the review.
Last November, in the first setback to the Act during its passage through Parliament, the Lords backed an amendment put forward by Lord Patel establishing "equality of provision" for charities supplying NHS services, which currently have to pay VAT on supplies while NHS bodies do not.
On March 19, Parliament widened this amendment to require a government review of the barriers affecting the involvement of a variety of health providers, and for the Health Secretary to report in a year's time on all matters affecting charities' ability to provide NHS services.
In his request to Monitor to conduct the independent review, Mr Lansley noted that "of particular importance will be the need to engage with charities, hospices, mutuals, palliative care organisations, co-operatives and social enterprises, as Lord Patel and others have emphasised. These organisations have always made valuable contributions to the NHS and will play a vital role in helping the NHS to provide better services and in improving health outcomes for the future," he says.
Mr Bennett has also told Mr Lansley that the need to undertake the review at speed will mean that "our recommendations to you are likely to be preliminary, to be supported by further work after the publication of the review as necessary."
He adds: "as our report will be independent of government, we expect you will want to produce your own statutory report on the fair playing field. To ensure you are able to produce this in good time, we will share drafts of the final report with [Monitor's Steering Group, which is chaired by Ian Dodge at the Department of Health] as they become available." The deadline for initial submissions to the review is July 6. 19.6.12
Elderly denied NHS care can sue individuals or trusts: Ministers will outlaw age discrimination by hospitals
- Those refused operations, test and scans can claim compensation from October
- Care Services Minister says elderly are sometimes treated badly due to 'ageist attitudes'
- Patients or relatives can file legal action if treated without dignity
Denying treatment to Health Service patients because they are too old is to be outlawed. From October, the elderly will be given the right to sue if they have faced age-discrimination by NHS staff. Those refused operations, tests and scans routinely offered to younger patients will be able to take legal action against individual members of staff or trusts, ministers will announce today.
The measure comes amid mounting evidence that the elderly are routinely being refused treatments for cancer, heart problems and strokes because of their age. Doctors have admitted that they often make judgments that are based on a patient’s date of birth before even seeing them.
And a spate of damning reports have revealed how the elderly are routinely left hungry, dehydrated and in soiled clothing on NHS wards as they struggle to make themselves heard.
Care Services Minister Paul Burstow will say today: ‘We know that older people are not always treated with the dignity and respect they deserve because of ageist attitudes. This will not be tolerated. There is no place for age discrimination in the NHS or social care. ‘Our population is ageing as more of us live longer. The challenge for the NHS is to look beyond a person’s date of birth and meet the needs of older people as individuals. ‘I have heard numerous stories from people who feel they have been discriminated against.’
The Government has made an amendment to the Equalities Act that will make it illegal for NHS staff to assume patients are too old for care.
There will, however, be cases where elderly patients are just too frail for certain high-risk operations or treatments such as chemotherapy.
But under the new law, doctors and other NHS staff will have to carry out proper consultations and take into account the patient’s fitness and health before making a judgement.
Mr Burstow said he knew of a woman of 84 whose doctor had refused her surgery to repair a leaky valve in her heart. He said: ‘She asked if she could have this fixed and the doctors said “What are you bothered about, at your age?”. 'This is exactly the kind of discrimination we want to rule out.’ He said the woman was finally getting the treatment she needed.
The Mail has long called for an improvement in the care of patients in old-age as part of our Dignity for the Elderly campaign. Last night Michelle Mitchell, director of Age UK, said: Discrimination based on your date of birth is as indefensible in 21st century Britain as prejudice on the basis of race, gender, disability or sexual orientation. ‘We hope the new law which will apply to the NHS, social care and other services will prevent older people being denied proper treatment because of their age. It sends a clear message to service providers that discrimination law will in future also protect older people.’
The amendment was first put forward by Labour by the then Health Secretary Andy Burnham. The age discrimination cases will be heard by county courts and if a judge rules in a patient’s favour they may be entitled to hefty compensation payouts. IVF treatment will be exempt from the new rules because it is not as effective for older patients.
Critics will claim that the proposals could become a ‘lawyer’s charter’ as firms seek to exploit a lucrative new market. However, last year a report by the National Cancer Intelligence Network found that women with breast cancer in their seventies and eighties were far less likely to be offered surgery than those in their fifties.
Experts said doctors often just looked at patients’ dates of birth in their notes and drew up treatment plans without even seeing them. And NICE, the NHS watchdog, has warned that the elderly with hip fractures are often regarded as ‘low priority’ by staff. Last June the organisation claimed the operations were frequently carried out by junior doctors rather than senior consultants.
There is also particular concern about the care for elderly patients with dementia. Experts warn that thousands are never given a proper diagnosis because doctors simply view it as an inevitable sign of old age. 13.6.12
NHS Campaigns like this don't save lives - they just clog my surgery with people scared witless
Comedian Ricky Gervais is one of several celebrities fronting a new government campaign to raise awareness about lung cancer. The hope is to save 1,300 lives a year. So why does leading GP DR TONY COPPERFIELD think it's such a daft idea?
Like many of my GP colleagues I think the new campaign to promote public awareness of the symptoms of lung cancer is an incredibly stupid idea. That might sound illogical, not to say heartless. How can I as a doctor be opposed to a campaign aimed at saving lives? Lung cancer is a dreadful disease which is often diagnosed too late to treat successfully and which is the leading cause of cancer deaths in the UK, killing 35,000 every year.
But I can predict what this campaign will lead to. It will unnecessarily freak people out and my surgery will be packed to the rafters with acutely anxious patients, most of whom have little wrong with them. The campaign urges anyone with a cough which lasts three weeks or more to visit their GP. But as any doctor will tell you, three weeks is on average the time that a cough lasts when it's caused by a straightforward viral infection. So this is going to encourage loads of basically healthy people who have a bog standard minor illness to rush off to their GP, suspecting they have something far worse.
'Unneccessary': Dr Copperfield claims the high-profile campaign will only encourage basically healthy people who have a bog standard minor illness to rush off to their GP, suspecting they have something far worse
I've already seen this happen during the ‘awareness campaign' for bowel cancer symptoms which ran earlier this year. At first I was puzzled why so many of my patients were coming to see me complaining only of diarrhoea.
I couldn't work out why my usually sensible patients were all so obsessed with their bowel movements. Then, after seeing the fourth such patient in a week, the penny dropped after he explained. ‘Haven't you seen?' he said. ‘It's been in all the papers and on the telly — bowel cancer awareness.'
The campaign had passed me by, but apparently the Department of Health had been telling people that one of the main symptoms of bowel cancer is loose stools for three weeks or more. (They seem to be obsessed by the magic three weeks, even though guidance from the National Institute for Health and Clinical Excellence — NICE — on bowel cancer states patients should be referred for tests after a more realistic six weeks).
Now, persistent diarrhoea might be a symptom of bowel cancer, but it depends on the context. Loose motions are more worrying if there is also blood in the stool, if you're over 60 (85? per cent of those with bowel cancer are in this age group) and if there's a family history of the disease.
But the campaign message was such a blunt instrument that many people became needlessly worried they had cancer. Buoyed by the ‘success' of the bowel cancer campaign, the Department of Health is at it again — with the lung cancer campaign.
But won't it be worth it if the campaign saves only one life?
My answer to this is that this won't happen if the surgery is so packed with the worried-well that people who are really at risk of cancer find it difficult to get an appointment.
And even if a cancer awareness campaign uncovers one cancer, even if one person is saved, you have to look at the negative side — the terrified patients, the unnecessary work for already overloaded GPs, and even, in some cases, the needless tests and investigations which some people will get referred for, potentially causing delays for those who really need testing. This keeps NHS departments with lots of patients.
I don't know why the government is getting it so wrong. My guess is it's a case of ‘You can't be too careful' — they don't want to come under fire for any cases of lung cancer being missed.
Also, I suspect it is specialists who advise on these campaigns and the patients they see are the serious cases, so they get a distorted view and are unaware there are masses of people with the same symptom who have nothing seriously wrong and never get as far as a specialist. There isn't enough input from GPs who can give more of a perspective on minor symptoms like a cough.
It may also be true that specialists — and cancer charities — have drums to bang and might decide it's worthwhile needlessly frightening people if it generates publicity for their particular field.
The lung cancer awareness campaign only went national after a pilot campaign in the Midlands was judged by the Department of Health to have ‘positive results.'
So what were these ‘positive results'? In areas where the pilot ran, more patients went to see their doctors and more were referred to hospital for chest X-rays and CT scans, compared with the same period the previous year.
In other words, the success of the pilot was judged not on whether more cases of lung cancer were detected or whether lives were saved, but on the fact that more people made appointments with their doctors and went to hospital for tests.
It's not just me who thinks the government has got it wrong.
When I wrote about this recently in a doctors' magazine, one anonymous NHS worker involved in the pilot said the Department of Health had been told by the pilot sites that three weeks was far too short a period for encouraging patients to go to the doctor with cough symptoms and that six weeks would be more appropriate, but the Department of Health didn't listen.
GPs are trained to put symptoms in context. The likelihood that you have lung cancer, for example, doesn't just depend on whether you have a cough but on whether there's an obvious alternative explanation like a virus infection, as well as your age (lung cancer is most common in people between 75 and 79), and — very important — whether you smoke or have ever smoked.
But this type of campaign ignores the context. The result is a simplistic message which might make a snappy headline — but which will worry a lot of people.
The government needs to look at the negative impact of these campaigns, including the false alarms and the fact that overall, waiting times may be driven up because of the increase in people with minor symptoms being referred to hospital. It needs to take account of these unintended consequences before deciding if a campaign is needed at all.
And if it is needed, the government should be braver and more realistic in its advice to the public.
It needs to forget the easy message which makes for snappy headlines and try to convey the complexities — for example, that an unexplained cough for three weeks in a smoker aged 60 coughing up blood is clearly a different thing from a cough of the same duration in a 20-year-old non-smoker who's just had a cold.
Obviously, no one wants to see any delays in the diagnosis of a deadly disease like lung cancer. Being aware of potential symptoms is a good thing — but there's a difference between improving awareness and generating needless anxiety.
Dr Tony Copperfield is a GP in Basildon, Essex, who writes for Pulse magazine and is the author of Sick Notes: True Stories From The GP's Surgery, published by Monday Books. He was speaking to CAROLINE LAVENDER. 7.6.12
Healthy hit by a plague of over diagnosis of conditions that will never cause serious symptoms
Peace of mind? No, health checks-ups can do more harm than good
Elmbridge councillor defends two-tier NHS proposal
Those who drink, smoke, take drugs or are obese should be told to shape up, ship out of Surrey or endure a slower healthcare service. That is the message in an email, leaked to the Elmbridge Guardian, from a Conservative councillor who sits on Surrey's health committee.
Cobham councillor John Butcher, elected in Surrey and Elmbridge, said offering a slower-moving waiting list for the “self-inflicted” would force them out of Surrey to areas where politicians believe in equality in the NHS.
As a result, these equality areas would see voters die out at a faster rate and lessen the power of those that represent them in Parliament, the email continues.
Coun Butcher said: “If the NHS in Surrey were to be run on the basis that patients with self-inflicted morbidity (mainly smoking, alcohol, narcotics, obesity) and injury (dangerous activities) are, following due warning, placed in a much slower-moving queue for healthcare than ‘other' patients, this would encourage the self-inflicted to move away from Surrey, to areas where there is no differentiation between patients on the grounds of their contribution towards their condition.
“And it would deter the self-inflicted from coming to live in Surrey. “Over time, that would result in the healthcare for the ‘other' patients in Surrey being significantly better than the average national level for all patients, as the resources deployed to the self-inflicted would be very much reduced.
“This factor would attract more ‘other' patients to come to live in Surrey – and that would push up house prices here.”
The comments were made in an email to a council employee to explain his absence from the health overview and scrutiny committee (HOSC) on May 24.
The email spread like wildfire through the council and was eventually forwarded to this newspaper by an anonymous source.
Residents' Association councillor Karen Randolph, chairman of the Save Our Surrey Community Hospitals campaign, said: “The views expressed by Coun Butcher challenge the very credibility of Surrey County Council's (SCC) HOSC.
“It is highly disturbing the Conservative administration at SCC has deemed it appropriate to appoint to this committee a councillor who clearly does not support the NHS and who holds such extraordinary views about the responsibilities of the state to its citizens.”
Brian Mackenzie, a volunteer in the drug and alcohol sector in Surrey, said addiction to drugs caused misery, pain and death. He said: “It is a disaster and we try to help these people get back on their feet, rather than export them to a desert island, like we used to do with prisoners to Australia to get them out of the way.
“We want to be positive about it and try to get treatment for them. “This man has no idea and he should probably inform himself by working as a volunteer in one of the agencies that help people with addictions and learn about the issues before he opens his mouth.
“I thought it was a joke at first, some sort of satire. It is unbelievable. But, thankfully he is in the minority and this is not an establishment view.”
Coun Butcher said the email was based on a submission he made more than two years ago about the NHS constitution, where he suggested the risk of worse healthcare for those with harmful habits would hopefully be enough to encourage them to lead healthier lives.
He said: “This country needs an honest debate on how the NHS can be saved and many patients must be encouraged to do a great deal more to reduce the self-inflicted demands they make on the NHS, to help it survive, and to help themselves and other patients, who suffer when resources are diverted into dealing with such self-inflicted demands.”
In response to Brian Mackenzie, Coun Butcher said: “I need to make it clear that, under my proposals, a condition would not be regarded as self-inflicted if the patient was unable to prevent the condition, as is the case with an addict, even if he or she was able to have done that before addiction set in. But I would expect an addicted patient to seek prompt help and to co-operate with NHS and related efforts to help him or her overcome that addiction.” 1.6.12
Time for a power shift in the NHS
The command and control culture of the NHS needs to be broken and the people – patients and doctors – given more of a voice, says Richard Vize
Moves to shift power from managers to clinicians will be all but worthless unless clinicians in turn cede power to patients. And patients are the managers' best hope for securing better and cheaper services.
It is an extraordinary British tradition that our brightest schoolchildren yearn to spend years training for modestly remunerated jobs in a nationalised industry – as doctors in the NHS. The realisation that the long term viability of the health service requires heroic improvements in quality and productivity is compelling managers to liberate the immense talents of these, and all their other, clinical staff. This means breaking the command and control culture and giving clinicians both the power and the responsibility to improve existing services and develop new ones.
The new King's Fund report Leadership and Engagement for Improvement in the NHS – subtitled "Together we can" – provides compelling evidence from the UK and internationally that engaging staff in improving services raises outcomes, cuts mortality and infection rates and reduces errors.
There are inspiring examples of the difference empowering staff can make, such as the McLeod Regional Medical Center in South Carolina, where visitors "marvel at the enthusiastic, effective leadership and participation of McLeod's doctors in quality, safety and value initiatives".
But empowering clinicians is only half the job. As Angela Coulter, a patient involvement expert, demonstrates in the King's Fund report, involving patients in their care improves the management of long term conditions, secures better treatment outcomes, promotes patients' independence and ensures a better experience. But everything – from a fear of losing power to a desire to remain remote from patients' emotions – has meant that in the UK involving patients as full partners in their care remains the exception.
The NHS has always found listening to patients rather a trial. Since 1974, a steady succession of organisations – community health councils, patient and public involvement forums, local involvement networks and now the over-hyped, poorly structured and probably ineffectual HealthWatch – have wrestled with trying to give patients a voice in the NHS structure. Each of these botched attempts have only highlighted the failure of the NHS to embrace the patient as a partner in care.
The value of patients to managers is that they are an unsurpassable source of intelligence on the performance of every part of the organisation. They are the ones who know where the gaps in the system are, where tests are duplicated and the same information repeatedly collected, and where the clinicians are trying to push patients into treatment options they do not want. And, of course, they also tell you where exceptional care is being delivered from which others can learn.
High performing boards and management teams put patient experience data at the heart of their work. Individual complaints are used to highlight and fix system-wide weaknesses. These are as likely to save money as cost it. Northumbria Healthcare NHS Foundation Trust, for example, has patient survey scores for named consultants which are used in appraisals. Salford Royal NHS Foundation Trust is impressively open about any incidents of patient harm, such as pressure ulcers and falls. When there are complaints or errors, nurses and other staff work closely with patients and families to identify what went wrong and change it.
For managers wanting to integrate care within their own organisation and with the wider health and social care system, the patients are the ones who know how the disparate parts connect and what it feels like to move from hospital to primary care to social care.
If listening to patients and involving them in their care was simply a matter of projects and initiatives, it would have happened already – the NHS is awash with projects and initiatives. They have largely failed to make a difference on the scope and scale needed because they are bolted on to a system where the command and control culture is reflected as much in the relationship between clinicians and patients as it is between managers and clinicians. Both need to change to secure the improvements the NHS needs. 31.5.12
Healthy hit by a plague of over diagnosis of conditions that will never cause serious symptoms
Healthy people are being harmed by the trend to ‘overdiagnose' conditions that will never cause serious symptoms, say medical experts. Millions of adults at low risk are being told (through screening) they may eventually suffer diseases that require drugs for life, according to an analysis.
But the decision to hand out such information is often made on lower thresholds of evidence than in the past, it is claimed.
Overdiagnosis is harming the healthy who are afflicted by anxiety and over-treatment and it wastes resources on unnecessary care, say specialists writing for the British Medical Journal.
Changing diagnostic criteria are increasing the numbers of ‘sick', causing ‘virtually the entire older adult population to be classified as having at least one chronic condition' claim the authors.
Research suggests one-third of people diagnosed with asthma may not have the condition, up to one in three breast cancers detected through screening may never have led to symptoms and some women at low risk of breaking bones are being harmed by osteoporosis treatment.
Around eight million Britons take statins for high cholesterol levels, some of whom have not had a heart attack or stroke, but there is pressure for even lower risk people to take them at younger ages.
Co-author Ray Moynihan, senior research fellow at Bond University in Australia, said overdiagnosis wastes £128billion a year in the US alone.
He said: ‘Increasingly we've come to regard being “at risk” of future disease as being a disease in its own right. Evidence mounts that we're harming the healthy.' Controversially, the experts believe the benefits of early diagnosis, particularly of cancer, have been oversold to patients.
‘Contrary to popular notions that cancers are universally harmful and ultimately fatal, some cancers can regress, fail to progress or grow so slowly they will not cause harm before the individual dies from other causes,' the authors claim. Such cancers include prostate, breast and thyroid cancer, the bulk of which will never harm.
The overdiagnosis trend is being driven by the cultural belief in early detection, fed by a deep faith in medical technology. Vested interests are also to blame, along with legal and health systems that punish underdiagnosis, say the authors.
Proposals for change include revising disease thresholds to reduce treatment for people at low risk of ill-health. 30.5.12
Better buying 'to save NHS £1.2bn' claims minister
Health ministers hope to save taxpayers £1.2 billion over the next four years by getting NHS managers to become better at buying millions of medical items from surgical gloves to MRI machines.
They admit the current system is extremely wasteful and that more must be done to make "every penny count".
A year ago the House of Commons' Public Accounts Committee criticised the "fragmented system of procurement" saying it had produced "a great deal of waste".
Hospital trusts were being charged different amounts for the same product, "ordering in inefficient ways" and "failing to control the range of products which they purchase".
A graphic example is that 61 trusts were found to have bought between them 1,751 different types of cannula, medical tubes that are inserted into the body, according to an earlier report by the National Audit Office.
It also found one hospital bought 177 types of surgical glove, while another made do with just 13.
Today (Monday), Simon Burns, the Health Minister, will announce new plans to improve procurement.
They include establishing a £300 million cash fund for NHS Supply Chain, which helps buy goods and services, to enable it to bulk-buy large items like CT and MRI scanners for less money.
These typically need replacing every 10 years or so due to wear and tear, and about 200 will be needed over the next two years, according to the Department of Health.
Mr Burns said: "Waste is unacceptable when we know there are simple solutions. That is why the NHS needs to buy smarter and get the best value for the taxpayer for every penny spent.
"We know that at least £1.2 billion could be saved over the next four years if the NHS innovatively changes the way it buys goods and services. "Already, over £11 million has been saved through bulk-buy discounts on the cash fund.
"This is the first step to better, smarter procurement in the NHS and we will be working closely with hospital trusts over the next six months to help them save even more money that can be reinvested in patient care." 29.5.12
Rip-off dentists face crackdown over fees for private treatment that costs FOUR times more and should be done free on the NHS anyway
Fees in Britain are among the highest in Europe
Many let teeth rot because they cannot afford the work
Unscrupulous dentists face a crackdown amid evidence that patients are being duped into paying for private treatments which should be free on the NHS. The Office of Fair Trading is today demanding an urgent and radical shake-up in the £5.73billion UK market as Britons are being 'deliberately misled' into spending up to four times more for fillings and crowns.
As many as 500,000 people a year are being duped into paying for expensive private treatments that should be free under the NHS, the OFT said. Research suggest fees in this country are among the highest in Europe, with a bill for a check-up running to as much as £124.
Many people struggle to find an NHS dentist at all while others are letting their teeth go to ruin because they cannot afford the work.
The OFT's findings are a damning verdict on new contracts for dental services which were introduced by the Labour government in 2006.
Importantly, the watchdog said any qualified dentist should be allowed to offer NHS treatment, rather than the current closed shop where a group of contracted dentists provide services based on annual quotas. This would allow individuals to choose their dentist from a wide field, so increasing competition.
The OFT also argues people should be able to make direct bookings with hygienists, rather than having to go through a dentist. This would allow High Street chains such as Boots and Superdrug to offer cheap ‘walk-in' services.
The watchdog is also concerned about the hard sell of expensive monthly dental plans by some practices which can be poor value.
Chief executive John Fingleton said: ‘Our study has raised significant concerns. ‘All too often patients lack access to the information they need, for example when choosing a dentist or when getting dental treatment. ‘We also unearthed evidence that some patients may be receiving deliberately inaccurate information about their entitlement to NHS dental treatment, and we expect to see robust action taken.'
Some 39 per cent of people who had been to the dentist in the past two years reported there were no leaflets or posters providing information on NHS charges. More than eight in ten people who recently received a course of dental treatment did not receive a written plan spelling out what was to be done and the cost.
The OFT said: ‘We are particularly concerned to find that around 500,000 patients each year may be provided with inaccurate information by their dentist regarding their entitlement to receive particular dental treatments on the NHS, and as a result be required to pay more to receive private dental treatment.'
The OFT is also highly critical of the NHS and industry bodies for doing too little to weed out rogue dentists who mislead patients, are incompetent or overcharge.
Patients' Association chief executive Katherine Murphy said: ‘Patients frequently tell us that they are not being given the information they need to make informed choices about their dentistry treatment. They feel they are paying for treatment that may not have been necessary.
‘Dentists have been able to get away with unacceptable practice.'
The British Dental Association insisted most patients were ‘happy'.
Executive board director Dr Susie Sanderson said: ‘The delivery of effective dental care is all about good communication between dentists and patients. That communication will not be enhanced by the OFT's headline-grabbing approach to publicising this report.'
Labour's controversial contracts resulted in thousands of dentists quitting the NHS, leaving many communities without a dentist. They were blamed for an estimated one million people losing access to an NHS dentist between 2006 and 2008.
The Coalition last year launched pilots of a new dental contract, focused on improving children's oral health.
Dentists will be paid for the number of patients they care for and the health results, rather than the number of courses of treatment performed.
Health minister Lord Howe said: ‘Denying patients care on the basis of misinformation is a very serious matter. Any dentist that does this risks breaching their contract and we would expect the local NHS to take action.' 29.5.12
Hospital 'fraud' threatens clinical commissioning, GP leaders warn
Hospitals that overcharge for care should be viewed as committing 'fraud', and failing to tackle the issue will 'kill' GP commissioning, an LMC has warned.
Avon LMC called on the GPC to act over what it called a 'crazy' situation that threatened GP commissioning. Representatives from the LMC staged a protest at the LMCs Conference in Liverpool by holding up a sign spelling 'FRAUD'.
Speaking at the conference, Avon LMC chairman Dr Simon Bradley said: 'Corrupt coding will kill clinical commissioning. Inappropriate coding of hospital procedures costs commissioners maybe hundreds of millions of pounds each year, and prevents the identification of funds to follow the work into primary care. Clinical commissioning will fail if we do not correct these coding practices.'
He said an Audit Commission report had found the problem was 'widespread and system-wide', yet he said SHAs, PCTs and the regulator Monitor had been unwilling to act.
Dr Bradley said this coding practice was being used by hospitals to prop up their finances. He said: 'I have one patient who goes daily for monitoring of her pregnancy. Because it's done on the delivery suite she's charged as an admission, but it's an outpatient procedure. That one patient has cost the commissioner £30,000, and it should only have cost a matter of a few hundred.
'I've had patients who have just had their pulse taken to make sure their heart is beating the right rhythm,' he said, explaining this is then coded as an admission. 'Crazy,' he said. He said in the past these may have been mistakes, but from now on if hospitals continued to do this it should be viewed as 'deliberate deception' and therefore 'fraud'.
Failing to tackle the problem will undermine clinical commissioning, he added. 'The whole basis of payment by results is undermined by hospitals being able to code things not by the rules but by what serves them best financially.' He said Avon LMC would continue to campaign on the issue. 23.5.12
We need an Office for Scientific Responsibility
Politics doesn't value evidence-based policy, but policy-based evidence. It's time for ministers to realise that science matters.
It was classic Malcolm Tucker.
Informed that scientific evidence had led the minister to question government policy, the Downing Street spin doctor fired back: "Yeah, but I've got an expert who will deny that."
Who was this authority, the minister inquired? "I have no idea, but I can get one by this afternoon." As so often with The Thick of It, the exchange captured a truth.
Politicians of all parties love to portray themselves as champions of science who follow the evidence wherever it leads. But they rarely want all the evidence – just the bits they can use to justify decisions they're taking anyway. What politics really values isn't evidence-based policy. It's policy-based evidence.
When the Gordon Brown government decided to reclassify cannabis as a class B drug, home secretary Jacqui Smith ignored the misgivings of the Advisory Council on the Misuse of Drugs (ACMD). Instead, she sought more convenient evidence – already weighed and found wanting by her advisers – to support "a compelling case to act now rather than risk the future health of young people".
The coalition has been just as bad. Stung by the ACMD's insistence on banning "legal highs" only on a scientific basis, Smith's successor Theresa May abolished its statutory scientific membership. It can now be packed with the "right experts", as Tucker might put it. Caroline Spelman claimed her long-promised badger cull as "evidence-based" over the protests of the scientists behind the very research she cited. And to justify his NHS changes, Andrew Lansley embarked on a wholly misleading comparison of heart attack deaths in Britain and France.
Each of these policies emerged from political calculation, to appeal to supporters or public opinion. Yet none of the ministers responsible had the guts or the honesty to admit that.
In search of cover for populism or ideology, they cherry-picked data to create a veneer of scientific authority for an unscientific case. This is evidence abuse, and the ease with which politicians get away with it has two pernicious consequences. They feel less pressure to act on scientific advice to make policy that is properly fit for purpose. And it devalues evidence as a currency that voters can use to make up their minds. When every policy is presented as evidence-based, it becomes difficult to know which are genuinely founded on science.
This damaging culture of evidence abuse is partly born of the staggering under-representation of science in the House of Commons. Some 158 of our 650 MPs have a background in business. Another 90 had prior careers in politics, 86 in law, and 38 in the media. Yet just a solitary MP – Julian Huppert, the Lib Dem member for Cambridge – has worked as a scientist, and only two more have scientific PhDs.
This shortage denies politics a cadre of people who understand that evidence isn't a kind of magic dust you can sprinkle on a policy to give it credibility, but that you have to look at it all. We need more MPs whose instinct is to consider research in the round before they decide, not twist it afterwards.
For those who lack that instinct, however, policy-based evidence will always be catnip for as long as it carries no political cost. We need urgently to create one, so ministers who aren't ashamed of evidence abuse avoid it out of self-interest. This government has already established an independent Office for Budget Responsibility as a disincentive to fiddling economic figures. It should set up an Office for Scientific Responsibility as well.
Like the OBR, this body wouldn't limit the executive power of ministers, who would remain free to act without, or even in the face of evidence. But when science is cited to justify a policy, the OSR would audit it, naming and shaming those who bend it to their political advantage. The Smiths and Spelmans who reject scientific advice would thus have to admit to it, or face an official rebuke that their Malcolm Tuckers would struggle to spin. It's only by making evidence abuse politically painful that we can hope to put a stop to it. 11.5.12
Screening has over-promised and under-delivered
What could possibly be wrong with having a mammogram? Or a PSA test for prostate cancer? Even a full body CT scan? Finding the signs of illness before it strikes you down is always the best course of action – isn’t it?
You might have similar thoughts when offered a routine screening test, ultimately believing that screening for illness before it happens can only do good. So, you may be in for a shock, as I was, when I discovered how often medical screening has overpromised and under-delivered. And how frequently the “screen early, screen often” paradigm — including even simple blood tests to check for high cholesterol — can rapidly turn perfectly healthy people into patients.
Some medical screening, such as early testing for colon or cervical cancer, has a long lineage of strong evidence that it can save lives. Others, not so much.
The poster child for inappropriate and harmful screening is probably the full-body CT scan, which is routinely promoted with a “better safe than sorry” message that is compelling, but neither supported by independent experts or good science.
Here’s what not advertised: a full-body scan is pretty much guaranteed to find some kind of abnormality that likely won’t hurt you. In a study published in Radiology, 86 per cent of patients of 1,000 symptom-free people who had full-body CT scans had an abnormality detected.
The average person had 2.8 abnormalities revealed by the CT scan – items which appeared unusual, but either disappeared on their own or were so slow-growing that they never went on to threaten the individual.
Even for screening programs that are well-studied, such as those for breast or prostate cancers, the chances of being saved by the test are often outweighed by the possibility that the individual will be hurt by the testing or possible treatments which follow.
Yet, since most of us know someone whose life has been “saved” by a test, we submit. The PSA test, which screens a man’s blood looking for risks of prostate cancer, might seem like a no brainer for many men, especially those who have lost brothers or a father to the disease. But what most of us aren’t going to hear is that when an individual has a high PSA score (which could be caused by many things), the doctor can’t tell if the patient has the slow growing-type of prostate cancer that the majority of men eventually get (and won’t die from), or the fast-growing type that can be quickly lethal.
Here’s the data, taken from a study published in the New England Journal of Medicine: to save a single man dying from prostate cancer, 1,410 men need to be screened, and of those, 48 will undergo treatment (with chemotherapy, surgery or drugs). About 30 of the treated men will end up impotent or incontinent (a possible consequence of the treatment).
Screening can be a terribly difficult and emotional decision because many of us don’t think in terms of numbers like these. Medical screening falls under the spell of the “popularity paradox” where despite high levels of false positives for many tests (common in breast, lung and prostate cancer screening especially), people still rally behind them. We ask our friends and relatives to help raise money for “the cure” and are cheerleaders for the message of early detection.
In the world of breast cancer screening, many of us know a woman who has dealt successfully with the disease, and are led to believe that early screening saved a life. The truth is that some women, even with screening, will die. And many women, without screening, will be treated successfully. What’s often not factored into the decision-making process is the potential harm incurred from the many false positives, the subsequent radiation from repeated testing, and the pain and suffering from potential biopsies and treatment.
One of the most common side effects of medical screening — the wrenching psychological impact of telling someone they may have cancer when they don’t — is rarely taken into account. And it’s significant.
The latest research for breast cancer screening, from the Canadian Task Force on Preventive Health Care, says that you’d have to give mammograms to 2,100 women aged 40 to 49 every two years for 11 years to save one life. In the interim, screening will result in almost 700 false positives (think more testing, more X-rays and investigations) and about 75 women will have an unnecessary biopsy.
Early screening on its own, without the evidence to back up its usefulness in saving or improving lives, is not only costly to our public health system, but may even cause patient harm.
The principle here is that even when saving a life by screening seems the intuitive and right thing to do, it’s not a deal you should ever enter into without understanding the probabilities first – your chances of being helped or hurt by the test. Talk to your health provider, and always ask for the evidence.
Alan Cassels is an expert adviser with EvidenceNetwork.ca, and a researcher at the University of Victoria. His new book, Seeking Sickness: Medical Screening and the Misguided Hunt for Disease (Greystone Books) will be released this month.10.5.12
End of anti-depressants? Magnetic pulse therapy eases depression in third of patients
Depression affects one in four of us at some point of our lives, but controversy still reigns over how to best treat the debilitating condition.
Now scientists have found that a type of 'magnetic therapy' - which involves no brain-altering drugs or invasive procedures - could be a potent new treatment.
A team from the University of California Los Angeles were testing NeuroStar TMS Therapy, which works by beaming magnetic pulses through the skull. These trigger small electrical charges that spark brain cells to fire. Results from tests on more than 300 patients with severe depression found 58 per cent achieved a positive response while more than a third (37 per cent) went into remission. The study was released at the annual meeting of the American Psychiatric Association.
Research leader Dr Ian Cook, said: 'The improvements we observed show that non-drug therapy with NeuroStar TMS not only reduces the symptomatic suffering of patients, but lessens the disability of depression with important implications for these individuals' ability to return to functioning effectively at home, in the workplace, and in the community.' All the patients filled in a health questionnaire before and after the treatment.
During each half-hour session the patient was placed under a treatment coil which is the size of a cupped hand. It sent a pulsed magnetic field an inch under the scalp to the prefrontal cortex, the ante cingulate cortex and the limbic system, which are the three areas of the brain thought to regulate mood.
The magnetic field is similar in strength to that created by an MRI machine and sparks off very small electrical currents within the brain. This stimulates neuron activity thought to provide relief from depression. Anti-depressants are released into the blood, which can cause widespread physical side-effects such as hot flushes and nausea. However, supporters of Neurostar say because it's a targeted therapy it only causes mild scalp pain.
After an average of five weeks of NeuroStar treatment, the percentage of patients reporting extreme problems with anxiety and depression decreased by 42.2 per cent. A previous study had found that the therapy was twice as effective as a placebo in reducing depressive symptoms.
Dr H. Brent Sovason from Stanford University, said: 'These data reinforce the clinical efficacy of TMS Therapy as a viable option for patients living with major depression who have not achieved or maintained symptom improvement with oral antidepressants. 'The most meaningful takeaway for patients is that TMS Therapy has the potential to make them feel better, in addition to potentially allowing them to experience a level of physical and social functionality they haven't had with their depression.'
In the UK depression for depression involves either medication or talking treatments such as cognitive behavioural therapy, or usually a combination of the two. 10.5.12
Think the drugs your GP gives you are safe? Well, don't be so sure
We are all swallowing an increasing number of pills, not just to treat disease but to cut the risk of getting a disease in the first place. Even in a time of austerity the NHS is spending nearly £12?billion on drugs and the total keeps rising. People believe the drugs are effective and safe because they have all been properly tested in clinical trials. But this is a dangerous delusion.
Failures in our system for testing drugs mean not only are drugs often no better than a placebo, but, at worst, they end up damaging the health of tens of thousands of Britons every year. Pharmaceutical companies spend billions conducting trials to come up with evidence for the benefits of drugs, but they have a number of ways of making small benefits look impressive.
Then they play down or conceal damaging side-effects. There are a number of examples of drugs with serious side-effects that the pharmaceutical companies have actively hidden from drug watchdogs as well as patients. Recent well-publicised cases include the anti-inflammatory painkiller Vioxx that caused heart attacks, the diabetes drug Avandia that also caused heart attacks and anti-depressants known as SSRIs that raise the risk of suicide.
Patients have been paid billions of dollars in compensation in America and Vioxx and Avandia have been taken off the market — but the SSRIs are still widely used. And these are just the drugs we know about.
We are in this disastrous situation because clinical trials today are part of what might be called ‘results-based medicine'. The original objective of clinical trials was simply to find out if the drug in question was effective and safe — but that ideal is at death's door.
What has taken over is a hard-nosed ‘whatever it takes' commercial approach. For instance, despite repeated requests by researchers for the full results that were used to license the blockbuster anti-flu drug Tamiflu, the company has refused to make them available. Researchers wanted to see the data because of a strong suspicion the drug was far less effective than claimed.
But it wasn't supposed to be like this. More than 50 years ago, following the Thalidomide disaster, a scientific system of properly testing drugs was set up. Before any drug could be prescribed, trials should prove it was safe and more effective than an inert ‘sugar pill', a placebo.
But drugs have been turned into just another commodity, supported by brilliant marketing of the benefits, while problems and dangerous side-effects are brushed under the carpet, turning what should be a huge benefit into an increasing problem.
Before a drug can be widely prescribed, it has to go through an intensive period of testing, first on animals, then on a small number of patients to see if it is more effective than a placebo. Finally, there are two larger trials, usually involving several hundred people treated for between three to six months. Information from these is then passed on to the drug regulators in each country — the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK — who then check it before issuing a licence.
So how have drug companies managed to get round this system designed to protect patients?
The simplest way is just not to publish unfavourable results. Another way is to publish negative trials but to make them look good. There are plenty of cases on record of senior consultants being paid handsomely to present findings from trials in a favourable light. Meanwhile, doctors who speak out about drug dangers can be vilified and journals who try to publish their work can be threatened with litigation.
As a psychiatrist who has spent nearly 15 years uncovering concealed evidence of how SSRIs can cause patients to commit suicide, I'm very aware of the ability of drug companies and drug regulators to keep asserting there is no problem in the face of the most damning evidence.
In a system committed to patient safety, reports of side-effects would be carefully investigated. But when I uncovered evidence that the companies making the SSRI drugs for depression were hiding studies that showed a raised suicide risk, no one wanted to know. The UK drug watchdog — the MHRA — did nothing. Another technique to play down unfavourable results is ‘ghost writing'. In theory, the scientist heading a clinical trial analyses the findings and the results are published with his or her name on it. Not so in the distorted version of evidence-based medicine created by drug companies.
We are talking here about the controlled trials, which doctors and regulators rely on to tell if a drug is more likely to work for you or to cause you harm. Worryingly, many that appear in top journals such as the New England Journal of Medicine have actually been written up by ‘ghosts' employed by the pharmaceutical company that has a patent on the drug, and so are far more likely to provide the results they want.
However, the name that appears on the paper is often that of a senior consultant who is well paid for lending his name and authority to the work.
Sometimes, there can be a shocking gap between what the trial had found and how it was written up.
Then there is the reclassifying of patients. Every trial has patients who drop out — for personal reasons or because they couldn't stand the side-effects. But they are all simply classified as being ‘non-compliant', meaning they didn't take their drugs. There is a fundamental reason why doctors and patients can't get reliable information about side-effects from supposedly ‘scientific' clinical trials.
It's not just that they are downplayed or hidden — the trials aren't designed to find the problems in the first place.
Trials run for only a few months with a few thousand people. That's not enough time or numbers to detect rare but serious side-effects when millions of people take a drug for years.
Also, the side-effects are often the same as the ones caused by the disease. Depression raises the risk of suicide but so do SSRI anti-depressants. Cardiovascular conditions cause memory loss and diabetes — as do statins. The way to isolate the side-effects of the drugs is to test them on healthy volunteers, which companies have to do, but the results are rarely released to the public.
Just how much the system allows drug companies to accentuate the positive and eliminate the negative was shown in the way a tranquiliser called Zyprexa (olanzapine in the UK) was promoted. It was licensed on the basis of four clinical trials involving just over 2,000 patients.
Yet the company was able to carve up the results into separate articles that appeared in 234 medical publications all saying how effective this drug was. The evidence for its benefits appeared overwhelming when it was just the same data being repeated.
Sales soared. There was no mention of the potentially deadly side-effects, even though it was known to increase the risk of diabetes and heart disease — as well as being linked with suicide. The companies cut the risk up into small bits so that overall it looks safe.
But until trial data is freely available for independent researchers to examine, these abuses are likely to continue.
Professor David Healy's book, Pharmageddon, is published by the University of California Press, £27.95. 24.4.12
NHS Leadership Academy launched to create managers of the future
The NHS Leadership Academy has been launched in a bid to become a “world class” national centre to produce and inspire current and future generations of NHS leaders to drive improvements in patient care.
It is hoped it will help develop outstanding leadership in order to improve patients’ experiences, their health outcomes and their wellbeing.
To do this it will work with doctors, nurses, health professionals and managers from across the NHS. It will also work with public health and social care, and with local government, where Health and Wellbeing Boards are key to improving health and care outcomes.
Secretary of state for health Andrew Lansley unveiled plans for the Academy in July last year.
NHS chief executive Sir David Nicholson said: “The ethos is simple. NHS success is dependent on great leadership right across the service, across clinicians and managers. Great leaders create working climates where people working with them feel engaged, empowered and satisfied. Those people in turn have a direct positive impact on patients’ experiences and their health outcomes. Everyone working for, with or on behalf of the NHS has a crucial role to play in this, as we focus on our purpose of improving health outcomes for our patients.”
“We face huge challenges across the world of health, social care and public health. Our leaders must be better equipped and more innovative than ever before. Vitally, they must be able to work in an integrated way across health and social care, to make sure people have a consistently good experience of our services.
“Developing outstanding leadership has never been more important than now.”
Jim Easton director of transformation for the NHS Commissioning Board, added: “The Academy will provide expertise and support to help the leaders we have now. At the same time it will support the development of a new generation. They will steer the NHS into a future, which builds on our existing strengths and adds new ones, championing clinical leadership, inclusion, equality and diversity, and encouraging innovation.
“People will be able to access this learning and support from an ‘entry’ level to the most senior and experienced leaders.
The Academy will give them all tools, techniques, support and behaviours to help them engage and enable their staff, partners and patients, as well as continually improving standards.
“'With change at a scale and pace the NHS has never seen before, the fundamental difference between success and failure is the calibre of leadership.”
The Academy launches its new website (www.leadershipacademy.nhs.uk) with video stories from some of the NHS’s most inspiring clinical and managerial leaders about their work and its impact on the NHS and patients.
The Academy has four main areas of work:
- Developing the approach to leadership: defining and promoting what good leadership looks like, based on the recently developed Leadership Framework; setting national standards for leadership development and talent management with frameworks and toolkits; rewarding and recognising outstanding leadership (the 2012 NHS Leadership Recognition Awards are being run by the Academy and nominations have now opened www.nhsleadershipawards.nhs.uk)
- Providing and commissioning a range of cutting edge national programmes: in total these will make up the single largest training programme for leaders in the world and culminate in the professionalisation of leadership in the NHS. They include: the Graduate Management Training Programme for the most; Breaking Through to support leaders from BME communities; Top Leaders for those in the most senior roles; the Clinical Leadership Fellowship Programme, along with career development programmes with different entry levels for different staff
- Supporting the development of local leadership capability: providing expert support for local NHS and key partner organisations to sustain and promote leadership in their area
- Supporting changing and developing parts of the NHS system: developing shared leadership approaches with local government and providers of NHS services; providing frameworks for Foundation Trust governors and Clinical Commissioning Group development; supporting leadership for innovation and QIPP. 13.4.12
Surgery and drugs couldn't fix my 13 years of crippling back pain. But six months of physio did: Emma Forbes on her last-ditch remedy
Ever since the birth of her first child, Lily, 15 years ago, former Radio 2 presenter Emma Forbes has suffered back ache, although those two words barely do justice to the agony that has often left her bedbound, shedding tears of frustration, unable to walk or to rest, sleep or eat.
In her darkest moments, after surgery failed, she admits to wondering if she would ever know a life without pain. Just like 80 per cent of pregnant women, Emma first suffered the condition during pregnancy. Known as postpartum back pain – and dubbed ‘baby back' – the problem is due to hormones such as relaxin being released to soften the joints and tendons, particularly in the pelvis and lower back, preparing the body for labour.
In one fifth of cases, this develops into chronic (long-term) back pain, and numbers are spiralling as a result of increasing obesity rates in women, say experts.
Although never overweight, Emma was one of the unlucky ones. ‘Before being pregnant, I'd never had back pain,' she says. ‘It started in the base of my spine and travelled down one leg. 'Everyone I spoke to seemed to have a remedy – try Pilates, try yoga, see a chiropractor.
‘If I lay down flat, I could relieve the pain, but when I stood up it returned.'It was worse when I was driving, or having to sit still or stand for any length of time. I thought it would disappear after I gave birth.'
Emma had a 38-hour labour with Lily and required an epidural. ‘I put on two-and-a-half stone in pregnancy, which is a lot for my size ten frame,' she says. ‘Because I had an epidural, I couldn't feel any pain, and I think I had extremely bad posture when I was giving birth.'
Hers was a classic case of baby back, according to orthopaedic specialist Dr John Outhwaite, of the Nuffield Orthopaedic Hospital.
He says: ‘It's common in pregnant women, not simply because of the weight of the child, but also the fact that the mass inside the abdomen distorts the transverse abdominal muscle, which is the key muscle for switching on and off our core stability. ‘It is stretched and squashed in pregnancy and its movement and efficiency are disrupted when carrying a baby. If you have weak core muscles, you will get a bad back.'
Key blood supply is also affected by pregnancy. ‘Metabolically, the baby is very active, and a huge percentage of a woman's blood supply is diverted to feed the child. 'This creates a weakness in the back muscles because they are being starved of blood. 'A prolonged birth can cause acute injury to the soft tissue in the lower spine, causing chronic pain.'
Emma says: ‘I struggled on, trying cranial massage, a chiropractor, acupuncture and massage, but nothing worked. 'Then I became pregnant with Sam (now 13) and after his birth the pain became unbearable.'
The 46-year-old, who lives in London with banker husband Graham Clempson, 47, visited her GP, who referred her for a magnetic resonance imaging (MRI) scan showing the inside of the body. ‘I was told, to my horror, that I had two slipped discs,' says Emma.
The spine is made up of 24 bones called vertebrae stacked on top of each other. Discs are the protective, circular pads of gel-filled cartilage that act as cushions between the vertebrae. A slipped disc occurs when one ruptures and the gel inside leaks out.
The damaged disc can put pressure on the whole spinal cord or on a single nerve fibre. This means a slipped disc can cause pain in the area of the protruding disc and in any part of the body that is controlled by the nerve the disc is pressing on.
In Emma's case, the damage was in the lumber – or lower – spine. ‘The surgeon said I could hope it would go away but the only real option was surgery. I knew this would be debilitating, that I'd be flat on my back for a while. I said, “I just don't have time!” His expression said it all.
‘I soldiered on but a few weeks later, in 1999, I was being driven down the King's Road in London with my sister Sarah and I said, “Stop the car.” The pain was so unbelievable I was in tears. 'I then knew I had to do something. I rang the Wellington Hospital in London and they rushed me in as an emergency patient and I had one-and-a-half hours of surgery. ‘When I came round I was euphoric – the pain had gone. I'd had 42 metal clips inserted in my spine, and I had to learn to walk again.'
Emma had a microdiscectomy, where the surgeon cuts away the bulging part of the disc via an inch-long incision in the back. This relieves the pressure on the nerves, alleviating pain. After five days in hospital, most patients are allowed home. However, recovery can take six weeks and some studies suggest that up to 25 per cent of patients will need further surgery for recurrent pain.
Emma's initial recovery was a false dawn. ‘I carried on happily for a year – and then the pain came back with a vengeance. 'I was mortified. I felt I couldn't go through it again. It was ruining my life.'
Emma struggled on until 2009, when a physiotherapist, David Bolton, was recommended to her by a friend. ‘He was a last gasp for me, because otherwise I could have been facing surgery again. 'Some people have this operation two or three times as the problem often recurs.
'By the time I went to see David, I was in so much pain I could barely walk into his consulting room – I shuffled in sideways. ‘His approach was calming and he taught me how to let go of the fear of my pain. 'I was walking around holding myself tensely upright, as if someone was about to punch me in the back. 'I was over-protecting myself, and making things worse.'
Twice a week, for half-hour sessions, he manipulated her back and legs with gentle movements. Emma says: ‘He wasn't pummelling me, rather gently moving me about, manipulating and rotating my spine.
‘Every day I had to do set exercises of twisting and stretching involving my spine, often lying down. 'Within six months, I was pain-free.'
Emma has now been without back pain for two years, and David's treatment has allowed her to begin exercising gently. ‘I can't play tennis but apart from that my life has improved immeasurably,' she says. ‘Every morning I wake and realise with a jolt of happiness that I have no back pain.'
Emma sees David every two weeks for maintenance sessions – not cheap at £90 but, she says, well worth the price. ‘I know I will always have to take care of my back, as the damage has been done. 'At least now I have got rid of the awful grating pain that had been dominating my life.'
Dr Outhwaite agrees physiotherapy is one of the best forms of treatment because it mobilises the spine and is self-correcting, rather than drugs that can just mask the problem. He says: ‘Operations are vital in some cases. What you should not do is try to ignore the pain and hope it will go away. 'If untreated, it will only become worse.' 14.4.12
Physiotherapists not allowed to touch patients in 'barmy' NHS initiative
Physiotherapists have been banned from touching their patients in a new set of 'barmy' NHS plans. Patients in one part of the country are instead being offered 'advice and guidance' instead of hands-on treatment after health bosses barred medics from using their skills.
Instead of massage or the manipulation of joints and limbs patients in Rushcliffe, Nottinghamshire, are now being directed to websites and handed information leaflets so they can teach themselves exercises at home.
Before January 1, 2011, the Principia clinical commissioning group, which plans and buys healthcare services in Rushcliffe, offered one assessment and up to four treatments for physiotherapy patients. This includes patients who are suffering from soft tissue injuries and pain in their back, neck or joints.
But, following a review of services, it has changed from a treatment service to an advice and guidance service.
This means that physiotherapists are no longer allowed to touch patients, and instead give advice on what exercises they should be doing and information on how to manage their condition themselves.
The Chartered Society of Physiotherapy has labelled the scheme ‘barmy'. Chief executive Phil Gray said: 'They seem to have invented a new form of physiotherapy that no one has heard of - do-not-touch physiotherapy.' 'Physiotherapists can't actually physically touch you at all under this system. It is deeply unscientific.
'There is no research or evidence to back up hands-off physiotherapy. 'Patients have been reporting back to GPs a very strong disappointment, and the physiotherapists providing this service are saying that basically "you are preventing us from doing a professional job".'
The professional body asked all primary care trusts in the country about their physiotherapy services and any budget cuts.
Mr Gray said that Principia was the only group not to offer a hands-on treatment to physiotherapy patients. He added: 'It is a completely barmy form of treating people, which means that the only solution will be to go to the private sector and pay for themselves.'
Patients in Rushcliffe are also capped to a maximum of two physiotherapy appointments a year and have to visit their GP twice, six weeks apart, to get a physiotherapy referral in the first place.
Mr Gray said this was too long to wait. He added: 'Getting people quickly into early intervention services makes a real difference to their ability to go back to work. 'The less treatment they go on to have and the longer it is left, the more complex problems it causes for people.'
Barbara Venes, of the Local Improvement Network, which represents patients in the county, also raised concerns. She said: 'I think it is just awful. If you need physiotherapy, you need the treatment, not just advice. 'They are pushing people into paying privately and some people cannot afford to pay for it and so won't get treatment.'
She added that older patients may struggle to access information online, and that people needed practical demonstrations of how physiotherapy exercises should be done to ensure that they were doing them correctly.
She said: 'If you need physiotherapy, it is painful when you start.' 'If you are doing it with a physiotherapist, then they can reassure you that it is normal to get some pain. 'But if you are doing it yourself, then people are afraid that if it is painful then they are going to get more damage.'
A spokesman for Principia said that the change in service had not been a cost-cutting measure, and that costs were broadly the same as before. She said that 'more vulnerable' patients received treatment through other means, such as a hospital specialist. She said: 'Following a review, the service was changed to one of advice and guidance to encourage patients to self-care prior to further review by the GP.
'In some parts of the county this is done by web-based advice or in group sessions, and is the important first step in patients with back and neck problems.' She added: 'Once a decision to refer to a specialist is made by a GP, patients are seen quickly by a physiotherapist.
'With the advice and guidance service, patients are given practical advice to help them self manage their condition. 'This includes exercises to alleviate and manage their symptoms. This service enables all patients to take control of their condition and get better quicker.'
Janis Powell, of Aspley, who suffered back pain for many years and is part of the Chronic Pain Support Group in Notts, said: 'I think it is really disgusting and is not helping patients whatsoever. 'As a former patient myself, I would feel let down by this new service. Patients might not try and help themselves if there is nobody there to support them.' 10.4.12
For every life that is saved by breast cancer screening up to TEN women suffer 'unnecessary treatment' including breast removals
'We've exaggerated the benefits of screening and we've ignored the harm,' says expert.
Thousands of women are undergoing unnecessary treatment for breast cancer including chemotherapy and even breast removal following screening, researchers have found. Academics from Harvard School of Public Health studied the results from 40,000 women who were screened in Norway.
They found for every 2,500 women offered screening, one death from breast cancer would be prevented - but six to 10 women would be treated for a benign cancer that would never cause symptoms.
This 'overdiagnosis' results in thousands of women receiving damaging treatment including surgery, powerful drugs like tamoxifen and chemotherapy. If the cancer appears aggressive the decision may be made to remove the whole breast - a procedure known as a mastectomy. The Harvard study is the latest in a recent slew of research to question the long-held belief that the benefits of national screening programmes far outweigh the harm they can cause.
In the UK, the NHS screens around 1.6million women for breast cancer every year. Women aged from 47 to 73 are invited to screening every three years as the risk of developing the condition increases with age. Breast cancer deaths have fallen by more than 10 per cent in Britain over the past five years, which Stephen Duffy from Cancer Research UK said was partly due to screening.
However, a recent study from the International Prevention Research Institute in Lyon, France, suggested better treatments are more likely to be causing the recent drop in death rates.
There is currently an independent review underway into whether the UK programme causes more benefit than harm. A Department of Health spokesman said: 'Our screening programme is regularly scrutinised. 'We know that there are some scientists who differ in their views towards screening, so as requested by ministers, the National Cancer Director Professor Sir Mike Richards has commissioned an independent review of the evidence in partnership with Harpal Kumar, chief executive of Cancer Research UK.'
In the latest study the Harvard researchers estimate that up to a quarter of breast cancers found by mammograms won't cause any problems during a woman's lifetime. Once cancer is found, however, doctors must treat it as they do not yet have an effective technique of working out which ones will be dangerous.
'When you look for cancer early and you look really hard, you find forms that are ultimately never going to bother the patient,' said Dr H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, who was not part of the research. 'It's a side effect of early diagnosis.'
The study from Harvard School of Public Health is the latest to explore overdiagnosis from routine mammograms - finding tumors that grow so slowly or not at all and that would not have caused symptoms or death. Previous estimates of the problem have varied.
The researchers took advantage of the staggered decade-long introduction of a screening program in Norway, starting in 1996. That allowed them to compare the number of breast cancers in counties where screening was offered with those in areas that didn't yet have the program. Their analysis also included a decade before mammograms were offered.
Study leader Dr. Mette Kalager and other experts said women need to be better informed about the possibility that mammograms can pick up cancers that will never be life-threatening when they consider getting screened. 'Once you've decided to undergo mammography screening, you also have to deal with the consequences that you might be overdiagnosed,' said Kalager, a breast surgeon at Norway's Telemark Hospital and a visiting scientist at Harvard School of Public Health. 'By then, I think, it's too late. You have to get treated.'
Kalager and her colleagues looked only at invasive breast cancer. The study did not include DCIS, or ductal carcinoma in situ - an earlier stage cancer confined to a milk duct. Under the Norway program, screening was offered every two years to women ages 50 to 69.
Researchers analysed nearly 40,000 breast cancer cases, including 7,793 that were detected after routine screening began. They estimated that between 1,169 and 1,948 of those women were overdiagnosed and got treatment they didn't need.
Their findings appear in Tuesday's Annals of Internal Medicine.
Commenting on the study Dr Welch said: 'The truth is that we've exaggerated the benefits of screening and we've ignored the harms. 'I think we're headed to a place where we realize we need to give women a more balanced message: Mammography helps some people but it leads others to be treated unnecessarily.'
An editorial published with the study said overdiagnosis probably occurs more often in the United States because American women often start annual screening at an earlier age and radiologists in the U.S. are more likely to report suspicious findings than those in Europe.
Radiologists could help by raising the threshold for noting abnormalities, wrote Dr Joann Elmore of the University of Washington School of Medicine and Dr. Suzanne Fletcher of Harvard Medical School.
A 'watch-and-wait' approach has been suggested instead of an immediate biopsy, but the editorial writers acknowledge that could be a 'tough sell' for some women and radiologists alike. They said most women aren't aware of the possibility of overdiagnosis. 'We have an ethical responsibility to alert women to this phenomenon,' they wrote. 4.4.12
I warned about the dangers of metal hips 15 YEARS ago: A whistleblower reveals the real scandal over danger joints
The horrifying revelations about the dangers of metal-on-metal hip implants may have come as a shock to the thousands who have them.
Sadly, the news didn't come as a surprise to me. As someone who designs medical devices, I worked with the company contracted to develop and manufacture one of the first of these hip resurfacing devices. What's shocked me is that this scandal has taken so long to be exposed.
With a metal-on-metal replacement, the top of the bone and the socket it goes into are replaced or resurfaced in metal. The first replacements were carried out at the start of the new millennium and were hailed as providing better mobility than the old — but safe and long-lasting — metal on plastic replacements.
Fifteen years ago, I and a number of other colleagues were vociferous in our criticism of the new design. I am not patting myself on the back. An averagely bright teenager knows that running metal against metal will cause friction, and sooner or later friction causes wear.
This wear results in debris, tiny particulates which, in a car engine, for example, will filter to the bottom and lie in the sump waiting to be drained out. There is no sump in the human body — just highly delicate tissues and organs, a complex vascular system and lungs, in which metal debris could cause untold damage.
The Medicines and Healthcare Products Regulatory Agency, the safety watchdog, has talked about toxins from the particulates causing inflammation in the body. Some studies are linking metal-on-metal replacements with bladder cancer. Certainly, they have a far higher failure rate than other types of replacement hips.
Those who warned against metal-on-metal included people like me who worked on the prototypes as well as engineers and designers who had heard about the development and were concerned.
But no one listened to us.
Indeed, when several of us pointed out this basic design flaw to the company I worked with, we were told the surgeon who'd come up with the idea — and who was working with the company to produce and endorse this replacement system — knew better than we did.
The attitude that the surgeons know best has become endemic in our industry.
‘Designed by surgeons for surgeons' seems to be a slogan that every medical device company wants to trumpet on their new products, without stopping to consider just how ludicrous this is. Certainly surgeons may spot a need for a medical advance or even come up with a rough concept of how this may work.
But unless they happen to also have an engineering or design degree alongside their medical and surgical skills, allowing them to act as if they are design experts is — as we can see now — a dangerous path to take. Unfortunately, instead of enlightening them regarding their limitations, the medical devices companies have been all too ready and willing to foster this illusion.
This is not to do with cost. It is no more expensive to hire an engineer than a surgeon. It is simply that there is nothing a medical device company likes better than to get a surgeon on board to ‘advise' on a product. As a result, virtually every surgical device in the past ten years has got surgeon approval or design input.
Most vitally, it also gives companies a gateway into that magic world of NHS buyers, who in turn rely heavily on the recommendations of those same surgeons when they spend our millions on medical products.
The medical world, particularly within individual specialities such as orthopaedics, is a small place. The medical device companies know only too well that if one surgeon turns their back on a product, their colleagues may well follow suit, and all those millions of pounds spent designing and producing will have gone to waste.
But if a surgeon endorses it — well, the sky's the limit. It is common knowledge within the industry that items costing just a few pounds to produce are sold to the NHS with profit margins as high as 2,000 or 3,000 per cent above the manufacturing cost.
The argument is that the high prices are necessary to recover the design and development costs, the on-going assessment of the product, surgeon training and possibly royalty payments to the surgeon who ‘assisted' with the design concept.
No wonder then that surgeons are so powerful — and that many of them are becoming very rich.
No longer content to earn a five-figure salary from the NHS, then doubling that with private work, a surgeon involved with a medical device manufacturer can be paid handsomely for that, too. One surgeon in the North-East told me quite openly that he earned well over £100,000 per year in device royalties alone.
No doubt the device he worked on, will, on his recommendation, be in regular use in his NHS operating theatres.
Even more blatant is the recent development of surgeons forming companies to buy medical devices and instrumentation direct from the manufacturers, often based overseas, at discounted prices and then encouraging their hospitals to buy from them at an inflated price. And all on the pretext that because they are surgeons they somehow provide a more authoritative endorsement of the products they are selling.
In any other profession this would be seen at the very least as a conflict of interest.
No one is saying that surgeons or, indeed, any doctor should not be allowed to come up with ideas for improving patient care. Of course, they are the ones at the front line, who see the need for a new device or a better product. But then they should step away, leave the design to experts who have had years of training in design and engineering to actually create, test and produce the device.
In short, surgeons should stick to being surgeons.
I'm not saying this because I want to protect my profession. I'm saying it because I genuinely believe it is unsafe to allow untrained people so much power and responsibility in producing devices that can have a huge impact on people's health. Maybe the NHS bureaucrats will wake up and realise what is going on under their nose and do something about it. But I'm not holding my breath. 20.3.12
The doctor who broke up families: Psychiatrist who damned hundreds as 'unfit parents' faces GMC probe
- Dr George Hibbert could be struck off over his conclusions that hundreds of parents had ‘personality disorders’
- Millionaire is now being investigated over shocking suggestions he distorted the assessments to fit the view of social services
- Lib Dem MP writes to Justice Secretary Ken Clarke demanding a full parliamentary inquiry
A leading psychiatrist faces extraordinary claims he deliberately misdiagnosed parents with mental disorders – decisions which meant their children were taken away from them. Dr George Hibbert faces being struck off over his conclusions that hundreds had ‘personality disorders’ after assessing them at his private family centre.
He was paid hundreds of thousands of pounds by social services for the reports which tore children from their parents – many of them young mothers. He is now being investigated over shocking suggestions he distorted the assessments to fit the view of social services. In one case, he is alleged to have wrongly diagnosed a ‘caring’ new mother – named only as Miss A – with bipolar disorder because her local authority wanted the baby adopted.
After being confronted with this allegation, Dr Hibbert offered to surrender his licence to practise as a doctor rather than face a General Medical Council inquiry. But his request has been rejected by the GMC which says there are still ‘unresolved concerns regarding his fitness to practise’. He will now face a full fitness to practise hearing.
Yesterday John Hemming MP, who has raised concerns about Dr Hibbert in Parliament, described the claims as shocking. The Lib Dem MP – alerted by a whistle-blower – said he had since spoken to ‘three or four’ other families who said the same had happened to them. He has written to Justice Secretary Ken Clarke demanding a full parliamentary inquiry.
Mr Hemming said: ‘He is someone about whom a number of people have complained. I am told that at least one person has refused to work for him because of what she saw as his unethical provision of reports to suit the demands of local authorities. ‘Much of the decision making in care proceedings rests on reports from experts such as Dr Hibbert,’ he told Parliament. He added that supposedly independent experts such as Dr Hibbert, 59, were often little more than ‘the hired gun of the local authority’. The lack of transparency over such experts was leading to‘thousands of miscarriages of justice in care proceedings.
Earlier this week, a study for the Family Justice Council revealed how life-changing decisions about the care of children are routinely being made on the basis of flawed evidence. A fifth of ‘experts’ who advise the family courts are unqualified.
Dr Hibbert charged local authorities £6,000 a week for every family in his care and £210 an hour just to read documents such as medical records.
By 2007 his company, Assessment in Care, was making a profit of around £460,000 a year from his lucrative arrangement with social services.
He is now worth more than £2.7million. Last night a black Porsche Turbo, thought to be worth around £120,000, and a grey Porsche 911 Carrera, worth around £80,000, were parked on the gravel driveway outside his £500,000 country cottage.
A former honorary lecturer at Oxford University, who has previously advised the government on care assessments, Dr Hibbert left the NHS to set up his private assessment centre in 2000. Since then, hundreds of parents in contact with social services – usually mothers and babies – have been referred to his centre to be assessed.
Concerns were first raised in 2007, when mother Miss A complained that Dr Hibbert had wrongly diagnosed her with a bipolar disorder. One consultant psychiatrist accused Dr Hibbert of having ‘no evidence’ for some of his claims and of deliberately ‘exaggerating’ and ‘misrepresenting’ aspects of the woman’s behaviour. Her report is among a number of documents being examined by the GMC with regards to Dr Hibbert.
Miss A, who has seen her son just a few times since, said Dr Hibbert was ‘corrupt and evil.’
‘Nothing will ever make up for what he has done to me and my child,’ Miss A said. ‘I want to make sure this man is exposed and that he can never do this to anybody else.’ In a letter sent to Miss A, a GMC investigations officer confirmed Dr Hibbert ‘has now applied for voluntary erasure from the medical register’. The letter continued: ‘He has no intention of returning to clinical practice in the future.’
However, the GMC officer concluded it was in the ‘public interest’ for his request to be denied ‘in view of the nature of the performance allegations and in the view of the conduct concerns.’ He has not been available for comment at his two-storey detached cottage in the small village of Blunsdon near Swindon. His assessment centre next to his home appeared to be closed.
A spokesman for Dr Hibbert at the Medical Protection Society, the indemnity organisation for doctors, said professional confidentiality meant Dr Hibbert was ‘unable to comment on allegations raised in relation to care of a patient’.
Paul Grant, of Bernard Chill & Axtell Solicitors, who represents Miss A, said: ‘Our client has instructed us to launch proceedings against Dr Hibbert and the local authority. ‘We believe this distressing case may be the tip of a very big iceberg.’ 17.3.12
What every family needs to know about the great NHS health revolution
It's the biggest NHS shake-up in 60 years and with even medics admitting they're confused, no wonder patients are growing increasingly worried.
Everyone knows they're important - and that they could transform the way you, and those close to you, are cared for when you're most vulnerable. Everyone also knows they're causing one of the most bitter political battles for years. But how many of us actually understand the Coalition Government's plans to reform the National Health Service?
The changes are the biggest shake-up of the Health Service in England and Wales for 60 years. Ministers say their aim is to create a ‘patient-led NHS' and cut bureaucracy by giving power to GPs and front-line clinicians.
This, they promise, will not only improve care but also slash bills at a time when health costs are rising due to our ageing population and the increased cost of drugs and new treatments.
Critics say the very foundations of the NHS, with its promise of free care for all, are at risk. But they, in turn, stand accused of putting the interests of bureaucrats and health workers ahead of patients.
Meanwhile, even doctors who support the reforms complain that Health Secretary Andrew Lansley has made a terrible job of explaining them, and there have already been hundreds of amendments to the original plans.
So what is all the fighting actually about? And what do the reforms really mean for patient care? Good Health asked the experts to explain how the reforms affect YOU . . .
Your GP will foot your medical bills
One of the biggest changes is that GPs will be given control over around 60 per cent of the NHS annual budget of £110?billion, with responsibility for planning and buying health services for their patients.
As well as using their budgets to buy your drug treatments and diagnostic tests, they will be paying for your hospital care. This responsibility previously lay with 151 primary care trusts, which are being abolished together with the ten Strategic Health Authorities which oversee them.
Your GP will exercise his new financial power through clinical commissioning groups (CCGs), made up of groups of GP practices covering around 100,000 patients (although there isn't actually a minimum or maximum size for them). Hospital doctors and nurses will also be involved in the CCGs.
Your GP won't, however, be responsible for arranging dental services or specialist care for people suffering from rarer conditions such as motor neurone disease, or needing neurosurgery. These will be handled by the new NHS Commissioning Board, which will also oversee the CCGs.
Giving GPs control of the money means, in theory, that you and your doctor — rather than a remote and bureaucratic primary care trust — will have the power to choose the 'best treatment' for your condition.
For example, this could mean that a man with advanced prostate cancer might now benefit from an effective drug such as abiraterone — even if it is turned down by the National Institute for Health and Clinical Excellence (NICE) because it's too expensive — if his GP chooses to prescribe it to him.
As Paul Bowen, a GP who heads a CCG already set up in Cheshire, explains: ‘Instead of someone else making decisions about what patients need, my clinical staff and I will work with patients, giving them a wider choice of where, when and how they receive their healthcare.'
Supporters claim this is a long-overdue revolution.
‘The biggest problem we have is the top-down nature of the NHS,' says Dr Charles Alessi, chair of the National Association of Primary Care, an organisation for those involved in primary care, including GPs and PCT staff.
‘This is really what is behind the reforms — devolution of responsibility to the frontline. ‘I will fight to the death for the NHS, but we have to change the way we do things for it to survive. The challenge of people living longer, and the increasing complexity of illnesses, cannot be met by existing processes and bureaucracy.'
The main argument against giving GPs control of the money is that while they're skilled at looking after patients in the community, few have the proven financial and planning skills to manage the business of commissioning services.
The expectation is that GPs will end up employing outside companies to arrange contracts for their patients' treatment. ‘Our worry is this will mean that GPs will end up rubber-stamping decisions made by vast management companies who have little actual insight about patients and their needs,' says Dr Clare Gerada, chair of the Royal College of General Practitioners.
There is also concern that GPs, under pressure to stick to tight budgets, will make decisions based on their balance sheet rather than what you, the patient, need. Another concern is about potential conflicts of interest when GPs commission services from organisations they part-own.
The commissioning groups will, for example, be allowed to own cataract clinics, so could in theory commission their own clinic to provide their patients with treatment. Meanwhile, rather than cutting bureaucracy, it is feared that the new NHS Commissioning Board will end up as yet another top-heavy layer of management.
Already, it's expected to employ 3,700 people and have an administrative budget of £492?million. Its responsibilities are growing rapidly, as GPs say they're not ready to take the reins with commissioning.
It's quality of care that matters
A key aim of the reforms is to shift the focus onto quality of care. There will be less emphasis on waiting lists and ‘access' targets (such as making sure you start treatment within 18 weeks of a GP referring you to a specialist).
Instead, the focus will be on performance targets, which measure patient outcomes — for example, how many patients are dying from heart disease. The original plan had been to abolish access targets altogether, but there has been some back-tracking on that. (It is not quite clear if the 18-week target will remain.)
So how will the NHS ensure you receive better care?
The answer is through new guidelines called Quality Standards, which set out the best practice for treating patients suffering from different types of diseases.
For example, if you've been treated for early breast cancer, you should expect to be given an annual mammogram for five years after treatment. GPs will be expected to take account of these standards when commissioning services.
As part of the shift to quality of care, patient feedback is also likely to be given more prominence, so you'll probably find yourself filling out even more feedback forms on the quality of care you've received in hospitals.
In theory, you should receive a better standard of care. The Quality Standards will be concise and set out treatment priorities clearly, unlike the current NICE guidelines on patient care (the Quality Standards won't replace these guidelines, but will sit alongside them).
‘The intention to bring forward more Quality Standards is a positive step for patients in disease areas like rheumatoid arthritis, which has been overlooked in the past,' explains Jamie Hewitt, of the National Rheumatoid Arthritis Society.
Doctors are concerned that asking patients if they're satisfied with the quality of their care might not actually be a good measure of best care.
As Dr Clare Gerada explains: ‘There are occasions when patients want hospital referrals, when the truth is they don't really need yet another fruitless visit to a specialist.'
The problem, she suggests, is that they won't be ‘satisfied' with their treatment unless they get that referral, even if it's not what they actually need for best care.
Hospitals will be allowed to go bust
Hospitals will now have to generate all their own funding by offering services to GPs for a fee.
All hospitals will be made into foundation trusts — a legal change that means they have control over their budgets and can borrow money. They'll also have greater powers to increase their revenues — for example by offering services to private patients.
This happens to a limited degree already (in most NHS hospitals, between 2 and 10 per cent of overall revenues come from private practice), but in future hospitals will be allowed to get up to 49 per cent of their revenue from private work.
For the first time, some hospitals that go too far into the red will be allowed to go bust.
Money from treating private patients could benefit NHS patients — as currently happens, for example, at King's College Hospital in London, where profits from the private fertility clinic are used to help NHS patients who have fertility problems.
London's Royal Marsden, one of the world's leading cancer hospitals, already gets one quarter of its income from private patients — just short of a 30??per cent cap set in 2003. A spokesman says: ‘The surplus from our private patient income is invested back into NHS facilities and care.'
Letting NHS hospitals increase their revenues from private patients should help make them financially viable. Currently, without Government support, many hospitals, including major teaching hospitals in London, might be technically bankrupt.
Previously, NHS hospitals have not been allowed to go bust but have been bailed out when in difficulties. Now, if they can't make ends meet, such hospitals could be allowed to go under and shut down.
‘The former NHS hospital sites will probably be sold off for development — the Bill contains new arrangements to facilitate this,' says Dr Lucy Reynolds, a health services researcher at the London School of Hygiene and Tropical Medicine.
The public would be outraged by the loss of a local hospital, even one that is losing money.
Critics also say that increasing income from private care could produce a divisive, two-tier system, where patients with the same illness on the same ward receive different treatment depending on whether they are NHS or private.
The Government wants to encourage greater competition throughout the NHS, and encourage the private sector and charities to compete for business with NHS staff and hospital trusts. This was already happening under the previous Labour government.
The private sector won't compete on price — there will be a set tariff for services and treatment — but on quality of service.
This is one of the most contentious areas of the reforms. ‘What we are seeing is privatisation by stealth,' says Good Health's regular columnist Dr Martin Scurr (himself a private GP). This is a universal concern among opponents to the bill. However, the Government insists that privatisation is not its aim.
PROS: Involving the private sector could free up NHS hospital doctors from carrying out straightforward routine procedures, so they can concentrate on more complex cases — and become more skilled at these specialisms.
CONS: The fear is that the private sector will ‘cherry pick' easy and high-profit services, such as hernia repair, leaving the difficult and costly areas, such as mental health, geriatrics, A&E and intensive care, to be handled by NHS staff.
More power to the patients
Making sure patients are involved in every stage of their own care — and can influence the way decisions are taken throughout the NHS — is a key part of the reforms.
Frustratingly, the reforms don't set out details about how this might be put into effect, but possibilities include more emphasis on annual reviews with your GP if you have a chronic disease such as diabetes, and expanding the Choose & Book programme.
Under Choose & Book, you can decide where you want to go to for specific care.
On a bigger scale, the reforms will launch HealthWatch, a new patients' organisation that has been described as the ‘independent champion for health and social care consumers'.
It is, essentially, a watchdog for patients, with the power to monitor the NHS and to refer patients' concerns to a wide range of authorities.
PROS: Involving patients in their treatment is widely acknowledged to be important for their health and for saving money. Research has suggested patients who are involved in this way cost the NHS around 20 per cent less.
Most people would agree that patients need a stronger voice than they currently enjoy.
When it comes to making a complaint, patients can find the current system complex and ineffective.
Accountability and public involvement have been ‘muddled' for the past 20 years, says Patrick Vernon, chief executive officer of health inequality charity the Afiya Trust.
He says that HealthWatch will have ‘real clout' to ‘influence, challenge and advocate patients' rights' in improving care, although this will depend on the strength of your local HealthWatch group.
CONS: Many patients would prefer to hand over difficult treatment decisions to the experts and don't want to take responsibility for their own care, says Dr Clare Gerada.
Others have expressed concerns that HealthWatch will be toothless and potentially underfunded. This is because its budget is not ring-fenced, so the money could be spent elsewhere.
As Dr Lucy Reynolds explains: ‘This is a missed opportunity, because patients should clearly be given more real powers to partner with the NHS in improving service quality through an independent mechanism with an adequate and protected budget.'There are also concerns that HealthWatch won't, in fact, be independent, as it now looks as if it is to become part of the Care Quality Commission, the healthcare watchdog. 6.3.12
NHS staff cash in on accidents at work, £4,000 for slipping on a potato and £2,500 for walking into a door
- Nurse given £1,650 for blister 'caused by serving mashed potato'
- Hospital staff member awarded £2,775 to hurting shoulder throwing litter into a bin
NHS staff are claiming nearly £20million a year in taxpayer-funded compensation for injuries such as bruises, twisted ankles and blisters. The number of employees seeking damages for accidents they insist were the fault of the Health Service has jumped by almost a third in just five years.
Last year more than 3,200 injury claims were filed by NHS staff, including one that resulted in a worker being paid £6,500 for a bruise. And the Wrightington, Wigan and Leigh NHS Trust paid out £3,980 to a nurse who slipped on a piece of potato on a ward floor.
An employee at the same trust was paid £5,750 after he fell over when the bottom of his trousers got caught on a metal bracket on a wall. In the past five years, the NHS has paid out £91.8million in compensation to 9,042 employees.
The number of claims made by staff has jumped from 2,535 in 2005/6 to 3,287 last year, according to figures obtained after Freedom of Information requests to the NHS Litigation Authority and NHS trusts.
There are concerns that staff are being egged on by ‘no-win no-fee' solicitors telling them to claim for injuries caused by their own clumsiness or bad luck. A hospital worker at Sherwood Forest NHS Trust was paid £2,250 after suffering ‘tennis elbow' – a common sports injury that he insisted was caused by ‘repetitive moving'.
The same hospital awarded £875 to a member of staff who cut their thumb, while a porter at Blackpool Teaching Hospitals got £3,400 for a ‘whiplash-type injury' that allegedly happened while pushing a trolley.
Brighton and Sussex University Hospitals awarded £10,000 to an employee who twisted their ankle on a step and the same amount to another worker who suffered a cut finger.
And at West Hertfordshire Hospitals a worker was given £2,775 for injuring their shoulder by throwing litter into a bin, while a secretary at Countess of Chester Hospital got £350 for falling off a chair. The same hospital awarded £875 to a member of staff who cut their thumb, while a porter at Blackpool Teaching Hospitals got £3,400 for a ‘whiplash-type injury' that allegedly happened while pushing a trolley.
Brighton and Sussex University Hospitals awarded £10,000 to an employee who twisted their ankle on a step and the same amount to another worker who suffered a cut finger.
And at West Hertfordshire Hospitals a worker was given £2,775 for injuring their shoulder by throwing litter into a bin, while a secretary at Countess of Chester Hospital got £350 for falling off a chair.
Tory MP Stephen Barclay said: ‘I would want to know why someone got £6,500 for a bruise. ‘It seems surprising that some payments are being made for what appear to be relatively minor injuries. ‘I would welcome some clarification from the officer responsible for the payments so that he can demonstrate that they were of value for money for the taxpayer. ‘This is money that would otherwise be spent on patients with medical needs.'
Matthew Elliott, of the TaxPayers' Alliance, said: ‘This is an incredible amount of money for the NHS to be losing to compensation claims, and means less cash is available for frontline care. ‘There will be some cases where payouts in the workplace are unavoidable, but health bosses need to ensure these are kept to a minimum by properly managing their facilities and rejecting and fighting frivolous claims.
‘Taxpayers can't afford endless huge payouts – they are a symptom of a growing compensation culture that needs to be stopped.'
The extraordinary amounts are being paid out while the NHS is under severe financial strain. Although its budget has been ring-fenced from Government cuts, it has been ordered to make £20billion of ‘efficiency savings' over the next few years so money can be ploughed back into patient care.
Many NHS trusts have resorted to cutting frontline staff and rationing treatments to try to meet these targets.
Only last month a report from MPs found the NHS was now paying out £15.7billion a year for medical accidents, with many claims driven by no-win no-fee lawyers.
Figures compiled by the public accounts committee showed the sum had jumped by 13 per cent in a year and accounted for a seventh of the Health Service's annual budget. 5.3.12
GPs make £162m out of 'ghost' patients: Anger over bill for 2.5m non-existent people
- 55 million people registered with a doctor in England - despite population being 52.5m
- Surgeries regularly fail to update patient lists when people die or move away
- 32,668 dead patients were on lists, including 157 who died more than 30 years ago
- 10,000 failed asylum seekers who had left the country were on the books
The NHS is paying GPs to look after 2.5million ‘ghost' patients, ministers admitted last night.
Doctors are receiving an estimated £162million a year – footed by the taxpayer – for non-existent patients on their books who have moved house, left the country or been dead for up to 40 years.
The Audit Commission has counted that in a single year at least 95,000 such ‘ghost' patients were registered with GPs and earning them annual payments. But the Department of Health last night admitted there are probably up to 2.5million such patients on doctors' lists in England.
Every year GP surgeries are paid an average of £65 for each patient they have on their books, regardless of how often – or whether – they make an appointment or what treatments they receive. Although there are currently 55million patients registered with GPs, there are only 52.5million actually living in England. It means the NHS is potentially wasting £162.5million every year on ghost patients.
Katherine Murphy, chief executive of the Patients Association, said it was ‘outrageous' that money was being wasted to treat patients ‘that only exist within NHS bureaucracy'.
Surgeries are meant to keep their lists up to date and take patients off when they die or move away, but this is frequently overlooked.
In some cases doctors have been found to be deliberately keeping patients on their books to earn themselves extra cash.
Last year the Mail revealed that four doctors at a surgery in Streatham, south London, were being investigated over a scam in which they were claimed to have 3,000 patients on their books who did not exist or had false information on their records that brought in extra NHS cash.
Of the latest findings, Mrs Murphy added: ‘At a time when the NHS is being asked to make huge efficiency savings the Government needs to provide answers as to how money was wasted in this way.'
In its extensive investigation the Audit Commission, the Government's spending watchdog, compared surgery lists to check patients were not registered with more than one GP if they had moved house.
The officials also compared these lists with Government records of deaths and data on failed asylum seekers who have since been deported.
When officials came across patients registered with two surgeries, or those recorded as being dead or deported, they contacted the local NHS body which asked practices to check that their lists were up to date.
The investigation, called the National Duplicate Registration Initiative (NDRI), covered 2009 to 2010. It found there were up to 32,668 dead patients on lists – including 157 who had died more than 30 years ago.
Officials even came across one surgery which was being paid every year to treat a patient who had died in 1969.
A further 29,416 patients had moved house and were registered with a different GP, but both their old and new surgeries were being paid for treating them. Another 20,000 patients were removed from the lists when officials found they were not living at the address shown on the books.
The officials also discovered 10,000 failed asylum seekers were on GPs' books even though they had since been returned to their home country.
Not all surgeries flagged up by the Audit Commission for having high numbers of ghost patients bothered to check their lists.
Health minister Lord Howe said: ‘The NHS needs to make the best use of the funds it has available and avoid giving GPs extra income for patients who have moved away or died. Identifying ‘ghost patients' will ensure that practices are fairly funded only for the patients they are responsible for.'
Andy McKeon, managing director of health at the Audit Commission, said: ‘The NHS and GPs generally manage patient lists well – at any one time there are some 58million records and many movements on and off lists. ‘It is disappointing that some areas did not rigorously follow up the information provided by NDRI.'
David Stout, deputy chief executive of the NHS Confederation, which represents NHS staff, said: ‘It is important to make sure that lists of registered patients are up to date and accurate. ‘Being able to plan and offer the most appropriate care for local people depends on accurate information.' 23.2.12
PM accused of 'dangerous game of divide and rule' as BMA and nurses excluded from summit over disputed Health Bill
Opponents to Health Bill have been shut out from Downing Street, claims Shadow Health Secretary
Health Minister accuses Labour of turning NHS reforms into 'game of political football'
David Cameron was today accused of deepening divisions in the health service after it emerged that opponents of controversial NHS reforms were excluded from a key Downing Street summit. The Prime Minister will hold discussions with chairs of the emerging GP-led clinical commissioning groups along with other health officials.
However, eight royal colleges and several health unions say they have not received an invitation to the meeting, which is intended to shore up support for the Health and Social Care Bill.
No 10 has refused to release the guest list for today's health summit on the Bill, which faces fierce opposition from professionals, patient groups, Labour and reportedly even Tory Cabinet ministers.
However, the British Medical Association and Royal College of Nursing, who represent more than 500,000 medical staff, said they had been excluded after opposing the reforms.
Both have called for the Health and Social Care Bill to be scrapped as it makes its way through the Lords.
Dr Peter Carter, from the RCN, told BBC Radio 4's Today programme that holding an 'emergency summit' on the health bill without their presence was not 'a sensible way forward' as they were 'intrinsic to making sure the NHS is successful'.
The BMA said in a statement: 'It would seem odd if the major bodies representing health professionals were not included.'
Labour's Shadow Health Secretary Andy Burnham, said: 'The NHS means too much to too many people for the Government to play this dangerous game of divide and rule.'
He added that the major health unions had 'strong and sincerely-held views' about the risks to the NHS from the Government's reorganisation.
'They deserved a hearing - not to have the door of Downing Street shut in their faces,' he said.
He called on Mr Cameron to invite the BMA and RCN along with the Royal College of Midwives and Royal College of General Practitioners to the meeting - all of whom oppose the Bill.
Health minister Simon Burns has denied that key bodies were being excluded from talks on the Bill. He said: 'This (summit) is part of an ongoing dialogue. We have had hundreds of meetings, there have been thousands of people involved in talking and looking into different ways of improving and engaging on the Health Bill. 'That includes the RCN,' he told BBC Radio 4's Today programme.
The Prime Minister's official spokesman later added: 'We are not excluding anyone,' at a daily Westminster briefing.
However, all those bodies confirming attendance today have yet to directly oppose the Bill. These include the Royal College of Paediatrics and Child Health, which will set out its position on the Bill in the next few days following a membership survey.
The Royal College of Surgeons, which has agreed to 'critical engagement with Government' over the Bill will also attend the meeting, as will the Royal College of Obstetricians and Gynaecologists, which has concerns but has agreed to continue talks with ministers.
The Royal College of Anaesthetists will also go, as will the Royal College of Physicians, which has pledged to continue discussions with the Government.
Mr Burns said on this occasion the Government was meeting organisations that were 'constructively involved' in the process.
'The meeting the Prime Minister is having today is simply part of an ongoing dialogue with those who are constructively involved in improving the reforms.' He warned that 'in some ways this has become a political football'. At the ‘summit', the Prime Minister will reveal statistics that show handing power to GPs can transform care and keep patients out of hospital.
He will go on the offensive amid growing demands from doctors and unions to drop the Health and Social Care Bill, now going through the House of Lords. Department of Health figures show a 0.5 per cent decline in emergency admissions in 2011, compared with a 36 per cent increase between 2001 and 2010.
Mr Cameron will tell the heads of commissioning boards and some of the royal medical colleges that patients are already beginning to see the fruits of greater GP influence – a key plank of the reforms – in areas where clinical commissioning groups have been set up.
He will point to Dartford, Gravesham and Swanley in Kent, where admissions to hospital of care home patients have been slashed 33 per cent in the past six months.
In Newcastle, the number of patients admitted with emergency respiratory problems has decreased by 70 per cent. In Bedfordshire a team has been set up to deal with emergency calls from care homes, helping reduce hospital visits by 40 per cent.
But Mr Burnham said: 'The reality is that hospitals are under intense pressure as last week's A&E figures continue to show.'
Those not invited : The Royal College of GPs, the Royal College of Radiologists, The Faculty of Occupational Medicine, the Royal College of Psychiatrists, The Academy of Medical Royal Colleges including the College of Emergency Medicine and the Faculty of Public Health, the Royal College of Pathologists, the Royal College of Ophthalmologists, The Chartered Society of Physiotherapy, the BMA, the RCN. 20.2.12
Shyness in a child and depression after bereavement could be classed as mental illness in controversial new reforms
Childhood shyness could be reclassified as a mental disorder under controversial new guidelines, warn experts. They also fear that depression after bereavement and behaviour now seen as eccentric or unconventional will also become ‘medicalised'. Internet addiction and gambling might also become forms of illness.
The threat comes in the form of proposed changes to a U.S. manual of mental disorders, viewed as a bible by some in the field.
Although the changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders would not directly affect clinical practice here – where doctors tend to use different guidelines – experts say it would eventually influence thinking.
Millions of people, including Britons, could be given a psychiatric diagnosis which could ruin their lives, warn psychiatrists and psychologists here.
The DSM5 changes are also opposed by many experts in the U.S., some of whom claim they reflect efforts by drug companies to sell more products.
Simon Wessely, of the Institute of Psychiatry, King's College, London, said: ‘We need to be very careful before further broadening the boundaries of illness and disorder. ‘Back in 1840 the census of the United States included just one category for mental disorder. ‘By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels?
‘Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger's and so on.'
Peter Kinderman, head of the Institute of Psychology, University of Liverpool, said: ‘It will exacerbate problems that result from trying to fit a medical, diagnostic, system to problems that just don't fit nicely into those boxes. ‘It will pathologise a range of problems which should never be thought of as mental illnesses. Many who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as “mentally ill”. ‘This isn't valid, isn't true, isn't humane.'
Paraphilic Coercive Disorder – becoming aroused by sexual coercion – is one condition proposed for inclusion in DSM5. Professor Kinderman said there was a danger that rapists diagnosed with it would use it as an excuse. He added that there were ‘huge concerns' about the changes, which are opposed by the British Psychological Society.
Other experts say the guidelines will straitjacket clinicians into ‘ticking boxes' that lead to a proscribed diagnosis. Dr Felicity Callard, of King's College, warned: ‘People's lives can be altered profoundly – and sometimes ruinously – by being given a psychiatric diagnosis.'
Among the U.S. psychiatrists against the changes is Allen Frances, of Duke University, North Carolina. He warned: ‘DSM5 will radically and recklessly expand the boundaries of psychiatry. Many millions will receive inaccurate diagnosis and inappropriate treatment.'
David Elkins, of Pepperdine University, Los Angeles, said individuals could be ‘labelled with a mental disorder for life and many will be treated with powerful psychiatric drugs'. Defenders of the American Psychiatric Association guidelines say they will make diagnosis more accurate and scientific. 10.2.12 Also see here.
You ARE more likely to die if taken to hospital at weekend: Study confirms that NHS care is worse on a Saturday and Sunday
- Chances of recovery are jeopardised because senior doctors are absent and tests are not always available
- Study finds that Sunday patients are 16 per cent more likely to die than those admitted on a Wednesday
- Health Secretary Andrew Lansley says the findings are 'unacceptable'
Patients admitted to hospitals at weekends are far more likely to die than those taken there on weekdays, a major study has confirmed.
Chances of recovery are jeopardised because senior doctors are absent and tests and scans are not immediately available. A study of over 14million NHS admissions found that Sunday patients are 16 per cent more likely to die within the next 30 days than those brought in on a Wednesday.
Patients admitted on a Saturday are 11 per cent more likely to die in 30 days.
Alarmingly, the researchers warned that patients who go to hospital at weekends tend to be sicker – making it crucial that they receive the highest standard of medical attention. This is due to a higher number of road accidents, drink-related injuries and poor out-of-hours GP care that means patients' deteriorate while treatment is delayed.
Earlier this week, Health Secretary Andrew Lansley ordered a ‘fundamental rethink' of how hospitals are run at weekends.
Responding to this study Mr Lansley said: ‘It is unacceptable that patients admitted to hospital on a Saturday or Sunday stay longer and have worse results. ‘Much of the rest of the country continues to be open for the public's needs at weekends – an NHS that revolves around patients should be the same.
‘By opening some services seven days a week, more patients will get the care and treatment that they need when they need it. In some parts of the NHS, this is already happening. 'On Saturdays and sometimes Sundays, some services have scanners open to provide tests, are doing operations, and have more senior staff around.'
Katherine Murphy, chief executive of the Patients Association, said: ‘The NHS exists to ensure that its users are given the best possible care, 24 hours a day, seven days a week.
It is simply not acceptable for somebody to face an increased risk of death just because they were unfortunate enough to suffer an injury or get sick on a Saturday or Sunday as opposed to any other day of the week.'
Researchers from University College London – whose work was commissioned by the Department of Health – looked at 14.2million hospital admissions in 2009/10. Writing in the Journal of the Royal Society of Medicine, the researchers concluded: ‘There may be aspects of care associated with weekend admissions which disadvantage patients.
‘Some urgent conditions require prompt treatment and in some cases the way weekend care is organised may lead to delays which can adversely affect the outcome.'
The study backs up a report in November by Dr Foster Intelligence linking a higher death rate at weekends with poorer staff levels. Most consultants tend to work office hours and at weekends the wards are left in the hands of junior doctors. In addition, departments responsible for certain scans and blood tests are shut until Monday.
The researchers pointed out that patients admitted at weekends may be more seriously ill. Some who become seriously ill on Friday try and hang on until Monday, during which time they deteriorate further and end up needing urgent treatment.
There are also more injuries from road accidents, alcohol and self-harming at weekends.
Dr Andrew Goddard, of the Royal College of Physicians, said: ‘This study is further evidence that patients admitted at weekends are more likely to die following admission than patients admitted to hospital during the week. ‘There are many reasons for this, but the two most important are that the patients are more ill and there are fewer doctors available.'
David Stout, deputy chief executive of the NHS Confederation said: ‘There is no doubt that this is something the NHS has to improve. 'Patients should never have to worry about what is the "right" time to visit their local hospital.' 3.2.12
NHS lawyer who told doctor to cover up a death is given £100,000 after she lost her job
Father of dead patient brand payout 'morally wrong'
An NHS lawyer who asked a doctor to suppress details of how a patient died has won a payout of more than £100,000. Kate Levy was fired from her job as head of legal services at scandal-hit Stafford Hospital after details of the cover-up were exposed. But after taking her former employers to a tribunal, she has now been awarded £103,000 for ‘wrongful and unfair dismissal'.
Her sacking centred on a request she had made to consultant Ivan Phair over a report he had written into the death of John Moore-Robinson.
Mr Moore-Robinson's father, Frank, branded the payout ‘morally criminal'. His 20-year-old son had been taken to the casualty department of Stafford Hospital after a mountain bike accident on Cannock Chase, Staffordshire, in 2006.
An X-ray revealed he had broken his ribs. He was vomiting and in agony but a junior doctor failed to spot a ruptured spleen and sent him home with painkillers. Within hours his parents called 999 because he was still in severe pain. He died minutes before paramedics arrived.
Mr Phair later wrote a report into the death for the coroner, which stated it was ‘avoidable' and there was a ‘high probability that the level of care delivered was negligent'. But when Miss Levy, 56, read the report, she wrote to Mr Phair asking him to delete the criticism to spare distress to Mr Moore-Robinson's family and avoid ‘adverse publicity'.
Miss Levy was suspended and sacked after details of the cover-up were exposed in a Sunday newspaper two years ago. She lost an appeal against her dismissal and then started tribunal proceedings against the Mid Staffordshire NHS Foundation Trust.
At the start of this week's hearing, the Trust conceded Miss Levy was ‘wrongfully and unfairly dismissed', and authorised a settlement of £103,000.
Mr Moore-Robinson's parents had received just £13,000 from the NHS litigation authority over their son's death, to cover his funeral costs and their legal expenses during the 2007 inquest. In the end, neither Mr Phair's original report nor the amended version were sent to the coroner.
Last night Mr Moore-Robinson's father said that senior executives at the Trust admitted to him that they had ‘cocked up big-time' over the way Miss Levy's dismissal was handled. He added: ‘In my opinion, the decision to sack her was correct. But it seems they went about it the wrong way.
‘I can accept that technically, the hospital may have been wrong to sack her but giving her a six-figure payout beggars belief. 'What she did was despicable and I hope she can live with herself. I just think it is obscene when you consider what we received for John's death.'
In a statement, the Mid Staffordshire NHS Trust said: ‘Following legal advice we received from our barrister at the start of the tribunal, we conceded that Ms Levy was wrongfully and unfairly dismissed.'
Miss Levy, who had previously been cleared of any wrongdoing by both the police and the Solicitors Regulatory Authority, said: ‘I have always maintained that my actions were entirely consistent with my duties as a lawyer, and that I was not in breach of contract or otherwise guilty of any misconduct.'
Stafford Hospital was first hit by scandal in 2009 when a report by the NHS regulator, the Healthcare Commission, said appalling standards of care there may have contributed to the deaths of at least 400 patients.
Robert Francis QC then chaired an inquiry which concluded that patients were routinely neglected by a Trust that was ‘preoccupied with cost cutting and targets'. 2.2.12
Tripadvisor banned from claiming its reviews are real
Tripadvisor, the travel review website, has been banned from claiming that all of its hotel and restaurant reviews are real. It follows complaints that some unscrupulous hoteliers have posted fake comments on the site to boost their own business or sabotage others.
Following a four month investigation, the Advertising Standards Authority found that it was possible for “non-genuine content” to appear on Tripadvisor, which is designed to allow holidaymakers to share tips and opinions on places they have visited.
The advertising watchdog said that because reviews can be posted on the site without any form of verification, Tripadvisor must no longer claim that all of its reviews are honest, or even from real people.
In a strongly-worded ruling, the ASA told Tripadvisor “not to claim or imply that all the reviews that appeared on the website were from real travellers, or were honest, real or trusted”.
The ASA's ruling, which applies only to Tripadvisor's UK site, follows a complaint last year from two unnamed hoteliers and a website called Kwikchex, which helps companies manage their online reputations.
They argued that wording on Tripadvisor's website - claiming that the site contained “reviews you can trust” and “honest” opinions from “real travellers” - was misleading as Tripadvisor could not prove that the reviews were genuine.
Chris Emmins, co-founder of Kwikchex, said that there are a “substantial” number of fake reviews on Tripadvisor, which is being “abused by fraudsters”. Fake comments range from unsubstantiated claims of food poisoning in restaurants to theft and credit card fraud in hotels, said Mr Emmins.
Tripadvisor, which has removed the wording from its website, said that the ASA had taken a “highly technical view” of its online marketing copy that was "used in a limited capacity”.
In a statement, the company said: “We have confidence that the 50 million users who come to our site every month trust the reviews they read on Tripadvisor, which is why they keep coming back to us in increasingly larger numbers to plan and have the perfect trip.”
A spokesman added that the average traveller reads dozens of reviews before making an informed decision on where to travel, rather than just “one or two” reviews. Travellers base their decision on “the wisdom of the crowds” rather than isolated reviews, the spokesman said.
“We know that our users approach Tripadvisor with common sense, and make an educated decision based on the opinions of many. If people did not feel the insight they gained from our site was an accurate reflection of their experience they wouldn't keep coming back,” the spokesman said. 2.2.12 Also see: Review site TripAdvisor is useless, damaging and used for blackmail
Jeremy Laurance: Why spare the drug companies?
We cannot provide every treatment to every patient regardless of cost
Why are Britain 's health charities bent on sucking the blood from the NHS? The very same organisations that do such sterling work funding research, supporting patients and promoting awareness appear to have a blind spot when it comes to assessing what treatments are worth. We see it each time the National Institute for Health and Clinical Excellence (Nice) reaches an unpopular decision to ban a drug on the NHS because it is too expensive, as it did yesterday with the new prostate cancer medicine abiraterone. Cue uproar from charities.
"This decision is a bitter blow to thousands of men and their families and must be overturned," said Owen Sharp, the chief executive of the Prostate Cancer Charity. It was the same last month, when Nice ruled against three bowel cancer drugs. Mark Flannagan, the chief excecutive of Beating Bowel Cancer, said: "This is yet another blow for bowel cancer patients. All bowel cancer patients deserve the best care." Of course – how could anyone dispute that? Nice agreed that some of the drugs were effective – extending life by an average of 3.9 months in the case of prostate cancer. As Mr Sharp said, that could give a terminally ill man the chance to "walk his daughter down the aisle or see the birth of a grandchild". It is a disaster for such a man to be denied such a drug.
But we cannot provide every treatment that is effective to every patient who would benefit without regard to the cost. If we did, we would quickly bankrupt the NHS. Yet that is what the health charities are helping to do. By turning their fire on Nice, and neglecting the other player in the tragedy – the drug company involved – charities are effectively saying that protecting drug-company profits is more important than protecting the NHS.
Nice assesses each drug and calculates how much benefit it delivers for the cost. It mostly approves drugs costing up to £30,000 per Quality
Adjusted Life Year (Qaly – a measure of the benefit), or for terminal conditions, up to £50,000. In this case, the prostate drug came in at £63,000 per Qaly, and the bowel cancer drugs at £110,000 per Qaly. So, in Nice's view, the drug companies Janssen and Amgen were charging more than they were worth. Did the health charities challenge the companies? No. Instead, they lambasted Nice. Do they receive drug company financial support? Perhaps we should be told.
Only Harpal Kumar, the chief executive of Cancer Research UK , struck the right note. Commenting on the prostate drug decision yesterday, he said: "We feel extremely let down that the drug's manufacturer couldn't offer Nice a price they could agree on." This is a £500bn global industry and it is time other organistations joined Nice in holding it to account to ensure fair prices are charged to the NHS. 3.2.12
Other critics pointed out these charities which do the complaining are usually funded by the drug companies to complain on their behalf. Drug companies spend approximately 11% of the budgets on research and development and are heavily supported by the tax system yet spent 45% on marketing and entertaining doctors to prescribe their products.
Instead of complaining about NICE all the time, these drugs could easily be priced to be cost effective but in their desire to milk the system, they often price themselves out of the market and get others to do their dirty work.
Now patients are denied 'breakthrough' prostate cancer drug as health watchdogs brand it too expensive
- Once-daily pill giving extra months of life is 'too expensive'
- Abiraterone is latest cancer drug facing an NHS ban
A ‘breakthrough' drug that gives extra months of life to men with advanced prostate cancer has been rejected for use on the NHS. The once-daily pill was developed by UK scientists at the Institute of Cancer Research (ICR) and trials were partly funded by British charities.
But it has been branded as too expensive by the rationing watchdog the National Institute for Health and Clinical Excellence.
Abiraterone is the latest prostate cancer drug to face an NHS ban despite being proven to extend life for men with advanced disease. Last month another drug – Jevtana – was turned down as ‘not cost-effective'.
It is a fresh blow for doctors and patients who hoped a new era of drugs could lessen the deadly toll of prostate cancer, which has been described in the past as a low-profile ‘Cinderella' disease.
Trials show men taking abiraterone and a steroid survived for nearly 15 months, while men given steroid treatment and a ‘dummy' pill lived for 11 months on average.
But some patients live far longer than expected, including Britons who have survived on the drug for more than four years after developing advanced disease. The drug also eased pain for twice as many men in the trials.
A year's course of treatment costs £35,000, which Nice says is too expensive.
Campaigners last night condemned the draft decision by Nice. Owen Sharp, chief executive of the Prostate Cancer Charity, which helped fund trials, said: ‘This draft decision is a bitter blow to thousands of men and their families – and must be overturned.'
Patients have been getting abiraterone, also known as Zytiga, through the Cancer Drugs Fund, set up by the Government to pay for treatments not approved by Nice.
But the fund only applies in England until 2014, which denies access to patients in Wales , Scotland and Northern Ireland. 2.2.12
Pharmaceutical giant AstraZeneca announces 7,300 job losses as it pares back staff to save money
Britain 's second-biggest drugmaker AstraZeneca said today it is axing 7,300 jobs by the end of end of 2014 in its latest round of cost savings. It said the restructuring was needed because of the weak economy and the impact of competition from generic drugs.
The company, which has 61,000 staff globally of whom 8,000 are in the UK, axed 12,600 positions between 2007 and 2009 and removed another 9,000 roles by the end of last year, when it closed a site at Charnwood near Loughborough.
Its sites in the UK are at Alderley Park in Cheshire , Macclesfield, Cambridge , Luton , Avlon near Bristol , Paddington in London , and Brixham in Devon. The company has not yet disclosed where the jobs will be cut.
Union representatives, who were seeking further details from the company today, warned that it was another blow for the UK economy after rival firm Pfizer announced plans to pull out of Sandwich in Kent.
Allan Black, GMB national officer for pharmaceuticals, said: ‘These cutting-edge research and development jobs are both well-paid and essential for a thriving UK economy. ‘As a nation we do need to find a viable way to continue to make breakthroughs in bringing to safe use much-needed new medicines.'
The jobs blow came as the company announced a 2 per cent fall in revenues to $33.3 billion (£21.1 billion) in 2011, while profits fell 4 per cent to $13.2 billion (£8.4 billion). It said generic competition as patents expire and intervention in pricing from central governments wiped $3 billion (£1.9 billion) from its revenues.
The company said revenues for 2012 are likely to be down by more than 10 per cent while its margins will also be squeezed, leading to lower profits.
It has suffered a number of setbacks in its efforts to secure approval for new blockbuster drugs.
It recently warned that profits would be at the low end of analysts' expectations after ovarian cancer drug olaparib was held back for further development when tests proved it was unlikely to prove effective.
The results of tests on drugs for patients with major depressive disorders were disappointing, although tests are ongoing. The US Food and Drug Administration also recently declined approval of a new diabetes drug dapagliflozin. Analysts have also been underwhelmed by sales of its new blood thinning drug Brilinta.
Astra warned that the coming years would be ‘challenging for the industry and for the company'.
Chief executive David Brennan said: ‘Disciplined execution of our strategy has delivered a good performance in 2011 in the face of intensified pricing pressure and generic competition.
‘While the further expected losses of market exclusivity make for a challenging 2012 outlook, we remain committed to a long-term, focused, research and development based strategy, and today we have announced further steps to drive productivity in all areas to improve returns on our investment in innovation.'
Despite the cost-cutting measures announced today, the Cheshire-based company announced a 10 per cent hike in its dividend and plans to return an additional $4.5 billion (£2.9 billion) to shareholders in 2012 on top of the $9.4 billion (£6 billion) last year. 2.2.12 & FT
Heartburn pills taken by thousands of women 'raise risk of hip fractures by up to 50 per cent'
Hundreds of thousands of women who take commonly prescribed heartburn pills could be up to 50 per cent more prone to hip fractures, scientists warn. Taking the drugs several times every week has been shown to increase the risk by more than a third. The figure is 50 per cent for smokers or those who have smoked in the past.
Researchers studied the long-term effects of proton pump inhibitor drugs, or PPIs, which are widely prescribed across the NHS for heartburn, indigestion and stomach ulcers. Some pills are also available over the counter, including omeprazole, which is sold under the brand name Zanprol.
The team from Harvard Medical School and Massachusetts General Hospital in Boston looked at data spanning nearly 20 years involving 80,000 women who had been through the menopause.
Every two years they were asked how often they had taken these drugs and whether they had suffered any hip fractures. The findings, published today in the British Medical Journal, show that women who had taken them at least three or four times a week over a two-year period were 35 per cent more at risk of suffering hip fractures. Researchers believe that the drugs may hamper the body's ability to break down and replace old bone tissue.
They also suspect that PPIs may reduce the take-up of calcium, which is an essential component of healthy bones.
But lead researcher Dr Hamid Khalili pointed out that even though the drugs increased the risk of fractures it was still very low. For every 500 patients on the drugs only one would be likely to fracture their hip in a year.
But he said that middle-aged women – particularly those who smoke – who had been taking PPIs for a long time should consider whether it was really necessary. The study concluded: ‘Our data suggest the importance of carefully evaluating the need for long-term, continuous use of PPIs, particularly among individuals with a history of smoking.'
Tobie de Villiers, president of the International Menopause Society, said: ‘Although the relative risk of hip fracture is significantly raised in users of PPIs when compared to non-users, the absolute risk increase is small. This is still important in view of the widespread use of PPIs and the significant burden of hip fractures on affected individuals and the healthcare system.'
Around nine million prescriptions for PPIs are written out every year at an annual cost to the NHS of more than £400million. Many patients with severe heartburn or acid reflux end up taking them for months. However, hip fractures can be devastating, particularly for the elderly who can die as a result. Patients may have to spend weeks immobile in hospital and this can lead to infections such as pneumonia.
The Harvard study only involved women, but other research suggests that men taking these drugs are also at risk.
One by Canadian scientists on both men and women in 2008 found that those who had taken the drugs for five years were 44 per cent more likely to have a hip fracture.
Dan Greer, spokesman on gastroenterology medicines at the Royal Pharmaceutical Society, said: ‘This is a useful study, that has taken account of the other factors that can affect hip fractures such as smoking, calcium intake, and obesity that has been missing from other studies looking at the link between PPIs and hip fracture. ‘It suggests there may be a small increase in hip fracture risk associated with these medicines in a high-risk group. Women should be reassured though that the absolute risk is small.' 2.2.12