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NHS sends thousands of its own staff private

Liberal Democrats say £1.5m bill "raises serious issues" about health service provision. The number of hospital staff who are receiving private healthcare treatment paid for by the NHS has prompted accusations that the health service is paying for its staff to queue-jump and raised questions about its ability to provide 'adequate treatment'.

Freedom of information requests sent out to all NHS trusts and hospitals in England reveal that over the past three years 3,337 employees were treated, at a cost to the taxpayer of £1,578,607. The figures – obtained by the Liberal Democrats – show the practice is becoming increasingly common.

In 2006-07, 708 staff received private treatment at a cost of £279,335. The following year, 988 staff received private treatment at a cost of £470,859. Last year, the number jumped to 1,641 staff at a cost of £828,413.

"If the NHS thinks it necessary to pay for private treatment for its staff to jump waiting lists, then it raises serious questions about whether the current system is working as it should," said Norman Lamb, the Liberal Democrat health spokesman.

Orthopaedic consultations, chiropody and aromatherapy were among the private treatments received. But those most used were physiotherapy and mental health services, notably cognitive behaviour therapy, private counselling and psychiatric consultations. "I'm not surprised that so many trusts have to contract in private companies to provide for physiotherapy, counselling and therapy as they are often woefully under-resourced," Lamb said. "The sad reality of our health service today is that, if you suffer from an illness not covered by a government target, then you will still often have to wait months for the care you need."

The Department of Health said that any decision on whether or not to fund private healthcare was taken at a local level by each authority and trust. "There is evidence that early intervention in tackling sickness absence enables staff to return to work more quickly," said a spokeswoman.

Lamb said: "These figures will be little comfort for those people stuck on waiting lists trying to get access to treatment." The Department of Health commissioned a report last year into the use of private health treatments as a cost-effective way of maintaining a productive workforce. The final version of the review, led by Dr Steve Boorman, an expert in occupational health, will be delivered next month.

"Evidence from the Department of Health shows that many people with acute musculoskeletal problems recover more quickly when they are given rapid access to effective physiotherapy, enabling them to return to or continue in work while they recover their health," said Phil Gray, chief executive of the Chartered Society of Physiotherapy.

"The fact that some NHS staff are receiving private physiotherapy treatment could be explained by the need to reduce the time that frontline staff are off sick and away from their duties. However, it may also indicate a shortage in provision and lengthy waiting lists for physiotherapy." 19.10.09

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Copper bracelet arthritis cure is a myth, say scientists

Copper and magnetic bracelets worn by thousands to alleviate arthritis are useless, researchers claim. The trial - the first scientifically-based study of its kind - raises doubts over the multimillion-pound alternative pain therapy industry. Magnetic therapy and copper replacement are said to help a variety of ailments, including chronic joint pain caused by osteoarthritis and other musculoskeletal disorders. 

Manufacturers suggest the condition can be alleviated by re-balancing the body's magnetic field or topping up depleted copper levels though the skin. Many prefer to use the bracelets rather than drugs because there are no side effects.

But researchers from the universities of York, Hull, Durham, along with the NHS, found there was no difference in symptoms whether patients wore magnetic straps or de-magnetised ones. They asked 45 arthritis sufferers aged 50 and over to wear four wrist straps in turn over a 16-week period. They tested out a commercially available magnetic wrist strap, a weak magnetic wrist strap, a de-magnetised wrist strap and a copper bracelet.

Their pain levels were rated on an internationally recognised score index and their use of medication noted, says a report published in the latest issue of the journal Complementary Therapies in Medicine. No difference was found in terms of their effect on pain between the four devices, with similar results found for joint stiffness and need for medication.

Stewart Richmond, of York University, who led the trial, said: 'It appears that any perceived benefit obtained from wearing a magnetic or copper bracelet can be attributed to psychological placebo effects. 'People tend to buy them when they are in a lot of pain, then when the pain eases off over time they attribute this to the device. However, our findings suggest that such devices have no real advantage over placebo wrist straps that are not magnetic and do not contain copper.'

Dr Richmond added that although some arthritis sufferers do have lower copper levels, this is an effect of the condition rather than a cause. Magnetic and copper bracelets typically cost between £30 and £50, with the industry worldwide worth around £2.45billion.  Dr Richmond said: 'I realise this may dispel the myth and puncture a few balloons, but I don't want to see people wasting their money.'

However participants reported lower sensory pain after wearing the standard magnetic wrist strap, than when wearing control devices. However, no adjustment was made for multiple testing. 17.10.09

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Make laser cancer treatments a mainstream alternative demand experts

Cancer experts have called for more NHS patients to be given pioneering laser treatments as an alternative to surgery, chemotherapy and radiotherapy. Photodynamic therapy (PDT) developed 10 years ago is often called 'bloodless surgery' because it uses drugs and laser light to destroy cancer tumours.

It is approved in the UK for the treatment of a range of cancers, with results as good as or even better than mainstream treatments. But too few patients are being offered the chance of PDT, say specialists who have teamed up to launch a national awareness campaign and to raise research funding. Patients having PDT are given injections of a photosensitising drug, or it is applied on the skin, depending on the cancer being treated.

The drug actively seeks out a cancer tumour and makes the cells more sensitive to light. The drug is actually a dye agent primed to absorb energy from light at a specific wavelength and is harmless until 'switched on' by non-thermal laser light when it becomes a cancer killer.

Cardio-thoracic surgeon and laser pioneer Professor Keyvan Moghissi said PDT could 'revolutionise' cancer treatment if used more widely. It is another option for patients which avoids invasive surgery, and the side effects associated with strong radiation and chemical therapies.

He said 'PDT offers a real 'ray of hope' for a large number of cancer patients and should have equal status as a treatment alongside chemotherapy, radiotherapy and surgery. 'Leaders in this field from across the UK decided they needed to form a specialist group to raise the profile of PDT within the NHS and Primary Care Trusts consistently across the UK and to collaborate to attract funding for future research on a coordinated national basis.'

The campaigners have set up the UK PDT Charitable Trust, chaired by Prof Moghissi. Research is currently under way to develop better dyes and by specific targeting of diseased tissue to achieve the ultimate goal of personalised cancer treatment. This involves loading antibodies generated from samples of a patient's unique tumour with PDT dyes to treat the patient.

Not all tumours can be treated by the laser treatment as each type of cancer needs specific drugs with specific dyes and not all have been developed yet. The National Institute for Health and Clinical Excellence (Nice) has issued guidance on a number of cancers for which PDT can be used. In the case of non-melanoma skin tumours, Nice said there were 'no major safety concerns' about the treatment.

Guidance on advanced oesophageal cancer meanwhile states: 'Current evidence on the safety and efficacy of palliative photodynamic therapy for advanced oesophageal cancer is of poor quality but appears adequate to support the use of this procedure to relieve symptoms in patients with a poor prognosis.' Possible complications identified included skin photosensitivity, Nice said.

But people with brain tumours are not recommended to have the procedure unless in the context of trials because of 'limited' evidence on its safety and efficacy, according to Nice guidance. 5.1109

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Why are cancer patients being told a proven treatment is ‘experimental or doesn't work'?

One of the most frightening aspects of being diagnosed with cancer is that the treatment can be harsh. You may be disfigured by surgery or damaged by radiotherapy and chemotherapy. Imagine your relief, then, to discover that there is a properly tested, officially approved treatment that avoids the worst side-effects. Now imagine your anger when you discover that only a very few people can get this treatment on the NHS.

That's the emotion powering a celebrity-backed appeal, launched last week, to increase the availability of a treatment called photodynamic therapy (PDT). PDT involves taking a drug that becomes active only when laser light is shone on it. Cancer cells absorb the drug and are destroyed when the light, which is carried on a flexible tube that can be put anywhere in the body, is focused on them.

The whole procedure can take as little as half-an-hour and for many patients only one treatment is necessary. Another benefit is that any healthy tissue that is affected grows back normally without scarring. This isn't just kinder to patients - it's also, remarkably for a breakthrough - cheaper. PDT avoids the risks of surgery, cuts the use of hospital beds and removes the need for repeated hospital visits required by chemo and radiotherapy.

Indeed, it could save the healthcare system between one and two billion pounds a year, according to estimates by cancer specialists at University College Hospital, London. But, despite the National Institute for Health and Clinical Excellence ( NICE ) approving the use of the therapy for cancers such as skin, mouth, oesophagus, head and neck, less than 1 per cent of those who could benefit actually get it.

Skin cancers are the most commonly treated, but even then the numbers are still tiny - only a few thousand of the 76,000 new cases of skin cancer a year receive PDT. The vast majority are treated with surgery, which can involve skin grafts and leave scars. 'All this can be avoided with PDT,' says Colin Hopper, a surgeon at the National Medical Laser Centre at University College London. 'It doesn't damage nearby tissue and there's rarely any scarring. It's also far cheaper: surgery can cost £6,000 if reconstructive work is needed compared with £1,000 for PDT.'

If the number of patients receiving the new treatment for skin cancer is low, for other types of cancer it is even worse. Just 300 cancer patients out of more than 300,000 were treated last year. Many are never even told about it or they are told (incorrectly) that it is experimental and doesn't work.

But it's in the treatment of head and neck cancer where the lack of PDT is possibly most keenly felt. These are vulnerable areas and treatment such as radiotherapy can leave patients unable to eat and in pain for months. For others, surgery can be devastating where it involves the removal of the tongue and voice box.

Virtually all of these horrendous side-effects can be avoided with photodynamic therapy, which involves no surgical destruction or burning by radiotherapy. Even though it was approved by NICE for head and neck cancer six years ago, out of 8,000 operations performed for it last year, just 180 patients got PDT, nearly all at University College Hospital.

Right now, however, the gap between the number of cancer patients who could benefit from it and those who actually get it is huge,' says Colin Hopper. 'It's a criminal injustice that this form of treatment is not available to everyone in Britain,' says musician Robert Plant, who is backing the new campaign. 'I have a friend receiving PDT, but only because we pushed to get it. None of his doctors told him about it.'

So, given its obvious advantages, why is it so little used? Partly it's because some medics consider it experimental on the basis there are no full-scale controlled trials for some of its uses (despite NICE approval for other uses). Funds for research are a big issue. 'We haven't been able to raise enough money from the traditional routes,' says Dr Stephen Pereira, a gastroenterologist at University College Hospital.

National Institute of Health has been more receptive than British charities and agencies, and it has joint ventures with teams from Harvard Medical School.' That's not to say there is no funding at all - Cancer Research UK has recently supported a clinical trial on PDT's effect on bile duct cancer as well as helping work at London's Imperial College to develop PDT for other cancers.

But funding is patchy at best. Red tape also plays a part in poor uptake. 'Some health authorities require approval every time PDT is used,' says David Longman, of Killing Cancer, the charity behind the new campaign. 'Then they may refuse it, even though it's cheaper than chemo, because any treatment beyond the norm shows up as an extra expense.'

This is borne out by the experience of Keith Webster, a consultant surgeon at University Hospital, Birmingham. He specialises in head and neck cancers and has been frustrated by having to make a fresh application for PDT for each of his patients. 'This is one of the major centres in the country and yet we have to keep seeking approval,' he says. 'When we say it's appropriate, we should be listened to.'

When this was put to the Department of Health, a spokesman said it was up to clinicians, 'using their judgment, to decide on the most effective treatment, and then for the relevant Primary Care Trust to decide'.

Clinicians and campaigners feel the NHS has been dragging its feet. Two years ago, the Department of Health commissioned a review of PDT - 'but it's not going to be finished for another seven months,' says David Longman. 'I thought we were getting somewhere, but the lack of urgency by the Department of Health has been astonishing.'

The Department of Health said: 'We are committed to ensuring that newer treatments are made available as widely as possible, and a review of the evidence will be published in spring 2010.'

The aim of the Killing Cancer campaign is to raise funds to pay for PDT treatment and equipment, and to help fund more research. What makes PDT potentially even more exciting is that it could transform the treatment of nearly all cancers, including those far inside the body. 'We can use fibre optics to put a light down a hollow needle - this enables us to treat solid tumours deep inside the body,' says Hopper. 'Improvements in ultrasound mean we can guide the needle to precisely the right spot.'

This means hard-to-treat cancers such as prostate, lung and pancreas are all within reach. Indeed, early evidence suggests that PDT may work well with prostate cancer, reducing surgical side-effects such as incontinence and impotence. Later this month, a trial is starting to test the effectiveness of PDT on breast cancer.

What is frustrating is that even though British researchers pioneered PDT, we are falling behind Europe in making it available. By Christmas, Mr Hopper will have trained 40 Italian doctors in how to use it. 'By comparison I've trained a total of 60 British doctors in the past ten years,' he says. 'Soon Italy's use of PDT drugs will be double that in Britain.'

Critics suggest the reason for the slow uptake by the medical profession is due to the influence of the pharmaceutical companies who make billions from doctors prescribing cancer drugs every year.

Making sure the therapy is more widely available is one reason Manchester United manager Sir Alex Ferguson is also backing the campaign. 'My mum and dad both died from cancer,' he told the Mail. 'One in three of the magnificent fans watching a match at Old Trafford will also die of it. 'The thought of getting it fills me with dread. I reckon both me and the fans deserve a better deal than is on offer.' www.killingcancer.co.uk 16.10.09 Link: http://www.dailymail.co.uk/health/article-1219948/A-ray-light-kill-cancer-cells-leaving-terrible-scars--offered-it.html

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Patients to take control of personal budgets as pilots get underway

Thousands of GPs will have to start helping patients decide what NHS treatments they can afford as a Government plan giving people with long term conditions control over their own budgets is launched in pilots across the country. The Government has named 20 PCTs which will carry out a three-year evaluation of the controversial personal health budget scheme.

The Department of Heath hopes the trial, which in some areas will involve every GP practice, will give more power over their care. But it also hopes to save the NHS money, on the back of research suggesting patients will not spend all their budgets when they see for themselves just how much their care is costing.

However, the scheme has provoked fears among GPs that they will face a big new workload dealing with potentially fraught discussions over what treatments patients - including those who are dying, have mental health problems or are drug misusers - can afford. The pilots cover a raft of long-term care categories, including end-of-life care, mental health and continuing care. Some PCTs' schemes cover a string of clinical areas such as COPD, CHD and diabetes.

Derek Hoddinott, interim commissioning manager at Medway PCT, which is to hand personal budgets to a trial group of patients all with 12 months or less to live, said it expected to provide the service to between 70-100 ‘clients' over the three years and estimates that up to 40 GP practices could be involved in the course of the trial.

He said the PCT would be measuring the success of the scheme based on improvements in palliative care outcomes, patient feedback on qualitative outcomes and whether it saved the PCT money. A control group will be used, without personal budgets, to see if the new system gets better results.

He added: ‘I don't think this will bring a significant extra workload for GPs. What it will bring is a different style of work, working in partnership with patients. It's a change of culture.'

Medway's scheme envisages giving around one in 10 dying patients in the area control over their end-of-life care budget but in other areas up to 10,000 patients at a time are expected to be considered for a part in one of the pilots. Dr Andrew Mimnagh, a GP in Sefton, which along with other PCTS in Liverpool will be piloting personal healthcare budgets for patients with mental health problems, said the system risked ‘opening a Pandora's box.'

He said: ‘I'm worried that we could end up with patients claiming that they are being denied treatment because of how much it costs.' ‘I also think many of my colleagues will be insulted at the idea that working in partnership with patients is a new idea and I can't see how this scheme can fail to increase our workload.' 10.10.09

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NHS care causes one in 50 hospital treatments

Up to one in 50 patients in hospital is being treated for problems caused by previous NHS care, official figures published today show. A study by the NHS Information Centre found that patients in England were treated for complications resulting from treatment on 326,000 occasions over a 12-month period — equivalent to 2 per cent of all hospital admissions.

The figures include cases of botched surgery, excessive bleeding or serious side-effects to medicines or therapies given to help patients. Overall, 95,930 complications (29 per cent of the total) involved the patient suffering an adverse effect from drugs used in their treatment. Another 5,050 (2 per cent of the total) involved “misadventures” during surgical and medical care, and 3,690 (1 per cent) involved an adverse incident relating to equipment used in diagnosis or therapy.

In more than two thirds of cases (68 per cent), patients suffered an abnormal reaction to treatment some time after a surgical or medical procedure because problems had not been identified when they were originally treated. A spokesman for the centre said: “These figures do not include people with minor complications that could have been dealt with outside hospital. They only deal with serious complications where patients had to be readmitted to hospital as a consequence of earlier treatment. “We were surprised that these figures were so high, but it is still a minority of total episodes of treatment carried out.”

The data covers England from July last year to June this year. The 326,000 courses of treatment represent 2 per cent of the 16.3 million carried out by the NHS during that period. This is a slight rise compared with the previous 12 months when 295,000 (1.9 per cent or one in 53) of the 15.6 million treatment courses resulted from a complication.

Tim Straughan, the head of the NHS Information Centre, said: “It is important to note that complications can occur as a result of a patient's physical reaction to treatment that was not able to be predicted, rather than arising due to any fault of the medical professionals involved. “Trends may also include effects of any changes in data recording and clinical coding practices,” he said.

Separate figures published this week by the National Patient Safety Agency (NPSA) show that more than 5,700 patients died or suffered serious harm as a result of staff errors in the NHS over a six-month period. Figures from the agency show that there were 459,500 patient-safety incidents and near misses in England between October last year and March.

This is a 12 per cent increase on the previous six months. Most incidents resulted in no harm or low harm to a patient. The NPSA, which collects and monitors safety data in the NHS, said that the rise was due to better reporting.

Martin Fletcher, the agency's chief executive, said: “More reports do not mean more risks to patients. Quite the reverse. These data are evidence of an improving reporting culture across the NHS. Frontline staff are more likely than ever to raise safety concerns much more openly.”

A spokeswoman for the Department of Health said: “Patient safety is a top priority for the NHS and the vast majority of NHS patients experience good-quality, safe and effective care. “While any preventable harm or death is unacceptable, complications can occur as the reasons are often unpredictable. “Many complications are not the result of poor-quality care,” she said. 10.10.09

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Tories vow to cut NHS bureaucracy by a third

Andrew Lansley says £1.5bn a year will be switched from backroom operations to frontline nurses and doctors. The cost of bureaucracy in the NHS will be slashed by a third under a future Conservative government, the party will pledge today. The switch in spending priorities will transfer £1.5bn a year from backroom operations to frontline nurses and doctors, the shadow health secretary, Andrew Lansley, will say.

No indication has been given of where the axe would fall but primary care trusts and assorted medical quangos are responsible for most of the NHS's annual administration costs of £4.5bn. By the end of its fourth year in power, a Tory government aims to have reduced that annual figure to £3m.

Addressing the Conservative conference in Manchester, Lansley will say: "Labour have made expensive commitments on the NHS with no price tag. In contrast, we are determined to identify how we will save money before we spend it. "To make the NHS successful we must devolve decision-making closer to patients. In doing so we'll save substantial sums of money.

"The NHS must be well managed but that's not expensive bureaucracy, it's about lean and good-quality management. "Labour has allowed wasteful spending on bureaucracy to spiral. A Conservative government would cut it right back. We are determined to shift NHS funds from the back office to doctors and nurses on the front line. Our tough new approach will shift £1.5bn a year out to where it's needed most."

Health is one of only two departments for which the Tories have promised real terms spending increases. Reducing bureaucracy is presented as the means of achieving this funding goal.

At least £850m would be saved by returning NHS spending on administration to what it was six years ago. Back then, the Conservatives point out, Labour had already suggested there were potential savings of £750m to be made by slimming down bureaucracy costs. Lansley will claim further savings can be made by scrapping "Labour's top-down process targets" while returning powers over budgets and out-of-hours care to GPs.

"Narrow" targets that focused only on part of a patient's treatment would be abolished, he promised, switching concerns instead to "overall results". "This will mean that many of the administrative posts which exist simply to monitor progress against these targets will no longer be needed," a party briefing document explained.

Lansley will endorse an assessment by David Nicholson, the chief executive of the NHS, that savings of between £15-20bn need to be found between 2011-14. He will say that the Tories will "go much further in slashing wasteful bureaucracy in the NHS hierarchy". In his speech, Lansley will repeat his pledge that "we are committed to real terms increases for the NHS in the next parliament".

He will also promise "zero tolerance" of hospital acquired infections and the right for patients to choose not only the hospital where they are treated but also "which consultant will be responsible for your hospital treatment". Determined to banish fears that a future Tory government would not look after the health service, he will declare in the closing passage of his speech: "Conservatives – the party of the NHS."

If the British health service was as effective as those in the rest of the Europe, up to 100,000 extra lives a year could be saved, he will tell the conference."We will not make the people of this country pay for Labour's debt crisis by undermining their access to quality healthcare. 5.10.09

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Cancer jabs programme is 'mass experiment' says researcher

The cervical cancer vaccination programme was last night branded a 'public health experiment' by a senior researcher who helped develop the drug. Dr Diane Harper - one of the world's leading cervical cancer experts - said health officials and drug firm bosses were exaggerating the jab's benefits.

And she claimed parents were not being properly warned about the 'small but potentially adverse' risks of Cervarix and other vaccines. But health officials, cancer charities and scientific experts all insist the programme is safe and urged parents and schools not to panic.

Dr Harper's comments follow the death of 14-year-old Natalie Morton, who collapsed an hour after receiving the jab at school on Monday. Initial post mortem results have suggested that her death was caused by a rare and serious illness - rather than the cancer vaccine.

Under the Government's cervical cancer programme, Cervarix is being offered to girls between 12 and 18. It works against two strains of HPV - a sexually transmitted virus that causes 70 per cent of cervical cancer cases.

Yesterday the Department of Health said it had 'great confidence' in the safety of its cervical cancer vaccination programme. 'We have been clear all along that there is no reason to suspend HPV immunisation - the programme against cervical cancer continues today,' a spokesman said.

'We have one of the most successful immunisation programmes in the world and have great confidence in the safety of them. 'Young girls can continue to protect themselves against cervical cancer by having this vaccine.' But Dr Harper, of the University of Missouri-Kansas, who was involved in the clinical trials of Cervarix, believes it should have been tested for another four years before being introduced in Britain.

Patient trials have only been running for seven and a half years - not long enough to show whether it continues protecting women into their late 20s and 30s, she said. 'It is a public health experiment,' she said. 'Parents consenting to HPV vaccination must be told that the duration of the vaccine is unknown, and that it is entirely possible that the initial vaccination series will only postpone, not prevent, future cervical cancers in their daughter,' Dr Harper said.

Around one million girls have been given the vaccine. There have been 4,657 reports of suspected adverse reactions - including sore arms, dizziness and swelling. Although the drug is safe for the majority of women, there are very rare 'real dangers' - including the risk of brain damage, paralysis and death, Dr Harper said. Even if the jab is only dangerous for one person in a million, women should be told the risks, she said.

She also believes the benefits of the vaccine as a 'cure' are being exaggerated. The jab does not prevent 30 per cent of cervical cancers - which means women will still need to be screened for pre-cancerous lesions. Dr Harper helped develop the HPV vaccine which is produced as Cervarix - the GlaxoSmithKline product distributed by the NHS - and Gardasil which is produced by Merck and distributed in the U.S.

A Department of Health spokesman said: 'It is wrong to suggest the benefits are exaggerated. Ninety nine per cent of cervical cancer cases are caused by HPV and the vaccine will protect against about 70 per cent of them.

'The evidence is that the vaccine is very safe. And long-term follow up studies have shown that it offers extremely high levels of protection that continue to last.' An initial post mortem showed the vaccine was 'unlikely' to have caused the death of Natalie Morton as she had a rare and grave underlying health problem, which was unknown to her family.

Stepfather Andrew Bullock said Natalie, who attended Blue Coat CofE School, in Coventry, had been 'poorly for some time'. She had been to see her GP several times and investigations into a mystery illness had been under way, he said.

How Britain went for the £18m cheaper option
Britain's decision to go against the rest of the Western world and opt for the Cervarix vaccine was made to save money, health charities claim. They said the decision condemned thousands of young women to an unpleasant sexual infection from which they would have been protected had ministers chosen the rival vaccine, Gardasil.

The U.S. and every single major western European country went for Gardasil, which protects against more strains of HPV, the sexual infection which can cause cervical cancer. It is understood that Britain chose Cervarix after the Health Protection Agency advised that it would save more than £18million a year.

There is no suggestion that Gardasil is any safer than Cervarix. In fact there have been 30 deaths following reported adverse reactions to Gardasil in the U.S., plus a number in Germany and Austria. But charities pointed out the extra strains of HPV that Gardasil protects against would have prevented thousands from catching genital warts - an infection on the rise, especially among the young.

They said the money saved will be outweighed by the £22million the NHS spends every year treating genital warts. 'Our concern is that we didn't pick the right vaccine in the UK,' said Lisa Power, of the Terrence Higgins Trust sexual health charity. 'We felt that Gardasil was more effective against more things. 'HPV may not be fatal, but it is very unpleasant and it is on the rise. In 2008 there were 92,525 new cases of genital warts. That's very expensive to treat, as well as leaving 92,525 very unhappy people.'

GlaxoSmithKline, which makes Cervarix, claims its vaccine lasts longer than Gardasil, meaning there is less chance of a booster being needed later in life. 1.10.09

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Dr Richard Halvorsen: I'm not opposed to jabs but there are serious worries

Evangelists for mass vaccination like to claim that these programmes are of universal benefit to public health. Indeed, so zealous is their enthusiasm for vaccines that, through a cocktail of scaremongering and propaganda, they attempt to suppress all debate.

The result is that people, especially parents, feel bullied or patronised if they dare to challenge the official drive to vaccinate against every possible risk of disease. Moreover, this climate of fear is ruthlessly exploited by the big pharmaceutical companies, which see vast profits in exaggerated health concerns.

Yet the sudden death of Coventry schoolgirl Natalie Morton after a jab against cervical cancer highlights the reality that vaccination programmes are not without their risks. The tragic irony for Natalie was that the injection may have triggered a reaction far more lethal than any future, distant threat of a comparatively rare disease.

And this exposes a fundamental problem about the Government's growing obsession with vaccinating children and teenagers. We have to be absolutely sure that the medical and political establishment's growing reliance on vaccines does not ultimately do more harm than good.

As a doctor, I have been concerned for some time about this issue. I should stress that I am not in any way opposed to vaccinations. Indeed I run an immunisation clinic which offers a wide range of vaccines as a protection against various diseases. But I am increasingly disturbed by the lack of any debate either about long-term vaccine safety or about the excessive influence of commercial interests.

Contrary to what Government officials and pharmaceutical giants pretend, the health of future generations could be compromised if we are not allowed to question this official fixation with mass vaccination. In the research for my recent book on this subject, I discovered that not only are inoculations being introduced with less and less research on their safety, but, just as worryingly, they are being promoted for diseases which do not represent a widespread danger to the public.

The cervical cancer jab that Natalie Morton was given shortly before she collapsed is a classic case in point. For all the hysteria that the Government and big business generated in support of the vaccine programme for teenage girls, cervical cancer only comes in 19th place on the list of cancers that kill women in modern Britain.

In 2005, just 911 women died of the disease. Though every death was obviously a terrible blow to the victim's family and friends, this figure pales beside the 12,000 who died from lung cancer or the 11,000 who succumbed to breast cancer. Indeed, cancers of the brain and the kidneys proved more deadly to women than those of the cervix, yet there is little publicity about these diseases. 

The fact is that the huge nationwide programme  -  which has already led to the vaccination of a large number of young women against cervical cancer  -  has partly been driven by naked commercial pressure. For decades, vaccines were the Cinderella sector of the medical industry, neglected because there was little money in them.

But all that is changed. Vaccines are now the fastest growing part of the pharmaceutical business so the giants, such as GlaxoSmithKline and Merck, which manufacture the two leading anti-cervical cancer drugs, have a vested interest in deliberately whipping up public anxieties.

In this world of cynicism, there is no sense of genuine proportion. Everything is geared towards the bottom line. Indeed Merck, which produces the anti-cervical cancer vaccine Gardasil, openly boasted in 2006 that its marketing campaign was 'proceeding flawlessly'. The company even won the industry award for 'the Pharmaceutical Brand of the Year' for creating 'a market out of thin air'.

In 2007, Merck made $1.5billion from the Gardasil vaccine and the same vast sum in 2008. GlaxoSmithKline is also doing well out of Cervarix, the drug used in the British vaccination programme.

One of the insidious ruses of the pharmaceutical companies  -  in which the medical establishment colludes  -  is to heighten the pressure for vaccines by drawing a false comparison between the present and the past.

In the Britain of the late Victorian age, tens of thousands of children died of tuberculosis, measles and whooping cough, but today such fatalities are almost non-existent. This is taken as evidence of the effectiveness of vaccines and is therefore used as an argument for an extension of programmes.

But such a claim is historically false. In fact, the death rate from measles and TB had fallen dramatically during the mid-20th century, well before any vaccines were introduced. This decline was mainly due to social factors, such as improvements in diet, housing and hygiene, as well as the discovery of antibiotics.

For all the noisy public relations campaigns, it is not clear that these vaccines even work anything like as effectively as their proponents claim. For instance, the jabs Cervarix and Gardasil only prevent a fraction of the number of viruses that can lead to cervical cancer. In truth, by suppressing those particular viruses they may encourage the growth of others in their place.

Given that these two drugs have been introduced in such haste with such limited testing, it will be 20 years before we know whether they are truly effective in achieving their primary purpose: that of fighting cervical cancer.

Nor should we be dismissive of the side effects of all these vaccines. It is now normal for a British child to be given no fewer than 25 vaccines by the age of 15 months. The Government's advisers, led by the Chief Medical Officer, Sir Liam Donaldson, say they are relaxed about this figure. Indeed, they have implied that there may be no upper limit to the amount of vaccines that a young child can take. As their defence, they point out that children constantly swallow lots of bugs and bacteria in their daily lives.

But that goes to the heart of the issue. When a child crawls around on all fours and takes in bacteria by licking hands, that is just part of natural human activity. Indeed, it is essential for strengthening of the immune system, the body's own vital defence network.

But that is very different from chemical injections, which completely by-pass the whole immune system.

There is mounting evidence that, by artificially stimulating the body's immune system, a barrage of vaccines can actually promote auto-immune disorders such as multiple sclerosis in susceptible people. Furthermore, some vaccines contain toxic metals such as aluminium and mercury. The fact is that the human body is a finely balanced eco-system, which overzealous vaccination can upset. 

What this all means is that we have to be more careful about vaccines. Colluding with the pharmaceutical giants, the Government has become far too cavalier about their use, promoting them as a risk-free solution to all sorts of medical conditions, no matter how low the incidence.

It has been madness, for example, to talk of vaccinating the entire population against swine flu, when the number of deaths from this illness is tiny compared to the annual toll for ordinary flu.

Vaccines cannot be used to build some medically controlled utopia, in which all disease has been banished. Indeed, the attempt to do may end up undermining the health of future generations. 30.9.09

● Richard Halvorsen is author of The Truth About Vaccines, published by Gibson Square

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The NHS? It's about as good as the health system in Slovenia

The National Health System is on a par with Slovenia and the Czech Republic, according to an analysis by European researchers. The NHS came 14th out of 33 European countries, making it one of the worst systems in Western Europe. The study - the Euro Health Consumer Index - found the NHS performed particularly badly on waiting times, even though these have fallen thanks to Labour targets.

It is also one of the least efficient, delivering less service per pound put in. The annual survey is by HealthConsumer Powerhouse, which campaigns for social insurance type systems rather than nationalised models such as the NHS. It ranks 33 systems on 38 factors such as patient rights, waiting times and access to medicines. 

Total possible score is 1,000 points and the Netherlands tops the list with 875, followed by Denmark (819) and Iceland (811). The UK, with 682 points, ranks just behind Ireland's 701. Lowest ranking of all was Bulgaria's 448 points.

The NHS ranking was just above former Communist states Slovenia and the Czech Republic but below France, Germany and Ireland. It did rank better than Italy however. The Netherlands is the only country which has consistently ranked in the top three during the five years the survey has been carried out.

But the UK's has been steadily increasing. It could have been higher this time, but the report comments: 'A mixed performance is shown by the UK: the overall UK score is dragged down by waiting lists and uneven quality performance'. A spokesman for the Department of Health said: 'Once again, the European Consumer Health Index report is based on flawed methodology and old data.

'There is a lot of credible and up-to-date evidence available showing just what great strides have been taken, on the back of record investment, in improving NHS services across the country. 'The NHS is treating more people and saving more lives than at any time in its history with waiting times at their lowest levels since records began.' 'Twelve years ago it was not uncommon for patients to have to wait over 18 months for an operation.

'Record investment and dedicated staff have given patients the shortest waits since NHS records began with average waits from referral to start of treatment at around eight weeks for admitted patients and four weeks for non-admitted patients.' 30.9.09

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Waiting times behind low ranking in EU healthcare index

The UK has been ranked 14th out of 33 countries in an annual survey of EU healthcare. The Euro Health Consumer Index (EHCI) is led by Netherlands for the second time, followed by Denmark , Iceland and Austria .

The UK scores 682 points from a potential 1,000 and performs well on pharmaceuticals (percentage of total prescription drug sales paid by subsidy, public information about drugs, access to new drugs) but poorly on waiting times, despite the government's investment in achieving the 18-week wait target.

The index groups 38 indicators of quality into six categories: patient rights and information, e-Health, waiting time for treatment, outcomes, range and reach of services provided and pharmaceuticals. Each sub-discipline is weighted for importance to provide the overall score, with outcomes and waiting times weighted most heavily. Scores for each indicator are based on a range of information, from patient surveys to international databases.  

"The UK in 2009 has showed surprisingly negative feedback from patient organisations on the waiting time situation, particularly after government spending on the NHS has been increasing heavily," said Dr. Arne Björnberg, the EHCI director. "It seems that management of the behemoth NHS organisation is difficult to do under a centralised paradigm."  

The winning dutch system is built on a range of health insurance providers acting in competition, separately from providers. The index report authors speculate that the success of the system may be generated by the fact that decisions are made "to an unusually high degree" by clinicians working in partnership with patients. Financing agencies, politicians and "bureaucrats" are also perceived to be further removed from decisions than in any other country.

"Bismarck" countries (with healthcare systems based on social insurance) have consistenly ranked higher than "Beveridge" ones (where financing and provision are handled within one organisational system) in the index. The authors conclude that systems such as the NHS "have difficulties at attaining really excellent levels of customer value", speculating that this may either be due to the difficulties of recruiting world-class managers or the interference of politicians.

Johan Hjertqvist, president of Health Consumer Powerhouse, which produces the Index, said: "With patient mobility growing around Europe , there is a strong need for transparency exposing the pros and cons of the national healthcare systems. The EU intends to introduce a crossborder care scheme which requires significantly better information to patients." 29.9.09

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Health fears that NHS switch to cheaper drugs could put millions of patients at risk of side-effects

Millions of patients could face life-threatening side-effects under a scheme which will swap branded drugs for cheaper versions. More than five million asthma sufferers and up to 500,000 with epilepsy could be hit by the change, while patients with conditions such as Parkinson's, bipolar disorder and hypertension may also be affected.

Pharmacists will be expected to substitute a brand of drug written on a prescription with a generic, cheaper version. For the first time, outside an emergency situation, they will not have to consult with a doctor to change a patient's prescription. The plan is expected to save the NHS up to £70million a year, but critics claim it may end up costing more in treating side-effects unless certain medical conditions are exempt from the rules.

Generic products are developed to cash in when branded drugs lose patent protection. Although generics are meant to be identical, the active ingredients can vary within an agreed percentage and inactive ingredients, such as colourings, may also differ. In epilepsy even tiny changes in bioavailability  -  the amount of active medication absorbed into the body  -  can have serious consequences.

NHS guidelines on epilepsy drugs currently warn against changing the brand for individual patients because of 'increased potential for excessive side-effects'. New regulations will be implemented next January, but no patient groups have been consulted. Doctors claim it is vital the 5.4million asthma sufferers in the UK are protected from having their inhalers automatically switched to cheaper versions. 

Dr Mike Thomas, chief medical adviser to the Asthma UK charity, said: 'Patients should only be swapped to another inhaler in a face to face consultation with a doctor or nurse. 'Generic substitution means asthma control may be lost and asthma that is not well controlled puts the patient at risk of an attack. 'An opt-out scheme will not be good enough, we need asthma inhalers to be exempt from the regulations.'

And Simon Wigglesworth, deputy chief executive of Epilepsy Action, said a survey of members revealed around 10 per cent had suffered more seizures as a result of changes to their anti-epileptic medication. 'We know people's epilepsy gets worse after their medication changes and seizures are life-threatening,' he said.  'Epilepsy patients should receive the same version of an anti-epileptic drug whenever they get a repeat prescription, from the same manufacturer and the same country of manufacture.

'The only safe way to bring in this scheme is to exempt anti-epileptic medication.  'The financial savings to be made from prescribing generically rather than by brand may not outweigh the cost of extra A&E admissions and hospital stays.'

Other countries with generic substitutions allow doctors to tick a box to indicate that a branded drug must not be changed. Around 86 per cent of NHS prescriptions are already written for generic drugs and Britain has one of the lowest levels of spending on drugs per head of any developed country.

David Fisher, of the Association of the British Pharmaceutical Industry, said savings from using cheaper drugs must go back to the NHS. A spokesman for the Department of Health said: 'Currently, there is nothing to prevent the prescribing of a particular generic or brand of drug if the prescriber considers it essential for the patient to receive a specific product. Our proposals for implementation of generic substitution will maintain this position.' 26.9.09

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One in six patients 'wrongly diagnosed by NHS doctors'

Hundreds of thousands of people could be misdiagnosed by NHS doctors every year, an investigation has revealed.Medics could be getting it wrong in as many as one in six of patient consultations in hospitals and primary care, according to Misdiagnosis, a BBC radio programme broadcast yesterday.

While most cases do not result in the patient suffering serious harm, a sizeable number are likely to experience significant health problems as a result. But cases of misdiagnosis are not recorded anywhere in the NHS and this has led to growing demands for better reporting systems to help doctors prevent it.  

The National Patient Safety Agency (NPSA) runs a database that records medical errors, patient incidents, mistakes in medical notes and near-misses on a voluntary basis. Between April 2008 and March 2009 there were 39,500 reports of incidents involving clinical assessment.

Dr Kevin Cleary, the medical director of the NPSA, said reasons for misdiagnosis included lack of training, test results that were misinterpreted, poor communication and diseases that had similar symptoms. Patient charity Action Against Medical Accidents (AAMA) has called for a change in the law to make reporting of misdiagnoses a mandatory requirement of doctors. 

AAMA chief executive Peter Walsh said: 'We have 4,000 inquiries a year and of those in primary care a large proportion, perhaps about 50 per cent of cases, involve misdiagnosis of some sort.   'We see no reason why it shouldn't be a legal requirement on healthcare organisations, including general practices, to report incidents that go wrong in healthcare, including incidents of misdiagnosis. 'It's ridiculous that we get so few reports when we know there are significant numbers of this going on already. ‘This is just the tip of the iceberg.'

A review published recently in the American Journal of Medicine, about misdiagnosis in developed countries, suggested that up to 15 per cent of all cases could be misdiagnosed. Professor Graham Neale, of the Centre for Patient Safety and Service Quality at Imperial College London, has been researching misdiagnosis for the past four years and wants to see improvements to medical training. He said: 'I think it's a very big problem, and a problem that we should address. But I think we're going to have to tackle it from both ends, try to get the colleges more involved in this and get senior staff to take this seriously, and then on the educational side bring it up from below.'  

Earlier this year a Westminster parliament health committee report identified that: 'Delayed or missed diagnosis in general practice is a significant problem, generating many complaints and claims.'  Separate research suggested that one in 10 patients in hospital was harmed because of the care they received. 22.9.09

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Specialist NHS clinics are 20 times more likely to botch hip operations

Patients who have hip replacement operations at specialist NHS clinics are 20 times more likely to need painful and expensive repair work. Operations on two-thirds of patients in one treatment centre showed clear evidence of below standard surgical procedure, a study revealed.

Leading surgeons warned that a lack of supervision in the NHS clinics amounted to a dereliction of duty by the Government. Nearly one in five patients who had hip operations at Weston-super-Mare NHS Treatment Centre needed repair work (posed by models). Orthopaedic surgeons in Cardiff found that of 113 hip operations on patients sent from their NHS trust to Weston-super-Mare NHS Treatment Centre between 2004 and 2006, two-thirds were poorly performed.

In the three years following their surgery, 18 per cent of patients had been back into hospital or were awaiting an operation - a figure 20 times the national rate. A study of knee operations at the same unit showed a tenfold increase in revision rates. The operations are part of the Independent Sector Treatment Centre (ISTC) programme which was introduced to great fanfare in 2003.

The initiative was designed to cut NHS waiting times and dozens of centres have been set up - mainly for orthopaedic surgery, cataracts and diagnostic screening. A total of 44 are described as NHS centres, though they are often staffed by private companies.

Surgeons from Sweden, Denmark and Finland were flown into Britain between 2003 and 2006 as part of a £3million scheme to speed up hip and knee replacements. But concerns were raised about the quality of the work carried out and many patients feared the surgeons were insufficiently trained or skilled.

But the Cardiff study, which was published in the Journal of Bone and Joint Surgery, has led leading figures in the medical world to call for an overhaul of the ISTC programme. They said NHS trusts were having to pick up the flak from botched private operations.

In the private clinics, hip replacements cost £6,000, while more complex repair operations, with expensive implants, bone grafts and longer hospital stays, cost between £10,000 and £15,000. In an accompanying editorial in the journal, Fares Haddad, a consultant orthopaedic surgeon based at University College Hospital, London, says that the whole programme is in jeopardy because of the lack of proper audit and follow-up.

He told the Times that the disruption caused by the errors had an acute impact on hospitals, budgets and patients. 'We all want to cut waiting lists and give excellent care to patients,' he said. 'But this was introduced without data to show that it worked. We are now seeing the studies to show that.

'We have all had work increased by this, and the cost implications are huge too. Revision work costs two or three times the cost of a primary replacement. 'What is more, the failure of a joint replacement is often worse than the arthritis that led to the original operation.' He called for every operation to be registered on the National Joint Registry to pick up treatments which were failing.

Tony Hui, chairman of the British Orthopaedic Directors Society, which represents heads of NHS orthopaedic departments, said that care in his area of South Teesside had also been affected. Steve Cannon, a surgeon at the Royal National Orthopaedic Hospital, Stanmore, north-west London, said the scheme had been about 'speed of getting through the numbers' and was an 'iniquitous waste of money'.

David Worskett, director of NHS Partners Network, which represents independent providers, said that the sector was being unfairly portrayed by surgeons and many were offering care of an excellent standard. He said that he could not comment on the case of Weston-super-Mare because, although private provision of care was involved, it was organised by the NHS. 23.9.09

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NHS told to find ways of saving £20 billion

The NHS will have to find ways of saving up to £20 billion, Health Secretary Andy Burnham has told think tank, the King's Fund. Mr Burnham said he planned to tell hospitals how much they would be paid for providing treatment over the next four years. This unprecedented move comes after he said he would like to see an "overall spending settlement" for the health service in the next few weeks, although this is the Chancellor's responsibility.

Mr Burnham told the King's Fund that detailing the costs of hospital treatment “will set out the scale of the efficiency and productivity challenge year on year, building up over time, with the most demanding savings coming later". He added that this would "begin the process of showing how we realise the challenge of finding £15 billion to £20 billion of savings” in the period up to 2014, according to the Financial Times.

The savings are designed to help the NHS cope with greater demand for its services from the UK's ageing population and the higher cost of drugs and treatment because of medical advances. This was emphasised by the Department of Health, with a spokesman saying: "The £15-20 billion is not being cut from the NHS, it will be taken away from areas where it is not needed and reallocated into areas where it will be most effective."

The NHS Confederation, which represents 99 per cent of health service organisations, had previously calculated that £15 billion would have to be saved by 2015. Nigel Edwards, its head of policy, said: "This is the first ministerial acknowledgement that I have seen of the scale of the challenge. "The good news is that it has been publicly acknowledged and we welcome that realism. “The bad news is that it is at least as bad as we thought." 18.9.09

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More reform of NHS needed as £15bn of savings must be found: Andy Burnham

The next decade in the NHS will see more reform of patient services than the last as £15bn of savings must be made as the era of big spending increases in the health service come to an end, Andy Burnham Health Secretary has said. In a speech Mr Burnham said although the big funding increases were over it did not mean the NHS would 'go backwards' and said improvements can still be made by increasing efficiency.

He said good patient care can go hand in hand with efficiency as proved by the fight on hospital superbugs which has saved over £260m as hospitals prevent infections that would have led to patients staying on wards for longer. Funding growth is set until 2011 but David Nicholson, NHS chief executive, has already said that over the next spending review between £15bn and £20bn of savings will have to be made as the health service is expected to receive little or no growth in funds and costs of providing healthcare continue to grow.

Mr Burnham said the financial outlook was 'tough' but protecting front line patient services will be his priority. When taking questions from King's Fund Chief Executive Niall Dixon, he indicated that the Department of Health would not be immune from staff cuts. He said the right system had to be put in place for the job and added: "If that means a smaller smarter centre than that is what it means."

The Department of Health has already dismissed management consultant proposals that the savings be made by cutting one in ten NHS staff and Mr Burnham said in the speech that ministers will not dictate to the service how to make the efficiencies and he hoped that 'knee jerk' reactions could be avoided.

Mr Burnham added that the financial climate meant that more changes are likely to health services in this decade than in the last saying: "It does mean getting very serious about service redesign on the ground. "The political parties have to be grown up about this. We can't stand in the way of local level progress just because we know we can win a council ward by opposing a service change."

Changes will be made to the way hospitals are paid for treatment with funds more closely linked to the patients' experience, Mr Burnham said. Payments for each treatment will also be set for a number of years, instead of being altered annually as they are now, which should allow managers more certainty to plan the future, he said. 18.9.09

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London NHS should "prescribe" debt prevention services

Primary care trusts and local councils in London should “prescribe debt advice” to help patients through the recession, according to a report published today by the London Health Forum.

The report – London Capital of Debt – said PCTs in the capital already spend £1.8 billion on treating patients with mental health issues, 26 per cent more than thenational average.

The report estimates that £450m of this is spent on patients who have mental health problems and are in debt. The recession is likely to make this worse, it warns.

While it acknowledges that not all debt leads to mental illness, the report recommends that PCTs and councils “prescribe” early debt advice as a preventive measure.

London Health Forum director John Murray said: “Unfortunately, many people struggling with debt seek advice later than they should becoming ill as a result. The NHS therefore needs to go onto a preventive footing by getting people to debt advice sooner, using the extensive channels of communication at its disposal.” 17.9.09

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Patients to get the freedom to shop around for a GP

Patients will have greater power over their choice of GP and can ditch doctors they are not happy with under reforms to be announced today. In his speech, Health Secretary Andy Burnham will also pledge that practice boundaries will be removed within 12 months. Under current guidelines those living outside a certain area are banned from registering with some doctors, leaving patients with little or no choice over which GP they can visit.

The reforms mean patients will find it easier to move to a GP surgery nearer work instead of one near their home, or to register with a surgery in a more affluent area where services are better. Mr Burnham hopes the fear that they could see patients leave in droves might prompt bad doctors to improve their service – especially as the fewer patients they have, the less government funding they receive.

Last night the plans were welcomed by patients groups and opposition parties, but they were criticised by the British Medical Association, the doctors' trade union. In a speech this morning at the King's Fund think tank in London, Mr Burnham will say: ‘In this day and age I can see no reason why patients should not be able to choose the GP practice they want. ‘Many of us lead hectic lives and health services should be there to make things easier.

‘A busy mum needs flexibility – she may want to register at a practice near her children's school. ‘Equally, a commuter may want to register near to work. I want them to be able to do this whilst ensuring that access to home visits won't be affected, wherever someone ends up registering.'

Michael Summers, chairman of the Patients' Association, said: ‘The lifting of these restrictions will be a boon for patients.' Tory health spokesman Andrew Lansley said: ‘We've always argued that it was ludicrous for the Government to talk about giving people a choice of GP when they restricted that choice based on their postcode. That is why we announced plans to abolish practice boundaries two years ago.'

Dr Laurence Buckman, chairman of the BMA's GPs committee, said: ‘Major logistical barriers would need to be overcome for patients to be able to register with practices a long distance from home. Home visits with a GP a long way away would become difficult, and costly for the NHS to fund.

‘Practices in rural and suburban areas could lose significant numbers of young, healthy, patients, destabilising their funding and threatening their viability.' 17.9.09

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REVEALED: The three TRILLION pounds Labour blew in 12 years of profligate spending

After 12-and-a-half years of New Labour government, £3trillion  -  that's £3,000,000,000,000  -  of our national wealth has been spent, which amounts to £50,000 for every man, woman and child in the country. Of that, £1.5 trillion went on profligate public spending during the boom years, and another £1.5 trillion has mysteriously vanished in the bust that followed.

The boom in spending began a couple of years after Labour took office, and by the end of the financial year of 2009-10, New Labour will have spent £1.7 trillion more than if it had continued the same spending plans it inherited from the Tories.

Health funding rose from £45billion to more than £100billion, education from £38billion to £80 billion and welfare benefits from £90billion to £160billion. Not that we saw much return on all this money; productivity in the public sector as a whole fell by 10 per cent, and in health and education the reduction was nearer 15per cent.

The estimated future cost of funding public sector pensions has increased from £ 360billion in 1997 to £880billion today, an increase of £520billion that will have to be found via the taxpayers. Then there is the bank bail-out, which has so far totalled £1.2 trillion of which, if we are lucky, taxpayers will lose only £200 billion.

Finally, there is borrowing, which even our wildly over-optimistic Chancellor believes will total £703 billion over five years  -  that's an increase of £561billion.

All of which helps bring the total cost of the bust to £1.5 trillion as well. So in total, that's £3 trillion down the New Labour drain. This is where much of the money went. . .

STATE BEHEMOTH
Under Labour, the power and funding of quangos has ballooned. Although officially their numbers have dropped from 692 in 1998 to less than 564 today, the number of people they employ has risen from one million to just over 1.5 million. And their spending has risen too, from £49 billion in 1998 to £130 billion a few years later. It is becoming increasingly hard to find out the total size of the quango state as ministers deliberately suppress the figures.

The Blair regime started with a flurry of openness, but soon began to fudge the quality and comparability of the information it was publishing. For example, it claimed that all 302 primary care trusts in the NHS only counted as one quango 'for statistical consistency'.  In 2006, New Labour closed the online directory listing quango information and confined publication to an annual booklet. Finally, when he became Prime Minister, Gordon Brown disbanded the Cabinet Office unit which monitored quango activity.

Meanwhile, despite devolving many powers to the EU, the regions and quangos, there seems to have been no corresponding reduction in the size of government. And the same applies in the Civil Service, where talk of savings is mere smoke and mirrors. Although the Cabinet Office announced it had cut its headcount by nearly 1,000, a quick look at the books suggests otherwise.

Allowing for the transfer of jobs and services to other departments, it turns out that total numbers employed to fulfil the same responsibilities had actually increased by 293. The same process, writ large, happened with the spending review carried out by Sir Peter Gershon, the Government's socalled efficiency czar.

This supposedly identified £21.5 billion in efficiency savings. But a recent National Audit Office report, which looked at £13 billion of these savings, concluded that £10 billion were 'uncertain'. Other examples of the state's approach to 'efficient' employment include the Department of Work and Pensions, which spent £401million in redundancy payments getting rid of 8,479 employees  -  and then hired another 16,554 new recruits.

PUBLIC SECTOR PAY
No Surprise, then, that between 1997 and 2006 rises in public sector earnings far outstripped those in the private sector. In particular, pay for the top civil servants increased dramatically. In the year 2007-08, the number of Whitehall pen-pushers in the top pay band of £102,100 to £209,300 went up by 14.7 per cent. And those working for quangos are even better paid, with the top ten quangocrats all earning more than £700,000.

In the NHS, since 1997 the average salary of an NHS chief executive has doubled to £158,000. And there are 20,000 more NHS managers, costing in total £3billion a year.

JUDGING BY RESULTS: HEALTH AND EDUCATION
Despite all this expenditure by the public sector, its performance is still poor. We doubled spending on the NHS, but are still 16th in the European league table on cancer and stroke survival rates, a performance which kills 17,000 people a year prematurely. Not forgetting the 6,000 or so patients a year dying from hospital acquired infections; it would be 120 if we matched the standards of our EU neighbours.

In education, despite twice as much spending in real terms since 1997, our performance in the Organisation for Economic Cooperation and Development's league tables on reading, maths and science has declined. Between 2000 and 2006, we fell from 4th to 14th in science, 7th to 17th in reading and 8th to 24th in maths.

One in four 11-year-olds leaves primary school without sufficient reading and writing skills. Sixty per cent of 18-year-olds don't manage a single A-level.

BIG PROJECTS, BIG MISTAKES
Ministers have lost all control of major spending projects. Ten of the biggest were budgeted to cost around £20billion, but will actually cost at least £46billion. The most disgraceful example is the London Olympics, which we were told would only cost taxpayers £2.4 billion and now looks likely to land us with a bill for £14billion.

Then there is the NHS computer system which was supposed to cost £2.3 billion and is now at £12.4 billion and rising.

Not forgetting the series of military procurement disasters, including the Type 45 Destroyer, the Astute Class submarine, and the Nimrod MRA4, which together have run £3 billion over budget.

PUBLIC SECTOR PENSION MONSTER
Ninety per cent of Britain's six million public sector workers enjoy gold-plated, index-linked final-salary pension schemes, an increase of 800,000 under Labour. That's helped push public sector pension liabilities up to £880billion, an increase of 140 per cent on 1997.

As many as 34,000 of these lucky people have pension pots that would, individually, cost more than £1 million to buy in the private sector. For example, a public sector manager earning £70,000 can look forward to an inflation-proof pension of £35,000 a year from the age of 60. And MPs, of course, have it even easier; in the private sector an employee would have to put £50,000 into their pension pot every year to get the same income in retirement that they will receive.

But for those not in line for such perks, the situation is not so cosy. The state pension has fallen in value against average earnings and today about half of pensioners have their income topped up through the pension credit and housing allowances in order to have enough to survive.

And it's getting worse; the retirement age has been raised to 65, and is set to rise to 68. Yet another increase to 70 is on the cards. Meanwhile, private sector pensions have been devastated under Labour, with most finalsalary schemes disappearing and 96 per cent of those firms that have retained them believing that they are unsustainable. 16.9.09

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NHS patients can reclaim private costs

The European Court of Justice has decided that the NHS should reimburse patients for medical treatment overseas if they have faced an "undue delay" for surgery at home. The British Medical Association has called on the Government to give GPs clear guidance on referring patients for treatment abroad following the landmark ruling.

The BMA said it welcomed the court's view that Government targets alone should not determine how long people had to wait for treatment. Dr Edwin Borman, chairman of the BMA's international committee, said: "When patients seek treatment overseas, doctors should be free to make a decision based on their clinical need. "What we need now is clear guidance from the Government about the way patient mobility will work in practice.

"GPs need to know how a patient should be referred to another member state for treatment, and the NHS needs to set out regulations for the reimbursement of cross-border care." Today's verdict came in a case brought by 74-year-old grandmother Yvonne Watts, who defied the NHS to have a £4,000 hip operation in France despite being warned that Bedford Primary Care Trust would not authorise payment.

The European Court of Justice confirmed that, under EU rules on free movement to provide services, one EU healthcare system must pay the bill if a patient is obliged to look elsewhere in Europe for treatment because of hold-ups. But the judges did not award Mrs Watts her £4,000 back - they said it was up to the domestic courts to decide if, in her case, she had faced an "undue delay".

The Bedford Primary Care Trust said it had acted within Department of Health guidelines. In a statement, the trust said: "We were able to ensure that she was offered treatment within (a) timescale which was well within those stipulated by the Department of Health.

"The ECJ judgment today did not decide the question of whether or not the NHS is obliged to reimburse Mrs Watts for the treatment she received abroad. The judgment clarified the entitlement of UK residents to treatment abroad at NHS expense where they face undue delay in receiving that treatment in the UK.

Shadow health secretary Andrew Lansley said the ruling struck at the heart of the Government's target culture. "Central targets have repeatedly undermined clinical judgment, meaning patients are not treated according to their need. "More judgments like the one today could be forestalled if the Government delivers treatment based on need, according to a set of national clinical standards, not according to politically-dictated targets," he said.

The case is the first of its kind involving the NHS to be challenged under EU law. Mrs Watts went to court after returning from her hip operation in France to face the refusal of Bedford Primary Care Trust to cover her costs. The Trust had insisted the three- to four-month wait for an NHS hip replacement did not amount to the "undue delay" which would warrant reimbursement of her foreign costs.

But today the European judges said the decision on what amounted to an "undue delay" should not be based on either National Health Service waiting lists or Government NHS targets. The decision was to be based entirely on the individual patient's medical condition and circumstances.

Now it will be up to British courts to reconsider the situation of Mrs Watts and decide if she gets her £4,000 back. Mrs Watts had originally been told she faced a waiting time of one year for a hip operation. She then saw a French consultant who advised her the need for treatment was becoming more urgent due to her declining health.

A few weeks later she saw a British consultant, who recommended that she be moved up the NHS waiting list to receive surgery within three or four months. But Mrs Watts wanted even swifter treatment abroad and asked the Trust to authorise such treatment. When authorisation was refused she went to France anyway, receiving the necessary surgery in Abbeville just one month later. 16.5.06

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Conservatives will set limits on NHS spending if they win election

The Conservatives will limit spending on the National Health Service if they win the next general election, the party admitted yesterday. The Tories were previously committed to unspecified increases in health spending while imposing limits on other departments. But Andrew Lansley, the Shadow Health Secretary, told The Times that they would be able to guarantee only “small increases” and not the huge sums put in by Labour.

Health experts warned that the move could endanger the moratorium on the closure of wards. It is likely, however, to please the Tory Right, which feared that the health service was to be given a blank cheque. This is the first time that the Conservatives have refined a commitment to increase health spending year on year in real terms for the Parliament. The party believes that there are dramatic efficiency savings to be made in the NHS.

We have trebled the amount taxpayers spend on the NHS but we have not seen a real return,” Mr Lansley said. “We are determined to turn this situation around. The NHS, just like any other organisation in this recession, needs to focus on getting more for less. If Labour's time in charge has taught us anything, it is that simply spending more money will not necessarily lead to improvements.”

The announcement was made easier by Labour, coming the day after Alistair Darling signalled that his party would consider cutting the health budget in the next Parliament. Mr Lansley did not place an exact limit on spending but said that the levels of investment seen after the 2001 election would not be repeated.

According to the health think-tank The King's Fund, the average real-terms funding increase to the NHS since its foundation is more than 4 per cent a year. Since 2000 it has run on average at 6.6 per cent a year, peaking at 10 per cent in 2003-04.

John Appleby, the fund's chief economist, said: “The Tories are trying to limit expectations for health spending but, given the state of public finances, they will be pressed even to deliver 1 or 2 per cent real-terms increases. That will still feel like a cut for the NHS because it needs to keep pace with the ageing population.”

The move suggests that party strategists feel emboldened to switch tactics, which had previously centred on reassuring the public that the NHS would be safe in Tory hands.

Mr Lansley confirmed that savings would be made by reducing the sums paid to hospitals for operations, as The Times revealed last month. They will also reduce the number of managers, open the NHS up to charities and private organisations and give GPs responsibility for managing the costs of their patients' care. “With part of GPs' pay dependent upon the results of their patients' treatment, they will have a direct incentive to buy the most efficient services,” Mr Lansley said. 10.09.09

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Tough new controls for everyday painkillers that can become addictive after THREE days

Over-the-counter painkillers taken by millions of people can become addictive within just three days, the Government's watchdog last night warned. New restrictions will now be applied to medicines containing codeine, including Nurofen Plus and Solpadeine, that are sold over the counter and are routinely used to ease headaches, back problems and period pain.

Clear and 'prominently positioned' warnings will be put on the front of packs and accompanying patient information leaflets, stating: 'Can cause addiction. For three days use only.' Official figures show that more than 30,000 consumers have become accidentally addicted to the drugs, many accidentally, with women most at risk of developing an addiction.

Growing concern about the spread of what experts describe as a 'hidden addiction', has led the Medicines and Healthcare products Regulatory Agency (MHRA) to announce a series of measures to counter the problem. Packets size will be limited to just 32 tablets with larger packs available only by prescription in a bid to curb misuse. New advertising will no longer state that the drugs are remedies for coughs and colds and it will be targeted towards acute and moderate pain.

The MHRA, yesterday (thurs) issued the updated advice for those taking medicines containing codeine and dihydrocodeine, which are opiates related to heroin and morphine. There have been fears of a growing market in 'bulk buying' of these medicines on the internet with many patients and doctors totally unaware of the dangers.

A recent report by the All Party Parliamentary Group on Drug Misuse warned the 32,000 addicted were just the 'tip of the iceberg'. The MPs recommended these painkillers be sold in smaller packets of just 18 tablets after hearing evidence from an online support group fielding 16,000 requests for help for addiction every year.

Some people were taking up to 70 pills a day, putting themselves at risk of serious complications such as bleeding stomach, liver problems, gallstones and depression. MHRA director of vigilance and risk management of medicines Dr June Raine said codeine and dihydrocodeine were safe and effective medicines if taken correctly. 'However, these products can be addictive and we are taking action to tackle this risk' she said.

'The MHRA is ensuring that people have clear information on codeine-containing medicines, on what they are to be used for and how to minimise the risk of addiction. 'Anyone who has concerns should speak to their pharmacist or a doctor.'

Around 27 million over-the-counter pills containing codeine are sold every year in a painkiller market worth £500 million. Women are feared to be most at risk from addiction. A survey found Solpadeine and Nurofen Plus were the most commonly misused products, followed by generic co-codamol, Syndol and Feminax.

Sheila Kelly, executive director of the Proprietary Association of Great Britain, which represents the over-the-counter industry, said its member added addiction warnings to these products four years ago. She said some countries only permitted codeine to be used on prescription, and predicted that might happen here if misuse of these products continued.

She said 'Safety is of paramount concern to the industry and manufacturers are fully supportive of this new package of measures for over-the-counter products containing codeine. 'The new labelling to increase the prominence of the addiction warning by moving it to the front of the pack and to limit the indications to moderate acute pain that does not respond to paracetamol, ibuprofen or aspirin alone, will be introduced as soon as possible. 'The vast majority of people use codeine containing products correctly and have no need to worry that they are doing themselves any harm.'

Dr Brian Iddon, who was chair of the All Party Parliamentary Group on Drug Misuse when the report was published, said: 'We are really pleased that the MHRA are now sitting up and taking notice. It is the hidden addiction, but it is affecting many, many more people than we think.'

John Turk, chief executive of the National Pharmacy Association, representing pharmacy owners, said 'The warning ‘can cause addiction', which will be displayed on the front of packs, should prompt consumers to talk to their pharmacist about what course of action would be most suitable for them and to heed advice given by pharmacists and their staff about how these medicines can be used safely.'

The full list
Co-codamol, Codis 500, Cuprofen Plus, Feminax, Migraleve Pink, Migraleve Yellow, Nurofen Plus, Panadol Ultra, Paracodol Capsules and Tablets, Paramol Tablets and Soluble Tablets, Solpadeine Max, Solpadeine Migraine Ibuprofen & Codeine Tablets, Solpadeine Plus Capsules, Tablets and Soluble Tablets, Syndol, Veganin Tablets. 4.9.09

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Number of children on adult-only slimming pills soars

The number of children on anti-obesity drugs has soared 15-fold over the past decade, despite concerns over unpleasant side effects. Hundreds of under 18s - perhaps as many as 1,300 - are now on the drugs, even though they are only licensed for use on adults. But many of them stop taking the drugs after a few weeks because their side effects are so nasty.

Almost one million children are obese, and experts warn that unless severe action is taken, a quarter of all children will be dangerously overweight by 2050. Critics say the massively increased uptake of the drugs proves Labour has failed in its efforts to diffuse the obesity timebomb.

Tam Fry, from the National Obesity Forum, said: 'This rise in the use of drugs is a real indictment on society. 'It seems to me that we are ignoring measures to prevent our children becoming obese and then turning to drugs as a treatment of choice when they should be a last resort. 'That borders on criminal because it means that all the messages about healthy eating and exercise for reducing weight are just being tossed aside by GPs and primary care. We are relying on drugs totally incorrectly.'

The study, published in the British Journal of Clinical Pharmacology, looked at the use of orlistat (Xenical), sibutramine (Reductil) and rimonabant (Acomplia) in children up to the age of 18. It looked at prescribing data from the UK General Practice Research Database between January 1 1999, and December 31 2006.

Overall, 452 youngsters received 1,334 prescriptions during the study period, and the prevalence of the drugs rose 15-fold among both boys and girls during that time. Extrapolated across the whole country, researchers estimated that 1,300 young people could now be being prescribed anti-obesity drugs every year.

Most prescriptions were for 14-year-olds, although 25 prescriptions were written for children under the age of 12. Orlistat accounted for 78.4 per cent of all prescriptions. But a large minority of children never completed the course of treatment - costing the NHS huge amounts of money.

Around 45 per cent of the youngsters stopped taking orlistat after only one month, as did 25 per cent of those on sibutramine. The estimated average length of treatment with orlistat was three months and four months with sibutramine. The researchers, from University College London, said it was unclear whether this was due to side-effects, which include severe diarrhoea, or other reasons.

Russell Viner, one of the authors of the study, said: 'It's possible that the drugs are being given inappropriately, or that they have excessive side effects that make young people discontinue their use. 'On the other hand, they could be expecting the drugs to deliver a miracle "quick fix" and stop using them when sudden, rapid weight loss does not occur.'

Study author Ian Wong said children who are prescribed orlistat may need more support and should be made fully aware of the potential side effects, which include loose, oily stools if fat intake is not reduced. 'You have to tell them that, yes, it is healthier not to absorb the fat, but if they continue to eat as much as they used to then it will be really unpleasant,' he said. 'The key thing is that the drug itself is not the answer. Kids should only be using it as part of a comprehensive weight-loss programme.'

Guidance from the National Institute for Health and Clinical Excellence (Nice), published in December 2006, said the drugs should only be considered for children and adults after dietary, exercise and behavioural approaches have failed. 'Drug treatment is not generally recommended for children younger than 12 years,' the guidance said.

'In children aged 12 years and older, treatment with orlistat or sibutramine is recommended only if physical comorbidities (such as orthopaedic problems or sleep apnoea) or severe psychological comorbidities are present.'

According to the researchers, it is highly unlikely that the drugs are doing any damage, as short-term clinical trials have not found life-threatening side-effects in young people. But they called for more research into the issue. 'Prescribing of unlicensed anti-obesity drugs in children and adolescents has dramatically increased in the past eight years,' they said.

'The majority are rapidly discontinued before patients can see weight benefit, suggesting they are poorly tolerated or poorly efficacious when used in the general population. 'Further research into the effectiveness and safety of anti-obesity drugs in clinical populations of children and adolescents is needed.'

Orlistat is now available over-the-counter in a half-strength dose (marketed as Alli). Alli is only available for obese adults aged 18 and over. Mr Fry said that a combination of bad food, lax advertising rules and nowhere to play is why more children are becoming obese.

'It's the failure to regulate the energy in and the energy out,' he said. 'Children are eating on the whole too much of the wrong sort of food, which is less than healthy food, which has high levels of salt, fat and sugar. They are failing to exercise enough to maintain the balance.

'That's not their fault, it's the fault of society which has consistently failed children in not providing the proper regulation of food companies and not providing the right kind of places in which to play.' 3.9.09

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Another medical U turn – take asprin – don't take aspirin - as trial casts doubt on aspirin guidance

Use of aspirin for primary prevention of cardiovascular disease has been dealt what could prove a fatal blow, after a major new trial found no evidence that it was beneficial. The Aspirin for Asymptomatic Atherosclerosis (AAA) study, found prescribing aspirin to patients identified as at high risk of events through screening could not be justified when weighed against the greater risk of internal bleeding.

The research, presented at the European Society of Cardiology's annual congress in Barcelona, Spain, adds to the results of a recent meta-analysis published in The Lancet which also questioned use of aspirin for primary prevention. The findings are set to lead to some searching questions over current guidance from the Joint British Societies Guidelines and NICE , which recommends use of aspirin for primary prevention in high-risk patients and those with diabetes.

Researchers found no statistically significant difference in fatal or non-fatal coronary events, strokes, or revascularisations between patients with asymptomatic atherosclerosis taking 100 mg aspirin per day for eight years and those on placebo. The study recruited 28,980 Scottish men and women aged 50 to 75 years who were free of clinically evident cardiovascular disease.

The ankle brachial index of all patients was measured, and the 3,350 with an index below 0.95 were randomised to once daily 100 mg aspirin or placebo. Aspirin treatment showed a surprise 3% increase in the risk of a coronary event, stroke or revascularisation with aspirin compared with placebo, although this was not statistically significant.

Major haemorrhages were more commonly seen in the aspirin group, with 34 cases requiring hospitalisation, compared with 20 in the placebo group. Professor Gerry Fowkes, lead author and professor of epidemiology at the University of Edinburgh, said the results showed aspirin had ‘absolutely no effect'.

‘More haemorrhages were observed in the aspirin than in the placebo group. There is no support for the use of aspirin for the prevention of vascular events in the general population', he added. The results prompted an immediate riposte by aspirin enthusiasts. Professor Carlo Patrono, professor of pharmacology at the University of Rome, said the study was underpowered.

‘The sample size would have to be about four times larger to achieve the intended power. Lack of statistical power does seem to be by far the most likely explanation for the null results of the AAA trial.'

Professor Patrono claimed a forthcoming analysis from the Oxford Clinical Research Trials Unit, including the AAA study result, suggested there still was a positive effect from aspirin when used in primary prevention.

The AAA study
The study recruited 3,350 men and women aged 50 to 75 years who were free of clinically evident cardiovascular disease in central Scotland with an ankle brachial index of ≤0.95 ABI . Participants were followed up for a mean of 8.2 years

Coronary event or stroke, or revascularisation occurred in 357 participants had a primary endpoint event, a rate of13•5 per 1000 person years, compared with 181 in the aspirin group and 176 in the placebo group.

A vascular event occurred in 578 participants, but again no statistically significant difference was found between the aspirin and placebo groups, at 288 versus 290 events respectively. All-cause mortality was similar in both groups at 176 v 186 deaths. An initial event of major bleeding requiring admission to hospital occurred in 34, or 2% of subjects in the aspirin group and 20, or 1.2% of the placebo group. 2.9.09

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Breast cancer 'wonder drug' actually increases risk of rare tumour by 440%

Breast cancer patients given tamoxifen are more than four times more likely to develop a more aggressive tumour than those not prescribed the drug, scientists have warned. A study of over 1,000 patients found the oestrogen blocking drug reduced the risk of the most common, easy to treat cancer recurring by 60 per cent. But the chances of a rarer type not sensitive to the female hormone appearing in the opposite breast increased by an alarming 440 per cent.

These are known as ER negative tumours, as opposed to ER positive, and are much more dangerous as there are no drugs that specifically target them. Dr Christopher Li, of the Fred Hutchinson Cancer Research Centre in Seattle, said: 'This is of concern, given the poorer prognosis of ER-negative tumours, which are also more difficult to treat.' Tamoxifen has been used to treat breast cancer for more than 20 years and has saved the lives of hundreds of thousands of women worldwide.

But Dr Li, whose findings are published in the journal Cancer Research, said although it has been shown to reduce the risk of dying from the disease it does have risks. The study confirms preliminary research by the same team published in 2001 which was the first to suggest a link between long-term tamoxifen use and an increased risk of ER-negative second cancers.

Dr Li said: 'The earlier study had a number of limitations. For example, we did not have information on the duration of tamoxifen therapy the women received. 'The current study is larger, is based on much more detailed data, and is the first study specifically designed to determine whether tamoxifen use among breast cancer survivors influences their risk of different types of second breast cancers.'

The latest research assessed history of tamoxifen use among 1,103 breast cancer survivors who were initially diagnosed with ER positive breast cancer between the ages of 40 and 79. Of these, 369 of the women went on to develop a second breast cancer. Nearly all of the women in the study who took hormonal therapy used tamoxifen specifically. Detailed information about tamoxifen use was ascertained from telephone interviews and medical record reviews.

Oestrogen encourages the growth of some breast cancer cells. Tamoxifen interferes with this action by attaching itself to the molecule, or receptor, on a cancer cell surface that is also used by the hormone. This, in effect, blocks the oestrogen effect on the cancer cells. Cancer cells without an oestrogen receptor are not affected by tamoxifen.

Dr Li said while the study confirmed a strong association between long-term tamoxifen therapy and an increased risk of ER-negative second cancer, it does not suggest that breast cancer survivors should stop taking hormone therapy to prevent a second cancer. He added: 'It is clear that oestrogen-blocking drugs like tamoxifen have important clinical benefits and have led to major improvements in breast cancer survival rates.

'However, these therapies have risks, and an increased risk of ER negative second cancer may be one of them. 'Still, the benefits of this therapy are well established and doctors should continue to recommend hormonal therapy for breast cancer patients who can benefit from it.' 26.8.09

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Quarter of a million people waiting more than 18 weeks for NHS treatment

A quarter of a million people are waiting more than 18 weeks for treatment on the NHS, new figures show. The disclosure of the statistics comes just three days after Andy Burnham, the Health Secretary, claimed there were no longer any waiting lists in the NHS.

Norman Lamb, the Liberal Democrat shadow health secretary, last night criticised the figures and said Mr Burnham's comments were offensive to the thousands of patients awaiting treatment. He said: "Three days after the Health Secretary claimed there were no more waiting lists in the NHS, Government figures have shown that a quarter of a million people are stuck waiting longer than 18 weeks for treatment.

"Andy Burnham's insensitive comments will anger the thousands of patients who are still waiting for treatment. The era of Whitehall targets must come to an end. "We need a health service which gets people treatment fast and has the flexibility to meet the demands of the public. If people are left languishing on NHS waiting lists, they should be entitled to go private."

The figures, published by the Lib Dems, show that 236,316 people are currently waiting more than 18 weeks for a range of treatments including oral surgery, rheumatology and geriatric medicine. This means that nearly 10 per cent of patients are not being treated within the government's waiting list target.

It stands in contrast to comments made by Mr Burnham on Tuesday that Labour had wiped out all waiting lists on the NHS. In an interview on BBC Radio Five Live, Mr Burnham said: "We have no waiting lists now in the NHS and people have full choice of NHS hospitals."

The Department of Health said the NHS had met targets for the first time last summer for 90 per cent of admitted and 95 per cent of non-admitted patients to receive treatment within 18 weeks. It said that the targets had been met every month since then.

A spokesman said: "Record investment and dedicated staff have given patients the shortest waits since NHS records began. "In the 1990s it was not uncommon for people to wait 18 months or more for their operation – with some people dying on the waiting list." 14.8.09

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1,000 cancer patient 'refused treatment'

More than 1,000 cancer patients have been refused drugs in the past three years because the medication was not licensed for their disease, new figures suggest. Charities warned that patients with less common forms of cancer were being discriminated against, while others condemned the system as a “scandal”. Patients and their doctors can appeal for the NHS to pay for drugs not currently licensed for that type of the disease.

But one in three applications were turned down in the last three years, leaving patients having to pay up £20,000 for the medication themselves.

The Rarer Cancers Forum, who obtained the figures, said that patients in France were up to 55 per cent more likely to get so-called “near-label” treatment, drugs licensed for a similar disease, than those in Britain. Rare cancers include pancreatic cancer, which Patrick Swayze is currently battling and which affects around 7,000 people in Britain every year.

Stella Pendleton, executive director of the charity, said: “If a doctor thinks that a patient with a rarer cancer should be given a drug, then the NHS should fund it. “The NHS is forcing desperate patients into the cruel situation where the chances of their being given the treatment they need depend on where they live. “No patient should be denied a treatment recommended by a doctor simply because the cancer it treats is too rare for the medicine to be licensed. “We need these obstacles removed.”

Dr Beatrice Seddon, a consultant clinical oncologist at University College Hospital, London said: “When conventional treatment options are exhausted, some patients are still strong enough to be able to continue their fight against cancer. “For these patients (these) drugs may offer a further therapeutic option, and the hope of prolonged good quality life. “It can be desperately difficult to be told that a patient's last-chance treatment won't be funded. “There needs to be a better way to deal with this hugely complicated issue.”

The figures were obtained by the charity through the Freedom of Information Act. Around a third of healthcare trusts provided data, indicting that there were 902 requests were made over three years, with 583 approved and 298 rejected.

The charity said this suggested a total of 3,188 requests made during the same period, with 2,061 approvals and 1,053 patients denied treatment. A total of three Primary Care Trusts, North Staffordshire PCT, Oldham PCT and Western Cheshire PCT, turned down all applications. In contrast, another 11 funded them all.

Andrew Lansley, the shadow health secretary, said: “It is a scandal that effective cancer drugs that are widely available in other countries are not available here. “No patient should be forced to pay privately for clinically effective drugs that they need for their treatment.”

A spokesman for the Department of Health said: “Doctors can use their clinical judgement to prescribe any treatment that will benefit their patient, even if it is outside its licensed indication. “Such decisions need to be made in discussion with the patient concerned and funding may need to be agreed with the local PCT.” Where NICE guidance is not available, it is only right that local PCTs should continue to make these difficult funding decisions according to the needs of their local population. He added: “The Government is committed to increasing patients' access to innovative new drugs and treatments.” 14.8.09

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'Worried well' are increasingly surfing Net for diagnosis rather than seeing GP

Rising numbers of the 'worried well' are going online for medical diagnosis, a report says. One in seven patients now surfs the web for information on illnesses and ailments before they go to see a doctor. The report predicts the trend will increase, with the number prepared to consult the internet before seeking medication set to double within a decade.

Some suggest it's because they are worried the doctors just prescribe drugs which have side effects and people want to search for other 'less harmful' methods of help.

The demand for online prescriptions is likely to soar because people like the convenience, says the report by the Future Foundation. The NHS could benefit, because remote diagnosis and prescriptions will give hospitals and GPs more time to cope with increasing demand from an ageing population. But there are dangers in DIY diagnosis, with serious conditions being missed.

There are also concerns that people might not be able to distinguish between information written by true experts and that put up by unqualified authors. The report's lead writer, Judith Kleine Holthause, said the Government's use of the internet and call centres to deal with swine flu proved the system could work both for private medicine and the NHS. But tighter regulation will be needed as there have been tragic deaths where meningitis was diagnosed as swine flu.

She said: 'Despite its clinical shortcomings, the use of the internet and call centres for diagnosing swine flu and distributing medication demonstrates that remote diagnosis can be an efficient way of dealing with certain conditions. 'If regulated and monitored appropriately, remote diagnoses and prescriptions could benefit the healthcare system in similar ways as remote services have helped the banking system.'

She believes consumers will back tighter rules to ensure they are not ripped off with fake medicines or exploited by bogus doctors. 'In certain areas consumers welcome regulation,' said Miss Holthause. 'We believe that regulation, monitoring and control will be crucial to the development of this market.

The report by the Future Foundation a consumer and business trends think tank, predicts that more than a third of the population will be using the web for medical information by 2020 compared to 14 per cent today. A poll by the Foundation shows 48 per cent of people are interested in online diagnosis and 56 per cent in online prescriptions.

The study comes as leading high street chain Lloydspharmacy introduces ' virtual' GPs, where patients can walk in and consult an online doctor service privately from a computer terminal. They can then leave with their medication dispensed via private prescription. The chain is using the online medical service Dr Thom, which it says is the only virtual doctor site registered with the Quality Care Commission watchdog.

Lloydspharmacy director Andy Murdock said: 'The face-to-face consultation will remain at the heart of primary care. But for an increasing array of conditions, remote services provide a viable alternative. 'Right now these include lifestyle conditions such as impotence and hair loss, and embarrassing subjects such as STIs and contraception. The list could expand considerably in the future.' 13.8.09

GPs to offer unfit patients prescriptions for the gym

Doctors are to start prescribing free swimming and gym sessions to overweight patients. Couch potatoes will be targeted with advice about exercise and given a programme of activities, including subsidised council gym and pool sessions. The Government campaign launched today is its latest attempt to improve levels of activity among the obese.

Health Secretary Andy Burnham wants the Let's Get Moving campaign to push Britain up the international fitness league table ahead of the 2012 Olympics. Doctors will identify patients at risk, using activity questionnaires, and set them a minimum amount of physical activity per week.

GPs and practice nurses will tell patients about 'local opportunities to stay fit' and agree activity goals with them. Extra cash is expected to be given to local councils to enable cash-strapped patients to have free swimming sessions and gym classes. Elderly patients could be recommended to take up ballroom dancing.

Patients will be offered followup appointments to check on progress. Surgeries will be encouraged to do deals with local gyms and council-run sports centres so they can refer patients with their 'prescription' for activity, either free or cut-price. The campaign follows the success of pilot projects.

David Haslam, chairman of the National Obesity Forum and a GP in Cambridgeshire, said some local schemes worked well. 'However, the evidence about the effectiveness of GPs prescribing exercise to patients is patchy at best,' he said. 'Just giving patients a piece of paper that lets them go into a gym free or for a reduced price is not much good if they aren't motivated,' he added. ' Unmotivated patients are unlikely to take up the advice.'

Critics have welcomed the plans as a step in the right direction and a move away from medication to tackle the route cause of the problem but warn if the plans are not supported with other 'motivational' treatments they might not be as successful as they could be. 13.8.09

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Sick benefit people 'must exercise'

People on incapacity benefit should take more exercise, which could help them back to work, the Health Secretary has said. The country could save millions of pounds a year if just 1% of those on the benefit were more active and were employed, Andy Burnham said.

His comments came as part of a wider announcement to encourage Britons to take up activities such as swimming and cycling. More than two-and-a-half million people are currently on incapacity benefit in Britain , with more than a third of those claiming it for mental health problems or muscular or skeletal disorders.

Mr Burnham said these were conditions that were known to respond well to exercise, which could lead to significant savings for the economy. He said: "In England , if we can get just 1% of people on incapacity benefit back into the workplace through active lifestyles, this would save the Exchequer £36 million and industry £31 million - that's a combined cost to the economy of £67 million a year."

The NHS spends £3,000 every second on treating illnesses - such as Type 2 diabetes - which could be prevented by people taking more exercise.

A modest increase in activity levels among older people could cut hip fractures by 1%, with a saving of more than £200 million a year, according to the Department of Health. Meanwhile, a 20% increase in cycling would save the NHS more than £50 million in treatments.

Mr Burnham said the UK must move from "relegation candidates to play-off contenders" when it comes to our exercise levels compared with other countries. Britain is currently in 21st place in Europe on activity levels. 13.8.09

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Management consultants cost the NHS dear

The McKinsey report on the NHS apparently fails to mention that one of the easiest ways of gaining efficiency savings would be to bring an immediate halt to the use of management consultants (NHS advised to lose one in 10 workers, 3 September). Recently having heard a rumour that one-third of McKinsey's revenues in the UK now came from the NHS, I made a number of inquiries with senior and junior practitioners as to their views of the resultant work.

Almost everyone reported armies of young consultants designing complex systems and structures that sat loosely on the top of the real NHS regime. Additionally there were numerous reports of shifting recommendations across time, suggesting that even such expensive consultants were both learning on the job and bowing to changing fashions and fads. There can be no doubt that management consultants have been deeply implicated in the expansion of bureaucracy in the NHS and the enormous expenditures on complex IT systems.

Indeed a fair amount of what McKinsey appears to criticise might well have emerged from an over-reliance on abstract conceptions of management rather than improvements in the reality of its practice – something which many management consultants know little about. A freeze on the use of management consultants in the NHS needs urgent consideration, not least with the prospect of cost-cutting times ahead of us.

Professor Anthony G Hopwood
Saïd Business School , University of Oxford

So management consultant McKinsey recommends axing one in 10 NHS workers to save £20bn. Coincidentally, £20bn is the estimated cost of the government's many and varied NHS privatisation schemes. A better way of saving money, maybe? Could we start with the £350m a year wasted on management consultants in the NHS?

We have a government that is now smashing the NHS into little pieces so the private sector can grab the profitable bits. This is madness – a process that is causing profound harm, particularly to community services such as health visiting, school nursing and speech therapy. Health workers are sick and tired of being the target of political and media games-playing. For goodness sake, stop attacking the NHS, stop the privatisation, and let us get on with using our skills to care for patients. The real NHS, in the real world, makes a difference to a million people every day.

Gill George and Frank Wood
Executive council members (representing health workers), Unite the Union

 No sooner does a report come out about proposed NHS staff cuts then up pops a Tory – Andrew Lansley this time – to complain about the "bloated bureaucracy" preventing the poor doctors and nurses from doing their jobs.

People, the NHS needs managers. They are the infrastructure. It needs financial planning, human resources departments and maintenance staff. It needs pharmacists, caterers, cleaners. It needs people to do research. It needs, God help us, people to keep us on track to meet our government targets. If the doctors and nurses had to carry out all these tasks, what does Mr Lansley think would happen to patient care? Doctors and nurses, lovely as they are, are not necessarily very good at doing all the rest of the stuff.

Jocelyn Rose
NHS Dumfries and Galloway

 In this discussion, can we factor in the unreasonable cost of insurance, the unreasonable demands for zero risk that insurers make, and the fear of the legal costs of unreasonable tort claims? Your article Slow walk to freedom (Society, 2 September) vividly illustrates how patients are denied treatment that they need, by the pervasive culture of risk-aversion that has grown up as a result of pressure from litigation and insurance companies. We hear constant complaints of too much bureaucracy, but rational management is difficult when managers have to spend so much of their time looking over their shoulders.

Jenny Tillyard
Seaforde, Sussex

Although the government no longer releases figures on administrative costs in the NHS, as Allyson Pollock points out (Comment, 4 September) they must now be a considerably higher percentage of the total budget than the 12% reached after the much simpler internal market of the early 1990s.

Zack Cooper and Julian Le Grand would have us believe that the commercialisation of healthcare is the reason for improvements in waiting lists. But how can they sustain that claim when at the same time the NHS budget has been virtually trebled? It is surely far more likely that the extra funding was responsible.

We are repeatedly told that we all want more choice, but certainly when it really matters we don't get it. Is there a political party prepared to give us the choice of whether we want unavoidable savings to be made by across-the-board cuts, or by jettisoning the market bureaucracy as the rest of the UK has done? If none is willing to do this, let it be put to the people in a referendum.

Peter Fisher
President, NHS Consultants' Association

Your health correspondent reports that many patients are killed every year through errors by NHS staff (NHS blunders 'may kill hundreds every year', 4 September). One major reason for these appalling statistics could be the stress caused by heavy workloads referred to by Bashyr Aziz in your Response column (4 September). I have been told that some of the major London teaching hospitals operate nursing shifts of 12 hours – many of such intensity that there is hardly time to stop to eat. No organisation should treat staff in this disgraceful way, especially those whose decisions can have such serious consequences. May one ask why government, various watchdogs and trade unions allow this to happen? 7.9.09

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The NHS gets a bad bill of health

The Government could make the NHS more efficient by contracting out the management of its care, says Simon Heffer. Since McKinsey and Co, the consultancy company, is not a registered charity, I presume it cost the taxpayer a substantial amount for the firm to conduct an efficiency review into the National Health Service. Having commissioned the report, the Department of Health took one look at its main finding – that 10 per cent of NHS staff should go in order to achieve efficiency savings – and rejected it. If you seek an example of how superbly the Government spends/wastes money, this is a magnificent one.

Any fool knows that the NHS is overmanned: perhaps not with doctors and nurses, but certainly with bureaucrats and support staff. Even the fools who run the Department of Health must have realised that if they asked McKinsey to do this job, it would find there were too many people on the payroll. To order this review and then to reject it immediately is completely obtuse.

Having read some of the findings of the report, even I would not agree with all of them. I doubt it is sensible, with our ageing population, to pursue a goal of fewer doctors and nurses. But it has long been apparent that the NHS is an organisation that exists as much for the benefit of many of those who work in it, as for those it purports to treat.

It is also apparent that, despite numerous reforms since it began in 1948, it is shaped by an immediate post-war ideology that has about as much relevance today as Bile Beans and Craven "A"s. No private-sector health concern would begin to think of running itself as the NHS does: it would be bankrupt within weeks. But then no private-sector health concern has as its mission in life the provision of jobs for Mr Brown's client state.

Labour rejected McKinsey's plans because it deemed them politically unworkable. It is not prepared to have a mature conversation with the British people about how their right to a health service free at point of use would not be affected by a desire to secure better value, in an economy that is cruising towards bankruptcy. Sadly, the Tory party doesn't want to have this conversation, either. Feeling morally blackmailed by a climate in which public spending, irrespective of the value obtained from it, is a good thing, it too has dismissed McKinsey, though with the caveat of saying (quite rightly) that there are bureaucratic jobs that can be lost.

Given the expense of the NHS – more than £100 billion a year, or about a seventh of total public spending – cowardice about how to reform it is not an option. It is derelict of anyone who seriously wishes to govern this country to say that we can go on in the same bloated, welfarist way that we have pursued since 1948. For a failure to get costs under control will, sooner rather than later, ensure that those same vulnerable people the NHS is supposed to help are at risk of having very little decent care at all.

The bold move for a government to take would be to contract out the management of the NHS. Hospitals, then possibly even whole health authorities, should be franchised out to the private sector, to break the culture of jobbery and self-serving trade unionism that has handicapped the development of the NHS. The service would still be free at point of use: but it would be delivered more efficiently. As McKinsey found, some hospitals are abominably wasteful. The rescue of the whole NHS should start with them.

Of course, all our politicians can carry on claiming that value doesn't matter, and believing that there is a bottomless pit of money to run our health-care service. In the suffering this will inflict on patients in the long term, it reveals an utter unfitness to govern. 5.9.09

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£1.2bn bill for the bureaucrat army within the NHS

Spending on NHS bureaucracy has almost doubled in four years, research shows. Nearly £1.2billion went on administrators and clerical staff in Primary Care Trusts in 2007/8, a rise of 81 per cent since 2003/4.

The total is nearly twice as much as the £700million the Health Service spent on anti-cancer drugs last year, with some patients being denied life-prolonging medication. A further £139million was spent on management consultants - almost three times as much as the £ 53million spent five years ago.

Critics say the figures show the NHS has become a 'bureaucratic black hole' under Labour with money being diverted away from front line services to pay for an army of administrators. The increase comes despite the number of PCTs halving from 303 to 152 - which was supposed to release £250million to front line services. PCTs are spending £115million a year on agency administrative and clerical staff, more than twice as much as in 2003-04.

At the same time acute hospital trusts - which provide the healthcare patients receive in hospital - have cut their spending on bureaucrats by 8 per cent.

Andrew Lansley, health spokesman for the Conservatives, who obtained the figures under the Freedom of Information Act, said: 'Every penny spent on unnecessary management and paperwork is a penny less to provide better care for patients. 'These figures show just how far Labour have broken the promise they made in 1997 to spend NHS funds on patients not bureaucracy.  'The Conservatives are the only party that has set out a clear plan to root out this waste and bureaucracy and get money to the front line.'

Michael Summers, of the Patients Association, said 'Surely if these management consultants were doing the job they're paid for the bill would be going down because there's less need for them.' But health minister Ann Keen said administrative and clerical staff formed only 8 per cent of the NHS workforce of more than 1.3million. 13.8.09

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NHS 'must sack one in ten staff' as management consultants call for £20billion of cuts

The NHS could be forced to sack tens of thousands of doctors and nurses and cancel hundreds of operations after the next election, a leaked report suggests. The document reveals that management consultants have told ministers that if the NHS wants to save £20billion to meet Government targets, it will need to reduce its workforce by 137,000, or ten per cent, over the next five years.

The cuts are being proposed despite assurances from Gordon Brown that public services will not be reduced under Labour. But the leaked document, written by consultancy firm McKinsey, sets out measures that the Government could be forced to implement.

Patients may have to be discharged from hospital much earlier, outpatient appointments could be scaled back, and minor treatments such as varicose vein removals and tonsillectomies may be banned. Planned improvements in stroke care and children's NHS services would also have to be put on hold.

The report, obtained by the Health Service Journal, was commissioned by Department of Health civil servants following warnings that funding would be increasingly squeezed as the country recovers from recession. Last night, Labour was accused of planning cuts in secret, with doctors and patients warning they will put patients at risk.

Conservative health spokesman Andrew Lansley said: 'Yet again Labour ministers are failing to be straight with the British people. '[Health Secretary] Andy Burnham promised to protect the NHS, but now we find out that his department has been drawing up secret plans for swingeing cuts.

Katherine Murphy, of the Patients Association, said: 'We are already short of specialist consultants and nurses, so to consider cutting frontline staff like this is astonishing. 'The Government should stop spending money on management consultants and invest properly in frontline staff.'

The Royal College of Nursing said the proposals would lead to more deaths in hospitals. Dr Peter Carter, RCN general secretary, said: 'When there are not enough nurses on the ward, patients are more likely to die or experience complications. 'It is reckless to think about reducing staff levels without considering in detail the impact on patient care.'

The McKinsey report claims that hospitals are rife with waste. It says £2.4billion could be saved if those with the lowest levels of productivity pulled themselves up to the average.

The analysis, presented to the Department of Health in March, bears the department's logo and has been disseminated among senior NHS managers. Last night health minister Mike O'Brien said that ministers had rejected it and that there were no plans to cut the NHS workforce. 'Advisers advise but ministers will decide after taking a range of advice,' he said. 'The McKinsey work is not in any sense an NHS plan of action. 'They are just making some suggestions which will be looked at with many other ideas.' But critics have said 'what is the point of employing consultants to provide advice and then ignoring it, its smacks of incompetence '.

Norman Lamb, the Liberal Democrat health spokesman, said: “The huge gap between what ministers say in public and the secret reports being circulated in Whitehall is becoming clearer by the day.” He added: “The credibility of outside consultants who have squandered billions of pounds of taxpayers' money over the last decade must be questioned.”

More than a third of those visiting their doctor end up being seen by a nurse, figures show. It means that GPs, who had big pay rises under contracts introduced in 2004, are seeing a much smaller proportion of patients than before Labour took power.

In 1995, 21 per cent of those visiting surgeries were seen by a nurse, but by last year the figure had risen to 34 per cent. The British Medical Association denied that doctors were shirking their responsibilities, saying that the increase was planned. 3.9.09

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The NHS is about care, not markets

Downsizing the workforce is a business response to loss of profit – but it doesn't account for the NHS goal of universal healthcare. The core goal of universal healthcare and services planned on the basis of need and not ability to pay is being jettisoned by the turnaround teams and management teams brought in to manage anticipated reductions in NHS budgets.

Downsizing the workforce is a traditional response of business to loss of profit where businesses have to pay the costs of operating in a market and earn surpluses for shareholders. Unlike Scotland and Wales, the NHS in England is continuing to pursue market-oriented healthcare in its reform of the NHS. So it should be no surprise that management consultants firm McKinsey have come up with market-oriented solutions to anticipated budgetary shorfall.

They have advised ministers to cut 10% of the NHS workforce in England by 2014, a reduction that will affect services provided primarily to the old and the poor who have among the highest healthcare needs. But strategies to reduce the NHS budget need to pay attention to the role of market structures and how they reduce the ability of the NHS to pool the risks and costs of care across its population.

The diversion of health spending from patient care to paying for a market are not apparently McKinsey's concern. Take for example the costs of the new market bureaucracy; for more than 40 years administration costs were in the order of 6% of the total budget a year, they doubled overnight to 12% in 1991 with the introduction of the internal market. We have no data today for England, but what we know from the US is that the introduction of for-profit providers increases administrative costs to the order of 30% or more.

So why hasn't McKinsey advocated making savings along the lines of Scotland and Wales by reintegrating trusts into area-based planning structures and thereby abolishing billing, invoicing, the enormous finance departments, marketing budgets and management consultants, lawyers, commercial contracts? In this way one could project savings of anything from £6-24bn a year for England.

A second set of savings would be the high costs of PFI where the taxpayer, having bailed out the banks, is now paying almost twice as much as it should for some PFI hospitals through high rates of interest and returns to shareholders. The total money raised from private finance so far is £12.27bn but the NHS will pay out £41.4bn for the availability of buildings and a total of £70bn over the life of the contracts. The irony is that the patient and the public are rebuilding the banks' balance sheets using scarce NHS funds intended for patient care and staff, especially in community-based services.

A third saving could be made by cancelling the contracts for the £5bn ISTCs programme – research in Scotland extrapolated to England has shown as much as £1bn has been wasted by giving money to for-profit ISTCs for work that was not carried out in the first wave.

Then there are all the other contracted out services including the pharmaceutical bill of £14bn. Are these contracted out elements part of the McKinsey scrutiny? It is doubtful since the company travels the world advocating market solutions.

And here we run up against the fundamental problem of retaining marketeers to advise on healthcare. Markets mean reducing the capacity of the NHS to pool the costs of care across the whole service, substituting instead hospitals, clinics and practices that have to pay their way like businesses and, like businesses, can fail. Needs-based planning, once the hallmark of the NHS in England, is being replaced by strategies to deal with artificially created market failure.

Solutions are sought from outside consultants and turnaround teams using unsubstantiated assertions that the NHS is inefficient and can increase productivity. What the selective use of data and evidence mask is the failure to view the system as a whole and to remember that its core goal is universal healthcare, not concocted operating surpluses.

In contrast to Wales and Scotland, England has established hospitals and services as competing trusts or firms operating in a market; competition has replaced the mechanisms which enabled health authorities to monitor and respond and direct resources to the needs of the populations that are being served. But markets create winners and losers – and the unpublished McKinsey report is an attempt at refereeing.

The moral is that if the Department of Health in England commissions private management consultants that derive their profits from markets you will get market solutions. It is the commissioning, not McKinsey's report itself, that should give offence. 3.9.09

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Care burden 'makes patients ill'

Some patients are so overburdened by treatment that it makes their health worse, according to a new study in the BMJ medical journal. The paper, by clinicians from Glasgow and Newcastle universities, says badly co-ordinated care leads to "wasted resources and poor outcomes".

It calls for more "minimally disruptive medicine" that is tailored to the realities of patients daily lives. The findings of the paper are based on 10 years of research. The paper, led by Carl May, professor of medical sociology at Newcastle University , states that patients can be burdened by much more than drug management and self monitoring.

He said: "It includes organising doctors' visits and laboratory tests. Patients may also need to take on the organisational work of passing basic information about their care between different healthcare providers and professionals. "In some countries, they must also take on the contending demands of insurance and welfare agencies. "Patients are thus overwhelmed not just by the burden of illness, but by the ever present and expanding burden of treatment."

The paper highlights cases where patients have suffered due to such a burden. Among these cases is that of a man treated for heart failure who rejected the offer to attend a specialist heart failure clinic to improve his condition. He said that over a two-year period he had made 54 individual visits to specialist clinics for consultant appointments, diagnostic tests and treatment - the equivalent of one full day every two weeks.

'Wasted resources'
Frances Mair, professor of primary care research at Glasgow University and co-author of the paper, said the findings showed the need for "better co-ordination of care". "Thinking seriously about the burden of treatment may help us begin to consider minimally disruptive medicine - forms of effective treatment and service provision that are designed to reduce the burden of treatment on users," she said.

"The treatment burden leads to poor adherence, wasted resources and poor outcomes". "We are calling for minimally disruptive medicine that seeks to tailor treatment regimens to the realities of the daily lives of patients. "Such an approach could greatly improve the care and quality of life for patients." 12.8.09

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Tories team up with Google to let patients read their medical records online

The Conservatives are to enter into deals with internet giants Google and Microsoft to let patients to check their NHS records online. Tory health spokesman Andrew Lansley will today unveil plans which he says will give people greater control over their data, even allowing them to edit it.

Under the scheme, personal details could be handed over to a range of private IT companies, who will give patients a username and password so they can check and amend their records on their home computers.

They will be able to note symptoms and drug side effects and log their blood pressure and cholesterol levels.

But critics, including the British Medical Association, claim the system could be vulnerable to hackers and would make it harder for doctors to access information in an emergency. Patients would not be forced to opt in to the scheme, and if they decided not to, or if they did not have access to the internet, their medicalrecords would remain at their GP surgery.

Mr Lansley told the BBC: 'If we are going to ask people to take more responsibility for their health, which I think is an important part of improving our overall health outcome, and controlling health expenditure in the longer term, then we need people to be engaged with it.'

Dr Vivienne Nathanson of the BMA said: 'The security of web-based medical systems is of great concern, as are the implications of data being held by the private sector.' 10.8.09

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Toxic combination - Mixing my medicines nearly made me bleed to death

When Peter Birtles awoke in the night with a streaming nosebleed, he wasn't unduly alarmed. But when it was still pouring blood after more than half an hour, his wife Linda became concerned. 'It wasn't just a trickle, it was like a tap had been turned on. It frightened the life out of us,' recalls Peter, 62, a businessman from Sheffield.

His wife called an ambulance and within minutes he was on his way to hospital. Doctors managed to stop the bleeding by plugging his nose. But they were concerned about what had caused such massive blood loss.

After taking his medical history, they came up with the answer: Peter had been prescribed two drugs that should never be used together and he was suffering from a potentially fatal side-effect. Up to 70 per cent of patients might be taking drugs that could interact with each other. Indeed, last week GPs were put on alert over fears the anti-swine-flu drug Tamiflu could put the 600,000 people on Warfarin in the UK at greater risk of suffering a stroke.

The Medicines and Healthcare products Regulatory Agency, the Government's drugs' watchdog, is concerned that Tamiflu can interact with the anti-blood-clot medication, causing dangerously thin blood, putting patients at risk of uncontrolled bleeding and stroke.

Serious side-effects can also occur when people have certain foods or drink with medication. For example, grapefruit juice dangerously magnifies the effect of the blood pressure drug Felodipine, which can lead to a dangerous decrease in blood pressure and increase in heart rate. Reactions may also occur because patients don't take their medication at the correct time. For example, statins should be taken at night because you produce the most cholesterol while sleeping.

The elderly are particularly at risk of serious side-effects because they tend to take more medication - almost half of over-65s are taking five or more medicines at any one time. And a recent survey by the Royal Pharmaceutical Society of Great Britain revealed that more than half of that age group have definitely or possibly had a side-effect from medicine - yet one in five didn't get it checked, prompting the launch of a campaign to get them to do so.

But most worrying is that some doctors seem unaware of which drugs should not be taken together. Recent research by the University of Arizona College of Pharmacy found that prescribers correctly identified fewer than half of drug combinations with potentially dangerous interactions.

In Peter's case, a GP failed to realise the painkiller Dihydrocodeine, prescribed for a leg injury, should never be taken with Warfarin, which Peter has taken since a heart valve operation in 1998. Both drugs increase the length of time the blood takes to clot and together they extended it to dangerous levels, so Peter couldn't stop bleeding.

According to the patient group Action Against Medical Accidents, drug interactions are an increasing problem. 'Because there are so many drugs on the market, there is more potential for a combination that doesn't work well together,' explains chief executive Peter Walsh. Patients are also taking more medication than ever. The number of dispensed prescriptions increases by around six per cent a year; while the average person received ten prescription items in 1997, this had risen to almost 16 a decade later.

David Pruce, of the Royal Pharmaceutical Society, explains: 'The problem is there are thousands of potential interactions and not all are serious, in fact, some are quite useful - sometimes two drugs together are better than one. 'Keeping up with all the latest research is almost impossible given the sheer amount of papers published about drugs.

For GPs, it is particularly difficult because they could be prescribing virtually any drug.' In some cases, doctors know drugs are going to interact, but still go ahead with the medication. 'A lot is a calculated risk and knowing what will be serious and what you can get away with,' says Mr Pruce. 'If we took notice of every single potential interaction, we would never prescribe anything.'

There are, however, safeguards to prevent patients being prescribed drugs that interact. Every doctor and pharmacist has a copy of the British National Formulary, which is updated twice a year and lists every known drug interaction. Their computers issue a warning if they try to prescribe drugs that don't mix. 'It is almost impossible to prescribe drugs that interact with a GP's computer system,' says Dr Laurence Buckman, a London GP and chair of the British Medical Association's GPs' committee.

'Problems mainly occur when patients are taking over-the-counter or herbal medicines a doctor doesn't know about or are prescribed drugs from different sources. 'A couple of patients a week will come to see me experiencing a drug interaction due to situations like this.'

The most serious problems occur when there is a fine line between a beneficial dose and a toxic dose - as is the case with Warfarin.

Mr Pruce, a pharmacist, says: 'Warfarin is commonly used for people who have had a heart attack, stroke or a heart valve replacement, but the dose has to be carefully adjusted to suit the individual. It determines how quickly the blood takes to form a clot. There are quite a few drugs that will affect how quickly Warfarin is broken down in the body and they can push the level of the drug in the blood stream into the toxic range. You have to be very careful.'

Side-effects caused by drugs - including interactions - can be reported by doctors, pharmacists, nurses and, as of recently, patients themselves by sending a form known as a 'yellow card' - available from pharmacies, GPs' surgeries or a hotline - to the Medicines and Healthcare Products Regulatory Authority. But only an estimated ten per cent of serious adverse reactions are reported. 

If a patient is worried about their medication, they can have it reviewed by visiting their local pharmacist and asking for a free Medicine Use Review. This consultation is available to anyone on one or more medicines or patients with long-term conditions and should be carried out yearly

But this wasn't much help to Peter. 'Thankfully, it was simply a nosebleed,' he says. 'But if it had been internal bleeding, I wouldn't have realised and the consequences could have been fatal. 'When I went back to the GP, he was very apologetic.

'My medical notes said I was taking Warfarin, but either he didn't check or didn't realise the drugs were contraindicated. But this is no excuse. GPs are busy but they shouldn't be handing out prescriptions that could do you harm.

'As an engineer, I've worked on nuclear reactors. If I made the kind of mistakes they are making, the reactor would have blown up.' For more information, visit www.anticoagulationeurope.org and www.foodanddruginteractions.co.uk. 1.9.09

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Statistics prove prescription drugs are 16,400% more deadly than terrorists

America was rudely awakened to a new kind of danger on September 11, 2001 : Terrorism. The attacks that day left 2,996 people dead, including the passengers on the four commercial airliners that were used as weapons. Many feel it was the most tragic day in U.S. history.

Four commercial jets crashed that day. But what if six jumbo jets crashed every day in the United States , claiming the lives of 783,936 people every year? That would certainly qualify as a massive tragedy, wouldn't it? Well, forget "what if." The tragedy is happening right now. Over 750,000 people actually do die in the United States every year, although not from plane crashes. They die from something far more common and rarely perceived by the public as dangerous: modern medicine.

According to the groundbreaking 2003 medical report Death by Medicine, by Drs. Gary Null, Carolyn Dean, Martin Feldman, Debora Rasio and Dorothy Smith, 783,936 people in the United States die every year from conventional medicine mistakes and the same thing is happening in the UK. That's the equivalent of six jumbo jet crashes a day for an entire year. But where is the media attention for this tragedy? Where is the government support for stopping these medical mistakes before they happen?

After 9/11, the White House gave rise to the Department of Homeland Security, designed to prevent terrorist attacks on U.S. soil. Since its inception, billions of dollars have been poured into it. The 2006 budget allots $34.2 billion to the DHS, a number that has come down slightly from the $37.7 billion budget of 2003.

According to the study led by Null, which involved a painstaking review of thousands of medical records, the United States spends $282 billion annually on deaths due to medical mistakes, or iatrogenic deaths. And that's a conservative estimate; only a fraction of medical errors are reported, according to the study. Actual medical mistakes are likely to be 20 times higher than the reported number because doctors fear retaliation for those mistakes.

The American public heads to the doctor's office or the hospital time and again, oblivious of the alarming danger they're heading into. The public knows that medical errors occur, but they assume that errors are unusual, isolated events. Unfortunately, by accepting conventional medicine , patients voluntarily continue to walk into the leading cause of death in America and the UK.

According to a 1995 U.S. iatrogenic report, "Over a million patients are injured in U.S. hospitals each year, and approximately 280,000 die annually as a result of these injuries. Therefore, the iatrogenic death rate dwarfs the annual automobile accident mortality rate of 45,000 and accounts for more deaths than all other accidents combined." This report was issued 10 years ago, when America had 34 million fewer citizens and drug company scandals like the Vioxx recall were yet to occur. Today, health care comprises 15.5 percent of the United States ' gross national product, with spending reaching $1.4 trillion in 2004.

Since Americans spend so much money on health care, they should be getting a high quality of care, right? Unfortunately, that's not the case. Of the 783,936 annual deaths due to conventional medical mistakes, about 106,000 are from prescription drugs, according to Death by Medicine . That also is a conservative number. Some experts estimate it should be more like 200,000 because of underreported cases of adverse drug reactions .

Americans today are used to fixing problems the quick way – even when it comes to their health. Thus, they rely heavily on prescription drugs to fix their diseases. For every conceivable ailment – real or not – chances are there's a pricey prescription drug to "treat" it. Chances are even better that their drug of choice comes chock full of side effects.

The problem is, prescription drugs don't treat diseases; they merely cover the symptoms. U.S. physicians provide allopathic health care – that is, they care for disease, not health. So, the over-prescription of drugs and medications is designed to treat disease instead of preventing it. And because there are so many drugs available, unforeseen adverse drug reactions are all too common, which leads to the highly conservative annual prescription drug death rate of 106,000. Keep in mind that these numbers came before the Vioxx scandal, and Cox-2 inhibitor drugs could ultimately end up killing tens of thousands more.

American medical patients are getting the short end of a rather raw deal when it comes to prescription drugs. Medicine is a high-dollar, highly competitive business. But it shouldn't be. Null's report cites the five most important aspects of health that modern medicine ignores in favor of the almighty dollar: Stress, lack of exercise, high calorie intake, highly processed foods and environmental toxin exposure. All these things are putting Americans in such poor health that they run to the doctor for treatment. But instead of doctors treating the causes of their poor health, such as putting them on a strict diet and exercise regimen, they stuff them full of prescription drugs to cover their symptoms. Using this inherently faulty system of medical treatment, it's no wonder so many Americans die from prescription drugs. They're not getting better; they're just popping drugs to make their symptoms temporarily go away.

But not all doctors subscribe to this method of "treatment." In fact, many doctors are just as angry as the public should be, charging that scientific medicine is "for sale" to the highest bidder – which, more often than not, end up being pharmaceutical companies. The pharmaceutical industry is a multi-trillion dollar business. Companies spend billions on advertising and promotions for prescription drugs. Who can remember the last time they watched television and weren't bombarded with ads for pills treating everything from erectile dysfunction to sleeplessness? And who has ever been to a doctor's office or hospital and not seen every pen, notepad and post-it bearing the logo of some prescription drug?

Medical experts claim that patients' requests for certain drugs have no effect on the number of prescriptions written for that drug. Pharmaceutical companies claim their drug ads are "educational" to the public. The public believes the FDA reviews all the ads and only allows the safest and most effective drug ads to reach the public. It's a clever system: Pharmaceutical companies influence the public to ask for prescription drugs, the public asks their physicians to prescribe them certain drugs, and doctors acquiesce to their patients' requests. Everyone's happy, right? Not quite, since the prescription drug death toll continues to rise.

The public seems to genuinely believe that drugs advertised on TV are safe, in spite of the plethora of side effects listed by the commercial's narrator, ranging from diarrhea to death. Patients feel justified in asking their physicians to prescribe them a particular drug they've seen on TV, since it surely must be safe or it wouldn't have been advertised. Remember all those TV ads heralding the wonders of Vioxx? One might wonder how many lives could have been spared if patients didn't see the ad on TV and request a prescription from their doctors.

But advertising isn't the only tool the pharmaceutical industry uses to influence medicine. Null's study cites an ABC report that said pharmaceutical companies spend over $2 billion sending doctors to more than 314,000 events every year. While doctors are riding the dollar of pharmaceutical companies, enjoying all the many perks of these "events," how likely are they to question the validity of drug companies or their products?

Admittedly, not all doctors reside in the pockets of the pharmaceutical companies. Some are downright angry at the situation, and angry on behalf of an unaware public. Major conflicts of interest exist between the American public, the medical community and the pharmaceutical industry. And although the public suffers the most from this conflict, it is the least informed. The public gets the short end of the stick and they don't even know it. That is why the pharmaceutical industry remains a multi-trillion dollar business.

Prescription drugs are only a part of the U.S. healthcare system's miserable failings. In fact, outpatient deaths, bedsore deaths and malnutrition deaths each account for higher death rates than adverse drug reactions. The problems run deep and cannot be remedied without drastic, widespread change in the system's money and ethics.

The first issue – money – is the main reason the medical industry cannot seem to change. Prescribing more drugs and recommending more surgeries means more profits. Getting more drugs approved by the FDA, regardless of their safety, means more money for the pharmaceutical industry. As the healthcare system stands today, physicians and drug companies can't seem to pass up earning loads of money, even if a few hundred thousand people lose their lives in the process. Even in drastic cases of deadly drugs, everyone involved has a scapegoat: Drug companies can blame the FDA for approving their product and the doctors for over-prescribing it, and doctors can blame the patients for wanting it and not properly weighing the risks.

What ultimately arises is a question of ethics. In layman's terms, ethics are the rules or moral guidelines that govern the conduct of people or professions. Some ethics are ingrained from childhood, but some are specifically set forth. For example, nearly all medical schools have their new doctors take a modern form of the Hippocratic Oath. While few versions are identical, none include setting aside proper medical care in favor of money-making practices.

On the research side of the issue, "Death by Medicine" cites an ABC report that says clinical trials funded by pharmaceutical companies show a 90 percent chance that a drug will be perceived as effective, whereas clinical trials not funded by drug companies show only a 50 percent chance that a drug will be perceived as effective. "It appears that money can't buy you love, but it can buy you any 'scientific' result you want," writes Null and his team of researchers.

The government spends upwards of $30 billion a year on homeland security. Such spending seems important. Since 2001, 2,996 people in the United States have died from terrorism – all as a result of the 9/11 attacks. In that same period of time, 490,000 people have died from prescription drugs, not counting the Vioxx scandal. That means that prescription drugs in this country are at least 16,400 percent deadlier than terrorism. Again, those are the conservative numbers. A more realistic number, which would include deaths from over-the-counter drugs, makes drug consumption 32,000 percent deadlier than terrorism. But the scope of "Death by Medicine" is even wider. Conventional medicine, including unnecessary surgeries, bedsores and medical errors, is 104,700 percent deadlier than terrorism. Yet, our government's attention and money is not put into reforming health care.

Couldn't a little chunk of the homeland security money be better spent on overhauling the corrupt U.S. healthcare system, the leading cause of death in America, the UK and worldwide? Couldn't we forfeit the color-coded threat system in favor of stricter guidelines on medical research and prescription drugs? No one is attempting to say that terrorism in the world is not a problem, especially for a high-profile country like the United States . No one is saying that the people who died on 9/11 didn't matter or weren't horribly wronged by the terrorists that day. But there are more dangerous things in the United States being falsely represented as safe and healthy, when, in reality, they are deadly.

The corruption in the pharmaceutical industry and in America 's healthcare system poses a far greater threat to the health, safety and welfare of Americans today than terrorism. If the Administration really wants to save lives -- a lot of lives -- it needs look no further than the chemical war has been declared on Americans by Big Pharma. 8.8.09

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Bonuses for doctors: How GPs are earning up to £380,000 a year

Family doctors are earning up to £380,000 a year, a Daily Mail investigation has revealed. GPs take home 'jaw-dropping' sums thanks to bonuses and overtime payments. They are being paid more than £200 an hour for evenings and weekends - work they did for free before the bungled introduction of a new contract in 2004. Six years ago GPs were paid around £70,000.

Now Freedom of Information requests by the Mail have uncovered the astonishing way their pay has risen, even though the average GP is working seven fewer hours a week. The investigation found one GP earning £380,000 a year and a number pocketing more than £300,000.

In some cases the figures include cash GPs have to pay out for staff salaries and rents. But in Norfolk, one GP takes home £310,000 even after these are subtracted. The investigation also revealed for the first time that family doctors are being paid up to £204 an hour for working in the evenings and at weekends - something they were expected to do at no extra charge before the new contract moved the responsibility to primary care trusts.

The continuing bonanza, when thousands of their patients are losing their jobs or taking pay cuts, came in for heavy criticism last night. Michael Summers, vice chairman of the Patients Association said: 'You begin to wonder how on earth GPs can earn that sum. 'I would hope that these figures are the exception rather than the rule. £100,000 would seem fair considering the fact that GPs are saving lives.'

Matthew Elliott, chief executive of the TaxPayers' Alliance, said: 'Some GPs are now earning jaw-dropping amounts of money despite a reduction in their requirement to do out-of-hours work. 'With many people struggling even to get appointments it is ludicrous that GP pay has soared. The pay and perks of every GP should be published to let taxpayers assess if we're getting good value.'

But the British Medical Association said: 'These figures don't tally with statistics based on GPs' tax returns. 'Primary care trusts have information based on the amount of income a practice receives but this is not what GPs earn, as clearly there are many expenses such as staff and rent to be paid.'

The Daily Mail used the Freedom of Information Act to ask primary care trusts for the family doctor with the largest earnings in their district. Many did not respond, claiming that the information was confidential or held by a private company - but responses were received from 22.

The highest-paid of all was a GP in North East Essex PCT, who earned £380,394. The trust, covering 40 surgeries in the Colchester area, would not name the doctor or say whether the figure included outgoings. A GP in Kirklees, which covers Huddersfield and Dewsbury, took home £321,794 and the highest-earning family doctor in the South London boroughs of Sutton and Merton earned £319,000.

The fact that only 22 of 152 PCTs replied leaves the distinct possibility that there may be GPs earning more than £380,000. Many of the highest salaries are in rural areas, where doctors can earn more from locally-targeted extra payments. GPs with their own pharmacies also increase their take-home pay.

Under the 2004 contract, doctors earn points for treating patients with certain conditions. The points translate into bonuses on their final salary and account for around a third of their income. Among the targets for points are monitoring asthma patients, testing and diagnosing diabetes, checking blood pressure and monitoring patients with coronary heart disease.

Critics say it is too easy for GPs to gain maximum points and accuse them of ignoring patients like dementia victims who are not covered by the scheme. 4.8.09

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Quango civil servant who's paid an astonishing £350,000 a year

Mike Mackay, a mid-ranking civil servant working for one of the country's smaller quangos and last year Mr Mackay was paid more than £350,000 of public money. He works for the Youth Justice Board which this year received public funding of £495million, of which £22.8million was spent on its 320 employees, averaging £71,250 each. The annual budget for health quangos now tops £1.2bn as the NHS has become a "bureaucratic monster".

Although the IT manager is more or less unknown, his astonishing earnings mean he is paid £150,000 a year more than Gordon Brown. Indeed, over the past three years the UK taxpayer has handed him close to £1million - making him one of the highest-paid public servants in the country. He also appears to be one of the best-treated.

Mr Mackay works to a flexible schedule and usually spends four days a week in the central London office of the Youth Justice Board. Fridays are usually spent 'working from home' in Aberdeen. The cost of his flights to and from Scotland as well as his London accommodation are picked up by the Youth Justice Board, and thus ultimately by the taxpayer.

Mr Mackay's astonishing wage and benefits packet is the most shocking example yet of how ultra-generous public sector salaries have been allowed to rise unchecked by economic realities. Earlier this week, the Daily Mail revealed how Dame Suzi Leather, the part-time head of the Charity Commission, is paid £80,000 plus £35,000 expenses for three days work a week.

The bumper salaries have prompted politicians of all parties to call for a cut in the number and cost of Britain's 790 quangos or 'quasi-autonomous non-governmental organisations'. Mr Mackay, 50, has spent the past three years working at the Youth Justice Board, a quango charged with overseeing youth justice and the rehabilitation of young criminals. As its chief information officer he is developing a computer network which will allow England's and Wales' 157 Youth Offending Teams to share details of their clients. He is by far the best paid employee of the organisation.

Freedom of Information requests and the YJB's annual accounts reveal that in 2007 Mr Mackay was paid £330,000 for his services. Last year that rose to £351,499. This year, he was paid £336,000, which is more than ten times the salary of a youth worker. An engineering graduate, Mr Mackay moved into IT management in the 1980s, working initially for the oil companies based in his native Aberdeen.

After working for the Cabinet Office, in October 2007 made an inter-departmental move across to the YJB, which is overseen by the Ministry of Justice. He lives in a detached house in the most exclusive area of Aberdeen with his wife Christina, a vet, and their two children Monica, 15 and Gregor, 13. A spokesman for the YJB said Mr Mackay is paid as a consultant and said that a proportion of his pay is taken by the recruitment agency which provides him. The spokesman would not say how much the agency takes.

Mark Wallace, campaign director of the Taxpayers' Alliance said: 'This is a massive bill for just one official in one quango. Once these bodies are removed from democratic control, they are free to start splashing huge amounts of money around.'

Liberal Democrat justice spokesman David Howarth, who is campaigning against overpaid public sector consultants, added: 'It seems difficult to justify this level of expenditure given the funding constraints imposed on the criminal justice system.' Mr Mackay is on a three-and-a-half week summer holiday and was unavailable for comment. 1.8.09

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‘Unsustainable' £186 billion social security payouts 'equal to a quarter of goverment's budget'

Total spending on social security will reach "unsustainable" levels this year, a think tank warns, as handout payments now equate to a quarter of the government's entire budget. A simplification of the benefits system is now essential, the Centre for Policy Studies report concludes.

The report, published on Monday, estimates the total Treasury spending bill for more than 50 different kinds of benefits will be £186 billion next year. It warned such complexity increased the risk of error, overpayment and fraud. The report, titled Benefit Simplification: How and Why It Must Be Done also made it difficult for the Government to control spending. It recommended a single agency should be set up to control a new simplified system in which applicants would have to fill in one form.

"In its 1997 manifesto, New Labour promised to 'decrease the bills of economic and social failure'," CPS director Jill Kirby said. "It has failed to do so'. "The Treasury now forecasts total social security payments in 2009/10 to be £186 billion – a quarter of all Government spending and more than is received by Government in income tax and corporation tax combined. At a time of economic crisis, this is not sustainable." She added: "But for any reform to be effective, simplification is the essential first step."

Benefits are administered not only by the Department for Work and Pensions, but also by HM Revenue and Customs, local councils and some other Government bodies. DWP manuals on how to apply benefits run into 14 volumes and 8,690 pages. A separate four volumes, totalling 1,200 pages, cover the housing and council tax benefits is operated by local authorities while HMRC has a further 260-page manual devoted to tax credits.

Tax expert David Martin, the report's author, gave the example of a woman with a disabled son, eligible for a series of different benefits, who had to complete 10 application forms containing over 1,200 questions to get the support to which she was entitled. Matthew Elliott, chief executive of the TaxPayers' Alliance, said: "The welfare state has gone from being a safety net to stop people falling into poverty, to being a fishing net which entraps people in its complexity. "Radical simplification would make it fairer for claimants and cheaper for taxpayers, because billions less would be wasted on bureaucrats and form-filling." A DWP spokesman said: "We are making strides in simplifying a complicated system. It is not possible to have a one-size-fits-all approach when you are trying to support people's individual needs." 3.8.09

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Management briefing: NHS business failure

NHS managers are doomed to failure according to a report published this week by Civitas, the independent think tank. The report's authors, James Gubb, director of the health unit at Civitas, and Peter Davies, a GP in Yorkshire, accuse the NHS of “following every known rule that guarantees failure in the business world”.

In 'Putting Patients Last: How the NHS keeps the ten commandments of business failure' they put forward the argument that there are fundamental problems with the health service. They say that NHS organisations are “isolated and risk-averse”, consumed with internal processes, bureaucracy and conforming to Government initiatives rather than focusing on high-quality care for patients.

“Blind faith in structure, process and satisfying government has made business immune to what is happening on the ground, where the world of people, cultures and emotion make the real difference. More of the same command-and-control attitude will not pull the NHS through the recession,” they write.

The two men measure the NHS's performance against Ten Commandments of Business Failure by Donald R Keough, former Coca-Cola Company chief executive, and find it lacking on every count:

1. Stop taking risks
An Office of Government Commerce study rated the NHS's ability to change as poor.

2. Be inflexible
NHS staff pay is set centrally; capital expenditure is constrained by Government; the National Programme for IT is being imposed top-down; and the National Institute for Health and Clinical Excellence decides which treatments are offered, the two say.

3. Isolate yourself
Healthcare is conducted in silos, with patients too often left in limbo — particularly between primary and secondary care.

4. Assume infallibility
Politicians refer to the NHS as “the envy of the world” but the latest figures found that the UK ranked 16 out of 19 industrialised nations for “amenable mortality” — deaths which should be preventable with good healthcare.

5. Play the game close to the foul line
Government targets rule, pushing NHS organisations to the edge, often to the neglect of patient care.

6. Don't take time to think
The past ten years has seen incoherent initiatives and policy reviews, decreasing the ability of senior managers to display leadership, think and positively affect the delivery of services; and left governance confused and void of focus, they write.

7. Put faith in (external) consultants
NHS organisations spend £350 million on external consultants a year.

8. Love bureaucracy
The NHS Confederation estimates that 69 bodies regulate, inspect and demand information from NHS organisations, many asking similar questions. In secondary care only 58 per cent of this is considered useful.

9. Send mixed messages
Only 69 per cent of the 290,000 NHS staff surveyed by the Healthcare Commission in 2008 said that they had clear objectives.

10. Be afraid of the future
Fear that the budget will not stretch to meet demand has led to initiative after initiative that has left clinicians feeling mistrusted and powerless, they write.

The NHS is not a commercial environment which means resources are wasted through mismanagement and illconcieved plans which in most cases result in dire decisions being made and financial resources wasted. 1.8.09

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Doctors use recession as excuse to 'drive thousands to use anti-depressant pills'

The recession is being blamed for a steep rise in the number of people taking anti-depressants. Doctors in London alone handed out nearly 3.27m prescriptions last year - a rise of 188,252 in 12 months. Figures also show that the NHS drugs bill for treating mental health problems such as depression and anxiety is £24.3m since the beginning of last year. This is despite a reduction in the cost of anti-depressants.

One mental health charity said it was not surprised about the rise given the stresses caused by the recession. But it emphasised that pills were not the only answer. Victoria Walsh, campaigns manager of Rethink, said: 'This shows there is a need for additional psychological therapies as anti-depressants alone are not the most effective way to deal with depression.'

The figures from the NHS Information Centre cover the 31 London primary care trusts, and refer to a wide range of anti-depressants including Prozac and Seroxat. They show that 3.27m prescriptions were given in the 12 months to April this year, up from 3.08m the previous year.

Sutton and Merton PCT spent the most in the last financial year, at £1.5m on 172,043 prescriptions, while the lowest was Kensington and Chelsea with 61,835 prescriptions at a cost of £558,089. London clinics have reported a doubling in the number of people seeking help for recession-related mental illness.

Ministers have moved to provide psychological help to those hit by redundancy and debt - psychotherapy centres are set to be established in every NHS primary care trust by the end of next year. 30.7.09 (related article: How do drug firms influence doctors to give you those happy pills? )

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The addiction ‘treatment' scandal

The national statistics are due in October 2009 for the number of people leaving the care of the addiction services free from their addiction. Experts predict that they will be no better than last years figure which was just over 3 per cent, the reason for this is simple government treatment programs do NOT work.

The government likes to imply that so called ‘treatment' is effective and they continually referred to ‘getting more people into treatment' as though the treatment actually works but the truth is, it doesn't. The government defines treatment as harm reduction but this is not an actual treatment process as one would assume, it simply refers to the management of addicts and their addiction.

The addiction services have enjoyed unprecedented funding for treatment over the last 10 years culminating in a £800million a year budget however this is due to be drastically cut but critics have said this will make no different to number of people getting clean, proving the so called 'treatment programs' don't work and are pointless.

An independent report by the Centre for Policy Studies confirms the Government has wasted £10 billion of taxpayers' money on a fruitless ‘harm reduction' approach to addiction, they are ‘squandering billions on ineffective treatment' and ‘costly treatment programs which do not work', so getting more people into this type of treatment is meaningless and achieves nothing except the swelling of the bureaucracy for the addiction services.

The actual success rate of the addiction services last year was just 3.6% which means the numbers of addicts emerging from Government treatment programs are at the same level as if there had been no treatment at all. As a direct result of this failure Britain has one of the highest levels of drug addiction in Europe .

But it's not just the drug treatment programs which don't work, an MPs' report also says ‘the responsibility for tackling alcohol misuse had been handed to PCTs, but many had not drawn up strategies to tackle alcohol harm in their area, or kept across what was being spent on relevant local services. This lack of co-ordination raised the risk that dependent drinkers would relapse into their old ways following treatment'.

Again the use the word ‘treatment' implies there is actually some benefit from the NHS services that deal with alcohol abuse but there isn't. In the last 10 years alcohol related deaths have risen by 40% under this government, which alone confirms their policy and efforts have both failed.

Drug and alcohol abuse costs society around £39 billion per year, so there has never been a greater need for treatment but the simple truth is current treatment methods do not work and those responsible for commissioning new services are failing to do so, so million of ordinary people continue to suffer. Critics insist the government should ‘stop referring to the management of people with addiction problems as ‘treatment' as they are not getting any real treatment only more of the same 'mismanagement', which is proven not to work'. 30.7.09

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Labour's spin bill rockets by 43per cent to £540million in a single year

The cost of Government spin leapt by 43 per cent last year, figures show. More than £540million was spent on advertising and marketing in the year to March, despite the deepening recession. The huge rise was last night blamed on the cost of high profile 'nanny state' campaigns to tackle obesity, smoking and climate change.

Official figures, slipped out as MPs concentrated on the swine flu epidemic, showed spending on television, press and radio advertising grew by 35 per cent to £211million. Digital marketing, which includes the internet, soared by 84 per cent to £40million. Other costs included 'news and PR', which rose by 52 per cent to £40.9million, while live events to spread government messages nearly trebled to £34.3million.

Mark Lund, the chief executive of the Central Office of Information, which co-ordinates government advertising, marketing and communications, said: 'Government campaigns can help save lives and save money. 'Changing behaviour is difficult but the benefits to the taxpayer and society can repay the investment many times over. 'But last night MPs accused ministers of stepping up their spin spending in order to win votes at the next general election.

Critics say 'Labour has been a disaster for a once rich and prosperous country. Their policies have seen many areas fall into disarray including :-

• Economy
• Education
• Crime
• Immigration
• Addiction
• Health
• Military

are all a disaster despite millions and billions of pounds being spent on them, they [Labour] have created many of the problems due to their mismanagement and inept bureaucracy'.

Conservative Party chairman Eric Pickles said: 'Whilst we now all accept that prudence has been given its last rites under Labour, it is shameful that Gordon Brown is continuing to use hard-pressed taxpayers' money to peddle government propaganda.'

Liberal Democrat frontbencher Norman Baker added: 'Doubtless the campaigns are all worthy causes but it raises questions that the bill has gone up so dramatically a year before a general election. 21.7.09

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Just one in 10 NHS staff willing to have swine flu vaccine

Patients could be put at risk because as few as 10 per cent of NHS staff may volunteer to have the swine flu vaccine, managers warn. Doctors and nurses are shunning the jab because they believe the virus is mild and there is only a slim chance they will get the disease.

But NHS bosses say their reluctance could lead to needless deaths during the expected second wave of the disease as staff pass the virus on to frail patients and those with compromised immune systems. And if staff are unprotected from another onslaught of the bug, sickness rates could lead to cancelled operations. The situation has forced the Department of Health to order all NHS organisations to ensure frontline staff get immunised against the disease.

A poll by Pulse magazine showed that 49 per cent of GPs would reject the jab; and last week a Nursing Times survey showed that 47 per cent of nurses were definitely not going to have the jab, while just 23 per cent said they definitely were. Ian Dalton, the NHS's national director of flu resilience, has told chief executives and boards to maximise the number of workers having the jab.

He wrote in a letter: 'We all know that uptake of the seasonal flu vaccine among NHS staff is traditionally low. 'It is an NHS board responsibility that we do not find ourselves in this position with the swine flu vaccine.'  Many NHS staff are reluctant to have the vaccine because they are concerned the jab has not been sufficiently tested.

One chief executive said: 'In my hospital, if nothing changes then it could be that 10 to 20 per cent of staff have the swine flu jab. 'Staff could have the virus and pass it on to patients, a proportion of whom will die - albeit a very small proportion.

'The other consequence is that if loads of staff go off with swine flu that will leave us short-staffed, which is dangerous to patients. That's a bigger danger than transmission.' And a medical director at another hospital said: 'The word on the street in NHS staff circles is that the vaccine is no good and you shouldn't bother with it.

'Nurses in particular worry that there may be side-effects, that corners have been cut in producing the vaccine and that the generally mild nature of the virus means they don't need to take it. 'As few as 10 to 15 per cent of doctors may have it because we doctors believe ourselves to be above such trivial things as infections.'

Dame Christine Beasley, the chief nursing officer for England, said: 'Nothing in life is risk-free. I can well understand people being worried. 'I can well understand people thinking it's only a mild illness and why should I bother? 'I do understand all that; I think you wouldn't be human if you didn't think that.'

A spokesman for the Department of Health said: 'Frontline healthcare workers will be absolutely crucial in the height of a pandemic. Without them, patient care will suffer and the NHS will be stretched. 'Getting the swine flu vaccine will protect them and their patients.

'All NHS organisations will be working hard to ensure that all eligible staff have the choice to protect themselves and their patients from swine flu by having the vaccine.' 13.10.09

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So we're not all going to die of swine flu after all

Chief medical officer reduces death estimates by two-thirds. Deaths from swine flu could be less than half the annual toll from the usual winter flu, it emerged last night. The news came as an expert accused ministers of an 'alarmist' response to the outbreak.

England's chief medical officer Sir Liam Donaldson was forced to admit yesterday that the worst case scenario had been slashed by two thirds from 65,000 deaths to 19,000. After millions were spent on antiviral drugs and telephone hotlines, he revealed the toll could be as low as 3,000 - less than half the number who die in an average flu season.

Even a total of 19,000 deaths would be 2,000 lower than the number who died in the last major seasonal flu epidemic of 1999-2000. The startling admission comes only weeks after Health Secretary Andy Burnham said there could be as many as 100,000 new swine flu cases a day. In fact it emerged that last week there were now fewer than 650 new cases a day.

Sir Liam is facing growing criticism that he caused panic as the virus turns out to be much milder than originally feared. Yesterday he unveiled new guidance for the NHS, describing a range from 3,000 deaths to a 'worst case scenario' of 19,000 - significantly lower than the 65,000 he warned of in July. Sir Liam said the revised figures, from Government scientists, were 'assumptions and not predictions', and they do not include an assessment of the impact the swine flu vaccine - due in October - may have.

The 19,000 figure is based on 30 per cent of the population getting the disease, and a death rate of 0.1 per cent - or one in 1,000. Other figures released yesterday showed there were an estimated 4,500 new diagnoses of swine flu in England in the past week. This is a slight drop on the 5,000 cases reported in the previous week and down from a high of around 100,000 cases a week more than a month ago.

The number of deaths in England linked to the virus stands at 61, up from 57 last week. Across the UK there have been 70 deaths. Sir Liam said he had been looking carefully at data from Scotland, where schools returned from their summer break earlier than in England.

Experts have predicted a surge in the number of swine flu cases once schools and universities go back across the UK. But Sir Liam said 'there is no suggestion of any significant upturn in Scotland', adding that England was unlikely to see a peak 'before the second half of October'. News of the reduced death forecasts came as an expert wrote in the British Medical Journal that the Western response to the outbreak of swine flu had been 'alarmist, overly restrictive, or even unjustified'.

Peter Doshi, a doctoral student at the Massachusetts Institute of Technology, said actions were taken 'in an environment of high public attention and low scientific certainty'. He called for a new framework for dealing with epidemics, saying a single, one- size-fits-all public health strategy cannot respond to the 'vastly different challenges' posed by the different types of threat in the world.

'Experts are unsure that the 2009 pandemic will be any worse than seasonal flu,' he said. 'Officials responded to the H1N1 outbreak as an unfolding disaster.' He added: 'If the 2009 influenza pandemic turns severe, far exceeding the impact of seasonal influenza, early and enhanced surveillance may prove to have bought critical time to prepare a vaccine that could reduce morbidity and mortality. 'But if this pandemic does not increase in severity, it may signal the need to reassess both the risk assessment and risk management strategies towards emerging infectious diseases.'

Yesterday the Chartered Institute of Personnel and Development and the Business Continuity Institute said businesses should be prepared for a 'significant' increase in absenteeism. Companies should be prepared for up to half of their staff being off work sick for two to four weeks because of the expected second wave of swine flu cases later this year.

A swine flu sufferer who had been through the ravages of chemotherapy was saved after being given the antiviral drug Relenza intravenously.

The 22-year-old woman's immune system had been impaired by the chemotherapy, but she survived a serious case of swine flu after being treated with the unlicensed intravenous form of Relenza, the Lancet medical journal reported. 4.9.09

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Half of GPs refuse swine flu vaccine over testing fears

Up to half of family doctors do not want to be vaccinated against swine flu. GPs will be first in the line for the jabs when they become available but many will decline, even though they will be offering the vaccine to their patients. More than two thirds of those who will turn the jab down believe it has not been tested enough. Most also believe the flu has turned out to be so mild in the vast majority of cases that the vaccine is not needed.

Last night Government experts criticised GPs who decide not to have the jab, saying they will put vulnerable patients needlessly at risk. A week ago, a poll of nurses showed that a third would turn down the opportunity of being vaccinated against swine flu.

News that medics are unconvinced by the need for a vaccine will cause grave concern to patients who will be invited for the jab over the next few months. A poll of doctors for Pulse magazine found that 49 per cent would reject the vaccine with 9 per cent undecided.

A separate survey for GP magazine found that 29 per cent would definitely opt out of having the jab, while a further 29 per cent were unsure. Just 41 per cent said they would definitely have the jab. Of those who said they did not want to jab, 71 per cent said it was because of safety concerns. Richard Hoey, editor of Pulse, said: 'The medical profession has yet to be convinced by the Government's whole approach to swine flu, with most GPs now feeling that the Department of Health overreacted in its policy on blanket use of Tamiflu.

'Inevitably, that has coloured feelings about the planned immunisation campaign. 'The view among many doctors is that the Government hasn't yet made its case for why such a huge vaccination programme needs to be rushed in for what seems to be an unusually mild illness.' But Professor David Salisbury, the Department of Health's director of immunisation, told GP magazine that frontline health workers had a duty to themselves regarding vaccination. 'They have a duty to their patients not to infect their patients and they have a duty to their families,' he said.

The Pulse survey questioned 15 doctors, while GP spoke to 216.  The poll raised further questions over the Government's planned mass vaccination programme. The jab, currently being processed, will be fast tracked and will not be fully tested before it is administered to patients.

There are also concerns the jab can spark cases of Guillain Barre Syndrome, which can lead to paralysis and even death. A mass swine flu vaccination programme in the U.S. in 1976 caused far more deaths than the disease it was designed to combat, and the Health Protection Agency watchdog has asked doctors to look out for cases of GBS when the vaccinations begin.

Earlier this month, Chief Medical Officer Sir Liam Donaldson announced that the jab will be given to people in high-risk groups, such as those with asthma or diabetes, as well as health workers such as GPs and nurses. Some 14million people will be covered by the first wave of the vaccination programme, with everyone else following over the next few months.

The BMA is still negotiating with doctors over how they should be paid to give out the jabs. The union is demanding £7 for every injection. A spokesman for the BMA said: 'The new vaccine has been thoroughly tested and we believe it should provide good protection against swine flu.

'It is important that doctors are among the first to be offered the vaccine as it will not only protect them but the patients they care for. However, doctors like all individuals have the right to decide whether they are vaccinated or not.' 25.8.09

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'Healthy' swine flu sufferers should NOT take Tamiflu: World Health Organisation rejects British advice

People who catch swine flu but have no other health problems should not be given Tamiflu, the World Health Organisation announced today. The advice contradicts British policy which has seen hundreds of thousands of doses of the antiviral drug given to people diagnosed with the bug.

However, the new guidance, issued by a panel of international experts, said at-risk groups, including patients with underlying medical conditions and pregnant women, should still receive the drug if they show swine flu symptoms. The announcement comes as new figures show 45,986 courses of antivirals were given to patients in England in the week ending 18 August. In the previous week, 90,363 courses of antivirals were given out.

But this data relates to people collecting the drugs after an assessment via the National Pandemic Flu Service. Many more have collected antivirals via their GP. A statement from WHO, the health arm of the United Nations, said: 'Worldwide, most patients infected with the pandemic virus continue to experience typical flu symptoms and fully recover within a week, even without any form of medical treatment. 'Healthy patients with uncomplicated illness need not be treated with antivirals.'

There have been fears mass use of Tamiflu will encourage the virus to become resistant to the antiviral. Medics have also expressed concern over the side effects of the drug, including sickness, nightmares and insomnia in children.

Today's advice, published on the WHO website, said most patients were experiencing typical flu symptoms and would get better within a week. It said Tamiflu and another antiviral Relenza should not be given to healthy people. However, the drugs should be given quickly to patients in a serious condition or who appear to be deteriorating. Those in at-risk groups - such as people with an underlying medical condition like diabetes - should also receive the drugs promptly.

A statement said: 'Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. 'Healthy patients with uncomplicated illness need not be treated with antivirals.'

Looking at children, the WHO experts recommended 'prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness.' They went on: 'This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness. 'Otherwise healthy children, older than five years, need not be given antiviral treatment unless their illness persists or worsens.'

The warning comes after the Government's chief medical officer said yesterday it was 'virtually impossible' to accurately predict when a second wave of swine flu will hit the UK. Sir Liam Donaldson said the Government was expecting the number of cases to rise in the autumn but it was difficult to predict the timing with accuracy.

Figures released yesterday showed a continuing fall in the number of people newly diagnosed with swine flu, with an estimated 11,000 new cases in England last week. This is down on the 25,000 new cases estimated for the week before. The data shows a drop in the number of cases across all age groups and in most parts of the country.

Experts believe the fact schools and universities are on a summer break is a major factor in why figures have gone down. There are currently 263 patients being treated in hospital in England, of which 30 are in intensive care, down on the 371 (39 in intensive care) reported last week.

The number of deaths linked to the virus stands at 54, with almost 25 of those having died in London. 22.8.09

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Tamiflu puts 600,000 at greater risk of a stroke

GPs have been put on alert over fears that Tamiflu can put some people at greater risk of suffering a stroke. A Government watchdog is concerned that the anti-swine flu drug can interact with the blood-thinning medication warfarin, which is taken by more than 600,000 people in the UK. The combination can dangerously thin the blood, putting patients at risk of uncontrolled bleeding which can lead to a stroke. 

The Medicines and Healthcare products Regulatory Agency has already received reports of such cases and has asked health professionals to watch out for more. Last night an expert warned that the dangers have been increased because people given Tamiflu over the national flu hotline are not being warned properly about the possible warfarin risk.

The MHRA has now received 418 reports of suspected adverse reactions to Tamiflu, including two deaths. Of these reactions,12 were are due to interactions with warfarin. The number may be small, but the MHRA is sufficiently concerned to place all such reports under 'close review'.

It is the latest concern to emerge about Tamiflu, the powerful antiviral handed out by the Government to people with swine flu or flu-like symptoms. Last week, Oxford scientists advised parents not to let children take it because the risks outweighed the benefits. A recent study found Tamiflu caused side effects such as nausea and nightmares in children.

On Monday it emerged that ministers ignored a warning from their own advisors that handing out Tamiflu widely could do more harm than good, especially as most swine flu victims suffer only mild symptoms. Health secretary Andy Burnham went ahead with the flu hotline, which lets people get Tamiflu by answering questions from call centre staff who have no medical training. More than 500,000 packs were handed out in the first two weeks. The concern about warfarin centres on the INR rate, which measures how long it takes the blood to clot. The higher the rate, the more the risk of uncontrolled bleeding. Patients on warfarin need regular monitoring to ensure they stay in a safe range.

An MHRA spokesman said: 'We have seen indications that INR rates could possibly rise due to interactions between warfarin and Tamiflu. However, flu-like illnesses have also been known to cause this, so at this stage it is difficult to know whether it is the interaction with Tamiflu or the underlying flu.' A significant increase in the INR rate could lead to a haemorrhagic stroke - bleeding in the brain.

Around 20 per cent of strokes are haemorrhagic and the rest are caused by blood clots, which warfarin is prescribed to prevent. Warfarin is known to interact with a range of drugs and even some foods and drinks, such as cranberry juice. Each year, around 12,000 warfarin takers have a major bleed, requiring hospital admission, because their INR rate goes up too much. More than 100 die.

Clinical testing of Tamiflu did not produce concerns over warfarin interaction, but experts say side-effects often do not become apparent until a drug has been taken by many thousands of people. Professor Hugh Pennington, bacteriologist at Aberdeen University, said the national pandemic service could be putting people at risk because call centre operators are not sufficiently trained.

He said: 'There is an issue about the health of chronicallyill people. The people on the flu line will not raise the issue of warfarin, and if people ask about it, all they will say is ask your GP.' Roche, the makers of Tamiflu, said last night: 'Roche takes all reports of potential adverse events seriously and encourages all patients and healthcare professionals to report any such event to the competent authority - the MHRA - and Roche.

'The potential for interaction of Tamiflu with warfarin is not documented within the Tamiflu licence approved by the MHRA and the European Medicines Agency.' 19.8.09

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Swine flu: more than 400 cases of Tamiflu side effects

More than 400 reports of Tamiflu side effects have been received since the start of the swine flu outbreak, according to the medicines watchdog. Between April 1 and August 6 there were 418 reports, of which 125 were received in the last week alone. The 418 reports detailed 686 suspected adverse reactions, including allergy to Tamiflu and nausea.

The Medicines and Healthcare products Regulatory Agency (MHRA) is collecting data on suspected side effects - not all of which are confirmed as being caused by the drug. Tamiflu, which is manufactured by Roche, has vomiting and nausea listed as its main side effects on its packaging.

A total of 11 per cent of adults and adolescents taking the drug experience nausea and 8 per cent have vomiting, according to the summary of product characteristics. Headaches are another side effect when the drug is taken preventatively rather than as a treatment.

In children, the most commonly reported side effect is vomiting, with 15 per cent suffering it and 10 per cent having diarrhoea. A total of 3 per cent of children will get nausea and 5 per cent have reported abdominal pain. Clinical studies accepted by health bodies in the UK and worldwide show that the drug should not aggravate asthma but a total of 4 per cent of children with asthma experienced worse asthmatic symptoms when taking the drug - the same proportion as in a group of asthmatic children taking a dummy drug.

The study, on 334 asthmatic children aged six to 12, found the drug did not help cut the length of the illness. But by the last day of treatment (day six) the lung function was better in children taking Tamiflu, with their Forced Expiratory Volume having increased by 10.8 per cent compared with 4.7 per cent among those on the dummy drug.

The Government has 23 million treatments of Tamiflu and 10.5 million treatments of another anti-viral, Relenza. Orders of Tamiflu have been placed to increase UK supplies to 50 million doses, enough to treat 80 per cent of the population. Pregnant women should take Relenza, which is inhaled and helps reduce flu symptoms without affecting the baby. However, if a pregnant woman has unusually severe flu, a doctor may prescribe Tamiflu.

An expert group reviewed the risk of anti-viral treatment in pregnancy and told the Government the risk was extremely small - smaller than the risk posed by the symptoms of swine flu. Some people have had wheezing or serious breathing problems when they have used Relenza and it is not recommended for people with asthma or other serious lung problems.

Other possible side effects of Relenza include headaches, diarrhoea, nausea and vomiting. The MHRA has received a total of 10 reports of side effects from Relenza since April 1. An MHRA spokesman said: “We have allocated a dedicated section of our website to receive reports of side effects to Tamiflu and Relenza from doctors and the public in order to spot any developing trends. “We have set up this specific site so that people can log on and report any potential side effects". 12.8.09

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Research has cast doubt on the policy of giving antiviral drugs to children for swine flu.

Work in the British Medical Journal shows Tamiflu and Relenza rarely prevent complications in children with seasonal flu, yet carry side effects. Although they did not test this in the current swine flu pandemic, the authors say these drugs are unlikely to help children who catch the H1N1 virus. The government has stuck by its policy of offering them to anyone infected.

The Department of Health said a "safety-first approach" of offering antivirals to everyone remained a sensible and responsible way forward, but promised to keep the policy under review. There were an estimated 30,000 new cases of swine flu in England in the last week, a drop compared with the 110,000 cases the week before. A decreased incidence has also been seen in Scotland and Wales in the past week.

The total of swine flu-related deaths in England and Scotland stands at 41. Antivirals are the mainstay of treatment at the moment until a vaccine becomes available, which is expected in September. The drugs are designed to ensure that symptoms are mild and reduce the chance of an infected person giving the illness to someone else. The UK has moved beyond the stage of containing swine flu into the "treatment phase", which means that Tamiflu is only being offered to people who have swine flu and not usually to their contacts.

No effect
While the latest study shows that antivirals can shorten the duration of normal seasonal flu in children by up to a day and a half, it also shows that they have little or no effect on asthma flare-ups, ear infections or the likelihood of children needing antibiotics.

But the drugs can cause unpleasant side effects, such as vomiting with Tamiflu. There is also the risk that widespread use of the drugs will mean the virus will develop resistance to them. For most children aged between 1 and 12, the risks associated with taking the drugs may well outweigh any benefits, say the researchers.

They say parents with sick children should make sure they get lots of rest and enough fluids and that they should contact their doctor if the child's condition gets worse. In most cases, swine flu is a relatively mild disease. Their work also reveals the effectiveness of using antivirals to contain the spread of flu. They found that 13 people need to be treated to prevent one additional case, meaning antivirals reduce transmission by 8%.

The University of Oxford team, led by Dr Matthew Thompson, carried out a review of four trials on the treatment of seasonal flu in 1,766 children and three trials involving the use of antiviral to limit the spread of seasonal flu in 863 children. Dr Thompson said: "Our research is finding for most children these antiviral drugs are probably not going to have much of an effect."

Co-researcher Dr Carl Heneghan, a GP and clinical lecturer at Oxford University , said the current policy of giving Tamiflu for mild illness was an "inappropriate strategy". He said: "The downside of the harms outweigh the one-day reduction in symptomatic benefits." Flu expert Professor Hugh Pennington said the findings were not surprising and underlined what was already known about Tamiflu. "Tamiflu has a place but it's not a wonder cure."

A Department of Health spokesman said: "Whilst there is doubt about how swine flu affects children, we believe a safety-first approach of offering antivirals to everyone remains a sensible and responsible way forward. "However, we will keep this policy under review as we learn more about the virus and its effects.

"The BMJ research is correct to say that many people with swine flu only get mild symptoms, and they may find bed rest and over-the-counter flu remedies work for them. "But for those who experience severe symptoms, the best scientific advice tells us that Tamiflu should still be taken as soon as possible - and to suggest otherwise is potentially dangerous. If people are in any doubt about whether to take Tamiflu, they should contact their GP."

Liberal Democrat Shadow Health Secretary Norman Lamb called for an urgent review of the policy. But Professor Steve Field, chairman of the Royal College of GPs, said the current policy was correct. The Royal College of Paediatrics and Child Health also supports the Department of Health advice.

BBC Health Correspondent Adam Brimelow
The government's flu pandemic plan has come under close and continuous scrutiny ever since the UK 's first H1N1 swine flu cases were diagnosed three and a half months ago.

One of the biggest concerns has been the aggressive use of anti-viral drugs, drawing on a stockpile built up in advance to treat half the population, with further supplies still coming in. The government has also lined up around a 130m vaccines, more than enough for everyone in the UK .

Over the last four years ministers have spent more than £500m on preparations for the pandemic. So is this outlay proportionate to the risk? The total of swine flu related deaths so far across the UK is 41. Seasonal flu routinely kills 12,000 people in England and Wales each year, without provoking anything like the same response.

But it is important to remember we are still in the first wave of swine flu. The situation in the autumn may be much worse. For now ministers and their advisers are prepared to err on the side of caution even if that means people having Tamiflu who do not need it. They say they will be guided in their decisions by science. However, a lot of the evidence on swine flu is still emerging so they will continue to rely on a safety-first approach. 11.8.09

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Swine flu drug Tamiflu 'a danger to children' and should not be given to them, expert warns

Children should not be given the anti-viral drug Tamiflu because its serious side-effects outweigh any benefits, researchers said today. They called on the Department of Health to have an urgent rethink of its current policy in the swine flu pandemic. Their study found that Tamiflu caused vomiting in some children, which can lead to dehydration and complications.

And the drug had little or no effect on asthma flare-ups, ear infections or the likelihood of a youngster needing antibiotics. Dr Carl Henegan, a GP and expert from the John Radcliffe Hospital in Oxford, said the current policy of giving Tamiflu for mild illness was an ‘inappropriate strategy'. He added: ‘The downside of the harms outweigh the one-day reduction in symptomatic benefits.'

The study comes little over a week after other research found that children given Tamiflu preventatively reported side-effects including nausea and nightmares. Although the number of cases of swine flu has declined in recent days, a second wave is expected to hit the country in October.

It is believed that many people are stockpiling Tamiflu in case they or a family member contracts the illness. Government data suggests that the number of people given the drug is seven times higher than those actually suffering with the virus. In the week up to August 4, there were 30,000 new cases of swine flu but 30,000 doses were prescribed on average each day for the same period.

Nigel Hawkes, director of Straight Statistics, a pressure group which monitors Government statistics, said: 'Either there are a lot more cases out there than the Health Protection Agency estimates, or tens of thousands who are not suffering H1N1 flu are ringing up [the National Pandemic Flu Service]. describing their "symptoms", and getting antiviral treatment.'

'Perhaps they all think they might have flu, or perhaps they think it might be nice to have some Tamiflu tucked away in the medicine cupboard for when they do get it.' Researchers analysed four studies involving children aged one to 12 taking Tamiflu or another anti-viral, Relenza.

The children were being treated for normal seasonal flu but the experts behind the research said their findings would extend to the current swine flu pandemic. Dr Matthew Thompson, a GP and researcher at Oxford University, said: ‘I don't think we have got any reason to think our results would be any different. ‘The current swine flu is generally a mild flu illness... it does not seem that different from current seasonal flu. ‘We would be happy to say our results apply to the current swine flu strain.'

He said children with mild symptoms should be treated in the same way as if they had any other mild flu - with drinks to cool high temperatures and rest. There was no need for children who were otherwise healthy to be taking Tamiflu or Relenza. Parents should be on their guard, however, for any potential complications and signs that their child is getting worse, he said.

For children with compromised immune systems or conditions like cystic fibrosis, parents may want to discuss the options with their GP. ‘I think what GPs should do is to weigh up the risks and benefits with the parent,' he said. Dr Henegan said the only benefit found in the study was that children got back to normal half a day to one day earlier if taking Tamiflu or Relenza.

He said his advice to GPs was ‘not to rely on Tamiflu as a treatment to reduce complications' or to think of it as a ‘magic bullet'. And he warned that widespread use of Tamiflu could result in the flu becoming resistant to the drug. ‘What is a problem going forward - like with antibiotics - is you run into a resistance issue. ‘Going forward we have a treatment which is ineffective because we've given it to everybody.'

Both researchers called on the Department of Health to review its current policy. Dr Thompson said: ‘It's possible a more conservative strategy (such as) reserving these anti-viral drugs for people, for children who are more likely to have complications of the illness might be a more sensible strategy.' Dr Henegan added: ‘I think the Government should be looking at this urgently, this week.' The experts said the studies had been publicly available to the Government before it formulated its current strategy with regard to Tamiflu.

And they said the Government should have demanded more data from the pharmaceutical companies which manufacture the drugs - Roche, which makes Tamiflu, and GlaxoSmithKline, which makes Relenza. 10.8.09

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Fears rise over side effects of Tamiflu as cases of adverse reactions double in a week

Fears over the side effects of Tamiflu grew last night as it was revealed that the number of suspected adverse reactions had doubled in one week. Figures from the drugs safety watchdog, seen by the Daily Mail, show there have been 293 reports of side effects from the powerful antiviral since the beginning of April, when the swine flu outbreak began.

This compares to the 150 reported the week before - a jump of 143 in only seven days. The cases include heart and eye problems, and psychiatric disorders. The figures come only a few days after a study showed that more than half of children who take Tamiflu suffer from nausea, nightmares and other reactions.

The massive rise coincides with the launch of the National Pandemic Flu Service, which allows Britons for the first time to get Tamiflu over the phone or internet without the intervention of a GP. In the first three days of its operation - between 24 and 26 July - no fewer than 150,000 Tamiflu packs were handed out.

A growing number of doctors have raised concerns over whether the drug is being handed out too readily, putting many at needless risk of side effects when in the majority of instances, swine flu is a mild illness. The 293 cases, reported by doctors to the Medicines and Healthcare products Regulatory Agency, are only of suspected adverse reactions. However, those that turn out not to have been caused by Tamiflu are likely to be only a fraction of the total.

There were 465 separate reactions reported, referring to 293 individuals. Around a third involved gastrointestinal problems, such as vomiting and diarrhoea. But there were also cases of heart and eye problems - together with 46 cases of psychiatric disorders and 48 disorders of the nervous system. There has also been one unexplained death. Last week England's top doctor urged parents to continue giving their children Tamiflu if they come down with swine flu.

Sir Liam Donaldson, the chief medical officer, appealed for calm after the release of a study which showed that 53 per cent of children who take it suffer from nausea, nightmares and other reactions. Sir Liam said: 'All drugs do have side effects. It is always a case of deciding the balance between benefiting a patient from a treatment and the side effects.'

There are, however, fears that if Tamiflu and the other antiviral drug Relenza are given to too many, it could lead to the flu virus developing resistance to them - leaving-Britain defenceless against swine flu until the arrival of new vaccines. A spokesman for the MHRA said: 'Tamiflu and Relenza are acceptably safe medicines and most people will not suffer any side effects. The balance of risks and benefits for Tamiflu and Relenza remains positive.'

Gap year students have been advised against charity work in Third World countries - because they could do more harm than good by spreading swine flu. Professor Robert Dingwall, an adviser to the Department of Health, said young Britons had a 'personal ethical responsibility' to consider cancelling such work. Developing countries have a shortage of antiviral drugs, and are likely to be at the back of the queue once a vaccine becomes available. Writing in the Observer, Professor Dingwall added: 'Staying at home this year will often be the morally right thing to do.'  3.8.09

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Children treated with Tamiflu suffer side effects including nightmares and nausea

More than half of children who take Tamiflu suffer side effects such as nausea and nightmares. The drug being used to fight swine flu can also produce stomach pain, diarrhoea and sleeping problems.

Researchers in two studies reported that many children found concentration difficult after taking the drug  -  which could affect their performance in school tests and exams. The findings will cause deep concern among parents and raise the question of whether the powerful anti-viral should be handed out so widely when the vast majority of swine flu cases involve only a mild illness.

Some 150,000 Tamiflu packs were distributed by the new National Pandemic Flu Service between Friday and Sunday alone  -  despite warnings from some experts that this could increase the resistance of the virus. The phone and internet service lets people obtain Tamiflu without a positive diagnosis of swine flu from a doctor.

The alarming studies of pupils in four schools emerged as chief medical officer Sir Liam Donaldson announced another 110,000 new cases of swine flu last week  -  up only slightly from 100,000 the week before. He also revealed that almost half those who have died with the disease in England had no previous serious health conditions.

The new studies will increase concern over the potential side effects of Tamiflu  -  liver failure is one of those listed on the box. Some 150 suspected adverse reactions, including one unexplained death, have been reported to safety watchdogs. The Medicines and Healthcare products Regulatory Agency says 59 of the victims are under 14. It also emerged yesterday that Japan has advised its GPs not to give the drug to youngsters between 10 and 19 because of high rates of 'neuropsychiatric side effects' such as feeling confused and having bad dreams.

The studies by Health Protection Agency experts were carried out in the early stages of the epidemic, when everyone sharing a classroom with a child who developed swine flu was given the drug, even if they showed no symptoms. One of the studies reveals that evidence of side effects prompted ministers to change the policy so only confirmed or suspected cases get Tamiflu.

The first study, of 103 children at three London schools, showed that 53 per cent suffered side effects. The most common were nausea (29 per cent), stomach pain or cramps (20 per cent) and problems sleeping (12 per cent). The other study, on a secondary school in South West England which was closed for ten days after a swine flu case, said 51 per cent of pupils had symptoms such as feeling sick (31 per cent), headaches (24 per cent) and stomach ache (21 per cent). Critics argue the side effects of the drug are worse than the symptoms of swine flu. Both studies were reported in the medical bulletin Eurosurveillance.

GPs are reporting increasing cases of suspected Tamiflu side effects. One told Pulse magazine: 'It's not the innocuous drug the public seem to think it is.' The Department of Health said last night: 'The EU regulatory position remains that no causal association between Tamiflu (or Relenza) and an increase in neuropsychiatric events has been established.' Roche, the Swiss company which makes Tamiflu, issued a similar statement, which critics claimed was a cop-out and a 'disgrace'.

Government chief medical officer Sir Liam Donaldson said Tamiflu should still be given to children if they have established symptoms and there are no existing medical reasons not to prescribe the drug. He told BBC Radio 4's Today programme: "All drugs do have side-effects. It is always a case of deciding the balance between benefiting a patient from a treatment and the negative side-effects. But critics who warned about using untested drugs could be dangerous as the side effects are always played down or ignored altogether said 'it was only last week the Department of Health said it was 'extremely irresponsible' to suggest Britain would use an unsafe vaccine' but it has happened. 31.7.09

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'Dangers' of the fast-track swine flu vaccine

Plans to fast-track the swine flu vaccine have been attacked by the World Health Organisation. The Department of Health plans to make the vaccine available at least two months earlier than in America after limited safety tests.

More than 132million doses have been ordered with the first batch due to arrive next month. But WHO flu chief Dr Keiji Fukuda said: 'There are certain areas where you simply do not try to make any economies. One of the things which cannot be compromised is the safety of vaccines.'

The European Medicines Agency, the drug regulatory body for the EU, is accelerating the approval process for the vaccine, allowing firms to bypass large-scale human trials. Countries including Britain, Greece, France and Sweden plan to start using it as soon as it is cleared.

Flu vaccines have been used for 40 years, and many experts say extensive testing is unnecessary because the swine flu vaccine will simply contain a new ingredient - the swine flu virus. EMA spokesman Martin Harvey-Allchurch said: 'With the winter flu season approaching, we need to make sure the vaccine is available.'

U.S. experts are taking a more cautious approach with longer testing. In 1976, mass vaccination after an outbreak of a strain of the H1N1 virus there led to hundreds developing the paralysing Guillain-Barre syndrome.

In Europe, flu vaccines are usually tested on hundreds of people for several weeks to establish whether the immune system has produced enough antibodies to fight the infection.

To speed up the process, the EMA will approve the first doses of the swine flu vaccine based on data from a previous 'mock up' vaccine of H5N1 bird flu, as both will have the same basic ingredients. The Department of Health said it was 'extremely irresponsible' to suggest Britain would use an unsafe vaccine. 26.7.09

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Swine flu vaccine will not be fully tested before use

Desperate health leaders are to start rolling out the new swine flu vaccine before full human trials are carried out. They are so anxious to stop the pandemic that the public will begin being immunised after the first drug batches arrive next month. Gsk - the company supplying the vaccine - admits tests would be limited in the early stages.

This has worried some experts who highlight America's dodgy swine flu immunisation programme 33 years ago which was linked to the deaths of 30 people. It was stopped early when several hundred people developed a rare condition that causes temporary paralysis. But, as the 31st British person died yesterday after getting the bug, a senior Government adviser said the benefits of the latest drug far outweigh any potential risks.

Professor Sir Gordon Duff, of the Scientific Advisory Group for Emergencies, added: "It is inconceivable that in the UK we would consider a vaccine without giving a full scientific appraisal of its benefits and theoretical risks. That is just what these risks are - theoretical.

"It has to be understood that it's a thing we have thought about a lot". "We've looked at it from every scientific angle and we have advised that getting this vaccine will be a lot safer for the population than letting the flu run away with itself." The Government has ordered up to 132 million doses from GSK and and co-supplier Baxter - enough to cover the population.

Ministers are now drawing up a priority list of people to get the drug with those aged six months to 65 with a health condition like asthma, diabetes, heart, liver or kidney disease at the top of the list. Pregnant women in their second or third trimester could also jump the queue along with health workers and children aged from three to 16. Yesterday it emerged two biotechnology companies had started the world's first human trials of a pig flu immunisation in Australia.

Adelaide-based Vaxine began tests on 300 adult volunteers on Monday while Melbourne's CSL has 240 people in its seven-month trial, which started yesterday.

REASSURANCE
It came as Gordon Brown yesterday moved to calm the public over the spread - and insisted Britain was ready to deal with it. The Prime Minister declared: "We have been preparing for a pandemic for a number of years."

The latest swine flu victim, whose identity has not been revealed, came from the virus blackspot of the West Midlands. A postmortem is being carried out to establish the exact cause of death. 23.7.09

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Safety fears over swine flu jab

The first doses of swine flu vaccine will be given to the public before full data on its safety and effectiveness become available, doctors confirmed yesterday. The aim is to provide maximum protection against the pandemic in the shortest possible time.

But, unlike seasonal flu vaccine, the pandemic version will be spread over two doses in a higher quantity, and one brand is expected to contain a chemical additive to make it go further, potentially increasing the risk of side-effects. Children, who are most vulnerable to swine flu and are likely to be among those first in line for the jab, may get the vaccine more than a month before trial results are received.

Adam Finn, professor of paediatrics at the University of Bristol and an expert on vaccination who will be testing the pandemic vaccine, said: "There will be a period where a risk judgement will have to be made. It will depend if there is an increase in the number of cases and deaths. Children are potent spreaders [of the virus] – they are now seen as the engine of the epidemic. We are dealing with information as it comes in – we could be dealing with a far worse epidemic, and we need to act sooner rather than later."

Yesterday it emerged that a baby aged under six months died at the Royal Free Hospital, London, last week and a 39-year-old mother who was reported to have given birth died at Whipps Cross Hospital, east London, on Monday. The Department for Children, Schools and Families said 1,000 schools had been affected by swine flu and some could be forced to stay shut after the summer holiday if the number of cases escalates.

The pressure to protect the population from the growing pandemic, and the short time available for production and testing of the vaccine since the H1N1 virus was identified in May, mean the licensing process is to be accelerated.

A previous vaccine against swine flu turned out to be worse than the disease. An outbreak in the US in 1976 infected 200 soldiers at a military camp in New Jersey, of whom 12 were hospitalised and one died. But before it was over 40 million people had been vaccinated, 25 of whom died and 500 of whom developed Guillain-Barre syndrome, an inflammation of the nervous system which can cause paralysis and be fatal.

Doctors said yesterday that today's vaccines are purer and cause fewer side-effects. Though the virus is mostly mild in its effects, it has claimed 29 lives in the UK and hospitalised 652 people in England. The NHS was ordered this week to plan for a worst-case scenario in which swine flu might cause 65,000 deaths over the coming winter, including several thousand deaths among children.

Discussions are still going on between the manufacturers, the European Medicines Evaluation Agency (EMEA), and the Department of Health over how much data will be required.

The Government has placed advance orders for up to 132 million doses of vaccine with two manufacturers, GlaxoSmithKline and Baxter. The manufacturers have tested and licensed in advance three "core" vaccines in preparation for a pandemic. These are vehicles into which the H1N1 pandemic strain of the virus is inserted.

A spokesman for the EMEA said the first samples of the fully functional pandemic vaccine were expected by the end of July and a decision on whether to approve them would be taken within five days. Trials involving 200 to 400 patients would be conducted, but the vaccine would be made available for use by the NHS before the results came in.

"What the manufacturers will be submitting will not have any clinical trial data. We expect the interim adult data from September and the first paediatric data from October onwards," he said.

Last night a spokesperson from the Department of Health defended the EMEA, saying : "The UK has one of the most successful immunisation programmes in the world. "Appropriate trials to assess safety and the immune responses have been carried out on vaccines very similar to the swine flu vaccine. The vaccines have been shown to have a good safety profile. More than 40,000 doses of the vaccines which the swine flu vaccines are based on have been given without any safety concerns." However critics suggest testing vacines on the population is unethical especially when swine flu is no worse than normal seasonal flu and the creation of the 'innovation pass' will see more untested drugs being used on patients without clinical date to establish their side-effects. 18.7.09

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Drug firm charges NHS £6 for swine flu vaccine that costs £1 to make

GlaxoSmithKline was today accused of profiteering from the swine flu pandemic after it emerged that it is making a 600 per cent mark-up on its vaccine for the virus. The drug maker, which is one of several firms commissioned by the World Health Organisation (WHO) to produce a vaccine, said it had already agreed contracts for 195 million doses with 16 countries worldwide.

But it emerged today that the drug giant is charging the NHS £6 per dose, even though it admits the vaccine only costs £1 to produce.  Liberal Democrat health spokesman Norman Lamb said: 'This is clearly a bonanza for the company. 'They have done the work so should legitimately benefit, but this is a staggeringly substantial return. I will write to the National Audit Office to determine whether we got the best deal for the taxpayer.' The Government has ordered 60million doses, making the drug giant's total profit about £300 million.

Glaxo has made £700 million worldwide so far this year from sales of the H1N1 vaccine and can expect to earn billions more as foreign governments desperately stock up. The company today announced profits of £2.4 billion for the last three months alone. It has also sold £60 million of its anti-viral flu treatment Relenza, which reduces the length and severity of the disease and is recommended for pregnant women with swine flu.

But Andrew Witty, the £1-million-a-year chief executive of GSK, denied his company was profiteering. He said: 'We've been preparing and investing in something like this pandemic situation for a very long time. We've spent £1.2 billion on vaccine technology in the last four years.

'We've deliberately been very responsible about pricing  -  the vaccine is not being sold at a special premium and we have been very proactive about making sure there is enough capacity to produce the huge number of vaccines required.' He added: 'We have been spending on vaccines for the past ­‑ years, far longer than any other drug firm. It has been a tremendously long investment.'

Susi Squire of the Taxpayers' Alliance said: 'We need an assurance from the Government that they have got the most competitive rate out of GlaxoSmith-Kline. 'It is good to hear that a company is doing well in the recession, but is it because they are charging over the odds for these vaccines?' Geoff Martin of London Health Emergency said: 'It's a scandal that any company could use the swine flu pandemic as an opportunity to jack up profits. 'The Government should step in and impose a windfall tax on private companies that have hit the jackpot as a result of the flu crisis.' 22.7.09

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Drugs giant GlaxoSmithKline could be set for swine flu financial boost

Swine flu may be turning into a global scourge, but as always there are winners in a crisis. One of them is drugs giant GlaxoSmithKline, which may rack up £1.3billion in 2010 selling vaccines against the H1N1 virus, according to analyst estimates. It also has an antiviral treatment in Relenza.

More details will emerge on Wednesday, when GSK chief Andrew Witty posts financial results and discusses the firm's swine flu response. Second quarter pretax profits are tipped to rise by 6pc to £1.95billion. The shares have recovered modestly since this year's low in April, advancing 12 per cent.

On Friday Glaxo also won approval from the European Commission to acquire U.S skincare company Stiefel Laboratories in a deal worth as much as $3.6billion. The transaction would not harm competition in Europe, the European Union said in a statement. It said its investigation had shown that overlaps between GSK and Teifel were limited to a number of products in the dermatological sector.

'For these products, the combined firm would continue to face several strong, effective competitors with significant market shares,' the EU executive said. Glaxo said in April it planned to buy Stiefel, the world's biggest independent dermatology company, partly owned by buyout firm Blackstone Group. The purchase will nearly treble the size of Glaxo's skincare business, giving it an 8 per cent share of the global prescription dermatology market. 20.7.09

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Swine Flu, Its all about the MONEY as Europe prepares for swine flu pandemic

Germany today followed moves by France and Britain to order vaccine stockpiles worth billions of euros to treat swine flu when the full-scale pandemic hits hard in the autumn, as is widely expected or claimed to do so.

But with the number of confirmed cases varying widely across Europe and no other country in the EU known to be even close to the rate of infection in Britain, vaccine plans are also vastly different and growing in controversy. The European Centre for Disease Prevention and Control in Stockholm said today that there were 15,774 confirmed cases of swine flu in the EU plus Norway, Switzerland, and Iceland, with two-thirds of those cases in Britain alone.

The UK is the only country in Europe with confirmed cases running to five figures. But why? "That's the million-dollar question," said a European Commission health official engaged in monitoring the crisis and European responses. However critics say the figures have been exagerated to bolst the need to order more vacine, making billions for the manufactures as the NHS was ordered this week to plan for a worst-case scenario in which swine flu might cause 65,000 deaths over the coming winter, including several thousand deaths among children.

Experts and public health officials say it is too early to conclude whether there are ethnic or genetic factors at play, and point to travel habits as a possible cause of the British leadership of the European swine flu league table, or is it just down to organised media hype to create panic?

Apart from Spain, whose close links with Mexico and Latin America may explain its four fatal cases of swine flu, there have been no more confirmed deaths from the disease in continental Europe. But 29 have died in Britain.

The confirmed cases in Europe range from 10,649 in Britain to five in Lithuania, according to the ECDC. Britain's nearest rival, Spain, has 1,222 confirmed cases.

But in Brussels and across the EU, authorities are braced for much bigger infection rates as the school year ends and the height of the mass tourist season looms. Germans are Europe's biggest tourists, and Frankfurt is one of the busiest air hubs in Europe, while France, Italy and Greece are some of the main magnets for mass tourism. "No one can tell how the virus will develop in the weeks ahead," Klaus Vater, the German health ministry spokesman, told journalists today.

As of this week, 11 of the 27 countries in the EU have given up trying to prevent swine flu in favour of "mitigation". "You can't preempt the outcome. It can't be contained. That's a fact," said the commission official. "They are not trying to contain the virus any more, just deal with it."

Amid fears that the pandemic will overwhelm public health, education, and economic infrastructures, a race between nations has started to secure the vaccines. It has the potential to turn nasty.

Up to 70% of the world's stocks of swine flu vaccine will be manufactured in Europe. The German order is for 50m doses, enough to treat around a quarter of the population. That is in line with the World Health Organisation's calls for moderation in stockpiling vaccines since there are not enough doses to go around.

Margaret Chan, the WHO director general, warned this week that poor countries would suffer as wealthier nations bought up the available treatments. But Britain has ordered 132m vaccine doses, enough for the entire population to be treated twice. This week France and Portugal announced similar procurement plans in the face of the WHO recommendations.

The European commission and other EU states are also keen to try to pool resources to help EU countries whose preparations have been inadequate. Britain, which sees itself as very well prepared, is resisting such efforts. But critics are quick to make clear, that swine flu will not kill any more people than normal seasonal flu, 'the situation has been made worse by exagerate media coverage, instigated by the pharmaceutical industry to create panic and sell more vacine' say some leading experts. 18.7.09

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Swine flu vaccine to net Glaxo £1.8bn

UK DRUG manufacturer GlaxoSmithKline is set to make more than £1.8 billion from its swine flu vaccine. A further nine countries have ordered the 96 million doses in the past month, pushing orders beyond 290m as governments prepare for a possible "flu season" in the autumn.

The first supplies will be distributed next month. Glaxo has earmarked 20 per cent of the vaccine output from its Canadian manufacturing unit for poorer countries.

Fellow drug maker Novartis has started trials on its own vaccine, while Sanofi-Aventis expects to follow within days. Some critics have suggested the drug companies were behind the media campaign to create hysteria over swine flu and hence the global need for the vaccine. 5.9.08

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How Russian breakthrough technology is being used to spot impending disease

Technology developed by the Russian KGB is being used to help diagnose and predict impending illnesses, a scientist said today. Russian-born consultant Alla Cranham has used the technique to develop the Health Detector, which measures impulses from the brain to pinpoint hidden weaknesses in other parts of the body. It can then identify potential problems in internal organs, bones and muscles, she said.

Mrs Cranham's Nottingham-based company In Vivo Health uses the technology to help patients across the country, and today she said she has successfully predicted ailments including skin cancer, sexually transmitted infections and cataracts. She said the Health Detector can find potential problems when the symptoms may not be picked up by conventional medicine.

'It is a successful early warning system for impending disease, which allows us to identify and treat ailments before symptoms become apparent,' she said. 'The Health Detector operates using the principles of Cybernetics, a scientific theory, which studies and maps control systems. 'It focuses on the way a system functions and how it self-controls and regulates.

'Cybernetic medicine assesses the function of body organs and can predict where problems are likely to occur. 'The brain is the centre of the human control system and it knows where weaknesses lie. 'The Health Detector picks up the signals from the brain and analyses them to produce a virtual scan of the whole body.

'Patients can then take action with a course of medication - usually natural - which will boost the affected area and correct the imbalance.' She said the Health Detector is portable and used in conjunction with a laptop. Patients see a display of the areas being examined on the screen, with a report on the condition of organs and systems.

Mrs Cranham compared it to a 'Virtual Bodytalk' system - the 'bodytalk' technique, widely used in Russia, sees a practitioner place his hand on a patient's body to 'diagnose' ailments. Mrs Cranham studied pharmaceutical chemistry in her native Russia and has since completed a Master's Degree in biomolecular sciences at Nottingham University.

She also studied at the Academy of Homotoxicology and Bioregulatory Medicine, and is a fellow of the Royal Society for Public Health, a member of the Biochemical Society and a lecturer at the Biomedic Foundation in London. She uses the Health Detector to treat patients across the country, including a clinic in London's Wimpole Street.

Today she added: 'Russians believe in treating the whole person - not just the areas which show symptoms and they are much more open to alternative therapies. 'The Health Detector is built on Russian technology, originally funded by the KGB and which is now being refined for use by the medical profession.' 17.6.09

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Take big Cabinet jobs away from politicians, urges business guru Lord Digby Jones

Incompetent politicians such as Labour's Jacqui Smith should not run major Whitehall departments, says a businessman who quit the Government earlier this year. Writing in today's Mail on Sunday, Lord Digby Jones calls for a massive shake-up in the way the country is run. He says the Prime Minister should be given US-style presidential powers to fill the Cabinet with top businessmen instead of ‘here today, gone tomorrow' politicians.

Lord Jones was one of five experts recruited by Gordon Brown to join his ‘Government of all the talents'. All but one have resigned in less than two years, with most of them frustrated by the stranglehold of Whitehall bureaucracy. The former CBI boss became a Trade Minister but says he was given too many trivial tasks to do instead of being allowed to focus on important issues. He also claims the Government would be more effective if experts like him took over from ‘enthusiastic amateur Cabinet Ministers and risk-averse civil servants'.

Under the system proposed by Lord Jones, politicians such as Ms Smith would be relegated to junior roles. And there would be more powerful Commons committees to keep a check on the new unelected supremos. His comments follow the candid admission by Ms Smith, who was a teacher before entering Parliament, that she felt overwhelmed by the scale of her task as Home Secretary.

Lord Jones says of Ms Smith: ‘With no training or experience, she had taken up the reins of the third great office of State and found herself in a system that is, to use her words, “frankly, pretty dysfunctional in the way it works”.' He added: ‘Expecting her to deliver in the post of Home Secretary without a scintilla of experience or training is not only unfair on her but damaging to us all.'

In addition, the Defence Secretary Bob Ainsworth suggested he was the victim of social prejudice because of his accent and moustache. Mr Ainsworth, who has faced heavy criticism for his performance in the job, admitted that he was not an intellectual. But the former factory worker from Coventry insisted he was qualified to run the Ministry of Defence but he also faced claims that he was over-promoted by Gordon Brown in the last reshuffle.

The top jobs in the land are often given to people who have no experience in running anything, they are placed in charge of huge departments with vast budgets but lack the commercial awareness to make the right decision, hence why so many government initiatives, awareness campaigns and policy's end in failure.

You must be mad!
That's how the Civil Service greeted Lord Digby Jones when he joined Gordon Brown's Government. Here he explains why he resigned, and why he agrees with Jacqui Smith that Britain's ministerial system is utterlybankrupt.

'You must be mad!' Those were the words of welcome from a very senior civil servant when I reported for duty on my first day two years ago as a Minister of State in Gordon Brown's new Government Of All The Talents – or GOATS as it became known. ‘I know you intend to do things differently round here,' he said, ‘but just remember you'll be gone in a couple of years while we all have careers to build and no one here is going to harm his or her career for the sake of this new idea.' Some welcome! But, as things swiftly revealed, so very true.

With the average length of service in ministerial jobs being 18 months, is it any wonder that our Civil Service runs the country with ‘here today and gone tomorrow Ministers' – merely ambitious, confused, frustrated, worried and overworked spectators at the feast? The crucial position of Secretary of State for Defence is now filled by its third incumbent in just two years, and we are so keen to make a difference in the national interest in Brussels that we are on our 11th different Europe Minister in 12 years. 

With the call from so many different quarters for radical change, we must use the impetus created by the MPs' expenses scandal to deliver a system of governing fit for purpose in a highly competitive, technically advanced, consumer-driven, delivery-focused 21st Century world.

Jacqui Smith, until recently Home Secretary, last week had the courage to speak out on the point. So did Estelle Morris when she stepped down as Education Secretary under Tony Blair six years ago. By her own admission, Ms Smith had never run a major organisation. Actually, as a former teacher from Redditch, she'd never run anything at all.  With no training or experience, she had taken up the reins of the third great Office of State and found herself in a system that is, to use her own words, ‘frankly, pretty dysfunctional in the way it works'.

Since becoming Prime Minister, Gordon Brown has done some things badly and some well. One thing he did recognise was that the current system of delivery of services did not work and he introduced his GOATS. By introducing specialists such as Alan West from the Royal Navy into Security, Ara Darzi from the surgeon's table into Health, Mark Malloch-Brown from the United Nations into the Foreign Office and me from the CBI into overseas trade and investment promotion, he was not only on to a good thing but he had the courage to face down his own party and other vested interests to do it.

The democratically elected Cabinet should formulate policy – but leave it to appointed specialists to implement.  But by last week there was only one GOAT left standing – Lord West at Defence. The rest of us had gone. We all had our own particular reasons, of course, but underlying them was that we were faced with the inability of the entire political system to change radically enough to accommodate a new way of working.

While I was head of the Confederation of British Industry, I found that very few Ministers understood business and that they would often cancel important overseas visits at the last minute, fearing that an absence from Westminster might damage their careers. No other major developed economy demands so much of their Ministers. All have constituencies and re-election to worry about. All have to deal with the highly centralised control-freakery of No10, something started by the Thatcher administration and happily continued by her successors.

So many of the Ministers I came into contact with saw the job mainly as a stepping stone to ‘greater things' in their political career advancement. ‘Greater things' meant moving on (and hopefully upwards) after a short while to another position for which they would be similarly unqualified in an increasingly specialised world. As a GOAT, I found there was a begrudging recognition in Whitehall and Westminster that we were personal appointments of the Prime Minister and that delivery was what we were all about. That was the theory. In practice, the system just went blithely on its own sweet Dickensian way.

People are kind enough to say I did the ‘business end' of the job quite well.  I made 45 separate overseas visits in 15 months promoting our nation around the world as no Trade Minister had done before. But the system still expected everything else that a Minister currently is expected to do, to be done on top of that. My Red Box was full every night, often with documents to sign that I had never seen before. I was expected to take responsibility for matters in which I had had absolutely no involvement.

I often refused. Of course, this caused no end of problems. I know many junior Ministers, in hope of preferment and advancement up the ministerial greasy pole, would have just crossed their fingers and signed. But that's the difference between an ambitious young politician and a specialist, experienced in other ways of life with no political career before or after him.

I was given the Energy Bill to steer through the Lords with its interminable and time- consuming committee work – so essential for the proper workings of Government but surely not the best use of a specialist's talents. I had absolutely no control over the actions of civil servants but was expected to take total, personal responsibility for them in the full glare of publicity. I know that my fellow GOATS had similar experiences, doing the job for which they were recruited extremely well but every day coming up against a system that had not adapted to meet the vision of the Prime Minister and the challenge of a changing world.

It cannot go on. We have to take a leaf out of America's book – or France's for that matter. Let us have senior Ministers who are skilled in the field in which they are asked to operate. Let us have fewer of them. India, with a billion people, has recently elected just 500 MPs to serve them. We have 675 to serve just 60million.

We already have personality politics. The electorate feel they elect the Prime Minister themselves, even though they don't. So we should give serious thought to borrowing elements of America's Presidential system. Parliament should enforce the will of the people and hold the executive to account. MPs should less slavishly follow the party whip and be more accountable to their constituents. Our democratically elected PM would appoint Ministers to deliver democratically formulated policy. But they could come from all walks of life and accountable to democratically elected and strengthened select committees.

They would be people who give several years to serving their country. They would have no axe to grind, no political career to worry about and not give a damn about who took the credit for what was achieved. The country badly needs change. We must seize this once-in-a-political-lifetime opportunity to bring our antiquated system into the 21st Century. Jacqui Smith is a good woman, trying to change the world for the better as she sees it. But expecting her to deliver in the post of Home Secretary without a scintilla of experience or training was not only unfair on her but damaging to us all.

Health, education, business, transport, defence and security are too important to be left any longer to enthusiastic amateurs and their honest and hard-working but risk-averse civil servants.  Our children are going to pick up a very expensive bill for our generation's actions. At least let us leave them with the tools to do the job. 19.7.09

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Incompetant Ministers - Jacqui Smith: I'd never run a thing before the Home Office

No training: Jacqui Smith revealed her inadequacies as Home Secretary. Jacqui Smith has admitted for the first time that she was not up to the job of Home Secretary. She said she was thrust into one of the biggest posts in Government without any training and called for MPs to receive help before they become ministers. She also suggested that any successes she had in her post were down to 'luck' rather than skill.

Her comments are sure to be used as ammunition by those who believe that too many of today's 'professional politicians' cannot run a department because they have little experience of management in the outside world.

Miss Smith left the Government in June after her tenure had been tarnished by a series of gaffes. In an interview with Total Politics magazine, Miss Smith said she had sleepless nights when she received her first junior ministerial job in 1999, when she joined the Education and Employment Department under David Blunkett. And when newly installed Prime Minister Gordon Brown shocked Westminster by making her the first female Home Secretary, she admitted she felt under-qualified. She said: 'I think we should have been better trained. I think there should have been more induction.

'When I became Home Secretary, I'd never run a major organisation. I hope I did a good job but if I did it was more by luck than by any kind of development of those skills.' Asked if she was worried she was not up to it, she said: 'Well, every single time that I was appointed to a ministerial job I thought that. I didn't sleep for a week in 1999 when I got my ministerial job.'

She added: 'If I ever describe the process of becoming a minister  -  moving from one ministerial job to another  -  to somebody in almost any other job outside, they think it is, frankly, pretty dysfunctional in the way that it works. 'I think there should be more emphasis given to supporting ministers more generally in terms of developing the skills needed to lead big departments.'

Before she quit, Miss Smith was widely tipped to be demoted anyway following her dismal period in charge of the Home Office, marked by a series of blunders, including saying she would not feel safe walking in Hackney at night. The former Home Secretary also faced strong criticism over her role in the arrest of Tory MP Damian Green in a leak inquiry, and when it emerged that one in five foreigners cleared to work in security jobs were illegal immigrants.

In March she was humiliated when it emerged she had used Commons expenses allowances to pay for her husband's porn films and a bathplug worth 88p. She told Total Politics the way to avoid expenses scandals in the future was to increase MPs' salaries massively and get rid of the allowances system.

Asked whether she sometimes thought 'why bother' during the lowest points of her tenure as Home Secretary, she said: 'Yes, in the middle of the night, most nights. If your reputation and family life and career were being dragged through the mud then you wouldn't be a human being if you didn't lose sleep over it.' She said sometimes she felt 'horrible'  -  especially during the furore over her husband's porn viewing. She said she had to go because every time she did an interview, she spent two thirds of it talking about expenses, rather than policy.

Miss Smith's comments echo those of Estelle Morris, who resigned in 2002 as Education Secretary after admitting she wasn't good enough for the Cabinet role, critics argue 'too many politicians are heading department but have no idea about the real issues at hand and are clearly out of their depth'. 17.6.09

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Ministers out of touch: Four out of five Britons want immigration capped, poll shows

Eight out of ten voters want a cap on immigration and say Alan Johnson is 'out of touch' with the public mood. The findings are revealed in two separate opinion polls which will set alarm bells ringing for the Home Secretary. Mr Johnson recently insisted he does not 'lie awake at night' worrying about the UK population soon reaching 70million.

But his stance is even at odds with voters in his own rock solid Labour constituency of Hull West and Hessle, where 80 per cent of people said both that he was out of step with their views, and that immigration was putting too much strain on public services. The polls were carried out by the pressure group Migrationwatch and by the Home Office itself.

The Ipsos Mori research for Mr Johnson's department found 81 per cent of Britons favour a cap on immigration  -  a policy which Mr Johnson explicitly rejected only a few days ago. The Migrationwatch poll, conducted by ORB , found 81 per cent of the public are worried about the prospect of the population reaching 70million in 2028, as predicted by Whitehall statisticians. It is currently 61million. Seventy- eight per cent say Alan Johnson is out of touch with people like them.

And 76 per cent want to see net immigration  -  the number of migrants entering the country minus the number leaving  -  cut from its present level of 237,000 a year to 50,000 or less. Of that 76 per cent, 32 per cent want to see a policy of 'one in, one out' while 22 per cent want to see no immigration at all. Broken down by party affiliation, 90 per cent of Conservative voters are worried about a population of 70 million. For Labour voters it was 70 per cent and for the Liberal Democrats 76 per cent.

In Mr Johnson's own constituency, 83 per cent of voters want to see net immigration reduced to 50,000 a year or less, and 78 per cent oppose his general attitude to immigration and population. Some 73 per cent are concerned that Britain is losing its identity and culture. Sir Andrew Green, chairman of Migrationwatch, said: 'The new Home Secretary and the Prime Minister are hopelessly out of touch with the mood of the nation on this issue. 'This is not just about a "cap" on immigration. It is about the future of our country.

'Failure to cut immigration back to the level of the early Nineties will result in our population going to 70, then 80million and beyond as immigration is the main driver of population growth. 'In many parts of Britain the public are seething with resentment at the total failure of the political class to take seriously their deep concerns about the impact of immigration on the future of our country.'

The Home Office's own research, released separately to the Migrationwatch poll, found that 64 per cent of adults believe 'laws on immigration should be much tougher', while another 9 per cent said immigration should be halted completely. Only 7 per cent favoured more relaxed immigration policies. While the economy has taken over as the biggest single concern facing adults in the UK  -  up from 4 to 54 per cent in the past 18 months  -  immigration remains a major issue.

In the Home Office study, 69 per cent described immigration as either a 'big problem' or a 'very big problem', listing the burden on public service and pressure on jobs as their main concerns. The Home Secretary caused astonishment last week when he told MPs he was relaxed about Britain's population rising from its current level of 61million to 70million in the next few years, claiming he 'did not lie awake' worrying about the prospect. He rejected setting an upper limit on the UK population, claiming any figure would be 'arbitrary' and would harm the economy.

And he accused those who argue that mass immigration has left more native Britons unemployed of using the same rhetoric of 'hate and division' as fascist leader Oswald Mosley. A Home Office spokesman said of the Migrationwatch poll: 'This survey tells us nothing  -  it is based on leading questions, and the Home Secretary's comments about Britain's population have been taken out of context.

'The Home Secretary made it very clear that he did not favour a cap on immigration because it is a crude measure which could harm the economy and is not as effective as the points-based system the Government introduced in 2008.' Critics have called it 'another failed government policy stacking up problems for the future because they lack the will or the motivation to deal them now'. 23.7.09

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Civil servant forced to lie by the government

A civil servant has broken ranks to reveal how he was forced to lie about the war in Iraq and Afghanistan. John Salisbury-Baker, 62, was working in the Ministry of Defence when he says he was ordered to deliberately mislead bereaved families and the public. He claims he was instructed to issue official statements through the media which were 'heavily spun' and clearly at odds with the reality.

Mr Salisbury-Baker was caught up with the huge political storm that has raged for years over the inadequacy of equipment and the safety of the controversial Snatch Land Rover which has been blamed for a series of soldiers' deaths. Only when the contradictory evidence was overwhelming did the official line from the MoD change, he claims.

Under the Official Secrets Act he is banned from speaking out for fear of prosecution and a possible jail sentence. But yesterday his partner spoke of his mental anguish and accused the Government of treating the British public like 'fools'. 'He was expected to lie for the MoD,' said Christine Brooke, 65. 'It was part of his job and a burden he simply couldn't bear. John tried to speak up but was swimming against the tide.'

In his role as a press officer for the MoD he often came into contact with the families of those soldiers killed in action. It was his duty to act as a 'media shield' - to provide the space for the family to grieve in peace - and to help with the arrangements for repatriation and their funerals.

But in doing so he struggled to cope with the moral dilemma, having previously lied at the behest of the MoD. 'He was plagued by the thought that some of them might have previously believed their loved ones were safe, because of what he himself had told the media,' said Mrs Brooke.

'He felt responsible and guilty. He felt he was having to defend the morally indefensible. 'The Snatch vehicles clearly did not give adequate protection from roadside bombs and yet here he was having to say they did.' She added: 'John cannot find it in his heart to forgive himself, let alone expect others to forgive him and this has torn him apart.' 

Mr Salisbury-Baker, whose stepson served in the Navy during the Falklands War, has since been diagnosed with post-traumatic stress disorder which he claims was brought on by the lies he was forced to peddle. He joined the MoD in 1996 as an information officer. By the time Britain invaded Iraq in 2003 he had been promoted to defence press officer, covering the Armed Services.

'Everything changed with Afghanistan and Iraq,' said Mrs Brooke. 'Put bluntly, he was expected to lie until the evidence was incontrovertible. These lies were centred around members of the Armed Forces being satisfactorily equipped to do their duty in Iraq and latterly Afghanistan.

'Sadly, most of the time they were ill-equipped to do their duty. This meant that when John attended military funerals and spoke with the families, he felt that he was being frugal with the truth. 'He wanted to say that many fatal situations were needless and could have been avoided if the correct equipment was provided to the individuals.' She said that when questions were first raised about troops being ill-equipped, Whitehall simply issued a statement denying any such thing.

It was only after the death of Sergeant Steve Roberts - the tank commander who was shot dead three days after being ordered to hand over his body armour to another unit because of shortages - that the official line was amended. The truth was that the Government had delayed for five months before buying life-saving body armour for UK soldiers in Iraq.

'John would hear from journalists and families on many occasions that equipment was not adequate,' said Mrs Brooke, a retired teacher. 'He was told there were shortcomings in the body armour and with the vehicles. 'But John would speak to superiors within the MoD, and they would again tell him that the equipment was adequate and again issue the same statement or amend it to say that new equipment was being ordered.

'When it came down to it, it was all about spin - never about the truth. 'It took a grieving widow fighting for justice or a soldier's death before they would even consider telling the truth, or going some way towards it. 'Even then it was simply respun, packaged up and sent out.'

In 2006, the MoD defended its use of the Snatch Land Rover in Afghanistan despite claims that it was wholly inadequate in protecting soldiers from roadside bombs. Armed Forces Minister Bob Ainsworth - now Defence Secretary - said other vehicles were 'not suitable for the task they were doing in the area in which they were required to work'. Mr Salisbury-Baker was again relied upon to push the official line that the Snatch Land Rover was an incredibly useful vehicle for entering the narrow streets run by the Taliban.

It was only after the death of intelligence officer Corporal Sarah Bryant in a Snatch Land Rover in June last year that the MoD amended its official line, adding that it had ordered replacement vehicles. Mrs Brooke said: 'John is an honest, sensitive and moral person, and he was having to peddle Government lies that soldiers in vehicles such as the Snatch Land Rovers were safe from roadside bombs, which made him very stressed indeed.'

He began to suffer from angina and has since been diagnosed with post-traumatic stress disorder. He went on sick leave in August 2007 and is on half-pay. He is now suing the MoD for disability discrimination, on the grounds that the stress of what he was being asked to do effectively made him disabled. He will attend an employment tribunal later this year.

A spokesman for the MoD said: 'It would be inappropriate to comment when proceedings are pending.'  5.8.09

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Cover-up denied after report claims MoD is squandering billions

Ministers today denied a cover-up after refusing to publish a report that lays bare billions of pounds of waste by the Ministry of Defence. It is said to have found £2.5billion is thrown away each year on bungled equipment contracts, from helicopters to aircraft carriers. The claim is hugely embarrassing because it comes after months of complaints from soldiers and their leaders that troops in Afghanistan were deprived of life-saving armoured vehicles and helicopters due to Whitehall penny-pinching.

It now appears that much greater sums were being squandered on poor handling of major contracts.

Gordon Brown 's office is said to have "panicked" over the findings and banned the MoD from carrying out a promise to publish it, according to a Defence official. The report was commissioned by former defence secretary John Hutton, who wanted to publish it before MPs' summer recess, and written by Bernard Gray, a former aide to ex-defence secretary Lord Robertson.

Among the "incompetent" decisions highlighted in the report is understood to be the construction delay of two aircraft carriers in December because the MoD had run out of money. Although it postponed the building cost, the ministry had to pay out £500million in compensation to manufacturers.

Another failure was the purchase of eight Chinook helicopters for special forces at a cost of £422million. They sat idle in hangars for eight years waiting for alterations and the MoD was eventually forced to obtain less sophisticated aircraft. According to Channel 4 News, Mr Gray warned that up to a third of the current MoD procurement projects were underfunded.

Defence Minister Kevan Jones denied suppressing the report and said its findings would be used for a wider review of procurement early next year. He said Mr Gray was "working very closely" with Defence Minister Lord Drayson to draw up new guidelines. "This is part of a three-stage process," he said. "The next stage, which Lord Drayson is leading together with Bernard Gray, is to see how we can actually get better value for money and better procurement."

Mr Jones said he did not recognise the £2.5billion figure and denied incompetence, but he admitted: "In terms of procurement, can we do it better? Yes we can."

Shadow defence secretary Liam Fox said the findings were a "damning indictment of 12 years of incompetence". He added: "The Government has a moral duty to ensure that our armed forces have the equipment they need for the war-fighting they are asked to do." 6.8.09

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'The medical myth of the chemical cure'

Taking a pill to treat depression is widely believed to work by reversing a chemical imbalance however this no medical test for a chemical imbalance and no evidence that such an imbalance exists. In this week's Scrubbing Up health column, Dr Joanna Moncrieff, of the department of mental health sciences at University College London, says they actually put people into "drug-induced states".

"If you've seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it". It's not just doctors that think this way, either. Magazines, newspapers, patients' organisations and internet sites have all publicised the idea that conditions like depression, anxiety, schizophrenia and bipolar disorder can be treated by drugs that help to rectify an underlying brain problem.

People with schizophrenia and other conditions are frequently told that they need to take psychiatric medication for the rest of their lives to stabilise their brain chemicals, just like a diabetic needs to take insulin. The trouble is there is little justification for this view of psychiatric drugs.

Altered states
First, although ideas like the serotonin theory of depression have been widely publicised, scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed. Second, it is often said the fact that drug treatment "works" proves there's an underlying biological deficiency. But there is another explanation for how psychiatric drugs affect people with emotional problems.

It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis. Psychoactive drugs make people feel different; they put people into an altered mental and physical state. They affect everyone, regardless of whether they have a mental disorder or not.

Therefore, an alternative way of understanding how psychiatric drugs affect people is to look at the psychoactive effects they produce. Drugs referred to as antipsychotics, for example, dampen down thoughts and emotions, which may be helpful in someone with psychosis. Drugs like Valium produce a state of relaxation and a pleasant drowsiness, which may reduce anxiety and agitation. Drugs labelled as "anti-depressants" come from many different chemical classes and produce a variety of effects.

Prior to the 1950s, the drugs that were used for mental health problems were thought of as psychoactive drugs, which produced mainly sedative effects.

'Informed choice'
Views about psychiatric drugs changed over the course of the 1950s and 1960s. They gradually came to be seen as being specific treatments for specific diseases, or "magic bullets", and their psychoactive effects were forgotten. However, this transformation was not based on any compelling evidence.

In my view it remains more plausible that they "work" by producing drug-induced states which then it makes sense to take the pill. If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing.

If you told people that we have no idea what is going on in their brain, but that they could take a drug that would make them feel different and might help to suppress their thoughts and feelings, then many people might choose to avoid taking drugs if they could. On the other hand, people who are severely disturbed or distressed might welcome these effects, at least for a time.

People need to make up their own minds about whether taking psychoactive drugs is a useful way to manage emotional problems. To do this responsibly, however, doctors and patients need much more information about the nature of psychiatric drugs and the effects they produce. 16.7.09

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Drug industry keen on new NHS trials ‘Innovation Pass'

Britain's drug industry has welcomed Government plans to trial new drugs ahead of approval by the regulatory body NICE as having the potential to deliver "a truly transformational change".

The Office for Life Sciences (OLS), led by Lord Drayson, is proposing an "Innovation Pass", which will make it easier for companies to get their products to market, especially those for illnesses that affect only a small number of people.

The three-year scheme will be piloted from 2010/2011 with a budget of £25m. It will see innovative drugs that have gone through the initial three phases of trial be used by the NHS before approval by the National Institute for Clinical Excellence (Nice), which decides what medicines the health service should purchase and for how much.

The proposals are part of a "Life Sciences Blueprint" designed to boost pharmaceutical groups and biotechnology companies. The scheme also includes a commitment to consider a "patent box" incentive, a lower rate of tax on profits derived from products with patents located in the UK.

Andrew Witty, the chief executive of GlaxoSmithKline, said: "Delivery of the 'patent box', the evolution of Nice and the NHS as catalysts for innovation, and the development of world-class life science clusters will be critical to the Blueprint's success."

Richard Barker, director-general of the Association of British Pharmaceutical Industry, said: "The OLS blueprint charts a course of action which is both sound and welcome. When the ship is steered safely home, it will deliver a transformational change for the life sciences industry in the UK." But critics have warned it could lead to dangerous drugs being tested on clients before the full extend of their side-effects has been established. Without such evidence, unsafe and ineffective drugs are being marketed and prescribed, and patients' health could be jeopardised. 17.7.09

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Breakthrough medicines to bypass NICE approval

Ministers have unveiled new plans aimed at giving the public better access to breakthrough medicines. The scheme, known as the ‘innovation pass', will make new medicines available to the public through the NHS for a limited period of time.

It will offer benefits for groups such as those in the late-stages of cancer, who could receive new treatment without having to face the lengthy appraisal process insisted on by NICE.

Health minister Lord Darzi, who has just announced his intention to resign, and science minister Lord Grayson unveiled the latest proposals as part of the Life Sciences Blueprint at the Imperial College London.

The Blueprint is intended to change the environment for life science companies to enable faster patient access to cutting-edge medicines and technologies.

Lord Grayson said it was important the life science industry becomes a real growth area in the country, adding: ‘It's one of our leading industries so we've spent the last six months working with the industry across government to identify what the problems are and what the solutions need to be to turn the situation around.' 15.7.09

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Pilot Scheme sees Arthritic knee pain eased with electrically charged needles

Electrically charged needles are being used to reduce the pain of arthritic knees. In a new U.S. trial, 180 men and women with chronic knee pain are having the treatment, known as periosteal stimulation. It follows results from a pilot study where pain levels were reduced by more than a third.

Periosteal therapy involves direct electrical stimulation of the periosteum. This is the membrane that covers the outer surface of all bones and which contains nerve fibres that cause pain when tissue is damaged. In the treatment, four very fine needles are placed in the periosteum and two in the adjacent soft tissue. Electricity is then passed through the needles for one minute. It's thought that the stimulation interferes with pain signals travelling between the knee and the brain. 13.7.09

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Can vitamin C injections help to beat shingles?

Injections of vitamin C are being used to treat the painful condition shingles. In a new German trial, patients are being given a dose of vitamin C intravenously. The theory is that the vitamin increases the body's production of interferon, an infection fighting protein. 

Shingles is a painful infection of the nerves and surrounding skin. It is caused by the varicella zoster virus, which also causes chickenpox.

Though people of any age can develop it, shingles is most common in the over-40s. Treatment usually involves repeated doses of antiviral medication or painkillers.

The researchers believe the vitamin C treatment will reduce symptoms within three days and lower the risk of complications such as postherpetic neuralgia, a debilitating condition resulting from nerve damage caused by the virus. 13.7.09 (linked article: Vitamin C jabs 'trigger fightback against cancer').

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We ALL have cancer

Mass screening for cancer is designed to detect abnormal cells the problem is we all have abnormal cells which develop naturally. A third of women diagnosed with breast cancer have gone through unnecessary treatments, a recent study revealed. Routine breast screening produces a high rate of 'false positives' - because it is not sensitive enough to detect which lumps will lead to dangerous cancers and which will not. This means that thousands of British women have been 'over-diagnosed' - forcing them to endure invasive and painful treatment such as needless mastectomies, surgery, chemotherapy and radiotherapy.

Cancerous cells are always being created in the body. It's an ongoing process that has gone on for eons. Consequently, there are parts of your immune system are designed to seek out and destroy cancer cells. Cancer has been around as long as mankind, but only in the second half of the 20th century did the number of cancer cases explode. Contributing to this explosion are the excessive amounts of toxins and pollutants we are exposed to, high stress lifestyles that deplete the immune system, poor quality junk food that's full of pesticides, irradiated and now genetically modified, pathogens, electromagnetic stress, lights, and just about everything that wasn't here 200 years ago. 

All these weaken the immune system, and alter the internal environment in the body to an environment that promotes the growth of cancer.

Cancer is not a mysterious disease that suddenly attacks you out of the blue, something that you can't do anything about. It has definite causes that you can correct if your body has enough time, and if you take action to change the internal environment to one that creates health, not cancer, while at the same time attacking cancerous cells and tumors by exploiting their weaknesses.

Cancer tumors begin when more cancerous cells are being created than an overworked, depleted immune system can destroy. Constant exposure to tens of thousands of manmade chemicals from birth onward, chlorinated and fluoridated water, electromagnetic radiation, pesticides and other toxins, leads to the creation of too many free radicals and excessive numbers of cancerous cells.

Alone this would be enough to raise cancer levels, but combined with an immune system weakened by a diet of refined and over processed food, mineral depleted soils, and too much exposure to artificial light at night, the immune system at some point no longer is able to keep cancer in check, and it starts to grow in your body.

Because of this stress and the overload of toxins, you end up with a malfunctioning immune system, and a body that is not capable of destroying the excessive numbers of cancerous cells that develop. Some, sooner or later, survive and multiply. And then you have cancer. Of course, our diets loaded with sugar and refined carbohydrates don't help. Refined carbohydrates digest so fast they act like sugar, and cancer cells love sugar. They have about 15 times more receptor cells for capturing sugar than healthy cells. Overcoming cancer is a process of reversing the conditions that allowed the cancer to develop, and going after and killing cancerous cells.

What The Medical Industry Won't Tell You About Treating Cancer
There was a woman whose daughter was in the advanced stages of brain cancer.  She asked her oncologist if it was ok to give her daughter a superfood called blue green algae. Her doctor told her that it was no problem, that in fact a number of his patients had used that supplement with success in fighting cancer. Naturally she wondered why he didn't tell her about this product a year before when they came to him.

Unfortunately, he couldn't tell her about this or any "natural or alternative health therapies" and stay employed.  Insurance regulations would preclude such suggestions.  And he could get into serious trouble by recommending natural, non-drug treatments for cancer. 

His advice is controlled by a large medical industry that makes billions off expensive cancer fighting drugs and treatments.  An industry that doesn't look favorably on natural supplements or other cancer treatments as they cannot patent them to make high profits.

Chemotherapy and other treatments damage cells and tear down and weaken the immune system. But the problem in the first place is that your immune system is already weak, and that your cells are already damaged. Even if tumors do go into remission, these treatments will have damaged other cells, which are more likely to turn cancerous. The immune system, unless it is supported by supplements and diet to help it recover, will be in worse shape then ever.

While it may have taken decades for cancer to develop the first time around, the second time usually takes a year or two. Another reason why doctors ignore sensible, safe and healthy treatments for cancer, and recommend costly and illogical treatments instead -- is human nature. They advise and prescribe what they know. Just what we all do. You go to them and you get what they know. You assume they will do the best they can for you, while in fact they only do what the system teaches them, promotes and allows them to do.

Every human experiences minor mutations in their DNA that may accumulate and end up with a cell multiplying uncontrollably. Sometimes certain viruses assist in causing the cells to multiply. These cells then form tumours, and they may be benign or they may be malignant. Those that are malignant are called cancers. Because of their uncontrolled growth, cancer cells can't be dormant in the sense that they are present but not multiplying.

However, every human, from time to time, may develop cells that would develop into a cancerous tumour. Under normal conditions, the body can destroy most of these cells before they are able to grow into a tumour. The tumour cells are abnormal, and the body's immune system can detect them and consider them as "foreign." The cellular immune system is the most important part of the immune system for this form of defence.

Sometimes the cancer cells are not detected properly by the immune system, or the immune system may not be working properly. In such cases, the cells do then grow into a tumour. It is not clear how often each human develops such abnormal cells, but it is likely that every human undergoes this process from time to time.

Human papillomavirus, the virus that causes warts, has many different types, and some of these types are able to cause cancers, especially cervix cancer. About 80% of sexually active women are eventually infected - so such cells are common. Cervix cancer cells often escape from the immune system and develop into cancer. The immune system can be stimulated by vaccination, which prevents the development of atypical cells by helping the body develop immunity against the virus.

Other vaccines that cause the immune system to respond directly to cancer cells are in the developmental stage, using proteins from tumour cells or killed tumour cells to provide the body with the foreign proteins to learn to identify and respond to. There are two kinds of laboratory mice or rats. One kind are inbred heavily so that they developed cancer spontaneously. The other had cancer injected into them and are cancerous. If the mice/rats had been injected with cancer a natural extracts did not work. BUT, if the cancer had been developed naturally, the extracts worked 100% of the time.

That was a major breakthrough. The perfection of the extract came about quickly at that point in time. It was called Laetrile, later it was called Vitamin B17. Because of the solid research by the now Dr. Kreb Jr. the formulations worked miracle after consistent miracle. At first they cured cancer by the dozen, then by the hundreds and later by the thousands.

If you will dig into the history of cancer, you will discover that a medical cancer system has been created so large that if a cure for cancer were applied today, some say it would be bigger then the recent banking collapse and within 6 months the total American economy would collapse; it is that much intertwined into the total economy, lets not forget the cancer markets are worth billions.

Therefore any cancer cure is a threat not only to the AMA and its membership doctors who do not decide policy, but also to the American government itself. Thusly the AMA and the FDA combines forces to stop all applications of cancer cures that affect more than a few people. 10.7.09

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Third of women with breast cancer 'don't need treatment'

A third of women diagnosed with breast cancer have gone through unnecessary treatments, a study revealed yesterday. Routine breast screening produces a high rate of 'false positives' - because it is not sensitive enough to detect which lumps will lead to dangerous cancers and which will not. This means that thousands of British women have been 'over-diagnosed' - forcing them to endure invasive and painful treatment such as needless mastectomies, surgery, chemotherapy and radiotherapy.

The study showed that in more than a third of cases, lumps which were flagged up as a cause for alarm were harmless - either because the tumour was growing so slowly that the patient would have died of other causes before it produced any symptoms, or because the cancer remained dormant or even regressed.

In an editorial accompanying the research, H Gilbert Welch, professor of medicine at the Dartmouth Institute in the U.S., said that women needed to be aware of the risks, as well as the benefits, of cancer screening. 'Mammography is one of medicine's "close calls" - a delicate balance between benefits and harms - where different people in the same situation might reasonably make different choices,' he said. 'Mammography undoubtedly helps some women, but hurts others. No right answer exists, instead it is a personal choice.'

Cancer charities were keen last night to stress that routine screening is estimated to save 1,400 lives every year in England alone. All women from 50 to 70 are invited to the checks every three years. Across the UK, more than 45,000 women are diagnosed with breast cancer every year and 12,000 die.

Scientists from the Nordic Cochrane Centre, who carried out the study, analysed breast cancer trends seven years before and seven years after the introduction of screening programmes in five countries - the UK, Canada, Australia, Sweden and Norway. Taking into account other factors, such as changes in background levels of breast cancer, they estimated the level of overdiagnosis as 35 per cent.

Writing in the British Medical Journal, the study's authors said: 'Screening for cancer may lead to earlier detection of lethal cancers but also detects harmless ones that will not cause death or symptoms. 'The detection of such cancers... can only be harmful to those who experience it.'

They said that perhaps doctors doing the screening should request biopsies only for breast masses larger than a certain size. Dr Sarah Cant, from Breakthrough Breast Cancer, said: 'We hope this research will not discourage women from attending breast screening. 'Unfortunately, it is currently not possible to predict which cancers found through screening will develop aggressively and which will grow very slowly. 'Based on all the current evidence, we believe the benefits of detecting breast cancer early still outweigh the risks.' 

But good news, death rates at new low
The British death rate from three of the most common cancers has fallen to its lowest level in almost 40 years, research has shown. The toll from breast, bowel, and male lung cancer is at its lowest since 1971, an analysis by Cancer Research UK found. This means Britain could be at last turning the tide on its appalling record of cancer survival compared with the rest of Europe.

The UK has the worst cancer record in Western Europe. Its survival rates are on a par with Poland and the Czech Republic, even though these countries spend two-thirds less on cancer treatment. Critics have claimed the UK's poor showing proves that the vast amount of extra funding poured into the NHS by Labour has been wasted - although ministers say the new figures should be a cause for optimism.

Breast cancer deaths among women peaked in 1989 at 15,625 but dropped to 11,990 in 2007, according to the data. Bowel cancer deaths among both sexes peaked in 1992 at 19,598, but fell to 16,007 in 2007. Meanwhile, the number of men dying from lung cancer peaked in 1979 at 30,391 but dropped to 19,637 in 2007.

The number of people developing cancer is on the rise as we live longer than ever before. But fewer people are dying from the disease - partly due to improved screening and new and better treatments. 11.7.09

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Cervical smear surgery 'given needlessly' to women with borderline results

Hundreds of women may undergo unnecessary surgery after cervical smear tests, it has emerged. Many women with borderline results are given invasive treatment which increases their chances of suffering complications in future pregnancies. A study in the British Medical Journal found many of these treatments are entirely pointless, as there may be no tumour, or it may so small that it would disappear naturally.

Some 2,700 women are diagnosed with cervical cancer every year, and around 1,000 die. The NHS screens women aged 25 and above for signs of pre-cancerous cells that may develop into tumours. It claims screening saves around 4,500 lives a year.

Many women with positive results are referred for a procedure known as a 'colposcopy' to carry out a more detailed investigation. In many cases lesions are found, and the patients are sent for an operation to remove abnormal tissue - even though it may not be cancerous.

Some doctors argue the operation should only happen if a biopsy proves it is cancerous. The BMJ research found that for those whose tests reveal only mild changes or borderline results, invasive treatment can do more harm than good.

The study concluded that while the colposcopy detected more serious lesions (known as cervical intraepithelial neoplasia or CIN) it could lead to overtreatment, because they could sometimes return to normal of their own accord. The study of more than 4,000 British women aged 20-59 whose results showed borderline or mild abnormalities also revealed a higher rate of after-effects. These included pain, bleeding and complications in later pregnancies.

The study's authors stated: 'We conclude that there is no clear benefit of a policy of immediate colposcopy as although it detects more CIN grade II or more severe disease, it leads to a large number of referrals with no high-grade CIN, overtreatment with associated after effects in young women, and no clear psychological benefit.' 30.7.09

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Harriet Harman defends £5.9m bid to cut teen pregnancies

Commons leader Harriet Harman today defended a £5.9 million Government drive to help cut pregnancies among disadvantaged teenagers which actually saw the numbers double. Ms Harman said the the Young People's Development Programme (YPDP), which ran in 27 parts of England between 2004 and 2007, was merely a pilot. 'There was no "dishonour" in experimenting with different solutions to the "complex" problem of teenage sex and pregnancy, she told MPs.

"This was a pilot scheme and the point is it was an experiment that was tried out. That is the whole point of a pilot scheme - to find out if something works.

"There is no dishonour in piloting something to see whether it works and if it doesn't work then acknowledging it and trying to press on and find out what does work."

She was responding to shadow Commons leader Alan Duncan who said: "This is a sad indictment of the Government's failure to develop a coherent strategy."

The YPDP was based on a similar model in New York and was designed to offer education and support for 13 to 15-year-olds deemed at risk of exclusion from school, drug abuse and teenage pregnancy. A total of 2,371 teenagers took part in the programme at a cost of £2,500 each, but the latest research shows the young women who attended were "significantly" more likely to fall pregnant.

A total of 16 per cent of the YPDP group fell pregnant compared with 6% in the other group, which was a youth programme not receiving YPDP funds. During questions on future Commons business Mr Duncan said: "The fact is that Britain has the highest rate of teenage pregnancy in Europe, more and more young girls are seeking an abortion and the higher rate of sexual activity is leading to an alarming increase in sexually-transmitted infections among teenagers."

Ms Harman said everyone wanted to see a fall in the number of teenage pregnancies, adding: "This is to do with good sex education, this is to do with contraception, this is to do with girls having aspirations for something beyond an early pregnancy...it also involves responsibility on boys as well. 10.7.09

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Awareness campaigns don't work as £6m drive to cut teen pregnancies sees them DOUBLE

A multi-million pound initiative to reduce teenage pregnancies more than doubled the number of girls conceiving. The Government-backed scheme tried to persuade teenage girls not to get pregnant by handing out condoms and teaching them about sex. But research funded by the Department of Health shows that young women who attended the programme, at a cost of £2,500 each, were 'significantly' more likely to become pregnant than those on other youth programmes who were not given contraception and sex advice.

Critics argued all along the scheme would fail due to 'cross contamination' and educatiing people about such issues as sex or drugs breeds familirity and those on the course are therefore more likly to 'try it' as opposed to those who know very little about it.

A total of 16 per cent of those on the Young People's Development Programme conceived compared with just 6 per cent in other programmes. Experts said the scheme failed because it introduced girls 'at risk' of becoming pregnant to promiscuous girls they might not otherwise have met. Because of peer pressure, the more timid teenagers were more likely to have sex and become pregnant.

The £5.9million YPDP programme was also designed to slash cannabis use and drunkenness among teenagers, but made no difference whatsoever, critics say 'awarness campaings simply do not work and have the effect of encouraging usage not stopping it'.

Last night ministers pledged to drop the scheme after admitting it had failed. Around 40,000 teenage girls become pregnant every year in the UK, the highest level in western Europe. The failed YPDP, launched in 2004, was based on a similar scheme in New York claimed to have significantly reduced teenage pregnancies.

However, attempts to replicate the work elsewhere in the U.S. did not lead to a fall in teenage pregnancies, casting doubt on the project as a whole. In England, 2,371 teenagers took part in the programme over three years. They were nominated by social workers, teachers or NHS staff who thought they were at risk of school exclusion, drug abuse and pregnancy.

The study, published online by the British Medical Journal, was carried out by Meg Wiggins, from the Institute of Education at the University of London and Chris Bonell, from the London School of Hygiene and Tropical Medicine. They were commissioned by the Department of Health to evaluate the programme independently.

They concluded that 'at best, the programme had no impact - and at worst it had a negative impact'. A Department of Health spokesman said: 'This pilot was based on a successful American programme. It did not appear to reduce teenage pregnancy so we will not be taking it any further.'

Case study - Lucy Lanelly
By the time she reached the age of consent, Lucy Lanelly had become pregnant four times. And on each occasion the teenager from Toll Bar, South Yorkshire, had an abortion. Now 19, she became pregnant at 12 after a single encounter with a 15-year-old boy. She was then given a three-month contraceptive jab but failed to get another one.

The following year Lucy became pregnant by a 19-year-old man at a party. Her third pregnancy was by a 15-year-old boy who said he was infertile. The last pregnancy was by her boyfriend Jack, 20, when a condom failed. Lucy said: 'I don't regret having the terminations because I was too young to have a baby, but I do regret having sex when I wasn't mature enough to deal with it.' 8.7.06

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£150m childcare pilot scheme for two-year-olds is a flop

Labour's scheme to offer free childcare places to two-year-olds has been an expensive flop, a Government-backed report has revealed. Attending nurseries, playgroups and childminders has not significantly improved youngsters' mental and social development. The news is a blow for the Government, which is putting increasing pressure on new mothers to return to work as soon as possible.

In an £18million pilot that ran from 2006 to 2008, 13,500 disadvantaged two-year-olds received 71⁄2 hours of early years education a week. It was designed to improve their confidence, independence, verbal skills, reasoning and their relationship with their parents.

Despite the report's findings, the Government plans to extend the scheme from September to 23,000 of the most disadvantaged two-year-olds, who will get 15 hours free childcare a week, costing £137million. To assess the pilot, researchers for the Department for Children, Schools and Families monitored youngsters' abilities at the age of two and then again a year later.

The study concluded: ‘The pilot did not significantly improve children's cognitive or social development, their parent-child relationship or home learning environment.' It found that four-fifths of the childcare was not good enough, which had undermined the study. Jill Kirby, of the Centre for Policy Studies think tank, said: ‘Two-year-olds benefit most from parental attention. ‘Government policy should be focused on supporting mothers who need or want to be with their young children.'

A spokesman for the Department for Children, Schools and Families said: ‘We strongly refute claims that early education for two-year-olds has no impact.' 31.7.09

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Failed awareness campaign - Stabbing deaths rise during high-profile £12million anti-knife campaign

A high-profile Government drive to reduce knife crime has seen an increase in the number of fatal stabbings in the worst affected inner city areas. Former Home Secretary Jacqui Smith launched the Tackling Knives Action Programme in ten police force areas last July, as public concern mounted over a string of murders, many involving teenagers.

But despite the expenditure of £12million of taxpayers' money, the number of people over the age of 20 murdered in those areas in the following nine months rose to 103, compared with 96 in the equivalent period a year earlier. Among under-20s the number of fatal stabbings was unchanged at 23.

The failure to curb knife killings prompted opposition MPs to claim that the Government was 'failing to get to grips' with knife crime. They blamed soft sentencing policies. The Home Office insisted the TKAP initiative was showing beneficial results, with a 16.6 per cent reduction in knife-related violence among under-20s - the main target of the programme - even though murders were not reduced. Police chiefs warned that changing attitudes towards knife crime was like 'turning the proverbial oil tanker' and could take generations.

The TKAP programme is to be expanded, with a further £5million available for 16 police forces, focusing on trying to reduce serious violence among 13 to 24-year-olds. Money has been spent on metal detector arches and metal-detecting 'wands', advertising campaigns and school patrols.

The initiative was originally introduced to reduce knife carrying and stabbings involving teenagers in London, Greater Manchester, Lancashire, Merseyside, Nottinghamshire, South Wales, Thames Valley, West Midlands, West Yorkshire and Essex. Seven of the forces recorded falls in teen knife crime but three - Thames Valley, Nottinghamshire and Greater Manchester - saw a rise.

Warwickshire Chief Constable Keith Bristow, who oversees the programme, said 'public angst' over knife crime was understandable. 'In any crime reduction approach the first thing to do is arrest the increase and turn that cycle around,' he said. 'We're starting to see some very promising signs in the reduction of homicides involving young people. 'This is a long journey. Success when you're dealing with these sort of problems might be measured in generations, not weeks or months.'

Shadow Home Secretary Chris Grayling said: 'The Government has completely failed to get to grips with knife crime. 'With just one person receiving the maximum sentence for knife crime it's little wonder that these figures are so bad.'

Last week, crime figures showed that more than 100 people per day were victims of serious violent or sexual assaults involving knives last year - far more than previous official figures have revealed. Officials insisted an apparent 50 per cent year-on-year increase to 38,000 offences was due to a change in counting rules. 22.7.09

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NHS recommends pupils have an 'orgasm a day' to reduce risk of heart attack and stroke

The NHS is telling pupils they have a 'right' to an enjoyable sex life in a leaflet being sent to schools. It encourages them to consider an 'orgasm a day' as a way reduce the risk of heart attacks and stroke. And if they can't get sex, the leaflet says children should consider masturbation.

The advice appears in guidance circulated to parents, teachers and youth workers. It says experts have for too long concentrated on the need for 'safe sex' and loving relationships - while ignoring the main reason people have sex, for enjoyment. But family groups condemned the guidance last night, saying it would encourage children to have underage sex and could lead to rising rates of sexually-transmitted diseases.

Around 40,000 teenage girls fall pregnant every year in the UK - the highest level in western Europe. More than half end up in abortion. The leaflet has come to light just a week after it emerged that a £6million initiative to reduce teenage pregnancies more than doubled the number of girls conceiving.

The Government-backed scheme tried to persuade teenage girls not to get pregnant by handing out condoms and teaching them about sex. But a study in the British Medical Journal found girls on the scheme were 'significantly' more likely to fall pregnant than other girls. Now criticism is focused on the new leaflet, entitled Pleasure, which has been drawn up by Sheffield primary care trust.

Under the heading 'an orgasm a day keeps the doctor away', it says: 'Health promotion experts advocate five portions of fruit and veg a day and 30 minutes physical activity three times a week. 'What about sex or masturbation twice a week?' Author Steve Slack, director of the Centre for HIV and Sexual Health and NHS Sheffield, denied the document promoted underage sex. He said it could encourage young people to delay losing their virginity until they are sure they will enjoy the experience.

Mr Slack added that as long as teenagers are fully informed about sex and are making decisions free of peer pressure and as part of a caring relationship, they have as much right as an adult to a good sex life. But Anthony Seldon, master of Wellington College, Berkshire, who introduced classes in emotional wellbeing at the public school, said the approach was 'deplorable'.

And Dr Trevor Stammers of the pressure group Family and Youth Concern said the leaflet would encourage children into risky behaviour, which could result in them catching sexually transmitted diseases. 'If you look at the people who come into my surgery, it's the orgasm that got them there - not kept them away,' he said. 'It is unbelievable that this is being sent to schools. 'I'd like to know what scientific evidence there is to back this up. There are an awful lot of overpaid and underoccupied health promotion officers around who are obsessed with sex.

'This leaflet encourages the idea that there is nothing more to sex than pleasure, and inciting underage sex is doing nothing less than encouraging child abuse. 'If the NHS wants to promote a healthy heart, as it says it does in this leaflet, it should put the money into reducing smoking and alcohol - which cause far more cardiac damage than encouraging people to have sex. 'The strapline I'd have is - sex is an adult activity. Underage sex is as dangerous as underage drink and usually leads to sexual ill-health.'

Two years ago a charity said masturbation techniques should be taught to children in sex education classes. The Family Planning Association suggested that pupils should be shown explicit videos of masturbation at school - but family values campaigners said the proposal was nothing more than the promotion of pornography. 12.7.09