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BMA campaign to shut out independent sector from NHS is misguided and foolhardy

The BMA today extend their ‘Look After Our NHS' campaign, to stop commercially run firms providing NHS care and end the market in the NHS, to patients.

Leaflets will be distributed containing stories such as a 70-year-old lady who is forced to go to a treatment centre run by a private provider and suffers ‘complications'. The BMA are shamelessly politicising health care on cherry-picked evidence.

The BMA states:

ON BUREAUCRACY
The creation of a market in the NHS has meant an increase in bureaucracy; the number of senior managers in the NHS rose by 91% between 1995 and 2008 – more than double the increase in numbers of doctors and nurses.

The market has increased transaction costs, but a large part of the increase in senior managers is due to: The NHS having historically low (and inadequate) levels of managers vis-à-vis other health systems.

The sheer amount of paperwork demanded by the government and numerous regulators to satisfy central requirements.

ON ISTCs
Many private NHS providers have received millions in guaranteed payments for contracts, despite treating fewer patients than planned; on average, the first wave of Independent Sector Treatment Centres delivered just 85% of activity paid for – suggesting a shortfall of £220 million on the £1.47 billion contracts.

This is true.  But what is not quantified is:

The fact quality of care is typically higher in ISTCs than the NHS.  For example, the Healthcare Commission found length of stay and rates of readmission to hospital to be consistently and significantly lower in ISTCs than the national average; and patient satisfaction rates to be significantly higher.

The impact of ISTCs on NHS providers.  There is mounting evidence to suggest ISTCs caused NHS providers to drive performance in a way that would not have happened without a competitive threat, such as in  Plymouth NHS Trust from the Peninsula ISTC; in  Southampton University Hospitals Trust from the Southampton ISTC; and in  Yeovil NHS Foundation Trust from Shepton Mallet ISTC.

ON GP-LED HEALTH CENTRES
New ‘GP-led health centres' have been costly, enjoying on average three times the funding per patient of regular GP practices, despite in some cases very few patients registering with them.

The new GP-led health centres were demanded of Primary Care Trusts by the Department of Health.  They were a central initiative and not a market response.  What they did do was address the fact that access to GPs is disproportionately better in more affluent areas.

ON PFI
The Private Finance Initiative is now funding over 100 new hospital schemes, valued at £10.9 billion, but set to cost the taxpayer £62.6 billion by the time the final payments are made in 2048.

PFI deals reflect more the weakness of public sector procurement and lack of trust on the part of the public sector towards the private sector, than a flawed model per se .  The contracts negotiated are inflexible.  Many facilities built are inappropriate and governed by rigid rules that make adaptation to 21 st century models of health care incredibly difficult.

… A CHOICE
The NHS is facing a choice.  The best estimates are that with zero real growth –which looks likely – the NHS will face a shortfall of £20 billion by 2013/14, rising to £38 billion by 2016/17 vis-à-vis need. Productivity improvements are needed on a scale never seen in the NHS's 62-year history.

The NHS can take the BMA's route and close its doors to the independent sector, or it can harness the sectors' expertise (and the voluntary sector's) by breaking down barriers to entry.  The latter is the optimum course:

NHS productivity has declined by 4% between 1997-2007, whereas average private sector productivity increased by 23% in the same period.

The liberalisation of other industries is indicative.  Regulatory reforms that introduced competition into UK electricity, gas and water industries resulted in ‘phenomenal rates' of productivity growth of over 10 per cent per annum across the 1990s.

… OUT OF TOUCH
The BMA are out of touch with the public and trying to protect their own from radical changes that will be required:

The number of patients now choosing to go to independent sector providers at the point of referral has increased from 8,928 (2.3% of Choose and Book referrals) to 26,733 (5.5%) between April 2008 and September 2009.  They do not seem concerned by ‘profiteering'.

In a nationally-representative survey of 2,001 people commissioned by the NHS Partners Network:

• 74% said the NHS needed ‘to change to survive'; and
• 74% more closely align themselves with the statement ‘I don't mind who owns or runs my NHS services so long as the quality is right' than ‘Services on the NHS should only be conducted in a hospital or other medical facilities run and owned by the government'. 23.7.10

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BMA launches public campaign against NHS commercialisation

The public is being urged to join the BMA's ‘ Look After our NHS' campaign against the role of commercial companies providing NHS care in England.

Successive government policies have created a market in healthcare and allowed commercially run firms to compete against existing NHS trusts and GP practices to provide NHS care. The BMA is concerned that this is having an adverse impact on many parts of the NHS in England.

The BMA's ‘Look After our NHS' campaign website has been revamped from today (Friday 12 February, 2010) , so that members of the public can show their support for an NHS which is publicly funded and publicly provided.

And next week (from Monday 15 February, 2010 ) the BMA is sending ‘ Look After our NHS' campaign packs to each of its members in England - over 100,000 doctors and medical students. The packs contain posters picturing businessmen taking money out of the NHS, and call on the public to “help us put patients before profits.”

Leaflets for patients, warning them that “your local GP practice, hospital or community health service could be run by a commercial, profit-driven company in the future”, will also be distributed via GP practices and BMA representatives in hospitals.

Dr Hamish Meldrum, Chairman of Council at the BMA, says:

“We want an NHS with patients, not profits, at its heart. The public values the NHS as a publicly provided, publicly funded service. Like doctors, they do not want vital funding to be diverted to shareholders.

“NHS staff see on a daily basis the waste of taxpayers' money caused by this fixation with market ideology. Particularly as the public purse strings tighten, it is crucial that public money is no longer wasted on expensive commercial experiments.

“Doctors have already backed the campaign. Now members of the public can show politicians the extent of opposition to commercialisation of their NHS.”

The campaign packs for doctors contain a brochure warning of the impact market-based reforms are having on the NHS. It states that:

The creation of a market in the NHS has meant an increase in bureaucracy; the number of senior managers in the NHS rose by 91% between 1995 and 2008 - more than double the increase in numbers of doctors and nurses

Many private NHS providers have received millions in guaranteed payments for contracts, despite treating fewer patients than planned; on average, the first wave of Independent Sector Treatment Centres delivered just 85% of activity paid for - suggesting a shortfall of £220 million on the £1.47 billion contracts

New ‘GP-led health centres' have been costly, enjoying on average three times the funding per patient of regular GP practices, despite in some cases very few patients registering with them. Every eight cases diverted to an Independent Sector treatment centre costs the taxpayer the equivalent of almost ten cases dealt with by the NHS

The Private Finance Initiative is now funding over 100 new hospital schemes, valued at £10.9 billion, but set to cost the taxpayer £62.6 billion by the time the final payments are made in 2048. 12.7.10

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A 'special needs' label on fifth of all children - double that of 20 years ago

Soaring numbers of young children are being diagnosed with special needs, including speech and behaviour problems, new figures show. Schools and nurseries are registering nearly 20 per cent more under-fives with special needs than just two years ago.

The trend will fuel concerns that teachers and parents are 'overlabelling' children and attributing medical conditions to normal antisocial traits or below-average performance. Figures show that 31,350 youngsters aged between two and four were assessed by schools or nurseries as having special needs in 2010 - up 19 per cent from two years ago.

An additional 8,280 were diagnosed by a multi-agency team as requiring a formal 'statement' of need, a legal document outlining the support they are entitled to. This marks an 8 per cent rise on 7,700 in 2008. Overall, a fifth of youngsters aged 16 or under are classified as having special educational needs at school, almost double the proportion diagnosed 20 years ago.

The statistics follow a warning from Philippa Stobbs, a senior Government adviser and expert on special needs, that schools are 'over-labelling' special needs to cheat league tables and attract more funding. Schools had a 'perverse incentive' to register children as having special needs even though they might simply be falling behind in their education, she said.

A school with high numbers of special needs pupils could be seen to be making more progress than projected by its overall exam results. They would shine in so-called 'value added' tables - which show a measure of pupils' progress - despite average or poor results overall. 'I don't think it's very helpful to infer that children behind in their learning have SEN [special educational needs],' said Miss Stobbs. 'They are only working below the standards they should be achieving. 'Teachers need to sidestep the label and look at children's progress in a more responsible way, using their age and prior attainment.'

Miss Stobbs warned that some children were effectively 'parked in a lay-by while others motor on past' because their achievement was hampered by the special needs label. Government officials have insisted the increasing incidence of special needs is to be expected since schools are more efficient at identifying emerging problems early.

But it has also been claimed that doctors, teachers and parents are too keen to pin medical labels - such as Attention Deficit Hyperactivity Disorder - on what might previously have been branded poor discipline. Dr Gwynedd Lloyd, an education researcher at the University of Edinburgh , said: 'You can't do a blood test to check whether you've got ADHD - it's diagnosed through a behavioural checklist. 'Getting out of your seat and running about is an example - half the kids in a school could qualify under that criterion.'

Critics have said 'the schools have a financial incentive to label kids as special needs and a lot of parents can't wait to have them classified with conditions such as ADHD because they'll get extra tax credits for having a "disabled" child. A lot of these children are just undisciplined and allowed to do anything they want'.

Experts have also warned that a growing culture of entertaining children with TVs and computer games may be contributing to language and attention problems. Department for Education figures show that the number of under-fives considered to need extra help with speech and language has risen to 17,940 - up from 14,710 in 2008.

The statistics also show that boys are almost twice as likely as girls to be registered as having special needs. In primary schools, 13.5 per cent of girls have special needs not considered to need a statement, compared with 23.4 per cent of boys. 22.7.10

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BMA urges GPs to use new powers to 'strangle' provider competition and restrict patient choice

The chairman of the British Medical Association trade union has written to GPs encouraging them to use their commissioning powers to freeze the independent sector out of the NHS by wherever possible to ensure that NHS providers, rather than private or voluntary sector ones, are “the providers of choice” regardless of their treatment outcomes.

Laurence Buckman said the reforms set out by health secretary represented a “potentially huge opportunity for GPs”, but he also said the developments represented a “major threat both to the current form of general practice and even to the NHS as a public service”. To mitigate this, Buckman urged colleagues to refer patients to NHS providers, rather than private or voluntary sector operators whenever possible, which would maintain their 'monoploy' and protect their own payment and profits with some GP's earning up to £500,000 per annum from the NHS while new evidence has suggested that more than 2,000 doctors and dentists are under investigation for tax evasion.

NHS fraud is also costing the tax payer £3billion a year, with millions being paid to NHS doctors and dentists who ‘invent' shifts and fake treatments. A dentist conned the NHS out of £1.4million with thousands of false claims – including fitting false teeth on patients who were actually dead. Joyce Trail filed more than 7,000 invoices for work she had never done and used the money to travel around the world.

Hamish Meldrum, chairman of the BMA council, said this would effectively allow GPs to “bypass if not ignore” the government's attempts to introduce competition into the health service.

'This is real hypocrisy' said one critic as 'GP's are already 'private businesses' with NHS contracts, they have a monopoly position within the NHS and don't want any competition. They want all private businesses excluded except themselves'. GP's receive cash bonuses for making referrals to other NHS services however the scheme has been criticised for wasting billions of pounds for the tax-payer while doing nothing to improve patient health.

The BMA extend their ‘Look After Our NHS' campaign, to stop commercially run firms providing NHS care and end the market in the NHS, to patients.

Leaflets will be distributed containing stories such as a 70-year-old lady who is forced to go to a treatment centre run by a private provider and suffers ‘complications'. The BMA are shamelessly politicising health care on cherry-picked evidence.

But critics have said ‘Mr Buckman has stepped outside his authority and his actions highlight exactly why true patient choice is needed as NHS treatment services are not always the best option, with the best treatment outcomes. Mr Buckman is ignoring the needs of the patient to serve his own ends. This has been the problem with the health service for many years, the medical profession abuse their power and block patients access to other [better] treatments to protect their own existence, ignoring the needs of the patient. Mr Buckman should be forced to step down, his views are out of touch, out of date and not in the spirit of reforming the NHS to serve the patient'.

Legal experts said 'not only is it unethical to deny patients access to successful treatment, it is also unlawful to discriminate against treatments on the basis of safeguarding NHS services'. Critics argue 'the NHS has become more not less protectionist, keeping patients within its own control rather than referring them to more successful or cost-effective treatment specialists'.

In a nationally-representative survey of 2,001 people commissioned by the NHS Partners Network:

• 74% said the NHS needed ‘to change to survive'; and
• 74% more closely align themselves with the statement ‘I don't mind who owns or runs my NHS services so long as the quality is right' than ‘Services on the NHS should only be conducted in a hospital or other medical facilities run and owned by the government'

Critics have accused GP's and PCT's of 'protectionism' while one expert said, 'the BMA has been blocking patients access to treatment [complementary] for many years, this is nothing new, what is new is now they are being quite blatant about it, they can not pick and chose the legislation they wish to implement, clearly something needs to be done to break their monopoly in the interests of patient choice and getting innovation into the NHS'. 21.7.10

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NHS shake-up grants new powers to doctors and patients

Patients and family doctors are to be given a central role in the NHS as the Government unveiled plans for the biggest NHS shake-up in decades. GPs are to be handed £80bn of the NHS budget to buy care from hospitals and other doctors for patients in their area, as hundreds of middle-management organisations are swept away.

Family doctors will be responsible, in consortiums, for commissioning the care for patients in their area by buying treatment from hospitals, charities and other doctors. The consortiums will be answerable to an independent Commission Board which will set objectives for healthcare, monitor performance and guide doctors in purchasing care.

Patients, meanwhile, are to be given a wider choice on where to be treated and they will be asked if their care was effective and lived up to their expectations. A raft of new information will be published giving greater detail than ever before on the quality of clinical care in hospitals, down to individual consultant teams, to help patients choose where to be treated and drive up standards.

Under the new Coalition government's health white paper, ministers will step back from the day-to-day running of the health service and hand power to the front line. Andrew Lansley, Health Secretary, said the white paper represented a "vision based on the principles of freedom, fairness and responsibility".

However, there was immediate criticism from Labour and the unions, saying handing £80bn to GPs who are private contractors was a mistake and that the plan was a 'Trojan horse' for widespread privatisation. The document entitled Equity and Excellence: Liberating the NHS includes wide-ranging reforms covering all aspects of the NHS and healthcare.

Mr Lansley said 'process-driven' Labour government targets, such as the 18-week waiting time between GP referral and hospital treatment, will be scrapped and the focus will instead be on quality of outcomes for patients. All hospitals are to become a Foundation Trust or part of one, giving them far greater freedoms from Whitehall and allowing them to earn more money from private patients.

Management costs are to be cut in half but the Government has already admitted that the NHS would be forced to make staff redundant. It is estimated that around 25,000 jobs could be lost.

Mr Lansley said: "The sick must not pay for the debt crisis left by the previous administration. But the NHS is a priority for reform too. "Investment has not been matched by reform. So we will reform the NHS to use those resources more effectively for the benefit of patients."

Much of the white paper will require primary legislation and the implementation will start now but take until 2013/14 to come into effect fully.

Nigel Edwards, acting chief executive of the NHS Confederation, which represents all NHS organisations, said the changes would represent a huge upheaval. "It is hard to stress just how radical this is. The NHS will look much more like the gas, electricity or telecom's market than it will the monolithic state bureaucracy we have come to understand," he said.

Dr Hamish Meldrum, Chairman of British Medical Council said: “Doctors are ideally placed to help determine the health needs of their local population. "Every time they see a patient they have to make decisions about their care, in partnership with them. Doctors, and their staff, already take the lead on designing services and innovating new treatments for patients and will be interested in discussing how these roles will be enhanced."

But he added: “Any reorganisation of the NHS must take place in consultation with clinicians so that it does not cause any disruption to patient services or needlessly waste the valuable time of healthcare professionals.” Dr Jennifer Dixon, director of the think thank, the Nuffield Trust, said handing billions of pounds of taxpayer's money to GPs was 'risky' and is a significant change from their current role.

She said: "Handing GPs real budgets for commissioning care on behalf of their local communities has real potential to help shift care out of hospitals and reverse the upward trend in avoidable hospital admissions. 22.7.10

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I don't know how, but homeopathy really does work

More of a mystery is why scientists continue to debunk it despite mounting evidence that homeopathy is effective. I was a dedicated scientist about to begin a PhD in neuroscience when, out of the blue, homeopathy bit me on the proverbial bottom.

Science had been my passion since I began studying biology with Mr Hopkinson at the age of 11, and by the age of 21, when I attended the dinner party that altered the course of my life, I had still barely heard of it. The idea that I would one day become a homeopath would have seemed ludicrous.

That turning point is etched in my mind. A woman I'd known my entire life told me that a homeopath had successfully treated her when many months of conventional treatment had failed. As a sceptic, I scoffed, but was nonetheless a little intrigued. She confessed that despite thinking homeopathy was a load of rubbish, she'd finally agreed to an appointment, to stop her daughter nagging. But she was genuinely shocked to find that, after one little pill, within days she felt significantly better. A second tablet, she said, "saw it off completely".

I admit I ruined that dinner party. I interrogated her about every detail of her diagnosis, previous treatment, time scales, the lot. I thought it through logically – she was intelligent, she wasn't lying, she had no previous inclination towards alternative medicine, and her reluctance would have diminished any placebo effect.

Scientists are supposed to make unprejudiced observations, then draw conclusions. As I thought about this, I was left with the highly uncomfortable conclusion that homeopathy appeared to have worked. I had to find out more. So, I started reading about homeopathy, and what I discovered shifted my world for ever. I became convinced enough to hand my coveted PhD studentship over to my best friend and sign on for a three-year, full-time homeopathy training course.

Now, as an experienced homeopath, it is "science" that is biting me on the bottom. I know homeopathy works, not only because I've seen it with my own eyes countless times, but because scientific research confirms it. And yet I keep reading reports in the media saying that homeopathy doesn't work and that this scientific evidence doesn't exist.

The facts, it seems, are being ignored. By the end of 2009, 142 randomised control trials (the gold standard in medical research) comparing homeopathy with placebo or conventional treatment had been published in peer-reviewed journals – 74 were able to draw firm conclusions: 63 were positive for homeopathy and 11 were negative.

Five major systematic reviews have also been carried out to analyse the balance of evidence from RCTs of homeopathy – four were positive
Kleijnen, J, et al ; Linde, K, et al ; Linde, K, et al ; Cucherat, M, et al ) and one was negative ( Shang, A et al ). It's usual to get mixed results when you look at a wide range of research results on one subject, and if these results were from trials measuring the efficacy of "normal" conventional drugs, ratios of 63:11 and 4:1 in favour of a treatment working would be considered pretty persuasive.

Of course, the question of how homeopathy works is another matter. And that is where homeopathy courts controversy. It is indeed puzzling that ultra-high dilutions of substances, with few or no measurable molecules of the original substance left in them, should exert biological effects, but exert biological effects they do.

There are experiments showing that homeopathic thyroxine can alter the rate of metamorphosis of tadpoles into frogs, that homeopathic histamine can alter the activity of white blood cells, and that under the right conditions, homeopathic sodium chloride can be made to release light in the same way as normal sodium chloride. The idea that such highly-diluted preparations are not only still active, but retain characteristics of the original substances, may seem impossible, but these kinds of results show it's a demonstrable fact.

Surely science should come into its own here – solving the riddles of the world around us, pushing the frontiers of knowledge. At least, that is the science I fell in love with. More of a puzzle to me now is the blinkered approach of those who continue, despite increasing evidence, to deny what is in front of them.

In the last few years, there has been much propaganda and misinformation circulated, much of it heralding the death of homeopathy, yet the evidence shows that interest in complementary and alternative medicine is growing. In February, the "sceptics" campaign had a breakthrough – a report from the House of Commons Science and Technology Committee recommended no further NHS funding for homeopathy, despite a deeply flawed hearing.

The Society of Homeopaths – the largest body representing professional homeopaths – was refused permission to give oral evidence. Also notable by their absence from the panel were primary care trusts who currently commission homeopathy and representatives of patients who use homeopathy. Yet oral evidence was heard from a journalist previously investigated by the Press Complaints Commission for unsubstantiated criticism of homeopaths, and a spokesperson for a charity that has long publicly opposed homeopathy. It is significant that one of the four MPs asked to vote on the report abstained due to concerns about the lack of balance in the evidence heard.

Homeopathy is well-established in the UK, having been available through the NHS since its inception in 1948. More than 400 GPs use homeopathy in their everyday practice and the Society of Homeopaths has 1,500 registered members, from a variety of previous professions including pharmacists, journalists, solicitors and nurses.

And yet the portrayal of homeopathy as charlatanism and witchcraft continues. There is growing evidence that homeopathy works, that it is cost-effective and that patients want it. As drugs bills spiral, and evidence emerges that certain drugs routinely prescribed on the NHS are no better than placebos , maybe it's time for "sceptics" to stop the witch hunt and look at putting their own house in order. It's all a far cry from the schoolgirl biologist who envisioned spending her life in a laboratory playing with bacteria. 19.7.10

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90 percent of scientists backing Avandia diabetes drug had financial ties to drug companies

More than 90 percent of researchers who have published studies favorable to the controversial diabetes drug Avandia had a financial stake in the issue, according to a study conducted by researchers from the Mayo Clinic.

The Mayo Clinic is one of the few research organizations in the United States that does not accept corporate funding. As most scientists [90%] do have ties or accept funding from the pharmaceutical industry, critics say it is virtually impossible to obtain 'independent' advice.

Sales of GlaxoSmithKline's bestselling drug Avandia plunged in 2007, after evidence emerged linking the drug to an increased risk of heart attack and death. These reports sparked a debate over the drug's safety that continues to this day.

In an analysis of more than 200 studies, articles, editorials and letters published in scientific journals since 2007, Mayo Clinic researchers have concluded that financial conflict of interest continues to play a major role in that debate. Fully 87 percent of all authors who expressed positive views about Avandia had financial ties to GlaxoSmithKline, while another 7 percent had ties to other pharmaceutical companies involved with diabetes. Among authors with financial conflicts of interest, only 30 percent "expressed unfavorable views" of the drug.

In contrast, authors who were critical of Avandia were "largely free of identifiable conflicts of interest," the researchers said.

The conflicts of interest cut both ways. Of 29 authors who recommended the drug Actos as a safer alternative to Avandia, 25 had ties to that drug's maker, Eli Lilly.

In order to identify conflicts of interest, the Mayo Clinic researchers searched through multiple published works by each given author, as well as conducting investigations on the Internet. This research uncovered that while 47 percent of all authors surveyed had a financial stake in the diabetes drug debate, 23 percent failed to disclose these links. Most of these authors merely remained silent about their conflicts of interest, while three actually lied and said they had none.

"The implication is that there should be better disclosure," lead researcher Mohammad Murad said. "People [with financial links to companies] should realize they are probably biased, and as readers we should be aware of probable bias." 22.7.10

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Legal charges drag GSK into the red for Q2

GlaxoSmithKline took a massive hit from one-time legal and restructuring charges during the second quarter of 2010, leaving its books well in the red compared to the healthy profit booked a year ago.

The world's second-largest drugmaker warned last week that legal settlements, primarily relating to the antidepressant Paxil (paroxetine) and the diabetes drug Avandia (rosiglitazone), would alone swipe £1.57 billion off its second-quarter results. And this, coupled with a £590 million restructuring charge, secured a loss of £304 million for the period, a far cry from the profit of £1.43 billion GSK booked for Q2 2009.

The group's swing into the red masked an OK growth in sales for the period given the current tough economic conditions, with revenue up 4% at £7 billion, though down 2% if pandemic products are taken out of the equation.

Pharmaceutical sales accounted for £5.8 billion of the total staying level with the year-ago quarter, with an acceleration of generic competition to herpes therapy Valtrex (valaciclovir), turover of which plummeted 59% to £165 million, a temporary suspension of its rotavirus vaccine Rotarix, and lower sales of Avandia (-26% to £152 million) particularly holding back growth during the period.

On the respiratory side, sales of COPD/asthma therapy Seretide/Advair (salmeterol and fluticasone) remained level at £1.3 billion, after a 3% dip (to £655 million) in the US (because of wholesaler stocking patters) was countered by a 12% rise in emerging markets (+12% to £86 million) and Japan (+23% to £62 million). But others in the segment fared better, with hay fever spray Avamys/Veramyst (fluticasone furoate) up 19% to £57 million and the asthma inhaler Ventolin (albuterol) up 16% to £134 million.

Total vaccine sales jumped 17% to £939 million, bolstered by £275 million brought in by the group's pandemic H1N1 jab. On the down side, a decision by US regulators to temporarily suspend marketing of Rotarix took a huge chunk out of the product's revenues, which slid 49% to £39 million. Hepatitis vaccine sales slipped 16% to £170 million, but the pneumococcal vaccine Synflorix continued to perform well, turning in £38 million for the quarter.

Elsewhere, strong performances were also recorded for: the heart disease drug Lovaza (omega-3-acid ethyl esters), +29% to £138 million; the breast cancer therapy Tykerb (lapatinib), +32% to £56 million; the bloodthinner Arixtra (fondaparinux), +28% to £79 million; and Avodart (dutasteride), for benign prostatic hyperplasia, +14% to £157 million, while new cancer drugs on the block Arzerra (ofatumumab) and Votrient (pazopanib) made sales of £8 million during the period.

Regionally, US sales for the business were flat compared to a year ago at £263 million, as strong growth in oral care products was dragged down by dwindling sales of what the company classes “non-essential OTC medicines”, because of economic pressures. In Europe, sales actually dropped 2% to £493 million, so it was really performances in the Rest of World markets – including the strategically vital emerging regions – that led growth, climbing +11% to £496 million.

Positive outlook
Going forward, GSK's chief executive Andrew Witty said the company is confident that its competitiveness in the US market will improve, but he acknowledged that, certainly in the short term, the underlying business performance across the Atlantic “will be somewhat masked by the continued impact of genericisation of Valtrex sales and reductions in pricing resulting from healthcare reform”.

The company has been undergoing an operational revamp for a couple of years now, and, in order to drive the business forward and secure global success, remains heavily focused on “reducing infrastructure costs and reallocating capital directly to pipeline asset projects and areas such as biopharmaceuticals and vaccines which offer potentially higher and sustained returns”, Witty said.

Under this strategy, the firm also announced that it has cherry-picked five new candidates for Phase III development, including two experimental oncology drugs targeting melanoma, as well as potential new assets for HIV and for Duchenne Muscular Dystrophy, and a vaccine for shingles prevention. 21.7.10

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Glaxo pays £1.6bn charge for Avandia, Paxil

GlaxoSmithKline, the British drug maker, is to take a £1.57bn charge to cover settlements and legal actions relating to its diabetes pill Avandia and antidepressant Paxil.

The second-quarter charge also includes £500m to settle a US Government investigation into its former manufacturing site at Cidra, Puerto Rico. This is still subject to negotiation, Glaxo said in a statement. With respect to Paxil and Avandia, the charge includes provisions for settled cases and an estimate for outstanding cases. Terms of the settlements reached are confidential, Glaxo said.

The after-tax cost of the legal charge, which covers settlements, agreements in principle to settle, and other provisions, will be £1.35 bn.

Glaxo's announcement follows a recommendation on Wednesday by advisers to the US medicines regulator that Avandia should be allowed to stay on the market but with additional warnings over heart risks. The company did not specify how much it was setting aside to settle liability claims over the diabetes pill.

Having spent two days hearing conflicting evidence over whether or not Avandia can pose a risk to the heart, 20 members of a 33-strong advisory committee to the Food and Drug Administration (FDA) voted to keep Avandia on the market while 12 voted to pull it and one member abstained. However, 17 members of the panel advised that the drug should be sold with new restrictions or warnings, while three panel members said no changes were needed to the drug's prescribing information, critics said 'there are at least 17 members on the committee with financial ties to the drugs industry'.

The FDA is not obliged to follow the recommendations of advisory panels, but often does.

Earlier in the day, the panel had voted that there was an increased concern about heart attacks with Avandia versus other diabetes drugs, but they voted against finding a greater risk of death with Avandia. Controversy has dogged Avandia since 2007 when a study first claimed it could be linked to cardiac risks. But, GSK has vigorously defended the drug, saying that since then, six clinical trials have shown it to be safe.

Responding to the vote, GSK's chief medical officer, Dr Ellen Strahlman, said: "We would like to acknowledge the efforts made by the FDA to apply scientific rigour to the debate and understanding of the benefit-risk profile of Avandia," She added: "Following [the] recommendations, we will, of course, continue to work with the FDA in the best interest of diabetes patients who face this chronic and serious disease."

Mike Ward, an analyst at Ambrian, said last night: "I think [the vote] is stronger in favour than many people would have thought." 15.7.10

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Weight-loss schemes help patients 'more than the NHS'

A leading nutritionist says GPs should send obese patients to weight-loss schemes rather than offer NHS help because they will see better results. Dr Susan Jebb of the Medical Research Council found in a study that people in a WeightWatchers programme lost twice as much weight as those with GP care.

WeightWatchers part-funded the study, but Dr Jebb stressed similar schemes would be as effective. The National Obesity Forum said buying in services could benefit NHS patients. The NHS is currently running pilot schemes with WeightWatchers. GPs can buy one patient a 12-week course for about £45.

It was a year-long scheme like this in Northampton that Dr Susan Jebb and colleagues studied, as well as two similar projects running in Australia and Germany. Over the course of a year, the Northampton GPs referred half of 772 overweight patients to weekly WeightWatchers meetings, paid for by the doctor's surgery.

The other half received GP-led care. This typically involved things like providing leaflets about healthy eating and scheduled appointments with a nurse for weigh-ins and advice. The patients had their weight recorded at regular intervals throughout the year to see the results.

At each measurement appointment, WeightWatchers came out best. By 12 months, that group had lost twice as much - nearly 7kg (15lbs) on average per patient, compared to around 3kg (6lbs) in the GP-led group.

Although this amount of weight loss may seem small, the researchers say it can make a big difference in terms of health.

Cost-effective
Dr Jebb said: "Losing four to five kilograms can halve a person's diabetes risk if they are overweight, so even a little can be beneficial. "We know a lot of people are overweight and need to lose weight. The challenge is how you do it. "In the NHS we do not have the resources for a massive weight management programme. But this would be cost effective."

But Dr Jebb said that WeightWatchers was not unique, and that any similar programme involving regular weight checks, goal-setting and peer support could achieve the same. "It's having a weekly weigh-in and the accountability it brings with it, as well as the support of the group, that seems to work. "People are more likely to stick at it."

Fewer patients in the WeightWatchers group dropped out of the trial than in the GP-led group, although compliance was a problem generally, with just over half of the patients completing the trial overall. Dr Jebb stressed weight-loss schemes would not be suitable for everyone, and GPs should bear this in mind.

"Men may not feel it's the right group for them, nor some ethnic groups. It's certainly not some panacea for the nation's weight problems. "But GPs can now be confident that here is a way they can really help some of their patients that's based on evidence."

Determination
The health advisory body National Institute for Health and Clinical Excellence ( NICE ) already recommends in guidelines that GPs should consider referring overweight patients to a commercial provider.

Dr Brian Karet of the Royal College of GPs said it was important that patients had the motivation to shed excess pounds. "Many GPs will try and find out how determined people are to lose weight, using techniques such as motivational interviewing, but it helps enormously to have a locally available group-based programme to then point people towards.

"Primary care trusts and commissioning groups should certainly consider setting up locality-based groups like this, or buying in to one of the commercial providers of weight loss support such as WeightWatchers."

Tam Fry of the National Obesity Forum said: "GPs are generalists by definition whereas WeightWatchers are the 'consultants' in their field. "It's therefore not surprising that the latter achieve the better results.

"Referral to any organisation with a proven weight-loss system which can be replicated anywhere has to be the best option for the patient, the GP and the NHS. "It may upset some PCTs to use commercial suppliers - but they do produce value for money." The trial will be presented at the International Conference on Obesity in Stockholm this week. 13.7.10

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Glaxo Said to Pay $460 Million to 10,000 claimants to End Avandia Law Suits

GlaxoSmithKline Plc agreed to pay about $460 million to resolve a majority of lawsuits alleging the company's Avandia diabetes drug can cause heart attacks and strokes, people familiar with the accords said.

Glaxo, the U.K. 's biggest drugmaker, agreed to settle about 10,000 suits for an average of at least $46,000 apiece, the people said. The company had been facing more than 13,000 suits alleging Glaxo hid the drug's heart-attack risk, according to a UBS AG analyst. The settlements come as Glaxo is set to face its first Avandia trial in federal court in Philadelphia in October.

“This is exceptionally good news given the market has discounted $6 billion liability,” for Avandia litigation, Gbola Amusa, an analyst at UBS in London, said in an interview. “We had outlined an absolute worst-case scenario where $500,000 per case would have to be paid.”

Glaxo, the U.K. 's largest drugmaker, is settling Avandia claims as a U.S. Food and Drug Administration advisory panel is meeting today to consider whether Avandia's ability to control blood-sugar levels outweighs a possible increase in heart attacks, strokes and deaths from cardiovascular disease. Mary Anne Rhyne, a spokeswoman for Glaxo, declined to comment.

Avandia generated $1.1 billion last year for Glaxo, only about a third of the revenue it had before researchers linked the medicine in 2007 to a 43 percent increased risk in heart attacks. Avandia was once the world's best-selling diabetes pill, generating $3 billion in annual revenue for London-based Glaxo.

A former FDA official said Glaxo withheld from regulators a study showing Avandia may cause heart attacks, according to two people familiar with her deposition in a lawsuit against the drugmaker.

Dr. Rosemary Johann-Liang, a former manager in the FDA's drug-safety unit, told lawyers suing Glaxo that the 2001 study found Avandia posed a greater heart-attack risk than rival medicines, the people said. Glaxo also didn't turn over an e-mail from researchers who concluded Avandia “strengthens the signals” of heart ailments, she testified in a pre-trial deposition last month, according to the people.

Johann-Liang's deposition may be considered by the FDA advisory panel, the people said. They declined to provide a transcript of the testimony.

Carried Risks
Glaxo disputes Johann-Liang's claims that it didn't turn over a 2001 review of Avandia's health risks to federal regulators, Rhyne, the company spokeswoman, said last week in an e-mailed statement.

An FDA panel agreed in 2007 that the drug carried risks though it should remain available. Almost a dozen more clinical trials and studies have been completed in the past three years, prompting the agency to re-examine the issue. The panel could recommend Glaxo pull Avandia from the market, which might prompt more suits, Amusa said.

The FDA review was a factor in the decision by Glaxo officials to start negotiating with lawyers for former Avandia users, the people familiar with the settlements said. During a first round of settlements of Avandia cases, Glaxo agreed to pay about $60 million to resolve more than 700 suits filed by attorneys such as Houston-based litigator Mark Lanier and Philadelphia-based plaintiffs' lawyer Sol Weiss, the people said.

Resolve Claims
Among lawyers settling Avandia cases in the second round of resolutions are Michael J. Miller, an Alexandria, Virginia-based attorney who represents about 1,500 consumers who took the drug, the people said. J. Paul Sizemore, a Los Angeles lawyer with more than 1,000 Avandia cases, also has agreed to resolve the claims, the people said.

Neither Miller nor Sizemore returned calls seeking comment on the settlements. On his law firm's website, Miller said the advantage of the accords is that they provide a “prompt resolution” of claims that have taken three years to get to the pre-trial stage. “It's a compromise that allows both sides to put this behind them and move on,” Miller said in a note to clients.

Avandia claimants' cases generated individual settlements ranging from $46,000 to almost $70,000, depending on the strength of the claims, the people said.

The settlements add more support to the idea that Glaxo may be able to resolve its Avandia liability for about $1.1 billion, said Amusa. He and other industry analysts have previously said that the company might pay as much as $6 billion to resolve all Avandia litigation.

$3.5 Billion
Glaxo set aside 2.3 billion pounds ($3.5 billion) for “legal and other disputes” as of the end of March, the company said April 28. It didn't specifically mention litigation relating to Avandia.

There are still at least 3,000 Avandia claims pending, either on court dockets or subject to so-called tolling agreements, the people said. These accords allow lawyers to stockpile claims without filing lawsuits while they investigate the cases or negotiate with the company.

Lawyers representing former Avandia users who are pushing ahead with claims against Glaxo include Denver-based litigator Joseph Zonies and Kansas City, Missouri-based plaintiffs' attorney Thomas Cartmell, the people said. Neither lawyer returned calls seeking comment. 13.7.10

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Beware Articles Against Homeopathy- They Are Running Scared

Are the physicians running scared? There are a group of well-organized and well-funded persons who are against natural medicine, even though most pharmaceutical drugs are just synthetic versions of properties already found in nature, so why not just use the natural compound? They have nothing more productive to do with their lives except spend their days thinking up negative things to say about natural health topics. Their latest tactic is to create fictitious articles that attempt to illustrate their point in a lame effort to turn the tide against CAM, and most especially homeopathy. Now, why would they do that?

Because it would burst their precious bubble to find out they are not the only type of effective medical care on earth. Their drug stocks would plummet as people began to take more responsibility for their health care. When people stop running to the doctor, the emergency room, or the hospital for every little bump and bruise they would not be able to pocket all that money on drug sales. They would lose a little prestige as the only game in town.

It seems so strange, because with the availability of natural health measures, the over-burdened medical systems would get a reduction in stress and breaking out at the seams. They could focus on shoring up what they do best in medical care. Clean up their buildings, train more nurses, physicians assistants and doctors to fill the great need across the country. And, hey, even these new staff could take a few classes in nutrition to beat obesity and diabetes, yoga for stress reduction for heart patients, breathing exercises for those prone to anxiety attacks, hands-on-healing to improve bedside manner and doctor-patient relationships. Perchance, even take some homeopathy emergency care courses to become familiar with its great potential in healing.

The naysayers are downright wrong on every account when they claim homeopathy is poison and with a twist of their tongue say that there is nothing in it. How can they have it both ways? They scream that homeopathy is so diluted that it is like one drop in the ocean and has no effect. They stage a mass suicide attempt to prove that homeopathy is harmless. And, in so doing show that these tiny pellets are sugar pills and nothing else. Yet, now they are claiming taking a few of these tiny pellets cause side-effects and can send someone to the emergency room. What a crock!

In fact, those extremists are really frightened now, because recently the traditional medical system is getting into the integrative and alternative field.

In England they've had specialty hospitals that have provided natural care. The naysayers, many call them denialists, are doing everything in the power to return to a one-door policy and remove personal choice for medical care. Now, media articles are turning up in other countries, including America. It's a basic fact, these treatments are privately funded and grow through recommendation, if they did not work people would not use them or recommend them. 12.7.10

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David Cameron tells civil servants he wants to 'turn government on its head'

Prime minister pledges to usher in 'people-power revolution' in the way country is run. David Cameron told civil servants today that he wants to "turn government on its head" and make every Whitehall department accountable for what they want to achieve through a system of published milestones.

Insisting he had "huge respect" for civil servants, the prime minister signalled a "sea change" in the way government staff will work as he pledged to usher in a "people-power revolution" in the way the country is run. Outlining his plans for radical public service reform, Cameron claimed that greater citizen control of public services is the best way to increase efficiency at a time of constraint.

He told staff they would be expected to switch the focus from targets to setting deadlines for action plans and said he was putting his faith in choice, competition and public accountability as the best way to improve public services.

He told a civil service conference in London that he wants to replace what he described as "the old system of bureaucratic accountability" with a democratic accountability "to the people, not the government machine". As part of that, every government department will be required to publish structural reform plans setting out how they will put "people in charge, not politicians".

"Be in no doubt about our determination to do this," he said. "Yes, we'll deal with the deficit, but we'll also completely change the way our country is run. So let's push out, let's reform our public services, and let's change our country for the better."

He cited example of schools and teachers having to impress parents – rather than the Department for Education – in response to the choice available in the local area. "It really is a total change in the way our country is run – from closed systems to open markets, from bureaucracy to democracy, from big government to big society, from politician power to people power," he said.

Cameron, whose government is currently at loggerheads with civil service unions over plans to cap their redundancy pay, said that civil service staff should no longer see their roles as guaranteeing public service outcomes or intervening to improve performance, but to create the conditions to allow performance to improve by ensuring professionals to improve.

He said that "the old top-down system" had failed the poorest and widened inequality because in a system where people have no choice, the richest can opt out while the poorest "have to take what they're given". "Where there has been caution about devolving power, there's got to be trust," he said. "Where there has been an aversion to risk, there needs to be boldness. "I'm telling you today that your job under this government is not to frustrate local people and local ideas, it is to enable them."

Cameron said the departmental reform plans would be part of the business plans published after the spending review this autumn. The first structural reform plans are released today by the Department for Education and the Department for Communities and Local Government. 8.7.10

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Never trust a medical expert!  Ever wondered why so much health advice is contradictory? It's because two-thirds of medical research is wrong or fraudulent

Have you been left confused by expert health advice? Even people like me, with years of experience in science and medical journalism, are left scratching our heads when research is contradicted by other studies or turns out to be wrong.

• two-thirds of the findings published in the top medical journals are refuted within a few years
• as much as 90% of physicians' medical knowledge has been found to be substantially or completely wrong
• half of what we will teach you in medical school will, by the time you are done practicing, be proved wrong
• half the research workers said they knew of studies that involved fraud

In early 2008, new guidelines for life-saving emergency heart attack treatment said you should no longer bother with the 'mouth-to-mouth' part of CPR (­cardiopulmonary resuscitation). Instead, you should pump the chest non-stop. Having got my Red Cross certificate some years ago, I wanted to know more - but discovered that while this change was endorsed by the European Resuscitation Council, the Red Cross still trains people to give mouth-to-mouth. 

So I asked Paul Schwerdt, a cardiac resuscitation expert who restarts hearts daily. He told me to forget about CPR, because even trained laypeople rarely do it well enough to make a difference. He said the best thing is an Automated External Defibrillator - a portable, easy-to-use device that is increasingly available in public places.

I found an article that said it can raise the survival rate for people having heart attacks outside hospital from 1 per cent to 80 per cent. But then I read another study saying such devices don't increase survival compared with CPR. Little wonder that 'expert' health research leaves many of us confused - and that includes medics, too.

John Ioannidis, a doctor specialising in infectious diseases who is also a medical research analyst, has looked at hundreds of studies and discovered that two in every three conclusions published in medical journals are later found to be wrong.

The problem is that those are the sorts of conclusion your doctor reads when deciding if it makes sense to prescribe an antibiotic for your child's ear infection, or if the benefits outweigh the risks in suggesting that middle-aged men take a small daily dose of aspirin or statins.

Take for example the changing medical advice on aspirin:

• Aspirin stops bowel cancer 16.9.10
• Aspirin during pregnancy could prevent pre-eclampsia in thousands of women, says NHS - 23.8.10
• Aspirin 'cuts prostate cancer risk by 30%': A tablet a day helps stop killer tumours forming - 12.8.10
• Healthy people 'should not take aspirin to prevent heart attack' - 3.11.09
• Take asprin – Don't take aspirin as trial casts doubt on aspirin guidance - 2.9.09

And the changing medical advice on statins:

• Prescribe statins to ALL over-55s, declares professor 5.5.11
• Doctors want statins served with fast food - 13.8.10
• Statins: The side effects 'are worse than feared' - 21.5.10
• The other side of statins: doctors now fear for some, the side effects could be devastating - 30.3.10
• Statins are the new NHS wonder but do they have sinister side-effects? - 10.3.06

As one critic said 'for an industry that gets it wrong most of time, they shouldn't be so dogmatic as medical advice changes all the time, what they told you do last year no longer applies this year and so on. It was only in November 2009 that medical 'experts' thought GP's should give patients advice on climate change'.

How about psychological problems: 'It used to be that Freudian principles were in vogue, then just sitting back and being a good listener while the poor soul talked his or her heart out was the way to go. Next came, "forget the talk, simply take this pill and you'll be just fine." Now everyone's worried because those pills are creating addicts who can't get off them. What's usually behind all this conflicting medical advice is the influence of the pharmaceutical industry'.

The two-out-of-three wrongness rate Professor Ioannidis found could be worse: he examined only the less than one- tenth of 1 per cent of research that makes it to prestigious journals. So, what is going on?

Here are some of the reasons why medical 'experts' get it so wrong:

RESEARCHERS MAKE UP FINDINGS
The research community likes to say that the high-profile cases of fraud we see in the media - such as the South Korean researcher Woo Suk Hwang's fake claims to have cloned human stem cells in 2005 - are rare events.

Another notorious example was that of the cancer researcher William Summerlin, who won praise for achieving skin grafts on genetically incompatible black and white mice. In fact, he had used a marker pen to blacken patches of fur on white mice. But research fraud appears to be rife.

In an anonymous survey of 3,200 medical researchers in the journal Nature, a third confessed to at least one fraudulent act or 'massaging' research results. In a similar survey, half the research workers said they knew of studies that involved fraud. The proportion that are caught is minuscule. What motivates such surprising levels of dishonesty?

The answer is simple: researchers need to keep on publishing impressive findings in scientific journals in order to keep their professional careers alive, and some seem unable to come up with them through honest work.

THEY FIDDLE THE RESULTS
Highly respected scientists toss out data all the time. They pretty much have to. It would be hard to justify keeping 'findings' when a key piece of equipment is faulty or if patients in studies are caught not sticking to their drug or diet regimens. The problem is that it's not always clear where to draw the line between data that is bad and data that the researcher just doesn't like.

Douglas Altman, who directs the Centre for Statistics in Medicine in Oxford , examined more than 100 drug studies, comparing raw data and published results. He found that in most studies some data was left out - and more often than not it didn't fit the conclusions and might raise difficult questions.

The ultimate form of data cleansing is throwing away a whole study's worth of information by not submitting it for publication because the results aren't the ones hoped for. Often, these 'lost' negative results are from studies funded by drug companies - if you are trying to get a medicine onto the market, you don't want to publish research that makes it look bad.

Secret emails reveal that the UK 's biggest drug company distorted trial results of an anti-depressant, covering up a link with suicide in teenagers. A public relations executive working for GSK said: "Originally we had planned to do extensive media relations surrounding this study [Seroxat] until we actually viewed the results. "Essentially the study did not really show it was effective in treating adolescent depression, which is not something we want to publicise." But later a favourable article on Seroxat was published in the Journal of the American Academy of Child and Adolescent Psychiatry which says it ranks as number one in child mental health in the world.

A study two years ago revealed that 23 out of 74 antidepressant trials were not published. All but one had found the drugs to be more or less ineffective compared with a sugar pill placebo. In contrast, all 37 positive studies were published.

THEY STUDY THE WRONG PATIENTS
The reason trials may prove untrustworthy is because they study the wrong people. A study might be virtuous about its results, except it was assessing a drug's effects on the wrong people - those who do not represent the patients who would need the drug.

Sometimes people in medical studies are particularly health conscious or unusually ill. Then there is the fact that many studies pay you to take part, which results in a high percentages of poor people, and sometimes alcoholics, drug misusers and the homeless. These sway the results.

Studies in the Nineties appeared to prove hormone replacement therapy (HRT) reduced the risk of heart disease by 50 per cent. Then a large study in 2002 seemed to prove HRT increased the heart disease risk by 29 per cent.

Why the huge discrepancy? It turned out the groups had significantly different balances of people: the first had relatively young women, the second older women, leading both to produce misleading results.

THEY MOVE THE GOALPOSTS
Sheer chance means that in a medical or psychological study, you will always see improvement in a group of people over time - a slight loss in excess weight, for instance.

That change needn't have anything to do with what is being tested, but the researcher can then claim it was due to whatever was being tested by writing up the study as if that change was what was being tested for. 'It's like throwing darts on a wall and then drawing a dartboard around them,' says Douglas Altman.

He has compared study proposals submitted by researchers with the published findings: 'We found the stated focus of research was different in more than half the cases.' In other words, half the results were flukes that had been turned into alleged scientific fact.

THEY STUDY THE WRONG MAMMAL
In a notorious incident four years ago at Northwick Park Hospital , Middlesex, an experimental leukaemia drug was given to six volunteers. They all quickly fell seriously ill. The drug had been safety-tested beforehand and passed with flying colours. But it had been safety- ested on animals, where it had shown no harmful effects, even at doses up to 500 times higher than those given to the volunteers.

Health research has become dependent on animals. Treatment breakthroughs you see in the media frequently turn out to be based on studies of mice. But often the results don't translate to humans.

Three-quarters of drugs fail human trials because of dangerous side-effects or simply failing to provide cures. You can read more from...

Adapted from Wrong: Why Experts Keep Failing Us And How To Know When Not To Trust Them by David H. Freedman (Little, Brown, £12.99). To order a copy (P&P free), call 0845 155 0720. 6.7.10

Wasteful NHS 'cuts 3 years off our lives': Excessive pay and inefficiency to blame, says OECD

Huge levels of waste in the NHS are cutting more than three years off the average Briton's life, according to an astonishing international study. If the Health Service spent its money as wisely as other countries' systems, millions of people would enjoy many months or years of extra life, experts say.

But instead, poor targeting of resources means the UK has one of the highest rates of avoidable deaths in the West - even after the doubling of health spending under Labour. The report, seen by the Daily Mail, found that billions of pounds are wasted on excessive pay, with GPs getting more than in any other country. The figure is twice as much as family doctors in France , despite the fact that doctors here carry out fewer consultations.

The study from the Organisation for Economic Cooperation and Development comes as patients face the prospect of cuts to the frontline as the NHS tries to reduce its spending. Report author Isabelle Joumard, senior economist at the OECD, which represents industrialised nations, said inefficiency was slashing life expectancy by around three years,

'Given the level of healthcare spending per capita in the UK , we would expect a much higher life efficiency than it has achieved,' she said. 'If efficiency was improved, we believe life expectancy would increase.'

The study found that health spending in Britain had risen by more than 4 per cent a year between 1995 and 2007, one of the highest rates. But life expectancy had gone up by fewer than three years - less than the OECD average and far behind the four-year rise seen in Ireland .

The authors said this indicated that the extra cash had not been spent wisely. And the report revealed that the level of preventable deaths in the UK is the highest in western Europe, bar Portugal. The authors looked at levels of 'amenable mortality', those deaths that are potentially preventable by timely and effective medical care. It showed that around 74 of every 100,000 deaths are avoidable in the UK, compared to 50 in France and almost 70 in Germany and Ireland .

The OECD said waste came in many forms. For example, UK patients spend much more time in hospital after serious illnesses. Using a complicated formula, they concluded that if money was spent more efficiently, life expectancy could be increased by around three years and four months.

However, the report found British doctors were among the most highly paid in the Western world - because of lucrative contracts agreed in 2003 which have seen pay soar by 40 per cent. In 2006, British GPs earned $168,000 (£110,000), the report found. The OECD average was $94,000 (£62,000) and the pay was just $89,000 (£58,000) in France. However, British doctors provide just 2,000 consultations a year. The OECD average was 2,500. Miss Joumard said: 'Efficiency is about comparing outcomes and inputs. On efficiency, the UK is not one of the best performers.'

Katherine Murphy of the Patients' Association said: 'Money must be saved but we must cut inefficiency rather than front-line services.'

The Mail reported yesterday that billions of pounds had been wasted through Labour's failed scheme to close the 'health gap' between middle and poor classes. It actually worsened, the National Audit Office found. 3.7.10

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MS patients denied pain-killing spray on NHS

A CANNABIS-based pain relieving drug made will not be made available on the NHS to Oxfordshire's 1,000 Multiple Sclerosis (MS) sufferers, it emerged yesterday. Patients of MS – an illness which attacks the nervous system – were given fresh hope when a mouth spray containing extracts of the drug was licensed for use in the UK last week.

Cannabis has been medically proven to alleviate the symptoms of the neurological condition – but it is illegal.

The NHS said it would not be routinely prescribing the spray – called Sativex – for patients in the county.

Stevan Heads, of Abingdon, took Sativex for about 10 years as part of a drugs trial and said it significantly reduced the symptoms of his MS. The 45-year-old, said: “It totally reduced my pain; I felt no pain at all when I was on it. It also reduced the spasms by about 90 to 95 per cent. “I have noticed an increase in both the pain and spasms since I stopped taking Sativex about 18 months ago.”

Sativex can be sprayed under the tongue up to 12 times a day and costs the NHS £125 per 10ml vial, which works out on average at £11 per person per day. Trials have found it to successfully reduce spasms and sleep disturbances in 40 per cent of people.

However, a priorities committee for the South Central NHS region, which decides which treatments will be routinely funded in areas including Oxfordshire, has deemed it a “low priority” for funding. This means only those in exceptional circumstances will be given the spray by NHS Oxfordshire.

The committee said in a policy document on Sativex: “South Central priorities committees have considered the evidence for clinical and cost effectiveness of medicinal cannabinoids – such as Sativex – in spasticity, chronic pain and other symptoms associated with MS... and consider that the evidence is currently insufficient to support their use for any indication.”

Other trusts are still considering whether to fund Sativex. Jayne Spink, director of policy and research for the MS Society, said the decision was disappointing. She said: “We'd like to see Sativex made available to anybody who might benefit.” But she added: “As we have seen, people with MS may have to fight for access to Sativex in some areas.

“The MS Society will launch a campaigns guide on access to drugs later this year, which will include guidance for people fighting for access to drugs including Sativex.” Mr Heads, former chairman of the Oxfordshire MS Society, said he now feared not prescribing Sativex would encourage more MS sufferers to buy cannabis illegally. He said: “It is not something that people talk openly about, but I can see that happening.”

Many drugs and treatments are only given to Oxfordshire patients in exceptional circumstances.

To be considered exceptional, a patient's GP has to prove to the PCT that the patient is being affected more than others and the treatment will be more beneficial to them than the average patient with the condition. Kidney cancer drug Sunitinib was only given to exceptional cases until 2008 when the National Institute for Clinical Excellence (Nice) said it should be routinely funded. And in Oxfordshire, IVF treatment for women aged under 30 and over 35 is only funded in exceptional circumstances – unlike many other areas. 2.7.10

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Labour wasted NHS billions

Devastating report says they spent £20bn trying to close health gap between rich and poor - but it got even WIDER. Labour's multi-billion pound project to close the ‘health gap' between the middle classes and the poor has been an abject failure, auditors declared yesterday.

Not only did NHS managers fail to reach targets set in 2000 despite the huge sums spent, but the difference in life expectancy between the poor and the rest of the population actually widened. The National Audit Office, Whitehall 's budgeting watchdog, said spending on people in the poorer areas is £230 a year higher than those in better-off areas.

This means that an extra £3billion a year is currently going into the target zones. Over the last decade the total spent is an estimated £20billion.

But, largely because of bad diet, inadequate health education and a failure to prescribe enough basic drugs to combat high blood pressure and cholesterol, the health of poor people has worsened in relation to the rest of society. This shocking waste of resources puts pressure on David Cameron to reconsider his controversial pledge to protect the NHS from spending cuts, despite the deep reductions to every other area of state expenditure.

The NAO report said: ‘We were unable to conclude that the Health Department's approach provided value up to the mid-2000s. ‘Although life expectancy overall has increased, the gap in life expectancy between the national average and the Government's dedicated areas has continued to widen. ‘The Department will not meet its target to reduce the health inequalities gap by 10 per cent by 2010, as measured by life expectancy at birth, if current trends continue.'

Matthew Elliott of the TaxPayers' Alliance said: ‘It simply isn't good enough to spend a fortune addressing a problem, only for it to get worse. ‘This failure shows that the expensive, nanny state approach taken in the last decade simply doesn't work. ‘As well as costing taxpayers a huge amount, people who do need help have not received it. ‘The old attitude of endlessly throwing money at a problem is discredited and must be ditched.'

Labour declared as soon as it was elected in 1997 that it would ‘tackle the root causes of ill health to create a fairer society'. It set targets in 2000 and later refined them around a basic goal of cutting the life expectancy gap by 10 per cent. Yesterday's report said that instead the gap has widened, by 7 per cent for men and 14 per cent for women.

While on average men can expect to live to 77.9 years and women to 82, in the poorer zones labelled ‘spearhead areas' by the NHS life expectancy is 75.8 years for men and 80.4 for women. The attempt to close the gap was dogged in its early years by a failure to understand what caused greater ill health among the poor, the report said, and a lack of serious planning to deal with the problems.

The NAO said the Government only belatedly recognised that, rather than throwing lots of money at treating diseases, there are inexpensive and cost-effective ways to stop people getting ill in the first place. Only in 2006 and 2007 did managers begin to work out what they needed to do.

By 2007 the Health Department worked out that the lives of the poor could be lengthened by three cheap and simple methods. These were increasing the supply of drugs to control blood pressure and drugs to reduce cholesterol, and doubling the amount of help available to those looking to stop smoking. The report said: ‘These interventions have not been used on the scale required to close the gap and progress in improving the take-up of these interventions is not monitored.' The cost of the drugs and anti-smoking programmes if properly used, the NAO said, would be £24million a year.

But critics said 'more drugs and doubling the spending on smoking treatments which do not work anyway, was not the answer. It's a trypical Labour failure, costly, illconceived, poorly executed and doomed to failure'.

The report compared this figure with the £3.9billion a year currently spent by the NHS on the circulatory and respiratory conditions that the drugs and anti-smoking programmes would prevent. The Audit Office also pointed to lack of effort among GPs and the failure of the Government to encourage them to do more to help poorer patients.

Its report said that the new contracts given to GPs in 2004 – which have pushed their pay up by a third while allowing them to stop carrying out night duties – also gave doctors the wrong incentives. They meant GPs could ignore the problems of poorer patients and still collect their full incentive allowances for treating healthy middle-class people, the report said. 2.7.10

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Call for greater transparency on NHS £1.7bn consultants' secret 'rich pickings'

BMA leaders have passed a motion calling for the open publication of money-spinning management consultant contracts, as evidence emerged they were still raking in millions from the NHS.

The conference heard £1.7bn had been spent in the past seven years on consultants, including two McKinsey reports which called for reduced consultation times and huge shifts in care from hospitals to primary care, but were later dismissed as unworkable.

But the conference heard trusts were still paying individual consultant staff up to £1,000 a day.

The conference overwhelmingly passed motions calling for money spent on management consultants to be publically available, and meet 'high standards of academic rigour'.

Dr Jacky Davis, a consultant in Islington and head of the Keep Our NHS Public campaign, told the conference the spending on consultants was ‘an affront to our democracy.'

‘Management consultants have had rich pickings from the NHS,' she said. ‘They have made hundreds of millions and it's been reported that McKinsey makes a third of its profits from the NHS.' BMA chair, Dr Hamish Meldrum, added: ‘In the last seven years of the last Government, we estimate they spent 1.5 billion on management consultants in the NHS.' 1.7.10

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DoH road tests NHS direct payments under personal health budgets

Government plans to hand National Health Service patients more power over their own care have shifted up a gear with the launch of personal health budget pilot schemes - testing direct payments - across England .

Eight pilot projects will see primary care trusts give patients with conditions such as stroke or diabetes direct payments to enable them to make their own decisions on how, when and where they receive their healthcare.

This differs markedly from previous personal health budgets, which could only be held by the PCT or another third party. The Department of Health confirmed that more trusts will be authorised to offer direct payments over the coming year, to help “inform decisions around how to proceed with wider, more general roll-out”.

Under the scheme, patients will be able to use their personal budgets in various ways, with a view to ultimately creating a much more personalised health service. For example, chronic pain suffers might choose alternative methods of pain relief – such as massage or hydrotherapy - over pharmaceutical intervention, the DH explained.

“This is an important step towards putting patients at the heart of everything the NHS does,” said care services minister Paul Burstow. “Direct payments have real potential to improve the lives of individuals with long-term health needs by putting treatment choices in their hands”.

However, earlier this year the British Medical Association said giving patients their own cash pots to pay directly for national health services could potentially “undermine some of the fundamental principles of the NHS and their very existence appears at odds with the workings of the system”.

It argues that while enabling patients to better meet their own healthcare needs could well foster a more equitable health service, the scheme could also open up yet another pathway by which patients could be given different levels of care, “raising significant equity concerns”. 1.7.10

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In full: Andrew Lansley's speech to the BMA ARM

'A shared ambition to improve outcomes'

Everything I do as Secretary of State will be directed towards freeing up the service to deliver better results. At every stage I will be endeavour to be open, clear and consistent about my plans. And every step we take we must take together - I want to draw on your views and your expertise, starting today.

Priorities
In opposition, and coming into Government, I have been clear about our priorities:

First, that patients must be at the heart of everything we do - as more than simply beneficiaries of care, but as participants in its design.

Second, the NHS must be focused on achieving continuously improving outcomes for patients - not inputs or processes, but results.

Third, we must empower clinicians - those responsible for patient care - to deliver those improvements.

Fourth, if we are to improve overall health outcomes and make the demands on the NHS more sustainable, we must prioritise prevention and create a public health service.

Fifth, we must reform social care alongside healthcare - and deliver closer integration in how services are commissioned and provided.

These are now my priorities for government.

And today I want to talk about perhaps the most important and fundamental issue of all - improving outcomes for patients. This must be the primary purpose of the NHS: to improve the quality of care, and achieve outcomes that are amongst the best in the world.

Why should we not? The service has doctors, nurses, scientists, researchers, as good as any in the world. People, I know, committed to achieving the best possible care. But I can't count how many times doctors have told me, on a personal and professional level, how frustrated they are by the way the system works. How their judgements and activities are restricted by the rigidity of the system, and how their clinical priorities have been distorted by narrow process targets.

If we are going to achieve the outcomes we all want to see, we need to break down that system and build one that is focused on improving results for patients. To do this I think there are four steps that we need to take.

Measuring outcomes
The first is to measure those things that really matter.For too long the focus has been on measuring inputs and processes that are remote to patients. The result has been the number of managers in the NHS increasing three times faster than the number of nurses, and a proliferation of targets - with over 100 major targets now governing your every movement.

So we are beginning to dismantle this system.

Just last week we published a revised Operating Framework to move towards scrapping the 18 week target for hospital waiting times, the 4 hour A&E target and the 48 hour target for GP access. But in doing this and more in this direction, we have in parallel to develop proper measures of quality which prioritise what matters to patients - not boxes ticked and processes followed - but their actual health outcomes.

And so I am calling for your help in constructing a national outcomes framework for the NHS. A framework that will help drive up quality across all services and show how we are performing against other countries. A framework that I can use to hold the new NHS Commissioning Board to account, and that patients and the public can use to hold all of us to account.

I've suggested some possible measures:

• Mortality amenable to healthcare brought down to the level of comparable countries

• Improving one and five year survival rates for cancer, so that they are at least in line with EU averages and progressively improve relative to comparators

• Reducing premature mortality from stroke, heart disease and lung disease, so that they are at least in line with EU averages

• Year-on-year improvement in patient-reported outcomes for patients living with long-term conditions

• Year-on-year improvement in patients' satisfaction with their access to and experiences of healthcare, and

• Year-on-year reduction in the number of adverse events

But - I repeat - I want to hear your views. Together we need to develop a small but balanced set of national outcomes measures that encompass the three things that we need to focus on to improve quality - the effectiveness, experience and safety of care. We'll be announcing a full consultation soon.

GP commissioning
In any healthcare system, a central factor in securing better outcomes is to bring the management of care together with the management of resources and services.

Most healthcare systems do not do this successfully - most suffer from this separation: to the greatest degree in America , where the third-party payment problem has inflated costs dramatically. Examples in America of physician-led, more integrated services, demonstrate how differently - and effectively - they can deliver care.

But even in this country there is a sense of management being separate from clinical care, whether in hospitals or where PCTs are remote from referral decisions about patients - creating the same lack of cohesion.

So the second step is to give control of commissioning to General Practitioners, working in local consortia, supported by an independent NHS Commissioning Board.

GPs coordinating healthcare so they are best placed to coordinate commissioning - but all clinicians must take on a much greater role. GPs will be expected to work closely with hospital consultants and their colleagues in all parts of the profession. As Iain Macleod told the BMA in the early 50s - seeing General Practice as much a multi-disciplinary team as hospital care.

I have discussed our plans with the GPC , and I will publish our proposals soon. There will be a full consultation on the implementation with the profession. I want to hear your views on exactly how this should work - we'll work through the details with the BMA and we'll negotiate those aspects that affect the GP contract.

But in doing so let's keep our focus on what we're trying to achieve. The danger with contract negotiations is that we end up not only just seeing the trees, but actually examining, very carefully, the bark on the trees - and failing to see the wood. So let's be clear - our aim is a major transfer of responsibility to the GP community; in order to empower clinical decision-making and improve outcomes for patients.

Many GPs are keen to take this on. And I want to appeal to all GPs - keen, or not so keen. I understand the philosophy that says your professional responsibility is to be concerned about the patient sitting opposite you. But giving GPs greater commissioning responsibility isn't about detracting from the support you give to individual patients.

Rather, it is about making sure that the really important decisions about the services available to your patients - and the quality you expect from the people providing those services - are driven by your clinical insight and by the holistic view you have of your patients' needs.

It is based on the understanding that to achieve the best for each patient, you need the power to design services that are right for all your patients. And that to get the priority right for each patient, you need to set priorities for all your patients. As the Royal College of Physicians argues - the responsibility for the use of resources is now a core responsibility for the whole profession.

Quality standards
And so, to support commissioning we need to have clear definitions of what constitutes excellence. So the third step is to introduce proper measures of quality across the service. Clinicians will be accountable in a different way - not to tick-box process targets, but to quality standards.

Standards which do not distort clinical judgement, but which are based on clinical evidence. Standards which achieve better outcomes and are comprehensible to patients so that they can hold clinicians to account. 1.7.10

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British taxpayers spent £1.2bn on the swine flu pandemic that never was

• Government left with vast stockpile of unused drugs
• But claimed response into outbreak was 'proportionate and effective'

British taxpayers were left with a staggering £1.2billion bill to tackle a swine flu pandemic that never materialised, it emerged today. Health officials spent millions on a vast stockpile of vaccines, antibiotics and anti-virals - many of which remain unused. Even when it became clear that the medicines were not needed, the Government was locked into inflexible contracts with no get-out clauses, a report into the crisis concluded.

But Dame Deirdre Hine, the investigation's author, described the reaction to last year's outbreak as 'proportionate and effective.' There were 457 reported and confirmed swine flu-related deaths across the UK between the outbreak in April last year and March this year.

Figures in today's report show that Britain spent £654 million preparing for a possible flu pandemic, and £587 million responding to the H1N1 outbreak - a total of £1.24 billion. This includes £1.01 billion on drugs, among them anti-virals, doses of vaccine and antibiotics.

The study comes in the wake of a number of claims that the threat caused by the H1N1virus was over-exaggerated. Last month an MP claimed that billions of pounds were wasted worldwide on buying drugs to combat swine flu. Welsh Labour MP Paul Flynn, who produced a report on the swine flu response for the Council of Europe, accused the World Health Organisation (WHO) of frightening 'the whole world with the possibility that a major plague was on the way'. 'The result of that was that the world spent billions and billions of pounds on vaccines and anti-virals that will never be used. It is a huge waste of money,' he said.

Ministers said that up to £300million of taxpayers' money was wasted on unneeded swine flu jabs in the UK alone. When the review was launched in March, the Department of Health said there were 457 reported and confirmed swine flu related deaths across the UK.

At the height of the scare, the chief medical officer SIr Liam Donaldson, said as many as 65,000 people could die from the disease. The final total is a fraction of the number of people who died from ordinary flu.

It has also emerged that the NHS was being forced to cut services because of the huge cost of the unfounded swine flu scare. A survey has found that as many as one in six health trusts may have to slash services - or already have done so - to recoup costs. The average cost of the crisis to primary care trusts was £340,000 - enough to pay the salaries of 17 nurses.

Dame Deirdre's review looked at the strategic approach to swine flu at UK level and the central decision-making rather than the operational responses in each nation or the actions of departments or agencies. The announcement said a review was normal procedure following a major emergency event. Just days later the WHO announced an independent review to assess its response to the outbreak.

The review, which is due to report to the WHO's annual meeting of member states in May 2011, is expected to examine whether it could have been clearer when it declared a pandemic of what turned out to be a relatively mild disease.

Despite the criticism that the UK Government over-reacted to the outbreak Sir Liam Donaldson, the Government's Chief Medical Officer through the crisis, said pandemic flu plans worked 'extremely well' and he was very pleased with how the NHS rose to the challenge.

In January the Government said it was considering selling or giving away some of the surplus doses of swine flu vaccine it stockpiled after receiving 23.9 million doses of vaccine from drug manufacturer GlaxoSmithKline and five million from rival company Baxter. But Sir Liam urged those eligible for the jab to have it before the next wave of the virus which is expected later this year. Critics said the whole event was a 'shameful disaster'. 1.7.10

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Lansley promises clarity on NHS strategy soon

Health Secretary Andrew Lansley has reiterated his vision for a National Health Service that is patient-centred, focused on outcomes, innovation friendly and free from “half-baked” reforms.

According to Lansley, the core priorities are to create a health service that offers patient-centred care and empowers the Service, the professionals, and the front-line to make decisions and drive improvements to quality and efficiency.

“The NHS appears to have acted as a brake for change rather than an accelerator”, Lansley said, and stressed that the character of decision-making is going to change. “I want to provide freedom, responsibility and accountability so that clinicians don't have to wait for permission to move from the thing that is targeted to something better”, he said.

“My view is clear, we have to strike a new balance of power in the service so that wherever possible, responsibility should lie with clinicians. I intend to provide leadership, strategy and direction – not command and control”.

Addressing the NHS Confederation's annual conference in Liverpool last week, Lansley promised to publish a new white paper detailing his strategy for the NHS as early as possible to provide a sustainable framework within which to work and eliminate some of the widespread confusion surrounding his key policies.

The hotly-anticipated publication of the white paper may, however, might be kept waiting in the wings while the finer details of one of the most radical changes – a move to GP commissioning – are hammered out between the Department of Health and the Treasury.

Many questions have been raised over the proposals to hand over a huge bulk of commissioning, worth up to £80 billion, to GP-led consortia, and rumours suggest the Treasury is somewhat uncomfortable with giving so much power to what could, in some instances, be relatively inexperienced groups of commissioners, particular during a time of such financial hardship.

But Lansley stressed that as these organisations will be spending public money systems will be put in place “to ensure that more money isn't spent that is in the pot”, and promised that accountability arrangements – not just for these commissioning hubs but for the entire Service – will be set out in the white paper. 28.6.10

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Re-label homeopathic remedies as 'placebos' say doctors

Chemists should be forced to mark 'nonsense' homeopathic remedies as 'placebos' to stop customers being misled, hundreds of doctors have said.

Doctors attending the British Medical Association annual conference voted for over-the-counter medicines to be clearly identified as having no provable clinical effect. The delegates also said the NHS should no longer pay for homoepathic remedies that do not work and could endanger patients' health.

Millions of pounds of health service funds should not be wasted on the treatments, the BMA conference heard. And the remedies should only be sold in chemists and other shops if they are clearly marked “placebo”, delegates to the BMA's conference in Brighton overwhelmingly voted.

Homeopathy was described as "nonsense on stilts" and that patients would be better off buying bottled water. There is no scientific evidence that the treatments are any better than dummy pills, doctors said. By diverting patients from conventional medicine the remedies could even lead patients health to deteriorate, they insisted.

The call to scrap homeopathy on the NHS drew an outraged response from supporters of the treatment, dozens of whom picketed the conference centre. Advocates of the alternative therapy, which has been in use for hundreds of years, claim that it can help patients who have not responded to more conventional treatments.

Homoeopathic remedies claim to be able to prevent diseases including yellow fever, typhoid and even leukaemia, as well as cure symptoms from toothache to hearing loss. Unlike herbalists, who use a variety of plants to combat diseases, homeopathic treatments are often heavily diluted. There can often be as little as one millionth of the original ingredient in such a remedy.

The NHS currently spends around £4 million a year on homeopathy, including to run a handful of homeopathic hospitals, which treat an estimated 55,000 patients annually. The remedies have been funded since the NHS was first set up more than 60 years ago. But earlier this year a report from the Commons Science and Technology Select Committee called on the NHS to stop funding the treatments. The report also fond that the remedies were not medicines. Dr Tom Dolphin, from the BMA's junior doctors committee, said that he had previously described homeopathy as witchcraft but now wanted to apologise to witches for making the link. "Homeopathy is not witchcraft, it is nonsense on stilts,” he said. "It is pernicious nonsense that feeds into a rising wave of irrationality which threatens to overwhelm the hard-won gains of the Enlightenment and the scientific method.

"We risk, as a society, slipping back into a state of magical thinking when made-up science passes for rational discourse and wishing for something to be true passes for proof.”

A spokesman for the Society of Homeopaths said: “There are approximately 600 doctors in the UK who use homeopathy, over 55,000 patients a year are seen through homeopathic hospitals, many with conditions not helped through other specialists in the NHS. “Homeopathic appointment and hospital costs are approximately £4 million per annum, compared with the cost of anti depressants alone which was £291.5million in 2007.”

He added: “Homeopathy has been available on the NHS since it was created in 1948, when five hospitals were already well established, and were handed over to the NHS to be run under the new system.” 30.6.10

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Patients free to buy their care with NHS money

PATIENTS are set to be given money by the NHS to spend on healthcare services of their choice. Care Services Minister Paul Burstow, who made yesterday's announcement, said the scheme would "put people in control" of the treatment they receive. Eight pilot projects are being set up across the country – including one in South Yorkshire – which will road-test the first "direct payment" schemes.

Primary care trusts (PCTs) will now give the money allocated for a patient's healthcare – called a "personal health budget" – directly to that patient, so they can decide how to spend it. After being given the agreed sum, patients can decide whether to use NHS or private care services. They could also choose to employ a personal assistant in their own home.

Mr Burstow said: "This is an important step towards putting patients at the heart of everything the NHS does. "Direct payments have real potential to improve the lives of individuals with long-term health needs by putting treatment choices in their hands."

The direct payment scheme is designed to help patients with long-term health problems such as diabetes, stroke, heart disease and mental health conditions. Doncaster PCT, which will be running the only pilot scheme in Yorkshire , will focus on mental health and "continuing healthcare" – care for people who have physical or mental problems and need care over a long period of time.

Other pilot schemes, which will all run until 2012, will be held in Kent , central London , Islington, Merseyside, Oxford , Somerset and West Sussex. The cost of providing direct payments, which is not anticipated to be any more expensive than the current arrangements, will come from existing funding within the PCTs.

Money will be paid to patients in a number of ways, including monthly direct payments or a lump sum for a one-off purchase such as a piece of equipment. Mr Burstow said: "There is strong evidence from the social care sector that direct payments help achieve better outcomes and give people more choice and control over the care they receive."

He added: "Direct payments will not work for everyone or for all patient groups or services, but we want to identify whether, for whom and how they could offer an opportunity to help achieve the best health and wellbeing outcomes. That is why we are developing this pilot programme."

A woman from Doncaster who was put in control of the personal health budget for her father, who was suffering from dementia after a series of strokes, praised the project. Debbie Robinson, 51, said: "What was so good about the personal health budget was that I could make sure care was flexible.

"Dad died on 23 December, 2009. In the end, he only received his personal health budget for two and a half months. However, the scheme helped transform our lives beyond recognition." 29.6.10

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NHS Cancer patients failed

Hospitals in Turkey and Slovakia have more scanners to spot tumours early. Cancer survival rates in the UK are so poor because hospitals have fewer high-tech scanning units than countries such as Turkey and Slovakia, a study shows. Despite a huge increase in health spending under Labour, Britain has one of the lowest numbers of specialised scanners to spot tumours early.

Out of 28 industrialised countries surveyed, only Hungary and Mexico have fewer numbers of computed tomography (CT) scanners per head of population. And only the Czech Republic, Poland, Hungary and Mexico have fewer magnetic resonance imaging (MRI) units.

The shortages mean that British patients often have to wait weeks for test results which could diagnose their cancer  -  delaying their treatment with life-threatening consequences.

Cancer survival rates in the UK are among the lowest in Europe.

A woman diagnosed with breast cancer has a 78.5 per cent chance of being alive five years later, compared to 82.6 per cent in France and 90.5 per cent in the U.S. The report, by the Organisation for Economic Cooperation and Development, which represents industrialised nations, also found that Britain had fewer hospital beds and fewer doctors than the average industrialised country.

It has led to an appalling situation where life expectancy and infant mortality rates are also higher. But it is the figures on cancer scans that are among the most stark. The average OECD country has 12.6 MRI units per million people. But in the UK , the figure is 5.6  -  above only the Czech Republic , Poland , Hungary and Mexico .

The British figure is far below Ireland (12.3), Greece (21.8), the U.S. (25.9) and Japan (43.1). It is even below Turkey (6.9) and Slovakia (6.1). And the differences are even greater with CT scans. The UK figure is 7.4 machines per million population, three times less than the 23.8 OECD average and lower than Turkey (10.2), Germany (16.4) and Australia (38.8). Again, Turkey and Slovakia have more scanners.

The report said: 'During the past decade, there has been rapid growth in the availability of diagnostic technologies in most OECD countries.

'Although the United Kingdom has also seen some increase in such technologies, the number of MRIs in 2008 was 5.6 per million population, less than half the OECD average of 12.6. 'Furthermore, the number of CT scanners stood at 7.4 per million population, less than three times the OECD average of 23.8.'

Last night Sarah Woolnough of Cancer Research UK insisted patients 'have timely access to the tests', adding: 'When cancer is caught early, treatment is more likely to be successful.' The report revealed that Britain 's spending on healthcare is £2,075 per person  -  around the OECD average.

But the rise in spending since 2000, at 4.6 per cent every year, is higher than the average. This has helped pay for more doctors, from two physicians per 1,000 population to 2.6 in 2008. This is still lower than the OECD average of 3.2, however. 30.6.10

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Typical public sector waste

In his emergency Budget this week, Chancellor George Osborne announced he was cutting public sector expenditure by 25 per cent. Unions have declared the cuts irresponsible. But are they? Here, one employee for a large inner London authority lifts the lid on the culture of inertia and incompetence at his workplace. The Mail knows the true identity of the man  -  a graduate who has been a planning officer for eight years. But to protect his job, he is writing under an assumed name.

Monday morning, it's 10am and I'm late for work  -  but there's no point hurrying because even though I should have been at my desk 30 minutes ago, I know I'll be the first to arrive at the office. Sure enough, the planning department is a ghost town.

Our flexi-hours policy means that employees can start any time between 7.30am and 10am , but council workers like to treat that as a rough guideline rather than the contractual obligation that it is.  I'm a senior planning officer: it's my job to inspect buildings, grant planning approval and to guide members of the public looking to alter their homes. Our department has 60 employees and  -  until last Tuesday  -  a budget of £22million.

I've been there for two years and in that period the only time I've ever seen every employee present and correct was at the Christmas party.

At least ten people will be off sick on any one day. The departmental record holder is Doreen  -  she has worked a grand total of eight days in 14 months. Doreen must be the unluckiest woman in the country. In the past year and a half she claims she has: fallen victim to frostbite; been hit by a car; and accidentally set herself on fire. But she's really pulled out all the stops with her latest excuse: witchcraft. That's right, Doreen believes somebody in Nigeria has cast a spell on her and that it would be unprofessional of her to attempt to do the job she is paid £56k a year for while under the influence of the spell. 

She has already been off for four months on full pay. I've no idea how long this spell lasts, but my guessing would be six months to the day  -  the exact amount of time council employees can take off on full pay before their money is reduced. But having just eight weeks of full pay left won't be a problem for Doreen and the rest of the council's sickly staff  -  they'll simply return to work when the six months is up, put in a day or two's work and then go off sick for another six months on full pay again. Easy. Of course they have to provide sick-notes from a doctor, but as you can buy fake ones online for £10 it's never proved a problem.

There are procedures in place to address attendance, but nobody ever follows them through  -  chances are the person whose job it is to monitor sickness is probably signed off himself. Some human resources managers, usually new to the job, do try to take action  -  but it mostly backfires.

All credit to the bright-eyed young HR manager who, last year, wanted to dismiss a senior employee who had been off sick for three months.

The employee had still been using his company mobile phone, from Marbella. However, the employee was able (with a little help from the mighty Unison union) to argue that there's no reason why 'sick' people can't rent villas in the Costa Del Sol.

I've been told by colleagues that I don't take enough sick leave  -  when I protest that it is because I'm in good health they look confused. What's that got to do with anything? At my borough a worker can take two weeks before having to produce a doctor's note (fake or not).

With the five weeks' annual leave plus bank holidays, even the most conscientious worker in my department is easily taking 12 weeks a year off.

To add insult to injury, some London boroughs recently introduced a new scheme whereby anybody who did an extra 15 minutes' work a day for 20 days could take an extra day's holiday. But when you can so easily take six months off, who needs official holidays?

Back to the day's business. Jerry is the next to arrive at 10.25am   -  before he takes his jacket off he performs his morning ritual of taking both his phones off the hook. God forbid that any resident and council tax payer should be able to speak to him and get some of the advice he's paid £64k a year to dispense.

Jerry is 63 and two years from retirement. He is what is known in the civil service and local government as an 'untouchable'  -  he's been at the council for more than 40 years, does no work, but would cost an absolute fortune to get rid of. So he's left alone to play online poker, Skype his daughter in Florida and take his two-hour daily snooze at his desk, no doubt dreaming of the day when his gold-plated public sector pension will kick in.

If you think Jerry's pay is generous, consider this: the head of my department is on an annual salary of £170k plus bonuses, his deputy nets £99k and even the office PAs are on a very respectable £38k  -  just two thousand less than I get. I listen to my answerphone and, as usual, there are about 20 messages from people trying to report faulty streetlights or complain that their rubbish hasn't been collected  -  calls that have been misdirected by our useless call centre.

When I first started here at the council, I tried to pass these messages on to the right department, but eventually gave up  -  nobody answers phones, nobody listens to voicemails, and emails go unread.

There's no point showing any initiative. I once wandered down to the 'Streetcare' department to ask why the hell nobody was answering the phone.But only two staff had turned up that day and they were both in the prayer room. Yes, you read that correctly, all large council offices now provide prayer rooms, primarily for their Muslim employees whose faith requires them to perform devotional prayers at midday, in the afternoon and at sunset.

Although it's two years since I started working for this authority I've also worked for two other London boroughs in various capacities over a period of 12 years. In that time I've never known anybody be sacked, no matter how inept and unprofessional they may be.  I'm not sure what it takes to get fired in local government. I'd say 'murdering the CEO' but, even then, you're more likely to be sent on an 'anger in the workplace' course.

Councils love their workshops, training courses and seminars. This week alone I've been invited to attend: A cycle hire and efficiency course; a traffic and pollution briefing; and a training course on offsite health and safety. Next week there is a two-day course on 'letter writing skills'  -  I dearly hope that Jackie, our departmental PA, will attend this one. I've given up using her and now type my own correspondence and reports.

The last time she typed a letter for me (to an architect) she misspelt 'accommodation' and 'environment' throughout. I gently pointed this out to her and asked her to redo the document. But she went sick for two weeks with stress, complaining that she was being bullied.

When my boss called me in to discuss this I, jokingly, said: 'Well I'll just let her misspell everything in future, shall I?' To which he replied: 'Yes, I think that's best for now.' I'm not sure what workshop I was asked to attend for that particular misdemeanour, but I do recall the 'cultural awareness and sensitivity' one following an incident where I outrageously asked a black colleague if I could open a window behind her desk.

It was 88 degrees outside and our offices have no air conditioning. This lady was born and bred in North London but claimed her Caribbean heritage meant she felt the cold and opening a window by six inches would cause her to suffer. I did the workshop and wrote her a letter of apology as recommended. I actually began to question whether I was racist or insensitive.

That evening I saw Sean, my oldest friend who is black. I ran the window story by him  -  he eventually stopped laughing after about 20 minutes. You can't be made to attend these workshops but, surprisingly, the take-up is remarkably high. Not because those going want to improve their skills, but because a full day's training comes with a full day's free catering.

'Fact Finding Missions' are another great favourite within the public sector. The last one I attended was a two-day trip (transport and four-star accommodation included) to a football club in the Midlands. Supposedly it was to understand how other inner cities tackle sporting events in areas of high population. However, the only 'fact' I discovered was that it takes about 11 pints and two whisky chasers before my boss keels over.

In fairness, there are some very hard workers at the council, but they are so massively outweighed by the workshy that they're fighting a losing battle. The culture is very much one of getting minimum done for maximum pay. Even when a reasonable proportion of the staff turns up for work (for our office that would be about 60 per cent) very little gets done because the officers cannot be bothered with the fiddly paperwork that goes with the job.

When residents contact the office because they want, for example, a loft extension or to replace windows in a conservation area, they hit such a wall of inefficiency and apathy that many simply give up or go ahead without permission. I recently received a letter from somebody looking for the plans to a building that was erected ten years ago.

I passed it on to Jackie the ever-efficient PA, who claimed she couldn't find them. I went to look and located them in 30 seconds. The only time the department ever really jumps into action is when architects complain. They know planning inside out and won't be fobbed off with delaying tactics that ordinary citizens have to contend with.

You can't even give them the old council favourite of claiming that you can't answer any of their questions because of 'data protection'. We love that excuse  -  nobody really knows what it means, but we use it all the time.

Bosses of local authorities have bonuses dependent on not getting high numbers of complaints. But the only way complaints can be recorded is if they are dealt with  -  if they're ignored or mysteriously lost then they never existed and won't be counted.

Despite all this, my department makes a huge amount of money  -  mostly from private developers. If they want to build something it costs them £2,300 just to have an initial planning meeting with us. What they don't know is that we've already had a meeting and decided they probably won't get permission - unless they agree to a 'planning gain' - a dodgy but perfectly legal practice whereby a developer who wants to build, say, a hotel, will be told that he can have his planning permission, but only if he also agrees to build a community centre too.

It's a way for councils to improve local amenities, without having to pay for them from public funds.  Some might call it bribery. For us, it's everyday business that ensures our budgets are protected for our vital work  -  like protecting our pay rises and perks.

So can anything be done to curtail this greed, waste and chronic incompetence? George Osborne clearly thinks so, with his bold promises to tackle the bloated public sector head-on. We had a meeting on Thursday to discuss the Chancellor's proposed cuts  -  there was talk of strike action among the younger workers, but much rubbing of hands among the 'untouchables', many of whom could walk away with six-figure golden goodbyes. 

The cuts and pay freezes are desperately needed, but the one thing Mr Osborne will never be able to control is the culture of inertia and inefficiency that is rife throughout the public sector. Of course, when I tell my friends in the private sector about my working conditions, they can scarcely believe it. As the recession bites, they consider themselves lucky to be holding on to their jobs, and are willing to work extra hours or take a pay freeze to ensure their firm's survival.

In the public sector, though, there is no competitive edge; no incentive to cuts costs or improve efficiency. Few genuinely fear for their job security, protected as they are by threats of union action every time the axe looks likely to fall.

It's the same story across the world: when a nation's public sector is allowed to expand into a bloated behemoth, it is almost impossible to cut it down to size, still less to change the culture of waste and laziness that sets in. I don't know what the solution is. Even those, like myself, who join with the best of intentions are soon worn down and end up subscribing to the 'if you can't beat them, join them' school of thought.

Of course the real scandal is it's your money that's paying for the jollies, the prayer rooms and the never- ending workshops. In my authority's borough, the average householder pays £1,330 a year in council tax. I'm sure they'd be thrilled to know that they're funding Jerry's internet gambling and Doreen's never-ending sick pay. Good luck Mr Osborne  -  you're going to need it. 26.6.10

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Swine flu risk 'was vastly over-rated' by World Health Organisation

Threats of a swine flu pandemic were 'vastly over-rated' by the World Health Organisation, an inquiry has concluded. The Council of Europe last night also accused the UN's health arm of 'grave shortcomings' in the process that led it to declare a pandemic last year.

Plummeting confidence in health advice could prove 'disastrous' in the event of a severe future pandemic, parliamentarians at the Strasbourg-based senate said. The assembly also accused the WHO of being 'highly defensive' of its handling of the outbreak and drugs companies of influencing the decisions taken.

Members, including five British MPs, voted overwhelmingly in favour for greater transparency in public health decisions.

It wants governments to 'ensure that the private sector does not gain undue profit from public health scares' and drug companies to revise their rules to ensure any potential conflicts of interests are made public.

The debate and recommendations follow a report which described the declaration of the H1N1 pandemic as a ' monumental error' driven by drug companies  -  spreading fear and wasting huge amounts of money. Paul Flynn, the British MP who led the Council Of Europe probe, described it as 'a pandemic that never really was'.

Mr Flynn said predictions of a 'plague' that would wipe out up to 7.5million people proved to be 'an exaggeration', with fewer than 20,000 deaths worldwide. Britain braced itself for up to 65,000 deaths and signed vaccine contracts worth £540million.

The actual number of deaths was less than 500 and the country is now desperately trying to unpick the contracts and unload millions of unused jabs. The focus on swine flu also led to other health services suffering and widespread public fear.

Pharmaceutical companies, however, profited to the tune of £4.6billion from the sale of vaccines alone. Mr Flynn said: 'There is not much doubt that this was an exaggeration on stilts. They vastly over-stated the danger on bad science and the national governments were in a position where they had to take action. 'In Britain , we have spent at least £1billion on preparations, to the detriment of other parts of the health system. This is a monumental failure on the WHO's part.'

The WHO has firmly rejected all the criticism, saying the outbreak fitted the criteria for a pandemic - and to claim otherwise was disrespectful to  those killed by the virus and their families. It also takes the view that not all ties to drug companies are necessarily conflicts of interest. 25.6.10

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Treasury sends back Lansley NHS plan to give GPs control of £80bn

Timetable for biggest shake-up in NHS for a decade put back to give officials more time to scrutinise GPs' accountability. Lansley's blueprint plans to give GPs control of 80% of the £100bn NHS budget. The Treasury is stonewalling over the publication of Andrew Lansley's radical blueprint for the NHS after officials said the health secretary's plans would "hand over £80bn of public money to 35,000 GPs who are private businesses", according to Whitehall sources.

Lansley's white paper, the biggest shake-up for a decade, was due to be out next week but the timetable has slipped after Treasury officials said there was not enough provision for making GPs accountable to the public, given they would control 80% of the £100bn NHS budget.

His plan would see the Department of Health pay GPs directly. They would then commission treatment from hospitals on behalf of patients. At present, the NHS works via primary healthcare trusts and the Department of Health determines each trust's spending priorities, which involves managing GPs' surgeries.

"The white paper got bounced back because there was no way the Treasury could sign up to a proposal which handed £80bn of public money to 35,000 GPs who are basically unaccountable private businesses," said one official.

At a question and answer session with professionals at the NHS Confederation, a group of health service organisations, Lansley said the transfer of budgets from trusts to GPs had to be done quickly. He added: "The risk in the long run will be mine. In the short run I need to put in place systems of financial control so GPs do not spend more money than they have."

The idea of GP budget holding comes from the US , where it has been in place since the mid-1980s. There is evidence that poor management has led to bankruptcies – unthinkable in the NHS – leaving millions of dollars owed to physicians, hospitals and ancillary service providers, because some doctors assumed too much risk and exercised too little control.

GP budget holding is a flagship policy of the government. In a speech earlier in the day, Lansley said: "Patients don't want to go to hospital: they want the right treatment, at the right place, at the right time, and GPs are often best placed to design those services."

However the speech, in which he was expected to outline a blueprint for the NHS, was light on detail. Lansley said his plans would see responsibility lie with GPs. "We are making clinicians accountable to patients … also for the results and outcomes they achieve." GPs will be expected to band together into 500 "commissioning consortia" by next year. However there are concerns over whether doctors will want to become "accountable" given that budgets are to be squeezed.

"There must be doubts [over] budget holding when GPs may perceive they are being asked to make cuts in services and take the lead in unpopular rationing or reconfiguration decisions," wrote Professor Chris Ham in a paper for the University of Birmingham's health services management centre last month. 25.6.10

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NHS targets scrapped as government cuts bureaucracy

KEY NHS targets are to be scrapped and management costs slashed by nearly half as part of a major shake-up unveiled by the coalition Government today. Health Secretary Andrew Lansley said GPs will no longer need to see patients within 48 hours, while the four-hour maximum A&E waiting time is being relaxed.

Central scrutiny of the 18-week referral to treatment target will also be ended. Patients' campaigners expressed concern that the reforms could lead to a "free-for-all" where health providers were not held to account.

But Mr Lansley insisted people would still have the right to demand high levels of service. "I want to free the NHS from bureaucracy and targets that have no clinical justification and move to an NHS which measures its performance on patient outcomes," he said.

"Doctors will be free to focus on the outcomes that matter - providing quality patient care. "Patients will still be entitled to rights under the NHS Constitution, and the quality of their experiences and outcomes are what will drive improvements in the future."

Mr Lansley said the changes would help drive down the management bill for Primary Care Trusts and Strategic Health Authorities from its current level of £1.85 billion to £1 billion by 2013-14. Although NHS spending was set to rise in real terms over the coming years, it was crucial to make "immediate" savings so they could be reinvested in care, he said.

Costs should be cut by £220 million this year, followed by a £350 million fall in 2011/12. By 2013/14 the total reduction will be £850 million.

Katherine Murphy, director of the Patients Association, said: "We have always supported reviewing the targets. They have been so heavily criticised and some had no substantial clinical evidence supporting them. "But we have never supported abolishing the targets and not putting in place something to replace them.

"The targets focused minds in the NHS, made people start realising services had to get better. "We might not have agreed with what they focused minds on, but that does not mean we advocate a return to a free-for-all."

Nuffield Trust director Dr Jennifer Dixon insisted central targets had been the most effective way of reducing waiting times in the NHS in England.

"However, too many targets can demotivate and may have perverse effects locally, so only a few should be used," she said. "The coalition Government's plans to move to outcome targets rather than process targets are welcome.

"But given that waiting for care is such a key part of patient experience on which the NHS is judged by the public, and given the miserable history of long waiting times in the NHS in the past, waiting times should remain firm targets." Ruth Spellman, chief executive of the Chartered Management Institute, said: "The Government is right to act now, before more bad management costs lives, but the desire to cut costs should not just be about imposing arbitrary reductions at management level.

"As the Government looks to make cost savings, it is an ideal time for PCTs and SHAs to review the standards of leadership within their organisations. "Now is the time to focus on removing managers whose capabilities fall below the first-class standards that patients have a right to expect." 21.6.10

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GW Pharmaceuticals launches world's first prescription cannabis drug in Britain

GW Pharmaceuticals, the British biotech company, today announced the UK launch of the world's first prescription cannabis medicine. Sativex, a ground-breaking cannabis-based drug for treating symptoms of multiple sclerosis, was approved in Britain on Friday, lifting GW Pharma's shares 11pc to a four-year high of 141p.

GW Pharma said the drug, which will be sold in Britain by its licensee Bayer, would cost the National Health Service (NHS) £125 for a 10 millilitre vial - enough to last the average patient just over 11 days, Reuters reports. Dr Geoffrey Guy, chairman of GW Pharma, said today's launch was the culmination of eleven years of research.

Sativex uses compounds extracted from marijuana plants. Clinical trials have shown that Sativex, which is sprayed under the tongue, reduces spasticity in multiple sclerosis patients who do not respond adequately to existing therapies. It became the world's first cannabis medicine to win regulatory clearance when it was approved in Canada in 2005 for neuropathic pain, but its roll-out in Britain – and other European markets thereafter – is a larger sales opportunity.

Last month, GW Pharmaceuticals indicated that the medicine would be approved by the end of June, with the final stages of the approval process involving only finalising product's packaging. At the time, Dr Geoffrey Guy, chairman of GW, said: "The first six months of this year have proven the most important in GW's history, in which we have made material progress towards Sativex's launch in Europe and generated positive cancer pain data."

A regulatory green light in Spain is expected shortly after the British approval. Sativex is to be marketed in the rest of Europe by Spain 's Almirall.

Approval of the drug in Britain has triggered a £10m milestone payment from Bayer, the company said. However, GW Pharma and Bayer must still convince Britain 's National Institute for Health and Clinical Excellence (NICE) that Sativex is a cost-effective treatment for use on the NHS. Until that happens, its sales may be slow, analysts believe. 21.6.10

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Concerns over Avandia Side Effects Prompt Critics to Call for Restructuring of the FDA

Consumers worried about the potentially lethal side effects of the diabetes drug Avandia have begun calling for sweeping changes to the US Food and Drug Administration's (FDA's) approval process, according to a recent report in the Boston Globe.

The problem, according to one critic of the system, is that the FDA lacks the checks and balances necessary for a more thorough approval process, leading many side effects to slip by unnoticed. The article cites the FDA's failure to heed the warnings of many of its staffers on Merck's recently pulled painkiller Vioxx and GlaxoSmithKline's Avandia, which were both found to possess potentially fatal side effects.

Avandia reduces the insulin resistance in the body to help use what little supply it already has as a means of combating the debilitating effects of diabetes. This process makes users more susceptible to a number of harmful conditions, including hypersensitivity, cardiac failure, hepatic impairment, macular oedema and bone fracture, as well as less serious risks like weight gain and fluid retention.

Iowa Senator Charles Grassley and Montana 's Max Baucus have led the charge to empower the FDA's surveillance office to pull potentially dangerous drugs like Avandia and have introduced pending legislation that could help the organization respond more quickly to the discovery of dangerous side effects. 18.6.10

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Shares down as German drugs gatekeeper rejects GSK's Avandia pill

Watchdog says no payments for glitazone, glinide drugs. Drugmakers Takeda, Novo Nordisk also affected

Pharmaceutical shares are edging lower, and none more so than GlaxoSmithKline after an unfavourable ruling in Germany regarding its Avandia diabetes treatment. The drugs sector is suffering from investors moving away - probably temporarily - from more defensive stocks.

But Glaxo has also been hit by news that Germany 's Federal Joint Committee recommended health insurers should stop paying for Avandia, citing concerns including worries about heart risk. Sales of Avandia have been falling in recent years, but these latest comments do little to help improve sentiment towards the drug.

Germany 's Federal Joint Committee of doctors and health insurers, which makes widely followed recommendations on reimbursement, cited bone fraction and heart risks associated with Avandia's class of drugs. Sales have been declining sharply since controversy over the drug's heart risks first emerged in 2007. Sales of Avandia products fell 16 percent to 771 million pounds ($1.14 billion) last year.

"The committee's course of action is not justified neither from a medical, nor legal point of view," the drugmaker said in a statement.

However, the committee's chairman Rainer Hess said: "There are other pharmaceuticals that have no such side effects and long-term risks. We believe that patients should be protected against useless and, more importantly, harmful therapies."

The ban on glitazone medicines also include Actos, sold by Japan 's largest drugmaker Takeda. The committee also said reimbursement of Novo Nordisk's diabetes pill NovoNorm/Prandin should be stopped alongside other drugs of the so-called glinide category, which include Novartis's Starlix.

The committee said even though glinides have been prescribed for nine years, studies show no evidence of their benefit.

Sales of NovoNorm/Prandin rose 11 percent 2.65 billion Danish crowns ($441.1 million) last year, but Novo Nordisk expects a decline this year because of competition from cheaper generic versions.

U.S. government scientists earlier this month found that GSK's Avandia increased heart risks and deaths compared to a rival pill, just weeks ahead of a highly anticipated public meeting on the drug's safety. The British drugmaker has started settling thousands of lawsuits brought by Avandia patients.

GlaxoSmithKline said by rejecting Avandia, the medical committee had gone beyond its responsibilities. 19.6.10

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‘Bloated' NHS to be stripped of 9,000 managers and faces around £250m in cuts

Thousands of hospital managers face the sack this year, after figures showed the Health Service has ballooned into one of the world's biggest employers. Health Secretary Andrew Lansley is to announce a £250million cut in management costs. This means around 9,000 NHS posts could be axed before the end of the financial year.

Mr Lansley said he was ‘appalled' to have discovered that Labour continued to allow NHS management costs – particularly in primary care trusts – to keep rising even as the public finances were plunging into chaos. Aides suspect that NHS organisations ‘fattened the pig' ahead of the election, knowing that the axe was likely to fall afterwards, to make it appear that they had tightened belts by simply returning to previous staffing levels.

Official figures show that a record 1.626million people now work for the NHS.

Another 5,000 were hired between January and March this year in the dying days of the Labour government. There are few employers who have a bigger workforce – only the Chinese Army, Indian Railways and the U.S. giant Wal-Mart, owner of Asda, are thought to outdo them.

Britain 's biggest private sector employer, Tesco, employs just 280,000 in this country.

Mr Lansley said: ‘We will not allow any of the fat added before the election to frustrate our determination to reverse the excessive increases in cost. ‘Every penny saved will be reinvested in NHS care, in order to meet the increasing demands on the NHS and improve the quality of the service.'

Matthew Elliott of the Taxpayers' Alliance said the figures from the Office for National Statistics were ‘shocking'. The NHS recruitment drive was in stark contrast to the crisis at private sector firms, with many only surviving the downturn by enforcing recruitment freezes or having mass redundancies. ‘The payroll of the NHS is clearly unsustainable and the numbers cannot keep rising at this rate,' Mr Elliott said. ‘Many of these employees are not doctors and nurses, they are pen-pushers, managers, administrators.'

Alan Downey, head of public sector at consultants KPMG, said he was also shocked by the recruitment boom. A decade ago, the NHS employed just 1.2million people. He said the increase was ‘irresponsible in the current climate'.

The latest official figures show the workforce of bureaucrats in the NHS is growing six times as quickly as the number of nurses.

While the number of health service managers went up 12 per cent in one year, the number of nurses increased by less than two per cent – and the number of health visitors plummeted. 17.6.10

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Former City Minister Lord Myners attacks 'considerable waste' of his Labour government

Labour's former City Minister Lord Myners has turned on the previous government and accused it of presiding over wasteful spending. He condemned the politicians who were his colleagues just weeks ago, claiming they had shown 'flawed thinking' on the economy. The peer insisted New Labour had not been progressive because it had spent more than it could raise in taxes and left future generations saddled with huge debts.

'There is nothing progressive about a government that consistently spends more than it can raise in taxation and certainly nothing progressive that endows generations to come with the liabilities incurred with respect to the current generation,' he said. His extraordinary attack on the administration he was a part of gave the coalition unlikely support on the need for spending cuts.

David Cameron seized on the comments today at his second Prime Minister's Questions in the Commons, with Lord Myners watching in the public gallery above. 'Lord Myners, who was hand picked by the last government to be Treasury Minister, has absolutely put his finger on the button,' he said. 'Those words are absolutely right - what a pity he didn't say it when he was in office and had the chance to do something about it.'

The Prime Minister again reiterated that spending cuts are absolutely vital, 24 hours after George Osborne laid the ground for the most drastic cuts since World War II. 'If we don't take action to deal with this deficit, we are going to be paying £70bn just on debt interest in five years time,' he said. 'All of the revenue gleaned from corporation tax - that doesn't even pay for barely half of the interest bill. 'That's the mess we have been left with because the last government did not have the courage to deal with it.'

Lord Myners, in the House of Lords last night, admitted there was 'considerably waste in public expenditure' where savings could be made. 'I have seen that in my own experience as a government minister and I hope that the Government will pursue with vigilance its search for waste and search for efficiencies without cuts which are injurious to the provision of public service,' he said.

He told peers: 'I found it very frustrating to sit in meetings with some of my fellow ministers talking about creating jobs in the green economy, creating jobs in biotechnology. The Government can't create jobs. The Government can create the environment which is conducive to the creation of jobs but it cannot create jobs and we mislead ourselves if we believe it can.'

The coalition seized on the remarks as a 'damning indictment' of Labour's record. Current City Minister Mark Hoban said: 'Lord Myners has let the cat out of the bag and admitted what we have been arguing all along. 'Coming after (ex-Treasury chief secretary) Liam Byrne's admission that there is no money left, this is yet another shocking indictment of the previous government's record and the legacy it has left behind that we are now having to deal with. This is just the latest blow to Labour's economic argument.'

Lord Myners had a successful City career before being drafted into the government by Gordon Brown in October 2008, at the height of the credit crunch. Although he was made a Labour working peer, he was not well-known as a supporter of the party before becoming a minister. 9.6.10

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Government poised to scrap GP patient survey in favor of outcomes and results

The Government looks set to scrap the GP patient survey in its current form after health secretary Andrew Lansley said it 'missed the point' and should be replaced with a new system placing greater emphasis on outcomes. In his first major speech since taking up his new role, Mr Lansley said that the patient survey is 'too much like asking patients whether they were grateful' and argued that ‘access is not as important as outcomes'.

The speech, to patients and clicinians at the Bromley-by-Bow health centre in East London , paves the way for the controversial survey, which has cost GPs millions despite high overall satisfaction scores, to be scrapped in its current form. It is the first time that the Conservatives have indicated that the survey is to go, although their coalition partners the Liberal Democrats have called for it to be axed because practices were losing millions on the word of a fraction of patients.

Mr Lansley said patients should be required to answer ‘more immediate, relevant questions', highlighting the example being set by some hospitals. He said: ‘Patient access surveys in general practice miss the point of whether patients are doing well and if they have good outcomes, if they required treatment or advice. Access is not as important as outcomes.'

‘I have seen hospitals asking more immediate questions, with more relevant and particular questions, like ‘when you pressed the call button, was the response what you expected, better than you expected or worse than expected.' Mr Lansley said he wanted to make comparable data more readily available to patients that embraces ‘all that goes to make up quality', including access, but also quality of clinical care.

The health secretary did not outline any further detail of the Government's plans to rewrite the GP contract to make GPs responsible for commissioning. But, as expected, he did announce plans to radically reshape Payment by Results, by refusing to pay hospitals double if patients are readmitted as an emergency within 30 days of being discharged, to reduce unnecessary bouncebacks of referrals to GPs. 9.6.10

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Nurses spend just a third of time with patients because of NHS bureaucracy

Nurses are so overwhelmed by NHS bureaucracy they spend just a third of their time with patients, the Health Secretary has revealed. Andrew Lansley said nurses are forced to spend the bulk of their time completing paperwork and filling in forms, limiting the time they can spend with those in their care. He called for an overhaul of the system to allow nurses to get on with their jobs and vowed to put patients in the 'driving seat' to improve the health service.

In his first major speech as Health Secretary, he also ordered hospitals to adopt a 'zero tolerance' approach to tackling superbugs to cut the thousands of unnecessary deaths caused by the infections. One possibility is that all patients could be routinely tested for MRSA when they arrive at hospital for treatment.

And in a pledge to end the scandal of emergency hospital readmissions, which rocketed by 50 per cent under Labour, Mr Lansley said hospitals would be held responsible for patients' health for up to a month after they are discharged. They will face fines if patients have to be readmitted because they are discharged too soon, he added.

'We need to free nurses to nurse much more,' Mr Lansley told the Telegraph. 'They often spend just 50 per cent of their time interacting with patients, and in some cases as little as 35 to 40 per cent, because of bureaucracy and the shift system.'

The Royal College of Nursing has repeatedly warned that nurses are being bogged down by the weight of administrative duties. It said that in 2008, nursing staff across England spent more than a million hours a week on paperwork  -  time it said could have been better spent tending to patients. As part of his plans the Health Secretary also pledged to set doctors free from centralised targets.

He also promised to publish more information on the performance of the health service, to allow patients greater choice within the NHS.
Mr Lansley also said that his ambition was for patients with cancer to live as long as patients treated by any other health service.

In a speech in East London , the Health Secretary strongly criticised the former government for its seemingly endless string of superbug targets. 'I have spent too long with too many people who have lost loved ones to healthcare associated infections not to be determined to act on this,' he said. 'The only acceptable strategy is a zero-tolerance strategy.'

Mr Lansley singled out the Royal Berkshire Hospital and the South-East Coast NHS, both of which have committed themselves to a zero-tolerance approach. 'If they can do it, so can others,' he said. Both organisations are introducing MRSA testing for emergency admissions as well as routine admissions. But the Department for Health was unable to say last night whether the scheme would be extended nationwide.

Around 3 per cent of people carry MRSA on their body without ill effects. Simple swab tests can pick up the infection, which can then be treated.

The Government has already ordered the weekly publication of MRSA and C.diff infection rates for every hospital in the country. Officials are now looking at extending the scope of the data to include individual departments or even wards, and other bugs. Hospital deaths from superbugs soared under Labour despite a string of initiatives to bring infection rates down. In 2008 C.diff was mentioned as a contributory factor in 5,931 deaths, while MRSA was associated with 1,230 deaths.

Mr Lansley also used yesterday's speech to confirm plans to tackle emergency hospital readmissions. Under a scheme to be introduced next year, hospitals will not receive funding for the emergency treatment of patients who have been discharged in the previous 30 days. The move is designed to end the scandal of 1,500 NHS patients a day being returned to hospital after apparently being discharged too soon. 9.6.10

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NHS 'should pay people' to lose weight

Paying people up to £3,000 to lose weight is more successful than traditional diets and should be rolled out across the NHS, it has been claimed. The founder of the controversial Pounds for Pounds scheme said that people who are paid according to how much weight they lose and if they keep it off are more successful than those on traditional diets.

Winton Rossiter, founder of Weight Wins, said dieters who completed the programme lost on average two stone, or around 12 per cent of their body weight, which was twice as much as those not being paid. The scheme included 402 people who were sponsored by the NHS Eastern and Coastal Kent.

However some will question if the NHS should be spending money in this way, especially as operations are being banned and staff face redundancy in order to save the health service £20bn over the next five years. A spokesman for NHS Eastern and Coastal Kent said the results were 'mixed' and three quarters of people dropped out before the end of the scheme despite the financial incentive on offer.

The programme works by adding up how much weight each participant has lost and how long it remains off for before applying a sliding scale of payments. Those who lose the most and keep it off earn the most money.

Winton Rossiter, founder of Weight Wins, which ran the trial, said: “We are absolutely thrilled with these results, which suggest that long-term financial incentives could be the best single weapon in the war on obesity. I urge the NHS and employers to adopt such schemes widely for the benefit of their patients and employees. I am so confident this works that, for our part, I am willing to guarantee results.”

In the trial, 45 per cent of participants lost five per cent or more of body weight, deemed to be medically significant, and one patient lost eight stone. The company is opening its trial to members of the public and increasing the maximum reward to £3,000 for a weight loss of more than 10 stone (150lbs), which must be achieved and maintained over two years.

Participants pay a one-off registration sum of £45 plus £10 a month.

The Department of Health obesity strategy launched under the Labour Government suggested financial incentives could be used to encourage weight loss after similar programmes have shown some success in America .

Claire Martin, Acting Assistant Director of Public Health for NHS Eastern and Costal Kent, said: “In these challenging times we need to make tough financial decisions and make sure we are investing our money wisely and these initial findings are just part of the overall picture. “Very often people lose weight but when they stop their diet the weight returns within a short space of time. We need to invest in programmes that return a sustained weight loss and produce long-term health benefits.

“In conclusion, there were high dropout rates and so it is very difficult to interpret the results to show how successful this would be across our population. “Clearly it works for some people, but more research needs to be undertaken to understand the true effect of incentives on weight loss.”

A Department of Health spokesman said: “The Government wants people to eat well and be active as this will help them live longer. The NHS must focus on prevention to tackle public health challenges – including obesity.

"Any incentives to help people change their behaviour must be based on sound evidence.” Two thirds of British adults are either obese or overweight and it has been forecast that this could increase to nine in ten by 2050 if no action is taken. 8.6.10

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Sea sponge breast cancer drug hope

A breast cancer drug based on extracts of sea sponge could extend lives, experts have said. The results of a final-stage clinical trial into the drug eribulin mesylate found it extended life by 2.5 months on average in women with advanced breast cancer.

All the women had undergone several treatment regimes before trying the new chemotherapy, and had either recurrent breast cancer or breast cancer that had spread. Those treated with eribulin typically survived for 13.1 months, compared with around 10.7 months for women on other treatments recommended by their doctor.

The clinical trial, led by a team in Leeds and presented at a major American cancer conference, involved 762 patients. Of these, 508 had previously been treated with at least two - and no more than five - chemotherapies, and were compared with 254 women receiving other treatments.

The new drug is based on a natural extract of marine sea sponge but has yet to be approved for widespread use. It is a man-made copy of a natural product extracted from the sponge Halichondria okadai, and affects the way cells divide.

Lead investigator, Professor Christopher Twelves, from the University of Leeds and St James's Institute of Oncology , presented his findings at the American Society of Clinical Oncology conference in Chicago . His team believes that adding 2.5 months to the lives of such seriously ill cancer patients is a big improvement.

The trial was set up to compare the new drug with various other treatments chosen by the women's doctors. This meant it was tested in a "real-life" setting. 7.6.10

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NHS pays private firm £26m for operations that never took place

Incompetent Health chiefs have wasted £26million paying a private firm for operations that never took place. The NHS signed a £70million contract with South African company Netcare to carry out 9,000 operations a year at the Greater Manchester Surgical Centre in Trafford.

However, fewer than two thirds of the operations ever took place. But under the terms of the deal with Netcare - which ended last month - the NHS had to pay for the lot. The amount of money wasted is enough to pay the salaries of 1,000 nurses for a year. Paul Mainwaring, from Greater Manchester patients' watchdog the Patients' Council said: ‘This is a huge amount of money and it could have been so much better spent.' 

The £26million would also have been enough to fund 100,000 overnight stays in hospital and is more than it cost to set up the Wolfson Molecular Imaging Centre, in south Manchester - one of the world's most advanced cancer research units.   The 10 Greater Manchester PCTs have only used 62 per cent of the Netcare contract since it was signed in 2005.

Health bosses say the contract has helped reduce waiting lists dramatically and more than 34,000 people have been to the treatment centre, which has carried out 27,000 operations. At the time of the agreement, some patients were being forced to wait 15 months for operations.

Almost 90 per cent of general surgery operations bought were used, 70 per cent of orthopaedic ops were used and just 30 per cent of ear, nose and throat procedures. The centre will transfer back to Trafford NHS Trust, as planned during the summer.  NHS North West declined to comment. 

A Netcare official said: ‘Whilst the level of activity  completed at the GMSC is lower than what was contracted, this difference may be attributed to the GMSC helping to decrease NHS wait times much sooner than anticipated.'  5.6.10

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The pandemic that never was: Drug firms 'encouraged world health body to exaggerate swine flu threat'

Declaring a swine flu pandemic was a 'monumental error', driven by profit-hungry drug companies spreading fear, an influential report has concluded. It led to huge amounts of taxpayers' money being wasted in stockpiling vaccines, it added.

Paul Flynn, the Labour MP charged with investigating the handling of the swine flu outbreak for the Council of Europe , described it as 'a pandemic that never really was'. The report accuses the World Health Organisation of grave shortcomings in the transparency of the process that led to its warning last year.

The MP said that the world relied on the WHO, but after 'crying wolf', its reputation was in jeopardy. The report questions whether the pandemic was driven by drug companies seeking a profit. Mr Flynn said predictions of a 'plague' that would wipe out up to 7.5million people proved to be 'an exaggeration', with fewer than 20,000 deaths worldwide.

Britain braced itself for up to 65,000 deaths and signed vaccine contracts worth £540million. The actual number of deaths was fewer than 500 and the country is now desperately trying to unpick the contracts and unload millions of unused jabs. The focus on swine flu also led to other health services suffering and widespread public fear. 

Pharmaceutical companies, however, profited to the tune of £4.6billion from the sale of vaccines alone.

Mr Flynn said: 'There is not much doubt that this was an exaggeration on stilts. They vastly over-stated the danger on bad science and the national governments were in a position where they had to take action. 'In Britain , we have spent at least £1billion on preparations, to the detriment of other parts of the health system. This is a monumental failure on the WHO's part.'

The Council of Europe inquiry heard allegations that the WHO had downgraded its definition for declaring a pandemic last spring  -  just weeks before announcing there was a worldwide outbreak. Critics said the decision to remove any need to consider the deadliness of the disease was driven by drug companies desperate to recoup the billions of pounds they had invested in developing pandemic vaccines after the bird flu scares.

But the WHO said its basic definition of a pandemic never changed. Mr Flynn said: 'It doesn't make any sense as to why they should have changed the definition a month before declaring an outbreak. 'In this case, it might not just be a conspiracy theory, it might be a very profitable conspiracy.'

A Daily Mail investigation earlier this year revealed more than half of the swine flu taskforce advising the Government on its strategy had ties to drug companies. Eleven of the 20 members of the Scientific Advisory Group for Emergencies had done work for the pharmaceutical industry or are linked to it through their universities.

Concerns about drug companies' influence are also highlighted by a separate investigation by the British Medical Journal and the London-based Bureau of Investigative Journalism. It found that key scientists behind the WHO's advice on stockpiling pandemic flu pills such as Tamiflu had financial ties with the drug companies that stood to profit. The WHO last night firmly rejected all the criticism.

Spokesman Gregory Hartl said: 'There is no question of this being a fake pandemic. If fits the criteria for a pandemic, which is a new virus to which human beings have little or no immunity and which has spread around the world. 'It spread from zero to 74 countries in the space of 9 weeks  -  that's a pandemic.' He said that not all ties to drug companies were necessarily conflicts of interest.

But critics said 'the fake pandemic highlights the bias between government advisory panels and the pharmaceutical industry, they are not independent they are in the pockets of the drug companies'. 5.6.10

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Critics sickened as just nine NHS bosses go in shake-up

Hundreds of health workers face axe as executives cling on. ONLY nine senior managers will be among more than 700 NHS Lothian staff facing the axe this year, it has emerged. Critics have reacted angrily to the fact only a handful of the health board's best-paid executives – on more than £60,000 a year – are being targeted in the drive to save £31 million.

In contrast, more than 330 nursing and midwifery posts and nearly 60 doctors are to be cut. The Scottish Government and health board today pointed out the proportion of executive jobs going was greater than in other areas.

But Jackie Baillie, Scottish Labour's health spokeswoman, criticised NHS Lothian for not aiming to get rid of more of the 174 senior managers earning salaries above £60,000. "This is a crazy sense of priorities," she said.

The 700 posts are just the first round of cuts, with the health board planning to lose 1,300 more jobs next year. The health board is fighting a funding battle on two fronts, with the tightening of budgets plus a funding formula which sees an "unfair" share of funds coming to Edinburgh compared with Glasgow.

Margaret Watt, chairwoman of the Scotland Patients Association, said: "People go into hospital and need the best care which is provided by frontline health workers. "It's time the ones at the top took the hit. They are employed by us, no-one else."

Department heads across NHS Lothian have all been asked to shave at least five per cent off their budget, but some senior NHS sources believe job cuts aren't the best answer. One told the Evening News: "What we have to ask is are we looking carefully enough at whether some tasks performed by one group could be done more sensibly by another?"

Health secretary Nicola Sturgeon added: "These figures are not set in stone. I expect boards to continue to try to minimise the reductions by working hard to maximise non-workforce- related efficiencies." Alan Boyter, NHS Lothian's director of human resources, said: "The figures are initial projections which are in no way indicative of any planned staffing reductions." 4.6.10

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MS drugs scheme a 'costly failure' that set back NHS £63,000 per patient

A risk-sharing scheme to supply multiple sclerosis (MS) medicines to patients has been a 'costly failure', experts have said. The NHS could have saved £250million if the scheme had been properly assessed after two years they said, adding that the money could have been better spent on other treatments.

The programme was set up between the Government and drug firms after the the National Institute for Health and Clinical Excellence deemed a group of MS medicines too expensive and questioned their effectiveness. Other, similar types of schemes are up and running to bring more drugs to NHS patients and are wasting millions of pounds.

Under the terms of the MS risk-sharing scheme, established in 2002, the Government agreed to pay for the drugs while research was carried out to assess their long-term cost effectiveness. The NHS would then gradually stop paying for the drugs if patients did not appear to be benefiting.

In 2009, seven years after the scheme was set up, data was published showing patients were performing less well than predicted. A total of 5,583 patients have received one or more treatments, costing in the region of £350million, or £63,000 per patient. The Multiple Sclerosis Society said twice as many patients were using the drugs outside the trial, implying a total NHS cost of £700m for a treatment that does not work.

The charity added that it withdrew its support for the scheme in 2009 after repeatedly raising concerns with the Department of Health over four years. Despite this and a lack of convincing evidence of benefit, a scientific advisory group reporting to the Government has said it would be premature to reduce prices without further analysis.

A group of experts led by Professor Christopher McCabe from the University of Leeds have criticised this decision in a series of articles published in today's British Medical Journal. The experts said the arguments did not stack up and said they were concerned about the supposed 'independence' of the group.

'The manufacturers, patient groups, clinicians, and the Department of Health are represented on the scientific advisory group,' they wrote. 'All these bodies have a vested interest in maintaining the status quo.

'The budget holders, who pay for these drugs, with responsibility for the health of populations served by the NHS, are not represented on the scientific advisory group, and as a result there is no countervailing influence on the group's decision making.'

Simon Gillespie, Chief Executive of the MS Society, said: 'The Risk Sharing Scheme has given many people access to MS drugs but it is stuck in the past and has failed to take account of the most up to date evidence and practices. 'We are calling on the new government to ensure that people with MS across the UK have equity of access to the right drug, at the right time in line with current evidence. This cannot be achieved through the current scheme.'

However Professor Alastair Compston at Cambridge University , who helped set up the scheme, argued that although it had not been run entirely properly or adequately governed, it had helped patients. "Regardless of the scheme's outcome, it has advanced the situation for people with multiple sclerosis,' he said. 'Now that the principles of when and who to treat are better understood, more effective treatments can be developed.'

But critics are furious about the comments and the waste of £700millions on a scheme which was poorly administered and only benefited the drug companies and those involved on the advisor panel. 4.6.10

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NHS 'has wasted millions on MS drugs which did nothing to help patients'

The NHS has wasted millions of pounds on MS drugs which did nothing to help patients, according to experts. They called for a Government-backed scheme to provide the drugs to be scrapped and called for a public inquiry. In total at least £250 million could have been saved if a review had been carried out on the “costly failure” after its first two years, they warn.

This money could have been used to help other health service patients, including those with multiple sclerosis. Charities backed the call for the scheme to be abandoned. Set up in 2004 it was intended to allow expensive MS drugs on the NHS. A key feature of its design was that the price of the drugs would be cut if they proved ineffective.

However, there has been no price reduction over the past six years, despite signs that the drugs were not working. Recent research results show that patients actually did worse on the drugs than if they were given a placebo.

Prof George Ebers, from Oxford University, one of a number of MS experts who have written articles in the British Medical Journal (BMJ) criticising the project, said: “The scheme may have been well intentioned, but perhaps the public interest would be served by an independent inquiry.” More than 100,000 people suffer from the devastating disease in Britain.

Patients experience difficulty walking or speaking and there is currently no known cure. MS itself is caused by the destruction of myelin, a fatty protective sheath surrounding the body's central nervous system. The MS society backed calls for the scheme to be abandoned.

Simon Gillespie, the charity's chief executive, said that while it had given many patients people access to drugs it was “stuck in the past and has failed to take account of the most up to date evidence and practices.” He added: “We are calling on the new government to work to ensure that people with MS across the UK have equity of access to the right drug, at the right time in line with current evidence. “This cannot be achieved through the current scheme."

The four drugs involved Avonex, Betaferon, Copaxone and Rebif, cost around £8,000 per patient per year.

Critics said 'this is not an isolated incident the NHS is wasting £billions on drugs that have little or no effect for patients and in most cases make matters much worse due to the side effects of the drugs which aren't helping anyway. Another example is anti-depressants, there are 34million prescriptions for these drugs each year and everyone knows they don't work. The problem is fuelled by the pharmaceutical industry who ‘look after' those who commission their drugs, it's a sleazy affair'. They welcomed the call for a public enquiry into all drug commissioning.

In 2002 the 4 drugs were rejected for use on the NHS by the National Institute for Health and Clinical Excellence (Nice), the Government's drugs rationing body, because they were too expensive. However, the following year the Government and the pharmaceutical companies involved agreed to start a “risk sharing” scheme, which saw an initial reduction in the price with the promise of more to come if the drugs did not work very well.

Around 10,000 patients in Britain are thought to have received the drugs thanks to the scheme. A Department of Health spokesman said: "The risk sharing scheme has brought many benefits to MS patients including better access to drugs, a stronger network of MS specialists including specialist nurses and a better platform for MS research. “We continue to monitor the progress of the scheme to ensure best value for money.” 4.6.10

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GPs call for more time with patients - as Ministers look for £20bn in NHS savings

Patients are being put at risk by GPs failing to diagnose them properly because appointment times are too short, a survey reveals. Two out of five family doctors said the brief consultations affected their ability to make a diagnosis, while half said they spent less time with patients than five years ago.

Separate research last month found two-thirds of people thought NHS appointments were rushed. The findings come as the Government released a report outlining the scale of cutbacks needed in the NHS to meet efficiency savings of £20billion by 2014.

Management consultants McKinsey warned the last Labour government that thousands of jobs would have to go in a report leaked to the media in the autumn. It also said nurses spent just 41 per cent of their time on patient care, with half of midwives' time spent dealing directly with patients.

The study of 200 GPs, from insurer Aviva UK Health, found 57 per cent said they had less time with people than five years ago. Half believed short appointment times affected their ability to do their job, while only seven per cent were confident it had no impact. Nearly 90 per cent of GPs would like 20 minutes per patient - double the standard of ten minutes each.

Some 85 per cent used online tools to diagnose patients but just 5 per cent said this was because they are pressed for time. GP Dr Hugh Laing, who worked on the study, said: 'Our research shows that GPs are overstretched and this can affect the quality of support they are able to offer.

'Web-based technology has revolutionised the way we all work. But ultimately there is no substitute for a thorough assessment by a qualified GP and this is clearly not happening in many cases. 'As such, we urge the new coalition Government to support and work with GPs to ensure delivery of the right care for patients.'

Dr Laurence Buckman, chairman of the British Medical Association's GPs committee, said he was not surprised to hear that doctors 'feel overstretched'. 'Pressure on general practice has been growing as more work has been transferred from hospitals and paperwork has increased,' he added.

'The BMA, and many patients, believe appointment times should be longer because we know GPs would like more time to care for patients. However, that means we would also need more GPs.' NHS figures show appointment times were 11.7 minutes on average in 2008/09, up from 8.4 in 1992/3.

However, a Department of Health spokesman said the survey results were 'misleading'. 'GP appointment times have actually increased over the past 15 years,' he added. 'GPs are best placed to make decisions about the length of their appointments based on their clinical judgment.'

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: 'The McKinsey report highlights the sheer scale of the financial challenge the NHS is facing. 'It is vital nursing staff are involved in discussions about efficiency savings to ensure quality and patient safety does not suffer.'

Meanwhile, a top doctor said NHS Trusts are compiling lists of treatments to be decommissioned or reduced in an effort to make £ 20billion of efficiency savings by 2014. Among treatments which could be targeted are hernias, joint replacements and cataract surgery.

Dr Mark Porter, chairman of the British Medical Association's consultants committee, warned NHS bosses were seeking 'wholesale reductions in budgets'. 3.6.10

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Straight to the point: As scientists prove acupuncture DOES beat pain, why it might help you...

Despite being dismissed by many as a pseudo science, new research has found that acupuncture does work. Scientists say the treatment, which involves sticking needles into the body, triggers a flood of natural painkillers. The research on animals showed that during and immediately after treatment, levels of the painkiller adenosine increased more than 20-fold and pain was reduced by two-thirds.

So should we all be rushing out to have the ancient Chinese therapy for our aches and pains?

What is it?
Acupuncture is a complementary treatment involving putting needles into various 'pressure points' in the body. It has been used as part of traditional Chinese medicine for at least 3,000 years and in Western countries since the Seventies.

What's the theory?
The Chinese believe we all have energy called Qi - pronounced chee - flowing through the body along channels called meridians.

The theory is that we become ill when this energy flow is interrupted and inserting tiny needles into socalled 'trigger points' around the body can restore the flow.

What is it used for?
Acupuncture is used for a huge range of diseases and disorders, including arthritis, headache and migraine, sinusitis, neck and back pain, joint pain, hot flushes, allergies, hay fever, eczema, depression, anxiety, irritable bowel syndrome, infertility and insomnia.

Any evidence it works?
The jury is out. Research suggests the most promising area for acupuncture is conditions involving pain and inflammation.

One Munich University study of hip and knee osteoarthritis, for example, based on more than 700 patients, found that acupuncture can significantly lower pain levels and improve quality of life. Meanwhile, a U.S. study showed that those who had acupuncture for headaches took 15 per cent fewer sick days compared to those who did not have the treatment.

However, despite its growing popularity in pregnancy and during labour, five trials involving 2,000 women, found that acupuncture did not help with labour pains. The National Institute for Health and Clinical Excellence (NICE) provides guidelines to the NHS on use of treatments and care of patients , and currently, recommends acupuncture as a treatment option for one condition: lower back pain

How could it work?
While the traditional explanations centre on energy lines, modern research suggests that needles stimulate skin and muscle nerves, which causes the body to release serotonin, endorphins and adenosine which act as natural painkillers.

What happens?
With traditional acupuncture, disposable needles pierce the skin at various pressure points in the body. They are usually left in for 20 minutes. Some acupuncturists insert 'intradermal' needles into the ear, which are left in for several hours to maintain the energy flow. A typical course of treatment is four to six sessions

Does it hurt?
Patients describe the sensation of the needles going in as a tingling or dull ache.

Any side-effects?
Some people may experience mild pain, bleeding or bruising. Some may also become drowsy.

Is it safe?
Yes, when carried out by a qualified practitioner. Tell your therapist if you are pregnant, because some acupuncture points should not be used during pregnancy.

Should I tell my GP?
Yes, to be on the safe side. Is it available on the NHS? YES, but it is limited and most people pay privately. Costs vary from around £25 to £60 a session.

How do I find a therapist?
British Acupuncture Council members are bound by codes of ethics, practice and disciplinary procedures, and have extensive training. 1.6.10

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Antidepressants 'increase the risk of miscarriage by 68%'

Mothers-to-be who take antidepressants during their pregnancy have a far higher risk of suffering a miscarriage, according to a new report. Researchers from the University of Montreal found the risk of miscarriage rose by 68 per cent among pregnant women taking the drugs.

Depression is very common during pregnancy due to the hormonal upheaval, with one in 30 women taking antidepressants while expecting a baby. Suddenly halting treatment can result in a depressive relapse which can put mother and baby at risk. The latest study sought to determine if there was a link between antidepressant use in pregnancy with the risk of miscarriage.

The scientists looked at data on 5124 pregnant women who had clinically verified miscarriages up to 20 weeks of gestation and a large sample of women from the same Registry who did not have a miscarriage. Of those who miscarried, 284 (5.5 per cent) had taken antidepressants during pregnancy.

Selective serotonin reuptake inhibitors, especially paroxetine and also venlafaxine were associated with increased risk of miscarriage as were higher daily doses of either antidepressant. A combination of different antidepressants doubled the risk of miscarriages. 'These results, which suggest an overall class effect of selective serotonin reuptake inhibitors, are highly robust given the large number of users studied,' writes senior author Dr Anick Birard, from the University of Montreal.

The researchers urge that physicians who have patients of child-bearing age taking antidepressants or have pregnant patients who require antidepressant therapy early in pregnancy discuss the risks and benefits with them.

Ms Adrienne Einarson, Assistant Director of the Motherisk Program at The Hospital for Sick Children (SickKids) writes that there is no 'gold standard for studying the safety of drugs during pregnancy, because all methods have strengths and limitations,' and results can vary from one study to the next.

In this study, there were missing data on important potential confounding factors. However, the overall results on the use of antidepressants during pregnancy and the risk of miscarriage, despite the different methodology, were almost identical to a Motherisk study with 937 women published in 2009. Although the author says the study could not reach a definitive conclusion she said less there were double the number of miscarriages in the women exposed to antidepressants compared to those not exposed. 1.6.10