NHS WASTE

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Getting patients to do things as simple as writing down details of their appointment themselves could save the NHS almost £250 million a year, according to a pilot study. Up to six million GP and hospital appointments are missed every year, costing the health service an estimated £700 million. Traditional approaches to the problem have included sending reminder letters and putting up posters telling patients how many GP days are lost every year because of "do not attends" (DNAs).

But a small project in Bedfordshire managed to cut the inattendance rate by up to 30% by jettisoning those ideas. Instead, patients were asked to write down when their appointment was, rather than the receptionist doing it, and repeat back to them out loud the details. Posters were also put up at the two participating GP surgeries, and messages run on digital tickers, saying: "Ninety-five per cent of people turn up to their appointments on time."

Steve Martin, director of Influence at Work, a behavioural science consultancy, said the psychology of negative messages was all wrong. He said, "The vast majority of practices and hospitals tend to have these posters that point out how many people don't turn up. But that just makes people think it's normal not to attend. The most important single action was getting people to write down the details of their appointment."

Nadia Shaw, practice manager of Toddington Medical Centre, outside Luton, said, "Given how simple the interventions were we weren’t too sure how successful they would be but they proved to be an amazing turnaround for us." Prof Robert Cialdini, founder of Influence at Work, added, "If there is any puzzlement, it concerns why approaches as simple and costless as these are not deployed more often." However, the question remains about whether the pilot's success could be replicated at a much larger scale. (Source: Daily Telegraph, Jul/11)

As many as 140,000 non-medical staff, including porters and housekeepers, have access to sensitive NHS patient files. The lack of privacy protection has been revealed by a Freedom of Information survey. Government guidelines say only staff involved in 'providing and supporting patient care' should have access to confidential information. But trusts are interpreting the rules so widely that administrators, porters and IT staff are all cleared to potentially delve into a person's medical file.

The Information Commissioner's office said access to records should be strictly controlled and it would study the revelations to see if further action was needed. Critics say it will become even easier to access medical records when they are stored on a controversial new NHS database, although the Health Department says this will make files more secure. The survey of NHS trusts was carried out by the privacy campaign group Big Brother Watch.

It asked specifically about the number of staff not directly involved in the treatment of patients who have immediate access to medical records. Immediate access was defined as being able to see at least a patient's name, date of birth and most recent medical history without needing the consent of the patient or another member of staff. In the 140 Trusts which responded, 101,272 non-medical staff could potentially access such records, an average of 723 per trust.

When trusts which did not respond are factored in, the total across the country could be as high as 140,000. Among those who replied, the University Hospital of North Staffordshire NHS Trust said those with access included 107 porters and 105 receptionists. At Cwm Taf NHS Trust the total included receptionists, housekeepers and domestic staff. North Staffordshire said porters did not have access to electronic records, but routinely carried paper files between departments as part of their job.

Fears have already been raised over the security of moving records online as part of the Government's National Programme for IT. Earlier this month the British Medical Association called for the programme to be slowed down, saying pilot schemes had not yet been properly evaluated and not all patients had been given the chance to opt out. Big Brother Watch says patients could challenge the legality of the system.

The European Court of Human Rights, passing judgment on a Finnish case, has said access should be restricted to those directly involved in personal care. Campaigners say such widespread access is behind the worrying level of data security breaches in the NHS. The latest-report by the Information Commissioner revealed 140 incidents reported in the NHS in just four months, more than central and local government put together.

The Department of Health said, "We have made it very clear that it is completely unacceptable for staff with no involvement in providing and supporting patient care to access confidential information. We have set clear standards for NHS organisations." The spokesman said the computer modernisation programme would cut the number of staff who could see files. He said, "Access to electronic records is controlled by smartcards, which allows all access to be tracked and audited. This means that, unlike with paper files, any abuse can be traced and dealt with."

The Summary Care Record will make patient files easier to access than ever before. And there are fears that the Government is making it too hard for patients to opt out of having their details added to the NHS computer system. The system will bring together a short medical history of a patient in a computer file. But before these records can be uploaded a person must have a written warning, which comes with an opt-out form.

Patients are supposed to have a 12-week window to contact the NHS if they want to opt out. They can also find the form online. However, the British Medical Association says letters may go missing, meaning a person's details are being added without their knowledge and 'at breakneck speed'. Almost 1.3million records have already been created and another 8.9million people have received a letter about the programme. (Source: Daily Mail, Mar/10)

Norfolk Primary Care Trust is to become the first to penalize smokers by taking them off waiting lists for surgery. The Trust, which is £50million in the red, said smokers have a higher risk of complications and take more time to recover from surgery, leading to longer stays in hospital. Health chiefs have taken the step because they say operating on smokers is more expensive. They are being ordered to try to quit their habit or risk losing the chance of an operation. The PCT recognised the health benefits of the move, but it made no secret that it is introducing the policy to save money. (Source: Sunday Mirror, Oct/06)

The NHS spent tens of millions of pounds removing nearly 200,000 tattoos in 2005, according to figures released by the Department of Health. Conservative estimates of the cost of removing a small tattoo under anaesthetic on the NHS put the bill for 2004-05 at £37m, but some consultants suggested a figure of £300m. Because tattoos penetrate under the skin, removing them is expensive. The tattooed area must be cut out and skin grafted over the gap. Removing tattoos with skin grafts in the private sector can cost £1,000-£2,500 and laser surgery costs from a minimum £200 to more than £2,500. A health trust in Manchester recently agreed to spend £2,500 removing the tattoos of transsexual Tanya Bainbridge. The former merchant seaman, previously called Brian, claimed the large tattoos on her forearms were “not ladylike” and made her depressed. (Source: Times Online, Oct/06)

The Government has spent £52.5 million in six years on management consultants for the health service. Frank Dobson, the former health secretary, said the sum was "the tip of the iceberg" because it represented only what the Department of Health had spent on outside consultants. Taking into account what individual hospital trusts and other health service bodies had spent in the same period, the figure was probably more than £200 million. Mr Dobson added that management consultants were "seldom value for money" and that patients would much prefer the money to be spent on reducing hospitals' deficits. New figures show that the department spent £12.8 million on management consultants in 2004/5, double the 2000/1 figure. (Source: Daily Telegraph, Mar/06)

Foreigners flocking to Britain to fiddle free healthcare are defrauding the NHS out of more than £2BILLION a year. And while hordes of "health tourists" cynically con their way to hugely expensive treatment, law-abiding Brits endure National Insurance hikes and ever-increasing hospital waiting lists. 100,000 foreigners turn up at emergency wards each year claiming to have "suddenly" fallen ill. But many have long-term diseases like kidney failure and others even need organ transplants. Some receive treatment costing more than £50,000. Thousands of heavily pregnant women arrive here specifically to exploit our system.

Some inner city maternity wards complain that HALF their patients are from abroad. Most get care worth over £1,500. And at least 6,000 HIV sufferers are coming into the UK annually, according to the Institute Of Hepatology, each taking treatment costing £15,000 a year. Some AIDS clinics reveal that up to 80% of patients have lived in the UK for less than a year. The potential bill is £900 million and rising. Last year immigration overtook gay sex as our biggest source of HIV infection. Hospitals should charge pat-ients not eligible for NHS care.

But the vast majority skip the country without paying a penny. And the crisis is made worse by the increase in asylum seekers and people on work visas ENTITLED to free treatment. An incredible 95% of hepatitis B cases reported here are actually contracted outside Britain, each costs us £10,000 a year. And 40% of London's acute psychiatric beds are taken up by foreigners. Australian backpackers doing Europe head to Britain first where they immediately use their visas to register with a GP and get free travel jabs and tablets, saving £300.

And, as figures collated by the Conservative Party put that £2billion price tag on the medical freeloading scandal, health chiefs warn that overstretched hospitals simply cannot cope. Dr Anne Edwards, a consultant at the Oxford Radcliffe Hospital, said, "We're in crisis. Not only do we not have enough money for our own population but we're having to treat lots of people from other countries. We're shelling out huge amounts of money. A lot of people are resentful." Richard Rawlins, consultant orthopaedic surgeon at Bedford Hospital, said, "One solution could be the introduction of entitlement cards. The alternative is total anarchy, where the British NHS becomes responsible for medical care of three-quarters of the world's population."

GPs are considered the "gatekeepers" of the NHS because any non-emergency patient wanting hospital treatment must be referred by them. GPs in one London health trust were recently advised NOT to seek proof of entitlement, for fear of discriminating against refugees and asylum seekers. GPs face legal action if they attempt to strike off suspected cheats. Manchester doctor Ian Burton tried to remove an Iranian family who registered a growing number of relatives and visitors at their address. He was threatened with the Commission for Racial Equality.

"Our own defence organisation said that if it went to court we'd have lots of bad publicity," he said. "From that point we've not policed anything." But Ronald Langstaff, consultant orthopaedic surgeon at a busy west London hospital, insisted, "This isn't a racial issue, it's a resources and entitlement issue." He knew one case where a foreign woman turned up at casualty demanding dialysis. He said, "When told she wasn't entitled she turned round and said if they didn't treat her she'd apply for asylum and get it free anyway! That is blatant abuse."

The NHS spent £40,000 on the 'Patient Experience Definition' to define what makes a good experience for a patient. The 64-word result says the sick want good treatment. Lib Dem health spokesman Paul Burstow said, "This definition is stating the obvious. Taxpayers will find it difficult to understand why £40,000 has been spent on common-sense definitions. Providing good quality care that treats people with dignity and respect is not rocket science. Ministers should not be wasting cash on dreaming up a statement of the blindingly obvious."

But a Department of Health spokeswoman said, "We make no apologies for seeking patients' views and listening to what they want from the NHS. We can't provide a truly patient-centred service unless we know what is important to them. This work will inform both the Department and the NHS about what patients want when developing and delivering services." If they don't know that for themselves, then they're in the wrong job.

The NHS is in deep financial crisis even though its budget has trebled from £34billion under the Tories in 1997 to £92billion for 2007-8. The extra money invested since Tony Blair's Labour Government came to power has mostly been spent on staff, computers and building work. More than 193,000 extra staff have been recruited over the last seven years, including 23,000 doctors, 67,900 nurses, 26,500 therapists and 71,700 clinical support workers. A new £6.2billion computer system being rolled out over 10 years had been hailed as the most innovative healthcare IT programme in the world. And record funds have been ploughed into building projects for hundreds of hospitals and health centres. (Source: Daily Mirror, Mar/06)

The new chief executive of Queen Elizabeth Hospital in King’s Lynn, Norfolk, is Jane Herbert. The same Jane Herbert who resigned as chief executive of South Manchester University Hospitals Trust in 2002 for fiddling waiting lists by removing patients even though they were still waiting for treatment. She joined Bedfordshire and Hertfordshire Strategic Health Authority as chief executive but quit in 2003 before the publication of a report into the Manchester scandal. The trust’s chief Neil Goodwin, said at the time, it was unlikely she would “ever be employed by the NHS again”. Queen Elizabeth Hospital said, “Jane’s skills, expertise and her strong financial background will be an asset.” (Source: The Sun)