NHS WASTE

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NHS managers are deliberately delaying operations as they wait for patients either to die or go private in order to save money, according to an official report. Health service trusts are “imposing pain and inconvenience” by making patients wait longer than necessary, in some cases as long as four months, the study found. Executives believe the delays mean some people will remove themselves from lists “either by dying or by paying for their own treatment” claims the report, by an independent watchdog that advises the NHS.

The Co-operation and Competition Panel says the tactic is one of a number used by managers that “excessively constrain” patients’ rights to choose where to be operated upon, and damage hospitals’ ability to compete for planned surgery. It claims unfair practices are “endemic” in some areas of England and pose a “serious risk” to the Government’s drive to open up the health service to competition. But managers, who are already rationing surgery for cataracts, hips, knees and tonsils, say they must restrict treatment as the NHS is under orders to make £20billion of efficiency savings by 2015.

Lord Carter of Coles, chairman of the panel, said, “Commissioners have a difficult job in the current financial climate, but patients’ rights are often being restricted without a valid and visible reason.” Katherine Murphy, chief executive of the Patients Association, said, “It is outrageous that some primary care trusts are imposing minimum waiting times. The suggestion that it could save money because patients will remove themselves from the list by going private or dying is a callous and cynical manipulation of people’s lives and should not be tolerated.”

Since 2006, NHS patients who need routine elective care have had the right to choose between at least four hospitals including privately-run units. But there have been claims that trusts, the local bodies that pay for treatment, restrict choice and favour some hospitals to balance their books. The panel investigated whether the allegations were true. It found “many examples of PCTs excessively constraining patients’ ability to choose, and providers’ ability to offer routine elective care services”.

Managers restricted GPs’ ability to refer patients to some hospitals by imposing “caps” on the number a provider would be paid to treat and by imposing minimum waiting times, its report said. Under government targets, patients should be treated within 18 weeks of referral by a GP. But even when surgeons could see them far sooner, the study found that some trusts made hospitals wait as long as 15 weeks before operating. The tactic forced private hospitals, which were more likely to be able to treat patients quickly, to operate as slowly as overcrowded NHS units in an “unfortunate levelling down”.

Some managers insisted that longer waiting times would lead to overall savings as “experience suggests that if patients wait longer then some will remove themselves from the list”. Interpreting this statement, the panel noted, “We understand that patients will 'remove themselves from the waiting list’ either by dying or by paying for their own treatment at private sector providers.” It said that minimum waiting times should only be used as a “last resort” and told trusts to publish their policies on the home page of their websites.

The panel also found that trusts tended to give elective business to their local NHS hospital, rather than allowing choice, in order to ensure its other services such as casualty departments remained financially viable. The findings come as the NHS is under pressure from increasing demand and tighter budgets. Waiting times have lengthened since last year’s general election and more trusts are increasing the number of procedures of “low clinical value” they turn down or insisting that patients’ conditions worsen before they are seen.

Treasury figures that show health spending totalled £101.985 billion in 2010-11, down from £102.751 billion in the last year of Labour, despite David Cameron’s pledge that “the money going into the NHS will actually increase in real terms”. The Tories pointed out that the fall represented the last part of the previous government’s five-year spending plan. Ministers welcomed the competition panel’s study. Paul Burstow, the care services minister, said, “This report illustrates exactly why we need to modernise the NHS and increase choice for patients."

He added, "“Trusts will want to take a hard look at practices in light of this report and ensure they are always in the best interest of patients and the taxpayer.” Under the Health and Social Care Bill, which has been watered down in the face of opposition from the medical profession and Lib Dems, power to buy treatment will be handed from trusts to new bodies led by GPs. The new Clinical Commissioning Groups are intended to be more accountable to patients, while the number of sectors where choice and competition apply is being extended.

David Stout, director of the NHS Confederation’s primary care trust network, said, “The report rightly acknowledges that each situation will be different and the extent that any benefits outweigh the loss of choice should be considered on a case-by-case basis. Commissioners will still be left to decide the right course of action when faced with trade-offs between patient choice and value for money. The suggestion that many current trust decisions are not justifiable on these grounds is largely unsubstantiated by the detail in the report as the CCP has not investigated specific cases in detail. (Source: Daily Telegraph, Jul/11)

Millions of people will be given a secret swine flu jab by health bosses this winter. The H1N1 vaccine will be mixed into the regular flu jab for OAPs, pregnant women and others at high risk. While millions refused to take the jab during last winter's pandemic, this time they will have no choice if they want to be protected against normal flu. The Government was left with more than 30million swine flu vaccines after the pandemic fizzled out in 2010. Some types of swine flu vaccinations are suspected of being linked to an increase in the rare condition narcolepsy, which causes sufferers to suddenly fall asleep at random times.

An NHS spokesman said that while the pandemic of the H1N1 swine flu virus was over, the disease was still a threat. The Department of Health said the Medicines and Healthcare Regulatory Authority, which monitors vaccines, had given the H1N1 jab the all-clear after fears in Europe over the narcolepsy outbreak. She added, "By March this year, that particular H1N1 vaccine had been given out 5.5million times and there have been no reported cases of narcolepsy in Britain." (Source: News of the World, Sep/10)

The NHS is being forced to cut services because of the huge costs of the swine flu scare that proved unfounded. 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 cuts required to pay for swine flu preparations are on top of the cuts needed after the election as the NHS adjusts to a post-credit crunch world. And, for the first time, it has emerged that the average cost of the swine flu scare to primary care trusts was £340,000, enough to pay the salaries of 17 nurses.

The huge amounts were spent on setting up antiviral collection points, storing and distributing vaccines, staff vaccination sessions and advertising to encourage people to have the jab. The news comes just a month after ministers revealed that up to £300million of taxpayers' money was wasted on swine flu jabs that were never needed. The Government ordered 90million doses of a vaccine last year as panic over the illness gripped the country, but when the pandemic failed to materialise, it soon became clear the order was far too large.

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. In fact, the toll has been less than 500, a fraction of the number who died from ordinary flu. The survey of 107 Primary Care Trusts in GP magazine, which submitted a Freedom of Information request, has laid bare the full cost to local health services. Five out of 31 PCTs which gave full details to the magazine said they had made cuts or were considering them, while others said they had used contingency funds to meet costs.

None of the PCTs would say where the axe would fall. Dr Richard Vautrey, deputy chairman of the British Medical Association's GP Committee, said individual trusts should not have had to foot the bill. He said, "I think a pandemic should be seen as an exceptional circumstance and a PCT should be fully supported by central government. The whole nature of a national health service is that one area should be able to support another, and the unusual financial burden of this episode should be borne centrally." (Source: Daily Mail, May/10)

The NHS is ruled by a "culture of fear", with bosses more worried about hitting targets than caring for patients. A report claims that Labour's huge upheavals in the health service have led to "chaos" rather than improvement. It comes despite NHS funds almost tripling from £39.9billion to £102billion in 11 years. The Policy Exchange think tank obtained the bombshell findings, commissioned by the Government as part of a shake-up in safety standards. One report, by the Institute for Healthcare Improvement, said, "The NHS has developed a widespread culture more of fear and compliance than of learning, innovation and enthusiastic participation in improvement."

Another report, by the highly-respected Joint Commission International, said there was a "pervasive culture of fear in the NHS and certain elements of the Department of Health". Watchdogs last year blamed managers' obsession with targets for filthy wards and staff shortages which led to up to 1,200 deaths at Stafford Hospital. A spokeswoman for the Department of Health said, "England is one of the world leaders in the drive to improve the safety of healthcare. Every death or serious injury due to mistakes in medical care must be investigated and the lessons must be learned and acted upon." (Source: The Sun, Feb/10)

The Royal Free NHS Trust hospital is recruiting five clerical staff costing £190,000 just days after axing 500 medical jobs. The trust admitted it is massively in debt and must make savings of £25million in the next year to balance its books. That means dozens of patient beds will also be lost but now the trust has advertised for five recruits, including a £30,000 ‘performance management analyst’ who will monitor data. The other four are ‘risk management’ roles, with salaries of £41,000, being created to ensure health and safety regulations are followed. A hospital spokesperson said, “Any trust staff who are eligible for redeployment under the current savings plan are welcome to apply.” (Source: The Sun, Mar/06)

University College Hospital, which spent £70,000 on a boulder to adorn its main entrance, is to spend hundreds of thousands of pounds on more artwork. Guy Noble, the new £41,000-a-year arts curator, said his ambitious programme would improve patients' health and staff morale and create "a pleasing environment" for visitors. The Chelsea and Westminster hospital also has a large arts programme and Royal London Hospital has a new £36,000-a-year art director. Mr Noble is confident that the critics will be won over. "In five years' time, I think nearly every hospital will have an arts curator," he said. This comes at a time when beds and wards in some NHS hospitals are to close to help to make £1.6 billion of "efficiency savings". (Source: Daily Telegraph)

Taxpayers are pouring billions of pounds extra into the NHS, but less than half gets through to frontline medical services. From £33billion when Labour came to power in 1997, spending in 2005 will be £44.2billion. By 2007 we will spend £92BILLION. Yet experts say the huge increase allocated by Chancellor Gordon Brown is not reflected in improvements in the service. Pay rises of around 20% mean the public don’t get the payback they should and a huge 59% of your money now goes on wages. Out of £5.9billion extra spent in 2004, £1.8billion went on pay rises for existing staff and another £1.6billion on salaries and pensions for new staff. But “output”, cases completed by hospital specialists, has risen by only 1.9% a year.

The longest hospital waiting times have been eliminated, but centrally-imposed “targets” force patients with urgent conditions to wait longer. These stark facts, unearthed by independent analysts after eight years under New Labour, show the price we pay for a cradle-to-grave service in which patients have to take it or leave it. Yet there is good news. Where GENUINE choice is on offer from public and private sectors, quality and speed of care improve instantly. Small pilot projects have seen waiting lists evaporate, with one London hospital having to ADVERTISE for patients.

In one pilot scheme, 18,000 patients waiting more than six months were offered the chance of choosing another hospital. Two-thirds opted to go elsewhere in the NHS or to a private hospital. Waiting lists in the Barking, Havering and Redbridge, East London, area fell by half. The Heart Hospital, bought by the NHS to increase cardiac surgery capacity, ran short of patients. Now the Independent Sector Treatment Centres introduced by Health Secretary John Reid are mopping up backlogs for knee, hip and cataract cases. And bed-blocking has been slashed by penalties for slow-moving local authorities.

The NHS’s financial problems were revealed by two prominent health experts who both back the NHS vision. Nick Bosanquet, Professor of Health Policy at Imperial College London, is an adviser to the independent think-tank Reform. Professor John Appleby is chief economist with the King’s Fund. Prof Bosanquet said, “Since 2001, Government NHS spending in England has increased by around 10% a year in cash terms, about £6billion. It claims real spending has gone up about 7.5%, but after adjusting for changes in pay scales and staffing costs, the rise in real resources is nearer 3%.”

And Prof Appleby warned, “The NHS has to spend on pay rises, increased pension contributions, payments for clinical negligence. When you take that into account it cuts the real rise to just over 2%.” Yet hospitals are under such pressure to cut waiting lists that non-urgent cases are treated first to avoid missing a target. Hospitals and primary care trusts are £341million in the red, with wards and A&E units closing and non-urgent ops postponed to save money. John Sussex, of the independent Office of Health Economics, said NHS activity rose at only half the rate of increased spending. (Source: The Sun)

Patients who refuse to change their unhealthy lifestyles could be refused medical treatment. The controversial suggestion from the National Institute of Healthcare and Clinical Excellence would mean that a smoker in need of heart surgery might be denied the operation unless he or she promised to give up the habit. The proposal is contained in a document which sets out for the first time the social values that should underpin decisions by the institute on which treatments to provide on the NHS. It says all patients should be treated equally regardless of their age or social responsibilities and rules out discrimination on the grounds of gender, race or socio-economic status.

The only exception should be where a patient's age might affect the chances of success of the treatment. "Health should not be valued more highly in some age groups rather than others," it says. On self inflicted illness, that caused by "unhealthy lifestyles", such as casual sex, smoking, drinking or dangerous sports, it rejects the idea of "deservedness" in deciding who should receive treatment and says it would be impossible in many cases to determine which illnesses were self-inflicted.

It adds, "If the self-inflicted causes of the condition influence the likely outcome ... of an intervention, it may be appropriate to take this into account." A spokesman admitted there was a "grey area" between denying treatment on clinical grounds, because a patient might not benefit from it, and "blackmailing" them to change their behaviour in line with medically accepted health norms. "It was felt that it wasn't fair to punish someone because they were, say, a smoker, but if the success of the treatment might be affected because they refused to give up smoking then it might be appropriate to take that into account. It is not about how they ended up in that situation but given they are there what do we do now."

The recommendation carries echoes of the case of Harry Elphick, who was told by consultants at Wythenshawe Hospital, Manchester, in 1993 that they would not conduct a test to determine whether he needed heart surgery unless he quit his 25-a-day habit. He eventually agreed but died before he could have the test. The case provoked a dispute about rationing in the NHS which has erupted often since, mostly in relation to patients denied liver transplants because their lifestyle has been judged "unstable" when other patients - including the footballer George Best, have had a transplant and subsequently returned to drinking.

A spokeswoman for the BMA said, "We do appreciate the health service is not a bottomless pit. We would not be in favour of blackmailing a smoker to give up before he got his operation but if there is a strong likelihood that, because of his lifestyle, he will be back on the operating table in three months then you have got to take that into account." The spokesman added, "This is our first attempt at this. Of course it is bound to be controversial. We would be enormously surprised if everyone came back and said yes to it." (Source: The Independent)