Paying for it all
A lot more from the clinical world with a few studies out recently that question established wisdom.
A study appearing to show that stents perform no better than Aspirin in preventing heart attacks in patients with partially blocked coronaries. Tie this in with the reluctance to offer bypass operations instead of stents.
A push to vaccinate every girl over 12 against HPV is all very well ( I support it & think boys should be included too) but the companies involved are not doing themselves any favours with their tactics.
A push in the US for MRI to be used to screen for breast cancer.
The Oxford cardiothoracic surgery imbroglio. The report is less interesting for the headline value which is that mortality rates are within acceptable limits but rather for the methodology & what the Healthcare Commission think makes a good unit.
The perennial saga of NHS dentistry again. Also in the Independent.
The BDA poll found 85% of dentists believed the new contract had not improved access to NHS services and 97% did not think it had removed dentists from the “drill and fill” treadmill.
The Citizens Advice report acknowledged this has been a problem and said extra money must be targeted at areas where there is a shortage of services.
The report was compiled from evidence given by nearly 4,000 of its clients, research on the 152 PCTs and government statistics.
It said that there had been “little evidence of any real growth” in services and in a quarter of PCTs no dentists were taking on new patients.
It said 2m patients - compiled from government estimates - could not get access to an NHS dentist, with most deciding to pay for private treatment, go on a waiting list or not get treatment at all.
And it added people in rural communities were particularly disadvantaged as they had to rely on public transport, forcing them to take expensive, difficult and time-consuming journeys to reach a dentist.
Those survey questionnaires. Here is one about mental health services.
In my experience, service users often have a lot to say about the care they receive - what works, what doesn’t, and how things might be improved. Their workers have plenty to say as well, after years of experience on the frontline, dealing with issues as they arise, coping with the impact of changes dictated from above. And, generally speaking, these two groups agree.
This is not a scientific survey, mind; it is what I have observed. The trouble is that what they have to say does not always fit neatly into boxes. And it is not always what the powers-that-be want to hear.
The policy makers want figures to prove things are getting better; to prove that it does not matter if, according to a report by the mental health charity Rethink, spending on mental health services is down by £30m - a figure the Department of Health disputes, putting the decrease at £16.5m.
Who cares either way? It is money well saved. Just look at these statistics. According to my local trust’s annual report, last year’s service user survey “showed that 95% of service users consider that their psychiatrist listens carefully to them and 97% feel that their psychiatrist treats them with respect and dignity”. But what does this mean? And does that include the “Yes, to some extent” answers, as well as “Yes, definitely”? In other words, everything other than “No”?
And finally about money, the handling of PFI deals coming under the microscope again:
The Financial Reporting Advisory Board (FRAB), a body which advises the Government on its accounts, has indicated that the Treasury’s previous definition of what PFI debt should fall on its books should be scrapped. A FRAB working group said the way the Government accounts for PFI makes it too easy for it to manipulate the figures so they either fall inside or outside its own debt totals.
The finding, which is expected to be endorsed by the FRAB, undermines recent calculations from the Office for National Statistics finding that only £5bn worth of PFI debt should be added to the national accounts. Its figure was far shy of the combined £48bn value of all PFI projects - but only because NHS debts were classified as belonging to the private sector.
The FRAB’s working group warned that many of the PFI debts were being left off the balance sheets of both private and public sectors. It has urged the department to withdraw the system no later than 2008-09.
Some analysts think this could add an extra £20bn to the UK’s net debt, potentially catapulting it above the 40pc of gross domestic product level Gordon Brown pledged to avoid under the terms of his sustainable investment rule.
There are suggestions that the true deficit in the NHS is five times higher than the 536 million declared.
The Department of Health spent £74.3bn in 2005-06, £2.7bn more than its original “near-cash resource limit” of £71.6bn. Ivan Lewis, the health minister, told parliament in December the NHS deficit was “the main reason” for the overspend.
The Conservatives accused the government of concealing the true extent of the overspend by using “sleight of hand” in the government’s accounts.
They said the government brought its books close to balance because it underspent on the “non-cash” part of the health budget, which included writing down the future cost of medical negligence claims.
They explained that the £2.7bn shortfall comprised a £1.5bn overspend on “near-cash”, or current spending, together with £1.2bn that has been taken from future annual expenditure.
Since according to Treasury rules the “near-cash” overspend must be paid back in the following year, the NHS will have to find an extra £1.5bn in 2006-07 to cover the previous shortfall.
On top of that, figures in last week’s Budget show that resources for the DoH will be £900m lower in 2006-07 than anticipated by the Treasury at the beginning of the financial year.
Bad news if it pans out. Not much more to be said.
But at-least it appears that RAB is to end. Commentary in the FT & the BBC
Now “absolutely confident” that the National Health Service would record a small surplus at the end of this financial year, Ms Hewitt said it could now use part of the £450m contingency reserve that strategic health authorities had built up to find the £179m needed to end a rule that the health department had long accepted was “unsustainable”.
Under resource accounting, a trust that overspends not only has to pay that money back the next year, but has to do so after the same amount is knocked off its budget.
The “double whammy” rule had affected 28 NHS trusts, “making it impossible for them, in some cases, to get out of debt”, Ms Hewitt said.
The accounting rule will still apply to primary care trusts as they are chiefly purchasers, not trading bodies like hospitals.
Some of the 28 trusts will now record a small surplus. Others, however, including Hinchingbrooke, the Queen Elizabeth in Woolwich, Whipps Cross and Mid-Yorkshire, will still be left with deficits not caused by the accounting rule that range from £12m to £21m. These will still have to be paid off over time.
Ms Hewitt told the Financial Times there remained “a small number” of hospitals - thought to be between 15 and 20 - with financial positions so serious that they were unlikely on their own to recover.
With the first take-over of an NHS hospital by a foundation trust expected to be formally approved this week, further foundation trust take-overs “may well be the solution in some cases”, she said, “but it won’t be the solution in every case.”
One surprise is that detailed work has shown the “double whammy” effect on hospitals - which has been inconsistently applied across the NHS - is smaller than original estimates that it would cost £500m to £600m to remove.
Ms Hewitt said the ending of the rule was the final part of a big set of financial reforms that would make the NHS finances “much more transparent” and “much fairer” in future.
They would end a trend that had seen healthier but overspending parts of the country being subsidised by other parts, chiefly in the north and Midlands, that had bigger health problems but which had, nonetheless, tended to break even or make surpluses, she said.
That definition of healthier but overspending has been questioned. I wait to see what the details are.