FrontPoint Systems Ltd

So what are we to believe?

That Blair regrets the wasted earlier years during which he took cautious steps to change matters (which the public feel happy with)?

And that the ideologically driven current “reforms” have made the NHS “much healthier now” (opposed by most of the public)? Funny how he can be so out of touch with the public.

Lord Falconer, the Lord Chancellor, and one of Mr Blair’s closest cabinet aides, told the Guardian that up to three years after the 1997 Labour victory were marred by slow reforms in areas such as health, education and welfare.

The Prime Minister’s own assessment of his time in office is markedly different to the views of voters as reflected in today’s Telegraph YouGov poll, in which two thirds of respondents said Mr Blair had been proved wrong in his election slogan “Things can only get better”.

While, in his own view, the Prime Minister’s increasingly aggressive policy will form a strong and positive component of his legacy, the Telegraph poll shows that voters take the opposite perspective, judging that Mr Blair started well and ended “mediocre or worse”.

Short term gains have been prioritised over thoughtful analysis & considered improvements. The predominant mood in the NHS is one of frustration.

Todays speech at the Kings Fund highlighted reduced waiting lists, “huge” investment in staff and 154 new or planned hospitals as proof Labour had “saved the NHS”.

On Monday the prime minister presented reports on progress in four areas - cardiac care, cancer treatment, emergency services and mental health.

Mr Blair, who warned voters in 1997 they had “24 hours to save the NHS”, used the event organised by the King’s Fund think tank to set out why he feels he has been successful.

“Ten years on, high quality care on the NHS is no longer the preserve of the lucky or the well-connected but genuinely universal, still free at the point of use and focused on those who need it most,” he said.

“We have ended the era of uniform, monolithic provision in the NHS. We have put new incentives into the system and devolved power to the front-line and communities to continue accelerating progress.”

The increased money was welcome. No one denies that there have been improvements. What did not help however was the orgy of unnecessary changes that came along with it. That these are likely to cause long term damage to the NHS is the whole point everyone is making.

The dental contract comes under more scrutiny.

Dentists may have to pay back millions of pounds to the NHS because they have failed to reach their targets in the first year of a new contract.

Some dentists face repayments of tens of thousands of pounds, and in a few cases more than £100,000. The impact on dental practices will be even greater because their income next year will be reduced, and it is feared that the problems may lead to even more dentists leaving the NHS.

Many dentists – nobody yet knows how many – have failed to achieve the UDA targets that were set by primary care trusts, and for which they have already been paid.

One dentist said that the contract had turned him into “a UDA factory”, working flat-out to achieve the targets. Others said that the only way to reach the targets was to take on quick jobs such as extracting teeth, rather than root-canal surgery to save the tooth, which earns the same UDA score.

A survey by the British Dental Association (BDA) found that 61 per cent of practices expected to miss their targets. There are about 20,000 NHS dentists, so as many as 12,000 could face financial penalties. In practice the number is likely to be smaller, because as long as a dentist achieves 96 per cent or more of the target, the money owing can be paid off in the next year.

The BDA figures are backed by a smaller survey by Denplan, a company that provides dental payment plans. This found that 53 per cent of the 122 dentists that it approached expected to miss their targets by enough for their PCTs to insist on “clawing back” money, and that they would receive a smaller contract next year. Another 13 per cent said that they expected to be asked to return money, but to be given the same contract.

“There is a huge potential for supervised neglect.”

The BDA has told the Government that alternative ways of monitoring dental contracts must be found. “UDAs are fundamentally unfit for purpose,” Lester Ellman, chairman of the BDA general dental practice committee, said in a letter to the chief dental officer for England, Barry Cockroft.

So what can we expect?

A blueprint for a shake-up of the NHS in England when Tony Blair’s successor takes over as prime minister in the summer has been provided by Labour in its campaign for this week’s elections.

Plans for full health checks for all men at 40 and free vaccination for girls against cervical cancer are among a dozen new policies in the party’s programme for Scotland.

They are strikingly different from policies being pursued in England by Patricia Hewitt, who is not expected to remain as health secretary if Gordon Brown becomes prime minister. Her successor will need fresh ideas to erode a Conservative lead in opinion polls on the NHS.

The policies include reform of prescription charges and hospital car parking tariffs, salaries for student nurses, speedy access for all patients needing chiropody, physiotherapy or clinical psychology, and a crackdown on shopkeepers selling alcohol or cigarettes to children.
The chancellor has not allowed his friends and advisers to speak about the health policy changes he might make during his first 100 days in No 10. They have privately met leaders of the NHS in England, but only to listen to their views and not to test reaction to Mr Brown’s ideas.

We have had enough of ideas imposed from on high with little consultation. Can we have a change from that please!

The Guardian continues reporting on Isoft with a statement this morning that talks over a possible takeover have reached an “advanced” stage.

It revealed today that discussions with potential buyers had taken longer than expected, due to concerns over its role in the National Programme for IT (NPfIT), but insisted that a deal was close.

“Discussions are well advanced with several parties, both trade and private equity, and the company will make a statement about the outcome as soon as is appropriate,” said iSoft.

ISoft also admitted that it must still address its long-term financing. Its current credit facilities are due for renewal on November 14, and it said today that it should be able to operate as normal until that point.

Matthew Jamieson Evans from Remedy UK guest blogs on Sky news.

If anyone had approached me to write an online blog a few months ago I’d have probably answered with something unprintable. In fact today I can already feel a level of embarrassment that I’m going to have to do my best to control over the next few days.

Deep breaths Matthew, it shall pass.

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No, I am not in favour! Just what does the govt think it is doing? Is there no thought given to the consequences?

For those wondering what I am incensed about, this headline from the FT claiming that Tony Blair is looking to bring in someone with absolutely no experience of the UK healthcare system to run the Commercial Directorate at the Department of Health.

For those who have been keen to explain away the current raft of policies as definitely not the wholesale privatisation of the NHS, will this open their eyes?

I quote again from Saturday’s admission by Tony Blair:

“What I have learned over those 10 years is that the original analysis I had was incomplete and therefore literally misguided, ie, guiding us to the wrong policy conclusion.”

A quote that is begging to be applied to practically every policy enacted for the NHS.

I foresee stiff opposition ahead.

There is enough wrong with the policies being discussed already, especially with their implementation by people who lack an understanding of the intricacies of the workings of the NHS that to appoint someone who knows nothing about the NHS whatsoever is proof of where Tony Blair would like to go. This will only damage the NHS & destabilise the delivery of healthcare in this country.

An American executive with a lifetime’s experience of paying for care in the US health system has been offered the job of commercial director at the Department of Health, overseeing the purchase of care for NHS patients.

But the appointment of R. Channing Wheeler, who is in the final stage of negotiations ahead of an expected announcement this week, is likely to be controversial as he has been caught up in the scandal of backdated stock options in the US.

The appointment of a US big-hitter with extensive healthcare purchasing experience is seen within the department as a clear signal of its continued commitment to market-based reforms and to the use of the private sector to treat and commission care for NHS patients.

His selection has been approved by Tony Blair, the prime minister, from a short list that included other experienced US candidates.

The department has been encouraged by their apparent belief that there is a job worth doing in the NHS.

Mr Wheeler, 55, was an executive vice-president of UnitedHealth Group, which is still being investigated by the US Securities and Exchange Commission over the alleged granting of backdated share options.

The scandal has brought down William McGuire, the former longstanding chairman and chief executive of UnitedHealth, one of the largest US managed-care providers.

Mr McGuire resigned after it was discovered that he and other executives had repeatedly received stock options, meant to incentivise future performance, that were granted at or near the lowest point of the share price in each year they received them.

Mr Wheeler, who until 2004 was chief executive of Uniprise, the UnitedHealth subsidiary that deals with some of the biggest US companies, is alleged to have received grants of more than 409,000 options on similar dates to Mr McGuire between 1998 and 2002, according to court papers filed in the US.

A civil action has been filed by public sector union shareholders in UnitedHealth seeking $5.5m in damages from him over the share options.

Mr Wheeler held executive positions with US health plans, while running UnitedHealth’s north-east region, before becoming chief executive of Uniprise in 1998. and 2004.

Karen Jennings, head of health for Unison, said: “The American health system is riddled with fraud and we must protect our NHS from that sort of corruption.

“UnitedHealth is trying to infiltrate the NHS, and it is worrying that someone from that organisation is being favoured over an NHS or civil service appointee.”

The FT continues its look at the impact of private sector involvement in the NHS with a claim from Chris Ham that

“It has enabled hospital chief executives to negotiate with their staff, particularly their doctors, to achieve higher levels of performance. They are able to say ‘if we don’t change the way we do things we will lose patients and income to those people down the road’. It has given managers a pretty powerful lever to change medical practices in ways that might not have been so achievable without the private sector’s involvement.”

When bidders linked to South African, US and Canadian operators won virtually all the business, the UK’s private hospital sector reacted with shock. Much of the NHS reacted with horror.

There were heady predictions that within a few years the private sector could be providing up to 15 per cent of planned NHS operations.

So how much of that brave new world has come to pass? On the face of it, not a lot. Dig deeper, however, and there are signs that the revolution may have been postponed rather than abandoned.

Asked if the changes are irreversible, Ken Anderson, former commercial director at the health department who negotiated the current contracts, says: “No. They could die of neglect. But I think to reverse them will take a much bigger act of political will than most people imagine.”

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Not much has been happening over the weekend I guess other than the BMA Junior Doctors Conference in London on Saturday which made the news by calling for the resignations of Patricia Hewitt & Lord Hunt.
The motion of no-confidence in the JDC executive was not carried but this was the wrong setting for it anyway. And given that the webcast reminded me of those model UN sessions for high school students, I did not expect much else. I am veering towards the view that the hot-house atmosphere of medical schools & the NHS delays the worldy maturity of a number of medics. But the BMA need to be more responsive as an organisation to their members & also to improve their media strategy.

There is though progress on the legal front with the Remedy UK sponsored challenge listed for hearing in two weeks. Both Dr Grumble & the Ferret Fancier go into this in detail.

Speaking of training, the Telegraph discusses the raiding of training budgets by SHAs.

The cuts come despite a promise by Lord Hunt, the health minister, that last year’s transfer of £340 million from health authorities’ training funds to a contingency fund to help meet the NHS deficit would be a “one-off”. David Nicholson, the NHS chief executive, had also assured staff that training budgets would be reduced “for one year only”.

But even though Patricia Hewitt, the Health Secretary, claimed earlier this month that the NHS financial problems were now “fixed”, six of England’s 10 strategic health authorities have taken £136 million from dedicated training budgets to store in “investment reserves” that will be used to offset future debts.

Figures compiled by the Conservatives show that the impact is greatest in the south and east. South Central, the strategic health authority covering Berkshire, Buckinghamshire, Hampshire, Oxfordshire, and the Isle of Wight, is to reduce its training budget by 12 per cent, and the East of -England authority (comprising Bedfordshire, Cambridge-shire, Essex, Hertfordshire, Norfolk and Suffolk) by 10 per cent.

The surveillance society comes under attack by the Information Commissioner but I fear that he is fighting a losing battle as too many people are complacent, having no understanding of the risks.

The conflict between clinical priorities & political imperatives flares up in Scotland with an attack by

Professor Charles Court-Brown, an orthopaedic surgeon at Edinburgh royal infirmary, who has accused ministers and NHS managers of sacrificing the needs of emergency patients by using scarce resources to meet “artificial” waiting list targets.

“There are increasing numbers of surgeons employed simply to do elective or non-emergency work but very few surgeons are employed only to undertake emergency work.”

Court-Brown’s criticism, which is sure to embarrass Labour, follows the claim last year by Clive Davis, chairman of the British Medical Association’s Scottish consultants committee, that surgeons had been asked by NHS managers to postpone cancer operations in order to bring down waiting lists for wisdom teeth extractions.

I seem to remember that there is an election due there shortly.

The treatment of AMD continues to get traction in the media as does the policy of some PCTs to exclude people from treatment on the grounds of weight or their smoking status. The decision to exclude people from treatment is not a medical responsibility unless there are overriding grounds to do so for either of the above reasons. This is a decision to be taken on a case by case basis with regards to the health of the patient, not as a matter of policy.

Pat Wood, from Sutton-on-the-Forest in North Yorkshire, was told by North Yorkshire and York Primary Care Trust it would pay for one of the drugs only if she goes blind in one eye and the disease then spreads to her other eye.

Margaret Maslowska, 82, from Eastwood, near Nottingham, is blind in one eye and losing the sight in her second eye due to AMD. Nottinghamshire County Teaching Primary Care Trust is refusing to pay for the medication.

Nottinghamshire County Teaching Primary Care Trust issued a statement saying: “We do not routinely provide treatment that is being investigated by Nice until the final appraisal is published.”

Not a good enough defence, having already been contradicted by the DoH for one. Are clinicians really going along with this?

According to Patricia Hewitt:

“Those decisions are being made by individual doctors all over the country. In a few places doctors have come together collectively through the primary care trusts to put in place guidelines for all of their patients.

“This isn’t a matter for managers or indeed Government ministers to decide who gets what operation - it’s a matter for doctors and always has been.

Really? Would any of these clinicians be willing to defend these restrictions publicly or to their colleagues?

This brings me back to my argument about trying to work with a failing policy in the stated hope that you can influence it for the better from the inside. This is a misguided approach & produces no worthwhile results. What you end up doing is providing cover for others to defend those self-same policies.

We are told that deficits are improving.

According to figures from three-quarters of the way through the 2006-7 financial year, one in three hospitals and primary care trusts, which pay for local services, were not expecting to balance their books.

But NHS bosses have insisted overall the health service will break even.

This is because regional health bosses have built up a contingency fund of £450m from savings made to budgets, such as training and public health, and held back £1.1bn of extra funding.

These are not savings. We need to start calling them by their proper name which is cuts in training & services.

And the battle for the soul of BUPA is described in the Telegraph.

First-round offers are due to be submitted to Citigroup, BUPA’s long-standing adviser, this week. Among those queuing up to bid are some of Britain’s largest private equity groups, including CVC Capital Partners, Cinven and BC Partners. Blackstone, the US house, is also expected to bid.

“The sale begs the question, what’s the role of third-way companies that are not plcs or charities,” says Bryan Sanderson, BUPA’s former chairman who stepped down last November. “BUPA is a provident association. It’s about the patients.”

Bryan Sanderson left the company last November, seven months before his official retirement date at next month’s annual meeting, after a disagreement over plans to sell the portfolio of UK hospitals, a key plank of the business. Sanderson argued that as a provident association one of BUPA’s core activities was to provide the best care for patients, which he felt included providing hospital care.

“I have no quarrel with the board but a watershed had been reached,” Sanderson told The Sunday Telegraph. “You have to think about what a provident association is for. At a time when there is a lot of anxiety about NHS hospitals, is this the right time for BUPA to be exiting? A provident association should exist for its customers, they must come first.”

The board’s decision to sell the hospitals business - even thought it only accounts for 11 per cent of sales - raises the prospect that BUPA’s provident status could eventually change and lead to a break-up of the group. It is understood that BUPA has in recent months rebuffed several offers from private equity groups that valued it at more than £5bn.

Instead, the decision to consider the sale of the hospitals, say supporters of the move, is based primarily on the rationale that the business has greater potential to grow outside of BUPA. It has been unable to expand as fast as it would like, notably blocked by the competition authorities from buying Community Hospitals some seven years ago. It has also sought to win NHS business, for example by providing independent treatment centres.

Selling the hospitals would also put to rest long-running suspicions that BUPA’s position as both the biggest health insurer in the UK and one of the biggest hospital providers is a conflict of interest. Although both businesses are run separately, divided by Chinese walls, suspicions have lingered as to whether BUPA, as an insurer, is always acting in the best interests of subscribers. According to BUPA, some 18 per cent of its subscribers are treated at its hospitals.

Operating on its own would also open up new opportunities for the insurance business. One potentially lucrative area of growth for the private sector is in providing commissioning services for primary care trusts - in effect, how they plan and deliver services - under the Commissioning Framework. BUPA has signalled its interest in bidding for these contracts but as both an insurer and a provider of hospital services it could be accused of a conflict of interest; in other words, if BUPA Insurance ended up commissioning care services, BUPA Hospitals would have to be excluded. Selling the hospitals does away with that conflict.

As I have previously mentioned, it depends on what the vision for BUPA really is. I would prefer it to provide services rather than commissioning them on behalf of the NHS, the necessity for which I do not accept. As has been said before, we are importing the wrong elements of the US healthcare system.

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Finally an acknowledgement of mistakes made.

Pride of place today goes to the interview in the Telegraph with Patricia Hewitt.

The new system, she says, “is clearly not working but the problems are being worked on day and night.”

As for calls for her resignation, she says: “When things go wrong people will call for your head. This shouldn’t have happened and I am desperately sorry that it did but the real priority now is to sort it out.”

“You don’t solve these problems by saying, ‘let’s charge people,’ you do it by spending more money and becoming more effective,” she says. “To go for a private insurance model like the States would be a disgrace.”

“People are the most important factor in any business - whether they are junior doctors, office workers, secretaries or even politicians, everyone needs to be cared for.”

Ha!

Tony Blair learns the wrong lessons from his handling of deprivation.

“What I have learned over those 10 years is that the original analysis I had was incomplete and therefore literally misguided, ie, guiding us to the wrong policy conclusion.”

A quote that is begging to be applied to practically every policy enacted for the NHS.

Gordon Brown gets ambushed by a patient’s mother as he visits the Heartlands hospital iin Birmingham. The decision made by the hospital to remove televisions from wards but not replace them with any similar services is typical of the penny pinching happening all over the country & Brown does have to bear some of the blame. I am sure that Patientline could have done without it too.

Similarly, an argument for starting with the basics.

Sir - I am a patient in a ward of a large East Midlands hospital. My bedding has not been changed for six days and the hand disinfectant provided at the bottom of the bed is almost never used.

The daily cleaning of the ward consists of a cursory dry mop, followed by an even more cursory wipe over with a wet mop loaded with dirty water.

Visiting one of the hospital departments, I found so much litter in the corridors that I picked up some and put it in a bin to avoid embarrassing visitors. There is one shower for more than 30 patients, and cutlery and glass-wear seems poorly washed.

By my bed is a cotton-wool swab that has been there since I arrived. I am leaving it to see how long it is before a “cleaner” removes it. I expect the swab to be my longest hospital acquaintance when I leave.

Exotic diseases must be expected in such disgraceful conditions.

E. C. Coleman, Bishop Norton, Lincolnshire

The job of management is to remove all the unnecessary crap and paperwork from the responsibilities of the frontline staff & let them do their work properly. It is not to stand in judgement or force them to complete endless reams of paperwork while chasing targets remotely connected with clinical matters.

The BMA Junior Doctors Committee meets in London today with strong words (of sorts) from James Johnson & Jo Hilbourne.

WPA’s cancer drugs policy gets more detailed coverage.

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It looks like the surgeons atleast have negotiated sensible changes to the training programme though the selection process is yet to unfold.

According to information confirmed by the Senate of Surgery / Royal College of Surgeons, the following have been agreed except for Oral & Maxillofacial surgery as well as Neurosurgery:

ST1 & ST2 to be fixed term appointments for 1 year.

ST3 onwards to be a run through programme, similar to what exists currently as the SpR grade.

Is this any different from current practice, except for contracts lasting a year instead of 6 months?
What will happen to those who do not gain entry to the ST3 programmes?
Do they get a chance to change specialty i.e. will there be a sufficient number of ST3 posts in other specialties for them to go to or are they doomed to FTSTAs / non-training posts?

A lot is left unclear & needs to be made known soon.

Via email communication finally received today, two days after the request:

At the meeting of Senate it was agreed to recommend to the MTAS review panel that for this year ST(1) and ST(2) would be fixed term one year appointments.

It will be for the review group to consider this recommendation.

Yours sincerely

B O Williams
Chairman, Senate of Surgery

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So who is right, the govt which claims that only a few hundred mostly non-clinical staff have been made redundant or the unions who say that the number is over 27,000 people in the last 18 months?

It appears that the unions have their figures right. The Information Centre for Health and Social Care (ICHSC) says that the number of people working in the NHS fell by around 17,000 between September 2005 and September 2006, equivalent to 8,118 full-time equivalent (FTE) staff, when part-time workers are taken into account.

Analysis of the figures shows a drop of 5,826 in the number of qualified nurses working in the NHS between 2005 and 2006. However, this figure includes 3,370 duplicate entries for 2006, leaving an actual fall of 2,456.

Equally, there were 18,342 fewer support workers for clinical staff, with a duplicate entry number of 2,719, leaving an actual drop of 15,243, according to the Department of Health.

There were 2,640 fewer managers and senior managers working in the NHS by September 2006 compared with the previous year, with 76 duplicate entries, leaving an actual drop of 2,564. The numbers of NHS staff in some areas increased over the year, leaving an overall drop of 17,390.

Even these figures are disputed with claims that what are called duplicate entries are not really that.

Peter Carter, general secretary of the Royal College of Nursing said the figures confirmed fears deficits were having a damaging impact.

“When you dig below the surface… the headline increase in nurse numbers is made up of double counting existing nurses working extra shifts.”

“Meanwhile, internationally recruited nurses, who make up a significant number of the extra nurses, now face the prospect of having to leave at the end of their contracts under new immigration laws.”

The Guardian, the Independent, the BBC as well as the FT have details.

That dispute then brings us to the claims about GP pay with the release of a revised set of figures down from 30% to somewhere near 23%. But it looks likely that they will have to come down even further. They have removed the employees NI contribution of 6% from the pay figures but left the 14% employers NI contribution in, thus guaranteeing another round of headlines over pay in a few weeks.
It makes for a good PR strategy though, (it is working), to release information known to be incorrect so that GPs get tagged as greedy profiteers & then to let the truth come out in stages over a long period of time. Does no one remember the recruitment crisis that existed just a few short years ago with juniors talking about going on strike & GPs / Consultants being in very short supply? Was it a mistake agreeing to conflate the very necessary correction in pay that needed to happen with the new contracts demanded by the govt, which is one of the reasons why the media find it easy to over-simplify the argument?

Dr Rant presents a rebuttal.

And I will agree with his prescription for reform, with very limited changes.

But in the real world, in an example of providers cutting the cloth to suit the budget, dentists are reducing the number of complex or expensive treatments they provide on the NHS to match the limited funding offered.

Patients are being offered cheaper dentures, crowns and bridgework, with dental laboratories reporting that demand for more expensive alternatives has plummeted by up to 90 per cent over the last year.

Critics claimed the plunge has been triggered by a new NHS contract that the Government introduced last year. Dentists are offered three payments: £15.90 for check-ups and minor work, £43.90 for fillings or root-canal work and £194 for crowns, dentures or bridges.

But there are fears that many dentists are using cheaper treatments, such as dentures costing £40, because they will receive the full fee.

David Smith, of the Dental Laboratories’ Association, told a conference in Westminster yesterday that there had been an alarming decline in the amount of complex treatment being offered by NHS dentists.

Derek Watson, chief executive of the Dental Practitioners’ Association, said NHS dentistry was being steadily pared down to a “cheap and cheerful” service that offered a limited range of treatments.

And dispensing practices are going generic in an unintended consequence of Pfizer’s sole distribution deal with Boots.

The Dispensing Doctors’ Association (DDA), which represents the interests of about 5,000 family doctors in remote areas who dispense drugs directly to patients rather than through a chemist, says that many doctors resent the new system for adding an extra layer of bureaucracy and cost to their work.

The DDA says that doctors will always put patient safety first, but where identical drugs are available from rival manufacturers, many are opting to prescribe non-Pfizer products.

So while the health gap widens in retirement at the same time as facilities are thrown into chaos with little or no integration of service provision, people are still waiting for diagnostics according to new data. The IS Diagnostics contracts were supposed to have come on stream at the beginning of April to help meet the 18 week target but are already in disarray with the failures in the North West causing the DoH to re-examine its procurement strategy.

As I have said before, resources are being wrongly targeted on political priorities with poor analysis of clinical requirements & little regard for sustainability and results.

Doctors for Reform reply to Patricia Hewitt’s claim in her letter to the Telegraph that the NHS was free at the point of need.

But her words did not address the thrust of our paper, which is the new demand by patients to “top up” their NHS care. This is a growing trend; on Wednesday, a new product was launched to provide the latest cancer drugs, not yet available on the NHS to NHS patients.

The questions raised by these developments are not easily resolved, but they are important and should not be ignored - especially as they relate to equity of access to new treatments. One way forward, recommended by the Prime Minister’s recent policy review, might be to start the process of defining an NHS entitlement, to eliminate what is currently a postcode lottery in respect of many treatments and clarify the responsibilities of individuals and government.

All the while, Clostridium Difficile cases rise by 8% a year according to the Health Protection Agency (HPA) data which showed 55,681 cases were reported among over 65s in 2006.

From 2004 to 2005, there was a 17% rise compared to the 8% being reported last year, (though this was from a smaller base & was also the time it came into prominence).

There were 1,542 MRSA bloodstream infections from October to December 2006 - 7% down on the previous quarter.

The HPA does not look at deaths although figures from 2004 show that MRSA was mentioned on over 1,000 death certificates in England and Wales, while C difficile was listed on over 2,000.

Overcrowded hospitals running at close to 100% capacity with staff under stress do not help.

Improvement has to come from the bottom up with individual teams improving their capabilities of service delivery. Centrally mandated programs have a very poor record of actually delivering. People end up thrashing around in a frenzy, trying to meet impossible mutually contrary diktats.

So Polly Toynbee blames it all on unbridled consumerism fuelled by Blair’s ideology of choice. And she thinks that NHS staff have a sullen crew who never had it so good & who cannot be trusted to decide in patient’s best interest.

So Tony Blair has arranged to face the enemy to fight it out over a final reckoning at the King’s Fund. He will confront a host of doctors, managers, nurses and patients’ leaders with his record and hear their verdicts, starting a campaign to win the NHS back for Labour.

NHS morale is always at “rock bottom”, but now it’s in meltdown. Unison barracked a health minister this week over a 1.9% pay offer to nurses. Though nurses’ pay has risen in the last decade by a real 25% for the newly qualified, £19,645 doesn’t get them on the mortgage ladder. Doctors are in a fury at being ordered about, despite massive pay rises, better hours and 32,000 more jobs. Patients have persuaded themselves everything is worse, even though they tell pollsters their local NHS is pretty good. Spending has trebled, heart deaths are falling, waiting times for inpatients are at just an average 6.6 weeks and 90% of hospital patients report that their treatment was “excellent”. By almost every indicator, ask any expert, there is no doubt things are very much better.

What’s his legacy? It’s not yet clear that Blair’s market NHS will work. The Commons health select committee gave a devastating portrait of the inadequacy of primary care trusts to commission services. Staffed by juniors, far from being the commanding heights directing more services into the community they are the weakest link, so money is sucked out of them by hospitals willy-nilly. The dash for all-powerful foundation hospitals and private treatment centres may have fatally unbalanced the market in favour of providers. Consultants have always found a way to run the show, and their power is little diminished, but even that little has made them dangerously incandescent.

Meanwhile, the computer system everyone said could never work hasn’t worked, advice ignored. The junior doctors’ employment system is another case of electronic chaos. Some 50 Save Our Hospital campaigns are doing lethal electoral damage locally: shutting dangerously underspecialised A&Es is the right thing to do, but not at the same time as a savage clampdown on age-old deficits, so everyone thinks closures are cash - not clinically - driven.

More serious problems lie ahead. All but abolishing waiting lists has taken the brakes off NHS rationing. Everyone thinks they have a right to everything they have read about on the internet, right here, right now.

So an inability to publicly recognise the concern that NHS staff feel about the direction of the “reforms” doesn’t stop her from admitting the problems herself. And as pointed out, if staff were merely mercenary, they would not bite the hand that feeds them. As a consultant to the private sector as well as the NHS, I have no reason to annoy my potential client base unless there were serious concerns about the prospects for the future of healthcare in the UK.

But even she has to admit that:

The truth is the NHS is nothing like a market. It is a collective agreement to spend a set amount of money as efficiently and as fairly as possible. It is not open-ended - no health system ever is: private insurers strictly limit treatments according to the policy paid. The NHS has always been a better system, but it relies on a measure of understanding by citizens of the nature of the compact.

And finally, MTAS gets further play with the suspension of the site being reported.

The doctors themselves ask a few pointed questions about it all.

The Health Select Committee’s enquiry into the NCRS continues but the transcript is not out yet with just a few outlets covering it. Richard Granger says that consultation led to the delays. What consultation?

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Then:

Hansard record

13 Mar 2007 : Column 314W

Dr. Murrison: To ask the Secretary of State for Health what the projected cost was of the Medical Training Application Service at the instigation of the service; and what the latest estimate is of the cost of the service. [126460]

Ms Rosie Winterton [holding answer 9 March 2007]: The projected cost of the medical training application service at instigation was £5.8 million over five years for an England only service. Expanding to United Kingdom wide coverage and incorporating academic/specialty and general practitioner recruitment into a single, two-round recruitment exercise has slightly increased set-up costs. The projected cost of the service is now expected to be £6.3 million over five years.

Now:

Written answer on the 23rd of April.

Dr. Murrison: To ask the Secretary of State for Health how much has been paid to the Work Psychology Partnership in connection with the medical training application service. [128713]

Ms Rosie Winterton: There is a contract in place between the Department and Work Psychology Partnership for the sum of £92,950 excluding VAT. Work Psychology Partnership are contracted to provide advice and tools to support the recruitment and selection into specialty training programmes, for which the Medical Training Application Service facilitates applications.

Dr. Murrison: To ask the Secretary of State for Health how much has been spent on the Medical Training Application Service (MTAS); and how much has been allocated to MTAS for 2007-08. [128715]

Ms Rosie Winterton: The cost of the Medical Training Application Service (including set up costs) is £1.9 million in 2006-07. The budgets for 2007-08 have not yet been agreed.

So far this fiasco looks like it will cost a lot more.

And this excerpt shows what process certifications are really worth:

Mr. Graham Stuart: To ask the Secretary of State for Health whether the Modernising Medical Careers and Medical Training Application Service process has been formally quality assured; and if she will make a statement. [129699]

Ms Rosie Winterton: The Medical Training Application Service (MTAS) processes have been developed following extensive consultation which included both paper based and workshop based reviews within a formal project quality management framework. The MTAS information technology system is provided by an ISO9000 accredited supplier and has been reviewed and found fit to be for purpose.

The Modernising Medical Careers programmes itself has been subject to scrutiny by the Office of Government Commerce Gateway Review process in both 2005 and 2006.

Well, that worked out very well in the end then, didn’t it?

As I have tried repeatedly to impress upon the Department of Health, measures & certifications like OGC Gateway Reviews & ISO 9000 are a very basic form of quality assurance and do not really provide much confidence that the finished product will be satisfactory.

The entire quality assurance strategy of the Commercial Directorate has become subject to the mistaken idea that a satisfactory demonstration of process on paper is adequate to guarantee the quality of the services being procured. This is a fallacy that has been pointed out to them time and again. Process verification is just the very basic first step & the department does the NHS / public no favours by refusing to test its purchases beyond that.

Will any software professional with the most basic pretensions to competence admit to letting this happen?

Anyone can register for an MTAS account simply by using an anonymous email account with no further verification required.

Any applicant can see ANY correspondence sent by another candidate or from MTAS to another candidate by just going to his inbox and changing the message number displayed in the url.

You do not even need to log onto the MTAS site. Dr Crippen has just been sent a URL, which ends in four numbers. Put any random four numbers in at the end and you are taken straight to a MTAS reply to a junior doctor offering him/her a job. The recipient is not named, but it is probable he/she could be traced by replying to the hospital who offered the job.

The URL on its own is enough to see the inbox of anyone without any password or log in! It basically means that all correspondence that has taken place is sitting on the Internet completely unprotected, all you need is the URL. Once the inbox URL is known you can even send emails for that person.

Bolting the stable doors after the horse is in the next county appears to be what the DoH do best.

This after Lord Hunt’s apology this afternoon for yesterday’s debacle.

Channel 4 news report this evening.

And I was flabbergasted to read this:

Director general of IT for the NHS, Richard Granger, told a Commons select committee he wished he was running the junior doctors system because then it “might not have gone wrong”.

So Channel 4 call him out on it by claiming that a previous failure occurred on his watch. We are given to understand that this is to do with the personal details of doctors who attended a conference in February organised by Connecting for Health who had their personal information displayed on the CfH site & from where it was only taken down after two weeks. We are told that it is still available in the Google cache for the site.

BBC report.

Jobsite & Methods Consulting ought to have known much much better than to be responsible for this sorry spectacle. And the DoH need to go away and read the guidance from their own colleagues.

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The Health Select Committee has published the written evidence received by it regarding the Summary Care Record service. This can also be read online.

There is too much to precis but it boils down to an overambitious and oversold plan, insufficient definition of the specs, inadequate consultation during planning, a botched tendering process, poor engagement with users and the public & finally a lack of understanding of working practices & software design among those charged with implementing the solution. So pretty much everything. Too much of a reliance on a group think mentality & freezing out dissenting voices did not help either.

It appears that the Public Accounts Committee isn’t about to let go either.

Speaking in the Commons on 19 April, Edward Leigh, chair of the PAC, said: The Government should not use the excuse of saying that although a particular report is fine and that they agree with it entirely, it is based on a National Audit Office report that was published nine months or a year ago and therefore all the excellent recommendations are already being implemented—when, on certain occasions, the Government, or rather accounting officers and their civil servants, have delayed the whole process. The process relies on the National Audit Office reports being agreed between the National Audit Office and the Department and there is often a long period of negotiation.

That was particularly apparent in the recent important report on the NHS computer system—a system that is worth about £12 billion. I notice that the Government’s response this week says, “Well, excellent report by the PAC, but we’re doing all this—it’s an out-of-date report.” I am going to call the Government’s bluff. I have talked to the Comptroller and Auditor General about the matter and, following my encouragement, we are to have another NAO report on the NHS computer in the next year so that we can have an update to check whether all the excellent recommendations of the NAO and the PAC on this £12 billion computer system—that amount is equivalent to the entire cost of the Olympic games—are being carried out.

The General Medical Council, Information Commissioner and the Department of Health have agreed a joint statement to ensure that all those who have access to patient information in the course of their work are clear about what is expected of them.

A bit weak & lacking in specifics with very little focus on informing patients but it is a start.

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Boris Johnson is a surprising convert to the side of public sector intervention as opposed to market mechanisms.

Lucentis, a drug which is made by the prodigious Californian company Genentech, said to be the very originator of the biotechnology industry.

Genentech makes another drug, Avastin, and though Avastin is technically a cancer drug, it is now widely agreed to be just as good as Lucentis at treating wet macular degeneration.

There are only two differences between them. The first is that if Lucentis were free on the NHS, it would cost about £750 million a year, whereas Avastin has been on the market as a cancer treatment for years, and would only cost £4 million a year for eye patients across Britain.

Genentech has spent huge sums developing Lucentis; the stock market requires that the company earns back the cost of the research and development.

So there is no way on earth the Pharma boys are going to seek a licence for Avastin, when they would be effectively cutting their own throats.

The licensing regulations are not my forte but I have to wonder what the obstacles are to allowing people other than the manufacturers of a drug to apply for a license. Of course, accessing the relevant data might be a tad difficult.

Botox restrictions are being urged but the govt comes under fire for bottling out.

Two years after Sir Liam Donaldson, the Government’s chief medical officer, warned of a risk of permanent injury caused by the treatments, including transmission of hepatitis and vCJD, ministers have asked the cosmetic surgery industry to set up a system of self-regulation to “further improve standards”.

The announcement was attacked by critics who said it did not go far enough. Which?, the consumer magazine, said it was “disappointing” that the Government had decided to “bottle out” and “leave it to the cosmetic treatments industry to make itself safe”. It has campaigned for statutory regulation.

Although surgeons who perform face-lifts and liposuction are subject to some regulation, high street beauticians who offer Botox and fillers are not.

A surprising turn of events given that the industry has actually been asking for regulation.

The insecurity surrounding the MTAS website is covered in the media but there is not more to add to the Channel 4 report. The Times, the Guardian & the Telegraph all pile in as does the BBC.

With the application process already beset by controversy, the security breach on the site where junior doctors apply for postgraduate medical training programmes is yet another blow to the scheme.

I am not going to politicise this but the following statement tells you how much the monitoring of doctors working times is worth.

Dr Hughes’s wife said that he had been depressed and had been working 85-hour weeks, training to become a consultant anaesthetist. NHS Lothian denied this, saying he had been monitored and was working a 45-hour week. Its thoughts were with the family, it said.

Somehow I feel that the wife might have a better idea about happenings than someone relying on a form filling exercise. I have heard complaints about the futility of monitoring exercise for a long time, especially from SpRs in their final year.

The Telegraph profiles a GP who

“would vote for him (Tony Blair) again, but I’d want to see far less spin, and proper, considered health policies.”

Accessibility and public health have got better but bureaucracy, targets and central control have got worse and mine is a completely different job.

Especially for dentists with the lack of NHS provision coming up again in the Commons yesterday:

The prime minister promised in 1999 that everyone would have an NHS dentist no matter where they lived within two years.
Eight years later, less than a half of the adult population is registered - a lower figure than when Labour took office.
Yet Mr Blair has never conceded that he had broken its promise to the electorate.
However, he was directly challenged at prime minister’s question time by Liberal Democrat MP Mark Cheadle, who asked when he expected the promise to be fulfilled.
He replied: “It is and has been a real problem. I entirely accept that.
“The reason for it is very simple: even though we have increased the number of NHS dentists, we cannot stop dentists going outside the NHS if they wish to do so.
“They are entitled to do that and despite the fact that we are paying far more and hiring far more within the NHS, we have not been able to fulfil that pledge.
“However, the majority of people are actually within their area able to access an NHS dentist if they want to, but that is not 100 per cent - I accept that.
“It will only be dealt with ultimately by increasing still further the number of NHS dentists and that is what we intend to do.”

The Telegraph investigates the postcode lottery.

And Patricia Hewitt’s letter to the Telegraph garners reaction.

I am interested in this but wonder if there will be the funding from penny wise but pound foolish decision making.

Researchers said yesterday that a group of children aged three who had received two years of intensive tutoring - so-called Early Intensive Behavioural Intervention (EIBI) - had higher IQs, more advanced language and better daily living skills than similar autistic children receiving a standard education.

The intensive teaching consists of about 25 hours a week at home supervised by specialist behavioural consultants. It helps children to improve their eye contact and concentration as well as their ability to copy words or actions.

The findings mean that autistic toddlers can go to mainstream primary schools at five with a much better chance of learning and coping, and can subsequently lead fuller adult lives.

Parents of autistic children argue that while the short-term costs to the local authority are high, this should be offset by the fact that it will not need to provide residential care or intensive mental health services in the long term.

Finally, after the repudiated HSJ list of trusts under threat covered here, the DoH has released its own list of trusts in a shaky financial position.

The 13 trusts that could not afford to repay debts were: Hinchingbrooke Health Care in Huntingdon; Mid Yorkshire; Queen Mary’s, Sidcup, Kent; Royal Cornwall; Royal Wolverhampton; Coventry & Warwickshire; West Middlesex; Weston Area Health, Weston-super-Mare; and three London trusts - Barking, Havering and Redbridge; Bromley; and Queen Elizabeth, Woolwich.

The five that could not repay loans in the foreseeable future were: North Bristol; Royal United hospital, Bath; Surrey and Sussex Healthcare; the Royal West Sussex; and Whipps Cross, London.

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In what appears to be an unacceptable & humongous breach of security, the much maligned MTAS website was found to be critically lacking in protection for the personal details including among other things addresses, sexual orientation & phone numbers of hundreds of applicants (Foundation programme applicants) according to Channel 4 news who were made aware of it this afternoon.

They showed footage of the website on the 7 ‘0′ clock news this evening with Jo Hilbourne from the BMA & Matthew Jamieson Evans from Remedy UK onscreen to comment. Andrew Lansley was on air to excoriate the govt who didn’t bother to send anyone to the studio to catch the flak.

“I’m absolutely gob-smacked, I don’t know whether to laugh or cry. I’m not going to be able to laugh because it’s so serious. After I’ve scraped my jaw up off the floor I’ll say that I’m not really surprised - it’s a level of ineptitude that has characterised this whole procecss. It takes the concept of a botched IT job just to a new dimension.”
- Matt Jameson-Evans, Remedy UK

Shadow Health Secretary Andrew Lansley:

There should be redress against anybody who is responsible for such a serious breach of people’s data confidentiality. But frankly, I come back to the point I was making a moment ago. We know that more than a month ago there was a risk to security.

There is an open challenge to the DoH from Jon Snow to send anyone in for an on-air explanation. Patricia Hewitt / Lord Hunt / Andy Burnham / Caroline Flint / anyone?

Throughout the junior doctors’ recruitment saga, we’ve been asking the Health Secretary Patricia Hewitt to appear on the programme, but she’s always declined - and tonight was no exception.

We offer her an open invitation to come on to Channel 4 News.

Who knows for how long the information has been exposed! It has been available for atleast a day. (Channel 4 reported on the 26th that the data had been exposed atleast for 3 days.)

The website was secured late this evening but the flannel put out claiming that it was accessed via an URL not meant to be available to the public is ridiculous. Putting the information on an excel spreadsheet without even a simple password protecting it is not just negligence, it is idiocy. Then placing it on a publicly accessible location is another thing altogether.

I hope that each & every applicant potentially affected by this complains to the Information Commissioner. Fines can & should be levied. (The initial response that there was nothing they could do on the other hand needs explaining by the IC).

And this is a government that claims to be able to secure the massive amounts of information an ID card database or the Electronic Patient Record (Spine) will collect. Show some competence in protecting the data of a few thousand people before attempting to do so for the entire country.

The muppets at Methods Consulting should not be allowed near a computer again.

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