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So what are we to believe?

Either Gordon Brown wants to devolve management of the NHS to an independent board as the FT claims or he does not as suggested in today’s Observer. The Observer editorialexamination of likely policies in the Telegraph tries laying out the odds.

Scrap private NHS clinics - Odds: 3-1

The Private Finance Initiative is safe. But, to mark a break with the past and mollify left-wing MPs and trade unions, Brown may rein in another Blairite pet policy - the use of independent sector treatment centres, or ISTCs.

Privately run but state-funded, the success of these centres will determine the fate of several listed companies. Investors have shelled out millions to meet the cost of building ISTCs - which often charge a lot more than the NHS to conduct minor operations.

Ministers insist their target to spend £550m a year on ISTC operations, treating 250,000 patients, remains in place. But some of the companies involved privately suspect the programme will be scaled back.

Ominously, a recent government-backed report said, in some cases, ISTCs may be compromising patient safety.

Health-related investment projects often sound great in theory, but then end up going wrong. If Brown wants to stamp his authority on the NHS, then ISTCs could also end up looking sick.

I guess we will have to wait and see.

In another call for public debate about the future of the NHS, the BMA has come out with a call for prioritisation.

The BMA proposes the drawing up of a new patients’ charter specifying those health services to which every citizen across England should be entitled, regardless of the local health authority’s financial situation. They also want to see a second list of all the treatments which the sick will get only if their primary care trust has the money, and if doctors decide they are clinically worthwhile.

Senior BMA sources say their report recognises the reality that despite record investment in the NHS, ‘postcode lotteries’ are rife. Primary care trusts, the local NHS organisations that commission and pay for care from hospitals on behalf of patients, are increasingly rejecting requests to pay for procedures or drugs because they are not perceived to be the best use of funds.

Some PCTs have been bitterly criticised for refusing to pay for expensive new cancer drugs; treatment to prevent older people going blind through age-related eye degeneration and operations to help obese patients lose weight through stomach-stapling.

An inevitable consequence of such prioritisation will be that the threshold for accessing the secondary list will become much higher. Optional treatments that will cost the service money are hardly likely to be offered & we will still have a postcode lottery anyway.

Healthcare in prisons is examined with a finding of serious gaps in provision.

“The problem is that too often prisoners are treated as if they are trying to get one over on the staff, that they are not ill or do not have health needs.”

It looks like the plan to reimburse PFI bidders for the costs of failed bids is going ahead after all.

A £374 million hospital in Bristol going out to tender this week will be the test case for the scheme which a DoH senior official said would “compensate” private sector consortiums for rising tendering costs following EU laws which came into force at the end of January.

In the case of Bristol, the “runner-up” company could receive around £6 million, while a third firm may also be paid. North Bristol NHS trust is planning the 947-bed hospital, which is due to open in Southmead by 2013.

New EU legislation requiring short-listed bidders to work up more detailed proposals, would push up the bid costs by an additional 2 per cent.

Mr Coates said the DoH’s private finance unit was now considering plans under which a “significant proportion” of that extra cost would be paid back by hospitals.

The DoH is understood to be the only Government department drawing up proposals for such payments.

Given the poor state of the tendering process in the DoH surely this funding needs to be accompanied by much greater scrutiny of the bids as well as changes in the process. So far I have seen nothing to suggest that there will be an improvement in standards.

There is a report of treatment in the French healthcare system with a suggestion that it faces the same challenges & criticisms as the NHS.

Hospitals are being shut to save money; bed numbers are being cut in those that remain; waiting for treatment is common, even when you have a booked appointment; and given the famous French “pudeur”, there is an extraordinary lack of concern for patients’ privacy and dignity.

Ordinary French patients pay for their care with a mixture of state funding and private insurance. For those without private insurance, treatment for costly or rare conditions may be limited. There is not enough capacity in the system because of the classic problem of “bed blocking” that is just as familiar in Britain – old people who can’t be discharged from hospital because intermediate care or convalescent homes no longer exist.

Rod Liddle takes a moment in the Times.

Greatest Living Briton

A tabloid newspaper has invited its readers to select the Greatest Living Briton from a list it has drawn up. Almost all the individuals who’ve made Britain what it is today are present – Kate Moss, Wayne Rooney, Lenny Henry, Ozzy Osbourne, Charlotte Church and so on. But there is one glaring omission: where on earth is the health secretary, Patricia Hewitt?

I suspect a fix: the paper realised that Pat – like Churchill, Shakespeare and Nelson in previous contests – would walk it and thus rob the feature of its edge.

Hewitt was on Question Time last week, reaping her usual harvest of public adulation. “Boooooo! Booooooo!” and “Resign, you useless cow!” people shouted, with enormous affection. Cabinet ministers should only resign, she told the howling audience, when they have made a serious policy blunder – and then admitted presiding over a record three catastrophes in her brief tenure (a useless computer system costing billions, putting thousands of junior doctors out of work and increasing bureaucracy).

But it is part of her selfless nature that she is unable to take responsibility for any of it. In fact, ministers never resign as a result of a policy blunder. They resign because they have been caught out on a technicality, or discovered with their trousers down by the side of the M4, watching badgers. Which fate will befall Pat?

But there is a dissenting voice in the Guardian with a suggestion that perhaps the grilling was overdone. Unfortunately he seems to have skipped the stage of checking his facts before putting pen to paper.

Doctors do not think that they have a call on public funds to the detriment of others. What they object to is the wanton thoughtless destruction.

And as the competition ratios make perfectly clear the mythical oversubscription for plastic surgery posts while ignoring elderly care medicine is a lie. The stats by specialty tell the real story. There are 544 applicants for 101 posts in Geriatric Medicine. Is Patricia Hewitt ready to fund more posts for them since she claims that it is an undersubscribed specialty?

An increase in the number of conditions PGD is offered for, including non-lifethreatening conditions.

Is the stage set for parliament to take another look at abortion? Is a hijack of unrelated legislation on the cards?

Campaigners plan to “hijack” the Government’s forthcoming changes to the law on fertilisation and embryology to stage what would be the first full-scale Commons vote on lowering the legal limit for 17 years.

A leaked memo from Caroline Flint, the public health minister, has revealed that ministers are preparing to be confronted with the incendiary move.

In a letter to Tony Blair, John Prescott and Sir Gus O’Donnell, the Cabinet Secretary, dated May 3, Miss Flint sets out her proposals to publish her draft Human Tissue and Embryos Bill.

But she admits: “There is a possibility that some members may wish to use the opportunity presented by the draft Bill to discuss wider issues dealt with by the original legislation… and related topics of interest, notably abortion (under the Abortion Act 1967).

“Provisional advice from the House authorities suggests that these topics could not simply be ruled out as a matter of scope.”

Many social conservatives feel that the current 24-week period is too long while some Tory MPs have signalled their support for a move to reduce it.

Inevitably the scientific debate will be overshadowed by the emotive & political one, especially by people with inadequate knowledge of medical issues. If we are to have a debate, can I atleast call for a properly informed one, not tub-thumping by Anne Widdecombe?

Asbestos & Mesothelioma are today’s key words in the Guardian with a NICE decision on treatment expected soon.

Nice denied approval for the life-extending chemotherapy drug Alimta in June last year, subject to consultation which closed last month. Final guidance is due for publication in September. The uncertainty over NHS funding for chemotherapy treatment (which is still available in parts of the country, including Manchester, Liverpool and certain London boroughs) comes at a time when campaigners are increasingly concerned about the financial security of families blighted by the disease, despite new government proposals for fast-tracking financial support for those diagnosed with the devastating illness.

So do we spend money on choice or do we provide treatments such as this to patients? I know what I would prefer.

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This entry was posted on Sunday, May 6th, 2007 at 11:52 am and is filed under Clinical, Legal, Management, NHS, Politics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.