Health policy debate, February 1st to 14th 2005
A joint venture to create Britain’s first private medical school
Buckingham and Brunel have joined their efforts and are in talks to set up a new graduate medical school, opening in 2008, for 200 students ready to pay around £20,000 a year.
The Economist said, 'Britain's state-subsidised medical schools are hugely oversubscribed . . . the chance of gaining a place is only one if five. So would-be doctors have been going abroad in increasing numbers, chiefly to the Caribbean and eastern Europe.'
'Already some small independent outfits are teaching students overseas courses in London. But Balraj Sidhu who runs the London College of Medicine, which teaches offshore courses, says that the business is "infested by charlatans" and that much of the teaching is "dreadful".'
'Brunel and Buckingham will have an advantage: their graduates will be able to practice in Britain'. They will also, officials say, be eligible for the same £10,000 annual subsidy for hands-on-hospital training that graduates, from state-funded medical schools receive.
The two universities had spotted the gap in the market independently: Britain is expected to be short of 25,000 doctors by 2022, according to an official estimate.
Combining forces - which both institutions' vice-chancellors favour - will create a much more powerful contender. Buckingham has already recruited Karol Sikora, a top cancer specialist, as dean. Now the search is for donors and investors in the school.
The move may lead to increased fees for students in existing medical schools who 'may now start wondering why they don't charge rich students more too'.
'That is a subversive thought as the planned economy of Britain's higher education system frays'.[Go to note 1]
More overseas doctors come into England to support primary care
'Riaan Vlok, a family doctor from South Africa's North West Province, said that the benefits on offer in Britain were such that he had decided to abandon private practice in his homeland for locum work on the NHS'.
'Dr Vlok, 49, is part of a growing foreign workforce brought in to help to support primary care services as more British GPs give up out-of-hours work and the profession struggles to attract junior doctors to general practice.'
'Health recruitment agencies in rural South Africa said that the number of doctors expressing an interest in working in Britain had risen sharply in recent months as word got round on how much they could earn. The Influx follows the recruitment of GPs from Germany and Polish dentists.'
'On GPNet, a website directory of family doctors in South Africa, advertisements offer doctors £7,300 to work for a month or £16,000 for ten weeks’ work. Other attractions offered include free flights, a "meet and greet" on arrival in Britain and the chance to travel around Europe.'
While family doctors in South Africa earn similar salaries to those in Britain . . . the hourly locum rate is much higher and comes without the overheads of running a surgery. Dr Vlok said that he was paid £200 for seeing 16 patients in a two-hour session and he normally worked about 12 sessions each week, earning £2,400.
Dr Vlok says, "here I keep what I make and walk out. I can make more money as a temporary GP here than operating a private practice back home."
John Howard, chairman of the Royal College of GPs International Committee, said that hiring from abroad did not address the essential problem. "With a current shortage of GPs the profession is placed in the position of having to recruit from abroad," he said. "We would like to see more doctors in the UK training to be GPs".[Go to note 2]
More GPs are needed
Research by GMAP Consulting, a market intelligence company, found regional inconsistency in the number of patients per GPs.
The poorly provided areas included Doncaster East, with 2,286 people for each GP, Amber Valley in Derbyshire, with 2,258, and South and East Belfast, with 2,254. These compared with areas such as Westminster in central London, with just 717 people for each GP, and Kensington and Chelsea with 1,013.
John Dobson, GMAP's managing director, said: "By analysing local populations and the number of GPs in each area we have been able to generate an accurate snapshot of the provision of GP services throughout the UK.
"The results have revealed a wide gap between the best and worst served areas through massive inconsistencies in the number of patients per GP."
Hamish Meldrum, chairman of the BMA's GPs committee, said: "We accept there are differences in the patient-GP ratio and that is why we have encouraged the government to look at ways to help incentivise recruitment of GPs to under-doctored areas. "In the longer term we hope the new national GP contract will encourage more doctors to train to become GPs."[Go to note 3]
Consultant vacancies increase in Scotland
The Herald reported that 'vacancies for consultants in Scotland's health service have reached a record high'.
There are more than 280 unfilled posts, according to the latest survey, compared to 153 when the official log began four years ago. The Scottish Executive's target to recruit an extra 600 consultants by 2006 is unlikely to be hit and the number of additional specialists hired since the aim was outlined in 2003 is only 80.
'Between September 2003 and 2004, the number of staff in the Scottish NHS grew by more than 2000. However new laws on the hours doctors and consultants are allowed to work have effectively reduced manpower'.
A spokeswoman for the consumer group Which? in Scotland said lack of staff was one of patients' key concerns. She said: "Shortages of consultants mean patients have to wait longer and that means more worry for them. We would ask the Scottish Executive to look at the best ways to fill these vacancies."
The proportion of the consultant posts which are unfilled is now 7.7% and 113 positions have been empty for more than six months. Some hospital departments are particularly badly hit. At the time of the latest survey, 22% of posts in medical oncology (cancer) were empty, 14.3% in child and adolescent psychiatry and 14.3% in accident and emergency.[Go to note 4]
Concerns expressed about European surgeons operating in England and Wales
According to the president of Royal College of Surgeons, European surgeons flying in to help English and Welsh hospitals cut waiting lists are performing substandard operations.
While Hugh Phillips accepted he had no hard figures, anecdotal reports suggested "a significant number of instances of poor practice" in, for instance, Wales, Bristol, Peterborough, east Kent and Portsmouth.
"There is a lack of equivalence between surgeons trained elsewhere and surgeons trained at home. My postbag is full of difficulties that arise as a result." Such visiting surgeons who might fly in for a week or weekend of operations on hip or joint replacements were using "untried and untested" artificial replacements.
Mr Phillips, an orthopaedic surgeon, said technical skills were also involved. "I did 6,000 joint operations in my career. What we are talking about here are people who may have done 20 to 30."
The college said a further 2,760 consultant surgeons across several specialities would be needed in England and Wales by 2010, against a baseline of 5,214 last year set by specialist associations. Early retirements (the average age is now 57 for orthopaedic surgeons), enforced cuts in working hours and an ageing population were among the factors the college said were causing the shortfall.
The Department of Health said all independent treatment centres were "audited to at least the standards of those in the NHS" and it was "unaware of any evidence" to support claims of poorer care.[Go to note 5]
Standards
Polly Toynbee eulogises about Labour’s successes with the NHS
A new book by Polly Toynbee and David Walker - Better or Worse? Has Labour Delivered? - argues the NHS has got better.
'Blair's reputation was always going to stand or fall on whether huge amounts of extra health spending secured improved care. It did. By 2005, Labour's success was palpable, measured by waiting times, cancer and heart results or staff numbers. At its simplest, Labour did what people had been asking for: by devoting a higher fraction of national resources than ever before to health, the UK drew level with other European nations'.[Go to note 6]
But there are still reports that patients are not happy with the NHS
The Observer (6th Feb) reported that hospitals are suffering from a growing shortage of neurologists, with some patients waiting more than a week in hospital with potentially life-threatening conditions before they are seen.
Although the government has agreed to the creation of more than 50 posts for neurologists, who specialize in disorders of the brain and nervous system, only four have been filled because funding has not been made available for the rest.
This means that patients who become acutely ill cannot be seen quickly. Experts warn that it is not unusual for patients to spend at least a week on a district general hospital ward waiting to see a specialist.
The Observer highlighted the case of Gary Horne, who spent a week in a London hospital with a brain tumour without seeing a specialist, until his wife demanded he be transferred elsewhere. It was only because of her persistence that he finally got the care he needed.'[Go to note 7]
Suffering from painful headaches he found himself in a medical admissions unit, "a kind of halfway house designed to help hospitals to meet their targets of not keeping anyone waiting in casualty for more than four hours".
He was told he 'would soon have a CT scan' but then that 'the Whittington didn't do scans at weekends'.
When the scan was complete they were sent to a neurologist at the National. 'I never saw a neurologist at the Whittington. How can a doctor really know how ill you are, just by examining scans electronically? Did he or she not need to see me in the flesh?'
Although he had been a priority for a transfer to the National, the effect of the steroids on the scan made him appear less critical and put him back in the queue for an available bed.
'The neurosurgeon's registrar at the National refused to speak to his wife because I was not yet his patient. In fact, I was in the care of a rheumatologist.'
'We were up against what Labour says no longer exists: a shortage of hospital beds. It's been a problem for the NHS since the Sixties, but I had mistakenly thought that the extra money which has been put into the service meant that there was now 'extra capacity'. My experience suggests that extra beds don't exist for patients with brain tumours'.
'Sue asked whether the Whittington could find me a bed in another hospital with a specialism in neurosurgery, but the doctor said it was not worth swapping a place on one list for another and that they had a contract anyway with the National. We have since been told that no contract exists.'
In a last ditch attempt to get me the care I needed, Sue mustered all her strength and told them she was going to take me to the National in a taxi with a BBC news crew in tow unless they found me a bed. I had worked for Panorama and, as a journalist and lecturer, had many media contacts. It was a desperate effort on her part, as by now I was wildly confused and in extraordinary pain.
A young casualty doctor started to ring other hospitals for a neurosurgical bed and eventually found one at Charing Cross Hospital, in west London. I was transferred in an ambulance at 3am.
The moral of the story is, "What if you don't have an articulate, knowledgeable advocate? My sadness comes from the realisation that what I had always taken to be a patient-centred, caring NHS had become steeped in New Labour's market-driven prescriptions.
Is this really what we want from our health service? In 2005, no one should have to rely on luck or, more accurately, the persistence of their wife, to get the treatment they need."[Go to note 8]
The Healthcare Commission are deluged with second-stage complaints
The new complaints system that came in last April created a second-stage for complaints when the issue could not be resolved locally. It seemed to create an incentive for trusts to pass on complaints and for patients to pursue issues further, but the Commission did not expect so many complaints would be passed to them.
The Commission has hired a consultancy firm to help ease a backlog of nearly 4,000 patient complaints.
At present only 525 of 4,500 complaints have been solved but still the Commission says it is confident the backlog would be tackled.
Marcia Fry, the commission's head of operational development is "committed to ensuring that by the end of the February all complainants will have received an update on the status of their complaint."
Ann Abraham, the parliamentary and health service ombudsman said she was growing extremely concerned about the situation.
"People aren't getting their complaints looked at in a timely manner. "If you are concerned that your loved one actually did not receive the quality of care they should have and died needlessly, you are going to want that looked at pretty quickly."[Go to note 9]
A report argues that the money invested in cancer has been wasted. Its subplot is that the NHS is incapable of efficient allocation of resources
A report said many patients are waiting longer for cancer treatment than when the programme was launched five years ago.
The Doctors for Reform report said, the government's £2 billion scheme to revolutionise the treatment of British cancer sufferers has failed, with much of the money wasted on creating 400 bureaucrats.
The proportion facing "appalling" delays for radiotherapy that could cure their cancer has doubled. Many new machines are waiting in boxes because of staff shortages.
The doctors' group commissioned the report from three experts (all of whom are sympathizers with Reform's liberalization agenda): Professor Karol Sikora, a former chief of the World Health Organisation's cancer programme, Nick Bosanquet, professor of health policy at Imperial College London, and Maurice Slevin, consultant oncologist at Barts and the London NHS Trust.
The study found:
- More than 70% of cancer patients are having to wait beyond the recommended maximum of four weeks for radiotherapy, compared with 32% five years previously.
- No improvement in waiting times from diagnosis to treatment for all the main cancers throughout 2002 and 2003 - and increased delays for urological and some gynaecological cancers.
- Huge delays in obtaining the scans and pathology tests needed to decide on the best treatment for a cancer victim.
- Patients continue to face a postcode lottery over the prescription of drugs despite an extra £124m to reduce those inequalities. For example, 5% of women with breast cancer in Derbyshire received the new drug Herceptin compared with 90% in Dorset.
- No national cancer information technology system: doctors continue to calculate doses of chemotherapy on paper where they are more likely to make potentially fatal errors than if done by computer. "If such a dangerous system existed for other procedures such as surgery. it would be regarded as completely unacceptable."
- A projected shortfall of one third - 400 - in the number of key specialists required to analyse tissue to ensure patients get the right treatment.
The report concludes: "The cancer plan is delivering poor value for money. It is simply not delivering as hoped and there are no reasons for expecting any dramatic improvements in the future. In the interests of patients we must look at ways of bringing about a rapid improvement in the situation."
Doctors for Reform advocate a social insurance model for healthcare and say progress in NHS reform has been held back by its monopoly provision. The report calls for 30% of cancer treatment to be handed to private companies over the next two years.[Go to note 10]
Plurality
At the same time as Doctors for Reform were asking for more treatments to be given to private companies, reports emerged that analysts were encouraging the government to do the same.
An analysis prepared for government of how to create a sustainable market in healthcare is uncovered
The Financial Times used the Freedom of Information Act to force disclosure of an independent analysis of how the NHS should create a sustainable and innovative market.
It said the current market "is likely to stagnate and ultimately collapse" in four to seven years time, says the analysis, released to the Financial Times under the Freedom of Information Act.
That may be enough time to clear the waiting lists, if the government sees the private sector as providing short-term capacity. However, if the government wants to create a sustainable market it will have to provide many more operations for the private sector to perform.
To keep overseas bidders interested, a third wave of 250,000 operations a year needs to be commissioned. The paper says 'this has already been agreed by Tony Blair, the prime minister, with tender documents expected soon'.
'To create a highly effective market that could also involve UK private sector operators, such as Bupa, BMI and Nuffield, at least another 200,000 NHS operations a year would be needed, the paper says.'
'More NHS work would help to enable UK companies to transform their businesses at a time when demand from private patients was likely to fall because NHS waiting lists were getting shorter. At the same time, it would enable them to offer private patients cheaper operations.'
'In all, that would give the private sector "at least" 700,000 NHS operations a year, or close to half of the growth of 1.6m that is needed by 2008-09 to hit the government's target that no-one will wait more than 18 weeks from seeing a GP to an operation.'
'At present, six companies, from South African Netcare and Afrox, to Swedish-owned Capio and US-backed groups including Nations Health, have won the vast bulk of the treatment centre contracts. But they, and the UK operators could consolidate into four big NHS providers. That, the paper says, would sustain a competitive and innovative market both nationally and locally for NHS care.'
The report added: 'critical to getting the extra operations was that the registration process for EU and US doctors was "streamlined" to allow extra foreign doctors to come in'.[Go to note 11]
The report admitted it "is a critical assumption" that professional regulation could be streamlined to allow foreign medical consultants . . . to work in this country and 'without which these productivity levels could not be delivered'.[Go to note 12]
Private Eye comments on treatment centres
In Private Eye, 'MD has been point out the contradiction in "new" Labour health policy for months. It pretends to offer individual patients more choice, but to increase this choice it has had to promise private providers a guaranteed slice of the cake. So patients are being coerced into going to ITCs whether they choose to or not.'
'The problem as ever with Labour, starts with an unrealistic target hastily forced on the health service without discussion with, or the agreement of, those who have to implement it. Half a million private FCEs have to be achieved this year regardless of how this destabilises the NHS. So the DH's commercial directorate has been busy pressuring trusts to use ITCs'.[Go to note 13]
Boots and Superdrug to play bigger role in the delivery of health promoting services
'Boots, the retailer, has entered into a groundbreaking partnership with the NHS to offer tests for the sexually transmitted infection chlamydia as it seeks to counter fierce competition from rivals, such as Tesco, by carving out a distinctive niche in the pharmaceuticals market.'
'The struggling retailer, which is in the middle of a three-year turnround plan, is attempting to see off the challenge from the big supermarkets by leveraging its chemist credentials.'
'Meanwhile, Superdrug, which has 226 pharmacies, is offering services linked to smoking and the brittle bone disease osteoporosis.'
Both 'are seeking to cash in on the increasing numbers of "worried well" who aspire to take active control of their health. But driving the strategy is a key change in government policy: the liberalisation of basic healthcare, which takes effect this year. It could offer the prospect of lucrative contracts to supply basic NHS services.'
'Under the schemes, the NHS foots the bill for the testing.'
'In anticipation of the liberalisation, Boots is also working with primary care trusts to launch other new NHS services in-store: smoking cessation clinics in Birmingham and weight management advice programmes in Manchester.'
'Boots acknowledged that offering NHS services was an important brand-building exercise. "If you look at competitors they will all have a particular strength in one sector. Department stores have premium cosmetics, grocers stock everyday toiletries. What we are trying to do is find a platform for the Boots brand that customers value above other competitors," said David Neil, chief commercial officer.'
Working with the NHS quasi market is better than trying to succeed in a pure market for health. 'Last year, Boots left a range of ancillary services - from Laser eye treatment to chiropody - because it could not make them pay. In contrast, contracting with the NHS to provide services means the stores concerned are guaranteed a secure, risk-free, revenue stream'[Go to note 14]. They won't have to compete for business.
BMA in Scotland suspects private firms of using the FOI Act to target particular doctors with pharmaceutical products
The Times reported that in Scotland, the BMA 'is demanding a review of the Freedom of Information Act after it was used by a private company to obtain details of the prescribing habits of hundreds of Scottish doctors'.
'IMS, an American-based market intelligence company, plans to pass on the information to pharmaceutical firms, which could use the data to target GP practices that are not using their drugs.'
Although NHS Scotland's Information Statistics Division (ISD), refused to provide information for every family doctor, it has provided a list of the prescribing habits of every surgery in Scotland with more than one GP. IMS now intends to ask for information about a broader range of drugs.
'The BMA is concerned that firms are abusing the legislation, intended to make government and public bodies more open and accountable, and is to raise the issue with Kevin Dunion, the Scottish freedom of information commissioner.'
Dr David Love, joint chairman of the BMA's Scottish general practitioners committee, said, "I cannot imagine that it was the intention of this act to have health service bodies spending huge amounts of time producing data for commercial companies so that they can increase their profits. It raises serious questions if commercial organisations, such as pharmaceutical companies, are seeking to make a profit by taking advantage of this legislation."
Peter Stephens, IMS vice-president of European public health affairs, said the company was examining the legality of selling on the data. "There may well be a commercial impact."
"All of a sudden we could end up with a lot of information we have never had before that we can combine with our existing databases to provide better services."
Asked whether the information would be valuable to pharmaceutical companies, Stephens said: "Absolutely, they would want to know it".
In England the request was rejected outright by local primary care trusts and the Prescribing Pricing Authority.[Go to note 15]
German health minister speaks at LSE on 'can markets sustain health improvement?'
The German health minister, Ulla Schmidt, gave a speech at the London School of Economics on Monday 7th February. Her subject was: 'can markets sustain health improvement'.
Like many other countries, Germany has experimented with markets recently. Inevitably there is tension between employing market mechanisms alongside state administration.
In Germany, the involvement of markets is less of an ideological issue than in England. "The question in Germany is not whether there should be a market, but how much healthcare should be exposed to it".
But while there is a trend to employing more competition in the supply of health services this doesn't mean the health system has to be predicated on markets.
The minister says she has "great doubts that markets can sustain health . . . particularly if social insurance is not mandatory". "Healthy and younger people would neglect insurance". "Market forces should not be given free reign, they should not be too pervasive, particularly in the relationship between doctor and patient" and they "should not be allowed to undermine social solidarity".
She said the most important part of having a market was effective regulation by the state so providers served the country’s strategic interests.
"Politics can always correct undesirable elements and perverse incentives". "The key for the state is to get regulation right". Regulation can be used to improve integration between primary and secondary care, as a lever for improvement, and to improve chronic disease management.
Politicians have to take a pragmatic approach and continually adapt the regulatory framework.
Ulla Schmidt thinks there is lots more scope for the English system to liberalise further.[Go to note 16]
Incentives
Second-wave treatment centres to be given guaranteed volumes of patients
'The next wave of privately run treatment centres will - like the first wave - be given guaranteed volumes of NHS patients'.
As reported above, the health department is expected shortly to put out tenders for a third wave of 250,000 operations a year from the private sector, doubling the capacity of independent treatment centres to provide operations for the NHS.
Reid said after the renewal of their contract, independent centres would from 2008 have to meet or beat NHS prices.
His stance brought protests from the British Medical Association that he was denying existing NHS hospitals the chance to compete fairly for NHS business.
'Mr Reid also made clear that he had not yet decided whether to allow NHS foundation trusts to compete for the new contracts, even though they were operating like independent businesses. The health department is understood also to have taken legal advice that European Union competition law would debar them from bidding as they are largely state funded'[Go to note 17]
NHS treatment centres stuggling to compete
Ravenscourt Park Hospital, a specialist centre for hip and knee replacements is facing high costs, low demand, and is set to close.
With relatively high costs, the centre has been rejected by 5 out of 7 local PCTs. It is estimated that double the current 6000 procedures are needed for it to remain viable.
The NHS centres are finding it very hard to compete against ITCs and their guaranteed patients flows.
An article in the Times estimated that Southampton General Hospital is set to lose 50% of its elective work to independent treatment centres over the next five years because of the need to feed the private sector guaranteed work.[Go to note 18]
BMA says treatment centres are having a negative impact on the NHS
James Johnson told the Daily Telegraph 'that three inter-dependent planks of the reforms - patient choice, the inclusion of private providers and the delayed system of payment by results - were in chaos and destabilising hospital finances'.
Ministers and senior officials had no answers to what would happen if hospitals began to close because new, neighbouring private treatment centres were taking their business.
That was beginning to happen, he said. An orthopaedic ward at Ravenscourt Park Hospital, west London, had been closed and Southampton University Hospital was in difficulties.
Mr Johnson said: "There will come a time quite soon when the patients moving to the treatment centres will de-stabilise the entire hospital. The NHS does not seem to be able to withstand surplus capacity, in other words empty beds. So it closes them down, sacks the nurses and the plurality of provision has failed".[Go to note 19]
John Reid says hospitals will close
If the creation of extra capacity left the National Health Service with underused wards and theatres, or if it paid privately run centres for operations that patients did not take up, that was a "price worth paying".
Everyone, he said, wanted the "best hospital in the world at the end of their street". But the way to get that was to allow patients the choice to go elsewhere, with competition producing better local services.
Asked if that might not lead hospitals to close, he said: "The patients will decide that. I am not going to force people to take a third rate service. Patients will get the choice because for 60 years they have had to take it or leave it."
Funding for treatment will "follow the patient", meaning that if patients opt for surgery somewhere else, their local hospital will lose money and could eventually be forced to close. To offer the extended choice of health care, the Government has guaranteed ITCs a certain volume of patients - and therefore money - for their first five years by "block-booking" capacity which NHS trusts will pay for.[Go to note 20]
Mr Reid said there would be a series of steps before a hospital closed, ranging from assistance to replacement of the chief executive and management team. "If all that fails and local people still say the quality of the hospital is so bad . . . am I going to say 'no, you are forced to go to that hospital?'"
Asked if politicians were prepared to face up to that and let a hospital close, he said: "This politician is."
Challenged by reports that some NHS-run treatment centres were already running half-empty as capacity expanded, with hospitals facing deficits as a result, he said: "Even if they are haemorrhaging £5m, that is out of £50bn [the NHS budget] and it is worth it to give patients this degree of choice."
He was equally prepared to see operating slots go unused in the independently run treatment centres, for which the NHS is committed to pay under the current contracts. Patients would not be forced to use the independent centres, he said, but providing them with choice would drive improvements.
The Guardian's John Carvel noted ‘his comments came at a briefing for journalists in London. He hinted that Labour would promise further extensions of patient choice in the run-up to polling day.[Go to note 21]
Reid's stance 'brought warnings from the NHS Confederation that hospital services were inter-related. Patients would only have a choice over non-emergency surgery. "But if patient choice closes the orthopaedic department, that would have a knock-on effect on its ability to do trauma surgery which means the accident and emergency department could go as a result," said Nigel Edwards, the confederation's policy director'.
"That may not be what patients want," he said. "The secretary of state's bullish approach to closure may be entirely appropriate for a day surgery unit or free-standing centre. It might not be so appropriate if it means closing the accident and emergency department in a large town".[Go to note 22]
The search for rules of engagement in the new market for health
The HDJ reported that 'a tough new NHS constitution is being drawn-up to prevent health economies sliding into bitter warfare in an era of foundation trusts and payment by results'.
The code of conduct is being drawn up by Mike Farrar and David Nicholson and the move comes after audit chiefs warned that, unless handled differently, payment by results could 'destroy' key parallel policies such as practice-based commissioning.[Go to note 23]
Alastair McLellan, in the HSJ, drew out some parallels between the liberalisation of the railway system and that proposed for the NHS.
'The break up of BR created a number of infrastructure businesses, a number of train operators and a host of new business arrangements with contractors - watched over by a regulator.'
'Against a background of growing demand the new system began to fall apart amid a welter of misunderstandings and misplaced assumptions. A major problem was that no-one had adequately thought through the new rules of engagement'.[Go to note 24]
One of the people putting together the plan is head of the Birmingham SHA, David Nicholson. The entire West Midlands NHS has agreed to roll out payment by results in full from April this year.[Go to note 25]
This experiment should be closely watched.
Clinical management
Waiting lists grow in Scotland
Waiting times for hospital treatment in Scotland have shot up by more than 50 per cent since 1999, according to new statistics released by the Scottish Executive.
The figures were published in response to a written question from Linda Fabiani, an SNP back-bencher.
On average, Scots were forced to wait 81.3 days for inpatient or day-case treatment in the third quarter last year, compared to 53.5 days in June 1999. In that time, average waiting times for outpatients also rose, from 64 days to 89.8 days - up 40 per cent.
Until now, the Scottish Executive had always refused to release details on the average waits for patients. They had always used the median method of calculation - the half-way point between the longest and shortest waits. 'But even on this calculation, waiting times had increased significantly'.
Health minister, Andy Kerr pledged to cut maximum waiting times to six months for both inpatients and outpatients by the end of 2005. In the long term he promised to build additional capacity in the NHS and make more use of the private sector to cut times.[Go to note 26]
He announced that health boards are to get £6 billion extra from the Executive next year.[Go to note 27]
The Executive also unveiled a new method to manage waiting lists.
'Patients who refuse hospital appointments without a good reason will pay the penalty of being placed at the end of the waiting list'.
'Some patients routinely turn down appointments because they clash with birthdays, weddings, football matches or because of problems arranging childcare. Thousands more fail to turn up for appointments, costing the NHS up to £10m every year. From 2007, anyone who is deemed not to have a valid reason for not attending a hospital appointment will lose their place in the queue and could face a lengthy delay before they can obtain treatment.'[Go to note 28]
Discomfort over service redesign in Lothian
One of the biggest arguments in Scottish health policy is the redesign of services.
The Herald on Sunday reported that NHS Lothian is to recommend to its board (on Feb 16) 'that it proceed with the largest ever review of health services in the region, toughing it out amid widespread public opposition to the proposals, with the aim of creating centres of excellence'.
Managers say change is needed because 'the status quo is not an option' with 'the introduction of European legislation limiting working hours for junior doctors, a new Mental Health Act, action required on waiting times and a growing emphasis on tackling health inequalities in recognition of the fact that middle-class patients tend to get better treatment than their poorer counterparts'.
'These pressures apply across Scotland, meaning NHS Lothian's service review points the way forward for health boards around the country.'
'Campaigners are particularly incensed at proposals to close the Royal Victoria Hospital (RVH) - which was at one time an internationally renowned centre for geriatrics and still provides services for the elderly - and transfer services to a £15m purpose-built facility at the Western General Infirmary.'
'Under the option to be recommended, long-term care beds for the elderly will be lost, although the board insists modern care facilities bringing services closer to communities means not as many beds are needed as before.'
'Phyllis Herriot, secretary of the Edinburgh area council of the Scottish Pensioners' Association, dismissed the proposals as a "farce". She said that "hundreds and hundreds" of people had written to the board asking that the Royal Victoria be improved and upgraded into a centre of excellence for older people.'
'Other campaigners highlighted the fact that the health board has gone down the road it preferred from the outset despite a three-month public consultation exercise last year which was extended due to the volume of response.'
"These consultations with the public are a sham. I'm just absolutely raging at the behaviour of that organisation [NHS Lothian]", said Dr George Venters, chairman of the Scottish Health Campaigns Network, an umbrella body representing various local campaigns against hospital reorganisation.
"They have made their minds up and presented options that are not options. They're making decisions in the managerial interest and political interest but not the public interest. It's appalling."
Shona Robison, SNP shadow health spokeswoman, echoed this view.
"It's quite tactless that these proposals are being put forward at a time when communities are being consulted by the Kerr Commission on how health services should look in Scotland for the future. That these two things are happening at the same time will, I think, astonish many people affected by these proposals."[Go to note 29]
Welsh waiting lists
On Valentines day, Peter Hain was in Wales to launch the Labour Party general election campaign. He said waiting lists in Wales will continue to reduce if Labour wins a third term but he stepped back from committing to the same targets for the Welsh NHS as have been set for England. The party will only only "guarantee shorter maximum waits".[Go to note 30]
English waiting lists rose between November and December 2004
England has its own waiting list problems. It is a popular myth that they have all disappeared.
According to the Press Association, 'the number of patients waiting for NHS treatment in England rose by more than 14,000 at the end of last year. At the end of December a total of 858,000 people were on the waiting list for an operation - up by 14,100 since the end of November'.
However, there was also good news in the figures.
The total number waiting longer than nine months for treatment has fallen by 34,000 in a year - only 86 patients had waited more than nine months at the end of December - down from more than 300 in November and twenty-four patients had waited longer than a year.
Health minister John Hutton met with a group of diagnostics experts who will lead work to meeting the 18-week target on February 11. The experts will head four national groups, covering imaging, pathology, endoscopy and physiological measurement, which will support the NHS in reforming its workforce, technology and service to speed up treatment.
Mr Hutton said: "If we are to meet the 18-week target from GP referral to treatment, we need to radically improve diagnostics. I'm confident that the expertise we have within these groups will enable us to drive towards that target," he said.[Go to note 31]
Doctors lose their enthusiasm for IT
'The £6.2bn programme to build an integrated IT system for the NHS in England is in danger of catastrophic failure due to a collapse of confidence among the doctors who are supposed to use it, a Guardian poll of GPs and consultants has revealed'.
A new 'survey of doctors by medical pollsters Medix found the government has squandered the support of clinicians by failing to consult them on specifications or pay attention to the practical difficulties of operating the systems in a busy clinical environment'.
'A year ago Medix found 56% of GPs in England were at least fairly enthusiastic about the health service's National Programme for IT (NPfIT), but during polling in the last week of January that fell to 21%. Among hospital doctors, support fell from 75% to 51%.'
The Medix poll, co-sponsored by the Guardian and Computer Weekly, found doctors were anxious about the confidentiality of the proposed NPfIT system for transferring electronic patient records. This will allow authorised medical staff throughout the NHS to access a patient's medical history.
The poll found 70% of GPs and 42% of non-GPs think records will be less secure than current systems. Only 2% of GPs believed the new system would be more secure.
Just 5% of doctors said they were adequately consulted about the IT programme and 71% were not consulted at all.
A spokesman for NPfIT said: "We know there has been some discontinuity in our clinical engagement. But we have recently adopted a new approach, appointing a number of senior clinicians to lead this engagement work."
Alan Burns, NPfIT's director of service implementation, said he would prove to doctors over the next three or four months that NPfIT was secure and Choose and Book would not overload GPs with extra work.
He acknowledged a series of personnel changes among top managers responsible for making the programme acceptable, but said he was now senior responsible owner "for all practical purposes". He added: "I don't take this job lightly and intend to stay responsible for it".[Go to note 32]
References
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