Public Services News Bulletin w/c February 5, 2007
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Just imagine somebody who has spent their whole life in
the Labour movement having to go to court, under a Labour
government, to try to get the NHS to pay for treatment.
Imagine being forced to choose between going private,
or going blind. I was Labour MP for Halifax for 18 years,
and I didn't believe this could happen. I can still hardly
believe it. But it has happened to me and - I have since
discovered - to thousands of others. I went to a GP last
September because I had some discomfort at the back of
my left eye. He sent me to an optician, who referred me
to a consultant at Calderdale Royal Hospital in Halifax.
The consultant diagnosed macular degeneration. Oh
dear, I said, that sounds a bit serious.
He said: It is, but it's treatable. Even though
you have got quite a bit of it, you would benefit from
Lucentis. It suppresses the condition immediately, and
in one or two cases there is real improvement.
The only problem is that you can't automatically get it
on the NHS. I was told I had to apply to a committee
of the primary care trust called the exceptions committee,
but this committee was not going to meet for seven weeks.
I had a condition which could result in me going blind
quickly, and I was having to wait. I was shocked. The
committee met, and they told me I could not have the treatment
on the NHS on the grounds that they didn't think it was
clinically effective and the National Institute for Clinical
Excellence (Nice) had not approved it - although in the
NHS eye clinic I spotted a pamphlet advertising this treatment
and singing its praises. I wrote to Gordon Brown and the
Health Secretary, Patricia Hewitt, saying that it was
against every principle I have to pay for NHS treatment.
I also said that I think it's a false economy to allow
somebody to lose their sight when there is treatment available.
Patricia wrote back, agreeing that the drug did not have
to be Nice- approved, and that it did not need to be licensed
in the UK before it was prescribed, because the Americans
and Europeans have approved it. She referred me to the
strategic health authority, as the only people who could
overrule the PCT, but they came back and said I had not
exhausted the appeal procedure at the PCT. But my condition
is time- limited. I was losing sight in one eye, and in
two or three months I could lose the sight of the other.
I saw the consultant again this month, and he warned me
that there is increased activity, so I agreed to go private.
I had the first injection the next day. Three of these
injections will cost me £5,500, but I have to say
that since then, the eye has been much more comfortable.
I have found out since that there are thousands of people
in my position. It was quite emotional when I went for
my first injection, because there were people spending
their life savings or whose relatives were coughing up
to pay for their treatment. I have decided that the best
service I can do for them is to generate as much publicity
as possible, and to get people to pressure their MPs and
the government to have the NHS fund this treatment.
Highly-paid family doctors are to be offered even more
money to start working in the evenings and weekends again.
The move comes just three years after the vast majority
of GPs stopped out-of-hours work. Since then GPs have
seen their pay soar to an average of £118,000 under
a new contract which scrapped their responsibility to
patients outside normal working hours. Now ministers are
preparing to effectively bribe GPs through fresh financial
incentives to change their working patterns again after
a major patient survey showed growing dissatisfaction
with the current service. An annual survey of patient
experiences found that a quarter of patients described
their local GPs' opening hours as inconvenient - up from
one in five the year before. A majority said they would
be happy for their local practice to close during the
day if it meant they could get appointments after work
or at weekends. Now ministers say they want to renegotiate
the GPs' lucrative contract, potentially paying them even
more to open at more convenient times. Average GP pay
is now around £118,000 - a 63 per cent increase
in three years. But doctors' leaders slammed the proposals,
saying that many patients would miss the daytime surgeries.
The current GP contract has been widely criticised for
massively increasing the amount a doctor is paid at the
same time as removing the requirement to be on call in
the evenings or at weekends.
More than 90 per cent of doctors took advantage of the
contract's opt-out, allowing them to stop providing out-of
hours services. To fill the gap, the NHS has been forced
to open more than 70 walk-in centres and bring in private
companies to provide primary care services. But many patients
are turning up in the evening at accident and emergency
departments with minor complaints because their local
GP surgery is no longer open. The government has said
it would look at offering GPs more money to open at times
more convenient to their patients. Health minister Andy
Burnham said: It's vital we ensure GP practices
are open when patients want. Opening hours should
reflect patient preferences and we will look to use the
GP contract to provide more incentives for GPs to offer
better opening hours. GP opening hours will become
even more important as we look to move more care out of
large hospitals and closer to patients' homes. Each
practice should be looking at opening for the times that
best meet the needs of their patients.
The poll of 10,000 patients, carried out by Picker Institute
Europe for the Health Department, found that 69 per cent
of patients would like to see surgeries close during the
day if it meant GPS offered appointments at more convenient
times. The most popular option was opening after 6pm in
the evenings, backed by 34 per cent of patients. Saturday
openings were favoured by 29 per cent, and another 8 per
cent wanted early opening hours, before 8am. Asked how
often they would like to see evening opening, the majority
- 60 per cent - said two or three times a week. The survey
also showed there was much room for improvement on GP
access. Although the figure was slightly down on last
year, 12 per cent of patients were still not able to see
GPs within 48 hours. Those unable to book an appointment
more than two days in advance stood at 30 per cent - unchanged
on the previous year. And more than half - 58 per cent
- said they had trouble getting through to their local
practice on the phone, slightly up. All in all, 25 per
cent of patients reported that they had been put off from
going to their GP because they found the opening hours
inconvenient - up from 21 per cent the previous year.
Dr Hamish Meldrum, chair of the British Medical Association's
GPs' committee, said: In pressing for longer opening
hours the government seems to forget why the opening hours
of the new contract were agreed.
They recognised the chronic shortage of family doctors
and that it was unreasonable and unsafe to expect the
same doctor to work through the day and then evening and
weekends as well. He said evening opening would
also require that staff would need to work later to do
x-rays and blood tests - stretching NHS resources. A
shift to more appointments in evenings or at weekends
would inevitably mean fewer during the day if we are to
work within existing resources, he said. The
majority of our patients - the young and those with chronic,
long-term conditions - don't want to lose daytime surgery
hours. They would be disadvantaged as a result.
A spokeswoman for the Patients Association said GPs needed
to improve access. The NHS is not accommodating
the local needs of patients, she said. We
get a lot of calls about this on our helpline and many
complain they cannot get through to their GP on the phone.
If we make services more acceptable to patients
we will encourage them to take more responsibility for
their healthcare - and that will save the NHS money in
the long run.
A spokesman for the Health Department said it would not
be putting forward the incentive payments for the 2007/08
contract, currently stalled. However the scheme would
be considered in future contract negotiations, which take
place every year. In a letter to all GPs sent yesterday,
Dr Meldrum said government criticism of GP pay and working
hours was 'unjustified and at times malicious'. The
government may feel that by blaming GPs they will divert
attention from where the real blame lies, he said.
They couldn't be more mistaken. They need
a confident, cooperative general practice more than ever
if they are to have some chance of getting the NHS out
of its present shambles and their persistent denigration
of GPs and their value if completely counter-productive.
They will not impress our patients, their voters.
The Government's drive to create a patient-centred NHS
is failing, a report warns. Patients are less involved
in healthcare than they were three years ago, and decisions
about medicines and treatment are increasingly being taken
out of their hands by GPs. The results will come as a
blow to ministers, who have championed choice in the NHS
based on increasing patient involvement. In the survey
of 10,000 patients conducted for the Department of Health,
only 45 per cent said they were given as much information
as they wanted about their medicines. Patients were also
unhappy about access to GPs, with seven out of 10saying
they wanted surgeries to open in the evening and at weekends.
But problems over patients obtaining appointments seem
to have been largely solved, with nine out of 10 saying
they could see a doctor within the Government's target
of 48 hours. The findings were released as the British
Medical Association urged GPs to unite to defend themselves
against politically inspired doctor bashing.
A fact sheet has been sent to all 42,000 family doctors
in the UK, which the BMA claims rebuts the inaccuracies
surrounding claims about the rise in [GPs'] earnings.
[No URL available]
Infections with the lethal hospital bug Clostridium difficile
rose to a record last year, defying efforts to curb the
growing threat. Figures released yesterday by the Health
Protection Agency (HPA) showed that there were 42,625
cases between January and September, up from 40,390 in
the same period in 2005, a rise of 5.5 per cent. Cases
of the infection have doubled since the late 1990s, and
have increased more than tenfold in the past 15 years.
The bacterium mainly affects the elderly causing severe
diarrhoea, which can lead to intestinal gangrene. It causes
2,000 deaths a year. Bloodstream infections with methicillin
resistant Staphylococcus aureus (MRSA) showed a small
decline to 3,391 in the six months from April to September.
The fall of 5 per cent, compared with the same period
in the previous year, is not a fast enough rate of progress
for the Government to hit its target of halving the infection
rate by 2008. MRSA causes 1,000 deaths a year. Georgia
Duckworth, the head of antimicrobial Resistance at the
HPA, said there was a plateau in MRSA cases rather than
a significant decrease.
Dentists are turning away patients because local health
chiefs are running out of funds, dental leaders say. A
new dental contract started last year, but early figures
suggest the government overestimated how much money would
be taken in patient fees. NHS trusts have begun to cut
their budgets in response and the British Dental Association
said this has led to some dentists refusing patients care.
A government memo has urged health chiefs to get to grips
with the issue. Surrey - NHS trust facing shortfall in
fees, although unclear how big at moment. Bosses admit
they have had to say no to dentists who want funds to
treat patients. Local dentists report having to turn away
patients. Bradford - Health chiefs expecting to get just
over half of the £5.7m it was expecting in fees.
Unclear how shortfall will be met, PCT says dentists are
treating more exempt patients than expected. Sheffield
- NHS trust facing a £2.3m shortfall in patient
fees, which bosses say will have an impact on dental services.
Some local dentists running out of money to treat patients.
Norfolk - Dentistry budget to be cut by nearly £3m
- about 10% - to cover shortfall in fees, with NHS bosses
admitting there are problems accessing dentistry in some
areas. Dentists say they are turning away patients. Coventry
- NHS trust facing shortfall in fees of about £600,000.
Officials say they are tightening orthodontistry access
restrictions, cutting dentistry budgets and using money
elsewhere to plug gap. London - Health bosses say seven
out of eight north west London trusts facing shortfall
in fees - mirroring the picture nationally. Cambridgeshire
- Shortfall predicted to be £2.2m - 25% of what
county expected to make in fees.
Managers said significant problems being reported
across country. The memo and many trusts say dentists
are treating more exempt patients than expected - children
and those on low income do not have to pay for care. Under
the contract, many adult patients make a contribution
towards the cost of their treatment. The Department of
Health said trusts should be making £630m from these
fees, making up a quarter of their entire dentistry budget.
But health chiefs have now started warning they will not
make enough, leading to cuts in budgets. Health chiefs
in Yorkshire, London, Surrey, East Anglia and the Midlands
have all reported problems. This has had two consequences
- firstly trusts have not been able to expand services
as much as expected and secondly dentists have been denied
funds to treat patients. The contract, which started in
April, was designed to expand NHS services amid reports
many patients were being forced to pay for treatment privately.
It gave local health chiefs working for primary care trusts
responsibility for providing services, while attempting
to make NHS work more attractive for dentists by offering
them the same money for seeing fewer patients. Since the
new deal came in last April, dentist numbers have fallen
from 21,111 in England to 20,285, but the government said
those left working In the health service were doing more
NHS work rather than private practice. Jackie Sowerbutts,
dental adviser to Surrey PCT, admitted the trust had had
to say no to a number of requests from dentists for money.
She said: The government totally and utterly changed
the system. It is not surprising the estimation [of patient
charges] is turning out wrong. Many trusts are in
A primary care trust is considering handing over a major
part of its work to a private management company. If Hillingdon
Primary Care Trust in north London goes ahead with the
plan to put commissioning of services and negotiating
contracts into the private sector it will be the first
in England to do so. Up to 270 jobs could be affected.
The trust has a deficit of £54 million and is projecting
losses of £11 million this year. In a statement
yesterday it said that it recognises that a factor
contributing to the financial challenges is a skills gap
in the commissioning function with regard to performance
management and contract negotiations. The proposal
is an option and no decision will be made before the board
meeting in April. The health services union Unison said
it was surprised by the reports since it was in discussion
with the trust over ways to manage the deficit. We
are firmly opposed to the trust giving its commissioning
role to the private sector. A private health company could
be commissioning services from its own organisation when
there would be a clear conflict of interest, a spokesman
said. Jonathan Fielden, of the British Medical Association
consultants' committee, said: What may happen at
Hillingdon sounds like a substantial step towards privatising
the NHS and NHS services? The Government seems hell-bent
on pursuing this line despite the fact that previous private
ventures have cost millions of pounds but have not benefited