Read what the papers have to say about the NHS…

Excerpts from The Times:
Health crisis for hospitals as huge debts hit services
March 18, 2005
BY NIGEL HAWKES, HEALTH EDITOR, AND DAVID ROSE

HOSPITALS across the country are running up huge debts despite the billions of pounds of extra funding going into the NHS, figures seen by The Times reveal.

The official government statistics show that at the end of the last financial year, nine hospital trusts had deficits of more than £10 million, 14 had deficits of more than £5 million, and another 39 of more than £1 million.

Overall, almost one third of all NHS trusts were in deficit, with the total standing at more than £350 million. However, experts believe that the situation now might be even worse, with many hospitals having to cancel operations, shed staff and close wards to try to claw back money before this financial year ends.

St George’s and Hammersmith hospitals, in London, have already closed beds, while Leeds Teaching Hospital announced plans to shed 230 beds and four operating theatres.

Airedale trust, which is predicting a £2.9 million deficit, has had to cut some non-urgent surgery while South Tees trust with a debt of £25 million, admitted that it was now increasingly hard to balance the books.

“In recent years we have gone from a situation of being able to balance the books year on year to one where we have to effectively borrow from next year to try and balance this year’s books,” managers wrote in a special staff briefing.

Experts said that the deficits were the result of hospitals expanding too fast to try to cut waiting times. They also overestimated the amount of money that they would get from central government, and underestimated the cost of implementing the new consultants contract.

The disclosure has caused a political storm just a day after Gordon Brown put Labour’s handling of the public services at the heart of its election campaign. “Despite the hard work of NHS staff and billions of pounds worth of taxpayer investment, resources are being wasted and swallowed up by additional bureaucracy and the pursuit of government targets,” Andrew Lansley, the Shadow Health Secretary, said.

“Eight years ago, Mr Blair said it would be ‘24 hours to save the NHS’, but today more than one in three hospitals is in deficit, resulting in closed wards and cancelled operations.”

A&E units distort data to meet four-hour wait target

March 14, 2005
BY NIGEL HAWKES, HEALTH EDITOR AND SAM COATES

CASUALTY departments have revealed that they are jeopardising patient care and deliberately distorting official waiting times in a desperate effort to meet government targets.

Eight out of ten accident and emergency units admit that they discharge patients too soon, give them sub-standard care or send them to the wrong wards to deal with them within the four-hour target.
Today’s major survey by the British Medical Association also casts serious doubt on the accuracy of government statistics on A&E waiting times. Three-quarters of hospitals say that they use a range of tactics during monitoring periods to manipulate the figures.

Half say that extra staff have been brought in during weeks in which monitoring takes place, while a quarter admitted that non-emergency surgery was cancelled. One in six hospitals even resorts to the “direct manipulation of the data” to make it appear that they have met the A&E target.

The news turns the spotlight on government claims about NHS improvements, pushing health to the top of the election agenda. It also comes the day after Tony Blair was publicly criticised by a gynaecologist who told him that target-setting in A&E was “actually jeopardising patient care”.

Amara Sohail from Basingstoke said: “As someone working within the system, we don’t see more money coming in. Targets don’t work.”
She said that the pressure on emergency medical staff would lead to “serious mistakes”.

Mr Blair told her: “If you went back a few years, I think most people would say that accident and emergency departments are a lot better than they were.” He added that he was prepared to look again at the issue of A&E waiting times to ensure that they were “sufficiently flexible”.

The target — that 98 per cent of patients be seen, treated, admitted or discharged within four hours — is due to come into force at the end of this month. The Government says that by the end of last year 96.8 per cent of patients were being seen within this time.

But the survey backs data collected from patients by the Healthcare Commission, which also suggested that targets were far from being achieved.

The claim has met with an angry response from the Government. John Hutton, the Health Minister, said it gave “a deliberately distorted picture of the changes that have taken place in A&E departments”.
He went on: “Chief executives of NHS trusts are responsible for signing off their performance data. If any doctors have concerns about patient care or fiddling of figures, they have a clinical duty to take them up with their medical director or chief executive or, failing that, with their strategic health authority or the Department of Health. To date we have received no formal complaints.”

The survey was sent to all 200 A&E departments in England, and 163 of them replied. Of the half that said they had failed to meet the Government’s 97 per cent end-of-year target, most cited a lack of beds, delays in accessing specialist opinion or diagnostic services and staff shortages.

Of departments which said there had been problems, just over half said patients had been moved to inappropriate areas simply to get them out of A&E within four hours, and 40 per cent said patients had been discharged before they were adequately assessed; 27 per cent said care of the seriously ill or injured had been compromised.

Donald MacKechnie, chairman of the BMA’s A&E committee, said that he doubted this 98 per cent target was feasible. “It is absolutely right that patients visiting A&E are seen and treated as quickly as possible but not if staff are being forced to make inappropriate decisions and patient care is compromised,” he said.

HOW TO CHEAT

• Bus in temporary agency workers for monitoring periods and force staff to work double shifts
• Cancel (non-emergency procedures to free beds and staff
• Deal with patients with less serious complaints first to keep turnover high
• Discharge patients earlier than normal
• Keep patients waiting in ambulances so they are not officially admitted until the department can cope
• Introduce “reserve” waiting lists
• “Admit” patients to corridor trolleys or inappropriate wards to free space
• Cheat by changing the results after monitoring is complete

This story appeared on Network World Fusion at
http://www.nwfusion.com/news/2005/0119uksaudit.html

U.K.'s audit office questions health of NHS IT system

By Laura Rohde

IDG News Service, 01/19/05
One of the centerpiece projects in the massive IT infrastructure upgrade of the U.K. National Health Service is not only running behind schedule but also risks losing the support of doctors and other health workers due to a lack of engagement with the medical profession, the public spending watchdog for the U.K. government warned in a report published Wednesday.

According to the report by the U.K. National Audit Office (NAO), an online appointment booking system called Choose and Book was scheduled to make 205,000 bookings by the end of December, but only 63 live electronic bookings were made. Rather than reaching its target of 100% availability by the end of 2005, the government agency said it now expects only 60% to 70% of the NHS will have access to the system by then.

Choose and Book, commissioned by the Department of Health's National Programme for IT (NPfIT), is designed to allow patients to make hospital appointments online from a choice of locations. Atos Origin was contracted in 2003 to deliver a functioning system and Cerner, of Kansas City, Mo., is providing the software.

The first e-booking was made in July 2004 but only 63 e-bookings were recorded by year-end, according to the NAO report. "Problems have included the reluctance of users to work with an unreliable end-to-end system, limited progress in linking to general practitioner and hospital systems and the limited number of GPs willing to use the system," the NAO said.

The British Medical Association (BMA), a professional association for doctors, said much work needs to be done by the Department of Health and, in particular, by the NPfIT before GPs are convinced that the IT initiative will be successful. GPs feel they are working in an information desert and need much more detail and experience of what is involved with Choose and Book, the BMA said. Additionally, many GPs are still not completely satisfied that the system will protect patient confidentiality, and they will not have confidence in the new system until this is properly addressed, the BMA said.

U.K. Health Secretary John Reid Wednesday said in an interview with the British Broadcasting Corp. (BBC) that the Choose and Book system was weeks, not months or years, behind its targets and that the progress of the project was not as "dramatically bad as it sounds." Officials from the Department of Health also said that more than 2,500 GPs have already been involved in developing systems to support the government's aims and that the department will seek to increase engagement with GPs during the year.

According to the NAO's survey of 1,500 GPs, around half of these know very little about the IT system and 61 percent feel either very negative or a little negative about the Choose and Book system. "GPs' concerns include practice capacity, workload, consultation length and fears that existing health inequalities will be exacerbated," the NAO report said. "The Department has deliberately held back its main effort to inform and engage GPs about choice until it has had a working e-booking system to show GPs, but it intends to mount a campaign to inform and engage GPs during 2005."

When queried Wednesday, health workers in a local doctor's office in Brixton, south London, for example, had not even heard of the project and complained of being hampered by old and inadequate office computers as well as drawers full of paper files.

Later on Wednesday, Reid announced a new government plan to spend £95 million ($177 million) on incentives designed to speed up the implementation of its program for offering NHS patients more choice, primarily through the Choose and Book system.

The two-year program will offer hospital groups, called Primary Care Trusts, rewards over three stages for meeting targets. For example, as part of the first stage, incentives will be available to the trusts when family doctors install the Choose and Book system and offer choice menus to their patients. The final stage aims at getting GPs to use the system for 90% of patient referrals by the time "the system is fully implemented in 2006," Reid said.

The BMA quickly responded to the incentive plan, saying that though the extra investment is welcomed, the plan will not address the fundamental problems that GPs have with the new system.
The chairman of the House of Commons Committee of Public Accounts, Edward Leigh, who is also a Conservative Member of Parliament, called the progress towards delivering the IT system "abysmal" and accused the government of failing to provide value for taxpayers' money. With only 63 e-bookings having been carried out, "the average cost so far (of Choose and Book) has been £52,000 ($97,100) a booking. This is against a background of some nine million referrals each year," Leigh said.

Along with the Choose and Book system, the NPfIT is implementing new local IT infrastructures, a system for transmitting prescriptions electronically and a database of electronic health records for 50 million patients in England, accessible by 30,000 doctors and handling five billion transactions a year by 2008. Last October, the Department of Health announced that its 10-year cost estimate (2003-2013) for the project had jumped from £6.2 billion to between £15 billion and £30 billion.