BBC News online Thursday, 3 November 2005, 00:33 GMT
Over 2,000 'die from NHS errors'
More than 2,000 people died in English hospitals last
year due to lapses in patient safety, a watchdog says.
About 980,000 patient safety incidents and near misses were reported in the NHS, the
National Audit Office found. But as many incidents are not reported, the numbers of deaths,
which are already higher than previous estimates, could be even higher, the study said.
The government said while the majority of mistakes were minor it was important the NHS
learned from them. But the study found about half the incidents in which a patient was
unintentionally harmed could have been avoided if lessons from previous incidents had been
The cost of the mistakes to the NHS was estimated to be £2bn a year in lost bed
days on top of the costs of litigation, according to the NAO.
The survey of 99% of NHS trusts revealed there were 2,081
deaths reported from April 2004 to March 2005 - more than
double the 840 figure given by the National Patient Safety Agency (NPSA) in July. The total
does not include hospital acquired infections.
NAO head Sir John Bourn said: "There needs to be significantly faster progress at the
national level in ensuring effective evaluation of numbers, types and causes of incidents.
And lessons and solutions must be better evaluated and shared by all organisations with a
role in keeping patients safe."
The report found falls were more likely to be reported than medical errors and near misses.
Other errors made included medication errors, equipment defects and patient accidents.
Doctors were the least likely to report an incident, the NAO said.
Two thirds of incidents resulted in no long-term harm.
The NAO said a "blame culture existed" and called for the development of an effective safety
culture in which employees need not fear blame or unequal treatment if they report
incidents, and for patient safety to become a core part of professional clinical training.
Conservative MP Edward Leigh, chairman of the committee of public accounts, said "no
public health system should tolerate a failure to learn from previous experience on this
scale". He said: "It is unacceptable that any NHS staff member might be too afraid to report
things going wrong." And he added the findings called into question the performance of the
NPSA which was set up to ensure lessons are analysed and learned from.
Bill Kirkup, deputy chief medical officer, said: "The majority of these incidents are minor and
have no lasting effect on patients. Regrettably, some are more serious.
"We must investigate and learn from all of them, so that we can make systems safer and
But he said the NPSA was making the NHS a world leader in this.
NPSA medical director Professor Sir John Lilleyman said trusts were developing a "more fair
and open culture", but there was still much more to be done.
BBC News online. Tuesday, 23 August 2005
Doctors warn on ad hoc screening
Doctors have warned patients may be being put at risk by
unregulated or ad hoc screening health checks.
The British Medical Association report said patients should be
particularly wary of tests which could be bought over the internet of
via mail order.
And it warns ad hoc tests may do harm than good, either through
false positive or inconsistent results.
The BMA says mammograms are
The prostate cancer test and mammograms for women under 50 are not proven to benefit all
two tests whose worth are questioned by the BMA.
The BMA report considers the range of screening tests available. People should be
especially cautious about
It says formal screening programmes, such as breast checks for testing kits that can be
women between 50 and 70, have been introduced because they bought through the
have been proven to be of benefit in detecting disease. Internet and mail
Dr Vivienne Nathanson,
British Medical Association
But the BMA says there are numerous examples where screening is
available without such strong evidence to support its use.
Research has shown for example, that mammograms in women under 50 may not detect small
cancers, and that it involves a high chance of misleading results.
This can lead to further invasive tests and to surgery in many women whose cancers might never
have progressed during their lifetime.
The use of the PSA test, which is provided on the NHS, is also questioned by the BMA, which says it
is concerned about the "over detection of symptomless diseases, which leads to unnecessary
Two thirds of men with high PSA do not have prostate cancer, while some men with prostate
cancer do not have high PSA.
The BMA adds that no evidence exists to show whether treating localised prostate cancer does
more good than harm.
Its report also raises concerns over whole body computer tomography (CT) scans for people
without any symptoms, offered by some commercial companies.
There is no evidence this benefits people, and it can cause false alarms leading to potentially
dangerous invasive tests, and involves significant doses of radiation, the BMA says.
Electrocardiograms (ECGs) for people without symptoms of heart disease is also criticised. The BMA
says as it is far more likely to give a false result than to lead to useful findings.
The report says unregulated screening can put patients at risk because of a lack of evidence they
are effective, no quality control, poor follow up and insufficient information before and afterwards.
It also considers pre-implantation genetic diagnosis (PGD), now carried out on embryos to see if
they carry an inherited disease.
Some are concerned it could be used to create 'designer babies' by selecting gender or eye or hair
But the BMA says, due to the difficulties involved, PGD is only to be used by couples at serious risk
of having a child with a disease, and "frivolous" use is unlikely.
It adds there are concerns about the use of information on genetic tests on adults by insurance
companies, and says the current moratorium should be used to consider if such information should
be treated any differently from other medical data.
Dr Vivienne Nathanson, the BMA's Head of Science and Ethics, commented: "There is no doubt that
some specific screening tests have the potential to save lives but this does not mean that there are
no associated risks.
"We want the public to be extremely wary of unregulated screening.
"People should be especially cautious about testing kits that can be bought through the Internet
and mail order.
"The BMA is also worried that even with the existing major programmes the information about the
benefits and limitations may be insufficient for patients to make an informed choice based on the
harms and benefits of taking part."
Last Updated: Sunday, 31 July 2005, 23:06 GMT 00:06 UK
Has the prescription worked?
By Nick Triggle
BBC News health reporter
Five years ago the government launched its NHS Plan.
The 10-year programme of reform set out a series of measures to overhaul the health service.
Pledges were made to reduce waiting times, increase the number of doctors and nurses and spend
more on fighting cancer and heart disease.
Prime Minister Tony Blair said the plan would make the NHS the envy of the world. But has it lived
up to the radical promises, and what is left to do?
While most NHS patients are satisfied with the care they receive, there are pockets where
treatment is not good enough, a leading patient group says.
Simon Williams, director of policy at the Patients Association, said the NHS Plan had driven forward
"Patients are being seen more quickly and the majority do receive a good quality of care.
"But there are still significant pockets were there are problems. If We have seen a lot of
you are old or poor you are unlikely to get the level of service you change, but patients needs
deserve. still need to be more of
"The fact remains those who shout the loudest get the best care."
Simon Williams, of the
Mr Williams also pointed out that a recent report by the Healthcare Patients Association
Commission said patients were still not being put first.
NHS blueprint unveiled
The NHS watchdog's annual health report said the service often seemed to be designed around the
needs of staff rather than patients.
"It was a good barometer of where we are at. We have seen a lot of change but patients' needs still
need to be more of a priority."
Despite some improvements in the health service, doctors are
concerned about the direction policy is heading.
James Johnson, chairman of the British Medical Association, which represents 130,000 doctors, said
there had been "successes and failures".
"Patients are seeing some improvements to services as a result of increased funding, and by
increasing medical school places, the government has begun to address chronic shortages of
"However, many of the government's aims remain unfulfilled. The modest target of an extra 2,000
family GPs between 1999 and 2004 was missed (when expressed in full-time terms), and there are
still problems with many of the waiting time targets."
And he warned since the plan was published there has been a "very significant shift" in the way the
reforms have started to be implemented.
The government envisages about 15% of NHS operations will be done by the private sector within a
couple of years.
Mr Johnson, a consultant surgeon, said: "It is increasingly determined that the only way to increase
NHS capacity and drive up standards is by opening up the service to private companies."
He added: "We remain concerned that the move could destabilise services and result in hospitals
closing - both at the expense of patients and the founding ethos of the NHS."
Health service managers remain positive about the effect of the NHS Plan on patients.
Dr Gill Morgan, chief executive of the NHS Confederation, which represents more than 90% of
trusts, said: "The plan has delivered some major successes thanks to the hard work of all NHS staff
- improved accident and emergency care and shorter waiting lists to name just two of the high
impact improvement areas.
"Every patient wants a health service that provides fast, efficient and high quality emergency
treatment when they need it and so it is a tribute to the hard work of NHS staff that public
confidence in our A&E departments is now so high that more and more people are using them."
Dr Morgan added: "It wasn't so long ago that horror stories about trolley waits were a weekly
occurrence, but now nearly all A&E patients are seen, treated and either discharged or admitted to
hospital within four hours."
She also said thanks to other targets, patients waiting for hospital treatment were being seen
"Just before the NHS Plan was launched, 50,000 patients had spent more than 12 months on an
NHS waiting list for an operation but by December 2004, only 24 had been waiting that long."
But she said there was still work to do. "The NHS Plan was always meant to be a 10-year roadmap
and so it is hardly surprising that there is still plenty of room for improvement when we are only
halfway through the journey.
"We want to work with the government so that all the different pieces of the jigsaw that are
intended to transform the NHS - patient choice and increased use of the private sector - make
sense and deliver improved care for patients."
Nurses leader Beverly Malone said one of the main benefits of the
NHS Plan was that it led on to a record programme of investment which had transformed the health
Two years after the reforms were published Chancellor Gordon Brown announced the health budget
would increase by more than 7% a year until 2008.
"The record level of investment has just been incredible," said the general secretary of the Royal
College of Nursing.
"It has shown a positive commitment to the health of the country."
"We were in such a basement situation that to get to a level floor you needed such a big
"I think what we have shown is that through investment and focusing on areas [such as waiting
lists and cancer treatment] we can make a difference.
"The areas where we don't have that focus, as in mental and sexual health, there are difficulties."
But she said she felt "foreboding" about the number of trusts posting end-of-year deficits.
One in four NHS organisations failed to balance the books in the last financial year.
"The NHS Plan has been pretty radical. But I think there are tricky times ahead."
She also said that despite the rise in the number of nurses since the plan was published, another
20-30,000 more nurses were required over the next four or five years as there was an ageing
Only time will tell if the NHS Plan lives up to its billing as a transformational programme, according
to leading health think-tank King's Fund.
Fellow Richard Lewis said: "Our view is that it has been pretty effective.
"The NHS has improved substantially in a number of areas - hospital facilities, amount of treatment
and lower waiting lists - and broadly speaking the targets have been met.
"But I would not say it has transformed and it would be unreasonable to expect that to have
happened within five years. Only in the future will we be able to tell."
However, Mr Lewis also said some of the reforms that have happened have had had a negative
"The public has quite rightly been concerned about MRSA. I think the rise in MRSA is inextricably
linked to success in other areas - the more patients which are pushed through, the greater risk of
And Mr Lewis also said there was a possibility the NHS may not be able to adapt to future changes.
"The NHS is operating at full pelt. There is no spare capacity so there have to be questions about
whether this is sustainable."
BBC News online Wednesday, 13 October, 2004, 13:04 GMT 14:04 UK
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NHS 'equality champion' appointed
The NHS has appointed its first ever champion to tackle
inequalities in the health of people from ethnic minorities.
Currently, 50% more first generation South Asian adults die from
heart disease than the national average.
Black people are six times more likely to be held under the Mental
Inequalities will be stamped out
The new director for equalities and human rights, Mr Surinder
Sharma, will also have to ensure all NHS staff are recruited from all communities.
There have been concerns about racism within the NHS towards staff and patients.
A report on the death of a black schizophrenic patient, David Bennett, after he was restrained by
staff at a clinic in Norwich said the failure to give ethnic minority people proper mental health care
was a "festering abscess".
Dr John Reid admitted "discrimination" existed in the NHS and In many ways the NHS
added that he was committed to improving mental health services. has done very well over
the years but I think we
This year a doctor successfully sued the British Medical Association can do even better going
when he claimed it had failed to back him in an employment forward.
dispute with his hospital.
Mr Surinder Sharma
Dr Rajendra Chaudhary from Manchester, who was born and
trained in India, said he repeatedly failed to be promoted to consultant level, even though British-
born colleagues with the same experience succeeded.
While people from black and ethnic minorities make up 35% of the UK's doctors and dentists, less
than 1% of health boards have a black or ethnic minority chief executive.
Mr Sharma, who was deemed the best candidate for the job, with
25 years of experience working in the equal opportunities field, said
this would be resolved with time.
"The Department has taken great strides really if you look at the
figures for March this year - 7.5% of directors are from black or
"We are the largest employer of black and Asian people in the UK.
Mr Sharma said it was an "exciting
"We have also increased the number of senior women in the NHS. opportunity"
That's now up to nearly 40%.
"In many ways the NHS has done very well over the years but I think we can do even better
He said he aspired to match service delivery to meet the needs of Mr Sharma's CV
the UK population, pointing out that nearly 8% of the population is Fully qualified lawyer
made up of black and minority groups.
Worked in equal
opportunities field for the
"I think that this is an exciting opportunity," he said. BBC, Littlewoods and Ford
Health Secretary John Reid said: "We have two aims with this Commissioner at the Equal
appointment. Firstly, to make sure that appropriate services are Opportunities Commission
available to anyone in the population, regardless of their
"Secondly, to ensure that we can draw on the talents, skills and passion of all parts of the
"Surinder is a very experienced professional who will enable us to do this."
BBC News online Thursday, 24 June, 2004, 00:30 GMT 01:30 UK
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Reid to unveil five-year NHS plan
Health Secretary John Reid is set to unveil Labour's vision
for the NHS.
He will outline a five-year plan for improving the health service in a statement to the House of
Mr Reid is expected to announce plans to cut NHS waiting times to 18 weeks and to give patients
more choice over where they are treated.
Tory health policies outlined on Wednesday included a pledge to give patients the right to choose
to be treated at any hospital.
They also promised to give patients who choose to go private, Labour plans
50% of the cost of the operation on the NHS. Cut NHS waiting times to 18
The government has pledged to spend billions more on the NHS - Patients to be given greater
at least until 2008. choice of hospitals
Reduction in "inappropriate"
In four years' time, spending on the NHS is expected to top admissions
£100bn a year, compared to £79bn this year.
Better treatment for chronic
conditions such as diabetes
The health secretary is expected to tell MPs that the extra money and asthma
will be used in part to reduce waiting times.
Patients will be promised treatment within four-and-a-half months of a GP referral.
At present, waiting times are only measured from the time of diagnosis, to the time of treatment.
At present, the government has set a target of a maximum of nine months for this period.
However, Dr Reid told the BBC: "The patient considers the journey right from the time he first
sees his GP through to the door of the operating theatre.
"I believe that with the increased capacity we are putting in, and the reform, and the efforts of
the staff we can come down from the years it was under the Conservatives for the whole journey
to a matter not of months, but some weeks."
The government is currently pledged to allow patients treatment at a choice of four or five
Leaks suggest ministers will extend that to unrestricted choice - be it an NHS hospital or a private
one where treatment costs the same. The Tories claim that is move which merely apes their own
Dr Reid is also expected to outline tough new targets for tackling obesity, smoking and improving
He will outline plans for a new emphasis on treatment of people with chronic health problems.
This is likely to include more treatment outside hospital to reduce pressure on waiting times.
The Health Secretary is also expected to say that he plans to reduce "inappropriate" hospital
admissions by 10% by 2008.
Health is expected to become a key battleground in the next general election, which could be less
than one year away.
The issue dominated prime minister's questions in the Commons on Wednesday.
Tony Blair said the Tories were offering a "right to charge", not "a right to choose".
Conservative leader Michael Howard said Tory policies could "make HAVE YOUR SAY
waiting lists a thing of the past", while he said Labour's policies The 'one size fits all'
would just lead to more bureaucracy. NHS is a relic from a
ghastly collectivist past
Liberal Democrat leader Charles Kennedy said people wanted high
quality public services near where they live, rather than "a false David Moran, Scotland
debate about choice".
Send us your comments
BBC News online Wednesday, 23 June, 2004, 13:20 GMT 14:20 UK
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At-a-glance: Labour vs Tories on NHS
Conservative health policy Labour health policy
A Tory government would offer patients Labour has pledged to allow patients
free of charge the choice of any hospital the choice of four or five hospitals by
- including those private hospitals which 2006. It is now thought likely that
match the cost of NHS operations. choice will be extended to any hospital
Patients wishing to use private care can
take a state subsidy with them of up to Labour allows NHS managers to buy
50% of the cost of NHS treatment some operations from privately-run
(formerly known as the 'patient passport' specialist treatment centres, but says
scheme). direct subsidies to patients for private
healthcare will just benefit the better
Tories would ban all centrally imposed Committed to centrally-set targets
hospital targets so hospitals can set their arguing they up standards. New target
own, including over waiting times. could limit waiting lists to 18 weeks.
Tories want more hospitals to become At the moment only top-rated trusts
foundation trusts with more freedom. can apply to become foundation trusts.
They want to lift controls on the amount There are restrictions on how much
these hospitals can borrow on the open they can borrow on the open market.
market and on staff pay levels. All hospitals to be foundation by 2008.
By 2009/10 Tories will raise NHS Spending on the NHS to increase in real
spending by £34bn a year above the terms by 7.4% per year up to 2007/8,
levels they inherit - this is roughly in line when £109bn will be spent on it.
with Labour's plans.
BBC News online Thursday, 18 March, 2004, 03:48 GMT
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Ill health 'must be prevented'
Government efforts to tackle obesity, smoking and sexually
transmitted diseases will fail unless prevention, not cure, is
given priority, a report says.
Ministers must look at practical measures to help people stay
healthy, according to the King's Fund.
The call follows a consultation by the government to ask what
measures could be taken to improve public health. Rates of obesity are rising in
A White Paper will be published in the summer, using the research findings.
Currently one in four men and one in five women are classed as obese in the UK - but experts think
40% of the nation could be obese within a generation.
Smoking is responsible for 120,000 premature deaths a year - and it is estimated there are more
than 13 million smokers in the UK.
Sexually transmitted diseases have also increased dramatically in recent years, especially among
On Thursday, the King's Fund report - entitled Prevention Rather Than Cure: Making the case for
choosing health - said the government consultation would have little impact unless there was a
move away from the preoccupation with health services focused on treating illness.
The King's Fund, a charitable foundation working for better health, criticised ministers for
concentrating on waiting lists and targets.
It called for a "broader approach" and cited ideas such as creating public health leaders, similar to
health mayors in some European cities, as well as health clubs where people could get information
and advice on how to stay fit and well.
The report said there should be new incentives to encourage health professionals to give higher
priority to preventing ill health as well as reducing inequalities between rich and poor.
The King's Fund also launched a programme - Putting Health First - to come up with ways the
government can tackle public health issues.
The report's author Anna Coote, King's Fund health policy director, said: "There are still powerful
disincentives for governments to focus on health - as distinct from health services.
"The NHS has become a national icon. It is tempting for politicians to try to 'save' it, without
looking very hard at ways of preventing illness."
Ms Coote said people did not only care about NHS waiting times and said the public had a
sophisticated understanding of the causes of illness and would "rather choose health than health
BBC News online Thursday, 12 February, 2004, 11:39 GMT
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Report urges 'NHS racism' curbs
Greater effort is needed to combat "institutional racism" in
the National Health Service, a new report has said.
It follows an inquiry into the 1998 death of black schizophrenic
patient David "Rocky" Bennett, after he was restrained at a clinic in
Among over 20 recommendations, the report says NHS staff working
with the mentally ill should be trained in "cultural awareness and The report said Mr Bennett had
sensitivity". been the victim of NHS racism
Retired High Court judge Sir John Blofeld lead the inquiry team.
The team said it believed institutional racism was present throughout the NHS.
"Until that problem is addressed, people from black and minority ethnic communities will not be
treated fairly," it said.
"Black and minority ethnic communities have a fear of the NHS: that if they engage with the mental
health services they will be locked up for a very long time, if not for life, and treated with
medication which may eventually kill them'."
It said more black and ethnic minority people were diagnosed as schizophrenic and that they
tended to receive higher doses of medication than Caucasian people with similar health problems.
"They are generally regarded as more aggressive, more alarming, more dangerous and more
difficult to treat", the report said.
The inquiry was commissioned by the Norfolk, Suffolk and Cambridgeshire Strategic Health
Authority and the Department of Health.
It followed a 2002 inquest into David Bennett's death in the Norvic Clinic, Norwich.
He had been restrained by at least three nurses after attacking David Bennett was not
another patient and punching a female nurse. treated by nurses as if he
was capable of being
His heart later stopped and he died in hospital. talked to like a rational
human being, but was
Jamaican-born Mr Bennett, from Peterborough, Cambridgeshire, had treated as if he was a
suffered from mental illness since his early 20s. lesser being
The inquest jury at King's Lynn, Norfolk, found that he died an Inquiry report
accidental death "aggravated by neglect".
Jurors heard he was given unauthorised doses of medication in the days before his death and that
nurses used inappropriate restraint procedures.
The Mental Health Act Commission said after the inquest it was keen to draw lessons from the case.
In the report on Thursday Sir John criticised nursing staff, health SOME OF THE REPORT'S
service managers and police. RECOMMENDATIONS
Mental health workers
He said staff had not been deliberately racist. should be trained in cultural
awareness and sensitivity
But the report said staff had not made it clear that they believed Ministers should
racist comments by other patients were wrong. acknowledge and commit to
"David Bennett was not treated by nurses as if he was capable of racism in mental health
being talked to like a rational human being, but was treated as if he
was a lesser being". A National Director for
Mental Health and Ethnicity
The inquiry said staff at the Norvic Clinic were "kind" and "helpful" should be appointed
towards Mr Bennett but said insufficient effort was made to recruit Steps should be taken to
ethnic minority staff. ensure an ethnically diverse
mental health workforce
It also criticised the mental health service's failure to involve Mr A national system of training
Bennett's family. in restraint and control
should be formed within a
"There was no attempt by any of the mental health trusts or year
facilities involved in Mr Bennett's care during the 18 years of his No patient should be
illness to engage his family in his treatment". restrained in a prone
position for longer than
Records should be kept of all
psychiatric units' use of
control and restraint
The DoH should publish
annual statistics on the
deaths of all psychiatric
inpatients, which should
BBC News online Friday, 6 February, 2004, 04:54 GMT
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Fixed prices for NHS operations
Hospitals in England are to be paid a fixed fee for the first
time for treating NHS patients.
The aim is to ensure the NHS gets better value for money by
stamping out variations in the cost of operations.
Ministers say the "fundamental reform" will make the NHS more
efficient but critics say it could cause some trusts to cut services.
Hospitals will be paid a fixed price
It comes as the government confirms that treating NHS patients in for each operation
private hospitals is proving expensive.
The NHS paid private hospitals £100m last year to treat 60,000 patients as part of efforts to cut
However, the operations cost 43% more than if they had been What hospitals will be paid?
done on the NHS. Heart bypass £8,080
Hip replacement £5,568
The new NHS tariff sets a fixed price for 48 different procedures,
ranging from cataract surgery to a heart bypass operation. Cataract operation £786
Varicose vein procedure
The tariffs will be phased in over the next four years. However, £1,063
foundation trusts will be able to adopt them from April. Major breast surgery £2,386
Figures are for planned
There are currently huge variations in the amount of money operations
hospitals are paid for carrying out certain operations. Source: Dept. of Health
The price of a heart bypass operation ranges from £2,540 to
£6,911. The cost of cataract surgery varies between £763 and Q&A: How the tariffs will
Ministers say a fixed fee will force many hospitals to become more efficient. Hospitals that fail to
reduce their costs will face losing millions of pounds a year.
Those that succeed in providing the operations below the tariff price will be able to keep the
profit. That money could be spent on new equipment.
Ministers hope the system will also drive up quality and improve choice for patients.
Health Minister John Hutton said: "By fixing a national tariff, we Given that the NHS
can minimise bureaucracy and unnecessary transaction costs cannot afford to lose
associated with local price negotiation, allowing trusts and PCTs to staff, how will these
focus on quality and speed of access. savings be made?
"And secondly, it will allow patients to exercise greater choice over British Medical Association
when and where they are treated."
However, the British Medical Association expressed concerns.
"The tariff system could cause the NHS problems," said its chairman James Johnson.
"Some tariffs will be far lower than the real costs of providing care, putting undue pressure on
hospitals to make cuts.
"Given that the NHS cannot afford to lose staff, how will these savings be made?"
Mr Hutton defended the government's use of private hospitals to cut NHS waiting lists despite the
relatively high cost.
"Our use of the private sector allowed nearly 60,000 NHS patients to have their operation more
quickly than would otherwise have been possible. That was absolutely the right thing to do."
However, trade union Unison condemned the policy.
Karen Jennings, its head of health, said the private sector was "ripping off the NHS... at the
expense of patient care".
BBC News online Wednesday, 1 October, 2003, 00:54 GMT 01:54 UK
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First private casualty unit opens
A centre claiming to be Britain's first purpose-built private
casualty unit opens on Wednesday.
The Casualty Plus centre in Brentford, west London, will offer rapid
treatment to people with minor injuries and illnesses.
It claims that for an initial consultation fee of £29, patients will be
seen "in minutes not hours".
The clinic is based in
The company running the £5m unit eventually wants to set up Brentford, west London
similar centres across the UK.
Casualty Plus chief executive Syed Jaffery said there were additional charges for further
treatment such as x-rays and fitting a cast on broken limbs.
"For the vast majority of people we expect to see, the average price will be somewhere between
£50 to £100," he said.
"Clearly somebody who is in a critical condition or has a life-threatening injury of some nature will
dial 999, call an ambulance and be taken to an National Health A&E department.
"And that is exactly the right place for them.
For the vast
majority of people we
"What we are talking about are the walking wounded, people who
expect to see, the
make their own way to casualty departments and have minor
injuries." average price will be
Mr Jaffery said the casualty unit was targeting people with minor £50 to £100
injuries who have to wait for treatment at NHS hospitals.
"People who are seriously injured and do have life-threatening Casualty Plus
conditions, they will get a fantastic service from the NHS and they
will not have to wait and they will be seen virtually straight away.
Inside the centre
"But that is at the expense of people with minor injuries."
He said the NHS would not suffer from the private sector recruiting their staff.
"The NHS is a massive organisation with over a million employees and the private sector in
comparison in quite tiny in this country.
"The amount of staff we could possibly take from the NHS is a drop in the ocean.
"It really has no overall impact on the NHS," Mr Jaffery added.
He also said the private company was "very careful" not to recruit from local hospitals.
"We actually want to work with our local hospital and be seen as part of the local health care
Clinical director Johan du Plessis said as many as 12 Casualty Plus units could be opened in
Greater London, with more planned in major cities such as Manchester, Leeds, Birmingham,
Bristol and Cardiff.
The Department of Health spokesman said: "Patients know how to access NHS services and will
continue to do so in the knowledge that it is both safe and free and they will be seen quickly.
"All private health care services, including minor injuries/illness services such as this, are a well
established part of the healthcare scene."
He added: "We are now providing more Walk in Centres, instant access to NHS Direct and more
efficient ways of working in A&E that are reducing overall A&E waiting times, not just those for
BBC News online Thursday, 25 September, 2003, 23:10 GMT 00:10 UK
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Vaccine rates are overestimated
Official data on global vaccination rates may exaggerate how
many people are immunised against common diseases, say
A team from the World Health Organization examined data on the
diphtheria-tetanus-pertussis vaccine. They found official coverage rates
were much higher than those recorded in house-to-house surveys.
Writing in The Lancet, they warn effective public health programmes
depend on accurate data. Vaccination is vital to control
The researchers examined vaccination
records for 45 countries in the developing world between
1990 and 2000. They compared official data submitted by health centres and workers who give out
vaccines, with that collected by researchers who asked individual people whether or not they had
Consistently, the household surveys showed that fewer people had been vaccinated than the
numbers suggested by the official returns. The discrepancy was so large that the researchers
calculated that an official vaccination rate as high as 16.3% could in reality mean that no effective
vaccinations took place on the ground.
The researchers believe that part of the problem is that data collection systems are not up to the job.
For example, official data often fails to record whether children received their jabs at the proper age,
or whether follow-ups were given at the correct intervals. It may be that lumping "valid" and "invalid"
vaccinations together inaccurately inflates the coverage rate. However, they also warn that it is
possible that incentive schemes designed to boost vaccine rates may lead to the figures being
In addition, they point out that it can be very difficult to keep track of vaccinations delivered outside
the public sector. Although house-to-house surveys appear to give a more accurate picture, they are
extremely labour intensive and expensive to carry out, and therefore can only be done on a very
Lead researcher Dr Bakhuti Shengelia told BBC News Online: "Reliability of data is important in order
to keep a better track of how well we are doing in terms of protecting children from infectious
Dr Maureen Birmingham, of the WHO's vaccine assessment and monitoring team, told BBC News
Online that a system of audit had recently been introduced to try to improve the way vaccination
programmes were reported. However, she said it was not fair to suggest that official records always
overestimated coverage rates. In fact some countries, such as Kenya, probably underestimated the
scope of their vaccination programmes.
"It's all about locating children who have not been vaccinated," she said. "If we don't have accurate
local data then we cannot do that."
BBC News online Friday, 12 September, 2003, 15:22 GMT 16:22 UK
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Firms to run 24 NHS centres
Private firms look set to run 24 new fast-track surgery
centres in England.
Ministers have selected two British companies and five from
overseas as preferred bidders to run the centres.
These are from Canada, South Africa and the United States. The
centres are expected to be up and running early next year.
The centres aim to help drive down
They will carry out non-urgent surgery on NHS patients, such as NHS waiting times
knee, hip and cataract operations. Ministers hope they will help cut NHS waiting times.
Over 20 diagnostic and treatment centres are already in operation. However, they are all managed
by the NHS.
This will be the first time that private firms will be involved.
Under the government's plans, private firms will run 22 new Where the centres will be
treatment centres and two mobile units, which will offer based
ophthalmology services. South West Peninsula
Mercury Health Ltd, a British based company, will run nine centres
Horton Hospital, North
North East Yorkshire
Birkdale Clinic, which is also British-based, will operate a centre at
The remainder will be run by overseas companies. East Berkshire
Anglo Canadian, a Canadian-led consortium, will operate three
clinics in London. Ashford, Surrey
Nations Healthcare, a US-led consortium, will run two centres in Barlborough Links,
Bradford and Burton while another US firm New York Presbyterian Nottinghamshire
will run two centres in Stanmore and Somerset.
A South African company called Netcare UK will run a centre in Chase Farm, Barnet, London
Manchester and the two mobile ophthalmology units. King George Hospital,
Care UK Afrox, a partnership between a South African and British Royal National Throat Nose
company, will operate three centres in Maidstone, Nottinghamshire and Ear Hospital, Kings
and Plymouth. Cross
The decision to allow foreign firms to run the centres is Daventry
controversial. Trafford, Greater Manchester
There are concerns that the centres will not provide value for Royal National Orthopaedic
money and will poach staff from NHS hospitals. Hospital, Stanmore
Shepton Mallet, Somerset
But Health Secretary John Reid said: Preferred bidders
"There will be 250,000 more Netcare UK (South Africa) operations, they will done
more quickly, there will be less chance of cancellation for the
Mercury Health Ltd (UK)
patients, and there will be a better service. Everybody wins in
this." Care UK Afrox (South Africa)
Anglo Canadian (Canada)
Nevertheless, the British Medical Nations Healthcare (USA) Association warned that the
move could destabilise the NHS.
Birkdale Clinic (UK)
Its chairman James Johnson, said: New York Presbyterian (USA) "DTCs must not take staff or
resources away from NHS hospitals." by leaving hospitals without
enough doctors and nurses."
Who are these companies?
Trades unions have also voiced their opposition to the policy of allowing private firms to run the
centres, accusing ministers of privatising the NHS.
A spokeswoman for Unison, the largest health workers union, told BBC News Online: "These
centres will be an expensive drain on the NHS both in terms of resources and staff.
"They will tie trusts into five year contracts where they will be paid more than the NHS for each
and every operation and a drain on staff because the government seems to be back pedalling on
its original commitment that staff would not be taken from the NHS to work in these centres."
Head to head: Treatment centres
The Royal College of Nursing said it was concerned about the impact the centres will have on
A spokeswoman said: "The RCN has concerns about the practical working arrangements and
this might have on existing staffing levels in NHS and is seeking assurance that the impact of
development will be properly evaluated."
Dominic Slade, secretary of the Association of Surgeons in Training, expressed concern that t
centres could damage surgical training.
Shadow Health Secretary Liam Fox suggested the contracts being offered to private firms wer
"The patients and the taxpayers will be paying the price."
Liberal Democrat health spokesman Evan Harris said: "This is an expensive use of taxpayers
The price per case is more than it's costing the NHS."
Andrew Fairburn of the Independent Healthcare Association said: "If the government made be
of the country's existing 218 voluntary and independent hospitals, then it could get more pati
treated more quickly ¿ as well as securing better value for money for taxpayers."
Phil Gray, chief executive of the Chartered Society of Physiotherapy, said: We also have conc
this will drain more physiotherapists from acute care - exacerbating the existing staff shortag
potentially leading to longer waiting lists in the NHS."
BBC News online Monday, 21 July, 2003, 08:54 GMT 09:54 UK
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UK still poaching African nurses
Nurses are still being 'poached' from Africa to work in
Britain - even though there is a ban on recruitment from
developing countries, unions have warned.
The head of Kenya's nursing union told the BBC it was the most
experienced nurses who were leaving.
In the UK, nursing leaders called for a code of conduct for
recruitment agencies to be extended to cover the private sector, as Agencies travel abroad to recruit
well as the NHS, to end the practice. nurses to work in Britain
But the government said it could only encourage independent agencies to comply with the code.
Evelyn Mutio, general secretary of the National Nurses Association We are not in a
told Radio 4's Today programme: "The UK is poaching our nurses position to direct the
though agents. independent sector
"The agents are here and they are opening up offices. They say 'If Sarah Mullally, Chief Nursing
you want to get a job in Britain, come here'." Officer
Ms Mutio said Kenyan nurses were getting jobs in nursing and residential homes and hospitals.
She said she did not think the voluntary code restricting recruitment in Africa was working.
"It may be that the government has said so, but it has not reached the agencies here."
Beverley Malone, general secretary of the UK's Royal College of Nursing, said: "The independent
agencies are not covered under the code.
"It's so important that the government do all that it can to extend that code to cover independent
She said the RCN would support nurses who decided themselves to come and work in the UK.
But she added: "When agencies recruit from the banned countries, it means that people in these
countries are not getting the healthcare that they need."
Ms Malone said although nurses were recruited from these countries into the private sector, they
often moved into the NHS because it has better working conditions.
She said this "back-door" employment meant the NHS was indirectly recruiting from banned
"Out of top 20 countries that the UK recruits from, 12 of them are on the banned list."
The UK Chief Nursing Officer Sarah Mullally said the code was working in the NHS.
But she added: "At the moment, we are not in a position to direct the independent sector to
adopt our code of practice.
"We are encouraging them, but what we have done alongside the code of practice is put together
a register of agencies which are willing to sign up to the code.
"It is those agencies that the NHS will do business with.
"If agencies are on that list, and are not living up to the code of practice, then we can remove
them from the list."
Ms Mullally said the UK government was also working with developing countries to help them
retain their nursing workforce.
Dr Evan Harris MP, Liberal Democrat health spokesman, said: "We cannot simply blame private
companies. If it is legal and there is demand for nurses, they will do it.
"It is the government's responsibility to stop unethical recruitment."
He added: "Poaching nurses does not even offer a long term solution.
"We need to 'grow our own' and 'keep our own' nurses in the UK."
BBC News online Sunday, 20 July, 2003, 23:05 GMT 00:05 UK
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Foreign doctor rules 'to be eased'
The General Medical Council is considering scrapping its
English language test for doctors who train overseas.
It is also considering making it easier for doctors from outside
Europe to take up jobs in the NHS.
The move follows claims that the current rules discriminate against
some overseas doctors.
The GMC is consulting on the
The proposals have been issued for consultation and would need a proposals
change in the law before they could come into effect.
But the GMC said the changes could be introduced within two years.
At the moment, most doctors who train overseas are required to pass the International English
Language Testing System.
This test is run by the British Council and tests a person's ability to speak, write, read and
understand spoken English.
It is widely regarded as an objective test and a good It is high time these
demonstration of whether a person can communicate effectively in changes were made
Dr Shiv Pande,
Only doctors who have trained inside the European Union or in British International Doctors
Iceland, Norway or Switzerland are exempt from passing the exam Association
under European law.
The GMC is now considering scrapping that requirement. However, officials insisted that overseas
doctors will still have to prove that they can communicate in English before they are allowed to
practise in the UK if the changes are introduced.
Nevertheless, the rules could be relaxed significantly under the proposals.
Overseas doctors would be able to choose which English language exams they wished to sit.
"What we have traditionally done in the past is require everyone to take a particular test," Richard
Marchant, a GMC policy advisor told BBC News Online.
"That policy has come in for criticism for a number of reasons and we are consulting on whether it
is really appropriate now.
"There are other exams around the world," he said.
The consultation document also proposes easing the rules on what type of medical posts overseas
doctors can take up in the UK.
At the moment, most overseas doctors are granted "limited registration".
This means that, unlike EU-trained doctors, they must work under the supervision of another
They are generally only allowed to take up recognised training posts within the NHS.
More than 3,500 overseas doctors were granted limited registration by the GMC last year.
They will have to demonstrate that they can work satisfactorily before they are granted full
This enables them to take up other jobs without any restrictions.
Under the proposals, they would be granted full registration from the start.
Dr Shiv Pande, chairman of the British International Doctors Association, welcomed the proposed
"It is high time these changes were made. The rules on registration should be uniform and
"If there are restrictions, they should apply to everyone."
BBC News online Wednesday, 16 July, 2003, 08:08 GMT 09:08 UK
Row over NHS star ratings
This year's NHS star ratings have sparked a furious row
between the government, doctors and opposition MPs.
Ministers say the ratings show that NHS services are improving
across England. But doctors and opposition parties have dismissed
the claim, saying the ratings are "ludicrous", "pathetic" and
And Dr Evan Harris, Liberal Democrat health spokesman, said The ratings are based on key
patients were dying because hospitals were forced to try to meet government targets
meaningless targets, rather than concentrate on providing
Overall, 53 out of 176 acute hospitals were awarded the top rating of three stars this year, up
from 45 in 2002.
ACUTE TRUST RATINGS
However, more hospitals also received a zero stars rating - 14
compared with 10 last year. Four trusts which scored three stars 63 three stars
last year have been downgraded to just two stars. They lose their 68 two stars
right to apply to become foundation trusts.
31 one star
'No political pressure' 14 zero stars
Trusts were assessed on a variety of government targets, from Click here to find out how
the length of time patients wait for treatment to the number of your local trust scored
patients who die after surgery.
The ratings also include primary care trusts (PCTs) for the first time. Of the 304 PCTs in England,
45 were awarded three stars while 22 received no stars. Ambulance and mental health trusts
were also assessed. Ten out of 31 ambulance trusts received three stars. Five were given a zero
stars rating. Fourteen out of 88 mental health trusts received three stars. Three received no
The figures were compiled by the independent watchdog, the Commission for Health
Improvement (CHI), for the first time. However, trusts were told what targets they would be
measured against. Dame Deirdre Hine, chairman of the CHI, said there had been no political
pressure to boost the ratings.
"The targets and many of the indicators were set by the PCT RATINGS
Department of Health but we have compiled the ratings this year. 45 three stars
"I would reiterate that there has been no pressure from ministers
139 two stars
and these have been produced absolutely independently."
98 one star
Health Secretary John Reid welcomed the figures. "I am 22 zero stars
encouraged that CHI has found that hospitals are improving
although obviously I am disappointed that there are four more
zero-rated hospital trusts," he said. "The purpose of this exercise Foundation hopefuls lose
is not to condemn or shame those trusts who fail to make the out
grade on any particular indicator but to help them overcome local
difficulties and offer better services for patients in the future."
'Time to reconsider
But the British Medical Association rejected that claim. Its chairman Mr James Johnson said:
"Nobody should judge how well a hospital is doing by looking at star ratings.
"They measure little more than hospitals' ability to meet political AMBULANCE TRUST RATINGS
targets, and take inadequate account of quality of clinical care, or 10 three stars
factors such as social deprivation. "It is grossly unfair on staff
7 two stars
working in low-rated trusts that public confidence in them is being
undermined." 9 one star
5 zero stars
Dr Beverly Malone of the Royal College of Nursing said: "The RCN
has great concerns about how performance ratings can affect
patients' confidence and staff morale." Record number of zero star
Those views were echoed by opposition parties. Shadow Health Secretary Dr Liam Fox said: "The
star ratings system is ludicrous and should be scrapped. "The ratings bear no relation to the
quality of care that patients are receiving."
Dr Harris said the system encouraged hospitals to concentrate on MENTAL HEALTH TRUST
patients who had long-term conditions, rather than those who RATINGS
were critically ill. He said: "This rating system is a pathetic 14 three stars
measure of hospital performance. 43 two stars
28 one star
"It shows whether hospitals can hit targets, tick boxes, and fill in
spreadsheets, but it tells us absolutely nothing about the clinical 3 zero stars
outcomes that should matter to patients. "This is a political
exercise which costs patients' lives."
How we got three stars
Dr Gill Morgan of the NHS Confederation, which represents health service managers, said: "We
would like to see the ratings based on more detailed information about individual services to help
patients choose the right service for them."
John Appleby, chief economist at the health think tank The King's Fund, said: "It's time for the
government to reconsider the whole picture of NHS targets, indicators and rankings."
Their comments follow last month's report by the Audit Commission.
It suggested the NHS was wasting millions of pounds trying to meet "piecemeal" targets.
It also raised concerns over whether recent improvements, such as cuts in waiting times, can be
sustained in the long-term.
BBC News online Monday, 30 June, 2003, 14:21 GMT 15:21 UK
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BMA leader slams NHS targets
The NHS is more concerned with meeting government targets
than treating patients, the chairman of the British Medical
Association has claimed.
In a hard-hitting speech to the BMA's annual conference in Torquay,
Dr Ian Bogle said "spreadsheets and tick boxes" were now more
important than the needs of patients.
His views were echoed by doctors attending the conference, who Doctors say patients don't benefit
voted overwhelmingly against the "target culture" in the NHS. from targets
They also criticised the government's flagship policy to create new foundation trusts.
Doctors said freeing top-rated trusts from Whitehall control will create a two-tier health service.
Targets under fire
In his last speech as BMA chairman, Dr Bogle said doctors supported the use of targets to measure
progress in the NHS.
But he suggested that doctors and not politicians should set them. We now have a
healthcare driven not by
"The use of targets to drive up quality and measure improvement is the needs of individual
not a bad idea. patients but by
spreadsheets and tick
"Good targets like those for a reduction in death rates from heart boxes
disease and cancers are drawn up by clinicians, not by politicians
looking for a quick fix to appease an expectant and impatient Dr Ian Bogle,
public," he said. BMA chairman
Dr Bogle suggested current targets, such as maximum waits for patient care
patients in A&E and for operations, were not in the best interests of
Watch Dr Bogle's speech
"Targets are set nationally without any appreciation of what they
might mean for individual doctors sitting in consulting rooms with individual patients," he said.
"The fundamental NHS principle of care based on need and need alone has been superseded by the
principle of care based on numbers.
"We now have a healthcare driven not by the needs of individual patients but by spreadsheets and
Dr Bogle also raised doubts over government plans to cut waiting times for operations to just six
months by 2005.
"I do not think it is achievable. There is already too much fall out to the detriment of patients. The
government should discuss the timescale and how we will go about it."
Dr Bogle said the government's targets "make honest people
He said hospitals had gone to "extraordinary lengths" to show they
were meeting the maximum four hour wait in A&E.
An official audit, carried out in late March, showed 85% of the 207
A&E departments in England met this target during the week in which
statistics were collected.
Dr Bogle is standing down this
But a study by the BMA found that in the following week the figure week
dropped to 63%.
Dr Bogle said hospitals had bussed in temporary staff, made staff work double shifts and cancelled
routine surgery to meet the target.
He said ministers were turning a blind eye to these practices.
"You would think, wouldn't you that the government would be distancing itself from these corrupt
and immoral practices.
"Instead, it has turned a blind eye, been triumphalist about its 'achievements' and colluded in the
deception and doublespeak."
Doctors told the conference that patients care is regularly undermined by hospitals seeking to meet
Dr Simon Calvert, a junior doctor, said patients with minor illnesses were often prioritised over
those with more serious conditions because treating them quickly would help the trust to meet its
He said targets were more "about meeting a manifesto commitment It is very disappointing
than patient care." that, just one day after
the Health Secretary John
Doctors said NHS managers were bullied into meeting targets and Reid said he would meet
were often driven to fiddle figures because of pressure from health the BMA consultants, Dr
authorities or the Department of Health. Bogle has responded in
such a childish way.
"NHS targets are the most perverted policies of this government,"
said Dr Charlie Daniels, a GP in Devon. "Targets damage patients." Department of Health
Dr Chand Nagpaul, a GP in London, rounded on the star rating system for hospitals.
He called it "a simplistic and damaging approach to measuring the quality of hospital services."
However, Liberal Democrat health spokesman Dr Evan Harris criticised the BMA for signing up to
the targets, which were detailed in the NHS Plan, published three years ago.
"Targets damage patient care by preventing the treatment of the sickest quickest.
"The BMA were foolish to sign up to the target-based approach in the NHS Plan in the first place,"
The Department of Health expressed anger at the idea that it was turning a blind eye to figures
A spokesman said they had always made it clear that those found responsible would be disciplined.
A Department of Health spokesman said: "It is very disappointing that, just one day after the
Health Secretary John Reid said he would meet the BMA consultants, Dr Bogle has responded in
such a childish way.
"We have always been clear that we won't stand for any manipulation of statistics and those found
responsible should be disciplined.
"Year on year the NHS is getting better, not because people are fiddling the figures, but because
the health service is now getting the investment and the reform it needs."
Hundreds of doctors from across Britain are attending the BMA conference, which runs from
Monday to Thursday.
BBC News online Monday, 30 June, 2003, 10:06 GMT 11:06 UK
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NHS claims body planned
The government has outlined plans to reform clinical
negligence claims, including no-fault compensation for
babies brain-damaged at birth.
A new body would administer an NHS Redress Scheme, and would
be asked to speed up the claims process.
In some cases, it could also offer compensation without cases going
to court. The bill for medical errors has
soared in recent years
Where babies are severely brain-damaged at birth, the scheme would offer families no-fault
This would mean they would be given compensation and support For many, it is not the
without the need to establish whether healthcare staff had been size of any compensation
negligent. that matters so much as
But the report by Professor Sir Liam Donaldson, Chief Medical
Officer for England, which details the plans, has ruled out a Professor Sir Liam
universal no-fault scheme, a position which was criticised by Donaldson, Chief Medical
doctors meeting for their annual conference this week. Officer
The British Medical Association (BMA) called for a no-fault scheme to end "the blame culture
within the NHS".
The publication of the CMO's report follows a sharp rise in the cost of compensating patients for
clinical errors in recent years.
The NHS Redress Scheme would investigate when something went wrong, offer explanations and
apologies, and financial compensation in certain circumstances.
Accepting a compensation package from the scheme would prevent claimants taking their cases
to court, the proposals say.
Official figures show the NHS paid out £446m in 2001 to 2002, up £31m from the previous year.
In 2002, there were £5.25bn worth of outstanding claims, which will be settled over around 10
This represents a sizeable proportion of the total NHS budget. In 2001, for instance, almost 8% of
the money earmarked for health was needed to fund compensation claims.
Sir Liam has been examining the way clinical negligence claims are dealt with for the last two
His report outlines 19 recommendations to change the system including assigning one person in
each NHS Trust to take overall responsibility for investigating complaints and better training for
all NHS staff in how to handle complaints.
Sir Liam is also recommending staff who report incidents should be exempt from disciplinary
There will now be a period of consultation for interested parties to submit their views of the
proposals to the CMO.
He said: "Patients deserve to be told what has happened when things go wrong, and to be
compensated if appropriate.
"However, we know that cases take too long to settle, that more is spent on legal costs than in
compensation in many cases and that many complainants are left fundamentally dissatisfied for
what are really very simple reasons.
"For many, it is not the size of any compensation that matters so much as an apology, an
explanation and, vitally, evidence that something is being done to minimise the risk of a similar
problem happening in the future."
Sir Liam said he did not want clinical negligence claims to spiral as they have done in the US.
"The climate of blame and retribution and acrimony that exists there, we don't want it to come
He added: "Where mistakes are made we must learn from them and use them as a driver for
Dr Michael Wilks, chairman of the BMA's medico-legal committee said: "The CMO report
represents a much needed review of clinical negligence, but in our view will do little to address
the blame culture within the NHS that discourages doctors from reporting accidents."
Richard Parnell, Head of Research and Public Policy at Scope, the charity for people with cerebral
palsy said only between 3% and 14% of cerebral palsy cases were caused by birth trauma.
"So in practice, this scheme will create a very clear two-tiered system of care for disabled children
and adults, regardless of need."
Dr Evan Harris MP, Liberal Democrat health spokesman, called the proposals "a cop-out".
He said: "A no-fault scheme has not been adopted for the most serious cases, and so a culture of
blame will still exist.
"This is an incomplete reform to which the government will need to return."
BBC News online Tuesday, 3 June, 2003, 11:58 GMT 12:58 UK
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Anger over health contract plan
Patients could have to sign up to healthier lifestyles under
new plans being considered by the Labour Party.
Written contracts would ensure a certain standard of treatment in
return for people following doctors' advice and attending
A party spokesman denied smokers or overweight people, for
instance, could be refused treatment if they did not give up or diet. Smokers may be forced to try and
quit in return for nicotine patches
But the plans have provoked a storm of protest. Claire Rayner, president of the Patients
Association, called them a "nasty piece of political chicanery".
The proposals, which could become part of Labour's manifesto at the This is another piece
next General Election, are aimed at addressing the pressures put on of political
the NHS by avoidable illnesses such as smoking. manipulation of the
The Times newspaper said new contracts would give patients
methods to demand a standard of care.
In return patients would be expected to play their part by heeding instructions such as nutritious
eating or attending a programme to conquer an addiction.
A consultation paper will be discussed at Labour's annual conference and the eventual results will
form the basis of the party's manifesto.
The proposals refer to the NHS as a "free, yet finite service" where waste must be cut back.
It says: "The concept of reminding patients about the limits of the In return for nicotine
National Health Service and about their responsibility in using its patches, you have to go
resources sensibly is one we want to take forward." to courses to help you
give up tobacco
The contract would set out standards of care but also "remind him
or her of the reciprocal nature of their relationship."
Labour Party spokesman
"This type of agreement would not be legally binding. It would take the form of a joint statement of
`mutual intent'," the Labour policy paper says.
A Labour spokesman said: "We are consulting on setting out clearly what you can expect as a
patient in the NHS.
"We also want to set out responsibilities people would have, for example not to abuse NHS staff.
"It is not true to say if you didn't give up smoking you wouldn't be treated.
"It could give people advice as we already do and help them. This idea amounts
to a bureaucratic
"In return for nicotine patches, you have to go to courses to help nightmare
you give up tobacco.
Dr John Chisholm
"The right is you can have the drug. The responsibility is that you
have to take part in the programme."
The proposals have been given a cool response from opposition politicians and patient groups.
Shadow Health Secretary Dr Liam Fox said: "This is yet further HAVE YOUR SAY
interference by the government in how health professionals should Such a regime would
treat their patients. free up more
resources for those in
"Since these contracts will not be binding on either party it seems need
this will just mean more red tape at a time when doctors are having
to spend too much time filling in forms and too little time seeing
Robert Crosby, Nottingham,
Paul Burstow, Liberal Democrat health spokesman, said: "The
danger is that initiatives such as this will not give us a patient- Send us your comments
"They could end up putting power back in the hands of providers, in this case those who issue the
Claire Rayner, president of the Patients Association, said the logical conclusion of the plan would be
to deny somebody treatment if they were hit while crossing the road because they were looking the
wrong way at the time.
She said many health problems were inextricably linked to poverty, If it was that easy to
and complex social issues. change your lifestyle
people would be
"This is another piece of political manipulation of the nastiest kind. doing it already
"I find it repellent, and no patient of any sense is going to fall for it.
"Let's have a bit of intelligent dialogue on this, not this finger-wagging, contract-making nonsense.
It just won't work."
Lyndel Costain, of Dieticians in Obesity Management UK, said action to tackle smoking and obesity
would be welcome - but questioned the merits of the new proposals.
"Changing day-to-day behaviour such as what we eat is very hard work.
"It's engrained into people's cultures and depends upon how much money we have to spend.
"It can be difficult for people with less money to buy the healthier food. And some people use food
to cope with stress.
"If it was that easy to change your lifestyle people would be doing it already.
"People need help from the NHS and if changes are to be made there must be support available to
Dr John Chisholm, chairman of the BMA's General Practitioners Committee, warned that the
proposal would jeopardise the relationship that doctors had with their patients.
He said: "Patients do need to take responsibility for their health care and their lifestyle choices and
doctors encourage them to do so.
"The NHS is not a limitless resource and it is right to exhort people to use it responsibly.
"But we would deplore any suggestion that people would be denied free care because of their
failure either to take medical advice or to respond to that advice.
"At a time when we are working with the government to reduce bureaucracy in general practice,
this idea amounts to a bureaucratic nightmare."
Editorial BMJ 24 May 2003
New leader, new hope for WHO
Setting an agenda for Jong-Wook Lee
In the mid-1990s the World Health Organization seemed doomed to
either "flounder in a morass of petty corruption and ineffective
bureacracy"1 or to die.2 Neither of these happened. Instead, Gro
Harlem Brundtland, who took office as director general in July 1998,
restored the organisation's reputation as a credible force in global
health.3 Last week the World Health Assembly approved Jong-Wook
Lee as Brundtland's successor. Unlike Brundtland, Lee is not being
charged with saving the organisation but with harnessing its
potential to transform the lives of the poorest. There are four things
he must do to help achieve this.
Think global, act local
Firstly, he must start to close the huge gap
between what WHO is doing on the global
stage and what is happening at country level.
Where Brundtland focused her energies and
much of WHO's resources on headquarters—a
strategy that was useful for launching new,
high profile public-private partnerships—Lee
must think globally and act locally.
High profile public-private initiatives are being rolled out in countries
with weak public health systems. The poorest countries struggle
with epidemics, natural disasters, famine, and wars, and they can
barely deliver the most basic of health services. Country support
from WHO could help strengthen these health systems, yet WHO's
country teams have been chronically underresourced and
undermined by poor coordination with Geneva's activities.4 WHO
needs a long term strategy of investment that should include
support for countries to build a public health infrastructure. Many
health activists in developing countries believe that the best way for
WHO to reinvigorate its country work is to recommit itself to the
Health for All initiative.5
The regional offices could be the missing link between the global
and the local. Regions can help countries to share experience,
information, and knowledge and they have a geographical
advantage over Geneva in reaching countries. But Lee will inherit an
uneasy relation between headquarters and the regional offices,6 one
that continues to threaten WHO's usefulness and responsiveness
locally. Although the roots of this unease run deep, Lee must
nevertheless find a way to create a truly organisation wide
Global support and finance
Secondly, Lee must argue the case that the world needs to support
and finance WHO now more than ever. New players in global health
are commandeering not just the limelight but also the funding—
money that is outside the governance of the world's health agency.7
Many WHO staff have expressed deep disquiet at the way that the
organisation has been sidelined by spin offs of WHO, like the Global
Fund and the Global Alliance for Vaccines and Immunisation.7 Lee's
advocacy and experience with the Stop TB initiative could help to
define WHO's place in the new global health landscape. WHO should
stake its claim as the agency that will help the poorest countries
apply for new health funds and roll out new health initiatives. It
should stand up and be counted as the agency that is best placed to
coordinate the disparate global health activities, one with an
unparalleled reputation for setting global norms and standards, and
one that can highlight the stark inequalities within and between
Thirdly, Lee should take stock of WHO's partnerships and ask some
crucial questions of them: which ones are having an impact at
ground level? Are partnerships diverting resources away from
WHO's less "fashionable" but arguably more important core
activities? Which partnerships are the most accountable to those
that they serve and the best governed? Which have managed to
include meaningfully a balance of private, public, and civil society
voices? This kind of appraisal is urgently needed. WHO does not
have a clear and consistent policy on working in partnerships, and
yet it is increasingly entering into them.
Openness in management
Fourthly, Lee needs to create a more open management culture, in
which internal debate is encouraged and shared with the rest of the
world rather than stifled in an attempt to keep staff "on message."
How disturbing that in the run-up to the recent election for director
general, a senior policy adviser instructed WHO staff not to discuss
their thoughts about the future of WHO publicly.8 Why the
censorship? Surely the views of WHO's executive and programme
directors are of central importance in the debate about where WHO
should be heading. Fostering openness, as we recently argued,
should also include a commitment to reforming the next election
process for director general.9
This agenda is achievable—and there is much in Lee's election
manifesto that leaves us profoundly optimistic.10 He has promised to
increase the proportion of resources allocated to countries and
regions from 67% to at least 75% by 2005 and 80% by 2008. He
says he will advocate a substantial increase in investment in public
health systems and services. He plans to launch a new initiative to
help countries close the widening gap in health service provision
between the rich and poor. And he has committed to prioritising
WHO's involvement only in partnerships that can show specific and
defined roles for all partners, measurable results in terms of health
outcomes for the poor, and a focus on action at the local level.
Gavin Yamey, deputy physician editor
Best Treatments (firstname.lastname@example.org)
Kamran Abbasi, deputy editor
BMJ BMJ Unified, London WC1H 9JR
Competing interests: The BMJ receives submissions and commissions papers from
many authors who work for WHO. KA is involved in decisions about publication of
these. KA is a former editor of the Bulletin of the World Health Organization and is at
present an editorial adviser.
1. Godlee F. WHO in crisis. BMJ 1994;309: 1424-8.[Free Full Text]
2. Smith R. The WHO: change or die. BMJ 1995;310: 543-4.[Free Full Text]
3. Yamey G. Have the latest reforms reversed WHO's decline? BMJ 2002;325:
1107-12.[Free Full Text]
4. World Health Organization. Improving WHO performance at country level:
"the country focus initiative." Consultation draft. Geneva: WHO, 2002.
5. People's Health Movement. People's charter for health.
14 May 2003).
6. Feachem R, Medlin C, Daniels D, Dunlop D, Mshinda H, Petko J, et al.
Achieving impact: roll back malaria in the next phase. Final report of the
external evaluation of Roll Back Malaria. 29 August 2002.
m#Eereport (accessed 20 May 2003).
7. Yamey G. Why does the world still need WHO? BMJ 2002;325: 1294-
8.[Free Full Text]
8. The Lancet. The rights and wrongs of WHO's policy of censorship. Lancet
9. Yamey G, Abbasi K. Electing WHO's next leader. BMJ 2002;325: 1251-
2.[Free Full Text]
10. Lee JW. Resources should be decentralised to countries and regions. BMJ
2003. http://bmj.com/cgi/content/full/326/7381/123/a/DC1 (accessed
19 May 2003).
BBC news online Monday, 19 May, 2003, 23:00 GMT 00:00 UK
Email this to a friend Printable version
Call to legalise live organ trade
A leading transplant surgeon has called on the government to
license the sale of human organs in the UK.
Professor Nadey Hakim, a surgeon based at St Mary's Hospital,
London, said a regulated market of organ donors would cut so-called
Senior doctors have complained of growing strains on the NHS from
botched transplant operations conducted abroad, while doctors in There is a serious shortage of
India see poor donors dying after selling one of their kidneys. organs in the UK
Professor Hakim told BBC Radio 4's File On 4 programme: "As this trade is going on anyway, why
not have a controlled trade where if someone wants to donate a kidney for a particular price, that
would be acceptable.
"If it's done safely the donor will not suffer." One in three of
patients from our waiting
Dr Robert Higgins, a transplant surgeon at Coventry Hospital, has lists who have gone
logged the inherent dangers of transplant tourism. overseas have either died
or had the transplant
"One in three of patients from our waiting lists who have gone fail
overseas have either died or had the transplant fail. It compares to
about one in 10 death or failure rate in this country." Dr Robert Higgins
The problem is particularly acute within the Asian community where people are at particular risk of
kidney failure and disease.
Asians represent 4% of the population but 14% of the waiting list for kidneys.
Heart attack HAVE YOUR SAY
It is an abhorrent idea
File On 4 spoke to a number of British Asian families with members and goes against every
who have gone to the sub-continent to pay for transplants. principle of civilisation
In his mid-50s, the father of Jamal travelled to India where he had Charles Moore, Scotland
arranged with a surgeon to buy a kidney on the open market.
"The hospital got five donors in a room and he could choose which Send us your comments
one to use," said Jamal.
The hospital declared the transplant a success, but they had apparently overlooked the risk from
the man's high blood pressure, and 45 minutes he died of a heart attack.
In the Punjabi capital, Amritsar, File On 4 tracked down the poor and homeless who are recruited
as donors by agents for the transplant surgeons.
16-year-old Harjinder was whisked off to a safe house near a hospital and introduced to the woman
patient he was being paid to help - but he did not know the truth of what she needed.
"When I gained consciousness after two or three days I had a big Ultimately, the organ
bandage on my side," he said. trade is like child
"I'd been told I was donating blood but the doctor said he had
removed a stone. Rajwinder Bains, Punjab
Human Rights Organisation
"It was when I left hospital I found out they had removed my
A police investigation into more than 2,000 questionable transplants in and around Amritsar found
that 22 donors had died after giving their kidneys.
Some were secretly and illegally cremated, others dumped into canals. The leading doctor has been
accused of culpable homicide.
In cases under investigation, scores of British transplant tourists are thought to be among those
who have received organs.
This is an aspect of the trade which disturbs the lawyer for the Punjab Human Rights Organisation,
"Ultimately, the organ trade is like child prostitution. The developed world comes to South-East Asia
"The British legal system should take care of this."
The UK National Kidney Research Fund said it was important to find new ways to increase the
supply of donor organs.
These could include the use of older donors, non-heart beating donors and living donors, and
improved co-ordination and training of transplant co-ordinators
But a spokesperson said: "The fund does not believe that compensating people for donating an
organ, over and above that of reasonable expenses, is necessarily the right answer."
File on 4 is broadcast at 2000 BST on Tuesday 20 May.
BBC News online Friday, 9 May, 2003, 09:57 GMT 10:57 UK
Email this to a friend Printable version
Q&A: State of the NHS
The Commission for Health Improvement says the NHS is
However, in a new report it also warns that progress has not been made in some areas.
And it also warns that pressure for reform may be counter-productive.
Dame Deirdre Hine, CHI chairman, told the BBC about the report's conclusions.
What did you find?
We found that there were tremendous advances in a whole lot of areas in the NHS.
For instance, people are getting treated faster, they are getting treated with very up-to-date
methods of treatment and in particular they are being given a lot more information about their
condition, the diagnosis, and the options are open to them for treatment.
Basically, they are being treated very much more as individuals than they were some years ago.
And are they noticing this improvement?
I think that it's very difficult to generalise about that.
Many people, if you ask them, say that they are very satisfied with their treatment.
But we are also very conscious of some areas where the treatment is not improving as fast as we
would like it.
Which particular areas?
I think mental health services, where people are still being treated sometimes in less than
Part of the problem is that there is a shortage of consultant psychiatrists, for instance.
Cancer services is another area. There have been tremendous improvements in the treatment of
But there are shortages of some skilled staff, like cancer nurses.
And this makes it difficult for the service to treat people to the very high standard of quality that
we expect of them.
There were other things that you highlighted - things like the control of
infection in hospitals and questions over NHS management . Can these
problems be resolved?
Absolutely. Let's focus on control of infection in hospitals.
This can be tackled if a hospital has a very clear policy on control of infection, which is backed by
the board and implemented by a strong strong team of doctors and nurses.
It also requires that frontline staff are reminded all the time of the very simple precautions that
need to be taken to avoid spreading infection from patient to patient or staff to patients or
patients to staff.
I won't say it's easy because it requires a lot of attention and continuous monitoring - but it
doesn't require a lot of money.
So what would your priorities be now?
Leadership. One of our findings is that where there is really strong leadership, both clinical and
management leadership, working together then you get the fastest and the best improvements.
BBC News online Thursday, 24 April, 2003, 23:17 GMT 00:17 UK
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PFI 'leads to hospital bed cuts'
Private finance initiative schemes damage hospital services,
turning the NHS into "an emergency service" because of a
reduction in beds, researchers have claimed.
The allegations were made after an examination of preparations for
the private finance initiative (PFI) in Lothian, Scotland - but the
analysts predict the pattern would be repeated across the country.
They said Lothian had not reached targets it set itself for cutting The existing Royal Infirmary in
inpatient admissions and shortening hospital stays - but the Edinburgh
hospital trust has strongly refuted their claims.
The targets were set in 1996 to prepare NHS services in the area for the opening of the
multimillion pound PFI hospital in Edinburgh, which opens next month.
The aim was to cut the number of beds available for patient care across by 24% in readiness for
the new hospital.
The reduction was supposed to be offset by providing more This is total nonsense,
efficient care, including shorter hospital stays, earlier discharge based on a complete
from hospital and more care provided in the community. misunderstanding of the
way the NHS works
But researchers from Glasgow Royal Infirmary and University
College London say this has not been achieved, resulting in a Department of Health
steeper decline in the number of beds available and rates of spokesman
admission to Lothian hospitals over the last five years compared to
the rest of the Scotland.
And they warn the situation is being repeated in all areas where a PFI hospital is being built,
affecting patient care.
The researchers looked at projected and actual trends in bed capacity and inpatient and day case
admissions in Lothian between 1995 to 1996 and 2000 to 2001, and compared them to figures for
the rest of Scotland.
They found 81% of the planned bed cuts for had been achieved. But the projected 21% increase
in inpatient and day case admissions to all acute specialties had only reached 0.3%.
Inpatient admissions to surgical specialties were projected to rise by 8% but actual admissions
fell by 13% due to severe capacity constraints.
Hospital stays only reduced slightly across all acute specialties, People are going
and in surgical specialties, they rose. untreated
The proportion of delayed discharges was higher than the Scottish Allyson Pollock, researcher
Lothian Health Board currently has a £95m deficit, largely due to the costs of the PFI, say the
They warn further cuts to hospital and community services may be needed to allow the board to
pay off its debt.
Writing in the British Medical Journal, Professor Allyson Pollock, of the School of Public Policy at
University College London, and Matthew Dunnigan of Glasgow Royal Infirmary, said: "Our analysis
shows evidence of reduced service delivery across Lothian and its associated PFI development
compared with other Scottish hospitals."
Professor Pollack warned fewer beds meant a reduction in planned operations such as hip
replacements and coronary artery bypass.
"People are going untreated. They are coming in much sicker. "They will have to go without care
until they get to the right sickness level, or go private." She added: "This is happening across the
country. The NHS begins to only operate as an emergency service."
She said the current situation was "very predictable" because of the expense of PFI, but local
health bodies went ahead with the plans because the government said it was "the only show in
Dr Charles Swainson, medical director of Lothian University Hospitals Acute Trust said the
researchers claims were "completely untrue" and based on inaccurate figures. He said: "The fact
is that we have treated all of the patients that have presented for surgery and for all other
treatment at our hospitals. "We have actually achieved the waiting time guarantees agreed in
Scotland that no-one waits more than nine months."
Dr Swainson added: "The researchers' argument is completely spurious." He called on them to
prove patients were not getting treatment when they needed it.
A spokesman for the Department of Health said: "This is total nonsense, based on a complete
misunderstanding of the way the NHS works."
"Decisions about bed numbers are made before any decisions about how building a new hospital
should be funded. The two things have no relationship."
He said bed numbers in both public ally and privately funded hospitals had been cut in the past
because it was thought beds could be used more efficiently and more people cared for outside
But he said the process could not continue, and bed numbers had increased in the last two years,
the first time since 1971.
BMJ 2003;326:671-672 ( 29 March )
Ethnic and sex bias in discretionary awards
Eliminating bias is part of modernising any new consultants'
See Papers p 687
George Bernard Shaw, in his preface to The Doctor's Dilemma,
summarised his conclusions as follows: "Nothing is more dangerous
than a poor doctor." His solutions included making doctors into "civil
servants with a dignified wage paid out of public funds" and
"municipalise Harley St."1 Shaw's reaction to the NHS, which
arguably made hospital doctors into civil servants, is not recorded.
Although he was aged 92 in 1948, he would probably have pointed
to the implications of failing to municipalise Harley St.
The United Kingdom is unusual in the extent to which the state
employs hospital consultants in state owned hospitals. International
trends towards greater autonomy for local organisations have been
partly reflected in the United Kingdom with the development of NHS
hospital trusts from 1991 and, more recently, the plans for
Any economist reviewing how hospital doctors in the United
Kingdom are paid would be struck by the following. Firstly, NHS
national pay scales, which have survived the shift of consultants'
contracts from regions to hospital trusts, make up 71% of
consultants' income (table). These pay scales take no account of
performance, let alone regional differences in the costof living, nor
of the costs of qualifying and remaining up to date, which plausibly
vary by specialty. Secondly, around half of all consultants hold NHS
discretionary awards, which vary by specialty, sex, and ethnicity
and account for some 6% of consultants' total income. Thirdly,
private practice, which varies by specialty, sex and ethnicity,
accounts for 23% of consultants' income. Fourthly, NHS salaries
qualify for generous pensions based on final salaries which are
boosted by the additional NHS awards.
Estimated total income of consultants, 1999
£ million (%)
NHS gross pay 1877 (71)
NHS awards 169 (6)
Private earnings 601 (23)
Total 2647 (100)
To get the NHS to deliver services more predictably, changing the
way in which consultants are paid has become a priority. According
to the NHS Plan, "the current consultants' contract is far from
satisfactory. Too few have proper job plans setting out their key
objectives, tasks, and responsibilities and when they are expected
to carry out their duties."2
Or, taking a much cited analogy: "No normal company would
contemplate it. Take your most highly skilled and talented staff
. . . Give them a job for life, an index linked pension, and six weeks'
paid holiday. Then let them go and work for the opposition not just
out of hours but during the normal working week. It sounds crazy.
Yet that is more or less exactly how the NHS consultants' contract
What of discrimination in NHS discretionary awards? For the first
half century of the NHS, consultants controlled the distribution of
distinction and merit awards. This provided incentives to
performance as judged by peers, at a time when few other criteria
existed. It also encouraged doctors to commit to the NHS and
academic medicine. But as doctors became more heterogeneous in
terms of ethnicity and sex and as their performance became more
measurable, the entire system has come to seem archaic. The
awards have been renamed (currently distinction awards and
discretionary points) and reformed to take the views of hospital
managers into account.
The process of unmasking how these awards are allocated has been
causing some amusement to outsiders. Attention has long ago been
drawn to differences by specialty.4 From being top secret, the
names of award holders are now available on the internet. Over the
past decade, disparities by ethnicity have been highlighted, mainly
by Esmail, who as a general practitioner does not qualify for one of
these awards, and his coauthors. They have highlighted disparities
by ethnicity in admissions to medical school,5 then distinction
awards,6 and now discretionary points.7
What of their recent findings? More white consultants get
discretionary points than those from other ethnic groups (56% v
41%) and more male ones than female ones (55% v 44%). The
authors claim that discrimination cannot be excluded as a factor
accounting for these differences, and that continuation of the
scheme is difficult to justify. Both being non-white and being female
are associated with lower chances of getting an award. Where
possible, the authors have allowed for age, type of hospital, and
specialty, showing that these make little difference.
Two caveats apply. Firstly, any discrimination by ethnicity applies
less to entry than to progress in the medical profession. The NHS
employs a disproportionate share of non-white (if not female)
consultants. Secondly, the degree to which consultants' choice
affects their career progress is unknown. Choices of specialty,
between NHS and private work, and between work and leisure, all
reflect preferences and constraints. Constraints may be fair or
otherwise, but career paths reflect individual choices to some
extent. Attempts by the advisory committee on distinction awards to
identify potential candidates from female and non-white consultants
have had little success.8
This time the government has been listening. Having accepted that
"institutional racism" exists in many public sector bodies including
the police and the NHS it sees disparities in distinction awards as
inbuilt biases against particular groups and specialties.9 The
government has committed itself to sweeping away bias and
outmoded working practices as part of modernising the NHS. In
return for record increases in NHS funding, national performance
targets to do with waiting times and standards will have to be met.
A new employment contract for hospital consultants is part of the
modernisation programme. A recently proposed contract would have
required NHS consultants to commit to the NHS, restrict private
work, and be paid according to their performance, via a unified
discretionary awards scheme. After its overwhelming rejection by
consultants in England and Wales its future is unclear. What is clear
is that if other elements of the modernisation strategy are to
succeed, particularly greater autonomy for the best performing
hospitals in the form of foundation status, then contracts that reflect
the commitment of consultants to the hospital that employs them
Failure to modernise the NHS, claim its advocates, could lead to
much more radical reforms, including a greater role for private
hospitals. Either way, distinction awards and discretionary points,
along with national pay scales, all of which can be seen as part of
the civil service, seem unlikely to survive much longer.
James Raftery, director.
Health Economics Facility, Health Services Management Centre, Birmingham B15
Competing interests: None declared.
1. Shaw B. The doctor's dilemma. London: Penguin, 1946. (Preface.)
2. Department of Health. The NHS Plan. London: Department of Health, 2000.
www.nhs.uk/nationalplan/ (accessed 19 Nov 2002).
3. Examination of witnesses (questions 156-179). House of Commons Official Report
(Hansard) 2000 Jun 22. www.parliament.the-stationery-
(accessed 2 Nov 2002).
4. Bruggen P, Bourne S. The distinction awards system in England and Wales 1980.
BMJ 1982; 284: 1577-1580[ISI][Medline].
5. Esmail A, Nelson P, Primarolo D, Toma T. Acceptance into medical school and
racial discrimination. BMJ 1995; 310: 501-502[Free Full Text].
6. Esmail A, Everington S, Doyle H. Racial discrimination in the allocation of
distinction awards? Analysis of list of award holders by type of award, specialty
and region. BMJ 1998; 316: 193-195[Free Full Text].
7. Esmail A, Abel P, Everington S. Discrimination in the discretionary points award
scheme: comparison of white with non-white consultants and men with women.
BMJ 2003; 326: 687-688[Free Full Text].
8. Department of Health. Advisory Committee on Distinction Awards. Annual report
2002. London: DoH, 2002:3.
9. Department of Health. New award scheme rewarding commitment and excellence
in the NHS. London: DoH, 2002.
BMJ 2003;326:687-688 ( 29 March )
Discrimination in the discretionary points award
scheme: comparison of white with non-white
consultants and men with women
Aneez Esmail, president a, Peter Abel, research assistant
, Sam Everington, vice president a.
Medical Practitioners Union, MSF Centre, London EC1V 8HA, b Rusholme Health
Centre, School of Primary Care, University of Manchester, Manchester M14 5NP
Correspondence to: A Esmail email@example.com
The discretionary points award scheme is one of the main
mechanisms for rewarding consultants beyond their basic salaries in
England, Wales, and Scotland. Half of all consultants have received
awards. Together, the discretionary points and distinction awards
cost the NHS about £251m ($410m; 380m) each year. Each
discretionary point is worth £2645, so a consultant with the
maximum of eight discretionary points earns £87 280.
Distribution of discretionary point awards by ethnic group and sex for
consultants in England and Wales and Scotland
Non- Ratio (95% Ratio§ (95%
White white Total CI) Male Female Total CI)
England and Wales
No eligible for 16 411 2395 18 17 5284 22
award 806 105 389
No with award 9 261 983 10 9 540 2351 11
% with award 56.43 41.04 1.37 (1.31 to 55.77 44.49 1.25 (1.21 to
No with award
D1 7 414 706 8 120 1.53 (1.44 to 7 622 1732 9 354 1.36 (1.30 to
D2 5 361 459 5 820 1.70 (1.57 to 5 540 1124 6 664 1.52 (1.44 to
D3 4 222 326 4 548 1.89 (1.70 to 4 408 805 5 213 1.69 (1.58 to
D4 3 488 245 3 733 2.08 (1.84 to 3 643 627 4 270 1.79 (1.66 to
D5 1 319 70 1 389 2.75 (2.17 to 1 304 223 1 527 1.81 (1.57 to
D6 594 23 617 3.77 (2.49 to 577 96 673 1.86 (1.50 to
D7 235 10 245 3.43 (1.82 to 229 45 274 1.57 (1.14 to
Mean age (years) 36.3 39.0 36.7 37.1
No eligible for 2 533 140 2 673 2 087 677 2 764
No with award 1 310 54 1 364 1 136 270 1 406
% with award 51.7 38.5 1.34 (1.08 to 54.4 39.9 1.36 (1.23 to
No with award
D1 984 29 1 013 1.88 (1.35 to 869 174 1 043 1.62 (1.41 to
D2 707 19 726 2.06 (1.35 to 635 103 738 2 (1.65 to
D3 503 6 509 4.63 (2.11 to 457 66 523 2.25 (1.76 to
D4 394 4 398 5.44 (2.06 to 359 50 409 2.33 (1.76 to
Mean age (years) 35.4 40.4 35.7 35.5
In England and Wales, 2425 consultants, and in Scotland, 91 consultants did not give their
ethnic group and we classified 1172 as "other ethnic group."
In England and Wales, 14 consultants did not provide information.
In England and Wales, 2 for the linear trend was 316 (P<0.0001); in Scotland 2 was
In England and Wales, 2 for the linear trend was 347 (P<0.0001); in Scotland 2 was
Department of Health guidance for awarding points instructs
employers to ensure that consultants are treated equally regardless
of colour, race, sex, religion, politics, marital status, sexual
orientation, membership or non-membership of trade unions or
associations, ethnic origin, age, or disability.1 We assessed whether
any disparity between the discretionary points awarded to
consultants in England and Wales and in Scotland is associated with
ethnic origin and sex.
Methods and results
Methods and results
We used data for 2000-1 from the Advisory Committee on
Distinction Awards for England and Wales and the Scottish Advisory
Committee on Distinction Awards. These disaggregated data
included date of birth, sex, ethnic origin, specialty, level of award or
number of discretionary points held, and the year the awards or
points were granted.
We categorised the ethnic groups Bangladeshi, black African, black
other, Chinese, Indian, and Pakistani as non-white and compared
these groups with consultants who described themselves as white.
Consultants classified as from any other ethnic group and those who
did not give their ethnic origin were excluded. We divided the
number of consultants with discretionary points by the total number
of consultants who did not receive distinction awards, as consultants
without awards are eligible for discretionary points. We compared
the proportion of consultants with discretionary points between
white and non-white consultants and between men and women
In England and Wales, white consultants had 1.37 (95% confidence
interval 1.31 to 1.44) times as many awards as non-white
consultants, and men had 1.25 (1.21 to 1.30) times as many as
women; in Scotland the ratios were 1.34 (1.08 to 1.66) and
1.36 (1.23 to 1.51). The ratios increased with increasing level of
Methods and results
Non-white and female consultants may be disadvantaged under the
discretionary point award scheme. The non-response rate of 16%
(3597/22389) in England and Wales may have affected the results.
To negate the differences, all the consultants who did not give their
ethnic group and received awards would, however, have to be non-
white. Non-white consultants are older when appointed, and,
therefore, their period of eligibility for discretionary awards is less
than for white consultants. Non-white consultants may also be
concentrated in specialties which are less likely to receive awards. 2
The reason for differences in the number of points awarded to men
and women is unclear, but differences could be due to
Points are awarded by local decision making groups which usually
consist of three non-eligible consultants and three managers. The
deliberations of these groups are not usually open to scrutiny. The
lack of published data on the scheme locally and nationally is a
continued source of concern. Employment tribunals have already
found in favour of consultants who have alleged racial
discrimination.5 Without effective monitoring, it is impossible to
judge whether the scheme is operated fairly and without
We thank Chris Roberts for statistical advice.
Contributors: AE planned the study, supervised the analysis, and
wrote the paper. PA obtained the data, carried out the analysis,
obtained the background information, and commented on drafts of
the paper. SE suggested the idea for the paper and commented on
drafts. AE is guarantor.
Editorial by Raftery
Funding: No additional funding
Competing interests: AE and SE are members of the Medical
Practitioners Union, which is opposed to distinction awards and
discretionary point awards.
Methods and results
1. Department of Health. Consultants discretionary points. London: Department of
Health, Dec, 1995. (Advance letter (MD)6/95; Annex B modified December 1999.)
2. Esmail A, Everington S, Doyle H. Racial discrimination in the allocation of
distinction awards? Analysis of list of award holders by type of award, specialty,
and region. BMJ 1998; 316: 193-195[Free Full Text].
3. Bruggen P, Bourne S. The distinction awards system in England and Wales 1980.
BMJ 1982; 284: 1577-1580[ISI][Medline].
4. Beecham L. Women consultants lag behind in merit awards. BMJ 1994; 308:
1106[Free Full Text].
5. Wise J. Trust accused of racism in awarding payments. BMJ 2000; 320: 269[Free
Last Updated: Friday, 28 March, 2003, 17:03 GMT BBC News online
Email this to a friend Printable version
NHS complaints overhauled
Responsibility for reviewing NHS complaints is to pass
to an independent watchdog, the government has
The new Commission for Healthcare Audit Improvement
(CHAI) will take over the role from NHS hospital and primary
Most complaints about NHS services are resolved at a local Most complaints are dealt
level. with locally
But in around 2% of cases, patients or their relatives want to take the matter further.
However this stage of the complaints procedure is not
currently seen as being impartial.
experiences with the
Health Minister David Lammy said: "Patients and staff alike
have told us that they want a new complaints procedure that procedures are far
is more flexible, responsive, independent and, as a result of from satisfactory
their concerns, leads to improved NHS services.
"Our radical plans will mean that individual patients will get Consumers' Association
full responses to their complaints and that the lessons learned
from them will lead directly to service improvement."
Peter Homa, Chief Executive designate of CHAI said: "We will play a key role in delivering an
NHS complaints procedure that provides both resolution for the individual and a direct link to
quality improvement processes."
Frances Blunden, principal policy adviser at the Consumers' Association, said: "Patients'
current experiences with the NHS complaints procedures are far from satisfactory.
"Most people find the process daunting and distressing and inadequate to address their
"Changes to procedures are part of the equation, giving funding to the Independent
complaints and advice services to support patients making complaints is also vital."
Overseas staff keep NHS afloat
Wednesday February 19, 2003
Some parts of the NHS would "cease to function" without the massive influx of nurses from
countries as far afield as South Africa and the Philippines, a report reveals today.
The scale of the NHS dependency on overseas health workers is illustrated by new figures
which estimate that there are over 42,000 foreign nurses working in the UK - more than
double the number of three years ago, and equivalent to one in 12 of all registered nurses in
The research by the Royal College of Nursing, based on unpublished data supplied by the
nursing regulatory body, the Nursing and Midwifery Council, shows that a quarter of all nurses
working in the NHS and independent hospitals in London are from overseas.
That proportion is set to rise in the future, the report says. It estimates that thousands more
qualified nurses from abroad are currently employed by the NHS in unskilled jobs while they
work a period of "adaption" - which will allow them in time to register as nurses in the UK.
"It is no exaggeration to state that some healthcare organisations, particularly in the
independent sector, would cease to function without their international nurses. Many more,
including NHS trusts, could not function effectively without their international recruits, " the
It says that overseas recruitment is no longer regarded by NHS employers as a "quick fix"
solution to chronic domestic nurse shortages but as an integral part of their workforce
planning strategies. Hiring abroad is seen as simpler and cheaper than recruiting at home.
The report, entitled Here to Stay, cites a London NHS trust which calculated that it was
employing nurses from 68 non-UK countries.
The influx has accelerated massively, partly as a response to nursing shortages but also to
meet a national NHS target of recruiting 35,000 more nurses by 2008.
Despite government attempts to prevent the direct recruitment of nurses by the NHS from
countries who can ill afford to lose skilled healthcare professionals, there is evidence that
nurses are still arriving in significant numbers from "developing" countries such as the West
Indies and Zimbabwe.
In some cases, independent healthcare employers are skirting ethical guidelines by
deliberately targeting nurses from the Indian and African subcontinents, charging them a fee
and offering them an adaption course so that they can register in the UK and move on to NHS
Professor James Buchan, the author of the report, says that while NHS managers appear to
be sensitive to the ethical aspects of direct recruitment, such loopholes allow organisations to
employ nurses from proscribed countries while apparently abiding by recruitment guidelines.
The report says: "At the moment, for most healthcare employers in the UK, the ethics
of international recruitment is subsidiary to the efficiency of the process. Meeting
staff targets is imperative."
GPs to be offered 30% pay rise
John Carvel, social affairs editor
Wednesday February 19, 2003
The government is to offer GPs a pay increase worth up to 30% over three years in an
attempt to improve the quality of primary care and avoid an exodus of demoralised doctors.
After 18 months of negotiation between the British Medical Association and NHS employers,
the deal is due to be announced on Friday with details of the biggest change in GPs' terms of
employment since the NHS was founded in 1948.
The generosity of the package may attract envious glances from 1.2 million other NHS
workers, including nurses, therapists and ancillary staff who are balloting on an offer worth
just 16% over three years.
It may also raise questions among other public sector workers, including the firefighters, who
have been told the government cannot afford to unleash an inflationary round of settlements.
However, the GPs are not certain to accept the new contract in the atmosphere of mistrust
that has developed between the profession and the government.
In October hospital consultants rejected a 21% offer for fear it would place them under the
tight control of NHS managers. GPs' leaders have told ministers that they will present the deal
to their members without recommending it.
The new "general medical services" contract is designed for about three-quarters of the
34,500 GPs in the UK who operate as independent contractors and do not consider
themselves to be employees.
For the first time they would escape legal responsibility for providing 24-hour care for their
patients. Instead they will be able to choose whether to provide a no-frills service, treating
people when they are sick, or a more comprehensive package of care, including
contraception, immunisation and diagnostic tests.
The biggest pay increases will go to GPs contracting to provide an even wider range of
"enhanced" services, including minor surgery and management of complex conditions such
as Parkinson's disease that was previously provided in hospitals.
With negotiations expected to continue until tomorrow night, it was expected that even GPs
opting to provide the minimum level of care will be offered a pay increase well above inflation.
Advantages for the government will include the opportunity to influence quality in primary care
that has been far more variable than in hospitals. Primary care trust managers have been
appalled that patients are willing to put up with abysmal standard of care and facilities in some
Under the new contract, the income of GP practices would vary according to their
performance across about 80 measurements of activity.
The government is willing to pay handsomely for these reforms because it is anxious to
reverse a decline in morale.
A report from Derek Wanless, the former chief executive of NatWest bank, warned that the
NHS would not be able to provide top-class healthcare if it could not double the number of
GPs to more than 55,000 by 2020.
Ministers have struggled to organise any increase in GP numbers since 1997 and are
confronted with growing demands for early retirement among doctors overwhelmed by an
The average number of applications for each vacant post in general practice in England and
Wales slumped from 8.5 in 2000 to 4.4 in 2001.
The deal is expected to raise the income of the highest-earning NHS family doctors to about
£120,000 a year.
Monday, 3 February, 2003, 10:42 GMT BBC News
NHS could implode say doctors
Funds are not reaching cancer units
A leading cancer expert has warned that the NHS is on the point of implosion.
Dr Maurice Slevin says that bureaucracy and bad management is rife in the
However, there are not enough front line staff such as nurses and ancillary
workers, and doctors are demoralised.
As a result, he says the quality of patient care is suffering.
Dr Slevin's grim diagnosis is set out in a pamphlet In the NHS
published by the right-leaning Centre for Policy Studies. His
views have been supported by 16 other leading doctors. the vast
Dr Slevin, who works at Barts and the London NHS Trust, managers are
argues the problems of the NHS will not be solved purely by
there to stop
the vast amounts of new money that the government is
pumping in. things
Too much of this is being wasted on proliferating
bureaucracy and is not reaching the patient, he says.
Dr Slevin cites the example of his own field of specialty - Slevin
cancer services. The government has increased spending in
this area by £407m, but many units say they have not received all the allocated
Meanwhile, there are eight managers for every 10 nurses in the NHS, compared
with just under two for every 10 nurses in the private sector. "In the NHS the
vast numbers of managers are there to stop things happening. In the private
sector, the small numbers of managers are there to make things happen."
Dr Slevin is calling for a voucher system to ensure money follows the patient -
and good hospitals prosper.
He also proposes a dramatic reduction in the numbers of managers and
administrators in the NHS, using the funds generated to substantially increase the
number and pay of nurses and allied professions.
A spokesperson for the Department of Health said the amount of money spent on
management as a proportion of the total NHS budget was falling. There was now
only one manager for every 10,000 patients.
"The NHS, after decades of neglect, is moving forward. "There are big problems
of course but progress is well under way. "The extra resources and the reforms in
the ten-year NHS Plan are biting. Resources produce results. Nurse, doctor and
bed numbers are all rising. "Thanks to the hard work of NHS staff the number of
patients waiting over twleve months for a hospital operation have fallen by
almost two-thirds in the last year. "By April, waiting times for a heart operation
will have halved from 18 months when the government came to office to nine
months. "That is still too long, and there is a long way to go, but the NHS has
turned the corner."
Nigel Edwards, policy director for the NHS Confederation also took issue with the
idea that there were too many managers in the NHS. He said: "Managers only
make up 3% of all NHS Staff. "There are just over 26,000 managers in the NHS,
many of them doctors and nurses, each one providing vital support so that front-
line staff can get on with focusing on patient care."
Specialists who back Dr Slevin's paper are:
Dr Peter Clark, Consultant Medical Oncologist, Clatterbridge Centre for
Oncolgy NHS Trust, Wirral.
Professor Charles Coombes, Professor of Medical Oncology, Head
Department of Cancer Medicine, Imperial College.
Professor Gus Dalgleish, Professor of Oncology, St. George's Medical
School, University of London
Dr Rob Glynne-Jones, Consultant Clinical Oncologist, Mount Vernon
Professor Martin Gore, Professor of Medical Oncology, Royal Marsden
Dr Peter Harper, Consultant Medical Oncologist, Guys and St Thomas's
Professor Ian Jacobs, Professor of Gynaecological Oncology, Barts and the
London NHS Trust, London
Professor David Luesley, Professor of Gynaecological Oncology,
Birmingham Women's Hospital, Birmingham
Dr Richard Osborne, Consultant Medical Oncologist, Poole Hospital, Poole
Dr Nicholas Plowman, Head of Clinical Oncology, St. Barts and the London
NHS Trust, London
Dr Anthony Rickards, Consultant Cardiologist, Royal Brompton Hospital,
Dr Matthew Seymour, Consultant Medical Oncologist, Cookridge Hospital,
Professor John Shepherd, Professor of Surgical Gynaecology, Barts and the
London NHS Trust, and the Royal Marsden Hospital, London
Mr Roger Springall, Consultant Surgeon, Charing Cross Hospital, London
Dr Andrew Thillainayagam, Consultant Gastroenterologist, Charing Cross
and Hammersmith Hospitals, London
Professor Jonathan Waxman, Professor of Medical Oncology, Charing Cross
and Hammersmith Hospitals, London