Thursday, September 13, 2007

NHS WASTED 43 Billion pounds

The money poured into the NHS has failed to produce a more efficient service, or to reduce unhealthy lifestyles. As a result even more cash will be needed in the future, says a new review by Sir Derek Wanless. It was published yesterday, five years after his review for the Treasury paved the way for the extra 43.2 billion pounds that the Government has since spent on the NHS.

Sir Derek, a former chief executive of NatWest bank, sees some improvements in the service, but also identifies a range of failings, including mismanaged structural changes; generous pay deals that failed to produce an obvious return; and a neglect of public health. He said at the publication of his report that the extra resources had undoubtedly improved patient care over the past five years. “But what is equally clear from this review is that we are not on course to deliver the sustainable and world-class healthcare system, and ultimately the healthier nation, that we all desire,” he said. Sir Derek would have liked the Government to have commissioned the review, but it showed no enthusiasm for doing so. The King’s Fund stepped in, enabling him to produce this report.

He states that more money will be needed over the next two decades unless steps are taken to deal with pressing concerns. That could undermine the current widespread political support for the NHS “and raise questions about its long-term future”, he says.

Of the more than 43 billion extra that has been spent, pay and price inflation have accounted for 18.9 billion, he concludes. New contracts for consultants, GPs and other staff have been introduced, but “there is very little robust evidence so far to demonstrate significant benefits arising from the new pay deals”. Staff numbers have risen far above the targets set in the NHS Plan of 2000, with targets for consultants exceeded by 16 per cent, for GPs by 166 per cent, for nurses by 272 per cent, and for therapists by 102 per cent. The biggest increase in NHS activity has been in accident and emergency departments, where attendances have grown by more than a third since 2002-03. This is hard to explain, but is probably caused by changes in behaviour, shorter waiting times and changes in GPs’ out-of-hours arrangements, the report says.

Public health budgets, aimed at tackling issues such as obesity and smoking, had been raided to bridge financial problems in the NHS, he said. It was impossible to track trends in public health spending or health promotion in the past five years because no official figures were kept. Sir Derek said: “It is also indicative of the relatively low priority given to public health that, while nonpublic health medical staff numbers have increased by nearly 60 per cent since 1997, the number of public health consultants and registrars has gone down overall.”

Sir Derek said at the publication of the report that there were “lots of positives” in his study. These included reduced waiting times, the use of less expensive statins and extra staff. He said that the framework introduced by the Government should remain in place for the next few years to minimise further disruption. He said in his report, however, that the restructuring had been expensive and had taken managers’ eyes off the priority of running the service.

Alan Johnson, the Health Secretary, will call today for direct intervention to encourage healthier lifestyles after the report’s warning of spiralling obesity levels. The future of the NHS depends on encouraging people to take care of themselves, he will tell members of the New Health Network. “Government simply cannot afford to be the passive observers of unhealthy lifestyles, only intervening when chronic diseases such as diabetes, heart disease or lung cancer are already well established,” he will argue. “Public health issues must be elevated to the top of the national agenda by a Department for Health which takes an even more active role in encouraging healthy lifestyles.”

Norman Lamb, the Liberal Democrat health spokesman, said: “This report is a damning critique of the Government’s failure to get value for money out of all the extra investment in the NHS. Ministers cannot ignore these recommendations as they did with last year’s report by Sir Derek into social care.”

Andrew Lansley, the Shadow Health Secretary, said: “Even Gordon Brown’s own adviser thinks he has mismanaged the NHS. Labour have invested lots and achieved too little. Gordon Brown is obsessed with pursuing top-down reorganisation instead of delivering genuine reform, which gives power to professionals and better healthcare to patients.” He added: “Public health budgets have been robbed to pay off huge deficits despite warnings about the strain that spiralling obesity levels will have on the NHS. Labour’s ignorance belies their arrogance.”

A spokeswoman for the Department of Health said: “We welcome this report and its recognition that the Government’s investment and reform have improved patient care. We agree that more has to be done to improve NHS productivity and to tackle some lifestyle issues like obesity. We also agree that spending on healthcare will need to continue to grow above inflation if we are to meet patients’ growing expectations. “These issues will be central to decisions made in the next few weeks as part of the Government’s Comprehensive Spending Review and the long-term review of the health service being conducted by Lord Darzi.”


Australia: The depersonalization of government medicine continues apace

HOSPITAL patients in Queensland are to be stamped with barcodes in a move to prevent operations being performed on the wrong body parts. Last financial year 31 mistaken procedures were performed, including three cases of the wrong tooth extracted and two operations on the incorrect part of patients' spines. In another instance, a person's left tonsil was removed in error and a separate patient had botox injected into the wrong body part.

Queensland Health's Patient Safety Centre senior director John Wakefield presented the figures to a Royal Australasian College of Surgeons state meeting near Cairns. They represented a huge increase on 2005-06 numbers, when six such cases were recorded, but Dr Wakefield said the centre had been actively encouraging public hospital staff to report incidents. "You might think: 'Oh gosh, how do these things happen?' " he said. "But as medicine has become more complex and we get people through the system quicker, there's more opportunities for mistakes to be made. "It usually happens in very busy hospitals. A major Brisbane hospital when I was working there three years ago had 22 operating theatres. That's a surgical factory."

Dr Wakefield said although the mistakes were rare, with more than 800,000 patients admitted to Queensland public hospitals in 2006-07, they were all preventable. "For the vast majority, there was very little harm but we regard all these errors potentially as leading to serious harm," Dr Wakefield said outside the meeting. "We're unearthing a problem, a risk in our system, which we've got to fix."

An analysis of the cases found patient misidentification was a significant cause of the problem. Dr Wakefield said Queensland Health planned pilot projects to eliminate the problem, including a study into the benefits of barcoding patients. "In the US veterans' health system, basically every patient has a barcode on the normal hospital wristband as well as their name and date of birth," he said. "It's a big technical investment but we'd like to explore that. "It doesn't just protect against patient misidentification, it protects against the wrong drug being administered as well."


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