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Health- It's time to take the NHS to the Streets to Kill the Bill
Updated: 23 Feb 2012
Andrew Lansley wins battle to keep NHS risk assessment under wraps
Labour motion demanding publication of document defeated
despite growing disquiet among Tory and Lib Dem MPs
The Guardian,
Health secretary Andrew Lansley looks more determined than ever not to reveal the findings of a risk assessment done on the government's NHS shakeup.
Lansley won the support of MPs, who voted on Wednesday by a majority of 53 against a Labour motion that the Department of Health should make its document public.
However, growing disquiet among some Conservative MPs and Liberal Democrats was voiced by Lib Dem MP John Pugh, who told the often bad-tempered debate that the bill was "toxifying the Tories" and "sadly detrimental" to his party.
Lansley suggested to MPs that he might refuse to release the risk register even if instructed to do so by a tribunal due to meet in a fortnight to judge on his dispute with the information commissioner, who has instructed him to publish.
Lansley twice refused the opportunity to tell MPs he would accept the tribunal's judgment.
Answering deputy Lib Dem leader Simon Hughes, the health secretary instead quoted from an article in the Observer by the information commissioner, in which Christopher Graham said he was "not infallible".
"The government has the right to appeal to the tribunal [following the information commissioner's ruling] and the tribunal is the proper place for that public interest test to be tested," he said.
Defending his decision, Lansley said the prospect of publishing such assessments reduced the quality of advice to ministers, meaning documents would become "bland and anodyne" and "cease to be of practical value".
"To be effective, a risk register requires all those involved to be frank and open about potential risk," Lansley told MPs. "It is their job to think the unthinkable and look at worst-case scenarios. It is vital nothing is done to inhibit that process."
Asked whether Lansley's comments suggested local and regional NHS risk registers, which have been published, were not as strong as they could be, a department spokesman said they could be "potentially watered-down".
As the Guardian reported last week, the risk assessments of the four English regional strategic authorities suggest there are wide-ranging concerns, including that patient care and safety could be damaged and costs could rise.
Lansley cleared up some confusion about the hotly debated risk register, saying the document in question was the "transition risk register", relating specifically to the reorganisation set out in the health bill, an assessment which was first drawn up in 2010 but is continually "reviewed and updated".
This was different to the department's "strategic" risk register of all its operations.
The department said that, unlike the strategic authorities' and other NHS risk assessments, its risk register concentrated on policy development.
However, a spokesman said refusal to publish the register extended also to explaining what questions it might cover, for example, if it dealt with how the bill might pass through parliament, or gave technical details about how its parts might impact on each other.
Labour's opposition day debate was fronted by
After the vote, Andy Burnham, the Labour shadow health secretary, said: "It is clear they are going to try to fight it: they are going to go to the High Court, go all the way, to go beyond the Bill [passing]."
He had insisted beforehand that MPs and peers had a right to know the implications of health reforms before they voted on the bill, which is currently in the report stage in the House of Lords.
"He [Lansley] is running unacceptable risks," said Burhnam. "What he's doing is wrong and needs to be stopped."
Burnham had to fend off repeated charges by Conservative MPs that he had refused similar requests for risk registers when he was health secretary in the previous Labour government.
Burnham said he had refused to publish a different document – the strategic register – and that he had not been overruled by the Information Commissioner. Labour did release a similar policy-specific risk assessment, into Heathrow's third runway, when it was in government, said Burnham.
Defending Lansley, Tory MP Mike Freer said: "The release of the risk register is seen as an opportunity by the opposition to cherry-pick doomsday scenarios the register may contain. It is simply a charter for shroud-waving."
Former shadow health secretary John Healey said: "These current plans are unprecedented in their nature, scale, pace and timing, and that means there is exceptional attention and exceptional concern about the risks associated with their implementation – and that's why there is an exceptional case for releasing this transitional risk register."
Former Labour health secretary Frank Dobson said: "I think the government will finally conclude it's foolish of them not to publish this register because everybody assumes they must have something to hide."
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Health- Risk to NHS vote Today
Updated: 22 Feb 2012
Today: NHS crunch vote
Wednesday, 22 February, 2012 10:56
From: "David Babbs - 38 Degrees" <action@38degrees.org.uk
Today's vote could be tight.
More and more government MPs are saying they may vote the right way.
Yesterday evening one Conservative MP admitted keeping the risk report secret looks "suspicious" and is a "toxic issue".
Meanwhile more than a dozen Lib Dem MPs have broken ranks and signed up in support.
We've got a few more hours until the vote. A surge of emails now could tip the balance.
Click here to send your MP an email now: https://secure.38degrees.org.uk/nhs-risk-report
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Dear Friend,
This Wednesday, there's a crunch NHS vote in Parliament.
MPs will vote on whether to demand the publication of a secret government report into the risks facing the NHS.
That could be another nail in the coffin of Andrew Lansley's plans - so let's pile the pressure on our MPs to vote the right way.
Right now, Andrew Lansley is in a tricky position to defend. He wants MPs and Lords to back his plans for the NHS.
But he's refusing to let them find out what the risks are. If we work together to put our MPs under pressure, there's a decent chance they'll refuse to do Lansley's dirty work for him.
This vote could go either way - send your MP an email asking them to back publishing the secret report - it takes two minutes:
https://secure.38degrees.org.uk/nhs-risk-report
The vote will take place on Wednesday afternoon.
That means we've got just over 48 hours to convince enough MPs to vote to publish the secret report.
The more of us that email our MPs right now, the more likely we are to succeed.
38 Degrees members, doctors, nurses and academics have all been warning for ages that Lansley's plans put our health service at risk.
We know there's a secret report that could prove that we're right - so let's work together to get this report published before it's too late.
Write to your MP and tell them to vote the right way at the risk report debate on Wednesday:
https://secure.38degrees.org.uk/nhs-risk-report
Thanks for being involved,
David, Johnny, Hannah, Marie, Cian, Becky and the 38 Degrees team
PS. Nearly 45,000 of us have now signed up to join The Big Switch, our attempt to drive down gas and electricity prices by bargaining with the power companies as a group.
That's got to be a record! If you haven't joined in yet, you can do so here: https://secure.38degrees.org.uk/the-big-switch
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Health - Lansley gets a mouthwashing
Updated: 22 Feb 2012
“I was trembling but I’d challenge Lansley again,”
says NHS protester June
by Tim Lezard - 21st February 2012, 13.31 GMT
Health Secretary Andrew Lansley is heckled by June Hautot as he arrives at a meeting on the future of the NHS.
Protesters gathered outside to protest what they called the 'Summit of the Uninvited'.
The woman who yesterday hit the headlines after confronting health secretary Andrew Lansley outside Downing Street has told UnionNews she would do the same to any politician who tries to destroy the NHS.
Former UNISON rep June Hautot attended a demonstration in Westminster to protest at the government’s refusal to invite her union and other health bodies to talks about the future of the NHS.
She said: “I was there because they weren’t allowing healthcare professionals into the meeting – they won’t even listen to us.
They just want to speak to their friends, people who are on their side, their businesspeople, that’s all.”
June says she was surprised to find herself face-to-face with Andrew Lansley.
“I didn’t even know he was coming, so it certainly wasn’t premeditated,” she says, “but when I saw him, I had to tell him to stop what he was doing.
“He had the audacity to tell me he’s not privatising the NHS, yet he’s only got to go back to his office and look at all the paperwork to find out he’s lying.
“The NHS is precious. If it’s taken away people will feel very unsafe.
We feel safe now because we know who’s accountable.
If it’s privatised, we lose that accountability.
“I want an NHS that treats everyone the same.
We shouldn’t have it divided into those who are rich and those who are poor.
By removing the cap on private beds, you’re going to have far more private patients coming through before the likes of me and you go through – we’ll be at the end of the queue.”
Responding to reports she was reduced to tears after the incident, she said: “Let’s just say I was trembling and I was annoyed because Lansley lied to me.”
She said she was surprised to find herself on the front page of newspapers and on the TV news, but feels her intervention was worth it – despite the tears – if the government changes its mind and drops the controversial Bill.
“If it helps highlight the issue to people who didn’t know about what was happening to our NHS – and it is ‘ours’ – then I’m pleased,” she said.
“I’d certainly challenge Lansley again if I saw him, the same as I’d challenge any politician, and there are many of them, who tries to destroy the NHS.” |
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Health- NHS BILL-Is privatisation by the back door
Updated: 21 Feb 2012
UNISON is calling for health workers to be represented at the NHS Summit for the Health and Social Care Bill, taking place tomorrow (20th Feb) at Downing Street.
The union, which represents 450,000 health workers, including nurses, midwives, healthcare assistants, hospital porters, cleaners, and caterers, has not been invited to the summit.
Other groups on the growing list of professional bodies and royal colleges that are calling for the bill to be dropped have also been excluded.
Sara Gorton, UNISON senior national officer for health, said: “Health workers should have their voices heard when major changes to the health service are being discussed.
Clearly, UNISON has not been invited because David Cameron and Andrew Lansley do not want to hear what we’ve got to say. But they need to face up to the truth that the bill is damaging for patients and for the NHS.
“Excluding our voices will not shut us up. UNISON will continue to call for this flawed and dangerous bill to be dropped, and for the government to come clean about the risks it poses to patients and to the cost of NHS care.”
UNSON’s key concerns about the Health and Social Care Bill include:
-It permits hospitals to raise huge extra amounts from private patients, meaning NHS patients may have to wait longer for treatment, endangering the principle that access is based on need rather than ability to pay.
-The bill brings wholesale competition into the NHS with the regulator able to enforce competition law in the style of the utilities regulators ñ standing in the way of integration and cooperation.
-It includes accompanying policies such as Any Qualified Provider, which will lead to a much greater role for private companies, despite scandals in other sectors demonstrating the folly of such an approach.
-It undermines the accountability of Parliament and the Health Secretary for the NHS, with implications for the maintenance of comprehensive, free and consistent NHS services.
-It will lead to at least 13,000 redundancies, with a colossal cost to the taxpayer and those who lose their jobs
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Health- NHS Bill -Talks Lock Out - Cameron- v's Health Professions heading for showdown
Updated: 21 Feb 2012
Lansley: Traitor
Monday 20 February 2012
by Will Stone, Health & Social Affairs Reporter
Angry protesters yelled "traitor" at Andrew Lansley as he scurried to No10 today to seek advice from pro-reform health organisations on how to enact his NHS Bill.
The Health Secretary's path to Downing Street was blocked by one elderly campaigner who shouted: "People are waiting for a bed and waiting times are going up - you can wait for a change."
But Mr Lansley could only bluster the tired mantra: "We will not privatise the NHS, it's not for sale" before saying nervously: "Excuse me, I'm going in there."
Other protesters at the Downing St gates chanted: "Kill the Bill, it will make you ill" and held placards that read: "Saving the NHS is a matter of life and death" with a picture of a tombstone enscribed with the words "NHS: 1948-2011."
Campaigners and politicians branded the meeting with those in favour of NHS reform a "PR disaster" and a case of "divide and rule," with those opposed to it such as the Royal College of GPs, the British Medical Association and Unison given the cold shoulder.
Easington Labour MP Grahame Morris said: "If Prime Minister David Cameron thought this meeting would be a PR coup he has made another terrible misjudgement.
"This meeting has turned into a summit of the uninvited with the major trade unions and royal colleges representing 90 per cent of NHS staff excluded.
"Lansley who was accosted in the street by a pensioner protesting at his NHS privatisation plans should cut his losses, drop the Bill and do the honourable thing and resign."
Labour leader Ed Miliband had earlier accused ministers of having a "bunker mentality" in a speech at Homerton Hospital in Hackney, London.
And author Marcus Chown, who joined the Downing St protest, said: "This Bill is a poison chalice for GPs.
"It's not going to empower them, it's going to ensure that they will be the ones to blame when things go wrong.
"The Bill is nothing more than hidden privatisation."
GP Dr Ron Singer added: "The PM has lied. He has ignored hard evidence and statistics and is determined to privatise the NHS."
Before the summit a Downing Street spokesman, who refused to reveal who had been invited, said: "There will be dialogue. The PM will be saying something, the people around the table will be saying something."
Speaking to the Morning Star outside Downing Street following the summit chief executive of the Foundation Trust Network Sue Slipman described "widespread concerns" over the reforms, particularly over the transitional period and making the government listen.
But the PM said he was "committed" to pushing through the reforms following the meeting.
willstone@peoples-press.com
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Health- Cameron-He couldn't see the wood for the trees & now he needs stitching up
Updated: 20 Feb 2012
A knife is driven deeper into the NHS
Despite the protests of a myriad professional medical associations, the Prime Minister refuses to abandon the ill-advised NHS reform Bill.
What do the British Medical Association,
the Royal College of General Practitioners,
the Royal College of Nursing,
the Royal College of Midwives,
the Royal College of Radiologists,
the Royal College of Pathologists,
the Royal College of Paediatrics,
the Chartered Society of Physiotherapists,
the Royal College of Psychiatrists,
the Institute of Healthcare Management, the Community Practitioners and Health Visitors Association, the Faculty of Public Health,
the British Psychological Society,
and the Allied Health Professions Federation (which represents a further 12 health professional organisations) have in common?
All of these professional bodies have come out opposing the NHS reform Bill.
Now, within a few days of a petition being set up, more than 100,000 members of the general public have signed it, calling for the Bill to be withdrawn.
Polls show that nearly two thirds of voters now don’t trust the Government with the NHS. Since I first sat at my desk on the day the Bill was released, back in January last year, and read with increasing horror and disbelief of the plans this Government had for the NHS, the chorus of disapproval has grown and grown.
The Government’s attempt at dismissing these concerns as groups protecting their members’ self interests is not only offensive to the professional bodies, but also does a grave disservice to the general public, who did not vote for these changes and are rightly worried about what the Bill will bring.
Now there is mounting concern from within the NHS itself, as well as from academics, about the impact of the Bill on our healthcare system.
It was reported last week that assessments conducted by the four English NHS regions have raised the question of a high potential for conflict between organisations under the proposed system.
There are also worries that there is a “high chance” that the reforms will fail to achieve management improvements and budget cuts.
But still the concerns are dismissed. It is clear that David Cameron is putting political pride before the welfare of the nation.
Despite staking his reputation – and that of the Tories – on defending the NHS, from a political perspective, I suspect he fears that he has now publicly committed himself to the Bill to the extent that to retreat would be a show of tremendous weakness.
It’s reminiscent of Macbeth’s utterance: “I am in blood stepp’d in so far that, should I wade no more, returning were as tedious as go o’er.” Instead of stopping the Bill, the Prime Minister stands by like an uxorious husband while Andrew Lansley frantically tries to scrub away the stain of public disapproval from his hands, insisting he is listening while carrying on with the proposals regardless.
The “pause” in the Bill’s progress last year was intended to appease those raising concerns.
But looking at what it actually achieved shows that it is little more than a precariously placed fig leaf designed to preserve the modesty of the more gross and gratuitous aspects of the Bill.
A closer inspection reveals that few of the fundamental tenets of the Bill have changed; Part Three, for example – which deals with the regulation of competition for NHS services – remains more or less intact, despite it being one of the critical elements that undermines the NHS.
Writing in The Lancet last week, Professor Allyson Pollock, professor of public health at Barts and The London School of Medicine and Dentistry, along with another academic and two leading lawyers who have scrutinised this and other aspects of the Bill, concluded that, under the proposals as they currently stand, patients will end up paying for treatments at present provided by the NHS.
They argue that at the heart of the Bill is a desire to “introduce a mixed financing system and to abolish the model of tax-financed universal health care on which the NHS is based”.
It is perfectly possible, of course, to continue with reforming the structure of NHS management without undermining its founding principles, but the bill is as much driven by ideology as it is by necessity.
It is this belief that the NHS must be dismantled and the parts sold for scrap to the private sector that explains the intransigent, belligerent insistence that the Bill is pushed through.
As the chorus of horrified voices calling for the Bill to be dropped reaches a crescendo, can the Government really keep telling us they’re listening while driving the knife deeper and deeper into the heart of the NHS?
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All aboard the drunk bus – let’s look at why we need it
Official figures show that treating alcohol abuse costs the NHS about £2.7 billion a year. That is equivalent to £90 for every taxpayer. One only has to stand in A&E on a Friday or Saturday evening to see the extent of the problem and the drain it places on resources.
Indeed, £1billion a year is spent just on ambulances and A&E services to look after drunks. And that’s before we even consider the cost to society as a whole through crime and lost work – estimated to be between £17billion and £22billion a year.
It’s heartening to hear that the Government is taking this seriously and is considering proposals to set a minimum price on alcohol.
Research has shown that a minimum price of 50p per unit would prevent 2,000 deaths a year. I also welcome the suggestion for “drunk buses” in town centres – mobile units that treat intoxicated people instead of them having to go to A&E departments.
But I also think it’s important that we look at the underlying reasons why binge drinking is considered acceptable, even a badge of honour among some. Until we do this, there is little hope of any fundamental, meaningful change.
For many youngsters in towns up and down the country, getting blind drunk on a weekend has become a way of life. They see nothing wrong with it.
Certainly, stiff penalties for those found drunk and causing a nuisance are likely to be sobering for them.
But it’s also important to invest in community projects and enterprises that provide alternatives to drinking. A little bit of money spent on those things might save a lot in the long run.
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Scandal of 40 peers who will benefit from reforms
Those hoping for a fair and objective evaluation of the NHS reform Bill from peers as it is debated in the House of Lords might be disappointed.
It emerged last week that more than 40 peers from across the political spectrum have a financial interest in privatising the NHS. Posts that include acting as advisors and consultants to private healthcare firms and PR and lobbying organisations come with impressive remuneration packages. Yep, we’re all in this together, right?
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Health- Weasel Words with Senior Scabs at No 10 = So its OUR NHS V's Cameron
Updated: 20 Feb 2012
The Health Bill plan B is dead, but plan C lives on
16 February, 2012 | By Alastair McLellan
Health Service Journal
David Cameron has made passing the Health Bill a matter of confidence – making it close to impossible the legislation will fail.
We now need to ask what kind of bill will be passed and what will happen afterwards.
Once again the prime minister felt the need to put his reputation on the line over the reforms because parliamentary opinion was in danger of swinging against his health secretary.
Part of that change in opinion came with the realisation there was a Plan B for NHS reform which could achieve much of its original intention without much of the current cost and disruption.
The Department of Health denies outright that there is a Plan B. But HSJ understands senior civil servants have informally discussed what would happen if the Health Bill was pulled.
Broadly, the solution would see the NHS Commissioning Board remain a special health authority and, as planned, take responsibility for commissioning development and oversight, and resource allocation.
Primary care trust clusters would be maintained. Clinical commissioning groups would continue to go through the authorisation process and would operate as cluster subcommittees.
However, HSJ understands most of these civil servants now believe, with so much water under the bridge, that just getting on with the structural reforms as is would be the best outcome.
However, they have also discussed a Plan C which would see the bill passed, but with section 3 – which deals with the regulation of competition for NHS services – dropped or amended, perhaps severely.
Andrew Lansley makes it clear in his article for HSJ this week that he believes competition has a “critical” role in delivering better NHS services.
However, despite this defiance, there is widespread cross-party belief that concessions are on their way.
The issue is fiercely complicated, but three broad scenarios are possible.
The most likely is that amendments counterbalance requirements to compete with those to cooperate, weaken the impact of competition law, and prevent foundation trusts being abandoned to the market by maintaining Monitor’s existing regulatory role.
Next in likelihood is some attempt to push the introduction of the new regulatory regime further into the future.
The least likely outcome is the complete abandonment of the proposals – something which would force Mr Lansley’s resignation.
Almost exactly a year ago HSJ declared competition should not be the first choice for NHS services, as “it too often has unfortunate consequences and costs”, but that it “may sometimes be the best option”.
We hope that peers – and just as importantly those same senior civil servants who are responsible for drafting the secondary legislation and guidance which will provide the substance of the new policy – will deliver something proportionate and workable. Certainly a longer timescale would help in that regard.
But those who take a harder line on increasing competition and a resulting larger role for the private sector – most notably the British Medical Association, but also the Royal College of GPs – may have some hard thinking to do.
If the bill is passed with the competition provisions more or less intact, what guidance will they give members?
Readers can judge for themselves the impact of a statement from the BMA or RCGP declaring members should not be involved in decisions giving private providers a greater role in determining or delivering NHS services.
But if that was deemed possible and desirable it might mean walking away from clinical commissioning, or at least fighting a guerilla war against the policy.
The passing of the Health Bill is only likely to mark the end of the beginning of the war these reforms have ignited within the service
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Health - NHS Crunch Vote
Updated: 20 Feb 2012
48 hours to go: NHS crunch vote
Monday, 20 February, 2012 11:01
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Dear Friend
This Wednesday, there's a crunch NHS vote in Parliament.
MPs will vote on whether to demand the publication of a secret government report into the risks facing the NHS.
That could be another nail in the coffin of Andrew Lansley's plans - so let's pile the pressure on our MPs to vote the right way.
Right now, Andrew Lansley is in a tricky position to defend. He wants MPs and Lords to back his plans for the NHS.
But he's refusing to let them find out what the risks are.
If we work together to put our MPs under pressure, there's a decent chance they'll refuse to do Lansley's dirty work for him.
This vote could go either way - send your MP an email asking them to back publishing the secret report - it takes two minutes:
https://secure.38degrees.org.uk/nhs-risk-report
The vote will take place on Wednesday afternoon.
That means we've got just over 48 hours to convince enough MPs to vote to publish the secret report.
The more of us that email our MPs right now, the more likely we are to succeed.
38 Degrees members, doctors, nurses and academics have all been warning for ages that Lansley's plans put our health service at risk.
We know there's a secret report that could prove that we're right - so let's work together to get this report published before it's too late.
Write to your MP and tell them to vote the right way at the risk report debate on Wednesday:
https://secure.38degrees.org.uk/nhs-risk-report
Thanks for being involved,
David, Johnny, Hannah, Marie, Cian, Becky and the 38 Degrees team
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Health -The Health Bill - One for Cameron today - Political Satire
Updated: 20 Feb 2012
Why do people with closed minds always open their mouths? |
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Health-Cameron Cronies- Lansley predicted to "be put down" for the Dog Kennel in next reshuffle ?
Updated: 20 Feb 2012
Lansley gets six-month stay of execution
but 'will lose his Health job in reshuffle'
By Glen Owen
Last updated at 4:08 AM on 19th February 2012
Beleaguered Andrew Lansley has been given a six-month ‘stay of execution’ in the Cabinet but could lose his job in the autumn, according to well-placed sources.
The Tory Health Secretary, who has faced mounting pressure over his controversial plans to shake up the NHS, is being tipped to lose his Cabinet chair to Culture Secretary Jeremy Hunt – but only if Mr Hunt delivers a successful Olympics this summer.
Mr Lansley has been fighting for his political life since an anonymous Downing Street source was quoted earlier this month saying that he should be ‘taken out and shot’ for the way he has presented the NHS reforms.
Embattled: Prime Minister David Cameron, left, was 'absolutely determined' reforms championed by Health Secretary Andrew Lansley, right, should go ahead
Mr Lansley has endured a torrid time over his Health and Social Care Bill, with critics claiming that the plans to allow GPs to commission health services would lead to a surge in costs and put NHS patients at the ‘back of the queue’ behind private patients.
At least three Tory Cabinet Ministers have privately called for the reforms to be scrapped, but David Cameron has declared that he is ‘absolutely determined’ not to do a U-turn on a shake-up he has ‘shed blood’ over.
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Mr Hunt, who has been tipped as a future Conservative Party leader, would be regarded as a ‘fresh face’ who could push through the reforms.
The Olympics, which have dominated Mr Hunt’s brief, finish in August, clearing the way for a mid-September reshuffle.
Mr Cameron, who is described as feeling ‘sentimental’ about Mr Lansley and reluctant to bow to pressure from his critics, is said to be likely to offer him a ‘swap’ with the Culture job.
Under pressure: Friends of Mr Lansley say he could quit cabinet amid growing criticism of his leadership stewardship of the health reforms
But friends of Mr Lansley suggest he would walk out of the Cabinet rather than accept the demotion.
It comes as Mr Cameron prepares to hold a Downing Street summit tomorrow with health professionals to discuss the changes.
Some of the fiercest critics of the planned reforms, including the British Medical Association and the Royal College of Nursing, complained that they had not been invited.
Labour accused the Prime Minister of a ‘last-ditch desperate bid to shore up collapsing support’ for the Bill.
Advisers also predict that Education Secretary Michael Gove will regain control over universities as part of the Cabinet changes.
David Willetts, the Universities Minister, operates out of the Business Department, run by Liberal Democrat Vince Cable.
Mr Willetts and Mr Cable have caused anger in the Education Department by approving the appointment of Professor Les Ebdon as a universities ‘access tsar’ who wants to impose ‘nuclear’ penalties for vice-chancellors who fail to meet targets on admitting working-class students.
A reshuffle would give Mr Cameron the chance to promote up-and-coming women MPs, such as Broxtowe MP Anna Soubry, who is tipped to be catapulted from her position as junior bag-carrier at the Health Department straight into the Cabinet.
'Damage continuity': David Cameron, centre, is said not to like reshuffles but might have to carry out substantially restructure the cabinet later this year
Mr Cameron and Deputy Prime Minister Nick Clegg would also welcome the chance to bring back David Laws, who was Chief Secretary to the Treasury for the first 17 days of the Coalition Government until he was forced to resign over his expenses.
Aides say that other plans being considered for the reshuffle, which would be Mr Cameron’s first major change to his team since winning power in May 2010, include turning the Scottish Office into a Department of the Nations, which would incorporate the jobs of Welsh Secretary and Ulster Secretary.
If agreed, the new department would play a central role in Mr Cameron’s battle to keep Scotland in the Union in the face of SNP leader Alex Salmond’s calls for independence.
Under one idea being canvassed, one of the Cabinet positions freed up by the merged department could be used to reinstate the post of Employment Secretary – abolished in 1995 – with particular responsibility for tackling youth unemployment.
Currently, the problem falls within the wide remit of Work and Pensions Secretary Iain Duncan Smith.
A source said: ‘The PM is not in favour of frequent reshuffles because he feels the example of Tony Blair’s Government shows how it damages continuity.
‘So far he has only made changes in extremis, following resignations. But it is generally accepted that a more substantial restructuring will be needed later this year.
'And I’m afraid poor old Lansley is likely to be one of those restructured
Read more: http://www.dailymail.co.uk/news/article-2103222/Lansley-sets-month-stay-execution-lose-Health-job-reshuffle.html#ixzz1moHIIkPi |
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Health - Two out of three don't trust Cameron over the NHS Reforms
Updated: 20 Feb 2012
Cameron not trusted over NHS
Matt Chorley
Sunday 19 February 2012
BMA expresses concerns over roll out of NHS helpline
Paediatricians condemn health bill
Just one in three voters believe David Cameron is a sincere supporter of the principles of the NHS, a devastating new poll reveals, as the row over the Government's health reforms shows no sign of abating.
Tomorrow, the Prime Minister will host a Downing Street summit on the Health and Social Care Bill, which critics say places too much emphasis on competition and is a distraction from the need to save £20bn by 2015.
But some bodies critical of the Bill, such as the Royal College of General Practitioners, haven't been invited. Ed Miliband, the Labour leader, said: "You don't get progress on the NHS by shutting the door of No 10 on doctors, nurses and patients' groups."
In the ComRes/IoS poll, 27 per cent of people said private firms should have more involvement in the delivery of NHS services; 36 per cent said the NHS would be safer under Labour. |
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Health-"Heads of the Five families"on Cameron list of invites to No 10 today named & shamed
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Health - Drink Black Tea to counter Cardiovascular disease
Updated: 20 Feb 2012
Three cups of tea a day ‘protects against heart problems and diabetes’
By Jenny Hope
Last updated at 11:04 PM on 17th February 2012
Drinking just three cups of tea a day may protect against heart attacks and type 2 diabetes, claim researchers.
A review shows regular drinking of black tea, with or without milk, can reduce the risk of heart problems by cutting levels of bad cholesterol and blood sugar.
Experts say the benefits of tea are largely due to the flavonoid content – antioxidant ingredients that counteract cardiovascular disease.
Benefits: Researchers claim that drinking just three cups of tea a day may protect against heart attacks and type 2 diabetes
One cup of tea provides 150-200mg of flavonoids and it is the best source of antioxidants in the nation’s diet. In terms of the delivery of antioxidants, two cups of tea is equivalent to five portions of vegetables.
A review in the journal Nutrition Bulletin found drinking three or more cups of black tea a day protects against heart disease and two or more cups a day may protect against type 2 diabetes.
In addition, a 12-week study in 87 volunteers found that drinking three cups of tea a day produced a significant improvement in various cardiovascular risk factors.
Almost 80 per cent of Britons are tea drinkers and 165million cups are drunk every day.
Overall, flavonoids found in tea are thought to control inflammation, reduce excess blood clotting, promote blood vessel function and limit furring up of the arteries.
Great news: In terms of the delivery of antioxidants, two cups of tea is said to be the equivalent to five portions of vegetables
Nutritionist Dr Carrie Ruxton, co-author of the latest review and a member of the industry-backed Tea Advisory Panel (TAP), said: 'There is far more to the nation's favourite drink than we realise.
'With its antioxidant flavonoids, black tea packs a powerful punch with many health benefits particularly for the heart. And recent studies show that the flavonoids work their magic whether or not we choose to add milk.'
Dr Tim Bond also from TAP, added: 'Black tea flavonoids are thought to be the compounds responsible for the protective effects of black tea on health.
'Chronic conditions such as heart disease, stroke and diabetes are associated with inflammatory processes and the presence of excessive pro-oxidant free radicals in the body.
'The proven antioxidant and anti-inflammatory effects of black tea flavonoids may therefore be responsible for the positive health effects of black tea.'
Read more: http://www.dailymail.co.uk/health/article-2102876/Three-cups-tea-day-protects-heart-problems-diabetes.html#ixzz1mtL7LgK9
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Health -Cameron - Talks breakdown with Health Professions opposed to NHS Reforms
Updated: 20 Feb 2012
Cameron's 'Cold Shoulder' To Health Leaders
By Jane Dougall, Sky News reporter | Sky News – 3 hours ago
David Cameron has been accused of shutting healthcare professionals out of talks on the coalition's controversial NHS reforms.
It has emerged that major bodies critical of the proposals have not been invited to a Downing Street meeting to take place on Monday.
The British Medical Association (BMA), The Royal College of GPs (RCGP) and The Royal College of Nursing (RCN) have all called for the Health and Social Care bill to be scrapped, but none of those organisations will attend.
The Bill has been so badly received that Monday's meeting is being described as an emergency summit.
The BMA said it was "odd that major bodies representing health professionals weren't included".
As the Health Care Bill plans to give GPs control over £80bn of NHS budgets, the RCGP said it was "surprised" not to have been invited.
Despite having the single biggest workforce in the NHS, the RCN has also been excluded.
Its chief executive, Dr Peter Carter, told Sky News: "We don't know why we haven't been invited but we, like others, find it extraordinary because at the end of the day, it's nurses, doctors, physios, GPs that actually keep the health service going.
"So whoever advised the Prime Minister that by excluding these groups would be the way forward, I would say they've given him poor advice.... Anyone who's opposed the bill seems to have been excluded and we would say that's not a very sensible way to move forward."
Mr Cameron has called the meeting to discuss the implementation of the Health and Social Care Bill, which has yet to reach the statute book.
Downing Street would not disclose who had been invited to attend the meeting, saying only that it was a "range of national healthcare organisations and clinical commissioning groups".
A spokeswoman said it was being held "to discuss implementation of the health reforms with representatives from a range of national healthcare organisations and clinical commissioning groups.
"This forms part of the Government's on-going dialogue with health practitioners about the implementation of these reforms."
Mr Cameron reaffirmed his support for the reforms last weekend after reports that three Tory Cabinet ministers were against the Bill and influential website Conservative Home urged him to drop it.
The Prime Minister insisted he was "at one" with his beleaguered Health Secretary Andrew Lansley .
More than 142,000 people, including footballer Rio Ferdinand and TV star and author Stephen Fry, have signed an e-petition calling for the Bill to be dropped |
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Health - 150 Paediatricians call on Cameron to scrap the Health Bill
Updated: 18 Feb 2012
Kids' doctors say No
Friday 17 February 2012
Over 150 paediatricians are calling on the government to scrap its controversial Health Bill, saying it will have an "extremely damaging effect" on the health of children.
In a damning letter to The Lancet medical journal, members of Britain's Royal College of Paediatrics and Child Health said there was "no prospect" of improving the Health and Social Care Bill, currently going through Parliament.
And they accused the government of "misrepresenting" the Bill as being something that was necessary for the NHS.
The signatories join several Royal Medical Colleges, including those for GPs, Radiologists, Midwives and Nurses in calling for the Bill to be scrapped.
And health unions are also calling for the changes to be stopped.
The move will pile more pressure on the government over the reforms.
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Health- Electromypgraphy - The Pain Machine
Updated: 18 Feb 2012
Electromyography
In addition to nerve conduction studies|, the doctor might also perform another test which records the electrical activity of the muscles.
Electromyography (EMG) involves inserting a small needle into the muscle, to view and listen to the electrical activity generated within the muscle.
The patient may be asked to move in a certain way in order to contract the test muscle.
The size of the needle means that it should not be too uncomfortable.
As with all needs, patients may experience some minor bruising o fthe muscles and it may feel sore for a short time after the test.
The activity recorded can provide information not only about the muscle but also about the nerve that supplies it and the neuromuscular junction between the two.
Depending upon the patient's symptoms and upon clinical examination by the doctor, EMG may be used to test only one, a few, or sometimes several muscles.
Patients taking warfarin or who have or might have a problem with bleeding or clotting should inform the clinical neurophysiology department, as there is a risk that the needle might cause problematic bleeding into the muscle in such circumstances.
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Health- A Pain Scale- Can you stand on one leg and shout yahoo ?
Updated: 18 Feb 2012
Pain scale
From Wikipedia, the free encyclopedia
A pain scale measures a patient's pain intensity or other features.
Pain scales are based on self-report, observational (behavioral), or physiological data.
Self-report is considered primary and should be obtained if possible.
Pain scales are available for neonates, infants, children, adolescents, adults, seniors, and persons whose communication is impaired. Pain scores are sometimes regarded as "the Fifth Vital Sign."
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Health- QUACK QUACK ? "I've got a pain"-Dr replies-"Two Paracetamol-I have nothing to measure it by"
Updated: 18 Feb 2012
Measuring pain
Karoly (1985) - we should focus on all of the factors that contribute to pain
- 1. Sensory - intensity, duration, threshold, tolerance, location, etc
- 2. Neurophysiological - brainwave activity, heart rate, etc
- 3. Emotional and motivational - anxiety, anger, depression, resentment, etc
- 4. Behavioural - avoidance of exercise, pain complaints, etc
- 5. Impact on lifestyle - marital distress, changes in sexual behaviour
- 6. Information processing - problem solving skills, coping styles, health beliefs
Site of pain: where is the pain?
• Type of pain: what does the pain feel like?
• Frequency of pain: how often does the pain occur?
• Aggravating or relieving factors: what makes the pain better or worse?
• Disability: how does the pain affect the patient’s everyday life?
• Duration of pain: how long has the pain been present?
• Response to current and previous treatments: how effective have drugs and other treatments been?
An important item to add to this list is the emotional and cognitive effect of the pain—in other words, how does the pain make patients feel and how does it affect their thought processes and attitudes?
Physiological measures of pain
Muscle tension is associated with painful conditions such as headaches and lower backache, and it can be measured using an electromyograph (EMG).
This apparatus measures electrical activity in the muscles, which is a sign of how tense they are.
Some link has been established between headaches and EMG patterns, but EMG recordings do not generally correlate with pain perception (Chapman et al 1985) and EMG measurements have not been shown to be a useful way of measuring pain.
Another approach has been to relate pain to autonomic arousal.
By taking measures of pulse rate, skin conductance and skin temperature, it may be possible to measure the physiological arousal caused by experiencing pain.
Finally, since pain is perceived within the brain, it may he possible to measure brain activity, using an electroencephalograph (EEG), in order to determine the extent to which an individual is experiencing pain.
It has been shown that subjective reports of pain do correlate with electrical changes that show up as peaks in EEG recordings. Moreover, when analgesics are given, both pain report and waveform amplitude on the EEG are decreased (Chapman et al, 1985).
Observations of pain behaviours
People tend to behave in certain ways when they are in pain; observing such behaviour could provide a means of assessing pain.
Turk, Wack and Kerns (1985) have provided a classification of observable pain behaviours.
• Facial /audible expression of distress: grimacing and teeth clenching; moaning and sighing.
• Distorted ambulation or posture: limping or walking with a stoop; moving slowly or carefully to protect an injury; supporting, rubbing or holding a painful spot; frequently shifting position.
• Negative affect: feeling irritable; asking for help in walking, or to be excused from activities; asking questions like ‘Why did this happen to me?’
• Avoidance of activity: lying down frequently; avoiding physical activity; using a prosthetic device.
One way to assess pain behaviours is to observe them in a clinical setting (although pain is also assessed in a natural setting as the patient goes about his or her everyday activities). Keefe and Williams (1992) have identified five elements that need to be considered when preparing to assess any form of behaviour through this type of observation.
• A rationale for observation: it is important for clinicians to know why they are observing pain behaviours. One reason is to identify ‘problem’ behaviours that the patient may be reluctant to report, such as pain when swallowing, so that treatment can be given. Another is to monitor the progress of a course of treatment.
• A method for sampling pain behaviour techniques for sampling and recording behaviour include continuous observation, measuring duration (how long the patient takes to complete a task), frequency counts (the number of times a target behaviour occurs) and time sampling (for example, observing the patient for five minutes every hour).
• Definitions of the behaviour: observers need to be completely clear as to what behaviours they are looking for.
• Observer training: in most clinical situations, there will be different observers at different times and it is important that they are consistent.
• Reliability and validity: the most useful measure of consistency in observation methods is inter-rater reliability, but test-retest reliability can also be useful.
Three types of validity that could be assessed are: concurrent validity (are the results of the observation consistent with another measure of the same behaviour?), construct validity (are the behaviours being recorded really signs of pain?) and discriminant validity (do the observation records discriminate between patients with and without pain?). |
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Health- Read some advice with a pinch of salt
Updated: 17 Feb 2012
Why full disclosure is healthy
14 February 2012 by James Davies
New Scientist
Do British people know enough about the financial interests of those writing health articles?
Time to toughen editorial codes
LAST year, the BBC News website published an article that questioned if psychological therapies were enough to tackle the rise of depression in the UK.
"Is it time," asked the author, "to question our seeming obsession with talking treatments?
I want to stand up for the very important role medication can play in the treatment of mental illness."
What stood out for me was not just the pro-pill stance, but an endnote that its author, Richard Gray, a professor in nursing research at the University of East Anglia, Norwich, had "given lectures on behalf of a number of pharmaceutical companies".
It did not state he had been paid for them, or that he had received fees and honoraria from antidepressant manufacturers, including AstraZeneca and Eli Lilly, for consultancy work.
This kind of omission happens all the time, so why single out this case?
Primarily because the site is run by the BBC, a global media corporation.
And the thousands reading the article could not judge its impartiality because they did not know about the payments.
After trying to get a comment for some time, the BBC agreed to amend the endnote.
But at medical journals such as The Lancet failure to disclose payments would have breached editorial codes. In the UK, we rely on codes, in the US, media outlets are legally obliged to declare potential vested interests.
Sophie Corlett of Mind, a UK mental health charity, thinks we should take this seriously.
"People experiencing mental health problems look to professionals... for many, this includes information that filters through the media.
The responsibility to inform readers of issues which may affect the impartiality of a published piece lies with... news outlets and contributing authors.
Mind has long campaigned for medical information to be conveyed in an open and balanced manner... we encourage... disclosure of interests."
This is happening at a time when concern is mounting over industry influence on psychiatric research and practice, and on public opinion.
Trials of antidepressants are mostly funded, and often analysed and directed, by pharmaceutical companies. Some 60 per cent of the task force behind DSM-IV (the psychiatrists' diagnostics handbook) received money from pharma, as have most research centres and many heads of psychiatry schools.
Of the 29 experts writing DSM-5, 21 received honoraria, consultancy fees or funding from pharma.
The BBC defends its coverage: "It's common for the BBC to speak to people with expertise in a particular subject.
We do so under clear editorial guidelines that contributors associated with a particular viewpoint or with a commercial interest in a subject should be clearly signposted... Nothing has been put to us which suggests that there has been any conflict of interest."
So the BBC aims to ensure articles are signposted. In this case one slipped through the net and was duly amended. But it must be more alert to contentious topics and conflicts of interest.
Perhaps its code needs tightening - or we should consider a law.
James Davies is a senior lecturer in social anthropology and psychotherapy at the University of Roehampton, London
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Health - Kill the Bill Petition reaches 121,000 -triggers Parliamentary debate
Updated: 16 Feb 2012
121,000 sign petition to kill Lansley's Bill
Wednesday 15 February 2012
Over 121,000 people have signed an online petition urging the government to abandon the Health and Social Care Bill.
In the latest sign of public opposition to Health Secretary Andrew Lansley's beleaguered NHS reforms the e-petition has been attracting signatures at a rate of more than 1,000 an hour.
By 10.30pm on Tuesday night it had reached the 100,000 signatures to trigger parliamentary attention and was continuing to grow. It will now be considered for debate in the Commons by the Backbench Business Committee.
The petition was tabled by GP Kailash Chand.
Despite anger from health professionals and patient groups alongside private criticism of the Bill by Tory Cabinet ministers Prime Minister David Cameron is pressing ahead with the legislation.
But shadow health secretary Andy Burnham said the petition's signatories had "sent a very clear message" that the government should scrap the Bill.
"They want him to listen and stop putting his political pride before the best interests of the NHS," he said.
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Health- Neck and Head Pain
Updated: 15 Feb 2012
Health Tip:
Got a Pain in the Neck?
(HealthDay News) -- The neck has an unusually important job -- supporting the weight of your head! When there's pain in the neck, it can stem from a soft tissue injury, or an abnormality in the joints and bones at the top of the spine.
The American Academy of Orthopaedic Surgeons mentions these possible causes of neck pain:
A problem, such as rheumatoid arthritis, caused by inflamed joints.
Injuries due to prolonged wear and tear.
Cervical disk degeneration (spondylosis), in which the padding inside the disks of the neck deteriorates.
An injury to the neck, stemming from factors such as an automobile accident, a fall or sports injury.
Rare tumors, infections or congenital defects of the vertebrae.
Headache
Questions to Ask Your Doctor About Headaches
Medical Author: Dennis Lee, MD
Medical Editor: Melissa Conrad Stöppler, MD
Headache is defined as pain in the head that is located above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headache, like chest pain or dizziness, has many causes.
There are two types of headaches: primary headaches and secondary headaches.
Primary headaches are not associated with (caused by) other diseases.
Examples of primary headaches are migraine headaches, tension headaches, and cluster headaches.
Secondary headaches are caused by associated diseases such as brain tumors, strokes, meningitis, subarachnoid hemorrhages, caffeine withdrawal, or discontinuation of analgesics. In rare occasions, headaches may signal heart attacks.
Establishing the diagnosis of the headache, arriving at effective treatment(s) for the headache, and taking measures to prevent or reduce headache episodes will require cooperation between you and your doctor.
Following are suggestions on how to work with your doctor in diagnosing and managing your headaches.
How Can I Help My Doctor?
Pay attention to your symptom(s) so you can describe your condition as accurately as possible:
- What are your headache location, duration, severity (worst ever headache?), and character (dull, sharp, throbbing, etc.)?
- What brings them on (for example, certain foods, stress, bright light, fasting, or sleep disturbances)?
Read more questions to ask your doctor about headaches »
Top Headaches Searched Terms
symptoms, neck pain, migraine, cluster, sinus, treatment, predinsone, types, anxiety
What is a headache?
A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.
How are headaches classified?
Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated classification system for headache.
Because so many people suffer from headaches and because treatment sometimes is difficult, it is hoped that the new classification system will allow health care practitioners come to a specific diagnosis as to the type of headache and to provide better and more effective treatment.
There are three major categories of headaches:
- primary headaches,
- secondary headaches, and
- cranial neuralgias, facial pain, and other headaches
What are primary headaches?
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.
Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches.
Tension headaches occur more commonly among women than men.
Migraine headaches are the second most common type of primary headache.
An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache.
Migraine headaches affect children as well as adults.
Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime.
Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer these types of headache.
Primary headaches can affect the quality of life.
Some people have occasional headaches that resolve quickly while others are debilitated.
While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes or intracerebral bleeding.
What are secondary headaches?
Secondary headaches are those that are due to an underlying structural problem in the head or neck.
There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis. |
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Health- Muscle relaxants as pain killers
Updated: 15 Feb 2012
Muscle Relaxants
By: Peter F. Ullrich, Jr., MD
Muscle relaxants are not really a class of drugs, but rather a group of different drugs that each has an overall sedative effect on the body.
These drugs do not act directly on the muscles; rather they act centrally (in the brain) and are more of a total body relaxant.
Typically, muscle relaxants are prescribed early in a course of back pain, on a short-term basis, to relieve low back pain associated with muscle spasms.
There are several types of muscle relaxant medications that are commonly used to treat low back pain.
Muscle Relaxant Medications List
· Carisoprodol (Soma). This drug’s dosage is 350mg every eight hours as needed for muscle spasm. Soma is typically prescribed on a short-term basis and may be habit-forming, especially if used in conjunction with alcohol or other drugs that have a sedative effect.
· Cyclobenzaprine (Flexeril). This medication can be used on a longer-term basis and actually has a chemical structure related to some antidepressant medications, although it is not an antidepressant. Usually it is prescribed as 10mg every six hours as needed to relieve low back pain associated with muscle spasm, or it can also be prescribed as 10mg at night as needed to help with difficulty sleeping. Flexeril can impair mental and physical function, and may lead to urinary retention in males with large prostates.
· Diazepam (Valium). Valium is usually limited to one to two weeks of use, and the typical dosage is 5-10mg every six hours as needed to relieve low back pain associated with muscle spasm. Because of its habit-forming potential, and because it changes sleep cycles and makes it very difficult to sleep after stopping the drug, Valium should not be used long term. Patients should also note that Valium is a depressant and can worsen depression associated with chronic pain. |
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Health- From Mild to Moderate to Severe Pain relief turn to the Opiates.
Updated: 15 Feb 2012
About Opiates
Opium poppies had been seen on drawings and coins predating mentions in greek literature by over 1000 years.
In Greek poppies were called Opion which came from the word for 'juice'.
When translated into latin this became Opium.During the Renaissance, Paracelsus thought that no matter what the disease, sleep and pain relief was part of the cure.
He used several different preparations of opium one you may have heard of which was a victorian favourite and available from most corner shops was Laudanum, from the latin 'something to be praised'.
Moving on a bit, Sigmund Freud treated his Opium addicts with cocaine.
This proved disatrous as cocaine is too short acting, but this gave other medical uses such as lignocaine and other local anaesthetics.
Us good old brits were also happy pushing Opium on China and after them grumbling about us flogging this stuff, we had a little war, funnily enough called the 'Opium wars', We did manage to win this and go on trading the stuff and took Hong kong on a 100 year lease as it was a vital trading port.
Custom figures from 1881 showed that 6million kg of opium was imported into China per year.
A scottish doctor Alexander Wood experimented with injecting opium and his wife who he used to experiment on was maybe the first woman to die of an injected opiate overdose.
Bayer, the german company who also were famous for aspirin patented heroin which they began to sell in 1898 as a cure for coughs and TB
MILD TO MODERATE PAIN RELIEF
CODEINE is a Mild Opiate, taken in different strengths 8mg – 30mg
The following are combinations of Aspirin and codeine or Paracetamol and codeine.
Dihydrocodeine is 30 mgs of codeine
The next opiate given in hospital for very severe pain would be morphine then diamorphine, heroin, usually given by injection.
Over The Counter products containing Codeine include:- Co-Codamol, Solpadeine, Syndol, Solpadol, Solpaflex, Codis, Paracodol, Propain Plus, Panadol Ultra, Feminax, Cuprofen Plus and Nurofen Plus.
Dihydrocodine is found in the OTC product Paramol. |
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Health-Pain Management
Updated: 15 Feb 2012
Patients frequently come to the pain clinic on medications
which are either simply not working on their pain
or are giving them inadequate pain relief.
www.painmanagement.org.uk
There may be many reasons for this and the simplest one and probably most common one is non-compliance; that is they are not taking the drugs regularly as prescribed.
If the body has a constant, adequate level of a drug then it fights pain much more effectively.
Another reason for a painkiller not working is because it is not the right painkiller for the job.
Pain may be felt coming from the tissues and organs e.g. muscles, bones and liver and this is nociceptive pain which responds well to classic painkillers such as aspirin, paracetamol, codeine and morphine.
Pain may be felt from nerves and this is called neuropathic pain and is frequently poorly responsive to aspirin, paracetamol, codeine and morphine.
The pain clinic often therefore will prescribe painkillers because it is felt that the pain described is neuropathic in nature.
These painkillers are usually used for other purposes such as treating epilepsy or depression. In common with their normal modes of treatment, they stop nerve cells firing spontaneously and this is basically what is happening in neuropathic pain.
The symptoms of neuropathic pain are quite distinct and include such descriptive words as burning, shooting, sensitive, cramping, itchy, lancinating.
Drugs for neuropathic pain include the antiepileptics such Gabapentin and Tegretol (Carbamezepine) and the Antidepressants such as Amitriptyline and Dothiepin.
The greatest problem with using these medications is that they give patients unpleasant side-effects much more frequently than aspirin, paracetamol etc.
To this end Gabapentin is the only one which is licensed for all neuropathic pains and is the one which is most agreeable with patients as its side-effects are the ones most tolerated by the majority.
Exact doses and information on side-effects can be given in the clinic but the most effective dose appears to be at least 600mgs. three time a day and common side-effects include tummy upset, headaches, sleepiness and rashes.
Drugs for nociceptive pain are those most commonly thought of as painkillers, that is paracetamol, aspirin etc.
There are the weaker painkillers as already mentioned and the stronger pain killers such as morphine, oxycodone and palladone.
Massive controversy exists over their use in patients without cancer as they are widely thought of as having a great potential for addiction and abuse.
Slowly but surely the medical world is coming round to seeing that where a patient has pain
which is not due to cancer and where the weaker drugs are ineffective,
then there is very little addiction and abuse potential
if the drugs are being used as painkillers alone.
The greatest risk with long term use is of the body getting used to a particular dose with a worstening of pain and a need therefore to increase the dose.
This whole area is extremely complex and needs a great deal of trusts between clinician and patient.
Another, less controversial area where there has been recent advances in painkiller therapy is the advent of safer aspirin-like drugs. Aspirin, Ibuprofen, Voltarol, Mefanamic Acid, Ketoprofen etc. are known as the non-steroidal anti-inflammatory drugs (NSAIDS).
They are very useful in nociceptive pain but can cause severe side-effects such as gastric ulcers and kidney damage.
Unfortunately the newer drugs in this area (the cox2 antagonists) Celecoxib, Rofecoxib and Parecoxib/Valdecoxib have now been found to have a statistically significant incidence of causing cardiovascular problems in at risk groups.
Parecoxib and Valdecoxib can cause unpleasant rashes.
Rofecoxib has been taken off the market and caution is urged in the use of all of these drugs.
Glucosamine is a medication that can be bought over the counter.
It appears that research has shown it to be effective in reduces the pain of knee arthritis alone in a dose of 1500mgs per day.
Drugs may also be effective when applied as creams or in patches.
Capsaicin cream comes in 2 strengths (0.025% and 0.075%).
The lower strength can help the pain of arthritis and the stronger solution can help some neuropathic pains such as scar pain and that of postherpetic neuralgia.
The problem with this cream is that it can burn and irritate before it works and more often than not it will stop working if its use is stopped.
Lidoderm patches can also be useful in scar pain and postherpetic neuralgia.
These patches are impregnated with local anaesthetic.
They do not make the skin greasy and stop working after they are removed so constant use may be needed.
NSAIDS are also available in creams and apart from being effective, cause almost negligible damage to the stomach and kidneys.
They help approximately 1 in 3 people who use them regularly.
Patches containing the strong painkillers fentanyl and buprenorphine are also available and may help in both cancer and non-cancer pain unresponsive to weaker painkillers.
Both are licensed for use in patients with chronic non-cancer pain.
Delivery of drugs to the body
Most people take drugs by mouth. Increasing numbers of people absorb drugs using patches.
There are of course other ways of delivering drugs to people.
These ways are used because not everyone can swallow drugs and even if they do, the dose required is higher than that achieved.
Other routes include into muscles, directly into veins and under the skin, under the tongue, inhaled through the nose and lungs and also via the back passage.
The most effective way of delivering drugs, however, is by putting them directly into the nervous system as this where the drugs actually do most of their work.
This is done by ‘tapping’ into the space around the spinal cord as already talked about in the section on low back pain and epidurals.
Tapping a little further leads to the subarachnoid (item 5 in the picture) or spinal space where the spinal cord and cerebrospinal fluid are. In both areas a catheter or hollow tube can be left and drugs infused into it.
It has to be stressed that this is a highly specialised area of drug delivery and only the very basics can be explained without tremendous background detail being required.
It is also used in very few patients with chronic non-cancer pain is has a greater place in the treatment of cancer pain.
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Health -The Differences between some analgesics
Updated: 15 Feb 2012
Differences Between Aspirin vs Tylenol vs Advil
Generic names -Aspirin Vs Acetaminophen vs Ibuprofen
Radical says- Always as for the generic name of a drug if you can buy it
over the counter. Where you can't the GP will prescribe the generic name!
Also some these drugs are not compatible if you take other drugs.
By Kathryn Vercillo
Traditionally I have been one of those people who doesn’t use pain relievers (or any other medications for that matter) all too often. On the rare occasion that I would get a headache or cramps or something else that required me to get some pain relief in the form of the pill, I would usually just take whatever was around. As far as I was concerned, Aspirin and Tylenol and Advil were all basically the same thing – drugs that were designed to relieve my pain.
Only recently did I start to realize that there are some major differences between these three common pain relief products. Although they do all essentially serve the purpose of relieving pain, they do so in different ways. This means that some types of pain are better served by one drug than the other. It also means that there are different side effects with each of these pain relievers. Depending on your condition, this could make it safe to take one of these pills and not the others.
As I’ve started to realize that all of these pain relief pills aren’t just the same, I’ve started to get more concerned about which ones I put into my body on those days when I actually do need to take a pill to get some relief. I’ve decided that it’s important to learn as much about them as I can so that I’m really taking the pills that are right for me when I need to do some over-the-counter pain relief. Here’s a bit of the information that I’ve uncovered about each of these drugs which may help you to figure out which one is the right one for any pain that you may be experiencing:
Aspirin
Aspirin is a pain-relief drug that is able to do several things other than relieve pain. First of all, it is an anti-inflammatory which means that it reduces swelling and inflammation in the body. This helps to cause reduction of pain when the pain is due to inflammation. Additionally, aspirin is an anti-clotting drug which means that it’s good for people who are at high risk of heart problems related to blood clotting but could be dangerous for people who already have thin blood.
Aspirin is generally considered to be the best pain relief drug for people who need to reduce their fever and get rid of aches and pains in the body particularly those that are due to inflammation. However it is considered to be the pain relief drug with some of the highest risks for long-term use (risks including stomach ulcers). At the same time, it is considered a good long-term drug for people who are trying to lower their risk of heart problems. So Aspirin is a powerful over the counter pain relief pill that may be great for some people and bad for others.
Main benefits of aspirin:
• Relief of minor aches and pains
• Reduction of fever
• Anti-inflammatory
• Anti-clotting
Main negative side effects of aspirin:
• Gastrointestinal ulcers
• Bleeding in the stomach
Tylenol
Tylenol is a brand name that people commonly refer to when they are talking about pain relievers with the main ingredient of acetaminophen. Tylenol is generally considered to be a good pain relief option for people who have muscles aches and pain but is primarily designed for people who want to get pain relief for headaches. The drug is considered to have very few side effects. However, long-term use of Tylenol or use of Tylenol while drinking alcohol can be high-risk for side effects and may even be fatal.
Main benefits of Tylenol:
• Relief of muscle aches and joint pain
• Relief for headaches
• Reduction of fever
Main negative side effects of Tylenol:
• Kidney, liver and organ damage
• Negative interactions when taken with alcohol
Advil
Advil is a common name brand for the drug that is based on ibuprofen. This drug is also good for relief of body pain and fever. However, it is milder than the other two drugs. This is good for people who are looking for a low risk of side effects but bad for people who are suffering from serious pain since the positive effects of Advil don’t last as long as those of Aspirin or Tylenol. The one thing that Advil seems much better at treating than the other two drugs are is the reduction of pain associated with menstrual cramps.
Main benefits of Advil:
• Relief of body pain especially arthritis pain
• Reduction of fever
• Anti-clotting
• Relief of pain associated with menstrual cramps
Main negative side effects of Advil:
• Nausea and dizziness
• Gastrointestinal bleeding
Summary of Differences between Aspirin, Tylenol and Advil
Basically what you’ll find is that there are a lot of similarities between these three drugs but that there are also enough differences that you should choose wisely when picking a pain pill. They are all used to relieve pain and can serve the purpose of reducing fever and diminishing joint and muscle pain. They all have limited side effects which usually aren’t experienced unless there is an overdose of the drug over an extended period of time. However, these side effects vary and may impact people differently. Someone with an alcohol problem may want to avoid Tylenol whereas someone with thin blood would avoid Aspirin. It is always best to consult a doctor to determine which drugs are right for you even when you are getting them over the counter.
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Health- A Study that shows Aspirin and Paracetamol reduce fever equally well
Updated: 15 Feb 2012
MEDIA BRIEFING
23rd August 2005
Study shows aspirin and paracetamol reduce fever equally well
There is no significant difference in efficacy between aspirin and paracetamol
when they are used to treat fever and other symptoms associated
with viral upper respiratory tract infection (URTI),
according to a large international study(1).
This new, randomised, double-blind, placebo-controlled trial shows that, at single doses of 500 and 1,000 mg, both aspirin and paracetamol significantly reduce fever, headache and other symptoms in adults with URTI with a similar frequency of adverse events.
The efficacy of aspirin and paracetamol was so impressive that the study was ended prematurely because it was considered unethical to deny such effective treatment to participants by giving them a placebo.
This study clearly demonstrates that aspirin is highly effective in relieving fever and other symptoms of URTI in adults, and that it is well tolerated.
Why was the study carried out?
Aspirin and paracetamol are familiar household medicines for the treatment of colds and minor pains but there are few scientific comparisons of their effectiveness and tolerability.
There is a misconception that paracetamol is better at reducing fever and has fewer side effects than aspirin, and that aspirin is a superior analgesic.
This study was conducted to provide scientific evidence of the comparative efficacy and tolerability of these medicines in relieving the common symptoms of viral URTI.
Who were the participants?
The participants were chosen to be representative of people with a common cold. They were men and women aged between 18 and 65 who had a URTI and fever probably caused by a virus and lasting for no more than 5 days. Their symptoms included headache, aching, sore throat, cough, runny nose, chills and sweating. People were excluded if they had more serious illness (such as bacterial sinusitis or pneumonia) or were taking other medicines that might affect their symptoms.
How was the study carried out?
392 participants were randomly assigned to one of the treatments or placebo. Neither they nor the investigators were aware of which intervention they took. The interventions were single doses of placebo, aspirin 500 or 1,000 mg, or paracetamol 500 or 1,000 mg.
The main endpoint of the study was the total change in fever over the first 4 hours following the dose. Other endpoints included the extent and timing of fever relief and the severity of other symptoms. Fever was measured every 30 minutes for 6 hours. Participants noted the severity of other symptoms at 2, 4 and 6 hours. Adverse events were recorded throughout the study.
What was the main finding?
Both doses of aspirin and paracetamol reduced fever more than placebo and these differences were statistically significant. There was no difference between similar doses of aspirin and paracetamol.
What were the other findings?
The reduction in fever began 30 minutes after the dose and persisted for at least 6 hours for both doses of aspirin and paracetamol. The higher doses of each medicine achieved greater reductions in fever than the lower doses.
Aspirin 1,000 mg reached its peak effect on fever (lowered by 1.67°C) more quickly than paracetamol 1000 mg (lowered by 1.71°C) (time to maximum temperature difference 174 vs. 213 minutes).
Both doses of aspirin and paracetamol reduced headache severity throughout the study.
Achiness and feverish discomfort were reduced at all time points for the higher doses of both aspirin and paracetamol.
Neither medicine relieved sinus sensitivity and only aspirin 1,000 mg reduced the pain of sore throat.
During the study, half of participants assigned to placebo took 'rescue' medicine to relieve their symptoms compared with only 5% who took aspirin or paracetamol 1,000 mg.
Tolerability
All treatments were well tolerated and all adverse events were of mild to moderate intensity.
The overall frequency of adverse events in those who took placebo was 21.8%; this compared with 15.4% for aspirin 500 mg and 12.7% for paracetamol 500 mg, and 30.8% for aspirin 1,000 mg and 29.1% for paracetamol 1,000 mg. These differences were not statistically significant.
The frequency of adverse events that investigators believed could be attributed to treatment was 5.1% with placebo, 10.3% for aspirin 500 mg, 11.4% for paracetamol 500 mg, 29.5% for aspirin 1,000 mg and 25.3% for paracetamol 1,000 mg.
The differences between the higher doses of each drug and placebo were statistically significant. Adverse events included increased sweating and gastrointestinal events but these were not significantly more common with either drug than with placebo.
What does this study tell us?
Aspirin and paracetamol are both effective treatments for fever and they also relieve other symptoms of viral URTI such as headache. In both cases, a dose of 1,000 mg is more effective than a dose of 500 mg. These medicines act quickly (within 30 minutes) and their effects last for at least 6 hours.
There is no difference in tolerability between aspirin and paracetamol. Both treatments are well tolerated and adverse events of mild to moderate intensity are more frequent with the higher doses of each drug than with placebo.
- ENDS -
Reference
1. Bachert C, Chuchalin AG, Eisebitt R, Netayzhenko VZ, Voelker M. Aspirin compared with acetaminophen in the treatment of fever and other symptoms of upper respiratory tract infection in adults: a multicentre, randomized, double-blind, double-dummy, placebo-controlled, parallel-group, single-dose, 6-hour dose-ranging study. Clin Ther 2005;27:993-1003
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Health- Pain and Painkillers
Updated: 15 Feb 2012
Your "ultimate" guide to pain relief
Radical -Frankly I think the medical profession has gone to sleep over this one !
But then I am not a Doctor, I am the sufferer of Pain,so I am talking from the
view that we should all be getting relief from pain-
Joint pain
‘This includes osteoarthritis, which is wear and tear on joints, such as hips and knees, and rheumatoid arthritis; your body’s immune system attacking its own joints,’ says 'Embarrassing Bodies' GP Dr Pixie McKenna, author of 'The handbag doctor' (Kyle Cathie).
‘It causes joints in the hands and feet to become stiff, swollen and inflamed.
’NaturalResearch has shown that ginger’s pain-killing properties for osteoarthritis were on a par with over-the-counter painkillers.
‘Start the day with fresh ginger tea,’ says Susan Smith Jones, author of 'The healing power of nature foods' (Hay House).
Over the counter‘
For osteoarthritis, try paracetamol, and glucosamine supplements at 1500g a day,’ says Dr Pixie. For rheumatoid arthritis, paracetamol and codeine can reduce pain, but non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen also reduce inflammation to ease swelling.
On prescription
For either kind of pain, your GP may prescribe capsaicin cream, made using the active ingredients from chilli peppers.
Headache
Tension headaches affect around 40 per cent of UK adults.
‘Women are twice as likely to suffer as men,’ says Dr Pixie.
‘They can be brought on by stress, poor posture, tiredness, depression, an ear infection, dehydration, eye strain, sinus problems or even teeth-grinding at night.
’NaturalTo soothe an occasional headache, apply three drops of neat lavender essential oil to a cotton wool pad and apply to forehead and temples, suggests aromatherapist Jennie Harding, author of 'The essential oils handbook' (Duncan Baird).
Or try Tisserand Head Clear Roll-On Remedy (www.tisserand.com)Over the counterTake ibuprofen or paracetamol if the pain is severe, says Dr Pixie.
On prescription
Take ibuprofen or paracetamol if the pain is severe, says Dr Pixie.
Period pain
That nagging, dragging pain caused by contractions of the uterus or womb can leave you feeling washed out and exhausted.
Natural
A hot water bottle is as effective as ibuprofen, according to one American study, or try this: ‘Steep a handful of fresh thyme in a teapot of boiling water for five to seven minutes, then drink hot or cold,’ says women’s health expert Emma Cannon (www.emmacannon.co.uk).
Over the counter
Ibuprofen is better for relieving period pain than paracetamol, according to recent research from New Zealand.
On prescription
Need something stronger?
For exceptionally bad days, your GP can prescribe Ponstan, which contains mefenamic acid, to relieve pain and reduce inflammation.
Mouth ulcers
More women than men get these painful sores (hormonal fluctuations can trigger them), and one in five people in the UK gets recurrent mouth ulcers.
Brushing your teeth too hard, biting your cheek, stress, and foods including chocolate, coffee, peanuts and tomatoes have all been identified as mouth ulcer triggers.
NaturalCooled chamomile tea can soothe inflammation – gently swish it around your mouth as you drink.
Over the counterTry a pain relief gel, such as Boots Pharmaceuticals Mouth Ulcer Patch (www.boots.com), which forms a protective barrier over the ulcer, reducing discomfort in 20 seconds.
On prescription
If you’re really struggling, your GP can prescribe corticosteroid lozenges, and painkilling sprays or mouthwashes.
Migraine
These severe throbbing headaches, sometimes with nausea and sensitivity to light, leave you with a fatigue ‘hangover’.
They affect around one in four women, and hormonal fluctuations at menopause, menstruation and via the contraceptive pill can influence migraines.NaturalTry Migra-Cap (www.migracap.co.uk), a light-blocking lycra cap filled with cooling gel patches designed for people with migraines.
Over the counterTry ibuprofen – around half of people with migraine will get relief in two hours from this, according to recent research.
Or, opt for Imigran Recovery, from www.boots.com).
On prescription
Your GP can prescribe stronger painkillers, and drugs including beta blockers and anti-inflamm atories to try and reduce the frequency, or refer you to a specialist migraine clinic.
Back pain
Backs are so complex that even twisting, coughing, reaching or slouching on the sofa for a day can set off lower back pain that makes everything a chore.
If it doesn’t get better in three days, see your GP.
In the meantime – or if you’re coping with a chronic condition – try these ideas as well as the usual painkillers.
Natural
According to the Pain Relief Foundation (www.painrelieffoundation.org.uk), a distraction can help you forget about pain.
Listen to your favourite music, go walking with a friend, or watch a feelgood film.
Over the counter‘
Try a hot bath with two drops of ginger, two drops of vetiver and two drops of rosemary essential oils,’ says aromatherapist Jennie Harding.
Find essential oils at www.lloydspharmacy.com).
On prescriptionAcupuncture is available on the NHS for chronic lower back pain.
Or find a qualified acupuncturist at the British Acupuncture Council (www.acupuncture.org.uk).
Breast pain
Tender breasts are a common symptom of premenstrual hormonal imbalances and can stop you getting a comfortable night’s sleep.
Natural‘Try evening primrose oil, rich in anti-inflammatory acids for at least two months, unless you have epilepsy,’ says Boots pharmacist Angela Chalmers.
‘Ditch dairy and red meat for a couple of months to see if it helps, too,’ says Dr Pixie.
‘It will reduce exposure to artificial hormones, and studies have shown a link between PMS and a high animal-fat intake.’
Over the counter‘
Take paracetamol, or rub in an antiinflammatory cream such as Voltarol Emulgel P (from www.boots.com), and wear a soft support bra overnight,’ says Dr Pixie.
On prescription
Only in extreme cases will your GP potentially prescribe hormonal-based medications, such as Danazol, which is licensed to treat severe pain caused by fibrocystic breast disease, when benign growths occur. |
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Health- Health Reforms expose risks -"Political Pride before Patient Care"
Updated: 15 Feb 2012
NHS papers expose risks of health reforms
Health and social care bill could harm patient care and increase costs, internal reports warn
Juliette Jowit, political correspondent
guardian.co.uk, Tuesday 14 February 2012 19.59 GMT
Kill the bill:
Andrew Lansley has been warned again of the risks NHS faces if the government persists with the health and social care bill.
The government's health reforms run a high risk of reducing levels of safety and patient care while leading to overspending, internal NHS reports have warned.
The potential for conflict between NHS organisations in the new system and upheaval during the transition is high, according to risk assessments drawn up by the four English NHS regions.
There is also a high chance the reforms will fail to achieve hoped-for management improvements and budget cuts, they say.
Some of the anticipated problems are rated at the highest risk category, "significant", and many others are considered "high risk", even after mitigation measures designed to tackle the issues raised, and despite all actions taken after previous risk reports last autumn.
The warnings – dated January and not due to be updated for three months – will be in place when the controversial health and social care bill becomes law, provided the government succeeds in getting it passed before Easter.
The reports are by the four NHS super-regions in England, created last year by merging 10 regional bodies together into London, the south of England, the Midlands and east, and the north of England.
They emerge at a tricky time for ministers as they are likely to reflect the concerns raised by a national risk register, drawn up by civil servants at the Department of Health last year, which the health secretary, Andrew Lansley, is fighting a legal battle to avoid publishing.
Pressure on Lansley will be further raised next week when Labour has called an opposition day debate on the issue.
Andy Burnham, the shadow health secretary, highlighted the "devastating" finding in London that officials are still warning of "preventable harm to children" because of the risk of losing key staff, and poor information sharing between the newly created organisations.
"You know something is seriously amiss when NHS London has identified a risk of 'preventable harm to children' but has been unable to reduce it," said Burnham.
"That should surely be a sign that it's time to listen to the view of health professionals that it's safer to abandon the reorganisation than press on.
"What these devastating documents reveal is that, even though risks to patient safety have been identified, the NHS has not been able to mitigate them.
The reason for this is simple: the government gave the NHS mission impossible when it asked it to save a massive £20bn whilst simultaneously dismantling it."
Burnham added: "David Cameron is putting political pride before patient safety. People won't forgive him if he digs in and damages the NHS.
He needs to listen to the sensible members of his own cabinet and drop the bill."
There was a further blow to the government after a surge in support for an e-petition on the government's website that urged ministers to drop the health bill.
The petition passed the 100,000 signatures threshold – the point where motions are considered eligible for debate in the Commons.
Health officials stressed the regional risk reports were intended to identify and manage threats in the hope they did not become actual problems.
Unlike the national risk register, which was a one-off, the regional risk reports are regularly updated, and the latest versions contain new and upgraded risks, as well as some which have been reduced, occasionally enough to be removed altogether.
A Department of Health spokesman said: "Departmental risk registers are management tools that play a key role in the formation of government policy – they are separate and independent to [strategic health authority] risk registers.
"We have never previously published our risk registers as we consider them to be internal management documents.
We believe that their publication would risk seriously damaging the quality of advice given to ministers and any subsequent decision-making."
The spokesman defended the bill, adding: "Our modernisation plans are essential if we are to put the NHS on a sustainable footing for the future, hand power to doctors and nurses, give patients more choice, and reduce needless bureaucracy."
The reports are the most up to date assessments of risks to the organisations, staff, budgets and patients in the English regions.
Each risk is rated on a scale of one to five for both the likelihood of it happening and the impact of the possible problem, with those scores multiplied to produce a final risk rating of up to 25.
According to the report for the north of England, risks rated 15 or higher are considered "significant" and coded in red; those from 8 to 12 are judged "high" or amber risk. In the north of England officials warn the risk of achieving "productivity gains at the expense of quality", defined as "safety, clinical effectiveness and patient experience", rates as 12 – a possible event with major impact – even after the mitigation actions so far chosen are taken.
The same report warns of a similarly high risk of "organisational and system instability" damaging management and governance, and uncertainty caused by the changes that could reduce the capacity and capability of staff and organisations.
Lower rated problems – still considered high risks – cover a wide range, again after existing mitigation, including a "loss of grip on current performance", that "safety is compromised by lack of clarity on accountability, poor morale, and loss of knowledge", that the benefits of the reforms are not achieved, and there is a loss of public confidence in the NHS.
In the Midlands and east of England, officials are most concerned that a combination of targets to reduce spending, and the management changes, will cause upheaval during the transition, and similarly warn of worse quality and safety, conflict between organisations, neglect of primary care, overspending, and failure to meet key targets such as limiting the number of patients who wait more than 18 weeks for treatment.
Moderate risks in the region include loss of key personnel, staff working in "silos" and so not co-operating as they need to, a rising risk of fraud, lack of clarity about structures for commissioning treatment for patients, staff distracted or overloaded by the upheaval leading to worse service and higher sickness levels among health service staff themselves, confused and unclear accountability leading to "organisational and system failures", culture clashes, "mission critical" staff leaving, lack of leadership skills among key staff, and loss of confidence among clinical staff leading to the reforms failing.
Unlike other regions, however, risk assessments in the Midlands and east of England are made only before mitigation actions, as officials say it is too early to judge their likely success.In the south of England, three moderate risks were alerted: that there would be worse safety and patient care, conflict in the system, and that there would be no management improvement or financial savings.
In London two new risks were added to the register between September and January, and one removed; five more risks were upgraded as being higher, and three downgraded – though two of those three improved areas still rated relatively high for their overall risk.
Among those considered greater problems than three months previously were a lack of clarity caused by the transition to a new system, possibly causing confused accountability; staff losing focus on patients because they were distracted by management changes; loss of "key talent"; and failure to cut costs.
As well as the threat to children's services, others among the highest-rated risks include future problems for maternity services and "specific failures or deteriorations in the financial position of one or more NHS organisations, with the resulting loss of operating credibility". |
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Health- Read My Lips Lansley -GP's are being "Set Up" -"Get rid of the Bill "
Updated: 15 Feb 2012
Prominent GP warns Lansley to abandon Bill
Tuesday 14 February 2012
by Will Stone, Health & Social Affairs Reporter
Unpopular NHS reforms suffered another vote of no confidence today after the former vice-chairman of a local commissioning group urged Andrew Lansley to scrap them.
Dr Peter Bailey, who is also a former local medical committee chairman, has told the Health Secretary he should "get rid of the Bill" in an article published on bmj.com.
The Cambridgeshire GP warned that family doctors were "being set up" by the Health and Social Care Bill as they are asked to take over jobs previously done at primary care trusts (PCTs) without sufficient skills or time to do so, while simultaneously trying to save £20 billion.
He spoke of the surprise at the Bill's proposal to abolish PCTs in light of the successes that have been achieved in the existing structure.
Dr Bailey told the Morning Star: "GPs are trained very differently to how NHS managers are and that's one of the Bill's biggest mistakes.
"But PCTs are far more cost-effective than they were, so it's not too late."
But he said his suggestions that the reforms were unworkable fell upon "deaf or reluctant ears" when he met Mr Lansley, Prime Minister David Cameron and NHS chief executive Sir David Nicholson.
He added: "Let us put down the sledgehammer. Get rid of the Bill. And bring in a structural engineer to stabilise our finest institution."
Dr Bailey is the latest in a lengthy list of growing opposition against the reforms including nurses, unions, medical groups, economists, Liberal Democrats and even senior Tories themselves.
But both the PM and Mr Lansley have defiantly defended the Bill, arguing that it cuts bureaucracy, despite experts warning that it is more likely to create more. |
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Health-THE NHS-A Socialist & Alternative Plan based on Prevention,a move from Acute to Primary Care
Updated: 15 Feb 2012
A socialist plan for health
This is our contribution to What Next for Labour
/ edited by Tom Scholes-Fogg and Hisham Hamid.
Summary
The NHS needs to change to meet rising expectations, demographic pressures of an aging population and advances in technology.
It is vulnerable to the tremors running through our failed social care system.
It needs to adapt a culture based on reacting to illness into one based on actively keeping people well; from cure to prevention; from care in hospitals to care nearer home.
It relies too much, and spends too much, on care delivered in institutions, mostly hospitals, and not enough on prevention, community and primary care.
We have to break down the institutional and cultural barriers which prevent care being delivered around the needs of patients; and remove the barriers between “health” and “social” care.
The founding principles of our NHS make it free at the point of need and that is seldom challenged.
That it is also universal, comprehensive and paid for out of general taxation is still fundamental to our view but are no longer quite so certain.
But change is necessary and all agree change is difficult.
The way ahead is not through reorganisation of structures or making health care into a regulated market.
What is needed to improve the quality and efficiency of the NHS is not, primarily, organisational change, but changes in clinical behaviour.
The answers are not found just through competition and innovation through the private sector.
We set out the key themes for an alternative which can be achieved through incremental change – not another radical reform.
Our views are our own but informed by widespread discussion with clinicians, campaigners, and party members.
Public Health – Prevention and Education
We need to begin our thinking at the point where we could have the greatest impact in the long term, with public health.
Clearing the slums, putting in clean water and sewers did a lot for our health, and better road design has reduced mortality as much as better surgery.
In recent years the smoking ban was probably the most important single policy as far as effects on health are concerned.
People who take enough exercise, eat enough fruit and vegetables, don’t smoke, and drink in moderation live on average 14 years longer than people who don’t.
These are not things over which the NHS has much influence.
The pricing and marketing of food, drink, and cigarettes are not susceptible to local action.
They need intervention at a national level.
Top down legislation needs to be met by bottom up measures which try and educate or nudge changes.
A major shift in thinking is required to put public health professionals into the key places where decisions are taken and to establish the function where it can be most influential.
Responsibility for all of our wellbeing, including health, should be within local authorities so the links to environmental and social issues can be made.
Moving responsibility for public health into local government will give elected representatives the opportunity to make a real difference to the health of their communities.
Active Care - Involvement
Involving people in their own health has a beneficial effect.
The NHS has not been good at involving people as patients or in decisions at a local or a national level, and this is an area where there are gains to be made in both health and politics.
We need to move to active care - active in the sense that as patients we feel more confident to look after ourselves and share decisions with clinicians.
Decision makers should embrace a proactive approach to public accountability, co-production and community development.
Active communities must guide the development of local services.
Clinicians should actively respond to needs and offer proactive care to people with long term conditions.
We should be using well established mechanisms to predict whose health is most at risk and reach out to them, not wait for them to become ill.
Organizations which provide our care need to be active too; working in collaboration across organizational boundaries (not in competition) to share best practice; working with patients and commissioners to develop the services required.
The best should help those trying to raise standards, not wait for them to fail.
Active regulation should ensure problems are identified early, support is provided where needed but firm action is taken if that is not enough.
We need regulation which does more than set up enquiries after the damage has been done.
Integration of Care
The boundaries between health and social care make little sense to anyone who needs both.
Many are shocked to find that when they need social care they are subject to means testing.
We need a National care service as much as we need a National health service.
In time personal social care should be free at the point of need, as with health and for the same reasons, but the taxpayers are not yet ready to take this step in one go.
There is a wall between health and social care with different cultures, managed in radically different ways, and totally different accountability structures – not to mention health being national and free whilst social care is local and means tested.
The failures of integration seen in bed blocking and unnecessary admissions cost money which could be better spent on improving care.
There should be an integrated assessment of need which is recognised across the country; recognising the needs of carers in the process; an assessment which is portable.
The criteria used for the financial part of the assessment should be the same as for benefits entitlement and should be simple logical and consistent - including a single method for treatment of capital.
It remains the job of local government to decide how social care needs are to be met, reflecting local circumstances. There need to be incentives to ensure that measures which reduce the need for services – which often require a long term investment – are encouraged.
This is not just about social services.
It is also about housing, planning, education, transport and other policies under the control of national and local government.
Top down integration can be driven by making local authorities responsible for the overall wellbeing strategy for the area which will include health care requirements.
Some services such as those for children or people with learning disabilities could be commissioned by them.
Bottom up integration can be fostered by joint appointments, joint staff training and development, shared budgets, shared services and collocation.
These have all been possible and have been used by the best but much stronger leadership is necessary and this has to come from elected representatives not from health bureaucrats!!
Shared Responsibility and Coproduction
We must all be encouraged, educated and supported to take more shared responsibility for our own wellbeing and the professions must be better trained in how to bring this about.
The many barriers which face those most likely to suffer poor health need to be addressed in ways which encourage involvement and improve access for disadvantaged groups.
The principles of co-production, where care professionals and patients work together, must feature more in medical training and professional development.
The model of care which leaves the patient a passive object of the clinician’s attention is expensive and ineffective.
Clinicians, especially Royal Colleges, must ensure that the idea of co-production is central to medical education.
Changing the Emphasis
Whilst we need more emphasis on prevention and less on cure we also have to shift where care is delivered. NHS culture is dominated by large hospitals and their large costs.
Other systems work well with more care being delivered outside institutions, in more local settings and in the home, and medical and technological advances make this easier.
If the appropriate infrastructure was in place outside hospitals then we could envisage perhaps a third of them closing and releasing resources back to fund local care.
Closing hospitals or even bits of hospitals raises local anxieties but the clinical model for concentration of high quality care in fewer centres of excellence combined with the ability to deliver a lot more care in more local settings has to be acknowledged and worked through.
Effective engagement with clinical and community leadership is vital. Major investment in primary care is essential as is investment in public health, and that may imply less investment in PFI hospitals!
Raising the capital to invest in building up community facilities remains a major issue. New sources of funding might be necessary such as allowing the issue of local “Health Bonds”.
Choice and Information
Evidence shows that greater involvement of patients in their care improves outcomes.
More patients want choice about how they are treated than about which organization they are treated by.
But choice and involvement must be, and can only be, built on better access to simple, officially sanctioned, information about care and treatment options and care pathways; entitlement and rights.
This kind of information is not available for either health or social care and nobody has responsibility for its provisions – this should be local authorities.
It also requires us to have access to our own records both health and other care.
For the less able, such as the frail elderly or children, support and agency must be offered to assist with provision of information and so to enhance choice and involvement.
The NHS has been slow to embrace the Internet.
Portable electronic patient records, with access controlled by the patients, will not only drive process efficiencies but offer other avenues to personalise care and make it independent of organizational boundaries.
Communities need a greater say in local services, especially when changes to local services or closures are planned.
This should be based on engagement rather than one off artificial consultations – but the trade-off is that harder decisions can be made in the wider interest.
An alliance between clinical leadership and local involvement is essential for extensive reconfiguration of services, such as closing an A&E or a birthing centre.
Commissioning and Rationing
Commissioning is the process where decisions are made about how public money is spent and on what priorities are set and what standards apply.
It is also about how we get best value for our public spending.
Across local and central government commissioning has been separated from providing so decisions are not unduly influenced (though they must be informed) by provider power or conflicts of interest.
This is hard in health care as the only place much of the necessary knowledge and expertise can be found is within the providers, so a more collaborative style to plan and then procure services is needed.
In such a model the local authority does the needs analysis and sets out the overall wellbeing strategy, guided by advice from public health experts.
Care professionals specify requirements and establish care pathways.
Those with expertise in procurement and contracting identify the providers, and develop the market to ensure the services are secured and best value is achieved.
These functions interact but some are best done at national level, some at regional level and some locally.
For some service design many clinicians may be involved (though not on a full time basis), for others a simple national template could be enough.
It depends and this flexibility mirrors other functions local authorities deal with but not how the NHS operates.
Over time leadership and overall responsibility for commissioning has to move to local authorities, although they will no doubt delegate much of it.
Private or Public?
In both health and care services we have, and always have had, mixed economies with private as well as public providers of services, and we have seen scandalous failures in both sectors.
In social care most is now privately provided.
In health care there have been many recent attempts to increase the role for private sector providers and even for them to support commissioning.
Private providers can produce innovative and sometimes disruptive solutions which public providers do not often develop.
There are additional risks in employing commercial providers because of the external pressures to which they may be subject and anyone procuring services needs to consider how these risks and benefits could be managed.
Continuing with an established public provider will often be the least risk and that must be honestly reflected in decisions; best value meets preferred provider.
Similarly there is some (limited as yet) evidence that competition for services can improve quality, and for teeth and eyes we have had competition between providers for many years.
It is not that competition has no part to play; it is that competition is not the best driving force for change in all services as the market evangelists try to argue.
We do not need a proper “market” system, even if we do need some elements of market behavior for some services.
Use What Works
If we have openness and transparency and publicly accountable decision makers then they can be left to make decisions, as occurs with most public services – but not the NHS.
There will be national quality standards which must be met and are regulated.
But they should not need prescriptive guidance, sets of rules and regulations and imposition from performance management or an intrusive regulator.
We need a quality regulator but not an economic regulator as well!
We don’t do that for education or social care so why do we do it for health?
Within this framework then using what works, locally if relevant, does make sense.
Patient centred care requires a major shift in resources from acute to primary care and a seamless joining up of social and health care into a single integrated system, but by evolving what works not by one off reorganisation – change coming from below where professionals learn to work together, more than from the top down.
By evolving not revolving. |
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Health - "Drop the Bill" vote reaches almost 90,000 so get signing.
Updated: 14 Feb 2012
Tens of thousands of 38 Degrees members have voted on what we do next to save the NHS. The votes have been counted. Here's our top priority: force MPs to hold a fresh debate on whether to scrap Andrew Lansley's dangerous plans for our health service. [1]
There's a petition on the government website calling for Lansley's NHS plans to be dropped. It's got 60,000 +30000 names on it. The government has said that when a petition reaches 100,000 names it can trigger a proper debate in Parliament. [2] So let's get signing!
Add your name to the government e-petition here:
http://epetitions.direct.gov.uk/petitions/22670
If 38 Degrees members pile in now, we can easily raise this petition past 100,000 signatures. The more names on it, the more pressure on the government and MPs to rein in Andrew Lansley's plans.
The government said they launched their own petition website to give voters more say. [3] So let's hold them to that. Just this week fresh opinion polls have shown that most voters don't support Lansley's plans. [4] Let's try to use their petition website to force MPs to listen to our message that the NHS plans are a dangerous mess and need to be stopped.
Add your name to the government e-petition here:
http://epetitions.direct.gov.uk/petitions/22670
38 Degrees members know that the future of the NHS matters. It’s about each one of us knowing that we can get the treatment we need when we need it, without having to worry about paying. It's about knowing that our loved ones will be able to rely on the same thing in years to come. It’s a national treasure, not a political football. So let's keep fighting for it!
Take two minutes to sign the government e-petition:
http://epetitions.direct.gov.uk/petitions/22670
Thanks for being involved,
Johnny, Becky, Hannah, Marie, David, Cian and the 38 Degrees team
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Health- An Alternative to NHS Privatisation & Reform Bill - Scotland and Wales show the way
Updated: 14 Feb 2012
Healthy alternatives
Colin Leys looks at how Scotland and Wales
have rejected marketising the NHS
Red Pepper article
As expert commentators have amply shown, the coalition’s plan to privatise the NHS lacks any basis in evidence – no surprise there.
What is less well recognised, and so far amazingly unmentioned in the debate, is that powerful evidence against privatisation exists on our own doorstep – namely, the fact that in Scotland and Wales the NHS is working well as a publicly provided and managed system, based on planning and democratic accountability.
Marketisation was tried, especially in Scotland, and rejected.
The purchaser-provider split, which is at the root of the marketisation project, was introduced but then abandoned in both nations, and neither foundation trusts nor payment by results were introduced in either of them.
PFI was used in Scotland under the first Labour government in Holyrood, and one private treatment centre for NHS patients was opened, but the SNP has since scrapped the use of PFI and taken the treatment centre into public ownership.
Wales has used neither PFI nor private treatment centres.
The NHS in both countries is once again planned and managed through a mix of democratically accountable central and local structures, as it was in England before the 1990s.
Modernising differently
This doesn’t mean that the NHS in Scotland and Wales has reverted to the past.
On the contrary, in both countries the NHS has been modernising, but in very different ways from those being promoted in England.
Instead of fragmenting the NHS and opening it to commercial competition, Scotland and Wales have opted for democratic and accountable planning.
There, the drivers of change are: a) the input of medical specialists and GPs (rather than businessmen) on the area and local health boards where key policies are developed; b) the input on the boards of community health and social care/social work staff, crucial for integrating primary and secondary care efficiently; and c) in Scotland, input from members of the local community, elected to the boards on a trial basis since 2009.
Scotland has also banned the provision of GP services by for-profit companies.
The restoration of full political responsibility for health services has led to further democratising or redistributive measures, including the abolition of prescription charges and the abolition of charges for personal care in Scotland, and their radical reduction in Wales.
Equally significant, and contrary to the claims of marketisers in England, health services in Scotland and Wales have steadily improved, on various measures, including waiting times.
Scotland’s have been among the shortest in the UK.
The contrast with England – where the NHS is now being driven into decline and, increasingly, into chaos, in the interest of privatisation – is dramatic.
If ‘what matters is what works’, as Tony Blair liked to say (confident that the catchphrase was enough to justify privatisation), it is actually publicly-provided and democratically-managed health services that do so, and the evidence for this is right here in the UK.
Wider lessons
There is a wider lesson here for everyone concerned to defend the public sector. It shows the state working in its active role as the agent and shield of the majority.
This needs emphasising. After 40 years of ideological onslaught, the very idea of ‘the state’ is close to joining others, such as ‘collective’ (not to mention ‘socialist’, and even ‘left’), in the depository of Unclean Concepts. ‘State bad, private good’ may be a crude slogan but it is the very real starting-point of many politicians and most media commentators and BBC interviewers today, from John Humphrys down.
‘State’ is so often coupled with ‘nanny’, ‘bureaucratic’, ‘inefficient’, ’wasteful’ or some other negative adjective, that this hardly raises an eyebrow.
It is never called ‘rational’, ‘efficient’, or even ‘democratic’ – even though commentators and interviewers like to stress the accountability of government (state) to parliament (also part of the state, and always called democratic) when criticising extra-parliamentary forms of political action.
Elements of the state that the corporate world likes and needs are usually treated as somehow not part of the state. The armed forces, the police, the judiciary, the monarchy and the Church of England are never described as part of the nanny state, or as being bureaucratic or inefficient.
The nanny, inefficient etc state just means, in practice, those parts of the state that provide social and cultural services for everyone – schools, social services, and not least the NHS – and that the right doesn’t like.
The effect of this incessant drip of denigration is to narrow down our concept of the state to just these parts of it, and to make us at best indifferent towards them.
We unconsciously absorb the idea that they are by nature bureaucratic, inefficient, monopolistic and so on.
Every fault they exhibit tends to be accepted as evidence of an inherently defective institution.
We stop seeing them as the historic collective achievements they are, as expressions of what a mature society can accomplish through collective effort, achievements we have a collective responsibility to protect and sustain.
Above all, we are conditioned to think that if they need improving, we ourselves can have no role to play in doing so – and that the only route to improvement is via privatisation.
Democratic values
Yet the NHS in Scotland and Wales provides a dramatic contradiction of this whole way of thinking.
The Scots and the Welsh have used their devolved powers to keep and develop the NHS as part of the state. This is partly a reflection of the stronger hold of solidaristic and democratic values in Scotland and Wales – including within the political class and the commentariat, and the medical professions.
It is also due to the fact that the voting system in both countries helps the majority to get the policies they want.
It will be important to follow what further improvements are achieved in Scotland and Wales – and how what counts as an ‘improvement’ is defined when it is patients’ needs, rather than business values, that are the measure of it.
At the same time we should not expect improvements to run ahead of changes in other parts of the state in Scotland or Wales.
The state was famously defined by the young Karl Marx as ‘the table of contents of civil society’: it registers the balance of social forces, and the level of democracy, solidarity and civic energy that exist in the wider society.
Without an expansion of the notion of democracy beyond the skin-deep variety, consisting merely of periodic heavily-managed elections, the progress made with the NHS in Scotland and Wales is bound to run up against limits set by the wider context.
Yet the progress already made could itself encourage experimentation in other fields, from education to central government.
And it offers a badly-needed antidote to right-wing ‘Anglo-Saxon’ ideology. At the very least, the ‘Celtic’ NHS shows that the state can be a democratic, rational, progressive state – if we want it to be.
Colin Leys and Stewart Player’s new book, The Plot Against the NHS, was recently published by Merlin Press. It contains more details of what’s different about the NHS in Scotland and Wales
Colin Leys is a professor of political economy and co-editor of Socialist Register |
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Health - "Drop the Health Bill"-Sign the Petition
Updated: 13 Feb 2012
e-petition
“Drop the Health Bill”
Responsible department: Department of Health
“Calls on the Government to drop its Health and Social Care Bill.”
- Number of signatures:
- 68,431
- Created by:
- Dr Kailash Chand OBE
- Closing:
- 16/05/2012
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Health- Now the Lib Dems have stuck the Knife into Lansley's Bill
Updated: 13 Feb 2012
Andrew Lansley must go, says Hughes
Health Secretary Andrew Lansley has come under increasing pressure over NHS reform proposals
David Cameron's efforts to close down speculation over the future of Health Secretary Andrew Lansley have suffered a setback when a senior Liberal Democrat urged his removal.
The Prime Minister used an article to insist he was "at one" with Mr Lansley and backed the controversial NHS reforms going through parliament.
A series of senior Tories were also deployed to television studios in a bid to shore up the Cabinet minister's position.
However, Lib Dem deputy leader Simon Hughes broke ranks to say Mr Lansley should be shifted from his post.
"My political judgment is that in the second half of the parliament it would be better to move on," he said.
A source close to Deputy Prime Minister Nick Clegg stressed that Mr Hughes had been expressing a personal opinion.
Several Conservative Cabinet ministers are said to have privately criticised Mr Lansley's handling of the Health and Social Care Bill, with one suggesting the Government's problems were now on the scale of the Poll Tax in the 1980s.
A Downing Street source was also quoted last week saying that the health secretary should be "taken out and shot".
However, writing in The Sunday Times, Mr Cameron stressed that there was no alternative to reform.
The Prime Minister - whose disabled son Ivan died in 2009 - said: "As a parent, night after night, I've known what it is to have the NHS by your side...
"But while the values are right, the system isn't.
It needs to change - and that is why I am at one with Andrew Lansley, the reform programme and the legislation going through Parliament." |
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Health- Hypocondriacs - I tell people I am dying slowly but they think I am only joking
Updated: 13 Feb 2012
Hypochondriacs may have a point!
They don't live as long as research suggests a person's outlook affects lifespan
By Fiona Macrae
Last updated at 2:41 PM on 11th February 2012
If you are a hypochondriac, it could be time for a pill and a lie down.
It seems you may have been right about the state of your health all along.
Scientists believe that hypochondriacs really may be destined for an early grave.
And while there’s little to celebrate in that news, there may be some comfort in having a gravestone emblazoned with the late great Spike Milligan’s triumphant epitaph: ‘I told you I was ill!’
Can it be true? Hypochondriacs really do die quicker, according to new research carried out (Posed by model)
A study found that those who complain about their health are up to three times more likely to die in the next 30 years than those who regard themselves as more robust.
Crucially, the finding can’t be explained away by the unlucky subjects having heart disease or other serious illnesses at the start of the study, or even being on medication.
According to the researchers, a person’s outlook can influence their lifespan. On that basis, they suggested that doctors should not limit their definition of good health simply to a patient being free of the physical symptoms of disease.
Be positive: People who are optimistic about their health may actually enhance their life-expectancy
The University of Zurich academics used data from the 1970s, in which more than 8,000 men and women were asked how they would describe the state of their health. Possible answers ranged from ‘excellent’ to ‘very poor’.
Using records of deaths and other data, the research team worked out how many were still alive 30 years later. Analysis of the results was startling.
After filtering the data to even out factors such as health at the start of the study, smoking and family life, they found that the worse a person had ranked their health, the less chance there was that they were still alive.
Men who had rated their health as ‘very poor’, regardless of whether there was any medical evidence to back up their view, were 3.3 times more likely to have died than those who had ticked the box marked ‘excellent’.
Women who rated their health as ‘very poor’ were 50 per cent more likely to have died.
The study, published in the scientific journal PLoS ONE, is one of the first to make the link over such a long period.
Co-researcher David Faeh said: ‘Our results indicate that people who rate their state of health as excellent have attributes that improve and sustain their health.
‘These might include a positive attitude, an optimistic outlook and a fundamental level of satisfaction with one’s own life.’ Previous research has shown that pessimists are more likely to die young than their more optimistic counterparts.
It is thought that optimists fare better because they refuse to let health blips make them miserable.
They may also be more likely to follow their doctor’s advice, believe in the benefits of a good diet and exercise and be better at handling stress and its effects.
Dr Faeh added: ‘The results suggest that being healthy does not only mean not being sick but also being socially, physically and mentally well. So it’s rather a question of what keeps you healthy than of what makes you ill.’
Read more: http://www.dailymail.co.uk/health/article-2099567/Hypochondriacs-dont-live-long-research-suggests-persons-outlook-affects-lifespan.html#ixzz1mG9ve1Ow
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Health-The Bill -Those is favour say Aye - An impressive array says Nay- that includes the people
Updated: 13 Feb 2012
Should David Cameron wash his hands of Lansley's NHS reform Bill?
Even the Health Secretary is unhappy with how the Health and Social Care Bill now stands.
But the PM seems determined to plough on in a way that, critics say, typifies his style in office
Matt Chorley
Sunday 12 February 2012
Not sick enough for hospital, not well enough to cope
Another day, another report concluding that “integration” is what will save a health and social care...
Health Secretary Andrew Lansley had a very different vision for NHS reforms but the version that is going through is being supported by the Prime Minister, despite widespread opposition
There are few things upon which everyone agrees about Andrew Lansley's hated Health and Social Care Bill.
But they do agree on this: no one wants it.
Not even Andrew Lansley.
Not really.
His original vision of the Health Secretary being released from day-to-day responsibility for the NHS, GPs in control as competition let rip – that's all gone.
In its place rests a piece of legislation amended some 2,000 times, expanded to more than 450 pages, so complex and multifarious that even Heath Robinson might struggle to unpick its component parts.
"This is not even what Lansley set out to do," admits a ministerial friend, wearily.
The Bill will take another kicking in the House of Lords tomorrow when government insiders expect to suffer up to a dozen defeats, though none of them fatal.
And yet still David Cameron insists it must go on. Despite three members of his own Cabinet briefing against it – and Mr Lansley – the Prime Minister will this week make another attempt at selling a cure to a public unconvinced that the patient is really ill.
Expect a sleeves-rolled-up visit to a hospital. But don't expect him to wash his hands of a project which, rightly or wrongly, could cost him the next election.
Almost two years in the making, the once eye-catching plan to take the axe to the NHS's bloated bureaucracy and hand power to family doctors has become a metaphor for Mr Cameron's worst failings as Prime Minister – lack of attention to detail, a hands-off management style, misplaced loyalty to old friends and a deep-rooted belief that shouting at the Despatch Box will silence one's critics.
One exasperated government strategist resorted to quoting Malcolm Tucker, the foul-mouthed spin doctor from The Thick of It, to sum up how bad things have become: "It is a fucking omnishambles."
At one stage during one of the many moments of paranoid crises that have gripped the reforms, civil servants were ordered not to commit anything to paper to prevent embarrassing leaks.
It has been another terrible week for the Health Secretary. Friends described Rachel Sylvester's column in The Times (saying he should be "taken out and shot") as a "depth-charge bomb".
The ConservativeHome report on three cabinet ministers voicing doubts about the Bill was likened to "lobbing in a hand grenade".
Downing Street stresses that no senior minister has raised concern with the Prime Minister, who remains "totally committed" to the reforms which he believes have broader support "in the country" than media reports suggest.
"The status quo is not an option," said a close aide.
Mr Cameron remains fiercely loyal to Mr Lansley, who was his boss in the 1990s when the future prime minister worked in the Conservative research department.
As with Andy Coulson, his disgraced former spin doctor, there is a sense that the Prime Minister is willing to stand by a friend long after their continued presence has caused him damage politically.
In a meeting on Monday, Mr Cameron banged the table and told Mr Lansley: "We've not shed blood on these proposals not to go through with them... Let's really get out there and work to sell them."
The problem is that every attempt to explain the reforms soon drifts into either generalisations ("efficiencies, choice, competition"), platitudes ("giving power to doctors and nurses") or jargon ("clinician-led commissioning").
There has also been the lack of consistency; where once ministers boasted of having the professional bodies signed up and on board, they now claim angry and almost universal opposition is an inevitable outcome of radical reform.
What was once hailed as the biggest change in the NHS for 60 years is now being represented as a logical, small-scale continuation of Blairite reforms. In July 2010, Mr Lansley boldly declared that "people voted for change" – which doesn't sit well with his pre-election promise of no more top-down reorganisations.
The Government's favoured option now is that the Bill is further amended in the Lords and limps on to the statute book just as the next Queen's Speech is unveiled in May.
One senior government source described the constitutional progress of the Bill: "Everyone expects the Bill will go through the House of Lords, and then the House of Commons.
It will receive Royal Assent from the Queen.
And then there will be a reshuffle and Lansley will be told to fuck off."
In a sign of the fiasco at the heart of the Government, it is now the Liberal Democrats who speak most warmly about the legislation, having rewritten large passages in a coup led by Baroness Williams.
The Lib Dems are furious after working hard behind the scenes to be constructive.
"The Tories are flip-flopping all over the place," says one.
"Cameron is panicking about local elections in May," says another, adding pointedly: "It is very much their Bill."
Andy Burnham, the shadow Health Secretary, is preparing to table amendments to the Bill which would delay the increased marketisation of the NHS – the most controversial section – until 2016.
"People haven't voted for this sort of NHS," he told The Independent on Sunday. "David Cameron does not have a mandate and it is essential that a general election intervenes before these game-changing elements are put into practice.
We are going to give Cameron the fight of his life because he is wrong."
He vowed to repeal the Bill if Labour wins the next election. But he insists the Bill could yet be killed off. "If I read the newspapers I am led to believe half the Cabinet has joined Labour's Drop the Bill campaign."
Labour is pinning its hopes on the release of the national risk register, detailing the dangers of the reforms.
The Government is resisting publication, and Labour has called a vote on the issue. At least 10 Lib Dems back its release. If the report was made public and it did contain stark warnings about the impact of the shake-up, it could prove lethal to the Government's programme.
As the farrago has dragged on, costs have risen too. Redundancy payments to lay off the bureaucrats are expected to top £800m, with doubts about the claimed future annual savings of £1.5bn.
In January last year, the official impact assessment suggested £7.7bn net savings, but after the pause and major rewriting of the Bill, the benefits were downgraded to £6bn.
Hundreds of thousands of pounds have been spent on getting the Bill passed.
Money is not in abundance in the NHS, which must save £20bn through efficiencies by 2015.
The extra cash is due to be ploughed back into the service, because spending increases will be marginal and nothing like the 3 or 4 per cent seen under Labour.
The big problem for the Government is that if the reforms do not work, or falter in any way, throwing money at the problem will not be an option.
Which means Mr Cameron could be left with a real mess on his hands come the next election, and he can't argue he wasn't warned.
Reforming the reforms: How the changes to the NHS were revised
Lansley's original plan
Layers of bureaucracy, including primary care trusts (PCTs) and strategic health authorities, would be swept away and by 2013 GPs handed sole control of £60bn to buy services through commissioning consortia.
The regulator, Monitor, would be charged with promoting competition: hospitals and trusts would be pitted against each other in a system modelled on the private utilities market.
The Secretary of State for Health would have no day-to-day responsibility for the NHS.
What changed?
After the "pause", the timescale slipped and the deadline for GPs to take over was no longer mandatory.
Nurses and hospital doctors are also involved in the design of services, with commissioning consortia becoming clinical commissioning groups (CCG).
It means 151 PCTs have been replaced by 279 (CCGs), many hiring the same staff.
The National Commissioning Board will take responsibility for a £21bn budget,
The Secretary of State will remain responsible for the NHS. Still a sticking point is the plan to raise to 49 per cent the cap on private work that hospitals can do. This has fuelled claims of "privatisations by the back door".
Lining up against the Bill
British Medical Association
Chartered Society of Physiotherapists
Community Practitioners' and Health Visitors' Association
Faculty of Public Health
GMB union
Institute of Healthcare Management
NHS Consultants' Association
Patients Association
Royal College of GPs
Royal College of Midwives
Royal College of Nursing
Royal College of Paediatrics and Child Health
Royal College of Psychiatrists
Royal College of Radiologists
Unison and Unite unions |
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Health-The Tories are ruining our NHS
Updated: 13 Feb 2012
Tories fear row over health bill may 'retoxify' party on NHS
Harm to Conservatives' reputation as trusted custodians of health service could herald blow to re-election hopes, say MPs
•
• Denis Campbell and Daniel Boffey
• The Observer, Sunday 12 February 2012
•
David Cameron's government is not trusted on the NHS by two-thirds of the country, in a sign that the furore over proposed reforms is "retoxifying" the Conservative brand.
A new poll today reveals the extent of the damage being inflicted on the Tory party by the controversial bill being pushed forward by health secretary Andrew Lansley.
It shows that 62% of voters do not trust ministers on the health service, nearly double the 34% who say they do.
Among Tory voters, nearly a quarter (24%) said they did not now trust their own government to handle the NHS, a belief shared by 59% of Liberal Democrat voters.
The YouGov poll, commissioned by the health union Unison, follows reports that three cabinet ministers supported an editorial on the influential Conservative Home website last week describing the NHS bill as "potentially fatal to the Conservative party's electoral prospects".
The prime minister has remained steadfast in his support of Lansley's reforms, but fears are growing in Tory ranks that the government's attachment to the health and social care bill, which would further open up the NHS to private providers, means their party will take the blame for any future problems in the NHS.
Some within the party have dubbed it the government's "poll tax", the policy that proved so damaging to Margaret Thatcher's last government.
The Tories' reputation on the NHS received another blow last night after a leaked letter from the NHS's deputy chief executive, David Flory, revealed that 30 acute care trusts failed to meet the required standards on 18-week waiting times last year.
Flory wrote: "It is unacceptable for performance to fall below the expected standards." In November 2011, 29,508 admitted patients waited longer than 18 weeks for treatment.
This is 3,605 more than in November 2010, a rise of 13%, and 8,846 more than in May 2010, a 42% increase.
It is understood that Andrew Cooper, Downing Street's director of strategy, has become highly concerned about the potential for the Tory brand to be "retoxified" as the bill is forced through parliament in the face of huge opposition from health professionals, including doctors.
When in opposition, both Cameron and Lansley boasted that changing the Conservative party's image on the NHS had been their greatest achievement. Before the election, Lansley's personal website said "he has been responsible for the Conservatives becoming the most trusted party with the NHS".
In April 2010, a Harris poll showed that 27% of people believed the Tories would be the most effective party to manage the NHS compared with 26% for Labour.
One Tory MP told the Observer: "The party is now bankrupt [on this issue] and has run out of credit with medical and nursing professionals and with the public.
At a meeting of Tory MPs I attended last week there was a realisation that we can't win an outright majority next time unless we have credibility on the NHS."
One MP supportive of reforms, Nick de Bois, admitted "the Conservative party has got itself in a phenomenal political mess".
Another said that, while many Tories did not disagree with Lansley's policies, they were furious with the mishandling of the bill's implementation, with many blaming the prime minister.
"There are a lot of us who are hugely pissed off it has come to this," he said.
Dave Prentis, the general secretary of Unison, said: "The public doesn't trust the government with the NHS and realises that this Frankenstein bill will mean the end of the NHS as we know it.
Voters will never forgive, or forget, the party that ruins our NHS."
The shadow health secretary, Andy Burnham, said: "With long waits up since the election and nurses being cut, David Cameron should listen to Labour, drop the bill and use the money saved to protect 6,000 nursing posts that are set to be cut by this Tory-led government."
A Downing Street source said that the prime minister was confident the voters would "over time" recognise the need for reform.
He said: "We believe in an NHS free at the point of use, regardless of ability to pay.
We'll never do anything to threaten that – that's why we've ring-fenced health spending at the time of an international debt crisis.
However, with an ageing population and more expensive treatments, the status quo is not an option.
That's why these reforms are necessary – and we're confident people will see that over time."
The YouGov poll asked 1,644 adults whether they trusted the government to handle the NHS |
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Health- A Final Solution needed to help Cameron to put Lansley out of his misery
Updated: 13 Feb 2012
David Cameron ready to force through NHS reforms...
"David Cameron is said to be willing to endure three final months of political controversy to push the health bill through parliament, but is convinced there is no serious dissent in his cabinet, parliamentary party or in the country at large.
No 10 argues that if the coalition did suddenly drop the bill, as some ministers are privately suggesting, the Conservatives would still be unable to avoid the political blame for closures and job losses likely to happen anyway due to long-term financial pressures on the NHS." - Guardian
• Rocky three months ahead over health Bill, warns No 10 - Daily Telegraph
• Andrew Grice: Cameron could live to regret his reluctance to kill the Bill - Independent
> From yesterday:
• ToryDiary: The unnecessary and unpopular NHS Bill could cost the Conservative Party the next election. Cameron must kill it.
• Baroness Warsi on Comment: As Conservatives it is our duty to support the NHS Bill
• Reform's Nick Seddon on ThinkTankCentral: The NHS Bill should not be dropped - it is only the start of the reforms we need to make
.
..But "half the Cabinet" is "in despair"
"Half the Cabinet is ‘in despair’ at Government plans to reform the NHS, sources claimed last night. ... But last night a dozen members of his top team were in private revolt – hopeful that the Bill or its creator, Health Secretary Andrew Lansley, will ‘go away’." - Daily Mail
• Lansley rejects calls to resign as Tory mutiny threatens health Bill - Independent
• "Mr Clegg has spent months trying to persuade his party to support the health reforms, but he believes coalition unity could be undone" - FT (£)
• Matthew Parris: Sure-footed bore required to replace Lansley - The Times (£)
• "For the six years since he took over the Tory party, Mr Cameron has sidestepped political clarity. The stresses are starting to show, and the fiasco over the NHS is only the most toxic sign of them. It is time for the Prime Minister to demonstrate real leadership and give his Government a clear sense of direction. He does not have long." - Independent editorial
• "Other ministers and MPs were against any full-scale retreat. It’s too late, they said, to abandon the reforms. But I couldn’t find a single person who was enthusiastic about the Bill. No one who would defend the Bill with gusto and no one had anything but scorn for the whole way that the saga had been handled." - Tim Montgomerie for the Times (£) |
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Health - That Bill is Cameron's Poll Tax - Whose leaving his sinking ship ?
Updated: 13 Feb 2012
Top Tories: Health Bill is 'Cameron's poll tax'
Friday 10 February 2012
by Will Stone, Health & Social Affairs Reporter
Three Conservative Cabinet ministers have proved that "even the Tories don't trust the Tories on the NHS" with an online attack on the Health Bill which compared it to the poll tax.
The ConservativeHome blog published an article by editor Tim Montgomerie today which cited opposition from top Tories in branding the controversial NHS plans as David Cameron's "greatest mistake."
Mr Montgomerie warned that the changes were "electorally fatal" and that there was a feeling the PM "isn't listening" to the party.
A picture of the Prime Minister sitting on a stick of dynamite with the letters NHS on it was published alongside the article.
Mr Montgomerie wrote: "Three Tory Cabinet ministers have now also rung the alarm bell. One was insistent the Bill must be dropped. Another said (Health Secretary) Andrew Lansley must be replaced.
"Another likened the NHS reforms to the poll tax. The consensus is that the PM needs an external shock to wake him to the scale of the problem."
He added: "David Cameron's greatest political achievement as leader of the opposition was to neutralise health as an issue.
"The greatest mistake of his time as PM has been to put it back at the centre of political debate."
A series of professional bodies including the British Medical Association, the Royal College of GPs and the Royal College of Nursing have aired strong opposition to the Health and Social Care Bill despite the coalition making more than 100 changes in a bid to appease them.
The blog confirms Labour leader Ed Miliband's claim during PMQs this week that "even the Tories don't trust the Tories on the NHS."
Shadow health secretary Andy Burnham said: "We already know that the PM isn't listening to doctors and nurses.
"But it's a shock to find out that even senior members of his own Cabinet have to take to a Conservative website to get through to him about the damage he is doing to the NHS.
"David Cameron promised to protect the NHS but every day he digs in behind his Bill he damages it further.
"He is out of touch with the people of Britain. He is betraying the NHS. He must drop this Bill."
willstone@peoples-press.com
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Health - NHS Re-Organisation - Predicted job losses 16,800- Some Reform !
Updated: 11 Feb 2012
NHS redundancies may top £600m
More than £600 million could be spent on NHS redundancies in one year as a result of the Government's controversial reforms, figures have shown.
Estimates from the Department of Health show £616.6 million accounted for in possible redundancy costs for 2011/12.
The health service has already made £195 million of redundancy payments in 2010/11, all of which have been attributed to "the modernisation" of the NHS, documents show.
Total redundancy costs as a result of the Health and Social Care Bill, including cash already spent in 2010/11, are expected to be between £632 million and £989 million, with a Government "best estimate" of £810 million.
Predicted job losses in the NHS - from April 2011 onwards - as a direct result of the reforms, which are still going through Parliament, is 9,100 to 16,800.
Howard Catton, head of policy at the Royal College of Nursing (RCN), said: "This is at a time when we are having to make cuts to services which are impacting on the frontline.
This is a huge amount of money that could be better spent, not to mention the loss of expertise and organisational memory that will result from this."
The NHS has been told to find up to £20 billion in efficiency savings by 2013/14.
A Department of Health spokesman said the £616.6 million in redundancy costs was accounted for in the total cost for the reforms.
"Our planned cost for NHS reform remains exactly the same as we published in the impact assessment in September 2011," he said.
"The short term costs are dwarfed by the £4.5 billion we will save over the course of this Parliament and £1.5 billion every year after that."
Shadow health secretary Andy Burnham said: "These eye-watering figures provide clear proof that the Tory-led Government has lost control of its NHS re-organisation."
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Health-The Health Bill is terminally Sick
Updated: 11 Feb 2012
The Health Bill is terminally Sick
It is unresponsive to consumer pressure, chaotically managed, poor at communication and inefficient.
No other country in the world - many of which achieve far better care outcomes than the NHS - runs its health care services in the 1940s-style way we do.
The NHS is a museum piece.
More...Ditch the bill! Tory bust-up over health reforms amid claims minister described it as Cameron’s 'poll tax'
Peers deliver another blow to NHS reform: Cameron on the back foot after Lords defeat
For the last 25 years, both Tory and Labour governments have recognised at least some of these flaws.
Endless attempts - from GP fund-raising, the internal market, and primary care trusts to polyclinics, independent treatment centres and clinical commissioning groups - have been made to break down the public sector monopoly of the NHS and introduce choice, competition and private sector investment.
None has been introduced coherently or worked properly.
More from Nick Wood... Class war warrior Vince Cable steps into Huhne's shoes with his assault on university independence 08/02/12
If David Miliband doesn't want to be a soap star, he should write himself out of the script 07/02/12 Sarko's 121 cars show why we don't want a French-style privacy law 07/02/12 India is right.
They don't need or want our aid 05/02/12 Memo to Ed Miliband: Listen to your brother on benefits 02/02/12 Dave's day of reckoning over Europe comes ever closer 01/02/12
Cameron made the weather at the last EU summit. Now he seems to be in retreat 30/01/12 Nick Clegg is as believable on tax cuts as he was on tuition fees 27/01/12 VIEW FULL ARCHIVE
Now the latest bid to reform the NHS has come badly unstuck.
Cabinet ministers and senior officials at No 10 are speculating that the Bill is doomed and should be dropped.
Health Secretary Andrew Lansley knows his job is on the line. One Downing Street source has said Lansley 'should be taken out and shot'.
Tim Montgomerie, editor of the influential ConservativeHome website, has concentrated minds as the much diluted Lansley Bill returns to the House of Lords for yet another mauling.
In an eloquent and insightful article, Montgomerie has pointed out that Dave faces an unenviable dilemma.
He could effectively abandon the Bill and suffer the humiliation of backing down on a flagship piece of legislation, which Lansley has described as the biggest reorganisation in NHS history.
Ed Miliband would have a field day.
Or Cameron could press on and use his Commons majority to ensure the Bill becomes law.
But if he does that, as Montgomerie rightly warns, every problem in the NHS from now to the next election, will be blamed (almost certainly wrongly) on the Bill.
The electoral penalty for the Tories and their Lib Dem allies is likely to be severe. Interfering with the NHS might well cost the Conservatives the next election.
Today, ministers have taken to the airwaves to defend the Bill and to insist it will hand greater power to patients, put doctors and nurses in charge of health services, and cut bureaucracy and costs.
Should he stay or should he go? Health Secretary Andrew Lansley knows his job is on the line
Speaking out: Tim Montgomerie editor of the influential ConservativeHome website, called for Mr Lansley to go on the Today Programme this morning
The problem is that after more than a year of debate few people believe this.
Most of the public and the medical and nursing professions oppose the Bill and vehemently deny it will bring the benefits that ministers claim for it.
The blunt truth is that Cameron and Lansley have lost the communications battle.
In recent weeks and months, despite last summer's 'pause' to listen to critics and supposedly fix the legislation, the tide of opinion has been steadily moving away from the Government.
Cameron is fond of saying that before introducing fundamental changes, governments have first to roll the pitch. In this case, he has not followed his own advice.
It may be that since the NHS is the nearest the British have to an organised religion, it would have been impossible to persuade the public of the case for a major health service shake-up.
But right now the pitch looks more like a cart track than the manicured turf of Dave's imagination.
Montgomerie and Cabinet ministers fearful of grave political fallout want the Bill either neutered or dropped entirely.
But the betting is that Cameron is in too deep to back down.
He is likely to pay a high price for meddling with the nation's favourite sacred cow
Read more: http://www.dailymail.co.uk/debate/article-2099339/Heath-Bill-Why-David-Cameron-ploughing-it.html#ixzz1m1zU0YCn
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Health -Tinnitus Awareness week for GP's and Sufferers
Updated: 10 Feb 2012
Health
Related topics:
Healthy living
Mental wellbeing
Tinnitus: what your doctor should know
Tinnitus Awareness Week
Wed 8 Feb, 2012 12:00 am GMT
With no visible signs of what sufferers are going through, tinnitus can leave people feeling isolated and depressed.
And with about one in ten people affected by tinnitus, there is a need for greater awareness among both the general public, and GPs specifically.
Typically referred to as a ‘ringing in the ears’, tinnitus is the sensation of hearing a noise when there is no external sound.
What that noise is, can vary from person to person but can include ringing, whistling and buzzing.
Sometimes the sound is continuous but sometimes it is sporadic.
But the British Tinnitus Association (BTA) is concerned that GP awareness and training of the condition is not sufficient, leading to inconsistent and inadequate advice being given to patients.
In a study part funded by the BTA, a third of patients said they were dissatisfied with the treatment they had received from their GPs, citing their doctors’ lack of knowledge and insensitivity to living with tinnitus.
Only 37 per cent of tinnitus patients were referred for further assistance.
David Stockdale, chief executive of the BTA, said: “Thousands of tinnitus patients are being short-changed by their GPs.
They are being either completely dismissed, told to ‘learn to live with’ the condition and are being given inaccurate information, or are not being referred to tinnitus clinics for specialist care.”
The BTA is encouraging audiology consultants to host seminars for GPs to tell them about the services available in their hospitals.
Although there is currently no cure for tinnitus, there are different treatments and behavioural techniques that can help to alleviate the condition.
The precise cause of tinnitus is not known and can affect people of all ages, especially after being exposed to loud noise.
Frequent and/or prolonged exposure to loud noise can damage the hearing system, which increases the risk of getting tinnitus or can make it worse in those already suffering from the condition.
Hearing loss, depression, anxiety, high blood pressure and post-traumatic stress disorder are all factors that can increase the risk of experiencing tinnitus.
Advice on how to manage tinnitus includes strategies such as:
Exercise - regular exercise boosts endorphins which improves your sense of well-being and lowers stress levels.
Relaxation - stress exacerbates the experience of tinnitus so relaxing as much as possible helps; some specific techniques include acupuncture, homeopathy and reflexology.
Music - listening to music can help as it distracts from the tinnitus noises, but avoid prolonged exposure to high-volume levels, which can make it worse.
Diet - if you are healthier and fitter it can make you feel better when you experience tinnitus. Stick to soft drinks and herbal teas, and keep well hydrated.
Products - sound therapy systems, mood lights, pillow speakers and relaxation CDs can all help.
Support groups - join a tinnitus support group in your area.
Family and friends - make sure your family and friends understand tinnitus; the more they know, the more they can help and support you.
Expert help - The BTA’s freephone helpline 0800 018 0527 and website www.tinnitus.org.uk offers more advice and help. |
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Health - More than just Neck Pain
Updated: 09 Feb 2012
Neck pain
Reviewed by Dr John Pillinger, GP
Pain in the neck can be due to: injury, a mechanical or muscular problem, a trapped nerve caused by a bulge in one of the discs between the vertebrae or from arthritis of the neck.
It can range from mild discomfort to severe, burning pain.
If the pain is 'acute' – sudden and intense – it's called a crick in the neck, facet syndrome or muscular rheumatism.
If the pain has lasted more than three months, it's termed 'chronic' neck pain.
Neck pain is a common condition and is more frequently seen in women than men.
Most people will experience pain in the neck at some point in their life.
What causes neck pain?
Many things can trigger neck pain. These include:
trauma or injury
worry and stress
falling asleep in an awkward position
prolonged use of a computer keyboard.
There are several theories about why so many people suffer neck pain, but they are not supported by scientific proof. For most people, no specific reason for the pain can be found.
But in some cases it's possible to make a precise diagnosis. The underlying problem could be a slipped disc, brittle bones (osteoporosis), deformed natural curvature of the spine (scoliosis) and, very rarely, structural damage due to tumours or infection.
Finally, road traffic accidents involving whiplash injury may result in acute or chronic neck pain that takes several months to improve.
What does neck pain feel like?
General pain located in the neck area, as well as stiffness in the neck muscles.
The pain may radiate down to the shoulder or between the shoulder blades.
It may also radiate out into the arm, the hand or up into the head, causing a one-sided or double-sided headache.
The muscles in the neck are tense, sore and feel hard to the touch.
Acute pain can give rise to abnormal neck posture in which the head is forced to turn to one side. This condition is known as torticollis.
The pain at the base of the skull may be accompanied by a feeling of weakness in the shoulders and arms.
There may be a prickly or tingling sensation in the arms and fingers.
Danger signals associated with neck pain
In some cases, neck pain may be a symptom of meningitis.
If any of the the following symptoms occur, dial 999 or seek medical attention urgently.
A rash develops that doesn't fade when you press it with a glass tumbler or a finger.
The patient feels ill or is running a fever, as well as feeling neck pain.
It's so painful to bend the neck forward that the patient can't put their chin on their chest.
Light hurts the eyes.
Neck pain is accompanied by severe headache or continuous vomiting.
Neck pain is accompanied by severe pain in the back.
In some cases, neck pain can be a symptom of head injury or disc trouble in the neck.
If any of the following symptoms occur, dial 999 or seek medical attention urgently.
Neck pain is the result of a recent head injury and the person is becoming drowsy, confused or is vomiting.
Neck pain is accompanied by headache.
If there's pain behind one eye.
Vision, hearing, taste or balance are affected.
Severe vomiting.
The muscle power in arms or legs is reduced.
What can you do yourself?
Stay as active as possible. Try to go to work and keep up your normal everyday activities – bed rest isn't necessary.
If you're given a neck-collar, try not to use this for more than one or two days. Avoid driving if you're unable to turn your head quickly.
Remember that neck pain is rarely caused by a serious illness and will often disappear within a week.
If you have had pains in the neck for a longer period, it's a good idea to consult your GP or a physical therapist – such as a chiropractor or physiotherapist.
Also, the following symptoms may indicate a more serious underlying problem than simple mechanical neck pain and require that you seek further advice from your GP:
co-existing illness, such as unexplained weight loss
actual tenderness or pain in the neck bones (vertebrae)
the pain simply continues to get steadily worse despite treatment
if one or both of your arms become affected, eg persistent numbness, weakness or clumsiness.
How does the doctor or chiropractor make a diagnosis?
In most cases, a neck problem can be diagnosed by carrying out a thorough examination that may include all or some of the following:
testing the movement of the neck
testing for trapped nerves
examination of the muscles
examination of the movement of the joints of the spine, neck and hands
X-rays, scans or blood tests may be necessary to make a precise diagnosis.
How is neck pain treated?
Acute pain at the base of the skull may well disappear without treatment.
For short-term problems, manual treatment (chiropractic or physiotherapy) and pain-relieving medicine are recommended.
With longer-term pain (ie three months or more) there's the following choice of treatment:
chiropractic treatment
intensive muscle training
physiotherapy, including advice on posture and the use of a supportive pillow
acupuncture provides relief for significant numbers of people with chronic neck and shoulder pain, although this is not routinely available on the NHS.
What medication is given?
Painkillers taken on a regular basis, eg paracetamol, are often sufficient alone.
Medicine used in the treatment of mild muscle pain includes non-steroidal anti-inflammatory drugs (NSAIDs). These are generally effective in those who can tolerate them. But they may cause side-effects in patients with a past medical history of indigestion or asthma and be unsuitable for certain patients with kidney impairment, heart failure and high blood pressure.
Consult your doctor or pharmacist if you think this might apply to you.
Stronger painkillers, such as codeine phosphate, may be used if NSAIDs are not working well or are unsuitable. Sometimes a muscle relaxant (eg diazepam) may be prescribed on a short term basis of up to 1 to 2 weeks depending on progress.
Exercise
People with weak neck muscles are more prone to neck problems, and in such cases an exercise programme to strengthen the neck is a good idea.
Future prospects
This depends on the underlying cause of the pain. The prognosis is generally good, provided the patient remains active and obtains the correct treatment without delay. |
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Health- Girl decides the Age of Consent is 13 years old
Updated: 09 Feb 2012
Contraception row: I had implant because
I felt like having sex says girl, 13
A 13-year-old girl who had a contraceptive implant fitted at school without her mother's
knowledge said she wanted the procedure because she "felt like having sex".
2:00PM GMT 08 Feb 2012
The teenager is one of 33 schoolgirls who have been fitted with the device in Southampton, Hants, as part of a controversial government initiative to drive down teenage pregnancies.
Now she has broken her silence to defend her actions, saying she believes she acted responsibly by taking measures to stop herself getting pregnant.
And her mother insisted she was "proud" of her daughter, although she claimed performing a minor surgical procedure at school without parental consent was "morally wrong".
The girl said: "The implant works really well and I think it is a good service.
"I think it has really helped me because if I am with my boyfriend and we feel like having sex, I have the peace of mind knowing that I am OK.
"At the time I didn't want to tell my mum because there are some things you don't want to talk to your parents about.
"But I am glad I have told her now.
I'd rather tell her I've had an implant than tell her I was pregnant.
"If I was told I couldn't have the implant unless I told my mum, I probably would have gone away to think about it and would have eventually got my mum involved.
"But I think there should be the option to have full confidentiality because some children just can't speak to their parents.
"I do get where my mum is coming from and maybe it shouldn't be done in school."
She added that she spent an hour discussing the issues of an implant with a health expert at the school and was told to speak to her mother.
She was fitted with the Nexplanon device at a meeting a week later and told she could book a follow-up appointment if she had any worries.
Her mother said she was proud her daughter has taken responsibility to protect herself.
But she is now demanding an apology from health bosses at the Solent NHS Trust and a review of the service in schools.
She said: "I believe they have neglected my daughter by not making sure she had a follow-up appointment.
"I want an apology. I know I may not be able to stop this surgical procedure being carried out on school grounds altogether.
"But, I at least want changes to be made to ensure every girl that has one is given a compulsory follow-up appointment."
Health chiefs have defended the scheme, saying letters were sent to parents at all nine participating schools in Southampton when the service was launched.
It was then left to individual schools to inform parents of all future students joining, either by letter or in the school prospectus.
The NHS Southampton and Solent NHS Trust has said the number of teenage pregnancies has dropped since the sexual health service was introduced.
A spokesman added: "We have a responsibility to provide a confidential service that ensures young people have access to professional advice and information as well as contraception, if appropriate.
"Full assessments are undertaken to ensure young people are mature enough to understand their choices and
are safe.
"School settings offer an opportunity to engage young people in sexual health and relationship information, as part of their overall health and wellbeing."
They added that the service is fully compliant with national safeguarding legislation and guidance.
As many as 770 pupils have used the sexual health service since 2009.
Nexplanon is the only contraceptive implant currently used in the UK.
The device is a 4cm thin tube which is placed under the skin of the upper arm.
Once inserted it steadily releases hormone progestogen in to the bloodstream which stops monthly ovulation.
It also helps prevent sperm passing through the womb and makes the lining of the womb thinner so it is unable to support a fertilised egg.
The implant does not need to be replaced for three years and is considered more than 99 per cent reliable in preventing pregnancy.
Simon Blake, chief executive of sexual health advice service Brook, said it was vital for younger people to have access to advice about sex.
He added: "Most young people under the age of 16 are not having sex.
"But we believe it's vital all young people, particularly those who are younger and may be more vulnerable, have a safe, confidential place to access advice, information, and support around sexual health and relationships.
"In some cases, this may include access to contraceptive implants from an appropriately qualified professional working within strict legal protocols.
"In these circumstances, we would include appropriate discussion and support for the young person in making that decision, during the fitting and in follow up afterwards.
"Young people may also need wider emotional and practical support in managing relationships, particularly where they are more vulnerable either because of their age or other personal circumstances." |
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Health-Government suffers new health bill defeat in Lords
Updated: 09 Feb 2012
Government suffers new health bill defeat in Lords
The Coaltion last night suffered its first defeat over the controversial NHS bill in a fresh round of scrutiny in the House of Lords.
By Rowena Mason and James Kirkup
6:27PM GMT 08 Feb 2012
Telegraph
The defeat raised fears the bill may hit more opposition among peers than expected, with three Liberal Democrats defying their party line.
Peers voted by 244 to 240 to emphasise the importance of mental health in the bill, suggesting the passage of the bill could be more of a battle than the Government previously thought.
The House of Lords will now spend several days debating the bill, which is opposed by many leading medical groups.
However, Lord Owen, the senior independent peer leading criticism of the reforms, has conceded the Government will probably be able to force them through the House of Lords.
"The House of Lords doesn't have the right to stop a bill because they find it politically disadvantageous,” he said.
“They are allowed to try and reform it and we've done our best. It is a whipped bill, and there is no doubt when the whips of Liberal Democrat peers and Conservatives they can force it through, as they did in the House of Commons.”
The Government suffered several defeated in the Lords over its welfare reforms, but managed to get it through the House of Commons by designating it a "financial" bill.
Lord Owen, the former leader of the Social Democratic Party, said the only person who could now call a halt to the health reforms now is David Cameron.
“I only think the Prime Minister can stop it,” he said.
“If he did it, the NHS would rally, because there are many reforms they're really committed to under the existing legislation you could do.”
The British Medical Association and the Royal College of General Practitioners are key groups opposing the reforms that will hand GPs and other health professionals control of up to £65 billion of NHS spending.
Despite growing attacks on the bill, Mr Cameron yesterday signalled that Andrew Lansley’s job as health secretary is safe.
The Prime Minister defended the health reforms in the House of Commons yesterday as Ed Miliband condemned the policy as “a complete disaster.”
“Every day he fights for this Bill, every day trust in him on the NHS ebbs away and every day it becomes clearer: the health service is not safe in his hands,” Mr Miliband said.
“He knows in his heart of hearts this has become a complete disaster.
That's why his aides are saying the Health Secretary 'should be taken out and shot', because they know it's a disaster.”
It was reported this week that some Downing Street aides blame Mr Lansley for mishandling the bill.
Mr Cameron hit back at Mr Miliband, suggesting Mr Lansley will be in his job longer than the Labour leader.
“I’ve got to tell him, the career prospects of my right honourable friend are a lot better than his,” he said.
Downing Street later signalled that Mr Cameron’s words were a signal that Mr Lansley will remain in his job at any reshuffle held this year.
Defending his plans, Mr Cameron hinted at the death of his disabled son Ivan, who died in 2009 at the age of six.
Mr Cameron said: “I care passionately about the NHS, not least because of what it has done for my family and because of the amazing service that I have received.
“I want to see that excellent service implemented for everyone and that means two things: it means we have got to put more money in to the NHS, and we are putting the money in, but it also means we have got to reform the NHS.” |
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Politics-Health & Social Care Bill -Lords Ladies and Ministers- Mental Health is being sorely tested
Updated: 09 Feb 2012
Senior Tories begin to get cold feet as health Bill is defeated in Lords
Prime Minister told that changes could be made to NHS 'without the need for legislation'
Oliver Wright, Jeremy Laurance
Thursday 09 February 2012
Independent
Welfare
Houses Of Parliament
City Of Westminster Borough
House Of Lords
Mental Health Law
David Cameron has been urged to abandon the Government's controversial Health and Social Care Bill by at least one senior Cabinet minister in the face of widespread public hostility.
Senior figures in Downing Street and the Conservative whips' office have also suggested to the Prime Minister that the Bill, which last night suffered its first defeat in the House of Lords, should be dropped.
The Government was defeated by 244 to 240 on an amendment to emphasise the importance of mental health in the Bill. The amendment had been rejected by the Government.
Senior Government figures have made the case to Mr Cameron that many of the changes to the health service could be carried out without legislation.
They also told him they feared "pushing" the Bill through against widespread opposition would give Labour an "open goal" to blame all future problems in the NHS on their reforms.
The concern was apparently backed up by private polling that shows the reforms are deeply unpopular.
The Treasury is also concerned that the reorganisation could increase health-service costs during the transition to the new system of GP commissioning.
But others within No 10, including Mr Cameron's director of strategy and close aide, Steve Hilton, argue it is too late to withdraw the Bill now and the only way cost savings can be made within the NHS is to introduce greater competition.
Mr Cameron is so far backing his Health Secretary, Andrew Lansley, dismissing suggestions that he might sack him while mounting a spirited defence of the reforms.
Mr Cameron, whose disabled son Ivan died in 2009, said the shake-up was essential to ensure everyone received the "amazing" care that his family had.
But Ed Miliband called on Mr Cameron to drop the Bill.
"This is a matter of trust in the Prime Minister," Mr Miliband told MPs. "Can he honestly look people in the health service in the eye and say he's kept his promise of no more top-down reorganisation?"
In another difficult day for the Government, fresh opposition to the Bill came from within the Government's own supporters.
The official blog of the Tory Reform Group called on Mr Lansley to "retire to the back benches and take his Bill with him".
And more health organisations demanded withdrawal of the Bill, including the Institute of Healthcare Management (IHSM) and the Faculty of Public Health. Sue Hodgetts, chief executive of the IHSM, representing 4,000 NHS managers, said it had hardened its stance because the Government had shown "total disregard for the advice we gave".
She said: "We can confidently say health and social-care managers do not support this Bill."
The Faculty of Public Health warned that the Bill would "damage the NHS and the health of people in England" after an online survey that drew almost 1,300 responses from its 3,300 members found three-quarters of them wanted the Bill abandoned.
Its president, Lindsay Davies, said: "It has become increasingly clear that the Bill will lead to a disorganised NHS with increased health inequalities, more bureaucracy and wasted public funds."
Extradition appeal: No 10 visit marks arrest anniversary
The actress Trudie Styler travelled to No 10 with the mother of Gary McKinnon yesterday to mark the 10th anniversary of his arrest for hacking into computers at the Pentagon.
Janis Sharp said her son, who suffers from Asperger's syndrome, was "unable to control the terror that consumes his every waking moment" as the US continues to demand his extradition. |
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Health- Dr's too busy to see you - He's doing his sums to save money
Updated: 09 Feb 2012
Does anyone like Lansley's health Bill?
Wednesday 08 February 2012
by Will Stone in Parliament
Demonstrators from across the country lined up outside Parliament today calling on the government not to privatise the NHS.
The protest was held before peers debated the Health and Social Care Bill in the House of Lords, with placards warning against the creation of a US-style health-care system in Britain.
Andrew McCabe from Keep Our NHS Public said: "Everything this coalition says the Bill will do is a lie.
The fact is that this legislation will privatise and fragment the NHS.
"If this government can privatise the NHS it can privatise anything."
Health visitors have become the latest organisation to come out against the Bill.
The Community Practitioners' and Health Visitors Association (CPHVA) argues the reforms will put private healthcare companies in the driving seat, fragment services and reduce access for the most vulnerable in society.
CPHVA chairwoman Alison Higley stated: "Our members believe the reforms will have far-reaching negative outcomes for the most vulnerable in our society, and this is the group we have devoted our working lives to supporting.
"We have worked with GPs closely for many years and they, too, like us, do not believe that they have been listened to about their legitimate concerns about the Bill."
A report published yesterday by a cross-party health select committee criticised social care, particularly for the elderly, and advised the government to create a more joined-up system integrating health, housing and social services.
And public health experts have warned the Bill would bring similar problems to those in social care with privatisation fragmenting and "disintegrating" the NHS.
They point out that over 80 per cent of residential care is now privatised and many care homes are run for private profit.
London GP Jonathan Tomlinson said: "If you want to know what a market in health-care would look like, just look at elderly care - or dentistry, where charges are rampant, the private sector rules the roost, and many people cannot find an NHS dentist.
"Now GPs see many patients with dental problems. The NHS leads the world in fair access to care - Health Secretary Andrew Lansley's Bill would undermine that."
Lancashire GP Dr David Wrigley added: "Our NHS was making real progress before Andrew Lansley's Bill and is recognised as one of the best [systems] in the world. The danger is that it could become as unfair and chaotic as care of the elderly."
Labour leader Ed Miliband brought the NHS reforms to the forefront of the debate during Prime Minister's Questions, calling on PM David Cameron to abandon the Bill.
He said: "The Royal College of GPs said these reforms will cause irreparable damage to patient care and the NHS.
"Mr Cameron says he wants the voice of doctors heard in the NHS, why doesn't he listen to them?"
Mr Miliband added that "even the Tories don't trust the Tories on the NHS" in reference to the Tory Reform Group coming out against the Bill.
The Prime Minister responded: "We are taking £4.5 billion out of bureaucracy and putting it into patient care."
willstone@peoples-press.com
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Health- The Social Care System of the Elderly needs a complete overhaul
Updated: 08 Feb 2012
MPs warn elderly care in 'crisis'
Tuesday 07 February 2012
by Will Stone in Parliament
Senior MPs will warn tomorrow that fragmented and under-resourced services are creating a major crisis in elderly care.
A Commons health select committee report into social care urges the government to integrate health, housing and social services to address the challenges of an ever-increasing elderly population.
Its recommendations come before the publication of the government's social care white paper.
MPs argued that joining up services as well as integrating commissioning would make it easier to move money around the local health, housing and social care system as well as help deliver "efficiency savings" within the NHS.
Labour MP Grahame Morris reminded the committee that it is also urging the government to recognise the "widening funding gap" in social care services between the number of those who need care and the amount of money in the system.
He said: "With many of us getting older these care needs are going to continue increasing all the time."
Mr Morris also lashed out at the reform proposals in the Health & Social Care Bill which he argued will only increase problems of fragmentation and underfunding.
Conservative committee chairman Stephen Dorrell said the report's recommendations aim to "avoid a system that has run out of money."
The National Pensioners Convention (NPC) said the report proved that social care is in need of a "radical overhaul" and that the government will need to go much further if it is to address the serious failings in the current system.
"The problem with our social care system is that it is the Cinderella of the welfare state - experiencing years of underfunding, rationing and poor standards," said NPC general secretary Dot Gibson.
"Nearly one million older people are denied any assistance at all, many are still forced to sell their homes in order to pay for care and the cost and quality of some treatment is shocking."
She urged the government to set up a National Care Service that will cut out any fragmentation by offering a comprehensive system of care for vulnerable pensioners funded through general taxation.
Conservative MP Dr Daniel Poulter added: "Hospital admissions are going up and the majority of them are frail and elderly.
"Every year there is an increasing number of families in crisis because of the revolving door of discharge and readmission to hospital."
willstone@peoples-press.com
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Health - Neck Pain or Cricked Neck
Updated: 07 Feb 2012
Neck pain
Reviewed by Dr John Pillinger, GP
| Neck pain can be caused by inappropriate working posture. |
Pain in the neck can be due to: injury, a mechanical or muscular problem, a trapped nerve caused by a bulge in one of the discs between the vertebrae or from arthritis of the neck.
It can range from mild discomfort to severe, burning pain.
If the pain is 'acute' – sudden and intense – it's called a crick in the neck, facet syndrome or muscular rheumatism.
If the pain has lasted more than three months, it's termed 'chronic' neck pain.
Neck pain is a common condition and is more frequently seen in women than men.
Most people will experience pain in the neck at some point in their life.
What causes neck pain?
Many things can trigger neck pain. These include:
trauma or injury
worry and stress
falling asleep in an awkward position
prolonged use of a computer keyboard.
There are several theories about why so many people suffer neck pain, but they are not supported by scientific proof. For most people, no specific reason for the pain can be found.
But in some cases it's possible to make a precise diagnosis. The underlying problem could be a slipped disc, brittle bones (osteoporosis), deformed natural curvature of the spine (scoliosis) and, very rarely, structural damage due to tumours or infection.
Finally, road traffic accidents involving whiplash injury may result in acute or chronic neck pain that takes several months to improve.
What does neck pain feel like?
General pain located in the neck area, as well as stiffness in the neck muscles.
The pain may radiate down to the shoulder or between the shoulder blades.
It may also radiate out into the arm, the hand or up into the head, causing a one-sided or double-sided headache.
The muscles in the neck are tense, sore and feel hard to the touch.
Acute pain can give rise to abnormal neck posture in which the head is forced to turn to one side. This condition is known as torticollis.
The pain at the base of the skull may be accompanied by a feeling of weakness in the shoulders and arms.
There may be a prickly or tingling sensation in the arms and fingers.
Danger signals associated with neck pain
In some cases, neck pain may be a symptom of meningitis.
If any of the the following symptoms occur, dial 999 or seek medical attention urgently.
A rash develops that doesn't fade when you press it with a glass tumbler or a finger.
The patient feels ill or is running a fever, as well as feeling neck pain.
It's so painful to bend the neck forward that the patient can't put their chin on their chest.
Light hurts the eyes.
Neck pain is accompanied by severe headache or continuous vomiting.
Neck pain is accompanied by severe pain in the back.
In some cases, neck pain can be a symptom of head injury or disc trouble in the neck.
If any of the following symptoms occur, dial 999 or seek medical attention urgently.
Neck pain is the result of a recent head injury and the person is becoming drowsy, confused or is vomiting.
Neck pain is accompanied by headache.
If there's pain behind one eye.
Vision, hearing, taste or balance are affected.
Severe vomiting.
The muscle power in arms or legs is reduced.
What can you do yourself?
Stay as active as possible. Try to go to work and keep up your normal everyday activities – bed rest isn't necessary.
If you're given a neck-collar, try not to use this for more than one or two days. Avoid driving if you're unable to turn your head quickly.
Remember that neck pain is rarely caused by a serious illness and will often disappear within a week.
If you have had pains in the neck for a longer period, it's a good idea to consult your GP or a physical therapist – such as a chiropractor or physiotherapist.
Also, the following symptoms may indicate a more serious underlying problem than simple mechanical neck pain and require that you seek further advice from your GP:
co-existing illness, such as unexplained weight loss
actual tenderness or pain in the neck bones (vertebrae)
the pain simply continues to get steadily worse despite treatment
if one or both of your arms become affected, eg persistent numbness, weakness or clumsiness.
How does the doctor or chiropractor make a diagnosis?
In most cases, a neck problem can be diagnosed by carrying out a thorough examination that may include all or some of the following:
testing the movement of the neck
testing for trapped nerves
examination of the muscles
examination of the movement of the joints of the spine, neck and hands
X-rays, scans or blood tests may be necessary to make a precise diagnosis.
How is neck pain treated?
Acute pain at the base of the skull may well disappear without treatment.
For short-term problems, manual treatment (chiropractic or physiotherapy) and pain-relieving medicine are recommended.
With longer-term pain (ie three months or more) there's the following choice of treatment:
chiropractic treatment
intensive muscle training
physiotherapy, including advice on posture and the use of a supportive pillow
acupuncture provides relief for significant numbers of people with chronic neck and shoulder pain, although this is not routinely available on the NHS.
What medication is given?
Painkillers taken on a regular basis, eg paracetamol, are often sufficient alone.
Medicine used in the treatment of mild muscle pain includes non-steroidal anti-inflammatory drugs (NSAIDs). These are generally effective in those who can tolerate them. But they may cause side-effects in patients with a past medical history of indigestion or asthma and be unsuitable for certain patients with kidney impairment, heart failure and high blood pressure.
Consult your doctor or pharmacist if you think this might apply to you.
Stronger painkillers, such as codeine phosphate, may be used if NSAIDs are not working well or are unsuitable. Sometimes a muscle relaxant (eg diazepam) may be prescribed on a short term basis of up to 1 to 2 weeks depending on progress.
Exercise
People with weak neck muscles are more prone to neck problems, and in such cases an exercise programme to strengthen the neck is a good idea.
Future prospects
This depends on the underlying cause of the pain. The prognosis is generally good, provided the patient remains active and obtains the correct treatment without delay. |
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Health- Lincoln County Hospital - Poor Patient care indentified
Updated: 07 Feb 2012
Lincoln County Hospital criticised by patient care watchdog
Inspectors visited the hospital in November
Lincoln County Hospital has been told it must improve after "unacceptable failings" were found by a health watchdog.
A Care Quality Commission inspection of five of the hospital's wards in November identified shortcomings in patient dignity and staff training.
Inspectors said they were particularly concerned with the Clayton ward, which specialises in elderly care.
United Lincolnshire Hospitals NHS Trust said it was making improvements.
The CQC's report described one Clayton patient as having been left in a degrading state for half an hour before they were cleaned.
Another had been in hospital for two days without being given a care plan.
The report also criticised staffing levels and training.
'Real concern'
The CQC said the hospital must improve or it could face further action, including the possibility of prosecution.
Andrea Gordon, CQC deputy director of operation (regions), said: "During our unannounced inspection, we identified a number of unacceptable failings on one ward in particular.
"Some of these related to the dignity of people, accuracy of records, and the risk this poses, as well as numbers of staff and the support and training they had been given to do their jobs.
"These are issues of real concern and we have demanded that improvements are made."
A spokesman for the trust said: "We are extremely disappointed that issues were found on one ward out of the five visited.
"This is unacceptable and the trust fully acknowledges that there are opportunities to improve.
We already acted swiftly to address concerns raised on this ward since the CQC visit in November."
The trust said inspectors had revisited the hospital in January and had given positive feedback on the progress being made. |
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Health- Lansleys Dr friends desert his sinking Welfare Reform
Updated: 07 Feb 2012
Backers of NHS shake-up turn against Andrew Lansley's plans
Leading doctors voice concerns that reforms will suffocate GPs and jeopardise promised freedom to commission care
The Guardian,
Two leading doctors have expressed fears that the new consortiums of local doctors will not have the freedom that the health secretary has repeatedly pledged. Photograph: Christopher Thomond for the Guardian
Two prominent backers of the coalition's NHS shake-up have joined the growing chorus of critics by claiming that GPs will be "suffocated rather than liberated" by the planned changes.
Dr Charles Alessi and Dr Michael Dixon have helped Andrew Lansley claim credibility for his plans among doctors over the past 18 months by strongly supporting his radical restructuring. They are leading lights in the NHS Alliance and the National Association of Primary Care, two key pro-reform organisations.
But they now fear that the new consortiums of local doctors, which will start commissioning healthcare for patients in England from next year, will not have the freedom that the health secretary has repeatedly pledged. Lansley has attempted to persuade sceptics that his reorganisation will put family doctors in charge of healthcare.
NHS primary care trusts (PCTs) and strategic health authorities (SHAs) are due to be abolished next year.
But the doctors are worried that the GP-led clinical commissioning groups (CCGs), which will replace PCTs, will find themselves unexpectedly under the control of another organisation, the NHA National Commissioning Board (NCB).
In July the NHS chief executive, Sir David Nicholson, said "CCGs will be the engine of the new system" and that the reformed NHS "gives pride of place to clinical leaders". But the reality is that primary care doctors and clinical commissioners will not have the promised ability to make key decisions because the current bureaucracy is simply being replaced by another that is growing up around the NCB, the pair claim.
The Department of Health's latest document about the design of the new board involves "layers of bureaucracy and management, with complex guidelines. The old 'footprint' [of the PCTs and SHAs], ie 50 local offices, remains there, plus four sector outposts, all using a single operating model," the two organisations said in a joint statement .
The fact that many of the staff of the new NCB will simply be staff who have joined from PCTs and SHAs "adds to clinical commissioners' concerns and perceptions that they will be suffocated, instead of liberated, which in our view is fundamental to the success of clinically-led commissioning", they added.
"What we are hearing and seeing are the same old messages and the same old structures, albeit with new nomenclatures", said Alessi, a key figure in a CCG in south-west London.
"If we put the same ingredients into the mix, the likelihood is that we shall deliver the same inefficient environment and outcomes. This is insupportable in an economy of tight financial restraint."
Most CCGs now see the new board as the greatest threat to their effective functioning, added Dixon, a GP in Devon and chair of the NHS Alliance.
The pair's comments are another blow to the health secretary as his health and social care bill prepares to undergo its report stage in the House of Lords, when peers will seek to force the government to accept further amendments to its plans. Labour seized on the men's remarks as further evidence of the growing concerns the bill is causing.
"Things are going from bad to worse for Andrew Lansley. In the last fortnight there has been a deepening crisis of professional confidence in the government's health bill, but until now the health secretary could rely on the support of the NHS Alliance and the National Association of Primary Care," said Andy Burnham, the shadow health secretary.
"Yet the bill's biggest cheerleaders are now lambasting the increasing layers of bureaucracy. Even the health bill's greatest supporters are now concerned that Lansley's plans are so complex and full of worrying uncertainties that they risk thwarting the principle of true clinician-led commissioning."
The British Medical Association also fears CCGs' freedom will be curtailed. "There are significant concerns that CCGs will not have genuine freedoms and sufficient independence to make locally sensitive, locally accountable, patient-focussed decisions," it said.
In a briefing to peers ahead of the report stage it says that, despite ministers agreeing to amend several aspects of the bill, the legislation should still be dropped because it involves too much use of "market forces", and could also affect doctors' relationship with their patients through financial incentives for CCGs.
The Department of Health said: "By handing power and responsibility for choosing and purchasing services to doctors and nurses on the ground, we are shifting the decision making closer to patients and building on the trusted role that GPs and other front line professionals already play throughout the NHS.
"The NHS commissioning Board will provide national standards, but doctors and nurses will have the freedom to make decisions about their patients and their organisations."
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Health- The Damned Health Reform Bill re-organisation would cost £1.7billion
Updated: 06 Feb 2012
UK Labour to slam health reforms’ costs
Mon Feb 6, 2012 1:43AM GMT
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Health