The government's kneejerk reaction to allow patients to top-up NHS care with treatment paid for privately is another nail in the coffin of the universal healthcare. We believe sanctioning top-ups is too simple an answer to a very thorny, complex and emotional issue, and doing so risks some serious unintended consequences. There is a danger that this might appease middle England but disregard the real health challenges facing us.
The NHS drugs watchdog has loosened the terms of approval for expensive treatments that extend life in patients with a short life expectancy. Drugs that would normally be ruled out of use on the NHS because they did not represent a cost effective use of resources are now more likely to be made available.
The UK government has quietly dropped a passage in the draft handbook to the NHS constitution that said that ministers had decided to give researchers the right to trawl medical records for research participants without the need for patients’ consent. Organisations that are charged with safeguarding patient confidentiality had objected strongly to a section in the draft handbook that said, "Patients can . . . expect that a health professional or a research professional who owes the same duty of confidentiality as a health professional may use care records, in confidence, to identify whether they are suitable to participate in approved clinical trials. Appropriate patients will be notified of opportunities to join in, and will be free to choose whether they wish to do so, after a full explanation."
The confidentiality of medical records is threatened by government plans to relax laws on data protection, doctors' leaders told the Guardian yesterday. Dr Hamish Meldrum, chairman of the British Medical Association, said the profession was "extremely concerned" about legislation tabled by Jack Straw, the justice secretary, which would allow the Department of Health to share information on NHS databases with other ministries and private companies.
NICE has introduced new criteria for appraising end of life treatments. James Raftery looks at how they might affect availability by applying them to previously refused drugs
The NHS's spending watchdog acted unlawfully when it decided to restrict access to drugs that could help thousands of older women with the bone-thinning disease osteoporosis, the high court ruled today. A judge ruled that the National Institute for Health and Clinical Excellence (Nice) wrongly failed to disclose the economic reasoning behind a decision in October to restrict the supply of strontium ranelate, a drug manufactured by Servier laboratories under the brand name Protelos.
A lesbian couple have won the right to NHS treatment to help them have a baby after threatening to sue health chiefs. NHS Greater Glasgow and Clyde (GGC) had denied Caroline Harris and Julie McMullan IVF treatment as they were not classified as an infertile couple. The health board said it had reviewed its position in light of regulations, including the Equality Act. The women, who were suing the health board for treatment costs, said they had not yet been offered a settlement. The couple were claiming £20,000 after unsuccessful private fertility treatment, which followed them being refused NHS help. They had taken their case to the Court of Session in Edinburgh and a judicial review of the decision was due to take place at a later date. The health board at first stood by its refusal, but it has now agreed to offer the couple treatment at an assisted conception unit.
A therapeutic programme hailed by ministers as a hi-tech, cost-effective solution to Britain's growing problem of depression and anxiety has been widely ignored by the NHS, leaving hundreds of thousands of people without access to treatment. Opposition politicians and charities have accused the government of creating a postcode lottery.
I'm not the only woman who has tried to make herself disappear. Anorexia nervosa, the disorder of pathological self-starvation, is on the rise, with an 80% increase in hospital admissions among teenage girls over the last decade. Pressure groups and parents complain that there is still a chronic shortage of specialist care, with many GPs apparently reluctant to refer patients for treatment in the early stages of the disease. And this approach leaves children and their families to struggle on alone - usually until it is too late for simple intervention.
The NHS Constitution was published on 21 January 2009. It was one of a number of recommendations in Lord Darzi’s report ‘High Quality Care for All’ which was published on the 60th anniversary of the NHS and set out a ten-year plan to provide the highest quality of care and service for patients in England. The NHS belongs to us all. The NHS Constitution brings together in one place for the first time in the history of the NHS, what staff, patients and public can expect from the NHS. As well as capturing the purpose, principles and values of the NHS, the Constitution brings together a number of rights, pledges and responsibilities for staff and patients alike. These rights and responsibilities are the result of extensive discussions and consultations with staff, patients and public and it reflects what matters to them.
The Handbook to the NHS Constitution is here to give NHS staff and patients all the information you need about the NHS Constitution in one place. It acts as a guide to: - patients’ rights and pledges - responsibilities of patients and the public and staff - staff rights and NHS pledges to its staff At the back of this Handbook is an appendix, which outlines the legal source for both the patient and staff rights in the NHS Constitution.
Doctors should apologise and provide explanations to patients and their relatives when treatment goes wrong, according to guidance from the NHS Litigation Authority, the body which defends the NHS against legal claims for clinical negligence. The letter from (KCL MA MEL alumnus) Stephen Walker. the authority’s chief executive, replaces an earlier circular that warned NHS bodies to take care when providing explanations "so as to avoid future litigation risks."
Aims: This Handbook represents initial good practice guidance and resources to help PCTs to review current decision-making processes about the funding of medicines with co-operation from Provider Trusts and other stakeholders. Intended audience: Healthcare professionals. Publication history information: Published February 2009. Access: Available to the general public.
The National Library of Guidelines is a collection of guidelines for the NHS. It is based on the guidelines produced by NICE and other national agencies. The main focus of the Library is on guidelines produced in the UK, but where no UK guideline is available, guidelines from other countries are included in the collection. NICE issues guidelines of very high quality. They are based on a systematic review of the evidence and have extensive consultation not only with clinicians but also with patients and, where relevant, industry. Professional associations do not have the resources to carry out this type of consultation but they can follow the principles set out in the AGREE protocol which helps guideline writers minimise bias, meet the needs of all stakeholders and maximise clarity.
Aims: These guidance notes have been produced to help healthcare workers and organisations to achieve uniformly high standards in making DNAR decisions and in ensuring that all relevant aspects of these decisions are recorded and communicated to others effectively. They are not intended to be a comprehensive guide to decisions about cardiopulmonary resuscitation. Intended audience: Healthcare professionals. Publication history information: Published May 2009. Access: Available to the general public.
This site explains how the law now allows people to make decisions to refuse treatments including those that sustain life. Many people want to achieve a natural and dignified death, this is one way to help achieve it. This is a free and non-profit NHS website. We suggest people enter the site using the relevent menu section (above). Many people benefit from looking at both sections.
A trainee teacher with primary refractory Hodgkin’s lymphoma has launched a High Court action against her primary care trust, NHS Surrey, which has refused to pay for her treatment with an unlicensed drug. Philippa Bigham, aged 28, from Frimley, Surrey, has been given a prognosis of two years’ survival without a bone marrow transplantation. But her medical team at the Royal Free Hospital in London want her to have treatment with radiolabelled basiliximab, a monoclonal antibody conjugated with radioactive iodine and also known as CHT-25, before she has the transplantation. The primary care trust has refused to pay for the drug, which costs £3000 ({euro}3500; $4900) for a course of treatment. Basiliximab is licensed in the United Kingdom for use in renal transplant rejection but the radiolabelled version is not yet licensed.
GPs’ representatives voted overwhelmingly this week for a system in which patients opt in to any sharing of medical data with third parties—rather than one in which their consent is assumed unless they opt out, the system favoured by the Department of Health. Clinical confidentiality depends on GPs being the prime data holder of their patients’ medical records, said the BMA’s annual conference of local medical committee representatives in London. It also strongly opposed using implied consent as justification for releasing information on named patients.
The hopes of people with mild Alzheimer’s disease have been dashed again by the agency that appraises treatments for use by the NHS in England and Wales, which has reaffirmed its original decision to deny them treatment with dementia drugs. The National Institute for Health and Clinical Excellence (NICE) has issued amended guidance but still asserts that the drugs would not be cost effective for the mild stages of the disease. The original guidance from NICE was challenged by Eisai, the UK licence holder for donepezil (Aricept), one of the class of acetylcholinesterase inhibitors affected. The Court of Appeal ordered NICE to hand over a fully executable form of its economic model for determining the drugs’ cost effectiveness, and Eisai and the Alzheimer’s Society made further representations that highlighted flaws in the model.
A LESBIAN couple have won the right to IVF on the NHS after a legal tussle, ahead of laws that will put same-sex patients on an equal footing with heterosexuals. The couple, who remain anonymous, had to go through a legal fight to push the NHS to fund IVF because, at the moment, individual trusts decide whether they wish to pay for treatment for lesbians. The couple were initially refused IVF by their primary care trust because they were of the same sex. One of the women had polycystic ovarian syndrome, which disrupts ovulation, and is one of the most common causes of infertility. From October, clinics will no longer be able to block lesbians by referring to a child’s “need for a father”. Instead, same-sex couples will need to demonstrate only that they can offer “supportive parenting”.
The government says it will ban all private transplants of organs from dead donors in the UK. The move comes after media reports of overseas patients paying to get onto the waiting list for organs donated by British people. An independent report said organs were scarce and no one should be able to pay for transplants, to ensure NHS patients did not miss out. Surgeons said it should reassure people organs went to those in most need.
More than 80% of NHS primary care trusts in England fail to offer the recommended three free cycles of IVF to infertile couples, an MP has claimed. The Department of Health says 30% of PCTs provide three cycles of the fertilisation treatment. But Tory MP Grant Shapps, who has contacted every PCT, says these figures are out of date. A "postcode lottery" operates, with rules on age, relationships and other children varying widely, he insists. In some cases women who would be deemed too old for treatment by one PCT would be seen as too young by another.
The 2009 Equality Bill will, if enacted, make age based discrimination in the provision of health care and social care illegal for the first time in the United Kingdom. In a speech in 2008, the then health secretary, Alan Johnson, said, "Old age is the new middle age. Health and social care services need to adapt to the changing needs of today’s older people . . . to promote health in old age and help older people to maintain independence and quality of life."
The National Institute for Health and Clinical Excellence proposes to reject a breast cancer drug despite its own rule changes on end-of-life treatments Wednesday 21 October 2009 18.11 BST A drug which can give women with advanced breast cancer extra weeks or months of life has been turned down by a government watchdog body for use in the NHS. The National Institute for Health and Clinical Excellence (Nice) says it proposes to reject Tyverb (lapatinib) in spite of changes in the rules brought in specifically to allow people at the end of their lives to have the chance of new and often expensive treatments. Tyverb is the only drug licensed for women with advanced breast cancer whose tumours test positive for a protein called HER2 and for whom Herceptin, a Nice-approved drug, is no longer working. In much of the rest of Europe, Tyverb is then given, in combination with a standard chemotherapy drug called capecitabine.
Hospital patients in England will get the legal right to be seen privately if they face NHS delays. Hospitals have to start treating patients within 18 weeks of referral - or two weeks in the case of cancer. But ministers will now give patients a legal right to private care - or treatment at another NHS centre if so desired - if this does not happen. The Tories, who would scrap waiting time targets, said it was an "unaffordable and uncosted" pledge.
The family of a man left severely brain damaged by a hospital trust's failure to diagnose meningitis promptly have been awarded £3.2m for his future care. Mark Thomas, of Walsall, in the West Midlands, developed an ear infection, which led to the meningitis in 2002. His parents took him for blood tests at Walsall Manor Hospital but the results were not reviewed for five days. Without the delay, Mr Thomas, 20, would not have been left brain damaged, Birmingham High Court was told earlier.
A powerful arthritis drug, judged too expensive for patients in England and Wales, has been approved in Scotland. The National Institute of Clinical Excellence (Nice) provisionally ruled that Tocilizumab was too costly for NHS patients south of the border. However, the body's Scottish equivalent has recommended patients in Scotland be treated with the drug.
The doctors' union claims that England's medical records database is being pushed through too fast, with details sometimes being uploaded without patients' knowledge. But those behind the new system say many patients are astonished that hospital doctors still do not have access to basic information, and the process to opt out is very straightforward. What are the issues?
Doctors leaders have called for a halt in the development of a medical records database for patients in England. The British Medical Association says the computer-based Summary Care Records are being set up at "break-neck speed", sometimes without patients' knowledge. Ministers have expressed surprise at fears of fast change after previous criticism that it was moving slowly. The NHS IT upgrade will link more than 30,000 GPs to nearly 300 hospitals through an online appointments system. It will also feature a centralised medical records system for 50 million patients, e-prescriptions and faster computer network links.
At least 100,000 non-medical staff in NHS trusts have access to confidential patient records, claim campaigners. Big Brother Watch, who based the figure on 151 responses from trusts, said it demonstrated "slack security". The group says hospital domestics, porters, and IT staff are among those with access to records in some trusts. The Department of Health says the report muddles paper files and the newer electronic systems for which access will be strictly controlled. Big Brother Watch asked every NHS Trust in the UK for the number of their non-medical staff who had access to confidential patient records.
Checklists that spell out exactly how to care for patients with common conditions have dramatically reduced hospital deaths, say doctors. The British Medical Journal reported a 15% fall in the number of people who had died at one north London hospital trust using so-called care bundles. These are checklists covering dozens of conditions including strokes, heart failure and MRSA infections. The researchers said death rates could be "halved" using the system.
This article examines the implications for patient care, and for the future of rationing within the NHS, of the recent decision to permit NHS patients to supplement their care by paying for medicines — mainly expensive new cancer drugs — which are not available within the NHS. The starting point is the recommendations of the Richards' Report and their implementation through new guidance issued by the DoH and NICE. Practical challenges arise from the insistence upon the 'separate' delivery of self-funded medicines, and more flexible cost-effectiveness thresholds for end of life medicines may have repercussions for other patients. While undoubtedly part of the trend towards explicit rationing, top-up fees might also represent a significant step towards regarding the NHS as a core, basic service. Finally, the issue of top-up fees is located within the broader context of current cancer research priorities and persisting health inequalities.
GPs are considering whether to abandon their involvement in a scheme to put medical records on a computer database. BBC News understands that talks are continuing to try to make it easier for patients to opt out of the system. Thirty million people in England have already been formally contacted about the computer record. Health ministers from the coalition government insist the rollout will continue.
Although the number of patients seeking treatment elsewhere in the European Union is small,3 this could easily change, especially if people are faced with growing waiting lists or other forms of rationing as the new groups seek to control their budgets. British residents have had the right to obtain treatment in another EU country since 1971.4 Initially, the opportunities were limited mainly to people who fell ill when abroad or, less often, when the NHS agreed that there were good reasons for patients being treated abroad (for example, a citizen of another country resident here returning home to give birth
Patients in England will be able to inspect and correct their NHS and social care records online from 2015 if the coalition government’s vision for the use of IT in the NHS becomes reality.
National efforts to improve care at the end of life should be speeded up to maintain the progress made in some parts of England, it has been claimed. The health policy think tank the King’s Fund has warned against a loss of momentum on England’s end of life care programme in a new report published this week and has questioned the government’s intention to leave a review of this area until 2013. Around 500 000 people die each year in England. More than half (55%) of deaths occur in hospital and only 20% at home. The government has said that several surveys have shown that most people’s preference is to die at home.
The medicines watchdog, NICE, is to lose its power to turn down new medicines for use on the NHS. It will give advice on which drugs are effective, but will not decide whether patients should be given treatments their doctor recommends, the Department of Health has confirmed. Instead, groups of GPs will decide whether a drug should be funded or not. Ministers hope to make new drugs affordable to the NHS by negotiating with pharmaceutical companies on price. The plans, called value-based pricing, are set to come into effect in 2014. They are subject to consultation.
All new IVF treatment will stop in Surrey as the NHS tackles a deficit this year of £125m. The board of NHS Surrey met in Cobham on Friday to look at how to tackle "serious financial challenges". A spokesman said current courses of IVF would continue and women nearing 40 would still be considered, with IVF policy to be reviewed next November. NHS Surrey is also no longer funding some treatments including acupuncture and some cosmetic procedures. Treatments which would no longer be funded included male baldness, facial blushing, tattoo removal and spinal epidural injections for chronic back pain.
The National Institute for Health and Clinical Excellence (NICE) has confirmed there will not be NHS funding in England and Wales for the anti-cancer drug Avastin. It is used to combat advanced bowel cancer and research shows the drug can give an extra six weeks of life. About 6,500 people per year may be eligible for the drug. But the health watchdog argued that at a cost of nearly £21,000 per patient, the drug is just too expensive.
In the recent White Paper, Equity and Excellence: Liberating the NHS, there is a commitment to providing better value from the resources available to healthcare. This requires the NHS to address variations in activity and spend. Such variations indicate the need to focus on appropriateness of care, and to investigate the possibilities that there is overuse of some interventions and that some lower value activities are undertaken. In the Atlas, Right Care presents a series 34 of maps of variation selected from topics which National Clinical Directors and others have identified as being of importance to their clinical specialty. We have worked with a wide range of teams in the Department of Health, Observatory network and primary care organisations to create this Atlas.The Atlas also contains a guide to the tools and data available for analysing health investment.
Hospitals in north Merseyside are planning to use the anti-trespass powers used to ban “hoodies” from shopping centres to shift patients who are blocking beds. NHS Sefton board papers say that from this month patients deemed fit for discharge but who refuse “transitional” care home placements will be given 48 hours’ written notice to make their own arrangements. If a patient still refuses to leave, the hospital could seek a court order for possession of their bed. A well-placed legal source told HSJ the primary care trust’s approach would rely on trespass law, which allows owners to regulate the terms on which visitors occupy their premises.
An investigation is under way into how two transplant patients were given kidneys from a donor with a rare and aggressive form of cancer. The incident at the Royal Liverpool University hospital involved organs from a woman who died at another hospital, and was later found to have had a hard-to-identify disease called intravascular B-cell lymphoma. Both patients had been preparing for live transplants from their sisters but accepted the donor kidneys instead. The recipients are now receiving chemotherapy treatment. Although cancer transmission is a known risk of transplantation among clinicians, the case raises questions about guidance to patients and whether sufficient checks are made. One senior of
NHS Blood and Transplant associate medical director Professor James Neuberger said transfer of malignancy was a very rare occurance but more organs were likely to carry diseases as donors get older. He admitted the scale of the problem was not known. A research fellow has now been appointed to find out how often infected organs are passed on to patients. Professor Neuberger said his first role was to try and get all the data together from transplant centres and then to work out strategies with clinicians to reduce risk.