British National Party Public Services News Bulletin w/c February 26, 2007
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1. BLAIR POLICIES DOOMING NHS

http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/02/26/hnhs26.xml

A short letter published in the Telegraph this week highlighted the contradiction inherent in the Government's attempts to improve the cost-effectiveness of the NHS. David Nunn, a consultant orthopaedic surgeon at Guy's and St Thomas' Hospital Trust pointed out that the drive to reduce waiting lists by performing more operations means that hospitals are losing substantial sums for each additional operation carried out. 'This is unsustainable,' wrote Mr Nunn. 'Tony Blair knows that his policies will lead to an implosion of the NHS but he will be out of office when it finally occurs.' What Mr Nunn was referring to is an accounting error built into the NHS, an error which means that, despite the most drastic measures, such as ward closures, staff cuts and withdrawal of certain treatments and services, the books can never be balanced. The introduction of the NHS tariff in 2002 - a standardised price list for operations and procedures to apply nationally - was intended to reform hospital accounting. It was also seen as crucial to the war on waiting lists, helping to ensure better use of beds and theatre time by allowing patients to travel around the country for their operations with the procedure being paid for by their own primary care trust (PCT). Money following the patient in this way was a fine idea in theory, but in practice the tariff has one massive flaw. Every price for every procedure on the list is a guesstimate.

No one in the whole system can say for certain that the price hospitals charge a PCT for work has any relation to the real cost of that procedure. In the majority of cases, it is simply wrong. When the tariff was first set up, financial directors from hospitals around the country were asked to submit the price they put on a particular procedure. The figures varied enormously, so the administrators took a mean figure and decided that was close enough. None of the participating hospitals performed an audit to crosscheck the figures they had submitted. No one asked the surgeons if they thought these figures were correct. Whitehall signed them off - and the price list was fixed. Mr Charlie Chan, a surgeon specialising in breast cancer at Cheltenham General Hospital, says no one has any idea how much operations really cost. Yet, as he points out, pricing them is not a difficult thing to do. 'We know the cost of running a hospital theatre, we know the costs of hip implants, for example. Even though surgeons operate at different speeds and use different quantities of sutures, it is possible to work out a consistent rate, as any 'sensible' audit would find.' Following the introduction of the tariff, hospitals managed to balance their books by juggling operations. As many as possible of the cheaper, quicker jobs, hernia repairs or bunion removals, for example, were slotted in around major life-saving procedures that cost tens of thousands of pounds. In effect, the simple operations subsidised the complicated ones.

But with the opening of independent sector treatment centres (ISTCs) - privately run clinics endorsed by the Government with the intention of helping to cut NHS waiting lists - there were fewer simple operations for the hospitals to perform. Bunion sufferers no longer had to wait or go private. They could have their operations performed much more quickly at an ISTC or at special NHS clinics established for the same purpose. The ISTCs weren't governed by the troublesome tariff system either. The NHS would pay a fixed lump sum, in separately negotiated business contracts, for the procedures to be carried out there. Economies of scale meant that a smart, bustling little unit carrying out routine surgery from 9-5, with an hour's lunch break, using cheaper, sometimes foreign staff, found it much more economical to operate on a bunion than the giant teaching hospital next door, which was paid according to the inaccurate tariff. Staff at the Royal National Orthopaedic Hospital in Stanmore, Middlesex, must deal with realities of this every day. Mr Steve Cannon, for example, runs a unit dealing with complicated sarcomas (bone and soft tissue cancers), and correcting complications of knee and hip surgery.

Cannon estimates that inaccurate pricing means he loses about £1,000 a case. 'We used to balance the books by performing arthroscopies [exploratory joint surgery],' he says. 'But if you remove these simple procedures, sending them to ISTCs or special NHS clinics, we can't make any profit. The proposed tariffs for what we have to do are inadequate. 'For an operation to excise a soft tissue sarcoma, the tariff allows £1,428 per case. Add in a minimum of three days in hospital, perhaps one night in intensive care, and a top-up payment, as it is a specialist area, and the cost we can claim is £5,216 each patient. 'At present, even with all our cost-cutting measures in place, each of these cases actually costs us £8,674. We will be short by £900,000 next year on that group of patients alone. 'Overall, we are looking at a deficit next year of £1,786,000 - all because of the tariffs. We will go on till we are bankrupt and have to close. But then where will the patients go? No one else will want to take on this work as it will cost them too much, nor will you get the same concentration of special skills. It is a horrific situation. People will suffer - this situation has become dire.' In the longer term, the impact on surgical training is also causing concern. Mr Nunn, who wrote to the Telegraph, says that so much work is being performed in ISTCs by non-NHS doctors that there is no work in hospitals for recent surgical graduates, and no jobs for them to go to. 'Not one of our graduates at Guy's has a consultant job,' he says. 'We will have a whole generation of junior doctors who won't be able to do simple operations on their own, let alone complex ones; and in turn they won't be able to train the next generation. It's self-perpetuating. This will destroy the health service.' Perhaps Tony Blair should look elsewhere for a legacy of his premiership.

2. LEADING EXPERT URGES REFORM IN NHS FUNDING

http://society.guardian.co.uk/health/story/0,,2021481,00.html

A leading architect of Tony Blair's health reforms warns in the Guardian today that the NHS will not survive as a universal tax-funded service without a change of policy. Chris Ham, professor of health policy at Birmingham University, said a 'fundamental weakness in the design of the reforms' made it impossible for the NHS to deliver the improvements in efficiency that will be needed when growth in its budget slows next year. Prof Ham, director of strategy at the Department of Health from 2001 to 2004, said the government hoped to increase efficiency by making hospitals compete for NHS patients. This gave them a strong incentive to raise quality and cut costs. But most hospital beds were occupied by patients who were admitted as emergencies - mostly older people who had no choice where the ambulance took them. They could be kept well at home if GPs, community nurses and hospital specialists worked closely together.

But Prof Ham said: 'With healthcare organisations competing with each other for a bigger share of the NHS budget, there is little incentive for them to collaborate to substitute care in the community for care in hospitals.' The government had strengthened the position of foundation hospitals and private-sector treatment centres, but gave 'scant attention' to building up the power of primary care trusts that buy services from them on behalf of NHS patients. 'This has created a fundamental weakness in the design of the reforms with the purchasers of care lacking the expertise and resources needed to make the healthcare market work efficiently,' Prof Ham said. 'The levers and incentives do not exist to reduce variations in productivity and performance on the scale needed to fund future medical advances.' His analysis reflected majority opinion among leading doctors, NHS managers and Whitehall policymakers who attended a series of private seminars at the Nuffield Trust, an influential health research institute.

The seminars, chaired by Prof Ham, concluded that the government's policies are in danger of sucking more resources into hospitals and starving primary care. He said the reforms had to be reformed to achieve a sustainable universal service and called on Gordon Brown, as chancellor and prime minister in waiting, to address the problem. The warning came as the NHS begins to prepare for the end of record growth in the health budget. Since 2002 health spending has increased by about 7% a year in real terms, but this rate of growth is due to end in March 2007. The NHS expects its subsequent funding to keep pace with the general rate of inflation, but managers fear this will be not nearly enough to keep pace with the rising cost of drugs and increasing demand from larger numbers of older people. Prof Ham said it was unrealistic to expect sufficient savings from eliminating waste or cutting bureaucracy. The only way of balancing the books was to change 'core medical processes' by winning support from doctors and nurses for new ways of working - often outside hospital, closer to patients' homes.

3. NHS DELAYING SURGERY TO SAVE CASH

http://www.guardian.co.uk/uklatest/story/0,,-6440015,00.html

Many NHS hospitals are being forced to delay operations in a bid to save money, it has been claimed. As part of an investigation by Channel 4's Dispatches programme into NHS funds, a poll questioned 60 hospitals and found 'minimum waiting times' had been imposed on 43% of them by their Primary Care Trusts (PCTs). A quarter of the PCTs questioned admitted they were demanding delays. The programme, to be broadcast on Monday night looks into why, despite the billions of pounds being pumped into the NHS in recent years, there are still huge deficits. It says GPs are being banned from sending patients for hospital treatment and hospital doctors are being asked to delay operation by 'cash-strapped' PCTs attempting to balance their books. James Johnson, chair of the British Medical Association told the programme: 'The really ridiculous thing is that in the hospital you're having to wait to go in to, the beds are probably empty, the doctors are doing nothing, the nurses are doing nothing.

'They've just been told by their purchasers not to do the work. Now that is a crazy situation which goes against absolutely everything we stand for as doctors.' Dispatches quotes North Yorkshire GP Dr Pat McGrann, who says he was sent a list by his PCT in January of procedures which cannot currently be carried out in hospital. It claims the ban is in place at least until March 31. Types of treatments to be sidelined include non-life threatening procedures such as varicose vain surgery. The programme says much of the multi-billion-pound investment has been 'squandered' on 'New Labour's complex health bureaucracy', with the large number of recent reforms leaving those running the NHS tied up in red tape. It also claims the Government's new IT system for the NHS, expensive Private Finance Initiatives and pay deals for medical staff like GPs have helped compound the problem.

4. ACADEMY SCHOOLS UNDER FIRE AGAIN

http://www.eveningnews24.co.uk/content/news/story.aspx?brand=ENOnline&category=
News&tBrand=ENOnline&tCategory=news&itemid=NOED2320Feb20200720083A413A153A237

Controversial city academies have come under fire again - just days before the launch of a public consultation into plans for one in Norwich. The proposal to turn Heartsease High School into an academy is due to come a step further in March as families, the local community and stakeholders are consulted. The news comes as the Government spending watchdog said today Tony Blair's £5bn city academies programme is raising school standards - but pupils are still failing to master the three Rs. The National Audit Office (NAO) criticised the academies scheme for millions of pounds of cost-overruns, low exam results, poor A-level provision and a failure to collaborate with neighbouring schools. Ian Gibson, Norwich North MP, has voiced his concerns about academies ever since the Heartsease plan was first mooted, in particular the effect it would have on neighbouring schools.

He said: “Given the information that's coming through and the effectiveness of the academies, they would do well to examine their bid for such a school in Norwich.” Teachers' unions and MPs have criticised the prime minister over the academies programme, which was set up to transform “failing” comprehensives in poor areas. In exchange for up to £2m, private sponsors, such as business figures and faith groups gain control of an academy, setting its ethos and appointing governors. In the case of Heartsease the sponsors are the Bishop of Norwich and city businessman Graham Dacre. In a new report, the NAO said academies cost more than other schools to build and most of the projects ran over-budget by an average of £3m. Pupils' A-level grades have been poor and GCSE results in English and maths are not good enough. Most academies are not achieving good results at A-level, and there is a risk that poor quality academy sixth-forms could even lower educational standards in the local area, the NAO said. The report also reveals that academies are being forced to restrict community groups from using their facilities in order to avoid VAT liability, despite the fact that academy buildings were always intended for community use. South Norfolk MP Richard Bacon called for the Government to resolve the tax issue and also called for better project management to stop building costs over running. He said: “VAT is stopping academies from playing a full role in their local communities.”.

The Heartsease proposal is being project managed by Cambridge Education. A spokesman for Cambridge Education, which is managing the Heartsease proposal, said: “Cambridge Education is currently managing a feasibility study for a proposed academy in Norwich. “As part of the feasibility study Cambridge Education will be undertaking a full consultation process. This is anticipated to start in March and finish in July, but we are currently taking advice on the impact of local elections on this timetable.” What do you think of the idea for an academy in Norwich? Write to Evening News Letters, Prospect House, Rouen Road, Norwich, NR1 1RE,
e-mail eveningnewsletters@archant.co.uk

5. REWARDING PUPILS HAS POSITIVE EFFECT

http://www.blackburncitizen.co.uk/mostpopular.var.1205329.
mostviewed.rewarding_pupils_has_positive_effect.php

REWARD schemes where pupils' efforts can lead to prizes are having a positive impact in Lancashire classrooms. That is the verdict of an education chief who says rewarding children for anything from good truancy records to getting better grades than expected is paying dividends. Coun Alan Whittaker, Lancashire County Council's cabinet member for schools, said: 'There's nothing wrong with a bit of encouragement. 'Parents do need to follow it up and carry on the praise when they get home.' But a parent group has blasted the reward schemes, saying pupils should know how to conduct themselves without 'needless bribery.' Nick Seaton, chairman of The Campaign for Real Education, which pushes for more parental choice in UK schools, has attacked such schemes. He said: 'It's giving out the wrong message saying you will reward children for what they should be doing anyway - it's using public money for a form of bribery.'

6. MAJOR ROW ON ROAD PRICING

The BNP is against road pricing, which is just another scheme to extract money for us to provide infrastructure we have already paid for with petrol tax.

http://www.theherald.co.uk/mostpopular.var.1204280.mostviewed.warning_major_road_row_ahead.php

By midnight tonight, around 1.7m people will have played their part in one of the most popular and unexpected experiments in online democracy the UK has had. For the past three months, from Land's End to Shetland, men and women have been putting their names and e-mail addresses to a petition on the Downing Street website calling for ministers to scrap all plans for road pricing. Tracking and billing every vehicle in the country by satellite is not only 'sinister and wrong', the new pay-by-the-mile tax will be unfair on those living apart from loved ones and the poor, runs the petition's rallying cry. The threat of paying extra for the school run or a weekend drive has generated a huge response from the public, catching the government off-guard and prompting Tony Blair to promise a reply to all who sign the petition before it closes tonight. But with the technology to pinpoint every vehicle on the road still a decade away and politicians scared of enraging the 74% of households regularly using a car, is the reaction proportionate?

The Westminster government has certainly put itself behind road pricing in theory, suggesting new charges could be offset by cutting fuel duty and road tax, and improving public transport to offer drivers an alternative. The busiest roads would be the most expensive to drive on - estimates go up to £1.50 a mile - while quiet roads, such as those in rural areas, would be priced at the lowest level or not at all. Last December, the idea seemed sealed when a Treasury report - for which read approved by Gordon Brown - warned congestion would cost the economy £22bn a year by 2025, the equivalent of £900 a household. Stephen Ladyman, UK roads minister, also declared recently that a national roads pricing scheme was 'inevitable'. However, 1.7 million angry voters are hard to ignore, and 'inevitable' covers an awfully long time. According to Paul Watters, head of roads and transport policy with the AA, a more likely short-term future is a series of local congestion schemes on the lines of the one pioneered in London by Mayor Ken Livingstone in 2003. Mr Watters said that over the next 10 to 15 years he expected Manchester to follow suit, and speculated Glasgow might dabble with the idea, despite the massive rejection of a congestion charge in Edinburgh. 'I think the government do understand motorists' sensitivities.

The sad thing about what the government is doing is that it keeps telling us road pricing is worth thinking about, yet don't tell us how it's going to work in practice. People should be sceptical but not paranoid about it.' The difficulties certainly should not be underestimated. Vast, complicated and intrusive, any satellite tracking system would also need to be backed up by a massive billing system. At the moment, the government cannot guarantee cars on the road are even taxed and insured. Why should rogue drivers be any keener to install a black box to monitor their every move, and pay up to £600 for the privilege? Moreover, despite some talk of road pricing being piloted, it would need to arrive as a big bang''. It would be impossible to cut fuel duty in some parts of the country but not others without causing yet more congestion as people flocked to trial areas to fill their tanks cheaply. Although tracking technology could be tested to generate notional bills, they would not change driver behaviour, making it difficult to say if a nationwide rollout would work. In Scotland, where car ownership is lower than the rest of the UK, congestion policy is lagging behind Westminster. In part, this is because the UK government funds work on schemes south of the border.

So far, 10 areas have been given money to develop congestion schemes, including Manchester and Bristol. In Scotland, councils have also been chastened by the backlash to the early Edinburgh proposal. Duncan McLaren, chief executive of Friends of the Earth Scotland, yesterday urged MSPs to look hard at congestion charging as an alternative to more road building. However, when our politicians debate the issue at Holyrood on Thursday, they are more likely to be looking hard at their shoes as they avoid saying anything too contentious before the election. A Scottish Labour spokesman last night said road pricing had 'not been ruled outand doing nothing was not an option', but was not ready to name his party's particular prescription. Fergus Ewing, SNP transport spokesman, said road pricing was 'plainly a possible system', but not one which energised him. The Tories are fiercely opposed to any form of road charges. The executive is pro-road pricing in theory, so long as it is part of a UK-wide scheme - as are the Scottish LibDems, although if UK reform remains 'glacial' they would lobby for road and fuel tax to be devolved in order to scrap them and go it alone on pricing.