Sunday 30 June 2013

League tables.


If you have been sharp, you will have noticed that I haven’t been campaigning for surgeons statistics to be made available to the general public.

This week, that’s what started, beginning with Vascular and Cardio Vascular surgeons. They have a right to opt out, but the pressure is on them not to.

Don’t get me wrong, I think the ‘league tables’ are really important but not for the likes of us.

The importance is that the NHS keeps a watch on surgeons relative outcomes.

The figures should be available to the profession – in my experience Doctors are, if anything, too competitive. Peer pressure is an important control which will ensure that those with poor outcomes will be encouraged to pass on patients to specialists.

It’s also very important that each surgeon has the figures – that will encourage them to pass on cases beyond their competence – to improve their averages.

So, all that is good.

What isn’t good is giving them out to the public – it only helps the pushy, arrogant, middle class patient scrambling to get some advantage for themselves or their relations and devil take the hindmost. In a time of scarcity it guarantees that the disadvantaged will be further disadvantaged.

That’s been the effect of publishing school league tables, it won’t be any different with health, because it isn’t going to bring about any increase in spending or the fairer allocation of scarce resources.

That’s why I haven’t been campaigning for it and I’m saddened that it is happening now.

Neil Harris

(a don’t stop till you drop production)
helpmesortoutthenhs@blogspot.com

Thursday 27 June 2013

Off to Dubai - the NHS will pay.


This article is another Daily Telegraph Exclusive – an undercover exposure of the [alleged] sharks of the Pharmaceutical Industry and how they prey on the NHS [allegedly] depriving the NHS of many £millions;

 

Hallelujah: £120 for drugs that cost pennies.

Telegraph.co.uk  Sunday 23 June 2013

 

It was a warm spring day in Newcastle and the conservatory overlooking the manicured grounds of the hotel was full of couples eating lunch in the sunshine.

By Holly Watt, Claire Newell and Ben Bryant

At a table at the rear of the hotel’s restaurant, a middle-aged executive from a leading pharmaceutical firm was attempting to secure a lucrative contract to provide NHS prescription drugs to a new firm of high street chemists.

His company, Quantum Pharmaceutical, one of the biggest specialist drugs firms in the country, had recently spent £150,000 taking a group of chemists to Verbier, Switzerland, for 10 days of skiing. No one had to “put the hand in their pocket”, he boasted.

Last year, they had taken clients to Sardinia, while another group was soon off to Dubai for a “party”. Leaning forward, Leo McDermott, the business development general manager, explained, “I’m trying to paint you a picture of what we’re like and how we do business.

“In your position, doing what you’re doing, you could have the biggest parties of your lives in the next couple of years.” “I’d jump through all hoops [to] get your business,” he said with a smile.

However, there was no “business” to win. Unknown to him, the people sitting opposite him were not prospective clients but undercover reporters investigating how drugs companies are offering “incentives” to win contracts in a lucrative part of the pharmaceutical industry – providing “specials” to the NHS.

A whistle-blower working in the medical industry contacted The Daily Telegraph with concerns that specific pharmaceutical companies were colluding with some chemists to exploit the NHS pricing system that covered specials.

Following the allegations, Daily Telegraph reporters posed as representatives of an investment group in the process of buying pharmacies. They arranged meetings with five companies to discuss “deals” available to potential clients and found that companies were prepared to offer “incentives” and large discounts to win business.

The market for specials is keenly chased by drugs firms as – despite it involving taxpayers’ money – “the profits are very high”.

In 2011, the government tried to clamp down on how much drug firms could charge for each item and introduced a tariff that capped the price of some of the most popular products. There are currently 148 products covered by the tariff, with more than 20,000 off the list.

Despite the steps the government has taken to reduce costs, some pharmacists and other medical sources have expressed concern that the drug tariff prices have been set artificially high because the NHS uses data supplied by the companies who were previously selling the items for thousands of pounds. When one of the reporters asked Mr McDermott how the tariff price was set, he replied, “We can make these products for pennies. “So for them to come in and say on these lines, they’re £100 there, £120 there, £75, it was hallelujah.”

If a product is on the tariff, the pharmacist is able to claim the full amount even if they have not spent this money buying the drug. They are also given £20 as a dispensing fee to cover the cost of dispensing the product.

Such are the profits to be had, chemists are being offered lucrative “incentives” as drug firms compete for the business. When the reporters met Dhruv Patel, the head of unlicensed pharmaceutical sales at Pharmarama, he revealed that deals were available for “big customers”.

 

“We do sometimes hold box seats at Old Trafford, Arsenal, Tottenham, places like that, and so you have lunch with the players, and enjoy an afternoon, watch the match, and come back. We do rugby as well, we do rugby and cricket,” said Mr Patel. “It’s a thank you.” The executive also said that the company held training for its clients in “nice hotels” every six months.

When a reporter asked if the events were held in the Caribbean, Mr Patel replied: “It could be. Depends on your spend. Might be a first class ticket.”

However, Mr Patel was keen to stress that the system was above board. “We’re not sort of bribing anyone. You guys are already doing the business with us and it’s a thank you,” he said.

Mr McDermott from Quantum was keen to offer the reporters similar perks to win their business with conferences held in the tropics. “I’ll take you anywhere. But be careful. You’ve got to be careful, in the pharmaceutical world now, because there are new rules, laws and regulations and things, but conferences can be anywhere. The last one was in Vietnam.”

A spokesman for Quantum said that Mr McDermott’s suggestion that he would take the reporters “anywhere” was untrue and the company would “never” do this.

They said it was untrue that the company produced drugs for “pennies” and that they were “confident that the “NHS and taxpayer get good value for money”. They added that the Department of Health set the tariff price.

All the companies said they fully complied with their obligations under the Bribery Act.

 

Neil Harris

(a don’t stop till you drop production)
helpmesortoutthenhs.blogspot.com

Wednesday 26 June 2013

Pharmadiddle.


So, how do you go about ripping off the NHS?

You set up a Pharmaceutical supplies company.

Don’t bother with everyday drugs – they have a set pricelist.

Go for ‘special drugs’ – they are for patients who can’t use the ordinary stuff – patients who have allegies or other problems in taking conventional medication.

Sell the drugs to pharmacists but don’t just send an invoice – send two invoices.

One is for what you are really going to charge the Pharmacist, the second invoice is the one the Pharmacist declares to the NHS.

Kerching!!!

The problem is it happens to be fraud.

The story comes from ‘Public Service’, but they lifted it from The Daily Telegraph (21/6/13);

“Pharmaceuticals companies have been accused of colluding with pharmacists to ensure the NHS pays far more for its drugs than it should, it has been alleged, resulting in hundreds of millions of pounds of public money being wasted.The Health Secretary Jeremy Hunt has said that if this is true it is "appalling" and ordered the alleged fraud to be investigated by NHS Protect.

The claims relate to 'special' prescription drugs that are not controlled by national NHS price regulations. The allegations were made after undercover journalists working for The Daily Telegraph secretly recorded drugs company representatives apparently saying they would raise an invoice for twice the price of the drugs so that the pharmacist could overcharge the NHS.

According to the newspaper Dhruv Patel, head of unlicensed pharmaceutical sales from Pharmarama International, said: "You get an invoice with a price which you stamp and submit [to the NHS]." The chemist would then be given a "credit note" by the company which "will show what you pay us and that's 50 per cent less than the value of the invoice".

And Zaheer Mushtaq, an executive from Temag, was quoted as saying: "There are some customers that are on the rebate system. They have a before and after discount price. Almost like a duplicate invoice if you like – so they can see the amount of discount that they're getting. Generally what would happen, the pharmacy will then just generally put the higher one in… and then obviously leave the remainder as the profit for the pharmacy."

 

In response to the newspaper reports, a spokesperson for Pharmarama International said: "Our initial enquiries suggest strongly that the issue at stake relates to inappropriate and over-enthusiastic claims made at a sales meeting."

And Magdalena Kulbat of Temag said: "It would be totally unrepresentative to make any suggestion that we are involved in any sort of practice to unfairly charge the NHS."

p

       BOOK ‘EM DANNO !

Neil Harris

(a don’t stop till you drop production)

Monday 24 June 2013

Book 'em, Danno.


I took this posting off my other Blog

 because I’m going to do some Posts about how drugs companies have been ripping off the NHS – that’s you and me and patients like us.

     FROM OUR FILES

15    

   THE HIDDEN TRUTH  

This is a quote from Reuters (I love the sound of that), back in April 2013, it illustrates how multi-national drug companies are alleged to rip-off our NHS.

GSK had patents on a drug which were due to run out. When that happens, other drug companies make cheaper copies which the NHS buys for us instead. It’s like supermarkets own brands.

GSK are alleged to have offered ‘bribes’ to those companies to postpone selling us the cheap copies.

The allegation is that when this drug’s patent ran out it was three years before cheap copies were available. During that time GSK made £100million a year, which they otherwise wouldn’t have made and which we paid for;

LONDON (Reuters) - The Office of Fair Trading (OFT) accused GlaxoSmithKline of market abuse for striking deals with three generic drugmakers that paid them to delay launching cheap copies of its antidepressant Seroxat.

GSK, Britain's biggest drugmaker, said it believed it had acted lawfully. If it is found to have broken the law, it could be fined up to 10 percent of its worldwide turnover, which amounted to 26.4 billion pounds in 2012.

The move by the OFT is the latest example of regulators trying to curb "pay-for-delay" deals, following a series of investigations against drug companies by U.S. and European antitrust officials.

The OFT alleged on Friday that GSK concluded anti-competitive agreements with Alpharma, Generics (UK) and Norton Healthcare over the supply of paroxetine - a top-selling medicine sold by GSK under the brand name Seroxat.

The case relates to deals struck a decade ago. The patents protecting paroxetine - known as Paxil in the United States - have now expired and the supply agreements under investigation were terminated in 2004.

The OFT said the agreements included substantial payments from GSK to the generic companies in return for their commitment to delay launching their products. This amounted to an abuse of GSK's dominant market position, it said.

GSK disputes the allegations, which relate to deals that were effective between 2001 and 2004.

"GSK supports fair competition and we very strongly believe that we acted within the law," the company said, adding that the deals resulted in generic versions of paroxetine entering the market before GSK's patents expired.

GSK also said the paroxetine case had been reviewed by the European Commission in 2005-2006 and the EU body, which acts as antitrust regulator, formally concluded its inquiry last year with no further action.

"The introduction of generic medicines can lead to strong competition on price, which can drive savings for the NHS, to the benefit of patients and, ultimately, taxpayers," said Ann Pope, senior director of services, infrastructure and public markets at the OFT.

(Reporting by Ben Hirschler, Editing by Erica Billingham)

Oh and when I say ‘alleged’, what I really meant to say was;

p

       BOOK ‘EM DANNO !

Neil Harris

(a don’t stop till you drop production)

Thursday 20 June 2013

The trouble is, we all got iller.


VHOLD THE

    FRONT PAGE !

This is an edited version of a ‘Mail on Sunday’ article by David Rose, published on 11the May 2013. It is very disturbing, using Freedom of Information material he has charted the dramatic rise in death rates amongst emergency cases in the Newark area, since the A and E at Newark Hospital closed and these people now have to be taken to hospitals much further away.

I’ve already posted the lengthy comments by Dr Claire Gerada – they are well worth reading.

Of course, it’s what campaigners have been saying for years. It’s common sense. But to prove common sense you need big double blind studies over many years, costing huge amounts of money and subject to rigorous peer review. None of that is ever going to happen and we just don’t have time anyway.

Shutting hospitals and A and E’s is so much simpler;

 

Death rate jumps more than a THIRD after department closes

  • Health Minister orders investigation as Mail on Sunday uncovers rise
  • Data revealed under FOI rules show 37% rise in emergency patient deaths
  • Accident and Emergency in Newark, Notts, closed two years ago.

11 May 2013

By David Rose

 

The Mail on Sunday today reveals the first shocking evidence that hospital casualty department closures are costing hundreds of lives.

Official figures uncovered by this newspaper show a 37 per cent rise in death rates for emergency patients from Newark in Nottinghamshire, where the Accident and Emergency unit closed two years ago. 

The figures, obtained under the Freedom of Information Act, come from the NHS trusts where Newark patients are now sent. They amount to the first authoritative study on what can happen when an A&E shuts.


Increase: The number of emergency patients dying since Newark A&E closed has risen by more than a third



Data: The Mail on Sunday obtained statistics on death rates from NHS Trusts

They show:

  • Of 5,441 Newark patients admitted for emergency treatment last year, 264 died – 4.85 per cent. Yet in 2009, when there were 5,431 emergency cases, just 192 patients died – 3.53 per cent. That was the year before NHS chiefs decided to close Newark A&E, promising ‘more lives being saved’. If the percentage rate had stayed the same after the closure, that would have meant 72 fewer deaths last year – in just one area, and in just one year.

  • When Newark had its own A&E  its death rate was lower than in nearby areas – despite the fact that the town has a higher than average elderly population. Now the Newark rate is higher.

  • Like other hospitals where A&Es close, Newark General now has only a so-called urgent care and minor injuries unit – banned from treating life-threatening conditions.

Having initially refused to investigate the MoS findings, health chiefs had a change of heart last night and, at 8pm, pledged to examine our evidence.

A spokesman for Health Secretary Jeremy Hunt said: ‘We always take changes in mortality data seriously and will look into the case in Newark in more detail.’

The U-turn came after doctors’ leaders said the data suggested the policy of axing A&E units was placing lives in jeopardy. They called on Mr. Hunt to order an immediate moratorium on further closures until more is known about their likely effects.

Their call was echoed by Tory MP Andrew Percy, a leading member of the Commons health committee.

Mr. Percy said: ‘These shocking figures confirm what many local people already suspected. Shutting local A&E Centre’s does not improve patients’ survival changes, it dramatically worsens them. 

‘There should be no more such closures until we have a thorough review of this policy.’

Mr. Percy said the closure policy was begun under Labour and ‘regrettably’ not reversed by the Coalition.

Even a former Coalition Health Minister said the closure programme should now be reviewed.

Liberal Democrat MP Paul Burstow, the former Care Services Minister, said: ‘I find these figures on death rates very worrying. ‘I do have misgivings ... it is now time to review the whole approach.’

Chairman of the Royal College of General Practitioners Dr Clare Gerada said yesterday: ‘The Newark data revealed by The Mail on Sunday points to a close association between A&E closures and mortality. It is clear the provision of emergency care is in crisis across the whole of the NHS.

‘Before any further closures are contemplated, there must be a full, independent assessment of their impact on patients and on the system as a whole.’


IN RESPONSE...
Throughout yesterday Mr Hunt’s spokesman said the Health Secretary would not answer these questions as, she said, this newspaper had not established that Newark’s rising death rate was caused by the A&E closure – because the rise began in 2010, the previous year. 

Yet the figures reveal admissions there were already falling. With the axe poised over the department, ambulances were being told to take serious cases elsewhere.

But at 8pm last night Mr Hunt’s department changed its position.

A spokesman said: ‘We always take changes in mortality data seriously and will look into the case in Newark in more detail.’

She added that a closure in one hospital was likely to worsen the pressure elsewhere.  

One consultant from North-West London, where five out of nine A&Es are set to be closed, said: ‘Newark tells us what happens when you close an A&E. As a frontline hospital consultant, these excess deaths are no surprise to me, and they clearly demonstrate the risk.’

The figures – which detail the number of patients who die within 30 days of admission to an A&E unit – have come to light in a week when Ministers have finally admitted that emergency provision nationally is in deep crisis.

There has been a doubling of the number of patients forced to wait more than four hours for treatment over the past 12 months.

David Prior, head of NHS watchdog the Care Quality Commission, has said the entire health system is ‘at the brink of collapse’ because of the pressure on A&E. 

Yet in the face of this crisis, health chiefs are pressing ahead with an unprecedented programme of A&E closures and downgrades.

As this newspaper and its readers have been saying for the past 11 months, this is soon set to affect no fewer than 34 hospitals.

One of the most shocking aspects of the cuts is that there has never been any independent academic study of their potential impact.

This means the arguments made by supporters of the closures – that most patients will be better served by travelling to ‘superhospitals’, even if they face longer journeys – have to be taken largely on trust.

There is evidence that some patients, such as stroke victims, are more likely to survive if taken immediately to major Centre’s where they can receive specialist treatment, rather than an ordinary A&E. Indeed in Newark stroke death rates have declined slightly.

But other research, led by Professor Jon Nicholl of Sheffield University, has found that overall, mortality will increase with longer ambulance journeys.

Further FOI data shows the average time between a 999 call in Newark and transfer to A&E at King’s Mill Hospital, near Mansfield, or Lincoln Hospital is almost two hours. In ten per cent of cases it is nearly three hours.

These hospitals, where most Newark emergency cases now end up, are both more than 20 miles away, along roads which can be difficult even for an ambulance with a blue light.

Professor Nicholl said: ‘The research indicates there is a relationship between the distance to hospital and mortality.’

Dr Clive Peedell, a consultant oncologist who is also co-leader of political party the National Health Action Party and chairman of the NHS Consultants’ Association, said it was now evident that pressing ahead with further closures would be ‘disastrous’.

He said: ‘There is no evidence base to justify what they are doing. In A&E trauma cases, doctors talk of the “golden hour” for treatment when patients’ chances are maximised. If it’s taking nearly two hours to reach hospital, mortality is bound to increase.’

In the case of Newark, The Mail on Sunday can reveal that David Bowles, the former chairman of the trust which runs Grantham and Lincoln hospitals, warned senior NHS management that increasing the burden on services there would have disastrous consequences.

He said that when closing Newark’s A&E was first mooted in 2009, he had warned the now-disbanded East Midlands Strategic Health Authority (SHA), the body which pushed through the closure, that Lincoln Hospital was already ‘close to a tipping point’ because its patient load was so great.

‘There were no vacant beds at all, and yet the SHA was saying we had to admit more patients,’ he said. In such circumstances, it was likely that patients would be sent to the wrong ward, and the control of ‘superbug’ infections would suffer, along with patient care in general.

Mr Bowles’s concerns were ignored. Now, in the wake of the Mid-Staffordshire hospital scandal, both Lincoln and King’s Mill are among 14 hospitals being investigated over ‘excess’ patient deaths.

Meanwhile, a report commissioned by the Say Yes To Newark campaign from independent health think-tank Dr Foster has found ‘higher than expected mortality’ among emergency case patients from the NG23 and 24 postcodes treated at Lincoln from 2008 to 2011. Doctors in other areas facing A&E closures now fear similar consequences. 

The trusts which run the hospitals where Newark patients are treated refused to comment yesterday.

They referred questions to Amanda Sullivan, chief officer of the Newark and Sherwood Clinical Commissioning Group – the GP-led body now responsible for buying hospital services in the area.

She claimed the increase in mortality was caused by Newark patients being ‘ill-er’ than they used to be because they have aged, while the criteria for admitting emergency patients to hospital had become stricter.

Those who might have been given beds in the past were now sent home, so that those who were admitted were ‘more likely to die’.

She admitted she had no hard data with which to back her assertions, but she insisted: ‘I don’t think the change [to Newark A&E] has worsened mortality.’

Last night a spokesman for Mr Hunt pointed out that the death rate increase began in 2010, the year before the A&E closed.

'MY MOTHER HAD TO TRAVEL 20 MILES AND DIED IN MISERY'

Muriel Powell, 85, was one of thousands of emergency patients affected by the closure of Newark’s A&E in 2011. 

She had been in good health, but when she started to cough up blood, her family dialled 999. 

A paramedic in a car was soon on the scene, but Mrs Powell had to endure a long wait for an ambulance to take her to Lincoln, more than 20 miles away.

Her daughter Pauline said she was eventually diagnosed with leukaemia. ‘They were constantly taking bloods, causing her great pain.

'No one lives for ever. But you do expect people at the end of their lives to be treated with dignity and compassion. That didn’t happen. My mother died in misery.’ 

In 2011 and 2012, Lincoln Hospital admitted 1,800 Newark emergency cases a year.

A staggeringly high proportion – 8.15 per cent in 2011 and 7.82 per cent last year – were dead within 30 days.

This is more than double the average death rates at Newark when it had its own A&E.

The original is at the Mail.

Neil Harris

(a don’t stop till you drop production)Top of FormBottom of Form
helpmesortoutthenhs.blogspot.com

Monday 17 June 2013

A tale of two countries.


Now everyone wants to shut down our hospitals – NHS managers meeting at their conference, the Royal College of G.P’s, M.P’s. Everyone except me.

Has no one learnt from the last time? It didn’t work then; have a look at ‘Merger Mania’, my series of articles based on an academic study into the wholesale closure of hospitals in the early years of the Blair government and the similar process in America in the Reagan era. This study showed that the closures did the opposite of what was really intended; standards fell, outcomes worsened, management costs increased.

Specialisation is sometimes a good idea – for planned operations and for treating strokes. As we learn more, we will probably realise that there are other specialisms that should be dealt with on a more centralised, specialised basis. There are many other procedures that are better done locally.

None of us would have chosen the system we have – If I had the choice I would go for a system of local ‘Polyclinics’, state run centres dealing with all first aid, minor operations, GP services, dentistry, pain relief, ante/post natal, community mental health, chiropody, pharmacy, hearing aids, opticians, you name it. A one-stop health shop.  Something much more than a General Practitioners but less than a hospital. Open till late, it would deal with all the walking wounded.

Hospitals would be centred around ambulance/paramedic initiated Accident and Emergency and complex elective surgery. Surgery would be more advanced, specialised and centralised to benefit from the concentration of skills.

As it is, we are going to end up with giant, distant, remote hospitals as well as no local services. The worst of all worlds.

Of course, once we had a system of local cottage hospitals but they were all shut down against our protests, to be replaced with the big general hospitals they now want to shut down.

OK, here’s a tale of two countries –both very similar in outlook, population and with a shared history; The UK and the Netherlands.

The first table is for the UK and shows how in the Blair era we had a huge decline in the number of large general hospitals as well as an increase in private hospitals registered to do NHS work, stealing public money and jobs out of the system:

Table 2: Hospital Market Structure, England, National Health Service,

1997-2007

 

Year # NHS Hospitalsa #Mergers            Private Hospitalsb

 

1997            227                   26                           

1998            214                   21                           

1999            202                   17                           

2000            193                   23                           

2001            188                   25                           

2002            174                     6                           

2003            171                     0                             

2004            171                     0                            3

2005            171                     3                          21

2006            168                     3                          32

2007            167                     0                    

 

 

 

a Source: U.K. Department of Health. Hospitals with fewer than 5,000

consultant episodes per year are excluded.

b Independent Sector Treatment Centres. These are private hospitals

with contracts with the NHS.

 

You can see the decline in the number of general hospitals in the first column, the spate of mergers 1997 to 2001 and then in the fourth column the increase in the number of private hospitals from 2004 on.

The process has continued and is now going to increase as Trust mergers will be looking to make hospitals ‘pay’ while everyone wants to do private work.

This second table is for the Netherlands – you can see a similar process of big general hospitals closing and merging, but at the same time a big increase in the number of local clinics dealing with outpatient operations:

Table 3: Hospital Market Structure, The Netherlands,

1997-2010a

 

Year # Hospitalsb               Outpatient Treatment Centersc

1997          117                                |

1998          117                                |

1999          115                                |

2000          111                                |

2001          104                                |

2002          102                                |

2003          102                                |

2004          101                                |

2005            99                              37

2006            98                              57

2007            97                              68

2008            97                              89

2009            95                            129

2010            94                            184

 

 

 

a Source: Netherlands Healthcare Authority.

b Total # of hospitals, including general hospitals, spe-

cialty hospitals, and university medical centers. The

vast majority are general hospitals.

c Independent Treatment Centers (ZBCs). These are

freestanding outpatient treatment centers, not part of

hospitals.

127

Now doesn’t that make a lot more sense? Which country has the queues at Accident and Emergency, I wonder?

Alright, I’m biased but this process in Holland ollandHollandhas been planned for patients to get the best outcomes, rather than change by accident which is the way we have been developing our NHS in the UK.

Neil Harris

(a don’t stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com