Tuesday, May 12, 2009

NHS spent £350m on management consultants

They could have hired a lot of doctors and nurses for that

The NHS paid £350 million to management consultants in England last year, according to figures released today. The Royal College of Nursing said that the spending — the equivalent of 330 fully staffed 28-bed medical wards, 9,160 experienced staff nurses or 267,647 bed days in an intensive babycare unit — was "utterly shocking”.

About £273 million of the money was not related to patient care, said Peter Carter, the RCN chief executive, who obtained the figures through freedom of information legislation. The bulk of the money was spent on increasing competition in the health service and supporting bids for foundation status by NHS trusts, he added. “These figures are utterly shocking when you consider the difference that this money could have made to patients,” Dr Carter said.

“A very significant sum of money is clearly being spent on setting up competition in the NHS and pursuing foundation status, rather than being invested in patient care. You only have to look at what happened at the Mid Staffordshire NHS Foundation Trust to see the consequences of this.” A report earlier this year into up to 1,200 deaths in Mid Staffordshire criticised the trust board for being more interested in attaining foundation status than caring for patients.

The RCN believes that the total spent on management consultants in 2008/09 may be higher, as more than 40 per cent of the NHS organisations which it contacted did not provide details of their spending.

Reducing the amount spent on management consultants could deliver 11 per cent of the £2.3 billion savings demanded from the Department of Health in last month's Budget, Dr Carter said. “Before the Department of Health and local health trusts look at cutting frontline services, training budgets or new facilities, they need to look very carefully at the money spent on external advice and what value is added to the patient experience,” he said.

“When some individual management consultants are getting more than £1,000 a day to advise on finance, we must surely be able to afford improvements to the quality of patient care. “Savings in this area could contribute a huge proportion of the savings to be made by the Department of Health, without jeopardising patient care."

According to the the RCN, 39 per cent of the money spent on management consultants was allocated to market testing designed to help providers and commissioners identify the most profitable options in the NHS market. Twenty-three per cent was used to support applications for foundation status, 13 per cent to achieve “provider separation”, and 12 per cent to buy advice on the Private Finance Initiative.

The Department of Health said: “Individual NHS organisations decide how best to invest their resources to ensure local people get the best possible care and services. We expect organisations to consider value for money and patients’ interests in all aspects of their expenditure. “All spending and investment is subject to independent audit — £350 million equates to less than half a per cent of total NHS expenditure for the last financial year.”


The decline into anarchy of British schools

The need for police to be permanently stationed in British schools would have been unimaginable only a few decades ago

Police have been drafted in at almost a quarter of schools as part of an initiative to tackle classroom violence, gang membership and truancy, according to new figures. More than 5,000 state schools in England, including one in five primaries, have their own dedicated officer, it was disclosed. The Government said the number was around 10 times higher than previous estimates and insisted every school in the country could eventually get its own police officer. Labour claimed the drive improved child safety, cut expulsion rates and stopped pupils slipping into crime or joining gangs. Police also helped search pupils for weapons in some schools, ministers said.

Opposition MPs said it underlined the extent to which teachers were powerless to impose discipline. It is also feared the initiative drains limited police resources.

But Rod Jarman, Metropolitan Police deputy assistant commissioner, said: "Partnerships have helped to make the schools and the surrounding area safer places, evidenced through significant reductions in crime and antisocial behaviour and greater confidence of young people that police will deal with their issues. "Through these partnerships we are also better able tackle the causes of violent extremism and to deal with specific issues that are of concern to young people such as bullying, weapons, drugs, alcohol and gang culture."

The Safer Schools Partnership was introduced by David Blunkett, the former Home Secretary, in 2002. Under the plan, some police officers are permanently based on the school site and others patrol schools as part of their beat. Ministers said police were used to deter crime and anti-social behaviour in corridors and classrooms, stopping children playing truant and helping pupils "at risk of offending or susceptible to violent extremism or gang culture".

They are also intended to help boost relations between the police and young people and provide "specialist support" for searching pupils suspected of attempting to smuggle weapons past the school gates. Teachers themselves have already been given legal powers to search pupils' clothes, bags and lockers for knives, but research suggests many are reluctant to use them.

On Monday, updated guidance was due to be launched by the Government, Youth Justice Board and the Association of Chief Police Officers about how to set up partnerships.

A survey of police forces also showed more than 5,000 schools already have dedicated officers. Previous figures suggested the number was nearer 500. It was disclosed that 45 per cent of secondary schools and 20 per cent of primaries are now involved.

But Nick Gibb, the Conservative shadow schools minister, said it showed some schools were out of control. The Tories have accused Labour of undermining headteachers' right to expel badly behaved pupils by allowing parents to challenge rulings - leading to many excluded children being reinstated. "We have reached a sorry state when thousands of policemen are stationed in primary and secondary schools in this country," he said. "We need to give heads and teachers powers they need to install discipline and not resort to using up valuable police time."

Ed Balls, the Schools Secretary, said: "It's great news that over 5000 schools are already involved in Safer School Partnerships but I want every school to work with the police to keep young people safe and prevent problems with youth crime before they escalate." More than 5,000 state schools in England, including one in five primaries, have their own dedicated officer, it was disclosed.


Statins: life-saving wonder-drugs or just life-damaging?

Many readers empathised with Christopher Hudson when he wrote about his experience of taking statins. Here, he renews his call for doctors to take the concerns of patients more seriously

The phone calls began around breakfast time on March 12. Emails also started pouring in, to me, to our friends, to our friends’ friends and to this newspaper, which, that morning, had published my story – “Wonder Drug That Stole My Memory” – about my experience of taking statins.

It seems to have struck a nerve. Over the next fortnight, scores of people up and down the country posted comments on telegraph.co.uk about their own experiences with the same drugs. Their symptoms included forgetfulness, confusion, loss of names and words, numbness in the fingertips. Reading about my predicament seemed to have synthesised a lot of fears and emotions, ranging from bitterness towards the medical profession, to relief that their symptoms might not premise Alzheimer’s after all.

How many more people must there be who think they are alone in their suffering? Last week it was claimed that every third person in England over the age of 45 was taking statins – around seven million people. Worldwide, they are now the most commonly prescribed drug in the history of medicine. Yet, according to the Department of Health, up to 10 per cent of patients may have significant side-effects. That is to say, 700,000 Britons may now be suffering moderate to crippling pain or loss of memory or libido, after taking a drug that is hailed everywhere as the greatest pharmacological find of the 21st century.

Many of my respondents had suffered far worse experiences that anything that the doctors, the warnings on the packets or the promotional literature could have led them to expect. They claim their limbs felt like lead weights; they had lost the power of concentration, and in some cases their sex drive was affected. One man who had severe muscle pains was told by his doctor that tests in the US had revealed that statins could have the effect of “dissolving muscles”.

It sounded like science fiction – but then I spoke to my cousin, a London GP, who rang me while recovering from hip surgery. He believes that his two hip replacements were both largely down to the statins he took, which weakened the musculature of his hips and thighs.

As for forgetfulness, there were writers who could not remember their own phone number. One post read heart-rendingly, “I am 62 and have been taking high-dosage statins for 20 years following a heart attack. My high cholesterol is genetic. I have insomnia, muscle pains and serious memory loss, short and long term. I can’t even remember the events of my wedding day. My life is a closed book.”

Why has the widespread evidence of such side-effects from statin intolerance been ignored by the medical profession for so long? The nonchalance with which some GPs appear to shrug off the problem is extraordinary. As another correspondent states, “If the substance was a sweet, a drink or a foodstuff, the Health and Safety Executive would get it banned immediately”.

I believe there is a reluctance to investigate any statin-related problems properly. Too many people in the scientific and medical professions see them as drugs that can do no wrong. They are also cheap and effective, and according to the Department of Health, they save 10,000 lives a year, significantly reducing strokes and coronary heart disease. The latest evidence suggests that they may also cut the risk of deep-vein thrombosis and pulmonary embolisms.

It is no wonder, then, that having found this “wonder-drug” effective against some of the most common health problems in the industrialised world, scientists are not all that keen to criticise it. For one thing, it would be taking on the pharmaceutical giants that developed the drug; for another, as Telegraph columnist Dr James LeFanu pointed out recently, family doctors get a special payment from the Government for everyone they treat for a raised cholesterol level.

It is left up to each GP as to what constitutes a “raised” level, which may be why I came across so many “cholesterol victims” among my correspondents. I have had relatively high cholesterol for years, probably genetic, and I have always been told the same thing by GPs and Bupa doctors: 7.5 is too high, 6.5 is rather higher than it should be, and if you can bring it down to a level of 5.5 that would be just fine. Yet there are patients here being treated with statins for mildly high blood pressure when their cholesterol level was at 4.3 or lower. These pills are handed out like Smarties.

Despite the mounting evidence of problems, the medical profession seems alarmingly relaxed about the risks. The other day I happened upon a six-year-old transcript of a BBC radio phone-in show on statins. A cardiologist was present in the studio. Everything was going swimmingly until a lady from Powys said she was getting terrible muscle pain in her thighs after taking the drugs. “I couldn’t lift my foot off the ground,” she complained. “I couldn’t get on and off the loo; let’s face it, I couldn’t even put my knickers on.” The cardiologist tried to reassure her. “In less than one person in a thousand, quite literally, less than one person in a thousand, do statins cause a serious inflammation in the muscles,” he said.

Today, the figure has risen to as many as one in 10. But just the other day, on a BBC ask-the-doctor website, a consultant was, to my mind, downplaying the side-effects. “Tummy upsets, aches, muscle aches and liver problems are among the common side effects of statins,” she stated airily. “Most of these settle with time.”

This is not good enough. Statin 'victims’ deserve better. For one thing, they need more answers to crucial questions, such as what alternatives there might be to statin therapy – such as fibrates or diet, for example – and how successful they are. The British Heart Foundation says that tests can be done to identify those patients at greatest risk of side-effects; if so, why are they not widely utilised? The Department of Health refuses to commit itself on alternatives to statins, saying only that there is a range of cholesterol-lowering treatments that can be used in cases of statin intolerance, and patients should consult their doctors about which one is most appropriate.

Many of those who responded to my article recommended a range of alternatives. My favourite came from Father Ignatius Brown: “Red wine, dark chocolate, porridge, fresh air, long walks, small amounts of cheese made from unpasteurised milk, plenty of leafy greens, wild salmon, berries – and laughter”.

For my part, I believe that I haven’t fully shaken off the effects of my encounter with statins, and I don’t know whether I will. What I do know is that there is a dark and growing underside to the “wonder drug” that needs to be exposed and more fully researched.

• A doctor writes...

A year ago I wrote an article in the Telegraph advocating the greater use of statins. Therefore, I feel obliged to respond to Christopher Hudson's concerns. Statins were first developed in Japan in the late Seventies. Today they are taken by tens of millions of middle-aged and elderly people worldwide. In the last 20 years, the use of statins has increased exponentially. So what impact have they had at the frontline of the NHS, in the emergency rooms of our District General Hospitals?

In the last 10 years death rates from coronary heart disease (CHD) have fallen by 46 per cent in people under 65. The decrease in mortality is greatest in the over 55's, and is due to a reduction in the major risk factors such as smoking, improved treatment in the immediate aftermath of a heart attack (eg clot-busting drugs), and widespread secondary prevention, including statins.

The figures are conclusive: we are winning the battle for our arteries, and statins are one of our most powerful allies against heart attacks, strokes, and other vascular diseases. We have enormous amounts of data on statins now, confirming that they are safe to take [How can this guy utter such obvious lies??], and that their benefits far outweigh the well-documented risks.

All drugs have side-effects, and with every prescription he or she writes, a doctor is making a risk-benefit analysis. The most significant side-effect of statins is a reversible inflammation of muscle which is seen in less than 0.01 per cent of recipients. As with every drug, extreme side-effects are occasionally reported: in the case of statins there have been fatalities due to renal failure with an incidence of 0.15 cases per million prescriptions. Abnormalities in liver function are also recognised but rarely significant, and almost always reversible on cessation of medication.

Memory problems are a rare but serious side effect of statins. Patients who are concerned about this aspect of statin medication, should consult their GP and consider a "drug holiday". The vast majority of side-effects would be expected to resolve within the course of a month and if symptoms persisted then other causes should be considered. In those at risk from vascular disease, memory problems are common after middle-age and often a result of damage to small blood vessels in the brain by high blood pressure and atheroma. In this case, it would be an error to attribute a poor memory to a side-effect when, in the majority of cases, the drug is protecting against further damage to our brains.

Let us return to the statistics: CHD is the most common cause of death (and premature death) in Britain; 1 in 5 men and 1 in 6 women die from CHD, and it causes 101,000 deaths here annually. Each year, 130,000 people succumb to strokes, and it is the biggest single cause of serious disability in Britain. In my view, and that of most doctors, the risk-benefit analysis for statins is favourable.


What the ignoramus doctor above omits to mention is that there is much evidence to show that high cholesterol does NOT elevate the risk of heart disease. Statins cure an imaginary problem. Heart disease is a big problem but statins are not the answer. The cholesterol/heart disease connection is a tenacious theory, nothing more

Getting real about the urban heat island effect

A MUCH higher estimate here of the urban heat island effect than Warmists normally allow. Jones and Wang argued for just half a degree and it is their work that dominated the IPCC conclusions

LONDON and other cities could see summer temperatures rise to more than 10C above those in the surrounding countryside, according to Met Office research being used to help devise the first official climate change map of Britain. Scientists have been studying a phenomenon known as the urban heat island effect, in which cities become significantly hotter than the areas around them because of the heat they generate themselves.

Big cities such as London, Birmingham, Manchester and Glasgow already reach temperatures 2C - 3C above their surroundings in the summer. Scientists fear that difference could grow four to fivefold as hotter weather combines with soaring energy use and population growth, making such temperature gaps more frequent and more extreme.

The research is linked to a wider project aimed at helping scientists predict the impact rising temperatures will have on different parts of the country. The full results will be released next month by Hilary Benn, the environment secretary.

Vicky Pope, the head of climate change advice at the Met Office, said: “As the climate gets warmer, sweltering summer temperatures will combine with rising energy use, the heat-retaining properties of buildings, and the sheer volume of people, to push temperatures higher and higher. “It may sometimes make life in the metropolis intolerable. Imagine the scorching conditions that commuters will face on London’s Tube network.”

The warning follows the disclosure by the Intergovernmental Panel on Climate Change that global temperatures have risen by almost 1C since preindustrial times. The panel predicts global temperatures will have risen by 2C by 2050 with total warming of up to 5-6C possible by 2100.

Such findings are now widely accepted but questions remain, especially regarding the impact on cities, where more than half the world’s population live. New York – hotter in summer than British cities - is regularly 7C-8C hotter than nearby rural areas.

In Britain, 90% of the population lives in urban or suburban areas so the impact on people is potentially huge. The research is based partly on data from heatwaves, such as the one in 2003, and on computer projections. It also looked at cities such as Athens and Beirut which suffer from the urban heat phenomenon. The August 2003 heatwave saw England’s daytime temperatures top 30C for 10 days and exceed 35C in many places. The same heatwave saw temperatures in the upper 30Cs in the centres of cities such as London, Birmingham and Manchester. This was often 6C-7C above those in rural areas.

Researchers fear central city temperatures may exceed 40C as the century progresses. “The high temperatures of 2003 were extraordinary but may become common by 2050 and even be seen as relatively cool by 2100,” said Pope.

One of the factors that made London so hot was its inability to cool down. At night during the heatwave, the city centre was sometimes 9C warmer than its surrounding green belt. This is because rural and suburban areas lose heat at night but in cities the materials used for hard surfaces store more solar energy and lose it more slowly. This effect is amplified by the heat from lights, electrical equipment and cars. Also, as cities get warmer, they consume more power trying to stay cool, because of air-condition-ers and fridges working harder.

Richard Betts, head of climate impacts at the Met Office, who oversaw the research, said Tokyo showed what British cities might face. Its tall, densely packed buildings and high energy use mean the Japanese capital is often 10C hotter than the surrounding countryside. [Yet Tokyo is thriving! How odd!!] “We must change how we plan cities, to maximise green spaces and create structures that dissipate heat,” said Betts.

Urban heat islands have a serious impact on health. In 2003 there were 2,091 more deaths than normal between August 4 and 13 in Britain, most of them among elderly people in southeast England. For people aged over 75 there was a 33% increase in mortality.


The new morality: You can say what you like but nobody must be upset

Particularly if they can afford to sue:
"Oscar-winning British actress Kate Winslet is suing a UK tabloid newspaper for the "unpleasant and nasty way" in which it reported about her fitness regime. Winslet, 33, claims that the Daily Mail article "injured her personal and professional reputation". She is suing the paper for libel damages of 150,000 pounds ($298,240).

In the feature article, headlined Should Kate Winslet win an Oscar for the world's most irritating actress?, it was claimed that the star had underplayed the amount of exercise she needed to stay in shape. It disputed a quote given to Elle magazine, in which Winslet said: "I don't go to the gym because I don't have time, but I do Pilates workout DVDs for 20 minutes or more every day at home."

According to the court papers, Winslet said she was particularly upset by the "very unpleasant and nasty way" in which the article was written."


I never thought I would agree with Perez Hilton on anything but I do on this

The fruit of Leftist moral relativism: "A "decade of yobbery" under Labour has seen the number of persistent young offenders plaguing Britain's streets increase by 60 per cent while the number of crimes they commit has almost doubled. In one police force they account for one in seven offences brought to justice while another saw the number of problem offenders more than treble. A persistent young offender is anyone aged 10 to 17 who is guilty of at least one offence on four or more separate occasions within a set number of years. The figures show the problem is growing suggesting a new generation of serial criminals committing more and more crime. David Ruffley, the Conservative police reform minister, said: "These new figures show that Labour Ministers have presided over a decade of yobbery, fuelled by massive increases in the number of repeat young offenders. "These figures make a mockery of Labour's promises to tackle youth crime. There have been 46 Labour strategies since 1997 to try and tackle youth crime and it's now clear they have failed."

British Labour party response to fraud revelations? A coverup: "A Labour plot to suppress the future release of MPs’ expenses has been uncovered by The Times. As the frenzy over MPs’ claims continues into a fourth day, senior figures from all parties will meet this morning to discuss how to salvage Parliament’s battered reputation and it emerged that the tax authorities are expected to investigate whether MPs have breached the law. Plans to bring in a private-sector company to run the expenses department have raised fears, however, that the move is being used as a smokescreen to suppress future embarrassing revelations."

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