More patients than ever waiting 18 weeks for treatment
The proportion of patients waiting more than 18 weeks for treatment has increased, official figures show. The terms of the NHS Constitution state that patients should be seen within 18 weeks.
Data for May 2011 reveals that 2.3 per cent of outpatients waited more than 18 weeks compared to 1.8 per cent in May 2010. Meanwhile 9.2 per cent of inpatients waited more than 18 weeks compared to 7.1 per cent last year.
NHS chiefs insist ‘the percentages fluctuate but remain low’ and they are committed to keeping waiting times low ‘despite rising NHS activity’.
The government said there were over 100,000 more diagnostic tests in the three months to May 2011 than in the three months to May 2010.
According to the figures, the vast majority of patients were referred to treatment within 18 weeks: 90.8 per cent of hospital inpatients and 97.7 per cent of outpatients started treatment in 18 weeks or under from referral, the Department of Health said.
Figures reveal the average waiting times for admitted patients being treated was 8.4 weeks in May 2010 and remains at 8.4 weeks in May this year.
Health Secretary Andrew Lansley said: ‘We are determined to keep waiting times low. ‘The first full year of NHS waiting time data under this Government confirms that the proportion of patients who wait longer than 18 weeks for treatment remains low and stable.
‘Average waiting times from referral to treatment are at the same levels as last year. ‘This is against a backdrop of rising demand for NHS services, so the low waiting times are a testimony to the hard work of NHS staff.’
Blindness fear as diabetics denied drug by NHS rationing watchdog
Hundreds of diabetes patients could lose their sight after the NHS rationing watchdog said it was too expensive to give them a treatment for an eye condition from which many suffer.
The National Institute for Health and Clinical Excellence acknowledged that the drug Lucentis was effective in treating diabetic macular oedema, which affects 50,000 Britons.
But in final draft guidance on the drug yesterday, it refused to make Lucentis available on the NHS, saying it was not ‘cost-effective’ compared with laser treatment.
A one-year course of the drug costs almost £9,000 per eye. The treatment, given by injections to the eyes, continues until a person achieves maximum vision.
Diabetes UK said Lucentis was the first licensed treatment to improve vision – and therefore quality of life – in those with sight loss due to DMO. It was also more effective than the laser treatment favoured by Nice.
‘This decision means more people will needlessly lose their sight,’ said a spokesman. ‘We pressed hard to make this treatment available on the NHS and we will campaign for Nice to reconsider its decision. ‘The cost of looking after people with sight loss far outweighs the cost of Lucentis treatment, let alone the human cost. We are very concerned local health services will use this decision as an excuse to stop treatment.
‘We will monitor the situation across the country closely to ensure patients currently receiving Lucentis continue to do so as per the Nice guidance. We would also like to see urgent testing into alternative treatments for diabetic macular oedema.’
In its guidance yesterday, Nice said it had not recommended Lucentis, also known as ranibizumab, for the treatment of DMO, although it is still available for those with other eye conditions.
The watchdog’s chief executive, Sir Andrew Dillon, said: ‘The independent appraisal committee was acutely aware that visual impairment can have a substantial negative impact on quality of life and activities of daily living in people with DMO, especially since it can affect people’s ability to manage their diabetes.
‘Nice already recommends ranibizumab for wet age-related macular degeneration and although it has been shown in clinical trials to be an effective treatment for DMO, the appraisal committee was unable to recommend the drug as a cost-effective use of NHS resources compared to laser photocoagulation for this condition.’
Laser photocoagulation uses heat to seal blood vessels in the eye, which degenerate in diabetes patients, leading to DMO. This leads to the leakage of blood plasma into the retina, which disrupts vision.
Lucentis works by preventing the production of a harmful protein called VEGF, which can cause degeneration of blood vessels.
Nice said it was not final guidance and the recommendations could change with an appeal. A final decision on the drug is expected early next year.
The Department of Health said: ‘We understand that Nice’s draft guidance may come as a disappointment to some people suffering from diabetes and their families. ‘These are very difficult decisions to make and Nice only issues final guidance to the NHS on the use of a drug after very careful consideration of the evidence and wide consultation with stakeholders.’
Sir Andrew admitted he found it ‘difficult’ going on TV and seeing patients the day after Nice banned a drug. He also said he tried to ‘put himself in the shoes’ of relatives and patients to understand their perspective.
Amazing turnaround: British doctors want more homebirths
Maybe I have a suspicious mind but I think I know why. They just want to reduce their workload. As public servants, they get paid regardless
Women should no longer assume they will give birth in hospital with a doctor on hand. In a watershed moment, leading medical experts declared that mothers should be given more opportunity to have babies at home because a maternity ward is not necessarily the ‘safer option’.
A report by the Royal College of Obstetricians and Gynaecologists suggests that as many as a third of all women should give birth ‘without a doctor going anywhere near them’.
It calls for a radical shake-up in the NHS which could lead to thousands more women having babies at home, as was the case 50 years ago.
In 1959, more than a third of women gave birth at home but by 1988 this had fallen to a low of 0.9 per cent. By last year this had risen only slightly to 2.4 per cent, figures from the Office for National Statistics show.
The report states that only women most at risk of suffering complications – such as those expecting twins or triplets, the obese, diabetics or those in their 40s – should have to give birth in hospital.
In addition it calls for dozens of maternity wards in smaller hospitals to be closed or merged into ‘super units’ to ensure those most likely to suffer complications receive the best care.
It warns that currently there are too many maternity units but not enough top-level consultants able to intervene should there be problems during the birth.
Often they are looked after by junior doctors with limited experience, particularly at nights and weekends when there are fewer staff on duty.
There are also concerns that maternity wards are becoming increasingly less safe because a shortage of midwives has left them at breaking point.
The report says that expectant mothers who are unlikely to need an emergency caesarean or suffer life-threatening complications such as pre-eclampsia should be offered the chance to have their babies in local birthing units or in their own homes.
At present, just three per cent of women give birth at home. A further seven per cent use midwife-led units – which are small centres designed to provide a more homely environment than hospitals.
Senior health experts warn that the present system is ‘not acceptable, nor sustainable’. The number of women going into labour every year is a fifth higher compared with a decade ago.
And higher proportions are suffering complicated labours due to rising levels of obesity and women delaying motherhood until their late 30s and 40s.
Anthony Falconer, president of the RCOG, said: ‘Too many babies are born in the traditional “hospital” setting’. He added: ‘There is a perception among patients that they still see the hospital birth as the safer option. The use of some of these midwife-led units is not as great as it should be. These places are very safe and appropriate to have babies.’
Dr Falconer said: ‘Roughly a third of women need a doctor, roughly a third need midwives and roughly a third might need both.’
David Richmond, vice president of the RCOG who wrote the report, said that most women could have their babies in a local birthing centre ‘without a doctor going anywhere near them’.
‘Do they need to be in an institution that can do MRI scans and renal transplants and brain surgery? Probably not. So we need to have this network of care where the woman is guided to the right part of the network to receive her care.’
Earlier this year the Royal College of Midwives warned that maternity units were ‘at breaking point’ due to a shortage of around 3,500 midwives.
Cathy Warwick, general secretary of the RCM warned that unless staffing levels were drastically increased women and their newborns would be put at risk.
In response to the report she said: ‘It clearly supports local care for women who do not need specialist support and supports midwife-led maternity units, informed choice for women about options for childbirth, and women-centred care models. The RCM thoroughly supports and endorses all these aspects of the report.’
But campaigners warned that putting pressure on women to have their babies in local birth centres could also put them in danger. They also pointed out that as these centres don’t administer epidurals – strong pain-relieving injections – women would be forced to suffer unnecessarily.
Maureen Treadwell of the Birth Trauma Association said: ‘The problem with maternity care at the moment is that women can appear low risk at the start and develop horrendous problems during the birth.’
She also warned home births could become an expensive business for the Health Service. She said: ‘If a woman wants a home birth, she will need two midwives and an ambulance – and there simply won’t be enough resources for this to happen on a large scale.
Last November a damning report by senior midwives said mothers and newborn babies were being put at risk by cuts to maternity services. It found that at least one in three labour wards were being forced to axe staff as part of belt-tightening.
British teachers must ‘uphold British values’ to work in schools
Teachers face being barred from the classroom for failing to uphold “British values” and proper discipline under rigorous new professional standards for schools. For the first time, staff are told they could be struck off for showing intolerance towards pupils with other faiths and beliefs.
Teachers in England are warned against staging lessons that undermine “fundamental” values such as the rule of law, democracy and individual liberty.
The move is designed to make it easier for heads to sack teachers who are members of the British National Party or those with extremist Islamic beliefs. It follows comments from Michael Gove, the Education Secretary, that membership of far-right groups was incompatible with the duty to “shape young minds”.
Under new guidelines, staff will also be told to take responsibility for promoting “good and courteous behaviour” among children in lessons and around the school.
In a further move, the standards – being introduced in 2012 – place a renewed emphasis on teachers’ subject knowledge, suggesting staff should uphold high standards of “literacy, articulacy and the correct use of standard English” at all times.
It represents an attempt to establish clear boundaries for staff in all state schools and weed out poor teachers failing to achieve basic skill-levels.
The slimmed-down rules focus on just eight key areas of teaching – and one section focusing on personal and professional conduct – as opposed to more than 100 separate standards introduced by Labour.
Mr Gove insisted the previous system placed a premium on “bland statements and platitudes”, covering areas such as communicating with colleagues, promoting wellbeing and establishing a safe learning environment.
The new standards will have “real teeth”, he said, adding: “They set clear expectations about the skills that every teacher in our schools should demonstrate. They will make a significant improvement to teaching by ensuring teachers can focus on the skills that matter most.”
Just 1.5 per cent of student teachers fail to satisfy the current standards during training and fewer than 20 teachers have been struck off in the last decade for incompetence.
New standards – covering just four pages – set out the key skills that each trainee must satisfy to win qualified teacher status and then remain in the classroom.
As part of the new guidelines, staff must set high expectations of pupils, demonstrate good subject knowledge, plan and teach well-structured lessons, promote good progress among pupils, adapt their teaching to children’s different needs, make good use of assessment, manage behaviour and fulfil their wider responsibilities to school life.
Under behaviour, teachers are told to establish “clear rules and routines” and promote “good and courteous” manners among pupils. The section on subject knowledge says staff must have decent standards of written English – whatever the teacher’s subject specialism.
Beyond teaching, the guidance says staff “must not undermine fundamental British values, including democracy, the rule of law, individual liberty and mutual respect, and tolerance of those with different faiths and beliefs”.
It comes after a teacher and BNP member was cleared of religious intolerance last year by the General Teaching Council – the profession’s regulatory body – despite using a school laptop to describe some immigrants as “filth” on a website.
The National Association of Head Teachers welcomed the document, saying the standards were “clear, concise and relevant”. But Chris Keates, general secretary of the NASUWT teachers’ union, said the rules underline “the punitive mind set this Coalition has towards teachers”. “The new standards are vague, poorly drafted, lack clarity, are open to wide interpretation, will breed confusion and uncertainty and will simply serve as a stick with which to beat teachers,” she said.
Britain needs the rich to get richer
The Government needs the rich to take an even bigger slice of the nation’s wages if future spending plans are to be met, according to the Office for Budget Responsibility (OBR).
Although growing levels of income inequality have been identified by economists as one of the causes of the recent crisis, analysis by the OBR shows that the Government is more dependant than ever on the rich for tax revenues.
Due to the UK’s progressive tax system, the rich pay a far greater share of income tax, which is expected to raise £158bn this year – 27pc of total receipts. As a result, the OBR estimates, for every one percentage point increase in the share of total wages taken by the top 5pc of earners the state receives an extra £2.4bn.
In the eight years between 2000 and 2008, the OBR found, the top 5pc of earners increased their share of the wage pool from 23.3pc to 26.4pc – generating an extra £7.2bn in tax. The top 5pc earn above £60,000, while the bottom 50pc are on less than £18,500.
“If the recent trend of increasing income inequality were to continue it would potentially drive an increase in personal tax receipts,” the OBR said in its Fiscal Sustainability Report. “Conversely, a reversal of income inequality would lead to a fall in revenues.”
The report demonstrated that the Government cannot afford to let personal tax receipts fall because it is already facing the loss of £29bn of revenues over the next two decades as cars become more fuel-efficient, people smoke less, and North Sea oil and gas reserves are depleted.
“Future governments are likely to need to find replacement revenue streams to keep the tax burden constant, let alone to meet the costs of the ageing population,” the OBR said. The report’s central finding was that Britain needs an extra £22bn-£58.5bn of tax rises or spending cuts as the costs of the ageing population make the public finances “unsustainable”.
Paul Johnson, director of the Institute for Fiscal Studies, said: “It is a little risky for the public finances to be so dependant on such a small chunk of the population.” He added that, if the income distribution changes, the Government would “adjust accordingly” by raising rates for those on lower pay.
Earlier this year, Min Zhu, the new deputy managing director of the International Monetary Fund, warned: “The increase in inequality is the most serious challenge for the world.”