Prostate Cancer Drug 'Too Pricey' For NHS

A drug which can extend the lives of men with late-stage prostate cancer has been ruled too expensive for use on the NHS.

The National Institute for Health and Clinical Excellence (Nice) says abiraterone (also called Zytiga) doesn't provide enough benefit to justify the price the NHS is being asked to pay.

Leading cancer experts said the decision was "disappointing" and a "huge blow" to patients who have very few treatment options left.

Cancer Research UK said the draft decision by Nice, which is still open to consultation, made "no sense" and Nice had used the wrong criteria to judge the drug.

Abiraterone was developed by scientists at the Institute of Cancer Research (ICR) and the Royal Marsden in London after the discovery that some prostate cancers can produce their own testosterone.

It works in a new way, by blocking the production of male hormones in all tissues, not just the testes, including both the adrenal glands and the tumours themselves.

A phase III trial, reported last year in the New England Journal of Medicine, involved 1,195 patients from 13 countries.

Prostate Cancer Drug 'Too Pricey' For NHS

All had stopped responding to standard hormone therapies as well as second-line treatments such as chemotherapy drug docetaxil.

It showed that men survived an average of four months longer and suffered far less pain with abiraterone compared to those taking a placebo.

Although the average extended survival time was four months, some men did much better, including two who were still alive after starting the treatment in 2007.

Abiraterone has been regarded as a "success story" for the ICR following more than two decades of work to develop the drug.

Experts said it has not only improved survival for men with prostate cancer but has also changed the way scientists think about the disease.

Nice has ruled that although abiraterone is clinically effective, it is not good value for money for the NHS at the price set by the manufacturer, Janssen.

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Town halls offered healthcare bonus

Town halls will be rewarded for cutting tooth decay in children and boosting breastfeeding under plans to be unveiled.

Health Secretary Andrew Lansley is expected to announce plans that would see councils allocated more than £2 billion to look after public health, a responsibility that has not lain with local authorities since the 1970s.

Under the system, councils will be judged against a range of measures including reducing the number of falls in older people and increasing breastfeeding rates, as well as factors such as truancy, air pollution, domestic violence and homelessness.

Data will be collected on more than 60 factors that influence health, and a "Health Premium" incentive scheme would see the most successful councils given extra funds.

Councils will be left to decide which practical steps they take to achieve the improvements laid out by the Government.

Andrew Lansley is expected to announce
a 'Health Premium' incentive scheme

Mr Lansley is to set out the new Public Health Outcomes Framework in a speech at the Faculty of Public Health.

According to the Daily Telegraph, he says that 2000 to 2010 was a decade in which public health was seen as "something to be sidelined".

He will reportedly say: "Obesity rates from 2000 to 2010 rose from 21.2% to 26.1% so now over a quarter of adults are obese. Sexually transmitted infections, after the steep declines in the 80s to 90s, doubled in the subsequent decade. And health inequalities persist, with gaps in life expectancy of over a decade between people born in the richest areas and people born in the poorest."

The public health budget is to be ring-fenced so it cannot be used to shore up day-to-day spending, he is expected to say. Next year £5.2 billion will be spent on public health, with the Government increasing the budget in real terms each year after that.

The announcement comes as the Commons Health Committee is this week expected to claim the Government's controversial NHS reforms are obstructing efforts to make the service more efficient.

Lansley defends health Bill plans

Health Secretary Andrew Lansley has defended the Government's controversial health Bill after the main medical unions became the latest bodies to declare all-out opposition to the reforms.

The Royal College of Nursing (RCN) and the Royal College of Midwives (RCM) have called for the Bill to be scrapped. It follows a move by the British Medical Association (BMA) in December to also fully oppose the Health and Social Care Bill, currently going through Parliament.

The RCN, the biggest nursing union, said "serious concerns" have not been addressed during the parliamentary process, listening exercise or political engagement and the Bill will not deliver on the principles originally set out.

Recent announcements such as the rise in the cap on private patients being treated in NHS hospitals to almost half (49%) "make the Bill in its entirety a serious threat to the NHS", it said.

But Mr Lansley backed the reforms, saying the opposition to the Bill was more about issues of pay and pensions. He said the legislation was "essential in order to give nurses and doctors clinical leadership".

The leading medical unions have declared their
opposition to the proposed NHS reforms

"I'm afraid the only thing that has happened in the last few weeks that has led to this situation with the Royal College of Nursing is that the two sides of the Royal College of Nursing have shifted," Mr Lansley said.

"There used to be a professional association that was working with us on professional issues and will carry on doing that, but now the trade union aspect of the Royal College of Nursing has come to the fore, they want to have a go at the Government - I completely understand it - but they want to have a go about things like pay and pensions.

"The Bill actually enables the NHS to deliver efficiency savings and improve performance - not least because actually the Bill is part of the process of cutting administration in the NHS. It takes about £1.5 billion a year out of NHS administration costs because it reduces that superstructure of bureaucracy in the NHS - over the course of this Parliament it will deliver over £4 billion savings itself.

"Through the NHS Future Forum we have been out there, making sure, and doing it ourselves time and again, that we're taking staff with us in terms of understanding these issues. And the RCN and the RCM are very clear that they support the principles of the Bill. What they are actually unhappy about is pay, pensions and jobs. I complete understand that.

"But if there were no Bill the same issues would have to be addressed. We inherited a deficit, we are having to manage the NHS within limited increases, but actually next year the NHS budget is going to go up by 2.8%."

©Press Association

HEALTHCARE ASSISTANT FEARS VOICED

Healthcare assistants are taking on jobs for which they are not always properly trained, including looking after intensive care patients, according to new research.

A survey of more than 2,500 NHS staff found examples where healthcare assistants (HCAs) were working beyond their competence, sometimes putting patients at risk.

Nurses cited cases where lesser-trained HCAs administered drugs without proper training, while others were left in sole charge of patients with complex needs.

Examples from the 2,554 people who responded to the Nursing Standard survey - made up mostly of qualified nurses and nursing students - said HCAs were also managing colleagues and running units and clinics.

Some nurses said HCAs had received training, but others said this was lacking - or HCAs were not competent in interpreting information about patients.

One respondent said HCAs were involved in "caring for 'low-risk' ventilated tracheostomy patients in an intensive care environment".

The respondent said: "The registered nurse working next to them is expected to supervise and overlook everything they do but this is an impossible task when they themselves are looking after a level-3 ventilated patient.

"As far as I'm concerned this is dangerous practice and unfair on all parties concerned."

Several respondents said HCAs monitored patient vital signs but "did not understand" the results.

Sone HCAs take blood pressure readings "but do not know what is normal or not" while others fail to notice when a patient is deteriorating.

Other examples included HCAs drawing up care plans with no training, interpreting blood levels, complex wound care and carrying out electrocardiograms (ECGs) for heart patients.

HCAs also gave antipsychotic medication without proper training, while one respondent said: "As a nurse manager I tend to supervise any practice that is deemed complex. ECGs are the most common but prior to being a manager I witnessed an HCA doing a catheterisation. They had no training and I was horrified."

There were further cases where HCAs acted as members of emergency or resuscitation teams and "give medication without knowing what the drugs are for and side effects".

Standards set by the Nursing and Midwifery Council (NMC) say nurses can delegate aspects of patient care to HCAs, including administering medicines.

However, the nurse is "accountable to ensure that the ... care assistant is competent to carry out the task."

But one nurse in today's survey said: "There is sometimes an attitude from unregistered staff that it doesn't matter what they do because ultimately it is the registered nurse looking after the patient who will take responsibility.

"No matter how hard we try to uphold standards it is impossible to be aware of everything going on with our patients, and we have to rely on support staff to provide a high standard of care without having to directly supervise them at all times."

In October, the Government unveiled plans for a code of conduct and training for HCAs but ministers are not in favour of statutory regulation.

The plan is designed to "bring clarity" to the training HCAs need to deliver more advanced tasks, although this training will be voluntary.

Dr Peter Carter, head of the RCN, has said the NHS is too reliant on untrained HCAs who are asked to pick up nursing skills as they go along.

He said assistants were employed to help nurses with basic tasks like washing and feeding, but ended up doing much more.

RCN HCA adviser Tanis Hand told Nursing Standard: "It is important for nurses to understand the principles of delegation and that HCAs are not put into situations that they are not fully prepared for."

RCN head of policy Howard Catton said: "These findings make it clear that if we want to maximise patient safety, we need to push forward with mandatory regulation of support workers.

"There is also a clear need for education and training of support staff to ensure we do not separate tasks from the knowledge required for clinical assessment and decision making."

Unison head of nursing Gail Adams said: "This list reaffirms our findings that HCAs are delivering most bedside nursing as well as many extended roles.

"I question whether some of these roles are appropriate given the lack of consistency and training."

Dr Carter said of the survey: "Today's findings add further weight to the case for mandatory regulation and guaranteed training standards for HCAs, which the RCN has been calling for for some years and throughout the Health and Social Care Bill process.

"The RCN is clear - a voluntary or optional scheme does not go far enough; not only would it continue to put patients at risk, it would also do a great disservice to the hardworking, dedicated HCAs who would welcome regulation."

Health minister Lord Howe said: "Healthcare assistants aim to give the very highest quality of care to patients, but they shouldn't be allowed to carry out tasks they are not qualified for.

"Employers must take responsibility for the quality of services provided and professionals, like nurses, must ensure appropriate delegation and supervision of tasks."

©Press Association

NEW IMPLANTS OFFER FOR NHS PATIENTS

Anxious women given PIP breast implants on the NHS will be able to have them removed for free, with private firms expected to offer the same deal, the Government said today.

While experts concluded there is no evidence to recommend routine removal of the implants, they said they could not entirely rule out that some are toxic.

Around 40,000 women in the UK received the implants, manufactured by a now-closed French company Poly Implant Prostheses (PIP), which were filled with non-medical grade silicone intended for use in mattresses.

The Government said those patients who had their implants on the NHS as part of breast reconstruction surgery - believed to be around 5% of the total - will be able to have them removed and replaced if they are concerned.

The Government expects private firms to give the same offer to anxious women who paid for their implants privately and also wish to have them taken out.

All women who have received an implant on the NHS will be contacted and offered a consultation with their GP or their original surgical team.

They could be offered scans to see if there is any evidence that their implant has ruptured.

With the support of their doctor, women who still have concerns will be able to have them removed and replaced free of charge on the NHS.

The Department of Health said it expected private firms to match the NHS offer.

It said: "Private providers have legal obligations to their patients. The NHS will offer a package of care for its patients, and we expect the private sector to do the same."

If the private clinic that provided PIP implants has closed down, the NHS will pay for removing the implants if the patient is entitled to NHS care.

But it will not pay for replacements in these patients.

The Government also intends to pursue private clinics to avoid the taxpayer picking up the bill.

Some private firms have already come forward to say they will offer women free removal of their implants.

The expert group behind the review concluded there is no link between the implants and cancer, as reported in one French case.

But it said it was "undeniably the case" that the implants are made up of non-medical grade silicone and should not have been implanted in women in the first place.

The expert group was unable to establish if the rupture rate is higher for PIP implants than for others.

But it could not be confident that PIP did not change the silicone in the implants, so could not rule out the possibility that some are toxic.

Health Secretary Andrew Lansley said his main concern has been for the safety of women who have had PIP implants.

"It has been a worrying time for these women," he added.

"We have at every stage sought to offer them as much advice and evidence as is available to us.

"Our advice remains the same, that there is not sufficient evidence to recommend routine removal.

"We have always recommended that women who are concerned should speak to their surgeon or GP.

"The NHS will support removal of PIP implants if, after this consultation, the patient still has concerns and with her doctor she decides that it is right to do so.

"We believe that private healthcare providers have a moral duty to offer the same service to their patients that we will offer to NHS patients - free information, consultations, scans and removal if necessary."

Mr Lansley said data from the industry has not been good enough to enable them to give a clear recommendation on the risk posed by PIP implants.

"We will therefore support women, including removal of the implant, if needed."

In France, the government has told 30,000 women they should have the implants removed while the Czech and German authorities have recommended that women should also have them taken out.

The boss of PIP has reportedly told police the victims are money-grabbers and he had "nothing to say" to them.

In the UK, the expert group will now examine wider issues around quality of data, surveillance and regulation of the cosmetic industry sector.

The Care Quality Commission is also reviewing whether clinics comply with registration requirements and is considering fuller inspections.

Fazel Fatah, president of the British Association of Aesthetic Plastic Surgeons, said women should be reassured that removal is a precautionary measure.

But he added: "It is accepted that these implants are sub-standard and not of a high medical grade.

"When they rupture, they cause significant disruption and it is not acceptable.

"This is a sensible decision, taken after intense deliberation and we support that."

Tim Goodacre, from the British Association of Plastic, Reconstructive and Aesthetic Surgery, said: "Our advice remains the same: the implants should be removed and women need to return to their implanting clinic which has primary responsibility for helping them, as emphasised in the report."

Mark Harvey, a partner at Hugh James solicitors, which is representing more than 250 women, said the Government seemed to have made a tacit admission that it has no power to compel private clinics but he expected clinics to follow the NHS's lead.

"If they do not, then we will be asking the courts later this year to compel them to do that."

PA 2012

PM UNVEILS HOSPITAL CARE REVAMP

Nurses will be told to undertake hourly ward rounds while members of the public will be allowed to inspect hospitals, under plans announced by the Prime Minister.

David Cameron said most patients were happy with NHS care but there was a "real problem" in some hospitals with people not getting food and drink or being treated with respect.

He said the Government was going to "put right" the problem after the Care Quality Commission (CQC) found issues with dignity and respect in hospitals up and down the country.

The PM wants hourly rounds by nurses.

Mr Cameron is pledging to strip away "stifling bureaucracy" and allow nurses to focus on what they do best, adding that the whole approach to caring in this country needs to be reset.

He also emphasised the need for leadership on wards, saying people wanted to see a figure of authority, whether they were called matron, ward sister or team leader.

In October, the CQC found a fifth of NHS hospitals are breaking the law on care of the elderly.

Its study also found half of hospitals are failing to provide all-round good nutrition to elderly patients while 40% do not offer dignified care.

Of 100 hospitals investigated in England, 49 were found to generate minor, moderate or major concerns about nutritional standards for elderly people.

Today's announcement is intended to mean nurses can focus on "patients not paperwork" while all hospitals will be expected to implement regular ward rounds "to systematically and routinely check that patients are comfortable, are properly fed and hydrated".

Strong leadership on wards will is also expected become common practice.

A new Nursing Quality Forum of frontline nurses and nursing leaders will be tasked with promoting excellent care and ensuring good practice across the NHS.

Patients will also lead inspections of hospital wards, with local people becoming part of teams assessing cleanliness, dignity and nutrition.

A new "friends and family test" will also ask whether patients, carers and staff would recommend their hospital to friends and family.

The results will be published and hospital leaders who fail the test will be held to account.

Mr Cameron said: "If we want dignity and respect, we need to focus on nurses and the care they deliver.

"Somewhere in the last decade the health system has conspired to undermine one of this country's greatest professions.

"It's not one problem in particular. It's the stifling bureaucracy. The lack of consequence for failing to treat people with dignity.

"Even, at times - as we saw with Mid Staffordshire - the pursuit of cost-cutting or management targets without sufficient regard for quality of care.

"Nursing needs to be about patients not paperwork.

"So we are going to get rid of a whole load of bureaucracy that stops nurses from doing what they do best.

"And in return patients should expect nurses to undertake regular nursing rounds - systematically and routinely checking that each of their patients is comfortable, properly fed and hydrated, and treated with the dignity and respect they deserve.

"This happens in the best hospitals. In some it has never stopped happening. "Now it needs to happen in every hospital. And the Royal College of Nursing support us on this and we'll be working with them to make it happen."

Under the plans, an NHS Institute Time to Care initiative will be rolled out with the aim of cutting paperwork.

More than 60% of NHS acute trusts are currently implementing the programme, which has helped nurses to spend an extra 500,000 hours with patients in one year, according to information from Downing Street.

The aim is to have all hospitals implementing the programme from April 2013.

Evidence also shows that regular nurse rounds enable patients to talk to a nurse at least every hour and a ward sister at least twice a day.

The aim is not for the rounds to replace usual nursing care, such as dressing wounds, but to run alongside them.

Where regular rounds have been implemented, evaluation suggests they improve patient safety by cutting the number of falls and patients suffering pressure ulcers, improve patient satisfaction and reduce anxiety and make the shifts less stressful for the nurses.

In another development, hospitals could receive bonus payments of up to 0.5% of their contract income if they use a new NHS Safety Thermometer to improve quality on basic care, including with regard to pressure ulcers, falls, blood clots and hospital infections.

Dr Peter Carver - Nurses care for people.

Dr Peter Carter, Royal College of Nursing chief executive and general secretary, said: "Nurses working in every field have one thing in common - they chose the profession because they want to care for people.

"The profession will welcome the moves to free up nurses to put care first, and to focus all their energies on the needs of their patients.

"In particular, nurses themselves have emphasised the enormous burden of the paperwork they have to complete, day in and day out."

Katherine Murphy, chief executive of the Patients Association, said: "This is a significant step forward in meeting the demands of our Care Campaign, launched in November last year.

"But we are disappointed that it has taken intervention at this level to bring about the change that is desperately needed.

"We have consistently said that nurses need time to care, and we have called for an end to the bureaucracy that stops effective nursing."

Shadow health secretary Andy Burnham said: "If David Cameron really wants to help nurses focus on patient care, he should listen to what they are saying and drop his unnecessary Health Bill."

Jo Webber, deputy policy director at the NHS Confederation, told BBC Radio 4's Today programme that the amount of paperwork required from nurses varied from hospital to hospital.

She said: "I think the first thing hospitals will do in any case is to do an audit of what nurses are actually doing and to try and pare away those tasks which are mundane and routine and can be done by, say, ward clerks.

"I am not saying they don't need to be done. They need to be done by somebody, things like ordering supplies etc, but maybe it is not the best use of nurses' time."

Speaking on BBC Radio 4's Today programme, Mr Cameron said: "There is clearly a problem in some hospitals in some settings where we are not getting the standards of care that the nation expects.

"And I think politicians frankly have done nurses a disservice by not talking about this. Such is our respect for nurses that we have almost hidden away concerns about this."


PA 2012

NHS WAITING LIST PENALTIES DELAYED

A Government plan to tackle hidden NHS waiting lists has been delayed - just two months after being announced by Health Secretary Andrew Lansley.

Mr Lansley said in November that hospitals would face a clampdown from this year on the number of people languishing on waiting lists for treatment.

But according to the Department of Health, although hospitals are expected to make progress towards that goal, penalties will not now be introduced until 2013/14.

Mr Lansley delays plans to tackle NHS waiting lists

Under NHS rules, patients should be treated within 18 weeks of being referred by their GP but when that deadline is breached, there is often no incentive for hospitals to see them.

To tackle this, NHS managers were told in November they had to reduce the number of long waiters from this year - and by about 50,000 by April.

Mr Lansley said at the time: "Because of Labour's perverse approach, the NHS actually had an incentive not to treat patients.

"The new approach we will take from next year will clamp down on this practice."

However, according to the Department of Health, penalties will now only be introduced "once progress has been made on validating the backlog data and the NHS has had time to adjust to working to the new standard."

Data suggests there are around 250,000 people waiting longer than 18 weeks to be treated and thousands have waited for more than a year.

The new delay, uncovered by the Health Service Journal (HSJ), was condemned by patient groups.

Patients Association chief executive Katherine Murphy said: "The Department of Health said they would tackle the issue yet instead of taking action they have just stuck to the same targets which have not helped these forgotten patients.

Katherine Murphy: NHS targets create "perverse disincentives"

"These targets have produced perverse disincentives meaning that once a patient has waited for longer than 18 weeks, there is no push to make sure they receive treatment as soon as possible after that."

A spokeswoman for the Department of Health said: "We want to reduce the number of patients on hidden waiting lists to help ensure everyone gets access to the treatment they need.

"Work on this has already started and we expect organisations to reduce their backlog and long waits whilst this is ongoing.

"Penalties will be introduced for 2013/14 once progress has been made on validating the backlog data and the NHS has had time to adjust to working to the new standard."

HSJ columnist and waiting list consultant Rob Findlay said delaying the measure "fundamentally undermines the government's stated intention to reduce the number of patients 'forgotten' on English waiting lists."

According to the HSJ, the 2012-13 operating framework and second quarter report, both released late last year by the Department of Health, planned to introduce a new target to cut the list of long waiters.

But the NHS standard contracts for 2012-13, released on December 23, leave the old system in place.

Shadow health secretary Andy Burnham said: "We are losing count of the Government's broken promises on health, but this seems to be the quickest on record.

"Only six weeks after making this promise the Health Secretary has further undermined the already fragile confidence in his ability to run the NHS.

"One of his first acts in office was to relax Labour's waiting time standards.

"We warned him that patients would pay the price and this is exactly what has happened.

"Sadly, things will get even worse for NHS patients if he succeeds in amending his health Bill to allow NHS hospitals to devote up to 50% of their beds and theatre time to private patients.

"This free-market NHS reorganisation opens the door to an explosion of private work in the NHS, meaning longer waits for NHS patients.

"It takes us straight back to the bad old days of the Tory NHS, when the only choice patients had was to wait longer or pay to go private."


PA 2012