Deficits and the end of record budget rises in 2008 mean the clock is ticking to get the NHS in order, the British Medical Association chairman said.
James Johnson said the public would not understand why cuts were being made once spending was up to the level of the top-spending European countries.
And he said questions may even be asked about how the health system is funded if the problems are not resolved.
But the government has maintained reforms are improving the NHS and the funding problems will be resolved this year.
Over recent years the NHS has been enjoying yearly budget rises of over 7%. Next year that is likely to return to a figure of slightly above inflation.
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Don't assume there's anything
automatic about the system we have at the moment continuing into
perpetuity James Johnson, of the British Medical Association |
But Mr Johnson said the NHS was not currently in the position one might expect after years of extra investment.
An awful lot of trusts were in "quite dire financial straits", very big savings were having to be made and people were hearing about wards standing empty and operating theatres not being used, he said.
Mr Johnson also warned that poor workforce planning by the government meant some doctors may be forced to go abroad for work.
Last week a leaked Department of Health document predicted an excess of more than 3,000 consultants in the NHS by 2010/11 that the service could not afford to pay.
Mr Johnson said it was a "disastrous waste of public money" to train doctors only for them to go overseas.
"The whole situation demonstrates an appalling lack of workforce planning.
"It costs around £250,000 to train a doctor plus many more years of specialist training.
"If juniors cannot secure suitable jobs in the future within the NHS they may look overseas for employment. What a disastrous waste of public money."
Questions
And he suggested questions may be asked over whether the NHS continues to provide everything or if people needed to contribute towards their treatment - although this was not BMA policy.
"Don't assume there's anything automatic about the system we have at the moment continuing into perpetuity."
And he added he was very worried that the public health system was "going down the tube".
He said the recent reorganisation of local health trusts, which had seen the number halved to about 150, had seen many public health doctors lose their jobs.
"This will start to hit the drive to tackle obesity, smoking and sexually transmitted disease. All the sort of things we should be doing to prevent ill-health."
In a recent interview, Health Secretary Patricia Hewitt said government reforms were improving the health service and by the end of the financial year it would find itself in balance.
She said: "I am confident that the NHS will be back in balance by the end of this financial year, as we have promised."
The British Medical Association's junior doctors conference called the Medical Training Application Service's problems "gross negligence".
The online job application service was suspended amid fears personal details of applicants could be accessed online.
The government says it is working hard to ensure the security of the system.
Earlier, the BMA called for Tony Blair to step in to avert more chaos over the online application system.
BMA chairman James Johnson has written to Tony Blair warning doctors' anger will grow if the government does not address the problems with MTAS "with the level of urgency they deserve".
He said the mistakes had the potential to damage patients' confidence in the proposed new database of individual health records.
The conference also criticised failures in the Modernising Medical Careers (MMC) scheme and demanded a review into the waste of public money it claims it has caused.
The delegates also raised concerns that the implementation of MMC speciality training would have "grave consequences for patient care".
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The fault is with this
government which has systematically ignored the people whose lives are
being ruined Jo Hilborne, BMA junior doctors committee |
The issue is also mired in internal feuding, with some doctors calling on their own leadership to resign for participating in the government review.
Delegate Dr Andrew Smith said there was "more anger and resentment than ever before".
Despite this the BMA leadership had remained engaged in and endorsed the "fiasco that is MMC", he said.
Health Secretary Patricia Hewitt has already apologised for the "terrible anxiety" caused to junior doctors over the scheme.
BMA junior doctors committee head Jo Hilborne told the conference that modernising medical careers should have brought an end to uncertainty for senior house officers.
'Total failure'
But instead, she said it had brought the fear of career stagnation, the danger of falling standards and loss of good doctors.
She called the application system a "desperate failure".
"The fault is with this government which has systematically ignored the people whose lives are being ruined by their ill-thought out, badly implemented policies," she said.
Conference delegates suggested the system should be scrapped and suggested two possible solutions to the MTAS problems.
They said either all candidates starting posts in 2007 must be interviewed for all their choices, or all MMC training be postponed and a return made to the old system (SHO/specialist registrars) for a year while a new application process was devised.
The MTAS computer system has previously been criticised for not allowing candidates to set out their experience, meaning the best candidates have not been selected for interview.
But it has also been attacked for having too few jobs for the number of candidates.
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DOCTORS' TRAINING
Under the new system, doctors should achieve
consultant level in 11 years instead of 14
The online application process MTAS (Medical
Training Application Service) has been heavily criticised
Doctors cited badly designed forms and poor
selection methods and warned the best candidates would miss out on jobs
An independent review panel has already
recommended a number of changes to MTAS
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Conference delegates also passed a motion calling for the National Audit Office to investigate how much public money had been spent on the computer system.
And they sought guarantees that no junior doctor would be unemployed as a result of system failures.
The BMA estimates that 34,250 doctors are chasing 18,500 UK posts, due to start in August.
But it has warned thousands of NHS doctors could go to work abroad because of their disgust at the process.
Lord Hunt insisted it was not a resignation issue and that all the medical organisations had called for the old system to be changed because it was not working.
Earlier he told the BBC action was being taken to make the system more secure.
"We have brought in over the weekend some independent experts from outside companies. They are clawing through it to make sure it is secure and we will only open it up again when we are satisfied about that."
Hospital staff gave the wrong treatment to the wrong patient on almost 25,000 occasions last year, leading to deaths, serious injury and long-term harm, official figures show. Errors in identifying patients led to at least 500 a week getting the wrong operation the wrong drugs or diagnostic tests, the National Patient Safety Agency said.
No breakdown of the figures was available yesterday to show how many had died or been seriously harmed and how many escaped injury. The agency admitted the total could be much higher because many incidents went unreported.
Almost 3,000 of the incidents are estimated to have occurred because of confusion over wristbands used to identify patients. An investigation found that the colour red on a wristband had eight different meanings in different NHS trusts, ranging from "allergic to penicillin" to "does not have English as a first language".
The agency issued a warning notice to all NHS trusts urging them to take "immediate action" to produce a standard wristband. It set a deadline of July 2008 for its introduction. The wristband will be white and carry the last name of the patient followed by the first name, date of birth and NHS number. Only one other colour - red - will be permitted, to indicate patients at high risk.
Christine Ranger, head of safer practice at the agency, said there were 24,382 incidents between February 2006 and January 2007 in which patients were "mismatched with their care." Of these more than 2,900 related to wristbands and their use. "These are causing patients to have the wrong operation, the wrong [blood] transfusion, the wrong medication or the wrong diagnostic test," she said. "Some incidents will involve significant harm and some have led to deaths."
People with common names such as Smith or Patel were at particular risk. Mistakes also happened when staff relied on first names, Ms Ranger said. "In one case a nurse on a ward for the elderly came looking for a patient called Elsie to take a blood sample for a transfusion. There were two Elsies on the ward and the sample was taken from one while the transfusion was intended for the other. That very nearly led to a serious incident."
Last year, the NPSA reported 41,000 medication errors between July 2005 to July 2006, which caused 36 deaths. A further 2,000 patients suffered "moderate or severe harm." In 2005, the National Audit Office reported that nearly one million errors or safety lapses had occurred in the previous year, causing 2,000 deaths. Half of the incidents could have been avoided if staff had learnt from past mistakes.
Unreported NHS figures
The disclosure that thousands of NHS patients are being wrongly identified only emerged yesterday after it was reported in Nursing Standard.
The NPSA said it issued a press release containing the figures last week, but had only circulated it to the trade press.
The shadow Health Secretary, Andrew Lansley, said the agency had to create a culture in the NHS where reporting what went wrong was 'everybody's business'.
'If we expect individuals on the front line never to cover up then surely it is the role of the NPSA to give the greatest possible exposure to the level of errors, not to shock but to ensure we are not going to have a culture that hides anything.'
A spokeswoman for the NPSA said: 'The decision was taken that this was not a big enough story for the national press. It may not have been a brilliant judgement on our part, but there was no attempt to bury bad news.'
It is estimated that 150,000 people in the UK have ME
Doctors have been ordered to treat chronic fatigue syndrome (CFS), far more seriously and not to dismiss it as 'yuppie flu.'
Those treating the debilitating condition should "acknowledge the reality and impact of the condition and the symptoms," according to the new guidelines from the National Institute for Health and Clinical Excellence (NICE).
It added every person diagnosed with CFS also known as myalgic encephalomyelitis (ME) should be offered "acceptance and understanding."
Patients with CFS or ME, have long struggled against prejudice towards their condition, which is not yet fully understood by the medical profession and dismissed by some as 'yuppie flu.'
NICE admitted 'uncertainties' about diagnosing and managing the condition had 'exacerbated the impact of ME' on patients and their carers.
Some doctors had told sufferers to 'go to the gym' or 'exercise more' despite evidence this could make symptoms worse. NICE has responded by instructing doctors not to give such advice or dismiss patient concerns.
The syndrome causes a range of symptoms, which includes fatigue, malaise, headaches, sleep disturbances, difficulties with concentration and muscle pain. Symptoms can range from the mild to the very severe.
While there are no definitive tests, the condition can be diagnosed through the symptoms and by ruling out other conditions.
In the new guidelines, doctors are told to develop a individualised management plan for each of their patients. There are no known cures for ME, however it can treated through diet changes and rest and relaxation programmes.
NICE advises doctors to limit patient rest periods during the day to 30 minutes at a time but not to impose a rigid schedule of activity and rest. It also tells doctors to warn patients that setbacks and relapses are to be expected.
The health charity 'Action for ME' welcomed the new guidelines and the new emphasis on doctors and patients sharing decision making.
George Armstrong, the chair of trustees said: "This guideline
could be a landmark in the mainstreaming of ME as a legitimate illness.
"Properly implemented, it should help GPs on the front line to reach a diagnosis and identify pathways of care, treatment and support."
However, the charity trustees said they were disappointed that cognitive behavioral therapy (CBT) and graded exercise therapy (GET) were suggested by NICE as treatments.
"Many patients have reported little or no benefit from CBT and others have experienced seriously adverse effects from GET," they said.
The charity trustees were also disappointed that NICE did not agree to recognise the World Health Organisation's classification of ME as a neurological illness.
He wants the cleaning to be pre-emptive rather than a reaction to outbreaks.
But critics question how effective such moves are, saying it is staff, patients and visitors who carry MRSA.
Meanwhile, comments by the PM that he wants to make the NHS's future the key issue at the next election have added to speculation about an autumn poll.
BBC political correspondent Norman Smith said the comments to the Sunday Times, which coincide with the start of the Labour Party conference, would be seen by many as evidence that he is weighing up the shape and timing of any contest.
'Ready for poll'
On Saturday, Labour's election co-ordinator Douglas Alexander said the party was ready for a general election whenever Mr Brown chose to call one.
Recent opinion polls suggest the party is in a strong position, with an ICM poll for the Sunday Mirror giving Labour a six-point lead over the Conservatives.
The poll of 1,029 adults, carried out by phone on 19 and 20 September, gave Labour the same lead as a previous ICM/Sunday Mirror poll in August.
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A ward at a time, walls,
ceilings, fittings and ventilation shafts will be disinfected and
scrubbed clean Gordon Brown |
The announcement of the ward-by-ward clean marked Mr Brown's first initiative since arriving at the Labour Party conference on Saturday.
In the Sunday Times, Mr Brown also promised a reduction in waiting times for cervical screening from six weeks to two and to extend the age range for routine screening from 47 to 73.
In the News of the World, he vowed that over the next 12 months all hospitals would be restored to a pristine state of cleanliness to rid them of infections such as MRSA and Clostridium difficile.
Turnover of beds
He said: "A ward at a time, walls, ceilings, fittings and ventilation shafts will be disinfected and scrubbed clean."
Some NHS trusts have already adopted these new cleaning systems and Mr Brown is keen others follow that example.
However, members of the healthcare community who contest the "deep clean" action believe the high volume of bed turnover in wards is a more serious issue.
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We've had years of ineffective
tinkering and complacency around the
problem of tackling superbugs like MRSA and C Difficile Norman Lamb Lib Dem health spokesman |
Roy Lilley, a former NHS trust chairman and the author of a book on healthcare management, told the BBC he thought the "deep cleaning" idea was "irritatingly populist".
He said: "This will get a huge round of applause from the Labour Party conference floor and everyone will say 'yes, he's the man that's cleaning up the hospitals'.
"But at the end of the day, the infection control systems are about handwashing; it's about clinical discipline and it's about screening people before they come in.
"You can clean a hospital on Monday and on Wednesday, you'll be back where you started."
'PR ploy'
Officials said that it would be up to individual NHS trusts to decide how the cleaning programme was implemented, but it could mean wards closing for a week at a time to be cleansed.
Shadow health minister Mike Penning said the announcement was a "cynical PR ploy".
And Liberal Democrat health spokesman Norman Lamb said: "We've had years of ineffective tinkering and complacency around the problem of tackling superbugs like MRSA and C Difficile."
He said a "serious change of culture within hospitals and care homes" would have a more long lasting impact than "grand gestures".
Earlier this year, the Health Protection Agency said that between April 2006 and March 2007, there were 6,378 cases of MRSA hospital infections reported, compared with 7,096 for the previous year.
Meanwhile, there were 15,592 reported cases of C. difficile in patients aged 65 and over in England in the first quarter of 2007 - up 2% on the similar period in 2006.
Dr Richard Horton accused the BMA of being insulting and cynical towards the government, and failing to represent ordinary doctors.
He said
it was not surprising ministers had attempted to
bypass the BMA, and appeal directly to GPs over an extension to their
working hours.
http://news.bbc.co.uk/1/hi/england/manchester/7229889.stm
The
BMA
is
misrepresenting
the
Governments
proposals
to
have
GPs
offer more
convenient hours of access to patients.
It seems to me obvious that this need not mean MORE hours, just
DIFFERENT hours of access, not always those when people are at work or
not in a convenient place.
LONDON: Preventing obesity and smoking can save lives, but it does not save money, according to a new report.
It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.
"It was a small surprise," said Pieter van Baal, an economist at the National Institute for Public Health and the Environment in the Netherlands, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."
In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.
Van Baal and colleagues created a model to simulate lifetime health costs for three groups of 1,000 people: the "healthy-living" group (thin and nonsmoking), obese people, and smokers. The model relied on "cost of illness" data and disease prevalence in the Netherlands in 2003.
The researchers found that from age 20 to 56, obese people
racked up
the most expensive health costs. But because both the smokers and the
obese people died sooner than the healthy group, it cost less to treat
them in the long run.On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.
Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
The cost of care for obese people was $371,000, and for smokers, about $326,000.
The results counter the common perception that preventing obesity will save health systems worldwide millions of dollars.
"This throws a bucket of cold water onto the idea that obesity is going to cost trillions of dollars," said Patrick Basham, a professor of health politics at Johns Hopkins University who was unconnected to the study. He said that government projections about obesity costs are frequently based on guesswork, political agendas and changing science.
"If we're going to worry about the future of obesity, we should stop worrying about its financial impact," he said.
Obesity experts said that fighting the epidemic is about more than just saving money.
"The benefits of obesity prevention may not be seen immediately in terms of cost savings in tomorrow's budget, but there are long-term gains," said Neville Rigby, spokesman for the International Association for the Study of Obesity. "These are often immeasurable when it comes to people living longer and healthier lives."
Van Baal described the paper as "a bookkeeping exercise" and said that governments should recognize that successful smoking and obesity prevention programs mean that people will have a higher chance of dying of something more expensive later in life.
"Lung cancer is a cheap disease to treat because people don't survive very long," van Baal said. "But if they are old enough to get Alzheimer's one day, they may survive longer and cost more."
The study, paid for by the Dutch Ministry of Health, Welfare and Sports, did not take into account other potential costs of obesity and smoking, such as lost economic productivity or social costs.
"We are not recommending that governments stop trying to prevent obesity," van Baal said. "But they should do it for the right reasons."