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Trio from The Times - 24th July The Times 24th July BY JILL SHERMAN AND ROLAND WATSON ANY health service patient whose operation is cancelled is to be guaranteed the surgery within 28 days - even if it means sending them to a private hospital. The proposal lies at the heart of the Government's blueprint, Creating a 21st century NHS, and is likely to alarm some Labour MPs as well as raise question marks over the effect on the private sector. Alan Milburn, the Health Secretary, said yesterday that "patient power" would be the dominant theme running through the ten-year plan to be unveiled by the Prime Minister on Thursday. Proposals also include a promise to recruit thousands more doctors and nurses - many from overseas - and the appointment of someone in every hospital to champion patients' concerns. They would be expected to ensure that complaints about anything from dirty wards and poor food to standards of clinical care are acted on. But the centrepiece pledge on guaranteed operation times is likely to raise both political and clinical questions. The guarantee, which will come into effect within two years, will apply to all operations cancelled for non-medical reasons, whether because of bed shortages, staff shortages or lack of theatre space. Every year 60,000 operations are cancelled, often more than once, and patients can find themselves back on a waiting list for years through no fault of their own. Now, if the hospital is unable to meet the target in its own theatres, it will have to fund the same procedure at the time and hospital of the patient's choice in either the public or private sector. That is likely to mean that the NHS will initially have to rely heavily on the private sector, particularly during the winter when all hospitals are hard-pressed. In his statement to the Commons, Tony Blair will unveil proposals to draw up a new concordat with the private sector, giving NHS hospitals the right to pay private hospitals to carry out operations when they are overstretched. And last night he hinted that there could be more partnerships with the private sector. "I have always made clear that it is not a question of ideology." Returning from the G8 summit in Japan, the Prime Minister said that the Government would attempt to redesign the way the health system worked around the patient. "At every level there will be significant reform and change and that must go with the investment." Mr Blair said that the national plan would come to be seen as a turning point for the NHS and Mr Milburn described it yesterday as a "once in a lifetime opportunity". His blueprint is also expected to include a promise to halve the average time that patients have to wait for an operation from 18 months to nine months by 2004-05. Mr Milburn is hoping to reduce this further to six months - and is still working on computer projections - but he is wary of making other patients wait longer. At present 70 per cent of patients are seen within three months but some routine operations have much longer waiting times. The key to reducing long waits will be more doctors and nurses. The NHS plan will include plans to increase substantially medical school places and recruit thousands more nurses. But the Prime Minister will also announce a massive recruitment drive to attract senior doctors from Australia, New Zealand, America and Europe to fill short-term contracts while British doctors are being trained. Doctors from developing countries are not part of the plan because ministers argue that they are more needed in their own countries. The NHS already makes heavy use of doctors from abroad. One in four of Britain's 110,000 doctors is trained overseas, but many of these are GPs, while others are used for locum or temporary posts. Officials admit that the NHS may have to pay higher rates to attract European and American doctors but they will be put on fixed-term contracts without the perks of a permanent job. The Tories will, however, urge caution in overseas recruitment. Liam Fox, the Shadow Health Secretary, will use figures showing that overseas doctors account for more than half of the complaints referred to the General Medical Council, and up to 80 per cent of those upheld, in calling for tougher controls on those who come from other countries to practise in Britain. The appointment of a patients' champion is in part designed to stem the escalating bill for medical negligence claims, which has already reached £2.8 billion. The advocate will be identifiable and accessible to all patients and their families. The plan may also identify a professional at ward level - probably a senior nurse - who can replace the hospital "matron" of the 1950s. The Times 24th July 2000 BY HELEN RUMBELOW, MEDICAL REPORTER THE Government must remedy the poor state of NHS cancer treatment by establishing a National Cancer Institute, a parliamentary committee will report this week. NHS cancer services are chaotic and underfunded because the Government has failed to set up a central authority to run them, the House of Commons Science and Technology Select Committee will announce on Thursday. Britain is alone in the Western world in relying on charities, which must appeal for public donations, to fund improvements to cancer care, the report will say. The treatment of cancer patients in Britain is among the worst in the West and the Prime Minister needs to establish urgently a National Cancer Institute, the document will conclude. Jonathan Waxman, head of the Prostate Cancer Charity, said that too little funding was available to cancer doctors. "It is scandalous that we have no major research institute. This report will be enormously critical of the amount of support for research in this country, which has a cynical disregard for people suffering." The MPs on the select committee have spent the past six months interviewing cancer specialists and patients. They have visited the National Cancer Institutes in Washington DC and Finland. In America, funding for the institute was established by law in 1971, and it now receives around £2 billion a year from the government, 5 per cent more than it requested this year. By contrast, Britain spends £200 million from all sources on cancer research. Most comes from charities that, the committee noted, had to compete against each other for donations. Around £80 million is raised by the Imperial Cancer Research Fund, £60 million by the Cancer Research Campaign, and around £40 million is contributed by smaller charities. The government allots just £800,000 to the improvement of prostate cancer care. British doctors say that national institutes end the confusion between charities and establish treatment guidelines. "We have to do something better for cancer, the way forward must be some kind of institute with its own budget, embracing and taking everyone in rather than excluding them," Professor Waxman said. Ian Gibson, Labour MP for Norwich North who chaired the committee, said it had conducted "the most thorough investigation of cancer services that has ever been carried out". The committee's report, A Fresh Start For Cancer, is expected to recommend a "virtual" National Cancer Institute, which will link all the smaller centres in Britain by computer. This will avoid the estimated £400 million cost of building a centre, but will force the Government to improve funding and address the need for "more interaction" between cancer charities. An anonymous consortium of advertising executives is to begin an advertising campaign to increase calls for an institute. Its slogan is "Scientists have discovered the worst place to develop cancer . . . Britain". The five executives are funding the campaign themselves after discovering, for example, that the NHS spends more on laxatives than on cancer medicine. "Even if they do decide on a building, that will cost half the amount of the Millennium Dome, and a third of people will develop cancer," one of the executives said. "One in three people certainly don't go to the Dome." The Times 24th July 2000 BY HELEN RUMBELOW, MEDICAL REPORTER A NEW league table of health authorities reveals that factors such as poor quality NHS treatment cause more unnecessary deaths than poverty. Several authorities in the Home Counties are exposed as giving sub-standard healthcare - shortcomings normally concealed by the healthiness of their middle-class residents. And although a deprived area such as East London is one of England's worst illness blackspots, its residents get some of the best NHS care. The independent King's Fund says that poverty is still the biggest single factor in people's health and accounts for two fifths of the gap between good and bad authorities. But its report, How Well is the NHS Performing? concludes that the rest of the difference is probably due to poor quality NHS care, lack of access to services such as GPs and cancer specialists, education and pollution. When hospital rankings are adjusted to take into account a region's poverty, rural areas suddenly fall in the Fund's table of 100 health authorities, while inner cities rise.
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