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  • Care homes warn of fee increases  Society Friday May 31, 2002
  • Hospital patients forced to watch TV you can't turn off. John Carvel, social affairs editor Thursday April 8, 2004 The Guardian
  • The row over NHS hospital televisions that patients cannot switch off intensified yesterday after further complaints to the Guardian. A report on Thursday described how 17,500 hospital sets were installed without off switches by Patientline, a company chaired by Derek Lewis, former director general of the prison service. Patients had to watch from when the service came on automatically at 6am or 7am until it closed at 10pm. Those not wanting to pay £3.20 a day for cable TV got hospital service messages instead. Mr Lewis gave assurances that a second generation system - with an off switch - was installed in more than 80 NHS trusts. But readers with experience of the new system say the switches do not work. John Carvel, social affairs editor Saturday April 10, 2004 The Guardian
  • A private company is being accused of charging NHS patients exorbitant rates to use the phone and watch TV. Seriously ill patients are being charged £3.50 a day to watch TV, and relatives up to 49p a minute for telephone calls in, by Patientline, a company that sells TV and phone cards through ward vending machines in 150 hospitals around the country. Sunday July 24, 2005 The Observer
  • The cost of calling patients in hospital is to be investigated by Ofcom after the communications watchdog received complaints about the prohibitive costs of bedside calls. Ofcom is to look at the prices charged by Patientline, the UK's biggest provider of bedside telephones, and its smaller competitor, Premier. Laura Smith Tuesday July 26, 2005 The Guardian
  • We were delighted to learn on Monday that Ofcom, the communications watchdog, is to start an investigation into Patientline, the private company that Cash revealed last week is charging exorbitant rates to NHS patients to use the telephone and watch TV in hospital. It is also looking at Patientline's smaller competitor, Premier. Lisa Bachelor Sunday July 31, 2005 The Observer
  • Several million hospital patients could be faced with paying prescription charges for their medicines if they opt for day surgery, surgeons warned yesterday, accusing the government of a further attempt to cut NHS debt.  Sarah Boseley and John Carvel Tuesday December 13, 2005 The Guardian
  • Giveaway deal could turn out costly for the NHS. An Ofcom investigation into the rates charged for incoming calls by Patientline, the provider of bedside telephones and TVs in hospitals, has brought into question how far competition law may apply to the NHS, with potential implications for things like hospitals' charges for car parking. If in the ruling NHS trusts are considered "commercial undertakings" rather than public service providers they will be subject to competition law, meaning that not only Patientline but also the NHS trusts that acquired its services could be "abusing a dominant position". Given that most trusts by definition dominate their local market the implications could be huge with policies such as telephone rates and high parking charges linked to PFI deals being just the tip of the iceberg. Summary by Keep our NHS Public of Financial Times 3 January 2006
  • Hospital car parks make visiting the sick costly. According to Macmillan Cancer Relief three quarters of hospitals now charge for parking. Hospitals set their own car park policy and can charge what they like - at some the fees reach £35 a day. The House of Commons health select committee starts an inquiry into hospital car park charges this month. Summary by Keep our NHS Public of Daily Telegraph 9 January 2006
  • The telecoms regulator Ofcom yesterday demanded that the Department of Health review the price of calling bedside telephones after friends and relatives of patients complained that it would cost less to call the other side of the world than it does to talk to loved ones in hospital. During a seven-month investigation, Ofcom found that incoming calls to bedside phones cost 49p per minute at peak time and 39p per minute at other times. In contrast a call to Australia from a basic BT phone at peak time costs 24p a minute. Richard Wray Thursday January 19, 2006 The Guardian
  • Department of Health ordered to pay for "free lunch". Ofcom's ruling that charges for calls on the Patientline bedside telephone service were high, but that this was down to the nature of the contracts and not profiteering, means the Department of Health may have to pay for a service it originally envisaged would be self-financing. Only two of 122 hospitals have chosen to buy the full range of services offered by Patientline, including patient record displays and meal ordering facilities, which would enable the costs of calls to be reduced. Trusts are strapped for cash, and some NHS managers have said they are not impressed with the system. The Ofcom ruling has left in abeyance the crucial issue of whether NHS trusts are commercial undertakings subject to competition law. If talks between the DoH and Patientline fail to reduce call charges, Ofcom could still then rule that they are. Summary by Keep our NHS Public of Financial Times 19 January 2006
  • NHS patients pay cash for superior care. Health Service patients are paying for enhanced levels of care and operations that are no longer available free at hospitals across England, in initiatives that are being criticised as the creation of a two-tier health service and privatisation by stealth. Harrogate and District NHS Foundation Trust is to open the Foundation Skin clinic, described by managers as a "halfway house" between state and private care. The clinic will carry out procedures like the removal of moles and warts, screening of moles and Botox injections to reduce heavy sweating - all for a fee. Trust managers admit that the initiative is a response to funding shortages. Some of the services were offered free by the trust until 2003. Queen Charlotte's and Chelsea NHS hospital in London recently began to offer one-to-one midwife treatment for £4,000. Professor Allyson Pollock, director of the Centre for International Public Health Policy at Edinburgh University, says the most vulnerable patients are suffering as a result of fees being widely introduced. "It is shocking that NHS patients can pay for a higher level of care. They are getting priority treatment and are able to pick and choose." Summary by Keep our NHS Public of Sunday Times 29 January 2006
  • NHS hospital charging for private MRI scans. The Royal Cornwall Hospital in Truro offers MRI scans to fee-paying private customers, whilst there is reportedly an 11-month waiting list for NHS patients who need to use the facility. The hospital claims it needs the money from private treatment to subsidise the cost of NHS scans. Lack of funding has meant the scanner has been underused since it was installed in September. Now the hospital has slashed the fee to private patients in a bid to attract more custom. It has denied it is involved in a price war with other NHS centres. Summary by Keep our NHS Public of BBC Online 31 January 2006
  • Breast cancer patients paying £2m for drugs. Women recovering from breast cancer are paying the NHS more than £2m a year for drugs that they would receive free if they were being treated in hospitals. Breast Cancer Care says that one in seven women do not take their drugs because they cost too much, and is calling for the prescription charge on breast cancer drugs to be scrapped. 70% of women who are treated for breast cancer take hormone therapy - costing between £90 and £400 a year - for about five years after treatment. Summary by Keep our NHS Public of Telegraph 6 February 2006
  • Anger as hospitals increase parking charges. Parking charges have been increased by more than 30% at Warwick and Stratford Hospitals. The charge for a week-long parking pass will more than double from £7 to £15. Summary by Keep our NHS Public of Coventry Evening Telegraph 13 February 2006
  • Parking fees outrage. Coventry's Walsgrave Hospital has increased its parking fees. Parking charges are also being introduced at Rugby's St Cross hospital for the first time. Summary by Keep our NHS Public of Coventry Evening Telegraph 13 February 2006
  • It amounts to a pay cut for workers. Amicus and Unison leaders have hit out at the revelation that Walsgrave Hospital may charge staff up to £300 a year to park. Summary by Keep our NHS Public of Coventry Evening Telegraph 13 February 2006
  • Firm behind high hospital phone charges ousts chief. Patientline, the company that provides bedside television and telephone systems to 120 hospitals, has removed Per Jonsson, its chief executive of less than a year. But a group of dissident shareholders led by stockbroker Shore Capital are calling for an extraordinary general meeting at which they plan to oust chairman Derek Lewis. Patientline shares have suffered due to an Ofcom investigation into high call charges and, according to Lewis, ward closures and changes to the NHS.  Summary by Keep our NHS Public of Guardian 13 February 2006
  • Fears over £4,000 midwife scheme. The Royal College of Midwives has criticised a scheme offering mothers-to-be one-to-one care from a midwife for a £4,000 fee. Queen Charlotte's and Chelsea Hospital in London offers 24-hour access to the same NHS midwife throughout pregnancy and labour to women who can afford it. The RCM said it compromised the belief that everyone is entitled to "high quality, one-to-one care", and that it created a two-tier system. The RCM called for "more working midwives, not extra charges for mothers". Hammersmith Hospitals NHS Trust, that runs Queen Charlotte's and Chelsea Hospital, said more than £160,000 had been generated from the scheme so far. Summary by Keep our NHS Public of BBC Online 14 February 2006
  • Hospital staff in strike threat over parking. Staff at Walsall Manor Hospital have threatened to strike over increased parking fees and a lack of spaces. A Unison representative said: "Staff currently pay £26 a year but those charges have been increased since the start of this month to £60 or £120 a year. That is disgraceful in itself but we also have problems actually finding a space to park sometimes. Nursing staff on night duty are having their safety put at risk because of this and it is simply not good enough." Summary by Keep our NHS Public of Birmingham Mail 16 February 2006
  • Abolishing prescription charges for generic drugs should be considered, NHS Confederation says. The NHS Confederation is considering supporting a system that made generic drugs free and that charged patients only if they wanted a branded drug. The Confederation said this could help improve equity in the NHS, while providing a choice of drugs.  Summary by Keep our NHS Public of British Medical Journal 17 February 2006
  • £1.2m in parking fees. The Great Western Hospital in Swindon has earned £1.2m in parking fees since it opened three years ago. Summary by Keep our NHS Public of  Public Finance 17 February 2006
  • Minister "uncomfortable" about charges for enhanced NHS services. Health Minister Jane Kennedy told the Commons health select committee that the government will investigate extra services provided at a charge by NHS hospitals, including a special service for pregnant women at Queen Charlotte's and Chelsea hospital, who can pay £4,000 to have a named midwife working with them through to the birth. She said such a service should be offered free on the NHS, and the only thing preventing it was a lack of midwives. Summary by Keep our NHS Public of Western Daily Press 20 February 2006
  • Ministers back £1m hospital car parking. Swindon's Great Western Hospital charges patients and relatives up to £35 a day to park - more than some private car parks in central London. The trust has raised £1.2million from drivers in three years. But speaking to the Commons health select committee, health minister Jane Kennedy backed hospitals charging for parking, saying "I think these are competitive charges and therefore fair." She also defended bedside telephone and entertainment systems. Summary by Keep our NHS Public of Western Daily Press 20 February 2006
  • Charge women for needless NHS epidurals, say midwives. Women having babies in NHS hospitals should pay for epidural injections unless there is a medical need for them, according to the education and research committee of the Royal College of Midwives. The treatment costs up to £500 in private maternity hospitals, and a fifth of pregnant women in the UK have it to help ease the pain of childbirth. A review of 21 studies comparing epidurals to other forms of pain relief showed women who chose them were 40% more likely to need intervention. But Maureen Treadwell, of the Birth Trauma Association, said: "The women least able to pay would get the rawest deal. Some professional women can just put the cost of an epidural on their plastic cards but women who can't afford it will suffer." Summary by Keep our NHS Public of Telegraph 23 February 2006
  • Charities turn up the heat on care funding scandal. The Department of Health has issued guidance to SHAs to ensure that the criteria they use to assess older people's eligibility for care funding are lawful. It follows a High Court victory by Maureen Grogan against Bexley NHS Trust in January. She had been forced to sell her home to pay for her nursing home fees, but the judge found that the trust had applied flawed criteria. Summary by Keep our NHS Public of  Telegraph 4 March 2006
  • Stop the massive hospital rip-offs. Hospitals that have sky-high charges for car parking are set to face a government investigation. Patricia Hewitt plans to order a sweeping inquiry after a flood of complaints. Summary by Keep our NHS Public of  Mirror 6 March 2006
  • Outrage over staff parking at hospital. Hundreds of staff at the Northern General Hospital in Sheffield have signed petitions against management plans to make them pay £260 a year to park their cars at work. Trade unions including Unison, the RCN, Amicus and unions representing physiotherapists and radiographers are circulating petitions to persuade managers at the Sheffield Teaching Hospitals NHS Foundation Trust to drop the proposals. Summary by Keep our NHS Public of  Sheffield Star 6 March 2006
  • Parent group hits at baby scan price hike. Cash-strapped George Eliot Hospital in Nuneaton has increased the charge for print outs of baby scans from £3.50 for two images to £5 for just one picture. The hike is part of measures being pushed through in response to the hospital's financial position. Summary by Keep our NHS Public of  Coventry Evening Telegraph March 2006
  • Thousands of elderly and disabled patients would lose their right to free long-term NHS care under draft proposals circulated by the Department of Health. The Guardian has obtained a leaked document suggesting criteria for deciding who among the old and infirm qualifies for free NHS "continuing" care. Ministers want standardised tests to address what they have called a "postcode lottery". But it is claimed that the proposals would also sharply reduce the number of patients eligible for free NHS continuing care. Diane Taylor and Hugh Muir Monday March 20, 2006 The Guardian
  • Hospital car parks make millions. Hospitals in England are each charging their patients up to £1.5m a year for car parking. Twelve hospital trusts each raised over £1m in charges, figures obtained by the BBC from the Department of Health under the Freedom of Information Act show. University Hospital Birmingham, raised £1.5 million from car parking charges in 2004-5; Cambridge University NHS Foundation Trust raised more than £1m; Basildon and Thurrock University Hospitals NHS Foundation Trust raised just over £1m; Oxford Radcliffe Hospitals NHS Trust raised more than £1.2m. Summary by Keep our NHS Public of  BBC Online 28 March 2006
  • A radical overhaul of social care for the elderly has been proposed in a report that also criticised a "failing" system. Sir Derek Wanless called for long-term investment in care services for older people and for the current means testing system to be scrapped. Thursday March 30, 2006 11:18 AM
  • Charging is no solution for the health service. A letter to the Guardian from John Groocock, reacting to the Doctors for Reform statement, points out that "the call from less than 1% of NHS doctors to introduce payment for treatment is an obviously unhelpful initiative. The one thing that is really efficient about the NHS is the way it gets its money: the cost of collecting it is virtually nothing." Professor Alan Maynard writes: "Switching NHS funding from tax-finance to tax plus user-charges would ensure that the sick paid more for their care and tax burdens on the rich were eased. Not only would such a funding switch be inequitable, it would also be inefficient, condoning the significant inefficiences inherent in current work practices." Summary by Keep our NHS Public of  Guardian 4 April 2006
  • Fury over hospital car park deal. Unions are furious about West Suffolk Hospital's plans to sell its car park to a private firm for almost £1m less than the deal could be worth. The car park made more than £660,000 profit last year, which was ploughed back into patient services at the cash-strapped Bury St Edmunds hospital, and could be worth more than £4.6m over the next seven years. But it was instead sold for a one-off payment of £3.8m. Geoff Reason of Unison said: "We are very much against the sale of assets - the money should be used to support the hospital. It is putting our financial problems off into the future." Summary by Keep our NHS Public of  Eastern Daily Press 5 April 2006
  • Thousands of cancer patients are waiting longer than two months before they can begin treatment, according to new figures that reveal a crucial health target has been missed. The government had promised that 95 per cent of patients would start treatment for cancer within 62 days of being referred by their GP. But figures to be released in June will show that 9 per cent of all patients had to spend longer in the queue, equating to around 12,000 people a year. The main delays happen in the wait for a diagnosis, where there is still a shortfall of both staff and equipment to carry out the tests needed to assess the nature and severity of a cancer. The biggest waits are for bowel cancer, the third most common form of cancer in Britain affecting 34,000 people a year, where patients need a colonoscopy, an internal probe to find the tumour, for their diagnosis. ... The figures came as new pressures emerged over the deficits facing the NHS. A rally took place yesterday in Stoke-on-Trent where up to 1,000 jobs could be lost as the NHS trust, the University Hospital of North Staffordshire, faces debts of up to £15m. Managers have launched a 90-day consultation on the plans, which have been greeted with dismay by staff there. The actual deficit in the NHS could be as high as £1.2bn with 58 per cent of hospital trusts facing deficits. Many of them now have to repay loans to the NHS Bank, which has traditionally lent money and allowed deficits to be carried over. Niall Dixon, the fund's chief executive, said further cuts in services were almost inevitable because of the pressure to meet targets on cancer and waiting lists. 'It's clear that these financial problems threaten to derail the reform agenda,' he told the Health Service Journal. 'Hospitals will be left with too little cash to fund policies which would improve patient care.' One leading economist called last week for the government to acknowledge that there would be a huge funding gap for the NHS by 2009, when the large year-on-year increases in funding dry up. Oxford economist Andrew Dilnot, former head of the Institute of Fiscal Studies, said the government should contemplate a system of 'co-payments' so that those able to afford it could pay towards routine care, and the NHS would be safeguarded. ...· Have you or your relatives had to endure a long wait for cancer radiotherapy? If you want to tell us about it, please email jo.revill@observer.co.uk   Jo Revill, health editor Sunday April 30, 2006 The Observer
  • More than a third of breast cancer patients in Scotland are struggling to pay prescription charges for vital drugs, according to a leading charity. Breast Cancer Care is calling on the Scottish Executive to scrap prescription charges for patients who need them as part of cancer treatment.  NHS Exposed news release.
  • The politics column - Allyson Pollock. In the New Statesman's main political column, Allyson Pollock writes: "According to Patricia Hewitt the NHS has had its best year ever. So why is the Royal College of Nursing threatening industrial action over cuts and closures, and why did the annual conference of Unison, traditional Labour supporters, greet the secretary of state with heckling? In her words, "the NHS must modernise or die". So why, from Surrey to Manchester and from Gateshead to Shropshire, are local people banding into hospital action groups and "Keep our NHS public" campaigns in an effort to defend the health service ? The chief targets for cuts are mental health services, palliative care, older people's care and emergency hospital care, yet Hewitt maintains, to general derision, that quality will not be affected… Pay accounts for 60-70 per cent of NHS hospital budgets, but pay awards accounted for less than 30 per cent of the new money and should have been absorbed easily. Nor was greed involved; the increases returned NHS pay to previous levels after years of pay freezes. The hourly rate of the lowest-paid rose initially from £5.16 to £5.67 an hour; medical consultants got increases of 4-5 per cent a year, taking them to averages of between £75,000 and £95,000, while managers - their numbers swollen by the complications of marketisation - got 7.5 per cent more last year. The real reason for the decision to axe in excess of 13,000 clinical staff and 1,000 NHS beds, plus associated services, is market-oriented reforms such as "choose and book", "payment by results" and foundation hospitals. Hospitals and services are required to behave like stand-alone companies, competing with each other and private corporations for income and patients… The government plans to hand over most of the NHS budget to the private sector through "practice-based commissioning". Under this policy, local PCTs will eventually contract with for-profit companies such as the US-owned UnitedHealth Europe to provide GP services… The Prime Minister asserts that the reforms are bearing fruit, and so they are - for "investors" such as the lucky shareholders of Norfolk and Norwich and Bromley PFI hospitals, who received a windfall of more than £500m within months of the new hospitals opening. But the PFI has been less "fruitful" for local people, who have seen a quarter of beds closed and clinical staff and community provision cut. A large part of hospital trust deficits is due to PFI debts, running at £1.5bn a year… And then there are the costs associated with establishing and operating a market - costs the NHS was explicitly designed to avoid: these are for invoicing, marketing, advertising, drawing up hundreds of thousands of contracts, legal disputes with contractors and rival hospitals, and using management consultants… And though NHS hospitals remain responsible for balancing their books, the government has ensured that the only way they can do so is by cuts, closures, the sale of land and buildings - and more privatisation. Some foundation trusts are entering joint ventures with companies such as the Hospital Corporation of America, providing care to private patients in what were previously NHS beds. Others are charging NHS patients for "extra" care: Queen Charlotte's and Chelsea NHS hospital has introduced a fee of £4,000 for one-to-one midwife care - once the NHS standard - and the government is allowing it. The less fortunate hospitals - if that is the right word - are closing services and sacking staff. Is this what the English patient needs or wants ?" Summary by Keep our NHS Public of  New Statesman 2 May 2006
  • Publicity over cost of calls hits hospital bedside phone provider. Patientline, the provider of telephone and internet services to hospital bedsides, has been hit by ward closures, empty beds and patients' unwillingness to use the terminals because of the bad publicity surrounding the cost of calls. The company admitted that its average revenue per terminal had declined 7% since last year. The company reported an annual pretax loss of £11.3m. Summary by Keep our NHS Public of  Guardian 14 June 2006
  • Visitors will pay to park at hospitals. Parking charges for patients are to be introduced for the first time next week at Wirral's two main hospitals. People parking at Arrowe Park and Clatterbridge will have to pay £2 for most of the spaces during the daytime. Summary by Keep our NHS Public of Liverpool Daily Post 28 June 2006
  • Up the creek without a compass: the Labour mess Charles has identified. In a comment piece, Alice Miles writes: "Among the next moves Tony Blair's advisers in No 10 discuss are a massive extension of individualised budgets, a degree of upfront charges in the health service, and allowing private providers to run schools and make a profit from doing so. But they recognise that Mr Blair has reached the limit of what he can get through the House of Commons. "It would be good if Cameron finished the job for us," one said…about schools reform." Summary by Keep our NHS Public of Times 28 June 2006
  • Patients in NHS hospitals are being ripped off by stealth charges for 'extras' such as telephone calls and parking, according to a hard-hitting report from MPs this week which highlights the creeping growth of fees in the supposedly free health system. Phoning a relative from the wards can cost more than calling Australia under the profit-making systems installed by many hospitals, while others are charging up to £30 a day for outpatients and visitors to park. This means, for example, that cancer sufferers who have to drive in for daily chemotherapy may end up spending hundreds of pounds for access to their 'free' NHS care. The Commons health select committee is also expected to highlight the growth of 'semi-private' services provided by NHS clinics for a fee, including one London hospital which promises pregnant women access to the same midwife throughout pregnancy if they join a £4,000 scheme, and one clinic at Harrogate in North Yorkshire which charges for screening suspect moles that might be cancerous. Some committee members are understood to be concerned that charges such as these will lead to a two-tier NHS where the well-off can get a better service without having to pay the full cost of going private.Gaby Hinsliff, political Editor Sunday July 16, 2006 The Observer
  • Patients fleeced by phone and parking charges, MPs say. Patients are being ripped off by a chaotic range of NHS charges with no underlying principle leading to inequalities in payment and disadvantages for the less well off, according to the commons health select committee. Its report attacked parking charges, phone calls, and prescription charges, amongst others. It said the 1968 list of exemptions for prescriptions was unacceptable "given the vast improvements in medical science". The report calls for a full scale review of charges to consider: abolishing the prescription charge, provide free parking or reduced price season tickets to those visiting hospital regularly, and subsidy of phone calls from friends and relatives. In addition the report calls for the immediate introduction of a monthly prescription certificate offering low-income families unlimited prescriptions for £6.65 a month. The committee more controversially suggested that patients pay for missing GP appointments and visiting A& E departments with non-emergency injuries. It singled out for criticism a scheme offering a one-to-one midwife for £4,000 at Queen Charlotte's Hospital in west London for offering a premium of service within a public system. It said: "Essential care of this type should be given to all or paid privately at full cost." Summary by Keep our NHS Public of Guardian 18 July 2006
  • End of a free NHS? Free NHS treatment in hospitals could be abolished under plans from an all-party group of MPs. The Labour-dominated Commons health committee recommended scrapping prescription charges, dental fees and opticians' costs but charging for certain hospital treatments. The MPs suggested establishing packages of free core services and treatments for which the NHS should charge, introducing a small fee for non-emergency A& E patients and charging patients who do not attend or fail to cancel GP or hospital appointments. Committee chairman and Labour MP Kevin Barron said: "The system needs to change. But first we need to know how the charges interact with health. At present, the evidence isn't strong enough." Summary by Keep our NHS Public of Mirror 18 July 2006
  • Free NHS is a must. A Mirror leader says: "MPs are playing with fire by suggesting you should pay twice for health treatment. If a Labour-dominated Commons committee got its way, charges would be imposed on top of the taxes levied to fund the NHS. The introduction of fees for unspecified treatments and visits to the doctor would demolish the fundamental principle that care is free when you're ill. Hard-working families and those living just above the means-tested cut-off point for free treatment would suffer most. These MPs may complain of high hospital phone and car-parking prices yet they risk making it worse by bringing in another round of expenses. Yes, it's true the system is a "mess", when charges for items such as prescriptions and eye tests exist. But the answer is to make them free, too. The NHS is getting better since the government tripled spending. But raising the spectre of charges threatens Labour's greatest creation - and plays into Tory hands." Summary by Keep our NHS Public of Mirror 18 July 2006
  • Trust told: do not fleece patients. Health chiefs have been warned against "fleecing patients unfairly" as it emerged Southampton hospitals charge some of the highest car parking fees in the country. The Lib Dem MP said: "The extent of charging in the NHS highlights how extra costs have crept into a service that should be free at the point of use." Summary by Keep our NHS Public of Hampshire News 20 July 2006
  • MPs call for review of NHS charges. The Commons' health select committee has asked the government to review the system of prescription and other NHS charges and to consider whether charges for services 'not clinically necessary' could be levied. The committee proposes the government consider the merits of a system similar to that in Sweden, whereby patients are charged for treatments that are not 'cost-effective' - such as the use of branded drugs when effective generics are available - and cosmetic surgery. 'Hotel fees' could be charged to cover the non-medical cost of overnight stays in hospital. Summary by Keep our NHS Public of Public Finance 21 July 2006
  • Too high a price to pay. In a comment piece Joe Farrington-Douglas argues that this week's call for means-tested charges for NHS services is wrong-headed. Such a move would raise few funds, deter the wrong people from using health care, and undermine the consensus that backs free care. HE writes: "Free at the point of need - the founding principle of the NHS - is under question from an unexpected source. At a time of financial difficulty for the health service, the Labour-chaired Commons' health select committee this week floated the idea of charges for public health care… Charging is a blunt tool. It will neither raise enough money to dent the deficit nor reduce misuse of resources. It will also undermine support for a progressive universal health service… Co-payments levied in other countries - including France, Germany and social democratic Sweden - raise only a small proportion of the total costs of health care (about 1% in Stockholm, for example). In some cases, the cost of collecting charges - forms, bills and accountants - exceeds the revenue collected… The other reason for charging is to dampen demand. But the worried well continue to make use of prescriptions despite the charge. Even then, 60% of drugs are not taken properly, questioning the effect of financial costs on behaviour… Means-tested charging would threaten the broad coalition supporting free health care. When we are all in, we are all willing to pay - thus middle England voted for a Labour government that raised contributions for the NHS. The British Social Attitudes Survey found that 75% of people opposed means testing in the NHS and more than half listed health as their top spending priority." Summary by Keep our NHS Public of Public Finance 21 July 2006
  • Is this a sick joke? Health workers are facing a 150% increase in car parking charges to help ease the cash crisis at the University Hospital of North Staffordshire. And patients and their visitors will see the cost of parking rise by one-third as part of a drive to raise £400,000 towards the trust's deficit. The amount the hospital will raise as part of the controversial move is enough to save the jobs of 20 nurses. But it was condemned by nurse union leaders as "another kick in the teeth" for workers already bracing themselves for redundancy. Summary by Keep our NHS Public of Stoke Sentinel 21 July 2006
  • Prescription charges review plea. Nine charities have urged the government to reconsider prescription charges for suffers of chronic illness. In a letter to the Government, Arthritis Care, Asthma UK, Breast Cancer Care, Citizens Advice, the Cystic Fibrosis Trust, Macmillan Cancer Support, Mind, the MS Society and the Parkinson's Disease Society said an urgent review was needed. In July the Commons Health Select Committee recommended a review of charges and a reassessment of the medical exemption list that has existed since 1968. Donna Covey, chief executive of Asthma UK said that inability to pay for medication was harming many chronic illness sufferers and putting extra pressure on the NHS. The Department of Health said that, although they were looking at Health Select Committee report carefully, they "don't agree with the committee that the current prescription system is a mess." Summary by Keep our NHS Public of Chester Chronicle 8 August 2006
  • Health Staff "sick" at cuts. Health workers, pensioners and trade unionists protested against NHS cuts across Oxfordshire on Saturday outside the half-built East Oxford Medical Centre on Manzil Gardens in Oxford. They were objecting to 600 job cuts planned by Oxford Radcliffe Hospital NHS Trust as it tries to find £33m in savings. Dr Helen Groom, spokesmen for the Oxfordshire branch of Keep Our NHS Public, said that patients were already feeling the effect of cuts. She said: "Cuts in mental health mean the day hospitals, which people did not have to pay for, have turned into day centres, which patients have to pay to go to…The cuts mean there will be 700 less outpatient clinics at the Oxford Radcliffe, which will mean patients will wait longer for treatment". The protesters explained their choice of location by saying that PFI deals, like the East Oxford Health Centre, were placing strain upon the NHS that was contributing to cuts. Dr Groom said: "The Oxford Radcliffe Hospitals Trust have to make £33m of cuts this year. By the time we get to 2008 they will be paying £36m each year to private finance companies. Our worry is that the government s handing over little parts of the health service to the private sector. We feel it is wrong that tax payers' money is no longer staying in the NHS and is instead going into the pockets of private investors." Summary by Keep our NHS Public of Oxford Mail 7 August 2006
  • 'Tax on being sick'. Plans for a 25% hike in short-stay parking fees at Nottingham's hospitals have been branded "a tax on being sick". Patient representatives have reacted angrily to the move. Nottingham's hospitals raised more than £1.3m last year from parking fees. Summary by Keep our NHS Public of Nottingham Evening Post 31 August 2006
  • Calls for strike in hospital row. An acrimonious dispute over staff car parking and charges for childcare at Sheffield's Northern General Hospital is threatening to escalate into strike action. Unions are holding a rally today outside the hospital to draw public attention to the situation, which has left some nursing staff and other workers without anywhere to leave their cars at work - in effect wiping out the benefits of this year's pay award. Summary by Keep our NHS Public of Yorkshire Post 1 September 2006
  • Hospital's multi-storey car park plan. A multi-storey car park could be built to ease notorious parking problems at Southend Hospital. Plans are being drawn up for a three-storey building with 400 staff spaces and 300 for patients and visitors. Hospital officials say profits from charging visitors - and possibly staff - would fund measures to persuade people to abandon their cars for greener modes of transport. It would be built in partnership with a private firm. The hospital has provisionally put aside more than £1million over the next two years, with the expectation of recouping £1.5million in the two years following that. Summary by Keep our NHS Public of South Essex News 8 September 2006
  • Care home nursing 'should be free'. All nursing given in care homes should be provided free of charge by the NHS, the Royal College of Nursing has insisted. The nurses' body said Department of Health proposals for national rules on continuing health care did not clear up confusion over which patients were eligible for NHS care. Summary by Keep our NHS Public of Public Finance 6 October 2006
  • Hospital parking fee cut - but deal is secret. NHS Lothian yesterday rejected demands for it to open its books and reveal details of a multi-million pound deal it has struck to refinance its flagship hospital privately. Bosses at the Royal Infirmary, Edinburgh (RIE) would say only they had agreed "a refinancing package" with Consort Healthcare, the firm that has come under fire for charging patients up to £10 a day to park at the hospital since it opened in 2002. One part of the deal NHS Lothian did make public was that Consort was to cut daily parking charges from £10 to £7. Politicians and trade unions accused the health board of trying to hide the details of its new deal with Consort - which could be longer and inevitably more expensive than the original PFI deal - by making a fanfare announcement about the reduction in parking charges. Together with the city's Western General Hospital, the RIE still operates the most expensive parking charges for patients and relatives in Scotland. A spokesman for NHS Lothian said details of the agreement were "commercially confidential", but insisted it would "deliver multi-million pound gains" for NHS Lothian. Shona Robison, the SNP health spokeswoman, said: "Secrecy and waste have been the hallmarks of PFI contracts. Taxpayers are entitled to see what the terms of the new deal are, given that they are the ones paying for the new contract. We are all entitled to know whether Consort have made significant financial gains out of re-negotiating this contract with NHS Lothian and they should publish the terms of the deal for all to see." Ms Robison said she welcomed the cut in parking charges, but added: "They were a classic example of the bad deal which PFI represents for staff, patients and the taxpayer. The fact that there has had to be a renegotiation of the contract at this stage due to public outcry reinforces that." The public service union Unison suggested the deal would mean a longer association with Consort which would, in the long run, cost taxpayers more. Tom Waterson, of Unison's health services group executive, said: "The NHS is still giving millions of pounds to a private company which continually refuses to disclose how much profit it is making from the health service and patients. If this deal is really making multi-million pound savings for taxpayers, it is time they opened up the books and showed us. What do they have to hide ? Until then we must assume the deal has been extended, so while repayments are less on a yearly basis, over the piece they will cost taxpayers more." Summary by Keep our NHS Public of Scotsman 24 November 2006
  • Nurse anger over parking fee hike. Nurses at an Essex hospital have reacted angrily after health bosses announced plans to hike up staff parking fees by more than 400 % to help pay off NHS debts. Charges for employees wanting to park their cars at Broomfield Hospital in Chelmsford are set to rise from the current £3.33 per month to £16.67 a month from February next year. Colin Rolfe, who represents trade unions and professional organisations at the trust, said he felt hard-working and already pressurised hospital staff were being punished for the inability of the trust to manage its own finances properly. Mid Essex Hospital Services NHS Trust, which runs the hospital, recently announced it was to shed as many as 250 jobs in an effort to pay back a £14m deficit. In an email sent to staff this week it announced that in order to generate additional money to help pay its debts it was going to increase staff car parking fees by five times. Patient and visitor parking fees would also be increased, it added. "The extra income generated from the increases, after paying for the upkeep of the car parks, will go straight back into the trust's overall budget. If you work more than 20 hours per week the change will increase to £16.67 a month. If you work 20 hours or less, the charge will be £8.33 per month." The email also said that the hospital staff's parking fee had not been increased in eight years, and that similar trusts in Essex, including Basildon and Thurrock university hospitals, were also increasing their charges. Mr Rolfe said: "It is indicative of what is going on in the wider NHS at the moment, with the poor financial controls of the trusts and a staff who are under great pressure to increase patient care and workloads. What with the redundancies as well, this feels like yet another nail in the coffin." Summary by Keep our NHS Public of East Anglian Daily Times 8 December 2006
  • Operating framework: updated principles put new emphasis on dignity. The Department of Health is consulting on a set of 10 principles to which all NHS organisations and contractors must sign up. The principles, published alongside the operating framework, update those in the 2000 NHS plan, but offer two new emphases: on continuously improving efficiency, productivity and performance; and on treating patients with dignity and respect. NHS chief executive David Nicholson said he wanted to 'close down' any debate on the possibility of independent sector providers offering co-payments of any kind. 'Any ideas that any providers can offer top-ups or extras that the patients pay for is unacceptable. That is a stake in the ground. There has been a focus on the technical aspects of reform rather than why we are doing it. People get focused on competition and the market and all this stuff but the whole point is to improve services to patients. I am trying to move completely away with that. I think we have lost the focus over the last two to three years and I am trying to pull us back. The great strength of the system is its cohesion. The need for reform drives us apart but we also need to stress those places where we are together.' Summary by Keep our NHS Public of Health Service Journal 14 December 2006
  • Prescriptions free for everyone…But only if you live in Wales. Anger is growing over Britain's two-tier health service after prescription charges were abolished in Wales. Anyone registered with a Welsh GP will get their drugs and medical supplies free from April 1 but patients in England and Scotland will continue to be charged £6.65 for each item. There is already resentment over the decision by the Scottish Parliament to provide free care for the elderly while councils in England are warning services will be slashed and fees raised. It emerged last week that Englishman George King is moving 105 miles from his home near Middlesbrough to Melrose in the Scottish borders to get life-saving treatment for bone marrow cancer. Prescription charges in Wales have been gradually reduced in line with a 2003 Labour promise. Welsh Health Minister Dr Brian Gibbons said: "The vast majority of ordinary working-class people will benefit substantially and, for us in Welsh Labour, that's what we are proud about." Summary by Keep our NHS Public of Express 26 January 2007
  • Insurance cost to rise as NHS chases work-injury payments. The NHS is to pursue employers to recover the cost of treating employees injured at work, ministers will announce. Rules that allow the NHS to claim back money for patients who have been paid personal injury compensation could see more than £150m refunded each year, the Government says. But insurers, who will bear the brunt of the costs, gave warning yesterday that the move could provoke a multimillion-pound increase in premiums. Summary by Keep our NHS Public of Times 26 January 2007
  • Call to reform NHS charge system. Most NHS prescription charges in England should be scrapped and applied to "ineffective treatments" instead, NHS public health chiefs say. The Association of Directors of Public Health said rising demands on the NHS will lead to more rationing. Their president, Dr Tim Crayford, said: "If NHS charges should be applied at all, they should be applied to relatively ineffective treatments." He gave tonsil removal and varicose vein surgery as examples. But he also speculated about the feasibility of allowing more serious procedures, such as cataract surgery and hip replacement operations, to remain free in all cases. "Medicine and treatment that people need for health reasons should be free. But where there's little proof of clinical benefit, the use of such treatments would reduce more quickly if they had a price tag attached." Professor John Appleby, chief economist at the King's Fund health think tank, said: "I do not buy into these doomsday scenarios. How much extra demand is there going to be on the NHS ? I don't think there are any miracle drugs in the pipeline and as for the people living longer, what matters most is how close you are to death, not how old you are. We consume the most health resources in the last year of life whether that is at 50 or 80." Professor Appleby also said it was likely there would be public appetite to increase the amount spent on health to keep pace with increasing demands. Summary by Keep our NHS Public of BBC Online 29 January 2007
  • Staff may be forced to pay to park at work. Hospital bosses have insisted no decision has been made on staff car parking charges at the town's hospital. Iain McInnes, interim chief executive of Scarborough and North East Yorkshire Healthcare NHS Trust, which runs the hospital, said car parking charges at the site were under review. Amicus union representatives criticised the trust for considering levying charges against staff. Amicus' regional officer Terry Cunliffe said: "Staff are being told they may have to pay for the privilege of working at Bridlington hospital. Amicus is fundamentally opposed to these charges. No one working in the NHS can afford to pay to park at their place of work." Summary by Keep our NHS Public of East Riding Daily Mail 5 February 2007
  • Patients could be told costs of care. In a letter to health secretary Patricia Hewitt, health minister Andy Burnham acknowledged that increasing demands from patients were putting pressure on staff. 'Rising expectations are changing the work environment for NHS staff and placing them under more pressure,' he said. 'This changing behaviour could also have... [an effect on the] long-term viability of a service free at the point of use.' He said patients could be told the 'actual value' of the health services they are using in a bid to make them use the NHS more responsibly and relieve pressure on staff. Burnham put forward the idea as part of his strategy to encourage NHS staff to engage better with the government's reforms. Mr Burnham's proposals were developed at the request of prime minister Tony Blair and Ms Hewitt. He spent seven days shadowing NHS staff to prepare his strategy. Among his proposals to get NHS staff back on side in the increasingly acrimonious debate over NHS reform, he argues for: short-term employment guarantees for midwives, newly-qualified nurses and allied professionals; better integration of cleaning and portering staff into ward teams; unions, strategic health authorities and local employers to replicate tripartite national structures for dialogue at local and regional level; improving the democratic legitimacy and accountability of primary care trusts; a formal constitution for the health service. Summary by Keep our NHS Public of Health Service Journal 8 February 2007
  • Let's charge for NHS and schools, says Clarke. Labour must drop its historic commitment to free education and health care, the former education secretary Charles Clarke has said. He said it was the only way to ensure public services could meet ever-increasing demands. In what will be seen as a pitch for the Labour leadership against Gordon Brown, Mr Clarke said "some level of charging" would prevent people turning to private schools and hospitals. In a speech entitled Economic Policy and Taxation after Blair, Mr Clarke said it was highly unlikely that spending increases proposed by the Government, plus extra money expected from efficiency savings, would provide the services people now expected. Nor would there be "any real appetite" to raise general taxation to pay for expanding education and health systems. "The only way out of the dilemma which governments will therefore face is to permit some levels of charging, along the lines of university tuition fees," Mr Clarke said at the London School of Economics. "Such charging is certainly likely to raise important issues of fairness and possible social division as was the case for student fees." But it was Labour's responsibility to grasp the nettle, he said. He suggested that "co-funding" of services through the tax system and some form of charges could be based on existing models such as dentistry, where people paid set fees for the services they received. Mr Clarke said at the weekend that he had not ruled out standing for the party leadership. Summary by Keep our NHS Public of Telegraph 8 February 2007
  • Clarke backs charging for non-essential NHS services. Labour should consider extending charging to more areas of the NHS, former cabinet minister Charles Clarke has said. In comments which could spark an explosive political debate, Mr Clarke warned that public services - including health - faced a "tight" financial outlook in the coming years. In order to ensure continued free provision of core services such as operations and emergency treatment, the government must be ready to consider asking patients to pay for services like rehabilitation, he suggested yesterday. Patients could be offered more choice on the kind of hospital ward they stayed in and be charged for hotel-style comforts. And, he said, people could be fined for missing appointments. Payments could be made either from patients' own funds or through insurance, Mr Clarke suggested. Critics are likely to say that the comments, from someone tipped as a possible contender for the Labour leadership when Tony Blair quits, represent the abandonment of the principle that NHS services should be free to all at the point of need. Press Association Friday February 9, 2007 Guardian Unlimited
  • Hard as nails. A cost-cutting NHS trust has banned a blind couple from having their toenails cut for free after 16 years. Michael Chester, 64, and Jennifer, 60, were told to get a relative to do it or go private. But the nearest family is Jennifer's 92-year-old mum, who lives 20 miles away. Privately, it costs £32 a time. Wilts PCT said: "We're looking into it." Summary by Keep our NHS Public of Mirror 23 February 2007
  • Hospital shop rent row settled. Bosses of Telford's Princess Royal Hospital and their main fundraisers have settled a row over a demand for £25,000 shop rent. The Friends run a shop in the hospital which generates £200,000 a year to help buy healthcare equipment and improve patient care. But its volunteers had been angered by a trust proposal to start charging rent - £25,000 a year - and backdate it 12 months. An agreed statement today said the Friends recognised the underfunding issue facing the trust and the need to achieve financial recovery so it can attain Foundation Trust status. In light of these "exceptional circumstances", the Friends have agreed a way forward for the next year. Alan Millward, chairman, said the Friends would pay £25,000 rent, but he had refused to have it backdated and this had been accepted by trust. Summary by Keep our NHS Public of Shropshire Star 27 February 2007
  • Doubts over bid to charge foreigners for NHS care. A fresh drive to charge foreign nationals, including illegal immigrants, for National Health Service care has been announced by John Reid, the home secretary - but well ahead of the health department being able to say how that will work in practice. Mr Reid announced pilot schemes to be run in three unidentified trusts in which hospitals and GPs will be able to check patients' eligibility for free treatment against data held by the Border and Immigration Agency. From 2008, all foreign nationals will have to have identity cards with records held on a national database. The Department of Health rejected fears that the pilots would result in NHS medical records and information being made available to law-enforcement officers. A spokesman said "categorically" that the information flow would be one way - the immigration agency providing data to the NHS. "We will not be breaching [medical] confidentiality in any way, or handing over records or identity information to the Border and Immigration Agency." In the past, the British Medical Association has said it would be "totally unjustifiable" to try to charge impecunious failed asylum-seekers who have no money. The Home Office appears to regard the pilot schemes as a potentially important building block in the development of the government's ID-card system. But Connecting for Health, the NHS information technology programme, has consistently rejected the idea of using such cards to establish entitlement to treatment. Summary by Keep our NHS Public of Financial Times 8 March 2007
  • Ministers guilty over care cash. The health service ombudsman, Ann Abraham, last night found the government guilty of maladministration for failing to organise proper compensation for thousands of vulnerable people who were unlawfully charged for NHS care. John Carvel, social affairs editor Wednesday March 14, 2007 The Guardian
  • Hospitals encouraged to allow mobile phone use. Patients should be allowed to use mobile phones in hospitals, the Department of Health has recommended. The DH is to update its guidance on mobile phone usage to hospitals, saying there is no reason why patients cannot use them in communal areas, although they may still be banned in some areas for medical or privacy reasons. A DH spokesperson said the guidance is being updated following the recommendations of a review by an independent group looking into high phone charges experienced by patients using bedside facilities. Quin Parker Wednesday March 14, 2007 SocietyGuardian.co.uk
  • Government told to revise guidance on payments for continuing care. The UK government has been found guilty of "maladministration" over rebates paid to elderly and disabled people who have tried to claim back money they spent on continuing care. The parliamentary and health service ombudsman, Ann Abraham, has ruled that the Department of Health issued "unclear and inconsistent" guidance to the NHS on this matter and insisted that new guidance be published, which is expected this week. A growing number of complaints have been made to the ombudsman's office from people who have made claims for reimbursement retrospectively-as recommended in 2003 by the ombudsman-for money they had to spend on their own continuing care and to which the government said they were entitled. Summary by Keep our NHS Public of British Medical Journal 16 March 2007
  • Probe into surgery call charges. A Probe has been launched into patient claims that they were charged 13p a minute to ring their GP's surgery. Patients at the Glebe surgery in Saxilby say they received phone bills charging them premium rates to call their doctor's surgery. The surgery has since distributed flyers to patients saying the report was not true. But now the phone company NEG, which installed the automated phone system, has begun an investigation into the patients' claims. Researcher Alistair Campbell said: "We are concerned these patients appear to have been charged this, as these calls should cost 4.2p a minute. We are investigating to see why they have been told this as it simply shouldn't happen." Summary by Keep our NHS Public of Lincolnshire Echo 16 March 2007
  • £95m NHS parking bill. Patients and visitors forked out £95million to park at NHS hospitals last year. Two trusts earned more than £2m from car park charges, while another 30 topped £1m. Cambridge University Hospitals Foundation Trust and Southampton University NHS Trust made the most. Judy Beard of Macmillan Cancer Support said: "These figures are shocking. Parking should be free for regular patients." Summary by Keep our NHS Public of Mirror 19 March 2007
  • Hospital car parks make millions. Figures from the Estates Return Information Collection have revealed that over 30 NHS trusts make over a million a year in car parking charges, with some making over £2.2m. The top earners were Southampton University Hospitals at £2.41m and Cambridge University Hospitals, £2.26m. The total for trusts looked at was £95m, however 74 trusts did not provide any figures. Macmillan Cancer Support acting chief executive, Judy Beard, said: "These figures are shocking. Cancer patients spend hundreds of pounds each year on hospital parking. Macmillan wants to see all cancer patients travelling regularly for treatment to be able to park free at hospital. NHS Trusts urgently need to implement this guidance - it is shameful that cancer patients are still paying to park at hospital." Sandra Gidley, Liberal Democrat health spokesperson, described the figures as a "tax on the sick". Roy Lilley, a former NHS trust manager, said: "Whilst most hospitals do have exemptions it is very hard to figure out how you get an exemption. You should not have to feel that you have to go begging for the refund. Where you pay there should be a list saying this is how you do it." Summary by Keep our NHS Public of BBC 20 March 2007
  • NHS may be restricted to core services. The prospect that the NHS might provide only core services, with additional treatment paid for directly or through private insurance by patients, has been raised by the government. The small print of the public services policy review, launched by Tony Blair and Gordon Brown, says the government should "look at the possibility of drawing up a package of services that all users are entitled to". The Department of Health confirmed that it was examining the possibility as part of normal process and that deciding what people were entitled to would also involve deciding "what they are not entitled to." Academics however warned that defining such a "basic basket" would be fraught by technical and political difficulties. Anna Dixon, deputy director of policy at the King's Fund think-tank, and a specialist on international health systems, said: "It sounds like establishing a core package of benefits that the NHS will fund - and that is something that has long been debated in academic circles. But politicians . . . have always shied away from being more explicit about entitlements." Social insurance systems tended to be much more explicit about what they covered, with private insurance markets developing to cover excluded treatments, she said. But she warned that when lists of exclusions were drawn up, "they often do not feel right to the public". She added that such a difficult exercise "is going to be very controversial". David Hunter, professor of health policy at Durham University, said: "It is very difficult to define what is in the basket, so either it doesn't get done or very little gets left out. You don't save much, and you are still left with the issues of how to ration care and assess quality and cost effectiveness" - something Nice was already doing but "in a rather less prescriptive way". The Health Secretary, Patricia Hewitt, was involved in producing a pharmaceutical industry-financed report study that in 1995 said that there should be restrictions on free services. But she disowned the report on becoming health secretary, saying the government's big increase in NHS spending removed the need for such measures. Summary by Keep our NHS Public of Financial Times 20 March 2007
  • Hospital parking 'a stealth tax on illness'. The NHS may be free at the point of delivery, but patients and their families paid hospital parking charges in England totalling £95m in 2005/06. The figures, released under the Freedom of Information Act, show that 12 hospital trusts each raised more than £1m in charges. Government guidelines on car parking charges in December "strongly recommended" that NHS bodies introduce some kind of "season ticket" arrangement, allowing free or reduced-price parking for patients with a long-term illness or those with serious conditions who require daily or regular treatment, and their prime visitors. It also suggested a weekly cap on parking charges. Macmillan Cancer Support, which is campaigning for all cancer patients to get free hospital parking and help with travel charges, says the figures are shocking. Judy Beard, the charity's acting chief executive, says: "When the government announced its revised hospital car parking guidance, Macmillan expected NHS trusts to exempt cancer patients. However, we have yet to see this happen." Research by the charity last year found a postcode lottery of hospital car parking costs, with patients in Scotland spending an average of £636 on travel and parking throughout their cancer treatment compared with patients in Wales who spent £318. In south-west England, the average bill was £477, in the south-east, £424, and those in the north paid £371. Some patients were found to have spent more than £1,000. The charity called the charges "a stealth tax on illness". Alison Benjamin Wednesday March 21, 2007 The Guardian
  • Soon hospitals will be charging rent for the beds. In a comment piece Mark Steel writes: "There's splendid news about the Health Service. It seems last year it made £95m profit from car park fees at hospitals. What an example of modern spirit and enterprise, and a contrast to the old "anti-business" ideology that allowed people to park at hospitals for free. These dinosaurs would never have had the imagination to say 'Hmm, they HAVE to come by car as they're limping - we can charge them as much as we like.' And they don't just charge, they charge more than anyone. In Edinburgh for example, the car park at the hospital is more expensive than the one at the airport. Maybe the thinking is this is the way to cut waiting lists. Because eventually it will be cheaper to park at the airport, fly to Canada and get it done there than to pay to have it done free round the corner. A spokesman from the Department of Health said the car park fees were reasonable because "they discourage people who are not using the hospital from using the car park spaces". Supermarkets have a similar dilemma with their car parks, so they pay a couple of bored guards to patrol them and check the people parking are customers. Which is one way of doing it, although another method is to make ninety-five million quid out of the sick and their visiting relatives. Which means the Health Service has arrived at the magnificent point where it is more profiteering than Tesco. Soon they'll be building huge "Health Malls" and placing adverts in magazines that say "Visit the catheter experience". Or they'll copy that trick they do at theme parks, and as you're walking round the ward, everyone has their X-ray taken, which they can buy for seven quid from a kiosk near the exit. Every corner of a hospital has been studied for its marketing potential. Bedside telephones are on offer at premium rates, and televisions can be hired for £16 a week…Supposedly the solution to the shortage of beds will be market reforms, so the beds will be rented like the televisions. Then instead of spending money training nurses, the hospital can be run by hotel staff, and as you check in they'll smile and ask "Will you be surviving for evening meal tonight, sir ?" A franchise can be offered to betting shops, who can set up in the corner of cardiac units offering odds on whether people make it or not…This is all a consequence of the Health Service being subordinated to the Private Finance Initiative, and you can study the details if you like but you ought to be able to tell from the title whether its purpose is to encourage a) health or b) private finance. One chap who is probably in favour is Adrian Montague, who back in 1997 was given the part-time job of setting up the rules for this system, for which he was paid £140,000 a year. And I bet the bastard got a free car parking space as well. The genius of all this is it's created such cynicism the Tories are now able to position themselves as the true defenders of the NHS. So David Cameron spoke to a rally of junior doctors who were opposed to the current wave of cuts. He had to speak to junior doctors, as there was no point speaking to anyone old enough to remember it was the Tories who started all this in the first place." Summary by Keep our NHS Public of Independent 21 March 2007
  • Long-term care patients out of pocket. Primary care trusts failed to reimburse fully patients who funded their own long-term care - because of poor Department of Health guidelines, the health ombudsman has said. Parliamentary and health service ombudsman Ann Abraham made the claim as she outlined findings of an investigation into complaints about the level of compensation for elderly and disabled people who belatedly got NHS funding for care. She said the problems were largely due to the DoH's 'maladministrative' means of coming up with the formula which PCTs used to calculate refunds. This meant the amount patients got was affected by where they lived. She said the DoH should develop 'properly considered' guidance on continuing care redress, which stated clearly how to calculate interest payments. Summary by Keep our NHS Public of Health Service Journal 22 March 2007
  • Hospital parking nets £700,000. Winchester and Eastleigh Healthcare Trust took nearly £700,000 in car parking charges last year. The trust, which runs the Royal Hampshire County Hospital and Andover War Memorial Hospital, netted £694,133 in 2005/ 6. Patients going for treatment and relatives or friends visiting people are charged £1.80 for one hour. The cancer charity, MacMillan, which obtained the details through the Freedom of Information Act, called for an end to the "shameful charges." Southampton University Hospitals Trust, a specialist cancer centre, raked in £2,414,672 in parking fees last year - the most of any trust in the country. The Department of Health has said that it is up to trusts to decide what to charge. Summary by Keep our NHS Public of Hampshire News 23 March 2007
  • Hospital gives cheap parking to football fans. A leading NHS hospital has sparked outrage by charging football fans less to park than patients and their relatives. Chelsea and Westminster Hospital charges Chelsea fans attending matches at nearby Stamford Bridge £10 for four hours. But patients receiving treatment in accident and emergency and other departments are made to pay £12.50 to park for the same period. A spokesman for Chelsea and Westminster Hospital said: "We actively promote the car park to Chelsea fans attending games because they generate extra income that can be reinvested in front-line patient care." Summary by Keep our NHS Public of Telegraph 26 March 2007
  • Trust me, I'm a junior doctor. Max Pemberton writes: "The same scene is played out week after week. Once again, Dr Webber's vehicle has been clamped while parked at the hospital where he works. The man he is remonstrating with is not a council traffic warden. He's not even a hospital employee; he works for the private service company that runs the NHS hospital. Dr Webber doesn't have a parking permit because the Trust has to pay for them and there aren't enough to go round. Dr Webber covers a number of hospitals and needs his car to travel between them. And it's no better for patients. In fact, I'm embarrassed as I walk past them as they queue to pay for the privilege of parking at a hospital that is funded by their taxes. Before Christmas, I witnessed an unbelievable sight. The car park attendants were threatening to tow away a car that belonged to a man who had just seen his wife die in A& E. These attendants - who seem to be taking lessons in how to be rude, thoughtless and officious - are not hospital employees and have absolutely no interest in the welfare of patients. Last week, Macmillan Cancer Support Research obtained figures which showed that hospitals made £95m last year from car parking charges. Given that 74 trusts didn't even bother to provide details of the money they made in this way, it would seem that this figure is a gross underestimate. But it is also part of a wider problem in hospitals up and down the country, and is indicative of the way the Government now sees healthcare. Increasingly, hospitals are beginning to resemble out-of-town shopping malls. This transformation of our hospitals began after the introduction of the "internal market", when trusts were expected to supplement their income from commercial retail rentals and service contracts. Block funding was abandoned and hospitals were established as financially independent corporations that were expected to generate money in order to break even. Trusts sold off land, cut back on staff and contracted out services as a way of producing revenue. It is this need to develop income-generating schemes that is behind the contracting-out of car parking, as well as the privately owned restaurants, newsagents and coffee shops that now litter hospital lobbies. The companies that manage these facilities, eager to increase their profit margins, can charge premium rates because they know they have a captive market. They are mercenaries not bound by the founding principles of the NHS - and the Trusts are happy to collude with them because of the income they generate. It now costs more to park at the Edinburgh Royal Infirmary than at Edinburgh Airport, for example. The generation of income is also the reason for the emergence of outrageously priced televisions and telephones by each patient's bed. To rent a telly for one week typically costs one fifth of the weekly state pension. The doctors and nurses have no jurisdiction over these companies and, as a result, are powerless to intervene when a little bit of common sense or compassion is called for. All they can do is stand and shout - and then pay up like everyone else." Summary by Keep our NHS Public of Telegraph 26 March 2007
  • Prime Minister's adviser calls for charges to visit GP. Patients should be charged to see GPs in order to limit the 'frivolous' use of services, a leading Blairite has said. Professor Anthony Giddens, who wrote New Labour bible The Third Way, believes the concept of an NHS 'free at the point of use' should be consigned to the past. Instead patients should be charged 'modest fees' to access GP services, Dr Giddens writes in his new book Over to you Mr Brown, published this week. In exchange, patient choice should be expanded to make it much easier to switch practices 'at short notice'. The former London School of Economics director believes 'modest' fees, such as in Sweden, contribute a little over 1 per cent of total funding. He argues: 'The principle that the NHS should be free at the point of use is based on the notion that even a small fee would deter some people from visiting the doctor when they need to, especially poorer people. 'But the whole point of introducing fees would be to deter people from seeing the doctor - those who come for minor or non-existent ailments. In a society where there is no grinding poverty, it is hard to see that a small charge would deter those who really might need treatment.' Summary by Keep our NHS Public of Pulse 29 March 2007
  • Cancer specialist: 'Let NHS patients pay for their treatment'. A cancer specialist has said that NHS patients risk losing out on an imminent revolution in cancer treatment unless they are made to pay towards the cost of their care. Professor Karol Sikora said at least six powerful cancer drugs would become available over the next year, costing at least £60,000 a year per patient. The "designer" cancer drugs, similar to Herceptin, are among the first to offer targeted therapy for cancers of the breast, lung, kidney and bowel. But it is unlikely the NHS will be able to afford any of them and the backlog of drugs awaiting approval by the National Institute for Clinical Excellence (Nice) will delay their assessment for at least a year, he said. Writing in the Journal of the Royal Society of Medicine, Professor Sikora said the dilemma this posed for the NHS could not be ducked any longer. If it declined to pay for the drugs, patients would be forced to go without. The only alternative was to allow patients to top up their NHS care by paying privately for the drugs. "There is now evidence of a growing use of co-payments to break through the access barriers in the NHS," he wrote. "Cancer patients are beginning to develop sophisticated approaches to buying extra clinical services either from the NHS directly or through the selective use of the private sector to purchase upgrades to their basic NHS care." NHS patients are officially forbidden from buying their drugs privately as this would mix NHS and private care. The Department of Health says patients must choose whether to be treated on the NHS, and accept what the NHS offers, or to go private in which case all of their care, not just the drugs, must be paid for. A Department of Health spokesman said: "You cannot be both a NHS patient and a private patient at the same time. Co-payments would risk creating a two- tier health service and be in direct contravention with the principles and values of the NHS." Summary by Keep our NHS Public of Independent 30 March 2007
  • Wales drops prescription charges. All patients in Wales are now entitled to free prescriptions, although the cost rose to £6.85 in the rest of Britain. The decision of the Welsh Assembly in Cardiff to scrap prescription charges, which it had already reduced to £3, raised the prospect of a two-tier NHS. Prescription charges rose by 20p in England, Scotland and Northern Ireland. Three million patients registered with a Welsh GP and 15,000 Welsh patients who have an English GP, will qualify. Summary by Keep our NHS Public of Telegraph 2 April 2007
  • Taking the private pennies - without the public grief. Private work done in NHS hospitals brings in around £400m a year, which can be used to support NHS work. For those hospitals that do a lot of private work it is an important source of income which can help support specialist clinical teams. In the last 10 years Labour has done remarkably little to touch this sector; the only exception being foundation trusts, which have their private income capped. Income has stagnated over the last couple of years - it may even have declined a little in 2006-07 - mainly because the self-pay sector of the private market has been weak. But as NHS finances tighten some trusts may be looking towards expanding their private work. NHS Confederation policy director Nigel Edwards feels there is interest in increasing private work but there are many factors limiting development - the foundation trust cap; the weak private market; and reduced prices charged by some private hospitals. But some trusts have increased their private work. Swindon and Marlborough trust, for example, increased the size of its private wing two years ago and has been keen to market it more widely and further develop services. 'We are a real success story,' says finance director Charlotte Moar. 'We have doubled our turnover in the last two years.' Addenbrooke's in Cambridge has also expressed an interest in increasing private work, including IVF services. London's Royal Free Hampstead trust chief executive Andrew Way says the trust is interested in increasing its private tertiary work - the sort of specialist work which draws in patients from overseas. He describes the hospital's private work as 'a business within a business - There is an opportunity for England plc and its health service to compete in the international healthcare market. We are competing with the US, Italy and Germany. We are actively marketing these services.' Over the last year, at least two trusts have run into trouble with the Department of Health for promoting private work. Hammersmith Hospitals trust was forced to withdraw a scheme offering low-risk pregnant women one-to-one care with a midwife. Women and their partners could pay £4,000 for round-the-clock contact with the midwife; women at higher risk of complications were given the same contact, although not with a specified midwife, free of charge. But the scheme was criticised by the Commons health select committee, which said it 'provides cut-price private care within an NHS hospital. That is unacceptable.' More recently, Northampton General Hospital trust chief executive Andrew Riley wrote to local GPs pointing out the hospital would perform various operations for a fee, if patients did not want to wait until the PCT would pay for it. Cash-strapped Northampton teaching primary care trust had stopped paying for some minor procedures and had introduced a minimum wait of four-and-a-half months for other routine surgery, pushing it into the next financial year. Mr Riley told a local paper that wards might have to be closed if the work was not forthcoming. However, the letter was withdrawn under pressure from NHS East Midlands. So are there hidden rules here ? Cynics would say the main one is to do whatever private work you like - but do not get it into the papers and do not link it to financial problems in the NHS. If the hospital had a well-established private practice and less obvious marketing, it would probably had got away with it. Certainly, quicker treatment is on offer, even if hospitals are coy about putting it that directly: websites tend to refer to 'the convenience of choosing the timing of your treatment' and 'prompt access' rather than 'pay to jump the queue'. What hospitals can offer without much criticism is areas that the NHS has withdrawn from. The health select committee also looked at a dermatology clinic in Harrogate, which offered procedures which the NHS in the area would not fund. It escaped without much criticism. But some years ago a number of hospitals were forced to stop charging for some antenatal classes because they were viewed to be normal NHS provision. The private arm of Oxford Radcliffe Hospitals trust even offers NHS staff 10 per cent off cosmetic surgery. Another area would be the enhanced services the NHS is never going to offer. For example, at least one hospital will provide a DVD of your unborn child, at a cost of £200. The scan to produce this is carried out by foetal medicine consultants in the early evening. You can also have your unborn child's sex determined and have additional scans. Hospitals that do private work say the profit is used to support NHS work. But it is not just about profits being used to improve NHS patient care. Private work has to be done in a way which does not compromise care for NHS patients. The DoH guidance is quite clear that services for private patients 'should not prejudice the interests of NHS patients'. Many trusts will put on separate operating lists for private patients, although in some cases they will be added on to an NHS list - or, allegedly, even put at the start of a list (which makes it less likely their operation will be cancelled). One of the concessions to outraged Labour backbenchers when foundation trusts were set up was over private work. Foundation trusts are capped at the percentage of income earned from private work in the year ending March 2003: this was to prevent them developing into private hospitals which do a bit of NHS work on the side. Some trusts have been exploring ways of getting round the cap. Ways which have been looked at include setting up a third-party organisation to do the work, which would then channel profits back into the trust; and 'outsourcing' private practice and charging an inflated amount for the space, operating theatres and other facilities used for this work. Both of these methods have problems. The third-party organisation would need to be entirely separate from the main trust. If the trust appeared to control it, then there is a risk it would have to be consolidated into the trust's accounts. The 'rent' model could incur VAT. In extreme cases the cap is even affecting trusts' willingness to press ahead with foundation applications. Great Ormond Street Hospital trust has recently delayed its application, in part because of this. The trust has built a new wing with facilities for both NHS and private patients over the last few years, which has added to its costs. It planned to meet some of the increased costs by more private patient work, most of which is for international patients. The trust currently gets just over 10 per cent of its income from private work and would like to increase this to 12-13 per cent. But it faces a cap at 9.4 per cent once it becomes a foundation. The trust is looking at establishing a community interest company which would carry out its private work and then channel profits back into the NHS side. But this would need to be legally separate from the trust. Summary by Keep our NHS Public of Health Service Journal 5 April 2007
  • NHS row over cheap insurance for cancer drugs. An insurance company will launch a policy that gives access to the most modern and expensive cancer drugs for less than £100 a year. Patients covered by a WPA policy would be treated on the NHS, but the cost of the drugs prescribed would be underwritten. In recent years a number of new cancer drugs have come on the market which offer patients a better chance of survival or a longer period before they relapse and the disease returns. However, the drugs can cost £20,000 a year per patient, and the NHS has struggled to fund the demand. The initiative comes as a group of senior doctors will argue that the NHS must also address the issue of co-payment - where a patient is seen for free, but can 'top up' the treatment by paying for extra therapies not available on the health service. The group, Doctors for Reform, will argue that the NHS should accept that it cannot meet all the costs of newer treatments, and that a co-payment system would be fairer and ultimately cheaper. Patients would not be forced to opt out of the health service if they want the most expensive therapies. But the move will be fiercely resisted by Health Secretary Patricia Hewitt, who has argued that the level of spending on the health service has been unprecedented and that the newer treatments are affordable and should be given by doctors if there is a clinical indication, regardless of whether or not they are approved by the National Institute for Health and Clinical Excellence (Nice). She intervened last year to fast-track the breast cancer drug Herceptin, after outcries over rationing. Joanne Rule, head of Cancerbackup, said: 'The policy will pay for drugs that are unavailable on the NHS, which highlights a gap in the current provision of cancer drugs within the NHS, but this must not set the long-term future for cancer care.' Summary by Keep our NHS Public of Observer 22 April 2007
  • More flexibility on cancer drugs urged. Cancer patients must be allowed to pay for non-NHS drugs in an attempt to head off a funding crisis in treatment of the disease, some specialists have said. Under the current guidelines cancer sufferers in England who wish to use drugs that are not available free on the NHS can only pay for them if they are prepared to fund their entire treatment privately. But some doctors want the rules to be relaxed in line with Scotland, where local health boards are willing to continue paying for other aspects of their care if patients pay for drugs privately. Specialists are concerned that the taxpayer will not be able to afford the new generation of highly effective cancer drugs. Many believe the current model of health funding will become unsustainable and some are calling for patients to be allowed to take out top-up insurance policies to cover drugs that the NHS cannot afford. However the British Medical Association and the Department of Health argue this would lead to a "two-tier system" that would leave the less wealthy with a poorer standard of care. The current situation varies across the country with different specialists and primary care trusts (PCTs) taking more flexible attitudes to the practice of "co-payment" than others. Summary by Keep our NHS Public of Telegraph 15 May 2007
  • Phone firm 'pressures patients'. A firm providing phone and TV services to hospital patients has been accused of pressurising vulnerable people. Ex-employees of Patientline, which has deals with 160 NHS trusts, said they were forced to approach ill patients to get them to sign up to the services. Company documents show that Patientline had recently started moving to a more "sales-driven" culture with all staff being urged to try to increase revenue. Only last month, the company which has systems installed at 75,000 hospital bedsides, was being criticised for increasing the cost of calls by 160%. Former workers told a BBC Breakfast News investigation that the company had changed its policy on sales. Peter Troy, who worked for the company for 18 months at a north east hospital, said he was effectively having to approach everyone. "My concern was that the culture was changing. It was becoming high pressure sales and I was becoming increasingly uncomfortable with it. To obtain the performance figures that they expected then by definition you were having to approach everybody." A company newsletter from March has revealed there was a change in approach. It said there was a "need to create a sales-drive culture". And it added: "Every individual in Patientline will be accountable either for direct selling or for supporting our sales teams in their quest to increase revenues." Summary by Keep our NHS Public of BBC 25 May 2007
  • Councils drive up fees for care at home. Hundreds of thousands of elderly people are facing massive increases in the amount they pay for basic services such as washing and dressing which allow them to live independently in their own homes. A survey has found some councils are raising fees by more than 100 per cent, while two councils in London, Brent and Lewisham, are trebling their charges for some. The survey of 87 of England's 150 councils found that older people face an average 29 per cent increase in home care fees this year. Eight councils are increasing fees by 100 per cent or more. Almost a quarter of the remainder are planning rises of more than 40 per cent. Councils say the reason they are increasing fees is because the NHS financial crisis is hitting social services. Hospitals have been ordered to cut costs to wipe out their £512 million deficit, and town hall chiefs accuse health trusts of trying to make council taxpayers foot the bill for services which should be provided by the Health Service. For example cuts to nursing services mean some home helps are having to take on tasks such as changing dressings or checking insulin levels. Campaigners say the council fee increases are morally wrong, financially short-sighted and their impact on older people "devastating". Summary by Keep our NHS Public of Telegraph 25 May 2007
  • GPs propose £20 fee for out-of-hours visit. Patients who want a routine appointment with their GP at evenings or weekends should be charged up to £20 a time, a group of doctors said today. Patient groups reacted angrily to the proposal, branding it a "scandal" that could put people's lives at risk. According to the proposal, patients would be charged for routine out-of-hours appointments made in advance. Out-of-hours emergencies would still be dealt with for free, by local health trusts rather than by individual GPs. The proposal will be debated at the British Medical Association's GPs conference later this month. David Batty and agencies Monday June 4, 2007 Guardian Unlimited
  • GP wants patients to pay for evening surgery. Patients should pay £20 to see their GP in the evening or on a Saturday morning, a British Medical Association conference will be told. Dr Andrew Green, a GP from Hedon in Yorkshire, will propose a motion calling for doctors to charge for their out of hours services. Gordon Brown has said that changing GPs' working hours to make it easier for working people to get an appointment will be one of his priorities when he becomes prime minister. Dr Hamish Meldrum, the chairman of the BMA's GPs committee, said the association firmly believed that NHS services should be free at the point of use. "Similar motions have been raised in the past and have all been defeated," he said. Summary by Keep our NHS Public of Telegraph 4 June 2007
  • 28-day medicines limit axed. NHS managers have halted a "heavy-handed" policy of limiting doctors to prescribing 28-day supplies of drugs. Many GPs had ignored the cost-cutting scheme saying that it would lead to financial burden on those with long-term illnesses. Some warned that many might even stop their treatment rather than pay up to six times as much. The change would have meant that those not exempt from the £6.65 charge for a single prescription would have had to pay each month. Managers said they were reviewing the measure to help patients who had seen a resultant increase in prescription charges. However PCT board members were told last week that the rule had been withdrawn because the Priorities Forum, which decides whether treatments and procedures should be allowed in Oxfordshire, had found "little evidence of financial benefit". GP Dr Prit Buttar, of Sturt Street Surgery, Abingdon, said: "As it was not contractual, there's no way they could've forced us to implement it and I know many other practices had a similar view. So I don't think the PCT had enough compliance to make any decent gains. The gains that would have been made would have been very modest and the price for those would have been too great. It was carried out in a rather heavy-handed manner and the PCT didn't take into account the consequences, so I'm glad for my patients that it's been scrapped." In a statement, a PCT spokesman said: "The PCT is still supporting 28 or 56-day prescribing times, but is revisiting the guidance in order to target the populations more effectively, for example advocating 28-day prescribing where patients do not pay for prescriptions, or do not have to travel to pick up prescriptions." Summary by Keep our NHS Public of Oxford Mail 12 June 2007
  • Hospital patients in phone charges dispute. Hospital bosses in Bolton are in talks with the firm that provides TV, telephone and Internet access to patients, amid claims sick people are being targeted by high-pressure salesmen. Managers at the Royal Bolton Hospital want assurances patients are not being strong-armed into buying costly services, amid reports salesmen are trained not to take "no" for an answer. Patients at the hospital pay £2.90 per day to use a bedside TV with Internet access. Outgoing phone calls cost 26p per minute, while incoming calls are charged at either 39p or 49p per minute depending on the time. Patientline, the private company which provides the service, has been criticised for its high rates. In April, public sector union Unison hit out when it raised its phone charges, claiming patients were being exploited. An investigation claimed staff who sell the firm's Freedom Payment Cards at the Royal Bolton were being instructed to pressure patients into paying out. The News of the World claimed an undercover reporter working in Patientline's Bolton office was urged to ensure every patient was signed up to their bedside unit. "Don't give them a chance to say no," staff were told, according to the report. It claimed an advice note pinned to the office wall read: "Don't ask them. Tell them what you are doing. Say, I'll just set this up for you. Be careful though, don't jump in. Get them relaxed first, give them some sympathy." Patientline, cleared of overcharging by government watchdog Ofcom two years ago, insists its staff do not use inappropriate techniques. The hospital does not receive any money from the service. Summary by Keep our NHS Public of This Is Lancashire 18 June 2007
  • Council orders care charge refund. The new administration of Dumfries and Galloway Council has announced it is to repay controversial care charges which were imposed on pensioners. It follows a long-running debate in the region over liability for food preparation bills under the Scottish Executive's free personal care policy. In one case a 94-year-old woman was being charged £60-a-week because her care worker helped make her toast. A report has now been sought to allow "immediate payment" of the refunds. A budget of £1.5m was set aside by the council earlier this year in order to meet the repayments. This article is from the BBC. Care & Health 21 June 2007
  • Victory over care 'lottery' for elderly. Thousands of gravely ill older people will no longer have to spend their savings or sell their homes to pay for round-the-clock medical care, under government guidelines to be revealed this week. Ministers are unveiling measures to tackle the 'postcode lottery' that gives pensioners in some areas free nursing care, but forces others in England to fork out tens of thousands of pounds. Around