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• Tony Blair's admission that the government should be "absolutely frank" about the time needed to improve the NHS was thrown back in his face yesterday when a senior surgeon accused him of raising unrealistic expectations by "spinning" the figures. Bernard Rebeiro, a consultant surgeon at Basildon hospital and member of the council of the Royal College of Surgeons, told the prime minister that by promising 7,500 new consultants, when only 1,500 of these would be new posts, or 200 new CT scanners, when all but 50 were replacements, "the government is giving the impression the health service is going to be so much better when it isn't". Guardian 18 October 2000
• NHS finances: the issue explained Steve Brown answers the important questions about the NHS budget. How much is it? Who gets it? And is it enough? Guardian Society Monday March 26, 2001
• NHS finance directors are to meet with the Department of Health (DoH) to discuss ways of improving the annual health service budget negotiations - known as service and financial frameworks. The meeting follows concerns over the recent "far from ideal" round of talks held to discuss the 2001-02 budgets in which managers argued there was insufficient cash to meet all the government's NHS plan initiatives. Health service journal round-up Publication date: April 19, Guardian Society Thursday April 19, 2001
• NHS finance: the issue explained The NHS budget is a never-ending source of debate. We detail Labour's spending initiatives and explain where all the money goes Guardian Society Wednesday May 30, 2001
• Treasury gives councils and NHS greater autonomy Guardian Society Wednesday June 13, 2001
• Urgent action needed to reform NHS funding process. This year's NHS funding negotiations have been the most bruising and divisive in memory. Now there are calls for reform of a system that has been described as a 'bureaucratic nightmare', writes Steve Brown. Guardian Unlimited Friday June 22, 2001
• Councils win £300m extra for care homes Bed blocking in NHS hospitals to be stemmed by extra grants over three years to provide alternative places for older people.  John Carvell, social affairs editor Guardian Wednesday October 10, 2001
• 'More money is not the only solution'.  The Observer NHS debate Sunday October 14, 2001 The Observer
• It may come as a surprise to patients but extra money has been pumped into the NHS. Most of it is swallowed up before it reaches them.  David Walker Guardian Society Wednesday November 7, 2001
• Extra funds to cut baby deaths.   Observer Sunday November 25, 2001
• Brown pumps extra £1bn into NHS budgets Simon Parker Guardian Society Tuesday November 27, 2001
• A ringing endorsement of the principles of the health service was delivered yesterday by Derek Wanless - the former chief executive of NatWest bank - in an interim report to the chancellor.  John Carvel and David Walker Guardian Wednesday November 28, 2001
• Link to the Wanless Report and email address for responses.
• The Wanless report.  Scrutiny is the price for more funding.  David Walker Guardian Wednesday November 28, 2001
• Extra cash for south-east NHS staff.  Patrick Butler Guardian Society Thursday December 6, 2001
• Until taxpayers are convinced their money will be wisely spent, raising taxes is risky.  Peter Mandelson Guardian Unlimited Thursday December 6, 2001
• Peter Mandelson's warning against tax increases fixes him in ancient history: the party has moved on.  Polly Toynbee Guardian Friday December 7, 2001
• Who is being dishonest about the NHS?  Tony Blair says he wants an open debate but accuses advocates of social insurance of dishonesty.  David Green Observer Sunday December 9, 2001
• Taking the pain out of paying up Tax payers are happy to pay more for better healthcare - as long as any increase can be seen to be earmarked for the NHS.  Guardian Society Tuesday December 18, 2001
• Blair hints at tax for NHS.  PM stung by open letter attacking Labour record.  Guardian Thursday February 21, 2002
• Milburn: NHS tax is the right thing.  Guardian Society Thursday February 21, 2002
• Welfare tax targeted for £4bn health boost.  Blair backs rise to bring spending in line with EU average after being convinced public prepared to pay more for good services.  Guardian Society Friday February 22, 2002
• Where a health service cash injection could be found Tony Blair has made it clear that there will be tax increases to raise spending on health. Larry Elliott looks at the options.  Guardian Society Friday February 22, 2002
• Milburn: cash boost depends on joint working.  Patrick Butler  Guardian Society Wednesday March 13, 2002
• Health service takes centre stage in Brown's Budget.  Simon Parker Society Wednesday April 17, 2002
• 'Best chance in a generation to secure the NHS'.  Patrick Butler Society Wednesday April 17, 2002
• NHS set for huge funding rise.  Michael White Society Wednesday April 17, 2002
• Report calls for more NHS spending.  Read the Wanless report in full.  Guardian Unlimited Wednesday April 17, 2002
• Key findings of the Wanless report.  Guardian Unlimited Wednesday April 17, 2002
• The Wanless report: main points.  Patrick Butler Society Wednesday April 17, 2002
• Tax rises 'essential to improve NHS'.   Society Wednesday April 17, 2002
• Vision of high quality, patient responsive healthcare. Patrick Butler analyses the findings and recommendations of the Wanless report into the future of health service funding.  Society Wednesday April 17, 2002
• The Wanless report: reaction in quotes.  Simon Parker Society Wednesday April 17, 2002
• 'People must be prepared to pay a little more'.  Helen Carter Guardian Thursday April 18, 2002
• Wonderful Wanless.  Tories are foolish to oppose this reform.  Leader Guardian Thursday April 18, 2002
• Budget heralds radical overhaul of the NHS.  Patrick Butler Society Thursday April 18, 2002
• Brown bets all on the NHS · £40bn injected into health · Anger at 1% rise in national insurance · £2.5bn for families.  Michael White and Larry Elliott Guardian Thursday April 18, 2002
• Main points of Alan Milburn's speech.  The health secretary, Alan Milburn, today outlined the latest phase of NHS reforms aimed at ensuring investment in the health service is spent effectively.  Patrick Butler Society Thursday April 18, 2002
• Budget for a better health service.  Guardian Letters  Friday April 19, 2002
• Trust chief envisages bright future if cash is channelled properly.  Urgent need for beds must be addressed. Sarah Boseley, health editor Guardian Friday April 19, 2002
• NHS finance 2002-03: the issue explained Society Friday April 26, 2002
• Full text of Gordon Brown's speech.  Guardian Monday June 10, 2002
• With record investment in the NHS planned over the next five years and an ongoing debate about how that investment should be raised, the financing of the NHS is a key public policy issue.  Guardian Tuesday June 11, 2002
• Brown pumps £61bn into public services.  Simon Parker Society Monday July 15, 2002
• Comment: Greater expectations.  The chancellor has today shown his willingness to be a big spender - but will the government departments be able to deliver, asks Julian Glover.   Guardian Unlimited Monday July 15, 2002
• Full text of Brown's spending review.  Guardian Unlimited Monday July 15, 2002
• Brown unveils education cash bonanza.  Matthew Tempest, political correspondent Guardian Unlimited Monday July 15, 2002
• What will the £61bn announced by Gordon Brown yesterday be spent on?  Guardian Tuesday July 16, 2002
• We can afford it, promises Brown.  Guardian Tuesday July 16, 2002
• Cautious welcome for pledges.  Guardian Tuesday July 16, 2002
• As Milburn meets foreign surgeons here to operate on hundreds of patients, the Treasury insists on maintaining control of health spending.  Michael White, political editor Guardian Wednesday July 31, 2002
• Ex-ministers seek to block 'foundation' hospitals.  Patrick Wintour, chief political correspondent Guardian Monday August 5, 2002
• Comment: Private battle for public good.  Charlotte Denny Guardian Monday August 5, 2002
• Focus on day surgery to boost NHS operations.  Guardian Friday August 16, 2002
• A primary care paradox.  GP shortfall despite new opportunities.  Leader Wednesday August 21, 2002 The Guardian
• NHS losing track of extra funds, claim Lib Dems.  Michael White, political editor  Saturday August 24, 2002 The Guardian
• More home dialysis for kidney patients.  James Meikle, health correspondent Wednesday August 28, 2002 The Guardian
• NHS to hand over 4,800 acres for housing.  Terry Macalister Thursday September 12, 2002 The Guardian
• NHS hospitals will be allowed for the first time to recover the costs of treating people injured at work by demanding compensation from negligent employers, under government plans published today for consultation.  John Carvel, social affairs editor Guardian Friday September 13, 2002
• NHS hospitals will be able to recover the costs of treating people injured at work by demanding compensation from negligent employers under plans published today for consultation.  John Carvel Friday September 13, 2002 The Guardian
• Insurers may have to cover cost of NHS treatment.  Guardian Friday September 13, 2002
• 'Wrongdoers' to pay NHS for victim care.  John Carvel, social affairs editor Friday September 13, 2002
• A committee of MPs has today condemned NHS managers for overseeing the "aggressive" sale of NHS surplus property at a time when nurses and other health workers are facing an acute housing shortage.  Thursday September 19, 2002
• NHS hospitals told to shun cheap chicken brands.  Felicity Lawrence, consumer affairs correspondent Tuesday October 8, 2002 The Guardian
• Plans to sell a prime hospital site in central London to the Aga Khan were last night rejected by the Council of King's College, London, which instead agreed to sell it to Guy's and St Thomas's charitable foundation.  Colin Blackstock Wednesday October 9, 2002 The Guardian
• Go-ahead for new-style hospitals.  Blair brokers Whitehall deal on trusts borrowing private cash.  Patrick Wintour and John Carvel Thursday October 10, 2002 The Guardian
• In a radical move reminiscent of the notorious internal market in the NHS, the government yesterday set out new funding proposals under which hospitals will be paid according to the number of patients who choose to be treated in them. Sarah Boseley and John Carvel Friday October 18, 2002 The Guardian
• More people suffering from terminal illness should be allowed to die at home if they wish, under plans for a 40% increase in government support for palliative care. James Meikle, health correspondent Monday December 30, 2002 The Guardian
• Tony Blair is being warned that his government is taking an "immense risk" in pumping billions of extra pounds into the national health service with no guarantee that productivity will rise fast enough to meet public expectations. Michael White, political editor Wednesday January 8, 2003 The Guardian
• Pay more tax or 'fantastically expensive' insurance, says PM.  Michael White, political editor Tuesday January 14, 2003 The Guardian
• The health secretary, Alan Milburn, yesterday ordered an emergency audit of NHS cancer services after his officials warned that more than £320m allocated to cancer care may have been siphoned off for undisclosed purposes. John Carvel, social affairs editor Thursday January 16, 2003 The Guardian
• Councils may get power to raise NHS funds.  Patrick Butler Wednesday February 5, 2003
• Alan Milburn, the health secretary, yesterday provoked a fresh cabinet split over NHS funding when he said public sector hospitals should be free to raise money through local bond issues outside Treasury control.  John Carvel, social affairs editor Thursday February 6, 2003 The Guardian
• Behind closed doors, the Health Secretary warns of a public backlash when higher taxes do not deliver better hospitals.  Jo Revill, health editor Sunday February 16, 2003 The Observer
• Tony Blair yesterday renewed his commitment to reform of the NHS with a pledge that record growth in spending on the health service will continue well into a third Labour term - at least until 2008.  John Carvel, social affairs editor Tuesday March 11, 2003 The Guardian
• It is two years ago this month since health secretary Alan Milburn signalled - in the run up to the 2001 election - Labour's big promise to NHS staff for its second term: an end to central control; money and decisions to be devolved to the frontline. Malcolm Dean Wednesday April 2, 2003 The Guardian
• The government today announced grants worth £4.5m to help give elderly and disabled people more choice over their care. Friday August 1, 2003
• Medical research funding is all mixed up with NHS patient care costs, complain academics, who are calling for a more transparent and generous funding system for clinical research. Anna Fazackerley reports. Tuesday November 18, 2003 The Guardian
• The government is to make a near 25% increase in funds devoted to improving care for people who are dying. Programmes to involve patients and carers in choosing where they want to spend their last days, whether at home, hospices, hospitals or care homes, are already being developed, mainly for cancer patients. James Meikle Saturday December 27, 2003 The Guardian
• Q&A The review of NHS procurement Wednesday January 14, 2004 The Guardian
• The health service is paying up to 50% more for operations in the private sector than the same procedures would cost if they were carried out in NHS hospitals, Department of Health figures are expected to show today.  Tash Shifrin Thursday February 5, 2004
• The government has published a price list for NHS treatments in a move that effectively reintroduces the market into the health service.  Tash Shifrin and agencies Friday February 6, 2004
• The Conservatives last night raised the electoral stakes in their efforts to regain the trust of voters when they promised to cut civil service costs and raise spending on the NHS - while hinting that the second pledge is not dependent on the first. Nicholas Watt and Michael White Wednesday February 11, 2004 The Guardian
• Selling off by stealth is here to stay. Co-payment is a menace already threatening our public services. Allyson Pollock Wednesday February 11, 2004 The Guardian
• Paying for our services. Letters Friday February 13, 2004 The Guardian
• The government's anti-corruption regulator has reduced prescription fraud by 60% over the past four years, it was announced today.  Roxanne Escobales Wednesday February 18, 2004
• Discomfort of strangers (part two). David Goodhart's essay challenging liberals to rethink their attitudes to diversity and the welfare state has provoked a bitter debate among progressive thinkers. Here, for the first time in a national newspaper, we publish it in full. Join the debate by emailing unlimited@guardianunlimited.co.uk   Read the first part of David Goodhart's essay here   Tuesday February 24, 2004The Guardian
• Social solidarity in a global market.  Letters Thursday February 26, 2004 The Guardian
• Our common bonds.  Letters Thursday February 26, 2004 The Guardian
• Coping with co-payments.  Sunder Katwala on how ministers can help the public understand and accept the latest big idea in funding.  Tuesday March 16, 2004
• More than 100 surplus hospital sites in the UK could be used to provide at least 15,000 new homes under a deal announced yesterday. The NHS-owned land, which covers just over 1,200 hectares (3,000 acres), could be hived off to developers without going on the open market, under revised Treasury rules. Peter Hetherington, regional affairs editor Thursday April 8, 2004 The Guardian
• The battle against a rising tide of sexually transmitted infections will get a £15 million boost this week in a drive to encourage embarrassed young lovers to come forward for treatment. Sexual health clinics are to be revamped to increase privacy and cut waiting times, after doctors argued that poor conditions were fuelling the reluctance many patients feel about visiting the clinics. Gaby Hinsliff, chief political correspondent Sunday April 11, 2004 The Observer
• The financial management capacity of most primary care trusts - the organisations that now control three-quarters of NHS funds - is inadequate to meet the challenges they face, the public spending watchdog has warned. In a report on financial management in the NHS, published today, the Audit Commission says that "overall, the basics of financial management are at most NHS bodies and provide effective financial control". Tash Shifrin Tuesday April 20, 2004
• The National Health Service is to spend more than £2m to fill "third world" gaps in dental care which have plagued a leading seaside resort. An emergency plan will offer treatment to an estimated 9,000 new NHS patients in Scarborough, north Yorkshire, where long queues of people attempting to register at a solitary new practice were televised across the world three months ago. Budget changes by the local primary care trust and a £650,000 grant from the health department will fund a "golden handcuffs" scheme for new dentists which may prove a model for other areas where tooth care is effectively on ration. Practices moving to Scarborough and its hinterland, where another 2,000 NHS patients will be able to register, will be helped with set-up costs in return for agreeing to stay at least three years. Martin Wainwright Monday May 31, 2004 The Guardian
• Independent NHS inspectors accused the government last night of shortchanging patients in some of the poorest parts of England by denying their local hospitals and GPs a fair share of resources. The Healthcare Commission disclosed that NHS trusts in areas with the greatest medical problems were losing up to 20% of the money they were due under the official formula for assessing local health needs, agreed in December 2002. They are being starved of cash because ministers feared the consequences of reallocating resources from well-heeled areas that were found to be overfunded. John Carvel, social affairs editor Thursday July 8, 2004 The Guardian
• How health and social services spent extra funding announced in the 2002 spending review. David Batty reports. Monday July 12, 2004
• Ambitious targets to improve the health of the working class were set by the chancellor yesterday as he confirmed a £23bn increase in health spending in England over the next three years. He required John Reid, the health secretary, to tackle health inequalities that lead to a disproportionate death toll among manual workers from cancer and coronary heart disease. They will become the prime targets of a government campaign to reduce smoking. John Carvel, social affairs editor Tuesday July 13, 2004 The Guardian
• About 6,000 jobs will be axed in a cull of NHS quangos in the next four years, releasing an extra £500m for frontline patient care, the health secretary promised yesterday. John Reid said a reorganisation of NHS agencies operating at arm's length from the Department of Health would include the abolition of the Mental Health Act Commission , the Health Development Agency and the NHS Modernisation Agency. A government report said 38 "arm's-length bodies" spent £4.8bn a year, including operating costs of £1.8bn. Half were created since Labour came to power in 1997. By 2007/8 they will be reduced to 20 organisations. Many will be merged or subsumed into other agencies and there were doubts in the service last night that the savings would be as large as ministers claimed. John Carvel, social affairs editor Friday July 23, 2004 The Guardian
• Hospitals' results earnings could be capped. Hospitals could lose potential revenue worth millions of pounds under the rollout of a scheme to fund patient care, it has emerged. The Department of Health (DoH) today confirmed that it would consider capping hospitals for surplus earnings gained under payment by results (PBR), the latest piece of government policy to fund patient care. Hélène Mulholland Thursday August 26, 2004
• Employers are to be made to pay the NHS for treating staff injured at work in a move that is expected to save the health service about £150m a year. Rosie Winterton, the health minister, published draft regulations yesterday giving the NHS power to recoup the cost from insurers. The NHS will charge a standard rate of £473 for treatment in accident and emergency and £582 a day if the patient has to be admitted to a hospital ward. Companies are already required to take out liability insurance to provide compensation for staff injured at work. Under the new scheme the insurers will be required to alert the NHS whenever compensation is paid, allowing hospitals to reclaim treatment costs. John Carvel, social affairs editor Saturday September 25, 2004 The Guardian
• Family doctors to keep half of savings. Labour proposal will in effect reintroduce GP fundholding. John Carvel, social affairs editor Wednesday October 6, 2004 The Guardian
• The health market is back. Monday October 11, 2004 The Guardian
• The new computer system being installed by the NHS is set to cost taxpayers at least £15bn over the next 10 years - more than the total investment in the Channel tunnel. The eventual price tag may reach £30bn, five times the procurement costs announced two years ago by the former health secretary, Alan Milburn, the Department of Health said last night. John Carvel, social affairs editor Tuesday October 12, 2004 The Guardian
• IT will help patients. Letters Friday October 15, 2004 The Guardian
• Quango cull will save health service £500m a year. John Carvel Wednesday December 1, 2004 The Guardian
• The chancellor claimed a victory yesterday in saving a third of a billion pounds a year on the cost of branded drugs for the NHS and the total savings on drugs could be three times that. According to the pre-budget report, the NHS will save £1bn in tax year 2005-2006 by introducing price cuts for drugs. Heather Tomlinson Friday December 3, 2004 The Guardian
• I agree hospital staff should have greater freedom from Whitehall control, and I do not believe we should oppose initiatives that reward trusts that achieve the most for their patients (Foundation hospitals, December 13). But there is more to providing round-the-clock patient care than performing operations. Under payment by results, different areas of hospital activity are funded through fixed tariffs. Yet hospital economies rely on cross-subsidisation. It is impossible to look at different procedures in isolation, and the price tag that is attached to one service - such as a hernia operation - will inevitably have consequences for others - such as emergency care - particularly if it does not match the true cost of providing it. Moreover, there is a risk that some services, such as A&E and psychiatry, will be neglected because they are not profitable. The government is yet to explain how such services which do not fit easily into the market model, will be safeguarded. James Johnson Chairman of council, British Medical Association Wednesday December 15, 2004 The Guardian
• Family doctors in England could be allowed to keep all the savings they make for the NHS by sending fewer patients for expensive hospital treatment, the government announced today. Health minister John Hutton said GPs would be allowed to keep up to 100% of the savings they make from directly purchasing hospital or primary care for their patients - twice as much as initially proposed by the government two months ago. Under the proposals, GPs would not be allowed to put the surplus into their personal bank accounts. The money would be regarded as a bonus for their practice to improve facilities for patients. David Batty Thursday December 16, 2004
• A key reform to NHS funding is being scaled back amid concerns over "financial volatility", it emerged today. The government is gradually bringing in a system known as Payment by Results (PbR), where NHS funds depend on numbers of patients, with hospitals receiving a set sum for each treatment they carry out. Hélène Mulholland and agencies Tuesday January 11, 2005
• Funding for local health services in England is going up by at least 8.1% from next year, the health secretary, John Reid, announced today. But the increases will be even higher in 88 deprived areas where cases of heart disease and lung cancer are high and life expectancy is low, he said. Wednesday February 9, 2005
• Nurses will for the first time be given their own budgets to care for patients under government proposals announced today. The offer is available to the new community matrons, who are being taken on to manage the care of patients with complex and multiple conditions living in the community. But the decision, which comes in new Department of Health guidance published this morning, is likely to be unpopular with GPs who have traditionally controlled the practice purse strings. Debbie Andalo Wednesday February 23, 2005
• The health minister, Stephen Ladyman, last night pledged big improvements in services to combat osteoporosis, the potentially crippling bone disease thought to affect up to one in three British women over 50. James Meikle, health correspondent Monday April 4, 2005 The Guardian
• The number of hospital meals left untouched by patients has risen by almost 40% in just three years, with nearly 17.5m thrown away last year, it emerged today. David Batty Friday June 3, 2005
• Fraud investigators have saved the NHS £675m in the last six years, the government announced today. Debbie Andalo and agencies Wednesday July 13, 2005
• It's time to consider the future for hospices and how they are financed, says Malcolm Dean. Wednesday July 20, 2005 The Guardian
• Patients who miss GP appointments are costing the NHS about £180m a year in wasted time, according to a survey by the Institute of Healthcare Management. John Carvel, social affairs editor Wednesday August 24, 2005 The Guardian
• Rethinking inconsistent hospital policies. Leader Wednesday December 28, 2005 The Guardian
• GP commissioning "bribe" will "sink" policy before it begins. The National Association for Primary Care, the leading pressure group for GP commissioning, says the new nationally set financial incentive to encourage GPs to take up practice based commissioning will mean the policy will "sink before it has even got going". They say the government's deal will will set up a "national standard-based approach" that will undermine the entire aim of the policy - to encourage GPs to be entrepreneurial. Summary by Keep our NHS Public of Health Service Journal 5 January 2005
• End the postcode lottery on long-term care costs. A solicitor in Devon has launched a free assessment service to help people decide whether to challenge NHS funding decisions on long-term care made by PCTs. The solicitor, Robert Campbell, says it may be possible to use "no win, no fee" deals or judicial review. Prospective clients can fill in an online form at the Care Directions website (www.caredirections.co.uk). In 1992 responsibility for virtually all long-term care funding was passed from the NHS to local authorities, with only those with the highest levels of clinical need still qualifying for continuous care on the NHS. But the rules governing continuous care are murky and ill defined, and PCTs interpret them differently. Summary by Keep our NHS Public of Telegraph 18 January 2005
• Provide to survive, managers told. The NHS has issued a guide to primary care managers and clinicians, a "call to arms" to ensure their services can compete with large corporations and foundation trusts in future healthcare markets. The Nuts and Bolts of Primary Care Provision encourages GPs, nurses and managers to organise themselves into social enterprise companies, co-ops and mutual societies. It warns that large corporations and foundation trusts could push up costs and fragment primary care services. NHS Alliance chair Dr Michael Dixon called for a level playing field so "smaller folk" can compete with "big corporates". He warned of the "fragmentation, over-provision and market tricks" that have lead to "'lower quality and more expensive care" in other of other market based systems, but said "I am happy with outside providers doing the things that we can't do - like the initiative in Derby". Summary by Keep our NHS Public of  Health Service Journal 26 January 2006
• PCT nursing care criteria "flawed in law". An elderly woman who was denied continuing NHS care has won her case in the high court, with wide implications for the NHS. The judge ruled that the criteria used by many primary care trusts to assess whether someone should have to pay for their nursing care are 'fatally flawed' in law. Bexley Care Trust had claimed that Maureen Grogan did not meet the criteria for continuing care, but did qualify for high-band nursing. The judge deemed the two categories to be indistinguishable - if she qualified for high-band nursing care, her health care needs should be deemed her "primary" need, meaning she should automatically qualify by law for free continuing NHS care. He said the trust had been "led astray" by the DoH, and he endorsed calls from the Commons health select committee and the health ombudsman for a single set of guidance. Liberal Democrat MP Paul Burstow said: "The judgment demonstrates that this government has connived and been part of a process of redrawing the boundaries by stealth between what people have to pay for themselves in terms of care and what is free." Summary by Keep our NHS Public of Public Finance 27 January 2005
• NHS chiefs warn over "debt crisis". The NHS Confederation is calling for trusts' long-term debts to be restructured and for the RAB financing system to be changed. Head of policy Nigel Edwards said: "RAB works at the moment because of the way we get our resource allocations, but under PbR the money doesn't come down to you like that any more, it's related to your activities" Summary by Keep our NHS Public of Public Finance 27 January 2005
• In-debt trusts free to plunder practice-based commissioning savings. PCTs will be able to skim off savings GPs make from practice-based commissioning to help pay off budget deficits. The Department of Health recommends that individual practices should be entitled to spend 70% of any surplus they make under PBC after meeting centrally set objectives. The remaining 30% could be used by PCTs to meet "wider need across the whole PCT area", including, as a last resort, covering PCT overspends. Critics have said that allowing PCTs access to the funds reduces the incentive for GPs to take up commissioning. Summary by Keep our NHS Public of  Doctor Update 1 February 2006
• DoH estimates 3,500 jobs could be lost under service restructuring. Data obtained under the freedom of information act from the Department of Health suggests that 3,530 'whole-time equivalent' jobs could be lost from SHAs and PCTs as a result of restructuring and the DoH target to reduce management costs by 15%. The total number of job losses is likely to be higher, given the number of part-time workers among management and administrative staff. Summary by Keep our NHS Public of Health Service Journal 2 February 2006
• White paper NHS changes 'not cost-neutral'. John Appleby, chief economist at the King's Fund, has called into doubt the government's presumption that its planned transfer of 5% of current hospital activity - £2.4bn in budget terms - to primary and social care will be cost-neutral. He said: "It's unlikely to be cost-neutral, although that's the way they present it. With all the structural changes going on, as well in terms of primary care trust reconfiguration, that makes it even more unlikely. When you have that sort of management upheaval, there's often a kind of paralysis." Patricia Hewitt said the changes would be cost-neutral and would happen quickly: "Particularly over the next two years, we expect more of the growth money to be invested into community services rather than acute services." Summary by Keep our NHS Public of Public Finance 3 February 2006
• Financial mayhem exposes structural problems that beset the NHS. Nicholas Timmins argues that "four factors underlie the financial crisis: pay and inflation; the NHS accounting system; culture; and structural problems…Plans to close the casualty department at Kidderminster saw a Labour minister lose his seat in the 2001 election to Dr Richard Taylor, the independent who still holds it. But in a ring around London, in parts of the north-west and Yorkshire, a string of Kidderminsters are needed." Summary by Keep our NHS Public of Financial Times 9 February 2006
• Caution urged over NHS spending. A King's Fund report says it is hard to know if patients are seeing value for money from the extra investment in the NHS, because there has not been a detailed review of the benefits and costs of bringing in new policies. It suggests the rate of improvement gained from increased health spending may be declining as more money flows into the NHS, as government policies induce more demand resulting in greater cost pressures. It also recommends using researchers and the National Institute for Health and Clinical Excellence to obtain better evidence on which to plan further investment.  Summary by Keep our NHS Public of BBC Online 9 February 2006
• UK faces sharp rise in spending on health and long-term care, says OECD. The Organisation for Economic Co-operation and Development has said that health and long-term care spending in the UK will increase from its current 7.2% of national income to 12.7% by 2050, assuming the rise in health spending overshoots growth in national income by 1% - which has been the trend among the 30 OECD member countries over the past 20 years. The report found the reason for the 1% increase was not an aging population but advances in medical technology. It said: "Even where new technology brings down the cost of a treatment, public spending may rise as demand for the treatment increases. It is these factors, which are not specifically related to ageing populations, that will put the most pressure on health spending over the long term."  Summary by Keep our NHS Public of Financial Times 10 February 2006
• Hospitals are being targeted by criminal gangs stealing medical equipment to sell abroad, according to reports. Police and NHS officials are linking a number of thefts in which hundreds of thousands of pounds worth of diagnostic equipment were taken, according to the BBC. Monday February 13, 2006 9:48 AM
• Criminal gangs have taken medical equipment worth £1m in what appears to be a series of stolen-to-order thefts on NHS hospitals. Police and health officials think gangs are stealing diagnostic equipment to be taken to eastern Europe or Africa. Sarah Hall, health correspondent Tuesday February 14, 2006 The Guardian
• PCT fury over lost millions as PbR compensation withdrawn. Primary care trusts are furious after learning that compensation for those that will see costs rise under payment by results is to be halved next year, before abolition in 2008. The change in policy, announced just two months before the new financial year, will leave black holes in their finances. Coventry PCT will be hit hardest with a £16.2m funding gap, and Huntingdonshire will be left with a £14.9m shortfall. PCTs in West Midlands South strategic health authority area will face a £53.1m gap, PCTs across Essex SHA will have to deal with a cut of £48m, and the four Birmingham PCTs are set to lose £20m. Norfolk, Suffok and Cambridgeshire SHA said its PCTs face a loss of £39m. Summary by Keep our NHS Public of Health Service Journal 16 February 2006
• Practice-based commissioning: Safety in numbers. The majority of GPs are not doing anything about practice-based commissioning. In areas where there is interest, the emerging model is one of groups of practices collaborating in locality commissioning consortia. Summary by Keep our NHS Public of Health Service Journal 16 February 2006
• Health rationing survey shows support for comprehensive service. BBC Online asked people to vote on how they would prioritise healthcare given limited resources. There were six options: that priority should go to the young; to the elderly; to the poor; to those who would get the greatest benefit; to those who have looked after themselves; or that taxes should be raised to look after everyone. The results show overwhelming support for the last option, with 75% of people saying we should pay more to get a fully comprehensive NHS, treating everyone as much as possible. Summary by Keep our NHS Public of BBC Online 20 February 2006
• Birth choice plan under attack. Under a target planned by ministers, NHS trusts that fail to provide an alternative to labour wards - such as home delivery or birth centres - could face financial penalties. This is despite the chronic shortage of midwives and fears that birthing centres are not as safe as hospitals. Summary by Keep our NHS Public of  Telegraph 5 March 2006
• Health service managers see 7% rise in salaries. Board pay for NHS chief executives and managers in England jumped by 7 per cent last year, and by 10 per cent for the directors of the government's flagship new foundation trusts. Sir Jonathan Michael, the chief executive of Guy's and St Thomas's foundation trust had the highest salary at £214,000, while Derek Smith, chief executive of Hammersmith Hospitals in London had around £200,000. Summary by Keep our NHS Public of  Financial Times 7 March 2006
• Health trusts' funding cut by more than £50m. Cash-strapped health trusts in the West Midlands are to have their Government funding cut by more than £50 million next year as a result of the Government phasing the purchaser parity adjustment earlier than expected. Summary by Keep our NHS Public of  Birmingham Post 10 March 2006
• Acute QOF could reward trusts for good clinical performance. Acute providers could increase their earnings under proposals to reward them for enhanced clinical performance, reducing A& E waiting times and effective combating of MRSA. The model is inspired by US company Medicare's 'premier pay for quality' programme. It recommends that achievement of points should mean providers get 'financial reward, preferred provider status and accreditation to appear on the choice menu'. Meanwhile Mike Farrar, chief executive of West Yorkshire SHA and a strong candidate to become NHS chief executive, has said the national tariff price should be set artificially low so PCTs can provide top-up payments to push new providers into disadvantaged areas. He said: "As the tariff beds in, over time we might look to consider a way that commissioners can add a premium to the national price, as a way of incentivising providers to work in areas of unmet health need." Summary by Keep our NHS Public of  Health Service Journal 17 March 2006
• Independent body should set prices, says Warner. The payment by results tariff should be set by an independent body rather than government, according to health minister Lord Warner. Summary by Keep our NHS Public of  Health Service Journal 17 March 2006
• Hewitt orders finance probe. Patricia Hewitt has asked the Audit Commission to investigate financial management in the NHS and the accountancy framework governing the system. Summary by Keep our NHS Public of  Health Service Journal 17 March 2006
• Call for windfall tax on banks and oil firms to bail out NHS. Gordon Brown has been urged by Labour MPs to impose a windfall profits tax on banks and energy companies in the Budget to ease the financial crisis in the NHS. A former cabinet minister said: "A windfall profits tax on banks would be very popular with our supporters. The NHS crisis is worse than our education reform problems." Summary by Keep our NHS Public of  Independent 18 March 2006
• Health Service slips down the waiting list. Nicholas Timmins writes that Gordon Brown's failure to mention the NHS in the budget should make the health service "quake in its boots". "The NHS is clearly in the doghouse with Gordon Brown. He has given the service its longest period of sustained growth in its near 60-year history and it has rewarded him by heading for a record overspend, managing to create a famine of delayed operations and disappearing jobs amid this enormous feast… Instead of deciding what the NHS needs after 2008 when the record spending increases end, and then adjusting other spending programmes to accommodate it, Mr Brown seems to be working the other way around: establishing his priorities and then leaving the health service to scrap with everyone else over what is left." Summary by Keep our NHS Public of  Financial Times 23 March 2006
• Why so quiet about the NHS? Health threatens to become Labour's poll tax. In an opinion piece Peter Riddell says: "Uniquely in all his Budgets, Mr Brown hardly mentioned the NHS yesterday. But health could be the most serious political problem for a Brown government, as it is likely to be, before the next election, the equivalent of the poll tax." Summary by Keep our NHS Public of  Times 23 March 2006
• NHS 'to be charged for borrowing'. The government plans to make NHS organisations pay interest on money they borrow from the NHS bank when they run up deficits as part of an overhaul of finances. From April, health bodies will be charged up to 10% for borrowing money, while trusts which invest their surpluses could receive 20% interest. NHS trusts said the plan would penalise those least able to pay. Summary by Keep our NHS Public of  BBC Online 31 March 2006
• The business leader who convinced Gordon Brown to pour more than £40bn into the NHS has issued a scathing rebuke over the government's failure to deliver genuinely radical improvements to patient care. In his first open criticism over the handling of the record investment in the health service, Sir Derek Wanless blamed generous increases in pay for doctors and nurses for the financial crisis now facing many hospitals. His attack came as the official [Andrew Foster] responsible for implementing the pay deals prepared to leave the Department of Health, just a month after the departure of its chief executive Sir Nigel Crisp. Ned Temko and Jo Revill Sunday April 2, 2006 The Observer
• Will practice-based commissioning affect patient registration? As market forces are introduced to primary care practices could resort to cherry-picking patients. Jessica Allen, senior research fellow at the think tank the Institute of Public Policy Research, said: "Under PBC, practices will benefit from saving cash, so there is a real risk they might be encouraged to cherry-pick or cream off patients by only registering the cheaper, healthier ones… Many PCTs do not know what their reconfigured area will be and are a long way from being able to monitor practice lists. In reality far tougher regulation is required to ensure more expensive patients or those in poorer areas are not left out. To an extent, taking on new patients will rely on the goodwill of practice partners." Dr David Jenner, commissioning lead at the NHS Alliance, predicts that there is a greater risk of under-referring to keep costs down. Summary by Keep our NHS Public of  Independent Nurse 3 April 2006
• Charging is no solution for the health service. Letters Tuesday April 4, 2006 The Guardian
• Our NHS will remain tax-funded.  Letter from Patricia Hewitt, secretary of state for health,  Tuesday April 4, 2006 The Guardian in response to proposals for charging patients .
• Good NHS trusts to bail out bad. Health trusts in the Midlands have been told to deposit £187 million into the central NHS Bank to help bail out debt-hit counterparts in the region. The "one-off" plan for primary care trusts has been designed to ensure NHS organisations balance their books by March 2007. Summary by Keep our NHS Public of  Birmingham Post 4 April 2006
• Cost and consultants in the NHS. In a letter to the Times, Dr Chris Laing writes: "There is justifiable concern about where the large increases in NHS funding has been going. This has been met with rather cynical briefing that it "has all gone on pay rises". This is preferable to the wastage being pinned on government initiatives, such as £5 billion for "choose and book". It is frequently stated that spending has gone awry because of a lack of reform. This "reform" has transformed the world's most efficient health service to one of the most inefficient. It has transferred huge amounts of public money into the coffers of management consultants, contract lawyers, IT firms, private healthcare companies and PFI builders and left a mounting bureaucratic burden. Perhaps a little less reform would be in order ?" Summary by Keep our NHS Public of  Times 6 April 2006
• At least 100,000 NHS employees will lose their jobs if the government carries through the health reforms Tony Blair wants as a lasting monument to his premiership, according to a report today from the pro-market thinktank Reform. Under the reforms, the benefits of a more efficient service, with greater productivity and a more highly skilled workforce, would be accompanied by severe unemployment, says the report by Nick Bosanquet, professor of health policy at Imperial College London. John Carvel, social affairs editor Wednesday April 12, 2006 The Guardian [Targets of this nature are very rarely achieved and ignore the long term growth in health care as more effective treatments result in more patients surviving from one disease and then needing treatment for other conditions]
• Patient choice and PBC incompatible. Patient choice and practice-based commissioning are not compatible, according to a report by the University of Birmingham Health Services Management Centre and the NHS Alliance. Conflict between the two flagship Government policies will arise because patients will often ignore GPs' decisions on how or where they should be treated. It also called for clarity on whether patients should be given a choice of primary care providers as well as hospitals. Dr Richard More, a GP in Yeovil, Somerset, said: "Patient choice embodies the thought you can have what you want and PBC implies you can have what we've got." Summary by Keep our NHS Public of  Pulse 11 April 2006
• Time to make the figures add up. John Carvel writes that Patricia Hewitt's political skills "may be tested to the limit if she has to explain why she is backing the closure of NHS capacity if she is funding new private-sector treatment centres to treat NHS patients in the same area." There are also fears that public health, mental health and social care will be able to hang on to their shares of resources when budgets are squeezed. In preparing development plans for 2006-07, PCTs were told to concentrate all growth money in this year's budget on eliminating deficits and delivering the health department's new list of six priorities. These are: progress towards reducing health inequalities by 10% by 2010; speedier treatment for cancer patients, backed by targets; achievement by 2008 of the maximum 18-week wait from GP referral to hospital treatment; year-on-year reductions in MRSA infection levels; ensuring every patient is offered at least four choices for a hospital appointment; and improved access to sexual health clinics. Services outside these areas are unlikely to expand this year, and may face cuts. Summary by Keep our NHS Public of  Guardian 12 April 2006
• NHS chief says hospitals must spend less on drugs and staff. Sir Ian Carruthers, the acting head of the NHS, has told Tony Blair that there is considerable scope for cuts in the £10.3 billion spent every year on drugs and the £1 billion on temporary staff. Carruthers believes that too many hospitals still have a "misplaced brand loyalty" to drugs, which adds to costs. Summary by Keep our NHS Public of  Times 12 April 2006
• Four children's hospitals have warned health ministers they will have to cut specialist services because of miscalculations in the new payments-by-results system championed by Tony Blair as part of his NHS reforms. The threat to specialist services for children was revealed by the Liberal Democrats, who released papers showing children's trusts have told ministers they will have to cut services because they claim they are facing a £22m shortfall in the new financial year. The letter was sent by the chairs and chief executives of Great Ormond Street, Alder Hey, Birmingham and Sheffield hospitals. Together the four hospitals form the National Children's Health Alliance, and they claim the proposed funding will damage the provision of cardiac surgery, neurosurgery and spinal surgery.  Patrick Wintour, political editor Tuesday April 18, 2006 The Guardian
• Heywood and Middleton primary care trust in Greater Manchester has agreed to pay about £2,500 for laser treatment to remove a transsexual woman's tattoos.  Riazat Butt Thursday April 20, 2006 The Guardian
• 'Cynical' GPs accused of referral ruse. GPs have cynically increased the number of patients they refer in order to make easy savings when they take over as practice-based commissioners, according to a report from the University of York. Dr Chaand Nagpaul, chair of the GPC's commissioning and service development subcommittee, said the suggestion GPs would increase referrals to boost budgets was illogical. "I don't believe it is happening. The only logical explanation for increased demand is the Government's perverse incentive for secondary care to income generate through Payment by Results." Summary by Keep our NHS Public of Pulse 21 April 2006
• Primary Care Trust chief executives are losing their jobs, accused of mismanagement by the merchants of spin (Leaders, April 25). No doubt some deserve their fate. But some will have gone because the Department of Health has used faith not science to fix the formula that now controls the division of about £60bn between 300 or so PCTs. There is a remarkable dearth of curiosity in all we hear and read about those deficits and in an influential formula that gives favoured PCTs twice as much per head as the less fortunate ones. The formula is nothing other than statistical legerdemain, based on a correlational study of socio-economic proxies rather than on any direct measurement of health need. Go to www.ucl.ac.uk/stats and research report 267 [pdf]. Download and save the Excel file PCTgrapher.xls, and see how your PCT fares in this politically engineered game. Mervyn Stone Department of statistical science, University College London. Wednesday April 26, 2006 The Guardian
• Health staff unite on NHS funding. A coalition of bodies representing 1m health professionals, managers, nurses and patients have united to call for a "free, fair and tax-funded" NHS. Twelve bodies, including health unions, royal colleges and patient groups, say tax is the best way to fund the NHS, and that a move to a social insurance system, as advocated by Doctors for Reform, would increase costs and red tape and see the most needy paying the most. Dr Gill Morgan, chief executive of the NHS Confederation, said: "We believe a social insurance system would be a step back not forward." Dave Prentis, general secretary of public sector union Unison, said: "Need, not the size of your wallet or the small print of your health insurance policy, must be the criteria for healthcare across the UK." Meanwhile Patricia Hewitt told MPs on the health select committee that hospital managers should stop complaining about the impact of privately-run but state-funded independent sector treatment centres. Summary by Keep our NHS Public of  BBC Online 27 April 2006
• A patient occupied a hospital bed for more than four years after doctors decided the person was ready to leave, it emerged yesterday. The cost of the patient's care at an unnamed hospital in Maidstone and Tunbridge Wells NHS trust is estimated to have been more than £300,000. Paul Lewis Tuesday May 2, 2006 The Guardian
• GPs achieve £143m saving in drugs bill. GPs in England have achieved the first drop in the drugs bill for at least 15 years - saving the NHS £143m. London GP Dr Chaand Nagpaul, chairman of the GPC commissioning and service development subcommittee, said the fact the figure was £3m more than the DoH's calculated 'overspend' on the quality and outcomes framework was a vindication for GPs in the row over pay rises. Summary by Keep our NHS Public of  Doctor Update 3 May 2006
• PCTs try to get around DES deal. PCTs are trying to renegotiate existing deals for practice-based commissioning rather than offer the directed enhanced service agreed in the latest contract review. GP negotiators have advised GPs to stand firm in the face of such pressure, and stick to the nationally-agreed deal on commissioning. Summary by Keep our NHS Public of  Doctor Update 3 May 2006
• How consultants are cashing in on pure incompetence. According to the Daily Telegraph, "government has poured billions into the pockets of grateful consultants, many of whom can barely believe their luck. In their excellent book, Plundering the Public Sector*, David Craig (a former consultant) and Richard Brooks (a former tax inspector), claim that Labour will have spent £70bn of state funds on management and IT consultants by the end of its third term." Summary by Keep our NHS Public of  Telegraph 5 May 2006
• MPs to probe IT fiasco at health service. The public accounts committee is to investigate the National Health Service's £6.2bn IT modernisation amid fears that the massive project is overbudget and behind schedule. Connecting for Health, launched by Tony Blair four years ago, involves centralised medical records for 50 million patients, prescriptions by email and online booking. Although much of the overhaul is funded by the government, hospitals are obliged to bear the cost of upgrading local networks, inputting patient data, and training staff to use the systems. Only a minority of hospitals are thought to have completed this so far. Summary by Keep our NHS Public of  Observer 7 May 2006
• Medical resources wasted by the millions of patients who fail to turn up for hospital appointments cost the NHS in England £614m last year, according to figures provided by trusts under the Freedom of Information Act.  John Carvel, social affairs editor Tuesday May 9, 2006 The Guardian [Note: the situation might be improved if patients did not get appointments at times and places they cannot reach. See 4 May 2006 on University Hospitals Coventry and Warwickshire Trust Performance for a letter about this problem.  Other patients have much worse problems with no convenient bus service] [West Midlands South Strategic Health Authority]
• London universities warned today that more than 3,000 staff could lose their jobs if plans proceed to change the NHS research and development budget. At present, the capital receives one-third of the national health research budget and London vice-chancellors fear new arrangements will mean funding is spread more evenly in the future. A report by London Higher, an umbrella group that represents 43 higher education institutions in London, estimates the financial impact of NHS proposals to restructure the research budget may cost London institutions £17.5m in the first year alone. Donald MacLeod Wednesday May 10, 2006
• Joint fund 'could revive NHS research'. Prof Colin Blakemore, the chief executive of the Medical Research Council, has said the decline in clinical studies in the NHS has been caused in part by the diversion of funds away from long-term medical research to cut waiting lists. Summary by Keep our NHS Public of  Telegraph 9 May 2006
• Firm signal on health reforms. The Department of Health has issued a message of "no surrender" as it reaffirmed its strategy for reducing waiting times by 2008 while balancing the NHS's books. Andy Burnham, the new health minister, said striving for financial balance would lead to "some difficult decisions" but claimed there will be funds available to meet the new targets. £1.4bn, followed by £2.9bn, has been set aside to meet the target of 18 weeks wait between referral and treatment over the two years. Although figures are hazy, it is estimated that presently only 50% of patients are dealt with in this time frame, and average waiting times are rising rather than falling. Summary by Keep our NHS Public of  Financial Times 11 May 2006
• NHS patients have the right to be treated abroad at public cost if they face "undue delay" getting surgery at home, the European court of justice ruled yesterday. In a ruling centring on the case of a 75-year-old woman from Bedford, EU judges said health authorities had to pay the bill if one of their patients could establish urgent medical reasons for seeking quicker treatment in another member country. John Carvel and Clare Dyer Wednesday May 17, 2006 The Guardian
  • A suitable case for treatment. Leader Wednesday May 17, 2006 The Guardian
• than in the bricks and mortar of hospitals, according to the NHS Confederation. Summary by Keep our NHS Public of  Financial Times 22 May 2006
• 'RAB' is distorting NHS spending figures. Resource accounting and budgeting exaggerated the NHS's net overspend last year by £117m, according to Department of Health finance director Richard Douglas. But calculations confirmed by the DoH and other sources show that while Rab made last year's overspending look worse, it also disguised similar amounts of overspending over the past five years, as resources were inflated in each of those years through the previous year's underspending. If the same transparency were afforded for previous years, the NHS would have overspent by between £225m and £395m each year since 2001/ 02. Summary by Keep our NHS Public of  Public Finance 23 June 2006
• GP rewards for innovation. Primary care trusts should "invest to save" by handing out more cash incentives to GP practices to help with achieving system reform priorities, the government has said. Practices should be rewarded for launching "cash-releasing" innovations that "facilitate the provision of care in settings more convenient to patients, closer to home", the Department of Health's commissioning framework has recommended. Incentives triggers could include lowering accident and emergency attendance and improve patients' ability to "self-care". Summary by Keep our NHS Public of Health Service Journal 20 July 2006
• England has become a nation of pill-takers. A record 720m prescriptions were dispensed last year, a rise of 50% in the past 10 years. The figures, released by the NHS Information Centre, show that in 2005 the prescribing bill reached £7,937m. More than half of all prescriptions were for people over the age of 65, and on average they each received 38 of them. Sarah Boseley, health editor Friday July 21, 2006 The Guardian
• NHS local care savings 'doubted'. Doubts are being cast on the push to move care out of hospitals and into the community, after research showed there was little difference in cost. A team from Bradford's St Luke's Hospital looked at the rehabilitation of 220 elderly patients after illness. They found the cost and quality of life score after treatment was similar for acute and community hospitals. Ministers have said one of the reasons for shifting care is to save money. The average cost of the treatment in community hospitals was £7,233, compared to £7,351 for the district general hospital. The cost of treatment per day was actually £2 cheaper in the district general hospital, but over the course of treatment the cost worked out slightly more expensive as the average length of care was 23 days - one day more than for community hospitals. Summary by Keep our NHS Public of BBC Online 21 July 2006
• The extra billions invested in the NHS have been largely wasted, an independent thinktank claims today, resulting in far less improvement in services than might have been expected. A report from Civitas (the Institute for the Study of Civil Society) says that while government spending on the NHS has doubled in cash terms from 2000 - an increase of around a third in real terms - productivity has gone down. "Service improvement has in too many areas resembled a country stroll, whereas expenditure has increased at a sprint," says James Gubb, the author of The NHS and the NHS Plan. The high-profile targets, such as waiting times and cancer care, have all been met, the report concedes. But this has sometimes been done through "gaming": in one trust, A&E patients were kept in ambulances until staff were confident they could be treated within the four-hour government target. But beyond the areas covered by such targets, the improvements are slight, says the report. The UK lags behind in mental health and stroke care, it says, and it is the only Organisation for Economic Cooperation and Development country to register virtually no improvement in death rates from stroke between 1999 and 2003. Sarah Boseley, health editor Monday August 14, 2006 The Guardian
• Hospital hailed as the future of the NHS is forced to close. A private hospital leased four years ago by the NHS and used as an NHS treatment centre is to be closed for lack of patients. Ravenscourt Park Hospital in West London - the former Royal Masonic Hospital - was acquired by Hammersmith Hospitals NHS Trust in 2002 on a 15-year lease. It was lauded by ministers at the time as being the future of elective surgery, a dedicated NHS centre concentrating on a limited number of procedures and offering top-class facilities. The deal was struck when ministers believed that the NHS was short of capacity. Ravenscourt Park, with six theatres and 105 beds, was improved at a cost of £14 million to help to cut waiting lists for operations. But there was never a true shortage of capacity in the NHS, and Ravenscourt Park has lacked the patients to make the investment work. During the four years since it was leased, 18,500 operations have been conducted at the hospital, an average of about 4,500 a year. But this was uneconomic, and the hospital was losing £12 million a year. To break even it needed to treat 11,000 to 12,000 patients a year. Other hospitals in the region were asked to send patients there to try to balance the books. But payment by results means that hospitals are paid by the number of patients, giving an incentive to keep patients, even when they may be treated more quickly elsewhere. The trust will close the unit, but the deal it signed in 2002 means that it must continue to spend up to £5 million a year on maintenance, security and rent until the lease runs out in 2017, unless it can find somebody else to take it over. The Hammersmith trust has an accumulated deficit of £20 million, most of it because of Ravenscourt Park. The Patient and Public Involvement Forum at the trust. is examining whether proper consultation was carried out, as stipulated by the 2001 Health and Social Care Act. If not, the trust could be forced to backtrack. Last week the Court of Appeal ruled that the award of a contract for GP services to a private company could not go ahead because patients had not been adequately consulted. Summary by Keep our NHS Public of Times 30 August 2006
• Successful foundations 'are hiding surpluses'. Some foundation trusts are reluctant to show surpluses because they fear a backlash over their relative wealth, according to regulator Monitor. Some foundations hid their surpluses as contingency funds. Monitor also expressed concern over loans to other NHS bodies that were struggling to balance their books. It did not object to the loans in principle but said they should include legally binding terms for repayment. A Monitor spokesman said: 'We have found in certain foundation trusts a reluctance to show surpluses in a challenged health economy, as they fear the money might be "clawed back" by strategic health authorities or primary care trusts, which undermines the incentives this system is designed to generate.' Summary by Keep our NHS Public of Public Finance 1September 2006
• Private centres "waste NHS millions". Private health companies are being paid tens of millions of pounds for operations that are not going ahead. An investigation by Health Service Journal found that hardly any of the new centres are meeting their targets. However under generous contracts the independent centres still receive payment, while NHS hospital are only paid for operations carried out. Only 59% of the operations the 20 centres are paid for are being carried out. The Department of Health denies any problem saying that the centres' five-year contracts can only be properly assessed once they have run their full course. The journal's survey of NHS chief executives found that three quarters thought their finances had been damaged by the centres. 7% called the effect disastrous. Summary by Keep our NHS Public of Times 25 September 2006
• Fat cats of the public sector take top pay. The civil servant in charge of the Health Service's disaster-prone £20 billion computer system is being paid £280,000 a year. Richard Granger's salary is £100,000 more than Tony Blair's - yet his 'Connecting for Health ' system has so far cost double its initial projection of £6 billion and is more than two years behind schedule. Granger was brought in from the consultancy Deloitte in 2002. Summary by Keep our NHS Public of Times 8 October 2006
• Fears that breast cancer charities are swallowing up an unfair share of research funding are to be tackled with a new national network of cancer research centres. Last week, Professor Karol Sikora argued that breast cancer was in danger of becoming a 'romantic' disease, funded for sentimental reasons, an intervention that has brought a fierce response from charities. The new centres, part-funded by the Department of Health and part by the charity Cancer Research UK, will attempt to speed up the introduction of new cancer drugs and treatments to the NHS by investigating potential breakthroughs. Crucially, they will target all cancers, including the more rare mouth and stomach cancers. 'It's redressing the balance and putting everything on an equal footing,' said a Department of Health official. The £35 million network will be unveiled this week at a conference organised by the National Cancer Research Institute. Centres will be in existing major hospitals and are planned to be running by April 2007.  Gaby Hinsliff Sunday October 8, 2006 The Observer
• Accounting for the regulators. The direct costs of public service regulators appear in general to amount to less than 0.5 per cent of the costs of the services they regulate - a conclusion reached by dividing their declared budgets against spending on services. To that has to be added the, usually unquantified and potentially much larger, costs on those being regulated - preparing for inspection, being inspected and responding to the results. In 2004/ 05, the Healthcare Commission cost around £76m, 0.1 per cent of the NHS budget. That doubles once the costs of the National Institute of Clinical Excellence, Monitor - the foundation trusts regulator - the Patient Safety Agency and some other regulators are added. Those costs exclude the impact of the Audit Commission, the Health and Safety Executive, and the medical royal colleges; some calculations suggest that more than 100 bodies have the right to demand information from the average NHS trust. Summary by Keep our NHS Public of Financial Times 11 October 2006
• The architect of the government's decision to increase NHS spending by £40bn will today cause anxiety across Whitehall by launching an independent inquiry into how well the money was spent. Sir Derek Wanless, the former NatWest chief executive who provided Gordon Brown with the economic justification for NHS growth, has accepted an invitation from the King's Fund to investigate whether the extra money produced sufficient improvement in the nation's health. In 2002, Sir Derek's review of the NHS for the Treasury paved the way for unprecedented levels of funding, with annual increases worth more than 7% in the health budget sustained for the five years to 2007-08. Now he will conduct a fresh six-month inquiry into the results. He intends to report in April or May - in time for his conclusions to influence the Treasury's comprehensive spending review. John Carvel Thursday October 19, 2006 The Guardian
• The NHS could save at least £2.2bn a year by eliminating wasteful procedures that often do patients more harm than good, ministers said last night at the start of the health service's biggest ever productivity drive. They published a mammoth set of indicators showing how much each hospital and primary care trust in England could save if it adopted the practices of the smartest 25%. Andy Burnham, the health minister, said he was not seeking to pillory the poor performers, but his decision to publish their shortcomings will inevitably subject them to criticism from their local media and politicians. Officials said they were assembling further data on the performance of individual consultants, but this will not be disclosed for fear of besmirching their reputations. John Carvel, social affairs editor Monday October 23, 2006 The Guardian
• NHS funding 'reaching key areas'. A detailed breakdown of NHS spending shows money is reaching key health priorities, the government says. Health Secretary Patricia Hewitt is set to use the figures in defence of her record. Critics have argued that key services, especially mental health, have been starved of funds as the health service tries to balance the books. But the figures, compiled from spending by primary care trusts, local bodies which control £63bn of spending last year - three quarters of the NHS budget in England, showed many areas were getting increases in line with the overall 8.7% annual budget rise. The money invested in mental health rose by 8% to £7.7bn to make it the biggest single spend area. Cancers, the third biggest spend, saw funds rise by over 10% to £4.1bn. Public health also saw a 10% rise to £1.2bn. John Appleby, chief economist at the King's Fund health think-tank, said the figures did not show the whole picture. "It is just half the equation, what we have not got is the results. Just because spending is increasing it does not mean we are getting better care." Meanwhile, the Conservatives used other figures from PCTs to show the cost of providing out-of-hours GP care under a new contract, which came in in 2004, is three times what was expected. The figures show that the government set aside £105m last year, but PCTs, which were given responsibility for the service under the terms of the deal, actually shelled out £346m. Shadow health secretary Andrew Lansley said: "The government has achieved a unique double-whammy - obtaining worse services for patients at a much greater cost. It is mismanagement of our NHS on a tragic scale."  Summary by Keep our NHS Public of BBC Online 29 November 2006
• £50m boost for war on superbug. The NHS's chief executive David Nicholson has announced £50m to tackle clostridium difficile as well as penalties for hospitals missing waiting time targets. The NHS's latest Operating Framework - which sets out financial priorities for 2007-08 - will give health trusts the chance to set reduction targets and bid for up to £300,000 for hygiene initiatives such as extra hand basins. Clostridium difficile now kills three times as many as MRSA. The framework will also include powers for local health authorities to withhold funds from trusts that miss key Government targets. Health Secretary Patricia Hewitt said that it was "not really appropriate" that hospitals who failed to meet the targets should get the cash. The Department of Health said the measure was not a "fine" because no money would be taken away.  Summary by Keep our NHS Public of Chester Chronicle 11 December 2006
• 'Unsustainable' NHS accounts rules to stay. The health department has postponed a decision to scrap a set of accounting rules that have plunged some NHS trusts into potentially irrecoverable financial deficit. The NHS Confederation, which represents health authorities and trusts, said yesterday that it was disappointed at the decision which came despite the health department accepting that the application of the rules to individual NHS trusts "will become increasingly unsustainable". Richard Douglas, the health department's finance director, in effect acknowledged that, with the NHS struggling this year to achieve overall financial balance, it cannot at present afford the £600m-plus bill for scrapping the system. Jonathan Fielden, chairman of the British Medical Association's consultants committee, said it was "extremely disappointing" to see that the rules had not been scrapped. They threatened to "imperil" NHS organisations by pushing them yet deeper into debt, while already causing "short term cuts directly impacting on patient care". At the same time, NHS trusts are due next year receive interest-bearing loans rather than cash support for any overspends, and loans for capital rather than cash allocations as they are moved towards the financial regime that applies to foundation trusts.  Summary by Keep our NHS Public of Financial Times 12 December 2006
• Private provider queries future of comprehensive NHS care. The NHS will be forced to abandon its founding principle of providing a comprehensive service 'free at the point of delivery' by 2015, a leading private sector provider has predicted. Patients will have to pay for a range of services including fertility treatment, some specialist drugs and weight-loss surgery, according to a director of Netcare, which holds NHS contracts as part of the independent treatment centre programme. Julia Eadie, Netcare's director of corporate affairs and a former senior Department of Health official, who most recently headed its policy on overseas teams, told an HSJ conference last week that financial constraints would force the NHS to restrict itself to a core service. She said that with financial growth forecast to be no more than 3 per cent from 2008, compared to the figure of nearly 7 per cent the NHS has seen over the last five years, the state would no longer pay for treatments including weight-loss surgery, infertility treatment, laser eye surgery, treatment for sports injuries, varicose vein surgery and many specialist drugs. She said that in future, patients seeking such treatments would need to use independent companies such as Netcare - which will have spare capacity once the NHS has met its overarching target of a maximum 18 weeks from GP consultation to treatment, she said. Ms Eadie was explicit about the potential benefits for the private sector as the increase in state funding shrinks. 'There will be a major funding gap post-2008, and we see this as an opportunity - the NHS will still be doing some services but it will also draw a line. Four years ago you would never have seen the NHS talking about "markets" or "demand management".' NHS Confederation policy director Nigel Edwards said constraints on financial growth highlighted the need for a more overt discussion about what the NHS should and should not pay for. Summary by Keep our NHS Public of Health Service Journal 14 December 2006
• Exclusive: PCT fitness bill hits £6.5m. The primary care trust fitness for purpose programme cost the Department of Health £6.5m. The costs were revealed in a written answer by health minister Ivan Lewis. In addition to £6.5m on the programme, he said the DoH also paid £287,000 to three companies that supported the recruitment of chief executives through controversial assessment centres. Some of this was paid to consultants McKinsey, which devised the programme for the DoH and have worked with PCTs in implementing it. The DoH has consistently refused to reveal the details of its contract with McKinsey. Summary by Keep our NHS Public of Health Service Journal 14 December 2006
• DoH says Rab is 'unsustainable' - but it carries on. The Department of Health has admitted that the financial regime governing NHS trusts is unsustainable, yet has declined to implement an Audit Commission recommendation to correct it. Instead, the DoH will introduce a 'more formal system' of loans to help trusts cope with their Rab deductions and underlying deficits. That will replace the informal brokerage system that has made deciphering where deficits stem from difficult. Transfers between trust capital and revenue allocations - used to cover up over £800m in revenue overspends over the past five years - will also be prevented by a new borrowing regime in which investments are financed through loans, similar to the foundation trust regime. NHS chief executive David Nicholson repeated his pledge of recent months that the system as a whole would break even by the end of the financial year. That balance will in part be produced through the further devolution of central funds to strategic health authorities. Earlier this year the DoH devolved £5.85bn previously ringfenced for training and public health to SHAs. That led to accusations that the DoH was sanctioning the 'raiding' of training and public health budgets to cover deficits. An extra £1bn has now been added to those devolved funds, including a budget covering student bursaries. Summary by Keep our NHS Public of Public Finance 15 December 2006
• The NHS in Scotland underspent its budget by £70.6m. The NHS in Scotland underspent its budget by £70.6m in 2005/ 06, Audit Scotland has found. Summary by Keep our NHS Public of Public Finance 15 December 2006
• Councils to be given bigger role in planning health services. Local government is to be given a significant role in planning health services for the first time in more than 30 years, under an amendment the government is tabling to its local government bill. Primary care trusts are to be given a statutory duty to work with local councils to produce a local health needs assessment covering public health and primary and community care. Priorities will be decided locally. But once agreed they become potentially eligible for funding through the burgeoning amounts of cash going to councils through local area agreement funding - a sum that Phil Woolas, the local government minister, said will reach £5bn in two years. This would be a larger amount than councils will be getting through the more general, non-earmarked, revenue support grant that central government provides. The duty to plan jointly is "a really significant change", Mr Woolas said, aimed at ensuring the health service and local government work much more closely on priorities of their own choosing. These could be anything from smoking cessation to teenage pregnancy and putting rails into elderly people's homes. It gives councils a bigger role in health than they have had since 1974, when the NHS reorganisation stripped them of many of their health powers. The unelected primary care trusts will remain responsible for commissioning NHS care, Mr Woolas said, but the bill will force the local authority and the PCT to jointly produce and act on a needs assessment for the area. Summary by Keep our NHS Public of Financial Times 22 January 2007
• Row as GPs landed with post-op checks. GPs are to have up to three- quarters of a million post- operative checks dumped on them every year for conditions such as varicose veins, hernias and joint replacements. The Department of Health has said no nationally agreed funds will be attached to the work and GPs will have to thrash out local deals with PCTs. But the failure to commit to paying practices has sparked an angry reaction, with the GPC warning 'it simply won't happen if there is no funding'. The plans were unveiled this week by Dr David Colin-Thome, the Government's primary care tsar. He insisted post-op checks in hospital would be scrapped for a range of clinical areas including orthopaedics, with patients instead encouraged to 'pop in' to see their GP if they had any concerns. He argued six-week post-surgery checks for everyone did not make economic sense. Summary by Keep our NHS Public of Pulse 8 February 2007
• NHS cash to help hit targets. The Department of Health is to give an extra £21m to Telford and Wrekin Primary Care Trust. But bosses have been warned that much of it will be spent on initiatives and meeting targets such as the 18 week referral to treatment target set for 2008. The 11.6% increase brings the trust's allocation from government up to £212m. "Whilst this is recognised as being a significant increase, it should be noted that there are some substantial investment commitments that the PCT will need to make to deliver national targets," says Trust finance director, Peter Price. Amongst other expenditures, including inflationary costs and contributions to the West Midlands NHS "bank", £508,000 will need to be earmarked to carry out the national "Choosing Health" policies. Summary by Keep our NHS Public of Shropshire Star 8 February 2007
• Cash for keeping patients alive. Hospitals are to be given cash bonuses - for keeping people alive. Regional health bosses are planning to try out a US system of rewarding trusts which have low death rates, levels of infection and readmissions. It will be piloted in part of the north west from October and all the region's hospitals from next April. Trusts will compete for a total pot of £1.5m. Any hospital that ranks in the top 10-20% will get a share. But Stephanie Thomas, of the Unison union, said: "We would be concerned that by rewarding the best performing trusts rather than giving extra help to those which are struggling. It will not improve the system as a whole but create super centres and leave other trusts struggling to survive." Performance tables will be published at the end of the year, so as well as earning cash incentives top-ranking hospitals are expected to attract more patients. Senior doctors yesterday welcomed the focus on quality of care but said they were concerned about the element of competition in the scheme and would prefer to see rewards for all trusts which achieved a fixed target. They also said bosses need to take account of the varying health levels in different areas which could affect survival rates. NHS north west chief executive Mike Farrar is pioneering the scheme. Currently the NHS is changing to a new payment system where hospitals get paid a set amount for each procedure they do. If successful, Mr Farrar's plan would ultimately replace this. He said: "Payments need to have some link to quality of care. At the moment organisations receive cash for each procedure they perform irrespective of whether the operation failed. This is the next step in the jigsaw. The results of the American trial are astounding. The hospitals which scored highest on quality outcomes showed very dramatic reductions in case costs, had significantly shorter lengths of stay, lower mortality rates, lower complication rates and lower readmission rates than hospitals which scored less well. Those hospitals which were serious in pursuing higher quality patient care were both more efficient and more effective than those that were unable to achieve the same quality standards." Summary by Keep our NHS Public of Manchester Evening News 9 February 2007
• Hewitt expects 3% growth in health budget. The National Health Service is to get a minimum 3% real terms growth in budget after 2008, Patricia Hewitt, the health secretary has implied. Sources at the Department of Health and the Treasury, however, say the two sides are "nowhere near" a final settlement on the health allocation for the next spending round. Ms Hewitt said last week that while the current record 7% a year real terms growth in NHS expenditure would not continue after April 2008, the budget would "continue to grow faster than the economy as a whole". That implies at least a 3% increase, given Gordon Brown's forecast in the pre-Budget report that the economy will grow at 2.75% a year. Three per cent would still be well below the 4.4-5.6% that Sir Derek Wanless projected would be needed over that period in his 2002 report on health spending which helped justify the current big investment in the NHS. In addition, both Sir Derek, for the King's Fund health think-tank, and the Treasury have been reworking his 2002 report to see if his assumptions still hold. It is not clear that the Treasury will publish the results of its study, but the King's Fund will produce Sir Derek's reworkings in an attempt to establish what health spending after 2008 "needs" to be. Talks between the Treasury and the health department remain tough, with the Treasury still angry at the NHS's loss of financial control last year and at its own failure to spot that coming. A battle appears to be being fought over social services spending, with the Treasury repeatedly saying it wants a freeze in real terms. That would have big effects on the NHS, as social services expenditure helps elderly patients out of hospital and can prevent admissions in the first place. Summary by Keep our NHS Public of Financial Times 12 February 2007
• NHS in £345m 'asset-stripping' sale. The government has been accused of orchestrating a £345m sell-off of former hospitals in one year in an attempt to balance the NHS budget. The value of the sales is 14 times the previous year's total.  Jo Revill, health editor Sunday February 18, 2007 The Observer
• Early intervention 'could free £3bn a year for NHS'. The National Health Service could release about £3bn a year by better use of medicines and particularly by early intervention in chronic diseases, Dr Richard Barker, director-general of the Association of the British Pharmaceutical Industry, argues. The forthcoming reduction in the rate of NHS growth, he said, provided an opportunity to focus on real effectiveness and value for money and not just a "more and cheaper" approach to health spending. Projects where the industry is working with the local NHS to "find and treat" patients in the community with cardiac and circulatory conditions, diabetes and obstructive pulmonary disease are already showing benefits that outweigh the costs, according to Barker. But the shift will require a new approach from primary care trusts who are "frankly suspicious" about the active involvement of the pharmaceutical industry in identifying and treating patients, Dr Barker said. Better and earlier diagnosis, case management and control of disease could cut hospital costs and improve quality of life, he said, and over the next three or four years perhaps £3bn could be released through better-value treatments for re