Two weeks in and there can be no doubt that the Prime Minister is choosing to focus strongly on the NHS. After last week's constitution talk, Gordon Brown has promised to make the NHS his 'highest priority'. However, the King's College London speech has been criticised for being big on plans but short on details. Watch this space.

The Financial Times reported on Monday that Alan Johnson (who was out in force at Gordon Brown's London speech) is pushing for a 10 per cent cut in the pharmaceutical price regulation scheme — the system that covers the price the NHS pays for branded drugs. Yet the very next day, the Department of Health and the Association of the British Pharmaceutical Industry delivered a collective 'no comment'.

The Prime Minister has continued his New Year focus on the NHS by making it his top priority and promising a more personal service with screening for early signs of stroke, diabetes, kidney and heart disease.

Crown copyright 2007

Following last week's intention to create an NHS constitution, Gordon Brown addressed King's College London with plans of delivering a programme of 'deeper and wider' NHS reform to enhance its role in care, prevention and personalised health services.

He identified three challenges that the NHS faces: embracing technological change; meeting rising expectations of healthcare; and adapting to a shift in priorities from tackling infectious disease to managing long-term conditions and lifestyle diseases.

In what is claimed to be the Prime Minister's first major speech on the health service, Mr Brown told his audience that stroke, diabetes, kidney and heart disease are conditions that affect the lives of 6.2m people, causing 200,000 deaths each year and accounting for a fifth of all hospital admissions.

'We will extend the availability of diagnostic procedures in the GP surgery,' the PM said, 'making blood tests, electrocardiograms and in some cases ultrasounds available and on offer not only when you are acutely unwell or if you can pay, but when you want and need them, where you need them, at the local surgery.

'Second, we will do more to extend screening, for example for colon cancer and for breast cancer.'

He added that the independent UK National Screening Committee will look at the evidence and advise on what additional screening procedures could be useful in detecting other conditions.

Mr Brown used his speech to claim there will be a focus on preventive care in relation to obesity, such as increasing activity-based prescriptions and better managing long-term conditions such as asthma and diabetes.

A 'patients' prospectus' will be launched this year that 'sets out how we will extend to all 15m patients with a chronic or long-term condition access to a choice of "active patient" or "care at home" options — clinically appropriate to them and supported by the NHS.'

Expanding on last week's New Year message to staff in which an NHS constitution was mentioned, Mr Brown said:

'… this year we will, for the first time, set out the "NHS offer" to patients as part of an "NHS constitution" — what you can expect to get from the NHS and what we expect to give you in return.

'As patients we will know the guarantees of service we can expect — for example the maximum time from GP referral to the commencement of treatment or the right to screening and advice at certain points in our lives.

'But we will also set out the responsibilities that come with this — our responsibility to make good use of NHS resources by turning up for booked appointments. So patients who do not turn up for appointments, for example, should not have the same entitlement to waiting time guarantees.'

Foundation trusts received a fair amount of attention in the speech. He has pledged to allow foundation hospitals to be able to 'take over failing hospitals to turn around their performance' and to allow them 'the freedom to provide primary care services where this is in the interests of patients.'

Continuing the patient involvement theme, the PM wants to see foundation trust members (ie, staff, patients and members of the public) increase from one million to three by 2012.

Gordon Brown concluded his speech by stating 'the renewal of the NHS will be our highest priority.'
 
'Our goal: deeper and wider reform — building on the values, principles and idealism of the NHS to create for the next decade an NHS that is: here for all of us but personal to each of us; focused on prevention as much as cure; and strong and confident enough to put real control into the hands of individuals and their clinicians.'

Shadow health secretary at the Conservatives, Andrew Lansley, accused the Prime Minister of 'chasing headlines'.

'Once again, his big "new" announcement crumbles when you look at the details. There is no proper timetable for delivery, we don't know where the money's coming from but we do know Brown has raided public health budgets.'

The speech received a lukewarm response from the British Medical Association (BMA). Dr Laurence Buckman, chairman of the GP committee said, 'we would like to be able to say that we fully support this new initiative — focusing on prevention should certainly be congratulated — but as ever the practical considerations have not been properly thought through. There has been no attempt to talk to GPs about how these proposals might work.'

Unsurprisingly, the independent regulator of NHS foundation trusts fully backed the speech. Bill Moyes, chairman of Monitor said it 'illustrated the central role the prime minister wants NHS foundation trusts to play in driving greater accountability and better quality of care.'

The NHS is seeking a 10 per cent cut in the price it pays for prescription medicines in a deal it plans to conclude with the pharmaceutical industry by June 2008.

Alan Johnson, the Health Secretary, said that he planned to generate substantial savings in the drugs budget during talks to be completed by June on the pharmaceutical price regulation scheme (PPRS), the agreement that covers the price to the NHS of branded drugs.

News that the government plans to cut the NHS medicines bill by 10 per cent has taken UK pharma industry leaders by surprise: the government's position has hitherto been kept confidential.

The Association of the British Pharmaceutical Industry (ABPI) were only prepared to comment: 'while negotiations on a potential new PPRS agreement have begun, neither party is commenting on any speculation on the content of these negotiations.'

Talks between the government and industry were begun behind closed doors last autumn in response to the Office of Fair Trading (OFT) report which recommended scrapping the current pricing system.

The OFT recommended that the PPRS be scrapped in favour of a new value-based pricing (VBP) system by 2010 — a move that would see medicines priced according to their longer-term benefit to patients.

The government had held its silence over whether or not it would follow the OFT's suggestions, or retain the PPRS system, but Johnson's remarks suggest the current system (which pharma favours) will remain, though the price will be the 10 per cent cut.

The enforced price cut is typical of earlier PPRS negotiations, including the last, which was agreed just three years ago but was intended to last until 2010.

The reduction in spending would represent about £1bn (of an £11bn NHS medicines bill) and is understood to be part of larger targets to cut 3 per cent each year from the Department of Health's budget.

The National Institute for Health and Clinical Excellence (NICE) has been criticised for taking too long to approve NHS drugs.

The House of Commons' Health Select Committee suggests that NICE adopts a two-stage approval process whereby a more in-depth review can take place later if required.

NICE was introduced in 1999 and provides recommendations on treatments for the NHS. The guidance applies to England, Wales and Northern Ireland. Scotland has its own body, the Scottish Medicines Consortium (SMC).

The Health Committee praised the important role that NICE takes by selecting drugs and making difficult decisions, but it believes NICE should focus on all new treatments rather than just the most expensive drugs. Health Committee chairman, Kevin Barron said: 'We have concerns about how NICE does its job. No healthcare system can deliver everything... but more cost-effective treatment means more treatment.'

Ministers also questioned the method which NICE uses to assess new treatments. Drugs are assessed using the quality adjusted life year (QALY) system whereby the drug is only recommended if it costs under £30,000 for each year of good health it provides.

This method has been criticised for not benefiting patients with long-term conditions. The committee recommended a change in the law which requires NICE to consider the wider society, such as carers, when issuing guidance.

The ministers' 'two-stage' process would speed up the introduction of guidance. When a drug is licensed it takes up to four months for it to reach the market. During this time NICE can produce any guidance required for the treatment. If a more in-depth review of the drug is needed then that can take place after the drug is on the market.

Joyce Robbins from Patient Concern agreed that NICE needed a faster review process but added: 'We would be concerned if the two-stage assessment process meant treatments were taken out of use when patients were on them.'

The Association of the British Pharmaceutical Industry (ABPI) felt that patients would see very little benefit from the Health Select Committee's recommendations. The director general of the ABPI, Dr Richard Baker said: 'British patients already have worse access to new medicines than others in Europe. Faster, "quick and dirty" assessments of medicines against tougher cost-effectiveness hurdles will actually make this problem worse.' However, the ABPI did welcome the introduction of specialist advisers for specific disorders to provide support with the appraisal process.

NICE chief executive Andrew Dillon regarded the criticisms as 'constructive' and said the organisation will consider the findings from the report.

An independent inquiry has called for the government to be stripped of its responsibility for training junior doctors in England.

Professor Sir John Tooke was asked to look at the modernising medical careers (MMC) system after 30,000 doctors competed for 20,000 NHS training jobs last spring, which resulted in street protests.

Sir John — an active clinician and dean of the Peninsula Medical School in Exeter — is calling for a new body, NHS Medical Education England, to manage postgraduate medical training. He is suggesting it should take on a ring-fenced budget and work across the UK to ensure cohesion with the devolved health systems. It would work with the government to establish how many doctors the NHS needs.

The final report (which follows last October's interim report) highlights 'weak Department of Health policy development, implementation and governance, together with poor inter- and intra-departmental links'.

Dr Hamish Meldrum, British Medical Association (BMA) chairman, commented: 'This report charts a path that can lead us out of the current mess the government has made of doctors' training.'

The Department of Health will assess the report, before setting out how it will proceed for 2009.

Health Secretary Alan Johnson has announced that every hospital trust in England will be able to recruit two infection control nurses, two isolation nurses and an antimicrobial pharmacist through new investment for infection control in the NHS.

The measures are part of the government's strategy to tackle healthcare associated infections (HCAIs) as set out in the Operating framework for 2008/09 and mean that NHS foundation trust applications will not be supported by the Secretary of State unless trusts are consistently hitting local targets on both MRSA* and Clostridium difficile.

Extra funding of £270m per year by 2010/11 to support infection control and cleanliness in the NHS has been made available, which will allow local organisations to invest up to £45m on additional specialist staff.

Alan Johnson said: 'The investment of an extra £270m and this strategy will help the NHS to continue the good work going forward. Patients have my assurance that the government will not take its foot off the pedal and will continue to do all we can to tackle infection.'

Other recently announced Department of Health anti-HCAIs initiatives include:

• a new 'bare below the elbows' dress code
• every hospital to have undergone a deep clean by March 2008
• guidelines to the public on the safe and appropriate use of antibiotics
• a new National tariff uplift, which will include a specific element to tackle infection, meaning that trusts have additional financial resources at their disposal
• fines for trusts not improving infection rates on C. difficile, over and above the fines that the new Care Quality Commission will be able to place on trusts that are in breach of the hygiene code
• a range of programmes designed to accelerate the development and uptake of new anti-HCAI technologies
• human resources procedures to be developed in conjunction with trade unions, including the importance of induction and training on infection prevention and control for staff

Chief nursing officer Christine Beasley was supportive, saying:

'Preventing infections requires a range of measures, from prudent antibiotic prescribing to implementing best practice in chronic wound management and only a comprehensive approach will succeed in driving down numbers.'

However, leading microbiologist Professor Hugh Pennington, from Aberdeen University, said: 'The measures being taken will all help, but one of the key things, especially for the screening, is that we have isolation wards available for infected patients.

'I don't think there is enough capacity for this at the moment and even though the rates look like they are coming down, there is still a long way to go.

'I think it will take another five years before we get our rates down to the best of the other European countries.'

Jo Webber, from the NHS Confederation, which represents all trusts and hospitals, stressed different measures were required for different bugs.

For instance, alcohol rubs were effective against MRSA, but soap and water was the best way to reduce the threat of C. difficile.

Shadow health secretary Andrew Lansley agreed isolation facilities were key, and said all the government had provided was 'years of broken promises'.

* Methycillin resistant staphylococcus aureus

Breast cancer screening has successfully cut mortality rates, according to a study in the British Journal of Cancer.

A study of the East Anglia screening programme has shown that mortality rates have been reduced by 30 per cent since the programme was introduced in 1989.

The team of researchers from Cancer Research UK, the Wolfson Institute of Preventive Medicine and the University of Cambridge, studied the screening histories of women who had died from the disease and women who had survived.

The results showed that those who had been regularly screened were more likely to survive.

Professor Stephen Duffy, lead researcher and professor of cancer screening at Cancer Research UK, said: 'This is the strongest evidence yet that screening programmes like this save lives.

'We hope to collect data from other regions in the future, allowing us to compare programmes across the UK, bringing the best practice to areas that aren't performing as well.'

Some experts disagree with the results stating that better treatment has led to the increased survival rate.

Michael Baum, professor emeritus of surgery, who has made great contributions to breast cancer research throughout his career said: 'The 30 per cent figure is consistent with the drop in mortality we have seen since better treatment began in the 1980s.'

'If you screened 1,000 women over 10 years, one life will be saved. In the meantime many women will go through the distress of false alarms. All the women I see have found the lump themselves, not as a result of screening.'

Breast Cancer Care believes breast awareness is as important as breast cancer screening and it is important that 'women of any age are breast aware throughout their life.'

The majority of people are prepared to contribute to the costs of long-term care for the elderly but want a fairer system, a think-tank claims.

The future of care funding: time for a change has been published by Caring Choices, a collaboration of 15 organisations (led by the King's Fund) representing all aspects of the long-term care system. 

It details the results of a consultation of 700 people (including carers and older people), with results showing high levels of dissatisfaction with means testing and the postcode lottery of social care entitlements.

Nine out of 10 respondents thought everyone should be entitled to some funding from the government. Most thought the current system of means testing unfairly penalised people who had made provision for their old age.

One in five believes personal care should be funded totally by the state.

Ivan Lewis, the social care minister, told BBC News that the needs of older people and their carers was a 'top priority' and that the government would be launching a consultation.

The number of people needing long-term care is forecast to rise by 50 per cent by 2026.

There are more than 2m online drugs purchasers in the UK, according to a research published by the Royal Pharmaceutical Society (RPSGB).

The society warns that up to a third of these medicines may be fake and could seriously damage people's health, it warns.

The society has launched a new logo for online chemists as a mark of safety and authenticity for internet pharmacy, so patients with genuine prescriptions, signed by a doctor, can buy drugs with confidence.

However, many people want to purchase pills without prescription, so this is unlikely to stop visitors to unregulated sites purchasing such drugs as Prozac for depression, Viagra for impotence and Valium to sleep, circumventing the process to go straight to an internet dealer, even though it is illegal to provide prescription drugs without a prescription.

The RPSGB has thus done what little it can in this case: warning illegal shoppers of the dangers of taking such drugs, which at worst can be positively harmful.

The RPSGB logo will be clearly visible on the homepage of legitimate UK online pharmacies, and will link to the society's registration page, where users can check the chemists' credentials and those of the pharmacists who run the business.

'The public must be vigilant and we recommend that they use the presence of this logo in conjunction with a routine of checks when deciding whether or not it is safe to buy,' said David Pruce, director of practice and quality improvement at the society.

The Medicines and Healthcare Products Regulatory Agency (MHRA) said the safest way to obtain drugs was via prescription from your GP and bought at your local pharmacy, although praised the RPSGB scheme for offering 'reassurance' to those who for whatever reason did prefer to buy online.

The Association of the British Pharmaceutical Industry (ABPI) has announced its approval of the logo.

Indigestion drugs are being over prescribed and wasting almost £100m of NHS money a year, according to experts.

Experts from King's College London have accused doctors of ignoring guidelines and prescribing more expensive drugs despite there being more effective alternatives available.

Indigestion is common but can usually be treated with over the counter medicine if the discomfort continues. Some people can experience extreme pain and require prescribed medicine which prevents the stomach producing acid. In these cases proton pump inhibitors (PPIs) are often recommended.

However, Dr Ian Forgacs and Dr Aathavan Loganayagam say PPIs now surpass all other drugs for this condition.

In an article in the British Medical Journal (BMJ) they said: 'Prescriptions for proton pump inhibitors have superseded those for all other acid inhibiting agents and now account for over 90 per cent of the NHS drug budget for treating dyspepsia.*'

Dr Forgacs, a consultant physician, accused the doctors of wasting NHS money. He said: 'Although they are incredibly safe and effective for indigestion, PPIs are being overused. It's a bit like giving morphine for a headache.'

The National Institute for Health and Clinical Excellence (NICE) issued guidance in 2000 suggesting that over £50m a year could be saved if more PPIs were prescribed more efficiently. Since then the patent on PPIs has expired allowing other pharmaceutical companies to make cheaper generic versions of the drug.

Chairman of the Primary Care Society of Gastroenterology, Dr Richard Stevens, says that this will allow the drug to be more cost-effective when it is prescribed frequently. However, he added: 'We do not want patients taking these drugs unnecessarily. Not all patients require acid suppression.'

A spokeswoman for NICE said: 'We would strongly urge primary care trusts to use the criteria set by NICE for prescribing PPIs so that they can be confident they are targeting resources where they are most likely to offer benefit.'

Researchers are warning against routinely giving people with learning disabilities anti-psychotic drugs to curb aggressive behaviour.

An Imperial College London study of 86 patients compared flexible doses of haloperidol (typical, first-generation antipsychotic drug), risperidone (atypical, second-generation anti-psychotic) and a placebo.

They found the drugs were no more effective than being given none at all. Aggression decreased substantially with all three treatments by week four — but patients receiving the dummy pill recorded the greatest change.

Aggressive challenging behaviour is frequently found in adults with intellectual disability and it is often treated with anti-psychotic drugs. In the UK, 200,000 people with learning disabilities are on anti-psychotics, even though there is a risk of side effects.

The research — published in The Lancet — reports that side effects can include risk of weight gain, impotence and strain to the cardiovascular system.

Lead researcher Professor Peter Tyrer said:

'The problem with patients with learning disabilities is that we haven't had the evidence on whether anti-psychotic drugs work. Therefore, these patients were assumed to be the same as other mental health patients.

'But what our research shows is that drugs are no better than not giving any drugs. It seems what is important is the care a person receives. When people with learning disabilities are aggressive it is important they are given support and people communicate with them.'

He acknowledged that the drugs were still necessary in exceptional circumstances.

The head of campaigns and policy at the learning disability charity Mencap welcomed the research. 'Anti-psychotic drugs should be seen as a last resort,' David Congdon said.

Welsh accident and emergency (A&E) departments have been set a 15-minute target to get patients out of ambulances on arrival at hospital.

Health Minister Edwina Hart ordered the limit in order to stop ambulance queues outside A&E units and to free them up for other emergencies. From April the target will be mandatory.

The British Association of Emergency Medicine backed the target as a way of helping ambulances meet their critical eight minute deadline for reaching emergency calls.

But the association's Welsh spokesman Peter Richmond warned it should not mean patients are simply waiting for treatment in a hospital corridor instead.

'The difficulties arise where the ambulance service simply offload patients into trolleys where there is no space, and no one to oversee them,' Mr Richmond said.

'This can lead to an unsafe, confused environment where ill patients are left in trolleys — are they being assessed and reviewed properly?'

He said other options should also be looked at to help prevent congestion at A&E, including more careful scheduling of relatively non-urgent ambulance arrivals.

'There are also alternatives to simply taking patients to A&E. Perhaps the out-of-hours service can handle them, GPs, or the paramedics dealing with them without bringing them to A&E.'

The handover period, which is subject to the 15-minute target, starts from when the A&E staff are notified by the ambulance crew that a patient has arrived and needs to be seen, and ends when the patient has been transferred into the care of A&E staff and the crew are free to return to the ambulance.

The Welsh Ambulance Services NHS Trust said it would be 'working closely with colleagues at the hospitals in order to achieve these turnaround times' to improve the situation, which during 2007 saw some patients regularly waiting more than 50 minutes in ambulances outside A&E departments where there were no beds available for patients.

Research has shown that exercising regularly, eating healthily, not smoking and not drinking excessive levels of alcohol can increase life expectancy by 14 years.

The study monitoring 20,000 over 10 years found that those who failed on all four criteria were more likely to die younger than those who didn't.

The University of Cambridge and the Medical Research Council carried out the research in Norfolk between 1993 and 2006. The participants were aged between 45 and 79 years.

A point was awarded for each of the following criteria:

• Eating five servings of fruit and vegetables a day
• Not smoking
• Drinking between one and seven units of alcohol a week
• Either taking at least half an hour of exercise a day or having an active job, eg, nurses

The results of the study showed that a 60 year-old with zero points was more likely to die than a 74 year-old with four points.

Lead researcher, professor Kay-Tee Khaw said the study revealed social class and the body mass index chart did not determine how long a person may live.

Judy O'Sullivan from the British Heart Foundation (BHF) said: 'This is good news and shows that by living a healthy life, people can reduce their risk of dying from heart and circulatory disease.'

In a similar study the European Heart Journal found that drinking a small amount of alcohol combined with an active lifestyle could reduce the risk of heart disease.

The study, which took part in Denmark, involved 12,000 people and took place over 20 years. The research found that those who did not drink or do any exercise had a 49 per cent higher risk of heart disease than those who drank, exercised, or did both.

When comparing people who took part in a similar amount of exercise each week they discovered those who drank moderately — one to 14 units a week — were 30 per cent less likely to get heart disease than non-drinkers.

Ellen Mason, a cardiac nurse at the BHF, said: 'The combination of moderate drinking and physical activity appears to be a winning one in reducing the risk of fatal heart disease.

'However, drinking too much starts to outweigh the benefits of alcohol intake and can increase your blood pressure.'

Government News Network website: Government announces major investment in drug treatment services
Funding of £398m is to be used for drug treatment programmes in 2008/09.

Government News Network website: NHS inpatient and outpatient waiting times figures
The latest waiting stats from November.

NHS Wales website: New statistical releases
GP referrals for first outpatient appointments and NHS diagnostic and therapy services waiting times from November.

NHS Wales website: New year, new voice for older people in Wales
Ruth Marks has been appointed commissioner for older people in Wales.

NHS Wales website: Patients encouraged to bring their own!
Under the patients' own medication scheme (POMS), patients at the Princess of Wales Hospital are being encouraged to bring their own medication into hospital where it is administered during their inpatient stay.