More people die from lung disease in the UK than in any other EU country, except for the Irish Republic, a new report has shown.

The only countries with a higher rate are former Soviet Union countries — Kyrgyzstan, Kazakhstan, Turkmenistan and Uzbekistan — and Ireland.

The European Respiratory Society (ERS) carried out the research. Its European lung white book shows illnesses such as lung cancer, asthma, pneumonia and chronic obstructive pulmonary disease (COPD) are killing more people in the UK than coronary heart disease.

Possible reasons for the poor record in good lung health include smoking and environmental factors, such as pollution and the cold, damp climate.

Among children respiratory disease is the most common long-term illness and the most common illness responsible for emergency admissions to hospital.

To help turn the tide against lung disease the ERS suggests Europe-wide policies are needed, such as education programmes on the symptoms of lung disease and better training and education for healthcare professionals.

Dr Edmund Neville, chairman of the lung disease charity the British Thoracic Society (BTS) commented:

‘These statistics are shocking. Britain has been left wheezing at the bottom of the European lung health league for many years. Respiratory disease is not being given the national priority it warrants from the huge burden it imposes on both patients and the NHS.

‘A key factor is disease discrimination in the NHS and its lack of funding. Respiratory disease is not currently one of the priority areas defined in the government’s national strategy for health and it does not have a national service framework.’

The number of NHS organisations with large debts increased during 2002-03. Fifty-one NHS organisations were significantly in debt, but this was matched by 104 organisations under spending, leaving the NHS with a £96m surplus. This is one of the findings made by the National Audit Office’s report of over 600 individual NHS organisations, comprising:

• 28 strategic health authorities
• 304 primary care trusts
• 275 NHS trusts
• 320 charitable funds held on trust
• 18 special health authorities
• the Dental Practice Board

The running of North Bristol NHS Trust is highlighted to show the impact that that poor financial management and corporate governance procedures can have. For 2002-03, the trust reported a deficit of £44.6 million, the largest ever deficit by an NHS organisation. The true scale of the deficit was not reported to the trust board until the final part of the financial year, leaving little opportunity for remedial action to be taken.

Sir John Bourn, head of the National Audit Office said:

‘Although, overall, the NHS successfully met its financial targets in 2002-03, I am concerned by the variation in financial performance and the large deficits incurred by some NHS bodies. Such deficits may put at risk the achievement of overall financial balance of the NHS if they are not matched by surpluses elsewhere in the NHS.

‘The Department of Health has delegated detailed monitoring of NHS trusts and primary care trusts to strategic health authorities. They must ensure that deficits of the scale of the £44.6 million incurred by North Bristol NHS Trust do not happen again.’

The latest prescription cost analysis (PCA) data for England has been published, providing details of the number of items and the net ingredient cost of all prescriptions dispensed in the community.

Summary of the number of prescription items dispensed by therapeutic classification based on British National Formulary chapters, England 2003
British National Formulary chapter	Prescription item dispensed	Net ingredient cost
1: Gastro-intestinal system	48,780.0	636,766.9
2: Cardiovascular system	179,871.9	2,010,703.4
3: Respiratory system	50,195.2	715,693.4
4: Central nervous system	117,775.8	1,310,278.8
5: Infections	42,421.6	235,235.9
6: Endocrine system	50,493.2	704,973.6
7: Obstetrics, gynaecology & urinary tract	15,482.6	205,228.9
8: Malignant disease & immunosuppression	3,807.5	268,351.0
9: Nutrition & blood	19,016.5	265,445.5
10: Musculoskeletal & joint diseases	29,189.5	284,969.1
11: Eye	15,058.7	103,702.1
12: Ear, nose & oropharynx	9,640.2	56,604.1
13: Skin	34,749.0	201,340.9
14: Immunological products & vaccines	13,076.5	115,448.3
15: Anaesthesia	816.7	3,216.0
19: Other drugs and preparations	694.5	13,188.1
20: Dressings	9,612.1	138,711.9
21: Appliances	5,894.2	81,104.2
22: Incontinence appliances	1,263.8	34,660.6
23: Stoma appliances	1,862.9	124,510.
Overall total	649,702.7	7,510,133.6

The GP recruitment targets set out in the NHS Plan were exceeded three months early.

In the three months leading up to December 2003, 240 GPs joined up so there are now 30,598 working for the NHS according to figures published this week.

Under the NHS Plan, the government aimed to increase GP numbers by 2,000 between 1999 and March 2004. The increase has actually been 2,131.

Health secretary John Reid emphasised the importance of diversity in the NHS while calling for tough rules to protect it from abuse.

He said at the Unison Health Group conference in Glasgow: 'As a British institution it was launched by a Welshman in the 1940s, its buildings built by Irish labour in every decade before and since. It has been sustained throughout its life by Asian doctors and Caribbean nurses and is now hugely assisted by doctors either born abroad or whose parents were born abroad and by Filipino, Spanish and Somali nurses all working with British colleagues from many ethnic backgrounds. The NHS was based on, and is now run on, diversity.

'What the NHS as a real living and giving organisation is telling us is that all these different other people living and working in our midst, are not 'others'. In fact, through the NHS they are obviously 'us'.

'So of course we will defend the NHS from abuse or fraud, whether by so-called health tourists or by others. And of course we want managed immigration, not an illegal free for all. But we will never forget that this is a British NHS run within British values of equity and tolerance and it encompasses all of this diversity within our Britishness.

'So let the message go out from this conference today — there is no room for racism in this NHS, the best of British institutions. It will not be tolerated.

'There is no place for discrimination or harassment in the NHS on grounds of race or ethnicity, gender, sexual orientation, disability, religion, or age.'

New guidelines suggest that using information and counselling to discourage mothers from opting for caesarean section (c-section) birth could save the NHS £11 million.

NICE guidance states that doctors have to let women choose the way they give birth, but that if mothers are given information about natural birth, they are more likely to choose this.

A c-section costs £3,200, almost double the price of a natural birth — £1,698. They may also require a longer stay in hospital.

More than one in five pregnant women in England and Wales have a caesarean, more often than not for medical reasons, such as in the case of breech babies (those lying feet or bottom first). About 7 per cent (1.5 per cent of all births in England and Wales) of these caesareans are elective. It is thought that by persuading these mothers to try natural childbirth, the NHS could save £11 million a year.

In England and Wales, caesarean rates have risen from less than 10 per cent to 21.5 per cent over the last couple of decades. The World Health Organisation says the rate should be between 10 and 15 per cent. The increase is partly attributed to women following the example of high-profile mothers such as Victoria Beckham, Madonna and Liz Hurley, who are believed to have been 'too posh to push'. Another reason women are opting for the procedure is that they feel more in control and able to 'schedule' the birth. The guidelines quote evidence showing that women are less likely to have bladder incontinence and to suffer a prolapsed womb after a c-section than after a natural birth.

However, natural birth babies are less likely to suffer breathing problems in early life, although the process is painful and exhausting for the mother.

One of the experts who helped draft the NICE guidelines was Jane Thomas, director of the national collaborating centre for women and children's health. 'If a woman requests a caesarean section and there is not a medical reason, rather than saying that's fine we should discuss what it is the woman is worried about during birth that is causing her to ask for a caesarean section and explain the risks and benefits.'

The guidelines recommend:

• a procedure to right the baby if it is lying in breech position
• support for mothers who have had one caesarean and now want to try a natural birth
• if an irregular heartbeat is picked up from the baby, further tests should be carried out before a caesarean is started
• women should be told that if they are supported during labour by a midwife or a woman who has experienced childbirth they are less likely to end up having a caesarean
• isotonic energy drinks to help with exhaustion during labour