The delivery of specialist services is to be temporarily removed from the new financial flows system. The DoH has announced that payment to NHS trusts delivering specialist services is to be changed because the current scheme does not take into account the high fixed costs and expensive drugs necessary to the work.

The current healthcare resource groups (HRGs) are to be modified to include more specialised work. The change in policy has been announced after the DoH consulted on its plans for payment by results (PbR), announced in Payment by results: preparing for 2005.

The consultation asked the specific question: ‘should there be an adjustment to the national tariff for patients with significantly more complex needs (ie, specialised services), and how should this be applied?’

Despite ‘the firm view of some that PbR should not apply to specialist services at all, and certainly not as early as 2005/06’, the DoH has announced it is committed to including specialist services in the new system, but recognises it will require a phased approach.

As possible solutions, the DoH’s consultation response document lists:

• trust-level block payments
• exclusion of certain HRGs from PbR
• review of classification tools and currencies
• adjustments to tariff

The response also outlines other changes to the new financial flows system:

• PbR will be introduced to 25 per cent of NHS work by April 2005, and then a further 25 per cent increase every year until 2008/09
  (original target: 60 per cent of NHS work by 2005/06)

• All trusts must make efficiency gains of 2 per cent a year
  (original target: 3 per cent a year)

NHS patients have a high opinion of the care they receive but many do not feel involved in decisions.

Over 300,000 patients were questioned by the Healthcare Commission during 2004, in five separate surveys:

Adult inpatients
— improvement in admission time from A&E departments to wards (26 per cent waiting more than four hours, down from 34 per cent in 2002)
— fewer people rated toilets and bathrooms in hospitals as ‘very clean’ (48 per cent, down from 51 per cent)

Young patients
— communication with staff rated highly but there are still possibilities for improving the explanations given about procedures, risks, benefits and expected outcomes of treatments

PCTs
— more patients obtaining GP appointments within two working days (54 per cent, up from 31 per cent in 2003)
— one in five smokers want help in giving up but aren’t receiving it

Ambulance services
— positive overall picture but one in five want more pain relief

Mental health services
— majority of patients positive about their care from clinical staff but want to be more involved with decision making

Surveys for ambulance services, hospital patients under the age of 18 (called young patients) and mental health services are the first of their kind.

Professor Sir Ian Kennedy, chair of the Healthcare Commission said:

‘In general, patients have given a “thumbs up” to the care they receive from the NHS. However, those patients who do not feel completely involved in decisions about their care and treatment are not able to consent to treatment in any meaningful sense.’

The Healthcare Commission is to take responsibility for reviewing patients' and carers' complaints about the NHS.

This new second stage takes place if the problem cannot be resolved to the complainant's satisfaction by the organisation concerned. It is intended to make the system fairer, faster and more independent.

The Healthcare Commission is an independent body that is in a position to review both sides of the complaint. It is also a national body, so the entire NHS can learn from mistakes, and problem areas can be pinpointed quickly.

Complaints will be examined in a three-part process:

• Initial review: A case manager determines whether further investigation is needed. The complainant and the body or practitioner complained about will each get a letter outlining the outcome.
• Investigation: If an investigation is needed, the Healthcare Commission, the complainer and the body concerned will agree terms of reference and both will receive a full report of the investigation.
• Panel review: Those unhappy with the outcome of the investigation can request a panel review. Three independent trained members of the public will hear both sides and make recommendations.

Formerly, second tier complaints — those that could not be resolved locally — were examined by a local NHS 'convener' (often the non-executive director of the body concerned).

According to the NHS complaints procedure national evaluation report (March 2001), 75 per cent of the public felt this system was not fair and just 10 per cent felt their complaint had been dealt with in a timely manner.

Trusts are preparing to limit their junior doctors' hours as European working time regulations come into force.

One in six trusts is breaking the rules and others will have trouble adjusting a survey by The Guardian discovered. The British Medical Association (BMA) is examining working times, and threatening to intervene at six unnamed trusts.

Trusts risk fines of £5,000 for failing to limit junior doctors to 58 hours work a week.

The BMA has promised to give doctors legal advice if needed.

Doctors and health professionals have been sent new guidance on the provision of contraceptive services for young people under the age of 16.

For the first time, medical staff are advised to establish a rapport with the patient if a request is made for contraception. The young person should be given time and support to make their own informed decision.

If abortion is requested and the patient does not wish to involve a parent, the guidance calls for effort to be made to find another adult (ie, a family member or specialist youth worker).

The new guidance updates the current framework, drawn up in 1986.

GPs throughout England have been given a share of £108m to refurbish and develop their premises. The money will be allocated to primary care trusts that can use the funding for:

• Improvement grants for GP surgeries
• Extending schemes to create more space to accommodate new trainee GPs and nurse practitioners in surgeries
• Capital for refurbishing GP premises owned by PCTs
• Buying up old GP leases or buying land to enable future development
• Bringing forward GP development/improvement schemes that would have been deferred until next year

Eight medical schools have each been given a £1.5m cash injection to establish up-to-date research facilities, attract top scientists and carry out research in areas such as genetics, diabetes and cancer.

NHS partners of the following schools will receive the funding:

• Brighton and Sussex
• Durham and Newcastle
• East Anglia
• Hull/York
• Keele and Manchester
• Leeds and Bradford
• Leicester and Warwick
• Peninsula (Exeter and Plymouth)

There should be a nurse in every secondary school according to a new report into caring for young people

Midwives and nurses must take a more active role in caring for children, says chief nursing officer Sarah Mullally in her review.

Recommendations include:

• Improving health services for school-aged children. PCTs should aim for a nurse in every secondary school and for its cluster of primary schools
• Midwives and children's nurses should have a stronger public health role
• Practice nurses should be recognised as having an important child-health role
• Health visitors are vital in deprived areas

Sarah Mullally said: 'In carrying out this review I have listened to what children and young people have to say about services and what matters most to them. I have engaged practitioners and a wide range of other stakeholders and heard their views. I have been impressed by the high levels of commitment shown towards children and young people and the common desire to improve services.'

Millions of patients do not understand basic information about health according to the National Consumer Council.

A new report, Health literacy — being able to make the most of health found a huge differences in the way the richest and the poorest parts of society get health information. The poor seem to have bad access to information, but even in higher social groups, only 27 per cent of people read medical information leaflets.

Health professionals do not escape, either. They are criticised for putting up barriers, such as appearing too busy to answer questions. Just 45 per cent of people in high social classes and 35 per cent of those in low social classes felt able to ask their GPs questions.

The report recommends that patients be helped to take a more active role in their care. It suggests that research is needed into patient expectations and experience and that professionals should be trained to help patients explore their fears and questions.

The governments drive to provide greater choice will bring problems of its own, with patients needing to navigate an increasingly complex system. The report underlines the role of patient care advisers (PCAs) in ensuring equal access for all.

The expert patient scheme, where patients are encouraged to help manage their own long-term condition and to advise other patients on how to do the same, was also praised.

It will soon be normal to see staff and patients chatting on mobile phones inside hospitals rather than standing outside with the smokers.

The Medicines and Healthcare Products Regulatory Agency (MHRA) has said that a total ban on mobile phones in hospitals is no longer necessary, and may even be hindering progress. The report says that in many cases the blanket ban policy is based on misinformation, and it does not address society's growing need for communication.

Hospitals are advised to:

• Employ staff to manage how mobile technology is used within the hospital and identify interference risk
• Consider designated mobile phone areas for staff and visitors
• Issue mobile wireless systems, which have low interference risk, to hospital staff
• Report interference problems to the MHRA

A charity debate has suggested that heart drugs could be added to the water supply.

Statins can cut the risk of heart attack by one third and are used as secondary prevention — ie, given to patients at high risk of cardiovascular disease, such as those who have already had a heart attack.

However, it is becoming commoner to prescribe statins to patients with risk factors but no obvious disease. This is primary prevention — which should stop the disease occurring in the first place.

The debate, which took place at the annual meeting of the cholesterol charity Heart UK, was intended to highlight the use of statins at an early stage. 'We are under-treating,' said Dr Reckless, chairman of the charity and a consultant endocrinologist at Bath University. 'A lot more people could benefit. Maybe people should be able to have their statin, perhaps if not in their drinking water, with their drinking water.'

The Joint British Societies — Diabetes UK, the British Cardiac Society, Heart UK and the Stroke Association — advise doctors to prescribe statins for those whose 10-year risk of cardiovascular disease is 20 per cent.

The other side of the debate was presented by nutritionist Professor Tom Sanders from King's College, London. 'There are serious side effects with statins. One is myositis, in particular rhamdomyolysis — a muscle wasting disease.' Another concern is that statins may cause defects in unborn children.