The Chancellor of the Exchequer, Gordon Brown, has confirmed that the NHS is set for a £23bn increase in funding over the next three years. This will see NHS funding increase from £69bn to £92bn. The plan is part of the 2004 spending review, which details public spending plans for 2005-08.

In the review, the government reconfirms its aims for the health and social care system, as:

• improving the health and wellbeing of the population
• improving patients’ experience of care
• reducing inequalities
• continuing to deliver value for the taxpayer

To meet the objectives of the spending review the government has created new public service agreement (PSA) targets:

• Health of the population: focuses on improving health outcomes by tackling smoking, child obesity and teenage pregnancy, and through reductions in mortality from diseases and in health inequalities
• Chronic care management: to improve health outcomes for people with chronic conditions by providing a personalised care plan for those most at risk
• Access to services: introduces a maximum waiting time of 18 weeks from GP referral to hospital treatment by the end of 2008
• Increasing participation in drug treatment programmes: to increase the proportion of users of illegal drugs on treatment programmes
• Improving the patient, user or carer’s experience: focuses on securing sustained national improvement in the patient experience of the NHS

The NHS is expected to maintain current standards in the areas of A&E waiting times, access to primary care, mental health, and patient choice.

Gordon Brown plans for the Department of Health to save around £6.5bn by 2007-08 — half of which will be cashable — by releasing resources for front-line activities. Cost-cutting plans include:

• losing 720 civil service posts
• reducing the staffing of arms length bodies by at least 5,000
• relocating 1,110 posts out of London and the south east by 2010
• making better use of staff time, accounting for up to half of efficiencies (eg, through the implementation of the IT programme)
• creating electronic patient records, appointment booking and prescription transfers
• making better use of NHS buying power at a national level
• ensuring PCTs can share ‘back office services’ (eg, finance, IT and human resources)

Chief executive of the NHS Confederation, Dame Gill Morgan, commenting on the extra funding said: ‘It's a lot of money, but there is a lot to do [after] 30 years of under-investment.’

The inquiry into the serial killer GP Harold Shipman has called for new measures to prevent doctors stockpiling drugs.

Shipman gathered stocks of diamorphine by writing false prescriptions and by retaining leftover supplies from patients.

The former Hyde GP is thought to have killed between 230 and 275 people over 23 years. This January he committed suicide in prison.

The report, which is the fourth produced by the inquiry, blames the GP for the murders but underlines a number of flaws in the system for monitoring controlled drugs.

Recommendations included:

• Special forms to allow easy monitoring of prescriptions
• Recording the identity of anyone who obtains controlled drugs
• Stricter rules for the disposal of controlled drugs
• It should be a criminal offence for doctors to prescribe drugs for themselves. At the moment, it is just seen as bad practice. Shipman was addicted to pethedine in the 1970s and prescribed it for himself.

It was felt that had Shipman been properly investigated when he was convicted of dishonestly obtaining pethedine, he might have stopped killing for a time.

The report also criticised an otherwise conscientious pharmacist for failing to recognise a peculiar prescribing pattern. A police chemists inspection officer, who also might have spotted something amiss, was considered to have been inadequately trained and poorly supported.

Greater Manchester Police said that it had already made changes to prevent anything similar happening again.

Home Office Minister Caroline Flint told BBC News that the report needed careful study, but decisions on some issues would not be made until the fifth report on the monitoring of doctors had been published.

Dr John Grenville of the British Medicial Association warned that any system would have to strike a balance between monitoring drug movements and caring for patients as poor access to opiates could leave patients in severe pain.

Pharmacists will get less reimbursement for four commonly prescribed generics which have recently dropped in price.

Health minister Lord Warner announced that as the supplier prices of generic versions of four drugs had fallen significantly, community pharmacists and dispensing doctors would be paid less for dispensing them.

The four drugs are:

• Doxazosin
• Lisinopril
• Omeprazole
• Simvastatin

It is thought that reducing the reimbursement price will save the NHS about £100m a year.

The NHS actively encourages the prescribing of generic medicines rather than the more expensive brand name medicines.

Community pharmacists and dispensing doctors are reimbursed for medicines they dispense. They are paid the basic price of the drug with deductions for wholesaler discounts on the most commonly prescribed drugs. These deductions are calculated periodically in a discount enquiry.

Generic versions of these four drugs entered the market since the last enquiry in 2000 and are not included in the current calculation. They were removed from the normal drug tariff in December 2003 after a consultation, Arrangements for the future supply and reimbursement of generic medicines for the NHS.

The revised prices will take effect from 1 September 2004.

The NHS has been attacked for failing to monitor hospital superbug cases and for not dealing with the crisis.

Data from the DoH and the Health Protection Agency show that reports of bloodstream infections of methicillin resistant strain Staphylococcus aureus (MRSA) have increased by 3.6 per cent in England over the last year.

Reports of blood stream infections caused by MRSA have increased from 7,384 in 2002-03 to 7,647 in 2003-04.

The total number of Staphylococcus aureus (resistant and non-resistant) infections has increased by 9.2 per cent from 10,683 in 2002-03 to 11,664 in 2003-04.

The National Audit Office (NAO) has complained that poor data has made it hard to assess cases. It estimates that 5,000 people die each year from hospital acquired infections, but warns that true figures could be much higher. It also said that if recommendations had been acted upon across the country infections and deaths could have been cut by around 15 per cent.

Karen Taylor, one of the authors of the NAO report (Improving patient care by reducing the risk of hospital acquired infection), said that a lack of information about the problem was slowing changes that could reduce rates. 'The dissemination of good practice is very poor. It's difficult to get the message to frontline staff.

'The lack of information hides what is actually happening. Without it, you can't target action.'

At the moment, the only kind of MRSA hospitals have to report is bloodstream infections. Neither wound or urinary tract infection rates are collected.

Another major criticism in the report was directed at staff. It warned that many doctors and nurses fail to wash their hands between patients. The report asked staff to appreciate that the issue was their problem and not just the responsibility of the infection control team.

Earlier this week, the government published a list of moves to reduce infection levels. These are:

• Public display of every trust's infection rates and trends
• Involving patients in monitoring the situation — patient forum inspections and speed dial buttons to housekeeping on every patient's bedside phone. Patients are to be encouraged to ask staff to wash their hands
• Tools and encouragements to staff. These include a matron's charter; putting matrons in charge of cleaning staff; checklists for infection control nurses; a 'Think Clean Day'; and the National Patient Safety Agency's cleanyourhands campaign
• Consistent national standards and monitoring of progress
• Good practice from home and abroad will be disseminated
• Research into testing cleanliness levels and 'science summit' to get advice from experts

The NHS was not given enough help to clear the backlog of care compensation claims, according to the health ombudsman.

As reported last month, the NHS promised to review all claims for compensation for long-term care by December 2003 and then March 2004. Both these deadlines were missed.

Health ombudsman Ann Abraham blamed a lack of support from the DoH. Last year, she found that some people needing long-term care had been unfairly denied financial support. NHS organisations all over the country were asked to identify patients in their area who should not have paid for their own care.

More than 11,700 requests for review flooded into strategic health authorities and primary care trusts in England.

Ann Abraham said: 'Despite my warnings last summer that there were likely to be large numbers of people affected by these issues and that the DoH would need to provide adequate support and guidance, it would appear they have not done so.'

'What the Department provided was clearly inadequate to the task,' she said.

Health minister Stephen Ladyman blamed publicity: 'Continuing publicity, including the ombudsman's own interest, subsequently generated around another 6,000 cases.'

He promised that the backlog would be cleared by the end of this month and that after that, all cases would be reviewed two months from submission.

Council offices in Sunderland are to offer minor surgery to patients by 2006. A new £10.7m centre will combine an extensive range of medical services alongside a 24-hour walk-in NHS primary care centre, community pharmacy and GP surgery.

Sunderland Teaching Primary Care Trust and City Hospital NHS Trust will offer minor surgery, diagnostic and treatment services and treatment for minor accidents that would normally be dealt with at the A&E department of the nearby Sunderland Royal.

The centre will also include:

• Council-run ‘wellness’ centre aimed at improving health and wellbeing
• Adult and community learning centre, providing basic skills and other non-vocational courses
• Customer service centre offering advice and information on a range of services (ie, housing benefit, council tax, education, environmental services, general enquiries)
• Community library
• Nursery
• Social Services/Sure Start facility providing activities and training for parents and under-fives
• Relocated Sunderland housing group neighbourhood housing office
• Community-run facilities, including a meeting hall, multipurpose meeting rooms, café, kitchen and office facilities

The centre, believed to be the first of it kind in the country, should be complete by January 2006.