Leading public health official calls for a lowering of the age of consent to make it easier for 15-year-olds to seek contraception
Britain's three main political parties joined forces to reject a call by a leading public health official to consider lowering the age of consent to 15.
A spokesman for the prime minister said the current age of 16 was designed to protect children, a view echoed by the Nick Clegg, the deputy prime minister, who rejected a "blanket reduction" in the age of consent.
Labour said the move would not tackle teenage pregnancy.
The three parties were responding after Professor John Ashton, president of the Faculty of Public Health, called for a lowering of the age of consent to make it easier for 15-year-olds to seek contraception and sexual health advice from the NHS. Up to a third of teenagers are thought to have sex before they reach 16.
Ashton told the Sunday Times: "Because we are so confused about this and we have kept the age of consent at 16, the 15-year-olds don't have clear routes to getting some support. My own view is there is an argument for reducing it to 15 but you cannot do it without the public supporting the idea and we need to get a sense of public opinion about this.
"I would not personally argue for 14 but I think we should seriously be looking at 15 so that we can draw a line in the sand and really, as a society, actively discourage sexual involvement under 15. By doing that, you would be able to legitimately organise services to meet the need."
Downing Street gave the proposal short shrift. A spokesman said: "We reject the call to lower the age of consent. The current age is in place to protect children and there are no plans to change it."
Asked on the Andrew Marr Show on BBC1 what he thought of Ashton's call, Clegg said: "I am not in favour of that. The age of consent has been a British law for generations in order to protect children.
"This health expert is right in saying there is a problem – we have far too high levels of teenage pregnancy. I am worried, like everybody is worried, about the sexualisation, the culture and the information so many young people are bombarded with.
"That is why I am constantly urging Michael Gove to update and modernise sex education in schools, which has not kept up with the internet age.
"But do I think simply a blanket reduction in the age of consent is the answer to this difficult dilemma? No. So yes, there is a problem. Yes, we need a debate. Yes, we need to update sex education. But this is not the answer."
The Department for Education dismissed Clegg's call for a change to the guidelines on sex education. A spokesperson told the BBC that existing guidance provided a sound framework for sex and relationship education.
Luciana Berger, the shadow public health minister, endorsed Clegg's call for sex education to be updated as she also rejected the call to lower the age of consent. "Lowering the age of consent is not the way to tackle teenage pregnancy and we are against such a move. The teenage pregnancy rate fell substantially under the last Labour government. But sexual health clinics are now closing their doors and young people are struggling to get appointments.
"Labour has called for improved sex and relationship education and tabled amendments to recent legislation for it to be made mandatory, not voluntary, in all schools. Regrettably, the change was voted down by Tory MPs."Nicholas Watt
Hospitals block reorganisations by claiming mergers are anti-competitive and would reduce patient choice
The government's drive to introduce more competition into the NHS is having the perverse effect of holding up the creation of world-class cancer treatment centres, the Observer can reveal.
Investigations show that individual hospitals whose roles would be downgraded under reorganisations are blocking moves to concentrate cancer services into fewer top-performing specialist centres, by claiming such mergers would be anti-competitive and would reduce patient choice.
NHS leaders, who are deeply concerned about the effect that legal disputes are having on progress, have admitted some cancer units are being allowed to carry on operating even though they do not meet the latest official guidelines on how services should best be organised.
In one case, a "rationalisation" of cancer services in and around Manchester, proposed by NHS England as a way to improve "outcomes" to world-class levels, is being challenged and held up by complaints from south Manchester NHS foundation trust and Stockport NHS foundation trust on legal grounds.
The health regulator Monitor is now involved in a detailed investigation into whether the changes contravene government regulations introduced in April this year, supposedly to widen competition and choice. The Manchester dispute is one of several affecting different aspects of healthcare across the country.
Former Tory health secretary Stephen Dorrell, who now chairs the all-party select committee on health, suggested patients' lives were at stake, and called on NHS England to drive through the improvements and make sure patient care took precedence.
Ten days ago, the outgoing chief executive of NHS England, Sir David Nicholson, made known his frustration at the way competition disputes were holding up progress and costing hospitals many millions of pounds in legal fees. He told Dorrell's select committee that "we are in my view getting bogged down in a morass of competition law, which is causing significant cost in the system".
Nicholson added that the law may need to be changed to sort out the mess. "It is causing great frustration for people in the service about making change happen. That may be because of the way in which we are interpreting the law – we are talking to Monitor – but it may be because that is the law, in which case to make integration happen we will need to change it." He said Manchester was "not the only cancer service that is not meeting guidelines".
Dorrell, whose committee is recalling Nicholson for further questioning on this and other issues, told the Observer that the interests of patients should come first. "I am in favour of engagement with local clinicians and management, and it is obviously better to proceed by agreement. If however, as is the case in cancer care, there is well-documented evidence from all over the world that more concentrated facilities deliver better patient outcomes, it is the duty of the commissioner to insist that services change to improve outcomes for patients. Local motivation and engagement are important, but they are not more important than patients' lives."
Another Tory member of the committee, Sarah Wollaston, who is a GP, said: "It is utterly perverse for any doctor to use competition legislation to try to block restrictions on their own practice where there is clear evidence that cancer surgery concentrated in specialist centres saves lives. David Nicholson should set out where this is happening and what needs to change in the legislation."
The arguments come as the government tries to tackle the immediate crisis of growing waiting times and overcrowded A&E departments. Labour is arguing that former health secretary Andrew Lansley wasted three years and billions of pounds on unnecessary and costly reforms of the NHS, introducing more competition, rather than tackling the urgent need to treat more patients outside hospital.
A spokesman for NHS England said that in order to comply with official guidance from the National Institute for Health and Care Excellence, "some cancer treatment needs to be concentrated into a smaller number of providers, where clinical expertise can be consolidated".
She added that Nicholson had been making the point to the health committee that despite the improvements that such change could bring "it could be viewed as anti-competitive" by opponents.Toby Helm
Health secretary Jeremy Hunt to announce new offence of wilful mistreatment in wake of Mid Staffs scandal
Doctors, nurses and NHS managers will face up to five years in jail if they are found to have wilfully neglected or mistreated patients under a new law aimed at stopping a repeat of the Mid Staffordshire hospital scandal.
The threat of criminal sanctions for NHS staff will be announced next week by Jeremy Hunt, the health secretary, following a series of reviews into patient safety.
In a move likely to alarm medical groups, the government will create a new offence of "wilful neglect or mistreatment" for hospital workers whose standards of care have fallen short in the most extreme cases.
Hunt, who has been very critical of the NHS, is expected to set out a range of measures to improve standards of care on Tuesday, which could include moves to boost transparency and the complaints processes.
However, he is likely to come under most pressure from Labour to say how the coalition will increase staffing, amid concerns about falling nursing levels and an impending crisis in A&E this winter.
Speaking from Sri Lanka at the Commonwealth summit, David Cameron said the new law was not about punishing those who have made mistakes but "specific cases where a patient has been neglected or ill-treated".
The new law was recommended earlier this summer by Professor Don Berwick, a former adviser to Barack Obama. His report also stressed that there are very few examples of wilful neglect in the NHS and called for an end to the "blame game" towards medical staff.
Medical defence organisations have said there are already enough sanctions to use against staff.
Berwick recommended new criminal penalties for "leaders who have acted wilfully, recklessly, or with a 'couldn't care less' attitude and whose behaviour causes avoidable death or serious harm".
The academic was commissioned to look into patient safety after the Francis inquiry into the Mid Staffordshire NHS scandal, where patients were left thirsty and in dirty conditions causing "appalling and unnecessary suffering of hundreds of people".
In that report, Robert Francis suggested wilfully causing death or harm to a patient should be a criminal offence but made it clear no one at Mid Staffordshire should be scapegoated. Since then, police successfully prosecuted the trust over health and safety laws relating to the death of 66-year-old Gillian Astbury, a diabetic patient who was not given insulin.
The trust pleaded guilty last month to failing to ensure the safety of Astbury, who lapsed into a fatal coma while being treated at Stafford hospital in April 2007.
It is understood exact details of the new sanctions are yet to be worked out and will be put out to consultation. However, they are expected to be similar to those under the Mental Capacity Act 2005 in relation to wilful neglect or ill-treatment of adults who lack capacity, which carries a fine, or imprisonment for a maximum of five years.
Downing Street sources said prosecutions under the current laws to protect vulnerable groups were rare but ministers believe the new crime will act as a deterrent to mistreatment.
Lawyers have said that the 2005 act had seen prosecutions of individuals working on the front line but said senior managers and organisations had been largely untouched by the law.
A number of social care organisations had been prosecuted, said lawyers, but most had been acquitted.
Cameron, who also warned that there is growing evidence climate change is causing more extreme weather disasters like the Philippines typhoon, said: "The NHS is full of brilliant doctors, nurses and other health workers who dedicate their lives to caring for our loved ones but Mid Staffordshire hospital showed that sometimes the standard of care is not good enough.
"That is why we have taken a number of different steps that will improve patient care and improve how we spot bad practice. Never again will we allow sub-standard care, cruelty or neglect to go unnoticed and unpunished.
"This is not about a hospital worker who makes a mistake, but specific cases where a patient has been neglected or ill-treated. This offence will make clear that neglect is unacceptable and those who do so will feel the full force of the law."
Shortly after Berwick's report, Dr Mark Porter, chair of council at the British Medical Association, told a fringe event at the Lib Dem party conference in September that he was worried about criminalising medics.
"That is no way to encourage openness, as was so powerfully shown by Professor Berwick in his recent report, with reference to the rich body of research into organisational psychology," he said.
"There is an answer to this, and that is to act against the bully, not the bullied. It is to build on the professional duty to speak out by placing a duty on healthcare organisations to listen. Active listening, as often happens, not hands over the ears, as sometimes, appallingly, happens."
There has also been unease about the possibility of criminal sanctions from Dr Christine Tomkins of the Medical Defence Union, who has said there were already sufficient penalties against doctors.
"Doctors who are accused of wilfully neglecting patients can already be reported to the General Medical Council and face having their licence revoked if found guilty," she said after the Berwick review.
"We believe this is adequate for the protection of the public and doubt the additional threat of potential police investigation is necessary or likely to lead to successful prosecutions. If the government decides to take this forward, we will need to look carefully at what it proposes."
The criminal offence comes after Hunt negotiated a new contract with GPs forcing them to reveal their pay and making sure everyone over 75 has a specific family doctor who knows their medical history.
Speaking from Sri Lanka, Cameron said he had no problem with GPs earning more than him but wanted their salaries to be more transparent. "Some GPs are very well paid. Some of them are running very large practices, are working extremely hard. You should be able to get to the top of your profession and I don't believe in artificial limits in these things," he said.Rowena Mason
Why did the health secretary again choose one of the three days when MPs are not in the Commons to announce something as apparently significant as a reorganisation of GPs' contracts?
Here's what may be a useful clue if you are trying to assess the true significance of the health secretary's announcements about family doctors on Friday.
Parliament is not sitting at the moment. The House of Commons is in one of its short recesses. MPs adjourned on Tuesday and are due back at Westminster on Monday.
But at the start of the week, while MPs were still sitting, the health secretary was forced to come to the Commons and answer questions about changes to A&E units proposed by Sir Bruce Keogh that would otherwise have been produced while parliament was away.
So why did Jeremy Hunt again choose one of the three days when MPs are not in the Commons to announce something as apparently significant as a reorganisation of GPs' contracts?
Was it because the plan is a big coherent initiative of which ministers can be truly proud? Or was it because the government puts greater priority on promoting a version of events that may not withstand scrutiny? The choice is yours.
What is not in doubt is the larger context of NHS politics as winter gets under way. The government is not popular. Only 30% of voters approve of its record. Only 32% would currently vote Conservative in an election. Labour has a 12-point lead on the health service, which is seen as one of the four most important issues facing the country.
All political parties are intensely aware of the damage – potentially irreparable if things get really serious – which a winter crisis could do to the government.
This is why David Cameron has brought in Labour adviser Simon Stevens to head NHS England. It's why Mr Cameron was said this week to have taken personal charge – always a double-edged move for a prime minister — of ensuring a proper supply of hospital beds to avoid a capacity crisis.
And it may be why Mr Hunt seems to have a strategy of avoiding responding to questions while simultaneously giving the impression that he has all the answers. It is because there is such a lot at stake.
Friday's announcements on GP contracts are part of that too. Mr Hunt said he was sweeping away nearly half of the targets set by Labour for GPs in order to free more time for them to concentrate on the elderly who are most at risk in the winter.
Patients aged 75 and over would be assigned a named GP who would help prevent A&E units from coming under so much pressure by providing a greater range of care. It would be, in the health secretary's spin, the return of "proper family doctors".
Some aspects of this make some sense. It is true, for example, that an office-hours-only approach to GP surgery openings can help to push patients unnecessarily towards hospitals – one in five emergency admission to hospital in England last year were avoidable, the health department estimates.
But there is no doubt, either, that Mr Hunt is doing something that seems deep in his own political DNA: he is playing the blame game.
Aware that voters may blame the government rather than the hospital doctors for an A&E crisis, Mr Hunt is trying to ensure that voters will now load some of the blame on the GPs if the system is overwhelmed.
That's part of why Mr Hunt pushed the envelope on salaries. He wants voters to think of the GPs as overpaid, unavailable and reluctant to do home visits.
Perhaps he will succeed, because there are undoubted problems with the current contract. But it does not follow that ministers should escape their share of responsibility.
The big NHS problem – for patients as much as for doctors and politicians – is that demand for the health service exceeds the willingness of government, and perhaps taxpayers, to pay for it.
That is a long-term issue facing all political parties, one which they are reluctant to discuss openly, especially in fiscally tightened times.
Instead of talking straight they get shifty, just as Mr Hunt has done throughout this week.Editorial
GPs get fewer targets and more responsibility for over-75s but question practical effect as spend on general practice declines
GPs in England will no longer be required to offer patients appointments lasting at least 10 minutes under a fresh contract agreed with ministers.
In a wide-ranging deal, GPs will have to accept "named doctor" responsibility for all patients aged 75 and older; phase out boundaries that prevent the public from signing up to any doctor from 2015; and commit to police the care their patients receive from out-of-hours providers.
But doctors won the right to organise their own appointments – at present NHS England says consultations last on average for around 12 minutes.
While about £290m has been added to funding, the Royal College of General Practitioners (RCGP) and the National Association for Patient Participation (NAPP) warned that the proportion of NHS money spent on general practice has slumped across Britain over the past nine years to the lowest percentage on record.
New figures showed that in 2004-05, 10.33% of the NHS budget was spent on general practice. By 2011-12, this figure had declined by almost two percentage points to 8.4%.
GPs say the fall in funding is compromising the standard of care they can offer patients, leading to longer waiting times and increasing pressure on hospitals.
GP leaders were now calling for the trend to be reversed. The chair of the RCGP, Maureen Baker, said: "The flow of funding away from general practice has been contrary to the rhetoric and has happened in the absence of any overall strategy as to how we spend the NHS budget.
"We need to increase our investment in general practice as a matter of urgency, so that we can take the pressure off our hospitals, where medical provision is more expensive, and ensure that more people can receive care where they say they want it – in the community."
She called on the government to increase spending on general practice to 11% of the NHS budget by 2017.
But the government maintained that the changes agreed in the new contract would reduce pressure on the NHS – especially in the vexed area of A&E.
The health secretary, Jeremy Hunt, said that every person aged over 75 would have a named GP who would know their medical history, ensuring they receive better and faster medical advice and so would have less need to resort to A&E departments. He also said the coalition government was scrapping 40% of GP targets to enable doctors to provide personalised care for patients.
GPs told the Guardian that any reduction in "box ticking" was welcome but questioned whether it would happen, given new demands being placed on them.
Dr Ketan Bhatt, a GP in Hertfordshire, said his feeling was that "the devil will be in the detail", which would become clearer next year: "It's good news if it reduces the box-ticking exercise that the government has reduced GPs to. This has demoralised GPs and no doubt reduced patient satisfaction. If this means I can focus more on the patient and less on the computer screen, then great."
He said named GPs for over-75s was a good idea in theory but questioned how it would work in practice, and rejected the idea that the changes would reduce congestion at A&E departments.
"What does having named responsibility mean?" he asked. "Does this mean out-of-hours people will call that GP at 2am to ask what to do? Does it mean GPs will be dealing with issues that social services should be dealing with, thereby reducing clinical time? Often, novel ideas from the government mean more tick-boxing in a different format."
Bhatt added: "The suggestion is that people go to A&E because the GP is shut. That is not true. People go to A&E because they think they are seeing the best or will be seen quicker – yet the wait is often four hours.
"What would reduce the pressure is if triage in A&E directed people back to their GP or out of hours. Or if there were GPs tagging along with paramedics on 999 calls."
In south Worcestershire, where GPs have already been going out with paramedics, GP Dr Chris Renfrew said it had made a big difference in terms of relieving the pressure on A&E. He suggested that named GPs could play a part in conjunction with other initiatives.
"One hopes that the increase in specific named GPs, in particular with respect to the elderly, may well manage to reassure those who become sick, instead of going straight to A&E," he said.
Dr David Fair, in York, expressed views more akin to those of Bhatt, proclaiming that he was very cynical about the changes. He too questioned how the named GP would work out-of-hours and said it would not reduce pressure on A&E services. "I don't see how it can," he said. "No one has put together a coherent argument about how it's supposed to make a difference."
Fair also questioned whether the reduction in targets would have a tangible effect. "There may be a reduction of me doing this tick-box stuff," he said. "But I don't know whether that can be channelled or swapped into being the named GP of hundreds of thousands of old people."
Dr Matthew Taylor, in east Cheshire, said that Hunt's admission, on Friday morning, that over-75s who are entitled to a same-day conversation with a GP under the new contract might not speak to their named GP meant there would be little change in practice.
"That's no different to now," he said. "All our patients have a named GP but it doesn't mean they'll see them. This idea is not going to make any difference to pressure on A&E … Most GPs feel that we are being pushed to do more and more. We will do the best with whatever system we are given."Haroon SiddiqueRandeep Ramesh
A named doctor can be advantageous to those who have complex medical needs – but it's reductive to assume this applies to all over 75
The health secretary, Jeremy Hunt, has announced that every person over 75 should have a named GP who will be responsible for their care. Furthermore, he says, a dedicated helpline should be set up to ensure that they can get through to their GP the same day, or at least speak to someone in the practice.
In itself, this seems like an excellent idea. But Hunt is seeking to make political capital by linking this proposal to other current hot potatoes; A&E waiting times, out-of-hours care and GP contracts.
A named doctor can be advantageous to those who have complex medical needs, learning difficulties, dementia or another reason why they find the healthcare system difficult to navigate. But most of us welcome choice to see the first available doctor, to shop around within a practice, to pick different doctors for specific problems or to get a second opinion. It doesn't seem right to limit this choice for those over 75. Equally it seems reductive, if not ageist, to assume that everyone over 75 needs special attention just because of their age. We have many patients in their 80s who are completely independent and would object to being put in a special category on age alone.
People have a right to know where the buck stops when they present a doctor with a medical problem. The answer is quite clear: it lies with the GP you see with that problem. If you need a return visit, it makes sense to try to follow up with that same doctor, if possible. But if that doctor is unavailable, practices are designed to ensure that you can see another doctor and get continuity of care. GPs discuss the plan with patients and keep clear medical records. No one doctor should be indispensable. I try to make sure that if I am run over by a bus, my patients wouldn't suffer any gaps in their care.
Practices have regular meetings of doctors and nurses to discuss difficult cases, agree clinical guidelines, and analyse problems. Within a practice, doctors will vary in their style and areas of expertise but should be all singing from the same hymn sheet when it comes to routine care. Hunt's proposal will engender anxiety with its suggestion that unless you have a named doctor, you won't get co-ordinated care.
The suggestion that practices need a dedicated helpline to enable the over-75s to get through to a doctor on the same day is bizarre. Patients who phone our practice always get a call back the same day. I would have thought that is standard practice. Surely people under 75 are entitled to be called back too? Why would a call from someone over 75 be necessarily more urgent than a call from anyone else who is ill?
There will be patient bloggers who respond by saying this doesn't happen in their practice: that no one calls back, they can't get an appointment and they don't know who is in charge of their care. GP practices welcome input and need to be told when their system isn't working, but it doesn't require wholesale political meddling or blanket legislation.
Hunt's idea of a named doctor to co-ordinate the care of people with complex medical needs is a good one. It already happens in the majority of practices. But to include everyone over 75, including the extremely healthy, makes no sense to me.Ann Robinson
The health secretary says GPs will ensure over-75s have access to good out-of-hours care. Andy Burnham, the shadow health secretary, gives his reaction
Everything you need to know about the changes in England, including named GPs for people over 75
Health ministers in England claim they are bringing back old-fashioned family doctors with more personalised, planned care.Whom will it most affect?
People over 75 and patients with complex long-term health needs – about 5 million patients in all.How will they be affected?
They will each have a named GP overseeing their total care, with the intention of ensuring patients do not get lost in a health and social care maze as their treatment ranges from home to hospital, as out-patient or in-patient, to care homes or to other settings.What will this involve?
Offering such patients same-day telephone conversations; providing paramedics, A&E doctors, care homes etc with dedicated phone numbers to advise on treatment or help with decisions on transfers and admissions to reduce avoidable hospital stays and A&E visits; reviewing discharges from hospital to ensure vulnerable patients have proper care once they leave the wards; and more formal monitoring of out-of-hours services.Why are these changes needed?
Out of 5m emergency admissions to hospital in England last year, more than 1m could have been avoided, says the Department of Health. A third of the 5m total were of people over 75. Ministers believe the new arrangements will avoid unnecessary trips to hospital and relieve pressures on hard-pressed A&E departments.How will other patients be affected?
All patients must have the opportunity to book appointments and order repeat prescriptions online and have online access to their summary care records. Strict consultation times laid down under agreements that were voluntary but brought GP practices extra cash will be abandoned. Under those, consultations with patients at routine booked appointments had to last at least 10 minutes, while patients who dropped in to their surgery had to be seen for at least eight minutes.
From next October it should be easier for patients to register with a surgery of their choice outside traditional practice boundaries. But they will not be guaranteed home visits. The NHS will have to ensure however that such patients have access to urgent out-of-hours care.How will GPs in England be affected?
They will have to fill in fewer forms and do less box-ticking on patients who are reasonably healthy. There will be less dictation on how GPs treat and test people for specific conditions such as heart disease. More will be left to the doctors' professional judgment. Automatic pay rises for senior doctors will be phased out, consistent with the government's desire to get rid of so-called progression pay across the public sector.
GPs' negotiators say they will work towards publishing details of their net earnings after expenses including insurance and registration fees are excluded.How many GPs are there in England?
About 35,400, working mainly in just over 10,000 practices.James Meikle
Is Hunt right to claim the new contract will reduce pressure on A&E services?
Jeremy Hunt has claimed that by assigning a named practitioner to parents over 75, his new contract for GPs reduces pressure on A&Es, as well as freeing up GPs to spend more time with patients and less time having to work towards targets and " box-ticking."
Are you a GP? What do you think of Jeremy Hunt's comments? Share your thoughts by filling in the form below.
Hunt says new contract for GPs reduces pressure on A&Es, but has been criticised for blaming crisis on Labour's 2004 NHS deal
GPs will be offered more than £450m from the government in a deal that sees ministers backtrack on changes to the health service brought in last year and offers practices cash to reduce unnecessary hospital admissions of elderly patients.
In return Jeremy Hunt, the health secretary, will announce on Friday that family doctors have committed to monitor the quality of out-of-hours services used by their patients. But doctors' leaders took issue with Hunt's claim that the new GP contract, which comes in next April, is the first step to rectifying mistakes made by Labour in 2004.
The changes will mean every person aged 75 and over will be assigned a named, accountable GP to ensure patients receive co-ordinated care. GPs will also take on more responsibility for out-of-hours care, with a commitment to monitor the quality of out-of-hours services used by their patients.
Hunt will say that "Labour's 2004 GP contract broke the personal link between GP and patient. It piled target after target on doctors, took away their responsibility for out-of-hours care and put huge pressure on our A&E departments. The government has a plan to sort this out. Today's announcement of a new GP contract is a vital step."
But Richard Vautrey, deputy chair of the British Medical Association's GP committee, said this was "nonsense".
"The reality is that the changes happened in the last few years with the most significant concerns to practices relating to recent contracts," he said.
Hunt's case is that inadequacies in out-of-hours care lie behind the ongoing rise in people going to hospital A&E units – but blaming Labour's 2004 deal rang alarms in the NHS.
The claims are controversial: Stephen Dorrell, Tory chair of the health select committee and former health secretary, has publicly disagreed with Hunt over the issue.
The BMA said the claims were without foundation. "This has been shown not to be the case by many experts including the King's Fund," said Vautrey. "There's no link between contract changes in 2004 and what we now see in A&E." Instead, GPs said that underlying the deal was a ministerial U-turn. The deal in effect switches £290m to assured funding from a previous "box-ticking" performance regime that had forced family doctors to question patients about whether they did enough exercise and about sensitive matters such erectile dysfunction.
Vautrey said that ministers had "increased bureaucracy and box ticking" with changes last year. "There was huge anxiety and anger amongst GPs in having to ask everybody with hypertension whether they could walk or whether they had enough exercise. We had patients in Zimmer frames and there was no way of us exercising our professional clinical judgments under these changes."
He also said that patients had complained. "Similarly we had to keep reminding men with diabetes about their impotence by asking them every time they came to see a GP about their erectile dysfunction. It was wholly insenstive".
Vautrey welcomed the climbdown by ministers – saying that the changes brought in last year had hit morale. He said surveys of doctors showed 97% said red tape had increased in the past year while 94% said their workload had increased.
The Royal College of GPs chairman, Dr Clare Gerada, said: "Preventing disease is a very important part of a GP's role. But expecting hard-pressed GPs – who are already struggling to cope with spiralling workloads but ever decreasing resources – to fill in questionnaires and randomly screen the wider population for very specific diseases is not an effective way of caring for patients or a cost-effective use of NHS money that could be better used elsewhere."
The negotiations, between doctors' leaders and the health department, have been carried out against the chancellor's call for public sector pay restraint and GPs have had to end the "seniority" payments system which had paid GPs more for longer service. "It will end in six years time.
While there is no new money, the deal will see more than £160m put into a scheme to help surgeries prevent patients being inappropriately admitted to hospitals, with the cash coming from reduced spend on the wards.
Andy Burnham, Labour's health secretary, said: "David Cameron cut Labour's scheme of evening and weekend opening and the guarantee of seeing a doctor within 48 hours.
This announcement will not put an end to patients phoning the surgery at 9am and finding it impossible to get an appointment – many of whom, not happy with a phone consultation, will still turn to A&E.
"People will fail to see how this package delivers the public commitment David Cameron gave last month to keep GP surgeries open from 8am to 8pm. It was another promise that he's got no intention of keeping and shows why he's not trusted on the NHS."
The BMA has denied claims in an interview by the health secretary in the Times that individual GPs salaries would be revealed.
Speaking to the Guardian, Chand Nagpaul, the BMAs negotiator on the contract, said that all that was agreed so far was to form a working party in April 2015.
"We will only consider revealing salaries if there are like for like comparisons. Will dentists and opticians be made to reveal salaries?".Randeep Ramesh
Labour accuses health secretary of 'self-serving spin' for claiming 2004 contract had increased pressure on A&E
The government is sweeping away 40% of GP targets set by Labour to ensure that doctors can provide personalised care for patients, the health secretary, Jeremy Hunt, has said.
As Labour accused Hunt of "self-serving spin" for claiming that the 2004 GP contract had degraded care, the health secretary said that every person aged over 75 would have a named GP who would know their medical history. This would help reduce pressure on A&E services by ensuring elderly patients received better and faster medical advice.
Hunt told the Today programme on BBC Radio 4: "The way we are freeing up the time for GPs to deliver this extra care is by removing a lot of the targets, a lot of the box-ticking. What happened in 2004 was we introduced a system where essentially we micro-managed every minute of a GP's day. That meant that GPs found they were spending more time looking at their computer screens than looking at patients.
"We are removing that culture. We are getting rid of 40% of the GP targets. By doing that we are giving them the time to make sure that they give proper personalised care to the people who need it most."
Hunt said there would be a dedicated helpline to ensure patients aged over 75 could have a same-day conversation with a GP. But when asked whether there was a guarantee that such patients could speak to a GP, he said: "Well, they will be able to get through to their practice and quite possibly speak to their GP. I think people understand that sometimes when they call a practice their GP might be on an appointment, might be speaking to someone else. The commitment is that they will be able to speak to someone in their practice who knows their medical history."
The health secretary insisted that assigning a named GP to elderly patients would mark a major change from the 2004 GP contract which removed the use of named GPs. "There will be someone in the NHS where the buck stops for making sure [patients] get the care they need. That person will know them. Sometimes that person will be able to see them. Of course there will be times when they need to see someone else because we are not saying here – and this did not happen before 2004 either – that you always see the same person every single time."
Andy Burnham, the shadow health secretary, welcomed the creation of the namnedGP. But he said Hunt was wrong to say that the GP contract had intensified pressures on A&E services.
Burnham told Today: "There is just no evidence to support Jeremy Hunt's claim that the 2004 contract that Labour introduced has led to the problems in A&E. It has been dismissed by the BMA [British Medical Association] as nonsense. I consider it to be self-serving spin to enable the government to avoid responsibility for an A&E crisis of their own making."
Hunt and Burnham clashed after the government announced that GPs will be offered more than £450m in a deal that sees ministers backtrack on changes to the health service brought in last year, and offers practices cash to reduce unnecessary hospital admissions of elderly patients. In return, Hunt will announce on Friday, family doctors have committed to monitor the quality of out-of-hours services used by their patients.
But doctors' leaders took issue with Hunt's claim that the new GP contract, which begins in April, is the first step to rectifying mistakes made by Labour in 2004.
Richard Vautrey, deputy chair of the BMA's GP committee, said it was nonsense to say that the 2004 contract was to blame for pressures on A&E services.
"The reality is that the changes happened in the last few years, with the most significant concerns to practices relating to recent contracts," he said.
Hunt has claimed that inadequacies in out-of-hours care lie behind the ongoing rise in people going to hospital A&E units. But Stephen Dorrell, Tory chair of the health select committee and a former health secretary, has publicly disagreed with Hunt over the issue.
The BMA said the claims were without foundation. "This has been shown not to be the case by many experts, including the King's Fund," Vautrey said. "There's no link between contract changes in 2004 and what we now see in A&E."
Instead, GPs said, a ministerial U-turn was behind the deal. It effectively switches £290m to assured funding from a previous "box-ticking" performance regime that had forced family doctors to question patients about whether they did enough exercise, and about sensitive matters such erectile dysfunction.
Vautrey said ministers had "increased bureaucracy and box ticking" as a result of changes last year. "There was huge anxiety and anger amongst GPs in having to ask everybody with hypertension whether they could walk or whether they had enough exercise. We had patients in Zimmer frames and there was no way of us exercising our professional clinical judgments under these changes."
He said patients had also complained. "Similarly we had to keep reminding men with diabetes about their impotence by asking them every time they came to see a GP about their erectile dysfunction. It was wholly insenstive".Nicholas WattRandeep Ramesh
Scott, who also chairs the NHS Confederation's community health services forum, says integrating health and social care is a priority and once used a Bladerunner clip in a presentation
Describe your role in one sentence Promoting the fantastic work that happens invisibly everyday in community services.
Why did you want to work in healthcare? I am proud to be part of a service that is free at the point of delivery and still the envy of the world.
How do you want to see the sector change in the next five years?
Rhetoric turned to reality so that new money is invested in community health.
My proudest achievement at work was ... helping the NHS deliver A&E waiting times.The most difficult thing I've dealt with at work is ... dealing with child abuse and taking children into care when I worked for social services.
The biggest challenge facing the NHS is ... compassionate care for frail, elderly people.
The people I work with are ... dedicated, hard working and fun!
I do what I do because ... I once worked outside the NHS and couldn't wait to get back.
Sometimes people think that I ... am a remote bureaucrat – they're wrong!
Right now I want to ... bring health and social care even closer together.
At work I am always learning that ... the dedication and capacity of our staff never ceases to amaze me.
The one thing always on my mind at work is ... how can we better engage with our staff and communicate and link agendas.
If I could go back ten years and meet my former self I'd tell them ... don't be so uptight – it will happen.
If I could meet my future self I'd expect them to be ... older and wiser.
What is the best part of your job? Going out with community nurses and being allowed into patients homes – always a humbling experience.
What is the worst part of your job? Having to find continuing efficiencies from already hard-pressed staff.
What makes you smile? Making connections – eg using a clip from Bladerunner to demonstrate compassion based selection of staff.
What keeps you awake at night? The heat of the night.
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Reorgansied health services might mean better specialist care
Professor Norman Williams is leading efforts by the Academy of Medical Royal Colleges to reorganise the NHS and create a "seven-day health service". Such reorganisation is essential if we are to achieve the highest possible standards in care at the point of delivery.
While the public may want their local hospital to be open 24 hours a day and be a 15-minute drive from their own door, they need to understand that services organised on that basis cannot provide the highest quality of care at every local hospital. Williams is arguing that a reorganisation of services could provide a more consistent, higher standard of care to all.
The hospitals in question are those currently regarded as providing lower standards of 24-hour care. There has been debate as to whether a risk of death at the weekend is significantly higher than on weekdays for some hospital procedures. However the difference needs to be understood between care standards which are lower than those available elsewhere in specialist centres, but still acceptable, and a negligent service.
Treatment provided is deemed legally negligent if it does not reach the standard of care considered 'proper' by a responsible body of relevant clinicians at the time. What is considered appropriate is determined by the circumstances in which care is provided. Medical care is a rapidly changing environment. Treatment considered acceptable 20, or even 10 years ago may be negligent by today's standards.
In circumstances where a local hospital receives a patient suffering a heart attack, the hospital's failure to provide treatment with the latest technology available is not negligent if a responsible body of A&E consultants agree that the treatment was 'proper' in that context. That may include the need to stabilise the patient and arrange a timely transfer for more specialist care. The legal test is not a question of what the best hospital in the country could feasibly have done.
If Williams' vision is realised and NHS services are reorganised, patients suffering a suspected heart attack would only be taken to an emergency department which specialises in treating heart attacks. This may involve a longer journey but increase the prospects for successful treatment.
As a result, definitions of 'proper' and negligent will change. In the meantime, it is accepted that many hospitals have to provide the best treatment they can without access to the specialist knowledge and equipment which may be available elsewhere.
Such treatment is not automatically negligent simply because it is not the very best that is possible.
The NHS needs to be transparent with the public about the improvements that can be achieved by reorganising service provision.
In turn, the public needs to decide what it wants. We cannot realistically expect our local hospital to have a specialist unit for all the many possible ailments brought to its door. Do we want the best care or the just the care that can be made available in the shortest distance?
The impetus is there to raise standards within the NHS; there remain a range of services provided in different care settings throughout the NHS which do not reach the ideal standard that the NHS and Williams aspire to. They are, however, far from negligent.
Tony Yeaman is head of healthcare at law firm Weightmans LLP
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Enforced competition, as predicted, is wasting millions and putting lives at risk. Just look at Bournemouth and Poole
It came too late. "We are bogged down in a morass of competition law. We have competition lawyers all over the place telling us what to do, causing enormous difficulty." So said Sir David Nicholson, departing head of NHS England, to the health select committee, excoriating what has been done to the NHS. David Cameron's pledge of "no more tiresome, meddlesome, top-down restructures" may have been wiped off the internet, but few will forget.
Nicholson could have stopped Cameron's Health and Social Care Act had he and other NHS leaders dared speak out as it struggled through parliament, hanging on exactly this point – infecting the NHS with competition law. It's too late, now the NHS has tendered out three-quarters of new contracts to competition, according to Pulse magazine. Headlines focus on the gathering storm in A&E, bed shortages, waiting times and rationing (one eye only for cataracts). Less visible, but equally disruptive, is section 75's competition clause.
Here's what's happening: two Blackpool commissioning groups (CCGs) are stunned at being referred to Monitor's competition arm for failing to send enough patients to Spire private hospital. Spire accuses the CCGs of telling GPs to use the NHS Blackpool hospital instead. Dr Amanda Doyle, head of one CCG, "strongly refutes" and "deeply resents" the charge. She says Spire has fewer referrals for good reasons: a faster, cheaper pathway for headache care has diverted patients away from Spire's neurology consultants, so GPs treat people in the community, ordering CT scans, avoiding costly hospital visits. GPs have been trained to give joint injections and make referrals to physiotherapy without hospital appointments, so Spire lost orthopaedic work. "Spire went direct to Monitor, without talking to us," Doyle says. The cost will be huge for her small group: she's had to hire an administrator to collect thousands of documents, tracking every referral from every GP for years. "This has shocked me. I didn't think it possible."
She's not alone. The final judgment by Monitor, the Office of Fair Trading and the Competition Commission forbidding Bournemouth and Poole hospitals from merging has stunned the NHS. Poole's CEO told a meeting it cost them more than £6m in lawyers and paperwork; without merger his trust will have an £8m-a-year deficit. Tony Spotswood, CEO of Royal Bournemouth, says: "The merger would have saved £14m a year, with great benefits to patients. A single A&E would offer 24-hour, seven-day-a-week consultants," but that's scrapped, along with a new maternity centre. Several specialisms only viable when shared will go, sending patients far away. Unified cardiology would give 24-hour consultant cover, but not now. Poole and Bournemouth, 10 miles apart with no other competitor in sight, have been forced to give the Competition Commission an undertaking not to try any backdoor co-operation. Bournemouth's motto is "Putting patients first", but priority goes to competition ideology.
Jeremy Hunt strives to airbrush out the past three Andrew Lansley years and the £3bn cost of the Health and Social Care Act. He tries to blame any fault on Andy Burnham's previous era, a ruse unlikely to see him through the unfolding turmoil. Wriggling in front of the Commons health committee, he hinted the act might be revisited to soften the disastrous section 75. But the government has privately ruled it out as too politically embarrassing to reopen the floodgates of that controversy. They hope Monitor, and the Competition Commission, will be more sensitive to the NHS in future, but without rescinding section 75, no one can stop the likes of Spire using their legal competition rights.
Chris Ham of the King's Fund thinktank says: "It's only becoming apparent now what it means to expose the NHS to red in tooth and claw competition law." He cites two Bristol trusts trying to create a unified cancer pathway, which has cut cancer deaths elsewhere. But the OFT has stopped them, ordering them to compete. London's King's College hospital wants to integrate community older people's services with the local council, as universally recommended, but competition law stopped it. Guy's, St Thomas's, King's and the Maudsley want to combine south London mental health services, but may be blocked. The OFT slapped down some NHS hospitals for agreeing tariffs for private patient units.
Cameron is ordering the NHS to use the private sector, but it's no cheaper. St Andrew's, a private mental health service, paid its CEO £650,000 – until Third Sector magazine reported it. Nuffield Health pays its CEO £840,000. A curiosity in private hospitals is that many are technically charities, in the same way Eton is a charity, gaining tax privileges for the privileged. NHS top salaries have risen steeply under this government, which inherited 290 very senior managers earning over £200,000 but has increased their number to 500. Perhaps that's what it takes to find those willing to run this chaotic, high-risk new system.
A leading competition lawyer at Clifford Chance tells me he acts for eight other NHS trusts planning to collaborate or merge various services – but they have been stopped in their tracks by the Bournemouth/Poole decision. Sir Bruce Keogh's call for A&E rationalisations may often trip over section 75 competition law too. Monitor, which supervises foundation trusts, is reportedly "at war" internally due to its two conflicting duties – to force competition yet ensure the financial viability of trusts. Now it will see Poole at risk of going bust because of its own competition duty.
Monitor, the OFT and the Competition Commission may be overwhelmed with cases, each requiring billions of bytes of data going back years. Poole had to collect half a billion documents in evidence, with mega fees and hours of lawyers and administrators – all for what? To stop the integrations and rationalisations that a hard-pressed NHS needs. This is precisely what was warned, and what Lord David Owen made such impassioned, forensic speeches about in the Lords. This was the point over which Shirley Williams caved in during the bill's notorious "pause", when her party might have stopped it.
One lesson for the NHS – why did so few speak out? Even now, with the NHS perched on a cliff edge, most of those I speak to in senior positions ask not to be quoted, so what hope for whistleblowers lower down the chain? One of the pledges Computer Weekly found wiped off the internet was this Cameron promise of "near-total transparency of the political and governing elite". The NHS needs that honesty now.Polly Toynbee