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No 10 accused of ‘caving in’ to cigarette lobby as plain packs put on hold

Category : Business

Tobacco giant warned of loss of jobs in UK before packaging rules were dropped, and anti-smoking camp also cites possible fear of Ukip

Anti-smoking campaigners have accused the government of caving in to pressure from the tobacco lobby and running scared of Ukip after plans to enforce the sale of cigarettes in plain packs failed to make it into the Queen’s speech.

Minutes released by the Department of Health show that one of the industry’s leading players had told government officials that, if the move went through, it would source its packaging from abroad, resulting in “significant job losses.”

Cancer charities and health experts were expecting a bill to be introduced last week that would ban branded cigarette packaging, following a ban introduced in Australia last December. At least one health minister had been briefing that the bill would be in the Queen’s speech. But the bill was apparently put on hold at the last minute with the government saying it would be a distraction from its main legislative priorities.

Ukip, which enjoyed considerable success in last week’s elections, has positioned itself firmly on the side of smokers and there is a suspicion that the Tories scrapped the plan because they did not want to be seen as anti-smoking.

It has emerged that senior Department of Health officials held four key meetings with the industry’s leading players in January and February, when at least one of the tobacco giants spelled out to the government that its plan would result in thousands of jobs going abroad.

Department of Health minutes released last week reveal that Imperial Tobacco, British American Tobacco (BAT), Philip Morris International and Japan Tobacco International were each invited to make representations to the government, in which they attacked the plan and its impact on the UK economy.

Only the minutes of the meeting with Imperial have been released. They record that Imperial warned if plain packs were introduced it would source packaging from the Far East resulting “in significant job losses in the UK.”

The tobacco giant also outlined how its packaging research and development department supported small and medium-sized enterprises in the UK and argued that standard packs would “result in some of these being put out of business”.

It added that the plan would boost the illicit trade in cigarettes, which already costs the Treasury £3bn in unpaid duty and VAT a year. And it noted that 70,000 UK jobs rely on the tobacco supply chain, implying some of these would be threatened if the illicit market continued to grow.

When asked to hand over its assessment of the impact of the plan, Imperial refused, citing commercial sensitivity.

The decision to delay the introduction of plain packs is a major success for the tobacco lobby, which has run a ferocious campaign against the move. Cigarette makers fear that the loss of their branding will deprive them of their most powerful marketing weapon. The industry has backed a series of front campaign groups to make it appear that there is widespread opposition to the plan, a practice known in lobbying jargon as “astroturfing”. Many of the ideas were imported from Australia, where the tobacco giants fought a bitter but ultimately unsuccessful campaign to resist plain packs. Much of the Australian campaign was masterminded by the lobbying firm Crosby Textor, whose co-founder Lynton Crosby is spearheading the Tories’ 2015 election bid.

Crosby was federal director of the Liberal party in Australia when it accepted tobacco money. Crosby Textor in Australia was paid a retainer from BAT during the campaign against plain packs. Some anti-smoking campaigners are now questioning whether the decision to drop the plain packs bill was as a result of shifting allegiances at Westminster.

“It looks as if the noxious mix of rightwing Australian populism, as represented by Crosby and his lobbying firm, and English saloon bar reactionaries, as embodied by [Nigel] Farage and Ukip, may succeed in preventing this government from proceeding with standardised cigarette packs, despite their popularity with the public,” said Deborah Arnott, chief executive of the health charity Action on Smoking and Health.

The decision to drop the plan will become a divisive issue for the coalition because the Liberal Democrats were strongly in favour of the measure, which will still be introduced in Scotland.

It is also a concern for the government’s own health adviser. “Our view is that plain packaging is one of a range of measures shown to be effective in reducing the amount of people taking up smoking,” said Professor Kevin Fenton, director of health and wellbeing at Public Health England, the government agency charged with helping people to live longer and more healthily.

A Department of Health spokeswoman denied that tobacco lobbying had been a factor in the decision to pull the bill. “These minutes simply reflect what the tobacco company said at the meeting, not the government’s view,” she said. “The government has an open mind on this issue, and any decisions to take further action will be taken only after full consideration of the evidence and the consultation responses.”

Health minister threatened with ejection from royal college

Category : Business

Earl Howe’s position on advisory committee under threat as doctors claim he ‘mis-sold’ health reforms

A health minister is facing the humiliation of being ousted from a prestigious role within the Royal College of Physicians over claims that he falsely reassured doctors who feared the coalition would privatise of the NHS.

Earl Howe’s position on an advisory committee is being reviewed following a complaint. Six influential members of the professional body that represents doctors wrote to its president, Sir Richard Thompson, claiming that the minister was “not a fit person to fulfil this important role”. Thompson has launched an investigation by the College’s trustees into Howe’s probity.

The senior doctors claim that Howe, a former banker, falsely advised them that reforms under the health and social care bill would not force doctors to use market mechanisms to choose where patients will be treated.

According to the doctors, the regulations will mean that clinical commissioning groups – the bodies to be set up by GPs to organise patients’ care – will have to put services out to tender if there is more than one provider capable of offering particular treatments. This means NHS hospitals and services will have to compete with private health firms for business.

Andy Burnham, the shadow health secretary, said there had been a breakdown in trust between health professionals and government, adding: “This whole issue has become a crisis of trust for the department of health. There would be a straight forward breach of trust given that statements ministers have given have not been honoured.

“The medical profession feels the government has mis-sold its NHS reforms. It was sold on the principle that doctors would be in control but in fact it will be the market that will decide.”

A spokeswoman confirmed that Thompson, and “in the interest of probity”, had “referred the issue to the board of trustees and would report back in June”.

She said the Friends of the RCP, the committee on which Howe serves, is an informal advisory group, including past presidents and officers, and figures from finance, industry, and other charities, that plays no role in the governance or management of the RCP but offers advice in areas such as effective fundraising.

The coalition denies the regulations will force doctors to put services out to tender, believing it will give GPs the ability to select a variety of providers and will improve standards.

Doctors demand soft drinks tax and healthier hospital food to tackle obesity

Category : Business

Academy of Medical Royal Colleges puts forward 10-point action plan to help end UK’s status as ‘fat man of Europe’

Britain’s 220,000 doctors are demanding a 20% increase in the cost of sugary drinks, fewer fast food outlets near schools and a ban on unhealthy food in hospitals to prevent the country’s spiralling obesity crisis becoming unresolvable.

The Academy of Medical Royal Colleges is calling for action by ministers, the NHS, councils and food firms, as well as changes in parental behaviour, to break the cycle of “generation after generation falling victim to obesity-related illnesses and death”.

In a report spelling out the problem in stark terms, the academy says doctors are “united in seeing the epidemic of obesity as the greatest public health crisis facing the UK. The consequences of obesity include diabetes, heart disease and cancer and people are dying needlessly from avoidable diseases.”

The academy castigates attempts by previous and current governments to counter obesity as “piecemeal and disappointingly ineffective”, and woefully inadequate given the scale of the problem. One in four adults in England is obese, and the figures are predicted to rise to 60% of men, 50% of women and 25% of children by 2050.

Following a year-long inquiry the academy has drawn up a 10-point action plan – including health professionals routinely asking overweight patients about their lifestyle, and help for new parents with their babies’ feeding habits – to end the UK’s status as “the fat man of Europe”.

The academy’s chairman, Professor Terence Stephenson, said the report did not claim to offer a full solution to obesity, but “it does say we need together to do more, starting right now, before the problem becomes worse and the NHS can no longer cope”. Obesity is estimated to cost the NHS £5.1bn a year.

The report puts forward measures it says “society as a whole needs to take to prevent the obesity crisis becoming unresolvable”. Calling for a reversal of widespread unhealthy habits, it adds: “Just as the challenges of persuading society that the deeply embedded habit of smoking was against its better interests, changing how we eat and exercise is now a matter of necessity.”

The academy wants a dramatic increase in anti-obesity efforts. Its 10 recommendations to end what it calls the “obesogenic environment” include backing for:

• An experimental 20% tax on sugary soft drinks for at least a year, like that in operation in parts of the US, to see what effect it has on sales. The potential £1bn annual tax yield could help fund an increase in weight management programmes.

• Local councils to limit the number of fast food outlets allowed to operate near schools, colleges, leisure centres and other places where children gather, to end the “paradox” of schools that try to get pupils to eat healthy lunches having their efforts undermined by council-licensed burger vans outside their gates.

• NHS staff to routinely talk to overweight patients about their eating and exercise habits at every appointment and offer them help, under a policy of “making every contact count”.

• The NHS to spend at least £300m over the next three years to tackle the serious shortage in weight management programmes so many more patients with weight problems can be referred and helped “in a supportive and sensitive manner”.

• An expansion of bariatric surgery for more severe obesity, from the current total of about 8,000 NHS operations a year, to help those most at risk of dying.

• Hospitals to adopt the same nutritional standards for the food they serve patients and staff that already apply in state schools in England, and an end to fast food outlets and vending machines selling unhealthy products on hospital premises.

• Health visitors to advise new parents how to feed their children properly, to avoid them getting hooked on sweet or fatty foods while still very young.

• All schools to have to serve healthy food in their canteens, including academies and free schools, which the education secretary, Michael Gove, has exempted from the requirement that applies in all other state schools.

The report says it is “perplexing” to find canteens in hospitals, which should be setting an example, selling unhealthy dishes, and “even more astonishing that in many hospital receptions patients pass by high street fast food franchises or vending machines selling confectionery, drinks and crisps”.

It is scathing of Gove: “It seems to represent the most extraordinary own goal on the part of the current government to exclude the wave of academies from the [nutritional] standards.”

Stephenson told the Guardian the 20% tax increase on sugary soft drinks was justified because they represented “useless calories” and were “the ultimate bad food. You’re just consuming neat sugar. Your body didn’t evolve to handle this kind of thing.”

The chef and anti-obesity campaigner Jamie Oliver welcomed the report as “the clearest warning sign yet that the medical profession is deeply concerned about obesity. We need action now to educate children and families on how to choose the right food to give them the best life chances.”

The Food and Drink Federation, which represents produce manufacturers, branded the report a “damp squib” that added “little to an important debate”. It said the report failed to recognise the role of alcohol in adding calories to adult diets, and said little about physical activity and “health in the workplace”.

The federation’s spokesperson Terry Jones said: “The Academy of Medical Royal Colleges has presented as its recommendations a collection of unbalanced ideas apparently heavily influenced by single-issue pressure groups.”

The Department of Health said it was studying the findings. “The threat posed by obesity in both adults and children represents one of today’s most important public health challenges,” said a spokesman. “This wide-ranging report recognises, as did our own recent call to action on obesity, that there is no single answer to the obesity problem.

“It is up to everyone – government, industry, health professionals and voluntary groups, as well as individuals themselves – to work jointly to promote healthy eating and healthy lifestyles.” .

The British Retail Consortium said it was wrong to “demonise” its members, which include Burger King, McDonalds and KFC. Its spokesperson Richard Dodd said such chains offered a range of items to customers and had reformulated products to reduce fat, sugar and salt content.

“It’s wrong to demonise any particular type of food or food outlet. What our members are hugely engaged in is encouraging healthy balanced diets and giving customers the choices and information they need,” he said. I

t was also down to parents to help children”build a healthy and responsible attitude to eating a balanced diet overall”.

Gavin Partington, director general of the British Soft Drinks Association, said: “We share the recognition that obesity is a major public health priority but reject the idea that a tax on soft drinks, which contribute just 2% of the total calories in the average diet, is going to address a problem which is about overall diet and levels of activity.”

“Over the last 10 years, the consumption of soft drinks containing added sugar has fallen by 9%, while the incidence of obesity has been increasing. And 61% of soft drinks now contain no added sugar. Soft drinks companies are also committing to further, voluntary action as part of the government’s calorie reduction pledge.”

Food and drink firms undermining public health policy, say scientists

Category : Business

A paper published in the Lancet calls for regulation of companies that experts say are using methods seen in the tobacco industry

Food, drink, and alcohol companies are using similar strategies to the tobacco industry to undermine public health policies and should be regulated, say public health experts.

Negotiating with multinational companies on salt, fat and sugar levels or including calorie and alcohol amounts on labels in the way the UK government has done through its “responsibility deal” will not work, say the authors of a study published by the Lancet.

“Self-regulation is like having burglars install your locks,” said Professor Ron Moodie of the University of Melbourne, Australia. “You feel you’re safe, but you’re not.”

The paper is one of a series published by the medical journal on the large and growing threat of what are known as non-communicable diseases (NCDs) across the globe – namely cancer, heart disease and stroke, diabetes and respiratory diseases. All are caused partly by our lifestyles – smoking, eating processed food, drinking and taking less exercise – in response to a world where energy-dense food, sugary drinks and alcohol is cheap and heavily marketed.

In 2010, 34.5 million people around the world died from these diseases, which were 65% of all deaths that year. That is expected to rise to 50 million deaths a year by 2030 as the NCD epidemic spreads. The World Health Organisation has set a target to reduce these deaths by 25% by 2025.

Moodie and colleagues say that the food and drink industries should be treated like the tobacco industry – as companies with too much of a vested interest in the sale of unhealthy products to help curb the epidemic of disease. They must have no role in the formulation of national or international policy, they say.

“Regulation, or the threat of regulation, is the only way to change these transnational corporations. The industry must be put under pressure if it is to change.”

The researchers were unable to find any health benefit to industry involvement in voluntary regulation or public-private partnerships. Industry documents, they say, reveal how companies shape public-health legislation and avoid regulation. They build “financial and institutional relations” with health professionals, non-governmental organisations, and national and international health agencies, says the paper. They distort research findings and they lobby politicians to oppose health care reform.

Huge multinational companies dominate sales worldwide. “The frequently used term ‘competitive market’ suggests a wide variety of traders; however, the most powerful corporate sectors of the world’s food system are increasingly concentrated to the point of oligopoly.

“For example, in the USA, the 10 largest food companies control more than half of all food sales. Worldwide, this proportion is about 15% and is rising rapidly. More than half of global soft drinks are produced by large transnational companies.”

The multinationals are now moving in on the developing world, the researchers say. “Saturation of markets in high-income countries has caused the industries to rapidly penetrate emerging global markets, as the tobacco industry has done. Almost all growth in the foreseeable future in profits and sales of these unhealthy commodities will be in low-income and middle-income countries [where consumption is currently low].”

The Food and Drink federation said: “We agree that action is required to tackle the worldwide health burden of obesity and diet-related diseases. However we believe that collaboration between a very wide range of organisations can successfully address the multifactorial causes of non-communicable diseases.”

Letters:Tax-break treatment for health firms

Category : Business

You quote David Cameron as saying he wanted to “turn the NHS into a fantastic business” (Private NHS providers in line for tax cut, 14 January). The NHS was not conceived as “a business” but as a service for everyone in the UK, free at the point of delivery. A business will, rightly as a business, seek to provide a good profit and return on investments.

Yes, the NHS faces difficult decisions – such as where should be the boundary between free treatment and conditions that should be paid for (eg some cosmetic procedures). But improvement to the operation and efficiency of an organisation is likely to be best achieved using knowledge and resources already within that organisation – not by turning part or all of it into private business activities.

If companies want to offer health treatment facilities, fine, and there is a need for that. But that is done on a business model, within a business environment – and that includes paying VAT and corporation tax. It is not a “level playing field” to compare an organisation, such as the NHS or a charity, with a business.
John Chubb
Cheltenham, Gloucestershire

• Your article inaccurately states that Monitor has written a draft of the Fair Playing Review report “sympathetic to the private sector demands” for exemption from corporation tax on profits made from NHS services. The article quotes a source claiming to have seen a draft of the final review, when in fact no such draft has been written.

Monitor has received representations concerning tax from providers from the charitable sector as well as the private sector. In addition we have received representations that other factors disadvantage the public sector, such as complying with FOI requirements or employee benefits. We have had responses and held detailed conversations with providers from all sectors and we are taking time to analyse the evidence before drawing our final conclusions.

The secretary of state asked Monitor to undertake the Fair Playing Field review as an independent report. It will report at the end of March. Monitor has a statutory duty to promote and protect the interests of patients and any suggestion that we are working on behalf of the private sector misrepresents our core duty.
Dr David Bennett
Chief executive, Monitor

• Social enterprises are not to be conflated with private firms that distribute profits to shareholders. While some employee-owned businesses are social enterprises, many, including Circle Healthcare, are not. Social enterprises exist for the people – they reinvest their profits to improve patient care, have strong track records of delivering health services and are accountable to the taxpayer. As health markets are opened up to competition, it’s crucial that the distinction is clear in the minds of the public and commissioners.
Peter Holbrook
Chief executive, Social Enterprise UK

• Paying corporation tax seems to be a more than fair exchange for the opportunity to make a profit off the back of medical staff whose degrees were funded by the taxpayer. There is no shortage of private companies bidding for NHS contracts under the current terms, so no “incentive” is required; tax breaks would be a cynical misuse of public money earmarked for the NHS.
Clare Brown
Bridford, Nottingham

• The NHS has professional and educational development responsibilities for doctors, nurses and all healthcare staff, all of which is a hidden cost. If there were a professional education and development tax on all former NHS staff working in the private sector, related to their years of pre- and post-qualifying training, this would be a fairer playing field.
Professor Colin Pritchard

• Reports that the government wants to give tax breaks for private companies in the NHS come as no surprise to those like UCU fighting similar plans in higher education. Private companies have been lobbying hard for the VAT exemption granted to charitable universities and colleges. We must stop the government indulging in yet more corporate welfare at the expense of public services.
Sally Hunt
General secretary, University and College Union

Calls for reform of the cosmetics industry date back to 2005 | Analysis

Category : Business

The failure of successive governments to protect patients from an industry capable of inflicting harm is baffling and inexcusable, writes Denis Campbell

The refusal of successive governments to properly regulate an industry clearly capable of inflicting medical harm – the cosmetic treatments business – is widely regarded as one of the most baffling and inexcusable failures of health policy in recent years.

In 2005 a Labour government happy to mandate and regulate in order to improve healthcare, for example by imposing waiting time and treatment targets on the NHS, was in power when a group of experts convened by the then chief medical officer, Sir Liam Donaldson, recommended sweeping changes intended to protect patients. The case for wholesale reform was clear, it suggested.

Those findings are decidedly similar to the observations and demands published on Monday that emerged from submissions to a call for evidence on how to better regulate cosmetic surgery that was initiated by the coalition in August.

The 2005 experts said, for example, that: “The evidence that we reviewed suggested that avoidable harm is done to some patients. We note that demand is considerable, that it is growing, and that cosmetic surgery and procedures are widely advertised and promoted in ways which would be quite unacceptable to the public or to professional ethics if they were used in relation to other surgical interventions.”

They added: “People should be confident that their treatment will be safe, that the medical and nurse practitioners who treat them are qualified and competent, and that they have the information they need to make informed decisions. Further than that, it must be the responsibility of individuals to protect themselves by checking on the qualifications, experience and commitment to good practice of the providers they use.”

While some of the recommendations were implemented, other key ones – such as regulating the injection of Botox and dermal fillers (wrinkle-smoothing treatments), which are toxic and potentially damaging – were not.

Labour ministers also took cosmetic laser treatment out of regulation, despite the statutory risk assessment warning that such a move could harm patients. “Removing red tape” was put above patient safety, despite patients undergoing laser hair removal having been burned or disfigured.

Under Labour, the Department of Health’s responses to the growing evidence of scandalous practices in the cosmetic treatments sector gave the impression that victims’ injuries were the result of their own vanity, stupidity or both. Those harmed by NHS blunders deserved sympathy; those by cowboy cosmetic surgeons did not. This ignored the principle that anyone capable of inflicting serious harm through medical treatment, whether motivated by clinical or aesthetic reasons, should be subject to the same scrutiny.

Fast forward almost eight years and very similar concerns remain – aggressive marketing techniques, too little information for patients, unqualified or underqualified practitioners carrying out potentially risky procedures and more. It remains, as Peter Walsh of Action against Medical Accidents puts it, “a murky industry which preys on people’s insecurity or vanity and is badly in need of better regulation”.

Sir Bruce Keogh, the NHS’s medical director, who is leading the new, ongoing review, feels broadly the same. His recommendations in March will put pressure on ministers to act in a meaningful way. The evidence presented to him is both a detailed indictment of an industry that too often ignores what should be an overriding duty of care and a useful roadmap to what has to be, finally, proper regulation of the sector.

“Virtually all respondents believed private providers of cosmetic interventions should meet the quality and safety standards expected of the NHS,” the summary says. This is a key principle that ultimately can only be realised through legislation, which could also cover another problem highlighted in the summary: a shameful lack of aftercare for patients inadvertently harmed while seeking to enhance their appearance. Similarly, “current regulation of fillers was felt to be inadequate” while most respondents “felt that greater regulation of lasers and light treatments was needed, given the potential risks to consumers”.

Critics say the scale of the malpractice in the treatments trade means voluntary agreements, woefully inadequate devices which the coalition uses with the food and alcohol industries, are not appropriate. Some laws are necessary to protect people from their own behaviour; others from irresponsible self-interested firms. Both apply here. Ministers who prefer deregulation will have to go against their instincts.

NHS cost-cutting being put ahead of patients’ welfare, claims watchdog

Category : Business

Care Quality Commission’s report on England’s healthcare says one in 10 patients are denied respect and dignity

Staffing problems in NHS hospitals are leading to patients receiving poor care and being exposed to danger from errors with their medication, the health service regulator warns in a report published on Friday that doctors’ and nurses’ leaders claim shows that cost-cutting is being put ahead of patients’ health and welfare.

Inspections of hospitals show that a lack of staff, especially those with the right skills, is a key reason why one in 10 patients are denied respect and dignity, 15% are not fed properly and 20% have their care and welfare neglected, according to the Care Quality Commission (CQC).

The annual report by England’s NHS and social care watchdog paints a picture of a service creaking under the strain of trying to provide high-quality care as demand rises while resources are increasingly stretched – a picture at odds with the government’s portrayal of an NHS meeting key performance targets in difficult circumstances.

One in six (16%) of the 250 hospital services inspected in 2011-12 did not meet the CQC’s standard for having enough staff on duty to care properly for patients.

Some NHS services “have clearly struggled to make sure they had enough qualified and experienced staff on duty at all times, and then to make sure staff were properly trained and supervised – making it more difficult for staff to understand and focus on the needs of each and every patient”, the report says.

Lack of staff is “a significant issue in many services”, including nursing homes, 23% of which had too few staff, and residential care homes, of which 16% were understaffed, the CQC found.

The watchdog blames staff shortages and other personnel issues for the fact that 21% of hospitals were not managing patients’ medication well enough and that 22% were guilty of inadequate record-keeping. “The poor performance of some NHS hospitals in both [areas] is an indicator of where standards may slip as staff are stretched”, it said.

It also warns that NHS trusts that operate with high vacancy rates and poorly deployed staff risk ending up with “cultures in which unacceptable care becomes the norm” and “an attitude to care that is ‘task-based, not person-centred’”.

Katherine Murphy, chief executive of the Patients Association, said: “The basics of good care, such as dignity, compassion and respect, cannot be delivered in a ‘conveyor belt’ approach that is task-orientated or lacking in empathy and human care.”

One in 10 hospital patients had been denied respect and dignity by having their call bell out of reach, being spoken to by staff in a condescending way and having too little privacy, inspectors found.

David Behan, the CQC’s chief executive, said: “Our report highlights concerns we have that pressures on some services are leading to problems in the quality of care, keeping people safe, treating people with dignity and respect, and involving people in decisions about their own care. These pressures cannot be used as an excuse to deliver poor care.”

The increasing difficulty of looking after growing numbers of patients with more complex conditions, for example older people with both dementia and cancer, was also a factor, though, Behan added.

The report adds to controversy over whether government demands for £20bn of NHS “efficiency savings” by 2015 are harming the service patients receive. The British Medical Association (BMA), which represents about 140,000 of the UK’s 200,000 doctors, said that was an inevitable result if hospitals operated with too few staff.

“The CQC report highlights inadequate staffing levels in hospitals and community care settings and the BMA is extremely concerned about this. Without sufficient staffing it is impossible for patients to receive the quality care they deserve”, said a BMA spokeswoman.

“The government’s £20bn efficiency savings drive will lead to fewer staff being recruited. And when trusts struggle financially, it is frontline staff and patients who suffer. You can’t reduce services and say that patients won’t be affected”, she added.

The Royal College of Nursing, which represents 300,000 NHS nurses, said the CQC’s findings vindicated its warnings in the past two years that the savings push was leading to staff being made redundant and posts being left unfilled, and that shrinking headcounts would undermine quality of care.

“The report echoes the RCN’s warnings that not enough hospitals, nursing and care homes are adequately staffed and when coupled with the wrong mix of skills is having a real effect on patient care”, said Dr Peter Carter, the RCN’s chief executive and general secretary.

More hospitals would fail to meet the CQC’s standards unless NHS employers took action to boost staff numbers, he predicted. “We hope that this report acts as a warning that cutting staff at a time when the country’s healthcare needs are becoming more complex is a recipe for disaster.”

Jeremy Hunt, the health secretary, warned the NHS that “changing demands or pressures are not an excuse for poor care” adding: “Where CQC inspections find NHS and social care providers failing in their legal duties to provide enough staff or appropriate care, we expect action to be taken.”

Official NHS workforce statistics on Wednesday showed that there were 7,134 fewer nurses working in the NHS in England in August than at the time of the general election in May 2010.

The RCN estimates that 61,276 jobs have been lost or earmarked to disappear from NHS organisations in England alone since 2010, despite NHS chief executive Sir David Nicholson’s pledge that savings made would be ploughed back into patient care.

But Hunt disputed the RCN’s claims. The same workforce data showed there were more clinical staff working in the NHS now than in May 2010, including 5,000 more doctors and 900 extra midwives, he said.

Michelle Mitchell, charity director general of Age UK, raised concern about the CQC report’s findings. She said: “It is appalling that 15% of hospitals and 20% of nursing homes failed to ensure people were given the food and drink they needed and that a significant proportion were equally unable to protect the dignity and respect of their patients and residents.”

She suggested that NHS and care services staff were failing in their “professional and moral duty to make sure the dignity of their patients and residents is enshrined in every action”.

The CQC report is also highly critical of private firms’ care of people with mental health problems, learning disabilities and substance misuse problems: 27% of non-NHS providers failed to safeguard those types of patients while 51% of independent operators did not meet the CQC’s standards for protecting the care and welfare of those with learning disabilities.

Drinks industry refuses to swallow government line on alcohol pricing

Category : Business

Despite general agreement that something must be done about Britain’s booze culture, opinions remain divided over plans to introduce a minimum unit price

On a Friday night in the City a young professional woman collapses on the floor of the bar where she has been drinking with colleagues. She vomits, then passes out, and when an ambulance crew arrives they are verbally abused by the patient’s friends, as the emergency service refuses to turn itself into a chauffeur to take the party home.

“They were horrible,” recalls the paramedic called to the scene. “They didn’t just want to be taken up the road, they wanted to be transported to the other side of London and were rather abusive when we said we weren’t willing.”

Speak to any paramedic, A&E worker or policeman and they will regale you with similar tales of weekend calls to assist overly refreshed young women claiming their drink has been spiked (they rarely have, the experts say); or of aiding City bankers who have lost a personal battle with gravity, leaving elderly people waiting for two hours for their ambulance to arrive.

This is all part of a British reality that refuses to conform to the cafe culture: the ideal that was supposed to emerge following the relaxation of UK licensing laws. It comes at a time when there is a civil war within the drinks industry, not to mention the battles outside it, about what to do with what most view as a serious problem. Meanwhile, both Scottish and Westminster legislators are fighting for the future of their respective solutions, following assaults from drinks lobbyists and lawyers.

By the end of this month, a new wave of alcohol promotions will be launched in supermarkets targeting Christmas pay packets. That big push should coincide with the long-awaited launch of a Home Office consultation on how to implement government plans to enforce a minimum charge per unit of alcohol. And, in January, a delayed judicial review will attack Scotland’s more advanced moves to legislate to increase the prices of the cheapest alcohol being sold in supermarkets and off-licences.

The challenge in Scotland has been spearheaded by the Scotch Whisky Association – a trade body whose policy-making council is dominated by major drinks groups such as Johnnie Walker-owner Diageo, Pernod Ricard’s Chivas Regal and Edrington, the home of Famous Grouse. Meanwhile, EU wine producers, concerned about how their exports to Britain will be hit, have launched their own campaign in Europe, albeit one that caused eyebrows to arch when the initial objection came from the seemingly unlikely quarter of Bulgaria. Conspiracy theorists even pondered if the former communist state challenged British policy with the assistance of the global drinks industry lobby.

The Bulgarian embassy declines to comment on that theory, although a spokeswoman for SABMiller, the brewer behind 86 beer and cider brands, including Peroni Nastro Azzurro, is more forthcoming. She explains: “Working with recognised industry trade bodies across Europe, SABMiller has sought to present the facts about minimum pricing. In such an important public policy debate, it’s vital that governments and regulators understand the unintended consequences that might ensue from what the UK government acknowledged is little more than an experiment.”

However, despite the objections, the Home Office insists it will be launching its consultation this autumn. “The government is committed to the introduction of a minimum unit price,” a spokesman says. “The proposal has the backing of the Royal College of Physicians and the Association of Chief Police Officers and could mean 50,000 fewer crimes and around 900 fewer alcohol-related deaths per year by the end of the decade.”

These health and crime statistics are the typical arguments presented by those who favour minimum pricing, and they frequently draw from research conducted by Sheffield University. The academics’ latest update in January stated that “increasing levels of minimum pricing show steep increases in effectiveness”, especially when combined with a ban on “price-based promotion, including straight discounting from list price in addition to multi-buy offers”. Introducing a 50p minimum unit price, the research predicts, would cause consumption to fall by 5.7%, or 7.8% if combined with a promotion ban.

However, it is not quite as simple as that. Those opposing the plans predictably hint at alleged flaws in the Sheffield report, and suggest minimum pricing would not work in reality in the way the model suggests, and that we are already drinking less as a nation. But while the arguments are obvious, those lining up on each side of the debate are not.

The Portman Group, the drink industry lobbyist that includes Diageo, Carlsberg and Heineken among its members, is twitchy about discussing the issue at all, as its members cannot agree on the topic. One, Molson Coors, has publicly stated that it broadly supports the proposals.

Meanwhile pub groups, which casual observers might expect to welcome the move as most of their alcohol is already priced higher than suggested thresholds, are also split.

Rooney Anand – the chief executive of pub operator and brewer Greene King, and one of the more outspoken supporters of the policy – argues: “It is time to take decisive and targeted action in the fight against the worsening relationship with alcohol that we see in Britain today.” Few disagree with that sentiment, but colleagues within his own industry still vehemently oppose minimum pricing.

One is Tim Martin, the candid chairman of JD Wetherspoon, who believes the whole policy is a political PR stunt.

“[Minimum pricing is] nuts,” he says. “It is obfuscation by trying to pretend that the government is dealing with the issue. All that will happen from a pub’s point of view is that the tax inequality [when compared with supermarkets] will remain. Tax equality between pubs and supermarkets would be much more effective than minimum pricing. [Minimum pricing] is a placebo that won’t have any effect on the underlying problem. It’s utter bollocks, basically. If you want people to pay more for their beer, there is one solution: get them to go to pubs. The problem with Cameron and Osborne is they haven’t worked in a fucking pub.”

The supermarkets, which are widely blamed for allowing young drinkers to “pre-load” on cheap booze before hitting the nightclubs, argue their case in slightly less colourful language. Even so, they cannot find much common ground.

Asda, Morrisons and Sainsbury’s have all come out against the government introducing a price floor, yet the biggest of them all – Tesco – is broadly in favour. That split generates all sorts of theories about motives.

Some industry watchers argue that a minimum price per unit would actually benefit supermarkets, as their buying power means they will not have to pass profit increases from higher prices on to suppliers. Equally, others say that supermarkets would be hit, as they would be unable to attract shoppers with cheap booze deals (although supermarkets deny that they discount alcohol to drive trade) who might then have gone on to buy more profitable products.

Richard Dodd, head of campaigns at the British Retail Consortium, says: “It is certainly possible that retailers end up selling products that were previously cheaper at a higher price, which makes the stance [against minimum pricing] even more principled.”

If one piece of common ground exists, it seems to be this: when it comes to Britain’s out-of-control drinking culture, some one needs to call time, gentlemen and ladies, please.

NHS ‘brand’ could be sold overseas to generate income for hospitals

Category : Business

Government suggests service could learn from the lucrative success of US firms which have established themselves abroad

Hospitals are to be encouraged by the government to sell their services abroad, setting up clinics with the famous NHS brand to pull in much-needed cash for the health service from overseas.

The scheme – which has been put together by the Department of Health (DH) and the UK Trade and Investment department (UKTI) – attracted immediate criticism from the Patients Association, concerned that in times of financial stringency at home, establishing overseas clinics would be a distraction too far and could undermine standards at home.

But the government points to clinics that already exist, run by big-name NHS trusts with a reputation around the world, such as Moorfields Eye Hospital and Great Ormond Street children’s hospital in the Middle East. The government thinks there could be lucrative possibilities for NHS-standard healthcare services in growing markets such as India and China.

It also points to work that has already been undertaken in Libya by an NHS ambulance trust, which is helping to set up emergency services, while Virgin healthcare, with NHS GPs, is in discussions with Abu Dhabi about the provision of primary healthcare services.

UKTI and the DH think that the NHS could learn from the success of some of the major American brands, such as the private Mayo clinics and Johns Hopkins in Baltimore, which have established themselves abroad.

The health minister Anne Milton said the NHS would benefit and not suffer from the diversification.

“This is good news for NHS patients, who will get better services at their local hospital as a result of the work the NHS is doing abroad and the extra investment that will generate,” she said.

“This is also good news for the economy, which will benefit from the extra jobs and revenue created by our highly successful life sciences industries as they trade more across the globe.

“The NHS has a world class reputation and this exciting development will make the most of that to deliver real benefits for both patients and taxpayers.”

But critics of the healthcare reforms, already alarmed at the increased opportunity for private companies to take over parts of the NHS, are unlikely to feel comfortable about NHS hospitals drumming up private custom overseas.

Katherine Murphy, chief executive of the Patients Association, told the Independent: “The guiding principle of the NHS must be to ensure that outcomes and care for patients comes before profits.

“At a time of huge upheaval in the health service, when waiting times are rising and trusts are being asked to make £20

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Winterbourne View abuse: report criticises authorities for failing to act

Category : Business

Independent expert details hundreds of incidents of restraint and dozens of assaults on patients by staff at private hospital

The shocking catalogue of abuse at a care home first exposed by a TV investigation has been as laid bare in a damning report.

The owners of Winterbourne View, health regulators, local health services and police were all criticised for failing to act on increasing warning signs of institutional abuse by staff at the care home.

The 150-page report by independent expert Margaret Flynn was released on Tuesday and details hundreds of incidents of restraint and dozens of assaults on patients at the private hospital in Hambrook, south Gloucestershire.

Winterbourne View was exposed by BBC1′s Panorama last year when an undercover reporter recorded secret footage of patients being abused by carers. The video appeared to show vulnerable residents being pinned down, slapped, doused in water and taunted. The footage of the treatment caused a national scandal.

Since the allegations were first broadcast, the home’s owner, Castlebeck, has closed Winterbourne View and two other residential homes following concerns raised by the Care Quality Commission (CQC).

On Monday Michael Ezenagu, 29, became the 11th former member of staff at Winterbourne View to admit offences relating to the ill-treatment of patients. They will all be sentenced at Bristol crown court at a later date.

Peter Murphy, chairman of south Gloucestershire’s Safeguarding Adults Board, said that on behalf of the organisations that made up the board – including the local council, the NHS, Avon and Somerset police and the CQC – he wished to “convey our deep regret for the events that took place at Winterbourne View private hospital”.

“In particular, I would like to express our regret to the hospital’s patients and to their families, friends and carers.

“Winterbourne View hospital should have been a safe place for them to be treated with care and compassion. But the hospital’s owners, Castlebeck Care Ltd, failed to provide that care.

“Instead it left vulnerable adults in the hands of poorly trained and poorly supervised staff, who dealt out torment and abuse to those entrusted to their care.

“Many of those staff have now been subject to criminal proceedings and this should send out a clear and powerful message – that where employees engage in this kind of criminal behaviour they will be held to account.”

Murphy said the board accepted the recommendations of the report.

“We are determined that the necessary improvements will be made. Many of those improvements are already in hand and our shared objective must be that events such as this never again occur in south Gloucestershire.”

Murphy said the report had national ramifications.

“It examines in detail the underlying ‘root cause’ issues that underpin the existence and purpose of hospitals such as Winterbourne View and the nature and quality of care provided,” he said.

“In this respect, the findings of the report and its recommendations point towards a national policy debate with far wider implications for the health and social care system.

“The board is encouraged by early recognition of this in the June publication of their own interim report by the Department of Health. A final report is promised which will incorporate the findings and learning available from today’s serious case review report.”

David Behan, chief executive of the CQC, said: “There is much for all the organisations involved with Winterbourne View to consider in Margaret Flynn’s thorough and comprehensive report.

“I will ensure that the Care Quality Commission responds fully to all the recommendations for CQC.

“We will continue to work with other organisations to improve communications and sharing information to ensure we all protect those who are most vulnerable.”

Andrew Havers, medical director of NHS Bristol, North Somerset and South Gloucestershire Primary Care Trusts, said: “Many of the systems that could have prevented the shocking abuse of patients at Winterbourne View hospital failed.

“One year on, significant measures have been taken by the organisations represented by the Safeguarding Adults Board to ensure better standards of adult protection and improve commissioning across health and social care services for people with behaviour which challenges to reduce the number of people using in-patient assessment and treatment of services.”

Tuesday’s report was published as campaigners warned that another care home scandal like Winterbourne View could happen again unless the government takes action.

Mencap and the Challenging Behaviour Foundation warned that moving people hundreds of miles away from their families increased the risk of abuse taking place.

The two charities said a report they had compiled, Out of Sight, detailed several serious cases of abuse and neglect of people with a learning disability in institutional care.

They said they had received 260 reports from families concerning abuse and neglect in institutional care since the Winterbourne View scandal was exposed.