For many years, the treatment and care of people with dementia suffered from medical impotence and society’s indifference. Now, this growing patient class is getting more attention. How is the revolution in dementia care affecting the UK market for Alzheimer’s disease drugs?

The word most often used to describe the care of people with Alzheimer’s disease (AD) and other forms of dementia in the UK is ‘shocking’. From official reports to newspaper headlines, the diagnosis, early-stage treatment and late-stage care of people increasingly unable to express themselves have repeatedly been found seriously inadequate. It has often been pointed out that the patients do not choose to forget, but their doctors, nurses and care workers sometimes do.

The problem is complex. AD was first described in 1906, and the misconception that ‘senility’ is a normal consequence of old age is still widespread. Because AD patients become progressively less able to make choices and express views, their power to influence their own care is limited. Partners and family members often find it easier to regard the patient’s condition as a kind of ‘death’ – and while such a view may be a way of coping with loss, for it to colour the mindset of health and care providers is unacceptable.

In terms of medication, AD presents further challenges. A neurodegenerative disease, AD is progressive and irreversible. There are drugs that can delay its progression (in the earlier or later stages) and temporarily moderate the symptoms, especially when combined with behavioural therapies. So far, that’s all that can be done. The use of antipsychotics to suppress disruptive behaviour in people with dementia is no longer accepted as a norm of treatment.

Public awareness of AD has benefited in recent years from the high-profile intervention of fantasy author Terry Pratchett, whose ‘Discworld’ novels are major bestsellers. Since being diagnosed with early-onset AD in his late fifties, Pratchett has worked to raise public awareness of the inadequacies of dementia care. A shocking (there’s that word again) fact is that he has had to pay privately for his own medication, as Aricept – which costs only £2.50 per day – is only approved by NICE for treatment of people aged 65 and over (an age Pratchett reaches on 28 April this year).

In an interview with Fiona Phillips, another campaigner for better AD care, Pratchett made the moving statement: “I think the best thing I ever did with my life was stand up and say I’ve got Alzheimer’s.” He noted that while people with cancer are recognised as having the right to immediate treatment, people with AD and their families are often “left to get on with it”. The NHS tries too hard to prolong life, he argued, but does not try hard enough to maintain quality of life.

Pratchett’s determination to challenge the stigma of AD and the under-achieving norms of care for people with the condition has certainly had an impact. But will future dementia treatment be able to prevent or cure AD – or is it, like the Discworld, doomed to a permanent ‘flat earth’ phase?

Quality of life

The dementia care revolution began with the Banerjee report (2009) into the over-use of antipsychotics in care homes and nursing homes to suppress disruptive behaviour in AD patients. Dr Sube Banerjee stated that about 145,000 people with dementia were being inappropriately treated with antipsychotic medication in the UK, and that these powerful drugs were causing around 1,800 deaths each year. He recommended that the number of patients given such treatment should be reduced by two-thirds.

The National Dementia Strategy ‘Living well with dementia’ (2009) outlined key objectives and outcomes to improve the diagnosis, treatment, care and support of people with dementia across the range of care locations and through the entire patient pathway. It sought to make dementia care more comparable, in terms of methods and expectations, to that of other life-limiting medical conditions, and to ensure that all roles within the care pathway were clearly defined.

In March 2012, Prime Minister David Cameron launched the ‘Dementia challenge’, calling for “an all-out fight back against dementia”. He noted that about 670,000 people were living with dementia in the UK, and the number was expected to double within 30 years. The challenge promised to make the provision of information for patients, carers and professionals about relevant local health and care services mandatory; and to double the public funding for research into dementia.

A year later, the DH launched a dementia nursing strategy that defined the skills and capabilities expected of general, “dementia skilled” and specialist nurses working across all care settings. Emphasis was placed on the need for “seamless” integrated care. Significantly for industry, the strategy requires nurses to be “research aware and committed to delivering evidence-based care”.

A four-card hand

These developments mean that the AD market is primed for effective medicines and strategies for optimising their use. What does pharma have to offer?

Four drugs are currently approved by NICE for treatment of AD: Aricept (donepezil) from Eisai, Reminyl (galantamine) from Shire, Exelon (rivastigmine) from Novartis and Ebixa (memantine) from Lundbeck.

The first three drugs are cholinesterase inhibitors: they inhibit the breakdown of acetylcholine, a neurotransmitter, thus compensating for the loss of neural transmission that occurs in AD. They are recommended for use in patients with mild to moderate AD (in a 2011 update to the original NICE guidance, which recommended them only for moderate AD). However, the patents on Aricept and Reminyl expired in 2012, while the Exelon patent was declared invalid by the Court of Appeal in January 2013 on the grounds that it was an “obvious” application.

Up to 70% of eligible patients benefit from receiving cholinesterase inhibitors, showing improvements in both cognitive and emotional health. In most cases, disease progression is delayed by only six to 12 months. Ebixa is the only drug recommended for use in patients with moderate to severe AD. Its action is linked specifically to the effects of AD: it blocks the chemical glutamate, which is produced excessively by damaged brain cells and triggers a cascade of further cell damage. Ebixa can help patients to maintain everyday function, and may also reduce anxiety.

Lundbeck’s patent for Ebixa expires in April 2014. The company has supported NHS organisations to review dementia patients and reduce the inappropriate use of antipsychotics such as risperidone – which are clinically appropriate only for a minority of patients with moderate to severe AD, and are associated with increased risks of falling and infection. Painkillers, which can be used safely as an adjunct to anti-dementia drugs, can also reduce behavioural symptoms.

Better medicines use

Two challenges face the pharmaceutical industry in relation to AD treatment. Firstly, can it work with healthcare providers to optimise medicines use in the context of integrated care? Secondly, can it develop drugs that go further in preventing and treating AD than those currently available?

One company that has been active in medicines optimisation is Lundbeck, mental health specialist and manufacturer of Ebixa. As part of its partnership strategy, Lundbeck UK has supported a number of organisations in improving dementia care. The clarity of the 2011 NICE guidance on the use of AD drugs has made it easier for Lundbeck to work with the NHS in this disease area.

For example, Lundbeck’s project with NHS Sandwell (now replaced by Sandwell and West Birmingham CCG) used an Integrated Performance Framework to drive change in clinical practice. The project, which was described in an HSP Partnership in Practice supplement in 2012, had two goals: to build on the existing mapping and reduction of inappropriate prescribing of antipsychotics in care homes; and to help develop a local tool to support care home staff and enable GPs and psychiatrists to work together more.

NHS Sandwell, Lundbeck and performance consultancy Res Consortium formed a working group together with local health and care stakeholders. The project focused on AD patients with behavioural symptoms referred to locally as ‘Distress Reactions’, who were likely to be on antipsychotics and to need emergency admissions. Lisa Hill, Senior Commissioning Manager for mental health at Sandwell PCT, described the project as “a positive piece of integrated working resulting in a clear pathway and developing clinical leadership to address a complex issue”.

A brighter future

As with cancer, the targeting of disease mechanisms at the cellular level promises to deliver more effective AD treatments. The pipeline includes therapies based on two novel targets: Lundbeck and Otsuka have formed a partnership to develop and license a selective 5HT6 receptor agonist for use as an adjunct to donepezil; and a new UK biotech company, CoCo Therapeutics, has formed to develop new AD drugs targeting the retinoic acid receptor gene.

Dr Simon Ridley, Head of Research at the charity Alzheimer’s Research UK, commented: “A treatment that could stop the disease in its tracks would be a ‘holy grail’ for Alzheimer’s researchers.

“Much of the current efforts to develop new drugs for Alzheimer’s are focused on a protein called amyloid, which builds in the brains of people with the disease. Drugs designed to target amyloid have not yet shown benefits for patients in clinical trials, but it may be that these trials were carried out too late in the disease process.

“We now know that amyloid build-up occurs years before symptoms first appear, and many researchers believe that drugs targeting amyloid will need to be given early.

“Work to uncover potential new treatment targets must also continue,” Dr Ridley added. “To make the fastest progress, it’s vital to keep researchers talking to each other, which is why at Alzheimer’s Research UK we are working to connect our scientific teams with the pharmaceutical industry.”

The Department of Health has launched a “vision and strategy” to support and develop the contribution of all nurses to the care of dementia patients.

The strategy, published as the Prime Minister’s Dementia Challenge reached its first anniversary, describes what is expected of general, “dementia skilled” and specialist nurses working across all care settings.

Significantly for industry, the strategy requires nurses to be “research aware and committed to delivering evidence-based care”.

Listing the values and behaviours necessary for nurses involved in dementia treatment and care, the strategy includes:

• recognising that dementia “brings cognitive, behavioural and physical changes”

• supporting advance care planning

• promoting patient choice and focusing on “strengths and unmet need”

• using “all available resources including networking, technology and social media to improve care and access to services”.

A pyramid of nursing care is outlined, with all nurses providing “usual care and support”, dementia skilled nurses providing “assisted care or care management”, and dementia specialist nurses providing “intensive or case management”.

Emphasis is placed on the need for “seamless” integrated care across a range of settings: home, community and hospital.

The strategy addresses the responsibilities of nurses not only in the NHS but also in social care, the prison service and the private and voluntary sectors.

Pauline Watts, DH Nurse Lead for Dementia Care, commented on the launch of the strategy: “Dementia is every nurse’s business – with a change in mindset, practice, commissioning and education, nurses can make a real difference to people living with dementia and their carers and families.”

The Government should impose a public spending freeze, including the NHS, in order to fund major tax cuts, according to Tory backbencher Dr Liam Fox.

Speaking to the Institute of Economic Affairs, Fox called for an end to protection of the NHS budget and a “systematic dismantling of universal benefits”.

While PM David Cameron immediately dismissed the possibility of cuts in NHS funding (apart from the existing ‘Nicholson challenge’), the speech has been taken as a sign that the public are being prepared for changes in health policy.

Fox, who resigned his cabinet role in 2010 over corruption allegations, said he may stand for the Conservative Party leadership after the 2015 General Election.

His speech proposed a public spending freeze of three to five years, overriding the current policy of ring-fencing health, education and overseas aid budgets.

He also called for universal benefits, such as winter fuel payments and free bus passes for pensioners, to be scrapped, and for housing benefit to be available to people aged under 25 only in exceptional cases.

The capital freed by these cuts, he argued, should be used to fund a temporary abandonment of capital gains tax and to end taxation on savings.

Admitting that the recession will last many more years, Fox stated: “We must ask whether ring-fencing departmental budgets makes sense in a period of prolonged austerity.”

Cameron insisted that he “would not listen” to advice that meant abandoning the promised annual [0.1%] increase in the NHS budget.

However, under his leadership, over £5bn per year cut from NHS spending via the ‘Nicholson challenge’ has been passed on to the Treasury instead of being reinvested in services.

It is possible, therefore, that Fox’s proposals and Cameron’s policies merely occupy different points along a scale of changing NHS policy.

A vital aim of the NHS reform act is to reduce the amount of time patients spend in hospital beds. Paralympian Bethany Woodward is the perfect example of what can be achieved by getting treatment at home, avoiding unnecessary surgery and reaching personal goals. With three major athletic medals – you can’t argue with the results.

We meet in an upmarket hotel in London, where she is about to attend an awards ceremony. In previous Paralympic years this situation would probably not have happened. In a few short months the world has changed its attitude to disability forever.

It’s been pretty hectic since those halcyon summer days, but Bethy – who is wearing that iconic Stella McCartney tracksuit – has loved every moment. “It feels like a dream now,” she reflects.

Her charm, confidence and winning smile makes her a natural under the spotlight. It all seems so effortless, and yet, getting to this point has been the result of incredible determination.

While still a baby Bethany was diagnosed with cerebral palsy (CP). From the beginning, however, her parents – who are both senior NHS nurses – insisted on positivity. “I wasn’t diagnosed until eighteen months, when I started to crawl round in a circle,” says Bethy. “There were chances to have surgery to stretch my Achilles, but my parents were anti-operations. They didn’t want me to spend years in and out of hospital. Instead I relied on massages and walking.”

Run way
Bethy has always refused to hide behind her condition. “I’ve always tried to look at what is possible rather than what isn’t,” she says. “I was abseiling down the side of a mountain at three. I’ve never looked at my disability as something that will hold me back.”

During a blissful childhood she started to take up running after seeing the Paralympians at Athens 2004. It quickly became obvious that she had something special and, by the age of 17, she left home and headed for London to start a career in professional athletics.

“For me the hardest part was showing people my disability,” she remembers. “I didn’t expose it that much outside my safe circuit of people, but I can’t hide it on the track, where it is laid bare to everyone. Showing people that I’m proud to have CP and love my disability is really important. I wouldn’t change it for anything.”

Fast tracked
Before the Paralympics Bethy had rapidly climbed the rankings and at the World Championships in 2011 had claimed gold in the 400m. As the New Year unfolded, however, it became clear that while her speed was improving, her endurance was suffering.

She made a difficult decision. Rather than continue with 400m, she opted for 200m. Ironically, it is actually because of CP that Bethy has become such a versatile athlete, medalling at three different distances.

“I couldn’t carry on doing 400m,” explains Bethy. “I changed to the shorter distance and within a week I went from not being in the Paralympics to qualifying as a European record holder. I had a goal and I wasn’t going to lose sight of the dream I had for seven years.”

Passing the baton
One of the most gripping moments during the Games came in the aftermath of the women’s 4×100m relay final (T35–38). After receiving the baton smoothly from Olivia Breen, Bethy ran a magnificent second leg, before delivering a masterful changeover to Katrina Hart. The girls were in a glorious position to claim some precious metal, when suddenly Hart and Jenny McLoughlin got in a pickle with their exchange. The nation held its breath while officials checked whether the baton had changed over legally.

“We weren’t aware what was going on, because they were quite far away,” Bethy recalls. “When I passed the baton I thought ‘we’re on to a winner now’. We had no idea that there was a problem and were lapping up the glory. Can you imagine if we were running round and suddenly it came over the public address system that we had been disqualified?”

Fortunately they were inside the zone and Bethy was able to pick up her first Paralympic medal which, she confirms, is “bigger than a Wagon Wheel.” The time had come for the 200m.

One moment
“I was not coming out of the arena without a medal,” she said. “I was ranked number one and I wanted gold.”

On the morning of the race, however, Bethy’s condition meant that she wasn’t quite firing on all cylinders.
“There was a huge gap between the heat and final so I went for a sleep, but the thing about CP is that it is completely unpredictable. When I woke up my legs just weren’t there,” she explains. “You train really hard, but you can’t work out whether it’s going to be a good or bad day. Three races in under 24 hours is hard for anyone, but especially people with CP.”

At this point Bethy transports me back to the Olympic stadium with a dazzling description of her race.
“You couldn’t get complacent. The level of competition was fierce. I went on to that track and everyone was looking at me. This was my race, my stage, my town. I was nervously waiting in the call-up room, but as soon as I was out on the track calmness came over me. My family were there and my two brothers were watching me run for the first time. I ran on pure adrenaline and once I started to kick, pushed on by a mask of noise, I knew I would have a good finish. I loved every second, and took as much as I could, because I’m never going to see anything like that again.”

Para-mazing
Since being inspired by the Paralympians in Greece, eight years before, Bethy has witnessed the astonishing development of the Games, while also taking a great interest in Paralympic history.

“In Atlanta [1996] they were actually taking the Olympic village down when the Paralympics started!” she tells me. “In Athens there was only 15 minutes of coverage. Beijing had a full crowd, but it was free. In London two million tickets were sold, coverage was constant and there was global interest.

“This has resulted in a society-wide shift in perception. It was a real shock to be recognised as elite athletes. I’ve had children coming up to me and saying that they were inspired by me and now want to take up sport. People have changed their opinions and that will be the legacy.”

Bethy then quotes David Cameron: “The disability drifted from view and the sports person appeared.”
I conclude that this is possibly the first time that I have wholeheartedly agreed with the Prime Minister!

Building blocks
In preparation for the World Championships next year Bethy recently relocated to Loughborough with her partner Lee Doran – the javelin thrower who was controversially left out of the GB Olympic team for London 2012.

The pair will now train together at the same facilities, as they start the long journey to Rio 2016. Lee’s disappointment at not qualifying for the Olympics has served as an inspiration to Bethy who was able to rely on his support throughout the Paralympics.

“He’s incredible,” says Bethy. “He had a week when he was upset, but picked himself up and has been the most positive guy in the world. He’s my hero.”

Bethy’s burning ambition now is to break records and take home two golds from Brazil. After that she would like to become a speech therapist for the NHS. “I could go and earn a fortune, but I’d rather use my experience to change people’s lives,” she says.

I think it’s safe to say, she’s already done that.

After taking a couple of photos, we exchange farewells. Reflecting on our meeting I realise that Bethy is actually the epitome of progress: of what can be achieved by people regardless of their circumstances. NHS reform wants to change our attitudes but, as a society, the process of reforming has already begun.

The new National Health Action (NHA) party will attempt to unseat the architects of the Health and Social Care Act at the 2015 General Election.

Launched this week, the NHA has announced it will contest the seats of Jeremy Hunt and Andrew Lansley, the current and previous health secretaries.

Other targets for the single-issue party include Schools Minister David Laws, co-editor of the Orange Book, and Health Minister Dan Poulter.

The NHA also plans to contest the safe seats held by the Prime Minister and Chancellor of the Exchequer in order to raise its profile.

The party aims to encourage health professionals to stand for election, challenging the coalition’s claim that the reforms have ‘empowered’ them.

In addition to contesting 50 Parliamentary seats, it will put forward candidates for local government.

The party’s founder, oncologist Dr Clive Peedell, explained that David Laws was a target because he authored the chapter on NHS reform in the Orange Book, thus engineering a joint coalition health policy.

Peedell leads the NHA together with Dr Richard Taylor, a former consultant who represented Kidderminster for nine years as an independent MP committed to opposing hospital closures.

The decision to stand against David Cameron and George Osborne suggests a widening of the NHA’s agenda towards a general opposition to ‘austerity’ policies.

Another member of the new party’s executive committee, London GP Dr Louise Irvine, commented: “We should challenge the politicians in the ruling parties who have betrayed the NHS, lied to the public about their plans, and hidden their grotesque conflicts of interest.”

The party aims to give “doctors, nurses, health workers, patients, and concerned citizens” a focus for protest, she said.

The train ride towards a new commissioning landscape will reach its final destination next April, but is already encountering leaves on the track along the way.

It’s been another eventful few weeks as the commissioning structure continues to take shape. On Monday 1 October, the NHS Commissioning Board (NHS CB) was finally formally established as an independent body with executive powers and exceptional responsibilities. But it will have to wait until April 2013 to take on its full range of responsibilities.

Professor Malcolm Grant, NHS Commissioning Board Chair, said the formal establishment was a “new phase
in the history of the NHS”. Sir David Nicholson, Chief Executive of the Board, called the new responsibilities the Board now holds a “once in a lifetime opportunity to do things differently”.

The transition completes a hectic twelve months for the Board. Having only been established at the end of October last year, it has played a fundamental role in the Government’s vision to modernise the health service as outlined in the Health and Social Care Act. Arguably its main and most important task, before it takes on full statutory responsibilities next April, has been to assist in the development and authorisation of more than 200 evolving clinical commissioning groups.

As you would expect, this has not been an easy process. Alongside the introduction of clinical commissioning, it has also been given the responsibility for authorising Commissioning Support Units
(CSUs), who will assist clinicians in the procurement of certain services. While this may seem a routine task compared with the authorisation of a raft of CCGs, the Board has been criticised for the time it has taken them to appoint managing directors for the CSUs when clinicians are finally in a position to tender services.

The Board has also issued its response to the Government on the draft mandate for its NHS care objectives. Professor Malcolm Grant agrees the mandate is “fundamental” to the Government’s vision of a ‘liberated NHS’. However, he urged David Cameron and Health Secretary Jeremy Hunt to be “ambitious” in searching for new opportunities to focus on the “outcomes that matter to patients and the public.”

Professor Grant said that the “critical tests” of the mandate will be whether newly empowered CCG leaders can address and analyse the mandate and then say ‘‘Yes, this gives me the necessary freedom to address the needs of my local population.” Grant added that the mandate “provides a unique opportunity to make this happen.”

The Commissioning Board has also been informed by the Department of Health of an initial set of specialist
services it will be expected to commission nationally. Although the central powers for commissioning have now been transferred locally, the NHS CB will still retain responsibility for certain services which are defined as treating rare and uncommon conditions and illnesses. The 38 specialist services, which were selected by the Clinical Advisory Group for Prescribed Services, include:

• Specialised Cancer Services (adults)
• Haemophilia and related bleeding disorders (all ages)
• Cystic Fibrosis services (all ages)
• HIV/AIDS treatment and care services (adults)
• Specialised Mental Health Services (all ages)
• Morbid Obesity Services (all ages).

A final set of regulations will be established later in the year on which services will be commissioned nationally – following a consultation between the DH and the NHS CB on the initial recommendations.

Board under fire
But it hasn’t all been clear sailing for the NHS CB. Alongside being accused of delaying the authorisation of certain CCGs because of its stuttering CSU MD recruitment drive, the Board has admitted that it has failed to recruit a significant number of individuals from ethnic minority backgrounds. Jo-Anne Wass, HR Director, admitted the Board’s recruitment data did “not make easy reading”.

Questions have also been raised about the huge variation between clinical commissioning groups’ internal staff levels when compared to support service organisations. Critics have argued that CCGs will be forced to rely heavily on support units after analysis showed huge variations in staffing levels. Recent estimates from the DH show there are 4,200–6,300 staff employed by CCGs. Commissioning support units are expected to employ around 8,000 people.

Dame Barbara Hakin, National Director for Commissioning Development, has also been put under the spotlight by the General Medical Council. The GMC has commenced an investigation after a complaint against the commissioning director, who allegedly placed United Lincolnshire Hospital Trust under unnecessary pressure in 2009 when she was Chief Executive of the now disbanded East Midlands Strategic Health Authority. It’s claimed that waiting times and A&E targets were prioritised ahead of patient safety, despite warnings the trust was over capacity. Depending on the outcome of the investigation, the GMC may decide to take no action, issue a warning, refer Dame Barbara to a fitness to practise panel where she may be ‘struck off’, or decide on undertakings to allow her to keep her registration.

Commissioning Groups
Yet despite the disparity in numbers, evolving CCGs appear to be in good shape. Following the successful scheduling of all of the wave one applications, the NHS CB confirmed that all 67 CCGs in the second authorisation wave had submitted their applications on time. In fact, every proposed CCG is now involved in an aspect of authorisation with the Board – be it a 360° stakeholder survey, a desk-top review, a case study or a site visit.

However, the authorisation process has been delayed. Initially the Board moved the ‘waves’ back by a month each. It subsequently moved the waves back by an additional month, meaning all CCGs will now be authorised by March 2013.

CCGs have also learnt when their final commissioning budgets will be confirmed. Commissioning Groups will have to wait until December to find out how much money they have been allocated to organise local services to meet the needs of their residents. The budgets will be decided using a system called the Fair Shares formula, which analyses the unique circumstances practices face and the health and wellbeing
of local populations.

Commissioners have aired frustration about the amount of ‘red tape’ they face when trying to organise new local health services. NHS Clinical Commissioners, who represent CCGs across the country, say bureaucracy is hindering doctors in their attempts to redesign new services. Dr Charles Alessi, Chair of the National Association of Primary Care, said there was an “overwhelming number of rules and regulations” which were having a significant impact on commissioners.

Supporting units
But it seems the frustration many commissioners have aired at the slow rate at which CSUs are being established may soon be coming to an end. David Stout has left the NHS Confederation to lead CSUs in Essex and Hertfordshire; Tim Andrews has also been given joint responsibilities at Cheshire, Warrington and Wirral CSU and at Merseyside CSU; Derek Kitchen will lead Staffordshire CSU and Lancashire CSU. Dr Leigh Griffin has also been appointed as the MD of Greater Manchester CSU – meaning only two of the 23 CSUs are still awaiting a permanent managing director.

While the NHS Commissioning Board is readily completing the authorisation process for CSUs it has recently been distanced from employing their support staff. The NHS Business Services Authority has agreed to employ some 8,000 staff during the hosting period up to 2016. The move means that although the NHS
CB will provide oversight and direction to CSUs it will not be the legal employer of CSU employees to avoid conflicts of interest. The new distancing arrangements were welcomed by the Board, who said it would help CSUs “develop appropriately as organisations in their own right.”

After confirming four lead CSUs to provide communications and engagement services around the country last month, the Commissioning Board will now focus on assisting support units to provide services and help to CCGs through the authorisation process, to ensure they are as individually autonomous as possible, to
help CSUs develop to become specialist suppliers and to ensure units seize opportunities open to them.

As the NHS reforms continue to evolve it would seem the commissioning landscape is far from being complete. It’s going to be a busy few months.

The Government will use £15m from the Cancer Drugs Fund for a new nationwide radiotherapy programme aimed at providing nearly 8,000 patients a year with life-saving advanced therapy.

The Cancer Radiotherapy Innovation Fund, which will commence next April, will increase the use of Intensity Modulated Radiotherapy (IMRT) across the NHS.

IMRT targets more precise doses of radiation at tumours whilst minimising the impact on surrounding health tissue thus reducing side effects.

Health Secretary Jeremy Hunt said radiotherapy is one of the most “clinically and cost-effective treatments for cancer” available to the NHS.

The investment will be funded from any under spend arising from the Drug’s Fund in 2012-13. If there is no under spend, the money will be taken from other budgets, the DH confirmed.

Radiotherapy experts, Cancer Research UK and other relevant professional bodies will work together to ensure designated centres adopt the new technique and provide innovative therapy that is clinically appropriate, safe and cost effective.

Prime Minister David Cameron said the new fund would ensure patients get the “drug and treatments they need”.

“We already have a guarantee for drugs – that if they’re safe, cost-effective and doctors say you need them, you will get them,” he said. “From April 2013, for the first time ever, we’re extending that guarantee to radiotherapy too. This is going to help thousands of people at one of the hardest times of their lives.”

An extra £100m for purchase of new IT resources to aid frontline NHS patient care has been promised by Prime Minister David Cameron.

The funding will be used for electronic data handling, recording and communication systems – enabling nurses and midwives to spend “more time at the bedside”, he said.

Hospitals will access the funding in the form of loans, repayment of which will be reduced depending on patient endorsement through the new ‘friends and family’ feedback system.

A further £40m is promised to develop the clinical leadership skills of 10,000 ward sisters and community nursing team leaders over the next two years.

The PM also announced a £15m cancer radiotherapy innovation fund, starting from April 2013.

New Health Secretary Jeremy Hunt commented: “Most nurses and midwives chose their profession because they wanted to spend time caring for patients, not filling out paperwork. New technology can make that happen.”

Guidance for foundation trusts on the ‘friends and families’ NHS patient endorsement system was published by the DH on 1 October, and the system will be operative from April 2013.

Patients will be asked whether they would recommend a particular hospital ward or department to their friends and family. The results will highlight local priorities for the trusts.

Chancellor George Osborne has blocked the Dilnot proposals on social care funding, according to former Social Care Minister Paul Burstow.

Burstow, who lost his role in the recent Cabinet reshuffle, told the Telegraph that Osborne refused to sign off the £1.7bn needed to implement the proposals.

The claim, which the Treasury has rejected, forms part of a current Liberal Democrat shift towards challenging Government austerity policies.

According to Burstow, plans for a review of care services based on the proposals of economist Andrew Dilnot, have been finalised but the Treasury has refused them.

“The thing that has kept Dilnot alive has been the Deputy Prime Minister Nick Clegg saying this has got to stay on the table, while there was a desire by the Treasury to get it in the trash bin as quickly as possible,” he said.

A key proposal in the Dilnot review is capping the amount that individuals have to pay for their own care at £35,000.

The Government has expressed support for the principle of capping, but has not committed to a figure or a mechanism for making the funds available.

One option being considered is allowing individuals to opt into a capping scheme by paying an initial fee.

Burstow claimed that the barrier to implementation of the Dilnot proposals was partly “inertia” and partly fear that any reform of social care would incur the same negative reactions as the NHS reforms.

However, he argued, David Cameron and Nick Clegg “probably hadn’t tuned into enough at the time to see the fact that this was a popular set of changes, not a controversial set of changes”.

The Government’s controversial NHS reforms have resulted in a host of health officials being paid more than Prime Minister David Cameron, research has found.

Figures released by the Treasury show that more than 50 NHS employees earn more than the £142,000 annual salary David Cameron receives for running the country.

The well paid roles include 15 team director posts at the NHS Commissioning Board.

Rachel Reeves, the shadow Treasury Chief Secretary, said it was “staggering” that whilst NHS employees are losing their jobs the Government is “forking out on dozens of salaries” higher than the PM’s.

A freedom of information request by The Sunday Telegraph found that originally 77 posts would earn more than the PM’s annual salary as a result of NHS restructuring. “In relation to these roles, consideration was given to the skills and remuneration of existing NHS employees, ensuring that salaries were approved within an equivalent range,” said a statement by the Treasury.

The Treasury added that a further ten posts were approved in the four temporary Strategic Health Authority clusters, which are set to be disbanded in April next year.

“No one voted for these changes to the NHS, and it is shocking to learn that they are costing taxpayers millions of pounds in these salaries alone,” said Rachel Reeves.