A host of NHS trusts across south east London have launched a new medicines management campaign to combat widespread drug waste and treatments being misused or taken incorrectly.

The campaign, called ‘Get the best from your medicines’, will provide tips on how to help patients use and gain the most from their medication with the aim to save up to £2 million.

Vanessa Burgess, Chief Pharmacist for NHS Lambeth, said reducing the amount of wasted medicines was “very important” to help save millions of pounds’ worth of drugs.

New measures to cut waste include residents across the region being advised to check what medicines they have at home before ordering repeat prescriptions.

During visits to hospital residents are advised to take their medication with them and take any unwanted drugs to a pharmacy for safe disposal. Residents are also urged against stockpiling any medication.

Additionally, patients taking medicines for a long-term illness can now receive a free review via an appointment with their pharmacist.

“We know from talking to people that there are many reasons why people don’t take their medicines properly,” said Vanessa Burgess. “They may have too many different medicines to take, or be confused about why they are taking them. By getting a medicines check up from their pharmacist, they can talk through any issues and make sure that they are taking the appropriate medication in the right quantities, at the right times, and in the right way.”

NHS Lambeth, Bromley, Greenwich and Lewisham are all involved in the campaign.

The end to the ‘postcode lottery’ will have to wait a little longer. Hopes were raised earlier this year when the Department of Health unveiled plans to introduce an ‘innovation scorecard’. The scheme would prevent hospitals blacklisting expensive drugs recommended by NICE. Patients, regardless of their location, would be able to receive the latest treatments without delay.

The DH initially planned to have the scorecard “fully implemented by the Autumn.” But, after discussions with the NHS and the pharmaceutical industry, it now looks likely that the scorecard will not be in place until the end of the year.

Speaking exclusively to Pharmaceutical Field, a DH spokesperson said talks were still ongoing between the health service and pharma to “collect all the data and information needed to ensure the scheme is accurate and effective. It will be launched in the coming months.”

The new scheme is expected to work in three different ways:

1. The innovation scorecard will allow patients and the public to see which NHS organisations have adopted the latest NICE guidance on recommended drugs and treatments.
2. The NHS will no longer have an excuse not to provide patients with NICE recommended products. Treatments recommended by the Institute will now be automatically added on to local formularies, allowing doctors to prescribe more expensive treatments if they wish.
3. A new group will be established to help the NHS overcome any barriers when implementing NICE guidance. The introduction of new medication or treatment may mean big changes in the
   way services are delivered. The group aims to spread best practice across the health service.

The DH added that NHS Trusts receive funding for each new NICE appraisal, so financial issues should not be used as a barrier to the uptake of innovative new treatments.

Speaking when the details were first announced in late August, then Health Minister Paul Burstow said the “new regime” would be a “catalyst for change”. He added that the DH is “determined to eradicate variation” across the uptake of NICE approved drugs. “NHS organisations must make sure the latest NICE approved treatments are available in their area, and if they are not, then they will now be responsible for explaining why not,” he said. “Being transparent with data like this is the hallmark of a 21st century NHS. It is
a fundamental tool to help healthcare professionals improve patient care.”

The introduction of the scorecard has been backed by the ABPI. Stephen Whitehead, ABPI Chief Executive, said it would be a “valuable tool” to support the latest NICE recommendations. “There is still a great deal of variation across the country on which treatments patients are able to access and so I am hopeful the scorecard will help highlight discrepancies which can then be addressed,” he said.

Whitehead called the scorecard a “definite step forward” in ensuring patients receive the latest treatments as quickly as their European counterparts. He said the existing system was bad news for the health of the nation which resulted in a lost opportunity to “drive efficiency savings through the use of medicines”.

The NHS Confederation was equally receptive to the introduction of the scorecard. But former Deputy Chief
Executive David Stout warned its implementation may cause “unnecessary bureaucracy” and stretch NHS finances even further. “It is also important to remember that the NHS is facing an unprecedented financial challenge and organisations must live within their means while providing high quality care,” he said. “The reality is we can only afford to provide new drugs or treatments where they are cost effective and demonstrably add real patient benefits. In a health system with no financial growth, any new costs have to be offset by savings elsewhere.”

Stout added that the introduction of the scorecard will only be a success if the NHS engages with local communities and clinicians to decide what local priorities are.

Mike Farrar, Chief Executive of the NHS Confederation, has said the growing crisis in hospital funding demands major investment in community-based healthcare.

His statement follows an Audit Commission report showing that the number of hospital trusts in deficit increased from 13 in 2010/11 to 31 in 2011/12.

While the report called for tight control of trust finances, Farrar argued that the underlying problem is the over-dependence of the NHS on acute care.

The Audit Commission’s annual report on NHS finances said that while PCT finance was mostly healthy, there had been a dramatic increase in the number of foundation trusts and NHS trusts in debt.

There was “no room for complacency” over hospital trust finances and the need for tight spending controls, the Commission said.

Andy McKeon, its Managing Director of Health, commented: “The Department of Health and other relevant national authorities need to focus their attention on the minority of organisations whose financial position is deteriorating and on their geographical distribution and service standards.”

Farrar, who has long argued for a shift in funding from acute to preventative and long-term care, said: “This is the time for the NHS Commissioning Board to help providers, not with bailouts, but by releasing money to new CCGs so they can work with providers to help put them on a sustainable footing by changing the type and range of services they provide.

“Now is the time for big investment in community and primary care. It is worrying that the number of trusts in deficit has more than doubled in the past year. This situation is likely get worse unless we take radical action.”

The NHS has billions of pounds which is being unused, according to a new report by the Audit Commission.

Research into the NHS’ financial year 2011/12 discovered there was nearly £4bn in ‘uncommitted finances” after PCTs, SHAs and NHS trusts restricted spending.

The NHS Confederation said the money should be given to CCGs across England to help transform local health services.

The report revealed NHS organisations had a combined under-spend and surplus of £1.6bn. However, the number of NHS trusts and foundation trusts in deficit increased from 13 in 2010/11 to 31 in 2011/12. A small number of trusts did report improved finances during the same period.

It also highlighted the financial difficulties NHS trusts have in different parts of the country. The majority of NHS trusts in deficit were either in London or around the south east.

Andy McKeon, Managing Director of Health at the Audit Commission, said the findings show there is “financial room for manoeuvre in the future.”

“The NHS has also delivered the first tranche of its £20bn savings required by 2014/15,” he said. “While nationally the NHS appears to be managing well financially, and preparing itself for the changes and challenges ahead, a number of PCTs and trusts are facing severe financial problems.

“The Department of Health and other relevant national authorities need to focus their attention on the minority of organisations whose financial position is deteriorating, and on their geographical distribution and service standards.”

Mike Farrar, NHS Confederation Chief Executive, said the funds should be used for “big investment in community and primary care” to ensure services can meet demand in the future.

“Fundamental changes to the way we provide care are necessary if the NHS is to maintain financial balance and become more responsive to patients’ needs,” he said. “Doing this will require some difficult decisions and in some cases will require changing or closing down some services, but this can only happen if we build up the capacity in the community and in primary care to enable people to be treated at home.”

The growing use of casual ‘zero hours’ contracts by NHS hospitals poses a threat to “coherent cohesive services”, according to the BMA.

Public sector union Unison has claimed that zero hours contracts, well established among hospital orderlies, are spreading among clinical staff.

However, several NHS trusts have said that putting nurses on zero hours contracts is more cost-effective than using agencies.

A zero hours contract does not set any level of hours or pay, but allows the hospital to call on staff when they are needed – however, the staff are not committed to being available at any given time.

Sara Gorton, Unison’s Senior National Officer for Health, argued that providers using casual staff risked lapses in care quality: “Staff on zero hours contracts will not get the same training and development as those permanently employed – this is vital to making sure patients get top-quality care.”

“An expansion of zero hours contracts in the NHS is of great concern,” said Mark Porter (pictured), BMA Chairman of Council. “While they have a minor role in allowing recently retired doctors to continue to work, they are not conducive to planning coherent cohesive services which focus on the care of patients.”

In a survey by the Independent, several NHS trusts stated that zero hours contracts saved hospitals money by reducing the need for agency nurses.

The Royal College of General Practitioners (RCGP) has queried the introduction of an innovation scorecard insisting it will not improve standards of patient care.

Chair Professor Clare Gerada (pictured) has revealed her scepticism towards the plans which would make it compulsory for NHS Trusts to have NICE recommended products on their formulary.

But Professor Gerada said that the scorecard focuses on individual diseases and not the complex patients that GPs see on a daily basis.

She said: “While it’s important that we follow best practice, we need to be allowed to do things if we know they’re in the best interests of patients.”

Dr Gerada added that the DH should allow doctors to express their professionalism instead of “monitoring everything that can be monitored.”

RCGP Deputy Chairman Dr Richard Vautrey said than an innovation scorecard would only work if resources were in place for the NHS to fund every drug recommended by NICE. “All it is going to indicate is which CCGs have the funding available,” he said.

“It is disingenuous of the NHS Commissioning Board to suggest that CCGs can provide every drug NICE recommends.”

The DH has told CCGs to start working with PCT pharmacies to remove any drugs which are recommended by NICE from local treatment ‘blacklists’ as part of measures to introduce the scorecard.

An earlier study by GPOnline found that one PCT in four was blacklisting drugs recommended by NICE.

Seven NHS trusts on the brink of bankruptcy will be visited by Government ‘hit squads’ in an attempt to reverse ailing finances.

Government lawyers and auditors are to be sent to trusts hindered by private finance initiative (PFI) contracts in an attempt to save up to £1.5 billion.

Health Minister Simon Burns (pictured) said the deals were “absolutely disgraceful” and the contracts show a “cavalier disregard” for taxpayers’ money.

The seven trusts set to be visited by the ‘hit squads’ are: Barking, Havering and Redbridge; Dartford and Gravesham; Maidstone and Tunbridge Wells; North Cumbria; Peterborough and Stamford Hospitals; and St Helens and Knowsley NHS Trust.

It’s also believed that the ‘hit squad’ will also visit South London Healthcare Trust – the first NHS trust to be placed into administration – as part of the cost saving measures.

Mr Burns said that officials had analysed various PFI contracts and identified billions of pounds’ worth of savings.

It’s believed that throughout the NHS there are PFI deals worth more than £79bn. While the Government says it will not walk away from these contracts and leave the NHS with years of legal disputes, it is now focusing on means of reducing repayments.

“Seven hospitals got it horribly wrong,” Mr Burns said. “It is an absolute disgrace.

“The problem is some of these contracts are 2,000 pages long and realistically I suspect very few people have looked through them and been able to identify all the implications and potentials to make sure they are getting a good deal.”

Hospitals across England are struggling to deal with real term cuts in funding imposed by the Government as part of its efficiency savings, the NHS’ economic regulator has warned.

Trusts across England are forecasting cuts of more than 8% over the next three years as the Government attempts to meet its target of saving £20bn by 2015.

But following a review of trusts’ three year plans Monitor said that hospitals need to make “significant changes” beyond efficiency savings to remain financially sustainable.

The review found that hospitals may be forced to reduce services in an attempt to meet financial targets – despite being tasked with treating the same amount of patients.

Hospitals across England have started to reduce their cost base by an estimated £7bn to meet Government targets. However, Monitor expects trusts with hospitals built using private finance initiatives and small general hospitals to suffer the most when aiming to cut costs.

Andy Burnham, Labour’s Shadow Health Secretary, accused the Government of making a “major mistake” in imposing harsh savings targets instead of finding cost-savings efficiencies.

“Eyes were taken off the ball just when the NHS needed its full focus on the money and this report suggests the NHS has failed to get ahead of the problem,” he said.

“Senior civil servants complain of how hard they have found it to get the Secretary of State on the seriousness of the financial challenge – a damning indictment of his time in office. This failure to plan is resulting in an increasingly crude approach to reducing costs and panic measures. Ministers are in danger of losing control of NHS finances and urgently need to get a grip.”

The King’s Fund anticipates that the outlook for hospital finances are bleak over the course of the next three years but is unsure how the cuts will affect standards of care. “The question is to what extent that will translate into a cut in quality or in the amount of care hospitals provide,” said Professor John Appleby, Chief Economist at the King’s Fund

Renowned NHS foundation trusts in England will be encouraged by the Government to establish new facilities abroad in measures to increase profits.

Proposals by the Department of Health and UK Trade and Investment will see high-profile hospitals such as the Royal Marsden and Great Ormond Street create branches abroad to boost funds.

Profits from the overseas facilities would then be reinvested back into the NHS.

The plans, which are set to come into force later this year, have been criticised by the Patients Association who called them concerning.

“The key and only focus of an NHS hospital should be to provide treatment to patients on the NHS,” said the Association’s Michael Watson. “Any moves which would see commercial ventures, which are naturally going to be important for hospitals because they need to use them to raise revenue, would simply result in the attention of the hospitals being taken away from the core purpose – to treat patients in the UK and instead be focused on these hospitals abroad.”

Under the plans, Healthcare UK will identify trusts wishing to expand into new countries and find clients who wish to use the services. Funding for the ventures would come from the private sector to establish the facilities.

London’s Moorfield Eye Hospital and Great Ormond Street already have facilities in Dubai. But critics have argued that other hospitals are not in a position to provide services overseas, and any profits raised would be minor compared to the £100bn annual running cost of the NHS.

Plans to globalise the NHS were first outlined by Labour back in 2010. However, Jamie Reed, Shadow Health Minister, said the proposals were further measures to commercialise the health service.

He said: “At a time when staff are losing their jobs and waiting times are rising, the Government’s priority should be sorting out the mess it has created in our NHS.

“Under David Cameron we’re seeing a rampant commercialisation of the NHS. He needs to get a grip and start focusing on patients, not profits.”

Circle, the first private healthcare provider to manage an NHS trust, has drawn up proposals which it estimates could make the firm more than £8bn from other failing trusts.

In a presentation given to investors before it took over the management of Hinchingbrooke Hospital, it highlighted a number of other money-making opportunities in the NHS.

The document identified 32 trusts it viewed as “NHS growth opportunities” including Mid Yorkshire Hospitals Trust, NHS Isle of Wight and Barts and the London Trust.

Investors were told how “Circle is well positioned to win new contracts” and how there were “attractive returns on capital invested”.

Delegates at the Jefferies Global Healthcare Conference in New York were also told that St Helens and Knowsley Hospitals Trust was “publicly acknowledged to be a possible contract.”

A spokesperson for Circle said it was well known there were a number of struggling trusts across England and that its business model “would make us a good strategic partner for many of them”.

“Circle’s partnership model and entrepreneurial drive offers an alternative to cuts and closure for struggling NHS hospitals across the country,” said the spokesperson. “We should be allowed to do more.”

Since the presentation, a number of the 32 trusts outlined in the document have gone on to merge or gain foundation trust status.

When Circle took over Hinchingbrooke it agreed to take on the hospital’s £40m debt and, in return, to take the first £2m profit, 25% of the next £4m and 33% of the next £4m. It has since said it has improved performance in the NHS hospital’s A&E and colorectal departments, as well as making £1.1m cost savings.