Greek hospitals and pharmacies are running short of around 300 medicines because drug companies are refusing to supply them.

Hospitals failing to pay drug bills and parallel trading by wholesalers and pharmacists are the main reasons for supplies being withheld.

Major pharmaceutical companies that have admitted halting shipments of some products include Pfizer, Roche and Sanofi.

Medicines for arthritis, hepatitis C and hypertension, statins, antibiotics, anaesthetics, antipsychotics and antidepressants are all affected.

Dimitris Karageorgiou, Secretary General of the Panhellenic Pharmaceutical Association, said: “I would say supplies are down by 90%. The companies are ensuring that they come in dribs and drabs to avoid prosecution. Everyone is really frightened.

“The government is panic-stricken and the multinationals only think about themselves and the issue of parallel trade because wholesalers can legally sell them to other European nations at a higher price.”

According to the Greek government, more than 50 companies are holding back products or planning to do so. The Ministry of Health is intending to fine eight major drug companies, which have not been named.

There are reports of widespread panic and anger among patients who are going from one pharmacy to another with prescriptions. “We have reached a tragic point,” commented Karageorgiou.

With austerity tightening in Greece, the debts owed to pharma companies by hospitals and social insurance funds has reached €1.9bn (£1.6bn).

Pfizer has admitted withdrawing four medicines “because alternatives were available and because of the parallel trade situation”: leukaemia drugs Zavedos and Aracytin, the analgesic Neurontin and the epilepsy treatment Epanutin.

Roche said it was withholding supplies to Greek public hospitals, apart from “critical medicines” such as HIV drugs, but was still supplying pharmacies.

Sanofi claimed it was still supplying public hospitals with life-saving and unique products (for which no generic version or recommended alternative exists).

GSK, AstraZeneca, Novartis and Boehringer Ingelheim denied they had stopped supply of any products to Greece.

The pharmaceutical industry has urged the Greek government to set its drug prices in accordance with a eurozone standard. Greek drug prices are 20% lower than the next lowest in the EU, giving rise to widespread parallel trading.

Greek regulator the National Organisation for Medicines has banned the export of 60 medicines and is considering another 300. It will fine wholesalers and pharmacists who have broken the export ban.

The Labour Party has outlined plans to integrate health, mental health and social care in a single system, ultimately run by local government.

Shadow Health Secretary Andy Burnham has argued that such a ‘whole person care’ approach is the only way to meet the challenges of chronic illness and the ageing population.

The current system, he argued, merely sees patients slipping in great numbers from primary care to hospital and hence to nursing homes.

Speaking to the King’s Fund health think tank, Burnham said a Labour government would legislate for “a one budget, one service approach”.

Health and social care would merge, he said, with the NHS providing social care and local authorities commissioning healthcare.

Echoing recent statements by NHS Confederation leader Mike Farrar, Burnham said that integrated care was the only way to meet the clinical and economic needs of the NHS.

To shift the balance of healthcare towards prevention, he argued, the Payment by Results tariff needed to be replaced by a ‘year of care’ payment system for patients with complex needs or chronic diseases.

The providers of integrated care might be either acute NHS trusts or primary care services, he said, but in either case both services would be combined – with mental health services brought under the same control.

Burnham said: “In the century of the ageing society the gaps are becoming dangerous. People are falling into the ever-expanding cracks between our three systems. We are paying for failure, allowing people to fail at home and drift into expensive hospital beds and from there into expensive care homes.”

However, critics will argue that local authorities lack healthcare expertise and are often the least responsible and reliable kind of politicians.

The payment by results (PbR) system for healthcare reimbursement is unfit for meeting the changing needs of society, according to the King’s Fund.

The think tank identified the current tariff as a barrier to the shift of healthcare from hospitals to the community.

A range of payment systems would be needed, the report argued, to encourage local innovation and to balance the priorities of quality, cost and supply.

The report explored the payment systems used in the NHS and other health economies, and examines whether PbR is able to support such long-term objectives as disease prevention and the care of long-term conditions.

Payment by results incentivises hospitals to continue treatment, thereby blocking a shift to preventative and community-based care, the report said.

It concluded that different services require different payment systems: PbR is most appropriate to elective care, but less suited to other services.

In addition, the King’s Fund said, payment systems need to be flexible to assist adaptation at a local level and trade-offs between priorities.

The NHS needs a new reimbursement framework that allows different payment systems for different types of service, the report argued.

Monitor, the foundation trust regulator, commented that it could “recognise many of the areas for improvement identified in the report” and would give it “careful consideration” when developing its pricing strategy.

Health Minister Lord Howe said: “We are working to make sure a payment system supports care being delivered closer to patients’ homes.”

He added: “We are working to expand our best practice tariff programme which supports patient-focused care, encourages innovation and makes better use of resources.”

Hospitals must prioritise ward rounds as a key element of clinical teamwork and patient-centred care, according to leading doctors and nurses.

In a joint statement, the College of Physicians and the Royal College of Nursing said a “concerted culture change” was needed to restore the team-based ward round.

Currently, doctors often conduct ward rounds on their own – wasting opportunities to share experience and insights, the colleges argued.

Pressure on hospital resources means that the formal ward round, where the clinical team visits each patient, has largely been discontinued – indeed, many wards have no distinct clinical teams.

According to the colleges, ward rounds serve key clinical functions: to make and refine the diagnosis; to review treatments and investigations; to communicate with family and other carers; to ensure safety; and to provide training.

“Ward rounds are critical to developing rapport and building trust with patients, while discharging a duty of care,” the statement noted.

“[They] also enable all individuals involved to express a shared aspiration to make the patient the centre of attention, empowered in his or her own care.”

The statement recommended that:

• Ward rounds should be led by consultants, include a nurse, and take place in the morning to allow decisions to be acted on the same day.

• Patients and carers should be given a summary sheet outlining the decisions made.

• Patients’ records should be kept centrally, and ward round teams should use locally adapted checklists.

Noting the financial barriers to these changes, the colleges argued: “Managers and the executive board bear a responsibility to protect time and resources, enabling all members of the multiprofessional team to prioritise the ward round.”

Acute care services across England are struggling to meet increasing demand and the complexity of patients’ conditions, a new report has said.

The report by The Royal College of Physicians (RCP) found that standards were falling in hospitals due to an increase in emergency admissions, the treatment of elderly patients with a variety of conditions and a reduction in the amount of beds.

Professor Tim Evans, from the RCP, said the evidence was “very distressing” and the Government must make “drastic changes” to improve standards of acute care.

The survey of RCP fellows found that doctors were most concerned about staff shortages, the workload in acute medicine, a lack of continuity of care, and the impact of NHS efficiency savings.

Doctors also raised concerns about how older patients were transferred between wards and that levels of care dropped at night time.

The report suggested that the NHS has been a victim of own success. Contemporary medicines are now allowing people to live longer, but this has resulted in them developing long-term conditions such dementia.

“All hospital patients deserve to receive safe, high-quality sustainable care centred around their needs,” said Professor Evans. “Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population who increasingly present to our hospitals with multiple, complex diseases.”

Solutions to tackle the problems, the report said, include concentrating services in fewer, larger sites that are able to provide excellent standards of care, regardless of the time of admission. The report also advises improving community services to stop patients returning to hospital.

Health minister Dr Dan Poulter said it is “completely wrong” to suggest the NHS is struggling to meet demand and insisted that the “NHS only uses approximately 85% of the beds it has available”.

“It is true that the NHS needs fundamental reform to cope with the challenges of the future,” he said. “To truly provide dignity in care for older people, we need to see even more care out of hospitals. That’s why we are modernising the NHS and putting the people who best understand patient's needs, doctors and nurses, in charge.”

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

The Care Quality Commission has experienced “serious difficulties” in its first 18 months, according to a National Audit Office report.

The NAO said the regulator had “struggled” to fulfil its role due to NHS instability, making only half of the hospital inspections it had planned.

However the CQC was “now taking action to improve its performance”, the report concluded.

The new inspection body replaced the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission in October 2010.

The NAO noted that the abrupt shift had caused “disruption for providers and confusion for the public”.

By April 2011 the CQC had carried out only 53% of its planned inspections of hospitals and care homes, and had not met its schedule for registering care providers.

The organisation suffered from lack of staff, the review said: after a year, 14% of its positions – including 100 inspector posts – were unfilled due to Government restrictions on recruitment.

Its failure to identify patient mistreatment and neglect at a residential care home near Bristol was also criticised.

Both the DH and the CQC itself were to blame for the regulator’s failings, the NAO concluded.

Amyas Morse, head of the NAO, commented: “The CQC has had an uphill struggle to carry out its work effectively and has experienced serious difficulties. It is welcome that it is now taking action to improve its performance.

He added: “The commission and the Department of Health should make clear what successful regulation of this critical sector would look like.”

The DH is currently reviewing the CQC; its findings will be published later this year. Margaret Hodge, Chair of the House of Commons Public Accounts Committee, called the NAO’s report “deeply worrying”.

The structural upheaval in the NHS is disrupting the roles of senior nurses who oversee quality and safety in hospitals, according to Nursing Times.

The journal reported that the impending end of the PCTs has tripled the turnover rate of senior hospital staff responsible for monitoring and reviewing quality.

Senior nurses are leaving PCTs for roles in the NHS CB, CCGs or commissioning support services, leaving hospitals short of clinical expertise.

A study by Health Service Journal looked at how the announcement in July 2010 of the coming end of PCTs affected hospitals.

It found that in the 16 months following that date, the turnover of PCT directors responsible for overseeing the quality of hospital care increased from 19 to 65, and the turnover of chairs of regular quality review meetings increased from 18 to 56, relative to the previous 16 months.

About two-thirds of these director and chair roles were held by senior nurses.

The findings have prompted comparisons with the Mid Staffordshire FT investigation, which revealed a link between loss of continuity at senior clinical level and failures to protect patient safety.

Sheffield University Hospitals Foundation Trust Chief Nurse Hilary Chapman emphasised the need for hospitals to retain senior clinical staff.

CCGs should only take over hospital management when they have proved they can monitor quality, she argued, while insufficiently experienced nurses should not take on such responsibilities.

The NHS needs to involve doctors and other clinicians more in its decision making, according to a leading UK healthcare think tank.

A report by the King’s Fund on hospital management identified a “very strong relationship” between clinical leadership and performance.

Quality, safety, patient access and financial performance all improve when clinicians have more influence over the system, the report concluded.

It noted that the NHS “employs some of the brightest people in the country, then disempowers and alienates them.”

The King’s Fund compared the CQC ratings of 30 hospitals over 2008–9 with their ratings on a ‘medical engagement index’.

It found that by increasing staff engagement to the level of the top 6 hospitals studied, the average hospital trust could reduce patient mortality by 2.4% and save £150,000 per year by reducing staff absenteeism.

John Clark, Senior Fellow at the King’s Fund, said those hospitals “where the doctors felt they had been valued, involved in setting the direction for the hospital, and were contributing to the priorities” were rated excellent or good in CQC terms, while those in the bottom third were rated fair or poor.

He emphasised that clinical leadership did not mean simply having a doctor in a key director role: “This is about wanting all doctors to be making a much bigger contribution overall to the running of the service or system.”

Primary Care Trusts will receive an extra 2.8% funding to provide services for patients in 2012-13, the DH has revealed.

The funding boost of £2.5 billion brings the total investment in local NHS services for next year to £91.6 billion.

Health Secretary Andrew Lansley says the investment gives trusts a “strong platform to sustain and improve NHS services for patients”.

The measure continues the Government’s pledge to increase NHS spending in real terms. However, after 2.7 per cent inflation is taken into account, PCTs will actually only receive an increase of 0.1%.

The overall billion pound budget includes an allocation of £87.5bn for PCTs to provide care for local patients. This includes £300m for re-ablement services to provide people with community care after spells in hospital – which the DH says is double the amount invested in 2011-12.

The remaining £4.1 billion will be invested in dental and eye care, pharmaceutical services and to support joint working between health and social care.

David Stout, PCT Network Director, said the weighted allocation was “pretty much what we expected”.

“There are no real surprises here,” he said, “but in areas under great pressure, this confirms they are under great pressure.”

The Government says the additional funding is “a significant step given the difficult economic climate” with Andrew Lansley insisting that the NHS must “still strive to get the best value out of every penny”.

“In the future, we want those closest to patients – doctors, nurses and other clinicians – to be in charge of the NHS budget to deliver care for patients,” he added. “Next year, the NHS will be bringing clinical leadership to the forefront in planning services for patients.”

Subject to the approval of the Health and Social Care Bill, the 2012-13 allocation will be last before the introduction of the NHS Commissioning Board which will be responsible for deciding how resources are divided.