Jim Gee, of the accountancy firm PKF, and one of the report’s authors, said: “The greatest proportion of the loss is high-volume, low-value fraud – prescription charges not being paid, for instance, equipment that disappears, or professionals claiming for an extra bit of treatment which perhaps they haven’t provided.”

Despite making progress in tackling the problem – the £3bn figure is around 3 per cent of the NHS budget, down from 5 per cent in 1998 – Mr Gee warns that greater transparency is needed to curb fraud further.

Mr Gee, who ran the NHS Counter Fraud Service between 1998 and 2006, said: “The Government should put the information into the public domain. How can you track whether you are being successful at tackling fraud unless you measure what the losses are? And how can you put in place the right solution if you don’t know what the problem is?”

A Department of Health spokesman contested the huge fraud losses. “While we do not recognise the figures quoted in this report, any suspicions of fraud or corruption in the NHS can be reported to NHS Protect on their confidential fraud and corruption reporting line,” he said.

The value of “fraud and unlawful action” identified by the NHS in 2010/11 – a year in which 105 criminal cases were successfully prosecuted – was £10,969,386.

More action is needed, said Julia Manning, chief executive of 2020health, a health and technology think tank: “If NHS management takes tackling fraud more seriously they will not only ensure taxpayers’ money is spent appropriately but find a significant source of savings to fund the growing demands that the NHS is facing.”

The report, written by PKF and Portsmouth University, reveals how the cost of fraud to the NHS is part of a wider picture of criminality, with an estimated 7.29 per cent of healthcare expenditure lost to fraud globally – amounting to £230bn a year, according to the report’s analysis of more than £1trn spent between 1998 and 2009.

In the autumn of 2009, Betty, who had suffered a devastating stroke five years previously, was felled by another which removed her capacity to walk, so she was rushed into hospital. Since UCH had been showered with government money, we anticipated top-quality care. And in the “acute” ward where they initially put her, she got it. But when they’d done all the tests and concluded that partial rehabilitation was the best that could be hoped for, they moved her to an over-sixties ward where people were put when medical science could no longer cure them. Here she would receive care, prior to her move to a residential rehab unit.

If that was the theory, the reality fell far short. It became immediately clear that care was at best intermittent: if you managed to find a nurse – not always easy – there was no guarantee that they would be either able or willing to help you. I got used to running errands for those of Betty’s neighbours without a relative or friend on hand, trying to get somebody – anybody – to bring them a commode, or change their soiled nightdress. A 90-minute wait for such assistance was not unusual. Opposite was a grand old lady whose dementia prevented her feeding herself, but every day her food was put in front of her and – unless some passing visitor lent a hand – was routinely taken away cold an hour later. Feeding her wasn’t the job of the food-trolley man, and it didn’t seem to be the nurses’ job either.

Indeed, we never knew what any given nurse’s job was, or where their duties ended and those of the rag-tag auxiliaries began. All we knew was that there weren’t nearly enough nurses, and almost no continuity, so that we had repeatedly to explain Betty’s needs from scratch. With a few gloriously shining exceptions, our nurses were either truculent, or bossy, or downright incompetent.

A further stroke removed Betty’s ability to swallow, and she was put on a drip. I enlisted a team of friends and private carers to provide the continuous day-long care which she now needed and which the hospital demonstrably could not provide. And it was one of these carers who noticed that the drip had come out of Betty’s vein after the evening nurse had “checked” her to ensure she was set up for the night: without those sharp eyes, Betty would have dehydrated until morning.

After having left her in good spirits one Saturday night – she always bounced back and made the best of things – I came in at 8.30am the next day to find that someone had got her out of bed and into a chair, with her tray of breakfast in her lap. But her speech was slurred, her movements lethargic, and there was food clogging her mouth… another stroke. When I grabbed a nurse and pointed this out, the reply was a weary shrug: OK, she would call for a doctor, but this was Sunday and there was only one on duty for the entire hospital, so it might take time. It took four hours. Illness may be a 24/7 thing, but medical care was unalterably 12/5. Later that day, when Betty indicated she was cold, even something as simple as an extra blanket could not be produced and I had to get a friend to bring one in from home.

With Betty’s natural optimism exhausted by anxiety and distress, it became imperative to get her out of this place. And though she only lived for seven further days after her return home, her escape from the dysfunctional world of UCH felt to her – and still does to me – like an absolute triumph.

So much had been wrong in this “flagship” hospital, from the blocked ward sinks and out-of-order televisions and drinks machines (all “out-sourced”) to the chronic lack of communication between departments; from the invisibility of consultants to the manic turnover of junior doctors. The ward’s (rotating) sisters were always hunched over their computer in a corner, implicitly discouraging enquiries of any sort. Nobody was in charge. Why have the consultants – all of whom must know this – never spoken out? Anecdotal evidence from neighbours indicates that, two years on, things are no better. And if UCH is one of Britain’s “best” hospitals, God help the others.

But nursing is the key, and the signs are – quite apart from rising staff shortages – that it’s going to become even worse. The Department of Health plans to abolish the practical diploma which nurses have traditionally taken: it plans to make nursing an all-graduate profession. Meanwhile state enrolled nurses – the junior ranks who used to keep the wards going – have been replaced by armies of untrained auxiliaries. It’s a safe bet that the new graduate nurses will regard the real mucky business of patient care as beneath their dignity.

What sick people need above all is empathy and human kindness. Those who possess these qualities make the best nurses in the world; those who don’t, simply shouldn’t work in hospitals. Empathy should be both prized and financially rewarded, and psychological screening should be used to sort the wheat from the chaff – among nurses as it is for hospital administrators. Without human kindness, we are lost.

Michael Church is a music critic for ‘The Independent’ (m.church@btinternet.com)

Tucked away at the side of the Great Western Hospital, social care staff from the local council and health workers from the NHS trust are leading the way in a revolution of public services, with advice from Britain’s best-known staff-owned business.

Last month, the 750 staff officially launched SEQOL, a not-for-profit social enterprise which has won a £30m taxpayer-funded contract to run adult social care for the next four and a half years. It runs two medical wards offering beds for stroke sufferers, among other services.

Free from the stranglehold of the town hall or Department of Health, they can restructure services, change shift patterns, improve staff benefits. Oh, and overhaul the storage cupboard. “We have saved a lot of money on our linen,” boasts healthcare assistant Lisa Simpkins. Pricing packets of pillow cases at £15 on the cupboard door has stopped staff wasting laundry. Every cupboard displays the price of what is inside. So 100 vomit bowls cost £15.03, while 100 bed pans are £14.48. It has cut waste.

“People can just get on and do things,” says Jane Trethewey, director of operations. “They don’t have to wait for permission for everything.”

One of the biggest ideas to transfer from John Lewis is the Colleague Assembly, which gives staff a direct say in how the organisation is run, including having access to the company’s finances. The reason they were able to become a mutual is a promise to deliver the same – or better – services more cheaply.

Heather Mitchell, chief executive of SEQOL, stresses that, unlike John Lewis, there will be no dividend for staff. “If we make a surplus we would reinvest that in the services or staff training.”

But whoever runs services, it is reassuring that some things never change. So far, patients agree. Colin Wadham, 83, heaps praise on the staff and says he has been sleeping better since transferring from the main hospital. “But the less said about the food the better.”

Maybe John Lewis could get colleagues at Waitrose to help in the kitchen.

The report due to be published on Tuesday, Good Growth: A Demos and PwC Report on Economic Wellbeing, shows that the average household would be willing to forgo £1,200 of its yearly disposable income if they believed this would reduce unemployment or long-term illness by 1 per cent. Most would also be willing to sacrifice £500 to improve equality within society.

In recent years, there has been a big increase in demand for all forms of flexible working. The law provides carers and parents with statutory rights to request more flexibility in hours. Jane and Liam Blackmore, both 34, from Caversham, have three children and Liam is a full-time father. Mrs Blackmore, who works full time, said a better work-life balance was difficult because she is the only breadwinner. “I work four days a week in the office and many more hours from home. I do strive for more of a work-life balance, but I find that if something has to give, it is usually time with my husband. The money I earn is very important as I am the only wage earner. In a dream world I would spend more time at home, but in reality it is not feasible.”

The Demos report recommends that encouraging firms to increase opportunities for flexible working would be well received by the public and could increase staff engagement, motivation and performance.

Kitty Ussher, co-author of the report said: “It might not be a complete surprise that people would rather work less than they currently do, but it is surprising just how dearly they value their free time.”

Firms that don’t allow employees to be flexible with their time are missing a trick. “A better rested, more engaged workforce would make business sense,” said Ms Ussher.

“Notwithstanding tight budgets, the desire to reduce levels of unemployment and disability, as well as looking out for future generations, reminds us that [the public] feel a sense of collective responsibility – perhaps more than they get credit for.”

Paul Cleal, a government and public sector leader at PwC, added: “Companies are getting better at meeting the demands for flexibility, not only because of new technology, but also new attitudes. By demonstrating flexibility as an employer, companies get more committed staff, which is reflected in lower turnover and higher productivity.”

There was a concern that there was a group of smokers who would remain smokers and not be interested in quitting, but, “in fact, what this study shows is quite the opposite,” McAfee said.

• MORE: Program urges smokers switch to smokeless tobacco

The percentage of smokers appears to hover around 20 percent as people take up the habit, he said. “But there has been a decline in the last five years in the rate of smoking, and smokers are actually smoking less,” he added.

“Perhaps the most dangerous situation we are in is we have seen over the past five years a flattening of the downward trend in youth initiation. We are very worried that there are a number of things that have been happening in terms of tobacco industry marketing techniques that affect youth,” McAfee said.

The report was published in the Nov. 11 issue of the CDC‘s Morbidity and Mortality Weekly Report.

According to the report, 68.8 percent of current smokers say they want to quit and 52.4 percent tried to quit during the past year.

In addition, 48.3 percent of smokers who saw their doctor in the past year say they got advice to quit. Moreover, 31.7 percent had counseling alone or with drugs to help them quit in the past year. And about 6 percent quit successfully in the past year.

McAfee noted that most smokers who manage to quit do so without the help of drugs or counseling. “About 20 percent of people take medication or sign up for counseling,” he said.

Other factors that are equated with quitting are education, where 11 percent of those with a college degree were able to quit, compared with 3 percent of those who did not graduate from high school, McAfee said.

In addition, blacks had the highest interest in quitting and the highest quit attempt rate than any other group, but blacks also had the lowest rate of successful quitting, McAfee said. Blacks were also less likely to use medication or counseling, he noted.

In addition, blacks were more likely to smoke menthol cigarettes, which decreases the rate of quitting, McAfee said.

If you can’t quit by yourself, the best way to quit is with a combination of counseling and drugs like Zyban, Chantix or other nicotine replacement therapy, the CDC report said.

“Smokers who try to quit can double or triple their chances by getting counseling, medicine or both,” CDC director Dr. Thomas R. Frieden said in a statement.

“Other measures of increasing the likelihood that smokers will quit as they want to include hard–hitting media campaigns, 100 percent smoke-free policies, and higher tobacco prices,” he added.

The CDC is releasing the report as part of the annual Great American Smokeout on Nov. 17. The event is sponsored by the American Cancer Society, and encourages smokers to make a plan to quit, or quit smoking that day.

The report also notes that the growth of smoke-free workplaces and public places offer smokers another incentive to quit.

In addition, the health care industry can help smoker quit through comprehensive insurance coverage with no deductibles or co-payments for cessation treatments and services.

Smoking is still the leading preventable cause of death and disease, including cancer, chronic obstructive pulmonary disease and other lung diseases. Each year in the United States, smoking and exposure to secondhand smoke kill some 443,000 people, the report noted.

In addition, for every smoking-related death there are 20 people living with a smoking-related disease, the agency said.

Vince Willmore, vice president of the Campaign for Tobacco-Free Kids, said that “the CDC report confirms that most smokers want to quit, but too many don’t get the help they need to succeed.”

“To help more smokers quit, it is critical that all private and government health plans provide affordable and accessible coverage for smoking-cessation medication and counseling, and that states use more of their tobacco revenues to properly fund tobacco prevention and cessation programs,” he said.

States must also continue to enact policies that encourage quitting, including higher tobacco taxes and smoke-free air laws, Willmore said.

In a related move, the U.S. Food and Drug Administration said Thursday that most of the warning letters it recently sent to more than 1,200 tobacco retailers were about illegal sales of cigarettes and smokeless tobacco products to minors.

FDA inspections of tobacco retailers found that most are in compliance with the law, but some still sell tobacco products to youngsters. Retailers who continue to violate the law could face fines.

“It should worry every parent that 20 percent of U.S. high school students smoke cigarettes,” FDA Commissioner Margaret A. Hamburg said in an agency news release.

“For many young people, that first cigarette or use of smokeless tobacco will lead to a lifetime of addiction, and for many, serious disease,” she said. “More than 80 percent of adult smokers begin smoking before 18 years of age. Retailers are vital partners in the FDA’s efforts to prevent tobacco use among kids.”

Chulabhorn, the king’s youngest daughter, said Friday during a visit to flood victims in Nonthaburi province north of Bangkok that King Bhumibol had gone into shock and lost consciousness after suffering abdominal bleeding and a sharp drop in his blood pressure. She said that about 800 cc of blood had been found in his bowel movements.

Chulabhorn said the king returned to normal health after being treated at the hospital where he has been staying for more than two years, according to the official royal news broadcast Friday night. The king, who took the throne in 1946, was originally hospitalized on Sept. 19, 2009, with a lung inflammation. Official statements said he remained at the hospital for physical therapy and nourishment to recover his strength.

In May this year, he had an operation to relieve a condition that made him walk unsteadily. A statement issued at the time said the spinal tap procedure was to relieve a condition common in the elderly — an excessive level of cerebrospinal fluid resulting in pressure on the brain.

Chulabhorn said Friday that after the May operation, the king “seemed to be at ease” until the flood crisis. The king has been shown from time to time on television speaking — sometimes with difficulty — at royal functions held at the hospital.

Chulabhorn said doctors told her the recent bleeding could have been caused by concern over the flooding.

“So I asked the nurse what he had been doing in the past few days,” Chulabhorn said. “It turned out that he had been watching news about the flood. This indicates that His Majesty the King loves his people as his own children. He is very concerned and he usually doesn’t speak much, but (his concern) is seen in his physical condition.”

She did not specify when the health problem took place, but her comments indicated it was more than a week ago. She had previously spoken about it on Nov. 7, though not in such detail, and said Friday that it happened the same day she had been visiting flooding victims in Ayutthaya province, also near Bangkok. She visited a Buddhist temple there on Nov. 4.

The Royal Household Bureau, which is in charge of releasing news about the king, said Saturday that it could provide no further details on the king’s health. Bangkok’s Siriraj Hospital, where the king is staying, said it could provide no information without the approval of the Royal Household Bureau.

It is potentially unlawful for private citizens to publicly comment on the king’s health. In 2009, four people were arrested on suspicion of using the Internet to spread rumors about the king’s health. Under the Computer Crime Act, spreading false information deemed harmful to national security is punishable by up to five years in prison and a fine of 100,000 baht ($3,260).

Open discussion of the monarchy is also constrained by strict lese majeste laws that make criticism of the monarchy punishable by up to 15 years in prison.

A doctor in neighboring Myanmar asked to comment on the king’s symptoms said it would take more than psychological stress for someone to lose 800 cc of blood. Dr. Tun Kyaw, assistant surgeon at the government hospital in Yangon’s North Okkala neighborhood, said there had to be other reasons, such as an existing affliction or side effect from medicine. Blood-thinning drugs can cause abnormal bleeding.

The doctor added that the blood the king lost “is a significant amount, especially for elderly people.”

Dr. O.P. Sharma, an expert in geriatric medicine in India, said the king likely would have required an immediate blood transfusion, constant blood pressure monitoring and an endoscopy if more bleeding occurred. But he added that the prognosis for such episodes is often good and that it’s difficult to predict whether the bleeding will occur again.

“They recover very well. He can recover pretty quickly,” he said. “… It’s a cause of concern, but I’m sure he’ll recover.”

The king traditionally has played a conciliating role in Thai society, and his decline in health has coincided with trouble in the Southeast Asian nation. A 2006 military coup ousting the then-prime minister ushered in a period of political instability marked by sometimes violent street protests.

His near-disappearance from the public scene has also raised concerns about what will happen after his passing. His son and heir-apparent, Crown Prince Vajiralongkorn, does not command the same respect and affection as the king.

Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

From The Daily Mail:

The Now That We Found Love hitmaker, who lost 150lbs in 2008, was embarking on daily runs and frequent gym sessions having fell off the health wagon, according to TMZ.com.

…

At the time of his death the 6ft4 star weighed in at 344lbs, TMZ reports.

Heavy D’s weight yo-yoed over the years. In 2003 he lost 135lbs – although he claimed it was in a bid to get film roles, not health related.

Three months before his untimely passing, he visited LA gym Ultra Body Fitness in West Hollywood to work out a new fitness programme.

One of his most recent trainers spoke to TMZ, saying Heavy D was working out six to seven times in the lead up to his death.

The personal trainer – named only as Tony – told the gossip website Myers diversified his routine with boxing and hiking.

Staff at Ultra Body Fitness have now erected a small memorial in his honour in the wake of this week’s sad news.

Eric Harris, 34, who is serving a life sentence for sexual battery on a child, said the soy in his prison chow is threatening his health by endangering his thyroid and immune system. Florida prisons serve meals with 50 percent soy and 50 percent poultry three times a day, a mixture that costs half as much as using beef and pork, the Department of Corrections says. The cost per meal: $1.70 a day for each inmate. Florida prisons began serving soy-based meals in 2009.

As an inmate at the Lake Correctional Institution near Orlando, Harris has few culinary choices. He can eat 100 grams of soy protein a day, use his own money to buy food at the commissary or eat a vegan diet, he says in the lawsuit.

“Excessive soy can be toxic to the thyroid gland,” said Sally Fallon Morell of the Weston A. Price Foundation, a nonprofit group that advocates a diet of whole, largely unprocessed foods and food high in saturated fats. “It can have hormonal effects.”

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Hippocrates of Cos, ca. 460-370 BC. Image via Wikipedia

In the land where Hippocrates was born, and the principle of selfless medicine invented, it has come to this: desperate Greek patients stuffing envelopes full of cash, in order to convince a doctor to see them. So reports Charles Forelle in today’s Wall Street Journal, where the end result of socialized medicine is on full display.

“Like nearly all Greeks,” writes Forelle, “[George] Gianakouras was covered by a state social-security fund, which paid €10,000 ($13,600) for [his] hospital bill. There was one more thing: Mr. Gianakouras said he gave his surgeon ‘black money’—€5,000 in cash—to perform the operation. ‘If you don’t pay,’ he said, ‘you don’t get anything done.” It has gotten to the point where the hallways of Greek hospitals are plastered with those circular no-smoking signs, with the red slash through the middle, except that the lit cigarette has been replaced by a stuffed envelope.

This is the point in the story where you get to pat yourself on the shoulder. “That could never happen here,” you reassure yourself. “Greeks are dirty, corrupt people, unlike us.” Admit it—that’s what you’re thinking. And, it must be conceded, Greece ranks 78th out of 178 countries in Transparency International’s 2010 Corruption Perceptions Index, below Bulgaria and Romania.

But the Greek experience points to the central illusion of government-controlled medicine. Advocates for state-sponsored health insurance do so out of a passionate conviction that such systems make their societies more equal. But, in reality, state-run systems create a coercive form of inequality, in which the poor and the middle class are consigned to ghettoized, inferior health care, while the rich and the politically-connected get the best care in the world.

This is what happens in Canada, which ranks sixth in the corruption survey (the U.S. ranks 22nd). When the multimillionaire Conservative premier of Newfoundland, Danny Williams, needed heart surgery, he didn’t need to bribe a Canadian surgeon to jump over that country’s infamously interminable waiting lists. Instead, he hopped on a plane and headed to an “undisclosed location” in the United States. “It was never an option offered to him to have this procedure done in this province,” explained Kathy Dunderdale, Newfoundland’s Deputy Premier.

In western country after western country, when the budgets get tight, governments try to balance their budgets by underfunding doctors and hospitals. Eventually, these providers do the rational thing and shut their doors to all but those who will pay more. It isn’t about corruption—it’s about math.

In September, large pharmaceutical companies like Roche and Novo Nordisk were forced to stop delivering life-saving drugs to Greek state-funded hospitals, which have paid for only $970 million of the $2.62 billion in drugs they used from January 2010 to June 2011. (The Greek government did end up paying some of these bills using—you guessed it—Greek government bonds.) In today’s WSJ article, Forelle talks about the extensive black market that has emerged from Greece’s financial failures:

Public health care’s strained finances have created a large private system, widely used by wealthier Greeks, as well as a shadow system built heavily on bribes—the envelopes of cash known in Greece as fakelaki. Generally, €20 to €50 buys a fast, basic office visit; surgeries can be thousands of euros, according to figures from Transparency International, the anticorruption group, which rates Greece the European Union’s most corrupt country.

“The state has exchanged public funding for private, under-the-table payments,” said Lycourgos Liaropoulos, a professor at the University of Athens and a prominent health-care economist. A study by Mr. Liaropoulos and his colleagues found that Greeks spend nearly as much on bribes and other “informal” payments as they do on “formal” costs such as insurance co-pays.

Bribery is so endemic that visitors to Evaggelismos Hospital in the heart of Athens will spot peculiar stickers in a corridor leading to the surgical suite. They look from a distance like no-smoking signs. But in place of the lit cigarette crossed through with a red line, there’s a hand offering an envelope.

The system is plainly under strain. Petros Avgerinos, an internist at the Polyclinic Omonia, a public facility in central Athens, said the hospital recently went several months without needles for bone-marrow biopsies. Like many doctors and some policy makers, he suggests legalizing the forbidden payments to help finance hospitals. “Greeks don’t feel well if they don’t pay their surgeon. It’s like a dowry,” Dr. Avgerinos said.

“In every house where I come, I will enter only for the good of my patients,” says the famous oath attributed to Hippocrates. Government-run, fiscally-broke medicine has made that oath harder, not easier, to uphold.