Liverpool Care Pathway 'wrongly blamed'

27 January 2014 Last updated at 07:43 By Dr Claud Regnard Newcastle upon Tyne
There is now debate over what should replace the Liverpool Care Pathway For 10 years the Liverpool Care Pathway (LCP) was used to monitor care at the end of life, but negative media reports raised concerns it had led to poor care and even deaths - and last summer a panel led by the Baroness Neuberger decided that the LCP should no longer be used.
But writing in Scrubbing Up, Dr Claud Regnard, a consultant in palliative care medicine in Newcastle-upon-Tyne, suggests the media, government and Neuberger panel were wrong to blame the LCP and questions whether the ban was justified and will benefit patients.
The distressing stories of poor care presented to the panel looking into the LCP could not be ignored.
The panel rightly laid the blame at many different doors including poor communication skills, inadequate attention to the need for food and drink, questionable decision making and insufficient training.
These have been noted before in many reports or research papers and they always deserve repeating.
And yet, the report rejected the accusation that the LCP was a means of deliberately hastening someone's death and even praised it as an effective tool.
A University of Nottingham review that accompanied the report found no evidence that such pathways cause harm.
The panel did criticise checklists like the LCP, but was apparently unaware that used intelligently and compassionately they are crucial to ensure safety - on your next flight try telling the pilots they cannot use a checklist.
Many improvements in the care of dying patients in the last 45 years are thanks to hospice and specialist palliative care teams and, had they been included in the panel, the outcome for patients might have been different since there was nothing in the report to justify banning the LCP.
The LCP wasn't perfect - nothing ever is. But it had improved over 10 years and could have been improved further.
The LCP never required patients to be denied food or drink and never demanded that patients be sedated.
When these happened inappropriately they occurred because of poor decision making, not because of the LCP.
Care 'vacuum' risk
The LCP did require patients to be regularly monitored for any sign that they might improve and benefit from treatment to reverse the cause.
It also required carers to communicate clearly and work in partnership with the patient and relatives.
Ignoring these requirements happened because of poor skills and training, not because of the LCP.
Continue reading the main story

Many health professionals are frustrated at the loss of the LCP, and some fear that that care of the dying may be set back years. ”

End Quote The Neuberger report wanted the LCP phased out by July this year, but it is now clear that no-one wants to create a replacement that may be banned by a future similar panel.
The consequence will be a vacuum in monitoring care with the risk that poor care continues without hindrance.
It was easy to make the LCP a scapegoat, but this has been a disservice to dying patients. Banning the LCP was like banning the Highway Code because of a few bad drivers.
What now?
Relatives who received excellent care under the LCP have already expressed their surprise at the ban.
Many health professionals are frustrated at the loss of the LCP, and some fear that that care of the dying may be set back years.
But one recommendation in the Neuberger report may provide a way forward: to set up a national leadership alliance to improve end of life care.
There are cases of poor care, but there is also a remarkable amount of compassionate care that still exists in all health care settings with a determination amongst health professionals to work in partnership with patients, partners and families.
Some good may come from this, despite the decision to ban the LCP.

Medic's lifesaving gift in Uganda

19 March 2014 Last updated at 13:46

 

Andrew Jones used his own money to buy anaesthetic, sutures and drugs needed to save this patient A Welsh anaesthetist has told how he paid for a patient's treatment in Uganda rather than watch him die.

Andrew Jones, who works at Morriston Hospital, Swansea, was on secondment with the UN in Mityana, Uganda, where patients must fund their own treatment.

The burns specialist said it would have been "inhumane" to stand by and do nothing.

Mr Jones said the experience taught him how fragile life was and how UK hospitals waste precious equipment.

"It's really, really basic out there," he said.

"Anyone who comes into the hospital as a patient has to provide everything themselves - gloves, anaesthetic, syringes, the lot. If they don't have it then they don't get treated.

"But I couldn't sit by and watch that - it's inhumane."

Village births

Carmarthen-born Mr Jones, who is also clinical tutor at Swansea University's School of Medicine, put his hand in his own pocket and paid for local anaesthetic, sutures and drugs to treat patients.

"If a lady who is pregnant comes in to give birth they have to have what's called a baby pack," he said.

"This has everything they need to give birth but if they don't have it they don't give birth in the hospital. Simple as that. They go back to the village and give birth alone."

Mr Jones knew just how horrendous the conditions would be when he accepted the opportunity to use his specialist burns knowledge at the Mityana Community Foundation.

Mr Jones wants to return to Uganda in October to continue the work he started

The charity began as a result of a terrible tragedy in the town.

"A couple of years ago there was a school out there that, for security reasons, the children were locked inside overnight," Mr Jones said.

"But one night a candle tipped over and all the children were killed. That's how the charity was started up."

In the two weeks Mr Jones was in Uganda, he performed 37 procedures - some as a result of gunshot wounds, hit-and-run incidents and stabbings.

Makeshift mortuary

"The conditions are absolutely incredible," he said.

"A 21-year-old lad was knocked down by a motorbike and died. But because the mortuary roof was damaged we had to do the post mortem in a room in his house with his parents there."

Mr Jones also carried out five caesarean sections on pregnant women to deliver their babies.

"A lot of the patients had torn uteruses or placentas but they couldn't get from their village to the hospital," he said.

"They don't have transport so you have to go out to them. We did some of the c-sections in the villages, but there were others we did in the hospital."

Continue reading the main story

Everyone should do this as part of their training. I put myself on call from the moment I arrived until I left”

End Quote Andrew Jones The conditions also made for difficult, and dangerous, deliveries.

"Once we had the lights go out mid-operation," he said.

"The generator failed and it was pitch black. You literally couldn't see anything.

"Luckily I had a head torch in my pocket. One of the nurses put it on my head and I had to work with that. It was crazy.

"There would a legal battle if something like that happened in this country, but it's a part of life over there."

Mr Jones said basic equipment used in the UK is just not available in Uganda, which costs lives,

"The thing we use most in theatre is a surgical diathermy machine, which basically stops you from bleeding to death," he said.

"But they don't have that machine because of the power supply out there, which basically means patients bleed to death. There's nothing you can do."

On returning to Swansea, Mr Jones said he has learnt not to take equipment for granted.

"I think there are certain skills they've taken from me, such as how to separate waste," he said.

"I've noticed how much we waste equipment in this country. Syringes only cost 2/3p but they're a huge thing to them.

"I try to not waste anything."

He added: "Everyone should do this as part of their training. I put myself on call from the moment I arrived until I left... I was very sad to leave and I cannot wait to go back."

'Ban junk food TV ads until 21:00'

 

An analysis of TV ads showed chocolate was promoted during family shows Children are being exposed to TV adverts promoting unhealthy food which should be banned during primetime family viewing, says a campaign group.

Action on Junk Food Marketing analysed 750 adverts shown during the X Factor on ITV and the Simpsons and Hollyoaks on Channel 4 over 20 hours.

It found one in 10 promoted fast food restaurants, confectionery or supermarket 'junk food'.

But the government said advertising was not to blame for childhood obesity.

Continue reading the main story

The UK's evidenced-based approach to the advertising rules works, balancing sensible protections with the freedom to advertise”

End Quote Ian Barber Advertising Association The analysis, which was carried out by researchers at the University of Liverpool, found that unhealthy food items accounted for 11% of all adverts and around half of all food adverts.

They said the most frequently shown adverts for unhealthy food products came from supermarkets such as Aldi and Morrisons, followed by fast food chains such as Dominos and Kentucky Fried Chicken (KFC).

Chocolate manufacturers like Lindt and Cadbury and brands such as Clover and Flora Buttery were also included on the "unhealthy" ads list.

The researchers looked at adverts shown during 10 hours of X Factor programmes and another 10 hours of early evening Channel 4 programmes during the run-up to Christmas 2013.

Peak viewing

The campaign group Action on Junk Food Marketing, whose members include the Children's Food Campaign and the British Heart Foundation, said children's TV viewing peaks around 20:00 but laws to protect children from targeted advertising only cover children's programmes, which tend to be broadcast earlier in the day.

Simon Gillespie, chief executive of the British Heart Foundation, said: "Parents don't expect their children to be bombarded with ads for unhealthy food during primetime TV, but that's exactly what happens.

Pizzas were one of the most common fast-food restaurant products advertised

"Even when the show is over, junk food marketers could be reaching out to young people online. A lack of regulation means companies are free to lure kids into playing games and entering competitions - all with a view to pushing their product."

Prof Mitch Blair, officer for health promotion at the Royal College of Paediatrics and Child Health, said advertising junk food during family-friendly programmes like the X Factor is known to work.

"Not only are children and young people easily influenced and parents worn down by pester power, but food companies wouldn't spend huge amounts of money if it wasn't effective."

Continue reading the main story

We are all eating too many calories and too much salt, fat and sugar which impacts on our health”

End Quote Dr Alison Tedstone Public Health England Campaigners want the ban on "junk food" advertising to be extended to 21:00.

"Children should not be commercially exploited and the advertising industry must take some responsibility for helping tackle the growing problem of childhood obesity," Prof Blair said.

Sensible rules

The government said advertising was just one aspect in determining children's choice of food and one part of the package aimed at tackling childhood obesity and poor diet. It added that it was keeping "this area under review".

The Advertising Association went further saying the report was "lobbying dressed up as science" and the current rules on advertising were working.

Communications director Ian Barber added: "The UK's evidenced-based approach to the advertising rules works, balancing sensible protections with the freedom to advertise, allowing companies to compete - to the benefit of us all - and providing important funding for free-to-air TV."

But there is general agreement that with around one-third of UK children now overweight or obese, encouraging families and children to eat healthier diets is important.

Dr Alison Tedstone, director of diet and obesity at Public Health England, said they were working with the food industry to promote healthier products on TV through their Change4Life campaign.

"We recognise that we are all influenced by food adverts on TV. We are all eating too many calories and too much salt, fat and sugar which impacts on our health, causing obesity which increases our risk of cardiovascular disease, type-2 diabetes, and some cancers."

'Threat of extinction' to GP service

23 March 2014 Last updated at 15:18  GPs have been the bedrock of the NHS, says the royal college A funding crisis and increased demand for care means general practice as patients know it in the UK is "under severe threat of extinction", the head of the Royal College of GPs has warned.

The royal college's president, Dr Maureen Baker, said failing to properly fund GP surgeries could have an impact on the sustainability of the NHS.

Some practices were already closing due to lack of staff, she said.

The Department of Health said it recognised the "vital" job GPs do.

Continue reading the main story

We are fiddling while Rome burns and the four Governments of the UK must wake up to the critical state that general practice is now in”

End Quote Dr Maureen Baker RCGP chairwoman Health think tank the King's Fund agreed that GP services were under increasing pressure, but said talk of "extinction" was "a huge exaggeration".

'Toxic mix'

While general practice deals with 90% of patient contact, it only receives 8.39% of the overall NHS budget, the RCGP said.

Dr Baker urged governments in London, Cardiff, Edinburgh and Belfast to take action to address the "huge and historic imbalance in funding".

"General practice as we know it is now under severe threat of extinction," said Dr Baker. "It is imploding faster than people realise and patients are already bearing the brunt of the problem."

She said: "For generations, GPs have been the bedrock of the NHS and provided excellent care for patients.

"But we can no longer guarantee a future for general practice as our patients know it, rely on it - and love it.

"GPs are doing all they can but we are being seriously crippled by a toxic mix of increasing workloads and ever-dwindling budgets, which is leaving patients waiting too long for an appointment and not receiving the time or attention they need and that GPs want to give them."

'Grave concerns'

Funding for GPs is vital to protect the future of the NHS as a whole, Dr Baker said.

"Cutting funding to the bone is a false economy - by investing in general practice, we are shoring up the rest of the NHS from collapse," she added.

"We are fiddling while Rome burns and the four governments of the UK must wake up to the critical state that general practice is now in."

Continue reading the main story

Spending less on something is not necessarily bad if it is a sign a service is becoming more efficient.

The figures quoted by the Royal College of GPs include funding for areas such as pay, IT and drugs. Arguments could be made that squeezing all three is justifiable.

Pay rises across the rest of the NHS - and the whole economy for that matter - have been suppressed in recent years. So why shouldn't GPs also share the pain?

Meanwhile, there has been a drive to increase the use of cheaper generic drugs and get better value for money out of IT systems.

The big question is really whether patient care is being hit. The government argues not, but not everyone agrees. There are plenty of GPs and patient groups that claim getting appointments is becoming more difficult as services are stretched.

If there is not sufficient funding in the 2014/15 budget rounds, the RCGP has "grave concerns for the sustainability of the NHS", according to its president.

The royal college says that funding for general practice in England has fallen by £400m in real terms over the past three years.

In October, it published a report saying that £8.5bn had been invested in 2012-13, compared with £8.3bn in 2009-10, which is the equivalent of £8.9bn in 2012-13 prices.

And in November, it published figures with the National Association for Patient Participation showing GP funding across the UK at a nine-year low.

Between 2004-05 and 2011-12, the proportion of the NHS budget spent on general practice had fallen from 9.47% to 7.78% in Scotland and from 8.58% to 7.77% in Wales, it said.

In Northern Ireland, the figure dropped from 8.22% in 2010-11 to 8.1% in 2011-12.

Dr Baker told BBC Radio 5 live that while budgets had dwindled over the past three years, demand for GP services was increasing - from 300 million consultations in 2008 to 340 million in 2012.

She warned that "in some areas, we believe that some practices are already shutting down".

She welcomed government moves to train more medical staff, but called for immediate action "to shore up the service in the next few years, until these new doctors, nurses and support staff come on stream".

Increase in trainees

Prof Chris Ham, chief executive of health think tank the King's Fund, said that factors such as the ageing population and the complex needs of patients were putting GP surgeries under pressure, and he agreed their share of the NHS budget had fallen in recent years.

But he added: "I'm not denying the real pressures and the lack of funding, but it's a massive leap from saying that to saying GPs face extinction."

He said some surgeries were finding ways to cope with the pressures, including by offering more services by telephone and email.

Labour's Andy Burnham said appointment delays were "simply unacceptable"

An RCGP survey found that 62% of 1,007 people questioned thought the number of consultations carried out by GPs each day, believed to be between 40 and 60 in most cases, risks the standard of patient care they provide.

More than a quarter, 28%, said the last time they tried to book an appointment with their doctor they could not get one in the same week.

Four in 10 were worried that the amount of time they have to wait to see their GP could affect their health.

The poll, carried out by ComRes, also showed that 60% of the public want funding moved to general practice from other parts of the health service.

Shadow health secretary Andy Burnham said it was "simply unacceptable" that some patients had to wait up to a week for a GP appointment.

He said this was putting pressure on hospital accident and emergency departments.

A DoH spokesperson said: "We recognise the vital job that GPs do.

"This is why we have cut GPs' targets by more than a third to free up more time with patients, and are dramatically increasing trainees so that GP numbers continue to grow faster than the population."

NHS England said its funding for GP services had increased by a third in real terms since 2002-03. It said recent changes to the GP contract would free up doctors' time by removing "rigid performance targets".

MP disputes 'no NHS evidence' claims

 

Ann Clwyd says she had received 'several hundred' complaints about the Welsh NHS Labour MP Ann Clwyd has defended claims that she has not given the Welsh government facts or evidence to back up her concerns about the Welsh NHS.

First Minister Carwyn Jones told AMs Ms Clwyd had provided "unattributable" comments that "can't be investigated".

The Cynon Valley MP agreed the identity of patients had been protected in some cases.

But she insisted she had provided Mr Jones with a comprehensive summary of the complaints raised.

Ms Clwyd led a UK government-commissioned inquiry on how NHS hospitals in England handle complaints, and said she also received hundreds of letters from Welsh patients outlining poor experiences they had suffered.

During First Minister's Questions on Tuesday, Mr Jones said Ms Clwyd had been asked "on more than one occasion" to produce the evidence to back up her claims.

Continue reading the main story

As I have explained on a number of occasions, unless people want their names and addresses released then we cannot do it”

End Quote Ann Clwyd Cynon Valley MP He said information she had provided so far could not be investigated because it was "anonymous".

Ms Clwyd insists she has provided substantial evidence, but said it was important patient confidentiality was maintained.

"As I have explained on a number of occasions, unless people want their names and addresses released then we cannot do it," she told BBC Wales.

"We have had several hundred people with complaints about the health service in Wales and the best thing we could do was give him [Carwyn Jones] a list of the kind of complaints that people were making.

"I have been on about it for a year. I wrote a very comprehensive letter to Carwyn Jones dated December 10 after a meeting I had with him a couple of days previously."

'Confidentiality breach'

Her latest comments come a day after she called for the chair and chief executive of Cardiff and Vale Health Board to resign claiming it released private details on the investigation into the death of her husband Owen Roberts.

She claimed he spent 27 hours on a trolley at Cardiff's University Hospital of Wales before dying, in 2012.

The health board confirmed information about her husband's case was released in response to a Freedom of Information request, but denied breaching confidentiality.

It said the details released were statements already in the public domain and were part of the outcome of the investigation, which was completed some months ago.

But Ms Clwyd said she had previously refused permission for the information to be released.

The MP said she would be making a complaint to the information commissioner and considering legal action.

Dog disease could be medical boon

23 March 2014 Last updated at 00:40 By Lizzie Crouch BBC Radio Science Unit

 

Texas has been diagnosed with OCD Texas is a very energetic, smart and playful German shepherd dog. "He always tries his best to please me," said his owner Helene Bäckman.

But when Texas was six months old, Helene noticed that he started to behave unusually.

He started to jump and bite the air repeatedly.

"It´s like he sees something. He jumps and when he´s biting, he bites hard," she said.

"You can hear his teeth against each other.

"He can do this for hours and he gets more and more stressed when he´s doing it. He never rests between jumps."

The reason for Texas' unusual behaviour? Obsessive compulsive disorder (OCD).

OCD is well described in humans and the dog version of the disease presents with similar repetitive behaviours.

Whereas people might wash their hands multiple times or hoard objects, dog symptoms include constantly chasing their own tails or shadows, blanket sucking or repeated grooming.

Texas' symptoms include a behaviour called fly-catching.

This is where dogs snap or chomp at the air as if they're trying to catch imaginary flies.

"It hasn't been easy to get him diagnosed because nearly all people around me have said that just the way he is," said Helene.

"I live in the north of Sweden and had to drive 700km to [the vet who diagnosed him] in Stockholm."

OCD is one of hundreds of disease which the domestic dog suffers from that presents in a very similar way to the human form of the condition.

Other 'human' conditions that dogs are susceptible include:

EpilepsyNarcolepsyHaemophiliaCancerMuscular dystrophyRetinal degeneration

Although seeing our canine companions suffer may be upsetting, these shared diseases mean that dogs are emerging as one of the most important animal models of human hereditary diseases, advancing our understanding and paving the way for new therapies.

Genes for disease

Recent studies have identified genes that might cause the canine form of these conditions.

"It is much easier to find disease genes in dogs than in people," said Professor Kerstin Lindblad-Toh, of Uppsala University and the Broad Institute.

This is due to the fact that humans have been breeding dogs for hundreds of years.

Continue reading the main story Golden retrievers get breast cancer. So do jaguars, kangaroos and beluga whalesSiamese cats and Dobermans get OCD. Some are on ProzacCanaries, fish, and even Yorkshire Terriers dogs faint when they're stressed outMares can become nymphomaniacsDinosaurs suffered from brain cancer, gout and arthritisKoalas catch chlamydia, rabbits get syphilisReindeer seek out narcotic escape in hallucinogenic mushroomsGorillas experience clinical depression and eating disordersStallions self-mutilate Source: ZoobiquitySelecting dogs to create pups with specific characteristics has resulted in a certain amount of inbreeding, allowing disease-causing genes to become widespread in certain breeds.

This breeding history also means that all dogs within a breed are very similar genetically.

"This makes the search for the specific disease mutations less complex," said Prof Lindblad.

"In dogs we can find [disease-causing] genes with only a few hundred sick and healthy dogs, whereas in people thousands of patients and controls are needed."

In 2005, Prof Lindblad-Toh's team analysed all the genes of a female boxer called Tasha to produce an extremely accurate genetic sequence for the dog.

They, and other groups, have shown that the genetic sequence that makes up dogs like Tasha are quite similar to humans, meaning that many of the genes causing a disease in dogs may also be behind the manifestation of the condition in humans.

Prof Lindblad-Toh and her colleagues have recently published a study in Genome Biology which has identified four genes that are associated with OCD in dogs like Texas.

They are currently carrying out studies into whether these genes are also implicated in the human condition.

"Since the disease symptoms and medications used in dogs and people are similar, we expect that the same genes or other genes with similar functions will be responsible for the disease also in humans," said Prof Lindblad-Toh.

Pets are often used for these studies. The fact that they live in the same environment as us gives the dog another advantage over other disease models.

"Dogs are exposed to many of the same stressors that contribute to health problems," said Jon Bowen, behaviour consultant and veterinary surgeon at the Royal Veterinary College in the UK.

"Their diet often contains the leftovers from human meals, they are exposed to family stress (such as arguments and conflict), and are relatively socially isolated from members of their own species."

It is known that the environment can have an effect on how genes are expressed, and so any gene-environment interactions that cause human disease also affect our canine friends.

The role of rodents

Currently, researchers still rely heavily on genetically engineered mice to further our understanding of a whole range of conditions.

Whether ethically right or not, our knowledge of human disease has progressed considerably as our understanding of how we can genetically induce disease in mice has advanced.

But there are limitations. Research is done primarily in specific strains of young mice, specially bred for research and genetically manipulated to induce a disease.

Gorillas develop depression

You have to have some understanding of what genes you need to manipulate in order to induce the disease, and not every disease can be induced through such genetic manipulation.

"Naturally occurring diseases in animals are a lot more complex," said Holger Volk, professor of veterinary neurology and neurosurgery at the Royal Veterinary College.

"In a rodent you simplify a lot of things."

But these simplified diseases in rodents are far removed from the complicated reality of naturally occurring diseases.

"When you look at certain diseases in humans, there are so many factors which could be involved [in causing that disease]," Prof Volk said.

These factors, and the fact we are a complex organism, can often hinder our search for the underlying genetic cause of a disease.

The relative ease with which you can find disease-causing genes in dogs, combined with the shared organism complexity and environmental factors, means it is likely that understanding hereditary disease in dog will take us further in understanding human diseases that rodents can.

To human medicine

Using the dog for investigations into physical diseases has had already led to significant advances in our understanding.

For example, the identification of the genetic basis of narcolepsy in dogs led investigators to a previously unknown pathway in the brain, while other studies have led to the development of a new gene therapy for haemophilia, which is showing promise in clinical trials.

Experts say that there is increasing recognition of the value that veterinary medicine can bring to human medical studies.

"Wherever we can, we try to present our work at medical meetings and conferences, so that the medical profession can see what we are doing. Universally this gets a great response," said Mr Bowen.

There are also large schemes, such as the One Medicine Initiative, that hope to bring together researchers in medicine and veterinary medicine to solve health problems, currently being carried out that recognise the important link between the two fields.

"My research is driven to improve animal health," says Prof Volk. "And by doing that I can also help the human counterpart; it's a win-win situation for both species."

Hospitals feeling the pinch

21 March 2014 Last updated at 08:59

The attention of many households has been on budgets this week. In the NHS, it has been a similar story.

On Thursday the NHS Trust Development Authority - part of the Department of Health - released its latest financial forecast for hospitals in England. It made grim reading.

Of the 99 hospital trusts it keeps an eye on - it has no jurisdiction over those trusts given foundation trust status - 26 are predicting they will record a deficit this financial year based on the situation to the end of January.

It means the NHS hospital sector is facing an overall deficit of £247m once the trusts with surpluses are taken into account.

This is much worse than previously forecast, although it must be said the situation looks much rosier once foundation trusts, which tend to be the better performers, are factored into the equation. They are expected to post a surplus of over £100m.

Nonetheless, if that does happen the hospital sector would still finish the year in the red - the first time that will have happened for eight years.

There are a number of reasons why problems are mounting however. Demands are rising, while the amount hospitals get for treating patients has been squeezed as have their training budgets.

Biggest expense

But does this really matter? After all, hospitals are not like a business or households that face the prospect of not being able to pay bills or going to the bank to borrow money.

Instead, the shortfalls are covered by the Department of Health. But that misses the point - and here's why.

The debt is still recorded against the individual trust's balance sheet. This means they have to draw up plans to rectify their financial position and recover the debt.

For those with the biggest problems that can prove very difficult. This was the case for South London Healthcare, the trust which was abolished last year after racking up the biggest historic debt in the NHS.

In drawing up those plans, the 26 NHS trusts forecasting a deficit - and indeed their foundation trust counterparts which are in a similar position - will face some difficult decisions, as the NHS TDA's Winter Report hints.

The next 12 months will see more pressure on hospitals to ensure they have safe nurse staffing levels and meet the requirements of seven-day working. Both these pushes will increase labour costs - the biggest single expense in the health service.

The government argues hospitals can become more efficient. But most would say that will require long-term structural change to the hospital sector. In the short-term hospital bosses say they are faced with a tricky choice: go further into debt or cut back on care.

NHS Winter: Weekly A&E tracker Week 19

Winter brings extra pressures for the NHS, particularly in Accident and Emergency departments, as cold weather, flu and other winter bugs lead to falls, chest infections or heart problems.

We have been tracking the data so you can find out how your nearest major A&E in England is coping week by week.

Are they meeting the target of seeing 95% of patients in four hours? How many beds are closed? The same figures are not provided by Scotland, Wales or Northern Ireland, but we aim to include detail about those nations when we can.

94.3%

patients seen in 4 hours at major A&E hospitals

96.3%

patients seen in 4 hours at all A&E units

3,706

Ambulances queuing

for more figures on trolley waits, queuing ambulances and blocked beds

This week at

The figures relate to the trust as a whole rather than individual hospitals. Some trusts have more than one hospital with a major A&E department but NHS England does not break the figures down by hospital. The government target is that 95% of patients arriving at a major Accident and Emergency should be seen within four hours. major A&E trusts missing 95% target major A&E trusts meeting 95% target The number of people who visit the unit during the week These are when patients need to be admitted into the hospital for further treatment. The majority come via A&E, but some also arrive after GP referrals or after outpatient appointments. The figure shown only includes those patients who have been admitted by A&E. The number of people who have waited longer than the target of four-hours to be seen or admitted into hospital. This is an indication of a long wait for an emergency admission. It measures the time it takes after A&E staff have decided a patient needs to be admitted to hospital to the point at which they are given a bed. Ambulances can only leave A&E when they have formally transferred a patient into the care of hospital staff. The NHS is meant to do this within 15 minutes of an ambulance arrival. A queuing ambulance is classed as one that has waited at least 30 minutes. Pressure on A&E can affect other parts of the hospital. This measures the number of non-emergency operations cancelled, which includes treatments such as hip and knee replacements. Some patients, particularly the frail elderly, can only be discharged when the hospital is satisfied there is the right care in the community, either from social care or the NHS, for them to be properly cared for. This is an indication of how many days have been lost due to patients being kept in hospital when they are ready for discharge because of insufficient services available out of hospital. The figures are calculated by adding together the number of beds blocked each day to create a weekly total. Figure is calculated by adding the number of beds unavailable each day due to diarrhoea and vomiting or norovirus-like symptoms over the week. Return to article

Adam Brimelow, health correspondent

Nearly 450,000 people turned up at A&E in England last week - the highest figure since July last year. But performance against the key waiting time target - to deal with 95% of patients within four hours - improved on the previous week.

NHS England says falling emergency admissions and fewer long waits for admission suggest pressure on the system is easing. It all reinforces evidence from outside the window - spring is here.

Overall 96.3% of patients were seen within the deadline. At major A&Es, the figure was slightly lower at 94.3%. Sixty out of 144 big emergency departments were outside the four-hour standard.

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Download the data Continue reading the main story Notes Saint Bartholomew's Hospital is missing data for 8 January. This means that figures for the following categories may be revised upwards when all the data is available; ambulances queuing, cancelled operations, beds blocked and bed days lost due to norovirus.

During the holiday period, weeks seven and eight of the tracker, figures were compiled slightly differently by NHS England. This means that week seven is slightly longer than week eight as the data for the 24-26 December was recorded as a single entry, meaning week seven gained a day, and week eight lost a day for the following categories of information; ambulances queuing, cancelled operations, beds blocked and bed days lost due to norovirus.

In week six of the tracker, Southend University Hospital NHS Foundation Trust was unable to provide the weekly figures for some of the data, so we have used an average from the last five weeks for: Patients seen in 4 hours, Attendance at A&E, Emergency admissions, People who waited more than 4 hours to be admitted and Trolley wait between 4 and 12 hours. We will update with the latest figures when they are available.

Chase Farm Hospital, part of the Barnet and Chase Farm Hospitals NHS Trust, no longer has an Accident and Emergency department. The data for the trust now only relates to Barnet Hospital.

The Princess Royal University Hospital (PRUH), Bromley, is now part of the King's College Hospital NHS Foundation Trust. We will be adding the PRUH to the search, but to see data for the trust in the meantime please enter the postcode: SE5 9RS.

Produced by Dominic Bailey, Ransome Mpini, Charlotte Thornton, John Walton, Chris Ashton

Why 'no make up selfies' raised £2m

 

The 'selfie' has reached a new zenith this week, thanks to the "No Make Up Selfie for Cancer Awareness" campaign which has seen £2m raised for Cancer Research UK in the space of just a few days. But how did it happen?

The #nomakeupselfie started trending on Tuesday as women posted pictures of themselves without make up on Twitter and Facebook, and urged their friends to do the same.

Cancer awareness became the theme, selfie posters pledged donations to cancer charities and CRUK set up a text number to make donating even easier.

Continue reading the main story

Very rapid communication like this has never been faster in human history, but you have to be careful...”

End Quote Dr Linda Gibson Nottingham Trent University But the cancer charity did not kick-start the trend - it grew organically, making a huge impact on social media and getting attention in national newspapers and on radio and TV news.

So why did it go viral? Was it all about raising awareness and money for life-saving research?

No-one quite knows how the trend started. It may have been related to the Oscars selfie featuring a gaggle of gorgeous A-list actors which was retweeted endlessly following the film awards in early March.

Or it may have been a reaction to the negative comments directed towards 81-year-old actress Kim Novak following the same event.

People lined up to sympathise with her by posting pictures of themselves in (mostly) unflattering lights.

Cancer Research UK staff celebrate the donations

With hundreds of thousands of donations, 826,000 likes on Facebook and 140,000 followers on Twitter, Cancer Research UK confessed to being "overwhelmed with donations and support".

But not everyone is behind the idea that women revealing their real face is something brave or altruistic.

Commentators have lined up to say that the campaign made cancer awareness all about vanity and emotion rather than about useful, practical action.

Dr Linda Gibson, senior lecturer in public health at Nottingham Trent University, says the success of the campaign shows that social media is a very powerful medium, particularly among young people, but there are dangers inherent in it too.

"This campaign has captured the imagination. Very rapid communication like this has never been faster in human history, but you have to be careful.

"You can lose the depth of message. When thinking of designing interventions using these media there can be unintended consequences."

Even a Virgin cabin crew join in the "no make up selfie" trend

The message may not be clear, but that can be a good thing because it forces people to ask "what's this about?", she says.

The problem comes when people believe they are doing something important when really their actions are not changing anything.

In that case, aren't we just using social media to clear our consciences, just by sending a selfie?

The money raised - 80p in every £1 donated goes to cancer research - suggests this is more than just an exercise in self promotion.

Images sent to CRUK demonstrate that people want to show their solidarity with cancer sufferers, and pay tribute to friends and family who have died from the disease.

The Institute of Fundraising says combining popular trends with fundraising is a great way to reach young and untapped audiences. Men are now getting on board by posting selfies of themselves wearing make-up, this time in a bid to raise awareness of men's cancers.

Use of celebrity trends also helps to target those that wouldn't necessarily think about the charity or the cause otherwise, it adds. And there have been plenty of big names posting their selfies this week.

But perhaps there is more to the success of this selfie campaign.

"Maybe it's about how women feel about themselves, and their private and public faces," says Dr Gibson.

"The image of women in the media can be so artificial and constructed that body image often becomes an issue.

"This is almost an act of rebellion."

Miscarriage link to low IVF success

21 March 2014 Last updated at 02:29 By Pippa Stephens Health reporter, BBC News

 

The study analysed 124,351 IVF pregnancies between 1991 and 2008 Women who produce fewer eggs during IVF treatment are more likely to miscarry, research suggests.

Scientists analysed 124,351 IVF pregnancies between 1991 and 2008.

About 20% of pregnancies in women who produced fewer than four eggs after the ovarian stimulation phase of IVF ended in miscarriage.

The research indicated the quality of the eggs in these cases was poorer - clinicians said this information would help them to counsel patients.

IVF involves stimulating a patient's ovarian cycle, extracting eggs from their ovaries, fertilising them with sperm in a laboratory, then transferring the embryo into the womb to develop.

Ovarian surgery risk

In the study, carried out at King's College London and the University of Birmingham, the miscarriage rate fell to 15.5% for women who produced between four and nine eggs, and 13.8% for those with between 10 and 14 eggs.

The average risk of miscarriage across the population is 15%.

The co-author of the research, Dr Sesh Sunkara from the Reproduction Unit at King's College London, said: "I think the information will empower women.

"IVF treatment can be a distressing experience, and miscarrying makes it even more agonising."

Dr Sunkara said the study could indicate new risk factors such as ovarian surgery, which could increase miscarriage risk if it lowered the number of eggs a woman produced.

The fact women with fewer eggs had more miscarriages indicated the quality of the eggs must be lower, she said, as it was through such eggs miscarriages happened.

Continue reading the main story

It is really devastating for women... you want to cry with them”

End Quote Prof Siobhan Quenby Professor of obstetrics, University of Warwick Early menopause Prof Neil McClure, professor in obstetrics and gynaecology at Queen's University, Belfast, said: "This study is vast in terms of its numbers, and reached a very logical conclusion."

He said reduced egg production was linked to a woman's age, as young women produced lots of healthy eggs, which decreased in number and quality with age.

Prof McClure said he thought the younger women in the study who produced fewer eggs did so because they were on the brink of an early menopause, which was "more common than we might think".

Women who had miscarried after IVF and were worried about miscarrying again could opt for an egg donor, he said, adding that cutting down on smoking and eating a healthy diet would also help.

Help for clinicians

Prof Siobhan Quenby, professor of obstetrics at the University of Warwick, said: "It [the study] will be very helpful for me as I see a lot of people who have miscarried after IVF."

She said uncovering the link between low numbers of eggs and egg quality was important to inform people in deciding whether to carry out another round of IVF, which costs on average about £10,000 if done privately, or opt for an egg donor.

Prof Quenby added: "There is a lot of emotional trauma involved in miscarrying after IVF. It is really devastating for women who wait 10 years to have a baby and then with eight weeks to go they miscarry.

"You want to cry with them."

Ambulances: A call centre worker on a busy job

 

On Tuesday, the BBC followed tweets put out by three busy ambulance call centres - North West Ambulance Service, West Midlands Ambulance Service and East of England Ambulance Service - under the #team999, giving a revealing snapshot of the high-pressure work of ambulance crews.

At the end of the day, we put a series of questions to Jess Parsons, a call handler for the West Midlands service.

Question: What was the biggest waste of time and what was the most rewarding in terms of cases?

Answer: Waste of time - either the chap who 'ordered' an ambulance earlier and didn't need it because 'the patient was just p****d' or perhaps the woman who at the bus station who hung up on me - we still needed to send a rapid response vehicle so that we could be sure: but we could have done it on the phone if she'd talked to me - obviously tied up a resource that could have been doing rather more.

Most rewarding - I would say the stroke case or the cardiac arrest.

Question: Do you ever manage to follow up on some cases that you wished to know more about?

Answer: Sometimes the crews will inform call centre staff, but once in hospital care we are unable to get individual updates

Question: Is it typical that falls account for a greater proportion of your calls than any other topic?

Answer: Falls make up for around 20% to 25% of our calls, though that can rise when it is icy.

While some of them can be simply people tripping over and injuring themselves eg a fractured hip, we need to be mindful that it is not because the patient has had a heart attack - or even a cardiac arrest.

Question: One of the featured tweets was about a man who was inebriated, what volume of calls would you say are completely inappropriate?

Answer: Clearly we get rather more alcohol related calls on a Friday and Saturday night for obvious reasons.

It is difficult to put an exact figure on how many calls are alcohol-related - we don't specifically record that as we often have no proof that it is alcohol that is the cause.

Some medical conditions produce a not dissimilar response from the patient eg head injuries often make patients very violent.

On a Saturday night is the patient aggressive because of booze or the head injury or both?

In regard to inappropriate, there are undoubtedly some calls that people should be accessing other parts of the NHS and that is why we think 111 has real potential as a way of signposting patients to the most appropriate place for the type of help they need.

We've just taken over the bulk of 111 in the West Midlands and this is an area we are working on really hard to help integrate the services much more closely.

Our statistics show that only about 10% of 999 calls are truly life threatening - our primary role. Roughly 90% to 95% will require some form of help from the NHS, just not necessarily the ambulance service.

Question: How pressurised would you say it is working in a call centre?

Answer: Pressurised is perhaps not the right word - it can be intense at times.

When it's really busy you need to give 100% to each call while being aware that there could be other people waiting to get through. Just need to be really focused on the job at hand.

Question: Are there times in the week that are busier than others? And times when it is quieter?

Answer: Friday and Saturday night into the following morning are particularly busy. The only 'Q' (we never say that word in the ambulance service) time is possibly in the early hours of a weekday morning, but even then it keeps ticking over.

Question: Some of the tweets were about working in public places, such as on a bus - how difficult is it for paramedics to carry out their work in such public situations?

Answer: At the end of the day, the staff get on and do what needs to be done. If possible we will always try and provide the patient with dignity whether that is clearing people away from the location or moving them onto the ambulance, but in the case of the very tragic incident on the bus, you don't have time to worry about that - every second counts in those situations and you just need to get on with providing the best care you possibly can.

Question: How often do you have to rely on interpreters to get vital information from callers who do not have English as a first language?

Answer: Not as often as you might think given the West Midlands is the second most ethnically diverse region in England.

The vast majority of people who call us use English and want to use English. We only need interpretation services about once every couple of shifts or so.

Question: One of the tweets featured a child who had swallowed a felt tip pen - is that unusual? Do you tend to get a spate of calls about children doing similar things from time to time as a result of crazes?

Answer: You'd be surprised how often children stick a whole variety of items into their ears, nose and mouth!

Crazes don't usually have an effect on 999 calls, but school holidays do - not sure whether they are bored or just experimenting.

Lost sleep may mean lost brain cells

19 March 2014 Last updated at 06:50 By Helen Briggs BBC News

Sleep loss is bad for mood and mental processing Sleep loss may be more serious than previously thought, causing a permanent loss of brain cells, research suggests.

In mice, prolonged lack of sleep led to 25% of certain brain cells dying, according to a study in The Journal of Neuroscience.

If the same is true in humans, it may be futile to try to catch up on missed sleep, say US scientists.

They think it may one day be possible to develop a drug to protect the brain from the side-effects of lost sleep.

The study, published in The Journal of Neuroscience, looked at lab mice that were kept awake to replicate the kind of sleep loss common in modern life, through night shifts or long hours in the office.

Continue reading the main story

We now have evidence that sleep loss can lead to irreversible injury”

End Quote Prof Sigrid Veasey University of Pennsylvania School of Medicine A team at the University of Pennsylvania School of Medicine studied certain brain cells which are involved in keeping the brain alert.

After several days of sleep patterns similar to those followed by night workers - three days of night shifts with only four to five hours sleep in 24 hours - the mice lost 25% of the brain cells, in part of the brain stem.

The researchers say this is the first evidence that sleep loss can lead to a loss of brain cells.

But they add that more work needs to be done to find out if people who miss out on sleep might also be at risk of permanent damage.

Prof Sigrid Veasey of the Center for Sleep and Circadian Neurobiology, told BBC News: "We now have evidence that sleep loss can lead to irreversible injury.

"This might be in a simple animal but this suggests to us that we are going to have to look very carefully in humans."

She said the next step was to examine the brains of shift workers after death for evidence of any loss of brain cells.

Shift work may have permanent health implications

In the long-term, they think it might be possible to develop a medicine that protects brain cells, by boosting a natural chemical involved in sleep recovery.

Prof Hugh Piggins of the University of Manchester said the experiment indicated in a mouse model of sleep deprivation what might go wrong in the human brain.

"The authors draw parallels with night shift work in humans and suggest how chronic sleep deprivation could adversely affect not only our physical, but also our mental health," he said.

"This possibility will need to be tested by a lot more research. Nonetheless, it is consistent with many recent reports of importance of circadian clocks and sleep cycles for optimal well-being. "

Fears over statins 'are misleading'

22 March 2014 Last updated at 11:26

 

A leading researcher on cholesterol-lowering statin drugs has accused critics of misleading the public about the dangers of taking them.

Prof Sir Rory Collins said two critical articles published in the British Medical Journal (BMJ) were flawed.

But BMJ editor Dr Fiona Godlee said they were well researched.

The drugs are already offered to about seven million people in the UK who have a one-in-five chance of heart disease in the next decade.

The National Institute for Health and Care Excellence (NICE) says the scope for offering this treatment should be widened to people with as low as a one in 10 or 10% risk to save more lives.

Its recommendation follows a study which was overseen by Professor Collins' team at Oxford University.

Prof Collins criticised articles in the BMJ by John Abramson from Harvard medical school, and Aseem Malhotra, a UK cardiologist, who both claimed statins caused harmful side-effects and did not reduce mortality.

He told BBC Radio 4's Today programme: "Statins are given to people at elevated risk of heart attacks and strokes - if people at elevated risk stop taking their statins or don't start taking their statins then they will have unnecessary heart attacks and strokes, there will be unnecessary deaths from vascular causes. This is really irresponsible journalism."

He said the studies' claims, that about 20% of people suffer disabling side-effects due to statins, was not supported by the original research referenced by the papers published by the BMJ.

Research 'not released'

He told the Guardian that the reporting was creating a situation which had echoes of the MMR vaccine controversy.

"It is a serious disservice to British and international medicine," he said.

But the BMJ's editor, Dr Fiona Godlee, defended the articles, saying some research understated the risks of side-effects.

"The randomised control trial data is notoriously poor at reporting adverse events. So I think it's extremely important that the public understand when we're talking about extending statins to people at low risk, that the balance between benefits and harms becomes much more important," she said.

She added: "The articles were well written, well referenced, they were peer reviewed."

Dr Godlee also criticised the fact that the individual patient data of Prof Collins' research had not been released. "It's no longer sufficient to make widespread extension of drug treatments on the basis of data that is not widely available for scrutiny," she said.

Currently, doctors are supposed to offer statin tablets to the estimated seven million people who have a 20% chance of developing cardiovascular disease over 10 years, based on risk factors such as their age, sex, whether they smoke and what they weigh.

Doctors will need to "make a judgement" about the risks to people who have a less than 10% risk of developing cardiovascular disease and advise them appropriately, say the draft guidelines.

The NHS currently spends about £450m a year on statins. If the draft recommendations go ahead, this bill will increase substantially, although the drugs have become significantly cheaper over the years.

UK experts back meningitis B jab

21 March 2014 Last updated at 10:40 By Caroline Parkinson Health editor, BBC News website

The vaccine will be given at two, four and 12 months A vaccine that protects against a deadly form of meningitis is set to be introduced in the UK.

The Joint Committee on Vaccination and Immunisation (JCVI), which has recommended the move to the government, had said last year that the jab was not cost-effective.

Meningitis charities said more data had led to today's decision, and it was a "wonderful outcome".

About 1,760 people contract meningitis B each year and one in 10 dies.

Continue reading the main story Meningitis is an infection of the meninges - the membrane that surrounds the brain and spinal cord.Meningococcal bacteria are common and carried harmlessly in the nose or throat by about 1 in 10 people.They are passed on through close contact.Anyone can get meningitis but babies and young children are most vulnerable.Symptoms include a high fever with cold hands and feet, agitation, confusion, vomiting and headaches. Babies under one year are most at risk of meningitis B, and the cases peak at around five or six months of age.

The bacterial infection causes inflammations of the brain and spinal cord.

It leaves around a third with life-altering effects, such as brain damage or limb loss.

The JCVI said the vaccine was effective in preventing meningitis B and should be rolled out subject to it being made available by the manufacturer "at a cost effective price".

It has recommended the jab be added to the existing immunisation schedule, starting at two months of age.

Around 700,000 infants will be eligible for vaccination each year.

'First in the world'

There are vaccines against other forms of meningitis but the Bexsero jab, developed by Novartis, is the only one thought to protect against meningitis B.

Mother speaks after Tilly Lockey lost her hands and most of her toes from the effects of the septicaemia

Tests have suggested the vaccine is effective against 73% of the different strains of the disease. It was licensed for use in Europe in January 2013.

The JCVI considered the introduction of the meningitis B vaccine last summer but in an interim judgement, it ruled it would not be cost-effective to introduce it.

At the time, campaigners called the decision a "severe blow" and urged the committee to look at the issue again.

More evidence has since been submitted, and the government will now begin negotiations with Novartis over the cost of the vaccine.

Novartis said it was "ready to supply" the vaccine as soon as the Department of Health had all the necessary processes in place,

Prof Andrew Pollard, chairman of the JCVI and professor of paediatric infection and immunity at the University of Oxford said: "MenB disproportionately affects babies and young children and can be devastating.

'Complex and brave decision'

"After very careful consideration, JCVI concluded that use of the new vaccine would reduce cases of meningococcal meningitis and septicaemia and lead to a reduction in deaths, limb amputations and brain injury caused by the disease.

Continue reading the main story 2 months - '5 in 1' - diptheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib); pneumococcal (PCV); rotavirus 3 months - 5 in 1 (second dose); meningitis C; rotavirus (second dose)4 months - 5 in 1 (third dose); PCV (second dose)12-13 months - Hib/Men C booster; MMR (measles, mumps, rubella); PCV (third dose)2 and 3 years - annual flu jabSAround 3 years and 4 months - MMR (second dose); 4 in 1 - diptheria, tetanus, pertussis, polioSource; NHS Choices"Today the JCVI published its recommendation to the UK health departments that if the new vaccine can be purchased at a low price and is therefore cost effective for the NHS, it should be used in the routine immunisation programme for babies in the UK to prevent disease.

"Routine use of the MenB vaccine is expected to make an important contribution to the health of our population."

The deputy chief medical officer, Prof John Watson, said: "We will now be working closely with Novartis in the coming months and if negotiations are successful, we hope to work with the other UK health departments to introduce a vaccine to prevent MenB as quickly as possible.

"This would make the UK the first country in the world to implement a nationwide vaccination programme."

Adam Finn, a vaccine expert and professor of paediatrics at the University of Bristol, said: "This was a complex, difficult and brave decision with far reaching consequences not only for the control of meningococcal disease but also for future vaccine development against severe but rare infections."

Christopher Head, chief executive of Meningitis Research Foundation said: "We are delighted that the JCVI have recommended vaccinating all babies against this most feared and deadly disease.

"It's a wonderful outcome which will save lives and spare countless families the trauma of seeing a loved one seriously disabled by the devastating after effects of MenB."

Call for change to breast screening

22 March 2014 Last updated at 01:09 By Pippa Stephens Health reporter, BBC News

A different approach could help determine the severity of breast cancer cells, the study said Almost one-third of women are at a higher risk of developing breast cancer and should be screened more than once every three years, a study says.

The study analysed 53,467 women between 2009 and 2013.

Scientists found 14,593 women had an "above average" risk of developing breast cancer.

They hope the study will help prevent cases of breast cancer through women being more aware of their own risk and adopting certain lifestyle changes.

NHS cost-saving

An above average risk was defined in the study as a 3.5% chance of developing breast cancer in the next 10 years.

Women aged between 50 and 70 are currently offered a mammogram once every three years, to help identify cancer early, so treatment has a better chance of working.

Lead researcher Prof Gareth Evans, at the University of Manchester, said greater prevention would not only save more women the "awful" actuality of being diagnosed, but would also save the NHS an "enormous amount of money".

Scientists assessed a patient's likelihood of developing breast cancer through questionnaires assessing risk factors, such as family history and lifestyle, and collected genetic information from saliva.

A new approach?

They also measured breast tissue density, which is an indicator of a patient's susceptibility to breast cancer, using mammograms and a visual assessment.

Prof Evans said in an "ideal world", women could fill in an online questionnaire documenting their risk factors and then have their breast tissue density analysed by a mammogram.

He said those at a greater risk could have more regular screening, to detect cancer early and stop it spreading.

Certain lifestyle changes could also be adopted, such as exercising, which he said decreases risk by 30%, not putting on weight, or losing weight, and reducing alcohol intake.

Continue reading the main story

Would more regular screening lead to a rapid decrease in risk or would it take some time?”

End Quote Prof Michael Marmot University College London Prof Evans added: "This would put women's destiny into their own hands."

Trial needed?

Since an independent review into the effectiveness of breast cancer screening was published in 2012, there has been much debate around the concept of "over-diagnosis".

Over-diagnosis happens when screening correctly identifies a tumour but one that would never have caused harm.

It means women undergo treatment which could be unnecessary, such as surgery, hormone therapy, radiotherapy and chemotherapy, and may suffer often considerable side-effects.

Prof Michael Marmot, from University College London, said the study could help with this issue.

He said women at a high risk of developing breast cancer would be more likely to show signs of a serious form of the disease, so the treatment could be more relevant.

But he said a trial was now needed to see assess the significance of missing one or two years of screening in a cancer's development.

NHS programme

He said: "Would more regular screening lead to a rapid decrease in risk or would it take some time?"

Prof Evans said he will now be approaching the NHS to try to secure funding for a new approach.

A spokeswoman for the NHS Cancer Screening Programmes said if "evidence changed", in relation to a change of approach, they were "sure that would be a step that would be looked at".

The organisation had now expanded to give women at high risk more frequent screening, using information about their family history, which they had passed on to their doctors, the spokeswoman said.

Poor care 'resulted in baby's death'

 

Deborah Horner said her daughter Abbie being delivered stillborn was 'a living nightmare' A hospital has admitted failings in medical care and poor communication resulted in a child being stillborn.

Parents Deborah and Richard Horner, from North Yorkshire, expected their daughter Abbie would be delivered at St James' Hospital in Leeds in 2011.

A midwife in charge of Mrs Horner's care was suspended by the Nursing and Midwifery Council and later retired.

Leeds Teaching Hospitals NHS Trust admitted liability and said the care offered "fell short of high standards".

'Living nightmare'

Mrs Horner's pregnancy was considered "high risk" because of her age - she was 43 at the time - and she had previously suffered a miscarriage.

On 17 August 2011 the couple's daughter Abbie was delivered stillborn in an emergency Caesarean section operation at the hospital

But the care given to Mrs Horner and her baby leading up to delivery was "far short of the high standards of care we normally provide", the hospital trust admitted.

Mrs Horner, 46, said: "It's as hard today as when I had Abbie, it doesn't get any easier

"I want them to make a formal apology, it's horrendous, it's a living nightmare, it never goes away, it's never going to get any better

"We just want to stop it happening to someone else."

Baby Abbie was stillborn in an emergency Caesarean section at St James's in Leeds in 2011

An investigation by the hospital revealed misinterpretation of a foetal heart trace reading and inadequate and inaccurate record keeping.

Julian Hartley, Chief Executive of Leeds Teaching Hospitals NHS Trust, said: "The events leading up to the loss of Abbie fell far short of the high standards of care we normally provide and for this I am very sorry.

"A full investigation led by a senior doctor was undertaken into the failure to recognise and escalate concerns in the labour care.

"This report has been shared with Mr and Mrs Horner and I can reassure them that we are committed to using this to ensure we learn from every aspect of what happened.

"Quite rightly our clinical staff have to be accountable for their actions.

"The midwife concerned was immediately removed from practice and referred to the local supervisory authority midwifery officer.

"Subsequently she chose to retire so is no longer employed by us."

Nose can detect one trillion odours

20 March 2014 Last updated at 22:43 By Helen Briggs BBC News

A flower smells sweet because of the combined effect of hundreds of odours The human nose can detect one trillion different odours, far more than we previously thought, say US scientists.

Until now, the long-held belief was that we can sniff out about 10,000 smells.

New estimates published in Science suggest the human nose outperforms the eye and the ear in terms of the number of stimuli it can distinguish between.

Researchers at the Rockefeller University say we use only a tiny part of our olfactory powers.

The human eye uses three light receptors that work together to see up to 10 million colours, while the ear can hear almost half a million tones.

Until now it was believed the nose, with its 400 olfactory receptors, could detect only about 10,000 different odours.

Scientists at the Rockefeller University, New York, set out to test the idea, which dates back to 1927 and was never scientifically investigated.

They devised experiments to see how good people are at distinguishing between cocktails of 128 different odour molecules, representing a large range of smells from grass to citrus.

The molecules were mixed randomly in groups of 10, 20 or 30 to create unfamiliar smells.

The 26 people were then asked to identify a scent from three samples - two that were the same and one that was different.

Based on these results, the researchers used theory to extrapolate how many different scents the average person would be able to discriminate if they were presented with all the possible mixtures that could be made from the 128 molecules.

They estimated that the average person can discriminate between at least one trillion different odours with the nose, far more than can be detected by the eye or ear.

This is probably an underestimate, they say.

'Urban legend'

The conventional wisdom on how well we can smell was based on little more than "urban legend", said co-author Dr Leslie Vosshall.

"It's the first real test of how good humans are," she told the BBC.

"People assume animals are much better smellers than us. Humans are remarkably good at smelling things."

Volunteers tested hundreds of cocktails of odours The dog's sense of smell outperforms humans The smell of coffee is made up of hundreds of different odours

She said animals remain two or three times better than us at smelling, as they devote more of their brain to the sense of smell.

However, the power of the human sense of smell should not be underestimated.

"You can push the sense of smell to work harder - you can get bigger and crazier, more intense perfumes," she added. "We are using a tiny part of our olfactory powers."

According to Charles Spence, professor of experimental biology at the University of Oxford, while it is good to see smell pushed up the rankings of human senses, there is still a lot to learn.

"I guess no matter how many smells we can discriminate, the evidence still shows that even the best experts cannot really pull much more than three odourants out of a mixture, contrary to what all those wordy wine writers might have us believe," he said.

Prof Stephen Liberles, of the Department of Cell Biology at Harvard Medical School, said the nose has a large number of olfactory receptors, which implies our sense of smell could be even more powerful than the latest estimate.

Commenting on the research, he said: "The research goes a long way to addressing the capability of the human olfactory system, but there are still specific questions to be answered about exactly how many individual chemicals can be perceived."

UK 100-year-olds increase by 73%

21 March 2014 Last updated at 15:21 By Pippa Stephens Health reporter, BBC News

The ONS said there were 264 women for every 100 men aged over 90 in 2012 The number of people living in the UK aged 100 increased by 73% in the decade to 2012, said the Office for National Statistics (ONS).

In 2012 there were 13,350 centenarians living in Britain, from 7,740 in 2002.

The ONS also said life expectancy in Britain had "reached its highest level on record for both males and females".

A newborn boy could live 78.7 years, and a girl, 82.6 years, if mortality rates stayed the same for 2010 and 2012 in the UK, it said.

Meanwhile, a man aged 65 in the UK could expect to live for 18.2 years, a 40% increase in the 30 years to 2012, and a 65-year-old woman, for 20.7 years, a 25% increase.

Continue reading the main story

It is time for politicians in all parties to act to make sure services can meet the needs of an ageing population”

End Quote Caroline Abrahams Charity director, Age UK The life expectancy gap between sexes had narrowed to four years, when it was measured between 2010 and 2012, from six years between 1980 and 1982, said the ONS.

'Country variation'

The latest ageing figures showed the changing nature of Britain's population, as the ONS reported more than half a million people aged 90 and over were living in the UK in 2012, a group the organisation calls the "very old".

There were 264 women for every 100 men aged over 90, it said.

Out of the 13,350 centenarians living in the UK in 2012, 660 were aged 105 years and older, while England and Wales had the most 100-year-olds.

The number of people aged 90 and over increased to 806 per 100,000 in 2012, compared to 305 per 100,000 in 1982.

Male life expectancy increased by two-and-a-half years every decade since 1980 to 1982, and two years for women over the same timeframe, the ONS said.

'Crisis' in care

Internationally, the UK lagged only behind Spain, Italy, France and Japan for the number of 100-year-olds in its population.

In 2012, Japan had almost double the number of Britain's 21 centenarians per 100,000 of its population.

But the ONS said: "In comparison to many other countries, the UK has relatively high numbers of centenarians."

It said Western Europe had higher rates of centenarians than countries in Eastern Europe, with Russia having four per 100,000 of its population.

The ONS said this reflected Russia's "relatively low life expectancy".

Caroline Abrahams, charity director at Age UK, said: "Nearly one in five people in our country will live to see their 100th birthday. The increase demonstrates the true worth of advances in medicine and the increasing effectiveness of preventative treatments."

Ms Abrahams said despite the ageing population there was a "real crisis in care" as the number of older people receiving social care support had fallen by "more than a quarter since 2005".

She added: "It is time for politicians in all parties to act to make sure services can meet the needs of an ageing population."

First UK genital mutilation charges

21 March 2014 Last updated at 17:42

 

An offence was allegedly carried out by a doctor at the Whittington Hospital in London The first UK prosecutions over female genital mutilation have been announced by the Crown Prosecution Service.

Dr Dhanuson Dharmasena, 31, of Ilford, east London, will be prosecuted for an alleged offence while working at the Whittington Hospital in London.

Hasan Mohamed, 40, of Holloway, north London, faces a charge of intentionally encouraging female genital mutilation.

Dr Dharmasena and Mr Mohamed will appear at Westminster Magistrates' Court on 15 April.

'Sufficient evidence'

In a statement, director of public prosecutions Alison Saunders said the CPS was asked by the Metropolitan Police to consider evidence in relation to an allegation of female genital mutilation (FGM).

Continue reading the main story FGM includes procedures that alter or injure female genital organs for non-medical reasonsAbout 140 million girls and women worldwide are living with the consequences of FGMDangers include severe bleeding, problems urinating, infections, infertility, complications in childbirth and increased risk of death for newborns

Source: World Health Organisation

It was alleged that following a patient giving birth in November 2012, a doctor at the Whittington Hospital repaired female genital mutilation that had previously been performed on the woman, allegedly carrying out female genital mutilation himself.

Ms Saunders said: "Having carefully considered all the available evidence, I have determined there is sufficient evidence and it would be in the public interest to prosecute Dr Dhanuson Dharmasena for an offence contrary to S1 (1) of the Female Genital Mutilation Act (2003).

"I have also determined that Hasan Mohamed should face one charge of intentionally encouraging an offence of FGM, contrary to section 44(1) of the Serious Crime Act (2007), and a second charge of aiding, abetting, counselling or procuring Dr Dharmasena to commit an offence contrary to S1 (1) of the Female Genital Mutilation Act (2003).

"These decisions were taken in accordance with the code for crown prosecutors."

NHS trust Whittington Health, which runs the Whittington Hospital, said it had contacted police and started its own investigation when staff raised concerns following a birth in November 2012.

Misunderstanding

The CPS has decided to take no further action in four other cases of alleged FGM.

In one of those cases it was alleged that two parents had arranged for their daughter to undergo female genital mutilation while abroad.

In another, a suspect contacted an FGM helpline to request the procedure for his two daughters after misunderstanding the purpose of the service for victims.

The CPS is currently considering whether to proceed with four other cases.

Prosecutors have also had discussions with police over investigations into two further cases, which are at an early stage.

'Unforgivable'

The UK has in the past been compared unfavourably to other countries over the issue, such as France where there have been more than 100 successful prosecutions.

Specialist midwife on the impact FGM has on women

MPs have said it is "unforgivable" that there have been no UK prosecutions since laws against FGM were introduced nearly 30 years ago.

This was despite more than 140 referrals to police in the past four years.

The Female Genital Mutilation Act 2003 replaced a 1985 Act, in England, Wales and Northern Ireland, raising the maximum penalty from five to 14 years in prison.

It also made it an offence for UK nationals or permanent UK residents to carry out FGM abroad even in countries where it is legal.

Home Office minister James Brokenshire said the government had "stepped up its response" to "take this crime out of the shadows" and give victims the confidence to come forward.

He said the "key message" was that the government took FGM "extremely seriously".

Education Secretary Michael Gove is writing to every school in England to ask them to help protect girls from FGM.

Swine bacteria kills man in northern Vietnam

Tiet canh, or blood pudding, a traditional dish made from raw pig blood considered a delicacy by many Vietnamese. Photo by Ngoc Thang  

A man from Thai Binh Province has been killed by a swine bacteria infection after eating tiet canh (blood pudding) after doctors and scientists issued many warnings against the danger posed by the traditional dish made from uncooked pig blood.

According to his family, they slaughtered a “healthy” pig they bred at home to celebrate Tet, Vietnam’s biggest holiday, on January 28, and made tiet canh with its blood.

One day after eating the dish, the 48-year-old man had high fever, shivers and digestive problems but did not go to the hospital.

The next day, he was exhausted, his blood pressure dropped and he went into shock, prompting his family to bring him to a local health facility, they said.

He was transferred to the National Hospital for Tropical Diseases the next morning (Lunar New Year's Day) and died later that day.

Dr. Nguyen Trung Cap, deputy director of the National Hospital of Tropical Diseases’ Emergency Department said Friday that the victim tested positive for the Streptococcus suis bacteria, a pathogen found in pigs.

Doctors tried to use several treatments and medicines to increase his blood pressure but failed to save him.

Cap said the case progressed very fast as blood pressure fell and he went into shock only one day after he had a fever even though he had yet to develop the typical signs of a bacteria infection at that time.

He told news website Dan Tri that five people in the deceased man’s family ate tiet canh, but only he was infected with the bacteria.

He said that although they all ate the same dish, an infection depends on how each person reacts with the bacteria and on the number of bacteria that are able to penetrate the body.

He told Thanh Nien that the hospital had admitted nearly 10 patients infected with and suspected of having the Streptococcus suis bacteria.

All of them had eaten tiet canh, he said.

He said most of them ate the dish made from their own pigs, Dan Tri reported.

Dr. Do Duy Cuong of Bach Mai Hospital’s Contageon Department, told Vietnam News Agency Friday that his hospital also received many simliar cases over the last 10 days as the patients had been eating tiet canh for the Tet holiday.

Dangerous luck

A common belief among Vietnamese people is that eating the red blood pudding in the beginning of the year will drive away their bad luck from the previous year and bring them luck good for the new year.

Cap said many families often butcher pigs bred at their home and eat tiet canh on Tet as they think homebred pigs cannot be infectious, news website VnExpress reported.

But all pigs pose the risk of carrying the bateria, and it is highly possible that the bacteria be transmitted from the pigs with the bacteria to people who eat their underdone meat or tiet canh.

He said people should not butcher ill or dead pigs.

They should not process raw pork with bare hands, especially when having injuries on their hands, adding that they should wash their hands carefully before and after processing the meat.

They should not eat undercooked pig meat and organs and tiet canh, especially from ill or dead pigs.

Those who have direct contact with the ill or dead pigs should wear protective clothing.

Delitescence lasts from a few hours to three days, and it is recommended that those who have a high fever of 40 to 41 degrees Centigrate, bleeding under the skin, diarrhea, stiff neck and breathing difficulties should be brought to the hospital immediately to prevent death.

The bacteria can cause complications such as septicemia or blood poisoning and meningitis, which can lead to death or other severe complications, and amputation of the hands or legs due to necrosis.

Necrosis caused by the Streptococcus suis bacteria, a pork-based pathogen, which many people have been infected with after eating tiet canh for the Tet holiday. Photo by Ngoc Thang

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Vietnam reports first bird flu death in 2014

Chickens are butchered and sold at market in Vietnam / FILE PHOTO

A 52-year-old man in the southern province of Binh Phuoc has become Vietnam's first bird flu fatality this year, the General Department of Preventive Health reported on Monday.

It was also the first human case of the H5N1 avian influenza strain to be reported in the country after nine months' absence, the department at the Ministry of Health reported.

The patient was sent to Bu Dang District's General Hospital with a fever, cough, and respiratory difficulties on January 11, according to the department.

As his lungs quickly deteriorated, his family had him transferred to the Hospital for Tropical Diseases in Ho Chi Minh City on December 18. He died there that same day.

His samples later tested positive for H5N1.

Related agencies also found that his family had killed and ate duck recently and there were chickens that had fallen sick and died without clear reasons nearby their home.

The latest case has brought Vietnam's H5N1 death toll to 63 since the disease first broke out in 2003.

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Measles kills 2 in northern Vietnam

A medical worker vaccinates a baby against measles in the northern province of Yen Bai. Photo courtesy of Tuoi Tre

The health ministry on Tuesday announced that measles had caused two deaths in Hanoi and nearby Yen Bai Province over the past week.

A 7-month-old baby from Hanoi’s Dong Anh District died during the Tet (Lunar New Year) festival while the fatal case from Yen Bai was a 3-year-old boy from the H’mong ethnic group who died on January 30, Tuoi Tre newspaper reported.

The ministry said measles outbreaks infected 99 children in Yen Bai, 87 in  nearby Son La and 117 in Lao Cai Province, and around ten children in Ho Chi Minh City who were not vaccinated.

Children in Vietnam are given two measles vaccination shots at nine and 18 months old, for free, according to Health Ministry regulations.

Tran Dac Phu, head of the ministry’s Preventive Heath Department, said investigations found that 20 percent of the infected children were fully vaccinated and 20 percent of the others had received their first shot.

Parents are instructed to send their children to medical centers for early examinations when they develop rashes combined with heavy coughing.

Phu said measles is not malignant but it quickly destroys one’s immune system and thus causes the children to be infected with other dangerous diseases such as pneumonia or diarrhea that can lead to fatal developments.

He said that of the vaccinated children, only 80-90 percent are protected. But the infection spreads more widely in highland provinces partly due to poor vaccination quality.

“Vaccination in remote, mountainous areas is still problematic, especially as especially as it was not that long ago that the vaccine was carried by horse carriage."

The northern highland provinces are also at high risk from recent measles outbreak in China across the border.

A measles outbreak also occurred recently among youths in Hanoi, who according to Phu were either not or poorly vaccinated as a baby.

Vietnam reported no measles outbreaks in 2012 and 2013 and plans to erase the disease by 2017.

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Vietnam cities run out of children's vaccines

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A child being vaccinated in Ho Chi Minh City. Photo by Thanh Tung

Hanoi and Ho Chi Minh City are running out of many essential vaccines for children.

The vaccination center at the National Institute of Hygiene and Epidemiology in Hanoi Wednesday informed parents that it is out of vaccines for seasonal flu.An employee said the center, just like the entire city, has also run out of the five-in-one Pentaxim vaccine made in France that protects children against diphtheria, pertussis (whooping cough), tetanus, polio and Haemophilus influenza type B (HiB), and the six-in-one Infanrix that protects against the five plus hepatitis B.Infanrix and Pentaxim use purified pertussis antigens and are thus safer and see greater demand than for the 5-in-1 Dutch Quinvaxem which has scared off parents after possibly causing 15 deaths since late 2012. Quinvaxem is cheaper and is given for free to infants in Vietnam.The center ran out of chickenpox vaccines late last year.They are administered to children in two doses, one at age one and the second one to three months later.Dr Truong Huu Khanh, head of the infection department at Ho Chi Minh City’s leading pediatrics facility, Children’s Hospital No.1, said it has not been in stock for a long time.“I do not know when we will have it again, and the disease season is coming.”Many parents bringing their children to the HCMC Preventive Health Department for the six-in-one vaccine last weekend also went back disappointed.An official from the Ministry of Health's Pharmaceutical Management Department  said it has placed an urgent order for 77,600 chickenpox vaccines. The department did not provide a reason for the shortage or say when the vaccines would be available again.An unidentified HCMC doctor said the health authorities failed to coordinate well with drug companies that supply vaccines.He also said they should educate people to vaccinate their children regularly instead of rushing for shots when outbreaks occur.Dr Nguyen Tri Dung, director of the city's Preventive Health Department, said measles vaccines are available.There was a severe measles outbreak in late January which killed six children in around 10 days, sparking off a rush for  vaccination.Health experts said demand for the vaccine had earlier dropped significantly, partly due to the Quinvaxem scare.

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Vietnam hospital fixes ear damage with coral

An ear surgery using biologically modified coral at the Ho Chi Minh City Ear, Nose and Throat Hospital. Photo courtesy of the hospital

The Ho Chi Minh City Health Department has announced that a local hospital has managed to intervene to cure ear diseases using coral.

The department announced last week that the treatment had been provided at the city Ear, Nose and Throat (ENT) Hospital since 2009.Doctor Le Hoang Phong who directly carries out coral treatments at the hospital, said traditional treatment removes the damaged area with a surgery, leaving a vacancy in the middle ear area. The disadvantage of the method is that it reduces the patient’s hearing, causing buzz sounds and regular dizziness as the middle ear loses its balancing function. The patient thus needs to revisit the hospital many times.But the coral method replaces this hole and eliminates these problems.Phong said his team started the project in cooperation with doctors from Pham Ngoc Thach Medicine University and Ho Chi Minh City Medicine University, using coral in treating ear conditions, especially cholesteatoma, which is a middle ear condition common in Vietnam, in which a mass of cholesterol and skin scales forms, grows and invades nearby structures including bones.The coral is produced by Pham Ngoc Thach Medicine University and has been modified biologically to be compatible with the human body. It costs around US$20 each operation, much lower than using similar foreign material.It has been used in 144 cases to fill up the removed area and/or to restructure the bony part or nerves.The hospital is working with Pham Ngoc Thach Medicine University to produce a biological glue from the patients’ blood for cosmetic purposes during the insertion of the coral.Other achievements announced by the department include more effective methods in stem cell transplants for blood production at the Hospital of Blood Transfusion and Hematology, hip surgeries for patients of broken thigh bones at 115 People’s Hospital, surgeries of left atrial budges at the Children’s Hospital No. 2, and the application of molecular biology techniques to diagnose modern infections like influenza A from bird flu virus strains H7N9, H5N1.

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