RxPG News : UK

Systematic bias in the assessment of UK doctors

Fri, 28 Oct 2011 20:00:00 PST

( from http://www.rxpgnews.com ) Official assessments of a doctor's professionalism should be considered carefully before being accepted due to the tendency for some doctors to receive lower scores than others, and the tendency of some groups of patient or colleague assessors to provide lower scores, claims new research published on bmj.com today.

Researchers from the Peninsula College of Medicine and Dentistry in Exeter investigated whether there were any potential patient, colleague and doctor-related sources of bias evident in the assessment of doctors' professionalism.

Doctors' regulator the General Medical Council (GMC) is working on a new system of revalidation for all UK doctors that could be introduced next year as a way of ensuring doctors are fit to continue to practise. This is likely to involve the use of multi-source feedback from patients, peers and supervisors as part of the evidence used to judge a clinician's performance.

The researchers used data from two questionnaires completed by patients and colleagues. A group of 1,065 doctors from 11 different settings, including mostly NHS sites and one independent sector organisation, took part in the study.

They were asked to nominate up to 20 medical and non-medically trained colleagues to take part in an online secure survey about their professionalism, as well as passing on a post-consultation questionnaire to 45 patients each. Collectively, the doctors returned completed questionnaires from 17,031 colleagues and 30,333 patients.

Analysis of the results that allowed for characteristics of the doctor and the patient to be taken into account, showed that doctors were less likely to receive favourable patient feedback if their primary medical degree was from any non-European country.

Several other factors also tended to mean doctors got less positive feedback from patients, such as that they practised as a psychiatrist, the responding patient was not white, and the responding patient reported that they were not seeing their usual doctor.

From colleagues, there was likely to be less positive feedback if the doctor in question had received their degree from any country other than the UK or South Asia. Other factors that predicted a less favourable review from colleagues included that the doctor was working in a locum capacity, the doctor was working as a GP or psychiatrist, or the colleague did not have daily or weekly professional contact with the doctor.

The researchers say they have identified possible systematic bias in the assessment of doctors' professionalism.

They conclude: Systematic bias may exist in the assessment of doctors' professionalism arising from the characteristics of the assessors giving feedback, and from the personal characteristics of the doctor being assessed. In the absence of a standardised measure of professionalism, doctor's assessment scores from multisource feedback should be interpreted carefully, and, at least initially, be used primarily to help inform doctor's professional development.

Why women in UK can't find sperm donors?

Mon, 17 Nov 2008 15:40:13 PST

( from http://www.rxpgnews.com ) London, Nov 13 - Where have all the generous sperm donors in UK gone?

Lately, the country is facing a severe shortage of such 'seminal' Samaritans. The problem has become particularly acute after the anonymity tag to protect their identity was removed in April 2005.

Although the move may have benefited children, who can now trace their biological parents when they attain the age of 18, it made donors back-off double-quick.

Reproductive experts pitched in for a slew of new measures in the British Medical Journal to keep their figures up after drastic decline in the number of donors.

Currently, many clinics struggle to recruit donors, have long waiting lists for those needing treatment, have high costs, the doctors said, according to an online report.

Mark Hamilton, who chairs British Fertility Society -, based at Aberdeen University, and Allan Pacey, BFS secretary informed that 4,000 patients required donor sperm every year, or an additional 500 new ones annually to meet meet demand.

In 1996, 403 men were newly registered with the Human Fertilisation and Embryology Authority - as donors, whose numbers dwindled to 247 eight years later.

Figures in 2006 rose to 307 but fewer women could be treated with donated sperm. In 2005, 2,727 women were treated with donor sperm but this fell to 2,107 in 2006.

Hamilton and Pacey described the current limit of 10 families from a single donor as 'arbitrary.' They called for more sperm sharing schemes.

Britain reviews child protection after toddler's death by torture

Sat, 15 Nov 2008 10:13:30 PST

( from http://www.rxpgnews.com ) London, Nov 12 - A shocked British government has ordered a full review of the country's child protection measures after a court convicted a young mother, her boyfriend and another man for the terrible death by torture of a 17-month-old child.

In his short life, the boy known as Baby P endured 50 injuries - including broken bones and back - at his home in a London borough.

Child officers, police and doctors saw him 60 times, temporarily took him under their care thrice and arrested his mother twice. However, according to lawyers at the trial, Baby P still did not pass the 'evidence threshold' to be taken into care. Now, after the convictions, the administration is wondering how it went wrong.

This is the second such case from the same borough of Haringey. The nation was shocked in 2000, when eight-year-old Victoria Climbie died of malnourishment and a whopping 128 injuries caused by her guardians. Child carers failed to notice her condition, leading to the first review of the child protection system.

Baby P's 27-year-old mother, her boyfriend and Jason Owen - a man staying in their house - were Tuesday convicted of allowing the child's death. They now await sentencing.

The child was used as 'a punching bag', the court was told, according to The Guardian.

A paediatric pathologist who examined Baby P after his death said that he had never seen such damage done to a child. The court heard that a tooth must have been swallowed after a violent blow to the head, fingernails were missing, eight ribs had been fractured and chocolate was smeared over him to cover his bruises when social workers visited.

His mother, who had a traumatic childhood with a drug addict mother, was able to manipulate social workers and police. She deceived them with the appearance of cooperation, taking the child to doctors when he was ill and apparently seeking help. On three occasions, the baby was released back into her care. The last was two months before he died.

The first signs of abuse began to appear in December 2006, a month after the boyfriend moved in. A police detective said he was 'sadistic - fascinated with pain' and jurors heard suggestions that he may have tortured his younger brother during childhood.

Police believe the biggest factor in the tragedy was the boyfriend's hidden presence in the house. Had they known he was living there, Baby P might have been saved, detectives said. The police had no idea that he had been in the house because he had 'purposefully evaded' them at every opportunity.

Two days before Baby P's death, he was examined at a hospital by paediatrician Sabah al-Zayatt who allegedly failed to spot his broken back. The General Medical Council is investigating her case.

Hospital chief executive Jane Collins said: 'Clearly we didn't get things right - a child died.'

Two social workers and a lawyer received warnings, but there were no sackings or resignations, said Sharon Shoesmith of Haringey Safeguarding Children Board.

Harry Ferguson, professor of social work at the University of the West of England, said: 'The striking thing for me is how the social workers failed to touch the child, to examine him...it exposes structural weaknesses in how we are failing to prepare professionals.'

Lord Laming, the child protection expert who led the inquiry into the Climbie case, said: 'People who do deliberate harm to a child go to great lengths to disguise what they have done. People working in this field have to recognise this in their evidence gathering.'

Mor Dioum, director of the Victoria Climbie Foundation, said: 'This case is worse than Climbie. The signs were there but were not followed.'

Children's Minister Beverley Hughes said the incident was shocking and asked Lord Laming to report on how his recommendations were being addressed nationally.

Most British Women Unaware of Lifestyle Stroke Risks

Wed, 12 Nov 2008 06:20:57 PST

( from http://www.rxpgnews.com ) A new survey, carried out by GfK NOP for UK charity The Stroke Association has revealed that 60 per cent of women don’t even know what their blood pressure is and 67 per cent are unaware what an ‘optimal’ reading should be. The survey also found that while more than a fifth of women surveyed had been prescribed medication to control their blood pressure, more than half of these said they did not take their tablets regularly, putting themselves at risk of death or disability from a stroke.

When asked about taking measures to protect themselves from a stroke, a second survey found that 83 per cent of the women did not know that lack of exercise increases the risk. Another 72 per cent of women did not recognise that a poor diet is a risk factor and 71 per cent were unaware that alcohol also increases the risk of stroke.

Joe Korner, Director of External Affairs, explains: “Many women will be blissfully unaware that they may have high blood pressure caused by the lifestyle choices they make. Regular, excessive drinking, smoking, poor diet and lack of exercise mean that women are pushing their blood pressure to dangerous levels without realising it.

“People do not realise that by making very small lifestyle changes they can dramatically reduce the risk of having a stroke. For example, moderate exercise can decrease the chances of having a stroke by 27 per cent and by eating your ‘five-a-day’ you can reduce the risk by a quarter,” Mr Korner said.

As part of its drive to raise awareness, The Stroke Association is urging working age women to be aware of how their lifestyle impacts on the risk of having a stroke and to have their blood pressure tested regularly. An optimal blood pressure reading is 120/80 mmHg. High blood pressure is defined as a reading above 140/90mmHg. Blood pressure testing can be carried out at a GP surgery by the GP or practice nurse. However gyms and pharmacies can also carry out blood pressure testing.

Depression is wrongly seen as natural part of getting older

Tue, 12 Aug 2008 10:02:41 PST

( from http://www.rxpgnews.com )

Photo by paveitapics

The vast majority of older people over the age of 65 in England have symptoms of depression are denied any help, according to a new report published today by Age Concern.

The charity found that shocking ageist attitudes held by many people, including GPs, and ageist rules in the NHS mean that an astounding eight out of ten older people with clinical depression don’t get any treatment. Most mental health services for depression exclude people aged 65 and older, despite the risk of depression increasing with age in later life.

Age Concern’s new campaign, ‘Down, but not out’, aims to improve the quality of life for older people with depression. Depression is the most common mental health problem in later life, affecting one in four older people yet it is often ignored. If depression is not identified and treated, it can lead to a life of misery. It can also cause other illnesses and, in extreme cases, can lead to suicide.

The charity will be helping older people to recognise the symptoms of depression and encouraging them to seek help. It will also be working with GPs to improve the diagnosis of older people with depression and ensure that effective treatments are available to all, regardless of age.

Poor health and problems, such as money worries, losing a loved one and stressful events like moving into a care home can trigger depression. Recently bereaved older people are three times more likely than married older people to show signs of depression.

Gordon Lishman, Director General of Age Concern, said:
“Negative attitudes about mental health problems make it very difficult for older people to talk about their feelings or to ask for help. It is scandalous that hundreds of thousands of older people may be denied treatment because depression is wrongly seen as a natural part of getting older.

“Older people deserve better treatment - there should be no excuse for inaction. Without a major change in policy and practice, there will be 3.5 million older people in UK with symptoms of depression by 2021.

“The Government and the NHS need to take action to stamp out ageist attitudes and practice, once and for all. The neglect of older people’s mental health ruins lives and must no longer be ignored.”

Awareness of depression is low among older people themselves and their relatives and is worse in some communities because of negative cultural perceptions of mental health problems. Beliefs about the origin of the illness and the high value placed on family reputation results in many black and minority ethnic (BME) elders, and their families, keeping the depression a secret.

Drink and drugs fuel Scottish suicide and homicide rates

Mon, 16 Jun 2008 04:00:00 PST

( from http://www.rxpgnews.com ) Alcohol and drug misuse mean Scots are almost twice as likely to kill or take their own life compared to people living in England and Wales, research published today (Monday, June 16) reveals.

The findings by The University of Manchester's National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI) also show that the number of mental health patients committing homicide or suicide was proportionately much higher in Scotland.

The 'Lessons for Mental Health Care in Scotland' report, commissioned by the Scottish Government, blames these higher death rates north of the border on alcohol and drug consumption, both in the general population and among mental health patients.

The NCI examined all suicides and homicides in the general population in Scotland, as well as those committed by people who had sought help from mental health services, and compared them to its findings for England and Wales.

Suicide rates in Scotland equated to 18.7 per 100,000 of the population, compared to 10.2 per 100,000 in England and Wales, while homicide rates north of the border were 2.12 per 100,000 people compared to 1.23 per 100,000 in England and Wales. The north-south divide was highest among teenagers, the report found.

NRI doctor guilty of unethical tests on British patients

Sat, 29 Mar 2008 18:04:41 PST

( from http://www.rxpgnews.com ) London, March 29 - An NRI psychiatrist from Assam faces the sack after being found guilty of conducting unethical drug tests on mentally ill patients, according to reports Saturday.

The General Medical Council has found Tonmoy Sharma, a former lecturer at the prestigious Institute of Psychiatry in London, guilty of recruiting patients suffering from schizophrenia and Alzheimer's in unsolicited telephone calls, conducting unauthorised tests and misleading drug companies about his methods, a newspaper reported.

The verdict could not be independently verified but a spokeswoman for the GMC, a regulatory body, told IANS Saturday that newspaper reporting on the case has been 'accurate'.

A GMC panel on 'Fitness to Practice' has been hearing Sharma's case this week, she confirmed.

The Times said the GMC, which examined Sharma's research over 10 years, could force the pharmaceutical industry to re-examine the way in which research on psychiatric drugs is commissioned and conducted.

It quoted the GMC panel as concluding: 'The findings of the panel indicate serious failings of personal integrity and honesty, of good clinical research practice, as regards to potential welfare of patients and participants in ethical research ... which risks bringing the reputation of the medical profession into disrepute.

'The panel has found that the facts proved against you would not be insufficient to support a finding of serious professional misconduct.'

According to the GMC website, Sharma gained his MBBS from Dibrugarh University, Assam, in June 1987 and has been on Britain's register of general psychiatry since May 1996.

Sharma is a Clinical Lecturer at the Institute of Psychiatry, Kings College, University of London, and a Principal Investigator undertaking research studies, the GMC said.

'The panel is satisfied that in acting the way you did, your intention was to conceal from each sponsor the fact that you were using the identical group of patients for their studies,' the panel report says.

'As a consequence, the patients were subjected to tests beyond those approved... The panel is satisfied that your conduct towards them - was dishonest. It was also unprofessional and not in the best interests of the patients.'

Healthcare commissioning- ?Adverse to patient care

Sat, 22 Mar 2008 02:32:16 PST

( from http://www.rxpgnews.com ) The government’s new healthcare commissioning policy for England has not only jeopardised the future of many hospitals but has also led to considerable frustration and disappointment among patients, argue senior doctors in this week’s BMJ.

Under the new policy, primary care trusts or general practitioners directly commission specialised services and the trusts pay for the treatment of their patients in hospitals. The aim of such commissioning is to save huge sums of money by using hospital services as sparingly as possible.

But Rahij Anwar and colleagues believe that weaknesses in the referral system mean that their patients are not receiving appropriate care.

The worst affected patients, they explain, are those who have more than one condition at the same time because to primary care trusts these are very “expensive” patients, and therefore some of their problems might be “downplayed” to be managed in the community, and referrals to specialists are filtered.

Constant reminders to comply with trusts’ policy in relation to clinic times and referrals also mean that patients are often sent back to their GPs if they have a new problem for which a referral has not yet been made.

The crux of the matter is that these patients could well have received better care had they been treated in the traditional system, where there were no “time bound appointments,” “designated payment pots,” and “referral politics,” they argue.

Patients should be given sufficient time and opportunity to discuss their problems properly, so that the problems may be dealt with concurrently, not consecutively, they say. Hospital specialists should also be allowed to generate a fresh “episode of treatment” if a patient develops a condition related to the same specialty while he or she is waiting for an appointment.

This will not only significantly lessen the workload of general practitioners but would also help to reduce waiting times, paperwork, and inconvenience to patients.

Although we all are expected to use the meagre resources of the NHS wisely in these difficult times, we should not forget that our foremost duty is to safeguard the interests of our patients, they write.

We should continue to question all policies that adversely affect the care of patients, and we believe that “one way healthcare commissioning” is one such policy.

New steps to curb overseas doctors in Britain

Tue, 09 Oct 2007 15:46:42 PST

( from http://www.rxpgnews.com ) London, Oct 9 - Indian doctors should think several times before coming to Britain for jobs - the employment situation has been difficult for non-European Union doctors, and new proposals have been drawn to guarantee jobs to doctors trained in Britain.

An increase in fresh graduates turned out by British medical schools and the availability of a large number of doctors from an expanded European Union have made it difficult for non-EU doctors to gain employment in the National Health Service -.

The health minister, Ben Bradshaw, has drawn up proposals to slash the number of junior doctors from overseas coming to Britain to train. The idea behind the proposals is to preserve jobs for the rising number of British medical graduates.

During the recent round of recruitment in the Medical Training Application Service -, non-EU doctors could not be excluded from consideration under court orders. During the MTAS rounds earlier this year, several hundred Indian doctors gained employment in the NHS.

However, the situation is likely to change if the new proposals are implemented. A court hearing is due later this month on the case brought by the British Association of Physicians of Indian origin -, which challenged changes to immigration rules for non-EU doctors who had entered Britain under the highly skilled migrants permit.

Putting forth his new proposals, Bradshaw said that if overseas applicants were preventing those educated here from getting specialist training places, 'then it is only right that we should consider what needs to be done'.

The government is proposing that doctors from countries outside the EU should not be considered for a job unless there are no qualified applicants from Britain or from elsewhere in Europe. This is an unlikely scenario given the popularity of medical training in Britain and the EU.

According to Bradshaw, Britain now has 6,451 medical school places, compared with 3,749 in 1997, and each student can cost up to 250,000 pounds to train. During the MTAS rounds, several British doctors who could not find employment left the country as the issue snowballed into a major public controversy through demonstrations and petitions.

There is also a proposal that fresh British medical graduates would automatically get a first-year hospital training place on graduation, which would give them a head start over even other European candidates.

Meanwhile, representatives of BAPIO met officials of the Conference of Postgraduate Medical Deans - after a BAPIO study raised concerns that non-white British graduates as well as those who had received their primary qualification overseas were more likely - to be found to be not making adequate progress with their training and referred for remedial training.

BAPIO sources told IANS that during the meeting, both groups affirmed their strong commitment to equality of opportunity within medical education. The discussions included plans to monitor educational outcomes and address areas of concern where these were identified.

Ramesh Mehta, president of BAPIO, said: 'We are pleased to note that COPMeD chairman Elisabeth Paice was very receptive of our concerns. We look forward to the approval of the draft plan by the CoPMeD.'

Elizabeth Paice said: 'It was very useful to exchange viewpoints with Mehta, and to discuss how we could move from concern and evidence to appropriate action.'

Second foot-and-mouth case confirmed in southern England

Tue, 07 Aug 2007 15:21:29 PST

( from http://www.rxpgnews.com ) London, Aug 7 - A second case of foot-and-mouth disease has been discovered at a farm in southern England, British Environment Minister Hilary Benn confirmed Tuesday.

Conclusive tests had been carried out on the case, found at a Surrey farm near the first outbreak discovered last week. Between 50 and 100 animals had already been culled on the farm as a precaution.

The European Commission earlier Monday banned exports of meat, milk and animals from Britain as an investigation continued into the source of the first foot and mouth outbreak, discovered Friday at a farm near Guildford.

Merial Animal Health, a private US pharmaceutical company located five kilometres away from the affected farm and where immunizations against a form of the foot-and-mouth virus were being tested, denied that there had been any breach in bio-security procedures as investigators continued to scour the site.

Britain's National Farmers Union - said Tuesday the British livestock industry could lose between 10 to 15 million pounds - of income per week due to foot-and-mouth.

Foot-and-mouth outbreak linked to research laboratory

Sun, 05 Aug 2007 08:58:48 PST

( from http://www.rxpgnews.com ) London, Aug 5 - The strain of foot-and-mouth disease discovered in cattle in a southern England farm is identical to the strain of virus uses for research and vaccine manufacture at a nearby laboratory, British officials said.

In response to the revelation, the Department for Environment, Food and Rural Affairs - late Saturday ordered a single, wider protection zone that includes both the farm and the laboratory.

But Defra said it could not immediately say whether the Institute for Animal Health at Pirbright was the source of the outbreak five km away on a farm in Surrey County.

British authorities had already feared more cases of foot-and-mouth disease Saturday and extended their investigations.

A small number of suspected cases included unpublicised infections in laboratories and illegal transport of animals, Chief Veterinary Officer Debby Reynolds said. An intentional release of the virus has not been ruled out either.

'All possible sources' of the disease are being probed, she said.

Reynolds said that her office had ordered the slaughter of 60 cows and the incineration of their carcasses at a farm near Guildford in Surrey.

British authorities have urged farmers to be vigilant for signs of the disease in their livestock. The disease poses little danger to human health.

An urgent review of bio-security at the Pirbright laboratory is underway.

Britain's Press Association reported that the outbreak probe was now focussed on a possible leak from the research facility, which is shared between the Institute of Animal Health and a private veterinary pharmaceutical firm, Merial Animal Health Ltd.

The institute researches diseases of cattle at the laboratory, while Merial activities at the facility include the manufacture of cattle vaccines against foot-and-mouth disease.

'The present indications are that this strain is a 01 BFS67-like virus, isolated in the 1967 foot-and-mouth disease outbreak in Great Britain,' the Defra statement said.

Merial used the same strain in a batch of vaccine manufactured last month at the Pirbright facility by Merial Animal Health. The firm announced that it has halted vaccine production.

Earlier Saturday, Britain voluntarily halted all exports of cloven-hoofed animals, including live animals, meat and animal products, pre-empting an EU ban expected next week. The ban applies to cattle, sheep and pigs.

Prime Minister Gordon Brown said Britain would do all it could to eradicate foot-and mouth-disease. He cancelled his holiday in response to the outbreak and chaired a meeting of the government's emergency committee, Cobra.

After the meeting, Brown said that British authorities were working 'night and day' to find the source of the virus and to halt its spread.

A spokesman for the German Federal Ministry of Agriculture said Saturday in Berlin that four shipments of live sheep and one Scottish bovine, all sent within the last 30 days from Britain to Germany, were being investigated.

As a precaution, farms in at least two German states have been sealed off. Japan has announced an import ban on British pork.

Irish Agriculture Minister Mary Coughlan told national broadcaster RTE that Dublin had banned the import of all live animals, fresh meat and non-pasteurised milk from Britain to prevent the spread of the disease.

It was confirmed late Friday that the cows at the farm in Wanborough village were infected with foot-and-mouth.

British authorities imposed a three-km protection zone around the farm and banned the movement of livestock within Britain. A 10-km surveillance zone was also established around the farm. A large number of agricultural fairs and shows have been cancelled.

The European Commission said in an initial statement that Britain had followed all EU-required measures for an outbreak of foot-and-mouth.

The current outbreak is the first in Europe since the outbreak of the disease in Britain in 2001, according to media reports. Parts of the Netherlands and France were also affected in 2001 when up to 10 million animals were destroyed in Britain alone.

The European Commission imposed a complete ban on British meat exports and the estimated economic cost of the crisis in Britain was 8.5 billion British pounds -.

Still some way to go in tackling racism in mental health care

Fri, 30 Mar 2007 02:09:44 PST

( from http://www.rxpgnews.com ) Mental health services in England and Wales have been accused of being institutionally racist. In this week's BMJ, two senior doctors say that, although services are pioneers in moving towards equity, they have some way to go before they meet the challenges of a multi-cultural society.

The "Count me in" census, published last week by the Healthcare Commission, makes grim reading for people of African and Caribbean origin living in England and Wales, write Professors Kwame McKenzie and Kamaldeep Bhui.

The survey of 32,023 inpatients on mental health wards in 238 NHS and private healthcare hospitals reported that 21% of patients were from black and minority ethnic groups, although they represent only 7% of the population.

Rates of admission were lower than average in the white British, Indian, and Chinese groups, but three or more times higher than average in black African, black Caribbean and white and black Caribbean mixed groups.

Not only were people in these three groups more likely to be admitted to hospital, but those in hospital were more likely to be admitted involuntarily. Once in hospital, people who defined themselves as black Caribbean had the longest stay.

In a separate survey of people with learning disabilities, comprising 4,609 inpatients from 124 hospitals, only 11% were from black and minority ethnic groups. Rates of admission were lower than average in the South Asian, other Asian, white, and Chinese groups, but again they were two to three times higher than average in some "black" groups. However, unlike inpatients with mental health problems, no ethnic differences were seen for involuntary admissions.

These results add to the increasing evidence of ethnic differences in the treatment of mental illness, say the authors. For instance, some black and minority ethnic groups are less likely to be offered psychotherapy, more likely to be offered drugs, and more likely to be treated by coercion, even after socioeconomic and diagnostic differences are taken into account.

These disparities reflect the way health services offer care according to racial group, and seem to satisfy the well established and widely known definition of institutional racism.

In response, a systems level approach called "Delivering race equality" has been developed to improve mental health services. This could improve services but leadership is needed to ensure that it is taken up, say the authors.

But there is a danger that its impact will be undermined by other government policy, such as the proposed amendments to the Mental Heath Bill, and there are also wider questions about whether treatment is being offered and delivered effectively.

The Count me in census and other research indicate that institutional discrimination does occur and that services have some way to go before the challenges of our multicultural society, they write. "If the concept of institutional racism had been more widely accepted and acted on, the Department of Health might not now be facing a formal investigation by the Commission for Racial Equality," they conclude.

Should EU patient information laws be relaxed?

Fri, 30 Mar 2007 02:07:46 PST

( from http://www.rxpgnews.com ) In 2002 the European parliament voted resoundingly against allowing drug companies to provide information about their products directly to patients. However, five years on, this decision is set to be challenged again.

A special report in this weekâs BMJ looks at the arguments.

Hard lobbying by the drug industry has convinced EU health commissioners that increasing the extent to which drug companies can provide information to patients is essential to stop Europeâs drug industry falling further behind those of the United States and Japan. Drug companies also assert that this change would benefit patients.

But health campaign groups insist that drug companies cannot provide the independent information consumers need.

The commission will set out its final position next month, but speculation is already rife that it is likely to suggest changes to legislation that would jeopardise the current ban on direct to consumer advertising for prescription drugs.

Campaigners are particularly concerned that if the commission decides it needs to relax the laws then direct to consumer advertising would be introduced almost as a side effect.

Despite assurances that blatant advertising is not the intention, Barbara Mintzes of the University of British Columbia disagrees, saying that any change in the law to allow industry to provide information could produce undesirable effects â even if the advertising ban remains in place.

Rita Kessler of the campaign group AIM agrees. She believes that the current proposals would result in poor quality information and questions the need for more health information. She suggests that the commission should instead endorse an EU logo mark that would be awarded to high quality information sources and act as a quality stamp to help patients identify reliable, evidence based advice.

In anticipation of the commissionâs final report in April, five international health associations have joined forces to step up their opposition campaign. They assert that ârelevant, comparative and appropriate information on health issues cannot be provided by drug companies,â because in a competitive marketplace, dug companies must present their own products in a more favourable light than other preventive or therapeutic options.

However, the quick turnaround of MEPs means that few of the original objectors from 2002 remain in office â and that could mean a completely different outcome when patient information laws are debated again.

Supermarket surgeries 'a wake-up call for the profession'

Fri, 30 Mar 2007 02:03:47 PST

( from http://www.rxpgnews.com ) Last week, the government announced plans to let supermarkets and retail pharmacies provide GP services, particularly in under doctored areas. Boots the Chemist welcomed this as "good news" but doctors raised concerns that this may be "a back door way of privatising the NHS."

A report in this weekâs BMJ asks is "24-7 healthcare" really likely and how real is the threat of backdoor privatisation?

Itâs understandable that general practitioners might fear this new face of primary care as a threat to their business, writes author and freelance journalist, Lynn Eaton. But so far no company has voiced any intention of being direct providers of primary care. If anything, they want to steer clear of it, insisting they are merely renting out empty space to others.

However, GPs cannot afford to be complacent, warns Michael Dixon, chair of the NHS Alliance. "Itâs a wake-up call for the profession," he says. "If supermarkets are going to open surgeries with longer hours, itâs going to put pressure on GPs to open longer too."

The national clinical director for primary care, David Colin-Thome, believes that shifting GP surgeries into supermarkets is, potentially, a good idea, but stresses the need to keep the principles of good general practice.

The threat of backdoor privatisation of primary care is real enough, if you look at what has happened in social care in the last decade, writes Eaton. Voluntary sector organisations now sit alongside multinationals, while care homes are run by anyone from big companies like BUPA through to local entrepreneurs. Whatâs to say primary care wonât go the same way?

One flaw in the "backdoor privatisation" argument is that GP practices are already independent businesses, so maybe the real question is not whether primary care services will be privatised, but whether we might now see the corporate heavyweights â the chains and multinationals that grace our shopping centres â muscling in on the primary care act.

The supermarket model is a step too far for most doctors, but Michael Dixon does see change ahead, as primary care trusts try to provide patients with the longer opening hours and Saturday morning surgeries.

He warns: "There is pressure on GP practices to shape up. The government has tried the command and control method, but they canât do that because GPs are independent practitioners. The next thing was to bribe us â which was the new GP contract. The last thing is to create the big bad wolf of open competition, which is what we are beginning to see now."

Institutional discrimination by NHS causing unnecessary deaths of people with a learning disability

Fri, 23 Mar 2007 02:49:32 PST

( from http://www.rxpgnews.com ) Leading learning disability charity, Mencap, is calling for an independent inquiry into six deaths. The charity believes people with a learning disability have died unnecessarily due to institutional discrimination within NHS care. The cases are set out in Death by indifference, published by Mencap today (12 March 2007). Mencap says the deaths are a result of widespread ignorance and indifference within the NHS.

â¢Martin, aged 43, went without food for 26 days whilst he was in hospital following a stroke. This left him too weak to undergo surgery. Martin died on 21 December 2005.

â¢Doctors told Emma, aged 26, that she had a 50:50 chance of survival, but decided not to treat her as they believed she would not cooperate with treatment.

Emma died of cancer on 25 July 2004.

â¢Mark, aged 30, died eight and a half weeks after being admitted to hospital with a broken leg (femur). He was clearly distressed and in pain, but he had to wait three days to see the pain team.

Mark died on 29 August 2003.

Dame Jo Williams, Mencapâs chief executive, said: âWe are deeply disturbed that three years on from Mencapâs Treat me right! report which exposed inequalities within the NHS, people with a learning disability continue to receive worse healthcare than those without a disability. Despite government recognition of the inequalities experienced by people with a learning disability within NHS care , there has been no commitment to tackle them. It is an outrage that the solutions to this problem have long been recognised, and yet action has not been taken.

âMencap is calling for an urgent independent inquiry into the six deaths outlined in Death by indifference. We want the underlying bad practice, which we believe is a result of poorly designed systems, policies and procedures within the NHS, to be identified and acted upon. If action is not taken to eliminate institutional discrimination from our health services, people with a learning disability will continue to die unnecessarily.â

Mencap is calling for an independent inquiry into the six deaths in the report - An independent inquiry, which investigates all six deaths together rather than individually, will uncover underlying poor practice behind the deaths. This will show what lessons can be learnt to stop such tragedies happening again. It is also asking for a confirmation that the long promised confidential inquiry into premature deaths of people with a learning disability will be carried out - Only the confidential inquiry will reveal the number of people with a learning disability dying unnecessarily, and the scale of the problem the NHS must address. It has called for major improvements to the investigation of complaints against the health service - The current complaints system is lengthy and complex. Families want to find out how their loved one died, and whether that death was avoidable.

Allan, father of Mark, who died in August 2003, said: âMark was the centre of our lives and gave us such joy. I believe that if my son had not had a learning disability, he would still be with us today. The discrimination and indifference my family faced was shocking. The medical staff had such poor understanding of Markâs needs. Our family will never recover from having him ripped from us so suddenly. Lessons must be learnt from my sonâs death, so that nobody has to go through the torture of losing a loved one as a result of discrimination.â

The new report follows Mencapâs 2004 Treat me right! report which exposed the unequal healthcare that people with a learning disability often receive from healthcare professionals.

In 2001 Valuing People acknowledged that âhealth outcomes for people with learning disabilities fall short when compared with outcomes for the non-disabled populationâ, and identified solutions â including the need for a confidential inquiry in to premature deaths, annual health checks and staff training. The White Paper âOur health, Our care, Our sayâ admitted that people with learning disabilities face inequalities and that âthe NHS has historically not served such people wellâ. However, nearly six years after the introduction of Valuing People (2001), Mencap says no action has been taken.

Recent cases of âinstitutional abuseâ found at NHS primary care trusts in Cornwall and Sutton and Merton , which included physical and sexual abuse, serve as further evidence that discriminatory practices still exist within the NHS. In September 2006 the Disability Rights Commission (DRC) conducted a formal investigation into physical health inequalities experienced by people with learning disabilities . The investigation showed that people with a learning disability are less likely to receive the healthcare they need.

The Royal College of Psychiatrists strongly supports the recommendations of MENCAPâs report, Death By Indifference, which raises questions about the standards of care from professionals in the National Health Service.

âThe tragic stories in this report about neglect of people with learning disabilities who were physically ill is of deep concern to the College,â said Dr. Roger Banks, Vice-President.

âWe are in total support of the recommendations on the need to educate health professionals, and to listen carefully to the views of families and carers.

âThe College is very aware, through its members working in this area and through research, of the health needs of people with learning disabilities, the higher rates of morbidity and mortality in this population, and the difficulties often experienced in gaining access to appropriate assessment and treatment.

Should the NHS curb spending on translation services?

Fri, 23 Feb 2007 12:59:55 PST

( from http://www.rxpgnews.com ) In December it was reported that the NHS was spending £55 million (82m; $107m) each year on translation services. In this weeks BMJ, two doctors practising in inner London go head to head over whether language services in the NHS should be curbed.

Kate Adams, a general practitioner in Hackney, believes that doctors should encourage patients to learn English to avoid future public health problems.

Many people who have lived in the UK for more than 20 years speak little English, she writes. These patients are vulnerable to depression and related psychological responses to alienation. Can we really say that this is in either their interests or the interests of the wider community?

In the UK, the legal right to translation services is unclear. Citizenship must balance rights against duties, and may include a right to a reasonable standard of health care that will, in certain circumstances, entail the use of a translator. But should there not also be a corresponding duty to learn the language of the adopted community which has granted the rights, she asks?

However we decide to respond to this, health professionals need to encourage their patients to learn English, thereby helping them in the process of integration, otherwise we will be storing up public health problems for the future, she warns.

Translation services will always need to be available for elderly people whose English is poor, and for new arrivals, but at a time when the NHS is facing a huge financial crisis, is it in anyones interests to see the costs of translation services increasing?

She believes that high profile campaigns are needed to encourage people to learn English. If doctors can prescribe gym classes for depression, is it really so far fetched to suggest that we should also be prescribing English classes?

But David Jones, a general practitioner in Tottenham, argues that more, not less, spending is needed on language services.

It is clearly a disadvantage not to speak the majority language of the country in which you live. But he believes it is inappropriate for doctors to encourage patients to acquire English language skills.

The GMCs 2006 publication, Good Medical Practice, clearly states: To communicate effectively you must: make sure, wherever practical, that arrangements are made to meet patients language and communication needs. But all too often no such arrangements are in place.

This is not because such arrangements are impractical but because provision for translation and interpreting in the NHS is patchy and often not adequate or not used, he writes.

Current NHS interpreting services may also have negative health and social care consequences because they are so poor, he adds. For example, a new study from the United States has shown that adverse clinical events are more likely to result in physical harm in patients with limited English proficiency.

All doctors working in the NHS, certainly in the inner cities, understand quite clearly that care for non-English speakers regularly falls short of the GMCs expectation of good communication with patients. We must not let the politicians persuade us that it is the patients fault, he says.

The NHS Redress Act may lead to more complaints

Fri, 23 Feb 2007 12:48:38 PST

( from http://www.rxpgnews.com ) The NHS Redress Act should make clinical negligence cases simpler and less costly, but it may create more, not fewer, complaints warn experts in this weeks BMJ.

The current system for patients to obtain compensation after medical error has been much criticised by the government, writes barristers Richard Furniss and Sarah Ormond-Walshe. It is seen as complex, slow, and costly, both in terms of legal fees and staff time. Patients are said to be dissatisfied with the lack of explanation and apologies, and the system is believed to encourage defensiveness and secrecy in the health service.

The new NHS redress scheme aims to improve on the present system.

The scheme will apply to hospital care in England and Wales and will allow negligence claims to be made without court involvement. Redress may include an apology, explanation, or compensation up to £20,000. The scheme is therefore likely to be more useful to, and used by, those who have no grounds for monetary compensation because they have suffered no financial loss.

The scheme will fill a gap in the current system, but there are some concerns, say the authors.

For example, it may be seen as less impartial because NHS trusts will carry out the investigations. It may also create more cases because claims for small amounts of compensation or an apology are not currently included in the present system.

As a result, overall costs could rise because more clinicians will be diverted from their duty as part of the investigations, argue the authors.

Currently the scheme seems likely to give rise to more complaints and the way in which it deals with them may be less satisfactory than at present, they conclude.

Patients should cc the benefits of doctors' letters

Mon, 12 Feb 2007 06:37:19 PST

( from http://www.rxpgnews.com ) Patients should be kept informed of their condition and care said health minister Rosie Winterton today, as she called on healthcare professionals to make more effort to routinely copy letters to their patients.

Ms Winterton will be writing to healthcare professional bodies like the RCN, BMA, and General Practitioners Committee, urging them to encourage their members to copy patients into correspondence between clinicians so that patients are more informed about their condition and can make better decisions about their own healthcare. They will also be invited to take part in a round table discussion to agree a consensus on how to push this important issue forward.

In a recent Department of Health survey, nearly 7 out of 10 patients referred to a specialist in the last year said they had not received any copies of correspondence, with only a quarter saying that they had received copies of all letters.

Rosie Winterton says:

"Copying letters to patients is at the heart of creating a partnership between patients and their clinicians - it helps patients share in the decision making process about their care and make informed choices. One of the issues that patients frequently raise with me is that this is not happening nearly enough. Too few patients are routinely copied into their clinicians' letters and so are kept out of the loop on their care. The knock-on effect of this is that patients cannot participate fully in decisions about their care."

Joanne Rule, Chief Executive of Cancerbackup, says:

"Most patients want to see what is written about their condition and treatment - it's hopelessly old-fashioned to be excluded like this. Cancer patients say that access to letters helps them to share information about their treatment history and also to ask further questions. Access to letters would improve communication because no one should read news they haven't already been told and more attention would be paid to clear, jargon-free writing styles. I wholeheartedly support this Ministerial initiative."

The Minister of State for Health Services is writing to the Royal College of Nursing, Allied Health Professionals, BMA, General Practitioners Committee, NHS Confederation, as well as voluntary organisations, like Cancerbackup and the Long Term Medical Conditions Alliance, to draw their attention to the patient benefits of seeing letters written about them, and inviting them to meet to discuss ways of promoting and implementing the policy.

The NHS Plan (2000) established the right for patients to see correspondence relating to their care: "Letters between clinicians about individual patient's care will be copied to the patient as of right." DH issued guidance on copying letters to patients in 2003, with an expected implementation date of April 2004.

The PCT Patient Survey of 2005/06 (published January 2007) revealed that 68% of patients (who had been referred from their GP to a specialist in the previous 12 months) received no copies of correspondence between their GP and hospital. 7% received some letters, and 25% received them all.

Copying letters to patients helps:

- Establish more trust between patients and healthcare professionals
- Ensure patients are better informed so better able to make informed decisions about treatment options and to support self care and management
- Give patients written confirmation of what was said at consultations and what action is being taken, and
- Promote better compliance, as patients who understand their treatment are more likely to follow medical advice.

FPA survey reveals widespread misunderstanding about sex and reproduction

Mon, 12 Feb 2007 06:27:57 PST

( from http://www.rxpgnews.com ) Launching this years Contraceptive Awareness Week (Reproduction: a quick guide to your body, 12th-18th February), fpa has published a new survey testing peoples knowledge about sex and reproduction. The results expose widespread confusion and misunderstanding about some of the most basic facts. Consequently fpa is calling for sex and relationships education to become a statutory subject in the national curriculum.

The survey was conducted by Gfk NOP and is based on common questions asked by callers to fpa's national helpline. Respondents were given a choice of answers, the results are below.

Answering 'what would stop a woman from becoming pregnant if she did it immediately after sex' a total of 29% of respondents either thought that short bursts of vigorous exercise (jumping and dancing around), douching or urinating would stop fertilisation or said they didnt know if it wouldnt work.

Half (50%) the respondents gave the wrong answer or didnt know when a womans most fertile time is (the time in her menstrual cycle when she is able to get pregnant).

The majority of those questioned (89%) gave the wrong answer or didnt know that it is possible for sperm to live inside a womans body for up to seven days.

24% incorrectly thought that pre-ejaculate (the fluid a man produces before he ejaculates or comes) does not contain sperm or didnt know.

Finally respondents were asked to judge the sex education they received at school. Only 4% said it was excellent. Most respondents answered negatively: a combined 39% said it was either poor or extremely poor, whilst 25% said it was adequate and 18% said they never had any.

Anne Weyman, Chief Executive, fpa said:

This survey exposes how far the current system of providing sex education is failing and also that people are acutely aware that it is letting them down. Reproductive biology is the only statutory part of the national curriculum and even this isn't achieving acceptable educational standards.

In todays sexualised society, we are bombarded with a multitude of sexual imagery and messages. Nevertheless, providing people with the information and skills they need to make positive choices about their health and lives is not considered a priority. she continued.

The consequences of Government not taking action to make sex and relationships education compulsory will be continued poor levels of sexual health across all groups in society, and especially the young.

None of us are born with the facts about sex and reproduction we are taught them Anne continued. If this doesnt happen, myths start getting into circulation and people end up not being able to tell fact from fiction. If contraception isnt used or if it fails, instead of seeking professional help and advice people may take action that is completely ineffective in preventing a pregnancy.

One in five pregnancies ends in abortion so the effects of this reaches far into peoples lives. It is now time to make sex and relationships education a statutory subject in schools and invest properly in contraception services.

Original posters designed especially for the week have been sent to over 2,000 health and other professionals across the country. Electronic images are available.

For further information please contact fpa s press office on 020 7608 5265/5254. Mobile 07958 921060.

fpa (Family Planning Association) is the only registered charity working to improve the sexual health and reproductive rights of all people throughout the UK.

Ten per cent rise in money spent on social care services

Fri, 09 Feb 2007 05:40:39 PST

( from http://www.rxpgnews.com ) Spending on public sector social care services has risen by ten per cent over the past two years, according to figures released today by The Information Centre for health and social care.

Councils spent £19.3 billion on social care services for adults and children during 2005-06, compared with £17.7 billion in real terms in 2003-04.

There has been a continued rise in social care expenditure over the last ten years, up from £10.8 billion in 1995-96. The past twelve months saw a four per cent rise in expenditure, with £18.6 billion being spent in 2004-05.
ending on services for adults and older people has risen by five per cent over the past year. Services for adults and older people comprised 74 per cent of the total social care expenditure (£14.2 billion) during 2005-06.

This rise in the level of expenditure reflects the increasing number of adults and older people receiving services 1.7 million were given care in the last year, a rise of two per cent.

Chief Executive of The Information Centre, Denise Lievesley said, "The rise in social care expenditure reflects continuing growth in investment and provision of a wider range of services, including residential and nursing care, assistive equipment that helps a client live at home, and adoption services.

"It also reflects the increased cost of providing care for older people as our population ages. As we live longer, councils are providing care to help a growing number of older people live independently in their own homes."

Children and families received 25 per cent of funding for social services. Other expenditure was accounted for by services for older people (43 per cent), adults with learning disabilities (16 per cent), physically disabled adults (7 per cent), adults with mental health problems (5 per cent) and other adult services (2 per cent). Asylum seekers accounted for a further one percent of expenditure.

New screening test for all babies to be introduced

Thu, 08 Feb 2007 09:35:13 PST

( from http://www.rxpgnews.com ) All babies in England are to be screened for an inherited metabolic disease called Medium Chain Acyl CoA Dehydrogenase Deficiency (MCADD), within two weeks of birth, announced Health Minister, Ivan Lewis today.

The check will be carried out as part of the standard "heel-prick" test for babies that screens for other diseases such as sickle cell disorders and congenital hypothyroidism.

MCADD is a rare inherited metabolic disease that reduces the ability to maintain a normal blood sugar during episodes of metabolic stress.

MCADD affects between one in 10,000 and one in 20,000 babies born in the UK and screening should identify around 28 cases a year in England.

If the disease is not identified at an early stage, around a quarter of affected children will die from the condition, with one third of survivors sustaining significant neurological damage.

Once babies are identified and given simple treatment, the risk of acute, life-threatening episodes needing emergency and intensive care and of death is substantially reduced.

Health Minister, Ivan Lewis:

"I am delighted that all newborn babies will be screened for MCADD. Not only will the introduction of this screening programme save lives it will improve the quality of life for those children affected by this condition"

National Clinical Director for Children, Sheila Shribman said:

"This is a very important screening programme and I fully support its implementation. Evidence shows that screening newborn babies for this condition will not only save lives but it can significantly improve their quality of life. Simple treatment through dietary management will substantially reduce the risk of death and the risk of acute, serious illness."

Ministers asked the UK National Screening Committee (NSC) to set up a pilot study to provide essential evidence in an NHS setting of the clinical and cost effectiveness of screening for this condition and the feasibility of implementation. The final report will be available in 2008 but sufficient evidence and analysis was available for the NSC to make its recommendation that newborn screening of all babies would be clinically and cost effective in the UK.

There will be a planned roll out of the screening programme over the next two years.

NICE asked to develop guidance on new treatments for breast and lung cancer, Crohns disease, ulcerative colitis, obesity and rheumatoid arthritis.

Thu, 08 Feb 2007 05:34:09 PST

( from http://www.rxpgnews.com )

NICE has also been asked to appraise adalimumab for moderate to severely active Crohn%u2019s disease.

The National Institute for Health and Clinical Excellence (NICE) today welcomes the announcement of additional topics for its forward work programme. Topics including new treatments for breast and lung cancer, Crohns disease, ulcerative colitis, obesity and rheumatoid arthritis, have been referred to NICE by the Secretary of State for Health in line with the national priorities they have established for the NHS.

The following topics have been referred:

2 clinical guidelines on:
o Rheumatoid arthritis in adults
o Diarrhoea and vomiting in children

1 rapid clinical guideline on:
o Acutely ill patients in hospital

5 technologies for appraisal as part of NICEs rapid single technology appraisal (STA) programme on:
o Bevacizumab for non-small cell lung cancer
o Certolizumab pegol for rheumatoid arthritis
o Infliximab for ulcerative colitis
o Lapatinib for advanced or metastatic breast cancer
o Rimonabant for the treatment of obese and overweight patients

3 technologies for appraisal as part of NICEs multiple technology appraisal (MTA) programme on:
o Endovascular stents for abdominal aortic aneurysms
o Machine versus cold (static) storage of donated kidneys
o Spinal cord stimulation for chronic pain

In addition, NICE has also been asked to appraise adalimumab for moderate to severely active Crohns disease. It has not yet been confirmed whether this will be appraised as part of the Institutes MTA or STA programmes.

Commenting on the referrals, Andrew Dillon, NICE Chief Executive said: NICE welcomes the referral of todays topics, which address areas of significant concern for those working in the NHS, patients and carers. We are keen to begin developing guidance that will help to inform their decisions about treatment and healthcare in these areas as soon as possible and we will publish details of the timetables for these topics on our web site shortly.

Is doctors' pay responsible for the financial crisis in the NHS ?

Mon, 05 Feb 2007 12:54:37 PST

( from http://www.rxpgnews.com ) Recent newspaper headlines have suggested that doctors' pay is responsible for the financial crisis in the NHS. In this week's BMJ, two experts go head to head over whether the remuneration is justified.

Alan Maynard, Professor of Health Economics at York University argues that doctors' self interest manifests itself in two ways: enhancing personal income and protecting clinical autonomy fiercely - the right to do what they think is best for their patients.

He maintains that the first type of self interest has enhanced average UK earnings to over £100,000 for both general practitioners and consultants, with little observable improved activity or patient outcomes.

The general practice quality and outcomes framework raised earnings, but, he argues, with a limited evidence base and little baseline data its benefits are uncertain. The consultant contract and the cost of replacing out-of-hours cover with other providers have also increased expenditure.

Professor Maynard writes that this pay increase has inflated NHS expenditure with all too little benefit to patients or taxpayers, while giving more general practitioners incentives to deliver what good practitioners were already providing.

The second area of doctors' self interest is the understandable desire to do the best for their patients. But he believes that this can lead to inefficient practice that ignores the opportunity costs of decision making. For example, a decision to give Jones a marginally cost effective treatment deprives Smith of cost effective care. Such inefficiency in the use of society's scarce resources is surely unethical, he asks?

These pay increases, together with workforce management which has led to unaffordable employment increases, are creating deficits and undermining patient care and the financial performance of the NHS, he argues. Instead of talking simply about money, we need to determine whether its use benefits patients or is merely a form of social security for providers.

But Laurence Buckman, a GP in London believes that demanding and receiving proper pay and conditions is everyone's right, even in the public sector. This is not self interest. Self interested doctors would go and work elsewhere, he writes.

Until 2003, general practitioners were working long hours, including nights and weekends, and out of hours pay was low. The new contract was an attempt to correct that by placing contracts with practices rather than general practitioners, setting limits to what a practice could be asked to do, and creating a total budget for staff and expenses. General practitioners' pay became the profit that was left after expenses.

The main source of extra income into practices from the new contract is the quality and outcomes framework, which accounts for 40% of practice income. The government claims that general practitioners' pay has risen unexpectedly, but this is not so. The BMA predicted the rise quite accurately, he says.

Total pay has been deliberately misquoted by adding the employers' pension contribution that general practitioners have to pay for themselves which makes pay seem 14% higher than it is.

Government figures show a shortage of general practitioners. If self interest had been pandered to there would be a glut of doctors. That there isn't is because of the dreadful way that the NHS is managed by a government bereft of ideas and the honesty and wit to tackle the problems that deter young people from joining us, he argues.

Doctors are fed up with being told that the small percentage of the NHS that they cost is the reason why the NHS is in financial trouble. Most patients see us as part of the solution and are willing to pay.

Britain plans medical hub to meet India, China challenge

Fri, 15 Dec 2006 16:28:54 PST

( from http://www.rxpgnews.com ) London, Dec 15 - Faced with India and China's growing strengths in medical research, British Prime Minister Tony Blair has announced the creation of a 'global medical excellence cluster' comprising universities and drugs companies.

The hub is to be set up in southeast England to protect Britain's science base and boost its ability to find new cures. This is the latest of measures initiated by government functionaries while citing the growing 'threat' of India and China in the fields of education, employment, trade and industry.

Blair said at a meeting of representatives of drugs companies and leading universities at 10, Downing Street: 'I am very concerned about the risk from India and China and competition from America.

'China and India are already in some respects First World economies. They are investing heavily in their science and technology. The development of science and technology is now central to our economic future. If we fail to make the most of what we have, then we will fall behind.'

According to Blair, the situation can be turned to Britain's advantage by linking business and academia.

Noting that Singapore, Dubai, Shanghai and New Delhi were developing similar approaches, Blair said the aim was for the 'cluster' to be similar to the one in Boston, Massachusetts, that includes Harvard, the Massachusetts Institute of Technology, eight medical schools, 14 teaching hospitals and 200 biotechnology companies.

The meeting was attended by David Brennan, the chief executive of AstraZeneca, Chris O'Donnell, the chief executive of hip-and-knee replacement maker Smith and Nephew, David Cooksey, a biotechnology guru, and Richard Sykes, a rector of the Imperial College in London.

Universities to be included in the cluster are Imperial College, University College London, King's College, Oxford and Cambridge. Extra funding would be available for specialist infrastructure and research projects in southeast England, including Oxford and Cambridge.

Obese patients in Britain to dance

Mon, 04 Dec 2006 19:29:36 PST

( from http://www.rxpgnews.com ) London, Dec 4 - Obese patients in Britain may have to dance to improve their fitness level as a part of upcoming national campaigns to get people to take more exercise.

The department of health is going to introduce dance classes such as street-dancing and tango classes to counter declining fitness levels and prevent a national obesity crisis, according to the online edition of Daily Mail.

Ministers are preparing to roll out a campaign to get people to take more exercise across England and Wales.

A spokesperson for the department of health said a series of pilot projects around the country had demonstrated that 'physical activity interventions were cost effective and saved the National Health Service money in the long run'.

More than 14 million people in Britain will be dangerously overweight by 2010, the website said.

The cost could be upwards of $15.8 billion a year, including medical bills for diabetes, heart disease, depression and lost work.

The British government has recommended that children participate in at least an hour of moderate activity a day while adults should lightly exercise for 30 minutes five days a week, it said.

Nationwide protests in UK against Alzheimer’s drugs decision

Sun, 19 Nov 2006 09:18:33 PST

( from http://www.rxpgnews.com )

The decision to deny life-changing drugs to thousands of people with Alzheimer’s at a saving of just £2.50 a day triggered protest marches across the country on Friday 17th November 2006.

The nationwide action brought together people with Alzheimer’s, carers, doctors and MPs, marching against the recommendation by the National Institute for Health and Clinical Excellence (NICE), to refuse access to treatments for people in the early and late of Alzheimer’s disease on the NHS.

Co-ordinated by the Alzheimer’s Society, more than 30 protests took place across England and Wales, including rallies in London, Manchester, Southampton and Newcastle. Protestors armed with placards, petitions and thousands of signatures met with MPs supporting the Alzheimer’s Society call for doctors to have greater flexibility in prescribing treatments.

Neil Hunt, chief executive of the Alzheimer’s Society, says,

"What sort of society have we become when the health of hundreds of thousands are sold to save just £2.50 a day? This blatant cost cutting will rob people of priceless time early in the disease and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke. This is victimisation of the most vulnerable in society and today is an opportunity for people to take a stand."

The guidance from NICE comes into force in less than a week, on Wednesday 22 November, despite five appeals and widely acknowledged problems in the appraisal of drug treatments. More than 125 MPs have already signed an Early Day Motion (EDM) demanding action from the Department of Health to make sure doctors continue prescribing treatments in the best interests of their patients.

Celebrities Richard Briers, Fiona Phillips and AA Gill are among those supporting the campaign. Children’s presenter Richard McCourt and Russell Grant led marches in Sheffield and North Wales, with Linda Nolan in Bradford and actress Nicola Duffet supporting the rally in Sutton.

Keith Turner a person with Alzheimer’s disease who took part in a protest in Hastings, said,

"These drugs have given me so much. I used to wander lost and confused but now I can play with my grandchildren, tell my wife I love her and do things for myself again. This is a priceless gift."

Eisai and Pfizer, the manufacturers of one of the drug treatments for Alzheimer's, have informed NICE that they intend to apply for a judicial review against its decision to restrict access to Alzheimer's drugs.

Although the Alzheimer's Society is not involved in this legal action and is seeking legal advice as to whether to launch its own judicial review against the decision in the High Court, our Chief Executive, Neil Hunt welcomed the news.

"It’s great news that NICE will be challenged in court. This has been a flawed process from start to finish. NICE holds the fate of thousands of people’s lives in its hands and it is only right that it is brought to account.

The Alzheimer’s Society has also been seeking separate legal advice as to whether to launch its own judicial review against this decision in the High Court.

NICE’s decision to deny people in the early and late stages of Alzheimer’s disease access to drug treatments is cruel and unethical. That is why thousands of people across the country are taking to the streets today (17 November) to voice their outrage.

This devastating decision was due to come into force next week, surely NICE must now postpone issuing this guidance until all legal challenges have been heard."

Indians among worst affected by TB in Britain

Sat, 04 Nov 2006 19:31:00 PST

( from http://www.rxpgnews.com ) Tuberculosis (TB) showed an alarming rise in Britain last year with ethnic South Asians, especially Indian, Pakistani and Bangladeshi, accounting for most cases.

According to figures released by Britain's Health Protection Agency (HPA), there was a 10.8 percent increase in TB cases in Britain, with 8,113 cases in 2005 as against 7,321 in 2004.

The highest proportion of cases, 38 percent, was reported among people from Indian, Pakistani and Bangladeshi ethnic backgrounds.

"The largest increase was seen among patients not born in the UK, who accounted for 5,310 cases," John Watson, head of the HPA's respiratory diseases department, said.

According to the figures, London had the highest proportion of cases in 2005 (43 percent), having increased from 3,129 in 2004 to 3,479 in 2005. The regions with the highest number of new cases were the North West (588 in 2004 to 757 cases in 2005), East Midlands (443 in 2004 to 556 in 2005) and the East of England (395 in 2004 to 483 in 2005).

The sharp rise in TB cases in Britain has raised concern among health workers.

TB was the biggest killer disease in Britain during the 19th century.

The disease is preventable and treatable. It usually spreads when somebody with the infection coughs or sneezes. It affects the lungs and sometimes other parts of the body. The symptoms include fever and night sweats, a persistent cough, losing weight and coughing or spitting blood.

Mental health units should not be exempt from smoking ban

Fri, 25 Aug 2006 19:43:00 PST

( from http://www.rxpgnews.com ) Exempting mental health units from the ban on smoking in public places would worsen health inequalities for people with mental health problems, warn doctors in this week's BMJ.

Smoking is the largest single cause of preventable illness and premature death in the United Kingdom, with 106,000 people dying of smoking related diseases in 2002, and more than 10,000 dying each year as a result of passive smoking.

The Health Act 2006 will make all enclosed public and work places in England and Wales smoke-free environments, but may exclude some mental health settings.

This would be a mistake, argue Jonathan Campion and colleagues, as the prevalence of smoking is high among people with mental health problems.

Nearly three quarters of people with schizophrenia, affective psychosis, and other mental health disorders who live in mental health settings are smokers, and they are more likely to be heavier and more dependent smokers than the general population, they write.

As a result, people with mental health problems are at a substantially greater risk of premature death from smoking related diseases than is seen in the general population. This is particularly important given that those with mental illness already experience high levels of social exclusion and health inequality, which are exacerbated by smoking.

Arguments for excluding mental health settings from the new smoke-free legislation are that they are places of residence and that some patients are detained under the Mental Health Act. However, health and safety legislation places a duty on NHS employers to protect staff and patients from exposure to environmental tobacco smoke.

Another argument is that preventing people smoking is an infringement of human rights, particularly for detained patients. But the Human Rights Act 1998 allows an individual choice only if that does not endanger others. Furthermore, this argument is not applied to other forms of drug misuse, and people are not allowed to drink alcohol or use illegal drugs in mental health units.

Research also shows that smoke-free policies have succeeded in mental health settings. Such bans have caused fewer problems than anticipated, and policies applied in a consistent way to all patients were more effective than selective bans.

The health select committee has proposed that psychiatric institutions in England and Wales should not be exempt from the Health Act 2006, say the authors. "We strongly endorse this proposal and suggest that all mental health settings should introduce complete smoke-free policies. These policies should be introduced in a flexible and pragmatic way, with support and treatment available for patients to stop smoking and manage withdrawal."

"Exemption from the Health Act will exclude mental health patients from mainstream health improvement strategies and exacerbate the inequality they already experience," they conclude.

NHS may be buying surgical equipment unethically

Sun, 30 Jul 2006 02:56:00 PST

( from http://www.rxpgnews.com ) The NHS may be buying medical equipment unethically and exploiting developing countries, it has been claimed in an article published on bmj.com today.

Unlike the campaigns for fair trade of goods like bananas and coffee, there have been no such campaigns for medical commodities, says Dr Mahmood Bhutta, a specialist registrar in otolaryngology (head and neck surgery) at Guys and St Thomas Hospital in London.

Dr Bhutta says that while NHS suppliers are encouraged to act in an ethical business manner, they do not and there are currently no checks or assessments made into the origins of surgical instruments used by the NHS.

The trade in surgical instruments is open to unethical sourcing because many such instruments are manufactured in the developing world, writes Dr Bhutta.

The global trade in hand held stainless steel surgical instruments is worth around £352million ($650m, 507m) a year and many of these instruments are made by firms in towns in Europe and Asia. The two largest producers are Tuttlingen in Germany and Sialkot in Pakistan.

Companies in Sialkot use more traditional production methods with most instruments manufactured and finished by hand, so production is more labour intensive, employing 50,000 people (7,700 of whom are children aged from 7 and older) to supply a fifth of the worlds surgical instruments.

Many firms in Sialkot sub-contact the initial production of these instruments to workers in small workshops or their own homes in an attempt to reduce overheads and minimise costs. These workers earn around £1 a day ($2, 1.50).

The firms sell to suppliers and retailers in the developed world who then sell on to companies in Germany which sell to the NHS and elsewhere in the world at a marked up price, says Dr Bhutta.

The solution lies in purchasers insisting on fair and ethical trade when sourcing instruments, he adds.

Is it time to give NHS more independence?

Sun, 30 Jul 2006 02:49:00 PST

( from http://www.rxpgnews.com ) In April this year, BMJ Editor Fiona Godlee called for an independent NHS run by a board of governors responsible for managing health care within a set budget and a broad political framework.

In this weeks BMJ, four opinion leaders give their views on whether it is time to give the NHS greater independence from government.

Democratic control is essential, argues Stephen Thornton, Chief Executive of The Health Foundation. Democratic checks and balances are the best way to ensure we continue to move the NHS in the right direction, not the creation of a barely accountable technocracy that would place all power in the hands of professionals and bureaucrats."

The key issue is how to do this more effectively than at present. He believes the trick is to deal with the democratic deficit in policy making and commissioning while giving much more operational freedom to healthcare providers.

A second article, by Gwyn Bevan, Professor of Management Science at the London School of Economics, argues that the destabilisation of the NHS in England through successive reorganisations has meant that the only options for governance have been either a competitive provider market or a regime of targets.

Each has serious limitations, he says, and the movement from one to the other has contributed to the squandering of unprecedented increases in NHS funding. His call for 'independence' for the NHS is to design systems of local accountability that would offer an effective alternative to provider competition or a centrally-driven regime of targets.

General gractitioner Stephen Gillam warns that "an independent NHS will become a glorified commissioning agency as what used to be a national health service becomes an amalgam of free floating foundation hospitals, NHS trusts, private companies, and traditional primary care providers."

We may now, indeed be ruled by fundamentalists whose faith in markets, competition, and the profit motive as the sole path to effective public service is unshakeable, he writes. Paradoxically, an NHS agency could spearhead the crusade.

In the final article, two US health experts believe that the NHS has the inherent capability to become the greatest healthcare system of any nation.

They applaud Labours original plan for modernisation and advise not to remove NHS leadership too far from government power. But they wonder whether something big should change to steady the NHS on its worthy, inspiring journey.

The NHS is not just a national treasure; it is a global treasure, they write. As unabashed fans, we urge a dialogue on possible forms of stabilisation to better provide the NHS with the time, space, and constancy of purpose to realise its enormous promise.

University of Leeds receives Gates Foundation grant for material approach to malaria prevention

Mon, 24 Jul 2006 19:25:00 PST

( from http://www.rxpgnews.com ) Every year there are more than 350 million new cases of malaria, but a revolutionary mosquito net being developed by Leeds textile experts with funding from the Bill & Melinda Gates Foundation could offer better and more sustainable protection from the disease.

Design lecturer Dr Stephen Russell and medical entomologist Dr Bruce Alexander from Xeroshield at the Roslin Biocentre will develop a precisely engineered material that uses its structure to kill the mosquito. By relying on its structure, the net will avoid the problems of chemically treated nets, which are the main method of controlling malaria.

Existing chemically-treated cotton or polyester nets need re-treating or replacing within 20-25 washes. The move away from insecticides has the added benefit of preventing mosquitoes from becoming resistant to these chemicals.

Dr Russell said: "For years, we've only seen small improvements in the design of mosquito nets and this research provides us a great opportunity to develop new insecticidal materials in a fundamentally different way.

"We are taking an unconventional approach to the design and construction of the nets whilst maintaining their inherent breathability, strength and durability."

Dr Alexander said: "Not only is this potentially a safer and cheaper method of protecting people, it will also avoid the problem of chemical resistance. We're already seeing bedbugs in the mattresses covered by nets becoming resistant to pyrethroids. We need to break the cycle of playing catch-up as insects develop resistance to insecticides."

"The new nets would be a more sustainable way of protecting people from mosquitoes and we hope could go some way to preventing some of the one million plus deaths from malaria seen every year."

The £360,000 funding from the Bill & Melinda Gates Foundation for the three year project was raised with support of the North America Foundation for the University of Leeds.

"Entrenched global health problems, such as malaria, require innovative solutions," said Dr Regina Rabinovich, director of the Gates Foundation's Infectious Diseases program. "If successful, this research could produce an important new tool to fight malaria in the world's poorest countries."

Tuberculosis control and impact of socially excluded groups

Mon, 10 Jul 2006 07:21:00 PST

( from http://www.rxpgnews.com ) Tuberculosis cannot be controlled unless the disease is tackled effectively among socially excluded groups, warn experts in this weeks BMJ.

Tuberculosis can infect anyone, but predominantly affects the poor, write Alistair Story and colleagues. In London, where over 40% of all cases in the UK in 2004 were reported, rates of tuberculosis have more than doubled since 1987 and are now the highest among homeless people, problem drug users, people living with HIV, prisoners and new entrants, particularly those from countries experiencing chronic civil conflict.

Recently published guidance from the National Institute of Health and Clinical Excellence (NICE) recommends chest x-ray screening for homeless people and entry screening for prisoners. Mobile x-ray units targeted at high risk groups are also being evaluated in London.

The guidance also suggests hospital admission for homeless people and those with clear socioeconomic need, allocation of a named key worker for all patients, and risk assessment to identify those patients unlikely to adhere to treatment. Directly Observed Therapy (DOT where a health worker or other responsible adult observes the patients taking their medication) is also recommended to improve adherence to treatment.

Most tuberculosis patients are not infectious, readily access health services, and complete treatment successfully without DOT, say the authors. As a result, they make only limited demands on services and pose little public health risk.

By contrast, many socially excluded patients are at risk of delayed presentation, poor adherence and loss to follow-up. A major and persistent outbreak including over 200 linked drug resistant cases disproportionately affecting homeless people, prisoners and problem drug users in London clearly illustrates the urgent need to strengthen tuberculosis control among socially excluded groups.

The occurrence of tuberculosis in England closely reflects indices of poverty and overcrowding, they add. If the major determinants of a disease are social, so must be the remedies.

Tuberculosis cannot be controlled unless the disease is tackled effectively among socially excluded groups. This demands co-ordinated action beyond established control strategies that will require significant and sustained investment, they conclude.

Pertussis Endemic Among UK School Children

Mon, 10 Jul 2006 06:37:00 PST

( from http://www.rxpgnews.com ) Nearly 40% of school age children in the United Kingdom who visit their family doctor with a persistent cough have evidence of whooping cough infection, even though they have been fully immunised, finds a study published on bmj.com.

These startling results suggest that whooping cough is endemic among young children in the UK, with important implications for clinical practice and immunisation policy, say the authors.

Previous research in several countries has shown that Bordetella pertussis (whooping cough) infection is an endemic disease among adolescents and adults. Data also shows that neither infection nor immunisation results in lifelong immunity. Yet general practitioners in the UK seldom diagnose or even consider pertussis in older children. It is perceived as a disease of very young children who have not been immunised and who have classic features such as whoop.

So researchers set out to estimate the proportion of school age children in Oxfordshire with a persistent cough who have evidence of a recent pertussis infection.

They identified 172 children aged 5-16 years who visited their family doctor with a cough lasting 14 days or more. Details on the duration and severity of cough were recorded and immunisation records were checked. Blood samples were taken to test for pertussis infection and parents and children also completed a cough diary.

A total of 64 (37.2%) children had evidence of a recent pertussis infection; 55 (85.9%) of these children had been fully immunised.

Children with pertussis were more likely than others to have whooping, vomiting, and sputum production. They were also more likely to still be coughing two months after the start of their illness, continue to have more than five coughing episodes per day, and cause sleep disturbance for their parents.

These results show that a substantial proportion of immunised school age children presenting to UK primary care with a persistent cough have evidence of a recent infection with Bordetella pertussis, say the authors.

They urge general practitioners to be alert to a potential diagnosis of pertussis in any child who presents with a persistent cough. A clear diagnosis will allow general practitioners to give parents an indication of the likely length of cough and prevent them prescribing unnecessary drugs for asthma or referring children for further investigations, they conclude.

Building a safer NHS: How safe are the patients?

Fri, 07 Jul 2006 00:23:00 PST

( from http://www.rxpgnews.com ) Mr Edward Leigh MP, Chairman of the Committee of Public Accounts, said today:

According to the Department of Health, one in every ten patients admitted to NHS hospitals is unintentionally harmed. This Committee has found, furthermore, that, in a single year, nearly one million reports of incidents and near-misses were recorded by NHS trusts. These statistics would be terrifying enough without our learning that there is undoubtedly substantial under-reporting of serious incidents and deaths. To top it all, the NHS simply has no idea how many people die each year from patient safety incidents.

What this points to are two related and deep-seated failures. One is the failure of the NHS to secure accurate information on serious incidents and deaths. The other is the failure on a staggering scale to learn from previous experience. Around 50% of all actual incidents might have been avoided if NHS staff had learned lessons from previous ones.

The National Patient Safety Agency was set up precisely to put a National Reporting and Learning System in place. The system was delivered several years late and has led to serious delay in the development and sharing of effective solutions, both locally and nationally.

Given this dysfunctional performance, the contribution the Agency has made towards improving patient safety and achieving value for money for the taxpayer has been extremely weak.

Mr Leigh was speaking as the Committee published its 51st Report of this Session.

Every day the NHS treats over one million people successfully. Healthcare does however rely on a range of complex interactions of people, skills, technologies and drugs. Sometimes surgical treatments go wrong, medication errors occur and patients can fall or have other accidents.

The drive to improve patient safety started in 2000 with the Chief Medical Officers Report An organisation with a memory. This found that a blame culture and the lack of a national system for sharing lessons learnt were key barriers to identifying and then reducing the number of patient safety incidents. The Report estimated that one in ten patients admitted to NHS hospitals are unintentionally harmed, costing the NHS around £2 billion a year in extra bed days and some £400 million in settled clinical negligence claims. Around 50% of incidents could be avoided if lessons from previous incidents had been learnt. These findings were similar to those of other developed countries.

In response, the Department of Health (the Department) published Building a safer NHS for patients, which set out the Governments plans, timetable and targets to promote patient safety, including establishing the National Patient Safety Agency. The Agencys objectives were to develop a mandatory national reporting scheme by December 2001 for incidents and near misses, assimilate other safety-related information from a variety of existing systems, learn lessons and develop solutions. At the time trusts had to report to one or more of over 30 different organisations depending on the type of incident. There was an expectation therefore that the creation of the Agency would reduce the complex regulatory framework for monitoring quality and safety.

On the basis of a Report by the Comptroller and Auditor General, the Committee took evidence from the Department of Health, the National Patient Safety Agency and the Chief Medical Officer for England.

The Committee found that in 200405 some 974,000 patient safety incidents and near misses were recorded on NHS trusts reporting systems. NHS trusts need to bring down the level of avoidable incidents, particularly those leading to serious harm and death, through rigorous implementation of safety alerts and adoption of high impact, evidence based solutions such as those promulgated by the National Patient Safety Agency and the Institute of Innovation and Improvement.

There have been some notable improvements at NHS trust level in developing a more open and fair reporting culture, reflected in the year on year increase in the numbers of reported incidents and near misses. Nevertheless, under-reporting remains a problem (trusts estimate that on average 22% of incidents go unreported, mainly medication errors and incidents leading to serious harm) and similar types of trusts report widely different levels of incidents per 1,000 members of staff. Few trusts have formally evaluated their safety culture. Furthermore, trusts have not done enough to inform patients when things go wrong or to involve patients in developing solutions to incidents.

Insufficient progress has been made in achieving the Departments plans in Building a Safer NHS for Patients and there is a question mark over the value for money being achieved by the National Patient Safety Agency, evidenced in the main by the delays and cost over-runs in establishing its National Reporting and Learning System and in the limited feedback of solutions to reduce serious incident that has, so far, been provided to trusts. The National Patient Safety Agency has also failed to evaluate and promulgate solutions that have been developed at trust level.

Experts Comment on New Blood Pressure Guidelines

Thu, 29 Jun 2006 01:52:00 PST

( from http://www.rxpgnews.com ) Professor Peter Littlejohns, Clinical and Public Health Director at NICE and Executive Lead for the guideline, said: It is unusual for NICE to consider reviewing its guidance ahead of its planned review date. In this case however, because significant new data became available, we took the decision to consider that data as part of a limited review of the existing NICE guideline. It is important to emphasise that the review was limited to the pharmacological aspects of managing hypertension. The original guideline also covered other aspects of managing the condition, such as lifestyle interventions, and these remain crucial to a proper holistic approach to controlling blood pressure.

Professor Bryan Williams, Member of the Guideline Development Group and Professor of Medicine, University Hospitals NHS Trust, Leicester, said: This is a hugely important step for people with hypertension and the healthcare professionals who treat them. This new guidance has benefited from a rigorous evaluation of the evidence and has resulted in a simple, pragmatic and practical approach to treating blood pressure, one of the most important causes of premature death in the UK. In addition, the recommendations have undergone a cost-effectiveness analysis which has reinforced the guidance. It is no longer a case of can we afford to do it? but more, can we afford not to do it! The decision to recommend that beta-blockers should no longer be used as a routine initial treatment for high blood pressure is a bold decision and the correct decision.

Professor Morris Brown, President of the BHS and member of the guideline development group, said: "The British Hypertension Society is pleased to be a partner in the first joint guideline between NICE and a specialist society. The application of the full rigour of the NICE process to the newer data on drug treatments has resulted in recommendations which, although not dissimilar to those at which the BHS arrived two years ago, has permitted some preferences to be expressed between drugs of the AB and CD pairs used in the treatment of hypertension. I hope that the new guideline will both stimulate and enable doctors to review treatment of all their patients with hypertension, and achieve the internationally accepted target blood pressure of 140 in the majority of patients.

Dr Mark Davis, GP, of the Primary Care Cardiovascular Society and member of the Guideline Development Group, commented: Primary care will welcome this unified guidance from two authoritative and respected organisations. The management of hypertension forms a major part of our workload and we can incorporate this update into our practice protocols. This will help us to further improve our success in managing this important cardiovascular risk factor to the benefit of our practice population. "

Courtesy: Blood Pressure Association (BPA)

Jan Procter- King, Nurse Practitioner and member of the Primary Care Cardiovascular Society and Guideline Development Group, said: These guidelines will be very welcome to all primary care nurses. Since the introduction of the Quality Outcome Framework for general practice, hypertension has been a fundamental focus of the primary care nurse. These pragmatic evidence based guidelines, presented in this clear manner, will I am certain, support the delivery of evidence based hypertension management.

Jean Thurston, patient and carer representative on the guideline development group, said: It is reassuring for patients to know that the treatment changes recommended in this guideline are based on the very latest evidence available and use a consistent approach. The accompanying Information for Patients literature is informative and should be easily understood by everyone.

Professor Graham MacGregor, Chairman of the Blood Pressure Association, said: High blood pressure is by far the biggest preventable cause of death and disability in the UK through the strokes, heart attacks and heart failure that it causes. This new agreed treatment regimen is tremendous news for people affected by raised blood pressure as the combination of drugs suggested are more effective and have less side effects. This will result in much better control of blood pressure and therefore large reductions in stroke, heart attack and heart failure.

Sarah Ransome, BPA Head of Information and Support, said: "Living with high blood pressure can be very difficult. We know from our own research that beta-blockers commonly cause side effects, including tiredness, lethargy, impotence and mood swings, and can enormously impact on that individual and their family's quality of life.

"The Hypertension Guideline update is good news for doctors treating hypertension and more importantly for people with high blood pressure. We now have clear, unified, evidence-based advice on the optimal drugs for younger and older individuals, and how to use these drugs to achieve the recommended targets." Professor Gordon McInnes, Vice-President, British Hypertension Society

New Guideance will Result in Better Control of Hypertension - BPA

Thu, 29 Jun 2006 01:45:00 PST

( from http://www.rxpgnews.com ) The UK's blood pressure charity, the Blood Pressure Association (BPA), heralded 28 June, 2006 launch of the updated NICE guideline on the clinical management of hypertension as a major advance in the treatment of the condition. For the first time, NICE and the British Hypertension Society have reached a clear consensus on the best way of treating raised blood pressure, and the BPA strongly endorses this new guideline.

Professor Graham MacGregor, Chairman of the Blood Pressure Association, said: "This is a major step forward in the treatment of high blood pressure and tremendous news for the millions of people in this country with the condition.

"The new guideline can easily be followed by health professionals and people with high blood pressure. The net result will be much better control of blood pressure with far fewer strokes, heart attacks and heart failure. This is particularly so because the treatment combinations suggested are more effective and have less side effects."

A major change is that beta-blockers, which have been shown to be less effective in reducing strokes and more likely to cause diabetes2, are no longer recommended for the routine treatment of the majority of people with high blood pressure.

"Access to more effective drugs will be really welcomed by patients and will have implications, not only for the newly diagnosed, but for the many millions of people already on beta-blockers," said Professor MacGregor.

High blood pressure is the biggest preventable cause of death and disability in the UK through the strokes, heart attacks and heart failure that it causes. Poor blood pressure control results in approximately 125,000 unnecessary stroke and heart attack events every year, about half of which are fatal3.

Sarah Ransome, BPA Head of Information and Support, said: "Living with high blood pressure can be very difficult. We know from our own research that beta-blockers commonly cause side effects, including tiredness, lethargy, impotence and mood swings, and can enormously impact on that individual and their family's quality of life.

"The new guideline will result in better control of blood pressure by giving patients access to the best available treatments and encouraging dialogue between patients and their health professionals so that they can make informed decisions about their care."

Professor MacGregor added: "We would encourage those people currently taking beta-blockers to talk to their GP or health professional on their next visit to discuss whether changing the medication in the fullness of time to newer medicines would be appropriate for them. People should not stop taking beta-blockers on their own as this will do far more harm than good. Furthermore, beta-blockers will continue to have an important role in the treatment of angina, heart failure and following a heart attack, or in women of child-bearing age with high blood pressure."

Three million babies born using assisted reproductive technologies

Thu, 22 Jun 2006 05:09:00 PST

( from http://www.rxpgnews.com ) More than three million babies have been born worldwide using assisted reproductive technologies (ART) since the first ART baby (Louise Brown) was born in the UK 28 years ago.

According to the 2002 World report on ART presented at the 22nd annual conference of the European Society of Human Reproduction and Embryology, 200,000 ART babies were born around the world in 2002. This compares with about 30,000 born in 1989, which was the first year that data were collected for the World report.

The report includes data from 52 countries, covering almost 600,000 ART cycles and 122,000 newborn babies. Dr Jacques de Mouzon, a member of the International Committee for Monitoring Assisted Reproductive Technologies (ICMART), told the conference: "The ICMART report covers two-thirds of the world's ART activity, so the total number of ART cycles in the world can be estimated at one million a year, and the number of ART babies produced at around 200,000 a year."

Since the previous World report for the year 2000, another four countries have started to contribute data to ICMART and there has been an increase of 100,000 cycles and 20,000 newborn babies. Data from most of Africa and many Asian countries is still missing.

One in six couples worldwide experience some form of infertility problem, but there are huge variations in availability and efficacy of ART between countries.

Dr de Mouzon said: "The average pregnancy rate for each cycle using fresh embryos was 25.1% and the delivery rate was 18.5%. However, these rates varied from 13.6% to 40.5% for pregnancy, and 9.1% to 37.1% for delivery. Availability was highest in Israel where there were 3,260 cycles per million inhabitants, followed by Denmark with 2,031 cycles per million, and it was lowest in most of the Latin American countries where there were less than 100 cycles per million."

Europe leads the world for ART treatment, initiating nearly 56% of all reported ART cycles. Almost 50% of the reported cycles in the world were in just four countries: USA (112,000), Germany (85,000), France (64,000) and the UK (37,000).

Another important phenomenon revealed by the world data is the trend away from multiple embryo transfers (and multiple pregnancies) towards single embryo transfer (SET).

"If we compare 2002 with 1998, there is a decline in several countries in the number of transferred embryos. However, this has not resulted in a sharp drop in the pregnancy rate except in the USA, indicating that efficacy is improving. The average number of embryos transferred in Europe now is 2.2%, while in the States it has dropped from 3.5% to 2.9%."

The percentage of ART births out of all births was highest in Denmark at 3.9% and lowest in Latin America at less than 0.1%.

"There is a real inequality between the different countries, and this is due to money," said Dr de Mouzon. "Some countries provide free cycles of IVF, while in others, couples cannot have ART unless they can pay for it, for example through medical insurance."

Professor Anders Nyboe Andersen presented figures from 2003 in Europe to the conference. The report from the ESHRE European IVF Monitoring committee included data from 28 European countries. There were 357,884 cycles in 2003, which represents a 10% increase on the previous year.

He said: "The trend towards single embryo transfer is the most important message. The Nordic countries and Belgium lead the way in this. In Sweden today there is 70% elective SET, which has resulted in a decline in twin birth rates to 5%, which is sensational. Triplets have virtually disappeared in Europe, but there are still countries where the triplet rate is too high.

"Elective SET is only of major importance in Finland, Sweden and Belgium. They have achieved this in different ways. In Finland, it has happened because patients and clinicians have chosen to do it. In Sweden, it has been achieved through regulation, and in Belgium it has been achieved through financial incentives, whereby patients have their IVF treatment paid for them by the state if they choose SET."

Professor Karl Nygren, chairman of the ESHRE EIM and ICMART committees, said: "These two reports together document the fact that the technique of IVF is spreading rapidly around the world, not only in Europe, but everywhere, although there are still inequalities in availability and efficacy between countries. ART is being used increasingly in India and China and we look forward to them contributing data in the future."

NICE issues draft guidance on Trastuzumab

Sat, 10 Jun 2006 17:15:00 PST

( from http://www.rxpgnews.com ) NICE has published draft guidance on Herceptin, just two weeks after the drug was licensed by the regulatory authorities for use in early breast cancer. The draft guidance recommends the drug for women with early stage HER2-positive breast cancer, except where there are concerns about the womans cardiac function. Final guidance is expected to be issued at the beginning of July 2006, assuming there are no appeals.

NICE Chief Executive Andrew Dillon said: These proposals are very good news for women with HER2 positive breast cancer. Herceptin, for these women is clinically and cost effective in the early stage of the disease and we look forward to being able to issue final guidance, subject to any appeal against our recommendations, in a few weeks time.

The draft recommendations by NICE are:

1.1 Trastuzumab, given at 3-week intervals for 1 year or until disease recurrence (whichever is the shorter period), is recommended as a treatment option for women with early-stage HER2-positive breast cancer following surgery, chemotherapy (neoadjuvant or adjuvant) and radiotherapy (if applicable).

1.2 Cardiac function should be assessed prior to the commencement of therapy and trastuzumab treatment should not be offered to women who have a left ventricular ejection fraction (LVEF) of 55% or less, or who have any of the following:
a history of documented congestive heart failure
high-risk uncontrolled arrhythmias
angina pectoris requiring medication
clinically significant valvular disease
evidence of transmural infarction on electrocardiograph (ECG)
poorly controlled hypertension.

1.3 Cardiac functional assessments should be repeated every 3 months during trastuzumab treatment. If the LVEF drops by 10% from baseline and to below 50% then trastuzumab treatment should be suspended. A decision to resume trastuzumab therapy should be based on a further cardiac assessment and a fully informed discussion of the risks and benefits between the individual patient and their clinician.

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. NICE produces guidance in three areas of health: public health guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector; health technologies guidance on the use of new and existing medicines, treatments and procedures within the NHS; and clinical practice guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS. NICE issues guidance on the clinical and cost effectiveness of selected new and existing drugs for the NHS in England and Wales. It does this after new medicines have been licensed by the Medicines and Healthcare products Regulatory Agency/European Medicines Evaluation Agency.

Very Few Mothers Reject Childhood Immunisation

Fri, 02 Jun 2006 23:13:00 PST

( from http://www.rxpgnews.com ) The mothers of children who are unimmunised differ from those who are partially immunised in a number of ways, finds a study in this weeks BMJ.

This is the first large scale study of its kind in the UK, and suggests that different approaches are needed to maximise uptake of immunisation in these groups.

Researchers from the Institute of Child Health analysed data for 18,488 infants born between September 2000 and January 2002 in the UK. The sample was stratified by UK country and electoral wards to adequately represent infants from ethnic minority groups and disadvantaged backgrounds.

Mothers were interviewed when the infants were about 9 months old. They were shown a card listing the primary vaccines, given at 2, 3, and 4 months of age, and asked if the infants had received three doses of all listed vaccines.

Overall, 3.3% of infants were partially immunised and 1.1% were unimmunised. These rates were highest in England (3.6% and 1.3% respectively).

Partially immunised infants were more likely to come from an ethnic minority group, a disadvantaged background, and a large family. They were also more likely to have a teenaged or lone parent, a mother who smoked during pregnancy, and have been admitted to hospital at least once.

In contrast, unimmunised infants were more likely to have older (40 years or above) and more highly qualified mothers, or mothers of black Caribbean ethnicity.

Mothers cited medical factors relating to their child or family as the predominant reason for partial immunisation. Mothers beliefs or attitudes towards immunisation were the main reason cited for no immunisation.

These findings indicate that mothers of unimmunised and partially immunised infants differ in terms of age and education, say the authors. Our study suggests that different interventions are needed to promote uptake of immunisation among older and more highly qualified mothers who reject primary immunisations, they conclude.

New programme encourages services to include people with learning disabilities in community life

Thu, 25 May 2006 13:04:00 PST

( from http://www.rxpgnews.com ) New programme encourages services to include people with learning disabilities in community life

The Foundation for People with Learning Disabilities is about to begin a new development and research programme, which will look at how people with learning disabilities and high support needs can involve people with learning disabilities who have high support needs into their communities.

The Life in the Community research programme will last for three years and involve four voluntary sector organisations. Supported by their local authorities, each site will explore how employment and community-based day activities may encourage people with learning disabilities who have high support needs to get involved in their communities.

Barbara McIntosh, Co-Director of the Foundation for People with Learning Disabilities, says: "Many people with learning disabilities who have high support needs have limited options and receive small amounts of support to get involved in their local communities. Through this project and its research, we hope to show positive examples of how people can be included and supported in a range of activities. This is imperative if we are to improve day services and achieve the changes set out in the Valuing People policy agenda."

The four voluntary sector organisations taking part in the research are Grapevine in Coventry and Warwickshire; the WM Morrison Enterprise Trust in Darlington, County Durham; the Brandon Trust in Bristol, North Somerset and South Gloucestershire, and the Tamarisk Trust in Barnet, London.

Life in the Community hopes to produce practical tools to help services and communities involve people with learning disabilities. A final report for service commissioners and practitioners will also be published.

NHS care for older people is still patchy

Fri, 19 May 2006 20:02:00 PST

( from http://www.rxpgnews.com ) Good, respectful NHS care for older people is still too patchy, argue senior members of the British Geriatrics Society in this week's BMJ.

Last month's government report A New Ambition for Old Age examined how the national service framework (NSF) for older people is being implemented and announced new aims and targets under three themes: dignity in care, joined up care, and healthy ageing.

So what has improved since the framework was launched five years ago, ask the authors?

A third of older people needing intensive daily help in England now receive this in their own homes rather than in residential care; delayed discharge from acute hospitals has been reduced by more than two thirds; and specialist services for people with stroke and for those prone to falls continue to improve.

But such health gains now need to be built on, say the authors. Despite older people being the prime users of health care and social services, investments have not been made in more specific services, such as general hospital care for older people.

Care for older people is still not sufficiently integrated, they add. The increasing emphasis in the NHS on moving patients rapidly through the emergency system towards discharge may benefit younger people at the expense of effective planning and specialist assessment of the frail and old.

The separation in the NHS of medical specialties from psychiatry is also hampering the provision of effective, humane, and responsive services for older people with mental health problems, such as dementia and depression.

They suggest that better coordination of care for people with complex needs will be achieved by strengthening commissioning arrangements between the NHS and local authorities, to ensure that social care is not provided without medical problems being treated.

The dignity of older frail patients is also infringed every day in many different ways, they warn. The establishment of a seven point plan to improve dignity in care is to be welcomed.

"This report contains much that is praiseworthy," they conclude. "We hope that the levers set out in this report really convince providers of health and social care to reorganise their priorities."

NHS could save £78m by improving staff productivity

Sun, 30 Apr 2006 23:40:00 PST

( from http://www.rxpgnews.com ) Health Secretary, Patricia Hewitt, highlighted recommendations from an NHS Institute for Innovation and Improvements report, showing that £78m could be saved by the NHS by driving down agency spend and improving staff productivity.

Patricia Hewitt said Most NHS resources are invested in staff so using staff as effectively as possible is crucial for patient care, staff satisfaction and financial efficiency. The HR function has delivered some major achievements in recent years and I congratulate you on them. Now we have a real opportunity to drive forward the productivity agenda.

Effective management of temporary staffing costs is one of the highest impact HR changes. Nursing has made the greatest reduction in agency costs out of all staff categories as the overall agency spend is continuing to decline, down from £1.4bn in 03/04 (5.1% of pay bill), to £1.3bn in 04/05 (4.2% of pay bill).

And whilst these reductions are significant, further action is needed. Based on 2004/05 figures, if all NHS Trusts reduced their agency spend to the national average, that would release around £78m for other improvements in the NHS."

The Institute will shortly be publishing a document "Delivering Quality and Value Focus on Productivity and Improvement." This document will identify where to focus activity for the greatest potential productivity and efficiency gains.

The creation of an in-house bank of staff at North Bristol NHS Trust in 2004 has achieved a reduction from an average 5,300 agency shifts per month in 2003 to under 500 by the end of 2005.

In addition Bank staff provide better continuity of care which in turn contributes to better patient satisfaction. NHS Trusts are encouraged to use the NHSs own bank staffing organisation, NHS Professionals, or ensure their high standards of NHS employment practice are rigorously adhered to for in-house bank staff recruitment.

On top of this, the Trust saved at least £100 per shift that was covered by its bank staff rather than an expensive external agency which resulted in a £6 million save in spending on temporary staff in 2004/05 compared to 2003/03.

The Health Secretary also encouraged NHS Trusts to reduce their sickness and absence levels in order to curb agency staffing spend.

The sickness absence rate for acute trusts varies from under three percent to over six per cent across the country. Reducing sickness rates to even average levels would create savings for each trust with a higher than average rate.

3 NRIs in Britain charged with price fixing of key drugs

Wed, 05 Apr 2006 18:38:00 PST

( from http://www.rxpgnews.com ) Nine people, including three of Indian origin, face criminal proceedings in Britain for allegedly price fixing and market sharing of generic drugs following a major investigation into pricing in the pharmaceutical industry.

The criminal proceedings were launched Wednesday by the Serious Fraud Office (SFO) against the nine individuals, including Anil Kumar Sharma, formerly of Ranbaxy (UK) Ltd, and Ajit Ramanlal Patel and Kirti Vinubhai Patel, both of Goldshield Group Plc.

SFO sources said the allegations against the individuals and five related companies concerned pricing and supply of warfarin, the branded drug Marevan and penicillin-based antibiotics amoxicillin, ampicillin, flucloxacillin, phenoxymethylpenicillin between January 1996 and December 2000.

The five companies for whom summons have been issued are Kent Pharmaceuticals Ltd, Norton healthcare Ltd, Generics (UK) Ltd, Ranbaxy (UK) Ltd, and Goldshield Group PLC.

Apart from the three India-origin individuals, summons were also issued to Denis O'Neill and John Clark, both of Kent Pharmaceuticals Limited; Jonathan Close and Nicholas Foster, both formerly of Norton Healthcare Limited; Luma Auchi, formerly of Regent-GM Laboratories Limited (now in liquidation); and Michael Sparrow, formerly of Generics (UK) Limited.

The case controller, assistant director Philip Lewis, said: "This important case involving an allegation of dishonest price-fixing by companies is likely to have a significant impact upon the business culture of this country."

In a statement, the Goldshield Group said two of its directors - Ajit Patel and Kirti Patel - had been told they would be charged on April 7 in relation to an alleged conspiracy to defraud the secretary of state for health and others in relation to warfarin and Marevan.

"Goldshield and both directors continue to maintain that they did not act in a way that was unlawful or improper," it said.

The SFO has been investigating allegations of a drugs cartel set up to swindle the National Health Service for several years. The investigation centres on suspected collusion by companies on price-fixing in the supply of penicillin-based antibiotics and the blood-thinning drug warfarin, used to treat stroke victims.

All the firms involved have denied any wrongdoing

Real battle over UK new mental health law about to begin

Fri, 31 Mar 2006 18:02:00 PST

( from http://www.rxpgnews.com ) The UK government's climb down on reform of mental health legislation is not a victory the real battle is about to begin, warns a senior doctor in this week's BMJ.

The UK government's announcement that it has abandoned its eight year attempt to achieve a new Mental Health Act for England and Wales is an apparent victory for patients, professionals, and liberal democracy, writes Professor Nigel Eastman of St George's Hospital, London.

But faced with almost unanimous opposition from those with an interest in mental health care, the government has stated that it will instead introduce a shortened and streamlined bill amending the 1983 Mental Health Act.

This amending legislation will replace the Draft Mental Health Bill that had been described as a "Public Order Act" which would be "unethical, unworkable, and also ineffective," even in enhancing public safety.

The bill's most contentious proposals included widening the criteria for compulsory detention and treatment, and removing the "treatability test" for personality disorder (so that those with dangerous and severe personality disorder could be detained by doctors when not capable of being sentenced by criminal courts). It's uncertain whether the legal amendments now being proposed will be any less controversial, says Eastman.

The government's climb down on reform of mental health legislation is, almost certainly, merely a prelude to climbing up by another route, he warns.

Crucially, amendments should include introducing guiding principles into the act, including those of autonomy and reciprocal rights, in order to enhance consistent and ethical operation of the legislation. Unsurprisingly, this is resisted by the government.

He urges professionals working in mental health care, including general practitioners, to be vigilant in scrutinising the detail of the proposed amending legislation.

"There is a grave danger of being lulled into a false sense of security through having apparently won the seven year phoney war. The real parliamentary battle is about to begin," he concludes.

Nurses to help check pregnancies in English schools

Sat, 25 Mar 2006 15:43:00 PST

( from http://www.rxpgnews.com ) Nurses will now work for birth control in all the schools of England in a move to slash the rising incidence of teenage pregnancies.

There are currently 2,409 nurses who work in primary and secondary schools across the country but the latest announcement signals a massive extension, reported the online edition of Daily Mail.

By 2010, every primary care trust will be funded to have at least one full-time qualified nurse working with each small group of state primary schools and their local secondary, it said.

Clinics based in secondary schools already offer condoms and the morning-after pill to pupils or arrange fast-track doctors' appointments.

Statistics released recently reveal that thousands of 13-year-old girls have been handed the morning-after pill by health service staff without their parents' permission.

Among 302 primary care trusts across the country, around 2,400 girls aged 13 or younger received the morning-after pill last year.

However, teenage pregnancies are continuing to rise despite a 40-million pound government campaign to reduce the problem. Sexually transmitted diseases are also reaching epidemic levels.

Nurses will be able to "provide contraceptive advice to pupils and emergency contraception and pregnancy testing to young women", says the new guidance to primary and secondary school heads.

It says nurses are the best people to provide this service because they are "able to assess need and prescribe appropriate medication/provide specialist contraception advice for the future".

They can also help pupils who are concerned with "issues of sexual identity", for example if they are gay or bisexual.

British Hospital Outsourcing Medical Typing to India

Thu, 23 Mar 2006 17:35:00 PST

( from http://www.rxpgnews.com ) A British hospital has hired a team of typists in India to type out routine letters from doctors to patients - the process takes less than a day and promises to make large savings for the hospital trust.

The Harshill complex of the University Hospital of North Staffordshire, facing debts of nearly £15.5 million, took the step to cut its operating costs. Correspondence is typed in India and returned to the trust within 24 hours.

The system is on trial for a month, but indications are that a long-term arrangement with the typists team in India is likely.

The system - Digital Offshore Transcription (DOT) - sees the correspondence dictated verbally by a doctor. It is stored as a digital file on a computer that is then transferred by email to a unit in India staffed by what the hospital describes as "qualified and experienced medical typists".

The typists then listen to the doctor's notes and type them into a letter, which is returned by email. The DOT system is being used on a trial basis in the fracture clinic, where there is said to be a shortage of medical secretaries and the nature of the work is unpredictable.

Hospital officials told The Sentinel newspaper that the staff decided on the trial because of difficulties in recruiting experienced medical secretaries and an increase in the number of patients being treated.

According to a statement from the hospital, if was not possible to recruit the right type of secretaries due to financial difficulties.

At least 750 employees were already facing compulsory redundancy from the hospital.

Mark Mould, divisional general manager, said: "We wanted to trial this service to support our medical secretaries who have sometimes been under a great deal of pressure with competing priorities. In the past, when extra cover has been needed, we have used agency staff.

"The big advantage of the DOT service is that we do not need a fixed contract. We can use the service as and when we need to. It is early days, but so far the results look very promising, with accurate letters being turned around within 24 hours.

"This takes a lot of the pressure off the staff, allowing them to get on with other aspects of their work. It also improves the service for patients and other healthcare professionals."

Concern over rapid rise of chronic kidney disease

Fri, 10 Mar 2006 21:12:00 PST

( from http://www.rxpgnews.com ) Chronic kidney disease is rising rapidly worldwide and is becoming a global healthcare problem, warn experts in this week's BMJ.

In the United Kingdom, the annual incidence of end stage renal disease is around 100 per 1,000,000 population. This figure has doubled over the past decade and is expected to continue to rise by 5-8% annually, but it still remains well below the European average (around 135/1,000,000) and that of the United States (336/1,000,000).

The rise in end stage renal disease worldwide probably reflects the global epidemic of type 2 diabetes and the ageing of the populations in developed countries (the annual incidence in people over 65 in the UK is greater than 350/1,000,000, and in the US it is greater than 1,200/1,000,000).

The number of people with diabetes worldwide, currently around 154 million, is also set to double within the next 20 years, and the increase will be most notable in the developing world, where the number of patients with diabetes is due to reach 286 million by 2025.

The cost of treating end stage renal disease is substantial and poses a great challenge to provision of care. In Europe, less than 0.1% of the population needs renal replacement therapy, which accounts for 2% of the healthcare budget. In the US, the annual cost of treatment for end stage renal disease is expected to reach $29 billion by 2010. Few countries will be able to meet these growing medical and financial demands.

More than 100 developing countries, with a population in excess of 600 million, do not have any provision for renal replacement therapy. Consequently, more than a million people may die every year worldwide from end stage renal disease.

Programmes to detect chronic kidney disease, linked to comprehensive primary and secondary prevention strategies, are needed urgently, say the authors.

Mass population screening for chronic kidney disease is neither practical nor likely to be successful or cost effective. But structured and well resourced programs targeting at risk individuals, such as those suffering from diabetes and hypertension, along with primary prevention programmes based on reducing risk factors across the whole population could make a big difference.

The authors believe that such an approach to risk reduction may slow or even reverse declining renal function.

Have targets improved performance in the English NHS?

Fri, 17 Feb 2006 19:05:00 PST

( from http://www.rxpgnews.com ) The star rating system for English NHS trusts seems to have improved performance, but systems need to be put in place to minimise gaming and ensure targets are not causing problems elsewhere, warn researchers in this weeks BMJ.

Annual performance ratings have been published for NHS trusts in England since 2001. This process of naming and shaming gave each trust a rating from zero to three stars. Although the government has now abandoned star ratings, targets are likely to remain.

But have targets improved performance and what ought to happen in the future, ask professors Gwyn Bevan and Christopher Hood?

The key target for accident and emergency departments was the percentage of patients to be seen within four hours. In 2002, before any target was set, 23% of patients spent over four hours in accident and emergency, but by 2004 only 5.3% stayed that long.

Similarly, reported performance improved greatly after ambulance trusts were star rated on their response times, and hospitals were rated on the number of patients waiting for elective surgery.

Interestingly, after 2003, reported performance improved in other UK countries, dramatically in Wales and Northern Ireland. This suggests that the naming and shaming policy in England put pressure on the NHS in the other countries, say the authors.

But the use of targets results in gaming, they add. For example, extra staff being drafted into accident and emergency departments, operations being cancelled, and patients having to wait in ambulances until staff were confident of meeting the target.

This means that when reported performance meets the targets, nobody knows how genuine the improvements are.

Nobody would want to return to the NHS performance before the introduction of targets, so how can we maximise the social benefits and minimise the costs of a regime of targets with sanctions?

They suggest introducing more uncertainty in the way that performance is assessed and better auditing of performance data. They also call for an independent body to investigate the genuineness of reported improvements and the costs to other services.

Although these changes would not wholly eliminate the gaming problems associated with any regime of targets and terror, they could reduce them, they say. The current combination of performance measures that are highly predictable to managers and an audit system that is poorly equipped to detect gaming, risks losing credibility, they conclude.

Over a million in Britain could live beyond 100

Sun, 12 Feb 2006 18:26:00 PST

( from http://www.rxpgnews.com ) More than a million people now in their 30s in Britain could live to 100 years and beyond, with improved health care contributing to the global rise in life expectancy.

According to official estimates, the population of centenarians is expected to soar from the present figure of 10,000 to 1.2 million by 2074 in Britain, reported the online edition of Daily Mail.

The projections mean today's 30 somethings have a one in eight chance of living to be 100, while thousands could live to be 110 or older, said David Blane, professor of medical sociology at Imperial College London.

Combinations of factors are thought to have contributed to the increase in longevity, he said. These include better medical care, the elimination of disease and better nutrition.

Improved treatment for heart disease and cancer, improved diet and lifestyle, especially among the affluent, are among the reasons for the global rise in life expectancy, he said.

And the decline of heavy industry means workers are far less likely to be exposed to the health risks and dangers or heavy machinery. The increased use of cholesterol-lowering drugs in recent years has been shown to reduce the risk of heart attacks and strokes.

Under new prescription guidance to GPs, up to one in 10 adults could end up taking statins to prevent cardiovascular disease.

This could save 20,000 lives a year while some experts believe a quarter of Britons could end up taking the drugs for life. "It is going to become extremely interesting in a few decades as people begin to reach 100 more regularly," Blane said.

The growth in longevity would also have a big impact on the size of the British population as a whole, with the number of people living in the country growing to 75 million by 2074, based on these figures.

The population could soar even higher, to 90 million, if the highest projections for fertility rates and immigration are also factored in.

British Asians travelling to India for cosmetic surgery

Fri, 03 Feb 2006 15:38:00 PST

( from http://www.rxpgnews.com ) British patients travelling to India for quality medical treatment is no longer news, but now many British Asians are joining the procession for cheap cosmetic surgery in the Indian sub-continent.

Cosmetic surgery to improve the shape of nose (called rhinoplasty), reduce the waistline and for breast improvements is prohibitive in Britain but in much demand. More than 100,000 cosmetic operations are carried out every year in Britain.

Recent figures released by the British Association of Aesthetic Plastic Surgeons revealed that breast enlargement topped the list of cosmetic operations performed in 2005. Each breast enlargement operation costs about 4,000 pounds here.

Sources in the industry told IANS that very few of the cosmetic operations conducted in Britain involved Asians. The main reason for this was that many Asians preferred to get the operations done in India or Pakistan during their visits to their country of origin.

Most of the British Asians combining family visits to the Indian sub-continent with cosmetic surgery are said to be in their 20s.

The desire for cosmetic surgery within the community is also fuelled by the increasing popularity of Indian film actresses and the increasing viewership of serials on Indian channels that are now widely available here.

Cosmetic operations in the Indian sub-continent are cheap compared to the costs in Britain. Some of the favourite operations are nose jobs, tummy tucks, liposuction and breast enlargements, the sources said. Unlike here, there is no waiting list for such operations in the Indian sub-continent.

They added that such operations are mainly sought by educated and prosperous British Asians, who feel the need and pressure to have Western-style physical features. A large majority of such Asians are women, born and raised in Britain and who hanker for Western dimensions of beauty.

While the Asians who visit India approach cosmetic surgeons in Delhi, Mumbai and Bangalore, those who visit Pakistan go under the knife in Islamabad, Lahore or Karachi where almost all Pakistan's 70 registered plastic surgeons are said to be based.

British experts, however, are wary of people travelling to the Indian sub-continent for cosmetic surgery.

David Sharpe, a professor of plastic surgery at Bradford University, said he was aware of the trend but warned against having plastic surgery abroad.

He told The Independent: "I would be confident about Pakistani surgeons who have been trained in the UK or have strong connections with training programmes here as being competent.

"But if you are going abroad to have surgery, there is a danger. One in 10 cases of nose reshaping and one in five cases of liposuction require additional work for up to six months, such as an adjustment to the tip of a nose.

"The patients would need to go back to the surgeon and this work would normally be carried out for free, as it would be part of the package."

Health and Social Care White Paper shows good intentions

Tue, 31 Jan 2006 19:50:00 PST

( from http://www.rxpgnews.com ) The Foundation for People with Learning Disabilities welcomes the intentions of the Government's white paper, Your Health, Your Care, Your Say. However, the charity believes that measures still do not fully ensure that people with learning disabilities are supported to access mainstream health services and engage in their communities.

The Health Secretary, Patricia Hewitt, has outlined proposals for the future of health and social care, including extending Direct Payments and piloting Individual Budgets. The Foundation believes this will give people with learning disabilities more control over their lives and encourage services to become more responsive to their needs. However, the charity believes that other proposals should be developed in more detail.

Hazel Morgan, Co-Director of the Foundation for Learning Disabilities, said: "The Department of Health must expand upon other measures if people with learning disabilities are to receive the support they need. We welcome a closer integration of health and social care but joined up working should include looking at all aspect of a person's life, including education, employment and leisure. Also, the Foundation has been calling for annual health checks for the last ten years and hopes that the commitment to regular checks will be speedily implemented.

"A major neglected area is support for family carers. Many need regular short term breaks that are flexible and can be accessed when the family experiences an emergency. Also, older family carers need trusted workers to help them and their relative with a learning disability plan for the future. We have a major concern that support for those in a caring role cannot be delivered without additional funding. The Government must seriously consider how to meet these additional needs."

Total Smoking Ban is the only way to protect employees

Tue, 31 Jan 2006 19:00:00 PST

( from http://www.rxpgnews.com ) Newly released documents reveal that, despite knowing that ventilation and air filtration are ineffective at removing environmental tobacco smoke, British American Tobacco (BAT) promoted these technologies to the hospitality industry as viable options to smoking bans.

Writing in this weeks BMJ, researchers argue that a total ban on smoking in public places is the only way to protect all employees from environmental tobacco smoke.

The documents show that, although BAT concluded that the air filtration units were only 34% efficient at removing particulate matter from tobacco smoke, it continued to install units worldwide. According to BAT scientist, Nigel Warren, the companys interest in air filtration was primarily, To negate the need for indoor smoking bans around the world

BAT targeted the hospitality industry by pushing a so-called smoker resocialisation initiative, which aimed to portray smoking in a more positive and stylish context and to lobby against smoke-free public places.

In June 2000, BAT also installed smoking tables designed to suck tobacco smoke down through a filter and re-circulate the partially filtered smoke out into the room again. But, even if the technology was improved from earlier filtration units, the tables would be ineffective because isolation of the source or the worker are the only control measures that yield air quality that is safe to breathe, write the authors.

In November 2004, the UK government published proposals to end smoking in most workplaces and public places, but with exemptions for private clubs and pubs that do not serve food.

The public health community should reject these proposals, say the authors. Without a comprehensive smoke-free workplace law, the tobacco and hospitality industries can continue to mislead the public about the hazards of exposure to environmental tobacco smoke by promoting separate seating, ventilation, and air filtration as viable options to smoking bans.

This will do nothing to reduce the risk of lung cancer among employees. All workers deserve to work in smoke-free environments. The United Kingdom should follow the lead of countries such as Bhutan, Cuba, Ireland, Italy, Malta, New Zealand, and Norway in legislating for a total ban on smoking in public places, they conclude.

Cutting street prostitution will threaten health of sex workers

Tue, 31 Jan 2006 19:00:00 PST

( from http://www.rxpgnews.com ) Plans to cut street prostitution, set out by the UK government last week, will threaten sex workers health, warn experts in this week's BMJ.

The Home Office strategy aims to challenge the view that street prostitution is inevitable; achieve an overall reduction in street prostitution; improve the safety and quality of life of communities affected by prostitution; and reduce all forms of commercial sex exploitation.

But the strategy does not explicitly tackle health and human rights and will not, therefore, do enough to reduce vulnerability and exploitation, argue the authors.

For instance, the proposed strategy rejects calls to licence premises, which could ensure that children were not employed, employees were not in possession of drugs, and foreign nationals had work permits.

Instead the strategy focuses on disrupting sex markets. Kerb crawling will be policed in established red light areas, despite evidence that this can lead to increased violence, pressure to abandon safer sex practices, and increased public disorder.

Specialist healthcare services in red light areas, such as provision of condoms and needle exchange schemes, could also be compromised if this strategy is enforced, they warn. This could have profound consequences both for sex workers and the wider population.

Furthermore, collaborative work by healthcare professionals, social services, and sex workers will be disrupted if red light areas are phased out, as the strategists intend, they add. Collaborative working gives sex workers the support and confidence to report violent clients and other predators who aim to coerce and control them.

The lack of detail in the strategy about implementing the new approaches, especially regarding indoor sex work, leaves most of the sex workers we have spoken to feeling uneasy that they will have to wait and see how the strategy affects their access to health care and their contact with the criminal justice system, conclude the authors.

Disappointment about the UK government not going further towards legalisation is reflected in a personal view by Juliet, a prostitute based in London. She believes that the government has failed enormously" and argues that neither having sex nor getting paid are inherently degrading, abusive, exploitative, or harmful. The problems, she says, are the associated coercion, drug dependency, and lack of choices, not prostitution itself.

BMJ Editor, Fiona Godlee also supports the idea of legalisation. It is surely time for an end to the arguments of moral opprobrium and for some bolder steps towards legalisation if we are to improve public health and human rights, she writes.

Reform should be supportive, not punitive says Mental Health Foundation

Wed, 25 Jan 2006 15:35:00 PST

( from http://www.rxpgnews.com ) The Mental Health Foundation today welcomed the Government's long awaited Green Paper on Welfare reform, but warned that planned changes to Incapacity Benefit may create fear and anxiety for thousands of people already living with mental health problems.

The Department for Work and Pensions today published the Welfare Reform green paper, outlining plans to get 1 million of the 2.7 million people currently on incapacity benefit back into work within 10 years.

Dr. Andrew McCulloch, Chief Executive of the Mental Health Foundation said: "The plans laid out in the green paper are broadly positive. We know that many people with mental health problems want to work. However, we would stress the vital importance of the provision of appropriate support, and properly trained staff. Forcing people back to work too soon could create fear and anxiety about loss of benefit if someone becomes unable to cope after a return to work. Mandatory interviews and sanctions would also be experienced as stressful for a lot of people with mental health problems. There is a danger these issues could produce a psychological trap. Claimants should be entitled to advocacy if needed. This kind of support will go further than punitive measures."

"Changes to the Personal Capability Assessment are sorely needed. We would encourage government to give this gateway mechanism careful and thorough consideration in order to make it fair and appropriate to the issues faced by those with mental health problems."

David Crepaz-Keay, the Foundation's Senior Policy Advisor for Patient and Public Involvement said, "We need to ask questions about why so many people with mental health problems are excluded from work in the first place. Until employer discrimination is tackled, we will be fighting an uphill struggle getting people who want to work into jobs. Otherwise, benefit reforms of this nature mean you'll have the ludicrous situation of people who are too ill to work inappropriately employed in entry-level jobs, alongside people who are too well to be unemployed claiming benefits."

Tailored support still needed to help people with learning disabilities into work

Wed, 25 Jan 2006 15:35:00 PST

( from http://www.rxpgnews.com ) The Foundation for People with Learning Disabilities broadly welcomes today's publication of the Government's long awaited Welfare Reform green paper, with the higher rates of benefits for those unable to work and the additional supports for finding and retaining a job. However, the Foundation believes that a detailed set of policies using the supported employment model and international best practice is needed to enable more people with learning disabilities to find work.

There are around 800,000 adults with learning disabilities of working age and it is estimated that only 11% have a job , although many more would like to work. The green paper outlines plans to get 1 million of the 2.7 million people currently on incapacity benefit back into work within 10 years.

Hazel Morgan, Co-Director of the Foundation for People with Learning Disabilities said: 'We believe that it is only through a more tailored approach using the supported employment model more extensively that the many people with learning disabilities who would like to work will be able to do so. Young people should also have the opportunities for work experience while at school or college.

"We welcome the green paper but also want to know how the government will ensure that jobs will be available. We hope these reforms will be flexible and allow people with learning disabilities to choose to work part time, for sixteen hours or less, while also benefiting from the tax credit system. Whatever happens, it is important that all information is provided in an accessible way."

Ignorance can leave two million in Britain blind: study

Wed, 25 Jan 2006 14:14:00 PST

( from http://www.rxpgnews.com ) More than two million people in Britain may become blind because of their ignorance even though they are having treatable conditions, according to a study.

The study by the Royal National Institute for the Blind (RNIB) said over half of all sight loss is avoidable, with 1.9 million diabetic and 250,000 people with early-stage glaucoma at risk that in later stage leads to blindness, the Daily Mail reported.

This is on top of the two million people in Britain who already have sight problems, said Steve Winyard of RNIB.

The study found a further 500,000 people are needlessly living with sight loss by not seeking treatment for cataract or by simply wearing the wrong prescription glasses.

Poor job satisfaction and burnout among mental health social workers in UK

Mon, 23 Jan 2006 17:22:00 PST

( from http://www.rxpgnews.com ) Excessive job demands, limited scope for decision-making and unhappiness about the place of the mental health social worker (MHSW) in modern services contribute to poor job satisfaction, stress and burnout, the first national study of this professional group has found.

Published in the January 2006 issue of the British Journal of Psychiatry, the researchers set out to examine the prevalence of stress, burnout and job satisfaction among MHSWs, and the factors responsible.

As many as 81% of local authorities report problems recruiting and retaining social workers, and staffing is more problematic in social work than in any other professional group.

High vacancy (5% - 16%) and turnover rates (7% - 30%) contribute to staff shortages, excessive workloads and reliance on temporary staff. Work pressures can lead to burnout - a combination of emotional exhaustion, 'depersonalisation' (a sense of being unreal, or feeling that your mind is separated from your body), and low personal accomplishment.

A postal survey was sent to 610 MSHWs in England and Wales. It included the General Health Questionnaire which assesses psychological problems (and measures stress); the Maslach Burnout Inventory; and job content questionnaires; and a job satisfaction measure.

237 returned questionnaires were eligible for inclusion in the analysis. 61% of respondents were female and most of the sample was aged under 50. Only 10% were from minority ethnic or other cultural groups.

83% of the sample worked full-time, and respondents worked an average of 43 hours per week, roughly six hours more than they were contracted for. 39% of the working week was spent in face-to-face contact with service users and 29% on administration (partly owing to limited support).

The most striking findings of the survey were the high levels of stress and emotional exhaustion, and low levels of job satisfaction. 47% of the sample showed significant signs of psychological problems and distress, which is twice the level reported by similar surveys of psychiatrists.

The factors which contributed to poor job satisfaction and most aspects of burnout were high job demand and not feeling valued for the work that they do. Those MHSWs who had approved social worker status had greater job dissatisfaction.

A significant number of people were sufficiently dissatisfied to want to leave their jobs. 21% had made specific plans to leave and 28% had a strong desire to leave.

Other factors, such as number of hours worked, scope for decision-making and feelings about how social work is perceived within mental health services, are also important determinants of stress and features of burnout.

The authors of the study comment that although MHSWs make a significant contribution to community mental health teams, they are a scarce and declining resource. This is in stark contrast to other countries, notably the USA, where social workers are the major professional group in mental health services.

In Northern Ireland the rates of approved social workers in mental health services are three times those in England and Wales.

Employers must recognise the demands placed upon MHSWs, and value their contribution to mental health services. Further research is needed into ways to decrease stress and improve job satisfaction among MHSWs, with the aim of improving recruitment and retention.

Project: London - supporting vulnerable populations

Fri, 13 Jan 2006 20:46:00 PST

( from http://www.rxpgnews.com ) This month, the medical humanitarian organisation, Medecins du Monde UK, launches Project: London, an initiative to help vulnerable people to access health care. In this week's BMJ the founders explain why such a scheme is needed, while an editorial explores what this says about society's attitude towards marginalised people.

Providing health care to marginalised groups is an integral part of Medecins du Monde's work in developed and developing countries, write Karen McColl and colleagues.

Some people in the UK, such as homeless people and female sex workers, find it difficult to access health care, while tougher restrictions on entitlement to NHS care are a barrier for migrants.

It is well known that there is a growing health gap between rich and poor within London, leading to reduced quality of life, and early death for many people, particularly those living in the most deprived areas of east London.

As a result, Project: London will help vulnerable people in east London to access the services that they are entitled to. Another key challenge will be to speak out for vulnerable people who are unable to access the medical care they need, say the authors.

This project raises fundamental questions about society's attitude towards marginalised people, add senior doctors in an accompanying editorial. Denying free basic health care to the most vulnerable groups in society, who are legally prevented from working and unable to pay charges, is ethically unsupportable and a breach of human rights, they write.

"We can only hope that the Secretary of State reviews this policy and ensures that the NHS continues to provide a service to everyone living in the United Kingdom."

Long waiting lists places cancer patients at risk

Fri, 13 Jan 2006 20:39:00 PST

( from http://www.rxpgnews.com ) Many radiotherapy departments in UK hospitals are heavily overstretched, resulting in long waits for cancer patients which may be jeopardising treatment, says a paper in this week's BMJ.

Radiotherapy treatment can be as successful at tackling some cancers as radical surgery, and often has the advantage of organ preservation. But waiting lists are severe in many radiotherapy departments, and although radiotherapy services in the UK offer high quality treatment, say the authors, they are often less able to cope with the volume of patients needing radiotherapy than other developed countries, and indeed many poorer countries.

For patients with a realistic chance of beating cancer, studies show that delaying treatment hampers doctors' ability to tackle the disease, report the authors.

With cervical cancer, for instance, a longer waiting time for radiotherapy reduces the chance of the patient's survival. And for head and neck cancer, patients waiting more than six weeks for post-operative radiotherapy are three times as likely to have the cancer recur. For breast cancer, patients are at a 60% increased risk of the disease returning if the delay between surgery and radiotherapy goes beyond eight weeks.

Despite considerable investment in radiotherapy equipment in recent years, a shortage of specialist staff - radiographers, physicists, and dosimetrists (specialists in radiation dosage) - means that hospitals cannot cope with the rising demand for radiotherapy treatment. More training places are being created, but that does nothing to remedy current staff shortages.

Many hospitals have already done all they can - including adapting staff rotas and skills mix - to optimize staff cover. Where possible patients are also transferred to other hospitals with more capacity to treat them. But removing them from the care of their local team of doctors can bring other problems for patients.

Doctors and radiotherapy managers are faced with the difficult decision to prioritise patients, say the authors, with no clear national guidance or precedent for the unpleasant choices that have to be made.

The time has come to agree a national policy to tackle these issues, say the authors, a strategy not subject to political timetables or funding waves. Avoidance of such a discussion is no longer an option, they conclude.

Denying Joint Replacements Based On Prejudice

Mon, 19 Dec 2005 15:48:00 PST

( from http://www.rxpgnews.com ) A decision by NHS trusts in Suffolk to deny replacement joints to obese patients seems to be based on prejudice or attribution of blame, argues a senior doctor in a letter to this week's BMJ.

In fact, no evidence supports withholding joint replacement from obese people, even on utilitarian grounds, says Nicholas Finer, a consultant in obesity medicine at Addenbrookes Hospital, Cambridge.

For knee replacement, there is no evidence that age, gender, or obesity is a strong predictor of functional outcomes, while a UK health technology assessment of hip replacement concluded that obese patients could benefit from surgery and are not noticeably at increased operative risk.

Another study concluded that relative body weight alone does not influence the benefit derived from hip replacement surgery, he writes.

Since obesity does not increase the risks or diminish the benefits of joint replacement, the trusts decision to deny such treatment seems to be based on prejudice or attribution of fault, or both, he says. Logically extended, such a policy would deny treatment to, among others, smokers, most patients with HIV infection, and those who sustain sports injury.

Rationing joint replacements is also false economy and potentially damaging, writes retired doctor, Martin McNicol in another letter.

Delaying operations on punitive grounds may increase long term costs. Personal experience shows that delaying joint replacement surgery causes deterioration of functional capacity, which is difficult or impossible to reverse after later operation. This is rationing by any other name, he says.

NHS needs to do more to provide need based health care

Mon, 19 Dec 2005 15:44:00 PST

( from http://www.rxpgnews.com ) The NHS needs to do more to provide health care according to need, argue researchers in this weeks BMJ.

They analysed the availability of primary care according to deprivation and health need in Scotland. Their study was based on a sample population of 5.35 million people served by 1,050 general practices and divided into ten groups of equal size according to deprivation.

They show that ill health is two and a half times greater in the most deprived group compared to the most affluent, but the number of whole time equivalent GP principals is distributed evenly across the population.

However, including non-principals and doctors in training, there are 11% more GPs in the more affluent compared with the more deprived half of the population.

Although they found larger numbers of practices in the most rural and deprived areas, this reflects the higher proportion of single handed and small practices in such areas, say the authors.

In fact, they show that practices in deprived areas tend to have younger doctors, fewer female doctors, and less involvement in voluntary activities such as quality schemes, health service initiatives, and training than practices serving more affluent areas.

Practices serving the most deprived areas are less likely to volunteer because they are so consumed by dealing with increased levels of morbidity, without increased levels of medical manpower, that they are unable or unwilling to take on additional activities, they write.

Professor Graham Watt, from the Department of General Practice at Glasgow University commented: Our paper helps to explain the persistence of health inequalities in the UK, and the under-achievement of the NHS in narrowing these inequalities.

The strict rationing of medical manpower, irrespective of need, places a major constraint on what the NHS can deliver in deprived areas. It follows that general practitioners in such areas have to ration what they do for patients in the time available.

Too many NHS agencies have policies and initiatives which fizzle out in the most deprived third of the population. There is an urgent need for NHS initiatives and support systems which reach the parts that current approaches fail to reach, he concludes.

UK's Ageing Population Will Impose Huge Healthcare Burden

Mon, 12 Dec 2005 16:05:00 PST

( from http://www.rxpgnews.com ) New figures published by Dr Foster in this weeks BMJ predict that the UKs ageing population will impose considerable workload and financial pressures on the NHS.

The number of people aged 65 and over is predicted to increase by about 53% between 2001 and 2031. This is likely to lead to an increase in the number of people who have chronic diseases, including cardiovascular diseases.

Researchers examined the possible impact of the ageing population on the expected number of people with three cardiovascular disorders: coronary heart disease, heart failure, and atrial fibrillation (irregular heart rhythm).

By 2031, they predict that the number of cases of coronary heart disease will increase by 44%, the number of cases of heart failure will increase by 54%, and the number of cases of atrial fibrillation will increase by 46%.

If realised, these increases will have important implications for the NHS, say the authors.

For example, statins have become the single biggest component of the NHS prescribing budget, and their cost to the NHS is likely to increase further. So too will the costs of other drugs, as well as the costs of diagnostic tests, surgical procedures, and regular monitoring of patients. New medical technologies may also have a considerable impact on future caseloads.

Obesity, diabetes, and high blood pressure all increase the risk of developing heart disease, they write. A key aim of government policy should therefore be to encourage people to remain active, engage in regular physical exercise, and refrain from behaviours that could have a detrimental effect on their health, such as smoking and overeating.

Nurses key to restore public confidence in UK hospital care

Mon, 12 Dec 2005 16:00:00 PST

( from http://www.rxpgnews.com ) Nurses are the key to restoring public confidence in UK hospital care, argues an expert in this weeks BMJ.

Nurses led the transformation of hospitals in the 19th century. So, why after a century of outstanding success, is the future of the large general hospital in question? asks Professor Nick Black of the London School of Hygiene and Tropical Medicine.

Hospitals are partly a victim of their success, he says. Developments in pharmaceuticals, information and communication technology now offer alternative ways of delivering care. And when patients do need to attend hospital, they are less likely to stay overnight.

These changes are generally welcomed by the public, healthcare professionals, managers, and politicians. But negative reasons also threaten the future of large hospitals, arising from changes over the past 20 years in management, nursing, and building strategy.

So, what can save the hospitals? If public confidence is to be maintained, nurses must have a central role. Indeed, nurses rather than doctors have always really run the hospitals at the clinical level with doctors providing specialist help, writes the author.

Nursing also has the potential to moderate the publics need for hospital care through innovations such as nurse led telephone help lines and delivering more care in the community.

In many ways, nursing is the key profession and doctors, managers and politicians must recognise and respect the contribution nurses can and must make, he argues. The response to the current crisis posed by MRSA suggests that this may be happening.

The 19th century teaches us that nurses must be central to the running of all aspects of hospitals, not just those areas deemed appropriate by the medical profession.

This will require improved leadership and enhanced opportunities for nurses. In this way everyone can benefit: hospitals will remain viable, doctors will be able to pursue the activities in which they excel, and the publics concerns will be allayed, he concludes.

NHS waiting list falls below 800,000 for the first time

Sun, 04 Dec 2005 10:03:00 PST

( from http://www.rxpgnews.com ) The number of people on NHS waiting lists in England has fallen below 800,000 for the first time, new figures released today by the Department of Health have shown.

The figures show that in October the waiting list stood at 792,000 a fall of 366,000 since March 1997. This is the lowest figure recorded since waiting list data was first collected in this way in September 1988.

Health Secretary Patricia Hewitt welcomed the further progress in improving access to NHS treatment.

She said:

Investment and reform are working. The waiting list is at a record low and patients are experiencing the fastest ever access to NHS treatment.

The service is on target to achieve a maximum wait of six months for an operation by the end of this year and we know that most patients are already being treated much quicker, with an average wait of around eight weeks.

But there is still more to do. In October I set out further details of how, by 2008, no one will wait longer than 18 weeks from GP to hospital treatment.

We are on track to abolish waits in the NHS.

Reforms are threatening the future of district general hospitals

Fri, 02 Dec 2005 19:24:00 PST

( from http://www.rxpgnews.com ) Government reforms are threatening the future of district general hospitals, says an expert in this weeks BMJ. Given the iconic status of hospitals in the eyes of the public, government risks huge unpopularity in dealing with the consequences.

District general hospitals have formed the backbone of NHS hospital care since the 1960s, but government reforms to increase patient choice will see these hospitals competing with other NHS hospitals, NHS treatment centres, and independent sector providers, writes Professor Chris Ham.

District general hospitals may also find themselves under pressure from the devolution of budgets to general practices and payment by results.

Taken together, these policies mean that many district general hospitals may find it difficult to sustain a full range of services and could be left providing expensive complex care.

In these circumstances, one strategy is for hospitals to compete aggressively to maintain, and if possible, increase market share. An alternative and more plausible strategy is for hospitals to reduce or cease some activities and to focus on improving productivity in areas where they have competitive advantage.

A third strategy is for hospitals to diversify into other services - for example, sub-acute and primary care.

In the NHS of the future, it is possible to envisage enhanced primary care facilities and independent sector providers acting as a one stop shop for most forms of care apart from hospital inpatient services, says the author. On a more pessimistic note, the changes could result in reduced access to services and ultimately hospital closures.

However, one thing is certain. Managing the effects of choice and competition represents a huge political challenge, he concludes.

New NHS patient choice policies take no account of limited resources

Fri, 02 Dec 2005 19:22:00 PST

( from http://www.rxpgnews.com ) The Governments current NHS reform programme could lead to patients being charged for access to healthcare, argues a paper in this weeks BMJ.

New patient choice policies take no account of limited resources and funding, say the authors. Patients - consumers in the new NHS - bear no financial responsibility for the choices they make. Primary Care Trusts (PCTs), who pay for local health services in each area, are simply picking up the bill with no control on spending.

The Governments proposals for expanding market forces in the NHS will also be inefficient, say the authors. The aim is to drive costs down and improve quality through competition - external companies vying for NHS contracts. But prices have been fixed in advance, neutralizing the benefits of market forces.

In addition, more resources are going into the black hole of the hospital sector, and the way Foundation Trusts are funded heavily distorts the market.

Such a system will not be sustainable, say the authors: We face the prospect of an NHS led totally by patients, with supply responding purely to consumer demand without any recognised cap on expenditure. If the Government does not change tack, this can only lead to user charges, they warn.

Current UK policy seems based on US systems, say the authors. But these may not be transferable, particularly since organisations in the US deemed as successful models to follow, such as Kaiser Permanente, do not have to look after the range of health needs of a whole community, as the NHS does.

Instead the UK should introduce specifically-designed superpractices, family doctor surgeries expanded to include some hospital and social care services, all working together. Superpractices, servicing communities of 25-30,000 people and based on the old 'fundholding' model, would work best for controlling costs without compromising patient care, conclude the authors.

New Guidelines For Resuscitation (CPR) Published By The European Resuscitation Council

Tue, 29 Nov 2005 19:39:00 PST

( from http://www.rxpgnews.com ) New guidelines for the resuscitation of adults and children have been published today in the international journal Resuscitation, announce the European Resuscitation Council (ERC) and Elsevier Ltd.

The guidelines are aimed at all healthcare workers; a section on basic life support also provides information for laypeople and first responders. The recommendations made by the ERC are based on a comprehensive, evidence-based review of resuscitation science that was undertaken over the last two years by experts from all over the world. These experts debated their findings in a Consensus meeting held in Dallas in January 2005 and their conclusions, also published today, form the basis for establishing best practice worldwide.

The last CPR guidelines were published in 2000; since then, science has moved forward and our understanding of the evidence has improved. The new CPR guidelines focus on a back-to-basics approach and are easier for laypeople and healthcare professionals to learn. The steps to successful resuscitation are described by the links in the revised Chain of Survival. Early recognition of the patient who is very ill will enable medical assistance to be called immediately, providing an opportunity for early treatment and the prevention of cardiac arrest. In the event of cardiac arrest, early chest compressions and breathing may keep enough blood going to the heart and brain to buy time until the heart can be restarted by an electric shock (defibrillation). Once the heart has been restarted new treatments aim to improve the chances of the patient making a full recovery.

In comparison with the 2000 guidelines, the 2005 guidelines recommend giving more chest compressions (30 compressions for every 2 breaths instead of the traditional 15 compressions for every 2 breaths). The ratio of 30:2 applies to all adults and children (except for newborn babies) this should make it easier for everyone to learn and remember. Advances in defibrillator technology (the device that gives an electric shock to restart the heart) enables healthcare workers and trained laypeople to give an electric shock earlier and more effectively to a person in cardiac arrest.

For many years, it has been known that cooling of the body (hypothermia) provides temporary protection for the brain when the heart stops beating. Recent evidence indicates that mild cooling of a person whose heart has been restarted after cardiac arrest, may increase the chance of a full recovery,. The new guidelines recommend that this cooling treatment (therapeutic hypothermia) is used for some patients admitted to intensive care units after cardiac arrest.

For many years, it has been known that cooling of the body (hypothermia) provides temporary protection for the brain when the heart stops beating. Recent evidence indicates that mild cooling of a person whose heart has been restarted after cardiac arrest, may increase the chance of a full recovery,. The new guidelines recommend that this cooling treatment (therapeutic hypothermia) is used for some patients admitted to intensive care units after cardiac arrest.

The ERC Guidelines 2005 provide comprehensive recommendations on all aspects of cardiopulmonary resuscitation for healthcare professionals working in Europe and beyond. The guidelines are based on an extensive review of all relevant research studies undertaken by experts from all over the world. It is hoped that adoption of this state-of-the-art practice will increase the numbers of survivors from cardiac arrest

said Dr Jerry Nolan, Co-Chair of the International Liaison Committee on Resuscitation.

âThe ERC Guidelines 2005 provide an up-to-date link between the science of resuscitation and improved survival from cardiac arrest. The International Consensus on Science developed and published in 2005 has provided the foundation for our European experts to write these latest recommendations. These guidelines will form the basis of resuscitation teaching and practice throughout Europe for both the healthcare professional and the lay person.Said Dr David Zideman, Chairman of the European Resuscitation Council

The Guidelines will also be published in a condensed version as a Pocket Book.

Right time for doctors to debate food policy

Fri, 25 Nov 2005 17:53:00 PST

( from http://www.rxpgnews.com ) The time is right for vets and doctors to join together to examine the case for radical reform of current food policy, say researchers in this weeks BMJ.

They argue that cheap food, particularly meat, is linked to reduced human health and reduced farm animal welfare, both of which are important matters of public interest that are within the professions respective purviews.

The 20th centurys drive to lower food prices has resulted in many hidden costs for consumers, animals, and society, write Caroline Hewson and Tim Lang. Doctors and vets have an important opportunity to guide the public about these costs and to encourage the relevant policymakers to make changes.

Historically, a good public health case existed for reducing the price of foods and vets have helped deliver that policy. Today, vets help farmers control the diseases and other welfare concerns that intensive farming inadvertently promotes. Doctors, in turn, deal both with farmers health, as they struggle to remain in business, and with the publics health, damaged by the modern diet.

There is also considerable cultural pressure to rethink food policy. Many customers now tend to associate good human health with good animal welfare, and the health professions are being asked to encourage a dramatic shift in national diets.

Thus, the time is right for joint veterinary and medical debate about food policy, and even a shared position, they conclude.

Antivenom antidote is underused in UK for snake bites

Fri, 25 Nov 2005 17:51:00 PST

( from http://www.rxpgnews.com ) Life threatening snake bites are uncommon in the UK but can happen, especially in children, and should not be underestimated, says an expert in this weeks BMJ.

Antivenom, the only specific antidote is underused in the UK.

As well as bites by the UKs only indigenous venomous snake, the adder, doctors should also be aware that large numbers of dangerous snakes are kept surreptitiously as macho pets, writes Professor David Warrell. This underground zoo reveals itself a few times each year when bitten owners are forced to seek medical help.

Envenoming can evolve over many hours, so patients must be carefully observed in hospital for at least 24 hours after being bitten, he says. Antivenom is effective and safe, but is currently underused in the UK.

Treatment for exotic venomous snake bites may be more challenging than for adder bites, and it may be difficult to establish which species was involved and so obtain the appropriate antivenom, he concludes.

7275 new HIV cases reported last year in UK

Fri, 25 Nov 2005 05:20:00 PST

( from http://www.rxpgnews.com ) The number of people living with HIV in the UK is now around 58,300, according to a report released today by the Health Protection Agency. This latest figure includes both those who have been diagnosed and also an estimated 19,700, who remain unaware of their infection and therefore undiagnosed.

Dr Barry Evans, an HIV expert at the Agency said: Our report Mapping the Issues coincides with World Aids Day and allows us to take stock of the progress made in our efforts to prevent the spread of HIV. There is no part of the UK that remains unaffected by HIV or other sexually transmitted infections. The report shows that rates of infection vary across the country. This is due to a range of factors including differing levels of risk behaviour, urbanisation and demographics.

During 2004, 7275 new HIV diagnoses were reported in the UK - this compares to 7217 diagnoses in 2003. The majority of cases (4287) were diagnosed in heterosexual men and women, 73% of which were likely to have been acquired in Africa.

"Of all cases thought to have been acquired in the UK, three-quarters were in gay and bisexual men and the total number of all new diagnoses in this group in 2004 2185 was the highest since 1990. This figure is a combination of both those who have been infected for sometime who have come forward as a result of increased HIV testing, and those tested as a result of recent risk. Separate laboratory testing has also shown that the rate of new infections in gay and bisexual men has remained constant.

While there has been a levelling off in the number of diagnoses likely to have been acquired through heterosexual sex in Africa between 2003 and 2004 (from 3457 to 3138), there has been a slow but steady rise in the number of heterosexual infections acquired in the UK in recent years, from 227 diagnoses in 2000 to 498 in 2004.

Some of the regional variations highlighted in the report include:

* The steep rise in the number of syphilis infections from 2003 to 2004, from 1641 to 2254, has occurred against a backdrop of several localised outbreaks amongst gay men and heterosexuals in areas such as London and Manchester .
* There have been 215 cases of Lymphogranuloma venereum (LGV) in an outbreak amongst gay men since 2004. This has mainly affected London and Brighton .
* In 2004, the rates of people accessing HIV-related treatment and care services were much higher in England (91 per 100,000 population) than in the rest of the UK (17 to 46 per 100,000 population).
* The London region cares for the largest number of diagnosed HIV individuals, with 22,642 accessing HIV-related care in the capital during 2004.
* Gonorrhoea diagnoses in England (42/100 000) were more than double those in Wales (18/100 000) and Scotland (15/100 000), and were five times higher than those in Northern Ireland (7.3/100 000) in 2004.
* There is a wide regional variation in access to genitourinary medicine clinics (GUM clinics) with less than 30% of patients in some areas being seen within 48 hours.

Dr Evans continued, Several prevention initiatives have progressed over the last year. For example, there was greater uptake of voluntary confidential testing (VCT) for HIV at GUM clinics, particularly among gay men. This will help inform us about the transmission of the infection. Also it was estimated that over 90% of HIV-infected pregnant women in England were diagnosed prior to giving birth. As a result, the proportion of children exposed to maternal HIV infection who acquire HIV continues to decrease.

People can play their own part in HIV and STI prevention by ensuring they protect themselves by practising safer sex with all new and casual partners. Anyone who thinks they have put themselves at risk of contracting infection should go to a sexual health clinic for testing. It is important to bear in mind that some infections can have no symptoms.

Commenting on the report, Professor Peter Borriello , Director of the Centre for Infections at the Agency, said Mapping the Issues clearly demonstrates the contribution the Agency makes in monitoring the spread of HIV and other STIs, identifying changing patterns and risk groups and advising on interventions. By providing the most up-to-date information to those implementing prevention initiatives, and those on the frontline working with patients, the Agency assists in tackling rates of HIV and STIs.

Poor diet costs UK health service £6 billion a year

Tue, 15 Nov 2005 15:03:00 PST

( from http://www.rxpgnews.com ) The UK's poor dietary habits are costing its health service an annual £6 billion - three times as much as the financial toll from smoking - reveals research in the Journal of Epidemiology and Community Health.

The research team used European data from the World Health Organization's burden of disease project, calculating the proportion of ill health and deaths attributable to food. The definition included food poisoning as well as dietary habits.

The information gathered was then backed up by an extensive review of published studies on the financial and health costs of disease and deaths related to food consumption.

The authors used a composite term to describe the impact of ill health and death, known as DALYs, or disability adjusted life years.

They calculated that 37% of DALYS were attributable to food related diseases, with just a fraction of this (0.2%) attributable to food poisoning. Cardiovascular disease, cancer, and diabetes account for most of this.

Clearly, diet is not responsible for all cardiovascular disease, diabetes, and cancer, which account for 28% of health service costs, amounting to an annual £18 billion in 2002.

But the authors calculate that food accounts for around a third, accounting for 10% of all DALYS and costing an annual £6 billion.

This is double the cost to the health service of road traffic accidents, over three times the cost of smoking, and significantly higher than the cost of obesity, estimated at £479 million.

The authors admit their calculations are crude, but suggest that they are probably reasonable. "The estimates suggest that the burden of food related ill health is large, compared with say, smoking, and suggests that [it] has been neglected by health and food policy makers," they say.

And they call for more specific government health targets on diet, equivalent to those already in place for smoking.

Examining NHS reforms: Health care in the market place

Sat, 12 Nov 2005 20:08:00 PST

( from http://www.rxpgnews.com ) The Government's use of private health care in the NHS is a much more open and aggressive version of the "internal market" tried by the Conservatives in the 1990s, says an article in this week's BMJ - the first of a series examining NHS reforms.

Initiatives like 'payment by results', foundation hospitals, and the "deliberate injection" of independent sector treatment centres (ISTCs) and other private sector services all create a sophisticated "supplier market" in UK health care, says the author.

The escalating use of the private sector stems from the NHS Plan in 2000, when the Government pledged to reduce waiting times, but realised that the NHS was too short of doctors and facilities.

The NHS already paid for extra capacity from private healthcare on an ad hoc basis, usually to meet year-end targets. But at prices sometimes 40% higher than the average NHS cost for each operation, Health Secretary Alan Milburn was keen to find a more cost-effective system, says the author.

Independent sector treatment centres, derived from fast-track surgery units in the US and staffed from overseas to avoid draining the NHS, were his answer.

The reforms have proved unpopular with the wider Labour party, but successive health ministers have pursued the policies, says the author. Within a few years, for instance, ISTCs will perform 500,000 operations - providing the private sector with more than £1bn worth of business annually.

The most important of the reforms is 'payment by results', says the author, which underpins all others since it fixes a rate for treatment based on average NHS costs. Critics say that ISTCs are not good value for money, as they are paid at the national tariff per case but mainly perform simpler - and below average cost - procedures. The NHS is left with more difficult and costly cases, but only paid the average rate.

Private sector providers have to date also been given guaranteed volumes of patients from NHS managers, while NHS treatment centres are not allowed to 'compete' for patients. One result is that NHS units have been running half empty say critics - and thus losing money, adds the author.

Current reforms in the NHS represent nothing short of "the biggest revolutionsince its foundation in 1948," says the author. Many fear they will result in the destabilising, and eventual closure of hospitals, he concludes.

Nurse and pharmacist prescribing powers extended

Fri, 11 Nov 2005 00:52:00 PST

( from http://www.rxpgnews.com ) Patients will be able to get quicker and more efficient access to medicines thanks to extensions to nurse and pharmacist prescribing announced today by Health Secretary Patricia Hewitt at the Chief Nursing Officers conference in London.

From spring 2006, qualified Extended Formulary nurse prescribers and pharmacist independent prescribers will be able to prescribe any licensed medicine for any medical condition with the exception of controlled drugs.

The extension means that specialist nurses running diabetes and coronary heart disease clinics will be able to prescribe independently for their patients. Pharmacists will be able to prescribe independently for the local community; for example, controlling high blood pressure, smoking cessation, diabetes, etc. This will take pressure off GPs, allowing them to focus on more complex cases and improving the availability of care for patients.

Patricia Hewitt said:

"Extending prescribing responsibilities is an important part of our commitment to modernise the NHS. By expanding traditional prescribing roles, patients can more easily access the medicines they need from an increased number of highly trained health professionals.

Todays announcement means that the young person wanting to control their asthma or the terminally ill patient being cared for at home by a multi-disciplinary healthcare team will soon find it easier and more convenient to get the medicines they need. This is another step towards a truly patient-led NHS, giving patients the power to choose where and by whom they are treated.

Chief Nursing Officer Christine Beasley said:

Nurses are the biggest single staff group in the NHS and they have already demonstrated that they are safe, careful and professional prescribers. Pharmacists have wide knowledge of medicines and the effects they have on people. This knowledge is invaluable to their colleagues and to patients. Todays announcement demonstrates our confidence in nurses and pharmacists and our wish to use their skills and professionalism to the full.

With these extended prescribing powers, nurses and pharmacists will be able to improve choice for patients and enable more flexible team working within the NHS.

And, as nurses and pharmacists undergo rigorous training before being able to prescribe, patients can be confident that they are receiving the safest, best possible care.

Head of Pharmacy Jeannette Howe, said:

"This is a major step forward in providing care that is more responsive to the needs of patients and the public. It is ground-breaking for the pharmacy profession. As independent prescribers, pharmacists will fully use their expertise in medicines, in partnership with patients and other members of the health care team."

Nurses and pharmacists will be able to undertake these roles once they have successfully completed the relevant training courses accredited by their respective regulatory bodies and had these qualifications noted on the professional register. Once trained, they will be required to keep their skills up to date. Employers will allow nurses and pharmacists to prescribe once they are satisfied that they have appropriate registration and have all the skills and competencies relevant to the clinical area in which they will be prescribing.

Nurse and pharmacist prescribers will have to work within their employers clinical governance frameworks and they will be accountable to both their employers and their regulatory bodies for their actions.

GPs advised to plan their flu pandemic response

Thu, 10 Nov 2005 18:50:00 PST

( from http://www.rxpgnews.com ) Family doctors are advised to plan their response to managing a flu pandemic in 5 November issue of BMJ.

The advice is based on a module that is freely available on BMJ Learning (www.bmjlearning.com) to help keep health professionals up to date with key issues.

It is important that general practitioners take the recent threat of a flu pandemic seriously, writes Dr Douglas Fleming, a general practitioner in Birmingham. If a pandemic does occur in the United Kingdom, general practice is likely to carry the major burden, and it is unrealistic to think that it will be contained in routine office hours.

Practice staff need to consider how to advise patients, target those at risk, cope with increased demand, and continue giving routine care, he says. He advises practices to train staff in triage methods and improve their capacity to manage illness by telephone.

He also warns practices not to be swayed by media hype, but to obtain and provide accurate information to a fearful and anxious population.

He points out that an appropriate vaccine cannot be developed until the pandemic virus is clearly identified and it will be some months before there are sufficient supplies for widespread use. Furthermore, it is not clear how useful antiviral drugs would be to treat a completely new virus, or how easy it would be to distribute them during the high-pressure conditions of a pandemic.

Supply shortages also bring ethical dilemmas between countries with manufacturing capacity and those without, and with respect to people in countries with inadequate resources to meet the cost of vaccines and drugs.

Should a pandemic emerge within 12 months, the availability of antiviral drugs will be limited, and people at high risk will need to be given priority. Healthcare workers and people operating essential services might be the most important groups to protect, he concludes.

Professor dispels bird flu paranoia

Fri, 04 Nov 2005 19:00:00 PST

( from http://www.rxpgnews.com ) The risk of human bird flu infection is small in Australia and people can still safely eat chicken and keep pet birds, according to bird medicine specialist Dr Bob Doneley.

"The chances of getting bird flu off a pet bird or your neighbours birds are so infinitesimally small," UQ School of Veterinary Science Adjunct Professor Dr Doneley said.

"You're more likely to have a light plane hit by a meteor and fall on your head than somebody getting bird flu off their cockatiel."

Dr Doneley, Queensland's only registered bird specialist, said he wanted to clear up some of the confusion and unnecessary panic about the virus.

He said bird flu was a viral disease of all birds, usually spread by water birds but normally only causing disease in poultry.

Contaminated water is the most common source of infection from bird droppings but it can be spread physically on boots or other clothing.

The virus is stable in water for up to 200 days and in droppings for four to five days, but can be stopped by heat, sunlight and most detergents.

Authorities have confirmed the dangerous H5NI strain of bird flu in South East Asia, Russia and Eastern Europe but not in Australia.

They fear an epidemic if this strain mutates to spread into a people-to-people virus.

"We need to be very alert for bird flu in poultry because the more people who get it from birds, the higher the chance that the virus could change."

Dr Doneley said the public were paranoid about catching bird flu off their neighbours' backyard pets because the media had "played up" the virus.

He said his West Toowoomba Vet Surgery had been swamped with inquiries from panicked bird owners and neighbours about their pet parrots, finches and budgies.

"We're getting three or four phone calls a day from people wanting to know if they should sell their house because their neighbours have got birds.

Some ways that bird owners can minimise risk are:

* Build pens to keep domesticated poultry away from wild birds.
* Stop domesticated poultry from accessing open ponds, lakes or creeks.
* Keep domestic waterfowl separate from poultry where the waterfowl have access to the same water as wild waterbirds.
* Be alert for bird flu symptoms in poultry such as coughing, sneezing, noisy breathing, increased tear production, swollen sinuses and head, decreased egg production, diarrhoea, convulsions, head arched backwards, unable to fly or walk properly, facial and comb swelling and mouth and comb turning blue and report any worries to your local government biosecurity officer.
* Don't eat raw or undercooked chicken.
* Don't use untreated water, use clean town water or bore water.

"Consumers of poultry meat and egg products should not be concerned as the risk of infection from eating poultry products is extremely low," Dr Doneley said.

"The avian influenza virus, like most other viruses and bacteria) is destroyed by adequate heating or cooking."

Orphan drugs and the NHS: should we value rarity?

Sat, 29 Oct 2005 15:04:00 PST

( from http://www.rxpgnews.com ) The growing number and costs of drugs for rare diseases (orphan drugs) are straining healthcare budgets. Should the NHS continue to pay for them and how will this affect other health services, ask two articles in this weeks BMJ. Orphan drugs are often expensive to produce and benefit only small numbers of patients. Historically, the NHS has paid for them because treatments for these diseases were so rare that the effect on health services was negligible.

But, as more and more orphan drugs come on to the market, the impact on other health services is becoming substantial.

In the first article, experts argue that the cost effectiveness of orphan drugs should be treated in the same way as for other healthcare technologies.

They believe that the costs of production and the value of innovation cannot justify special treatment, and that arguments about the measurement and valuation of health outcomes apply equally to orphan drugs and drugs for more common conditions. Why should a persons health be valued less simply because the condition is not rare?

Special status for orphan drugs in resource allocation will avoid difficult and unpopular decisions, but it may impose substantial and increasing costs on the healthcare system, they write.. The costs will be borne by other patients with more common diseases who will be unable to access effective and cost effective treatment as a result.

The second article describes how a national decision to provide therapies for a group of rare disorders prevented local funding for other equally vital services in the West Midlands.

The new commissioning arrangement came with no extra funding. The cost to primary care trusts doubled from £3.2m to £6.7m, limiting budgets available to commission and develop other services.

It is time to educate ourselves, policy makers, and the public, say the authors. We need to learn how to make trade-offs between equity and efficiency that are explicit, principled, and generalisable and how to admit openly when there are treatments and services that are not being funded.

Meeting MRSA Targets Largely Down To Chance, Says Expert

Sat, 29 Oct 2005 14:53:00 PST

( from http://www.rxpgnews.com ) Chance makes it impossible to assess reliably whether hospitals are meeting government targets to reduce MRSA infections, argues a statistics expert in this weeks BMJ. The UK government has set a national target for reducing the rate of MRSA infection by 50% by 2008, but David Spiegelhalter, a senior scientist at the MRC Biostatistics Unit Cambridge, warns that setting these targets for individual hospitals is fraught with difficulties.

The basic problem, he says, is that it is unclear whether the targets refer to an observed rate reduction or a true reduction in underlying risk: this ambiguity is unimportant at the national level but, for individual hospitals, chance variation can make the observed rates extremely volatile and make simplistic notions of hitting targets unreliable.

MRSA is an infectious disease and so tends to occur in clusters, making the volatility even worse.

Using data for financial years 2001-4, he found far more variability in the figures than would be expected by simple chance alone. For example, Aintree Hospitals NHS Trust had 34 cases in 2001-2, rising to 66 cases in 2002-3, and falling to 48 in 2003-4.

He therefore suggests that any attempt at ranking trusts into a detailed league table of change would be entirely spurious.

He also shows that, since high or low rates are largely due to chance events that are unlikely to be repeated, rates in the subsequent year will tend to be closer to the overall average rate (a phenomenon known as regression to the mean). This immediately explains reports of hospitals slipping significantly down the league table from one year to the next.

He believes that, if MRSA rates are to be used to assess performance, further changes are needed.

Finally, the government needs to be more precise about what it means by the term target, he adds. When it comes to assessing whether a target has been met, it is vital to distinguish between observed reduction in numbers of cases and reduction in true underlying risk.

Even if the average trust is truly reducing the underlying risk at the government target of 20% per year, there is still only a 50:50 chance that the observed rate will drop by more than 20%. Underlying risk, though it cannot be precisely measured, is the appropriate interpretation when setting local targets, he concludes.

But an accompanying editorial says that, despite these limitations, mandatory surveillance of MRSA infection rates has raised the profile of infection control .

UK steps up preparedness for a flu pandemic

Mon, 24 Oct 2005 16:35:00 PST

( from http://www.rxpgnews.com ) Chief Medical Officer, Sir Liam Donaldson on Wednesday 19 October 2005 announced that the Department of Health is inviting manufacturers to tender for a contract to supply pandemic flu vaccine once the pandemic strain is known. The UK will need approximately 120 million doses to be available as soon as possible. The move comes alongside the publication of an updated version of the Pandemic Influenza Contingency plan.

Influenza pandemics are caused when a new flu virus emerges to which people have no immunity. Because it is new, annual seasonal flu vaccine will not be effective and a new vaccine against the exact strain needs to be made at the time it emerges. The proposal to purchase in advance the capacity needed to make pandemic flu vaccine will make sure that an effective vaccine is available for use in the UK as quickly as possible after a flu pandemic starts.

Chief Medical Officer, Sir Liam Donaldson said:

"We can't prevent a flu pandemic, but we can reduce its impact.

"We are constantly reviewing and improving our pandemic plans. Today we have published an updated version of our influenza pandemic contingency plan. This takes into account feedback and further work carried out since the publication of the flu pandemic plan earlier this year.

"One of the most effective countermeasures we can take against a flu pandemic is to make sure we develop and manufacture a vaccine as quickly as possible.

"A vaccine to protect against pandemic flu can not be made until the new virus is known. However, there are steps we can take to reduce the time before manufacturing starts.

"Today we are inviting manufactures to tender for a contract to supply future requirements for around 120 million doses of a pandemic vaccine. We will use this vaccine to immunise the UK population and reduce the impact of a pandemic on society.

"We also need to make sure that the NHS is ready to respond to a flu pandemic. We are asking the primary care community, including asking GPs to draw up plans setting out how they will respond to a flu pandemic and an information pack is being sent to every GP practice to help them answer patients' concerns.

âPlanning to combat pandemic flu is our number one priority. We regard pandemic flu as public health enemy number one and we are on the march against it. With good planning and preparation we can reduce the impact of pandemic flu on the health of our population.â

The revised contingency plan includes new and updated information on the latest science and advice to the NHS.

People with Learning Disabilities in the UK still Excluded from Mainstream Education and Jobs

Sat, 22 Oct 2005 02:36:00 PST

( from http://www.rxpgnews.com ) The report, Rights of People with Intellectual Disabilities: Access to Education and Employment in the UK, was released on 20 October, 2005 in London, at an event at the Royal Society. Produced by the Open Society Institute in co-operation with the Foundation for People with Learning Disabilities, the report finds continuing inadequacies in the UK's mainstream education and employment systems.

UK legislation and policy sets out to include more children in mainstream schools, but there is a need for more resources and training. Hazel Morgan, Co-Director of the Foundation for People with Learning Disabilities and one of the report's authors, says: "Many local secondary schools and colleges here in the UK have inadequate resources, skills and experience to provide the level of support needed for students who have learning disabilities. We need more specialist teachers who can give them the support they need and there also needs to be greater flexibility in both teaching arrangements and the curriculum if children with learning disabilities are to be included."

The transition from school to employment is not an easy journey for young people with learning disabilities either. Many are not prepared for employment opportunities and leave school or college with no skills or experience, making it virtually impossible for them to find a job.

Despite a clear policy by the UK Government to provide new employment opportunities specifically for people with learning disabilities, the Valuing People Support Team estimates that only 11 per cent of people with learning disabilities in England are in paid employment.

Because of the lack of employment opportunities, most people with learning disabilities in the UK are "economically inactive". They rely on benefits, such as Income Support (IS) and Disability Living Allowance (DLA), as well as other non-disability specific benefits.

Dr. Stephen Beyer from the Welsh Centre for Learning Disabilities and another of the report's authors, says: "We know that there are around 800,000 people with learning disabilities who are of working age, yet few have a paid job and even that may be part time. Many people want to work but there are barriers to them achieving this. There is not enough appropriate support available for people with learning disabilities, Government schemes aren't fully geared towards helping them and the benefits system acts as a barrier."

While the social welfare system is supposed to help people make the transition from benefits to employment, the reality is much different for people with learning disabilities. The fear that any form of work may threaten their benefit status acts as a deterrent to finding a job and this is particularly the case for people in staffed accommodation who could potentially lose their Housing Benefit. The Government should consider ideas for a radical reform, including abandoning "incapacity" as an organising principle and replacing it with compensation for "disadvantage in the labour market". This would remove inherent contradiction between any form of move to work and receiving protection offered by special benefit status.

The report released today covers the whole of the United Kingdom and is translated partially into Welsh. It includes recommendations to Government and policy makers to offer more appropriately resourced mainstream education and employment opportunities to people with learning disabilities.

Call for an independent regulator for NHS

Fri, 21 Oct 2005 15:51:00 PST

( from http://www.rxpgnews.com ) The NHS should have an independent regulator like other public utilities in the UK, argues a senior doctor in this weeks BMJ. Many public utilities have independent regulators to see that commercial interests and unfair pricing do not disadvantage the public.

At present the UK does not have an independent regulator of healthcare reform, yet the consequences of ill judged reform of the NHS may inflict long term damage to the delivery of health care to its citizens, says Ian Kunkler, a consultant at the Western General Hospital in Edinburgh.

He believes that the shortcomings of the private finance initiative are persuasive arguments for an independent regulator, and suggests that key tests might include equity of access to care; collaboration between healthcare professionals, managers, and patients, and financial prudency and transparency.

If these golden rules were met, the UK government would be more likely to carry the support of the public and NHS professionals to meet the healthcare challenges of the 21st century, he concludes.

Acute lack of services for children in pain in UK

Mon, 17 Oct 2005 19:01:00 PST

( from http://www.rxpgnews.com ) Almost half a million children and teenagers in the UK experience chronic pain but there are not enough NHS services to help treat them, says the head of the Bath Pain Management Unit on Global Day Against Pain (Monday 17 October 2005).

Research suggests that as many as eight per cent of children experience severe headaches, stomach cramps or musculoskeletal pain that keeps them away from school regularly.

But the absence of specialist paediatric pain services in most hospital trusts means children who need help managing and living with their pain are not being supported.

Professor Christopher Eccleston, Director of the Bath Pain Management Unit based at the University of Bath and the Royal National Hospital for Rheumatic Diseases, is using the Global Day Against Pain to call for more specialist pain services for children and adolescents.

Many people used to think that chronic pain was a uniquely adult problem, but almost half a million children report severe or recurrent pain, said Professor Eccleston.

These children experience high levels of distress, have more mental health and social problems, and tend to do worse academically than those without pain.

They also use more health services and are absent from school more often, so there are financial implications for parents, the health service and the nation too.

Research suggests that children who experience chronic pain are more likely to become adults with chronic pain, so there are long-term consequences for the lack of support for this condition.

The Bath Pain Management Unit has been treating children and adolescents for the last six years. The team of doctors, nurses, occupational therapists, physiotherapists and psychologists run intensive treatment programmes for children and their parents or carers covering exercise, leisure, school, self management, pain education and lifestyle.

Three months after programme young people are significantly fitter, are less distressed, judge themselves to be less disabled and are more active. Almost all can learn more and most can return to a mainstream school.

Although adolescent pain is a major problem with long term consequences, there is a paucity in services to help those most at need, said Professor Eccleston.

Pain in children can be treated, there just needs to be better support to improve the service provision for adolescents with chronic pain.

Cost effectiveness of complementary treatments in the United Kingdom

Fri, 14 Oct 2005 21:43:00 PST

( from http://www.rxpgnews.com ) The cost-effectiveness of using complementary treatments in the United Kingdom has been the subject of much speculation and controversy.

For instance, a report commissioned by the Prince of Wales last week said that complementary therapies should be given a greater role in the NHS, while others believe that more studies are needed before they are made widely available.

As an example of how poor the evidence is, researchers carried out a systematic review of cost effectiveness analyses of complementary treatments. They found only five studies done in the UK before April 2005, one of acupuncture for headache and four of spinal manipulation for back pain.

They conclude that these treatments represent an additional cost to usual care with questionable clinical benefit.

In an accompanying editorial, two senior doctors and general practice researchers suggest that complementary medicine should be considered for inclusion in national clinical guidelines despite limited evidence of cost effectiveness.

They believe that the integration into the NHS of specific complementary therapies for chronic conditions would be beneficial to patients, but that each therapy needs to be considered on its merits, including cost-effectiveness.

Services for liver disease in the United Kingdom need immediate improvement

Fri, 14 Oct 2005 21:43:00 PST

( from http://www.rxpgnews.com ) Mortality from liver disease is increasing in the UK. In 2000 liver disease killed more men than Parkinsons disease and more women than cancer of the cervix. Deaths from alcoholic liver disease has doubled in the past 10 years, while liver disease arising from hepatitis C infection is expected to treble by 2020.

Evidence also suggests that the standard of care may vary widely from place to place.

But are there enough specialist staff and facilities in the UK to manage these projected increases in liver disease, or even the current workload, asks the author?

He conducted a survey on the staffing and facilities of liver centres at 28 English hospitals. Relatively few were able to provide a full range of liver services and there were serious shortages of staff at all levels.

Lack of dedicated beds was one of the most common problems, while waiting times for outpatient appointments were often unacceptable, with only seven hospitals able to offer an urgent appointment within two weeks. An earlier survey also showed the need for a substantial increase in consultant liver specialists (hepatologists).

Recent initiatives to improve teaching and specialist training are a step forward, says the author, but liver services need better funding as well as better staffing.

Increasing the number of transplant centres would be one way to provide liver services more widely in the United Kingdom, he suggests. At present, large areas of the country currently lack a transplant centre, and it was once estimated that a patient living in Cornwall was four times less likely to be referred for a liver transplant than someone in Leeds.

Clearly, specialised services for liver disease and transplantation will have to improve substantially to meet the considerably increased burden of liver disease that is predicted for the next 20 years, he concludes.

Blunkett's welfare plans must be fleshed out and rigorous

Tue, 11 Oct 2005 00:44:00 PST

( from http://www.rxpgnews.com ) The Mental Health Foundation today warned that David Blunkett's principles of welfare reform provide positive aspirations, but helping people with mental health problems return to work will require a detailed strategy.

The Work and Pensions Secretary today outlined his eight principles of welfare reform to get many of the 2.7 million people currently on incapacity benefit back into work.

Dr. Andrew McCulloch, Chief Executive of the Mental Health Foundation said: "These are broadly good aspirations. We know that many people with mental health problems want to get back into work. But the Secretary of State has not yet outlined a strategy for enabling them to do it. He now needs to outline a clear set of policies that use the learning of the Pathways to Work scheme and international best practice including supported employment to enable a safe return to work, removing the very real risks to people's benefits status if they dip a toe in the water. He must also tackle employer discrimination. Existing Personal Capability Assessment for mental health appears ill thought through, inappropriate and unfair and the benefit system can confuse people, compounding their anxiety and fear of getting their correct benefit entitlement and returning to work."

David Crepaz- Keay, the Foundation's Senior Policy Advisor for Patient and Public Involvement said: "You have to tackle employer discrimination alongside benefits. Otherwise, benefit reforms of this nature mean you'll have the ludicrous situation of people who are too ill to work inappropriately employed in entry-level jobs, alongside people who are too well to be unemployed claiming benefits."

Blunkett's welfare plans must not ignore people with learning disabilities, says the Foundation for People with Learning Disabilities

Tue, 11 Oct 2005 00:44:00 PST

( from http://www.rxpgnews.com ) The Foundation for People with Learning Disabilities welcomes David Blunkett's principles of welfare reform but warns that people with learning disabilities must not be forgotten.

The Work and Pensions Secretary today outlined his eight principles of welfare reform to get many of the 2.7 million people currently on incapacity benefit back into work.

Hazel Morgan, Co-Director of the Foundation for People with Learning Disabilities says: "We welcome this first step but people with learning disabilities must not be forgotten. There are currently around 800,000 people with learning disabilities of working age. Many want to work yet only 11 per cent are in paid employment. Mr Blunkett needs to ensure that Government programmes become more sensitive to their needs and more appropriate support and training is provided to help people with learning disabilities find work. Many fear that they may be worse off in a job. The transition from benefits to work needs to be further improved."

The Foundation for People with Learning Disabilities is publishing a report about education and employment opportunities for people with learning disabilities later this month. The charity sincerely hopes that the Government takes serious note of its findings and acts on its recommendations.

Hewitt fast-tracks Herceptin to save 1000 lives

Sat, 08 Oct 2005 05:52:00 PST

( from http://www.rxpgnews.com ) Patricia Hewitt, Secretary of State for Health, has announced that women who are diagnosed from this week onwards with early stage breast cancer will have the opportunity to be treated with the drug Herceptin. This means that the lives of around 1000 women a year will be saved the same number of lives saved by the NHS national breast cancer screening programme for roughly the same cost.

Patricia Hewitt said that from today all women diagnosed with early stage breast cancer will be tested for suitability for treatment with Herceptin. As soon as Herceptin receives a licence it will be fast-tracked for use throughout the NHS.

The National Cancer Director Professor Mike Richards is meeting the medical directors of the NHS Cancer Networks on Thursday to ensure that the new testing service is ready as soon as possible.

Of the 35,000 women diagnosed with breast cancer each year, about 20,000 will be suitable for HER2 testing. From this group of 20,000 women, about 5,000 women may benefit from Herceptin. The drug could save around 1000 lives a year, at an annual cost of about £100 million.

Patricia Hewitt said:

Herceptin has the potential to save many womens lives and I want to see it in widespread use on the NHS. Today I am asking Professor Mike Richards to ensure that the facilities are put in place to enable women who require it to be tested. I want the licence for Herceptin to be granted as quickly as possible, without compromising peoples safety, and to be available within weeks of the licence being given.

I share the huge frustration of many women about the delays in getting Herceptin licensed. I am determined to take action, and this represents a major step forward in our fight against cancer.

Hewitt fulfils commitment to NHS workers

Sat, 08 Oct 2005 05:52:00 PST

( from http://www.rxpgnews.com ) Thousands of staff working in the NHS are set to benefit from a new agreement that will bring cleaning, portering, catering and other similar soft facilities management services provided by contractors into line with the NHS Agenda for Change pay deal, Health Secretary Patricia Hewitt announced today.

The joint statement agreed in partnership between the Department of Health, relevant NHS Unions, the CBI and BSA and the new NHS Employers organisation is part of the NHS Agenda for Change programme (covering 1.2 million NHS employees) to create a modern flexible workforce that delivers better health outcomes.

From October next year, the new deal will give cleaners, porters and other soft facilities management staff working for contractors, pay and conditions no less favourable overall than the Agenda for Change pay deal, and provide for better development and training and closer involvement in NHS workforce reforms.

Interim measures have also been agreed.

* From 1 October 2005 staff covered by the agreement will receive a minimum of £5.65 an hour basic pay
* From 1 April 2006, the minimum hourly rate of basic pay will rise to £5.88 (matching the current minimum under Agenda for Change)

Health Secretary Patricia Hewitt said:

Cleaners, porters, and catering assistants are all part of the team that delivers care to patients in every hospital, whether employed directly or through a contractor. They are key to delivering cleaner hospitals, reducing MRSA, helping patients access services and ensuring patients have nutritious meals.

Government, unions, and private sector employers recognise that hospitals function better when there is good team working between clinical and support staff, and fair rewards irrespective of how they are employed. This deal will help ensure better services for patients in our hospitals.

The NHS is a unique institution and this agreement demonstrates that all parties central to its success - the public sector, unions and the private sector - can work together effectively to achieve the reform of the NHS to create a modern health service.

Dave Prentis, General Secretary of UNISON, the UK's largest union said:

"This is a great step forward towards ending the two-tier workforce in the NHS. The proposals will also avert the threat of widespread industrial action by contracted out staff across the country.

"The new £5.88 minimum wage will drive up standards and help tackle the recruitment and retention problems experienced by many hospitals. It will also give a welcome boost to staff who, as a result, will feel more valued and respected as an integral part of the NHS team. The agreement will also provide staff with better training opportunities which is very welcome."

Steve Barnett, Director of NHS Employers said:

This is an important agreement which will make a big difference to the lives of thousands of staff who are part of the wider NHS team . They provide a crucial service and are integral to positive patient experiences.

Norman Rose, BSA Director-General said: "Under the proposed deal announced today, private sector employers will be given the opportunity to demonstrate their ability to deliver high-quality services to the NHS through flexibility and innovation and not through cutting costs. We welcome this deal as setting the foundations for a new way forward in which we and the public sector unions can work together with NHS Trusts in the interests both of our employees and the patients whom we serve."

John Tizard, Director of Public Services at the CBI said: We welcome this agreement and the commitment to continued reform it embodies. This agreement recognises that there are a wide range of private and voluntary providers involved in delivering health services and their staff have an important part to play in NHS reform

Health Protection Agency begins winter flu activity reporting

Sat, 08 Oct 2005 05:28:00 PST

( from http://www.rxpgnews.com ) This week the Health Protection Agency (HPA) resumes its UK surveillance of flu activity for the winter season. Regular updates will be published on the Agency's website either weekly or fortnightly depending on the level of flu activity.

The Agency's surveillance will monitor the level of flu activity occurring; the strains of the flu virus that are circulating (for example are we seeing any new or unexpected strains and do the flu strains differ to those included in this year's flu vaccine); and the situation elsewhere in Europe and around the world.

One of the primary methods used to monitor flu levels is through the Royal College of General Practitioners (RCGP) surveillance scheme. The scheme takes a sample of GPs from around the country and measures the number of people consulting those GPs for flu or flu-like illness.

The current thresholds used to define the level of flu activity are:

Baseline activity (200 consultations per 100,000 people).

By interpreting the data using thresholds, clear and consistent information about the levels of influenza illness in the community can be estimated, including when it is appropriate to recommend the use of antiviral drugs.

Dr John Watson, Head of the Respiratory Diseases Department for the Agency, said:

For the past few years flu levels in the UK have remained low. However, as flu can be an unpredictable illness we should remain vigilant and continue to monitor flu activity week by week throughout the season. By doing this we can assess how levels are changing, ascertain which viruses are circulating and issue warnings if levels of activity begin to increase significantly.

For the majority of people, although it is unpleasant, the flu is not life-threatening. Symptoms can include a headache, fever, cough, sore throat, and aching muscles and joints.

However, the flu can be dangerous for at-risk groups, such as the elderly or patients with heart problems, diabetes or asthma or those who are immunocompromised. It is important that these people take up the offer of influenza vaccination.

It is important to note that the influenza viruses that regularly circulate during the winter are different from pandemic influenza. Pandemics arise when a new virus emerges that is capable of spreading worldwide. Its emergence and potential impact are both difficult to predict and it causes illness in a high proportion of the people infected. Most people will have little or no immunity to a new subtype of influenza because they will not have been infected or vaccinated with it or a similar virus before.

Day surgery rates continue to rise in UK

Fri, 07 Oct 2005 21:16:00 PST

( from http://www.rxpgnews.com ) New figures published by Dr Foster in this weekâs BMJ show that day surgery rates continue to rise, yet there is still considerable scope for improvement. These findings support a recent Healthcare Commission report showing that day surgery units are not being used to their maximum capacity.

The NHS Plan predicts that 75% of all elective operations will be carried out as day cases. According to the British Association of Day Surgery, patients prefer day surgery as it provides timely treatment with less risk of cancellation, lower incidence of hospital acquired infections, and an earlier return to normal activities.

Researchers looked at day surgery rates by using hospital episode statistics between 1996-7 and 2003-4, and comparing them against the 25 operations identified by the Audit Commission as day cases.

Overall, the proportion of procedures carried out as day surgery rose from 55.7% in 1996 to 67.2% in 2003. Cataract operations showed the greatest increase in total admissions (including day cases), rising 94.8% over the study period.

Day surgery rates varied considerably between NHS trusts ranging from 40.2% to 82.7%, with only 12% of trusts carrying out 75% or more of the 25 operations identified by the Audit Commission as day cases. The authors suggest this variation might be explained by inconsistent coding or differences in case mix between hospitals.

The conclusions are much the same as those of the Healthcare Commission: day surgery rates are continuing to improve, yet the range of performance between NHS trusts remains wide leaving considerable scope for the poorer performers to improve.

Reforming the NHS in England - Views

Fri, 07 Oct 2005 21:16:00 PST

( from http://www.rxpgnews.com ) The NHS is being taken over by big business so that money that could go towards clinical care is diverted to corporations and their shareholders, warn two senior doctors in this weekâs BMJ.

Robert Lane and Alex Paton argue that huge amounts are paid to large private firms for advice about the Private Finance Initiative (PFI) and independent sector treatment centres (ISTCs). Profits are then swollen by the scandalous practice of refinancing buildings, while cash-strapped hospitals must pay the mortgage for 30 years.

But problems go deeper than money, they say. While clinicians are expected to provide evidence to support the actions they take, ideas generated by government advisers are often applied without consultation.

âThe result is a stream of untried schemes, based on ideology rather than evidence, that often have unforeseen consequences on different parts of the NHS.â

But for those in favour of reform, the problem is not that we have gone too far but that we have not yet gone far enough. In a second article, Jennifer Dixon calls for full implementation of the reforms already designed (payment by results, patient choice, and provision of care by non-NHS providers).

âThe supply of private providers must continue to grow,â she says.

But she also wants more. Key elements, such as stronger financial incentives, boosted commissioning, and effective economic regulation, are urgently needed. The government must also provide more evidence that the risks of reform on this scale can be managed effectively, she concludes.

Is the private finance initiative dead in NHS?

Fri, 07 Oct 2005 21:16:00 PST

( from http://www.rxpgnews.com ) Government enthusiasm for the Private Finance Initiative (PFI) in the health service - private sector investment in hospital building projects - may be dropping because of its high cost, says an editorial in this weekâs BMJ.

Hospital trust boards initially welcomed the financing system, which they were told was the major way they could fund new facilities, paying investors back in annual instalments.

But concerns were soon raised that new PFI funded projects were providing less patient capacity than those they were designed to replace. PFI contracts also seemed very expensive, though details on costs were âshrouded in commercial secrecyâ, says the author.

The House of Commons Public Accounts Committee recently questioned the âlarge profits made by the private contractor which built the Norfolk and Norwich hospitalâ, says the author. And the recent shelving of a flagship PFI venture in West London may herald the end for the PFI healthcare experiment in the UK, he suggests.

The fundamental problem is that PFI does not suit the rapidly changing climate of delivering healthcare in the UK, says the author, as private investors need long-term commitment from hospital managers â commitments increasingly unwise for trust boards to make.

The final blow could be the Governmentâs own economic operating constraint that debt should not exceed 40% of gross domestic product. Hospital repayments to PFI investors have always been treated as âoff balance sheetâ finance - not registered in public accounts. But this may soon change if the Governmentâs Office for National Statistics reclassifies PFI investment, since much of it may be categorized as debt â and at levels possibly breaching the Governmentâs own economic condition, says the author.

This would remove a key justification for PFI in healthcare, since a financing system which incurred heavy debts on the Government balance sheet overturns the argument for having PFI in the NHS at all, he concludes.

BHF raises crucial heart health issues at the Labour Party Conference

Wed, 28 Sep 2005 07:56:00 PST

( from http://www.rxpgnews.com ) Decisions are imminent on the legislation to restrict smoking in public places and workplaces as part of the forthcoming Health Improvement and Protection Bill.

The Labour Party Conference Smokefree Legislation Fringe Meeting, Its about health and its about time, will provide party delegates an opportunity to hear Caroline Flint MP and Peter Hollins, Director General of the BHF, discuss the proposals for smokefree legislation to cover all workplaces and enclosed public places, with exemptions for pubs that dont serve food and private members clubs.

Peter Hollins, Director General of the BHF said,"Secondhand smoke is a killer. The case for comprehensive legislation is now overwhelming.

"Everyone has a right to a smokefree workplace. The current proposals will leave the most heavily exposed workers unprotected and will lead to an increase in health inequalities."

The BHF is also supporting a fringe meeting on inequalities in end of life care. The BHF will call on Government to substantially invest in palliative care services for heart patients, who currently receive much less support than cancer patients at the end of their lives.

Each year about 300,000 people with life threatening conditions other than cancer would benefit from palliative care but are excluded from it principally by reason of their diagnosis.

Report will help "end confusion about the role of doctors in drug treatment'

Tue, 27 Sep 2005 17:51:00 PST

( from http://www.rxpgnews.com ) A recent report, published by the Royal College of Psychiatrists (RCPsych) and the Royal College of General Practitioners, will help "end confusion about the role of doctors in drug treatment and ensure their skills are fully utilised", according to the National Treatment Agency for Substance Misuse (NTA).

The publication, entitled 'Roles and responsibilities of doctors in the provision of treatment for drug and alcohol misusers', is a culmination of three years work by the two leading colleges involved in the sector, with input from the National Treatment Agency and the Department of Health.

Designed as a resource for treatment commissioners, providers and doctors, the report seeks to clarify the role of different specialists, as well as the skills and competencies they require to work with drug and alcohol users. The report also provides examples of how doctors with a range of competencies, from addiction psychiatrists to GPs, can work together to provide a comprehensive range of drug treatment services in an area.

The NTA has produced a separate summary of the report focusing specifically on drug treatment.

Commenting on the publication, Dr Emily Finch, clinical psychiatrist at the NTA and member of the Addictions Executive of the RCPsych, said:
'In recent years there has been a large increase in the number of doctors working with drug users. The expansion has resulted in a mixed picture with individual doctors working in different ways with a variety of competencies. It has also meant that the full skills of some drug treatment practitioners are not been utilised.

'In the context of a wider drive by the NTA to increase the effectiveness of treatment services, this report should help clarify how local treatment systems can draw on a range of specialists to meet the needs of drug users and the skills required for each role.

'It also highlights need for all doctors to be part of a proper clinical governance structure, with regular supervision and appraisal to ensure they have the competencies consistent with their role."

National consultation on NHS-funded infertility treatment

Sat, 10 Sep 2005 23:11:00 PST

( from http://www.rxpgnews.com ) A national consultation on NHS-funded infertility treatment aimed at improving equality of access across Scotland was launched today.

The consultation, which runs until December 8, will examine:

* Clinical criteria - e.g should the (38 year-old) age limit for women to receive infertility treatment be increased?
* Social criteria - e.g should priority for treatment be given to couples who have no other children living in the home?
* Other issues - e.g what impact would widening the access criteria have to NHS waiting times for treatment?

Deputy Health Minister Lewis Macdonald said:

"Infertility affects roughly 75,000 couples in Scotland. Demand for NHS-funded assisted conception has increased and we need to ensure there is equal access for all regardless of where people live in Scotland.

"We have national criteria for accessing infertility treatment provided by the NHS, and Boards are expected to follow this guidance. However I am aware there is still some variation among Boards regarding the provision of infertility treatment, and that not all Boards are following this guidance as they should.

"I also know there are differences in criteria and waiting times for the most specialist treatments within the four specialist centres in Scotland. This is why we are launching a national consultation today, with the aim of securing equity of access to high quality infertility services across Scotland.

"We want to seek views on what changes are necessary to improve access to assisted conception treatment. This consultation is mainly aimed at NHS Boards and service providers so we can examine the issues that are preventing the implementation of consistent access criteria. We also hope to find out why there are discrepancies in waiting times across different areas in Scotland.

"I am also keen to hear from people who use infertility services and other interested groups. We are asking questions to gauge people's views on issues that may affect access to infertility treatment for women in Scotland like age or whether their partner has a child who lives in their home.

"We are consulting widely in the hope that we can secure an equal service for all in Scotland."

Infertility is defined as a 'failure to conceive after regular unprotected intercourse for one or two years".

There has been no real increase in prevalence of infertility, but evidence shows that more couples are seeking fertility assistance.

The Expert Group on Infertility Services in Scotland (EAGISS) set out recommendations for national criteria for NHS-funded infertility treatment in 1999. It was hoped the publication of the report would provide equity of access to service and treatment. In 2000, the Chief Medical Officer asked Boards to adopt this framework.

EAGISS criteria states a woman should be less than 38 at the time of treatment. It also states that eligible women should be entitled to a maximum of three assisted conception cycles.

Following one cycle of treatment, a couple should be able to undergo successive cycles within a timeframe of their own choosing.

However more recently, guidelines produced by NICE in 2004 state the age limit for women to receive infertility treatment should be 40 and that cycles of treatment should be increased to five. Clinicians, NHS Boards and service users will be consulted to find out what criteria should apply in Scotland.

Access to infertility treatment is not currently covered by the waiting times guarantee as it is measured separately from national waiting times standards. Following this consultation on access criteria for NHS-funded infertility services, the need to apply a target waiting time for tertiary infertility treatment will be considered.

A woman's age is the single most important variable that affects the success of conception. Women aged 35 to 39 have a 50percent less chance of conceiving spontaneously than women aged 19 to 26 years. Approximately 30 per cent of infertility is unexplained and the rest can be contributed to ovulatory failures, low sperm count or quality, tubal damage or conditions such as endometriosis. Lifestyle factors such as diet, smoking and substance misuse also influence a couple's chance of successful conception.

British drinking: a suitable case for treatment?

Sat, 10 Sep 2005 00:10:00 PST

( from http://www.rxpgnews.com ) The Governments strategy on alcohol will do nothing to tackle problem drinking in Britain, because it embraces the industrys diagnosis and preferred remedies, says an editorial in this weeks BMJ.

Current policy accepts the industry view that those who endanger their health through drinking and take part in anti-social behaviour are a minority, and should be targeted through education campaigns, treatment, better policing and self-regulation from the industry.

But these are exactly the policies least likely to reduce problem drinking according to the evidence, says the author.

The rise in drinking in Britain is probably the result of lowering the cost of alcohol while increasing its availability, mixed with heavy promotion of alcohol in British cities, he argues.

Alcohol abuse is now thought to cost the British economy £30bn a year, and alcohol dependency rates in the UK are amongst the highest in Europe, at 7.5% of British men and 2.1% of British women.

The most effective policy to reduce problem drinking is to increase taxes on drinks with the highest alcohol concentration a policy which the Government has snubbed, rejecting the views of the worlds leading researchers on alcohol.

In Australia, a country with liberal licensing laws, alcohol consumption has fallen per head by 24% in twenty years, while at the same time rising by 31% in the UK. A policy of lowering taxes on low alcohol drinks, reducing the drink-driving limit to 0.05% (rather than the UKs 0.08%) with vigorous enforcement, has been effective. Low alcohol beer now accounts for 40% of all beer consumed in Australia.

The two alcohol reduction treatments evaluated in this weeks BMJ motivational enhancement treatment and social network therapy are cost-effective, and ministers should also look at investing in these to increase access for those affected.

If the Government wants to prevent a worsening epidemic of alcohol misuse, it should replace its current policies with some that have a chance of reducing (rather than merely preventing further rises in) alcohol related harm, concludes the author.

Latest Government Report On Health Inequalities Hushed Up

Sat, 10 Sep 2005 00:10:00 PST

( from http://www.rxpgnews.com ) Researchers in this weeks BMJ accuse the government of suppressing their latest report on health inequalities, showing that the gap between the rich and poor in England has continued to widen under New Labour.

They argue that the report appeared at a time when the responsible minister was on holiday and her deputy unavailable - curiously reminiscent of the deliberately covert release of the Black Report on an August Bank holiday Monday in 1980. Labour, then in opposition, was incensed by this cover up attempt.

Even stranger, say the authors, the press release referring to the report deflected attention from its main message by focusing on the introduction of health trainers. The scientific endorsement of the report was also at odds with its key findings.

To dismiss health inequalities as minimal is surely misleading when even the most conservative measures show that infants in poorer areas of England are at least twice as likely to die in their first year of life than those in more affluent areas, they write.

The hushed up release of this report raises fears that the bold statements and unprecedented promises of Labours first years in power (for example, the pledge to eradicate child poverty within a generation) have now been wholly overtaken by the individualistic rhetoric of behavioural prevention and choosing health and its three principles of informed choice, personalisation, and working together, say the authors.

They suggest that rather than focusing on changing the health choices of millions of individuals, the government should think more about a healthier way to govern and at last choose to use the tax and benefit systems to kerb growing social inequalities in income and wealth.

PCT patient survey is proof of high standards in primary care services

Fri, 09 Sep 2005 15:51:00 PST

( from http://www.rxpgnews.com ) The NHS Confederation, which represents 93 per cent of primary care trusts (PCTs), says that the key findings of the Healthcare Commissions PCT patient survey are good news for NHS patients.

Patients overall impressions of their experiences of primary care services are broadly positive and PCTs have made clear improvements in meeting the Governments waiting times targets.

The Healthcare Commissions survey highlights that 74 per cent of patients are seen within the Governments waiting time target of 48 hours for a GP appointment - an increase from 65 per cent in 2003.

Dr Gill Morgan, Chief Executive of the NHS Confederation, said: the Healthcare Commissions PCT patient survey shows that standards continue to improve in primary care services and patient satisfaction is improving.

Most patients accessing primary care services are happy with the care that they receive, for example 92 per cent said that they were always treated with dignity and respect by their GP.

Although largely positive, the survey highlights room for improvement, especially with regards to GP access and registering with an NHS dentist.

Dr Gill Morgan said: of course it is not right that 12 per cent of patients surveyed could not get a GP appointment within 48 hours but the flipside of the coin is that 88 per cent are able to see their GP within two days when they really need to.

It is clear that the 48-hour target is still having unintended consequences in a minority of areas but many PCTs and GP practices have found ways to deal with this and now is the time for this learning to be shared.

We welcome todays announcement by the Department of Health that NHS patients and staff will be asked for their views on advance booking of GP appointments as part of the White Paper public consultation and our members will be feeding their experiences of what works into the consultation.

And PCTs will clearly have a key role to play in the tighter checks on the 48-hour target which have also been announced by the Department of Health today.

The PCT patient survey identified that 69 per cent of patients who were not registered with an NHS dentist would like to be while 75 per cent of those treated by an NHS dentist said they definitely had confidence in their dentist.

Dr Gill Morgan said: Access to NHS dentistry is clearly an issue for patients and we hope that the increased funding being devoted to training more dentists will ensure that access to NHS dentistry improves over time.

However, it is positive that 75 per cent of patients who saw an NHS dentist were happy with the care that they received.

NHS Confederation calls for debate on NHS drug costs

Fri, 09 Sep 2005 15:49:00 PST

( from http://www.rxpgnews.com ) The NHS Confederation is calling for an urgent debate on rapidly increasing NHS drug costs following todays Audit Commission report about the financial implications of implementing NICE guidance on new medication and surgical procedures.

Dr Gill Morgan, Chief Executive of the Confederation which represents more than 90% of NHS organisations, says: The annual cost to the NHS of complying with NICE guidance on new drugs and procedures is £800 million, but thats just 10% of the total NHS drugs bill.

Prescribing drugs cost the NHS £8 billion last year, an increase of 46% since 2000, and this rapid rise in the medication bill is a major cause of the financial pressures currently facing NHS organisations.

Extra investment in the NHS is growing by an average of 7.4% a year in real terms but drug costs are rising even faster.

That is why 85% of the NHS organisations who were questioned by the Audit Commission for its report said there wasnt enough funding available for them to fully implement NICEs guidance on new drugs and procedures.

The Audit Commission acknowledges that the NHS is not given specific funding to implement NICE guidance and that comprehensive implementation of all guidance across the NHS may not be possible as there may be competing priorities for funding locally.

Dr Gill Morgan says: Scientific advances mean that new and often expensive drugs are recommended for NHS use, which is clearly good news for patients and clinicians, but we urgently need a proper debate about how these drugs can be funded.

Weaknesses in NHS financial management, rather than cost, are identified by the Audit Commission as the major barrier to implementation of NICE guidance.

Dr Gill Morgan says: Financial planning and management can always be improved and we welcome NICEs proposals to help NHS organisations.

NICE guidance is published throughout the financial year and so PCTs are in the difficult position of trying to second guess NICEs likely decisions when they are planning their annual budgets and set aside money they anticipate will be sufficient to implement their guidance.

If the cost of implementation is greater than anticipated or if NICE issues unexpected guidance, thats when PCTs face financial issues.

Cancer deaths decrease in Scotland

Thu, 08 Sep 2005 01:41:00 PST

( from http://www.rxpgnews.com ) Figures out today show that more people in Scotland are living with and beating cancer.

Taking age into account, cancer mortality has decreased by 12 per cent among men and six per cent among women in the last 10 years.

Of the cancers that cause the most mortality, the largest fall for men was in lung cancer - 27 per cent. For women that largest fall was in stomach cancer - 33 per cent.

The number of cancer cases (excluding non-melanoma skin cancer) has increased between 2001 and 2002 from 25,788 to 25,999.

Health Minister Andy Kerr said:

"With some of the best treatment in the world, more and more Scots are living with and beating cancer.

"The figures out today show that while the number of new cancer cases increased between 2001 and 2002, fewer Scots are dying from the disease.

"We are on track to achieve our target of reducing premature cancer deaths by 20 per cent by 2010.

"Cancer treatment in Scotland is as good as anywhere in the world - with new drugs and state of the art radiotherapy equipment in all of our cancer centres.

"It is particularly pleasing to see the drop in lung cancer deaths among men. The biggest cancer killer among men is still lung cancer.

"We have not seen the same decrease in lung cancer rates for women. This is largely due to the greater reduction in smoking among men compared to women over the past 30 years.

"Scotland will be the first part of the UK to become completely smoke free in all enclosed public places from 26 March 2006.

"Our country's health and productivity will improve and the incidence of smoking-related diseases will fall."

But within this positive picture, the figures also highlighted the need for continued action on skin cancer. Although melanoma of the skin is only the 10th most common cancer in men, male deaths from this cancer over the last 10 years increased steeply by 31 per cent to 93 in 2004. Melanoma now accounts for 1.2 per cent of male and 0.8 per cent of female cancer deaths.

Mr Kerr said:

"It is disappointing that mortalities from malignant melanomas have increased. The numbers are low but more can be done to address this cancer.

"We know that sun exposure is a major risk factor for skin cancers including malignant melanoma even in a country with Scotland's climate

"That's why we invest in the Cancer Research UK national skin cancer prevention campaign 'SunSmart'.

"We also fund NHS Health Scotland, which has a range of materials to educate people about the dangers of skin cancer.

"Awareness raising campaigns aimed at highlighting the risk of unnecessary exposure to the sun are also being undertaken by NHS Boards across the country.

"We have invested £150 million in cancer services since 2001 and we are now beginning to see real improvements and benefits for patients.

"We have increased capacity to treat patients with cancer. There are now 300 additional staff including doctors, nurses and other health professionals delivering treatment and care across Scotland.

"In addition, we are investing £50 million over three years so that by the end of 2007 no patient waits more than nine weeks for a routine MRI or CT scan. The first fruits of this initiative - a £3 million full MRI service from Forth Valley - are already visible and there is more to come.

"Faster detection and treatment will mean that in future, even more people will be able to beat cancer."

The Executive and other UK health departments fund the Cancer Research UK annual national skin cancer prevention campaign "SunSmart". SunSmart aims to increase skin cancer awareness and methods of effective sun protection through information provision via website and printed resources for professionals to use in local health promotion . The campaign reached 76 per cent of the UK population in 2004.

'Guaranteed' appointments with your GP

Thu, 08 Sep 2005 01:31:00 PST

( from http://www.rxpgnews.com ) Patients will be guaranteed the choice of being able to book an advance appointment with a GP under measures to improve access to family doctor services announced today by Health Minister Lord Warner.

The move to guarantee advance booking should allow patients to be able to fit in seeing a GP around their daily lives and remove the frustration of having to call their practice back on the day they require an appointment.

Checks will also be tightened to ensure that achievement of the 24/48 hour access target, which allows patients to book a GP appointment within two days, is a true reflection of patient experiences.

The strengthened checks will include tighter monitoring by Primary Care Trusts (PCTs) by varying monthly survey dates, a sample check of PCT data and introducing more patient surveys to ensure that existing tests reflect patients experiences.

Lord Warner said:

The Healthcare Commission survey confirms that NHS care outside of hospitals is improving. It shows improvements in GP access when necessary compared with 2004 and very high levels of satisfaction with the visit to the GP. However, the commissions survey also brings to light areas where further improvement is needed.

It is unacceptable that some practices are still not allowing patients to book an advance appointment with a GP. Patients rightly expect to see a GP at a convenient time more than two days in advance.

They should not face the frustration of having to call their practice back on the day they want an appointment. Practices must already offer quick access to a GP, but we will move to guarantee patients more flexible access if they want to book ahead.

The 24/48 hour access target is a key priority and has by any measure led to patients being able to see a GP more quickly. There is absolutely no justification for this target being used as an excuse for an inflexible appointments system. We recognise patient surveys show a gap between patient experience and the departments data. Our aim now is to make improved access more real for everybody.

We will make our system of checks more robust to ensure achievement of the target truly reflects the experience of patients across the country.

Whilst official figures show a steady reduction in the percentage of patients who are being denied the choice of booking ahead, some GP practices are still operating restrictive booking systems preventing patients from booking an appointment with a GP more than two days ahead. Instead, patients are often required to contact their practice nearer the time.

The department will now ask patients and NHS staff what timescale they want to see in terms of a national guaranteed advance booking period as part of the Your Health, Your Care, Your Say White Paper public consultation process. This will enable contract improvements to be agreed.

Virtually all patients can see a GP within 2 working days or a primary care professional under current measures of achievement against the 24/48 hour target.

RxPG News : UK

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NICE asked to develop guidance on new treatments for breast and lung cancer, Crohns disease, ulcerative colitis, obesity and rheumatoid arthritis.

Is doctors' pay responsible for the financial crisis in the NHS ?

Britain plans medical hub to meet India, China challenge

Obese patients in Britain to dance

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Over a million in Britain could live beyond 100

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Health and Social Care White Paper shows good intentions

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Cutting street prostitution will threaten health of sex workers

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Denying Joint Replacements Based On Prejudice

NHS needs to do more to provide need based health care

UK's Ageing Population Will Impose Huge Healthcare Burden

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NHS waiting list falls below 800,000 for the first time

Reforms are threatening the future of district general hospitals

New NHS patient choice policies take no account of limited resources

New Guidelines For Resuscitation (CPR) Published By The European Resuscitation Council

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7275 new HIV cases reported last year in UK

Poor diet costs UK health service £6 billion a year

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Professor dispels bird flu paranoia

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Meeting MRSA Targets Largely Down To Chance, Says Expert

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NICE asked to develop guidance on new treatments for breast and lung cancer, Crohns disease, ulcerative colitis, obesity and rheumatoid arthritis.

Latest Government Report On Health Inequalities Hushed Up