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Nearly half the population takes prescription drugs

Half of women and 43% of men in England are now regularly taking prescription drugs- according to the Health Survey for England.

Nearly half the population takes prescription drugsThe report by the Health and Social Care Information Centre (HSCIC) showed an average of 18.7 prescriptions per person in England in 2013 with the annual cost to the NHS was in excess of £15 billion.

All the figures exclude contraceptives and smoking cessation products.

Nearly a third of prescriptions were for cardiovascular disease with more than 65 million prescriptions for tackling high blood pressure, heart failure or cholesterol levels.

Simvastatin – which lowers cholesterol – was the single most prescribed item with 40 million prescriptions.

Dr Jennifer Mindell, one of the report’s authors at University College London, said: “This is the first nationally-representative study to report on the use of prescribed medicines taken by people in the community, not just those within the healthcare system.”

“That half of men over 65 are taking cholesterol-lowering medicines reflects the high risk of cardiovascular disease in this group.

“Stopping smoking, being a healthy weight, eating more vegetables and fruit, and being physically active reduce people’s risk of these diseases, for people who want to avoid taking medicines.”

This study focuses on the drugs patients say they are taking rather than the number of prescriptions written by a GP as up to half of such prescriptions are either not taken or not taken as recommended.

But figures for community prescribing – which include GPs and dentists, but not hospitals – show:

  • In Wales there were 74 million prescriptions in 2013.
  • In Scotland there were 99 million prescriptions in the financial year 2013-14.
  • In Northern Ireland there were 35 million prescription in 2010.

Analyses of similar data sets for England shows community prescribing, including contraceptives, increased from 650 million in 2003 to more than 1,000 million in 2013.

Antidepressants were taken by more than one in 10 women – double the figure for men.

The drugs were most commonly taken by middle-aged women and those from deprived areas – 17% of the poorest women took antidepressants compared with 7% of the richest.

Dr Sarah Jackson, at University College London, commented: “It’s well known that rates of depression are much higher among women than men, so I am not surprised to see that antidepressant use follows the same pattern in this study.

“People with depression are less likely to be in regular employment, and people who are unemployed or in low paid jobs are more likely to have depression.”

Overweight and obese people were more likely to need prescription drugs. More than half of severely obese people in England reported taking at least one prescribed medicine and a third took at least three.

Obesity is often associated with high cholesterol, high blood pressure, joint pain and depression. Lifestyle changes are always recommended in the first instance, but medicines can help to address the symptoms and this study shows that medicine use increases steadily with body mass index.

NHS A&Es use locums in quarter of senior posts

Almost a quarter of NHS A&E departments in hospitals in England are filled with agency doctors or locums.

NHS AnEs use locums in quarter of senior postsThe reliance on freelance staff to fill senior posts costs hospital trusts more than £120 million in a year.

Some trusts have far higher rates of vacancies filled by locums, with three trusts running at rates of more than 50% and the highest at 69%.

The information comes from a Freedom of Information request made by the BBC.

Locum or agency doctors are routinely used to plug gaps in rotas, not just in A&E departments but generally across the health service.

But the BBC has found that many hospitals are routinely using locums to fill the two most senior roles in Emergency Departments; consultants who run the teams and senior registrars.

They approached 142 hospital Trusts in England that run large Emergency Departments, known in the NHS as Type 1 A&Es. Of those, nearly 90% responded to our request for information about how many of the senior roles were filled with locums, and how much that was costing.

Given a shortage of consultant and senior registrar grade doctors working in emergency medicine the use of locums is an expensive but unavoidable way of making sure A&E departments are properly staffed.

Locums offer hospitals a flexible way of managing their workforce in response to demand.

When drawn from other specialties or departments they can also help spread best practice and the latest knowledge.

But A&E consultant Prof Suzanne Mason, of the College of Emergency Medicine, the professional body for senior A&E doctors, says there are significant downsides to relying so heavily on locums.

“They often will provide different levels of care and perhaps not such high-quality care as we would come to expect as a specialty. That may be due to a lack of knowledge of the local systems but it may also just be due to just a general lack of clinical experience.”

But at present hospitals have little choice over their use of locums, according to Bill McMillan from the NHS Employers organisation.

“Tonight at A&E you need to be able to deal with the patients who turn up. You can’t say to them, ‘You’re in the wrong place, we can’t do anything for you.’

“So hospitals are obliged to try and fill those rotas as best they can with the best quality people they can. You can hardly blame the patients for turning up. You always get a certain amount of flexible workforce in any industry and the health service is no different.

“The question is making sure we recruit locums who are also of the best quality, doing the work we are asking of them, paying the right pay for that. Those are things I think hospitals find really difficult at the moment.”

A spokesperson for the Department of Health in England said: “A&E doctors are at a record high in the NHS, with 1,187 more than in 2010, including 420 more consultants.

“We’ve given the NHS £700m this winter to help it respond to the pressure of an ageing population with more doctors, nurses and beds, and plans in every area to manage extra demand.”

UK air pollution causing deadly public health crisis

The Environmental Audit Committee argues air pollution is a “public health crisis” causing nearly as many deaths as smoking.

UK air pollution causing deadly public health crisisThe committee suggested a scrappage scheme for diesel cars to cut emissions as there are an estimated 29,000 deaths annually in the UK from air pollution.

Nitrogen dioxide is known to cause inflammation of the airways, reduce lung function and exacerbate asthma. Particulate matter – tiny invisible specks of mineral dust, carbon and other chemicals – are linked to heart and lung diseases as well as cancer.

Some particulate matter lodges in the lungs, while the finest particles can enter the bloodstream, risking damage elsewhere in the body.

Joan Walley, the committee chairwoman, said “There is a public health crisis in terms of poor air quality. There are nearly as many deaths now caused by air pollution as there are from smoking, so the main thing is we stop a new generation of children being exposed.”

She said government “should make it impossible” for new schools, care home or health clinics to be built in pollution hotspots. She added that “well over a thousand” schools were already near major roads and that it “made sound economic sense” to filter the air coming into the buildings.

The committee’s report says traffic is responsible for 42% of carbon monoxide, 46% of nitrogen oxides and 26% of particulate matter pollution.

It said government had promoted diesel vehicles as they produced less of the greenhouse gas carbon dioxide. But the committee said diesel was now seen as “the most significant driver of air pollution in our cities”.

They called for government to pay for diesel drivers to upgrade their engines or for a national scrappage scheme to take the most polluting vehicles off the road.

Other measures suggested include:

  • The Met Office and BBC producing high pollution forecasts alongside ones for pollen and UV.
  • A national plan for “low emission zones” to tackle heavily polluting vehicles, like the one in London.
  • Changes to fuel duty to encourage low nitrogen dioxide vehicles as well as low carbon dioxide.
  • Financial incentives for alternative fuels.
  • Encourage walking and cycling as the “ultimate low emission” option

Dr Ian Mudway, a lecturer in respiratory toxicology at King’s College London, told the BBC: “The evidence is there. The 29,000 figure is very solid, so really it is a case of acting.

“But it is a strange one, because it’s their third [report] in five years and it is an attempt to get the government to do anything.”

The British Lung Foundation said the recommendations “may seem drastic”, but air pollution was so bad they were necessary “to protect the nation’s health.  Our dirty air will simply not clean itself, and this issue is one that will, without the government’s intervention, continue to impact on current and future generations,” said Dr Penny Woods, the charity’s chief executive.

Asthma UK said air pollution increased the risk of a life-threatening attack and “urgent and concerted action” was needed to bring pollution levels down.

Chief executive Kay Boycott said: “In the short term some of the measures recommended in this report, such as the publicising of high air pollution forecasts, could help people with asthma know in advance if they should seek advice from their GP or asthma nurse.”

Simon Gillespie, the chief executive of the British Heart Foundation, said: “The government cannot continue to ignore this issue. Enough is enough. The government must act on these recommendations quickly if we are to improve the quality of the air we breathe and protect the nation’s heart health.”

NHS surgery restriction for smokers and obese

The NHS in Devon is to deny routine surgery to smokers and the morbidly obeseunless they quit smoking or lose weight.

NHS surgery restriction for smokers and obesePatients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.

The NHS in Devon has a £14.5 million deficit and says the cuts are needed to help it meet waiting list targets. The measures were announced the same day government announced an extra £2 billion of annual NHS funding.

The Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) organises most NHS treatment in the area.

It announced a range of cost-cutting measures yesterday including only providing one hearing aid, instead of the normal two, to people with hearing loss. Shoulder surgery will also be restricted.

In November, the CCG said it would take “urgent and necessary” measures to prioritise major treatment. That included delaying hip and knee operations for the morbidly obese, but Wednesday’s announcement applies to all routine procedures.

NEW Devon CCG said it would not restrict IVF treatment or caesarean sections carried out on medical grounds.

A statement said all the decisions were “interim commissioning positions” and would require further consultation. Patients with a date for surgery will not be affected but will be offered weight management or quit smoking support.

Dr Tim Burke, Chair of NEW Devon CCG, said: “All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.

“We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case.”

NEW Devon CCG said it would announce another round of cost-cutting measures “in due course”.

“We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them,” said Dr Burke.

“The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that.”

In a statement the Royal College of Surgeons said it was “concerned” by the move and warned the region was merely storing up “greater pressures” for the future.

It said: “The need for an operation should always be judged by a surgeon based on their clinical assessment of the patient and the risks and benefits of the surgery – not determined by arbitrary criteria.”

“Losing weight, or giving up smoking is an important consideration for patients undergoing surgery in order to improve their outcomes, but for some patients these steps may not be possible.”

“A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable and too rigid a measure for ensuring patients receive the best care possible.”

Seasonal Affective Disorder- SAD winter blues

Seasonal Affective Disorder (SAD) describes a type of depression with a seasonal pattern, usually occurring during winter.

Seasonal Affective Disorder- SAD winter bluesA lack of light is thought to affect the part of the brain that rules sleep, appetite, sex drive, mood and activity levels. Patients experience lethargy and a craving for sugary snacks.

In 1984 psychiatrist Norman Rosenthal first used a term that changed the way people thought about winter. He included the term in a paper he co-wrote following a move from the warm climate of Johannesburg in South Africa to the north-eastern US, with its more severe winters.

“It took about three years of seeing the winters alternating with the summers,” Rosenthal, who lectures at Georgetown University in Washington, says. “It was a sort of given that people were grouchy in the winter, not so happy.”

But the work of Rosenthal and others established that there was more to it than that for some people. The cultural idea of many people being less happy in winter was not to obscure the fact that for a smaller group of people something more serious was happening. “It becomes a medical thing when it has consequences in people’s lives, like not being able to get to work or their quality of life going down the drain,” says Rosenthal.

SAD has been accepted as a condition by many. The NHS offers advice, And it has also gained significant currency in popular culture – with the term being widely used by laymen.

In the UK the term was first used by the Times in 1988, in a piece highlighting a link between afternoon shift workers and a lack of daylight. Since then it has gradually filtered into common parlance. According to Google Trends the term is still much more commonly searched for in Canada and the US, with the UK third.

Rosenthal admits the acronym, which suggests the kind of feeling sufferers get, was chosen to make a maximum impact on the media. It seemed to work.

Rosenthal suggests that 6% of people in the US suffer from the most acute form of SAD and that another 14% get winter blues. A study found the severest form affected just 1.5% in the southern state of Florida, which averages seven hours of sunshine a day even in winter, rising to almost 10% in the northern state of New Hampshire, which gets just four hours daily in November and December.

Rosenthal advocates the use of electric lights, among other methods, to offset the effects of SAD, including in the UK, whose population spends a “long time in gloom” in winter, as much because of large amounts of cloud as the shortness of the days.

Light therapy is long established, the ancient Greek physician Hippocrates advocating healing properties in exposure to the sun. From the late 1800s heliotherapy, or phototherapy, became popular. Some tuberculosis-infected children from slums, where little sunlight was available, were taken to retreats where they could spend as much time outdoors as possible.

Light treatment has been used for other ailments. In 1903 Faroe Islands physician Niels Ryberg Finsen was awarded the Nobel Prize for inventing an ultraviolet lamp for tuberculosis of the skin.

But in 2009 the National Institute for Health and Care Excellence ruled there wasn’t enough evidence to justify the NHS in England spending money on this type of treatment for depression. The guideline is currently under review.

Rosenthal says a lack of direction from above means doctors are not asking patients the right questions, such as whether the symptoms they describe are seasonal or year-round. “I’ve just come to terms with the limits of my ability to persuade people about SAD,” he says. “People have to find out about it to some extent on their own.”

Osborne gives NHS £2 billion for extra winter funds

George Osborne has announced that he will add an extra £2 billion into the NHS in his Autmn Statement this week.

Osborne gives NHS £2 billion for extra winter fundsThe chancellor said it was not a “one off” but what he called a “down payment on a long term NHS plan”. There would be no “unfunded giveaways”, he said, adding he could make the pledge because the economy was strong.

Mr Osborne’s pledge – to be officially announced in his Autumn Statement on Wednesday – comes after NHS bosses warned of a need for an extra £2 billion funding, to cope with the immediate, unprecedented pressure on NHS budgets.

The chancellor told BBC One’s Andrew Marr Show “Because we have a strong economy and we’ve got the public finances under control, we can afford to put £2 billion into the frontline of the NHS across the United Kingdom.

“I can tell you we can go further and use those fines that have been paid by the banks for a permanent improvement in GP services. This is a down-payment on the NHS’s own long-term plan and it shows you can have a strong NHS if you have a strong economy.”

Further details are expected on Wednesday when Mr Osborne will update Parliament on his tax and spending plans, based on the latest predictions for the economy.

He rejected claims public services would suffer if funding was cut further and said he would outline how the UK would “stay the course to prosperity”.

“We shouldn’t face this false choice of either bankrupting the country or having decent public services,” he said.

But he added that “difficult decisions” might lie ahead on welfare – possibly freezing working age benefits, although he appeared to rule out cuts to pensioners’ benefits.

Health Secretary Jeremy Hunt will make a statement on Monday, in which he is expected to explain where the money is coming from.

About £1.3 billion is thought to be new money, from savings in other departments, while around £700 million will come from non-NHS parts of the Department of Health’s budget.

It is understood that around £1.7 billion of that will go to NHS England, with the remainder going to the rest of the UK.

For months, NHS leaders have been warning politicians about a growing shortfall in their budget. Today the message from the chancellor was that he’s heard their call.

The Liberal Democrats are keen to take credit, saying they’ve fought hard to secure it. Labour say they want to go further and have pledged £2.5 billion a year to be spent on the NHS, on top of today’s announcements, paid for by a so-called mansion tax and other tax crackdowns.

NHS funding is going to be one of the key battlegrounds ahead of the next election but with figures due out this week expected to confirm that government borrowing is not coming down in line with the Treasury’s plans, all parties will face tough questions about how they can increase spending without increasing borrowing yet further.

Mr Hunt will also announce that the government is committed to implementing a five-year plan – NHS Forward View – unveiled by six national bodies last month. Many of the measures put forward are designed to curb the rise in hospital admissions and the impact of the ageing population.

The plans involve increasing spending on the health service by £8 billion in real terms over the next Parliament.

The NHS is a huge political issue with all the main parties pledging extra money in the future.

NHS U turn over cancer drug trial funding

Hospital chiefs and cancer research leaders had been warned that funding for patients taking part in drug trials might be cut- but these were now “incorrect” according to NHS England.

NHS U turn over cancer drug trial fundingExcess treatment costs (ETCs) cover the care of patients involved in drug trials which are not already covered by the pharmaceutical or academic research body involved.

Traditionally the NHS has covered these costs for patients who wish to take part in the trials.

The letter from the head of specialised commissioning at NHS England London Region, dated 21 November, was written to hospital trust medical directors and leaders in the field of cancer research.

NHS England statement

It said: “I am sure you will appreciate that in the current financial climate, the primary call for resources is to support clinical service provision for established service priorities.

“To this end, the NHS England London Region Area Team is unable to identify any uncommitted resources which could be used to support ETCs for clinical trials. This is the national position which is being adopted, in respect of all current requests for ETCs.

Cancer Research UK, which is currently supporting drug trials involving about 35,000 patients, said it had concerns.

Prof Peter Johnson, Cancer Research UK’s chief clinician, said: “The partnership between the NHS and organisations which fund research, such as Cancer Research UK, has been a great success story.”

“We lead the world in being able to offer patients participation in clinical trials, but all this will be undone if the NHS cannot keep its side of the bargain.”

A spokesman for NHS England said: “We strongly support medical research and we will fund excess treatment costs in line with the national rules, so these local letters were incorrect and are being withdrawn.”

A Department of Health spokesman said: “Research in the NHS is vital and has this government’s strong support. We have asked NHS England to set out how they will deliver their objective to promote research and ensure the payment of excess treatment costs.”

Delayed NHS hospital discharges reaches record high

Delays in discharging patients ready to leave NHS hospitals rose to record levels last month official figures show.

Delayed NHS hospital discharges reaches record highPatients spent a total of 143,000 days in hospital when they should have been sent home.

In a further sign of growing pressure on the system, the number of emergency admissions also reached record levels and indicate a system under stress which is unable to free up beds because of problems arranging suitable support from care workers or district nurses.

The exact total number of “days delayed” rose to 143,118, the figure for October 2013 was 123,852.

Experts say the true situation is even worse because a lot of delays are not formally counted.

Pressures are likely to grow as winter approaches and last week there were nearly 110 emergency admissions – another record high.

Hospital bed occupancy rates are also high due to more patients being admitted and problems in discharging those who are ready to leave.

The Department of Health said there were plans in place to manage the extra demand  and that planning for winter had been underway since June.

“We’ve given the NHS an extra £700 million to buy thousands more doctors, nurses and beds this winter. NHS England has ensured there are plans in every area to manage the extra demand.”

There was a slight improvement last week in the number of patients seen and treated in A&E within four hours compared with the previous seven days.

But the latest figure, 93.9%, still falls short of the official target of 95%.

Richard Murray, the director of policy at the health research group The King’s Fund said this was a particular problem for mental health services. He expressed concerns about how the NHS would cope in the coming months.

“You do wonder how much further the situation will have to go before we have a classic winter crisis,” he said.

Obesity costing UK economy same as smoking

New research shows that the cost of obesity to the UK economy is now the same as smoking.

Obesity costing UK economy same as smokingThe worldwide cost of obesity is about the same as smoking or armed conflict and greater than both alcoholism and climate change new research has suggested.

The McKinsey Global Institute said obesity cost £1.3 trillion, or 2.8% of annual economic activity – it cost the UK £47 billion.

Some 2.1bn people – about 30% of the world’s population – were overweight or obese, the researchers added.

They said measures that relied less on individual responsibility should be used to tackle the problem.

The report said there was a “steep economic toll”, and the proportion could rise to almost half of the world’s population by 2030.

The financial costs of obesity are growing – for health care and more widely in the economy. By causing illness, obesity results in working days and output lost.

The researchers argued that a range of ambitious policies needed to be considered and a systemic rather than piecemeal response was essential.

The report said the right measures could save the UK’s NHS £760 million a year

A person is considered obese if they are very overweight with a high degree of body fat.

The most common way to assess if a person is obese is to check their body mass index (BMI), which divides your weight in kilograms by your height in metres squared. If your BMI is above 25 you are overweight. A BMI of 30-40 is considered obese, while above 40 is very obese. A BMI of less than 18.5 is underweight.

“These initiatives would need to draw on interventions that rely less on individual responsibility and more on changes to the environment,” the report said.

If the right measures were taken there could be long-term savings of £760m a year for the UK’s National Health Service, it added.

The initiatives assessed in the report include portion control for some packaged food and the reformulation of fast and processed food.

It said these were more effective than taxes on high-fat and high-sugar products or public health campaigns. Weight management programmes and workplace fitness schemes were also considered.

The report concluded that “a strategy of sufficient scale is needed as obesity is now reaching crisis proportions”.

The rising prevalence of obesity was driving the increase in heart and lung disease, diabetes and lifestyle-related cancers, it said

The report was produced by McKinsey Global Institute, the business and economics research arm of consultancy firm McKinsey & Company.

Doctors GPs surgeries ranked by risk

Doctors’ GPs surgeries are now being ranked by the health watchdog the CQC.

Doctors GPs surgeries ranked by riskThe Care Quality Commission (CQC) has ranked almost every GP surgery in England in terms of risk of providing poor care and whilst the majority are of low concern, 11% have been rated in the highest risk band by the CQC.

Many of the elevated risk practices had possible issues with appointments, mental health plans, and cervical cancer screening.

The watchdog said the register did not necessarily indicate poor GP surgery performance.

“It is important to remember that the data is not a judgement, as it is only when we inspect we can determine if a practice provides safe, high-quality and compassionate care,” said CQC chief inspector of general practice Prof Steve Field.

“The data is a further tool that will help us to decide where to inspect and when,” he said.

The health watchdog ranked 7,276 practices out of the total 7,661 in England, and placed 864 practices in the “highest concern” category.

In about 3% of high-concern practices, patients stated they had difficulties in getting an appointment to see a GP or nurse.

However, surgeries that were not at high risk also saw patient dissatisfaction with appointments. In about one sixth of practices, patients had a limited ability to get appointments and services, the CQC said.

Potential issues in elevated-risk practices also included the provision of care plans for people with schizophrenia, bipolar disorder or other psychoses, and potentially low numbers of women aged 25 to 64 who had received a cervical screening test in the past five years.

The regulator used 38 different indicators to calculate the level of risk. Practices were graded in six bands, with Band One being the highest concern, and Band Six the least risky.

Measures including patient experience, care and treatment were taken into account, based on “sources including surveys and official statistics”, the CQC said.

Between April and September 2014 the CQC inspected 336 GP surgeries. At the start of October a new inspection regime came into force, and CQC hopes to have inspected all surgeries by March 2016.

The CQC will look at whether surgeries are safe, effective, caring, responsive, and well-led.

Risk indicators include:
• Unnecessary A&E admissions
• High use of antibiotics
• Coronary heart disease incidence
• Emergency cancer admissions
• Not hitting flu vaccination targets
• How sleeping pills are prescribed
• Dementia diagnosis rates
• Whether care plans for psychoses are in place
• Cervical screening test numbers
• Diabetes care
• Patients being overheard in reception
• Ability to get an appointment

The doctors gps surgery results rankings are here on the QCQ webite