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Cameron promises seven day health services

All hospitals in England will provide “a truly seven day NHS” health service under a future Conservative government.

Cameron promises seven day health servicesMr David Cameron said that more hospitals must provide top-level treatment at the weekend, starting with emergency care.

In a wide ranging speech, he said his party’s message to various sections of the population was: “We’re with you.” This spring forum is about fighting back against Labour on the NHS.

The Conservatives are committing to providing full weekend hospital care in England – in line with the NHS’s own five year plan.

This is an attempt to try to neutralise the NHS and enable the Conservatives to return to what they want to be talking about – the economy.

Speaking at the forum in Manchester, Mr Cameron warned that figures showed patients were “more likely to die” if they were admitted at weekends.

According to the Conservatives, official studies suggest mortality rates for those admitted on Saturdays and Sundays are 11% and 16% higher respectively than for those admitted on Wednesdays.

“For years it’s been too hard to access the NHS out of hours. But illness doesn’t respect working hours. Heart attacks, major accidents, babies – these things don’t just come from nine to five,” Mr Cameron said.

At weekends, he said, “some of the resources are not up and running. The key decision makers aren’t always there.

“With a future Conservative government, we would have a truly seven-day NHS. Already millions more people can see a GP seven days a week but by 2020 I want this for everyone, with hospitals properly staffed especially for urgent and emergency care, so that everyone will have access to the NHS services they need seven days a week by 2020 – the first country in the world to make this happen.”

The Liberal Democrats said NHS England already had plans to open hospitals and GP surgeries seven days a week, while UKIP said the Tories had “degenerated the NHS beyond all recognition” during the last five years in government.

The Conservatives have pledged to guarantee a real-term increase in funding for the NHS during the next Parliament, extending the ring-fence in place for the past five years. Labour has said it will spend £2.5bn more than its opponents.

Health Secretary Jeremy Hunt said government reforms of the NHS were saving £1.5bn a year but that the NHS “will need more money”.

He added that the NHS’s own sums suggested the predicted £30bn annual shortfall could be “reduced with efficiency changes, and we’re backing that plan”.

New clinical standards set out in 2013 require hospitals to provide seven-day access to diagnostic tests, such as X-rays, ultrasound, MRI scans and pathology, as well as providing access to multi-disciplinary teams, which include expert nurses and physiotherapists.

In its blueprint for services over the next five years, published last October, NHS England said hospital patients should have access to seven day services by 2020. “

Three IVF cycles a minimum treatment requirement

A charity is calling for couples who need help conceiving to have access to three cycles of IVF instead of two.

Three IVF cycles a minimum treatment requirementIn 2013 a working group, set up by the Scottish government, recommended eligible couples should be offered up to three treatments. But that would only be after health boards had reduced IVF waiting times.

Infertility Network UK said it was a “no-brainer” there should now be three cycles as waiting times have fallen.

New IVF criteria was introduced in July 2013, following recommendations by the National Infertility Working Group.

The changes were designed to standardise fertility treatment across Scotland to prevent a “postcode lottery”.

Giving evidence to Holyrood’s health committee, the charity’s chief executive Susan Seenan said: “The group recommended three cycles and said that once the waiting times were down to below 12 months, at the latest early 2015, they would consider moving to three cycles.

“It just doesn’t seem to be happening as fast as we would like it to. We just think now that the waiting times are down, that it is a no-brainer – we should move to offering everybody who is eligible three cycles.”

IVF treatment guidelines

  • A guaranteed two full cycles of IVF, as well as unlimited frozen transfers for eligible couples until the woman’s 40th birthday
  • Women aged between 40 and 42 will be offered one full cycle of IVF provided they meet all necessary criteria
  • From 31 March, 2015, all eligible couples will start treatment within 12 months of being accepted for IVF treatment
  • Obese women – those with a Body Mass Index (BMI) over 30 – will have to lose weight and have a BMI of 29.9 or less before treatment
  • If either partner smokes, they will need to have stopped before treatment is started

Susan Seenan added: “Everybody in the group was agreed that…three cycles was the best possible way to move forward for patients.

“Why anybody would not want to move forward with that, I have no idea, unless it is finance related.”

Fertility treatment is currently available to those under 40, and is not offered to women who are obese.

In addition, couples need to have been in a stable relationship for two years and neither partner can smoke for three months before treatment begins.

Both partners also need to be methadone-free for a year before IVF starts.

Women aged between 40 and 42 are eligible for one cycle of fertility treatment if they have never previously undergone the procedure.

Pharmacists could help ease GP pressures

An army of pharmacists could step in to help treat patients at GP practices across England leading health professionals plan.

Pharmacists could help ease GP pressuresThe proposals focus on pharmacists seeing patients with common ailments directly – not on setting up shops within surgeries.

Pharmacists would provide health advice and be able to prescribe medication once extra training had been completed.

Charities welcomed the move but say patient safety must be a priority.

NHS England officials said the idea complemented their plan to increase staffing in GP surgeries. But it is not yet clear whether they will push the proposals forward.

The plans, aimed at every practice in England, have been put forward by the Royal College of General Practice (RCGP) and Royal Pharmaceutical Society (RPS).

It could mean when patients call up their surgeries they are offered an appointment with a pharmacist, general practitioner or practice nurse.

Those who opt to see the pharmacist could get advice about their symptoms and discuss troubling side-effects of medication, as well as getting help with their repeat prescriptions.

People with long term conditions are likely to benefit the most under the plans – those on multiple medications could get help streamlining their daily drugs.

In a handful of practices pharmacists already help with the management of conditions such as diabetes and asthma, for example, helping patients get annual checks.

Under the proposals more practices could do this. And with additional training some pharmacists would prescribe commonly used medicines such as antibiotics.

Any patient who still needed advice from a doctor could still be seen by their GP.

GP and pharmacist leaders say the move is needed as practices face staff shortages and are struggling to meet the demands of an ageing population.

The RCGP predicts that on some 67 million occasions this year, patients will have to wait more than one week to get an appointment.

In contrast, there is currently an over-supply of skilled pharmacists who could ease this burden experts argue.

Initial pharmacist training lasts one year longer than basic nursing qualifications and one year less than medical school for doctors.

Dr Maureen Baker, chairwoman of the RCGP, said: “Even if we were to get an urgent influx of extra funding and more GPs, we could not turn around the situation overnight due to the length of time it takes to train a GP.

“Yet we already have a ‘hidden army’ of highly-trained pharmacists who could provide a solution.

“This isn’t about having a pharmacy premises within a surgery, but about making full use of the pharmacist’s clinical skills to help patients and the over-stretched GP workforce.”

David Branford, of the RPS, said: “Pharmacists can consult with and treat patients directly, relieving GPs of casework and enabling them to focus their skills where they are most needed, for example on diagnosing and treating patients with complex conditions.

“Pharmacists can advise other professionals about medicines, resolve problems with prescriptions and reduce prescribing errors.”

These types of partnership already exist in a handful of practices but experts hope the plan will eventually be rolled out across the UK.

Katherine Murphy, of the Patients Association said: “Any action that can, at the very least, ease the problem is to be welcomed and this plan for doctors and pharmacists to work together is an innovative step in the right direction.

“Of course, there must always be concerns that the pharmacists who undertake this work have the relevant skills and qualifications to treat patients, and with care.”

War on drugs is unwinnable

Four decades after President Nixon declared a “war on drugs”, US states have legalised the sale of marijuana and most Americans support legalisation.

War on drugs is unwinnableAcross the world, drug laws are being relaxed, from Uruguay to Portugal, Jamaica and the Czech Republic.

After many years prosecuting drugs offences as an Assistant US Attorney, growing frustration with the approach inspire

The US prison system is a disaster. There’s virtually no rehabilitation. Locking up low level individuals who have drug problems or who have limited other options is not effective, because they go to jail, they come out, they get involved with drugs again, and they go right back to it.

The war itself is at a draw- which will be maintained indefinitely unless there’s a dramatic change in our approach to drugs and drug trafficking.

Former Colombian President Cesar Gaviria worked on the Global Commission on Drug Policy report in 2011 which called on states to decriminalise drugs.

“Our recommendation is regulation for everything. That’s what Portugal did.

“If you look at the last 50 years, what has been done? In the US, 600,000 people in jail, £27 billion of spending a year. The highest rates of consumption of the whole world. You have to say that it doesn’t work. It’s a failed policy, and public opinion knows that.

“Ten years ago it was unthinkable that the US would move massively to the legalisation of cannabis. That taboo has been broken. In the US, a majority of people are talking about approving legalisation of marijuana.”

He cites the example of Uruguay, the first country to legalise the marijuana trade.

“All Latin America’s looking at Uruguay. It’s a country that also looks how to deal with the production, with the supply of the marijuana that is in the state hands. I don’t expect any major set back of the policy that the Uruguayans have put in place.”

“From the beginning in 1961, the objective of the UN Conventions has been to live in a world free of drugs, but it’s a utopia. It’s something unreachable. It’s not to recognise human nature.”

Professor Peter Reuter from the school of public policy at the University of Maryland has been a leading academic in the field of drugs policy for decades.

“The need for national leaders to stand up and talk about the scourge of drugs, and signal to the population that being tough on drugs was a priority was an important part of the war itself.

“There’s going to be less and less of that. I think there’s going to be a change both in tone and substance, so the ‘war on drugs’ will become a less and less plausible metaphor for describing policy. I think it’s going to be a public health rhetoric for the foreseeable future.

“I do believe that we have in a sense had an experiment with trying to be very aggressive about controlling drugs through use of prohibition. And we have a sense that that did not work well. And so we’re now trying to find better ways of managing the problem, and I think that’s welcome.

“If you look at the number of people who are in prison for drug offences, at least in the US, that’s an important indicator of the change in real policy, and those numbers are starting to go down. Not dramatically, but they are definitely going down, and many states are making changes that are likely to accelerate that decline.”

As drug laws soften he argues the question of regulation becomes key, as happened when gambling was legalised:

“Lottery play was always seen as a bad thing, you legalised it because you wanted to take money away from organised crime, but the result was that the state lotteries became the most aggressive promoters.

“You have slogans like ‘Why be a mug and work when you can play the lottery and win easily?’, just the kind of slogan you’d associate with the worst commercial promotion, but done by the state.

“Alcohol is still heavily promoted, and it’s promoted in states that have state liquor monopolies, and we’ve only recently really been able to restrict smoking promotions.

“You cannot with a straight face say that marijuana legalisation won’t lead to more marijuana dependence.

“Choose your problem. There is no solution. Use of psychoactive drugs is a social problem like a whole lot of other social problems. We manage it. And we may manage it better or worse, but the notion that we solve a problem is simplistic. We’re simply managing a problem.”

NHS track record over the winter

The NHS has had it’s hardest difficult winter for a long time- so haow has it coped?

NHS track record over the winterThe four hour target to be seen in A&E has been missed in each nation – and that has had a knock-on effect on other parts of the hospital system.

In England all the evidence points to it being the worst winter since the target was introduced at the end of 2004.

The target is officially measured on a quarterly basis and covers the point from arrival to when a patient is discharged, transferred elsewhere or admitted into hospital for further treatment, .

During the last three months of 2014 92.6% were seen within four hours – the worst figure during this whole period.

We will have to wait until the end of March to get the next quarterly data, but performance is on track to be even worse than that.

And NHS England has already admitted the average for the whole of 2014-15 will be below 95% – the first time this has happened for a whole year under the target.

The situation was particularly bad at the turn of the year. A number of hospitals had to declare major incidents, a move normally associated with accidents involving multiple injuries.

To the NHS’s credit, performance did pick up after that point – although not enough to return above the 95% mark.

However, it is worth noting that the UK’s National Health Service has one of the toughest waiting time measures in the world.

Another way to look at it is to see the performance of individual trusts. Take a look at this chart.

England – as the biggest health service and the one that produces the most up-to-date data – has received the most attention.

But the problems have been just as acute elsewhere in the UK. In fact, England could be said to have faired the best.

In January waiting times reached their worst levels in Wales since the current way of recording performance was introduced in 2009.

It got so bad that one police force reported it had had to start taking people to hospital because there weren’t enough ambulances.

Of course, A&Es do not work in isolation and so, unsurprisingly, other parts of the hospital system have experienced problems.

Analysis by the House of Commons Library shows how such pressure points got worse this winter between November and March.

The simple answer is the number of people coming to A&E has gone up. Take a look at these figures.

Between November and February just over 7m visits were made to A&Es in England – 190,000 more than the year before.
The busiest week – the one ending 21 December – saw 446,000 people arrive, up by nearly 10% on the same week the year before and the highest ever recorded.

There were 1.82m emergency admissions – the most complicated cases that cannot be dealt with by A&E – up 51,000 on last year.

But this winter there has also been heated debate about what other factors may have played a role. These have ranged from the new 111 urgent phone service not being as good as it should to problems accessing social care and GPs.

Last spring and summer were also difficult, with the target being missed several times in England.

What is more, Scotland, Northern Ireland and Wales are all still a long way from achieving the target. The A&E story is unlikely to go away just yet.

Simple skin test may diagnose Alzheimer and Parkinson disease

Scientists have proposed a new simple idea for detecting brain conditions including Alzheimer’s and Parkinson’s diseases.

Simple skin test may diagnose Alzheimer and Parkinson diseaseTheir work which is at an early stage- found the same abnormal proteins that accumulate in the brain in such disorders can also be found in skin.

Early diagnosis is the key to preventing the loss of brain tissue in dementia-  which can go undetected for years.

But experts said even more advanced tests, including ones of spinal fluid, were still not ready for clinic. If they were, then doctors could treatment at the earliest stages, before irreversible brain damage or mental decline has taken place.

Investigators have been hunting for suitable biomarkers in the body – molecules in blood or exhaled breath, for example, that can be measured to accurately and reliably signal if a disease or disorder is present.

Dr Ildefonso Rodriguez-Leyva and colleagues from the University of San Luis Potosi, Mexico, believe skin is a good candidate for uncovering hidden brain disorders.

Skin has the same origin as brain tissue in the developing embryo and might, therefore, be a good window to what’s going on in the mind in later life – at least at a molecular level – they reasoned.

Post-mortem studies of people with Parkinson’s also reveal that the same protein deposits which occur in the brain with this condition also accumulate in the skin.

To test if the same was true in life as after death, the researchers recruited 65 volunteers – 12 who were healthy controls and the remaining 53 who had either Parkinson’s disease, Alzheimer’s or another type of dementia.

They took a small skin biopsy from behind the ear of each volunteer to test in their laboratory for any tell tale signs of disease.

Specifically, they looked for the presence of two proteins – tau and alpha-synuclein.

The 20 people with Alzheimer’s and the 16 with Parkinson’s had raised levels of both these proteins in their skin compared to the healthy controls and the patients with other types of dementia.

The people with Parkinson’s also had higher levels of alpha-synuclein protein.

Dr Rodriguez-Leyva, who will soon present his findings to the annual meeting of the American Academy of Neurology, said: “More research is needed to confirm these results, but the findings are exciting because we could potentially begin to use skin biopsies from living patients to study and learn more about these diseases.

“This new test offers a potential biomarker that may allow doctors to identify and diagnose these diseases earlier on.” It could also guide research into new treatments, he said.

Dr Arthur Roach, Parkinson’s UK Director of Research and Development, said: “This work points to a possible diagnostic test that would be minimally invasive and could provide earlier, more accurate diagnosis.”

“There is still a need for more innovation in this area – at the moment there’s no way to definitively diagnose Parkinson’s.”

Dr Simon Ridley of Alzheimer’s Research UK said it was too early to say if a skin test would become available.

He said research into biomarkers in cerebrospinal fluid – the fluid that surrounds the brain and spinal cord – was at a more advanced stage, but that even these methods were not yet close to becoming a routine test.

Health Direct notes that whilst more research is obviously needed a skin test which finds a correlation between alpha synuclein proteins and degenerative brain disease would be hugely significant as it would allow for quick, cheap non invasive testing and diagnosis.

Smoking kills two thirds of smokers

The risk of death from smoking may be much higher than previously thought – tobacco kills up to two in every three smokers not one in every two according to new research.

Smoking kills two thirds of smokersThe study tracked more than 200,000 Australian smokers and non smokers above the age of 45 over six years.

Mortality risk went up with cigarette use, the BMC Medicine reported.

Smoking 10 cigarettes a day doubled the risk, while 20 a day smokers were four to five times more likely to die.

Although someone who smokes could lead a long life, their habit makes this less likely.

Smoking increases the risk of a multitude of health problems- including heart disease and cancer.

Cancer Research UK currently advises that half of all long term smokers eventually die from cancer or other smoking related illnesses- but recent evidence suggests the figure may even be higher.

Newer studies in UK women, British doctors and American Cancer Society volunteers have put the figure at up to 67%, says Prof Emily Banks, lead author of the Australian study.

“We knew smoking was bad, but we now have direct independent evidence that confirms the disturbing findings that have been emerging internationally.

“Even with the very low rates of smoking that we have in Australia, we found that smokers have around threefold the risk of premature death of those who have never smoked. We also found smokers will die an estimated 10 years earlier than non-smokers,” she said.

George Butterworth, tobacco policy manager at Cancer Research UK, said: “It’s a real concern that the devastation caused by smoking may be even greater than we previously thought.”

“Earlier research has shown, as a conservative estimate, one in two long term smokers die from smoking related diseases in the UK, but these new Australian figures show a higher risk.”

“Smoking habits differ between Australia and the UK in terms of how much people smoke and the age they start, so we can’t conclude that the two-in-three figure necessarily applies to the UK.”

In Australia, about 13% of adults smoke. In the UK, the figure is about 20%.

Health Direct points out that stopping smoking can bring a person’s health risks back down.

Ten years after quitting, risk of lung cancer falls to half that of a smoker and risk of heart attack falls to the same as someone who has never smoked, according to NHS Smokefree.

A&E waiting times- rise in waiting more than 12 hours

More patients had to wait over 12 hours for treatment at seven of Northern Ireland’s A&E departments in January.

A&E waiting times- rise in waiting more than 12 hoursDepartment of Health figures show that 380 people waited more than 12 hours, compared to 92 in the previous month.

In January, 54,910 people went to emergency departments compared to 56,656 in December. The Ulster Hospital had the biggest rise in those waiting longer than 12 hours and Antrim Area Hospital had the biggest fall.

There was also a fall in the percentage of people seen and treated within four hours, from 73.5% in December to 71.4% in January. The target is 95%.

Figures released in December showed that Northern Ireland was the worst performing region in the UK for seeing patients in emergency departments within the four hour target.

The Health and Social Care Board said it had been a challenging month, with significant pressures during the first week of January coming after a two week period of substantially increased demand.

Chief executive Valerie Watts said delays were regrettable, but “it must be noted that significantly fewer people are waiting over 12 hours in emergency departments, compared to five years ago”.

“In 2011/12, over 10,000 patients waited longer than 12 hours in our emergency departments – that had almost halved in 2012-13 to 5,500 and was just over 3,000 last year,” she said.

Ms Watts said the board had been working closely with trusts to alleviate pressures in emergency departments and throughout the hospital system.

Winter deaths- why are they higher this year?

There has been a considerable increase in the numbers of people dying in England and Wales so far this year.

Winter deaths- why are they higher this year?The Office for National Statistics (ONS) says that in the first six weeks of 2015 just over 82,000 deaths were registered- which is 23% higher than the average from the previous five years.

The ONS recently published the graph above, which compares the last week in December and first three weeks in January for the last 16 years.

First of all, while we are currently well above the average for the past five years, we are at about the same level as we were in winter 2008-09.

Secondly, the spike for this year is exaggerated somewhat by last year, when there was the smallest number of Excess Winter Deaths since records began in 1950.

Excess Winter Deaths are the number of people whose deaths were registered between December and March, compared with the numbers for the previous four months and the following four months.

Thirdly, while the figures are high by recent standards, they are dwarfed by the levels in 1999-2000, which was the last year classified as a flu epidemic. An epidemic year is one in which more than 200 people per 100,000 go to see their GPs with flu-like symptoms.

We know that flu has played a part in this year’s high numbers.

Public Health England’s analysis says that the high number of deaths, “coincides with circulating influenza and cold snaps”, with the over-65s particularly hard hit by the strains of the virus spreading this year.

It also appears that this winter’s flu vaccine has been less effective than usual, which is suspected to be contributing.

But as for cold snaps, the temperature this winter was a bit warmer than average in December, close to average in January and only slightly below average in February, according to this blog from the Met Office on Wednesday.

It’s possible that deaths have been relatively low for five years and coincidentally have been a bit higher this year.

In short- Health Direct doesn’t statistically know- we will get a better idea when the breakdown of causes of death are published later in the year.

Obese could lose benefits if they refuse treatment

People who do work because they are obese or have alcohol or drug problems could have their benefits cut if they refuse treatment.

Obese could lose benefits if they refuse treatment David Cameron has launched a review of the current benefits system, which he says fails to encourage people with long term, treatable issues to get medical help.

Some 100,000 people with such conditions claim Employment and Support Allowance (ESA), the government says.

There is currently no requirement for people with alcohol, drug or weight-related health problems to undertake treatment.

Mr Cameron has asked Prof Dame Carol Black-  an adviser to the Department of Health, to look at whether it would be appropriate to withhold benefits from those who are unwilling to accept help.

Announcing the proposal, he said: “Some people have drug or alcohol problems, but refuse treatment. In other cases people have problems with their weight that could be addressed – but instead a life on benefits rather than work becomes the choice.”

“It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the support and treatment that could help them get back to a life of work.”

David Cameron sees the wide-ranging welfare reforms introduced in this Parliament as part of a “moral mission”. He has said they give new hope to people who have been written off by helping them back to work.

Similar proposals have been considered by the government before- in 2010 and 2012 the Conservatives considered plans to remove or cut benefits for drug and alcohol addicts who refused treatment.

At the time the plans were met with concern by charities, who said there was no evidence benefit sanctions would help addicts engage with treatment.

Disabilities Minister Mark Harper said people who were overweight or had alcohol or drug problems needed treatment to get back to work

ESA was introduced in 2008 to replace incapacity benefit and income support, paid because of an illness or disability. It requires claimants to undertake a work capability assessment to see how much their illness or disability affects their ability to work.

Once a claim is accepted, those receiving ESA get up to £108.15 a week. Some 60% of the 2.5 million people claiming ESA have been doing so for more than five years, government figures show.