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Study suggests safe alcohol guidance unrealistic

UK government guidelines on how much alcohol it is safe to drink are unrealistic, largely ignored and should be changed to reflect modern drinking habits.

UK government guidelines on how much alcohol it is safe to drink are unrealistic, largely ignored and should be changed to reflect modern drinking habits
Men are currently recommended to drink no more than three or four units a day, and women no more than two or three.

But the study found that the guidelines are largely ignored because most people do not drink every day. Instead they drink heavily at the weekend – in order to get drunk.

Many people taking part in the research also found the idea of alcohol “units” confusing as they measured their intake in pints, bottles and glasses.

The results suggested that people think the recommended quantities of drink are unrealistic, as they don’t recognise that many people are motivated to drink to get drunk.

When participants did regulate their drinking, this was usually down to practical issues such as needing to go to work or having childcare responsibilities, rather than health concerns or due to guidance on safe limits.

Researchers found that participants preferred the current Australian and Canadian guidelines, which include separate advice for regular drinking and for single occasion drinking, which were regarded as more relevant and flexible to occasional drinkers.

Australia recommends drinking no more than four standard sized drinks on one occasion, or two drinks a day.

The study was carried out by researchers from the UK Centre for Tobacco and Alcohol Studies, which includes the universities of Stirling and Sheffield.

They interviewed focus groups in Scotland and the north of England. The results have been published by the Addiction journal.

The chief medical officers in both England and Scotland are looking at new guidelines to be published next year, and the researchers have been feeding their results to them.

Prof Linda Bauld of the University of Stirling’s Institute for Social Marketing told BBC Scotland that the advice on “safe” alcohol limits was helpful, but needed to be revised.

And she said more emphasis should be put on helping people to drink more sensibly rather than simply telling them what they need to do.

Prof Bauld added: “The Scottish government is trying to push forward with pricing measures, for example, we need to look at marketing, we need to look at glass sizes.”

NHS trusts told financial plans unaffordable

Hospitals and health trusts in England have been told by regulators to look again at their financial plans as current ones are “simply unaffordable”.

Hospitals and health trusts in England have been told by regulators to look again at their financial plans as current ones are "simply unaffordable
Monitor has written to the 46 foundation trusts with the biggest deficits “challenging” their plans. It urged money saving measures such as filling only essential staff vacancies.

David Bennett, chief executive of Monitor, said the NHS was facing an almost unprecedented financial challenge this year.

“We are already reviewing and challenging the plans of the 46 foundation trusts with the biggest deficits,” he wrote in a letter to trusts.

NHS trusts are caught between a rock and a hard place. On the one hand they have the number crunchers – like Monitor – demanding they keep a tight control on the finances and on the other they are being asked to ensure standards don’t slip.

This is only likely to get worse. While the NHS has been promised an extra £8bn a year by the end of this Parliament, it is being asked to make £22 billion in efficiency savings to plug the predicted shortfall of £30bn by 2020. That is a monumental task.

Within the health service there is a desire for the £8 billion to be front loaded in November’s government spending review – that is to say they want all or most of it from next year rather than seeing it gradually dripped fed in over the years.

That, so the argument goes, would allow them to get a grip of the deficits and make the changes needed to (hopefully) improve efficiency. The next year or two is crucial for the NHS.

“However, it is clear that this process will not close the funding gap and so we need all providers – even those planning for a surplus this year – to look again at their plans to see what more can be done.”

He urged trusts to leave non-essential vacancies unfilled, and to follow guidelines on safe staffing in a way which was “proportionate and appropriate”.

Rosters should be rigorously managed to deploy staff efficiently across all required shifts, including evenings and weekends, he said.

In May, NHS trusts in England reported a total deficit of £822 million in 2014-15, compared with £115 million the previous year.

A big rise in spending on agency nurses contributed to the deficits.

At the time, Monitor said figures for this financial year were likely to be even worse.

How to have a good death

For more than a decade a system called the Liverpool Care Pathway was used by hospitals and hospices in an effort to give people comfortable, dignified deaths.

For more than a decade a system called the Liverpool Care Pathway was used by hospitals and hospices in an effort to give people comfortable, dignified deaths

Among other things, it involved checklists prompting staff to consider whether invasive procedures and drugs should no longer be given to people in the last stage of life.

But two years ago it was abolished in response to fierce criticism.

An independent report suggested that, on some occasions, the balance had swung too far, from preventing unnecessary treatment to denying some people basic care.

It found some patients on the pathway had been left thirsty and deprived of food and water, while others were given sedative drugs they did not need.

Now the National Institute of Health and Care Excellence (NICE) is re-writing the rules for England. Its draft proposals are wide-ranging. But can new guidance really improve how people die?

Families had described loved ones being put on the Liverpool Care Pathway without their knowledge. Others viewed it as solely a tick-box exercise, that took health care staff away from people’s last needs

But retired palliative care expert Dr Claud Regnard, writing just after the LCP was scrapped, said it was not the pathway itself that was to blame

He suggested the guidance was “made a scapegoat”.

Instead Dr Regnard suggested, bad decision making, insufficient training and poor communication all played a part in the tragic cases.

And as he pointed out lists can be extremely important – asking if people would choose an airline that had no tick boxes to check all safety procedures were in place?

NICE accepts the problems were caused by the poor way the document was implemented – rather than a direct consequence of the pathway itself.

But the question remains, with increasing financial pressures on the NHS and concerns that staff are over-worked, whether these issues can once more get in the way of a dignified death.

Charities and the Royal College of Physicians warn training for healthcare staff must not be skimped.

And some have warned the focus on these caring skills has been displaced as more and more technical knowledge is required of nursing and care staff.

The new proposals make no mention of lists or tick boxes.

And much of the content comes as no surprise – there are calls for basic daily checks to make make sure patients are well hydrated and nourished.

Families might also be encouraged to be more closely involved in care if appropriate and safe – for example helping to give loved ones sips of water.

Throughout clear communication and involving patients and relatives in decisions is paramount.

While focusing on some simple, fundamental areas of care, NICE recognises there is still much we don’t know about the final stages of life – particularly how to predict who is approaching their last few days.

And it suggests some drugs – for example those used to reduce fluid in the chest – might be causing more harm than good.

More research is needed to find out when best to give medicines and when best to withhold them, its experts say.

Recruiting foreign nurses is frustrating and expensive

It is “distracting, frustrating and expensive” to have to recruit large numbers of nurses from overseas.

It is distracting, frustrating and expensive to have to recruit large numbers of nurses from overseasDr Keith McNeil, who runs Addenbrooke’s Hospital in Cambridge, urged officials to “figure out” what resources were needed and improve UK recruitment.

Around 7,500 nurses from countries such as Spain, Romania and Italy registered to work in the UK last year.

Figures from the Nursing and Midwifery Council (NMC) show the recruitment of overseas staff to the UK is growing.

The number of nurses coming here from other parts of the EU has risen steadily during the past six years – now making up the vast majority of new overseas recruits – while the number of foreign nurses from beyond Europe has dropped.

The trend has been driven partly by the financial crisis in countries such as Spain and Portugal – and because of extra demand for NHS nurses in the wake of the Mid Staffordshire scandal.

The number of training places for nurses in England fell in 2011 and 2012.

Cambridge University Hospitals NHS Foundation Trust has taken on 303 foreign nurses in the past year. Half were from the Philippines – with significant numbers from Italy, Spain and Portugal.

Dr McNeil, the trust’s chief executive, told BBC News: “Nurses are the backbone of the NHS. You can’t run services effectively in an acute hospital like this without adequate numbers of trained nursing staff.

“It’s distracting, frustrating and expensive to do international recruitment. It would be nice not to have to do it and to have a more targeted approach.”

He added: “We don’t have enough home grown nurses, but we know the demographics. The health service has to figure out what resources are needed for our activity.”

“We need proper planning; I think the people at Health Education England are doing that now.  At least doing it now means avoiding having to do this in the years to come.”

Nursing experts fear that shortages could be fuelled in the coming years by retirement among the baby-boomer generation, and limits on the number of skilled workers from outside the EU who are allowed into the UK.

Last month, NHS Employers issued guidance to trusts on how to plan successful international recruitment.

Addenbrooke’s believes it costs £3,000 to recruit each nurse from elsewhere in the EU. New arrivals are given their first month’s accommodation and also £400, so long as they stay for 18 months.

They are also sent on a language course if they need to boost their conversational skills in English – as well as being given 10 weeks of support in the hospital to help their technical and clinical language.

The Cambridge hospital believes the big recruitment drive is paying off, because it is now using fewer temporary staff from agencies.

But there have been concerns that some overseas nurses leave the UK after just a short period here.

Commenting on the need for more UK training, the head of the Royal College of Nursing, Dr Peter Carter, said: “Last year there were 57,000 applicants for 20,000 nurse training posts.

“Isn’t that a matter of huge regret that you’ve got people in the four countries of the UK who want to train as nurses. They’re being turned away, while we’re going off and raiding the often impoverished workforce of other countries.”

He added: “It’s hugely regrettable and the UK is not exactly covering itself in glory in this.”

IVF- guide to effectiveness

In July 1978 Louise Brown was hailed as the world’s first “test-tube baby”, born through the fertility treatment IVF.

In July 1978 Louise Brown was hailed as the world's first "test-tube baby", born through the fertility treatment IVFBut how has IVF effectiveness improved compared with modern IVF procedures?

Louise’s birth was cloaked in secrecy. Even her father John’s first visit to see her in Oldham General Hospital was under the eye of police officers, who lined the corridor outside.

She was the first to be born through in-vitro fertilisation (IVF), a process in which an egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory, before being implanted into the uterus.

It is a treatment used to enable couples with a range of fertility problems to conceive a child, and now allows same sex couples and single mothers to have children too.

Technological advancements mean – according to 2013 estimates – more than five million people worldwide have been born through IVF.

But in 1978 it was highly experimental, and Dr Mike Macnamee, chief executive at the world’s first IVF clinic – Bourn Hall in Cambridge – believes Louise “really was a miracle”.

The two men who pioneered the treatment – gynaecologist Patrick Steptoe and Nobel Prize-winning physiologist Robert Edwards – “had gone through hundreds of embryo transfers before Louise was conceived”, he adds.

The pair had joined forces a full 10 years earlier, with skills that perfectly complemented one another – Edwards having developed a way to fertilise human eggs within the laboratory and Steptoe having devised a method for obtaining the eggs from the ovaries.

When Louise’s mother Lesley was put in contact with Steptoe by her doctor, she was warned there was a “one in a million” chance of success.

So when it worked, it was such a momentous scientific advancement that the birth had to be filmed – under agreement with the government – to give documented evidence that Louise was indeed her mother’s.

This is a far cry from modern procedures, which – owing much to the work of Bourn Hall in the 1980s – follow a refined and well established clinical process.

“Once Steptoe and Edwards worked out how to fertilise the egg, they very soon wanted to restrict the number of embryos they transferred into women – so they didn’t have too many multiple births,” Dr Macnamee explains.

“Development of the freezing technique in the mid-80s meant they could implant one or two embryos into the would-be mother and then freeze other embryos for future use, saving her the uncomfortable procedure of having the eggs removed again.”

Progress can also be seen in the modern use of ultrasound imaging to harvest the eggs under a mild sedation, rather than the form of keyhole surgery known as laparoscopy that was previously employed.

Techniques developed in the late 1980s also made a big difference in treating male infertility by injecting single sperm directly into the egg.

These, and other, small incremental steps mean the success rate for each round of IVF has grown from 10% to 40% since the early 80s, when Dr Macnamee’s first role included the hands-on task of mixing the eggs and sperm in a petri dish.

The chances of successfully conceiving through IVF decline with age, but the process is now more effective per cycle than natural reproduction. It does not, however, have approval from all quarters.

Dr Macnamee thinks the chances of women conceiving through IVF will only increase in future – and says he hopes to see a 60% success rate in IVF cycles before he retires.

One prominent area of research is aimed at exploring the way in which embryos interact with the lining of the womb when they are implanted.

Many believe it is when the two fail to engage with each other that the IVF cycle can prove unsuccessful.

Progress is slow – as there is no model to undertake tests in the lab – but Dr Macnamee believes this line of research could be key. “If we understand that better, it’d be the next big breakthrough,” he says.

NHS negligence bill tops £1 billion

The NHS in England paid out over £1.1 billion in 2014/15 to lawyers and to patients who suffered harm.

The NHS in England paid out over £1.1 billion in 2014/15 to lawyers and to patients who suffered harmThis coming year it will be £1.4 billion, said the NHS Litigation Authority. The body said it would work with other parts of the NHS to reduce costs and improve safety and learning.

Chief executive officer Helen Vernon said: ”Negligence claims place increasing pressure on the health service, frontline staff, our members and ultimately patients.

“It is one area of the NHS where no one would argue against a reduction.”

The NHS in England has seen an increase in costs associated with clinical negligence claims in recent years, although the figure last year was slightly higher at £1.192 billion.

The authority said in its annual report that several factors were involved, including an increase in the number of patients being treated on the NHS.

It also said there was an increase in the number of reported incidents, although this could be due in part to a positive reporting culture.

The Medical Defence Union, which provides medical indemnity to doctors, said the money paid out by the NHS to compensate patients could have funded over eight million MRI scans.

Dr Michael Devlin, head of professional standards and liaison, said: “The cost of care is the main reason for the staggering negligence bill.”

“The money paid is no reflection on clinical standards, which remain high, but it reflects the unsustainable cost of private sector health and social care packages.”

“We have to stop money haemorrhaging out of the NHS in compensation awards. Today’s figures only accentuate the need for a complete rethink of personal injury law.”

Last month, the government said it intended to put strict limits on the “excessive fees” some lawyers claim in medical negligence cases against the NHS in England.

Officials have called for a defined limit on legal costs in cases where the claims are below £100,000, saying that some lawyers submit bills that charge more than patients receive in compensation.

Solicitors have warned the move could deny patients access to justice.

Female lung cancer cases top 20,000

Cases of lung cancer in women have reached 20,000 a year in the UK for the first time since records began.

Female lung cancer cases top 20,000The figure for 2012 represents a rise from 14,000 in 1993, according to the data compiled by Cancer Research UK.

It means the rate of lung cancer in the female population has risen by 22% to 65 cases per 100,000 people.

The trend is the opposite of what is happening with men and is linked to smoking-  which peaked in men in the 1940s but in women peaked in the 1970s.

About 24,000 men are diagnosed with lung cancer each year, which means it is the second most common cancer for both sexes.

Prof Caroline Dive, from Cancer Research UK, said: “It really is devastating to see that the number of women diagnosed with lung cancer continues to climb.”

“We also know survival remains poor and one of the problems is that lung cancer tends to be diagnosed at a late stage when it has already spread.”

That makes it hard to treat and as a result lung cancer claims the lives of 35,000 people each year.

Just 10% of people live for five years after diagnosis – compared with more than 80% for breast and prostate cancer.

Prof Dive said efforts were being made to tackle this with lung cancer one of its key priorities of its research strategy.

The work focuses on a new technique to carry out a biopsy using magnets to capture rogue cancer cells in the blood of patients – potentially providing vital information on the biology of the disease, which could help improve treatment.

But as well as investing in new treatment techniques, Nell Barrie, senior science communication manager at Cancer Research UK, said: “It’s vital that we keep on fighting against lung cancer.”

“It’s the biggest cancer killer in the UK so the government and health service must work to help smokers quit by providing more stop smoking services to help people give up this deadly addiction.”

Health Direct laments the sad increase in female lung cancers as these deaths are wholly preventable.

New drug may delay Alzheimer’s decline

New research of how a new drug could slow the pace of brain decline for patients with early stage Alzheimer’s disease have emerged.

New research of how a new drug could slow the pace of brain decline for patients with early stage Alzheimer's diseaseData from pharmaceutical company Eli Lilly suggests its Solanezumab drug can cut the rate of the dementia’s progression by about a third.

The results, presented to a US conference, are being met with cautious optimism. A new trial is due to report next year and should provide definitive evidence.

The death of brain cells in Alzheimer’s is currently unstoppable. Solanezumab may be able to keep them alive.

Current medication, such as Aricept, can manage only the symptoms of dementia by helping the dying brain cells function.

But solanezumab attacks the deformed proteins, called amyloid, that build up in the brain during Alzheimer’s.

It is thought the formation of sticky plaques of amyloid between nerve cells leads to damage and eventually brain cell death.

Solanezumab has long been the great hope of dementia research, yet an 18-month trial of the drug seemingly ended in failure in 2012.

But when Eli Lilly looked more closely at the data, there were hints it could be working for patients in the earliest stages of the disease. It appeared to slow progression by around 34% during the study.

So the company asked just over 1,000 of the patients in the original trial with mild Alzheimer’s to take the drug for another two years.

And positive results from this extension of the original trial have now been presented at the Alzheimer’s Association International Conference.

They show those taking the drugs the longest had the most benefit.

Dr Eric Siemers, from the Lilly Research Laboratories, in Indiana, said “It’s another piece of evidence that solanezumab does have an effect on the underlying disease pathology. We think there is a chance that solanezumab will be the first disease-modifying medication to be available.”

The company also started a completely separate trial in mild patients in 2012, and these results could prove to be the definitive moment for the drug.

At the moment there is no medication that can slow down dementia. If such a drug was developed it could transform how the disease is managed.

People would still get worse, but they would spend more time in the milder phase of the degenerative disease rather than needing constant care.

In a field that has been plagued by repeated disappointment, even a hint of such a drug is an exciting moment.

Next year, when further trial results are due, we will know for certain whether solanezumab is the breakthrough everyone hopes it could be.

Dr Eric Karran, the director of research at Alzheimer’s Research UK, said “If this gets replicated, then I think this is a real breakthrough in Alzheimer’s research. Then, for the first time, the medical community can say we can slow Alzheimer’s, which is an incredible step forward.”

“These data need replicating, this is not proof, but what you can say is it is entirely consistent with a disease-modifying effect. We’ve never ever had evidence that we can affect the disease process.”

Many NHS hospital patients complain of lack of dignity

A fifth of people in hospital in England are not always treated with respect and dignity according to new research.

A fifth of people in hospital in England are not always treated with respect and dignityAnalysis of the 2012 poll has found that poor care was more likely to be experienced by those aged over 80. It also found that more than a third of patients who need help at mealtimes did not receive enough assistance.

Age UK, which helped to advise the researchers, said there had been “remarkably little change” over time in the care experienced by older patients.

The report, carried out by the Centre for Analysis of Social Exclusion at the LSE, found that poor or inconsistent care was more likely to be experienced by women as well as the over-80s.

The risks were also higher for those with a long-standing illness or disability like deafness or blindness, with those in hospital for a long period, or who stayed in three or more wards, at an even greater risk.

The report was compiled using evidence from the Adult Inpatient Survey 2012, which covers people aged 16 or above who stayed in hospital for at least one night.

According to the report: “There was a widespread and systematic pattern of inconsistent or poor standards of care during hospital stays in England in 2012.”

“Patient experiences of inconsistent or poor standards of dignity and help with eating do not appear to be limited to isolated ‘outlier’ providers. Rather, this appears to be a significant general problem affecting the vast majority of NHS acute hospital trusts.”

The researchers found 23% of patients reported experiencing poor or inconsistent standards of dignity and respect, the equivalent to 2.8 million people a year, of whom a million would be aged 65 and over.

They also found that a quarter of all respondents said they needed help with eating during their hospital stay, amounting to just under 3.5 million patients a year.

Of those who needed help with eating, 38% said they only sometimes, or never, received enough help from staff – equivalent to 1.3 million people a year, and 640,000 aged 65 and over.

Age UK charity director Caroline Abrahams said: “It must be recognised that the data this research is based on is two years old now and that the newest figures suggest some welcome improvement, especially as regards older people’s experiences of dignity, but this sobering report certainly shows that hospitals need to redouble their efforts.”

“Above all it is really worrying, if perhaps not altogether surprising, that the more vulnerable an older person is, the greater their risk of not being treated as we would all wish for ourselves or our loved ones.”

“Turning this situation around ought to be a top priority and no hospital can afford to be complacent.”

NHS to show cost of missed appointments to patients

Patients who miss appointments will be shown how much they have cost the NHS.

Patients who miss appointments will be shown how much they have cost the NHS.The NHS estimates more than 12 million appointments are missed each year

Overall, missed GP and hospital appointments cost the health service in England nearly £1bn a year, Jeremy Hunt said in a speech this week.

He said he sympathised with the idea of charging patients for missing GP appointments, although there are no plans for this to happen.

But he said people would have to “take personal responsibility” for NHS funds.

In a measure announced in a speech to the Local Government Association on Wednesday, Mr Hunt said he planned to display the cost of prescription medicines on packets.

The figure and the words “funded by the UK taxpayer” will be added to all packs costing more than £20 in England.

The move is part of efforts to reduce the £300 million bill for “wasted” medication, which is prescribed but not used.

In the same speech, he said missed GP appointments cost the taxpayer £162 million and missed hospital appointments cost £750 million.

Mr Hunt told the Question Time programme that NHS resources were stretched already, adding there would be more than one million extra people aged over 70 by the end of the current parliament.

“If we’re going to square the circle and have a fantastic NHS, despite all those pressures, then we have to take personal responsibility for the way that we use NHS resources,” he said.

Mr Hunt told the audience in Essex he did not have a “problem in principle with the idea of charging people for missed appointments.”

But he added: “I think in practical terms it could be difficult to do, but I’ve taken a step towards that this week by announcing that when people do miss an appointment they will be told how much that’s cost the NHS.”