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Poor diabetes care in England leading to preventable deaths

Poor diabetes care in England is leading to preventable deaths, record rates of complications and huge costs to the NHS.

Poor diabetes care in England leading to preventable deathsDiabetes UK says the disease is the fastest growing health threat of our times and current care models are not working to get on top of the problem.

The NHS spends a tenth of its annual budget on diabetes- but most of the money goes on managing complications not preventing them.

Health Direct notes that Diabetes is currently estimated to cost the UK £23.7 billion and with diabetes becoming more common, this figure is set to rise to £40 billion by 2035-36.

Diabetes is a chronic condition and, if poorly managed, can lead to devastating complications, including blindness, amputations, kidney failure, stroke and early death.

Best-practice guidelines say patients should get regular checks to ensure they are controlling their condition well enough to avoid future complications. But official audits of NHS care in England show many patients do not receive these checks.

Diabetes UK’s own annual snapshot says there has been very little overall improvement in diabetes provision in the past year and that some aspects of care have got worse – such as fewer people with type 1 diabetes receiving an annual check-up.

It says just 41% of people with type 1 diabetes – which must be treated with insulin – receive all the annual checks recommended by the National Institute for Health and Care Excellence, and only 16% meet the three recommended treatment targets for blood sugar, cholesterol and blood pressure.

Young diabetes patients receive fewer vital checks than older patients. There is also wide variation depending on where you live in England.

People with diabetes living in some areas receive better care and treatment than people living in other areas, says the charity.

Barbara Young, Diabetes UK chief executive, said: “This is not a question of spending more money. In fact, better ongoing standards of care will save money and reduce pressure on NHS resources.”

“It’s about people getting the checks they need at their GP surgery and giving people the support and education they need to be able to manage their own condition. Doing this, together with improving diabetes care in hospital, would give people with diabetes a better chance of a long and healthy life, and save the NHS a significant amount of money. We want to work with local authorities to be able to help them put good practice into place.”

NHS plans for earlier cancer diagnosis to save lives

Patients are to be given the option to refer themselves for cancer tests, as part of an NHS England bid to diagnose an extra 10% of people early.

NHS plans for earlier cancer diagnosis to save lives

The NHS said it would start testing new ways of speeding up diagnosis, including offering patients the option to book appointments directly with a hospital or testing unit ahead of seeing a GP.

The body will also fund further trials of a pioneering form of radiotherapy.

Currently, around 25% of cancer diagnoses are made too late to save the patients.

The plans are part of a drive to improve cancer survival rates in England, which are below the European average, especially for people over 75.

NHS England says diagnosing 60%, rather than 50%, of people early would mean 8,000 more patients would be alive five years after diagnosis.

This would also result in a fall in the number of cancer diagnoses which have to be made in A&E.

NHS England said it would test the following initiatives:

  • Enabling patients to book their own appointments directly with a hospital diagnostic service or testing unit instead of going to see their GP first
  • Offering patients different types of cancer tests in the same place, on the same day
  • Using community pharmacists to fast-track patients when recurring cancer symptoms are suspected
  • GPs sending patients directly for specific tests, without having to refer to a specialist
  • Better treatments
  • A potentially less damaging and more precise type of radiotherapy, called stereotactic ablative radiotherapy (SABR), has been shown to be effective when used to treat certain kinds of lung cancer.

Now NHS England wants to test how well SABR works on other types of cancer, by enrolling 750 patients a year in four new studies.

An NHS cancer taskforce, made up of cancer doctors, patient groups and charity leaders, has also been asked to draw up a five-year action plan for cancer services to make this happen.

Recent figures show that more than one in three people in the UK develop cancer, and half of those will now live for at least 10 years. Forty years ago, the average survival of cancer patients was just one year.

NHS hospitals are gridlocked

Hospitals like the Cheltenham General Hospital are being closed to new patients and routine operations- but why?

NHS hospitals are gridlocked

Primarily hospitals are all about flow- as new patients arrive, others must move on through the system and, eventually, leave. But what has happened in the past month is that the system has stalled.

Last year more than 14 million patients arrived at A&E – effectively the front door of the hospital.

Most of those are dealt with by the doctors and nurses in A&E. But one in four need more complicated care than can be given so are admitted into the hospital. These tend to be the frailest and most vulnerable patients.

Once the decision has been made to admit them, those patients need to be found a bed. When that has happened, they can receive their treatment and, once they are ready, leave the hospital.

With A&E units full, ambulances have found it difficult to drop off patients. When they turn up at hospital, it is only meant to take 15 minutes to handover a patients.

But over the last four weeks there were over 37,000 occasions when ambulances were left waiting for over 30 minutes. That is more than double the number the year before.

Once inside A&E the delays have continued – as we know from the extensive coverage given to how the NHS has been struggling to meet its four-hour target.

A growing number of those that are then admitted into hospital are facing long waits (over four hours) for a bed to be found. These are sometimes known as trolley waits. During the last four weeks the number of these has trebled from last year to over 47,000.

But it doesn’t end there- when patients are ready to be discharged, delays are once again being experienced.

The frailest and most vulnerable patients need care to be in place in the community either via council-run social care teams or local NHS services before they can be released.

If it isn’t available, they have to stay in hospital. The NHS measures this as bed days lost due to delayed discharge. There were over 62,000 of these over the past four weeks – up by nearly a third.

This creates a scarcity of beds. The effect of this is two-fold. Firstly, hospitals are forced to put emergency patients in whichever ward they can find a bed, which means patients do not always end up in the place that is most appropriate for them.

This is not good for patients or for the effective running of the hospital. Doctors and nurses waste time going on what are known as “safari rounds” looking for their patients that can be spread across many different areas. In short, the hospital stops running smoothly.

The problems also have an impact on the non-emergency side of the system. One step that is taken is that routine operations, such as knee and hip replacements, are cancelled.

It is this catalogue of problems that prompts hospitals to raise the alarm. In recent weeks a number of trusts have even been forced to declare major incidents – like the Cheltenham General Hospital- which should be something normally reserved for major accidents, like train crashes.

The most common reason put forward for the problems has been the rise in attendances. But what seems remarkable when you look at the figures is that the increase in those seems extremely small by comparison.

They have only risen by 7% on last winter. But that is significant because it equates to more than 100,000 patients.

And in the case of the Cheltenham hospital it is compounded because the local health trust want to close the A&E department completely- to save money and move all emergencies to just one hospital in Gloucestershire- which is currently loss making.

Police not NHS should deal with drunks

The Police rather than the NHS should be dealling with drunks claims the AnE boss.

Police not NHS should deal with drunksPolice should crack down on binge drinking to stop hospital staff being distracted by disorderly drunks according to a leading doctor.

Dr Clifford Mann, president of the College of Emergency Medicine, said the “softer approach” used for anti-social drunkenness did not seem to be working. Police could instead increase arrests, convictions and fines, he suggested.

Crime prevention minister Lynne Featherstone said the government was “determined to tackle alcohol-fuelled harm”, which she said cost society around £21 billion a year.

The coalition had improved the powers available to the police and licensing authorities to tackle alcohol-related crime, and had banned the “worst cases of very cheap and harmful alcohol sales”, the Liberal Democrat MP said.

Dr Mann said: “All I am saying at the moment is the softer approach – where we don’t any longer arrest many people for being drunk and disorderly – certainly doesn’t seem to be working.”

He said the number of people arriving at A&E units while drunk was increasing year on year, while the number of licensed premises in the UK was also increasing and alcohol was getting cheaper.

“I think these people, by the nature of the disorder, they are distracting medical and nursing staff from looking after other patients and therefore are wasting public resources,” he said.

“I think they therefore fall into the category of being drunk and disorderly in their behaviour and the police can act to take them away.”

Health Direct agrees with the suggestion. To use the Greens’ parlance of “the polluter should pay”- the drunks should be charged- literally and financially. Until the politicians, police and society in general starts to deal appropriately of issue of people drinking too much alcohol then it is unfair and detrimental to the expect the NHS to pick up the pieces.

Not only would this approach save the NHS money- but the police and courts would make money by fining people who have paid to incapacitate themselves- and who are after all breaking the law.

Fourty per cent of cancers are avoidable

Four in 10 cancer cases- 600,000 in the UK- could be prevented if people led healthier lives say experts.

Fourty per cent of cancers are avoidableThe latest research figures from Cancer Research UK show smoking is by far the biggest avoidable risk factor- followed by unhealthy diets.

The charity is urging people to consider their health when making their New Year resolutions.

Limiting alcohol intake and doing regular exercise is also good advice.

According to the figures spanning five years from 2007 to 2011, more than 300,000 cases of cancer recorded were linked to smoking.

A further 145,000 were linked to unhealthy diets containing too much processed food.

Obesity contributed to 88,000 cases and alcohol to 62,200.

Sun damage to the skin and physical inactivity were also contributing factors.

Prof Max Parkin, a Cancer Research UK statistician based at Queen Mary University of London, said: “There’s now little doubt that certain lifestyle choices can have a big impact on cancer risk, with research around the world all pointing to the same key risk factors.”

“Of course everyone enjoys some extra treats during the Christmas holidays so we don’t want to ban mince pies and wine but it’s a good time to think about taking up some healthy habits for 2015.”

“Leading a healthy lifestyle can’t guarantee someone won’t get cancer but we can stack the odds in our favour by taking positive steps now that will help decrease our cancer risk in future.”

Public Health England says a healthy lifestyle can play a vital role in reducing cancer risk. It says campaigns such as Smokefree, Dry January and Change4Life Sugar Swaps all aim to raise public awareness.

Ambulance waiting time targets may be extended

Target waiting times for ambulances to reach some seriously ill patients could be lengthened.

Ambulance waiting time targets may be extendedA leaked NHS document includes plans to change the response time for some Red 2 patients – those with “serious but not the most life-threatening” conditions – from eight to 19 minutes in England.

It said the plans had been backed by Health Secretary Jeremy Hunt, subject to approval by ambulance trust bosses.

The government said no decisions had been made and the party has rejected suggestions from ambulance chiefs that it was told about the plan to change response times and raised no objections.

The leaked document, drawn up for the Association of Ambulance Chief Executives and dated 16 December, said NHS England had “explicitly stressed” the plans were confidential and “should not be disseminated beyond the group” involved in the discussions.

The document said there were existing plans for changes “after the general election” in May.

To many in the service, the general ideas are good – but there this concern it should have been a more thoughtful exercise where time was taken to consult widely and the public was involved in the process.

Paramedics say response times distort their ability to treat patients because they have to chase the clock. They also say some illnesses such as strokes, should be moved up a category.

The target for these changes was early January, according to the document, but it seems unlikely the proposals will now go ahead by then.

There are currently three main call types:

  • Red 1: Respiratory or cardiac arrest – response in eight minutes
  • Red 2: All other life-threatening emergencies, such as stroke and fits – response in eight minutes
  • Other response times are agreed locally

Ambulance trusts dealt with almost 8.5 million emergency calls in 2013-14 in England, an average of 16.1 calls per minute.

The national target is for ambulance trusts to reach 75% of Red 1 patients within eight minutes, and 95% within 19 minutes. The time starts as soon as an emergency call is connected.

Red 2 targets are currently the same, except that the “clock start” can be up to 60 seconds after a call is connected.

The changes proposed to Red 2 are:

A “small number” moved to Red 1 – those where a short extra wait “could have a potentially serious detrimental impact”
Just under half to keep the 75% within eight minutes target, but trusts will have up to three minutes from receiving a call before the clock starts
About 40% to have a 19-minute response target, as well as three minutes before the clock must start

The Red 2 category includes strokes and fits, but the document does not say which conditions would be put in each of the new categories.

It said the proposed changes could bring “substantial improvements”.

The document also said trusts would be able to cut the number of fast-response cars being used in favour of deploying more double-crewed ambulances, but it acknowledged the plans have not had the “breadth of exposure that would normally be expected”.”

The leak comes after it emerged on Friday that pressures in England’s A&E units had hit record levels, with the lowest percentage of patients seen within four hours since monitoring began in 2010 – NHS A&E has worst week in 2014.

NHS A&E has worst week in 2014

Pressures in England’s NHS A&E units have hit record levels- with the lowest percentage of patients seen within four hours since monitoring began.

NHS A&E has worst week in 2014New data showed just under 90% of patients were seen within four hours in the seven days up to December 14. Major units particularly struggled, with just six out of 140 meeting the target to see 95% within four hours.

As England is the only part of the UK that produces weekly data, how the NHS is performing here gives the best indication of the pressure the system is under.

Just over 440,000 patients visited A&E in the week ending 14 December with 89.8% seen within four hours.

As well as posting the worst performance against the four-hour target, other measures also show the service is under strain.

There were over 111,000 emergency admissions to hospital – 80,000 from A&E units – which is an all-time high.

Trolley waits – that is waits of four hours or more for a bed once a decision to admit a patient into hospital from A&E is made – topped 10,000 for the first time which compares to under 4,000 for the same week last year.

Delays getting patients out of hospital once they are ready for discharge are also much higher than average.

Performance in England has hit an all time low since weekly monitoring began in 2010, but this looks like it will just be the start of what promises to be the most difficult winter for the NHS for a generation.

The four hour target was introduced in 2004 to combat the long waits patients faced for treatment, since then hospitals have performed remarkably well.

During winter months it has tended to dip below the target level, but not for long. The scale of the drop is causing concern not only to the health service, but to the government too with an election just around the corner.

As health is devolved, data is published differently across the UK.

While England publishes weekly data, the others release it monthly or quarterly. In Wales the data from November shows just 83.8% of patients were seen in time.

Northern Ireland is performing even worse – just over 80% of patients were seen within four hours in November. Scotland has a slightly tougher waiting time target – 98% of patients should be seen in four hours – but in September 93.5% were.

Comparing the September figures for England and Scotland shows England was performing slightly better in that month.

It means according to latest data all parts of the UK are missing the A&E waiting time target.

Each nation has set aside extra money for winter pressures:.

  • In England an extra £700m has been set aside to help the NHS. This is paying for the equivalent of 1,000 extra doctors, 2,000 nurses and 2,000 community staff, including social workers and physios.
  • Ministers in Scotland have announced a total of £28.2m for the NHS to increase capacity and improve the way patients are discharged during winter.
  • In Wales the NHS has been given an extra £200m for this year. The money is for the whole health service, but ministers say it will help relieve the pressures in the coming months.

Painkillers linked to reduced skin cancer risk

Regularly taking aspirin and ibuprofen may help protect against some forms of skin cancer new research suggests.

Painkillers linked to reduced skin cancer riskAn Australian analysis of all studies to date found that non-steroidal anti-inflammatory drugs (NSAIDs) reduced the risk of squamous cell carcinoma by 18%.

The drugs have previously been linked to a reduced risk of other cancers, including colon cancer.  The theory that NSAIDs such as aspirin may protect against skin cancer has been raised before, but the overall evidence had been unclear.

So researchers did an analysis of nine studies looking at use of the drugs and the risk of squamous cell carcinoma – the most common form of skin cancer.

Reporting in the Journal of Investigative Dermatology, they found that taking any NSAID was associated with an 18% lower risk of developing the cancer.  And taking NSAIDs other than aspirin was linked with a 15% reduced risk.

It is the most convincing evidence so far that the drugs help prevent the development of squamous cell carcinoma.

But experts still cannot be sure of the effects because some factors – such as how much sun someone is exposed to or even what doses of the drugs they take – have been difficult to pin down with any accuracy.

It is thought that NSAIDs, which also include diclofenac, may prevent skin cancer because they inhibit an enzyme called COX-2, which is involved in tumour development.

The researchers did find a greater degree of reduced risk associated with use of the drugs in people with pre-cancerous growths or a history of skin cancer.

It raises the possibility that the drugs could be used as a preventive treatment in some groups.

Some people are prescribed NSAIDs long term for conditions such as arthritis, but they are not recommended for regular use in healthy people because of side effects, which can include, in rare cases, bleeding in the stomach.

Vulnerable doctors need more support

An independent report recommends that a national support service be set up to help vulnerable doctors- as up to 28 doctors took their own lives between 2005 and 2013 while being investigated by the General Medical Council.

Vulnerable doctors need more supportThe GMC, which investigates about 3,000 complaints about doctors each year, said its processes should be “quick, simple and low stress”.

The independent report, based on a review of GMC cases over eight years, found that 24 doctors undergoing fitness to practise investigations were classified as “suicide” and four as “suspected suicide”.

Many of the doctors suffered from a recognised mental disorder, such as depression, bipolar disorder and personality disorder, or had addiction problems.

Other factors in their deaths may have included marriage breakdown, financial hardship and the impact of the GMC investigation itself.

The report calls on the GMC to treat every doctor as “innocent until proven guilty”.

It also recommends appointing a senior medical officer from the GMC to oversee cases involving doctors with health problems.

The GMC said it has made significant improvements to its fitness-to-practise investigations process in recent years – but recognises that it could offer more support to doctors.

Niall Dickson, chief executive of the General Medical Council, said: “We know too that for any doctor, being investigated by the GMC is a stressful experience and very often follows other traumas in their lives.

“Our first duty must, of course, be to protect patients but we are determined to do everything we can to make sure we handle these cases as sensitively as possible, to ensure the doctors are being supported locally and to reduce the impact of our procedures.”

He said the aim was to handle complaints as quickly and effectively as possible. The GMC will now review it procedures for dealing with doctors with health problems.

Dr Clare Gerada, medical director of the Practitioner Health Programme, a support service for doctors in London, said she welcomed the review.

“They [the GMC] need to continue to show their commitment to reducing the impact of fitness-to-practise investigations on vulnerable doctors whilst always maintaining patient safety – a substantial task.

“Doctors are sometimes patients too and supporting vulnerable doctors is a shared responsibility.”

Dr Gerada said the British Medical Association, the Royal College of Psychiatrists and the Practitioner Health Programme should all be involved in implementing the GMC’s recommendations.

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.