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Alcohol detox centre saves NHS millions

The NHS could save £27 million a year by changing the way it deals with alcoholic patients.

Alcohol detox centre saves NHS millionsAlcohol abuse costs the NHS £3.8 billion a year, £145 for each UK household. One in three of all A&E admissions are alcohol related- but on a weekend that can rise to 70%.

Dr Chris Daly, the lead consultant at the unit, believes the NHS is wasting money by often treating people for the effects of alcohol problems without dealing with the underlying problem.

“We were very surprised that a significant proportion, maybe as much as 50% of the patients that we see, were not open to any services and some of them had never been seen by alcohol services before, so it’s almost as if we’re dealing with a different sort of population,” he says.

“These are people who are maybe only using their A&E department as their main source of treatment for their alcohol problems.”

The Radar ward at Chapman Barker is the first of its kind in the UK. Set up three years ago it takes alcohol dependent patients directly from 11 A&E departments across Manchester.

Some 75% of the people who come through the unit do not go back to hospital for at least the next three months.

The Radar ward is split with separate eating and living spaces for both sexes. Four in 10 of the places here are taken by women, from teenagers right up to pensioners in their 80s.

Patients are treated with talking therapies, support and counselling, but also specialist medical care they would not always get in a large hospital.

Around half of all alcohol dependent patients can develop clinical symptoms when they try to quit, including seizures, fits and hallucinations.

Without the right support the most severe cases often end up back in hospital.

An independent analysis of the unit by academics at Liverpool John Moores University published in April 2015 found it saves the NHS £1.3 million a year.

If the same approach was taken across the country the researchers say it could save the NHS £27.5 million in England alone.

This unit has secured funding to operate for another year but the future is always uncertain. The people working there say ignoring these patients will cost the NHS more in the long run.

Health Direct repeats numerous research warnings that alcohol is the drug that causes the most damage to the UK population- so anything that curbs preventable crisis is to be welcomed.

GP services face retirement crisis

GP services are facing a crisis- with a third of doctors considering retirement in the next five years a BMA poll suggests.

GP services face retirement crisisThe survey of more than 15,000 UK GPs also found over a quarter were considering working part time and one in 10 said they were thinking about moving abroad.

BMA GP leader Dr Chaand Nagpaul said the findings showed some of the promises being made about doctors by politicians were “absurd”.

Improving GP care has been one of the major themes of debate in the election, with the Conservatives promising seven day access to services and Labour pledging a 48-hour waiting-time guarantee.

The findings are in the second tranche of results from the BMA’s poll of GPs, in which nearly a third of doctors in the UK took part.

Last week the BMA released figures suggesting excessive workloads were harming care. This batch of results focused on the effect those rising demands were having. It suggests:

  • 34% of GPs are considering retiring from general practice in the next five years
  • 28% of those working full-time are thinking about moving to part-time
  • 9% are considering moving abroad
  • 7% are considering quitting medicine altogether

They also cited various factors that had a negative impact on their commitment to being a GP, including:

  • excessive workload – 71%
  • unresourced work being moved into general practice – 54%
  • not enough time with their patients – 43%Dr Nagpaul said: “This poll lays bare the stark reality of the crisis facing the GP workforce.

“It is clear that incredible pressures on GP services are at the heart of this problem, with escalating demand having far outstripped capacity. GPs are overworked and intensely frustrated that they do not have enough time to spend with their patients.”

“In this climate, it is absurd that in the recent leaders’ debate, political parties were attempting to outbid each other on the number of GPs they could magically produce in the next Parliament. Since it takes five to eight years to train a GP, it is not possible to create thousands of GPs in this timeframe.”

Katherine Murphy, of the Patients Association, said: “We know from the many calls to our helpline that patients are not able to access GP services at times when they need to.”

“What patients want is a clear and firm commitment that GPs now and tomorrow will have the resources to meet their needs.”

“Anything less is just not acceptable. We need a 21st Century primary care service with access 24/7.”

There are currently 9,000 GPs in training, although 14,000 doctors – about four in 10 – are over the age of 50.

Hospital charges to rise for non EU patients

Visitors from outside the EU who receive treatment in NHS hospitals in England are now charged 150% of the cost.

Hospital charges to rise for non EU patientsThe charges however only apply to non EU citizens settling in the UK for longer than six months. The new rules from the Department of Health came into force on 6 April.

However primary care and Accident and Emergency treatment will continue to remain free.

Permanent residents of 32 European countries qualify for NHS treatment, which is then billed to their country of residence, but this new ruling applies to foreign migrants or visitors based in other countries, mainly those outside the EU.

These patients can be treated in an NHS hospital but are expected to repay the cost of most procedures afterwards.

But up to now, the DoH has only sought to reclaim the actual costs, without adding any extra charges.  The DoH hopes the changes will help it recoup up to £500 million a year by 2017-18.

The new guidelines do not require patients on trolleys in hospitals to produce passports before getting access to urgent care. Nor do they apply to accident and emergency or a visit to a GP.

What is covered is ongoing treatment on the NHS after an initial diagnosis or referral – for example an outpatient appointment.

The Department of Health is incentivising hospitals to be more vigilant in checking patient credentials by allowing them to charge more for treatment of people “not ordinarily resident” in the UK.

The department can recoup those costs from the patient’s member state if they are from the European Economic Area.

In the paperwork filled in by the patient before the appointment they will be asked for proof they are “ordinarily resident”.

This could be a utility bill, national insurance number or passport details. Some hospitals were doing this already but many were not.

The guidelines are designed to increase the chances that the treatment costs for a non UK resident can be recovered. Critics may ask why it has taken so long for the initiative to be launched.

The charges are based on the standard tariff for a range of procedures, ranging from about £1,860 for cataract surgery to about £8,570 for a hip replacement.

Similar charges can be imposed by the NHS in Northern Ireland, Scotland and Wales for hospital care received by non-EU residents.

Patients using hospital services have been required to show their passports and other immigration documents if their UK residence status was in doubt.

The “health surcharge” on visa applications for non-EU citizens comprises an annual fee of £200-a-year, which is reduced to £150 for students.

Certain individuals, such as Australian and New Zealand nationals, are exempt from the surcharge.

And non-EU citizens who are lawfully entitled to reside in the UK and usually live in the country will be entitled to free NHS care as they are now.

New government should boost nurse numbers

Immediate action must be taken by the next government to increase the number of NHS nurses, a report has warned.

New government should boost nurse numbersThe Royal College of Nursing (RCN) said there were fewer nurses now than in 2010 if midwives, health visitors and school nurses were not included.

It said government cuts to nurse training places in 2010 were a significant factor in the shortage.

The Conservatives and Liberal Democrats said they were committed to investing £8 billion each year in the NHS.

The RCN said that while the government claimed the number of nursing posts has increased the actual headcount figure for nurses fell from 317,370 in May 2010 to 315,525 in December 2014.

It described this as “remarkable” given the continued increase in demand for the NHS.

While 50,000 people applied to become nurses last year, there were only 21,000 places – meaning there is no shortage of people wanting to do the job, the RCN said in its report.

It said cuts the coalition government made to student nursing commissions in 2010 led to a reduction of 3,375 places.

The report said that as it takes three years for student nurses to qualify, these cuts are impacting on the supply of nurses right now.

Dr Peter Carter, chief executive and general secretary of the RCN, said: “We warned that cutting the workforce numbers to fund the NHS reorganisation and to find the efficiency savings was the wrong course to take.

“The cuts were so severe that we are only just catching up with where we were five years ago.  Many areas, like district nursing and mental health, are even worse off. While the health service has spent the last five years running on the spot, demand has continued to increase.”

“Whoever forms the next government must learn from this report and take immediate action to grow the nursing workforce, and ensure it can keep up with demand with a sustainable and long term plan.”

The report also said the community nursing workforce had been cut by more than 3,300, despite NHS plans to move care from hospitals to the community.

From May 2010 to December 2014 there has been a 28% reduction in the number of specialist district nurses, a loss of 2,168 posts across England.

A reliance on using agency nurses means that the NHS would have spent an estimated £980 million on them by the end of the 2014/15 financial year, the RCN said.

As with GPs, the nursing workforce is ageing, with around 45% being over 45, the RCN added.

Skin cancer linked to package holiday boom

A boom in cheap package holidays in the 1960s is partly behind the “worrying rise” in skin cancers in pensioners, Cancer Research UK suggests.

Skin cancer linked to package holiday boomThe charity says that although all ages are at risk, many older people would not have been aware of how to protect themselves four decades ago.

Figures show that 5,700 over 65s are diagnosed with the condition each year, compared to just 600 in the mid-1970s.

The condition can often be prevented by covering up and avoiding sunburn.

Around 13,300 people are diagnosed with malignant melanoma – the most serious form of skin cancer – each year in the UK. And 2,100 lives are lost to the disease annually.

Numbers are increasing across all age groups but the steepest rise is seen in over-65s.

The charity said all ages are benefitting from public health messages explaining the dangers of holiday sun.

Professor Richard Marais of Cancer Research UK (CRUK), said: “It is worrying to see melanoma rates increasing at such a fast pace, and across all age groups.”

“It is important people keep an eye on their skin and seek medical opinion if they see any changes to their moles or even to normal areas of skin.”

Research suggests that getting sunburnt just once every two years can increase the odds of developing malignant melanoma.

Dr Julie Sharp, head of health information at CRUK, said: “You can burn at home just as easily as you can on holiday, so remember to spend time in the shade, wear a T-shirt and a hat to protect your skin and regularly apply sunscreen that is at least factor 15 and has four stars.”

Johnathon Major, from the British Association of Dermatologists, said: “The increasing incidence of skin cancer within the UK is alarming.

“As people are living longer, more people are reaching an age where they are at a higher risk. Interest in package holidays and in fashion tanning are among the reasons that more people are developing skin cancer.”

“But it’s crucial to remember that you don’t have to go on holiday or use a sun bed to heighten your risk. Skin cancers can develop as a result of both short term and long term overexposure to the sun’s rays within the UK.”

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.

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