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NHS funding debate call by health experts

How the NHS is funded should be a national debate according to leading health experts.

NHS funding debate call by health expertsIn a letter to The Times, they say challenges from an ageing population mean the system is “creaking at the seams” and cannot continue as it is.

Signatories include the heads of the Royal College of Physicians and Royal College of Nursing.

Without action an extra £30 billion will be needed by 2020 to fund the NHS at current levels their letter adds.

They are asking for a cross-party, independent conversation on the way forward for the “scope, provision and funding of health and social care”.

The nine signatories say that in 50 years’ time, at least two-and-a-half times as many patients will suffer from multiple health problems.

Their letter says: “The status quo is not an option. We are already seeing the signs of the system creaking at the seams.”

Warning that “business as usual won’t do”, they assert there needs to be “an honest, open dialogue between politicians and citizens”.

“We need a new settlement; a fundamental, holistic agreement with the country on what health and social care should be, how and where it is delivered to maximise the quality of care, and how it should be paid for.”

This “national conversation” should start now and be completed by the end of 2015, the letter concludes.

Two signatories – Ciaran Devane, chief executive of Macmillan Cancer Support, and Turning Point chief executive Lord Adebowale – are non-executive directors of NHS England.

It is also signed by: Sir John Oldham, who chaired the Independent Commission on Whole Person Care; Jeremy Hughes, chief executive of the Alzheimer’s Society; Peter Carter, chief executive of the Royal College of Nursing; Maureen Baker, chairwoman of the Royal College of GPs; Sir Richard Thompson, president of the Royal College of Physicians; Jean-Pierre van Besouw, president of the Royal College of Anaesthetists, and Chris Hopson, chief executive of the Foundation Trust Network.

Obesity and diabetes drugs cost needlessly harms NHS

NHS Scotland has spent nearly £230 million on drugs to treat diabetes and obesity within the last three years figures have shown.

Obesity and diabetes drugs cost needlessly harms NHSThe diabetes drugs bill was £75.7 million in 2013-14, £73.2 million last year and £74.2 milion in 2011-12.  Another £6.1 million went on obesity prescriptions in the three year period.

The figures were obtained by the Conservatives who said the conditions were harming both sufferers and the NHS.

The Scottish government said obesity and diabetes were on the rise across Europe and Scotland was no exception. It said the problem was being taken seriously and a range of measures had been implemented to try to tackle it.

The most recent statistics suggested nearly a quarter of a million people in Scotland now have diabetes, almost 5% of the population. The majority of sufferers, about 220,000, have type 2 diabetes.

A total of 3.34 million items were dispensed to treat diabetes in Scotland in 2013-14.

The official figures revealed that obese patients were prescribed more than 52,000 items in the same period – about 1,000 a week – at a cost of £1.9 million.

That is up from the cost of £1.5 million in 2012-13, but lower than the previous year, when £2.7 million was spent on obesity prescriptions.

Conservative health spokesman, Jackson Carlaw, who obtained the figures, said: “Of course, not every case of diabetes is related to weight, there are a range of reasons. But the fact prescriptions for both diabetes and obesity are rising at an alarming rate year-on-year cannot be ignored.”

“While we need the NHS and Scottish government to do all they can to force through messages on healthy living, it isn’t just down to them.  There has to be a level of personal responsibility.”

“Obesity generally isn’t something you catch on a bus, and people know that a healthy diet and active lifestyle are what’s required to keep the weight down.  If they don’t, diabetes is just one of the serious conditions lurking round the corner.”

A Scottish government spokesman said: “Our diabetes action plan, which will be updated this summer, sets out a clear commitment to the prevention and early detection of diabetes and to improve the treatment and care of people with diabetes.

“Although the number of people with Type 2 diabetes has increased in the last year, the number of prescriptions per person has remained at the same level.

“We are supporting child healthy weight interventions and are increasing opportunities for children to get involved in sport and physical activity, through active schools and our target of all primary children having two hours of PE lessons a week.”

Dying need free social care cancer campaigners say

Free end of life social care is needed to save the NHS money and improve patient care claim cancer campaigners.

Dying need free social care cancer campaigners sayMacmillan Cancer Support says it could save the NHS in England £69 million a year on the care of cancer patients alone. Its analysis is based on a review of patient surveys, official NHS spending data and interviews with senior decision-makers.

Social care is currently means tested, but ministers are considering providing it to everyone at the end of life.  About half of people end up dying in hospital despite eight in 10 saying they would prefer to die at home.

Macmillan’s analysis said this equated to about 180,000 people spending their last days in hospital against their wishes.

The cost to the NHS of this was estimated to be £685 million a year, Macmillan said.

If those patients were cared for in the community via a combination of community NHS services and social care the cost would be £340 million – a saving of £34 5million.

Of those 180,000 patients, about 36,000 are cancer patients. This would equate to a saving of £69 million if they were able to die at home, Macmillan said.

Earlier this week the Association of Directors of Adult Social Services warned the current system of social care was “unsustainable” because of a lack of funding and rising demands.

Macmillan chief executive Ciaran Devane said: “We urgently need to reform end-of-life services in England. Every day around 100 cancer patients die in expensive hospital beds when they wanted to die at home.

“This is both morally wrong and a scandalous waste of precious NHS resources.”

A Department of Health representative said: “We want to make sure that people nearing the end of their lives can choose where to spend their last days and have more of a say on how they are cared for.  We are currently reviewing how to improve the quality and experience of care at the end of life and the system for funding it.”

Higher stroke and heart attack risk linked to faulty gene

Researchers have identified a gene that may put people at greater risk of strokes and heart attacks.

Higher stroke and heart attack risk linked to faulty gene Published in PLOS ONE The PlA1/A2 Polymorphism of Glycoprotein IIIa as a Risk Factor for Myocardial Infarction: A Meta-Analysis they say the gene fault may encourage the formation of blood clots – the ultimate cause of most heart attacks and strokes.

Scientists hope gene tests may help doctors one day to pinpoint individuals more likely to suffer these conditions, but experts say lifestyle factors such as smoking and exercise have the greatest influence on risk.

Around one in 10 people in the Caucasian population carries this variation of the gene, named PIA2.

And researchers from King’s College London reviewed more than 80 studies involving about 50,000 people – the largest analysis of this genetic fault to date.

They found individuals with PIA2 were more likely to have a stroke – caused by a blood clot blocking blood supply to the brain – than those without the gene.

Scientists calculate the gene increases a person’s risk of having a stroke by 10-15%.

But how significant this increase is depends on an individual’s baseline risk – influenced by factors such as smoking, diet, weight and exercise, the scientists say.

For people with two copies of the gene the risk rises by up to 70% from this baseline.

In a second study published in the same journal, the scientists show PIA2 is also linked to an increased risk of heart attacks in people under 45.

More research is needed to see whether this holds true for the whole population, they say.

About 150,000 people have a stroke in the UK each year and more than 100,000 heart attacks are recorded annually.

Both thrombotic strokes (the most common kind) and heart attacks are caused by blockage of blood vessels in the heart and brain – ultimately through the formation of clots.

The faulty gene appears to affect a protein called glycoprotein IIIa – present on platelets, natural clotting cells in the blood.

Platelets help trigger the formation of clots to stop bleeding after injury. But scientists say carrying the gene may render them overactive.  They caution that overall the genes play a smaller role in risk than more established factors, such as high blood pressure and obesity.

But developing a genetic test could help predict people at highest risk, allowing doctors to suggest more potent medication or lifestyle changes, they say.

Prof Albert Ferro, of King’s College London, who led the research said: “We would now need to validate this test and see how useful it is in the clinical world.

Leonardo da Vinci still teaching us about the heart

After Leonardo da Vinci dissected the heart of a man he produced the first known description of coronary artery disease.

Leonardo da Vinci still teaching us about the heartMore than 500 years later, coronary artery disease is one of the most common causes of death in the western world.

“He had a great mind, and he was willing to really look and see,” says Mr Francis Wells, a consultant cardiothoracic surgeon at Papworth Hospital in Cambridge, who has spent years studying Leonardo da Vinci’s anatomical drawings, which form part of the Royal Collection in Windsor.

His diagrams and sketches of the skull, skeleton, muscles and major organs fill countless notebooks while his theories on how they function fill many more pages.

But it was the heart that appeared to particularly fire his interest, from 1507 onwards, when he had reached his 50s.

In those drawings, he used his knowledge of fluids, weights, levers and engineering to try to understand how the heart functions. He also looked closely at the actions of the heart valves and the flow of blood through them.

Mr Wells’ book, ‘The Heart of Leonardo’, explores the artist’s drawings and writings on the organ, and he says his insights are “quite astonishing. The more we look, the more right we realise he was.”

Many of Leonardo’s conclusions, such as the description of how the arterial valves close and open – letting blood flow around the heart – holds true today, but is not widely known.

“Even cardiologists get this wrong now,” Mr Wells says. “Only with the use of MRI technology has knowledge of this subject been revisited.”

Many of Leonardo’s drawings were based on studies of hearts from ox and pigs. It was only later in life that he had access to human organs, and these dissections had to be carried out quickly in winter before the body began to degrade.

Contemporary dissections of the heart show he was correct on many aspects of its functioning. For example, he showed that the heart is a muscle and that it does not warm the blood.

He found that the heart had four chambers and it connected the pulse in the wrist with the contraction of the left ventricle.  He worked out that currents in the blood flow, created in the main aorta artery, help heart valves to close. And he suggested that arteries create a health risk if they fur up over a lifetime.

Mr Wells also believes that Leonardo realised that the blood was in a circulation system and may have influenced William Harvey’s discovery in 1616 that blood was pumped around the body by the heart.

Yet none of Leonardo’s theories or drawing were ever published during his lifetime. In fact, his notes were not rediscovered until the late 18th century – more than 250 years after his death.

With hindsight they may have had the potential to revolutionise surgery.

In the 16th century, for example, there was no treatment for cardiac disease, or many other diseases, and surgeons occupied a low status in society.

If people survived surgery, it was more by luck than judgement. Heart surgery has transformed in the past century, but Leonardo’s insights could have made a huge difference if they had been made public earlier.

Even now, however, there is common consensus that we have barely scratched the surface of what we know about the heart.

According to Mr Wells, Leonardo’s legacy is that we should follow the Renaissance Man’s example and continue to challenge, question and enquire rather than listen to accepted wisdom.

Personal breast cancer drugs hope after gene study

“Personalised” treatments for breast cancer are a step closer, according to research scientists at Cardiff University.Personal breast cancer drugs hope after gene studyThe scientists used gene technology to compare and contrast specific genetic errors in particular types of mouse breast cells. They were able to replicate “almost the entire spectrum” of aggressive breast cancer coming from one cell type.

It helps understanding of the disease, which has at least 10 different forms.

The research was led by Matt Smalley from the European Cancer Stem Cell Research Institute at Cardiff University and conducted in collaboration with colleagues from Spain, Brazil and the UK.

He said the work involved a genetic “trick” to study how one generic error manifested itself in two different cell types and what happened when different errors were in just one cell type.

“We now have strong evidence that here is one particular cell type in the breast associated with the most aggressive form of human breast cancer,” said Dr Smalley.

Breast cancer is the most common female cancer

  • Around 50,000 women and 400 men are diagnosed with breast cancer each year
  • One woman in eight will be diagnosed with breast cancer in their lifetime
  • Around 12,000 women and 80 men will die from breast cancer each year
  • More than 80% of women with breast cancer are still alive five years after diagnosis

Source: Breast Cancer Campaign

“In one part of the study, we created the same cancer-predisposing genetic errors in each of the two cell types. In another part, we created different genetic errors in the same cell type.”

He said is was remarkable that some of the cancers that formed in one cell type – oestrogen receptor negative luminal cells – resembled common human breast cancer types.

Dr Smalley said the cell type concerned responded to both normal menstrual cycles and the hormones of pregnancy by dividing to generate the extra cells needed for breast feeding.

Scientists suspected breast cancer occurs when these cells go wrong and start to divide at an inappropriate time, he said.

“These results add to our understanding of the origins of breast cancer diversity and emphasise the importance of understanding the biology of this cell type to better understand how breast cancer develops,” said Dr Smalley. “It takes us towards a way of personalising medicine, where “drugs X” is good for that particular type of breast cancer.”

Cancer Research UK senior science information manager Nell Barrie said: “This research takes us one step closer to understanding why we see so much diversity in breast cancer, and will help expose each cancer’s weakness so we can develop more effective and kinder treatments.”

Urgent action needed over weekend doctor numbers

With the weekend coming up Health Direct again warns- hospitals in the UK have a fraction of the number of doctors on site at weekends as they do during the week.

Urgent action needed over weekend doctor numbersOn average, doctor staffing levels at weekends were only 16% of those during the week. The figures also showed a difference in terms of the grades of doctors on duty.

Hospitals in England had an average of 86 consultants on a Wednesday, compared to just over eight in the afternoon at the weekend.

One medium-sized hospital, St Marys on the Isle of Wight, had 63 consultants in the building during the week, but none on a weekend afternoon.

The NHS published its last figures about patient mortality in 2011.

The survey of 14 million admissions showed that a patient is 11% more likely to die if admitted on a Saturday and 16% more likely to die if admitted on a Sunday than during the week.

Overall, patients stay longer in hospital when they are admitted at weekends.

They wait longer for a diagnosis and part of the reason for that is that there are not the senior doctors around in the departments that do the blood tests, X-rays and scans.

Prof Sir Bruce Keogh has set out a 10-point plan to achieve 24-hour, seven day a week staffing in hospitals. He wants to see it in place by 2017.

“It’s a bold plan because the NHS, like other parts of society, has not functioned the same at the weekend as it has in the week – but we need to do it with urgency.  The rest of society has moved on, all other service industries are starting to address how they provide more routine services at the weekend and it’s time we did so in health”.

But Sir Richard Thompson of the Royal College of Physicians thinks it will take longer.

“I think we’re heading in the right direction but I think the plan is optimistic. Without getting a large extra number of staff of all grades and all types I cannot see how we can get a full equal service on Monday, Tuesday, Wednesday, Thursday, Friday, Saturday and Sunday”.
‘Bit of a rest’

According to the research the Royal Liverpool Hospital has 7% of the level of staffing for doctors at the weekend compared to a Wednesday afternoon.

Another sticking point for Dr Williams is the attitude of staff:

“There may be some reluctance. It becomes more difficult when you tell people they will be on call 24/7 on site. That’s a big step.”

“Some of our specialties have already done it, but if I’m going out to consultants in their late 40s and 50s and saying, ‘I know you’ve been on your contract for 15 years, but I would now like you to be up all night on a Saturday or Sunday’, that’s a big ask”.

Smoking bans cut asthma and premature births by 10%

Laws banning smoking in public places have had a positive impact on child health, an international study in the Lancet suggests.Smoking bans cut asthma and premature births by 10%Researchers found a 10% reduction in premature births and severe childhood asthma attacks within a year of smoke-free laws being introduced.

A research team analysed 11 previous studies from North America and Europe.

The Royal College of Obstetricians and Gynaecologists said smoking bans benefitted adults and children.

This is one of the first large studies to look at how anti-smoking laws in different countries and states are affecting the health of children living in those regions.

Laws that prohibit smoking in public places, such as bars, restaurants and workplaces, have already been shown to protect adults from the dangers of passive smoking.

In this study, researchers from the University of Edinburgh, Maastricht University, Hasselt University in Belgium, Harvard Medical School and Brigham and Women’s Hospital looked at more than 2.5 million births and almost 250,000 hospital attendances for asthma attacks in children.

Dr Jasper Been, lead study author from the Maastricht University Medical Centre in The Netherlands, said the research on children under 12 was revealing.

“Our study provides clear evidence that smoking bans have considerable public health benefits for perinatal and child health, and provides strong support for WHO recommendations to create smoke-free public environments on a national level.”

The study also found a 5% decline in children being born very small for their age after the introduction of smoke-free laws.

Co-author Professor Aziz Sheikh, of Brigham and Women’s Hospital, in Boston, Massachusetts, and the University of Edinburgh, said there was potential to improve the health of more children.

“The many countries that are yet to enforce smoke-free legislation should in the light of these findings reconsider their positions on this important health policy question.”

Previous research suggests that 40% of children worldwide are regularly exposed to second-hand smoke, which has been shown to be a cause of respiratory disease and a trigger for asthma attacks in children.

Recent European research also showed that passive smoking causes thickening of children’s arteries which can increase the risk of heart attacks and strokes in later life.

Experts say children are particularly vulnerable to the negative effects of second-hand smoke because their lungs and immune systems are still developing.

At present, 16% of the world’s population is covered by smoke-free laws.

Commenting on the study, Professor Ronnie Lamont from the Royal College of Obstetricians and Gynaecologists said the study provided further evidence that smoking bans had substantial health benefits for adults and children.

“Smoking during pregnancy has been shown to have adverse effects on foetal development and pregnant women need to be informed of the risks and should be offered advice and support to help them give up. It is important that healthcare professionals encourage women to lead a healthy lifestyle.”

Pet cats infect two people with TB

Two people in England have developed tuberculosis after contact with a domestic cat, Public Health England has announced.Pet cats infect two people with TBThe two human cases are linked to nine cases of Mycobacterium bovis infection in cats in Berkshire and Hampshire. Both people were responding to treatment, PHE said.

M. bovis is the bacterium that causes tuberculosis in cattle, known as bovine TB, and other species.

Transmission of M. bovis from infected animals to humans can occur by breathing in or ingesting bacteria shed by the animal or through contamination of unprotected cuts in the skin while handling infected animals or their carcasses.

The nine cases of M. bovis infection in cats in Berkshire and Hampshire were investigated by PHE and the Animal Health and Veterinary Laboratories Agency (AHVLA) during 2013.

Tuberculosis (TB) is an infectious disease caused by a germ which usually affects the lungs.

Symptoms can take several months to appear and include:
•Fever and night sweats
•Persistent cough
•Losing weight
•Blood in your phlegm or spit

Almost all forms of TB are treatable and curable, but delays in detection and treatment can be damaging.

TB caused by M. bovis is diagnosed in less than 40 people in the UK each year. The majority of these cases are in people over 65 years old.

Overall, human TB caused by M. bovis accounts for less than 1% of the 9,000 TB cases diagnosed in the UK every year.

Those working closely with livestock and/or regularly drinking unpasteurised (raw) milk have a greater risk of exposure.

Public Health England

Screening was offered to people who had had contact with the infected cats. Following further tests, a total of two cases of active TB were identified.

Molecular analysis showed that M. bovis taken from the infected cats matched the strain of TB found in the human cases, indicating that the bacterium was transmitted from an infected cat.

Two cases of latent TB were also identified, meaning they had been exposed to TB at some point, but they did not have the active disease.

PHE said it was not possible to confirm whether these were caused by M. bovis or something else.

No further cases of TB in cats have been reported in Berkshire or Hampshire since March 2013.
‘Uncommon in cats’

Dr Dilys Morgan, head of gastrointestinal, emerging and zoonotic diseases department at PHE, said: “It’s important to remember that this was a very unusual cluster of TB in domestic cats.

“M. bovis is still uncommon in cats – it mainly affects livestock animals. These are the first documented cases of cat-to-human transmission, and so although PHE has assessed the risk of people catching this infection from infected cats as being very low, we are recommending that household and close contacts of cats with confirmed M. bovis infection should be assessed and receive public health advice.”

Out of the nine cats infected, six died and three are currently undergoing treatment.

Overweight seen as the norm warns chief medical officer

Being overweight is increasingly seen as the norm, England’s chief medical officer warns.
Overweight seen as the norm warns chief medical officerIn her annual report on the state of health, Dame Sally Davies said this was concerning, pointing out many people did not recognise they had a problem.

Parents of overweight children were also failing to spot the signs too, she said.

Dame Sally blamed the way weight was being portrayed by the media and clothes industry.

  •     Body mass index (BMI) is used to calculate whether a person is underweight, a healthy weight, overweight or obese for their height.
  •     It is calculated by measuring weight (in kilograms) and dividing it by height (in metres) squared to give a BMI score
  •     A BMI of 25 to 29.9 is considered overweight and one of 30 or above is considered obese.

“I have long been concerned that being underweight is often portrayed as the ideal weight, particularly in the fashion industry.

“Yet I am increasingly concerned that society may be normalising being overweight.

“Larger mannequins are being introduced into clothes shops and “size inflation” means that clothes with the same size label have become larger in recent decades.

“And news stories about weight often feature pictures of severely obese people, which are unrepresentative of the majority of overweight people.”

Dame Sally also reiterated her belief that a sugar tax may be necessary to combat obesity.

At the start of March she told the Health Select Committee it may be needed, although she hoped not.

This caused some controversy as the government’s approach has been characterised by working with industry to get them to make food and drink products healthier.

In her report she says this should continue, but if it fails to deliver a tax should be “considered”.

She said children and adults of all ages are consuming too much sugar.

Nearly two thirds of adults and a third of children are overweight or obese – classed as a body mass index of above 25. This is about double the numbers in the early 1990s.