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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.”

NHS medical legal costs- excessive should be capped

The UK government plans to limit excessive fees some lawyers claim in medical negligence cases against the NHS.

UK government plans to limits "excessive fees" some lawyers claim in medical negligence cases against the NHSOfficials want 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.

But solicitors warn the move could deny patients access to justice. Figures show the NHS was charged £259 million in legal fees for claims in 2013-14.

The NHS did recoup £74 million by challenging some claims made in 2013-14, but the Department of Health says taking these cases to court is costly and time consuming and believes further savings could be made.

Officials say their proposals, which will be open to public consultation in the autumn, would ensure lawyer’s fees are more proportionate and reflect the amount of compensation patients receive

They give as an example once case where a patient received £11,800 in damages but the legal fees, which the NHS had to recompense, totalled £175,000.

Health Minister, Ben Gummer, said: “Safe, compassionate care is my upmost priority and to achieve this, the NHS must make sure every penny counts.

“Unscrupulously, some lawyers have used patient claims to load grossly excessive costs onto the NHS and charge far more than the patient receives in compensation.”

The Medical Defence Union, which offers doctors guidance on medico-legal issues, supported the move.

Dr Matthew Lee, professional services director for the MDU, said: “Patients often need to meet part or all of these costs themselves but the system must provide access to justice where patients have been negligently harmed.”

“Legal fees must, therefore, be affordable and proportionate.”

“If it was decided to introduce a well-thought-out, fixed-cost structure for legal costs in clinical negligence claims that could only be a good thing and should result in legal fees becoming more affordable and proportionate to the compensation claimed by the patient.”

New cancer strategy could save thousands of lives

About 5,000 lives could be saved each year in England if GPs follow new guidelines on cancer diagnosis.

About 5,000 lives could be saved each year in England if GPs follow new guidelines on cancer diagnosis.The health watchdog NICE say that a new approach is necessary to tackle England’s lagging cancer survival rates.

The guidelines suggest all GPs order certain tests directly, side-stepping referrals to specialists first, to speed up access to treatment.

Charities say they support the changes but warn that more funds are needed.

Doctors have long agreed that the sooner most cancers are diagnosed, the greater the chance of survival.

But according to experts from the National Institute of Health and Care Excellence (NICE), although the situation is improving, thousands of lives are lost each year because tumours are being diagnosed too late.

The new guidelines make wide-ranging changes to previous recommendations, to encourage GPs to think of cancer sooner and lower the threshold at which people are given cancer tests.

For the first time the guidance focuses on key symptoms, rather than encouraging GPs to consider first which cancer a patient may have and then to cross check it with the symptoms.

The recommendations also say all GPs across England should be able to order some cancer tests directly, without waiting for an appointment with a specialist.

For example in certain cases, GPs will now be able to access CT scans and internal examinations such as endoscopies, without a specialist referral.

NICE hopes this will allow patients to get investigations more quickly and take the pressure off specialists’ time.

The committee has produced information to help patients spot the most common signs of cancer so they can seek medical advice quickly.

And the guidance encourages doctors to put “safety nets” in place to ensure difficult cases are not missed.

Patients whose symptoms are worrying but do not currently suggest cancer, for example, should be given follow-up appointments or advice on when to come back.

The Royal College of GPs welcomed the guidance but warned that there might not be enough capacity to do the extra scans and checks, which could cause a backlog and longer wait times for patients.

“It would be regrettable if something that was so well-intentioned resulted in patients being worse off,” said Dr Maureen Baker, chair of the RCGP.

Sara Hiom, from Cancer Research UK, said: “We know the strain the NHS is already under and the number of people diagnosed with cancer is increasing – further investment is essential in order to support this much needed shift in investigative testing. “

She added: “Research would indicate we do fewer diagnostic tests in this country than comparable countries, but there are a lack of workforce, perhaps a lack of kit, to do those tests, so patients may be missing out because there are delays, backlogs or bottlenecks and this really does need to be addressed.”

Health Direct agrees with Cancer Research that not enough diagnostic proceedures are taking place- but we warn that the resources to fund and undertake these extra processes are not in place.

New stroke treatment should be more available

Specialists are urging the NHS to make a new stroke treatment widely available.

New stroke treatment should be more availableStudies suggest the technique for removing blood clots in the brain doubles the chance of recovery for people who have suffered an ischaemic stroke.

The specially designed “Solitaire” stent is highly effective at catching and removing blood clots. However, it is currently only available at 28 specialist hospitals in the UK.

Stroke is one of the leading causes of disability in the UK, and the treatment could benefit a quarter of patients who have a particular type of blood clot in the brain.

Stents are normally used to hold open or strengthen damaged blood vessels, but experts realised this particular device was a very effective way to “catch” and remove blood clots.

The Solitaire stent is made of a nickel-titanium alloy and looks like a net.

The Solitaire stent is used more widely to treat strokes in nearly every other developed nation. In the UK, it is only being used in hospitals that specialise in interventional neuroradiology – and there are only 28 of those.

Anyone who has an ischaemic stroke needs to get to one of these centres within six hours to even have a chance of benefitting from it.

The health regulator for England and Wales, NICE, and Scotland’s regulator, SIGN, have yet to issue guidance.

The treatment has also won the backing of Chest Heart and Stroke Scotland, a group offering free advice and support to stroke survivors and their families.

Chief executive Mark O’Donnell said the Solitaire stent method was “far more effective than any other treatment available”.

He said: “This benefit is over and above that from clot busting alone and can sometimes be used even when patients cannot safely be given clot busting drugs.

“It is likely that 300 to 500 patients could potentially benefit from clot retrieval in Scotland each year. “If this could be delivered, then over 100 people would avoid serious disability and many others would achieve improved outcomes from their stroke.”