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Millions of Ebola vaccine doses ready by end of 2015

Millions of doses of experimental Ebola vaccines will be produced by the end of 2015 the World Health Organization has announced.

Millions of Ebola vaccine doses ready by end of 2015The WHO said “several hundred thousand” would be produced in the first half of the year and vaccines could be offered to health workers on the frontline in West Africa as soon as December 2014.

However, the WHO cautioned that vaccines would not be a “magic bullet” for ending the outbreak as there is no proven cure or vaccine for Ebola.

In response to the largest epidemic of the disease in history, the WHO is accelerating the process of vaccine development- it normally takes years to produce and test a vaccine, but drug manufacturers are now working on a scale of weeks.

Two experimental vaccines, produced by GlaxoSmithKline (GSK) and the Public Health Agency of Canada, are already in safety trials.

The GSK vaccine is being tested in Mali, the UK and the US. Research on the Canadian vaccine is also under way in the US with further trials expected to start in Europe and Africa soon.

The results are expected in December. After that, trials will move to countries affected by Ebola, probably starting with Liberia. That will allow researchers to assess how effective the vaccine is and what dose is needed to provide protection.

Healthcare workers, who place themselves at risk when treating patients, will take part in the first trials in West Africa.

The WHO says we should have the first hints of how effective these experimental vaccines are by April.

There are no plans for mass vaccination before June 2015 but the WHO has not ruled it out.

The WHO says vaccines are likely to be key to ending the outbreak, even if cases fall in the next few months.

Dr Marie Paule Kieny, a WHO assistant director-general, said: “While we hope that the massive response, which has been put in place will have an impact on the epidemic, it is still prudent to prepare to have as much vaccine available as possible if they are proven effective.

“If the massive effort in response is not sufficient, then vaccine would be a very important tool. And even if the epidemic would be already receding by the time we have vaccine available, the modelling seems to say vaccine may still have an impact on controlling the epidemic.”

The vaccine plan was the culmination of a day of talks at the WHO in Geneva.

As well as the two vaccines already in trials, there are a further five in the pipeline which could yet play a role in the outbreak.

The World Bank and the charity Medecins Sans Frontieres will help finance the vaccine.

There are also suggestions that an “indemnity fund” could be set up in case people have a serious adverse reaction to a vaccine being rushed through, but until a vaccine is found to prevent the virus from spreading, treating and isolating sufferers will remain the key strategy for containing the outbreak.

NHS needs extra cash and overhaul claim health bosses

A five year plan for the NHS unveiled by six national bodies claims to have found an annual £30 billion budget shortfall.

NHS needs extra cash and overhaul claim health bossesTheir report said changes, such as GP practices offering hospital services, would help to plug a large chunk of the gap, but health chiefs said the NHS would still need above inflation rises of 1.5% over the coming years.

That works out at an extra £8 billion a year above inflation by 2020. The current budget stands at £104 billion a year, but all the political parties have already started talking about what they would do in the next Parliament.

Health Secretary Jeremy Hunt said difficult decisions needed to be taken, but added the Conservatives were committed to “protecting and increasing” funding in real terms.

“A strong NHS needs a strong economy, then it is possible to increase spending this report calls for.”

Labour’s shadow health secretary Andy Burnham said some of the proposals were ideas Labour had already suggested.

“We’ve have found an extra £2.5 billion for the NHS, we’ve said that the NHS will be our priority in the next Parliament, and alongside that, we’re saying that the time has come to bring social care into the NHS.”

The Liberal Democrats have said they will make sure the budget rises above inflation.

The five year plan – called the NHS Forward View – also said the future of the health service depended on it becoming more efficient.

To achieve this, it called for a rethink about the way services were delivered and it put forward a range of models – although it stressed it was up to each local area to decide which ones to adopt.

These include:

  • Large GP practices to employ hospital doctors to provide extra services, including diagnostics, chemotherapy and hospital outpatient appointments
  • In areas where GP services are under strain, hospitals could be encouraged to open their own surgeries
  • Smaller hospitals to work as part of larger chains, sharing back-office and management services
  • Larger hospitals to open franchises at smaller sites, as Moorfields Eye Hospital has done in London
  • Hospitals to provide care direct to care homes to prevent emergency admissions
  • Volunteers could be encouraged to get more involved, by offering council-tax discounts

Many of these measures are designed to curb the rise in hospital admissions and the impact of the ageing population – the source of most pressure in the health service.

But the report – produced by NHS England, Public Health England, the regulator Monitor, the NHS Trust Development Authority, Care Quality Commission and Health Education England – also said more needed to be done to reduce obesity, smoking and drinking rates.

It also suggested employers should be encouraged to incentivise their staff to become healthier by taking steps such as offering them shopping vouchers for healthy behaviour.

NICE conflicts of interest call doctors claim

Doctors are calling on MPs to investigate potential conflicts of interest at the health spending watchdog NICE.

NICE conflicts of interest call doctors claimIn a letter to the Health Select Committee, they have expressed concern about financial ties to drug companies among experts working for NICE- the National Institute for Curbing Expenditure.

The concerns follow controversy over the recent NICE guideline on statin drugs.

The letter reflects continuing disquiet among some doctors and researchers over the recent decision by NICE to extend the availability of cholesterol-lowering drugs to millions of people at low risk of developing heart disease.

A majority on the NICE panel that recommended this had ties to pharmaceutical companies. Their interests were declared but the letter argues that is not enough to ensure impartiality.

“Transparency is important but accuracy and objectivity should be the gold standard expected of an independent panel,” it says.

The letter argues disclosure of a conflict of interest may even make matters worse because experts may feel “licensed” to emphasise their advice still further.

NICE rules stipulate that members of advisory committees should not have had a personal financial interest in a related company in the last 12 months.

One of the letter signatories, the former Conservative shadow health minister Lord Ian McColl, said this was dubious.

“They could have had millions paid before the 12 months. It really needs to be tightened up.”

Another signatory, a London cardiologist Dr Aseem Malhotra, urged NICE to act.

“I have always had tremendous respect for NICE but their conflicts-of-interest policy clearly needs to be strengthened so that the medical profession and patients can feel fully confident that decisions are made completely independent of personal or industry interests.”

The letter is clear that there is no suggestion of any impropriety, but it says the governance arrangements for conflicts of interest at NICE are “not fit for purpose”.

It proposes the establishment of “more independent panels” to minimise the possibility of conflicts of interest, and calls on the Health Select Committee to consider looking into the issue “as a matter of urgency”. They will discuss the matter later today.

In June, a letter supported by many of the same signatories argued that plans to extend the use of statins should be scrapped. It said NICE had used data which “grossly underestimated” the side-effects.

Ebola screening extended to more UK airports

Passenger screening for Ebola is to be extended from Heathrow and Gatwick to Manchester and Birmingham airports.

Ebola screening extended to more UK airportsStaff at the two airports will begin checking passengers from at-risk countries after it is introduced at Heathrow, Gatwick and Eurostar last week. Screening of arrivals from West Africa, where 4,500 have died in the outbreak, started at Heathrow on Tuesday.

David Cameron earlier urged other countries to follow Britain’s lead in tackling the Ebola outbreak. The prime minister described it as “the biggest health problem facing our world in a generation” and called on other nations to “look at their responsibilities”.

Canada and the US have already introduced increased screening of travellers arriving at airports from West Africa. France is to check passengers flying to Paris Charles de Gaulle Airport from Guinea’s capital Conakry from Saturday.

In September, about 1,000 people arrived in the UK from Ebola affected countries in West Africa. There are currently no direct flights to the UK from the three worst affected countries – Sierra Leone, Liberia and Guinea.

British Airways recently suspended flights between Britain and Liberia and Sierra Leone because of the “deteriorating public health situation” in the two countries.

Public Health England initially ruled out screening because the risk of Ebola arriving in the UK was low and would mean screening “huge numbers of low-risk people”.

Downing Street said the Chief Medical Officer for England, Dame Sally Davies, still regarded the risk to the UK as “low”.

Announcing that airport screening would be extended, Chief executive of Public Health England Duncan Selbie said the challenge of introducing screening at Heathrow was “phenomenal”.

In a weekly message to staff, he said that once the existing measures covering Heathrow, Gatwick and the Eurostar terminal at St Pancras had “settled”, they would be rolled out to Manchester and Birmingham.

“Please be assured that we are thinking hard and listening carefully to those on the ground to see how we can make this more sustainable,” he said. “What I am certain of is that we have the people who know how to keep the country safe and that is exactly what we will do.”

On Friday, a senior Doctors Without Borders official said recent pledges of help and deployments to Africa’s Ebola-hit regions have had no impact on the epidemic.

It follows the launch of another urgent appeal for funds by the UN to help fight the virus after a $1 billion trust fund which opened last month received just $100,000 (£62,000).

NHS mistakes costing £2.5 billion a year

Mistakes in hospitals in costing the NHS up to £2.5bn a year according to the Health Secretary Jeremy Hunt.

NHS mistakes costing £2.5 billion a yearAs a result the NHS could afford to hire more nurses if the errors were cut out, Mr Hunt claimed during a speech in Birmingham.

Cost is incurred through problems like medication errors, avoidable infections after surgery, and litigation.

In his speech Mr Hunt described these kind of mistakes as “expensive and wasteful” at a time when hospital trusts are trying to save money.

He said: “I want every director of every hospital trust to understand the impact this harm is having not just on their patients, but also on their finances.

“And I want every nurse in the country to understand that if we work together to make the NHS the safest healthcare organisation in the world, we could potentially release resources for additional nurses, additional training, and additional time to care. More resources should be invested in improving patient care rather than wasted on picking up the pieces when things go wrong.”

Jeremy Hunt Mr Hunt wants hospital trust directors to understand the financial impact of harm

A recently-published report commissioned by the Department of Health (DoH) described what it termed as “preventable adverse events” rather than mistakes, as costing the NHS “a significant amount of money”.

It estimates the cost of such mistakes are “likely to be more than £1 billion” – and could possibly be as high as £2.5 billion a year.

Last year the NHS spent £1.3 billion on payouts after being sued by patients over care errors.

Four areas of poor patient safety highlighted by the DoH include falls and trips, bed ulcers, urinary infections caused by poorly fitted catheters, and deep vein thrombosis.

Mr Hunt’s words will mark the start of a poster campaign warning staff about the financial problems basic errors cause.

The health secretary is due to argue that it would be wrong to set targets or “issue a new ministerial decree” in an effort to cut out such problems – instead he favours a “cultural change” to make hospitals safer.

But Dr Peter Carter, chief executive of the Royal College of Nursing, said the government needed to invest in more staff before patient care can be improved.

He said: “Falls and preventable conditions such as pressure ulcers happen when there are not enough staff on a ward to care properly for every patient, not because nurses are unaware that these things should be prevented.”

People dying at home lack expert support

The NHS is failing to provide expert 24 hour support for the majority of patients dying at home in England.

People dying at home lack expert supportAround 92% of NHS clinical commissioning groups (CCGs) do not provide round the clock telephone help lines, the charity Sue Ryder said- even though there are half a million carers for terminal patients in England.

The research by Sue Ryder said there is an “obvious inequality” between help and advice for the start and the end of life, with 24-hour, seven-day-per-week help available for maternity issues.

The charity asked all of the 211 clinical commissioning groups (CCGs) in England whether they had commissioned 24-hour end-of-life care support, including help lines staffed by nurses.

Out of 180 CCGs which responded to requests for information from the charity, only 8% said their local area had a dedicated 24-hour help line and palliative care coordination centre.

A poll of 2,048 UK adults conducted by Populus on behalf of Sue Ryder suggested that around four out of five people support the availability of 24-hour advice for those who are dying.

Around the same proportion of people think 24-hour emergency home visits should be available to alleviate pain and other symptoms.

The Leadership Alliance for the Care of Dying People-  a group of government bodies, health experts and charities, published official guidance in June specifying that palliative care should include access to telephone support.

“Service providers and commissioners are expected to ensure provision for specialist palliative medical and nursing cover routinely 9am to 5pm seven days a week and a 24-hour telephone advice service,” the guidance said.

According to the National Institute for Curbing Expenditure (NICE), service providers should ensure that carers and terminally ill should be offered information “in an accessible and sensitive way, in response to their needs and preferences.”

Care should be “coordinated effectively”, the NICE guidelines from 2011 add.

Bee Wee, NHS England’s national clinical director for end of life care, said: “Over the past year we have been working hard to make changes and move towards a palliative care service that gives everyone a choice about how and where they spend their final days.

“It is really important that dying people, and those close to them, have access to care, support and advice whenever they need it, so we support this as an important issue to address.”
‘Terrifying experience’

Sue Ryder chief executive Heidi Travis said: “People who are dying, their carers and their families should be able to access the care they want, when they want. Unfortunately many areas of the country simply don’t have the services in place to make this ambition a reality.”

Despite concerns from some charities and carers, the UK has some of the best-rated end-of-life care in the world, according to the Worldwide Palliative Care Alliance (WPCA).

The UK ranks with the Australia, Austria, Norway, and the US as having the best-rated palliative care, while Egypt, Ethiopia, Morocco, Mozambique, and Pakistan have some of the worst-rated care.

Around 98 countries around the world have no hospice or palliative care.

Type 1 diabetes- possible cure

The possibility of a cure for type 1 diabetes has recently taken a “tremendous step forward”, scientists have announced.

Type 1 diabetes- possible cureThe disease is caused by the immune system destroying the cells that control blood sugar levels.

A team at Harvard University used stem cells to produce hundreds of millions of the cells in the laboratory. Tests on mice showed the cells could treat the disease, which experts described as “potentially a major medical breakthrough”.

Beta cells in the pancreas pump out insulin to bring down blood sugar levels.

But the body’s own immune system can turn against the beta cells, destroying them and leaving people with a potentially fatal disease because they cannot regulate their blood sugar levels.

Type 1 is different to the far more common type 2 diabetes which is largely due to poor lifestyle.

The team at Harvard was led by Prof Doug Melton who began the search for a cure when his son was diagnosed 23 years ago. He then had a daughter who also developed type 1.

He is attempting to replace the approximately 150 million missing beta cells, using stem cell technology. He found the perfect cocktail of chemicals to transform embryonic stem cells into functioning beta cells.

Tests on mice with type 1 diabetes, published in the journal Cell, showed that the lab-made cells could produce insulin and control blood sugar levels for several months.

Dr Melton said: “It was gratifying to know that we could do something that we always thought was possible. We are now just one pre-clinical step away from the finish line.”

However, his children were not quite so impressed: “I think, like all kids, they always assumed that if I said I’d do this, I’d do it.”

If the beta cells were injected into a person they would still face an immune assault and ultimately would be destroyed. More research is needed before this could become a cure.

Sarah Johnson, from the charity JDRF which funded the study, told the BBC: “This isn’t a cure, it is a great move along the path. It is a tremendous step forward. Replacing the cells that produce insulin as well as turning off the immune response that causes type 1 diabetes is the long-term goal.”

Prof Chris Mason, a stem cell scientist at University College London, said: “A scientific breakthrough is to make functional cells that cure a diabetic mouse, but a major medical breakthrough is to be able to manufacture at large enough scale the functional cells to treat all diabetics.

“This research is therefore a scientific and potentially a major medical breakthrough. If this scalable technology is proven to work in both the clinic and in the manufacturing facility, the impact on the treatment of diabetes will be a medical game-changer on a par with antibiotics and bacterial infections.”

Increase in paramedics quitting NHS jobs

Increasing numbers of paramedics are leaving NHS ambulance services, according to new research.

Increase in paramedics quitting NHS jobsSenior staff say remaining paramedic crews are under greater pressure than ever before to meet demand. At least 1,015 paramedics left their job in 2013-14, compared with 593 in the same period two years earlier.

London Ambulance Service saw 223 paramedics leave in 2013-14, four times the number in 2011-12, and the largest increase in the country.

An internal document, produced by London Ambulance Service and seen by BBC Radio 4′s The Report programme, suggests morale among paramedics is low.

It says three-quarters of paramedics surveyed had considered leaving the service in the past 12 months.

Anonymous paramedics quoted in the report point to rising workloads as one of their greatest grievances.

But this is not just a London problem.

Association of Ambulance Chief Executives chairman Anthony Marsh says a surge in 999 calls this year and higher numbers of paramedics leaving some services, means the remaining front-line staff are facing pressures that are “greater than they’ve ever been”.

“Traditionally, ambulance services receive just over 4% more 999 calls each year, and we have done for the last 10 years – some years a little bit more than that, some a little bit less – but this year we’re seeing substantially more 999 calls,” says Dr Marsh.

This growth in emergency calls has outpaced the rise in numbers of qualified ambulance staff, which has increased on average by 1.6% each year in England over the past decade.

In 2011-12, there were 13,828 paramedics employed by the 12 of the 13 emergency ambulance trusts in the UK that responded to a request for the data by the BBC. This grew to 15,004 in 2013-14.

Dr Fiona Moore, medical director for London Ambulance Service, estimates there is a shortfall nationally of up to 3,000 paramedics.

And she says expectations of what the service is for have also changed.

“We’ve seen an increase in calls from the 21- to 30-year-old group, and I think that now reflects the sort of supermarket culture we now have, so if you can buy a loaf of bread at 04:00 in the morning, why can’t you access your healthcare when it’s convenient to you?” she says.

The trust in London is taking action to try to reduce staff workloads, and improve the service.

It has offered more than 180 paramedics jobs on a recruitment expedition to Australia and New Zealand and has recently increased the number of calls that do not receive an ambulance but are instead referred on to other services.

But nationally, the number of new paramedics recruited in 2013-14 was lower than the year before, and some paramedics are concerned that the number of new recruits coming through degree courses is too low to meet demand.

More European doctors in NHS than ever

There are “more doctors than ever” coming to work in Britain from Europe, says the General Medical Council.

RMore European doctors in NHS than everSouthern Europe now provides more doctors than South Asia to the UK- which was previously the main source. The GMC said the tightening of immigration rules for people outside the continent could explain the change.

In an annual report, the regulator also said more women were working in “traditionally male” areas such as surgery and emergency medicine. It said the profession would soon have equal numbers of men and women.

In total, the number of doctors coming to Britain from overseas increased 8% from 5,204 in 2008 to 5,619 in 2013. Of these, in 2008, 18% were from southern Europe and 28% from South Asia. This changed to 33% from southern Europe and 20% from South Asia in 2013.

Overall there were 259,650 doctors in the UK in 2013.

The GMC’s report said: “We do not know all the reasons for these changes but some are already clear – after changes to immigration rules in 2010 it became harder for international medical graduates to secure training and employment here.”

It also said the economic downturn in Europe and the increased opportunity for European Economic Area graduates to work in the UK following changes in 2004 and 2007 were behind the rise.

Meanwhile, doctors working in primary care repeatedly described feeling “overloaded” and “at risk of burning out” said the report.

GMC chief executive Niall Dickson said potential shortages in specialist areas, such as public health and occupational medicine, with diminishing numbers of doctors in postgraduate training and large numbers of those aged over 50 were of “particular concern”.

Mr Dickson said: “Recruitment in some parts of the UK, especially deprived areas and more remote communities, is also a significant challenge.”

He also said the needs of patients were changing with many living longer, with more long-term conditions.

“The challenge for governments, educators and those who commission services must be to work together to make sure we have a medical workforce with the right skills and one which is adequately resourced, trained and supported to meet those needs,” he added.

Drinking alcohol when pregnant- what are the risks?

Women who drink alcohol and are pregnant at the time are seeking abortions under the misapprehension their babies will suffer foetal alcohol syndrome (FAS).
Drinking alcohol when pregnant- what are the risks?The British Pregnancy Advice Service (BPAS) says there is “no need” for an abortion in such cases, as there is “minimal” damage to babies from isolated episodes of binge drinking by their mothers.

FAS is a rare but serious condition that can cause:

  •     facial deformities
  •     restricted growth
  •     learning and behavioural disorders
  •     a poor memory or short attention span

Statistics for the incidence of the disorder in the UK are not available, but in America, experts say 0.2 to 1.5 cases occur for every 1,000 live births in certain areas of the country.

BPAS says this risk is incredibly small and women should not needlessly fear their behaviour has damaged their baby.

A Danish study in 2012 of more than 1,600 women suggested low-to-moderate drinking was not linked to adverse neurological effects in five-year-olds, but heavy, weekly drinking was associated with a lower attention span in the children.

What are the guidelines for drinking alcohol during pregnancy?

Up until the 1980s, pregnant women were advised to drink stout to boost their iron levels. Official advice today is somewhat different.

Pregnant women should avoid alcohol altogether, says the British government. And if alcohol really must be consumed, it should be limited to the equivalent of one small glass of wine, once or twice a week, it adds.

This advice is mirrored by the Royal College of Obstetricians & Gynaecologists, (RCOG), which says the safest option for women is not to drink at all for the first 12 weeks and then minimal amounts per week after that.

Meanwhile, national guidelines from the National Institute for Health and Care Excellence say women should not drink for the first three months of their pregnancy, to minimise the risk of miscarrying.

And after that, it says pregnant mothers should drink only one to two units a week.

Alcohol can disrupt the baby’s normal development in the womb, its health at birth, susceptibility to illness in infancy, childhood, teenage years and later life, warns the RCOG.
Woman and man drinking Binge drinking during pregnancy tends to have an “all or nothing” effect, says the RCOG

It says the effects of drinking are “most harmful” just before pregnancy, due to the way alcohol hampers fertility, in both men and women – the mechanism of which is largely unknown.

Later in pregnancy, the shared blood supply between the mother and her baby via the placenta means that any alcohol that is consumed could easily reach the baby.

Before this – soon after conception and often prior to the woman finding out she is pregnant – could be a different matter.

There is limited evidence about how alcohol affects the baby before there is a direct line between the mother and baby’s blood supply, which happens about week four of pregnancy, the point at which a woman might be aware of missing her period and suspecting she is pregnant.

Understandably, it is ethically difficult to study. This uncertainty means experts often err on the side of caution when providing advice

The jury is largely out about exactly how much alcohol can be drunk during pregnancy, and when.

New draft guidelines from the government are expected to be released in the middle of next year – until then, the Department of Health suggests anybody concerned they have drunk too much alcohol during pregnancy should contact their doctor.