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Good News on World Cancer Day

The cancer death rate for men fell by 12% and for women 8% between 2003 and 2013.

The cancer death rate for men fell by 12% and for women 8% between 2003 and 2013

In 2013, 284 out of every 100,000 people died from cancer. In 2003, it was 312. Improvements in diagnosis and treatment are thought to be the reason.

The death rate for men fell 12% and for women by 8%, narrowing the gender gap.

But the actual number of cancer deaths rose – from 155,000 in 2003 to 162,000 in 2013 – as more people live longer and develop the disease in old age.

“The population is growing, and more of us are living longer,” Cancer Research UK chief executive Sir Harpal Kumar said.

Almost half of all the cancer deaths in 2013 were from lung, bowel, breast or prostate cancer.

Although the combined death rate for these four cancers had dropped by about 11% over the past 10 years, some other cancers, such as liver and pancreatic, had increased death rates.

Sir Harpal said: “Too many people are still being diagnosed with and dying from cancer, not just here in the UK but around the world.”

He said CRUK was focusing research on how to achieve earlier diagnosis and manage hard-to-treat cancers.

“Our scientists are developing new tests, surgical and radiotherapy techniques, and drugs,” he said.

“It’s important to celebrate how much things have improved, but also to renew our commitment to saving the lives of more cancer patients.”

Cancer Research UK compiled the cancer death rate data, which was taken from cancer registries in England, Wales, Scotland and Northern Ireland.

Health Direct cheers the great news that half of cancer sufferers now survive the diagnosis.

David Bowie thanked by end of life care doctor

A doctor specialising in end of life care has  thanked David Bowie helping people to talk about death.

A doctor specialising in end of life care has thanked David Bowie helping people to talk about deathDr Mark Taubert, palliative care consultant at Velindre NHS Trust in Cardiff, said it prompted a “weighty” discussion with a dying woman.

His letter, published on the blogs website page of the British Medical Journal (BMJ), has been retweeted by Bowie’s son, Duncan Jones.

The singer died from cancer aged 69.

Mr Jones had not tweeted since confirming his father’s death, which happened in New York on 10 January.

But he retweeted a link to the letter, where Dr Taubert described the conversation he had with the woman after she had been told her cancer had spread and that she would not live much longer than a year.

Starting the letter with “Dear David”, Dr Taubert wrote: “We discussed your death and your music, and it got us talking about numerous weighty subjects, that are not always straightforward to discuss with someone facing their own demise.

“In fact, your story became a way for us to communicate very openly about death, something many doctors and nurses struggle to introduce as a topic of conversation.”

He went on: “We talked about palliative care and how it can help.

“She told me about her mother’s and her father’s death, and that she wanted to be at home when things progressed, not in a hospital or emergency room, but that she’d happily transfer to the local hospice should her symptoms be too challenging to treat at home.

“We both wondered who may have been around you when you took your last breath and whether anyone was holding your hand.

“I believe this was an aspect of the vision she had of her own dying moments that was of utmost importance to her, and you gave her a way of expressing this most personal longing to me, a relative stranger.”

Dr Taubert also said dying at home and the last photos of Bowie carrying “off a sharp suit” would help people deal with any fears they had about the last weeks of life.

“You looked great, as always, and it seemed in direct defiance of all the scary monsters that the last weeks of life can be associated with,” he added.

Overseas nurses denied NHS jobs

Thousands of nurses were denied permission to work in England last year- despite hospitals facing staff shortages.

Thousands of nurses were denied permission to work in England last year- despite hospitals facing staff shortages
The Royal College of Nursing (RCN) has found that the refusals have hit high profile hospitals in Cambridge, Newcastle and Manchester.

A Freedom of Information request to the Migration Advisory Committee (MAC) found more than 2,341 refusals.

The RCN asked for the number of applications to allow overseas (non-European Union) nurses to work in England between April and November 2015 and the number refused.

It found that East Lancashire Hospitals NHS had the highest number of refusals with 300 out of 300 applications.

The research found that Brighton and Sussex University Hospitals and North Cumbria University Hospitals both had about 240 refusals.

Snapshot of FOI request results- total application for restricted certificates to allow overseas nurses
NHS Trust                     Total applications                            Total refused
Newcastle Hospitals                127                                                 85
The Queen Elizabeth Hospital King’s Lynn     157                    82
Central Manchester University Hospitals        195                    75
Cambridge University Hospitals (including Addenbrooke’s)     123     66
Bedford Hospital                     150                                                 45
Luton and Dunstable Hospital                             31                    15

Nursing was temporarily placed on the MAC shortage occupation list (allowing more overseas nurses) in December.

Janet Davies, chief executive of the RCN, said: “These figures show that when nursing is not on the list, many trusts are unable to recruit enough nurses, which could have an impact on patient care.”

Catherine Morgan, director of nursing at The Queen Elizabeth Hospital in King’s Lynn, she had been prevented from recruiting a number of overseas nurses.

“It is frustrating because we are running a hospital and do want it to be safe, and we had the opportunity to recruit from India and the Philippines and we had nurses keen to come over but haven’t been able to bring them over,” she said.

A Department of Health spokesman said: “The MAC is currently reviewing the shortage occupation list. Staffing is a priority and there are already more than 8,500 more nurses on our wards since 2010 and 50,000 more nurses in training.

“We want more home-grown staff in the NHS and our recent changes to student funding will create up to 10,000 more nursing, midwifery and allied health professional training places by 2020.”

Hospital staffing levels affect death rates

Fewer patients die after emergency surgery in hospitals that have more doctors and nurses.

Fewer patients die after emergency surgery in hospitals that have more doctors and nursesThe research, published in the British Journal of Anaesthesia, analysed data involving nearly 295,000 patients.

The findings stood despite patients at these hospitals being sicker and suffering more complications.

Researchers also found death was more likely following a weekend admission, which they said showed staffing was factor in the so called weekend effect.

That is the term given to the on going debate about Saturday and Sunday services.

Ministers in England are looking to improve staffing levels on the weekend, citing previous research as the basis for their policy.

Higher rates of death following weekend admissions and among babies born at weekends have been identified in two papers published by the British Medical Journal since the summer.

While this study confirms what would be expected – better resourced hospitals provide better care – it is this link with weekend care that has sparked interest.

The St George’s University of London team looked at what factors were behind variation in death rates following emergency abdominal surgery at 156 NHS trusts between 2005 and 2010.

This included surgery on ulcers, to remove appendixes and repair hernias.

While only a small number died within 30 days – just over 12,000 patients – there were small but significant variations in the death rates between those hospitals with the highest level of staffing and those with the lowest.

The third of hospitals with the lowest number of doctors per bed had death rates 7% higher than the third with the most. The difference was the same for nurse staffing levels.

Weekend admissions for emergency surgery led to an 11% increased risk in death compared with weekdays.

Lead researcher Dr Peter Holt said it was likely there would be a number of factors behind the higher death rates at weekends, but “clearly” staffing was one. “We need to ensure the whole system is safe seven days a week,” he said.

But he added the government needed to focus on getting emergency care right before even thinking about non-urgent services.

Royal College of Nursing general secretary Janet Davies said the study highlighted the importance of supporting “hard-working” staff.

“The NHS could reduce its staff turnover and save on the cost of temporary staff if it valued and invested in its permanent staff,” she said. “The benefits for all – staff, patients, and the NHS itself would be immeasurable.”

Health Direct praises hard working doctors and nurses in the NHS- but points out the current discussions on junior doctors is just one aspect of increased effectiveness- 7 day week diagnostics and consultants also needs to be addressed.

AnE visits for alcohol poisoning double in six years

Hospital visits for alcohol poisoning have doubled in six years- with the highest rate among females aged 15 to 19.

Hospital visits for alcohol poisoning have doubled in six years- with the highest rate among females aged 15 to 19.With the holiday season on us emergency admissions due to the effects of alcohol, such as liver disease, have also risen by more than 50% in nine years to 250,000 a year in England.

Rates were highest in deprived areas and in the north, and among men aged 45-64, the Nuffield Trust revealed.

The Nuffield Trust said their figures were an underestimate of the impact of drinking because they did not include alcohol -fuelled falls and fights, just illnesses such as alcohol poisoning and liver disease.

Nor do they count people who come to A&E drunk and are then sent home without being treated or admitted as a patient.

Half of all A&E attendances likely to be due to alcohol poisoning – when a person drinks a toxic amount of alcohol, usually over a short period of time – took place on a Friday, Saturday or Sunday, peaking between midnight and 2am.

Three in four arrived by ambulance – putting a strain on already stretched resources, said the Nuffield Trust.

Young women aged 15 to 19 were admitted to hospital for alcohol poisoning 1.4 times as often as young men in the same age group.

A&E attendance rates that are likely to be due to alcohol poisoning and emergency hospital admissions linked to alcohol were three to four times higher in the poorest fifth of the population, the figures showed.

The report also reveals the number of people actually being admitted to hospital with alcohol-related problems, such as liver disease.

Men aged between 45 and 64 made up the largest share of this group.

Joint author of the report Claire Currie said: “With the Christmas party season in full swing, it’s worth considering the full burden over-indulgence in alcohol is placing on our NHS, as well as the obvious human cost.

“Our research has uncovered a picture of rising and avoidable activity in hospitals, representing a stark challenge for the Health Service at a time when it’s already great pressure. Hospitals alone cannot tackle this issue – the government must consider measures such as minimum unit pricing, restricting availability and limiting marketing and advertising.”

In England in 2013, approximately 18% of men and 13% of women drank at a level considered to be putting them at increased risk of harm.

In 2013/14, approximately 1 in 20 emergency admissions in England were related to alcohol.

Figures from the Office for National Statistics suggest binge-drinking among young adults in Britain is continuing to fall, and more than a fifth of UK adults now say they do not drink alcohol at all.

A government spokesman said: “People should always drink alcohol responsibly – very busy ambulance services and A&E staff can do without this extra demand.

“The government has taken action to tackle cheap alcohol by banning the lowest priced drinks and we are already seeing fewer young people drinking on a regular basis.”

Health Direct repeats the maxim- please drink moderately over the festive break.

Locum doctors increase risk of health problems

Figures from the General Medical Council (GMC) show that in the three-year period to 2013, locums working in the acute sector were attracting almost twice as many complaints as staff doctors.

Figures from the General Medical Council (GMC) show that in the three-year period to 2013, locums working in the acute sector were attracting almost twice as many complaints as staff doctorsThat amounted to more than 250 locums being complained about with the majority of those complaints result in a formal investigation.

“I do not want to demonise locums,” the GMC’s chief executive Niall Dickson said. “Lots of good doctors are doing lots of good locum work.”

But “locum work does attract risk,” he added. “It is risky in the sense that the doctor may not know enough about the hospital where he or she is working.

“It is risky in the sense that they may be brought in when the team is under considerable pressure, and it is risky in the sense that there may be some locum doctors who find it more difficult to find a permanent job. So it is an area where we have some concerns.”

Many locums are employed through medical recruitment agencies. It’s a fast-paced business where staff have to be found – sometimes at short notice – to cover for absences and busy periods.

The GMC says employers have to do more to verify the qualifications and competence of the locums they take on. In the summer, a court case highlighted concerns that some NHS trusts and agencies were not doing the most basic pre-employment checks.

Levon Mkhitarian was jailed for six years after impersonating a doctor. He’d worked as a locum in A&E departments, cardiology and cancer wards across south London and Kent for almost two years before finally being caught.

He used a false passport and other forged documents to assume a legitimate doctor’s identity. The recruitment agency that placed him in work failed to inspect the original documents – relying instead on photocopies, which masked the fact that had “cut and pasted” them together.

It’s estimated he dealt with more than 3,000 patients – although there was no evidence that he had harmed anyone.

Mkhitarian – who had a medical degree but had failed to complete his practical training – was eventually caught when a hospital security check revealed another doctor with the same details.

Mkhitarian had a history of using deception to get locum work. Back in 2010, he obtained provisional registration with the GMC, which allowed him to work with very close supervision.

He applied, and got, locum work requiring doctors with full registration – and that went on for three years because no-one was doing the simple check on his registration status.

When the GMC discovered he had lied about his registration, he was struck off. At that point, he stole a legitimate doctor’s identity.

For Mr Dickson, the Mkhitarian case stands as a stark reminder to vet doctors before they get on to the wards.

“If someone turns up brandishing a GMC number – that does not mean they’re fit to practice,” he said.

“A GMC stamp is not good enough for anyone to say, ‘Oh, that’s alright – I don’t need to do anything.’ There are responsibilities that agencies, and responsibilities that employers, have.”

The regulator has now introduced a system of revalidation – requiring the performance of all doctors, including locums, to be regularly assessed.

The Department for Health said: “We want the NHS to be the safest healthcare system in the world and we expect all employers to carry out appropriate pre-employment checks to make sure their doctors are fit to provide safe patient care.”

Overseas patients to be charged for emergency healthcare

Foreign patients could be charged for emergency treatment under new government plans for the NHS in England.

Foreign patients could be charged for emergency treatment under new government plans for the NHS in EnglandVisitors from outside the European Economic Area already pay for planned hospital care. The EEA covers the European Union, Iceland, Liechtenstein and Norway.

Health Secretary Jeremy Hunt wants to save the NHS millions of pounds by extending the charges to A&E care. A consultation is expected to be set up in the next few weeks.

Overseas visitors can currently receive A&E treatment, ambulance services and GP visits free of charge, but if the plans go ahead some treatment could be withheld until fees are paid.

The Department of Health said exemptions would be put in place for refugees and asylum seekers, and pregnant women would not be turned away from maternity units if they had not paid upfront.

A department spokesman said: “International visitors are welcome to use the NHS, provided they pay for it – just as families living in the UK do through their taxes.”

“This government was the first to introduce tough measures to clamp down on migrants accessing NHS care and have always been clear we want to look at extending charges for non-EEA migrants.”

“No-one will be denied urgent treatment and vulnerable groups will continue to be exempt from charging.”

All visitors to the UK and British expats are charged 150% of the cost of non-emergency NHS treatment in order to discourage people travelling to the UK just to use health services – so-called “health tourism”.

The latest crackdown is expected to reclaim around £500 million.

A spokesman for the Royal College of Emergency Medicine told the newspaper that A&E doctors “cannot reasonably be expected to take on the burden of identifying who is eligible for free treatment, and who should be charged”.

The British Medical Association agreed, saying: “A doctor’s duty is to treat the patient in front of them, not to act as border guard. Any plans to charge migrants and short-term visitors need to be practical, economic and efficient.”

In April new rules came into force which mean non-EU citizens settling in the UK for longer than six months are required to pay a “health surcharge” as part of their visa applications.

UK end of life care- best in world

End of life care in the UK has been ranked as the best in the world with a study praising the quality and availability of services.

End of life care in the UK has been ranked as the best in the world with a study praising the quality and availability of servicesThe study of 80 countries said thanks to the NHS and hospice movement the care provided was “second to none”.

Rich nations tended to perform the best – with Australia and New Zealand ranked second and third respectively.

But the report by the Economist Intelligence Unit praised progress made in some of the poorest countries.

For example Mongolia – ranked 28th – has invested in hospice facilities, while Uganda – 35th – has managed to improve access to pain control through a public-private partnership.

The rankings were worked out following assessments for the quality of the hospitals and hospice environments, staffing numbers and skills, affordability of care and quality of care.

Just 34 out of 80 countries provided what could be classed as good end-of-life care – and these accounted for just 15% of the adult population.

The report said the quality of end-of-life care was becoming increasingly important with the ageing population, meaning people were increasingly facing “drawn-out” deaths.

It’s no major surprise that richer countries, with stronger health systems, provide some of the world’s best palliative care. But a few poorer nations are bucking the trend, and it’s often down to the efforts of individuals campaigning for everyone to be allowed a dignified and pain-free death. Panama, Chile, Mongolia and Uganda are singled out for praise, whereas the situation in India and China is described as “worrying”.

India ranked 67th in the index, and China was in the bottom 10 at 71. Both have huge populations and have experienced rapid economic growth, but care for people at the end of their lives has not kept up. The report warns further improvements are needed across all countries to cope with the future demands of an aging population, increasingly facing drawn-out illnesses such as cancer, heart disease and dementia.

The UK received top marks for affordability – as would be expected for a service that is provided free at the point of need – but also got a perfect score for quality of care.

Overall it was given 93.9 out of 100, but the report still said there was room for improvement – as there was with all the top-performing nations.

Services in England have recently been criticised by the Parliamentary and Health Service Ombudsman.

The UK also came top the last time this report was produced in 2010. Also in the top 10 this time were the Irish Republic, France, Germany and the US.

Iraq and Bangladesh finished bottom of the ranking, while China was in the worst 10.

Fraud could be costing NHS in England £5.7 billion a year

The NHS in England could be losing up to £5.7 billion a year to fraud from its £100bn budget, a new report suggests.

The NHS in England could be losing up to £5.7 billion a year to fraud from its £100bn budget, a new report suggests.A review – led by former NHS anti-fraud boss Jim Gee – highlighted fraud by pharmacists, dentists, GPs and patients.

Among the areas it found to be affected were procurement, prescriptions, registration of patients and payroll.

To work out how much fraud is being committed, the review had to rely on estimates as well as detected fraud. It said the level of fraud was likely to be between £3.7 billion and £5.7 billion a year- out of a budget of more than £110 billion.

Among the scams highlighted were dentists claiming money for NHS care they did not carry out and GPs falsifying records for extra payments.

To illustrate the scale of some of these cases, it highlighted the jailing of a Birmingham dentist in 2012 after she stole £1.4m from the NHS.
The biggest sources of fraud in the NHS
Area                                                     Scams used                                                          Estimated value per year
Payroll                  False allowance claims and incorrect qualifications used                   £555m – £1.49bn
Procurement          Overcharging for goods and services or under-delivery                      £1bn – £1.27bn
General practice     Claims for services not provided and for ghost patients                          £348m
Patients       Claim for free prescriptions, dental care and optician services they are not entitled to     £304m
Dentistry                 Claims for dental work not carried out                                                        £121m – £137m
Pharmacy     Staff claiming for more drugs than actually dispensed or for services not provided     £83m – £96m

Patient fraud identified included wrongful claims for free prescriptions, dental and optician care.

But the biggest area of fraud was estimated to be payroll, at between £555m and £1.49bn – although the report said this mainly consisted of lots of small-scale cases.

Mr Gee, who carried out his work for PFK Littlejohn accountants, said: “There is a vast, honest majority who find fraud against the NHS to be completely unacceptable. However, there is also a dishonest minority who can cause significant financial damage.

“The best way of stopping this is not to wait for fraud to happen and then act after losses have been incurred, but to proactively deter and prevent them. Fraud is a cost to be measured, managed and minimised like any other.”

There is nothing new about fraud in the NHS. The scams are all too familiar – whether it’s health service managers purchasing hospital supplies and taking backhanders or corrupt GPs claiming they have patients who don’t actually exist.

But the report’s authors argue that, even though the NHS’s fraud problem is no worse than in other healthcare systems, the need for a crackdown is as urgent as ever because of the intense financial pressure on the NHS and the need to make efficiency savings.

They accuse the government of failing to carry out a detailed audit of the extent of health service fraud. The Department of Health said it didn’t recognise the figures, but there has been no official denial that there is a problem that needs fixing.

Fraud officers work in each local area while at a national level, fraud work is co-ordinated by NHS Protect.

Target of four week cancer diagnosis plan

More details of plans to improve cancer care in England have been revealed.

Target of four week cancer diagnosis plan They include a target that 95% of people should be given a diagnosis or the all-clear within 28 days of being referred by a GP, by 2020. Implementing it will cost £300 million a year until then.

The target – recommended by the Independent Cancer Taskforce – will be trialled in five hospitals before being rolled out nationwide if successful.

Faster cancer diagnosis could save 11,000 lives a year, the taskforce said.

Health Secretary Jeremy Hunt said the UK lagged behind other western European countries in cancer survival rates and the new measures would help “close the gap”.

“We know that the biggest single factor that means that our cancer survival rates lag those of France, Germany and other European countries is the fact that we have too much late diagnosis; we don’t get an answer to people quickly enough,” he said.

Mr Hunt said he was making “a very simple promise to all NHS patients” that by 2020 they would have a cancer diagnosis or an all-clear within 28 days.

However, the Department of Health later clarified that while it hoped to achieve the Independent Cancer Taskforce target of 95% by 2020, it would only be clear once trials were completed whether that was achievable.

Speeding up diagnosis would require more cancer consultants, specialist nurses, staff trained in endoscopies and diagnostic tests, Mr Hunt added.

Currently 280,000 people in England are diagnosed with cancer each year – with half surviving for at least 10 years.

Patients are meant to see a specialist within two weeks of a GP referral under existing targets but may then face a long wait for test results, meaning a growing number of patients do not get their treatment started within the recommended 62 days.

Cancer patients will also get online access to their test results if they choose, under the new measures.

Harpal Kumar, chief executive of Cancer Research UK and chairman of the Independent Cancer Taskforce, said services for diagnosing cancer were under immense pressure, which is why increased investment and extra staff were so important.

“Introducing the 28-day ambition for patients to receive a diagnosis will maximise the impact of this investment which, together with making results available online, will spare people unnecessary added anxiety and help cancer patients to begin treatment sooner,” he said.

The announcement comes after a cross-party group of MPs warned that cancer services had “lost momentum” in the past two years.

The health service has been struggling to meet waiting times and seen resources reduced, the Public Accounts Committee warned.

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