Thousands of people who go on to be diagnosed with cancer were not referred to a specialists by their GP.
NHS England data from around 4,000 GP practices suggests symptoms were picked up in other ways, for example by accident and emergency departments.

The NHS said not all cancer patients went to their GPs and the figures were not a clear measure of performance.

Patients who do go to their GP with cancer symptoms should be seen within two weeks in 95% of cases, the NHS said.

Health Secretary Jeremy Hunt said the government was tackling the “unacceptable variation” across different practices.

National performance data allows patients to look up their GP surgery and see how it performs against dozens of diagnosis and treatment indicators.

NHS England collected the figures on cancer referral rates from GP surgeries across the country as part of a drive to make the health service more transparent.

The NHS has a target that 95% of patients with suspected cancer should be seen by a specialist within two weeks – a target it says is consistently met.

But in around half of the GP practices sampled, fewer than 50% of patients on their books who were subsequently found to have the disease were referred to a specialist by their doctor.

Sean Duffy from NHS England said: “We know that early diagnosis is the single most important factor in cancer survival, and that’s why patients who visit their GP with ‘red flag’ symptoms like very persistent coughs, blood in urine or faeces or breast lumps should always be referred for further tests on two-week pathways.

“But not all patients visit their GP about these symptoms and others may have cancer without developing specific symptoms.

“These patients will therefore have their cancer diagnosed after going to a hospital as an emergency, or have it spotted incidentally while receiving treatment for another, unrelated issue.”

Mr Hunt said: “Every single patient in the NHS has the right to the very best care – and to see a GP who can spot cancer symptoms early enough to make a difference.

Non emergency operations by the NHS in England appear to be rationed according to recent research.
The analysis by the Dr Foster research group looked at three key procedures – knee, hip and cataract operations.  For much of the past decade, patient numbers have been rising as would be expected with an ageing population.

But since 2010, the numbers have levelled off – with just one in eight areas now doing more hips and knees and one in five seeing rises in cataracts.

It comes amid mounting pressures on the health service. The challenges facing A&E units have been well documented, but reports have also been emerging that non-emergency care is being squeezed too.

The health care analysts looked at the number of operations being carried out for the three types of procedures – among the most life-enhancing done by the NHS – for the past decade.

It found virtually no change in the overall numbers over the past two years with the total numbers hovering around the 475,000 mark each year.

Hip replacements were the only treatment out of the three that were still going up – although the rate of increase has slowed.

Meanwhile, the number of cataract operations is at its lowest level for five years and 2012-13 saw the first fall in knee replacements for a decade.

What has been happening:

• Cataracts – From 2002-03 to 2009-10 the numbers increased from 266,000 a year to a peak of just over 332,500, but since then they have fallen to under 322,000 – the lowest level for five years.
• Knee replacements – The past year saw the first fall in numbers for a decade – albeit a small one – after the yearly total fell by 550 to just over 81,500 in 2012-13.
• Hip replacements – The yearly total has continued to go up, but at a much slower rate of 2% a year on average since 2008. There were 71,000 operations carried out last year.

The review also provided details of what local areas were up to by looking at the individual figures for the 200-plus clinical commissioning groups which are now in charge of local health budgets.

The data showed that just 27 (13%) areas saw a significant rise in knee replacements over the past two years, 27 (13%) a rise for hip replacements and 40 (19%) a rise for cataracts. These include procedures such as tonsillectomies and knee washouts where the benefits are marginal.

While overall the numbers being done had fallen by 8% in the past five years there are still 124 areas where their use has increased since 2010-11.

Food poverty in the UK has now become such a big problem that it should be seen as a public health emergency according to a group of health experts.
In a letter to the British Medical Journal, six leading public health figures warned poor nutrition could lead to a host of problems.

It comes amid reports that people are struggling to feed themselves as the UK Red Cross has started asking for food donations for the first time since World War Two.

And in October the Trussell Trust, which runs 400 food banks, said the numbers of people it was helping had tripled to 350,000 in the past year.

The letter also cited research from the Institute for Fiscal Studies that indicated the amount of money being spent on food by households had fallen by over 8% in real terms over the past five years.

Families with young children have been hit the hardest.

The study also suggested that much of the savings had been made by people buying cheaper, processed food.

The BMJ letter, signed by academics and pubic health directors, said this had “all the signs of a public health emergency”.

It warned malnutrition, particularly during childhood, could have lifelong effects including increasing the risk of cardiovascular disease and other chronic illness.

David Taylor-Robinson, a population health scientists at the Medical Research Council and one of the authors of the letter, added: “It is clear people are increasingly struggling with their food bills. We need to start monitoring this and treating it as a public health problem.”

Chris Mould, the executive chairman of Trussell Trust, said he wanted the government to set up an official inquiry because “these alarming developments point towards serious trouble for the nation in the years ahead unless urgent action is taken now”.

But a government spokesman said action was been taken to help people with the cost of living, including increasing the tax-free personal allowance and freezing council tax and fuel duty.

He added: “The benefits system supports millions of people who are on low incomes or unemployed and there is no robust evidence that welfare reforms are linked to increased use of food banks.”

Men and women’s brains are connected in different ways- which may explain why the sexes excel at different tasks researchers have found.A US team at the University of Pennsylvania scanned the brains of nearly 1,000 men, women, boys and girls and found striking differences.

Male brains appeared to be wired front to back, with few connections bridging the two hemispheres.  In females, the pathways criss-crossed between left and right.

These differences might explain why men, in general, tend to be better at learning and performing a single task, like cycling or navigating, whereas women are more equipped for multitasking, say the researchers in the journal Proceedings of the National Academy of Sciences.

The same volunteers were asked to perform a series of cognitive tests, and the results appeared to support this notion.

But experts have questioned whether it can be that simple, arguing it is a huge leap to extrapolate from anatomical differences to try to explain behavioural variation between the sexes. Also, brain connections are not fixed and can change throughout life.

In the study, women scored well on attention, word and face memory, and social cognition, while men performed better on spatial processing and sensori-motor speed.

To look at brain connectivity, the researchers used a type of scan called DTI – a water-based imaging technique that can trace and highlight the fibre pathways connecting the different regions of the brain.

Study author Dr Ruben Gur said: “It’s quite striking how complementary the brains of women and men really are.  Detailed connectome maps of the brain will not only help us better understand the differences between how men and women think, but it will also give us more insight into the roots of neurological disorders, which are often sex related.”

Prof Heidi Johansen-Berg, a UK expert in neuroscience at the University of Oxford, said the brain was too complex an organ to be able to make broad generalisations.

“We know that there is no such thing as ‘hard wiring’ when it comes to brain connections. Connections can change throughout life, in response to experience and learning.”

“Often, sophisticated mathematical approaches are used to analyse and describe these brain networks. These methods can be useful to identify differences between groups, but it is often challenging to interpret those differences in biological terms.”

Reducing the number of patients not turning up for appointments with their Doctor should be a top priority.
Patients’ non-attendance at appointments is as high as 11% in some doctors’ surgeries.

David Sissling the NHS Wales chief executive was giving evidence to the Welsh Assembly’s Public Accounts Committee (PAC).

He said health boards were trying to tackle the issue but he believed new systems, such as online bookings and text reminders could help reduce the problem.

Mr Sissling said: “We should do a major exercise to better understand the 11%. Sometimes they are the most vulnerable, sometimes they have the greatest needs and sometimes they have chaotic lifestyles.

“I think adopting a blame culture would be inappropriate,” Mr Sissling added.

Recently the British Medical Association (BMA) claimed family doctors in Wales faced a “crisis” and “enormous pressures” meant the profession was “on its knees”.

In an interview with BBC Wales, Dr Charlotte Jones said increasing demand from patients coupled with a shrinking workforce meant GPs were often “too exhausted” to see patients out of hours.

She insisted the problems were particularly acute in rural areas.

Mr Sissling told the committee he was aware that some areas of Wales were facing “particular challenges”, but that the Welsh government was “taking action” to deal with the concerns.

Doctors representatives are currently negotiating with the Welsh government elements of a new GP contract, which will set out what family doctors are expected to deliver.

A Welsh government spokesperson recently suggested the new contract was likely to involve less bureaucracy, so GPs can spend more time with the most vulnerable patients.

Mr Sissling was giving evidence as part of a PAC investigation into “unscheduled care” in the NHS.

It is known that A&E departments last spring struggled to cope with what ministers called “unprecedented demand” from patients, including a large number of elderly people who were very ill or had complicated needs.

HIV care is at risk from the changes to the health service in England specialists are warning.
As part of NHS reorganisation, sexual healthcare became the responsibility of local authorities, while HIV care remains within the NHS.

The British HIV Association says many specialists feel the split has worsened patient care, and worry the situation will deteriorate even further.

The government said the NHS and local authorities should work together.

A survey by BHIVA, released to mark World Aids Day on Sunday 1st December, found a third of the 100 HIV specialists questioned thought care for people with HIV was poorer since the reorganisation in April this year. In addition two thirds thought care was set to deteriorate further.

In the past, HIV and genitourinary medicine (GUM) services were integrated, sharing staff and resources.

But the reorganisation transferred responsibilities for tackling public health issues such as obesity, smoking prevention and sexual health – but not HIV care – to local councils.

Around 100,000 people in the UK live with HIV.

Dr David Asboe, chair of BHIVA and a consultant in HIV medicine at the Chelsea and Westminster Hospital, said: “Key to the concerns uncovered in this survey are fears about the separation of HIV care from broader genitourinary medicine.”

Dr Janet Wilson, president of the British Association for Sexual Health and HIV (BASHH), said: “Sexual health clinicians have been sounding the warnings around restructuring since the introduction of the government’s health reforms.

“We are already hearing about tendered GUM services being prevented from undertaking partner notification on people newly diagnosed as HIV-positive even though this is the most effective public health intervention for identifying undiagnosed HIV infection.”

She added: “We need government, national and local agencies to urgently work together to prevent HIV and GUM care going backwards.”

Dr Steve Taylor, lead consultant in HIV Services at Birmingham Heartlands Hospital, said there was an issue with staff who had worked for joint HIV and GUM services in the past moving to a new sexually transmitted infection centre and being lost to the HIV services: “The way the system has been created has made an artificial divide between classic GUM services and HIV.

And he suggested anything not in the GUM service contracts risked being lost or downgraded, such as contact tracing to find current and former partners, data collection and training.

Dr Taylor added: “It’s about who is going to pick up the responsibility for all of those things that appear to be falling in the middle of what’s being covered by NHS England and by local authorities.”

A Department of Health spokesman said: “Public Health England’s report on HIV care last year reported an increase in people being diagnosed and prompt integration into care. However, the NHS and local authorities should work together to make sure that sexual health services are convenient and work for patients.”

More needs to be done to support carers who are at breaking point the Older People’s Commissioner for Wales warns.

Sarah Rochira who is the Older People’s Commissioner is concerned that too many carers across Wales are missing out on much needed help and their work is often undervalued.

She said it can often lead to a deterioration of their mental and physical health.

Ministers said much had been achieved in policy to support unpaid carers since devolution.

Speaking on Carers Rights Day, Ms Rochira is worried at the pace of progress in a strategy to help carers and said she wants to ensure Wales gets it right for its 370,000 carers.

“Without the care provided by unpaid carers in Wales, estimated to be nearly £6 billion a year, many of our statutory services would, quite simply, be unable to cope,” she said.

“Carers should therefore be seen and treated as one of our greatest assets. Many of the carers I have met as part of my Engagement Roadshow are at breaking point – they feel that no-one listens to them, despite asking for so little.”

“In so many cases they just want a little bit of help before a crisis occurs, such as information, advice, help to make decisions, practical help and training, and advocacy – someone to speak up on their behalf.”

Ms Rochira said the Welsh government’s Carers Strategies Measure, which was launched in 2010, was a “welcome step forward”.

It is a requirement on the NHS and local authorities in Wales to work in partnership to prepare, publish and implement a joint strategy to help carers.

But while she said improvements were starting to be seen, she added she had “real concerns” over the pace of the progress and that she intends to review the impact the measure is making with carers being at the heart of the review.

She also wants service providers to work together more effectively and focus on what carers want, not what they think the carers need.

The Welsh government said: “We should be grateful that so many people in Wales are prepared to care in this way.

The spokesperson said a refreshed carers strategy was published in June and “much has been achieved in terms of policy, legislation and service development” for unpaid carers since the first version in 2000.

This includes the Carers Strategies (Wales) Measure in 2010 which requires health and social services to engage with carers.

When the diagnosis is cancer- concern about survival prospects and what the treatment will involve will naturally be the first thoughts for many people in that position.
However the financial consequences can be pretty severe too, as  a new report produced by Demos demonstrates that four in five people with cancer find that they are also losing out financially.

Not only is there the cost of not working- and not earning, particularly if you are self employed.

On top of that, there are the extra costs of spending money on wigs and new clothes as the steroids- coupled with the frequent inability to exercise which means that many also put on weight.

Also heating bills also go up not only because people are at home more- but they also feel the cold more- needing to turn the thermostat up.

The think tank calculates the average cost is about £7,000 a year – equivalent to the standard mortgage.

And it is not just in the immediate aftermath of a diagnosis that the costs are accrued.

With more and more people surviving cancer, the financial hit can last for years, the report Paying the Price suggests.

There is some support available. Those on low incomes can get free transport too and from hospital, while prescription charges for cancer patients are waived (elsewhere in the UK they have been abolished for all patients).

Several charities offer grants too. But Demos doesn’t think that goes far enough.

It wants to see those affected by cancer given the same legal right to request flexible working as parents have and the government to offer a financial health check as part of the routine follow-up care.

Jo Salter, who authored the report, says this is the “new reality” with cancer diagnoses on the rise – nearly half of people are now expected to get it in their lifetime.

Ministers say they are considering what support can be given.

For patients, this can’t come quickly enough, according to Macmillan Cancer Support.

“People living with cancer should not be left to deal with the terrible financial strain alone,” says its chief executive Ciaran Devane.

The NHS must stop turning a “blind eye” to smoking and ban it in all hospital grounds in England, according to new guidance.The National Institute for Curbing Expenditure (NICE) said that it wanted to see smoking shelters scrapped so patients, visitors and staff could not light up.

Staff should also stop helping patients out of their beds to go for a smoke. And patients who smoke must be identified and offered help to quit, the guidance added.

It said nurses, doctors and other staff could give brief advice and then refer smokers on to NHS stopping smoking services.

Smoking rates are particularly high among mental health patients with one in three smoking, rising to 70% in psychiatric units.  That compares with the one in five among the general population who are smokers.

The guidance, which is voluntary for the NHS to follow, even suggested staff caught smoking should be disciplined.

NICE conceded some parts of the NHS had already adopted these approaches, but said the idea of the guidance was to make sure it became consistent across the health service.

NICE public health director Prof Mike Kelly said the NHS had turned a “blind eye” for too long.

“It has been tolerated by the NHS and it is high time that stopped.  NHS hospitals and staff have a duty of care to protect the health of people who use or work in their services. We need to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances.”

In practice, he said, doctors and nurses could provide nicotine replacement therapies and advise patients about counselling to ensure they were not “going up the wall” with nicotine cravings.

He acknowledged that stopping a determined smoker from going outside to light up was “clearly very difficult”.

“This is not about imposing some sort of penal regime in which doctors, nurses, administrators spend all their time trying to enforce a series of rules and regulations.

He said it was about a culture shift and removing smoking shelters would help eliminate any subliminal message that it was ok to smoke around a hospital.

The first case of MRSA in poultry in the UK has been found in turkeys and chickens on a farm in East Anglia says the Department of Health (DH).A spokesman said that two thirds of the turkeys on the farm, which hasn’t been named, were found to be infected.

It is thought that hundreds of turkeys have already been sold to local retail outlets and farm gate sales.

The spokesman said the strain of the disease found in the poultry – Livestock-Associated (LA) MRSA – “rarely caused disease in humans” and if it did would involved a mild skin infection which cleared up quickly.

LA-MRSA is different to the MRSA that causes the healthcare associated infections seen in people.

It can potentially pass from animals to humans through direct contact or through dust in animal housing, meaning poultry workers are at risk.

But LA-MRSA rarely causes disease in people and in most cases the bacteria clear within 24 hours.

Appropriate handling and cooking of raw meat should eliminate any risk of transmission to people.

Steve Wearne, Director of Policy at the Food Standards Agency, said: “Any risk of contracting MRSA through meat from animals with these bacteria is very low when usual good hygiene and thorough cooking practices are observed. All poultry should be handled hygienically and cooked thoroughly to destroy any bacteria that may be present.”

Prof Angela Kearns of Public Health England said: “There are many different strains of MRSA that cause illness in people but this is not one of the strains that we are overly concerned about given the very low number of clinical infections that have been seen in people.”

In the UK, since 1999, there have been published reports that MRSA has been isolated from dogs, cats and from a rabbit and a horse.

Other countries have also reported cases in cattle and poultry.

Prof Peter Borriello, Chief Executive of the Veterinary Medicines Directorate, said: “LA-MRSA has been identified in livestock in a number of countries and is not considered to represent a significant risk to animal health and welfare.”