Health Direct » 2005 » November

MRSA Action UK campaigns for proper action to prevent and treat MRSA

Dr Search- Principal Consultant at the Search Clinic — Wed, 30 Nov 2005 11:44:00 +0000

Health Direct highlights the mission of MRSA Action UK which is to influence the Labour Government and Healthcare providers in the fight to prevent MRSA. They do this by providing an advocacy and counselling service for victims and their dependants; and by giving feedback to Government and Healthcare providers- being guided by the principle that the care and safety of patients is never compromised by poor practise.

MRSA- Methicillin-Resistant Staphylococcus Aureus
Infection with MRSA bacteria mainly occurs in people who are already ill in hospital. It can be difficult to treat as MRSA bacteria are resistant to most types of antibiotics.

What is Staphylococcus aureus?
Staphylococcus aureus is a bacterium (germ). It is often just called ‘S.aureus’ or ’staph’. S. aureus bacteria are often found on the skin and in the nose of healthy people. In fact, about 3 in 10 people have S. aureus bacteria living on (colonizing) their skin. These people are called S. aureus ‘carriers’. In healthy people who are carriers, S. aureus is usually harmless.

However, S. aureus bacteria sometimes invade the skin to cause infection. This is more likely if you have a cut or graze which can allow bacteria to get under the surface of the skin. S. aureus is the cause of skin infections such as boils, pimples, impetigo, skin abscesses, and is a common cause of wound infections.

In some people, S. aureus can sometimes get into the bloodstream and travel to internal parts of the body to cause more serious infections. For example, blood poisoning (septicaemia), lung infection (pneumonia), bone infection (osteomyelitis), heart valve infection (endocarditis), etc. These serious infections are more likely to occur in people who are already unwell or debilitated, or who have a poor immune system. These infections need to be treated with antibiotics.

What is MRSA?
MRSA stands for Methicillin-resistant Staphylococcus aureus. There are various sub-types (strains) of S. aureus and some strains are classed as MRSA. MRSA strains are very similar to any other strain of S.aureus. That is, some healthy people are carriers, and some people develop the types of infections described above.

The difference is that, most S. aureus infections can be treated with commonly used antibiotics. In recent years some strains of S. aureus have become resistant to some antibiotics. ‘Resistance’ means that it is not killed by the antibiotic. MRSA strains are not only resistant to the antibiotic called Methicillin, but also to many other types of antibiotics.

How serious is an MRSA infection?
MRSA strains of bacteria are no more aggressive or infectious than other strains of S. aureus. However, infections are much more difficult to treat because many antibiotics do not work. Therefore, infections tend to become more severe than they may otherwise have been if the cause of the infection is not diagnosed early, and antibiotics that do not work are given at first.

Who gets MRSA?
MRSA occurs most commonly in people who are already in hospital. People who are more prone to it are those who are very ill, or have wounds or open sores such as bed-sores or burns. The wounds or sores may become infected with MRSA and the infection is then difficult to treat. Infections, which start in the skin, may spread to cause more serious infections. Also, urinary catheters and tubes going into veins or parts of the body (‘drips’ etc) are sometimes contaminated by MRSA and can lead to urine or blood infection.

MRSA can also cause infections in people outside hospital, but much less commonly than in hospitalised people.

How is MRSA diagnosed?
If an infection with S. aureus is suspected then, depending on the type of infection, a sample of blood, urine, body fluid, or a swab of a wound can be sent to the ‘lab’ for testing. If S.aureus is detected, further tests are done to see which antibiotics will kill the bacteria. MRSA strains can be identified by seeing which antibiotics kill the bacteria found on testing. Healthy people suspected of being carriers of MRSA can have a swab or the nose or skin taken and tested.

How is S.aureus and MRSA spread?
S.aureus bacteria (including MRSA strains) spread from person to person usually by direct skin-to-skin contact. Spread may also occur by touching sheets, towels, clothes, dressings, etc, which have been used by someone who has MRSA.

However, as mentioned, S. aureus (including MRSA strains) will not normally cause infection if you are well. The bacteria may get onto your skin, but do no harm. So, for example, people who visit patients with MRSA, or doctors and nurses who treat people with MRSA, are not likely to develop an MRSA infection. But, they may become ‘contaminated’ with the bacteria and may pass it on to someone who is ill, or who has a wound, who then may develop infection.

What is the treatment of MRSA infections?
MRSA infections are usually treated with antibiotics. (Boils or abscesses caused by MRSA may only need to be drained and may not need antibiotics.) However, the choice of antibiotic is limited as most antibiotics will not work. Many MRSA infections can only be treated with antibiotics that need to be given directly into a vein. The course of treatment is often for several weeks. Also, the risk of side-effects with the limited choice of antibiotics is higher than the more ‘usual’ antibiotics which are used to treat non-MRSA infections.

People who are carriers of MRSA but who are healthy do not need any treatment. However, in some cases it may be advised to try and clear the bacteria from the skin by washing with antiseptic lotions, and using antiseptic shampoos, and using an antibiotic cream to place in the nose. These measures may reduce the risk of developing an infection, or spreading the bacterium to others (particularly to ill people who may develop an infection).

Can MRSA infections be prevented?
The number of MRSA infections in hospital can be kept down if all hospital staff adhere to good hygiene measures. The most important is to wash hands before and after contact with each patient, and before doing any procedure. This simple measure reduces the chance of passing on bacteria from patient to patient.

Other measures are used in hospitals to reduce the spread of infection. For example, cleaning of bedding, regular cleaning of wards, etc. Patients with an MRSA infection may be kept away from other patients, perhaps in a single bedroom or in an isolation unit until the infection has cleared.

You can find out more by clicking on this link to their website:
http://www.mrsaactionuk.com/

Private hospitals to face NHS-style red tape inspections

Dr Search- Principal Consultant at the Search Clinic — Tue, 29 Nov 2005 08:53:00 +0000

Private hospitals are to face broadly the same system of inspection and regulation as National Health Service establishments, the Healthcare Commission will announce this week. The body that inspects the NHS and gives the private sector a licence to operate believes that by 2008 hospitals, clinics and treatment centres run by the independent sector might treat one in seven non-emergency patients.

As the government’s market in the supply of healthcare services develops, it is expected the NHS will be the single largest source of funding for hospitals in the independent sector by 2010, the commission says in the final draft of a consultation document – seen by the Financial Times – which it is to issue shortly.

That new approach to acquiring NHS services means that a “level playing field” of inspection and regulation is needed between NHS-run and independent services.

At present, private hospitals and clinics are inspected annually – against, until recently, an inspection once every three or four years for NHS bodies. But against that, different methods of assessment are used that would require independent providers to supply “significantly” more data than they do at present.

The commission’s aim is to produce the same risk-based assessment for independent healthcare providers as it is developing for NHS-run bodies.

That means moving by 2008 to a system where private providers make a self-declaration of the standards of care they provide that will then be checked against information they and others provide.

All establishments will be visited regularly, based on risk assessment. But strong performers will no longer get an annual inspection. As in NHS-run establishments, however, there will still be unannounced spot checks, with the results published, as well as follow-up inspections where concerns are raised.

The government will have to legislate before the changes can be made in full. As a result, all independent sector establishments, which include mental health services, 80 per cent of whose patients are NHS-funded, beauty salons that use lasers, and in time establishments that provide botox and other non-surgical cosmetic procedures will be inspected next year.

New sets of data that the independent sector will have to provide are being developed, but with the aim of lightening the regulatory burden and aligning it with the rest of the NHS.

“In our view, it is inevitable that we will continue to need more detail in our monitoring of the independent sector for the time being,” the consultation document says, “and that we rely less on self-assurance than in the NHS to compensate for the relative scarcity of independent sources of information”.

The commission also plans to hold primary care trusts and other NHS commissioners to account for the services they buy from the independent sector.

http://news.ft.com/cms/s/6636423c-5fb3-11da-a628-0000779e2340.html

ITC gets 600pc profit mark up in red tape Oxfordshire farce

Dr Search- Principal Consultant at the Search Clinic — Mon, 28 Nov 2005 08:48:00 +0000

An independent treatment centre that sparked rows and resignations in Oxfordshire has lost the local health economy over £200,000 in its first six months, according to a revealing report by South East and West Oxfordshire primary care trusts.

The report found that the cataract centre run by South African company Netcare has carried out only 93 of the 572 procedures it has been contracted to perform since April.

The review found the number of patient operations has been ‘disappointing’ and ’slow’, but despite this the PCTs had been forced to pay £255,000 for a quantity of work that should have cost £40,000.

Lib Deb spokesperson for Wantage councillor Andrew Crawford said the report showed the public had paid ‘600 per cent over the odds’ thanks to ‘government bullying’ on choice.

Although the PCTs have used ‘various marketing strategies…to encourage uptake of the service’, not enough patients had been willing to be treated at the Netcare centre.

‘The PCTs are unable to commercially advertise one service over another. The population commonly requiring cataract surgery is elderly, and the Oxford Radcliffe hospitals have a strong reputation and short waiting lists,’ the report found.

Jane Dudley, the PCTs’acting chief executive, told HSJ the contract was ‘an extra burden’ for the trust as it attempted to break even by the end of the financial year.

She said that the PCTs were hoping to use up the spare capacity in the contract by the end of the year and were ‘exploring opportunities’ with other strategic health authorities to use the cataract operations.

According to the review, the SHA is ‘negotiating directly with the Department of Health on Oxfordshire’s behalf to have [the financial risk to the PCTs] underwritten’.

Oxford Radcliffe Hospitals trust ophthalmology unit head of nursing and service development Rebecca Turner said the centre had not had any impact on the trust.

‘The national target is to get the cataract waiting times to three months,’ she said.

‘In Oxford we only have an average wait of five weeks, so we didn’t need the extra capacity. Fundamentally the damn thing was flawed in the first place.’

Netcare was unavailable for comment.

Troubled history of Oxford treatment centre
November 2003 South East and West Oxfordshire PCTs’ board votes against a treatment centre for Oxford but reverse its decision when Thames Valley SHA agrees to take on the risk if capacity is not used.

March 2004 PCTs’ chair Professor Martin Avis and SHA chair Jane Betts both resign over the issue.

June 2004 PCT non-executive director Jane Hanna resigns, claiming the PCTs have been forced to agree a deal with Netcare. NHS chief executive Sir Nigel Crisp terminates a Radio 4 interview after being repeatedly questioned about whether managers were ‘in fear for their jobs’.

September 2004 A report on the deal finds that Oxford already has enough cataract capacity.

December 2004 Then health secretary John Reid tells the Commons health select committee that the government will always ‘reserve a bit of a right [to intervene in a local decision] where self-interest is concerned’.

April 2005 ITC opens.

October 2005 PCTs’review reveals only 93 operations have been carried out.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=3707019

HIV cases continue to increase and rates rise also increases

Dr Search- Principal Consultant at the Search Clinic — Fri, 25 Nov 2005 08:44:00 +0000

The number of people with HIV in the UK has risen by more than 5,000 in a year, statistics show. The Health Protection Agency report found that HIV cases stood at 58,300 last year – up from 53,000 in 2003.

Increases in other sexually transmitted infections, such as chlamydia, which topped 100,000 new cases, and syphilis, were also recorded, the agency said.

Campaigners said there needed to be more focus on prevention and access to halt the rise.

And Dr Barry Evans, an HIV exert at the HPA, added: “There is no part of the UK that remains unaffected by HIV or other sexually transmitted infections.”

But he said rates of infection did differ from area to area.

STI STATISTICS
HIV – 58,300 people now living with infection, up by 5,000 on the previous year, including 7,275 new cases
Chlamydia – New diagnoses up by 8.6% from 95,879 to 104,155
Syphilis – Up by 37% from 1,641 in 2003 to 2,254 a year later
Genital warts Rose by 4.2% from 76,457 to 79,678
Gonorrhoea Fell by 11% from 24,956 to 22,335
Genital herpes – Decrease of 1% in diagnoses from 19,180 to 18,991

And he added people could play their part in preventing STIs by practising safe sex with new and casual partners.

The latest HIV figure included both those who have been diagnosed and also an estimated 19,700, who remain unaware of their infection and therefore undiagnosed – meaning they could unknowingly be helping the spread of the infection.

The report reveals there were 7,275 new infections in 2004 in the UK – up from 7,217 in 2003.

It showed that most of these – 4,287 – were diagnosed in heterosexuals, with 73% most likely to have been acquired in Africa.

Of the 58,300 with HIV in the UK, around 29,700 are thought to be heterosexuals.

The steep rise in the number of syphilis infections from 1,641 to 2,254, has occurred against a backdrop of several localised outbreaks in London and Manchester.

But chlamydia remained the most common STI with new diagnoses rising by 8.6% to 104,155.

While cases of genital warts rose by 4.2% from 76,457 to 79,678.

But diagnoses of gonorrhoea and genital herpes fell by 11% and 1% respectively.

Nick Partridge, chief executive of sexual health charity Terrence Higgins Trust, said: “We’re at a crossroads – if we don’t concentrate on prevention and access to services now, we will continue to have ever-increasing rates of HIV and the worst sexual health in Western Europe.”

And Deborah Jack, chief executive of the National Aids Trust, said: “The continuing high numbers of people newly diagnosed with HIV underlines the need for more effective HIV prevention in this country. In addition, the increased estimate in undiagnosed cases is worrying.”

Shadow Health Secretary Andrew Lansley said there was “now a new generation of younger people oblivious to the dangers posed by STIs”, while Liberal Democrat health spokesman Steve Webb added the findings were “distrubing”.

http://news.bbc.co.uk/1/hi/health/4465884.stm

Holby- style hospitals on casualty list as closures loom

Dr Search- Principal Consultant at the Search Clinic — Thu, 24 Nov 2005 14:33:00 +0000

The district general hospital – epitomised in the television series Holby City – may soon become a relic of the past as patients turn to private providers for their healthcare, according to a top-level report being prepared in Whitehall. The likely end of the district hospital underlines the scale of change in the National Health Service as it adapts to government reforms.

More private providers of non-emergency care and the shift of more care and diagnosis outside hospital means “the current configuration of acute hospital services is likely to be unsustainable in many parts of the country”, according to a late draft of the report seen by the Financial Times.

The report, being compiled for Sir Nigel Crisp, NHS chief executive, and Patricia Hewitt, the health secretary, in effect heralds the end of the provision of at least one main hospital in every town, offering all but the most specialised services.

Instead, fewer hospitals will have a full accident and emergency service, more care will be delivered by networks of hospitals, and key staff are likely to have to work across institutional boundaries, says the report.

The pressures for change will become “irresistible”. If services do not adapt “they risk becoming unsustainable, unsafe, unstaffable, and unpopular” which in turn will result in “service failure”, the draft adds.

It is being drawn up for the National Leadership Network, an advisory body of top NHS figures set up by Sir Nigel and supported by a Department of Health secretariat. A department official said: “This is a draft report of advice to ministers. It is not departmental policy.”

But senior NHS managers are already acknowledging the scale of the change. Neil Goodwin, chief executive of the Greater Manchester Strategic Health Authority, told a conference this month that what is under way is “the death of the district general hospital as we have come to know and love it”.

That posed a big challenge “to national and local politicians and to NHS management. They will have to explain in a very clear and sophisticated way how hospital services are going to be delivered in future, against a backdrop of dramatic consumer and technologically driven change”, he said.

The report says the local hospital will continue to play a crucial role. But competition between providers is likely to take much routine surgery out of some hospitals, and not all hospitals will be left with the “core” services needed to support trauma and emergency surgery. That is likely to have to be managed across networks in fewer hospitals.

The ambulance service will play an expanded role in providing immediate care and taking key decisions on where people are taken for treatment, and “there will be much greater diversity of service provision between local hospitals than has been allowed for under the old district general hospital model”.

The draft report adds: “A crucial challenge will be to ensure that the future vision for acute hospitals is financially sustainable, especially as the NHS transitions from its current period of expansionary funding to a steady state of lower annual growth.”

The big shift raises important questions about medical and other training and where it will take place, the report says. “Considerable work is still required to improve service integration . . . especially in the area of urgent and emergency care, paediatrics and maternity services.”

Its findings follow warnings earlier this year from Bob Ricketts, head of capacity planning at the health department, that there was “an increasing threat to the viability of the districtgeneral hospital” and the shift of care outside hospital and to private providers could produce the “hollow hospital”.

http://news.ft.com/cms/s/13500c5a-5c8f-11da-af92-0000779e2340.html

Labour in disarray as Flu jab runs out

Dr Search- Principal Consultant at the Search Clinic — Wed, 23 Nov 2005 14:30:00 +0000

Labour Ministers are being blamed for shortages as Britain is facing a serious shortage of flu vaccine less than a month after ministers assured the public that it had enough supplies to inoculate everyone at risk from the virus.

After weeks of denying reports in The Times that there would be a shortage, the Department of Health was forced to write to every GP yesterday admitting that 400,000 “contingency” doses of the vaccine were nearly exhausted.

It urged doctors not to overorder any remaining vaccine, to ensure what they have in stock is used for the high-risk groups, and that if they have any spare to let others know, so that it can be shared.

“Vaccine is pretty scarce” David Salisbury, head of immunisation, at the Department of Health said yesterday. Asked if this meant that people in the high-risk categories might go unvaccinated, he said: “I sincerely hope not.”

The letter tells GPs that there is no vaccine left, with the exception of a further contingency of 200,000 doses which will not be delivered until late January.

The unprecedented demand for jabs is blamed on the fears of avian flu developing into a new pandemic that could claim tens of thousands of lives.

Although the vaccine offers no protection against such a pandemic strain, the intensive publicity has driven more people than usual to seek jabs against seasonal flu.

The suspicion is that doctors may have used up the vaccine treating the “worried well” and that as a result the over-65s and other high-risk groups may find that they are denied it.

GPs themselves are responsible for ordering flu vaccine and are only reimbursed by the Government for the actual vaccines given. GPs have to pay for any remaining stock, encouraging them not to overorder. This year, Dr Salisbury said, 14.5 million doses had been ordered, half a million more than last year.

Peter Holden, a GP from Matlock and a senior member of the Derbyshire British Medical Association’s GPs’ committee, said that he was short of 400 vaccines for his patients, who had come to get immunised in unprecedented numbers this year. “At the last count we were 400 short,” he said. “As of Friday night we had no ideas where we are getting vaccines for our clinics from December 3.”

The practice serves 8,500 patients, of whom 2,000 are eligible for flu jabs. But while most years it was hard to get more than 1,200 people interested, this year it had passed 1,500 with ease.

When Patricia Hewitt, the Health Secretary, was pressed in the Commons last month on whether enough supplies of vaccines had been ordered, she said: “I am assured by our experts there are adequate supplies available to ensure anybody at risk can be vaccinated.” She refused to comment yesterday on the new advice to GPs.

The Times was also assured that supplies were ample. A department spokeswoman said: “There are 11 million people who are either over 65 or in the high-risk groups, so there will be enough for them all, even if we got 100 per cent take-up.” But soon after that, on November 3, GPs were sent a letter reminding them to “prioritise” the vaccine for the at-risk groups. This appears tohave been ignored, at least by some. GPs have been ringing the department seeking extra supplies.

The department has no clear idea where the vaccine has gone. Some of it will still be waiting in doctors’ surgeries to be administered, and some has yet to be delivered by the manufacturers. But data on uptake is still scant.

“From the audit that we have undertaken, there is some concern that the vaccine may have been used on the ‘worried well’ rather than the pre-agreed risk groups and that this has contributed to the shortfall,” Dr Salisbury’s letter says.

Laurence Buckman, deputy chairman of the BMA’s GPs Committee, said: “Patients will feel that they have been let down. The flu campaign is designed to protect the old and the sick in advance of the flu season. GPs were told that there would be enough vaccine and now it seems this is not the case. There is no evidence that family doctors have been using the vaccine inappropriately.”

Andrew Lansley, the Shadow Health Secretary, said: “Ministers have unfortunately failed to recognise the risk sufficiently, which has led to the current situation.”

http://www.timesonline.co.uk/article/0,,2-1882775,00.html

Huge Nursing crisis looms, warns RCN

Dr Search- Principal Consultant at the Search Clinic — Tue, 22 Nov 2005 14:23:00 +0000

Britain is facing a mass exodus of nurses. Hospital staff who came from overseas several years ago to help out the NHS are now being lured to other countries where wages are much higher. The warning has been made by the Royal College of Nursing which has discovered that half of the foreign nurses in Britain are now considering jobs in other countries.

Decisions by them to depart would leave the NHS with a huge headache. Although many more people are now going into nursing training, a substantial number decide not to stay. Homegrown nurses, particularly junior staff, may also be tempted to go abroad.

The wage differential is particularly tempting for nurses on the lower grades of the profession. ‘We have Filipino and Indian nurses who may have come to the UK via Saudi Arabia and the Emirates some time ago, who are now looking to move onto other countries,’ said Josie Irwin, head of employment relations at the RCN. ‘They are tempted by offers from America and Australia, who are recruiting staff aggressively.’

An experienced specialist nurse on around £25,000 here would be offered £10,000 more – plus accommodation and opportunities to travel – in the States.

Despite a 23 per cent increase in the nursing workforce in England since 1997, the RCN says the government needs to take urgent action to avoid a return to the chronic shortages of the early 1990s.

The RCN’s annual Labour Market Review highlights an ageing nurse population with an average age of 44. While there are around 20,000 new UK entrants to the nursing register per year, the number of nurses retiring in the near future raises the issue of whether this is enough.

Some 45 per cent of new entrants over the past four years have been from overseas, including more than 12,000 in the past year.

The government claims to have done much to make nursing attractive, with better conditions and fairer pay. But despite increased numbers, pay still lags behind that of other countries.

http://politics.guardian.co.uk/publicservices/story/0,11032,1646871,00.html

Health Direct points out that the NHS already has a huge nursing staff crisis with 50,000 nurses leaving in 2004 alone. See also:
http://www.healthdirect.co.uk/2005/04/50000-nurses-left-nhs-in-2004.html

MS patients to be given cannabis spray drug

Dr Search- Principal Consultant at the Search Clinic — Mon, 21 Nov 2005 14:06:00 +0000

A cannabis-based medicine is being made available to British patients with multiple sclerosis for the first time following approval from the Home Office for its importation from Canada. The oral spray derived from the cannabis plant will be available on prescription for around £4 a day. Research indicates that it relieves the pain and spasticity associated with multiple sclerosis.

Sativex will be available on private presciption
Although the drug, called Sativex, has no licence for use in Britain, and despite its refusal of a licence by the Medicines and Healthcare Products Regulatory Agency (MHRA) last year, Paul Goggins, the Home Office Minister, has agreed to its use in special circumstances.

The medicine can only be obtained from doctors who have a licence for the controlled drug from the Home Office. They will prescribe it on a named patient basis, the system available for the use of unlicensed medicines.

It is expected that people with MS will have to buy Sativex on private prescriptions. It would only be available on the NHS if a trust specifically agreed to its use for an individual patient.

Mike O’Donovan, the chief executive of the Multiple Sclerosis Society said yesterday: “This is a move in the right direction. We believe there is now good evidence that cannabis-derived medicine can relieve distressing symptoms like spasticity and pain in MS.

“Many people do not find available treatments effective and will now have the opportunity to try a new drug which could significantly improve their quality of life. We very much hope it will not be long before it is licensed for NHS prescription.”

A Department of Health spokesman said: “It is vital that we ensure that drugs are safe before they are used in the NHS. It is for this reason that Jane Kennedy, the health minister, has referred Sativex to the Commission on Human Medicines to determine its safety, quality and efficacy.”

http://telegraph.co.uk/news/main.jhtml?xml=/news/2005/11/16/nms16.xml

NHS Direct may be broken up as national contract is reviewed

Dr Search- Principal Consultant at the Search Clinic — Fri, 18 Nov 2005 13:02:00 +0000

NHS Direct will make its case for survival this week as it faces the imminent regional break-up of its national contract to provide unscheduled and urgent care advice and information services. The government is widely expected to advocate regional break-up of unscheduled access to advice and information in its forthcoming white paper on healthcare outside hospitals.

This is partly fuelled by feedback from the recent public consultation at which the Department of Health found only patchy awareness of the service.

NHS Direct was expected yesterday to outline its vision for a national non-urgent information service, which it wants to run.

Speaking to HSJ before its first major conference this week, the organisation’s medical director, Dr Mike Sadler, said he fully accepted ‘there will be some areas where services will be contestable’ following the white paper.

He added that he believes unscheduled care should be locally commissioned. However, he argued that national contracts should be awarded for the provision of web, phone and digital information services.

The proposed contracts would also cover integrated health and social care advice and interactive forums for patients with long-term conditions.

‘We have said in our consultation response that specific internet and digital television health information provision, which we are already doing in some areas, will only be cost effective if commissioned on a national basis,’ he said.

‘For others to start from scratch what is a difficult and costly service to promote, to divide that market up when we have a service that generates 2 million contacts a month for only £2.40 per head of population, would be unhelpful both for the NHS and the DoH,’ he said.

Former DoH head of unscheduled care Pippa Bagnall told an NHS Confederation conference at the beginning of the month that she believed the government still believed in ‘the model’ of an unscheduled, nurse-led telephone health advice service, but ‘perhaps not the way it is currently delivered’.

Ms Bagnall is currently leading on a regional pilot of an integrated urgent care service for Avon, Gloucestershire and Wiltshirestrategic health authority.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=3650256

Tamiflu anti bird flu drug linked to two deaths

Dr Search- Principal Consultant at the Search Clinic — Thu, 17 Nov 2005 08:52:00 +0000

The anti-flu drug Tamiflu can induce strange behaviour leading to accidental death, Japan’s health ministry has warned, after two teenagers died shortly after taking the medicine.

A 17-year-old high school student from Gifu jumped in front of a truck in February 2004 shortly after taking the medicine, while a middle school student from Aichi is believed to have fallen from the ninth floor of his apartment building this February, according to Japanese news reports. Neither exhibited psychological problems before taking Tamiflu.

The drug’s Japanese distributor, Chugai Pharmaceutical, issued a report to the health ministry after the first incident saying a link between taking the drug and the odd behaviour that led to the death cannot be ruled out.

The ministry is warning that taking the drug may lead to abnormal behaviour and accidental death, an official said.

The deaths, and their possible link to the drug will cause second thoughts in governments around the world since Tamiflu is now being coveted as an answer to a feared bird flu epidemic. The Japanese government plans to increase its stockpile of Tamiflu to 250 million capsules, from 150 million, over the next five years.

http://news.independent.co.uk/uk/health_medical/article326817.ece