Doctors at five sites in England are comparing vaccines from two manufacturers to see which works best and has the fewest side-effects.

Over the next two weeks 1,000 children aged six months to 12 years are being recruited in Oxford, Bristol, Southampton, Exeter and London.

Both vaccines are expected to be licensed in the coming weeks.

One has already been recommended for use.

Professor Andrew Pollard, from the University of Oxford, says vaccines are the best way to protect against flu and any side effects should be limited to sore arms or sometimes a fever.

This clinical trial comes just a month before more than 11 million people considered to be most at risk from flu will be offered the swine flu vaccine.

It will also be made available to more than two million front-line health workers.

The Care Quality Commission found nearly a fifth of homes were not being told if patients discharged from hospitals are or had been infected.

Even when they were told, the data was sometimes incomplete or illegible, the survey of more than 1,000 homes showed.

Latest figures show that MRSA levels in hospitals – they are not measured in care homes – have fallen in the past year.

C difficile figures have also been falling. But the CQC report said the progress being made could be compromised by communication problems.

Hospitals are meant to include infection history on discharge summaries.

However, the survey revealed 17% of care homes said they did not receive information from hospitals, while another 28% complained of incomplete and ineligible data.

The regulator also highlighted poor practice by care homes – a quarter were not following guidelines covering issues such as isolating residents with infections and antibiotic management.

It said care homes had until next year to follow the guidelines or face being refused registration.

CQC chief executive Cynthia Bower said: “Infection prevention and control is not simply an issue for hospitals – care needs to be clean and safe wherever it is provided.

“If we are to tackle infections effectively we need to check that all providers of care are talking to each other.”

Health minister Mike O’Brien said while there had been good progress on infections, he agreed closer working was needed.

“People have the right to the same standards of clean, safe care whether in health or social care.”

A separate CQC report also criticised the way patient information was being used.

The regulator said it had concerns about privacy – a third of staff said they had not been given training on confidentiality – while delays in hospitals sending GPs information after discharge were also noted.

The scrapping of existing GP catchment areas would allow commuters to register with a family doctor near work, or choose another practice locally, outside the catchment area of their primary care trust.

“I want to open up real choice in primary care,” Mr Burnham said in a speech to the King’s Fund health think-tank. Patients should be able to choose a practice “based on their needs, not by lines on a map” or by postcode.

Wider choice of GP is already Conservative policy and, according to the British Medical Association, this will be the fourth attempt by Labour to widen the choice of a family doctor, with previous efforts foundering over the cost and complexity of what appears a simple change.

Dr Laurence Buckman, chairman of the British Medical Association’s GP committee, said: “Most GPs would be comfortable with flexible boundaries.”

But “major logistical barriers would need to be overcome for a patient to be able to register with practices a long way from home”, he warned.

The issue of home visits would need to be sorted out, Dr Buckman said. But a bigger problem was that patients came with an amount of money attached to them, which funded hospital and community as well as GP services. Without some compensation system, big movements of young, fit patients, whose fees help subsidise sicker and older patients, could hit funding formulas for rural and suburban services.

“Practices in rural and suburban areas could lose significant numbers of young, healthy patients, destabilising their funding and threatening their viability,” Dr Buckman said.

“Meanwhile, city centre practices would be inundated with requests for appointments at lunchtimes and evenings, which would effectively limit patient choice.” Dr Buckman said the problems “are not insurmountable”. But they needed “a lot of careful thought” and could prove costly to solve.

Mr Burnham appears determined to do that. Dual registration – allowing patients to register both with a practice near work and one at home – has been raised in the past, but ruled out because of the cost.

Analysts said that young people contracting the condition, which is often associated with obesity, were helping to push up costs as doctors tried to improve their long-term control of the disease and prevent complications.

A total of 32.9 million diabetes drugs, costing £599.3 million, were prescribed in the past financial year. In 2004-05 there were 24.8 million, costing £458 million.

More than 90 per cent of the 2.4 million diabetics in England have type 2 diabetes, with the remainder suffering from type 1, the insulin-dependent form of the disease caused when the body’s immune system destroys insulin-producing cells in the pancreas. There are thought to be 500,000 undiagnosed cases of diabetes.

While rates of type 1 have shown slight increases in recent years, type 2 has risen far more rapidly — a trend linked to the increasing number of people who are overweight or obese. Almost one in four adults in England is obese, with predictions that nine in ten will be overweight or obese by 2050. Obesity costs the NHS £4.2 billion annually. This year the Government started a £375 million campaign aimed at preventing people from becoming overweight by encouraging them to eat better and exercise more.

An NHS Information Centre spokeswoman who worked on the report, which was published yesterday, said that diabetes was dominating the primary care drug bill as better monitoring identified more sufferers and widely used medications such as statins became cheaper. She said that the data suggested a growing use of injectable insulin in type 2 diabetes care, which was helping to push up costs.

Doctors agreed that more expensive long-acting insulin, which can cost about £30 per item, was being used more often, as well as more expensive pills and other agents.

The report, an update of the centre’s June publication Prescribing for Diabetes in England, shows that the number of insulin items prescribed last year rose by 300,000 to 5.5 million, at a total cost of £288.3 million. It marked an 8 per cent rise on the £267 million spent in the previous year. However, while the number of anti-diabetic drugs, which are mostly in tablet form, also rose, the cost dropped slightly to £168.1 million.

“Type 2 is increasing. We are seeing it in younger people, and because it is a progressive disease people are needing an increasing number of interventions as time goes by,” the spokeswoman said, adding that long-acting insulins such as Glargine were now common. “For people who are struggling to control their type 2 diabetes it makes sense, but it is quite a big clinical change from five or ten years ago.”

Other anti-diabetic items, such as use of the subcutaneous injection exenatide, have also increased and cost £14.3 million.

Laurence Buckman, chairman of the British Medical Association’s general practice committee, said that he had observed a trend with drugs such as exenatide, which costs £80 per item. He said that younger patients could start on cheaper tablets such as metformin, which costs £3.70 per box, but were needing increasingly sophisticated treatments to keep their condition in check.

“You are talking about an ever larger number of people getting a large range of drugs to reduce long-term complications. Type 2 is a common chronic illness that is getting commoner. It’s in everyone’s interest to treat people early and with the most effective drugs, and these are the more expensive tablets and long-acting insulins,” he said.

From:

The publicly funded legal challenge by Dennis Harland Roberts, 59, could prompt other prisoners to seek treatments they might otherwise have been denied because of an undisclosed policy operated by Jack Straw, the Justice Secretary.

The policy restricts prisoners’ access to cosmetic and certain other treatments regarded as non-urgent — even though the labour Government has said that they are entitled to the same NHS care as the rest of the population.

Roberts won a declaration at the High Court in London that Mr Straw had acted unlawfully and “contrary to good administration”in failing to disclose his full policy.

Coincidentally, Roberts, a Category A prisoner, was represented in court by Adam Straw, a barrister who is a nephew of the Justice Secretary.

The court case led to the full policy being publicly revealed last week. After its disclosure, the Ministry of Justice agreed to reconsider Roberts’s application to be escorted to hospital for laser treatment, if he could show that the birthmark was having a negative impact on his health. But Roberts and his lawyers continued their legal action to obtain a formal High Court declaration, making the position clear for other prisoners.

Roberts said that the large, congenital port-wine stain on the left side of his face, neck and shoulder had led to his being bullied at school and was linked to a violent temper. He had previously had hospital treatment to remove it on three occasions, the last one in July 2007. But his appointments last year were cancelled.

Roberts, from Newhaven, Sussex, was convicted at Lewes Crown Court in March 1991 of stabbing to death Stephen and Iris Hadler, both in their 70s, after breaking into their home in the summer of 1989. He is now at Frankland Prison, Durham.

A consultant dermatologist recommended him for treatment for the birthmark in 2006.

The consultant stated: “This has always been an embarrassment to him, but he is now developing small vascular nodules within it and I think that laser treatment on the NHS is entirely justified.”

Roberts said in a written statement to the court that the treatment he had already received appeared to have had some success, lightening and removing some 30 per cent of the birthmark. He said he was “extremely pleased” and was expecting an estimated further four sessions of treatment but delays over further treatment caused by the failure to provide him with hospital escorts had sent him into depression.

Adam Straw told the court that, as a result of being bullied at school, “he has a low tolerance for people commenting on his face. He “feels self-conscious and fearful of his own reaction when he becomes aware of others looking at the mark. When the treatment was halted in July 2007, Roberts slid into depression and his violent temper re-emerged.”

The Government’s full policy, which had now come to light, allowed “elective treatment” only if there was “a negative impact on the prisoner’s mental or physical health”. The policy required the need for treatment to be balanced against “public acceptability” issues, and the fact that Category A escorts were “resource intensive, both for staffing and expenditure”.

This differed from the published policy relied on by the Government in a case last year, which gave inmates “access to the same range and quality of services as the general public receives from the NHS”.

Had Roberts known about the unpublished policy, his lawyer said, he would have sought a medical report to show the impact that the birthmark was having on his health, and legal proceedings would have been avoided.

Mr Straw said that it had been necessary to seek a High Court declaration “to prevent prejudice to many other prisoners with similar claims”. Prisoners were entitled to know the correct policy so that they had a proper and fair chance to make their case.

Agreeing with Mr Straw, Michael Suppertone, QC, a deputy High Court judge, declared in a judgment revealed: “In my judgment it is contrary to good administration, and unlawful, for the defendant’s full policy on medical appointments not to be published.”

From:

A tough package of measures is needed to “tackle the soaring cost of alcohol related harm” in Britain, said a report from the British Medical Association (BMA).

Young people are particularly affected by such advertising, which encourages them to binge-drink and stock up on cheap alcopops, it said.

The BMA also renewed its calls for a minimum price to be set per unit of alcohol, for alcohol to be taxed at a higher rate than inflation and for a ban on two-for-one offers.

It follows a report last year from the union which said there should be a curb on the sale of cut-price alcohol, such as in supermarkets.

The latest study – Under The Influence – said alcohol consumption in the UK has “increased rapidly” in recent years among all age groups.

It blames advertising and heavy discounting, the availability of cheap alcohol and 24-hour licensing laws.

The report said: “The population is drinking in increasingly harmful ways and the result is a plethora of avoidable medical, psychological and social harm, damaged lives and early deaths.

“As consumption has increased, so the market for alcohol has grown. In 2007, sales (including supermarket, off-licence, restaurant and bar sales) were high enough to put virtually every British adult over Government guideline drinking levels.

“These sales are driven by vast promotional and marketing campaigns that dwarf health promotion efforts: the UK alcohol industry spends approximately £800 million each year encouraging consumption of its wares.”

The report said current controls on promoting alcohol are “completely inadequate” because they are based on voluntary agreements with the industry and focus on their content, rather than the amount of alcohol advertising.

“Even in their control of content the rules are weak with, for example, prohibitions on advertising which associates drink with youth culture or sporting success sitting alongside alcohol sponsorship of iconic youth events like music festivals and premiership football.”

Dr Vivienne Nathanson, head of science and ethics at the BMA, said the body was not “anti-alcohol” but doctors were right to focus on the health of their patients.

She added: “Over the centuries, alcohol has become established as the country’s favourite drug.

“The reality is that young people are drinking more because the whole population is drinking more and our society is awash with pro-alcohol messaging and marketing. In treating this we need to look beyond young people and at society as a whole.”

According to the World Health Organisation (WHO), alcohol is the leading risk factor for premature death and disability in developed countries after smoking and high blood pressure.

It is related to more than 60 medical conditions, costs the NHS millions of pounds every year and is linked to crime and domestic abuse, the report said.

Professor Gerard Hastings, who was an author on the study, said: “Given the alcohol industry spends £800 million a year in promoting alcohol in the UK, it is no surprise that we see it everywhere – on TV, in magazines, on billboards, as part of music festival or football sponsorship deals, on internet pop-ups and on social networking sites.

“Given adolescents often dislike the taste of alcohol, new products like alcopops and toffee vodka are developed and promoted as they have greater appeal to young people.

Don Shenker, chief executive of Alcohol Concern, said: “There’s no longer any doubt – the heavy marketing and promotion of alcohol, combined with low prices – are encouraging young people to drink at a level our health services are struggling to cope with.”

Justice secretary Jack Straw has called for imaginative solutions to tackling to the problems of drug addiction

He called for “imaginative” solutions to hard-drug abuse and said there could be “huge benefits” to issuing the drug to chronic addicts.

At the moment addicts can be prescribed heroin substitutes designed to wean them off the drug, but the idea of prescribing the drug itself is aimed at keeping long-term addicts away from drug dealers and crime.

“For the most problematic heroin users it may be the best means of reducing the harm they do themselves, and of stamping out the crime and disorder they inflict on the community,” said Mr Straw.

The Justice Secretary is the first cabinet minister to get involved in the debate following the results of a pilot scheme involving 127 heroin addicts in three cities, published last week.

The trial, which involved users injecting themselves under medical supervision in London, Brighton and Darlington, showed that crimes committed by addicts who had been prescribed heroin dropped by two thirds after six months.

Mr Straw said prescription heroin was “no magic bullet” but claimed it could reduce the £15 billion a year cost of the abuse of hard drugs.

The trials were set up in 2002 by David Blunkett, the then home secretary, but Mr Straw is the first cabinet minister to endorse prescribing the drug.

Harry Shapiro of Drugscope, which represents 800 drug projects, said: “It’s important to do everything possible to discourage Britain’s 300,000 problem drug users from injecting their drugs, and we should allow injecting heroin users to be provided with foil as part of a harm-reduction programme.”

From:
http://www.telegraph.co.uk/Jack-Straw-calls-for-heroin-on-prescription

Meanwhile, Nicholas Hewitt Birtles, a sales rep, was arrested when police raided a car parked near his home in Camden, north London, on Saturday evening, Scotland Yard said.

Officers observed three men sitting inside the vehicle parked in Camden Square and went to investigate at about 7.45pm.

They searched the car and allegedly recovered a small amount of white powder, arresting two of the occupants while the third was allowed to go.

The pair were taken to a nearby police station for questioning.

Mr Hewitt Birtles, whose father is Judge William Birtles, was later charged with possessing cocaine while the other man, who has not been named, was released on bail while tests are carried out on the powder.

The former Cabinet minister’s son was released on Sunday but ordered to appear in court next week. His friend is to answer police bail next month.

Australian-born Miss Hewitt, who served as Trade and Industry Secretary before moving to the Department of Health, left the Government in 2007 and is stepping down as an MP at the next election.

A Scotland Yard spokesman said: “Nicholas Hewitt Birtles, a sales representative of NW1, is bailed to appear before Highbury Corner Magistrates’ Court on Sept 30 charged with possession of a class A drug, namely cocaine, on Saturday Sept 19 at Camden Square.

From:
http://www.telegraph.co.uk/Patricia-Hewitts-son-Nicholas-charged-with-cocaine-possession

Health Direct has long question the “logic” of labour’s drugs policy.

Hospitals are to get their first indication in the autumn of just how far and fast they will have to cut costs to help achieve that. His acknowledgement of  the scale of the challenge comes as Gordon Brown and Alistair Darling, prime minister and chancellor, have begun a series of meetings with cabinet ministers to discuss priorities and potential candidates for cuts in the run-up to the pre-Budget report in the autumn.

Labour Government insiders played down suggestions that the autumn statement would be a mini spending review, setting out departmental spending limits beyond March 2011.

But after the prime minister’s use of the “c” word this week, promising to “cut unnecessary programmes and cut lower priority budgets”, the chancellor is likely to offer some totemic sacrifices in the pre-Budget report, while possibly spelling out areas likely to be protected from the worst of the squeeze.

It is already clear that the capital intensive areas of transport and housing are set to take a hammering given previously announced plans to halve capital spending from this year’s level.

“They will almost certainly be amongst the hardest hit,” said Robert Chote, director of the Institute for Fiscal Studies.

Health is likely to be relatively protected, not least because the Conservatives are promising some real terms growth. That, however, will still leave the NHS having to make massive savings in the face of rising demand from medical advances and an ageing population, which together with pay and price inflation tend to outstrip economic growth.

Mr Burnham indicated this week that he would like to set out an “overall spending settlement” for the NHS in the autumn, while acknowledging that is a matter for the chancellor.

But whether that happens or not, he told the King’s Fund health think-tank, he will take the unprecedented step of spelling out the prices the NHS is likely to pay hospitals for treatment over the next four years.

That “will set out the scale of the efficiency and productivity challenge year on year, building up over time, with the most demanding savings coming later,” he said. In turn, he said, that “will begin the process of showing how we realise [the] challenge of finding £15bn to £20bn of savings” up until 2014.

Nigel Edwards, head of policy for the NHS Confederation, which itself has calculated that the NHS needs to make up to £15bn of savings by 2015, said: “This is the first ministerial acknowledgement that I have seen of the scale of the challenge.

“The good news is that it has been publicly acknowledged, and we welcome that realism. The bad news is that it is at least as bad as we thought”. 

One in five people who have had a heart attack in Britain do not receive all four drugs recommended to prevent a second, a study of 60,000 people have found.

NICE guidelines say heart attack patients should be prescribed two blood pressure drugs, a cholesterol lowering statin and aspirin to thin the blood.

However research based on a database of all surviving heart attack patients in England and Wales has found one in 20 people received only one or two drugs.

Women and older people are less likely to receive all four drugs, the study by University of Leicester has found.

Only 29 per cent of people leaving hospital on all four drugs were women. In addition the average age of those on one drug was 82 while the average age of those on four was 67.

Lead author Prof Iain Squire, professor of cardiovascular medicine at University of Leicester and consultant at the Leicester Royal Infirmary, calculated that 2,000 out of the 5,000 deaths over the two year study period had been undertreated and ‘could potentially have been avoided’.

He said: “The patients who are most likely to get undertreated are the elderly and females but they get incremental benefit for each drug they take so we should not be withholding these therapies based on age and gender alone.”

People aged 65 to 74 were 20 per cent less likely to get all four drugs compared with those under 55; while people aged over 85 were three times less likely to get all four medicines.

The findings, based on an analysis of the national registry called the Myocardial Infarction National Audit Project collected between January 2004 and December 2005, were presented at the European Society of Cardiology Congress in Barcelona.

It is thought doctors believe the drugs are less beneficial and more difficult to use in older people, and that women do not gain as much as men from them.

But the study showed that the survival benefits are similar in women as in men and in the elderly, the research showed.

The chances of surviving for one year after a heart attack increased with the number of drugs prescribed.

When other factors such as age, gender, and other illnesses were taken into account, people on four drugs were 54 per cent more likely to be alive one year later compared with people on just one drug.

Those on three drugs were 42 per cent more likely to be alive 12 months on than people on one drug; and people on two drugs were 27 per cent more likely to survive for one year than patients receiving one drug.

The effect was the same in men and women and the graded benefits of multiple drugs remained evident for patients aged 80 and over, the authors said.

Prof Squire said: “Our data indicate that provision of equitable management in these high-risk groups has the potential to deliver major improvements in prognosis for patients with acute myocardial infarction.”

Prof Adam Timmis, co-author and professor of clinical cardiology at the London Chest Hospital, said the majority of people are receiving all four drugs but improvements could still be made.

He said: “If you optimised the use of exisiting drugs and people were all managed appropriately across the country that would have a very large effect on cardiovascular outcomes.”

Prof Timmis said the guidelines, complied by the National Institute for Curbing Expenditure, Nice, are clear that there should be no discrimination on the basis of age or gender.

He said: “There is a general feeling that women don’t get this [heart attacks]. But we are not dealing with a condition that is rare in women, but there has been this perception.”

Prof Peter Weissberg, Medical Director of the British Heart Foundation, said this data was four years old.

He said: “We can pretty reasonably assume we are better now then we were then. We are getting better because we have this audit, hospitals are named and shamed when they are poor performers.

“There is a way to go and, generally speaking, women get a poorer deal in cardiovascular disease. That is improving but still less than perfect.”

Around 113,000 people in Britain each year suffer a heart attack and about one in three die before reaching hospital.

Charges under which patients pay more than the cost of a local call from a landline are being scrapped in England after a consultation.

As we reported in 2007, many NHS organisations use numbers starting with an 0844 or 0845 prefix, which can be up to 30p a minute more expensive to call than a standard local number.

Patients will still dial 084 numbers to get through but tariffs will be adjusted to ensure that they pay only for the cost of a local call, ministers said.

Mike O’Brien, the Health Minister, said: “We have been concerned that some people are paying more than the cost of a local-call rate to contact the NHS. For people on low incomes, and for those who need to contact their doctor or hospital regularly, these costs can soon build up.

“We want to reassure the public that when they contact their GP or hospital, the cost of their call will be no more expensive than if they had dialled a normal landline number.”

A letter will be sent to NHS organisations informing them of the changes this week, while amendments will be made to GP contracts over the coming months.

Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, said: “Patients who call their surgery because they’re ill shouldn’t be penalised because they have to call an 084 number, so we’re pleased that the phone companies who supply these lines to practices have agreed to ensure that their tariffs are in line with local charges.

“Combining the benefits of 084 numbers with an assurance that they won’t cost more than a local phone call is the best solution for patients and practices.”

Katherine Murphy, director of the Patients’ Association, said: “It’s great that the Department of Health has listened to patients. Asking them to pay extra costs for phone calls was unreasonable. Patients have had to wait long enough for the ruling-let’s hope the change happens as quickly as possible.”

Mass recruitment schemes in the Sixties were a great success. Nursing numbers rose as social shifts allowed greater numbers of women to take up full-time careers, while doctors’ ranks swelled with immigrants from the Commonwealth.

This workforce bulge can, in part, be identified as a cause of recruitment ripples ever since. Sharp rises in the uptake of staff occurred as the NHS expanded to meet further demand but these have prompted a natural slowdown in recruitment. The key, which the labour Government has yet to grasp properly, is to soften the troughs as effectively as possible.

Take nursing, where the effect of demographics is felt most acutely. In the mid-Nineties health professionals raised concerns about future vacancies. Labour took action when it came to power and hired a total of 80,000 more nurses, many from the Philippines and India. Now the NHS has limits on international recruitment and fewer nursing places in tertiary education.

However, an estimated 200,000 nurses are expected to retire over the next decade, a disproportionate chunk of the workforce and the most valuable in terms of experience. Health professionals argue that governments rarely factor in vital long-term workforce planning because they focus on short-term parliamentary cycles.

For this latest ripple to occur at a time of severe economic stretch is even more concerning. Past worries about retaining sections of the doctors’ workforce have been solved with attractive pay packages.

The likelihood of enough money being found to replace the retiring nurses is slim and will perversely mean the NHS ends up paying more for the quick fix sticking plasters of agency workers who can earn ten times the hourly rate of a middle-ranking staff nurse. 

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn.

As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong. As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients.”

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.

Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.

It was recommended as a model by the National Institute for Curbing Expenditure (Nice), the labour Government’s health scrutiny body, in 2004.

It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system.

Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.

They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication.

Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance.

When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit.

If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention.

Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition.

He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.

He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in. It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

He added: “What they are trying to do is stop people being overtreated as they are dying. It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”

He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.

Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours.

In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.

“If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.

Katherine Murphy, director of the Patients Association, said: “Even the tiniest things that happen towards the end of a patient’s life can have a huge and lasting affect on patients and their families feelings about their care.

“Guidelines like the LCP can be very helpful but healthcare professionals always need to keep in mind the individual needs of patients. There is no one size fits all approach.”

A spokesman for Marie Curie said: “The letter highlights some complex issues related to care of the dying.

“The Liverpool Care Pathway for the Dying Patient was developed in response to a societal need to transfer best practice of care of the dying from the hospice to other care settings.

“The LCP is not the answer to all the complex elements of this area of health care but we believe it is a step in the right direction.”

The pathway also includes advice on the spiritual care of the patient and their family both before and after the death.

It has also been used in 800 instances outside care homes, hospices and hospitals, including for people who have died in their own homes.

The letter has also been signed by Dr Anthony Cole, the chairman of the Medical Ethics Alliance, Dr David Hill, an anaesthetist, Dowager Lady Salisbury, chairman of the Choose Life campaign and Dr Elizabeth Negus a lecturer in English at Barking University.

From:
http://www.telegraph.co.uk/Sentenced-to-death-on-the-NHS

Nanny state officials said that NHS staff had a duty to take the jab, to ensure they did not pass on the virus to those who were already sick. Even though the vaccine has not met their own NICE drug guidelines.

The warning follows a spate of surveys which suggest that many healthcare workers will refuse the vaccine, despite being on the labour Government’s “priority list”.

Up to half of GPs and one in three nurses say that they do not plan to take the vaccine, some because of concerns over safety.

Vivienne Parry, a member of the Joint Committee on Vaccination and Immunisation, (JCVI) who advise ministers on vaccines, said that health professionals should protect “vulnerable patients” from the virus.

She said: “This (protection) aspect does not seem to feature at all in medical staff responses about flu vaccination, which is extremely concerning.

“Indeed the word ‘patient’ hardly seems to figure at all in responses in this and other surveys of healthcare workers, even though 75 per cent of deaths from swine flu are in those with serious underlying medical conditions who are in regular contact with healthcare workers.”

Prof David Salisbury, the nanny states’s Department of Health director of immunisation, told GP magazine, which carried out the poll, that frontline health workers had a “duty” to have the vaccine.

“They have a duty to their patients not to infect their patients and they have a duty to their families,” he said.

More than two thirds of GPs who told Pulse magazine that they would turn down the jab believe that it has not undergone enough tests.

Doctors have been warned to look out for possible signs of Guillain Barre Syndrome, a rare neurological condition, which can cause paralysis and even death.

A vaccine used against flu in America in 1976 caused a number of cases of the condition.

However, the World Health Organisation (WHO) insists that the production of vaccines has become much safer since then.

Human trials are currently underway and will be scrutinised by the regulatory authorities before the vaccines will be licensed for use, probably in October.

Earlier this month a poll of almost 1,500 Nursing Times readers revealed that one in three said that they would not have the swine flu vaccine.

Uptake of the seasonal flu vaccine among NHS staff has been traditionally low, and just 16 per cent of all those employed by the health service took the vaccine last year.

Another study published online by the British Medical Journal shows that half of 8,500 healthcare workers in Hong Kong say that they would refuse a swine flu vaccine, because of safety concerns and worries that it would not work very well.

Researchers said that the figures were surprisingly low given the impact the SARS (Severe Acute Respiratory Syndrome) virus had on the area.

However, some experts insisted that the polls did not prove that NHS staff were “irresponsible” or had serious concerns about the safety of the vaccine.

Prof Robert Dingwall, Director of the Institute for Science and Society at the University of Nottingham, said that it was important not to blow the apparent reluctance of healthcare workers to have the vaccine “out of proportion”.

He said: “(These polls) identify a communication challenge for those managing the pandemic but they are not evidence of a crisis of confidence in the vaccine or of professional irresponsibility by health workers.”

In the last six years, the Patients Association claims hundreds of thousands have suffered from poor standards of nursing, often with ‘neglectful, demeaning, painful and sometimes downright cruel’ treatment.

The charity has disclosed a horrifying catalogue of elderly people left in pain, in soiled bed clothes, denied adequate food and drink, and suffering from repeatedly cancelled operations, missed diagnoses and dismissive staff.

The Patients Association said the dossier proves that while the scale of the scandal at Mid-Staffordshire NHS Foundation Trust – where up to 1,200 people died through failings in urgent care – was a one off, there are repeated examples they have uncovered of the same appalling standards throughout the NHS.

While the criticisms cover all aspects of hospital care, the treatment and attitude of nurses stands out as a repeated theme across almost all of the cases.

They have called on Government and the Care Quality Commission to conduct an urgent review of standards of basic hospital care and to enforce stricter supervision and regulation.

Claire Rayner, President of the Patients Association and a former nurse, said:“For far too long now, the Patients Association has been receiving calls on our helpline from people wanting to talk about the dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses.

“I am sickened by what has happened to some part of my profession of which I was so proud. These bad, cruel nurses may be – probably are – a tiny proportion of the nursing work force, but even if they are only one or two percent of the whole they should be identified and struck off the Register.”

The charity has published a selection of personal accounts from hundreds of relatives of patients, most of whom died, following their care in NHS hospitals.

They cite patient surveys which show the vast majority of patients highly rate their NHS care – but, with some ten million treated a year, even a small percentage means hundreds of thousands have suffered.

Ms Rayner said it was by “sad coincidence” that she trained as a nurse with one of the patients who had “suffered so much”.

She went on: “I know that she, like me, was horrified by the appalling care she had before she died. We both came from a generation of nurses who were trained at the bedside and in whom the core values of nursing were deeply inculcated.”

Katherine Murphy, Director of the Patients Association, said “Whilst Mid Staffordshire may have been an anomaly in terms of scale the PA knew the kinds of appalling treatment given there could be found across the NHS. This report removes any doubt and makes this clear to all. Two of the accounts come from Stafford, and they sadly fail to stand out from the others.

“These accounts tell the story of the two percent of patients that consistently rate their care as poor (in NHS patient surveys). If this was extrapolated to the whole of the NHS from 2002 to 2008 it would equate to over one million patients. Very often these are the most vulnerable elderly and terminally ill patients. It’s a sad indictment of the care they receive.”

The Patients Association said one hospital had threatened it with legal action if it chose to publish the material.

Pamela Goddard, a piano teacher from Bletchingley, in Surrey, was 82 and suffering with cancer but was left in her own excrement and her condition deteriorated due to her bed sores.

Florence Weston, from Sedgley in the West Midlands, died aged 85 and had to remain without food or water for several days as her hip operation was repeated cancelled.

The charity released the dossier to highlight the poor care which a minority of patients in the NHS are subjected to.

Ms Murphy said the numbers rating care as poor came despite investment in the NHS doubling and the number of frontline nurses increasing by more than a quarter since 1996.

The personal stories were revealed to prevent their cases being ignored as only representing a small portion of patients.

The report said: “These are patients, not numbers. These are people, not statistics.”

Dr Peter Carter, Chief Executive of the Royal College of Nursing, said he was concerned that public confidence in the NHS could be undermined by the examples cited and it would affect morale in hardworking staff.

He said: “The level of care described by these families is completely unacceptable, and we will not condone nurses who behave in ways that are contrary to the principles and ethics of the profession.

“However we believe that the vast majority of nurses are decent, highly skilled individuals. This report is based on the two per cent of patients who feel that their care was unacceptable. Two per cent is too many but we are concerned that this might undermine the public’s confidence in the world-class care they can expect to receive from the NHS.”

Barbara Young, Chairman of the Care Quality Commission, the super-regulator, said: “It is absolutely right to highlight that standards of hospital care can vary from very good to poor.

“Many people are happy with the care they receive, but we also know that there are problems. I am in no doubt that many hospitals need to raise their game in this area.

“Where NHS trusts fail to meet the mark, we have tough new enforcement powers, ranging from warnings and fines to closure in extreme cases. We will not hesitate to use these powers when necessary to bring improvement.

“We will be asking NHS trusts and primary care trusts how they are ensuring that the needs of patients and their safety and dignity are kept at the heart of care.”

From:
http://www.telegraph.co.uk/Cruel-and-neglectful-care-of-one-million-NHS-patients-exposed

Or not, at least, if the Conservatives win the next general election. For the Tories have pledged to scrap the countrywide version of the National Health Service’s electronic patient record.

Back in 2002, the idea of a full patient record, available anywhere in an emergency, was the principal political selling point for what was billed as “the biggest civilian computer project in the world”: the drive to give all 50m or so patients in England (the rest of the UK has its own arrangements) an all-singing, all-dancing electronic record. 

The drugs are currently offered to anyone in England with flu like symptoms but the WHO’s guidance contradicts this policy, suggesting that the side effects may outweigh the benefits for otherwise healthy people.

But Tamiflu (oseltamivir) or Relenza (zanamivir) should still be used as “soon as possible” if people present with severe illness or whose condition was deteriorating, the UN’s health agency said.

Those in at-risk groups — such as pregnant women or people with an underlying medical condition such as diabetes — should also receive treatment promptly.

The latest WHO advice, from a panel of international experts, comes as new figures show that 45,986 courses of antivirals were given to patients in England last week.

In the previous week, 90,363 had been given out after people contacted the National Pandemic Flu Service, the telephone and internet service which allows people to obtain medication without seeing a doctor.

There have been fears that mass use of Tamiflu will encourage the H1N1 swine flu strain to become resistant to the antiviral.

Researchers have also expressed concern over the side-effects of the drug, including sickness, nightmares and insomnia in children.

A team from the University of Oxford said earlier this month that children with mild symptoms should not be given the antiviral to combat swine flu and urged the Department of Health to urgently rethink its policy.

The advice, published on the WHO website, said that most patients were experiencing typical flu symptoms and would get better within a week.

A statement said that the new guidelines “represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs.

“Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalisation, and reduce the duration of hospital stays.

The first national audit of staff habits has found that high rates of obesity, smoking, absenteeism and poor mental health are having a direct impact on the quality of patient care.

Dr Steve Boorman, a leading occupational health expert, was asked by the Government to assess links between staff habits and NHS productivity. His findings are drawn from six months of staff surveys, workshops, data reviews and responses from trusts and experts.

— More than 45,000 NHS workers are calling in sick every day, one and a half times the rate of absence in the private sector. Reducing the 10.3 million working days lost per year by a third would save the NHS £555 million annually.