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Dementia patients face Russian roulette in hospital

Dementia patients admitted to hospital in England play “Russian roulette” with their health, a charity is warning.

Dementia patients admitted to hospital in England play "Russian roulette" with their health, a charity is warning.

The Alzheimer’s Society said it had found “shocking” evidence of poor and variable care during its review.

The report, based on Freedom of Information (FOI) requests, found problems with falls, night-time discharges and readmissions, and said standards needed to improve urgently.

The Department of Health said the disease was a key priority as one in four hospital beds is believed to be occupied by a person with dementia.

The Alzheimer’s Society called for all hospitals to publish an annual statement of dementia care, to include information on satisfaction, falls, readmissions and staff training as part of its campaign to improve standards.

The charity received responses to their FOI request from half of the 163 hospital trusts in England; however, for some of the questions the figures were based on a fifth of trusts as not all hospitals could provide answers to all the questions.

Its report showed:

  • more than one in four people over the age of 65 who fell had dementia, but in some trusts it topped 70%
  • people with dementia stay five to seven times longer than other patients over the age of 65 in the worst-performing hospitals
  • one in 10 people over 65 who were discharged overnight had dementia – with the numbers rising to nearly four in 10 in the worst trusts
  • more than half of over-65s readmitted within 30 days – a sign of inappropriate care – had dementia in the worst-performing trust.

The Alzheimer’s Society also carried out a survey of dementia patients. It found examples of patients being treated with excessive force, not being given enough help with meals and drinks and being left in wet or soiled sheets.

Nine in 10 said hospitals were frightening and only 2% felt all staff understood the needs of people with dementia.

The charity described these findings as unacceptable and a sign that dementia patients were not getting the standard of care they should.

Alzheimer’s Society chief executive Jeremy Hughes said: “In the worst cases, hospital care for people with dementia is like Russian roulette. People with dementia and their carers have no way of knowing what’s going to happen to them when they are admitted.

“In many cases they are well looked after but, as our investigation shows, too often people with dementia fall and injure themselves, get discharged at night or are marooned in hospital despite their medical treatment having finished.”

A Department of Health spokesman said the disease was a key priority and in recent years £50m had been spent on making hospitals and care homes more “dementia friendly”, while 500,000 staff had received extra training.

“People with dementia and their carers deserve the very best support,” he added.

Suicide gene therapy kills prostate cancer cells

A new gene therapy technique is able to modify prostate cancer cells so that a patient’s body attacks and kills them, US scientists have discovered.

A new gene therapy technique is able to modify prostate cancer cells so that a patient's body attacks and kills them, US scientists have discovered.

The technique causes the tumour cells in the body to self destruct, giving it the name ‘suicide gene therapy’.

Their research found a 20% improvement in survival in patients with prostate cancer five years after treatment.

Prostate cancer is the most common cancer in men in the UK with more than 41,000 diagnosed each year.

The study, led by researchers from Houston Methodist Hospital in Texas, appears to show that this ‘suicide gene therapy’, when combined with radiotherapy, could be a promising treatment for prostate cancer in the future.

The technique involves the cancer cells being genetically modified so that they signal a patient’s immune system to attack them.

Usually, the body does not recognise cancer cells as the enemy because they have evolved from normal healthy cells. Unlike an infection, which the body reacts against, the immune system does not react to kill off the offending cancer cells.

Using a virus to carry the gene therapy into the tumour cells, the result is that the cells self destruct, alerting the patient’s immune system that it is time to launch a massive attack.

In two groups of 62 patients, one group received the gene therapy twice and the other group – who all had more aggressive prostate cancer – received the treatment three times. Both groups also received radiotherapy.

Survival rates after five years were 97% and 94%. Although there was no control group in this study, the researchers said the results showed a five to 20% improvement on previous studies of prostate cancer treatment.

And cancer biopsy tests performed two years after the trial were found to be negative in 83% and 79% of the patients in the two groups.

Dr Brian Butler, from Houston Methodist Hospital in Texas, said it could change the way that cancer is treated. “We may be able to inject the agent straight into the tumour and let the body kill the cancer cells. Once the immune system has knowledge of the bad tumour cells, if they pop up again, the body will know to kill them.”

Kevin Harrington, professor of biological cancer therapies at The Institute of Cancer Research, London, said the results were “very interesting” but more research was needed. We would need a randomised trial to tell if this treatment is better than radiotherapy alone.”

“The viruses used in this study cannot reproduce. Next generation viral therapies for cancer can selectively replicate in cancer cells, something that can kill the cancer cell directly, and also help spread the virus to neighbouring cancer cells.”

“It would be interesting to see this approach used with viruses that could reproduce to see if it makes for a more effective treatment.”

NHS trust failed to investigate hundreds of deaths

The NHS has failed to investigate the unexpected deaths of more than 1,000 people since 2011 according to a new report.

The NHS has failed to investigate the unexpected deaths of more than 1,000 people since 2011 according to a new report.

It blames a “failure of leadership” at Southern Health NHS Foundation Trust and that the deaths of mental health and learning disability patients were not properly examined.

Southern Health said it “fully accepted” the quality of processes for investigating and reporting a death needed to be better, but had improved.

The trust is one of the country’s largest mental health trusts, covering Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire and providing services to about 45,000 people.

The investigation, commissioned by NHS England and carried out by Mazars, a large audit firm, looked at all deaths at the trust between April 2011 and March 2015.

During that period, it found 10,306 people had died. Most were expected. However, 1,454 did not.

Of those, 272 were treated as critical incidents, of which just 195 – 13% – were treated by the trust as a serious incident requiring investigation (SIRI).

The likelihood of an unexpected death being investigated depended hugely on the type of patient.

The most likely group to see an investigation was adults with mental health problems, where 30% were investigated. For those with learning disability the figure was 1%, and among over-65s with mental health problems it was just 0.3%.

The average age at death of those with a learning disability was 56 – over seven years younger than the national average.

Even when investigations were carried out, they were of a poor quality and often extremely late, the NHS England report says.

Repeated criticisms from coroners about the timeliness and usefulness of reports provided for inquests by Southern Health failed to improve performance, while there was often little effort to engage with the families of the deceased.

Key findings from the report

  • The trust could not demonstrate a comprehensive systematic approach to learning from deaths
  • Despite the trust having comprehensive data on deaths, it failed to use it effectively
  • Too few deaths among those with learning disability and over-65s with mental health problems were investigated, and some cases should have been investigated further
  • In nearly two thirds of investigations, there was no family involvement

The reasons for the failures, says the report, lie squarely with senior executives and the trust board.

There was no “effective” management of deaths or investigations or “effective focus or leadership from the board”, it says.

Even when the board did ask relevant questions, the report says, they were constantly reassured by executives that processes were robust and investigations thorough.

The culture of Southern Health, which has been led by Katrina Percy since it was created in 2011, “results in lost learning, a lack of transparency when care problems occur, as well as lack of assurance to families that a death was not avoidable and has been properly investigated,” the report says.

UK pays less for cancer drugs than some countries

The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology.

The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology

While the UK, Greece, Spain and Portugal pay the least, on average, for the drugs they use, Germany, Sweden and Switzerland pay the most.

The authors said more transparency was needed because some countries risked overpaying for drugs. The pharmaceutical industry said the UK was getting a fair deal on medicines.

Prices of cancer drugs have risen steeply in recent years, placing major stress on many healthcare systems, including the NHS.

The report said drugs had accounted for nearly a third of the EU’s £37 billion cancer healthcare spending in 2009.

And the researchers then compared the 2013 price of 31 cancer drugs in 18 high-income countries, including the UK, Australia, New Zealand, France, Greece, Switzerland, Sweden and Portugal.

Prices in Greece were the lowest for 14 out of the 24 cancer drugs available there.

The price of drugs in the UK was also low.

Prices of drugs in Switzerland, Germany and Sweden were frequently the highest – and for some drugs, such as interferon alfa 2b to treat leukaemia and skin cancer, were twice as high.

The price figures come from the Pharma Price Information service in Austria, which details what manufacturers charge per unit – a single tablet or vial of a drug, for example.

But although the official list prices published in this report are freely available, any further discounts – which are often negotiated by organisations in different countries – remain confidential.

David Watson, director of pricing and reimbursement at the Association of the British Pharmaceutical Industry, said the report was evidence that newer medicines “are affordable in the UK”.

He said the UK was “getting a fair deal with regards to medicines pricing” and the NHS was “getting good value for money”.

Antibiotic resistance- world on cusp of post antibiotic era

The world is on the cusp of a “post-antibiotic era”, scientists have warned after finding bacteria resistant to drugs used when all other treatments have failed.

The world is on the cusp of a "post-antibiotic era", scientists have warned after finding bacteria resistant to drugs used when all other treatments have failed

They identified bacteria able to shrug off the drug of last resort – colistin – in patients and livestock in China.

They said that resistance would spread around the world and raised the spectre of untreatable infections. It is likely resistance emerged after colistin was overused in farm animals.

Bacteria becoming completely resistant to treatment – also known as the antibiotic apocalypse – could plunge medicine back into the dark ages.

Common infections would kill once again, while surgery and cancer therapies, which are reliant on antibiotics, would be under threat.

Chinese scientists identified a new mutation, dubbed the MCR-1 gene, that prevented colistin from killing bacteria.

The report in the Lancet Infectious Diseases showed resistance in a fifth of animals tested, 15% of raw meat samples and in 16 patients.

And the resistance had spread between a range of bacterial strains and species, including E. coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.

There is also evidence that it has spread to Laos and Malaysia.

Resistance to colistin has emerged before. However, the crucial difference this time is the mutation has arisen in a way that is very easily shared between bacteria.

The concern is that the new resistance gene will hook up with others plaguing hospitals, leading to bacteria resistant to all treatment – what is known as pan-resistance.

Early indications suggest the Chinese government is moving swiftly to address the problem.

New drugs are in development, such as teixobactin, which might delay the apocalypse, but are not yet ready for medical use.

A commentary in the Lancet concluded the “implications [of this study] are enormous” and unless something significant changes, doctors would “face increasing numbers of patients for whom we will need to say, ‘Sorry, there is nothing I can do to cure your infection.'”

NHS health data sharing project scrapped

The Department of Health in England is scrapping its controversial data sharing project – known as

The Department of Health in England is scrapping its controversial data sharing project - known as programme, which was due to launch in 2014, faced widespread criticism – including fears the public had been left in the dark about it.

The announcement comes as Dame Fiona Caldicott and the Care Quality Commission published two reviews on data security in English healthcare.

Their reports put forward a series of proposals to safeguard data in the NHS:

  • They call for stronger government sanctions for malicious or intentional data breaches, together with tougher criminal sanctions against those who use any anonymised data to re-identify individuals.
  • Meanwhile, out of date computer software and hardware should be replaced urgently, they say.
  • The reviews recommend an opt-out system so patients can say no to confidential or personal health data being used for anything beyond their direct care.
  • But this could be overridden for mandatory requirements such as fraud investigations or situations of public interest such as epidemics, they suggest.
  • And patients could give explicit consent for specific research studies, even if they had opted-out.

Responding in a written statement to Parliament, the Department of Health said it has launched a public consultation on the option of opt-outs, alongside 10 security standards that Dame Fiona suggests NHS organisations must meet.

Officials also say they support stronger criminal sanctions for misuse of anonymised data and are working with suppliers to ensure IT systems are up-to-date.

Meanwhile, the Department of Health said though it had taken the decision to close the programme it was “committed to realising the benefits of sharing information”.

The project, led NHS England, together with the Health and Social Care Information Centre, was designed to bring health and social care information from different settings together to see what was working well and what could be done better.

It was due to launch two years ago, but was paused after concerns a public information campaign explaining its use was not clear enough and did not reach everyone.

Whilst Health Direct is pleased that this discredited IT system is being closed, one wonders with the Chilcott enquiry and Wales football game dominating the news agenda whether yesterday was a good day to bury bad news.

Healthier lifestyles could cut cancer cases by a third

About a third of cancer cases in the UK could be prevented if people ate healthily, exercised more and cut down on alcohol according to new research.

About a third of cancer cases in the UK could be prevented if people ate healthily, exercised more and cut down on alcohol according to new research
Exercise is an important way of keeping fit and cutting body fat, which is linked to the risk of developing cancer.

Data from the World Cancer Research Fund suggests that 20,000 cases of breast cancer and about 19,000 cases of bowel cancer could be stopped each year with small changes in lifestyle.

In 2013, there were more than 351,000 new cases of cancer in the UK. The WCRF said 84,000 could have been prevented.

Head of research Dr Rachel Thompson said simple changes to diet and lifestyle could make “a huge difference” in the battle against cancer.

“Even minor adjustments, like 10 to 15 extra minutes of physical activity each day, cutting down on alcohol, or limiting your intake of high calorie foods and sugary drinks, will help decrease your cancer risk,” she said.

She said that after cutting out smoking, being a healthy body weight was the most important thing people could do to cut their risk of getting cancer.

“There is strong evidence that being overweight or obese increases the risk of 10 cancers,” she said.

The link between a healthy lifestyle and the risk of developing cancer is well known, and this new data looks at preventable cases in 13 of the UK’s most common cancers.

For example, among men, 9% of cases of advanced prostate cancer could be prevented every year if men were not overweight or obese.

Lung cancer cases could be cut by 15,000 (33%) by getting people to stop smoking.

And 38% of breast cancer cases could be prevented, particularly in postmenopausal women, by increasing physical exercise and reducing body fat.

The WCRF also said that 2,200 cases of kidney cancer and 1,400 cases of pancreatic cancer could be prevented if people adopted a healthier lifestyle.

Prof Kevin Fenton, director of health and wellbeing at Public Health England, said the UK was currently behind on cancer survival rates compared with other European countries.

He said one major factor was that cancer prevention was not in the public consciousness.

“The link between tobacco and cancer is widely known and readily accepted by the public, but many are not yet fully convinced that healthy eating, regular exercise and not drinking alcohol, can lower your cancer risk.”


Health bodies call for drugs to be decriminalised

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.
The Royal Society for Public Health and the Faculty of Public Health said the government’s approach to drugs policy had failed.  There should be a greater focus on treatment and education, they added.

The report, called Taking A New Line On Drugs, said criminal sanctions failed to deter illegal drug use, undermined people’s life chances and could act as a barrier to addicts coming forward for help.

It called for a “sea change in approach” and said the UK should adopt the Portuguese system under which people caught using drugs were offered treatment and support rather than being punished. However, dealers and suppliers would still be prosecuted.

The report also suggested that drugs education be made mandatory, and that responsibility for drugs policy be moved from the Home Office to the Department of Health.

Royal Society for Public Health chief executive Shirley Cramer said: “For too long, UK and global drugs strategies have pursued reductions in drug use as an end in itself, failing to recognise that harsh criminal sanctions have pushed vulnerable people in need of treatment to the margins of society, driving up harm to health and wellbeing even as overall use falls.

“On many levels, in terms of the public’s health, the ‘war on drugs’ has failed.”

“The time has come for a new approach, where we recognise that drug use is a health issue, not a criminal justice issue, and that those who misuse drugs are in need of treatment and support – not criminals in need of punishment.”

Baroness Molly Meacher, speaking on behalf of the All-Party Parliamentary Group for Drug Policy Reform, welcomed the report.

She said the current system “criminalises some users of psychoactive drugs whilst very harmful psychoactive drugs including alcohol and tobacco remain legal”.

A Home Office spokesman said: “The UK’s approach on drugs remains clear – we must prevent drug use in our communities and support people dependent on drugs through treatment and recovery.

“At the same time, we have to stop the supply of illegal drugs and tackle the organised crime behind the drugs trade.”

The spokesman said there had been a drop in drug misuse over the past decade and more people were recovering from dependency now than in 2009-10.

Health Direct has for a long time noted the costly failure that is the current policy on drugs. On August 02, 2006 in Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal we reproduced the first ranking based upon scientific evidence of harm to both individuals and society.

It was devised by government advisers – then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, the then senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council.

NHS health staff crisis is worse than cash woes

The growing crisis in healthcare professionals’ morale is a greater risk to the NHS than the financial problems it is grappling with.

The growing crisis in healthcare professionals' morale is a greater risk to the NHS than the financial problems it is grappling with
Nigel Edwards, chief executive of the Nuffield Trust think tank, warned staff shortages, disputes with government and bullying were creating a “toxic mix”.

He said if the problems persisted, the affinity staff felt for the NHS could be irreparably broken.

The warning comes amid growing tensions between the healthcare workforce and government ministers.

This year has seen a series of strikes by junior doctors in England, while nurses and midwives have been protesting about plans to scrap the bursaries they receive while they are studying.

Mr Edwards said this industrial unrest was happening at a time when there were looming shortages – last month, a report by the Public Accounts Committee warned the NHS was short of about 50,000 staff out of a front line workforce of just over 800,000.

The most recent staff survey – published earlier this year – also highlighted the problem, with only 31% of respondents saying there was enough staff for them to do their jobs properly.

The Nuffield Trust also pointed to feedback it had received from health managers warning about deteriorating morale and uncontrollable growth in workload.

One manager said there was a “creeping sense of inevitability and acceptance that failure will happen at some point”.

Mr Edwards said the care and compassion of health workers was underpinned by a “psychological” contract.

He said while financial problems – last month it was revealed NHS trusts had overspent by a record £2.45 billion in 2015-16 – could be rectified in time, deteriorating morale was harder to fix.

“Once the psychological contract with staff is broken, it may be impossible to reverse,” he added.

Siva Anandaciva, of NHS Providers, which represents NHS trusts, said he shared the concerns. “This is a pivotal time for the NHS, with extreme financial and capacity challenges putting extra pressure on staff,” he said. “Perhaps inevitably, staff morale can take a battering.”

A Department of Health spokeswoman said there were signs in the staff survey that some measures were improving.

She added: “Good leadership is the single most critical ingredient to raising morale in any team. We also see that the best hospitals combine tight financial grip, an unrelenting focus on improving patient care and high levels of staff engagement.”

Health Direct notes frequent HR research which finds that levels of staff morale inversely correlates with managements’ staff appreciation in many organisations- the NHS is no expection Mr Hunt.

Agreement in sight for Junior doctors’ contract deal

A potential deal in the long running dispute over a new junior doctors’ contract has been agreed.

AgreementGovernment negotiators and the British Medical Association leadership have reached an agreement after eight days of talks at conciliation service Acas.

Health Secretary Jeremy Hunt said the deal was a “significant step forward”, while the BMA said it represented the “best and final way” to end the row.

The offer will now be put to a vote of over 40,000 BMA members.

That means it could still end up being rejected, but the fact the union and government have agreed a deal to end the stalemate is a major breakthrough.

These talks were seen as the last chance to get an agreement and were set up after a series of strikes, including the first ever full walk out by doctors.

It comes after the government announced in February it would be imposing the contract from this summer after previous talks failed.

The details released this week include several major changes:

  • the basic pay rise is to be reduced from 13.5% to between 10% and 11%
  • weekends will no longer be divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year
  • extra pay for night shifts is to be reduced from 50% to 37%
  • extra support will be made available for doctors who take time out, such as women who go on maternity leave, to enable them to catch up on their training and thus qualify for pay rises – after claims women were being unfairly penalised
  • junior doctors will get an enhanced role in advising and liaising with the independent guardians who keep an eye on the hours doctors work
  • the deal remains cost neutral, which means the government is not putting in extra money

The fact that something has been agreed is a major breakthrough. But this dispute is still a long way from being over. The BMA has promised its 40,000 members a vote on the agreement. That will be carried out in June and there are no guarantees the membership will give it the green light.

Junior doctors have been incredibly united throughout. Some 98% voted in favour of taking strike action last autumn and whenever union leaders have taken soundings since, the overwhelming sense has been that they have wanted to fight on.

If this hadn’t been the case the leadership would probably have agreed a deal long before now. What will be interesting, and perhaps crucial, is just how strongly the BMA leadership tries to sell the agreement to members in the coming weeks.

BMA junior doctor leader Dr Johann Malawana said he was pleased to have reached a deal after “intense but constructive talks”, adding it was the “best and final way” of resolving the dispute.

“Junior doctors have always wanted to agree a safe and fair contract, one that recognises and values the contribution junior doctors make to the NHS, addresses the recruitment and retention crisis in parts of the NHS and provides the basis for delivering a world-class health service.”

“What has been agreed today delivers on these principles, is a good deal for junior doctors and will ensure that they can continue to deliver high-quality care for patients.”

He said he would be recommending the deal to junior doctors ahead of the vote of BMA members, which will be run in June.