Foreign nurses are receiving a crash course in euphemism after bewildered patients expressing the wish to “spend a penny” found themselves being escorted to a hospital shop.
Norfolk’s Queen Elizabeth hospital has organised special “adapting to life in Norfolk” sessions for Portuguese staff whose otherwise excellent English results in too-literal translations of everyday expressions.

Patients, particularly the elderly, face being met with incomprehension when complaining of “feeling under the weather”, suffering “pin and needles” or experiencing problems with their “back passage”.

Local expressions such as “blar”, meaning to cry, and “mawther”, meaning “young woman”, are also likely to see mystified nurses flicking in vain through conventional phrasebooks. The distinct Norfolk brogue provides another linguistic obstacle for the recruits hired by the Queen Elizabeth Hospital King’s Lynn NHS trust.

“One of the things people from overseas had difficulty with was our euphemisms such as ’spend a penny’,” said a hospital spokesman. “In the past some of the new recruits from abroad, when patients used the expression, were taking people to the hospital shop.”

“They all speak exceptional English, but that doesn’t necessarily cover the type of English spoken in Norfolk. We have many different phrases and sayings in this part of the world. A lot of patients are elderly and use what can only be described as quaint phrases and descriptions, especially for body parts and common illnesses.

” The hospital has organised two-hour induction courses in dialect, idiom and colloquialism, covering phrases such as “spick and span”, “higgledy-piggledy”, “la-di-dah” and “tickled pink”. Other useful terms on the agenda are “jim jams”, “a cuppa” and “elbow grease”. Nurses are being asked to write down any confusing phrases they hear on the wards so they can be discussed in follow-up meetings.

Katherine Murphy, chief executive of the Patients’ Association, said the training would ensure “safe service” in hospitals. “Anyone working for the NHS – nurse, doctor, other healthcare professional, healthcare assistant – must be able to be understood by the patient and must demonstrate that they are safe to treat patients,” she said.

But Fiona McEvoy, of the Taxpayers’ Alliance, resorting to idiom herself, said it was “using a sledgehammer to crack a nut”. It made more financial sense for foreign nurses to pick up local phrases “from hearing them used and being advised by peers”, she said.

From: http://www.guardian.co.uk/foreign-nurses-taught-english-euphemisms

The Government’s drive to switch patients to cheaper statins could put lives at risk, new research has shown.
A study indicated that one third of patients who were switched from a branded statin to a cheaper generic one received a less powerful equivalent.

Those switched from Lipitor, known as atorvastatin, to a generic simvastatin would see their levels of dangerous “bad” cholesterol rise by between five and six per cent.

This could increase their risk of suffering a heart attack or stoke by about three per cent, said experts from the University of Melbourne.

In Britain, about five million people are on statins, which combat cardiovascular diseases. The Government has encouraged doctors to switch patients to generic drugs for several years. It means hundreds of patients could be at greater risk because they have been put on a less potent drug.

“This is a warning not just to look at the cost of medicines. You might be saving money but you could be losing a life,” said Lieven Annemans, a professor of health economics, at the European Society of Cardiology Congress in Stockholm.

The NHS spends twice as much on Lipitor than it does on simvastatin, despite fewer people taking the branded drug. A month’s supply of tablets of Lipitor costs about £26 per patient, whereas the equivalent cost of simvastatin is £2.

Prof Danny Liew, of Melbourne University, who led the latest study, said some research suggested that a triple dose of simvastatin was needed to be equivalent to Lipitor. “We must be careful about non-equivalent switching because of the potential for increasing cardiovascular disease risk and patients need to be aware of the difference in potency of different statins,” he said.

Branded drugs can be made only by the company that holds the patent and Pfizer makes Lipitor. After the patent has expired, the drug becomes “generic” and can be made by any manufacturer, meaning the price drops substantially. About eight in every 10 drugs prescribed by GPs in England are generics and statins, in particular, have been targeted by policy-makers to reduce costs.

A 10mg daily dose of Lipitor produces a 38 per cent reduction in bad cholesterol, whereas 10mg of simvastatin produces a 28 per cent drop.

Many British doctors are reluctant merely to increase the dose of a generic drug because of the risk of side effects. Statins can induce muscle aches, dizziness and headaches, and have been linked to kidney and liver problems.

Prof Liew studied data from almost 40,000 patients in Holland who were switched from Lipitor to simvastatin in the first three months of 2009. One third of patients ended up with a lower equivalent dose of simvastatin. The study was funded by Pfizer.

Dr Jeremy Pearson of the British Heart Foundation said: “It is clear that GPs need to be informed that you cannot switch 20mg of one for 20mg of another.

“Switching cannot be done thoughtlessly, otherwise you are at risk of doing something that is not advantageous to your patient at all.”

From: http://www.telegraph.co.uk/Heart-patients-lives-at-risk-in-switch-to-cheaper-drugs

More than 10,000 cases of breast and bowel cancer could be prevented each year if people took more exercise, such as going for brisk walks.
Just 45 minutes a day of activity at a moderate level could prevent about 5,500 cases of breast cancer in the UK.

At least 4,600 bowel cancer cases could also be stopped if people were moderately active for at least 30 minutes a day, five days a week, research showed.

Moderate activity is described as any type of exertion which gets the heart beating faster and makes people breathe more deeply.

Shorter bouts of exercise are also just as effective as longer sessions – it is the total time spent on activity that is important.

The calculations, from the World Cancer Research Fund (WCRF), show the importance of diet and exercise in lowering the risk of developing cancer.

Alongside brisk walking, other activities that would count include cycling at a leisurely pace, dancing, swimming at a leisurely pace, gardening and vacuuming combined with other housework.

According to the WCRF, exercise also cuts the risk of women developing womb cancer.

And because people who exercise tend to be more likely to keep a healthy weight, their risk of dozens of other cancers is lower than people who are overweight or obese.

Health experts warned last week that obesity was placing an “overwhelming” burden on the NHS as figures showed a 785% rise in weight-loss surgery.

Some doctors are “skirting around the rules” and not insisting on months of lifestyle change and pharmaceutical treatment before allowing patients to undergo surgery, specialists said.

Operations carried out for the most obese people in England have soared over the past five years, according to the NHS Information Centre.

Data for 2003/04 showed there were 480 procedures, rising to 4,246 in 2008/09.

Dr Rachel Thompson, deputy head of science at the WCRF, said people should aim to be physically active for at least half an hour every day.

“There is now very strong evidence that being physically active is important for cancer prevention,” she said. “Even relatively modest increases in activity levels could prevent thousands of cancer cases in the UK every year.

“These figures also show you do not have to go to the gym every day to benefit.

“You can reduce your cancer risk just by making small changes and this is highlighted by the fact that so many cancer cases could be prevented through something as simple as brisk walking.

“By taking up walking as a hobby or even walking to the shops instead of taking the bus or car, people can make a real difference to their health.”

Henry Scowcroft, science information manager at Cancer Research UK, said: “You don’t have to be an athlete to reduce your cancer risk.

“There’s solid evidence that certain cancers – including breast and bowel cancer – are less common in people who do regular, moderate exercise such as brisk walking.”

From: http://www.independent.co.uk/moderate-exercise-could-prevent-cancer

More than 3 million doctors have downloaded a 59p application – invented by Prof Peter Bentley, a researcher from University College London – which turns an Apple iPhone into a stethoscope.Last week, Bentley introduced a free version of the app, which is being downloaded by more than 500 users a day. Experts say the software, a major advance in medical technology, has saved lives and enabled doctors in remote areas to access specialist expertise.

“Everybody is very excited about the potential of the adoption of mobile phone technology into the medical workplace, and rightly so,” said Bentley, who initially developed the app “as a fun toy”.

“Smartphones are incredibly powerful devices packed full of sensors, cameras, high-quality microphones with amazing displays,” he said. “They are capable of saving lives, saving money and improving healthcare in a dramatic fashion – and we carry these massively powerful computers in our pockets.”

Bentley’s iStethoscope Pro application is not the only mobile phone programme lightening doctors’ bags and transforming their practices: there are nearly 6,000 applications related to health in the Apple App Store. The uptake has been rapid. In late 2009, two-thirds of doctors and 42% of the public were using smartphones – in effect inexpensive handheld computers – for personal and professional reasons. More than 80% of doctors said they expected to own a smartphone by 2012.

The trend looks likely to gain pace as younger doctors enter the workplace. Some medical schools issue students with smartphones. In America, Georgetown University, the University of Louisville and Ohio State University are among those requiring undergraduates to use one.

However, experts say they are being prevented from exploiting the technology’s opportunities. Bentley says that he is unable to launch a new range of applications because of out-of-date regulations.

“It’s much easier to develop technology than it is to get permission to use it,” he said. “I could create a mobile ultrasound scanner and an application to measure the oxygen content in blood, but the regulations stop me. We’re not allowed to turn the phone itself into a medical device, and what that precisely means is currently a grey area in terms of regulation. That’s the only reason we’re not seeing a flood of these devices yet.”

Professor Ian Wells, head of the scientific computing section in the department of medical physics at the Royal Surrey County hospital in Guildford, agrees that innovation is being hindered by regulations that are “still in their infancy”.

He said: “The approach of the regulators is not well worked out yet. There’s a wonderful new world out there but we need to find a way for regulators to protect patients and doctors, while not impeding innovation, research and development.”

The Medicines and Healthcare products Regulatory Agency (MHRA) – the government body with responsibility for standards of safety, quality and performance in healthcare – recently set up the Medical Device Technology Forum, a group of industry representatives, regulators, users and scientists, to help establish how to regulate novel technologies.

“This is such a complex area that we are currently looking at every application on a case-by-case basis,” said an MHRA spokesman. “We want to ensure that these new technologies are effectively regulated – thereby protecting health and avoiding unnecessary deterrents – while at the same time removing any unnecessary obstacles to manufacturers who wish to exploit new technologies for the benefit of patients.”

European regulators are also striving to bring their guidelines up to date. A group of regulators from Austria, Belgium, Denmark, France, Ireland, Sweden and the UK was set up last December to develop guidance for software under the European Medical Device Regulations. They are expected to report at the end of the year.

• Star Analytical Services has developed an app that allows patients to cough into their phone, and tells them whether they have a cold, flu, pneumonia or other respiratory diseases.

• OsiriX lets doctors look at x-rays, ultrasounds, CT and MRI images on handheld devices or mobile phones with special software, enabling radiologists, for example, to diagnose acute appendicitis from remote locations.

• ERoentgen Radiology Dx helps radiologists identify the most appropriate radiology exam for a patient by searching a large database of signs, symptoms and diagnoses to help them make quick assessments.

• Instant ECG is just one app that analyses the most common ECG results. It distinguishes the difference in various myocardial ischemia or injury patterns. Using the iPhone’s interactive touch screen, the app offers “real-time” films to make rhythm analysis similar to the clinical setting.

• AirStrip OB, an iPhone app, gives obstetricians real-time remote access to foetal heart tracings, contraction patterns, nursing notes, and vital signs. Obstetricians can monitor different stages of labour even when they are not by a patient’s side.

From: http://www.guardian.co.uk/technology/2010/aug/30/iphone-replace-stethoscope

Cancers of the food pipe in Britain have doubled in men over 25 years, figures from Cancer Research UK show. However, over the same period – 1983 to 2007 – cases in women only rose by 8%.
Researchers said the gender contrast in oesophageal cancer rates could be largely explained by the way men put weight on – as “beer bellies” – as well as genetic differences.

Men are also likely to have poorer diets, eating more fatty foods and lower amounts of fruit and vegetables.

Oesophageal cancer is the ninth most common cancer in the UK.

It is one of the most difficult cancers to detect and treat, with only 8% surviving for five years or more. The risk of developing the disease increases with age.

In 1983, about 2,600 men were diagnosed with oesophageal cancer (9.6 in every 100,000 men).

Latest figures show 5,100 men (14.4 in every 100,000) were diagnosed with the disease in 2007.  The number of cases in women rose from 5.1 to 5.5 per 100,000 people.

The most dramatic rise was among men in their 50s, where the rates rose by 67% over the period.
Poor survival

Professor Janusz Jankowski, an oesophageal cancer expert at Barts and The London School of Medicine and Dentistry, whose work is backed by Cancer Research UK, said: “One basic issue is that men’s diets are worse than women’s.

But Professor Jankowski said obesity may be a big reason behind the increase.

“Being overweight significantly increases the risk of adenocarcinoma – the main type of oesophageal cancer that’s on the up.

“Men tend to put weight on their abdomen as beer bellies and become oranges, – whereas women tend to put it on differently and become pears.”

He said having fat on the abdomen was riskier in this context because it put pressure on the stomach.

The researchers are also studying genetic changes that also appear to be linked to the disease.

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: “These new figures are particularly concerning as oesophageal cancer is a very difficult cancer to treat.

“Oesophageal cancer rates have risen dramatically in the UK compared with many other Western countries so we need to determine the underlying causes.

“To combat the poor survival rate for oesophageal cancer, Cancer Research UK is funding research to find new ways to identify the disease earlier and improve treatment so that more people beat the disease.”

From: http://www.bbc.co.uk/news/health-11108218

A mother whose son suffered severe brain damage after being given the MMR vaccine as a baby has been awarded £90,000 compensation.
Jackie Fletcher has campaigned for compensation for her son Robert – now 18 – because she believed his severe epilepsy was triggered by the jab.

Now a tribunal has ordered that the payment be made, after concluding that it could be “no coincidence” that he suffered his first seizure 10 days after being vaccinated.

All injections carry the risk of extreme reactions, and in rare cases, children have been left brain-damaged by them.

The Vaccine Damage Payment Scheme does not examine the safety of particular jabs, but the likelihood that the process caused a reaction.

However, the payout for damage following a MMR jab the first to be known about since a major public scare about its safety, following research in 1998 that suggested the vaccine caused autism. The study, now discredited, provoked widespread public concerns about the safety of the vaccine.

The payment agreed by the Government compensation scheme is likely to reignite the debate over the safety of common childhood vaccines.

Robert Fletcher, from Warrington, in Cheshire, is unable to talk, stand unaided or feed himself. He suffered the effects after being given the combined measles, mumps and rubella vaccine when he was 13 months old.

In a six-page judgment, the panel which examined the case said: ‘Robert was a more or less fit boy who, within the period usually considered relevant to immunisation, developed a severe convulsion … and he then went on to be epileptic and severely retarded. The seizure occurred ten days after the vaccination. In our view, this cannot be put down to coincidence.”

The panel said the reaction only happened because the child had a genetic predisposition to epilepsy, but said that “on the balance of probabilities” the vaccination triggered the onset of the condition.

Mrs Fletcher said she believed the compensation award was the first to a surviving MMR-damaged person since controversy erupted in 1998 when the now discredited Dr Andrew Wakefield raised concerns about a possible link between the combined MMR injection and autism.

Mrs Fletcher runs pressure group JABS – Justice, Awareness and Basic Support. Around 2,000 families seeking compensation for their vaccine-damaged children are registered with the group, which provides advice and support.

‘My husband John and I have battled for 18 years for the cause of Robert’s disability to be officially recognised,’ she said.

‘We were told the vaccine was perfectly safe. Like most people, we trusted what the doctors and nurses were putting to us.

‘Robert is nearly 19 but mentally he is like a 14-month-old toddler. He can’t stand unaided and he is doubly incontinent.

‘He can’t speak except to say “Hi, Mum” or “Hi, Daddy”.

Her first application for compensation was rejected in 1997 on the grounds that it was impossible to prove beyond reasonable doubt what had caused Robert’s illness.

But Mrs Fletcher appealed and in a ruling delivered last week, a new panel of experts came to a different conclusion.

The one-day hearing last week was chaired by a barrister sitting with two doctors. While one said the child would have developed epilepsy regardless of whether he had been given the vaccine, he was overruled by his two colleagues.

The panel said that the judgement was specific to the particular case and should not be seen as a precedent. It underlined in particular that the ruling had no relevance to the question of a link between MMR vaccine and autism.

Dr Michael Fitzpatrick, a London GP whose own son is autistic, said: ‘It is a very important principle that parents should be compensated in cases of this kind.

‘But although a causal link has been established in law in this instance, exhaustive scientific research has failed to establish any link between MMR and brain damage.

This case should not make parents feel any different about the safety of the vaccine”.’

A spokesman for the Medicines and Healthcare products Regulatory Agency, which collects data on adverse reactions to drugs and vaccines, said although the vaccine could, on rare occasions, cause a temporary fever fit, there remained no confirmed evidence that these caused long-term brain injury.

He added: “The benefits of MMR vaccine in preventing serious and life threatening infections far outweigh any known side effects of the vaccine”.

From: http://www.telegraph.co.uk/Mother-wins-MMR-payout-after-18-years

The government has confirmed it is planning to scrap the NHS Direct telephone service in England and replace it with an alternative service.
Nick Chapman, chief executive of NHS Direct: “The new helpline will be better and more cost effective than NHS Direct” A new 1-1-1 helpline is already being piloted in north-east England.

It was previously reported that the new service may replace NHS Direct, but now the Department of Health has confirmed it will definitely do so.

The move comes as the government curtails public spending, even though it has promised to protect the NHS.

The change will not affect existing NHS helpline services in Scotland and Wales.

Health Secretary Andrew Lansley announced the plan to scrap NHS Direct in England during a hospital visit.

NHS Direct currently employs more than 3,000 staff, 40% of whom are trained nurses. It is understood the ratio on the 1-1-1 helpline is “slightly less” in the pilot, but no figures are yet available for what will happen when the scheme is rolled out nationally.

Critics claim the change would undermine the quality of the service by reducing the number of qualified nurses answering calls, but chief executive of NHS Direct Nick Chapman told the BBC the new helpline would be better and more cost effective than NHS Direct.

In June GPs urged the government to get rid of NHS Direct, claiming it was not cost effective.

Roughly 14,000 people a day call NHS Direct for medical advice, with the service costing £123m a year to run.

Dr Peter Carter, chief executive and general secretary of The Royal College of Nursing , said reducing the number of specialist nurses who worked on the new helpline was “short-sighted.”

He said: “We urge the government to consult fully and look at all the evidence before enacting changes which could leave people without expert advice from trained nurses.”

From: http://www.bbc.co.uk/nhs-direct-to-be-scrapped

Decriminalising drug use could drastically reduce crime and improve health, the outgoing president of the Royal College of Physicians has said.
Sir Ian Gilmore said the laws on misuse of drugs should be reviewed and that their supply should be regulated.

He had formed his view after seeing the problems caused by dirty needles and contaminated drugs, the BBC’s health correspondent Adam Brimelow said.

In a parting e-mail to 25,000 RCP members, which Sir Ian said expressed his own views rather than those of the RCP, he wrote that he felt like finishing his presidency on a “controversial note”.

He endorsed a recent article in the British Medical Journal by Stephen Rolles, from the think tank Transform Drug Policy Foundation, which argued that the policy of prohibition had harmed public health, encouraged organised crime and fuelled corruption.

Sir Ian told the BBC: “Everyone who has looked at this in a serious and sustained way concludes that the present policy of prohibition is not a success.  There are really strong arguments to look again.”

Sir Ian said he had had a longstanding interest in the subject, stemming from his work as a liver specialist.

“Every day in our hospital wards we see drug addicts with infections from dirty needles, we see heroin addicts with complications from contaminated drugs,” he said.

He argued that many of the problems health staff encountered were the consequences not of heroin itself, but of prohibition.

In his e-mail, Sir Ian wrote: “I personally back the chairman of the UK Bar Council, Nicholas Green QC, when he calls for drug laws to be reconsidered with a view to decriminalising illicit drugs use. This could drastically reduce crime and improve health,” he wrote.

In his recent report to the Bar Council, Mr Green said there was growing evidence that decriminalising personal use could free up police resources, reduce crime and improve public health.

Mr Rolles – whose recent BMJ article Sir Ian cited in his e-mail – told BBC Radio 4’s Today programme their arguments were “built on a critique of the failure of the last 40 or 50 years”.

He said the “punitive criminal justice-driven war on drugs” had delivered the opposite of its goals.

“It hasn’t reduced drug use, it hasn’t prevented the availability of drugs, but it has created a whole raft of secondary problems associated with the illegal market, including making drugs more dangerous than they already are and undermining public health and fuelling crime.”

“That is provoking a debate on what the alternative approaches are and the one that we are calling for is legally regulated production supply.”

From:  http://www.bbc.co.uk/news/health-10990921

Health workers made more than 1,300 mistakes involving the use of strong painkilling drugs in less than a year, resulting in at least three deaths and severe harm to two other patients.
Nearly one in five dosage errors involving morphine, diamorphine and similar opiate drugs resulted in some harm to NHS patients.

Figures released under a Guardian Freedom of Information request show mistakes in England and Wales continue at a high level despite the publicity that followed the Guardian’s revelation in May last year about the death of David Gray.

The 70-year-old died at his home in Cambridgeshire when he was injected with a tenfold overdose of diamorphine by Daniel Ubani, a locum GP who had flown in from Germany that day.

The official report into the incident last month revealed two other GPs hired, like Ubani, by Take Care Now – a now-defunct company that was then providing some out of hours services for the NHS – had been involved in non-fatal diamorphine overdoses the year before.

The breakdown of the new figures suggest lessons have not been learned, with little change in the numbers of people harmed by medication errors involving this class of drugs despite several official safety warnings.

David Gray’s son, Rory, called the new figures “unbelievable”. “Taken at face value [they] suggest nothing has been made safer with regards to opiate medicines at all. Whilst there is no accountability then it seems there will continue to be no effective measures put in place to stop these unnecessary and avoidable deaths.”

The charity Action against Medical Accidents (AvMA) said the statistics were shocking and “confirm our worst fears about not implementing patient safety alerts”.

In its own research, coincidentally being published at the same timetoday, the organisation accuses hospitals and other care providers of killing and injuring patients by not complying with official directives from the National Patient Safety Agency (NPSA) intended to protect those receiving care.

However, safety experts point out that the numbers of patients being treated by such drugs is rising, so the proportion of mistakes may be going down.

Both the NPSA, established in 2003 to help the NHS learn from its mistakes, and the Care Quality Commission (CQC), the health service regulator, insisted things were improving, although notifying the two bodies over drug and other errors that resulted in death or severe harm only became mandatory on 1 April this year.

The NPSA received a total of 4,223 cases involving opiate drugs between November 2004 and June 2008. Of these, 3,338 were recorded as causing no harm, 629 low harm, 242 moderate harm and four severe harm. Five patients died. There was insufficient data on five other cases. Figures from May 2009 to April this year show 1,329 cases, 1,078 said to have resulted in no harm, 179 low harm, 67 moderate, and two severe. Three patients died.

Linda Hutchinson, CQC director, said: “Unfortunately we will never be able to eliminate human error from healthcare, but the risks can be minimised. That is why it is so important that NHS trusts and other health providers report incidents, thoroughly investigate them and make changes to stop the same mistakes happening again. They should also implement changes as a result of safety alerts. Had Take Care Now done this, it is possible that Mr Gray would still be alive today.

“The increase in reporting is a good thing. We often find it is the NHS trusts reporting a high number of incidents that are doing a better job of investigating them and taking action to prevent them happening again.”

The NPSA said its reporting system was one of the most sophisticated in the world: “We gather patient safety incidents, analyse them for trends and use these as a platform on which to produce patient safety alerts and guidance for the NHS.

“It is evident the reporting culture in the NHS has improved with over 1 million incidents [relating to drugs, medical and surgical procedures] reported each year. The majority of incidents reported to us in relation to diamorphine and other opiates result in low or no harm to the patient. In addition, most of these do not relate to mis-selection of injectable diamorphine or morphine.”

The agency believed it was now told of the “vast majority” of serious incidents.

The revelations come as hospitals and other providers of care are accused by AvMA of killing and injuring patients by not complying with official directives from the NPSA intended to protect those receiving care. Dozens of hospitals, mental health trusts and primary care trusts are failing to implement patient safety alerts from the agency, despite the Department of Health writing to them reminding them to do so.

Some 29 NHS organisations had not put at least 10 alerts into action by 7 June, on issues such as drugs and oxygen, even though with some, the deadline for compliance was several years earlier, according to AvMA: “It is impossible not to conclude that lives are being put at unnecessary risk and it is likely that avoidable injuries or deaths are still being caused as a result of trusts not complying,” it says.

Public health minister Anne Milton said: “Across the NHS there must be a culture of patient safety above all else. We have set out how we intend to free NHS staff from central control and targets that are not clinically justified to allow them to focus on what really matters – reliable, effective and above all safe care for each patient.”

From: http://www.guardian.co.uk/nhs-lethal-painkiller-dosage-deaths

The NHS spends up to £86m a year on thousands of websites that are difficult to find, confusing for patients and which do not meet their needs, according to research commissioned for a Department of Health report.
Research for the NHS Digital Communications Review, conducted by communications agency Precedent and leaked to the Health Service Journal, found 2,873 nhs.uk websites that were in use and more than 1,000 other nhs.uk sites that were no longer active. A total of 287,300 web pages were accessible and Google listed 56 million pages within the nhs.uk domain.

The researchers concluded that the public would appreciate fewer contact points online but the digital communications review said there was not sufficiently strong evidence that there were too many NHS domains.

Instead the review said there was a need for a digital brand strategy with standards for all NHS sites. It said a central information role was “sound in principle but its adoption requires a general acceptance that it is the role of the centre to perform this organising function.”

EHI understands that the researchers suggested that the NHS may be spending too little on too many websites rather than too much.

The Precedent researchers said that two of most recognised health service websites, NHS Choices and NHS Direct, were often competing for attention and although NHS Choices focuses on health information and local service data and NHS Direct offers online diagnostic tools the differences in content between the two was not clear to patients.

They added: “NHS Choices and NHS Direct are both established as national sites with similarities of positioning, brand and audience. This confuses users about the ‘definitive’ access point for NHS information and the roles of each site.”

Research for the review also concluded that GP practices websites were also the weakest of the health service’s online offerings.

It added: “GP surgeries have by far and away the poorest sites, in that they have the largest percentage of problems identified. GP sites failed to provide the means to allow interaction with users.”

The researchers found that overall the NHS was failing to meet patients’ needs for online functionality such as online appointment booking, repeat prescription requesting, test result reporting and contact via email. Only 50.3% of sites included email addresses. “The NHS is not making itself easy to do business with,” the report said.

The research is also critical of the accessibility of websites and said that vulnerable members of the public were not been catered for with 30% of sites exhibiting at least one “notable deficit in standards” which might cover poor quality content, lack of NHS branding, poor navigation or out of date content.

The researchers said it was very difficult to estimate the cost to the NHS of the websites with responses to information on usage and cost received from only 188 out of 4,121 sites. However it estimated that the cost of running the sites “could be as high as £86m per year” and said costs could be higher as those figures did not include set up costs.

The digital review, however, said no broad conclusions could be drawn about value for money “given the relatively low cost of establishing and operating small, focused websites.”

The researchers claimed the public “struggled to locate the NHS online with a Google search” when searching on health-related terms and said the scale and depth of information on offer was daunting to many. It said patients also often ended up going to information offered by Wikipaedia, the charity sector and websites such as NetDoctor and PatientUK rather than the NHS.

The researchers said interviews with users revealed that the public wanted to see “one NHS” online which would tally with their perception that they were receiving care from “one NHS”.

The Department of Health said the white paper had outlined the government’s plan to being about an NHS information revolution to give people access to comprehensive, trustworthy and easy to understand information. Information on how this will be achieved is to be set out in the DH’s information strategy, due to be published in the autumn.

From: http://www.e-health-insider.com/nhs_%C3%82%C2%A386m_website_spend_confusing