Foreign doctors who cannot speak English are to be banned from working in NHS hospitals and clinics, the Health Secretary will announce today.The NHS will introduce mandatory language tests for doctors moving to Britain after training elsewhere in the European Union.

The decision follows a series of cases in which patients have died or suffered poor care as a result of doctors speaking sub-standard English.

The issue was brought to national attention three years ago when Dr Daniel Ubani, a German-trained GP on his first out-of-hours shift in Britain, killed David Gray, 70, by giving him 10 times the normal dose of diamorphine.

In his speech to the Conservative Party conference today, Andrew Lansley will say that the Medical Act will be amended so that doctors must speak good English to practise in Britain.

“I am determined that doctors who come from overseas to work here in our NHS must not only have the right qualifications, but also the language skills to practise here,” the Health Secretary is expected to say. “We will amend the Medical Act to ensure that any doctor from overseas who can’t use a decent level of English is not able to treat NHS patients. This is not about discriminating; we’ve always appreciated how much overseas doctors and nurses give to our NHS. It is simply about our absolute commitment to put patients’ safety first.”

There are more than 88,000 foreign-trained doctors registered to work in Britain, including 22,758 from Europe. They account for almost a third of the total.

Under the proposals, local NHS trusts would have a duty to check the language skills of foreign-trained doctors before they can be employed. In addition, the General Medical Council would be given powers to take action against doctors when there were concerns about their ability to speak English. At present, only doctors from outside the European Economic Area are routinely scrutinised for their language skills before being registered by the GMC.

This means that doctors from Canada or Australia are routinely tested for their language skills while those from countries such as Poland and France are not.

It had previously been thought that European Union laws ensuring the freedom of movement of labour prevented language testing. However, the European Commission has recently stated that the language tests would be legal.

Dr Ubani, who admitted he had never heard of the drug he gave to Mr Gray, was struck off by the GMC in June last year but still practises in Germany. His poor English meant he was refused work by the NHS in West Yorkshire but was accepted in Cornwall and Camb-ridgeshire, where he saw Mr Gray.

Since the case, the GMC and other NHS leaders have repeatedly warned that some foreign doctors’ language skills are so poor that patients are being put at risk.

Compulsory language tests for foreign doctors will raise concerns that the NHS could be left short-staffed, such is its reliance on overseas medics. Ministers believe that the majority will reach the necessary standard of English.

Mr Lansley will today deliver a robust defence of the Government’s health policy, saying that money is being diverted from cutting bureaucracy to front-line services.

“Unlike Labour, we will make sure that every penny of our investment goes right to the patients who matter, not the huge Labour bureaucracy which we inherited,” he will say. “And all that is why, since the election, we now have 1,500 more doctors and 5,000 fewer managers in the NHS.”

He will also claim that hospital infection rates have fallen and the number of people being treated in mixed-sex wards has fallen by more than 90 per cent over the past eight months.

From: http://www.telegraph.co.uk/Conservative-Party-Conference-2011-doctors-from-overseas-must-speak-English-or-be-banned

The number of under 25s being given weight loss surgery on the NHS in England has quadrupled over the last three years.That includes people being fitted with a gastric band, having their stomach stapled, or having a gastric bypass.

Between 2006 and 2007, 55 people under the age of 25 had one of these operations, but between 2009 and 2010 the number had risen to 210.

That included 34 teenagers, some as young as 15.

Doctors and eating disorder groups say they are worried about the rise, claiming the NHS in many cases is not giving young people the support they need before and after the surgery.

Gastric bands are given to overweight people to help them lose weight quickly. They work by reducing the size of a patient’s stomach, therefore limiting the amount of food they can eat.

The eating disorder charity Beat says too often this is not being treated as a life-changing procedure.

Beat’s chief executive Susan Ringwood says: “Having a gastric band fitted is a very serious operation that has long-term, permanent consequences, yet we know young people are not always being given this information and that is very concerning”.

The group says patients aren’t getting the support they need after the surgery, when their bodies are likely to be struggling to adjust to the change in diet.

Patients can also be vulnerable to anxiety and depression, says the charity.

Dr Samantha Scholtz, an NHS psychiatrist who prepares people for gastric band surgery, admits aftercare across the NHS is ‘patchy’.

“Every single patient that has bariatric surgery should have some sort of psychological intervention”, she says.  “We are essentially removing food from someone’s life, doing something artificial”.

The Department of Health says people are only given bariatric surgery after being assessed by a doctor, who will decide on the best type of weight-loss treatment for each individual.

From: http://www.bbc.co.uk/newsbeat/14948716

Eating lots of fruit and vegetables with white flesh may help to protect against strokes, says a study in the journal Stroke.But Dutch researchers say they do not know why people with a high intake of apples, pears, bananas or cauliflower reduce their risk of stroke by 52%.

The study followed more than 20,000 adults over 10 years.

Stroke experts said people should not be put off eating other colours of fruit and veg.

At the start of the study, carried out in The Netherlands, participants were asked to fill in a detailed questionnaire on diet and lifestyle for the previous year.

By using this information and tracking the health of participants over the next decade, researchers were able to examine the link between the colour of fruit and vegetables consumed and stroke risk.

The study found that a 25g per day increase in white fruits and vegetables was linked to a 9% lower risk of stroke.

Of the white fruit and veg eaten, over half was apples and pears. An average apple weighs 120g.

But no link was found between stroke incidence and green (dark leafy vegetables, cabbages and lettuces) orange/yellow (mostly citrus fruits) or red/purple fruits and vegetables.

Linda Oude Griep, lead author of the study and postdoctoral fellow in human nutrition at Wageningen University in The Netherlands, said more research was needed to find out why white flesh was important.

“It is difficult to say which nutrients are responsible in white fruits and vegetables. We know that apples and pears are high in dietary fibre, but there may be other explanations.”

She said it might be useful to consume considerable amounts of white-flesh fruit and veg to prevent strokes.

“Eating one apple a day is an easy way to increase white fruits and vegetable intake.”

Dr Sharlin Ahmed from The Stroke Association said the findings should not deter people from eating other colours of fruit and vegetables.

“All fruit and vegetables have health benefits and remain an important part of a stable diet. A lot more research is needed before the colour of our groceries alone is used to determine what health benefits they may have.”

“Everyone can reduce their risk of stroke by eating a healthy balanced diet that is low in saturated fat and salt, exercising regularly and ensuring that your blood pressure is checked and kept under control.”

From: http://www.bbc.co.uk/news/health-14931634

The General Medical Council (GMC) says some overseas doctors come to the NHS with ‘little or no preparation’ for working in the UK.Along with the Nursing and Midwifery Council, it wants the right to test the English language skills of applicants from within the EU in the same way they test applicants from outside of Europe.

But an EU red tape Directive prevents any systematic testing of language skills of doctors from the European Economic Area (EEA).

The GMC says UK legislation – the Medical Act 1983 – ‘gold plates’ the directive and prevents the GMC from doing any language-testing of doctors from the EEA at all.

Employers are allowed to assess the language skills of applicants from the EEA, but it is thought many do not.

A spokesperson from the GMC said: “Doctors who come to work in the UK make a vital contribution to our healthcare system, but we must make sure they receive the support they need to practise safely and to conform to UK standards.”

“It is unacceptable that the current system enables doctors to practise in the UK without a sufficient grasp of English.”

The GMC says some overseas doctors come to the NHS with “little or no preparation” for working in the UK and those trained under different cultural and professional standards need more support.

The GMC is planning a basic induction programme for all doctors – including those who qualify in the UK – to help understand how healthcare is practised in the UK.

A spokesperson from the Department of Health said: “This government is determined to make sure that foreign healthcare professionals are not allowed to work in the NHS unless they have proven their competence and language skills.”

“We do think the Directive needs updating and we are in the process of responding to the EU proposals, but we can’t pre-empt that response.

“We have already taken steps to strengthen the current system by introducing a duty for responsible officers to check the qualifications, experience and references of all doctors, including foreign doctors.”

But poor English language standards are not just an issue among some European NHS staff, for whom English is not their first language.

Asian nurses said they found it difficult to understand European colleagues – particularly those from Eastern Europe.

But when one was asked what a patient meant if they said they wanted to ‘spend a penny’ – slang for go to the lavatory – she replied “they want to spend money”.

A spokesperson from Imperial College Healthcare NHS Trust, said: “We take patient experience and patient complaints very seriously.”

“We care for a diverse patient population and employ a diverse workforce, and understand the importance of staff being able to talk to patients and their families in an appropriate way.”

From: http://www.bbc.co.uk/news/health-14921565

Nurses and midwives are being urged to get their flu jabs after figures reveal less than a third did last year.All front line healthcare workers are meant to be vaccinated to stop them going off sick with influenza and spreading the virus to patients.

Last year only 30% of hospital nursing staff in England got immunised compared with 43% of GP practice nurses, 38% of GPs and 37% of other doctors.

Nursing and midwifery groups say having the jab is a “professional duty”.

This is the first time the figures have given broken down by occupation.

The number of healthcare workers getting the vaccine had increased from 26.4% in the 2009 winter to 34.7% in 2010.

However, the majority of nurses who work with the most critically ill over the winter months and midwives who work with pregnant women, were left vulnerable to flu, its potentially life-threatening complications and passing it on to patients and family, says the Department of Health which released the figures.

The data also shows that only 25.2% of youngsters aged six months to two years in at-risk groups were vaccinated last winter, compared with 51.7% of those aged 16 to 65.

Those at risk include people with conditions such as asthma, diabetes, heart disease and liver disease, as well as the over-65s and pregnant women.

Last winter people in at-risk groups were 11 times more likely to die from seasonal flu than people with no underlying health problems.

Chief Medical Officer Dame Sally Davies said: “It is never too early to start thinking about flu. So as NHS staff return from their holidays, I urge them to plan ahead and get vaccinated.”

Dr Peter Carter, of the Royal College of Nursing, said while NHS staff should not be forced to get immunised, they had a professional duty to do so: “Patients and healthcare staff suffer when nurses are off sick.

“It is vital that nurses do all they can to take responsibility for their own health and of those around them. The RCN will be working with our members to ensure they have access to all of the relevant information to enable them to make the right decision about the uptake of the vaccine.”

Louise Silverton, of the Royal College of Midwives, said: “Midwives are strongly advised to encourage all pregnant women to be vaccinated against seasonal flu.

“In addition midwives as key health workers should themselves seriously consider being vaccinated to prevent transmission of influenza to the women for whom they care and also to their own families.”

A National NHS Staff Seasonal Flu Vaccination Campaign launches later this month and will use resources like Twitter and Facebook, as well as leaflets, to encourage more healthcare professionals to get vaccinated.

From: http://www.bbc.co.uk/news/health-14792570

Drinks industry lobbyists now make up almost half the members of a key body tasked with advising ministers on alcohol policy, research papers show.
Seven out of 16 members of the Government and Partners Alcohol Working Group are from industry, up from just a couple last autumn.

Critics believe it is evidence that the Coalition is pandering to the interests of the drinks industry, potentially at the expense of the nation’s health.

Some nine million people in Britain suffer from the harms of alcohol in some, either directly or indirectly, while the cost to the NHS stands at £2.7 billion a year.

Don Shenker, chief executive of the charity Alcohol Concern, believed companies were being allowed a bigger say in “setting the agenda” under the Coalition.

Speaking of the changes to the working group “I can only imagine it’s because this government believes that the drinks industry has a big role to play in shaping policy, in setting the agenda.

“And so they have extended the invitations to a larger set of people from the drinks industry.”

However, Anne Milton, the Public Health Minister, claimed ignorance of the body.

She said: “I think we have a communications problem in Whitehall because you know something that I have never heard of before.”

In opposition David Cameron talked tough on alcohol abuse, and the Conservatives’ manifesto said the party would ban off-licences and supermarkets from selling alcohol below cost price.

In January the Coalition announced that retailers would be banned from selling drinks for less than the value of duty and VAT.

But they will not have to take into account the cost of producing the drinks, meaning they will still be able to sell drinks at a net loss.

The Coalition has pursued an approach of working with industry, arguing it will be more effective than legislation.

However, in March eight organisations pulled out of the Coalition’s Public Health Responsibility Deal – including Alcohol Concern, the Institute of Alcohol Studies and the British Liver Trust.

They wrote to Andrew Lansley, the Health Secretary, saying the deal on alcohol – which includes voluntary agreements with industry – would not help reduce illness or deaths.

At the time Mr Lansley said imposing laws was often “costly” and they could “take years” to implement.

A spokesman for the Department of Health yesterday re-iterated that argument.

She did not deny that changes to the working group had been made.

The spokesman said: “We are committed to challenging the assumption that the only way to change people’s behaviour is through adding to rules and regulations.

From: http://www.telegraph.co.uk/Alcohol-advisory-body-stacked-with-drinks-industry-lobbyists

Almost 600 children below the age of 13 have been treated in hospital for eating disorders in the past three years, new figures have revealed.
The statistics include 197 children between the ages of five and nine – with cases within this age group almost doubling over the period.

Experts blamed the trend on a “pernicious” celebrity culture which glorified size zero figures, leaving increasing numbers of young girls struggling to cope with their growing bodies.

The figures, from 35 NHS hospitals in England, show more than 2,100 children were treated for eating disorders before they reached their sixteenth birthday.

They include 98 children aged between five and seven at the time of treatment and 99 aged eight or nine. Almost 400 were between the ages of 10 and 12, while more than 1,500 were aged 13 to 15.

Even these statistics, disclosed under the Freedom of Information Act, are likely to be an underestimate.

Some NHS hospitals treating such patients refused to provide any data, while among the 35 hospitals, some would only disclose the figures for those children admitted to wards after becoming dangerously emaciated – excluding those undergoing psychiatric therapy as outpatients.

Susan Ringwood, chief executive of eating disorders charity B-eat said the figures reflected alarming trends in society, with young children “internalising” messages from celebrity magazines, which idealised the thinnest figures.

“A number of factors combine to trigger eating disorders; biology and genetics play a large part in their development, but so do cultural pressures, and body image seems to be influencing younger children much more over the past decade,” she added.

Research carried out by the charity with the Brownies found that even by the age of seven, girls who looked at outline drawing of women thought the thinner ones were happier and more popular than those with slightly larger outlines.

Mrs Ringwood said young girls felt increasingly frightened by the prospect of gaining weight in puberty. She said: “Children are receiving very pernicious messages.

“The ideal figure promoted for women these days is that of a girl, not an adult women. Girls see the pictures in magazines of extremely thin women and think that is how they should be.

“That can leave them fearful of puberty, and almost trying to stave it off.”

In 2009, Kate Moss, the supermodel, was accused of encouraging girls to become anorexic when she said she lived by the phrase ‘nothing tastes as good as skinny feels’ – a mantra of pro-anorexic groups.

While disorders among men are increasing, cases involving boys were often sparked by specific incidents, such as being bullied because of their weight, she said.

Separate research published in the British Journal of Psychiatry earlier this year suggests one in five children diagnosed with an eating disorder have a history of early feeding problems, such as fussy eating.

Almost half of those diagnosed with disorders by the age of 12 had a close family member with a mental health problem such as anxiety or depression.

The study by the University College London’s Institute of Child Health found more than 80 per cent of cases involved girls, with anorexia – which involves drastically reducing the intake of food and drink – far more common than bulimia – which involves sufferers binge eating and then making themselves sick.

Last year a survey of women suffering from anorexia found almost half said they had a problem with food by the age of 10.

Experts say there is no clear relationship between “fussy eating” and the later development of a disorder.

But Mrs Ringwood said some particular behaviours with food – such as cutting it into tiny pieces, or insisting that foods were eaten separately, could indicate early signs of a more significant problem.

Other types of behaviour which had nothing to do with food could provide some clues, she said.

“If children become very rigid in their routines and get upset if changes are made that can be an indicator of the type of anxiety associated with disorders,” she said.

Even young children who were trying to restrict their diet could be stealthy about it, she said, hiding food up their sleeves at mealtimes, in order to throw it away.

From: http://www.telegraph.co.uk/Hundreds-of-preteen-children-treated-for-eating-disorders

Hip replacements, cataract surgery and tonsil removal are among operations now being rationed in a bid to save the NHS money.
Two thirds of health trusts in England are rationing treatments for “non-urgent” conditions as part of the drive to reduce costs in the NHS by £20bn over the next four years. One in three primary-care trusts (PCTs) has expanded the list of procedures it will restrict funding to in the past 12 months.

Examples of the rationing now being used include:

• Hip and knee replacements only being allowed where patients are in severe pain. Overweight patients will be made to lose weight before being considered for an operation.
• Cataract operations being withheld from patients until their sight problems “substantially” affect their ability to work.
• Patients with varicose veins only being operated on if they are suffering “chronic continuous pain”, ulceration or bleeding.
• Tonsillectomy (removing tonsils) only to be carried out in children if they have had seven bouts of tonsillitis in the previous year.
• Grommets to improve hearing in children only being inserted in “exceptional circumstances” and after monitoring for six months.
• Funding has also been cut in some areas for IVF treatment on the NHS.

The alarming figures emerged from a survey of 111 PCTs by the health-service magazine GP, using the Freedom of Information Act.

Doctors are known to be concerned about how the new rationing is working – and how it will affect their relationships with patients.

Birmingham is looking at reducing operations in gastroenterology, gynaecology, dermatology and orthopaedics. Parts of east London were among the first to introduce rationing, where some patients are being referred for homeopathic treatments instead of conventional treatment.

Medway had deferred treatment for non-urgent procedures this year while Dorset is “looking at reducing the levels of limited effectiveness procedures”.

Chris Naylor, a senior researcher at the health think tank the King’s Fund, said the rationing decisions being made by PCTs were a consequence of the savings the NHS was being asked to find.

“Blunt approaches like seeking an overall reduction in local referral rates may backfire, by reducing necessary referrals – which is not good for patients and may fail to save money in the long run,” he said. “There are always rationing decisions that have to go on in any health service. But at the moment healthcare organisations are under more pressure than they have been for a long time and this is a sign of what is happening across many areas of the NHS.”

According to responses from the 111 trusts to freedom-of-information requests, 64 per cent of them have now introduced rationing policies for non-urgent treatments and those of limited clinical value. Of those PCTs that have not introduced restrictions, a third are working with GPs to reduce referrals or have put in place peer-review systems to assess referrals.

In the last year, 35 per cent of PCTs have added procedures to lists of treatments they no longer fund because they deem them to be non-urgent or of limited clinical value.

Some trusts expect to save over £1m by restricting referrals from GPs.

Chaand Nagpaul, a member of the British Medical Association’s GPs committee, said he was concerned about PCTs applying different low-priority thresholds and rationing access to treatments on the basis of local policies.

He said the Government needed to decide on a consistent set of national standards of “low priority” treatments to help remove post-code lotteries in provision. “Patients and the public recognise that with limited resources we need to make the maximum health gains and so there needs to be prioritisation. What is inequitable is that different PCTs are applying different thresholds and criteria,” he said.

A Department of Health spokesman said: “Decisions on the appropriate treatments should be made by clinicians in the local NHS in line with the best available clinical evidence and Nice [National Institute for Health and Clinical Excellence] guidance. There should be no blanket bans because what is suitable for one patient may not be suitable for another.”

From: http://www.independent.co.uk/cataracts-hips-knees-and-tonsils-nhs-begins-rationing-operations

Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.
It wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.

The National Childbirth Trust welcomed the report but says the proposals do not go far enough.

NHS managers said maternity care desperately needed to be reorganised.

Too many babies are born in traditional hospital units, says the college, which also warns the current system is neither acceptable nor sustainable in its report on maternity care.

The college estimates there are about 1,000 too few consultants to provide adequate round-the-clock cover for hospital units.

Dr Falconer said: “There is no doubt if you look at the worst scenario of serious complications, you need the right person, a senior person, there immediately.”

Previous attempts to re-organise maternity care around a smaller number of hospital units have proved controversial, but Dr Falconer said if women could be convinced of the greater safety they would be prepared to travel to have their babies.

The need for change would be largely in cities or large towns, because in rural areas it might be more important to support smaller units.

The report estimates that across the UK there are 56 units with fewer than 2,500 deliveries of babies a year.

In order to take the pressure off busy hospitals, the college is also calling for an increase in the number of midwife-led units.

Midwives have welcomed the report, saying it could improve the experience for about a third of women who have straightforward deliveries.

The proposals for maternity are part of a wider vision of delivering all women’s gynaecology and obstetrics care in networks, similar to the model which has helped improve cancer treatments in England.

The National Childbirth Trust said the idea of having a network to provide joined-up care for women was one it could support but it would prefer care during pregnancy and maternity to be concentrated in one NHS organisation in each area.

The NHS confederation, which speaks for managers, described maternity care as a classic example of a service which desperately needed to be reorganised.

Chief executive Mike Farrar said politicians needed to be prepared to speak up for change.

“Where the case for change is clear, politicians should stand shoulder-to-shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change.”

Although Scotland has reorganised some of its maternity services, there are likely to be pressures for change elsewhere in the UK.

In North Wales maternity care across three hospitals is expected to change after an initial review recently concluded improvement was needed.

From: http://www.bbc.co.uk/news/health-14145862

Rising cancer rates mean four in 10 people in the UK get the disease at some point in their lives, a health charity says.Macmillan Cancer Support says the figure has risen significantly in the past decade.

The charity says the rise poses a “massive challenge” for the NHS.

Ministers in England say they are working to improve cancer survival rates and the quality of life after diagnosis and treatment.

Macmillan Cancer Support says a decade ago about a third of people, or 33%, developed cancer at some point in their lives. The charity says that figure has risen to more than 40%.

The estimates are drawn from projections published two years ago in the British Journal of Cancer, which concluded that at the end of 2008 there were two million cancer survivors in the UK and that the figure was rising every year.

Macmillan also looked at recent cancer incidence and mortality statistics for the UK, indicating that 310,000 people were diagnosed with cancer in 2008.

About 157,000 people died from the disease, and 89,000 who had been diagnosed with cancer died from other causes, making a total of 246,000 who died “with” cancer.

The charity says this accounted for 42% of total deaths in the UK – which stood at 580,000.

Macmillan says the increase is partly down to an ageing population – older people are more likely to develop cancer. It says lifestyle factors, such as diet and exercise, and improved diagnosis have also contributed to the rise.

The chief executive of Macmillan Cancer Support, Ciaran Devane, said the calculations had important implications for the health service.

“It is really alarming that the number of people who will get cancer is now well past one in three and that there are so many more people with cancer today than even 10 years ago,” he said.

“There are currently two million people living with cancer in the UK and that number is doubling to four million over the next 20 years. Yet no-one thinks the country can afford to double its spending on cancer. We’ve therefore got to become twice as effective in how we spend that money.”

The charity says there is growing evidence of the long-term health problems many cancer patients are experiencing long after initial diagnosis and treatment. It says there is a need for more services to help people stay well at home, rather than waiting until they require emergency hospital treatment.

The Care Services Minister for England, Paul Burstow, said it was absolutely right for Macmillan to raise this as a major issue.

“We agree with Macmillan. That’s why we are working to deliver more personalised care and more help to keep people well in their own homes. We are investing more than £750m over four years to improve cancer outcomes,” he said.

The chair of the Royal College of GPs, Dr Clare Gerada, said the figures highlighted the increasing impact of cancer on many people’s lives.

“What is clear from this study is that cancer survival is not the whole picture. All healthcare professionals have a duty to see that patients receive the best possible care, and aftercare, following a diagnosis of cancer, and to ensure their patients are not just living, but living well,” she said.

From: http://www.bbc.co.uk/news/health-14140424