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

Dr Pierre Dukan, the weight loss guru, whose diets are popular with Gisele Bundchen and Carole Middleton, has lost in court against a rival he accused of libel, and has been fined himself.
Dr Dukan, the creator of a diet which has swept the globe, had filed a legal complaint against Jean-Michel Cohen, who criticised the protein-rich diet in a magazine.

A Paris court ruled on Tuesday that there was nothing libelous about Dr Cohen’s comments, and ordered Dukan to pay £2,700 in damages for “abusive procedure.”

Dr Cohen had warned that Dr Dukan’s methods could lead to serious health problems among some patients.

Dr Dukan issued a statement on Tuesday defending the safety of his diet and suggested Dr Cohen was jealous of the “Dukan phenomenon.”

Dukan’s book was France’s best-selling publication last year and is also a US best-seller. The protein-based diet urges against counting calories, instead allowing dieters to eat as much as they like from a limited list of foodstuffs.

Dr Cohen’s diet says readers can eat anything they like providing they stick to one of four calorie-based programmes of up 1,600 calories a day. The overall aim is to foster good eating habits and take regular exercise.

From: http://www.telegraph.co.uk/Weight-loss-guru-Pierre-Dukan-loses-libel-suit

Drugs used to stimulate the ovaries of older women undergoing IVF treatment may be causing genetic defects in the embryo which have until now gone undetected.
Scientists have discovered abnormalities in the chromosomes of eggs from women over 35 years of age who had been treated with synthetic hormones to stimulate their ovaries prior to IVF.

The researchers said they were surprised to find the chromosome defects which appeared to have occurred during the second stage of the specialised process of cell division that leads to the creation of the human egg cell.

Chromosome defects in eggs were previously considered to have resulted in the first stage of cell division, which occurs when a woman was herself a foetus in the womb. Finding them during the second stage, which occurs at ovulation, therefore suggests they may have resulted from the hyperstimulation of the ovaries during IVF treatment.

The defects included abnormal variations from the usual number of 23 pairs of chromosomes. Three copies of chromosome 21 instead of the normal two, for instance, leads to babies with Down’s syndrome. As women get older it becomes increasingly difficult for them to produce enough viable eggs for IVF treatment. It is common practice for older women to have their ovaries stimulated with stronger doses of drugs than is the case for younger women.

The results of the study are to be presented at a fertility conference in Stockholm this week but the scientists behind the research said that they wanted to reassure older women considering IVF treatment. They said further work needs to be done fully to explain the findings and there is no evidence to suggest that IVF babies of older women are at any higher risk of birth defects than babies conceived naturally by women of the same age.

“We found that some IVF eggs have up to seven chromosome abnormalities. This suggests the possibility that ovarian stimulation during the treatment may have caused some of these defects,” said Professor Alan Handyside, director of the London Bridge Fertility, Gynaecology and Genetics Centre, who led the study.

“These defects are unexpected and it may be that this is just an undiscovered aspect of biology. At the moment all we can say is that this is part of the natural process as women get older.”

The study, which will be presented at the European Society of Human Reproduction and Embryology, analysed more than 100 egg cells from 34 couples undergoing IVF treatment. The average maternal age was 40.

Scientists screened the chromosomes of the eggs and structures known as “polar bodies” that result from a type of cell division known as meiosis. Meiosis is a specialised form of division that results in eggs with half the normal complement of chromosomes – crucial to ensuring that the fertilised egg has the full complement of 46 chromosomes when it fuses with a sperm cell.

The first stage of meiosis occurs when the woman’s ovary is developing in the foetus before birth, when the dividing chromosomes are held together by a kind of cellular “glue” ready for the second stage of division at ovulation.

However, when the ovary of an older women is stimulated with synthetic hormones it is possible that this dislodges the glue prematurely. This might result in abnormal numbers of chromosomes to segregate into the resulting egg cell.

“Our evidence demonstrates that, following IVF, there are multiple chromosome errors in meiotic divisions, suggesting more premature separation of single chromosomes resulting in more random segregation,” Professor Hanyside said.

Stuart Lavery, a consultant gynaecologist at Hammersmith Hospital in London, said “This provides evidence that there is a problem, but it does not prove that it’s treatment related,” Mr Lavery said.

The most important conclusion to be reached from this research isn’t so much the “why” but that the screening process for eggs to be used in IVF must be improved.

It is possible to screen the chromosomes of so-called First Polar Body eggs, at least as part of research. This paper stresses the importance of also screening Second Polar Body eggs, those that have been fertilised.

Doing so will, we can now see, allow us to better identify eggs that have developed abnormalities that result in conditions like Down’s Syndrome.

The issue of whether drugs used to stimulate ovulation are having a role is two-fold. Are the drugs damaging the eggs or simply releasing those that would otherwise be discarded naturally because of abnormalities? Or it could be the drugs have no role at all? We don’t know.

One intriguing point is that if the drugs are a factor we would have anticipated having seen more cases of Down’s Syndrome among older mothers. They may be there but we haven’t detected any such increased risk yet – it means we need to research the possibility.

From:  http://www.independent.co.uk/ivf-drugs-may-be-linked-to-genetic-defects-discovered-in-embryos

Ninety per cent of two year old children in the UK have received their first dose of the MMR vaccine – the highest level for 13 years, says the Health Protection Agency.
But this is still short of the 95% uptake rate which would stop the spread of the disease in the community.

A measles epidemic spreading across Europe in recent months is thought to be behind the rise in immunisations.

The HPA is urging parents to vaccinate their children before they travel.

In the UK, two doses of the MMR vaccine are usually given, the first at around 12 months and the second around the time of starting school.

The increase in the number of children aged two receiving their first dose is a 0.6% rise on the previous quarter.

The uptake rate for two doses in children aged five increased by 0.3% from the previous quarter to 85.1%, show the HPA’s figures.

Children who received their first dose of the MMR vaccine by the age of 5 in the UK remains at 92.8%.

Dr Mary Ramsay, head of the immunisation department at the HPA, said she was pleased by the figures.

“We’re very encouraged to see that UK MMR uptake has reached 90 per cent in children aged two, indicating increasing levels of trust by parents in the immunisation programme.”

The Health Protection Agency says that in England and Wales there has been a total of 496 confirmed measles cases between January and May 2011.

This is more than the 374 total for the whole of last year.

It says the new cases of measles in England and Wales are predominately in children and adults under 19 years old, the vast majority of whom are unvaccinated.

The outbreak is thought to be linked to an epidemic in Europe where more than 11,000 cases have been reported across 35 European countries in the first four months of this year.

In France, where the outbreak appears to have started, more than 7,000 cases were reported between January and April this year.

Dr Ramsay said families should plan to vaccinate their children before the summer.

“It’s that time of year when children are travelling on school trips and family holidays and we are reminding parents and young adults of the importance of immunisation before they travel.

“We cannot stress enough that measles is serious and in some cases it can be fatal.”

From: http://www.bbc.co.uk/news/health-13903374

Health groups in the UK are calling for a ban on cosmetic surgery prize draws.
The Independent Healthcare Advisory Services (IHAS) and the British Association of Aesthetic Plastic Surgeons (Baaps) have criticised procedures like boob jobs, face lifts and botox being offered through competitions.

They claim cosmetic surgery promotions are becoming more popular, especially over the last three months.

As well as prize draws, they say loyalty card schemes, divorcee packages, magazine competitions and online deals are also big concerns.

Some health experts believe advertising surgery in this way is encouraging young people to get treatments they don’t want or need.

Their concerns come days after My Big Fat Plastic Surgery Prize Draw, the first of a series of monthly events across the UK.

Tickets cost £25, with free entry into a lottery to win £4,000 worth of surgery of your choice.

The event was hosted in a nightclub in London and sponsored by a cosmetic surgery group. Runner-up prizes included fillers and semi-permanent make-up.

Jackie Lewis from Baaps specialises in breast surgery and criticised the draws.

“Cosmetic surgery should not be offered as a commodity prize,” she said. “This is not something that can be trivialised.

“If you’re going to subject yourself to a procedure which is irreversible with lifelong consequences, we recommend you think about it carefully first.”

The Government says you are free to choose where you have cosmetic surgery and the Advertising Standards Agency (ASA) insist all adverts must be socially responsible and not misleading.

From: http://www.bbc.co.uk/newsbeat/13908448

People who have had obesity related type 2 diabetes for years have been cured- at least temporarily, by keeping to an extreme low calorie diet for two months British scientists report.
The discovery, reported by scientists at Newcastle University overturns previous assumptions about type 2 diabetes which was thought to be a lifelong illness.

In the UK about two and a half million people have been diagnosed with diabetes, the large majority with type 2, and numbers are rising across much of the world. The condition has to be controlled with drugs and eventually insulin injections. It can cause blindness and end in foot amputation, as well as shortening life.

The results of the Newcastle investigation- though the study was small, demonstrated that full recovery was possible not through drugs but through diet.

Eleven people with diabetes took part in the study, which was funded by Diabetes UK. They had to slash their food intake to just 600 calories a day for two months. But three months later seven of the 11 were free of diabetes.

“To have people free of diabetes after years with the condition is remarkable – and all because of an eight-week diet,” said Roy Taylor, professor at Newcastle University, who led the study. “This is a radical change in understanding type 2 diabetes. It will change how we can explain it to people newly diagnosed with the condition. While it has long been believed that someone with type 2 diabetes will always have the disease, and that it will steadily get worse, we have shown that we can reverse the condition.”

Type 2 diabetes, which used to be known as adult onset, is caused by too much glucose in the blood. It is strongly linked to obesity, unlike type 1, which usually develops in children whose bodies are unable to make the hormone insulin to convert glucose from food into energy. They need daily insulin injections.

The research, presented today at the American Diabetes Association conference, shows that an extremely low-calorie diet, consisting of diet drinks and non-starchy vegetables, prompts the body to remove the fat clogging the pancreas and preventing it from making insulin.

The volunteers were closely supervised by a medical team and matched with the same number of volunteers with diabetes who did not get the special diet. After just one week into the study, the pre-breakfast blood sugar levels of the study group had returned to normal. And MRI scans showed that the fat levels in the pancreas had returned to normal. The pancreas regained its ability to make insulin.

After the eight-week diet the volunteers returned to normal eating but had advice on healthy foods and portion size. Ten of the group were retested and seven had stayed free of diabetes.

Taylor, the director of the Newcastle Magnetic Resonance Centre, had the idea for the study after it was shown that diabetes was reversed in people who had undergone stomach stapling or other forms of bariatric surgery because of obesity. “What was remarkable was that the diabetes went away over the course of one week. It was widely believed the operation itself had done something, [that] the hormones in the gut were thought to be the cause. That is almost universally believed.”

Taylor thought the massive drop in calorie intake after surgery could be responsible and to test this hypothesis set up the study, which included MRI scans of the pancreas to look at any changes in the fatty deposits.

“We believe this shows that type 2 diabetes is all about energy balance in the body,” said Taylor. “If you are eating more than you burn, then the excess is stored in the liver and pancreas as fat, which can lead to type 2 diabetes in some people. What we need to examine further is why some people are more susceptible to developing diabetes than others.”

He warned that only a minority of people, perhaps 5% or 10%, would be able to stick to the harsh diet necessary to get rid of diabetes. But even that, he said, would dramatically improve the health of many people and save the NHS millions.

Iain Frame, director of research at Diabetes UK, said people should not embark on such a diet without a doctor’s approval and help. “We welcome the results of this research because it shows that type 2 diabetes can be reversed, on a par with successful surgery without the side effects.

“However, this diet is not an easy fix and Diabetes UK strongly recommends that such a drastic diet should only be undertaken under medical supervision. Despite [it] being a very small trial, we look forward to future results, particularly to see whether the reversal remains long term.”

From: http://www.guardian.co.uk/low-calorie-diet-hope-cure-diabetes

David Cameron has agreed to make changes to the plans for the NHS in England and insisted the government had not made “a humiliating U-turn”.
Ministers have accepted all the recommendations suggested by a panel of experts, including more controls on competition and a slower pace of change.

Doctors’ groups have broadly welcomed the revisions.

The NHS bill will now go back to the committee stage in the House of Commons to be scrutinised again by MPs before going through its House of Lords stages.

The prime minister’s official spokesman said he expected that to happen before the summer recess begins in July, and the bill to be on the statute book by the end of the current Parliamentary session.

That gives ministers until May 2012 to make it law.

On Monday – following a 10-week “listening exercise” – a panel of experts called the NHS Future Forum gave its recommendations on the changes needed to the bill.

They include:

• Reinstating the legal responsibility of the health secretary for the overall performance of the NHS
• Scrapping the primary role of the regulator, Monitor, to promote competition – and focusing on improving patient choice instead
• Relaxing the 2013 deadline for new GP commissioning arrangements to be introduced – a National Commissioning Board, based in Leeds, will control budgets until GP groups are “able and willing” to take over
• Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them
• Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them

After criticism from medics and complaints from rebellious MPs, the Coalition will be hoping the dust will now settle over its NHS reforms.

If politics is the art of persuasion, then the test for Messrs Cameron, Clegg and Lansley is whether or not they have convinced people that the listening process has been, as the prime minister claimed, a sign of strength.

The government and many health professionals believe changes to the NHS are necessary to deal with the demands of the ageing population, cost of new drugs and lifestyle changes such as obesity.

Mr Cameron said those who described the reworking of the plans as “a humiliating U-turn”, or the listening exercise as “a big PR stunt”, were both wrong.

“The fundamentals of our plans – more control to patients, more power to doctors and nurses, less bureaucracy in the NHS – they are as strong today as they’ve ever been,” the PM said.

The health secretary has faced personal criticism for his inability to garner widespread support for the original bill, but the prime minister said he accepted full responsibility for what had happened.

“I am every bit as responsible as Andrew Lansley for the fact that we actually decided we could improve on what we already put forward,” Mr Cameron said.

The British Medical Association said it was pleased the government had accepted the Future Forum’s recommendations and addressed many of doctors’ concerns.

But it said more detail was needed on how commissioning of care would work in future and there must be “robust safeguards” to prevent competition of any kind destabilising the health service.

From: http://www.bbc.co.uk/news/uk-politics-13757380

Reforms to the NHS are already under way and working well doctors claimed after Andrew Lansley insisted that change was essential.
The head of a doctors’ group said that new bodies led by GPs have taken over from managers across the country, and are improving services to patients while saving money by reducing pressure on hospitals.

Dr Michael Dixon, chairman of the NHS Alliance, defended the changes by saying that neither medics nor the public wanted to be “pawns in the system” any more.

But he was warned that the power GPs appear to have been given to buy treatment is just an “illusion” and that they will end up merely rationing care in order to save money.

It comes after the Health Secretary, Mr Lansley, wrote in The Daily Telegraph that the NHS faces a £20 billion a year funding black hole unless it undergoes major surgery.

His Health and Social Care Bill proposes abolishing two tiers of management and allowing new GP-led bodies, called commissioning consortia, to buy £60billion a year of treatment from either state-run hospitals or private providers.

It has been bitterly opposed by much of the medical establishment on the grounds it may fragment services and lead to backdoor privatisation, and the legislation was put on “pause” by David Cameron after Liberal Democrats and peers threatened a rebellion.

But BBC Radio 4’s Today programme heard on Thursday that many of the changes are already happening on the ground, as clusters of GPs form consortia to take over from Primary Care Trusts.

Dr Dixon of the NHS Alliance said: “The evidence is in our report, showing over 20 commissioning groups already delivering better services for their patients and also delivering them more cost effectively.

“For instance, in this country the use of hospitals is disproportionately more than anywhere else in the world and those commissioning groups are showing how they can look after patients better in the community.

“If the commissioner is king, they can get the right balance of private and public and the right balance of competition and collaboration.”

Asked why more GPs were not in favour of the new regime, he replied: “To look after our whole patient population is quite an added responsibility and I think some people find that quite daunting.”

But he went on: “Many of us in this commissioning movement are fed up with being pawns in the system and fed up with our patients being pawns in the system.

“We feel that if we can make sure the NHS is delivering change and improvement from the bottom up instead of having to listen to targets coming down from Whitehall, that often don’t mean much to us, we can actually make a difference.”

From: http://www.telegraph.co.uk/GP-group-says-Andrew-Lansleys-NHS-reforms-are-already-working