Postcode lottery for IVF treatment faced by patients

Couples seeking IVF infertility treatment in some parts of Scotland are having to wait up to three years longer than those in other areas, it was revealed.

Labour MSP Jackie Baillie called on the Scottish government to end what she described as a postcode lottery on IVF treatment.

Figures obtained by the MSP under a freedom of information request showed that the longest average waiting times among the 11 boards that responded were in NHS Lothian, where patients wait three years for treatment. Patients in the Borders, referred to the same unit in NHS Lothian, had no waiting time.

In Glasgow the average wait was 22 months, while couples from Lanarkshire were referred to the same hospital, Glasgow Royal Infirmary, within an average of six months.

In Fife the average wait for IVF treatment was two years. In NHS Highland and Tayside it was one year, and in Grampian a maximum of 18 months.

“This shows clearly that it is the board of residence that determines length of wait,” Ms Baillie said. “There is no consistency in the rules. NHS Borders will fund patients for treatment in neighbouring areas if they have shorter waiting lists, but other health boards refuse to consider such a sensible step.”

Although some boards, notably NHS Greater Glasgow and Clyde, did not reveal the number of patients, Ms Baillie’s figures indicate that more than 1,000 couples across Scotland are waiting to see a specialist.

Long waiting times have a particular resonance for inferitlity treatment, as a woman’s age is critical to success rates. One expert describes the age factor as “the most monumental challenge”.

Ms Baillie said national guidelines were needed to ensure that patients were treated fairly and had access to treatment as quickly as possible.

Shona Robison, the Public Health Minister said: “There is huge demand for IVF and we know it can be very upsetting to have to wait for treatment, but we are working to make access as fair as possible.”

Jackie Sansbury, of NHS Lothian, said: “We are investing an additional £180,000 to increase the number of IVF cycles we are able to offer by about 40 per cent during 2009-2010.”


High society- Britain’s drug taking clubbers pt 2

The first wideranging academic study of clubbers’ behaviour in a decade, indicates that thousands of apparently successful, healthy and economically active people in their twenties, thirties and forties choose to be heavy recreational drug users at the weekend.

With permission from club proprietors, Measham and Moore did their fieldwork in Manchester, the epitome of the 24-hour party city. They set up a website to verify their work to clubbers, then interviewed them at the start of the evening before the drugs had made revellers too intoxicated.

One of the fundamental ironies the research uncovered is that because recreational drug users fuel the economy and cause few social problems — violent crime, aggression and antisocial behaviour are much more likely to be alcohol-related and occur outside pubs — they fail to get the support and services they need.

“There is a lack of knowledge about the types of drugs, a lack of accurate, non-judgmental and non-sensationalist information for these users,” says Moore, a lecturer in criminology. “Ketamine, for instance, does not go well with alcohol. Nor does GBL [which coverts to GHB in the body], which is widely used as an industrial cleaner, and is not illegal. I’ve been working with one man who had a serious daily dependency on GBL, but the doctors simply didn’t know what to do with him.”

Here too is highlighted another contradiction: between the growing commercialisation of the night-time economy and the increasing government policy of what Measham calls “the criminalisation of intoxication” without education, advice or treatment services attached. The people who suffer, under the present situation of tacit tolerance of drugs, are the users. “Even if the club owners wanted harmreduction literature in their club, it would acknowledge that there was drug taking on the premises. And they are concerned about being arrested or shut down.”

Last year the owner of the Dance Academy in Plymouth, Manoucehr Bahmanzadeh, and its manager, Tom Costelloe, were found guilty of allowing the venue to be used for the supply of Ecstasy and jailed for nine years and five years respectively. This despite neither man having actually sold drugs on the premises.

What is important, Measham and Moore say, is to draw the distinction between this kind of recreational drug use, and the problem drug use that dominates the political agenda and absorbs its resources. The two groups do not overlap; the dealers are different; and so are the drugs. 

Clubbers almost never take heroin or crack cocaine, the academics’ surveys show, and they remain in society. The UK’s problem drug users, with a daily dependency on such drugs, may be hugely outnumbered by the recreational drug takers — 150,000 as opposed to four million — but they remain the focus of government policy.

To use the phraseology of Russell Newcombe, a drug researcher for Lifeline Manchester, drugs represent “cocktails of celebration” for one group. For the other, they are a “cocktail of oblivion”. And the difference is profound.

Significantly, however, trends are changing. Recent analysis from the NHS’s National Treatment Agency for Substance Misuse shows 22 per cent fewer young adults with a drug problem are using heroin and crack, and the number of under-25s seeking treatment for dependency on cocaine has risen 11 per cent.

To visit a club is to witness striking inconsistencies in the way that society deals with drugs. It is amusing to see a line of people, most of who have taken illegal drugs, queueing politely to get outside to the smoking area to consume a drug that is banned inside.

The lack of focus, criminal and otherwise, on recreational drugs means the risks to clubbers are going largely unassessed. Measham and Moore are concerned about the health impact from the new fashion for mixing drugs. The outcry over the death of Leah Betts appears not to have checked universal acceptance of Ecstasy, although there have been more than 200 Ecstasyrelated deaths in the UK since 1996. Many younger clubbers, the academics discovered, are ignorant of the fact that the increasingly popular MDMA powder is pure Ecstasy; and few are aware that ketamine is dangerous when mixed with alcohol.

“We would like to see a sensible debate about drugs without the shock, horror bit — if only because of the sheer numbers we see involved,” says Measham. “People have a desire to get intoxicated on a Friday night — the American pharmacologist Ronald Siegel once described intoxication as the fourth strongest irrepressable human desire after food, sleep and sex.

“That suggests that blanket prohibition is destined to be a disaster. We need a more sophisticated but also more realistic response. If people have a choice they don’t really want to break the law. That’s where the debate needs to take place.”

98 per cent of club customers had tried an illegal drug at least once
79 per cent had taken an illegal drug within the previous month
Only half as many bar customers (35 per cent) had taken an illegal drug in the previous month
85 per cent of clubbers had tried Ecstasy at least once
83 per cent had tried cocaine at least once
44 per cent had tried ketamine at least once
40 per cent had tried MDMA at least once


High society- Britain’s drug taking clubbers

Almost all Britain’s thousands of clubbers routinely take drugs, in particular cocaine , cannabis and ecstasy.

The first wideranging academic study of clubbers’ behaviour in a decade, released this month, indicates that thousands of apparently successful, healthy and economically active people in their twenties, thirties and forties choose to be heavy recreational drug users at the weekend.

Not only do the findings suggest almost ubiquitous drug use in and around Britain’s clubs, in particular cannabis, cocaine and Ecstasy, but they point to the emergence of new substances on the pharmaceutical block, such as ketamine and GHB, being used increasingly by clubbers as part of assorted drug “repertoires” at the weekends.

Ketamine, a Class C drug, is an anaesthetic, sometimes used on animals, which causes temporary hallucinations. GHB — gammahydroxybutrate — is also Class C and produces a feeling of euphoria. Both can be dangerous, powerful drugs.

Dr Fiona Measham and Dr Karenza Moore, criminologists from Lancaster University, set out to explore the hidden world of pharmaceutical intoxication in Britain’s bars and night clubs. What they found, in the most thorough examination ever undertaken of drugs across the British night-time economy, was extraordinary.

They discovered evidence that almost all Britain’s thousands of clubbers routinely take drugs, in particular cocaine (tried by 83 per cent of people), cannabis (93 per cent) and ecstasy (85 per cent). Eight in ten had taken a drug within the previous month, and nearly two in three of those questioned had taken, or were going to take, drugs on the night they were surveyed.

These statistics, published in the journal Criminology and Criminal Justice, demonstrate how drug-enduced dancing and socialising has become a significant part of modern culture, albeit taking place “under the radar” with the tacit acceptance of police, politicians and economists.

Indeed, the figures indicate that much of Britain’s burgeoning night time economy, worth as much as £30 billion, and employing about one million people, is inextricably linked to the night long consumption of illegal drugs. 

The trend is such that the main clubbing nights have been moved from Saturdays to Fridays specifically to allow people to recover in time for work or lectures on Monday morning.

The extent and complexity of drug use that the academics uncovered surprised them. “Everyone knows that it goes on,” says Measham, a senior lecturer in criminology, whose 2001 study Dancing on Drugs was until now the seminal study of recreational drug use. “How else would the clubbers stay awake until 5am, when the club closes? But it’s unspoken.

“Drug taking is implicitly facilitated but it’s the individual who takes the risks. And there are risks — the implications of having a criminal record on your career, for one, and the health aspects.

“One of the big surprises was the scale of polydrug use [the taking of several substances]. Fifteen years ago people would take an Ecstasy tablet or two and a wrap of speed; now they are taking a whole range of drugs without knowing what the impact is of these polydrug cocktails. We just don’t know about ketamine and GHB. We’re seeing a lot more use of both drugs. Ketamine has not displaced Ecstasy but it has been added to the repertoire.”


Health Direct will be posting the second part of this research tomorrow.

NHS told to brace itself over swine flu epidemic

The NHS has been told to brace itself for action after a steep rise in swine flu infections.

The number of new cases reported in England over the past week has nearly doubled to 53,000. In Scotland, there was a slight rise to 14,650.
swine flu information and symptoms
It comes as more and more people are being admitted into intensive care and the number of deaths hit 128 in the UK.

Ian Dalton, head of flu planning at the NHS, said if the rises continued critical care would be expanded.

Plans have been drawn up over the last few months to double the number of intensive care beds to over 4,000.

And with the UK well into the second peak, concerns are being raised about the sustained pressure that will be put on the health service.

Mr Dalton said: “If current trends continue we are going to have to surge capacity. My message now is that the NHS must be ready.”

In England, there are 99 people in critical care beds – the highest since the pandemic began. But it is the rate of admission to these specialist beds which is causing particular concern.

During the summer, about 1 in 10 patients in hospital with swine flu ended up in critical care, compared with one in five now.

‘Sustained pressure’

Sir Liam Donaldson, the government’s chief medical officer, said the pattern emerging on intensive care wards was “mystifying”.

There are no signs the flu strain has mutated to become more deadly – indeed the latest worst-case scenario for total deaths over the winter has been reduced from 19,000 to 1,000.

But Sir Liam said: “What we are starting to worry about is the sustained pressure over the winter.

“The NHS has never before had a run from mid July to March and April with intensive infectious disease like this.”

Latest estimates suggest there could be another 35,000 admissions in the coming months – more than 5,000 of which could require intensive care support.

Sir Liam also said while the 1,000 death-toll was low even compared to the normal number of deaths from seasonal flu, which normally stands at about 6,000 to 8.000, the tragedy was that the victims of swine flu were often young.


3,000 NHS staff get private health care

The National Health Service has spent £1.5m paying for hundreds of its staff to have private health treatment so they can leapfrog their own waiting lists.

More than 3,000 staff, including doctors and nurses, have gone private at the taxpayers’ expense in the past three years because the queues at the clinics and hospitals where they work are too long.

Figures released under the Freedom of Information act show that NHS administrative staff, paramedics and ambulance drivers have also been given free private healthcare. This has covered physiotherapy, osteopathy, psychiatric care and counselling — all widely available on the NHS.

“It simply isn’t fair to have one service for staff and another for everyone else,” said Norman Lamb, the Liberal Democrat health spokesman, who obtained the figures.

“If the NHS has to circumvent their own waiting lists the system isn’t working well enough. It’s an admission by the NHS that their own system isn’t able to respond to the mass of people desperate to get back to work.”

The number of health service employees sent to private healthcare facilities has more than doubled in the past three years.

In 2006-7, 708 staff working for NHS trusts received private treatment at a cost of £279,000. Last year it increased to 1,641 at a cost of £828,413.

The health department defended the practice and said sending doctors, nurses and other key staff for private treatment helped to get them back to work.

“If trusts want to get their staff back to work more quickly they can’t jump NHS waiting lists, so going private is an option,” said the spokesman.

“There is evidence that early intervention in tackling sickness absence enables staff to return to work more quickly. Other benefits include: reducing the risk of chronic illness that could result in ill health retirement, cost-saving on temporary staff and having a positive impact on staff health and wellbeing and, in turn, patient satisfaction.”

The East Midlands ambulance service recently set up a contract with a private occupational healthcare specialist worth £300,000 a year. It has sent its staff to the specialist for vaccines, health screening and to deal with needle injuries and blood tests.

Other big spenders include the south east coast ambulance service, which has sent more than 800 staff for physiotherapy, osteopathy and counselling at a cost of more than £279,000 over three years.

Humber mental health trust has spent more than £47,000 on private counselling, even though it specialises in offering this service along with psychiatric help. A spokeswoman said staff would feel awkward being counselled by NHS colleagues.

“An appropriate and professional counselling and therapeutic service has to be free from any other existing pressures in respect of relationships and therefore cannot always be provided by an organisation,” she said.

“Staff may also be referred externally due to peak of demand to meet the need in a timely manner.”

West Suffolk hospital has spent £56,000 over the past three years on private treatment for staff but said it would no longer do so.


One in eight NHS trusts could face fines and hospital closures due to substandard services

One in eight local NHS healthcare trusts could face fines and even be forced to close hospitals from next April if they do not improve standards, the new health regulator has warned.

The Care Quality Commission said that “alarm bells” should ring in the boardrooms of 47 of the country’s 392 NHS trusts, which have been persistently rated as either weak or fair.

“They must do better for their patients… It is clear that many have significant work to do and a short time in which to do it,” said Cynthia Bower, the commission’s chief executive.

From next April all NHS organisations must be registered with the CQC in order to treat patients.

Trusts will face tough tests on quality before they will be allowed to register.

From next year the regulator will have powers to demand improvements, to fine and prosecute trusts, suspend services and even close hospitals.

However, Barbara Young, the commission’s chairman, said that they did not want to force hospital closures.

“We don’t want to get to the last one, because quite frankly that raises the major question of when you get to that nuclear option, where do people get services?,” she said.


Swine flu could lead to rise in MRSA

A second wave of swine flu hitting Britain could lead to a rise in MRSA infections, medics have warned.

The MRSA Working Group, together with National Concern for Healthcare Infection and the Patients Association, is calling for the early discharge of patients from hospital to try and prevent a rise in the killer superbug.

They said when hospital bed occupancy rates were high, MRSA infection rates increased.

The group has written to all NHS hospital staff, reminding them to review their policy for the early discharge of MRSA patients.

The also urge hospitals not to let increasing pressure on staff and rising bed occupancy rates during winter to reverse the good work they have done to date to reduce MRSA rates.

Department of Health research has shown that when a hospital’s bed occupancy rate exceeds 90%, MRSA rates can be as much as 40% above average.

Dr Matthew Dryden, consultant microbiologist at the Royal Hampshire County Hospital and General Secretary of the British Society of Antimicrobial Chemotherapy, said: ”The NHS has been working really hard to plan for swine flu and ensure there will be enough hospital beds available for patients who need to be admitted.

”What we don’t want to see is an increase in infections such as MRSA, which have been linked to high bed occupancy rates.

”A way to get around this is to support patients with infections to get out of hospital earlier with outpatient and home care and good antibiotic stewardship.”

The letter to hospitals outlines methods to help ensure sufficient critical care beds are available this winter through identifying MRSA patients and discharging them early. Studies have shown that providing IV treatment at home or switching eligible patients to oral antibiotics could free-up scarce hospital beds by enabling patients who are well enough to go home earlier.

”When faced with a difficult winter, it is vital that hospitals ensure sufficient beds are available,” said Dr Dryden.

”Treating patients with infections such as MRSA at home can help by reducing their length of stay in hospital, freeing up much-needed beds and easing pressure on staff and resources.

”It also helps to improve a patient’s quality of life.”

Katherine Murphy of The Patients Association, who co-signed the letter, said: ”There is a real risk that swine flu patients may block isolation beds resulting in patients with healthcare infections such as MRSA being treated on general wards.

”This coupled with a highly pressured and reduced workforce, could increase the risk of infections such as MRSA spreading to other vulnerable patients and throughout the hospital.”

Neil Manser, of the NCHI, added: ”Where possible and when it is clinically prudent, patients who have been infected or colonised with infections such as MRSA should be treated in the safety and comfort of their own homes.

”Only then can we be sure we are doing our best to effectively contain the spread of infectious diseases such as MRSA and prevent further infection of hospital patients during any winter bed crisis period.”


False waiting time figures probed

A hospital has apologised and launched an inquiry after hundreds of patients’ records were altered to suggest NHS waiting time targets were met.

Records were changed to claim patients were treated within four hours at the Queen’s Medical Centre, Nottingham.

A review found 765 records were amended between March and September.

The hospital previously said it met government targets of treating 98% of patients within four hours, but the review shows in reality it did not.

The actual figure is 97.4% rather than the published figure of 98.3%, which was based on the altered records.

‘Small number’

Officials are now looking back even further to see whether records from other periods were altered.

Dr Peter Homa, chief executive of Nottingham University Hospitals NHS Trust, said: “The scale of the problem relating to the inaccurate reporting of breach numbers remains unclear at this stage.

“However our initial review, which was initiated on Friday when this first came to our notice, indicates this involves a small number of patients.

“We would like to reassure our patients and the public that this has not in any way affected the standard of care our patients have received at our hospital.


Unoffical NHS euthenasia as daughter saves mother, 80, left by doctors to starve

An 80 year old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened.

Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton’s daughter, Christine Ball, who had been looking after her mother before she was admitted to the Conquest hospital in Hastings, East Sussex, on January 11, says she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.

Ball, 42, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.

Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”

On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

Fenton is now being looked after in a nursing home five minutes from where her daughter lives.

Peter Hargreaves, a consultant in palliative medicine, is concerned that other patients who could recover are left to die. He said: “As they are spreading out across the country, the training is getting probably more and more diluted.”

A spokesman for East Sussex Hospitals NHS Trust, said: “Patients’ needs are assessed before they are placed on the [plan]. Daily reviews are undertaken by clinicians whenever possible.”

In a separate case, the family of an 87-year-old woman say the plan is being used as a way of giving minimum care to dying patients.

Susan Budden, whose mother, Iris Griffin, from Norwich, died in a nursing home in July 2008 from a brain tumour, said: “When she was started on the [plan] her medication was withdrawn. As a result she became agitated and distressed.

“It would appear that the [plan] is . . . used purely as a protocol which can be ticked off to justify the management of a patient.”

Deborah Murphy, the national lead nurse for the care pathway, said: “If the education and training is not in place, the [plan] should not be used.” She said 3% of patients placed on the plan recovered. 


National swine flu vaccination to start this week

A national swine flu vaccination campaign will begin this week, with high risk patients and frontline health workers the first to receive a single dose jab, the Chief Medical Officer has announced.

Sir Liam Donaldson said that from today hospitals would start vaccinating priority patients, such as people receiving cancer treatment, with the first deliveries to GPs for other at-risk groups including those with chronic conditions and pregnant women from October 26.

Sir Liam said that while overall rates of infection were rising slowly, and at similar rate to recent weeks, he was more concerned at the proportion of people ending up in critical care. Of the 364 patients currently in hospital, 74 are in critical care – the highest total in the pandemic so far.

The death toll also rose at a sharper rate, with 10 recorded in the last week, taking the UK total past 100. 

There have been a total of 83 deaths in England, 4 in Wales, 4 in Northern Ireland and 15 in Scotland. The announcement came as it was confirmed that a 17-year old pregnant woman from the Borders had died after contracting swine flu in the last 24 hours – the second pregnancy fatality of the week.

Professor David Salisbury, the Department of Health’s head of immunisation, said that Pandemrix, the vaccine made by GlaxoSmithKline, would be used for the first roll-out. He dismissed suggestions that as an adjuvant vaccine it carried more risks for pregnant women, and said that the fact that it could offer immunity with a single dose – rather than the more lengthy time period required with the UK’s other supply, the two-dose Celvapan – made it far more preferable.

Sir Liam added that postal workers’ decision to stage a national strike was “extremely unwelcome piece of timing” which, though it would not impact on vaccine delivery, would disrupt GPs’ letters sent out to those being called up for vaccination.

“While the rates of infection are not increasing more quickly, I am concerned at the relatively high proportion of patients in hospital in a serious category,” he said, adding that there was a school of thought suggesting that while the virus had not changed, it might carry a greater impact now the country was entering its seasonal flu period. “I also remain concerned at the rates of child hospitalisation,” he said.

On the topic of vaccinations for pregnant women, he added: “While the disease is mild for the majority of people including pregnant women, pregnant women are at higher risk of complications caused by flu. I know they wish to reduce risks to themselves and their unborn babies and therefore the sensible would be to have the vaccine. I do not want to see pregnant women dying from a preventable disease, and that is the bottom line.”