Andrew Lansley- an open, transparent NHS is a safer National Health Service

The health secretary Andrew Lansley explains why Dr Foster’s Hospital Guide should be welcomed by patients and NHS professionals.
Andrew Lansley- an open, transparent NHS is a safer National Health ServiceIn the first speech I delivered as health secretary, I made one thing perfectly clear: we need a cultural shift in the NHS: from a culture responsive mainly to orders from the top down to one responsive to patients, in which patient safety is put first.

A key driver in this is the provision of meaningful and easily accessible information. An open, transparent NHS is a safer NHS. Dr Foster’s Hospital Guide, published today, is a welcome source of information about standards in healthcare services, which patients and purchasers of healthcare services can use.

In particular, the guide highlights high levels of “adverse medical events”, the widespread under-reporting of incidents and too many hospitals with death rates higher than one would expect.

Safe care saves lives and saves money. Adverse events like high levels of infection, blood clots or falls in hospital, emergency readmissions and pressure sores cost the NHS billions of pounds every year. There is a serious human cost too, with patients ending up injured, or even dead. Most are avoidable with the right care.

So what are we doing about it? For a start, the NHS consists of many highly skilled, dedicated and motivated people. We will free them from central control while holding them to account for the quality of care they deliver. Soon, GPs will be responsible for designing and paying for local health services, working with their colleagues across the NHS to get the best results for their patients.

We will shine a bright light on NHS performance. A new culture of openness and transparency will transform patient care. Everyone – patients, the public and other clinicians – will be able to see just how well a particular organisation, team or even an individual is performing. This will create a huge incentive for ever higher levels of quality and patient safety.

We have already published hospital infection data for MRSA and C-difficile online, updated weekly for all to see. And we are planning to publish regular data on other potentially fatal infections too. We are also changing the way we collect and publish mortality statistics so that they act as an early trigger for unsafe care.

In the coming years, we will add significantly to this, making it much easier for patients and their doctors to choose the best and safest care. Our plan to deliver a payment system linked to the result of treatments will encourage hospitals to improve the quality of care they deliver for patients – like our 30-day readmission tariff – and should help drive up even higher the standards of care in hospitals.

And we will focus on outcomes: reducing avoidable deaths, continually cutting infections, treating patients safely and successfully and then getting them back home. This already happens in heart care where publishing data on outcomes has been critical to taking our results well above those elsewhere in Europe. We want to see this happen across the board.

The NHS deals with nearly a million patients a day. No one can guarantee that nothing will ever go wrong. But we can eliminate the culture of blame and secrecy that can compound the initial mistake and stops lessons being learned.

I never want anyone working in the NHS to be afraid of coming forward when they believe patient safety is compromised. We will strengthen the whistleblowing rights of staff and place a duty on their employer to support and investigate their concerns.

I want the NHS to give all patients care that compares with the very best in the world. To help it achieve this, a new range of quality standards – designed by the professions themselves and monitored by the independent Care Quality Commission – will set out what safe, high-quality care looks like. But the standards will not dictate how this is to be achieved. This government will never undermine the clinical judgment of health professionals.

Where the NHS embraces a culture of transparency, of learning from its mistakes and constantly striving for higher performance, it is a world-beater.

There are real centres of excellence – the challenge now is to achieve that excellence across the whole of the health service.

The interview was carried at: http://www.guardian.co.uk/andrew-lansley-doctor-foster-comment

NHS hospitals where high death rates are failing the National Health Service patients

Nineteen hospital trusts were exposed as having alarmingly high death rates in a major report that also reveals how hundreds of people are dying needlessly because of substandard NHS care.
NHS hospitals where high death rates are failing the National Health Service patientsThe Dr Foster hospital guide, which the Observer published exclusively yesterday, disclosed that tens of thousands of patients were harmed in hospital last year when they developed avoidable blood clots, suffered from obstetric tears during childbirth, had objects left inside them after operations or were not given immediate treatment after a stroke.

The authoritative study also identifies four hospital trusts where an unexpectedly high number of patients died after developing complications following routine operations. It names Hull and East Yorkshire Hospitals NHS Trust as the place where patients have the highest risk of dying in these circumstances – 66% above the average.

Last year that equated to 33 deaths more than expected there, although it is not possible to say how many of these deaths could have been prevented. Dr Foster says the mortality rate is too high to occur by chance and is a warning sign of potential issues in the quality of care provided.

The Care Quality Commission – the NHS watchdog for England – will now investigate the trust.

Andrew Lansley, the health secretary, welcomed the report last night and increased the pressure on the NHS to improve patient safety by warning that lax procedures were costing lives.

He wrotes in the Observer: “Safe care saves lives and saves money. Adverse events like high levels of infection, blood clots or falls in hospital, emergency readmissions and pressure sores cost the NHS billions of pounds a year. There is a serious human cost, too, with patients ending up injured, or even killed. Most are avoidable with the right care.”

The minister sets out plans to eliminate what he calls a “culture of blame and secrecy in the NHS that can compound the initial mistake and stop lessons being learned”.

Dr Foster’s report reveals that, despite recent improvements, in 2009-10:
¦ Almost 10,000 patients suffered an accidental puncture or laceration.
¦ More than 2,000 had post-operative intestinal bleeding.
¦ More than 13,000 mothers suffered an obstetric tear while giving birth.
¦ Some 30,500 patients developed a blood clot.
¦ 1,300 patients contracted blood poisoning after surgery.

Naren Patel, who chaired the National Patient Safety Agency (NPSA) until June, said some patients were dying because – as the report confirms – the NHS was still failing to provide high enough quality care in key areas, despite many initiatives from influential bodies.

“It [the report] identifies three or four key areas, such as with strokes, blood clots and prostate care, where there’s evidence that optimum care is still not being delivered,” said Patel. “Therefore some people do die unnecessarily because they haven’t received the best possible care.”

The NHS Confederation, which represents hospitals, conceded more action was needed. “There are still parts of our health system where particular services are having problems, and for the hospitals concerned this report presents an opportunity to learn and improve,” said acting chief executive Nigel Edwards. “There will always be variations in any nationwide system but the golden principle must be that our NHS is safe for the patients who rely on it. This report shows where we can do better.”

Peter Walsh, of patient safety charity Action against Medical Accidents, said: “This report confirms that far too little progress has been made on patient safety. Our system of regulation is failing to deliver consistently good quality care across the country or pick up on unacceptable variations and intervene.”

He also accused ministers of recently backtracking on a pledge to require hospitals to always tell a patient or relatives when a blunder occurs, which could let mistakes be covered up. “Mr Lansley and the coalition government say almost all the right things about patient safety, but now is the time to see them put their money where their mouth is. The worry is that political correctness about not regulating and the financial cutbacks will mean patient safety loses out,” Walsh warned.

John Healey, Labour’s shadow health secretary, welcomed Dr Foster’s disclosure that 30% fewer hospitals than in 2008-09 have unexpectedly high death rates. But he claimed the coalition’s NHS reforms would worsen the problem. “The health secretary should make patient safety and care top of his in-tray, instead of forcing the health service through a £3bn internal reorganisation.

“Andrew Lansley has to drop his hands-off attitude to problems in the NHS and tell people in Hull [and other areas] what he’s going to do to make their hospitals safer and better.”

From: http://www.guardian.co.uk/hospital-death-rates-nhs-dr-foster

Maternity postcode lottery revealed in NHS figures

Midwives have criticised the postcode lottery in maternity care after official NHS figures revealed caesarean rates are twice as high in some hospitals as others.
Maternity postcode lottery revealed in NHS figuresIn some cases even neighbouring hospitals have widely varying rates of caesarean section, revealing that it is not necessarily down to the characteristics of the local population.

The proportion of women having their first antenatal appointment within the first 12 weeks of pregnancy varies 11-fold, according to the data published by the NHS Information Centre.

This may be due to women recognising that they are pregnant later but also reflects on how well organised services are.

The figures show that almost nine in ten women were seen in the first 12 weeks at the Royal Cornwall Hospitals NHS Trust compared with less than one in ten at Walshall Hospitals NHS Trust in 2009/10.

Similarly more than three in ten women had a caesarean birth at Imperial College Healthcare NHS Trust, in London – twice as many as at Shrewsbury and Telford Hospital NHS Trust in Shropshire.

However the variations cannot be completely explained by deprivation as neighbouring hospitals will had large differences in rates.

At Rotherham NHS Foundation Trust 87.6 per cent were seen in the first 12 weeks, five times higher than in neighbouring Barnsley Hospital NHS Trust where 17.2 per cent were seen.

There were twice as many caesareans at Hereford Hospitals NHS Trust than at nearby Shrewsbury and Telford.

Nationally more women are being seen within the first 12 weeks in 2009/10 compared with the previous year and the caesaearan section rate has remained for the last year at around one in four of all births, the majority of which were conducted as emergencies.

The figures show that the proportion of births delivered by doctors instead of midwives has increased from less than one in four in 1989/90 to almost four in ten in 2009/10, as a result of more caesarean and instrument deliveries due to greater numbers of older and obese mothers giving birth.

Tim Straughan, Chief executive of The NHS Information Centre, said: “The figures show that the experience women have of NHS maternity care varies markedly across the country and even within regions.

“Rates of caesareans and access to antenatal assessment in the first 12 weeks of pregnancy vary according to which hospital they use.

“In some trusts, there may be specific demographic or clinical reasons that explain why they carry out, for example, more caesareans. But others will need to examine closely the full range of reasons why their rate is different from the national average of about one caesarean delivery for every four deliveries.”

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM), said: “These results show that there is a postcode lottery when it comes to maternity services, and this is worrying when those services are part of a ‘national’ health service. Women should expect and receive high quality care wherever they live, not care that is based upon chance and plain old good luck.

“Superficially the huge variations revealed in this report are a concern and further analysis is needed to find out why they are occurring.

“The variation on the first antenatal booking is astonishing and those on caesarean section rates – already widely known – are worrying in their persistence at such a level.

“Midwives are the experts when it comes to normal births and will deliver the vast majority of women having their baby in this way. The fact that midwives’ involvement in birth has decreased will be reflected in the increase in caesarean rates and instrumental deliveries over the years.

“I think some of the large variations could be linked to staffing levels; as we know one-to-one care from a midwife increases the possibility of a normal delivery but I am sure this is not the whole story. It could also be related to how services are organised.

“In the statistics around intervention, maternity units need to be looking at each other’s practice to see where they can learn from each other, and make their services better for women and their babies.”

From: http://www.telegraph.co.uk/Maternity-postcode-lottery-revealed-in-NHS-figures

Cancer patients abandoned after treatment

The number of cancer patients being admitted to hospital through accident and emergency has doubled in less than a decade amid claims they are being “abandoned” after receiving treatment.
Cancer patients abandoned after treatmentSuch admissions are meant to be “the exception” but the number has increased from 70,000 in 2000/01 to 140,000 in 2008/09, according to the National Audit Office (NAO).

Macmillan Cancer Support said that showed too many patients were not being cared for properly after being given treatment like chemotherapy and radiotherapy.

According to the NAO’s report, which examines how well the NHS has managed to deliver the last government’s five year Cancer Reform Strategy so far, waiting times have fallen and the number of days cancer patients spend in hospital has dropped.

The strategy, launched in 2007, was meant to make NHS cancer services “among the best in the world” by 2012.

But the NAO report said there was “limited assurance” as to whether the £6.3 billion spent on cancer care annually was money well spent, because such poor information linking spend and outcomes was available.

In particular it illuminated problems caring for cancer outpatients.

Ciaran Devane, chief executive of Macmillan Cancer Support, said: “English cancer services have improved but there is still an incredibly long way to go for the UK to be a world leader.”

She warned: “The NHS won’t be able to support the growing number of cancer patients unless it seriously ups its game.

“The whole NHS needs to realise that cancer is a long term condition for many. If the NHS does not provide appropriate services after patients leave hospital, they can expect to see a massive increase in costs as cancer patients are forced to use emergency services.

“Abandoning cancer patients after treatment is no longer acceptable, nor does it make any financial sense.”

The previous government had pledged to cut the total number of emergency cancer admissions – not just via A&E but also for example by doctors making emergency referrals – but instead the number has been rising steadily.

It has risen from 231,000 in 2000/01 to 300,000 in 2008/09. However, the rate of annual increase has almost halved. Four in five have an existing diagnosis.

Karen Taylor, from the NAO, said there was “poor understanding” of the issue while primary care trusts “don’t appear to be aware of it’s extent”.

Mike Hobday, head of policy at Macmillan, said the reason was clear.

“The traditional NHS approach at the end of cancer treatment has been to say, ‘Go away, you are cured.’ ”

But he explained: “While treatment is in most cases extremely good, people with cancer have ongoing problems. Chemotherapy is toxic – you can’t do it without impacting people’s health.

“Patients aren’t being given the support to manage themselves, so they turn up at A&E.”

A “small investment” in things like better information and dedicated helplines for cancer patients would reap large savings by lowering emergency admissions, he predicted.

With growing numbers of cancer survivors and stretched budgets “the NHS has to do this smarter”, he said.

Dr Jodie Moffatt of Cancer Research UK said the increase could partly be explained by the tripling of cancer patients receiving chemotherapy since 2000. The government was trying to tackle the problem, she argued.

Paul Burstow, the Health Minister responsible for care services, said: “This report is a damning indictment of Labour’s failure to deliver on their promises to improve the quality of cancer care.

“The shocking levels of emergency admissions are the legacy of Labour’s obsession with hitting targets instead of helping patients.

“Under Labour, NHS spending rose to European levels of funding, but they have failed to deliver European levels of quality cancer care. If the NHS was performing at the level of the best in Europe, an extra 10,000 lives could be saved each year.”

Jo Webber, deputy director of policy at the NHS Confederation, which represents health trusts, said: “It is difficult to attribute a rise in emergency re-admissions to any one factor.

“Commissioning appropriate after-care services and providing patients with access to specialist services and home support services all play their part in bringing numbers of re-admissions down.

“Providing patients with access to quality treatment in or close to home, as well as information on local support services, is just as important as the early detection and treatment of the disease when planning an effective cancer strategy.”

From: http://www.telegraph.co.uk/Cancer-patients-abandoned-after-treatment

GP appointments could be booked via central call centre

Patients could be forced to make doctors’ appointments through remote call centres under an efficiency drive to save the NHS £600 million.
GP appointments could be booked via central call centreA report commissioned by the Department of Health says GPs’ administrative support teams should be radically altered to cut costs.

The plan would involve centralising appointment bookings through a national call centre, clearing surgeries of thousands of staff.

However, doctors and surgery staff say the proposal is “flawed”.

Unison, the public sector trade union, said call centres could not provide the “very personal service” that patients needed.

The report by the NHS Confederation’s Foundation Trust Network looks at ways back office functions could be streamlined.

It says the message to all NHS bodies is that they must “simplify, standardise and share” to save money.

The NHS is “highly fragmented”, with a total of £2.8 billion spent on back office functions.

The trust, headed by Tony Spotswood, chief executive of Royal Bournemouth and Christchurch Hospitals, recommends: “There are substantial efficiency gains to be achieved through transforming GP back office functions, such as the potential to move towards regional and national GP appointment centres.”

A Unison spokesman said surgery staff not only made appointments.

He said: “A call centre cannot begin to do the job these staff do.”

Doctors and their support staff were more forthright.

“Even your average alien would consider this hilarious stupidity,” said Dr David Iles from Southampton.

The Department of Health has distanced itself from the proposal. A spokesman said there were “no plans” for a national call centre.

From: http://www.telegraph.co.uk/Book-time-to-see-GP-via-central-call-centre

Ministers broke midwife pledge claims RCM

The Royal College of Midwives (RCM) has accused the government of backing down on a pre-election pledge to increase midwife numbers in England.

It says mothers and babies will suffer unless the 3,000 extra midwives it says were promised are delivered by 2014.

RCM general secretary Cathy Warwick told its annual conference there are too few to cope with a rising birth rate and increasingly complex births.

The Tories said the rise was now not needed as the birth rate was stable.

She said: “Just before the election, both the prime minister and the deputy prime minister told us that they would commit to continuing the previous government’s promise to give us more midwives.

“We’ve just done a survey of all the heads of midwifery and they’ve got vacant posts but they’re having difficulty filling them.”

The RCM survey of 83 out of 194 heads of midwifery suggested maternity units were already seeing budget and staffing cuts.

Some 30% said their budgets had fallen over the past year, while a third had been asked to reduce staff.

And two-thirds surveyed said they did not have enough midwives to cope with demand.

Meanwhile, the number of live births in England has risen by 19% between 2001 and 2009, to 670,000 a year.

The RCM said births over the same period had become more complex, with obese pregnant women and older or teenage women needing extra support.

The Royal College of Obstetricians and Gynaecologists (RCOG) said maternity services were facing many challenges.

President, Dr Tony Falconer, said: “As well as need for more midwives, there is a need for more consultants to deal with the increase in the number of high-risk pregnancies.”

A Conservative Party spokesman said: “The commitment to 3,000 midwives made in opposition was dependent on the birthrate increasing as it has done in the recent past. It was not in the coalition agreement because predictions now suggest the birthrate will be stable over the next few years.

“People can be absolutely clear that our commitment to meet the needs of expectant mothers remains, and we will continue to train new midwives to meet the demands arising from the births.”

From: http://www.bbc.co.uk/news/health-11772485

Breast examinations- call to extend screenings

Annual breat screening for women in their 40s with a family history of breast cancer may save lives, research suggests.
Breast examinations- call to extend screeningsThe NHS breast screening programme currently offers mammograms to women aged between 50 and 70.

But UK researchers say a pilot study suggests regular mammograms should be given to younger women who have relatives with breast cancer.

A cancer charity said more data was needed to weigh up risks and benefits.

The study, published in the journal Lancet Oncology, looked at women deemed at moderate risk of breast cancer because they have relatives with the disease.

Screening is considered unjustified in women with no family history of breast cancer because of the risk of a false-alarm.

Women at high-risk – because they are thought to have a gene mutation associated with the disease – are already closely assessed, with many given MRI scans or offered early surgery.

The study recruited 6,710 moderate risk women across the UK who were given mammograms to check for signs of breast cancer every year for four years.

These women are not currently included in the main NHS breast screening programme, which offers mammograms to women aged 50-70 every three years.

The researchers, led by Professor Stephen Duffy of Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, compared cancer rates and deaths in this group with women from other trials who were not given annual screening.

They say the women given screening were significantly more likely to be alive 10 years after a diagnosis of cancer than women in the two control groups.

Professor Duffy told the BBC: “It means that annual mammography does reduce the risk of dying of breast cancer in this group of moderate risk women.

“It means they can go and seek medical help knowing that there is something that can be done.”

Rough figures suggest that it would probably save an extra 50 lives a year, he added.

“It doesn’t sound like much but it means alot to the people who are in that group because they have relatives who have had breast cancer,” he explained. “It’s not a huge expense to the NHS.”

But Hazel Nunn, senior health information manager at Cancer Research UK, said the full picture was not yet clear.

“Since it seems 5,000 women would need to be screened to save one life, it will be important to weigh up these benefits carefully against potential risks of routine mammography before deciding whether screening really is the best course of action for this group,” she said.

“We await the results of further research measuring the risks.”

The NHS Breast Screening Programme said plans were in place to extend screening to women with a family history of breast cancer in the future.

Assistant Director, Sarah Sellars, said current guidelines for women at risk of breast cancer because of their family history recommend that certain women should be offered surveillance.

She said these services were currently commissioned locally but in the future would be run by them.

“In the future, the NHS Breast Screening Programmes will be taking on responsibility for routinely screening higher risk women under 50,” she said.

“Several breast screening sites are currently testing the software to be able to manage these women effectively. This service will sit alongside our current breast screening programme for women aged 50 years old and over.”

From: http://www.bbc.co.uk/breast-examinations-should-be-extended

Major NHS websites suffer lack of awareness

A new study to better understand what prevents people from using information technology to help them manage their health and care has found that few people have even heard of the three major NHS health information websites.
Major NHS websites suffer lack of awarenessThe study commissioned by Connecting for Health, looked at how social groups who may be excluded from electronic health information services used websites including health information website, NHS Choices, online health record, HealthSpace and health advice for those with learning disabilities, Easyhealth.

The report titled ‘Including Everyone in Electronic Health Information Services,’ states: “One of the most important findings of this study was that people had not heard of NHS Choices, HealthSpace and Easyhealth. This was even the case for people who had searched online for health information previously.”

The quantitative study by Raft, which interviewed 50 older people, people on low incomes and those with a learning disability from Bolton, Salford, Bury and Manchester, found that although few people had heard of NHS Choices and Easyhealth, participants were positive about the services when they were demonstrated to them.

However, some felt NHS Choices in particular was aimed at people that were newly diagnosed and could not help those who had had a condition for many years.

Others said that fear of health information, puts them off searching for health information “as a computer can’t reassure you if you’re frightened.”

In relation to HealthSpace, again, few participants had heard of the service including those in Bolton and Bury which are early adopters for the summary care record.

The reaction was mixed and found that it was “clear that most people would only wish to used certain functions of the website” such as the calendar function to help them remember hospitals appointments and the communicator.

Several added that they saw no advantage of seeing a record of medications or allergies when they already knew that they had them.

The report concludes that there is a high degree of trust in the information from the NHS websites which could usefully be used to promote the websites for effectively.

“Most people felt that leaflets and posters in GP surgeries and hospitals clinics would be suitable. Several people suggested the idea of TV advertising.”

The study also aimed to address those who had never accessed the internet, which amounts to 9.2 million people across England. It found that those who would consider learning wanted to do it as possible to home as possible in such as at home, community group they attended, GP surgery or hospital clinic.

Another finding was that although many people did not have access to computers or did not know how to use them, family members were able access the websites and provide the information.

The report recommends that “By promoting NHS websites to all computer uses, we can indirectly improve access to electronic health information for those people who do not use a computer.”

Marlene Winfield OBE, director for patient and public at CfH said: “This report is already helping CfH in the design and delivery of its products and services.

“It will we hope, contribute to the wider digital inclusion discussions taking place as a result of the current health whitepaper and the information strategy consultation that followed it.”

From: http://www.e-health-insider.com/major_nhs_public_websites_unheard_of

Emergency patients let down by labour targets, say surgeons

Emergency patients are being let down by the health service because managers are more concerned with meeting targets by treating those with appointments, the heads of Royal Colleges warn.Emergency patients let down by labour targets, say surgeons

In a letter to The Daily Telegraph, some of the country’s most senior doctors say they are “deeply frustrated” at the low priority given to Accident and Emergency.

Targets concerning waiting times and cancelled operations, introduced under Labour, result in managers pushing doctors to operate on patients whose care has been pre-planned, in order to avoid financial penalties. But they can also mean that those who come in as emergency cases are stabilised and admitted but then left to wait for surgery.

Studies have shown that elderly people with fractured hips who do not undergo surgery within 48 hours are less likely to regain full mobility. Younger patients with shattered pelvises, from motorcycle or horse-riding accidents, are less likely to walk again if their operations are delayed.

A report published on Thursday criticised care for the elderly, finding that two thirds of those who died within a month of surgery had not received proper care and that they had often been left in pain.

Most of those patients were being treated for bowel conditions or broken hips, which are usually admitted as emergency cases.

John Black, president of the Royal College of Surgeons, said the report echoed concerns that surgeons had been raising for some time.

In the letter, Mr Black said: “It is a source of deep frustration to our members that hospitals have become organised to deal quickly with elective operations at the cost of properly managing emergency care.”

The Coalition’s reforms of the NHS could help by making hospitals more accountable to GPs for the care they provide, he said.

The letter was signed by Peter Nightingale, president of the Royal College of Anaesthetists; Peter Kay, president of the British Orthopaedic Association; Finbarr Martin, president of the British Geriatric Society; Mike Horrocks, president of the Association of Surgeons; and Clare Marx, the Royal College of Surgeons’ lead representative in matters of patient safety.

Mr Horrocks said: “In recent years, the NHS has been set targets for elective operations to bring down waiting lists.

“This has been fantastic for patients with non-emergency conditions, but came at the detriment of those who require urgent treatment as hospitals focused on hitting those targets.

“The new government has committed to moving away from targets and towards measuring and rewarding hospitals who deliver good outcomes and this report should provide further evidence that this approach is correct.”

Under Labour, patients had to be treated within 18 weeks of a referral by their family doctor.

Surgeons have told the Telegraph that this resulted in extreme pressure to operate on any patients in danger of failing to meet that target, ahead of cases that came in as emergencies.

Any pre-planned operation that was cancelled was recorded and the data published. The patient then had to be rescheduled within 28 days, adding to the pressure to give elective operations priority, doctors have said.

Mr Black added: “Surgeons have been saying for some time that emergency surgery is a Cinderella service in the modern NHS.

“We will only solve these problems if focusing on emergency care becomes a priority in the boardroom as well as the ward.”

Katherine Murphy, director of the Patients Association, said: “It can be so debilitating for someone who has a fracture to be left for a couple of days or longer, waiting for an operation when the trust is focused yet again on meeting these pernicious targets. It is an appalling way to determine who gets care. An emergency should be an emergency.

“The financial rewards for elective surgery are more lucrative for the trust than for emergencies and that is why trusts continue to focus on elective treatment. We cannot make savings by putting patients through unnecessary pain and suffering.”

From: http://www.telegraph.co.uk/Emergency-patients-let-down-by-targets-say-surgeons

Statin increase will save lives

Raising the dose of cholesterol lowering statin drugs could prevent many more heart attacks and strokes, say researchers.
Statin increase will save livesUK and Australian teams compared a standard statin treatment with a more intensive therapy, publishing results in the Lancet medical journal.

They concluded that higher doses cut heart attacks and deaths by 13%.

Experts warned that a bigger dose of the most popular statin could produce many more cases of side effects.

Statins cut levels of so-called “bad” LDL cholesterol, and the risk of heart attacks and strokes in higher risk patients.

Almost two million people in the UK are prescribed them, and one type is even available over the counter at pharmacies to patients assessed as at “moderate” cardiovascular risk.

The two studies in the Lancet were carried out at the universities of Oxford and Sydney, and pooled the results of dozens of other trials to give a more reliable verdict on the likely benefits and risks of doing this.

In the first study, when a standard statin regime was compared to an “intensive” regime, further drops in LDL cholesterol levels were produced.

In turn, there was a 15% further reduction in “major vascular events” – which included a 13% drop in heart deaths and non-fatal heart attacks, 19% fewer operations to treat heart disease, and a fall of 16% in the number of strokes.

The other study also revealed falls in LDL cholesterol and “vascular events”.

Commenting on the study, two academics, Professor Bernard Cheung and Professor Karen Lam, from the University of Hong Kong, said that people with a “substantial” heart or stroke risk should have intensive statin treatment.

Even those with apparently low LDL cholesterol could benefit, they said.

They added: “At the population level, statins are underused, so the urgent priority is to identify people who would benefit most from statin therapy and to lower their LDL cholesterol aggressively, with the more potent statins if necessary.”

However, the study authors warned that simply raising the dose of the most commonly-used statin in the UK, simvastatin, the version available direct from pharmacies, might be counterproductive.

A rare side-effect of low-dose simvastatin is muscle weakness, known as myopathy. In some cases this can lead to more serious muscle damage.

At a low dose, three in 10,000 (0.03%) patients developed myopathy, but when a higher dose of simvastatin was prescribed, this jumped to nine in a 1,000 (0.9%).

Dr Louise Bowman, one of the researchers, said: “It may be safer to lower cholesterol using low doses of the more potent statins rather than increasing the dose of simvastatin.”

This advice was echoed by the British Heart Foundation, which part-funded the study.

Professor Jeremy Pearson, associate medical director at the British Heart Foundation, said that simply “ramping up the dose” of simvastatin might not be the best option.

He said: “We know that cholesterol is a major risk factor for heart disease – cutting it cuts your risk of a heart attack. However it’s been unclear whether going the extra mile to lower cholesterol even further, pays off.”
From: http://www.bbc.co.uk/news/health-11712569