Obese and smokers denied NHS treatment to save money

The NHS has been accused of trying to save money by blocking access to surgery for smokers and obese patients as new figures show how they are routinely being denied treatments.Obese and smokers denied NHS treatment to save moneyData shows that more than a quarter of Primary Care Trusts in England have brought in new restrictions based on patients’ lifestyle criteria in the last year.

It reveals that people are being denied IVF treatment, breast reductions and fat-loss operations based on their weight and whether they smoke.

In the case of one trust, NHS Hertfordshire, a controversial ban imposed last year on knee and hip operations for anyone with a body mass index (BMI) over 30 as well as smokers, has been extended to cover all routine surgery.

The new Hertfordshire policy, introduced in January, makes exceptions only for neurology, cardiac and cancer operations.

Freedom of Information responses from 91 PCTs, obtained by Pulse the  doctors’ magazine, show 25 have brought in new restrictions on treating obese patients or smokers since April 2011.

Dr Clare Gerada, head of the Royal College of GPs, said some of the restrictions, particularly for IVF, were “dreadful”.

She added: “It’s becoming the deserving and the undeserving. I think it’s discriminatory and I find it astonishing.  The Government should determine what should be applied universally.”

The figures showed that the Peninsula health technology commissioning group, covering Cornwall, Devon, Torbay and Plymouth, is now banning both men and women from undergoing IVF treatment unless they have been non-smokers for at least six months.

Men and women must also have a BMI of between 19 and 29.9 before they will be given certain fertility drugs.

The two PCTs covering County Durham and Darlington will not treat people for varicose veins unless they have a BMI of 30 or under, the figures also show.

The figures also showed that the three PCTs covering North Essex must not accept referrals for joint replacement surgery from people with a BMI of 40 or over.

Furthermore, all patients who smoke in the region must be referred to stop-smoking services before they will be considered for stomach surgery, breast reconstruction, breast reduction, scar revision surgery or nipple inversion treatment.

In Lincolnshire, as of June last year, patients must have had a stable BMI of 18 to 25 for at least a year before they will be considered for breast reductions.

Meanwhile, hip and knee replacements will not be given to patients who have a BMI greater than 35, or current smokers.

In Bedfordshire, access to hip and knee replacements is denied to patients with a BMI of 35 or over until after they have lost 10% of their initial body weight or moved below a BMI of 35.

Before July last year, there was no BMI cut-off in the region.

Steve Nowottny, deputy editor of Pulse, said: “Rationing in the NHS is nothing new – but PCTs and clinical commissioning groups are increasingly taking the decision to ration care based on patients’ lifestyle choices.

“In some cases there may be genuine clinical justification for rationing treatment on these grounds. But there is a growing suspicion that some PCTs are now blocking access to surgery for smokers and the obese simply to help achieve ever greater efficiency savings.

“Such a policy has disturbing implications – and GPs are increasingly uneasy about the NHS providing a second-class service to patients with less healthy lifestyles.”

More than half care home residents denied basic care

More than half of elderly and disabled people in care homes are being denied basic health services while staff are failing to to do enough to preserve their dignity, according to an official review.More than half care home residents denied basic careSome older people routinely have to wait up to three months for formal checks for painful conditions such as bed sores, according to figures from the health care watchdog.

A quarter were not given a choice of male or female staff to help them use the lavatory and more than a third of care homes surveyed admitted delays in getting medication to residents.

Campaigners blamed NHS bureaucrats showing a “lack of interest” and failing to provide expert assessments for conditions as basic as incontinence.

The findings emerged after almost 1,000 elderly people yesterday descended on Parliament to lobby their MPs calling for a radical overhaul of the social care system.

Paul Burstow, the care minister, signalled that a widely anticipated white paper of the future of social care had been delayed until next month insisting: “Getting it right is better than rushing it out and getting it wrong.”

Among those who addressed the crowd was the actor Tony Robinson, an ambassador for the Alzheimer’s Society, who said it was an “undeniable fact” that the system of social care is now in crisis with millions of people faced with paying large sums for care unlikely to meet their needs in old age.

The Archbishop of York also threw his support behind the lobby. Speaking during a visit to a care home he called for an overhaul of the care system to provide “dignity and peace of mind” to older people.

Fresh evidence of the failings in the system was detailed as a raft of previously unpublished data gathered by the health care regulator the Care Quality Commission (CQC) was released.

It was drawn from the first ever nationwide review of how the needs of needs of care home residents across England are met.

The CQC report discloses that people suffering from incontinence have to wait more than two weeks for an assessment of their condition in almost 40 per cent of homes for the elderly surveyed.

But a separate detailed analysis of the CQC data carried out by the British Geriatrics Society, also found that more than 40 per cent specialist providers set themselves a target as long as 90 days to carry out such assessments.

Such delays have led to elderly people being denied the treatment they need or forced to wear incontinence clothing when they do not need it.

The CQC research also says that 30 per cent of nursing homes investigated had no clear policy on when to attempt to resuscitate patients who suffer a serious deterioration in their health.

In a quarter of homes, staff admitted they were unsure about the health care needs of those in their care.

The Geriatrics Society study showed that only 57 per cent of Primary care trusts ensure that all elderly people under their responsibility have access to key services including continence assessments, physiotherapy, pressure sore checks and mental health services.

In 40 per cent of cases trusts set no specific targets to ensure the services were being delivered.

The society concluded that this showed the PCTs had “limited interest” in services for care homes.

Its president, Prof Finbarr Martin, said: “What it shows is that there is a massive disconnect between what the NHS aspires to and what it actually delivers to people in care homes and they are the most vulnerable group of people.

“The issue is there is a negative about people in care homes. There is a nihilism about care homes that is completely unreasonable and unjustified.”

Michelle Mitchell, director of Age UK, said: “The majority of people living in care homes have profound and complex health care needs.

“The British Geriatrics Society’s CQC data analysis reveals that many thousands of residents are failing to receive basic geriatric and community health care from the NHS.  Older people who live in care homes should have the same rights to NHS care as anyone else.”

In a letter to The Daily Telegraph today, the heads of a string of charities including Age UK voice their support for a move in the House of Lords to protect the human rights of all elderly people receiving care.

The Daily Telegrpah publishes a free Guide to Long and Short Term Health Care, you can order one here.

Ivabradine lifesaving £1.40 heart pill gets European approval

A new pill costing only £1.40 a day that could save the lives of thousands of heart failure patients every year has been approved by European regulators.Ivabradine lifesaving £1.40 heart pill gets European approvalNew data on Ivabradine suggested it could cut death rates by up to 39 per cent, while experts said it could prevent between 5,000 and 10,000 deaths a year.

The drug was also found to reduce the need for patients to be treated in hospital for heart failure, which affects about 900,000 people in Britain, by 30 per cent.

The drug has been approved by European regulators but has yet to be assessed for widespread use on the NHS as the killer quango NICE has yet to approve it.

It costs £1.40 a day and is already prescribed for patients in this country with angina.

It could reduce the risk of death from all types of cardiovascular disease by 17 per cent and the risk of death from all causes by 17 per cent.

In addition, the drug, which slows down the heart rate, was found to cut the risk of heart failure patients requiring treatment by 30 per cent. The study involved 6,505 people in 37 countries, including Britain.

Heart failure occurs when the organ becomes too weak to pump blood efficiently round the body, leading to fatigue, breathlessness, a higher heart rate and other problems.

Prof Martin Cowie, a consultant cardiologist and specialist in heart failure at the Royal Brompton Hospital in central London, and the British lead investigator for the study, said: “Heart failure is a very common problem, affecting approximately 1 per cent of the population.

“The decision to approve this new indication for ivabradine is great news for both doctors and patients, and is a significant step forward in the management of heart failure.”

Prof Cowie added: “While Ace inhibitors and beta-blockers remain very important in the treatment of this condition, the results of the trial demonstrate the value that a reduction in heart rate with ivabradine can bring both in terms of improving symptoms and preventing disease progression, but also in helping patients return to normal daily activities and increasing their enjoyment of life.”

IT firm behind unworkable NHS database keeps IT deal

Ministers have agreed to give the American company responsible for the “unworkable” NHS database NPfIT almost £1 billion in health contracts, The Daily Telegraph can disclose.
The National Audit Office criticised the NPfIT NHS database project for being poor value for money, patchy and long overdue.

Computer Sciences Corporation, (CSC) an American IT firm, previously had a £1.9 billion contract for the national NHS system which was scrapped by Andrew Lansley, the Health Secretary, last year.

The firm is understood to have threatened legal action against the Government and is now thought to have agreed to continue with up to £900 million of NHS work in return for dropping any legal action.

It will run computer systems for the NHS across the north, midlands and eastern England under the deal which is expected to be agreed in the coming days.

Ministers are expected to herald the “compromise deal” as a success which will save the taxpayer about £1 billion. However, it underlines the difficulties faced by the Coalition in extricating itself from previous contracts agreed by the last Government.

It will also add to growing allegations that despite the high profile announcement that the beleaguered national NHS database is being scrapped – it is simply being replaced by a series of similar regional systems which will perform the same function.IT firm behind unworkable NHS database keeps IT dealThe NHS database attracted widespread criticism following a series of damning official reports. Last year, the House of Commons Public Accounts committee described the programme as “unworkable”.

When he announced the “acceleration” of the dismantling of the system last year, the Health Secretary said: “Labour’s IT programme let down the NHS and wasted taxpayers’ money by imposing a top-down IT system on the local NHS, which didn’t fit their needs.

“We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernised NHS.”

Computer Sciences Corporation had previously largely written off the value of the NHS contract in its accounts, leading to a reduction in the company’s share price. Last May, David Cameron said the Government would not sign any new contracts with the firm until a review of its work on the NHS IT programme was complete.

However, the firm announced yesterday that it had entered into a non-binding letter of intent with the British Government. The letter “defines a way forward for CSC to deliver healthcare solutions and services, primarily across the North, the Midlands and east of England.”

The company’s share price rose yesterday after falling by more than a third over the past year.

A Department of Health spokesman said: “The Department of Health has secured agreement to an approach which will involve a hugely improved settlement for the NHS with CSC, the company responsible for introducing Lorenzo software in the North, Midlands and East.

“A Letter of Intent has been negotiated which makes clear that a new contract, to be signed this Spring, will ensure that the local NHS has control over whether to introduce Lorenzo. The agreement we have negotiated gives choice to Trusts about taking this software, rather than imposing the decision on NHS organisations.”

From: http://www.telegraph.co.uk/IT-firm-behind-unworkable-NHS-database-keeps-IT-deal

BMA calls for ‘active stand’ against health bill

Family doctors must take an “active stand” against the Government’s health reforms by preventing private firms from controlling NHS budgets, the British Medical Association has warned.BMA calls for 'active stand' against health billThe call-to-arms is contained in a strongly-worded letter from the BMA to 22,000 general practitioners, which argues the Health and Social Care Bill will be “irreversibly damaging to the NHS”.

It marks a move from the BMA opposing the Health and Social Care Bill to advising members to do something about it, if it receives Royal Assent.

The letter, by Dr Laurance Buckman, chair of the BMA’s GPs’ committee, describes the Bill as “complex, incoherent and not fit for purpose”.

It warns the legislation will be “almost impossible to implement successfully, given widespread opposition across the NHS workforce”.

Dr Buckman argued the reforms “will be irreversibly damaging to the NHS as a public service, converting it into a competitive marketplace that will widen health inequalities and be detrimental to patient care”, and “could cause irreparable damage to the relationship between GPs and their patients”.

Although stronger in tone than previous criticisms the BMA has made, the statements in the letter do not change the union’s position. It moved to a position of total opposition last November.

However, Dr Buckman also called for GPs to act if the Bill becomes law.

Doctors have become increasingly concerned about the role of private firms in running clinical commissioning groups (CCGs), which will be responsible for buying services for the NHS. These will control about two-thirds of the service’s £100+ billion budget.

The Bill contains provisions for private firms to become involved in CCGs, with the Government arguing they will just provide back-office support.

But Dr Buckman wrote: “Unless GPs take an active stand, the day-to-day running of the CCG, and especially its commissioning function, is likely to be outsourced to the hands of organisations providing commissioning support services (CSSs).

“These bodies will initially do some or all of the “back office” functions, but we fear that, in time, they could become the de facto CCG management.”

He continued: “We believe this will lead to the privatisation of commissioning, destroy the public health dimension to commissioning, with a loss of local accountability to local populations, and is likely to exacerbate health inequalities.”

This point is central to much opposition to the Bill, which opponents argue is a poorly-disguised Trojan horse for privatisation of the NHS.

Many GPs favour some sort of clinically-led commissioning – putting doctors in charge of buying health services – but Dr Buckman said the Bill was not necessary to achieve this.

Killing babies article reveals the truth of abortion say pro-lifers

Pro-life campaigners have welcomed publication of an article arguing killing newborns should be “permissible”, saying it showed there was no moral difference between abortion and infanticide.Killing babies article reveals the truth of abortion say pro-lifersThe article, which argued newborns and foetuses were only “potential persons” and not “actual persons”, has provoked a storm of protest.

The authors, whose piece was published in the Journal of Medical Ethics, have received death threats for suggesting that “what we call after-birth abortion (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled”.

Many believe such possibilities should never be raised – even within the confines of an ethics journal.

However, some anti-abortionists have welcomed its publication, saying it casts a bright light on what abortion actually is.

Anthony Ozimic, from the Society for the Protection of Unborn Children (SPUC), said the article, which he described as a “chilling promotion of infanticide”, showed how abortion was “creating a culture of death”.

While he was appalled at the suggestion that newborns should be killed for their parents’ convenience, he nevertheless said it showed the logical framework behind infanticide and abortion was the same.

He said: “The paper proves what pro-lifers have long been arguing: that the common arguments for abortion also justify infanticide.

“There is no difference in moral status between a child one day before birth and a child one day after birth.  Birth is merely a change of location, not a change from non-personhood to personhood.”

He continued: “All human beings, regardless of age, location or capacities, are regarded in international law as equal members of the human family and thus as having an equal right to life.”

The authors, ethicists Dr Alberto Giubilini and Dr Francesca Minerva, argued: “The moral status of an infant is equivalent to that of a foetus in the sense that both lack those properties that justify the attribution of a right to life to an individual.”

Rather than being “actual persons”, newborns were “potential persons”. They explained: “Both a foetus and a newborn certainly are human beings and potential persons, but neither is a ‘person’ in the sense of ‘subject of a moral right to life’.

“We take ‘person’ to mean an individual who is capable of attributing to her own existence some (at least) basic value such that being deprived of this existence represents a loss to her.”

As such they argued it was “not possible to damage a newborn by preventing her from developing the potentiality to become a person in the morally relevant sense”.

“Actual persons” could be harmed by being killed, in that they were prevented from accomplishing “aims”.

But they argued: “Now, hardly can a newborn be said to have aims as the future we imagine for it is merely a projection of our own minds.”

Parents should be able to have the baby killed if it turned out to be disabled without their knowing before birth, they said, citing the example that only 64 per cent of Down’s syndrome cases in Europe were diagnosed by prenatal testing.

Once such children were born there was “no choice for the parents but to keep the child”, they wrote.

“To bring up such children might be an unbearable burden on the family and on society as a whole, when the state economically provides for their care.”

However, they did not argue that some baby killings were more justifiable than others – their fundamental point was that, morally, there was no difference to abortion as already practised.

They preferred to use the phrase “after-birth abortion” rather than “infanticide” to “emphasise that the moral status of the individual killed is comparable with that of a fetus”.

The authors argued: “The alleged right of individuals (such as foetuses and newborns) to develop their potentiality … is over-ridden by the interests of actual people (parents, family, society) to pursue their own well-being because, as we have just argued, merely potential people cannot be harmed by not being brought into existence.”

“Actual people’s well-being could be threatened by the new (even if healthy) child requiring energy, money and care which the family might happen to be in short supply of.

“Sometimes this situation can be prevented through abortion, but in some cases this is not possible. In these cases, since non-persons have no moral rights to life, there are no reasons for banning after-birth abortions.”

While accepting that many people would disagree with their arguments, Prof Savulescu commented: “The goal of the Journal of Medical Ethics is not to present the Truth or promote some one moral view. It is to present well reasoned argument based on widely accepted premises.”

Speaking to The Daily Telegraph, he added: “This “debate” has been an example of “witch ethics” – a group of people know who the witch is and seek to burn her. It is one of the most dangerous human tendencies we have. It leads to lynching and genocide.

“Rather than argue and engage, there is a drive is to silence and, in the extreme, kill, based on their own moral certainty. That is not the sort of society we should live in.”

He said the journal would consider publishing an article positing that, if there was no moral difference between abortion and killing newborns, then abortion too should be illegal.

From: http://www.telegraph.co.uk/Killing-babies-article-reveals-the-truth-of-abortion-say-pro-lifers

PFI indebted hospitals to be given £1.5 billion lifeline

Seven English NHS hospital trusts with debts caused by Labour’s Private Finance Initiative (PFI) debts are to have access to a £1.5 billion government bailout fund.PFI indebted hospitals to be given £1.5 billion lifelineThe subsidy will be available over the course of 25 year long contracts.

Trusts will have to show they have improved efficiency and provide good care in order to access the money.

The seven trusts are: Barking, Havering and Redbridge, St Helens and Knowsley, South London, Peterborough and Stamford, North Cumbria, Dartford and Gravesham and Maidstone and Tunbridge Wells.

There are 100 plus PFI schemes, where private firms pay to build hospitals, leaving the NHS to pay an annual fee or “mortgage”.

Coalition ministers have attacked Labour over its deals, but the National Audit Office recently reported that for most trusts with financial difficulties PFI was just part of the problem.

The Department of Health says without the funding, services at the hospitals would be put at risk.

Health Secretary Andrew Lansley said: “We need to balance the accountability of the NHS at local level to live within its means on one hand, with recognising that there is a legacy of debt for some trusts with PFI schemes.”

Record number of legal highs detected by doctors

A record number of new legal highs were identified last year by British scientists.Record number of legal highs detected by doctorsThe scientists – who’ve advised the government before – said that more than 41 new substances were detected across Europe in 2011, breaking the previous year’s tally.

They are mainly from China and being bought by UK users over the internet.

The official figure is set to be confirmed later in the year by the EU drugs agency, the EMCDDA.

Because the substances haven’t been tested yet the long term effects are unknown.

Katy MacLeod from Edinburgh Crew 2000, a charity that helps young people with substance issues, said legal highs were difficult to deal with.

“We already know quite a lot about cocaine, ecstasy and ketamine,” she said.

“It’s probably easier to treat people with those kind of drugs, because we have much more pieces of research done. With legal highs, the same knowledge base isn’t there yet.”

In just a couple of weeks, they treated 34 people who had all been poisoned by Ivory Wave, which has now been banned.

The government says it will use powers that came in in November to ban all potentially dangerous new substances while they’re being tested.

But Dr Stephen Potts, who works at the Edinburgh Royal Infirmary, says he’s worried about new legal highs emerging as soon as others are banned.

“The people who take them don’t know what’s in them,” he explains. “The people who sell them don’t know what’s in them, and we as the doctors certainly don’t know what’s in them.”

Dr John Ramsey tests new legal highs in his laboratory at St George’s medical school in London.

He told Newsbeat that some of the new substances he comes across are potentially very dangerous: “We’ve got a compound we found a couple of days ago which is potent at 100 micrograms – that’s a tiny amount.

“Most drugs are active at about 100 milligrams. This one is about a 1000 times more potent.  The risks people are taking are just not worth it.”

From: http://www.bbc.co.uk/newsbeat/16866929

Patients more likely to die if admitted to hospital at weekends

Research finds that patients are more likely to die if they are admitted to hospital at the weekend.Patients more likely to die if admitted to hospital at weekendsThe study Weekend hospitalization and additional risk of death: An analysis of inpatient data was published in the Journal of the Royal Society of Medicine, found that patients were 16% more likely to die if they were admitted on a Sunday than mid-week.

The review looked at all admissions to NHS hospitals in England in one year.

The NHS medical director has called for weekend services to be extended.

The research was carried out at University College London and the universities of Birmingham and East Anglia, and covered more than 14 million hospital admissions – both emergency and planned.

The study looked at more than 187,300 patients who died within 30 days of being admitted to hospital during 2009-10.

The researchers found higher death rates if patients went in at the weekend, but a slightly lower death rate if people were already in hospital at the weekend.

For every 100 deaths following admissions on a Wednesday, 116 occurred for admissions on a Sunday – a “significant increased risk”, the researchers said.

These results confirm previous reports of increased 30-day mortality risk for patients admitted to hospital with emergency conditions at the weekend”

Prof Domenico Pagano University Hospital Birmingham Foundation Trust

They added: “We identified a significantly higher risk of subsequent in-hospital death during the 30-day follow-up period associated with admission during the weekend (Saturday or Sunday), compared to mid-week days.

“Admission on Tuesday through Friday was associated with the lowest risk of in-hospital death, while admission on Sunday was associated with the highest risk.

“Admission on Saturday was associated with a marked increased mortality (death) risk and admission on Monday was associated with a less, but statistically significant, increased risk.”

Researchers said the results were consistent with data from 254 not-for-profit hospitals in the United States, which they also analysed.

Lead researcher Professor Domenico Pagano, from the University Hospital Birmingham Foundation Trust, said the results offered conclusive evidence.

Prof Pagano also said reduced staffing and fewer senior doctors on duty, as well as poor access to diagnostic tests at weekends, could have an effect.

His team said seven-day access to “all aspects of care” could improve the outcomes for higher-risk patients currently admitted at weekends.

The medical conditions resulting in the biggest number of in-hospital deaths included pneumonia, congestive heart failure, heart attack, septicaemia, acute renal failure, urinary tract infection and neck or hip fracture.

“We’ve tried to take account of the severity of illness and we’re not clear yet whether it’s the severity of illness or the way we deliver services that are the key thing.”

He also said he thought the research added weight to the argument to extend NHS services through the weekend.

“It’s about our NHS catching up with other service industries and offering a routine six- or seven-day week where people can see consultants or experts on a Saturday and maybe even a Sunday, where people can have routine operations over the weekend – more at their convenience than the convenience of the service – and also people who are worried on a Friday have access to expert advice – and that’ll put the compassion back into the NHS.”

Northumbria trust takes over two Cumbria hospitals

Northumbria Healthcare NHS Foundation Trust is to take over the running of two hospitals in north Cumbria.Northumbria trust takes over two Cumbria hospitalsNorth Cumbria Hospitals NHS Trust has suffered a number of financial problems and some medical staff said they had no faith in their management.

The trust had accepted it was not strong enough to survive on its own and agreed the takeover.

The move affects the Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven.

In November 2011 it emerged from a leaked email by the trust’s chief executive that its financial position had worsened and urgent action was needed, which could include ward closures.

Some staff later talked about being “at breaking point”, with morale at an “all time low”.

However, the Cumbria trust had always denied that patient safety was at risk.

Two organisations were in the running for the takeover, with Northumbria Healthcare NHS Foundation Trust beating off competition from a partnership between the trusts that run Cumbria’s community health services, and Newcastle’s hospitals.

Jim Mackey, chief executive of Northumbria Healthcare NHS Foundation Trust, said: “Our focus for the coming months will be on working with all stakeholders to ensure hospital-based care is fit for the future and on a sound financial footing.

“Whilst we recognise that there are many challenges ahead, we are optimistic and confident in being able to deliver real benefits to patients.”

The move was also welcomed by the joint health unions, Royal colleges and professional associations.

They said in a joint statement: “We believe the appointment should represent a fresh start, and we therefore call on the new management of the trust to work in partnership with us to ensure that the interests of the patient are now given the priority they deserve.

“The patients, families and staff of North Cumbria deserve a trust that is well run, well managed, and that focuses on delivering high quality patient care.”