Sexual healthcare at risk from NHS changes

In April 2013 many health services are being put out to private tender – and will be overseen by amongst others the GP-led Clinical Commissioning Groups (CCGs).Sexual healthcare at risk from NHS changesBut CCGs will not commission sexual health or public health services such as obesity and smoking prevention.

This function will fall to local councils, and elected officials. The directors of public health who will advise on these decisions will need to be strong advocates for the disadvantaged and stigmatised.

HIV services, meanwhile, will be commissioned centrally by the NHS Commissioning Board.

This separation is fraught with difficulties: especially when both sexual health and HIV care are currently provided by the same healthcare professionals on the same premises.

It is similarly unclear who will pay for HIV prevention campaigns.

Over 85% of all people attending NHS sexual health clinics take up HIV testing, with referral and retention rates both excellent – resulting in world-class patient outcomes.

Currently, we are able to treat patients, map epidemiological trends (disease patterns in the population) and target our prevention campaigns in a manner which is the envy of the world.

Any private company tempted to bid for a contract from a local council, may have subtly different priorities.

There will certainly be a handsome profit to be made from delivering straight-forward tests for sexually transmitted infections and HIV.

But diagnosis, management and treatment of the more complicated cases or assiduous epidemiological data collection might not be such money-spinners.

Is the private sector willing to provide such expertise, to perform ‘contact-tracing’, the unique NHS service which helps us track the spread of pathogens and identify outbreaks?

The worried well are an easy market.

But will private companies really target the hard-to-reach populations who need the services most, such as prisoners, commercial sex workers and intravenous drug users?

The difficulty with splitting HIV service provision apart from sexual health provision will also begin to tell.

Relatively expensive HIV services may become untenable without the staff and stability offered by providing the two services together.

Instead, there is a very real risk that currently joined-up services will become fragmented, with huge variation in service.


Weight loss surgery sold as a quick fix for obesity

Weight loss surgery is being sold as a quick fix option to obesity surgeons warn.Weight loss surgery sold as a quick fix for obesityFirms are using questionable selling techniques including limited period offers, potentially misleading before-and-after photos and celebrity ‘success stories’ to attract clients.

Too often patients are not being properly informed of the risks of gastric band and gastric bypass surgery – which are major operations – according to a report Obesity surgery ‘no quick fix’, NCEPOD calls for improvements to pre-surgery counselling published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), a charity.

Yet almost a fifth of patients have to be re-admitted to hospital because of complications with what is known as bariatric surgery, and seven per cent require a second operation to sort out problems.

Ian Martin, co-author of the study, said firms were “stressing the benefits but not balancing that with some of the risks”.

“They are suggesting these operations are a quick fix rather than part of a long term commitment to a healthier lifestyle.”

The report found private firms touting for business regularly used “potentially misleading” before-and-after pictures where patients had shed large amounts of weight.

Mr Martin, a facial surgeon, said: “They show lots of pictures of people who were very big becoming ideally slim.  But to get these ideal figures patients will usually require further cosmetic procedures, for example to remove excess skin.”

Mr Martin said advertising websites sometimes contained pictures “of people like Fern Britton, who quite often give their success stories as well”.  The television presenter had a gastic band operation six years ago, but only admitted it two years later.

The report warned: “The use of celebrities in advertising .. could possibly impart a false sense of security.”

Some firms used irresponsible inducements, included a prize draw to win back the cost of surgery.

They also put patients under “undue financial pressure” to sign up, such as cut-off dates for deals and clauses that meant patients could not get their deposit back if they decided against an operation.

Mr Martin said all this mattered because it risked giving bariatric surgery “a bad name”.  He said: “We risk undermining what’s a very very valuable treatment.”

The prospect of the report appears to have spurred Independent Healthcare Advisory Services, which represents private healthcare providers, into action. The organisation released updated guidelines “to protect patients from poor or unsafe practice”.

Mr Martin described the move as “encouraging”, saying: “We hope that the updated guidelines by the IHAS will have a real impact in improving standards of care received by patients in the private sector.”

Professor Norman Williams, president of the Royal College of Surgeons, said: “Bariatric surgery is not a quick fix.  It has been proven to be an incredibly successful and cost-effective treatment for morbid obesity and the many serious conditions associated with it.”

Social care cuts could lead to higher NHS bills

Dying people could end up in hospital sooner – and so cost taxpayers more – if cuts to social care services continue.Social care cuts could lead to higher NHS billsBetter social care appears to reduce the need for hospital until the very latest stage among the dying, found the Nuffield Trust.

The Nuffield Trust, a think tank, has found that good social care tends to keep the terminally ill out of hospital until they really need it.

Their report looked at the usage that 73,000 people made of council social services and hospitals in the last months of their lives.

Dr Martin Bardsley, head of research at the Nuffield trust, said: “Our study suggests how social care might be effectively substituting for hospital care for this group of people.

“The worry is that if funding for social care is cut back, people may have no option but to use hospital care.  This may not be the best care for people who wish to be at home in their last months of life, as well as cost far more for the NHS.”

“Given the short- to medium-term financial climate, this type of analysis is critical now more than ever if more value for patients is to be extracted from public funds.”

The report, which looked at anonymised records from seven local authority areas in England, also found social care costs rose predictably in the last year or so of life, while hospital costs jump in the last three months.

The authors consequently argued that the Government would not be taking on too much financial risk by agreeing to fund social care above a certain threshold. Andrew Dilnot, the economist, has proposed that cap be set at £35,000.

Simon Chapman, from the National Council for Palliative Care, said the report provided “timely evidence that introducing free social care at the end of life would not carry significant economic risks”.


Viruses and bugs widespread in NHS medical technology

NHS medical technology has been found to be infected by computer viruses and malware according to  health and security experts.Viruses and bugs widespread in NHS medical technology They fear that the virus infections could become so severe that a patient may end up getting harmed.

Many out dated computer systems which were not able to be changed were to blame for the vulnerabilities, the experts said.

One hospital is said to be deleting viruses from up to two machines a week.

The warnings were given as part of a panel discussion in Washington DC, as reported by Technology Review from the Massachusetts Institute of Technology.

Mark Olsen, chief information security officer at Beth Israel Deaconess Medical Center in Boston, said the hospital had 664 pieces of medical equipment running on old versions of Windows.

This means the equipment is affected by weaknesses which later releases of Windows have since fixed.

There are also fears that medical devices could even end up being part of botnets – large networks of hijacked computers that are often used to send out spam email.

Medical devices could also be struck down by slow performance related to being infected.

“Imagine you have a heart monitor that’s running Windows and it gets infected by a computer virus and slows down. This mere slowing down of the computer could cause the device to miss a sensor reading. It certainly raises an eyebrow. Who’s watching out for that?”

He said that there is no evidence as yet that the malware is reaching medical machines as a result of being targeted by criminals.

Instead, he said it was more likely to be “collateral damage” from conventional malware designed to infect normal PCs.

“What we’re finding is that software has brought tremendous benefit to medicine, but we’ve kind of forgotten that there’s these inconvenient risks of software,” he said.

In the UK, the NHS faces similar challenges.

“The need to implement security and privacy at the design of all systems, whether they’re embedded or not is of paramount importance, particularly to the health industry,” said Raj Samani, who worked in the health sector and is now chief technology officer for security specialists McAfee.

A Channel 4 investigation in 2008 discovered that NHS computers had been affected by more than 8,000 viruses.


Grumpy old men and women lead to early demise

Research warns that levels of happiness among over 50s had a significant bearing the onset of disability, slower walking speed and incidence of coronary heart disease.Grumpy old men and women lead to early demiseThe study, which follows the lives of more than 10,000 English people throughout older age, shows that psychological well being could be used to predict which people will go on to develop serious problems in their 60s.

Researchers insisted that the link remained irrespective of other factors such as age, gender, ethnicity, wealth and education.

The conclusions were made in the latest of a series of reports published by the English Longitudinal Study of Ageing – an 11 year on-going study led by academics from University College London, Manchester University, the Institute for Fiscal Studies and NatCen Social Research.

It comes after the Coalition launched a well-being survey aimed at tracking the emotional health of the British public. Initial findings released in the summer showed the average adult was rated 7.4 out of 10 for life satisfaction.

The findings suggest that happiness levels may have significant bearings on future health.

The study said: “Those who were recorded as having a greater enjoyment of life in were more likely to still be alive nine to 10 years later than were other participants.

“The difference between those who enjoyed life the most and those who enjoyed life the least was marked, with nearly three times more people dying in the lower than greater enjoyment group.”

Researchers added: “We found that psychological well-being in 2004/05 predicted the onset of disability, slower walking speed, impaired self-rated health and the incidence of coronary heart disease in 2010–11, in people who were initially free of these problems.”

In further conclusions, the study found that one in six people in England aged over 50 were “socially isolated”.

They had few socially orientated hobbies, little civic or cultural engagement with society and may have very limited numbers of friends. Wealthier adults were half as likely to become isolated as those in poverty, it emerged.

Moral of the story is to be happy and keep smiling with a sunny disposition. Admittedly tricky at this time of year and weather- but it’s better than an early grave!

NHS bill for PIP breast implant scandal almost £2 million- and growing

The NHS is facing a bill of almost £2 million for the PIP breast implant scandal as thousands of women are being turned away by their private clinics.NHS bill for PIP breast implant scandal almost £2 million- and growingAround 47,000 British women are believed to have been given faulty implants manufactured by French company Poly Implant Prothese (PIP).

They were filled with non-medical grade silicone intended for use in mattresses and have been linked to ruptures and swelling in the body.

The latest data from the Department of Health (DoH) shows 607 women who had operations with private doctors have been forced to turn to the NHS to have them removed after their clinic refused to help.

Of those 384 of these having already had the surgery.

More than 7,000 have approached the NHS in total and more than 5,000 have had appointments with doctors and scans to establish if the implants have ruptured.

The cost to the NHS of the appointments and scans that have already taken place is more than £850,000 and this will rise by a further £901,000 once the 607 women have all had their surgery.

The cost could rise further as the women already in the pipeline work their way through and if more women come forward.

There has been a furore over who should pay for the removal or replacement of implants.

In January, the Government announced that anxious women given PIP breast implants on the NHS would be able to have them removed for free, with private firms expected to offer the same deal.

But it emerged that some private clinics no longer existed and others refused to remove the implants.

The Department announced that any woman refused help by a private company would be able to visit their GP and access NHS care, but the NHS will only remove the implants, not replace them.


NHS doctors must treat foreign health tourists to promote eu human rights

Foreign health tourists must be given free treatment by NHS doctors to avoid discriminating against them- new eu guidelines for doctors have ruled.NHS doctors must treat foreign health tourists to promote eu human rightsThe principles, issued to English doctors, stipulate they must register any foreignborn patient in a bid to “promote eu human rights and public health”.

New patients registering to British GP surgeries could include overseas students, asylum seekers and even tourists visiting the country for a short period.

Registration with a GP will allow them to receive the same primary NHS care as British citizens.

The guidance, from NHS London, stipulates “nationality is not relevant” to the entitlement for primary care, and states practices can not insist on seeing passports as it could be “discriminatory”.

“There is no set length of time that a patient must reside in the UK in order to become eligible to receive NHS primary care services,” it states.Nigerian ‘health tourist’ flew to It specifies temporary resident status can be given to “asylum seekers and refugees, overseas visitors, students, people on work visas and those who are homeless”.

It summarises: “Immigration status does not affect eligibility to primary care – practices should not enquire about patients immigration status.”

Dr Vijayakar Abrol, a GP who practises in Edgbaston, Birmingham, last night said “We do not have endless resources,” he said. “Why should we give these patients – be they from India, Canada, the US or Eastern Europe – free treatment?

“We cannot go to those countries and get free treatment ourselves.”

Chris Skidmore, a Conservative MP who is campaigning for tougher regulation on health tourism, added: “It is alarming that managers are passing these kind of diktats to doctors, many of whom are rightly worried that GP registration is effectively buying free treatment on the NHS.

“This is not just about the money, vital though that is – we cannot have the NHS, paid for by taxpayers, being abused by people who pay nothing into the system and who are not eligible for free care.”

Earlier this month, a Panorama investigation found places on GP lists were being sold to health tourists on the black market for up to £800.

The practice enables foreign nationals who have no legal right to free hospital treatment to be seen without paying.

In August, a heavily pregnant Nigerian woman was found to have travelled more than 3,000 to Manchester hospital for an emergency caesarean, costing the taxpayer an estimated £10,000.


Fake drug websites raided

A global raid on websites selling fake and unlicensed medicines has netted £6.5 million worth of drugs.Fake drug websites raidedUK drug officials took part in a series of co-ordinated raids with Interpol and agencies from more than 100 different countries over the past nine days.

A total of 79 people have been arrested over the distribution of the “medicines” and tests carried out on the drugs seized.

In the UK, 10 different addresses were raided as part of Operation Pangea.

Dozens of boxes of fake Viagra were seized, with names like Weekend Prince and Hard 10 Nights, along with Viagra only licensed for sale in India.

The latest research indicates half of all unsolicited emails are trying to sell medicines and nearly 900 orders are placed every day worldwide.

About 60% of the drugs dealt on the internet are male sexual stimulants, but there are also medicines for a range of problems such as cancer, thyroid and hair loss. It is estimated £1.5m of orders are placed globally every month.

The operations are often based in a single house processing orders on behalf of criminal gangs overseas.

Nimo Ahmed, acting head of enforcement at the MHRA, said: “We have these medicines which we found being supplied in very unhygienic conditions with dogs being kept in the area or in filthy bedrooms. And we have no idea of the conditions where these medicines were actually made.”

“The vast majority of medicines come from East Asia or South East Asia, but it can be difficult to shut down the manufacturers.

“Often by the time you get the parcels in the UK, they have been through two or three different countries often through a free trade zone. Then the previous paperwork is not required. Tracing it back becomes very difficult.”


Doctors to undergo annual checks but concerns kept from patients

Doctors will undergo annual assessments from next year to ensure they are up to the job- but patients will not find out if concerns were raised.Doctors to undergo annual checks but concerns kept from patientsThe system, called revalidation, will involve an annual ‘beefed-up’ appraisal with a senior colleague going over complaints, compliments, clinical data, complications and mistakes as well as any management and research work they have undertaken.

Every five years this will have to include feedback from at least 35 patients and colleagues before the doctor can be recommended to the General Medical Council to continue to practice.

The aim is to detect low level poor practice that would not currently warrant a referral to the GMC so action can be taken early to rectify the situation with extra training or supervision.

It should also allow doctors to ensure they stay up to date with their skills and knowledge, although it will not involve formal exams or tests.

In a survey concerns were raised in 4.1 per cent of cases, the equivalent to 6,800 doctors in England.  That includes 2.4 per cent, or 4,000 nationally, with low level concerns such as lateness that would be addressed within the organisation.

One per cent, or 1,600 doctors nationally, had medium level concerns raised which could include rudeness and other behaviour issues that may need further training or a ‘contract agreement’ to change.

The remaining 0.7 per cent or 1,200 doctors in England had high level concerns raised which could include problems such as alcoholism as well as patient safety issues. These concerns could be enough to trigger a referral to the current GMC fitness to practice panels, which remains unchanged.

Of the concerns raised, one quarter were about the doctor’s health, one quarter were about their conduct and 60 per cent were about competency or a combination of those factors.

Officials at the GMC and Department of Health admitted that patients would not know of any concerns raised about their doctor unless they were referred to fitness to practice and there was considered to be a case to answer.

Niall Dickson, chief executive of the GMC, said no other profession published the results of appraisals and patients should be reassured that all doctors would now undergo annual checks in the first such national system anywhere in the world.

He said it was a ‘historic movement’ and the biggest change in medical regulation for 150 years.

Medicine was a ‘safety critical’ industry, he said and added: “Doctors’ capacity to do good is greater than it has ever been but so to is the capacity to do harm.”

Katherine Murphy, chief executive of the Patients Association said patients wanted to be in a position to see the best doctor no matter what their condition and needed good information to do that.

She said: “When a serious clinical matter has been raised in the revalidation process then patients have a right to know. The GMC must make sure that their first priority is protecting the public.”

However she added that where concerns raised were of a managerial or human resources nature then that should stay between the doctor and their employer.

The first wave will be revalidated using one appraisal and a feedback questionnaire instead of the usual five years’ worth of appraisals in future.

There should be no additional cost to the NHS as responsible officers are already in post, and annual appraisals and preparation for them should already have been happening, officials said.


Men need to become match fit if they want to be fathers

Men have been warned they need to become ‘match fit’ if they want to be fathers, as a fertility study claims too much attention has been focused on mothers’ weight.Men need to become match fit if they want to be fathersWhile the health risks surrounding obesity and pregnancy have largely been centred on overweight mothers, the focus is now on men to lose weight.

Less efficient sperm results in smaller foetuses, poor pregnancy success and reduced placental development.

The discovery was made by reproductive experts from the University of Melbourne, Australia.

World Health Organisation figures show that a staggering 48 per cent of adult males are overweight or obese – making the findings even more of a worry.

The research was conducted by Professor David Gardner, Dr Natalie Hannan and PhD student Natalie Binder.

Prof Gardner, Head of the Department of Zoology, said: “A lot of men don’t understand they need to be healthy before conceiving. Sperm needs to be ‘match fit’ for the games of life and creating life is the biggest thing that we can do.”

The study used IVF to determine the effects of paternal obesity on embryo implantation into the womb and foetal development.

PhD candidate Natalie Binder generated embryos from both normal weight and obese male mice.

She said: “We found development was delayed in the foetuses produced from obese fathers.  Furthermore, placental weight and development was significantly less for embryos derived from the sperm of obese males.

These findings indicate that paternal obesity not only negatively affects embryo development, but also impacts on the successful implantation into the womb.

“This then results in a small placenta which impairs fetal growth and development with long term consequences for the health of the offspring. Our study provides more information about the impact of obesity in men and their ability to start a family and the need to shed kilos in preparation to conceive.”

The findings were presented at the Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2012.