HIV care at risk from NHS changes

HIV care is at risk from the changes to the health service in England specialists are warning.
HIV care at risk from NHS changesAs part of NHS reorganisation, sexual healthcare became the responsibility of local authorities, while HIV care remains within the NHS.

The British HIV Association says many specialists feel the split has worsened patient care, and worry the situation will deteriorate even further.

The government said the NHS and local authorities should work together.

A survey by BHIVA, released to mark World Aids Day on Sunday 1st December, found a third of the 100 HIV specialists questioned thought care for people with HIV was poorer since the reorganisation in April this year. In addition two thirds thought care was set to deteriorate further.

In the past, HIV and genitourinary medicine (GUM) services were integrated, sharing staff and resources.

But the reorganisation transferred responsibilities for tackling public health issues such as obesity, smoking prevention and sexual health – but not HIV care – to local councils.

Around 100,000 people in the UK live with HIV.

Dr David Asboe, chair of BHIVA and a consultant in HIV medicine at the Chelsea and Westminster Hospital, said: “Key to the concerns uncovered in this survey are fears about the separation of HIV care from broader genitourinary medicine.”

Dr Janet Wilson, president of the British Association for Sexual Health and HIV (BASHH), said: “Sexual health clinicians have been sounding the warnings around restructuring since the introduction of the government’s health reforms.

“We are already hearing about tendered GUM services being prevented from undertaking partner notification on people newly diagnosed as HIV-positive even though this is the most effective public health intervention for identifying undiagnosed HIV infection.”

She added: “We need government, national and local agencies to urgently work together to prevent HIV and GUM care going backwards.”

Dr Steve Taylor, lead consultant in HIV Services at Birmingham Heartlands Hospital, said there was an issue with staff who had worked for joint HIV and GUM services in the past moving to a new sexually transmitted infection centre and being lost to the HIV services: “The way the system has been created has made an artificial divide between classic GUM services and HIV.

And he suggested anything not in the GUM service contracts risked being lost or downgraded, such as contact tracing to find current and former partners, data collection and training.

Dr Taylor added: “It’s about who is going to pick up the responsibility for all of those things that appear to be falling in the middle of what’s being covered by NHS England and by local authorities.”

A Department of Health spokesman said: “Public Health England’s report on HIV care last year reported an increase in people being diagnosed and prompt integration into care. However, the NHS and local authorities should work together to make sure that sexual health services are convenient and work for patients.”

Carers at breaking point Commissioner warns

More needs to be done to support carers who are at breaking point the Older People’s Commissioner for Wales warns.
Carers at breaking point Commissioner warns

Sarah Rochira who is the Older People’s Commissioner is concerned that too many carers across Wales are missing out on much needed help and their work is often undervalued.

She said it can often lead to a deterioration of their mental and physical health.

Ministers said much had been achieved in policy to support unpaid carers since devolution.

Speaking on Carers Rights Day, Ms Rochira is worried at the pace of progress in a strategy to help carers and said she wants to ensure Wales gets it right for its 370,000 carers.

“Without the care provided by unpaid carers in Wales, estimated to be nearly £6 billion a year, many of our statutory services would, quite simply, be unable to cope,” she said.

“Carers should therefore be seen and treated as one of our greatest assets. Many of the carers I have met as part of my Engagement Roadshow are at breaking point – they feel that no-one listens to them, despite asking for so little.”

“In so many cases they just want a little bit of help before a crisis occurs, such as information, advice, help to make decisions, practical help and training, and advocacy – someone to speak up on their behalf.”

Ms Rochira said the Welsh government’s Carers Strategies Measure, which was launched in 2010, was a “welcome step forward”.

It is a requirement on the NHS and local authorities in Wales to work in partnership to prepare, publish and implement a joint strategy to help carers.

But while she said improvements were starting to be seen, she added she had “real concerns” over the pace of the progress and that she intends to review the impact the measure is making with carers being at the heart of the review.

She also wants service providers to work together more effectively and focus on what carers want, not what they think the carers need.

The Welsh government said: “We should be grateful that so many people in Wales are prepared to care in this way.

The spokesperson said a refreshed carers strategy was published in June and “much has been achieved in terms of policy, legislation and service development” for unpaid carers since the first version in 2000.

This includes the Carers Strategies (Wales) Measure in 2010 which requires health and social services to engage with carers.

Cost of cancer as much as a mortgage

When the diagnosis is cancer- concern about survival prospects and what the treatment will involve will naturally be the first thoughts for many people in that position.
Cost of cancer as much as a mortgageHowever the financial consequences can be pretty severe too, as  a new report produced by Demos demonstrates that four in five people with cancer find that they are also losing out financially.

Not only is there the cost of not working- and not earning, particularly if you are self employed.

On top of that, there are the extra costs of spending money on wigs and new clothes as the steroids- coupled with the frequent inability to exercise which means that many also put on weight.

Also heating bills also go up not only because people are at home more- but they also feel the cold more- needing to turn the thermostat up.

The think tank calculates the average cost is about £7,000 a year – equivalent to the standard mortgage.

And it is not just in the immediate aftermath of a diagnosis that the costs are accrued.

With more and more people surviving cancer, the financial hit can last for years, the report Paying the Price suggests.

There is some support available. Those on low incomes can get free transport too and from hospital, while prescription charges for cancer patients are waived (elsewhere in the UK they have been abolished for all patients).

Several charities offer grants too. But Demos doesn’t think that goes far enough.

It wants to see those affected by cancer given the same legal right to request flexible working as parents have and the government to offer a financial health check as part of the routine follow-up care.

Jo Salter, who authored the report, says this is the “new reality” with cancer diagnoses on the rise – nearly half of people are now expected to get it in their lifetime.

Ministers say they are considering what support can be given.

For patients, this can’t come quickly enough, according to Macmillan Cancer Support.

“People living with cancer should not be left to deal with the terrible financial strain alone,” says its chief executive Ciaran Devane.

NHS told to ban all smoking in hospitals

The NHS must stop turning a “blind eye” to smoking and ban it in all hospital grounds in England, according to new guidance.NHS told to ban all smoking in hospitalsThe National Institute for Curbing Expenditure (NICE) said that it wanted to see smoking shelters scrapped so patients, visitors and staff could not light up.

Staff should also stop helping patients out of their beds to go for a smoke. And patients who smoke must be identified and offered help to quit, the guidance added.

It said nurses, doctors and other staff could give brief advice and then refer smokers on to NHS stopping smoking services.

Smoking rates are particularly high among mental health patients with one in three smoking, rising to 70% in psychiatric units.  That compares with the one in five among the general population who are smokers.

The guidance, which is voluntary for the NHS to follow, even suggested staff caught smoking should be disciplined.

NICE conceded some parts of the NHS had already adopted these approaches, but said the idea of the guidance was to make sure it became consistent across the health service.

NICE public health director Prof Mike Kelly said the NHS had turned a “blind eye” for too long.

“It has been tolerated by the NHS and it is high time that stopped.  NHS hospitals and staff have a duty of care to protect the health of people who use or work in their services. We need to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances.”

In practice, he said, doctors and nurses could provide nicotine replacement therapies and advise patients about counselling to ensure they were not “going up the wall” with nicotine cravings.

He acknowledged that stopping a determined smoker from going outside to light up was “clearly very difficult”.

“This is not about imposing some sort of penal regime in which doctors, nurses, administrators spend all their time trying to enforce a series of rules and regulations.

He said it was about a culture shift and removing smoking shelters would help eliminate any subliminal message that it was ok to smoke around a hospital.

MRSA found in UK poultry

The first case of MRSA in poultry in the UK has been found in turkeys and chickens on a farm in East Anglia says the Department of Health (DH).MRSA found in UK poultryA spokesman said that two thirds of the turkeys on the farm, which hasn’t been named, were found to be infected.

It is thought that hundreds of turkeys have already been sold to local retail outlets and farm gate sales.

The spokesman said the strain of the disease found in the poultry – Livestock-Associated (LA) MRSA – “rarely caused disease in humans” and if it did would involved a mild skin infection which cleared up quickly.

LA-MRSA is different to the MRSA that causes the healthcare associated infections seen in people.

It can potentially pass from animals to humans through direct contact or through dust in animal housing, meaning poultry workers are at risk.

But LA-MRSA rarely causes disease in people and in most cases the bacteria clear within 24 hours.

Appropriate handling and cooking of raw meat should eliminate any risk of transmission to people.

Steve Wearne, Director of Policy at the Food Standards Agency, said: “Any risk of contracting MRSA through meat from animals with these bacteria is very low when usual good hygiene and thorough cooking practices are observed. All poultry should be handled hygienically and cooked thoroughly to destroy any bacteria that may be present.”

Prof Angela Kearns of Public Health England said: “There are many different strains of MRSA that cause illness in people but this is not one of the strains that we are overly concerned about given the very low number of clinical infections that have been seen in people.”

In the UK, since 1999, there have been published reports that MRSA has been isolated from dogs, cats and from a rabbit and a horse.

Other countries have also reported cases in cattle and poultry.

Prof Peter Borriello, Chief Executive of the Veterinary Medicines Directorate, said: “LA-MRSA has been identified in livestock in a number of countries and is not considered to represent a significant risk to animal health and welfare.”