A&E units start to miss four hour waiting targets

The NHS in England is starting to miss its four hour Accident and Emergency (A&E) waiting time targets for the first time this winter.A&E units start to miss four hour waiting targetsOver the past week, 94.8% of patients were seen within four hours compared to 95.6% the week before. The target is 95%.

The figures cover all 242 centres – major A&Es, smaller minor injury units and urgent care centres. The figures show two thirds of the 144 trusts with major units are missing the target.

It is the first time since April the target has been missed overall – although the major units have been below the 95% mark since July.

It is not unusual for performance to drop in December. For the last three years individual weekly figures have fallen below 95% before Christmas- indeed last winter the NHS was consistently below the 95% figure overall from January to April.

Hospitals are given a 5% leeway to allow doctors to prioritise the sickest patients.

NHS England chief operating officer Dame Barbara Hakin said it was “disappointing” performance had dropped, but said last week was the busiest so far this winter with more than 415,000 people attending A&E, while the numbers that needing admitting to hospital for further treatment – emergency admissions – hit its highest level since 2010.

She added: “We know the A&E standard is ambitious and that is only right. This is the first week since April the 95% standard has not been met, however we do know that sometimes this will happen.”

“Every year we see a dip in the figures for December, with week on week variations which is why we fully assess how local systems are coping with winter pressures over a longer period.”

“We knew this winter would be difficult but it is important to stress the NHS continues to deliver a good service. This is thanks to the hard work and dedication of our frontline staff.”

The drop in performance comes despite the government giving the NHS extra money to cope with winter – £250 million was announced in the summer and another £150m was pledged last month.

A Department of Health spokeswoman added: “We have always been clear that this could be a difficult winter – and there could be more difficult weeks ahead. But the majority of patients continue to get the excellent care they deserve.”

Legal highs review launched

A new review of legal highs could finally lead to sweeping changes to UK drug legislation, the Home Office has said.
Legal highs review launchedLegal highs – officially known as psychoactive substances – are synthetic drugs which can be bought online and sometimes in shops.

The review follows concern drug laws are not flexible enough to tackle them.

Deaths from legal highs in England and Wales almost doubled to 52 last year. The government said it was “determined to clamp down on the reckless trade”.

It is estimated that across the EU one new substance a week is being detected.

Among options the review will consider is legislation modelled on US laws. In the US, drugs are automatically banned if they are “substantially similar” to the chemical structure of substances that are already illegal.

The review will also look at whether those who supply legal highs over the internet and in “head shops” should be required to prove substances are safe and are not being used as a drug. Similar laws have already been introduced in Poland and the Republic of Ireland.

The review panel – which will include police, prosecutors, health experts and local council officials – has been asked to report back in the spring 2014.

Crime prevention minister Norman Baker said: “Despite being marketed as legal alternatives to banned drugs, users cannot be sure of what they contain and the impact they will have on their health.”

“Nor can they even be sure that they are legal. Our review will consider how current legislation can be better tailored to enable the police and law enforcement officers to combat this dangerous trade and ensure those involved in breaking the law are brought to justice.”

The review is being launched on the day the government has announced a permanent ban on two party drugs which were previously legal highs. Hallucinogenic NBOMe – also known as N-Bomb – and the ecstasy-like BenzoFury were banned for a year in June.

Under legislation to be passed next year, NBOMe – a powerful hallucinogen which causes euphoria but can also lead users to feel nauseous and panicky – will be made a class-A substance.

The government has banned more than 200 substances since coming to power.

Health Direct warns that whilst many governments have often had reviews of drug policies- they have all ducked out of making any constructive decisions.

On August 02, 2006 in Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal we reproduced the first ranking based upon scientific evidence of harm to both individuals and society.

It was devised by government advisers – then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, the then senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council.

Faulty breast implants- PIP director given jail sentence

The boss of the French company PIP which made faulty breast implants has been given a four years jail sentence.Faulty breast implants- PIP director given jail sentenceJean-Claude Mas, the founder of the PIP company, was also fined £63,000 (75,000 euros) by a court in Marseille. However,  he will remain at liberty until a French court hears an appeal lodged by his lawyer.

PIP’s sale of faulty implants caused a global health scare which affected about 300,000 women in 65 countries.

The company was found to have used sub-standard silicone gel – rather than medical-grade silicone – which the result that many implants ruptured.

Apart from Mas, four other former PIP executives were convicted and given lesser sentences.

The health scare came to public attention in 2011 when the French government recommended that women have PIP implants removed due to an abnormally high rupture rate.

There was confusion as British health authorities said there was no need for routine removal. However, they later agreed to remove the implants to put women’s minds at rest.

The company’s head of quality control received two years, one of them suspended, and the head of research and development was sentenced to 18 months, suspended.

When an implant ruptures, the silicone gel filling can leak into the body. Some women will not notice anything at all, and there is no evidence of an increased cancer risk.

However, it can result in the formation of scar tissue that can change the shape and feel of the breast. The gel can be an irritant, causing pain and inflammation. It can also be more difficult to remove an implant once it has ruptured.

France’s Health Products Agency (ANSM) has to date registered more than 7,500 implant ruptures and 3,000 cases of undesirable effects, mainly inflammations, among the 30,000 women using PIP products in France.

In a report released in June, the ANSM said such incidents tended to be under-reported, and so “the number of women actually explanted may be greater than the number of cases reported to the agency”.

Dementia- priorities for avoidance and treatment

Dementia has been described as a “global disaster waiting to happen” and the biggest health and care problem of a generation.Dementia- priorities for avoidance and treatmentSomeone is diagnosed with the disease every four seconds and cases are expected to soar from 44 million now to 135 million by 2050.

The disease already costs the world £370 billion each year. This week ministers from the G8 major economies are meeting in London to discuss how to tackle this devastating disease.

What is dementia?

  • It’s an umbrella term that describes around 100 diseases in which brain cells die on a huge scale.
  • All damage memory, language, mental agility, understanding and judgement.
  • Alzheimer’s disease is the most common form, affecting 62% of those living with dementia.
  • It gets worse with time and eventually people are left completely dependent on carers.
  • It is incurable.

So what are the key actions required?

1) Diagnose dementia early

Early diagnosis will be key to tackling dementia. On the day your doctor tells you that you have dementia you might think that’s the early stages of the disease, but it’s not

It takes 10 to 15 years of brain cells dying before memory problems become noticeable and memory tests lead to a diagnosis.

By this stage a fifth of the core memory centres of the brain will be dead.

It’s why doctors think drug trials have failed, they’re simply trying to treat the disease way too late.

However, developments are being made. It is now possible to see one of the damaged proteins closely tied to Alzheimer’s disease in brain scans, but the challenge is to use these tools to predict the development of dementia.

Other methods, such as finding chemicals in the blood which might predict the onset of dementia, are being investigated as well.

Dementia is also not one disease, but many. Alzheimer’s disease, vascular dementia and dementia with Lewy bodies all have similar symptoms, but may need different treatments. Scientists will need to come up with techniques which can readily distinguish between different forms of dementia.

2) Stop brain cells dying

Currently, there is no drug which can halt or even slow the progression of any form of dementia.

A lot of hope was placed on two potential Alzheimer’s drugs – solanezumab and bapineuzumab – but they failed in trials which showed no benefits for cognition.

However, there were hints that solanezumab may work in people with the earliest stages of the disease. A new trial has started looking at patients with mild dementia.

A cure is obviously the dream, but just slowing the pace of the disease would deliver massive rewards. Delaying dementia by five years could halve the number of people living with the disease.

3) Develop drugs to treat the symptoms

There are dementia drugs, which help people to live with the condition, but there are not enough.

Medication can boost the chemical signalling between surviving brain cells. But the last new medicine, memantine, was approved by the US in 2003. Since then there’s been nothing.

4) Find ways to reduce the risk

Want to massively cut the risk of lung cancer? Don’t smoke. Want to avoid a heart attack? Then exercise and have a healthy diet. Don’t want dementia? Then the answer is less certain.

Age is the biggest risk factor. In the UK, one in three people over the age of 95 has dementia, but there’s not much that you can do about that.

Many of the familiar messages – exercise and eat healthily – have been linked to preventing or delaying the onset of dementia. But the full picture of how family history, lifestyle choices and the environment combine to result in dementia is still unclear.

Prof Peter Passmore, from the British Geriatrics Society and Queen’s University Belfast, says the best advice so far is: “To do what’s healthy for the heart to reduce blood vessel damage to the brain.

So avoid obesity, don’t smoke, regular exercise, control blood pressure, sugar and cholesterol.

5) Work out the best care

Dementia has huge costs for society, but medical bills account for only a small fraction of the overall bill. The real cost is in time in care homes and the lost income of families quitting work to care for relatives.

Research will also need to focus on the best ways to care for patients with dementia and to keep them independent for as long as possible.

Studies have already shown that antipsychotic prescriptions can be halved with the correct training for staff.

Cancer patients not referred to specialists by GPs

Thousands of people who go on to be diagnosed with cancer were not referred to a specialists by their GP.
Cancer patients not referred to specialists by GPsNHS England data from around 4,000 GP practices suggests symptoms were picked up in other ways, for example by accident and emergency departments.

The NHS said not all cancer patients went to their GPs and the figures were not a clear measure of performance.

Patients who do go to their GP with cancer symptoms should be seen within two weeks in 95% of cases, the NHS said.

Health Secretary Jeremy Hunt said the government was tackling the “unacceptable variation” across different practices.

National performance data allows patients to look up their GP surgery and see how it performs against dozens of diagnosis and treatment indicators.

NHS England collected the figures on cancer referral rates from GP surgeries across the country as part of a drive to make the health service more transparent.

The NHS has a target that 95% of patients with suspected cancer should be seen by a specialist within two weeks – a target it says is consistently met.

But in around half of the GP practices sampled, fewer than 50% of patients on their books who were subsequently found to have the disease were referred to a specialist by their doctor.

Sean Duffy from NHS England said: “We know that early diagnosis is the single most important factor in cancer survival, and that’s why patients who visit their GP with ‘red flag’ symptoms like very persistent coughs, blood in urine or faeces or breast lumps should always be referred for further tests on two-week pathways.

“But not all patients visit their GP about these symptoms and others may have cancer without developing specific symptoms.

“These patients will therefore have their cancer diagnosed after going to a hospital as an emergency, or have it spotted incidentally while receiving treatment for another, unrelated issue.”

Mr Hunt said: “Every single patient in the NHS has the right to the very best care – and to see a GP who can spot cancer symptoms early enough to make a difference.

Operations being rationed to save NHS money

Non emergency operations by the NHS in England appear to be rationed according to recent research.
Operations being rationed to save NHS moneyThe analysis by the Dr Foster research group looked at three key procedures – knee, hip and cataract operations.  For much of the past decade, patient numbers have been rising as would be expected with an ageing population.

But since 2010, the numbers have levelled off – with just one in eight areas now doing more hips and knees and one in five seeing rises in cataracts.

It comes amid mounting pressures on the health service. The challenges facing A&E units have been well documented, but reports have also been emerging that non-emergency care is being squeezed too.

The health care analysts looked at the number of operations being carried out for the three types of procedures – among the most life-enhancing done by the NHS – for the past decade.

It found virtually no change in the overall numbers over the past two years with the total numbers hovering around the 475,000 mark each year.

Hip replacements were the only treatment out of the three that were still going up – although the rate of increase has slowed.

Meanwhile, the number of cataract operations is at its lowest level for five years and 2012-13 saw the first fall in knee replacements for a decade.

What has been happening:

  • Cataracts – From 2002-03 to 2009-10 the numbers increased from 266,000 a year to a peak of just over 332,500, but since then they have fallen to under 322,000 – the lowest level for five years.
  • Knee replacements – The past year saw the first fall in numbers for a decade – albeit a small one – after the yearly total fell by 550 to just over 81,500 in 2012-13.
  • Hip replacements – The yearly total has continued to go up, but at a much slower rate of 2% a year on average since 2008. There were 71,000 operations carried out last year.

The review also provided details of what local areas were up to by looking at the individual figures for the 200-plus clinical commissioning groups which are now in charge of local health budgets.

The data showed that just 27 (13%) areas saw a significant rise in knee replacements over the past two years, 27 (13%) a rise for hip replacements and 40 (19%) a rise for cataracts. These include procedures such as tonsillectomies and knee washouts where the benefits are marginal.

While overall the numbers being done had fallen by 8% in the past five years there are still 124 areas where their use has increased since 2010-11.

Food poverty is now a health emergency

Food poverty in the UK has now become such a big problem that it should be seen as a public health emergency according to a group of health experts.
Food poverty is now a health emergencyIn a letter to the British Medical Journal, six leading public health figures warned poor nutrition could lead to a host of problems.

It comes amid reports that people are struggling to feed themselves as the UK Red Cross has started asking for food donations for the first time since World War Two.

And in October the Trussell Trust, which runs 400 food banks, said the numbers of people it was helping had tripled to 350,000 in the past year.

The letter also cited research from the Institute for Fiscal Studies that indicated the amount of money being spent on food by households had fallen by over 8% in real terms over the past five years.

Families with young children have been hit the hardest.

The study also suggested that much of the savings had been made by people buying cheaper, processed food.

The BMJ letter, signed by academics and pubic health directors, said this had “all the signs of a public health emergency”.

It warned malnutrition, particularly during childhood, could have lifelong effects including increasing the risk of cardiovascular disease and other chronic illness.

David Taylor-Robinson, a population health scientists at the Medical Research Council and one of the authors of the letter, added: “It is clear people are increasingly struggling with their food bills. We need to start monitoring this and treating it as a public health problem.”

Chris Mould, the executive chairman of Trussell Trust, said he wanted the government to set up an official inquiry because “these alarming developments point towards serious trouble for the nation in the years ahead unless urgent action is taken now”.

But a government spokesman said action was been taken to help people with the cost of living, including increasing the tax-free personal allowance and freezing council tax and fuel duty.

He added: “The benefits system supports millions of people who are on low incomes or unemployed and there is no robust evidence that welfare reforms are linked to increased use of food banks.”

Men and women’s brains are different- it’s official

Men and women’s brains are connected in different ways- which may explain why the sexes excel at different tasks researchers have found.Men and women's brains are different- it's officialA US team at the University of Pennsylvania scanned the brains of nearly 1,000 men, women, boys and girls and found striking differences.

Male brains appeared to be wired front to back, with few connections bridging the two hemispheres.  In females, the pathways criss-crossed between left and right.

These differences might explain why men, in general, tend to be better at learning and performing a single task, like cycling or navigating, whereas women are more equipped for multitasking, say the researchers in the journal Proceedings of the National Academy of Sciences.

The same volunteers were asked to perform a series of cognitive tests, and the results appeared to support this notion.

But experts have questioned whether it can be that simple, arguing it is a huge leap to extrapolate from anatomical differences to try to explain behavioural variation between the sexes. Also, brain connections are not fixed and can change throughout life.

In the study, women scored well on attention, word and face memory, and social cognition, while men performed better on spatial processing and sensori-motor speed.

To look at brain connectivity, the researchers used a type of scan called DTI – a water-based imaging technique that can trace and highlight the fibre pathways connecting the different regions of the brain.

Study author Dr Ruben Gur said: “It’s quite striking how complementary the brains of women and men really are.  Detailed connectome maps of the brain will not only help us better understand the differences between how men and women think, but it will also give us more insight into the roots of neurological disorders, which are often sex related.”

Prof Heidi Johansen-Berg, a UK expert in neuroscience at the University of Oxford, said the brain was too complex an organ to be able to make broad generalisations.

“We know that there is no such thing as ‘hard wiring’ when it comes to brain connections. Connections can change throughout life, in response to experience and learning.”

“Often, sophisticated mathematical approaches are used to analyse and describe these brain networks. These methods can be useful to identify differences between groups, but it is often challenging to interpret those differences in biological terms.”

Missed Doctors’ appointments is top priority for NHS

Reducing the number of patients not turning up for appointments with their Doctor should be a top priority.
Missed Doctors' appointments is top priority for NHSPatients’ non-attendance at appointments is as high as 11% in some doctors’ surgeries.

David Sissling the NHS Wales chief executive was giving evidence to the Welsh Assembly’s Public Accounts Committee (PAC).

He said health boards were trying to tackle the issue but he believed new systems, such as online bookings and text reminders could help reduce the problem.

Mr Sissling said: “We should do a major exercise to better understand the 11%. Sometimes they are the most vulnerable, sometimes they have the greatest needs and sometimes they have chaotic lifestyles.

“I think adopting a blame culture would be inappropriate,” Mr Sissling added.

Recently the British Medical Association (BMA) claimed family doctors in Wales faced a “crisis” and “enormous pressures” meant the profession was “on its knees”.

In an interview with BBC Wales, Dr Charlotte Jones said increasing demand from patients coupled with a shrinking workforce meant GPs were often “too exhausted” to see patients out of hours.

She insisted the problems were particularly acute in rural areas.

Mr Sissling told the committee he was aware that some areas of Wales were facing “particular challenges”, but that the Welsh government was “taking action” to deal with the concerns.

Doctors representatives are currently negotiating with the Welsh government elements of a new GP contract, which will set out what family doctors are expected to deliver.

A Welsh government spokesperson recently suggested the new contract was likely to involve less bureaucracy, so GPs can spend more time with the most vulnerable patients.

Mr Sissling was giving evidence as part of a PAC investigation into “unscheduled care” in the NHS.

It is known that A&E departments last spring struggled to cope with what ministers called “unprecedented demand” from patients, including a large number of elderly people who were very ill or had complicated needs.