Police not NHS should deal with drunks

The Police rather than the NHS should be dealling with drunks claims the AnE boss.

Police not NHS should deal with drunksPolice should crack down on binge drinking to stop hospital staff being distracted by disorderly drunks according to a leading doctor.

Dr Clifford Mann, president of the College of Emergency Medicine, said the “softer approach” used for anti-social drunkenness did not seem to be working. Police could instead increase arrests, convictions and fines, he suggested.

Crime prevention minister Lynne Featherstone said the government was “determined to tackle alcohol-fuelled harm”, which she said cost society around £21 billion a year.

The coalition had improved the powers available to the police and licensing authorities to tackle alcohol-related crime, and had banned the “worst cases of very cheap and harmful alcohol sales”, the Liberal Democrat MP said.

Dr Mann said: “All I am saying at the moment is the softer approach – where we don’t any longer arrest many people for being drunk and disorderly – certainly doesn’t seem to be working.”

He said the number of people arriving at A&E units while drunk was increasing year on year, while the number of licensed premises in the UK was also increasing and alcohol was getting cheaper.

“I think these people, by the nature of the disorder, they are distracting medical and nursing staff from looking after other patients and therefore are wasting public resources,” he said.

“I think they therefore fall into the category of being drunk and disorderly in their behaviour and the police can act to take them away.”

Health Direct agrees with the suggestion. To use the Greens’ parlance of “the polluter should pay”- the drunks should be charged- literally and financially. Until the politicians, police and society in general starts to deal appropriately of issue of people drinking too much alcohol then it is unfair and detrimental to the expect the NHS to pick up the pieces.

Not only would this approach save the NHS money- but the police and courts would make money by fining people who have paid to incapacitate themselves- and who are after all breaking the law.

Fourty per cent of cancers are avoidable

Four in 10 cancer cases- 600,000 in the UK- could be prevented if people led healthier lives say experts.

Fourty per cent of cancers are avoidableThe latest research figures from Cancer Research UK show smoking is by far the biggest avoidable risk factor- followed by unhealthy diets.

The charity is urging people to consider their health when making their New Year resolutions.

Limiting alcohol intake and doing regular exercise is also good advice.

According to the figures spanning five years from 2007 to 2011, more than 300,000 cases of cancer recorded were linked to smoking.

A further 145,000 were linked to unhealthy diets containing too much processed food.

Obesity contributed to 88,000 cases and alcohol to 62,200.

Sun damage to the skin and physical inactivity were also contributing factors.

Prof Max Parkin, a Cancer Research UK statistician based at Queen Mary University of London, said: “There’s now little doubt that certain lifestyle choices can have a big impact on cancer risk, with research around the world all pointing to the same key risk factors.”

“Of course everyone enjoys some extra treats during the Christmas holidays so we don’t want to ban mince pies and wine but it’s a good time to think about taking up some healthy habits for 2015.”

“Leading a healthy lifestyle can’t guarantee someone won’t get cancer but we can stack the odds in our favour by taking positive steps now that will help decrease our cancer risk in future.”

Public Health England says a healthy lifestyle can play a vital role in reducing cancer risk. It says campaigns such as Smokefree, Dry January and Change4Life Sugar Swaps all aim to raise public awareness.

Ambulance waiting time targets may be extended

Target waiting times for ambulances to reach some seriously ill patients could be lengthened.

Ambulance waiting time targets may be extendedA leaked NHS document includes plans to change the response time for some Red 2 patients – those with “serious but not the most life-threatening” conditions – from eight to 19 minutes in England.

It said the plans had been backed by Health Secretary Jeremy Hunt, subject to approval by ambulance trust bosses.

The government said no decisions had been made and the party has rejected suggestions from ambulance chiefs that it was told about the plan to change response times and raised no objections.

The leaked document, drawn up for the Association of Ambulance Chief Executives and dated 16 December, said NHS England had “explicitly stressed” the plans were confidential and “should not be disseminated beyond the group” involved in the discussions.

The document said there were existing plans for changes “after the general election” in May.

To many in the service, the general ideas are good – but there this concern it should have been a more thoughtful exercise where time was taken to consult widely and the public was involved in the process.

Paramedics say response times distort their ability to treat patients because they have to chase the clock. They also say some illnesses such as strokes, should be moved up a category.

The target for these changes was early January, according to the document, but it seems unlikely the proposals will now go ahead by then.

There are currently three main call types:

  • Red 1: Respiratory or cardiac arrest – response in eight minutes
  • Red 2: All other life-threatening emergencies, such as stroke and fits – response in eight minutes
  • Other response times are agreed locally

Ambulance trusts dealt with almost 8.5 million emergency calls in 2013-14 in England, an average of 16.1 calls per minute.

The national target is for ambulance trusts to reach 75% of Red 1 patients within eight minutes, and 95% within 19 minutes. The time starts as soon as an emergency call is connected.

Red 2 targets are currently the same, except that the “clock start” can be up to 60 seconds after a call is connected.

The changes proposed to Red 2 are:

A “small number” moved to Red 1 – those where a short extra wait “could have a potentially serious detrimental impact”
Just under half to keep the 75% within eight minutes target, but trusts will have up to three minutes from receiving a call before the clock starts
About 40% to have a 19-minute response target, as well as three minutes before the clock must start

The Red 2 category includes strokes and fits, but the document does not say which conditions would be put in each of the new categories.

It said the proposed changes could bring “substantial improvements”.

The document also said trusts would be able to cut the number of fast-response cars being used in favour of deploying more double-crewed ambulances, but it acknowledged the plans have not had the “breadth of exposure that would normally be expected”.”

The leak comes after it emerged on Friday that pressures in England’s A&E units had hit record levels, with the lowest percentage of patients seen within four hours since monitoring began in 2010 – NHS A&E has worst week in 2014.

NHS A&E has worst week in 2014

Pressures in England’s NHS A&E units have hit record levels- with the lowest percentage of patients seen within four hours since monitoring began.

NHS A&E has worst week in 2014New data showed just under 90% of patients were seen within four hours in the seven days up to December 14. Major units particularly struggled, with just six out of 140 meeting the target to see 95% within four hours.

As England is the only part of the UK that produces weekly data, how the NHS is performing here gives the best indication of the pressure the system is under.

Just over 440,000 patients visited A&E in the week ending 14 December with 89.8% seen within four hours.

As well as posting the worst performance against the four-hour target, other measures also show the service is under strain.

There were over 111,000 emergency admissions to hospital – 80,000 from A&E units – which is an all-time high.

Trolley waits – that is waits of four hours or more for a bed once a decision to admit a patient into hospital from A&E is made – topped 10,000 for the first time which compares to under 4,000 for the same week last year.

Delays getting patients out of hospital once they are ready for discharge are also much higher than average.

Performance in England has hit an all time low since weekly monitoring began in 2010, but this looks like it will just be the start of what promises to be the most difficult winter for the NHS for a generation.

The four hour target was introduced in 2004 to combat the long waits patients faced for treatment, since then hospitals have performed remarkably well.

During winter months it has tended to dip below the target level, but not for long. The scale of the drop is causing concern not only to the health service, but to the government too with an election just around the corner.

As health is devolved, data is published differently across the UK.

While England publishes weekly data, the others release it monthly or quarterly. In Wales the data from November shows just 83.8% of patients were seen in time.

Northern Ireland is performing even worse – just over 80% of patients were seen within four hours in November. Scotland has a slightly tougher waiting time target – 98% of patients should be seen in four hours – but in September 93.5% were.

Comparing the September figures for England and Scotland shows England was performing slightly better in that month.

It means according to latest data all parts of the UK are missing the A&E waiting time target.

Each nation has set aside extra money for winter pressures:.

  • In England an extra £700m has been set aside to help the NHS. This is paying for the equivalent of 1,000 extra doctors, 2,000 nurses and 2,000 community staff, including social workers and physios.
  • Ministers in Scotland have announced a total of £28.2m for the NHS to increase capacity and improve the way patients are discharged during winter.
  • In Wales the NHS has been given an extra £200m for this year. The money is for the whole health service, but ministers say it will help relieve the pressures in the coming months.

Painkillers linked to reduced skin cancer risk

Regularly taking aspirin and ibuprofen may help protect against some forms of skin cancer new research suggests.

Painkillers linked to reduced skin cancer riskAn Australian analysis of all studies to date found that non-steroidal anti-inflammatory drugs (NSAIDs) reduced the risk of squamous cell carcinoma by 18%.

The drugs have previously been linked to a reduced risk of other cancers, including colon cancer.  The theory that NSAIDs such as aspirin may protect against skin cancer has been raised before, but the overall evidence had been unclear.

So researchers did an analysis of nine studies looking at use of the drugs and the risk of squamous cell carcinoma – the most common form of skin cancer.

Reporting in the Journal of Investigative Dermatology, they found that taking any NSAID was associated with an 18% lower risk of developing the cancer.  And taking NSAIDs other than aspirin was linked with a 15% reduced risk.

It is the most convincing evidence so far that the drugs help prevent the development of squamous cell carcinoma.

But experts still cannot be sure of the effects because some factors – such as how much sun someone is exposed to or even what doses of the drugs they take – have been difficult to pin down with any accuracy.

It is thought that NSAIDs, which also include diclofenac, may prevent skin cancer because they inhibit an enzyme called COX-2, which is involved in tumour development.

The researchers did find a greater degree of reduced risk associated with use of the drugs in people with pre-cancerous growths or a history of skin cancer.

It raises the possibility that the drugs could be used as a preventive treatment in some groups.

Some people are prescribed NSAIDs long term for conditions such as arthritis, but they are not recommended for regular use in healthy people because of side effects, which can include, in rare cases, bleeding in the stomach.

Vulnerable doctors need more support

An independent report recommends that a national support service be set up to help vulnerable doctors- as up to 28 doctors took their own lives between 2005 and 2013 while being investigated by the General Medical Council.

Vulnerable doctors need more supportThe GMC, which investigates about 3,000 complaints about doctors each year, said its processes should be “quick, simple and low stress”.

The independent report, based on a review of GMC cases over eight years, found that 24 doctors undergoing fitness to practise investigations were classified as “suicide” and four as “suspected suicide”.

Many of the doctors suffered from a recognised mental disorder, such as depression, bipolar disorder and personality disorder, or had addiction problems.

Other factors in their deaths may have included marriage breakdown, financial hardship and the impact of the GMC investigation itself.

The report calls on the GMC to treat every doctor as “innocent until proven guilty”.

It also recommends appointing a senior medical officer from the GMC to oversee cases involving doctors with health problems.

The GMC said it has made significant improvements to its fitness-to-practise investigations process in recent years – but recognises that it could offer more support to doctors.

Niall Dickson, chief executive of the General Medical Council, said: “We know too that for any doctor, being investigated by the GMC is a stressful experience and very often follows other traumas in their lives.

“Our first duty must, of course, be to protect patients but we are determined to do everything we can to make sure we handle these cases as sensitively as possible, to ensure the doctors are being supported locally and to reduce the impact of our procedures.”

He said the aim was to handle complaints as quickly and effectively as possible. The GMC will now review it procedures for dealing with doctors with health problems.

Dr Clare Gerada, medical director of the Practitioner Health Programme, a support service for doctors in London, said she welcomed the review.

“They [the GMC] need to continue to show their commitment to reducing the impact of fitness-to-practise investigations on vulnerable doctors whilst always maintaining patient safety – a substantial task.

“Doctors are sometimes patients too and supporting vulnerable doctors is a shared responsibility.”

Dr Gerada said the British Medical Association, the Royal College of Psychiatrists and the Practitioner Health Programme should all be involved in implementing the GMC’s recommendations.

Nearly half the population takes prescription drugs

Half of women and 43% of men in England are now regularly taking prescription drugs- according to the Health Survey for England.

Nearly half the population takes prescription drugsThe report by the Health and Social Care Information Centre (HSCIC) showed an average of 18.7 prescriptions per person in England in 2013 with the annual cost to the NHS was in excess of £15 billion.

All the figures exclude contraceptives and smoking cessation products.

Nearly a third of prescriptions were for cardiovascular disease with more than 65 million prescriptions for tackling high blood pressure, heart failure or cholesterol levels.

Simvastatin – which lowers cholesterol – was the single most prescribed item with 40 million prescriptions.

Dr Jennifer Mindell, one of the report’s authors at University College London, said: “This is the first nationally-representative study to report on the use of prescribed medicines taken by people in the community, not just those within the healthcare system.”

“That half of men over 65 are taking cholesterol-lowering medicines reflects the high risk of cardiovascular disease in this group.

“Stopping smoking, being a healthy weight, eating more vegetables and fruit, and being physically active reduce people’s risk of these diseases, for people who want to avoid taking medicines.”

This study focuses on the drugs patients say they are taking rather than the number of prescriptions written by a GP as up to half of such prescriptions are either not taken or not taken as recommended.

But figures for community prescribing – which include GPs and dentists, but not hospitals – show:

  • In Wales there were 74 million prescriptions in 2013.
  • In Scotland there were 99 million prescriptions in the financial year 2013-14.
  • In Northern Ireland there were 35 million prescription in 2010.

Analyses of similar data sets for England shows community prescribing, including contraceptives, increased from 650 million in 2003 to more than 1,000 million in 2013.

Antidepressants were taken by more than one in 10 women – double the figure for men.

The drugs were most commonly taken by middle-aged women and those from deprived areas – 17% of the poorest women took antidepressants compared with 7% of the richest.

Dr Sarah Jackson, at University College London, commented: “It’s well known that rates of depression are much higher among women than men, so I am not surprised to see that antidepressant use follows the same pattern in this study.

“People with depression are less likely to be in regular employment, and people who are unemployed or in low paid jobs are more likely to have depression.”

Overweight and obese people were more likely to need prescription drugs. More than half of severely obese people in England reported taking at least one prescribed medicine and a third took at least three.

Obesity is often associated with high cholesterol, high blood pressure, joint pain and depression. Lifestyle changes are always recommended in the first instance, but medicines can help to address the symptoms and this study shows that medicine use increases steadily with body mass index.

NHS A&Es use locums in quarter of senior posts

Almost a quarter of NHS A&E departments in hospitals in England are filled with agency doctors or locums.

NHS AnEs use locums in quarter of senior postsThe reliance on freelance staff to fill senior posts costs hospital trusts more than £120 million in a year.

Some trusts have far higher rates of vacancies filled by locums, with three trusts running at rates of more than 50% and the highest at 69%.

The information comes from a Freedom of Information request made by the BBC.

Locum or agency doctors are routinely used to plug gaps in rotas, not just in A&E departments but generally across the health service.

But the BBC has found that many hospitals are routinely using locums to fill the two most senior roles in Emergency Departments; consultants who run the teams and senior registrars.

They approached 142 hospital Trusts in England that run large Emergency Departments, known in the NHS as Type 1 A&Es. Of those, nearly 90% responded to our request for information about how many of the senior roles were filled with locums, and how much that was costing.

Given a shortage of consultant and senior registrar grade doctors working in emergency medicine the use of locums is an expensive but unavoidable way of making sure A&E departments are properly staffed.

Locums offer hospitals a flexible way of managing their workforce in response to demand.

When drawn from other specialties or departments they can also help spread best practice and the latest knowledge.

But A&E consultant Prof Suzanne Mason, of the College of Emergency Medicine, the professional body for senior A&E doctors, says there are significant downsides to relying so heavily on locums.

“They often will provide different levels of care and perhaps not such high-quality care as we would come to expect as a specialty. That may be due to a lack of knowledge of the local systems but it may also just be due to just a general lack of clinical experience.”

But at present hospitals have little choice over their use of locums, according to Bill McMillan from the NHS Employers organisation.

“Tonight at A&E you need to be able to deal with the patients who turn up. You can’t say to them, ‘You’re in the wrong place, we can’t do anything for you.’

“So hospitals are obliged to try and fill those rotas as best they can with the best quality people they can. You can hardly blame the patients for turning up. You always get a certain amount of flexible workforce in any industry and the health service is no different.

“The question is making sure we recruit locums who are also of the best quality, doing the work we are asking of them, paying the right pay for that. Those are things I think hospitals find really difficult at the moment.”

A spokesperson for the Department of Health in England said: “A&E doctors are at a record high in the NHS, with 1,187 more than in 2010, including 420 more consultants.

“We’ve given the NHS £700m this winter to help it respond to the pressure of an ageing population with more doctors, nurses and beds, and plans in every area to manage extra demand.”

UK air pollution causing deadly public health crisis

The Environmental Audit Committee argues air pollution is a “public health crisis” causing nearly as many deaths as smoking.

UK air pollution causing deadly public health crisisThe committee suggested a scrappage scheme for diesel cars to cut emissions as there are an estimated 29,000 deaths annually in the UK from air pollution.

Nitrogen dioxide is known to cause inflammation of the airways, reduce lung function and exacerbate asthma. Particulate matter – tiny invisible specks of mineral dust, carbon and other chemicals – are linked to heart and lung diseases as well as cancer.

Some particulate matter lodges in the lungs, while the finest particles can enter the bloodstream, risking damage elsewhere in the body.

Joan Walley, the committee chairwoman, said “There is a public health crisis in terms of poor air quality. There are nearly as many deaths now caused by air pollution as there are from smoking, so the main thing is we stop a new generation of children being exposed.”

She said government “should make it impossible” for new schools, care home or health clinics to be built in pollution hotspots. She added that “well over a thousand” schools were already near major roads and that it “made sound economic sense” to filter the air coming into the buildings.

The committee’s report says traffic is responsible for 42% of carbon monoxide, 46% of nitrogen oxides and 26% of particulate matter pollution.

It said government had promoted diesel vehicles as they produced less of the greenhouse gas carbon dioxide. But the committee said diesel was now seen as “the most significant driver of air pollution in our cities”.

They called for government to pay for diesel drivers to upgrade their engines or for a national scrappage scheme to take the most polluting vehicles off the road.

Other measures suggested include:

  • The Met Office and BBC producing high pollution forecasts alongside ones for pollen and UV.
  • A national plan for “low emission zones” to tackle heavily polluting vehicles, like the one in London.
  • Changes to fuel duty to encourage low nitrogen dioxide vehicles as well as low carbon dioxide.
  • Financial incentives for alternative fuels.
  • Encourage walking and cycling as the “ultimate low emission” option

Dr Ian Mudway, a lecturer in respiratory toxicology at King’s College London, told the BBC: “The evidence is there. The 29,000 figure is very solid, so really it is a case of acting.

“But it is a strange one, because it’s their third [report] in five years and it is an attempt to get the government to do anything.”

The British Lung Foundation said the recommendations “may seem drastic”, but air pollution was so bad they were necessary “to protect the nation’s health.  Our dirty air will simply not clean itself, and this issue is one that will, without the government’s intervention, continue to impact on current and future generations,” said Dr Penny Woods, the charity’s chief executive.

Asthma UK said air pollution increased the risk of a life-threatening attack and “urgent and concerted action” was needed to bring pollution levels down.

Chief executive Kay Boycott said: “In the short term some of the measures recommended in this report, such as the publicising of high air pollution forecasts, could help people with asthma know in advance if they should seek advice from their GP or asthma nurse.”

Simon Gillespie, the chief executive of the British Heart Foundation, said: “The government cannot continue to ignore this issue. Enough is enough. The government must act on these recommendations quickly if we are to improve the quality of the air we breathe and protect the nation’s heart health.”

NHS surgery restriction for smokers and obese

The NHS in Devon is to deny routine surgery to smokers and the morbidly obeseunless they quit smoking or lose weight.

NHS surgery restriction for smokers and obesePatients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.

The NHS in Devon has a £14.5 million deficit and says the cuts are needed to help it meet waiting list targets. The measures were announced the same day government announced an extra £2 billion of annual NHS funding.

The Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) organises most NHS treatment in the area.

It announced a range of cost-cutting measures yesterday including only providing one hearing aid, instead of the normal two, to people with hearing loss. Shoulder surgery will also be restricted.

In November, the CCG said it would take “urgent and necessary” measures to prioritise major treatment. That included delaying hip and knee operations for the morbidly obese, but Wednesday’s announcement applies to all routine procedures.

NEW Devon CCG said it would not restrict IVF treatment or caesarean sections carried out on medical grounds.

A statement said all the decisions were “interim commissioning positions” and would require further consultation. Patients with a date for surgery will not be affected but will be offered weight management or quit smoking support.

Dr Tim Burke, Chair of NEW Devon CCG, said: “All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.

“We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case.”

NEW Devon CCG said it would announce another round of cost-cutting measures “in due course”.

“We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them,” said Dr Burke.

“The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that.”

In a statement the Royal College of Surgeons said it was “concerned” by the move and warned the region was merely storing up “greater pressures” for the future.

It said: “The need for an operation should always be judged by a surgeon based on their clinical assessment of the patient and the risks and benefits of the surgery – not determined by arbitrary criteria.”

“Losing weight, or giving up smoking is an important consideration for patients undergoing surgery in order to improve their outcomes, but for some patients these steps may not be possible.”

“A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable and too rigid a measure for ensuring patients receive the best care possible.”