Cameron promises seven day health services

All hospitals in England will provide “a truly seven day NHS” health service under a future Conservative government.

Cameron promises seven day health servicesMr David Cameron said that more hospitals must provide top-level treatment at the weekend, starting with emergency care.

In a wide ranging speech, he said his party’s message to various sections of the population was: “We’re with you.” This spring forum is about fighting back against Labour on the NHS.

The Conservatives are committing to providing full weekend hospital care in England – in line with the NHS’s own five year plan.

This is an attempt to try to neutralise the NHS and enable the Conservatives to return to what they want to be talking about – the economy.

Speaking at the forum in Manchester, Mr Cameron warned that figures showed patients were “more likely to die” if they were admitted at weekends.

According to the Conservatives, official studies suggest mortality rates for those admitted on Saturdays and Sundays are 11% and 16% higher respectively than for those admitted on Wednesdays.

“For years it’s been too hard to access the NHS out of hours. But illness doesn’t respect working hours. Heart attacks, major accidents, babies – these things don’t just come from nine to five,” Mr Cameron said.

At weekends, he said, “some of the resources are not up and running. The key decision makers aren’t always there.

“With a future Conservative government, we would have a truly seven-day NHS. Already millions more people can see a GP seven days a week but by 2020 I want this for everyone, with hospitals properly staffed especially for urgent and emergency care, so that everyone will have access to the NHS services they need seven days a week by 2020 – the first country in the world to make this happen.”

The Liberal Democrats said NHS England already had plans to open hospitals and GP surgeries seven days a week, while UKIP said the Tories had “degenerated the NHS beyond all recognition” during the last five years in government.

The Conservatives have pledged to guarantee a real-term increase in funding for the NHS during the next Parliament, extending the ring-fence in place for the past five years. Labour has said it will spend £2.5bn more than its opponents.

Health Secretary Jeremy Hunt said government reforms of the NHS were saving £1.5bn a year but that the NHS “will need more money”.

He added that the NHS’s own sums suggested the predicted £30bn annual shortfall could be “reduced with efficiency changes, and we’re backing that plan”.

New clinical standards set out in 2013 require hospitals to provide seven-day access to diagnostic tests, such as X-rays, ultrasound, MRI scans and pathology, as well as providing access to multi-disciplinary teams, which include expert nurses and physiotherapists.

In its blueprint for services over the next five years, published last October, NHS England said hospital patients should have access to seven day services by 2020. “

Three IVF cycles a minimum treatment requirement

A charity is calling for couples who need help conceiving to have access to three cycles of IVF instead of two.

Three IVF cycles a minimum treatment requirementIn 2013 a working group, set up by the Scottish government, recommended eligible couples should be offered up to three treatments. But that would only be after health boards had reduced IVF waiting times.

Infertility Network UK said it was a “no-brainer” there should now be three cycles as waiting times have fallen.

New IVF criteria was introduced in July 2013, following recommendations by the National Infertility Working Group.

The changes were designed to standardise fertility treatment across Scotland to prevent a “postcode lottery”.

Giving evidence to Holyrood’s health committee, the charity’s chief executive Susan Seenan said: “The group recommended three cycles and said that once the waiting times were down to below 12 months, at the latest early 2015, they would consider moving to three cycles.

“It just doesn’t seem to be happening as fast as we would like it to. We just think now that the waiting times are down, that it is a no-brainer – we should move to offering everybody who is eligible three cycles.”

IVF treatment guidelines

  • A guaranteed two full cycles of IVF, as well as unlimited frozen transfers for eligible couples until the woman’s 40th birthday
  • Women aged between 40 and 42 will be offered one full cycle of IVF provided they meet all necessary criteria
  • From 31 March, 2015, all eligible couples will start treatment within 12 months of being accepted for IVF treatment
  • Obese women – those with a Body Mass Index (BMI) over 30 – will have to lose weight and have a BMI of 29.9 or less before treatment
  • If either partner smokes, they will need to have stopped before treatment is started

Susan Seenan added: “Everybody in the group was agreed that…three cycles was the best possible way to move forward for patients.

“Why anybody would not want to move forward with that, I have no idea, unless it is finance related.”

Fertility treatment is currently available to those under 40, and is not offered to women who are obese.

In addition, couples need to have been in a stable relationship for two years and neither partner can smoke for three months before treatment begins.

Both partners also need to be methadone-free for a year before IVF starts.

Women aged between 40 and 42 are eligible for one cycle of fertility treatment if they have never previously undergone the procedure.

Pharmacists could help ease GP pressures

An army of pharmacists could step in to help treat patients at GP practices across England leading health professionals plan.

Pharmacists could help ease GP pressuresThe proposals focus on pharmacists seeing patients with common ailments directly – not on setting up shops within surgeries.

Pharmacists would provide health advice and be able to prescribe medication once extra training had been completed.

Charities welcomed the move but say patient safety must be a priority.

NHS England officials said the idea complemented their plan to increase staffing in GP surgeries. But it is not yet clear whether they will push the proposals forward.

The plans, aimed at every practice in England, have been put forward by the Royal College of General Practice (RCGP) and Royal Pharmaceutical Society (RPS).

It could mean when patients call up their surgeries they are offered an appointment with a pharmacist, general practitioner or practice nurse.

Those who opt to see the pharmacist could get advice about their symptoms and discuss troubling side-effects of medication, as well as getting help with their repeat prescriptions.

People with long term conditions are likely to benefit the most under the plans – those on multiple medications could get help streamlining their daily drugs.

In a handful of practices pharmacists already help with the management of conditions such as diabetes and asthma, for example, helping patients get annual checks.

Under the proposals more practices could do this. And with additional training some pharmacists would prescribe commonly used medicines such as antibiotics.

Any patient who still needed advice from a doctor could still be seen by their GP.

GP and pharmacist leaders say the move is needed as practices face staff shortages and are struggling to meet the demands of an ageing population.

The RCGP predicts that on some 67 million occasions this year, patients will have to wait more than one week to get an appointment.

In contrast, there is currently an over-supply of skilled pharmacists who could ease this burden experts argue.

Initial pharmacist training lasts one year longer than basic nursing qualifications and one year less than medical school for doctors.

Dr Maureen Baker, chairwoman of the RCGP, said: “Even if we were to get an urgent influx of extra funding and more GPs, we could not turn around the situation overnight due to the length of time it takes to train a GP.

“Yet we already have a ‘hidden army’ of highly-trained pharmacists who could provide a solution.

“This isn’t about having a pharmacy premises within a surgery, but about making full use of the pharmacist’s clinical skills to help patients and the over-stretched GP workforce.”

David Branford, of the RPS, said: “Pharmacists can consult with and treat patients directly, relieving GPs of casework and enabling them to focus their skills where they are most needed, for example on diagnosing and treating patients with complex conditions.

“Pharmacists can advise other professionals about medicines, resolve problems with prescriptions and reduce prescribing errors.”

These types of partnership already exist in a handful of practices but experts hope the plan will eventually be rolled out across the UK.

Katherine Murphy, of the Patients Association said: “Any action that can, at the very least, ease the problem is to be welcomed and this plan for doctors and pharmacists to work together is an innovative step in the right direction.

“Of course, there must always be concerns that the pharmacists who undertake this work have the relevant skills and qualifications to treat patients, and with care.”

War on drugs is unwinnable

Four decades after President Nixon declared a “war on drugs”, US states have legalised the sale of marijuana and most Americans support legalisation.

War on drugs is unwinnableAcross the world, drug laws are being relaxed, from Uruguay to Portugal, Jamaica and the Czech Republic.

After many years prosecuting drugs offences as an Assistant US Attorney, growing frustration with the approach inspire

The US prison system is a disaster. There’s virtually no rehabilitation. Locking up low level individuals who have drug problems or who have limited other options is not effective, because they go to jail, they come out, they get involved with drugs again, and they go right back to it.

The war itself is at a draw- which will be maintained indefinitely unless there’s a dramatic change in our approach to drugs and drug trafficking.

Former Colombian President Cesar Gaviria worked on the Global Commission on Drug Policy report in 2011 which called on states to decriminalise drugs.

“Our recommendation is regulation for everything. That’s what Portugal did.

“If you look at the last 50 years, what has been done? In the US, 600,000 people in jail, £27 billion of spending a year. The highest rates of consumption of the whole world. You have to say that it doesn’t work. It’s a failed policy, and public opinion knows that.

“Ten years ago it was unthinkable that the US would move massively to the legalisation of cannabis. That taboo has been broken. In the US, a majority of people are talking about approving legalisation of marijuana.”

He cites the example of Uruguay, the first country to legalise the marijuana trade.

“All Latin America’s looking at Uruguay. It’s a country that also looks how to deal with the production, with the supply of the marijuana that is in the state hands. I don’t expect any major set back of the policy that the Uruguayans have put in place.”

“From the beginning in 1961, the objective of the UN Conventions has been to live in a world free of drugs, but it’s a utopia. It’s something unreachable. It’s not to recognise human nature.”

Professor Peter Reuter from the school of public policy at the University of Maryland has been a leading academic in the field of drugs policy for decades.

“The need for national leaders to stand up and talk about the scourge of drugs, and signal to the population that being tough on drugs was a priority was an important part of the war itself.

“There’s going to be less and less of that. I think there’s going to be a change both in tone and substance, so the ‘war on drugs’ will become a less and less plausible metaphor for describing policy. I think it’s going to be a public health rhetoric for the foreseeable future.

“I do believe that we have in a sense had an experiment with trying to be very aggressive about controlling drugs through use of prohibition. And we have a sense that that did not work well. And so we’re now trying to find better ways of managing the problem, and I think that’s welcome.

“If you look at the number of people who are in prison for drug offences, at least in the US, that’s an important indicator of the change in real policy, and those numbers are starting to go down. Not dramatically, but they are definitely going down, and many states are making changes that are likely to accelerate that decline.”

As drug laws soften he argues the question of regulation becomes key, as happened when gambling was legalised:

“Lottery play was always seen as a bad thing, you legalised it because you wanted to take money away from organised crime, but the result was that the state lotteries became the most aggressive promoters.

“You have slogans like ‘Why be a mug and work when you can play the lottery and win easily?’, just the kind of slogan you’d associate with the worst commercial promotion, but done by the state.

“Alcohol is still heavily promoted, and it’s promoted in states that have state liquor monopolies, and we’ve only recently really been able to restrict smoking promotions.

“You cannot with a straight face say that marijuana legalisation won’t lead to more marijuana dependence.

“Choose your problem. There is no solution. Use of psychoactive drugs is a social problem like a whole lot of other social problems. We manage it. And we may manage it better or worse, but the notion that we solve a problem is simplistic. We’re simply managing a problem.”

NHS track record over the winter

The NHS has had it’s hardest difficult winter for a long time- so haow has it coped?

NHS track record over the winterThe four hour target to be seen in A&E has been missed in each nation – and that has had a knock-on effect on other parts of the hospital system.

In England all the evidence points to it being the worst winter since the target was introduced at the end of 2004.

The target is officially measured on a quarterly basis and covers the point from arrival to when a patient is discharged, transferred elsewhere or admitted into hospital for further treatment, .

During the last three months of 2014 92.6% were seen within four hours – the worst figure during this whole period.

We will have to wait until the end of March to get the next quarterly data, but performance is on track to be even worse than that.

And NHS England has already admitted the average for the whole of 2014-15 will be below 95% – the first time this has happened for a whole year under the target.

The situation was particularly bad at the turn of the year. A number of hospitals had to declare major incidents, a move normally associated with accidents involving multiple injuries.

To the NHS’s credit, performance did pick up after that point – although not enough to return above the 95% mark.

However, it is worth noting that the UK’s National Health Service has one of the toughest waiting time measures in the world.

Another way to look at it is to see the performance of individual trusts. Take a look at this chart.

England – as the biggest health service and the one that produces the most up-to-date data – has received the most attention.

But the problems have been just as acute elsewhere in the UK. In fact, England could be said to have faired the best.

In January waiting times reached their worst levels in Wales since the current way of recording performance was introduced in 2009.

It got so bad that one police force reported it had had to start taking people to hospital because there weren’t enough ambulances.

Of course, A&Es do not work in isolation and so, unsurprisingly, other parts of the hospital system have experienced problems.

Analysis by the House of Commons Library shows how such pressure points got worse this winter between November and March.

The simple answer is the number of people coming to A&E has gone up. Take a look at these figures.

Between November and February just over 7m visits were made to A&Es in England – 190,000 more than the year before.
The busiest week – the one ending 21 December – saw 446,000 people arrive, up by nearly 10% on the same week the year before and the highest ever recorded.

There were 1.82m emergency admissions – the most complicated cases that cannot be dealt with by A&E – up 51,000 on last year.

But this winter there has also been heated debate about what other factors may have played a role. These have ranged from the new 111 urgent phone service not being as good as it should to problems accessing social care and GPs.

Last spring and summer were also difficult, with the target being missed several times in England.

What is more, Scotland, Northern Ireland and Wales are all still a long way from achieving the target. The A&E story is unlikely to go away just yet.