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Send heavy drinkers for liver scan, GPs told

After the festive season- when people often over indulge there is a new warning on the damage that alcohol does.

After the festive season- when people often over indulge there is a new warning on the damage that alcohol does.

Women who regularly drink more than three-and-a-half bottles of wine a week should get their livers checked, says new draft advice for England.

For men, the threshold is five bottles of wine a week or 50 units of alcohol, says the National Institute for Health and Care Excellence.

The organisation says GPs should refer “harmful” drinkers for liver scans.

Cirrhosis can be silent until the damage becomes so extensive it stops the liver working. It usually takes years for the condition to reach this stage of organ failure.

Anyone who has been drinking harmful amounts for months should get scanned, say the draft recommendations.

Early treatment and support can prevent serious liver damage.

According to Public Health England, nearly 2 million people in England are drinking harmful amounts of alcohol – more than 50 units a week for men and 35 units a week for women.

The NHS recommends adults should not regularly drink more than 14 units of alcohol a week.

If you drink as much as 14 units a week, it is best to spread this evenly over three or more days.

A unit of alcohol is about half a pint of normal-strength lager or a single measure of spirits. A small (125ml) glass of 11% strength wine is about 1.4 units, while the same size glass of 14% strength wine is 1.8 units.

Prof Gillian Leng, deputy chief executive of NICE, said: “Many people with liver disease do not show symptoms until it is too late.

“If it is tackled at an early stage, simple lifestyle changes or treatments can be enough for the liver to recover. Early diagnosis is vital, as is action to both prevent and halt the damage that drinking too much alcohol can do.”

Dr Andrew Fowell, liver expert at the Portsmouth Hospitals NHS Trust, said: “Identifying people who are at risk of liver disease and offering them non-invasive testing to diagnose cirrhosis is key to ensuring they are given the treatment and support they need early enough to prevent serious complications.

“Ten years ago diagnosis of cirrhosis would often require a liver biopsy, but now with advances in non-invasive testing it is much easier for patients and health professionals to make a diagnosis.”

The draft quality standard from NICE recommends a non-invasive scan called transient elastography which uses ultrasound and low-frequency elastic waves to check the liver. A consultation on the draft document is open until February 2017.

Prostate cancer laser treatment truly transformative

Surgeons have described a new treatment for early stage prostate cancer as “truly transformative”.

Surgeons have described a new treatment for early stage prostate cancer as "truly transformative".

The approach, tested across Europe, uses lasers and a drug made from deep sea bacteria to eliminate tumours, but without causing severe side effects.

Trials on 413 men – published in The Lancet Oncology – showed nearly half of them had no remaining trace of cancer.

Lifelong impotence and incontinence are often the price of treating prostate cancer with surgery or radiotherapy.

Up to nine-in-10 patients develop erectile problems and up to a fifth struggle to control their bladders.

That is why many men with an early stage tumour choose to “wait and see” and have treatment only when it starts growing aggressively.

“This changes everything,” said Prof Mark Emberton, who tested the technique at University College London.

The new treatment uses a drug, made from bacteria that live in the almost total darkness of the seafloor and which become toxic only when exposed to light.

Ten fibre optic lasers are inserted through the perineum – the gap between the anus and the testes – and into the cancerous prostate gland.

When the red laser is switched on, it activates the drug to kill the cancer and leaves the healthy prostate behind.

The trial – at 47 hospitals across Europe – showed 49% of patients went into complete remission.

And during the follow-up, only 6% of patients needed to have the prostate removed, compared with 30% of patients that did not have the new therapy.

Crucially, the impact on sexual activity and urination lasted no more than three months.

No men had significant side effects after two years.

Prof Emberton said the technology could be as significant for men as the move from removing the whole breast to just the lump in women with breast cancer.

He said: “Traditionally the decision to have treatment has always been a balance of benefits and harms. The harms have always been the side effects – urinary incontinence and sexual difficulties in the majority of men.”

“To have a new treatment now that we can administer, to men who are eligible, that is virtually free of those side effects, is truly transformative.”

More than 46,000 men are diagnosed with prostate cancer in the UK each year.

The tumours tend to grow slowly, but still around 11,000 men die from the disease.

However, the new treatment is not yet available for patients. It will be assessed by regulators at the beginning of next year.

Other therapies to kill prostate cancers, such as very focused ultrasound – known as focal Hifu – have a lower risk of side effects.

But these treatments are not universally available.

Dr Matthew Hobbs, from the charity Prostate Cancer UK, said the technology could help men who face the conundrum of whether or not to have treatment.

“Focal therapy treatments like this one have the potential to offer a middle ground option for some men with cancer that has not spread outside the prostate,” he said.

He said the next challenge would be to find out which patients should still wait and see, which ones should have this type of therapy, and which should have more invasive treatments.

“Until we know the answer to this question, it is important that these results do not lead to the over-treatment of men with low risk cancer, or the under treatment of men at higher risk.”

The technology was developed at the Weizmann Institute of Science in Israel alongside Steba Biotech.

Scottish life expectancy still lowest in UK

Life expectancy for Scottish men and women has continued to improve – but they still die younger on average than people anywhere else in the UK.

Life expectancy for Scottish men and women has continued to improve - but they still die younger on average than people anywhere else in the UK.
Statistics from the National Records of Scotland put life expectancy at 77.1 years for baby boys born in the past three years, and 81.1 years for girls.

This was two years lower than the UK average for men, and 1.7 years lower than the female average.

And there were considerable differences between different areas of Scotland.

It showed males in East Dunbartonshire can expect to live for 80.5 years – 7.1 years longer than in Glasgow City, which has the lowest life expectancy in the UK at 73.4 years.

Females in East Dunbartonshire can expect to live for 83.5 years – 4.8 years longer than in West Dunbartonshire, which also has the lowest in the UK at 78.7 years.

In general, male and female life expectancy has tended to increase over time, by 5.8 years for women and by eight years for men since 1980-1982 – meaning the gap between the sexes has also narrowed.

However, the gap between Scottish and English life expectancy for both males and females has widened since 1980-1982 by 0.3 years for males and by 0.2 years for females.

And Scots of both sexes continue to have the lowest life expectancy at birth of any of the four UK countries.

In Scotland, men and women can expect to live shorter lives, by 2.3 years and 1.9 years respectively, than in England, where life expectancy is the highest in the UK.

Among the 28 EU countries, male life expectancy was highest in Cyprus (80.9 years), 3.8 years higher than in Scotland.

Female life expectancy was highest in Spain (86.2 years), 5.1 years higher than in Scotland.

The report also showed that males in Scotland could expect to live for a further 17.3 years at age 65 and females a further 19.7 years.

Despite Scotland’s comparatively low life expectancy, a European survey published last month suggested the country had the highest quality of life of the four UK nations.

The findings considered factors such as health, safety, access to education and personal rights.

Ambulances too slow to reach 999 calls

Ambulance services are struggling to reach seriously ill and injured patients quickly enough after rising demand has left the system over-stretched.Ambulance services are struggling to reach seriously ill and injured patients quickly enough after rising demand has left the system over-stretched.

Ambulance services are struggling to reach seriously ill and injured patients quickly enough after rising demand has left the system over-stretched.
Patients with life-threatening conditions – like cardiac arrests – are meant to be reached in eight minutes, but only one of the UK’s 13 ambulance trusts is currently meeting its target.

Freedom of information requests by the BBC to ambulance trusts showed over 500,000 hours of ambulance crews’ time in England, Wales and Northern Ireland was lost last year waiting for A&E staff to be free to hand over their patients to – a rise of 52% in two years.

This is the equivalent of 286 crews being taken out of the system for a whole year or enough to increase the number of ambulance journeys by 10%.

Senior paramedics said the situation had become so critical that it was not uncommon to run out of ambulances at peak times.

The Welsh ambulance service is the only one that is hitting its targets to respond to life-threatening calls – and that is only after it reduced the number of cases it classed as an emergency from a third to about 5% so it could prioritise the most critical calls.

Last week Scotland adopted a similar system to help it cope, while services in Northern Ireland and England are also looking to follow suit.

It comes after average response times for life-threatening calls topped 10 minutes in Northern Ireland – a rise of nearly three minutes in two years.

Figures provided by two trusts in England also showed average times topping eight minutes for the second highest priority calls, including strokes and fits.

College of Paramedics chair Andrew Newton said the situation was of “great concern”.

“Talking to colleagues around the country, it’s not uncommon to find there are no resources to respond at all at a given time, particularly at nights and weekends. I was talking to one colleague recently who was explaining to me that the nearest ambulances were probably in France.”

Prof Jonathan Benger, the ambulance lead at NHS England, said delays at hospitals were causing “big problems” for ambulance crews as it meant they were taken out of the system and could not answer 999 calls.

But he also said a crucial factor was the increasing number of calls being handled – they hit 9.4m last year, nearly treble the number a decade ago.

“In the face of rising demand it is not surprising we are having difficulty meeting these targets. It is time to look at the system,” he added

Thousands miss out on stroke treatment

About 9,000 stroke patients a year are missing out on a treatment that can prevent disability following a stroke, say UK experts.About 9,000 stroke patients a year are missing out on a treatment that can prevent disability following a stroke, say UK experts.

In the UK, nearly 90,000 people each year are admitted to hospital following a stroke. Clot retrieval can restore blood flow to the brain, preventing some lasting damage, but currently only 600 patients a year get this therapy, they estimate.

A national stroke audit reveals part of the problem is a lack of skilled staff to do the procedure.

During a stroke, the blood supplying vital parts of the brain is interrupted. The most common reason is a clot blocking a major blood vessel in the head, although some strokes are caused by a bleed.

The longer a part of the brain is starved of blood, the more likely lasting damage – such as paralysis and speech problems – will occur.

While many people with a stroke caused by a clot currently get drugs to help dissolve the blockage, this does not always work completely.

Thrombectomy – or clot retrieval – is another method, which aims to remove the clot mechanically. It is a highly skilled operation, and stroke services need to be set up to be able to deliver the treatment.

A thin metal wire housing a mesh is inserted into a major artery in the leg and, under X-ray guidance, it is directed to the site of the problem in the brain.

The mesh is then expanded, like a miniature fishing net, to trap and remove the clot.

Researchers from Newcastle University, Northumbria University, Oxford Academic Health Science Network and the National Institute for Health Research looked at thrombectomy data and stroke statistics in the UK to work out how many patients might benefit from the procedure.

In a presentation given to the UK Stroke Forum national conference, they estimated one in 10 people admitted to a hospital with a stroke could be eligible for thrombectomy.

Investigator Dr Martin James, at the Royal Devon and Exeter Hospital, said: “Delivering the procedure to the 9,000 people who need it will require major changes to the configuration and skill sets of existing acute stroke services.

“We must work quickly to establish what needs to be done so that more people in the UK can benefit from a treatment which can dramatically reduce disability after a stroke as well as cutting associated costs to the NHS and social care.”

Thrombectomy has already been deemed safe and effective by the health watchdog the National Institute of Health and Care Excellence.

NICE says the treatment should be carried out only in places that have trained specialists and the necessary support staff and equipment.
Consultant shortages

The Royal College of Physicians said: “There is a major shortage of appropriately trained staff to undertake thrombectomy, particularly outside of London, and it will take time to train up enough doctors to undertake this skilled procedure.”

NHS will miss targets on foreign patient cost payments

The government is expected to fall well short of its target of recovering £500m a year from overseas visitors treated in NHS hospitals in England.

The government is expected to fall well short of its target of recovering £500m a year from overseas visitors treated in NHS hospitals in England.

The Department of Health has “refined” to £346m its target for 2017-18, says the National Audit Office. Some £289m was paid in 2015-16; £73m in 2012-13.

A new “surcharge” for non-EU patients accounts for much of the rise, but only about half of debts owed are recovered.

The Department of Health said the increase showed “very good progress”.

NHS Trusts in England are legally obliged to check whether patients are eligible for free non-emergency NHS treatment and to recover any costs from overseas patients.

People from the European Economic Area (EEA), and Switzerland, are usually covered by agreements such as the EHIC scheme – where their government is billed for their treatment – while those from outside the EEA are invoiced directly.

But the National Audit Office report estimated that only half of debts were recovered from patients from outside the EEA and found that only 58% of hospital doctors knew some people were chargeable for NHS healthcare at all.

The Department of Health’s “ambitious” £500 m recovery target was aimed at reducing NHS trusts’ deficits, which reached £2.45 bn in 2015-16.

That year, an extra £164m was raised from a new £200 a year surcharge on visa applications paid by temporary migrants from outside the EEA.

That year also saw a 53% increase on the amount NHS trusts in England charged directly to patients, mostly to visitors from outside the EEA – much of which is thought to be due to new rules that allow hospitals to charge up to 150% of the cost of treatment, rather than a case of more people being charged.

And although amounts charged to people visiting from countries within the EEA increased slightly, they remain “well below” the ambition to recover £200m a year by 2017-18. The latest forecast for EEA income for that period is £72m.

The report found some hospitals were better than others at recovering money – 10 NHS trusts in London accounted for half of the total amount charged to non-EEA patients in 2015-16. Twenty trusts said they had no patients using the EHIC scheme.

It praised the Department of Health for using IT systems to help trusts find patients who should be charged and for visiting 60 trusts to promote its “cost recovery programme”, and said new financial incentives for reporting and charging overseas visitors had had an effect.

But it estimated that “trusts recover around half of the amounts they charge directly to patients, mainly visitors from outside the EEA”, with recovery rates varying widely – and it was not really understood why.

Head of the National Audit Office, Amyas Morse said: “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.”

He said much of the increase in amounts charged and recovered over the past two years was due to changes to charging rules: “If current trends continue and the charging rules remain the same, the department will not achieve its ambition of recovering up to £500m of overseas visitor income a year by 2017-18.”

Implant register launched to safeguard patients

A register of patients in England with breast and other cosmetic implants has been set up to allow them to be traced in the event of any safety concerns.

A register of patients in England with breast and other cosmetic implants has been set up to allow them to be traced in the event of any safety concerns.

The move comes after faulty Poly Implant ProthËse (PIP) silicone breast implants were recalled in 2010, affecting thousands of women.

The inclusion of individual patients’ details will not be mandatory.

However, all providers of breast implant surgery will be expected to participate in the scheme.

Health Secretary Jeremy Hunt said: “We want the NHS to be the safest healthcare system in the world and anyone who chooses to have a cosmetic procedure has the right to safe care.

“The PIP breast implant scandal in 2010 affected thousands of people which is why we asked NHS Digital to develop a new register which will allow people to be traced swiftly if that is ever needed.”

As a result of poor record-keeping following the PIP scandal, many women were unable to find out if they had been given the faulty implants.

In some cases, because surgery providers had gone out of business, women who received the implants could not be traced.

The Breast and Cosmetic Implant Registry – which will be managed by NHS Digital – will include patients treated by both NHS and private providers.

And participation in the registry will be noted during Care Quality Commission (CQC) inspections.

The registry will be expanded in the future to also cover other cosmetic implants, such as buttock or calf implants.

It is expected to record more than 20,000 cases of implant surgery every year and allow complications with specific implants to be picked up.

Providers will be expected to submit data on patients via an online portal.

Explicit consent from patients will be required to add their details to the registry – and this is in addition to the usual consent for the surgical procedure.

Noel Gordon, chair of NHS Digital, said the registry marked a major step forward in improving patient safety for people who undergo breast implant surgery each year.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons, the Association of Breast Surgery and the British Association of Aesthetic Plastic Surgeons welcomed the registry.

In a joint statement, they said: “This will protect patients by providing a way to actively monitor all implants, track and trace their use and provide data for further research, which may be used to further technological advances. We hope that all patients will consent to the submission of data on their behalf.”

DVLA making unfair health driving licence decisions

The Driver and Vehicle Licensing Agency (DVLA) is not making fair decisions about medical fitness-to-drive cases, a report has suggested.

The Driver and Vehicle Licensing Agency (DVLA) is not making fair decisions about medical fitness-to-drive cases, a report has suggested
The Parliamentary and Health Service Ombudsman’s report found “major failings” in eight drivers’ cases. It said people’s lives had been put on hold for years because of flawed decision-making and poor communication.

The DVLA said the vast majority of cases it handles are dealt with swiftly and correctly.

Criticisms in the report are directed at the Drivers’ Medical Group – the part of the DVLA which considers whether drivers with a medical condition are safe to drive.

The DMG makes between 600,000 and 750,000 licensing decisions every year and around 10% of those are complex cases dealt with by medical experts.

The report looked at eight complaints in detail which were received by the ombudsman between 2014 and 2015.

These all concerned people with complex medical conditions who were unfairly prevented from driving, sometimes for several years, the ombudsman’s report said.

The report found “major failings”, including evidence of flawed decisions, significant delays, poor communication and complaint handling in those cases.

And it said it was concerned that other people had also been treated unfairly and that the same mistakes could be repeated.

The report recommends that the DVLA improves the way it communicates with people applying for a licence and with medical professionals, and sets up robust standards to assess people with medical conditions fairly.

In addition, it says financial compensation should be offered to those affected by failures, where appropriate.

Parliamentary and Health Service Ombudsman Julie Mellor said the DVLA’s failings had had a real impact.

“People’s lives have been put on hold for years because of severe delays and flawed decisions by the DVLA, leading people to lose their jobs, causing stress, worry and isolation.”

She said the DVLA had produced a new guide for medical professionals and improved its complaint handling and communications – but there was still more to do.

“Further action is needed to make the assessments of fitness to drive more robust, to prevent others from suffering the same injustice in the future.”

Conditions that could affect your ability to drive safely include:

  • Epilepsy
  • Strokes
  • Other neurological and mental health conditions
  • Physical disabilities
  • Visual impairments

ESA benefit payments- retests axed for chronically ill claimants

Claimants of long term sickness benefits will no longer face repeated medical assessments to keep their payments.

Claimants of long term sickness benefits will no longer face repeated medical assessments to keep their payments.

Work and Pensions Secretary Damian Green said it was pointless to re-test recipients of Employment and Support Allowance (ESA) with severe conditions and no prospect of getting better.

More than two million people receive ESA, which is worth up to £109 a week. The move has been welcomed by charities supporting those with severe illness.

Shadow work and pensions secretary Debbie Abrahams said it was “a welcome U-turn” by the government, but “the devil was in the detail”. What about mental health conditions, conditions that are fluctuating, conditions that may not necessarily have a physical manifestation?” she said.

Applicants for ESA have to undergo a work capability assessment to find out if they are eligible and they are re-tested to ensure their condition has not changed. Some are re-tested every three months and others up to two years later.

Under the government’s change, those who are deemed unfit for work and with conditions that will not improve will no longer face re-testing.

Illnesses such as severe Huntington’s, autism or a congenital heart condition are among those that are likely to qualify for continuous payments without reassessment. The criteria will be drawn up with health professionals.

Mr Green said a “key part” of making sure those who were unable to work received “full and proper support” included “sweeping away any unnecessary stress and bureaucracy”.

Currently, those in the “work-related activity group” – deemed unable to work at the moment but capable of making some effort to find employment – receive up to £102.15 a week in ESA payments.

Those in the “support group” – deemed unable to work and not obliged to do anything to improve their chances of finding work – receive up to £109.30 a week.

From April 2017, payments will fall to £73 for new claimants in the “work-related activity” category as ministers argue that too few people in the category are moving into work.

Former Work and Pensions Secretary Iain Duncan Smith, welcomed the “progressive” reform to the re-testing regime, which he had set up when in office.

“I hope that the government will… move on to the fuller reform… where we lock together with the health department much more to be able to get a better health assessment of people, rather than a just strictly work assessment.”

Tim Nicholls, policy manager at the National Autistic Society, said ESA was a vital benefit for those unable to work, covering basic daily living costs such as food, heating and clothes.

“The flawed assessment process can be highly stressful for autistic people who can experience high levels of anxiety meeting new people or when their routine is broken, particularly when the stakes are so high,” he said. “We will be looking out for more details from the government.”

The smoking ban has led to a sharp fall in heart attacks

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking.

Major research suggests that the introduction of a smoking ban has resulted in a 40 per cent fall in the number of people suffering from heart attacks as the result of passive smoking
Heart attack rates in the UK have fallen by up to 42 per cent since the 2007 smoking ban, major research suggests.

A review of 77 studies found that reduced exposure to passive smoking has caused a “significant reduction” in heart problems across the population.

Several of the studies found that non smokers and ex-smokers gained most the benefits.

The Cochrane study examined a range of health outcomes in 21 countries, including the UK, which have introduced bans in recent years.

Researchers concluded that there was strong evidence that reduced exposure to passive smoking reduced the number of people suffering from cardiac problems.

The studies examined included a Liverpool study of 57,000 hospital patients. This found admissions for heart attacks fell by 42 per cent among men and 43 per cent among women in the five years since the ban was introduced in 2007.

And US research reviewed found a 14 per cent reduction in strokes in counties which introduced a ban, compared with those which did not.

Some 33 out of the 44 studies reviewed on heart disease found a “significant reduction” following the introduction of smoking bans.

Researchers said the studies took account of other trends over the period – such as a large increase in rates of statin prescribing, to protect against heart disease.

Review author, Professor Cecily Kelleher, from University College, Dublin, said: “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in second hand smoke exposure for countries and their populations.”

Professor Peter Weissberg, medical director of the British Heart Foundation, said: “This review strengthens previous evidence that banning smoking in public places leads to fewer deaths from heart disease and that this effect is greatest in the non-smoking population.

He said the studies were observational and all had their limitations, but it would be difficult to study the effects of passive smoking in a more robust scientific way.

Researchers said the evidence was less clear about whether the introduction of bans had actually helped people to give up smoking.

Nonetheless, smokers seemed to benefit from some reduction in exposure to passive smoke.

One Scottish study, which found no fall in smoking rates after a ban was introduced in 2006, found a 14 per cent reduction in hospital admissions for heart problems among smokers, and a 21 per cent reduction in admissions among non-smokers.

The research found the impact of the ban on respiratory health, and conditions such as asthma, was less clear cut, though seven of 12 studies on asthma found reduced hospitalisations since the ban.