Mental health loophole 'closed'

30 October 2012 Last updated at 12:36 ET

Emergency legislation designed to close a loophole in the law on mental health has been approved by the Commons.

It corrects a technical error affecting up to 5,000 patients sectioned under the Mental Health Act since 2002.

The error meant doctors who sectioned patients in England did not have the right authority to do so.

Health Secretary Jeremy Hunt insists all were qualified to make the clinical decisions and that no patient was wrongly detained.

He has ordered an independent review.

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"Start Quote

We believe that no one is in hospital who shouldn't be and no patients have suffered because of this"

End Quote Jeremy Hunt Health Secretary

Mr Hunt said: "We believe that all the proper clinical processes were gone through when these patients were detained. They were detained by medically qualified doctors. We believe that no one is in hospital who shouldn't be and no patients have suffered because of this.

"But for the avoidance of any remaining doubt, and in the interests of the safety of patients themselves, as well as the potential concerns of their families and the staff who care for them, we are introducing emergency legislation to clarify the position."

Approval error

Continue reading the main story

"Start Quote

We believe that the Department of Health and Strategic Health Authorities are taking swift action and we will continue to monitor the situation"

End Quote Paul Jenkins Chief Executive of Rethink Mental Illness

A patient can be sectioned if they are perceived to be a threat to themselves or other people.

Generally, a patient can be sectioned only if two doctors and a mental-health professional believe it is necessary.

Doctors who assess patients and make recommendations under the Mental Health Act, are required to be "approved" to do so by the Secretary of State.

Since 2002, the Secretary of State has delegated that approval function to strategic health authorities (SHAs).

However, four out of the 10 SHAs in England asked mental health trusts to carry out the validation and approval process for them, but did not ask for it to be referred back to them for final confirmation.

This is the error that Mr Hunt says needs rectifying as a matter of urgency.

He said up to 2,000 doctors working for the four SHAs - North East, Yorkshire and The Humber, West Midlands and East Midlands - did not have the right approval to section patients sent to hospitals that included Ashworth and Rampton Secure Hospital.

The Department of Health has asked Dr Geoffrey Harris, chairman of NHS South and former chairman of Buckinghamshire Mental Health Trust, to undertake an independent review to look at how this responsibility was delegated by these four SHAs, and, more broadly, the governance and assurance processes that all SHAs use for delegating any responsibilities.

He will report back to the Secretary of State by the end of the year.

All doctors involved have now been approved under the correct processes.

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Elderly 'housebound' by fall fear

30 October 2012 Last updated at 20:45 ET

A fear of falling is making many elderly people prisoners in their own homes, a survey has suggested.

More than one in five of the 500 people aged 75 and older, interviewed by the Women's Royal Voluntary Service charity, lived in fear of falling.

And 5% are so fearful that they will not leave their homes unaccompanied, the report found.

A third of them had suffered falls in recent years and a fifth of these said they had lost confidence as a result.

Many said they were especially worried during winter months.

'Bleak' findings

A quarter said poor street conditions - poor lighting and uneven pavements - made them feel less confident about leaving the house.

Continue reading the main story

• Try not to panic if you have a fall. It is likely that you will feel shocked and a bit shaken, but staying calm will help you to gather your thoughts and remember what to do
• Do not get up quickly. Roll onto your hands and knees and find a stable piece of furniture, such as a chair or bed, to support you as you slowly get up
• Rest for a while before carrying on with your daily activities
• If you are injured or cannot get up, call for help

David McCullough, chief executive of the WRVS, said: "These are bleak findings.

"With winter approaching, older people have little confidence to get out and about because they fear they will fall and, as this research shows, the psychological effects of worrying about a fall can be as debilitating and devastating as physical injuries."

Every year in the UK nearly three-quarters of a million people aged over 60 end up in the local A&E department after a fall, and one in three of these will end up staying in hospital because of their injuries.

Figures show around a third of adults who are over 65 and living at home will experience at least one fall a year. This rises to half of adults over 80 who are either at home or in residential care.

'Not inevitable'

In 2009 in England and Wales, there were 3,593 deaths as a result of falls.

Making small changes at home, such as using non-slip rugs and mats and ensuring that rooms are clutter-free and well lit, can help prevent falls.

Michelle Mitchell, of the charity Age UK, said: "At their worst falls can be the cause of death, but falls are not an inevitable part of ageing - many falls can be prevented and there is much that can be done to help people who have fallen not to fall again."

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Backing for malaria drugs subsidy

31 October 2012 Last updated at 05:07 ET By Jane Dreaper Health correspondent, BBC News

Researchers who evaluated a global subsidy for malaria treatment say it had a substantial impact in a short space of time.

Publishing their results in The Lancet, the global health experts acknowledged that the scheme had been "highly controversial".

The Affordable Medicines Facility for malaria (AMFm) was called into question by Oxfam last week.

The research says it reduced the price of drugs and led to more treatment.

AMFm was launched in seven African countries by the Global Fund with the aim of bringing down the price of the most effective form of malaria treatment, to discourage problems with resistance.

Continue reading the main story

"This programme rapidly met its benchmarks despite the many constraints, expectations and unrealistic timelines imposed on it"

End Quote Comment article by scientists The Lancet

The researchers, led by a team from London School of Hygiene and Tropical Medicine, found the subsidy led to large falls in the price of drugs in most of the pilot schemes.

They said: "There had been concern that the poorest would not benefit from the programme, because the drugs were not free.

"The effect of AMFm in Niger and Madagascar was limited, with low orders.

"In all other pilots, it's likely AMFm had a dramatic effect on drugs sold through the private for-profit market.

"These changes were substantial and achieved in only a few months, which showed the power of tapping into the distributional capacity of the private sector."

Oxfam has criticised the scheme for focusing on "untrained shopkeepers" to help deliver treatment in rural communities - but supporters of AMFm claim these objections are purely ideological.

US opposition

The evaluation did not measure health outcomes, and the researchers said data on the use of treatment was not yet available.

In an accompanying comment article, 10 eminent scientists noted "unremitting opposition" to AMFm from the United States, and appealed for the scheme to be preserved in its current form when the Global Fund's board decides its future next month.

The scientists said: "This programme, when fully implemented, rapidly met its benchmarks despite the many constraints, expectations and unrealistic timelines imposed on it.

"We must acknowledge that an efficient approach to subsidising anti-malarial drugs has worked, making them available in the private sector where people go to buy them."

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Failure regime in NHS 'unclear'

29 October 2012 Last updated at 21:09 ET By Nick Triggle Health correspondent, BBC News

The way financially-troubled parts of the NHS are being dealt with appears to be done "on the hoof", MPs say.

The Public Accounts Committee also expressed concern that ministers could not offer adequate assurances that access to good quality care would be maintained when trusts had problems.

And the MPs also suggested the reforms being introduced next year could make the situation worse.

It comes as a number of NHS bodies in England are struggling with debt.

The cross-party group of MPs said that while overall the NHS finished last year with a £2bn surplus, the figure masked the problems developing in a number of trusts.

A total of 34 organisations - nearly one in 12 - failed to balance their books in 2011-12.

It represents a significant rise on the year before and would have been even higher if local health chiefs and the Department of Health had not provided bailouts

'Short-term decisions'

But despite this growing problem the MPs said the government was unable to explain what would trigger action in a trust with serious financial problems and how essential services would be maintained while this happened.

One trust - South London Healthcare - has already been put into administration. A report published on Monday recommended the trust be dissolved, paving the way for a radical reorganisation of services across the area.

Continue reading the main story

We need the government to accept that financial pressures are the biggest facing the NHS at the moment"

End Quote Mike Farrar

But the committee said there were no clear rules or thresholds that trigger such steps.

Committe chairman Margaret Hodge said: "It very much looks like the department [of health] is inventing the rules and processes on the hoof rather than anticipating problems and establishing risk protocols."

The committee said keeping control of finances was only going to get more difficult as the NHS was in the middle of a £20bn savings drive.

And it said the introduction of clinical commissioning groups - the GP-led organisations that will take charge of the NHS budget next year - could lead to short-term decisions being taken that could make the problems worse.

The MPs also criticised the impact of the private finance initiative (PFI).

Under the programme, private money was used to fund building schemes which NHS trusts then paid back over time - similar to a mortgage on a house.

But the committee said there was a number of trusts where those repayments were so high that they were struggling to break even and priorities were being "distorted".

Mike Farrar, chief executive of the NHS Confederation, which represents trusts, said he agreed there needed to be greater clarity for dealing with financial failure.

"We need the government to accept that financial pressures are the biggest facing the NHS at the moment. We cannot deal with these issues on a piecemeal basis. We need a frank conversation with the public about how we deal with these problems.

"Propping up struggling trusts with short term solutions is not the answer. We need to take action before we reach crisis point."

But Health Minister Lord Howe denied there were problems on the scale being described, adding: "This NHS is in robust financial health."

He said the government was working with NHS trusts and regulators to ensure where financial problems developed they were dealt with properly.

"To be clear - we are not 'making these rules' up," he added.

Shadow health minister Andrew said: "Ministers must get a grip on the turmoil and put staff and patients first."

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Breast screening harm highlighted

30 October 2012 Last updated at 02:43 ET By James Gallagher Health and science reporter, BBC News

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Christine Davidson: ''I went for screening because I thought if I had cancer it was better to discover early''

Women invited for breast cancer screening in the UK are to be given more information about the potential harms of being tested.

An independent review was set up to settle a fierce debate about whether the measure did more harm than good.

It showed that for every life saved, three women had treatment for a cancer which would never have been fatal.

The information will be included on leaflets to give women an "informed choice", the government said.

Cancer charities said women should still take up the offer of screening.

Controversy

Screening has been a fixture in diagnosing breast cancer for more than two decades. Women aged between 50 and 70 are invited to have a mammogram every three years. It helps doctors catch cancer early so treatment can be given when it is more likely to save lives.

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Screening in numbers

• More than two million women are screened each year in the UK
• Women between 50 and 70 are screened every three years.
• 48,000 women are diagnosed each year.
• One in eight women will develop breast cancer at some point in their lives.
• More than 11,000 women die from breast cancer each year

However, the national cancer director Prof Sir Mike Richards said it had become "an area of high controversy".

The debate centres around the concept of "overdiagnosis", that is screening which correctly identifies a tumour, but one which would never have caused harm. It leads to women who would have lived full and healthy lives having treatments - such as surgery, hormone therapy, radiotherapy and chemotherapy - which have considerable side-effects.

There is no way of knowing which tumours will be deadly and which could have been left alone.

The review, published in the Lancet medical journal, showed that screening saved 1,307 lives every year in the UK, but led to 3,971 women having unnecessary treatment. From the point of view of a single patient they have a 1% chance of being overdiagnosed if they go for screening.

The independent review panel was led by Prof Michael Marmot, from University College London. He said screening had "contributed to reducing deaths" but also "resulted in some overdiagnosis".

He said it was "vital" women were told about the potential harms and benefits before going for a mammogram.

Prof Richards said: "My view is that the screening programme should happen, we should invite women to be screened and give women the information to make their own choice."

He said the leaflets on breast cancer screening sent to women would be updated in the "next few months" to "give the facts in a clear, unbiased way".

Current advice does not highlight the scale of the risk.

To screen?

Cancer charities have unanimously argued that women should still choose to be screened.

Continue reading the main story

Analysis: Debate over?

The national cancer director described the findings as the "best data" available on the issue. However, this is unlikely to be the final word on breast cancer screening.

One of the lead voices questioning screening, Prof Peter Gotzsche from the University of Copenhagen, has told the BBC he has "serious reservations" about the findings.

His previous research suggested 10 women were treated unnecessarily for every life saved and questioned whether screening had any overall benefit.

He said "the estimate of the balance [of benefit vs harm] is still too positive" in this study.

He criticised the independent panel for using old data and ignoring more recent studies showing no benefit of screening.

He will be publishing a response in a medical journal soon.

A joint statement by Breakthrough Breast Cancer, Breast Cancer Campaign and Breast Cancer Care said: "We encourage all women to attend their screening appointments."

It said the review provided "much-needed clarity" that screening saves lives, but women must be given "clear and balanced information" to highlight the harms.

Cancer Research UK, which commissioned the review alongside the Department of Health, said that "on balance" it thought that women should go ahead with screening.

Its chief executive Dr Harpal Kumar said: "Because we can't yet tell which cancers are harmful and which are not, we cannot predict what will happen in an individual woman's case.

"Research is advancing at pace and we hope that in the future there will be a number of new techniques that we can use alongside the screening programme to make it more sophisticated and reduce the numbers of women having unnecessary treatment."

Richard Winder, the deputy director of the NHS Cancer Screening Programmes, said: "This was a robust review and we appreciate the rigour and efforts of the panel in conducting it.

"We are pleased that the panel concluded the NHS Breast Cancer Screening Programme confers significant benefit and should continue.

"Where they have made recommendations, we will work with all partners to take these forward."

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Care home abuse must end - Lamb

30 October 2012 Last updated at 09:53 ET

Abuse at care homes such as Winterbourne View was a "national scandal" that "has to end", health minister Norman Lamb has said.

Last week six people were jailed for their role in abusing patients at the private hospital near Bristol after an investigation by BBC's Panorama.

"What has been exposed by Panorama is utterly intolerable and has to come to an end," Mr Lamb told the Commons.

He confirmed that there were still safety concerns about six ex-patients.

The government's full response to the abuse at Winterbourne View will be published in November, he told MPs in response to an urgent question in Commons, tabled by shadow health minister Liz Kendal.

On Monday Panorama revealed new safety alerts had been raised about 19 of the 51 patients who were abused at Winterbourne View but who now live at other care homes.

Not all of the safeguarding alerts issued meant that the patient had been harmed.

Mr Lamb said: "Years and years of public money being spent on putting people into inappropriate settings, often putting them at risk of abuse - this is a national scandal and it has to end."

Mr Lamb said that he was "absolutely determined" that the government's final response "will be robust and clear".

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Cheap colour test picks up HIV

28 October 2012 Last updated at 14:53 ET By James Gallagher Health and science reporter, BBC News

A cheap test which could detect even low levels of viruses and some cancers has been developed by UK researchers.

The colour of a liquid changes to give either a positive or negative result.

The designers from Imperial College London say the device could lead to more widespread testing for HIV and other diseases in parts of the world where other methods are unaffordable.

The prototype, which needs wider testing, is described in the journal Nature Nanotechnology.

The test can be configured to a unique signature of a disease or virus - such as a protein found on the surface of HIV.

If that marker is present it changes the course of a chemical reaction. The final result is blue if the marker is there, red if the marker is not.

The researchers say this allows the results to be detected with "the naked eye".

Prof Molly Stevens told the BBC: "This method should be used when the presence of a target molecule at ultra-low concentration could improve the diagnosis of disease.

"For example, it is important to detect some molecules at ultra-low concentrations to test cancer recurrence after tumour removal.

"It can also help with diagnosing HIV-infected patients whose viral load is too low to be detected with current methods."

Early testing showed the presence of markers of HIV and prostate cancer could be detected. However, trials on a much larger scale will be needed before it could be used clinically.

The researchers expect their design will cost 10 times less than current tests. They say this will be important in countries where the only options are unaffordable.

Fellow researcher Dr Roberto de la Rica said: "This test could be significantly cheaper to administer, which could pave the way for more widespread use of HIV testing in poorer parts of the world."

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Miliband plans mental health push

29 October 2012 Last updated at 09:10 ET

The problem of mental illness in the UK is the "biggest unaddressed health challenge of our age", Labour leader Ed Miliband has said.

It "blights the lives of millions", costing UK business £26bn and the NHS an extra £10bn a year, he said.

Mr Miliband wants to give patients the same legal right to mental health therapies as physical healthcare.

Mental illness is "a taboo which must be broken if we are to rebuild Britain," he said.

Mr Miliband was giving his first major speech since the Labour Party conference where he adopted the "one nation" slogan created by 19th Century Tory Prime Minister Benjamin Disraeli.

He said that just as Disraeli addressed the national challenge of sanitation in the 19th Century, and the foundation of the NHS followed in the 20th Century, the mental health challenge facing the UK must be addressed this century.

"One in four of us will have a mental illness at some point in our lifetime," Mr Miliband said.

Continue reading the main story

Good mental health doesn't start in hospital or the treatment room, it starts in our workplaces, our schools and our communities"

End Quote Ed Miliband Labour Party leader

"There are so many people in Britain today who could be treated but who are intimidated from seeking help. And so many people who need support but... believe that no-one will care.

"For far too long our leading politicians have been far too silent about mental health, part of a taboo running across our society which infects both our culture and our politics.

"It is a taboo which not only blights the lives of millions but also puts severe strain on the funding of our NHS and threatens Britain's ability to pay our way in the world.

"It is a taboo which must be broken if we are to rebuild Britain as one nation."

The Labour leader criticised those in the public eye who "abuse the privilege of their celebrity to insult, demean and belittle others".

Sickness absence

This includes Janet Street-Porter and Jeremy Clarkson, whose "lazy caricatures" reinforce the taboo on the issue, he said.

"Just as we joined the fight against racism, against sexism and against homophobia, so we should join the fight against this form of intolerance."

He announced proposals to improve mental health provision in the NHS, including:

• Rewriting the NHS constitution to enshrine patients' legal right to therapies for mental illness
• Mental health training for all staff
• Better integration of physical and mental healthcare, and social care

Neglecting the problem ends up costing the NHS more, Mr Miliband argued, "in the strains and demands placed on those who carry the burden of care and in the trouble stored up over the years as minor problems become major ones".

Meanwhile, the annual costs to UK business are £15bn in reduced productivity, £8.5bn in sickness absence, and £2.5bn to replace staff who can no longer work.

The Labour leader is setting up a taskforce - led by the chairman of Barts Health NHS Trust, Stephen O'Brien - to draw up a strategic plan for mental health in society.

Mr Miliband said: "Too often governments have been stuck in a mindset that thought that physical health should always take priority - or that the answer to our health crises started and stopped with new government programmes.

"But good mental health doesn't start in hospital or the treatment room, it starts in our workplaces, our schools and our communities.

"So the task falls as much to organisations like the CBI as it does to the Royal College of Psychiatrists. In fact, everybody has a part to play. Only a nation acting together can overcome the challenge we face."

Mental health charities welcomed Mr Miliband's speech and his commitment to giving patients a legal right to therapies for mental illness.

Paul Farmer, chief executive of Mind, said: "Mental health is everyone's business. We are now seeing politicians finally realise that it isn't just the responsibility of health services to support people with mental health problems and that they have their own role to play in changing attitudes."

Marjorie Wallace, chief executive of the mental health charity SANE, said: "It is extraordinary that despite the scale of the challenge and the fact that mental illness costs the NHS and employers more than any physical condition, people do not have a legal right to therapies for mental health problems."

Rethink Mental Illness praised Mr Miliband for making mental health a priority, particularly improving the training of NHS staff: "As things stand, you can become a doctor having only studied mental health for a few days.

"As a result many health professionals do not have a good enough understanding of mental illness."

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Bust NHS trust 'to be broken up'

29 October 2012 Last updated at 10:00 ET By Nick Triggle Health correspondent, BBC News

A financially-troubled NHS trust should be broken up, leading to a radical overhaul in services across south east London, an administrator says.

The trust - South London Healthcare - was put into administration in July after being declared bust.

It is the first time such measures have been taken in the NHS.

The move, if agreed by ministers, would lead to the reorganisation of A&E, maternity and non-emergency surgery across seven hospitals.

Private providers would get the opportunity to bid to run some of those services - and possibly a whole hospital.

The special administrator - Department of Health official Matthew Kershaw - said without radical change the services would become unsafe in the future.

Write off debts

South London Healthcare, which incorporates the Princess Royal Hospital in Orpington, Queen Mary's in Sidcup and the Queen Elizabeth in Woolwich, has run up debts of more than £150m since being created in 2009 by the merger of the three. These are predicted to rise to £240m by 2016.

Some of the debt that has been built up on a turnover of £424m a year is related to the private finance initiative which was used for buildings at Woolwich and Orpington.

Continue reading the main story

Without radical intervention now, the situation has no prospect of turning itself around"

End Quote Matthew Kershaw Special administrator

As well as struggling financially, the trust also has some of the longest waiting times for operations and longer-than-average waits in A&E. However, it does have low infection and death rates.

Mr Kershaw has made a series of recommendations, which will now be put out to consultation until December before a final report is drawn up for the health secretary to examine.

Central to them is the dissolution of South London Healthcare and the writing off of its debts, which could then pave the way for key services to be run by other organisations. But the effect of this means services in other trusts would be affected.

The recommendations include:

• Queen Mary's losing in-patient surgery, which means it would no longer carry out operations such as knee and hip replacements and in effect become a community health centre. It is recommended it is renamed Bexley Health Campus and brought under the management of the Oxleas NHS Trust, which specialises in mental health and community care. Underused buildings could then be sold off to free up money.
• Princess Royal to be taken over by the bigger King's College NHS Trust, although an alternative option that may be considered is running a procurement process that would allow other NHS trusts and independent sector providers to bid to run it.
• The Queen Elizabeth merging with Lewisham NHS Trust to create a new organisation. Lewisham's A&E unit would then be downgraded to an urgent care centre, meaning emergency cases would be seen at nearby hospitals. The maternity unit at Lewisham could also be slimmed down, meaning complex cases would be dealt with elsewhere.
• The organisations which take responsibility for Queen Elizabeth's and the Princess Royal should get yearly bailouts from the Department of Health to cover the costs of making PFI repayments.

Mr Kershaw said: "Without radical intervention now, the situation has no prospect of turning itself around."

Taxpayers

Health Secretary Jeremy Hunt said it was essential that services in south east London were put on a sustainable footing as the continual amassing of debts meant that "vital resources were being diverted from other parts of the NHS".

"In making my final decision next year my objective will be to ensure that services are delivered more efficiently and to a high standard for the people of south east London. Patients and taxpayers deserve this," he added.

The decision to put the trust into administration - a measure made possible by legislation Labour introduced in 2009 - is being closely monitored within the NHS because it provides a blueprint for what could happen elsewhere.

An increasing number of hospitals are racking up debts during an era when money is tight and more and more services are being moved out into the community.

Experts believe the current network of hospitals is unsustainable.

There are another 20 hospitals that are in financial trouble - about a tenth of the network - although none has amassed debts on the scale of South London Healthcare.

Anna Dixon, director of policy at the King's Fund think tank, said it was good that tough action was being taken.

"While the recommendations will undoubtedly be controversial and tough to implement, radical redesign of health services is needed in many parts of the country."

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Trust 'should be split' over debt

26 October 2012 Last updated at 13:38 ET

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The department only opened six months ago

A London hospital trust which ran up debts of £150m should be divided up, a report will say next week.

Spiralling debts led to South London Healthcare Trust becoming the first NHS trust to be put into administration.

A government-appointed administrator will say on Monday its three hospitals should be hived off to nearby trusts and a Lewisham A&E unit should close.

BBC London's Karl Mercer said the plans could lead to "a radical shake-up" of care across the whole of south London.

Lewisham Hospital's A&E unit has been earmarked for closure in the report, six months after it reopened as part of a £12m refit.

The trust, unions and local MPs are not commenting on the report until it is officially announced on Monday.

South London Healthcare NHS Trust, which serves one million people in Bexley, Bromley and Greenwich, was put into administration in July.

The then Health Secretary Andrew Lansley appointed special administrator Matthew Kershaw after the trust ran up debts of £65m a year, which is about £1.3m a week.

Continue reading the main story

Karl Mercer Political Correspondent BBC News

---

Wherever you look in London, the NHS is in flux. This is a service that has to save £5bn in the coming three years, and a service that is having to adapt to the changing needs of an ageing population.

Health chiefs say doing nothing is not an option, but the changes being proposed across the capital are controversial.

In north-west London a four-month consultation on closing four of the nine A&E departments in the area has just ended. The plans led to a series of demonstrations and a 60,000 signature petition against the changes. The NHS locally says the changes will be better for patients in the future - more care delivered out of hospital and closer to home.

Expect similar arguments in south London when administrator Matthew Kershaw announces his recommendations on Monday.

Local politicians have already indicated privately there will be a big campaign against such changes - plenty for the new Health Secretary Jeremy Hunt to consider when both the south and north-west London plans end up on his desk for a decision in February.

Three hospitals make up the trust; Queen Elizabeth in Woolwich, The Princess Royal in Orpington and Queen Mary's in Sidcup.

Mr Kershaw will recommend that the A&E unit at Lewisham Hospital closes and patients be moved to Queen Elizabeth's to save money.

The BBC correspondent said: "The trust has struggled to pay the bills for its new buildings which were built under the Private Finance Initiative (PFI). That's a kind of mortgage which has to be paid back over 30 years.

"Efforts to tackle the problems have so far failed which is why the administrator was brought in.

"His draft report out on Monday will lead to a radical shake-up of care across the whole of south London."

The Princess Royal is likely to be taken over by King's Health Partners in south London, Queen Mary's would be taken over by a mix of Dartford and Gravesham and Oxleas NHS trusts and the Queen Elizabeth is expected to join up with Lewisham Hospital.

The BBC correspondent said Mr Kershaw believes savings of up to £100m will have to be made in the next five years, with "huge" implications for jobs.

"He'll also say that the government should pay up to £20m a year to cover the PFI bill currently being paid by South London Healthcare Trust for its hospital buildings," he said.

Mr Kershaw's draft report announcement will be followed by a month-long consultation with staff, patients and the public.

A final report will be submitted to Health Secretary Jeremy Hunt in January 2013 for a final decision in February.

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Women who quit smoking 'cut risk'

27 October 2012 Last updated at 08:39 ET By James Gallagher Health and science reporter, BBC News

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Dr Peter Mackereth: "It's important to get the message to young people not to start smoking in the first places"

Women who give up smoking by the age of 30 will almost completely avoid the risks of dying early from tobacco-related diseases, according to a study of more than a million women in the UK.

The results, published in the Lancet, showed lifelong smokers died a decade earlier than those who never started.

But those who stopped by 30 lost, on average, a month of life and if they stopped by 40 they died a year younger.

Health experts said this was not a licence for the young to smoke.

Continue reading the main story

'I started aged 11'

Angela started smoking when she was 11. "Before I knew it, I was addicted," she said.

She used to hide her habit by taking the dog out for a walk. At one point she was smoking 10 cigarettes a day and more if she was going out.

After several attempts to quit she was successful: "I had a bit of a health scare and that really gave me the motivation to finally kick the habit."

She is now 29 and says it is "brilliant" news that quitting before the age of 30 could make a big difference to her health.

"It's amazing, I can feel it already actually."

The study followed the first generation of women to start smoking during the 1950s and 60s. As women started smoking on a large scale much later than men, the impact of a lifetime of cigarettes has only just been analysed for women.

"What we've shown is that if women smoke like men, they die like men," said lead researcher Prof Sir Richard Peto, from Oxford University.

He told the BBC: "More than half of women who smoke and keep on smoking will get killed by tobacco.

"Stopping works, amazingly well actually. Smoking kills, stopping works and the earlier you stop the better."

Professor Peto added the crucial risk factor was "time" spent smoking, rather than amount.

"If you smoke 10 cigarettes a day for 40 years it's a lot more dangerous than smoking 20 cigarettes a day for 20 years," he said.

"Even if you smoke a few cigarettes a day then you're twice as likely to die at middle age."

He added it was hard to measure the risk of "social smoking" a few times a week.

Early death

The records from 1.2 million women showed that even those who smoked fewer than 10 cigarettes a day were more likely to die sooner.

Sir Richard said that it was exactly the same picture as for men.

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The British Lung Foundation said the prospects for long-term health were much better if people stopped smoking before they were 30, but cautioned that this was not a licence to smoke "as much as you want in your 20s".

Its chief executive, Dr Penny Woods, said: "Stopping smoking can also be difficult to do - an estimated 70% of current smokers say they want to quit, so you shouldn't start and just assume you'll be able to quit smoking whenever you want to.

Continue reading the main story

Smoking

• Smoking is responsible for more than five million deaths worldwide every year
• Smoking tobacco is a known or probable cause of around 25 diseases
• Cigarette smoke contains 4,000 chemicals that can damage the human body
• Eighty of which are known to cause cancer

Source: BBC Health

"The best thing for your health is to avoid smoking at all."

Prof Robert West, from the health behaviour research unit at University College London, said it was important to remember that smoking had more effects on the body than leading to an early death, such as ageing the skin.

"Around your mid-20s your lung function peaks and then declines. For most people that's fine - by the time you're into your 60s and 70s it's still good enough. But if you've smoked, and then stopped there is irreversible damage, which combined with age-related decline can significantly affect their quality of life.

"Obviously there is an issue around smoking if they want to get pregnant because it affects fertility and then there are the dangers of smoking during and after pregnancy."

The chartered health psychologist, Dr Lisa McNally, who specialises in NHS stop smoking services, also emphasised other factors.

Speaking to BBC News, she said: "There's the danger isn't there that people could almost take permission to continue to smoke to 30 or even to 40, but actually in my experience younger women quit smoking for other reasons other than life expectancy.

"They're more concerned about the cosmetic effects."

The Department of Health has announced that more than 268,000 people registered to take part in its "Stoptober" campaign - the UK's first ever mass event to stop smoking.

Health minister Anna Soubry said the £5.7m campaign had "exceeded expectations", adding that smokers were "five times more likely to give up for good after 28 days".

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Concerns over care home ratings

27 October 2012 Last updated at 20:28 ET By Hannah Barnes Reporter, 5 live Investigates

Care homes with five-star ratings are receiving premium fees despite not meeting essential standards set out by the care regulator.

Local authorities pay higher fees to care homes awarded top ratings.

But critics say this is a "cheque book system" open to any home prepared to pay for a rating.

The Care Quality Commission advises people to visit homes and check their most recent CQC inspection report before making a decision on care.

Care regulator the Care Quality Commission (CQC) stopped issuing its own star ratings in 2010 and now some homes pay independent ratings companies and consultants to assess them instead.

Gwenda Dunn was surprised to find that her aunt's care home had been awarded five stars by such a company.

"This is not a complaint against the home - it's a complaint as to how the home could be given five stars when it patently was not," she told the BBC's 5 live Investigates.

5 star failures

Mrs Dunn says her aunt's room was often cold and calls from her aunt for a commode during the night were sometimes ignored by staff.

Continue reading the main story

"Start Quote

People who aren't in the know would take it as face value, not recognising the reality"

End Quote Gwenda Dunn Niece of care home resident

Also, her aunt was frequently disturbed by another patient with dementia who often entered her room uninvited.

"I was there when the inspection was done. I spoke to the inspector and raised a fair amount of issues and then we found out within a week that the home had got five stars again," says Mrs Dunn.

"People who aren't in the know would take it as face value, not recognising the reality."

Continue reading the main story

Find out more

Listen to the full report on 5 live Investigates on BBC 5 live on Sunday, 28 October at 21:00 GMT or download the programme podcast.

The home was rated by David Allen, an independent consultant who trades under Prestige Quality Ratings (PQR).

Mr Allen says the issues raised with him lacked substance and were misplaced. He also says other people at the home spoke very highly of the care provided and he saw no reason to downgrade the home.

PQR is one of three independent ratings companies recognised by Sefton Council. The others are RDB Star Rating Limited and Assured Care.

With the top five-star rating attached, families might believe a home is providing an outstanding level of care.

But the BBC has found that out of 80 homes given a four or five-star rating in the Sefton area, 14 are failing to meet one or more of the essential standards set out by the CQC.

This includes standards of staffing, standards of treating people with respect and standards of caring for people safely and protecting them from harm.

All of the homes had been rated by either RDB Star Rating, Assured Care or PQR.

The CQC is taking action against two of the highly-rated homes, demanding immediate improvements be made - although it is not known which company provided their rating.

All three ratings companies have defended their awards system.

"I always take account of what the CQC have to say… but the CQC doesn't have to be right every time," says Frank Watts of Assured Care.

David Allen of PQR insists that his company's ratings are "accurate reflections of the quality of the care provided at care homes at the time of the assessment".

RDB Star Rating told the BBC its assessments were "comprehensive and reliable".

Higher fees for homes

Sefton Council pays a quality premium to homes given a high rating by the companies - a residential or nursing home with five stars receives an additional £40 per week on top of the basic fee paid for each person in its care.

A spokesman for Sefton Council said: "All the companies providing quality ratings use assessment criteria linked to outcomes in care home provision.

"We work closely with the CQC to ensure quality standards are closely monitored. If either party feel standards have reduced, through their own monitoring activity or inspections, we will decline or even suspend a particular rating and work with CQC in relation to this."

Continue reading the main story

"Start Quote

We maintain it is the responsibility of CQC as the regulator to assess the quality of care home"

End Quote Nadra Ahmed National Care Association

Sefton council is not the only one to pay a quality premium to homes awarded a four or five-star rating.

Redcar and Cleveland Borough Council says that since it introduced the RDB rating scheme in 2001, standards of care homes across the borough have improved.

But the BBC has learned that a quarter of its highly rated homes are failing to meet all the essential standards set out by the CQC.

"The council does feel that a new quality assessment tool would help to continue the drive to improve the quality of provision and therefore the RDB scheme will cease to be used at the end of this financial year," a council spokesperson said.

While the old Care Quality Commission rating system did have problems, critics say it was at least a system which was nationally recognised, independent, and easy for the public to understand.

"We maintain it is the responsibility of CQC as the regulator to assess the quality of care homes," says Nadra Ahmed, chair of the National Care Association which represents care homes.

"When the star rating system was scrapped by the CQC they consulted on the introduction of a system whereby assessments would be carried out by organisations independent of the CQC, which would be selected through a tendering process.

"The process was voluntary, so providers would pay to be assessed. The National Care Association felt strongly that this would be a cheque book rating system which enabled those who could afford it, to purchase a rating."

Bupa, the UK's second-largest care home group, is also critical of the CQC for abolishing its rating system:

"We would like to see them [star ratings] back so people can identify excellent care homes," said a company spokesperson.

"Other organisations, such as local councils and independent companies, are creating their own systems - but this could be confusing because there is no consistency."

The CQC warns people not to rely on ratings from outside companies when choosing a home.

"We do not endorse any external ratings systems," CQC operations director Amanda Sherlock told the BBC.

"We would recommend people look at a range of information including our website to get the latest reports into care homes, nursing homes, hospitals and other care providers."

Listen to the full report on 5 live Investigates on Sunday, 28 October at 21:00 GMT on BBC 5 live.

Listen again via the 5 live website or by downloading the 5 live Investigates podcast.

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Trust 'should be split' over debt

26 October 2012 Last updated at 13:38 ET

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The department only opened six months ago

A London hospital trust which ran up debts of £150m should be divided up, a report will say next week.

Spiralling debts led to South London Healthcare Trust becoming the first NHS trust to be put into administration.

A government-appointed administrator will say on Monday its three hospitals should be hived off to nearby trusts and a Lewisham A&E unit should close.

BBC London's Karl Mercer said the plans could lead to "a radical shake-up" of care across the whole of south London.

Lewisham Hospital's A&E unit has been earmarked for closure in the report, six months after it reopened as part of a £12m refit.

The trust, unions and local MPs are not commenting on the report until it is officially announced on Monday.

South London Healthcare NHS Trust, which serves one million people in Bexley, Bromley and Greenwich, was put into administration in July.

The then Health Secretary Andrew Lansley appointed special administrator Matthew Kershaw after the trust ran up debts of £65m a year, which is about £1.3m a week.

Continue reading the main story

Karl Mercer Political Correspondent BBC News

---

Wherever you look in London, the NHS is in flux. This is a service that has to save £5bn in the coming three years, and a service that is having to adapt to the changing needs of an ageing population.

Health chiefs say doing nothing is not an option, but the changes being proposed across the capital are controversial.

In north-west London a four-month consultation on closing four of the nine A&E departments in the area has just ended. The plans led to a series of demonstrations and a 60,000 signature petition against the changes. The NHS locally says the changes will be better for patients in the future - more care delivered out of hospital and closer to home.

Expect similar arguments in south London when administrator Matthew Kershaw announces his recommendations on Monday.

Local politicians have already indicated privately there will be a big campaign against such changes - plenty for the new Health Secretary Jeremy Hunt to consider when both the south and north-west London plans end up on his desk for a decision in February.

Three hospitals make up the trust; Queen Elizabeth in Woolwich, The Princess Royal in Orpington and Queen Mary's in Sidcup.

Mr Kershaw will recommend that the A&E unit at Lewisham Hospital closes and patients be moved to Queen Elizabeth's to save money.

The BBC correspondent said: "The trust has struggled to pay the bills for its new buildings which were built under the Private Finance Initiative (PFI). That's a kind of mortgage which has to be paid back over 30 years.

"Efforts to tackle the problems have so far failed which is why the administrator was brought in.

"His draft report out on Monday will lead to a radical shake-up of care across the whole of south London."

The Princess Royal is likely to be taken over by King's Health Partners in south London, Queen Mary's would be taken over by a mix of Dartford and Gravesham and Oxleas NHS trusts and the Queen Elizabeth is expected to join up with Lewisham Hospital.

The BBC correspondent said Mr Kershaw believes savings of up to £100m will have to be made in the next five years, with "huge" implications for jobs.

"He'll also say that the government should pay up to £20m a year to cover the PFI bill currently being paid by South London Healthcare Trust for its hospital buildings," he said.

Mr Kershaw's draft report announcement will be followed by a month-long consultation with staff, patients and the public.

A final report will be submitted to Health Secretary Jeremy Hunt in January 2013 for a final decision in February.

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Abuse home care workers jailed

26 October 2012 Last updated at 09:58 ET

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Workers from Winterbourne View were filmed pinning down and hitting patients

Six out of 11 care workers who admitted a total of 38 charges of neglect or abuse of patients at a private hospital have been jailed.

Five other workers from Winterbourne View near Bristol were given suspended sentences after the acts of abuse were uncovered by BBC Panorama.

Ringleader Wayne Rogers, 32, who admitted nine counts of ill-treating patients, was jailed for two years.

Judge Neil Ford QC said there was a "culture of cruelty" at the care home.

'Vile and inexcusable'

Continue reading the main story

It would be naive to believe that this monstrous behaviour had not been continuing for a very long time"

End Quote Victims' families

Judge Ford said no attempt was made to provide a caring environment and if the abuse had not been uncovered by the BBC, it would have continued.

He told the sentencing hearing the home had been "run with a scandalous lack of regard to patients and staff".

"What happened was a gross breach of trust," he said.

Alison Dove, 25, of Kingswood, was jailed for 20 months as was Graham Doyle, 26, of Patchway. Both pleaded guilty to seven charges of abuse.

Addressing Dove, Judge Ford said: "You suggested it was born of boredom during long shifts and that you had viewed patients as playthings."

He also referred to a letter Doyle wrote to him, in which the defendant had described his own behaviour as "disgusting, vile and inexcusable".

'Bite face off'

Judge Ford then told Doyle: "You are considered genuinely remorseful and haunted by guilt.

Please turn on JavaScript. Media requires JavaScript to play.

Ch Supt Louisa Rolfe: "These vulnerable people were subjected to the most extreme and persistent abuse."

"But your treatment of Simone Blake was often cruel, callous and degrading. It was always wholly unjustified."

Prosecutor Kerry Barker QC, said care watchdogs failed to act on repeated warnings of "inhumane, cruel and hate-fuelled treatment" of patients.

"The so-called restraint techniques were used to inflict pain, humiliate patients and bully them into compliance with the demands of their carers," he said.

Abuse of five residents at the home featured in footage played to the court during a week of sentencing hearings.

Among the hours of graphic footage, support worker Rogers is shown slapping patient Simon Tovey across the cheek before telling him: "Do you want a scrap? Do you want a fight? Go on and I will bite your bloody face off."

In a statement read outside court after the hearing, families of the abused patients said seeing the footage had been "distressing and extremely harrowing".

"The guilty parties were only charged with offences shown on the Panorama programme and it would be naive to believe that this monstrous behaviour had not been continuing for a very long time," they said.

Lawyers representing 17 families say they are now pursuing compensation in a civil action against Castlebeck, who owned Winterbourne View.

Defendant Jason Gardiner, who received a suspended jail term after admitting two charges of abuse, said he wanted to apologise for his actions.

"I take full responsibility for everything I have done," he said outside the court.

'Major flaws'

"It was a very difficult place to work, a tough place to work. We were under-staffed and working 12-hour days without a break.

"All I can do is apologise to everybody for what happened."

Sentencing Gardiner, Judge Ford had said he had heard he was "barely coping" with his remorse and regret.

James Welch, legal director of human rights campaign group Liberty, said he was "disappointed" with some of the sentences but thought the judge had been fair.

The home's owners, Castlebeck, said there had been "extensive changes in board and management" and new measures introduced to ensure it could not happen again.

The Care Quality Commission, which was heavily criticised after it ignored attempts by whistleblower Terry Bryan to inform them of the abuse that was happening at the home, said the responsibility for the abuse rested with the home's owners Castlebeck and individual employees.

Outgoing chair of the CQC, Dame Jo Williams said: "We are committed to do all we can to protect people whose circumstances make them vulnerable - and since the abuse at Winterbourne View was uncovered we have made changes to ensure that we are better placed to prevent abuse."

Care and Support minister Norman Lamb said: "This terrible case has revealed the criminal and inhuman acts some so-called care workers are capable of.

"It has also shone a light on major flaws in the system which we will address. We will publish our final recommendations very soon."

Sentences of all those found guilty are detailed below:

• Wayne Rogers, 32, of Kingswood, jailed for two years after admitting nine charges of ill-treatment.
• Alison Dove, 25, of Kingswood, was jailed for 20 months for seven counts of abuse;
• Graham Doyle, 26, of Patchway, was jailed for 20 months for seven counts of abuse;
• Nurse Sookalingum Appoo, 59, of Downend jailed for six months for wilfully neglecting patients;
• Nurse Kelvin Fore, 33, from Middlesbrough, also jailed for six months for wilfully neglecting patients;
• Holly Laura Draper, 24, of Mangotsfield, pleaded guilty to two charges of abuse and was jailed for 12 months;
• Daniel Brake, 27, of Downend, pleaded guilty to two charges of abuse and was given a six month jail sentence suspended for two years and ordered to carry out 200 hours of unpaid work;
• Charlotte Justine Cotterell, 22, from Yate, pleaded guilty to one charge of abuse and was given a four-month jail term suspended for two years. Cotterell was ordered to do 150 hours of unpaid work and complete 12 months supervision;
• Michael Ezenagu, 29, from Shepherds Bush, west London, admitted two counts of abuse and was given a six month jail sentence suspended for two years and ordered to carry out 200 hours of unpaid work;
• Neil Ferguson, 28, of Emerson Green, admitted one count of abuse and was given a six month jail term was suspended for two years and ordered to carry out 200 hours of unpaid work;
• Jason Gardiner, 43, of Hartcliffe, who admitted two charges of abuse, was given a four month jail term was suspended for two years and ordered to carry out 200 hours of unpaid work.

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Women who quit smoking 'cut risk'

27 October 2012 Last updated at 08:39 ET By James Gallagher Health and science reporter, BBC News

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Dr Peter Mackereth: "It's important to get the message to young people not to start smoking in the first places"

Women who give up smoking by the age of 30 will almost completely avoid the risks of dying early from tobacco-related diseases, according to a study of more than a million women in the UK.

The results, published in the Lancet, showed lifelong smokers died a decade earlier than those who never started.

But those who stopped by 30 lost, on average, a month of life and if they stopped by 40 they died a year younger.

Health experts said this was not a licence for the young to smoke.

Continue reading the main story

'I started aged 11'

Angela started smoking when she was 11. "Before I knew it, I was addicted," she said.

She used to hide her habit by taking the dog out for a walk. At one point she was smoking 10 cigarettes a day and more if she was going out.

After several attempts to quit she was successful: "I had a bit of a health scare and that really gave me the motivation to finally kick the habit."

She is now 29 and says it is "brilliant" news that quitting before the age of 30 could make a big difference to her health.

"It's amazing, I can feel it already actually."

The study followed the first generation of women to start smoking during the 1950s and 60s. As women started smoking on a large scale much later than men, the impact of a lifetime of cigarettes has only just been analysed for women.

"What we've shown is that if women smoke like men, they die like men," said lead researcher Prof Sir Richard Peto, from Oxford University.

He told the BBC: "More than half of women who smoke and keep on smoking will get killed by tobacco.

"Stopping works, amazingly well actually. Smoking kills, stopping works and the earlier you stop the better."

Professor Peto added the crucial risk factor was "time" spent smoking, rather than amount.

"If you smoke 10 cigarettes a day for 40 years it's a lot more dangerous than smoking 20 cigarettes a day for 20 years," he said.

"Even if you smoke a few cigarettes a day then you're twice as likely to die at middle age."

He added it was hard to measure the risk of "social smoking" a few times a week.

Early death

The records from 1.2 million women showed that even those who smoked fewer than 10 cigarettes a day were more likely to die sooner.

Sir Richard said that it was exactly the same picture as for men.

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The British Lung Foundation said the prospects for long-term health were much better if people stopped smoking before they were 30, but cautioned that this was not a licence to smoke "as much as you want in your 20s".

Its chief executive, Dr Penny Woods, said: "Stopping smoking can also be difficult to do - an estimated 70% of current smokers say they want to quit, so you shouldn't start and just assume you'll be able to quit smoking whenever you want to.

Continue reading the main story

Smoking

• Smoking is responsible for more than five million deaths worldwide every year
• Smoking tobacco is a known or probable cause of around 25 diseases
• Cigarette smoke contains 4,000 chemicals that can damage the human body
• Eighty of which are known to cause cancer

Source: BBC Health

"The best thing for your health is to avoid smoking at all."

Prof Robert West, from the health behaviour research unit at University College London, said it was important to remember that smoking had more effects on the body than leading to an early death, such as ageing the skin.

"Around your mid-20s your lung function peaks and then declines. For most people that's fine - by the time you're into your 60s and 70s it's still good enough. But if you've smoked, and then stopped there is irreversible damage, which combined with age-related decline can significantly affect their quality of life.

"Obviously there is an issue around smoking if they want to get pregnant because it affects fertility and then there are the dangers of smoking during and after pregnancy."

The chartered health psychologist, Dr Lisa McNally, who specialises in NHS stop smoking services, also emphasised other factors.

Speaking to BBC News, she said: "There's the danger isn't there that people could almost take permission to continue to smoke to 30 or even to 40, but actually in my experience younger women quit smoking for other reasons other than life expectancy.

"They're more concerned about the cosmetic effects."

The Department of Health has announced that more than 268,000 people registered to take part in its "Stoptober" campaign - the UK's first ever mass event to stop smoking.

Health minister Anna Soubry said the £5.7m campaign had "exceeded expectations", adding that smokers were "five times more likely to give up for good after 28 days".

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Hospital to cut 750 jobs by 2015

26 October 2012 Last updated at 09:18 ET

A hospital trust in South Yorkshire has announced it will be cutting 750 jobs, about 20% of its workforce, by 2015.

Rotherham NHS Foundation Trust said it needed a "smaller hospital, with substantially fewer beds" and a smaller workforce to save £50m over the next four years.

A report presented to the board by its chief executive said "compulsory redundancies are inevitable".

Unison has blamed the cuts on mismanagement.

Chief executive Brian James said: "The NHS continues to face tough times financially.

"Our staff are our biggest asset, but also our biggest cost and we are exploring how to best manage and substantially reduce our costs whilst ensuring we continue to provide quality healthcare."

The report, entitled Creating Certainty in an Uncertain World, said "radical change" was necessary for the trust to save £50m from its £220m budget before 2015, and meet government targets.

Continue reading the main story

"Start Quote

Patients and staff are already feeling the strain, feeling there aren't enough nurses"

End Quote Sue Cookman Unison

Unions and patients have reacted angrily to the announcement.

Unison regional organiser Sue Cookman said it was a "kneejerk reaction" from the trust.

She said: "Nothing's new about the savings. To talk about culling 750 jobs seems to be highly irresponsible and will have a massive impact on patient care.

"I think the patients and staff are already feeling the strain, feeling there aren't enough nurses, feeling that things are taking too long."

Lorraine White, from Rotherham, an outpatient at the hospital, said: "It's unacceptable. There doesn't appear to be enough staff to cover the roles that are required already.

'Unnecessary admin staff'

"This is my local hospital and I'd like to think it was going to stay with at least the amount of staff that it has right now. I can't imagine that it will function effectively with less staff.

"I do rely heavily on this service."

Continue reading the main story

The trust in numbers

• 3,800 employees
• £220m is the current annual operating budget
• £150m of that is spent on staff
• £50m is the amount the trust said it needs to cut from its budget by 2015

Source: Rotherham NHS Foundation Trust

Katherine Murphy, Chief Executive of The Patients' Association, said: "Every hospital needs to put delivering the highest standard of patient care at the heart of re-organisation plans.

"The government's decision to cut £20bn from the NHS budget is affecting the services patients receive - evidence from our research and calls to our helpline demonstrate that waiting times are rising, treatments are being rationed and too many are experiencing poor care.

"The government needs to urgently consider the financial pressure trusts are facing and the inevitable impact on patients."

One staff member, who did not want to be named, told the BBC he was not aware of the plans.

He said: "I think it would be quite nice to see some redundancies from the administrative side of the NHS, rather than the clinical and nursing side... I think there is a lot of unnecessary staff in the admin department.

"I think without further investment in the NHS we're really going to struggle to deliver the service provision when we have an aging population.

"More and more people are seeking hospital attendances as they go on and yet we're shutting hospital beds and making staff redundant."

The British Medical Association said it was "surprised by the scale of the job cuts".

A spokesperson said: "We are also concerned about the impact that this decision will have on patients and the morale of staff.

"It is difficult to conceive of a way in which you can make staff cuts of this magnitude without a reduction in the quality of patient care."

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NHS maternity claims cost £3bn

26 October 2012 Last updated at 07:54 ET By James Gallagher Health and science reporter, BBC News

The NHS paid out more than £3bn in compensation claims linked to maternity care between 2000 and 2010, figures for England show.

An NHS Litigation Authority report said fewer than one in 1,000 births resulted in compensation.

However, it called for better training and for more senior staff to be available during labour.

The government said the NHS was one of the safest places to give birth, but it was important to learn from mistakes.

Continue reading the main story

Hidden behind the financial burden are countless stories of tragedy to individuals and families"

End Quote David Richmond Royal College of Obstetricians and Gynaecologists

Legal claims resulting from maternity care cost the NHS more than claims from any other type of treatment. The figure is high as children may need care which lasts a lifetime.

Of five and a half million babies born during the decade there were 5,087 claims.

They included mistakes in managing labour and failing to notice an abnormal heartbeat of a foetus in the womb, which can result in death or brain damage.

'Mistakes rare'

The report said claims often involved junior doctors and inexperienced midwives. It said more senior staff should be available.

The chief executive of the NHS Litigation Authority, Catherine Dixon, said: "Having a baby while under the care of NHS doctors and midwives remains very safe.

"However, because maternity claims are so serious as they involve harm to mothers and their babies, it's vital that we learn and share lessons from them so that professionals can improve their clinical practice in the future and prevent harm."

The health minister for England, Dr Dan Poulter, said mistakes were rare but "should never be tolerated".

He added: "The NHS remains one of the safest places in the world to have a baby, but no matter how well our midwives and doctors look after women giving birth, bad things still sometimes happen to a very small number of mothers and babies.

"If these incidents hadn't happened in the first place, the NHS would have had £3bn more to spend on patient care over the past 10 years."

The Royal College of Obstetricians and Gynaecologists said the cost was "enormous" and the report was "staggering in its stark facts".

David Richmond, the college's vice president said, "Hidden behind the financial burden are countless stories of tragedy to individuals and families, which are not included in this report.

"This is a serious wake-up call to all with responsibilities in providing maternity care, whether as providers, commissioners or regulators.

"Urgent action is needed to further improve the safety of clinical services for women and their babies."

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Abuse home care workers jailed

26 October 2012 Last updated at 09:58 ET

Please turn on JavaScript. Media requires JavaScript to play.

Workers from Winterbourne View were shown pinning down and hitting patients, in a BBC Panorama undercover report

Six out of 11 care workers who admitted a total of 38 charges of neglect or abuse of patients at a private hospital have been jailed.

Five other workers from Winterbourne View near Bristol were given suspended sentences after the acts of abuse were uncovered by BBC Panorama.

Ringleader Wayne Rogers, 32, who admitted nine counts of ill-treating patients, was jailed for two years.

Judge Neil Ford QC said there was a "culture of cruelty" at the care home.

'Vile and inexcusable'

Continue reading the main story

It would be naive to believe that this monstrous behaviour had not been continuing for a very long time"

End Quote Victims' families

Judge Ford said no attempt was made to provide a caring environment and if the abuse had not been uncovered by the BBC, it would have continued.

He told the sentencing hearing the home had been "run with a scandalous lack of regard to patients and staff".

"What happened was a gross breach of trust," he said.

Alison Dove, 25, of Kingswood, was jailed for 20 months as was Graham Doyle, 26, of Patchway. Both pleaded guilty to seven charges of abuse.

Addressing Dove, Judge Ford said: "You suggested it was born of boredom during long shifts and that you had viewed patients as playthings."

He also referred to a letter Doyle wrote to him, in which the defendant had described his own behaviour as "disgusting, vile and inexcusable".

'Bite face off'

Judge Ford then told Doyle: "You are considered genuinely remorseful and haunted by guilt.

Please turn on JavaScript. Media requires JavaScript to play.

Ch Supt Louisa Rolfe: "These vulnerable people were subjected to the most extreme and persistent abuse."

"But your treatment of Simone Blake was often cruel, callous and degrading. It was always wholly unjustified."

Prosecutor Kerry Barker QC, said care watchdogs failed to act on repeated warnings of "inhumane, cruel and hate-fuelled treatment" of patients.

"The so-called restraint techniques were used to inflict pain, humiliate patients and bully them into compliance with the demands of their carers," he said.

Abuse of five residents at the home featured in footage played to the court during a week of sentencing hearings.

Among the hours of graphic footage, support worker Rogers is shown slapping patient Simon Tovey across the cheek before telling him: "Do you want a scrap? Do you want a fight? Go on and I will bite your bloody face off."

In a statement read outside court after the hearing, families of the abused patients said seeing the footage had been "distressing and extremely harrowing".

"The guilty parties were only charged with offences shown on the Panorama programme and it would be naive to believe that this monstrous behaviour had not been continuing for a very long time," they said.

Lawyers representing 17 families say they are now pursuing compensation in a civil action against Castlebeck, who owned Winterbourne View.

Defendant Jason Gardiner, who received a suspended jail term after admitting two charges of abuse, said he wanted to apologise for his actions.

"I take full responsibility for everything I have done," he said outside the court.

'Major flaws'

"It was a very difficult place to work, a tough place to work. We were under-staffed and working 12-hour days without a break.

"All I can do is apologise to everybody for what happened."

Sentencing Gardiner, Judge Ford had said he had heard he was "barely coping" with his remorse and regret.

James Welch, legal director of human rights campaign group Liberty, said he was "disappointed" with some of the sentences but thought the judge had been fair.

The home's owners, Castlebeck, said there had been "extensive changes in board and management" and new measures introduced to ensure it could not happen again.

The Care Quality Commission, which was heavily criticised after it ignored attempts by whistleblower Terry Bryan to inform them of the abuse that was happening at the home, said the responsibility of the abuse rests with the home's owners Castlebeck and individual employees.

Outgoing chair of the CQC, Dame Jo Williams said: "We are committed to do all we can to protect people whose circumstances make them vulnerable - and since the abuse at Winterbourne View was uncovered we have made changes to ensure that we are better placed to prevent abuse."

Care and Support minister Norman Lamb said: "This terrible case has revealed the criminal and inhuman acts some so-called care workers are capable of.

"It has also shone a light on major flaws in the system which we will address. We will publish our final recommendations very soon."

Sentences of all those found guilty are detailed below:

• Wayne Rogers, 32, of Kingswood, jailed for two years after admitting nine charges of ill-treatment.
• Alison Dove, 25, of Kingswood, was jailed for 20 months for seven counts of abuse;
• Graham Doyle, 26, of Patchway, was jailed for 20 months for seven counts of abuse;
• Nurse Sookalingum Appoo, 59, of Downend jailed for six months for wilfully neglecting patients;
• Nurse Kelvin Fore, 33, from Middlesbrough, also jailed for six months for wilfully neglecting patients;
• Holly Laura Draper, 24, of Mangotsfield, pleaded guilty to two charges of abuse and was jailed for 12 months;
• Daniel Brake, 27, of Downend, pleaded guilty to two charges of abuse and was given a six month jail sentence suspended for two years and ordered to carry out 200 hours of unpaid work;
• Charlotte Justine Cotterell, 22, from Yate, pleaded guilty to one charge of abuse and was given a four-month jail term suspended for two years. Cotterell was ordered to do 150 hours of unpaid work and complete 12 months supervision;
• Michael Ezenagu, 29, from Shepherds Bush, west London, admitted two counts of abuse and was given a six month jail sentence suspended for two years and ordered to carry out 200 hours of unpaid work;
• Neil Ferguson, 28, of Emerson Green, admitted one count of abuse and was given a six month jail term was suspended for two years and ordered to carry out 200 hours of unpaid work;
• Jason Gardiner, 43, of Hartcliffe, who admitted two charges of abuse, was given a four month jail term was suspended for two years and ordered to carry out 200 hours of unpaid work.

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Three-person IVF trial 'success'

24 October 2012 Last updated at 13:01 ET By Michelle Roberts Health editor, BBC News online

US scientists say a human and animal trial of a controversial new IVF treatment has yielded promising results.

The findings in Nature magazine show healthy-looking embryos can be created from a mix of three adult donors.

Human embryos were grown in the lab and some appeared normal, while monkeys born using the same technique remained fit and well, now aged three.

A public consultation on the ethics of using this IVF in the UK is under way.

Its findings will be reported to the health secretary in spring 2013.

The technique is designed to prevent debilitating and fatal "mitochondrial" diseases, which are passed down only from mother to child and which cause muscle weakness, blindness and heart failure.

Continue reading the main story

"Start Quote

It is still a long way off ready for human use"

End Quote Prof Peter Braude King's College London

By using two female egg donors, these DNA errors could be cancelled out, scientists believe.

Three-person IVF uses the core genetic information from mother and father as usual, but puts it into a donor egg which contains healthy mitochondria.

Mitochondria sit in the cystoplasm of the egg - akin to the white of a hen's egg. They contain only a tiny fraction of our genetic material, with the bulk that determines things like our hair and eye colour housed in the nucleus - a speck in the yolk if you use the hen's egg analogy.

Scientists have been studying two ways of creating three person embryos.

One way is to take the nucleus from the mother's egg and put it into a donor egg that has healthy mitochondria and has had its own nucleus removed. This new egg can then be fertilised with the father's sperm.

Another way is to fertilise the mother's egg first before removing the nucleus and putting it into the donor egg.

The latest study looked at the first method.

Testing

The Oregon Health team took eggs from seven women who had volunteered to take part in the research.

Continue reading the main story

"Start Quote

The question is which method will work best in humans? Neither the US nor Newcastle researchers has allowed any human embryos to be implanted - all were destroyed after just a few days when still smaller than a pinhead."

End Quote

The scientists were able to replace the mitochondrial DNA in 65 of the eggs and then looked to see how well these fared over the next week or so.

The fertilisation rate afterwards was similar to the 33 control eggs that had not been manipulated, although over half had abnormal qualities.

Those that did fertilise normally developed to blastocyst stage - five or six days later, the point at which IVF embryos are normally transferred into the mother's womb - at a similar rate to the controls.

Dr Masahito Tachibana and colleagues say their research shows that the technique can work, at least in the lab. It is still not clear if it could lead to a healthy baby.

The scientists now want to be able to do more studies to ensure the treatment is also safe.

UK expert Prof Mary Herbert, of Newcastle University, has also been studying three person IVF, but using the other method which takes the nucleus out of an already fertilised egg.

She called the latest findings "encouraging" and said they were further proof that the concept was sound, although she believes the technique she uses will provide better results.

Review

Before either method could be used to help couples have a healthy baby in the UK, the government would need to give its approval and any clinic would need to obtain a license from the regulator - the Human Fertilisation and Embryology Authority (HFEA). Similar approval would be needed in other countries.

Last year the HFEA was asked to review the scientific effectiveness of both techniques. That review panel decided that the two methods might be useful in preventing mitochondrial disease, but asked for further experiments to assess their safety.

Prof Peter Braude, Emeritus Professor of Obstetrics and Gynaecology, King's College London, said: "It is exactly the sort of science that the HFEA expert committee recommended needed doing, and demonstrates further the feasibility of this technique.

"However it is still a long way off ready for human use."

He said: "Only one in five of the original eggs obtained fertilised normally and made it through to the implantation stage.

"This would mean that in order to be certain of getting embryos that might be suitable for transfer, around 12 eggs might be needed, not always possible in an IVF procedure."

How do you make a baby from three people?

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Elderly care target 'is at risk'

24 October 2012 Last updated at 19:06 ET By Nick Triggle Health correspondent, BBC News

The government's pledge to try to make England a world leader in elderly care is at risk of becoming "superficial" words, council chiefs are warning.

The Local Government Association and Association of Directors of Adult Social Services (ADASS) said the social care crisis had to be solved first.

The target of becoming the "one of the best" in terms of elderly care was made by the health secretary last month.

Jeremy Hunt will be expanding on the aim in a speech later.

He is expected to tell the annual ADASS conference in Eastbourne on Thursday that he wants England to become "one of the best countries in Europe to be old" and that councils "must take the lead".

To help, he will be announcing a £50m fund for hospitals and care homes to help pay for improvements to help patients with dementia.

These could include things such as hi-tech lighting, smells and sound to stimulate those with the condition.

'Danger of collapsing'

But the two groups have warned that mainstream services are under too much strain to achieve the goal.

A joint analysis they have produced has shown nearly £2bn has been trimmed from the social care budget in the past two years - a cut of nearly 15%.

Continue reading the main story

Unless we see urgent action the growing funding crisis threatens our ability to provide basic daily services that older people rely on, such as help with washing, getting out of bed and meals on wheels"

End Quote Councillor David Rogers Local Government Association

It predicts the funding gap will get worse in the coming years, partly because of the growing demands of the ageing population.

And it goes on to say that unless councils are given extra money, other budgets, including those covering leisure, libraries and transport, will have to be raided.

The government is considering reforming the system to cap the costs individuals have to pay. This was an idea put forward by the Dilnot Commission last year.

But the two groups have argued that such a change while helping individuals avoid huge costs, will do nothing to solve the funding problem they are facing.

ADASS president Sarah Pickup said the Dilnot proposals were just "one piece of the puzzle".

In reference to Mr Hunt's call made at the Conservative Party conference earlier this month that England should become the "best in the world" at caring for the elderly, Ms Pickup said if an answer was not found all that talk would be just "superficial" words.

"At the moment [social care] is a minimum wage industry. We have to think about what good care costs and be prepared to pay it."

David Rogers, from the Local Government Association, said: "The current care system is in danger of collapsing.

"Unless we see urgent action, the growing funding crisis threatens our ability to provide basic daily services that older people rely on, such as help with washing, getting out of bed and meals on wheels."

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Tenth whooping cough baby death

25 October 2012 Last updated at 06:24 ET By James Gallagher Health and science reporter, BBC News

A tenth baby has died in the worst outbreak of whooping cough for decades, Health Protection Agency figures for England and Wales show.

Cases continue to soar with 1,322 more people infected in September, bringing the total to 6,121 this year.

Newborn babies are most at risk of death from the disease.

Last month a UK-wide campaign was launched to vaccinate pregnant women in order to pass protection on to their child while it is still in the womb.

There have been more than 1,000 cases of whooping cough in Scotland and nearly 200 cases in Northern Ireland, but no reported deaths.

The infection can stop a baby breathing or lead to pneumonia, brain damage, weight loss and death.

Continue reading the main story

• It is also known as pertussis and is caused by a species of bacteria, Bordetella pertussis
• It mostly affects infants, who are at highest risk of complications and even death
• The earliest signs are similar to a common cold, which then develop into a cough and can even result in pneumonia
• Babies may turn blue while coughing due to a lack of oxygen
• The cough tends to come in short bursts followed by desperate gasps for air (the whooping noise)
• Adults can be infected - but the infection often goes unrecognised

However, newborns are too young to be protected by routine vaccination, which starts at two months of age.

So women who are between 28 and 38 weeks pregnant are now offered a whooping cough vaccine. The idea is to boost the mother's immunity, which is passed on to the child.

'Very concerned'

Dr Mary Ramsay, the head of immunisation at the Health Protection Agency, said: "We have been very concerned about the continuing increase in whooping cough cases and related deaths.

"All parents should ensure their children are vaccinated against whooping cough on time, even babies of women who've had the vaccine in pregnancy - this is to continue their baby's protection through childhood.

"Parents should also be alert to the signs and symptoms of whooping cough - which include severe coughing fits accompanied by the characteristic "whoop" sound in young children but as a prolonged cough in older children or adults.

"It is also advisable to keep babies away from older siblings or adults who have the infection."

Dr David Elliman, who's an immunisation expert at the Royal College of Paediatrics and Child Health, encouraged mothers to have the vaccine.

"When people have looked at where young babies get whooping cough, how they acquire it, common sense would tell you it's probably someone within the family and in fact, in practice it turns out to be the mother, which again is what you'd expect.

"So this is the logic behind giving the vaccine to mothers.

Routine vaccination was introduced in 1957. Before then cases could affect in excess of 100,000 people and kill 300 in a single year.

There are surges in whooping cough cases every three to four years. The current outbreak started at the end of 2011, but cases are already seven times higher than the last outbreak in 2008.

Health experts do not know why the outbreak is so large this year, especially as vaccination for whooping cough is at record levels.

One theory is that the bacterium which causes the infection, Bordetella pertussis, has mutated.

Another idea is that tight control of whooping cough is part of the problem. Repeated infections of whooping cough used to naturally boost people's immune systems.

However, after years of low levels of whooping cough the whole population may be more vulnerable to the infection.

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Inhale less, smokers told by NHS

23 October 2012 Last updated at 20:44 ET

Smokers who struggle to quit should inhale less or stop during set points of the day, such as at work, an official NHS body is suggesting

The National Institute for Health and Clinical Excellence (NICE) believes for hardcore smokers the approach will act as a stepping stone to quitting.

Traditionally the NHS has focused on advising smokers to give up completely.

But this proposal, which covers England, is an acknowledgement that for some a softer approach is needed.

Smoking rates dropped dramatically from the 1950s - when the link with lung cancer was proved beyond all doubt - to the turn of the century.

But over the past decade they have remained stubbornly stuck above the 20% mark.

'Kick-start'

Research shows that two-thirds of smokers want to quit and so this guidance is an attempt to reach out to those who are struggling.

Continue reading the main story

• Smoking is responsible for more than five million deaths worldwide every year
• Smoking tobacco is a known or probable cause of around 25 diseases
• Cigarette smoke contains 4,000 chemicals that can damage the human body
• Eighty of which are known to cause cancer

Source: BBC Health

It still makes clear that giving up completely is the best option and it even acknowledges it is questionable how big the health effect of smoking less will be.

Prof Mike Kelly, a public health expert at NICE, said: "If you are a smoker, quitting smoking is the best way to improve health and quitting in one step is most likely to be successful.

"However, some people - particularly those who are highly dependent on smoking - may not feel able or don't want to do this.

"Harm reduction approaches provide an alternative choice... for some people this can kick-start a gradual change in behaviour that eventually leads them to quit smoking."

Among the tactics being advocated is a temporary abstention by stopping smoking at home or at work or smoking less of a cigarette.

The guidance, which will now be consulted on, also said nicotine replacement therapy could be used to help with this approach.

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Malaria drugs scheme questioned

24 October 2012 Last updated at 05:09 ET By Jane Dreaper Health correspondent, BBC News

The charity Oxfam has cast doubt on an international scheme that aims to boost the provision of the most effective treatment for malaria.

The UK government has contributed £70m to the Affordable Medicines Facility for malaria (AMFm).

Oxfam says there is no evidence the programme has saved the lives of the most vulnerable people.

The body behind the AMFm says an independent study shows it has improved access and reduced drug prices.

Continue reading the main story

"Start Quote

This is a dangerous distraction from genuine solutions like investing in community health workers"

End Quote Dr Mohga Kamal Yanni Oxfam

The scheme was introduced three years ago by the Global Fund to Fight Aids, TB and Malaria.

It acts as a global subsidy to provide greater access to combination therapy for malaria, particularly through private-sector drug retailers in developing countries.

The idea is to reduce the use of older treatments that carry a higher risk of resistance, and to untap the potential of the private sector in reaching remote communities.

More than 200 million people contract malaria every year and 655,000 die from the disease - most of them are young children.

The scheme is being piloted in seven countries including Kenya, Ghana and Nigeria. Its future will be considered at a meeting of the Global Fund's board next month.

Oxfam has criticised it as "risky and dangerous".

The charity's senior health policy advisor, Dr Mohga Kamal Yanni, said: "It is dangerous to put the lives of sick children in the hands of a shopkeeper with no medical training, and to pursue a scheme that doesn't help those people who need it the most.

"There is no cheap option or short cut to combat malaria.

Continue reading the main story

"Start Quote

This programme is getting life-saving medicine to people who need it most."

End Quote The Global Fund

"The AMFm is a dangerous distraction from genuine solutions like investing in community health workers, who have slashed the number of malarial deaths in countries such as Zambia and Ethiopia.

"The Global Fund board must act on the evidence and put a stop to the AMFm now."

The Global Fund said Oxfam's claims were "simply untrue".

Continue reading the main story

How is malaria spread?

• Malaria is caused by an infection of the red blood cells with a tiny parasite called a protozoa
• It is a vector-borne disease, which means it is spread by another organism - the Anopheles mosquito
• When it bites an infected person the mosquito sucks up blood containing the parasite, which is then passed on to its next victim
• Latest estimates suggest there are about 250 million cases each year, resulting in more than one million deaths

Source: BBC Health

In a statement, it said: "Some Western aid groups oppose a pragmatic approach that includes any involvement of the private sector.

"But the reality of this programme is that it is getting life-saving medicine to people who need it most from the private sector outlets where they already seek treatment.

"Before the launch of AMFm, life-saving malaria treatments cost up to 20 times as much.

"An extensive study has shown that AMFm has increased availability and reduced prices for high quality anti-malarial drugs."

The UK's Department for International Development (DfID) allocated £40m to the scheme in its first two years, and boosted it by £31.6m this year. AMFm is also supported by the Canadian government and the Bill and Melinda Gates Foundation.

A DfID spokesman said: "DfID is helping to halve the number of malaria deaths in the most badly affected countries by 2015 in a number of ways, including improving access and availability of life-saving drugs.

"Studies have shown that quality drugs have got through to remote areas - and that more vulnerable groups, including children under five in rural areas and from the poorest backgrounds, are now being reached."

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