Cancer survivors deserve 'care plan'

29 March 2013 Last updated at 09:18 ET

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Cancer survivor, Sonia Wilson: "I felt like I was on my own"

All cancer patients should receive a "recovery package" at the end of their treatment offering ongoing support, the Department of Health (DoH) has said.

Some three in four patients are not given enough information on coping with long-term effects of the illness, its report with a leading charity suggests.

It calls for care targeting patients' financial, mental and physical needs.

Health minister Anna Soubry urged the NHS in England and local NHS teams to take "urgent action".

The call comes as a national survey of cancer survivors indicated about a quarter of people were feeling isolated after being treated for the illness - according to the DoH.

And almost 30% said they had numerous issues that were not being addressed, including fears about their cancer spreading.

Macmillan Cancer Support, which helped develop proposals for a recovery plan, estimated that about 200,000 people were not getting a package of support following their treatment.

Continue reading the main story

Local NHS teams need to consider providing a new range of care services for cancer survivors to tackle their needs"

End Quote Anna Soubry Public health minister

Nor were they being told how to contact someone outside of routine follow-ups if they had any problems.

The group's report calls for a recovery package that would provide a checklist for doctors and nurses to assess what emotional, physical and practical needs a patient might have after their treatment has ended.

This would include referrals to mental health or social services, as well as advice about financial support.

Care plans would also point patients towards physical activity services to help them regain their strength and fitness.

'Closer conversation'

Public health minister Anna Soubry said there were currently about 1.8m people who were being or had been treated for cancer - a figure set to rise to 3.4m by 2030.

"This joint document calls on NHS England and local NHS teams to take urgent action and consider our recommendations when they provide cancer services based on their local community's needs.

"Whether it's specialist help to get back to work, or being recommended to do a physical activity group, local NHS teams need to consider providing a new range of care services for cancer survivors to tackle their needs and improve their quality of life."

Ciaran Devane, chief executive of Macmillan Cancer Support, said that many cancer patients were crying out for this type of personalised support.

"If the NHS does one thing for cancer survivors it should be to commission this recovery package for its local population.

"We also need to keep on top of how cancer patients' quality of life is affected long-term."

Dr Frances Goodhart, a consultant clinical psychologist who works with cancer patients, said people needed to be given a realistic understanding of what recovery would involve, adding: "So often people are sent home with a message of just go home, pick up the pieces, make up for lost time - and actually, as we know, the consequences of cancer treatment are far more complicated."

Macmillan spokeswoman Nicola Cook added that regular contact with doctors was key to improving the system.

"We want GPs to be starting to have a much closer conversation and relationship with the cancer patient so that they're taking that information and they're seeing their GP say every three months - and the GP's asking them how things are.

"How are things at home? How's life at home? How's your marriage? How's your relationship? Are financial worries a concern? How's your mood? And so it's about having that community support in place by the GP and by other services so that people can live their life."

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Leeds heart surgery data 'wrong'

30 March 2013 Last updated at 13:11 ET

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Elspeth Brown: ""We are confident that our mortality figures are well within what would be expected"

Children's heart surgery was wrongly suspended at Leeds General Infirmary because of "incomplete" information, a senior doctor has said.

The unit was shut after the NHS medical director said data showed mortality figures were higher than expected.

But cardiologist Elspeth Brown said the data did not include all the operations, and that staff were confident in their clinical work.

NHS managers say various factors contributed to the suspension.

Surgery was suspended on Thursday, just 24 hours after a High Court ruling kept the unit open.

NHS medical director Sir Bruce Keogh said while the timing was "embarrassing" he had to act because data suggested a death rate twice the national average, and after concerns were raised about junior staff.

Ms Brown told the BBC that, since the announcement, she and colleagues had been examining the data that was used to make the decision..

"We do now know that the figures that were presented... were simply wrong, they were incomplete, did not include all the operations in Leeds, and that they had then been subject to some statistical analysis which generated this headline figure.

Continue reading the main story

We need people to stop attacking us, and we need to resume surgery as soon as possible"

End Quote Elspeth Brown Senior cardiologist

"We've been looking very hard at the figures over the last three years and we are confident that our mortality figures are well within what would be expected. All the clinicians in Leeds are very happy with our figures at present."

The hospital is at the centre of a long-running dispute over the future of children's heart services, and an NHS review said surgery would be better focused at fewer, larger sites.

Staffing concerns

Ms Brown said that it must be worrying for families of patients, but as clinicians they were "completely confident in our service".

"We need to put this to bed. We need people to stop attacking us, and we need to resume surgery as soon as possible."

Children who would have been treated in Leeds will be sent to other hospitals around England while a review, expected to last three weeks, is carried out.

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Professor Sir Roger Boyle: "Safety first is the watchword"

Sir Bruce had been contacted by, among others, Professor Sir Roger Boyle, director of the National Institute of Clinical Outcomes Research, which oversees mortality figures across the NHS.

Sir Roger told BBC Breakfast concerns were raised that two "relatively junior surgeons" had been left in charge of the unit, as well as from families of patients who claimed their requests to be transferred to other units were ignored.

"To have two relatively inexperienced people holding fort, without the ability for any senior advice, is a precarious situation in my view.

"It's a question of experience and fine balance between being able to offer a safe service and one that is precarious."

However, Ms Brown said there were two locum consultants who had been in their posts for six months, and although they were "relatively junior in their consultant career but they are both very experienced surgeons, and I have no concerns about them whatsoever."

Meanwhile, the Archbishop of York, John Sentamu, has paid tribute to the work of the staff at the cardiology unit and said he hoped the data would be properly analysed and published.

"I'm a layman, I'm not a doctor, I'm not a surgeon, all I can say is that I'm grateful for the commitment and the care this particular clinic has given and so when all the statistics are come out, I hope they'll be made public."

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Cystic fibrosis bug spread discovery

30 March 2013 Last updated at 20:33 ET

A dangerous infection which is becoming more common in people with cystic fibrosis can spread between patients, UK researchers say in The Lancet.

Doctors previously thought the Mycobacterium abscessus bacteria could only be caught from water and soil.

But hospitals around the world may now have to change the way patients are treated, the study says.

Around 3-10% of cystic fibrosis patients in Europe and the US are infected with the hard-to-treat bug.

There are around 9,000 people with cystic fibrosis in the UK although around one-in-25 people carries the faulty gene which causes the condition.

It affects the internal organs, especially the lungs and digestive system, by clogging them with thick sticky mucus which makes it hard to breathe and digest food.

Continue reading the main story

We believe the infection gets aerosolised, for example, when people cough - and because this bacteria is tough it hangs around in the air"

End Quote Dr Andres Floto Papworth Hospital, Cambridge

Researchers writing in The Lancet do not know exactly why Mycobacterium abscessus - which is distantly related to the bacteria that causes tuberculosis - is more likely to infect people with cystic fibrosis but it could be related to problems with the immune system.

It causes lung damage, and can be incredibly hard to treat with infected patients needing months of treatment with toxic drugs.

Although the infection has been on the rise over the past decade, doctors always believed it could not spread between humans.

But by looking at DNA from almost 170 samples of the bacterium, and using that to create a family tree, researchers found that it can indeed spread from person to person.

Infection control

Study leader Dr Andres Floto, research director of the Cystic Fibrosis Unit at Papworth Hospital in Cambridge and principal investigator at the Cambridge Institute for Medical Research, said the results had prompted them to completely rethink their infection control, despite already having strict policies in place.

He explained they already treated all in-patients in individual rooms without exposing them to other patients and out-patient clinics were set up so individuals did not have direct contact with each other.

"But despite that we were seeing transmission events in hospital which tells us that transmission is likely to be indirect," Dr Floto said.

"We are doing more research into that but we believe it gets aerosolised, for example, when people cough and because this bacteria is tough it hangs around in the air."

All inpatients at Papworth are now treated in negative pressure rooms to prevent the spread of airborne bugs and those with the infection are cared for away from the cystic fibrosis unit.

"And in outpatients for people with this bug, we use clinic rooms only once and then not for other patients until the next day when it has been deep cleaned."

Dr Floto said his team had already been in touch with hospitals in the UK and abroad to inform them of their findings and encourage them to change their practices and prevent the infection spreading as much as possible.

"Our results will help to protect patients from this serious infection."

Co-author Professor Julian Parkhill, head of pathogen genomics at the Wellcome Trust Sanger Institute, said: "By sequencing the complete genomes of bacteria we can accurately describe where they have emerged from and how they pass from person to person.

"This new information has led to rapid changes in how people with cystic fibrosis are cared for in hospital to protect them from this emerging threat."

Jo Osmond, director of Clinical Care and Commissioning at the Cystic Fibrosis Trust, said: "We will work closely with clinicians and the NHS to ensure appropriate measures are in place to deal with this issue.

"It is reassuring that this issue has been picked up early and that we are working positively to put in place measures to ensure cross-infection risks are reduced to a minimum.

"People with cystic fibrosis who have concerns about this issue should speak to their clinician."

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Heart patients 'helped by vest'

29 March 2013 Last updated at 04:24 ET By Jane Dreaper Health correspondent, BBC News

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The vest has 250 electrodes

Doctors are using special vests to precisely diagnose abnormal heart rhythms, in the first UK tests of their kind.

Cardiologists from Imperial College Healthcare NHS Trust in west London say the vests have enabled them to successfully treat more patients.

They hope the technology could eventually help more people suffering from heart palpitations.

The Arrythmia Alliance described the tests as a "fantastic development".

The work is in its early stages - doctors have used the vests on 40 patients so far.

However, they are impressed with the precision that each vest can give them. The results have been sent to a medical journal.

The panels contain about 250 electrodes, to determine exactly where abnormal electrical activity in the heart is causing problems.

Computer images are then generated to produce an "electrical map" of the patient's heart.

Using this technology - known as the ECVUE system - means that a subsequent procedure called ablation - in which a catheter is placed in the heart through veins in the leg and then used to burn away the problematic area - stands a better chance of success.

Dr Prapa Kanagaratnam, the consultant cardiologist leading the work, said: "It was very appealing right from the start to be able to get measurements of the heart's electrical activity with that degree of precision, without having to initially put wires into the heart.

"It was obvious to us straight away there was a group of patients we could apply the technology to effectively.

Continue reading the main story

Anything that can help diagnose these patients will ultimately help save lives"

End Quote Trudie Lobban Arrhythmia Alliance

"Many patients suffer palpitations at night or when they are resting and this can be impossible to treat by current techniques, as it is difficult to recreate a relaxing environment in the operating theatre.

"It's been very satisfying to use the ECVUE system and see the results over the last couple of years."

Each vest costs about £1,000 - the doctors say this compares well with conventional diagnosis techniques, especially given the benefit of treating patients they were sometimes not able to previously help.

It is thought there are about two million people with heart rhythm problems in the UK, although many of these will be undiagnosed. Arrhythmia is an umbrella term which covers various conditions.

'Huge shock'

Lana Morgan, 29, from Watford, is among the patients who have benefited from trying the vest at Imperial.

Lana, a former air stewardess, was retraining as an interior designer last year when episodes of breathlessness and a pounding heart began to feel serious.

She said: "I was working late on a project one day and I was quite stressed. I had to run for my train home and I felt quite unwell. I went home and phoned my doctor.

"I'd been brushing it off, but it got to the point when I couldn't ignore it any longer.

"My heart would beat quickly and then slow down, or beat strongly and then go faint. At the time I would feel as though I was going to pass out.

"It was only when I had a 24-hour monitor that it showed up that my heart wasn't beating correctly. They kept me in hospital for a week and that was a huge shock."

Unlike some patients, Lana's extra heartbeats tended to occur during exertion - but doctors struggled to trigger the palpitations and therefore pinpoint the exact area of the problem until they used the electrode vest.

She said: "They've told me that without this they couldn't have corrected my heart. But now I'm fixed and can get on with my life."

Trudie Lobban, the founder and chief executive of the Arrhythmia Alliance, a heart rhythm charity, said: "Anything that can help diagnose these patients will ultimately help save lives.

"These arrythmias are like electrical faults in your car - it can take ages to identify which wire is faulty.

"So being able to then successfully do the soldering work with the ablation is fantastic.

"It means people can return to work and live normal lives."

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Cancer survivors deserve 'care plan'

29 March 2013 Last updated at 09:18 ET

Please turn on JavaScript. Media requires JavaScript to play.

Cancer survivor, Sonia Wilson: "I felt like I was on my own"

All cancer patients should receive a "recovery package" at the end of their treatment offering ongoing support, the Department of Health (DoH) has said.

Some three in four patients are not given enough information on coping with long-term effects of the illness, its report with a leading charity suggests.

It calls for care targeting patients' financial, mental and physical needs.

Health minister Anna Soubry urged the NHS in England and local NHS teams to take "urgent action".

The call comes as a national survey of cancer survivors indicated about a quarter of people were feeling isolated after being treated for the illness - according to the DoH.

And almost 30% said they had numerous issues that were not being addressed, including fears about their cancer spreading.

Macmillan Cancer Support, which helped develop proposals for a recovery plan, estimated that about 200,000 people were not getting a package of support following their treatment.

Continue reading the main story

Local NHS teams need to consider providing a new range of care services for cancer survivors to tackle their needs"

End Quote Anna Soubry Public health minister

Nor were they being told how to contact someone outside of routine follow-ups if they had any problems.

The group's report calls for a recovery package that would provide a checklist for doctors and nurses to assess what emotional, physical and practical needs a patient might have after their treatment has ended.

This would include referrals to mental health or social services, as well as advice about financial support.

Care plans would also point patients towards physical activity services to help them regain their strength and fitness.

'Closer conversation'

Public health minister Anna Soubry said there were currently about 1.8m people who were being or had been treated for cancer - a figure set to rise to 3.4m by 2030.

"This joint document calls on NHS England and local NHS teams to take urgent action and consider our recommendations when they provide cancer services based on their local community's needs.

"Whether it's specialist help to get back to work, or being recommended to do a physical activity group, local NHS teams need to consider providing a new range of care services for cancer survivors to tackle their needs and improve their quality of life."

Ciaran Devane, chief executive of Macmillan Cancer Support, said that many cancer patients were crying out for this type of personalised support.

"If the NHS does one thing for cancer survivors it should be to commission this recovery package for its local population.

"We also need to keep on top of how cancer patients' quality of life is affected long-term."

Dr Frances Goodhart, a consultant clinical psychologist who works with cancer patients, said people needed to be given a realistic understanding of what recovery would involve, adding: "So often people are sent home with a message of just go home, pick up the pieces, make up for lost time - and actually, as we know, the consequences of cancer treatment are far more complicated."

Macmillan spokeswoman Nicola Cook added that regular contact with doctors was key to improving the system.

"We want GPs to be starting to have a much closer conversation and relationship with the cancer patient so that they're taking that information and they're seeing their GP say every three months - and the GP's asking them how things are.

"How are things at home? How's life at home? How's your marriage? How's your relationship? Are financial worries a concern? How's your mood? And so it's about having that community support in place by the GP and by other services so that people can live their life."

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Leeds heart surgery data 'wrong'

30 March 2013 Last updated at 09:11 ET

Children's heart surgery was wrongly suspended at Leeds General Infirmary because of "incomplete" information, a senior doctor has said.

The unit was shut after the NHS medical director said data showed mortality figures were higher than expected.

But cardiologist Elspeth Brown said the data did not include all the operations, and that staff were confident in their clinical work.

NHS managers say various factors contributed to the suspension.

NHS medical director Sir Bruce Keogh said data suggested a death rate twice the national average, and that concerns had been raised about junior staff.

Ms Brown told the BBC that, since the announcement, she and colleagues had been examining the data that was used to make the decision.

"We do now know that the figures that were presented... were simply wrong, they were incomplete, did not include all the operations in Leeds, and that they had then been subject to some statistical analysis which generated this headline figure.

Continue reading the main story

We need people to stop attacking us, and we need to resume surgery as soon as possible"

End Quote Elspeth Brown Senior cardiologist

"We've been looking very hard at the figures over the last three years and we are confident that our mortality figures are well within what would be expected. All the clinicians in Leeds are very happy with our figures at present."

The hospital is at the centre of a long-running dispute over the future of children's heart services, and an NHS review said surgery would be better focused at fewer, larger sites.

However, the High Court ruled just last week that the Leeds unit should be kept open - a move that was superseded a day later by Sir Bruce suspending surgery.

Staffing concerns

Ms Brown said that it must be worrying for families of patients, but that as clinicians they were "completely confident in our service".

"We need to put this to bed. We need people to stop attacking us, and we need to resume surgery as soon as possible."

Children who would have been treated in Leeds will be sent to other hospitals around England while a review, expected to last three weeks, is carried out.

Sir Bruce had been contacted by, among others, Professor Sir Roger Boyle, director of the National Institute of Clinical Outcomes Research, which oversees mortality figures across the NHS.

Sir Roger told BBC Breakfast that concerns were raised that two "relatively junior surgeons" had been left in charge of the unit, as well as from families of patients who claimed their requests to be transferred to other units were ignored.

"To have two relatively inexperienced people holding fort, without the ability for any senior advice, is a precarious situation in my view.

"It's a question of experience and fine balance between being able to offer a safe service and one that is precarious."

However, Ms Brown said there were two locum consultants who had been in their posts for six months, and although they were "relatively junior in their consultant career but they are both very experienced surgeons, and I have no concerns about them whatsoever."

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Heart patients 'helped by vest'

29 March 2013 Last updated at 04:24 ET By Jane Dreaper Health correspondent, BBC News

Please turn on JavaScript. Media requires JavaScript to play.

The vest has 250 electrodes

Doctors are using special vests to precisely diagnose abnormal heart rhythms, in the first UK tests of their kind.

Cardiologists from Imperial College Healthcare NHS Trust in west London say the vests have enabled them to successfully treat more patients.

They hope the technology could eventually help more people suffering from heart palpitations.

The Arrythmia Alliance described the tests as a "fantastic development".

The work is in its early stages - doctors have used the vests on 40 patients so far.

However, they are impressed with the precision that each vest can give them. The results have been sent to a medical journal.

The panels contain about 250 electrodes, to determine exactly where abnormal electrical activity in the heart is causing problems.

Computer images are then generated to produce an "electrical map" of the patient's heart.

Using this technology - known as the ECVUE system - means that a subsequent procedure called ablation - in which a catheter is placed in the heart through veins in the leg and then used to burn away the problematic area - stands a better chance of success.

Dr Prapa Kanagaratnam, the consultant cardiologist leading the work, said: "It was very appealing right from the start to be able to get measurements of the heart's electrical activity with that degree of precision, without having to initially put wires into the heart.

"It was obvious to us straight away there was a group of patients we could apply the technology to effectively.

Continue reading the main story

Anything that can help diagnose these patients will ultimately help save lives"

End Quote Trudie Lobban Arrhythmia Alliance

"Many patients suffer palpitations at night or when they are resting and this can be impossible to treat by current techniques, as it is difficult to recreate a relaxing environment in the operating theatre.

"It's been very satisfying to use the ECVUE system and see the results over the last couple of years."

Each vest costs about £1,000 - the doctors say this compares well with conventional diagnosis techniques, especially given the benefit of treating patients they were sometimes not able to previously help.

It is thought there are about two million people with heart rhythm problems in the UK, although many of these will be undiagnosed. Arrhythmia is an umbrella term which covers various conditions.

'Huge shock'

Lana Morgan, 29, from Watford, is among the patients who have benefited from trying the vest at Imperial.

Lana, a former air stewardess, was retraining as an interior designer last year when episodes of breathlessness and a pounding heart began to feel serious.

She said: "I was working late on a project one day and I was quite stressed. I had to run for my train home and I felt quite unwell. I went home and phoned my doctor.

"I'd been brushing it off, but it got to the point when I couldn't ignore it any longer.

"My heart would beat quickly and then slow down, or beat strongly and then go faint. At the time I would feel as though I was going to pass out.

"It was only when I had a 24-hour monitor that it showed up that my heart wasn't beating correctly. They kept me in hospital for a week and that was a huge shock."

Unlike some patients, Lana's extra heartbeats tended to occur during exertion - but doctors struggled to trigger the palpitations and therefore pinpoint the exact area of the problem until they used the electrode vest.

She said: "They've told me that without this they couldn't have corrected my heart. But now I'm fixed and can get on with my life."

Trudie Lobban, the founder and chief executive of the Arrhythmia Alliance, a heart rhythm charity, said: "Anything that can help diagnose these patients will ultimately help save lives.

"These arrythmias are like electrical faults in your car - it can take ages to identify which wire is faulty.

"So being able to then successfully do the soldering work with the ablation is fantastic.

"It means people can return to work and live normal lives."

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Leeds child heart ops 'had to stop'

29 March 2013 Last updated at 08:19 ET

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The medical director of the NHS has defended the suspension of child heart surgery at Leeds General Infirmary while a safety review is carried out.

Sir Bruce Keogh said the trust had no choice, after data suggested a death rate twice the national average, and surgeons had raised their concerns.

He conceded the timing, just 24 hours after a High Court ruling kept the unit open, was "embarrassing".

MP Stuart Andrew, who fought to keep the unit open, said it was "very odd".

The hospital is at the centre of a long-running dispute over the future of children's heart services, and an NHS review said surgery would be better focused at fewer, larger sites.

Sir Bruce said as well as the mortality rates, another area of concern among the "constellation of reasons" to suspend operations was the allegation that the hospital was not referring children to other specialist surgical units when appropriate.

"There have been rumblings in the cardiac surgical community for some time that all was not well in Leeds."

On Tuesday, two surgeons had called him to express concerns and on Wednesday there was another telephone call from an "agitated cardiologist".

All three doctors had connections with Leeds but were not staff there, he added.

Continue reading the main story

• Present in about six out of 1,000 babies
• Take form of holes between chambers, blockages in pathways from heart to lungs or body, or abnormal connections between chambers and vessels of heart

The cardiologist was worried about mortality rates for the last two years, which Sir Bruce said were "about twice the national average or more" and rising.

"As medical director I couldn't do nothing. I was really disturbed about the timing of this.

"I couldn't sit back just because the timing was inconvenient, awkward or would look suspicious, as it does."

He visited the hospital on Thursday to present the evidence and the trust decided to suspend operations.

Children who would have been treated in Leeds will be sent to other hospitals around England.

Affected families are being contacted directly by the trust and the review is expected to take three weeks.

Local MPs were enraged by the news. Greg Mulholland, a Liberal Democrat representing Leeds North West, said it was a "deliberate attempt" to undermine the heart unit.

Mr Andrew, Conservative MP for Pudsey, said it was a "very odd" decision coming after the jubilation that greeted the court ruling on Wednesday.

"We have always been told it's safe at Leeds, suddenly that's changed."

He added he had not received one complaint about care, only praise from parents of young patients.

Peter Jacques, from Bradford, said his son, now seven, had a heart operation at Leeds two years ago and the care he received was "outstanding".

He said: "In our opinion, given the initial campaign to reverse the closure of the unit, the timing of this decision is beyond suspicious."

The Children's Heart Federation first raised concerns about death rates at Leeds General Infirmary two years ago.

Chief executive Anne Keatley-Clarke says the charity wrote to the Care Quality Commission again in February about the difficulties parents were experiencing in getting referred elsewhere.

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Cancer survivors deserve 'care plan'

29 March 2013 Last updated at 09:18 ET

Please turn on JavaScript. Media requires JavaScript to play.

Cancer survivor, Sonia Wilson: "I felt like I was on my own"

All cancer patients should receive a "recovery package" at the end of their treatment offering ongoing support, the Department of Health (DoH) has said.

Some three in four patients are not given enough information on coping with long-term effects of the illness, its report with a leading charity suggests.

It calls for care targeting patients' financial, mental and physical needs.

Health minister Anna Soubry urged the NHS in England and local NHS teams to take "urgent action".

The call comes as a national survey of cancer survivors indicated about a quarter of people were feeling isolated after being treated for the illness - according to the DoH.

And almost 30% said they had numerous issues that were not being addressed, including fears about their cancer spreading.

Macmillan Cancer Support, which helped develop proposals for a recovery plan, estimated that about 200,000 people were not getting a package of support following their treatment.

Continue reading the main story

Local NHS teams need to consider providing a new range of care services for cancer survivors to tackle their needs"

End Quote Anna Soubry Public health minister

Nor were they being told how to contact someone outside of routine follow-ups if they had any problems.

The group's report calls for a recovery package that would provide a checklist for doctors and nurses to assess what emotional, physical and practical needs a patient might have after their treatment has ended.

This would include referrals to mental health or social services, as well as advice about financial support.

Care plans would also point patients towards physical activity services to help them regain their strength and fitness.

'Closer conversation'

Public health minister Anna Soubry said there were currently about 1.8m people who were being or had been treated for cancer - a figure set to rise to 3.4m by 2030.

"This joint document calls on NHS England and local NHS teams to take urgent action and consider our recommendations when they provide cancer services based on their local community's needs.

"Whether it's specialist help to get back to work, or being recommended to do a physical activity group, local NHS teams need to consider providing a new range of care services for cancer survivors to tackle their needs and improve their quality of life."

Ciaran Devane, chief executive of Macmillan Cancer Support, said that many cancer patients were crying out for this type of personalised support.

"If the NHS does one thing for cancer survivors it should be to commission this recovery package for its local population.

"We also need to keep on top of how cancer patients' quality of life is affected long-term."

Dr Frances Goodhart, a consultant clinical psychologist who works with cancer patients, said people needed to be given a realistic understanding of what recovery would involve, adding: "So often people are sent home with a message of just go home, pick up the pieces, make up for lost time - and actually, as we know, the consequences of cancer treatment are far more complicated."

Macmillan spokeswoman Nicola Cook added that regular contact with doctors was key to improving the system.

"We want GPs to be starting to have a much closer conversation and relationship with the cancer patient so that they're taking that information and they're seeing their GP say every three months - and the GP's asking them how things are.

"How are things at home? How's life at home? How's your marriage? How's your relationship? Are financial worries a concern? How's your mood? And so it's about having that community support in place by the GP and by other services so that people can live their life."

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Synchrotron yields 'safer' vaccine

27 March 2013 Last updated at 18:00 ET

Producing vaccines against viral threats is a potentially hazardous business and that's why manufacturers have to operate strict controls to ensure that no pathogens escape.

British scientists have developed a new method to create an entirely synthetic vaccine which doesn't rely on using live infectious virus, meaning it is much safer.

What's more the prototype vaccine they have created, for the animal disease foot-and-mouth, has been engineered to make it more stable.

That means it can be kept out of the fridge for many hours before returning to the cold chain - overcoming one of the major hurdles in administering vaccines in the developing world.

The research, published in the journal PLOS pathogens, was a collaboration between scientists at Oxford and Reading Universities, the Pirbright Institute, and the UK's national synchrotron facility, the Diamond Light Source near Oxford.

What we have achieved here is close to the holy grail of foot-and-mouth vaccines"

End Quote Dave Stuart Prof of Structural Biology

Diamond is a particle accelerator which sends electrons round a giant magnetic ring at near light speeds.

The electrons emit energy in the form of intense X-rays which are channelled along "beamlines" - into laboratories where they are used to analyse structures in extraordinary detail.

Infectious

Synchrotrons have been used before to analyse viruses at the atomic level, but the technology has advanced considerably to enable scientists to create a stable synthetic vaccine.

"What we have achieved here is close to the holy grail of foot-and-mouth vaccines.

Unlike traditional vaccines, there is no chance that the empty shell vaccine could revert to an infectious form," said Dave Stuart, Life Sciences Director at Diamond, and MRC Professor of Structural Biology at the University of Oxford.

"This work will have a broad and enduring impact on vaccine development, and the technology should be transferable to other viruses from the same family, such as poliovirus and hand-foot-and-mouth disease, a human virus which is currently endemic in South-East Asia."

These human disease threats, like foot-and-mouth, are all picornaviruses.

Viruses are inherently unstable and fragile, but picornaviruses can be studied using X-ray crystallography.

This enables the protein shell of the virus to be analysed at the atomic level - something a billion times smaller than a pinhead.

Pathogen

As with any vaccine, the aim is to prompt the immune system to recognise this outer shell and destroy the pathogen before it has time to lock onto cells and infect them with its genetic material.

In this research the scientists created a synthetic viral shell, but lacking its pathogenic RNA interior - the genetic material the virus uses to replicate itself.

Crucially they were able to reinforce the structure of the viral shell to make it stronger, to improve the stability of the vaccine.

Pre-clinical trials have shown it to be stable at temperatures up to 56C for at least two hours. Foot-and-mouth is endemic in central Africa, parts of the Middle East and Asia, so this would be a significant improvement over existing vaccines.

With current foot-and-mouth vaccines it is difficult to distinguish between immunised livestock and those which have been infected.

That proved to be a major hurdle in controlling the foot-and-mouth outbreak in the UK in 2001 because it would have prevented the export of livestock.

Polio

But the synthetic vaccine should allow scientists to show the absence of infection in vaccinated animals.

"The foot-and-mouth-disease virus epidemic in the UK in 2001 was disastrous and cost the economy billions of pounds in control measures and compensation," explained Dr Bryan Charleston, Head of Livestock Viral Diseases Programme at the Pirbright Institute.

"This important work has been a direct result of the additional funding that was provided as a result of the 2001 outbreak to research this highly contagious disease."

The potential hazards of working with viruses was underlined in 2007 when the Pirbright laboratory site was identified as the source of a leak which led to an outbreak of foot-and-mouth disease.

Polio, another picornavirus, which exclusively affects humans, has been eliminated from nearly every country in the world, although it stubbornly persists in Nigeria, Pakistan and Afghanistan.

The need for secure vaccine production will become even more vital should polio be wiped out.

"Current polio vaccines, which use live virus for their production, pose a potential threat to the long-term success of eradication if they were to re-establish themselves in the population.

"Non-infectious vaccines would clearly provide a safeguard against this risk", said Dr Andrew Macadam, a virologist specialising in polio at the National Institute for Biological Standards and Control in Hertfordshire.

"This technology has great potential in terms of cost and biosafety.

"Any design strategy that minimises the chances of accidental virus release would not only make the world a safer place but would lower the bio-containment barriers to production allowing vaccines to be made more cheaply all over the world."

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Consultants warn of A&E 'meltdown'

28 March 2013 Last updated at 04:25 ET

Hospital consultants have spoken out to warn that A&E departments are at the point of meltdown and patients are dying as a result.

Almost half of the Wales' A&E consultants have signed a joint letter to new Health Minister Mark Drakeford.

It says pressure to meet financial targets has meant the loss of beds "at the expense of quality care".

Earlier this month A&E units were under intense pressure with record numbers of patients.

The Welsh government said one of Mr Drakeford's priorities was to look at ways of easing the pressures on unscheduled healthcare.

Continue reading the main story

"Start Quote

Each of us has seen standards of care slipping in our departments"

End Quote Consultants' letter to health minister

Meanwhile, the consultants warn that a lack of beds means serious overcrowding is almost a daily occurrence.

The letter, sent by the College of Emergency Medicine, reads: "Our emergency departments are at the point of meltdown. Most days, they are seriously overcrowded.

"This jeopardises safety and puts patients at risk: there is clear evidence that death rates go up if patients requiring admission remain in emergency departments for hours whilst they wait for ward beds to become available.

"Each of us has seen standards of care slipping in our departments, as we struggle to look after a dozen or more patients stuck in the emergency departments whilst waiting for ward beds, in addition to our normal workload."

They point to examples of patients coming to harm because of overcrowding:

• A patient with chest pain having a cardiac arrest whilst being seen in the eye examination room (as there was no room in the resuscitation bay)

• No space in the resuscitation bay to accommodate a baby having a severe seizure

• These pressures, they say, have a knock-on effect on the Welsh Ambulance service which is unable to respond to emergencies "when scores of ambulances are queuing outside gridlocked emergency departments".

'Speak out'

Mark Poulden, chair of the Welsh National Board of the College of Emergency Medicine, and one of the signatories to the letter, said many factors played a role in their concerns.

He told BBC Radio Wales: "We have seen this deterioration. We're all working in a very complex system. We just see the system continuing to deteriorate. We felt that we had to speak out.

"There's obviously a lot of change in the NHS but that all takes time and what we see, because of the financial squeeze, is that beds have been closed but the system is not ready for that yet.

"Whatever we need to keep those beds open is what we need. It needs to change."

Wales' ambulances have missed a response time target for life-threatening calls for the ninth consecutive month.

Continue reading the main story

"Start Quote

This is a dire warning from Welsh NHS emergency consultants that patient safety is being dangerously compromised as a result of financial pressures"

End Quote Darren Millar AM Conservative health spokesperson

Statistics from February show 60.8% of emergency responses arrived within eight minutes, missing the Welsh Ambulance Service target of 65%.

A Welsh government spokesperson said: "The newly appointed minister for health and social services, Mark Drakeford, has stated that one of his priorities over the next 12 months is to look at ways of easing the pressures on unscheduled healthcare - this includes out of hours services, emergency departments and ambulance services."

The consultants warn that creating a culture whereby health boards are required to achieve financial balance could lead to the same result as the Mid Staffordshire scandal.

A public inquiry report found that neglect and abuse at Stafford Hospital between 2005 and 2008 had led to needless deaths.

Published at the start of February, the Francis report accused the NHS of putting corporate self-interest ahead of patients.

The consultants say: "The motive behind the financial squeeze affecting hospitals in Wales is different to that underpinning the Mid Staffordshire scandal, but from our perspective, the result is the same: the pursuit of targets and financial balance at the expense of quality of care."

Wales' seven health boards are currently in the process of trying to balance their books before the end of the financial year.

The largest, Betsi Cadwaladr, predicts it may be £3.9m in debt by the end of the financial year, despite £15m of extra funding from the Welsh government.

Analysis by BBC Wales indicates other health boards are also facing similar challenges, but some are predicting they will succeed to stay within budget.

Darren Millar AM, Conservative health spokesperson, said: "This is a dire warning from Welsh NHS emergency consultants that patient safety is being dangerously compromised as a result of financial pressures.

"Axing inpatient bed numbers to save money is leading to overcrowded A&E departments, which cause ambulance queues outside our hospitals and delay them from being able to get back on the road to emergencies."

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Weight loss surgery bacteria find

28 March 2013 Last updated at 06:49 ET

Weight loss after gastric band surgery may be partly caused by changes to micro-organisms that live in the gut, say US researchers.

A study in mice has shown that surgery causes different types of bacteria to colonise the gut.

Transferring samples of those bacteria into healthy mice caused them to rapidly lose weight without surgery.

But the Harvard University researchers said they could not yet explain the mechanism behind their results.

There are differences in the bacteria in the stomachs and intestines of obese people compared with those who are of a normal weight.

And in people who have had gastric bypass operations to help them lose weight, the types of microbes that are found in the gut change.

Continue reading the main story

The ability to achieve even some of these effects without surgery would give us an entirely new way to treat the critical problem of obesity."

End Quote Dr Lee Kaplan Harvard Medical School

In the latest study, researchers compared three groups of obese mice on a high-calorie diet.

• One group was given a gastric bypass
• One was given a sham operation, and the high-calorie diet continued
• One was given the same fake operation but then fed a low-calorie diet to promote weight loss

A week later the mice who had undergone the real obesity surgery had different bacteria in their guts, with an increase in types usually seen in lean individuals and a drop in types associated with obesity.

Three weeks after surgery they had lost about 30% of their bodyweight, the researchers reported in Science Translational Medicine.

There was little change in micro-organisms present in the mice who had had sham operations, even though the group on the low-calorie diet lost just as much weight as the mice who had had the bypass surgery.

Metabolism impact

Researchers then transferred samples from the guts of the three groups of mice into other germ-free mice.

Those who received bacteria from the bypass mice, lost a significant amount of weight in two weeks but the others saw no change.

It is not yet clear how the microbes influence weight loss, but one theory is that they have an impact on metabolism.

"We need to learn a good deal more about the mechanism by which a microbial population changed by gastric bypass exerts its effects," said study author Dr Lee Kaplan, an associate professor of Medicine at Harvard Medical School.

"The ability to achieve even some of these effects without surgery would give us an entirely new way to treat the critical problem of obesity, one that could help patients unable or unwilling to have surgery."

Co-author Peter Turnbaugh added: "It may not be that we will have a magic pill that will work for everyone who's slightly overweight.

"But if we can, at a minimum, provide some alternative to gastric bypass surgery that produces similar effects, it would be a major advance."

Prof David Haslam, from the National Obesity Forum, said: "We know the effects of bariatric surgery are not just mechanical and we don't know the full reasons why it works so well, especially in the resolution of diabetes.

"There is more to it than meets the eye."

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No more covering up errors, NHS told

26 March 2013 Last updated at 08:42 ET By Nick Triggle Health correspondent, BBC News

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Health Secretary Jeremy Hunt: "Stafford Hospital to be ''a catalyst for change''

The NHS will have a legal duty to be honest about mistakes as part of an overhaul of the system in the wake of the Stafford Hospital scandal.

The move is part of a package of measures in England to put patients at the heart of the NHS, ministers said.

There will also be a new ratings system for hospitals and care homes, while changes to nurse training will be piloted.

It comes after the public inquiry claimed patients had been "betrayed".

The harrowing neglect and abuse at the hospital between 2005 to 2008 which led to needless deaths has already been well documented.

Statistics at the time showed there were between 400 and 1,200 more deaths than would be expected.

The £13m inquiry, published at the start of February, focused on why the problems were not picked up sooner.

It accused the NHS of putting corporate self-interest ahead of patients, concluding the failings went from the top to the bottom of the system.

'Fundamental change'

In total, the report made 290 recommendations.

Ministers have not responded individually to each one.

But Health Secretary Jeremy Hunt said the response on Tuesday marked the start of a "fundamental change to the system".

Continue reading the main story

• Duty of candour to be placed on NHS boards to be honest about mistakes.
• Consideration being given to making individual doctors and nurses criminally responsible for covering up errors.
• New ratings system for hospitals and care homes based on Ofsted scheme used in schools.
• Posts of chief inspector of hospitals and care homes to be created.
• Nurses to spend up to a year working as a healthcare assistant so they get experience providing basic care such as washing and dressing in pilot schemes.
• Managers who fail in their jobs to be barred from holding such positions in the future.
• Code of conduct and minimum training standards for healthcare assistants, but not full registration scheme as recommended by inquiry.
• Tough rules to be drawn up to allow trusts to be put into administration when basic standards are not met unless problems can be resolved quickly.
• Department of Health civil servants to be forced to spend time on the front line of the NHS.

"We cannot merely tinker around the edges - we need a radical overhaul with high quality care and compassion at its heart."

He said he wanted to create a culture of "zero harm" through the changes.

Key to this will be the new post of chief inspector of hospitals - announced immediately after the publication of the public inquiry - and the statutory duty of the NHS to be honest about mistakes, known as a duty of candour.

But the government said it would wait before deciding whether to make individual doctors and nurses criminally accountable for hiding mistakes as recommended by the inquiry as it was concerned about creating a "culture of fear".

The government has also stopped short of the inquiry's demand for a registration system for health care assistants.

Instead, it confirmed it will push ahead with a code of conduct and minimum training standards.

On training for nurses, ministers said there would be a pilot programme whereby nurses will have to work for up to a year as a healthcare assistant before getting NHS funding for their degree.

Meanwhile, managers who fail in their jobs will be barred from holding such positions in the future.

Please turn on JavaScript. Media requires JavaScript to play.

Heather Wilhelms describes how her husband had to resort to drinking from a vase while in hospital

The ratings system, which will start being rolled out later this year, will be based on the Ofsted system used in schools.

Hospital and care homes will be given an outstanding, good, requiring improvement or poor rating.

However, in hospitals individual departments will be given their own rating as well to reflect the increased complexity of the organisations.

But shadow health secretary Andy Burnham said the culture of the NHS would not be changed unless staffing problems were resolved first.

"We will never get the right culture on our wards if they are understaffed and overstretched," Mr Burnham said.

Royal College of Nursing general secretary Peter Carter agreed staffing was an issue and said he was disappointed there would not be a registration system for healthcare assistants.

He also said he had concerns about the measures on nurse training, but added the the union was still "committed" to working with government to ensure a "patient-centred NHS becomes a reality".

But Don Redding, policy director of the patient group National Voices, felt the changes would make a difference, particularly the duty of candour.

"In cases where patients have been harmed or worse, both senior managers and their legal advisers have generally decided their first duty is to the interests of the trust. This new legal duty will rebalance that."

Mike Farrar, chief executive of the NHS Confederation, which represents health trusts, said: "The government has used this time to produce an overarching response rather than a something which tries to tick all the boxes.

"The response finds the right balance between external assurance measures and internal changes focused on transforming the NHS culture."

Robert Francis QC, who chaired the public inquiry, added: "Even though it is clear that it does not accept all my recommendations, the government's statement indicates its determination to make positive changes to the culture of the NHS."

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NHS emergency set-up unclear, say MPs

26 March 2013 Last updated at 21:55 ET

The government's overhaul of the NHS in England mean it is "not clear who will be in charge in the event of a health emergency", MPs have warned.

From April, councils must set up health and wellbeing boards to oversee and co-ordinate services across the NHS, social care and public health sectors.

The Communities and Local Government Committee said this could result in "muddle" and demanded more "clarity".

The government says there are "clear lines of responsibility".

The boards will include representatives from clinical commissioning groups, hospitals and patient groups, as well as councillors.

'Confusion'

But the committee's report said it "is not clear who will be in charge in the event of a health emergency" either at a regional or national level.

It urged the government "to set out clearly and unambiguously the lines of responsibility".

The report said: "We heard serious concerns about the arrangements for screening and immunisation.

Continue reading the main story

We are eager to take on this new responsibility"

End Quote David Rogers Local Government Association

"We urge the government and the NHS Commissioning Board to review the arrangements with a view to devolving these services to public health staff within local government, who have the local knowledge to make the system work."

The setting up of the boards follows the passing of the Health and Social Care Act last year.

The committee's chairman, Labour MP Clive Betts, said: "Without clarity there is only confusion, and a health emergency is no time for muddle.

"The government must set out unambiguously the lines of responsibility, and it must do so now as a matter of urgency.

"These arrangements need to be clear and in place on day one, 1 April. Anything else is unacceptable."

The committee also warned that the national NHS Commissioning Board would lack "local accountability" and that its status in relation to Health and Wellbeing Boards was unclear.

Mr Betts said: "Under the reformed system, considerable power is to be invested in a range of new bodies. With such power must come accountability.

"The purpose of localism is not only to devolve decision making to a local level, but to make it accountable to local people.

"With these changes it is clear that there is a shift of power and money from the Whitehall to local government and I welcome that.

"But the new arrangements are complex and responsibilities are shared across several bodies.

"The result is that lines of local accountability are fragmented and blurred."

However, David Rogers, the Lib Dem chairman of the Local Government Association's community wellbeing board, said: "The transfer of responsibility for public health to councils is the biggest change in local government for a generation, yet in stark contrast with the unnecessarily negative view of the select committee there is widespread confidence among council bosses that we are ready for the challenge.

"In October last year we conducted a survey in which 95% of local authorities said they expect a safe and successful transition and over the last six months we have been ramping up preparations. We are eager to take on this new responsibility."

A Department of Health spokesperson said there were "clear lines of responsibility" under the new systems and the health secretary was ultimately accountable.

The spokesperson added: "From next month Public Health England (PHE) will be responsible for preparing and responding to health-related emergencies, such as a flu pandemic and will work together with NHS England [Commissioning Board] and local authorities to ensure that local areas are prepared.

"A number of experienced public health organisations and functions will transfer into PHE including the Health Protection Agency."

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Parental 'problem behaviour guide'

26 March 2013 Last updated at 21:58 ET By Michelle Roberts Health editor, BBC News online

A health watchdog has issued guidelines to help parents distinguish between naughtiness and more worrying behaviour in their children that might need medical intervention.

About one in every 20 children aged five to 16 has a conduct disorder - persistent and extreme misbehaviour.

The National Institute for Health and Clinical Excellence guidelines outline how to spot and treat these conditions.

They say parents should play a central role in this.

Continue reading the main story

It's not a bit of tantruming or getting into trouble now and then. It's picking up the 14in TV and throwing it through the window"

End Quote Prof Steven Pilling National Collaborating Centre for Mental

While all children can be naughty from time to time, the behaviour of children with conduct disorders is different.

They persistently misbehave - both at home and in school - and their actions can be extreme and harmful.

As well as stealing, fighting or vandalising property, they might hurt people and animals, for example.

Prof Steven Pilling, who helped develop the guidelines, said: "Children with conduct disorders are different. It's not a bit of tantruming or getting into trouble now and then. It's picking up the 14in TV and throwing it through the window."

He said it was important that parents be taught how to how to handle this type of behaviour.

Pointless punishment

"Firmness and saying 'No' is not the solution for these children. We need to get parents to switch the focus from being controlling and punitive to encouraging positive behaviour," he said.

About half of children with antisocial behaviour or conduct disorders not only miss out on parts of their childhood but also go on to have serious mental health problems as adults. Some go on to be repeated offenders.

The National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE), who jointly developed the guidelines, say early intervention is essential to break this chain.

Prof Peter Fonagy, a professor of psychoanalysis at University College London who co-authored the guidelines, said: "All children can be naughty, defiant and impulsive from time to time, which is perfectly normal. However, some children have extremely difficult and challenging behaviours that are outside the norm for their age.

"Recognising and accurately diagnosing a conduct disorder is vital to ensuring children and their families are able to access the treatment and support they need to manage the condition."

Fiona is a mother of a child with a conduct disorder. She said: "It is not just the child who is affected by a conduct disorder; it can have a significant impact on their brothers or sisters, their parents, family members, teachers and other people they come into contact with.

"Real practical support and advice is needed to help parents manage their child's condition, such as what to say to calm the child when they are very distressed to avoid inflaming the situation."

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TV 'does not make children unruly'

25 March 2013 Last updated at 21:24 ET By Michelle Roberts Health editor, BBC News online

Spending hours watching TV or playing computer games each day does not harm young children's social development, say experts.

The Medical Research Council (MRC) team who studied more than 11,000 primary school pupils says it is wrong to link bad behaviour to TV viewing.

Although researchers found a small correlation between the two, they say other influences, such as parenting styles, most probably explain the link.

But they still say "limit screen time".

This cautionary advice is because spending lots of time in front of the TV every day might reduce how much time a child spends doing other important activities such as playing with friends and doing homework, they say.

US research suggests watching TV in early childhood can cause attention problems at the age of seven.

Continue reading the main story

We found no effect with screen time for most of the behavioural and social problems that we looked at and only a very small effect indeed for conduct problems, such as fighting or bullying"

End Quote Dr Alison Parkes Lead investigator

In the US, paediatric guidelines recommend that total screen time should be limited to less than two hours of educational, non-violent programmes per day. There are currently no formal guidelines in the UK.

For the MRC study, published in Archives of Diseases in Childhood, Dr Alison Parkes and colleagues asked UK mothers from all walks of life to give details about their child's TV viewing habits and general behaviour.

Electronic entertainment

Almost two-thirds (65%) of the 11,014 five-year-olds included in the study watched TV between one and three hours a day, 15% watched more than three hours and less than 2% watched no television at all.

Watching more than three hours' TV a day at this age predicted a very small increase in "conduct" problems at the age of seven.

After their seventh birthday, these boys and girls were slightly more likely to get into fights, tell lies or be bullies than their peers, according to their mothers' reports.

Time spent playing computer games bore no such relationship.

And there was no association between TV or any screen time and other issues such as hyperactivity or problems interacting with friends.

Dr Parkes, head of the MRC's social and public health sciences unit in Glasgow, said it was wrong to blame social problems on TV.

"We found no effect with screen time for most of the behavioural and social problems that we looked at and only a very small effect indeed for conduct problems, such as fighting or bullying.

"Our work suggests that limiting the amount of time children spend in front of the TV is, in itself, unlikely to improve psychosocial adjustment."

She said interventions focusing on the family dynamic and the child were more likely to make a difference and that much may depend on what children are watching and whether they were supervised.

Sonia Livingstone, professor of social psychology, at the London School of Economics, said the findings were a "good reason to ask why some children spend so much time watching television".

Prof Annette Karmiloff-Smith, of Birkbeck, University of London, said that rather than focusing on the possible adverse effects of TV and video games, it would be better to look at what positive impact they could have on children.

Prof Hugh Perry, chair of the MRC's neurosciences and mental health board, said: "We are living in a world that is increasingly dominated by electronic entertainment, and parents are understandably concerned about the impact this might be having on their children's wellbeing and mental health.

"This important study suggests the relationship between TV and video games and health is complex and influenced by many other social and environmental factors."

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Social isolation 'ups death risk'

25 March 2013 Last updated at 21:24 ET

Social isolation is associated with a higher risk of death in older people regardless of whether they consider themselves lonely, research suggests.

A study of 6,500 UK men and women aged over 52 found that being isolated from family and friends was linked with a 26% higher death risk over seven years.

Whether or not participants felt lonely did not alter the impact of social isolation on health.

Age UK says cuts to services for older people are compounding the problem.

It is not the first time that loneliness and social isolation has been linked with poor health.

But researchers wanted to find out if it was the emotional aspect of feeling lonely that was having an impact or the reality of having little social contact.

Those who were socially isolated - that is had little or no contact with friends or family - were more likely to be older and unmarried and have long-standing illnesses limiting their mobility, such as lung disease and arthritis.

People who described themselves as feeling lonely were more likely to be female and have a wider range of health conditions, including depression.

'Surprise' findings

Both social isolation and feeling lonely were associated with a higher chance of death.

Continue reading the main story

This study shows more clearly than before that being lonely and isolated is not only miserable, it is a real health risk"

End Quote Michelle Mitchell Age UK

But after adjusting for factors such as underlying health conditions, only social isolation remained important.

That risk did not change when researchers added in whether or not someone felt lonely in their isolation.

Writing in the Proceedings of the National Academy of Sciences, the researchers said they were surprised by their findings.

Study leader Prof Andrew Steptoe, director of the Institute of Epidemiology and Health Care at University College London, said: "Social connections can provide emotional support and warmth which is important but they also provide things like advice, making sure people take their medication and provide support in helping them to do things.

"It would suggest that those practical aspects are quite important for older people's survival.

"There's been such an increase in people living alone. In the last 15 years, the number of 55 to 64-year-olds living alone has increased by 50%.

"And it might be that people in those circumstances aren't looking after themselves so well."

Michelle Mitchell, director general at Age UK, said: "This study shows more clearly than before that being lonely and isolated is not only miserable, it is a real health risk, increasing the risk of early death."

She added that cuts to local authority budget cuts may exacerbate the problem of isolation for many older people.

"Across the country day care centres, often the only regular social life that many older people enjoy, are closing, social care support which can enable older people to leave the house is being cut down to the bare minimum, and too many older people are hidden behind closed doors struggling to cope."

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No more covering up errors, NHS told

26 March 2013 Last updated at 08:42 ET By Nick Triggle Health correspondent, BBC News

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Heather Wilhelms describes how her husband had to resort to drinking from a vase while in hospital

Government's response: At a glance

The NHS will have a legal duty to be honest about mistakes as part of an overhaul of the system in the wake of the Stafford Hospital scandal.

The move is part of a package of measures in England to put patients at the heart of the NHS, ministers said.

There will also be a new ratings system for hospitals and care homes, while changes to nurse training will be piloted.

It comes after the public inquiry claimed patients had been "betrayed".

The harrowing neglect and abuse at the hospital between 2005 to 2008 which led to needless deaths has already been well documented.

Statistics at the time showed there were between 400 and 1,200 more deaths than would be expected.

The £13m inquiry, published at the start of February, focused on why the problems were not picked up sooner.

It accused the NHS of putting corporate self-interest ahead of patients, concluding the failings went from the top to the bottom of the system.

'Fundamental change'

In total, the report made 290 recommendations.

Ministers have not responded individually to each one.

But Health Secretary Jeremy Hunt said the response on Tuesday marked the start of a "fundamental change to the system".

Continue reading the main story

• Duty of candour to be placed on NHS boards to be honest about mistakes.
• Consideration being given to making individual doctors and nurses criminally responsible for covering up errors.
• New ratings system for hospitals and care homes based on Ofsted scheme used in schools.
• Posts of chief inspector of hospitals and care homes to be created.
• Nurses to spend up to a year working as a healthcare assistant so they get experience providing basic care such as washing and dressing in pilot schemes.
• Managers who fail in their jobs to be barred from holding such positions in the future.
• Code of conduct and minimum training standards for healthcare assistants, but not full registration scheme as recommended by inquiry.
• Tough rules to be drawn up to allow trusts to be put into administration when basic standards are not met unless problems can be resolved quickly.
• Department of Health civil servants to be forced to spend time on the front line of the NHS.

"We cannot merely tinker around the edges - we need a radical overhaul with high quality care and compassion at its heart."

He said he wanted to create a culture of "zero harm" through the changes.

Key to this will be the new post of chief inspector of hospitals - announced immediately after the publication of the public inquiry - and the statutory duty of the NHS to be honest about mistakes, known as a duty of candour.

But the government said it would wait before deciding whether to make individual doctors and nurses criminally accountable for hiding mistakes as recommended by the inquiry as it was concerned about creating a "culture of fear".

The government has also stopped short of the inquiry's demand for a registration system for health care assistants.

Instead, it confirmed it will push ahead with a code of conduct and minimum training standards.

On training for nurses, ministers said there would be a pilot programme whereby nurses will have to work for up to a year as a healthcare assistant before getting NHS funding for their degree.

Meanwhile, managers who fail in their jobs will be barred from holding such positions in the future.

Please turn on JavaScript. Media requires JavaScript to play.

Helene Donnelly, former nurse at Stafford Hospital: ''We all have to be more vigilant''

The ratings system, which will start being rolled out later this year, will be based on the Ofsted system used in schools.

Hospital and care homes will be given an outstanding, good, requiring improvement or poor rating.

However, in hospitals individual departments will be given their own rating as well to reflect the increased complexity of the organisations.

But shadow health secretary Andy Burnham said the culture of the NHS would not be changed unless staffing problems were resolved first.

"We will never get the right culture on our wards if they are understaffed and overstretched," Mr Burnham said.

But Don Redding, policy director of the patient group National Voices, felt the changes would make a difference, particularly the duty of candour.

"In cases where patients have been harmed or worse, both senior managers and their legal advisers have generally decided their first duty is to the interests of the trust. This new legal duty will rebalance that."

Mike Farrar, chief executive of the NHS Confederation, which represents health trusts, said: "The government has used this time to produce an overarching response rather than a something which tries to tick all the boxes.

"The response finds the right balance between external assurance measures and internal changes focused on transforming the NHS culture."

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Young cancer deaths halved since 70s

24 March 2013 Last updated at 21:00 ET

The number of teenagers and young adults dying from cancer in the UK has halved since the 1970s, according to a report from Cancer Research UK.

Deaths fell from about 580 per year to 300 in this age group while the largest drop was in those with leukaemia.

More specialised treatments are likely to be behind the trend, the report said.

However, a teenage cancer expert said more young people should be enrolled on clinical trials.

Cancer remains the main cause of death from any disease in teenagers and young adults. Only transport accidents account for more deaths in this age group.

The report, Cancer Statistics Report: Teenage and Young Adult Cancer, calculated that about 2,100 young people aged 15-24 years old are diagnosed with cancer each year in the UK.

But in the past 30 years or so, death rates have fallen in males from 88 deaths per million (in 1975-1977) to 44 deaths per million (in 2008-2010) and in females from 61 deaths per million to 31.

Leukaemia deaths among teenagers and young adults have seen the greatest drop since 1995 in the UK - from an average of 54 per year to 39 in 2006-2010 in young males and from 38 to 21 deaths per year among females.

Brain tumours were the most common cause of cancer deaths in this age group between 2008 and 2010.

Simon Davies, chief executive of Teenage Cancer Trust, said he was pleased by the figures but wanted to see greater improvements.

Continue reading the main story

Drug development and clinical trials are at the heart of helping more teenagers and young adults survive cancer"

End Quote Dr Harpal Kumar Cancer Research UK

"It's fantastic to see such a fall in the number of young people dying from some types of cancers during this time. However, many of the rarer cancers which affect young people like sarcomas have made little or no progress.

"More investment in rare cancer research is urgently needed. We want to work with Cancer Research UK and the pharmaceutical industry to ensure better access to clinical trials for young people with cancer."

The report said that less than 20% of patients aged 15-24 with cancer take part in clinical trials, compared to 50-70% of child cancer patients under 15 in the UK.

It added that broadening access to clinical trials was essential to improve knowledge of the best treatments for cancers.

Dr Harpal Kumar, chief executive of Cancer Research UK, said more needed to be done to make treatments kinder and more effective.

"Drug development and clinical trials are at the heart of helping more teenagers and young adults both survive cancer and live a full life after their treatment.

"Too many young people are left out of clinical trials due to rigid age restrictions and this must change for us to continue to see improvements across all cancer types."

Those restrictions exist because there are potential dangers in giving young cancer patients adult doses of drugs, therefore researchers are often reluctant to develop trials which cover this age group. Children's cancer drug trials are also very specialised.

Although cancer mortality rates for young people are falling, the incidence of all types of teenage and young adult cancers combined has been rising since the 1990s.

The report was a collaboration between the North West Cancer Intelligence Unit, on behalf of the National Cancer Intelligence Network, and the Institute of Cancer Studies, at the University of Manchester.

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Amniotic fluid 'may heal babies'

24 March 2013 Last updated at 22:26 ET By James Gallagher Health and science reporter, BBC News

Amniotic fluid may hold the key to healing a fatal gut disease which affects premature babies, doctors say.

Severe inflammation, called necrotizing enterocolitis, can destroy the gut's tissues and lead to major organ failure.

Early animal tests, published in the journal Gut, showed that stem cells inside amniotic fluid could heal some of the damage and increase survival.

Further tests are still needed before it is tried in premature babies.

Pregnancy fluid

Babies born too soon are not ready for the world outside the womb and their guts are ill-prepared to deal with food. About one in 10 premature babies in a neonatal intensive care will develop necrotizing enterocolitis.

The inflammation can cause tissue death and lead to a hole in the baby's intestines which can result in a serious infection.

Continue reading the main story

What appears to be happening is a direct effect on calming inflammation and also stimulating resident stem cells in the gut to be more efficient at repairing the intestines"

End Quote Dr Simon Eaton Institute of Child Health

Breast milk can reduce the risks, but the only major treatment is surgery to remove the diseased tissue. However, 40% of those needing an operation will not survive.

"It is quite a problem and we think it is on the increase," said Dr Simon Eaton, from the Institute of Child Health at University College London.

He was part of a team investigating the use of stem cells, which are able to become any other type of cell in the body from nerve to bone, taken from the amniotic fluid which surrounds a developing foetus in the womb.

In experiments on laboratory rats, which are programmed to develop fatal necrotizing enterocolitis, injections of stem cells appeared to increase survival times.

Dr Eaton told the BBC news website: "We're able to prolong survival by quite a long way.

"What appears to be happening is a direct effect on calming inflammation and also stimulating resident stem cells in the gut to be more efficient at repairing the intestines."

The study, funded by Great Ormond Street Hospital Children's Charity, showed the intestines were also working better after the treatment.

Cancer risk?

Fellow researcher Dr Paolo De Coppi said: "Stem cells are well known to have anti-inflammatory effects, but this is the first time we have shown that amniotic fluid stem cells can repair damage in the intestines.

"Although amniotic fluid stem cells have a more limited capacity to develop into different cell types than those from the embryo, they nevertheless show promise for many parts of the body including the liver, muscle and nervous system."

Far more testing would be required to work out if the treatment would work in babies and if it would be safe.

The stem cells would have to be taken from a donor as it would not be practical to store fluid from every birth, just in case. This means there is the risk of rejection.

As the stem cells are capable of becoming other types of cells there is also concern that they may pose a cancer risk.

However, in the future doctors hope they could harness a drug instead.

"It's not the cells, they're delivering something and if we knew what that was then we could deliver that directly," said Dr Eaton.

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Fears over launch of NHS 111 line

25 March 2013 Last updated at 08:18 ET By Michelle Roberts Health editor, BBC News online

Doctors are questioning the safety of a new non-emergency NHS telephone advice line that is due to launch 1 April.

The 111 service, which will replace NHS Direct in England, is being piloted in some regions ahead of a nationwide launch but has proved problematic, with some callers left on hold for hours.

Dr Laurence Buckman, the British Medical Association's GP committee chair, says rollout should be stalled.

The Department of Health says it is giving some areas extra time to launch.

It has already sanctioned an extension of up to six months of the original April 2013 deadline for regions struggling to set up the new service.

Continue reading the main story

"Start Quote

The BMA is seriously concerned that these failures are not only having impact on other, already overstretched NHS services, but potentially putting patient safety at risk"

End Quote Dr Laurence Buckman BMA's GP committee

The NHS Direct 0845 4647 service will continue to be available to callers in areas where the NHS 111 service is in the process of being introduced, Health Minister Lord Howe insists.

These include: North of Tyne and Tees, North Essex, Bedfordshire and Luton, Cambridgeshire and Peterborough, Leicestershire and Rutland, Berkshire, Cornwall and Devon.

But the British Medical Association is concerned that many of the places which are set to launch in the coming week are ill-prepared, putting patients' lives at risk.

The BMA says it has been receiving widespread reports of NHS 111 failures

Some of the pilot regions have been unable to cope with call volumes or have suffered catastrophic IT failures.

In Greater Manchester the entire system crashed, meaning calls went unanswered.

One elderly patient had to wait 90 minutes for a call back from NHS 111.

Problems led to a surge in ambulance callouts and casualty visits as callers have resorted to other measures to get seen by a healthcare professional.

'Reconsider rollout'

Dr Buckman said: "The BMA is seriously concerned that these failures are not only having impact on other, already overstretched NHS services, but potentially putting patient safety at risk. Patients need to have their calls answered immediately and correctly and not be faced with any form of delay.

Continue reading the main story

NHS 111

• The free one-stop number is for patients with urgent, but not life-threatening symptoms
• This includes people needing fast medical help, but who are not a 999 emergency
• Trained advisers who answer the phones offer basic health advice and direct the caller to the most appropriate service for their needs - A&E or GP out-of-hours services, for example

"The Department of Health needs to reconsider immediately its launch of NHS 111 which clearly is not functioning properly. They must ensure that the system is safe for patients before it is rolled out any further."

Lord Howe said: "NHS 111 will help patients access the whole of the NHS through just one simple number.

"Over the coming months this new service will replace the existing NHS Direct telephone advice line. To ensure that patients get the best care and treatment, we are giving some areas more time to go live with NHS 111 while we carry out thorough testing to ensure that those services are reliable."

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Warning over 'struggling GP system'

21 March 2013 Last updated at 19:58 ET By Nick Triggle Health correspondent, BBC News

Patients in England do not feel safe relying on GP out-of-hours care and are struggling to get access to doctors during normal hours, a leading patient group is warning.

The Patients Association said the government needed an urgent review of the "complex and convoluted" system.

Its report said if the problems persisted, the service would lose the trust of the public completely.

The warning comes after it surveyed 3,000 of its members and supporters.

The Patients Association said it had been prompted to investigate the GP system after a rising number of calls to its helpline.

Four out of every five of those polled said they would not feel safe relying on the NHS out-of-hours service for a potentially urgent medical problem.

Nearly half of those who had used an out-of-hours provider in the past two years said they were not satisfied with the service they had received.

'Workload'

Some 61% said they had had to wait longer than 48 hours to book an appointment with a GP.

And more than a third had had to take a day off work to attend.

Patients Association chief executive Katherine Murphy said: "We need an NHS in every community that operates effectively, safely and compassionately during and outside of office hours.

Continue reading the main story

The local NHS has a legal requirement to make sure high quality out-of-hours care is in place"

End Quote Lord Howe Health Minsiter

"Keeping people out of hospital and living independent, healthier lifestyles means delivering more integrated and accessible community-based care."

She said as the government's changes to the NHS settled in - they come into force on 1 April - it was essential the GP system was reviewed to ensure the problems did not mount.

She also suggested clinical commissioning groups, which will get control of the bulk of the budget, should raise awareness about the options available to people when GP surgeries are closed.

Dr Laurence Buckman, of the British Medical Association, said: "GPs across the country are working extremely hard to see as many patients as possible as quickly and promptly as possible.

"Nearly nine out of 10 patients reported that they had a good overall experience in the most recent GP patient survey that was answered by close to a million respondents."

But he added: "Many GP practices are struggling to cope with a combination of government targets, falling resources and rising workload."

Health Minister Lord Howe said: "The local NHS has a legal requirement to make sure high quality out-of-hours care is in place.

"If this is not happening, it is totally unacceptable and we expect action to be taken immediately to improve these services."

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'570 children a day' start smoking

22 March 2013 Last updated at 07:50 ET

About 207,000 11 to 15-year-olds take up smoking every year in the UK, a charity has warned.

Cancer Research UK said government figures suggested 570 children smoked for the first time every day.

The charity urged the government to commit to plain, standardised packaging of tobacco, which is considered less appealing to youngsters.

The figures come from an annual Smoking, Drinking and Drug Use Among Young People in England survey.

Results for smoking rates at each age group in 2011 were compared with smoking rates in the same group the year before and extrapolated to the UK population.

About 27% of all under-16s have tried smoking at least once - equivalent to one million children, the figures suggest.

And eight out of 10 adult smokers started before they turned 19.

The total number of children who started smoking was 50,000 higher than the 2010 figure of 157,000.

Getting hooked

Data also suggested that children smoked more and more as they got older, Cancer Research UK said.

The survey among 12-year-olds in 2010 found none was a regular smoker, 1% smoked occasionally and 2% said they used to smoke.

But a year later in 2011, among the same group of children, now aged 13, 2% were found to smoke regularly, 4% smoked occasionally and 3% said they used to smoke.

Half of all long-term smokers will die from tobacco-related illness, which causes 100,000 deaths a year.

The charity called on the government to commit to the plain packaging plan, as was introduced in Australia in December 2012.

A public consultation on the future of tobacco packaging closed in August 2012, but there has been no decision on whether it will be introduced. It follows a ban on tobacco displays in shops.

Research has shown that children find plain packs less appealing and are less likely to be misled by the sophisticated marketing techniques designed to make smoking attractive to youngsters, Cancer Research UK said.

Sarah Woolnough, the charity's executive director of policy and information, said: "With such a large number of youngsters starting to smoke every year, urgent action is needed to tackle the devastation caused by tobacco.

"Replacing slick, brightly coloured packs that appeal to children with standard packs displaying prominent health warnings is a vital part of efforts to protect health.

"Reducing the appeal of cigarettes with plain, standardised packs will give millions of children one less reason to start smoking."

'Worrying'

Public Health Minister Anna Soubry said: "It's worrying that these figures show that more 15-year-olds are trying cigarettes.

"We have consulted on introducing standardised packaging, looking at whether this could reduce smoking in young people. We have an open mind about this.

"Any decisions to take further action will be taken only after full consideration of the consultation responses and evidence."

The Tobacco Manufacturers Association said: "The percentage of children who smoke in this country is at an all-time low - 5%.

"There is no credible evidence that the proposals for plain packaging will have an impact on youth smoking rates - in fact it could actually increase youth smoking by driving the availability of smuggled tobacco being sold by criminals in local communities."

Simon Clark, from the campaign group Forest, said: "There is no credible evidence that plain packaging will reduce youth smoking rates. The main reasons teenagers start smoking is because of peer pressure and parental influence, not packaging."

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