Pregnancy flu 'link to baby bipolar'

8 May 2013 Last updated at 20:52 ET By James Gallagher Health and science reporter, BBC News

Flu during pregnancy may increase the risk of the unborn child developing bipolar disorder later in life, research suggests.

A study of 814 expectant women, published in JAMA Psychiatry, showed that infection made bipolar four times more likely.

The overall risk remained low, but it echoes similar findings linking flu and schizophrenia.

Experts said the risks were small and women should not worry.

Bipolar leads to intense mood swings, which can last months, ranging from depression and despair to manic feelings of joy, overactivity and loss of inhibitions.

Researchers at the Columbia University Medical Center identified a link between the condition, often diagnosed during late teens and twenties, and experiences in the womb.

In their study looking at people born in the early 1960s, bipolar disorder was nearly four times as common in people whose mothers caught flu during pregnancy.

The condition affects about one in 100 people. The lead researcher, Prof Alan Brown, estimated that influenza infection during pregnancy could lead to a 3-4% chance of bipolar disorder in the resulting children.

However, in the vast majority of cases of bipolar disorder there would no history of flu.

Seasonal vaccination

So in the list of things pregnant women have to worry about, how high should it rank?

"I wouldn't say high," Prof Alan Brown told the BBC.

"The chances are still quite small. I don't think it should raise alarms for mothers."

He said seasonal flu vaccination, which is advised for pregnant women in many countries, would reduce the chances of catching flu.

Similar studies have shown a link between flu and schizophrenia

How flu could affect the foetal brain has not been completely explained.

Influenza is not thought to directly affect the foetus, but the mother's immune response to the virus could affect development.

Dr Fiona Gaughran, lead consultant psychiatrist at South London and Maudsley NHS Foundation Trust, said: "This highly regarded group of researchers has reported similar links between schizophrenia and various maternal infections.

"If future work confirms the link reported here, policymakers may need to consider implications for flu prevention pre-pregnancy, but mothers need not be worried.

"The overall risk of offspring developing bipolar disorder is low, even if one did get flu in pregnancy."

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Hospital toll of preventable errors

9 May 2013 Last updated at 07:08 ET By Nicola Beckford BBC Radio 4, The World at One

More than 750 patients have suffered after preventable mistakes in England's hospitals over the past four years, a BBC investigation has found.

The incidents, such as operating on the wrong body part or leaving instruments inside patients, are categorised by the Department of Health as "never events".

This means they are incidents that are so serious they should never happen.

NHS England admitted the figures were too high and said it had introduced new measures to ensure patient safety.

Continue reading the main story

Find the "never events" in your NHS trust

The department has categorised 25 incidents that should never happen if national safety recommendations are followed by medical staff. The BBC discovered through Freedom of Information requests to NHS trusts that the majority of mistakes fell into four categories.

There were 322 cases of foreign objects left inside patients during operations; 214 cases of surgery on the wrong body part; 73 cases of tubes, which are used for feeding patients or for medication, being inserted into patients' lungs; and 58 cases of wrong implants or prostheses being fitted.

Continue reading the main story

Find out more

• Listen to the full report on BBC Radio 4's The World at One at 13:00 BST on Thursday 9 May

Frances, whose name has been changed to protect her identity, was admitted to hospital last year for a hysterectomy. After her operation, surgeons realised that a swab was missing and had been left inside her.

They immediately carried out a second operation to remove it, but during this procedure a drain was left in her abdomen. A few weeks later, she was taken back into hospital as she was seriously ill and in severe pain.

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A routine gall bladder operation left Donna Bowett suffering constant abdominal pain after surgeons left a seven-inch pair of forceps inside her body

Frances underwent emergency surgery to remove the drain, which had caused a large, pus-filled abscess to develop. She has now been left with a colostomy and faces further surgery.

"My initial reaction was 'no'. They can't do it twice," she said.

Continue reading the main story

"Start Quote

It's been a life-changing episode because never in my wildest dreams did I think I would end up with a colostomy"

End Quote Frances Hysterectomy patient

"They did an internal inquiry and the consultant who was leading the internal inquiry said on a couple of occasions he couldn't understand how this has happened, because the procedures for this sort of thing were written in stone.

"Thinking about it philosophically, better the colostomy than a coffin. I had one foot in a coffin so it's the better option. I'd rather be here than up the crematorium with a wreath on me."

Ian Cohen, a medical negligence solicitor and head of medical negligence at Goodmans Law, based in Liverpool, said the whole system of reporting "never events" was flawed.

"I think the figures are shocking," he said. "They really are the tip of the iceberg.

"There is an emphasis on the 'never event', but actually there is a bigger picture: missing the fact that we have hundred of thousands of adverse incidents, never mind just 25 particular categories. And the danger is that it takes the focus away from a much wider problem."

He argued that hospitals have no incentive to report "never events" because they may have to reimburse the cost of the procedure to the NHS as well as paying for the patients' long-term care.

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Margaret's mother died after a feeding tube was inserted into her lungs

"If that's the case, surely that does not encourage openness if there are already problems with the budget in the NHS," he said.

Horrific as these incidents are, it is important to put them in context. On average each year there are 4.6 million hospital admissions to the NHS in England that require surgery. The NHS says the risk of a "never event" happening to you is one in 20,000.

Dr Mike Durkin, director of patient safety for NHS England, said the 700 "never events" were "too many". He said: "One is too many in any week, in any day, in any hospital."

He added that NHS England had started collating the data to help educate staff on better practice.

Continue reading the main story

"Start Quote

You feel angry after because you think someone's killed your mum"

End Quote Margaret

"We need to understand what it is, in some systems and in some hospitals, that that team working hasn't produced an effective outcome and a mistake, and a 'never event' has occurred," Dr Durkin said.

"This is not just the concern of one operating theatre in one hospital. It should be the concern of the leadership of that organisation, of the trust, so that they lead that trust and support both the staff in the operating theatres to work effectively, but also recognise their responsibility for leading safety across the whole of the trust."

The World Health Organisation's patient safety checklist has also been adapted for use in England and Wales.

However, when the patient safety rules are not followed, the results can be catastrophic, as Margaret, whose name has also been changed for reasons of privacy, found.

Guilt

Her mother was admitted to hospital after a stroke. But medical staff put a feeding tube into her lungs rather than her stomach. Nutritional fluids went into her lungs, she contracted pneumonia and died.

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"You feel guilty because when she [was] talking to us she kept saying she wanted to come out, and we kept saying, 'You can't come out, mum, until you get better," Margaret said.

"You feel angry after, because you think someone's killed your mum. No, they probably didn't do it on purpose but that's how it feels. You feel that somebody's killed her."

Margaret is still awaiting a date for an inquest. She thinks staff failed to follow basic procedure by omitting to give her mother an X-ray to check the tube's location. NHS guidance says that, if in doubt, this should be done as a secondary test.

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NHS chiefs want rapid action on A&E

9 May 2013 Last updated at 08:31 ET

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Dr Peter Carter, of the Royal College of Nursing: "This is a system under huge strain"

Health service chiefs have demanded urgent action to tackle the growing pressures on A&E departments.

NHS England has given regional health bosses until the end of the month to come up with plans to tackle problems.

Emergency funds will be made available to help amid warnings from the regulator that hospitals will no longer be able to cope if demands keep rising.

The Care Quality Commission said another Stafford Hospital scandal was being risked because of the problems.

In recent months the NHS has been struggling to hit its four-hour waiting time target.

Reports have emerged of hospitals setting up temporary waiting areas in car parks and storerooms to cope with queues.

Ambulances have also been forced to wait to drop off patients.

Continue reading the main story

It has been clear for some time that pressures have been growing in A&E.

For the past decade the numbers attending the units has been rising year by year. There are now more than 21 million visits annually - up 50% in a decade.

There is a combination of reasons why they have grown, including a rise in number of people with chronic conditions, such as heart disease that end up having emergencies; the ageing population; and problems accessing out-of-hours GP care. A&E units have also had problems recruiting middle-grade doctors, which creates staffing problems.

But until recently hospitals had just about been coping. The harsh winter seems to have tipped A&E units over the edge.

In the past few months, the waits that patients face have reached their worst levels for a long time.

The four-hour target - 95% of patients have to be seen to in this time - started to be breached in many places. Since the start of last month, the NHS overall has missed it.

There are signs that, with the weather improving so have the waiting times, but not as much as many would have liked.

The problem is that A&E is the safety net of the NHS: the place people go when there is no other option. If it breaks there is a real problem.

NHS England said it now wants regional health bosses to work together to ensure plans are in place for each A&E in their patch, with extra money being made available where problems are identified.

Prof Keith Willett, of NHS England, said: "When pressure builds across the health and social care system, the symptoms are usually found in the A&E department.

"We need the whole NHS system, in the community and hospitals, to recognise the problems and help to relieve the pressure on their colleagues in A&E."

A review, led by medical director Sir Bruce Keogh, is already under way to address the issues in the long term.

'Market failure'

The announcement by NHS England came on the day the Care Quality Commission painted a dire picture of the pressure hospitals were under.

CQC chairman David Prior said: "Emergency admissions through accident and emergency are out of control in large parts of the country. That is totally unsustainable."

He added that there was no cast-iron guarantee that there would not be a repeat of the situation at Stafford Hospital.

Mr Prior is also reported to have suggested the large-scale closure of hospital beds and investment in community services.

He added: "The patient or resident is the weakest voice in the system. It is a classic market failure. The user doesn't know nearly as much as the professionals, even with the internet."

Mr Prior is not alone in proposing a radical shake-up of A&E services.

The College of Emergency Medicine, which represents casualty department doctors, believes that between 15% and 30% of patients admitted could be treated elsewhere.

Care Minister Norman Lamb said that people had lost confidence in the services provided when their GP surgery was not open.

"We have out-of-hours care that too often falls down," he said.

"People end up with the default option of A&E because there is nothing else that they are confident in."

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Benefits of sun 'may outweigh risks'

7 May 2013 Last updated at 19:24 ET

The health benefits of exposing skin to sunlight may far outweigh the risk of developing skin cancer, according to scientists.

Edinburgh University research suggests sunlight helps reduce blood pressure, cutting heart attack and stroke risks and even prolonging life.

UV rays were found to release a compound that lowers blood pressure.

Researchers said more studies would be carried out to determine if it is time to reconsider advice on skin exposure.

Heart disease and stroke linked to high blood pressure are estimated to lead to about 80 times more deaths than those from skin cancer in the UK.

Continue reading the main story

Dietary vitamin D supplements alone will not be able to compensate for lack of sunlight"

End Quote Dr Richard Weller Edinburgh University

Production of the pressure-reducing compound, nitric oxide, is separate from the body's manufacture of vitamin D, which rises after exposure to sunshine.

Researchers said that until now vitamin D production had been considered the sole benefit of the sun to human health.

During the research, dermatologists studied the blood pressure of 24 volunteers under UV and heat lamps.

In one session, the volunteers were exposed to both UV rays and the heat of the lamps.

In the other, the UV rays were blocked so that only the heat affected the skin.

The results showed that blood pressure dropped significantly for an hour after exposure to UV rays, but not after the heat-only sessions.

Scientists said that this suggested it was the sun's UV rays that brought health benefits.

The volunteers' vitamin D levels remained unaffected in both sessions.

'Reconsider our advice'

Dr Richard Weller, a senior lecturer in dermatology at Edinburgh University, said: "We suspect that the benefits to heart health of sunlight will outweigh the risk of skin cancer.

"The work we have done provides a mechanism that might account for this, and also explains why dietary vitamin D supplements alone will not be able to compensate for lack of sunlight.

"We now plan to look at the relative risks of heart disease and skin cancer in people who have received different amounts of sun exposure.

"If this confirms that sunlight reduces the death rate from all causes, we will need to reconsider our advice on sun exposure."

The study will be presented on Friday in Edinburgh at the world's largest gathering of skin experts. The International Investigative Dermatology conference starts on Wednesday and runs until Saturday.

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App taps clues to your happiness

7 May 2013 Last updated at 22:51 ET

Researchers at Cambridge University have developed an app that tries to track happiness by combining smartphone data with users' perception of mood.

EmotionSense collects information about where users are, how noisy the environment is and whom they are communicating with.

It then combines this data with the user's own report about mood.

The app is part of a project to see how mobile phones can be used to improve health and wellbeing.

Emotional state

Mood-tracking apps already exist but the team from the Cambridge Computer Laboratory think this is the first time that user-input data and phone information sources have been combined.

"Most other attempts at software like this are coarse-grained in terms of their view of what a feeling is," said Dr Jason Rentfrow, a senior lecturer in the department of psychology at Cambridge University.

"Many just look at emotions in terms of feeling happy, sad, angry or neutral. The aim here is to use a more flexible approach, to collect data that shows how moods vary between people. That is something which we think is quite unique to the system we have designed," he said.

When the app is opened for the first time, a sensor that tells the researchers what time of day it is is unlocked. The app spends roughly a week collecting data from this sensor and testing it against the user's emotional state.

'Journey of discovery'

At the end of this, the user is asked to complete a short life satisfaction survey, which unlocks a new sensor.

It takes about eight weeks to unlock all the sensors, which include gauging how sociable someone is dependent on how many texts they send or calls they make, their movements, location and how much they are interacting with their mobile phones.

It has been designed as "a journey of discovery" for the user to give them a step-by-step guide to what might be influencing their mood swings, said lead researcher Dr Neal Lathia.

"This helps us understand both how a person perceives things and how they are actually behaving," he said.

Therapeutic tool

"They may say that they are feeling happy but they may have stopped communicating with friends, for example. This is all about building a bridge between the two sources of data."

The system that allows users to input their own data about how they are feeling has been designed by psychologists.

At different times of the day, the app sends the users a notification asking them about their mood. Users are asked to input their mood on an "emotion grid" that has two axes. The first charts negative to positive feelings while another charts activity.

It is hoped the app can be used by doctors as a therapeutic tool as well as by individuals to work out the times that they are most stressed, for example.

Explicitly consent

"Most people who see a therapist only have an appointment once every fortnight," said Dr Lathia.

"Many, however, keep their phones with them most of the time. In terms of sheer presence, mobiles can provide an ongoing link with a person," he said.

The code used to collect sensor data is being made publicly available to allow other researchers to conduct their own experiments.

Initially the app will be available only for Android phones but the team is working on a version for other smartphones.

Users must explicitly consent to their data being used by members of the team, although it will not be made available more widely.

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Money 'needed to make care cap work'

8 May 2013 Last updated at 08:50 ET By Nick Triggle Health correspondent, BBC News

The government's commitment to reform social care will require greater investment, ministers have been told.

A bill limiting the cost to disabled and elderly people of their social care will form part of the government's legislative programme for the next year, the Queen's Speech revealed.

Previously ministers had proposed introducing a cap of £72,000 in 2016.

But campaigners and council chiefs told ministers budget cuts were already putting the system at risk.

Research by the Association of Directors of Adult Social Services (ADASS) suggests the £16bn budget for social care, including services for both elderly and disabled people, is likely to be trimmed by £800m in the next 12 months.

It comes after nearly £2bn has already been cut from them in the past two years - despite the prospect of an extra 450,000 people needing state help following the introduction of a cap.

'Bleak'

ADASS president Sandie Keene said: "Gazing into the next two years, without additional investment from that already planned, an already bleak outlook becomes even bleaker."

Michelle Mitchell, of Age UK, added: "The legislation announced has the potential to transform our crumbling, unfair social-care system for current and future generations of older people.

"But to have any chance in succeeding we need to see the legislation twinned with a commitment in the spending review for increased spending on social care."

Currently anyone with assets of more than £23,250 faces unlimited costs.

But under the proposed changes, the state will pick up the bill as soon as an individual's costs hit £72,000.

The cap has been designed to protect people against the catastrophic costs that push some into selling their homes.

One in 10 people face costs above £100,000 for old-age care.

As well as paving the way for a cap, the legislation will also change the law regarding social care.

A report in 2011 by the Law Commission said current laws were "outdated and flawed".

There are currently more than 40 different laws that affect social care, but the government is seeking to replace them with a single piece of legislation so people can be clear about their rights.

For example, people with conditions that vary over time, such as bi-polar disorder or dementia, can currently, in theory, be excluded from care because of the contradictory way regulations are written.

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Threat to measles elimination plans

6 May 2013 Last updated at 20:07 ET By James Gallagher Health and science reporter, BBC News

Outbreaks of measles are putting Europe's commitment to eliminate the disease by 2015 under threat, the World Health Organization (WHO) has warned.

Levels of vaccination have been too low in some countries, particularly in rich western European nations.

It says catch-up vaccination campaigns, such as the one launched in the UK, are needed across the continent.

Experts said it was not too late to hit the target, but "extraordinary" effort was needed.

It is theoretically possible to eradicate measles from the planet in the same way smallpox was defeated in 1980.

The 53 nations which form the WHO's European region, from Portugal to Uzbekistan, have pledged to stop the disease spreading on the continent.

However, there are high numbers of cases in the UK, Turkey, Ukraine and Romania. These follow outbreaks in Italy and France in previous years.

Robb Butler, the technical officer for WHO Europe's vaccination team, told the BBC: "It's too early to say the 2015 goal is not achievable, but it is certainly under threat, we would be fools to think it is not under threat."

Continue reading the main story

"Start Quote

One thing is clear, if we continue to do the same as we did last year we will not reach the goal"

End Quote Dr Pier Luigi Lopalco European Centre for Disease Prevention and Control

Two doses of the MMR vaccine give almost total protection against measles. It is a highly infectious disease, however, if 95% of people are fully immunised it should stop the virus spreading.

Some countries fall short of this target and even in countries with high uptake there are pockets of unvaccinated people.

Claims of a link between the vaccine and autism in 1998, which have since been completely discredited, damaged uptake figures - particularly in the UK.

Dr Pier Luigi Lopalco, the head of vaccine preventable diseases at the European Centre for Disease Prevention and Control, said "that story survives" and keeps cropping up across Europe.

He said: "Another problem is the acceptability of vaccination by a part of the population that is becoming larger and larger.

"I'm talking about middle class people that more and more are sceptical towards vaccination and accepting alternative remedies instead."

Continue reading the main story

Analysis

Smallpox is the ultimate poster-child for vaccination.

More than 300 million people were thought to have died from smallpox in the 20th Century alone.

The disease once killed 30% of those infected, but after an intense global vaccination campaign it was declared eradicated in 1980.

Measles is a tougher proposition as it is more infectious than smallpox, which means you have to vaccinate a higher percentage of the world's population.

However, lessons from polio show that the achievements from smallpox are not easy to repeat.

In 1988 the World Health Assembly set a target of eradicating polio by 2000.

Even now, polio is stubbornly clinging on in a handful of countries.

In theory measles could be completely eradicated, but it is still a very distant prospect.

Some countries are on target, particularly in Scandinavia and parts of central and eastern Europe. The Ministry of Health in Slovakia said it has not had a case among its own residents since 1998, with cases coming only from abroad.

But across the 53 countries, Dr Lopalco said it would be difficult to reach the target.

He said: "One thing is clear, if we continue to do the same as we did last year we will not reach the goal. We will not do it if we do not put in place extraordinary measures - large catch-up campaigns."

In response to epidemics in the UK, a large vaccination campaign has been launched to target more than one million schoolchildren who have not had their two doses of MMR.

Mr Butler, at the WHO, said other countries needed to act before they had outbreaks.

"At the European level we would like to see more member states doing what the UK are doing right now - going out and vaccinating adolescents and younger adults."

He argues that even countries with 97% uptake of the vaccine still have pockets of unvaccinated people so some form of catch-up campaign would be needed.

"I honestly believe most member states need to consider it as one of the best alternatives to seeing increased cases and outbreaks in the future."

Dr David Elliman, an immunisation expert at the Royal College of Paediatrics and Child Health in the UK, said the 2015 target was in danger.

"I think it is very difficult because we are talking about a very infectious disease so it is not like smallpox where uptake of the vaccine could be much lower and you would still be able to eradicate it.

"Unfortunately I think 2015 is very, very optimistic. It is possible, but I think two years hence, I would be surprised."

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Asthma admission rates 'vary widely'

6 May 2013 Last updated at 20:28 ET

There are "alarming variations" in the number of people with asthma admitted to hospital in an emergency, depending on where they live, says Asthma UK.

Figures for 2010-11 in England show that the admission rate for children in Liverpool was 19 times higher than in Tower Hamlets.

Adult hospital admission rates also varied widely across England.

The charity said good care and management of the condition could prevent three-quarters of admissions.

It has launched the Compare Your Care campaign to find out which parts of the country are offering good quality asthma care and which are lagging behind.

The figures, from the NHS Atlas of Variation: Respiratory Disease, show that the highest rate of adult emergency hospital admissions for the disease in England - 193 per 100,000 of population - was found in the London borough of Newham.

That rate was over six times higher than in Bromley, in London, at 30 per 100,000 people.

Continue reading the main story

Shannon Batt-Hilliard was diagnosed with asthma when she was a young child, living in Kent.

When she was five, the family moved to Northampton - and that's when her mother Glynnis realised how sub-standard her daughter's care had been.

"The difference was unbelievable. Until that point Shannon had never been given an inhaler and we'd received no care or support following her asthma attacks.

"Once we were in Northampton, she was put on nebulisers, given an inhaler and referred to an asthma nurse.

"The doctors were far more attentive and were keen to help improve and manage her asthma.

"For us as a family, relocating was the best thing we could have done health wise."

In children, aged up to 17 years, the disparity between a rate of 732.6 in Liverpool and 38.7 in Tower Hamlets was even greater.

Around one in 11 children and one in 12 adults in the UK suffers from asthma.

Emily Humphreys, head of policy and public affairs at Asthma UK, said the number of people being rushed to hospital with an attack could be reduced.

"Quality of asthma care is of paramount importance - we estimate that 75% of hospital admissions could be prevented with the right care and management.

"For example, people who don't have written asthma action plans are four times more likely to be hospitalised."

According to national guidelines, every sufferer should receive a written plan from their doctor or asthma nurse so they know what steps to take when their symptoms get worse.

However, only 12% of people with asthma actually have one, the charity says.

It also says sufferers should have a review at least once a year, yet one in five patients has not been invited to have an annual check-up, it says.

The charity's Compare Your Care campaign asks people with asthma to complete an online quiz and rate the care they receive where they live.

"By building a picture of where care is meeting national standards and where it may be falling behind, we'll be able to see if that explains the huge geographical variation in hospital admissions," said Ms Humphreys.

The responses will allow Asthma UK to help people with asthma demand better care in order to meet the national standards.

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NHS 111 'shows signs of improvement'

7 May 2013 Last updated at 06:29 ET

There are signs the NHS non-emergency helpline is getting better after the bank holiday weekend passed by without major problems, NHS England says.

The 111 service has been beset by problems recently with reports of patients struggling to get through.

Some areas even suspended their lines after they failed to cope with demand.

But chief nursing officer Jane Cummings said more than 100,000 rang for help over the weekend and the early signs suggested improvements had been made.

She said the "vast majority" were dealt with properly after providers had taken on more call handlers in the lead-up to the weekend.

But she conceded improvements still needed to be made.

Continue reading the main story

• 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

"We need to look at individual cases where perhaps advice was incorrect or not as good as we would have wanted it to be.

"But I think overall the message we are getting is that while in some places there is still some way to go, it is better."

Ahead of the weekend, the board of NHS England agreed to a review of the 111 service - introduced to replace NHS Direct - after discussing a report which said the service remained in a "fragile" state in a number of places.

There are actually 46 different services across England run by a variety of providers, including ambulance crews and private companies.

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Seven of the services have yet to go live while a number of others have been suspended or are receiving help from other parts of the health service.

Despite the claims by Ms Cummings, the BBC has still been contacted by patients who have experienced problems.

One emailed in to say: "Was becoming worryingly ill on the Friday evening. Phoned 111 on Sat at 7.30am. Was told that I would be phoned back within six hours. Didn't hear anything for 28 hours. Ended up in hospital on the Sunday."

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Paramedic reveals ambulance failures

3 May 2013 Last updated at 19:00 ET By Rob Cave 5 live Investigates

Patients are coming to serious harm and even dying because of ambulance delays, a paramedic whistle-blower has warned.

He says 'lone-response' paramedics at emergencies in the east of England can be stranded for several hours while they wait for fully crewed ambulances.

The ambulance trust serving the region is investigating eight "serious incidents" in March.

They involve delays in getting patients to hospital, including four cases in which people died.

The East of England Ambulance Service (EEAS) admitted the service had fallen short, and said it was investing in extra staff and ambulances.

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"At least once every shift we are waiting for more than 30 minutes," said the paramedic, who did not want to be named.

"And we're talking about time-critical patients, not someone who has just cut a finger.

"It's happened to me with a patient who was having severe breathing difficulties. I had to wait for an ambulance to come from 50 miles away. Regrettably she passed away before the ambulance arrived."

The EEAS covers Essex, Hertfordshire, Bedfordshire, Cambridgeshire, Norfolk and Suffolk, a population of almost six million people.

The service needs to find savings of almost £60m in the five-year period to 2016-17.

Continue reading the main story

"Start Quote

I cheated death twice... The paramedic was superb, but the delay was disgusting"

End Quote James Sadler

But paramedics say the funding crisis has been compounded by previous management putting too much of its resources into lone-response paramedics at the expense of fully staffed ambulances.

James Sadler was left stranded twice after suffering first a heart attack and then, a month later, chest pains at his home in Sheringham, Norfolk.

On the first occasion, the sole paramedic who attended was told that one ambulance had been diverted to another emergency and a second had run out of petrol. The third ambulance to arrive got him to Norfolk and Norwich Hospital three hours after his family had made the 999 call.

As he waited to get to hospital, his heart stopped beating.

Continue reading the main story

Find out more

Listen to the full report on 5 live Investigates on BBC 5 live on Sunday, 3 February, at 11:00 GMT

"I cheated death twice, first at home and then in the ambulance. The paramedic was superb, but the delay was disgusting. The problem is not getting into hospital," he said.

On the second occasion, a paramedic again responded quickly to a call from his family, but the ambulance arrived late and then broke down at his house. Eventually he got to hospital several hours after the 999 call was made.

Although the trust recorded eight serious incidents linked to delays in March, the problem has been developing since the end of 2011.

Figures released after a Freedom of Information request show that incidents where patients waited for more than 30 minutes after the first responder called for back-up increased from 1,241 in December 2011 to 2,884 last November. The biggest problems were in Essex.

The investigation into the serious incidents will determine if the delays played a part in any of the four subsequent deaths.

A new chief executive, Andrew Morgan, has been brought in to sort out the problems facing the trust. In a report last month, he said senior managers had taken their eye off the ball as they pursued foundation trust status.

Mr Morgan said there had been a lack of "clear and visible leadership from the board".

The trust says it is "seeking to recruit" an additional 351 frontline staff, and is investing an additional £5m in its frontline operations, as part of a plan to improve the service. An extra 25 fully crewed NHS ambulances will also be deployed in areas where delays have been most acute.

"We have to improve our service to better support patients and staff. A number of patients have waited too long for an ambulance and in some areas there has been an overreliance on rapid-response vehicles.

"Our turnaround plan sets out how we will achieve that. The changes we require will not happen overnight, but we are starting to see some improvements in our services," said Mr Morgan.

You can listen to the full report on 5 live Investigates on Sunday 5 May at 11:00 GMT on BBC 5 live.

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

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Some liver transplants 'avoidable'

4 May 2013 Last updated at 19:08 ET

Some patients with severely damaged livers may not need a transplant as their own organ is actually regrowing, say doctors at a hospital in London.

They made the discovery by looking at a rare group of patients given a transplant while their own damaged liver is left in the body.

Sometimes the original liver recovers.

A study, in the American Journal of Transplantation, suggests doctors can predict which patients do not need a transplant as their liver is healing.

King's College Hospital has a leading liver transplant centre and is one of few places to perform "auxiliary transplants".

They are performed in sudden cases of liver failure caused by overdoses or viral infections, rather than the long-term damage caused by alcohol abuse.

Normally in organ transplants one organ comes out and a new one goes in. However, in this complex operation the transplant is put in beside the old liver.

After any transplant a patient needs to take a lifetime of drugs to suppress the immune system in order to avoid rejection. The drugs leave the body vulnerable to infection.

However, if the patient's liver does eventually recover then they can come off the immunosuppressant drugs and their body will get rid of the transplant.

Continue reading the main story

What we may be able to do is come up with a better set of tests to allow us to identify those patients who are already regrowing and may not need transplantation"

End Quote Dr Varuna Aluvihare King's College Hospital

The transplant is used to get the patient past the critical stage of the illness.

But the recovery happens only in some patients. In the study, the transplant was no longer needed in seven out of 11 patients.

So doctors analysed the detailed chemistry inside the liver cells of patients and looked for differences between those who recovered and those who did not.

Dr Varuna Aluvihare told the BBC: "There was a big difference right from the point of transplantation in the expression of some very small molecules between the group that would, three years down the line, regrow their liver versus the group that never did."

Those molecules regulated the way cells in the liver grow.

"Some of them were already starting to regrow. So what we may be able to do is come up with a better set of tests to allow us to identify those patients who are already regrowing and may not need transplantation.

"So we may be able to remove a group from the transplant list."

The liver does have a phenomenal ability to regenerate. In healthy people it will recover in the space of months even if a large amount is taken away.

People who need a transplant because of acute liver failure are seriously ill. Even if doctors could tell which patients' livers were already on the path to recovery, they would still need to keep those patients alive long enough for the liver to return to form.

Dr Aluvihare argued this would be possible as a small amount of restored liver function would be enough for patients to leave hospital.

He said there are cases at King's of patients recovering while they were on the waiting list.

"I would say five to 10 patients a year we seriously consider for emergency transplantation and then they start recovering.

"That tells us there probably is a pool there and there is probably quite a lot of mileage in identifying people would would recover."

Whether this would work is still uncertain. The team have received funding to look for those chemical differences in the blood of patients.

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Quarter of adults 'walk hour a week'

6 May 2013 Last updated at 09:49 ET

A poll for the walking charity the Ramblers suggests 25% of adults walk for no more than one hour each week.

The YouGov survey, which polled 2,000 adults across Britain about walking habits, found another 43% reported walking for less than two hours a week.

Government guidelines suggest people should do 150 minutes of "moderate" physical activity each week.

The survey asked people about the total amount of walking they did, including trips to school, work or the shops.

The Ramblers, which is promoting a "Get Walking Week" from 4-11 May, said there was already research showing that two thirds of adults in the UK took too little exercise.

It said the survey backed that up.

'Inactivity pandemic'

The West Midlands was revealed as the worst region for weekly walking, with more than a third of adults (34%) walking for no more than an hour a week.

The East Midlands came out top, with 59% of people doing enough to satisfy recommended physical activity guidelines.

Continue reading the main story

Walking is the easiest and cheapest way to keep fit. You can walk anytime, anywhere and you don't need any equipment"

End Quote Dr Mike Knapton British Heart Foundation

Despite the low levels of walking reported, nearly all of those surveyed - 93% - agreed walking was a good form of exercise.

The Ramblers charity, which promotes walking for health and pleasure, wants to get people to go on walks of five miles or less. It is running free walks led by guides.

Benedict Southworth, chief executive of the Ramblers, said: "Walking is one of the most accessible and achievable ways to truly conquer this inactivity pandemic in Britain and we need to get started now."

Public health minister Anna Soubry, said walking was "one of the best ways to keep healthy", and that she supported the initiative.

The British Heart Foundation (BHF) advises that moderate intensity aerobic activity is the most effective type of activity for maintaining a healthy heart.

Aerobic activity is a repetitive rhythmic exercise involving large muscle groups such as legs, shoulders and arms.

Moderate intensity activities should make a person feel warmer, breathe harder and make their heart beat faster than usual. But, they should still be able to have a conversation.

The BHF also advises 150 minutes of moderate intensity aerobic activity each week.

'Boost self-esteem'

Dr Mike Knapton, associate medical director for the BHF, said: "Walking is the easiest and cheapest way to keep fit. You can walk anytime, anywhere and you don't need any equipment."

Dr Stuart Biddle, professor of physical activity and health at Loughborough University, said there was long-standing evidence to support a link between walking and mental health benefits.

Walking can elevate a person's mood, lessen feelings of depression and allow a person to think more clearly, he said.

"If you feel you are doing something worthwhile rather than sitting around doing nothing and watching junk on the telly [walking can make] you feel a bit better about yourself and boost your self-esteem," he added.

Dr Biddle said 30 minutes of brisk walking each day would bring substantial health benefits.

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Paramedic reveals ambulance failures

3 May 2013 Last updated at 19:00 ET By Rob Cave 5 live Investigates

Patients are coming to serious harm and even dying because of ambulance delays, a paramedic whistle-blower has warned.

He says 'lone-response' paramedics at emergencies in the east of England can be stranded for several hours while they wait for fully crewed ambulances.

The ambulance trust serving the region is investigating eight "serious incidents" in March.

They involve delays in getting patients to hospital, including four cases in which people died.

The East of England Ambulance Service (EEAS) admitted the service had fallen short, and said it was investing in extra staff and ambulances.

Please turn on JavaScript. Media requires JavaScript to play.

"At least once every shift we are waiting for more than 30 minutes," said the paramedic, who did not want to be named.

"And we're talking about time-critical patients, not someone who has just cut a finger.

"It's happened to me with a patient who was having severe breathing difficulties. I had to wait for an ambulance to come from 50 miles away. Regrettably she passed away before the ambulance arrived."

The EEAS covers Essex, Hertfordshire, Bedfordshire, Cambridgeshire, Norfolk and Suffolk, a population of almost six million people.

The service needs to find savings of almost £60m in the five-year period to 2016-17.

Continue reading the main story

"Start Quote

I cheated death twice... The paramedic was superb, but the delay was disgusting"

End Quote James Sadler

But paramedics say the funding crisis has been compounded by previous management putting too much of its resources into lone-response paramedics at the expense of fully staffed ambulances.

James Sadler was left stranded twice after suffering first a heart attack and then, a month later, chest pains at his home in Sheringham, Norfolk.

On the first occasion, the sole paramedic who attended was told that one ambulance had been diverted to another emergency and a second had run out of petrol. The third ambulance to arrive got him to Norfolk and Norwich Hospital three hours after his family had made the 999 call.

As he waited to get to hospital, his heart stopped beating.

Continue reading the main story

Find out more

Listen to the full report on 5 live Investigates on BBC 5 live on Sunday, 3 February, at 11:00 GMT

"I cheated death twice, first at home and then in the ambulance. The paramedic was superb, but the delay was disgusting. The problem is not getting into hospital," he said.

On the second occasion, a paramedic again responded quickly to a call from his family, but the ambulance arrived late and then broke down at his house. Eventually he got to hospital several hours after the 999 call was made.

Although the trust recorded eight serious incidents linked to delays in March, the problem has been developing since the end of 2011.

Figures released after a Freedom of Information request show that incidents where patients waited for more than 30 minutes after the first responder called for back-up increased from 1,241 in December 2011 to 2,884 last November. The biggest problems were in Essex.

The investigation into the serious incidents will determine if the delays played a part in any of the four subsequent deaths.

A new chief executive, Andrew Morgan, has been brought in to sort out the problems facing the trust. In a report last month, he said senior managers had taken their eye off the ball as they pursued foundation trust status.

Mr Morgan said there had been a lack of "clear and visible leadership from the board".

The trust says it is "seeking to recruit" an additional 351 frontline staff, and is investing an additional £5m in its frontline operations, as part of a plan to improve the service. An extra 25 fully crewed NHS ambulances will also be deployed in areas where delays have been most acute.

"We have to improve our service to better support patients and staff. A number of patients have waited too long for an ambulance and in some areas there has been an overreliance on rapid-response vehicles.

"Our turnaround plan sets out how we will achieve that. The changes we require will not happen overnight, but we are starting to see some improvements in our services," said Mr Morgan.

You can listen to the full report on 5 live Investigates on Sunday 5 May at 11:00 GMT on BBC 5 live.

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

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Seven NHS 111 helpline incidents

4 May 2013 Last updated at 04:56 ET By Caroline Parkinson Health editor, BBC News website

Please turn on JavaScript. Media requires JavaScript to play.

Howard Wensley: Using the 111 helpline was "like banging my head on a brick wall"

The NHS says it has experienced seven "potentially serious" incidents in the first few weeks of its 111 urgent care helpline in England.

One case involved a patient in the West Midlands who died unexpectedly and there have been reports of calls going unanswered and poor advice being given.

All the cases are being reviewed.

Other organisations are also running 111 lines for NHS England and have been warned they must deliver good care or face financial or contract penalties.

According to GPs' magazine Pulse, there have been 22 incidents classed as serious across all providers of 111 lines.

NHS Direct, which previously ran the phone line for people needing urgent treatment at evenings and weekends, has confirmed that seven potentially serious incidents on the 111 helpline it runs are being investigated.

The incidents occurred between 18 March and 11 April - which included the period when the service was being trialled, it said. During that time, it dealt with about 122,000 calls.

The organisation added it was "not unduly concerned" about the level of incidents.

A spokesperson said: "We take the responsibility for the safety and wellbeing of our patients extremely seriously.

"When a concern is raised we listen to the call and undertake an incident review involving experienced clinical staff. This allows us to identify clear actions so that lessons can be learnt and acted on quickly and thoroughly."

'Totally inadequate'

Continue reading the main story

"Start Quote

"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas. "

End Quote Dr Clare Gerada Royal College of GPs

NHS 111 is a free number for patients with urgent, but not life-threatening symptoms, including those who need fast medical help but who are not a 999 emergency.

It is designed to replace the NHS Direct advice line and out-of-hours GP call centres, with a more practical service.

Trained advisers who answer the phones offer basic health advice and direct the caller to the most appropriate area for their needs - A&E or GP out-of-hours services, for example.

But its launch has been plagued with difficulty, with some patients facing long delays before they had their calls answered and others abandoning calls altogether.

Seven of the 46 services across England are not yet in operation and a number of others have been suspended or are receiving help from other parts of the NHS.

One of the areas that has seen a 111 service start and then been abandoned is Greater Manchester.

A GP who was working when the system crashed said the service was "totally inadequate".

Dr Mary Gibbs told the BBC: "Patients' health was put at risk."

The British Medical Association has also repeatedly raised concerns about the 111 service being able to provide a safe and effective service.

'Losing confidence'

Where problems are identified with NHS 111, NHS Direct will continue to operate.

A contingency fund of £8.4m has reportedly been set aside to fund this until June.

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

At the board meeting of NHS England on Friday, deputy chief executive Dame Barbara Hakin said the 111 service was operating well in the majority of the country, but there would be no further roll-out until NHS England was satisfied it could be delivered safely.

She said the service had improved from late March when the worst of the problems were encountered and plans were in place to cope with the extra demand expected over this bank holiday weekend.

A review into NHS 111 has already been announced.

An NHS England spokesman said: "The safety of patients must be our paramount concern and NHS England will keep a careful eye on the situation to ensure NHS 111 provides not only a good service for the public, but one which is also safe."

Dr Clare Gerada, chair of the Royal College of General Practitioners (RCGP), said: "The RCGP believes NHS 111 must be more effectively supported if it is going to properly direct patients to the most appropriate form of urgent NHS care.

"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas.

"We are also concerned that patients are losing confidence in the new service before it is even fully up and running. We call on NHS England to provide more reassurance about its effectiveness and ability to deliver the necessary standards of care for all patients using the service, right across England."

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Some liver transplants 'avoidable'

4 May 2013 Last updated at 19:08 ET

Some patients with severely damaged livers may not need a transplant as their own organ is actually regrowing, say doctors at a hospital in London.

They made the discovery by looking at a rare group of patients given a transplant while their own damaged liver is left in the body.

Sometimes the original liver recovers.

A study, in the American Journal of Transplantation, suggests doctors can predict which patients do not need a transplant as their liver is healing.

King's College Hospital has a leading liver transplant centre and is one of few places to perform "auxiliary transplants".

They are performed in sudden cases of liver failure caused by overdoses or viral infections, rather than the long-term damage caused by alcohol abuse.

Normally in organ transplants one organ comes out and a new one goes in. However, in this complex operation the transplant is put in beside the old liver.

After any transplant a patient needs to take a lifetime of drugs to suppress the immune system in order to avoid rejection. The drugs leave the body vulnerable to infection.

However, if the patient's liver does eventually recover then they can come off the immunosuppressant drugs and their body will get rid of the transplant.

Continue reading the main story

What we may be able to do is come up with a better set of tests to allow us to identify those patients who are already regrowing and may not need transplantation"

End Quote Dr Varuna Aluvihare King's College Hospital

The transplant is used to get the patient past the critical stage of the illness.

But the recovery happens only in some patients. In the study, the transplant was no longer needed in seven out of 11 patients.

So doctors analysed the detailed chemistry inside the liver cells of patients and looked for differences between those who recovered and those who did not.

Dr Varuna Aluvihare told the BBC: "There was a big difference right from the point of transplantation in the expression of some very small molecules between the group that would, three years down the line, regrow their liver versus the group that never did."

Those molecules regulated the way cells in the liver grow.

"Some of them were already starting to regrow. So what we may be able to do is come up with a better set of tests to allow us to identify those patients who are already regrowing and may not need transplantation.

"So we may be able to remove a group from the transplant list."

The liver does have a phenomenal ability to regenerate. In healthy people it will recover in the space of months even if a large amount is taken away.

People who need a transplant because of acute liver failure are seriously ill. Even if doctors could tell which patients' livers were already on the path to recovery, they would still need to keep those patients alive long enough for the liver to return to form.

Dr Aluvihare argued this would be possible as a small amount of restored liver function would be enough for patients to leave hospital.

He said there are cases at King's of patients recovering while they were on the waiting list.

"I would say five to 10 patients a year we seriously consider for emergency transplantation and then they start recovering.

"That tells us there probably is a pool there and there is probably quite a lot of mileage in identifying people would would recover."

Whether this would work is still uncertain. The team have received funding to look for those chemical differences in the blood of patients.

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Paramedic reveals ambulance failures

3 May 2013 Last updated at 19:00 ET By Rob Cave 5 live Investigates

Patients are coming to serious harm and even dying because of ambulance delays, a paramedic whistle-blower has warned.

He says 'lone-response' paramedics at emergencies in the east of England can be stranded for several hours while they wait for fully crewed ambulances.

The ambulance trust serving the region is investigating eight "serious incidents" in March.

They involve delays in getting patients to hospital, including four cases in which people died.

The East of England Ambulance Service (EEAS) admitted the service had fallen short, and said it was investing in extra staff and ambulances.

Please turn on JavaScript. Media requires JavaScript to play.

"At least once every shift we are waiting for more than 30 minutes," said the paramedic, who did not want to be named.

"And we're talking about time-critical patients, not someone who has just cut a finger.

"It's happened to me with a patient who was having severe breathing difficulties. I had to wait for an ambulance to come from 50 miles away. Regrettably she passed away before the ambulance arrived."

The EEAS covers Essex, Hertfordshire, Bedfordshire, Cambridgeshire, Norfolk and Suffolk, a population of almost six million people.

The service needs to find savings of almost £60m in the five-year period to 2016-17.

Continue reading the main story

"Start Quote

I cheated death twice... The paramedic was superb, but the delay was disgusting"

End Quote James Sadler

But paramedics say the funding crisis has been compounded by previous management putting too much of its resources into lone-response paramedics at the expense of fully staffed ambulances.

James Sadler was left stranded twice after suffering first a heart attack and then, a month later, chest pains at his home in Sheringham, Norfolk.

On the first occasion, the sole paramedic who attended was told that one ambulance had been diverted to another emergency and a second had run out of petrol. The third ambulance to arrive got him to Norfolk and Norwich Hospital three hours after his family had made the 999 call.

As he waited to get to hospital, his heart stopped beating.

Continue reading the main story

Find out more

Listen to the full report on 5 live Investigates on BBC 5 live on Sunday, 3 February, at 11:00 GMT

"I cheated death twice, first at home and then in the ambulance. The paramedic was superb, but the delay was disgusting. The problem is not getting into hospital," he said.

On the second occasion, a paramedic again responded quickly to a call from his family, but the ambulance arrived late and then broke down at his house. Eventually he got to hospital several hours after the 999 call was made.

Although the trust recorded eight serious incidents linked to delays in March, the problem has been developing since the end of 2011.

Figures released after a Freedom of Information request show that incidents where patients waited for more than 30 minutes after the first responder called for back-up increased from 1,241 in December 2011 to 2,884 last November. The biggest problems were in Essex.

The investigation into the serious incidents will determine if the delays played a part in any of the four subsequent deaths.

A new chief executive, Andrew Morgan, has been brought in to sort out the problems facing the trust. In a report last month, he said senior managers had taken their eye off the ball as they pursued foundation trust status.

Mr Morgan said there had been a lack of "clear and visible leadership from the board".

The trust says it is "seeking to recruit" an additional 351 frontline staff, and is investing an additional £5m in its frontline operations, as part of a plan to improve the service. An extra 25 fully crewed NHS ambulances will also be deployed in areas where delays have been most acute.

"We have to improve our service to better support patients and staff. A number of patients have waited too long for an ambulance and in some areas there has been an overreliance on rapid-response vehicles.

"Our turnaround plan sets out how we will achieve that. The changes we require will not happen overnight, but we are starting to see some improvements in our services," said Mr Morgan.

You can listen to the full report on 5 live Investigates on Sunday 5 May at 11:00 GMT on BBC 5 live.

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

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Seven NHS 111 helpline incidents

4 May 2013 Last updated at 04:56 ET By Caroline Parkinson Health editor, BBC News website

The NHS says it has experienced seven "potentially serious" incidents in the first few weeks of its 111 urgent care helpline in England.

One case involved a patient in the West Midlands who died unexpectedly and there have been reports of calls going unanswered and poor advice being given.

All the cases are being reviewed.

Other organisations are also running 111 lines for NHS England and have been warned they must deliver good care or face financial or contract penalties.

According to GPs' magazine Pulse, there have been 22 incidents classed as serious across all providers of 111 lines.

NHS Direct, which previously ran the phone line for people needing urgent treatment at evenings and weekends, has confirmed that seven potentially serious incidents on the 111 helpline it runs are being investigated.

The incidents occurred between 18 March and 11 April - which included the period when the service was being trialled, it said. During that time, it dealt with about 122,000 calls.

The organisation added it was "not unduly concerned" about the level of incidents.

A spokesperson said: "We take the responsibility for the safety and wellbeing of our patients extremely seriously.

"When a concern is raised we listen to the call and undertake an incident review involving experienced clinical staff. This allows us to identify clear actions so that lessons can be learnt and acted on quickly and thoroughly."

'Totally inadequate'

Continue reading the main story

"Start Quote

"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas. "

End Quote Dr Clare Gerada Royal College of GPs

NHS 111 is a free number for patients with urgent, but not life-threatening symptoms, including those who need fast medical help but who are not a 999 emergency.

It is designed to replace the NHS Direct advice line and out-of-hours GP call centres, with a more practical service.

Trained advisers who answer the phones offer basic health advice and direct the caller to the most appropriate area for their needs - A&E or GP out-of-hours services, for example.

But its launch has been plagued with difficulty, with some patients facing long delays before they had their calls answered and others abandoning calls altogether.

Seven of the 46 services across England are not yet in operation and a number of others have been suspended or are receiving help from other parts of the NHS.

One of the areas that has seen a 111 service start and then been abandoned is Greater Manchester.

A GP who was working when the system crashed said the service was "totally inadequate".

Dr Mary Gibbs told the BBC: "Patients' health was put at risk."

The British Medical Association has also repeatedly raised concerns about the 111 service being able to provide a safe and effective service.

'Losing confidence'

Where problems are identified with NHS 111, NHS Direct will continue to operate.

A contingency fund of £8.4m has reportedly been set aside to fund this until June.

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

At the board meeting of NHS England on Friday, deputy chief executive Dame Barbara Hakin said the 111 service was operating well in the majority of the country, but there would be no further roll-out until NHS England was satisfied it could be delivered safely.

She said the service had improved from late March when the worst of the problems were encountered and plans were in place to cope with the extra demand expected over this bank holiday weekend.

A review into NHS 111 has already been announced.

An NHS England spokesman said: "The safety of patients must be our paramount concern and NHS England will keep a careful eye on the situation to ensure NHS 111 provides not only a good service for the public, but one which is also safe."

Dr Clare Gerada, chair of the Royal College of General Practitioners (RCGP), said: "The RCGP believes NHS 111 must be more effectively supported if it is going to properly direct patients to the most appropriate form of urgent NHS care.

"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas.

"We are also concerned that patients are losing confidence in the new service before it is even fully up and running. We call on NHS England to provide more reassurance about its effectiveness and ability to deliver the necessary standards of care for all patients using the service, right across England."

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Cancer recall over doctor fears

4 May 2013 Last updated at 06:27 ET

Hundreds of women have been recalled for breast cancer screenings after a hospital claimed a junior doctor failed to follow proper procedures.

The Royal Bournemouth Hospital said 272 patients have been asked back to have reassessments.

The women attended the clinic between January 2011 and July 2012 .

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust said it had referred the case to the General Medical Council.

The trust said concerns were raised over the way the women were assessed by the junior doctor, who is no longer working for the trust.

In a statement it said: "This assessment potentially did not meet our usual high standards."

Consultant breast surgeon Tony Skene said: "Although we have found no evidence of any harm, the safety of our patients is our number one priority.

"We do however realise that for those patients that we do recall this may lead to additional anxiety and we apologise for the distress that this may cause."

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Child weekend care 'no added risk'

2 May 2013 Last updated at 21:39 ET

There is no added risk of death for children admitted to intensive care as emergencies out of normal hours, a study says.

Previous research had suggested an increased risk for weekend admissions.

But new work at Leeds and Leicester universities, looking at 86,000 child admissions to 29 units in England and Wales in 2006-11, found no difference.

The authors said it showed how having senior staff present mattered.

There have been previous calls for more involvement from senior doctors in health service care, with Sir Bruce Keogh, medical director of NHS England, calling in February for seven-day-a-week consultant-led care.

'Added pressures'

The latest study, published in the Journal of Pediatrics, was designed as the largest analysis of the impact of admission times on paediatric intensive care cases.

Out-of-hours admissions were defined as any admission at the weekend, night-time or on a bank holiday.

It found that those admitted at night or at the weekend had the same chance of survival as those admitted during normal working hours.

However, mortality rates were significantly higher in the winter, up 13%, even after taking into account added health risks for children in the colder months.

Further research is needed to discover why that is, the team say, though they suggest it could be added pressures on services.

Continue reading the main story

This study provides a reassuring message for parents"

End Quote Dr Hilary Cass Royal College of Paediatrics and Child Health

'Consistency of quality of care'

Dr Roger Parslow, senior lecturer in the University of Leeds School of Medicine, who co-led the study, said: "Paediatric intensive care units have direct consultant input and dedicated staffing out-of-hours, so proponents of 24/7 consultant care may see this as supporting their case."

Prof Elizabeth Draper, of the University of Leicester, who also worked on the research, said: "The consistency of the quality of care provision by all paediatric intensive care units at any time during the week will be very reassuring for the parents of children requiring intensive care."

Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health, said: "This study provides a reassuring message for parents: if your child is admitted to an intensive care unit, they'll receive the best possible level of care, day or night."

She added: "Paediatrics is a seven-day, 24-hour speciality.

"Whilst you can't necessarily translate the experience in intensive care to other settings, this study helps to bolster the case for increased consultant presence at the times when children need them most, and we have to be prepared to re-examine the way in which care is delivered to make this a reality."

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Under-50s' breast cancers top 10,000

3 May 2013 Last updated at 01:30 ET

The number of British women under 50 having breast cancer diagnosed annually has topped 10,000 for the first time, according to Cancer Research UK.

The charity says one case in five in the UK is among the under-50s, though fewer than ever in that age group are dying of the disease.

Higher alcohol intake and childbirth patterns could be factors, it believes.

In 1993-95, 38 women per 100,000 had breast cancer diagnosed, compared with 42 per 100,000 in 2008-10.

In total, more than 49,500 women of all ages had breast cancer diagnosed in 2010, compared with 37,107 in 1995.

The majority of cases occur in older women.

Continue reading the main story

These figures show that breast cancer still affects more and more families every year in the UK and the need for research into the disease remains vital"

End Quote Chris Askew Breakthrough Breast Cancer

However, the incidence rate of breast cancer in women under 50 rose by 11% over that period.

In 2010, 10,068 women under the age of 50 in the UK were told that they had the disease - 2,300 more than the number diagnosed in 1995, Cancer Research UK said.

It says it is not clear exactly what factors are behind the rise, but that increasing alcohol intake and hormonal factors such as having fewer children and having them later in life, and increased use of the contraceptive pill may be playing a role.

Sara Hiom, the organisation's director of health information, said: "Women of all ages who notice anything different about their breasts - including changes in size, shape or feel, a lump or thickening, nipple discharge or rash, dimpling, puckering or redness of the skin - should see their GP straightaway, even if they have attended breast cancer screening.

'Better care'

"It's more likely not to be cancer. But if it is, detecting it early gives the best chance of successful treatment."

Ms Hiom said the improvements in survival rates are linked to research, more awareness and better care, as well as the availability of new drugs that can be used to treat the disease.

The charity said that as breast cancer had affected younger people in the public eye, such as Kylie Minogue, that might have encouraged women to come forward sooner. But that would not explain the rise in the number of cases.

Chris Askew, chief executive of the Breakthrough Breast Cancer charity, said: "These figures show that breast cancer still affects more and more families every year in the UK and the need for research into the disease remains vital."

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Tough warnings for NHS 111 services

3 May 2013 Last updated at 08:54 ET By Caroline Parkinson Health editor, BBC News website

The board of the NHS England has warned organisations running the new NHS 111 urgent care helpline they must deliver good care - or face penalties.

Just days after it was revealed the service is seen as "fragile", the NHS board said poor performers could face financial penalties or even have contracts withdrawn.

There have been reports of calls going unanswered and poor advice being given.

However the board did say the service was working well in 90% of England.

NHS 111 is a free one-stop number for patients with urgent, but not life-threatening symptoms, including those who need 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

It is designed to replace the NHS Direct advice line, as well as out-of-hours GP call centres, with a more practical service for those needing urgent but not emergency care.

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"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas. "

End Quote Dr Clare Gerada Royal College of GPs

But its launch has been plagued with difficulty, with some patients facing long delays before they had their calls answered and other abandoning calls altogether.

Seven of the 46 services across England are not yet in operation and a number of others have been suspended or are receiving help from other parts of the NHS.

One of the areas that has seen a 111 service start and then be abandoned is Greater Manchester.

Doctor's concerns

A GP who was working when the system crashed said the service was "totally inadequate".

Dr Mary Gibbs told the BBC: "Patients' health was put at risk."

The British Medical Association has also repeatedly raised concerns about the 111 service being able to provide a safe and effective service.

Where problems are identified with NHS 111, NHS Direct will continue to operate.

A contingency fund of £8.4m has reportedly been set aside to fund this until June.

At the board meeting of NHS England on Friday, deputy chief executive Dame Barbara Hakin said the 111 service was operating well in the majority of the country, but there would be no further roll-out until NHS England was satisfied it could be delivered safely.

She said the service had improved from late March when the worst of the problems were encountered and plans were in place to cope with the extra demand expected over this bank holiday weekend.

A review into NHS 111 has already been announced.

Dr Clare Gerada, chair of the Royal College of General Practitioners (RCGP), said: "The RCGP believes NHS 111 must be more effectively supported if it is going to properly direct patients to the most appropriate form of urgent NHS care.

"It is extremely worrying that there is still so much uncertainty around the delivery and reliability of the advice provided by NHS 111 in some areas.

"We are also concerned that patients are losing confidence in the new service before it is even fully up and running. We call on NHS England to provide more reassurance about its effectiveness and ability to deliver the necessary standards of care for all patients using the service, right across England."

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NHS 111 advice line 'still fragile'

1 May 2013 Last updated at 13:01 ET By Nick Triggle Health correspondent, BBC News

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Dame Barbara Halkin: "Some patients haven't received the quality of service"

The new NHS non-emergency 111 telephone service in England is in a fragile state in a number of areas ahead of bank holiday weekend, NHS bosses admit.

Reports have been emerging for weeks of calls going unanswered and poor advice being given, leading to hospitals being inundated with patients.

The problems plaguing the advice line will now be discussed at a board meeting of NHS England on Friday.

Officials are expected to agree to an urgent review of the system.

A board paper produced by NHS England says some of the problems have been "unacceptable" and, despite improvements, the system still remains in a "fragile" state in places.

There are 46 individual 111 services across England. They were supposed to have been in place by 1 April to replace NHS Direct, although ministers relaxed this deadline after it became apparent some areas were not ready.

Continue reading the main story

"Start Quote

The quality of some of the information being given out appears from anecdotal sources to be questionable in some instances"

End Quote Dr Laurence Buckman British Medical Association

Seven have yet to go live. And of those that have, several have subsequently been suspended because of problems, while a number are relying on extra staff and support brought in from other parts of the health service.

One of the areas that has seen a 111 service start and then abandoned is Greater Manchester.

Dr Mary Gibbs, a GP who was providing out-of-hours cover when the system crashed there, said: "Calls just weren't coming through. It was totally inadequate. Patients' health was put at risk."

"Delays"

Where problems are continuing, NHS Direct - the service 111 was meant to replace - is remaining operational. A contingency fund of £8.4m has reportedly been set aside to fund this until June.

It comes as the NHS gears up for the three-day weekend.

The 111 service tends to be busiest when local GP surgeries are closed.

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

Dame Barbara Hakin, the interim chief operating officer for NHS England, said the organisations providing the 111 services, which include ambulance services, private companies and NHS Direct, would face having their contracts revoked if they continued to fall below the expected standards.

"We will be relentless and diligent in making sure that this service is as it should be everywhere.

"I am confident it is a great service in the majority of the country. I am not comfortable with that, it needs to be a great service everywhere."

Dr Laurence Buckman, chairman of the British Medical Association's GPs committee, said: "We are still receiving reports that patients are facing unacceptably long waits to get through to an NHS 111 operator and suffering from further delays when waiting for calls back with medical advice should they manage to have their call answered.

"The quality of some of the information being given out appears, from anecdotal sources, to be questionable in some instances."

He added: "If any area of the country is failing to meet high standards of care then its NHS 111 service needs to be suspended. NHS England also need to be more transparent about how the system is functioning across the country."

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Child surgery halt over failings

2 May 2013 Last updated at 04:04 ET

Children's surgery has been suspended at a private Surrey hospital after "serious concerns" were raised by the health watchdog.

The Care Quality Commission (CQC) demanded immediate improvements to "protect people from coming to harm" at BMI Mount Alvernia Hospital, Guildford.

Inspectors visited the hospital in December 2012 and January 2013.

BMI Healthcare apologised for "entirely unacceptable" failings and said it had voluntarily halted children's surgery.

'Let patients down'

The CQC was due to publish a report on Wednesday about the inspection but said the publication would be delayed because the hospital had made representations on two issues.

BMI Healthcare chief executive officer Stephen Collier said: "The hospital's practices let BMI and our patients down and I apologise for that.

"In 2012 we were not maintaining the high standards that we and our regulators demand at Mount Alvernia.

"I want to reassure our patients that the hospital has already been in touch with anyone who may have been affected by a particular incident.

"I have personally written to all patients who were admitted for treatment at Mount Alvernia in the last year explaining what has happened and providing contact details should they want to discuss the matter further with us."

A CQC spokesman said: "Following the inspection CQC raised serious concerns with the provider and formally warned them that immediate improvements were required to protect people from coming to harm.

"As a result of our concerns being raised with them, BMI agreed to voluntarily suspend children's surgical admissions at the hospital and to start making other changes required.

"We have continued to monitor the hospital closely. Full details of our inspection will be published shortly."

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Measles cases in epidemic rise again

2 May 2013 Last updated at 09:20 ET

The number of cases in the Swansea measles epidemic has risen to 1,039, an increase of 28 in the past two days.

Public Health Wales (PHW) said across Wales the total has reached 1,170, and 85 people have been hospitalised.

It said that 33,000 non-routine MMR vaccinations have been given around the country during the outbreak.

But it said that too few 10-18-year-olds were receiving the jab, and they were the hardest hit by the epidemic.

Large numbers of children in that age group were never given the MMR vaccine, the result of a scare that caused panic among parents.

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Vaccination sessions are continuing in schools throughout Wales and I urge pupils and their parents to take advantage of these"

End Quote Dr Marion Lyons Public Health wales

It followed research by Dr Andrew Wakefield in the late 1990s which linked the vaccine with autism and bowel disease.

His report, which was published in The Lancet medical journal, was later discredited, with health officials insisting the vaccine was completely safe.

But PHW said it was concerned that many of those children were still unvaccinated and urged their parents to ensure they now received the jab.

Of the 33,000 non-routine vaccinations given across Wales during the outbreak, only about 8,000 of those were in the 10-18 age group. This still leaves almost 43,000 unvaccinated.

Dr Marion Lyons, director of health protection for PHW, said: "The efforts to vaccinate susceptible young people children across Wales have been excellent, with non-routine vaccinations being given in their thousands by GPs, in schools and in emergency drop-in clinics.

"This undoubtedly will have reduced the length and severity of the outbreak, but the number of unvaccinated people in the hardest hit age group remains a cause for concern."

She added: "Vaccination sessions are continuing in schools throughout Wales and I urge pupils and their parents to take advantage of these."

School clinics

The measles outbreak started last November and is centred on the Abertawe Bro Morgannwg health board area, which covers Swansea, Neath Port Talbot and Bridgend

A total of 85 people have been treated in hospital since it began while a post-mortem examination into the death of a man who died while suffering from measles proved inconclusive.

An inquest into the death of 25-year-old Gareth Colfer-Williams from Swansea was opened and adjourned on Tuesday.

Vaccinations are also continuing in schools in the Swansea and Neath Port Talbot area.

The MMR jab is also being offered to up to secondary school pupils in Bridgend, Carmarthenshire, Pembrokeshire and Ceredigion over the next few weeks.

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Stroke 'emotional support needed'

30 April 2013 Last updated at 21:03 ET

The emotional impact of a stroke is too often overlooked and should be given the same priority as physical rehabilitation, campaigners say.

A survey of more than 2,700 survivors and their carers in the UK found many had experienced emotional suffering.

More than half of the stroke survivors surveyed said they had felt depressed and two-thirds reported anxiety.

But 42% told the Stroke Association they felt they had been abandoned after their physical needs had been seen to.

Of the carers who took part in the poll, eight in 10 had experienced anxiety and frustration.

Strokes affect about 152,000 people in the UK every year. The brain damage caused by the condition means it is the largest cause of adult disability in the UK.

There are now more than a million stroke survivors in the UK - a figure set to rise because of the ageing population.

Stroke Association chief executive Jon Barrick said: "Stroke leaves survivors and families shocked, shaken and anxious as their lives are often irreversibly changed in an instant.

"Better recognition by health and social care professionals of the impact of stroke will help people to be properly assessed and get the right support."

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Smoking 'poses bigger risk to women'

30 April 2013 Last updated at 21:10 ET By Michelle Roberts Health editor, BBC News online

Smoking may pose a bigger health threat to women than men, say researchers.

Women who smoke have a higher risk of cancer than men, Norwegian investigators found.

They looked at the medical records of 600,000 patients and discovered the bowel cancer risk linked to smoking was twice as high in women than men.

Female smokers had a 19% increased risk of the disease while male smokers had a 9% increased risk, Cancer Epidemiology, Biomarkers & Prevention reports.

Continue reading the main story

For men and women, the evidence is clear - being a non-smoker means you're less likely to develop cancer, heart disease, lung disease and many other serious illnesses"

End Quote Sarah Williams of Cancer Research UK

In the study, nearly 4,000 of the participants developed bowel cancer. Women who started smoking when they were 16 or younger and those who had smoked for decades were at substantially increased risk of bowel cancer.

Biologically vulnerable?

The University of Tromso team who carried out the research say it is the first study to show women who smoke less than men still get more colon cancer.

But they were unable to take into account other factors that might affect the risk of this type of cancer, such as alcohol and diet.

The findings suggest that women may be biologically more vulnerable to the toxic effects of tobacco smoke.

Experts already know that women who start smoking increase their risk of a heart attack by more than men who take up the habit, although it is not clear why.

A new piece of research published in the Journal of Clinical Endocrinology & Metabolism suggests a possible explanation.

A team from the University of Western Australia found teenaged girls exposed to passive smoking had lower levels of the "good" form of cholesterol that reduces heart disease risk.

Second-hand smoke

Second-hand smoke did not appear to have the same impact on teenage boys, however.

The study looked at more than 1,000 adolescents living in Perth, Australia.

Lead researcher Chi Le-Ha said: "Considering cardiovascular disease is the leading cause of death in women in the Western world, this is a serious concern."

Around one in every five men and women in the UK is a smoker.

Although smoking rates have been falling among both sexes, the decline has been less rapid in women.

In England in 2010, more than a quarter of secondary school pupils had tried smoking at least once and 5% were regular smokers. Girls were more likely to smoke than boys - 9% of girls had smoked in the last week compared with 6% of boys.

Quitting smoking cuts your risk of many diseases, including cancer.

According to research in more than one million women, those who give up smoking by the age of 30 will almost completely avoid the risks of dying early from tobacco-related diseases.

Sarah Williams of Cancer Research UK said: "It's well established that smoking causes at least 14 different types of cancer, including bowel cancer.

"For men and women, the evidence is clear - being a non-smoker means you're less likely to develop cancer, heart disease, lung disease and many other serious illnesses."

June Davison, senior cardiac nurse at the British Heart Foundation, said more research was needed to understand the effects of second-hand smoke.

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