Dirty stethoscopes 'bacteria threat'

27 February 2014 Last updated at 13:05 ET

Doctors should disinfect their stethoscopes after every examination because the instruments are heavily contaminated by bacteria, a study says.

Stethoscopes were found to carry as many bacteria as the palms of doctors' hands, and only doctors' fingertips were 'dirtier'.

University of Geneva researchers said stethoscopes may contain thousands of bacteria, including MRSA.

Doctors should clean stethoscopes regularly to cut down on transmission.

The study, published in an issue of Mayo Clinic Proceedings, said the hands of healthcare workers were still the main source of bacterial transmission in hospitals, but stethoscopes also appeared to have a major impact.

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The stethoscope should be regarded as an extension of the physician's hands and be disinfected after every patient contact"

End Quote Dr Didier Pittet

Lead researcher Dr Didier Pittet, director of the infection control programme at the University of Geneva Hospitals, said the instruments were transmitters of bacteria.

"By considering that stethoscopes are used repeatedly over the course of a day, come directly into contact with patients' skin and may harbour several thousand bacteria (including MRSA) collected during a previous physical examination, we consider them as potentially significant vectors of transmission."

Dr Pittet added: "From infection control and patient safety perspectives, the stethoscope should be regarded as an extension of the physician's hands and be disinfected after every patient contact."

Dr Clare Taylor, a council member from the Royal College of General Practitioners and a GP in Birmingham, said doctors were "more aware than ever" of the importance of maintaining hygiene standards to protect patients.

She said: "I regularly clean my own stethoscope with alcohol wipes and ensure I wash or sanitise my hands after every patient. It's part of our role to ensure we do everything we can to prevent the spread of infection."

Contaminated

The University of Geneva research team carried out tests for bacteria on the diaphragm or metal circular end of a stethoscope, which is put against the skin to listen to the body's internal sounds, and the tube connecting it to the ear-pieces.

They also measured bacteria levels on four areas of a doctor's dominant hand - the back of the hand, fingertips and two regions of the palm.

They did this after each of 71 patients had been examined.

Three doctors carried out the examinations using a sterile stethoscope and sterile gloves.

While the doctors' gloved fingertips were found to be most heavily contaminated by bacteria, the stethoscope diaphragm was more contaminated than all other areas of the doctors' hands and the tube of the stethoscope carried more bacteria than the back of the doctors' hands.

When researchers looked for levels of MRSA contamination (meticillin-resistant staphylococcus aureus) in particular, they found similar high levels of bacteria on stethoscopes and doctors' hands.

They did not isolate any other bacteria.

The study said further research was needed to understand how stethoscopes could best be disinfected.

More work is also required on how long bacteria survive on stethoscopes and how they are transmitted on to a person's skin, the Geneva team added.

The British Medical Association said there was no evidence of infections coming from stethoscopes.

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Care package to help fight dementia

28 February 2014 Last updated at 05:01 ET

A new package of care for dementia sufferers will help fight the illness, the health secretary says.

Jeremy Hunt has announced help from businesses to support customers with dementia, and a "world dementia envoy" has been appointed.

NHS England will invest £90m in an effort to bring down diagnosis waiting times by March next year.

But Labour warned that the government must tackle "poor care standards" in order to combat the condition.

As part of the announcement, 190,000 staff from British businesses, including Marks and Spencer, Argos, Homebase, Lloyds Bank and Lloyds Pharmacy, have signed up to become "dementia friends".

Continue reading the main story

We welcome the focus on post-diagnosis support which will provide a vital lifeline to thousands who are currently left in the dark"

End Quote Jeremy Hughes Alzheimer's Society

They will be trained to learn how to spot the signs of dementia among customers and offer support for sufferers.

'Heartbreaking disease'

Mr Hunt said: "Dementia can be a horrific and heartbreaking disease, but it is my mission as health secretary to make this country the best place in the world to get a dementia diagnosis, as well as a global leader in the fight to find a cure.

"Today's package is about government, clinicians, business, society and investors coming together to raise our game on every front - from speedy diagnosis to compassionate care, and from help on our High Streets to the quest for a cure."

According to the Alzheimer's Society, there are around 800,000 people in the UK with dementia.

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Health Secretary Jeremy Hunt: "We are putting in place schemes with hospitals and GPs surgeries across the country to speed up diagnosis rates"

One in three people over 65 will develop the condition, and two-thirds of sufferers are women.

NHS England will target work in areas where it can take up to 25 weeks to carry out a diagnosis. In other areas, diagnostic assessments can take as little as six weeks.

Mr Hunt added: "To have variation in diagnosis rates from a few weeks to close to six months is totally unacceptable and I am pleased that NHS England have agreed to address this within the funding they have available."

Jeremy Hughes, chief executive of the Alzheimer's Society, said it was unacceptable that some people with dementia had to wait months for a diagnosis.

"Today's announcement is a positive step forward to increasing diagnosis rates and ensuring that no matter where you live you will receive a timely assessment.

"Too often we hear about a lack of suitable services available to people with dementia and their carers. We welcome the focus on post-diagnosis support which will provide a vital lifeline to thousands who are currently left in the dark, with nowhere to turn for advice or support."

Dementia envoy

The prime minister has appointed a "world dementia envoy" following agreement between the G8 countries at a dementia summit in London in December.

Dr Dennis Gillings, an expert in clinical trials, plans to create a World Dementia Council to raise funds for research towards a cure.

Dr Margaret Chan, director general of the World Health Organization, said: "Dementia is a costly and heartbreaking epidemic with an immense impact.

"I can think of no other condition that has such a profound effect on loss of function, loss of independence, and the need for care - care that is immensely challenging, physically, psychologically, and financially."

Liz Kendall, Labour's shadow minister for care and older people, said she supported the prime minister's commitment to dementia research, but warned that more needed to be done to help those struggling with dementia now.

She said: "£2.7bn has been cut from council care budgets under this government, hitting the quality of life of hundreds of thousands of people with dementia and their families.

"The prime minister cannot credibly claim to show leadership on dementia unless he tackles poor care standards, like the increasing number of 15-minute home visits which are barely enough time to make a cup of tea, let alone help a frail, elderly person with dementia get up, washed, dressed and fed."

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Significant drop in measles cases

28 February 2014 Last updated at 06:30 ET By James Gallagher Health and science reporter, BBC News

There was a sharp fall in the number of cases of measles in England at the end of 2013, figures from Public Health England show.

Twenty four people were infected between October and December, in sharp contrast to the hundreds of cases each month at the beginning of the year.

The fall has been put down to efforts to get more children vaccinated with the MMR jab.

However, the number of cases of mumps has increased slightly.

A drop in the number of children being vaccinated, due to the MMR-scare a decade ago, led to a resurgence in measles infections in 2012 and 2013.

Back in 2010 there were just 380 cases all year in England.

Outbreaks in the north-west and north-east of England led to 2,030 cases in 2012 and 1,413 last year.

There was also a large outbreak of measles in Wales with more than 1,200 reported cases.

However, after the summer of 2013 the cases fell significantly and to very low levels in last three months of 2013.

There were 24 cases in England and previous figures showed 25 cases in Wales and two in Northern Ireland.

Public Health England said there were 3,524 cases of mumps in 2013 - a marked increase on the 2,476 case the previous year.

The head of immunisation at Public Health England, Dr Mary Ramsay, said: "Measles is a potentially fatal, but entirely preventable, disease so we are delighted that measles cases have recently decreased.

"The best way to prevent measles outbreaks is to ensure good uptake of the MMR vaccine across all age groups, so it's heartening to see the success the catch-up programme had in ensuring 95% of 10 to 16 year olds in England received at least one dose of the vaccine.

"Although mumps has increased a little from the same quarter of last year, the numbers remain much lower than the levels seen in 2004/5, when outbreaks were reported in several universities."

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Baby-boomer drug and alcohol warning

26 February 2014 Last updated at 21:43 ET

There is a growing problem of drug and alcohol misuse among older people, as "baby-boomers" age, campaigners are warning.

A report from the charity DrugScope says more are drinking too much, and alcohol-related hospital admissions and deaths are rising.

Drug misuse was also an increasing problem in the age group, it said.

DrugScope said policy too often centred on young people and "age-appropriate" help was needed.

The oldest of the baby-boomer generation are now reaching old age, and the charity says their attitudes were formed when alcohol was becoming more widely available and socially acceptable.

In addition, they tend to have drunk more in middle age than previous generations, establishing worrying patterns for old age.

'New starters'

The European Monitoring Centre for Drugs and Drug Addiction has estimated that the number of people aged over 65 needing treatment for drug problems in Europe will double between 2001 and 2020.

The DrugScope report says about 1.4 million people aged over 65 exceed recommended drinking limits.

Continue reading the main story

"Start Quote

It's time to bring this largely 'invisible' issue into the light and to improve the support for older people with drug and alcohol issues"

End Quote Marcus Roberts DrugScope

And between 2002 and 2010 alcohol-related hospital admissions for men aged 65 and over have risen by 136% and for women by 132%.

Office for National Statistics figures show alcohol-related deaths among the over-75s are at their highest level since 1991, when records began.

Overall, the number of people in drug treatment is declining, as is the number of people starting treatment for heroin and crack cocaine.

But the number of people aged 40 and over in treatment is rising, as is the number of people in that age group who are "new starters".

Public Health England has said this "ageing population", overwhelmingly made up of heroin users, is now becoming "one of the key features of drug treatment in England" and poses "a significant challenge for treatment services in the years ahead".

DrugScope said increased use of other illicit drugs, particularly cannabis, was also a growing problem among middle-aged and older age-groups.

'Embarrassment'

The charity says services need to be specifically targeted for older people with drug and alcohol problems.

Its chief executive, Marcus Roberts, said: "Drug and alcohol policy and practice - and the attention of the media - invariably focuses on young people.

Continue reading the main story

"Start Quote

The generation of baby-boomers now progressing into later life represents a burgeoning tidal wave of substance misuse in the UK"

End Quote Dr Tony Rao, Royal College of Psychiatrists

"Drugs and alcohol issues may affect older people differently, but that does not make them less real or important. They may be a symptom of other problems, such as loneliness and isolation, caring for a partner, bereavement or the struggle to make ends meet."

He added: "This is not an issue that we can ignore.

"The barriers to older people accessing help and support need to be addressed. These can range from a belief on the part of professionals that older people can't change, to embarrassment on the part of the individual at having to ask for help.

"We also need to develop a range of age-appropriate interventions, and to make the connections between drug and alcohol issues and older-people policy, both nationally and locally.

"It's time to bring this largely 'invisible' issue into the light and to improve the support for older people with drug and alcohol issues."

Problem 'will only get worse'

Dr Tony Rao, chair of the Royal College of Psychiatrists' older people's substance misuse working group, said: "The generation of baby-boomers now progressing into later life represents a burgeoning tidal wave of substance misuse in the UK, with both hospital admissions and deaths from alcohol misuse in older people of particular concern.

"Substance misuse in older people should now be everyone's business and kept firmly on the radar of those commissioning and providing services for this growing hidden and vulnerable population."

Caroline Abrahams, charity director at Age UK, said: "Drug-taking and excessive drinking in later life are serious problems that are often linked with other issues such as bereavement, loneliness and isolation.

"Whilst the spotlight on excessive drinking generally falls on younger people, the most significant increases in alcohol related harm are actually in older age groups."

She added: "It is positive that the issues of excessive drinking and drug abuse in older age are starting to be recognised, however the problem will only get worse unless appropriate preventative and treatment services are made available."

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Child health 'link to father's age'

26 February 2014 Last updated at 21:59 ET By James Gallagher Health and science reporter, BBC News

A wide range of disorders and problems in school-age children have been linked to delayed fatherhood in a major study involving millions of people.

Increased rates of autism, attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, suicide attempts and substance abuse problems were all reported.

The study, in JAMA Psychiatry, suggests mutated sperm were to blame.

However, experts say the benefits older dads bring may outweigh any problems.

The investigation by Indiana University, in the US, and Sweden's Karolinska Institute has been described as the largest and one of the best designed studies on the issue.

The researchers looked at 2.6 million people and at the difference between siblings born to the same father as it accounts for differences in upbringing between families.

Comparing children of a 45-year-old dad to those of a 24-year-old father it indicated:

Continue reading the main story

"I would make the point very strongly that men should not decide on whether or when to have children on a single study, or cumulative studies"

End Quote Dr James MacCabe Institute of Psychiatry

• autism was more than three times as likely
• a 13-fold increased risk of ADHD
• double the risk of a psychotic disorder
• 25 times more likely to have bipolar disorder
• 2.5 times more likely to have suicidal behaviour or problems with drugs
• lower scores at school

There was no starting point after which the risk started to increase, rather any increase in age had an associated increase in risk.

However, the overall risk is likely to remain low. Even if a the risk of a rare disorder is doubled, it is still very unlikely to affect a child.

The problem is small increases in risk scaled up over millions of people having children later can lead to an increased incidence of such disorders.

One of the researchers, Dr Brian D'Onofrio, said he was shocked by the findings, which suggested a higher risk than previously estimated.

He told the BBC: "The implications of the study is that delaying childbearing is also associated with increased risk for psychiatric and academic problems in the offspring.

"The study adds to a growing body of research, that suggests families, doctors, and society as a whole must consider both the pros and cons of delaying childbearing."

Faulty sperm

Sperm are produced constantly throughout a man's lifetime. As the sperm-making mechanism ages, so too do the number of errors - older sperm have more mutations which may be damaging.

Dr James MacCabe, senior lecturer in psychosis at the Institute of Psychiatry: "I would make the point very strongly that men should not decide on whether or when to have children on a single study, or cumulative studies."

He said the risks were low and that even a doubling or trebling of risk would still affect a small proportion of people.

"Having said that, with the demographic change we have seen in the last decade, on a population level this is a concern and we might expect higher rates of psychoses now and in the future."

He added that older dads bring many advantages such as more stable relationships and higher income, which "probably outweigh" any risks.

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Three-person baby details announced

27 February 2014 Last updated at 06:03 ET By James Gallagher Health and science reporter, BBC News

How the creation of babies using sperm and eggs from three people will be regulated in the UK has been announced.

The draft rules will be reviewed as part of a public consultation and could come into force by the end of 2014.

Doctors say three-person IVF could eliminate debilitating and potentially fatal diseases that are passed from mother to child.

Opponents say it is unethical and could set the UK on a "slippery slope" to designer babies.

Using the parents' sperm and eggs plus an additional egg from a donor woman should prevent mitochondrial disease.

Mitochondria are the tiny, biological "power stations" that provide energy to nearly every cell of the body.

One in every 6,500 babies has severe mitochondrial disease leaving them lacking energy, resulting in muscle weakness, blindness, heart failure and even death.

As mitochondria are passed down from mother to child, using an extra egg from a donor woman could give the child healthy mitochondria.

However, it would also result in babies having DNA from two parents and a tiny amount from the donor as mitochondria have their own DNA.

Scientists have devised two techniques that allow them to take the genetic information from the mother and place it into the egg of a donor with healthy mitochondria.

Continue reading the main story

The Department of Health has already backed the technique and says this consultation is not about whether it should be allowed, but how it is implemented.

Continue reading the main story

Every time Sharon Bernardi became pregnant, she hoped for a healthy child.

But all seven of her children died from a rare genetic disease that affects the central nervous system - three of them just hours after birth.

When her fourth child, Edward, was born, doctors discovered the disease was caused by a defect in Sharon's mitochondria.

Edward was given drugs and blood transfusions to prevent the lactic acidosis (a kind of blood poisoning) that had killed his siblings.

Five weeks later Sharon and her husband, Neil, were allowed to take Edward to their home in Sunderland for Christmas - but his health slowly began to deteriorate.

Edward survived into adulthood, dying in 2011 at the age of 21.

Now Sharon is supporting medical research that would allow defective mitochondria to be replaced by DNA from another woman.

The regulatory body, the Human Fertilisation and Embryology Authority, will have to decide in each cases that there is a "significant risk" of disability or serious illness.

It is anticipated that only the most severely affected women - perhaps 10 cases per year - would go ahead.

The regulations suggest treating the donor woman in the same manner as an organ donor.

Any resulting children will not be able to discover the identity of the donor, which is the case with other sperm and egg donors.

Prof Doug Turnbull, who has pioneered research in mitochondrial donation at Newcastle University, said: "I am delighted that the government has published the draft regulations.

"This is very good news for patients with mitochondrial DNA disease and an important step in the prevention of transmission of serious mitochondrial disease."

The chief medical officer for England, Prof Dame Sally Davies, said: "Allowing mitochondrial donation would give women who carry severe mitochondrial disease the opportunity to have children without passing on devastating genetic disorders.

"It would also keep the UK at the forefront of scientific development in this area.

"I want to encourage contributions to this consultation so that we have as many views as possible before introducing our final regulations."

Dr David King, the director of Human Genetics Alert, said this was a decision of "major historical significance" which had not been debated adequately.

"If passed, this will be the first time any government has legalised inheritable human genome modification, something that is banned in all other European countries.

"The techniques have not passed the necessary safety tests so it is unnecessary and premature to rush ahead with legalisation.

"The techniques are unethical according to basic medical ethics, since their only advantage over standard and safe egg donation is that the mother is genetically related to her child.

"This cannot justify the unknown risks to the child or the social consequences of allowing human genome modification."

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Virtual arm eases phantom limb pain

25 February 2014 Last updated at 20:07 ET By Michelle Roberts Health editor, BBC News online

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Amputee Ture Johanson moves his virtual hand on the computer screen

Doctors have devised a new way to treat amputees with phantom limb pain.

Using computer-generated augmented reality, the patient can see and move a virtual arm controlled by their stump.

Electric signals from the muscles in the amputated limb "talk" to the computer, allowing real-time movement.

Amputee Ture Johanson says his pain has reduced dramatically thanks to the new computer program, which he now uses regularly in his home.

Continue reading the main story

"Start Quote

For 48 years my hand was in a fist but after some weeks with this training I found that it was different"

End Quote Ture Johanson

He now has periods when he is free of pain and he is no longer woken at night by intense periods of pain.

Mr Johanson, who is 73 and lives in Sweden, lost half of his right arm in a car accident 48 years ago.

After a below-elbow amputation he faced daily pain and discomfort emanating from his now missing arm and hand.

Over the decades he has tried numerous therapies, including hypnosis, to no avail.

Within weeks of starting on the augmented reality treatment in Max Ortiz Catalan's clinic at Chalmers University of Technology, his pain has now eased.

"The pain is much less now. I still have it often but it is shorter, for only a few seconds where before it was for minutes.

Continue reading the main story

Phantom limb pain

• Almost all people who have lost a limb have some sensation that it is still there
• A majority of amputees will also experience phantom limb pain - painful sensations associated with the missing limb
• The exact cause is unknown but it is thought that nerves in the severed limb continue to communicate with the brain, which interprets the mismatch as pain and discomfort
• It can manifest as an insatiable itch or a stabbing or niggling pain

"And I now feel it only in my little finger and the top of my ring finger. Before it was from my wrist to my little finger."

Mr Johanson says he has noticed other benefits too. He now perceives his phantom hand to be in a resting, relaxed position rather than a clenched fist.

"Can you imagine? For 48 years my hand was in a fist but after some weeks with this training I found that it was different. It was relaxed. It had opened."

Mr Johanson has also learned to control the movements of his phantom hand even when he is not wired up to the computer or watching the virtual limb.

Max Ortiz Catalan, the brains behind the new treatment, says giving the muscles a work-out while being able to watch the actions carried out may be key to the therapy.

"The motor areas in the brain needed for movement of the amputated arm are reactivated, and the patient obtains visual feedback that tricks the brain into believing there is an arm executing such motor commands. He experiences himself as a whole, with the amputated arm back in place."

He says it could also be used as a rehabilitation aid for people who have had a stroke or those with spinal cord injuries.

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Women have more obesity treatment

26 February 2014 Last updated at 07:56 ET

More than twice the number of women than men needed hospital treatment because of their waistline, figures for England show.

Health and Social Care Information Centre data showed 8,740 admissions in women and 2,990 admissions in men listed obesity as the primary reason.

Weight loss operations - known as bariatric surgery - accounted for the majority of these 2012-13 admissions.

There was a 7% decrease in admissions on the previous financial year.

They went from 11,740 in 2011-12 to 10,960 in 2012-13.

Tam Fry, from the National Obesity Forum, told the BBC: "On the face of it, it looks terrific.

"But I am concerned that this fall is because of the number of obesity operations being refused because of a lack of funds.

"The barrier for treatment is going up and people are being denied the treatment they deserve."

The latest figures still mark a huge increase on a decade ago when there were only 1,280 admissions in 2002-03.

Around one in four adults in the UK are classed as obese.

The difference in hospital admissions between men and women is thought to be down to differing attitudes to health.

Alan Perkins, the head of the Health and Social Care Information Centre, said: "Obesity has been a public health issue for many years and can increase the risk of disease and long-term illness.

"The past 10 years of data show hospitals have dealt with considerably more women for obesity than men and it will be interesting to see if this pattern changes in coming years."

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Hunt to scrap Stafford health trust

26 February 2014 Last updated at 09:14 ET

Health Secretary Jeremy Hunt has backed calls to dissolve the trust that runs the scandal-hit Stafford Hospital.

Mr Hunt said Mid Staffordshire NHS Trust would be scrapped, with services moved to other hospitals.

The trust has been in administration since April when services were deemed "unsustainable" by the health watchdog Monitor.

However, campaigners who oppose the move have pledged to challenge the decision in the courts.

Continue reading the main story

Administration is a pretty brutal and - for the NHS - quick process. In years gone by, troubled trusts would have limped on regardless.

But the landscape has changed. With the health service under pressure to be as efficient as possible, there is now a growing acceptance that action is needed to deal with unsustainable trusts.

And so, less than a year after this process was started, the health secretary has signed off the dismantling of this trust.

Mid Staffordshire, like many small trusts, has struggled to attract staff and patients. But its financial viability has also been hit by the scandal over poor care from 2005 to 2009.

However, this is only the second time the process has been used in the health service. The first was in 2012 when administrators went into South London Healthcare. That ended with one of the key elements of the plans - the downgrading of Lewisham Hospital - being overturned in court.

NHS bosses are confident this will be a much more straightforward process from now on by comparison - unlike in south London other trusts are not losing services.

That will no doubt elicit mixed emotions in the town with a number of locals unhappy at what they see as the demonisation of their hospital trust despite the scale of the scandal that has engulfed it. But for the rest of the health service it will act as a shot across the bows.

Mr Hunt said the changes would "secure the safe and high-quality services that the people of Stafford deserve having endured years of uncertainty and failures in care".

He added: "I want Stafford to be a proper district hospital that continues to meet the needs of patients nearby, including for emergency care and births."

He said he wanted to dissolve the trust "as soon as possible" to stabilise local health services.

Under today's announcement, the Mid Staffordshire NHS Foundation Trust will be dissolved while Stafford and Cannock Chase Hospitals will be "operated by other local providers".

Stafford could still retain consultant-led maternity services after Mr Hunt agreed to NHS England carrying out a review into the issue.

The original plan from administrators had been for maternity services to close, but this was later amended to allow for the creation of a midwife-led unit.

Mr Hunt has now agreed to review that decision to see whether consultant-led services - needed for more difficult births - should be retained.

The trust was criticised in February 2013 in a public inquiry headed by Robert Francis QC for causing the "suffering of hundreds of people" under its care between 2005 and 2008.

The inquiry made 290 recommendations aimed at tackling the wider cultural problems in the NHS.

Sue Hawkins, from the Save Stafford Hospital group, said: "We were expecting the trust to dissolve.

"We understood from the outset that would be the case, but we are a semi-rural area and people are going to have to travel long distances to receive care.

"It's been a very lengthy process. I wouldn't wish this on any other hospital."

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More NHS trusts sliding into the red

31 January 2014 Last updated at 13:08 ET By Branwen Jeffreys Health correspondent, BBC News

Almost one in three NHS trusts in England is now forecasting they will end the financial year overspent, official figures show.

More organisations are now in difficulty, compared with the same point last year.

Budget pressures may partly be due to hospitals hiring more nurses.

But the Department of Health says hard decisions on public finances have meant it has increased the overall NHS budget.

Overspends

The financial outlook appears to be deteriorating across all types of NHS organisations providing care in England.

Continue reading the main story

All the evidence we have is that our members are finding it increasingly difficult financially, and the situation is getting worse quickly"

End Quote Nick Samuels Foundation Trust Network

There are 102 NHS organisations, mainly hospitals, which have their finances overseen by a new body called the Trust Development Authority.

Recent board papers from the TDA show 33 expect to be overspent by the end of March.

This suggests a number may struggle to demonstrate the standards of financial governance needed to become more independent foundation trusts.

Among the 147 existing foundation trusts, 38 are already known to be expecting overspends, with those figures due to be updated soon by their regulator Monitor.

'Care versus deficits'

Some of the increased financial pressure may be due to an increase in the number of nurses employed.

In the year up to October 2013 an additional 2,390 nurses were taken on by trusts in England.

Prof John Appleby, chief economist of the Kings Fund health think-tank, said there was every indication that senior managers were putting the standard of care first.

"We've had terrible incidents like Mid Staffs. We've had a number of reports produced by the NHS, and independently, suggesting that the NHS really needs to get a grips of its quality of care and services.

"And you can see boards making that choice - between perhaps overspending, but maintaining quality."

A recent Kings Fund survey of finance directors suggested a growing number were gloomy about the financial prospects, although it was only a small sample who replied.

At the beginning of the financial year 20% of all types of trusts in England were expecting a deficit, but that has now risen to 29%.

One-off help

Nick Samuels, the Foundation Trust Network spokesman said " All the evidence we have is that our members are finding it increasingly difficult financially, and the situation is getting worse quickly.

"All NHS trusts have been asked to review their staffing ratios as a result of the response to the Francis report into Mid Staffs.

"We know a very large number of trusts have had to increase number of staff increasing costs.

"For a hospital, between 60-70% of their costs are pay, and that's higher for community and mental health trusts."

Between now and the end of the year the forecast position could either improve, or deteriorate further.

NHS England holds a £60m fund which can be used for one-off help to financially troubled non-foundation trusts this year.

It is small in comparison to the net predicted deficit of £250m, but may be enough to lift those with the smallest financial problems out of deficit.

Andy Burnham, the shadow health secretary, said the NHS was facing a "growing financial crisis" because focus had switched to reorganisation.

And he warned: "As financial panic spreads, patients will be denied treatments and wards will cut back on staff."

But the Department of Health said the government had taken difficult financial decisions, allowing it to give small real terms increases to the health service.

A spokesman added: "Most trusts are in a healthy financial position while the NHS sees more patients and carries out more operations than ever."

He said productivity had improved for two years running, for the first time in a decade.

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Inactivity 'pandemic' in poor areas

31 January 2014 Last updated at 04:24 ET By Nick Triggle Health correspondent, BBC News

A "pandemic" of inactivity in poor areas of England is leading to premature deaths, a report shows.

The analysis by UKactive, which represents the leisure industry, found 13 of the 15 local authorities where people were the most inactive were in the most deprived parts of the country.

Between 35% and 40% of adults in these areas are classed as inactive - that is exercising less than 30 minutes a week.

That compares with a figure of 28% nationally.

Where inactivity levels were at their highest, early deaths also peaked, according to the analysis based on the Active People Survey, which is commissioned by Sport England.

Local authority	Proportion of adults not doing 30 minutes of activity a week
Source: UKactive
Manchester	40.24%
Sandwell	39.13%
Salford	39.07%
Bradford	37.68%
Dudley	37.67%
Slough	37.58%
Sunderland	36.99%
Blackburn with Darwen	36.95%
Coventry	36.81%
Oldham	36.28%
Kingston upon Hull	36.07%
Luton	35.88%
Barking and Dagenham	35.14%
Newham	35.11%
Stoke-on-Trent	35.07%

In the 15 most inactive local authorities, there was an average of 342 premature deaths per 100,000 people per year, compared with 242 in those where people exercised the most. The only areas in the 15 most inactive not to be in the most deprived areas of England were Slough and Dudley.

The report urged councils, which took on responsibility for public health last year, to use more of their budgets to promote physical activity.

Data obtained from 85 out of 129 councils under the Freedom of Information Act showed they spent just 2% of their public health budgets on physical activity promotion and investment.

This was in "stark contrast" to the 38% spent on sexual health and 12% on alcohol misuse, the report said.

Researchers also found that the most inactive local authorities have, on average, a third fewer leisure facilities than the least inactive areas.

Cutting physical inactivity by just 1% a year over a five-year period would save the UK economy just under £1.2bn in health and economic gains, the report said.

'Urgent action'

Fred Turok, chairman of Ukactive, said: "It's no longer acceptable that physical inactivity remains the forgotten cause of death in the UK.

"More deprived areas are faring worse in a physical inactivity pandemic - with no national strategy to improve our fitness levels."

Lord Sebastian Coe, who is backing the report, said: "There is no doubt that the issue requires immediate national attention and urgent action."

But Prof Kevin Fenton, of Public Health England, said his organisation and local government were "committed" to increasing physical activity levels.

"Physical activity is undertaken across communities in a range of ways, from walking and cycling, through fitness, leisure and play to structured amateur and elite sport.

"We need to embrace and support this diversity through cross-sector collaboration and action to embed physical activity within daily life," he added.

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Dead eyes 'may give blind sight'

31 January 2014 Last updated at 22:36 ET By James Gallagher Health and science reporter, BBC News

Cells taken from the donated eyes of dead people may be able to give sight to the blind, researchers suggest.

Tests in rats, reported in Stem Cells Translational Medicine, showed the human cells could restore some vision to completely blind rats.

The team at University College London said similar results in humans would improve quality of life, but would not give enough vision to read.

Human trials should begin within three years.

Donated corneas are already used to improve some people's sight, but the team at the Institute for Ophthalmology, at UCL, extracted a special kind of cell from the back of the eye.

These Muller glia cells are a type of adult stem cell capable of transforming into the specialised cells in the back of the eye and may be useful for treating a wide range of sight disorders.

Continue reading the main story

This interesting study shows that Muller glial cells are another viable avenue of exploration for cell therapy in retinal diseases"

End Quote Dr Paul Colville-Nash Medical Research Council

In the laboratory, these cells were chemically charmed into becoming rod cells which detect light in the retina.

Injecting the rods into the backs of the eyes of completely blind rats partially restored their vision.

Brain scans showed that 50% of the electrical signals between the eye and the brain were recovered by the treatment.

One of the researchers, Prof Astrid Limb, told the BBC what such a change would mean in people: "They probably wouldn't be able to read, but they could move around and detect a table in a room.

"They would be able to identify a kettle and cup to make a cup of tea. Their quality of life would be so much better, even if they could not read or watch TV."

The cells might be able to help patients with disorders such as macular degeneration or retinitis pigmentosa.

Human stem cell trials are already taking place using material taken from embryos.

However, this is ethically charged and takes several months to prepare the cells. The Muller glia cells can be ready within a week.

Prof Limb commented: "They are more easily sourceable and very easy to handle in the lab so from that perspective they're better, but they do express antigens that could induce an immune response."

It means the donated cells could be rejected like an organ transplant.

The next step is to prepare the cells as a clinical grade treatment in order for human trials to begin.

The researchers believe it could take three years before such a trial takes place.

Dr Paul Colville-Nash, the regenerative medicine programme manager at the Medical Research Council, which funded the study, said: "This interesting study shows that Muller glial cells are another viable avenue of exploration for cell therapy in retinal diseases.

"It's not clear yet which approach will be most effective when these experimental techniques enter human trials, which is why it is important to progress research across all avenues in pursuit of a cure for sight loss."

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