Cheap colour test picks up HIV

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Miliband plans mental health push

29 October 2012 Last updated at 09:10 ET

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

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

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

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

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

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

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

Continue reading the main story

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

End Quote Ed Miliband Labour Party leader

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

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

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

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

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

Sickness absence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Bust NHS trust 'to be broken up'

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

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

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

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

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

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

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

Write off debts

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

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

Continue reading the main story

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

End Quote Matthew Kershaw Special administrator

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

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

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

The recommendations include:

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

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

Taxpayers

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

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

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

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

Experts believe the current network of hospitals is unsustainable.

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

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

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

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Trust 'should be split' over debt

26 October 2012 Last updated at 13:38 ET

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The department only opened six months ago

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

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

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

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

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

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

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

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

Continue reading the main story

Karl Mercer Political Correspondent BBC News

---

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Women who quit smoking 'cut risk'

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

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

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

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

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

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

Continue reading the main story

'I started aged 11'

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

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

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

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

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

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

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

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

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

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

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

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

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

Early death

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

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

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

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

Continue reading the main story

Smoking

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

Source: BBC Health

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

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

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

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

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

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

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

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

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

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Concerns over care home ratings

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

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

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

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

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

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

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

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

5 star failures

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

Continue reading the main story

"Start Quote

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

End Quote Gwenda Dunn Niece of care home resident

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

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

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

Continue reading the main story

Find out more

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

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

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

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

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

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

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

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

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

All three ratings companies have defended their awards system.

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

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

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

Higher fees for homes

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

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

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

Continue reading the main story

"Start Quote

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

End Quote Nadra Ahmed National Care Association

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Trust 'should be split' over debt

26 October 2012 Last updated at 13:38 ET

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The department only opened six months ago

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

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

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

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

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

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

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

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

Continue reading the main story

Karl Mercer Political Correspondent BBC News

---

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Abuse home care workers jailed

26 October 2012 Last updated at 09:58 ET

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Workers from Winterbourne View were filmed pinning down and hitting patients

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

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

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

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

'Vile and inexcusable'

Continue reading the main story

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

End Quote Victims' families

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

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

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

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

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

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

'Bite face off'

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

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

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

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

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

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

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

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

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

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

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

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

'Major flaws'

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

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

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

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

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

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

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

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

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

Sentences of all those found guilty are detailed below:

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

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Women who quit smoking 'cut risk'

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

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

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

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

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

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

Continue reading the main story

'I started aged 11'

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

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

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

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

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

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

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

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

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

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

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

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

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

Early death

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

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

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

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

Continue reading the main story

Smoking

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

Source: BBC Health

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

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

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

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

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

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

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

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

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

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Hospital to cut 750 jobs by 2015

26 October 2012 Last updated at 09:18 ET

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

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

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

Unison has blamed the cuts on mismanagement.

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

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

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

Continue reading the main story

"Start Quote

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

End Quote Sue Cookman Unison

Unions and patients have reacted angrily to the announcement.

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

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

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

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

'Unnecessary admin staff'

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

"I do rely heavily on this service."

Continue reading the main story

The trust in numbers

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

Source: Rotherham NHS Foundation Trust

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

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

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

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

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

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

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

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

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

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

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