NHS satisfaction 'now stabilising'

2 April 2013 Last updated at 20:12 ET By Nick Triggle Health correspondent, BBC News

Public satisfaction with the NHS appears to have stabilised following a record fall, according to the British Social Attitudes Survey.

The poll of more than 1,100 people in England, Wales and Scotland last year found satisfaction with the way the NHS was run stood at 61%.

This followed a record fall from 70%, in 2010, to 58% in 2011.

The drop coincided with the first year of the spending squeeze and controversy over reforms in England.

The 2012 survey, conducted by NatCen Social Research, found that 74% were satisfied with GPs while just 30% were satisfied with social care.

A total of 59% said they were satisfied with A&E units and 56% were satisfied with dentists, it found.

'Appalling care'

Prof John Appleby, of the King's Fund think tank, said the poll was an "important barometer".

"With no real change in satisfaction with the NHS in 2012, this suggests the fall in 2011 was not a blip and that the ground lost may take some time to recover," he said.

Patients Association chief executive Katherine Murphy said it was important to "look beyond statistics and properly assess patient experience".

"People are still contacting our helpline every day to tell us that they or a loved one is receiving the most appalling care in hospital.

"These serious issues need to be tackled and the government needs to monitor closely the impact of its reforms."

A spokesman for NHS England, the new national board which oversees the health service, said: "The changes which have been implemented put patients at the centre of everything the NHS does.

"We are committed to providing the best services possible for patients in England."

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Warning over 'patchy' dementia care

2 April 2013 Last updated at 20:13 ET By Nick Triggle Health correspondent, BBC News

The standard of care provided for people with dementia is "patchy", the National Institute for Health and Care Excellence (NICE) has said.

Some people with the condition were not getting even basic levels of care, it added.

The warning came as NICE unveiled new standards for dementia care in England, covering issues such as housing and access to leisure services.

Care services were playing "catch-up" on dementia, it said.

The guidance is the first to be produced by NICE under its new extended remit.

To date, the organisation has focused on issuing recommendations about NHS treatments and encouraging healthy lifestyles.

But under the shake-up of the NHS, it now has responsibility for providing guidance on care and support provided by the likes of councils and care homes.

NICE's dementia guidance includes 10 standards it wants the care sector to follow.

Continue reading the main story

The general picture is that care is patchy. We know that it is really good in places but it's not consistent"

End Quote Prof Gillian Leng, NICE

One calls for people with dementia to live in housing that meets their needs, while another says they should be given the support they need to access leisure activities.

Others focus on keeping patients involved in community life and ensuring they get access to services such as dentists and opticians.

NICE deputy chief executive Prof Gillian Leng said: "The general picture is that care is patchy.

"We know that it is really good in places but it's not consistent.

"My personal view is that we are all playing catch-up because the number of people with dementia has been increasing so dramatically."

Currently about 670,000 people in England are living with dementia but one in three over the age of 65 are expected to develop the condition.

George McNamara, of the Alzheimer's Society, said people with the condition were being denied the quality of life they deserved.

"These standards will be a useful tool for the care sector and show what people with dementia and carers should be able to expect," he said.

"But, as they are not mandatory, it's a case of 'wait and see' as to whether this guidance will drive real change or just sit on the shelf."

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Over 500 cases in measles epidemic

3 April 2013 Last updated at 08:33 ET

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Public Health Wales has renewed its appeal for children to be vaccinated

The number of people diagnosed with measles in an area at the centre of an epidemic has passed the 500 mark, Public Health Wales (PHW) says.

Latest figures show there are now 541 cases in and around Swansea.

The figures have gone up by more than 100 in a week and health experts are urging parents to ensure their children receive the MMR vaccine.

The epidemic has also prompted some babies to be offered the jab seven months earlier than recommended.

PHW said that cases continue to be reported across Wales, with the majority in Abertawe Bro Morgannwg, Powys and Hywel Dda health board areas.

It warned that the risk of unvaccinated children coming into contact with those already infected is "increasing every day".

Continue reading the main story

The alarming numbers of cases of measles and continuing spread of the disease in Wales illustrates how vital it is for parents to get their children vaccinated"

End Quote Dr Marion Lyons Director of health protection for PHW

It added that it was "just a matter of time" before a child was left with serious and permanent complications, such as eye disorders, deafness or brain damage, or even dies.

Parents have been urged to use the Easter holidays to get their children vaccinated.

PHW has also taken the more unusual step of allowing babies as young as six months old to have an MMR jab, if their parents live or travel to the epidemic 'hotspots' of Swansea or Neath Port Talbot.

In some cases it would mean children getting three doses of MMR instead of the usual two.

In addition to the early jab, they would still receive the recommended vaccine at around 13 months of age and have a booster jab at around three years four months.

A spokesman said having three doses of the vaccine was safe but only usually offered during an epidemic.

Meanwhile, a free MMR vaccination session will be held at the Princess of Wales Hospital, Bridgend, on Saturday.

'Effective and safe'

PHW had previously said it was disappointed in the number of children being vaccinated, with only 100 of the 3,800 susceptible children aged over two in the Swansea area having the jab last week.

But Dr Marion Lyons, director of health protection for PHW, said it appeared the uptake of the MMR was now improving.

"We are starting to see parents bringing unprotected children to get vaccinated, showing that they're taking the outbreak seriously and have confidence in the jab as the best way of protecting their children," she said.

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"Unfortunately some parents are continuing to put their children at unnecessary risk of catching this potentially serious disease.

"They need to get their children vaccinated without delay.

"The MMR jab is recommended by the World Health Organization, UK Department of Health and Public Health Wales as the most effective and safe way to protect children against measles.

"The alarming numbers of cases of measles and continuing spread of the disease in Wales illustrates how vital it is for parents to get their children vaccinated."

Some GP surgeries have responded to the epidemic by offering extra clinics for the MMR vaccine.

Swansea GP Dr Dai Lloyd said his surgery had seen people queuing for the vaccine following the outbreak.

PHW and Abertawe Bro Morgannwg University Health Board have organised a free MMR vaccination session on Saturday, 6 April from 10:00 to 16:00 BST at the Princess of Wales paediatric outpatients department.

A spokeswoman for Bridgend council said it was aimed at children but jabs would be available for anyone born after 1970 and who has not had measles or been vaccinated against it.

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NHS whistleblower hotline launched

1 April 2013 Last updated at 20:12 ET

A free, confidential phoneline has been launched to allow employees to raise any concerns about practices in NHS Scotland.

The National Confidential Alert Line for NHS staff is a year-long pilot.

The trial was first announced in November following a BBC investigation into hospital safety.

More than 300 reports into the most serious incidents in Scotland's hospitals in 2011, including 105 deaths, were published by the BBC.

At the time First Minister Alex Salmond expressed his sympathies to patients and families who had "experienced care which fell short of standards which we all expect".

The role of whistleblowers was noted in a recent auditors' report into allegations of fiddled waiting-time data in the NHS in Scotland.

Audit Scotland, which scrutinises the way public money is spent, investigated NHS boards after the problem was found in Lothian.

In a report last month, the organisation said: "In order to safeguard patients' interests, it is important to have effective whistleblowing policies and an environment where people can raise concerns safely and know that they will be acted upon."

The launch of the phoneline also comes in the wake of the Francis Inquiry, which uncovered "appalling" failings at Mid Staffordshire NHS Foundation Trust in England.

Concerns investigated

Scottish Health Secretary Alex Neil said all NHS workers should feel able to raise concerns safely and confidentially.

He added that following the Francis Inquiry, staff should be reassured that health boards would listen.

The phoneline, 0800 008 6112, will pass any concerns raised by employees on to the employer or the relevant regulatory organisation for investigation.

Mr Neil said: "All areas of concern must be investigated and lessons will be learned to ensure that the NHS in Scotland is providing the best possible service to patients.

"We already have whistleblowing policies in place. Staff can be assured that these policies will be enforced and the alert line will give staff the best possible support."

The line is being delivered by Public Concern at Work, an independent organisation, with the aim of ensuring confidentiality and impartiality.

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Charity urges more diabetes checks

1 April 2013 Last updated at 22:10 ET

One in five people with diabetes are meeting targets to keep their condition under control, a charity has warned.

Just 20% of people in England and Wales hit the recommended levels for blood pressure, cholesterol and blood sugar, figures from Diabetes UK suggest.

It wants more people to get the recommended annual checks and action taken against parts of the NHS with the worst record.

The Department of Health said it wants to improve diabetes services.

The charity obtained the figures by analysing data from the National Diabetes Audit.

It showed that for type 1 diabetes, just 11% of people meet the targets which help prevent the risk of complications.

High blood pressure, cholesterol and blood sugar suggest the patient's diabetes is not well controlled and can lead to complications such as kidney failure and stroke.

The charity also said it goes a long way to explaining why 24,000 people with diabetes die early every year in England and Wales.

Annual checks

Currently only 54% of people with diabetes in England get the nine annual checks recommended nationally to prevent future problems.

Continue reading the main story

It is extremely worrying that so few people have it under control"

End Quote Barbara Young Diabetes UK

As well as calling for more patients to receive this annual review, Diabetes UK said it wanted the government to hold poor performing areas to account because in some places fewer than 20% of people with the condition were getting the checks.

Care needs to improve to cope with the increasing numbers of people living with diabetes, the charity said.

It is estimated that the NHS spends about £10bn a year on diabetes - 10% of its entire budget - and about 80% of this goes on treating complications that could often have been prevented.

There are currently around three million people diagnosed with the disease.

Barbara Young, chief executive of Diabetes UK, said: "Given that diabetes is serious and can lead to early death if not supported to manage their condition, it is extremely worrying that so few people have it under control.

"The high rate of preventable complications is the inevitable consequence of a healthcare system that has all too often not been good enough and this highlights the need for local services to put in place self-management support programmes to help people manage their diabetes well.

"At the moment there is virtually no access to the ongoing education and support to help people manage their diabetes and so help avoid complications reduce their chance of early death."

A spokesperson from the Department of Health said: "We are determined to improve NHS services across the country for people with diabetes and end the unacceptable variation in care that still exists.

"We have set clear objectives for the NHS to improve the care and management of people with diabetes and we will be monitoring NHS England to make sure this is delivered."

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Male bowel cancer 'on the increase'

1 April 2013 Last updated at 23:16 ET

Bowel cancer rates among men have increased by more than a quarter in the last 35 years, a report has suggested.

The Cancer Research UK study said this contrasted with a rise of just 6% in the rate for women over the same time.

However, bowel cancer survival rates are improving with half of all patients living for at least 10 years after being diagnosed.

It is not known why there should be such a large difference in the increase in rates between men and women.

Rising rates of bowel cancer may be linked to obesity and diets high in red and processed meat and low in fibre, as well as the increasing age of the population.

The disease is the second most common cause of cancer death in the UK after lung cancer.

Continue reading the main story

It's important to find out what's behind the rise and what we can do about it"

End Quote Prof Matthew Seymour National Cancer Research Network

Cases of bowel cancer for men have increased from 45 per 100,000 in 1975-77 to 58 per 100,000 in 2008-10, a rise of 29%.

The figures for women were 35 per 100,000 rising to 37 per 100,000 in the same timescale.

The age group with the biggest rise is those in their 60s and 70s, who experience 23,000 new cases a year.

'Starring role'

Professor Matthew Seymour, of Leeds University, who is director of the National Cancer Research Network, said: "We know the risk of bowel cancer increases as we get older and, since we're all living longer, it's no surprise to see that the number of people getting the disease is rising.

"But when we look at these figures and take people's age into account, we still see that the risk of bowel cancer has gone up in men in the last 35 years.

"It's important to find out what's behind the rise and what we can do about it.

The figures are released to mark bowel cancer awareness month and the launch of a new campaign by the Bobby Moore Fund charity.

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Stephanie Moore: "People must not die of embarrassment in this day and age"

The Make Bobby Proud campaign aims to spread the word about the disease, especially among men involved in the football community.

Stephanie Moore, whose footballer husband Bobby Moore died of bowel cancer in 1993, said it was encouraging that bowel cancer survival rates were improving.

But she added: "However, it's vital we continue to fund research to fight this disease as these new statistics show."

Dr Julie Sharp, senior science information manager at Cancer Research UK, said the charity's researchers had played a "starring role" in the diagnosis and treatment of the disease.

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Cystic fibrosis bug spread discovery

30 March 2013 Last updated at 20:33 ET

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

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

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

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

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

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

Continue reading the main story

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

End Quote Dr Andres Floto Papworth Hospital, Cambridge

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

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

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

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

Infection control

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

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

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

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

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

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

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

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

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

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

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

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

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

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NHS changes come into force

1 April 2013 Last updated at 03:30 ET By Nick Triggle Health correspondent

Government reforms of the NHS in England have come into force and health leaders warn of a tough year ahead.

Monday marks the first day of the new structures.

GP-led groups have taken control of local budgets and a new board, NHS England, has started overseeing the day-to-day running of services.

The NHS Confederation said the reforms represented a big opportunity but should not be seen as a "silver bullet" for the challenges ahead.

Mike Farrar, chief executive of the confederation, which represents health managers, said the squeeze on finances and the need to rebuild public confidence after the Stafford Hospital scandal meant the NHS was facing a critical period.

He said the reforms would bring clinical expertise to the fore of decision making, which would be a "huge asset".

Continue reading the main story

"Start Quote

Because GPs have face-to-face contact with patients every day... they are really well-placed to be able to make decisions about how healthcare should be delivered best"

End Quote GP Catherine Briggs

But he warned: "We need to recognise the huge challenges facing the health service. New structures alone won't enable us to tackle these challenges, and we should not see them as a silver bullet.

"Those doing the day-job face major pressures in trying to keep the NHS's head above water, while focusing on making the new world work."

The start of the new system comes nearly three years since the changes were put forward.

The publication of the plans in the summer of 2010 sparked a long and, at times, damaging battle for the government to push through with its changes.

Ministers even had to take the unprecedented step of halting the progress of the bill through Parliament amid criticism from medical bodies, academics and unions.

In particular, concerns have been expressed about what many believe is a greater role for the private sector.

'Compassionate care'

Some have also questioned whether introducing such major changes - they have been dubbed the most radical overhaul since the NHS was created - at a time when money is so tight makes sense.

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"Start Quote

Far from letting 'doctors decide', ministers are forcing the medical profession to open up all NHS services to the market"

End Quote Andy Burnham Shadow health secretary

But as the new bodies take up control - and the old organisations, including 152 primary care trusts, are scrapped - the government maintained the changes would put the NHS on a firm footing for the 21st century.

Health Minister Anna Soubry said: "The health service will improve, work smarter and, importantly, build an NHS that delivers high quality, compassionate care for patients."

But shadow health secretary Andy Burnham predicted the changes would have the opposite effect.

"Far from letting 'doctors decide', ministers are forcing the medical profession to open up all NHS services to the market.

"Hundreds of new private companies now risk fragmenting patient care when more integration is needed."

GP Catherine Briggs said she would welcome more control over how budgets are spent.

"Because GPs have face-to-face contact with patients every day and because they know their patients and their communities really well," she said.

"That means they are really well-placed to be able to make decisions about how healthcare should be delivered best."

But GP John Hughes said he had reservations.

"The GPs aren't really free to do what they like with the money as a lot of people seem to think," he said.

"Most of the directions as to what happens to that money and what should be bought or commissioned locally is coming from the Department of Health."

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India rejects Novartis patent plea

1 April 2013 Last updated at 08:56 ET

India's Supreme Court has rejected a plea by Novartis to patent an updated version of its cancer drug, Glivec.

The Swiss drugmaker had been denied a patent by Indian authorities on the grounds that the new version was only slightly different from the old.

The decision means generic drugmakers can continue to sell copies of the drug at a lower price in India, one of the fastest growing pharmaceutical markets.

Novartis said the decision "discourages future innovation in India".

"This ruling is a setback for patients that will hinder medical progress for diseases without effective treatment options," said Ranjit Shahani, vice-chairman and managing director of Novartis India.

Glivec, which is used to treat chronic myeloid leukaemia and other cancers, costs about $2,600 (£1,710) a month.

The generic equivalent is currently available in India for just $175.

Continue reading the main story

"Start Quote

Some 40% of the drugs produced by India's $11bn pharmaceutical industry are exported"

End Quote

There were concerns that, if granted, a patent could threaten access to cheap generic versions of life-saving drugs in poorer countries.

"This will go a long way in providing affordable medicine for the poor," said Anand Grover, a lawyer representing Cancer Patients Aid Association, adding that he was "ecstatic with the ruling".

Long battle

Novartis applied for a patent in 2006 for its new version of the drug, arguing that it was easier to absorb and therefore qualified for a fresh patent.

However, the Indian patent authority rejected the application based on a law aimed at preventing companies from getting fresh patents by making only minor changes to existing drugs, a practice known as "evergreening".

Officials also turned down a subsequent appeal by the company three years later.

Continue reading the main story

Analysis

There were celebrations outside the Supreme Court as the landmark decision was read out. One charity, Doctors Without Borders, called it a victory for poor patients not just in India but across the world.

The bone of contention was Section 3D of India's patent laws and the court argued that Novartis had to demonstrate that Glivec represented more than just a small improvement to an existing substance. In its ruling, the court said it wanted to discourage "repetitive patenting".

The decision is seen as a major boost for generic drugmakers in India who supply cheap medicines to poor people across the developing world.

India exports generic drugs worth $11bn (£7.23bn), including crucial anti-retrovirals supplied to Africa.

Experts say Monday's court order will set a precedent for the so-called "patent cliff" - a phrase used to describe the expiry of pharmaceutical patents across a range of blockbuster drugs.

It is estimated that drugs with combined annual sales of $150bn will go off-patent by 2015 and that could help companies here earn millions of dollars in profits.

On Monday, India's Supreme court rejected the firm's appeal to get patent protection for the drug.

The AFP news agency quoted the court as saying that the updated drug "did not satisfy the test of novelty or inventiveness" as required by the law.

Setting a precedent?

Patents usually protect the companies for 20 years of exclusive sales. After that, it is open to other firms who can make cheaper copies of the original drug.

Once the protection expires, the first company to challenge the patent gets an exclusive right to sell the copy for 180 days.

After 180 days, more companies can sell the generic versions, potentially resulting in a further price drop.

It is estimated that drugs with combined annual sales of $150bn will go off-patent by 2015.

India's generic drug makers are among the biggest in the world and many expect them to benefit from these patents expiring in the coming years.

However, there have been concerns that if firms are granted patents for updated versions of their drugs, it may not only deny access to cheaper medicines to poor people, but also hurt the makers of generic drugs.

Pratibha Singh, a lawyer for the Indian generic drug manufacturer Cipla, said the ruling had set a precedent that would prevent international pharmaceutical companies from obtaining fresh patents in India on updated versions of existing drugs.

"Patents will be given only for genuine inventions, and repetitive patents will not be given for minor tweaks to an existing drug,'' she said.

Shares of Novartis India fell almost 5% on the Bombay Stock Exchange, while stocks of generic drugmakers such as Cipla and Natco rose after the judgement.

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Cancer survivors deserve 'care plan'

29 March 2013 Last updated at 09:18 ET

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

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

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

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

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

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

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

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

Continue reading the main story

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

End Quote Anna Soubry Public health minister

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

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

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

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

'Closer conversation'

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

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

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

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

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

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

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

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

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

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

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