Three e-cigarette TV adverts banned

24 December 2014 Last updated at 06:44

Three television adverts for electronic cigarettes have been banned, just weeks after the rules were changed so people could be shown using them.

Two of the adverts featured a woman exhaling vapour which, according to the Advertising Standards Authority (ASA), appeared to glamourise the smoking of tobacco products.

Another was said to be encouraging non-smokers to take up e-cigarettes.

The ASA had received more than 200 complaints about the adverts.

Since November, manufacturers have been allowed to advertise the use of electronic cigarettes on TV, as long as they do not promote tobacco or target non-smokers or young people.

Critics of so-called e-cigarettes argue that the devices may encourage people to see smoking as acceptable.

Vapour focus

Two adverts for Must Have, which trades as VIP Electronic Cigarettes, showed a woman exhaling vapour - known as vaping - as a voiceover recommended "the great taste of VIP".

The ASA received 199 complaints, including some from organisations such as Ash (Action on Smoking and Health), the Association of Directors of Public Health UK (ADPH) and the British Medical Association (BMA).

Must Have argued that the adverts stated the product was an e-cigarette, which they said made it clear that no tobacco was being promoted.

But although the advert did not mention tobacco, the ASA ruled that close-ups of the woman exhaling drew particular attention to the vapour.

The ASA said: "We considered that the manner in which the vapour was exhaled and the heightened focus on this action created a strong association with traditional tobacco smoking.

"Because the ads presented it, as the central focus of the ads, in a sultry and glamorous way, we considered that they indirectly promoted the use of tobacco products."

'Irresponsible' advert

In a separate ruling, the ASA banned a Vape Nation advert for encouraging ex-smokers to use e-cigarettes.

The clip promoting KiK e-cigarettes featured a group of adults using and discussing the devices, with one man saying: "I used to smoke normal cigarettes, but after I quit, I tried these. I actually prefer them."

The ASA received seven complaints from viewers who argued the advert would encourage non-smokers, and particularly former smokers, to use them.

Vape Nation denied this, arguing the advert was aimed at current smokers.

But the ASA said: "We considered that the man's statement could encourage non-smokers to take up using e-cigarettes and we therefore concluded the ad was irresponsible."

It ruled all three adverts must not appear again in their current form.

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Ebola crisis 'likely to last a year'

24 December 2014 Last updated at 07:49

West Africa's Ebola crisis is likely to last until the end of 2015, says a leading researcher who helped to discover the virus.

Peter Piot, who has just returned from Sierra Leone, told the BBC that he was encouraged by progress there and by the promise of new anti-viral therapies.

But he also warned that vaccines would take time to develop.

The current Ebola outbreak, the deadliest to date, has so far killed more than 7,300 people.

Most of the victims have been in Sierra Leone, Liberia and Guinea.

Prof Piot was one of the scientists who discovered Ebola in 1976 and is now Director of the London School of Hygiene and Tropical Medicine.

He said that even though the outbreak has peaked in Liberia and was likely to peak in Sierra Leone in the next few weeks, the epidemic could have a "very long tail and a bumpy tail".

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"This epidemic all started with one case" - Professor Peter Piot

"The Ebola epidemic is still very much there. People are still dying, new cases are being detected," he told the BBC World Service's Newsday programme.

"We need to be ready for a long effort, a sustained effort [for] probably the rest of 2015."

But he added that he was impressed by the progress that he had seen in Sierra Leone.

"Treatment centres have now been established across the country with British help. You don't see any longer the scenes where people are dying in the streets," he said.

He also said he was also encouraged that thanks to simple treatments such as intravenous fluids and antibiotics, mortality rates had fallen to as low as one in three.

"Getting it below that will require specific therapies that are now going to be tested," he said, adding that he hoped that within three months it would be clear which anti-viral therapies were effective.

Developing a vaccine would be more complicated, he said, but must be done "so that when there is another epidemic or maybe when this epidemic drags on for a long time, that we have that vaccine available".

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Planned NHS cash changes spark anger

24 December 2014 Last updated at 12:13

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"The plan is to pay a reduced fee to hospitals for each extra patient they take on", reports Hugh Pym

Hospital specialists have hit out at plans to reduce funding for specialised operations and treatments NHS trusts provide, including some cancer care.

Some 345 specialists have written to NHS England saying the changes could mean longer waiting lists and avoidable deaths, the Daily Telegraph reports.

Under the plans, centres treating more patients than expected would receive just half the extra treatment costs.

NHS England says these services have already seen a big increase in funding.

Lower income

The body channels taxpayers' money to the select NHS trusts that provide specialist services for conditions such as uncommon cancers, burns and medical genetics.

Its proposals - due to come into force in April - aim to curb a growth in spending in this area.

NHS England says providers had seen their incomes rise by more than £1bn over two years.

Curbing this growth in spending would free up resources to be used on other services including care for mental health patients, ambulance provision, casualty departments and GP care.

Analysis: Hugh Pym, BBC Health Editor

It's another illustration of a central question about the future direction of the NHS - what should priorities be at a time of rising demand for care and more sophisticated medical technology and treatment becoming available?

NHS England have taken a decision to shift some resources from specialised provision, including some complex cancer surgery, to areas which they feel are in need of more funding, such as mental health. In effect it has a cake, agreed with the Department of Health, and it has decided to slice it differently from next year. There is no plan to cut specialised services, rather to pay hospitals less for each new patient they take on.

Hospitals and their consultants are understandably upset that their income for new work will be lower than they expected. They warn that patients will suffer as waiting lists for treatment will get longer. Why, they argue, should people needing cancer treatment lose out at all?

No final decisions have been reached. The haggling will continue over the next few weeks. Whatever the outcome, the debate about a health service with finite resources but ever-increasing demands on it won't go away.

However, the letter quoted by the Daily Telegraph says the proposals will leave hospitals with a choice of treating patients and incurring a financial loss, or not treating them at all.

"The clinical consequences of these longer waiting times and a lower quality service to patients with conditions such as heart disease, liver disease, leukaemia, complex cancers etc will be severe," it reportedly says.

Continue reading the main story

Each patient should get the treatment they need where and when they need it, instead of essentially robbing one part of the system to pay for another"

End Quote Dr Mark Porter British Medical Association council chair

"There will inevitably be avoidable deaths as patients die on waiting lists or find that their disease has progressed during the wait for treatment, to the point that it is no longer curable."

A consultation period ends on Wednesday with a final decision expected early next year.

NHS England said in a statement: "We will listen carefully to all consultation responses on these proposals, while recognising that providers of specialised services have enjoyed income increases of over £1bn over the past two years."

Dr Mark Porter, of the British Medical Association which represents doctors, said: "This is a way of putting into action the latest round of NHS cuts, but the funding changes ignore the underlying problem that those hospitals facing unprecedented levels of demand are being forced to provide patient care at a loss, pushing more and more into deficit and collapse.

"The BMA believes that each patient should get the treatment they need where and when they need it, instead of essentially robbing one part of the system to pay for another."

Andrew Gwynne, Labour's Shadow Health Minister, said NHS England needed to listen carefully to the hundreds of hospital consultants who had raised serious concerns about funding plans for specialist services.

"These proposals could put lives at risk and harm patient care."

He said it was right to move appropriate services out of hospital, into the home and community setting.

"That is how we can reduce pressure on hospitals and allow them to deliver the specialist services that need to be done in the hospital."

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E-books 'damage sleep and health'

23 December 2014 Last updated at 00:45 By James Gallagher Health editor, BBC News website

If you curl up under the duvet with an e-book for a bedtime read then you are damaging your sleep and maybe your health, US doctors have warned.

A team from Harvard Medical School compared reading paper books and light-emitting e-readers before sleep.

They found it took longer to nod off with a back-lit e-reader, which led to poorer quality sleep and being more tired the next morning.

Original Kindle readers do not emit light so should be fine, say experts.

Experts said people should minimise light-exposure in the evening.

Whether you are perusing the Man Booker shortlist or leafing through Zoella, the impact of reading on your sleep is probably the last thing on your mind.

But there has been growing concern about the dangers of light before bedtime.

Body clock

Our bodies are kept in tune with the rhythm of day and night by an internal body clock, which uses light to tell the time.

But blue light, the wavelength common in smartphones, tablets and LED lighting, is able to disrupt the body clock.

Blue light in the evening can slow or prevent the production of the sleep hormone melatonin.

Twelve people were locked in a sleep laboratory for two weeks.

They spent five days reading from a paperback and five days from an iPad.

Regular blood samples showed the production of the sleep hormone melatonin was reduced by reading an e-book.

People also took longer to fall asleep, had less deep sleep and were more tired the next morning.

The researchers said other e-readers such as the Nook and Kindle Fire produced similar wavelengths of light and would have the same impact.

The findings were published in the journal Proceedings of the National Academy of Sciences.

'Concern'

Lead researcher Prof Charles Czeisler told the BBC News website: "The light emitted by most e-readers is shining directly into the eyes of the reader, whereas from a printed book or the original Kindle, the reader is only exposed to reflected light from the pages of the book."

He said disrupting sleep in turn affected health.

"Sleep deficiency has been shown to increase the risk of cardiovascular disease, metabolic diseases like obesity and diabetes, and cancer.

"Thus, the melatonin suppression that we saw in this study among participants when they were reading from the light-emitting e-reader concerns us."

Sleep hygiene

Dr Victoria Revell, who researches the impact of light on the body at the University of Surrey, told the BBC: "This is a very good study and I think it's really interesting.

"We should be advising people to minimise their [light-emitting e-reader] use in the evening, particularly teenagers who are a group that are using their phones and tablets late in to the evening."

Teenagers naturally have a late body clock, which makes them slow to rise in the morning and up late at night.

"People who already have a delayed body clock are delaying themselves much further and that is a very important message," Dr Revell added.

Prof Czeisler agreed, saying there was "special concern" for teenagers who were already sleep deficient by being forced to get up early for school.

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Tackle loneliness to 'shield' A&E

23 December 2014 Last updated at 00:46 By Adam Brimelow Health Correspondent, BBC News

NHS leaders are urging people to look in on elderly friends and neighbours over the Christmas period to ease pressures on hospital A&E departments.

They warn loneliness and isolation can increase the risk of emergency hospital admissions.

They say people are more likely to report health problems in good time if they have someone to talk to .

The Patients Association says the service could be heading for a "crunch weekend".

Hospitals and ambulance services are already coming under enormous pressure this winter.

Figures released on Friday showed in England there were more than 440,000 visits to A&E the previous week - a rise of 6% on the same period last year.

Emergency admissions reached record levels, rising to more than 111,000.

Continue reading the main story

We often see a sharp spike in emergency admissions at this time of year and we know that the majority of these are elderly people who have stored up a health problem at home and haven't sought treatment early hoping it will 'go away'"

End Quote Prof Keith Willett NHS England

'Spike' in admissions

NHS leaders say they want to keep people out of busy A&E departments "as far as possible".

They are worried that over the festive period the impact of loneliness and social isolation could cause a major "spike" in admissions.

Prof Keith Willett, NHS England's national clinical director for acute care, cited a recent study in south west England in which 45% of elderly patients admitted as an emergency said they were socially isolated.

"We are calling on the public to think about those people living nearby who might benefit from a visit.

"If they see other people they are more likely to mention a health problem and then are more likely to seek help early."

And - with GP surgeries closed for some of the festive period - Prof Willett reminded people to order medicines in good time so they do not run out.

Lifesaving services

It is a similar message across the UK for the festive period.

In Scotland, Shona Robison, cabinet secretary for health, wellbeing and sport, said people should think through their options.

"We are encouraging people to make themselves aware of the services available to them over the festive period and think about where best to turn if their condition is not life-threatening.

"NHS 24, the local pharmacy, the GP surgery or minor injuries unit may be the better place to go rather than a busy A&E unit, keeping emergency lifesaving services free for those who really need them."

The chairman of the Patients Association, Dr Mike Smith, said there was a risk people could "completely swamp" A&E departments because of a lack of faith in out of hours services.

"We need a new way of providing 24/7 community services, it's going to have to evolve, the current situation is very difficult for people to cope with."

Speaking for the British Medical Association, Dr Chaand Nagpaul, said services were in place to help people without them having to turn straightaway to their nearest hospital emergency department.

"There is a service available through the bank holiday period. People can get to see a GP if they need to through NHS 111.

"Knowing that, there is no need to feel they have to rush to A&E."

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Ebola vaccine 'promising in Africa'

23 December 2014 Last updated at 00:47 By Smitha Mundasad Health reporter, BBC News

The first-ever trial of an Ebola vaccine in Africa shows promising initial results, according to a report in the Lancet medical journal.

Scientists say it is a crucial step as other vaccines have shown lower levels of protection in African populations.

Tests involving Ugandan and American volunteers reveal the vaccine is so far safe and generates an immune response in both populations.

It provides reassurance for other trials currently underway, they say.

The Ebola virus has killed more than 6,900 people in the worst-affected countries of Sierra Leone, Liberia and Guinea.

No proven vaccine exists to prevent people from getting the disease, though several trials are underway.

The aim of a successful vaccine is to train the immune systems of healthy people to produce antibodies - proteins capable of fighting off any future infections.

Viral protection

Researchers from the National Institutes of Health tested this experimental vaccine on healthy adults in Uganda, having first trialled it in the United States.

Dr Julie Ledgerwood, the lead researcher, said: "This is the first study to show comparable safety and immune response of an experimental Ebola vaccine in an African population.

"This is particularly encouraging because those at greatest risk of Ebola live primarily in Africa and diminished vaccine protection in African populations has been seen for other diseases."

According to the study some 57% of people in Uganda who received the Ebola vaccine alone developed antibodies against Ebola in their blood.

Dr Sridhar of the University of Oxford, commenting on the research, said the data provided reassurance about separate Ebola virus vaccines trials currently underway in Mali, the US and the UK.

But further tests would be needed to see if the antibodies are strong enough and long-lasting enough to provide adequate protection against the disease.

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Ambulance wait times 'may increase'

21 December 2014 Last updated at 14:45

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Labour has said Health Secretary Jeremy Hunt has questions to answer over the plans

Target times for ambulances to reach some seriously ill patients could be lengthened, the BBC has learned.

A leaked NHS document includes plans to change the response time for some Red 2 patients - those with "serious but not the most life-threatening" conditions - from eight to 19 minutes in England.

It said the plans had been backed by Health Secretary Jeremy Hunt, subject to approval by ambulance trust bosses.

The government said no decisions had been made. Labour has demanded answers.

And the party has rejected suggestions from ambulance chiefs that it was told about the plan to change response times and raised no objections.

"We have never given any support for this plan. When raised in passing, [Shadow health secretary Andy] Burnham explicitly warned of the need for caution and consultation as he repeated today, " a Labour spokesperson told BBC political correspondent Carole Walker.

"The evidence needed to be produced first and it hasn't been. Instead, ministers are forcing it through from January, in the middle of a crisis, without proper planning," the spokesperson added.

Mr Burnham has written to Mr Hunt asking him to explain why the measures - proposed to be brought in within weeks - were not disclosed to Parliament days after he signed them off.

The leaked document, drawn up for the Association of Ambulance Chief Executives and dated 16 December, said NHS England had "explicitly stressed" the plans were confidential and "should not be disseminated beyond the group" involved in the discussions.

The document said there were existing plans for changes "after the general election" in May.

But it said Prof Keith Willett, head of acute care at NHS England, had made an "urgent request" for discussions due to "unprecedented demand" on health services - and the "target for implementing these changes was the first week of January 2015".

In an interview with the BBC, Prof Willett stressed nothing had been agreed but the proposals must be taken "very seriously".

He said the plans would be scrutinised, and only implemented if proved safe and following testing.

Analysis

By BBC home affairs correspondent Sally Chidzoy

A whistleblower leaked the memo to the BBC because of serious concerns over patient safety, fears the plans were rushed at the height of winter when the service is under unprecedented pressure and anger over the secrecy involved.

To many in the service, the general ideas are good - but there this concern it should have been a more thoughtful exercise where time was taken to consult widely and the public was involved in the process.

Paramedics say response times distort their ability to treat patients because they have to chase the clock.

They say some illnesses such as strokes, should be moved up a category.

The target for these changes was early January, according to the document, but it seems unlikely the proposals will now go ahead by then.

One ambulance service director, who asked not to be named, told the BBC: "This is being done for political expediency rather than patient safety and it's being done with the full blessing of Jeremy Hunt.

"This is being pushed through with limited consultation with the chief executives and the health service as a whole."

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Professor Keith Willett, head of acute care at NHS England: ''We may well be able to give individual patients a better response''

Martin Berry, executive officer of the College of Paramedics, said he was not opposed to change but it could not be done "behind closed doors".

"There's been no effort to engage with the paramedic profession. We're just very concerned about the way this has been kept in the dark."

The College, which represents paramedics across the UK, said it would be discussing the proposals with AACE and NHS England and seeking to be involved in negotiations.

President of the College of Emergency Medicine, Dr Clifford Mann, said the proposals appeared "sensible" but they needed to be trialled to provide evidence to prove it was not a "cosmetic exercise".

Call types:

• Red 1: Respiratory or cardiac arrest - response in eight minutes
• Red 2: All other life-threatening emergencies, such as stroke and fits - response in eight minutes
• Other response times are agreed locally

Ambulance trusts dealt with almost 8.5 million emergency calls in 2013-14 in England, an average of 16.1 calls per minute.

The national target is for ambulance trusts to reach 75% of Red 1 patients within eight minutes, and 95% within 19 minutes. The time starts as soon as an emergency call is connected.

Red 2 targets are currently the same, except that the "clock start" can be up to 60 seconds after a call is connected.

The changes proposed to Red 2 are:

• A "small number" moved to Red 1 - those where a short extra wait "could have a potentially serious detrimental impact"
• Just under half to keep the 75% within eight minutes target, but trusts will have up to three minutes from receiving a call before the clock starts
• About 40% to have a 19-minute response target, as well as three minutes before the clock must start

The Red 2 category includes strokes and fits, but the document does not say which conditions would be put in each of the new categories.

It said the proposed changes could bring "substantial improvements".

The document also said trusts would be able to cut the number of fast-response cars being used in favour of deploying more double-crewed ambulances.

But it acknowledged the plans have not had the "breadth of exposure that would normally be expected".

'Full apology'

Mr Burnham said: "Jeremy Hunt was dragged before Parliament last Thursday to answer questions on NHS winter planning but treated [it] with contempt. It is outrageous that he decided to keep MPs and the public in the dark about a decision he had already taken and one which will have far-reaching implications across the NHS...

"This leak leaves Jeremy Hunt with extremely serious questions to answer. He must do so today."

He said if the health secretary did not have an "acceptable reason for withholding information" he should make a full apology to MPs.

Mr Hunt has not commented but the Department of Health said the health secretary "would only agree to proposed changes that improve response times for urgent cases".

The leak comes after it emerged on Friday that pressures in England's A&E units had hit record levels, with the lowest percentage of patients seen within four hours since monitoring began in 2010.

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First UK reservists join Ebola fight

20 December 2014 Last updated at 18:17

The first British reservists to fly to West Africa to tackle the Ebola outbreak have left for Sierra Leone, the Ministry of Defence has said.

Sixteen reserves left RAF Brize Norton on Saturday along with 100 UK regulars and members of Canada's military.

They will take over duties at 22 Field Hospital, caring for healthcare workers who have contracted Ebola.

Minister for reserves Julian Brazier said they would join others doing "crucial work".

The reserves were trained in how to operate protective equipment in a hangar converted into a mock-up field hospital at Strensall Barracks.

The nine-day course saw them treat simulated casualties.

Captain Eric Teague, of 202 Field Hospital, said: "The training we've had has exceeded my expectations. It's filled us with confidence in the equipment we'll be using and in the routines we will be following to keep us all safe."

There are around 800 UK military personnel in Sierra Leone.

They include planners and engineers, who are overseeing the final stages of the building of infrastructure for a total of 700 beds.

More than 6,800 people have died this year after contracting Ebola, mostly in Sierra Leone, Liberia and Guinea.

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NHS to 'unlock secrets' using DNA

22 December 2014 Last updated at 09:22 By James Gallagher Health editor, BBC News website

A new genetics project could help "unlock a series of secrets about devastating diseases", the NHS says.

Under the scheme, 11 Genomics Medicine Centres are being set up in English hospitals to gather DNA samples to help devise targeted treatments for a wide range of diseases.

It is focusing on cancer and rare genetic diseases.

The aim is to sequence 100,000 genomes within three years in order to develop new tests and drugs.

Doctors will offer suitable patients the opportunity to take part in the scheme.

They will have to agree to have their genetic code and medical records - stripped of anything that could identify them - made available to drugs companies and researchers.

Up to 25,000 cancer patients will have the genetic code of their healthy tissue compared to the genetic code of their tumour.

A giant game of spot-the-difference will then take place to identify the precise mutations in DNA that are causing a patient's tumour.

This would allow targeted medicines to be developed.

Genetic code

Previous genetics research has shown how different cancers can be - for example that breast cancer is not one disease but at least 10 - each with a different cause and life expectancy and each needing a different treatment.

And the development of targeted drugs such as Herceptin - given only if a patient's breast tumour has a certain mutation - has been possible because of genetics research.

Meanwhile, 15,000 patients with rare diseases will have their genome compared with those of their parents and grandparents.

Thousands of genetic diseases - which are individually rare but combined affect large numbers of people - could be identified by finding mistakes in the three billion pairs of letters that make up our genetic code.

The resulting knowledge could give patients an explanation for a disease that has plagued their entire life.

Prof Graeme Black, who will lead the project in Manchester, told the BBC: "It's possible to sequence an individual's entire genetic make-up, their genome, in merely a few days where five years ago that was completely unimaginable.

"Therefore it's possible for conditions where there's a possibility that it's genetic, that we can identify genetic causes much quicker than had been imagined previously."

Case study

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Edward Sherley-Price's daughter has a rare genetic disease

Edward Sherley-Price has first-hand experience of just how little is known about some conditions.

His 11-year-old daughter Alysia has regular seizures.

She was diagnosed with a developmental delay before her second birthday, but the cause was unknown.

It took until 2013 for genetic testing to discover what was wrong - a rare genetic mutation in a gene known as STXBP1.

The family say getting a diagnosis has given them a renewed sense of optimism.

The 100,000 Genomes Project could help people like Alysia by identifying a specific mutation, which lead to taking part in future drug trials.

The NHS said it was aiming to be the most scientifically advanced healthcare system in the world.

Target treatment

The 11 Genomics Medicines Centres will open across England in February at:

• Cambridge University Hospitals NHS Foundation Trust
• Guy's and St Thomas' NHS Foundation Trust, London
• Liverpool Women's NHS Foundation Trust
• Central Manchester University Hospitals NHS Foundation Trust
• Great Ormond Street Hospital NHS Foundation Trust, London
• Newcastle upon Tyne Hospitals NHS Foundation Trust
• Oxford University Hospitals NHS Trust
• Royal Devon and Exeter NHS Foundation Trust
• University Hospital Southampton NHS Foundation Trust
• Imperial College Healthcare NHS Trust, London
• University Hospitals Birmingham NHS Foundation Trust

The 11 centres are just the first wave of the project, which will eventually cover the whole of England.

Scotland, Wales and Northern Ireland are not taking part.

The pilots have been under way this year and 3,000 genomes will have been sequenced by January.

All the data produced in the 100,000 Genomes project will be stripped of anything that could identify the patient and then be made available to drugs companies and researchers to help them create precision drugs for future generations.

The project's leaders say it will be the partnership between the health service, industry and academics that will deliver a new era of genetics-based medicine.

'Devastating diseases'

NHS England medical director Prof Bruce Keogh said the impact of genomic medicine will be on the same scale as other British successes including the smallpox vaccine and IVF.

He said: "Our NHS is better equipped for the emerging science that will determine the future practice of medicine than any other Western healthcare system.

"[It] puts us in a position to unlock a series of secrets about devastating diseases, that have remained hidden for centuries, for the whole of human kind."

Life sciences minister George Freeman said: "We want to make the UK the best place in the world to design and discover 21st century medicines."

Angela Douglas, chairwoman of the British Society of Genetic Medicine, said: "The challenge of the project will be to embed its outcomes into routine health practice.

"The genetics community looks forward to working with researchers, scientists, associated medical specialists and Genomics England to meet that challenge."

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Ambulance wait times 'may increase'

21 December 2014 Last updated at 13:59

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Labour has said Health Secretary Jeremy Hunt has questions to answer over the plans

Target times for ambulances to reach some seriously ill patients could be lengthened, the BBC has learned.

A leaked NHS document includes plans to change the response time for some Red 2 patients - those with "serious but not the most life-threatening" conditions - from eight to 19 minutes in England.

It said the plans had been backed by Health Secretary Jeremy Hunt, subject to approval by ambulance trust bosses.

The government said no decisions had been made. Labour has demanded answers.

Shadow health secretary Andy Burnham has written to Mr Hunt asking him to explain why the measures - proposed to be brought in within weeks - were not disclosed to Parliament days after he signed them off.

The leaked document, drawn up for the Association of Ambulance Chief Executives and dated 16 December, said NHS England had "explicitly stressed" the plans were confidential and "should not be disseminated beyond the group" involved in the discussions.

The document said there were existing plans for changes "after the general election" in May.

But it said Prof Keith Willett, head of acute care at NHS England, had made an "urgent request" for discussions, because due to "unprecedented demand" on health services, the target for implementing the changes was the first week of January.

In an interview with the BBC, Prof Willett stressed nothing had been agreed but the proposals must be taken "very seriously".

Analysis

By BBC home affairs correspondent Sally Chidzoy

A whistleblower leaked the memo to the BBC because of serious concerns over patient safety, fears the plans were rushed at the height of winter when the service is under unprecedented pressure and anger over the secrecy involved.

To many in the service, the general ideas are good - but there this concern it should have been a more thoughtful exercise where time was taken to consult widely and the public was involved in the process.

Paramedics say response times distort their ability to treat patients because they have to chase the clock.

They say some illnesses such as strokes, should be moved up a category.

The target for these changes was early January, according to the document, but it seems unlikely the proposals will now go ahead by then.

One ambulance service director, who asked not to be named, told the BBC: "This is being done for political expediency rather than patient safety and it's being done with the full blessing of Jeremy Hunt.

"This is being pushed through with limited consultation with the chief executives and the health service as a whole."

Martin Berry, executive officer of the College of Paramedics, said he was not opposed to change but it could not be done "behind closed doors".

"There's been no effort to engage with the paramedic profession. We're just very concerned about the way this has been kept in the dark."

The College, which represents paramedics across the UK, said it would be discussing the proposals with AACE and NHS England and seeking to be involved in negotiations.

President of the Royal College of Emergency Medicine, Dr Clifford Mann, said the proposals appeared "sensible" but they needed to be trialled to provide evidence to prove it was not a "cosmetic exercise".

Call types:

• Red 1: Respiratory or cardiac arrest - response in eight minutes
• Red 2: All other life-threatening emergencies, such as stroke and fits - response in eight minutes
• Other response times are agreed locally

The national target is for ambulance trusts to reach 75% of Red 1 patients within eight minutes, and 95% within 19 minutes. The time starts as soon as an emergency call is connected.

Red 2 targets are currently the same, except that the "clock start" can be up to 60 seconds after a call is connected.

The changes proposed to Red 2 are:

• A "small number" moved to Red 1 - those where a short extra wait "could have a potentially serious detrimental impact"
• Just under half to keep the 75% within eight minutes target, but trusts will have up to three minutes from receiving a call before the clock starts
• About 40% to have a 19-minute response target, as well as three minutes before the clock must start

The Red 2 category includes strokes and fits, but the document does not say which conditions would be put in each of the new categories.

The document said the proposed changes could bring "substantial improvements".

It also said ambulance trusts would be able to cut the number of fast-response cars being used in favour of deploying more double-crewed ambulances.

However, it acknowledged the plans have not had the "breadth of exposure that would normally be expected".

'Full apology'

Mr Burnham said: "Jeremy Hunt was dragged before Parliament last Thursday to answer questions on NHS winter planning but treated [it] with contempt. It is outrageous that he decided to keep MPs and the public in the dark about a decision he had already taken and one which will have far-reaching implications across the NHS...

"This leak leaves Jeremy Hunt with extremely serious questions to answer. He must do so today."

He said if the health secretary did not have an "acceptable reason for withholding information" he should make a full apology to MPs.

Mr Hunt has not commented but the Department of Health said the health secretary "would only agree to proposed changes that improve response times for urgent cases".

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