'Lethal failures' led to baby deaths

3 March 2015 Last updated at 14:22 By Nick Triggle Health correspondent, BBC News

A "lethal mix" of failures at a Cumbrian hospital led to the unnecessary deaths of 11 babies and one mother, an inquiry has ruled.

The investigation into Morecambe Bay NHS Foundation Trust found 20 major failures in care from 2004 to 2013 at Furness General Hospital.

It called the avoidable incidents "serious and shocking".

And it criticised the wider NHS for the way it had monitored and regulated events at the hospital.

Health Secretary Jeremy Hunt said in the House of Commons that the tragedy was "a second Mid Staffs", albeit on a smaller scale.

Second Mid Staffs

In an echo of the inquiries in the Stafford Hospital scandal, the independent report said the problems found represented a "simultaneous failure of a great many systems at almost every level, from labour ward to the headquarters of national bodies".

Mr Hunt made number of recommendations, saying that the tragedy "must strengthen our resolve to deliver real and lasting culture change so these mistakes are never repeated."

He has appointed Dr Mike Durkin, National Director of Patient Safety at NHS England, to draw up new guidelines about reporting serious incidents as well as establish an independent national team that can go on rapid fact finding missions on a "no blames basis" as soon as issues arise.

And he's asked Prof Sir Bruce Keogh, Medical Director of NHS England, to review the professional codes of conduct for doctors and nurses to ensure mistakes are reported, not covered up.

The investigation - led by Dr Bill Kirkup, a former senior Department of Health official - found:

• The maternity unit had been "dysfunctional" with "substandard care" provided by staff "deficient in skills and knowledge"
• Working relationships between doctors and midwives had been extremely poor, with midwives referring to themselves as "the musketeers"
• There had been "significant organisational failure" on the part of the Care Quality Commission.
• The North West Health Authority and Parliamentary and Health Services Ombudsman had failed to take opportunities that could have brought the problems to light sooner
• The Department of Health had been reliant on misleadingly optimistic assessments from regulators

Despite the failures starting in 2004 and continuing throughout the period, including a cluster of five major incidents in 2008, it was only in 2011 that the issues at Furness General came to wider attention.

This was after strong criticism from a coroner who looked into the death of newborn Joshua Titcombe. The coroner ruled Joshua had died of natural causes in 2008 but midwives had repeatedly missed opportunities to spot and treat a serious infection.

Around this time, a report came to light that the trust itself had commissioned. It was produced in early 2010 but "suppressed" by the trust.

But before that, the trust had failed to act on earlier incidents and even distorted the way information was presented to inquests.

Catalogue of errors

The CQC, regional health authority and ombudsman had not acted properly on what they knew either. There was knowledge of five major incidents in 2009 as the trust had revealed them as part of its application for foundation trust status, which is reserved for elite trusts.

But the regulators did not take the necessary action to fully investigate what had happened, and the trust gained foundation status in September 2010.

Dr Kirkup said: "This was a disturbing catalogue of missed opportunities."

His inquiry makes 44 recommendations, including:

• a national review of maternity care
• the General Medical Council and Nursing and Midwifery Council (NMC) to investigate the staff involved in care during the period

Six midwives are already due before the NMC later this year - and a seventh is being investigated.

Meanwhile, a police investigation into the death of Joshua Titcombe is continuing, and the Health and Safety Executive is looking into the case.

Health Secretary Jeremy Hunt is due to make a statement later.

The parents' story

Parent power prompted midwife review

James Titcombe's son Joshua was nine days old when he died of sepsis. He was born at Furness General Hospital and was transferred to two other hospitals before dying in Newcastle.

"We asked repeatedly if Joshua should have antibiotics and we were told 'No, he didn't [need any]'," said Mr Titcombe.

"He was wheezing, and he wasn't feeding properly, and my wife called the emergency bell because he was grunting.

"And every time, we were told Joshua was fine and that there was nothing to worry about. At no stage was a doctor ever called."

Afterwards Joshua's progress chart went missing, never to re-emerge, and the coroner later said there was a suspicion that it may have been deliberately destroyed.

On the report's publication, Mr Titcombe said: "I think I feel deeply sad, angry as well, and vindicated, all at the same time.

"For me this report really lays out how preventable Joshua's death was. I really recognise now when we talk about missed opportunities in this report, that for me means not having a six-year-old."

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Coffee linked to 'cleaner' arteries

3 March 2015 Last updated at 00:08 By Michelle Roberts Health editor, BBC News online

Drinking a few cups of coffee a day may help people avoid clogged arteries - a known risk factor for heart disease - Korean researchers believe.

They studied more than 25,000 male and female employees who underwent routine health checks at their workplace.

Employees who drank a moderate amount of coffee - three to five cups a day - were less likely to have early signs of heart disease on their medical scans.

The findings reopen the debate about whether coffee is good for the heart.

Heart effects

There is a lot of confusion when it comes to the effect of coffee on heart health.

Some studies have linked consumption to heart risk factors, such as raised cholesterol or blood pressure, while others suggest the beverage may offer some heart protection.

But there is no conclusive evidence either way, and the latest research from South Korea, which is published in the journal Heart, only adds to the discussion.

Unexplained link

In the study, the researchers used medical scans to assess heart health.

Specifically, they were looking for any disease of the arteries supplying the heart - the coronary arteries.

Continue reading the main story

More research is needed to confirm these findings and understand what the reason is for the association"

End Quote Victoria Taylor of the British Heart Foundation

In coronary heart disease, the coronary arteries become clogged by the gradual build-up of fatty material within their walls.

The scan the researchers used looks for tiny deposits of calcium in the walls of the coronary arteries to provide an early clue that this disease process may be occurring.

None of the employees included in the Korean study had outward signs of heart disease, but more than one in 10 of them were found to have visible calcium deposits on their scans.

The researchers then compared the scan results with the employees' self-reported daily coffee consumption, while taking into account other potential heart risk factors such as smoking, exercise and family history of heart problems.

People who drank a few cups of coffee a day were less likely to have calcium deposits in their coronary arteries than people who drank more than this or no coffee at all.

The study authors say more research is needed to confirm and explain the link.

Coffee contains the stimulant caffeine, as well as numerous other compounds, but it's not clear if these might cause good or harm to the body.

Victoria Taylor of the British Heart Foundation said: "While this study does highlight a potential link between coffee consumption and lower risk of developing clogged arteries, more research is needed to confirm these findings and understand what the reason is for the association.

"We need to take care when generalising these results because it is based on the South Korean population, who have different diet and lifestyle habits to people in the UK."

How much caffeine?

• In the US, experts say up to 400mg a day appears to be safe for most healthy adults
• There is no recommended daily upper limit for caffeine consumption in the UK, except for pregnant women
• If you're pregnant, you should limit the amount of caffeine you have to 200mg a day - equivalent to two mugs of instant coffee
• one mug of instant coffee: 100mg
• one mug of filter coffee: 140mg
• one mug of tea: 75mg
• one can of cola: 40mg
• an espresso contains about 50mg of caffeine
• Coffee shop caffeine levels vary widely

Source: NHS Choices

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A&E waiting time targets missed

3 March 2015 Last updated at 12:16

Scotland's A&E departments treated 87% of people within the Scottish government's target of four hours in January, NHS statistics show.

For the first time, weekly waiting times in Scottish A&E's have also been published.

They cover major hospitals only and suggest 86% of people were treated in four hours between 16 and 22 February.

The Scottish government target is 95%. This winter has been one of the worst for Scottish A&E's in recent years.

Only the weekly figures can be compared with those produced in England, where 88% of people were seen in four hours during the same week of 16 to 22 February.

'Particular strain'

Health Secretary Shona Robison said more needed to be done to tackle the issues facing the NHS, and said the Scottish government was committed to improving performance throughout the whole system.

She said: "While weekly figures show 10 out of 14 health boards are treating around nine out of 10 A&E patients within four hours we are seeing particular strain on hospitals in the west, with NHS Ayrshire & Arran and NHS Greater Glasgow and Clyde falling below the national average for both weekly and monthly figures.

"To tackle this we are targeting £5m from our £31.5m performance fund to drive forward improvement across NHS Greater Glasgow & Clyde, to relieve pressure at the front door of the hospital.

"This is in addition to the support team put into the Royal Alexandra Hospital, which is now using its learning across the health board."

In January, the Scottish government announced £100m to help health boards and local authorities tackle bed blocking which it is hoped would help people move out of A&E and through the system.

Ms Robison added: "I am determined to work with all health boards across the country to improve performance and ensure waits are brought down for patients. Our targets are the most challenging in the UK but it means we need to work even harder to meet them."

'Eye off the ball'

Scottish Liberal Democrat health spokesman Jim Hume said the government should make clear how they plan to tackle the problems in the NHS.

He said: "These figures show SNP ministers have taken their eye off the ball, with far too many people not being seen within the target treatment time.

"The crisis facing A&E units couldn't be more apparent - now NHS staff and patients need to know what the SNP is going to do to fix it."

The Scottish Conservatives have called for the establishment of recovery centres, where police and ambulance staff could refer those heavily under the influence of alcohol, which they said would reduce the demands on A&E.

They said the plan would not mean that people with injuries or in genuine need, who happened to also be drunk, would be diverted away from A&E.

Scottish Conservative health spokesman Jackson Carlaw said: "Recovery centres are up-and-running in America and Australia.

"However, in Scotland we have not seen any real national effort to deal with this increasing problem which now regularly overwhelms casualty [departments].

"When they're already at breaking point, experienced and specialist A&E doctors and nurses shouldn't be expected to simply clean up after someone who has drunk 10 pints on Saturday night and can't find their way home."

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Child health 'an election issue'

2 March 2015 Last updated at 04:07

Measures to protect children's health should be put at the forefront of the general election, say doctors.

The Royal College of Paediatrics and Child Health said child health was falling "to the wayside", with too much attention on the elderly.

It said there was large public support for junk food advertising bans, cooking lessons in school and lowering speed limits.

It added that such measures would make moral, economic and political sense.

Dr Hilary Cass, the president of the college, said: "We often see policies hitting the headlines that are targeted at the ageing population - increased funding for dementia research and additional dementia training for NHS workers are among the pledges that have been made in recent weeks.

"But whilst caring for our ageing population is important, it shouldn't mean that children's health falls to the wayside."

The organisation's poll of 2,118 adults in the UK suggested:

• Two-thirds wanted junk food TV adverts banned before 21:00
• 90% wanted cooking and nutrition lessons in schools
• 82% were in favour of compulsory personal, social and health education (PSHE) schools
• 58% supported the national speed limit being lowered to 20mph in built-up areas.

Dr Cass added: "The UK has the worst child mortality rate in Western Europe, has the highest rate of childhood obesity and has an estimated 850,000 children and young people living with serious mental health conditions - 76% of five-15 year-olds with anxiety or diagnosable depression are not in contact with mental health services.

"These are figures that are going to see little improvement if bold policies are not put in place to directly address them.

"What's needed is urgent and increased investment in children's mental health services and policies like taxation of foods high in salt, sugar and fat, compulsory PSHE lessons in all schools and heightened road safety measures such as 20mph zones - policies that are backed by the public.

"I call on the next government to listen to the facts and listen to the public - make child health a priority. Not only does it make strong moral sense, it makes economic and political sense too."

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Concern over online gonorrhoea care

1 March 2015 Last updated at 02:30 By Faye Kirkland Reporter, 5 Live Investigates

Some websites offering treatment for gonorrhoea put patients at risk by not following best treatment guidelines, BBC 5 Live Investigates has found.

Sexual health experts recommend patients receive a powerful antibiotic, which can only be injected, but the BBC found seven UK-based websites offering only oral antibiotics.

Such treatment can lead to antibiotics becoming less effective, experts warn.

The websites, which include Superdrug, say they are providing a vital service.

Gonorrhoea is the second most common bacterial sexually transmitted infection (STI) in the UK.

Nearly 30,000 people were diagnosed in England in 2013. It can lead to serious health problems if not treated properly.

'Deeply concerned'

In 2011, the British Association for Sexual Health and HIV (BASHH) - which sets national guidelines for doctors treating gonorrhoea - said the use of antibiotic tablets alone was not the best treatment.

They recommend patients should receive a more powerful antibiotic which can only be injected alongside another antibiotic given as a pill.

Failure to do so could mean some patients get less effective treatment.

But a BBC investigation found seven UK-based websites offering only oral antibiotics, which is not in line with best practice treatment guidelines.

Continue reading the main story

5 Live Investigates broadcasts Sundays from 11:00 GMT on BBC Radio 5 Live

The websites provide an online consultation, asking patients for a basic medical history and symptoms.

But some failed to advise patients to notify partners they have the disease, or to take a further test to see if the treatment works. They have now changed their advice after being contacted by the BBC.

Dr Jan Clarke, president of BASHH, said: "We are deeply concerned if, as it appears, oral antibiotics for gonorrhoea are being used as a standard treatment by online pharmacies.

"There is a risk to individual patients, and a real public health risk that the effectiveness of the limited range of antibiotics still available to us will deteriorate through this practice.

"From a patient perspective, in receiving oral antibiotics rather than an injection, they are receiving sub-optimal treatment and care."

Clearer warnings

The pharmaceutical chain Superdrug - which runs one of the websites - has now placed a clearer warning online that an injection is the best form of treatment.

The company says it saw a 66% increase in the number of people getting treatment for gonorrhoea online last year.

It does ask patients to notify sexual partners and offers a free test to see if the treatment has been successful.

Its spokesperson said: "Where a patient is unwilling to visit a sexual health clinic for an injection, we provide the oral antibiotic treatment. A practice commonly used by GPs."

Two other websites - HealthExpress and Doctor Matt - have now advised on their websites that patients should notify their sexual partners.

The Doctor Matt site also now makes it clear that an injection is the recommended best form of treatment.

Gonorrhoea

• Infection can be passed on by unprotected vaginal, oral or anal sex
• It can also be passed from a pregnant woman to her baby
• Of those infected, about one in 10 men and nearly half of women do not have symptoms
• There were almost 30,000 new diagnoses of gonorrhoea in England in 2013, according to the latest Public Health England statistics
• Gonorrhoea can be easily diagnosed with a swab test

'Public health concern'

Public health officials say they are concerned that if people are treated in a way contrary to best practice guidelines it could lead to the spread of antibiotic resistance by the disease.

A spokesperson for Public Health Wales said: "The intention of online gonorrhoea resources may be well-meaning, but potentially with a lack of realisation about the implications of resistance. Any increase in resistance is a public health concern.

"Should online sites be offering treatment which is not in line with BASHH guidelines, this would be a public health concern."

The chief medical officer for England, Dame Sally Davies, says patients with gonorrhoea should be treated by their GP or their local sexual health clinic, and should not order treatment online.

She explained: "There are concerns many websites aren't meeting national standards.

"All medical staff have also been reminded of their responsibilities to help halt the rise in antimicrobial resistance."

Find out more with 5 Live Investigates, Sunday 1 March from 11:00 GMT on BBC Radio 5 Live - or catch up online.

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Drug drivers targeted by new rules

2 March 2015 Last updated at 13:25

New regulations aimed at stopping people driving while on drugs have come into force in England and Wales.

Drivers face prosecution if they exceed limits set for the presence of eight illegal drugs, including cannabis and cocaine, and eight prescription drugs.

Police will be able to use "drugalyser" devices at the roadside.

Campaigners welcomed the move and ministers said it would save lives, but a motoring lawyer said the impact on prescription drug users was a concern.

Meanwhile, Greater Manchester Police says it will delay implementing the new rules for about two weeks as it needs more time to train its officers and examine the legal implications of the changes.

The new rules run alongside the existing law, under which it is an offence to drive when impaired by any drug.

The existing penalties mean drug drivers already face a fine up to £5,000, up to six months in prison and a minimum one-year driving ban.

'Devastates families'

The new regulations set low levels for the eight illegal drugs, with higher levels set for eight prescription drugs, including morphine and methadone.

Those using prescription drugs within recommended amounts will not be penalised.

Apart from using the "drugalysers", officers can test for various drugs including ecstasy, LSD, ketamine and heroin at a police station, even if a driver passes the roadside check.

Please turn on JavaScript. Media requires JavaScript to play.

Lillian Groves was killed by a driver who admitted he was high on drugs

David Taylor, professor of psychopharmacology at Kings College, London and a member of the Department of Transport's advisory panel on drug driving, said the rules would work as a much stronger deterrent and make prosecutions much easier.

Speaking on Radio 4's Today programme he said: "It's a zero-tolerance approach."

He said any exposure would render people over the limit and would leave them over the limit for up to 36 hours.

The situation for people who use prescription drugs had not changed, he said, but "the onus is on the individual to assure themselves that their driving ability is not impaired".

He recommended that drivers who take prescription drugs carry proof so they could produce it at the roadside if needed.

Prescription drugs covered by the new law

• Clonazepam is prescribed to treat seizures or panic disorders
• Diazepam is used for anxiety disorders, alcohol withdrawal symptoms or muscle spasms
• Flunitrazepam (also known as Rohypnol) is a sedative originally used in hospitals for deep sedation in the 1970s
• Lorazepam is used to treat convulsions or seizures caused by epilepsy
• Oxazepam is used to relieve anxiety, including anxiety caused by alcohol withdrawal
• Temazepam affects chemicals in the brain that may become unbalanced and cause insomnia problems
• Methadone is used in the treatment of heroin addiction and for pain relief
• Morphine or opiates treat moderate to severe pain

The changes have been welcomed by the campaigning mother of 14-year-old girl who was killed by a speeding driver who had smoked cannabis.

Lillian Groves died outside her home in New Addington, in Croydon, south London, in June 2010. The driver of the vehicle involved later received an eight-month jail sentence.

"We have fought tirelessly since losing Lillian, and our determination has brought about this significant change," said Lillian's mother, Natasha Groves.

She told the Today programme the problems with drug driving were much bigger than people realised "because they have been able to get away with it for so long".

A government road safety THINK! campaign has also been launched to coincide with the new legislation.

Road Safety Minister Robert Goodwill said: "This new law will save lives.

"The government's message is clear - if you take drugs and drive, you are endangering yourself and others and you risk losing your licence and a conviction."

'Done nothing wrong'

Sarah Sillars, chief executive of the Institute of Advanced Motorists, said the law was "a real step in the right direction".

Greater Manchester Police Chief Inspector Mark Dexter said the force would delay use of the legislation until it was satisfied "the legal and procedural issues involved in prosecuting these cases can properly withstand legal scrutiny".

"This will be a temporary delay whilst we ensure our equipment has the right certification and our officers have the right training and understand the required procedures."

Damien Simmonds, a lawyer at JMW solicitors in Manchester, suggested the change could create legal "complications".

He said many users of prescription drugs who "feel they have done nothing wrong" could be prosecuted for failing to provide roadside samples to police rather than under the new law.

"There's a lot of people driving on levels they feel comfortable with, that they've been prescribed," he told BBC Radio Manchester.

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Cut music to 'an hour a day' - WHO

27 February 2015 Last updated at 14:27 By James Gallagher Health editor, BBC News website

People should listen to music for no more than one hour a day to protect their hearing, the World Health Organization suggests.

It says 1.1 billion teenagers and young adults are at risk of permanently damaging their hearing by listening to "too much, too loudly".

It said audio players, concerts and bars were posing a "serious threat".

WHO figures show 43 million people aged 12-35 have hearing loss and the prevalence is increasing.

In that age group, the WHO said, half of people in rich and middle-income countries were exposed to unsafe sound levels from personal audio devices.

Meanwhile 40% were exposed to damaging levels of sound from clubs and bars.

The proportion of US teenagers with hearing loss went from 3.5% in 1994 to 5.3% in 2006.

WHO v The Who

Dr Etienne Krug, the WHO's director for injury prevention, told the BBC: "What we're trying to do is raise awareness of an issue that is not talked about enough, but has the potential to do a lot of damage that can be easily prevented."

The full report argued: "While it is important to keep the volume down, limiting the use of personal audio devices to less than one hour a day would do much to reduce noise exposure."

Dr Krug said that a good ambition aim: "That's a rough recommendation, it is not by the minute, to give an idea to those spending 10 hours a day listening to an mp3-player.

"But even an hour can be too much if the volume is too loud."

Safe listening levels

The louder the noise (measured in decibels), the faster it damages the ear.

The WHO's safe listening times are:

• 85 dB - the level of noise inside a car - eight hours
• 90 dB - lawn mower - two hours 30 minutes
• 95 dB - an average motorcycle - 47 minutes
• 100 dB - car horn or underground train - 15 minutes
• 105 dB - mp3 player at maximum volume - four minutes
• 115 dB - loud rock concert - 28 seconds
• 120 dB - vuvuzela or sirens - nine seconds

The World Health Organization recommends keeping the volume to 60% of the maximum as a good rule of thumb.

For people trying to drown out the noise of flying or train journeys, it says noise-cancelling headphones allow music to be heard clearly at a lower volume.

And the WHO adds that ear plugs should be worn at noisy venues and advises taking "listening breaks" and standing far away from speakers at gigs.

But what is the point of a concert if you are going to avoid the music?

"We do realise this is a bit of a struggle, like alcohol consumption, so many risk factors linked to pleasure are not easy to change, but we have to make people aware," Dr Krug said.

But as well as calling for personal responsibility, the WHO says governments and manufacturers have a responsibility.

It says clubs should provide chill-out rooms and give out free ear plugs, headphone manufacturers should set limits on the volume, and governments need to adopt stricter laws.

Paul Breckell, the chief executive of the charity Action on Hearing Loss, said: 'When listening to loud music, for every three decibel increase in level, to stay safe you should halve your listening time.

"For example, at 88 dB, safe allowable exposure is cut to four hours, at 91 dB, two hours and so on.

"I urge music lovers to consider the long term risks of listening to loud music from their personal music players over the 85dB safe level, as over exposure can trigger tinnitus, and remember that a good pair of noise cancelling headphones can make all the difference."

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Distinct ME stages found, says study

28 February 2015 Last updated at 02:31

Distinct changes in the immune systems of patients with ME or chronic fatigue syndrome have been found, say scientists.

Increased levels of immune molecules called cytokines were found in people during the early stages of the disease, a Columbia University study reported.

It said the findings could help improve diagnosis and treatments.

UK experts said further refined research was now needed to confirm the results.

Continue reading the main story

It appears that ME patients are flush with cytokines until around the three-year mark, at which point the immune system shows evidence of exhaustion"

End Quote Dr Mady Hornig University of Columbia

People with ME (myalgic encephalopathy) or CFS (chronic fatigue syndrome) suffer from exhaustion that affects everyday life and does not go away with sleep or rest.

They can also have muscle pain and difficulty concentrating.

ME can also cause long-term illness and disability, although many people improve over time.

It is estimated that around 250,000 people in the UK have the disease.

Disease pattern

The US research team, who published their findings in the journal Science Advances, tested blood samples from nearly 300 ME patients and around 350 healthy people.

They found specific patterns of immune molecules in patients who had the disease for up to three years.

These patients had higher levels of of cytokines, particularly one called interferon gamma, which has been linked to the fatigue that follows many viral infections.

Healthy patients and those who had the disease for longer than three years did not show the same pattern.

Lead author Dr Mady Hornig said this was down to the way viral infections could disrupt the immune system.

"It appears that ME/CFS patients are flush with cytokines until around the three-year mark, at which point the immune system shows evidence of exhaustion and cytokine levels drop."

This shows there are distinct stages to the disease, she said. When the cytokine response starts to settle down, the disease also appears to quieten down.

Drug treatments

Peter White, professor of psychological medicine at Queen Mary University of London, said it was premature to draw any conclusions from the study.

"Only one out of the 51 immune proteins studied was elevated in all cases compared with controls, something that could happen by chance alone.

"I hope the authors will go on to re-examine their data after stratifying their samples by other factors that determine the different sub-groups that most scientists now accept make up this illness.

"Finally, as the authors themselves suggest, we need to see these results replicated independently."

Dr Charles Shepherd, medical adviser to the ME Association, said the research was interesting and useful, and added more support to what is already known about the abnormal immune response in people with chronic fatigue syndrome.

"If distinctive patterns of cytokine abnormality can be linked to both stage and severity of disease, this is a finding which could be used to aid diagnosis and open the door to the use of anti-inflammatory drug treatments that would dampen down the abnormal immune system response."

But he indicated that this was still some way off.

He added: "Although some doctors do still mistakenly believe that ME/CFS is a psychological illness, there is now very robust evidence being produced to show that we are dealing with a physical disease process that includes significant abnormalities involving the brain, muscle and the immune system."

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Concern over online gonorrhoea care

1 March 2015 Last updated at 02:30 By Faye Kirkland Reporter, 5 Live Investigates

Some websites offering treatment for gonorrhoea put patients at risk by not following best treatment guidelines, BBC 5 Live Investigates has found.

Sexual health experts recommend patients receive a powerful antibiotic, which can only be injected, but the BBC found seven UK-based websites offering only oral antibiotics.

Such treatment can lead to antibiotics becoming less effective, experts warn.

The websites, which include Superdrug, say they are providing a vital service.

Gonorrhoea is the second most common bacterial sexually transmitted infection (STI) in the UK.

Nearly 30,000 people were diagnosed in England in 2013. It can lead to serious health problems if not treated properly.

'Deeply concerned'

In 2011, the British Association for Sexual Health and HIV (BASHH) - which sets national guidelines for doctors treating gonorrhoea - said the use of antibiotic tablets alone was not the best treatment.

They recommend patients should receive a more powerful antibiotic which can only be injected alongside another antibiotic given as a pill.

Failure to do so could mean some patients get less effective treatment.

But a BBC investigation found seven UK-based websites offering only oral antibiotics, which is not in line with best practice treatment guidelines.

Continue reading the main story

5 Live Investigates broadcasts Sundays from 11:00 GMT on BBC Radio 5 Live

The websites provide an online consultation, asking patients for a basic medical history and symptoms.

But some failed to advise patients to notify partners they have the disease, or to take a further test to see if the treatment works. They have now changed their advice after being contacted by the BBC.

Dr Jan Clarke, president of BASHH, said: "We are deeply concerned if, as it appears, oral antibiotics for gonorrhoea are being used as a standard treatment by online pharmacies.

"There is a risk to individual patients, and a real public health risk that the effectiveness of the limited range of antibiotics still available to us will deteriorate through this practice.

"From a patient perspective, in receiving oral antibiotics rather than an injection, they are receiving sub-optimal treatment and care."

Clearer warnings

The pharmaceutical chain Superdrug - which runs one of the websites - has now placed a clearer warning online that an injection is the best form of treatment.

The company says it saw a 66% increase in the number of people getting treatment for gonorrhoea online last year.

It does ask patients to notify sexual partners and offers a free test to see if the treatment has been successful.

Its spokesperson said: "Where a patient is unwilling to visit a sexual health clinic for an injection, we provide the oral antibiotic treatment. A practice commonly used by GPs."

Two other websites - HealthExpress and Doctor Matt - have now advised on their websites that patients should notify their sexual partners.

The Doctor Matt site also now makes it clear that an injection is the recommended best form of treatment.

Gonorrhoea

• Infection can be passed on by unprotected vaginal, oral or anal sex
• It can also be passed from a pregnant woman to her baby
• Of those infected, about one in 10 men and nearly half of women do not have symptoms
• There were almost 30,000 new diagnoses of gonorrhoea in England in 2013, according to the latest Public Health England statistics
• Gonorrhoea can be easily diagnosed with a swab test

'Public health concern'

Public health officials say they are concerned that if people are treated in a way contrary to best practice guidelines it could lead to the spread of antibiotic resistance by the disease.

A spokesperson for Public Health Wales said: "The intention of online gonorrhoea resources may be well-meaning, but potentially with a lack of realisation about the implications of resistance. Any increase in resistance is a public health concern.

"Should online sites be offering treatment which is not in line with BASHH guidelines, this would be a public health concern."

The chief medical officer for England, Dame Sally Davies, says patients with gonorrhoea should be treated by their GP or their local sexual health clinic, and should not order treatment online.

She explained: "There are concerns many websites aren't meeting national standards.

"All medical staff have also been reminded of their responsibilities to help halt the rise in antimicrobial resistance."

Find out more with 5 Live Investigates, Sunday 1 March from 11:00 GMT on BBC Radio 5 Live - or catch up online.

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Cut music to 'an hour a day' - WHO

27 February 2015 Last updated at 14:27 By James Gallagher Health editor, BBC News website

People should listen to music for no more than one hour a day to protect their hearing, the World Health Organization suggests.

It says 1.1 billion teenagers and young adults are at risk of permanently damaging their hearing by listening to "too much, too loudly".

It said audio players, concerts and bars were posing a "serious threat".

WHO figures show 43 million people aged 12-35 have hearing loss and the prevalence is increasing.

In that age group, the WHO said, half of people in rich and middle-income countries were exposed to unsafe sound levels from personal audio devices.

Meanwhile 40% were exposed to damaging levels of sound from clubs and bars.

The proportion of US teenagers with hearing loss went from 3.5% in 1994 to 5.3% in 2006.

WHO v The Who

Dr Etienne Krug, the WHO's director for injury prevention, told the BBC: "What we're trying to do is raise awareness of an issue that is not talked about enough, but has the potential to do a lot of damage that can be easily prevented."

The full report argued: "While it is important to keep the volume down, limiting the use of personal audio devices to less than one hour a day would do much to reduce noise exposure."

Dr Krug said that a good ambition aim: "That's a rough recommendation, it is not by the minute, to give an idea to those spending 10 hours a day listening to an mp3-player.

"But even an hour can be too much if the volume is too loud."

Safe listening levels

The louder the noise (measured in decibels), the faster it damages the ear.

The WHO's safe listening times are:

• 85 dB - the level of noise inside a car - eight hours
• 90 dB - lawn mower - two hours 30 minutes
• 95 dB - an average motorcycle - 47 minutes
• 100 dB - car horn or underground train - 15 minutes
• 105 dB - mp3 player at maximum volume - four minutes
• 115 dB - loud rock concert - 28 seconds
• 120 dB - vuvuzela or sirens - nine seconds

The World Health Organization recommends keeping the volume to 60% of the maximum as a good rule of thumb.

For people trying to drown out the noise of flying or train journeys, it says noise-cancelling headphones allow music to be heard clearly at a lower volume.

And the WHO adds that ear plugs should be worn at noisy venues and advises taking "listening breaks" and standing far away from speakers at gigs.

But what is the point of a concert if you are going to avoid the music?

"We do realise this is a bit of a struggle, like alcohol consumption, so many risk factors linked to pleasure are not easy to change, but we have to make people aware," Dr Krug said.

But as well as calling for personal responsibility, the WHO says governments and manufacturers have a responsibility.

It says clubs should provide chill-out rooms and give out free ear plugs, headphone manufacturers should set limits on the volume, and governments need to adopt stricter laws.

Paul Breckell, the chief executive of the charity Action on Hearing Loss, said: 'When listening to loud music, for every three decibel increase in level, to stay safe you should halve your listening time.

"For example, at 88 dB, safe allowable exposure is cut to four hours, at 91 dB, two hours and so on.

"I urge music lovers to consider the long term risks of listening to loud music from their personal music players over the 85dB safe level, as over exposure can trigger tinnitus, and remember that a good pair of noise cancelling headphones can make all the difference."

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