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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Asthma inhalers 'not used properly'

20 December 2014 Last updated at 00:00 By Emma Wilkinson Health reporter, BBC News

Patients with asthma and severe allergies are often not taught how to use their medical devices properly, charities have warned.

Asthma UK said in some cases poor technique led to people being put on stronger inhalers than they actually needed.

And studies by Allergy UK suggest people struggle with instructions on auto-injectors in allergy emergencies.

The charities are calling for better training for patients and NHS staff.

The warning comes after a separate US study revealed only 16% of those prescribed adrenalin auto-injectors in case of a potentially life-threatening allergic reaction used them properly.

Common errors included not holding the device in place for at least 10 seconds and not pushing down forcefully enough with the needle to allow the adrenalin in.

In the same study, only 7% of asthma sufferers were found to use asthma inhalers in the right way, researchers reported in Annals of Allergy, Asthma and Immunology.

Training

Study leader Dr Rana Bonds from the University of Texas Medical Branch said the results suggested people weren't properly trained in using the devices in the first place or "forgot the instructions over time".

Maureen Jenkins, clinical director of Allergy UK, said she was not at all surprised by the findings.

She said because there were different designs of inhalers and auto-injectors, people needed to get specific advice for the exact ones they had, which often did not happen.

"We have just finished a leaflet on allergic asthma which talks about proper use of these devices."

Yearly checks

She added that pharmacists were ideally placed to talk patients through using the devices when they picked them up from the chemist.

Dr Samantha Walker, director of research and policy at Asthma UK, said even though in theory everyone with an inhaler should have their technique checked annually, figures showed a third of people with asthma make mistakes with their inhalers.

And many of these mistakes are significant enough to reduce the effectiveness of their treatments.

"This is also hugely wasteful - asthma-prescribing is one of the most expensive areas of cost for the NHS, costing almost £1bn annually.

"You wouldn't give someone a new car without them having driving lessons first, so if you are going to invest in prescribing a lifetime of asthma medicines, it's crucial that healthcare professionals ensure that their patients know how to use them."

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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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Stem cell scandal scientist resigns

19 December 2014 Last updated at 12:27 By James Gallagher Health editor, BBC News website

A Japanese stem cell scientist at the heart of a scandal over false claims and fabricated research has resigned.

Dr Haruko Obokata published supposedly groundbreaking research showing stem cells could be made quickly and cheaply.

There were irregularities in data, no other group in the world could repeat her findings and her own university concluded it could not be done.

In a statement Dr Obokata said: "I even can't find the words for an apology."

Stem cells can become any other type of tissue and hold great potential in medicine.

They are already being investigated to heal the damage caused by a heart attack and to restore sight.

But they are expensive and difficult to produce and one source - embryos - raises serious ethical questions.

'Major discovery'

Dr Obokata's scientific paper published in the prestigious journal Nature claimed that stem cells could be produced from normal adult cells by dipping them into acid for a 30-minute shock period.

The announcement of the creation of these "Stap" cells (stimulus-triggered acquisition of pluripotency) sent shockwaves around the world.

They were described as a "major scientific discovery" and a "game changer" by respected scientists in the field.

However, the findings were too good to be true.

The work was investigated by the Riken Institute, the centre that conducted the research, and was retracted by Nature in July, amid concern that some of the results had been fabricated.

Dr Haruko Obokata was later found guilty of misconduct.

Riken has been attempting to reproduce the results, but this week announced it had been unsuccessful.

Shinichi Aizawa from the university said: "We have conducted verification experiments but can't repeat the Stap phenomenon. As a result, we will terminate the verification experiments."

In her resignation announcement, Dr Obokata said: "I worked hard for three months to show significant results, but I'm so exhausted now and extremely puzzled.

"I am keenly aware of my responsibility for troubling a number of people because of my inexperience.

"I even can't find the words for an apology."

Riken has accepted her resignation.

Prof Chris Mason, from University College London, told the BBC: "There were serious problems with the whole thing.

"They've given her a chance, which is right, but she didn't manage to reproduce the results.

"I don't think it has damaged science, there have been some really solid breakthroughs this year and the focus is on truly transformative therapies."

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A&E has 'worst week' in England

19 December 2014 Last updated at 11:32 By Nick Triggle Health correspondent, BBC News

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Patients tell of their experiences in A&E

Pressures in England's A&E units have hit record levels, with the lowest percentage of patients seen within four hours since monitoring began in 2010.

Data showed just under 90% of patients were seen within four hours in the seven days up to December 14.

Major units particularly struggled, with just six out of 140 meeting the target to see 95% within four hours.

Performance in Wales and Northern Ireland is even worse, while the picture in Scotland is unclear.

Continue reading the main story

As England is the only part of the UK that produces weekly data, how the NHS is performing there gives the best indication of the pressure the system is under.

Strain

Just over 440,000 patients visited A&E in the week ending 14 December with 89.8% seen within four hours.

As well as posting the worst performance against the four-hour target, other measures also show the service is under strain.

There were over 111,000 emergency admissions to hospital - 80,000 from A&E units - which is an all-time high.

Trolley waits - that is waits of four hours or more for a bed once a decision to admit a patient into hospital from A&E is made - topped 10,000 for the first time.

That compares to under 4,000 for the same week last year.

Delays getting patients out of hospital once they are ready for discharge are also much higher than average.

Dr Barbara Hakin, from NHS England, said the pressures were continuing to increase "significantly".

"We have admitted more people to hospital this week to take care of them than in any previous week on record. I want to pay tribute to the staff dealing with that - they are doing a brilliant job.

"While we are now below the extremely high waiting time standards that we set ourselves, the service we provide remains robust.

"The NHS's waiting times for urgent treatment are among the best for any major country that measures them.

"As we come into the holiday period, it is important people continue to look after themselves and nip problems in the bud.

"They should ensure they have proper medication, get their flu jab if they have not done so, and get advice from their pharmacist."

Patients' experiences

Megan Hill, from London, told the BBC about the contrasting experiences of both her grandmothers who fell and broke their hips within days of each other.

"Two London paramedics were forced to sit with my grandmother on a trolley for over eight hours, waiting for an available bed. The first time she was offered food was 01:00 on Wednesday morning - she fell on Tuesday morning.

"In a horrible coincidence, my other 86-year-old grandmother also fell and broke her hip just 48 hours earlier.

"She was picked up immediately by North Wales paramedics, seen and admitted the moment she arrived. Suffice to say she was also offered food.

"The level of patient care should not be postcode dependent."

Analysis: How bad is it going to get?

Performance in England has hit an all-time low since weekly monitoring began in 2010.

But this looks like it will just be the start of what promises to be the most difficult winter for the NHS for a generation.

The four-hour target was introduced in 2004 to combat the long waits patients faced for treatment.

Since then hospitals have performed remarkably well.

During winter months it has tended to dip below the target level, but not for long.

That is in stark contrast to Wales and Northern Ireland, which routinely miss their target.

This, however, is completely different. The target has been met only once since August and now performance has dipped below 90%.

The scale of the drop is causing concern not only to the health service, but to the government too with an election just around the corner.

Around the UK

As health is devolved, data is published differently across the UK.

While England publishes weekly data, the others release it monthly or quarterly.

In Wales the data from November shows just 83.8% of patients were seen in time.

Northern Ireland is performing even worse - just over 80% of patients were seen within four hours in November.

Scotland has a slightly tougher waiting time target - 98% of patients should be seen in four hours - but in September 93.5% were.

Comparing the September figures for England and Scotland shows England was performing slightly better in that month.

It means according to latest data all parts of the UK are missing the A&E waiting time target.

Each nation has set aside extra money for winter pressures.

In England a record £700m has been set aside, while earlier this week the Scottish government announced it was increasing its funding by £10m, bringing the total pot to over £28m.

Scottish Health Secretary Shona Robison said: "We know the winter months may be challenging for our health boards."

British Medical Association leader Dr Mark Porter said: "These figures confirm just how much pressure the NHS is under.

"Staff are working flat out but the system is really struggling to cope with the sheer number of patients coming through the door."

How the UK is preparing for winter

• In England an extra £700m has been set aside to help the NHS. This is paying for the equivalent of 1,000 extra doctors, 2,000 nurses and 2,000 community staff, including social workers and physios.
• Ministers in Scotland have announced a total of £28.2m for the NHS to increase capacity and improve the way patients are discharged during winter.
• In Wales the NHS has been given an extra £200m for this year. The money is for the whole health service, but ministers say it will help relieve the pressures in the coming months.
• Ministers in Northern Ireland have released an additional £5m for both hospitals and the community, including ambulance liaison officers to speed up handovers between paramedics and A&E teams.

Have you recently visited an A&E unit? Are you an NHS worker? Email your experiences to haveyoursay@bbc.co.uk

Have your say

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Asthma inhalers 'not used properly'

20 December 2014 Last updated at 00:00 By Emma Wilkinson Health reporter, BBC News

Patients with asthma and severe allergies are often not taught how to use their medical devices properly, charities have warned.

Asthma UK said in some cases poor technique led to people being put on stronger inhalers than they actually needed.

And studies by Allergy UK suggest people struggle with instructions on auto-injectors in allergy emergencies.

The charities are calling for better training for patients and NHS staff.

The warning comes after a separate US study revealed only 16% of those prescribed adrenalin auto-injectors in case of a potentially life-threatening allergic reaction used them properly.

Common errors included not holding the device in place for at least 10 seconds and not pushing down forcefully enough with the needle to allow the adrenalin in.

In the same study, only 7% of asthma sufferers were found to use asthma inhalers in the right way, researchers reported in Annals of Allergy, Asthma and Immunology.

Training

Study leader Dr Rana Bonds from the University of Texas Medical Branch said the results suggested people weren't properly trained in using the devices in the first place or "forgot the instructions over time".

Maureen Jenkins, clinical director of Allergy UK, said she was not at all surprised by the findings.

She said because there were different designs of inhalers and auto-injectors, people needed to get specific advice for the exact ones they had, which often did not happen.

"We have just finished a leaflet on allergic asthma which talks about proper use of these devices."

Yearly checks

She added that pharmacists were ideally placed to talk patients through using the devices when they picked them up from the chemist.

Dr Samantha Walker, director of research and policy at Asthma UK, said even though in theory everyone with an inhaler should have their technique checked annually, figures showed a third of people with asthma make mistakes with their inhalers.

And many of these mistakes are significant enough to reduce the effectiveness of their treatments.

"This is also hugely wasteful - asthma-prescribing is one of the most expensive areas of cost for the NHS, costing almost £1bn annually.

"You wouldn't give someone a new car without them having driving lessons first, so if you are going to invest in prescribing a lifetime of asthma medicines, it's crucial that healthcare professionals ensure that their patients know how to use them."

Do you have an asthma and any other severe allergies? Have you been affected by the issues mentioned in the story? You can share your experiences to haveyoursay@bbc.co.uk.

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Stem cell scandal scientist resigns

19 December 2014 Last updated at 12:27 By James Gallagher Health editor, BBC News website

A Japanese stem cell scientist at the heart of a scandal over false claims and fabricated research has resigned.

Dr Haruko Obokata published supposedly groundbreaking research showing stem cells could be made quickly and cheaply.

There were irregularities in data, no other group in the world could repeat her findings and her own university concluded it could not be done.

In a statement Dr Obokata said: "I even can't find the words for an apology."

Stem cells can become any other type of tissue and hold great potential in medicine.

They are already being investigated to heal the damage caused by a heart attack and to restore sight.

But they are expensive and difficult to produce and one source - embryos - raises serious ethical questions.

'Major discovery'

Dr Obokata's scientific paper published in the prestigious journal Nature claimed that stem cells could be produced from normal adult cells by dipping them into acid for a 30-minute shock period.

The announcement of the creation of these "Stap" cells (stimulus-triggered acquisition of pluripotency) sent shockwaves around the world.

They were described as a "major scientific discovery" and a "game changer" by respected scientists in the field.

However, the findings were too good to be true.

The work was investigated by the Riken Institute, the centre that conducted the research, and was retracted by Nature in July, amid concern that some of the results had been fabricated.

Dr Haruko Obokata was later found guilty of misconduct.

Riken has been attempting to reproduce the results, but this week announced it had been unsuccessful.

Shinichi Aizawa from the university said: "We have conducted verification experiments but can't repeat the Stap phenomenon. As a result, we will terminate the verification experiments."

In her resignation announcement, Dr Obokata said: "I worked hard for three months to show significant results, but I'm so exhausted now and extremely puzzled.

"I am keenly aware of my responsibility for troubling a number of people because of my inexperience.

"I even can't find the words for an apology."

Riken has accepted her resignation.

Prof Chris Mason, from University College London, told the BBC: "There were serious problems with the whole thing.

"They've given her a chance, which is right, but she didn't manage to reproduce the results.

"I don't think it has damaged science, there have been some really solid breakthroughs this year and the focus is on truly transformative therapies."

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A&E has 'worst week' in England

19 December 2014 Last updated at 11:32 By Nick Triggle Health correspondent, BBC News

Pressures in England's A&E units have hit record levels, with the lowest percentage of patients seen within four hours since monitoring began in 2010.

Data showed just under 90% of patients were seen within four hours in the seven days up to December 14.

Major units particularly struggled, with just six out of 140 meeting the target to see 95% within four hours.

Performance in Wales and Northern Ireland is even worse, while the picture in Scotland is unclear.

Continue reading the main story

As England is the only part of the UK that produces weekly data, how the NHS is performing there gives the best indication of the pressure the system is under.

Strain

Just over 440,000 patients visited A&E in the week ending 14 December with 89.8% seen within four hours.

As well as posting the worst performance against the four-hour target, other measures also show the service is under strain.

There were over 111,000 emergency admissions to hospital - 80,000 from A&E units - which is an all-time high.

Trolley waits - that is waits of four hours or more for a bed once a decision to admit a patient into hospital from A&E is made - topped 10,000 for the first time.

That compares to under 4,000 for the same week last year.

Delays getting patients out of hospital once they are ready for discharge are also much higher than average.

Dr Barbara Hakin, from NHS England, said the pressures were continuing to increase "significantly".

"We have admitted more people to hospital this week to take care of them than in any previous week on record. I want to pay tribute to the staff dealing with that - they are doing a brilliant job.

"While we are now below the extremely high waiting time standards that we set ourselves, the service we provide remains robust.

"The NHS's waiting times for urgent treatment are among the best for any major country that measures them.

"As we come into the holiday period, it is important people continue to look after themselves and nip problems in the bud.

"They should ensure they have proper medication, get their flu jab if they have not done so, and get advice from their pharmacist."

Analysis: How bad is it going to get?

Performance in England has hit an all-time low since weekly monitoring began in 2010.

But this looks like it will just be the start of what promises to be the most difficult winter for the NHS for a generation.

The four-hour target was introduced in 2004 to combat the long waits patients faced for treatment.

Since then hospitals have performed remarkably well.

During winter months it has tended to dip below the target level, but not for long.

That is in stark contrast to Wales and Northern Ireland, which routinely miss their target.

This, however, is completely different. The target has been met only once since August and now performance has dipped below 90%.

The scale of the drop is causing concern not only to the health service, but to the government too with an election just around the corner.

Around the UK

As health is devolved, data is published differently across the UK.

While England publishes weekly data, the others release it monthly or quarterly.

In Wales the data from November shows just 83.8% of patients were seen in time.

Northern Ireland is performing even worse - just over 80% of patients were seen within four hours in November.

Scotland has a slightly tougher waiting time target - 98% of patients should be seen in four hours - but in September 93.5% were.

Comparing the September figures for England and Scotland shows England was performing slightly better in that month.

It means according to latest data all parts of the UK are missing the A&E waiting time target.

Each nation has set aside extra money for winter pressures.

In England a record £700m has been set aside, while earlier this week the Scottish government announced it was increasing its funding by £10m, bringing the total pot to over £28m.

Scottish Health Secretary Shona Robison said: "We know the winter months may be challenging for our health boards."

How the UK is preparing for winter

• In England an extra £700m has been set aside to help the NHS. This is paying for the equivalent of 1,000 extra doctors, 2,000 nurses and 2,000 community staff, including social workers and physios.
• Ministers in Scotland have announced a total of £28.2m for the NHS to increase capacity and improve the way patients are discharged during winter.
• In Wales the NHS has been given an extra £200m for this year. The money is for the whole health service, but ministers say it will help relieve the pressures in the coming months.
• Ministers in Northern Ireland have released an additional £5m for both hospitals and the community, including ambulance liaison officers to speed up handovers between paramedics and A&E teams.

Have you recently visited an A&E unit? Are you an NHS worker? Email your experiences to haveyoursay@bbc.co.uk

Have your say

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EU approves first stem cell therapy

19 December 2014 Last updated at 13:48 By James Gallagher Health editor, BBC News website

A stem cell therapy has been approved for widespread medical use in the EU for the first time.

Stem cells can become any type of tissue in the body and hold huge promise in medicine.

The treatment - Holoclar - is used to treat a rare eye condition that can lead to blindness. It works in around 80% of cases.

The European Medicines Agency (EMA) said the move represented a "major step forward" for the field.

The act of blinking strips cells off the surface of the eye. These are normally replaced by limbal stem cells in order to keep the eye healthy.

Some people, after burns or acid attacks, do not have enough limbal stem cells and the surface of the eye begins to scar.

It can eventually lead to blindness.

Restore

Research clinics and specialised centres have been testing a technique to replace the lost stem cells.

A small sample of remaining stem cells are taken, grown into larger numbers in the laboratory and placed back on to the surface of the eye.

The decision by the EMA means the therapy can move beyond a limited research or case-by-case setting and be offered far more widely.

Enrica Alteri, the head of the Human Medicines Evaluation Division at the EMA said: "This recommendation represents a major step forward in delivering new and innovative medicines to patients."

Prof Chris Mason, from University College London, told the BBC: "This is a therapy that has been done a lot and is very successful, we've treated around 20 people at Moorfields hospital.

"This move would enable far more people to access it, you could now prescribe this."

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Obesity 'could be a disability' - EU

18 December 2014 Last updated at 13:26

Obesity can constitute a disability in certain circumstances, the EU's highest court has ruled.

The European Court of Justice was asked to consider the case of a male childminder in Denmark who says he was sacked for being too fat.

The court said that if obesity could hinder "full and effective participation" at work then it could count as a disability.

The ruling is binding across the EU.

Continue reading the main story

If employers suddenly have to start ensuring that they've got wider seats, larger tables, more parking spaces for people who are obese, I think then we're just making the situation worse"

End Quote Jane Deville Almond British Obesity Society

Judges said that obesity in itself was not a disability - but if a person had a long-term impairment because of their obesity, then they would be protected by disability legislation.

The case centres around childminder Karsten Kaltoft who weighs about 160kg (25 stone).

He brought a discrimination case against his employers of 15 years, Billund local authority, after he was sacked four years ago.

The authority said a fall in the number of children meant Mr Kaltoft was no longer required.

But Mr Kaltoft said he was dismissed because he was overweight.

'No problems'

Earlier this year, he told the BBC that reports that he was so fat he was unable to bend down to tie children's shoelaces were untrue.

Describing his work with children, he said: "I can sit on the floor and play with them, I have no problems like that.

"I don't see myself as disabled. It's not OK just to fire a person because they're fat, if they're doing their job properly."

The Danish courts asked the European Court of Justice (ECJ) to clarify whether obesity was a disability.

The ECJ ruled that if the obesity of the worker "hinders the full and effective participation of that person in professional life on an equal basis with other workers", then obesity can fall within the concept of "disability".

Rulings from the European Court of Justice are binding for all EU member nations.

The courts in Denmark will now have to assess Mr Kaltoft's weight to see if his case can be classed as a disability.

Analysis by Clive Coleman, BBC's legal correspondent

Today's ruling was of great interest to employers across Europe. The judgement makes no direct link between Body Mass Index and obesity, but is a powerful statement that an obese worker whose weight hinders their performance at work is entitled to disability protection.

That will mean employers must, on a case by case basis, make reasonable adjustments such as providing larger chairs or special car parking, and protect such employees from verbal harassment.

But there are wider implications. Providers of goods and services such as shops, cinemas and restaurants will also have to make reasonable adjustments for their customers, which might include things like special seating arrangements.

The key concept here is that adjustments must be "reasonable" - so it may be deemed reasonable for a Premier League football club to make two seats available for someone disabled through obesity, but not for a small, non-league club.

Obesity, particularly what is sometimes known as morbid or severe and complex obesity, can be a particularly sensitive subject.

Employers and service providers will have to take care not to make assumptions about the needs of an obese worker or customer.

'Wider seats'

Jane Deville Almond, the chairwoman of the British Obesity Society, said obesity should not be classed as a disability.

She told the BBC: "I think the downside would be that if employers suddenly have to start ensuring that they've got wider seats, larger tables, more parking spaces for people who are obese, I think then we're just making the situation worse.

"[It is] implying that people have no control over the condition, rather than something that can be greatly improved by changing behaviour."

Paul Callaghan, head of employment law at international law firm Taylor Wessing, said the ruling does not change UK law.

"The European Court of Justice has ruled that obesity itself is not a disability, but that the effects of it can be.

"As such, workers who suffer from, for example, joint problems, depression, or diabetes - specifically because of their size - will be protected by the European Equal Treatment Framework Directive and cannot be dismissed because of their weight."

Employers' responsibility

Audrey Williams, employment law partner at Eversheds, said the mere fact someone is obese is not enough to make them disabled.

"What the court are saying is that obesity is not protected unless it hinders professional life."

She said the ruling would increase awareness among employers of their responsibility towards obese employees in the workplace.

This could include making reasonable adjustments to working arrangements, seating arrangements or making access to the office easier.

However, Tam Fry, from the National Obesity Forum, said the ruling had opened a can of worms for UK employers.

"They will be required to make adjustments to their furniture and doors and whatever is needed for very large people.

"I believe it will also cause friction in the workplace between obese people and other workers."

One in four people in the UK is classified as obese.

What do you think about the ECJ ruling that obesity could constitute a disability? You can share your experience by emailing haveyoursay@bbc.co.uk.

If you are willing to talk to a BBC journalist, please add a contact number.

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