Thursday, 10 May 2012

A more joined-up strategy, driven at the local rather than national level, is needed to cut falls by the elderly


NHS report calls for joined up plan to cut falls by elderly


They warn that prevention needs to become a key priority as the elderly population grows.Fall (posed by model)A more joined-up strategy, driven at the local rather than national level, is needed to cut falls by the elderly, says an NHS Confederation report.
The group says not enough is being done to stop people falling again after an initial incident.
The Department of Health said it was working hard to prevent falls and improve the treatment of them.
Injuries from falls are the leading cause of death in people over 75 in the UK.
Integrated approach
Jo Webber, representing ambulance services in the NHS Confederation, said: "Half the people in this country over 80 will suffer a fall this year."Falls are not only physically debilitating but, particularly for older people, they really knock their confidence and can slow recovery.
"We have to take the opportunity of the NHS reforms to get organisations across health, social care and local authorities working together.
"Effective falls services that are already up and running across the country show that for little initial investment, patients are getting better care, more falls are being prevented and money is being saved."
The NHS Confederation, a group that represents NHS managers in England, believes that government policies for the last 20 years have not been entirely successful, with many patients experiencing disjointed care.
They recommend that local government, the NHS and social care services work more closely together and suggest using a patient's NHS number as a way for tracking and assessment.
'Unacceptable' care
It has been estimated by the Department of Health that such a fall prevention strategy could cut falls by 30%.
A Department of Health spokesman said: "The coalition government realises the devastating effects that falls can have on people's health, and the contribution that falls make to the level of hospital admissions and costs.
"We know that (treatment is) most effective when social care and the NHS work together, and we are putting in place the legal conditions and financial incentives to drive greater integration."
Michelle Mitchell, from the charity Age UK said: "We warmly welcome this briefing and urge local organisations to implement the recommendations.
"The quality of falls prevention services vary a great deal from place to place - and this is unacceptable. We should have effective services in all areas to support people who have fallen and prevent it from happening again.
"We know that by investing in specialist services that help older people to avoid falling and breaking bones, we can save the health service money."
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Wednesday, 9 May 2012

osteoarthritis


Arthritis cases 'set to double to over 17m by 2030'

Osteoarthritis of the hip If the hip is badly damaged a replacement joint may be needed
Cases of osteoarthritis in Britain look set to double to over 17 million by 2030, according to experts.
A report by the charity Arthritis Care says the predicted rise is down to the UK's ageing population and growing obesity problem.
Experts estimate that by 2030 over half of the UK population will be aged 50 or older and nearly the same proportion will be obese.
The charity is urging government to plan ahead for this "tsunami of pain".
Its report - OANation 2012 - says 8.5 million people in the UK have osteoarthritis and 71% of them - 6m - are in constant pain.
Osteoarthritis (OA), the most common form of arthritis affects the joints, causing pain and stiffness and often reduced mobility. It usually develops in people aged over 50, but some are younger. The exact cause is not known, but anything that puts stress and strain on the joints - including obesity - can play a part.

“Start Quote

We need policy-makers and professionals to take the condition seriously”
End Quote Judith Brodie CEO of Arthritis Care
Although not life-threatening, OA can have a significant impact on quality of life.
The report, which include the results of a YouGov poll of 2,000 OA patients, suggests one in five give up work or retire early because of their condition.
Each year, 2m adults visit their GP because of OA. The NHS in England and Wales performs over 140,000 hip and knee replacement operations every year.
Judith Brodie, CEO of Arthritis Care, said: "The individual, economic and societal burden of OA is already enormous, but with an ageing and increasingly obese population the future is looking bleak.
"We need policy-makers and professionals to take the condition seriously; to implement robust and meaningful strategies to address how OA is treated and managed across the UK and to improve health services."
Liam O'Toole of Arthritis Research UK welcomed the report, saying: "The increasing burden of osteoarthritis is exactly the reason we have continued to increase our research funding into this disease over the last few years."
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Tuesday, 8 May 2012

commentsThe Prime Minister
10 Downing Street
London
SW1A 2AA
4
th
 May 2012
Dear Prime Minister,
Social care is in crisis – the system is chronically under funded and in urgent need of reform. Without
this, too many older and disabled people will be left in desperate circumstances: struggling on alone,
living in misery and fear.
The system is a lottery – some of us will be lucky enough never to need care, but many of us will need
support at some stage in our lives to carry out everyday tasks and could lose everything – our savings,
our dignity, our independence. We agree with your comments in March that action is needed to
reform a system which can currently leave people helpless, in the dark about their care and suffering
massive losses as a result of care bills.
We see the devastating impact of years of failure to reform. The right care and support can enable
older and disabled people to live independent and fulfilled lives – but we currently face a vicious circle
where limited resources are focussed on only those with the very highest of needs. This only worsens
the crisis in care as many older or disabled people are left without support - in quiet desperation, trying
to cope alone, often ending up in hospital or crisis care. Families are paying the price too, as
experienced staff are forced out of work to care for relatives, and many carers pushed to breaking
point caring for loved ones.
There is widespread and increasing support for urgent reform - from across society and the political
spectrum. That is why we are calling on you to take forward social care reform as your personal
mission, your legacy to future generations. Without this leadership, we fear the fundamental and
lasting change needed cannot be delivered.
We recognise that it is not an easy task, but it is achievable. The reports of the Dilnot Commission and
the Law Commission have set out a roadmap for the funding structure and legal reforms that together
will help to produce a fair and sustainable system. As the Government prepares to publish a White
Paper on social care and progress report on funding, it is essential we bring together all those who can
play a part in creating a better care system for the future and help to ensure this year marks a turning
point for care.
We firmly believe that the care challenge we face requires all of us to pull together, and we stand
ready to work with you to secure the changes we need. That is why we are calling on you to personally
convene a care summit in advance of the White Paper, to bring together all parts of Government along
with public service leaders, local government, charities, providers, community groups, unions and the
business community. Whilst we know decisions, particularly on the funding of care, will be difficult;
they must be made now - older and disabled people and their families cannot wait and will not accept
delay or half-measures.
We want disabled and older people and their families to be able to live without fear of what tomorrow
might bring. We are asking you as Prime Minister to show the vision and courage to make this a reality
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radical reform originally promised.


Social care reform: No half-measures, campaigners urge


    Eighty-five groups have written to David Cameron asking him to make urgent reform his "personal mission", and to host a summit to galvanise support.Elderly careA White Paper setting out new plans, including how care will be funded in the future, was due by Easter.Ministers say it is now due to be released in the summer.But fears are growing that even if the plans are set out in the coming weeks, they will fall short of the radical reform originally promised.Behind the scenes officials are already talking about not addressing the trickiest question - paying for care - until the next Parliament.The open letter - signed by leading charities and the Local Government Association - says that without radical change the elderly and disabled will be left living in "misery and The letter - published in the Daily Mail - urges the prime minister to show "vision and courage", and make social care reform his "legacy to future generations."It says: "Social care is in crisis - the system is chronically under-funded and in urgent need of reform."Without this, too many older and disabled people will be left in desperate circumstances: struggling on alone, living in misery and fear."It goes on to say that "delay or half-measures" will not be tolerated.And it adds: "We want disabled and older people and their families to be able to live without fear of what tomorrow might bring."Teresa Quinn from Lincolnshire is a full-time carer for her mother Violet, who developed Parkinson's disease and dementia following a stroke.She told the BBC the best thing for her mother was to be cared for at home, but that she was aware that there was intense pressure on the care system."A lot of care workers are really struggling."The [care workers] that are coming now come such a long way, and have to cram so many calls in."There's long distances, being a rural area - it's not just like in the city where you can go road-to-road or house-to-house, there's miles in between."Radical reformMichelle Mitchell, Age UK's charity director, has urged the government to invest in social care, and not kick the bill "into the long grass".She says the average cost of care for an individual in the UK is £30,000 a year, but one in ten face an annual bill of £100,000."We are seeing increasing numbers of older people - because they're not getting the care at home that they need - going in to hospital earlier."What we are looking at is the government making investment in social care, backing radical reform - not just tinkering at the edges... radically reforming care to give people the opportunity to save for their retirement and prepare for their retirement," she added.Helena Herklots, the chief executive of Carers UK and one of the signatories of the letter, said the organisations had come together as the next few months presented a "real opportunity" to get reform right.But she warned without a push from the top of government, the risk was that the "political will" would not be there.

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    Sunday, 6 May 2012

    'Antipsychotic drugs


    'Antipsychotic drugs made me want to kill myself'

    By Melissa HogenboomBBC News
    Medicines, mental health patient

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    While antipsychotic drugs are seen as the most effective treatment of psychotic episodes, they are also recognised to have devastating side effects.
    Doctors say many patients don't like taking medication long term, but a study published in the Lancet suggests that taking antipsychotic medication more than halves the risk of relapse in schizophrenic patients.
    "I used to see nasty, dirty rat-like things running around when I went outside, I could see people in the streets screaming abuse at me and making obscene and threatening gestures.
    "I was hearing a voice that was saying all kinds of nasty things about me. I was terrified, I tried to kill myself."
    David Strange was diagnosed with paranoid schizophrenia when he was 25. He was sectioned and given antipsychotic drugs, which he says made him feel "a bit better for a while," but gave him a succession of unpleasant side effects.

    “Start Quote

    When I first became ill, I was warned there are certain drugs that weaken the lower lip, even now I still dribble”
    Daniel Levy
    But without medication, the voice he hears is a constant stream of abuse that "comments on what other people are thinking and the horrible things they want to do to me".
    'Unliveable hell'
    Professor of psychiatry Stefan Leucht, from the Technische Universitat in Munich, led the latest research. He also found that fewer patients on antipsychotic drugs were readmitted to hospital - one of the highest costs associated with mental illnesses.
    David says taking antipsychotic drugs for 14 years has helped him deal with his hallucinations and the voices he hears. They are still present but they no longer dominate his life.

    Antipsychotic drugs explained

    handful of medication
    • Antipsychotic medication helps weaken delusions and hallucinations. It can control (but not cure) symptoms in about four out of five people
    • Older antipsychotics work by reducing the action of a chemical in the brain called dopamine. They can cause side effects such as stiffness, shakiness, restlessness, sexual problems and unwanted movements, mainly of the mouth and tongue
    • Newer antipsychotics work on different chemicals in the brain. These are less likely to produce unwanted movements but can cause weight gain, diabetes, tiredness and sexual problems
    Source: Royal College of Psychiatrists
    One of the many drugs he was given was thioridazine, which gave him an irregular heartbeat, something which can be potentially fatal. David remembers lying down with his heart beating really fast, thinking he did not have long left to live.
    "Some drugs made me so anxious I tried to kill myself and ended up getting locked up in hospital."
    Even what he refers to as the "good ones" give him muscle and joint pain, jerkiness similar to the symptoms of Parkinson's Disease and severe sexual dysfunction.
    But he says he would still rather take the drugs than try and function without them.
    "Being unmedicated is an unliveable hell. I'm happy to put up with all of this just to be more functional and less scared."
    'Price to pay'
    The longer antipsychotic drugs are taken, the more chronic the side effects become. The nature of mental illness means patients are often prescribed medication for the rest of their lives.
    Daniel Levy, aged 54, has bipolar disorder and has been taking antipsychotic drugs for nearly 30 years. During that time he has been sectioned and has also attempted suicide.
    David StrangeDavid has been taking antipsychotics for many years
    "The drug chlorpromazine made me tremble, it also made me dribble. When I first became ill I was warned there are certain drugs that weaken the lower lip, even now I still dribble.
    "I don't know I'm doing it until I notice it on my clothes. It looks absolutely terrible."
    But the drug did help him to stay out of hospital and was effective in controlling his symptoms.
    "The side effects are the price I pay for keeping out of hospital," says Daniel.
    "It's a balancing act - doctors never know in advance how you will react to a particular drug."
    Newer "atypical" antipsychotic drugs show fewer of the physical tremor-inducing side effects and are commonly prescribed to patients starting treatment for the first time, says Dr Oliver Howes from the Institute of Psychiatry.
    These still often lead to severe weight gain, increasing the risk of diabetes, blood clots and cardiovascular diseases. The risk is especially high for patients who stay on medication for many decades.
    "We have no way of knowing in advance if a given drug is going to suit a patient - so sometimes patients have to try several before they find one that both helps them and is tolerable," says Dr Howes.
    Unfortunately the drugs with the most side effects are also the ones which have been shown to be the most effective and are supported by many years of research, says Prof Leucht.
    He says that if a patient experiences unpleasant side effects, their clinician should always try another drug, but acknowledges that this is not always possible in practice as some doctors are afraid to change their patient's medication if it appears to be working well.
    Dr Howes says the side effects of antipsychotics need to be put into perspective.
    "Mental health illnesses are devastating. There is a substantial loss of life associated with illnesses such as schizophrenia, predominantly from suicide. We want to prevent that."
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    MRSA and C. difficile infections in hospitals fell


    Hospital hygiene drive 'saved 10,000 lives'

    'CleanYourHands' campaign has led to significant fall in MRSA and other superbug infections, says BMJ report
    • Press Association
    • guardian.co.uk, 
    • Article history
    A doctor scrubbing up in hospital
    MRSA rates in hospitals fell by more than half between July 2004 and June 2008, according to the BMJ study. Photograph: Getty Images
    The government-funded campaign to improve hand hygiene at hospitals across England and Wales led to a significant fall in the rates of superbug infections, a report has revealed.
    After the "CleanYourHands" campaign was rolled out in 2004, the amount of soap and alcoholic hand rub bought by NHS trusts almost tripled, according to a study published in the British Medical Journal (BMJ).
    Over the same period, MRSA rates in hospitals were slashed by more than half, while there was a significant drop in the number of Clostridium difficile infections.
    The campaign, backed by the Department of Health, was introduced across the 187 acute NHS trusts in England and Wales between December 2004 and June 2005.
    It encouraged hospital visitors, patients and staff to wash their hands with soap or an alcohol gel when entering or leaving wards. People were also encouraged to clean their hands before touching patients or eating food and after going to the toilet.
    As part of the drive, alcohol gels were put by bedsides, posters reminded staff to wash their hands and regular checks were made to ensure hands were kept clean.
    The BMJ study, which analysed statistics between July 2004 and June 2008, found that the number of patients infected with MRSA fell from 1.88 cases per 10,000 bed days to 0.91 over the four-year period.
    Rates of C difficile infection dropped from 16.75 to 9.49 cases, while the number of cases of MSSA – a bacterium found on the skin – did not fall.
    The study also found that hospital trust procurement of soap and alcohol hand rub rose from a combined 21.8ml to 59.8ml per patient bed day over the period.
    The increased use of soap in hospitals was linked to reduced rates of C difficile infection, while rising use of alcohol hand rub was associated with a reduction in MRSA cases.
    The report concludes: "The CleanYourHands campaign was associated with sustained increases in hospital procurement of alcohol rub and soap, which the results suggest has an important role in reducing rates of some healthcare associated infections.
    "National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections."
    Sheldon Paul Stone, senior lecturer at UCL medical school, who led the study, estimated that around 10,000 lives were saved because of the campaign, which ended in 2010.
    He told the Independent: "Without a doubt, lives were saved by the campaign. I would say 10,000 lives over the four-year period of the study was a reasonable estimate.
    "If hand hygiene were a new drug, pharmaceutical companies would be out selling it for all they were worth."
    Stone added: "It is obvious the campaign should be continued. Independent groups have suggested it should. It needs a new focus on staff who use gloves. They deal with the most infectious patients but they are much less likely to use soap."
    A spokesman from the Department of Health was quoted as saying: "The CleanYourHands campaign was successful in its aim to highlight the importance of good hand hygiene practice across the NHS. We know this has been successful.
    "The challenge now is to ensure the NHS embeds the good practice highlighted in the campaign to achieve our ambition to wipe out avoidable healthcare-associated infection."

    Hand hygiene campaign 'cut superbug infections'the campaign to improve hand 


    hygiene in hospitals in England and Wales contributed to a significant fall in the rates of superbug infections, according to a report.

    The study published on the BMJ website showed the amount of soap and hand gel being used tripled during the campaign.
    At the same time, levels of MRSA and C. difficile infections in hospitals fell.
    The government has since dropped the campaign, but said its ambition was to "wipe out" such infections.
    Hospital superbugs were once a real fear for many patients. In response the Clean Your Hands campaign, funded by the Department of Health, was introduced in all hospitals by June 2005.
    Alcohol gels were put by bedsides, posters reminded staff to wash their hands and there were regular checks to ensure hands were kept clean.
    By 2008, the total amount of soap and alcohol gel being purchased by hospitals trebled, going from 22ml per patient per day to 60ml per patient per day.
    Rates of MRSA more than halved in the same time period and C. diff infections fell by more than 40%.
    'Success story'
    One of the report's authors, Dr Sheldon Stone from the Royal Free University College London Medical School, estimated that around 10,000 lives were saved because of the campaign.
    He told the BBC: "It's been a real British success story, we've gone from being the dirty man of Europe to being world leaders.
    "What we need to do is keep up the momentum and stay at the forefront of world hand hygiene."
    A spokesman from the Department of Health said: "The Clean Your Hands campaign was successful in its aim to highlight the importance of good hand hygiene practice across the NHS. We know this has been successful.
    "The challenge now is to ensure the NHS embeds the good practice highlighted in the campaign to achieve our ambition to wipe out avoidable healthcare-associated infection.
    "We know real progress has been made in this area as MRSA bloodstream infections have dropped by 41% and C. difficile by 30% across the NHS in England since 2009/10.
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    Saturday, 5 May 2012

    ritual slaughter


    Leading vet criticises ritual slaughter of animals

    Halal abattoir in Oudeschoot, NetherlandsProf Reilly says if there is no alternative to non-stun slaughter, then it ought to be kept to a minimum

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    A leading vet has criticised the "unacceptable" rise in the number of animals killed in ritual slaughter.
    Ritual slaughter is lawful in the UK and the EU to satisfy the dietary requirements of Jews and Muslims.
    Prof Bill Reilly, former president of the British Veterinary Association, said estimates suggested more animals were slaughtered than was necessary.
    The Food Standards Agency (FSA) said its own figures showed most animals were stunned before being killed.
    The FSA conducted a survey into animal welfare in slaughterhouses in September.
    A spokesman said: "The results indicate that the number of animals not stunned prior to slaughter is relatively low, accounting for 3% of cattle, 10% of sheep and goats, and 4% of poultry.
    "They also show that the majority of animals destined for the halal trade in both the red and white meat sectors are stunned before slaughter."
    The FSA said full details of the survey would be published ahead of a discussion at a board meeting on 22 May.
    'Not acceptable'
    But Prof Reilly, writing in the Veterinary Record, said: "In my view, the current situation is not acceptable and, if we cannot eliminate non-stunning, we need to keep it to the minimum.
    "This means restricting the use of halal and kosher meat to those communities that require it for their religious beliefs and, where possible, convincing them of the acceptability of the stunned alternatives."
    He suggested some abattoirs might be refusing to stun animals simply to cut costs.
    UK legislation allows halal (Muslim) or schecita (Jewish) "non-stun" slaughter as long as it does not cause "unnecessary suffering".
    But Prof Reilly said he witnessed schecita slaughter in the 1970s and he wrote: "The distress, fear and pain were there for all to see in the abattoir."
    Prof Reilly said his own estimates suggested around two million animals, mostly poultry, were killed in the UK each year without stunning for the orthodox Jewish community.
    Halal meat now accounted for 25% of the entire UK meat market, Prof Reilly added. Anecdotal evidence suggested that almost half of lambs destined for slaughter were killed without prior stunning.
    Joyce D'Silva, from the charity Compassion in World Farming (CWF), said: "Judaism and Islam believe that animals are creatures of God; science tells us that they are sentient beings, who can suffer.
    "If you hold either view, or both, then your principle concern must be to ensure the least possible suffering for the animal concerned.
    "Therefore animals should be handled with care and stunned effectively before their throats are cut in order to minimise their distress and pain.
    "Consumers should be able to tell how the animals they eat are reared, transported and slaughtered," he added.

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