Saturday, 6 December 2014

NHS Devon surgery restriction for smokers and obese plan revealed

An overweight child can't do up his trousers

Morbidly obese people and smokers in Devon will be refused routine surgery until they have lost weight

Smokers and the morbidly obese in Devon will be denied routine surgery unless they quit smoking or lose weight.

Patients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.

The NHS in Devon has a £14.5m deficit and says the cuts are needed to help it meet waiting list targets.

The measures were announced the same day government announced an extra £2bn of annual NHS funding.

'Urgent and necessary'

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The Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) organises most NHS treatment in the area.

It announced a range of cost-cutting measures on Wednesday including only providing one hearing aid, instead of the normal two, to people with hearing loss.

Shoulder surgery will also be restricted.

What is morbid obesity?

People with a body mass index (BMI) of 35 or more are considered morbidly obese by medical professionals
BMI is calculated by dividing weight in kilograms by height in metres, then dividing the answer by height again
Women of average height, 1.62 metres (5ft 3ins), are considered morbidly obese if they weigh more than 91.5kg (14st 6lb)
Men of average height, 1.75 metres (5ft 9ins), are considered morbidly obese if they weigh more than 108kg (17st)

In November, the CCG said it would take "urgent and necessary" measures to prioritise major treatment.

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The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that”

Dr Tim BurkeNEW Devon CCG

That included delaying hip and knee operations for the morbidly obese, but Wednesday's announcement applies to all routine procedures.

NEW Devon CCG said it would not restrict IVF treatment or caesarean sections carried out on medical grounds.

A statement said all the decisions were "interim commissioning positions" and would require further consultation.

Patients with a date for surgery will not be affected but will be offered weight management or quit smoking support.

Dr Tim Burke, Chair of NEW Devon CCG, said: "All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.

"We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case."

NEW Devon CCG said it would announce another round of cost-cutting measures "in due course".

"We don't under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them," said Dr Burke.

"The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that."

In a statement the Royal College of Surgeons said it was "concerned" by the move and warned the region was merely storing up "greater pressures" for the future.

It said: "The need for an operation should always be judged by a surgeon based on their clinical assessment of the patient and the risks and benefits of the surgery - not determined by arbitrary criteria.

"Losing weight, or giving up smoking is an important consideration for patients undergoing surgery in order to improve their outcomes, but for some patients these steps may not be possible.

"A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable and too rigid a measure for ensuring patients receive the best care possible."

GP 'disgust' at watchdog errors

By Sarah BlochHealth reporter, BBC News

GPs have told the BBC their reputations have been "tarnished by incompetence" from the health watchdog.

The Care Quality Commission has been forced to apologise to hundreds of GPs for giving incorrect patient safety risk assessments.

A BBC investigation found serious errors in the calculations used by the CQC.

The British Medical Association is calling for the whole banding system to be withdrawn.

Around 60 practices have been taken out of the highest risk categories and four low-risk surgeries need early inspection.

John Flather, a GP in Hadleigh, Suffolk, said his practice had been incorrectly banded as high risk.

He said he was "totally disgusted by the process" and that a formal complaint had been made.

He told the BBC: "Our reputation, which has been built over many years, has been tarnished by incompetence that they purport to eradicate.

"If they had only given us a chance to view their ratings we could have pointed out their errors and avoided this mess."

Dr Chris Cullen, from Ipswich, said: "My practice was rated for highest risk despite being one of the very high achieving practices in the country.

"The CQC claim we gave flu jabs to 24% of our patients, in fact it was over 96%.

"Our true rating should be for lowest risk, but the CQC aren't interested and have not returned our calls."

Bad data

Practices were judged on 38 indicators of performance, ranging from how easily patients managed to get appointments to how good doctors were at picking up conditions such as dementia.

Practices were graded in six bands, with Band 1 being the highest concern, and Band 6 the least risky.

The majority were of low concern, but 11% were rated in the highest risk band.

The BBC discovered that for one indicator, whether patients were able to get an appointment with a GP or nurse the last time they tried, the calculations were so flawed that the CQC has been forced to remove the indicator altogether.

A further four indicators had to be refined based on revisions to data provided to the CQC by NHS England.

Hundreds of practices will now be assigned a different band.

In its initial register, published two weeks ago, the health watchdog ranked 7,276 practices out of the total 7,661 in England, and placed 864 practices in the "highest concern" category.

Original rankings

As a result of the recalculations, around 60 practices will be lifted out of the two "highest concern" categories, and four that were previously deemed low-risk have been found to be in need of early inspection.

The CQC says 519 practices will move bands, but most were between the lowest risk bands.

The CQC register was set up to help target inspections, and the watchdog said it did not necessarily indicate poor GP surgery performance.

Sir Mike Richards, chief inspector of hospitals for the CQC, told the BBC: "We will make them a big apology. This only became apparent when we ran the data on the thousands of practices rather than just the hundreds that we tested them on."

He defended the publication of the risk bands in the interest of transparency.

He said: "We are using the data to help us know where we might go first. Our judgement comes from a combination of data and inspection. The main thing that is going to matter is that we are going to be inspecting every practice."

Poor data

Measures removed

Whether patients were able to get an appointment with a doctor or nurse last time they tried

Measures recalculated

Coronary heart disease incidence
Chronic obstructive pulmonary disease (COPD) incidence
Unnecessary A&E admissions
Dementia diagnosis rates

The British Medical Association said mistakes by the CQC risked "doing serious harm" to the reputation of good surgeries.

Its GP committee chair, Dr Chaand Nagpaul, said: "The banding system as a whole needs to be withdrawn.

We warned at the time that simplistic targets would fail to take into account the enormous pressures GP practices are facing, and that skewed and limited information does not tell us about the quality of care.

"These failings have the potential to seriously undermine the trust in the system and patients' confidence in their GP and it is only right that all of those practices affected are now contacted and receive a full apology."

Text messaging service 'helps people take their pills'

One third of patients do not take their medicine as directed, research suggests

A text messaging service could help people remember to take the medicines they have been prescribed, say researchers.

A test scheme, which involved heart patients, cut the numbers who forgot or just stopped taking their pills.

One in six was helped to continue their treatment, reducing their risk of heart attack and stroke.

It has been estimated that the NHS spends more than £500m on wasted medicines and avoidable illness.

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In general, patients really valued the text messages and were disappointed when they stopped”

Prof David WaldQueen Mary University of London

Other research has shown around a third of patients do not take their medicine as directed.

Study leader Prof David Wald said text reminders could be used by GPs, hospital doctors and pharmacists for a range of different conditions, including diabetes, TB and HIV.

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Professor David Wald said the service helped identify and help people who stopped taking their medication

In the study, published in Plos ONE, 300 patients who were already on blood pressure medicines or statins were either sent daily texts for two weeks followed by a fortnight of alternate days, then weekly texts for six months, or no texts at all.

Participants had to reply to say whether they had taken their medication, whether the message had reminded them to take it if they had forgotten, or whether they had simply not taken it.

Telephone support

Anyone who had not taken their medicine was flagged up by a computer and received a telephone call to offer advice.

Of those who did not receive texts, 25% stopped taking their medicine completely, or took less than 80% of it.

In the text group, that figure was 9% - 14 out of 150 patients.

There were only three patients who did not start taking the medicine again after receiving advice.

Prof Wald, consultant cardiologist at Queen Mary University of London, said there was a range of reasons why people stopped taking their medicine, including uncertainty over the need for treatment and concerns over potential side-effects, often prompted by negative reports of statins they had read in the media.

"In general, patients really valued the text messages and were disappointed when they stopped."

David Taylor, emeritus professor of pharmaceutical and public health policy at University College London, said text messaging could be coupled with each relevant prescription and prevent several thousand heart attacks and strokes in the UK annually.

It could also be used for other diseases, he said.

Maureen Talbot, senior cardiac nurse at the British Heart Foundation, added that the study was small but encouraging.

"It's crucial that heart patients take prescribed treatments to control their blood pressure and cholesterol as it helps reduce their risk of having a heart attack or stroke.

"Carrying out a larger study over a longer period would help establish the full extent of the benefits of sending this type of reminders to patients."

Friday, 28 November 2014

yellow fever

Early sign of yellow fever could lead to new treatment

By Pippa StephensHealth reporter, BBC News

Scientists analysed the gene activity in macaques after they were infected with yellow fever

Picking up early signs of yellow fever, an infectious disease which can be fatal, could lead to a new treatment and better diagnosis, a study said.

Writing in the journal PLOS Neglected Tropical Diseases, US scientists looked at the virus in macaques, in the first study in primates for more than 20 years.

They found out how the virus damages the body and which genes it disrupts.

The World Health Organisation (WHO) said the study was encouraging.

The virus, endemic in tropical areas of Africa and Latin America, can cause jaundice and kidney failure and mainly targets the liver.

It kills 50% of people infected if they are not treated, the WHO said. There are around 200,000 cases of the infection every year.

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This research work is at an early stage and, although encouraging, will need additional work in both animal models and on human beings ”

No approved drug

Researchers at the University of California, Riverside, gave 20 macaques yellow fever. A control group were given the virus and the vaccine, to compare the results.

The study said within 24 hours of the virus, 90% of the animal's lymphocytes, or white blood cells, had been lost in all 20 animals, leaving it vulnerable to infection.

Yellow fever does not present in humans until quite a late stage, said lead author Ilhem Messaoudi in California, and there are no approved drugs to treat it, meaning early diagnosis is crucial for survival as it allows for rehydration and supportive care.

She said it was extremely challenging to get the vaccine to people in remote areas who need it and that it was not safe for babies and the elderly.

The loss of white blood cells occurred before changes in the liver, the study found, meaning if this translated to humans, doctors could spot it earlier and the chances of survival could be improved.

'Quick analysis?'

Researchers also looked at the macaques' genes and 800 were found to have been switched on within 72 hours of the initial infection, compared to the control group.

Twenty-five percent of the monkeys survived the infection, said Ms Messaoudi. She said she would now be looking at what it was, genetically, in those animals that made them survive, with a view to developing a drug.

She said: "Can we use gene expression as a diagnostic in the clinic - could we run a quick analysis on patients' white blood cells and determine which infected person is at high or low risk?

"Supportive care would follow for all patients, but it would change the dynamics of how aggressive the treatment needs to be."

William Augusto at the WHO said: "This research work is at an early stage and, although encouraging, will need additional work in both animal models and on human beings to better estimate its implications in terms of diagnostics and antiviral therapy."

A&E care 'still unsafe'

Medway Maritime Hospital A&E care 'still unsafe', CQC says

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The CQC's Edward Baker said the hospital gives them the "most concern"

A Kent hospital's A&E department is still failing to protect patients from "inappropriate or unsafe" care, a health watchdog has said.

The Care Quality Commission (CQC) said assessment of patients at Medway Maritime Hospital "remained flawed".

The CQC's deputy chief inspector of hospitals, Edward Baker, said it was the hospital that caused them the "most concern".

The hospital said it had made a number of changes since the CQC inspection.

Inspectors highlighted confusion over the movement of patients from the A&E department, which is in special measures, to wards in the hospital.

Inspectors found one patient was at the A&E department at the hospital in Gillingham for more than 12 hours, and was then assigned to a ward bed only to be told later it was no longer available.

Another patient remained in a trolley for nine hours, when policy said all patients should be transferred to a bed within six hours of arrival.

The report, following an inspection on 26 August, said: "We have taken enforcement action against Medway Maritime Hospital to protect the health, safety and welfare of people using this service."

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We realise the challenges before us”

Dr Phillip BarnesMedway NHS Foundation Trust

An earlier inspection at the hospital, which was put into special measures in July 2013, found a "crisis situation" with bloodstained walls, overcrowding and potentially life-threatening unsafe practices.

'Lack of leadership'

The CQC wrote to Medway NHS Foundation Trust in July, resulting in an action plan being devised.

In its latest report, the commission said: "The pace of change remained slow; the ability to introduce change was hindered by the continued lack of leadership within the department.

The hospital trust has been in special measures since July 2013

"However, we were reassured that the trust was in the process of appointing experienced nurses to lead the workforce as well as commissioning external specialists in emergency medicine to help improve the safety of the department.

"We have judged that the trust continues to fail to ensure that patients are protected from the risks of receiving care or treatment that is inappropriate or unsafe."

The trust said: "Two new emergency care consultants took post in September and October, there is now a dedicated head of nursing in the department and three new emergency care matrons will all be in post by 2 December."

A spokesman said work was under way to "improve patient flow" and "alleviate congestion in the emergency department".

A new children's emergency department is due to open in December.

Dr Phillip Barnes, acting trust chief executive, said: "We realise the challenges before us and are fully committed to providing the high quality of care our patients deserve."

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Saturday, 6 December 2014

NHS Devon surgery restriction for smokers and obese plan revealed

NHS Devon surgery restriction for smokers and obese plan revealed

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