let down by poor end-of-life care

Thousands of dying patients are being let down by poor end-of-life care provision, the organisation that makes final decisions about NHS complaints in England has said.

The health ombudsman's report detailed "tragic" cases where people's suffering could have been avoided or lessened.

In one instance, a patient had suffered 14 painful attempts to have a drip reinserted during his final hours.

The government said improving end-of-life care was a priority.

The Parliamentary and Health Service Ombudsman has investigated 265 complaints about end-of-life care in the past four years, upholding just over half of them.

Catalogue of failings

Its Dying Without Dignity report said it had found too many instances of poor communication, along with poor pain management and inadequate out-of-hours services.

One mother told the ombudsman how she had had to call an A&E doctor to come and give her son more pain relief because staff on the palliative care ward he had been on had failed to respond to their requests.

In another case, a 67-year-old man's family learned of his terminal cancer diagnosis through a hospital note - before he knew himself. This "failed every principle of established good practice in breaking bad news", the report said.

"There was an avoidable delay in making a diagnosis," it added. "An earlier diagnosis would have meant opportunities for better palliative care."

Ombudsman Julie Mellor told Radio 4's Today the report made "very harrowing reading".

She also urged the NHS to learn lessons from the report, adding: "Our casework shows that too many people are dying without dignity.

"Our investigations have found that patients have spent their last days in unnecessary pain, people have wrongly been denied their wish to die at home, and that poor communication between NHS staff and families has meant that people were unable to say goodbye to their loved ones."

'Appalling cases'

Macmillan Cancer Support chief executive Lynda Thomas said: "The report cites heartbreaking examples of a lack of choice at the end of life that are totally unacceptable.

"If we are to improve the current situation, we will have to see a dramatic improvement in co-ordination of care, and greater integration of health and social care."

The chief inspector of hospitals at the Care Quality Commission, Prof Sir Mike Richards, said the organisation had seen examples of excellent end-of-life care, but also instances where it had not been given enough priority.

He said the CQC would continue to highlight those services that were failing.

A Department of Health spokesman said: "These are appalling cases - everyone deserves good quality care at the end of their lives.

"The five priorities for end-of-life care we brought in emphasise that doctors and nurses must involve patients and their families in decisions about their care, regularly review their treatment and share patients' choices to make sure their wishes are respected.

"NHS England is working on making these priorities a reality for everyone who needs end-of-life care."

Lower back pain

Lower back pain linked to chimpanzee spine shape

Chimpanzees are our closest primate relatives

People with lower back problems are more likely to have a spine similar in shape to the chimpanzee, our closest ape ancestor.

A lesion which forms in the disc between the bones of the spine is the reason for the differing shape.

It would have caused the vertebrae to change as humans evolved from using four legs to two legs.

The researchers say their findings could help doctors predict who may be at risk of back problems.

The study, published in BMC Evolutionary Biology, involved scientists from Scotland, Canada and Iceland.

The research team analysed the vertebrae of chimpanzees, orangutans and ancient human skeletons to investigate the relationship between the shapes of the bones of the spine, upright movement and the health of the human spine.

Prof Mark Collard, from the University of Aberdeen and Simon Fraser University in Canada, said they provided valuable insights into our ancestors' health and lifestyles.

Back pain is a very common health issue in humans

The skeletons also provided information about how humans evolved to move on two "rear" legs.

"Our findings show that the vertebrae of humans with disc problems are closer in shape to those of our closest ape relatives, the chimpanzee, than are the vertebrae of humans without disc problems."

The research picked up that these individuals have a lesion called a Schmorl's node - a small hernia which can occur in the disc between the vertebrae.

Although there is not one cause for the node, it is thought to be linked to stress and strain on the lower back.

Evolution is not perfect, so over many thousands of years humans have not all adapted in the same way.

Prof Collard said: "Our study suggests that the pathological vertebrae of some people may be less well adapted for walking upright."

They say their findings could have benefits for modern health issues and be used as a predictive tool.

Speaking exclusively to the BBC, Dr Peter Wilson, paediatric intensive care consultant at Southampton General Hospital,

Ashya King: Southampton hospital staff criticise parents

By David FentonHealth correspondent, BBC South Today10 April 2015

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Media captionAshya King was taken out of hospital by his parents to receive proton beam therapy abroad

Doctors and nurses who treated cancer patient Ashya King have criticised his parents while speaking out for the first time in a BBC documentary.

Ashya was being treated in hospital in Southampton when his parents took him abroad without telling staff last year.

They ignored medical advice and took him to Prague for proton beam therapy.

It was later revealed Ashya did not receive subsequent chemotherapy in Prague, a move the team in Southampton say could jeopardise his recovery.

Speaking exclusively to the BBC, Dr Peter Wilson, paediatric intensive care consultant at Southampton General Hospital, said: "We are unsure as to exactly what treatment he is receiving but what we do know is... every month that goes by that he's not getting chemotherapy, his outcome worsens.

Dr Peter Wilson and other members of the medical team received hate mail

"There are experts in the country that have already quoted figures of halving survival - so survival going from 80% to 40% or 50%, which is quite dramatic."

The Kings' version of events last year sparked a public outcry and staff members in Southampton said they received angry emails, letters and phone calls which, at one stage, forced the hospital to shut its switchboard.

The King family, who in March said five-year-old Ashya was now cancer free, declined to be interviewed as part of the BBC programme.

Has Ashya been cured?

In March, four months after the proton treatment ended, Brett King told a national newspaper a recent scan showed "no evidence" of the tumour.

But cancer experts have told the BBC although it appears Ashya is in remission it is far too early to say he has been completely cured.

Oncology specialist Professor Karol Sikora said: "Ashya is not completely out of the woods yet, but 78% of children with this type of rare cancer actually survive and are cured.

"The fact he is disease free at this point is great, but it doesn't mean he is cured yet."

The breakdown in the relationship between Brett King and the hospital stemmed from his belief that Ashya should not receive radiotherapy and chemotherapy following surgery to remove a brain tumour.

Mr King claimed in a YouTube video that staff threatened him with a court order if he refused Ashya's treatment, something the hospital has denied.

He told journalists in Spain after his arrest: "They were going to kill him in England or turn him into a vegetable."

Brett King made accusations against the hospital in a YouTube video

Key events

• Ashya had surgery for a medulloblastoma brain tumour at Southampton General Hospital in July 2014
• His parents, Brett and Naghemeh, removed him from the hospital on 28 August and sparked a manhunt when they travelled to Spain
• They were arrested but later released and Ashya was flown to Prague, Czech Republic, for proton beam treatment
• He had six weeks of proton beam therapy, which cost between £60,000 and £65,000, according to the treatment centre, and was paid for by the NHS
• Ashya returned to hospital in Spain
• In March, Brett King announced his son was free of cancer

Through the media, the King family raised tens of thousands of pounds for Ashya's treatment before the NHS agreed to pay for proton therapy in Prague.

Dr Nicky Thorp, of the Children's Cancer and Leukaemia Group of paediatricians, said: "We were dismayed, but on reflection I can see why NHS England agreed to fund that child's case. The child was there, the child needed radiotherapy.

"The use of protons does not improve cure rates of tumours... and it saddens me to see the way the truth can be twisted and misunderstood."

Southampton General Hospital received abuse on social media

In Prague, Ashya's parents refused the chemotherapy, which had been recommended by doctors and ordered by the High Court.

But in March, four months after the proton treatment ended, Mr King said his son was cancer free.

Paediatric oncology consultant Dr Ramya Ramanujachar, who was involved in Ashya's treatment, warned the case could set a worrying precedent.

Dr Ramya Ramanujachar accused the Kings of "dictating" their son's treatment

She said: "I don't think the parents can look after their own child with a brain tumour and be not only the carers but also the professionals directing, managing and dictating their child's treatment."

Dr Wilson said the case had led to an "impossible situation" for clinicians faced with families in the same situation.

"That is deeply unfair when the NHS is always supposed to be about equal healthcare for all," he added.

Ashya: The Untold Story is to be broadcast on BBC1 in the South region on Friday at 19:30 BST.

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Care system gets 'biggest shake-up in 60 years'

 England are being introduced in what is being dubbed the biggest shake-up for 60 years.

The Care Act 2014 includes rights for those receiving care and those who provide it to their loved ones.

It includes standards for access to services from care homes to help in the home for tasks such as washing and dressing.

Meanwhile, NHS and care budgets are being merged in Scotland.

The Public Bodies (Joint Working) Act has been described as the most substantial reform north of the border for a generation.

It effectively forces councils and the NHS to work together to provide more streamlined services.

That aim is also a major topic of debate in England in the election campaign with the Conservatives, Labour, Liberal Democrats, UKIP and Greens all having plans for greater integration.

Policy guide: Health and care

This issue includes NHS funding, GP access and social care, particularly of older people.

Compare parties' policies

But the changes coming into force in England on Wednesday apply only to the care system for older people and younger adults with disabilities.

Four major changes are being introduced:

• The creation of national eligibility criteria establishing for the first time when someone should be entitled to help - to date, it has been up to councils to set their own criteria
• A duty on councils to offer schemes by which those who need to pay for residential care can get a loan from their local council, which is then paid back from their estate after death
• Giving carers for the first time the same right to assessment and support as the people they care for; before, they had to provide "substantial care on a regular basis" to get an assessment
• Those who pay for care themselves will be entitled to go to councils to get advice and information about the care system.

To help protect people's assets, a cap on care costs they have to pay for - set at £72,000 for the over-65s - will kick in from April next year. How the cap works for younger people has still to be finalised.

Today's changes, however, still mark a major milestone in care services, which experts say have hardly changed since the current system was created along with the NHS after the Second World War.

BBC Cost of Care project

The BBC has launched an online guide to the care system for the over-65s. The "care calculator" covers residential care and the support provided in people's own homes, for tasks such as washing and dressing.

Users can submit their postcode and find out how much each service costs where they live in the UK.

There is also a dedicated BBC Cost of Care website, with news stories, analysis and video.

• The care calculator
• Cost of Care website
• How the systems differ in the UK
• England's care cap explained

David Pearson, president of the Association of Directors of Adult Social Services, said the changes were "probably the most significant development" since 1948.

But he said there were still issues to resolve on the underfunding of the system. Unlike the NHS, the care system budget has been cut in real terms this Parliament.

Izzi Seccombe, leader of Warwickshire council, who chairs the Local Government Association's Wellbeing Board, agreed with both points.

"Councils simply cannot afford any more financial burdens when social care services are already chronically underfunded," she said.

Janet Morrison, of the charity Independent Age, said the Care Act had the "potential to revolutionise" services.

But she said: "With a rapidly ageing population, we need an honest debate during and after the election about the true costs of care."

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Office workers 'too sedentary'

1. Office workers 'too sedentary'
2. By James Gallagher
3. Health editor, BBC News website

1. comments
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4. Office workers need to get off their backsides and move around more, according to a new campaign.
5. On Your Feet Britain says sitting for long periods at work is linked to a host of health problems, which are not undone by working out in the gym.
6. It is calling on people to stand regularly, walk around more and embrace ideas such as standing meetings or standing desks.
7. Experts described inactivity as "one of the biggest" challenges in health.
8. Heart disease, type 2 diabetes, cancers and poor mental health have all been linked to sedentary behaviour.
9. The effect is found even in people who class themselves as fit, such as those who cycle to work, if they also spend long periods of time sitting.
10. Prolonged sitting is thought to slow the metabolism and affect the way the body controls sugar levels, blood pressure and the breakdown of fat.
11. The campaign is a partnership between the group Get Britain Standing and the British Heart Foundation (BHF) charity.
12. Their survey of 2,000 office workers suggested:

1. 45% of women and 37% of men spend less than 30 minutes a day up on their feet at work
2. More than half regularly eat their lunch at their desk
3. 78% office workers felt they spent too much time sitting down
4. Nearly two-thirds were worried sitting at work was having a negative impact on their health
5. Gavin Bradley, from Get Britain Standing, told the BBC News website: "We're all victims of our environment, we've taken a lot of activity out of the workplace and we're sitting longer and longer.
6. "We need new and innovative ways of addressing the issue.
7. "Stand up when you're on the phone or in meetings, do everything you can to avoid sitting."
8. Office inactivity
9. 5.2lb(2.4kg)
10. estimated amount of weight that can be lost by standing up for an extra 30 minutes a day for a year

1. 37% of men spend less than 30 minutes a day up on their feet at work
2. 45% of women spend less than 30 minutes a day up on their feet at work
3. 50% regularly eat their lunch at their desk
4. Source: Get Britain Standing and British Heart Foundation
5. Getty Images
6. Other ideas including using the stairs instead of a lift, eating lunch away from your desk, taking a break from your computer every 30 minutes and walking to a colleague's desk rather than phoning or emailing them.
7. Get Britain Standing says standing burns an extra 50 calories per hour than being seated.
8. Dr Mike Loosemore, head of exercise medicine at University College Hospital, told the BBC: "Inactivity and sedentary behaviour is one of the biggest challenges we have in public health today.
9. "Compared with 100 years ago, our levels of activity are tiny, the number of manual jobs are continually reducing, even if you dig a road up you sit in a little tractor.
10. "It's about changing attitudes to how people behave at work and changing the culture of the workplace that just means moving around at little bit more, even just standing up can make a big difference to calories burned and how alert, creative and productive you are."
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13. Lisa Young, project manager for the BHF's Health at Work programme, said: "We're all guilty of being too glued to our screens sometimes, but these results show just how far the couch potato culture has infiltrated the workplace.
14. "Too many of us are tied to our desks at work, which could be increasing our risk of developing cardiovascular disease.
15. "That's why we want workers to get up and get moving on 24 April and take a stand against cardiovascular disease.
16. "A bit of healthy competition in the workplace could go a long way to reversing this trend whilst raising vital funds for our ground-breaking research."