Thursday, 10 May 2012

Most NHS costs wasteful, says Diabetic Medicine

Diabetes: Most NHS costs wasteful, says Diabetic Medicine

More frequent health checks and risk assessments could reduce the cost of diabetes

The majority of NHS spending on diabetes is avoidable, says a report in the journal Diabetic Medicine.

It suggests that 80% of the NHS's £9.8bn annual UK diabetes bill goes on the cost of treating complications.

Experts say much of this is preventable with health checks and better education - something the Department of Health says it is tackling.

The report also predicts that by 2035, diabetes will cost the NHS £16.8bn, 17% of its entire budget.

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If this rise in diabetes is allowed to continue, it will simply be disastrous for NHS budgets”

Baroness Barbara YoungChief executive of Diabetes UK

BBC Health: Diabetes treatment

There are 3.8 million people living with diabetes in the UK.

The study looked at annual direct patient care costs for both types of diabetes, with Type 2 at £8.8bn being far higher than that of Type 1 at £1bn.

Both Type 1 diabetes, which tends to appear in childhood, and Type 2 diabetes, often linked to diet, lead to problems controlling the amount of sugar in the blood.

Complications occur when people with diabetes sustain high levels of glucose over a long period. This can lead to increased chances of developing disease-related complications, such as kidney failure, nerve damage, damage to the retina, stroke and cardiovascular disease.

Budget crash

Baroness Barbara Young, from Diabetes UK - one of the charities involved in the Impact Diabetes report - said: "The report shows that without urgent action, the already huge sums of money spent on treating diabetes will rise to unsustainable levels that threaten to bankrupt the NHS.

"If this rise in diabetes is allowed to continue, as is happening at the moment, it will simply be disastrous for the NHS and wreck NHS budgets. I think we have a car crash coming.

"But the most shocking part of this report is the finding that almost four-fifths of NHS diabetes spending goes on treating complications that in many cases could have been prevented.

"That's hugely wasteful - in human life, in the quality of human life, and in NHS budgets. We need to stop this now and make sure people get the right sort of care early on in their condition."

Baroness Young speculated that investing in better education and more frequent health checks to reduce the risk of complications could actually be less expensive than the current approach.

Type 2 diabetes is often linked to lifestyle and diet

She said: "We need to make sure... that we prevent people getting diabetes through good risk assessment and early diagnosis to prevent spending on avoidable complications."

A Department of Health spokeswoman said that this was something they were doing.

"We agree that diabetes is a very serious illness and one that has a big impact on the NHS.

"That's why we are tackling the disease on three fronts. First, through prevention of Type 2 diabetes - encouraging people to eat well and be more active. Second, by helping people to manage their diabetes through the nine annual health care checks performed in primary care. And by better management of the condition in hospital."

Different challenges

Karen Addington, from Juvenile Diabetes Research Foundation (JDRF) - which was also commissioned the report - said: "It's the first time that we have been able to see the cost of the unavoidable autoimmune condition Type 1 diabetes separately.

"This is important because the causes of Type 1 and the challenge it presents are very different to Type 2, and only medical research can lift this burden on families, the NHS and the economy."

The report was authored by the York Health Economic Consortium and developed in partnership between Diabetes UK, JDRF and Sanofi diabetes.

At a separate conference in Copenhagen, the cost of diabetes has also been under discussion.General Yves Leterme, from the Organisation for Economic and Co-operation and Development said: "Preventing and treating diabetes and its complications costs about 90bn euros (£73bn) annually in Europe alone.

"With health budgets already under great pressure and national budgets severely strained, for the sake of our health and the health of our economies we must find ways to prevent and manage diabetes in a cost-effective manner."

NHS 'can't cope' with multi-disease patients

GPs often have to deal with patients who have multiple health problems

The health system in the UK cannot cope with the rising number of under-65s with long-term medical conditions and needs "radical change", says a study in The Lancet.

A team of researchers analysing 1.75 million people in Scotland found that nearly a quarter had two or more chronic diseases.

Their care was often co-ordinated poorly and inefficient, the study said.

The team wants a more personal approach to patients with complex problems.

At present, healthcare services, medical research and the education of medical students are dominated by a focus on individual diseases, the study authors say.

Yet rising numbers of people are living with more than two long-term disorders, called "multimorbidity", which could include coronary heart disease, diabetes, cancer, stroke and depression.

In general, people with multimorbidity are more likely to live in deprived areas and have a poorer quality of life. Their care is fragmented because they see a number of different specialists.

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Patients with multiple conditions need someone who can oversee all the problems of a patient.”

Prof Graham WattGlasgow University

Generalist approach

The study, led by Bruce Guthrie, professor of primary care medicine at Dundee University, Professor Stewart Mercer, of Glasgow University, and Graham Watt, professor of general practice at Glasgow, says this approach should change.

"Existing approaches need to be complemented by support for the work of generalists, providing continuity, co-ordination, and above all a personal approach for people with multimorbidity."

Their study of nearly two million patients registered with 314 medical practices in Scotland showed that people living in the most deprived areas were particularly affected by long-term physical and mental disorders.

These disorders were more common among poorer communities and occurred 10-to-15 years earlier than among those living in affluent areas.

The study looked for 40 chronic conditions among the participants' data.

Researchers found that 42% of patients had one or more conditions and 23% had two or more.

It also found that only 9% of those with coronary heart disease, had that one disease alone.

Similarly, only 23% of those with cancer, had only cancer and no other long-term disease.

'Wake-up call'

Although the prevalence of multimorbidity increased with age and was present in most people aged over 65, the actual number of people with multimorbidity was higher in those under 65, the study said.

Graham Watt, professor of general practice at Glasgow University, said this was a problem affecting many countries, not just Scotland.

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This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways.”

Dr Chris SalisburyUniversity of Bristol

"Any country with an ageing population is heading in this direction. All these countries are waking up to the problem.

"The status quo isn't an option because it leads in the wrong direction."

Prof Watt said that rather than more specialists, patients with multiple conditions "need someone who can oversee all the problems of a patient".

"These patients need continuity, and we need ways of measuring how well care is joined-up."

Financial burden

In an accompanying article in The Lancet, Dr Chris Salisbury, from the School of Social and Community Medicine at the University of Bristol, said the increasing proportion of people with several co-existing medical problems had a financial impact.

"Expenditure on health care rises almost exponentially with the number of chronic disorders that an individual has, so increasing multimorbidity generates financial pressures. This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways," said Dr Salisbury.

Dr Salisbury suggests that general practitioners in more deprived areas should have lower caseloads to account for higher levels of multiple morbidity.

He also says that in hospitals, those with multimorbidity should be assigned to a generalist consultant who would be responsible for co-ordinating their care.

The Scottish Government's Health Secretary, Nicola Sturgeon, said: "We are working in partnership with NHS, primary-care providers and patients, as well as the research community, so that we have effective systems in place to address the needs of people with multiple health conditions and to reduce these health inequalities."

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.

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."

Wednesday, 9 May 2012

osteoarthritis

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

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.

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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."

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

radical reform originally promised.

Social care reform: No half-measures, campaigners urge

There must be no half-measures on the reform of social care in England, campaigners are warning, amid signs ministers are getting cold feet.Continue reading the main story
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.A 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.

Sunday, 6 May 2012

'Antipsychotic drugs

'Antipsychotic drugs made me want to kill myself'

By Melissa HogenboomBBC News

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.

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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

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 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."

mengele plus

Thursday, 10 May 2012

Most NHS costs wasteful, says Diabetic Medicine

Diabetes: Most NHS costs wasteful, says Diabetic Medicine

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NHS 'can't cope' with multi-disease patients

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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