Thursday, 13 September 2012

Hospitals 'on brink of collapse'

By Nick Triggle

Health correspondent, BBC News

Hospital beds are being closed, but demands are increasing

Hospitals in England could be on the brink of collapse because of rising demand and the increasing complexity of patients' conditions, doctors warn.

The Royal College of Physicians' report said the number of beds had been cut by a third over the past 25 years.

It said at the same time emergency admissions had started rising and hospitals were seeing older patients with a wider variety of conditions

The college said this process now meant urgent care was being compromised.

And it warned the problems could lead to another scandal like that surrounding the Mid Staffordshire NHS Trust, which became the subject of a public inquiry after regulators said poor standards had led to needless deaths.

The Royal College of Physicians (RCP) said standards were slipping in hospitals throughout England.

It cited the way older patients were repeatedly moved around wards, the lack of continuity of care while in hospital and tests being done during the night as some of the examples of how care was suffering.

The college also highlighted the results of feedback from its members, which showed concern about discharge arrangements and workload.

The report said in some ways the NHS had been a victim of its own success. Advancements in medicine had led to people living longer, but this meant they were increasingly developing complex long-term conditions such as dementia as a result.

Doctor Andrew Goddard of the Royal College of Physicians: ''The winter pressure is an all-year pressure''

Prof Tim Evans, of the RCP, said: "This evidence is very distressing. All hospital patients deserve to receive safe, high-quality sustainable care centred around their needs.

"Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population who increasingly present to our hospitals with multiple, complex diseases.

"We must act now to make the drastic changes required to provide the care they deserve."

The report said the solution lay in concentrating hospital services in fewer, larger sites that were able to provide excellent care round-the-clock, seven days a week.

But it also said this would require improvements in community services as there were many patients who ended up in hospital because of a lack of help close to home.

Jeremy Hughes, chief executive of the Alzheimer's Society, said: "These latest findings are alarming but, unfortunately, not surprising.

"It is painfully evident that the healthcare system stands on the brink of crisis.

"People with dementia are going into hospital unnecessarily, staying in too long and coming out worse."

Health minister Dr Dan Poulter said: "It is completely wrong to suggest that the NHS cannot cope - the NHS only uses approximately 85% of the beds it has available, and more and more patients are being treated out of hospital, in the community or at home.

"But it is true that the NHS needs fundamental reform to cope with the challenges of the future.

"To truly provide dignity in care for older people, we need to see even more care out of hospitals. That's why we are modernising the NHS and putting the people who best understand patient's needs, doctors and nurses, in charge."

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Wednesday, 12 September 2012

Some of the pants used as cleaning cloths Kamran Ajaib, director of Hamza Poultry Limited.

A MAN has admitted supplying chicken to takeaways across Bristol from a filthy, unlicensed backstreet processing plant.
Kamran Ajaib used Y-fronts as cleaning rags and had no wash handbasins or knife steriliser in his makeshift butchers in Maggs Lane, Fishponds, which produced 20 tonnes of meat a week.

Some of the pants used as cleaning cloths
Kamran Ajaib, director of Hamza Poultry Limited.

The chicken went to takeaway restaurants and kebab shops in Bristol, as well as surrounding towns and cities as far afield as Swindon, Cardiff, Newport and Swansea.
But the premises had none of the necessary food hygiene approvals or licences to work with meat.
Council officials raided the site on the Fishponds Trading Estate after a customer found a piece of metal wire in a takeaway chicken.
At Bristol Crown Court yesterday Ajaib, of Gordon Road, Whitehall, pleaded guilty to 16 charges of failing to comply with food hygiene regulations, between June 2010 and May last year.
He faces a possible jail sentence when he returns to the court next month.
Initially, Ajaib, the sole director of Hamza Poultry Limited, had denied any knowledge of cutting chicken on the premises.
He told a previous hearing, held at the city's magistrates court last year, that it arrived in boxes from EU-regulated factories and was left in those boxes.
But city council principal environmental health officer John Barrow said equipment used in meat preparation had been found during a raid on the premises, along with off-cuts of meat.
Mr Barrow said council officers, accompanied by police, found work tables, a bandsaw – a type of saw often used to cut meat – knives, a chainmail glove – used by butchers to prevent accidental cuts to their hands while chopping meat – and open wheelie bins containing meat debris and bones.
The court was shown a photograph of a box of meat with a pair of underpants draped over it.
It was said that the pants were clean and came from a next door business, which had a surplus of old stock, and had been used as cleaning cloths at the chicken plant.
Bristol City Council successfully applied for an order from magistrates to destroy more than four tonnes of chicken seized in a raid on the unit in May last year.
Mr Barrow said a member of the public had made a complaint to the council after finding a piece of metal wire in a chicken takeaway.
A council investigation into the takeaway's suppliers led them to Hamza Poultry. Council investigators estimated the unit processed "in excess of 20 to 30 tonnes a week" of chicken.
From mobile phones and receipts seized in the raid they realised the meat was being distributed across the South West to what were described in court as "KFC clones and kebab shops", including outlets in Swindon, Wales and Bristol itself.
Asked what the premises needed to comply with safety standards, Mr Barrow said it lacked washbasins by work areas, a knife steriliser and any kind of safety management system.
Kate Burnham, who brought the application to destroy the meat on behalf of the council, said: "It doesn't matter whether this meat is fit for human consumption or not. It is simply because they have not got the right licences in place."
Ajaib told the earlier court hearing that he had stepped in at short notice to help his family, taking over the business from a brother who had been "locked up" some months before the raid. He said he had not known he needed a licence, and that the equipment he had on the site had come from a butcher who owed him money

Trust chief executive Lyn Hill-Tout said she welcomed working with Monitor

Rescue package for troubled Mid Staffordshire NHS Trust

A rescue package is being drawn up for a hospital trust accused of "appalling standards of care" three years ago.

Independent experts will look at a long-term solution for patients using Mid Staffordshire NHS Foundation Trust, health service watchdog Monitor said.

The watchdog, which oversees finance and management, said clinical care has improved but needs to be made sustainable.

Experts will look at how services can be made viable.

Financial advisors, accountants, administrative and legal service firms will form part of the team recommending how services should be run.

'Deeply dysfunctional'

Monitor said the body had an "open mind" about what solutions would be reached but suggested a solvent restructuring of the trust or possibly putting it in special administration could be options.

A final report will be delivered to Monitor in spring 2013.

The trust looks after Stafford and Cannock Chase Hospitals.

A 2009 Healthcare Commission report revealed a higher than expected number of deaths at Stafford Hospital.

Analysis

Nick TriggleHealth correspondent, BBC News

After the placing of South London Healthcare into administration in July, this is another significant step for the NHS.

The decision by the health secretary two months ago was a first for the health service and could lead to that trust being broken up and services closed.

Mid Staffordshire is a foundation trust so this option is not open to ministers or regulators - yet.

But come April Monitor will have the powers to take the same step and so by announcing troubleshooters will be brought in Monitor has paved the way for that to happen.

It will not be the first time that outside experts have been asked to assess the governance and finances of an NHS trust.

But it is the first time they will have the remit to recommend administration for a foundation trust.

It is another sign that in the current financial climate tough action will be taken against struggling trusts.

A public inquiry into the role of regulators in the lead up to the critical report is set to report later this year.

The A&E unit is also temporarily shut at night and earlier this month an NHS report criticised the standard of breast cancer care, describing the set-up as "deeply dysfunctional".

A contingency planning team will work with local commissioners and clinicians, Monitor said.

Dr David Bennett, chair and interim chief executive of Monitor, said: "We have been working closely with Mid Staffordshire NHS Foundation Trust to improve its performance.

"It has made significant improvements in the clinical care provided for patients, but we need to make sure these services can be secured in the long-term.

"It is therefore time for us as the sector regulator to step in and look for a solution that ensures services are provided for local patients on a sustainable basis.

"We have an open mind about the form that solution might take, but it should be the best one for patients in the long term."

Lyn Hill-Tout, the trust's chief executive, said she welcomed working with Monitor so "clear decisions" could be made.

She said: "Reviews of the trust over the last few years and the changes to the way healthcare has begun to be provided nationally have led to a growing feeling of uncertainty about the future of the two hospitals."

Dr David Bennett: "We are open minded about what is the right answer"

In July a new medical director took over at the trust replacing Manjit Obhrai, who was brought in three years ago to improve standards.

At the same time, the Care Quality Commission lifted all of its previous concerns regarding the hospital, saying all "essential standards" were being met.

A Department of Health spokeswoman said the hospitals trust was "still facing serious financial challenges".

She added: "This puts at risk its work on improving services for patients.

"It is important that valued local services are sustainable and able to continue providing high quality treatment and advice for patients."

Tuesday, 11 September 2012

WESTOFMENGELE: Black Death genetic code 'built'

Areas of Somerset and Gloucestershire are designated as badger killing areas, pending an Appeal Court hearing next month

badger vaccine gloucestershire

England badger cull court appeal
1. BBC News‎ - 12 hours ago
  
  Dr Gordon McGlone of the Gloucestershire Wildlife Trust argues that the vaccination of badgers is a better alternative in the control of cattle TB.Published on Tuesday 28 August 2012 15:36
  
  A four-year programme to vaccinate Somerset badgers against bovine TB (bTB) has begun.
  
  The project is part of a nationwide initiative by badger groups to offer vaccination opportunities to farmers and landowners.
  
  Areas of Somerset and Gloucestershire are designated as badger killing areas, pending an Appeal Court hearing next month, and Adrian Coward, chairman of Somerset Badger Group (SBG) said: “Our members are delighted to be working alongside farmers. On behalf of the badgers and farmers we want to take advantage of the recently licensed vaccine to help constructively with the battle against bTB.
  
  “During field trials the vaccine has been proved to be effective in at least 74% of badgers vaccinated. It is the modern, scientific way to conquer the disease and –unlike culling--does not carry the risk of causing infection to spread”.
  
  SBG are carrying out the work in association with Secret World Wildlife Rescue of Highbridge, Somerset, supported by the Badger Trust and Network for Animals. Licensed members and volunteers place peanuts in open cage traps for several nights to familiarise the badgers with the traps before setting the catches which close the traps as badgers enter. Within hours, at first light, the trapped badgers are given a health and condition check, vaccinated, marked and released without harm. Farms will be revisited at regular intervals to increase the proportion of badgers vaccinated.
  
  Badgers are highly territorial. Research has shown that badgers which survive a cull wander much more widely, increasing the possibility of disease spread. The phenomena is known as perturbation. Vaccination has no such disadvantage. The badgers remain in their home ranges, preventing others from moving in from neighbouring areas.
  
  Perturbation with its worsening of disease was so marked in the £50million Randomised Badger Culling Trials that in 2003 the then government suspended localised (“reactive”) killing of badgers.
  
  Vaccination by licensed members of badger groups began last autumn coordinated by Trust director Simon Boulter. Specially-trained leaders and volunteers established procedures in the field monitored and approved by senior Defra veterinary staff. Badgers on farms in Worcestershire, Derbyshire, Devon, Cornwall, Oxfordshire and Buckinghamshire have already been vaccinated by badger group members.
  
  The Badger Trust says perturbation is likely to follow the proposed “free shooting” of badgers.

increasing vitamin intake

'Super soup' test in asthma trial

By Jonathan BallBBC News, Aberdeen

Asthma inhaler dispensing a dose of medication

There are more than five million people in the UK who suffer from asthma

Scientists are to begin clinical trials to determine if eating more foods rich in vitamin E during pregnancy prevents childhood asthma.

Women will eat soups naturally high in the vitamin, which it is believed may promote lung growth in the developing foetus.

Children born with good lung function are less likely to develop asthma.

Details of the trial were outlined at the British Science Festival being held in Aberdeen.

Asthma is highly prevalent - in the UK, 10-15% of children and 5-10% of adults have been diagnosed with the disease.

The majority of children with asthma will carry the illness into adulthood.

The disease is managed by preventing and relieving the major symptoms - breathlessness, wheezing and coughing - using inhalers and, in extreme cases, with steroid tablets.

There has been a recent increase in the prevalence of asthma in children.

To try to understand why, a team of researchers from the University of Aberdeen established a cohort of approximately 2,000 women and measured the impact of diet on the incidence of asthma in children up to the age of five.

Prof Graham Deveraux, who led the study, said: "We were able to show, for the first time, that children born to mums with a lower vitamin E intake during pregnancy were more likely to develop asthma by the age of five and have poor lung function."

These early findings were then confirmed in studies carried out in Japan and the US.

The next challenge for the researchers was to show that altering nutrition during pregnancy could positively impact on a child's susceptibility to asthma.

Avoiding potions and pills

Prof Deveraux considered that a trial using vitamin supplements lacked credibility - trials of vitamins to treat various conditions had so-often failed.

He said the key may be intake in food.

"People have never actually eaten vitamin E tablets; normally most people get their vitamin E from food.

"I wondered whether it might be the other nutrients that go with vitamin E in food that may be responsible for the effect. There may be interactions between vitamin E and the other nutrients.

"So, I was very keen to do a dietary intervention rather than a pill or a potion."

With the help of a team of dietitians, he performed a small study on pregnant women to see if he could manipulate their diet to increase their vitamin E intake up to the recommended levels and, he says, "it worked a treat".

But vitamin E was not the only thing that altered, as Prof Deveraux observed: "Lots of other things changed, like the fatty acids changed, the zinc changed, the selenium, the vitamin D - and all these are nutrients which we know have been associated during pregnancy with childhood asthma."

Whilst the results vindicated their overall approach, the dietary interventions were too complex and would not be readily accessible to a wide range of society. Also it was difficult to standardise and control.

Super soups

To overcome these problems, the team approached a commercial soup manufacturer to develop a range of enhanced soups. Each one is naturally rich in vitamin E - and other potentially important minerals - and for each there is a similarly tasting "normal" soup that could be used for the control group of pregnant women.

By judicious tweaking of ingredients - for example, substituting normal tomatoes found in cream of tomato soup with their super-nutritious sun-dried counterparts - they were able to develop three new varieties of "super-soups".

The team now plan to test the soups in a small pilot study involving 50 women. They will be enrolled during early pregnancy and asked to eat either enriched or normal soup three times a week.

The study will show whether the new dietary intervention is well tolerated by the women and - by carrying out blood measurements - if it has the desired effect on vitamin intake.

They might also get an early indication that the approach could prevent asthma. "If we're really lucky we might show that the children [born to women] receiving vitamin E enhancement may actually have better lung function," Prof Deveraux commented.

The overall approach has support from both nutritionists and asthma experts.

Prof Maijaliisa Erkkola, from the University of Helsinki, told BBC News: "Appropriate food-based strategies that could contribute to reducing low maternal intakes of vitamin E to prevent asthma in offspring and to improve health of children are welcome."

Whilst Prof Ian Hall, from the University of Nottingham and an expert on asthma, told us: "In general these studies [using diet supplement tablets] have been disappointing in that they have failed to show reductions in the risk of developing asthma in the treated subjects.

"The current study adopts a novel approach by using natural supplementation in soup rather than a tablet based approach: it will be interesting to see if this proves more successful".

If the pilot study is successful in its primary aim - increasing vitamin intake - then Prof Deveraux and his team plan to carry out a much larger trial in over 1,000 women.