Major new nursing plans released
Wednesday April 30th, 2008
Nurses' leaders have announced a new overall plan, outlining their aims for the next five years.
"Strategic plan: Forward together - the RCN's strategic plan for 2008-2013" was launched by the Royal College of Nursing at their congress on Monday (April 28).
It sets out the organisation's aspirations, and will be used to guide their future priorities. Its contents are based on a year of research, debate and consultation, say the RCN.
"The new strategic plan continues to support the RCN's overall mission to represent nurses and nursing, promote excellence in practice and shape health policy," the authors state. "We've created the pathway that takes us step-by-step towards fulfilling our ultimate vision."
Key goals include creating an organisation to bring together the professional and trades union functions, "so their power is enhanced by working together". This would maximise opportunities for working across functions, says the plan.
Another central theme is "engaging members and staff and their clinical and workforce talents and experience". This will include a greater commitment to nurse education and the recruitment of more nurse leaders across the UK.
The RCN also want to build on their position as the leading authority on nursing on health and social care, having a broader influence on "the wider health and social care agenda". Other goals include working more closely with social workers, campaigning more effectively, valuing diversity, and benefiting national, EU, and global health.
All together there are ten key goals. The plan was finalised after extensive debate at the RCN's AGM in October 2007.
Angina patients left under-diagnosed
Tuesday April 29th, 2008
Many patients with suspected angina pectoris are left unexamined, raising their risk of serious heart problems, warn researchers.
Professor Gene Feder of Bristol University, UK, and colleagues set out to discover how often diagnostic tests are given to individuals with suspected angina pectoris.
They were concerned that an x-ray test called coronary angiography is underused in certain groups of patients.
They recruited 1,375 outpatients who they considered suitable for coronary angiography and followed them for three years. Overall, 69 per cent of patients deemed appropriate for angiography did not receive one.
Analysis showed that patients aged over 64 were 40 per cent less likely to have an angiography, with those aged under 50. Women were 58 per cent less likely than men to have the test, and south Asians were 52 per cent less likely than white people.
Patients in the most economically deprived fifth were 34 per cent less likely to receive the test than those in the other four fifths.
On the website of the British Medical Journal, the researchers write: "Not undergoing angiography when it was deemed appropriate was associated with higher rates of coronary event."
They conclude: "At an early stage after presentation with suspected angina, coronary angiography is underused in older people, women, south Asians, and people from deprived areas.
"Our findings and those of previous studies should inform policy to deal with sources of inequity in the provision of cardiac services." The use of appropriateness ratings for cardiac tests "now needs to be tested in real clinical settings", they add.
Sekhri, N. et al. Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris. The British Medical Journal, published online April 25, 2008.
Almost half of smokers tried to quit last year
Monday April 28th, 2008
New findings suggest that 43 per cent of England's ten million smokers made an attempt to give up in 2007.
Surveys of more than 27,000 smokers and ex-smokers were carried out by Professor Robert West, of Cancer Research UK's Health Behaviour Research Centre at University College London, UK, and his team.
From a series of monthly surveys between November 2006 and January 2008, they calculate that 800,000 people (eight per cent) tried to quit as a direct result of the smokefree legislation, introduced in England on July 1, 2007.
Professor West said: "We know that the majority of smokers want to give up so it's very encouraging to see that half of the smokers we surveyed made a quit attempt in the past year."
Many of these smokers made several attempts, he found. "It can take many attempts to stop smoking for good, but the more times you try, the more likely you are to succeed in the end."
The team also calculate that more than one million smokers (ten per cent) tried to quit at New Year. Results are presented today (April 28) at the Action on Smoking and Health (ASH) Wales conference in Cardiff, UK.
Professor West found that smokers used a variety of methods to help them quit, such as nicotine replacement gum, patches and lozenges, and he recommends local NHS Stop Smoking Services which offer ongoing free face-to-face support and advice close to people's homes.
He said: "I think the best chance of success comes from getting advice and assistance from the specialist NHS Stop Smoking Service. It provides friendly advice and assistance and is based on sound evidence of effectiveness."
Good uptake for cervical cancer vaccine
Friday April 25th, 2008
A pilot of the national human papillomavirus (HPV) vaccination scheme has been largely successful, organisers reported today.
The pilot was carried out by Dr Loretta Brabin of Manchester University, UK, at 36 secondary schools in Manchester. It offered the HPV vaccine to 2,817 girls aged in year 8 (12 and 13 years old), in three doses.
The researchers found an uptake rate of 70.6 per cent for the first dose and 68.5 per cent for the second dose. The main reason for parents' refusal was insufficient information about the vaccine and its long term safety, they report.
Completing the vaccine schedule was challenging, they add, as several girls missed their vaccination day and had to be offered alternative appointments. None of the girls experienced serious side-effects.
The study is published online by the British Medical Journal. It concludes: "Delivery of the first two doses of HPV vaccine to adolescent schoolgirls is encouraging, but the success of the vaccination programme depends on high coverage for the third dose."
The national vaccination programme will be rolled out to all girls in year 8 from September 2008. It is likely to cost 100m UK pounds. The vaccine that will be used prevents two types of HPV, both sexually transmitted. These are linked to approximately 70 per cent of cases of cervical cancer.
Professor Jane Wardle of University College London, UK, points out in an editorial that: "It is essential to engage with groups and communities who have concerns about the vaccine and take steps to ensure that existing disparities are not widened by inequitable uptake."
Brabin, L. et al. Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study. The British Medical Journal, published online April 25, 2008.
Waller, J. and Wardle, J. HPV vaccination in the UK. The British Medical Journal, published online April 25, 2008.
Millions lose out on diabetes care improvements
Thursday April 24th, 2008
Nearly two million people with diabetes remain at risk because of "patchy" implementation of policies designed to improve care, campaigners warned yesterday.
A ten year strategy was launched in 2003 in the shape of the National Service Framework for diabetes.
Five years on, some places are putting it into practice but many are not, according to a Diabetes UK report.
Diabetes UK chief executive Douglas Smallwood called on the government to conduct its own review of progress and to make primary care trusts accountable for ensuring the NSF targets were achieved.
He said: "We are very worried about the slow progress the NHS is making towards delivering all the NSF standards by 2013.
"It is not good enough that almost two million people with diabetes are facing an unnecessarily increased risk of life-threatening complications because of the Government's failure to address the quality of diabetes services across the country.
"Action is needed today to safeguard the health and quality of life of everyone with diabetes in the future."
MS people urged to "fight back"
Tuesday April 22nd, 2008
People with multiple sclerosis have been urged to "fight back" against the disease this week.
The week has been declared MS Week 2008 and four sufferers are speaking out, explaining how they have demanded the best care for themselves.
The four stories are to be shared nationwide to encourage others to seek good care and overcome the disability caused by the disease.
Simon Gillespie, chief executive of the MS Society, said: "This MS Week, we want people to pick up the phone, get online, speak to their local MS Society branch, and find out what they can do to actively manage their condition.
"MS has many invisible symptoms, but people with MS shouldn't make themselves invisible to the health and social care system. It's your right to expect the best possible care and support and the Society is here to help."
He added: "If you get the right help and support in living with MS, you can make the most of the opportunities available to you. But we know that many people with MS feel like there is nothing they can do to tackle it."
One of the participants in the campaign, Harriet, from London, gained ideas and support through using MS Society on-line forums.
She said: "I have found great support in using the MS Society's online forums and through the campaign I wanted to show that being diagnosed with MS is not the end of the world, there is life after MS - since being diagnosed I've done so much to be proud of."
Arthritis research boosted by charity
Thursday April 18th, 2008
Thousands of people in the UK who suffer from painful joint and muscle problems will be glad to hear of a major new research centre.
The Arthritis Research Campaign National Primary Care Centre will be based at Keele University, with the aim of "promoting primary care research".
"Primary care - where most people with painful joints and muscles are treated - has often been the poor partner in the NHS, lacking the size and focus of the hospital," said Professor Croft, director of the new centre.
"Until recently, research in primary care has been very much a second class citizen receiving only a fraction of the funding that hospitals can attract. Our new centre will give a strong message that primary care is important."
The centre is to receive 2.5m UK pounds funding over the next five years from the leading arthritis charity the Arthritis Research Campaign.
Medical director of the charity, Professor Alan Silman, said: "At a time when the government policy is to shift care of patients with arthritis and joint and back problems from hospitals into primary care, it is vital that we look at the best ways of delivering this care to patients."
Arthritis and related musculoskeletal conditions cause about one in five UK adults to visit their GP every year, with a predicted rise due to the aging population and growing obesity.
"The most important consequence of our obesity epidemic and poor levels of physical activity will be osteoarthritis of the knee, and finding ways for primary care to help patients prevent their symptoms, and offer early effective treatment for this common condition is essential," Professor Silman explained.
Should the law prevent online suicide advice?
Wednesday April 16th, 2008
Websites and chat rooms which give advice on how to commit suicide have prompted widespread concern.
However, banning such websites is fraught with difficulty, Nursing Standard reports today.
At least 29 suicides have involved the use of the internet, according to the charity Papyrus (Prevention of Young Suicides). They say there is overwhelming support for change in suicide law to make it illegal for internet sites to publish material that has the sole purpose of encouraging and aiding suicide.
They point to a YouGov survey which found that 81 per cent of those surveyed agreed that UK law should be amended. But there has never been a successful UK prosecution for promoting suicide online.
Paul Kelly of Papyrus, whose teenage son Simon visited an online suicide chat room before committing suicide in 2001, said: "We have already delivered two petitions seeking a review of the Suicide Act (1961). The National Suicide Prevention Strategy has a target to reduce suicide by 20 per cent by 2010. Changing this law could make a significant difference to whether or not this target is met."
Nursing Standard points out that proving a causal link between the use of such websites and actual incidents of death by suicide is tricky.
Speaking to the magazine, a spokesperson for the Law Commission explained: "The question is whether the simple provision of a website with details of how to commit suicide, or enabling would-be suicides to meet one another, is in itself an attempt to aid, abet, counsel or procure suicide."
Despite the lack of a legal imperative to block such websites, the department of health and the Samaritans are both currently discussing with the Internet Service Providers Association how to support vulnerable people who visit such sites.
Nurses train in burns care
Monday April 14th, 2008
Nurses who work in burns units have begun Britain's first course devoted entirely to enhancing their skills.
The programme is being run at the University Hospital of South Manchester NHS Trust and involves 15 nurses and practitioners.
Over the course of two fifteen week modules, students will study burns injury management from admission to discharge and then in a second part of the course they will study critical care and rehabilitation.
The programme is being led by Jacky Edwards, a clinical nurse specialist at Wythenshawe Hospital, Manchester.
She said: "Previous programmes have combined burns and plastic surgery, which doesn't work well for nurses who don't have exposure to plastic surgery.
"75 per cent of senior/specialist nurses and above must have formal training in burn care. As this is the only accredited course of its kind for nurses and other professions allied to medicine in this specialism, it will help hospitals meet that target. Unlike other courses it is also open to psychologists and dieticians while the core module has potential for paramedics and other emergency care practitioners."
Rachel Robertson, a senior sister from Wythenshawe, said staff usually had to learn "on the job".
She said: "I've got 12 years experience in burn care and have had lots of informal and competency-based training but I wanted to learn more about the theoretical side of burn management, and, as a clinical manager, how to support other nurses in their development.
"Such a programme has been sadly missing in burn care for a long time while it's also a great opportunity to build stronger ties with professionals from a wide range of healthcare disciplines."
Mothers' health habits worsen in the UK
Friday April 11th, 2008
Women who move to live in Britain become more likely to smoke and stop breastfeeding early, according to new research.
These "maternal health behaviours" worsen with length of residency in the UK, found Professor Catherine Law and colleagues at the UCL Institute of Child Health, UK.
The team set out to compare smoking and alcohol intake among 6,478 British/Irish white mothers and 2,110 mothers from ethnic minority groups.
Mothers from ethnic minority groups were less likely to smoke (15 per cent v. 37 per cent) or drink (14 per cent v. 37 per cent) during pregnancy. They were more likely to breastfeed (86 per cent v. 69 per cent) and to breastfeed for at least four months (40 per cent v. 27 per cent ).
But first and second generation mothers were around four times more likely than immigrant mothers to smoke during pregnancy. They were about ten per cent less likely to breastfeed, and thirty to forty per cent less likely to breastfeed for at least four months.
Alcohol consumption was similar among the groups. The study is published online by the British Medical Journal today (April 11). The authors calculate that among immigrants, for every additional five years spent in the UK, the likelihood of mothers smoking during pregnancy increased by 31 per cent.
The researchers conclude: "After immigration, maternal health behaviours worsen with length of residency in the UK. Health professionals should not underestimate women's likelihood of engaging in risky health behaviours because of their ethnicity.
"National policies should ensure that all mothers can achieve recommendations to foster their own and their children's health."
Hawkins, S. S. et al. Influence of moving to the UK on maternal health behaviours: prospective cohort study. The British Medical Journal, published online April 11, 2008.
NHS workers cynical about management
Thursday April 10th, 2008
Many NHS staff are cynical about their senior management - believing that patients are not the top priority, according to a major survey.
The annual Healthcare Commission found cynicism rife in many NHS Trusts - with 65 per cent in some establishments accusing managers of failing to give patients priority.
The commission said trusts who scored "poorly" on this measure must address it.
But overall it found just 46 per cent of staff agreed the care of patients was the top priority for their NHS Trust.
Some 156,000 employees in England's 391 trusts filled in surveys - more than half of the total.
The commission said most staff seemed satisfied with their jobs - and 94 per cent took part in some form of training last year. But just 26 per cent believed their employers valued their work.
Some 82 per cent said their trust promoted hand-washing to staff - compared with 70 per cent in 2005.
Commission chief executive Anna Walker said: "The results show that there are a lot of reasons to work in the NHS, including the satisfaction staff get from their jobs, the ability to work hours that suit, through to real training opportunities.
"But there are challenges to making the NHS a better place to work. Some of those will be tough to crack because they are about the environment that the healthcare system operates in.
"We know that health workers are more likely to experience violence, harassment and abuse than workers from other sectors and the NHS has made a concerted effort to address this problem.
"Trusts must continue to step up to this challenge because it is unacceptable for NHS staff, who provide vital, often life-saving care, to be put in the position where they face violence and abuse as they go about their day-to-day work."
She added: "There are other issues that are not about the environment. Staff in the NHS provide vital, often life-saving care. Yet they do not feel their work is valued by their trust and that communication with senior management is poor. These are things that trusts can and must change."
New alert on sunbeds
Wednesday April 9th, 2008
Campaigners have released a new warning over the dangers of sunbeds - amid new evidence that users start young.
Cancer Research UK says that eight out of ten sunbed users have a significantly raised risk of the life-threatening skin cancer, malignant melanoma.
It found that most sunbed users take up the habit before the age of 35 - significantly increasing their risk of cancer.
The charity also highlights a review of 19 studies showing that sunbeds are associated with a 15 per cent rise in melanoma risk. Those who first use a sunbed before 35 may have a 75 per cent higher risk.
This review, by the International Agency for Research into Cancer, warns that sunbed use does not protect against later sun exposure. "Young adults should be discouraged from using indoor tanning equipment and restricted access to sunbeds by minors should be strongly considered," it concludes.
Cancer Research UK's new SunSmart campaign includes the advice that sunbeds can produce UV rays ten to 15 times as intense as that from the midday sun.
Rebecca Russell, campaign manager, said: "The results of our survey make for a stark warning to young people about the dangers of indoor tanning.
"You can't always see the damage that UV does straight away. It builds up over time. But every time you use a sunbed you are harming your skin and increasing your risk of skin cancer. Our key message is to alert young people about the damage sunbeds can do to their skin, especially if they have fair skin that doesn't tan easily."
Ms Russell added that the charity is working with the government on possible regulation of the sunbed industry.
For its survey some 4,000 people were surveyed and 82 per cent said they took up using sunbeds before the age of 35.
The government's national cancer director, Professor Mike Richards, agrees that the statistics are worrying. "It is a matter of particular concern that even children may be getting access to sunbeds," he stated.
The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. International Journal of Cancer, Vol. 120, March 1, 2007, pp. 1116-22.
Anger at pay offer
Tuesday April 8th, 2008
Doctors are likely to be "angry and disappointed" by their pay offer this year, the British Medical Association warned yesterday.
Hospital doctors are being offered 2.2 per cent - compared with 2.75 per cent for the rest of the NHS.
In addition junior doctors will lose their entitlement to free accommodation - without compensation, a sum worth up to £5,000 a year for many new doctors.
The BMA said GP resources would increase on average by just 0.2 per cent overall but many GPs would receive nothing. GPs are to get 2.7 per cent on the "global sum" they receive but there will be no increase on the Quality Outcomes Framework or for enhanced services.
The figures have all been recommended by the Doctors and Dentists' Pay Review Body.
BMA chairman Dr Hamish Meldrum said: "This is a complex report which we need to study in depth before commenting in detail, but it is clear that the treatment of junior doctors is completely unacceptable. This will further outrage a group that has already suffered enough.
"The loss of free hospital accommodation means doctors graduating from medical school with massive debts will effectively be losing £400 a month - a 20 per cent pay cut.
"It makes the government's promises to increase the diversity of the medical profession look completely hollow. The BMA will now be considering the next steps to ensure first year junior doctors are not left out of pocket."
Meanwhile nursing unions are at loggerheads over the main NHS proposals which would mean an eight per cent increase over three years. Royal College of Nursing leaders are backing the deal while the Royal College of Midwives opposes it.
The Prime Minister Gordon Brown said: "It shows that we can deal with the challenges ahead and deal with them in a long term way that is to the benefit of the nurses, who deserve proper settlements and proper pay for the work that they do, and in the interests of the whole economy, which needs the stability that such a deal will give."
NHS should fight climate change - report
Thursday April 3rd, 2008
The health service will be in the front-line if climate change starts to make a serious impact on British weather, a report warns today.
Malaria and diseases spread by flooding are among the new problems that might become routine for many doctors, according to the British Medical Association report.
There would also be an increase in problems caused by heat and sun, such as skin cancer, sunstroke and sunburn.
A heatwave in Europe in 2003 cost 70,000 lives, the report says.
The BMA report says the poorest people will be the hardest hit and are most likely to live on the coastal floodplain.
It calls on the NHS to take a lead in reducing the impact of climate change - with a view to helping prevent problems in the future.
BMA head of ethics Dr Vivienne Nathanson said: "Our report provides doctors with practical measures they can take in order to reduce their negative impact on the environment.
"The NHS is the largest single organisation in the UK with an annual purchasing budget of around ?17 billion. It employs over one million people and emits around 1 million tonnes of carbon every year.
"There is huge potential for this employer to promote combating climate change. It is essential that when new hospitals, GP surgeries and other premises are being built that we learn from best practice construction projects.
"Given that it is the health service that often picks up the pieces when severe weather conditions strike, it makes sense for the NHS to invest in preventative healthcare and treatment for the health implications relating to climate change."
New screening plan "flawed"
Wednesday April 2nd, 2008
The government's plan to provide vascular screening for everyone between the ages of 40 and 74 has been criticised by doctors' leaders.
Vascular diseases include coronary heart disease, strokes, chronic kidney disease and diabetes. Together they kill 170,000 people a year and affect about four million. Health minister Alan Johnson believes the case for a national programme of vascular checks is "compelling".
But Dr Laurence Buckman of the British Medical Association fears there will not be sufficient time or resources for such a large project. Speaking yesterday (April 1), he warned that over a third of the population fall into this age range - two thousand patients at the average GP's practice. This screening could mean at least 40 extra appointments a week.
"We have serious concerns about the pressure this will put on an already overstretched general practice," said Dr Buckman. "Whether it is nurses, GPs, healthcare assistants or pharmacists who do these checks, there is not currently the workforce, the time in the day, or even the space in our surgeries to carry out this number of consultations. At the moment all our appointments are booked up with patients who are in immediate need of medical care."
Dr Buckman is concerned that the extra screening appointment could delay or prevent appointments for the truly sick. He also raises questions over the scientific evidence behind such screening.
"Those patients who are at risk regularly have their vascular risk factors checked including their cholesterol," he said, concluding: "To justify healthcare spending on this scale there would need to be very clear evidence that this is both cost and clinically effective."
Room for improvement in breast treatment
Tuesday April 1st, 2008
In spite of great advances, breast cancer treatments are "not always" effective, experts have warned.
An analysis by 56 British experts, reported in the journal Breast Cancer Research, suggests areas where research need to be concentrated.
The Breast Cancer Campaign said it now had five priorities, including the development of new ways to predict and prevent the disease.
It calls for ways to predict advanced and secondary disease - and also identify who is at risk of recurrence.
It also calls for new techniques to determine the effectiveness of new treatments at an early stage.
And it calls for greater understanding of the social and psychological impact of breast cancer.
Pamela Goldberg, chief executive of the Breast Cancer Campaign, said: "Breast cancer research has made considerable progress over the past two decades and vital work is still underway. But there are still significant knowledge gaps.
"Greater attention must be paid to all stages of breast cancer. The experiences of older women and those from minority ethnic groups must be considered, particularly in light of recent research showing breast cancer develops earlier in black women and their survival rates are poorer."
She added: "While we are working in an exciting age of discovery, our resources are limited. The Government, funding bodies and scientists should focus on these gaps to drive advances in knowledge into improvements in patient care.
"If we co-ordinate our resources and target the priorities in breast cancer research, we can ensure an environment of scientific excellence and plug these gaps."
Breast Cancer Research 2008, 10:R26
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