Deep clean misses target
Monday March 31st, 2008
Some 22 NHS Trusts have failed to comply with the Prime Minister's order to complete a deep clean by April 1st, it has been announced.
Some 306 have completed the exercise since Mr Brown announced his plans at the Labour Party conference in September.
The department of health said three NHS Trusts are now subject to improvement notices, using new legislation, after spot checks revealed their standards are cleanliness are inadequate.
Health secretary Alan Johnson said: "Although we are nearing the end of this particular programme, it is just the beginning for deep cleaning in general.
"I expect hospitals to continue the good work that they have started and ensure that deep cleaning is an integral part of their routine cleaning plans.
"To ensure that Trusts maintain high levels of cleanliness, new teams of specialist inspectors will soon be monitoring every Trust in England to ensure that they are meeting the standards set in the Hygiene Code."
Warning over cold remedies for small children
Friday March 28th, 2008
Changes have been made to the recommendations on cough and cold medicines for children under two years old.
New advice from the Commission on Human Medicines (CHM) - part of the Medicines and Healthcare products Regulatory Agency - warns that certain medicines should no longer be used.
The CHM reviewed over the counter products for cough and colds in children and are now advising parents to give paracetamol or ibuprofen to lower the child's temperature, with a simple cough syrup (such as glycerol, honey or lemon).
"For young babies who are having difficulty feeding, nasal saline drops are recommended to help thin and clear nasal secretions," they write. "Vapour rubs and inhalant decongestants, which can be applied to a child's clothing, can also be used to provide relief from a stuffy nose."
Professor Rosalind Smyth of the CHM said: "Coughs and colds are generally self-limiting conditions which will get better themselves usually within a few days. Medicines intended to treat the symptoms will not cure the illness or shorten the length of the illness."
The CHM say the pharmaceutical industry has voluntarily agreed to change product labels by October 2008, in line with the advice. A new advice leaflet will be made available for patients and carers.
Affected medicines contain certain antihistamines, expectorants, and decongestants linked with serious safety reports in the US. In many of these cases, children had received overdoses or more than one product with the same active ingredient.
The CHM have asked that, as a precaution, some products directly targeted at children under two should be removed from the shelves. But "it is essential that it is done in a way that ensures that the medicines remain available for use by the rest of the population," they add.
Anger a mental health problem
Thursday March 27th, 2008
A leading mental health charity has warned that "problem anger" is left untackled in the UK.
In a new report, the Mental Health Foundation shows that unchecked anger is linked to family breakdown, and a range of physical and mental health problems.
As part of Mental Health Action Week 2008 (held March 23-29), the charity released a report showing chronic and intense anger is associated with heart disease, cancer, stroke, colds and flu, depression, self-harm and substance misuse.
"Anger is more likely to have a negative effect on relationships than any other emotion," they write. Nevertheless, "problem anger goes largely untackled unless someone commits an aggressive criminal act, when a court may refer them to anger management training."
The Mental Health Foundation believes we are intervening too late and "could save many lives being damaged if we tackle it earlier".
Dr Andrew McCulloch of the charity said: "In a society where people can get help for depression and anxiety, panic, phobia, eating disorders and a range of other psychological and emotional problems, it seems extraordinary that we are left to fend for ourselves when it comes to an emotion as powerful as anger. We need to be able to recognise when anger is damaging our lives, ask for help and receive it.
"It is the elephant in the room in mental health."
The report says suggests many of the everyday tools used in mental health can be used to help people cope better with anger, but the area has been neglected. It calls for more research and education, and improved support services.
Olive branch to embryo rebels
Wednesday March 26th, 2008
The Prime Minister offered an olive branch to his Catholic ministers yesterday - by promising them a free vote on the most controversial clauses of the embryology bill.
Mr Brown said the free vote would apply to all Labour MPs - but they would be expected to vote for the whole bill, whether it was successfully amended or not.
The free vote will apply to three clauses:
- the creation of hybrid embryos for stem cell research;
- legalising the decision to create a child, which could donate tissue to a sick sibling;
- removing the "need for a father" from the definition of the welfare of a child born through fertilisation techniques.
Mr Brown spoke directly to the media at the launch of his party's local election campaign.
He said: "I do believe that in stem cell research we have the power in the future to treat and to cure some of the diseases that have afflicted mankind for centuries."
He has written to MPs stating: "But the bill itself cannot be subject to a free vote because there are so many other changes that I believe are necessary as part of building up the research framework of our country and, of course, creating the right ethical framework for the development of embryo research."
Heart patients get advice on safe dentistry
Tuesday March 25th, 2008
Patients who are at risk of developing heart infections should no longer be given antibiotics before a range of common medical or dental procedures, according to new guidance.
The National Institute for Health and Clinical Excellence says there is no evidence that dental treatment and some other procedures may lead to infection.
It says antibiotics should no longer be given to prevent infective endocarditis for dental procedures, obstetric and gynaecological procedures, procedures on the gullet stomach or intestines and other procedures on the airways.
In the past antibiotics have been given to people with valve replacements, congenital heart disease and several other heart conditions.
The advice says those at risk should be given "clear and consistent" advice on preventing infection, including the need for good dental health.
Anne Keatley-Clarke, chief executive of the Children’s Heart Federation, said patients had received "contradictory" advice in recent years.
She said: “We therefore welcome this clear guideline and hope that cardiologists, dentists and other medical professionals will agree to follow it.
"The guideline will mean a big change for the many heart children who previously received antibiotics before all dental procedures so professionals must be prepared to give these patients and their parents a clear explanation for the changes."
NICE deputy chief executive Dr Gillian Leng said: "Although the anticipated cost savings are quite modest – around £1million across the NHS in England and Wales - the implementation of this guideline will have other far-reaching benefits, notably an increased patient awareness of the risk of IE and a decrease in the number of adverse reactions to antibiotics, such as anaphylaxis.
"The implementation of this guidance should reduce the level of antibiotic resistance in the general population, the cost and wider benefits of which we haven’t calculated but are likely to be substantial."
Concern for 'overstretched' maternity services
Friday March 21st, 2008
A new report is raising fears that maternity units regularly turn women away because they are full.
Some 42 per cent of NHS trusts had shut their doors or diverted women in labour to other sites in 2007, according to figures obtained by the Conservatives.
Of the 103 trusts that responded to the survey, ten per cent said they had turned women away on more than ten occasions. University Hospitals of Leicester NHS Trust said they had to do so 28 times over the year.
Shadow health secretary Andrew Lansley said: "The government's plans to close maternity units when services are already overstretched fly in the face of common sense. Labour are fixated with cutting smaller, local maternity services and concentrating them in big units. But women don't want to have to travel miles to give birth."
The Royal College of Obstetricians and Gynaecologists (RCOG) responded to the survey by pointing out that maternity units across the country are facing increasing pressure. They are calling for more money for maternity services, to fund both staff and facilities. They also want more consultant obstetricians on labour wards.
Honorary secretary of RCOG, Richard Warren, said: "It is imperative to ensure that maternity units are appropriately staffed and resourced to meet the demands that the service requires.
"Safety and quality of care are paramount and although the UK is a safe place to give birth, growing pressures require long-term investment. Our current calculation is that 400 extra consultants are immediately required across England and Wales."
The Royal College of Midwives said the findings showed the dangers of centralising maternity services.
Deputy general secretary Louise Silverton said: "There is a place and an argument for the centralisation of specialist and emergency maternity services for the women who need them. However, the vast majority of women do not need medical intervention, and midwife led services in smaller units or at home may be the best option for them.
"Women should have a choice of how and where they give birth. This is guaranteed in the Government's plans for maternity services and we want to make sure that this choice is expanded not reduced. If a unit closed because of staff shortages, then their choice is eroded and their experience of birth suffers.
Containing latex allergy in hospitals
Thursday March 20th, 2008
Hospitals should switch to non-allergenic latex gloves to prevent allergies and asthma caused by rubber, according to new guidelines.
The low-protein gloves should be used instead of the conventional method of using powdered gloves, according to the Royal College of Physicians.
Some employees know they have latex problems - and they should use non-latex gloves, the guidelines say.
As many as one in six people suffer from latex-related problems, which range from hay fever type symptoms to chest tightness and anaphylactic shock.
The college says national guidelines will be needed as many clinicians prefer latex gloves and will not change on a voluntary basis.
It says all but the most severe cases of latex allergy should be managed without redeployment or retirement through ill health.
Dr Simon Sheard, of the Faculty of Occupational Medicine, said: "The protection of workers from workplace hazards is one of our main tenets and so we hope this guidance will be widely read and used in the workplace".
Dr Syed Ahmed, a specialist registrar in occupational medicine at East Kent Hospitals Trust, who led the team drawing up the guidelines, said: "The optimal management of latex allergy in the workplace has been unclear for a long time.
"We're delighted that our work has looked comprehensively at all the research and has established evidence based guidelines to address this important issue."
Focus on home-grown food helps mental health patients
Wednesday March 19th, 2008
Innovative outdoors projects are helping people with mental health problems improve their lifestyle by connecting with nature, reports Nursing Standard.
The projects, run by the mental health charity Rethink, provide allotments for people to grow fruit, vegetables and berries, and boost their diet with the rewards.
Rethink aim to help people capture the traditional therapeutic value of gardening in their National Lottery-funded projects across Wiltshire, Somerset and Dorset. All the allotment keepers are people with illnesses ranging from mild depression to schizophrenia.
Working the land builds self-esteem, says the charity, and helps to improve diet. Individual support is given to patients to develop their gardening skills.
Area services manager for Wiltshire, Kris Scotting, said: "We want to move away from the junk food culture. The allotment keepers get gentle exercise, are in the great outdoors getting sunshine and can eat fresh seasonal food."
Although there are currently no plans to extend the scheme, Mr Scotting intends to set up a support network and develop an advice pack for people with mental health problems who want to take on an allotment.
He said: "There is research saying that being outside in the light improves your mood. Being in the sunshine has to be better than staying in a bedsit. We have found this scheme gives people a greater appreciation of food - they begin to look at recipes and value food more."
Chief executive of the Mental Health Foundation, Andrew McCulloch, agrees that diet is crucial for mental health patients.
"We know dietary interventions may hold the key to a number of mental health challenges, yet we rarely invest in developing this knowledge," he said. "A relatively tiny, but growing, number of professionals are, however, putting it to effective use."
Fit notes will tackle incapacity costs
Tuesday March 18th, 2008
"Incapacity" is costing Britain some £100 billion a year in benefits and lost effort, a senior doctor revealed yesterday.
Dame Carol Black, former president of the Royal College of Physicians, has been given the job by the government of changing the nation's "sick note" culture.
Her report, published yesterday, warns that most people who unable to work through sickness are suffering "immeasurable" cost.
Dame Carol said: "For most people their work is a key factor in their self-worth, family esteem and identity.
"‘So if they become sick and are not helped quickly enough, they can all too easily find themselves on a downward spiral into long-term sickness and a life on benefits. This is not only devastating for them, but also for their families. Their children suffer financially, emotionally and it can affect their long-term futures."
Her report calls for the sick note process to look at what people can do - rather than what they cannot do, creating "fit notes" rather than "sick notes".
She calls for a "fit to work" service to be offered to ill people at an early state and for occupational health to be regarded as part of mainstream health provision.
The report was welcomed by the British Medical Association but chairman Dr Hamish Meldum warned that GPs could not be used as a "policing arm" of the Department for Work and Pensions.
He said: "GPs are often placed in a difficult position when issuing sick notes to patients in the early stages of their illness and it is not always possible for them to confirm whether a patient is well enough to do their job. This is often determined by the nature of their job and working environment.
"A major, additional problem, is that GPs can have huge difficulties in accessing physiotherapy and counselling services that would help patients to return to work more quickly."
Doctor numbers up
Monday March 17th, 2008
The NHS has more front-line staff and fewer managers than before, ministers have claimed.
New figures show a small reduction of less than one per cent in the overall NHS workforce following two years of budget pressure on many trusts.
Numbers of managers and support staff have reduced by about 11,000 - and some 250 of these were management jobs.
But the government said numbers of doctors and nurses have increased.
In the last year the NHS has employed some 624 more midwives, 1,262 more nurses and more than 2,000 more doctors, according to the workforce census.
Ministers said there had been an overall massive expansion of staff numbers in the last decade - with some 272,000 more people being employed in the service than in 1997.
Health minister Ann Keen said: "Following a period of unprecedented growth in the NHS workforce, our focus has now shifted from increasing capacity to improving quality. What matters to patients is that the right staff are in place to deliver personalised services to the highest standard.
"Of course, where more staff are needed we will recruit them. Just last month we committed to recruiting 4,000 extra midwives by 2012 to keep pace with a rising birth rate and ensure the best possible care for mothers and their babies."
But Louise Silverton,of the Royal College of Midwives, said: "The slight increase in the number of midwives is welcome, but it trails in the wake of the rapidly rising birthrate which is swamping midwives and affecting the quality of care they can give. Our latest figures also show that almost half of all midwives are set to retire over the next decade."
Pratchett speech boosts campaigners
Friday March 14th, 2008
A team of researchers has spoken of the impact of writer Terry Pratchett's dramatic revelation of his diagnosis with Alzheimer's disease.
The Discworld writer's announcement of a £500,000 donation for research was expected to lead to a flood of further donations.
Researchers in Bradford, Yorkshire, spoke of the work they are doing to help affected people hold on to the memories of their lives.
Some £1.2 million is being spent on the work, which also involves specialists in Bangor, Manchester, Hull and London.
Some 600 families are involved, using photographs, recordings, music, objects and activities to "trigger and celebrate" memories.
Professor Murna Downs, head of the Bradford Dementia Group, said: "This is very welcome news. Evaluating approaches that help people live with dementia and maintain well-being is central to the work we do here.
"We applaud Mr Pratchett for his generosity and bravery for speaking out about his condition."
Rebecca Wood, chief executive of the Alzheimer's Research Trust, added: "Whilst we were deeply saddened to learn of Mr Pratchett's diagnosis, we are delighted that he has chosen to speak out about his experiences with Alzheimer's disease, to raise awareness about its impact and the desperate need for more research."
Neil Hunt, chief executive of the Alzheimer's Society, said 700,000 in Britain had Alzheimer's.
He said: "I admire Terry's determination to fight dementia; his honesty, candour and courage will do so much to tackle the misunderstanding and stigma that keeps dementia in the shadows.
"As Terry's experience demonstrates dementia isn't only about memory loss; it has a devastating impact on the person's life and the lives of those around them."
Screening places pressure on surgery
Wednesday March 12th, 2008
Breast cancer surgery is not keeping up with growing rates of diagnosis and improved screening services, according to a new audit of services.
Just ten per cent of women are offered reconstruction surgery at the same time as they undergo mastectomy, according to an audit published by the Royal College of Surgeons.
In 2002 the NHS was advised to offer the service to all women by the National Institute for Clinical Excellence.
The number of operations for breast cancer increased by more than a third between 1997 and 2006, rising from more than 24,000 to more than 33,000.
John Browne, of the Royal College of Surgeons Clinical Effectiveness Unit said: "This audit of breast cancer surgery shows that a good service is available in England, despite the health services being under pressure.
"However, over the last ten years we have seen little improvement in access to immediate reconstruction after mastectomy.
"Current funding arrangements in the NHS, cancer waiting list targets and problems with the information and support provided to patients while making their decision about breast reconstruction may have contributed to this lack of progress."
The study was commissioned from the college and the NHS Information Centre by the Healthcare Commission.
The commission revealed it was having trouble getting hospitals to agree to carry on with the audit.
Plastic surgeon Chris Caddy said: "This audit is the first step in giving us a comprehensive picture of the services available to women who are suffering from breast cancer.
"For many patients, reconstruction is felt to be the final step in their recovery. Currently, most women have reconstructive surgery some time after their mastectomy. Whilst immediate breast reconstruction has a longer anaesthetic and recovery time, it tends to achieve better cosmetic results, smaller breast scars and only one hospital stay."
Jonathan Boyce, of the commission, said: "These preliminary results show that not enough women have access to immediate reconstruction, and this needs to be addressed.
"We also know that not enough trusts have signed up to the next stage of the audit. The audit can help deliver better care for cancer patients and we encourage trusts to take part as a matter of urgency."
Safety campaign plan
Tuesday March 11th, 2008
Plans for a major campaign to boost "patient safety" in the NHS have been announced.
The campaign is set to be launched in July - after NHS staff have been invited to a series of workshops.
It is to be led by Stephen Ramsden, chief executive of the Luton and Dunstable NHS Foundation Trust.
His hospital has for the last four years led an initiative called the Safer Patients Initiative.
The campaign is being backed by the National Patient Safety Agency and the NHS Institute for Innovation and Improvement.
Mr Ramsden said: "Since 2004, when Luton and Dunstable was chosen as the lead site for England to undertake the Safer Patients Initiative, our staff have achieved tremendous improvements for patients.
"I am excited by the prospect that all NHS organisations will want to get involved in keeping patients safe."
Chief medical officer Professor Sir Liam Donaldson said: "The NHS campaign will be a key component of a national patient safety strategy to prioritise patient safety and embed it into the fabric of everyday practice.
"It is a unique and timely opportunity to intensify efforts to implement interventions that continuously reduce risks to patients."
Hospital staff are to be invited to a series of workshops around England in April to find out more about the campaign.
Smoking bans not working in hospitals
Thursday March 6th, 2008
Efforts to stamp out smoking in British hospitals have not been very successful, according to a new study.
Researchers found patients and visitors smoking at almost every hospital they visited when they set out to find out how effective smoke-free policies are.
And on more than a third of sites, staff were also spotted enjoying a smoke.
The study, conducted at Nottingham University, found that policies at many hospitals allowed for exemptions for bereaved relatives or some psychiatric patients. But most managers also reported that their smoke-free policies were routinely ignored.
Researchers said hospitals need to do more to "support" staff to give up smoking and to deal with patients and visitors who want to smoke.
Researcher Elena Ratschen said: "Whilst I was encouraged that Trusts have made an effort to introduce comprehensive smoke-free policies, I was surprised about the lack of enforcement when I made the site visits. Smoking still appears to be the rule rather than the exception.
"Nevertheless the people I interviewed were very positive about the benefits of smoke free policies, and I believe with more support, a smoke-free NHS is achievable."
Professor Ann McNeill, the university's professor of health policy, said: "The NHS has a responsibility to promote health and achieving smoke-free premises is the best way to do this.
"Stopping smoking is probably the single most important thing a smoker can do to improve their health and every effort must be made to support smokers in being smoke free whilst on NHS premises."
Plans to tighten up on herbal remedies
Wednesday March 5th, 2008
British regulators yesterday warned of a crackdown on dangerous herbal remedies.
Several remedies have recently been withdrawn from sale by the Medicines and Healthcare Products Regulatory Agency.
The agency reports that over the past few months it has seen "continuing evidence of bad and dangerous practices across parts of the unlicensed herbal sector". Remedies have been found to trigger dangerous side-effects, or have the potential to cause harm.
For example, the agency heard about suspected adverse drug reactions to an illegal unlicensed product for diabetes. Called DBCare, the product claimed to naturally lower blood sugar levels. It was removed from the UK market after suppliers gave "extremely dangerous advice to patients" to stop taking their prescribed medication.
In other cases, new labels were illegally placed on Traditional Chinese Medicine (TCM) products covering up the original list of ingredients. The adulteration of products with potent pharmaceuticals and toxic ingredients has also been investigated by the MHRA.
"This is a serious problem that is indicative of low grade manufacturing standards and in some cases a deliberate intention to deceive the public," says the agency.
But they add that there is good news for consumers of herbal products. "The MHRA is looking to reduce these risks through the new traditional herbal registration scheme (THR), for manufactured over-the-counter traditional herbal medicines."
The scheme will require products to meet assured standards of safety, quality and patient information. So far, 11 applications to register herbal products have been accepted by the MHRA.
"We are expecting the number of applications received and registrations granted to increase steadily over the coming months as we move towards 2011 when transitional protection for certain existing unlicensed herbal medicines expires," they state.
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