Revealed: 100,000 wait more than two weeks to see cancer specialist

More than 100,000 patients a year are “having their worst fears dragged out” by having to wait longer than the stated maximum of two weeks to see a cancer specialist to find out if they have the disease, new NHS figures obtained by the Guardian reveal.

A total of 102,697 people in England did not get to see a consultant within 14 days of being urgently referred by their GP last year – a key patient right in the NHS constitution. Some 25,153 people had to wait more than the official target of 62 days to start their treatment.

Macmillan Cancer Support said growing delays to see a specialist, have a diagnostic test and start treatment meant that “thousands of people are being left in an appalling state of limbo”. The Royal College of Radiologists said it feared that long waits beyond the supposed maximums may also reduce patients’ chances of survival and risk some cancers becoming untreatable.

The findings are contained in an analysis of cancer waiting times performance in 2016 undertaken by the House of Commons Library at the request of the shadow health secretary, John Ashworth. “These statistics should be a badge of shame for Theresa May. It’s a national disgrace that this Tory government’s sustained failure to properly fund cancer services has left thousands of patients waiting longer than expected for treatment they urgently need,” he said.

Dr Nicola Strickland, the president of the Royal College of Radiologists, said: “Any delay in diagnosis or time to start therapy risks a growth in the cancer, potentially making it incurable. These delays increase the anxiety experienced by patients and their relatives at this difficult time.”

Diagnostic services’ difficulty in meeting demand means that 230,000 patients a year are also waiting more than a month for the results of X-rays and CT and MRI scans, she said. NHS cancer services are hobbled by chronic shortages of radiologists and clinical oncologists, she said.

The Commons research also breaks down the month-by-month performance by about 150 NHS hospital trusts and several private sector organisations which provide NHS-funded cancer services against the three main cancer targets. They specify that 93% of patients must see a specialist within 14 days of being referred for suspected cancer, 96% should have their first treatment inside 31 days and that 85% of those feared to have a new primary cancer should start treatment within 62 days.

“These targets exist for a reason. If cancers are caught early, survival rates improve. Behind every single one of these figures is a family having their worst fears dragged out for even longer,” said Dr Ann McMahon, the professional adviser to the Royal College of Nursing and Breast Care Nursing Forum.

The analysis shows that 25 out of 157 providers, almost one in six, failed to ensure that the required 93% of patients urgently referred by their GP last year saw a specialist within 14 days. The troubled Worcestershire Royal Acute Hospitals NHS trust recorded both the worst monthly performance – seeing just 39.4% of patients – and also the worst overall performance across the year against that standard, with only 74% of patients seen on time.

It provided 13,100 people with an appointment with a specialist within 14 days, but it failed to do so with 4,605 other patients, by far the largest number of any hospital trust or private firm. The Shrewsbury trust has been involved in controversy recently after two patients died in early January during the NHS’s worst winter crisis in years, reportedly after long waits on trolleys to get a bed. The Care Quality Commission said that month that safety standards were inadequate.

FEighty-six of of all 155 providers, or 55%, breached the 62-day target.

“A cancer diagnosis is a devastating, life-changing moment in many people’s lives. Every cancer patient should be given the comfort of knowing they were diagnosed and treated as quickly as possible, but as these data show, thousands of people are being left in an appalling state of limbo each year,” said Moira Fraser, Macmillan’s director of policy, public affairs and campaigns.

“Extended waits to start treatment can have a serious impact on someone’s mental wellbeing and we are concerned may ultimately harm someone’s long-term health outcomes.

“Unless you have been through it, it is impossible to imagine the stress and uncertainty of waiting for treatment, treatment you know could be the only chance for you or a loved one. We are seeing more and more referrals, which is to be welcomed, but investment in cancer services has not been keeping pace,” McMahon said.

A spokesman for the Department of Health said: “Cancer survival rates are actually now at a record high, and the NHS treated over 110,000 patients – 82% – within the target of 62 days last year, as the NHS rises to the challenge of an increase in urgent referrals for suspected cancer of over 90% compared to 2009/10.

“To build on this progress we have announced up to £300m a year to meet our new target for patients to be given a definitive diagnosis, or the all-clear, within 28 days of a GP referral‎.”

Revealed: 100,000 wait more than two weeks to see cancer specialist

NHS to create specialist centres for childbirth mental health problems

The NHS is set to overhaul services for women who develop mental health problems around childbirth in a bid to ease the suffering caused by postnatal depression and reduce the number of new mothers who kill themselves or their baby.

NHS England is putting £40m into new specialist treatment centres for the one in five women whose pregnancy, birth or experience afterwards triggers serious psychological problems, including anxiety, depression and psychosis.

Claire Murdoch, its national mental health director, said these centres would end a “postcode lottery” in which two in three women currently affected missed out on vital help. While 14,000 new mothers each year received specialised support, the planned expansion of care would enable another 30,000 to do so by March 2021, said Murdoch, a former mental health nurse who also runs the Central and North West London NHS foundation trust in London.

“It’s self-evidently true that the current provision of these services is inadequate. There is a big postcode lottery. Some areas just do not have specialist community perinatal services available,” she added.

The money will be put into new community mental health units solely for women with perinatal mental health problems in 20 parts of England. They will be staffed by consultant psychiatrists specialising in such conditions, nurses with experience in the field, occupational therapists, psychologists and nursery nurses. Each will also run a buddying service in which women who have already experienced childbirth-related mental health problems will support those going through that or at risk of that.

Childbirth-related mental health conditions are estimated to cost the UK £8.1bn a year, or about £10,000 per birth.

Prof Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, said: “Around one in five women develop a mental illness during pregnancy or in the first year after delivering their baby, and one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems.

“Despite these alarming figures, in almost half of the UK, pregnant women and new mothers have no access to specialist maternal mental health services and only 3% of [NHS] clinical commissioning groups [in England] have a maternal mental health service strategy,” she added.

The Royal College of Midwives backed the move but said that every maternity unit needed to have a specialist maternal mental health midwife on staff to help women in sometimes desperate need.

“We cannot continue to read the constant reports of the number of women killing themselves because they were not identified earlier and treated or because of the lack of trained staff or as a result of lack of services. It’s heartbreaking and we can do better as a country,” said Janet Fyle, the college’s professional policy advisor.

The NCT, the parenting charity, welcomed the NHS’s “positive plan” but warned that even if all 20 units were set up by 2021 as promised, there will still be “a long way to go” before all mothers who need help get it, said Elizabeth Duff, its senior policy adviser.

“There are nearly 300,000 women in the UK who suffer from mental health problems postnatally or when pregnant each year and the funding aims to reach 30,000 women in 20 areas, so there’s still a long way to go,” she added.

NHS England is also pledging to spend another £120m putting psychiatrists and specialist nurses into A&E units so that patients undergoing a mental health crisis when they turn up at an emergency department get better help.

NHS England plans to introduce new waiting-time standards to ensure that any such patient is seen by a mental health specialist within an hour of their arrival in A&E and also given a plan for their care within four hours.

NHS to create specialist centres for childbirth mental health problems

Council cuts push specialist housing for vulnerable people into the cold

Last November, housing staff at one housing association were confronted with a tenant claiming to have a bomb in his bag; in another incident, an officer from another housing provider claimed to have been held hostage by a man who believed there was an alien outside his home.

In both incidents, the tenants involved had mental health issues. Housing providers are concerned that growing numbers of tenants with mental health issues are ending up in general needs housing, where they do not receive the help provided in specialist supported housing. A recent survey by Inside Housing reveals a 14% fall in spending by councils on people with mental health issues in supported housing since 2011–12, based on 250 English councils that responded to Freedom of Information requests,

Between 2011 and 2017 there will have been a drop of nearly £7.3m in spend on people with mental health in supported housing by the 47 councils in England that responded fully to the survey. In 2011–12, those councils’ combined budget, including both commissioned services and those they pay for directly, was £50.9m; this year’s budget is £43.6m.

This squeeze on council spending has put pressure on other housing providers, including housing associations. “We have noticed councils are seeking to reduce the amount of specialist accommodation they procure for adults with mental illness,” says Alex Reeve, regional director of London supported housing at housing association Family Mosaic.

Supported housing has been operating within a constricted funding environment for years. Supporting People funding – a national programme for housing related support made available to councils in England – dropped from £1.8bn when it started in 2003 to £1.6bn in 2014–15. That equates to a 38% fall in real terms.

Ministers have given supported housing a one-year exemption from the 1% rent reduction announced in last year’s summer budget, while in September the government said it would transfer top-up money to councils for the service to counter its planned housing benefit cap.

But supported housing providers say the threat of funding cuts has already affected business. Among the 250 councils that responded at least in part to Inside Housing’s FOI requests, there is a wide range of provision for tenants with mental health conditions: some have specialist units, some do not; a handful have floating support for their general needs stock, most do not; others have budgets for specific conditions – such as hoarding – while others have no housing budget at all allocated to people with mental health needs

Chris Hampson, chief executive of Look Ahead, which provides care, support and housing services across London and the south-east, says councils are cutting back on supporting those with less serious mental health issues to concentrate on those with more acute needs. “A lot of the preventative services have been cut back,” says Hampson, who believes further cuts are to come.

This, he says, is short-sighted: “If you take money out of the lower-end preventative services, in the long run more money is spent because people end up back on the streets or in hospital.”

Richard Colwill, media manager at mental health charity Sane, says the FOI results show the budgetary crisis across the board for mental health provision, which is of deep concern for the charity. “Mental health has always been a ‘Cinderella service’,” he explains, and cuts to services are a false economy: if what initially appears to be a tenancy problem is not addressed early, it can develop into a much more complex issue and they can find themselves supporting a customer experiencing mental health issues. “Care in the community only works if there is provision for people in the community,” he says. “Housing is a really big issue for us. Losing a home or being in fear of losing your home can be a trigger to push someone into crisis.”

While most councils have cut spending on mental health in supported accommodation, the FOI responses reveal some exceptions. In 2016–17 Ealing spent £1.6m on mental health in supported housing, up from £1.2m in 2011–12. “We recognise the benefits of supported living in enabling people to live as independently as possible in the borough while getting appropriate care from professionals,” a spokesperson for Ealing says. “We also find that supporting people to live in the local area near to family and friends can have a positive impact on their well-being.”

In Yorkshire, Wakefield council is another bucking the trend, with its supported housing mental health budget growing 15% in the past five years. It is also developing an innovative strategy to address the issue. Wakefield and District Housing has partnered with NHS Wakefield Clinical Commissioning Group to employ mental health support workers to work with tenants. The council, which still manages the local housing register, can give applicants with mental health needs extra priority. Jon Feasey, a service manager for vulnerable adults at Wakefield Council, says the council sees tackling mental health as an important frontline service. “It has a preventative outcome that can create real efficiencies by preventing homelessness.”

Feasey believes the right place for people with mental health needs is in the community but that people need support in their homes – including those with less acute mental health needs who can slip through the net. As well as preventing homelessness, the support can also help reduce unplanned hospital admissions, he says.

This is an edited extract from an article originally published by Inside Housing (£).

World Mental Health Day on 10 October focuses this year on psychological first aid and providing support to those in distress

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Council cuts push specialist housing for vulnerable people into the cold

Blind guests fear for future of three specialist hotels sold by charity

The futures of the UK’s three remaining specialist hotels for the blind are in doubt, sparking fears that visually impaired people could be left isolated.

Action for Blind People is selling the Cliffden in Teignmouth, Devon; the Lauriston in Weston-super-Mare; and Windermere Manor, in the Lake District, because it can no longer justify the running costs.

The charity is hopeful that the hotels will stay open under new management, but critics of the sale believe that closure is more likely and that blind and partially sighted people will suffer.

David Haynes, 69, from South Milford, Yorkshire, said: “Without this sort of facility, I don’t know what people will do. You can’t imagine what it’s like leaving your house without any sight at all. People go there because all the staff are trained with regard to working with visually impaired people. It’s safe and secure.”

As well as being a regular visitor, Haynes sits on the Action for Blind People customer council. He is angry the council was not consulted over the decision, which was made by senior management and approved by the charity’s trustees, most of whom are blind or partially sighted.

The three hotels have swimming pools, textured surfaces, talking alarm clocks, large button phones, braille menus and facilities for guide dogs. They also provide a pick-up service from nearby stations and run supervised trips.

Action for Blind People said 2,000 visually impaired people used the hotels last year – just under half the total number of guests – although many went more than once. The charity said an increase in sighted guests is one reason it cannot justify the extra expenditure of £950,000 needed to run and maintain the hotels over the next three years.

But Haynes said the hotels provided an invaluable opportunity for the visually impaired to talk to each other and interact with the sighted. “We all learn from each other,” he said.

“It’s an indictment of 21st-century Britain that there’s no provision for the visually impaired to go to a hotel. All hotels have to have access for people in wheelchairs but they don’t all have to have staff trained to work with the visually impaired, to do small things like saying your meat is at eight o’clock [on your plate], your potatoes are at four o’clock.”

Christine Newcombe, vice-chair of Guide Dogs Circle, is another patron angry about the decision. She describes the hotels as a lifeline, particularly for the most vulnerable, who are completely blind, like herself.

“People are going to be isolated,” she said. “There’s been no consultation. No one has actually asked blind people what they actually want. The hotels offer peace of mind, health and safety.

“I just go with a friend and and leave John [her husband] at home. We have both got guide dogs. We just have a nice time. They do trips during the stays, [and] that would be difficult in an ordinary hotel.”

An Action for Blind People spokeswoman said: “We’re doing everything we can to find suitable buyers for the three Vision hotels to make sure they stay open, but we do understand that a lot of people are upset by the news that Action for Blind People will no longer be running the hotels.

“This has been a very difficult decision to make as we know how much Vision hotels mean to customers, staff and volunteers. To have kept the hotels open, we would have had to divert funds from other services and after careful consideration, we decided that this was not the right thing to do.”

She said the hotels were still taking bookings.

Blind guests fear for future of three specialist hotels sold by charity

Sally Phillips’s film on Down’s is ‘unhelpful’ for families, warns antenatal specialist

One of Britain’s leading antenatal experts has strongly criticised a BBC film about children with Down’s syndrome, before its broadcast this week.

The documentary, A World Without Down’s Syndrome?, will be shown on Wednesday and is presented by the actress Sally Phillips, who has a child with Down’s herself. In the programme Phillips, known for her role as Tilly in Miranda, makes the case against the introduction of a new NHS pregnancy screening test that would detect with 99% accuracy the foetal abnormalities indicating Down’s syndrome.

Jane Fisher, director of Antenatal Results and Choices, an organisation set up to support parents affected by foetal screening and its consequences, said she thought the programme – in which she is interviewed – was “not at all helpful” to people facing difficult decisions around a prenatal diagnosis of disability.

“Sally is a very compelling presenter,” Fisher told the Observer, “and – absolutely – it’s great to have the positive images of people [with Down’s] who are already here. But it’s very personal, and it’s an extra layer of difficulty for couples and families who might be making the decision now about whether to end their pregnancy. It risks offering the suggestion to those who have [decided to end a pregnancy] that they have made the wrong decision.

“It’s too problematic to have one individual representing that choice – one who is an advocate for not screening, who has a high-functioning, much-loved child. A woman who admits she has the resources for extra help with her absolutely lovely little boy.” She added: “No one is casting aspersions on Sally’s son. Or trying to invalidate his right to be here.”

People with Down’s have an extra copy of a chromosome and have learning and developmental difficulties ranging from mild to severe. Some are more prone to serious health conditions, especially heart and thyroid problems.

Jane Fisher, director of Antenatal Results and Choices.

Current testing for the condition takes place after 12 weeks, at which point women are told if they are at high or low risk. They can also be invited to have a more accurate – but invasive – amniocentesis test, which carries a one-in-100 risk of miscarriage.

The new test, non-invasive prenatal (NIPT), is a blood test that boasts a detection rate of 99%. Currently 90% of people informed that their child has Down’s choose to terminate the pregnancy. Anti-screening campaigners fear that rate will rise if the more accurate, non-invasive NIPT is made available on the NHS, something ministers are currently considering. When NIPT was introduced in Iceland, the termination rate rose to 100%. The test is already available in private clinics, costing around £400.

About 750 babies are born each year with Down’s syndrome in the UK, and there are an estimated 40,000 people living with the condition.

In a joint statement with the BBC, the programme’s makers, Dragonfly, said the film was intended to “bring difficult questions into the public arena. This film follows Sally Phillips as she explores what effect the test could have on our society, drawing not only from her first-hand experience but also by meeting several families who give an insight into their experiences of having a child with Down’s syndrome, as well as people with Down’s syndrome themselves. She also talks to health professionals and experts with a wide variety of views.”

Phillips, who is a Christian, is pro-choice, but says women are pressurised into having abortions by medics, and that the positives and rewards in parenting a disabled child are ignored. “Nobody knows what Down’s syndrome children can achieve,” she says.

There will always be people who choose not to screen, who choose to have the child. The point is choice

Jane Fisher

Anti-abortion groups are involved in the Don’t Screen Us Out (DSUO) campaign, calling on MPs not to introduce NIPT. Lynn Murray of DSUO has called the test the “new eugenics”.

But, according to Fisher, the programme’s warning of a potential “world without Down’s”, if NIPT screenings are introduced, is an over-simplification.

“Full respect for Sally,” said Fisher. “You can see her empathy and her love for her son, and wish for people to have a more positive attitude towards the condition. But it’s important we don’t get too simplistic about this. There will always be people who choose not to screen, who choose to have the child. The point is choice.

“We want to make sure that women who take the decision to end the pregnancy are not perceived somehow as saying they do not value people who are here – they are saying this is not something they can do, that it is not right for them or for their families.

“Not only does no one know how their child would be affected by Down’s, but the big conflict for women is the adult the child will be 20 or 30 years down the line. For most women, that is the bit that tips them to end the pregnancy. An adult who will be, at best, vulnerable,” she said.

Sally Phillips in a scene from A World Without Down’s Syndrome? Photograph: Brian Ritchie/BBC/Dragonfly

The Down’s Syndrome Association has not taken a position either for or against the proposed new screening regime, focusing instead on its own Tell It Right, Start It Right educational campaign, which calls for better training and information provided for health professionals.

Carol Boys, chief executive of the charity and mother of a young man with Down’s, said: “For a long time, we’d been receiving calls from families who are going through the screening process and want more information. Quite a number complain about the way they have been treated.

“Our organisation wasn’t set up to make judgments, but you cannot make an informed decision if you don’t have all the facts. The problem with testing is that people go along and don’t really know what they are being tested for or the implications of the result.

“They find themselves in a high-risk category and don’t know what it means. The screening committee have asked us to help them with training, and we are happy to do that.

“We are essentially here for people with Down’s and their families. As far as life for people with Down’s goes, things have come a long, long way in the past 30 years. Life is always going to be more challenging. They have a learning disability, and they are always going to need extra help and support – but then so do a lot of other people in our communities.”

A World Without Down’s Syndrome? is on BBC2 at 9pm on Wednesday

Sally Phillips’s film on Down’s is ‘unhelpful’ for families, warns antenatal specialist

Tortured Syrian refugees need specialist help | Letters

A reported 55% of the Syrians who have been given protection in the UK under the Syrian resettlement programme are torture survivors, according to the National Audit Office. The NAO report, a review of the progress of the Syrian Vulnerable Persons Relocation Scheme (VPRS), highlights concerns of human rights charity Freedom from Torture that these vulnerable people are not able to access specialist help so that they can begin a journey of rehabilitation and rebuilding their shattered lives. Freedom from Torture provided input to the report after raising repeatedly with the former minister for Syrian refugees the need to ensure that all of those resettled under this scheme can access specialist support including torture rehabilitation.

Without these services it can be difficult for survivors to address the trauma they have faced and to access other opportunities that are being provided, such as English language lessons. Since the launch of the scheme we have received only a few referrals for resettled Syrians and we are concerned that many more are being resettled in areas where they cannot access support. Our concerns are shared by local authorities, which highlighted that those refugees with physical or mental health needs require substantial support, especially in the long-term, which is not covered by existing funding arrangements.

We welcome the UK’s commitment to provide sanctuary to torture survivors and other vulnerable Syrians through this programme and to meet its arguably modest goal of accepting 20,000 Syrian refugees by 2020. As the only UK-based human rights organisation dedicated to the treatment and rehabilitation of torture survivors, we know that torture is widespread in Syria. This scheme’s objective is to help the most vulnerable, so we are surprised not to have more being referred to our centres. Torture survivors risk being either identified too late or missed entirely. The government needs to immediately improve its coordination with specialist voluntary sector providers. The amount of funding given to local authorities to support each refugee will be reviewed after the programme has been in operation for a year. We strongly recommend that mental health services are included in the programme without delay so that torture survivors coming in the next wave of the refugee resettlement scheme get the vital support and services they need and deserve.
Susan Munroe
Chief executive, Freedom from Torture

• Join the debate – email guardian.letters@theguardian.com

Tortured Syrian refugees need specialist help | Letters

Children can be "damaged" by spending evening with father, kid specialist claims

She also mentioned when attorneys bid for their client to have overnight accessibility with their younger young children they are ignoring proof about the distressing and damaging affect on the youngster.

Leach said the rights of the kid have to usually outweigh those of the mother and father and extra: “It can be damaging to the youngster to divide time equally between the mothers and fathers.”

Ian Maxwell, from Households Want Fathers, informed the Independent on Sunday that society had moved on from traditional attachment concept when bonds amongst mother and little one have been observed as the strongest.

He additional: “The bond between fathers and youngsters is just as essential and we would query the evidence Ms Leach is citing for the primacy of the maternal bond.”

He stated her argument did not accord with typical sense was described her claims as “worrying.”

Leach has previously drawn criticism for her prior bestselling guide, Your Little one &amp Little one: From Birth to Age 5, published. In this she claimed only mothers could care properly for their kids.

She has also attracted controversy after she claimed scientific evidence showed that leaving a child to cry could impact the improvement of its brain and make it prone to anxiousness in later lifestyle.

It comes as a consider tank recommended that working fathers should be offered the opportunity to perform a bigger function in early parenting, by way of an entitlement to four weeks of paid depart following the birth of their child.

The IPPR argues that this doubling of the present paternity leave entitlement of just 2 weeks ought to be mixed with a doubling of the degree of shell out and paid at least the nationwide minimal wage.

They claim that a lot more than 400,000 functioning dads a year would benefit.

Only fifty five per cent of fathers get the complete 2 weeks off operate when their little one is born and a single third of eligible fathers do not get any of their statutory depart at all. Most state this is since they cannot afford to consider the entitlement.

The proposed 4 weeks of paternity depart would be a period of leave specifically for fathers that are not able to be taken by mothers. The IPPR also argues that operating dads need to also be ready to get twice as significantly paid time off to go with their parenters to hospital scans and midwife appointments.

Kayte Lawton, IPPR Senior Study Fellow, said: “New parents need to have time away from work to care for their younger children, and to strengthen their relationship with every single other at what can be a hugely satisfying but also extremely nerve-racking time. Nonetheless, this is usually difficult for fathers because they have restricted entitlements to paid depart, and so they typically assume the function of breadwinner while their companion is on maternity leave.

“Fathers who consider a lot more than a number of days off all around the birth of their child are much more most likely to be actively involved in raising their little one than those who do not. Fathers’ better involvement in family members existence can make it simpler for mothers to return to work after taking maternity depart, which assists to increase the family’s earnings and lessen the affect of motherhood on women’s careers.”

Children can be "damaged" by spending evening with father, kid specialist claims

Proof for NHS statins guidance "wholly inadequate", says specialist

He has now stopped taking them and mentioned: “I am not going back on statins unless I have the evidence”.

Great will publish its final suggestions on statins following month, after a public consultation. Its draft guidance suggests cutting the “risk threshold” for statins in half — meaning that the vast bulk of men aged in excess of 50 and most girls above the age of 60 are most likely to be recommended to consider the medication to guard towards strokes and heart condition.

Experts said the adjustments would indicate that the amount of individuals recommended to get cholesterol-lowering medication was very likely to rise from 7 million to twelve million, leaving a single in 4 grownups on the medicine.

Last week the tips was criticised by a group of nine major medical doctors and academics who said the medication could do much more harm than great.

In a letter they accused Good of an “overdependence” on research funded by the pharmaceutical business, which are kept “hidden” due to business confidentiality agreements.

The group cited research, independent of the drug sector, displaying that statins have been connected with a 48 per cent boost in the threat of diabetes in middle-aged females.

Other likely side effects could incorporate depression, fatigue and erectile dysfunction, they warned.

Prof Mark Baker, director of NICE’s centre for clinical practice, admitted the expert panel which drew up the advice had partly relied on summaries of data from the Clinical Trial Support Unit at Oxford University, which is run by Sir Rory.

Prof Baker said the total data could not be launched to Nice or independent researchers simply because the trials have been “commercially funded” and the details was owned by drugs companies.

The unit receives tens of hundreds of thousands of pounds in funding from this kind of companies, though Sir Rory has insisted its outcomes “bear no relation to our funders.”

On Saturday Sir Rory explained the group which criticised the guidance need to be “ashamed of themselves”. Such considerations in excess of statins could “cause really massive numbers of pointless deaths from heart attacks and strokes”, he advised the Guardian.

Even so Prof McPherson, who chairs the Uk Health Forum, said he supported the points raised in the letter. He known as on Sir Rory, a fellow epidemiologist, to let the data on statins trials to be scrutinised by “independent reviewers”.

Prof McPherson told The Telegraph: “It is outrageous that Great is producing these pronouncements with no seeing the information and with out the data becoming witnessed by independent reviewers.”

He added: “My interpretation of the proof base currently being utilized is that it is wholly inadequate to make this kind of a prescription.

“As far as I can inform the trials had been not correctly accomplished in the sense that there was not systematic, routine periodic double blind evaluation of high quality of existence in between therapy of handle in all these trials, which you need.

“Also, in so far as there was, none of these information are offered for public scrutiny.

“I feel Great creating these slightly draconian guidelines on the basis of such an inadequate proof basis is foolhardly.”

He added: “I have just stopped taking statins and I am significantly more agile than I was when I was on them. I want to know why, what is the proof for it. I am not going back on statins except if I have the evidence.

“You envision all this creaking an aching is a matter of aging, and it may not be.”

On Saturday Sir Rory intervened in a row more than two current academic papers in the British Health-related Journal which questioned the widespread use of statins.

The authors have both withdrawn statements right after some figures they cited had been discovered to be incorrect, and the posts are getting reviewed by the journal. Sir Rory mentioned a third party, such as the Standard Medical Council or Division of Wellness, should carry out its personal evaluation of the articles.

Proof for NHS statins guidance "wholly inadequate", says specialist

How American Doctors Misplaced Their Specialist Autonomy

About the very same time that the Centers for Medicare and Medicaid Companies was botching the rollout of healthcare.gov, the company also announced its profitable creation of two mobile apps developed to support physicians hold track the things they get from drug makers. It lets physicians electronically tabulate (and report to the Feds) every consulting charge, pen, and jelly doughnut that they acquire, appropriate on their I-Phone.

The aim of this de rigueur is to assist medical professionals comply with a new federal law passed as component of the Cost-effective Care Act. Commencing this year, drug and healthcare gadget businesses should report to CMS almost every single transaction they have with personal medical professionals and how considerably the doctors received. CMS will post the data on a searchable, public website that goes live September 2014.

The “Physician Sunshine Act” is as considerably a response to the past marketing and advertising excesses of the drug and gadget makers as a reflection of the retreating stature of the American physician. Factors of medical practice that had been when firmly the domain of specialist bodies are now subject to federal tinkering. This has profound implications for medical professionals and individuals alike who have firmly ceded important autonomy.

The Sunshine Act mandates that healthcare product companies report to the Federal government any payment or “items of value” that total $ 10 or far more and are supplied to an person doctor above the program of a single year. The law also applies to “indirect transfers.” For illustration, when a drug company pays money to a advertising company and then expects the group to supply some thing of value to medical professionals.

Physician groups like the American Health-related Association celebrated the new restrictions. Medical doctor groups supported the Sunshine Act on a belief that doctors’ receipt of drug market income leaves an impression that doctors have fiscal conflicts. They worry that these perceptions undermine patient confidence.

But specialist healthcare societies need to also ponder how the rise of these types of state and federal laws represents a failing of their duty to act as stewards of the occupation’s standards.  This type of federal regulation represents an enduring adjust in how Washington views the whole occupation. Other professions (journalism, economic providers) impose principles and limits on consulting perform and outdoors payments. But perhaps no other profession is subject to federal limits and reporting demands that are as profound as those now imposed on physicians.

A single of the central tenets of skilled autonomy and responsibility is the act of self-regulation. There’s a historical expectation that prestige professions like law, medicine, and accounting weren’t just afforded certain privileges simply by virtue of their specialized understanding. It is also their dedication to certain rules of impartial support that prompted society to entrust these professions. There was a time when the Hippocratic oath meant something tangible. Now the only specialist currency that counts is what gets codified into federal regulation.

These days, few can argue that healthcare societies nevertheless give an satisfactory measure of regulatory supervision more than physicians and their specialist routines. The imposition of laws like the Sunshine Act is the consequence. The complete-throated endorsement that this legislation received from health-related societies is the clearest admission of failings of these groups to offer any measure of self-regulation. Right now, medical “professional” societies exist largely to lobby Washington above medical doctor pay out underneath Medicare. Most every little thing else they do supports that enterprise.

Beneath the imposition of the Sunshine Act is a far more troubling revelation: Washington has small faith in American physicians, and sees a require and a license to regulate just about each aspect of medical practice, even trinkets physicians acquire. There’s a clear view that medical professionals cannot be trusted to have any economic interactions with drug and gadget makers, no matter how little or basic these transactions. A free of charge mug is as very likely to influence a physician’s judgment as a $ 50,000 consulting charge.

There’s no doubt that a small variety of physicians took extreme payments from health care product companies. This money may possibly have influenced some doctors. Nor is it debatable that some companies acted badly, making use of fancy trips and big payments to attempt and influence the prescribing selections. A lot of of the most egregious behaviors constituted kickbacks, and have been currently unlawful beneath current laws.

As complete implementation of the Sunshine Act commences, the law’s provisions are currently having some predictable but regrettable consequences to the broader enterprise of medicine and science. Because monetary and criminal penalties attach to lapses in compliance, drug and gadget companies are interpreting the provisions with no frills. They are frequently lumping worthwhile scientific consulting perform with sales and advertising pursuits (like paid speeches given to other medical doctors) that the law’s architects constantly viewed with a lot more suspicion. I have observed my own scientific consulting relationships constrained or curtailed as a outcome of this law.

Organizations are ending a great deal of very helpful dealings. For instance, the variety of investigator-sponsored scientific studies (exactly where drug companies spend medical professionals to do tiny scale, exploratory clinical research) has plummeted. Barred from recognizing the complete economic value of their experience through consulting work, some companies will seek other endeavors in which their expertise will be put to less useful functions.

In Washington, American medication is sick. The Sunshine Act is a mark of both the symptom and the disease. It is the culmination of a much more protracted failure of American medication to self regulate, opening the way to far-reaching Federal oversight. It’s the demise of American medication. At least there’s an app for that.

You can follow Dr. Scott Gottlieb on Twitter @ScottGottliebMD

How American Doctors Misplaced Their Specialist Autonomy

Children"s hyperactivity "is not a true disease", says US specialist

Bruce D Perry of the Houston ChildTrauma Academy: ‘We are very immature in providing diagnoses.’

One of the world’s leading neuroscientists, whose operate has been acknowledged by perform and pensions secretary Iain Duncan Smith, has suggested that consideration deficit hyperactivity disorder (ADHD) is not “a genuine ailment”.

On the eve of a visit to Britain to meet Duncan Smith and the health secretary, Jeremy Hunt, Dr Bruce D Perry advised the Observer that the label of ADHD outlined a broad set of symptoms. “It is best thought of as a description. If you appear at how you end up with that label, it is impressive since any one particular of us at any provided time would match at least a couple of individuals criteria,” he mentioned.

Prescriptions for methylphenidate medicines, this kind of as Ritalin, which are utilized to deal with children diagnosed as suffering from ADHD, have soared by 56% in the Uk, from 420,000 in 2007 to 657,000 in 2012. Such “psychostimulants” are believed to stimulate a element of the brain that modifications psychological and behavioural reactions.

Even so, Perry, a senior fellow of the ChildTrauma Academy in Houston, Texas, stated he was concerned that young children were becoming labelled as obtaining ADHD when that just described the signs of a selection of distinct physiological difficulties. The symptoms that lead to a diagnosis of ADHD contain inattentiveness, hyperactivity and impulsiveness over a sustained time period.

Perry extra that clinicians were also as well readily prescribing psychostimulants to children when the proof suggested there had been no long-term positive aspects. Animal scientific studies have raised worries above the potential for damage to be done.

Perry, who will also meet cabinet secretary Sir Jeremy Heywood throughout his go to as a guest of the Early Intervention Foundation, a charity aimed at tackling the root brings about of childhood dysfunctions, said: “We are extremely immature in our recent evolution in offering diagnoses. A hundred many years in the past, a person would come to the medical professional and they would have chest pain and would be sweating. And they would say, ‘Oh, you have fever.’ They would label it, just like we label it [ADHD] now. It is a description rather than a true ailment.”

He extra: “If you give psychostimulants to animals when they are younger, their rewards methods change. They demand considerably much more stimulation to get the same degree of pleasure.

“So on a really concrete level they need to consume more meals to get the same sensation of satiation. They require to do more substantial-threat items to get that tiny buzz from undertaking some thing. It is not a benign phenomenon.

“Taking a medication influences methods in ways we never constantly comprehend. I tend to be pretty cautious about this stuff, notably when the study shows you that other interventions are equally efficient and over time a lot more successful and have none of the adverse results. For me it is a no-brainer.”

Perry explained he favoured an strategy that went back to the root causes of the issue, and typically needed attention getting focused on the mother and father. “There are quantity of non-pharmacological therapies which have been pretty successful. A good deal of them involve assisting the grownups that are around youngsters,” he said.

“Portion of what happens is if you have an anxious, overwhelmed mother or father, that is contagious. When a child is struggling, the adults all around them are easily disregulated too. This damaging feedback approach in between the frustrated teacher or mother or father and disregulated child can escalate out of manage.

“You can educate the grownups how to regulate themselves, how to have realistic expectations of the children, how to give them options that are achievable and have achievement and coach them by means of the method of assisting youngsters who are struggling.

“There are a great deal of therapeutic approaches. Some would use somato-sensory therapies like yoga, some use motor exercise like drumming.

“All have some efficacy. If you can place collectively a package of people items: keep the grownups far more mannered, give the youngsters achievable objectives, give them opportunities to regulate themselves, then you are going to minimise a massive percentage of the problems I have seen with children who have the issue labelled as ADHD.”

The chairman of the Early Intervention Basis, Labour MP Graham Allen, explained Perry was the “very best in his field” and was meeting senior officials and politicians already “convinced by the philosophy of his research. I would argue that if you can diminish adverse childhood experience, then we get rid of a good deal of the triggers of dysfunction.”

Children"s hyperactivity "is not a true disease", says US specialist

Why did Connor Sparrowhawk die in a specialist NHS unit? | Saba Salman

A year in the past, 18-year-previous Connor Sparrowhawk was admitted to Slade Residence, an NHS assessment and remedy unit in Oxfordshire.

Sparrowhawk, who had autism, a finding out disability and epilepsy, lived at house and went to a special college, but was unsettled and agitated. His family members imagined assessment at the 7-bed unit run by Southern Well being NHS basis believe in would help secure the right assistance for the teenager.

Instead, significantly less than four months later on on 4 July 2013, he was located unconscious in the bath at Slade Property and died. A postmortem showed he had drowned, almost certainly as a outcome of an epileptic seizure.

The trust at first attributed his death to normal leads to, but an independent investigation demanded by Sparrowhawk’s family concluded his death could have been prevented.

Its damning report, published last month, states that Sparrowhawk’s epilepsy was not appropriately assessed or managed. It even more discovered there was no sufficient supervision at bath instances, no loved ones involvement in his evaluation and care, no powerful clinical leadership and no proper attempts to engage the teenager in routines.

Sparrowhawk’s mother, Sara Ryan, a senior researcher and autism specialist at Oxford University’s Nuffield department of principal care health sciences, says: “We thought it [the unit] was risk-free. Connor lived at house with us for 18 years – 107 days in that place and he was gone.”

A social media campaign, Justice for LB (Sparrowhawk’s nickname was Laughing Boy), launches its 107 Days drive to raise awareness each day till the anniversary of his death.

Slade Property is now closed, its individuals moved to option care, and disciplinary hearings for seven workers are due this month. An inquest is expected and healthcare regulator Monitor is investigating the believe in. In November the Care Quality Commission (CQC) failed Slade Property for all 10 quality and safety requirements. CQC inspectors have also identified failings at two of the trust’s other amenities, an Oxfordshire care residence for people with finding out disabilities and a psychological well being unit in Southampton.

In response to campaigners’ calls for the trust’s chief executive, Katrina Percy, to resign, she replies: “I do not see that it truly is acceptable that I would resign.” Percy, who apologised in a statement in response to the report, told the Guardian: “[Connor"s death] is utterly tragic and it was preventable.” She adds: “We do absolutely every thing in our energy to safeguard and give the highest top quality of care that we possibly can … but what we need is a culture the place folks are in a position to be open when items never go as effectively as they probably could.”

Sparrowhawk’s death has reignited debate about assessment and treatment method units. Winterbourne View was a privately run unit the place the abuse of individuals with learning disabilities was exposed by BBC’s Panorama in 2011. Soon after the outcry more than the abuse in the south Gloucestershire unit, a £2.86m government-funded improvement programme was launched by the Regional Government Association and NHS England. Its aim was to move absolutely everyone out of this kind of units by 1 June 2014.

Nevertheless these days, about 3,200 people with understanding disabilities and autism are nevertheless in personal or NHS-run settings like Winterbourne See, according to government figures. Far more than 60% have been there above a 12 months and 20% for a lot more than five years. So, why are they nonetheless in such widespread use when they are broadly criticised as warehouses that supply wholly inadequate support at a weekly cost of about £3,500 per patient?

Commissioners of providers and clinicians bemoan the lack of neighborhood-based mostly options, but service suppliers for individuals with studying disabilities propose the commissioners are ignorant of, or can’t afford, existing options.

The improvement programme’s new director, Bill Mumford – who is chief executive of finding out disability charity MacIntyre – describes the June deadline as “an aspirational target and not thought through”. He adds: “I am not expecting a large fall in numbers.” Alternatively, he says he is trying to advertise excellent-practice choices to assessment and treatment units, and supporting commissioners to use these options.

The lack of pooled funding amongst regional authorities and NHS England undermines moves to get men and women out of units simply because income-strapped councils are forced to select up the bill for neighborhood provision. Mumford says: “The challenge is for clinicians and commissioners, they are the crucial choice-makers, we can connect them up, show them what can be completed, preserve the pressure on them.”

Care minister, Norman Lamb, says: “We assume health and care commissioners to function together to transform care and support. We will publish standard progress reviews, which will make extremely clear which commissioners are failing to make the improvements we are committed to.”

However, neighborhood-primarily based very best practice is nevertheless the exception. Despite the closure of a lot of NHS lengthy-stay hospitals in the 1980s, high-priced, harmful “dumping grounds” nonetheless exist. Considering that 1993′s influential Mansell Report, policy and investigation has quite a few white papers and inquiries have advocated greater care for people with complicated demands, from the 2001 report Valuing People, to the 2006 Our Overall health, Our Care, Our Say white paper, and the confidential inquiry into the deaths of folks with finding out disabilities. But in spite of the intentions and proof, the pace of alter for people with complex requirements is slow.

There is an additional reason for slow progress. The Department of Health’s Winterbourne View report, noted: “Failure to listen to people with demanding behaviour and their families [is] a typical expertise and totally unacceptable”. Sara Ryan says of Slade Residence: “It was as if it was an imposition that we visited every single day.”

A senior figure at a national care supplier, who declined to be named, says: “There is an endemic difficulty in the sector of household bashing, it is ‘the family members are difficult and a pain’ … Mother and father are the experts on their son or daughter – and we must tap into that knowledge.”

Jenny Morris is a advisor who advised the Office for Disability Issues below the earlier government. She believes public perceptions of people with studying disabilities are partly responsible for inadequate progress. “There are unfavorable attitudes in society in common towards individuals with understanding disabilities, plus ignorance and lack of knowing about how denying people the ability to communicate their demands, and failure to meet their wants, prospects to ‘challenging behaviour’,” she states. According to Morris, “institutional disablism” persists in many providers.

Sparrowhawk’s death is very likely to force closer scrutiny of premature deaths amid men and women with learning disabilities. Ryan and her husband Richard Huggins, who raised him because he was a infant, met outgoing NHS chief executive David Nicholson and chief nursing officer Jane Cummings. Between their demands have been automatic independent investigations of deaths in evaluation and therapy units, a corporate manslaughter charge towards the believe in and the closure of all this kind of units.

Studying disability charity Mencap, has warned in a joint statement with household-led organisation The Demanding Behaviour Foundation that Connor’s death is not the only tragedy. “We are at the moment operating with households in comparable, dreadful conditions,” it states.

As disparate components of the overall health and social care sectors wrestle yet again with bettering help, society’s most vulnerable men and women are becoming failed by the extremely mechanisms created to safeguard them. As Huggins says: “We put our faith in the system and received desperately allow down.”

Why did Connor Sparrowhawk die in a specialist NHS unit? | Saba Salman

Meals poverty now greater public overall health concern than diet plan – specialist claims

Panorama has found that over a third of regional authorities in England and Wales have been now supplying funding for foods banking institutions. Photograph: Christopher Thomond for the Guardian

The prevalence of poverty–stricken families who can’t afford to purchase enough food is overtaking unhealthy eating as the most pressing public overall health concern, a public well being professional has claimed.

The claim is produced in a BBC Panorama documentary to be broadcast on Monday evening which identified that over a third of local authorities in England and Wales had been now offering funding for foods banking institutions, despite government claims that charity food is not a part of the social security technique.

Julie Hirst, public health specialist at Derbyshire county council, advised Panorama the authority had invested £126,000 from its public wellness budget in meals banks.

She mentioned: “It really is now turn into an situation of foods poverty and some men and women in the nation are not currently being able to eat at all – and if individuals can’t consume at all, what’s the level in attempting to get them to consume healthily?”

Elizabeth Dowler, a professor at Warwick University and the co-author of a latest government-commissioned report on meals support provision, advised the programme it was shocking so a lot of councils were investing in foods banking institutions.

“Food banking institutions are an inadequate plaster in excess of a gaping wound … They do not resolve the issues. And that they ought to be enshrined as an inadequate remedy is deeply immoral.”

The programme also uncovers proof that a job centre seems to be explicitly alerting its employees to the economic cost savings to be made by means of “sanctioning” job seekers when they are judged to have broken advantage circumstances.

A wall chart in a Grantham work centre explicitly sets out the funds savings obtainable to the Division for Perform and Pensions (DWP) by means of stopping the rewards of claimants, ranging from £227.twenty a week for a 4-week sanction to £3,728 for a sanction lasting one yr.

The DWP advised Panorama: “This was an isolated incident and does not reflect our policy on sanctions.”

Charities and campaigners say record totals of DWP sanctions – 875,000 in the 12 months to September 2013 – are a prime reason why men and women are forced to turn to foods banking institutions.

They complain that several sanctions are unfair and unjustifiable, and that hundreds of folks are wrongly penalised every day forcing them to survive for weeks on little or no money.

The DWP insists there is no robust hyperlink amongst welfare reforms and the rise in meals bank use.

The programme interviews a mom of two who says her family’s well being suffered soon after she was wrongly sanctioned for three months after a clerical combine up, leaving them on reduced income.

Suzanne Harkins, who lives in Paisley, Scotland, advised Panorama: “It was devastating. It acquired to a level that there was no food in the property and any foods that did come in had to feed the two youngsters and my husband and I would go for days at a time with no eating.

“I was nonetheless breastfeeding Mason at the time and I stopped making milk since I wasn’t getting sufficient nourishment into me to create milk to breastfeed him.”

The two councils covering the parliamentary constituency of Iain Duncan Smith, the function and pensions minister – Redbridge council and Waltham Forest council – have offered above £70,000 to fight foods poverty, the programme discovered.

The DWP stated regional authorities, who run regional welfare assistance programmes, most of which refer vulnerable residents to emergency meals charities, have been very best placed to fund meals banking institutions.

However, the DWP mentioned earlier this yr that it would stop its £180m funding for council neighborhood welfare schemes in 2015, a move that charities warned would set off a rise in the amount of individuals turning out to be dependent on food banks or loan sharks to survive.

Hungry Britain?, 8.30pm, Monday three March, BBC One particular

Meals poverty now greater public overall health concern than diet plan – specialist claims

Much more Guideline Controversy: Blood Pressure Specialist Decries "Political Correctness"

Now include “political correctness” to the long record of criticisms directed against the current publication of new and updated cardiovascular recommendations. One particular major hypertension professional writes that the authors of the recent AHA/ACC/CDC Science Advisory on blood strain control have been picked not for their knowledge but for political expediency.

Last 12 months the NIH stated it would no longer get obligation for coordinating and publishing its properly-established and extremely influential cardiovascular tips. The American Heart Association and the American University of Cardiology took above this responsibility, but the transition has been filled with controversy and confusion. In November the AHA and the ACC launched four major cardiovascular tips, but one of the most eagerly-anticipated recommendations, the hypertension guideline, was conspicuous by its absence. As a stopgap measure the AHA and the ACC, along with the CDC, launched the Science Advisory. This advisory is the topic of the new charge of political correctness. (Subsequently the authors of the unique NIH hypertension group published their guideline in JAMA below their very own auspices. But, to include to the confusion, a “minority report” from a number of of the authors expressed disagreement with 1 main element of the guideline.)

Franz Messerli, the director of the hypertension plan at St. Luke’s-Roosevelt Hospital Center in New York City, writes in the journal Hypertension that the 7 authors of the AHA/ACC/CDC advisory are not professionals in hypertension. The authors are neither hypertension specialists who have written extensively about the illness, nor have they served on the advisory board of hypertension journals. By contrast, in accordance to Messerli, the authors of the preceding NIH-supported hypertension guideline had “extensively published on hypertensive cardiovascular disease ” and had been indeed “ accurate specialists displaying skills or information to guidebook other doctors in detection, evaluation and remedy of individuals with hypertension.” Messerli concludes:

On a constructive note, compared to the JNC 7 authors, the AHA/ACC/CDC Science Advisory have a significantly shorter checklist of conflict of interests and consist of a a lot more diversified group of individuals. We are not privileged to have access to the selection criteria for the authors of these tips. Plainly they should have been other than skills in hypertensive cardiovascular illness, i.e. “special ability or information derived from training or experience”.

In a response, the presidents of the AHA and the ACC, Mariell Jessup and John Harold, compose:

…the writing group members had been invited, chosen not for functions of “political correctness,” as Dr. Messerli asserts, but rather to incorporate men and women with credentials and experience, not only in in major care and cardiology, but also in population health and clinical quality improvement in healthcare care delivery programs. These individuals genuinely qualify as authorities in one or much more of these locations, and they signify a diversity of healthcare specialty, skilled setting, gender, and, despite the fact that not apparent by title alone, racial/ethnic diversity. And as mentioned by Dr. Messerli, the writing group had number of conflicts of curiosity. The terms “guideline” and “expert” panel had been intentionally averted. Guidelines supply the science base for what requirements to be accomplished. This advisory was meant to offer advice on how to get it carried out.

They also note that the AHA and the ACC are “in the preparing stages” for creating a much more extensive expert hypertension guideline.

In an interview Messerli explained that the composition of the authors of the JAMA hypertension guideline “seems to be acceptable.”

Comment: A mindful reading of the AHA/ACC response leads to the inevitable conclusion that Jessup and Harold are not really disagreeing with Messerli but are alternatively supplying a distinct interpretation of the identical straightforward and inarguable set of information. Messerli views these information as proof of “political correctness” and therefore, presumably, a negative thing. Jessup and Harold seem at the very same set of information and see diversity and inclusiveness, presumably a excellent thing.

Confusion (Photo credit: quinn.anya)

Much more Guideline Controversy: Blood Pressure Specialist Decries "Political Correctness"