GPs are failing people with eating disorders, says charity

GPs are routinely failing to provide adequate care to patients with eating disorders, with one in three not referred for specialist assistance, a leading charity has warned.

Beat, the UK’s primary eating disorder charity, found that half of people with some experience of the condition rated GP care as “poor” or “very poor” and 30% were not referred to mental health services after their appointment.

The charity polled 1,700 people, the majority of whom had sought medical help for an eating disorder. Of the 1,267 who had gone to a GP for help, only 34% said they felt their doctor knew how to treat them.

This is despite National Institute for Health and Care Excellence (Nice) guidelines that say patients should “receive treatment at the earliest opportunity”.

It comes amid growing concern about eating disorder services in general and the help available for patients once they are referred. NHS data shows a 36% drop in the number of hospital appointments for eating disorders in England, leaving thousands of children and teenagers forced to wait months for help. Charities warned that some patients were essentially being told they would not get help unless they starved themselves further.

Beat’s warnings will add more pressure on the government to improve care for patients. The charity has called for better training for medical students specialising in general practice, as well as more funding for mental health services once referrals are made.

Andrew Radford, the chief executive of the charity, said: “Unfortunately many of our respondents identified poor care, with many GPs not knowing what the real signs and symptoms are.

“This isn’t about blaming GPs, it’s about enabling the 50% of GPs who didn’t provide good care to be as supportive of eating disorder sufferers as the 50% who did.”

Elizabeth McNaught, 25, a junior doctor who had eating disorders when she was younger, agreed training was not good enough. “Many doctors do not know enough about eating disorders because they don’t feature very highly in medical training. We had just two hours on the subject throughout five years of study.”

Eating disorder numbers among the young have risen over the years. While 658 under-19s in England needed a spell in hospital in 2003-04 to treat an eating disorder, by 2013-14 that number had increased to 1,791, up 172%.

At least 725,000 people in the UK of all ages, genders and backgrounds now have an eating disorder. Research has found 20% of anorexia sufferers will die prematurely from the illness.

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, dismissed claims that family doctors were not trained to identify and treat eating disorders. She added that Nice guidelines did not recommend immediate referral for all patients who might have an eating disorder. “In some cases the condition can be dealt with effectively in primary care,” she said.

Stokes-Lampard said the figures did show the intense pressure GPs were under. She added that it was not always possible to assess the needs of complex patients in a 10-minute appointment, calling for more investment and longer consultations. She also said better mental health services in the community were needed.

The Guardian heard from several people who had trouble with their GP, including Matt Foster, 28. He said: “I had spoken to my GP before about mental health issues and they were unsympathetic.” Another person, who wished to be anonymous, said: “When I first asked my GP for help, he sounded bemused. He said throwing up your food is bad for you and you are hardly fat, so what do you have to worry about?”

Rhiannon Lambert, a nutritionist, said: “Approaching a GP will always be a vital move in treatment and more needs to be done to support patients. Eating disorders need to be taken seriously. While recovery is possible, they often last a lifetime or sadly take a life.”

GPs are failing people with eating disorders, says charity

Generation snowflake is not failing us: we’re failing them | Deborah Orr

A healthy society, surely, is one that helps its children feel safe and secure. If this were a banal proposition, it wouldn’t even have to be stated. Yet there are plenty of people who would contend that it’s not up to society to make kids feel safe. That, they will announce with tremendous self-satisfaction, is the job of their parents. It’s as if they don’t even know that humans are social animals, and that it is the ability of humans to think and act from social motivations that fostered civilisation.

For these folks, any sign that children are struggling in Britain today is sneeringly dismissed as more evidence of generation snowflake’s feeble lack of resilience. This aggressive, sloganeering refusal to engage with the feelings of vulnerability of others, but instead to mock and belittle them? That in itself is a statement of intent. It is an assertion that helping young people to feel safe and secure is not in the least their business. On the contrary.

Research by the NSPCC, gathered through freedom of information requests, warns that serious cases of self-harm among young people have jumped by 14% in the last three years, with 19,000 children and young people treated in hospital in England and Wales in the last 12 months. People self-harm when they crave the primitive distraction of physical pain from the insistent complexity of emotional distress. The respite is brief and dangerous. Often, it piles shame and guilt on to a chaotic heap of negative emotions that has already proved overwhelming: snowflakes dissolving in their own sticky blood.

The fact that these children choose to harm themselves rather than others is a sign that they feel plenty of shame about their fears already, for which they blame themselves. Often, children report that they couldn’t talk to their parents because their parents were too busy. What they tend actually to mean is that they’re worried and upset because they know their parents are worried and upset, and they don’t want to add to the burden.

But if it’s the job of parents not to be worried and upset, so that they can help their children, then you have to ask why it’s such a great idea to consider human competition rather than human collaboration as the magic fountain from which all good things gush. It’s always too simplistic to theorise about how a vast range of individual and particular crises are all down to one thing. Yet the list of the usual suspects that’s aired when mass psychological struggle hits the headlines does include a lot of stuff that has competitive elements.

Any sign that children are struggling is sneeringly dismissed as more evidence of generation snowflake’s feebleness

There’s the pressure to look attractive, the pressure to succeed at school, the pressure to be popular, the pressure to get a job, to get a home. If I were growing up now, I’d be terrified. I was pretty terrified in the 1970s, when I’d no idea how much more demanding and complex life was going to get. Are children wrong to feel these pressures? Can any parent honestly tell them that none of it matters and that life has a way of turning out OK?

Yet all this is just a backdrop to the existential struggles of life. Children still have to deal with private catastrophe – bereavement or abuse, illness or trauma – as well as global horror: the horrific evidence of human aggression and the suffering it causes, there on your phone all day, every day. All this, alongside the sheer effort of becoming yourself in an era that idolises individualism.

Left and right, politically, they both do this. The left champions identity, the right champions robust economic self-sufficiency. Do we give children time to find out who they are, among the blanket demands that they should Be Themselves? We don’t give them time and we certainly don’t give them much in the way of psychological tools or support. After all, therapy costs money in this economically competitive world.

We need to feel part of something bigger than ourselves, and sometimes I think Brexit is best understood as an expression of that yearning. Young people, on the whole, felt like part of Europe because they’d grown up with it. Maybe older people just felt like their own place in the world had just become so much harder to locate in their hearts once they weren’t simply British. And how people viewed Europe in their daily lives also raised the spectre of competition; people coming here looking for work, and helpless employers, themselves governed by competition, quite unable to do anything other than pay the lowest wages possible.

I’m not saying that vulnerable young people self-harm because hashtag Brexit. That would be too simple. But I am saying that it may reflect the fact that there is too much competition in the world and not enough caring support. Competition can be a great driver of achievement, but so can collaboration. The corrosive thing about competition is that it fosters fear of failure, which has to be countered. Balance is everything, and that’s what we don’t have. People are afraid and ashamed of their fear; so it festers, and explodes in anger and resentment. It’s fertile ground for demagogues who offer glib, bogus answers and, boy, do they plough it.

You can choose to see “generation snowflake” as a bunch of wimps, or you can observe that there is plenty going on in the world to traumatise a sensitive child – or adult. Then you can think a bit about how traumatised people make bad decisions, and conclude that the aggression, the fear, the shame, the self-harm – it has to stop. The very essence of what it is to be human – to be able to look after one another and help one another find solutions to our problems – is what is at stake, and children feel it.

Generation snowflake is not failing us: we’re failing them | Deborah Orr

Global health leaders failing women in Zika-hit areas, experts warn

Public health experts are warning that the failure of global health agencies to challenge political and religious resistance to contraception in Zika-affected countries in Latin America and the Caribbean is leading to a humanitarian crisis for women .

The World Health Organisation (WHO) and US Centre for Disease Control (CDC) recommended women in the region delay pregnancy or not have sex well before the Zika virus was definitively linked in April to the birth defect microcephaly. But family planning experts say that women are merely being told to avoid pregnancy without being given the means to do so and that such advice is insufficient in the face of a global epidemic.

“This is in a region where rates of violence against women are high and women do not always have the power or ability to say no to sex,” says Giselle Carino, director of the International Planned Parenthood Foundation’s western hemisphere region, which covers Zika-affected areas.

“Asking women not to get pregnant without ensuring they have the means to prevent unintended pregnancies puts them in an impossible catch-22 situation.”

Most Zika-affected countries in Latin America and the Caribbean are predominantly Catholic and have strong political and cultural barriers to women accessing and using contraception. In Haiti, only 34% of women have access to contraception, while in El Salvador, almost 90% of pregnancies are unplanned. Terminating pregnancies is another minefield: more than 97% of women of child-bearing age in Latin America and the Caribbean live in countries where abortion is restricted or illegal.

Although the Pope suggested earlier this year that contraception could be used – in a departure from Catholic teaching – to prevent infection with Zika, he tempered the advice by calling it a lesser evil. Abortion, he stressed, was still “an absolute evil”.

But international funding to provide contraception in the region has all but dried up, say family planning experts. In the US territory of Puerto Rico, where a Zika epidemic is raging, two-thirds of pregnancies are currently unintended [pdf] and nearly 140,000 women are estimated to not use contraception, according to the CDC. Yet Congress stalled for months to push through an emergency funding bill to combat Zika in the US and its territories, thanks to a provision that would have banned funding to a Puerto Rican Planned Parenthood affiliate that provides sexual health services, including contraception and abortion. Under US law, federal funds cannot be allocated for abortion.

As a result of such political in-fighting, countries most in need of family planning are at crisis point, says Carino: “The unfinished sexual and reproductive health and rights agenda has now become a humanitarian crisis in Latin America.”

Asking women not to get pregnant without ensuring they [can] prevent pregnancies puts them in an impossible situation

Giselle Carino, International Planned Parenthood Foundation

Perhaps as a result of the delicate balance in the region, the WHO, CDC and Pan American Health Organisation (which works in the Americas) have been seemingly loth to stress the significance of contraception in relation to the Zika virus. The CDC, tellingly, refers instead to the timing of a woman’s pregnancy as a “deeply personal and very complex decision” that should be taken with her partner and healthcare provider.

Such tempered language points to the fine line that global health agencies walk, says James Hodge Jr, professor of public health law and ethics at Arizona State University.

“These issues are deeply political and at times legally contested in some countries where access to contraceptives and abortions is greatly restricted, if not prohibited,” he told the Guardian. In Latin America, for example, “public health organisations can be reticent to engage in policies that directly contravene national laws or politics”. As a result, recommendations remain recommendations, not global health policy.

While the WHO has developed a Zika strategic response plan that would also include family planning and education, the $ 122m required to put it into practice is “drastically underfunded”, says Dr Babatunde Osotimehin, executive director of the UN population fund, UNFPA, and under-secretary general of the UN.

“Women of childbearing age and their partners in Zika-prone or affected areas [must] have full access to sexual and reproductive health supplies and services,” he says. “We already know that voluntary family planning is one of the most cost-effective investments in our futures, with some estimated benefits as high as $ 120 for every dollar invested. The Zika outbreak means that, for affected countries, that return on investment could be even higher.”

But Dr Vincent DeGennaro of the University of Florida, who runs a clinic supporting women’s health in Haiti, told the Guardian that the failure to put family planning at the heart of the response to Zika is contributing to a growing crisis.

“When we are in clinic and we offer women access to birth control they accept it like a hungry man eating food,” says DeGennaro. “The current policy on Zika is short-sighted and narrow. There are millions of women of reproductive age without access to contraception and the majority of pregnancies are unintended. We are failing women, and with the low cost of contraception, it’s hard to say it’s not deliberate.

“Why are we talking about Zika? Microcephaly. How do you prevent microcephaly? Prevent pregnancies,” DeGennaro adds. “I struggle to find a more urgent public health issue.”

Global health leaders failing women in Zika-hit areas, experts warn

So child mental health services are failing. Why’s that then, Jeremy? | Hannah Jane Parkinson

Actions speak louder than words is perhaps the maxim that governments should live by; that governments should have as their desktop screensavers or written on Post-its on ministerial fridges. It came to mind when Theresa May made her Milibandesque inaugural speech as prime minister, and it came to mind again last week when Jeremy Hunt told us that the NHS is failing Britain’s young people on mental health. “Too many tragedies” occur because of weaknesses in the children and adolescent mental health services (Camhs), Hunt said.

It’s a popular opinion. So popular in fact, that people who work in Camhs have been saying it for years. Ditto the individuals who use the service, or would use the service if they were not languishing on waiting lists. Or those who are put off even trying to enter the system, or don’t know what help is available. Not to mention the parents and guardians of these young people.

Hunt says services need to intervene earlier. He is absolutely right. Will he tell us next that people need air to breathe and plants need water to thrive? And why then, has the government he is a member of, and the previous one, overseen the decimation of mental health services, and in particular, those dedicated to helping young people?

Earlier this month the Guardian revealed that 235,000 young people in the UK are receiving mental health care, and that’s a figure based on responses from 60% of trusts, so the real number will be higher. Figures released by NHS Digital show a shocking rise in young people self harming, including an increase of 42% over the past decade in the number of girls treated as inpatients after self poisoning. Almost two-thirds of headteachers are concerned about depression in pupils. One in 10 five to 16-year-olds are thought to have a mental illness. Time and again we are warned that young people’s mental health is an area that needs huge investment to prevent a generation of unwell adults. Prof Dame Sue Bailey, former head of the Royal College of Psychiatrists, has called the situation a “car crash waiting to happen”.

And yet freedom of information requests find that one in five local authorities have either frozen or cut their Camhs budgets every single year since 2010. From the same year to 2015, £50m was cut from Camhs across the board. Funding promises do not make it to the frontline. The NSPCC found that a fifth of young people are turned away from Camhs services for not meeting the threshold for help. Years and years of the falling axe; years and years of avoidable deaths and futures derailed.

Now Hunt has the gall to tell us that mental health services are failing children and adolescents. They are. But it’s not, for the most part, the fault of the psychiatrists, psychologists, therapists, community psychiatric nurses and all of the support and admin staff who make up the mental health services; they often work after hours and take on additional duties for no extra pay. Services are failing thanks to budgets being cut, departments merged or closed and a lack of staff, all courtesy of a government that seems to think the public will forget it has been in charge for this duration.

Teenage girls talk about anxiety: ‘It’s always linked to failure’

It is not uncommon for unwell youngsters to spend nights in police cells because of a lack of available beds. It is even more typical for young people to be offered inpatient beds many miles away from their homes, or on adult wards, or to turn 18 and slip through the gap between Camhs and the adult system.

Hunt’s rhetoric towards junior doctors will not help the dire take-up of psychiatry posts. And now Brexit will deter the overseas staff that large parts of the mental health services rely on.

Of course, episodes of mental illness are horrific at any point in a person’s life. Depression in older people has reached crisis levels too, but what is especially devastating about children and teenagers becoming ill is that it can knock them off course for life.

This happened to me, and is the sole reason I did not sit A-levels or earn a degree. Because I became ill at 16, and did not manage to access proper treatment until years later. I am, despite this, lucky. The kindness of people and their willingness to understand and appreciate the different road I have taken (unwillingly), and to spot potential, has meant that I, eventually, got to where I wanted to go – but it often didn’t look as though things would turn out this way and the effects are life-lasting.

So I agree with Hunt. He is entirely correct: Camhs is weak. But when you starve something, neglect it, take away everything that makes something strong, it will inevitably become weak. The truth is the UK could afford to give more money to the NHS, which spends less than many other countries on its health system. As Simon Stevens, head of NHS England, has said, even if the £1.25bn that has been “pledged” to young people’s mental health services is delivered, Camhs would still only be in a position to help one in three youngsters in mental health need.

After the leave campaign stood in front of its lie-on-wheels promising £350m per week to the NHS, to hear Theresa May point blank refuse the NHS the money it needs is enough to turn the stomach. Hunt may be a wealthy man, but to hear him cast aspersions on a service that the Tories have stripped of all resources and funding since it came to power? That’s rich.

So child mental health services are failing. Why’s that then, Jeremy? | Hannah Jane Parkinson

Councils failing to monitor most British schools for dangerous air pollution

Councils are failing to monitor most schools in Britain for dangerous air pollution despite government advice, freedom of information requests have revealed.

All Britain’s 433 local councils were asked by the British Lung Foundation (BLF) whether they placed pollution monitors within 10 metres of school grounds. Of the 322 which replied, only 140 said they did.

In urban areas identified by the World Health Organisation as having harmful levels of particulate pollution, nearly half were found to be monitoring only one or two schools. Less than one in three local authorities monitored more than two schools.

Air quality monitoring guidance for the UK is drawn up by the Department for Environment, Food and Rural Affairs (Defra). The government does not insist that schools are monitored and local authorities are left to implement and interpret results and take action where needed.

The survey showed “alarming discrepancies” in council behaviour, said a BLF spokeswoman. Some used very simple diffusion tubes to measure only NO2 gas, but others monitored for different-sized particles called PM10s and 2.5s which are spewed out by traffic and industry, she said.

Equally, some authorities monitored the air close to school playgrounds, but others measured air quality hundreds of metres away.

“The guidance on monitoring that Defra gives local authorities needs to be revised and strengthened. Parents should be able to tell what their children are breathing, especially if they have conditions like asthma,” the spokeswoman said.

Concern about children’s health has grown following new scientific research which has shown lung capacity can be permanently impaired by pollution at very early ages.

A study of 2,400 children at 25 schools across east London found children had 5-10% less lung capacity, with an increased risk of diseases such as asthma and bronchitis.

According to the BLF, nearly 1 million schoolchildren up to 15 years old have been diagnosed with lung conditions.

“Children and teaching staff are not being made fully aware of the health risks posed by air pollution. Local authorities need clear guidance to monitor the air that children breathe as well as more resources and funding to tackle it,” said Russell Hobby, general secretary of the National Association of Head Teachers.

“Children’s lung health is particularly vulnerable to air pollution, yet they are not being protected by the government’s air quality monitoring guidance. There is a huge discrepancy in the levels of monitoring outside schools across the country, with many schools in the most harmfully polluted places not being monitored,” said Dr Penny Woods, chief executive of British Lung Foundation.

A an LGA spokesman said: “Councils follow guidelines on monitoring air pollution which are laid down by central government. These are to take a risk-based approach – monitoring those locations where members of the public might be regularly exposed.

“As well as schools this could also include residential properties, hospitals and care homes – depending on which area is at greatest risk. Many schools are actually some distance from busy roads and therefore unlikely to have high air pollution levels.”

He added that the “real issue” was for councils to move from monitoring pollution to acting on it, which would take government support.

A report that was commissioned but not published by London city hall under Boris Johnson showed that the number of primary schools in the capital breaching EU pollution levels had fallen from 433 in 2010 to 357 in 2013.

Another report, for the mayor of London, found children at nearly 90 secondary schools in London regularly breathed illegal and dangerous levels of air pollution.

Research by the Campaign for Clean Air found that 1,148 schools in London are within 150 metres of roads carrying 10,000 or more vehicles per day, and a total of 2,270 schools are within 400m of such roads.

“Children across the UK are exposed to illegal levels of air pollution on a daily basis. Air pollution is an invisible problem and parents have a right to know if their children are breathing dirty air, so it should be monitored,” said Andrea Lee, healthy air campaigner at environmental law firm ClientEarth.

Councils failing to monitor most British schools for dangerous air pollution

By failing to update their warnings, drug regulators are letting patients down

US drug regulator the Food and Drug Administration (FDA) has issued warnings about possible side effects of taking varenicline. Varenicline (marketed as Chantix in the US, and Champix in the UK) is a drug which can help people stop smoking. The FDA’s warnings are out of date, do not reflect the scientific evidence, and urgently need to be updated. They may have led the public and clinicians to incorrectly believe that there was strong scientific evidence that varenicline causes or exacerbates mental health problems. Given varenicline is the most effective way to successfully stop smoking, these safety concerns may have resulted in fewer people successfully stopping smoking.

A brief history FDA’s warnings over varenicline

In May 2006 the FDA approved varenicline for use as a medication to help people stop smoking. This was the first treatment licensed for smoking cessation since 1997, and initial evidence suggested that people who took it were more likely to successfully stop smoking. However, it was not long before concerns were raised that people prescribed varenicline were experiencing mental health side effects. Newspapers reported a series of anecdotes that people taking varenicline had suicidal behaviour. The FDA’s Adverse Event Reporting System (AERS) suggested patients prescribed varenicline were more likely to report suicidal behaviour than patients prescribed other medications. The key question was, are these differences a result of taking varenicline, or is it just that patients prescribed it had a higher risk of these events even before they were prescribed treatment? Were they due to correlation or causation?

The FDA attempted to answer this question in a safety review that was published in February 2008. They concluded that “[varenicline] may cause worsening of a current psychiatric illness even if it is currently under control and may cause an old psychiatric illness to reoccur.” In July 2009, after pressure from the media and consumer groups, the FDA went further, mandating that varenicline carry a “Black Box warning”. Black Box warnings are the FDA’s strongest warning about possible side effects of drugs. The Black Box warning for varenicline highlights “the risk of serious neuropsychiatric symptoms in patients using these products”. Symptoms included changes in behaviour, hostility, agitation, depressed mood, suicidal thoughts and behaviour, and attempted suicide.

The FDA then commissioned two large observational cohort studies to examine the risks associated with varenicline. They also instructed Pfizer to conduct a large randomised trial to investigate the side effects of varenicline in people with mental health problems.

Results from the observational studies were reported in October 2011. In both studies people prescribed varenicline had similar risks of being hospitalised for psychiatric problems as patients prescribed nicotine replacement therapy – in other words, there was no evidence of increased risk. However, these were observational studies, rather than experimental (randomised trials), so could not prove that varenicline did not cause adverse outcomes. However, most epidemiologists would regard these studies as more reliable evidence than the anecdotal case reports and newspaper reports which originally raised concerns about these risks. Nevertheless, in response to this new evidence, the FDA “determined that the current warnings in the varenicline drug label, based on post marketing surveillance reports, remain appropriate” and did not remove the Black Box warning.

Meanwhile, further observational studies were amassing evidence about whether varenicline use is associated with adverse events. In 2009, our colleagues found no evidence that patients in UK prescribed varenicline had higher risks of suicidal behaviour. In 2013, we updated this evidence to include over 100,000 patients, and again found that patients prescribed varenicline had similar risks of suicidal behaviour and similar rates of self-harm. In 2015, we systematically reviewed the literature of randomised controlled trials, and again found that participants given varenicline had similar risks of suicide and self-harm as those given placebo.

In March 2015 the FDA issued a further update. Despite mounting evidence about the safety of varenicline, they did not change their warnings. In 2016, the randomised controlled trial the FDA commissioned reported its findings. This trial randomised 8,144 people to receive varenicline, nicotine patch, bupropion or placebo, and found that people allocated to varenicline rather than nicotine replacement products experienced fewer moderate and severe mental health adverse events. The European Medicine Agency, which regulates pharmaceuticals in Europe, recently updated the information it provides about varenicline. In contrast, to date the FDA has refused to update its warnings.

Correlation does not equal causation

Patients who take medications are different from the general population. This means that even if patients prescribed a drug are more likely to have a particular adverse event this does not necessarily prove that these events are caused by the drug. In the case of varenicline, people who smoke are different from the general population on average; they are usually poorer, sicker, and more likely to have mental health problems. So the fact that patients taking varenicline reported higher rates of suicidal behaviour than patients prescribed other drugs in the FDA Adverse Events Reporting System, may have been because these patients were at higher risk of these events, before taking varenicline. This means these adverse events are unreliable evidence of the difference when taking varenicline or other nicotine replacement products.

Spurious safety warnings can be extremely harmful

In 1998 a paper was published which suggested that there might be an association between taking the measles, mumps and rubella (MMR) vaccine and developing autism. These claims were false, and multiple, large, well-conducted studies have proven that these claims were false, and the MMR vaccine is not associated with, and does not cause autism. Nevertheless, these warnings led to a substantial fall in vaccination rates, and an increase in cases of measles. So it is vital for regulators to distinguish between side effects which are caused by drugs, and potential events which the drugs do not cause. These could be events that are correlated with a medication, or risks for which the regulator does not have any reliable evidence.

In 2007 3.9 million patients took varenicline in the US. In 2012, after the safety warnings were issued, only 1.2 million patients took varenicline. Thus a potential cost of issuing safety warnings is that fewer patients take otherwise effective medications.

What should we do now?

From the first warnings about potential adverse effects of varenicline on mental health in November 2007 to today, 4.1 million people are likely to have died from smoking related disease in the US alone. The FDA’s Black Box warning of mental health problems associated with varenicline is inconsistent with the latest scientific evidence. Ultimately, it could discourage people from using the most effective smoking cessation treatment. In 14^th of September 2016, the FDA’s expert advisory group for drug safety met and again reviewed the evidence about the side effects associated with varenicline. The vote was close: they voted 10 to 9 in favour of advising the FDA to remove its warning. However, given the committee’s lack of consensus, it is not clear if the FDA will follow their guidance. In our opinion, given the evidence, the FDA needs to urgently revise this safety warning.

Dr Kyla Thomas is a National Institute for Health Research funded Clinical Lecturer in Public Health Medicine based at the University of Bristol and an Honorary Consultant in Public Health. She tweets sporadically @drkyla_thomas. Dr Neil Davies is an epidemiologist based in the MRC Integrative Epidemiology Unit at the University of Bristol. He occasionally tweets from @nm_davies. These views are their own.

A longer more detailed version of this blog post was published in the Addiction journal available here.

By failing to update their warnings, drug regulators are letting patients down

Public health is in crisis – and Theresa May is failing to act | Sarah Wollaston

In her first speech as prime minister, Theresa May promised to tackle the nine-year gap in life expectancy between rich and poor, placing this at the top of her list of burning injustices. This yawning inequality has defeated successive governments, and the gap is even wider between rich and poor for years lived in good health. Closing it will require action across areas such as poverty, housing and education, as well as those more conventionally thought of as affecting health. May will need to start early and look far beyond the short-term political cycle for results.

Public health seldom makes headlines. We tend not to recognise, let alone thank it for preventing disease or life-changing accidents, despite public health measures transforming our life expectancy. We are more likely to focus on and appreciate the specialists who treat a condition than to complain about the absence of the expertise or policy that could have helped to prevent it.

The childhood obesity strategy was the first test of the government’s determination to take action on health inequality. It was greeted with near-universal dismay because of the wasted opportunities to make a difference. Whole sections from earlier drafts, covering promotions and advertising, were conspicuously erased and reformulation yet again left to ineffective voluntary agreements. The final paragraph sums up the tone that it will be “respecting consumer choice, economic realities and, ultimately, our need to eat”. This crass statement entirely misses the point; of course children need to eat, but the childhood obesity strategy needed to make sure that they benefitted from a better diet.

Five years ago, amid the huge controversy surrounding the Health and Social Care Act, one proposal received a cautious welcome: the transfer of responsibility for public health from the NHS to local authorities. It was felt that local authorities could make a greater difference to the health and wellbeing of their communities if the right expertise, powers and funding were based there rather than within a health service more focused on treatment than prevention of disease. In a report published today, the Commons health select committee has looked at those changes and made a number of recommendations about how public health could be strengthened to make sure that it has the tools to do the job. These will be key to helping to narrow health inequalities.

The chief executive of the NHS, Simon Stevens, has rightly called for a “radical upgrade” in public health and prevention, not only for the benefits to health but because it will be essential to reducing future demand for health services. The future financial sustainability of the NHS depends on the prevention of more expensive long-term conditions. This was not the time to undercut the role of public health with budget reductions, including in-year cuts. Witnesses before the committee described their extreme frustration at these decisions, which they described as “irrational” given the current focus on reducing demand.

While local authority public health teams are doing their best to cope with funding cuts, the potential impact of this was clear, and unsurprising – figures from a survey conducted by the Association of Directors of Public Health show that large proportions of local authories are already having to reduce a wide range of different public health services.

Messages on improving health are drowned out by the unfettered advertising and promotion of junk food and alcohol

Perhaps more surprising was that we heard from witnesses – both from local authorities and from NHS organisations – a sense that prevention is no longer seen as the responsibility of people practising in the NHS. While local authorities now hold the ring for funding and co-ordinating public health and preventative work across their local area, every NHS professional has the potential to advance the prevention agenda in every patient appointment they carry out – but they will also need the time and space to do so. It is also a shame that those messages on improving health will continue to be drowned out by the unfettered advertising and promotion of junk food and alcohol.

While the local mechanisms are in place to embed health in all policy decisions, this will not succeed without stronger, more joined-up action at a national level. At a time of budget cuts it is more important than ever that local authorities have the levers to make a difference. Unfortunately, they have their hands tied when it comes to negotiating with business interests even where the health of local communities is at stake. The government could and should introduce health as a material consideration in planning and licensing to allow proportionate action to develop healthier communities, homes and workplaces.

I hope that the government will prioritise health inequality, but the early signs are not encouraging. If future policy is to be judged by the childhood obesity “plan”, we can expect little real progress. Tackling health inequality requires far more than warm words on education and personal responsibility.

Public health is in crisis – and Theresa May is failing to act | Sarah Wollaston

20 Reasons You’re FAILING To Lose Weight

We can all agree to that losing weight is not easy. In fact, most people never attain their weight goal, and some who do, end up regaining the weight.

Folks usually blame metabolism, but most of the time that’s not the problem. The truth is dieters make diet or exercise mistakes that hinder them from reaching their ideal weight. Today we’ll look into 20 common weight loss mistakes and how you can avoid them.

1. Underestimating calorie intake – studies show that most dieters (even experts) underestimate the number of calories in a meal. Counting calories will help you avoid this.

2. Overeating on holidays – according to research, most people are not able to lose the weight gained during holidays. Avoid overindulging during holidays to prevent unwanted weight gain.

3. Late night snacking – studies show that late night snackers gain more weight than folks who don’t eat at night. Set a rule not to eat past a certain time. And keep all unhealthy snacks out of the house.

4. Hormonal imbalances – in recent years researchers have discovered that our hormones have an impact on weight loss. Use these methods to keep your hormones balanced.

5. Extreme calorie deficits – maintaining extreme calories deficit long term can mess up your metabolism and hormones. Maintain a deficit of not more than 25 percent of your total calorie intake.

6. Cheat days – while cheat days are a great way to maintain your sanity while dieting, most people abuse them. The calories from cheat days can quickly add up and cause weight gain. I’d suggest you forget about cheat days.

7. Overeating on the weekends – if you’re like most people, your weekend starts on Friday afternoon. That’s when you start eating junk and boozing. Make a habit of eating healthy on the weekend and you’ll lose weight consistently.

8. Consuming too much vegetable oil – this is especially true for folks who eat in restaurants (even healthy restaurants). Vegetable oils might make the food tastier but they’re very high in calories. Note that excess intake vegetable oil can lead to lots health problems.

9. Relying on herbs for weight loss – you may not want to hear this but herbs won’t magically melt away the excess flab. You have to eat unprocessed foods, maintain a calorie deficit and exercise.

10. Excess sugar consumption – not only is sugar harmful to your health but it’s also packed with lots of calories. Reduce the intake of table sugar and avoid foods with added sugar.

11. Binge eating – binge eating is a big challenge for most dieters. Seek professional help if you have this disorder because it can make it impossible for you to lose weight.

12. Jumping from one diet to another – The average dieter has tried more than 4 diets. Most people don’t realize that what works for someone else might not work for them. Stick to eating habits you’re comfortable with and work on improving your weaknesses.

13. Lack of quality sleep – research has associated lack of sleep with weight gain. Make sure you get 8-9 hours of quality deep sleep every night.

14. Excess alcohol consumption – not only is alcohol high in calories but it also hinders fat oxidation. If you have to drink, go for spirits like gin and vodka since they’re low in calories.

15. Calories from beverages – calories from sodas, energy drinks and juices quickly add up and cause weight gain. If you have to drink beverages make sure you account for them in your total daily calorie intake.

16. Overestimating calories burned during workout – exercise doesn’t burn as many calories as most people think. Most workout machines give wrong readings. I’d recommend not to consider calories burnt during workout when tracking your calories.

17. Mindless eating – eating mindlessly leads to overeating and bingeing. Always focus on your meals, eat slowly and put food in plates, even if it’s nuts or snacks.

18. Not having a meal plan – a meal plan is one of the most important weight loss tools. It’ll guide you on what to eat and prevent you from opting for junk food.

19. Eating processed foods and junk – Processed foods and junk foods are high in calories and usually lead to bingeing. Stay away from them.

20. Not doing strength training – Strength training helps increase lean muscle mass, boost metabolism and enhance fat loss. Both men and women need it.

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20 Reasons You’re FAILING To Lose Weight

I"m an NHS ambulance dispatcher and I know my service is failing you

If you were to call for an ambulance, most of you wouldn’t realise I exist. I’m an ambulance dispatcher, which is different to the call handlers you speak to over the phone.

Even though I rarely speak to callers directly, it is a stressful job. We are under incredible pressure to send the right resource to the right patient, hit government waiting-time targets, and deal with paramedics on the radio who often forget how many calls we are juggling every day.

When your call comes in, it is coded via a computer system. If it’s red 1, that means cardiac arrest. Red 2 could mean chest pain, breathing problems, fitting, or an unconscious patient. We try our best to get the nearest resource to you as quickly as possible and are set a target by the government to be on the scene within eight minutes of these most serious calls. We don’t always manage that.

Other calls will be categorised in the green 1 or 2 category – this might be falls with an injury, broken bones, road traffic collisions, headaches, or bleeding, for example. In most cases, these requests for help are held with me until I can allocate an ambulance. If your call is categorised as a green 3 or 4 – this might be non-injury falls, abdomen pain, headaches – you’ll most likely get a call back from a clinician to arrange the most appropriate help. Heartbreakingly, if you’ve fallen, that means you could wait on the floor for hours before we manage to send someone to help.

There is a shortage of resources and the unions that represent paramedics put even more pressure on dispatch teams. They argue that a paramedic who will have to work 30 minutes past the end of their shift to see the patient and potentially take them to hospital should not have to take an emergency call. This means that some may not go on a call for the last hour or more of their shift. We might have to send a team that’s an hour away, when there is an available ambulance much closer, because of such rules.

Our guidelines state that we should rarely use paramedic cars for less serious calls – they should mainly be used for red 1 and 2 calls that are subject to government targets. But an incident that was initially low risk can easily become more serious, and this delay in sending help is having dire consequences. We continue to see an increase in fatalities from calls coded as green once our crews arrive.

These incidences are not reported on, because there are no targets for these calls. Every time it happens, we dispatchers are left wondering if we did everything we could, if we could have found a car to send to you sooner. If we had done so, perhaps you or your relatives would have had a better chance. Paramedics will often get feedback when there is a serious incident, but we rarely hear anything. We also never see changes implemented to prevent such incidences in the future.

The pressure in my control room has become so severe that it is damaging staff wellbeing. Our concerns for patient care are rarely listened to by management and the overall morale is incredibly low. There’s a high turnover of staff and many of my colleagues end up off sick with stress.

I’m an NHS ambulance dispatcher. I am overworked and undervalued. I try to do my best for you, but I’m sorry my service often fails when you need it the most.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

Talk to us on Twitter via @Guardianpublic and sign up for your free weekly Guardian Public Leaders newsletter with news and analysis sent direct to you every Thursday.

I"m an NHS ambulance dispatcher and I know my service is failing you

The global community is failing to address mental health

When it comes to mental health, the global health community has failed.

Mental, neurological, and substance-use disorders are among the leading causes of the global burden of disease. By 2020, depression will be the second leading cause of disability. Suicide is a leading cause of death among adolescents. People with severe mental disorders die decades earlier than others in their community and face grievous forms of discrimination and abuse.

Most governments spend less than 1% of their health budget on mental health.

Our failure in the global health community is that we have left large proportions of those affected, up to 90% in some low-income countries, without access to even basic mental health care from which they can greatly benefit. Most governments spend less than 1% of their health budget on mental health, a figure also reflected in international development assistance for health. The consequences are grave, not only for the mental health of the individuals affected, but also for their physical health and the wellbeing of families and society at large.

This unmet need for mental health services is greatest among populations affected by conflict and displacement. Our world is currently in the midst of the worst humanitarian crisis since the second world war. But the violence does not end even when people flee the conflict zones. In refugee camps in Greece last month, we saw hundreds of Syrian children too afraid to leave their tents to play, frail elders on a hunger strike to protest abominable living conditions, and suicides that could have been prevented. Similar conditions can be found in refugee camps set up by the Australian government in small Pacific island nations. Millions who have faced some of the worst imaginable adversities and atrocities are exposed to further adversities, including denial of freedom and hope – conditions that undermine mental health among even the most resilient.

Related: The diaspora groups bringing aid to Syria: ‘This isn’t a job, it’s now our life’

Facing an acute shortage of funding and resources, we must act creatively to ensure better mental health outcomes. The most important first step is ensuring that refugees are getting sufficient access to basics such as food. Actively working to normalise the appalling situations experienced by these populations – for example, by ensuring schooling for children and enabling work for adults – is a good strategy to promoting mental health.

But we can also look at some more creative approaches. Turning to community-based, non-professional providers to deliver psychosocial interventions can address the acute shortages of mental health professionals. This has been effective in low-resource settings such as Uganda, Pakistan, and India and recently proven more cost-effective than standard treatment.

Through short skills-focused trainings, simplifying complex treatments, peer supervision, and using models of illness which are consistent with the experiences of refugees, we can empower lay people in refugee communities to provide frontline psychosocial interventions. Those specialists who are available can design and oversee mental health programmes, as well as train, supervise, and support refugees in using evidence-based techniques to promote resilience and alleviate mental health distress in their own communities. This not only enables greater access to mental health services but, importantly, calls for the harnessing of personal and community resources, thereby giving refugees a sense of empowerment at a time of severe disempowerment.

Related: Unaccompanied child refugees: ‘These children aren’t seen as children’

Ultimately, however, there needs to be a structural revision in how those fleeing violence and conflict are welcomed and integrated in safe countries. The cost of doing nothing is immense. Untreated, the impact of conflict on mental health can endure for years, and over generations, at great cost to society. With more than 60 million people displaced by war, conflict, or persecution, now is the time for the global health community to wake up and realise what’s at stake if we keep ignoring mental health.

Laila Soudi is a researcher at Stanford University School of Medicine and director of mental health at the Syrian American Medical Society. Vikram Patel is Wellcome Trust principal research fellow at the London School of Hygiene and Tropical Medicine and co-founder of Sangath.

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.

The global community is failing to address mental health

Watchdog will get new powers to near failing care residences

Last month a serious case overview into Orchid View care home, in West Sussex, in which 19 residents suffered unexplained deaths, said independent care home providers need to be subjected to far better scrutiny.

The new scheme will cover 25,000 care residences and suppliers of residence care, this kind of as domestic home-helps.

From April, care services rated as inadequate face following Ofsted-style inspections can be given a constrained time period to make improvements. If they fail to increase, the Care Good quality Commission will be capable to near them down.

Mr Hunt is expected to describe Mid Staffs as a “wake up call” from which the total wellness and care sector should learn.

“Getting discovered from the schooling system, we brought in some of the very best individuals in the organization with the knowledge and dynamism necessary to inspire a various culture,” he will say.

Mr Hunt will say hospitals have tackled “deep-rooted failings” for the 1st time and that the care property sector demands up to face up to its difficulties in the exact same way.

Last evening CQC mentioned two of the trusts, Basildon Basis trust and George Eliot NHS believe in had produced a “remarkable turnaround” in a yr, and now had an total rating of “good.”

Medway trust in Kent- which last week acquired a damning report from regulators – is the only one of the eleven which is identified has obtaining created no progress.

Investigations by The Telegraph identified the hospital has been paying out at least ten senior managers on costs of at least £200,000 a yr, in spite of a shortage of 120 nurses.

Buckinghamshire Healthcare trust and East Lancashire believe in are now out of particular measures, although North Lincolnshire and Goole trust is suggested to comply with shortly. United Lincolnshire and Goole Hospitals Basis believe in, North Cumbria university Hospitals trust and Tameside trust have been all located to have created progress , but will stay in unique measures, with selections awaited on Burton Hospitals Basis believe in and Sherwood Hospitals Basis trust.

Watchdog will get new powers to near failing care residences

Hospital believe in regime extended to failing care properties

Care homes will face a ‘tough’ new inspection regime from October, and providers rated inadequate face getting place into specific measures. Photograph: Alamy

Failing care properties could be place into a comparable failure regime as bad-carrying out hospitals, the wellness secretary is to announce.

Jeremy Hunt will say that most of the hospital trusts that were place into unique measures a 12 months in the past have proven substantial improvements as he announces that the initiative is to be rolled out to incorporate care properties and residence-care services.

If these companies fail to make improvements they could then face getting shut down, Hunt is to announce.

Placing hospital trusts in specific measures was a move introduced as part of the government’s response to the Stafford hospital scandal.

Mid Staffordshire NHS basis believe in was at the centre of a key public inquiry after it was found that poor care could have led to the deaths of hundreds of patients as a result of maltreatment and neglect. The inquiry highlighted the “appalling and pointless struggling of hundreds of men and women” at the believe in and probes into the occasions there uncovered that several patients were left lying in their very own urine and excrement for days, forced to drink water from vases or provided the wrong medication.

A 12 months ago, following a review into 14 other hospital trusts with greater than expected death charges, 11 trusts were put into special measures for a catalogue of failings and fundamental breaches of care.

Now the Care High quality Commission’s (CQC) chief inspector of hospitals, Professor Sir Mike Richards, has said that since the trusts had been place into the failure regime, most have shown major improvements in leadership, patient security, compassionate care and personnel engagement.

Following inspections, 5 of the trusts have been, or are expected to be, taken out of unique measures, he mentioned.

4 have made enhancements but will be kept in the regime for an “extended time period”, and choices on the ultimate two will be announced later on in the week, he explained.

Hunt will make a statement to parliament outlining the progress that has been manufactured in addressing the failings.

He will also announce the roll-out of the scheme into care residences and property-care solutions.

From October these companies across England will encounter a “tough” new inspection regime, he will say.

The services that are rated inadequate face getting put into specific measures and if they fail to make enhancements following this they could be shut down, he will add.

“Mid Staffs was a wake-up phone that uncovered how staff in a minority of isolated hospitals believed bad care was somehow standard and acceptable,” he explained.

“Thanks to a sharp target on admitting difficulties rather burying heads in the sand, some of these hospitals have tackled their deep-rooted failings for the 1st time and are on the road to recovery. Everyone desires to know they can get risk-free, compassionate care from their regional hospital.

“The massive distinction special measures has created is that considerations of patients and personnel are listened to and acted on swiftly.”

Professor Sir Mike Richards explained: “We have witnessed significant enhancements in practically all of the eleven trusts that had been place into specific measures, with excellent progress in two trusts and really very good progress in a additional 3. The hard perform by believe in employees that has underpinned this progress must be recognised.

“Specific measures brings a new target on good quality improvement in trusts that have previously struggled to provide substantial high quality care.”

Hospital believe in regime extended to failing care properties

We are failing our frightened young children, leaving them with no a single to speak to| Rhiannon Lucy Cosslett

‘One in seven councils in England have been deemed by Ofsted to be failing vulnerable youngsters.’ Photograph: Alamy

What do you do if, aged twelve, you discover your self feeling hopeless and terrified of the planet around you? To whom do you flip? Melvyn Bragg has uncovered that his struggle with depression started at this age. “I had clinical depression but I did not know who to speak to,” he explained. “I never think anybody who has not been through depression is aware of what it truly is like to be frightened out of your thoughts each and every day from the second you wake up to the moment you go to rest.”

A kid with such feelings is clearly in need of urgent support from grownups, but for many, all these years soon after Bragg 1st struggled, help is still not forthcoming. These who operate with youngsters know this, and have been calling urgently for an overhaul of psychological overall health providers. The charity Children Business has launched a campaign referred to as “See the little one. Change the program”, supported by some of Britain’s foremost children’s authors – they are shocked that a single in 7 councils in England have been deemed by Ofsted to be failing vulnerable children. The mental health charity Young Minds is also campaigning, following a freedom of data request that revealed sweeping freezes and cuts to mental overall health service budgets for children and youngsters.

Voices are rising, but whether politicians will pay attention is an additional matter. Children Business founder, Camila Batmanghelidjh, has explained vulnerable young children are “relegated to the bottom of the political pile”, and social staff describe getting unable to supply adequate assistance due to cuts. Childline stated that reviews in self-harm in 2013 had risen by 41% from 2012, even though reviews of suicidal ideas increased by 33%.

Media retailers are quick to blame social media for the deterioration in children’s mental health – an effortless, practical scapegoat. There has been a amount of broadly reported suicides of shockingly youthful children who had been bullied online, foremost to rampant speculation. But no matter what the perceived causes, we know that to leave a vulnerable kid unassisted can lead to the really worst of outcomes. If the youngster survives their formative many years with no appropriate help, they can be left to struggle with mental health issues all through adulthood.

Given the dearth of providers, youngsters and households come up with other coping mechanisms. Lately, whilst getting a clear-out, I came across a small yellow box inside of which have been five worry dolls. Originating in Guatemala, be concerned dolls are vessels for a child’s nervousness – the child talks to them, tells them their fears, then spots them below their pillow. It struck me that I had spent my childhood surrounding myself with talismans in an energy to fight the reality I was scared and anxious all the time. There had been dream catchers to cease the nightmares, comfort blankets cuddled way previous the acceptable age, a present of worry beads (there was a lot of fear) in an try to get me to quit selecting at my skin compulsively until finally it bled.

Twelve was the worst year. My mother and father split up, I was being viciously bullied, and it was turning into clear that my brother, then 6, was so severely disabled he would never ever lead a normal daily life. My mum tried several times to get me counselling, and even though our household was acknowledged to social providers the waiting listing was limitless. I’m most likely nevertheless on it.

I resorted to books, angry music and writing horrible poetry Melvyn Bragg buried himself in schoolwork. Other folks use medication or alcohol. None of these is adequate. In hindsight, I realise I talked a lot more to people fear dolls than I ever did to an grownup, and that is what it all boils down to. The country’s grownups are failing kids – children far worse off than I ever was – and unless we do one thing now, we will proceed to allow them down.

We are failing our frightened young children, leaving them with no a single to speak to| Rhiannon Lucy Cosslett

Paramedic left heart assault victim to die 4 many years right after failing to spot toddler"s fatal injury

The North West Ambulance Services paramedic only assessed the toddler for 15 minutes and explained he did not want urgent hospital treatment.

Even so for the duration of the evening, the toddler misplaced consciousness and died with a 56-gram blood clot soon after Orme failed to advise the toddler’s parents to check out on their son at normal intervals for the duration of the evening.

The paramedic then had to go before the Wellness Professions Council (HPC) in 2010 and obtained a four-yr caution but was permitted to proceed treating individuals.

The panel ruled he was not responsible for the toddler’s death.

In the situation of Mrs Davies, Orme made a decision to quit as a paramedic and prevented a 2nd disciplinary hearing by removing himself from the register of approved health-related pros.

Orme admitted to a series of failings prior to the Tuesday’s hearing and wrote to the HPC panel asking to be struck off the register.

The allegations which Orme admitted to in the course of his employment incorporate failing to supply adequate care, failing to enquire about Mrs Davies’s past health care history and leaving her with junior workers despite her essential issue.

He also admitted to failing to perform an ECG, which can aid detect issues with heart fee or heart rhythm, as nicely as failing to travel with the patient to hospital.

The paramedic admitted to leaving the scene ahead of the ambulance went to the hospital and failing to give an adequate handover to the attending crew.

Orme has agreed not to apply to be readmitted to the HCPC register.

HCPC panel chairman Helen Carter explained a full hearing was not in the public interest, and would danger upsetting family members of Mrs Davies.

Ms Carter said: “The balance falls in favour of permitting the voluntary removal, especially as there is an unequivocal admission of the allegations and it will be known that Mr Orme will no longer be on the paramedic part of the HCPC register and will no longer be ready to practise as a paramedic.”

She extra elements of the hearing would have been limited to go over Orme’s overall health troubles.

A spokesman for North West Ambulance Service said: “We provide our sincere condolences to the households of the sufferers concerned in these incidents and value that occasions such as this hearing must be a challenging time for them.

“In line with Trust policies and procedures, the workers member and his carry out was entirely investigated, resulting in the elimination of paramedic standing inside of the Trust and referral to the HPC. We will take into account the suggestions and outcomes from the hearing.”

Paramedic left heart assault victim to die 4 many years right after failing to spot toddler"s fatal injury

Wounded soldiers failing to receive the care they are entitled to

The Division of Well being has responded to the warning by saying that from up coming 12 months every single part of the country will have GPs specially educated to react to the bodily and mental overall health needs of veterans.

“Veterans are now entitled to priority accessibility to NHS care when their medical condition or care relates to their time in the Armed Forces, and we’re investing £22 million to help veterans bodily and mental health as well as funding 24 professional veterans prosthetics centres,” a spokesman explained.

“From summer 2015 there will also be a expert GP in each regional area trained in the physical and mental health demands of veterans.”

Prof Briggs has recommended that personnel serving complete-time are handled inside of 6 weeks and those who have retired from services are noticed inside twelve weeks. At the moment there is an 18-week waiting time target for civilians.

In a foreword to the report, the Duke of York writes: “This will boost care for all individuals and provide a extremely significantly much more constant strategy to rehabilitation. Without a doubt, some of my fellow Falklands veterans – often forgotten by the program – are living confirmation of the urgent want for this.”

Prof Briggs’s overview, acknowledged as the Chavesse report after Captain Noel Chavesse, a medical professional who was awarded the Victoria Cross twice in the course of the 1st Globe War for treating injured soldiers, is anticipated to discover:

·  There is nevertheless some lack of connection between the MoD and the NHS, particularly in rehabilitation. This results in a fragmented service and dangers serving personnel, reservists and veterans falling into “no man’s land”

·  When services personnel are discharged, the NHS gets to be the sole supplier of their on-going care. There is a threat that they will not acquire on-going care in a timely method

·  Variable and patchy rehabilitation signifies veterans might miss clinical consultations and get misplaced in the method

·  It is presently impossible for NHS systems to recognise serving reservists and veterans in order to ensure quickly tracked care for them

·  Both clinicians and veterans appear unaware of the Covenant and its implications for their care. As a consequence, veterans frequently neglect to inform the GP that they are an ex-serviceman and do not supply the GP with their discharge report.

Dr Dan Poulter, the well being minister, said: “Veterans are some of our bravest and very best and the entire country has a moral obligation to support them. By generating a specially educated GP available to each nearby region we are continuing to prioritise help for our veterans’ physical and mental wellness.”

Wounded soldiers failing to receive the care they are entitled to

NHS "failing disabled and significantly sick teenagers" transferred to grownup solutions

Prof Field stated a single young patient informed him she had stopped making use of adult providers as she felt the attitude towards her was ‘poor and patronising’. Photograph: Alamy

The NHS is failing disabled and seriously sick teens by depriving them of essential companies this kind of as ache relief when they grow to be adults, the service’s watchdog warns right now.

In a highly vital report published on Monday the Care Quality Commission (CQC) castigates doctors and hospitals for leaving vulnerable young folks baffled and stressed when they begin becoming cared for as grownups by different wellness professionals.

Too numerous of the 40,000 beneath-18s in England with complicated and tough well being wants end up dropping access to key solutions they have relied on considering that childhood – this kind of as help with their mobility, breathing and swallowing – as they undergo what can be a quite challenging “transition” to becoming handled as grownups, the CQC says.

They contain younger individuals with often profound bodily disabilities, continual situations this kind of as diabetes and existence-threatening illnesses this kind of as cystic fibrosis.

Prof Steve Field, the CQC’s chief inspector of main health-related solutions and integrated care, said: “This report describes a wellness and social-care technique that is not functioning, that is letting down desperately unwell youngsters at a critical time in their lives. We have put the interests of a method that is no longer match for function above the interests of the men and women it is supposed to serve.

“In an age exactly where individuals can obtain organ transplants, keyhole surgeries and targeted cancer therapies, it really is actually disappointing that the standard care needs of many young folks with physical disabilities and other prolonged-phrase well being requirements are not currently being met,” added Area, a GP and ex-chair of the Royal University of GPs.

The CQC’s evaluation of care for this kind of younger men and women prior to, during and following the switch to grownup companies identified a host of troubles. They incorporated that “Some children’s health or treatment companies stopped at sixteen but there was no grownup support available right up until they had been 18. This resulted in crucial care getting efficiently withdrawn,” the report says.

The overview, based on the knowledge of 180 young individuals aged 14 to 25 or their dad and mom, identified that “from the standpoint of a lot of households we spoke to, transition by means of health was un-coordinated and often sudden. For some, it caused excellent tension and nervousness.”

In addition, current national advice on how to assistance them is typically ignored or medical professionals are unaware of it. Discipline also found “inconsistent and often poor details and planning from children’s services for younger individuals and their dad and mom about the changes they can expect as they move into grownup solutions. This led to a lack of comprehending of the method of transition.”

One particular parent summed up their child’s transfer to adult health care companies by saying: “From the pond, you are picked up and put in the sea.”

Area explained that a single youthful girl he had spoken to had felt so badly handled by adult providers that she stopped using them. “As a youngster she was being taken care of as a human getting whereas when she was transferred to grownup providers she felt the frame of mind in direction of her was poor and patronising,” he stated. As well many hospital doctors’ attitudes towards younger people who had transferred into their care was “outdated and paternalistic”, he explained.

Anna Bird, head of policy and research at Scope, the disability charity, explained: “Several young disabled people uncover that their good quality of lifestyle can ‘nose-dive’ when they move from childhood solutions into the adult world. They struggle to get their health demands met but also to find perform, to proceed their training and to discover a ideal place to live.”

Prof Gillian Leng, the deputy chief executive of the Nationwide Institute for Overall health and Care Excellence (Good), stated that “for a lot of young people on the cusp of adulthood, moving among overall health and social-care solutions can be a tumultuous and nerve-racking time. A poor transition between youngster and adult solutions can have a profound and prolonged-lasting unfavorable influence on a person’s existence.

“The last thing we want is for young people to fall between the gap in little one and grownup services and not get the support or care they require.” Her organisation is drawing up new advice to assist remedy the issues identified.

Area stressed that the CQC had uncovered some examples of excellent care. Even so, the NHS needed to undertake urgent technique-broad change, with GPs taking part in a essential part in smoothing the transition process, he stated.

NHS "failing disabled and significantly sick teenagers" transferred to grownup solutions

Government failing on violence reduction scheme by means of A&E departments

A violence reduction sheme involving A&ampE departments sharing anonymised data with police has not been fulfilled. Photograph: Bethany Clarke/Getty Images

Ministers are failing to fulfil a coalition pledge to roll out a violence reduction scheme that has been proven to reduce attacks by as much as 40%, top accident and emergency surgeons claim.

The Tories and Liberal Democrats agreed in 2010 to introduce the nationwide scheme, which involves A&ampE departments sharing anonymised data about violent incidents with police forces, enabling problem spots to be targeted.

But as handful of as a third of A&ampE departments in England have completely adopted the programme, which was pioneered in Cardiff 20 many years ago and has been copied as far afield as South Africa and the US.

Department of Wellness officials have created it clear that A&ampEs ought to share info with police, but a spokesperson admitted it basically did not know how a lot of hospitals have been working the model. It is undertaking a assessment this summer season to discover out.

Dr Adrian Boyle, chair of the good quality in emergency care committee of the University of Emergency Medication (CEM), said he was annoyed at the lack of progress. “The implementation is not functioning as effectively as we would have liked,” he mentioned. “It is aggravating.”

Boyle, an A&ampE consultant who has worked closely with the Division of Wellness and NHS England to get the system up and running, referred to as for the government to give hospitals incentives to introduce the scheme. He mentioned there was a wariness within hospitals about workers to liaising with experts “out of their silo”. The reorganisation of the NHS may possibly also have hampered the programme, he said.

An audit two years in the past discovered two-thirds of A&ampE departments were not sharing information to the standard advisable by the CEM. Boyle mentioned he did not feel the new audit would present any progress.

The architect of the unique Cardiff scheme, Jonathan Shepherd, professor of oral and maxillofacial surgery at the Cardiff school of dentistry, expressed concern at the slowness of the adoption of the model.

He mentioned there was even now as well great an acceptance of “schedule” street violence. “Folks grow to be immune to the concern and the social catastrophe it represents. For health-related personnel, police and local authority employees it becomes a schedule portion of what transpires when you’re on shift at the weekend.

“Pros are used to getting reactive, suturing folks up and arresting offenders rather than taking a a lot more preventative approach. I’m not shocked it is taking some hospitals so prolonged [to adopt the Cardiff model] and others aren’t doing it properly.”

Shepherd’s thought stemmed from research he did in the 1980s which located only a quarter to a third of violent incidents resulting in a journey to A&ampE come to the interest of the police. He realised that for forces to have a full image of what was happening they ought to know about all situations of emergency treatment.

His scheme – the Cardiff violence prevention programme – launched in 2003. Hospital personnel recorded anonymised information of where, when and how a victim had been attacked. This info was shared, making it possible for maps of violence hotspots to be developed and the organisation of operations to tackle the problem.

The outcomes were striking. Inside 5 years there had been an estimated 42% fewer woundings in the Welsh capital in contrast with similar cities.

There was a 35% decrease in the number of sufferers seeking emergency treatment method and one particular study place the savings in economic and social expenses at just below £7m a 12 months. For every £1 invested on the scheme, £82 was saved.

Shepherd mentioned he realised the scheme was working when the price of violence in Cardiff, a well-liked get together city, dropped to amounts noticed in towns this kind of as Eastbourne and Harrogate. Shepherd advised the government essential to do more to fulfil its coalition agreement guarantee. He explained: “In the runup to the 2015 election I feel people will want to be reassured that this government commitment has come to fruition.”

Shepherd’s model or variations of it are in place in Amsterdam and the Western Cape in South Africa. Milwaukee in the US has also been investigating it.

Alun Michael, a former Labour minister and now police commissioner for south Wales, was also surprised that a lot more hospitals had not adopted the model. “Analysing incidents which brought victims of violence to A&ampE has led to considerable and sustained reductions in the variety and seriousness of violent incidents,” he said.

Gary Smith, the director of Cardiff Street Pastors, which assists keep revellers safe in the city centre on Friday and Saturday nights, said he had noticed a big difference in the city in excess of latest many years. “It feels a secure, area to be now. I feel that’s partly because everybody performs collectively so nicely now.” Michael and Smith each explained the programme in Cardiff had led to a wider cultural shift with companies far more utilised to functioning closer and better together.

South Wales police created it clear it believed the scheme was worthwhile. A police spokesperson mentioned the scheme had produced a “important contribution” to the reduction in violent crime. “It is an superb illustration of how partnership perform in Cardiff is producing a genuine big difference to retaining our communities protected.”

There are examples that display the scheme has worked nicely in other places the place it has been adopted. In some, violent crime has fallen by 40%. In Cambridge, for example, analysts realised foreign college students had been being injured on Monday evenings after Addenbrooke’s hospital shared info. Officials found that drinks promotions aimed at foreign students were currently being offered by bars. The premises have been told they must end such promotions.

In the south-east of England, people began attending an A&ampE having been hit by planks of wood and bricks. The information was passed on and council officials realised an open skip had been left close to a nightclub. Such skips had been banned from the area.

Mark Bellis, who advises the World Wellness Organisation on violence prevention who has implemented a productive info sharing scheme in the north west of England, said there remained a reticence in some locations to take it up. “It can function phenomenally well but some are reluctant since of the investment and the time.”

Caroline Shearer, of the anti-knife campaign group Only Cowards Carry stated the government essential to do a lot more to tackle violent crime – like generating sure hospitals shared information.

“The government talks challenging, it demands to act difficult,” she said.

A spokesperson for the Department of Overall health mentioned: “We have been clear A&ampE departments should share details with police and we are about to assessment compliance ahead of the rollout of a new legal regular which all key A&ampEs will be obliged to meet. We’re also supporting hospitals to train nurses to specifically champion this.”

Government failing on violence reduction scheme by means of A&E departments

Failing to brush your teeth could improve risk of heart attack

“Our hope is that the American Heart Association will acknowledge causal backlinks in between oral ailment and elevated heart condition.

“That will adjust how physicians diagnose and deal with heart condition sufferers,”

Gum disease is a widespread situation exactly where the gums grow to be swollen, sore or infected.

It is estimated to impact a lot more than half of all grownups in Britain to some degree and most folks encounter it at least once in their lives.

Despite the fact that earlier research have proven back links amongst gum condition and heart ailment, it was imagined this could be basically a signal of an unhealthy lifestyle and a large sugar diet program.

In the most recent review, nonetheless, researchers infected mice with 4 certain bacteria – Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum – that lead to gum ailment and tracked their spread.

The investigation is element of a more substantial research on the effects of gum condition on overall health currently being performed in the laboratory of Kesavalu Lakshmyya in the University of Florida’s Department of Periodontology.

Physician Kesavalu mentioned: “In Western medicine there is a disconnect between oral health and basic wellness in the rest of the physique Dentistry is a separate discipline of examine from Medication.

“The mouth is the gateway to the physique and our information provides one much more piece of a increasing entire body of study that factors to direct connections between oral well being and systemic wellness.”

Cardiologist Alexandra Lucas, of the University of Florida University of Medicine who is a co-investigator in the research, explained: “Our intent is to improve physician awareness of back links amongst oral bacterial infection and heart ailment.

“Understanding the relevance of treating gum ailment in patients with heart illness will lead to potential studies and recommendations for cautious attention to oral overall health in order to safeguard patients towards heart illness,”

Failing to brush your teeth could improve risk of heart attack

Kid psychological health providers "failing 3-quarters of kids"

Assessments for circumstances such as autism are below risk. Photograph: Stephen Voss/Alamy

Only a quarter of youngsters with psychological well being problems are receiving the treatment method they want, according to a study produced by the body charged with bettering the well being services in England.

An inner presentation, made by NHS England and shared with the Observer, paints a picture of a services in crisis, in accordance to one particular charity, due to the fact of spending budget cuts and growing demand. It notes that “multiple critiques have recognized the identical troubles”.

The report also provides proof that, as a outcome of a rise in younger people needing treatment method for complex mental wellness problems, assessments for problems this kind of as focus deficit hyperactivity disorder (ADHD) and autism are being delayed, even though other individuals are not currently being recognized or handled. The presentation says that 35% of grownups with anxiety or diagnosable depression are not in get in touch with with mental health companies, but this rises to 76% of those aged five to 15. It notes that only six% of paying on mental wellness goes on solutions aimed at children and young individuals, even however 50% of lifetime mental illness commences by the age of 14.

The analysis – carried out more than in the past 3 months – will raise concerns that a service that is currently failing to meet the demands of many customers is getting reduce additional, and will help claims that youthful people are currently being hit by a double whammy: psychological overall health is a “Cinderella support” compared with physical circumstances and inside of that support younger men and women do not get the same degree of attention as adults.

The presentation reveals that cuts are increasingly getting reported in spots such as south-west London. It says the Maudsley Youngster and Adolescent Psychological Well being Services reviews cuts across its London boroughs ranging from 17% to 38%, and quotes the considerations of mental wellness teams across the nation.

1 crew said that its £1m spending budget was to be slashed by £300,000 from up coming yr. As a result, it was obtaining to draw up ideas to turn out to be an urgent assessment and urgent remedy support only.

Professionals would be unable to deliver the treatment for which they had been educated. One more acknowledged that its specialist and early intervention providers were getting dismantled.

A third mentioned that an increase in both schedule and emergency presentations had left it with no selection but to give priority to clinical danger instances more than routine adhere to-up exercise, such as assessments for ADHD and autism.

The document quotes statistics, which reveal that in England there is only one psychological wellness professional per thirty,000 young folks below twenty, compared with one per five,300 in Switzerland, 6,000 in Finland and seven,500 in France.

A recent survey by YoungMinds, a mental overall health charity, located that two-thirds of nearby authorities had minimize their budgets for younger people’s mental wellness.

“For all the welcome policy announcements from government about youngsters and youthful people’s psychological health, the picture on the ground for a lot of kids, younger men and women and their families is of solutions in crisis,” stated Sarah Brennan, chief executive of YoungMinds.

“The cuts to early intervention companies are now triggering serious pressures on inpatient beds. It is verging on inhumane for kids and younger men and women to finish up, as they do now, being shipped hundred of miles across the nation for the nearest bed, held in police cells or placed on unsuitable adult wards. We ought to be ashamed of the paltry help and care we assign to the psychological overall health of kids and younger men and women in this nation.”

The presentation explains that a database mapping psychological well being provision for young people was “discontinued post April 2010″.

“The final national review was completed ten years ago and so we have no up-to-date nationwide data on the numbers of kids and young individuals with mental wellness troubles,” Brennan said. “Organizing service provision without having recent information is very tough, fraught with hazards and not price-effective.”

The acute strain on the program will have repercussions later on, the presentation warns. It claims that social emotional programmes – used to deal with “perform disorder” (a lot more frequently acknowledged as antisocial disorder) in young young children – conserve the NHS £84 for each pound spent.

Dr Jacqueline Cornish, NHS England’s nationwide clinical director for kids, younger people and transition to adulthood, said: “We should make positive kids and young people get the correct care from the proper person as quickly as achievable.

“We are especially investing £17.4m to boost earlier intervention, diagnosis and remedy of mental well being issues in underneath-18s, as we know that this is the most productive and effective way to tackle psychological overall health problems.”

But Enver Solomon, director of proof and influence at the Nationwide Children’s Bureau, stated that young children and younger people’s mental well being had not obtained the “financial and political priority” it deserved for far too lengthy.

“It is very clear that there is a damaging lack of clarity on responsibility and accountability for the powerful commissioning of children’s psychological wellness services as well as an alarming reduction in the provision of expert and early intervention providers,”

Kid psychological health providers "failing 3-quarters of kids"