NHS patients waiting months for vital bowel cancer tests, figures show

Patients with one of the most lethal forms of cancer are having to wait months to have vital diagnostic tests, in a new sign of the relentless pressure on NHS services.

People suspected of having bowel cancer are facing waits of three months for tests when they should have them within a maximum of six weeks, the latest NHS waiting time figures show.

In March almost half the patients referred for the disease to Mid Yorkshire Hospitals NHS Trust had to wait more than the six weeks set out in the NHS constitution. In all 144 (49.3%) of the 292 patients that month had to ensure waits of several months, and 39 of them were kept waiting for more than 13 weeks.

Campigners warned that patients could die as a result of the delays in patients undergoing either a colonoscopy or flexible sigmoidoscopy, the two tests used to detect bowel cancer.

Prof Colin Rees, vice-president of the British Society of Gastroenterology, said: “By testing the right people at the right time we can save lives and stop people dying needlessly.”

In March 24% of hospital trusts in England missed the six-week target for colonoscopy, which meant that 1,121 patients were kept waiting. In the same month, 18% of hospitals breached the six-week target for flexi-sigmoidoscopy.

Deborah Alsina, chief executive of Bowel Cancer UK, said the waiting times “present a worrying picture for patients”. She identified a lack of diagnotic staff as a key problem and lamented the latest of several delays in Health Education England publishing a plan, first promised in 2015, to boost the NHS cancer workforce.

About 41,000 people a year in the UK develop bowel cancer and around 16,000 die from it. It is Britain’s fourth most deadly cancer after lung, breast and prostate.

Meanwhile, NHS performance against its key waiting times targets is now the highest it has been for five years, NHS Englnd’s latest statistics show.

During 2015-16, 2.5 million people were not treated within four hours of arriving in A&E, and a total of 362,687 patients did not receive planned care in hospital – usually an operation – within 18 weeks.

Another 26,113 waited longer than 62 days for supposedly urgent cancer treatment after being referred by their GP, while 985,583 people with a life-threatening condition waited more than the maximum eight minutes for an ambulance to respond to an 999 call.

“These figures reveal the dismal human cost of the NHS crisis,” said Norman Lamb, the Liberal Democrat health spokesman. “Millions of patients are waiting in distress and anxiety, but Theresa may doesn’t care.”

Responding to the latest monthly statistics, a Conservative spokesman said: “These figures show A&E performance has improved a great deal since the equivalent time last year. Waiting times for an operation again got shorter in March, and crucially patient outcomes continue to improve. Breast cancer survival is at its highest ever level.”

The figures came as the Health Foundation warned that the care patients receive is under threat because of the NHS’s unprecedented financial squeeze.

In a report, the thinktank says: “It is difficult to see how the intense financial pressures on all NHS and social care services will not threaten the quality of care in the near future if nothing changes.

“As OECD analyses have shown, the UK’s performance on quality is middling when compared with other OECD countries, but then so are our funding levels.”

NHS patients waiting months for vital bowel cancer tests, figures show

Netflix show condemned for "romanticising" teenager"s suicide

Mental health groups have criticised a new Netflix drama for its “sensationalised” portrayal of a 17-year-old’s suicide, which they say could encourage young people to take their own lives.

The Samaritans, psychiatrists, and mental health campaigners claim 13 Reasons Why could prompt troubled young people to copy the suicide of its central character, Hannah Baker.

“We have a responsibility to protect children and teenagers,” said Dr Helen Rayner, a psychiatrist specialising in children and adolescent mental health who is also a spokeswoman for the Royal College of Psychiatrists. “Dramatic and detailed portrayals of suicide needlessly put vulnerable young people at risk of copycat behaviour as they see how to carry out harmful or potentially fatal acts.

“Graphic depictions of suicide may only influence a small number of viewers, but the consequences can be tragic.”

Ged Flynn, the chief executive of Papyrus, a charity that seeks to prevent suicide among young people, said parents and young people viewing the series should “be aware that when watching this programme there is a danger that suicide is romanticised and sensationalised”.

The US-set series aimed at young people is based on a novel of the same name by Jay Asher. Selena Gomez, the actor and singer, is among its executive producers. Its 13 episodes depict 13 friends of Hannah listening to a tape she made for each of them explaining the difficulties she faced that prompted her to kill herself.

Dylan Minnette and Katherine Langford in episode two of 13 Reasons Why. Photograph: Beth Dubber/Netflix

Sarah Hulyer, a mental health campaigner, said the show’s portrayal of Baker’s plight was irresponsible.

“Mental ill-health and suicide isn’t pretty and while we need to admit that, we also have a duty to look out for the wellbeing of our younger generations and not encourage unhealthy behaviours. By graphically depicting the protagonist’s suicide method, they’re not helping vulnerable young people; they’re encouraging them,” said Hulyer.

“[13 Reason’s Why’s] creators claimed they were hoping to ‘help’ people struggling with the issues shown in the show, but it’s a storyline that is about revenge suicide, demonises counsellors and includes none of the characters reaching out for help and receiving it, it’s not clear exactly what they think ‘helping’ is,” she added.

While she acknowledged that the show has helped thousands of young people think about the lasting impact of suicide, Hulyer asked: “Does a show that depicts a young girl who uses her own death to inflict pain upon others really deserve to be put on a pedestal?”

The number of suicides in the UK among 10 to 14-year-olds has risen from four in 2010 to 10 in 2015, and among those aged 15-19 from 166 to 221 over the same period, according to the Office of National Statistics.

The Samaritans said 13 Reasons Why exposed failings in the UK’s media regulation. “It is extremely concerning that a drama series aimed at young audiences can be produced outside of the UK and made available to UK audiences and yet not subject to UK media regulation. This is simply not acceptable and creates a barrier to protecting our young audiences i the UK,” said Lorna Fraser, a Samaritans media adviser.

The show’s writer, Nic Sheff – who has been open about his own suicide attempt – said he wanted to jolt viewers and make them realise how awful suicide is.

“When it came time to discuss the portrayal of the protagonist’s suicide in 13 Reasons Why, I of course imediately flashed on my own experience. It seemed to me the perfect opportunity to show what an actual suicide really looks like – to dispel the myth of the quiet drifting off, and to make viewers face the reality of what happens when you jump from a burning building into something much, much worse,” he wrote in a blog for Vanity Fair.

“It overwhelmingly seems to me that the most irresponsible thing we could’ve done would have been not to show the death at all,” Sheff said.

In the UK, the Samaritans can be contacted on 116 123. Papyrus are contactable on 0800 068 41 41 or by texting 07786 209 697 or emailing pat@papyrus-uk.org. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

Netflix show condemned for "romanticising" teenager"s suicide

Bed-blocking three times worse than NHS figures show – study

The number of patients trapped in hospital despite being fit to leave is three times higher than official data shows, according to a study.

Nuffield Trust, a health thinktank said far more hospital beds were taken up by patients classed as “delayed transfers of care” than NHS England’s counting system detected.

NHS bosses said the findings bore out their own experience and the official figures hugely underestimated how many people had to stay in hospital because of problems elsewhere.

Nigel Edwards, Nuffield Trust’s chief executive, who undertook the research, said: “Our audits show that up to two-thirds of the patients stuck unnecessarily in hospital beds aren’t actually being counted in the official figures.

“That means that a typical 650-bed hospital may actually have only around 250 beds available for all its emergency patients, once you’ve taken out all the people who could go home if they had more support, and discounted maternity, paediatric and cancer beds.”

Delayed transfers – which some call bed-blocking – are running at their highest ever level, with 193,680 bed days lost because of it in November, according to the most recent official NHS figures.

Edwards cited his thinktank’s own research about bed occupancy trends at three small and medium-sized hospitals NHS hospitals and a separate study of 7,500 bed days in a large number of bigger hospitals.

In one small rural hospital, only 40 (24%) of the 277 patients examined were counted as delayed transfers of care (DToCs). However, 80 others (30%) were also fit to leave, and another 35 (13%) were not medically fit to be discharged but could have been safely looked after in a nursing home if places in them had been available.

Separate research by the Oak Group, a firm that reviews inpatient stays, found the same picture in the bigger hospitals it analysed. “These audits confirmed that significant numbers of patients could be cared for elsewhere; for typically 50%-60% of the acute bed days examined,” Edwards said.

He said 19% could have gone home without receiving any support afterwards, 28% needed nursing or social care support in order to get out of hospital, and 12% needed long-term supported live-in nursing or residential care.

“This failure to record the true situation is significantly increasing the pressure hospitals are facing. Speeding up the discharge of patients who would be better cared for elsewhere needs to be the top priority for the NHS and social services departments,” Edwards added.

Chris Hopson, the chief executive of NHS Employers, which represents NHS trusts, said: “Our hospital members tell us that because the official definition of delayed transfers is so specific, the actual number of patients medically fit to discharge, or who could be cared for in other settings, is much greater than the definition implies. So in that sense the problem of blocked hospital capacity is significantly greater than the DToC figures by themselves suggest.”

Separately, Whitehall’s spending watchdog has concluded that a £5.3bn reserve designed to relieve strain on overcrowded hospitals by integrating health and social care is failing to save money or stem the rise in admissions.

The Better Care Fund has not achieved the main targets set for it when it was established two years ago by the health secretary Jeremy Hunt, according to a report by the National Audit Office.

Health officials hoped to use the fund to reduce emergency admissions by 106,000, but the report discloses that admissions instead rose by 87,000. The fund was supposed to be used to make savings of £511m, but instead spent an additional £311m, the report says.

Officials had aimed to reduce the days lost when patients are ready to leave but cannot do so by 293,000, but instead that figure rose by 185,000, costing £146m more than planned, it adds.

Norman Lamb, the Liberal Democrats’ health spokesman, who helped draw up plans for the fund when a coalition minister, said the report showed the NHS was hurtling towards a “catastrophe” without a bigger financial injection.

“This does not undermine the case for joining up health and social care and ending the irrational divide which too often lets patients down. But it is a clear warning that with demand rising so rapidly, more funding is needed,” he said. “It would be unforgivable for the government not to act in light of these warnings.”

Meg Hillier, the chair of the public accounts committee, which scrutinises public spending for parliament, said the “deep flaws” in the fund were first highlighted two years ago but the warnings had not been heeded by ministers.

Under the Better Care Fund, councils receive money, mainly from the NHS budget, in return for introducing schemes to reduce demand for hospital care.

Auditors found that the Department of Health and NHS England were both over-optimistic about what the fund could achieve.

The NAO did notice some benefits from the fund, such as 90% of local areas agreeing or strongly agreeing that delivery of their plan had improved co-operation between different bodies.

A Department of Health spokesperson said: “The Better Care Fund is just one element of this government’s programme to integrate health and social care for the first time – and as the report recognises, it has already incentivised local areas to work together better. We will build on this for the future in making care even more joined up.”

An NHS England spokesperson said the NAO report was a “statement of the obvious” because the NHS never believed or claimed that cutting hospital budgets to fund social care would by itself save money.

“The obvious lesson for next phase of care integration is that joining up local NHS and council services may be worthwhile, but is not by itself a silver bullet solution to wider pressures on health and social care,” she said.

Bed-blocking three times worse than NHS figures show – study

Jackfruit Is The #1 Cancer Killer, Studies Show

Jackfruit Is The #1 Cancer Killer, Studies Show

Nurse shifts left unfilled at nearly every hospital in England, figures show

Almost every hospital in England has fewer nurses on duty than each believes are needed to guarantee safe patient care, research shows.

Analysis of official data by the Health Service Journal (HSJ) found that 96% of NHS hospital trusts in England had fewer nurses covering day shifts in October than they had planned and 85% did not have the desired number working at night.

The disclosure of such widespread failure to ensure hospitals are properly staffed has prompted fresh concern that a chronic lack of nurses and the NHS’s dire finances are putting patient safety at risk.

Nurse shortages have led to patients having to wait for medication, going unwashed or not having observations done on time, the HSJ said.

Janet Davies, the chief executive of the Royal College of Nursing, said: “This is yet more evidence that there are too few nurses caring for patients, putting people at serious risk. Safe staffing levels aren’t an optional extra. Having the right number of nurses is essential to ensure that patients can recover properly.”

The college estimates there are as many as 24,000 vacancies for nurses across the UK.

Nurses told the HSJ that understaffing meant hospitals were already providing substandard care, leading to patient safety “near misses”.

The figures are the worst hospitals have recorded since they were obliged to start publishing details of staffing levels in 2013, in the wake of a report on the Mid Staffordshire care scandal.

The number of trusts that do not have planned numbers of staff at work has gone up despite the recruitment of record numbers of nurses by acute hospitals. Limits introduced in 2015 on the amount hospitals can pay to hire agency nurses may help explain why staffing levels are dropping in many places.

One nurse said: “Sometimes observations get missed and I can recall many times where the patient is found to be deteriorating when they are eventually done. This gives you immense stress as you are left with the realisation you did not pick up on your patient’s condition early enough to prevent an acute episode.”

Another said: “I have seen patients not have proper care, dressings not changed, [and] not given the choice of shower or a wash as it takes more time that we do not have.”

HSJ reached its conclusions by examining data on nurse staffing levels that trusts release through the NHS Choices website. These include the numbers present in general medical wards, maternity units, surgical wards and intensive care units at 214 acute hospitals.

In hospitals in England, a nurse is meant to look after no more than eight medical patients, and the ratio can be as low as one to one in neonatal and intensive care units.

The figures show that Dewsbury and district hospital in West Yorkshire had 75% of the number of nurses it had planned to have on duty last October, down from the 87% it managed in the first three months of 2015.

Princess Alexandra hospital in Harlow, Essex, which went into special measures that month, covered 77% of shifts, as did Pontefract general infirmary in West Yorkshire.

The HSJ found that some trusts were employing unusually high numbers of healthcare assistants. That may suggest they are replacing nurses with cheaper personnel who have little clinical training.

Prof Peter Griffiths, of Southampton University, a member of NHS Improvement’s safe staffing committee for acute wards, said: “This is clearly not a good place for the NHS to be and it isn’t getting any better.” He said healthcare assistants could help plug gaps but relying on them to deputise for nurses in the long term risked compromising patient safety and involved “the risk of a false reassurance”.

The shadow health secretary, Jonathan Ashworth, said: “Tired, overworked nurses cannot be expected to continue providing the quality of care which patients need. The government needs to do much more to make sure nursing remains an attractive profession and to ensure hospitals can get in place the number of nurses they need to keep patients safe.”

A Department of Health spokesman said: “We expect all parts of the NHS to make sure they have the right staff in the right place at the right time to provide safe care. That’s why there are already almost 26,000 extra clinical staff, including almost 11,400 additional doctors and over 11,200 additional nurses on our wards since May 2010.”

Nurse shifts left unfilled at nearly every hospital in England, figures show

More than 2m people wait over four hours in A&E, figures show

More than 2 million people had to wait more than four hours at A&E units last year, a sharp rise on the previous year, official NHS figures have shown.

The latest annual data from NHS Digital shows that more people than ever before were treated at an accident and emergency unit in England last year – the first time the figure has risen above 20m – which suggests shortstaffed units are under increased pressure.

In 2015-16, 20,457,805 people attended either an emergency department at an acute hospital or an urgent care centre or walk-in centre. That was about 900,000, or 4.6%, more than the previous year.

The NHS experienced a surge in demand last winter, similar to the one this year that has prompted widespread claims from medical groups that the service is in crisis.

While A&E attendances between April and December 2015 rose by just 2.2% to 15.2m, compared with the same period a year earlier, they shot up by 12.2% between January and March 2016 to 5.2m, again compared with the same quarter in 2015.

A&E attendances

More patients are waiting longer before they leave A&E. In 2015-16 a total of 2,090,200 people were not dealt with for at least four hours and one minute, well up on the 1,638,058 seen the year before. Last year, 5.2 million people waited between three and four hours for care, up from the 2.4 million who did so in 2007-08, and the 4.9 million who did so in 2014-15.

NHS waiting times

The figures, which underline the relentless and ongoing increase in demand for A&E care, come a day after the health secretary sparked a huge political row by vowing to water down the NHS’s commitment to treat and then admit, transfer or discharge 95% of patients within four hours of their arrival.

Jeremy Hunt told MPs: “This government is committed to maintaining and delivering that vital four-hour commitment to patients. But since it was announced in 2000 there are nearly 9m more visits to our A&Es, up to 30% of whom NHS England estimate do not need to be there. And the tide is continuing to rise.

“So, if we are to protect our four-hour standard, we need to be clear it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”

Labour and the Liberal Democrats said Hunt was letting down patients by saying that the four-hour pledge – which has existed since 2004 though initially with a target of 98% – should not apply to the 30% of people who attend A&E with a minor ailment.

Theresa May’s spokeswoman insisted on Tuesday that Hunt had made no change to the four-hour pledge when he addressed MPs.

“The point that the health secretary was making in the house yesterday is a point that the government has made before, which is about making sure that A&E is there for people for what it says on the tin – accident and emergency. It’s not about non-urgent care,” she said when asked if Hunt had weakened the target.

There was, the spokeswoman said, “more to be done to make sure that the public understand” when they should go to A&E departments. Hunt had briefed the cabinet on Tuesday about the pressures facing A&E, she added.

“The target is a target for accident and emergency,” she said. “I understand what accident and emergency should be about. If I have a cold, I’m not going to go to accident and emergency and expect to be treated for a cold within four hours.”

Asked whether the four-hour target originally featured this distinction, she said: “There’s a commitment that accident and emergency is for emergency care.”

NHS organisations say inadequate GP and social care services outside of hospitals, including sometimes long waits to see a family doctor, are prompting more and more people to use A&E.

Growing numbers of patients who arrive at hospital through A&E are having to be admitted as a medical emergency, with 4.1m such cases last year. But that remains about one in five of all attendees, and not a growing proportion, despite the growing numbers of older people and the often complex medical conditions they present with.

Four million (19.8%) other patients were discharged to be followed up by their GP, and 2.6m (12.7%) were referred to a specialist clinic or outpatients department, NHS Digital’s data shows.

NHS England also produces data on A&E activity. While it covers every type-one unit, urgent care centre and walk-in centre in England, NHS Digital’s figures are based on just 87% of such places, though they do include every hospital emergency department.

“This report confirms what we have been saying, that hospitals are coming under increasing pressure but in the main are continuing to cope,” said a spokesman for NHS England.

“In fact, these figures show that last year the median time to assessment was 11 minutes and, on average, patients left A&E just two hours and 40 minutes after arriving. This shows the fantastic job staff are doing in ensuring patients get the urgent care they need.”

NHS England repeated its plea to the 30% of people believed to be turning up at A&E unnecessarily to seek care elsewhere, such as with a GP, pharmacist or NHS111.

More than 2m people wait over four hours in A&E, figures show

Eight charts that show 2016 wasn"t as bad as you think

2016 is likely to be remembered as an annus horribilis for so many reasons that it’s tempting to think everything is doomed.

But things are not always as they seem. There are silver linings. You just have to look hard to find them.

Death in conflict

Overall, 2016 looks set to have slightly fewer deaths through armed conflict than 2015, when 167,000 people died. Hardly numbers to celebrate.

But narrow the focus and pockets of progress can be found. According to the International Institute for Strategic Studies, the death toll from the war with Boko Haram in Nigeria has fallen sharply, as Nigerian government troops retake territory.

Boko Haram. Photograph: AP

“The group’s operational capacity within Nigeria was weakened,” notes Anastasia Voronkova, IISS research fellow for armed conflict. “At least 4,500 civilians held captive by the group were rescued in 2015 alone; another around 5,000 people were freed by June 2016. 2016 fatalities are expected to be noticeably lower than the 11,000 recorded in 2015.”

Nigeria death toll

Death tolls are also expected to be lower from internal conflicts in the Philippines, Myanmar and India, according to the IISS. Mark Rice-Oxley

Emissions

Carbon is flatlining, and our planet has breathing space. After more than a century and a half of nearly unbroken growth, the quantity of greenhouse gases we pour into the atmosphere each year has stalled for the third year running. Burning fossil fuels and chopping down forests released about 40 gigatonnes of carbon dioxide last year, roughly the same amount as in the previous two years.

What is more, this plateau in emissions is taking place against a background of quickening economic growth, showing that increasing prosperity and lifting people out of poverty need not come at the expense of the climate.

A disused mine in Pumarabule, Spain, where the struggling coal mining industry is on its way out. Photograph: David Ramos/Getty Images

These are big reasons to be cheerful, and we need them. We are coming to the end of the hottest year ever recorded. The Arctic ice cap is 20C above its normal winter temperatures, a heating that scientists are calling “literally off the charts”, and may soon result in more rapid melting than anything yet seen. Donald Trump is hellbent on destroying the Paris agreement, boosting the coal industry and defunding Nasa’s ground-breaking climate research in favour of sending people into space. But at least our global warming emissions are abating. It has only taken 25 years to achieve.

Carbon emissions

Stalling emissions should also spell better health, because coal burning in particular pollutes the air with lung-shredding particles and choking chemicals. Finished celebrating? Good. There’s work to do. Flatlining emissions are not enough. Carbon dioxide levels in the atmosphere are still at the highest levels since humans first walked the earth. That invisible stock of carbon in the air is what causes warming, so even if we stopped burning fossil fuels tomorrow the climate would continue to change because of the greenhouse gases already there.

We are not going to stop burning fossil fuels tomorrow, and emissions need to come down by as much as 80% to have a chance of keeping warming under control. That will take decades. Every molecule of carbon dioxide we release stays in the air for up to 100 years, all the while trapping heat on the planet’s surface. Every tonne of carbon emitted puts the goal of halting climate change just a bit further out of reach. We are not out of the rapidly dwindling woods yet.

For now, we still have a chance of saving the planet from runaway warming, if we act fast to save energy and invest in clean sources. So cheer the carbon slowdown and put up more windmills. Fiona Harvey, environment correspondent

Crime

While violent crime ticked up in the UK in 2016, the overall level of offences continued its long-term decline to the lowest level since 1981. The Office for National Statistics said there were an estimated 6.5m incidents in the year to June 2016.

crime

Various reasons are given for the long-term decline: better security against car and home theft, the drop in the jobless claimant count and a broader sociological shift towards greater civility in richer countries.

Cybercrime. Photograph: Cultura/Rex/Shutterstock

But police also report a rise in the number of reported rapes, while hate crime increased after the Brexit referendum in June and cybercrime poses an ever greater threat.

Connectivity

Connectivity is taken for granted in the western world, where smartphone and internet use rise inexorably year on year.

Now there are strong signs that this take-up is at last being mirrored in poorer parts of the world, with positive outcomes for growth, health and democratic participation.

Africa in particular is experiencing the sharpest growth anywhere of smartphone proliferation: by 2020 there will be more than 700m smartphone connections in Africa – more than twice the projected number in North America, according to GSMA, an association of phone operators. In Nigeria alone in 2016, an estimated 16 smartphones are sold every minute.

smartphones

The mobile industry will account for 8% of GDP by 2020 – double what it will be in the rest of the world. And internet penetration is rising faster than anywhere else as costs of data and devices fall.

Population

Could 2016 go down as the year that the great global population surge finally showed signs of slowing?

The number of people around the world increases by about 80 million every year, and forecasts predict that the global population will continue to mount through this century, to hit about 11 billion people by 2100.

But much depends on behaviour and attitudes in parts of the world that have yet to experience the sudden drop in birthrates that swept across rich countries in the three decades after the second world war.

In January, the latest figures published by the UN showed more women than ever are now using some form of contraception. Some 64% of women aged between 15 and 49 who are married or living with a partner are now using traditional or modern forms of family planning, up from 36% in 1970.

Contraception

Poorer regions of the world – particularly Asia and Africa, where access to contraception has been a barrier to development – have witnessed the fastest pace of growth. The UN predicts that Africa, a continent with the largest demand for contraceptives but the worst access to services, will record the highest rates of growth over the next 15 years.

In November, the Family Planning 2020 initiative reported that the number of women using contraceptives in its 69 target countries had leapt by 30 million in the past four years alone.

A reproductive health volunteer gives a condom demonstration to a young family in Kasese, Uganda. Photograph: Jake Lyell/Alamy

This is not only good news for women and their families: the increase in family planning could cut projections of population growth by as much as 1 billion over the coming years. Jagdish Upadhyay, of the UN population fund, said if by 2030 the average family size was down by the equivalent of one child, then by 2030 the world population would be approximately 8 billion rather than 9 billion. Liz Ford

Homicide

Murder rates have been in decline in western democracies for years, but had persisted at stubbornly high levels in parts of central America. However, 2016 could go down as a good year in El Salvador, for years one of the most murderous places in the world.

The July-September period produced a year-on-year drop in homicides of almost 50%, according to data gathered for the Guardian by the IISS.

Death toll

“This decline can be attributed to the government’s tightened security policies at prisons, the creation of a new paramilitary force comprising 600 members of the military and 400 police officers, as well as a negotiated truce between the leaders of the three main gangs,” said Anastasia Voronkova at the IISS.

Gang members are escorted after their arrival at the maximum security prison in Zacatecoluca El Salvador. Photograph: Marvin Recinos/AFP/Getty Images

“The timing of the announcement by the gangs seemed to match the downward homicide trend: homicides fell by 42% in April 2016 in comparison with March [from 611 to 353], and have remained stable since then.”

Disease

The standout news in 2016 was that Sri Lanka had become the latest country to be declared malaria free. More than 30 countries that are collectively home to some 2 billion people are hopeful that they might follow suit in the next four years.

Malaria

The task of reducing the toll of malaria in sub-Saharan Africa, which has 90% of cases and 92% of deaths, is hard and needs more resources. But 2016 brought good news from other quarters: the World Health Organisation declared that measles had been eradicated from the Americas; death rates fell in the developed world from some forms of cancer, and the number of people getting Aids treatments continued to rise, from negligible levels in 2000 towards a target of 30m by 2020.

The global assault on infectious diseases has led to ever longer lifespans: life expectancy is on average 10 years longer in 2016 than it was in 1980.

Poverty

The number of people living in extreme poverty has yet to be estimated for 2016, but the long-term trend is a happy one, describing steep decline.

Numbers have more than halved since 1993, despite a growth in the world population of almost 1.9 billion.

Poverty

Statistically, as economies grow and middle classes expand, almost 50 million people escape poverty every year in net terms — a population equivalent to Colombia or Korea. Put even more simply, every single day over the past 25 years, the number of people living in extreme poverty has declined by 137,000.

According to the newest figures, the east Asia and Pacific region accounted for the greatest reduction in extreme poverty over the 23-year measuring period, based on a $ 1.90-per-day poverty line.

In just one year alone – 2012 to 2013 – the number of poor in east Asia and the Pacific declined by 71 million, while in south Asia the number of poor dropped by 37 million.

Declining poverty in extreme terms has shown significant regional fluctuations, however. In 2013, Sub-Saharan Africa accounted for nearly 51% of the global poor (389m people), but in 1990, it was east Asia and the Pacific that accounted for half of the global poor.

While the UN aims to eradicate extreme poverty by 2030, the World Bank report warns that economic growth has to be more equally distributed – in other words, the rich can’t keep getting richer – and says that extreme poverty trends depend on the economic success of Sub-Saharan Africa.

Eight charts that show 2016 wasn"t as bad as you think

Shock figures show Tory plans are ‘making social care worse’

The full extent of the crisis facing social care is revealed by an Observer investigation which demonstrates the government’s flagship policy to keep elderly people out of hospital is failing in most parts of the country.

The findings – amid claims from senior NHS figures that “we are going backwards in many places” – come as ministers face calls to provide an urgent injection of extra cash to local councils to avoid services buckling under increasing financial pressure.

The Tory chair of the Commons select committee on health, Sarah Wollaston, said ministers should act immediately to prevent more suffering for elderly people, their families and other patients.

She also demanded all-party talks on the future of the NHS and social care. “We are at a tipping point,” she said. “We are seeing indications of the great stresses in the system and these need addressing now.”

The Observer’s investigation reveals that the landmark government scheme designed to relieve the strain on overcrowded hospitals – the Better Care Fund – is failing to deliver its aims of keeping older people healthy at home and so cutting “bedblocking”, despite £4bn a year being poured into it.

Theresa May and the health secretary, Jeremy Hunt, have repeatedly claimed that the fund, and a separate policy of allowing councils to raise more money for social care by increasing council tax, are jointly addressing the spiralling problems in social care.

Responses to freedom of information requests submitted to 151 local councils reveal that in England 58% of targets for improving care in people’s homes and local communities were missed.

In another blow to ministers, new figures from the King’s Fund thinktank show English councils will raise just a fraction of the sums required to plug gaps in their budgets by increasing council tax bills.

Better care at home is universally accepted as the way to keep people out of hospital and free pressure on beds. With so many elderly people and others having no alternative but hospital, services suffer a chain reaction of lengthening waiting lists and cancelled operations for other patients.

May and Corbyn clash over NHS and social care funding at PMQs

Data from 98 of the 151 local authorities in England with statutory responsibility for social care show that they met only 218 (42%) of 515 targets to improve social care in their area and missed the other 297 (58%).

Under the Better Care Fund councils receive money, mainly from the NHS budget, in return for introducing schemes to reduce demand for hospital care. This is done, for example, by providing better care for people in their own home or in care homes. But the FoI responses reveal that councils met barely a quarter of their targets in 2015-16 for reducing non-elective (emergency) admissions to hospital.

One senior NHS boss, speaking on condition of anonymity, said the disclosures raised the possibility that the fund was turning out to be “a waste of money”.

Chris Hopson, chief executive of NHS Providers, which represents hospitals, said efforts to improve out-of-hospital care were “going backwards in many places”. He added: “These findings show that the Better Care Fund – a key government scheme to increase out-of-hospital care – is not delivering as intended.

The findings are echoed in the fact that more than 50% of NHS trusts told us in a survey conducted last week that reductions in care facilities beyond hospitals have made it more difficult for the NHS to meet the demand it faces.

“Just at the point when the NHS desperately needs more out of hospital care, we seem to be going backwards in many places. That can’t be right,” Hopson said.

Stephen Dalton, chief executive of the NHS Confederation, said: “These figures are very worrying as we head into what could be a very tough winter for the NHS. We only need a significant dip in the weather, which has been mild so far, and people would become more vulnerable and we would see a big spike in demand. We have a perfect storm going on at the moment of unprecedented demand for care, the fact that we have reached a tipping point in terms of the demographics, and cuts to local councils that are among the biggest in their history.”

Oxfordshire council performed worse than in 2014-15 against all six targets, while Bracknell Forest, Wolverhampton and North Yorkshire each did worse against five of the targets.

The new data from the King’s Fund shows councils across England will raise £382m a year as a result of their ability to increase council tax to pay for social care in 2016-17, a fraction of the funding gap they face this year.

The social care “precept” allows councils to charge up to an extra 2% on council tax bills from this year in order to fund social care services. But King’s Fund analysis shows it will raise less than 3% of what councils will spend on social care, which does not even cover the extra £612m cost they face as a result of the “national living wage”.

The King’s Fund figures also show the social care precept will widen inequalities in access to care services, contributing further to fears of a developing two-tier system.

The 10 most affluent areas will raise more than two and a half times (£41m) the amount of the 10 areas with the greatest level of pensioner need (£17m). Tower Hamlets, the council with the highest level of pensioner need as measured by pensioner income deprivation, will raise just £7 per head of its adult population, compared with the £13 per head that will be raised by Wokingham, with the lowest level of pensioner need in England.

This week ministers are rumoured to be preparing to increase further the amount that councils can raise to pay for social care. But the Tory chairman of the Local Government Association’s community wellbeing board, Izzi Seccombe, said this would not be an adequate response, as she warned that the country was facing the “worst ever funding crisis” in social care.

“Extra council tax-raising powers will not bring in enough money to alleviate the pressure on social care and councils will not receive the vast majority of new funding in the Better Care Fund at the end of the decade,” she said. “Even with this extra money, we have estimated the funding gap amounts to at least £2.6bn. This includes £1.3bn needed right now to stabilise the provider market and a further £1.3bn by 2019-20.”

A Department of Health spokesperson said: “We are giving local areas access to up to £3.5bn extra for social care by 2020. While many areas are already providing high quality services within existing budgets, the Better Care Fund, which brings together health and social care provision locally for the first time ever, will get additional funding in the next few months to raise standards further. This government is committed to ensuring those in old age throughout the country can get affordable and dignified care.

Chancellor wrong on social care funding, says former health secretary

Shock figures show Tory plans are ‘making social care worse’

Magic mushroom ingredient psilocybin can lift depression, studies show

A single dose of psilocybin, the active ingredient of magic mushrooms, can lift the anxiety and depression experienced by people with advanced cancer for six months or even longer, two new studies show.

Researchers involved in the two trials in the United States say the results are remarkable. The volunteers had “profoundly meaningful and spiritual experiences” which made most of them rethink life and death, ended their despair and brought about lasting improvement in the quality of their lives.

The results of the research are published in the Journal of Psychopharmacology together with no less than ten commentaries from leading scientists in the fields of psychiatry and palliative care, who all back further research. While the effects of magic mushrooms have been of interest to psychiatry since the 1950s, the classification of all psychedelics in the US as schedule 1 drugs in the 1970s, in the wake of the Vietnam war and the rise of recreational drug use in the hippy counter-culture, has erected daunting legal and financial obstacles to running trials.

“I think it is a big deal both in terms of the findings and in terms of the history and what it represents. It was part of psychiatry and vanished and now it’s been brought back,” said Dr Stephen Ross, director of addiction psychiatry at NYU Langone Medical Center and lead investigator of the study that was based there.

Around 40-50% of newly diagnosed cancer patients suffer some sort of depression or anxiety. Antidepressants have little effect, particularly on the “existential” depression that can lead some to feel their lives are meaningless and contemplate suicide.

The main findings of the NYU study, which involved 29 patients, and the larger one from Johns Hopkins University with 51 patients, that a single dose of the medication can lead to immediate reduction in the depression and anxiety caused by cancer and that the effect can last up to eight months, “is unprecedented,” said Ross. “We don’t have anything like it.”

The results of the studies were very similar, with around 80% of the patients attributing moderately or greatly improved wellbeing or life satisfaction to a single high dose of the drug, given with psychotherapy support.

Professor Roland Griffiths, of the departments of psychiatry and neuroscience who led the study at Johns Hopkins University school of medicine, said he did not expect the findings, which he described as remarkable. “I am bred as a sceptic. I was sceptical at the outset that this drug could produce long-lasting changes,” he said. These were people “facing the deepest existential questions that humans can encounter – what is the nature of life and death, the meaning of life.”

But the results were similar to those they had found in earlier studies in healthy volunteers. “In spite of their unique vulnerability and the mood disruption that the illness and contemplation of their death has prompted, these participants have the same kind of experiences, that are deeply meaningful, spiritually significant and producing enduring positive changes in life and mood and behaviour,” he said.

Patients describe the experiences as “re-organisational”, said Griffiths. Some in the field had used the term “mystical”, which he thought was unfortunate. “It sounds unscientific. It sounds like we’re postulating mechanisms other than neuroscience and I’m certainly not making that claim.”

Ross said psilocybin activates a sub-type of serotonin receptor in the brain. “Our brains are hard-wired to have these kinds of experiences – these alterations of consciousness. We have endogenous chemicals in our brain. We have a little system that, when you tickle it, it produces these altered states that have been described as spiritual states, mystical states in different religious branches.

“They are defined by a sense of oneness – people feel that their separation between the personal ego and the outside world is sort of dissolved and they feel that they are part of some continuous energy or consciousness in the universe. Patients can feel sort of transported to a different dimension of reality, sort of like a waking dream.”

Some patients describe seeing images from their childhood and very commonly, scenes or images from a confrontation with cancer, he said. The doctors warn patients that it may happen and not to be scared, but to embrace it and pass through it, he said.

The commentators writing in the journal include two past presidents of the American Psychiatric Association, the past president of the European College of Neuropsychopharmacology, a previous deputy director of the Office of USA National Drug Control Policy and a previous head of the UK Medicines and Healthcare Regulatory Authority.

The journal editor, Professor David Nutt, was himself involved in a small trial of psilocybin in a dozen people with severe depression in the UK in May. The ten commentators in the journal, he writes in an editorial, “all essentially say the same thing: it’s time to take psychedelic treatments in psychiatry and oncology seriously, as we did in the 1950s and 1960s.”

Much more research needs to be done, he writes. “But the key point is that all agree we are now in an exciting new phase of psychedelic psychopharmacology that needs to be encouraged not impeded.”

The studies were funded by the Heffter Research Institute in the USA. “These findings, the most profound to date in the medical use of psilocybin, indicate it could be more effective at treating serious psychiatric diseases than traditional pharmaceutical approaches, and without having to take a medication every day,” said its medical director George Greer.

Magic mushroom ingredient psilocybin can lift depression, studies show

Having to show ID for NHS treatment is not a problem | Letters

I live in Brittany, France. It is routine for hospitals to ask for proof of identity at the start of treatment, either carte d’identité (ID card) or passport, as well as closely scrutinising the means of payment such as the carte vitale (card issued by the state to show entitlement to healthcare) and assurance mutuelle (top-up insurance for conditions not reimbursed at 100% by the state). When I first moved here six years ago I found it strange that you had to go into the finance office with the paperwork before anything clinical happened, but I now accept that it is a necessary part of keeping the well-oiled French healthcare system running. People seeking medical help in the UK should not fear the proposed changes but welcome them as a means to providing what should eventually become a better service (Show your passport for NHS treatment, 22 November).
Mark Bennett
Billio, France

• I have been resident in Peterborough for 30 years. I am all in favour of getting people to pay what they should, but the Peterborough system is cumbersome and annoying. Two questions arise in my mind every time I have to get out the documents and take them with me to the hospital. First, when one has established one’s right once, why can this fact not be put on one’s medical record so that one does not have to do it repeatedly? Second, if one has been on a local GP’s list for some years and been seeing them from time to time, why can this fact not be conveyed to the hospital and put on one’s record?

I hope that the accounts people who suppose that Peterborough already has a good answer to the problem of getting people to pay will consider these questions.
Jim Haigh
Peterborough

• I have in front of me my official NHS medical card showing my name, address, date of birth, doctor and NHS number. I have never had to show this to anyone, which makes me wonder why I was issued with it so many years ago. I would not object if I had to produce it in order to obtain medical treatment, even retrospectively after an emergency.
Dan van der Vat
London

• Three times in the past week, I have been asked to prove my identity – once when picking up a parcel, once in a mobile phone shop and once in a bank. And now there’s talk of having to prove one’s identity to get treatment at hospitals.

While I applaud these organisations’ attempts to curtail fraud and theft, I’m concerned that all take the same flawed approach.

Many of us have passports, of course. Some have the alternative – a photographic driving licence. But no British citizen is required either to have or to carry either of these documents. Those who prefer not to drive and to staycation must find life very hard.

And then there’s the need to prove one’s address. Organisations require an original utility bill or bank statement – not one printed at home. But those same organisations are often at the forefront when it comes to cutting out paper and moving us all online.

The problem is one of our own making. Some time back, we were told each of us would have to have an identity card. Millions have them in other countries, and find life easier as a result. But this was going to be forced on us, so we Britons objected.

Instead, it seems we have to carry an increasing array of bulky documents around with us in case someone wants us to prove who we are.

Personally, I’d prefer to carry an identity card – something like a bank card with a chip and a pin. Others might not want one, and that’s fine. It they want to weigh themselves down with paperwork, that’s their choice. It isn’t mine!
Colin Maunder
Martlesham Heath, Suffolk

• It does matter that the NHS is being abused by people from abroad seeking free treatment. I know neighbours who bring relatives in to do just that. It matters because we have to pay abroad and we have paid for this service over three generations. Rachel Clarke (I’m a doctor, not a gatekeeper turning ‘health tourists’ away, 23 November) is being naive – and anyway, what are managers for?
Jenny Bushell
London

• Nye Bevan wrote in answer to Tory critics of the proposed NHS potentially providing free healthcare to foreigners: “The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilised principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialised medicine.”
Ted Watson
Brighton

• What is the problem? I had to cut short a holiday in France in September after a visit to the local hospital A&E department, where I was advised to go home within three days and arrange for an urgent colonoscopy. I had to show my passport at the admission desk and provide details of where I lived etc.

The treatment was excellent and as the French do not appear to use A&E as a proxy GP there were no great numbers in the waiting room. We received a bill one month after we arrived home and can claim back any surplus above what a French national would have paid. The bill was only €138 for four hours’ treatment in the hospital and the advice was spot-on. Letting someone examine my passport seemed a small price to pay.
Toni Reilly
London

• Those who do not travel or those who cannot afford it may not have a passport. But everyone who is registered with a GP should have an NHS medical card and number, which states that it is proof that that person is entitled to NHS treatment.
Katharine Makower
London

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

• Read more Guardian letters – click here to visit gu.com/letters

Having to show ID for NHS treatment is not a problem | Letters

Doctors threaten to boycott plan for patients to show ID for NHS care

Doctors have said they will boycott attempts to introduce identification checks as part of government plans to combat “health tourism”.

Chris Wormald, the most senior official in the Department of Health, told MPs that he was looking at making hospitals check patients’ papers to find out whether they should be paying, a proposal he admitted was controversial.

It would mean that those trying to access health services in England, including British citizens, might have to prove their identity before having operations and undergoing tests in hospitals, but it would not cover care received at GP surgeries.

Doctors have reacted with fury to the plan, and have threatened not to implement it. One described it as “disgusting”, saying it was not the role of the NHS to be “actively working to kick migrants out”.

SJ Stallworthy (@caremanmeow)

What the hell? This is absolutely disgusting, the NHS should not be actively working to kick migrants out – https://t.co/3Nh4XTaXsR pic.twitter.com/TFwGyp1goT

November 22, 2016

Dr Ben White, one of the junior doctors who mounted an unsuccessful legal challenge to the imposition of new contracts, signalled he would not comply with initiative.

Dr Ben White (@drbenwhite)

Well, I won’t be asking anyone for their passport before resuscitating them, thanks. pic.twitter.com/DkQ6udrVJr

November 22, 2016

Dr Natalie Silvey, an anaesthetic registrar agreed.

Natalie Silvey (@silv24)

“The health of my patient will be my first consideration”

Not their passport details https://t.co/vmolLG2pXp

November 22, 2016

Wormald told the public accounts committee that passport checks were already taking place at one hospital in Peterborough that treats a population with a high number of immigrants.

He accepted it was not part of “health service culture” but that it might be necessary to crack down on use of the NHS by visitors from abroad who do not have an automatic right to free care.

A National Audit Office report issued last month said the government paid out £674m to other European countries for the treatment of Britons abroad, but received only £49m in return for the NHS treatment of European citizens.

Prof Meirion Thomas, a former cancer surgeon at the Royal Marsden hospital who has campaigned against health tourism, welcomed the initiative. He told BBC Radio 4’s Today programme he had recommended such a idea in a letter to the Department of Health in August 2015. “It will put the message out there that the NHS is not open to health tourism, that when you come here you will be checked for eligibility,” he said.

But Thomas pointed out that it would not stop maternity tourism. He said: “Ladies arrive in this country in the late stages of a pregnancy and they don’t declare themselves a month before the expected date of delivery and no airline will fly [them home] so they become what’s called ‘immediately necessary’ and they are entitled to have care.”

Dr Mark Porter, the chair of the British Medical Association, said the idea was a politically motivated response that would not solve the funding crisis in the NHS.

He told Today: “There is a problem, the question is whether the proposal to require everybody using the NHS to show a passport and another form of identification before receiving hospital treatment is either proportionate or going to resolve the problem.

“The National Audit Office estimates that the uncollected fees are £200m a year.

“We have got an NHS with a deficit approaching 100 times that amount opening up over the course of this parliament. This is little other than a pinprick on top of the actual problems facing the NHS.

“Introducing something across the entire NHS in this way in response to such a small problem would be tremendously controversial.”

He added: “The background is an NHS that has been deliberately starved of the resources necessary to treat British people and recouping a small amount of those from overseas visitors by introduction of a new mechanism by which British people have to show their eligibility is simply not going to fill that gap.”

Doctors threaten to boycott plan for patients to show ID for NHS care

Hospitals may require patients to show passports for NHS treatment

Patients could be told to bring two forms of identification including a passport to hospital to prove they are eligible for free treatment under new rules to stop so-called health tourism.

The most senior official in the Department of Health told MPs on Monday that he was looking at making hospitals check patients’ papers to find out whether they should be paying, a proposal he admitted was “controversial”.

It would mean that those trying to access health services, including British citizens, might have to prove their identity before having operations and undergoing tests in hospitals, but it would not cover care received at GP surgeries.

Chris Wormald, the department’s permanent secretary, told the public accounts committee that passport checks were already taking place at one hospital in Peterborough which services a high immigrant population.

Wormald said: “On the general question of are we looking at whether trusts should proactively ask people to prove their identity – yes we are looking at that.

“Individual trusts like Peterborough are doing that and it is making a big difference – they are saying please come with two forms of identity, your passport and your address, and they use that to check whether people are eligible.

“It is quite a controversial thing to do, to say to the entire population you’ve got to prove your identity.”

Peterborough and Stamford hospitals trust covers an area that has received a high number of eastern European immigrants in recent years.

The senior civil servant told MPs that he accepted it was not part of “health service culture” but that it may be necessary to crack down on use of the NHS by visitors from abroad who do not have an automatic right to free care.

A National Audit Office report issued last month said the government paid out £674m to other European countries for the treatment of Britons abroad, but received only £49m in return for the NHS treatment of European citizens.

Wormald said he could not guarantee that ministers would meet their target to increase the amount the government claws back from European countries from the current £49m to £200m.

Other parts of the NHS have been experimenting with tougher identity checks. It was disclosed earlier this year that at least one hospital in south London piloted a scheme to cut what has been described as “maternity tourism”.

Expectant mothers going to St George’s in Tooting will have to provide papers showing they are eligible for free NHS care when they arrive for scans. Those unable to do so will be referred to the Home Office, and could face deportation.

Wormald said NHS trusts need to do far more to identify foreign people with no eligibility for NHS treatment if the target is to be met.

“Some trusts are looking to see whether they need to require people to prove their identity by bringing in a passport or some other form of ID – which is not the culture of the health service up to now,” he said.

“We are looking at whether more trusts should go down that route, as had been done in London and elsewhere, on people having to prove their identity.

“And we are looking at whether that is proportionate – whether in just some places, or the whole country.”

Wormald’s comments show that such an approach is being considered more widely. He said: “We are not here to criticise NHS frontline staff, but what we want is a culture of everybody who works in it to understand financial rigour. We need a culture where we are more careful with the tax pound.”

Asked whether the NHS will ever meet Jeremy Hunt’s target of clawing back £200m a year form European countries, he said: ‘I’m not going to guarantee whether we will meet it.”

A source close to the health secretary confirmed that the idea of passport identification had been floated and piloted and that plans for a nationwide scheme have not been ruled out.

But the source added that that the pilot was still at an early stage and that checks might only be applied in areas with shifting populations and large influxes of immigrants. “We have not yet made any decisions on this,” the source said.

A spokeswoman for Peterborough and Stamford hospitals NHS trust said: “In response to a national requirement, our trust devised a process for recovering money for the NHS from the treatment of non-EU citizens.

“This was looked at by the Cabinet Office and we understand our system may be used as a basis for other trusts to follow. We are delighted to have been identified as an exemplar of good practice.”

Hospitals may require patients to show passports for NHS treatment