Hunt broke law by axing NHS 18-week treatment target, says Labour

Jeremy Hunt has broken the law by not forcing the NHS to ensure that patients receive hospital treatment within the stated maximum of 18 weeks, according to legal advice obtained by Labour.

The counsel’s opinion says the health secretary is acting illegally by not obliging NHS England to compel hospitals to treat the required 92% of patients within 18 weeks of being referred by their GP.

The advice, by James Goudie QC, is potentially embarrassing for Hunt as it draws attention to the NHS’s increasingly poor performance against key waiting time targets for A&E care, cancer treatment and ambulances’ responses to 999 calls, as well as the referral to treatment (RTT) requirement. It specifies that at least 92% of all those waiting for non-urgent hospital treatment, such as hip or knee replacement or cataract removals, should wait no more than 18 weeks.

Controversy erupted last month when Simon Stevens, NHS England’s chief executive, announced that he was relaxing the 18-week target so that under-pressure hospitals could focus on more important priorities, in a move critics said meant it was being scrapped. The Royal College of Surgeons accused the NHS of “waving the white flag” on the target and condemning patients already in pain to further suffering due to the extended delays they would now face to get surgery.

Labour peers commissioned the 12-page opinion from Goudie, a barrister specialising in public law and employment law at 11 King’s Bench Walk chambers in London. It says: “I am asked whether the SoS [secretary of state] acted unlawfully by failing to include the 92% RTT target in the mandate to NHS England for 2017-18. My answer is: ‘Yes’.”

It goes on to explain: “This is because the 2012 Regulations and the NHS constitution have the effect that this must be included. The annual mandate cannot lawfully be used to circumvent or undermine by omission the absolute statutory and sub-statutory requirements.”

The mandate is the detailed annual document in which the Department of Health spells out precisely what key priorities it wants NHS England to fulfil in the coming year.

Labour claimed Goudie’s advice showed the government’s NHS plans were “in total chaos”. The party planned to use a motion in the House of Lords on Thursday to try to force ministers to explain what it says is a fundamental breach of patients’ rights under the NHS constitution. Philip Hunt [no relation], Labour’s health spokesman in the Lords, will also challenge ministers to publish the legal advice they have taken surrounding the 18-week target.

“Tory plans for the NHS are in total chaos. Legal advice commissioned by Labour confirms that the government have acted unlawfully in failing to deliver the 18-week treatment target for patients,” said Jonathan Ashworth, the shadow health secretary.

“Almost 4 million people are now on waiting lists because of the neglect and underfunding of this Conservative government and now this year’s NHS mandate is at risk of legal challenge. The government are failing to deliver the standards of care to which NHS patients are legally entitled,” he added.

Labour is now considering what its next move should be in light of Goudie’s advice, including whether it should seek a judicial review to challenge the legality of Jeremy Hunt’s actions over the 18-week target. No decision has yet been made on possible legal avenues it may pursue.

But Hunt last night insisted that he had done nothing wrong and that he had ordered NHS England to start hitting the 92% target again, which hospitals have missed every month since March last year at a time when the total number of patients awaiting treatment has crept up to almost 4 million.

“We do not believe there is a case to answer,” a Conservative spokesman said.

“Indeed, we wholeheartedly reject any suggestion that the government is not committed to the 18-week target, and as the mandate itself clearly states, we are specifically requiring the NHS to return to delivering that standard,” he added. The NHS is now carrying out record numbers of operations and treating 5,000 more people a day than in 2010, the spokesman added.

Hospitals breached the 92% target for the first time in December 2015 since its introduction in 2010. After meeting it again in the next two months, performance slipped to 91.5% last March and has stayed below 92% since. It hit an all-time low of 89.7% last December. In February, a total of 367,094 patients waiting for treatment had already waited for more than 18 weeks, according to the most recent NHS data.

Tim Gardner, a senior policy fellow at the Health Foundation thinktank, said: “The failure of the NHS to treat patients within the 18-week target is a symptom of wider pressures on the system. NHS hospitals are running at or near capacity to cope with growing demand for emergency care, and this limits their ability to perform planned procedures. If funding pressures continue to increase, the NHS will increasingly be forced to make trade-offs to live within its means.

“The government must ensure there are adequate levels of investment to maintain good standards of care in every part of the health and care system.”

Hunt broke law by axing NHS 18-week treatment target, says Labour

Why axeing 18-week surgery target won"t create more capacity in A&E

Press coverage of the recent Next steps on the NHS Five Year Forward View [pdf] concentrated heavily on the argument that a lower 18-week elective surgery target in 2017/18 will make it easier to recover performance against the four-hour accident and emergency target. But false linkages between the two targets are hiding the real risk for the NHS.

While the lower elective surgery target is a welcome, but painful, acceptance of reality, the linkage between the two targets is neither direct nor strong. And overemphasising that linkage underplays the serious risks the NHS faces next winter.

NHS performance between December 2016 and March 2017 showed the service is running a higher risk in the provision of urgent care than at any point over the past decade.

The 95% four-hour A&E target isn’t a particularly good measure of that risk – the Royal College of Emergency Medicine argues that 75% performance against the four-hour standard is the “magic mark for safety … when it becomes very overcrowded and … unsafe”. Better measures of patient safety risk are the levels of hospital bed occupancy, ambulance handover delays and the number and frequency of long hospital trolley waits.

All of these took a significant turn for the worse last winter. A third of hospitals had bed occupancy rates of 100% on at least one day. Many reported trying to manage bed occupancy levels well over the recommended 85%-90% level for weeks on end. This required continual, difficult, “one in, one out” admission/discharge decisions that usually led to worse care for the patients concerned. Ambulance diversions – hospitals turning away ambulances because they were full – were up 85% compared with the previous year.

While the NHS as a whole just about coped with record levels of demand, a number of local systems were overwhelmed for periods of time, putting patients at unacceptable risk.

Hospital and ambulance trust leaders are now concerned about their ability to manage this growing risk and that the number of systems in danger of failing over next winter is rising. Their colleagues in community and mental health report similar pressures, risks and concerns though, frustratingly, we either don’t have the public data to show this or the data is too new to be robust.

Aiming for a lower 18-week elective surgery target will, in many instances, make little difference, for three reasons.

First, many hospitals are now undertaking such relatively low levels of elective activity that they are, in the words of a recent Health Foundation Report, “becoming more of an emergency service” (pdf). Relaxing elective surgery performance targets won’t help them much.

Second, most hospitals have already scaled back their elective work over the crucial winter period. Indeed, they were formally instructed to do so by NHS Improvement. Relaxing the elective surgery target won’t create much extra winter capacity as it has already largely been freed up anyway.

Third, urgent and emergency care performance is not just about hospitals. While concentrating more hospital capacity on emergency, as opposed to elective, care may help a little, it does nothing to address the problem of capacity constraints in primary and social care, and the ambulance, community and mental health sectors.

The NHS can no longer do everything. Trying to hit the elective surgery target would have required the service to abandon proposed increases in cancer, mental health and primary care funding. But relaxing the target does have unwelcome side effects. As the £300m deterioration in last year’s trust finances in the third quarter showed, reducing elective surgery seriously hits trust financial performance just when we are trying to recover it. Delaying surgery also risks turning some cases into emergencies, adding to the urgent care burden.

Good urgent care largely depends on supply and demand across a local geography. The NHS struggles with winter pressures because we don’t have enough capacity. If we want to manage growing risk, we have to increase capacity to match growing demand.

We need to boost capacity in primary care, where the number of GPs is falling, not rising. We need to increase capacity in out-of-hospital care, not reduce the number of out-of-hospital beds by 8% as happened between winter 2016 and winter 2017. We need to grow capacity in social care, not cut the number of care packages available, to reduce delayed transfers and enable hospitals to properly manage their patient flow. And we need to increase temporary capacity in both acute hospitals and ambulance services too, if that’s what’s needed. It’s important to note that we added eight extra hospitals’ worth of temporary acute bed capacity last winter and still struggled.

What we shouldn’t do is kid ourselves that relaxing the 92% 18-week elective surgery target is any real substitute for that extra urgent and emergency care capacity. It isn’t.

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Why axeing 18-week surgery target won"t create more capacity in A&E

Labour challenges Hunt over dropping NHS waiting times target

Labour has challenged the health secretary over the legal basis for dropping a commitment on NHS waiting times.

The shadow health secretary, Jon Ashworth, wrote to Jeremy Hunt claiming the government and NHS England were acting unlawfully by accepting that the 18-week target would be missed.

NHS England’s chief executive, Simon Stevens, said he expected waiting times to rise slightly as a “trade-off” for improvement in other areas such as hitting the four-hour A&E target and better cancer care.

Longer waits can be expected for planned operationssuch as hip and knee replacements, cataract removal, hernia operations and laparoscopies.

The NHS target is for 92% of patients to be treated within 18 weeks of referra. Ashworth said: “The absolute nature of this legal duty to meet the 92% is reflected in the NHS constitution.

“The NHS constitution isn’t just a pledge by politicians; it’s a legal guarantee about the standards of care that patients can expect to receive in the English NHS. That includes a guarantee to treatment within 18 weeks, which NHS England have now said they can no longer provide because the government has denied them the funding they need.

“Government ministers need to urgently clarify they are not breaching the NHS constitution and must outline the consequences of denying patients their legal right to treatment within 18 weeks.

“As a first step, the secretary of state must publish his department’s legal advice urgently.

“Earlier this week NHS chiefs announced – without any public consultation or changes to the law – that the NHS will no longer be required to meet the 18-week treatment target because the financial crisis has got so bad. It’s utterly unacceptable and a striking admission of how badly the Tories are running the NHS.

“Since Theresa May became prime minister standards of care for NHS patients have been in a rapid downward spiral. She might be prepared to ignore NHS staff and the public but she can’t just ignore the NHS constitution based on legislation voted upon by parliament.”

On Sky News’ Sophy Ridge on Sunday Ashworth said he thought the NHS needed up to £5bn extra funding this year, suggesting the government should scrap tax cuts in order to pay for the health service.

“We can afford the NHS if the government is prepared to put the money in and make different decisions on tax,” he said.

Asked if he was prepared to consider tax increases to fund the NHS, he said: “I am ready to have that discussion with people about how we fund the NHS.”

But he added that money was being wasted because of the “privatisation agenda” and a failure to deal with public health problems such as obesity.

Labour challenges Hunt over dropping NHS waiting times target

NHS accused of waving white flag as it axes 18-week operation target

Patients will face longer delays for operations after the NHS decided to shelve one of its most important waiting time targets as part of its ambitious survival plan, which will also result in hundreds of thousands of people being denied surgery.

Simon Stevens, NHS England’s chief executive, has announced that the NHS is significantly relaxing the requirement on hospitals to treat, within 18 weeks, 92% of all patients in England who are waiting for a hip or knee replacement, cataract removal, hernia repair or other non-urgent operation.

The Royal College of Surgeons of England (RCSE) immediately accused the NHS of “waving the white flag on the 18-week target”.

A clampdown on surgery deemed of “limited clinical value” will affect people with certain spinal conditions, for example. Overall, a greater number of people with back pain will be treated with physiotherapy rather than surgery.

Stevens said rolling back the 10-year-old 92% target was necessary so that hospitals could concentrate on more urgent priorities, particularly in terms of easing the strain on overloaded A&E departments, as well as enhancing access to GPs and improving the treatment of cancer – diagnosis will be speeded up to 28 days – and mental health care.

The RCSE said the move risked going back to the time when patients faced excessive delays for surgery, leaving them to suffer in pain for even longer before finally undergoing necessary procedures.

“We are concerned that the 18-week waiting times target for surgical treatment has now effectively been jettisoned in all but name, having been dropped from the list of priorities for the next 12 months,” it said.

Clare Marx, the RCSE president, said: “It will be difficult for the general public to understand how waving the white flag on this target is compatible with a vision of an improved health service. We risk returning to the days of unacceptably long waits for elective surgical treatment.”

The move could see the number of people waiting for surgery within 18 weeks under the referral to treatment system going above 4 million for the first time since September 2007. The political importance of the target is likely to prompt criticism of Jeremy Hunt, the health secretary.

Stevens said: “We are saying that we expect that the number of operations that the NHS pays for will continue to go up, but we recognise that [while] right now about nine out of 10 people get their operations in under 18 weeks, in some parts of the country that will be under pressure.

“There is a trade-off here. We expect there will be some marginal lengthening of waiting lists, but this will still represent a strong, quick waiting times experience compared to 10 years ago, let alone 20.”

Simon Stevens, chief executive of NHS England. Photograph: Jonathan Brady/PA

The British Medical Association claimed the NHS’s inability to meet all its waiting time targets showed that it was “at breaking point”. Its leader, Dr Mark Porter, said: “Achieving one delivery promise only by missing another is a textbook example of rationing access to care. It should not be happening in today’s NHS.”

Hunt insisted that the fact that hospitals were still giving around nine out of 10 patients elective care within 18 weeks, despite the huge demands being placed on them, was a sign of success, not failure. The NHS met the 92% target every month since its inception in April 2007 until December 2015, when performance was 91.8%.

However, medical bodies fear that watering down the 92% target will lead to a significant further jump in the number of patients forced to wait beyond the maximum 18 weeks guaranteed under the NHS constitution. Although the target is not being formally scrapped, in future NHS trusts will face no sanctions for failing to deliver on it.

Hospitals have already breached the target for the past 11 months and, in January, hospitals only achieved a 89.9% rate: 3.255 million people were treated on time but 364,218 were left waiting. Scores of hospitals across England had to declare large-scale alerts and convert gyms and other non-clinical areas into makeshift wards.

Chris Hopson, the chief executive of NHS providers, which represents most hospital trusts in England, welcomed Stevens’s move as proof of “greater realism” among NHS bosses. “But we do need to remember the impact on patients. The [NHS] plan reinforces a simple, stark truth: that you get what you pay for,” said Hopson.

NHS England’s 75-page delivery plan outlines how it intends to transform healthcare by 2020. The document makes repeated reference to how “modest” budget increases mean that it is unable to provide as much care or care within existing waiting times.

The plan makes clear that what critics call greater rationing of some types of care was imminent. GPs will be expected to refer fewer people to hospital and instead arrange treatment in the community. NHS England will expand the use of “referral management processes”, under which doctors assess whether patients need to go to hospital at all. More patients will be offered online advice.

Stevens announced that hospitals would be financially penalised if they did not screen patients who smoked or drank too much and refer them to tobacco or alcohol services, and said he was determined to reduce the wide variation in patients’ chances of being referred for certain surgery depending on where they lived in England.

Radical modernisation of how the NHS works is needed to ensure it survives as a service funded by general taxation that is free at the point of use, the document adds.

But Niall Dickson, the chief executive of the NHS Confederation, called the plan “a leap in the dark”, adding: “We have no alternative but to embark upon such fundamental change, but to do so when services are under enormous pressure and money is so tight is without precedent.”

NHS accused of waving white flag as it axes 18-week operation target

Trump"s next target: people living with HIV/Aids | Steven W Thrasher

A month into 45’s presidency, and the ways in which Trumpism is a threat to lesbian, gay, bisexual and transgender existence are almost too many to count. However, those most vulnerable to HIV/Aids will be hit the hardest.

The threat of actually losing health insurance due to the president’s promise to repeal the Affordable Care Act is making millions of Americans so terrified, even his own voters are increasingly warming up to Obamacare.

But the ACA’s death is still a real possibility, and it would take a particular toll on queer Americans. According to a Yahoo investigation, “Before the ACA was passed, only about 13% of people with HIV had private health insurance and 24% had no coverage at all.” Indeed, the ACA has been a lifesaver for many people living with HIV: its subsidies for private insurance and its robust expansion of Medicaid in many states have greatly increased their access to medical treatment. If you doubt the scale of the continuing epidemiological emergency, consider that only about half of African Americans with HIV have access to continuous medical treatment, according to the Centers for Disease Control.

One way the ACA has addressed the crises is by funding the prevention efforts of Aids service organizations. Beyond people living with HIV, this work is helping to keep the transmission of the virus from further harming the most vulnerable communities, such as transgender women of color, or the one in two black gay men the CDC predicts may become HIV positive in his lifetime unless radical action is taken.

But if “silence equals death,” as the ACT UP slogan says, then loud protest is needed to keep people living with HIV from losing access to medication.

Creating swaths of uninsured people living with HIV who will likely lose access to viral suppressing medication (which makes HIV almost impossible to transmit) will also increase the likelihood of transmission to others. We know that when people in prison who are HIV positive are released with little medication, they often stop taking it altogether when they run out; their viral load then becomes very high and, research has shown, their sex partners are more susceptible to becoming HIV positive. (And if Republicans failed to keep the Obamacare provisions which allow people with pre-existing conditions to buy insurance without discrimination, it would be even worse.)

Remember, when then Indiana Governor Mike Pence presided over one of the worst HIV outbreaks in the history of the country in 2015, he first turned to prayer before then turning to Obamacare to ameliorate the outbreak (and the latter worked).

But as Vice President, Politico reported this week, “Pence is helping to lead the Republican effort to dismantle the program that helped him halt the deadly outbreak in an impoverished swathe of Indiana.” Pence wants to end what he knows worked. His horrific HIV record, steeped in heterosexism, racism and Christian supremacy, is going to hurt people living with HIV, queer people, ethnic minorities and the poor the most.

Advocates of science were alarmed when the Environmental Protection Agency was told it could no longer talk to the public because, among other reasons, the EPA protects the public from environmental harm by giving information and guidance. Similarly, LGBT Americans should be very worried that the Trump administration seems to be dialing back on providing information on HIV/Aids and LGBT health to the public. The website for the White House Office of Aids Policy is now blank and the office’s future is unclear. A CDC summit in the works to address LGBT youth health (meant to address pressing issues a CDC report exposed such as how “young gay and bisexual males have disproportionately high rates of HIV, syphilis, and other sexually transmitted diseases”) was infinitely postponed after Trump was elected.

In funding prevention programs, the ACA still remains an important channel of government information about HIV/Aids. But if it disappears, the loss may be especially harmful in states which only teach “abstinence only” sex education.

As an LGBT community (and this applies to our supporters too), we cannot be focused simply on the Trump administration’s conservative stance on our civil rights. We must be vigilant about how HIV/Aids stands to harm the most vulnerable among us first, do all we can to protect the 1.2 million people in the US already living with HIV, and insist that the government keep the epidemic from getting even worse.

Trump"s next target: people living with HIV/Aids | Steven W Thrasher

193,000 NHS patients a month waiting beyond target time for surgery

An increasing number of patients are having to endure long waits for operations, according to a study that provides the latest evidence of the NHS’s failure to meet waiting time targets because hospitals are so busy.

Analysis by the Royal College of Surgeons found that over the past year an average of 193,406 people a month did not get surgery within 18 weeks of being referred.

The figure compares with 139,240 the previous year and 105,427 four years ago, and is the NHS’s worst performance by this measure since 2008. It covers patients waiting for operations including for broken limbs, traumatic injuries, brain conditions and eye problems.

Ian Eardley, the college’s vice-president, said: “We are now struggling to meet the standards and timeliness of care that the public rightly expect. Waiting longer creates prolonged pain, uncertainty and immobility for patients and is stressful for them and their families, especially those who may be very ill or in significant pain.

“Many of these patients are older and in the most serious cases, such as heart or cancer surgery, waiting longer could have a big effect on the quality of someone’s life and their eventual recovery from surgery.”

He said the sharp rise in the number of patients waiting longer than 18 weeks suggested the NHS had passed a tipping point.

In October 2016, for example, patients who had been on the waiting list for more than 18 weeks included 52,816 who needed trauma and orthopaedic surgery, 33,547 classified under general surgery, and 24,578 who needed a procedure to improve their eyesight.

The increases were most pronounced in ear, nose and throat surgery, up 124% since 2012-13, to 23,454 a month in 2015-16, and neurosurgery, up 109%, to 5,004.

The number of women who did not receive gynaecological surgery within the target time rose by 102% in the same period, to 14,795 a month..

Some NHS hospital trusts are leaving notably large proportions of patients waiting longer than 18 weeks for certain forms of surgery. For example, of the 717 patients who were waiting for neurosurgery at Plymouth Hospitals NHS trust last October, 59% had been waiting longer than 18 weeks.

The same applied to 48% of the 1,359 people awaiting oral surgery at Walsall Healthcare NHS trust and 44% of the 655 patients awaiting oral surgery at the University of South Manchester NHS foundation trust.

The shadow health secretary, Jon Ashworth, said he hoped hospitals’ poor performance against surgery waiting time standards would not prompt the government to soften the targets.

“We already know ministers want to water down the A&E target. Given this more widespread deterioration in waiting times, I hope this won’t lead to ministers abandoning others standards too,” he said.

Eardley said the delays in accessing surgery were likely to get worse given the intense pressure on hospitals and widespread bed shortages. “There is no sign of waiting times reducing any time soon and they are very likely to have become worse this winter. The key question is: how much longer will patients have to wait before the government steps in to relieve the pressure?”

On Friday, Theresa May seemed to edge closer to acknowledging the seriousness of the crisis confronting the NHS. “I recognise, and we have acknowledged, that the NHS is under pressure,” she said at a Downing Street press conference. She stressed the NHS had put £400m into preparations for coping with winter pressures.

She had said on Thursday there had been a “small number” of incidents of unacceptable practice in NHS trusts, and the health secretary, Jeremy Hunt, said there were problems in “one or two” areas.

Earlier on Friday, NHS England revealed that 65 out of its 152 acute trusts had had to declare an alert during the first week of January.

193,000 NHS patients a month waiting beyond target time for surgery

What could Facebook target next? Our mental health data | Emily Reynolds

It used to be that the eyes were considered the window to the soul. In 2016, you might have better luck checking someone’s social media. The tiny details we share about our lives have blurred the lines between “online” and “real life” – our Facebook accounts even get “memorialised” when we die.

According to a study published this week in Lancet Psychiatry, these seemingly innocuous tidbits can actually lead to quite a comprehensive picture of who we are, at least in terms of our mental health. Researchers from the University of Cambridge and Stanford Business School argue that data from Facebook – the photos we upload, the statuses we share, the frequency and content of the messages we send to friends – is “more reliable” than offline self-reported information, which is often considered to be inadequate or incomplete when it comes to understanding how mental illness is affecting someone.

Status updates in particular, they say, can provide a “wealth of information” about users’ mental health. A language analysis algorithm can pick up symptoms of mental illness, and could even flag early warning signs for conditions such as depression or schizophrenia. Yet more algorithms, these analysing pictures for “emotional facial expressions” could provide insights into offline behaviours. The next question is: what can we – and what can Facebook – do with that data?

Of course, a lot of the information the company has on us all is superficial at best – sure, it might be slightly uncanny to have advertisements served to us that perfectly reflect our taste in music or the TV shows we’ve discussed online, but it doesn’t really say anything very essential about who we are as people. Data about mental or physical health, however, cannot be treated so flippantly, either by those of us who are thoughtlessly supplying it or by the people collecting it. Discrimination against those with mental health problems is still rife; a recent NatCen British Social Attitudes survey, for example, found that 44% of people would be “uncomfortable” working with someone who’d experienced symptoms of psychosis. In legislative terms, this isn’t supposed to impact chance of employment or employment rights. In reality, there is a persistent and pervasive culture of distrust around those with mental health problems.

What if an algorithmic branding of ‘ill’ was shared with the world without our knowledge or consent?

Understandably, many people choose not to share the status of their mental health with colleagues or friends. But such privacy may be a luxury when “emotional facial expressions” can be neatly scanned and categorised by an algorithm, or when our heartfelt statuses are simply part of an input-output exchange. What if employers were able to use the same technology to scan our private posts, monitoring what we say and how we say it to avoid taking a risk on someone they may see as a “liability”? What if the data wasn’t secure, and an algorithmic branding of “ill” was shared with the world without our knowledge or consent?

As the study suggests, the internet can be a vital tool in how people express themselves about their mental illness, from the grandiose horrors of a serious breakdown to the minutiae of living day-to-day with a chronic illness. We can also foster genuine connections with others who might be experiencing the same things. And the potential benefits of the findings are clear – not least in the way we could be able to reach people such as refugees, the homeless or the elderly who are often shut out of traditional mental health services. We may even be able to find new therapeutic routes or platforms with which to help people.

What we can’t do, however, is continue to proceed the way that we are. The ethics of this particular study aren’t questionable; everybody involved in the study consented to their data being used, after all. But if it were to be used more broadly? The team suggests that detection of poor mental health could be a way for social networks to provide on-site support for users – in which case we may have a problem. For one thing, on a practical level, vulnerable users may not fully understand what their participation in such a scheme would mean, nor know the impact it could have on them. We need strict legislation about the ethics of gathering such sensitive data, and even stricter punishments should it be inadvertently or purposefully shared.

And, as we must never forget, Facebook makes money from our data. Slotting us into neat little boxes may be OK when it comes to things such as gender or age – what does that say about us, really? – but the idea of being neatly categorised as “mentally ill” or “mentally well” simply because of the things we choose to share online is both unethical and potentially dangerous. At best, of course, we could receive help that is currently unavailable to us. At worst? It doesn’t bear thinking about.

What could Facebook target next? Our mental health data | Emily Reynolds

NHS set to fall £150m short of target on payments from foreign patients

The NHS is set to miss its target of recovering £500m a year for treating patients from overseas, the Whitehall spending watchdog has said.

The National Audit Office (NAO) said hospital trusts in England were getting back more money from overseas visitors who were not entitled to free treatment, but were still facing a shortfall of more than £150m by 2017-18.

The target for reducing the cost of treating overseas patients was announced by the Department of Health in 2014 in a drive to cut trusts’ deficits and counter claims the NHS was being overly generous.

The amount collected has risen from £73m in 2012-13 to £289m in 2015-16. However, the NAO said the increase was mainly due to a new surcharge on temporary migrants from outside the European Economic Area (EEA), which brought in £168m last year.

The department’s forecasts suggest trusts will recover £346m in 2017-18, significantly less than the £500m target. The NAO said the shortfall was in part due to the failure to take account of the cost of administering the programme, while patients were still not paying the full amounts they owed.

“The charging regulations are complex. Trust staff may have to rely on judgment in determining whether a patient is chargeable, sometimes with limited information,” the NAO’s report said.

There was a “particular challenge” in collecting payments from patients – mainly from outside the EEA – who were personally liable for the cost of their treatment, it said. On average, only about half the amount due was being collected.

The head of the NAO, Amyas Morse, said: “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.

“In the past two years, the amounts charged and amounts actually recovered have increased. Much of this increase is the result of changes to the charging rules. If current trends continue and the charging rules remain the same, the department will not achieve its ambition of recovering up to £500m of overseas visitor income a year by 2017-18 and faces a potential shortfall in the region of £150m.”

NHS set to fall £150m short of target on payments from foreign patients

Owen Smith to target Tories over threat of NHS privatisation

Labour leadership hopeful Owen Smith is to hit out at the threat of creeping privatisation in the NHS, highlighting Department of Health accounts showing that spending on private-sector NHS providers has doubled under the Conservatives.

In a speech on Monday at a campaign trail stop at Trafford General hospital in Manchester, Smith will say that a Labour government led by him would boost health spending by 4% a year, suggesting there is “a secret Tory plan to privatise the NHS”.

Department of Health accounts published on the last day before parliament’s summer recess showed the spend on private-sector NHS providers more than doubled, from more than £4bn in 2009-10 to £8.7bn in 2015-16.

Smith’s early campaign has been dogged by accusations that he lobbied for further private-sector involvement in the NHS during his time as policy chief at the pharmaceuticals companies Pfizer. During his career as a lobbyist for the US firm, Smith had called on ministers to improve incentives for the pharmaceutical industry.

His speech on Monday will attempt to divert attention to his time as shadow health minister, saying that he “fought the Tories’ top-down reorganisation of the NHS line by line”. He will say: “I warned that it would lead to an explosion of privatisation – and that is exactly what has happened.”

Smith, a former shadow work and pensions secretary, has previously claimed it was a gross exaggeration to suggest he had campaigned for more privatisation of NHS services while at Pfizer, and suggested it had been an error for Labour to advocate greater choice over care providers.

He will focus his efforts on health policy a day after Corbyn’s announcement about plans for a national education service based on NHS principles.

Owen Smith to target Tories over threat of NHS privatisation

FGM hit squads to target summertime flights out of Britain

New border force youngster protection squads will team with police officers across the country to target certain flights this summer in a bid to prevent vulnerable girls getting taken out of the country for female genital mutilation.

The beefed up teams at significant airports and border crossings in the Uk are on alert for the begin of the summer holidays, when authorities say girls are at the highest risk of currently being taken out of the country.

Specially skilled border force agents will be functioning with police forces, which will get new tips telling officers to place aside cultural sensitivities and fears of getting branded racist in order to pursue investigations into FGM.

The very first advice for the police on how to tackle FGM has been drawn up by the College of Policing and is getting put out for consultation on Tuesday – as the prime minister, David Cameron, launches the Lady Summit, which aimed at mobilising domestic and global efforts to end FGM and forced marriage inside of a generation.

As the summer season holidays begin, an 80-powerful staff of professional officers at Heathrow, 65 at Gatwick and 21 at Manchester will be on the lookout for at-chance young children. The port of Harwich also has a new staff, although specialised FGM instruction is also planned at Birmingham, London City and Stansted airports and the ports of Calais and Dunkirk.

Flights to nations that practise FGM – like Kenya, Ethiopia, Ghana, Nigeria, Dubai, Egypt and Turkey – will be targeted, explained the assistant director of Border Force, Ingrid Smith.

“The message we are sending with this intensification of operations is that the practice of FGM will not be tolerated in this nation,” she stated. “Police, border forces agents and social solutions will act with each other to end this and folks trying to get kids out of the country will be caught.”

James Brokenshire, the immigration and safety minister, stated border police were effectively-positioned to gather intelligence on achievable perpetrators and prevent FGM from getting carried out.

“The college summer season holidays are a time of certain threat for numerous women,” he explained. “Which is why we have teams of specially skilled officers at major airports with the capabilities to identify and defend potential victims and end the perpetrators.”

The guidance drawn up by the University of Policing is the initial dealing with female genital mutilation and displays increasing public and political concern more than the practice as properly as the lack of prosecutions of men and women in the Uk.

Police officers in England and Wales will be advised that when investigating the mutilation of young girls in the Uk they need to contemplate all child protection measures, including getting rid of a lady from her loved ones if they feel she is at chance.

Under area 46 of the Children Act 1989. police officers can choose to remove a little one who they think is at threat of “significant harm” to a place of safety for up to 72 hrs. They can also apply to a court for an emergency safety order where they feel a little one is in imminent danger.

Officers will also be told that they must take into account elimination of younger sisters in a household exactly where there are issues that an older woman is at threat of FGM, due to the fact the younger siblings will also need to have protection.

Ch Con Alex Marshall, chief executive of the University of Policing, stated: “We want to ensure that officers have the best data attainable to support them to safeguard the vulnerable and tackle this horrible crime.

“We have to not allow perceptions of cultural sensitivities get in the way of action against female genital mutilation. This advice will help develop our knowing and self confidence in policing this crime so that we’re far better in a position to react to victims’ requirements and ultimately deliver perpetrators to justice.”

It warns officers not to be place off pursuing investigations simply because of the “cultural sensitivities” concerned.

“Female genital mutilation is the deliberate cutting of the female genitalia. It is illegal, very painful and a kind of violence towards ladies and girls  … Officers must not stay away from tackling FGM for dread of carrying out or saying the wrong factor or getting deemed racist.”

FGM has been unlawful in the United kingdom given that 1985, and the law was tightened up in 2003 to make it an offence for a British resident to travel abroad in order to have FGM carried out on a kid. Stress has been expanding on police and prosecutors more than the failure – until finally earlier this yr – to bring a single case to the British courts. Alison Saunders, the director of public prosecutions, announced the initial ever charge relating to FGM earlier this yr but the situation has however to go via the courts.

The new police tips will be published on Tuesday as Cameron opens a Ladies Summit aimed at eradicating female genital mutilation and forced marriage in a generation. It is estimated that 24,000 girls in the United kingdom are at chance every single yr of FGM and the school is calling for police forces in locations with huge communities that practise the cutting to set up a directory of expert interpreters whom they can believe in.

The guidance says: “Officers … need to not use members of a person’s own loved ones or community as an interpreter as this may result in info currently being fed back to the suspects, the victim or witness currently being ostraticised from their neighborhood, pressure being utilized to withdraw a statement and the classic view of the local community getting relayed to the witness.”

The tips is getting place out to consultation from interested events in purchase for the police to get input from all these with experience on the subject. It will then be issued to all police forces to highlight the crucial locations officers need to contemplate when investigating instances of suspected FGM.

Officers are taken by means of diverse scenarios where the crime that has been committed is highlighted. The issues of pursuing situations of FGM are also picked out.

“As opposed to other forms of child abuse a mom who agrees to her daughter being mutiliated believes she is acting in the ideal interests of the child … in some situations mother and father could be beneath substantial strain from members of their household or neighborhood to permit their daughter to undergo FGM.” The police are recommended to contemplate youngster protection measures – including the elimination of the child at threat and younger sisters – if they have worries they are at significant chance of FGM.

Ahead of the Girl’s Summit, councils have also called for promoting the practice of FGM by community or faith leaders to be manufactured unlawful below new government ideas to toughen up the law.

The Nearby Government Association – backed by the NSPCC, British Arab Federation and FGM charity Forward – mentioned the Significant Crime bill becoming utilized to toughen up FGM legislation essential to go even more.

“Nearby authorities are determined to work with communities to end the practice and decrease the 1000′s of women and girls estimated to be at danger of FGM in the Uk,”explained Ann Lucas, the chair of the LGA’s afer and Stronger Communities Board. “Nevertheless, their function to change lengthy-standing cultural practices is created a lot more hard when local community or religious leaders carry on to promote it.”

FGM hit squads to target summertime flights out of Britain

We"re right to target dementia, but a cure will be elusive

So will equivalent moves to chill out laws now adjust the outlook for people with dementia?

Although I help the sentiments behind Cameron’s speech, I’m not convinced it will be as simple to discover new medicines for this problem, which is not a condition in itself but an umbrella phrase used to describe symptoms of memory loss and issues with thinking, dilemma-solving or language.

The commonest kind, Alzheimer’s, benefits in chemical and structural alterations in the brain this is a fairly different disease procedure to the 2nd most widespread, vascular dementia, which is induced by alterations in blood movement to the brain. Rarer varieties of dementia incorporate Creutzfeldt-Jakob Ailment (CJD), which is induced by an infectious particle recognized as a prion.

So dementia is not a clinical diagnosis in itself, even though the public, politicians and even some medical professionals use the term as if it were. Creating powerful therapies will rely on the underlying pathology that is currently being targeted.

Undoubtedly, some dementias share some of the exact same processes, and some folks have a mixture of types – for instance, Alzheimer’s and vascular dementia mixed. But to speak of a cure for ”dementia’’ is misleading.

It would help to start employing the correct terms for the diverse kinds. Carrying out so would aid individuals realize that this is a complex spot of medication, requiring a distinct scope of investigation for diverse pathologies.

The most hopeful region for investigation into therapies is Alzheimer’s, simply because the pathological process underpinning it is comparatively properly understood. There are presently some drug treatment options in this area, such as donepezil, though they are not as efficient as was after hoped.

Alzheimer’s stays a puzzling illness, for which medicines that must operate in theory are ineffective in practice. In the previous year alone, three medication that had proven promising preliminary final results failed in late-stage drug trials.

The background of study into Alzheimer’s, as with other sorts of dementia, is littered with this kind of blind alleys. It can be frustrating for researchers, who have to stay doggedly established in the encounter of agonisingly meagre returns. Only about five per cent of medication trialled in medication will ever make it to marketplace, and with Alzheimer’s analysis, even this figure looks optimistic.

I suspect that the issues in finding successful treatments for the dementias is not down to sluggishness on the component of the drug businesses or bad-good quality investigation. It is because the structure and workings of the brain are so complex.

Nevertheless, I keep in mind, when I 1st started as a medical professional, dementia care was a Cinderella service, ignored, underfunded and misunderstood. Now, it is on the national agenda and rarely out of the news. It’s heartening to feel that, lastly, folks are paying it attention.

Don’t be a sun victim like Hugh Jackman

According to research published final week, package deal holidays are to blame for the soaring prices of skin cancer in excess of the past ten many years.

Incidents of melanoma, the deadliest type of the condition, have improved by 78 per cent in males and practically 50 per cent in women.

It is imagined that a lot of folks being diagnosed right now suffered sunburn when on holiday years ago.

Only final month, Hugh Jackman, star of the X-Men movies, had a basal cell carcinoma (a benign type of skin cancer linked to sun publicity) removed from his face, and tweeted pictures of the resulting scar, imploring followers to dress in sunscreen.

I hope that people listen to him, when so usually doctors’ guidance appears to fall on deaf ears. It appears this kind of a tragedy that in the pursuit of a tan, folks are putting their lives at danger.

Far better pale and interesting than tanned and dead.

It is a single rule for them…

The scandal of patient data currently being offered to insurance coverage organizations continues. Following an investigation by The Telegraph revealing that data of 47 million individuals had been offered, an independent overview final week discovered there had been significant lapses in patient confidentiality and in the sharing of delicate individual info with third events.

What is specifically galling about this fiasco is that no individuals are getting held responsible. This is in sharp contrast to individuals who function at the NHS coalface. Penalties for breaches of confidentiality by clinicians are eye-wateringly harsh. At a hospital where I worked, a doctor was fired and referred to the GMC when a piece of paper containing a list of all her sufferers and their complaints was blown out of her hand and down the street, to be later on retrieved and handed in by a member of the public. A grave error, but really worth ruining someone’s occupation more than?

At another unit in which I when worked, a senior nurse with thirty years’ experience left a letter containing identifiable patient data on top of a ticket machine in a auto park. He realised, returned and retrieved it – and reported what had took place to his manager. He was suspended, faced disciplinary proceedings and later resigned below stress.

Can we anticipate the identical rigour for these persons large up in the NHS who sanctioned the selling of people’s health care data and presided over such appalling breaches of confidentiality?

Max Pemberton’s latest guide, ‘The Physician Will See You Now’ (Hodder), is offered to purchase from Telegraph Books at £8.99 + £1.95 p&ampp. Phone 0844 871 1514 or go to books.telegraph.co.united kingdom

We"re right to target dementia, but a cure will be elusive

Cancer waiting time figures reveal very first breach of target

NHS England has launched figures on waiting instances for cancer treatment. Photograph: Dominic Lipinski/PA

The target time period for sufferers to start remedy right after an urgent referral for suspected cancer has been breached for the very first time since it was launched.

NHS guidelines stipulate that 85% of this kind of sufferers must wait a optimum of 62 days to get started their 1st definitive treatment following referral by their GP. Figures present the proportion slipped to 84.four% in the course of the time period from January to March, down from 85.eight% in the preceding quarter.

The national clinical director for cancer for NHS England, Sean Duffy, explained work was essential to ensure standards have been met.

“It is vital cancer sufferers are diagnosed and taken care of swiftly so they have the best possible possibility of recovery,” he explained. “Newest figures present nationally the NHS has met and exceeded 7 out of eight cancer waiting time standards. But there is variation in meeting the challenging standards, and nationwide performance against one of the targets has dipped.

“CCG commissioners are operating together with local suppliers the place the standard is not currently being met to identify the concerns to guarantee individuals are taken care of in a timely way.”

Other figures launched by NHS England on cancer waiting instances demonstrate that the proportion of men and women witnessed by a professional inside of two weeks of an urgent GP referral for suspected cancer dropped from 95.6% to 95%, and the proportion of folks urgently referred for breast signs (exactly where cancer was not initially suspected) seen within two weeks fell from 95.five% to 93.9%, just above the target of 93%.

In all cancers, patients need to encounter a highest wait of one month in between obtaining their diagnosis and the begin of very first definitive remedy, with the operational regular being 96%. This was met in 98% of cases in the very first three months of the 12 months, down from 98.three% in the previous quarter.

Ranges decreased in individuals diagnosed with breast cancer (from 99.2% to 98.9%), lung cancers (from 98.9% to 98.six%), reduce gastrointestinal cancers (98.5% to 98.3%), urological cancers (96.4% to 96.one%) and skin cancers (down from 98.1% to 97.eight%).

The failure in the 62-day wait from urgent GP referral to first definitive treatment method is the 1st breach of any cancer waiting time considering that the introduction of the existing operational common in 2009.

Even more figures relating to this target indicate that 96.6% of individuals taken care of for breast cancers met the guideline, down from 97% in the final 3 months of last yr. There had been also drops amid individuals treated for reduced gastrointestinal cancers (from 78.seven% to 76.eight%) and urological cancers excluding testicular cancer (from 81.five% to 78.seven%.)

The figures improved amid people with lung cancers, from 77.8% in the ultimate quarter of final yr to 78.2% this year, and skin cancers (from 95.eight% to 96.2%).

Figures for waiting times for 2nd or subsequent therapy demonstrate that 96.8% of people underwent surgery inside 31 days, down from 97% the previous quarter.

Mike Hobday, director of policy and investigation at Macmillan Cancer Help, stated the figures had been worrying. “This is the 1st breach of any cancer waiting time in England because 2009 and is a clear warning sign that the NHS is below enormous strain,” he mentioned.

“The Uk presently has some of the worst cancer survival charges in Europe. More sufferers are now facing delays, which indicates far more sufferers are facing nervousness for longer and more lives are currently being put at chance. We’re very anxious that the coordination of cancer care is getting worse and that cancer is currently being overlooked in the new NHS. The quantity of cancer patients is set to boost from two to 3 million by the end of the subsequent government in 2020, and we cannot afford to see much more and far more individuals waiting longer.”

Cancer waiting time figures reveal very first breach of target

"I would like to see a greater target on using investigation to increase patient care"

Sharmila Nebhrajani would like to discover the proper stability amongst encouraging growth in study and guaranteeing it is risk-free and legal.

Describe your position in a single sentence:
Overseeing the perform of the Human Tissue Authority (HTA), the watchdog that can make positive human tissue and organs are utilized securely, ethically and, most importantly, with consent.

Why did you want to work in healthcare?
I didn’t consciously get that selection. I studied medicine at university, which gave me a robust interest, but I never ever practised. I spent most of my job in company and I kept my science hand in, sitting on the board of the Human Fertilisation and Embryology Authority and operating as chief executive of the Association of Medical Research Charities. But science was an itch I didn’t fairly scratch – so it really is a genuine delight to have been appointed chair of the HTA.

How do you want to see the sector alter in the following 5 years?
I would like to see a higher target on using study to enhance patient care. The United kingdom has 1 of the most impressive research pedigrees in the world – we have far more Nobel prizes than any country other than the US – but the challenge remains translating that into treatment options for sufferers that are progressive, efficient and reasonably priced. We regulators have our position to play in helping that take place – obtaining the right stability in between encouraging that advancement and guaranteeing it is protected and legal.

My proudest achievement at work was … currently being part of the crew at the BBC that constructed and delivered the iPlayer. We were blessed in realizing we have been constructing one thing genuinely groundbreaking from the begin.

The most difficult issue I’ve dealt with at operate is … chairing the committee that accepted the first study licence to create a human/animal hybrid embryo. It was radical science, raised enormous ethical concerns and had a substantial “yuk” factor. The discussions have been lengthy and challenging fought on all sides.

I feel the biggest challenge facing the NHS is … how we will finance healthcare in the future. The Uk wants to put together itself for a conversation about what funding options exist. Obtaining a way to make certain the very best achievable companies are obtainable here in the Uk at the most economically cost-effective costs will challenge us all.

The people I operate with are … new to me. I have not too long ago began at the HTA, but what is struck me is our people’s expertise and passion for what they do and why it matters. The privilege of operating in the health sector is that our work is the two intriguing and important.

I do what I do since … I am relentlessly curious.

Sometimes folks consider that I … talk also much.

Appropriate now I want to … quit speaking.

At perform I am usually studying that … there is usually a lot more to find out, no matter how senior you get and most of it is going to be fascinating.

The 1 thing always on my mind at function is … could I have completed that greater? I am a perfectionist and that helps make me tough on myself. My largest struggle is discovering the sweet spot amongst creating anything the really best it can be, and settling.

If I could go back 10 many years and meet my former self I would say … there are fewer poor decisions in life than you feel. There are a number of right answers, a handful of wrong ones and most issues, if they are meticulously deemed, are really worth a punt.

If I could meet my future self I’d expect to be … in possession of a pilot’s licence. I have often wanted to find out to fly – I have had a handful of lessons but time stays a barrier.

What is the very best element of your occupation?
Working for an organisation in which the decisions we get matter and lead to improvements in the well being sector.

What is the worst element of your task?
Being super active – operating from a single location to another and constantly fretting that I am striving to pack also significantly in.

What can make you smile?
My children. Normally.

What keeps you awake at night?
Nothing – I sleep the rest of the contentedly exhausted.

If you would like to characteristic in our Five minutes with… series, or know somebody who would, allow us know by emailing healthcare@theguardian.com

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"I would like to see a greater target on using investigation to increase patient care"

Terminally unwell teenager "still fighting" as he smashes £2m fundraising target

Stephen Sutton wrote ‘to get to see the million pound target was phenomenal!’ – he has now raised more than £2m.

A teenager who is terminally unwell with cancer has raised a lot more than £2m for charity in an on the web campaign, smashing his £10,000 fundraising target.

Stephen Sutton stated he was “nonetheless fighting” as donations from the public for his Teenage Cancer Trust appeal carry on to flood in.

The 19-12 months-old, who has drawn up a bucket listing of things to do ahead of he dies, has been backed by celebrities including Simon Pegg, Steve Coogan and James Nesbitt.

Sutton, from Burntwood, Staffordshire, mentioned he imagined he was a goner a few days in the past when he suffered a collapsed lung, writing on his Facebook webpage that despite pondering he did not have lengthy to live, he had made regular progress because.

“Hi everyone, it’s Stephen here – still here and even now fighting!,” he wrote. “Throughout the complete journey I’ve been sensible about my place and at my last publish I genuinely thought I was a goner … But hey, I’m still right here!!

“Sunday morning my right lung collapsed: I had a complete emergency team surrounding me and in all honesty was almost certainly not also far from almost leaving you all …

“The progress considering that has continued to be good but regular. I am even now in a very vulnerable position. I am quite constrained in what I can do and am nonetheless permanently hooked up to oxygen.

“But I am in high spirits and blessed to have so significantly love and support close to me. To get to see the million pound fundraising target currently being reached was just phenomenal!”

Sutton extra that he planned to take issues day by day “but I am pleased – and that is the primary thing”.

A host of celebrities have taken to Twitter to help the result in, posing for photos and holding indicators urging the public to donate.

The teenager was diagnosed with bowel cancer when he was 15. Despite surgical procedure, the aggressive cancer spread and, after more treatment method and operations, doctors concluded it was incurable.

Alongside the fundraising campaign, Sutton made the decision to set up a bucket list of 46 things to do prior to his death. It integrated hugging an elephant, crowd-surfing in a rubber dinghy, playing the drums at a Wembley cup ultimate, acquiring a tattoo and appearing on BBC drama Physicians.

Sutton’s fundraising drive is becoming backed by the comedian Jason Manford, who mentioned he had previously met the teenager at charity gigs. Appearing on ITV’s Daybreak, Manford mentioned he and other individuals have been inspired to get concerned by the teenager’s optimistic mindset as he strove to make the greatest of his circumstance.

He explained: “That is what acquired their imaginations going genuinely. It was that he just had such joy for daily life. He wasn’t bitter about leaving the get together early, he was just pleased that he was ever invited at all. He’s 19, which is no age at all.

“There is so many things he is not going to be able to do, but there’s anything he said on his Facebook webpage and on his web site – he mentioned that lifestyle should not be measured in time, it should be measured in achievements you have accomplished and I thought ‘this guy’s 19′, and it genuinely received to me.”

Sutton set up his charity fundraising web site and weblog on Facebook in January last yr to keep men and women up to date with his progress.

On Tuesday he wrote that his problem had worsened, including “regrettably I have not received much time left”. Thanking family, pals and fundraisers, he mentioned: “Which is it from me. But existence has been very good. Really excellent.”

Siobhan Dunn, chief executive of the Teenage Cancer Believe in, praised the inspiring teenager and ambassador for the charity.

She mentioned: “I have had the privilege of meeting him and his positivity is usually remembered by all that meet him or hear him communicate. Stephen is generating the biggest attainable variation to Teenage Cancer Trust and the youthful folks who want our assist.

“We’re a comparatively small charity and Stephen has inspired his loved ones, buddies and communities up and down the country to raise above £1,300,000 and it really is still climbing. This is a impressive sum which will assist us assistance numerous far more younger men and women with cancer.”

Speaking previously, Sutton stated he disliked the term “dying from my cancer – I am living with my cancer, in spite of it being there”.

Manford tweeted a image of himself going to Sutton in hospital on Thursday afternoon. He wrote on Twitter: “Remarkable @_StephensStory is up &amp chatting soon after his brush with death. He is so satisfied that we are close to £2million!”

Terminally unwell teenager "still fighting" as he smashes £2m fundraising target

Terminally unwell teenager posts "final thumbs up" as he reaches £1m target

The teenager later tweeted from his hospital bed after he heard his campaign had reached £1million.

Mr Sutton, from Burntwood, Staffordshire, was diagnosed with bowel cancer at the age of 15 but this spread to other components of his physique.

He created a bucket-list of 46 issues he wished to do ahead of he died, setting up a charity fundraising website and a website on Facebook in January last 12 months to maintain individuals up to date with his progress.

His ‘bucket list’ incorporated hugging an animal larger than himself, which noticed him embrace an elephant at West Midlands Safari Park. He also played the drums in front of 90,000 individuals at last year’s at final year’s Bayern Munich v Borussia Dortmund Champions League ultimate at Wembley.

Mr Sutton set an original fund-raising target of £10,000 for the Teenage Cancer Believe in but as this was exceeded he set a new aim to increase £1 million, which he accomplished on Wednesday morning.

On Tuesday he was rushed to hospital and posted a “last thumbs up” picture on his Facebook web page.

He wrote: “I’ve carried out nicely to blag issues as effectively as I have up until now, but regrettably I consider this is just 1 hurdle also far.

“It’s a shame the finish has come so suddenly- there is so several people I have not got round to properly thank or say goodbye as well. Apologies for that.

He said that future messages would probably be posted from a family members member, and extra: “I will proceed fighting for as lengthy as I can, and whatever takes place subsequent I want you all to know I am at present in a good spot mentally and at ease with the scenario. “That’s it from me. But life has been very good. Extremely good.

“Thank you to my mum and the rest of my family for almost everything. Thank you to my close friends for getting wonderful.

“Thank you to my medical group for the hard work and energy they’ve continually they’ve place towards me. And thank you everyone else for sharing this superb journey with me.”

Mr Sutton’s story attracted the focus of celebrities which includes Jason Manford, John Bishop and Piers Morgan who publicised his fundraising efforts on Twitter.

The teenager achieved his target at eleven.13am on Wednesday and tweeted shortly afterwards: “But seriously… Wow. Just wow. Thank you all so significantly :)”

Comedian Jason Manford posted a screen-grab of a text from his dad which revealed his authentic response to the news had just been: “Awesome.”

A £10 donation by a individual identified only as Jilly tipped the figure past the £1 million mark with the message: “Seems like your wish will come correct, ideas are with you and your loved ones”.

The Teenage Cancer Trust tweeted: “BREAKING: you have completed it! £1 million! We really cannot thank you all enough!!”

To make a donation go to Justgiving.com/Stephen-sutton-TCT.

Terminally unwell teenager posts "final thumbs up" as he reaches £1m target

Target on wellbeing an different cure for the NHS"s ills

Younger youngsters function out at a children’s gymnasium session. Prevention is better than remedy when it comes to obesity, which leads to many illnesses later in life. Photograph: Murdo Macleod

The Division of Well being (DH) faces an enormous challenge: how to meet ever-rising demand from an ageing society whilst public spending increases no more rapidly than inflation. And perhaps significantly less quick: last month’s price range implies more public expenditure cuts, to meet the government’s deficit targets.

The “solution” most frequently proposed is more beneath-inflation spend rises for NHS workers, a lot more reconfiguration of hospitals and new methods of improving productivity. There is no option? Well, really this time there is: but it entails a radical alter of concentrate, a Whitehall shakeup, and some challenging spending alternatives.

The drive to increase productivity has led to ever-more emphasis on “output” measures for the NHS: numbers of operations carried out, or sufferers examined. But the inadequacies of this approach have heightened curiosity in a wider concept: existence satisfaction, or “wellbeing”. In a current report “Wellbeing and Policy”, commissioned by the Legatum Institute, my fellow economists and I advocate producing wellbeing the government’s overriding aim when designing policy.

This would call for a enormous modify of priorities for the DH: 1st, shifting interest from physical to mental wellness, generating a reality of the department’s theoretical commitment to equal standing for both.

Mental illness accounts for an massive amount of struggling, or reduction of wellbeing. And it is estimated that 3-quarters of it goes untreated. To tackle this needs not just income, but also a joined-up method with the Department for Schooling. There need to be a minister for psychological overall health with a seat in the two departments, complementing much better treatment method with greater prevention, by way of programmes to advertise emotional and social development in schools. In reality, there would require to be a basic emphasis on prevention of sickness. As a lot of as 4-fifths of deaths from significant diseases are primarily the consequence of life-style elements, such as smoking, drinking and obesity. Far much more of the price range demands to be directed at reducing individuals hazards, and not just through elevated fiscal investment: this is an region desperately in need of a combination of private-sector innovation and sensible regulation.

Take street safety. Considering that the 1930s, the quantity of vehicles on our roads – and the amount of miles we drive – has risen enormously. But far fewer men and women are killed on the roads. Innovations in car style, road style and driving regulations, backed up by social pressures, have aided to transform road safety. Today, 3 occasions as several individuals die from suicide as in motor car accidents. Now we require to emphasis on avoiding these tragedies with the identical blend of skills.

This kind of modifications won’t be simple, simply because even if they yield cost savings in the extended term, they will need income to be reduce from other elements of the wellness price range in the short phrase. But the third vital alter will be, institutionally, even more difficult.

Well being services and social care need to have to be brought a lot closer together. That is much more or less accepted. A lot more controversially, the DH need to be offered portion of the spending budget for disability benefits, so it focuses on getting folks back to perform. This would aid the reallocation of assets to the two physical and psychological therapies. Increased employment costs among disabled individuals may possibly look like an previous-design, output-driven measure of good results. It is not. For not only would their perform contribute to greater GDP, it would have a strong result on their wellbeing. One of the clearest insights from wellbeing investigation is that unemployment has a huge psychological expense. (In truth, making adjustments for a variety of disabilities is a whole lot less expensive than most employers realise and such workers have a tendency to be extremely loyal.)

Other Whitehall departments need to also review their priorities. But health demonstrates the possibilities, and the problems, of defining, measuring and pursuing the wellbeing of the nation as a total. It is a fantastic location to begin on this vital journey of policy reform.

Target on wellbeing an different cure for the NHS"s ills

Obamacare Signup Could Hit 7 Million Target As SignUp Enters Final Day

With one particular day left to signal up for well being coverage underneath the Inexpensive Care Act, the Obama administration right now mentioned the healthcare.gov website has supported more than eight million visits since last Sunday.

The Centers for Medicare &amp Medicaid Providers, which is dealing with rollout of the law, last week said much more than 6 million had signed up but the agency  was not ready to say whether the last tally would exceed the authentic projection of 7 million. But the last-minute surge of buyers could put the 7 million quantity within reach if the calls and website visits turn into people really selecting strategies, in accordance to statistics launched this afternoon. The last day of open enrollment is Monday, March 31 to receive coverage yet this year.

“Over the previous week the web site has dealt with record client demand well –supporting more than 8.seven million visits given that last Sunday, with 2 million alone this weekend,” the Centers for Medicare &amp Medicaid Providers explained in an “operational update” released this afternoon. “The website continues to carry out properly under the greatest sustained period of volume to date with regular response occasions significantly less than 400 milliseconds and an error charge of .5%.

Ahead of the open enrollment period began in October of last year to indicator up for coverage, the Obama administration was assured seven million Americans would indicator up. Considering that that time, the internet site was dogged for significantly of October and November with technical problems that made some observers wonder if even 4 million would signal up by tomorrow, the March 31^st deadline for coverage that would get started this 12 months. The White Property last Thursday explained more than six million individuals had signed up for coverage through the well being insurance coverage marketplace.

Shoppers can pick from an array of strategies sold by the likes of Aetna Aetna (AET), Cigna Cigna (CI), Humana Humana (HUM), UnitedHealth Group UnitedHealth Group (UNH) and various Blue Cross and Blue Shield strategies. Well being insurance coverage businesses are giving the plans on marketplaces recognized as exchanges that are operated by both states or the federal government.

In downtown Denver, for illustration, customers flocked to a “Connect for Well being Colorado” office Sunday. A lady staffing the office told Forbes that customers in the final week have gone from purchasing to “lock and load” and are following through to pick ideas.

On Sunday morning speak demonstrates, both Republicans and Democrats mentioned the law would stay an concern in the approaching November midterm elections with most Americans unhappy with the rollout, positive aspects and fees.

But White Property adviser David Plouffe mentioned on ABC’s “This Week” that the law is “working” and the quantity of Americans receiving overall health coverage is truly near 10 million when those who have signed up for expanded Medicaid coverage for the bad were included.

The Obama administration said the “24/seven phone center that supports the Health Insurance Marketplace has taken a record variety of calls from consumers – in the last week alone the phone center took far more than two.5 million calls, in contrast to two.4 million for the whole month of February.”

Obamacare Signup Could Hit 7 Million Target As SignUp Enters Final Day

Police target "cutters" in campaign against Uk female genital mutilation

A senior police officer has appealed for details about the “cutters” who carry out female genital mutilation on young ladies, as stress grows more than the failure to bring a single prosecution in the United kingdom for the abuse, which is thought to influence tens of thousands of ladies.

Detective Chief Superintendent Keith Niven, who leads the sexual offences, exploitation and youngster abuse command of the Metropolitan police, said he would use every single tactic obtainable to him, including covert techniques, to investigate and prosecute men and women who mutilate infants and young girls.

As the Guardian launched its campaign towards FGM, Niven also criticised the lack of action being taken by headteachers and the Department for Training (DfE) to deal with the dangers young women in their schools were facing.

“We require to break down the taboos and enable young women to feel able to talk about it at school to their teachers,” explained Niven. “This is little one abuse – it can lead to lifelong psychological and physiological damage. There requirements to be a consistent strategy across colleges, inside the large-chance places as a beginning level, and that is not taking place.”

The Guardian’s campaign to help end FGM – which calls on the education secretary, Michael Gove, to create to every headteacher in the nation to inform their workers and mothers and fathers about FGM – has turn into the fastest expanding overall health campaign to be hosted on the site Alter.org, soon after launching on Wednesday.

By mid-morning on Thursday – the UN’s FGM zero tolerance day – the petition had gathered a lot more than thirty,000 signatures and was gathering the momentum to spark political motion. In comparison Caroline Criado-Perez’s campaign, which effectively stored a girls on a Financial institution of England banknote, gained 35,000 signatures. “The Guardian campaign is totally flying. The numbers are off the scale,” stated John Coventry, from Alter.org. “The people who are signing this campaign are obviously extremely committed and they want to see action.”

Niven named for fresh intelligence on individuals operating as cutters as he exposed that the lack of victims coming forward to police with details about the abuse they had suffered was a main obstacle to bringing a prosecution. Many younger ladies, he explained, had been very reluctant to give information that could lead to the prosecution of their dad and mom or other relatives.

“I do understand why young ladies who have been subjected to this may be reticent about coming forward and offering proof,” he mentioned. “We embrace anyone that needs to come forward and speak to the police and we will help them – we have got the assets and the officers qualified to deal with this. But we are not acquiring the instances coming through.”

FGM has been illegal in England and Wales given that 1985, with the law amended in 2003 to criminalise the taking of younger girls abroad for the practice. A lot more than 66,000 women in England and Wales have undergone FGM and a lot more than 24,000 women beneath the age of 15 are at danger, according to a current report.

But given that 2009 the Metropolitan police has had only 195 referrals about FGM, most of which involved tiny snippets of details or suspicion, rather than direct speak to from victims, and there have been no prosecutions in connection with FGM. “I want men and women who have information about the cutters to come forward,” he mentioned. “I can use tried and tested techniques and techniques and assets to consider a near look at them and gather evidence towards men and women so I will not require to depend on victims coming forward.

“That is the place I want to get to. But to get there I want a beginning level, I need to have details, I require people to inform me who it is that is committing these crimes.

“They know that they are breaking the law, and it is carried out for economic acquire, and we need that further piece of data to pursue them. I want to get the stress off the victims and appear at probably what would be a victimless prosecution. That would send a genuinely sturdy message.”

In an attempt to tackle the reluctance of victims to speak to the police, Niven has brought in the National Society for the Prevention of Cruelty to Kids (NSPCC) to act as a neutral intermediary for victims to speak to through a 24-hour helpline (0800 028 3550).

The strongest chance of a criminal situation going to trial fell away final 12 months when the alleged victim, who had been subjected to FGM in Kenya in 2006, informed detectives she could no longer help the prosecution. The authorities could have forced her to give proof, but police and prosecutors rejected the concept, as they did not want to put this kind of a vulnerable witness by way of the ordeal.

Niven has hopes that with the right excess weight of proof, he could pursue a victimless prosecution against cutters in this nation. Police are beneath stress as the house affairs choose committee prepares to mount an inquiry into the failure to prosecute anyone for FGM.

The Globe Health Organisation describes FGM as “procedures that involve partial or complete elimination of the external female genitalia, or other damage to the female genital organs for non-health-related factors”. It is normally carried out on girls in between infancy and 15, with the bulk of situations taking place among the ages of 5 and eight.

Many young ladies are taken out of the nation for the duration of the summer time holidays for the practice to be performed abroad, and Niven believes colleges could do far more to safeguard them.

He advised the Guardian he had repeatedly known as for a higher-profile public health campaign targeted at young women at chance, to be utilized from main upwards, but was nevertheless waiting for educators to act.

“I would like to get a DVD place into the social schooling classes of all schools in the at-chance areas which explores what FGM is, consists of the NSPCC helpline and offers folks some help and alternatives about how they can disclose what has happened,” he stated. “That is my vision. I have raised it in all places I can, at really large levels, but it has not took place.”

The government says teachers have a crucial position in spotting youngsters who might be at threat of or who have undergone genital cutting, and last year Ofsted said it would be testing the alertness of schools to FGM as part of its inspection regime.

But an NSPCC report revealed surprising ranges of ignorance between teachers in England and Wales, with 83% saying they had not had little one protection education in this location. The poll of one,000 teachers also suggested that 68% have been unaware of government guidance about safeguarding policies concerning FGM, with one particular in 6 teachers saying they did not know that it was unlawful in the Uk. The same proportion did not see it as kid abuse.

The opportunity of a prosecution in the near long term rests on eight cases being considered by the CPS. The police are also investigating a London-primarily based medical professional, Sureshkumar Pandya, who is alleged to have performed a labia reduction on a patient in March 2012. He was reported to the Basic Medical Council soon after the patient was examined by an additional physician.

Cases of FGM in the Uk tend to occur in areas with huge populations of FGM-practising communities, such as from components of Africa, Asia and the Middle East these locations incorporate London, Cardiff, Manchester, Sheffield, Northampton, Birmingham, Oxford, Crawley, Reading through, Slough and Milton Keynes.

A spokesman for the DfE, responding to Niven’s remarks, said: “Female genital mutilation is unacceptable it is kid abuse and a criminal offence. The government’s new action program for tackling violence towards ladies and women has a renewed focus on guarding possible victims and sends a robust message that FGM will not be tolerated.

“Schools perform an important position in raising pupils’ awareness of this problem. We count on them to refer cases of concern to the pertinent companies in the identical way as they would for any sort of abuse.”

Anybody who is worried that a child could be or has been a victim of FGM can contact 0800 028 3550 for data and support.

Police target "cutters" in campaign against Uk female genital mutilation

WHO: To Tackle Cancer Crisis, Target On Prevention

On Planet Cancer Day, the Globe Well being Organization releases its 2014 cancer report, and appropriate off the bat, the outcomes really don’t search great. Cancer charges are  rising: Globally, 1 in 5 males and 1 in 6 females will create cancer prior to the age of 75. One in eight men and a single in 12 ladies will die from the illness, despite all the advances in cancer medication over the last few decades. But there’s some encouraging information, also. Several of these circumstances and cancer-connected deaths could be averted with equipment that are simply within our reach: Life style and habits modifications.

In 2012, the WHO estimates that the around the world cancer burden had enhanced to 14 million new instances per 12 months, and incorporated 8.two million deaths. The number of new circumstances of cancer, they say, will very likely rise to 22 million situations annually inside the following 20 years.

MRI pixie (Photo credit score: Rum Bucolic Ape)

The economic price is stratospheric. The WHO estimates the worldwide yearly value of cancer to have been $ one.sixteen trillion in 2012. It’s the quantity 1 foremost result in of fiscal reduction due to disability and premature death.

And there is an uneven distribution in the rise in instances globally. Far more than 60% of the world’s cancer situations take place in Africa, Asia, and Central and South America. These parts of the globe also account for about 70% of the world’s cancer deaths, which, the WHO says is exacerbated by bad early detection and access to care. Building countries are, in standard, much more likely to see cancers linked to viruses (like HPV and Hepatitis B), as properly as, ironically, particular cancers that are connected with an industrialized way of life, like breast, lung, and colon cancers.

On the upside, the WHO says that a third of cancer deaths, and half of all cancer circumstances, could be prevented by producing the life-style alterations that we know play a massive role in cancer. These include:

• Tobacco use


• Currently being obese or obese


• Unhealthy diet with reduced fruit and vegetable consumption


• Lack of bodily action


• Alcohol use


• Sexually transmitted HPV-infection


• Urban air pollution


• Indoor smoke from family use of solid fuels


• Vaccinate against human papilloma virus (HPV) and hepatitis B virus (HBV).


• Management occupational hazards


• Lessen publicity to sunlight

In fact, thirty% of cancer deaths are due to the large five: weight problems, lower fruit-and-vegetable intake, lack of physical activity, tobacco use, and alcohol use. “It’s untenable to believe we can deal with our way out of the cancer problem. That alone will not be a ample response,” said Christopher Wild, the director of the WHO’s International Company for Study on Cancer and co-editor of its Planet Cancer Report 2014, in a briefing. “More commitment to prevention and early detection is desperately needed… to complement improved therapies and address the alarming rise in the cancer burden globally.”

How is this to be done? Government support is probably the single most critical essential, and they want to see prevention as a potential investment rather than a current expense, argue the authors of the WHO report. “Governments should display political dedication to progressively phase up the implementation of substantial-good quality screening and early detection programmes, which are an investment rather than a cost,” says Bernard W. Stewart, coeditor of the report.

“Adequate legislation can inspire healthier behaviour,” he added, “as effectively as having its recognized position in safeguarding people from workplace hazards and environmental pollutants.”

We have a prolonged way to go, clearly, but the data all recommend that it’s attainable to make a fairly sizable dent in the amount of cancer circumstances and deaths across the globe.

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WHO: To Tackle Cancer Crisis, Target On Prevention