NHS staff "quitting to work in supermarkets because of poor pay"

NHS staff are quitting to stack shelves in supermarkets instead of caring for patients because they are so demoralised by years of getting pay rises of only 1% or nothing, hospital bosses have warned.

The health service is now so understaffed that patient safety is being put at risk and people with mental health problems are experiencing delays and setbacks as a result, NHS leaders say.

The intervention in the general election campaign comes from NHS Providers, which represents almost all of England’s 240 NHS hospital, mental health and ambulance trusts. They told ministers bluntly on Monday that the government’s longstanding policy of holding down NHS staff pay is wrong and is damaging the service by deepening its already severe staff shortages.

“Years of pay restraint and stressful working conditions are taking their toll,” said Chris Hopson, NHS Providers’ chief executive. “Pay is becoming uncompetitive. Significant numbers of trusts say lower paid staff are leaving to stack shelves in supermarkets rather than carry on with the NHS.”

He urged Theresa May to abandon her plan to limit NHS staff’s pay increases to 1% a year until 2020 and not pursue it during the next parliament as a way of making the NHS’s books balance.

He added: “Trust leaders tell us that seven years of NHS pay restraint is now preventing them from recruiting and retaining the staff they need to provide safe, high-quality patient care. The NHS can’t carry on failing to reflect the contribution of our staff through fair and competitive pay for five more years.

“Pay restraint must end and politicians must therefore be clear about when during the lifetime of the next parliament it will happen and how.” He repeated the organisation’s demand for £25bn in extra funding to help the NHS in England get through until 2020 and warned that staff are also leaving because they are exhausted from having to work so constantly to keep up with the unprecedented demand for care.

Hopson added: “We are getting consistent reports of retention problems because of working pressures in the health service causing stress and burnout.”

Medical royal colleges, health trade unions and health charities such as Cancer Research UK have been highlighting in recent months the damaging effects on patient care of widespread shortages of doctors, nurses, GPs, paramedics and many other NHS staff groups.

Norman Lamb, a former coalition government health minister, said NHS pay restraint – which had operated since 2010 – was “stupid” and had gone on so long that it was proving counterproductive.

“The Conservatives expect NHS staff to take year-on-year real-terms pay cuts in order to try to stave off financial disaster in the NHS,” said the Liberal Democrat health spokesman. “You can’t possibly justify this over such a long period. It is also stupid because great staff will vote with their feet and leave.” s

He contrasted his party’s plan for a 1p increase in income tax to generate extra funds for health and social care with May’s refusal to commit to any tax increases for that purpose. With the Tory majority set to increase, “this guarantees a bleak future for the NHS and for its staff under the Conservatives”, claimed Lamb.

Jeremy Hunt, the health secretary, repeated his pledge of more money for the NHS if the Tories are re-elected and said that nurses’ pay should go up. Responding to a question from the BBC interviewer Andrew Marr about some nurses going to food banks, Hunt replied that average nurse’s pay is £31,000.

“Is that enough considering the brilliant work that they do? I think many people would say they want to pay them more. I think they do an incredible job. If you want more money to go into the NHS – and this government recognises we will need to put more money into the NHS and the social care system because of the pressures we face – then the question is how you get there,” said Hunt.

He also insisted that key NHS waiting time standards, such as the four-hour target in A&E and 18-week wait for planned hospital care, were not particularly useful measures of true NHS performance. Lives saved from cancer and heart disease as a result of better care showed the service was doing well, he added.

Jonathan Ashworth, Labour’s health spokesman, said Hunt’s agreement that it was unacceptable that the A&E target had not been met in England for more than two years was “an admission of failure straight from the horse’s mouth: the Tory-made A&E crisis is simply ‘not acceptable’”.

Responding to Hopson’s comments on NHS pay, Ashworth added: “This is a stark warning from NHS Providers about the Conservatives’ catastrophic management of the NHS workforce. It is incredible and disgraceful that NHS staff are leaving to work in supermarkets instead because NHS pay has been squeezed so far. The country’s shortage of paramedics, nurses and consultants now threatens a raft of NHS strategies to provide better services for patients.”

NHS Providers are also warning that understaffing is so serious in mental health services that patients are now suffering delays in receiving treatment, taking longer to recover and having a bad experience of NHS care. “We are particularly worried about the pressures in the mental health workforce,” said Hopson. “These are resulting in delays in treatment, people are taking longer to recover, and as a result their care is more expensive and their experience is worse.”

A Conservative spokesman declined to respond directly to Hopson’s warning. He said only that: “As NHS England say, outcomes for every major disease in this country are now better than they’ve ever been. But the truth is that in order to continue to invest in the NHS, grow staff numbers and pay, and improve patient care, we need to secure the economic progress we’ve made and get a good Brexit deal. That is only on offer at this election with the strong and stable leadership of Theresa May.”

NHS staff "quitting to work in supermarkets because of poor pay"

EpiPens Are Being Recalled in U.S. Because of Potential Defect

If you or a loved one carries an EpiPen or EpiPen Jr. auto-injector for use in the case of a dangerous allergic reaction, check the device’s lot number. A subset of devices distributed between December 2015 and July 2016 have been voluntarily recalled in the United States after the manufacturer received two reports that EpiPens did not activate as intended.

The two problems were caused by a defective part that could potentially make the device difficult to activate in an emergency, the Food and Drug Administration reported on Friday. Both reports occurred outside the United States, and in both cases the EpiPen users were able to receive treatment from an alternative device.

The voluntary recall began in mid-March in Europe, Japan, Australia, and New Zealand, and has since expanded into North and South America and other parts of Asia. In the U.S., 13 separate lots—with expiration dates of April, May, September, and October 2017—are included in the recall.

People who have EpiPen or EpiPen Jr. devices can check the 2-pack cartons or the auto-injectors themselves for lot numbers and expiration dates. The lots affected in the United States are 5GM631, 5GM640, 6GM082, 6GM072, 6GM081, 6GM088, 6GM199, 6GM091, 6GM198, and 6GM087 (regular EpiPen, 0.3 mg), and 5GN767, 5GN773, and 6GN215 (EpiPen Jr., 0.15 mg).

Any auto-injectors from those lots should be replaced as soon as possible, says a statement from Mylan, EpiPen’s distributor. But don’t toss them before you get your hands on a new one: “We are asking patients to keep their existing product until their replacement product can be secured,” says Mylan’s statement.

Instead, consumers are encouraged to visit mylan.com/EpiPenRecall or call 877-650-3494 for further instructions. Starting today, Mylan says, consumers will begin receiving vouchers to trade in for new replacement products at their local pharmacies. They’ll also receive a container for mailing back back the recalled devices.

As a replacement, consumers can receive either EpiPen branded auto-injectors or Mylan’s authorized generic equivalent. (None of the currently recalled lots include the generic version.)

RELATED: 31 Everyday Things That Can Trigger Allergies

If your EpiPen is from a lot not included in the recall, it does not need to be replaced before its expiration date, says Christina Ciaccio, MD, assistant professor of pediatrics at the University of Chicago Medical Center. However, she does recommend keeping an eye on the list of affected products, in case the recall expands further.

And for anyone who relies on EpiPen and is spooked by the news, Dr. Ciaccio offers some words of reassurance. “Recalls on epinephrine auto-injectors have occurred in the past,” she says, “but overall, the reliability of these devices has been excellent. Companies that manufacture auto-injectors have done an excellent job moving quickly when a problem has been discovered.”

That being said, she adds, it is always a good idea to carry more than one auto-injector—for two reasons. “The first is in case the auto-injector misfires, either by user error or manufacturing error,” she says. “The second is in case he or she needs a second injection before arriving at the emergency department.”

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According to Mylan’s statement, both of the reports that prompted the recall occurred in a single lot, and the defect that was responsible for the failures is extremely rare. However, the statement continues, the recall has being expanded to include additional lots “as a precautionary measure out of an abundance of caution.”

The EpiPen has been in the news consistently over the last few months, after a report in August showed that the device’s price had skyrocketed by more than 600% since 2008. To save money, some patients and doctors even resorted to making their own pre-filled epinephrine syringes.

In the past few months, several new commercial products have hit the market, as well: Mylan now produces its own generic auto-injector at a lower price; CVS announced its own generic version called Adrenaclick; and the competing brand Auvi-Q recently returned to the market—with new and improved safety checks—after it was voluntarily recalled in 2015.

Dr. Ciaccio says that she and her colleagues are “very excited” that several options of epinephrine auto-injectors are now available for patients to choose from. “If EpiPen is not the right device for you or you have difficulty getting one after the recall,” she says, “try another, or even carry more than one brand.”

EpiPens Are Being Recalled in U.S. Because of Potential Defect

NHS intensive care "at its limits" because of staff shortages

The NHS’s network of intensive care units is “at its limits” because they are overwhelmed by staff shortages and the sheer number of patients needing life-or-death care, senior doctors are warning in an unprecedented intervention.

Intensive care units (ICUs) are becoming so full that patient safety is increasingly at risk because life-saving operations – including heart, abdominal and neurosurgery – are having to be delayed, the leaders of the specialist doctors who staff the units have told the Guardian.

“Intensive care is at its limits in terms of capacity and struggles to maintain adequate staffing levels,” said Dr Carl Waldmann, the dean of the Faculty of Intensive Care Medicine (FICM).

“It is important that bed occupancy rates do not exceed 85% in order to ensure there is capacity for emergencies. The reality is that many units are quickly reaching 100% capacity whenever there is excessive hospital activity,” he added.

The Guardian can reveal that, in a stark example of the growing problems, Hull and East Yorkshire Hospitals NHS trust last week ran out of intensive care beds at its two hospitals and was struggling to provide normal care to the many patients needing treatment for life-or-death conditions.

In a letter to its nurses, it said: “The critical care units have been working under considerable and sustained pressure. This is as a direct consequence of both the high number of patients requiring critical care support, and the intensity of each patient’s needs. This is in excess of the established number of level 3 [intensive care] equivalent beds on both hospital sites.”

Dr Liam Brennan, the president of the Royal College of Anaesthetists, voiced similar concerns. “In order to care for acutely unwell patients, surgery is being postponed because of lack of ITU [intensive therapy unit] beds. The combination of inadequate staffing levels in intensive care units together with a shortage of high-dependency beds is having a very real impact on patients, which are needing to have critical surgery such as major abdominal or chest surgery, or neurosurgery, delayed for their own safety,” he said.

“I’ve had reports from anaesthetists and intensive care specialists across the country of 100% occupancy rates in intensive care units and of major surgical cases, including cardiac cases which are potentially life threatening, being cancelled because the beds required for the post-operative care are needed for other critically ill patients,” Brennan added.

Steve Jessop, the trust’s nurse director, added that as a result, “at this time the service is currently unable to deliver critical care services to the high number of patients that require treatment resulting in: cancellation of life-saving operations for patients requiring critical care support, including neurosurgery, cardiothoracic surgery, vascular surgery and cancer operations.

“Currently the critical care units are caring for patients which are significantly above the number of patients we are resourced to care for.” Jessop offered nurses increased pay for working extra shifts to help relieve the pressure in its critical care units in Hull and Cottingham in east Yorkshire.

Doctors working in intensive care have told the Guardian how ICU bed shortages have become even more acute during the NHS’s “winter crisis” and forced patients needing life-or-death treatment in an ICU to wait many hours before getting a bed. One told how a patient with sepsis, the blood infection that kills an estimated 44,000 people a year, had to wait more than 12 hours in A&E for an ICU bed to become free. Another patient, an elderly man who was known to be dying after a cardiac arrest, ended up passing away in an A&E unit rather than in a side room in the hospital’s ICU as doctors hoped because it was so full.

Waldmann and Brennan also fear that patient safety is at risk as a result of ICUs becoming overloaded. “Multidisciplinary teams have maintained patient safety, but in future years this may increasingly come at the expense of quality of care,” said Waldmann.

The disclosure that ICUs are under such intense strain challenges both Theresa May’s recent insistence that the unprecedented problems seen in hospitals are in line with normal winter pressures and the claim by the health secretary, Jeremy Hunt, that the NHS is “performing well”. Copious official data shows that hospitals, GP surgeries and ambulance services, under the heaviest pressures on record, are routinely breaching NHS-wide targets for seeing and treating patients fast enough.

NHS-wide shortages of specialist doctors and nurses means ICU beds often lie unused because there are no staff to care for patients, added Brennan. One in three of the 220 ICUs across the UK have a vacancy for at least one consultant, according to new survey data collected by the FICM. “Bed capacity figures still do not give a true reflection of the situation on the ground. A number of seemingly empty beds have to remain empty as there are not sufficient doctors and nurses in place to support them,” said Waldmann.

Jonathan Ashworth, the shadow health secretary, said: “Reports that intensive care is at capacity and without adequate staffing should set alarms bells ringing in Downing Street, but instead we have a prime minister utterly lacking in her response to the NHS crisis.

“The truth is problems are getting worse and more widespread than in previous years with even life-saving cardiac, abdominal or neurosurgery operations being cancelled. Theresa May needs to get a grip of the crisis and explain what action she’s going to take to make sure that hospitals can get in place the number of staff they need to keep patients safe.”

NHS England denied there were any serious problems. “At this time of year it’s not unusual for specialist intensive care units to become busy, but tracking data on occupancy rates show hospitals have teams in place to ensure the right care is available. This can include moving patients to other hospitals or bringing in extra staff where necessary,” said a spokeswoman.

NHS intensive care "at its limits" because of staff shortages

5 Best Prebiotic Foods – Because Probiotics Need to Eat Too

Probiotics are a type of friendly, or “good” bacteria that live in your digestive tract. They are found in natural items including yogurt and fermented foods like sauerkraut – and they are more important to your health than you may think!

Did you know that your body is made up of more bacteria that living cells? It’s true! The human body contains approximately 10 times more living bacteria than it does individual cells.⁽¹⁾ These little buggers can be found just about everywhere both inside and outside of the body including in your mouth, skin and digestive system – where most of the living microbial communities reside. It may sound like a creepy crawly and downright disgusting matter, but the fact is that there are trillions of bacteria in and on our bodies that are vital to our overall health.

Researchers suggest that an average healthy adult is home to over 600 different bacterial species in the mouth alone, 180 different species in the skin, and approximately 1,000 species in the digestive system. That’s a lot of bugs! With more and more information coming out every day from scientists, researchers are understanding the bacterial microbiome better than ever before.

The “Good” Bugs and The “Bad” Bugs

Researchers previously estimated that the human microbiome only contained a few hundred microbial species. Bur recently the results of a five-year long effort called the Human Microbiome Project involving hundreds of scientists and dozens of universities, revealed that the human microbiome is actually home to TRILLIONS of bacteria. These bugs include an estimated 100,000 different species and a wide range of bacterial strains, yeasts and wormlike parasites.⁽²⁾

While all of these bugs are needed for a healthy body, some types can be considered “bad” bugs, while others can be called “good” bacteria. A few examples of “bad” bacterial strains include: Escherichia coli (E. coli) listeriosis, salmonella. Examples of “good” bacteria include: Lactobacillus and Bifidobacterium and Streptococcus.

The “good” bacteria strains are also known as probiotic bacteria. It is essential to keep probiotic bacteria flourishing in your body so that those “bad” bugs don’t take over the microbiome population. If “bad” bacterial strains take over, many different health problems can result including: constipation, intestinal gas, diarrhea, bad breath, candida infections, anemia, respiratory problems, Vitamin B deficiency, loss of good sleep and more! “Bad” bugs LOVE to eat sugary drinks, high fat foods and artificial ingredients, and they will communicate that to your brain. Scientists have called this the gut-brain connection.⁽³⁾

You don’t want those bad bugs making dietary decisions for you, so in order to keep their numbers down, it’s important to feed the “good” bugs in your body. Get to know their favorite menu items below.

Feeding The “Good” Bugs    

Scientists have found that the strains of friendly little buggers living in and on your body love to eat foods called “prebiotics” (a classification of certain types of fiber).

Here is a list of the 5 best natural food sources of prebiotics:  

Garlic. This flavorful food contains approximately 11% inulin fiber, and 65 % of a naturally occurring prebiotic called fructooligosaccharides (FOS). The “good” bugs love to eat it and studies have shown that consuming garlic may help to prevent specific disease promoting bacterial strains from growing.⁽⁴⁾

Onions. 10% of the total fiber in onions is a prebiotic fiber called inulin and 6% is made up of FOS – known to strengthen “good” bacterial strains.⁽⁵⁾

Dandelion Greens. These fiber-rich greens can be collected from just about anywhere, as they grow like weeds. In fact, most people would consider them just that but if you see dandelions don’t toss them. Add them to your salad! They not only provide about 7% prebiotic fiber (4 grams of fiber per 100-gram serving) but they also help to detoxify the body by cleansing the kidneys and liver.⁽⁶⁾

Chicory Root. This food is easily added to main dishes and lends itself to many flavors. It is one of the most effective prebiotic foods and provides about 76% inulin fiber.⁽⁷⁾

Apples. They aren’t just delicious – apples also keep the doctor away! Eating just one of these tasty fruits provides a short-chain fatty acid that feeds the “good” bacteria and helps kill off the “bad” bugs that can cause health problems.⁽⁸⁾ They also contain large amounts of a specific type of prebiotic fiber called pectin.⁽⁹⁾

Probiotics Need to Eat Too!

How you care for the “good” bugs in your body is one of the most important relationships you have. Get to know other prebiotic foods friendly bacteria strains like to eat including: chicory root, Jerusalem artichoke, leeks, asparagus, bananas, oats, cocoa (dark chocolate… yep!), flaxseed, and seaweed.

Keep these foods on your plate! The “good” bugs and your good health with thank you.

References:

1. American Society for Microbiology. “Humans Have Ten Times More Bacteria Than Human Cells: How Do Microbial Communities Affect Human Health?.” ScienceDaily. ScienceDaily, 5 June 2008.

2. National Institutes of Health. Human Microbiome Project. Overview.

3. Emeran A. Mayer, Rob Knight. Gut Microbes and the Brain: Paradigm Shift in Neuroscience. J Neurosci. 2014 Nov 12; 34(46): 15490–15496.doi: 10.1523/JNEUROSCI.3299-14.2014.

4. Ning Zhang, Xuesong Huang, Yanhua Zeng. Study on prebiotic effectiveness of neutral garlic fructan in vitro. Food Science and Human Wellness. Volume 2, Issues 3-4. September–December 2013, Pages 119–123.

5. Kumar VP, Prashanth KV. Structural analyses and immunomodulatory properties of fructo-oligosaccharides from onion (Allium cepa). Carbohydr Polym. 2015 Mar 6;117:115-22. Epub 2014 Sep 28. doi: 10.1016/j.carbpol.2014.09.039.

6. SELF Nutrition Data. Dandelion Greens, Raw Nutrition Facts & Calories.

7. Barszcz M, Taciak M, Skomiał J. The effects of inulin, dried Jerusalem artichoke tuber and a multispecies probiotic preparation on microbiota ecology and immune status of the large intestine in young pigs. Arch Anim Nutr. 2016 Aug;70(4):278-92. doi: 10.1080/1745039X.2016.1184368.

8. Zacharias B1, Kerler A, Drochner W. The influence of 5% and 10% dietary apple pectin on parameters of fermentation in faeces and caecal digesta of weaning pigs. Arch Anim Nutr. 2004 Apr;58(2):149-56.

9. Licht TR, Hansen M, Bergström A. Effects of apples and specific apple components on the cecal environment of conventional rats: role of apple pectin. BMC Microbiol. 2010 Jan 20;10:13. doi: 10.1186/1471-2180-10-13.

5 Best Prebiotic Foods – Because Probiotics Need to Eat Too

A male pill matters because both partners can share the side-effects | Deborah Orr

An experimental male contraceptive jab has proved just as effective as the pill is for women. Trials were abandoned, however, because side-effects included depression, raised libido and acne. Which is weird, because the pill has similar side-effects – although sometimes it can cure acne. The pill’s other common side-effects include nausea, headaches, breast tenderness, anxiety, weight gain and, sometimes, decreased libido. However, suggesting that the pill isn’t an almost perfect form of birth control tends not to go down very well.

This is understandable. The pill has given women agency over their own lives like nothing else. And women don’t want that great freedom to be tarnished. The advantages of an equally reliable male contraceptive, of course, are much less direct. If anything, the pill freed men from worry about contraception or “getting a girl pregnant” to the extent that an unwanted pregnancy is often looked on as something that’s entirely the fault of the fool who’s enceinte. It’s hard not to look on all those anti-abortionists and morning-after pill killjoys as people determined that foolish women should pay for their own singular mistakes.

Yet a male contraceptive is simply more sensible, in biological terms, than a female one. In her book, Sweetening the Pill, and in numerous articles, Holly Grigg-Spall points out that men have no fertility cycle, while women are only fertile for six days every month. Women take a lot of responsibility for those six days, while the constant risk is not from their ova but from ever-ready sperm.

Grigg-Spall, who is a passionate advocate of raised awareness about the pill’s risks to women, believes that its side-effects are minimised not just because of feminism, which cannot help but see the pill’s advantages as outweighing its disadvantages, because they do, but also because of sexism, which tends to dismiss female problems as trivial and male advantages as important. It’s hard not to agree with her, when comparing this latest research, in which side-effects were given such emphasis, with Danish research published last month that linked the pill to depression and gained little more than shrugs.

‘Shared responsibility for reproductive freedom still seems so far away.’ Photograph: Garo/Phanie/Rex/Shutterstock

Yet it’s precisely because hormonal contraceptives have side-effects, and that these vary from person to person, that a decent male contraceptive would be such a good thing. If one partner finds the side-effects unbearable, then the other can take up the mantle. If one partner has been on contraceptive hormones for a long time, he can give his body a rest and ask his partner to take her turn. A male pill would promote the idea of shared responsibility. Which in matters of sex and reproduction still needs a lot of promoting.

The pill unleashed sexual freedom on a grateful world. It took a while for feminism to realise that this was not by any means always to the advantage of women. Ever since that time, discussion about the male pill has tended to focus on casual sex – whether a woman would trust a man who said he was on the male pill, since a lie wouldn’t leave him up the duff. But the truth is that barrier methods remain necessary for casual sex, to protect against sexually transmitted diseases, whether other contraception is being used or not. Hormonal contraception for both sexes is at its most positive as a goal in stable relationships, where it is so important for responsibility and risk to be shared.

Yet shared responsibility for reproductive freedom still seems so far away. One reason why the development of an effective male contraceptive has been painfully slow is lack of enthusiasm for the idea. Money for research isn’t there because big pharma doesn’t think men will be keen enough. The prospect of more equality, empathy and understanding between the sexes just doesn’t thrill the market.

Unlike Grigg-Spall, who had a terrible time when she was on the pill, and suffered major side-effects such as panic attacks, I’m not against hormonal contraceptives, even if they are risky. I stayed on the pill for a long time, maybe too long, and eventually I couldn’t face it any more. I’d have very much liked it if my partner could have taken his turn too. That alternative wasn’t available. But that isn’t just scientific and pharmaceutical happenstance. I’m troubled by the idea that risks women are routinely encouraged to take are risks that men are not willing also to take. There are related risks that men won’t take either. Vasectomies are at a historically low level. Addressing this particular inequality is a huge step towards addressing many others.

With double as many people willing to take a contraceptive pill, fewer women would have to suffer in silence for the sake of worry-free sex. I’m sure that some men would be happy to take a hormonal contraceptive. But the market tells us that not nearly enough are interested, while research tells us that even when they are, they’re too risk-averse for the idea to be driven forward with enough urgency.

Reliable contraception is a Great Thing for humanity. It’s about time that half of humanity stopped shirking and joined women in engaging in the physical challenges that are undertaken in embracing it.

A male pill matters because both partners can share the side-effects | Deborah Orr

Third of maternity units have shut doors to labouring women because they could not cope

More than a third of maternity units have been forced to shut their doors to labouring women because they could not cope with demand, leading midwives have warned. Figures from the Royal College of Midwives (RCM) show that 38.6% of maternity units had to temporarily shut during the last year.

A poll conducted among senior midwives revealed that units closed their doors on 281 separate occasions. The RCM said the average unit temporarily closed eight times, but one unit was at full capacity 50 times. Eight units had to close their doors on 10 or more occasions.

The college, which is holding its annual conference in Harrogate, said the number of closures was a reflection of the rising demands on services as well as increasingly complex births and issues with staffing levels.

The poll, which was completed by 53% of the heads of midwifery from around the UK, found that nine in 10 believed their unit was dealing with more complex cases than last year. Almost two in five said that they did not have enough midwives to cope with the demands on the service, and 19% of the 85 senior midwives who responded said their budget had decreased in the previous 12 months.

One in 10 said that they had been forced to reduce services in the last year, including reductions in parent classes and breastfeeding and bereavement support. Four in five also reported that they had to redeploy staff to cover essential services, meaning that staff who were supposed to be delivering antenatal care and community care were redeployed to cover labour delivery suites.

“Yet again we are seeing senior midwives describing services that are being battered by increasing demands, inadequate resources and staffing shortages,” said Cathy Warwick, RCM chief executive. “It is very often only through the hard work, goodwill and sacrifice of maternity staff that services are able to deliver the safe and high-quality care women need.

“It is astonishing that units are temporarily closing because they can’t meet the demands of the service, staff are redeployed to the detriment of antenatal and community services, and just after Baby Loss week, we are finding that bereavement support services have been cut.

“Every week I speak to midwives who tell me they are exhausted by the pressures they are facing, and they lack the time to do their jobs as well as they would like. This situation isn’t sustainable, and the government must start to invest in NHS staff because we all know that an investment in staff is an investment in high quality, safe care.”

A separate poll from the RCM released on Wednesday revealed that inadequate staffing levels were driving midwives to leave the NHS. The study, which polled more than 2,700 people, found some were working in “dangerous” conditions, having 12-hour shifts with no break, and worried about making “tragic” mistakes, and reports of midwives looking after as many as 15 mothers and babies at a time.

Warwick criticised the government’s “disastrous” policy of pay restraint in the NHS. “Midwives and maternity support workers are working harder than ever at the same time as they have had six years of real-terms cuts to their pay. We want to see a cost of living increase for midwives, maternity support workers and other NHS staff to show them they are valued and to reward their hard work.

“There is a growing shortage of midwives, and midwives tell us because of the demands they face, they are intending to leave midwifery, making the shortage worse. However, 80% of midwives who are intending to leave say they would stay if pay improved. The government can’t afford not to invest in maternity services.”

Labour’s shadow health minister, Justin Madders, said: “This shocking poll is yet more evidence of the crisis engulfing our NHS as a result of Tory underfunding. Six years ago the Tories promised 3,000 more midwives, but they failed to deliver them. This has left maternity units across England operating without enough staff and unable to cope with rising demand.

“This situation is causing chaos for thousands of women in labour, and could pose a serious risk to patient safety. Jeremy Hunt and Theresa May are in complete denial about the extent of this issue. They need to use the Autumn statement to deliver a rescue package for the NHS before this crisis turns into a catastrophe.”

Third of maternity units have shut doors to labouring women because they could not cope

Hospital doctors ‘miss signs of illness’ because of chronic staff shortages

“Dangerous” medical understaffing in hospitals is so rife that signs of illness are being missed, blood tests delayed and newly qualified doctors left in charge of up to 100 patients.

Chronic shortages of medics are also leading to those with little experience of some types of illness taking responsibility for wards full of medically needy patients, or with complex issues, whose conditions they know little about and do not feel qualified to give proper care to, including in intensive care and stroke and surgical units.

Related: A&Es are closing and doctors are leaving. It should be Jeremy Hunt who goes | The Secret Doctor

A survey of UK doctors, the results of which have been given to the Observer, reveals widespread concern that gaps in rotas were risking patients’ safety. Doctors said they were left stressed and in tears at being “pressurised” by managers to work more shifts to help hospitals cope with rising demand and said their relationships with patients were suffering.

One trainee surgeon said shortages meant a colleague in his first year of training was the only doctor in charge of more than 100 surgical patients overnight.

An elderly care registrar said: “I was the only medical doctor covering medical emergencies [and] cardiac arrests in the whole hospital, medical admissions, referrals from A&E [and] GPs, and the whole hospital for a medical opinion. It was frankly unsafe.”

Another doctor said: “I feel out of my depth.”

Pete Campbell, a hospital doctor in the north-east who undertook the survey with the assistance of the British Medical Association, said: “This survey is just a snapshot of medical understaffing, which is going on on a significant, worrying and dangerous scale. Doctors believe that these rota gaps pose a direct threat to patient safety because the time-critical work they do is put under pressure.”

Doctors’ leaders said the survey reflected worsening medical understaffing across the NHS. “The findings are yet another stark warning of the fragility of our health service. A demoralised, stressed and struggling workforce is not going to stay in the NHS for long. This situation is unsustainable,” said Professor Neena Modi, president of the Royal College of Paediatrics and Child Health.

Professor Jane Dacre, president of the Royal College of Physicians, said: “Patient care is being compromised by gaps in trainee rotas. This is a major challenge for the NHS and it is having a detrimental effect on the morale of both trainees and consultants. We need more doctors.”

One medic said that hospitals’ growing inability to have a full complement of doctors on duty meant “we don’t have time to review patients properly. [I am] constantly fighting fires as covering three people’s jobs, so never have time to think about a patient properly.”

In the survey, 395 doctors below the level of consultant described how rota gaps were affecting care. It also found that many medics fear the quality of care they could give patients was declining because so many are often so busy. The findings paint a stark picture of doctors having too little time to talk to patients about their conditions, discharge others, do routine checks on babies, or seek patients’ consent for procedures as quickly as they should.

The survey found that many medics feared that the quality of care they could give patients was declining because they were often so busy that they had less time to engage with them.

“Delayed care, sick patients getting unwell due to this, long waits, histories being taken too quickly to compensate and speed up the process, meaning critical pathologies have been missed,” said one. Doctor shortages are now so acute that, in some areas, emergency ear, nose and throat clinics and non-urgent operations have had to be cancelled at short notice, said respondents.

The survey found that 21% of rota gaps were not covered by any doctor, even a locum. Unfilled gaps result in the doctors on duty on wards becoming responsible for far more patients than usual. Another 18% of gaps were filled by staff agreeing to provide cover, often on top of an already heavy schedule.

The findings come soon after Grantham and District hospital in Lincolnshire closed its A&E unit overnight because it had too few doctors. In April, Chorley hospital in Lancashire downgraded its A&E unit to an urgent care centre for the same reason.

Last week the RCP, which represents many hospital doctors, warned that shortages of many specialist medics meant the NHS was “heading into an extremely difficult autumn”.

Anaesthesia and intensive care are facing particular shortages of doctors.

Unfilled slots are also jeopardising hospital finances and have caused the NHS’s bill for agency staff to hit £3.3bn a year in England.

The Department of Health declined to respond directly to the findings. A spokeswoman 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 the very best care for patients that is both safe and sustainable. That is why we have invested in the frontline and there are already 25,000 extra clinical staff on our wards since May 2010.”

Hospital doctors ‘miss signs of illness’ because of chronic staff shortages

Patient safety at risk because language tests for medics "not stringent enough"

Patient safety could be at risk because doctors, nurses and dentists from elsewhere in Europe are not facing stringent enough language tests, leading medics have said.

In only one year, 29 medics from the European Economic Area faced allegations of “inadequate knowledge of English language”, according to data obtained by the Royal College of Surgeons.

By contrast, only 10 doctors from outside the EEA faced the same accusations during 2014/15, the figures obtained by the RCS from the General Medical Council show.

Under current EU rules, doctors coming to Britain from the EEA only have to show they have general English language skills. Those arriving from further afield have to prove their language abilities in a clinical context – showing they can talk fluently about symptoms and equipment. Brexit negotiations pose an “excellent opportunity” to ensure language checks are up to scratch, the RCS said.

Professor Nigel Hunt, dean of the faculty of dental surgery at the RCS, said: “The NHS would struggle to provide care in hospitals, clinics and dental practices without the very skilled doctors, dentists and nurses that come from both the EU and non-EU countries.

“It’s absolutely vital that the government find ways to ensure they can remain working in the NHS post-Brexit. That said it’s unquestionable that such staff should be able to communicate clearly with patients in English about their clinical problems, illnesses and treatment.

“While the professional regulators are able to require proof of the clinical language skills of non-EU applicants, the same checks do not apply to EEA applicants and our fear is that this could be putting patients at risk. We want the same rules to apply to all non-UK professionals, regardless of where in the world they come from.”

During 2014/15, 145 allegations were made about poor communication by dentists from the EEA compared with 27 about dentists from the rest of the world, according to data from a freedom of information request to the General Dental Council by the RCS.

A new briefing paper from the faculty of dental surgery at the RCS warns that despite attempts to improve language checks, EU law still prevents regulators from systematically testing EEA applicants’ language skills in a clinical setting, including on medical terms, ensuring consent, describing a procedure and possible side-effects.

A Department of Health spokesman said: “Patient safety is of the utmost importance, and we expect all healthcare professionals working in the UK to have a good command of the English language.

“That is why we have tough rules, allowing the GMC and individual employers to test employees at and beyond the initial point of employment – and these cases represent just 0.002% of NHS staff.”

Niall Dickson, chief executive of the General Medical Council, said: “Our language requirements are among the toughest in the world, and we keep them under regular review to make sure they continue to be effective.

“We have twice raised the standard in recent years and have secured a change in the law to allow us to take action against doctors who cannot communicate effectively.

“In the past we were not able to check doctors from Europe. Now we can and the difference is clear – this has been a huge step forward for patient safety. Since 2014 nearly 1,100 doctors from Europe have not met our English language requirements and cannot therefore practise in the UK.

“We have always argued that we should have the right to test the competence of European doctors as well as language and that remains our position.”

Patient safety at risk because language tests for medics "not stringent enough"

Why Two MDs Chose To Examine Company: Because Healthcare Wants It

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Ultimately, Mongan responded, &ldquoWell, medical professionals don&rsquot know something about how to run something. You can&rsquot add. You don&rsquot understand how hospitals make funds. You don&rsquot recognize how to handle individuals. You&rsquore just a narcissistic crazy resident. Go away and get an MBA.&rdquo

Why Two MDs Chose To Examine Company: Because Healthcare Wants It

Bariatric surgical procedure is no cure-all for obesity I know, simply because I have had it | Sharon Bates

‘What issues would bariatric surgical procedure expansion solve? Will it tackle the social and cultural issue of readily available, comparatively low cost food?’ Photograph: Chris Radburn/PA

I am probably one of the few individuals in the United kingdom who is each a extended-phrase bariatric patient and a skilled specialising in the discipline of fat-loss surgical procedure. Fourteen many years in the past, when I was a dimension 32, function and everyday tasks – even getting in and out of the bath – proved challenging. I developed avoidance tactics to minimise bodily discomfort and the resultant sweating, soreness or breathlessness. Supermarket purchasing meant parking as near to an entrance as attainable, and often employing a trolley, basically so I could lean on it. I had sores from my flesh rubbing collectively in the summer time, and at the time I had excess weight-reduction surgical procedure, in 2000, buying outfits online was not an choice, so my selections had been severely constrained.

Last week, new NHS draft tips suggested gastric bands and other bariatric surgical treatment could be made offered to 800,000 further people to aid address the escalating problem of sort two diabetes. This is linked with becoming overweight, and the National Institute for Well being and Care Excellence (Great) has proposed lowering the threshold for bariatric surgical procedure. This would suggest that sort 2 diabetics with a BMI of 30, rather than 35, would potentially be eligible.

Possessing misplaced fat via bariatric surgical procedure, you may anticipate me to be in favour of this. But what difficulties would it fix? Will it deal with the social and cultural concern of readily accessible, fairly low cost foods? It is hardly likely to address the insistent marketing and advertising ploys of huge firms. Will it tackle why some of us are hugely geared to use foods and consuming as a reward, or the production and provision of overly huge portions? Will it quit meals or a huge latte getting consumed on the hoof? Stroll outdoors and note how clear and subliminal triggers connected to food and fluid surround us. We require to alter our culture as nicely.

These of us who have had surgical procedure realise that neither the surgical procedure nor weight reduction offers a easy solution. Surgery does not remedy diabetes, though it may possibly cause remission. Surgical procedure does not cure the practically assured osteoarthritis of people who are considerably obese.

When I stepped into the then practically unknown globe of excess weight reduction surgical treatment, I had the naive belief that fat loss surgery would be an easy, basic, swift and long term way to be thin. I would be asleep, and would wake up as a new man or woman who would rapidly shrink, both unable to eat or not wanting to eat.

It had taken me more than forty many years to turn out to be the shape and dimension I was, and there were numerous motives I had chosen to self-soothe or medicate employing foods. At the time I had no comprehending of the psychological, emotional, bodily and sensible approach that would comply with surgical treatment. I only wished to be thin – and two many years soon after my surgical treatment I had misplaced nine and a half stone.

Weight-reduction surgical treatment alterations your anatomy internally, but it can’t bypass previously learned behaviours. My weight was not the end result of becoming tied down and force-fed I chose to eat as a form of self-soothing, self-medicine and pleasure. I genuinely believed I did not consume massive quantities of foods and was resistant to accepting duty for how I cared for my physique or how I dealt with anxiety and wellbeing. I avoided workout, cooked and ate enormous enormous quantities and had little “me” time – when I was excess fat, I felt I wasn’t well worth my personal time.

To preserve or accomplish a healthy form and dimension, surgery has to be 1 of a selection of approaches, along with other people this kind of as yoga, pilates, counselling, private treatment, dietary assessment, treatment of allergy symptoms and healthcare problems. For me, the approach has mainly involved accepting responsibility for my overall health and wellbeing.

There are new factors to contend with when you alter size and shape. My skin became too massive for my frame and it was my accountability to decide on to whether do anything about it. The NHS may possibly be in a position to fund reconstructive plastic surgery following damage or congenital problems, but it is highly unlikely to fund redundant skin removal following bodyweight-reduction surgical procedure.

To make bariatric operations available to a lot more individuals, the NHS will have to alter. Even now, men and women who fall into the “agreed Wonderful criteria” are unable to accessibility the multi-disciplinary technique required for this surgical treatment to be profitable. There is not enough funding, also few appropriately qualified workers, psychology departments which are overstretched or simply unable to function one to a single for a lot more than a restricted number of sessions. Are we all ready to place our hands into our pockets and make substantially increased nationwide insurance payments?

More contentiously, any treatment method being integrated in a state-financed health method indicates difficult decisions. Do I stand prior to a thirty-yr-old soldier who has misplaced a limb and seeks funding for physio or a prosthesis? Does a tummy tuck come ahead of a skin graft for a kid who has suffered burns?

Thank goodness the proposal is at the moment a draft document, as it raises so several emotive factors. Do people have a “correct” to surgery? Has anybody costed prolonged-term aftercare for surgical individuals? The cost of related metabolic illness down the line? Re-operation, large-dependency bed use? The NHS must consider all these factors into account as well.

Medicare in the US is facing the same dilemma and forecasts that sort two diabetes and the resulting expenses will crush the technique, as predicted in the United kingdom. It has used fat-reduction surgical procedure far more broadly than Britain for many years. Has it really helped? It is well worth noting that I am still as most likely, if not far more very likely, to develop age-connected or weight problems-connected illness this kind of as variety 2 diabetes.

Would I do it again? It’s been a difficult journey but a revealing 1. Understanding how to be a man or woman in a “typical” body has been interesting. I have had counselling and therapeutic input. I have paid for every thing from commence to finish, and am so glad that I did it when I did.

As I walk the puppy four or 5 miles a day, it has taken me all these many years to get out of a fat-lady mind set. I can kayak, take pleasure in lifestyle and food much more than ever.

Paradoxically, obtaining not been diabetic when I had the surgery, I am probably pre-diabetic now. What would Good say about that predicament? I have no “appropriate” to be thin. I accept I may possibly regain some excess weight, and have, and only I can deal with that. There is no fairy godmother waving her magic scalpel for me – I have utilised that one up.

Bariatric surgical procedure is no cure-all for obesity I know, simply because I have had it | Sharon Bates

Patient died throughout drug trial "because of numerous organ failure"

She was admitted to Royal Shrewsbury Hospital with a chest infection and died of a number of organ failure on August 24 last year following establishing a variety of viral infections. Dr Atheer al-Ansari, a advisor rheumatologist at the Orthopaedic Hospital in Gobowen, Shropshire, who cared for her throughout the trial, mentioned he was “shocked” by her issue and had never observed a patient with 3 such significant infections ahead of.

Mrs Owen, of Coed Y Go, Oswestry, suffered from rheumatoid arthritis and had been taking part in a clinical examine of a new drug, MK8457, to see if it could ease her symptoms.

He assured the hearing that he had created it clear from the commence that she ought to end taking the medication if she suffered any unwell effects.

Nonetheless, Heidi Knight, on behalf of Mrs Owen’s family, claimed that on the weekend she became sick, Dr Ansari informed her to keep taking the pills. He replied: “I spoke to Mrs Owen 3 instances that weekend and repeated that she ought to end the medication.”

He also sent a letter to her GP giving the very same advice.

Mrs Owen was the only Briton out of 60 patients in the globally study, run by a overall health care business referred to as MSD. In accordance to Dr Ansari, none of the other patients had suffered from severe infection.

Dr Catherine Whittall, analysis programme manager at the Orthopaedic Hospital, confirmed Mrs Owen totally understood the hazards and was content to get part. “Mrs Owen in no way expressed any concern about being on the trial and Dr Ansari often stored her up to date with the hazards and positive aspects,” she said.

The inquest heard Dr Ansari had ordered the review to be discontinued and the hospital had considering that carried out its personal inner assessment into the circumstances of Mrs Owen’s death.

John Ellery, the Shropshire coroner, ruled Mrs Owen had died from multi-organ failure due in component to rheumatoid arthritis and its treatment method.

Patient died throughout drug trial "because of numerous organ failure"

Legalise assisted suicide simply because "choice" the most critical principle in medicine - says BMJ

It difficulties MPs and peers to back the bill, describing them as “our timid lawmakers”.

Supporters of the bill welcomed the intervention, saying it was recognition that a “growing number” of medical doctors and other healthcare personnel support a adjust in the law.

But the BMA insisted that the journal did not represent its views or people of the wider healthcare occupation.

In just over two weeks Lord Falconer’s bill, which would allow medical professionals to prescribe lethal doses of drugs to terminally sick patients with a “settled intention” to finish their lives, will have its initial complete parliamentary airing with a second reading debate in the Residence of Lords.

Members of each houses are to be given a free vote on the concern and ministers, including Norman Lamb, the care minister, have presently signalled they would assistance it.

Last week the President of the Supreme Court, Lord Neuberger, publicly challenged Parliament to review the law on assisted suicide or encounter intervention by the courts.

The court turned down a challenge involving the loved ones of Tony Nicklinson, the “locked-in syndrome” sufferer who fought a lengthy campaign for assisted suicide, but signalled it could be prepared to declare the ban on assisting an individual to take their very own existence as “incompatible” with human rights if Parliament did not act.

“Let us hope that our timid lawmakers will rise to the [court’s] challenge,” the editorial remarks.

It goes on: Folks must be capable to workout decision in excess of their very own lives which must include how and when they die, when death is imminent.

“In current decades, respect for autonomy has emerged as the cardinal principle in health care ethics and underpins developments in informed consent, patient confidentiality, and advance directives.”

“Recognition of an individual’s appropriate to establish his or her best interests lies at the heart of this journal’s method to advance the patient revolution in wellness care.

“It would be perverse to suspend our advocacy at the second a person’s days have been numbered.”

Dr Peter Saunders, campaign director of the Care Not Killing Alliance, explained: “While autonomy is important it has to be balanced against other principles such as public security.

“None of us believes autonomy is absolute, if we did we would have to say that there was no location for law because every single law restricts personal autonomy.”

Sarah Wootton, Chief Executive of Dignity in Dying explained: “We are delighted that the British Health care Journal has backed Lord Falconer’s Assisted Dying Bill.

“The recognition by the leading healthcare journal of the importance of safeguarded patient choice in finish of daily life care is to be welcomed, and comes at a time when a developing amount of foremost wellness care experts are supporting this kind of decision.”

Dr Mark Porter, chair of the BMA Council, stated: “There are strongly held views inside of the medical profession on the two sides of this complex and emotive issue.

“The BMA remains firmly opposed to legalising assisted dying.

“This problem has been often debated at the BMA’s policy forming yearly conference and latest calls for a adjust in the law have persistently been rejected.

“The BMJ is a wholly owned subsidiary of the BMA, and quite rightly has editorial independence.

“Its position on assisted dying is an editorial decision and does not reflect the views of the BMA or the health care occupation.

“Our concentrate have to be on creating sure every single patient can accessibility the really best of palliative care, which empowers individuals to make selections in excess of their care.”

Legalise assisted suicide simply because "choice" the most critical principle in medicine - says BMJ

Thousands of NHS individuals left waiting for medication simply because of troubles with private contractor

A joint inspection by the GPC and the Care High quality Commission in April found that a “proportion of individuals did not receive their medicines at the scheduled time.

“While a number of measures had been taken by the time of the inspection… Healthcare at Home needed to do a lot more to treatment the predicament,” the Council concluded. The watchdog ordered the firm to resolve the problems inside 3 months.

The company explained it was working hard to address the concerns and had increased its client support personnel by a lot more than 60%.

Liz Carroll, chief executive of the Haemophilia Society, which represents patients with the blood-clotting disorder, described the failures as “unacceptable and unsafe.”

“We have met with Healthcare at Home and it truly is clear they are attempting to tackle the issues, but they look to be overwhelmed.

“It is extremely scary for patients when their medicines will not arrive simply because failure to consider their treatment could be lifestyle threatening. Then there are sensible troubles, like deliveries taking area at 2am, or treatment method currently being sent to the incorrect handle, or cotton wool being provided as an alternative of needles,” Ms Carroll stated.

Nick Rijke, Director of Policy and Analysis at the Multiple Sclerosis Society Society, mentioned: “It is a disgrace that crucial medicines have not been reaching men and women who require them, and that this dilemma has been allowed to go on for so long.’

The Royal Devon &amp Exeter Hospital at present has 129 a number of sclerosis individuals who obtain medication from Healthcare at House. Given that March five, in excess of a fifth of these sufferers have contacted an in-residence pharmacy staff due to the fact they have had problems with their deliveries.

University University Hospital in London, which at present has 1500 patients who receive medication from Healthcare at Home, says it has stopped giving the company new referrals. And nearby Guy’s and St Thomas’s NHS Basis explained Healthcare at Home has been topic to fines above the final couple of months due to failed deliveries.

In Gateshead the Queen Elizabeth Hospital has stopped using Healthcare at Property to supply drugs to its personal IVF individuals since of complaints.

According to minutes of a meeting held with the Division of Overall health on December eleven 2013, a “full and frank discussion took area which concerned an explanation as to the trigger of recent services concerns [by Healthcare at Home"s representatives] and how they are getting resolved by the organization.”

The troubles have been place down to two crucial troubles: the outsourcing of distribution arrangements to one more company in an try to lengthen its services to include weekend and evening deliveries, and the addition of nearly 3,000 additional individuals which it took in excess of following an additional provider withdrew from the market.

The organization issued a statement to patient groups blaming “a considerable and unexpected rise in demand’ for homecare solutions, which had caused ‘significant disruption and backlog of deliveries’ ‘over the past couple of months.”

The statement reassured sufferers that the company was operating to remedy operational troubles that had caused “important disruption” more than the “past couple of months”.

Three months later in March 2014 Healthcare at Home said that it was no longer accepting new ‘high risk’ sufferers such as people struggling from haemophilia or respiratory diseases like cystic fibrosis since it could not ensure acquiring their medicines to them on time or in complete.

The firm blamed IT concerns and a “method failure” relating to the firm’s outsourcing of its logistics and warehousing departments.

On April 10, NHS England warned NHS trusts stating that reports of medicines failing to be delivered on time had ‘increased significantly’.

It advised trusts to place substitute approaches of supply in area for patients whose deliveries had been delayed and to assess providers’ capability just before assigning them far more patients.

Ruth Poole, Healthcare at Home’s clinical director mentioned the firm’s deliveries had been affected because November 2013, but she stated the firm was operating tough to deal with troubles. She stated: “We have elevated our client services capability by 60%. We are not having to pay attention to price when fighting this. We will spend what we want to.”

She directed patients help web site which will give patients up to date info about the current support and measures getting taken to increase deliveries and contact queuing occasions.

Thousands of NHS individuals left waiting for medication simply because of troubles with private contractor

E-cigarette users have tripled to two million because 2012, review finds

An e-cigarette user. In accordance to the survey, in 2010, only 2.7% of smokers stated they utilised electronic cigarettes on a typical basis, but now that is up to 17.seven%. Photograph: Tim Ireland/PA

Far more than 2 million folks are believed to use electronic cigarettes in Britain, but almost all are recent smokers or ex-smokers who use the products to stay off tobacco, in accordance to a survey published on Monday.

The anti-tobacco charity Ash (Action on Smoking and Health) says the variety of e-cigarette customers has tripled from 700,000 in 2012. Almost two-thirds of end users are smokers and the other third are ex-smokers, Ash says, although use of the units amid non-smokers is negligible, at only .one%.

Ash’s findings are released on the day that a consultation on e-cigarette marketing closes. The Advertising Requirements Authority has been examining worries, notably between public well being physicians, that advertising encourages non-smokers and specifically youngsters to consider them, and that they will graduate to ordinary cigarettes.

But Ash’s survey, carried out by YouGov, suggests this is not occurring and that men and women are using e-cigarettes to kick their tobacco habit as an alternative.

“The dramatic rise in the use of electronic cigarettes over the previous four years suggests that smokers are increasingly turning to these devices to support them cut down or quit smoking. Drastically, usage among non-smokers stays negligible,” said Deborah Arnott, Ash’s chief executive.

“While it is essential to manage the advertising of electronic cigarettes to make certain kids and non-smokers are not getting targeted, there is no proof from our analysis that e-cigarettes are acting as a gateway into smoking.”

YouGov surveyed a lot more than twelve,000 men and women, with Ash extrapolating the complete number of e-cigarette users in the population from the findings.

In a related YouGov survey in 2010, eight.2% of recent or ex-smokers had experimented with e-cigarettes, but now half of them have (51.seven%). In 2010, only 2.seven% explained they utilised them on a regular basis, but now that is up to 17.7%.

Between recent e-cigarette users, the main reason provided by ex-smokers was “to aid me end smoking completely” (71%) and “to support me keep off tobacco” (48%). The principal explanation given by present smokers was to “aid me minimize the amount of tobacco I smoke, but not cease completely” (48%) followed by “to save funds compared with smoking tobacco” (37%).

A study from University College London earlier this month had comparable findings. The Smoking Toolkit Research carried out in England located that e-cigarettes have been taking more than from nicotine gum and patches as an assist to giving up smoking.

The leader of that study, Professor Robert West, stated: “Regardless of claims that use of electronic cigarettes dangers renormalising smoking, we identified no evidence to help this see. On the contrary, electronic cigarettes might be assisting to reduce smoking as a lot more folks use them as an aid to quitting.”

The consultation is looking at regardless of whether marketing guidelines require to be modified for e-cigarettes. Some public health doctors argue that marketing could normalise ordinary cigarettes, which have otherwise turn into pariah merchandise.

The e-cigarette business explained the Ash survey showed that public wellness opponents, such as the British Health care Association, have been incorrect to oppose the devices as determinedly as they do. “Review after examine is showing that scaremongering that e-cigarettes are luring folks into tobacco is baseless nonsense. The reverse is going on – smokers are switching into e-cigarettes as the way to minimize the harm from tobacco,” explained Charles Hamshaw-Thomas, legal and corporate affairs director of E-Lites.

E-cigarette users have tripled to two million because 2012, review finds

Refined sugar is the genuine villain because it raises chance of heart condition

Five cans of soft drinks have 46 sugar cubes but there is sugar lurking in more healthy foods options such as canned fruit salad. Photograph: Geoff Abbott/Corbis

Simon Capewell, professor of public health and policy at Liverpool University, says we need to aim for ten portions of fruit and veggies a day – by no means thoughts five or 7 – and strike smoothies and fruit juice off the acceptable checklist.

Capewell is 1 of a growing band of authorities who think sugar is the hidden enemy of great wellness. Vegetables are very good for you and fresh fruit picked from trees and plants is very good for you. But, he points out in a commentary with the Oyebode research, dried, tinned, canned and squeezed fruit supply plenty of sugar.

“Underneath existing recommendations, 150ml of freshly squeezed orange juice (sugar 13g), 30g dried figs (sugar 14g), 200ml of a smoothie made with fruit and fruit juice (sugar 23g) and 80g of canned fruit salad in fruit juice (sugar 10g) all count as the 5 portions of the ‘five a day’ and include a complete of some 60g of refined sugars,” he writes. “This is a lot more than the sugar in a 500ml bottle of cola.”

The proof against sugar is strengthening, he advised the Guardian, pointing to a welter of new stories and scientific studies in current months. In February, Quanhe Yang and colleagues from the Centers for Disease Control and Prevention published a study in the journal JAMA Inner Medicine that recommended larger sugar consumption increased the danger of death from heart ailment – whether or not people ate also significantly.

“Extra refined sugar is the clear villain,” mentioned Capewell. He thinks the new and tentative locating that tinned fruit might be a issue may possibly be far more proof. “Even though fruit could be protective, if you place it in a tin with syrup, the harm of the sugar begins to outweigh something else.”

Government suggestions is outdated, he says, pointing out that Professor Susan Jebb, often named the weight problems tsar because she chairs government initiatives this kind of as the responsibility deal, mentioned in January that fruit juice ought to not be a single of the five-a-day since the abdomen can’t distinguish the sugar in it from that in Coca Cola. Swap it for a piece of genuine fruit, she stated. “If the government and Public Well being England don’t shift at all and present any acknowledgment that science goes forward, they will lose their street cred,” he explained. “There is so a lot hidden sugar and so many folks do not realise it.”

“I would like to say that five a day is wonderful. Ten a day is almost certainly greater. We are in a negotiating game. If there are lots of men and women shouting for ten, possibly the government will grudgingly go to seven.”

Refined sugar is the genuine villain because it raises chance of heart condition

Public lacks believe in more than health-related records because also many lies in previous

He explained the true difficulty for several critics of the scheme was “we really do not believe in the government.”

Mr Lilley, who runs a internet site for healthcare managers, explained: “They lied to us about the Well being and Social Care Act. They could be lying to us about the use of our information. It’s been a balls up. It’s a balls up of the politicians’ creating. We can find out. There is considerably to criticise, but criticise the politicians – and not the NHS.”

He told the Wellness and Care Innovation Expo that data had “revolutionised” attitudes in direction of healthcare, and could vastly boost the top quality of care.

Tim Kelsey, national director for patients and data at NHS England, which is in charge of the scheme, stated efforts to describe the programme to the public so far were “not excellent enough”.

He informed delegates: “For a safe NHS we need to have a information-driven wellness service. My message is we have to make this perform. We are going to make this work. We are going to promise that people’s data is safe. we are going to have a proper public conversation.”

A poll of 2,000 grownups by the Royal School of Standard Practitioners located two thirds of folks do not truly feel the public was properly informed about the programs and their appropriate to opt out.

Previously, Wellness Secretary Jeremy Hunt announced that he was going to introduce new legislation to guarantee that insurance coverage firms could not buy data through the scheme.

Mr Hunt wished to give “rock-solid” assurance to sufferers that confidential data could not be offered for commercial insurance coverage functions, the Division of Wellness mentioned.

The Daily Telegraph disclosed that hospital data of 47 million sufferers have been offered to a society of actuaries for insurance purposes. Yesterday it emerged that similar information had been employed to advise companies on how to target audiences by way of social media.

Public lacks believe in more than health-related records because also many lies in previous

How has the NHS workforce modified because the coalition took energy?

The all round size of the NHS has varied tiny in excess of the final 4 years, according to an analysis of workforce numbers. Photograph: Christopher Thomond

The number of overall health services workers in England is a political situation. Labour has criticised the government for properly causing NHS work cuts by demanding that trusts do much more with the exact same budgets. In December, it released Division of Well being figures stating that seven,060 clinical workers have been produced redundant since the coalition took energy in 2010. But an examination of NHS workforce numbers, making use of Well being and Social Care Information Centre data drawn from the electronic employees record method that pays nearly all staff, displays that the wellness service’s overall dimension is virtually unchanged more than the final 4 many years. In October 2009, the English NHS (excluding GPs and their workers) employed the complete-time equivalent of one.052m folks. 4 many years later on, the overall health services employed 1.046m, .five% fewer. As the thick black line on the graph displays, numbers have fluctuated in excess of this time period, but have not moved drastically.

Graph. Photograph: SA Mathieson

What has altered substantially is the combine of employees. The quantity of doctors employed by NHS trusts rose by six.9% in excess of the four years to last October, to 105,056. Inside of this group, the number of consultants rose nearly twice as fast, up 13.2% to forty,709. Numbers of experienced ambulance and technical staff rose somewhat. Meanwhile, nursing numbers initially fell, leading to criticism from Labour leader Ed Miliband. But numbers have because recovered to 310,924, up 994 (.3%) in excess of the four years, with clinical help staff following a similar pattern.

But there have been large NHS task cuts in one region: infrastructure help personnel, down 10.two% more than the time period. Inside of this group, the folks suffering the largest cuts have been non-senior managers, down 18.five% to 24,349, and senior managers, down 22.1% to 10,197. Many left as the consequence of the government’s phasing out of main care trusts and strategic well being authorities, completed final April.

Candace Imison, deputy director of policy at health support research charity the King’s Fund, says: “1 of the real hazards in cuts in funding is that we have minimize management capacity to the bone. But I feel in the potential, it demands to grow to be everyone’s work.”

Imison says that the best healthcare organisations involve all their employees in management, by allowing and encouraging them to enhance processes. This model is used by a couple of NHS trusts, like Salford Royal basis trust, but is unusual.

She adds that the boost in hospital doctors is an illustration of the NHS deploying its staff in probably the wrong places, provided that most professionals feel far more healthcare need to be carried out in the neighborhood rather than in hospitals. Even so, one solution is for consultants specialising in chronic circumstances this kind of as diabetes, heart and respiratory ailment to devote portion of their time instruction and advising GPs. This would have a tendency to reduce the number of individuals referred by GPs to consultants, but would see consultants assisting to sustain the health of far a lot more patients.

The Wellness and Social Care Data Centre also tracks occupation numbers at person NHS trusts, with big variations in rates of improve and lessen. This is shown on the map of the thirty greatest trusts, with green pointers showing fast-expanding trusts, yellow showing those increasing far more gradually and red people shrinking in the yr to October. The centre also tracks regional adjustments, though these figures are much less clear. Final April’s reorganisation transferred numerous jobs to central organisations outside the regional classification, meaning that every area appears to have lost posts, though the staff are often nevertheless doing work in the identical places. For areas, the map signifies ranges of reduce, with green areas displaying the fewest and red the most, even though none have changed that a lot.

In many instances, huge increases at trusts over the last four many years are due to them absorbing main care trusts’ local community healthcare employees or taking over other trusts. Central Manchester university hospitals foundation trust, which had 47% far more employees final October than 4 many years previously, has accomplished each. Workers numbers at King’s University hospital basis trust jumped by two,393 to 9,937 amongst September and October last yr when it took over solutions from the dissolved South London Healthcare trust.

But the biggest NHS trust, Barts Wellness, saw staff numbers drop by 3.one% in the year to final October, to 13,129. It was formed from a merger of 3 trusts in April 2012, and standardisation of staffing levels led to 400 posts becoming lower, which includes 123 redundancies as properly as the elimination of vacant posts and not replacing retirees. The trust also says that many personnel have been transferred to other employers.

Nevertheless, numbers are now rising. “We are presently conducting the biggest recruitment exercise that Barts Health has undertaken,” says a spokesperson, by way of which it expects to have supplied about 700 nursing jobs by the end of March. “Further employees have currently been recruited to locations, such as surgical procedure and healthcare departments to increase the amount of staff caring for older people, especially at night.”

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How has the NHS workforce modified because the coalition took energy?

"I virtually died simply because I ignored the risk of malaria"

Due to fly back to Haiti the day after my symptoms appeared, I rashly assumed hospitals in that stricken country would be able to treat whatever it was I had. And twice, the plane I was due to take, suffered mechanical failure, which meant spending a night in Miami and the loss of precious time. I was finally admitted to a clinic in Port-au-Prince, the Haitian capital, some 48 hours after my first symptoms – by which time the falciparum parasite was hard at work. Pneumonia and jaundice caused by liver failure had already set in. No wonder everything had a golden glow; catching sight of myself in a mirror at one point I saw my eyes were totally yellow.

The clinic did its best, but my case was too serious for its medical facilities to deal with. Thank heavens I had bought full medical and evacuation insurance: it probably saved my life, as it meant I could be flown out to the Dominican Republic, the closest country with a decent, functioning medical system.

Being flown out by air ambulance was a relief, but the intensive care unit I was taken to was full. The friend who had come with me was handed a list of other hospitals to try: off we went on a midnight tour of the darker side of Santo Domingo, the country’s capital, until we found one.

From this point on, my memory is a blur. By now, the parasite had attacked my lungs, liver, kidney and stomach, and there was fluid on my heart. As my organs failed, my body went into septic shock. My legs swelled to twice their normal size, while my skin, eyes and urine were yellowish orange. I had numerous medications to tackle the different problems, as well as undergo blood transfusions and dialysis.

The worst part was the feeling of drowning, since my lungs were full of fluid. The last thing I remember is having an oxygen mask on my face, trying desperately to breathe. To my right was the doctor, arms crossed staring intently at a monitor of my vital signs; behind him, my friend, silent and in tears.

I am not going to die, I thought. I am close, but it is not yet my time. Strangely, I did not feel frightened. And then I slipped off into a coma, induced so that I could be put on a ventilator that would breathe for me.

Apparently, people look pretty appalling on a ventilator. The tubes have to be strapped across the face to ensure they don’t move. The body rises and falls in an artificially eerie way. Add this to the swelling and infection – I wasn’t a pretty picture. One friend who visited was so shocked he couldn’t even approach my bedside.

Of the week I spent on the ventilator, I remember very little. The faces of family and friends who came to visit me occasionally floated across my vision and I recall voices telling me stay calm. I didn’t feel any pain because of the heavy sedation, but I felt in a very dark place. At 33, I was fighting for my life.

At some point, things turned around. My lungs were getting better, and my liver count improved. Around the same time, I had to come off the ventilator, to prevent permanent damage to my windpipe from the tubes. Doctors carried out a tracheostomy, in which a small opening is made in the neck, into the windpipe and a tube attached to a machine inserted to aid breathing. Slowly I emerged from the coma, back into the real world.

And yet intensive care is not the real world. It is an oppressive, strip-lit place of eternally beeping chaos. There are people dying and people crying. There is the 24/7 chatter of the nurses. There are no windows, no daylight, no starlight. Time stops: minutes blur into hours, into days, into weeks. Like 80 per cent of ICU patients, I was delirious, in an alternative reality full of fear and paranoia. It was like one of those nightmares that seems to go on forever.

It took the doctors a few attempts to remove the tracheostomy tube so that I could breathe on my own, but finally they managed it. The minute they wheeled me out of the ICU into a quiet room of my own, I emerged from my nightmare.

Very slowly, things started returning to normal. After a few weeks, I took my first few steps, my blurry vision started to clear and I began eating food again. It had never tasted better.

Depression set in, though, when I realised I wouldn’t be returning to my previous life in Haiti – in fact, I wouldn’t be able to do much of anything for a few months. My wonderful doctor – without whose determination I believe I would never have made it – noticed this dip in my morale and would push my wheelchair outside into the sunshine: after four weeks of windowless hell, it was blissful.

After six weeks, still fragile, I left hospital to stay in a nearby hotel. I improved steadily and, after numerous tests and surgery to close the tracheostomy, I was allowed to fly home to London. There, I had surgery twice to get rid of scar tissue in my trachea from the ventilation tubes. It took six months for me to feel anything like normal.

Being very ill has taught me a lot, not least about complacency when it comes to protecting my health. My message to would-be travellers is this: if antimalarials are recommended, be sure to take them and stock up well – they may save your life. Try to avoid getting bitten: use spray, nets and long sleeved clothing. Fever and other symptoms should be checked immediately, and in remote areas, a malarial testing and treatment kit is useful. And always make sure you have good medical insurance.

If my terrifying experience can help save just one young life, it will have been worth it.

Mandy George is fundraising for Malaria No More UK, a charity dedicated to saving lives from malaria. For details, go to justgiving.com/mandygeorge

What is malaria?

Malaria is an infection caused by the malaria parasite entering the bloodstream through the bite of an infected mosquito. There are five different strains, of which P. falciparum and P. vivax are the most dangerous.

Malaria is found in over 100 countries worldwide and causes at least 660,000 deaths annually. The disease is common in tropical and subtropical regions including much of Sub-Saharan Africa, Asia, and the Americas

Malaria usually begins with flu-like symptoms such as fever, sweats and chills, headaches, joint pain, vomiting and jaundice, and can lead to coma and death. Early, accurate diagnosis and treatment is critical.

Malaria can be prevented by taking antimalarial medication and avoiding mosquito bites with the use of insect repellents and mosquito nets.

In 2011, 1,677 travellers returning to the UK were diagnosed with malaria and eight died. Travellers should seek medical advice before travelling to a malarial area. If you develop malaria symptoms while travelling or after returning to the UK, seek medical treatment immediately.

"I virtually died simply because I ignored the risk of malaria"

Heat-connected deaths will rise 257% by 2050 because of climate change

Deaths as a consequence of hot climate are to soar over the up coming 4 decades as a consequence of climate modify, researchers have predicted.

The variety of annual deaths in the United kingdom that take place as a end result of the heat will rise by 257% by 2050, they mentioned. Elderly individuals are most at chance, in accordance to the new examine.

Although the variety of extra deaths observed in the summer months will rise, those recorded in winter will actually decrease, they stated.

Researchers needed to attempt to figure out the impact that climate alter will have on temperature-associated deaths in the coming decades. Their study, published in the Journal of Epidemiology and Neighborhood Wellness, examined fluctuations in climate patterns and death rates between 1993 and 2006 to characterise the associations amongst temperature and mortality.

The researchers, from Public Health England (PHE) and the London School of Hygiene and Tropical Medicine, then looked at projected population and climate increases so they could estimate temperature-relevant deaths for the United kingdom in coming decades.

Researchers noted a 2.one% increase in the quantity of deaths for each and every 1C rise in the mercury and a two% boost in mortality for every 1C drop in temperature. The variety of hot weather days is projected to rise steeply, tripling by 2080, they mentioned. Meanwhile the amount of cold days is expected to fall, although at a less dramatic tempo.

At present there are about 41,000 winter-connected deaths and two,000 excess summer time deaths.

The authors predicted that without adaptation, the amount of heat-related deaths will boost by 66% in the 2020s, 257% by the 2050s and 535% by the 2080s. Cold weather-associated deaths will increase by three% in the 2020s, then decrease by 2% in the 2050s and by twelve% in the 2080s, they additional.

This means by 2080 there will be all around twelve,500 heat-associated deaths and 36,500 cold-relevant deaths.

The authors mentioned that the burden of extreme climate remains such increased in these above the age of 75, notably in the over-85s.

At existing there are regional variations in excess temperature-connected deaths and these are probably to persist, they added. The south and the Midlands are the regions most vulnerable to heat even though Wales, the north west, the east of England and the south are most vulnerable to the cold.

“The most direct way in which climate alter is anticipated to affect public health relates to adjustments in mortality prices linked with ambient temperature,” they wrote. “In the Uk, 1000′s of preventable deaths happen naturally from cold weather and a smaller burden is also linked with scorching climate. Future modifications in climate are probably to lead not only to an boost in heat-related deaths in the Uk, but also a proportionally smaller sized lessen in cold-relevant deaths.”

They added: “Our final results indicate that overall health safety from scorching weather will become more and more required this century, and measures to minimize cold impacts will also stay crucial. Air conditioning is likely to become much more extensively used in the United kingdom, which will minimize heat vulnerability. Nonetheless, the distribution of cooling systems may possibly reflect socio-financial inequalities except if they are heavily subsidised, and rising fuel expenses may exacerbate this.”

Dr Sotiris Vardoulakis, head of the PHE’s air pollution and climate modify group and co-author of the paper, explained: “For the duration of periods of warmer climate larger temperatures can lead to higher-than-normal tension on the entire body triggered by heat and higher levels of air pollution, which can aggravate the signs of these with persistent situations, this kind of as cardiovascular and respiratory circumstances.”

“This paper has yet again pointed to the anticipated growth of the UK’s elderly population, broadly the most at-risk group from the results of heat, and once more states that simply because the Uk elderly population will increase in excess of the coming years, it will be even a lot more essential to prepare how the country will cope with forthcoming temperature rises.”

David Spiegelhalter, professor of the public knowing of risk at the University of Cambridge, mentioned: “It seems clear from this examination that the reduction in cold-relevant deaths per 100,000 individuals in each and every age group very easily outweighs the projected increase in the heat-relevant death charge.”

“So, have been the population make-up to remain the same into the 2080s, temperature-relevant deaths would in fact fall. “For that reason it would be more accurate to say that increased number of potential temperature-associated deaths was wholly driven by projected population development and ageing.”

Heat-connected deaths will rise 257% by 2050 because of climate change