Antibiotics leave children "more likely to contract drug-resistant infections"

Children are at substantially increased risk of contracting drug-resistant infections in the months after taking a course of antibiotics, a leading public health official has warned.

Paul Cosford, medical director at Public Health England, told MPs on Wednesday that children are 12 times more likely to contract drug-resistant infections in the three months after being prescribed antibiotics, suggesting that their unnecessary use poses a direct risk to individual patients as well as a broader threat to society as a whole.

“We’ve got good evidence that if you or I have a course of antibiotics now, within three months our risk is three times to get a resistant infection of some sort because we’ve had the antibiotics affecting all the organisms in our bodies,” he told the Science and Technology Select Committee. “If you’re a child you’re 12 times more likely to get a resistant infection in the three months after a course of antibiotics.”

He said the figures, based on two major reviews, highlighted the need to continue driving down our reliance on the drugs. “There is a growing body of evidence that taking antibiotics makes it more likely that your next infection will be a resistant one, so prudent use of these life-saving medicines is essential,” he told the Guardian.

The study cited by Cosford, in fact found that children who had urinary tract infections (cystitis) were 13.23 times as likely to have contracted drug-resistant strains if they had been given antibiotics in the previous six months.

In a previous survey, 90% of GPs said they come under pressure from patients to hand out the antibacterial medication, and 45% said they had done so knowing it would not help.

Mark Woolhouse, professor of infectious disease at the University of Edinburgh, said that the figures matched his qualitative experience from the clinic. “In hospitals you definitely do get patients who will get a string of different drug-resistant infections,” he said.

Antibiotics pose a risk of subsequent illness, he said, because the drugs do not uniquely target the infection, but also eradicate useful bacteria in the gut. “They change the ecology of the gut, a bit like using a pesticide in a rich woodland,” he said. In the ecological niche that opens up after a course of antibiotics, opportunistic infections can spring up.

“This comes with the proviso that people should follow their doctor’s advice,” he added. “Antibiotics are a good thing when prescribed correctly, but they can have longer-term disadvantages of all kinds.”

The committee heard that that overall Britain had made progress on reducing the use of antibiotics since the government asked the economist Jim O’Neill to produce a report on antimicrobial resistance two years ago.

Prescriptions of antibiotics fell by 7.3% in the financial year 2015-16 compared with the previous year, Cosford told the committee.

Farms are also on track to meet a Defra target for 2018 of reducing average antibiotic use on farms to 50mg of drug per 1kg of meat produced (56mg this year, compared to 62mg in 2014). The target is designed to combat the blanket use of antibiotics as a way of boosting the growth of livestock – particularly poultry and pigs.

Certain strains of drug resistant infections are decreasing, the committee heard, with only 800 cases of MRSA bloodstream infections last year, compared to 7,000 in 2003. “When we focus on specific infections that are causing a problem then we can be extremely successful,” said Cosford. However, a more worrying trend was the rise in drug resistant E coli strains, he said, mostly linked to urinary tract infections.

O’Neill said that the current government appeared “less passionate” about the issue than the previous administration. “There is interest, perhaps not with the same passion as with David Cameron,” he said. “The prime minister himself and the chancellor played an active role in international engagement on the issue. I have not seen this government talk about it anything like as much as the previous leadership did.”

He added that it was crucial for policy-makers to make international efforts now rather than waiting for the “scary outbreak of a crisis”.

“We need to stop treating these things like sweets,” O’Neill said. “We all need to be re-educated that these things aren’t a magical solution for as many things as people think.”

Antibiotics leave children "more likely to contract drug-resistant infections"

BMA facing backlash from members over handling of contract dispute

The British Medical Association is facing a major backlash from angry members and an exodus by medics disillusioned with its “appalling” handling of the bitter junior doctors’ dispute.

There has been a spate of resignations from the doctors’ union after it announced, then called off, a series of five-day all-out strikes in a failed attempt to stop the health secretary, Jeremy Hunt, imposing a controversial new contract on the 54,000 trainee medics in the NHS in England.

Members are accusing the BMA of being “spineless” and “incompetent” and of betraying junior doctors, and there are growing calls for the creation of a rival trade union to represent them. BMA leaders, one of whom admitted privately that it has ended up “in a big mess”, are worried that its handling of the year-long contract row has left it divided and weakened in defeat.

Junior doctors have inundated their Facebook discussion group with angry messages about the BMA and Dr Ellen McCourt, the chair of the union’s junior doctors committee (JDC). Some have posted screengrabs of cancelled direct debit forms, showing that they are rescinding their membership.

“I don’t want to just cancel my direct debit. I want to tell the BMA why I am withdrawing my subscription. I want to tell them how spineless they have been,” said junior doctor Mukhtar Ahmed.

He criticised the BMA for endorsing in May a revised contract that it had negotiated without seeking members’ views. The contract was later rejected by 58% to 42% in a referendum among junior doctors.

“I want them to know that these series of blunders have not only lost us this fight, but any future fight and the NHS as a whole. I believe in the power of the union but not this one,” Ahmed said.

The BMA is examining alternative forms of protest against the contract, which will start being imposed from next week. It is due to announce details this week, though the options under consideration are believed not to involve any form of industrial action, such as a work-to-rule or refusal to do overtime.

Many doctors are angry that they heard from the BBC rather than the BMA last Saturday night that the union had called off planned strikes. Junior doctor David Pye said: “I am done. I shall not be sending you any more money. I have put up with utter incompetence, fucking survey monkey polls to see what I think, leaks, power struggles and, for the third time, I find out our master plan via BBC news and not via my union. Goodbye.”

Increasing calls to set up an alternative organisation to represent trainee doctors intensified after the decision. “Time to form a new trade union – run by junior doctors and only for junior doctors. Getting recognised won’t be easy and it may take too long for this dispute but now the BMA has proven it is not fit for purpose, this is our only option for the future,” said medic Christopher Howarth.

McCourt and the JDC decided to abandon further industrial action in the campaign against Hunt after large numbers of junior doctors made clear that they had deep misgivings about taking part. BMA leaders feared that turnout might be as low as 20%, well down on the majority support during the eight previous days of industrial action between January and May.

A five-day strike due earlier this month was cancelled after the BMA admitted giving hospitals too little time to make arrangements to cope with the disruption. The first long stoppage was due to take place on 5, 6, 7, 10 and 11 October, despite warnings from senior doctors, medical bodies and the chief executive of NHS England, Simon Stevens, that patients would be at risk.

There is widespread anger among junior doctors at the cancellation, even though it appears that many of them were opposed to such a long stoppage. Many think the U-turn was merely the latest in a series of tactical blunders by the union in their unsuccessful battle to force Hunt to back down.

A sizeable minority of members of the BMA’s ruling council fear the union has done itself potentially irreparable harm and that the plan for five-day strikes has severely damaged public trust in doctors and left them looking uncaring and reckless. Some believe that Dr Mark Porter, the union’s leader, allowed its JDC too much freedom under McCourt and her predecessor, Johann Malawana, to decide its own tactics.

In a post on the Facebook site in response to the torrent of online anger, McCourt insisted the junior doctors’ campaign would go on. Defending the cancellation, she said: “We had a choice that included continuing the current planned industrial action, changing the planned IA or suspending the action. The JDC, having weighed up the new information, debated the options and voted to suspend the IA and pursue other means of resisting the contract. This does not mean the fight against imposition and this contract is over.”

BMA facing backlash from members over handling of contract dispute

Junior doctors may desert NHS over contract, says union boss

The junior doctor at the heart of an escalating row over NHS strike action has warned that the imposition of a new contract could lead to a collapse in morale and an exodus of staff.

Ellen McCourt, chair of the British Medical Association’s junior doctors committee, said that the health service, which faces the looming prospect of Brexit and an ageing population, was already “chronically understaffed” and that the proposed changes risked pushing the service to breaking point.

“The biggest risk with this contract, and also with this dispute continuing, is that doctors will leave the NHS,” said McCourt. “You can’t stretch us more thinly. There needs to be a plan – how are we going to make medicine more attractive to people? How are we going to make people stay in the NHS?”

The BMA announced on Wednesday that it would begin an unprecedented five-day walkout by junior doctors later this month, with further five-day strikes proposed for each month in the run-up to Christmas. Earlier this summer, 58% of doctors rejected a compromise contract deal backed by the then BMA junior doctor leader, Johann Malawana. He has since resigned and been replaced by McCourt.

The strike announcement has divided the medical community, provoking criticism from Academy of Medical Royal Colleges, which brings together doctors’ professional bodies. Many within the BMA are also concerned about the impact the action will have on patients and there have reportedly been ferocious exchanges at meetings where the proposed action was discussed.

McCourt said the greatest risk was that doctors, whose morale is at “rock bottom”, will no longer want to work in the UK if NHS resources are stretched still further. The new contract is designed to make it cheaper to rota more doctors in at weekends.

“I have some colleagues who took time out to work in New Zealand between their first two years of training and their speciality training, and they came back to the UK because they’d always planned on coming back to the UK,” she said. “Now they plan on leaving again. One is a general practice trainee and one is an emergency medicine trainee – our most under-recruited specialities.”

Last year, General Medical Council figures showed newly qualified doctors formed a growing proportion of the thousands of British medics seeking jobs abroad each year. This summer the Institute of Public Policy Research thinktank warned about the threat Brexit would pose to the NHS, stating that the health service would collapse if it were to lose its 57,000 workers who are EU nationals.

The increased number of places for prestigious medical courses offered this summer through university clearing – traditionally the bargain basement for degree places – could be a worrying sign of what may be to come, she said.

Ellen McCourt: ‘You can’t stretch us more thinly. There needs to be a plan.’ Photograph: Sarah Turton/BMA

McCourt added that the strikes could have been avoided, but that when she wrote to the health secretary a month ago outlining the reasons why junior doctors had rejected the new contract, she was ignored. “When he imposed the contract, he said in parliament: ‘My door is always open, I want to be able to address any outstanding problems’, so I took him at his word.”

Health Education England and NHS Employers, who were also addressed in the letter, responded to the points raised – which included concerns relating to part-time workers – but Hunt did not, said McCourt. “I tried two weeks ago to get back in touch with the secretary of state to ask why haven’t we heard anything back and I could only get in touch with his special advisers; I couldn’t get in touch with him. And when we [met] on Tuesday it was very different – it was: ‘Well, you’re proposing industrial action so we haven’t responded’.

“If we’d seen some response or some movement then we could have said, well, the government do want to talk to us, they are willing to make changes without us again resorting to industrial action.”

A Department of Health spokesperson said: “It’s unfair to suggest we haven’t responded to this letter – we resolved two of the issues the BMA raised and gave them a clear timeline of when we would respond on the final two pay-related issues. Despite this, the BMA didn’t wait and announced industrial action. As doctors’ representatives, the BMA should be putting patients first, not playing politics in a way that will be immensely damaging for vulnerable patients.”

The BMA argues the new contract, which is being phased in from the autumn, unfairly affects those who work less than full time, many of whom are women. It also says the terms are damaging to doctors who work the most weekends, which typically includes those who are in areas such as A&E, where there are already staff shortages.

“This contract financially disincentivises less-than-full-time trainees – carers, parents, who are predominately women, in a workforce that is predominantly women,” said McCourt. “It will cost some women more money to go to work than to stay at home.”

McCourt, who has become the focus of press attention following the strike announcement, said that the drastic action was being taken as a last resort. “I would much rather be in a room with the government getting this sorted out than having to make the plans that we’re being forced to make, hearing that the press are hounding my family. I would much rather be talking with the government, with NHS employers to try and get an resolution to this.”

Junior doctors may desert NHS over contract, says union boss

Junior doctors consider further strikes in contract dispute

Junior doctors are considering further strikes in September after rejecting the health secretary Jeremy Hunt’s proposed new contract.

Ellen McCourt, who chairs the British Medical Association’s (BMA) junior doctors committee, said that by standing together they could demand the government takes them seriously.

Strikes took place between January and April after junior doctors failed to come to an agreement with the government. In July the government announced it would impose a contract after junior doctors and medical students voted to reject a deal brokered with the BMA.

In a letter to members released on Thursday night, McCourt said the government had remained “persistently silent” on the issues she said had led to the rejection of the contract.

— #hellomynameisEllen (@McCourtEllen) August 11, 2016

The road ahead will not be easy,by standing together we speak with one voice,our unity remains our strength @TheBMA pic.twitter.com/DAuXhf5fjS

She said: “In light of this, the JDC executive has voted to reject the proposed new contract in full and to call for formal renegotiations on all of your concerns.

“In response to the government’s silence, JDC exec has today made a formal request for a special meeting of BMA council to authorise a rolling programme of escalated industrial action beginning in early September.”

She said the BMA could not stand idly by as the date for imposition drew nearer, and argued that forcing a contract on doctors that they did not have confidence in would be bad for patients.

Daniel Mortimer, the chief executive of NHS Employers, said: “Industrial action achieves little or nothing but places pressure on already stretched teams and services and causes worry, distress and disruption for patients, carers and their families.

“Over the last two months we have been talking with the junior doctors committee and have, along with the Department of Health and others, responded positively to their concerns regarding the guardian role and whistleblowing.”

He said employers were serious about “positive engagement” with the BMA.

Junior doctors consider further strikes in contract dispute

Doctors need to engage in contract talks | Letters

In response to your letter (Safeguarding sufferers and trying to keep Britain healthful, 19 August), NHS organisations know that junior physicians continue to be a single of the hardest working and most essential parts of our NHS. But the reality is that the contract they are employed beneath today was created to drive down the unacceptably lengthy hrs worked by prior generations of medical doctors. It indicates that a huge proportion of junior doctors’ earnings continue to be variable, leading to unpredictable pay and an unwieldy bureaucracy for them and their employer. The contract needs to adjust.

The wellness secretary and NHS Employers have been clear that the all round shell out bill will not be minimize, nor will junior doctors be essential to function a lot more hrs. Even so, a new contract is necessary that effectively rewards and recognises the crucial contribution junior doctors make. Proposals contain an enhance in their basic shell out and new protections towards doing work unsafe extended hours. We had been disappointed that the BMA junior physicians committee could not once again carry themselves to talk to us as our default setting is to look for agreement by means of discussion. Refusing to enter into talks does not advantage junior medical professionals or their individuals and we ask junior medical doctors to talk about with us the independent Physicians and Dentists Assessment Body report and the way forward.
Danny Mortimer
NHS Employers

• Clinical negligence claims are brought by people who have been injured via no fault of their personal as a outcome of negligent NHS care (NHS pays out £1.1bn – and a third of that goes to lawyers, 19 August). Last year the NHS spent nearly half a billion lbs on obstetric claims – mostly paid to the families of brain-broken children to cover the assistance and adaptations they require to help them reside as typical a existence as achievable. Although compensation can’t totally recompense the damage induced, harmed patients require the assistance of a professional solicitor to support them carry a declare to shell out for essential services this kind of as ongoing care. These cases are usually complex and need expert legal expertise to properly support individuals throughout very hard times. The proposed introduction of fixed costs may possibly restrict the marketplace and reduce the availability of this important advice in future.
Jonathan Smithers
President, Law Society

Doctors need to engage in contract talks | Letters

Steve Bell on ending of Atos contract cartoon

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Steve Bell on ending of Atos contract cartoon

Atos contract comes to an end bringing considerably relief for campaigners

Demonstrators in Manchester gather outdoors the Atos centre to protest towards the French-owned business. Photograph: Steven Purcell/ Steven Purcell/Demotix/Corbis

As forecast, Atos Healthcare has left its controversial £100m-a-yr contract with the Division for Perform and Pensions to deliver the operate capability assessment, the notorious “match for work” test that for its several critics has grow to be a grim byword for out-sourced state incompetence and callousness.

There will be some relief among campaigners that Atos has quit but most understand that although the French-owned company could have been the lightning rod for public anger above disability benefit reform it was ministers and the state who the two brought in the test and created and enforced the norms and laws by which it is delivered.

Two queries arise: why, after many years of mounting concern about Atos’s efficiency and the accuracy and safety of the WCA has it taken so lengthy for matters to come to a head? And second: does Atos’s departure signal a want on the element of ministers to genuinely reform a approach that handful of outdoors of the DWP – whether campaigners, GPs, MPs, or benefit claimants – think about to be either humane or match for goal?

Ministers indulged in the usual political blame game on Thursday morning: the WCA was a undesirable contract inherited from Labour. But 1 of the earliest acts of this government, back in November 2010, was to extend the Atos contract for a additional five many years. It was Coalition ministers who made the decision on a large and fast expansion of the test, in May possibly 2011, to re-assess one.5m existing incapacity benefit claimants, despite obvious warnings from their personal skilled advisor, Professor Malcolm Harrington, that the rollout ought to be delayed right up until what he described as an “inhumane and mechanistic” test could be additional refined.

A long list of reviews, campaigns and inquiries more than the past 3 years testify to the terrible human consequences of that austerity-led dash to pull vulnerable individuals off incapacity benefit as a way of driving down welfare investing. In the publish-industrial functioning class communities the place incapacity advantage take up was highest the WCA became a kind of terror: for years, claimants had been advised they had been too sick to perform now they would be tested and if they failed, their currently slender weekly revenue would be cut by 30%. Not just did they face becoming pitched into deep poverty overnight but they would endure the stigma of currently being labelled a “scrounger”.

The widespread distress amongst claimants brought on by the re-evaluation of incapacity advantage was swiftly picked up in GPs surgeries, welfare tips bureaux and food banking institutions. Right after an attempted suicide in a Merseyside jobcentre, DWP staff were warned by officials to be “empathetic” in direction of folks impacted by the changes. Alarmingly, the WCA cropped up with regularity at coroner’s inquests, the place fear of imminent re-assessment, or depression brought on by currently being declared fit for perform, was more and more noted as a factor in the deaths of vulnerable folks.

There is no company proof that the WCA drives folks to consider their life but this week a report by the Psychological Welfare Commission for Scotland concluded that the check straight led a lady with a historical past of stress related depression to consider her own existence. She died significantly less than a month soon after an Atos assessor declared her match for perform, resulting in her £94.25 a week benefit cash flow getting minimize to £67.50. “There was not something else which we could identify that would lead us to think that there was any other aspect in her existence that resulted in her selection to finish her daily life,” stated the commission. The WCA, the commission concluded, was flawed. The DWP disagreed. It declared that its methods were “largely robust and proper.”

WCA appeals tribunals tell a diverse story. The WCA – dubbed by a single MP as a “crude pc check” – is notorious for delivering seemingly incomprehensible decisions. Tales of claimants with terminal cancer who are located match for work, for example, have grow to be a stock neighborhood newspaper story. There have been above 600,000 appeals towards fit-for-work decisions in latest years, clogging up tribunal courts and costing the taxpayer above £60m a yr. Nationally, 4 out of ten appealed selections do well. Where claimants have skilled representation this figure rockets. Oxfordshire Mind reported not too long ago that a startling 98% of WCA appeals taken up by its advisors on behalf of mentally-unwell customers had been effective.

Nevertheless it was not until relatively lately that Atos and the government dropped the fiction that all was properly. In January, Atos boss Joe Hemming informed a sceptical committee of MPs: “We have a genuine passion for delivering solutions to the citizen in a way that continues to satisfy the way the citizen needs to be served.” But tensions between government and Atos had come to a head final summertime. The DWP had raised issues about Atos’s efficiency for its element Atos was desperate to leave a contract that it regarded as both undeliverable and a public relations disaster.

The disability minister, Mike Penning, explained on Thursday morning that Atos will quit the WCA ahead of its contract ends in August 2015 (even though it will proceed to operate a separate WCA contract in Northern Ireland). The choice will not impact Atos’s other huge government welfare contract, to carry out the Individual Independence Payment assessments (although the National Audit Workplace has raised concerns that this contract also is working into critical problems). There are number of indications that the government sees the WCA issue as something other than a technical contracting concern. Outsourcing giants Serco and G4S are believed to be in the frame to substitute Atos.

Campaigners, on the other hand, think that Atos’s departure alone will consequence in minor materials alter to the WCA. No government is probably to abandon the principle of incapacity benefit re-evaluation but they will look for a root and branch assessment that make certain that the check gets to be far more sensitive and puts the person first, rather than welfare money financial savings. “The check must be more than an exercising in obtaining men and women off rewards,” said the Scope charity chief executive Richard Hawkes: “It need to make sure disabled individuals get the specialist, tailored and flexible help they need to have to locate and preserve a job.”

Atos contract comes to an end bringing considerably relief for campaigners