A mental health trust is to be the first NHS provider to be prosecuted under legislation brought in after the Mid Staffs scandal.
Southern Health NHS foundation trust is being taken to court after a patient sustained serious injuries during a fall from a low roof at Melbury Lodge, Royal Hampshire county hospital, Winchester, in December 2015.
It is accused of failing to provide safe care and treatment resulting in avoidable harm to a patient and other patients being exposed to a significant risk of avoidable harm, the Care Quality Commission (CQC) said on Monday.
Legislation allowing the CQC to prosecute for such alleged offences was introduced in 2014 as a response to events at Mid Staffs, which was was criticised by a public inquiry for the “routine” neglect of patients between 2005 and 2009.
Southern Health provides services to 45,000 people across Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire.
Melbury Lodge includes a specialist mother and baby unit for women suffering with mental illness, as well as a ward for older people with mental health problems.
In its most recent report, in September last year, the CQC noted that anti-climb guttering had been installed to prevent patients getting on to the roof and that the fence had been fixed to reduce potential footholds after concerns were previously raised about its accessibility.
Basingstoke magistrates court will hear the case relating to Melbury Lodge this year.
Julie Dawes, interim chief executive of Southern Health said: “I express again our apologies to the patient involved, and the patient’s family. The safety of people using our services is of central importance to us and we are doing everything we can to improve the safety and quality of our services at present.
“Since the incident the trust has made significant improvements to Melbury Lodge, investing over £1m. This includes climb-proof guttering to prevent a similar incident taking place, as well as comprehensive refurbishment of the interior to make the ward safer and more therapeutic for patients.”
Jeremy Hunt has been accused of failing to deliver his promised revolution in hospital food after the health secretary’s own department found that many hospitals have still not improved patient catering.
A Department of Health study shows that almost half of hospitals in England have failed to implement key improvements almost two and a half years after Hunt’s crackdown.
The disclosure led food campaigners to claim that supposedly legally binding duties put on hospitals in 2014 to serve healthier food and check if patients were malnourished had come to nothing.
At the time Hunt claimed his new hospital food standards would force NHS trusts to offer patients fresh fruit around the clock and cut the amount of salt in meals or risk being fined or losing contracts to deliver vital care.
“These figures from the government’s own research show the widespread failure in England to drive up food standards in hospitals. We can see from the report that almost half of all hospitals are not meeting the government’s own standards on hospital food,” said Katherine Button of the Campaign for Better Hospital Food.
The DH research, titled “Compliance with hospital food standards in the NHS. Two years on: a review of progress since the Hospital Food Standards Panel report in 2014”, found widespread breaches of what were meant to be mandatory standards that all should meet.
• 48% of hospitals are still not meeting government buying standards that oblige them to meet a range of standards regulating the quality, nutritional value and ethical sourcing of the food they serve patients, staff and visitors.
• While over half of all hospitals had by last year begun assessing the nutritional needs of every patient in order to detect and avoid malnutrition, an unspecified substantial minority still had not.
• Only 55% of hospitals have fully complied with the British Dietetic Association’s nutrition and hydration digest, a toolkit designed to help hospitals ensure patients receive nutritious meals that meet their dietary requirements.
Katharine Jenner, the campaign director of Consensus Action on Salt, Sugar and Health, said: “This is more evidence that voluntary measures don’t work, even when they are dressed up as ‘legally binding’ in NHS standard contracts for hospitals. We need mandatory standards, with rigorous monitoring, reporting and meaningful sanctions for non-compliance.”
Button said she feared that hospitals’ push to overhaul their food may have been hampered by NHS-wide cost-cutting. “It seems that this well-intentioned drive to increase standards has fallen victim to budget cuts in catering departments and kitchens across the country.”
The DH insisted that its research painted a much more positive picture of progress made since Hunt unveiled the new standards to widespread acclaim in August 2014. It also shows, for example, that 96% of hospitals are either already compliant with the 10 key characteristics of good nutritional care or working towards that goal.
A spokeswoman said: “Every patient deserves nutritious food when they are in hospital which is why we introduced the first ever legally binding food standards in the history of the NHS. We can now see that over 90% of hospitals are compliant or actively working towards compliance with food standards and food is rated good in nine out of 10 hospitals.”
Late last year an American child, not yet a teenager, killed herself. A video has surfaced online which purportedly shows the girl recording herself via life stream video doing it.
I came across the video via Facebook. Someone alerted me to it less than a week after her death. I did what any reasonable person would do: I followed Facebook’s own advice and reported it for showing graphic details of self-harm or suicide.
Less than two hours later I received a reply. It wasn’t what I expected:
We’ve reviewed the share you reported for showing someone injuring themselves and found that it doesn’t violate our Community Standards.
In subsequent communications, Facebook also claimed that because it is not hosting the video, it is not responsible. This is despite the fact that due to its inaction the links were widely available on Facebook for anyone to see long after I reported the problem. It has not been verified that the video is authentic but whether it is or it isn’t, the content of the video shows a child committing the most serious act of self harm and is not appropriate for public viewing.
After nearly 20 years working with suicidal people I have a particular view on whether this is something that people should be watching:we should not. What community would find this acceptable?
Before social media, we used to have a term for videos like this: snuff films.
In New Zealand, we have very clear laws around the reporting of suicide. You can’t even report that a death is a suicide without permission from the chief coroner. And even then, talking about how the person did it, or what happened is out. There’s a good reason for this.
Research shows that when suicides are reported in detail, including how the person did it, there is a sharp rise in “copycat” suicides. Vulnerable people are triggered and influenced by the gratuitous details of suicide stories. In fact, if you feel suicidal it’s not uncommon to feel compelled to watch such a video. And in doing so, drive yourself even closer to the edge.
Despite what many might think, suicidal people are not going to be “talked out of” their situation by the reality of how painful, or messy the death they choose for themselves might be. You don’t shock people out of such state; you care them out of it.
Facebook has recently made a big deal of being sensitive to, and aware of, mental health issues and the impact of graphic videos about self-harm and suicide. They even have a “Compassion Team”.
But is it compassionate to allow the sharing of a snuff video of a child’s death? If a distressed child stumbles across the video on Facebook and takes their own life, is Facebook liable?
Facebook claims to have taken the video down but it still appears on other pages. Whatever systems Facebook has in place aren’t working. They claim people need to report each and every instance of the video being shared in order for it to be taken down – but couldn’t it use its extensive resources more effectively than that? That’s why I have set up a petition with suicide prevention ambassador Mike King to call on Facebook to make the required changes urgently.
Perhaps the last word should go to her family, the people who loved her and have watched this unfold. They posted their own request, on Facebook of course, begging people to share their tribute rather than the video:
I get the fact that people want to spread awareness about depression and I stand up for that 100% because I know how real it is, but spreading a video showing a … girl do the absolute unthinkable is not the way to do it. Please remember that we (her family) already have to live with it and having that video pop up every time we turn around is NOT what we need right now.
For those who have showed our family nothing but compassion, I would like to say THANK YOU. It is a very difficult time for us all and your support is greatly appreciated.
May you finally rest in peace.
I assume they’re not thanking Facebook for their compassion.
So it’s up to all of us. If you think you’re helping by sharing this video, you’re not. So please if you have shared it, delete your post. And if you see a link to this video in your feed report it to Facebook.
Facebook has failed us. But we don’t have to fail each other.
In Australia, the crisis support service Lifeline is on 13 11 14. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In New Zealand, you can contact Lifeline on 0800 543 354.
Kyle MacDonald is a New Zealand based psychotherapist.
I love New Year’s! It’s a new beginning; a fresh start filled with optimism and hope. It’s like hitting the reset button on life.
I particularly love New Year’s resolutions. My whole life, I’ve been a goal setter, which probably harkens back to my days as an athlete where each day was met with new goals. And, success was clearly measured: If you achieved your goal, you succeeded. If you didn’t, you failed. Hence, New Year’s resolutions are like finding a pot of gold for goal-setters like me! Each New Year’s bring a new opportunity to set new goals. Here are a two of my favorite resolutions from over the years:
“This year I will go to the gym twice a week.”
“I’ll lose 5 pounds by the summer so I feel comfortable wearing my bathing suit.”
The problem is: The New Year comes and goes and my New Year’s resolutions inevitably fall to the wayside. I start the year extremely motivated and then, life gets in the way. I get busy, and I push the New Year’s goal off to the next month, and then the next month, and the next. Until, before I know it, it’s time to make New Year’s resolutions all over again:
“This year I will definitely go to the gym twice a week. This year I’ll make it a priority.”
“I’ll lose 5 pounds by the summer so I’ll finally feel comfortable wearing a bathing suit. This time I’m serious. This time, I’m going to do it. I’m tired of feeling fat.”
Does that sound familiar?
Why do we do that to ourselves? It’s great to have goals. But, if setting goals isn’t working for you, why not try something different?
I recently read a book by Scott Adams titled How to Fail at Almost Everything and Still Win Big. Scott Adams is the creator of Dilbert, the comic strip. His book changed my life.
I no longer set goals. Instead, I create systems.
According to Adams, setting goals and assigning deadlines can set you up for failure. For example, if your goal is to lose 5 pounds, you may fixate on that number:
Even if you lose 4 pounds, it won’t be “good enough” because you didn’t reach your goal.
In addition, until you lose those 5 pounds, you may “exist in a state of continuous presuccess failure,” according to Adams. In other words, you feeling successful hinges on that specific goal. Consequently, you may not feel like you are “good enough” until that goal is achieved.
Alternatively, Adams proposes a system-oriented model, with no deadlines and no specific goals. Instead, you implement a system where you do something “on a regular basis with a reasonable expectation that doing so will get you to a better place in your life.” Using this approach, you succeed every time you apply your system because you did what you intended to do. This approach promotes lasting change.
I think of the system-oriented model as focusing on the “how” and not the “what.” For instance, Instead of setting a goal of going to the gym twice a week (the “what”), I choose to create a system of being more active (the “how”). But, there are no specific goals or timelines attached to the “how:”
I create a system by making a list of what it looks like to be more active. For instance, I can choose to get up from my chair at work and walk a lap around the office, I can park further away from the grocery store, and if I walk down the stairs I can walk back up and down an extra time.
But, I don’t set myself up for failure by attaching a timeline, such as walking up and down the stairs every day.
That way, each time I choose to be more active, I have succeeded. And, if I’m not active on any given day, I haven’t failed because my activity level is not attached to a specific goal.
Instead of setting a goal to lose 5 pounds (the “what”), I choose to create a system of eating healthy (the “how”). But, there are no specific goals or timelines attached to the “how:”
I don’t set myself up for failure by attaching a timeline, such as promising to eat healthier every morning, or on the weekdays.
Instead, I create a system by making a list of what it looks like to eat healthier. For instance, I can choose to eat nuts instead of potato chips or a salad instead of fried chicken.
Consequently, each time I choose to eat healthy, I have succeeded. But, if I don’t eat healthy on any given day, I don’t beat myself up about it. I simply keep moving forward.
This year, instead of setting specific goals with specific timelines attached, I am implementing systems (Technically, you could say I just set a goal!). Instead of setting myself up for failure, I am setting myself up for success. By creating systems, I am filling my year with hope:
I hope to stop beating myself up for not achieving a “goal” in a specific amount of time that I arbitrarily establish.
I hope to encourage myself to implement change when I can, instead of scolding myself for missing a self-imposed deadline.
I hope to practice kindness by allowing myself the time it takes to create a new, healthy habit instead of expecting myself to change in an instant.
I hope to give myself the gift of grace, instead of harboring the feeling that I’m still not “good enough.”
This year, I hope to end the failure that’s all too often attached to New Year’s resolutions, and goal-setting in general. This year, I hope to find a system that works for me.
I’d love to hear from you!
Have you implemented a system-oriented model? If so, has it worked for you?
Sally will never forget the day she had to section her 13-year-old daughter. “Maisie was already in hospital. She was there because she’d taken an overdose, and she wouldn’t stop talking about death and saying she would do it again. She kept telling me she wanted to die – and I believed her.”
Sally agreed to let doctors formally assess Maisie, and then allowed her to be sectioned and detained in hospital under the Mental Health Act. “I feared for her life. I felt I had no other option.” Maisie had been moved from A&E to the children’s ward to recover from her overdose, but the hospital was planning to discharge her. “I couldn’t risk taking her home,” says Sally. “I didn’t dare. I thought she was going to kill herself. I was terrified.”
Maisie started self-harming when she was 12, shortly after her father died of cancer and Sally suffered an episode of ill health. “Maisie can’t regulate her emotions and she copes by trying to hurt herself. Everybody sees the behaviour, but not what’s behind the behaviour.”
Once Sally had signed the section, she no longer had the power to bring her daughter home again. “I didn’t have a clue how much control over my child I was giving up. After you sign the papers for a section, the doctor has more power than you over what happens to your child, and other professionals will listen to the doctor rather than you.”
She talked to other kids in the hospital. It was a game the children played: what medication are you on?
Maisie was sectioned in a specialist children’s unit for six months. “I thought I had done the right thing, and that Maisie would finally get the therapies she needed. I thought they would fix her. I was wrong.”
Instead, Maisie learned a new way to self-harm. “Maisie copied another girl in the mental health unit.” Her medication was expanded and now includes antipsychotic drugs and antidepressants as well as sleeping tablets. “They’ve given her all sorts – she’s asked for it. She talked to other kids in the hospital. It was a game the children played: what medication are you on?”
One night, Maisie grew so desperate to leave the hospital that she escaped from the ward. “I got a phonecall saying, ‘Maisie’s missing and we don’t know where she is.’”
Maisie had been gone for an hour by the time staff realised she was gone. “She was found at a National Express coach depot by the police, waiting to get a bus home.”
When Maisie was eventually released after six months, Sally felt as though her daughter had done time in prison. “No, actually, it was worse than prison.”
The family recently agreed to take part in a Channel 4 documentary on teenagers with mental health problems in conjunction with the Tavistock and Portman NHS foundation trust, hoping it would raise awareness about the need for better NHS funding. “The government takes advantage of the stigma that surrounds mental illness. That’s why children’s mental health has got such a poor budget.” Sally thinks parents are embarrassed to speak out or complain about the poor care their children receive. “It’s time to change that.”
The documentary shows Maisie’s emotions and behaviour getting out of control again. “I was exhausted, just from trying to restrain her from hurting herself,” says Sally. “It was constant, 24 hours a day. But I had no extra support.”
Sally must keep all Maisie’s medication locked in a safe, along with anything sharp. Over the summer, Maisie started barricading herself in the bathroom so she could self-harm, physically fighting her mother off when Sally tried to stop her. “I was covered in bruises – not that she’d hit me, just while I was restraining her, it would happen.”
Sally asked for more help at home. “But it didn’t materialise. That made me very angry. Maisie disassociates, so when she comes back round and sees I have bruises, she can’t cope, knowing that she’s done that.”
Eventually, in August, Maisie herself asked to go away to an inpatient unit. “I needed to protect my mum,” Maisie explains. “Asking to go away was the only way I could do that.” Her mother, she says, is her rock.
Sally believes the way Maisie was treated from that point on was disgraceful. “I begged the doctors not to section her again, because she would go informally, without the section,” says Sally. “But they said because it’s an emergency admission, no one would take her on an informal basis.”
The head of Maisie’s local adolescent mental health service, who knows Maisie well, felt she only needed two weeks in hospital. But Maisie was sent to a secure paediatric unit 95 miles away from her mother’s home and sectioned for 28 days by a doctor she’d never met before. “As soon as she arrived at the hospital, the doctor there had control over Maisie. He totally dismissed her previous diagnoses.”
In total, Maisie – who is now 15 – has been given 15 different diagnoses over the past three years, ranging from autism to severe depression. After visiting Maisie in the mental health unit, Sally became extremely concerned about her. “Her face was very swollen and all the blood vessels had popped.” It turned out Maisie had been managing to self-harm. “The hospital staff weren’t telling me. I was only hearing because of Maisie.” Sally had never seen her daughter in such a terrible state before and complained to staff. “I don’t think they took me seriously. These people are in powerful positions making crucial decisions for your child. It’s scary.”
The relationship between the parents of mentally ill children and hospital staff can be fraught. “Professionals perceive me as a pain. They don’t have the ability to empathise. I think a lot of it is that they don’t understand. When Maisie’s gone into crisis on a weekend, the hospital doesn’t want her there because there’s nothing medically wrong with her. But there’s nowhere else for her to go if she doesn’t feel safe at home. At those times, it’s like being an alien on that ward, an inconvenience, a nuisance. I’m seen as part of that nuisance. ”
She believes some doctors and hospital staff make judgments about the parents of children with mental health problems. “They think, ‘Bad home.’ Or they think, ‘Mum’s not set enough boundaries.’ There’s a culture of: ‘We can’t help you because it’s your parenting skills.’”
I failed her and I don’t want to fail her again. That’s why I fight like I do
Mental illness is an invisible disease, she says, so people – parents, particularly – need to get more clued up about it. “We were happily going along in our lives and didn’t realise that one day it would affect us. I failed her and I don’t want to fail her again. That’s why I fight like I do.”
Sarah Brennan, chief executive of YoungMinds, says: “We often hear from parents who are furious that they can only visit their children once a week or once a fortnight, because the distances are so far and travel costs are so expensive. It can also be incredibly stressful for young people to be cut off from their families and friends.
“Inpatient care should be a last resort. We need to ensure that help is available locally, in the community, when problems first emerge. Draining money from early intervention is incredibly short-sighted, and just stores up problems for the future.”
Last year, Sally launched a successful petition to get a local mental health unit for children reopened, and convinced her NHS foundation trust to introduce a 24/7 crisis team. But she admits there are days when she struggles, and she is now having counselling. “Maisie’s illness has definitely made me a more confident mum in many ways. However, it’s also made me a very angry person. I don’t trust the system.”
Maisie is back home now. Eventually, after Sally highlighted her concerns about Maisie’s treatment to her MP and got a good package of care put in place for Maisie at home, she was discharged from the hospital. Reunited with her mother and her dog, Honey, she has recently started attending a school for children with autism. But Sally still locks herself in her own bedroom at night with the safe, so that Maisie cannot try to open it while Sally is sleeping.
“It’s hard having Maisie home. I can’t lie to you and say it’s a breeze. But when you’re a parent, you make sacrifices.”
She loves her clever, articulate daughter unconditionally. “I want her to be happy one day. I hope she will be. I always just cling on to hope, and that’s what I tell all the other parents I meet to do, too. Never, ever let go of hope. Because without hope, it’s really bleak.”
She never wants Maisie to be sectioned again. “The most challenging part, as a parent, is feeling absolutely helpless. When a doctor sends your child miles away, for a long time, and you know it will be difficult to bring her home … it’s like torture. It could slowly drive a parent insane.”
•Kids on the Edge: Troubled Girls is on 30 November at 10pm on Channel 4.
In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.
An 87-year-old motorist was killed in a head-on motorway crash two months after police failed to notice his driving licence had been revoked because of dementia, an inquest has heard.
Albert Newman and a passenger in a van died after the “confused” motorist drove the wrong way for up to 30 miles along the M42, A42 and M1 in the early hours of 12 October last year.
An inquest heard Newman had been reported to Nottinghamshire police in August 2015 by a bank worker who spotted him driving his Mazda despite “severe” signs of dementia.
The hearing in Loughborough, Leicestershire, was told a police officer who visited the pensioner’s Nottingham home assessed his welfare, but did not check a printout showing he had no valid licence or MOT.
Newman and 27-year-old Michael Luciw, also from Nottingham, died at the scene after the Mazda crashed into a Ford Transit van in the outside lane of the southbound M1 near Lockington, Leicestershire.
The north-west Leicestershire coroner was told overhead signs warning that a car was driving the wrong way were activated near Birmingham because of an error by Warwickshire police.
Although a motorist had called police at 2.01am to report that Newman’s car was driving north on the southbound M42, the information was “incorrectly logged” and passed to Highways England as an incident involving a southbound vehicle.
Pamela Oxlade, a witness who was travelling towards Birmingham airport with her husband, told the inquest: “We were fortunately just past a lorry when suddenly, out of nowhere, there were two balls of light. It was really quick and it was just unreal because you couldn’t see the outline of the car in the dark.
“I dialled 999 and spoke to a gentleman, explained what had happened and he just said they were aware of it. We said we were almost half an hour from the M1 and going towards Birmingham. It was such a great relief to hear that he was aware of it.”
The inquest was told that approximately 20 minutes after the near-miss, Oxlade spotted motorway signs near Birmingham warning motorists to slow down because of a car travelling in the wrong direction.
Before the crash Newman’s car was recorded as being in Nottingham at 11.19pm and he is thought to have joined the M42 via an exit slip road at junction 9 in north Warwickshire.
Details of prior contact between Nottinghamshire police and Newman, whose licence was revoked in December 2013, were given to the inquest by DS Jackie Alexander, of the force’s professional standards department.
She told the hearing Newman was reported to police by a member of staff at a bank in Sneinton Dale, Nottingham, who expressed concern that he was driving on the afternoon of 12 August last year.
The call was initially graded as an immediate priority but was later downgraded to “urgent” and an officer was asked to attend Newman’s address.
Alexander told the inquest: “The beginning of the message was clear that this was about his driving. The officer did not note that part of the message and focussed on the welfare part of the message. He came to the conclusion that everything was OK in respect of this gentleman and signed the message off accordingly.”
During her evidence, Alexander agreed with the coroner, Trevor Kirkman, that the visit had been an opportunity to recognise that Newman’s licence had been revoked, that he had been driving and should not have been.
Kirkman asked the senior officer: “The most basic of steps to verify that Mr Newman had authority to drive – ie, a current licence – were not taken?”
Alexander replied: “That’s correct sir.”
Earlier in the hearing, the driver of the Transit van, Andrew Harrington, who was travelling from Ilkeston in Derbyshire to Carlisle with Luciw, told how they joined the M1 minutes before the crash.
Harrington, who suffered a broken pelvis, told the hearing: “We were just getting up to 70mph and the next minute I saw a set of headlights. I swerved slightly and the next minute it was all over – we were up in the air and landed on the crash barrier.”
The inquest was adjourned until 8 December after the coroner requested further information to be provided by Nottinghamshire police and Highways England.
No less than 17 years have passed since new rules were approved in the UK to save thousands of lives by limiting deadly air pollution in our towns and cities.
Pollution is the “invisible killer” because, for the most part, it goes unseen. Its impact on human health and the planet is why those laws were necessary.
Yet disgracefully – and illegally – we are still subjected to excruciatingly dirty air. Conditions are sometimes so poor that you notice it in your nostrils or lungs. Those days, when the air feels thick with fumes, you may be under the impression that it’s just one vehicle with a bad exhaust in front of you which is to blame. It’s generally not.
London’s pollution – the worst in the UK – was visible on a trip I made to Canary Wharf a few weeks ago. From the 11th floor, a brown haze sat across the skyline, its deadly toxins testing the health of millions of city-dwellers and workers, particularly those who suffer from asthma, heart or respiratory conditions.
Pollution is right there with you when you’re puffing as you cycle through the park on a summer’s day, or when you’re chatting with friends on a visit to the shops on a Saturday morning, or when you’re taking your child to school.
Why are you and I are still inhaling unlawful levels of nitrogen dioxide nearly 20 years after it should have been cleaned up?
There is a simple answer: because the UK government is breaking its own and the EU’s laws.
It has failed to protect your health and mine, and more importantly the health of our children. It has failed legally. And it has failed morally.
ClientEarth is taking the government back to court on Tuesday, because of the lack of urgency, the failure to tackle the problem. Cleaning the air isn’t rocket science. Not doing so is simply unacceptable political behaviour.
The fact that it’s taken the Department for Environment, Food & Rural Affairs (Defra) 18 months to launch a consultation on just five clean air zones – when there are many more badly polluted towns and cities across the UK – is just one illustration of that lackadaisical attitude.
In April last year, in our first legal challenge, the supreme court ordered the environment secretary to draw up a new Air Quality plan to meet legal limits in the shortest time possible. The plan was woefully inadequate and didn’t envisage UK compliance on pollution levels until 2025. That would be 26 years since the rules were first approved.
Not only that, but while motor manufacturers have been exploiting legal loopholes and using dubious techniques to pass emissions tests, the government has failed to hold them to account – while bidding behind the scenes to allow increased emissions.
The Treasury, meanwhile, is still giving incentives through the tax system, for motorists to buy diesel cars. That is also unacceptable.
A reason some give for not taking action to solve this public health crisis is the cost to the economy and the Treasury and the impact on business, hauliers and motorists. But surely the health impacts of pollution are worth more than that?
Pollution is responsible for 40,000 premature deaths in the UK. It triggers heart attacks and strokes. It can make existing heart conditions worse. It causes cancer and stunted lung growth in children. It aggravates respiratory conditions which can be fatal.
But there is also a substantial economic and societal impact. Defra’s own analysis suggests that the cost to the economy from early deaths by air pollution is £27.5bn. Every year.
So what should the government be doing? A national network of Clean Air Zones, preventing the worst polluting vehicles from entering our towns and city centres; a scheme to retrofit buses and heavy goods vehicles to make them compliant with legal emissions limits; and a targeted diesel scrappage scheme part funded by the car industry – used to fund low emission vehicles and alternatives to car use.
Other solutions should run in tandem: a clean public transport system and a car labelling scheme so that motorists know they cars they are buying are compliant with emissions limits in the real world.
That would be a start. There is also a great opportunity: to move the economy toward zero emission vehicles. We could become a leader in sustainable energy, and sustainable cities.
The air law will be UK law under the government’s Brexit plans. It should be made even stronger in future with a new Clean Air Act.
First, we need to win this court case to make sure the government understands that pollution is a health hazard which we – or rather they – can solve.
The national mental health commissioner, Prof Ian Hickie, has said workplaces rely too much on “1970s-style” HR programs to help staff in distress rather than implementing comprehensive mental health policies.
His comments come in response to a survey of Australian workplaces conducted by the law firm MinterEllison found almost three-quarters had no formal policy or procedure for managing staff mental health issues.
The study found 44% of participants reported suicide or attempted suicide among staff at their workplaces in the last two years.
The survey was issued to organisations of all sizes including overseas-owned enterprises, Australian listed and private companies, sole traders and partnerships, government entities and not-for-profit organisations.
“This issue of workplace mental health has been on the agenda for the last 15 years and we assumed managers would make progress,” Hickie told Guardian Australia.
“In truth it’s the area of mental health in which we’ve made the least progress and there is a real reluctance from employers to buy into the serious effects of mental health on workplace productivity.
“An overemphasis on employee assistance programs and simplistic, 1970s-style HR processes which are secretive and isolating exacerbate the problem and discourage an open workplace conversation.”
While he said there were some examples of companies taking a leadership role in assisting staff with mental health concerns, it remained rare. Too often, staff had their roles diminished for speaking up about their mental health concerns, which wasn’t always what the employee wanted, he said.
Workplace representatives were asked by MinterEllison about how mental health issues were handled by managers, about policies and programs available to help workers manage their mental health, and about what more they believed could be done to support the management of mental health in their workplace.
Of 226 responses received across a range of industries, 74% of the respondents reported there was no formal mental health management policy. This was despite 81.3% of respondents reporting that they spent about one quarter of their time managing staff with mental health issues. One third of respondents said more than 15 staff members at their company had come to them with mental health issues in the past year.
While 56% of participants reported they were seeing more cases compared with the previous 12 months, only 38% of the organisations said staff mental health had been discussed at a board level. Most respondents said their organisation made no or little investment in mental health and wellbeing programs.
“It is clear the increased incidence of mental health issues in workplaces is affecting the performance of organisations and increasingly occupying the time of management,” the report found.
The three most common strategies reported by organisations to support the mental health of staff were access to a confidential employee assistance program, flexible work arrangements, and providing access to mental health information. But the impact and effectiveness of these strategies was not often measured by most of the workplaces.
“Our survey results reveal that, over the past two years, the two most common mental health issues affecting staff are depression and anxiety (94%),” the report found.
“Quite unexpectedly, 44% of participants reported suicide or attempted suicide at their workplaces in the last two years.”
According to Heads Up, a partnership between the Mentally Healthy Workplace Alliance and beyondblue, untreated mental health conditions cost Australian employers $ 10.9bn every year through absenteeism, reduced productivity and compensation claims. Other research has found that every dollar spent on effective mental health procedures returns an average of $ 2.30 in benefits to an organisation.
Unaddressed, the organisations said poor workplace mental health led to low morale and staff engagement, high staff turnover and potential penalties for breaches of work health and safety legislation.
Associate Prof Samuel Harvey, a psychiatrist with the Black Dog Institute who runs the workplace mental health research program at the school of psychiatry, University of New South Wales, said it was not enough for a workplace to provide a phone number for an employee counselling program.
“Good workplaces now create a suite of interventions, from prevention through to recovery, and they do it because it’s right and because economic analyses show it makes good business sense,” he said.
Build a wall … A great wall. But will it be high enough, big enough, thick enough? Will it be Trump-size, visible from space? Will it keep out the undesirables ? Will it protect the lorry drivers and nervous holidaymakers? Will it look nice if we put a few plants around it? Are the French going to raze the Jungle to the ground just as they did Sangatte?
I do not know whether Robert Goodwill, the immigration minister who announced the grand folly of a £1.9m wall in Calais – “We’ve done the fences, now we are doing a wall” – has a clue what he is talking about but this is part of a £17m security package that “we” are partaking in with the French to tackle the problem of the camp in Calais. This is the ultimate in closed thinking.
Walls, barriers, boundaries, borders, blockades: these are structures that make us feel in control, but in the end remind us only of chaos. This is part of the Brexit mentality, part but not all. There is another part that means opening up to a world beyond Europe and righteous Remainers should be wary of constructing even more walls around their own arguments, which seem to outdo each other in convincing us that everything will be terrible for ever.
The result of this on the left – except among those with a vivid enough imagination to actually envisage Jeremy Corbyn shambling down the G20 red carpet in China – is political paralysis. No more pessimism of the intellect, optimism of the will, but pessimism about everything. This a truly dangerous place to be. I understand the feeling: the world is going to hell in a handcart, so there is nothing to be done. It is a form of paralysis solved only by moving to places where nothing ever happens: New Zealand, Canada … Failing that, we make little walls around ourselves. Cosy up as the nights draw in and try not to think. About anything.
Strangely, though, the best cure for such a feeling is the opposite. It is getting involved with people who do work to change the lives of others, who make movement possible, whose very work is to pull down barriers not erect them.
This was made clear to me by Undocumented, an exhibition celebrating 10 years of a Bethnal Green clinic run by Doctors of the World which is used by migrants locked out of the healthcare system. In reality, everyone in the UK should be able to access healthcare. One of the myths is that this is what people come here for. The reality is that, if you are homeless and don’t have a national insurance number, you can’t access it.
Sarah (pictured above) explained this to me. She is from South Africa where she had been “correctionally” raped. Men, she said, had come to “fix” her because of her sexuality. She became pregnant and HIV positive. She could not get a GP but the clinic helped her. And there she was, beaming in front of photographs of herself despite her horrific story.
Ibrahim, a former Doctors of the World service user who is now training to practise as UK GP. Photograph: Toby Coulson
A man, Ibrahim Muyhayer, who was a doctor in the Sudanese army but had to leave because of the political volatility, told me how it had taken him five years to access the system. He was charged £2,000 for an ultrasound scan for his pregnant wife though he was earning £50 a week. Now he volunteers in the clinic and is retraining to practise as a doctor here.
This basic ethos of treating medical need, whatever the patient’s immigration status, is what this charity does. This is why it also runs clinics in Calais and works with refugees in Greece.
Users of the clinic often carry stories of awful suffering, torture, loss and rape, but this is the only service providing primary healthcare. Tearing down the barriers. It was the same in Calais. Unlike the immigration minister, I have been to the camps. It would take him an hour to get there. It’s incredible that he has not. Anyone who has actually talked to anyone in the Jungle, or worse, in Grande-Synthe, the camp in Dunkirk, would smell the desperation. Every night, these people risk getting their hands ripped up, breaking their limbs and getting teargassed trying to get over the fences because they feel that they have no life anyway. They will get around a wall.
So this wall is a symbolic gesture to be built with taxpayers’ money. That money could surely be used to fund centres for the processing of asylum claims. But something unforgivable is happening when we cannot even let in the unaccompanied children from the camps. Stella Creasy, MP for Walthamstow, went over with Alf Dubs to try and do something about this. Those kids, with their strange “protectors” lurking behind them, haunt me. These are traumatised children, left to rot and be exploited. The volunteers do the best they can, but the situation is at breaking point.
Nevertheless, to hear the stories of those who have been helped, is to be jolted out of political ennui. Lives can be rebuilt.
A wall is sign of a failure of humanity. In 1964, the artist Joseph Beuys satirised the Berlin wall, suggesting it be raised by 5cm to have better proportions. He made his point and we know what happened to that wall. It is good to be reminded that there are those who build walls but there are those who will build ladders over them. That is called hope.
“I have a teenage daughter with heart and kidney failure,” says Jo from Wolverhampton. “Regardless of the great care she receives, her condition can and does suddenly become critical. Her mother lives in constant fear of changes to the NHS and her support system. We must keep a tight hold on our very precious NHS.”
The story of Jo’s family is moving. But it’s not that surprising – most of us have some experience of the NHS as a true life-saver. And sadly, many of us will also recognise the anxiety Jo describes about the future of the NHS.
Elizabeth, from north-west London, has a rare autoimmune disease that requires regular visits to hospital, including overnight stays. She echoes Jo’s fears. “It is imperative that numbers of beds are not cut,” she says, “my last wait for a bed, following complications with an outpatient procedure, was approximately seven hours.” Valerie from Dorset gave 33 years of her career to the NHS as a registered nurse. “Now I am possibly facing cardiac surgery,” she says, “and I need the NHS to support me.”
Many of us have gradually started to feel less confident than our parents and grandparents were that we will be able to rely on the NHS into our old age – let alone that our children or grandchildren will have a service they can trust.
Not all the pressures on today’s NHS are the fault of politicians. We’re living longer. There are more of us. Demand has risen in hospitals and in health centres. But at the same time, government funding for the health service has been dangerously squeezed. Social care is continually neglected, putting even more pressure on hospitals. And successive ministers have refused to listen to doctors, nurses or patients when pushing through politically motivated NHS reorganisations.
Conventional politics has failed us when it comes to the NHS. The voice of ordinary people – the likes of Jo, Elizabeth and Valerie – has never been more needed. And that’s why they and hundreds of thousands of us are taking matters into our own hands. Think back to David Cameron’s costly and damaging NHS reorganisation. Without a people-powered campaign to prevent the worst elements of Cameron’s legislation, the Health and Social Care Act would have had far more harmful consequences.
A new investigation commissioned by the campaign organisation 38 Degrees, where I work as executive director, is published today. Carried out by a team of health policy experts at Incisive Health, it exposes new plans being drawn up for the NHS across England, called “sustainability and transformation plans” (STPs). The investigation has been funded by hundreds of thousands of people making individual donations via the 38 Degrees website. People like Jo, Elizabeth and Valerie have shared their personal stories, signed the campaign petition and donated to fund the research. Independent of party politics, we’ve chipped in to protect the health service we value so much by putting these plans under the spotlight.
The research finds huge funding gaps for local services, which, the experts say, could lead to A&E closures, cuts to beds and mergers of hospitals. Put together, the projected funding shortfalls across England would see a £23bn deficit in health and social care spending by 2021.
Where Jo lives, in the Black Country, there are plans for major changes at Midland Metropolitan hospital, including the closure of A&E. The plans also include the proposal to shut one of two district general hospitals. By 2021, the health and social care system in the Black Country is projected to be £476.6m short of the funds it needs to balance its books while maintaining the same level of care. Where Elizabeth lives, the draft plan indicates “reducing demand for acute services by approximately 500 beds”. That’s health manager-speak for cutting 500 hospital beds.
Our crowdfunded investigation shows that this worrying plan for the Black Country is typical of many others across England.
These kinds of cuts aren’t the fault of local NHS leaders. They’re being planned all across the country, the result of a growing black hole in the funding provided to the NHS by the government. Whether or not Theresa May allows these cuts to go ahead will be a key test of her commitment to protecting the NHS.
The NHS belongs to all of us. So before these plans go any further, local people should have a say on any changes to their services. That’s why almost 250,000 people have already signed the 38 Degrees campaign petition to the health secretary, Jeremy Hunt, calling for full public disclosure of the STPs for each and every one of the 44 areas across England.
No one is suggesting that all changes to NHS services are bad. There may be a good case for some of the changes that are being proposed. But because the plans are not out in the open – we have had to hire specialist researchers to give us even a partial picture – there’s every reason to fear that many of these will be about cost cutting at the expense of patient care and patient safety.
One thing is certain: we know that when we leave the politics of the NHS to the politicians, it doesn’t end well. Now, more than ever, people-powered campaigning is critical to the future of the NHS.
Leading health experts have accused Theresa May of failing the first test of her premiership over the government’s response to the obesity crisis.
The delayed obesity strategy had already attracted strong criticism over its failure to restrict junk-food marketing and advertising and its reliance on voluntary action by the food and drink industry.
And now one campaigner has labelled it a “national scandal” that augurs ill for the future given that, on entering No 10, May pledged to reduce inequalities and that obesity disproportionately affects those in socially deprived areas.
Related: May’s obesity ‘plan’ betrays children who face a rising tide of preventable cancer | Harpal Kumar
Prof Graham MacGregor, an NHS cardiovascular expert and chair of Action on Sugar, said he had seen a previous version of the plan under David Cameron and while it was still not satisfactory, Thursday’s final version was even worse.
“She [May] came in saying ‘We are going to look after the poor and the socially deprived’ and immediately shown she’s absolutely not interested. This is a huge crisis facing the UK: we are the most obese nation in Europe; it’s going to bankrupt the NHS. Farcically, she’s gone backwards even on Cameron. It’s a national scandal.
“It’s been watered down in the last three weeks. To release it [while May is] on holiday when neither Jeremy Hunt nor her are there, it augurs very badly for her as prime minister. If she continues like that it’s [going to be] a disaster.”
The strategy was delayed for more than a year amid much speculation about its contents and grave warnings by campaigners about the consequences if it did not take a tough line on practices they say are fuelling obesity.
They include: supermarket price-cutting promotions on junk food; promotion of unhealthy food to children in restaurants, cafes and takeaways; and advertising of unhealthy food through family TV programmes, social media and websites.
Cancer Research UK’s chief executive, Sir Harpal Kumar, who headed up NHS England’s cancer taskforce, which reported last year, said the government had given in to industry lobbying despite May’s talk on entering office of not being in thrall to “the privileged few”.
Writing in the Guardian, he said: “The new prime minister entered Downing Street with a pledge to tackle health inequality and to champion the needs of the individual in preference to the ‘mighty’.
“Obesity has a disproportionate impact on the poorest in our society … The new government faced its first test of this pledge with a chance to address inequality and to protect the next generation from diseases like cancer. This plan fails that test.
“There can be little doubt that preventing cancer has fallen victim to economic scaremongering and industry lobbying, despite the fact that obesity costs UK society almost £1bn every week.”
Drinks cans labelled with their sugar content. Photograph: Frank Augstein/AP
While welcoming the reaffirmed commitment to the sugary drinks tax and the funding for school breakfast clubs and sport that it will facilitate, Kumar said there was an inexcusable failure to address the impact of marketing and in-store promotions.
“Some will say parents should be responsible for what their children eat,” he wrote. “Parents clearly have a key role, but as a father I know the pitfalls of pester power and how hard it can be for families to shun the tempting junk and ensure healthy food is always on the table.”
Kumar said restrictions on junk food adverts before the 9pm watershed could more than halve children’s exposure to them.
A Department of Health spokesman said: “Our obesity plan is world-leading, with more far-reaching and comprehensive measures than anything pursued by any other western government. Nevertheless, we will measure progress carefully and do not rule out further action if results are not seen.”
Ministers have pledged to boost the top quality of such care, right after Labour’s GP contract absolved loved ones doctors of duty for their sufferers at evenings and weekends.
Patients groups explained the case exposed “catastrophic and systemic” failings in the method of out-of-hrs care, and in the failure of the NHS to appropriately investigate the case until now.
His parents told how the tragic loss of their 2nd born son in 2010 had been compounded by a 3 and a half year struggle to seek out the reality about how the blunders occurred, in a bid to prevent long term deaths.
Mr and Mrs Morrish accused neighborhood wellness providers of failing to conduct a thorough investigation and said the Ombudsman – the highest authority on NHS complaints – had been slow to investigate.
They also stated the Ombudsman had made a series of factual errors, forcing them to repeatedly proper accounts of what had occurred to their son and the subsequent investigations.
Mr Morrish stated: “This is incorrect and cruel. Why need to we have to keep reliving the sudden, suffocating, lifestyle shattering death of our stunning minor boy?”
Sam fell unwell with suspected flu on December 21, 2010, at his family’s property, in Devon. His mom Susanne took him to their nearby GP, who prescribed antibiotics in situation he designed an infection, but by the subsequent morning the minor boy’s condition had worsened.
Mrs Morrish rang the GP surgical treatment, saying his issue had deteriorated and that he was “constantly thirsty” and was wearing a nappy because he was also weak to go to the lavatory. Nevertheless, the GP failed to inquire no matter whether there was any urine in the nappy, which was dry in a clear signal that Sam’s kidneys have been failing.
That evening Sam vomited what appeared to be blood and his mother and father contacted NHS Direct. A nurse answering the phone wrongly recorded Mrs Morrish’s answers to inquiries about her son’s situation and crucially recorded the contact as regimen rather than an emergency.
When they failed to call her back Mrs Morrish contacted the out-of-hours GP support, Devon Medical doctors. Rather of recommending she get Sam to the regional hospital’s A&E she was advised to go to the treatment centre alternatively.
An unqualified contact handler wrongly assured her the treatment method centre was the right area to get her son. At the therapy centre the household were positioned in a lengthy queue. It was only when a passing nurse realised how significantly ill Sam was that he alarm was raised and he was rushed by ambulance to Torbay Hospital.
But even right here Sam not given the needed antibiotics until 3 hrs after they had been prescribed. By this level an invasive bacterial infection had taken hold in Sam’s bloodstream and he died from septic shock on December 23.
The case is set to renew considerations about the safety of health-related out-of-hours services.
A decade in the past, a new contract for loved ones doctors allowed GPs to abandon obligation for sufferers at evenings and weekends, with solutions increasingly contracted out, even though NHS Direct ran a network of call centres providing telephone guidance.
Amid fears that the method was failing sufferers and heaping as well significantly stress A&E departments, this Government introduced a 111 phoneline, to replace NHS Direct and coordinate out-of-hrs care, as well as providing tips.
Nonetheless, the launch of the scheme last spring was disastrous, with paramedics complaining they were becoming sent out to trivial circumstances, while emergencies had been not being effectively prioritised.
Subsequent week’s report is also anticipated to spark criticism over weaknesses in the complaints methods which are supposed to investigate NHS failings.
Last month Dr Sarah Wollaston, now chairman of the Commons overall health choose committee, questioned Dame Julie Mellor, the Ombudsman, about why her investigation into Sam’s death has taken more than two many years.
The Individuals Association, which has supported the Morrish loved ones for the past 3 years, said: “As an organisation we have in the previous advisable men and women to refer their complaints to the ombudsman in the self-confidence they would handle those complaints correctly, with total and honest answers.
“But if the expertise of the Morrish family is something to go by it may properly have failed hundreds of individuals we have referred to them. The Ombudsman seems not to accountable to anyone and this dreadfully sad situation demonstrates that the ombudsman is not fit for goal.”
Consider a swift search about any overall health IT conference and you will see a increasing quantity of businesses working in the areas of personal health records and health portals. It is an natural response to the disappointment millions of Americans routinely express about a lack of connectivity and transparency with their care companies.
One particular of the newer gamers in this room is MDCapsule, which gives a patient engagement platform so individuals can connect with their healthcare suppliers far more effortlessly. We had a likelihood to talk with the company’s co-founder, Dr. Nathalie Majorek, about the challenges she faces with beginning up such a firm. Throughout our conversation, she observed that due to the nature of the enterprise, “many men and women feel our business will fail, but quite couple of truly quit to listen to why we’ll be profitable.”
It was an interesting comment that we made a decision to broaden on. I asked Dr. Majorek for the top five criticisms of her enterprise, and 5 factors why they’re wrong. Right here are some highlights from our discussion:
1) A lot of big companies, such as Google, have experimented with to perform in the personalized wellness portal room and had been unsuccessful. If these huge companies, with massive amounts of resources, couldn’t realize success why do you consider you can?
MAJOREK: There are many theories why Google Health failed to provide in the private health record space. Timing is a single, being too early when buyers were not ready to get on some of the operate with their well being. But occasions have changed and shoppers are recognizing the want to be much more concerned.
One MDCapsule patient commented: “Google would not give direct accessibility with my physician ought to queries come up, whereas that is the complete point with MDCapsule. I know my information is secure and safe, and I have simple access to my suppliers need to I have a question or want help.”
John Moore of Chilmark Analysis summed it up fairly nicely. “Few buyers are interested in a digital filing cabinet for their information. What they are interested in is what that information can do for them. Can it support them greater handle their wellness and/or the health of a loved one? Will it help them make appointments? Will it conserve them money on their overall health insurance bill, or their subsequent medical doctor check out? Can it aid them instantly get a prescription refill? These are the basics that the vast majority of buyers want addressed and Google Wellness was unable to deliver on any of these.”
Will private health portals change the ways doctors and sufferers interact? (Photograph credit score: Wikipedia)
2) A physician’s day is presently quite total, with a common complaint getting that they really don’t have sufficient time to efficiently interact with their patients. Most physicians would say they want to see fewer individuals in the course of the day, and see each 1 for a longer period. Won’t including a social media or virtual communication channel basically overwhelm physicians who previously really do not have significantly totally free time?
MAJOREK: Healthcare needs techniques that enable physicians and other health suppliers to function smarter, not more difficult. Currently, physicians, nurses, and office employees are overworked and devote an escalating amount of time on administrative processes (coding, billing, referrals, and so forth.) and not on direct patient care. In reality, several of the information technological innovation tools launched into the healthcare system have even more fragmented the communication among well being and ancillary care suppliers rather of facilitating it. In the finish, sufferers drop out and medical doctors and nurses burn up out.
The idea that doctors don’t want to engage a lot more with their individuals is overhyped. If there are medical professionals out there who want to lessen patient engagement I’d say they are in the incorrect area. MDCapsule is like getting a winning coach on your basketball group. By providing clear and simple measures to functioning with each other, each player feels much less burdened and the team as a whole functions far more effectively and successfully.
three) Electronic health-related record (EMR) vendors are positioning themselves as the details hub of clinical environments. Don’t you want to be integrated with them, in some capacity, in purchase to be productive?
MAJOREK: Of program, we would welcome integration with EMR techniques, but only if it delivers worth to the patient. Currently, most EMRs offering integration enable information to movement into their EMR, but none to movement out. How does that benefit the patient? It does not, especially if the patient has his/her overall health historical past distributed over multiple EMR programs and has no collaboration with companies across the techniques. We are hopeful that EMR businesses will present rising willingness to adjust the status quo. Of the 800 EHR systems in the nation, I hope leaders will emerge who are willing to collaborate and advocate for patient-centered overall health.
four) There are so many patient overall health portals presently obtainable that the buyer is presently confused and frustrated. How is your approach any various?
MAJOREK: Presently, EMR patient portals are linked with a distinct institution or medical professional(s). We hear from individuals that they are exhausted of repeating the very same information to several doctors who do not share the very same methods. A patient’s healthcare journey is dynamic and ever-altering. With EMR portals that act as silos for particular institutions or companies, what transpires when a patient’s condition needs a care crew that resides in several portals? MDCapsule provides the solution to this difficulty.
five) Quickly developing a income stream is clearly crucial for any new enterprise. Historically, supplier organizations have not paid for these kinds of services and the price has been passed on to the client. In the previous, this has confirmed to be an ineffective model. Why do you believe items are distinct now?
MAJOREK: With new reimbursement models trending away from fee-for-services towards an final result-primarily based model, organizations will need to invest in tools that aid encourage much better communication and better outcomes – not just within their very own organization but beyond. If your organization commences shedding money due to the inability to help care teams or comply with a lot more cost-effective care processes (like minimizing hospital readmissions), don’t you consider they will take notice?
Allow us know what you think by leaving a comment. Is MDCapule a game-changer in this space or just yet another well being portal that does not recognize the dynamics of this challenging market?
Robert J. Szczerba is the CEO of X Tech Ventures and author of the Forbes column “Rocket Science Meets Brain Surgical treatment.” Stick to him via Twitter, Facebook, or LinkedIn.
In spite of robust epidemiological evidence suggesting that HDL has a sturdy protective result towards cardiovascular disease, there has been no excellent proof showing that HDL-primarily based therapies are helpful. Huge trials of medicines that increase HDL levels, including niacin and CETP-inhibitors, have failed to show enhancements in final result. Some observers gleaned hope from numerous small scientific studies of drugs that mimic HDL activity but these research have been as well modest to supply convincing evidence. Now a new study– the biggest to ever examine an HDL mimetic– has failed to locate even a glimmer of benefit.
Final results of the CHI-SQUARE (Can HDL Infusions Substantially QUicken Atherosclerosis Regression) examine were published on the internet in the European Heart Journal. Within two weeks of having an acute coronary syndrome, 507 patients had been randomized to obtain 6 weekly infusions of either placebo or one of 3 doses of CER-001, an HDL-mimetic from Cerenis Therapeutics.
Benefits of the trial were extensively unfavorable. CER-001 had no substantial impact on atherosclerosis, as assessed by both intravascular ultrasonography (IVUS) and quantitative coronary angiography (QCA). There were also no significant distinctions in the number of individuals who had at least a single significant cardiovascular occasion.
Cerenis was apparently so shocked by the unfavorable finding that it asked for a publish-hoc re-analysis of the IVUS recordings from a separate group. The outcomes, unluckily for them, were no diverse.
I asked several cardiologists who have performed HDL research to comment on the research. They remain remarkably optimistic about the prospects of HDL.
PK Shah sent the following response:
This is a really disappointing study displaying no quick phrase results of rHDL (containing wild kind Apo A-I linked to two phospholipid carriers) infusion at doses of 3, 6, 12 mg /kg on non-culprit coronary lesion size as assessed by IVUS and QCA.
If you are a pessimist and disregard all the biological plausibility information on vascular protective effects of Apo A-I or its mutants such as Apo A-I milano proven in preclinical models and modest clinical research , you could conclude that APo A-I infusions treatment may possibly not understand its guarantee on the other hand if you are an optimist , you could make the arguments that a damaging examine could have been due to:
Not measuring plaque composition which is more very likely to adjust just before plaque dimension modifications i.e not measuring lipid core dimension and irritation that goes with it. IVUS could not be the ideal methodology.
Not deciding on the sort of patient most likely to show a change in plaque, i.e., a patient with a lipid wealthy plaque rather than any plaque without regard to its composition.
Not employing a large ample dose ( Apo Milano review in 2003 utilized 15 and 45 mg/kg /per dose even though as the dose utilised in this study were 3, 6, 12 mg/kg/dose)???
Not using enough infusions to remodel the plaque ???
The compositional attributes of the HDL mimetic utilised in this examine may possibly not be optimum HDL containing APo A-I milano, probably a obtain of perform mutant, may possibly make different final results as suggested by preclinical scientific studies carried out in our laboratory.
As a believer in HDL’s vascular protective results, I stay optimistic that, even though HDL has been a difficult nut to crack, one particular of these days we will get it right making use of the correct formulation, appropriate patient and correct dose investigation in this area need to continue till we get it correct, the simple biology is very compelling.
I asked William Boden, PI of the NIH’s AIM-Substantial trial, if it was time to write the obituary for HDL:
You have to be kidding me! The finish of what? HDL RIP? How about: RIP suboptimal examine style and trial hypotheses? I proceed to be astonished that we see nothing but pejorative commentary and noise about the death knell for the HDL hypothesis and HDL-raising therapy when, time right after time and trial after trial, we see the very same unenlightened examine style perpetuated.
What do ILLUMINATE, Dal-OUTCOMES, HPS-two THRIVE, and this CHI-SQUARE trial all have in frequent? The answer is: an unreasonable review population in which to test HDL-raising treatment. The two CETP inhibitor trials and this 1 incorporated ACS individuals who have been not pre-chosen for a profile of minimal HDL-C cholesterol. In reality, I did not see any baseline lipid worth for CHI-SQUARE. The baseline apo-B values were <80 mg/dL in two groups and had been 81 and 86 in the other 2 groups–values that would be considered “optimal” or perfect. The Apo-A1 values of >130 mg/dL are likewise typical. Consequently, we can presume that the baseline LDL-C and HDL-C had been regular, or possibly optimum. Why on earth would one assume that a patient with an HDL-C of, say, 50 mg/dL to demonstrate a reduction in coronary atherosclerosis or clinical events when you are producing a regular baseline worth super-typical with an HDL-raising intervention? Since the epidemiology of HDL-C tells us that the danger of incident CV events is both inverse and curvilinear, if the starting up HDL-C is on the flat (typical) component of the event connection, then why would a single count on that raising the HDL-C to 70 or 80 would decrease CV events?
Our latest data (from four separate sources of observational and submit hoc RCTs) recommend that baseline HDL-C <30 mg/dL could be the threshold under which one particular requirements to target HDL-Raising therapy. This is the place the event curve steepens inversely and the place one might anticipate to see an HDL-raising therapeutic advantage.
So this trial tells me practically nothing new that I haven’t witnessed in the other above trials. In our submit hoc evaluation of AIM-Substantial (admittedly only “hypothesis-generating”) an HDL-C <31 mg/dL was associated with a niacin treatment method result for the primary endpoint. This would really be the 5th information set to present that it is the extremely lower HDL-C subset that we need to target, not these “all-comers” styles where patients have typical or high HDL-C to start.
We have nevertheless to see the right trial design and style. And, of course, since the wonderful bulk of AIM-Substantial and HPS-two individuals have been getting statins for one-5 years, how can you assume, as in HPS-two, to see an incremental HDL-C raising effect when the baseline LDL-C was 63 mg/dL and the baseline HDL-C was ~47 mg/dL? Perhaps we require trials of individuals who are statin naïve, not such well-taken care of patients exactly where danger mitigation possibly cannot be attained.
The issue refers to a reduction of kidney function and can build very speedily. It can take place in individuals who are presently ill with situations such as heart failure or diabetes, and these admitted to hospital with infections.
Researchers located that acute kidney injury leads to among 15,000 and forty,000 extra deaths every 12 months.
The condition refers to a reduction of kidney perform and can develop very speedily. It can take place in men and women who are presently ill with problems this kind of as heart failure or diabetes, and those admitted to hospital with infections.
Researchers identified that acute kidney damage triggers in between 15,000 and 40,000 excess deaths each and every 12 months.
Dr Porter referred to as East Midlands Ambulance Services at one.53pm on November 5 and informed the operator his patient, who had previously suffered a stroke, necessary intravenous fluids when he arrived at hospital.
The ambulance failed to arrive, so Dr Porter dialled 999 to say it was an emergency, but the pensioner was not picked up right up until six.19pm since the dispatcher did not log the contact effectively.
When Mr Maltby ultimately arrived at the Queen’s Healthcare Centre (QMC) in Nottingham, he was admitted to Ward D57, but even more delays meant he was not offered fluids till 3.50am the following morning.
But even he was offered an intravenous drip, he was not offered the proper dose, which meant he acquired just two litres within 24 hrs as an alternative of the advised five litres.
Mr Maltby died the subsequent day on November 7 right after struggling kidney failure.
Recording a narrative verdict, Assistant Coroner Jane Gillespie condemned the healthcare personnel who handled Mr Maltby.
“These failures were far-reaching and impacted on all aspects of his care, from basic observations and recordings, to a delay in the escalation of his care and a failure to overview his problem by an appropriately senior physician when essential,” she mentioned.
“All the even though, Mr Maltby’s problem continued to deteriorate and those caring for him were oblivious to the same.
“During the time period of his admission, there had been several missed possibilities when the right treatment program could and must have been pursued. I uncover that had this been so, the end result could have been distinct.”
Speaking right after the inquest, Mr Maltby’s household criticised the medics who failed to care for their father.
“It is clear that the first reply from the ambulance services to our complaint about the delayed response to the get in touch with for an ambulance that they were ‘very busy’ was just paying lip services to their preliminary failings in this unfortunate and distressing series of events,” they mentioned in a statement.
“In his short and tragic time at the QMC, Stewart was dealt with by close to 36 men and women.
“Some have been obviously shown by the inquest to be hard-operating, committed individuals struggling in a extremely-pressured surroundings with tiny support from management in spite of direct and repeated requests for added help.
“Stewart was a character who produced us laugh with his mischievous sense of humour. He invested a lot of time caring for other individuals, typically to his personal detriment. Eighteen months on he is nevertheless very considerably missed by us all.”
Both the QMC and East Midlands Ambulance Services have apologised to the household.
Peter Homa, chief executive of Nottingham University Hospitals NHS Trust, mentioned: “We extend our condolences and reiterate our unreserved apologies to Mr Maltby’s household for the failings in our care and for letting them and their father down so badly.
“The absence of standard clinical observations, handovers among employees and failure to administer fluids appropriately meant Mr Maltby’s rapidly deteriorating issue was not acted on as it ought to have been.
“We have learnt from this unhappy and tragic situation and manufactured alterations to boost safety and outcomes for our future patients.”
A spokesman for the ambulance services extra: “The support we supplied to Mr Maltby fell brief of the large common our sufferers should assume, and we are extremely sorry about that.
“We have given that initiated a amount of changes and issued advice to all manage staff to guarantee that the exact same error can not be made when coming into bookings in potential.”
Last month, Telegraph reporters approached a centre in Luton, named the Alma Pregnancy Advisory Services (APAS), claiming to be taking into consideration an abortion.
The counsellor, named Moira, informed the reporter, “there’s also a hyperlink with breast cancer”.
The same adviser also mentioned that ladies who had terminations were 25 percent significantly less likely to be capable to carry a pregnancy to full term.
The Royal School of Obstetricians and Gynaecologists stated there was “absolutely no evidence” that women have been far more very likely to create breast cancer soon after possessing an abortion. It also described the suggestion that they were much less most likely to be capable to carry a pregnancy to total term as “absolutely wrong”.
