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9 Mayıs 2017 Salı

Patients need motivation to recover. The NHS must offer hope | Kate Allatt

Our NHS is under attack from all angles. People are living longer, we don’t eat well or exercise enough. Yet we expect more from the NHS; more people are visiting A&E departments and minor injury units year on year, and costs are rising.


How do we tackle this? What if we focus on marginal gains, the performance strategy that helped British Cycling to success in multiple Olympics?


This is an approach that focuses on “small incremental improvements in any process adding up to a significant improvement when they are all added together”. Could this improve patient outcomes and reduce waste in the health service?


One incremental enhancement we could seek in the NHS might be to improve our understanding of and response to the barriers to patient motivation. For example, could we find a way of encouraging stroke survivors to practise their rehabilitation exercises as frequently and intensively as they are prescribed? Patient adherence to rehabilitation regimes after discharge from hospital is described as “less than ideal”. By addressing these barriers, we will be more able to efficiently allocate therapy time, and thereby reduce GP appointments and hospital readmissions.


You might wonder what makes me an expert on this.




L​owering ​​patients’ expectations of ​recovery​ can be extremely damaging




In February 2010, at the age of 39, I had a huge brainstem stroke and was diagnosed with locked in syndrome. I was on life support and in intensive care for nine weeks, and was then written-offin rehabilitation after a further six weeks. My husband received a phone call telling him that I would never walk or talk again.


Over eight painstaking months in rehabilitation, I obsessively willed my body back to life, practising actions or movements 450 times per week. Slowly I learned how to do basic things like eat again, and at the end of it all I walked out of hospital. I went for a run on the first anniversary of my stroke. I’m now a motivational speaker and go to the gym every day.


[embedded content]

I never gave up pushing my body to improve: to speak, to eat, to run and to hug my kids. I managed to use my bad prognosis to galvanise my recovery, but the risk is that lowering patients’ expectations of recovery can be extremely damaging. Recovery should be measured in terms of improvements, not “getting better” – and that is always possible. My only focus, with three young children at home, was on when I would achieve my goals, not if.


Since embarking on my career in advocacy and stroke activism, I’ve found many reasons why patients lack the motivation to try to help themselves. They may be suffering from post traumatic stress disorder, which is common after a stroke and, just like depression, it affects mood and motivation levels. The side effects of the drug treatments for strokes – sleeping pills and muscle relaxants – can also affect motivation. After a brain injury many patients suffer varying levels of executive dysfunction affecting the set of mental skills that help to get things done, which can be mistaken for apathy or laziness. The overwhelming tiredness felt by those suffering from neurological fatigue can leave patients unable to complete normal daily tasks and therefore non-compliant with their treatment plans. It may be that some patients simply hate exercising or have no family support.


It is futile prescribing a stroke rehabilitation plan if – for any of these reasons – the patient is unmotivated before the therapy session starts or they are left at home trying to manage their own condition. The NHS should be offering hope and encouragement to motivate patients. And to do that, they need to listen to expert patients.


My advice to the King’s Fund Leadership Summit is that we need a better understanding of patient motivation to help rebuild the lives of stroke survivors. If patients adhere to clinical advice about practising their exercises as frequently and intensively as I did, just imagine how much we could improve their outcomes and reduce the waste in the NHS. But to do this we must understand the complex reasons why patients don’t do this already and listen to those who have struggled through similar experiences.


I don’t promise anything when I speak to people now – I just offer possibilities. I talk about how to optimise improvement, but never use the word recovery. After a life-changing event none of us will ever be the same as we were, even if we physically improve really well. We need to embrace that new self and strive to be the best version of ourselves that we can be, both in hospital and back home.


Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.



Patients need motivation to recover. The NHS must offer hope | Kate Allatt

5 Nisan 2017 Çarşamba

New Brunswick becomes first Canada province to offer free abortion pill

New Brunswick has become the first province in Canada to distribute an abortion pill for free, in a major step for a region that previously had one of the country’s strictest policies on women’s reproductive rights.


The provincial health minister, Victor Boudreau, unveiled the policy on Tuesday, announcing that women will be entitled to receive Mifegymiso without payment if they have a valid healthcare card.


“By making Mifegymiso available free of charge for all New Brunswick women, our government is ensuring that financial barriers do not stand in the way of a woman’s right to choose,” said Boudreau in a press release.


Access to publicly funded abortion in New Brunswick was restricted from the 1980s until 2015. During that period, Medicare – the country’s national heath system – would only cover an abortion at one of the province’s two approved facilities if two doctors had certified that it was necessary for medical reasons.


“It was such a strict criteria that it became very difficult to get a publicly-funded abortion,” said Beth Lyons, executive director of New Brunswick Women’s Council.


“The New Brunswick government’s offer to cover the cost of Mifegymiso is a tremendous step forward in making sure there is a real choice for women and trans people seeking abortion care,” said Sandeep Prasad, executive director of Action Canada for Sexual Health and Rights. “We were both pleased and surprised, surprised because New Brunswick is ahead of the pack, so to speak.”


Pharmacists will not be allowed to directly dispense Mifegymiso to patients: they must get a prescription from a doctor. To do that, physicians must complete training and be registered to work with the drugs.


“We do think that we’re going to see this improve access for women and trans folks in rural areas, and this could also be particularly helpful for those living in violent situations,” said Lyons. “Having those choices and being able to make the decision that’s best for them, based on their contexts, might ensure that women are more safe or their anonymity is preserved.”



New Brunswick becomes first Canada province to offer free abortion pill

New Brunswick becomes first Canada province to offer free abortion pill

New Brunswick has become the first province in Canada to distribute an abortion pill for free, in a major step for a region that previously had one of the country’s strictest policies on women’s reproductive rights.


The provincial health minister, Victor Boudreau, unveiled the policy on Tuesday, announcing that women will be entitled to receive Mifegymiso without payment if they have a valid healthcare card.


“By making Mifegymiso available free of charge for all New Brunswick women, our government is ensuring that financial barriers do not stand in the way of a woman’s right to choose,” said Boudreau in a press release.


Access to publicly funded abortion in New Brunswick was restricted from the 1980s until 2015. During that period, Medicare – the country’s national heath system – would only cover an abortion at one of the province’s two approved facilities if two doctors had certified that it was necessary for medical reasons.


“It was such a strict criteria that it became very difficult to get a publicly-funded abortion,” said Beth Lyons, executive director of New Brunswick Women’s Council.


“The New Brunswick government’s offer to cover the cost of Mifegymiso is a tremendous step forward in making sure there is a real choice for women and trans people seeking abortion care,” said Sandeep Prasad, executive director of Action Canada for Sexual Health and Rights. “We were both pleased and surprised, surprised because New Brunswick is ahead of the pack, so to speak.”


Pharmacists will not be allowed to directly dispense Mifegymiso to patients: they must get a prescription from a doctor. To do that, physicians must complete training and be registered to work with the drugs.


“We do think that we’re going to see this improve access for women and trans folks in rural areas, and this could also be particularly helpful for those living in violent situations,” said Lyons. “Having those choices and being able to make the decision that’s best for them, based on their contexts, might ensure that women are more safe or their anonymity is preserved.”



New Brunswick becomes first Canada province to offer free abortion pill

8 Mart 2017 Çarşamba

How dementia-friendly shops, offices and cities offer hope for sufferers

In coming decades, rates of dementia will rise sharply, partly due to a “silver tsunami” as the boomer generation ages and partly because we are living longer than ever. By 2030, the WHO predicts 75.6 million people globally will have the disease.


In response, cities around the world are creating communities that better help people with dementia go about their daily lives (there are more than 200 such dementia-friendly communities in England and Wales alone).


This includes engaging businesses whose customers may have or be caring for people with dementia. “Making small changes in the way businesses and communities act can transform the quality of life and the contribution those with dementia and their carers can make,” says George McNamara, policy chief at Alzheimer’s Society.


Those small changes include training companies to recognise and support people with cognitive decline. In Bruges, for example, dozens of shops are designated as dementia friendly. Select employees are trained to recognise customers with the condition, allowing them to help those struggling to pay or find what they need, for example.


In Greater Manchester, taxi drivers are also being trained as “dementia friends” who recognise and assist customers with dementia, while in London, Lord’s cricket ground has created a project to reduce stigma and raise awareness. London recently announced a goal to become the world’s first dementia-friendly capital by 2020. Key areas of focus include (pdf) working with local health authorities to improve diagnosis rates and collaborating with Transport for London to make getting around safer and easier.


“If you get it right in cities you can have a big impact on a large number of people,” says Mark Drane, a Bristol-based architect and doctoral researcher with the WHO Collaborating Centre for Healthy Urban Environments. “And a city, in theory, has the levers to pull, especially for integrated care.”


Elsewhere, banks are training employees to help people with the dementia manage their money. HSBC, for example, has joined with Alzheimer Scotland and the Alzheimer’s Society in a three-year awareness raising partnership that has so far trained 2,000 UK staff across 742 branches.


In Southampton, British Gas is training staff as “dementia champions”, who can then teach other local business people and the public about the needs of those with dementia, holding monthly drop-ins to support people with the disease and their carers, and connecting staff to volunteer and fundraising opportunities in the community.


Around 7,000 of British Gas’s 30,000 UK staff are taking part in a dementia friends programme that trains them to be more informed about the illness.


Cutting costs


In addition to their work supporting customers, British Gas and Centrica are working to support employees who face dementia-related issues in their own lives. British Gas carers’ network, for example, offers a range of support, including giving employees flexibility to attend family members’ hospital appointments.


Centrica estimates that its caregiver support initiatives (paywall) save £2m in staff retention and potential training costs, and another £4.5m in preventing absenteeism of employees who are caregivers.


A 2014 report found that dementia costs UK businesses roughly £1.6bn per year, because of carers, more than half of whom are in work, having to reduce their hours or give up their jobs to look after a relative or friend with dementia. The Alzheimer’s Association estimates dementia costs US businesses $ 61bn (pdf), more than half of which it attributes to costs to businesses – including lost productivity – related to employees providing care.


As well as saving money through supporting employees, assisting customers with dementia offers businesses an opportunity to build and maintain their customer base. Sainsbury’s and the Federation of Small Businesses are among those that joined a federal retail task and finish group, which has produced a guide (pdf) on making shops dementia friendly. This isn’t merely corporate altruism: 83% of people with memory issues have changed where they shop based on how the business caters for people with dementia, according to the Alzheimer’s Society.


While a single company can have a significant impact locally, a multi-sector approach is crucial to creating dementia-friendly cities. Care City, for example, a research, education and innovation site in north-east London, works with the technology sector to develop products such as wearable devices for those with dementia.


Through NHS England’s healthy new town programme, Care City is also working with local communities to foster innovation in their backyards. That includes everything from an online platform where patients and their carers can log information about their health to a wearable location device that alerts carers if someone with dementia leaves a designated safe space.


Many projects currently begin in the health and social care system, or are driven by charities who work with businesses. In the future, more products and services to help people live at home longer and stay safe in their communities may come from industry itself.


According to McNamara, progress is being made by businesses, among others, to help those with dementia engage with their communities but there’s work to be done to ensure these ideas spread further. “Dementia,” he says, “is everyone’s business.”


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How dementia-friendly shops, offices and cities offer hope for sufferers

6 Mart 2017 Pazartesi

NHS mental health trust to be prosecuted amid claims it failed to offer safe care

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.”



NHS mental health trust to be prosecuted amid claims it failed to offer safe care

25 Şubat 2017 Cumartesi

The NHS is struggling. Labour must offer a credible health policy

Labour’s attempt to terrify the voters of Copeland with talk of dead babies has failed. Now it needs to get serious about developing a credible health policy.


In north Cumbria the NHS faces difficult choices on maternity care. It has been struggling to maintain the support services and staffing necessary for consultant-led maternity care of acceptable quality in both Whitehaven and Carlisle. This means Whitehaven may lose its maternity service. Both staff and public are anxious about the risks.


Labour’s take during the Copeland byelection was “mothers will die, babies will die, babies will be brain-damaged”, and of course “only a vote for Labour will save our hospital”. Meanwhile, at prime minister’s questions this week, Theresa May easily swatted away Jeremy Corbyn’s latest riff on the theme of Tory NHS cuts.


The manner of Labour’s defeat in Copeland is instructive. It took the most emotionally charged line possible, on an issue of great local sensitivity, on its signature issue of the National Health Service, and lost to the government.


Yet the defeat came as evidence mounts that all three of the drivers of current NHS policy – quality and efficiency improvements under the Five Year Forward View, reconfiguration of local health systems under the Sustainability and Transformation Plan (STP) process, and devolution, are in difficulty.


An analysis of Forward View progress by Kingsley Manning, former chair of what is now NHS Digital, has concluded that “the acceptance of sub-optimal productivity is the default position for the NHS”. The STP plans will not change that, he says, because they do not see productivity as a priority.


This week’s report by the King’s Fund on STP progress highlighted the chasm between aspirations and credible delivery plans. Its authors do not believe that proposed cuts in beds will happen and see the delivery timetable for STP changes as unrealistic.


Crucially, from a Labour party perspective, the King’s Fund provides evidence that some of the current problems can be blamed on the 2012 health reforms. It points out the obsession with market forces is undermining the development of new ways of delivering services, and highlights the obvious but little discussed fact that STPs do not legally exist, so they have no authority to implement the changes they are recommending. They have been stitched together to overcome the structural chaos ushered in by Andrew Lansley.


Meanwhile, a report on health devolution by the Institute for Public Policy Research out next week will highlight the changes in accountability, commissioning, financing and regulation needed to unlock the potential of the devolution strategy.


Labour has to build a credible response to these problems. The Copeland defeat shows “save our NHS” will not be enough to save the Labour party. If it is going to demonstrate it is ready for government it will have to stop writing its health policy on a placard.


It will obviously promise more funding, but to do what? Will it have the courage to stop “saving” services and instead build community-based systems which in the long term will need fewer acute hospital beds? Will it push the NHS to face up to weaknesses in clinical productivity and back-office efficiency?


It needs to construct a proper role for the private sector in providing healthcare, rather than endlessly repeating “public sector good, private sector bad”. Companies, notably SMEs, have a critical role to play if the NHS is ever going to exploit the potential of digital to drive efficiency and quality and improve the lives of patients with long-term conditions.


Health devolution is difficult territory for Labour. Andy Burnham personifies Labour’s conflicting views, having moved from attacking the government’s devolution plans to being Labour’s candidate for Greater Manchester mayor. The party needs to decide how balance the benefits of services built around, and accountable to, local populations with its desire for equitable access across the country.


These are all big questions which the NHS is struggling to answer. Labour needs to offer its solutions.


Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.



The NHS is struggling. Labour must offer a credible health policy

14 Ocak 2017 Cumartesi

CVS to Offer 2-Pack EpiPen Alternative For $110 — a Fraction of the $600 Name-Brand Price

This article originally appeared on People.com.


CVS is stepping up to help consumers frustrated with the EpiPen’s price hike.


The drugstore chain announced Thursday that it reduced the price of an EpiPen alternative, Adrenaclick, to just $ 110 for a two-pack, compared to $ 608 for the Mylan-produced EpiPen.


“We recognized the urgent need for a less-expensive epinephrine auto-injector,” CVS says in a press release. “Patients with life-threatening allergies need immediate access to injectable epinephrine. But over time, the brand-name epinephrine auto-injector pens that make it easy to quickly and safely administer the medication have become increasingly expensive.”


The move comes just days after insurance company Cigna said it was dropping coverage for Mylan’s EpiPens. A Cigna spokesperson, Karen Eldred, applauded CVS’ decision in a statement.


“It is positive news for our customers,” said Eldred said, according to NBC News. “The generic version, available now in pharmacies, has the same drug formulation and device functionality as the branded medication, but at a substantial cost savings.”


Mylan is currently under investigation by Congress for raising the price of EpiPen by 500% since they took over production of the life-saving device in 2007. Amid the outcry, Mylan said they would introduce a generic version of the EpiPen, priced at $ 300 for a two-pack.


Mylan CEO Heather Bresch told Congress that the company “never intended” for the price of EpiPens to rise to this level, and claims the hike is due to taxes.


Mylan’s main competitor, Auvi-Q, had stopped production in 2015 because of a lack of name recognition compared to the EpiPen. The company announced in October that it would resume production, hoping to provide another epinephrine auto-injector at an affordable price.


“This is personal for us,” Eric Edwards, who created the Auvi-Q with his twin brother after growing up with severe allergies to nuts, eggs and shellfish, told Forbes. “I’m a patient who may have to respond with this product not only for myself but for my child, and we are committed to making sure that Auvi-Q is going to work during an allergic emergency.”




CVS to Offer 2-Pack EpiPen Alternative For $110 — a Fraction of the $600 Name-Brand Price

21 Kasım 2016 Pazartesi

Scotland’s offer to give abortions to Northern Irish women shames Stormont | Patrick Corrigan

Scotland and Northern Ireland are separated by just a few short miles of sea. But when it comes to access to abortion, they are divided by more than 150 years of history. While Scots women are able to access abortions on the same basis as their counterparts in England and Wales, Northern Irish women still face a near-total ban on the termination of pregnancy.


In 2014-15, only 16 women were able to have lawful abortions in Northern Ireland. By contrast, 833 Ulster women travelled to England or Wales and paid for terminations at private clinics. And despite being full and equal taxpayers, Northern Ireland-resident women have been barred from accessing free abortions in NHS hospitals in England, Wales and Scotland.


It was into this breach that Scotland’s first minister, Nicola Sturgeon, stepped last week when she told the Scottish parliament that she would explore the possibility of women and girls from Northern Ireland being able to access terminations through NHS Scotland. Her intervention has enraged the deeply conservative Democratic Unionist party (DUP), Northern Ireland’s largest party of government, but been welcomed by pro-choice and human rights campaigners in the region.


While healthcare has been a devolved matter in Scotland since the creation of the Scottish parliament, it was only in May this year that abortion law was handed over to Holyrood. It is against this backdrop that Sturgeon’s intervention has demonstrated leadership on behalf of Northern Irish women sorely lacking both at Stormont and Westminster. There is near unanimous support in the Holyrood parliament for keeping abortion provision for Scotland in line with the 1967 Abortion Act. The picture couldn’t be more different across the water.


As recently as February this year, the Northern Ireland assembly voted to keep the region’s abortion law as it is, refusing to legislate for abortion even in cases of rape, incest, or where the foetus has no chance of survival outside the womb. This was despite a Belfast high court finding, just two months previously, that Northern Ireland law breaches the European convention on human rights.


Meanwhile, the UK health secretary Jeremy Hunt has determined that the NHS in England must operate a residence-based system so that women who live in Northern Ireland are barred from accessing NHS abortion services in England, despite being UK citizens. This position is currently the subject of a legal challenge at the UK supreme court taken by a Northern Ireland teenager and her mother. They want women and girls from Northern Ireland to receive free abortions on the NHS in England.


The young woman at the centre of the case was 15 in 2012 when she and her mother travelled from Northern Ireland to Manchester and were asked to pay for a private termination. It is estimated that, with private clinic charges as well as the cost of travel and accommodation, a Northern Ireland woman needs to find anything between £400 and £2,000 to obtain a lawful abortion across the water in Britain – NHS care available for free to women in every other part of the UK.




Northern Ireland’s politicians are being left behind by the people




Stephen Cragg, who is acting as QC for the mother and daughter, told the supreme court at a hearing earlier this month that women and girls like his client are “second-class citizens” who “live in the UK, but – unlike all other women and girls in the UK – they are at risk of the most serious criminal penalty if they procure an abortion in their own area”.


In Northern Ireland, any woman or girl who has an abortion deemed unlawful is liable for prosecution and could face a sentence of up to life imprisonment. Earlier this year a woman who had induced her own miscarriage by taking abortion pills obtained over the internet was found guilty under the 1861 Offences Against the Person Act and given a three-month suspended sentence. There are a number of other similar cases poised to come before the courts in Northern Ireland, including the prosecution of a mother who obtained the pills on behalf of her pregnant teenage daughter.


Despite all this, a majority of Northern Ireland’s politicians have set their face against reform. Comfortable in their self-designation as “pro-life”, they appear to be immune to criticism – even from the UN, whose human rights committee recently ruled that this part of the UK’s laws prohibiting and criminalising abortion constitute a human rights violation.


But, increasingly, Northern Ireland’s politicians are being left behind by the people. Independent polling published recently by Amnesty International showed that seven in 10 people want to see Northern Ireland’s harsh abortion laws changed, while more than half want to see abortion decriminalised altogether. The tens of thousands of people who are calling for abortion to be decriminalised also speak to that shift.


Sturgeon’s offer of possible help to Northern Irish women and girls should be a matter of deep embarrassment to ministers in Northern Ireland. Theresa May should match Sturgeon’s offer to stand up for Northern Irish women abandoned by their own politicians. When it comes to the human right to healthcare, lines on a map should be no barrier.



Scotland’s offer to give abortions to Northern Irish women shames Stormont | Patrick Corrigan

22 Eylül 2016 Perşembe

Mylan to Offer Generic EpiPen

MONDAY, Aug. 29, 2016 — A cheaper generic version of the emergency allergy treatment EpiPen will be made available within the next few weeks, manufacturer Mylan said Monday.


In the wake of mounting criticism over recent price hikes, the company said the generic version will be distributed by its U.S. subsidiary. It will have a list price of $ 300 for a two-pack, compared with $ 608 for the brand-name version. The generic version will be available in both 0.15 milligram (mg) and 0.30 mg strengths, the Associated Press reported.


EpiPens are used to treat anaphylaxis — a severe, potentially fatal allergic reaction to insect bites and foods like nuts and eggs.


The auto-injection device, which contains the hormone epinephrine, expires after a year. Since most users need several — one for home, and one for school or work, for example — the costs can mount up.


With just one competitor, Mylan has a near monopoly on the device. Now, the company is being accused of price gouging after significantly increasing the EpiPen price in recent years.


The list price for the pack of two was a little more than $ 100 when Mylan first bought the device in 2007. Most of the increase — from $ 265 to more than $ 600 — has come in the last three years, The New York Times reported.


Health insurance doesn’t necessarily help all people who need EpiPens, because those with high deductibles must pay almost the total price.


Some politicians have called for: Congressional hearings on the escalating pricing, an investigation by the Federal Trade Commission, and action by the U.S. Food and Drug Administration to increase competition by hastening approvals of competitors’ products, the AP reported.


EpiPens have been marketed since the 1980s, and some observers have also questioned why Mylan still holds a patent. The patent applies to the device itself, not the active ingredient.


At least two companies are seeking approval to sell a rival brand or generic version of EpiPen in the United States, but none are likely to be available until later next year.


However, the compounding pharmacy Imprimis Pharmaceuticals said it may have a version available for individual patients in a few months. It said it would likely charge about $ 100 for two injectors, the AP reported.


More information


The American Academy of Pediatrics has more about treating anaphylaxis.



Mylan to Offer Generic EpiPen

30 Haziran 2014 Pazartesi

Rupert Everett: "Offer me a line of coke, and I would take it"

“There’s a total side of my organization now which clicks its fingers for globe peace and equal rights. Film stars and directors and studios invest a great deal of cash promoting human rights and becoming charitable in Africa but, in fact, in their own backyard, they really don’t accept that any of these things is taking place. So men and women largely explained to me: ‘Oh, but you’ve been so tough and you have blown every thing for oneself, you have sabotaged your personal profession.’ To a certain extent, it’s accurate, but to a specified extent, it is not. There is only a specific quantity of mileage you can make, as a younger pretender, as a major guy, as a homosexual. There just is not really far you can go.”


Everett was born in Norfolk and was brought up and educated as a Catholic – “I was fed it like a foie gras goose,” he says. His father was an Army key and Rupert was taught by Benedictine monks at Ampleforth in Yorkshire. He took on the girls’ components in school plays but he was otherwise very bored. “Once I knew I desired to be an actor, I just wished to get out as swiftly as achievable.” He left for London at 15. “That’s when everything exploded for me in general.”


He lodged with a family members and studied at an A-degree school but “discovered everything else”. He lived in a “very gay area” and frequented two pubs in distinct. “I basically invested my lifestyle there and going to clubs.” Right after getting dismissed from acting school, Everett was accepted at the Glasgow Citizens Theatre. He acquired his huge break as a gay schoolboy opposite Kenneth Branagh in Another Nation at the Greenwich Theatre. It transferred to the West End and became a film.


Rupert Everett, over left, with Colin Firth in ‘Another Country’ (1984)


It was, he believes, at the age of “about three”, that Everett determined he could act. “I desired to be an actress. I loved curtains. We had a huge pair with pulleys at my grandparents’ property. Swishing curtains inspired me first, being behind them and the audience in front.” He thought he would like being looked at, but says he really feels quite embarrassed. He by no means, he maintains, managed to pull off the relaxed look on Hollywood chat demonstrates. “I was so uptight.” He invested hours in his bedroom imagining the noise of camera shutters photographing him, but the reality was different. “Whenever that occurred, I felt amazingly uneasy. That is possibly partly to do with the truth that the entire beginning of my job was when Aids happened.


“Aids in the Eighties was a really, extremely scary point. There were men and women walking all around with the condition that looked like the undead. Terrifying. I spent the first 6 many years of my job contemplating that any minute now I would almost certainly come out with it. The first 10 many years of my job were carried out with this interior hysteria of terror. In one particular sense, it created almost everything unpleasant. With each lens, I was asking yourself if they had been going in also tight on what I may be hiding. I was very fortunate, considering my very sluttish behaviour, never to get HIV. But I constantly thought I had it. I can appear at movies I’ve been in and see in my face this sheer terror.”


When I inquire Everett to describe the excitement of Hollywood accomplishment, he is modest. “I never ever was quite significantly of 1.” But he concedes, “After My Best Friend’s Wedding [with Julia Roberts], for a time I was quite, really profitable.” Even that, although, wasn’t satisfying. “As quickly as it’s occurred, you just want more. You require some thing else. Something’s incorrect. You want to preserve consolidating.”


Fame is, he says, extremely addictive. “You get so a lot of items provided to you and you get them for granted virtually straight away. Acquiring into eating places. Obtaining people be wonderful to you on the bus. You think that is how absolutely everyone is to everybody.” But his accomplishment hasn’t been consistent. “One of the excellent things about mine is that it’s been so cyclical, I’ve often been so up 1 minute and then so down. I learnt pretty speedily there was no stage going on with ‘successful me’ when I was currently being a failure. I discovered how to move into ‘humble me’.”


Hollywood stopped calling, but Everett has manufactured a success the two of creating – his initial memoir “changed his life” and gave him a “whole new vista” – and he has also won admirers on the British stage. “I truly feel really lucky to have the theatre, since motion pictures dried up for me. After my Hollywood career – from 1998 to, say, 2004 – I actually hardly ever acquired a task.” Is he enjoying it? “I’ve in no way approached perform with an enjoyment factor, precisely, simply because it is very scary and you’re often dealing with failure inside your head. Although, definitely, now, I uncover it miraculous to be undertaking any kind of perform. So in that sense, I take pleasure in it much more. But you do wake up in the middle of the evening in a muck sweat, wondering if you are ever going to be capable to pull it off and contemplating: ‘Why aren’t I just on vacation?’ Every thing prospects in direction of a initial night or a premiere. A complete group of folks coming to judge it and one more group coming to take pleasure in it. That is the sword hanging in excess of you.”


Everett is “probably fairly irritating” to operate with. “I’m not extremely rapidly. Josh [McGuire] and Jessie [Buckley] – his co-stars in Amadeus – are both spellbinding actors. I’m like Windows two in contrast to their agility in a rehearsal area. I’m so considerably far more complex and coiled. It will take me the entire rehearsal period to get to the beginning of my efficiency. It could be to do with baggage, but I believe even when I was younger it took me a long time. I was always a extremely challenging performer. I am a really limited actor. There is a particular quantity I can do and that is it.”


When he’s not operating or travelling, Everett is “mostly at residence viewing telly, performing nothing”. It is hardly the way of life of the red carpet and hanging out with Madonna after ascribed to him. “I was buddies with her [she reportedly stopped speaking to him soon after comments he made about her in his memoirs] but… I was usually perceived as having a very A-listy life, which I didn’t truly. I did have a couple of A-listy close friends, but I wasn’t on a circuit that was constantly that.”


Everett drinks “like a fish, normally” and has begun to make use of his kitchen. “Up till 50, I was out for each and every meal from the age of possibly 22, and never ever cooked.” He has, he says, stopped taking drugs, but how significantly, I wonder, did he used to do? “I was usually very lucky. I was also vain to get into that a lot problems. I had this quite middle-class function ethic that held me back at the last minute from going on and on and on. Proper up until finally I turned 50, I took, I suppose, what most men and women would contemplate a great deal. But by a drug taker’s point of view, I actually was very conservative.


“I’m nevertheless possibly not in the position to say ‘no’. If you acquired out a gram of coke now and offered me a line, I’m positive I’d take one particular. But I wouldn’t seek out one particular out and I know it’s not going to get me any area a lot. Weed, which I adore, I had to quit smoking, if only for finding out Amadeus.” Did he ever consider heroin? “Yes, tons.” How did he stay away from addiction? “Because it made me really, extremely sick, usually.”


Everett has long since rejected the religion of his mother and father, but has “great admiration” for the story of Jesus.


St Paul, he says, need to be attempted at the Hague. What about his street-to-Damascus moment, I counter? “The blinding flash for St Paul was the ker-ching of the money register. He knew he was ready to genuinely make one thing of this person.”


Everett lost his father in 2009 but feels he still has a connection with him. “I do not know why or how, but I do really feel with numerous folks some variety of ongoing connection. Perhaps it is just a connection with memory.”


Past the dread of failure, what scares Everett these days? “Everything. Paying out the payments is scary. Maintaining going is scary. You cannot look forward to quite considerably entertaining as an previous man or woman in 2030.” Is he still vain? “Not so much now. I want to be taken care of with a specified respect. That is a vanity. I’m not vain about the way I seem, particularly.” At first, he bats away my question about regardless of whether he’s had work accomplished but later on agrees to speak about it. He has his personal blood injected into his face each 4 months.


“They put it by way of a Magimix, turn it into plasma and inject it back in. It’s truly good for your skin. Blood is the new point. What you genuinely want to have, if you’re rich, is a person with your blood group working large up in the mountains all day long and sending you down their blood, deliciously oxygenated, which you can inject in a variety of elements of your physique. I’d advise you to inject the entire of your encounter with blood – it will make it appear radiant. Then I would have a tiny bit of laser, which is very good for tightening.”


Rupert Everett has invested much of his existence enjoying other men and women. Understanding the guy himself is challenging. He is, he says, challenging. “Very. Yes. I can get sulky even now.”


Broadly, he says, he enjoys his life extremely much. But the angst hasn’t gone away. “I still come to feel frustrated. I still want far more than I have. But at the very same time I also truly feel very satisfied to be so fortunate and to have always been.”


You can download the audio interview, thirty Minutes with Rupert Everett, free of charge. Pay a visit to telegraph.co.uk/ruperteverett


‘Amadeus’ opens in the newly redeveloped Chichester Festival Theatre on July 18. www.cft.org.uk



Rupert Everett: "Offer me a line of coke, and I would take it"

16 Haziran 2014 Pazartesi

Nurses" leader to members: do not strike over pay offer lobby your MP instead

A female nurse in white uniform helps an elderly patient

‘If you are a nurse, striking indicates abandoning your sufferers,’ Dr Peter Carter advised RCN representatives. Photograph: Alamy




The leader of Britain’s nurses has urged them not to strike above the government’s “insulting” spend provide and advised alternatively they target MPs with marginal seats to consider to force the overall health secretary, Jeremy Hunt, into a rethink.


Nurses would not be justified in taking action, which would be “abandoning” their sufferers, in spite of their rightful deep anger above currently being denied a 1% payrise, Dr Peter Carter, basic secretary of the Royal University of Nursing (RCN), told its yearly congress.


Carter combined a strongly worded assault on Hunt’s “blatantly unfair” determination to reject the NHS spend overview body’s recommendation of a 1% rise for all the NHS’s 1.35 million personnel in England with a heartfelt plea not to walk out in protest.


“I know you’re angry. But nonetheless insulting this government’s pay settlement is, and even so tough that tends to make issues for you, you do want to believe meticulously about any speak of strike action. But if you are a nurse, it implies abandoning your sufferers: leaving individuals babies in the neonatal unit, cancelling that visit to an elderly patient in the local community, strolling out of the emergency department or psychiatric ward,” he advised the four,000 representatives of the RCN’s 400,000 members gathered in Liverpool.


Carter’s intervention comes as other wellness unions – which includes Unison, Unite, the Royal College of Midwives and the GMB – put together either to ballot their members or seek the advice of them about a potential ballot above industrial action brief of and such as a strike. Unions are incensed at Hunt’s determination that only some NHS workers need to get the one% rise, with other individuals missing out due to the fact they currently get boosts to their cash flow by means of the NHS’s extended-established method of yearly shell out increments primarily based on someone’s skills and experience.


Alternatively of striking, nurses should inquire their MP regardless of whether he or she supports nurses obtaining the spend rise and use their electoral muscle – and that of their buddies and relatives – to punish individuals who do not at the ballot box subsequent Could, Carter mentioned.


“There are numerous MPs on all sides of the Residence of Commons that have small majorities, some just a couple of hundred, some even as lower as thirty or 40. There are about one,000 nurses in each and every constituency and if we mobilise ourselves I know that a lot of of people MPs will be seeking in excess of their shoulders and wondering if they will be re-elected at the basic election up coming yr.”


He mentioned nurses should seek to establish the views of all MPs, but afterwards conceded that these occupying the forty most marginal seats could be most well worth pursuing. He advised that nurses target Conservative and Liberal Democrat MPs in the coming months as a way of pressuring Hunt to alter his mind.


Offered the latest volatility of politics given that Ukip’s emergence, even MPs with a majority of 2,000 or three,000, who would previously have been regarded safe, may be vulnerable to organised strain, he mentioned. “Now is the time to flush them [all MPs] out to say in which they are standing on well being workers’ salaries,” he additional.


Hunt should not turn into complacent about staff’s deep emotions about NHS spend or “trade” on the reality that he believed nurses should keep away from strike action.


Carter’s phone probably poses a dilemma for NHS unions, which are arranging to consider combined industrial action, if their ballots endorse that. Their present considering is to deploy an overtime ban as an preliminary tactic as a demonstrate of power some time this autumn.




Nurses" leader to members: do not strike over pay offer lobby your MP instead

31 Mayıs 2014 Cumartesi

Poland"s healthcare tourism clinics offer you half-value treatment method to the planet

The services would make any NHS manager envious. The medical doctors are experts with globe-class achievement charges. The costs are often half what you’d pay at property. Why, then, are a lot more of us not travelling to Poland to have routine health care treatments carried out?


For many many years expat Poles have been returning property to get costly dental perform, plastic surgical procedure and procedures this kind of as hip replacements carried out at 30% to 60% of the expense they would pay in their adopted country.


Now a Polish government-backed initiative is advertising medical tourism into the nation, targeting non-Poles from across the globe, especially people in Scandinavia, Germany, eastern Europe – and the United kingdom. These behind the plan hope Poland’s location at the heart of Europe – along with its plethora of reduced-cost flights, low-cost accommodation, and desirable tourist cities such as Krakow – will be enough to tip the more and more competitive battle for health-related tourism in Poland’s favour.


The EU directive that came into force final yr giving buyers the correct to use overall health services in other European countries will only more its bid to turn into the health care tourism centre of Europe, officials hope.


At the really swish Dentestetica dental clinic on the outskirts of Krakow, one particular of the owners, Dr Krzysztof Gonczowski, tells his multilingual staff that their mission is to “drill, fill, and bill”. He has designed a one-quit-store company model that other Polish clinics are increasingly adopting.


His clinic is packed with the extremely most current products that can make your correspondent’s Hertfordshire NHS dentist search like one thing out of the dark ages – products, says Gonczowski, that permits his workers to provide the most sophisticated procedures in a five-day window. Customers from abroad usually save £2,500, creating the £100 Ryanair flight seem like an incidental expense.


“We offer clientele the comprehensive package deal – we pick them up at the airport and they can stay in our apartments up coming to the clinic,” he says. “They can pay a visit to the beautiful city of Krakow although obtaining their treatment method done by staff, who are absolute professionals in their discipline. The therapy prepare is made to match fully close to the consumer.”


Implants that cost close to £2,500 in the United kingdom can be had at Dentestetica for under £1,000, while ceramic veneers are half the £600 United kingdom cost.


Maciej Szarek, a economic adviser who has lived in Edinburgh for 12 years, was going to last week and programs to return to the clinic later on in the year to have his problematic wisdom teeth eliminated: he expects to shell out half the Uk expense for the treatment, which will need the elimination of element of his jaw.


“My regional clinic in Edinburgh is fine for schedule work, and the personnel are wonderful, but you just have to seem at the facilities right here – it really is like yet another globe. And financially it makes every sense.”


At the occupied Carolina Healthcare Centre, a 3-hour train ride away in Warsaw, Adam Tarnawski displays off the clinic’s state-of-the-art MRI scanner, which has aided to make the centre – owned by Bupa – the go-to facility for the nation’s skilled athletes.


The site specialises in treating anterior cruciate ligament injuries, which have ended a lot of footballers’ careers, and carried out 266 knee surgeries and 60 hip replacement final year. It will normally deal with victims for close to a third of the UK’s private treatment price, but, in spite of that, Tarnawski is not keen to concentrate on the price tag.


“We are all about delivering the highest-top quality remedy, which also transpires to be at a decrease price,” he says. If you want the lowest costs you will usually uncover other clinics that will charge much less. Our aim is to give the best top quality – but with savings.”


Across Warsaw at the Swedish-owned Medicover centre – recently named Polish international hospital of the yr – the services are even a lot more plush, but there is curious absence of patients. The French managing director and other executives make a excellent perform of how they have started out benchmarking the 180-bed facility against the very best US hospitals, to “drive requirements to the highest level they can perhaps be”. Their reduced infection charges, they say, are tremendously assisted by the fact that hospital is under 5 years previous and was function-built to be straightforward to clean. So far most of their non-Polish clients have largely come from Norway and Sweden.


In accordance to Magdalena Rutkowska, who heads Poland’s medical tourism growth programme, which is 75% funded by EU cash, around 320,000 individuals visited the country for treatment in 2012 – of which 42% came for plastic surgery, notably breast implants. A third came to use dentists, even though 9% came for obesity-connected therapies this kind of as gastric bands, which in Poland usually price forty% of the €10,000 EU regular.


“We realize that people have outdated pictures of Polish health-related amenities but we are here to say we now have world-class facilities,” she says.


“It amazes me that folks can be asked to shell out $ one hundred,000 for heart bypass surgical treatment in the US, but they can fly nine hours to us, they can have as good or far better remedy, and pay out just $ 15,000.”


She says success charges at Poland’s Bocian IVF clinic are 10% greater than rivals in Spain, Germany and in the Uk. IVF, which can be ruinously costly in Britain, expenses between €2,000 and €3,000 per cycle – all around a third of the value of the less costly Uk suppliers.


Across the country clinics are becoming developed, even though Rutkowska admits that locating clientele will be tough as nations all around the world vie to grab healthcare tourism bucks. Turkey is moving quickly into this arena, and there is previously competition from India, Thailand, Malaysia and Lithuania. As a end result her subsequent target is Uk health-related insurance firms, which have so far been reluctant to get involved. In July she is foremost a trade mission to London in a bid to persuade insurers to supply Poland as a location.


The writer travelled as a guest of Polandmedical tourism.com



Poland"s healthcare tourism clinics offer you half-value treatment method to the planet

27 Nisan 2014 Pazar

Hospitals in England failing to offer secure care have tripled, says Labour

Shadow health secretary Andy Burnham

Shadow health secretary Andy Burnham mentioned the figures were indisputable proof that the NHS was ‘heading critically downhill on this government’s watch’. Photograph: David Gadd/Allstar/Sportsphoto Ltd




Labour has released figures showing a threefold boost in the variety of hospitals in England criticised by the Care Quality Commission for not supplying safe care.


Labour mentioned that in the 12 months to March 2014 the CQC recognized 45 hospitals failing on the measure of delivering “secure and appropriate care”. Above the exact same period in the prior year only sixteen hospitals failed on this measure.


People 45 hospitals represented close to 20% of those inspected, Labour explained.


The party also explained that the number of hospitals criticised by the CQC for not possessing satisfactory numbers of employees had also elevated, from 14 to 32, in excess of the exact same period.


Andy Burnham, the shadow health secretary, mentioned the figures had been indisputable evidence that the NHS was “heading seriously downhill on this government’s observe”.


He also said: “What we are now seeing are the consequences of David Cameron’s disastrous selection to destabilise he NHS with an undesirable and unnecessary reorganisation.”


But the wellness secretary Jeremy Hunt stated that the figures were indicative of the government’s choice to make hospital inspections more rigorous: “Labour made the disastrous choice to abolish expert led inspections which we have now reversed. Inevitably when you impose a much more rigorous inspection regime you uncover far more difficulties but it is in the best interests of patients to acknowledge exactly where there is poor care alternatively of trying to cover it up.”


The row erupted after Hunt used an interview with the BBC’s Andrew Marr display to all but confirm that a potential Conservative government would proceed to ringfence NHS spending.


Asked if the policy of NHS ringfencing would proceed beyond 2015, Hunt stated: “We have currently shown our instincts on that, if I can put it that way, by continuing to protect the NHS spending budget into the following monetary year [2015-sixteen].


“I consider David Cameron and George Osborne are passionate about creating confident the NHS continues to deliver for the British men and women and they comprehend the pressures it is underneath.”


On the programme, Hunt also announced that the government was setting a central procurement checklist for the NHS to allow hospitals to make financial savings via the bulk buy of ordinary things of tools.


“Hospitals spend also a lot for some of the simple goods and services. That drives them mad,” Hunt said.


At the moment hospitals negotiate costs individually for products they require. Underneath the new technique, the NHS will negotiate centrally with suppliers.


The Department for Overall health estimates the move will conserve the NHS £500m by the end of 2015-6. It is component of a wider try to safe procurement financial savings in the NHS which will also see the appointment of a “procurement tsar”.


Hunt gave the example of paying on sterile surgical gloves and said hospitals could conserve up to 38% on the price they paid for the item if they switched from the industry leader to an alternative supplier.




Hospitals in England failing to offer secure care have tripled, says Labour

13 Nisan 2014 Pazar

Doctors" surgeries to offer out-of-hrs appointments and Skype checkups

Doctor issuing medication to patient

The scheme will give funding for more personalised care for 800,000 elderly and vulnerable individuals. Photograph: Alamy




1 in ten surgeries are to offer sufferers the selection of seeing a GP at evenings and weekends, reserving appointments on the web, getting electronic prescriptions and having checkups more than Skype, David Cameron will say on Monday.


The prime minister unveiled the £50m scheme in October amid fears that also many men and women are turning up to A&ampE when they can not get appointments with their GP, placing too much strain on emergency departments.


Medical professionals have been invited to apply for funding, and demand for the money indicates seven million patients at far more than 1,a hundred practices – rather than the 500,000 sufferers envisaged – will benefit from the trials from up coming month.


Nonetheless, Labour raised concerns that the vast majority of folks nevertheless have unacceptably lengthy waits to see their GP because the government eliminated a requirement for individuals to be noticed within 48 hrs.


Andy Burnham, the shadow well being secretary, mentioned it had become a lot tougher to get a GP appointment under the coalition.


“The big difficulty with this new strategy is that it will not benefit hundreds of thousands of people,” he stated.


“For the huge bulk who are outdoors of this scheme, items will carry on acquiring worse and they are being told to assume to wait a week for a GP appointment.


“No wonder more and far more individuals are turning to A&ampE, which has just had its worst year in a decade.”


Beneath the ideas, a lot more surgeries will offer seven-day opening and 8am-8pm appointments. There will also be greater use of Skype, email and telephone consultations for those who would uncover it easier.


There will also be funding for more personalised care for 800,000 older and vulnerable individuals, who will get a lot more assist, a named GP responsible for their care and very same-day access to a GP when they need it.


Cameron will say: “Back in October, I said I wanted to make it less complicated for folks to get appointments that fit in all around a hectic doing work week and loved ones commitments.


“There has been a fantastic response from doctors, with plenty of innovative suggestions, and we will now see more than seven million sufferers provided weekend and evening opening hrs, alongside a lot more accessibility to their family members medical doctor on the mobile phone, by means of e mail or even Skype.”


Simon Stevens, chief executive of NHS England, said the plans would assist totally free household medical doctors to spend much more time with their sickest patients.


Dr Chaand Nagpaul, chairman of the British Healthcare Association’s GP committee, explained the government should be cautious that additional accessibility to surgeries is not supplied at the cost of availability for the most vulnerable.


He additional: “Outside of individuals signed up to the pilot, there will even now be close to seven,000 GP practices across the country who will not be obtaining extra support to improve patient entry or keep existing solutions. Furthermore, given that this funding is only for a single yr, there is no assurance of these changes becoming reasonably priced in potential many years.”




Doctors" surgeries to offer out-of-hrs appointments and Skype checkups

25 Şubat 2014 Salı

Angela Merkel ready to offer Britain limited EU opt-outs

David Cameron Angela Merkel

Angela Merkel is believed to be inclined to grant ‘limited opt-outs’ to David Cameron’s government. Photograph: Sean Gallup/Getty Photos




Angela Merkel is prepared to grant David Cameron specific assurances in a revised EU treaty to ensure that the interests of Britain and other non-euro members are protected in the European single market place.


In a sign of the lengths the German chancellor is prepared to go to to make sure Britain stays in the EU, authoritative sources in Berlin say Merkel is also ready to grant “constrained opt-outs” to Britain and to ensure that EU regulations are enforced in a far more flexible way.


1 senior figure in Berlin has raised the prospect of providing the NHS an opt-out from the functioning time directive – a contentious measure criticised by Eurosceptics – which gives workers a series of rights.


The thinking amid senior figures in Berlin has emerged on the eve of a go to to Britain by Merkel on Thursday in which the German chancellor will meet the Queen, address a joint session of parliament and hold separate meetings with the leaders of the 3 main political events.


Downing Street believes Merkel will be the pivotal EU figure if Cameron wins the 2015 basic election and embarks on a renegotiation of Britain’s EU membership terms just before a referendum by the end of 2017.


The Foreign Workplace is advising Downing Street not to shed sight of the truth that Britain will need to have the agreement of all other 27 EU leaders if it is to attain a favourable revision of the Lisbon treaty. One source said: “There is perhaps also much optimism emanating from No ten. We have to be a quite difficult-headed about this and bear in thoughts that the bedrock of the EU is the Franco-German partnership. There is only so far the Germans will go. We should be generating a significantly greater energy with the French.”


Senior figures in Berlin have outlined a series of concessions they would be prepared to grant Britain to help the prime minister win a referendum campaign. They say Merkel believes new governance arrangements for the eurozone will have to be launched in “targeted” treaty change. This would go past a simple “simplified revision procedure” but would fall brief of a full “inter-governmental conference” modify that would take at least five many years.


The prime minister regards treaty change as vital because it would hand Britain, which would have a veto, a likelihood to table its demands.


One particular senior Berlin official said: “Cameron’s assumption that there will be treaty modify is almost definitely appropriate. I am assured that a number of legal routes exist to get by way of adjustments in treaties, based on political constellations. We are not speaking about rewriting the treaties but making targeted changes or submitting an addendum. It may lengthen beyond a limited treaty revision under the simplified revision process (on the model of the treaty facilitating the establishment of the European Stability Mechanism) but Germany does not want a basic treaty revision.”


The considering in Berlin is outlined in a paper drawn up by the City of London Corporation and the Policy Network thinktank. Officials advised the authors of the paper that Berlin is ready to countenance offering:


• Assurances that Britain and the nine other EU members outside the euro will not be outvoted when guidelines are drawn up for the single market place, which covers all 28 members. Cameron has voiced fears that the non-euro members could fall victim to “caucusing” by the 18 members of the euro because the guidelines of the single marketplace are made the decision by “experienced majority voting” in which no member state has a veto. One particular senior official is quoted as saying: “Germany is sympathetic to British demand for assurances of non-discrimination in single industry provided eurozone integration. Even so this can not extend to a reversion to unanimity above fiscal services regulation. […] In negotiations on a new treaty, I could see the inclusion of a new clause to safeguard the United kingdom against discrimination as a euro out.”


• Limited opt-outs for Britain, even though these would fall quick of repatriation of powers. A single idea is the NHS exemption from the EU’s operating time directive. British workers can opt out of the 48-hour doing work week but other demands in the directive, this kind of as holidays and rest breaks, are mandatory.


• The implementation of EU regulations in a much less intrusive and prescriptive way. This would apply across the EU and would be designed to meet British considerations that EU regulations fail to get account of the considerations of businesses.


A senior Berlin government adviser is quoted in the paper as saying: “There is also a lot life style regulation coming out of Brussels. It is critical that the EU seems at its core organization in instances of crisis and does no matter what it can to advertise financial growth. Germany might be ready to countenance the abrogation of some secondary legislation.”


1 senior Whitehall figure mentioned that Merkel was keen to aid Cameron but there were lines she would not cross. The source said: “Angela Merkel wants Britain to keep in the EU and desires to do what she is able to do to assist with that. But she is not simply going to throw over key German interests and that contains the stability of the euro.


“Merkel and Cameron have a shared vision about the existential economic challenge dealing with Europe as a total – the want for competitiveness, to see the emerging economies as an chance as well as a challenge. She regards Cameron as one particular of the few European leaders who will get that. It is correct she needs us in since of where the stability of the financial argument lies and also due to the fact a British exit would damage the EU in the eyes of the world beyond.”


But Sir Menzies Campbell, the former leader of the Liberal Democrats, mentioned the Tories were incorrect to feel Merkel would be ready to grant significant concessions. Campbell stated: “Any individual who believes that Merkel, who is following all the leader of a coalition, is going to come to London with the sort of agenda that would satisfy the most rabid anti-Europeans in the Conservative celebration has acquired yet another think coming. Germany and France have been the engine room of the EU, typically resentful of the truth that Britain appeared from time to time to be disconnected. Why need to Merkel offer some kind of unique romantic relationship for the United kingdom underneath a Tory celebration which embarrassed her by leaving the European People’s party [in the European parliament] as quickly as the 2010 election was in excess of?”


David Cameron and Angela Merkel have forged this kind of a robust bond in recent years that aides like to debate the precise moment when they clicked.


There was the time when they went for a walk minus aides, accompanied just by their security detail, up Coombe Hill close to the prime minister’s nation residence in Chequers in the Chilterns in the autumn of 2010.


Then there was the box set of Midsomer Murders DVDs Cameron handed to the German chancellor at the end of the Chequers weekend soon after they had spent hrs watching Merkel’s favourite detective drama.


Others say it is crucial not to fail to remember the prime minister’s go to, accompanied by his wife and children, to the German equivalent of Chequers at Schloss Meseberg in April last year. Merkel is explained to have been especially attentive to the Cameron kids.


The strength of their bond exhibits that the two leaders have come a long way given that Cameron announced throughout the Tory leadership contest in 2005 that he would take his celebration out of the primary centre proper grouping in the European parliament.


Even prior to his appointment as prime minister in 2010 Cameron worked tough to rebuild relations with Merkel who now regards him as a “naughty nephew”, 1 No ten source advised the Mail on Sunday.


Cameron calculated that he would be unable to obtain considerably in Europe without having the assistance of the leader of the EU’s greatest nation and economic climate. Merkel was encouraged by Cameron’s fairly constructive approach towards the EU after he became prime minister.


But their relations suffered a blow at the finish of 2011 when Cameron vetoed a fiscal compact for the eurozone, forcing the eurozone members to agree a separate treaty outdoors the architecture of the EU. The fallout from that row, which prompted fears in the German chancellery that Britain could leave the EU, ended up strengthening their partnership. Merkel advised Cameron in the run up to his main speech on Britain and the EU in January last 12 months to argue in favour of reform across the EU. She said that would be the best way of developing a consensus across the EU.


The German chancellor is established to see Britain continue to be in the EU. But the Foreign Workplace has warned Cameron to bear in thoughts that any German chancellor will also place Berlin’s relationship with France very first. Nicholas Watt




Angela Merkel ready to offer Britain limited EU opt-outs

Angela Merkel prepared to offer you Britain constrained EU opt-outs

David Cameron Angela Merkel

Angela Merkel is believed to be willing to grant ‘limited opt-outs’ to David Cameron’s government. Photograph: Sean Gallup/Getty Images




Angela Merkel is prepared to grant David Cameron special assurances in a revised EU treaty to ensure that the interests of Britain and other non-euro members are protected in the European single market.


In a sign of the lengths the German chancellor is prepared to go to to ensure Britain remains in the EU, authoritative sources in Berlin say Merkel is also prepared to grant “limited opt-outs” to Britain and to ensure that EU regulations are enforced in a more flexible way.


One senior figure in Berlin has raised the prospect of giving the NHS an opt-out from the working time directive – a contentious measure criticised by Eurosceptics – which gives workers a series of rights.


The thinking among senior figures in Berlin has emerged on the eve of a visit to Britain by Merkel on Thursday in which the German chancellor will meet the Queen, address a joint session of parliament and hold separate meetings with the leaders of the three main political parties.


Downing Street believes Merkel will be the pivotal EU figure if Cameron wins the 2015 general election and embarks on a renegotiation of Britain’s EU membership terms before a referendum by the end of 2017.


The Foreign Office is advising Downing Street not to lose sight of the fact that Britain will need the agreement of all other 27 EU leaders if it is to achieve a favourable revision of the Lisbon treaty. One source said: “There is perhaps too much optimism emanating from No 10. We have to be a very hard-headed about this and bear in mind that the bedrock of the EU is the Franco-German relationship. There is only so far the Germans will go. We should be making a much bigger effort with the French.”


Senior figures in Berlin have outlined a series of concessions they would be prepared to grant Britain to help the prime minister win a referendum campaign. They say Merkel believes new governance arrangements for the eurozone will have to be introduced in “targeted” treaty change. This would go beyond a straightforward “simplified revision procedure” but would fall short of a full “inter-governmental conference” change that would take at least five years.


The prime minister regards treaty change as vital because it would hand Britain, which would have a veto, a chance to table its demands.


One senior Berlin official said: “Cameron’s assumption that there will be treaty change is almost certainly correct. I am confident that a number of legal routes exist to get through changes in treaties, depending on political constellations. We are not speaking about rewriting the treaties but making targeted changes or submitting an addendum. It might extend beyond a limited treaty revision under the simplified revision procedure (on the model of the treaty facilitating the establishment of the European Stability Mechanism); but Germany does not want a general treaty revision.”


The thinking in Berlin is outlined in a paper drawn up by the City of London Corporation and the Policy Network thinktank. Officials told the authors of the paper that Berlin is prepared to countenance offering:


• Assurances that Britain and the nine other EU members outside the euro will not be outvoted when rules are drawn up for the single market, which covers all 28 members. Cameron has voiced fears that the non-euro members could fall victim to “caucusing” by the 18 members of the euro because the rules of the single market are decided by “qualified majority voting” in which no member state has a veto. One senior official is quoted as saying: “Germany is sympathetic to British demand for assurances of non-discrimination in single market given eurozone integration. However this cannot extend to a reversion to unanimity over financial services regulation. […] In negotiations on a new treaty, I could see the inclusion of a new clause to protect the UK against discrimination as a euro out.”


• Limited opt-outs for Britain, though these would fall short of repatriation of powers. One idea is the NHS exemption from the EU’s working time directive. British workers can opt out of the 48-hour working week but other requirements in the directive, such as holidays and rest breaks, are mandatory.


• The implementation of EU regulations in a less intrusive and prescriptive way. This would apply across the EU and would be designed to meet British concerns that EU regulations fail to take account of the concerns of businesses.


A senior Berlin government adviser is quoted in the paper as saying: “There is too much lifestyle regulation coming out of Brussels. It is important that the EU looks at its core business in times of crisis and does whatever it can to promote economic development. Germany might be prepared to countenance the abrogation of some secondary legislation.”


One senior Whitehall figure said that Merkel was keen to help Cameron but there were lines she would not cross. The source said: “Angela Merkel wants Britain to stay in the EU and wants to do what she is able to do to help with that. But she is not simply going to throw over key German interests and that includes the stability of the euro.


“Merkel and Cameron have a shared vision about the existential economic challenge facing Europe as a whole – the need for competitiveness, to see the emerging economies as an opportunity as well as a challenge. She regards Cameron as one of the few European leaders who gets that. It is true she wants us in because of where the balance of the economic argument lies and also because a British exit would damage the EU in the eyes of the world beyond.”


But Sir Menzies Campbell, the former leader of the Liberal Democrats, said the Tories were wrong to think Merkel would be able to grant major concessions. Campbell said: “Anyone who believes that Merkel, who is after all the leader of a coalition, is going to come to London with the kind of agenda that would satisfy the most rabid anti-Europeans in the Conservative party has got another think coming. Germany and France have been the engine room of the EU, often resentful of the fact that Britain appeared from time to time to be disconnected. Why should Merkel offer some kind of unique relationship for the UK under a Tory party which embarrassed her by leaving the European People’s party [in the European parliament] as soon as the 2010 election was over?”


David Cameron and Angela Merkel have forged such a strong bond in recent years that aides like to debate the exact moment when they clicked.


There was the time when they went for a walk minus aides, accompanied just by their security detail, up Coombe Hill near the prime minister’s country residence in Chequers in the Chilterns in the autumn of 2010.


Then there was the box set of Midsomer Murders DVDs Cameron handed to the German chancellor at the end of the Chequers weekend after they had spent hours watching Merkel’s favourite detective drama.


Others say it is important not to forget the prime minister’s visit, accompanied by his wife and children, to the German equivalent of Chequers at Schloss Meseberg in April last year. Merkel is said to have been particularly attentive to the Cameron children.


The strength of their bond shows that the two leaders have come a long way since Cameron announced during the Tory leadership contest in 2005 that he would take his party out of the main centre right grouping in the European parliament.


Even before his appointment as prime minister in 2010 Cameron worked hard to rebuild relations with Merkel who now regards him as a “naughty nephew”, one No 10 source told the Mail on Sunday.


Cameron calculated that he would be unable to achieve much in Europe without the support of the leader of the EU’s largest country and economy. Merkel was encouraged by Cameron’s relatively constructive approach towards the EU after he became prime minister.


But their relations suffered a blow at the end of 2011 when Cameron vetoed a fiscal compact for the eurozone, forcing the eurozone members to agree a separate treaty outside the architecture of the EU. The fallout from that row, which prompted fears in the German chancellery that Britain could leave the EU, ended up strengthening their relationship. Merkel advised Cameron in the run up to his major speech on Britain and the EU in January last year to argue in favour of reform across the EU. She said that would be the best way of building a consensus across the EU.


The German chancellor is determined to see Britain remain in the EU. But the Foreign Office has warned Cameron to bear in mind that any German chancellor will also put Berlin’s relationship with France first. Nicholas Watt




Angela Merkel prepared to offer you Britain constrained EU opt-outs

15 Ocak 2014 Çarşamba

Empowered and engaged NHS workers will offer far better care

General Election - National Health Service

Frontline personnel should really feel valued and supported by management if they are to supply the greatest quality care. Photograph: Christopher Furlong/Getty Pictures




It should not be news to any individual operating in healthcare that the way employees truly feel about their workplace has an impact on the high quality of patient care, as properly as on the efficiency and monetary efficiency of an organisation.


This has been driven house by the Boorman review on the significance of health and wellbeing in the NHS. Analysis also demonstrates the link amongst staff satisfaction and mortality prices, that greater personnel fulfillment is linked to higher patient fulfillment, and that workers expertise shapes patients’ encounter, rather than the other way about.


Nevertheless despite these scientific studies, NHS personnel engagement – as measured by a score from the NHS workers survey, which requires account of measures including employees involvement and total task satisfaction – fell for 3 consecutive many years from 2009 before rising slightly in 2012. Only fifty five% of employees would advocate their organisation as a spot to operate.


Functioning in healthcare ought to be rewarding and fascinating, yet all as well typically healthcare specialists feel overworked, disempowered and unappreciated. This is not a unique NHS problem: analysis exhibits it’s a difficulty in healthcare in all the innovative economies throughout the world. According to the Boorman assessment, healthcare workers in the Uk report larger amounts of anxiety and burnout than people in other sectors. In 2013, over a third had reported feeling unwell as the consequence of perform-relevant stress in the previous year. Amongst nurses, the figure was 55%.


Caring for individuals is difficult work. It is specifically challenging in the course of a period of institutional modify this kind of as we are going through now, because this generates uncertainty and anxiety about occupation protection and the potential. Feeling valued, supported and listened to is vital if personnel are to have the mental and emotional stamina required to supply the best-high quality care.


Nevertheless, as the Point of Care Foundation’s report published right now highlights, only one in 3 NHS employees say communication between senior managers and staff is successful. And although 3-quarters of employees say they are capable to make improvement tips, only 26% say senior managers act on them. Nevertheless our analysis demonstrates senior leaders report a far much more good outlook, citing staff engagement as a single of their prime priorities and an mind-boggling self-confidence that workers can increase worries.


This sort of gap between perception and actuality can undermine self-confidence and enthusiasm and engender cynicism. I will not feel it truly is the item of deception or deliberate intent, it is the inevitable outcome of people positioned at distinct levels of the hierarchy possessing distinct experiences and points of see.


Bridging the gap is possible, but it requires deliberate and intentional action on the portion of senior executives to overcome it. It calls for clear communication, trust and acknowledgement of the experiences of others. Our report, has eight situation scientific studies of organisations initiating good practice.


There is not 1 single lever that can be pulled to engage workers. But there are steps board members and managers can take to improve personnel wellbeing and engagement. These contain:


• Articulating values in plain English and showing how they translate into behaviours


• Offering frontline personnel obligation and authority to fix the difficulties they think influence patient care


• Creating time and area for workers to reflect on the emotional challenges in their work with patients. Schwartz Center Rounds sessions, which the foundation supports, are one way of undertaking this.
• Coaching line managers in men and women management skills – like the large amount of clinicians who lead and supervise other staff but don’t see themselves as managers.


These actions are critical, but they are not a substitute for taking a truly strategic method to staff engagement. Great practice in a couple of teams or on a couple of wards is not going to carry about the degree of cultural transformation known as for by the Robert Francis’s inquiry into Mid Staffordshire NHS foundation trust. This is why our report calls on the NHS to make supporting personnel a central driver of its techniques to enhance patient care, productivity and financial performance.


Jocelyn Cornwell is the founding director of the Stage of Care Basis


This write-up is published by Guardian Specialist. Join the Healthcare Professionals Network to obtain typical emails and unique offers.




Empowered and engaged NHS workers will offer far better care