Radical ketamine therapy could treat alcohol addiction

Scientists believe that a radical treatment involving the horse tranquilliser, ketamine, could help overcome alcohol addiction by “erasing” drink-related memories.

Psychologists based at University College London are testing whether a one-off dose of the drug could help hazardous drinkers who are trying to reduce their alcohol intake. Alcohol addiction is notoriously difficult to treat, and there are few effective therapies available.

Using a recreational drug to treat addiction may sound counterintuitive, but the researchers say there is a growing body of research suggesting that ketamine can be used to disrupt harmful patterns of behaviour.

Ravi Das, one of the lead researchers, said: “There is evidence that it could be useful as a treatment for alcoholism.”

Crucially, ketamine can block the formation of memories, and scientists believe that this property could be harnessed to help over-write the memories that drive addiction and harmful patterns of behaviour.

“Memories that you form can be hijacked by drugs in some people,” said Das. “If you were an alcoholic you might have a strong memory of being in a certain place and wanting to drink. Those memories get continuously triggered by things in the environment that you can’t avoid.”

Scientists believe that psychological cravings, as opposed to short-term physical withdrawal, are underpinned by alcohol-related memories. For instance, seeing a glass of beer, hearing the clinking of glasses or even arriving home from work may trigger memories of the rewarding sensation of taking a drink – and might prompt a person to follow this urge.

“The main problem is the really high relapse rate after treatment,” said Das. “People can successfully quit using over the short term while they’re being monitored in the hospital … but when they return home they’re exposed to those environmental triggers again.”

There is increasing evidence, however, that memories are less stable than once assumed and may be open to manipulation.

Each time our brain accesses a memory, the neural connections that encode it are temporarily destabilised, meaning that our recollection can be slightly altered before it goes back into storage. This is one reason why, in everyday life, people can recall wildly different versions of the same events.

In the clinic, scientists believe this short period of instability in the memories, represents a window of opportunity. Ketamine blocks a brain receptor called NMDA, which is required for the formation of memories. So the logic is that giving someone the drug just as a memory has been destabilised could help weaken the memory, or even erase it.

A similar approach with a different drug was shown to eradicate people’s phobia of spiders. And research in rats that were made to be addicted to cocaine showed that the memories underpinning their addiction could be completely wiped out using a similar strategy (although this involved injecting a chemical into the brain).

In the UCL trial, the scientists will intentionally trigger alcohol-related memories by placing a glass of beer in front of the participants, who are all heavy drinkers. They will then disrupt the memory, by surprising the participant (the team is not disclosing the exact details as this could bias the results).

Participants will then be given either a ketamine infusion, with a concentration equivalent to a high recreational dose, or a placebo. The team will follow up the people for a year and monitor whether their drinking has changed and by how much.

In total the scientists are aiming to include 90 people in the trial and more than 50 have already taken part. It involves people who drink harmful quantities of alcohol, but excludes anyone who meets the clinical criteria for alcoholism. The participants were drinking at least 40 units for men (equivalent to four bottles of strong wine) and 28 units for women, and drinking on at least four days.

Nikki, 31, who works as a consultant in London said she decided to take part in the study when she had some time off between jobs and realised she was drinking more than she wanted to. “It’s just in the culture, that’s what all my friends are like. Everyone drinks to excess,” she said.

She described the experience of being given the ketamine as “overwhelming and intense”, but not unpleasant. “My body felt like it was melting away,” she said. “It was quite psychedelic, I felt untethered from my body.”

In the week after the session, she said, she felt in an “incredibly positive mood” and that since taking part she has been more conscious about deciding whether to have a drink, although said this could also be linked to starting a new job and taking up meditation. “In the past, there were occasions where I would be drinking and I’d be on autopilot ‘Let’s get another drink’,” she said.

If the trial yields promising results, the team hope that the approach could form the basis for therapy sessions targeted at alcoholics and people who are drinking unhealthily. However, they acknowledge that there may be resistance to the use of a recreational drug to treat people with addiction.

“There’s just the general social attitude that everything that’s illegal is terrible. There will obviously be that kind of narrow-sighted pushback,” said Das. “But if it’s safe and effective enough it should be recommended.”

Andrew Misell, a spokesman for Alcohol Concern, said: “The researchers have quite rightly highlighted what a lot of people in recovery from alcohol problems know from experience, namely that cues or triggers like the smell of beer can cause a relapse even after long periods of abstinence. Any work looking at how people can overcome these pitfalls is going to be useful.”

However, he added, no drug-based therapy is risk-free “and that certainly includes ketamine”.

Radical ketamine therapy could treat alcohol addiction

STPs: Radical local modernisation plans or the end of the NHS as we know it? | Denis Campbell

To some, they are bold, painful, inevitably controversial but nevertheless necessary local blueprints designed to save the NHS in England, area by area, by making it fit for the clinical, financial and organisational challenges it is facing. To others, though, they are sinister schemes that will see parts of, or even entire hospitals shut, fewer beds, the number of GP surgeries drastically reduced, NHS land sold to profiteers and private healthcare firms treating more NHS patients. What an NHS boss calls modernisation is an NHS campaigner’s road to destruction.

Either way, Sustainability and Transformation Plans (STPs), are the most important issue in the NHS and the thing that will do more than anything else to decide if it is still a viable and well-functioning healthcare system that can live within its means by 2020. They will dominate and form the backdrop to many of the speeches and debates at the NHS Expo in Manchester today and tomorrow. From an NHS point of view, they absolutely have to succeed. However, to do so, these microcosms of the NHS Five Year Forward View survival masterplan from 2014 must overcome a daunting array of very difficult obstacles.

Back in March, the NHS England chief executive, Simon Stevens, outlined the importance of STPs when he declared that: “Now is the time to confront – not duck – the big local choices needed to improve health and care across England over the next five years, and STPs are a way of doing this. Their success will largely depend on the extent to which local leaders and communities now come together to tackle deep-seated and longstanding challenges that require shared cross-organisational action.”

Six months on, England has been divided into 44 STP “footprints”. Each is a collaboration between all the statutory bodies in that area involved in health and social care – such as NHS trusts and clinical commissioning groups, and local councils, which fund social care. NHS England describes them as “collective discussion forums” and Stevens sees them as evidence of unprecedented cooperation between organisations which historically have done their own thing.

In the Lancashire and South Cumbria STP, for example, there are 31 different statutory bodies — nine clinical commissioning groups (CCGs), six NHS provider trusts, four upper-tier local authorities and 12 district councils. It is led by Dr Amanda Doyle, a GP who is also the chief clinical officer of Blackpool CCG. Its discussions also involve voluntary organisations, four local Healthwatch branches and several local committees, which represent GPs.

“We have three aims. Firstly, to improve the health of the population. On our patch we have some of the poorest health and shortest life expectancy in the country. Secondly, to improve the outcomes of care. Some of those outcomes could be improved if care was delivered in a different way, for example, if more stroke or cancer patients were treated in specialist centres,” says Doyle. “And thirdly, to make our bit of the system more financially sustainable. Although we’ve had extra investment, rising demand is outstripping that, so we need to make our population healthier so that we can in some way control the demands they put on the healthcare system.”

Doyle, like other STP advocates, is clear that achieving these objectives will involve big changes to the way NHS services are organised, and care delivered. She admits that a reorganisation of hospital services will be part of that. “It could also mean looking at the number of sites on which we do certain things and rationalising some of that. We are starting to look at all of our services to see if they are in the right place or whether we are duplicating efforts.” The local NHS’s inability to recruit enough staff to work in every department of all four of the STP’s acute hospital trusts – especially in A&E, dermatology and radiology – will mean fewer centres in key areas of care, she hints.

But will rationalisation necessarily help the NHS make the £22bn of savings it has to deliver by 2020? “There are concerns that some areas are focusing on plans to reorganise acute hospital services, despite evidence that major reconfigurations of hospital services rarely save money and do not necessarily improve care,” says Chris Ham, chief executive of the King’s Fund thinktank. Plans in some STPs to reduce the number of hospital beds are also unlikely to succeed, he believes. Nigel Edwards, his counterpart at the Nuffield Trust thinktank, says: “I’ve been visiting a lot of STPs and nobody I’ve spoken to is confident they can reduce the financial gap. One insider said to me: ‘Optimism bias abounds’.”

Ham adds: “It would be a huge shame if a vital opportunity to improve services for patients is derailed by bruising rows about ill-conceived hospital closures.” Colin Crilly, a spokesman for the Keep Our St Helier Hospital campaign group in south-west London, speaks for grassroots NHS campaigners who are profoundly worried by the emerging details of how STPs could affect hospitals. ”With the government’s annual budget [for the NHS] shrinking in real terms, the NHS is facing huge debts. STP is a quick plan to get rid of these debts by getting rid of services, wards or hospitals.”.STPs are odd entities, as Edwards points out. “They’re not organisations. They’re ‘footprints’ — lines on maps. There’s no building with a name on the door.”

It is unusal to find what are in effect high-level talking-shops expected to tackle the biggest problems in the NHS and then agree push through changes that no one pretends will be popular. The fact that they are non-statutory bodies and have no formal power – and, crucially, their reliance on reaching agreement among bodies with sometimes different agendas – could yet prove a flaw, adds Edwards. What happens if a hospital that is set to lose a much-loved A&E or maternity unit as a result of an STP decides to go to court to thwart it? The cooperation vital to the whole programme would disappear.

Perhaps the biggest risk, though, is that while the NHS has talked for years about building up out-of-hospital services, little progress has been made, as acute hospitals have received an ever-bigger slice of the cake. NHS England say that general practice, mental health and community-based services will get more and more of the cake in coming years. But will it be enough to cope with the planned massive shift of care into places that are as yet undefined and unfunded, and will there be enough staff there, in or closer to people’s homes, to enable that?

Doyle admits that, while general practice will need to expand its role, “GPs are already busy, that’s their trouble.” But she points to innovation in out-of-hospital care, such as last year’s introduction on the Fylde coast, in Lancashire, of “wellbeing support workers”, who try to keep frail elderly people as well as possible at home, to reduce their risk of hospital admission. STPs are looking to replicate good ideas like that everywhere.

The stakes could not be higher. So will STPs save the NHS?

“It’s absolutely vital that they succeed. We have to have a sustainable NHS and to do that we have to adapt how we do things,” says Doyle.

Jim Mackey, chief executive of the financial regulator NHS Improvement, says there is no option. NHS bodies need “to work together, to think boldly and to work out how change — no matter how radical — can best be achieved to meet the major challenges we face,” he says.

Despite all the dramatic rhetoric about STPs, Edwards remains sceptical. “There are a significant number of risks associated with them and the jury is still out as to whether they are going to work or not,” he points out. “ It’s too early to say.”

STPs: Radical local modernisation plans or the end of the NHS as we know it? | Denis Campbell

NHS plans radical cuts to fight growing deficit in health budget

NHS bosses throughout England are quietly drawing up plans for hospital closures, cutbacks and radical changes to the way healthcare is delivered in an attempt to meet spiralling demand and plug the hole in their finances, an investigation by the Guardian and campaign group 38 Degrees has revealed.

Without the changes, the NHS at local level could be facing a financial shortfall of about £20bn by 2020-21 if no action is taken, the research suggests.

The cost-cutting shakeup is being overseen by NHS England, but is already sparking a series of local political battles over the future of services, and exposes the health secretary, Jeremy Hunt, to fresh criticism after his controversial role in the junior doctors dispute.

Last year’s Conservative manifesto pledged an extra £8bn a year for the NHS by the end of this parliament, as demanded by the NHS chief executive, Simon Stevens, in his 2014 “five-year forward view”. But Stevens made clear that was the minimum money needed, and radical reforms to the way healthcare is delivered would also be necessary to make the NHS hit its budgets.

NHS England has divided England into 44 “footprint” areas, and each was asked to submit a cost-cutting “sustainability and transformation plan” (STP).

The Guardian has seen the detailed plans for north-west London, while 38 Degrees, a crowdfunded campaign group, commissioned the consultancy Insight Health to collate and analyse proposals from across the rest of England.

The picture that emerges includes:

• In the Leicester, Leicestershire and Rutland region, there are proposals to reduce the number of acute hospitals from three to two.
  


• In the Black Country region of the West Midlands there are proposals to reduce the number of acute units from five to four and close one of two district general hospitals.


• A reduction in the number of face-to-face meetings between doctors and patients in north-west London through the use of more “virtual consultations” and a proposal to give patients coaching to help them manage their own conditions without seeing a doctor.

Some of the proposals are likely to be given the go-ahead as soon as October, though consultation would then have to take place locally.

Health policy experts, doctors and campaigners say that the public are unaware of how significant the changes are going to be, and while some elements are likely to be welcomed, hospital closures tend to be highly unpopular among voters.

A spokesperson for NHS England said the health service needed to make major efficiencies:“We need an NHS ready for the future, with no one falling between the cracks. To do this, local service leaders in every part of England are working together for the first time on shared plans to transform health and care in the communities they serve, and to agree how to spend increasing investment as the NHS expands over the next few years.

“It is hardly a secret that the NHS is looking to make major efficiencies and the best way of doing so is for local doctors, hospitals and councils to work together to decide the way forward in consultation with local communities.”

North-west London’s draft plan highlights risks to the implementation of the programme, including a failure to shift enough acute care out of hospitals, a possible collapse of the private care home market, and a failure to get people to take responsibility for their own health.

Two local authorities in north-west London, Hammersmith and Fulham and Ealing councils, have refused to sign up to the draft plans because of concerns about hospital closures. Officials claim that pressure was exerted on them to sign off an executive summary of the draft plans quickly without seeing the full document. NHS officials have denied this.

A spokeswoman for NHS North West London insisted the policies were based on evidence, saying: “There is a whole body of clinical evidence, research and best practice that clinicians are using to deliver better clinical care for patients.”

Hugh Alderwick, senior policy adviser at the King’s Fund, said that while some elements of the plans were positive others were less so: “There are some concerns that NHS leaders have focused their efforts on plans for reconfiguring acute hospital services, despite evidence that major acute reconfigurations rarely save money and can sometimes fail to improve quality of care.”

Dr Eric Watts, consultant haematologist and chair of the campaigning group Doctors for the NHS, said: “We as an organisation welcome any plan that holds true to the founding principles of the NHS and gives our patients the fairest possible treatment. But from what we can already see, STPs do not bode well for the future health of the NHS itself. Plans to move services into the community have been given as a reason for reducing hospital beds for many years now but we see the beds being closed without increases in community provision.”

Steve Cowan, leader of Hammersmith and Fulham council said: “This is about closing hospitals and getting capital receipts. It’s a cynical rehash of earlier plans. It’s about the breaking up and selling off of the NHS. It will lead to a loss of vital services and will put lives at risk.” He added: “Our job is to protect the NHS and this plan is about dismantling it.”

Laura Townshend, of 38 Degrees, said: “This is new evidence that plans are being made to close local NHS services. We all rely on these services, yet we are being kept in the dark.

“These proposed cuts aren’t the fault of local NHS leaders. The health service is struggling to cope with growing black holes in NHS funding. These new revelations will be a test of Theresa May’s commitment to a fully-funded National Health Service.

NHS plans radical cuts to fight growing deficit in health budget

NHS squeeze can be reversed by applying some radical thinking | Letters

As Polly Toynbee scathingly pinpointed in her splendid article (Jeremy Hunt saves his own skin as he lets the NHS sink, 26 July), the NHS is as dependent on injections of foreign labour as a drug user is on heroin. According to the OECD report Health Workforce Policies in OECD Countries, published in March, Britain is the world’s second largest importer of health workers after the US, with more than 48,000 doctors and 86,000 nurses in 2014. While 5% of Italy’s and 10% of Germany’s doctors were born overseas, the figure for the UK is a shameful 36%. Shameful because in 2010, along with all WHO members, we signed the Global Code of Practice on the International Recruitment of Health Personnel, which “encourages countries to improve their health workforce planning and respond to their future needs without relying unduly on the training efforts of other countries, particularly low-income countries suffering from acute shortages”. Clearly, Jeremy Hunt has a lot to do. Explaining why 12,000 British doctors prefer to work abroad might be a good place to start.
David Hughes
Cheltenham

• Polly Toynbee refers to Jeremy Hunt “talking up the scandal in Mid Staffs” in order to “encourag[e] the Care Quality Commission to set higher nursing and doctor numbers per ward”.

The CQC does not set staffing ratios; we make recommendations for practical actions to improve care, based on detailed inspections involving clinical professionals. It is the responsibility of the leadership of individual trusts to determine how best they implement our recommendations in a way that ensures the delivery of high-quality care within the resources available.

Trust boards are ultimately responsible for the future of their organisations and must use the CQC’s reports to help them plan that future – this includes taking a rounded look at staffing. Boards must ensure that there are sufficient medical and nursing staff to meet the needs of patients; it is for them to determine whether this is best done through additional recruitment, or whether demand could be more effectively managed by making changes to their model of care – as we have already seen some trusts successfully achieve. In an increasingly challenging context, the CQC is committed to supporting the NHS in the delivery of good, safe care that is clinically and financially sustainable: the care that we would want for ourselves and our families.
David Behan
Chief executive, Care Quality Commission

• The plan you refer to (Overspent hospitals are told ‘reset’ means they must make cuts or face punishment, 22 July) is another blow in the unspoken agenda to destabilise the NHS. Why not “Underfunded hospitals struggle to provide safe care while budgets are cut”?

The Department of Health has returned an average of £2.5bn a year to the Treasury for the last three years. Why don’t the managers get together and ask for more money, and say they would resign rather than continue to attempt to fulfil the demands of NHS England and the DH? I am told that the average length of stay for a CEO in an NHS hospital is three years, so what have they got to lose?

Portraying the NHS as failing when it is being systematically undermined by government policies in order to bring in the private sector is dishonest and affects those Theresa May said she wanted to help. Can we ask her to look at what has been happening to the NHS over the last six years and apply some radical thinking to restore its funding?
Wendy Savage
President, Keep Our NHS Public

• The easiest way to resolve overspent hospital budgets is just to stop treating patients with minor or non-life-threatening conditions or “voluntary” disorders such as sporting injuries. Patients who already suffer from these conditions should be treated. Healthy people should be advised to take out insurance. No private organisation pretends that it can do more and more with less and less resources. If politicians want to spend money on armaments, railways and nuclear power etc, and to merely write off the cost of their extremely expensive mistakes in the NHS, they must bear the public opprobrium for reducing what can be provided free at the time of use. Professional staff should no longer compromise either their health or their standards by trying to do too much.
Dr Richard Turner
Harrogate

• We urgently need a Labour party that is prepared to undo the damage done to our NHS by successive governments. Cuts, privatisation and opening the NHS up to the market, against public and professional opinion, has made the NHS less safe, less efficient, and at risk of becoming less caring. The Health and Social Care Act 2012 speeded up a process of destruction that had already started. The junior doctors’ dispute, still unresolved, reflects the impossibility of providing the same level of routine services over seven days, when the resources scarcely exist to provide this over five.

So we, as NHS doctors from all branches of the profession, whether we are in the Labour party or not, urgently need an opposition that is united, with clear policies to increase funding to the NHS, repeal the Health and Social Care Act, reverse the privatisations, and get rid of markets in healthcare.

Jeremy Corbyn and his shadow secretary of state Diane Abbott have declared an intention to do all of this, and have displayed exactly the type of decisive leadership the NHS is calling for. We believe the re-election of Corbyn as leader of the Labour party is essential for the very survival of the NHS.
Dr Kambiz Boomla General practitioner, London
Dr Jacky Davis Radiologist, London
Dr Louise Irvine General practitioner, London
Dr David Wrigley Chair of Doctors in Unite, Carnforth, Lancashire
Dr Ron Singer Retired GP, London
Dr Youssef El-Gingihy London
Dr Anna Livingstone GP, London
Dr Yannis Gourtsoyannis Specialist registrar, infectious diseases; junior doctors committee, BMA, London
Dr Aislinn Macklin-Doherty Oncology, London
Dr Pete Campbell Acute medicine, Newcastle
Dr Megan Parsons Junior doctor, Manchester
Dr Jackie Applebee GP, London
Dr Pam Wortley Retired GP, Sunderland
Dr Haroon Rashid GP, Ilford
Dr Saul Marmot GP, Bromley by Bow health centre, London
Dr Sasha Abraham GP, London
Dr Gerard Reissman General practitioner, Newcastle upon Tyne
Dr Sheila Cheeroth GP, Limehouse practice, London
Dr Robert MacGibbon Retired GP, Westleton, Suffolk
Dr Maureen O’Leary Retired consultant psychiatrist, Sheffield
Dr Jack Czauderna Retired GP, Sheffield
Dr Mona Kamal Ahmed Forensic psychiatrist, London
Dr Muna Rashid GP, London
Dr Alex Hardip Sohal GP, London
Dr David Kirby Retired GP, London
Dr Robert Hirst Emergency medicine, London
Dr Iain Maclennan Consultant in public health and retired GP, Sandown, Isle of Wight
Dr Hennah Bashir Emergency medicine, London
Dr Kelly Cruickshank Psychiatry, Salford
Dr Max Thoburn Junior doctor, Manchester
Dr Kathryn Greaves Anaesthetics, London
Dr Shamira Bhika GP, London
Dr Mary Edmondson Retired GP, London
Dr Rishi Dir Orthopaedics, London
Dr Helen Murrell GP, Newcastle upon Tyne
Dr John Puntis Consultant paediatrician, Leeds
Dr Thabo Miller Paediatrics, Somerset
Dr Ben Hart GP, London
Dr Paul Hobday GP, Horsmonden, Kent
Dr Hilary Kinsler Consultant, old age psychiatry, King George hospital, Ilford
Dr Michael Fitchett GP, London
Dr Soraya Boomla GP, London
Dr Kevin O’Kane Consultant, acute medicine
Emma Runswick Medical student, Salford
Dr Coral Jones GP, London

• Join the debate – email guardian.letters@theguardian.com

NHS squeeze can be reversed by applying some radical thinking | Letters

Geoff Shaw proposes radical alterations to Victorias abortion laws

Geoff Shaw, the MP who holds the balance of power in the Victorian parliament, will place forward a bill that would radically alter the state’s abortion laws by banning partial-birth and gender variety abortions.

Shaw said he also wished doctors to give discomfort relief to foetuses throughout abortion procedures and for babies to be resuscitated if they survived abortion attempts.

The independent MP has previously voiced his objection to suggestions that demand medical doctors to refer a girl to another healthcare expert if the 1st medical doctor objects to abortion. Shaw says the system is as well onerous on anti-abortion medical professionals.

This bill goes a lot more, and could end result in the largest changes to Victoria’s abortion laws given that 2008, when the practice was decriminalised.

Shaw mentioned Victoria’s abortion laws had been between the worst in the planet, and maintained he was standing up for women’s rights.

“If in society we are saying there need to be a lot more women on boards, there must be a lot more females in parliament, nicely you are killing them,” Shaw informed the Herald Sun.

“Here in Australia we cannot kill snake eggs but we are quite happy to kill an egg in the tummy and it ought to be the safest area for a child to be.

“How can any girls who are professional-women’s rights say that you can destroy girls?”

Shaw resigned from the Liberal celebration in March amid moves for him to be expelled. The Coalition government, which had a one particular-seat majority before his departure from the party, relies on his vote to pass legislation.

Shaw, a committed Christian who has been involved in a series of controversial incidents which includes two physical altercations with taxi drivers, has explained he will use his stability of energy position to drive the greatest deal for his Frankston electorate.

The independent’s new bill will put stress on the premier, Denis Napthine, who has previously ruled out any modifications to the abortion laws.

There is help for change amongst some in the Coalition. In March, upper property Coalition MP Bernie Finn mentioned women who were raped must not have abortions.

Finn stated there was “no acceptable reason for having an abortion”, claiming that “many rapists and particularly paedophiles use abortion as a defence, they use it as a way to ruin the evidence”. Napthine condemned Finn’s comments as “inappropriate”.

Labor has stated it is towards any modifications to abortion laws, even though women’s groups have urged the government not to make the procedure harder for girls in search of an abortion.

Geoff Shaw proposes radical alterations to Victorias abortion laws

Simon Stevens sets out vision for radical NHS change and innovation

Practice nurse Lesley Dobson requires Simon Stevens’ blood stress at Consett Health care Centre in County Durham. Photograph: Owen Humphreys/PA

In his 1st speech as NHS England chief executive, Simon Stevens ready the ground for radical adjust in the way health services workers think and operate.

Speaking at Shotley Bridge hospital in County Durham, exactly where he began his NHS occupation as a trainee manager 26 many years ago, Stevens encouraged employees to “consider like a patient, act like a taxpayer” as he gave the first indications of what he would – and would not – be carrying out.

He will not be getting into a trial of strength with the wellness secretary, Jeremy Hunt. He stressed the need for the nationwide leadership of the NHS to operate “in coherent and purposeful partnership”, and in highlighting that the NHS England board is operationally independent, he implicitly recognised the legitimacy of political influence on its objectives. He and Hunt are also politically astute to fall out.

He also manufactured clear that he would not be debating how many clinical commissioning groups there must be his only interest is in producing clinical commissioning work.

There have been robust themes in his speech of breaking down barriers and driving innovation from each inside and outdoors the NHS.

Having broad expertise of healthcare systems around the globe, Stevens is not going to let his vision for the NHS be constrained by traditions of structure or expert demarcation. This contains the rigid demarcations in between professional and acute solutions, primary and community these NHS silos appear a lot less wise from abroad.

He welcomes new providers who will drive change and test new designs of care, and needs NHS jobs to fit the requirements of patients within and outside hospitals, rather than the existing preference for generating patients stick to inflexible care pathways constructed all around outdated occupation structures.

That puts pay and coaching – including the new GP contract – near the top of his priorities.

He sees an urgent need to have for transformational adjust in out-of-hospital care. He can be anticipated to urge CCGs to be adventurous in testing new techniques of delivering solutions, whilst giving them a bigger position in the commissioning of major care. NHS England, which controls 35,000 principal care contracts, has proved incapable of developing powerful neighborhood main care strategies, which is a main impediment to shifting care out of hospitals.

Stevens’ technique to integrating well being and social care is each pragmatic and radical he gave robust hints that he has minor interest in grand schemes for what he described as “combining two financially leaky buckets”, whilst currently being established that the NHS and nearby government should collaborate on new models of care delivery within current structures. Once again, he highlighted the importance of making an attempt suggestions from abroad.

His determination to challenge conventional methods of functioning will be liberating for several employees, whilst presenting a dilemma for organisations such as the BMA.

While several in the well being services believe they can frighten government into escalating NHS paying, a glance by way of the Office for Spending budget Responsibility’s analysis of this month’s budget reveals that a a lot more practical query is when is the NHS going to shed its funding ringfence. Arguably the creation of the £3.8bn Greater Care Fund for integrating well being and social care currently marks the end of that protection.

So some thing has to give. Redesigning jobs and designing shell out structures that drive the correct behaviours and efficiencies has to be the way forward. Unions need to have to be open-minded or risk exacerbating an presently dire economic prognosis, with far worse consequences for NHS personnel.

The other portion of making NHS cash drive adjust is reforming the payment-by-outcomes method to shift care out of hospitals. In a culture of demanding classic demarcations, experiments in vertical integration and clinical staff routinely moving between hospitals and communities during their doing work day should be portion of that potential.

In his first speech, Stevens has presently established himself as a radical. He is starting to describe a more networked, more free of charge-flowing overall health service that is thrilled by clinically led adjust, searches for innovation and will take a lot more dangers.

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Simon Stevens sets out vision for radical NHS change and innovation

DNA pioneer James Watson sets out radical concept for selection of illnesses

James Watson, 85, says he produced his theory soon after pondering why exercising appears to benefit people with higher blood sugar. Photograph: Edmond Terakopian/PA

Not satisfied with his work that unravelled the double helix construction of DNA and landed him a share of a Nobel prize half a century ago, James Watson has come up with a radical concept for diabetes, dementia, heart ailment and cancer.

The 85-year-outdated scientist has turned to the pages of the Lancet medical journal to set forth his grand notion, which some academics say might not have observed the light of day had it come from anyone else.

Watson, who stepped down as director of the Cold Spring Harbour Laboratory in New York in 2007 after the Times quoted his views on Africa and intelligence, has organized a conference at the lab this 12 months to discover his most recent hypothesis.

Writing in the Lancet, Watson claims that late onset, or variety two diabetes, is typically considered to be induced by oxidation in the physique that causes irritation and kills off pancreatic cells. But he thinks the root of that irritation is fairly different: “The basic result in, I suggest, is a lack of biological oxidants, not an excess,” he writes.

Watson, a keen singles tennis player, says he developed his theory right after pondering why workout appeared to advantage individuals with high blood sugar, an early indicator of potential diabetes. Workout developed “reactive oxygen species” that were extensively believed to be dangerous.

Other study fed into his thinking, chiefly a research by Matthias Blüher at the University of Leipzig. He showed that reactive oxygen species released in exercising combatted the insulin resistance noticed in diabetes, but that the benefits vanished if you gave men and women antioxidants prior to the exercised.

Watson believes that rather than getting wholly negative, oxidising molecules, such as hydrogen peroxide, are vital for the body’s wellness. In certain, he factors out that hydrogen peroxide goes to operate in a cellular organ called the endoplasmic reticulum, the place it guarantees proteins are secure. If levels of oxidants are too minimal, he suggests, the proteins grow to be misshapen and trigger the inflammation that damages the pancreas. And a raft of other illnesses.

Huge research have currently proven that antioxidant dietary supplements do not help folks to dwell longer. Watson’s hypothesis also suggests there is nothing to be acquired, although he makes a point of saying he is not experienced to give individuals well being guidance.

“Just about every doctor I’ve ever known tells every patient who is capable of carrying out so to exercise. I feel physical exercise assists us create healthy, functional proteins. But we genuinely want to have some higher-good quality research to demonstrate this.”

He adds: “We sorely need to consider a much a lot more critical and thorough scientific seem at the mechanisms via which exercising improves our overall health.”

Watson’s thought acquired a mixed reception from scientists on Thursday. A single professor of metabolic medicine was unimpressed and said the idea was not even novel. “It is only because of his identify that James Watson is permitted to present his woolly ideas in the Lancet,” he explained.

The director of the MRC Metabolic Illnesses Unit at the University of Cambridge, Stephen O’Rahilly, was significantly less scathing. He said: “He is exhorting more science to be completed on how physical action may possibly be beneficial. We want to realize the mechanism. Making the proper reactive oxygen species in the appropriate place at the correct time is essential for us to stay effectively, and blocking them may possibly not be a very good idea.”

DNA pioneer James Watson sets out radical concept for selection of illnesses

CQC head David Prior warns NHS will "go bust" with no radical culture change

A radical shift in the culture of the NHS is needed to rid it of outdated functioning practices, remedy it of widespread bullying and heal the damaging rift among managers and clinicians, the head of its official regulator has warned.

David Prior, chairman of the Care Top quality Commission (CQC), referred to as for significant “transformational modify” of the well being service, without having which it will “go bust”.

Writing in the Sunday Telegraph, Prior called for greater input from the private sector, the merging of hospitals and alterations to the way the NHS is held to account – particularly, the scrapping of waiting targets.

He highlighted the “alarming” revelation that a survey of a hundred,000 NHS employees discovered one in 4 had been bullied. He described the NHS as obtaining a culture that “stigmatises and ostracises” whistleblowers who increase concerns or complaints.

His warning comes at a time when the NHS is struggling to emerge from crises this kind of as the Mid-Staffs scandal, the place hundreds of patients died and suffered neglect, as well as facing growing costs and an ageing population.

Prior, a former MP and deputy chairman of the Conservative get together, who was appointed to run the CQC last year, explained: “Too typically it [the NHS] delights in the ritual humiliation of these deemed to fail, tolerates and institutionalises outdated operating practices and outdated-fashioned hierarchies, and can almost inspire ‘managers’ and ‘clinicians’ to occupy opposing camps.

“I have worked in the NHS for twelve years. I enjoy it – I am frequently overwhelmed by the kindness, care and skills of its staff – and however am too often shocked by some of the behaviour I see.”

He described a “them and us” relationship in between hospital managers and clinicians, a harmful rift he explained required “radically altering” to steer clear of jeopardising patients’ security and blocking care enhancements.

Prior named for a major restructuring in healthcare provision, with a lot more successful hospitals taking over failing ones, shared companies, enhanced neighborhood providers and much better care outside hospitals.

Much more competitors – with more entrants into the marketplace from personal organizations, the voluntary sector and other care companies – was needed to drive up standards, and measures of hospital overall performance necessary to adjust, he said.

“We need the government to change the way it holds the NHS to account: an end to trusts getting blindsided by waiting targets that miss the stage, skew priorities and have unintended consequences.

“With out serious change, the NHS will provide poor care, and in the end go bust.”

CQC head David Prior warns NHS will "go bust" with no radical culture change

Overall health watchdog: My prescription for healing the NHS is radical alter

Lately, I visited the United States to see what we can learn. There is tiny to envy about their funding model. But when it comes to the way the well being care organisations themselves work, there are effective lessons.

Initial, about studying. In the US, the best organisations are open, trusting and, over all, continuously understanding. Errors and complaints are sources of improvement, not retribution. Substantial reporting ranges of errors, and close to-misses need to be witnessed as a signal of excellent practice, not a badge of shame.

There comes a level when the surgeon who does not stick to the security checklist or the doctor who does not comply with infection-handle policy has to be advised “we do not want you functioning in our hospital”.

There is no substitute for fantastic, visible, brave leadership. In the USA, the leaders of productive hospitals are paid severe income, and are usually in submit for numerous many years. This displays the complexity of the task and its significance. They take hard selections and live with the consequences.

Right here, hospital chief executives are routinely shuffled around. There is tiny incentive to tackle long-phrase, deep-seated cultural concerns. When issues go incorrect, they are hauled in excess of the coals, usually in public. Meanwhile, the main challenges go unaddressed.

I feel that the NHS wants major lengthy-phrase alter to deal with the requirements of our ageing population and more and more tight budgets.

We require to see profitable hospitals taking above failing hospitals and neighborhood providers, and making certain much better care outside hospitals.

We need bigger centres of excellence, with financial savings from shared providers such as pathology labs and radiology. Modest hospitals will not be in a position to supply the quality we need 24 hours a day unless they turn into element of bigger operations and radically alter or integrate with neighborhood services.

Without having serious adjust, the NHS will deliver poor care, and in the end go bust.

We want a lot more competition to drive up requirements of care a lot more entrants into the market place from private-sector businesses, the voluntary sector and other care companies.

Probably most crucially, we want to modify the culture.

For us, as a regulator, that implies hunting holistically at the performance of hospitals, using measures that matter to sufferers and that continuously boost performance.

We need to have the Government to modify the way it holds the NHS to account: an end to trusts being blindsided by waiting targets that miss the stage, skew priorities and have unintended consequences.

To make these modifications, we need to have to radically alter the connection amongst NHS staff and management. In far too several hospitals, there is a “them and us”, with individuals number of clinicians who go into management branded as “going above to the dark side”.

This is not the situation in the USA, exactly where numerous clinicians are on the executive teams. Medical professionals and nurses here need to have to recognise that an involvement in management permits them to influence the care of 1000′s of individuals.

Above all, clinicians require to get a top position in changing the culture of the NHS.

Scientific studies have discovered a effective correlation in between personnel and patient fulfillment.

The ideal US organisations know that a satisfied employees leads to happy, effectively looked-following individuals. But when more than a hundred,000 NHS employees have been asked how they felt about their functioning setting, the outcomes were alarming. One in four reported feeling bullied.

The rift between management and clinicians expenses us deeply — jeopardising safety, silencing whistle blowers and blocking enhancements in care. It have to be healed.

That signifies stronger clinical leadership and a workplace that encourages studying, openness and respect.

If the health support is to move beyond the scandals of current years, now is the time for radical change — to honour the values on which it was founded.

David Prior is chairman of the Care Quality Commission

Overall health watchdog: My prescription for healing the NHS is radical alter

Well being support demands tweaks, not radical surgery | @guardian letters

‘Three diverse operations on three various family members, of diverse ages, in 3 various hospitals. The widespread aspect? The brilliance of the medical and nursing personnel.’ Photograph: Cate Gillon/Getty Photographs

I was delighted to study the letter (1 January) from several of the major individuals in the NHS calling for a constructive response to the challenges it faces. Final yr, feedback varied from refusal to accept any criticism at all to undeserved and unfair generalisations about its requirements based on a few untypical and awful situations. By worldwide standards, the NHS creates excellent value for cash, remarkable achievements in terms of universal coverage, treatment of individuals with a number of overall health difficulties and workers at every single level who are motivated by devotion to their vocation and to their patients. In numerous techniques, the service is the victim of its very own good results, as far more and far more of us survive for longer and conquer severe sickness or damage.

Above all the NHS demands a consensus primarily based on the determination that it should remain a public service, that change is needed but need to be in the curiosity of sufferers, and that there need to be a shift from dependence on hospitals to the integration of neighborhood care and the involvement of GPs at every single stage. That in turn implies that medical doctors have to be obtainable 24/seven, but a suitable rota program must enable them to enjoy standard weekend breaks as in other professions.
Shirley Williams
House of Lords

• I totally comprehend why the leaders of NHS organisations do not spell out the real reason for the continual carping by Tory ministers and their slavish followers in the rightwing press: to persuade voters that the only resolution is privatisation. If the imperfect NHS performs, which fulfillment amounts nonetheless say it does, there would be no require for a radical resolution when easy, sensible tweaking will do the task. The powers that be, literally, are not interested because there are this kind of effective vested interests who want to make income from the nation’s ill well being. If they do well, their following target will be the BBC, an additional far-from-best organisation that, nevertheless, operates massively nicely in the national interest.
Peter Gacsall
Haywards Heath, Sussex

• Not too long ago I had my appraisal, an annual overall performance evaluation all doctors have to undertake (how several other professions do this?). It integrated an independent survey in which my patient fulfillment score was 91%. I was proud of this until finally I found that it is bang on average for GPs, but I note that it is about the inverse of Jeremy Hunt’s score on YouGov. These surveys have been introduced by the government to assess the accurate normal of services, and the benefits recommend that the individuals to whom the NHS matters most are not taken in by their propaganda. Nevertheless, their message is receiving through: lower morale from this regular battering has encouraged early retirement and discouraged recruitment to A&ampE and general practice. When the shortage of medical professionals gets crucial in these locations I count on the common of support will turn out to be the government’s self-fulfilling prophecy.
Dr Richard O’Brien
Highbridge, Somerset

• At final, recognition that all is not unwell with the NHS. Also, it is recognised that far more must be completed with the present finances accessible, and that in spots, where necessary, enhancements in patient security and quality of care are paramount following the Francis report. The Nationwide Health Action party’s aims precisely support this: “We will restore the NHS as a risk-free, thorough, publicly funded, publicly delivered and publicly accountable, integrated healthcare technique by reversing the Health and Social Care Act 2012 and supporting Lord Owen’s parliamentary bill to restore the NHS – the NHS reinstatement bill.”

Methods of attaining these aims are manufactured clear in reports of operate carried out by the earlier overall health select committee on patient safety and value for funds.
Richard T Taylor
Co-leader, Nationwide Wellness Action party

• Like many households, when we have needed the NHS we have been overwhelmed by the quality of the remedy and compassion of the staff who have cared for us – and I suspect our experiences are far more widespread than latest reviews would propose. Four years in the past, my 60-year-previous wife had a lifestyle-saving operation in Frenchay hospital when a glioblastoma was resected two many years ago, our 34-year-previous son-in-law had a lifestyle-saving operation in Bristol Royal Infirmary when a mitral valve was replaced a single month in the past, my 92-yr-outdated mother was nursed back to lifestyle soon after a hip operation in Musgrove Park hospital. Three various operations on three various family members members, of various ages, in 3 various hospitals. The common aspect? The brilliance of the health care and nursing personnel, their insistence that we knew precisely what was taking place all through those tense and worrying days and their willingness to pay attention to our inquiries. This kind of human involvement can never ever be “captured” on any type and nevertheless it is the most priceless of all information.

Add to this provision the insight of the GPs who spotted the initial troubles and expedited admissions to the suitable hospitals and you have a support which lies at the heart of the community but is nonetheless nimble sufficient to pull in nationwide knowledge when it is urgently required. It truly is referred to as the NHS and we need to cherish it as one particular of the ideal indicators of a caring and democratic society.
Paul Kent
Easton in Gordano, Somerset

• Like extremely several who take into account themselves British, I don’t have to go back to 9000BC to create that I am, partly, an immigrant. I am of 25% Swedish and 12.5% German ancestry. If Scotland votes for independence, a additional 25% of me will be “foreign”. If the prime minister continues down the path of managing NHS demand by restricting free entry additional, I would like to know from him which elements of me will be covered. Will I be capable to select from a drop-down menu when I seek therapy, or will the well being practitioners have an algorithm to work by means of, along with all the other bureaucracy they have to satisfy?
Bob George
Tiverton, Devon

Well being support demands tweaks, not radical surgery | @guardian letters