History > 2006 > UK > Health (I)

The Guardian        Work        p. 2        15.4.2006

Infographie sans article

Abortions at home for 10,000

May 29, 2006
The Times
By Alexandra Frean, Social Affairs Correspondent

A RECORD 10,000 women had an abortion in their own home last year, according to new figures.

Britain’s biggest independent abortion provider, bpas, said yesterday that use of the abortion pill — also known as EMA (early medical abortion) — now accounted for nearly a third of the 32,000 terminations it provided last year to women in the first nine weeks of pregnancy.

Ann Furedi, the organisation’s chief executive, said that demand for the pill had really “taken off” in the past two to three years after bpas started allowing women to go home after the second dose. In 2003 bpas clinics provided 3,500 women with the abortion pill. This rose to 5,000 in 2004 and then doubled to 10,000 in 2005. This made bpas the single biggest provider of the abortion pill in Europe.

Anti-abortion campaigners condemned the provision of what some have called DIY abortions, saying that they have been linked with the deaths of ten women. It was clear, they added, that bedroom abortions, like backstreet abortions, were dangerous.

The abortion pill is given in two stages. A woman must go to a clinic to take the first oral dose of a drug called mifepristone (also known as RU486), which blocks pregnancy hormones. She returns 48 hours later for a second drug, a prostaglandin, which triggers a miscarriage some hours later.

Women receiving the abortion pill at bpas clinics are sent home after the second dose so that they can have the miscarriage at home.

Supporters argue that being able to go home to have the miscarriage gives a woman more control over a very personal procedure. It means she does not have to stay in hospital or in a clinic for hours and that she can guard her privacy even from those closest to her, if she wants. It also gives a woman greater flexibility to fit the procedure into what may be a hectic schedule.

“Many women find the fact they can go home is more natural, private and something they can organise into their lives better. With EMA, it’s the woman having the abortion, rather than a doctor doing it to them.

“This is what makes it attractive to women, as opposed to a surgical abortion involving a general anaesthetic,” Ms Furedi said.

She added that women needed to have proper counselling before going home to miscarry after the second dose. “They lose a lot of blood and the cramping can be intense. It’s not just like having a heavy period. We give women a number they can use to contact us any time of day or night in case they are worried.”

Opponents, who are largely opposed to abortion altogether, argue that the abortion pill poses serious health risks, such as haemorrhaging when the foetus is expelled from the uterus. Leaving a woman isolated at home at this difficult time could also cause lasting psychological damage, they say.

Michaela Aston, a spokeswoman for the anti-abortion organisation LIFE, said:“RU486 is a powerful and dangerous cocktail of drugs.”

She claimed it had been responsible for the death of at least ten women and that the US Food and Drug Administration was currently considering a ban because of safety concerns. “As a counsellor with first hand experience of the traumatic effects that abortion can have on women, I am disturbed that the bpas seems prepared to sacrifice women’s health out of expediency.”

Opponents have also said that the convenience and speed offered by the abortion pill may encourage women to opt for a termination which they later regret - a point emphatically denied by bpas, which was formerly known as the British Pregnancy Advisory Service. “It absolutely won’t make it easier for a woman to decide whether to have an abortion,” Ms Furedi insisted.

EMA can only be provided in the UK in the first nine weeks of pregnancy. After that women must have a surgical abortion. Although bpas has been providing the abortion pill since 2000, its use has recently increased sharply in line with a big increase in early abortions.

The number of abortions bpas provided to women in the first nine weeks of gestation rose from 27,000 to 32,000 between 2004 and 2005. Early abortions now account for 65 per cent of the organisation’s 49,000 case load, up from 56 per cent a year earlier. This increase is part of an overall trend. In 2004, the latest year for which government figures are available, there were 185,400 abortions in England and Wales, compared with 181,600 in 2003, a rise of 2.1 per cent.

Abortions at home for 10,000, Ts, 29.5.2006, http://www.timesonline.co.uk/article/0,,2-2201486,00.html

Cut more beds, says NHS official

Monday May 22, 2006
Guardian
John Carvel, social affairs editor


NHS hospitals in England have jettisoned nearly a third of their beds in the past 20 years and patients would benefit if they got rid of even more, the leader of the health service's managers said last night. Gill Morgan, chief executive of the NHS Confederation, said the cuts announced during the past few weeks paved the way for improvements in patient care.

"Patients' needs are changing and the NHS is adapting to meet those needs," Dr Morgan said as the confederation published a report extolling the benefits of cutting the time patients stay in hospital. It listed reasons why patients do not necessarily require beds. For example, new chemotherapy treatments can be administered to patients at home, keyhole surgery involves shorter recovery times, and the ambulance service treats more people in their own homes. Improved hospital efficiency has also produced quicker test results and shorter waiting times, allowing patients to go home sooner.

But Karen Jennings, head of health at the public sector union Unison, said beds were often lost due to cost-cutting by hospitals built under the private finance initiative. "We need to look at how close beds are together, cross-infection rates and other issues that arise from a smaller number of beds," she said.

Andrew Lansley, shadow health secretary, said: "We run a severe risk of shutting down hospital capacity when the community services cannot cope."

Cut more beds, says NHS official, G, 22.5.2006, http://society.guardian.co.uk/health/news/0,,1780257,00.html

Obesity tests: The fat police

Every four-year-old in the country
to be officially screened

Published: 21 May 2006
The Independent on Sunday
By Francis Elliott, Whitehall Editor
 

Primary schoolchildren are to be routinely weighed and their parents told if they are obese in a controversial initiative to tackle the worsening health crisis, The Independent on Sunday can today reveal.

Ministers have decided to overrule the Children's Commissioner and their own child health officials, who fear that telling parents the test results will stigmatise some children.

Primary schools are preparing to weigh and measure the height of four- and 10-year-olds during this summer term to help prepare a national "map" of childhood obesity. Individual statistics will only be given to parents who ask for them and no extra help will be offered to children who are found to be overweight or obese.

From next year, however, parents of any obese four- or 10-year-olds can expect a letter telling them their child faces long-term health damage unless they lose weight, prompting allegations that the Government is policing the size of our children. The move came after MPs dismissed as "drivel" claims that telling parents the results could lead to children being bullied.

Caroline Flint, the health minister leading the anti-obesity drive, believes parents are the "first and foremost influence" on their children. She has overruled Professor Al Aynsley-Green, the Children's Commissioner, who fears that obesity screening at four could do more harm than good. Her decision has delighted obesity campaigners, who say the danger to obese children's future health is so great it outweighs any fears that they may be bullied.

But some experts expressed concern that it could distort children's relationship with food and their own bodies. Dr Robin Arnold, of the BMA's psychiatry committee, said he feared there would be increased rates of eating disorders.

The agony aunt Virginia Ironside was sceptical of the need for an official obesity screening programme. "It's not as if being fat is a hidden problem, is it? It all seems a bit Germanic to measure everyone, and it will probably only succeed in getting parents' backs up."

This summer's tests will be done in "light clothes" and children will be told why they are being measured, according to Department of Health guidance issued earlier this year.

But the guidance spells out officials' concerns at the potential for fatter children to be bullied as a result. "Children can be very sensitive about their own size and those of children around them. Measuring height and weight could accentuate this sensitivity and increase the risk of stigmatisation and bullying."

Parents will be given the right to refuse permission for the child to be tested and can ask not to be sent the results next year.

But ministers hope the vast majority will want to be told the results of the tests. "It's about making sure that whatever we do, government supports families to make the right decisions. It is families who first and foremost influence what their children eat and what their children do in terms of exercise," Ms Flint said earlier this year.

It is thought that the minister is studying US trials in which parents are sent one of three letters following their child's measurements being taken. The first congratulates them on keeping their child within health limits, the second raises concerns that they may be getting out of shape, and the third is a stark warning that their child is obese and risks long-term health damage.

Dr Fiona Adshead, the Deputy Chief Medical Officer, told a meeting of the Public Accounts Committee that child health officials had urged ministers not to tell parents the test results. "We had a lot of concerns from child health officials who wanted to caution us against systematically feeding information back to children. The reason they did that is we are not sure we can guarantee effective treatment."

But the committee's chairman, Edward Leigh, dismissed the excuse as "absolute nonsense" and "drivel".

    Obesity tests: The fat police, IoS, 21.5.2006, http://news.independent.co.uk/uk/health_medical/article549530.ece

Fat: How the national obsession

is coming into the classroom

Adults fret over weight and body shape, and now every child in school is to be weighed for obesity. Experts fear this will only encourage bullying and eating disorders. By Francis Elliott and Megan Waitkoff

Published: 21 May 2006
The Independent on Sunday

The letters are starting to land on doormats already. "Dear Parent," they begin, "next week school nurses will be coming to school to weigh and measure the height of your child."

Barbara Richardson-Todd is readying herself for a frenetic month. "We've got about three or four weeks to weigh and measure 10,000 children," says the senior nurse in charge of collecting obesity data on Suffolk's primary school children. She would have had longer, she says, but there is a national shortage of Government-approved scales caused by this summer's mass weigh-in.

Almost without publicity, health officials have been preparing an extraordinary and controversial data-collection exercise. The Department of Health wants a detailed "fat map" of England's children. Within months we will know the most obese school in Britain, the skinniest, and every calibration in between.

The measurements are needed because the Government set a target to reduce the year-on-year increase in obesity in children under 11 by 2010, but has no standard figures to measure its progress. Ministers have decided that from next year parents of obese children will be told the results in an attempt to shock them into taking more responsibility for their children's size.

That decision, taken in secret last week, overrules the Government's own Children's Commissioner as well as some child-health experts, who fear that such a screening programme could do more harm than good. Not only will it increase bullying, they say, there is a limited amount that can be done to make fat children thinner.

Ministers, however, stung by criticism that efforts to curb childhood obesity are stalled, have decided it's time to tell parents the truth about their children. Although the food industry, advertisers and school dinner ladies all have their part to play, until parents wake up to the problem nothing will change, they say.

In all likelihood, the "fat map" that emerges from the weigh-in will match closely race and class demographics: working-class children are more likely to be overweight, as are black girls.

"Girls from black and Afro-Caribbean communities are more likely to be obese than some of their counterparts," Dr Fiona Adshead, Deputy Chief Medical Officer, told MPs this month.

But the sensitivities of weighing and measuring more than a million primary school children in two months are not limited to race and class.

"The little ones don't mind much," says Ms Richardson-Todd. Just as in measuring eyesight, school nurses play pirates to get children to wear eye-patches so they make a game out of getting on the scales, she says. "The 10- and 11-year-olds are more tricky. They are becoming body conscious, so we see them one at a time."

In one pilot project in Birmingham, the older children are weighed and measured behind a screen by teaching assistants as part of their maths class. It is a "de-medicalised" model that other schools are being urged to follow - and is designed to reduce the stigmatisation of fatter children.

Indeed, the Government's own Children's Commissioner, Professor Al Aynsley-Green, was so worried about what children would make of being measured that he commissioned research on the issue.

Reporting to MPs, health officials admitted they had found that some children feared they would be bullied as a result.

"Some of the kids, particularly the younger ones, expressed concerns about being measured. What they said is that they might be bullied, and particularly if children already have a reason why they might be bullied," said Dr Adshead.

Psychiatrists worry what sort of messages young children will pick up from the anti-obesity drive. Dr Robin Arnold, of the British Medical Association's psychiatry committee, said: "It may well be justified in public health terms but one wonders what it will do to rates of eating disorders like anorexia nervosa in the future."

It is because of such fears that the Children's Commissioner is opposed to feeding children's measurements back to parents.

Anti-obesity campaigners, however, insist that both measuring and reporting the results are justified. Dr Colin Waine, chairman of the National Obesity Forum, said: "We know that being obese in childhood can double the standard mortality rate in adults over the age of 50. It can increase the chance of cancer by 20 per cent in men and 14 per cent in women, the risk of type 2 diabetes is well known - the list goes on."

Tam Fry, of the Child Growth Foundation, agrees: "I am delighted that ministers seem to have seen sense and decided to tell parents the data about their children. I just think that it is disastrous that we are only measuring children as they enter and exit primary school - we should be doing it much more frequently."

Hugh Taylor, the Department of Health's most senior civil servant, told MPs he rejected claims that there was no effective treatment for childhood obesity, citing what he called the "chocolate biscuit test".

"If you look at what it would take to shift children out of the obesity category, we are talking about children on the cusp reducing the calorie intake by 30 to 40 calories a day. A chocolate biscuit is 80 calories a day; a packet of crisps is 120 calories a day. That gives you a measure that this ought to be a problem that is tacklable," he said.

The weighing exercise marks a return to what was routine in the age of the school medical, according to Claire Rayner. "Anyone over 50 will remember they took it for granted that they would be weighed and measured. As long as children know that it is happening to all of them there is no need to worry and, yes, parents should be told. I can imagine no better wake-up call than receiving a letter from the school," said the agony aunt and patients' rights campaigner.

Virginia Ironside, however, is sceptical about the programme. "It's not as if being fat is a hidden problem is it? It all seems a bit Germanic to measure everyone and will probably only succeed in getting parents' backs up."

Prue Leith, the celebrated cook and chairman of the British Food Trust, said: "We are getting obsessed with obesity, but weight is just too simple an answer. Children can be obese but at the same time malnourished because so many of them are protein deficient, thanks to a diet of largely pasta and bread.

"A better solution is to give schools more money to improve ingredients, upgrade kitchens and train dinner ladies so they can motivate and inspire the kids. If they can get children caring about what they put into their bodies, the children will sort it out for themselves... weighing the kids and lecturing the parents is not the path to take."

Jamie Oliver, who has led the campaign to improve the quality of school meals, has recently expressed his frustration at the lack of progress: "Last time I met Charles Clarke, he moved on the very next day. Ruth Kelly was next, and I had just lined up another meeting with her when she was replaced. And there is always the same bloody excuse - 'I've just started'. It makes it hard."

Perhaps the biggest concern about telling parents the results of the tests is that the measure used, body mass index, is notoriously misleading, especially when used to measure children. It cannot distinguish between fat and muscular physique, so paediatricians use waist circumference as a deciding measure when assessing whether a child is obese.

But plans to routinely measure children's waist circumference were dropped by health officials because it would involve the touching of children.

Caught between not wanting to hurt children's feeling or expose them to potential abuse, and wanting to save them from a life dogged by ill-health, ministers have ended up with a messy compromise.

Case study: 'She'd prefer a roast to a burger every time'

Rachel and John Taplin are in their 30s and live with their five-year-old daughter Annabel in Solihull

"I do think it is really important that children eat healthily. Both my husband and I were brought up that way and we are determined to do the same with Annabel," said Rachel. "Cooking and eating together is very important to us as a family. We buy fresh organic fruit and vegetables and lean, free-range meat."

The couple run a website that helps women find work that fits around school hours. In a typical week, the Taplins have meals like home-made cottage pie, pasta, baked potatoes and a traditional roast dinner. Annabel has managed to escape the lure of fast food, according to her mother, and takes an omega-3 and vitamin supplement every day.

"Because she's always had things like salmon and fresh pasta, she prefers home-cooked food to things like chicken nuggets and chips. She will take a home-made roast over a McDonald's any time," said Rachel. "She has not been brought up to have chocolate and sweets as rewards. They are available if she wants them, but it is not a big issue and she really would rather ask for a juicy red apple.

"As a family we make time to have a proper routine around mealtimes and eat at five so that Annabel has time to digest her meal properly before going to bed. Unfortunately, a lot of parents don't have the time and lead such busy lives that mealtimes can suffer," she said. "Good food and a good diet is part of a healthy lifestyle."

Jonathan Owen

A life in the day of a British 4-year-old

Breakfast time

This boy sometimes starts his day with a bowl of porridge (113 calories) but prefers chocolate cereal with whole milk - 275 calories

Off to school

He burns about 150 calories walking to school and back. Like 79 per cent of children, he lives within walking distance; 39 per cent are driven
 

Morning break

He runs around for at least 60 minutes a day as recommended by the Chief Medical Officer. One in three children don't do even this
 

Lunchtime

He eats a healthy packed lunch - its contents are inspected by his school. No crisps, sweets or fizzy drinks are allowed
 

PE lesson

He has a regular PE lesson, unlike 25 per cent of British schools that still don't offer pupils a bare two hours of PE a week
 

Hometime

He spends 12 hours a week in front of the telly or computer - the average. But snacks can add up to 170 calories an hour

Teatime

Home-made vegetarian shepherd's pie, mash and juice at 575 calories means he can indulge in a scoop of chocolate ice-cream

Bedtime

And so to bed, he typically sleeps the recommended 10 hours. Usually.

    Fat: How the national obsession is coming into the classroom, IoS, 21.5.2006, http://news.independent.co.uk/uk/health_medical/article549519.ece

Antidepressant linked to suicide risk in adults

· Top-selling drug already banned for children
· Minister announces move towards talking therapies

Saturday May 13, 2006
Guardian
Sarah Boseley, health editor


Britain's bestselling antidepressant, Seroxat, can cause adults as well as children to become suicidal, according to the manufacturer, GlaxoSmithKline.

GSK, which for years denied there was a problem with the drug, has sent a letter to all doctors in Britain warning of the potential risk in some adult patients. The company has reanalysed data from the clinical trials of the drug and found that significantly more adults who were given Seroxat became suicidal than those given a placebo. Seroxat has been banned from use in children by the UK drug regulator for the same reason. The revelation came as the health secretary, Patricia Hewitt, declared the end of the "Prozac nation" yesterday, launching a programme to cut the numbers of patients on drugs such as Prozac and Seroxat and extend counselling to the thousands of people with mild to moderate depression and anxiety.

"Millions of people suffer from mild to moderate mental health problems and treating them takes up about a third of GPs' time," she said in a speech to the National Mental Health Partnership's conference. "Too many people are prescribed medication as a quick-fix solution."

Talking therapies worked just as well as drugs and people preferred them, she said. Two centres dedicated to counselling and psychotherapy will open in Doncaster and Newham as "demonstration sites" with the intention of extending access to talking therapies across the UK.

Seroxat is the biggest-selling SSRI (selective serotonin reuptake inhibitor) in Britain. In 2003 doctors wrote 19m prescriptions for the drug for patients with anxiety and depression. But concerns about the drug and others in its class have been growing.

GSK's letter to doctors is the result of a reanalysis of its trials requested by the US drug regulator, the food and drug administration, which is reviewing SSRIs. Seroxat is given to patients not only for depression and anxiety but, for a range of other problems defined by psychiatrists as separate conditions, such as panic disorder, generalised anxiety disorder and obsessive compulsive disorder. The analysis has found that patients taking the drug for those conditions may also have an increased risk of suicidal thinking and behaviour. But the clearest findings come from trials of the drug in people who were depressed. In those, says the letter, the frequency of suicidal behaviour was higher in patients on Seroxat than those who, without knowing it, were on a placebo. The numbers were small - 11 out of 3,455 on Seroxat and one out of 1,978 on placebo - but the difference was statistically significant, meaning it was unlikely to have occurred by chance.

Because of the small numbers, GSK says the findings should be interpreted with caution.

It adds that "all of the reported events of suicidal behaviour in the adult patients ... were non-fatal suicide attempts, and the majority of those attempts were in younger adults aged 18 to 30". But the data does suggest "that the higher frequency observed in the younger adult population across psychiatric disorders may extend beyond the age of 24".

GSK says in the letter that it "continues to believe that the overall risk:benefit of paroxetine (Seroxat) in the treatment of adult patients" with depression and other disorders "remains positive", but it warns that young adults particularly should be carefully monitored on the drug.

David Healy, professor of psychiatry and director of the north Wales department of psychological medicine, who has for years called for warnings about the suicide risk of SSRIs, said yesterday that GSK had been in possession of the statistics it was now making public for at least 15 years."Seroxat has a severe withdrawal syndrome, which seems to me to be worse than for other drugs in the group, and the withdrawal syndrome in its own right is linked to people becoming suicidal," he said.

GSK yesterday rejected any accusation of dragging its feet on the data on suicidal behaviour in depressed adults. It had taken advice from experts who had suggested new ways of looking at the information, a spokeswoman said. The analysis, completed recently, had been forwarded to US and UK authorities.

    Antidepressant linked to suicide risk in adults, G, 13.5.2006, http://www.guardian.co.uk/medicine/story/0,,1773935,00.html

Success of heart drugs masks cause of disease

· Call to tackle underlying factors of biggest killer
· 30m prescriptions for statins cost NHS £769m

Wednesday May 10, 2006
Guardian
Sarah Boseley , health editor

Britain is becoming a nation of pill takers, increasingly reliant on drugs to counter its biggest killer, heart disease, rather than tackling the underlying lifestyle causes like obesity and smoking, according to figures released today.

Thirty million prescriptions for cholesterol-lowering drugs, statins, were written in 2004 - one every second of the day - the British Heart Foundation's annual statistical compendium reveals. The bill to the NHS was £769m and is rapidly rising, while the number of prescriptions is 17 times the level 10 years ago and has doubled since 2001.

The foundation, which helped to fund the research into the drugs, says the increased use of statins has prevented thousands of deaths from heart attacks and strokes, with a 7% drop in heart related fatalities in 2004.

Other heart drugs - there are now 200m prescriptions in total a year - and more frequent angioplasties and heart bypass operations have also helped to bring the total of deaths down.

But according to the BHF's figures, 105,842 people still died of heart related disease in 2004, and a third of those were premature deaths under the age of 75.

"The message from the statistics that we have is that we have become pretty good at managing the disease when we know it's there," said Peter Weissberg, BHF medical director. "Fewer people die when they have a heart attack. The problem is that we have done nothing yet really to prevent the disease occurring in the first place."

While those at risk of heart disease seem happy to take their medicines, there is little evidence that they are motivated to tackle the unhealthy lifestyle that is the cause of their life-threatening disease.

The BHF estimates that at the current rate of progress, it will take 50 years before adults in the UK reach the government's target of eating five portions of fruit and vegetables a day.

Only a third of men and a quarter of women take the recommended level of exercise - at least 30 minutes, five days a week. The UK has the fifth most obese population in Europe.

In less than 20 years, the number of overweight or obese men in England increased from 45% to 67% and the number of women from 36% to 59%. "A big concern we have is that the group of people most likely to die are the overweight who get type 2 diabetes, and sitting in the wings is a huge population of youngsters who are overweight and likely to get type 2 diabetes," said Professor Weissberg.

Type 2 diabetes leads to heart disease. Since the 1970s the trend in heart disease deaths has been steadily downwards. That could change, he said.

"Over the next decade we may start to see the curve climb up again with this cohort of younger people with diabetes and cardiovascular disease." The heart problems in today's obese teenagers could kick in within 10 years.

Statins have cut the risk of a heart attack by 30% in trials, but they are not the whole answer.

"The fact is that we still end up with people with heart attacks on statins. The best way to avoid heart attacks is not to get the heart disease that causes it in the first place," he said.

The BHF says the government and the food industry need to do more. It says it is disappointed that efforts to make food labelling clearer and restrict junk food advertising to children have been "so undermined by some in the food industry".

Few doubt the benefits of statins for people at high risk of heart disease or who have already had a heart attack or stroke. But many take issue with the government's strategy to allow high street chemists to sell them to the public.

The Department of Health says it has no idea how many people are taking the low-dose statin called Zocor Heart-Pro, which was given a licence for pharmacy sale. Graham Jackson, consultant cardiologist and editor of the International Journal of Clinical Practice, described the exercise as "one huge experiment" in which the public were guinea pigs.

"The reason I'm not - and a huge number of people as well are not - happy is because you don't know the profile you are dealing with," said Dr Jackson. "You could be giving them strong medication without any real indication that they need it."

Pharmacists are supposed to give patients cholesterol tests, but the needleprick sort they administer is "totally inaccurate", said Dr Jackson. A doctor would measure the levels of different types of cholesterol, as well as triglycerides, in the blood, and then set targets for reducing them with appropriate drug treatment.

There is no long-term data on the effectiveness of giving people statins through a pharmacy.

"These are not Smarties. They do have side-effects," Dr Jackson said. "While they are thankfully low, they are present." The commonest are muscular aches and pains. One high dose statin, called Baycol, was taken off the market because of the numbers of people developing a serious condition involving muscle breakdown.

Ike Iheanacho, editor of the Drug and Therapeutics Bulletin, said the promotion of statins could send confused messages to the public.

"The way the message is often presented in terms of the wonder drug is very glamorous compared to the one about eating a healthy diet and taking regular exercise and stopping smoking," he said.

At a glance

· Coronary heart disease costs the healthcare system around £3.5bn a year, according to the British Heart Foundation. Most of this is the cost of hospital care for people with heart attacks and strokes and treatments such as bypass operations. Drug costs are a significant part of the bill, though, at 16%

· Death rates have been falling in the UK, but not as fast as in some other countries. Deaths in men aged 35-74 fell by 42% between 1990 and 2000 in the UK, but by 54% in Norway and 48% in Australia

· Smoking causes more than 30,000 deaths a year from heart disease, it is estimated

· Declining physical activity is a cause of rising heart disease. Since the mid-1970s the average number of miles per person travelled on foot each year has dropped by around a quarter and by bike by around a third

· Coronary heart disease causes more than 105,000 deaths a year, approximately 21% of all male deaths and 15% of those in women

    Success of heart drugs masks cause of disease, G, 10.5.2006, http://society.guardian.co.uk/health/story/0,,1771342,00.html

Fears of panic as St Ives HIV cluster is discovered

· Health authority tries to track down man's partners
· Men and women aged 20 to 60 could be at risk

Saturday May 6, 2006
Guardian
Steven Morris

An unusual cluster of HIV cases has been discovered in the small Cornish resort of St Ives, health chiefs revealed yesterday.

The local primary health care trust took the rare step of calling a press conference to announce the disturbing finding and warn other residents in the close-knit community that they may be infected.

Health officials set up a hotline to field calls from worried residents of the harbour town, renowned throughout the world for its artists' colony and as the home of the Tate's Cornish outpost. Today and next week clinics will be run in St Ives and in Truro so that people can be tested.

The trust said people may have been infected eight years ago or longer and residents of ages ranging between 20 and 60 could be at risk.

It refused to give any details of the men and women - up to 10 of them - who have been found to be infected. However it is understood that a local heterosexual man is at the centre of the scare. The health authority felt it had to go public because it has not been able to trace all his sexual partners or identify others linked to them. There is no suggestion that the man was deliberately infecting others and the police have not been involved.

At the press conference yesterday the West of Cornwall primary health care trust said the situation had come to light only in the last month.

David Miles, director of public health, said: "We hope that there aren't more people who have contracted HIV - however we think it is quite possible that there may be. Our investigations so far suggest that people will have been at risk for at least the last eight years, and possibly longer.

"It also seems that those at risk are in a wide range of age groups, from young adults through to men and women in their 50s, who have had unprotected sex. People may have contracted HIV and not yet be experiencing symptoms."

There was scepticism from some health professionals about the decision to go public as it is thought such a move could drive people underground, as well as causing panic. Dr Miles said the trust had consulted with the health protection agency before making its announcement. It felt it had to act as it did because it was not certain it could trace all the partners of those involved.

The trust's revelation dominated conversation in St Ives' cafes, pubs, beaches and art galleries yesterday. Emerging from the surf on Porthmeor beach, Steve Jones, 32, said: "It's a real shock. Everyone's been looking around, wondering has he got it, has she got it? Have I got it?"

Bar worker Sam Duda, 24, said: "It does worry you. I think lots of people will be confused and just go and get tested because they are not sure. There will be a lot of people panicking. I think the lines and clinics may be overworked."

Plumber, Ian Bird, 49, said: "It's concerning to think that somebody might be out there infecting people. I will have a word with my kids and my friends to make sure they all know to be careful. You don't really expect it in a place like St Ives."

In relative terms the cluster is large. Between 70 and 80 people in the whole of Cornwall are being treated for HIV or Aids. In 2004 - the most recent years for which figures are available - there were only 49 new cases in the whole of Cornwall and Devon.

The move to go public is rare but not unprecedented. Eight years ago health chiefs in Doncaster, South Yorkshire, identified 10 cases of HIV, five of which were linked to one heterosexual man.

But fears are bound to be even more acute in St Ives because of its size - only around 6,000 people live in the picturesque centre of the fishing town.

Artist Alexandra Dickens said: "It's a very small community. You come across the same people again and again. People break up and move on, relationships overlap. I should think a lot of people are very frightened at the moment."

HIV may be passed on through unprotected vaginal, anal or oral sex. Unprotected sex is sex without a barrier such as a condom. There is also a risk with condoms that split during sex.

Any individual who is concerned they may be at risk can be tested for HIV through the genito-urinary medicine service. A dedicated, confidential helpline number is available on 0845 850 9850.

    Fears of panic as St Ives HIV cluster is discovered, G, 6.5.2006, http://www.guardian.co.uk/aids/story/0,,1768853,00.html

Stuff the kids

It bombards them with adverts, seduces them with merchandise - and then fills them with additives. In an exclusive extract from his explosive new book, Eric Schlosser reveals how the fast-food industry exploits its key audience - the very young

Monday April 24, 2006
Guardian
Eric Schlosser


In late August 2004, on the island of Singapore, John Pain asked a large gathering of business people from Malaysia, China, Indonesia and the Philippines to stand up. Then he asked them to raise their arms and form the shape of three letters, one after another. "Give me a Y!" Pain yelled out. "Y!" they yelled back. The auditorium was suddenly full of people looking like Ys. "Give me a U!" "U!" "Give me an M!" "M!" "What's that spell?" "YUM!" "What's that spell?" "YUM! YUM! YUM!"

It was strange to see adults behaving this way, especially at a business meeting in south-east Asia. Pain works for KFC and he was trying to get the crowd excited about Yum! Brands, Inc, the company that owns KFC, Pizza Hut and Taco Bell. He was giving a speech about the "Top 10 ways to market to Asian youths of today" at the Youth Marketing Forum 2004 conference. Hundreds of business people had paid thousands of dollars to learn the secrets of how to sell things to children. Sitting in the audience were representatives from McDonald's, Disney, Coca-Cola, Toyota, Nestlé and MTV. A special workshop held the previous day had promised to help companies create "brand preference and loyalty" among children.

"It is all about establishing a relationship early," Paul Kurnit, the president of a marketing firm called KidShop, told the conference on opening day.

The relationship between big companies and small children has changed enormously in the past 30 years. Until recently, just a handful of companies aimed their advertising at children and they mainly sold breakfast cereals and toys. By 2002, however, the top five food advertisers in the UK were McDonald's, Coca-Cola, KFC and Pizza Hut. British food companies now spend £300m every year advertising to kids. Business people now realise that kids have a lot of money to spend and a lot of influence on what their parents buy. Every year in the United States children are responsible for more than $500bn worth of spending. Big companies want that money. And too often they are willing to manipulate kids in order to get it.

Before trying to control children's behaviour, advertisers have to learn what kids like. Today's market researchers not only interview children in shopping malls, they also organise focus groups for children as young as two or three.

At a focus group, kids are paid to sit around and discuss what they like to buy. The idea of creating a squeezable ketchup bottle came from kids in a focus group. Heinz earned millions of dollars from the idea; the kids who thought of it were paid a small amount. Advertisers study children's drawings, hire children to take part in focus groups, pay children to attend sleepover parties and then ask them questions late into the night. Advertisers send researchers into homes, stores, fast food restaurants and other places where kids like to gather. They study the fantasy lives of young children, then apply the findings in advertisements and product designs.

"Children are important because they not only represent a significant percentage of our customers," a Burger King spokesman said, "but they also have an incredible influence on what fast food restaurant their parents will choose."

The latest scientific research is also being used to make kids buy things. At the Singapore conference, Karen Tan, representing Coca-Cola, discussed how to make children remember a company's ads and create "brand stickiness". According to Tan, research has found that one way to make a lasting imprint on a child's mind is to run the same advertisement over and over again. Repeating the same ad for a product is more effective than running a variety of different ads. The more times a child sees exactly the same ad, the more likely he or she will remember the product.

The average American child now spends about 25 hours a week watching television. That adds up to more than 1.5 months, non-stop, of TV every year. And that does not include the time spent in front of a screen watching videos, playing video games or using a computer.

Aside from going to school, American children now spend more time watching television than doing anything else except sleeping. The average British child spends two hours and 20 minutes every day watching television and 25 minutes playing video games. In the UK, more than half of children under the age of 16 have a television in their bedroom.

During the course of a year, the typical American child watches more than 40,000 TV commercials. About 20,000 of those ads are for junk food: soft drinks, sweets, breakfast cereals and fast food. That means American children now see a junk food ad every five minutes while watching TV - and see about three hours of junk food ads every week. American kids aren't learning about food in the classroom. They're being taught what to eat by the same junk food ads, repeating again and again.

Although the fast food chains in the US now spend more than $3bn every year on television advertising, another form of product promotion has proven even more effective. "The key to attracting kids," one marketing publication says, "is toys, toys, toys."

The fast food chains now work closely with leading toy makers, giving away small toys with children's meals and selling larger ones at their restaurants. As part of its Happy Meals programme, McDonald's has worked with Fisher Price to give away Toddler Toys aimed at kids aged one to three. One of the Fisher Price toys was a tiny doll of a McDonald's worker holding a milkshake. Both McDonald's and Burger King have given away Teletubbies dolls. Teletubbies is aimed at children too young to speak.

Children's meals often come with different versions of the same toy so that kids will nag their parents to keep going back to the restaurant to get a complete set. For many hard-working parents, buying a children's meal that includes a free Hot Wheels car, a Simpsons talking watch or a Butt-Ugly Martians doll seems like an easy way to make their kids happy. For the fast food chains, the toys are an easy way of making money. Giving away the right toy can easily double or triple the weekly sales of children's meals. And for every additional child, one or two additional adults are usually being dragged into the restaurant to eat.

"McDonald's is in some ways a toy company, not a food company," says one retired fast food executive. Indeed, McDonald's is perhaps the largest toy company in the world. It sells or gives away more than 1.5 billion toys every year. Almost one out of every three new toys given to American kids each year comes from McDonald's or another fast food chain.

McDonald's Happy Meal toys are manufactured in countries where the prices are low. On the bottom of these toys you often find the phrase "Made in China". Too often the lives of the workers who make Happy Meal toys are anything but happy. In 2000, a reporter for the South China Morning Post visited a factory near Hong Kong. The factory made Snoopy, Winnie the Pooh and Hello Kitty toys for McDonald's Happy Meals. Some of the workers at the factory said they were 14 years old and often worked 16 hours a day. Their wages were less than 20 cents (11p) an hour - almost 30 times less than the lowest amount you can pay an American worker. They slept in small rooms crammed with eight bunk beds without mattresses.

At first, McDonald's said it had seen no evidence that such poor conditions existed at the factory, but later it admitted that some things were wrong there. A few months later, a reporter found that another factory in China that made Happy Meal toys was mistreating its workers. They were working 17 hours a day - and being paid less than 10 cents an hour. McDonald's now tries to ensure that children aren't employed to make its toys. But the company hasn't done much to increase the wages of the workers at Chinese toy factories. Low wages are one of the things that keep Happy Meal toys so cheap.

In fact, low wages are at the heart of the whole enterprise. Danielle Brent is a 17-year-old schoolgirl at Martinsburg High School in West Virginia. On Saturday mornings the alarm in her mobile phone goes off at 5.30am. It's still dark outside as she stumbles into the bathroom, takes a shower, puts on her makeup and gets into her McDonald's uniform. Her father stays in bed, but her mother always comes downstairs to the kitchen and says goodbye before Danielle leaves for work. Sometimes, it's really cold in the morning and it takes a while for the engine of the family's old car to start cranking out heat. There are a lot of other things she would rather be doing early on a Saturday morning - such as sleeping. But like thousands of other American kids of her age, Danielle gets up and goes to work at a fast food restaurant.

When Danielle was a little girl, she loved to eat at McDonald's. Sometimes she would even go there for breakfast, lunch and dinner. When she was 16, a friend suggested that she apply for a job at the McDonald's near Interstate 81. The friend already worked there, classmates of theirs always ate there and working behind the counter sounded like fun.

Danielle soon realised that the job was different from what she had expected. Some of the customers were rude. Workers in the kitchen didn't always wash their hands and didn't care if the food got dirty as a result. Her friend soon quit the job, but Danielle can't afford to do that. She needs the money. A number of kids at school tease her for working so hard at a job that pays so little. Kids who break the law and sell drugs at her high school earn more money in a couple of hours than Danielle earns at McDonald's in a couple of weeks.

Danielle worries about the amount of time she is spending at McDonald's. Sometimes she is there, on school nights, until two in the morning. "At school, I'm really tired, and I can't do my homework a lot," she admits.

Fast food chains often put attractive girls behind the counter to deal with customers, and that's where Danielle works. The first thing she does at the restaurant is log into the cash register, punching the last four digits of her social security number into the touch screen. Then she grabs a cup of coffee to clear her head before the doors open and customers start pouring in. She usually doesn't feel awake until 10 or 11 o'clock, about halfway through her shift. But that grogginess never gets in the way of her job. Danielle thinks she could operate the cash register - as well as most of the other fancy machines - in her sleep.

Fast food kitchens often look like a scene from Bugsy Malone, a movie in which all the actors were children pretending to be adults. No other industry has a workforce so dominated by teens. Teenagers open the fast food outlets in the morning, close them at night and keep them going at all hours in between. Even the managers and assistant managers are sometimes in their teens. Unlike Olympic gymnastics - a sport in which teenagers tend to be better than adults - there is nothing about the work in a fast food kitchen that requires young workers. Instead of relying upon a small, stable, well-paid and well-trained workforce, the fast food industry seeks out part-time, unskilled workers who are willing to accept low pay. Teenagers have long been the perfect candidates for fast food jobs. They usually don't have a family to support. And their youthful inexperience makes them easier to control than adults.

The labour practices of the fast food industry have their origins in the assembly-line systems that were adopted by American factories in the early 20th century. As a result, the fastfood industry has changed the way millions of Americans work and turned restaurant kitchens into little food factories. At Burger King restaurants, frozen hamburger patties are placed on a conveyor belt and come out of a broiler 90 seconds later, fully cooked. The ovens at Pizza Hut and at Domino's often use conveyor belts. The ovens at McDonald's look like commercial laundry presses, with big steel hoods that swing down and grill hamburgers on both sides at once. The burgers, chicken, French fries and buns are all frozen when they arrive at a McDonald's. The shakes and soft drinks begin as syrup. At Taco Bell restaurants, the food is "assembled", not prepared. The avocado dip isn't freshly made by workers in the kitchen; it is made at a gigantic factory in Michoacan, Mexico, then frozen and shipped to the US. The meat at Taco Bell arrives frozen and pre-cooked in vacuum-sealed plastic bags. The beans are dehydrated and look like brownish cornflakes. The cooking process is fairly simple. "Everything's add water," a Taco Bell employee says. "Just add hot water."

In 1958, a McDonald's executive named Fred Turner wrote a training manual for the company that was 75 pages long. It was a book of instructions that described how almost everything had to be done. Hamburgers were always to be placed on the grill in six neat rows; French fries had to be exactly 0.28in (about 8mm) thick. Today, the McDonald's manual has 10 times the number of pages and weighs about 2kg. Known within the company as "The Bible", it tells workers exactly how various appliances should be used, how each item on the menu should look and how customers should be greeted. This is standard practice in the industry.

"Smile with a greeting and make a positive first impression," a Burger King training manual suggests. 'Show them you are GLAD TO SEE THEM. Include eye contact with the cheerful greeting."

The strict rules at fast food restaurants help to create food that always tastes the same. They help workers fill orders quickly. And they give fast food companies an enormous amount of power over workers. When all the knowledge is built into the operating system and the machines in the kitchen, a restaurant no longer needs skilled workers. It just needs people willing to do as they're told. It seeks workers who can easily be hired, fired and replaced.

The rate at which fast food workers quit or are fired is among the highest in the American economy. The typical fast food worker quits or is fired after only three or four months. One of the reasons they leave their jobs so often is that the pay is so low. The fast food industry pays the minimum wage to more of its workers than any other industry in the US. And fast food workers are the largest group of low-income workers in the US today.

Whenever members of Congress try to raise the minimum wage (which in 2006 is only $5.15 (£3) an hour), the fast food industry always fights hard against any increase. And the industry almost always wins. Between 1968 and 1990, the years in which the fast food chains grew at the quickest rate, the real value of the minimum wage fell by almost half. The fast food chains earn large profits as wages fall, because it costs them less money to hire workers.

According to the Oxford English Dictionary, a McJob is a job that's low-paid and offers little opportunity to get ahead. McDonald's isn't happy about that dictionary definition and has publicly complained that it isn't fair to the company. But the dictionaries insist that that's what the word actually means: a McJob is a job that doesn't promise much of a future.

· These are edited excerpts from Chew on This by Eric Schlosser, published on May 25 by Puffin. © Eric Schlosser 2006. To order a copy for £5.99 with free UK p&p go to guardian.co.uk/bookshop or call 0870 836 0875.

The 59 ingredients in a fast-food strawberry milkshake

To make one at home, you need four fresh ingredients. The processed version isn't so simple ...

Britons now spend more than £52bn on food every year - and more than 90% of that money is spent on processed food. But the canning, freezing and dehydrating techniques used to process food destroy most of its flavour. Since the end of the second world war, a vast industry has arisen to make processed food taste good.

During the past two decades the flavour industry's role in food production has become so influential that many children now like man-made flavours more than the real thing. As marketing to children has become more and more important to processed food companies and fast food chains, flavourists have increased their efforts to discover what children like. The flavour companies constantly run "taste tests" for kids - focus groups in which new products are piloted.

Fresh fruit and vegetables often have complicated, unpredictable flavours that combine bitterness with sweetness. When flavourists create additives for adult foods, they try to imitate nature as closely as possible. When flavourists create additives for kids' foods, they usually get rid of the bitterness and increase the sweetness. Children's flavours are often twice as sweet as those made for adults.

"Children's expectation of a strawberry is completely different," says one flavourist. "They want something that is strong and that has something like bubblegum notes."

The phrase "artificial strawberry flavour" offers little hint of the scientific wizardry that can make a highly processed food taste like a strawberry. For example, if you wanted to make a strawberry milkshake at home, here's all you'd need: ice, cream, strawberries, sugar and a touch of vanilla.

Now take a look at the ingredients you might find in a fast-food strawberry milkshake: milkfat and nonfat milk, sugar, sweet whey, high-fructose corn syrup, guar gum, monoglycerides and diglycerides, cellulose gum, sodium phosphate, carrageenan, citric acid, E129 and artificial strawberry flavour.

And what does that "artificial strawberry flavour" contain?

Just these few yummy chemicals: amyl acetate, amyl butyrate, amyl valerate, anethol, anisyl formate, benzyl acetate, benzyl isobutyrate, butyric acid, cinnamyl isobutyrate, cinnamyl valerate, cognac essential oil, diacetyl, dipropyl ketone, ethyl butyrate, ethyl cinnamate, ethyl heptanoate, ethyl heptylate, ethyl lactate, ethyl methylphenylglycidate, ethyl nitrate, ethyl propionate, ethyl valerate, heliotropin, hydroxyphrenyl- 2-butanone (10% solution in alcohol), ionone, isobutyl anthranilate, isobutyl butyrate, lemon essential oil, maltol, 4-methylacetophenone, methyl anthranilate, methyl benzoate, methyl cinnamate, methyl heptine carbonate, methyl naphthyl ketone, methyl salicylate, mint essential oil, neroli essential oil, nerolin, neryl isobutyrate, orris butter, phenethyl alcohol, rose, rum ether, undecalactone, vanillin and solvent.

The chicken nuggets and hamburgers at fast food restaurants are usually the least profitable things on the menu. Selling French fries is profitable - and selling soft drinks is incredibly profitable. "We at McDonald's are thankful," a top executive once said, "that people like drinks with their sandwiches." Today, McDonald's sells more Coca-Cola than anyone else in the world.

The fast food chains buy Coca-Cola syrup for about 53p a litre. They add the syrup to bubbly water and serve it in a paper cup. A medium Coke that sells for 75p contains about 5p worth of syrup. Buying a large Coke for 85p instead, as the worker behind the counter always suggests, will add another 2p worth of syrup - and another 8p in pure profit.

Thanks in large part to the marketing efforts of the fast food chains, Americans now drink about twice the amount of soft drinks as they did 30 years ago. In 1975, the typical American drank about 120 litres of soft drinks a year. Today, the typical American drinks about 240 litres of soft drinks a year. That's well over 500 340ml cans of soft drink, per person, every year.

Even toddlers are now drinking soft drinks. About 20% of American children between the ages of one and two drink soft drinks every day.

    Stuff the kids, G, 24.4.2006, http://www.guardian.co.uk/g2/story/0,,1759882,00.html

Industry lobbying 'derailed junk food ban'

· Broadcasting regulator met food bosses 29 times
· Advertising controls too weak, say campaigners

Saturday April 22, 2006
Guardian
Felicity Lawrence, consumer affairs correspondent

The broadcasting regulator drew up its controversial proposals on the advertising of junk food for children after being lobbied on 29 occasions by the food and advertising industry, records show.

The meetings took place between May 2005 and last month. In the same period, Ofcom saw health and consumer groups on four occasions.

Campaign groups are now considering boycotting Ofcom's consultation on the proposed restrictions on advertising, saying they are too weak and put the interests of industry before the wellbeing of children.

They had wanted junk food advertising banned before the 9pm watershed to protect children of all ages.

Ofcom's proposals rule out that possibility. Ofcom spokeswoman Kate Stross said: "The cost to broadcasters of a ban on such advertising pre-watershed would be very high indeed. We came to the view that it would be disproportionate." It has been estimated that a ban on junk food and drink advertising before 9pm would cost broadcasters up to £240m a year.

Instead, Ofcom has suggested three options, including a ban on junk food ads during programmes targeted at children under 10, which would cost broadcasters £28m a year in lost revenue.

Ofcom was asked by culture secretary Tessa Jowell two years ago to produce targeted plans to curb advertisements of unhealthy foods to children. The move followed a pledge from the Department of Health in its white paper to tackle the marketing of unhealthy products to children.

But, according to campaign groups, industry lobbying has dominated Ofcom's work on the issue.

Ofcom defended its suggested curbs yesterday, saying they were "proportionate" to the "complex problem of obesity".

The records were obtained under a freedom of information request by Sustain, a coalition of 160 health and consumer groups.

They show that Ofcom met representatives from broadcasters of children's programmes, the food industry and advertising industry 29 times between May 2005 and last month. Turner Broadcasting, which owns CNN and the Cartoon Network, Nickelodeon, ITV, Channels 4 and 5, and the satellite and cable broadcasters group all met Ofcom, as did the Food and Drink Federation, Kraft, Unilever and Cadbury Schweppes.

Twelve meetings with industry took place before the first with health groups was held.

Mary Creagh, MP for Wakefield and sponsor of a private member's bill on children's food, said: "I am disappointed by Ofcom's lack of consultation with health and consumer campaigners. They have ruled out a 9pm watershed, which is the only way to stop junk food advertising to children and tackle the timebomb of childhood obesity. Advertisers are now planning their autumn campaigns, and these delays will mean that they will avoid any changes to the broadcast code before 2007."

The consumer watchdog Which? said the Ofcom proposals would not address the issue of obesity. "Even the toughest of the weak options proposed by Ofcom would not cover the programmes children are actually watching," Which? policy expert Michelle Smyth said.

Ms Stross said: "There are a lot of players in industry and we say yes if they want to see us. Consumer groups tended to come to see us together."

    Industry lobbying 'derailed junk food ban', G, 22.4.2006, http://society.guardian.co.uk/health/story/0,,1758968,00.html

12.15pm

Child obesity almost doubles in 10 years

Friday April 21, 2006
Press Association
Guardian Unlimited

The number of obese 11 to 15-year-olds in England has almost doubled in a decade, according to government figures published today.

Around a quarter of children aged 11-15 were classified as obese in 2004, according to the latest health survey for England conducted by the NHS health and social care information centre.

Between 1995 and 2004, the number of obese children in the same age group increased from 14% to 24% for boys, and from 15% to 26% for girls, the survey of around 2,000 children found.

Its also shows that rates of obesity have risen in both young children and teenagers, despite government pledges to tackle the problem.

The proportion of obese two to 10-year-olds rose from 10% in 1995 to 16% in 2004 for boys, and from 10% in 1995 to 11% in 2004 for girls.

The public health minister, Caroline Flint, said the government recognised that it needed to do more and would continue working to meet its target "to halt the year-on-year increase of childhood obesity by 2010".

The survey also showed that a quarter of adults in England are now considered obese. The number of obese men has almost doubled from 13% in 1993 to 24% in 2004. For women, the obesity rate rose from 16% to 24% over the same period.

But the survey also shows that people are exercising more, eating more fruit and vegetables and smoking less.

The number of men eating at least five portions of fruit and vegetables a day increased from 22% in 2001 to 24% in 2004, while the figure for women went up from 25% to 27%.

Between 1993 and 2004, the number of men who smoke dropped from 28% to 22%, while the number of women who smoke went from 26% to 23%.

The number of men exercising moderately for 30 minutes five or more times a week increased from 32% to 35% between 1997 and 2004, and from 21% of women to 24% during the same period.

    Child obesity almost doubles in 10 years, G, 21.4.2006, http://www.guardian.co.uk/medicine/story/0,,1758575,00.html

UK transplant patients go to China for organs from executed prisoners

· Surgeons condemn breach of human rights
· Donor shortage at home drives Britons to travel

Thursday April 20, 2006
Guardian
Sarah Boseley, health editor


British surgeons yesterday condemned the use of executed prisoners' organs for transplants in China, saying that shortages in the UK were tempting British patients to travel despite the grave ethical issues involved.

The British Transplantation Society said that "an accumulating body of evidence suggests that the organs of executed prisoners are being removed for transplantation without the prior consent of either the prisoner or their family".

Thousands of organs are thought to be involved in the lucrative trade, it said. Transplant centres, patients, and the Chinese authorities and judiciary could all be implicated in a breach of human rights.

"The British Transplantation Society condemns unreservedly any activity that transgresses an individual's human rights or involves the coercion of an individual to become an organ donor," said Stephen Wigmore, chairman of its ethics committee. "The alleged use of organs from executed prisoners without consent is considered a breach of human rights and is an unacceptable practice. A reported close relationship between transplant units and the authorities regulating executions and the availability of organs is unethical."

He added: "The alleged sale of organs derived from executed prisoners for financial gain is a lamentable practice.

"Aware also of the burden of human suffering that flows from the worldwide shortages of ethically acceptable organs, any act that risks calling the practice of transplantation into disrepute is to be regretted."

Prof Wigmore said he and his colleagues all knew of patients who had researched the possibility of going to China for transplants.

Two patients at Prof Wigmore's unit in Edinburgh had considered going to China, he said. "One was advised to stay here by the Chinese hospital he approached in Shanghai. The other decided against it for a mixture of ethical and personal reasons," he said.

But evidence from doctors who have left China suggests that many patients are travelling for kidney or liver transplants, perhaps in desperation because of the shortages of donor organs in their own country. Most patients came from Japan and Korea and there were quite a few reports of Chinese Americans returning to China for their operation, he said.

Websites of Chinese transplant centres openly tout in English for business from foreigners. Although they do not suggest the organs come from executed prisoners, they offer a fast supply - between a week and a maximum of a month for a kidney transplant. One website declares: "Viscera providers can be found immediately!" The cost of a kidney transplant is put at $62,000 (£34,600), and a heart transplant at $140,000.

Prof Wigmore told BBC Radio 5 Live that the speed with which donors and patients were matched implied prisoners were being selected before execution. "The weight of evidence has accumulated to a point over the last few months where it's really incontrovertible in our opinion. We feel that it's the right time to take a stance against this practice."

There have been allegations from Falun Gong supporters that members of the banned organisation detained in a labour camp near Shenyang, where a transplant centre is situated, have been executed to provide organs to order.

In response to the growing concern, the Chinese government last month announced that it would ban the buying and selling of organs from July 1. Doctors would be forbidden to remove organs without the written permission of the donor and only a few top centres would be permitted to carry out the operations. But there are doubts in the international community as to whether the profitable trade will cease.

The British Transplantation Society statement "is not timed for any specific reason, but we hope it will inform doctors and patients in the UK about the potential risks of going to China for a transplant and the moral and ethical dilemmas they might not be aware of," said Prof Wigmore. He hoped it might also increase pressure on the Chinese authorities "to make sure these reforms do take effect".

Last September, the Guardian revealed that a Chinese cosmetics company was using skin harvested from the corpses of executed convicts to develop beauty products for sale in Europe. The report prompted the House of Commons health select committee to examine the regulatory system.

The shortfall

One in five people in the UK - more than 13 million - are signed up to donate their organs in the event of death, and yet there is a shortfall of organs available for transplant. More than 8,000 people need a transplant each year, but fewer than 3,000 can be carried out.

Part of the problem is the decreasing number of deaths among younger people, whose organs are most suitable. Seatbelt legislation brought about a steep drop.

Most patients will get their transplant in the end, but about 400 die on the waiting list every year. The biggest need is for kidneys - around 6,000 need a kidney transplant.

The phone number for registration on the donor database is 0845 6060400.

    UK transplant patients go to China for organs from executed prisoners, G, 20.4.2006, http://www.guardian.co.uk/medicine/story/0,,1757219,00.html

Blair faces inquiry into NHS crisis

MPs to probe £700m deficit as prime minister says reform at 'crunch point'

Wednesday April 19, 2006
Guardian
Patrick Wintour, political editor

MPs are preparing to launch an inquiry into how NHS trusts have managed to accumulate multimillion pound deficits despite record extra spending, the Guardian has learned.

The inquiry, expected to be agreed by the health select committee, will pile further pressure on Tony Blair and the health secretary, Patricia Hewitt, over the impact of their reform programme.

Downing Street now believes that it is potentially more vulnerable over the NHS than any other issue, with the prime minister warning yesterday that his long planned reforms have reached "crunch point". In his second speech on health in a week, Mr Blair admitted that the scale of the challenge to deliver a new NHS was "very, very tough".

It is thought the overall size of NHS deficits has reached more than £700m, and some well-managed trusts are angry that they are seeing some of their extra funding for this year reduced to bail out those trusts that are in deficit.

The health select committee - which has the power to call Ms Hewitt and other ministers for questioning - is sceptical about claims from some No 10 advisers that ministers had always foreseen the deficits emerging as the NHS change programme started to bite.

Kevin Barron, the committee's Labour chairman, said yesterday: "The biggest issue inside the NHS is that we know what the NHS spends, but we do not know what it costs. Rolling over deficits has been one way of disguising the costs."

The inquiry is likely to look into the scale and location of the deficits, the government's planned recovery programme and whether successful trusts are still having to bail out inefficient ones. Ms Hewitt has blamed poor financial management, and pointed out that the deficit is only 1% of the total NHS budget. But government critics blame miscalculations over the escalating cost of GPs', consultants' and staff pay. There were claims yesterday that some GPS are earning more than £250,000 a year.

For some months No 10 has not sought to dramatise the scale of the NHS reform programme for fear of stirring up backbench dissent, but Mr Blair has evidently decided he needs to re-explain the purpose of the reforms.

He said yesterday: "This is not the moment to back away or dilute these changes, but rather the moment to hold our nerve, back the change-makers in the NHS who are making it happen, and see the process of change through."

Mr Blair defended the deficits being tackled by primary care trusts up and down the country, which has so far led to more than 7,000 job cuts. "We need to be clear about why the deficits are appearing," he said. "The reforms expose the deficits, they do not create them. Our reforms are opening up the system for scrutiny. They are closing off the hiding places for poor financial management."

In the Commons, Ms Hewitt admitted that NHS redundancies were "very worrying" for staff, but said reports of thousands of job losses were "nonsensical". She added: "It is very few hospitals indeed who will need to consider and may be consulting on redundancies."

David Cameron said: "There is a huge mystery at the heart of British politics, which is how can they have spent quite so much money on the health service and yet today we have got thousands of people facing the sack and we have got hospitals facing closure and vast deficits."

    Blair faces inquiry into NHS crisis, G, 19.4.2006, http://politics.guardian.co.uk/publicservices/story/0,,1756468,00.html

Britons turn to alcohol to mask depression

· 1 in 10 drink every day to 'self-medicate' emotions
· 88% find it hard not to drink at all, study reveals

Tuesday April 18, 2006
Guardian
Polly Curtis, health correspondent

Britons are using "dutch courage" to mask the fact that they are suffering low-level depression, according to research. The soaring drinking rate - consumption has doubled in the past 50 years - is evidence that people are attempting to "self-medicate" their emotional upsets away, the Mental Health Foundation reported today.

Research carried out for the foundation identifies one tenth of the population who drink every day - around 5 million people. The same one in 10 were most likely to report that they drink to feel less anxious or depressed and would find it most difficult to stop drinking. But it also challenges the idea that drinking is the terrain of the young - 15% of over-55s drink daily compared with just 3% of 18-34-year-olds.

People with psychiatric disorders are twice as likely to be alcoholic than the general population, the report says. Seventy per cent of men who kill themselves have drunk alcohol before doing so.

But the report highlights the wider problem of "self-medicating" emotional trauma with alcohol. Research by NOP found that 40% of people drink to feel less anxious, 26% to deal with depression and 30% to "forget their problems".

Some 88% of more than 1,000 people questioned would find it difficult to give up alcohol completely while 77% said it made them feel relaxed.

Government figures showed 38% of men and 16% of women drink above recommended limits while 1.1 million people in the UK are said to be dependent on alcohol.

Andrew McCullock, chief executive of the foundation, said: "People are drinking to cope with emotions and situations they can't otherwise manage, to deal with feelings of anxiety and depression.

"Drinking alcohol is a very common and accepted way of coping - our culture allows us to use alcohol for 'medicinal purposes' or 'dutch courage' from an early age. But using alcohol to deal with anxiety and depression doesn't work as alcohol can weaken the neurotransmitters that the brain needs to reduce anxiety and depressive thoughts. This is why lots of people feel low when they have a hangover." The report was published to coincide with the beginning of National Depression Week.

Separately the mental health charity Depression Alliance has written to the National Institute of Health and Clinical Excellence, which approves medicines for use by the NHS, appealing to it to consider how complementary therapies are used to treat depression because, it says, there is an overwhelming demand from patients.

Research for the charity found 11% of members of the public questioned had either tried a complementary therapy to deal with depression or had a friend of family member who had. The letter suggests the use of the herb St John's wort could save the NHS thousands of pounds. Antidepressants cost on average £18.82 a week compared with 82p for the remedy.

Lynsey Conway, a trustee of the alliance, said: "We get so many hundreds of calls about complementary therapies and it seems there is a complete lack of guidance, support of medical evidence."

A spokeswoman for Nice said the Department of Health referred subjects to it for investigation and it would pass the letter on to the ministers concerned.

    Britons turn to alcohol to mask depression, G, 18.4.2006, http://www.guardian.co.uk/medicine/story/0,,1755741,00.html

2.45pm

Woman wins Herceptin court appeal

Wednesday April 12, 2006
Guardian Unlimited
David Batty and agencies

Breast cancer patient Ann Marie Rogers today won her appeal to receive the drug Herceptin on the NHS.
The court ordered her local health body Swindon primary care trust (PCT), which had refused to fund her treatment with Herceptin, to review its policy of only providing the breast cancer drug in "exceptional cases".

Ms Rogers, 54, had said she faced a "death sentence" if she was not provided with the treatment.

In a landmark ruling, the master of the rolls, Sir Anthony Clarke, and fellow appeal court judges Lord Justice Brooke and Lord Justice Buxton said this policy was irrational and "therefore unlawful".

Sir Anthony Clarke said the PCT must now "formulate a lawful policy" upon which to base future decisions about the provision of Herceptin.

Under the ruling Ms Rogers, 54, will receive the drug until the PCT draws up a new policy. If the PCT decides to continue its current policy, it must fund her treatment for another 21 days.

The judgment could have implications for hundreds of breast cancer patients. Herceptin is currently only licensed for use in advanced stage breast cancer, but the ruling could lead PCTs to offer it to those - like Ms Rogers - in the early stages on the disease because it declares it is irrational to treat one patient but not another.

The ruling came as Tony Blair held a Downing Street summit on NHS finances with PCT chief executives, many of whom are struggling with mounting debts. The annual bill for providing Herceptin to the 5,000 women diagnosed each year with early stage breast cancer susceptible to it would come to £109m, according to estimates by cancer specialists.

Speaking outside the court, Ms Rogers said she was "extremely grateful" for the judges' "humanitarian judgment."

She said: "I couldn't have asked for a better verdict, I did this for all women battling this dreadful disease. I believe everyone prescribed this treatment by their doctor should be given the same healthcare wherever they live. I can now look towards the future and have more confidence that I will win this battle against breast cancer."

Ms Rogers' solicitor, Yogi Amin, said: "The judgment means that all women whose doctor has prescribed Herceptin to them for early breast cancer all over the country should have a treatment funded by their health authority.

"Half of the health authorities in England were 'umming and ahing' and giving it to some patients and not to others. Hopefully there is going to be uniform approval of Herceptin for those patients whose doctor prescribes it."

Mr Amin said there were 20 women in Ms Rogers' home town of Swindon who would benefit from the ruling. He estimated there would be hundreds across the country.

Swindon PCT had refused to give the mother-of-three Herceptin as the drug is not licensed for the treatment of early-stage breast cancer, which she has.

The PCT was refused permission to appeal to the House of Lords although it can apply directly. It was also ordered to pay Ms Rogers reasonable legal costs.

But its chief executive Jan Stubbings said it had not been ordered to provide the drug for anyone, only to revisit its policy. She said: "Following this new judgment we will now revisit our policy taking into consideration the points made by the court."

Ms Rogers took the PCT to court because it refused to fund her treatment with Herceptin, despite her doctor prescribing the drug. She has already borrowed £5,000 to fund further courses of treatment but cannot afford to pay for any more. A year's treatment with the drug costs an estimated £20,000.

Earlier this year the pharmaceutical company Roche, which manufactures Herceptin, applied to the European Medicines Agency for a license to approve the drug as a treatment for early-stage breast cancer. The health secretary, Patricia Hewitt, has promised that the NHS treatments watchdog, the National Institute for Clinical Excellence, will fast-track guidance on the use of Herceptin as soon as an early-stage licence is granted.

Joanne Rule, chief executive of Cancerbackup, called for a new fund to be set up to pay for Herceptin to take the pressure off PCTs, many of which are struggling with mounting debts.

    Woman wins Herceptin court appeal, G, 12.4.2006, http://society.guardian.co.uk/health/news/0,,1752310,00.html

Avian flu: wild birds, pets and poultry now at risk

More swans tested amid fears deadly virus will spread across UK

Friday April 7, 2006
Sandra Laville and Ian Sample
Guardian

The lethal avian flu virus found in a swan in Scotland is almost certain to spread to wild birds across the UK before threatening Britain's poultry industry, experts warned yesterday.

Their prediction came as a further 14 swans were being tested for the deadly H5N1 virus that scientists yesterday confirmed had killed the mute swan found in the village of Cellardyke in Fife.

The investigation has now shifted focus to how the bird became infected.

Professor Albert Osterhaus, an expert on avian flu at Erasmus Medical Centre in the Netherlands, told the Guardian Britain could now expect to see a similar spread of bird flu as has been witnessed in Germany. There the virus has spread slowly among wild birds but yesterday reached a poultry farm. Prof Osterhaus warned the virus could also spread through domestic cats and be passed on by them to poultry farms.

Bob McCracken, a former president of the British Veterinary Association, said: "We have to accept the situation that the virus will be spreading among wild birds in the Fife area and probably through time will spread to other parts of the UK. That's the reality."

Yesterday farmers outside a six-mile surveillance zone already in place in Fife, were ordered to move free-range and organic poultry inside. The precaution was in addition to instructions to the owners of millions of birds within the zone to restrict the transport of poultry products to isolate them from wild flocks.

There were recriminations during the day from local people at the speed with which the authorities had removed and tested the contaminated carcass, which was seen moving with the tide in the village's small harbour for days. It was not until Thursday last week that the partially eaten remains were removed by the Scottish authorities for tests.

Tina Briscoe, a university researcher who raised the alarm after spotting the dead bird, said: "It was reported in the evening to Defra and they collected the bird around lunchtime, about 12.30 or so, the following day. I would have expected a quicker reaction, particularly because in the tidal water it could have been washed away or cats could have picked on it."

The H5N1 strain of avian flu has killed more than 100 people, mostly in Asia, since 2003, but as yet it has not mutated to be able to spread from human to human. A Home Office report said this week that up to 320,000 people could die if a pandemic struck Britain. Symptoms include a sore throat, aching muscles, lethargy, eye infections, breathing problems and chest pain. Deterioration in patients with the H5N1 strain can happen quickly, and within a few days they can be dead.

But Dr Harry Burns, the chief medical officer for Scotland, insisted the risk to the public was extremely low. "It is no greater today than it was last week or last month. Nothing has changed. This is an avian incident, the risk of this particular virus passing to humans is extremely low."

He said people should not be concerned about eating poultry products, such as chicken or eggs, if they were properly cooked.

Charles Milne, Scotland's chief vet, defended the speed with which the dead bird had been tested. "There were a series of laboratory procedures that needed to be gone through," he said.

The National Farmers Union said although the presence of H5N1 was unwelcome it was well prepared.

"All of the contingency plans that we have for avian influenza have been drawn up on the basis that the highly pathogenic H5N1 strain would reach the UK sooner or later," a spokesman said.

If the virus spreads to the poultry population, as some predict, birds on infected premises will be culled to stop the spread of the disease. But mass bird vaccination is not expected.

    Avian flu: wild birds, pets and poultry now at risk, G, 7.4.2006, http://www.guardian.co.uk/birdflu/story/0,,1748947,00.html

Anti-abortionists turn sights on schools and hospitals in US-style campaign

· Catholic teachers targeted by pro-life website
· Police keep watch as tactics of hatred spread

Monday March 27, 2006
Guardian
Sandra Laville

Anti-abortionists inspired by the militancy of the movement in America are adopting tactics associated with animal rights extremists in an escalating campaign of intimidation.

The latest victims of harassment by a group called UK Life League are the pupils and teachers at a Catholic girls school in Surrey. The head teacher of Woldingham School, Diana Vernon, has been accused of "child abuse" for providing sex education for her 14- and 15-year-old pupils as required under the national curriculum. Activists are being encouraged to bombard Ms Vernon with hate emails.

Earlier this month, a gynaecology nurse at King's College Hospital in London, who has been commended for her work, was the target of a hate campaign by the anti-abortion group. Her home address was posted on its website and she was accused of being a "cold-hearted baby killer".

Elsewhere, hospitals have been sent images of aborted foetuses and abortion clinics subjected to noisy demonstrations.

Police sources within the National Extremism Tactical Coordination Unit (Netcu), set up primarily to tackle animal rights extremists, said it would be closely watching the activities of the Life League, and the man behind it, James Dowson, a businessman and self-styled vicar, who is a former member of the Orange Lodge in Northern Ireland.

"These tactics are akin to those of animal rights extremists," the Netcu police source said. "The posting of addresses on the internet and the way they are encouraging spam mails all sounds very familiar to us, which is why we are interested."

Abusive emails

Staff at Woldingham School, a private day and boarding school in a remote location in Surrey, became aware they were Mr Dowson's latest target only last week, when they began to receive abusive emails from America and the UK.

"I couldn't believe it," said Ms Vernon. "What we teach falls entirely within the national curriculum and the way in which we teach the use of contraception is in the context of a committed relationship. Every Catholic school in the country will be doing what we are doing.

"Bearing in mind that I have 500 girls here it worries me that our school's name and address, our email, has been put on their site and people who have been encouraged to think bad things about us have been given our exact location. That in itself is irresponsible," she said.

Mr Dowson, 42, who has offices in Glasgow and Belfast, operates in London from a rented office in Trafalgar House in Piccadilly. Receptionists working for the office rental company First Base, collect mail sent to the Life League and forward it to Mr Dowson in Glasgow. Office staff said they were horrified when they saw the leaflets he was sending out and were led to his website, where images of what he claims are late abortions are posted.

"I didn't realise what he did until someone told me to look at the website," said one receptionist. "Then I looked and I thought it was awful, so harsh and unfair." Staff said Mr Dowson came to the office infrequently and had described himself as a "vicar".

Mr Dowson, whose campaign in Scotland has targeted members of the Scottish parliament and the chief executive of the Brook clinic, told the Guardian his tactics were deliberately "direct" and that he was extending his campaign. He does not feature on any list of clergy in Scotland, but he claims to have been the vicar of a small Scottish church, a role he has relinquished to concentrate on the Life League.

His latest campaigns against Woldingham School, and Sue Bush, a nurse who works in sexual health and abortion services at King's College Hospital, were the result of stepping up his campaign in England. "Woldingham is a Catholic school and Catholic schools have a special onus to teach Catholic teachings," he said. "The Pope is very adamant that this recreational sex education cannot be taught."

US activism

Mr Dowson denied that putting the address of the school on the internet and encouraging anti-abortion activists to target it was putting the 500 pupils and the teachers at risk. "There has been 40 years of pro-life activism in this country and there has been no violence yet," he said.

Mr Dowson said he watched the activities of American anti-abortion activists but denied taking his inspiration from them and said he did not encourage violence. But his direct action has earned him the respect of Neal Horsley, founder of The Nuremberg Files, an extremist US anti-abortion website which prints the names and addresses of doctors and nurses working in clinics across America.

Mr Horsley has said in the past: "Jim [Dowson] is really the key to seeing the expectation of punishment develop in the UK."

Life League, which is a registered company, raises money through donations, and stalls on streets across England and Scotland, a tactic successfully employed by animal rights groups.

Mr Dowson prints images of aborted foetuses on his website and encourages supporters to send pictures of them to hospitals across the country.

Asked how he obtains the pictures, he said: "Some of the images came from other websites, some I have gleaned myself looking through hospital bins. I have searched through hospital bins in Liverpool, Birmingham and Glasgow and took the contents away to photograph."

But Marie Stopes UK, which has been the subject of many demonstrations by supporters of the UK Life League, has challenged Mr Dowson over the images. "That kind of waste is incinerated within hospitals. It has not been possible to access it in hospital bins for 20 years. These images come from American websites, and some look as if they have been tampered with," it said.

    Anti-abortionists turn sights on schools and hospitals in US-style campaign, G, 27.3.2006, http://www.guardian.co.uk/frontpage/story/0,,1740485,00.html

Madness: Britain's mental health time bomb

New figures reveal one in five people will need treatment.
Which is why experts are calling £20m cuts in services 'cruel and insane'

Published: 26 March 2006
The Independent on Sunday
By Sophie Goodchild, Chief Reporter

Health authorities are secretly cutting millions of pounds in funding for psychiatric services, despite alarming new evidence of a crisis affecting an estimated one in five people in Britain. In a move branded "the real madness" by health experts, debt-ridden NHS trusts are slashing budgets and cutting care for the mentally ill.

An Independent on Sunday investigation has established that trusts are planning to cut more than £20m from budgets ear-marked for psychiatric care, using the cash to bail out other parts of the NHS instead.

In some parts of the country, primary care trusts have drawn up secret measures to slash spending on mental health care by up to a third.

With new figures today showing that children as young as seven are now being affected in an epidemic that costs Britain £100bn each year, the disclosures were seized on as evidence that mental health services were at breaking point.

Marjorie Wallace, head of the mental health charity Sane, last night described the plight of the estimated 10 million people suffering from mental illness as a "scandal bordering on cruel". "The real madness is that, while we are bringing in reforms, UK health trusts in debt are turning first to cutting mental health services. It's cruel and insane."

Last week, following this newspaper's four-year campaign, the Government dropped its controversial Mental Health Bill. Ministers announced the abandonment of their draft reforms in response to widespread opposition by psychiatrists, politicians and patients who had labelled them "unworkable and draconian". These measures included the extension of powers to lock up people suspected of mental illness who had not committed a crime and plans to force those living in the community into taking medication.

A short list of reforms will now be added to existing mental health laws instead, a move which has been cautiously welcomed by campaigners.

But the news that key services are being cut back is expected to push the issue of how Britain cares for the mentally ill back to the top of the political agenda. It comes as a raft of new reports confirm the growing problem of mental illness in the UK, made worse by drug abuse, family break-ups and alcoholism.

Reports by the Mental Health Foundation and the World Health Organisation reveal:

* 1 in 15 children self-harming;

* 19,000 suicide attempts by teenagers every year;

* 20 per cent of people suffering from genuine mental distress such as anxiety or depression and in need of urgent help;

* 25,000 people sectioned every year under the Mental Health Act.

A report to be published tomorrow by Childline will reveal that as many as 1 75,000 children are being deprived of their childhoods because they have been forced into caring for lonely and depressed parents who have been abandoned by services.

Charities say that mental health remains the Cinderella of the NHS and warn of a mental health timebomb if money is wasted on badly thought-out measures. They have reacted with fury to private comments by ministers that the cutbacks are "minor".

"People are labelled 'mad' but what is the real madness?" said Sophie Corlett, policy director at Mind. "Cutting overstrained services struggling desperately to serve some of the most vulnerable people in society?"

    Madness: Britain's mental health time bomb, IoS, 26.3.2006, http://news.independent.co.uk/uk/health_medical/article353687.ece

Thousands of jobs go in NHS cash crisis

4,000 shed in last two weeks as Tories predict total may reach 15,000

Friday March 24, 2006
Guardian
John Carvel and Will Woodward

NHS hospitals serving Tony Blair's Sedgefield constituents announced 700 job losses yesterday, bringing the total cut over the past fortnight to more than 4,000, according to figures compiled by the Guardian.

Conservatives accused the government of allowing the health service to sink under financial pressures caused by ministers' mistakes. They forecast job losses in England might top 15,000 as staff are made to pay for government errors.

Many of the trusts forecasting the biggest deficits have not yet announced their plans, but are expected to do so in the next few days. Officials at the Department of Health think local NHS trusts will try to enter redundancy cost estimates on balance sheets before the end of the financial year, so they can make a fresh start in 2006-07.

Andrew Lansley, the shadow health secretary, said the overall job losses could be 15,000 to 25,000. As many as one in three trusts might end this financial year in the red, with the deficit reaching £750m, he said.

He accused the chancellor of deliberately ignoring the troubled NHS in his budget speech on Tuesday. "Gordon Brown promised investment with reform. The NHS has seen the investment but not the reform. Gordon Brown blocked freedom for NHS foundation trusts. He is opposed to patients' choice. Without patient choice and GP budget holding, the NHS will not respond efficiently."

Job losses announced over the past two weeks included 1,000 at North Staffordshire, 300 at the Royal Cornwall, 300 at New Cross hospital, Wolverhampton, 300 at Telford and Shrewsbury, 200 in Plymouth, 400 at NHS Direct, 180 at Peterborough. On Wednesday the Royal Free hospital in north-west London said 480 posts would go and St Mary's hospital, Sidcup, earmarked 190.

Strategic health authorities submitted plans to the Department of Health on Wednesday for eliminating deficits in 2006-07. They are believed to include closing hospitals and shedding more staff.

The Royal College of Nursing said a preliminary analysis suggested nurses on the basic grades are bearing the brunt of cuts, with work transferred to lower-paid healthcare assistants. Trusts were trying to recruit senior nurses to take on some tasks previously performed by doctors.

Frank Dobson, the former Labour health secretary, said: "The so-called NHS reforms are costing a fortune. The government is spending hundreds of millions of pounds on management consultants and franchising operations to the private sector. Money is being squandered on the new payment system. Paperwork used to cost 4% of the NHS budget, but now costs 15-16%."

Patricia Hewitt, the health secretary, said: "Let's not forget that most of our hospitals are not only improving patient care and hitting targets, but they're doing it within their substantially increased budgets. Even where trusts are now making some reductions - starting with agency staff, managers and administrators - patients should be reassured by the determination of clinicians and management to maintain the best care for patients."

    Thousands of jobs go in NHS cash crisis, G, 24.3.2006, http://society.guardian.co.uk/health/news/0,,1738595,00.html

NHS 'MoTs'

to give early warning of illnesses

Saturday January 28, 2006
The Guardian
Colin Blackstock

All British people will be offered an NHS "MoT" in which they will be told how likely they are to develop certain diseases and illnesses based on tests taken at five stages during their lives.
After the tests, to be revealed in the health white paper next week, those who are most at risk will be given personal trainers and targets on exercise and diet regimes aimed at improving the state of their health.

The health check was one of the top three requests made by people surveyed in citizens' juries on the NHS in October. The health secretary, Patricia Hewitt, said people would be asked to undergo the NHS life check at birth, at 11 and 18, when they have their first child and as they reach their 50s, according to an interview in the Daily Telegraph.

"It will be at key stages in your life," Ms Hewitt said. "It will look at your lifestyle and the medical history of your family. It will examine your diet, smoking habits and weight. If you are high-risk, there will be a follow-up. You'll get a health trainer."

The test will not be compulsory and people will not be punished or penalised if they do not wish to participate.

The introduction of the test is an attempt to make the NHS more of a preventative system than one that responds to illness. Data from the Organisation for Economic Cooperation and Development show that the NHS spends 1.8% of its budget on work to help prevent people falling ill. That is about half the outlay in the US, Germany and the Netherlands.

A Department of Health spokesman said the aim would be to roll out the scheme in more deprived areas first, before broadening it throughout the country. Some primary care trusts are already using health trainers, and the government hopes there will be about 1,200 working in the country by the end of the year.

One practice already trying the scheme is Walnut Lodge surgery in Torquay, which recently began offering a health MoT to patients with long-term conditions such as diabetes and asthma.

Mark Thomas, the practice manager, said about 1,500 were invited for a consultation lasting from 20 minutes to two hours, depending on the number and complexity of their chronic conditions. Nine out of 10 attended. GPs at the surgery made early diagnoses of diabetes in 20 patients and another nine were prevented from becoming "revolving door" patients who might otherwise have needed multiple stays in hospital during the year.

The white paper will also propose a change in the way surgeries operate. Ms Hewitt said the government was keen to encourage GP surgeries to offer more flexible opening hours, with patients able to arrange appointments in the evenings and weekends. There is also likely to be an expansion of walk-in centres in public places such as railway stations.

"The complaint we get most is that patients can't get through on the phone," Ms Hewitt said. "GPs' pay in future will depend on their patients being satisfied."

    NHS 'MoTs' to give early warning of illnesses, G, 28.1.2006, http://society.guardian.co.uk/health/news/0,,1696968,00.html

NHS Crisis

We're spending £94bn

on the health service this year,

compared with £52bn six years ago...

so why are wards shut down,

operations cancelled

and trusts in turmoil?

Published: 18 January 2006
The Independent
By Jeremy Laurance

Doctors: Half the extra cash has gone on staff pay

Since 1997, NHS spending in the UK has doubled to £94bn this year. Consultants and GPs have had salary increases worth up to 50 per cent over three years, taking the average GP through the £100,000 barrier for the first time, making them the highest-paid doctors in the world outside the US. Nurses have had smaller but still substantial rises.

More than 190,000 extra frontline staff have joined the NHS since 1997. Health is a labour-intensive activity and well over half the extra billions invested - 56 per cent - has been spent on pay and pensions for staff. When the NHS Plan was launched six years ago there was plenty of money but a shortage of staff and capacity. Today, the capacity is there but there is a shortage of cash. Too much has been spent to deliver too little - NHS productivity has not risen in line with the resources. In the end, the NHS has ended up costing more but delivering less value for money.

Hospitals: Big debts left by pre-election spree

Funding increases have averaged more than 7 per cent a year in real terms for the past five years, double the long-term trend. Yet wards are closing, operations are being delayed until the new financial year and outpatient appointments are being deferred or cancelled.

In the run-up to the last election, ministers ordered NHS managers to hit the Government's targets to cut waiting times and increase treatments at all costs. No expense was spared as NHS trusts hired temporary staff and sent patients to the private sector to clear lists. There were "no Brownie points for balancing your books".

Since the election, as the bills have come in, ministers have ordered trusts to curb spending and cut deficits - with inevitable pain. One in four trusts forecasts a deficit by the end of the year, a combined total of £948m. Hospitals built under the private finance initiative have faced hefty repayments on their 30-year leases, adding to the deficit.

Waiting lists: Huge sums spent on hitting targets

Waiting lists, which stand at just under 800,000, are at a record low - 500,000 below their peak in 1998. Hardly anyone now waits longer than six months for surgery, compared with more than 250,000 who had to do so five years ago.

From the start, ministers have seen waiting lists as the litmus test of the Government's success on the NHS. At the 1997 election, Tony Blair pledged to cut the waiting list by 100,000 over the first term of parliament. Within a year, the pledge had become a millstone round many of his ministers' necks, cost hundreds of millions to deliver, and remains as problematic as ever, as the new pledge to cut waiting times to a maximum of 18 weeks from the time of GP referral is due to be met by 2008.

Ministers insist the focus on shorter waits reflects what patients want but safety and quality matter to patients too. The effort to cut waiting times risks bankrupting the service.

Drugs: UK pays over the odds for pharmaceuticals

The NHS spends £176 per head of population on drugs, amounting to £10.5bn, almost double the figure in 1997. That amounts to 12.2 per cent of the NHS budget.

Despite cuts worth more than £1bn in the cost of drugs negotiated by the health department, the UK is paying more for branded pharmaceuticals than most other European countries. France, Italy, the Netherlands, Austria and Belgium all pay up to 20 per cent less.

The UK Government controls the cost of drugs under an agreement with the manufacturers designed to give the companies a sufficient return on their investment while charging the NHS a reasonable price. Balancing the needs of the industry and its contribution to the economy against the needs of the NHS means the NHS loses out. There are further pressures in the pipeline from the cost of new "wonder" drugs, such as Herceptin, coming on stream.

Doctors: Half the extra cash has gone on staff pay

Since 1997, NHS spending in the UK has doubled to £94bn this year. Consultants and GPs have had salary increases worth up to 50 per cent over three years, taking the average GP through the £100,000 barrier for the first time, making them the highest-paid doctors in the world outside the US. Nurses have had smaller but still substantial rises.

More than 190,000 extra frontline staff have joined the NHS since 1997. Health is a labour-intensive activity and well over half the extra billions invested - 56 per cent - has been spent on pay and pensions for staff. When the NHS Plan was launched six years ago there was plenty of money but a shortage of staff and capacity. Today, the capacity is there but there is a shortage of cash. Too much has been spent to deliver too little - NHS productivity has not risen in line with the resources. In the end, the NHS has ended up costing more but delivering less value for money.

Hospitals: Big debts left by pre-election spree

Funding increases have averaged more than 7 per cent a year in real terms for the past five years, double the long-term trend. Yet wards are closing, operations are being delayed until the new financial year and outpatient appointments are being deferred or cancelled.

In the run-up to the last election, ministers ordered NHS managers to hit the Government's targets to cut waiting times and increase treatments at all costs. No expense was spared as NHS trusts hired temporary staff and sent patients to the private sector to clear lists. There were "no Brownie points for balancing your books".

Since the election, as the bills have come in, ministers have ordered trusts to curb spending and cut deficits - with inevitable pain. One in four trusts forecasts a deficit by the end of the year, a combined total of £948m. Hospitals built under the private finance initiative have faced hefty repayments on their 30-year leases, adding to the deficit.
Waiting lists: Huge sums spent on hitting targets

Waiting lists, which stand at just under 800,000, are at a record low - 500,000 below their peak in 1998. Hardly anyone now waits longer than six months for surgery, compared with more than 250,000 who had to do so five years ago.

From the start, ministers have seen waiting lists as the litmus test of the Government's success on the NHS. At the 1997 election, Tony Blair pledged to cut the waiting list by 100,000 over the first term of parliament. Within a year, the pledge had become a millstone round many of his ministers' necks, cost hundreds of millions to deliver, and remains as problematic as ever, as the new pledge to cut waiting times to a maximum of 18 weeks from the time of GP referral is due to be met by 2008.

Ministers insist the focus on shorter waits reflects what patients want but safety and quality matter to patients too. The effort to cut waiting times risks bankrupting the service.

Drugs: UK pays over the odds for pharmaceuticals

The NHS spends £176 per head of population on drugs, amounting to £10.5bn, almost double the figure in 1997. That amounts to 12.2 per cent of the NHS budget.

Despite cuts worth more than £1bn in the cost of drugs negotiated by the health department, the UK is paying more for branded pharmaceuticals than most other European countries. France, Italy, the Netherlands, Austria and Belgium all pay up to 20 per cent less.

The UK Government controls the cost of drugs under an agreement with the manufacturers designed to give the companies a sufficient return on their investment while charging the NHS a reasonable price. Balancing the needs of the industry and its contribution to the economy against the needs of the NHS means the NHS loses out. There are further pressures in the pipeline from the cost of new "wonder" drugs, such as Herceptin, coming on stream.

We're spending £94bn on the health service this year, compared with £52bn six years ago... so why are wards shut down, operations cancelled and trusts in turmoil?, I, 18.1.2006, http://news.independent.co.uk/uk/health_medical/article339324.ece