History > 2006 > UK > Health (II)

Health experts

warn of English addiction

to binge drinking

· A fifth of adults double safety limits once a week
· Newcastle, Liverpool and Durham are booze capitals

Friday August 4, 2006
Guardian
John Carvel, social affairs editor

England is no longer a nation of tipplers, but a land in the grip of a dangerous alcohol addiction, public health experts warned last night after the release of research showing 18.2% of adults binge drink more than double the daily recommended limit at least once a week.

In the north-east and north-west nearly a quarter of all adults consume double the limit in one or more drinking bouts each week. This is equivalent to four pints of beer or eight spirit measures in one session for men - three pints of beer, three glasses of wine or six spirit measures for women. Even in the most abstemious regions across eastern and southern England 16% of adults drink this amount or more, at least once a week.

The alcohol map was drawn up by the Centre for Public Health at Liverpool John Moores University and the North West Public Health Observatory.

It showed Newcastle, Liverpool and Durham as the capitals of binge drinking with more than 27% of adults admitting a spree at least once a week, compared with less than 10% in east Dorset.

The north-east and north-west had the most hospital admissions, with 1,100 men and 610 women admitted per 100,000 population in 2004-05. This compared with less than 700 men and 400 women per 100,000 in the south-east.

Liverpool, Manchester and Middlesbrough had around 70% more admissions than the national average. Wokingham and West Berkshire had nearly 50% less.

Professor Mark Bellis, director of the Centre for Public Health, said: "These profiles illustrate the growing costs of cheap alcohol, a night-time economy almost exclusively packed with bars and clubs, and a failure to deliver a credible drinking message to both youths and adults."

Professor John Ashton, the north-west regional director of public health, blamed the government for failing to act against the drinks industry.

"Alcohol is racing ahead as one of the biggest threats to public health, not least in some of the most disadvantaged parts of the country. Fears of being accused of being part of the nanny state have intimidated governments from tackling head-on the manufacturers of cheap alcohol in the same way that they would if this was any other kind of drug."

The average loss of life due to drinking across England was 10 months for men and five for women. But in Blackpool, men could expect to die 23 months earlier and women 13 months. In Manchester, Salford, and Barrow-in-Furness, men lost 16.5 months due to alcohol, compared with two to four months in the Isles of Scilly or east Dorset.

A spokeswoman for the Department of Health said: "We are working hard to raise awareness and ensure that treatment is available to those who need it. The first-ever national needs assessment concerning alcohol problems has just been completed and we are getting more people into treatment.

"We are working with the drinks industry, police and health professionals to increase awareness of the dangers of excessive drinking and make sensible drinking messages easier to understand."

But David Davis, the shadow home secretary, said: "This alarming research shows why it was wrong of the government to unleash 24-hour drinking on all our towns and cities without a proper assessment of the consequences."

Steve Webb, the Liberal Democrat health spokesman, said: "The government still seems to be tiptoeing around the problem."

Health experts warn of English addiction to binge drinking, G, 4.8.2006, http://society.guardian.co.uk/drugsandalcohol/story/0,,1836993,00.html

Blair to defy Bush over stem cells

PM will publicly back California's research into disease treatment despite White House's strong opposition

Sunday July 30, 2006
The Observer
Gaby Hinsliff in San Francisco

Tony Blair is to use his trip to America to back stem cell research despite sharp opposition from President George Bush. The Prime Minister will give his support to scientific research into the treatment of incurable diseases, which has been blocked by Bush.

The President objects on moral grounds to the technique, which involves harvesting human stem cells, the most basic building blocks of life. These are then stimulated to grow replica human tissue, which could ultimately be used for transplants or the treatment of diseases like cancer and Alzheimer's.

Pro-life and religious groups oppose stem cell research because one source of the cells is human embryos created during fertility treatment and subsequently destroyed. Bush vetoed federal funding for embryonic stem cell research five years ago, driving some US scientists to Britain to continue their work, but the state of California - where Blair will deliver a speech tomorrow - has legislated to fund research locally.

The Prime Minister will meet 10 bioscience companies in the San Francisco area and unveil plans for a joint UK-Californian conference on stem cell technology in Britain in November.

Announcing the conference in America will be seen as a bold contradiction of Bush's views, less than two weeks after the President personally vetoed another bill passed by the Senate that would have allowed federal funding for the research, saying it crossed a 'moral boundary'.

However, a Downing Street spokesman insisted there was no conflict, adding: 'George Bush has his own approach [to stem cells], we have our own, and California has its own.'

Blair's attempt to boost the profile of British researchers was in danger of backfiring last night, however, after Downing Street, apparently mistakenly, published private criticism of one of the flagship bodies he is promoting.

Among the 'strengths' of British research listed in a briefing pack handed to journalists was the UK Stem Cell Foundation, set up last year to help turn lab work into medical treatments. Unfortunately, a junior official had failed to remove before publication a note, apparently added for Downing Street consumption, that 'the UKSCF hasn't done much since its establishment'.

It then referred helpfully to further material on 'the difficulties of the California Institute for Regenerative Medicine'. The institute is among the US organisations Blair is meeting tomorrow.

    Blair to defy Bush over stem cells, O, 30.7.2006, http://observer.guardian.co.uk/politics/story/0,,1833431,00.html

American firm is hired

to do all NHS shopping

Contractors will buy everything
from beds to bandages in £4bn deal

July 26, 2006
The Times
By Nigel Hawkes, Health Editor

A GIANT American firm is poised to take over the responsibility for spending more than £4 billion a year of NHS money in the biggest privatisation yet seen in the health service, The Times has learnt.

Novation, the Texas-based group, is in the final stages of negotiating a far-reaching contract that will make it and its German partner, DHL, responsible for buying everything from bandages to hip implants for the health service. The move will mark a massive step towards opening up the NHS to outside companies and is certain to inflame simmering tensions within the Labour Party over what is perceived as creeping privatisation.

Unison, the largest public sector union, announced plans yesterday to ballot members on strike action over the move, and accused Tony Blair of accelerating his market-driven NHS reforms. Such action could coincide with the party conferences and put the battle for the soul of the Labour Party centre stage as Mr Blair comes under pressure to set a timetable for his departure.

Many in the party want to draw a line on private sector involvement in the NHS but Mr Blair says that the test of keeping the health service public is whether services are free to the user.

Karen Jennings, head of health at Unison, said: “The Government’s decision to privatise is driven by pure dogma and an obsession with market-testing.”

The Times has learnt that DHL/Novation is expected to take over from the NHS Logistics Authority and much of the NHS Purchasing and Supply Agency, which are responsible for £4.2 billion a year of purchasing and distribution, or about 5p out of every NHS pound.

The disclosure comes less than a month after The Times revealed that the world’s largest private health companies were being asked to submit tenders for control of primary care trusts, which spend 80 per cent of the NHS’s budget. The advertisement was withdrawn soon afterwards for “redrafting”.

Novation has promised big savings by making tougher, more efficient buying arrangements, alarming unions and the medical devices industry. John Wilkinson, director-general of the Association of British Healthcare Industries, has written to Andy Burnham, the Health Minister, to raise a concerns including fears over “the concentration of such buying power in a single entity”. DHL/Novation would make savings by concentrating on a few large suppliers, squeezing out smaller ones that could not compete on price, he said.

That, he added, would have a profound impact on whether patients received new and innovative treatments — which often come from smaller companies — and would undermine the strategy of the Treasury and the Department for Trade and Industry to encourage such companies.

“We support the need for better procurement in the NHS, but nobody in their right mind would hand over this much power to one organisation when savings, not quality, is the target.

“These small, innovative companies are forging the latest medical breakthroughs for patients, yet the Government’s NHS policy is going to send many of them into bankruptcy. Thousands of jobs are at stake and patients will miss out on the latest care.

“We would welcome a system of several purchasing organisations to provide contestability, not this proposed monopoly.”

DHL/Novation will be paid on the basis of the money it saves the NHS, with no similar incentive for quality. The contract is expected to cover a huge range of equipment, from bandages and syringes to pacemakers and hip prostheses. The Department of Health has refused requests to disclose the full list, on the ground that it is a confidential part of the negotiations.

It was no secret that NHS Logistics, responsible for distributing products to hospitals, was due to be privatised, and that DHL/Novation was the preferred bidder. But it appears that the privatisation will go much wider than thought, to include much of the NHS Purchasing and Supply Agency as well.

NHS Logistics employs 1,400 staff in five distribution centres, making an average of 1,200 deliveries a day to 10,000 destinations. Unison represents about 1,000 of its staff.

Novation and other American group purchasing organisations (GPOs) were the subject of a US Senate hearing this year at which criticisms were made of their influence on the market. One witness, Prakash Sethi, of the Zicklin School of Business in New York, claimed that such organisations took part in questionable contractual arrangements, which enriched them “at the expense of healthcare providers, new entrants and the public at large”.

Mr Burnham said: “We are looking at this option to improve the service and we believe there is significant scope to bring down the prices of goods that hospitals buy, savings which can then be reinvested in patient care.

“However, we recognise the concerns of staff and are looking closely at the proposals before making a final decision.”

THE PROS . . .

Experienced companies that are motivated by profit tend to strike harder bargains


Savings made by buying supplies more cheaply can then be used to provide more NHS services


By contracting out procurement and logistics, the NHS can cut labour and pension costs


Involving private industry sharpens performance by introducing competition and undermining outdated practices

. . . AND CONS

Contracts are based on cost alone, with no measurement of quality — so patient care could suffer


Having a single purchaser is not a good idea because it puts too much power in too few hands


Buying cheap will favour bigger suppliers selling established products, so new entrants with bright ideas will be squeezed out


The NHS is already one of the hardest markets to crack, and this will make it even harder

American firm is hired to do all NHS shopping, Ts, 26.7.2006, http://www.timesonline.co.uk/article/0,,2-2285857,00.html

12.15pm

Major killer disease

'unknown to most'

Thursday July 20, 2006
Guardian Unlimited
David Batty and agencies

Nearly three-quarters of people in the UK have never heard of the country's fifth-biggest killer disease, a charity said today.

A survey by the medical charity Developing Patient Partnerships found that 72% of people were unaware of chronic obstructive pulmonary disease (COPD).

The survey also found that more than three-quarters (77%) of people did not know that the chronic lung disease kills more people than either breast, prostate or bowel cancer.

COPD is caused by smoking in 80% of cases and includes the conditions emphysema and chronic bronchitis. It affects 3 million people in the UK and causes around 30,000 deaths a year - twice the number caused by breast cancer. But the survey found that most people think it is either a minor disease or can be cured.

Developing Patient Partnerships found that 51% of the 1,028 people surveyed would not visit their doctor if they had a common symptom of the disease - a persistent smoker's cough.

The charity has launched an Ever Smoked? campaign to raise awareness of the disease and its symptoms. The campaign encourages people to quit smoking as this can slow the progress of the illness.

The charity's chairman, David Wrigley, said: "Our research shows a worrying level of ignorance about COPD and its often devastating effects on the body."

Dr Wrigley, a Lancashire GP, added: "We know that nearly two-thirds (59%) of smokers would be more likely to try quitting if they knew about the risks of COPD."

    Major killer disease 'unknown to most', G, 21.7.2006, http://www.guardian.co.uk/uk_news/story/0,,1825086,00.html

Care homes scandal:

Abused. Bullied. Confined. Drugged.

The scandal of how Britain cares
for its most vulnerable people - the mentally disabled

Published: 05 July 2006
The Independent
By Jeremy Laurance, Health Editor

Every home for people with learning disabilities in England is to be inspected by the Government's NHS watchdog after an inquiry revealed shocking evidence of "widespread institutional abuse".

Vulnerable people suffering from such conditions as autism and cerebral palsy endured years of bullying, harassment and physical ill-treatment at the hands of NHS staff, the inquiry into services in Cornwall found.

One severely disabled man was tied to his bed or wheelchair for 16 hours a day. Others were given cold showers, had food withheld and spent hours locked in their rooms. A number were drugged to control their behaviour.

The Healthcare Commission, the NHS inspectorate, which conducted the inquiry jointly with the Commission for Social Care Inspection (CSCI), said it is feared the abuse uncovered in Cornwall could be widespread.

During the investigation, 40 residents were referred to Cornwall County Council under the procedure for the protection of vulnerable adults. But the report says "despite the seriousness of the evidence" neither the Cornwall Partnership NHS Trust, which ran the homes, nor the council took adequate action to ensure there was no abuse elsewhere. Five staff were dismissed.

There are more than one million people with learning disabilities in the UK. More than 100,000 are in homes supported by social services, voluntary organisations and the NHS.

The revelation of the abuse in Cornwall follows the closure last year of a private home for adolescents in Norfolk after an inspection by the commission. The commission is investigating allegations of physical and sexual abuse in homes in south London.

In a joint statement, Anna Walker, chief executive of the commission, and David Behan, chief inspector of the CSCI, said: "Our Cornwall investigation highlights unacceptable standards of care. In the light of these events, it is right to ask about the state of services around the country. Sadly, Cornwall is not the only service where serious allegations have been made. Instances of abuse can be symptomatic of services that have been neglected for too long."

The inquiry into services run by Cornwall Partnership NHS Trust began after five families complained to the charity Mencap. The trust runs services for 200 people with learning disabilities at Budock Hospital, near Falmouth, with 18 beds, and in four treatment centres and 46 homes in the community.

The commission clashed early on with the trust, over what it said was its slow and inadequate response. Yesterday, the commission wrote to the Health Secretary, Patricia Hewitt, requesting the trust be placed on special measures after it found senior managers had "failed to identify and correct situations involving physical, emotional and environmental abuse".

At one home, staff removed all taps because of misbehaviour by a resident - leaving the rest with access to a single shower. People were unable to wash their hands despite the presence of a resident who habitually smeared faeces. At another home, light fittings were removed. In more than two thirds of the 46 "supported living" houses, people had their movements too heavily restricted, with staff locking internal and external doors.

Between 2002 and 2005, there were more than 3,000 incidents recorded each year involving the 200 residents looked after by the trust. The report says the high number was a cause for concern and many involved "extreme violence between residents". Residents' money was also misused. The family of one man planned a two-night holiday for him for which the cost on the application form was £260. But when they received the bill, the cost was £751.40. The explanation given was that the extra was to cover staff costs. The commission has referred those cases to the NHS Counter Fraud and Security Management Service.

In a statement, Lezi Boswell, who took over as chief executive of Cornwall Partnership Trust in May, said she had apologised in writing to those involved .She said: "The failings which have been brought to light are shocking and shameful. There are no excuses. I cannot and will not attempt to justify what has happened as it is inexcusable. My job now, as the new chief executive, is to turn the services around.

"The trust fully accepts the recommendations in the report and we are determined to work together with partners to quickly and effectively address the problems raised and to implement all its recommendations."

David Congdon, head of campaigns and policy at Mencap, said: "The extent of abuse of people with a learning disability in Cornwall has been truly appalling. It is quite horrific that this has been allowed to continue for as long as it has."

Pauline and Gerald Bevan, whose son Russell used to be a resident at a care home in Cornwall, welcomed yesterday's report. They now care for their son, 37, at their home in Newquay.

'He was crying and saying he didn't like it there'

The mother of one resident described how she removed her son from the care of the Cornwall Partnership Trust after he returned home for Christmas in 2004 and begged not to be sent back. "He was crying and saying he was unhappy and didn't like it there. He was afraid of going back. It wasn't like him."

Her son, referred to as Y in the Healthcare Commission's report, had spent a year in Budock Hospital before moving to one of the 46 homes in the community, where he lived for seven years. He is described as "moderately disabled".

According to the report, after he had been living there for some time, a member of staff told his mother he had been sexually assaulted on two occasions while at Budock Hospital. It was also alleged that while he was living in the home a member of staff struck him. His parents had earlier complained that their son was frightened of the member of staff who had allegedly struck him and asked that he be moved from the house but the request was turned down.

After his parents, who are both in poor health, decided to have him at home they lodged a formal complaint. The trust said there was no evidence to support either allegation. In its investigation, the Healthcare Commission found that the member of staff alleged to have physically assaulted him had received a formal warning and was moved to another job. An independent review found no evidence that he had been bullied or assaulted but said there was evidence that his clinical care had "fallen below the required standard".

    Care homes scandal: Abused. Bullied. Confined. Drugged., I, 5.7.2006, http://news.independent.co.uk/uk/health_medical/article1160969.ece

3.30pm

Sexually transmitted diseases on the rise

Tuesday July 4, 2006
Guardian Unlimited
Hélène Mulholland

The number of cases of syphilis and other sexually transmitted diseases in the UK has been steadily rising, despite a national government strategy introduced five years ago to tackle them.

Latest figures released today by the Health Protection Agency (HPA) show that the number of sexually transmitted infections (STIs) and other conditions diagnosed in genitourinary medicine (GUM) clinics in the UK increased by 3% between 2004 and 2005.

The figures prompted criticism from the Family Planning Association, which warned that cash-strapped NHS trusts were siphoning off money allocated to improve sexual health services.

Rates of syphilis soared by 23%, affecting 2,807 people, with the rise particularly affecting women, among whom the increase was almost two and a half times higher than among men.

The number of cases of chlamydia, still the most common STI, went up by 5%. It now affects 109,832 people. Cases of genital herpes increased by 4%.

Gonorrhea was the only disease included in the figures that was on the decrease, with the number of cases falling by 13%. It was the second successive year that cases of the disease had decreased substantially.

The highest rates of infection for both sexes were among 16 to 24-year-olds, the figures show.

The 2005 figures show the government's national strategy for sexual health is failing to deliver. Published in 2001, the 10-year programme committed extra investment worth £47.5m to reduce STI transmissions, which soared during the 90s.

Professor Peter Borriello, director of the HPA's centre for infections, welcomed the "significant" fall in gonorrhoea cases last year but warned that "much has to be done" to tackle the "disappointing" rates of infection overall.

He said: "Some of this increase may reflect the greater availability of testing which helps detect cases which would otherwise remain undiagnosed. But the overall trend of increasing numbers shows the full extent of the challenge facing healthcare professionals as they try to limit the spread of STIs."

The chief executive of the Family Planning Association, Anne Weyman, said better public awareness screening services introduced as part of the government's sexual health strategy meant more people were coming forward for testing and treatment.

But she warned that services were struggling to cope, as trusts were failing to spend allocated money on GUM clinics.

Although waiting times had improved, many sufferers were not being seen within 48 hours, with "massive" regional variations in services across the country. The government set a target for all GUM patients to be seen within 48 hours by 2008.

Many clinics were a long way off for the target, Ms Weyman pointed out. Just 37% of patients were seen within 48 hours in the north-east, compared to 69% in London, for example.

"There is grave concern about whether services can cope with this extra demand and pressure," Ms Weyman said.

"A total of £300m was allocated in [the public health white paper] Choosing Health. But primary care trusts faced with crippling budget deficits are skimming off this money to soak up costs. This extra allocation of money only lasts until 2008. Unless genitourinary medicine services are properly modernised now, they never will be.

"Primary care trusts must ensure that money for sexual health services actually reaches the clinics it is intended for. Modern and robust sexual health services need to be put in place now to serve the needs of the population in the future."

    Sexually transmitted diseases on the rise, G, 4.7.2006, http://society.guardian.co.uk/health/news/0,,1812547,00.html

Child mental health disorders have soared, says report

· Some conditions doubled over 30 years
· Alcohol, diet and family decline could be causes

Wednesday June 21, 2006
Guardian
Sarah Hall, health correspondent

The number of children with certain types of mental health disorders has more than doubled in the past 30 years, with a million experiencing problems at any one time in England, doctors' leaders warned yesterday. About one in 10 children will experience a clinically recognised mental health disorder between the ages of one and 15, says the report by the British Medical Association's board of science.

Factors such as the decline of the family, alcohol abuse and diet are cited as potential causes of the rise.

The report, Child and Adolescent Mental Health, reveals that 9.6% of children aged between five and 16 experience some kind of mental health disorder such as eating, emotional or behavioural problems. The study finds that in the 11-16 age group, 12.6% of boys and 10% of girls suffer from a mental disorder.

Launching the publication, the child psychiatrist David Skuse said there had been "a convincing increase" in conduct disorders (extreme behaviour such as bullying and fighting), which usually affects boys, and in emotional disorders (including phobias and depression), which are more prevalent in girls.

Professor Skuse, who is professor of behavioural and brain science at the Institute of Child Health, Great Ormond Street, London, said: "There does appear to have been a real increase over time which isn't due to increased recognition. There was around a 50% increase between the early 70s and mid 80s, and another 50% since the mid-80s in conduct disorders in boys."

The report notes that poorer children, asylum-seeker youngsters, those in care and those who had seen domestic violence were particularly susceptible to mental health problems, but, said Prof Skuse, the rise in emotional and conduct disorders had occurred "across the board".

He said: "It's something that affects children as a whole." The risk might increase with family break-ups but the problems could be linked to housing changes, or diet or alcohol abuse, he said.

The BMA board called for adequate backing for child and adolescent mental health teams and improved services for children in care. Sir Charles George, chair of the board, said that only about a third of children excluded from school were referred to mental health specialists.

A Department of Health spokeswoman said that from 2002 to 2005 the number of child mental health cases seen had risen by more than 40%.

    Child mental health disorders have soared, says report, G, 21.6.2006, http://society.guardian.co.uk/health/story/0,,1802261,00.html

Britain's first beating heart transplant heralds new era

· Cambridge procedure an 'extraordinary' success
· Donor organ carried in its own life support system

Monday June 5, 2006
Guardian
James Randerson, science correspondent


A pioneering form of heart transplant has been performed for the first time in the UK. Doctors say the technique, which keeps the donor heart beating while it is transported, could double the number of heart transplants each year.

Surgeons at Papworth hospital in Cambridge carried out the so-called beating heart transplant on May 22 and the patient - a 58-year-old man - should soon be well enough to go home. The procedure, which has been performed just three times before, in Germany, involves putting the donor heart in a device which keeps it beating and supplied with blood.

Chris Rudge, managing and transplant director of UK Transplant, the NHS organisation that matches transplant donors to recipients, described the operation as a "really significant development".

"I think we've got to be cautious because it is very preliminary, but if its possible benefits are realised I am struggling a bit to contain my excitement," he said.

The device - called an organ care system - resembles a hi-tech tea trolley and was developed by American company TransMedics. Vessels leading to the heart are plumbed in and receive oxygenated and nutrient-rich blood, which is warmed to just below normal body temperature.

"This buys you lots of time," said Bruce Rosengard, the surgeon who led the transplant team. He believes it could lead to a 50-100% increase in the number of transplants performed each year. He said the Papworth operation had been a great success. "The patient's recovery has been nothing short of extraordinary."

Currently, hearts for transplant are simply kept on ice while they are moved, but this means they have to reach the recipient within four to six hours.

This restricts the distance a heart can be transported and presents problems if removing the diseased heart turns out to be more complicated than expected. "When that happens we start getting very nervous, because we know that the heart is sitting in the box and the clock is ticking," Professor Rosengard said. "With this device the clock is no longer ticking."

So far, the longest a human heart has been kept beating in the device is five and a half hours, but pig hearts have been kept going for at least 12 hours.

The system allows surgeons to check the heart's function before putting it into the recipient. In the Papworth operation, Prof Rosengard transported the heart in so-called resting mode, in which it is beating, but not working hard. He and his surgical team, Cliff Choong and David Jenkins, then switched it into working mode for 10-15 minutes to check it could deal with a full pumping load. Once they were happy, they stopped it from beating and transferred it to the recipient. The professor stressed that none of his team has any financial interest in TransMedics.

The breakthrough means organs which, for example, become inflamed after brain death in the donor can be repaired by treatment with hormones, drugs or gene therapy, said Prof Rosengard.

The system could open up a new source of transplants - so-called non-beating heart donors. Currently, transplant surgeons only harvest from people who are brain dead, but with a beating heart. Other patients who have died because their heart stopped beating are not used because by the time the organ is removed it has typically been damaged by sitting inert in a warm body. These hearts might be recoverable with the machine, which could could triple or quadruple the number of heart transplants each year, said Prof Rosengard.

Five to 10 years off is the possibility of modifying a heart to prevent rejection. "That would be very exciting [and make] transplant surgery a whole lot simpler and safer," said the professor.

Waleed Hassanein, chief executive of TransMedics, said that if clinical trials went to plan he hoped to begin marketing the system around Christmas. It will also be tested on lungs, livers and kidneys.

According to UK Transplant, 106 people in the UK are waiting for a heart transplant and 44 need a heart and lungs. In 2005, 139 heart and seven heart-lung transplants were carried out.

    Britain's first beating heart transplant heralds new era, G, 5.6.2006, http://www.guardian.co.uk/science/story/0,,1790560,00.html