Reports have indicated that NHS leaders intend to extend the rationing of treatment for smokers and obese patients.
A leaked letter has been acquired by the press, with NHS bodies across England seemingly forced to implement restrictions on access to treatment.
The plan is outlined in a letter sent on 15th March by Dr David Black, NHS England’s medical director for Yorkshire and the Humber, to Rotherham Clinical Commissioning Group.
Within the letter, Black praises the GP-led group that controls the NHS budget for introducing what has been described by critics as ‘lifestyle rationing’.
“We are very supportive of your work to best manage resources for the benefit of all patients and understand that this may mean that difficult decisions need to be made,” Black writes.
The letter goes on to suggest that the scheme could be extended to other aspects of the NHS system in the coming months.
“We expect that many CCGs will be in the process of developing similar schemes and initiatives to deliver plans for 2017-19. This is something we would encourage, where plans are well developed and clinically validated.”
There has been huge opposition to curtailing NHS treatment on the basis of lifestyle issues.
And ex-health minister Norman Lamb has been one of the critics of this notion, suggesting that it is inimical to the ethos of the NHS.
“This is yet more evidence of the creeping advance of rationing. Guidance based purely on medical judgment on weight loss is fine, but what is happening around the country goes well beyond that in practice. It will inevitably result in those people with money paying for speedy treatment, while everyone else is left waiting,” Lamb commented.
Lamb went as far to suggest that the Conservatives are presiding over the destruction of the NHS.
“We are seeing, bit by bit, the destruction of the solidarity that this country has been so proud of with the NHS – the idea that whatever your income or wealth, you get access to the care you need, in your hour of need.”
Jonathan Ashworth, the shadow health secretary, suggested that the Tories have failed to fund the NHS adequately, and now healthcare bodies are consequently forced to make tough decisions.
“This secret memo from NHS chiefs reveals the truth of what’s happening to the NHS under the Tories – more and more rationing of treatments. People will be waiting longer and longer in pain and discomfort for surgery such as hip and knee replacements. There is now a very clear choice in this election. Cuts, longer waiting times and restrictions on treatment under the Tories, or Labour, who will return our NHS to its founding principle of universal provision, free at the point of need, with best quality of care for all.”
Cancer Research UK believes that obesity can be blamed for a surge in kidney cancer in Britain.
The charity indicates that approximately 20,000 additional cases in the last 10 years can be traced back to Britain’s bulging waistlines.
New cases of kidney cancer have risen rather alarmingly, with Cancer Research UK stating that such conditions have escalated by 40% over the last past decade.
Obesity is implicated in approximately one-quarter of kidney cancers, with smoking also cited in relation to approximately 25% of the remainder.
However, although the number of people smoking has declined significantly, obesity continue to rise.
Cancer Research UK suggests that there will be a further 26% of kidney cancer cases by 2035, effectively making it one of the fastest-growing forms of the disease.
This is also a particularly virulent strain of cancer, with kidney cancer killing over 50% of those who develop it within just 10 years.
Although it is possible to operate on kidney cancer, it is often not picked up early due to a lack of symptoms.
The symptoms of kidney cancer – when there are any – include blood in urine, a persistent pain below the ribs in the lower back or side, and a lump or swelling in the side.
Kidney cancer is sometimes picked up during urine tests carried out for other reasons.
Dr Julie Sharp of Cancer Research UK indicated that the figures are cause for concern, and that more must be done to address the obesity epidemic.
“It’s concerning to see kidney cancer cases rising like this. Being overweight or obese is linked to 13 types of cancer, including kidney which is becoming more and more common. Similar to smoking, where damage to cells builds up over time and increases the risk of cancer, damage from carrying excess weight accumulates over a person’s lifetime.”
While Sarah Toule of the World Cancer Research Fund encouraged Britons to maintain their ideal body weight, suggesting that this would have a massive impact on the number of kidney cancer cases.
“In fact, if everyone was a healthy weight, around 25,000 cancer cases could be prevented every year in the UK. There are simple ways people can help maintain a healthy weight, such as cutting out high-calorie food and drinks and doing at least 30 minutes of exercise every day.”
Toule called on the government to do more in order to prevent people from making unhealthy choices.
“The government also plays a vital role in ensuring strong measures are in place to help the healthy choice be the easy choice. These include restricting junk food marketing to children and reducing the amount of sugar found in everyday products.”
An 11 year-old child has been provided with medical marijuana on the NHS in what is believed to be the first ever prescription of its kind.
Epileptic Billy Caldwell had travelled to the United States on a regular basis in order to medicate up to 100 daily seizures.
Cannabis oil had been provided by doctors in America, but when he was unable to travel to Los Angeles in order to require more, Dr Brendan O’Hare provided Caldwell with CBD oil.
This is a derivative of cannabis that does not contain tetrahydrocannabinol; the illegal psychoactive component of cannabis.
Caldwell’s mother told the Daily Telegraph that she was in a desperate situation and was simply at the end of her tether.
“With just a few days’ doses of Billy’s US medication left, I was getting desperate. In the end I called my GP and gave him all our paperwork and he said he’d prescribe the medicinal cannabis for Billy, and that’s exactly what he has done. We went down to our surgery and picked it up. It was as simple as that. It’s a huge step forward. It’s an alternative treatment and it’s worked out well for Billy.”
Campaigners have supported the total decriminalisation of marijuana in Britain, in common with numerous American States and European nations such as the Netherlands and Portugal.
Research has previously demonstrated that cannabis oil can be extremely effective in treating epilepsy.
A study of Epidiolex – a purified, 99% oil-based CBD extract from the cannabis plant – indicated a 54% decrease in seizures.
The side-effects of Epidiolex are also moderate, considered to be another major advantage of this cannabis offshoot over rival drugs.
One such medicine has been attributed for the severe malformations of approximately 4,000 children in France.
While there is no indication that the government intends to review the policy towards marijuana at present, there been a strong reaction to the behaviour of Dr O’Hare.
Both MPs and drugs policy reform groups have hailed the success of the treatment, and suggested that it should open the door to other British patients in the same position.
Liberal Democrat health spokesman Norman Lamb suggested that the treatment was potentially life-saving, and that similar common sense should be utilised in future prescriptions.
“I don’t think anyone seriously argues against him getting access to treatment that has had such a dramatic impact. There’s lots of evidence, particularly in conditions involving lots of pain, that medical cannabis can be extraordinarily effective.”
As of 2017, Australia, Bangladesh, Cambodia, Canada, Chile, Colombia, Costa Rica, the Czech Republic, Germany, India, Jamaica, Mexico, the Netherlands, Portugal, South Africa, Spain, Uruguay, and some U.S. jurisdictions have the least restrictive cannabis laws.
City Hospitals Sunderland
2014/15 – £4,999,118
2015/16 – £9,551,056
County Durham & Darlington
2014/15 – £5,641,747
2015/16 – £15,080,417
2014/15 – £2,497,625
2015/16 – £4,546,957
Newcastle upon Tyne Hospitals
2014/15 – £12,063,576
2015/16 – £10,714,215
North East Ambulance Service
2014/15 – £79,127
2015/16 – £112,729
2014/15 – £4,739,303
2015/16 – £7,323,200
Northumberland, Tyne and Wear
2014/15 – £52,906
2015/16 – £47,981
2014/15 – £8,924,323
2015/16 – £12,029,320
South Tyneside 2014/15 vs 2015/16
2014/15 – £5,192,995
2015/16 – £4,770,467
The World Health Organisation is calling for developed nations to play a leading role in work on viral hepatitis.
It is known that the disease is currently killing as many people globally as HIV and TB, with the death toll in 2015 reaching 1.34 million people.
A new report confirms this figure, while also suggesting that an estimated 325 million people worldwide are living with chronic hepatitis caused by B or C virus infection.
Although there are hepatitis vaccines and medicines available, distributing them to those in need often proves problematical.
There are logistical reasons for this, but it is also partly due to the fact that infections are not always effectively identified.
Indeed, just 9% of all hepatitis B infections and 20% for hepatitis C infections were diagnosed in the 2015 calendar year.
Consequently, the World Health Organisation suggests that millions of people are placed at an unnecessary risk, with chronic liver disease, cancer and ultimately death all possible results.
In some parts of the world, including regions within Africa and the Western Pacific, hepatitis B and C infections are all hugely common, and treatment can be conspicuous by its absence.
Yet the World Health Organisation points to the achievement of some countries in implementing new initiatives that have resulted in hepatitis coverage being significantly improved.
For example, China has achieved a 96% coverage rate for the timely birthdays of HPV vaccines, and reached the hepatitis B control goal of less than 1% prevalence in children under the age of five back in 2015.
This is despite the huge Chinese population, in excess of one-billion people, which means that implementing any medical programmes across the nation is hugely complicated.
Mongolia also improved uptake of hepatitis treatment by including hepatitis B and C medicines in its National Health Insurance scheme, which covers 98% of its population
Dr Gottfried Hirnschall, from the World Health Organisation, noted the progress made globally, but also suggested that more needs to be done in order to eradicate the problems caused by hepatitis.
“We are still at an early stage of the viral hepatitis response, but the way forward looks promising. More countries are making hepatitis services available for people in need – a diagnostic test costs less than $1, and the cure for hepatitis C can be below $200. But the data clearly highlight the urgency with which we must address the remaining gaps in testing and treatment.”
While Raquel Peck, from the World Hepatitis Alliance, believes that the report published by the World Health Organisation should be a wake-up call for countries all over the globe.
“Today, 325 million men, women and children are living with a cancer-causing illness, despite the availability of preventative vaccines for hepatitis B and curative treatments for hepatitis C. We need to use this report to advocate for a public health approach, so that testing and treatment are rolled out at the scale necessary to ensure that every person has the opportunity to live a healthy life.”
Data that has recently become available, shows that in the WHO European Region an estimated 13.3 million people live with chronic hepatitis B (1.8% of adults) and an estimated 15 million people with hepatitis C (2.0% of adults).
A major medical charity has suggested that government guidance will effectively make doctors into border guards.
Doctors of the World insist that Home Office plans to gain access to details of undocumented migrants who seek NHS treatment is placing unreasonable demands on GPs in particular.
In order to challenge this policy, the organisation has recently collaborated with the human rights charity Liberty, along with the National AIDS Trust.
The three parties have raised a petition aimed at assessing the data-issuing policy between the NHS and the Home Office, which came into effect earlier this year.
Lu Hiam, a GP and Doctors of the World adviser, believes that the policy is fundamentally ill-founded.
“Confidentiality is the cornerstone of the doctor-patient relationship. Deterring sick people from getting healthcare has serious consequences. Putting this data-sharing agreement in place without consulting doctors is nonsensical, given what a huge impact it has on our professional role.”
NHS Digital was involved in the agreement published in January, with the organisation required to deliver non-clinical patient details, such as addresses and dates of birth, to the Home Office.
But the coalition of forces believe that doctors are being placed in an insidious position, and have provided a toolkit intended to ensure that surgery can circumnavigate the existing legislation
Meanwhile, Martha Spurrier of Liberty suggests that “fostering fear of the doctor is a whole new dangerous and irresponsible low” for the government.
Other organisations have passed similar motions recently, with the National Union of Teachers condemning the Department of Education requirements for the supplication of pupils’ nationality and country of birth to schools.
Official figures already indicate that the number of Home Office requests to NHS Digital has tripled in the last three years alone.
Over 8,000 requests for patient details have been made in the first 11 months of 2016, which led to nearly 6,000 people being traced by immigration enforcement.
This high percentage of success will certainly be vindication for defenders of the policy, but campaigners believe that the approach runs contrary to basic principles of privacy.
Martha Spurrier, the director of Liberty, spoke very strongly on the approach advocated by the Home Office, suggesting that doctors were being treated unfairly.
“This government has made border guards of teachers, landlords, bank clerks and now even doctors, all as part of a misguided and counterproductive obsession with creating a ‘hostile environment’ for undocumented migrants. Fostering fear of the doctor in this way is a whole new dangerous and irresponsible low. It will put the health of the most vulnerable in society at risk, including children and victims of trafficking and torture.”
Doctors of the World, also known as Médecins du Monde, was founded in 1980 by a group of 15 French physicians, including Bernard Kouchner.
GP leaders believe that an update to the standard NHS contract will have a positive effect on attempts to prevent hospitals from dumping work on GP surgeries.
The new provisions in the contract could potentially save millions of appointments, easing the pressure on the beleaguered general practice system.
Change to the contract have become operational from 1st April, with the aim of preventing hospitals from inappropriately transferring standard responsibilities to GP practices.
Fit notes, medication and answering patient queries must be dealt with differently under the terms of the new agreement.
This latest update follows on the back of changes implemented last year which prevent hospitals from forcing GPs to refer patients after missed appointments.
Also included in these alterations to hospital policy was legislation to make hospitals communicate test results directly to patients, while hospitals may now also refer patients on to other departments rather than sending them back to their local GP.
In order to encourage these new changes to be implemented, the British Medical Association has produced template letters and has distributed them to surgeries throughout the NHS system.
However, despite the fact that the rules have become operational, the British Medical Association has warned on more than one occasion that many managers have failed to enforce rules, effectively heaping greater pressure on general practice.
GPC chair Dr Chaand Nagpaul believes that the new changes are absolutely essential in the existing general practice climate.
“GP practices have for far too long had to cope with poor communication and unnecessary bureaucratic workload being directed to them from hospital managers. At a time when general practice is at breaking point from rising patient demand, stagnant budgets and staff shortages, we cannot afford GPs and their staff to be dealing with work that could easily be undertaken by the administrative wing of secondary care.”
Nagpaul suggested that the new changes were indicative of the fact that the government is listening to the concerns of healthcare bodies and experts.
“These new requirements aim to reverse a culture spanning decades, of secondary care passing on inappropriate workload and bureaucratic demands on GP practices. It is a reflection of the success of our lobbying that the GP Forward View dedicated 10 pages to this issue and clearly articulated the need to enable GPs to spend their time on what they should be doing: delivering care to their patients.”
Previous evidence has indicated that patients fail to turn up for 14 million appointments on an annual basis.
Dutch research has suggested that peer review schemes fail to reduce the level of GP prescribing, nor do they result in decreasing the value of tests ordered.
Scientists from the Netherlands concluded that the peer review process “may not be useful to deliver better adherence of guidelines and contain costs” in regards to GP prescribing and test ordering.
The study was published in BioMed Central Family Medicine, and represented the first time that peer review schemes have been attested outside of general research settings.
Previous studies have suggested auditing and feedback from peers may be useful methods of tackling overprescribing.
The theory is that this would influence needless test ordering behaviour from GPs.
Peer review schemes have been recommended by NICE as another way of limiting GP prescribing, but it seems that this may be somewhat flawed.
Nice guidance suggests that peer review can help in gaining control over antibiotic prescribing in local regions.
However, Nice has also stated that this is a recommendation rather than mandatory policy.
With the guidance due to be reviewed on a two-yearly basis, it seems that an update to this policy may indeed be due, with the last such assessment having been presented in 2015.
Meanwhile, the authors of the new research suggested that a lack of confidence and adherence to the strategy may have contributed to its failings.
Some participants “felt it was too complex and too ambitious”.
The scale of the study will lead many to conclude that its findings are valid, with 88 GP practices in the southern region of the Netherlands having been assessed.
Anaemia, rheumatic complaints, UTI, chlamydia, stomach complaints and type 2 diabetes were all assessed over a three-year period.
The researchers concluded that their findings challenged the conventional orthodoxy regarding peer review.
“Our study found that the beneficial results obtained in earlier, well-controlled studies were not confirmed when we introduced this intervention in existing primary care. Although we provided complete transparency on the data sources and instructed the moderators in this respect, we learned from the process evaluation that the source of the feedback was often not clear to the participants.”
They also suggested that the nature and efficacy of working agreements could have a big influence over both the results and the practical operation of surgeries in the real world.
“We found that many groups failed to set achievable and measurable working agreements. More than half of the meeting reports we received from groups did not contain specific, achievable, realistic or measurable working agreements.”
The compensation bill for mistakes in the NHS in the north east reached over £100 million over the last two years, according to official data.
Figures indicate that clinical negligence claims reached a total of £108,367,7062 in 2014/15 and 2015/16.
This represents a significant rise over the £78 million that was paid out over the two previous financial years.
Hospital leaders responded to the figures by stating that the complex medical cases that the north east NHS region has been forced to deal with should be considered in assessing the amounts involved.
Some trusts also stated that claims can take several years to resolve, and as such the increase in claims did not necessarily reflect a similar increase in number.
Data was obtained from the NHS Litigation Authority, recently rebranded NHS Resolution.
Responding to the issue, several trusts provided spokespersons to comment on the apparent rise in litigation.
A spokesperson on behalf of County Durham & Darlington NHS Foundation Trust, pointed to the complexity and time involved with resolving many claims.
“Due to their complexity, some claims can take several years to be resolved. As a result, the figure reported for CDDFT for 2015/16 doesn’t reflect an increase in claims during that time period.”
Meanwhile, a spokesperson for The Newcastle upon Tyne Hospitals NHS Foundation Trust cited the amount of complex surgery that the trust is involved with, due to its unique capabilities.
“As one of the largest NHS Trusts in the UK, offering a wide range of specialist services, we are involved in many complex medical cases each year. As can be expected figures fluctuate each year and are comparable to Trusts of similar size and complexity.”
And a spokesperson from City Hospitals Sunderland NHS Foundation Trust stated that it particularly prioritised quality treatment.
“As a trust we treat thousands of people every year, from minor injuries to highly complex medical issues. Our first and absolute priority is to provide the highest standards of care to all of our patients and the feedback that we receive shows that in the majority of cases, we do this very well.”
In the UK alone the NHS treats one-million people every 36 hours and carried out 10.5 million operations in 2012/2013.
In 2013/14, the NHS set aside £22.7 billion in order to cover medical negligence liabilities.
NHS England will ban sugary drinks from hospital shops in the next year unless suppliers are able to take voluntary steps outlined by the authorities.
The measures are intended to reduce the consumption of sugary drinks on NHS premises.
Leading retailers have already agreed to cut the proportion of sugary drinks to 10% or less of total sales, according to NHS England.
This is to be achieved in the next 12 months, otherwise the new restrictions will come into place.
NHS England has also pointed to the fact that new national incentives to hospitals and other NHS providers will come into force shortly.
These will ensure that food on hospital premises is improved, dictating that by April next year, 60% of confectionery and sweets stocked do not exceed 250 calories.
This figure will rise to 80% of sweets by April 2019.
Meanwhile, 60% of pre-packed sandwiches and other savoury pre-packed meals must contain no more than 400 calories per serving, while also providing less than 5g of saturated fat in every 100g.
Again, providers will be expected to raise this figure to 75% by April 2019.
Simon Stevens enthusiastically welcomed the new approach.
“It’s great that following discussion with NHS England, big name retailers are agreeing to take decisive action, which helps send a powerful message to the public and NHS staff about the link between sugar and obesity, diabetes and tooth decay.”
The initiative is particularly intended to address the obesity and diabetes epidemic, with figures indicating that more money is spent on addressing this annually than the police, fire and judicial services combined.
It is currently estimated that around 700,000 NHS staff are either overweight or obese, representing approximately 60% of the overall workforce.
Public Health England has already published guidelines intended to reduce the amount of sugar in nine product categories, with yoghurt, breakfast cereals and biscuits particularly targeted.
The news follows closely on the back of WHSmith, Marks & Spencer, Subway and Greggs all agreeing to cut the proportion of sugary drinks that they sell in their hospital shops in England.
Commenting on the issue, Katherine Button, Campaign for Better Hospital Food co-ordinator, echoed the comments of Stevens, suggesting that the move would be beneficial to both NHS employees and patients.
“NHS hospitals are trusted by patients, families and staff to keep them fit and well and NHS England is helping everyone to take a big healthy step in the right direction.”
While Chris Askew, chief executive of Diabetes UK, believes that the impact on diabetes could be particularly critical.
“With this plan, people with type 1 diabetes should still have access to products that are commonly used to treat hypos.”
Since 1996, the number of people living with diabetes has more than doubled, and it is believed that over five million people in the UK will have diabetes imminently.
Public Health England figures for 2015 indicated that 62.9% of adults were overweight or obese (67.8% of men and 58.1% of women).
New clinical data indicates that a major form of medication has a massive impact on a prominent virus.
AbbVie’s late-stage information demonstrates that the ribavirin-free hepatitis C therapy glecaprevir/pibrentasvir has achieved high cure rates across the majority of patients infected with the virus.
Glecaprevir/pibrentasvir is a once-daily regimen that combines two distinct antiviral agents.
Both the NS3/4A protease inhibitor glecaprevir (300mg) and NS5A inhibitor pibrentasvir (120mg) are involved in the treatment, with patients requested to consume the medicine orally.
In a recently conducted study, 99% of chronic hepatitis C virus infected patients with genotypes 1, 2, 4, 5 or 6 and compensated cirrhosis achieved sustained virologic response at 12 weeks post-treatment after consuming the treatment prepared by AbbVie.
It was also notable that high SVR12 rates were experienced by patients after 12 weeks of glecaprevir/pibrentasvir treatment without ribavirin.
In order to ensure that results were as legitimate as possible, strains that are typically associated with high resistance were included in the study, as were those with a high quantity of the virus in the bloodstream before treatment.
Researchers noted that adverse events observed were mild in nature, with all participants completing the study.
Some patients did complain of fatigue and headaches, but even these minimal side-effects were only found in 10% of respondents.
Xavier Forns, head of hepatitis unit, Hospital Clinic de Barcelona, suggested that the results represented another step forward in the treatment of HCV patients.
“We have already seen great progress in the treatment of HCV patients with compensated cirrhosis. However, treatment challenges remain related to the use of ribavirin. The positive findings from the EXPEDITION-1 study, along with previously reported data, show that glecaprevir/pibrentasvir has the potential to become a ribavirin-free treatment for patients with compensated cirrhosis across these genotypes.”
In an attempt to ensure that the drug becomes widely available, ,arketing applications for glecaprevir/pibrentasvir are currently under review by regulatory authorities across the globe.
The treatment has been granted accelerated assessment by the European Medicines Agency, and priority review designations by the USA Food and Drug Administration and Japanese Ministry of Health, Labour and Welfare.
According to AbbVie, the glecaprevir/pibrentasvir regimen could provide a shorter, eight week, once-daily, ribavirin-free treatment option for the majority of HCV patients without cirrhosis, as well as an additional treatment option to patients with compensated cirrhosis.