Category Archives: Good News

NHS will help to find jobs for patients

Just because NHS England is going to do this, it does not mean the other 3 health services will do it. or that it will work. But it is good news, and the right way to think. The comment from the Times online which I have cut and pasted below summarises the “good news”. It will be interesting to see if the service lasts, and if the other Regions take it up.

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Kat Lay reports on the NHS England announcement 12th June in the Times: NHS will help to find jobs for patients

The NHS is to hire 300 employment coaches who will find patients jobs to keep them out of hospital.

Those in work tend to be in better health, visit their GP less and are less likely to need hospital treatment.

The specialists will help people with severe mental illness to seek work and hold down a job. They will offer assistance on CVs and interview techniques and are expected to work with 20,000 people by 2021. Pilot schemes running in Sussex, Bradford, Northampton and some London boroughs suggest that the coaches find work for at least a quarter of users. The scheme is being extended nationwide.

Claire Murdoch, NHS England national mental health director, said: “Tackling severe mental illness is not just about getting medication and treatment right but ensuring people can recover to live independently with their condition, including the reward and satisfaction of getting and keeping a job.”

NHS England is putting £10 million into the scheme over the next two years with further investment planned.

Coaches are urged to build relationships with employers to gain access to the “hidden” labour market of jobs that are never advertised. The specialists, whose support is not time-limited, then act as a link between a patient, their employer and their medical team.

A Centre for Mental Health review calculated that the scheme saved £6,000 per client over 18 months.

Far from being a waste of money this is long overdue. So often adolescents with special needs are let down by CAHMS and then as they mature, adult social services. What they need is an opportunity to contribute to society as they are able and in return receive both a fair wage and a sense of worth. At the moment all they hear is “limited resources”.

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The cost of technology is exceeding our ability to pay.

Commissioners and Trust Board directors find themselves in an impossible position. Their political masters will not allow use of the word “rationing”, and yet they are expected to keep up with new treatments, and make them available to all. We rarely hear any “exit interviews” but the resignation of Bob Kerslake following the demoting of KGT to “special measures” should tell the politicians what the professionals already know: the health services are founded on financial sand. The edifice is falling.

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Chris Smyth reports 6th June in the Times: Discount deal opens up new cancer treatment but 

Of course there are numerous other treatments, and much money has been invested to get a return!

Hundreds of lung cancer patients will receive a cutting-edge immunotherapy drug on the NHS after health chiefs boasted of beating down prices.

The deal was the first test of a controversial policy that allows NHS England to restrict or delay medicines that will cost taxpayers more than £20 million a year, even if deemed cost-effective.

Officials said the threat of such measures had been enough to persuade the drugmaker, MSD, to agree a confidential discount. Pembrolizumab costs £84,000 per patient at full price and to get below the threshold would have to be reduced to a fraction of that. About 1,800 patients a year will now be eligible.

Pembrolizumab is one of new class of medicines that boost the body’s own natural defences against cancer. It is used in cancers of the lung, stomach, head and neck, skin and bladder and is being tested in other types such as prostate cancer.….

On the same day Kat Lay reported: Targeting cancer’s genes prolongs life

Treating cancers based on their genes, rather than where they occur in the body, increases a patient’s chance of surviving for a decade six-fold, a study has found.

Data presented at the American Society for Clinical Oncology (Asco) meeting in Chicago showed that 15 per cent of patients given drugs that targeted specific genetic mutations in their tumours survived for three years, compared with 7 per cent of patients who had standard unmatched therapy.

Six per cent of the matched group survived for ten years compared with 1 per cent of the unmatched group.

“All patients should have access to next-generation sequencing and I believe in the next few years we are going to see this approach dramatically improving outcomes,” Apostolia Tsimberidou, who led the research, said. “We need to know what is really causing these diseases so we can treat them properly.”

Researchers from the University of Texas looked at more than 3,000 patients with cancers including breast, lung, gynaecological and stomach tumours. After using a technique called next-generation sequencing, which tested between 20 and 50 genes simultaneously to determine exactly which molecular abnormalities were present in the tumours, they found that 1,307 had at least one genetic change. Some 711 of those patients received drugs matched to the biology of the tumour, for example blocking the function of the mutated or altered gene, sometimes alongside chemotherapy. A further 596 received a drug that was not matched to their tumour’s biology, usually because a matched treatment was not available to that patient at the time.

Those studied had advanced cancer that standard care had failed to halt, with some having tried 16 therapies. While overall survival in the study was small because the patients involved were very ill to start with, Professor Tsimberidou said that the results would probably be even more striking had the technique been used earlier.

In the NHS, many cancer patients receive genetic testing of some type, but next-generation sequencing has yet to be adopted widely. The cost can vary but has declined rapidly in recent years, with some versions costing about £300.

Professor Tsimberidou said that one patient in her clinic had had glioblastoma — the aggressive brain cancer that killed Tessa Jowell, the former cabinet minister, last month — diagnosed in 2011 but was still alive thanks to personalised treatments.

Catherine Diefenbach, an Asco expert, said: “We’ve just scratched the surface. Now with faster and more robust genetic tests we can help even more patients by treating the cancer based on its genetic makeup rather than solely on its location in the body.”

 

There is advantage in enhancing choice by enlarging trusts. And it will improve outcomes… Good news for Devon: bad news for Wales.

Apart from economies of scale, and reducing overhead, there is advantage in enhancing choice by enlarging trusts. And it will improve outcomes…

Hywel Dda and ABMU trusts in West Wales need to merge. The politics of Wales may prevent this but in England there is a utilitarian precedent in Devon. Exeter and Barnstable trusts are combining. Good news for Devon: bad news for Wales if the option is not taken.

Sarah Howells for the North Devon Gazette reports that “North Devon MP welcomes move to share health care bosses with Exeter”.

North Devon’s MP has said a new collaboration between Exeter and North Devon’s healthcare trusts could increase the services available in Barnstaple.

Peter Heaton-Jones released a statement reacting to the news Northern Devon Healthcare Trust (NDHT) and Royal Devon and Exeter (RD&E) will be working in collaboration.

If agreed by both trust boards, Exeter’s chief executive and chairman will take over the running of NDHT as well.

Mr Heaton-Jones said: “Last week I met the acting chief executive of the Northern Devon Healthcare Trust, Andy Ibbs, and the board chairman, Roger French, to discuss these new arrangements.

“I sought and received assurances that the collaboration has a single purpose: to ensure that all acute services can continue to be delivered in Barnstaple.

“Last year, the NHS England review concluded rightly that all services should be retained at the NDDH, but set the challenge of doing so in a sustainable way.

“This new arrangement does just that, and means we can share resources and expertise to our long-term advantage.

“In fact, I have been told that some procedures currently not available in Barnstaple may be able to be delivered here in future as a result of this collaboration..

“The local community is passionate about our hospital, and I will soon be meeting the new chief executive to hear more about the collaboration and how it will safeguard the future delivery of services in Barnstaple.”

Hospital campaigners have welcomed the move, and a spokesman for Save Our Hospital Services said the group hoped the new management would ensure the retention of acute services in North Devon.

As part of the draft agreement, a senior management team will be based at both North Devon and Exeter hospitals, and an appraisal will look into a long-term solution.

However, Devon County Councillor Brian Greenslade, said he felt the move could cause concern for those already worries about a loss of services in North Devon.

He said: “For the people of North Devon the critical thing is to protect the delivery of acute services provided in the NDDH.

“This is my key objective and where I will focus my scrutiny attention.

“I will also be probing to see whether this proposed collaboration gives the opportunity to repatriate some acute services from the RDE to Barnstaple.

“I also believe with the increasing population in North Devon there is a case now to look at growing the facilities at the NDDH.

“We have been very lucky to have such a good hospital in North Devon with such dedicated staff.

“Let us remember that had it not been for former MP Jeremy Thorpe and the 50,000 signature he presented to Parliament, we probably would have not had this facility in our community.”

Jennifer Howells, regional director South West for NHS Improvement and NHS England, said the two trusts were ‘determined to do the right thing’ for the community.

She added: “Working with the RD&E through this agreement, and with ongoing support from NHS Improvement, I am confident that NDHT will have the best possible support to make the necessary, sustainable improvements that will enable them to provide the quality of services patients expect from the NHS.”

Swansea should combine with Hywel Dda, This option is not in the Trusts gift, but is political. And the opportunity afforded by restructuring may be lost if choice and specialist access is not improved…

Some good news on new medical schools. Lets hope the politicians sieze the real opportunity for virtual medical schools living in local communities

Bearing in mind that only 2 years ago, 9 applicants out of 11 were rejected for medical school  and that thousands have been disappointed when we really needed them, we now have politicians acting. They need to do more. The new places need to be graduates, rather than undergraduates, , and there needs to be additional “virtual” medical schools attached to each Deanery. If everyone is subjected to the same assessment exams, we could see whether community based training is as good as centralised raining. Careers officers should have been listened to. We have wasted a whole generation of disappointed talent.

Five medical schools are created in England in bid to increase home grown doctors BMJ 2018;360:k1328  21st March 2018

Five new medical schools have been created under government plans to increase medical student numbers in England.

In 2016 England’s health and social care secretary, Jeremy Hunt, announced a 25% expansion in medical student places in a bid to expand the number of home grown doctors rather than recruiting from overseas.1 He said that as many as 1500 more doctors would be trained in England every year from September 2018.

Health Education England (HEE) has now announced the creation of five new medical schools offering undergraduate places.2 The new schools will be at the University of Sunderland, Edge Hill University in Lancashire, Anglia Ruskin University in East Anglia, the Universities of Nottingham and Lincoln, and the Universities of Kent and Canterbury Christ Church.

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In 2017, 500 new medical school places were allocated to existing medical schools. The remaining 1000 places have now been allocated after a bidding process run by HEE and the Higher Education Funding Council for England.3

Ian Cumming, chief executive of HEE, said that the allocation of places was prioritised in areas “with a relative shortage of doctors overall, or in certain specialties, and also to widen the social profile of new medical students.”

Overall, the south and south east of England are receiving the largest increase in student numbers, with 200 student places allocated to the region, 100 of which went to a joint bid by the Universities of Kent and Canterbury Christ Church.

Excluding London, which received 137 additional places, the north east received the smallest allocation of 147 medical school places. Figures from HEE published in 2017 showed that the north east had a sufficient number of doctors per weighted population.3

References

  1. Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

    Comment on the New Medical Schools. How will continuity of care improve?

Five new Medical Schools: better late than never. Lets hope selection criteria are different from before..

Five new Medical Schools: better late than never. Lets hope selection criteria are different from before..

Beginning to realise the mess they are in, New Medical Schools have been announced, which will produce new doctors in 6-10 year’s time. The full details have yet to be announced, but there will be less wastage, more efficiency, more long term work hours, if the places are predominantly for graduates. It’s still not enough, and why didn’t we do it 20 years ago? The rejection of 9 out of 11 candidates for years is unforgiveable. Lets hope the new Deans listen to Dr Cairns advice (see letter below)

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BBC News 20th February: Under-doctored areas to get new medical schools

…Places at existing schools are also being increased as part of the government’s commitment to increase student places by 25%.

It will mean by 2020 there will be 1,500 more students each year.

Health Secretary Jeremy Hunt said the new schools were being targeted at parts of the country where it “can be hard to recruit and attract new doctors”.

Overall 90% of the new places will be outside London.

“It will help us deal with the challenges of having around one million more over 75s in ten years’ time,” added Mr Hunt….

Alex Matthews-King in the Independent:Emphasis on training doctors in areas with staff shortages will expand university places in Sunderland, Lancashire, Canterbury, Lincoln and Chelmsford

The Lincolnite: New Medical School to address staff shortage.

Chris Havergil in the Times Educational Supplement: 5 new Medical Schools

Chris Smyth in the Times: More medical schools to fill NHS gaps

Five new medical schools will open in the next two years to train doctors as fears grow about NHS staffing gaps.

Anglia Ruskin University will train medical students at its Chelmsford campus from September, followed by the University of Sunderland and a partnership between Nottingham and Lincoln universities next year. Schools will open in Canterbury and at Edge Hill University in Lancashire in 2020.

The NHS is short of thousands of doctors and ministers have promised to increase training places by a quarter. Health chiefs say that staff shortages are rapidly overtaking money worries as the biggest threat to care.

Jeremy Hunt, the health secretary, said yesterday: “Setting up five new medical schools is part of the biggest ever expansion of our medical and nursing workforce, which will help us deal with the challenges of having around one million more over 75s in ten years.”

The 33 existing schools take 6,000 doctors and the 1,500 places Mr Hunt promised have been allocated, giving priority to areas where shortages are worst. The Chelmsford school will take 100 this autumn and there will be 530 more at existing schools. Places will increase by 690 next year and 180 in 2020.

Comment from a Dr Andrew Cairns in the Times 21st March 2018: MEDICAL ATTRIBUTES
Sir, I hope that the introduction of new medical schools to train 1,500 more doctors each year (report, Mar 20) will bring with it a review of selection criteria. Too many medical students have been high-achievers throughout their short lives and have not experienced failure. When this occurs, as it inevitably will in a medical career, they may not have the resilience to cope. The academic bar should be lowered and attributes such as common sense, stamina, resilience, a sense of humour, dexterity and interpersonal skills encouraged.
Dr Andrew Cairns (retired GP)

Petersfield, Hants

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Compassion needs to be tempered with honesty.

We need more compassionate care of the dying and elderly for whom there is no curative treatment.  If we are to improve patients’ experience and quality of life in the last few months, as well as saving money, we will need more trained primary care people explaining what is going to happen when the time arrives. Compassion needs to be tempered with honesty, and this needs to come from a doctor you know. Unfortunately there are fewer rather than more, of these individuals, and less and less time to discuss choices with patients. A good professional handover to adequate numbers of staff with good language and cultural awareness would negate this “need”, but whilst standards fall it is for the greater good. More patients die in Hospital than at home, and their desire is the other way round. This good news initiative needs integration into Primary Care…

Kent and Canterbury begins “compassion” symbol.

The Pilgrims Hospice logo which is being used for compassion signs on hospital wards

Chris Smyth reports 19th Feb 2018: “compassion” symbols alert hospital staff to dying patients.

Dying hospital patients will be marked with “compassion” symbols to encourage staff and visitors to be more respectful.

Hospitals in Kent have begun placing the symbol on bedside curtains or on doors next to people expected to die within days.

The project, thought to be a first in the NHS, is in use in 50 wards after managers found that it went down well with grieving families by encouraging a more dignified atmosphere on wards.

Annie Hogben of Pilgrims Hospices, which runs the project with East Kent Hospitals University NHS Foundation Trust, said: “How a loved one dies can have a profound and long-lasting impact on those who are left behind. Therefore it’s essential that staff and visitors are sensitive to the needs of the person who is dying, and their loved ones at all times.”

The hospital insists that symbols are only displayed with the consent of patients and relatives, and are not designed to single them out or chastise rowdy visitor.

Dying hospital patients will be marked with “compassion” symbols to encourage staff and visitors to be more respectful.

Hospitals in Kent have begun placing the symbol on bedside curtains or on doors next to people expected to die within days.

The project, thought to be a first in the NHS, is in use in 50 wards after managers found that it went down well with grieving families by encouraging a more dignified atmosphere on wards.

Annie Hogben of Pilgrims Hospices, which runs the project with East Kent Hospitals University NHS Foundation Trust, said: “How a loved one dies can have a profound and long-lasting impact on those who are left behind. Therefore it’s essential that staff and visitors are sensitive to the needs of the person who is dying, and their loved ones at all times.”

The hospital insists that symbols are only displayed with the consent of patients and relatives, and are not designed to single them out or chastise rowdy visitors.

“It would never be done without consultation and is really about raising awareness among other visitors to the ward that someone is receiving end-of-life care and to encourage an atmosphere of quiet dignity and respect in that area,” Steve James, a spokesman, said.

Almost 300,000 people die in hospital every year and the NHS has been criticised for not taking end-of-life care seriously enough. A review by the Royal College of Physicians two years ago found that thousands were dying thirsty and in pain because doctors and nurses were terrified of talking about death.

Bill Noble, medical director of the charity Marie Curie, said that compassion was an “essential part of palliative care”, but urged the hospitals to learn the lessons of the well-intentioned Liverpool Care Pathway, which was scrapped after patients were left thirsty and suffering because of misuse of the end-of-life protocol.

“This [compassion symbols] appears to be excellent idea but like all interventions of this nature it requires evaluation. We have learned there are unintended consequences of labelling people as requiring end-of-life care,” Dr Noble said.

The logo, featuring a stylised pair of hands cupping a person’s face, is also used on bags containing property of patients who have died that is awaiting collection by relatives.

Andrea Reid, from Folkestone, said that the sign made a big difference to her aunt’s final days. “The nursing staff all hesitated at the door, explained why they needed to come in and gave us time to either leave the room or move out of the way with a calm, unhurried air,” she said.

“Our hospital staff are often working in a pressured and high-speed environment but the small and unassuming compassion symbol is just enough to trigger a pause and a moment’s consideration for those dealing with the worst news possible.”

Sue Cook, a palliative care nurse and the trust’s end-of-life clinical lead, said: “Those of us who work in the NHS have a duty to ensure that our patients are cared for with dignity, respect and compassion until they die. That’s why the Compassion Project and its symbol is so important to us and all who help those approaching the end of their lives.”

 

The cost of curing just one congenital disease…. The pace of advance of technology is faster than any government can afford

Retinitis Pigmentosa is not uncommon. Affecting approximately 1 in 3,500 people, there will be approximately 7000 victims in the UK. The overall cost of treating all these patients, without thinking about new annual cases, is £2,205,000,000, and that is treating only one eye, for which the Health Services have plenty of precedent: single cataract and single hearing aids. This is just one genetic disease treatment. There are potentially many others. The pace of advance of technology is faster than any government can afford. We could afford more low volume high cost treatments if we rationed out the high volume low cost treatments, and if we allowed co-payments.

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Tom Whipple for The Times reports 5th January: Cure for blindness costs £630,000

A drug that can cure some kinds of blindness and is one of the most expensive could be introduced in Britain at £315,000 per eye.

Luxturna, which is based on gene therapy, is only approved for use in the USA. Spark Therapeutics, which manufactures the drug, has applied for approval from the European Medicines Agency, after which it may be offered on the NHS, although cost will be a factor in the decision.

Gene therapies work by repairing faulty genes, allowing the effects of inherited conditions to be permanently reversed. Luxturna works by a modified cold virus being injected into the eye. The virus then delivers the correct genes to the retina. In trials it has been shown to repair a mutation that causes retinitis pigmentosa, a genetic form of blindness that affects about 1 in 3,000 people.

The Daily Mail reported 3 days earlier: Long-awaited gene therapy for blindness will cost $850000

Oliver Moody on October 3rd in The Times reported : Gene therapy raises hopes of blindness cure

A gene therapy has restored sight to mice whose vision had been wiped out by a common form of inherited blindness.

Scientists at the University of Oxford are planning to test their technique on humans after achieving what they say are the most promising results yet.

About 20,000 British families are thought to be affected by retinitis pigmentosa (RP), a cluster of genetic conditions that cause the light-capturing rods and cones at the back of the eye to die off. There is little that eye doctors can do once the disease reaches its final stages.

One approach is to use harmless viruses to ferry chunks of algal DNA into the remaining cells in the retina so that they produce various light-sensitive proteins, effectively rigging up an artificial photoreceptor for the optical nerve.

The Oxford researchers have developed a new method for reaching around the back of the eyeball and squirting DNA below the retina.

They also used the gene for a human protein called melanopsin, which carries a much lower risk of being rejected by the immune system than the algae-derived proteins used in other gene therapies.

Findings published in the journal PNAS showed that loss of sight was reversed in mice for at least 13 months.

Counting the cost: NHS cuts to cataract surgery can be fatal

Rationing hearing aids could cost you dear – “There is a perfectly good reason we have two ears…”